Thinking ahead: labour and birth

Some women are lucky and find labour easy and empowering but, for many, it’s difficult, exhausting and not what they were expecting.

Common emotions afterwards include exhaustion, joy and relief. No matter how it goes you should feel a sense of achievement and pride – after all, you will have just brought a tiny baby into the world.

But if the birth is different to how you’d hoped or imagined – harder, longer or more painful, for example – you may end up feeling distressed or disappointed.

How can I prepare for childbirth?

Your perinatal mental health team may offer you a pre-birth planning meeting at 30-32 weeks of pregnancy. This meeting is a chance to talk to your healthcare team about what support you will need before and after your baby is born. It also helps everyone know what to do and who to contact if you or those around you are worried about your mental health.

Your perinatal mental health team will give you information in advance about what will happen at the meeting and who will be there.

At the meeting, you and your healthcare team will talk about your past mental health and any worries you may have. You will also talk about what support you will have at home after your baby is born.

It’s also a chance to talk about other help you may need, for example with housing or relationship problems.

‘We did a care plan and I was very happy with it. In the care plan we made sure that if something happens we all know what to do.’

Woman talking about her 32-week meeting

You can take your partner, a family member or friend to the meeting if you would like to. You can also have an independent advocate, who will help you express what you want to say. Ask your doctor or midwife if you would like this. After the meeting, you will be sent a written summary of what you talked about and agreed.

You can also talk to your midwife or perinatal mental health team at any time during your pregnancy.

Making a birth plan

Making a birth plan with your care team can help you feel more in control of what will happen during the birth. The birth plan covers your preferences on things like pain relief, who you might like to have in the room with you, positions during labour and so on. You can change your mind at any point before and during the birth so don’t worry, the birth plan is not committing you to anything.

Sometimes things don’t go according to plan so you need to be flexible and be prepared to do things differently from what you wanted. For example, certain facilities may not be available on the day or there may be complications.

Read more about making a birth plan here

Coping with labour

Some women who are managing a severe mental illness worry that a long labour, with a lack of sleep, may trigger their symptoms. If you’re worried about this, your midwife or perinatal mental health team can talk through your options with you.

In some cases women with bipolar disorder choose to have a caesarean section (c-section), but there’s no evidence that this helps to avoid symptoms coming back.

A c-section is an operation where a doctor makes a cut in your abdomen (just below your bikini line) and womb and lifts your baby out through it. If you feel you want a c-section, speak to your midwife about the advantages and disadvantages. It’s a major operation but if you’re still sure you want a c-section after talking it through with your healthcare team, you should be able to have one.

There’s more information about c-sections here.

What happens during labour and childbirth?

You can have a partner, friend or family member with you during labour and birth to support you and speak for you, if you need them to. This person is usually called a birth partner. You can have more than one person with you, but there may be a limit on numbers in a hospital or birth centre, or if you’re having a caesarean.

Every labour and birth is different but there are three main stages of labour. Before the first stage, you will start getting contractions but they won’t be regular. This is called the latent phase. It’s a good idea to phone your midwife at this point so they can assess you. They will let you know when to go to hospital or the birth centre, if you’re not having your baby at home.

Pain relief

There are things you can do at home to help you feel more comfortable during the latent phase, such as:

• having a warm bath
• asking someone to give you a back massage
• taking paracetamol
• using a transcutaneous electrical nerve stimulation (TENS) machine
• moving around.

You may want to think about what type of pain relief you will want during labour. You could include this in your birth plan but don’t worry if you change your mind once you go into labour. Your midwife can talk through your options with you, which may include:

• breathing and relaxation
• hypnobirthing
• complementary therapies
• using a birthing ball
• having a water birth
• using a TENS machine
• gas and air (Entonox)
• medication, such as diamorphine or pethidine
• having an epidural.

You can read more about the pros and cons of different types of pain relief here.

First stage of labour

In the first stage of labour, your contractions become stronger and more regular. Your midwife will talk you through what’s happening and will monitor you and the baby. They will offer you regular vaginal examinations to see how your labour is progressing. They will explain what they’re doing and why, but you don’t have to have these examinations if you don’t want them.[5]

Towards the end of the first stage, when the cervix is nearly open, contractions get stronger. This is known as 'transition'. You may not notice when you’re moving from the first to the second stage.

Second stage of labour

In the second stage, your cervix is fully open (dilated) and the muscles of your womb are tightening and loosening to push the baby down and out. Your midwife will monitor you and the baby closely and support you as you push.

Third stage of labour

You’re in the third stage of labour when you’ve had your baby but need to deliver the placenta. Your midwife will speak to you during your pregnancy about the 2 options for delivering the placenta and the pros and cons of each.

You can read more about the stages of labour here.

After the birth

The healthcare team will monitor your baby to check for any effects of your mental health medication if you were taking it. If your baby shows signs of withdrawal from the medication, they may need to spend some time in the newborn (neonatal) care unit.

More information and support

Bipolar UK: Women and Bipolar

Family nurse Partnership
Home visiting programme for first-time young mums and families.

MumsAid 
Provides pregnant women and new mums with specialist counselling for emotional or mental health difficulties.