Interaction and cooperation between the mother, the child and the obstetrician/midwife are crucial to a normal childbirth and to leaving the mother with a positive experience.
It is not possible to know in advance how the birth will be experienced by the mother, which may make the time leading up to the birth both exciting and a little scary for some. Not all mothers experience the birth as they had expected; for some, the experience may be worse than expected, whereas others have the opposite experience.
You should talk about the birth with the midwife or doctor during pregnancy check-ups. They will provide information and answer questions and thoughts you may have about the birth.
Referral and assessment
You do not need a referral to contact the maternity clinic/hospital where you are going to give birth.
When you believe the birth is starting, you must call the maternity ward. Then you will be able talk to a midwife who will give you advice and guidance. It is important for the ward to know that labour has started to enable them to plan and prepare for your and the accompanying person’s arrival.
Information and knowledge
As an expectant mother you may prepare for the birth yourself and thus contribute to a good childbirth experience. It is a good idea to acquire knowledge and information as to what happens during childbirth: What happens to your own body and what happens to the child?
We advise you to be selective regarding what information you choose to attach importance to. Not all available information is good or correct, and it is a good idea to seek advice from your general practitioner or the midwife to check the quality of what you have read or heard.
Get into shape
Childbirth is a strenuous physical process. If you are fit, you will be able to tackle the birth better. If you have not been exercising or training before you became pregnant, you should start going for walks on a regular basis or start training to improve your condition and muscular strength as the birth approaches. It is never too late to start, but the sooner you start the better.
Contact and other preparations
Find out whom to contact when the birth starts.
- If there is anything the health personnel should know about you to enable them to give you maximum support and help during the birth and the first period after it, it is important that you are open about it. Remember that all health personnel have a duty of confidentiality.
- If you have special thoughts about the childbirth, or any wishes or needs, it may be a good idea to write this down and bring it to the hospital when you are admitted. This may make it easier to communicate it to those who will help you during the birth.
- It is important to realize that the birth may be different from wat you have envisaged. All childbirths are unique irrespective of whether you are giving birth for the first time or have given birth previously.
Signs of labour
Most childbirths start spontaneously between the 37th an 42nd week of the pregnancy. Most often the birth starts by the uterus starting to contract, which makes you have contractions. You may, however, experience other signs that the birth is soon going to take place.
- Birth contractions are painful contractions of the uterus occurring more frequently than every 10 minutes, lasting for 45-60 seconds.
- Most often the contractions occur with intervals of several minutes. At the beginning they are short, but frequency, duration and intensity will increase. Most will feel pain in the lower part of the abdomen and/or the lower back.
- When you believe the contractions are established or occur with an interval of 5 – 6 minutes, you must contact the hospital.
- If the distance to the hospital is long, if you have given birth quickly previously, if during previous pregnancies or births you have experienced complications, or if you feel insecure, you should contact the hospital when the contractions start.
Premonitory labour pains (Braxton Hicks-contractions)
Towards the end of the pregnancy all pregnant women will have contractions of the uterus, so-called premonitory labour pains (Braxton Hicks-contractions), which are not the same as birth contractions. Women who have given birth before, in particular, may have some premonitory labour pains and find it difficult to distinguish between premonitory pains and birth contractions.
The premonitory pains may occur regularly, be uncomfortable and triggered by activity, and then calm down if you lower the level of activity. These contractions prepare the body for the birth and form an important part of the childbirth process.
- If you have acute stomach pains, you should contact the hospital.
Leaking amniotic fluid
If the amniotic fluid starts leaking, this may be the first sign that labour has started. If the hole in the foetal membranes is large, there will be an abundant flow of opaque liquid from the vagina. If the hole in the foetal membrane is small, only a small quantity of amniotic fluid will be discharged. Many experience this as moistness in the lower parts.
Irrespective of the amount of amniotic fluid, you must always contact the hospital or doctor/midwife if you feel that you are leaking, and the fluid is not urine or discharge.
After the discharge of the amniotic fluid, there will often be contractions as well. Some, however, will not have these contractions until many hours later. If the amniotic fluid is discharged but you have no contractions, you must contact the hospital.
Read more about the leaking of the amniotic fluid at helsenorge.no (Norwegian)
- Blood mixed with discharge is often a sign that labour has started. As the orifice of the uterus/cervix opens, there will always be traces of blood, blood-mixed discharge, or moderate bleeding.
- If you are bleeding a lot, you must always contact the hospital.
Induction of labour
The purposes of all obstetric aid/midwifery, is to contribute to a natural birth. The spontaneous start of the birth between the 37th and 42nd week of the pregnancy in a healthy mother following an uncomplicated pregnancy is the best thing for the mother and the child. But this is not the case for everybody. There may be factors both with the mother and the child, or with both, that make induction of labour the best option.
Induction of labour is always based on a thorough assessment and is only done when this is considered the best treatment for the mother and/or the child.
Contact with the maternity ward at the hospital
You should talk with the doctor/midwife during pregnancy check-ups regarding who, where and how to make contact when labour starts. You must always call the maternity ward and notify them that the labour has started.
Admission to the maternity ward
Many hospitals have a separate admission telephone for expectant mothers that is answered by a midwife. They will give you advice and together with you plan the next steps. You should notice that such admission telephones should only be used for acute problems and that this service cannot be used for general counselling in connection with pregnancy and childbirth. For more general counselling, a midwife, general practitioner or possibly a casualty clinic may be contacted.
Are you uncertain as to whether everything is well with the child?
When the birth approaches and the space in the uterus is more restricted, you may feel kicks and movements that are different from previously during the pregnancy. The child, however, is moving all the time except for the short periods when it sleeps and therefore you will feel movements throughout the day. It is important that you notice your child’s pattern of movement.
If you are uncertain as to whether the child is well since you do not feel the usual kicks and movements, you should contact your general practitioner or midwife.
If a situation that makes you particularly uneasy arises, and you are not able to get in touch with the general practitioner or the midwife, or if this occurs during a weekend, in the night or during a holiday, you must contact the maternity ward directly.
Aggravation of the condition and the symptoms
If you have been in contact with a doctor, midwife or the maternity ward and your condition changes, you must contact them again.
If you have a disease or if a complication has arisen during the pregnancy, you must contact the doctor, midwife or the maternity ward in case of an aggravation, or if new symptoms that may be related to this occur.
