If you don't want to receive this information, please call (03) 8345 3272 or email patientexperience@thewomens.org.au
About 4 weeks have passed since our last update. By now, you’ve probably had or are about to have your 32-week appointment. This week, we have a few reminders and information about things affecting your pregnancy now. We’ll also explain how labour works and include a video tour of our Birth Centre.
Part 1: Reminders and recap
You’re probably quite familiar with your baby’s movements. Whether it’s light flutters, a swish, a roll or stronger kicks and punches. these are all signs that your baby is well. Paying attention to your baby’s movements is a simple thing you can do to help keep your baby safe and healthy. Regular movements are a good sign of wellbeing.
Your baby will continue to move during pregnancy, changing positions and stretching. How often they move varies from baby to baby. They’ll also have periods of being awake and asleep. These movements continue throughout your pregnancy.
It’s a myth that babies’ movements slow down or become weaker towards the end of pregnancy. When a baby is unwell, they may try to save energy by reducing their movements. This may be the first sign of a problem and can occur at any time in a pregnancy.
How will you know if a quiet time is normal or too long?
If your baby is unusually quiet at a time when they’re normally active, it might be a sign that your baby is becoming unwell. Please go to the Women’s Emergency Care department immediately if you notice a change in your baby’s movements that worries you. Don’t wait until the next day or your next hospital appointment. You know your baby best - it’s your body and your baby, so trust your instincts.
For more information, visit The Centre of Research Excellence in Stillbirth website - Movements matter.
The Women’s Emergency Care department is located on the Lower Ground Floor, near our carpark entrance on Flemington Road.
If your doctor or midwife asks you to come to the hospital, here’s what you can expect to happen:
- your doctor or midwife will ask you about any risk factors or issues you’ve had during your pregnancy
- they may do a cardiotocograph (CTG) to measure your baby’s heart rate by placing an elastic belt around your belly
- they’ll feel your belly to check your baby’s position and growth
- if you haven’t had an ultrasound recently, they might do one to check the amount of water (amniotic fluid) around your baby, and measure the blood flow in the placenta, umbilical cord, and your baby’s organs
- they may also do a blood test.
In the last few weeks before your baby arrives, you might start thinking about what will happen when your labour starts. Our fact sheet - when to call the hospital: advice in late pregnancy - provides advice for recognising the signs that labour is starting.
From 36 weeks, we’ll give you a phone number to call the hospital when you’re in labour.
If you have any labour symptoms, including contractions or your waters breaking before 36 weeks, go to the Women’s Emergency Care Department.
Family violence and sexual assault are unacceptable and against the law. Everyone deserves to live without violence and make their own choices.
If you’re experiencing family violence, talk to a midwife or doctor at the Women’s or call the Safe Steps Family Violence Response Centre on 1800 015 188. You can call any time, day or night.
In an emergency or if you’re in danger right now, call Emergency Services on Triple zero (000).
Everyone should exercise their pelvic floor muscles every day to prevent weakness and improve strength. This is particularly important during and after pregnancy. You can generally restart these exercises a few days after giving birth.
Two common signs of pelvic floor problems are urine (wee) leakage and a heavy feeling in the vagina. Other signs that might suggest pelvic floor problems are constipation, lower back pain, pain during sex, and pain around the pelvic bones.
To learn more about exercise after birth, visit our website and refer to the detailed information from week 22.
During pregnancy, the long muscles of your tummy (abdomen) can separate. This is a natural way to prevent the muscles from tearing as your baby grows. It only becomes a problem if the muscles stay separated after your baby is born. Stretched and separated muscles may not fully support your back and may increase the chance of back pain.
For more information, read our fact sheet on abdominal muscle separation.
Your midwife or doctor can refer you to our Physiotherapy Department for a review and advice if needed.
Part 2: Things affecting your pregnancy now
The Women’s recommends that you be tested for Group B Streptococcus (GBS) around 36 weeks of your pregnancy, unless you’re having a planned caesarean.
GBS is a germ commonly found in the bowel and in the vagina. Having GBS won’t hurt you, but it can cause infection in your newborn baby.
GBS isn’t spread through sex.
If you test positive for GBS, you can get antibiotics during your labour to reduce the risk of your baby getting seriously ill from an infection.
The GBS germ isn’t always present in the vagina. The test can only find GBS if the germ is there when the swab is done. Sometimes, the test may not detect GBS in about 5 in every 100 people who have GBS.
