We want to help you to have as straightforward a birth as possible, as this has been shown to be better for the health and emotional well-being of mothers and babies.
Every labour and birth experience is different for each woman, baby, and birth partner.
Information including our infographics for labour and birth choice are in our patient information library.
Writing your birth preferences is a good opportunity to talk about your options with your community midwife or birth partner.
Having your baby at a birth centre
Having your baby at Tunbridge Wells Hospital
We advise packing a bag at least three weeks before your due date.
Make sure your birth partner is aware of what is in the bag ahead of time.
The NHS better start in life website has a hospital bag checklist with ideas of what to pack for you and your baby.
Early labour is often called the latent phase and is your body’s way of preparing for the arrival of your baby.
During the latent phase the opening of the womb (cervix) begins to shorten and soften (effacement). This is an important process before your cervix starts to open or dilate.
It is normal for the early stage of labour to last for a few days, especially with your first baby.
It is important you stay active and well hydrated during this time. You may need to start using some of the methods of breathing and relaxation as your contractions become more regular.
There are several signs labour might be starting, including:
During the latent phase it is best for you to stay at home in the comfort of familiar surroundings, as you are more likely to find ways to keep yourself comfortable and active.
It may be useful for you to contact the Maternity department for advice.
You should call a midwife when your contractions become regular and more intense or if you need some advice whilst at home. However you should call a midwife if you experience:
There is a midwife available 24/7 for labour advice on Maternity Triage, please do not hesitate to call on 01892 633500.
If you are planning to give birth at Maidstone Birth Centre please call 01622 220160 / 1
The NHS website has more information on early labour.
It is estimated only 4% of babies are born on their due date, with many arriving later rather than earlier.
There are many reasons why you may be advised to have your labour induced (starting labour artificially) and the risks and benefits should be fully explained to you before you agree.
Inducing labour without a good reason is not recommended as this can lead to an increased likelihood of a caesarean section, ventouse (suction cap) or forceps delivery, compared to those who go into labour naturally.
Around one in every four births at Tunbridge Wells Hospital have their labours induced for a variety of reasons. These may include;
The method used to induce your labour will depend on the reason for induction. It often takes 24-72 hours to get into active labour and this is normal.
The induction process begins on the antenatal ward, where you can have one nominated person with you to stay overnight. Bring plenty of magazines or books to keep yourself entertained, and you can use the free guest WiFi. You may also wish to bring a sleeping bag and pillow for your birth partner as we will be unable to provide this.
When it is appropriate and safe to do so, you will be transferred to Delivery Suite to continue the next stage of your induction.
You may be offered a hormone infusion drip called syntocinon to help start or progress your labour.
We offer a variety of pain relief options during the induction process.
The NHS website has information on induction of labour
Induction of labour and transfers to another hospital
Leaflets about the reasons for and statistics about induction at Tunbridge Wells Hospital, as well as the use of syntocinon are in our patient information library
* this video mentions the non-hormonal method of induction, Dilapan. We no longer use this method.
Labour usually starts naturally before 42 weeks. There is some evidence that certain risks associated with a pregnancy continuing beyond 41 weeks may increase over time, although the actual risks remain low. Induction of labour from 41 weeks may reduce these risks, and you should consider how induction of labour may affect your birth experience.
National guidance recommends you discuss your preferences early in your pregnancy and confirm these towards the end of your pregnancy.
Your midwife will offer to discuss the options at your 36 or 38 week appointment and give you information about the benefits and risks of waiting for labour to start naturally, having an induction or planning a caesarean birth.
We will respect your decision whichever option you choose. You do not have to decide immediately. Please ask questions, look at other information and take time to discuss your decision with others if you wish.
If your pregnancy is low risk and you choose to be induced, we will offer to arrange a date between 41 weeks and 41 weeks plus 6 days. You may choose to wait longer if that is your preference.
If you have any questions please speak to your community midwife.
Many of our maternity team are trained to use complementary or alternative therapies to support women in labour or during their pregnancy.
