The Labour & Birth Guide

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Introduction
Where to birth
Vaginal birth
Caesarean birth
Everything else

Navigating the complexities of childbirth well requires informed decisions and an understanding of the options available to you. To do that, you need some direction. Our comprehensive, reseearch-backed guide was created to help you gain insights into child birth in Australia, from birth locations, to pain relief methods, to birth plan, to deciphering medical jargon and more. Whether you're anticipating the arrival of your baby or simply seeking knowledge, these pages aim to empower and reassure you on this transformative journey.

Choosing where to give birth

Hospital private, public or at home

The decision of where to birth your baby (or babies) is personal and one that requires you to be very honest with yourself. Where will you feel most safe, most comfortable and most positive? Your particular options may depend on where you live and if your pregnancy is high- or low-risk, but generally there are three main options: private hospital, public hospital or home. To help you with this decision, and because many things can happen in pregnancy that will dictate the location, it is beneficial to have an understanding of each.

Private Hospital

Private hospitals are run by private organisations, unlike public hospitals, which are run by government. As such, they charge patients directly for their services and are all differently equipped and run. Therefore they don’t always have medical facilities for more intensive or complex care needs. In Australia, private hospitals have a higher rate of birth interventions and caesarean births compared to public hospitals. A private hospital may be the best option for you if;

You’d prefer continuity of care i.e. you’d prefer to see the same person (obstetrician/midwife) at each antenatal appointment. You may be able to contact them directly outside of appointments. You’d also like this person to deliver your baby.
You’d prefer your baby to be delivered by an obstetrician rather than a midwife.
You’d like the option to stay in the hospital for a longer period of time following the birth (usually 4 or 5 days).
You feel more comfortable opting for an elective caesarean.
You know and feel comfortable with your particular hospital, it's policies, proceedures and statistics.
You have private health cover*

*Prior to choosing a private hospital, it is very important to check that Pregnancy & Birth is covered within your package. It’s also important to understand exactly what is covered, how much you’re likely to be out of pocket and if there are any lead times to consider. For example most health providers have a 12 month lead time before you gain access to the cover. If you fall pregnant before you add Pregnancy & Birth to your insurance, or if you add it during your pregnancy, your options may will be compromised.

Public Hospital

Public hospitals are run by the government. In the public health system your pregnancy and birth is mostly free. Depending on the facilities at your local hospital, they offer many different types of care, including shared care (where you have many of your antenatal appointments with your GP), midwives clinic, routine antenatal care, midwifery group practice or team midwifery care. Most public hospitals are set up to deal with high-risk pregnancies and serious complications. A public hospital may be the best option for you if;

You’d prefer midwifery care.
Assuming there are no complications, you’re happy to return home quite soon after the birth. In some cases women who give birth in the public sector are approved to go home between 4 and 24hrs. Shorter hospital stays such as these, however, usually only apply to vaginal deliveries. If you do require a caesarean, it’s very likely you’ll remain in hospital for a few extra nights.
You don’t have private health cover or don’t have Pregnancy & Birth cover within your private health cover.

You’re comfortable within your chosen hospital, you feel positive about their staff and you’re aware of the statistics around their vaginal delivery rates, caesarean rate, induction rates and their pain relief options.

Home Birth

A home birth is a birth that takes place at a private residence rather than a hospital or birth centre. It may be attended by a private midwife or doula with experience in managing home births. It may be an option for you if;

You are healthy and have a low-risk pregnancy.
You have arranged a midwife who is adequately qualified and experienced with home births.
Your chosen midwife has a highly organised plan in place for both your birth, and for transferring you to the safest and appropriate hospital with absolute efficiency, should any issues arise. This contingency plan for transferring you to the hospital is paramount.

If you are sure you feel comfortable giving birth at home, knowing that there are more risks as you’re further away from more medical staff and medical equipment. You understand you do not have immediate access to resources if an emergency was to arise.
If you are safe in your own home and you feel able to voice your needs and wants, and have them actioned asap by the people around you.
You want privacy or to have as many of your family and support system with you during labour and birth.
You understand and are comfortable with pain medications not being an option.

Get prepared. Have your hospital bag by the door.

Your hospital bag list

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Vaginal Birth

Each year in Australia, roughly 2 in 3 births are vaginal. It is possible to have no or minimal intervention in a vaginal birth. When needed, intervention can include an episiotomy, the use of forceps or the ventouse (vacuum). In 2021, half of all births were non-instrumental vaginal births. Almost 5% involved forceps and almost 8% the vacuum.

Benefits

A vaginal is usually the safest way for your baby to be born. Generally speaking, the recovery time following a vaginal delivery will be shorter and less challenging on the body when compared to a caesarean and require less pain medication. With the exception of women who experience a 3rd or 4th degree tear or other complications during birth, you should be able to go home sooner than if you were to have a caesarean (i.e. after 1-2 days, as opposed to 3-5) and more physically able to care for their baby sooner.

You are more likely to have skin-to-skin contact immediately after birth and statistically have a better chance of starting breastfeeding straight away. Your milk may also arrive a little sooner than what it would after a caesarean, and feeding may feel slightly less painful as you won't have a wound in your abdomen.

