Your Birthing Choices

Deciding where to have your baby is an important decision for you and your partner. We believe that you should give birth in an environment where you feel relaxed, comfortable and in control.Together with your midwife or doctor you will have a conversation about your choices and personal circumstances and what would happen if they change in pregnancy or labour. At the Royal Surrey we have different options available to meet your individual needs. Deciding where to have your baby is an important decision for you and your partner. We believe that you should give birth in an environment where you feel relaxed, comfortable and in control.

Home Birth

Homebirth is a good option if you are having a straight forward pregnancy. We have a dedicated and enthusiastic team of midwives who look after women who choose to have their babies at home. They are all passionate about homebirth and are equipped with the knowledge and expertise to not only achieve safe outcomes for mother and baby, but also provide a positive birth experience.

You will be cared for by a midwife in the team who will provide the majority of your care for you throughout your pregnancy, birth and in the first few weeks as a new parent. She will be supported by other members of the team who you will have an opportunity to meet during your pregnancy.

You can refer yourself to the homebirth team at any point in your pregnancy by email to rsch.homebirth.referrals@nhs.net or by asking your community midwife to forward your details to the team.

The Royal Surrey Birth Suite

The Birth Suite is a homely environment particularly suitable for all women having a straight forward pregnancy. It is next to the Delivery Suite and a relaxed environment with two rooms, each with their own birthing pool and en-suite facilities. Birthing balls, beanbags and mats are available to help you stay active and comfortable during labour. Your care will be provided by a midwife who is experienced in normal birth, hypnobirthing, water birth, massage and active birth. Pain relief available includes hydrotherapy, entonox, pethidine, paracetamol and dihydrocodeine.

How can I use the Royal Surrey Birth Suite?

Women who have a straight forward pregnancy are suitable to have their baby in the Birth Suite. You can decide this at any point in your pregnancy or you can wait until you are in labour. Please tell the midwife you speak to when you telephone the Call a Midwife advice line in labour and tell them you would like to use the Birth Suite. If you plan to use the Birth suite but have developed complications in your pregnancy, your birth choices may still be possible on delivery suite. Your midwife or doctor can discuss this with you.

The Delivery Suite

The Delivery Suite is a good option for women who have certain medical conditions, specific pregnancy needs or require specialist input.

There are 10 en-suite birthing rooms with mats and birthing balls on hand. Our rooms also include:

  • A pool room for women wishing to experience a water birth, but who may require additional monitoring or have a disability (wheelchair accessible pool room).
  • A high dependency room for women who may need more care and support at any stage of their pregnancy.

We also have two dedicated state of the art obstetric theatres and a theatre team based on the Delivery Suite. If you choose an epidural or a caesarean section birth your care will be in labour ward. We have a 24 hour obstetric team with doctors, anaesthetists, midwives and support workers. We offer a 24 hour epidural service as well as supporting other methods of pain relief, including hydrotherapy, massage, Entonox and pethidine.

Choosing to have a caesarean section

If you are thinking about choosing to have a caesarean section when there is not a ‘medical’ reason to do so please talk to your midwife who will be able to arrange appointments for you to talk with other health professionals. Your doctor and midwife will be able to explain the risks and the benefits of a caesarean section compared with a vaginal birth. They will ensure you have the right support and information to help you choose the right birth for you and your family.

What to do when you're in labour

When the time comes, you are unlikely to mistake the signs of labour. If you are in any doubt, please contact the 24/7 advice line Call a Midwife on 0300 123 5473 who will be able to advise you. Strong, regular contractions and a ‘show’ (when the plug of mucus from your cervix comes away) are the main signs that labour is starting. Your water breaking, backache and an urge to go to the toilet, which is caused by your baby’s head pressing on your bowel, are other signs to look out for.

If you think that you are in labour or are worried and would like advice call the 24/7 advice line Call a Midwife on 0300 123 5473. Please contact us before coming in, so that we can ensure a room is ready for your arrival.

While in labour, different women experience labour pains in different ways. Often, your first labour will be the longest. 90% of women use a range of pain relief techniques to cope with labour pain. To prepare for labour we offer a range of education classes, run by our midwives. The classes will help you understand what will happen in labour and may help you to feel less anxious. Ask your midwife about the support on offer to reduce labour pain.

If you need more information about epidurals (an injection into your back to numb the lower half of your body), the midwife can arrange for you to meet an anaesthetist at our Anaesthetic Clinic to discuss various aspects of this procedure.

 

The five R's

During labour we suggest you follow the five R's:

  • At the beginning of labour Rest and Relax
  • Rehydrate regularly to support your bodies ability to labour
  • Reposition yourself regularly to keep yourself comfortable
  • Seek Reassurance from us and your birth partners/support.

