If you've already started thinking about your birth plan or labour day, chances are it doesn't include being induced, needing forceps or having stitches. But, however determined you are to welcome your baby into the world to the sound of chill-out music and the relaxing aroma of your favourite scented candle, remember even the best-laid plans can go awry when it comes to childbirth!
As Annette Briley, a research midwife for baby charity Tommy's, says, 'The best thing to take into labour is an open mind.' It's a good idea to go through some of the 'what if?' scenarios before the big day, as knowing what to expect can really help if things don't work out exactly as you'd imagined.
What if... my waters break early?
For around 15% of women, breaking waters is the first sign of labour. It can be a gush or just a trickle, so even if you're not sure, ring your midwife or the labour ward as you'll need to be examined. Consultant obstetrician Dr Virginia Beckett, of the Royal College of Obstetricians and Gynaecologists, says, 'If your waters break early but you don't have any complications, you'll normally be offered two options: waiting for 24 hours, or inducing labour. We'd want labour to start within 24 hours to reduce any risk of infection.'
Lots of women wait and contractions start naturally. But if this doesn't happen, you'll need to be induced. 'Some hospitals induce labour by inserting gel or a pessary into the vagina which contains a hormone-like substance called prostaglandin. Alternatively, you might be offered a drug called Syntocinon through a drip in your arm, to help kick-start contractions,' explains midwife Annette.
What if... the baby is lying in an awkward position?
In the last few weeks of pregnancy, your midwife will try to work out your baby's position by feeling your tummy. The ideal position for birth is head down, with the back of his head towards the front of your tummy. If he's breech (bottom-down), you'll be offered a process called external cephalic version (ECV), which aims to turn him manually. This is successful in about two-thirds of cases, but if he still hasn't turned by the time labour starts, you'll probably be offered a Caesarean. But remember, a breech baby isn't always identified before labour and he can turn at the last minute, too - so you may only find out your baby's in an awkward position when you're in labour. 'The back-to-back position is very common and often results in a long, painful labour. Meanwhile, a brow position - where the baby is looking "up" - means he can't be delivered vaginally because the angle of his head is simply too wide,' says midwife Annette. 'For this, you would need to have an emergency C-section. Similarly if the baby is lying across the womb, this will always result in a Caesarean.'
What if... I'm not dilating?
The early stage of labour, when the cervix is less than 3cm dilated, can be very slow. 'If you're in the early phase of labour and your waters haven't broken, we usually recommend waiting. It can be frustrating, but if we intervene you're more likely to end up with an assisted delivery,' says Dr Beckett. However, once you're in active labour (more than 3cm dilated) but aren't dilating steadily - 1cm per hour - you may be offered the option of speeding things up. 'If you're in the active phase or your waters have broken, we'd look at why you're not dilating. It could be because the baby's in a difficult position and, if this is the case, making the contractions stronger can help him turn. We'd normally use a Syntocinon drip to increase their strength,' says Dr Beckett.
What if... I can't cope with the pain?
'The main thing is to keep an open mind about pain relief,' says midwife Annette. 'This isn't like any pain you've had before and you're not letting anyone down by having relief - so if you need it, have it! Pain and tiredness together can be intolerable, so you might just need something to help you relax or sleep. There are lots of options available. It's also important to be comfortable in your surroundings, because if you're less stressed, you'll experience less pain.'
What if... my baby's in distress?
During labour, the midwife will listen to your baby's heartbeat regularly, probably using a hand-held sonic aid. If the heart rate drops, you'll be hooked up to a CTG monitor for continuous assessment. Other signs of distress include lack of movement or meconium - a dark sticky substance passed by your baby - in your waters. Lots of things can cause distress, from a high temperature to a lack of oxygen.Distress won't automatically lead to an emergency delivery, but doctors will need to find out what's going on. Dr Beckett says, 'If you're more than 4cm to 5cm dilated, we may take a blood sample from the baby's head. This is a very light scratch and doesn't seem to cause distress. If we're very concerned we can monitor him by putting a clip on his head connected to a CTG machine.' If doctors are worried the baby's life is at risk, he'll need to be delivered immediately, either using instruments such as ventouse or forceps, or by an emergency Caesarean.
What if... the cord is wrapped around my baby's neck?
This sounds terrifying, but it's quite common and is usually easy to deal with. 'If the cord is loose we'd simply loop it over your baby's head,' says Annette. 'But if it's tight we may have to clamp and cut it, although this is rare. In that case we'd have to deliver the baby immediately because once you cut the cord, you cut off the baby's oxygen supply. So with the next contraction, you would have to push really hard to get the baby out as quickly as possible.'
What if... I get too tired to push?
By the time you're ready to start pushing, you may be feeling hungry, stressed and exhausted. 'For some women, it can be a bit like doing a sprint after running a marathon,' says midwife Annette. Some hospitals try to keep the pushing stage to an hour or less before offering assistance. But Annette says it should depend on the woman. 'Sometimes it takes time to get the hang of pushing - it feels a bit like opening your bowels and some women struggle to do that in front of strangers,' she says. 'But as long as the mother and baby are fine we don't have a set rule about how long she can push for - it could be one hour for a woman who's had a baby before or two hours for a first-time mum.'
However, if pushing isn't effective, you'll be offered help to deliver with a ventouse or forceps. 'These still require some effort, and if the mum isn't pushing strongly enough we might have to do a C-section,' says Dr Beckett.