What must I bring with me to the hospital?
Always bring the following:
- Health card for pregnant women
- Blood test results - Rhesus test result
- The ultrasound description
- Other test or examination results
- Other documents related to this or previous pregnancies or childbirths
- Regular medicines - if you take medicines, you should bring these to the maternity ward. You must always inform about any use of medicines.
Besides, it is a good idea to bring:
- Toilet articles
- Breastfeeding bra
- Several spare panties
- Loose and comfortable clothing for yourself that can easily be taken off and on, for the time after the birth
- Dressing gown and/or jogging suit
- Warm socks
- House shoes
- A baby carrier shawl or tube to carry the baby
- A package of large sanitary towels (from the pharmacy)
- A cap for the child
- A few sets of clothing for the child
- A blanket for the child
We want you to bring a cap that the child can wear after the birth. It is placed on the child’s head right after the birth, so as to prevent the baby from losing warmth from its head (wet hair). We recommend that during the first period after the birth the child lie skin to skin, without any clothes, with its mother. Provided that the mother is well and awake the child should lie like that with its mother, but also with the father/person accompanying the mother if the mother is not able to – or does not want – to have the child skin to skin on her chest.
Lying skin-to-skin with the mother is also important to get started with the breastfeeding. If you are well and up walking around the ward, we recommend that you carry the child close to your body. We have tubes that you may borrow, but if you have a private baby carrier shawl, we want you to bring that.
When you are going to dress the child for the first time, you may very well use its own clothes. It is our experience that most mothers have brought some clothes from home that the look forward to dressing the child in. The same applies to blankets. Many mothers think it is nice to dress the child in clothes they have selected themselves. You may also wear your own clothes as soon as you arrive in the maternity ward. The most important thing is to wear comfortable clothes that you feel well wearing that and make it easy to start breastfeeding.
You will be given a bag with a hospital shirt, towels, napkins, sanitary towels and washcloths when you and the child move to the room where you will be staying after the birth. If you need more of anything, please let us know and we will take care of it.
Other things you may bring
Music may have a relaxing, calming, and pain-alleviating effect. If you like listening to music, it may be a good idea to listen to some music during the birth.
Camera/video camera. You decide whether photos are going to be taken or films recorded during the birth, and what is to be photographed or filmed. We recommend that you determine this before you arrive and that it is agreed with the person who will be present during the birth.
Wish letter. Good communication between you, the person who accompanies you and the hospital staff during the birth is important. To give you the best possible help, it is important that your wishes, thoughts and questions related to giving birth are communicated to those who are going to help you. Some find it helpful to write this down before being admitted.
What happens when you arrive at the ward?
When you arrive at the maternity ward, the reason for coming will determine what examinations, follow-up and treatment are relevant for you. The examinations here will be in the form of an extended maternity check-up by which we check the following:
- Your stomach to find the bodily posture of the child, how big the child is -and to check contractions
- Foetal sound
- Amniotic fluid (if leaked)
- Vaginal examination to feel how far down the pelvis the child has moved, and whether the contractions have made the cervix/orifice of the uterus open.
- Blood pressure
- A urine specimen if relevant
- Pulse and temperature
If you have had constipation troubles during the period before the childbirth, you may be offered to empty your bowel (enema). In addition to this, the midwife or doctor will requisition additional examinations if this turns out to be necessary, for instance ultrasound, X-ray and blood tests. Based on what you tell us, how you feel and the examinations that are carried out, we will plan the further follow-up.
What happens during the birth?
The way women experience childbirth, its start and course, is very individual. This also applies to a woman from the first time she gives birth to the second time. When labour has started, the contractions cause changes to the cervix, which starts moving to the side to give the child room to pass through the birth canal.
The birth canal consists of the following:
- The pelvis – the bony part of the birth canal
- The musculature of the pelvis
- The vagina – the soft part of the birth canal
The pelvis has the shape of a funnel with different size at the different levels of the pelvis. This implies that the child has to make some turns and rotations during the birth in order to adapt and pass through the pelvis.
Monitoring of the child during the birth
The most important information the midwife gets concerning the situation of the child during the birth comes from the child’s heartbeats/pulse. The midwife, therefore, will listen to and count the heartbeats throughout the labour.
The different stages of childbirth
Childbirth is divided into three stages with opening stage, expulsive stage and placental stage. The opening stage is the longest period, whereas the expulsion period lasts for 30 – 60 minutes. The placental stage lasts from a few minutes up to an hour.
Several factors affect the time a childbirth takes:
Whether you have given birth previously or not. The first birth usually takes the longest.
- The frequency and effectiveness of your contractions may affect the labour a great deal.
- Regular and effective contractions are crucial to the progress of the birth process; the child is forced downwards in the pelvis and cervix/the orifice of uterus opens. For first-time mothers the birth lasts from 4 to 16 hours. For mothers who have given birth more than once, it will usually last from 2 to 11 hours. This may vary from woman to woman and from birth to birth.
Childbirth – the opening stage
The first stage of labour is called the opening stage. At this stage the cervix/orifice of the uterus will move to the side and to give room for the child to pass down to the vagina and be born.
The opening of the cervix/orifice of the uterus passes from being closed to an opening of 10 cm (full opening). Not until the cervix/orifice of the uterus is fully open can the child be born.
As the orifice of the uterus gradually opens, there will be some discharge mixed with blood, so-called sign bleeding. This is a sign that the orifice of the uterus is affected by the contractions and the pressure from the head of the child. The amniotic fluid may leak during all the stages of the birth. As a rule, however, this happens during the active phase of the first stage.
The latent phase – the first part of the opening stage, is the longest phase of the birth. This phase starts from the time when you have regular contractions with intervals of less than 10 minutes. The contractions usually start with a long interval between each contraction. They will gradually increase in strength and occur with shorter intervals. When the orifice of the uterus has opened about 4 – 5 centimetres, the birth passes into the active phase. The contractions become more effective, and the orifice of the uterus opens more quickly.
The midwife will check the progress of the birth process by feeling your stomach to find out how the contractions work. Through a vaginal examination the midwife will check how big the opening of the orifice of the uterus is and how the child is placed in the birth canal. It is not unusual that such examinations are performed several times during the birth process and you will be informed about this as the birth progresses. You will also be informed about the development and progress of the labour.