Read our fact sheet Group B Streptococcus (GBS) screening test for more information.
During pregnancy and labour, how you sit and move can affect how your baby positions itself for birth. To help your baby get into the best position - head down and facing your spine – focus on staying healthy, using upright forward-leaning positions, and exercising your pelvic floor.
Talk to your midwife, doctor, or physiotherapist to find out which positions are best for you.
Part 3: Things to consider
A birth plan or birth map tells everyone what you want during labour and birth. It helps you, your support team, and care providers understand your preferences and goals.
Since every labour and birth is unique, your birth plan needs to be flexible. Sometimes, for safety reasons, changes or medical assistance might be needed. But we’ll support you in making informed decisions.
For more information, read our fact sheet creating a birth plan.
When your body and baby are ready, labour usually begins naturally around 37 to 41 weeks.
Your uterus is a muscular organ that sits in the lower pelvis. The cervix is at the bottom of your uterus. During pregnancy, the cervix remains long and closed to keep your baby safely inside. During labour, your uterus contracts, and the cervix becomes softer, thinner, shorter, and gradually opens up over time.
Labour happens in 3 stages:
- Stage one – has 3 phases
- latent labour
- active labour
- transition labour
- Stage two – involves pushing and the birth of your baby
- Stage three – is when the placenta is passed.
At the beginning of labour, especially if this is your first birth, contractions are often spaced apart and irregular. There isn’t yet a set pattern for how often or how long your contractions will last.
These early contractions usually last 10 to 20 seconds, and can feel like strong period pain or intermittent back pain. At this stage, your cervix is getting thinner and shorter before it begins to dilate and open.
If it’s your first baby, this phase can last many hours. We encourage you to rest as much as possible and call the hospital for advice.
Naps, baths, showers, and a heat pack on your belly or lower back are great options for this stage. Home is a good place to stay when:
- your pregnancy is low-risk
- you feel your baby moving regularly
- your waters haven’t broken.
The early stages of labour progress well when you feel comfortable and safe. In most cases, it’s best to stay at home during early labour.
If you’ve laboured before, this early phase of labour might be very short, or you may not notice it as much if you’re busy caring for other children. It might seem like you’re quickly moving into the next, active stage of labour
For more information, check out our:
Active labour is when contractions are generally 3 to 4 minutes apart and lasting 50 to 60 seconds. Or if you have 3 contractions in a 10-minute period. When this happens, it’s a good time to go to the hospital.
As your uterus continues to contract, your cervix will continue to open.
If you’ve laboured before, you may feel that these contractions are stronger than in your last labour. This is because your body has done this work before and it often progresses more quickly and efficiently.
Watch our video and take a tour of our Birth Centre.
During labour, there may be times when you feel like you can’t keep going. Your midwife and support people will help you through this. This feeling can happen at any time in labour, but it may be stronger around this time.
You may feel some pressure in your bottom as your baby moves down in your pelvis and pushes on your bowel. This pressure increases with each contraction until you feel an involuntary urge to push during contractions. These contractions often occur closer together and are longer and more intense.
Your cervix is now fully open, and your baby’s head is usually well down in the pelvis.
If you’re in an upright position - standing, bending forward, kneeling, or on your hands and knees - it gives your baby more space to move through your pelvis and assists birth. Work with the pressure sensations, take deep breaths, and try to change positions to help birth your baby.
As you near the end of the second stage, the midwife will help guide you with pushing as needed, aiming for a slow, calm birth of your baby’s head and body.
If this is your first labour, this pushing stage may last 30 minutes or more.
If you have laboured before, it may take as little as 5 minutes.
It is standard practice for the midwife to ask if they can apply warm compresses to your perineum to help reduce the chance of perineal damage. We will explain more about protecting the perineum in a later section.
After the birth, while you and your baby have skin-to-skin contact, your uterus will contract to loosen and push out the placenta and membranes through your vagina.
You might also need to give a small push to help the placenta come out. This may occur between 5 to 30 minutes after your baby is born.
The muscles of your uterus will keep contracting to stop the bleeding and help your uterus begin returning to its normal size. The birth of the placenta involves some blood loss. This stage is closely monitored to prevent excessive bleeding (postpartum haemorrhage).
