Our staff have a strong ethos of promoting informed choices and delivering personalised care.
Deciding where to have your baby:
There are choices available to you when deciding where you would like to have your baby. Your midwife will be able to discuss these with you at your booking appointment and again as your pregnancy progresses. You should take certain matters into consideration, such as your medical history and if your pregnancy has progressed normally. You should also consider what services you may want, in particular, the forms of pain relief and taking into account where you feel most relaxed, comfortable and in control. Ultimately, the decision you make about where to have your baby is yours and we will support you in your choice.
Please read the sections ‘choosing place of birth’ and ‘Personalised birth preferences’ in your PCSP Personalised Care and Support Plan
If you choose to have your baby at home you will be supported by a midwife who will come to you when your labour is established and she will stay until your baby is born. Women tend to feel safer and more relaxed in their own environment and you can have more family members around to support you if you wish to. This is a suitable choice for those who have a straightforward pregnancy.
Chichester Birth Centre
Although the Chichester birth centre is based on our St Richard’s site in Chichester, our birthing centre is open to those that are booked for care under Worthing or St Richards hospitals. The birth centre is situated alongside our Labour Ward and offers midwifery led care for low risk women in labour. There are two rooms on the birth centre and these contain birthing pools. Within each room we offer a homely relaxing environment. Should you develop any problems during your labour you will have the reassurance that the main Labour Ward is just seconds away.
Obstetric led Units at Worthing & St Richards hospitals
If you decide to give birth in the hospital you will be looked after by a team of midwives and doctors. You will have the choice of either St Richard’s Hospital in Chichester or Worthing Hospital. We aim to offer one to one midwifery care during labour. Hospital births are recommended for women who have certain medical conditions or obstetric concerns. Should complications occur, you have the reassurance that doctors are available 24 hours a day. Both hospitals offer a variety of birthing options including birthing pools and a 24 hour epidural service and both maternity units have an operating theatre if needed.
Please discuss your options with your partner, family and friends, as well as your midwife or obstetrician. Even if you decide early on where you would like to have your baby, you can change your mind at any stage of your pregnancy. It might be recommended that you change your birth place choice if your pregnancy develops complications. Any care plan changes will be made in tandem with you and our staff.
The start of labour is called the latent phase. This is when changes in the body start occurring in preparation for actual labour. It tends to be longer in the first pregnancy. The latent phase varies widely amongst individuals in terms of character and duration. However, it is usually described as a period of time, not necessarily continuous, where there are painful contractions accompanied by your cervix thinning and dilating up to 4cm. The contractions may be irregular and vary in frequency, strength and length. You may get lots of regular contractions and then they may slow down or stop completely.
When you have a contraction, your womb tightens and then relaxes. For some people contractions may feel like extreme period pains. Some women say they feel pain in their back and thighs instead of, or as well as, pain in the front of their bump.
You may see some blood-tinged mucous, also called a ‘show’. If the blood is more than a streak or you are concerned about the amount, you should contact us immediately on the telephone triage number 01903 285269, which open 24 hours a day. You can call back at any time of the day or night, whenever you need further advice.
Occasionally your waters will break before contractions. It is important to call Triage immediately, even if you are in doubt. We will assess the symptoms on the phone and arrange a midwife appointment if necessary. If labour doesn’t start within 24 hours from confirmation of your waters having gone, you will be offered augmentation of labour to reduce the risk of infection. We will discuss the risks and benefits of having this procedure over waiting for labour to start on its own.
If all is well in early labour your midwife will recommend that you stay at home until you’re in established labour, which is considered to be having regular contractions (approximately 3 in 10 minutes) for at least an hour, however each individual experiences labour differently so if you feel you need to call again, we are here to support you via Triage. At the point where the midwife considers it necessary for you to have an assessment she will arrange for your admission to hospital or for a Community Midwife to visit your home if you are having a Home Birth.
Breathing exercises, immersion in water and massage may reduce pain during the latent first stage of labour.
You’re more likely to have a smoother labour and fewer interventions if you stay at home until labour is stronger and your contractions are regular. Research shows that when a person feels safe and relaxed, the levels of oxytocin, the love hormone that stimulates the uterus to contract, in her body are greater and therefore labour progresses much more effectively. The best place for women/people in the latent phase of labour is at home in familiar surroundings, supported by people she/they trust.
In order for us to maintain safety it is very important that you call Triage first before arriving, this is so we can ensure that there is a midwife and a room ready for your arrival.
It is extremely important to us that you feel listened to and if you have not had a satisfactory interaction with our staff, we would encourage you to contact PALS. Patient Advice and Liaison Service (PALS) / Complaints – Western Sussex Hospitals
Pain in labour
There are many pain management options available for managing your labour discomfort, there are drugs and natural methods, or a combination of both. Not all methods are available at home or in birth centres.