Activity and rest during the birth (VIDEO)
During the first stage of the birth, it is important that the mother alternates between activity and rest. Movement and activity will help the child to rotate and pass through the pelvis. Most women also find the contractions to be less painful if they carry out some activity rather than lying still in bed. The midwife will help you to alternate between good resting positions and activities.
One of our most important tasks during the opening stage is help you find positions that will help your child to move downwards in the pelvis/birth canal. During this phase of the birth, we want you to use the gravitational force and move at the same time as your body is relaxed.
Watch video – various positions for rest and activity (Norwegian):
The labour process requires much energy. Therefore, you should supply energy to your body through drinking and light meals. You will be offered food and drink.
Birth – the expulsion stage
Each contraction is now used to force the child out. In combination with the force of the contractions, you will force the child, contraction by contraction down into the vagina and out. You will have to find labour positions that enable to push when you have a contraction and rest between the contractions. It is usually favourable to vary between different labour positions at this stage. It may help the child to rotate and force its way downwards in the pelvis. The midwife will help you find labour positions that feel good and are favourable for the progress of the birth.
The midwife will tell you how you should push as the child’s head and body are born. You and the midwife then will have to cooperate to make the actual birth take place as gently as possible for the child, and to protect your tissue and prevent tears. The midwife will support the tissue between the vagina and the anus (perineum) when the child’s head and body are born.
Birth positions (VIDEO)
In the video below we show several different birth positions in addition to explaining why they may be good (Norwegian):
The midwife will guide you as to how you should push when the child’s head is born. You and the midwife then will have to cooperate to make the actual birth take place as gently as possible for the child, and to protect your tissue and prevent tears.
Labour pains are caused by the contraction of the uterus, which is a large muscle, which results in stretching and pressure on muscles, tendons, and nerves. The pains change both in strength, duration, and localization during the labour. In the beginning, the interval between each contraction is usually a few minutes, whereas towards the end of the labour the contractions are more frequent and more painful. In most cases there will be periods without pains when you may take a breath and recharge for the next contraction.
When the child passes through the birth canal, it will exert pressure against tissue and nerves. Towards the end of the labour, the pressure from the child will lead to pressure and engorgement in the vagina and the rectum, and this will trigger a strong urge to press.
Women experience labour pains in very different ways. Each woman faces labour with her own background, previous experiences, and cultural background, which may be of importance to the way the birth and labour pains are experienced.
The offer of pain alleviation may vary and not all maternity wards are able to offer all forms of pain alleviation. Here, you will find information about different alternatives. You should talk to the midwife/doctor during maternity check-ups to find out what is offered at the ward where you are going to give birth.
Information about different forms of pain alleviation (helsenorge.no) (Norwegian)
Non-medication pain alleviation during labour
The body has its own pain-alleviating system. When you are in pain, the body will start producing several different pain-alleviating substances that resemble morphine – these are called endorphins. As the intensity and frequency of the contractions increase, there is also an increase in the body’s production of endorphins. Beside the alleviation obtained through the endorphins, other non-medication pain-alleviating measures may have a good effect.
Breathing and relaxation
As a reflex many people will tighten their muscles and hold their breath when feeling pains and discomfort. However, if one is tense and one’s breath is shallow and strained, this will intensify the experience of pain. In other words, the right breathing technique and relaxation are important during labour.
If you are very tense and your breathing is shallow, the midwife will help you to use breathing and relaxation techniques. It is easier to accomplish this if you have «practiced» a little in advance. The midwife will be able to provide advice and guidance on this during pregnancy check-ups. In a number of birth-preparation courses there is a strong focus on breathing and relaxation techniques that can be used during labour.
Movement and rest (VIDEO)
It is important to find a balance between movement and rest during labour. Lying passively in bed is not favourable neither for the labour process nor for the way the experience of pain will be. If there are no reasons causing you not to move or stand upright, the best thing is to alternate between standing upright, moving and taking breaks in a chair or bed.
The video shows positions and activities that help the child to move downwards in the pelvis. It may also help you to tackle the contractions, breathe and find good positions for relaxation and rest (Norwegian):
For many, massage on the painful area has a good pain-alleviating effect. The effect is dual – alleviation and diversion, also called «grindteorien». In short, pain signals may be blocked or diverted through contact and massage, which means that you will feel less pain. Massage can be performed in different ways – from light stroking, deep rubbing to continuous pressure. It is important to inform about how you prefer the massage.
Hot/cold packs and hot baths
Some women find that a hot-water bottle or cold packs on the painful area, or a shower or a bath has a relaxing and pain-alleviating effect. Many feel a good effect by lowering themselves into a bathtub filled with water. The hot water and the buoyancy caused by the water give many women the pain-alleviation they need.
Sterile water injections
Sterile water injections are particularly effective against backache. These injections are harmless and may be repeated several times during the labour process. The midwife injects sterile water just under the skin in the area where you feel pain. In the spots where the injections are made there will be a stinging pain lasting for about 20 seconds. Afterwards, most will find that the pain is strongly reduced. The time of effect of this treatment varies from woman to woman and may be brief or last for several hours.
Acupuncture needles are placed in different places on the body to alleviate pain and contribute to relaxation. Not all maternity wards offer acupuncture. This treatment is given by the midwife or by a doctor with additional education in acupuncture, which means that one is dependent on a midwife/doctor with this additional education being on duty.
Medication pain alleviation during labour
In some cases, the labour pains may be so intense that the woman needs or wants medication pain alleviation. There may also be medical reasons for such treatment:
- Expectant mothers with preeclampsia
- Illness with the mother or cases where it is expected that the birth process must be finished by a Caesarean, forceps, or vacuum.
The use of medication pain alleviation and the choice of alleviation method must always be based on the situation of the mother and the child, where in the birth process the woman is and availability.
Regional anaesthetization (epidural or labour spinal anaesthesia) is used in connection with about one third of births in Norway and is offered at most maternity wards. An epidural is always administered by an anaesthetist who will ask you whether you have diseases or allergies that may affect the possibility of having an epidural or not.
If you have an
infection in the area where the anaesthesia is to be given, this will often mean that you should not have this anaesthesia.