At the Women’s, we wait for a short period before clamping the umbilical cord. This helps your baby keep getting blood from the placenta after birth. Sometimes, we have to clamp the cord immediately if you or baby need urgent medical care or if we need to collect blood from the cord.
There are 2 ways to birth the placenta:
1. Physiological birth of the placenta
This means you wait for the placenta to come out naturally. Your uterus contracts to help separate the placenta from your uterus. Then it moves into your vagina for you to push out.
2. Active management
This is when you get an injection after your baby is born. It’s often used if there were complications during your pregnancy, labour, or birth. The injection helps prevent heavy bleeding after childbirth.
The midwife or doctor will ask to give you an injection of synthetic oxytocin. This causes the uterus to contract, helping the placenta separate from your uterus and move into your vagina. This usually takes 5 to 15 minutes. The midwife or doctor will gently pull on the umbilical cord to guide the placenta out through your vagina. If possible, we’ll delay cord clamping.
After giving birth, either vaginally or by caesarean section, it’s normal to have some bleeding from your vagina. This bleeding usually comes from where the placenta was attached to the uterus. It can also come from any cuts or tears that happened during a vaginal birth. Bleeding is usually heaviest just after birth and gradually decreases over the next few hours, days, and weeks.
It's common to lose up to 500mL of blood during the birth of a baby and placenta. In about 25 in 100 births, there is more bleeding. This is called a postpartum haemorrhage or PPH. If you have a postpartum haemorrhage, you’ll be treated while you’re in the hospital.
Postpartum haemorrhage can also occur up to 6 weeks after the birth. This is called a secondary PPH and affects less than 2 in 100 people. But if this happens to you, call Triple zero (000) for an ambulance or go to your nearest Emergency Department.
It’s important to know that most people don’t experience this heaving bleeding after birth.
Your perineum is the diamond-shaped area between the vagina and anus. It stretches during childbirth to allow your baby to come out.
Sometimes, the perineum gets grazed or torn during birth. In some cases, you might need an episiotomy. This is when a midwife or doctor makes a cut in the perineum to make the vaginal opening larger during birth. The cut is stitched up after the birth.
This isn’t done for every birth but may be recommended in some circumstances. These include assisted births, when the perineum isn’t stretching well, or when there’s a risk of significant perineal injury.
Talk with your midwife or doctor if you have any preferences or want more information.
3rd and 4th degree tears
About 8 in 10 people who give birth vaginally will have a vaginal or perineal tear. Most of these tears need stitches but heal well without any problems.
However, a small number of people, about 3 out of 100, will have a more severe tear that affects the muscle around their bottom. This is called a 3rd or 4th degree tear.
It’s not possible to tell if you’ll have a 3rd or 4th degree tear, but there are some common risk factors. These include having your first vaginal birth, delivering a bigger baby, or if you’re from an Asian background.
Your midwife will provide suggestions during the birth to help lower your risk of tears.
There are also things you can do to prepare your body for birth, like perineal massage and other ways to reduce damage.
Protecting the perineum
To protect the perineum:
- use warm compresses when the baby’s head is being born
- perform perineal massage starting from 35 weeks of pregnancy
- ensure a slow and controlled birth of baby’s head.
Perineal massage
Perineal massage involves stretching the skin to prepare you for sensations like tingling, burning, or stinging during childbirth. Doing this towards the end of your pregnancy can help prevent perineal trauma.
Watch the video, What is perineal massage, for more information.
The concept of pain and labour
Your relationship and experience with pain will affect the way you deal with pain during labour.
Many people fear pain because they’ve felt it before from surgery, accidents, illness, or overuse. We usually want to stop this pain and make it go away.
However, in labour pain is different. In labour the pain comes in surges or waves. It’s a sign that your labour is progressing and your body is getting ready to birth your baby. Each wave or surge helps your cervix soften, shorten, and open.
Understanding this pain can help you work with your body instead of trying to fight the pain.
Hormones of labour
Three main hormones help with labour:
- oxytocin
- endorphins
- melatonin.
Promoting the release of these hormones can greatly assist the birthing process.
However, another hormone, adrenaline, can negatively affect your labour and potentially reduce the benefits of the helpful hormones.
This hormone is often referred to as the ‘love and bonding’ hormone because it’s linked to falling in love, sexual activity, birth, breastfeeding, and bonding with others.