The main options available are:
- Water immersion (suitable for Home, Birth Centre and Obstetric led Unit)
- Transcutaneous Electrical Nerve Stimulation (TENS) (suitable for Home, Birth Centre and Obstetric led Unit)
- Hypnobirthing (suitable for Home, Birth Centre and Obstetric led Unit)
- Gas and air (Entonox) (suitable for Home, Birth Centre and Obstetric led Unit)
- Injections of analgesia (painkiller) medicine (suitable for Obstetric led Unit)
- Epidural (suitable for Obstetric led Unit)
A useful comparison chart of pain relief options in labour can be found here: pain relief comparison card september 2014.pdf (labourpains.com)
Click here to see the Obstetric Anaesthetists’ Association’s website about pain relief for childbirth: Coping with LabourPains for Mothers
Click here to see the NHS page on Pain relief in Labour: www.nhs.uk
Click here to see the Tommy’s page on Hypnobirthing: What is hypnobirthing? | Tommy’s (tommys.org)
Click here to see the Tommy’s page on Coping in Labour: Pain relief in labour and birth | Tommy’s (tommys.org)
Induction of Labour
In most pregnancies labour starts naturally between 37 and 42 weeks. Induction of labour or ‘being induced’ is a process that starts your labour artificially when the pregnancy goes on too long beyond your due date or where there is a problem with the pregnancy that means that it is better to shorten it so the baby is born earlier than the due date.
When is induction of labour recommended?
When it is felt that your health or your baby’s health is likely to benefit from the baby being born sooner, your midwife or doctor will offer the option of induction of labour.
If you are healthy and have had a straightforward pregnancy, induction of labour is offered when:
- your pregnancy is beyond 41 weeks; and/or
- your waters break and you do not go into labour after 24 hours.
Methods for inducing labour
Before inducing labour, you’ll be offered a membrane sweep, also known as a cervical sweep, to bring on labour.
To carry out a membrane sweep, your midwife or doctor sweeps their finger around your cervix during an internal examination.
This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour.
You may experience some discomfort or slight bleeding afterwards. If labour does not start after a membrane sweep, you’ll be offered induction of labour.
Click here for the NHS Website about Induction of Labour which covers Medical (using drugs) methods of induction: Inducing labour – NHS (www.nhs.uk)
At Worthing and St Richards you may also be offered induction of labour using a cervical ripening balloon or Artificial Rupture of Membranes (ARM).
Balloon cervical ripening
This is a drug-free method to open the cervix so that the midwife or doctor can then break your waters to get the labour process started. The procedure involves inserting a very thin silicon catheter into your cervix during vaginal examination. It has 2 balloons at the tip and when it is in place the balloons are inflated with sterile fluid.
The catheter stays in place for at least 12 hours up to a maximum of 24 hours. The aim of the balloon is to put gentle pressure on your cervix. The pressure should soften and open your cervix enough to enable us to break the waters in front of your baby’s head which may start labour. This doesn’t hurt you or the baby.
Most women remain on the maternity ward after insertion but going home with the balloon may be a safe option too. If you are asked to remain in hospital this will be for 12 to 24 hours on the antenatal ward and will likely be because you need to be monitored, depending on the reason for induction.
The balloon will be removed after this time but sometimes as the cervix opens the balloon will slip out on its own. Removing it is simple and painless; the balloons are deflated by the midwife and the catheter slips out, leaving the cervix slightly open and ready for your waters to be broken.
Benefits of balloon method
- It doesn’t use drugs.
- It works for most women.
- After some discomfort of having it inserted most people find it pain free.
- As it doesn’t involve using drugs, some women will be able to go home with it and come back into the labour ward for the next stage.
Risks of balloon method
- A small risk of infection.
- A small risk that the baby’s head will be pushed out of the pelvis and that the baby moves to a different position or the umbilical cord can come down. In either of these cases an emergency Caesarean would be required. To reduce the small risk of this happening, our service uses half the volume of fluid in the balloon than other services and we don’t use the balloon if the baby’s head is high in the pelvis or isn’t fixed in position and more likely to ‘bob out’.
Breaking your waters (artificial rupture of membranes)
Next the balloon catheter will be removed if you have one and, if your cervix is favourable, your waters will be broken. This is done by undertaking a vaginal examination and a thin plastic ‘hook’ is then inserted through the open cervix and the membrane holding the water in front of the baby’s head is punctured to let the fluid out. This doesn’t harm you or the baby but you will feel a warm, wet sensation as the water drains and will need to wear a pad.