On the whole
tattoos in the area are not a problem, but the skin must be healthy and the tattoo so old that the skin has had time to heal completely and is healthy. We try to prick into skin that is not tattooed, or a small cut may be made during the local anaesthetic in the tattooed skin. If there is any doubt, the anaesthetist will assess and decide in each case.
If you take
blood-thinning medicines or have
bleeding troubles, this may prevent you from having an epidural.
An epidural rarely causes serious complications, but the anaesthetic may result in weaker contractions and slow down the progress of the labour process. A few mothers experience headaches after the birth and some have a temporarily reduced nerve function in their legs after an epidural. Lasting changes are otherwise very rare.
Ideally, the contractions should be well established before an epidural is administered, which means that the contractions are regular, are increasing in strength and intensity and that the cervix/orifice of the uterus has started to open.
The midwife will examine how far the labour has come before a decision of administering an epidural is taken, or whether some other pain alleviation should be offered waiting for the epidural. During labour it is important that you can recognize the contractions and when to push the child out. An epidural, therefore, must not remove the pain altogether, but alleviate it and make it less intense.
It is important that you and the anaesthetist cooperate when the epidural catheter is inserted. The doctor will inform you during the process about how to sit and lie, and it is important that you follow the instructions given to you and manage to be still when the catheter is put in place.
Side effects of an epidural
An epidural is a safe method of pain alleviation during labour, and we rarely see any serious complications. The side effects that may arise are as follows:
- A fall in blood pressure (very rarely in connection with the use of an epidural during labour). The blood pressure is checked and if it falls, adequate measures will be taken.
- The use of an epidural may cause you to lose some of the bladder control and therefore it may be difficult to feel that you need to go to the toilet.
- The contractions may decline or disappear during a certain period. If this happens, we will administer a contraction-stimulating medicine via the peripheral venous catheter on your hand.
- Itching – for some, an epidural causes itching of the skin, but it is rarely a big nuisance.
- A headache may occur after the birth.
During the final phase of the labour, when the child is so far down in the birth canal that it causes pressure and engorgement against the vagina and the rectum in addition to an intense urge to push, pudendal anaesthesia may provide good pain alleviation. The nervus pudendus that sends nerve fibres to the vagina and the bottom of the pelvis are numbed.
The midwife/doctor administers the local anaesthetic at two points in the vagina, and you will feel a sting and a temporary shiver in the area where the anaesthetic has been administered. The anaesthetic reduces the feeling of engorgement and pushure, but does not completely remove the urge to push the child out. This may be a good alternative to an epidural in connection with quick births, in case the labour must be finished by means of forceps or vacuum, or if there are tears that must be stitched in the birth canal.
If stitching is required after the birth, local anaesthetic will be given.
Some maternity wards offer nitrous oxide. This is a gas with no taste or smell that has a pain-alleviating, sleep-inducing and “intoxicating effect”. You breathe in the gas through a mask held over your mouth and nose. The gas is only used during contractions. Between contractions you will breathe as usual. The effect of the gas is limited to the time the mask is used and declines rapidly when the mask is removed and you breathe as usual.
Birth by means of vacuum or forceps
Situations may arise during the expulsion stage of the labour requiring that the doctor must help you get the child out by means of vacuum, a pair of forceps or a Caesarean.
When must vacuum or a pair of forceps be used?
The following are the most usual causes for using forceps or vacuum:
After having examined you, the doctor will determine what delivery method is the best for you and your child.
- The child. Situations may arise that require that the child be helped to come out more quickly than by your own pressure:
- If the child shows any signs of stress or if there is a suspicion that the supply of oxygen to the child is not optimal.
- It the child has positioned itself unfavourably in the birth canal that leads to a halt in the birth process, or the child neds help to get out through the birth canal.
- The mother. Situations may arise requiring that you need assistance to push the child out, as in connection with:
- Illness, for instance heart disease, high blood pressure, preeclampsia, and a prolonged expulsion period – a long pressure period.
What is vacuum?
Also called suction cup or cup. This is a metal or rubber cup that is attached to the child’s head by means of vacuum/negative pressure. The doctor may then help you to pull the child downwards in the birth canal at the same time as you press.
After birth the child will often have a mark and swelling of the skin in the place of the head where the vacuum was attached. The swelling will subside quickly, but some children may also have a bruise that will disappear gradually in a few days.
What is forceps?
Also called obstetric forceps. A pair of forceps consists of two identical arms/branches formed to fit the head of the child. The forceps branches fit around the child’s head without squeezing it. When the pair of forceps has been attached, the doctor will draw the child downwards through the birth canal at the same time as you push. There are different types of obstetric forceps. Forceps are also used in connection with breech births to help the child’s head out. After a birth by means of forceps, there will often be red marks on the skin of the child’s cheeks. These will quickly disappear after the birth.
Sometimes we do not succeed to deliver the child, even if we use vacuum or forceps. Then a Caesarean will be performed.
Birth, twins/multiple births
If you are pregnant with twins/triplets, etc., you should give birth to your children in a maternity ward where an obstetrician, an aestheticist and a paediatrician are available at all hours.
Information about twins/multiple births
Based on the course of your pregnancy, how far advanced it is when the labour starts and the situation of you and your children at the beginning of the labour, a decision will be made as to what type of delivery, labour monitoring and obstetric aid you will need. A twin/multiple birth requires more monitoring of the labour than in the case of just one child.
A twin/multiple children pregnancy and birth entails an increased risk of complications as compared to being pregnant with only one child. It is important, therefore, that you follow up the pregnancy check-ups.
When you are pregnant with more children, there is an increased risk that the labour will start before the expected
date of delivery. If you have contractions or suspect that the amniotic fluid has started to leak, you must contact the doctor or maternity ward immediately.
When it has been planned that you are going to give birth to your children in a usual way, there will be a team of midwives, children’s nurses, gynaecologists, and paediatricians with you or near your delivery room. It the children are born in a head position, a midwife will usually deliver them, but the gynaecologist will also be present either in or close to the delivery room, ready to help if necessary.
The child who is likely to be born first, is called twin 1, and the one who seems to be coming last is called twin 2 (triplet 1-3, or quadruplet 1-4 if relevant).
When twin 1 has been born, the focus will be on twin 2. After twin 1 has been born, the doctor will examine your stomach with ultrasound to find out how twin 2 moves down in the birth canal.