The therapies we have selected are those with good scientific evidence that they are beneficial and can also be used safely for pregnancy and/or childbirth.
The NHS website has information about pain relief in labour.
Aromatherapy and massage have been found to be beneficial in pregnancy for general relaxation, relief of stress, anxiety and tension and to ease conditions such as constipation and headache. It can also help labour progress and improves women’s satisfaction with their birth experience. It's important to remember that some oils may not be suitable for use in pregnancy or in the presence of certain medical conditions.
Aromatherapy is available in birth centres and Antenatal and Delivery Suite areas at Tunbridge Wells Hospital.
This is often used for back pain and is popular in the earlier stages of labour. Trained midwives administer injections of sterile water into the skin layers in the lower back, often feeling like a bee sting initially. This can help relieve lower back pain. This can be performed in birth centres, antenatal ward and delivery suite and can be repeated regularly.
Entonox, or gas and air, taken via a mouthpiece and breathed in. It is a very safe method of pain relief with no lasting effects. Entonox can make you feel slightly dizzy and lightheaded and some people can feel sick while using it but the effects are very short-lived. Gas and air is available at home, in birth centres and hospital and usually recommended when you are in active labour.
Pethidine is an injection into the thigh or buttock to help with the discomfort of contractions. Pethidine is an opioid drug which means that it can also make you feel drowsy or sleepy. Your midwife will discuss whether it is suitable for you when discussing your pain relief options. Pethidine passes in very small amounts through the placenta so your baby will also be slightly affected by the drug but this very rarely causes any problems. Pethidine can be used in early and active labour and is available at the birth centre and hospital.
Epidurals are only offered on the Delivery Suite, usually once you are in active labour. An epidural is the most effective form of pain relief for labour and is carried out by an anaesthetist.
A needle is put in the lower part of your back and used it to place a thin plastic tube (epidural catheter). The needle is removed and the tube left in place next to the nerves in your back. Local anaesthetic is given through the tube to provide pain relief throughout your labour. You will be given a button to control when you top-up the pain relieving medication.
It can take around 20 minutes to set up and 20 minutes to start working. You will need to have a drip placed in an arm and may need continuous monitoring of the baby’s heart rate. We use a mobile (low dose) epidural, which aims to give excellent pain relief while allowing you to walk and have an active birth.
This is a short acting morphine-like drug which has been shown to reduce pain during labour. It works very quickly and wears off very quickly.
It is started by an anaesthetist as a second option for women that cannot have an epidural, and given by a pump directly into a vein through a cannula (drip) in your arm. You control when each dose is given by pressing a hand-held button.
The pain relieving effect is usually felt in 20 to 30 seconds, and wears off within a few minutes. It can only be given on the delivery suite as occasionally it can slow your breathing. The oxygen levels in your blood are monitored by a peg on your finger and sometimes extra oxygen is given by a facemask. There is a safety feature built into the pump so only safe amounts of the drug is delivered.
Labour Pains website has information for expectant parents on pain relief choices during labour, including a pain relief comparison chart.
An assisted birth using a ventouse or forceps is sometimes needed in the final part of labour. Around 12% of births are assisted with forceps or ventouse at our hospitals.
An instrument is placed on the baby’s head to help guide the baby out and this is only done by an obstetric doctor.
An instrumental birth may be performed in the labour room or sometimes in theatre.
The reasons for needing an assisted birth vary but usually include:
The process of an instrumental birth and the reasons why it is being recommended should be fully explained to you.
Your midwife will support you throughout the birth and answer any questions you may have.
Risks associated with instrumental birth can include:
The doctor may need to perform an episiotomy (vaginal cut) to the muscles around the vagina (perineum) or rectum.
This will only be done with adequate pain relief. Repair of an episiotomy or tear will follow straight after the birth. Full aftercare will be discussed with you after your baby is born.
More information about the procedure of an instrumental birth and the risks involved can be found in our patient information library
Providing there are no concerns about you or your baby after an instrumental birth there would be no reason for a longer stay in hospital, with many women able to go home the same day.