Babies born vaginally are less likely to need time in the special care nursery, and have several health benefits, for example, they are more comfortable because they have been squeezed down the birth canal so most of the fluid in their lungs is pushed out. There is evidence that vaginally born babies tend to develop stronger immune systems from the bacteria they are exposed to during the birth and the hormones released.

Considerations and Risks

Complications from delivering vaginally can include pelvic floor damage such as prolapse and incontinence. To help prevent these outcomes it’s advised to work with a women’s health physio in the lead up to the birth. They’ll be able to walk you through some exercises and provide direct feedback as to areas of your pelvic floor you may need to work on.

Other risks include, but are not limited to, postpartum haemorrhage (drastic loss of blood), vaginal tears (tears in the perineum tissue which rests your vagina and anus), and postpartum preeclampsia (excessively high blood pressure).

If within the first 6 weeks post delivery you’re dizzy, lightheaded, nauseated or you’re seeing spots or flashing lights, make contact with your health practitioner asap for urgent treatment.

To mitigate risk during your delivery, make sure you remain open and honest with your midwife, obstetrician or GP throughout your pregnancy. While not everything can be controlled, predicted or prevented, communicating any changes, concerns or difficulties in your pregnancy can contribute to less variables in birth.

So... What Actually Happens

Whether it’s on your back, your side or on all fours, there are positions to take… and some things to know.

Contractions

Contractions occur when the uterine muscles tighten and relax in a continuous motion as your body prepares to birth your baby. In the earlier stages of labour, contractions are likely to be irregularly timed, short and sharp. They can be anywhere from 45 minutes (or less) to hours apart, each lasting around 20-30 seconds.

Generally speaking, when your contractions become strong, painful to the point you may be unable to speak, 45-60 seconds each and they've occurred five minutes apart for around an hour, it's a good sign to make contact with your birth team. Grab your hospital bag as it's likely to be 'go time'! Like everything else, if you're in doubt or confused whether to stay at home or go into hospital - always call your team to be safe.

Dilation

Whether in the movies or in pregnancy books, we've all heard about the phrase '10cm dilated!" Dilation refers to the size of the cervix opening, where your baby will come out. Your cervix is continuously checked during the early stages of labour by your midwife via a vaginal examination (with your consent). The reason being; the size of the cervix opening is a good indication of the progression of your labour.

The time it takes to dilate is different for all women. It can take hours or minutes to move from one stage to the next.

Bring in pain relief

The hospital will have medical pain relief available should you need it. These will have varying effects on you and sometimes your baby so it is important to understand them and their effects. As way of introduction, these include;

- Nitrous oxide. Also known as ‘laughing gas’ or just ‘gas’. It is administered through a face mask or tube held at the mouth. It takes a few seconds to be felt so for it to be effective you must breathe from it as soon as a new contraction starts. It will not completely block the pain but will dull the intensity.

- Pethidine. A strong pain reliever related to morphine which is usually injected into a muscle or given intravenously (into a vein). It usually lasts 2-4 hours and is given with anti-nausea medication to mitigate side effects of feeling sick.

- Epidural anaesthesia. The most effective pain relief available, it numbs feeling from the waist down via an injection into the spinal cord through the back. It is available for vaginal births and used in caesarean births because it allows the mother to stay awake and alert during the baby's birth. It is always accompanied by a urinary catheter and often a further mode of monitoring the baby’s heart. A It can take some time after delivery for the numbness to go away, so you may be confined to bed for the rest of the day.

You may like to consider bringing in some other non-medical pain relief options from home. These may include;

- A heat pack for your lower back

- A TENS machine. A TENS machine is attached to your back with sticky pads and its job is to send electrical impulses to certain parts of the body to block pain signals.

- Soothing music for distraction

- Magnesium oil to rub into your lower back, helping any strained muscles to relax

- Your partner or doula for massage

- Pushing or bearing down

As your labour progresses and your baby's head lowers, this will place pressure on your lower pelvis. At this point, many women feel a very strong urge to push or poo. The latter is totally normal, it's a common sign of birth approaching! Despite your body's instinctive response (to push), it's important to communicate with your birthing team before doing so.

The reason for this is that you might not actually be 10cm dilated yet and as your body is still contracting, there are certain times when pushing is optimal and certain times when pushing is not. Follow the guidance from your birth team to help you find a nice rhythm while also lowering the risk of tearing or other pelvic floor damage.

Bring in assistance

Forceps and a ventouse are instruments that protectively hold or suck onto the baby’s head, allowing the birth team to gently (and safely) pull and assist your baby through the birth canal and then through the vagina.

Examples of when your birth team may opt to use either of these tools for assistance include (but are not limited to);

- If after a certain duration of pushing, the baby is having trouble coming through the birth canal

- If there are concerns for the baby's heart rate or if the baby is showing signs of fatigue or distress

- If the baby has wriggled or turned into an 'awkward' potion making it harder for you to push them out

- If you are showing signs of fatigue or;

- If you have pre-existing medical conditions that have to be considered (i.e. previous heart issues)

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Caesarean Birth

In Australia more than 1 in 3 babies are born via caesarean section. Of those, 2 in 5 are unplanned.