Twin 2 has now gained ample space in the uterus. To avoid that the child turns into an unfavourable position, the midwife/doctor may take a grip around twin 2/your stomach to prevent the child from turning. This grip is not released until the child’s head or seat has started to move into the birth canal and it is not possible for the child to turn.
Twin 2 is usually born quite quickly after the birth of twin 1. The contractions, however, may subside or stop after the birth of twin 1. The birth may then stop for a little and therefore we always have a contraction-stimulating drip ready.
If you are pregnant with more than two children, there is a greater risk that the pregnancy and birth will not progress completely as normal. Your general practitioner or midwife at the public health centre will therefore refer you to a gynaecologist or a policlinic for pregnant women at the hospital, if it is suspected or if it has been confirmed that you are pregnant with more than two children.
Together with you gynaecologist will plan for the pregnancy check-ups and the birth. The birth should take place at a maternity ward with high preparedness where a gynaecologist, paediatrician, and an aestheticist/operating staff are available at all hours. When you expect triplets or more children, a Caesarean is most often considered the best and safest way to deliver the children.
There is an increased risk that a twin birth will be finished by a caesarean or by means of forceps or vacuum as compared to giving birth to only one child. We therefore recommend that you have an epidural anaesthetic when the labour has started.
If a situation arises that makes it necessary to deliver one child or both children by means of forceps, vacuum or a Caesarean, a gynaecologist, paediatrician, and an aestheticist/operating staff will be available and ready to act.
After the birth
The time after the birth is an important period for you, the children, and the family. This period should be used to get to know the two new members of the family and learn how to take care of the children and feed them. Most mothers of twins stay in the maternity ward for a few days after the birth – until the mother feels safe about care and feeding and the children show signs of well-being and growth.
Twins are often born before the expected date of birth and therefore need extra follow-up during the period after birth. If the labour starts early in the pregnancy/premature birth, or if the children need extra follow-up/monitoring, or the birth weight is low, or if the children do not take sufficient food, the children must be moved to the postnatal ward.
Breastfeeding twins often requires some extra effort, particularly in the beginning. For some mothers of twins, it will take some time to get the production of milk and the breastfeeding started.
Since twins are often born before the expected date of birth and are smaller than children from pregnancies with one child, it may be particularly important that the children get breast milk. Therefore, you should use time and strength in the first period after birth to get the production of milk and breastfeeding started.
If the children are healthy and have strength to breastfeed, they are placed at the breast for every meal. In addition, they are given a breast-milk substitute after the breastfeeding if and as long as they need it. Not all mothers are able to fully breastfeed both children. However, all the mother’s milk the children can have, is important.
We work continuously to prevent and reduce the number of tears. Consequently, we are very preoccupied with how to protect and support the area between the vaginal opening and the anus (perineum) when the child is being born. A severe vaginal tear (a so-called sphincter rupture degree 3 and 4) is defined as a tear where parts or the whole of the sphincter muscle around the rectum is damaged.
Prevention of tears
By reducing the speed when the head comes out during the birth, we may contribute to prevent tears. This applies both to normal, spontaneous births and to cases where we have use forceps and/or vacuum during the birth.
The midwife/doctor will ask you not to push actively when the child’s head is born. We shall do everything we can to help you avoid tears during the birth. Women whose child is delivered by means of a pair of forceps and/or by vacuum, or who give birth to a big child, will automatically run a greater risk of severe tears than women who give birth spontaneously.
Preventing tears is very important; however, detecting tears and have these stitched is equally important!
Treatment of tears
After the birth the midwife/doctor must examine you to find out if there are any tears in the birth canal. If you have a tear after the birth that must be stitched, you will be given an anaesthetic before we stitch. The thread used will dissolve by itself in the tissue and there is no need to have it removed by health personnel.
If you have sphincter ruptures degree 3 and 4, the tear will be checked while you are in the post-natal ward before you go home. If you so wish, a physiotherapist will see you in the post-natal ward and give you training advice.
Before you go home, you will be given information as to how to treat the tear, training of damaged muscles, and when and where you should have check-ups.
The post-natal period
The great majority of women who have severe tears will have no problems later. Some, however, may experience pain, unvoluntary discharge of wind and problems of urine and stool leakage.
It is also important that you see the doctor for the six-week check-up after the birth, and that you turn up for the check-up appointment at the Maternity Hospital if such an appointment is made before you go home.
The child has been born – the afterbirth period
The child has been born. However, the birth is not yet quite over. The placenta and foetal membrane must also be born. This usually takes place shortly after the child is born or within about an hour. The placenta and foetal membranes then loosen from the wall of the uterus and fall towards the vagina. When the placenta loosens, you may fell a weak contraction and a little blood may emerge from the vagina. When the placenta has loosened from the wall of the uterus, you push it out in the same way as you did when the child was going to be born. This may be a little uncomfortable, but it is not painful.
In the place where the placenta was attached to the wall of the uterus, there will be an ulcer surface causing a menstrual-like bleeding and a usual contraction of the uterus. After the birth, the midwife also must check whether there are any tears in the birth canal. If you have a tear after the birth that must be stitched, you will be given an anaesthetic before we stitch. The thread used will dissolve by itself in the tissue and there is no need to have it removed.
As soon as the child is born, it will be given to you. After the birth the child will quickly try to find its mother’s breast. Now it is important that you, the father of the child/accompanying person and the child are given time to be together undisturbed. You now need to take a breath after the birth and the great experience. The child now needs your full attention to find the breast and its first meal. This is an important period where there should be no unnecessary disturbances. All unnecessary tasks, noise and unrest must be avoided. This also applies to the use of telephone, visits, and unnecessary activity in the delivery room.
After the birth
The length of the period mothers will stay in the post-natal ward after a birth is individual and adapted to the needs of the mother and child. After a Caesarean, the mother will usually stay for 3-4 days.
The midwife will examine the child directly after birth. During the first days after the birth a paediatrician will examine the child. One of the parents should be present during this examination. In addition to this, we perform some other examinations of all newborn children.
Newborn screening and examination
Today, all newborns in Norway are offered an examination for 26 severe congenital diseases. To find out whether your child has a congenital disease that should be treated as soon as possible, a blood sample is collected from the child’s heel as soon as possible after 48 hours after the birth.