A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.
The cut is usually made across your tummy, just below your bikini line.
A caesarean is a major operation carrying a number of risks, so it's usually only done if it's the safest option for you and your baby.
For a proportion of women, birth by planned (elective) caesarean section may be recommended. This could be because you have a pre-existing medical condition, because of your previous pregnancy history or because a complication develops during your pregnancy.
We will tell you why we recommend an planned caesarean section birth and the benefits and risks. We will also explore are any other options for your birth.
The Royal College of Obstetricians and Gynaecologists website has information on choosing a caesarean birth.
If you are booked to have a planned caesarean you will receive an email around 1-2 weeks before your birth with:
A caesarean birth is performed under either a spinal or epidural for pain relief. You will be offered regular pain relief while in hospital and we will advise you how to continue to take your own pain relief at home.
It is common to stay in hospital, usually on the Postnatal Ward, for at least one night after a caesarean. Your birth partner is able to stay with you.
Our aim is to get you mobilising as soon after surgery as is comfortable for you as this can improve your recovery.
Women who have had a caesarean birth have a higher chance of forming a blood clot in the legs or lungs following surgery.
Some women who have had a caesarean birth are given a blood thinning injection to reduce the risk of blood clots. If you have additional risk factors, you may need to have these injections at home for up to six weeks. This will be discussed with you.
The Royal College of Obstetricians and Gynaecologists have information on reducing your risk of blood clots in pregnancy and in the postnatal period.
We offer most women having a planned caesarean the opportunity to have immediate skin to skin contact with their baby in theatre using a KangaWrap Kardi, developed and researched by midwives.
Our research found that many women found it gave them a sense of security and warmth and its use was associated with an increase in the number of women who were able to breastfeed successfully.
Please discuss this with your doctor and midwife during pregnancy and then let the midwife or nurse caring for you on the day of your caesarean know you would like to do this. You will be shown how to wear the Kardi under your hospital gown and we will explain how to use it safely, until you feel well enough to get out of bed. There may be certain medical conditions when this will not be possible.
Pain varies from woman to woman and the type and amount of painkillers needed will vary. We believe you are the best person to understand what pain relief you need and when you need it.
Pain control will mean you are less stressed, more likely to sleep better and have a speedier and healthier recovery. This can be achieved by asking yourself at least every four hours: “How is my pain and what is my pain score?”
We supply you with your own painkillers and teach you how to take them when you need them. You will be given three different types of painkillers, depending on your requirements, and a supply to take home with you.
More information about self-administration of medication is available in our patient information library.
An unplanned or emergency caesarean is performed if there are immediate concerns about mother or baby and it is not possible to deliver the baby vaginally. There are different categories of emergency depending on the level of concern for mother or baby. This dictates how quickly the birth of the baby needs to occur.
Premature labour is labour that happens before 37 weeks of pregnancy. About 8 out of 100 babies will be born prematurely.
The midwife or hospital will offer checks, tests and monitoring to find out whether your waters have broken, you're in labour or you have an infection.
These may include a vaginal examination, blood test, urine test and cardiotocography to record contractions and the baby's heartbeat.
PREM7+ is the south east region’s perinatal optimisation care bundle.
Tommy's have information on premature (preterm) birth and the Royal College of Obstetricians and Gynaecologists has information about cervical cerclage (cervical stitch) which you may be offered if you are at risk of giving birth early.
The third stage of labour is the birth of your placenta, the membranes that surround your baby and the baby’s cord.
There are two ways to manage this stage of labour:
Your midwife will explain both ways to you while you're still pregnant or during early labour, so you can decide which you would prefer.
There are some situations where physiological management is not advisable. Your midwife or doctor can explain if this is the case for you.
Whether it’s your partner, daughter or friend due to give birth, it‘s an honour to be asked to be a birth partner.
There are many ways you can help support the mum-to-be during labour. A good place to start is asking them how they’d like you to support them. This will help you both feel more prepared and for you to feel more confident in your role as birth partner.