As your labour develops and your contractions become stronger, longer and more regular:

  • Walk and move around if you feel like it
  • Drink plenty of fluids
  • Eat little and often, even if you don’t feel hungry
  • Use your breathing excercises as your contractions get stronger and more regular
  • Having your birth partner rub or give you a light stroking massage over your back can help with contractions and be very reassuring.

Contractions

When contractions start this is your womb tightening and relaxing. You may have experienced painless tightening, particularly at the later stages of your pregnancy, known as Braxton Hicks.

When you experience regular, painful contractions that feel stronger and last more than 30 seconds, your labour may have started. These contractions will continue to become longer, stronger, and more frequent as things progress.

The contractions are pushing your baby down and opening your cervix ready for the baby to pass through into the birth canal.

Your midwife will advise you to stay at home until your contractions become regular and more frequent. Call us for guidance when they last between 30 and 60 seconds and are occuring regualrly every five minutes on the 24/7 advice line Call a Midwife on 0300 123 5473.

If at any stage you feel you need more support, pain relief and reassurance, please call us and we will invite you to come in for assessment. However, if your labour is still in the early stages and you are coping, it will be recommended that you return home until labour becomes more established.

The 'show'

While you are pregnant, a plug of mucus is present in your cervix. Just before labour starts, or in early labour, the plug comes away and you may pass this. This small amount of sticky, jelly-like (sometimes pink or bloodstained) mucus is called a 'show'.

The 'show' can come away in one piece, or in several smaller sections. It is normal to lose a small amount of blood mixed with mucus and as a result it is pink in colour. If you are losing more blood that is bright red and fresh, it may be a sign that something is wong, so telephone the hospital straight away.

After you have experienced the 'show', labour could come quickly, or it may still take a few days.

Some women do not experience the 'show' at all.

Waters breaking

Most women’s waters break during labour, but it can also happen before labour starts.

Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it’s time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.

You may feel a slow trickle, or a sudden gush of water that you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you are going out and put a protective sheet on your bed or car seat.

Amniotic fluid is clear and a pale straw colour. It also may be a little blood-stained to begin with.

If you think your waters have broken or are not sure, please call the 24/7 advice line Call a Midwife on 0300 123 5473.

What to bring with you

There is very little space to store items on the ward, so it is easier to bring the minimum and have things taken home and brought in as required.

  • Any medication you require (please make sure you give this to the midwife when she admits you)
  • Toiletries
  • Bath towel (we will provide a towel for you after labour)
  • Large t-shirt or old nightie for labour
  • Cotton wool for cleaning your baby's bottom
  • Dressing gown
  • Nursing bra
  • Slippers/flip flops
  • Breast pads if intending to breast feed
  • Nightwear
  • Daywear
  • Maternity sanitary pads (not provided)
  • Formula in disposable ready made cartons if intending to bottle feed. We will provide sterile bottles and teats
  • Underwear
  • Babygros, vests, hat, cardigan, scratch mitts
  • Disposable nappies (not provided)
  • CDs
  • Reading material
  • Pen
  • Phone charger
  • Snacks for labour for you and your partner.

What to expect when you arrive

The midwife will ask you about what has been happening so far and will examine you. If you are having a home birth, this examination will take place at home. The midwife will:

  • Take your pulse, temperature and blood pressure, and check your urine
  • Feel your abdomen to check the baby’s position and record or listen to your baby’s heart
  • Possibly do an internal examination to find out how much your cervix has opened, so they can then tell how far your labour has progressed.

These checks will be repeated at intervals throughout your labour. Always ask about anything you want to know. If you and your partner have made a birth plan, show your midwife so they know what kind of labour you want and can help you to achieve it.

What if you need an operation?

If you need an operation such as a caesarean section, you would not usually need a general anaesthetic. If you already have a good working epidural in place then this can be topped up with a much stronger local anaesthetic. If you do not already have an epidural, a spinal anaesthetic will often be used. A spinal is similar to an epidural in terms of insertion and effects, but it works much quicker. If an epidural or spinal method did not work or there was an immediate threat to your’s or your baby’s life, we will give you a general anaesthetic.

Occasionally, babies can be in awkward positions and the doctor may not be certain they can help you deliver vaginally with either forceps (an instrument shaped like a pair of large spoons or salad tongs is applied to the baby's head to help guide the baby out of the birth canal) or ventouse (assisted delivery of a baby using a vacuum device).. In this case, you would go to theatre and have your epidural topped up or a spinal epidural given before the doctor tries to help you deliver. If this was then unsuccessful you would be in the right place, with the right painrelief to proceed immediately to caesarean section.

However you birth your baby, our aim is that you are cared for by a midwife throughout your labour and birth and feel safe and informed throughout. Please always ask questions of your midwives and doctors if you are concerned or need more information to make a fully informed choice.