During labour, oxytocin increases, making your uterus contract more frequently, effectively, and intensely. Oxytocin can help you feel focused, strong, and more accepting of the labour process.
Endorphins help your body cope with pain. Your body releases them when you move, get a massage, or feel strong sensations like pain or contractions.
They make pain feel less intense and give you a feeling of strength, motivation, and happiness.
Melatonin, a hormone that works best in the dark, helps your body produce oxytocin. Keep the lights dim both at home and in the birthing room. Rest during early labour, especially at night. Bright lights can slow down the labour process.
Your body produces adrenaline when you’re stressed, scared, or anxious. Too much adrenaline during labour can stop oxytocin from working properly. This can slow down labour and make the pain feel worse. It’s important to try and keep adrenaline levels low. Adrenaline can increase during the pushing stage to boost energy, but it’s important to maintain a calm, safe environment.
Ideas for assisting the labour process
Here are some ways to create a comfortable, familiar, and safe environment:
- use dim lighting, an essential oil diffuser, and play music
- use massage and heat packs
- use distraction techniques
- practise mindfulness techniques like affirmations and visualisations
- practise deep breathing.
Reminder: relaxation techniques help your body relax and reduce stress. They can be very helpful during pregnancy and labour. Refer to Week 22 for more information.
Staying active and upright during labour can help your baby move down. It can also help reduce pain. There are many ways to move, depending on what feels right for you. You could try:
- walking
- sitting and gently rocking on a fit ball
- sitting in a chair with armrests to support you, or leaning forward in the chair
- kneeling or leaning over a bed or raised surface for support
- using bed positions that keep your upper body upright
- slow dancing
- swaying or rocking your body
- lying on your side with pillows for support if standing or kneeling isn’t comfortable.
Your support team can help you find positions that feel comfortable, safe, and supportive.
For more information, read our fact sheet on active birth.
You can choose to labour and/or give birth in water at the Women’s if it’s safe for you and your baby. Using the shower or bath has many potential benefits.
If you’re interested, read our fact sheet on the use of water birth in labour and birth and talk to your doctor or midwife about your options at your next appointment.
Additional things to consider
If you’re expecting 2 or more babies, your healthcare team will talk with you about your options for birth. This includes whether to let labour start naturally (spontaneous labour), have labour induced (induction), or have a caesarean section.
Get to know the Women’s and our birth suites by taking a virtual hospital tour.
After your baby is born, the Women’s will give you details on how to register the birth, apply for a birth certificate, and meet Centrelink requirements.
You don't automatically get a birth certificate when you register your baby’s birth. You can order it when you register or order one later.
For more information, visit Birth, Deaths, and Marriages Victoria.
To learn about Centrelink payments, eligibility, the application process and Medicare, go to Services Australia – Before the birth of your baby.
Part 4: Tests and treatment for your baby after their birth
After your baby is born, you’ll be asked if you want your baby to have several tests. You have the right to agree, ask for more information, or refuse.
Here is some information to help you decide. You can also ask your healthcare team for more information about these tests at any time.
The Apgar score assesses your baby’s overall condition, including breathing, heart rate, and colour. This is done at 1 minute and 5 minutes after birth. The Apgar score tells your carers how well your baby has adjusted from life inside your uterus to life outside.
Babies with a lower Apgar score may need extra care.
For more information about the Apgar score, visit the Pregnancy Birth and Baby website.
Vitamin K helps the blood clot and prevents bleeding.
We recommend giving babies a single dose of vitamin K by injection within a few hours of birth because newborns may have low vitamin K levels during their first 8 days.
For more information on vitamin K, visit the Better Health Channel.
Hepatitis B is a liver disease caused by a virus. It spreads through infected blood and other body fluids like saliva. We recommend immunising babies soon after birth and during infancy. The hepatitis B vaccine will be offered to your baby before you leave the hospital. More vaccinations are given over the next 4 years to complete the immunisation.
If you are hepatitis B positive, we suggest that your baby be given another injection in the hospital called hepatitis B immunoglobulin. This gives your baby immediate protection from hepatitis B.
For more information, read our fact sheet hepatitis B immunisation: the birth dose and your baby.
We hope you have found this information helpful.
Remember you can go back to previous weeks.
If you have any health concerns, please talk to one of your health care professionals – midwife, General Practitioner (GP), hospital doctor, etc.
There will be more to read and learn next month in week 36. Stay safe and well.