Talk to them beforehand about the type of birth they would like and the things they would prefer not to do so you can help support their decisions. It can help to go through the birth plan together.
There’s no way of knowing what labour is going to be like or how each of you will cope, but there are many ways a partner can help:
There are many ways to improve your birth experience and give your baby the best start in life, regardless of the type of birth you are planning. We encourage you to read about birth optimising and think how you may want to incorporate this into your birth plan.
You can choose what fits yours and your baby’s needs and discuss this with your midwife at your birth choices appointment.
Hypnobirthing uses relaxation, breathing and hypnosis which can help keep the birthing process natural and gentle. It enables women and their partners to be calm, confident and in control during childbirth.
Learning how to be free of fear and tension means women can embrace the birthing process and place trust in their bodies to birth easily and effectively.
From 35 weeks onwards, you or your partner can use daily perineal massages until your baby is born which may reduce your risk of tearing. This is particularly helpful for first-time mothers.
The Royal College of Obstetricians and Gynaecologists have made an animation about reducing your risk of perineal tears.
In the last few weeks of pregnancy it is important to try and help your baby get into the best position possible. Sitting ‘slumped’ on a sofa may encourage the baby to lie with its back to your back, which can result in a much longer labour than if the baby were facing the other way around.
We advise you adopt more forward leaning positions whenever possible.
We try to make every labour room as comfortable as possible with a range of birthing aids such as the birth couch, bean bags, rocking chairs, mats, and birth balls. Women are encouraged to be as active and upright as possible.
Being able to move freely and use different positions is likely to help keep your labour normal. There are advantages to staying off the bed and keeping yourself upright during the first and second stage of labour:
Equipment such as birth balls, mats, and rocking chairs are available for all the delivery rooms. These can help you use a variety of good positions for labour. Ask your midwife to advise you on positions to try. One of the most important findings of research studies is that you should listen to your own body and use the positions most comfortable for you.
Try changing position frequently and if you need to lie down, avoid lying flat on your back as this can reduce the blood flow to your baby. This may affect the baby’s heart rate as well as tending to slow labour down.
If you do need to lie down you may find it helpful to try relaxing on your left side with a large pillow between your knees; it is also possible to give birth in this position.
Using water for labour can be very effective. You may be advised to try using a warm bath in early labour to help soothe the discomfort of contractions, or you may wish to use a birthing pool throughout your labour, usually once labour is established. Water can help you to remain mobile and help you get into comfortable upright positions to help your labour progress.
We have birthing pools in both birth centres and at our main hospital. Please speak to your midwife if you think you may wish to use water in labour.
Tommy's have more information on preparing for a water birth.
Delayed cord clamping is now recognised as standard practice following the birth of your baby. This means blood is able to flow through the umbilical cord to the baby for at least one minute following birth; this helps to increase the baby's blood volume, iron and stem cell levels, as long as your baby has a normal heart rate and doesn’t require any breathing support.
You can opt for a physiological birth of the placenta, in which case the umbilical cord should be left until it has stopped pulsating and turned white. This may take up to twenty minutes.
Delayed cord clamping is also recommended during caesarean sections, both planned and unplanned, as long as your baby does not require immediate support and your bleeding is normal.
Tommy's has more information on delayed (optimal) cord clamping.
Birth planning infographics are to support you in making informed choices during pregnancy and birth, using clear, local data to help you explore your options.
They are designed to give personalised insights, whether this is your first baby or not, how your labour begins (naturally or by induction) if you’re planning a vaginal birth after caesarean (VBAC) or if you’re expecting twins.
They are intended to be used as part of your care and discussed with your midwife or doctor.
These conversations help make sure the information is relevant to your own circumstances and supports shared decision-making.
You can look at these infographics at any stage of pregnancy, but they’re especially helpful between 28 and 34 weeks. This is often a good time to talk about your birth preferences, where you might give birth, possible interventions, and how we can work together to support the birth experience you want.