Induction following previous Caesarean section
If you have had a Caesarean section in the past and need induction you will have the opportunity to discuss this with a consultant. Generally prostaglandins are not recommended in this case because they may increase the risk of complications because there may be frequent contractions that are difficult to control which could cause the previous scar on your uterus to start to separate.
Your consultant will discuss the risks and benefits with you and make an individual plan for your care during induction.
If induction doesn’t work
If despite attempts to soften and dilate the cervix we are unable to break your waters and help get you into labour, the obstetrician will talk to you about options including having a rest period and trying again in a few days. Ultimately though, your doctor may also offer Caesarean section to birth your baby if the induction of labour process isn’t effective for you.
Click here to see the National Institute for Clinical Excellence (NICE) guideline for Induction of Labour: Information for the public | Inducing labour | Guidance | NICE
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 may be recommended as a planned procedure, often referred to as ‘elective’ however if complications occur, an emergency caesarean section may be offered as the most appropriate mode of birth.
Having your baby by caesarean section when there isn’t a medical reason to do so is also considered a planned or elective caesarean section. For information on this procedure in a non-emergency situation, read the Royal College of Obstetricians and Gynaecologists guidance on the link below.
If it has been recommended that your baby be delivered by caesarean section by a healthcare professional or you have chosen this as your preferred mode of birth, it is important that you are fully informed of this procedure. The healthcare professional recommending the procedure will discuss some of the information that you need to be aware of during your pre-operative appointment.
For more information about what happens in a caesarean section, recovery and the risks please click here to read information from NHS.UK
Click here to read about the risks of having a caesarean section from the NHS.UK
Anaesthesia for caesarean section
There are different forms of anaesthesia available for a caesarean section. For the operation, you can either to go to sleep, known as general anaesthetic, or to stay awake, known as spinal or epidural anaesthetic. The anaesthetic will be given to you by an anaesthetist who is a doctor trained in anaesthesia. Your anaesthetist will discuss the options with you and recommend the best form of anaesthesia for you.
Royal college of anaesthetists– patient information about Spinal anaesthesia
Caesarean section information sheet (labour pains.com)
Anaesthetics and pregnant women with a high BMI labourpains.com
Recovery after Caesarean Section
Recovery after a caesarean section may take a little longer and you may need extra assistance in the first few days and weeks with your own and your baby’s care. Some women may feel upset or disappointed following their caesarean section, especially if the caesarean section was unplanned. It is important to talk about how you feel and you can talk to the midwife or doctor to find out more about what happened and why. It might also be useful to talk about how your caesarean section may affect any future pregnancy.
If you are not ready to talk or ask questions before you leave hospital you can also contact the midwife counsellor and birth afterthoughts midwife at a later date on 07876 475772.
Women/People stay in hospital for a minimum of 24 hours following a caesarean section birth, Every woman/person’s care is individualised to suit them and their needs. Please talk to the doctors and midwives to decide the right time for you to go home. Early mobilisation following caesarean section birth is recommended as this will support your recovery.
Click here to read NHS.UK information about recovering from a caesarean section, including: Looking after your wound, your scar, Pain and bleeding, returning to normal activities and when to seek medical advice.
Preventing Hospital Associated Blood Clots
Deep Vein Thrombosis or ‘DVT’ is a clot which can develop in the veins of your leg. It can cause pain, swelling and redness, or at times have no symptoms at all. A clot can also move to your lungs and this is known as a pulmonary embolism, or ‘PE’. Symptoms of this include chest pains and breathlessness. This is a serious condition, which can be life-threatening.
There is an increased risk of DVT and PE in women who are, or have recently been, pregnant, and the risk is increased further following surgery.
Reducing your risk
- Blood thinning injections. You will be given a small injection each day to help thin the blood. You may need to continue these injections for a while after you return home and we will show you how to do this for yourself before you go home.
- Stockings. You will be measured for and fitted with some tight fitting stockings which make your blood move more quickly through your legs and help to prevent DVT. It is important to wear these as at all times while in hospital and as much as possible when you go home until you are back to your usual level of activity. The stockings should be removed daily so legs can be cleaned and your skin condition checked.
- Keep moving. You will be encouraged to get out of bed as soon as it is safe to do so. Once you are up, try to move around as much as possible, and when you are resting in bed or a chair. Try not to cross your legs or ankles.
If you are unwell at home following your Caesarean birth, please contact Maternity Triage on 01903 285269. If you experience breathlessness and chest pain please call 999.
Looking after your skin: Pressure area care
Pressure ulcers, which are also known as pressure sores or bedsores, are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.