It is also common to perform examinations for hepatitis and hip dysplasia in case of suspicion of this.
During the examination carried out by the paediatrician, you may ask questions and mention things you believe the paediatrician should be aware of. Before you go home you will receive information as to where and whom you may contact if you need guidance, advice or help after coming home.
The goal of the post-natal care unit is to organize things in such a way that the individual woman, child and family are taken care of based on their needs, resources and situation.
Read more about auditory screening and other examinations of children after birth at helsenorge.no
The post-natal period lasts from the time just after the birth until the body is back to its pre-pregnant condition and the breastfeeding is well established – the first 6–8 weeks after the birth. For women who breastfeed, it will usually take six weeks before they experience that the breastfeeding is well established.
The post-natal period is a lot about readjustment and new routines. It is an exciting and great period, but also a period that may be experienced as demanding and challenging. After a birth, there are great changes both to the body and the circumstances of life. Most are prepared for the physical changes. After the birth, however, many mothers experience mood changes, fatigue and the feeling of not being quite equal to the new situation and what is required. The experience of mastering as parents often takes some time.
Video - The mother's body:
Video - The mother's health:
Video - The baby from top to toe:
Video - About the baby:
Returning home early
If you leave the hospital early (0-2days after the birth), certain conditions may arise with the child that it is important to be aware of.
Should one of these conditions arise during the first day after the return home, you must contact the post-natal ward. If it happens later than this, you must contact the public health centre, your general practitioner or the casualty clinic.
- Most children will have slightly yellow skin the first days after birth. This is normal and usually decreases after 3-4 days.
- With some children the yellow colour may be very strong. If in addition the child is weak, have problems eating or seems irritable, you must contact health personnel.
Undiagnosed cardiac defect
- Cardiac defects occurs in 1 per cent of all newborn children and is in most cases detected through the routine examination carried out at the post-natal ward.
- Since the symptoms may be diffuse, some cardiac defects may be difficult to detect in the first examination. If the child’s behaviour is different from its usual behaviour, or if the child reacts differently, health personnel must be contacted.
- The first days or weeks after birth, the child may develop severe infections that need to be treated quickly. The symptoms may be diffuse, but if the child’s behaviour is different from is usual behaviour, or if the child reacts differently, health personnel must be contacted.
Good advice for the mother
To make the post-natal period a good period for you who have given birth and for the family, it is important that as a newly fledged mother you take good care of yourself. It is a good investment for the family to organize things in such a way that the newly fledged mother is given time and opportunities to care for herself, as well as opportunities for rest and quiet and relief from everyday chores.
The post-natal period is "a period of getting to know each other", and the newborn is completely dependent on care. The child communicates with its parents by means of sounds, looks, crying and movements. To acquaint themselves with all these signals given by the child, parents must spend much time with the child and keep close physical contact with it.
Holding the child skin to skin during feeding increases the ties between the parents and the child. This also applies to bottle-feeding in case you cannot or do not want to breastfeed.
The parents’ calm, closeness to the child and a focus on the child’s signals as regards hunger are important factors to strengthen a good start of breastfeeding and interaction. Using a baby carrier top or a shawl might be a good idea.
Post-natal women and their partners are often preoccupied with questions related to nutrition/breastfeeding of the child. It is also important, however, to make sure that you yourself have regular meals and enough drink.
To get the milk production going and maintain it, your body is dependent on food and drink. You do not need large amounts of extra food, but you should take care to eat regularly, that the food is healthy, and that you get enough drink.
After the birth, many post-natal women are given different dietary advice. Some experience that the child’s stomach is upset by certain types of food, whereas others may eat all types of food without any reaction by the child. You and your child must make your own experiences. You should be conscious about what you eat and drink; if the child’s stomach is upset every time you have one special type of food, you may avoid or reduce the intake if this type of food.
If you or your close family have diseases or allergies related to food/diet/gastrointestinal diseases, you should consult the midwife, public health nurse or the doctor before the birth or during the post-natal period. Then you will receive advice and guidance adapted to you and your child.
Many newly fledged mothers are concerned about breastfeeding. At helsenorge.no an introduction to starting breastfeeding, as well as some advice on breastfeeding that may be useful during the first period after the child has been born, is available.
Read more about breastfeeding and the start of breastfeeding at helsenorge.no
As a newly fledged mother, you will soon find out that your circadian rhythm is now dependent on another person. Perhaps the child will rather sleep during the day and stay awake during the night, particularly in the beginning.
Then it may be a good idea to think differently and rather sleep during the day simultaneously with the child. We recommend that you give priority to sleeping well and sufficiently rather than doing housework, for instance. That can wait. Perhaps family or friends may borrow the baby’s siblings for a while to enable you as parents to have some extra sleep?
Fresh bleeding is normal during the first days after the birth. This bleeding is called «purification». The bleeding is at its strongest just after the birth and will then decrease. The bleeding may be experienced as stronger particularly in the morning after you have been lying in bed for some time. The reason for this is that the blood that has accumulated in the uterus while you were lying, will be discharged more easily when you stand up or move.
If you are uncertain of whether you bleed more than what is normal, you should talk to the midwife or doctor. The bleeding is supposed to decline gradually and in a few days it should be noticeably reduced. The bleeding will gradually become browner in colour and then it will resemble discharge with a brownish colour.
The duration of the purification is individual but in most cases it stops during the first six weeks. It is common to have a new, small fresh bleeding ten to twelve days after the birth. This will usually last for two days, in some cases a little longer. This bleeding arises from the area where the placenta was attached to the uterus. Here a scab has been formed, that is now falling off, causing this fresh bleeding.
The purification contains a lot of bacteria and therefore you should be very careful with hygiene. Change sanitary towels frequently during the first period, take daily showers, or wash the lower parts a couple of times every day during the first days after the birth. You should avoid a «strong» shower jet against the vaginal area if you have had any stitching here. Always wash your hands thoroughly after visits to the toilet and when you have changed sanitary towels. The newborn is very susceptible to infections. We recommend that you refrain from tub baths or bathing in public pools as long as the purification is going on.
If the purification becomes smelly, you should contact the midwife/doctor. Normally, the purification will have the same smell as a menstrual bleeding towards the end of a menstruation.