Definitions

A caesarean section is a surgical procedure in which a baby born through an incision in the mother's abdominal wall and uterus. Your baby will need to be born by caesarean section if there are problems that prevent the baby being born by a vaginal birth.

A caesarean section may be planned (elective) if there are signs that a vaginal birth is risky or unfavourable, or unplanned (emergency) if there are problems during labour.

A caesarean can only be performed if you give your written permission. Your partner or next of kin can give written permission if you are not able to.

In Australia, a caesarean section is a common and relatively safe surgical procedure, but it is still major surgery. As with all surgical procedures, there are risks for both you and your baby. Generally, there is all the same recovery and care as a vaginal birth as well as recovery from the abdominal surgery and scar care, because of this, your hospital stay may be longer, usually 3-5 days.

When your baby is gently pulled out by the obstetrician, the umbilical cord will be clamped and cut. Your baby will then be checked over by a paediatrician, before coming to you to start skin-to-skin on your chest. If you would like to start skin-to-skin and establish breastfeeding as soon as possible, have a conversation with your obstetrician in the lead up to your birth, to let them know your wishes.

While you’re enjoying this special moment, the obstetrician will remove your placenta (through the same incision) and stitch you up. As a caesarean is a major surgery, you will experience some pain and discomfort for a period of time, as the wound heals.

Benefits

If you’re a planner, in the case of an elected caesarean, what an advantage to know exactly when your baby will greet you!. On a more serious note, the benefits of a caesarean include less trauma endured by the vagina and reduced risk of postpartum incontinence and/or pelvic floor damage such as prolapse.

If you’re planning an elected caesarean, like all births there are some elements to consider. Some of the reasons a caesarean may be a good birth option for you include:

For personal reasons, you feel more comfortable scheduling in your birth date, rather than waiting to go into spontaneous labour.
You’ve previously birthed via caesarean (elected or non elected).

There is a concern for your baby’s wellbeing. They may be showing signs of distress in which case a vaginal delivery holds the risk of exacerbating the issue/s.
The size of your baby poses a risk to your health (and their own).
Your baby hasn’t ‘turned’ and they’re either breech (bottom or feet down rather than head) or transverse (on their side).
You’re experiencing major placenta praevia, a condition where the position of the placenta is blocking the birth canal and therefore interrupting the option to birth vaginally.

Considerations and Risks

A caesarean is the surgical delivery of a baby through an incision in the mother's abdominal wall and their uterus. Like all things in life, there are both pros and cons to having a caesarean, but it is major surgery and as such, carries certain risks. These should be spoken about with your obstetrician as they will vary with every woman and every pregnancy.

Risks to consider include (but are not limited to); pain, the risk of an infection in the uterus lining or at the incision site, greater loss of blood, the development of blood clots (hence the compression socks you’ll be asked to wear), a longer recovery time (both in hospital and potentially when you return home) and a reaction to the anaesthetic. Talk to your medical practitioner to learn more.

Emergency Caesarean

Unlike an elected caesarean, an emergency caesarean is not scheduled but required as a matter of urgency due to reasons including (but not limited to);

You have started to labour however your cervix is slow (or unable) to dilate, which increases the stress on your baby. In this instance, immediate intervention is required.
Monitoring of your baby's heart rate is indicating that they are not receiving enough oxygen.

The placenta has separated from the uterine wall too soon. This is known as placental abruption. If this is not treated immediately, there can be haemorrhage and blood clotting complications for the mother and baby.
In some instances the umbilical cord may enter the birth canal before the baby, which is known as an umbilical cord prolapse.

So... What Actually Happens?

Keep in mind that while a caesarean is a common method of delivery, it is also a major abdominal surgery meaning you’ll be in an operating theatre rather than a birth suite. It may feel and look a lot more clinical, however rest assured you’re in safe hands.

So how will it all unfold?

After you’re wheeled into the operating theatre on your bed, you’ll have monitor screens placed around you. These will track your heart rate, your oxygen levels and your blood pressure.
An anaesthetist will administer an epidural or a spinal block (or sometimes a combination of both). Following this, the lower half of your body will be without feeling, however you will remain awake.
You’ll have a catheter inserted into your bladder through your urethra as you won’t be able to stand and walk to the bathroom to wee. Rest assured, you should be numb at this point, so you won’t feel a thing.

A privacy screen will be erected near your belly, blocking you from the actual procedure. Your birth partner will sit in a chair as guided by your anaesthetist. If you would like to witness your baby being born, just make this known by your obstetrician.
Your belly will be washed with an antiseptic solution and the procedure will begin. The obstetrician will make the incision (roughly 10cm) and moments later, you’ll meet your baby.
Due to the epidural and/or the spinal block you won’t feel any pain. You will however feel a range of sensations as the baby is being born. Some women describe it as a ‘tugging’ or a pulling/pushing sensation.
If the baby is healthy after a check over by the medical team in the room, the umbilical cord will be cut and it’s time for skin-to-skin.
The obstetrician will now remove your placenta, from the same incision point and stitch you up.
The steps listed above will usually take between 30 and 60 minutes.