What to expect when giving birth and the post-birth period

Your options for where to plan to give birth are linked to whether you plan a vaginal or caesarean birth.

All caesarean births require to be carried out in an operating theatre in a hospital.

Vaginal birth may be planned in your home, in a midwife-led birthing unit or in a hospital, although you may be advised to give birth in hospital if you are at increased risk of complications.

Most maternity units will support you to have up to two birth partners during a plan for vaginal birth, and one birth partner during a planned caesarean birth. However this may vary - do check with your midwife or doctor to find out what happens in your area

Pain relief options are different if you plan a vaginal birth compared to caesarean birth. During a plan for vaginal birth, you may have the option of being in a bath or pool, taking simple pain-relief medicine, stronger pain-relief such as morphine injections, or epidural analgesia. Pain relief during a caesarean birth usually involves an injection around your spine to make you numb from the chest downwards. Pain-relief options for after the birth are similar for each type of birth. Find out more about the pain-relief options at your local unit by asking your midwife or doctor.

Your baby usually benefits from blood flowing to them from the placenta in the minutes after birth. If the cord is not clamped and cut immediately, this is called deferred cord clamping. The cord is usually clamped around 3 minutes after vaginal birth, and 1-2 minutes after caesarean birth.

If you give birth by caesarean section your placenta will usually be removed in the 2-3 minutes after your baby is born. If you give birth vaginally, your placenta will usually be born up to 30 minutes after your baby. Sometimes [add figures] extra help is needed to remove your placenta after vaginal birth, when a doctor uses their hand to separate and remove your placenta. This is called manual removal of placenta. This procedure usually involves spinal or epidural analgesia and is performed in an operating theatre.

Your midwife will support skin-to-skin contact as soon as possible after birth. If your baby is well this may be immediate. Each hospital may have different processes in theatres, so this should be discussed with your local midwife or doctor so that you know what to expect.

You will be supported to feed your baby in the way that you prefer after both a vaginal or caesarean birth.

Around x in 100 women successfully start to breastfeed after a planned caesarean birth and around x in 100 do so after a vaginal birth.

The length of time you may stay in hospital after giving birth can vary by several days, depending on how well you and your baby are, and any support you need with feeding your baby. On average women spend 2.5 days in hospital after planning vaginal birth and 4 days after a planned caesarean birth.

There are no specific recommendations that you delay another pregnancy after a vaginal birth. Following a caesarean birth, the chance of the caesarean scar opening up during a future labour appears to be increased if there is less than a year between pregnancies.

If you have a medical condition (e.g. diabetes, a heart condition or a spinal problem) that could affect, or be affected by how you give birth, your doctor may advise you on the best option. Planning either a caesarean birth or a vaginal birth may carry certain advantages or disadvantages for you. If you have any questions about a health condition that you have, you are encouraged to discuss this with your care team.

Emotions can vary after childbirth. While childbirth experiences can evoke different emotions, it is not known whether you are more likely to experience certain emotions after a plan for vaginal birth compared to a plan for caesarean birth.

On arriving, you will usually be shown to the theatre table and have monitors attached to you. This means that your heart rate, blood pressure and oxygen levels are known.

Anaesthetic

A spinal anaesthetic is most commonly used so that you are awake during the operation.

Occasionally you and your care team plan to use a general anaesthetic instead.

You may notice that labour has started when you first experience painful tightenings or if you leak fluid from the vagina.

Your midwife will advise you of who to call for advice when you think your labour has started.

You may be offered the option of induction of labour if you are aiming for vaginal birth.

Induction of labour means artificially starting labour using either medications or devices to open the cervix (neck of the womb).

Induction of labour is offered when it is judged to offer benefits over waiting for labour to start. These benefits could be for you or your unborn baby.

Induction of labour should be offered as one of a set of options: watching and waiting for labour to start; induction of labour; or planned caesarean birth.

Further information on induction of labour is available at [link to INCE/RCOG/NHSE information]

In your first labour, if your labour takes longer than expected, you may be offered oxytocin medication via a drip in your hand or arm. This usually increases contraction strength and number. This requires that your baby be monitored continuously to be sure that they cope will the contractions. This means that straps are applied around your tummy so hold the transducer in place.

If your midwife or doctor are concerned about how long labour is taking, they may discuss the option of unplanned caesarean [hyperlink] with you, or forceps or ventouse-assisted birth [hyperlink] if your cervix is fully open.

Once your cervix has fully opened (to 10cm) you may feel your baby's head low in your pelvis. You may have an urge to push (which feels like you are straining to do a poo). Your midwife will offer to examine your vagina to confirm that your cervix is fully open before you start pushing.

Who will look after you

• You should receive one-to-one care from a midwife once you are in active labour, or from when your waters are released during an induction of labour.
• Another midwife will also carry out regular checks to ensure your wellbeing.
• If you are in a consultant-led birthing unit, doctors will carry out regular checks to ensure you and your baby's wellbeing.
• If concerns arise about you or your baby's wellbeing, a senior midwife or doctor will attend to discuss these with you.