You should contact a doctor if:
- Bleeding is not reduced or if it increases
- If the bleeding starts smelling strongly - «stinking» purification
- If you have a temperature or stomach pains
Stitches – birth tears
If you have a tear or episiotomy (surgical incision of the perineum) in connection with the birth, this might be painful during the first period after the birth. The discomfort will be strongest during the first few days; it is not, however, unusual to feel some discomfort for a few weeks after the birth. During the first period one has to take the stitching in the vaginal area into consideration and relieve the area through rest. One should lie down rather than sit.
If the pains in the wound do not decrease or if they increase, you must contact the doctor/midwife. They will have a look at the stitches and the wound to ascertain whether you for instance have an infection. If so, you will be treated for this.
Usually, a dry and clean wound will heal without any problem. It is important, therefore, to keep the wound dry and clean, which may be difficult if there is also a bleeding. We recommend daily showers during the post-natal period. A couple of times every day you may use a pot of lukewarm water (and perhaps add some feminine washing soap), and rinse while you sit on the toilet. When you wash in the lower parts, you should use a soft and clean cloth moving it lightly from the front and backwards. Dry well.
In case of pains, you may take painkilling pills. You should consult the midwife before leaving the hospital as to what painkillers you may use.
You should also talk to the midwife at the ward before you go home about how to tend the wound. You will be given advice and guidance adapted to you and your situation. It may be a good idea to have look at the stitches yourself, together with the midwife, before you leave the hospital. Then you know how the wound looks and may see whether it is healing or changing.
The post-natal period is a period of great upheavals and changes – both bodily and as regards the situation of life. Parents and child are to get to know each other, and a great deal of new learning and decisions are required. This may lead to both tiredness and fatigue, and it is not unusual to feel very vulnerable in this period. Tears come easily and it does not take much to get angry, sad, and upset. These are quite normal changes in mood that the father/partner, is not used to. It is important that the father/partner understands that this is a period where the post-natal woman feels vulnerable, and that he gives care, support, and assistance. Many women will benefit from talking to someone who is close and in whom they have confidence.
It may be that the rejoicing feeling of happiness and the motherly/fatherly love that you expected as soon as the child was born, is long in coming. Many will need some time to digest the experiences before the joy of having a child arrives. This is common and not unnormal.
If you feel very sad and depressed, and have many negative thoughts, you should talk to the doctor, midwife, or public health nurse about this. Depressions after a pregnancy may occur and many mothers need help to deal with them.
Some women also develop a psychosis after the birth including loss of their perception of reality, extreme uneasiness, and confusion. This is a severe condition that the post-natal woman is not able to describe herself. In such cases, next of kin must immediately get medical help for the woman
Towards the end of the post-natal period, within 8 weeks after the birth, we recommend that you have a post-birth check-up. This check-up is voluntary and you have to make an appointment with your doctor or midwife yourself.
During this check-up the doctor/midwife will want to know if you have any special troubles or questions after the birth and post-natal period and ascertain that your uterus is back to its pre-pregnancy condition, that the purification is normal, the breastfeeding status and your situation in general.
Cohabitation and contraception is a natural topic during this consultation and you may talk to the doctor/midwife if you want to start with contraception.
Intercourse after the birth
When to have intercourse after a birth is quite individual. Breastfeeding and the hormonal status after the birth may make the mucous membranes of the vagina drier than usual. If in addition you have had a tear, intercourse during the first weeks after the birth may be uncomfortable. A lubricant may be quite helpful during this phase.
It is also common that the desire for sex is a little slow in coming after a birth. This applies both to the woman and the man. You should wait until you are ready and feel desire. Remember that you may get pregnant even if you are breastfeeding, and if you do not want a new pregnancy, you should use contraception.
Home from the post-natal ward - whom can we talk to then?
When you and your child go home from the ward, a message is sent to the public health centre in your area notifying them that you have had a child. Shortly after that (usually within one week) the public health nurse will contact you to agree on further follow-up and checks of he child.
The public health nurse of the public health centre will follow up the child throughout childhood, offer vaccinations, follow the child’s development and help and support you as parents/guardians.
It is also common that the public health nurse visits you at home for the first check-up of the infant. An appointment for this can be made when the public health nurse/midwife contacts you.
If you have not been contacted by the public health centre within a week after coming home, you must call the health centre yourself for an appointment for further follow-up.
Care and bathing of the newborn
Wash the child with lukewarm water at about 37 degrees. You may use a soft cloth or just your hands. The child does not need a bath every day and a good alternative is a daily, thorough body wash.
Preparations for the bath
- The temperature in the room must be comfortable so that child won’t feel cold when it gets out of the water.
- Find all the equipment you need in advance: clothes, nappies, towel etc.
- Never leave the child on the bathinette. If you have forgotten something, you must take the child with you to fetch it. Alternatively, you may also place the child in a towel on the floor.
- Wash off any stools before starting the bath.
- Start by washing your own hands. Find the right working position for yourself.
- Fill the child’s bathtub with suitably warm water, about 37 degrees. Check whether the water has a comfortable temperature with your forearm.
How to hold a baby during bathing - watch video
Let the child’s shoulder/neck rest on your left forearm and hold with a firm grip like this:
- Your thumb, index finger and middle finger around the left upper arm of the child.
- Place your right hand under the child’s bottom and lower it carefully into the water up to its neck.
- Hold the child firmly with your left hand throughout the bath and wash with your right hand, or with a soft cloth.
- If the child slides on your forearm during the bath, you must hold it in a firmer grip.
How to give a baby a bath - watch video
- Start from the top by washing the child’s face with a soft cloth. Avoid water running into the child’s eyes. Then wash the child’s hair with a few drops of shampoo without perfume. Rinse carefully with your hand.
- You do not have to turn the child around – wash with your hand or a soft cloth from the top and downwards. Remember to wash all the folds of the skin, under the chin, behind the ear, under the arms and in the groin.
- Place your right hand under the child’s bottom again and lift it out of the water. Place the child safely on the towel on the bathinette or on the floor.
- Dry carefully with a soft towel or cloth nappy. Remember all the folds. Dry any old foetal fat evenly out; do not leave any lumps of fat on the child’s body. Any dry blood can be carefully washed off with cotton wads. Check all the folds of the skin with a dry hand.
- The navel must be air-dried before you dress the child.
- Remember that practice makes perfect and that the child likes your caring hands!
Newborn children from top to toe
In the hospital you will get help from children’s nurses, midwives, and doctors. After you come home, you and your child will be followed up by the public health nurse, the municipal midwife and your general practitioner.
Safe sleep for babies
It is safest for the newborn child to sleep on it's back.
Read more about safe sleep for babiea (PDF)
The newborn’s eyes
It is common that the child’s eyelids are swollen the first few days, and there may be some secretion or tears. This can be washed off with lukewarm boiled water or eye-rinsing water.
Use a wet cotton wad and dry from the outer end of the eye towards the corner of the eye – or from the cleanest end towards the end where there is secretion.
If there are no signs of improvement, a bacterial sample must be taken to find out if it is caused by an infection that requires treatment by antibiotics. You must contact a doctor who will assess whether treatment is necessary.
The newborn’s ears
Just after birth, a certain amount of fur is found in the child’s ears. You will see some whitish fur which is a residue of the layer of fat that protects the child’s skin during the pregnancy. There may also be residues of blood from the birth.
Only the utmost part of the child’s ears must be dried. Do not wash the child’s ears, only dry the utmost part of the ear.
Newborn children sneeze a lot. This is not a sign of a cold or illness. The child sneezes to clean up its somewhat narrow nasal canals.
Some children belch, whereas others do not. Children have varying «belching habits». It may be a good habit to allow the child to belch after meals. The air will usually come out after a few minutes but remember that not all children need to belch.
If your child is restless, it may be easier for it to belch if you hold it close to you with its head resting on your shoulder. Support the child’s back and head and stroke its back lightly.
Some children have a lot of hiccups and often follow the same «hiccup pattern» as during the pregnancy. This is quite normal, and it is not dangerous or a sign of illness. Hold your child to your breast to give it some mother’s milk. This may help stop the hiccups.
Thrush appears as a white layer on the child’s tongue and/or on the inside of the cheeks. Usually, thrush is a yeast infection in newborns. It usually disappears by itself without other symptoms than the white layer.
If your child has a great deal of thrush, and always if in addition it resists taking the breast/food, you should consult the midwife, public health nurse or the doctor.
Thrush may infect your nipple and make breastfeeding painful. It is not dangerous but requires treatment by antifungal medicine. If you see that your child has thrush and breastfeeding is painful, you must see your doctor for treatment.
Read more about thrush at ammehjelpen.no (Norwegian)
The child’s nails are often long and sharp and enables the child to scratch its own face. The nails of newborns must not be cut since you may easily cut into the skin under the nails. The nails are very soft and often a little chippy at the outer edge. Take a careful grip at the outer edge and see if it is possible rip off a bit. You may also put thin cotton gloves or a baby sock on the child’s hands to prevent it from scratching itself.
Urine and excrements
The child’s first excrement is black and is called «meconium». It is sticky and has no smell since the child’s intestines are still sterile. As the child gradually gets milk, the normal intestine flora will be established. After a few days, the excrement will change colour from black to greenish brown, after which it will be granular and mustard yellow and often very liquid when the milk production has started.
If the child is given a substitute for mother’s milk, the establishment of the excrement pattern may take shorter.
The change-over from the uterus, where «the food» came through the umbilical cord, to the child eating by itself, is great. The child must learn to eat, and the digestive system must get used to receiving and digesting the milk. This may give the child a somewhat upset stomach during the first days and is not a sign of beginning colic or illness.
After 4-7 days the child should have 4-6 pee diapers and excrements daily. This indicates that your child gets enough milk. Breastfed children often have fewer «poop diapers» than children who are given a mother’s milk substitute in the beginning. If the child’s weight increases normally, there is no need to worry about its intake of food.
Orange/red stains in the child’s diaper during the first days after birth is normal. This is urate (calcium hydrate sediments) secreted through the kidneys, which causes the orange/red colour. This is quite normal and not a sign of illness in the child. As the milk production gradually gets started and the flow through the child’s kidneys increases, traces of urate in the nappy will disappear.
Read more about the childs excrementa at ammehjelpen.no (Norwegian)
Discharge among newborns
Infant girls will often have a whitish discharge with some red in it. This is caused by hormonal influence from the mother and is often called «mini menstruation». It is not dangerous and will disappear gradually by itself. There may also be long mucus threads from the vagina which will dry up and dissolve by themselves.
Many parents are concerned about the newborn’s umbilical stump. How is it to be tended? The part of the umbilical cord left on the umbilical cuff (the area of the skin to which the umbilical cord is attached) will fall off during three to ten days. After a few days the umbilical stump will emit a somewhat insipid smell, which indicates that the normal process has started.
Keep the child’s umbilical stump dry and clean. It is common that a little blood plasma may leak out if for instance the nappy has been rubbing against the area around the navel. This is not dangerous, but it is important to dry it off to avoid irritation of the skin around it. If the skin around the stump becomes red, hot and there is more fluid than this, you should contact the public health nurse, midwife or doctor for advice concerning care.
The child’s skin
Hands and feet
The first days after the birth, infants’ hands and feet often have a slightly bluish colour. This is due to a somewhat poorer blood circulation in the parts of the body most remote from the heart.
Then warm socks may be good for the child. To find out whether the child is as warm as it should be, you can feel its neck. A child who is too warm often has a red face and is irritable.
The small whitish nodules in the child’s face, particularly on the nose, are called milia. These nodules are enlarged sebaceous glands and are quite normal. It will take a few weeks until they disappear by themselves.
Infant rash often appear as small light red specks, or somewhat larger areas, especially on the neck, chest and forearms. Often a small hard and white spot can be seen inside the speck/area. This rash appears quickly and disappears quickly. It is caused by hormonal influence from the mother.
Heat rash appears when the child is too warm. It has the form of small red nubs which will disappear when the child cools off.
Both boys and girls may have slightly swollen mammary glands after birth. This is caused by hormonal influence from the mother during pregnancy and will disappear after a few days. It may feel a little sore for the child and you should be careful when touching the area.
If your child has red marks on its eyelid, forehead or neck, we often call them salmon patches. These patches become less visible or gradually disappear, preferably within the first year of life. Sometimes they will reappear when the child exerts itself.
Birthmarks are common among newborn, and most are benevolent and harmless.