Pressure ulcers can affect any part of the body that’s put under pressure. They’re most common on bony parts of the body, such as the bottom, heel, hip, elbows, shoulder, back and the back of the head. They often develop gradually but can sometimes form in a few hours.
How can I help to reduce my chances of getting a pressure ulcer?
- Check your skin on your pressure areas before coming in to hospital, you will then know what is normal for you and what isn’t.
- Change your position every 1 to 2 hours. Ask your midwife to help. If you have an epidural this does not have to be a big change, just a tilt will do.
- Keep as mobile as possible.
- Change wet pads or sheets regularly.
- Eat and drink normally, unless told otherwise by a doctor or midwife. It is very important you stay hydrated during and after labour.
- Check your blood sugars regularly if you are a diabetic (hourly when in labour!) and let your midwife know your readings.
- Keep your skin clean; your midwife can help with this.
- If you have a catheter, try to make sure it is over your leg, and not resting underneath.
Assisted vaginal birth
Please read number 12 in ‘personalised birth preferences’ section In your PCSP Personalised Care and Support Plan
If your baby needs to be delivered urgently in the second stage of labour, your obstetrician, a surgeon who specialises in childbirth, may recommend that you have an assisted vaginal birth.
This involves using a ventouse vacuum cup, or forceps (like large tongs), to guide your baby as you push with your contractions.
The obstetrician will tell you about the benefits and risks to help you to make an informed decision. Please ask your obstetrician or midwife if there is anything you do not understand.
Click here read the Royal College of Obstetrics and Gynaecologists patient information leaflet on assisted vaginal birth
Click here for information from NHS.UK
Perineal tears and episiotomy
Your perineum is the area between your vaginal opening and your anus. This area stretches during childbirth and sometimes it can tear.
Up to 9 in 10 first-time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy. There are different degrees of tearing; some will require stitching. For most women, these tears are minor and heal quickly.
Stitching of a tear will be performed using dissolvable stitches under local anaesthetic, and undertaken by a midwife at home following a homebirth; or in the hospital.
Click here for the RCOG information on 1st and 2nd degree tears: First- and second-degree tears | RCOG
Third or fourth degree tears will require repairing in theatre by a doctor under regional anaesthetic.
Click here for the RCOG information on 3rd and 4th degree tears: Third- and fourth-degree tears (OASI) | RCOG
Techniques for reducing perineal trauma
Perineal massage in pregnancy aims to gradually soften and stretch the vagina and perineum in preparation for birth. Research shows that perineal massage is associated with lower risk of severe perineal trauma and post-birth complications.
From 35 weeks onwards, you or your partner can use daily perineal massage until your baby is born which may reduce your risk of tearing. This is particularly beneficial for first-time mothers.
Manual perineal protection
Your midwife may discuss with you a hands-on technique where they will apply pressure to your perineum using their thumb and fingers, whilst “cupping” the baby’s head with their other hand to ensure your baby is born in a slow and controlled way. This technique is believed to reduce the amount of severe (third or fourth degree) tears. View a PDF showing images of the manual perineal protection the technique.
Click here for the RCOG information on reducing the risk of perineal tears: Reducing your risk of perineal tears | RCOG
Speak with your midwife for further information and advice.
What is an episiotomy?
An episiotomy is a deliberate diagonal cut on the perineum, the area between your vagina and anus, An episiotomy is done during the birth of the baby’s head under local anaesthetic. It is usually directed to one side, to the right in most cases. If you have already had an epidural, the dose can be topped up before the cut is made. The cut is stitched together using dissolvable stitches after the birth. Episiotomies are always performed with consent.
Why might you need an episiotomy?
When a baby is born, its head stretches the opening of the vagina. It can be a very tight stretch, because the head is large in proportion to the baby’s body. An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.
Your midwife or doctor may advise you to have an episiotomy if:
- Your baby needs to be born quickly.
- You are having an instrumental (assisted) birth. This would involve forceps or suction cups, known as ‘ventouse’.
- You are at risk of having a severe tear to your perineum
Click here to the NHS information on episiotomy and perineal tears: www.nhs.uk
How long should the tear take to heal?
Your tear should take around 6 weeks to heal, when you will be seeing your GP for the 6 week postnatal check. For those with third or fourth degree tears, you will also have a follow-up appointment at around 6 weeks with a doctor at the hospital to check that the tear is healing well.
It is important to keep this area clean and dry to reduce the chances of infection. Your Community Midwife will visit you at regular intervals for the first 10 days, or longer if required, after the birth of your baby, and will check that your perineum is healing well.
Signs of infection to look out for:
- red, swollen skin;
- discharge of pus or liquid from the cut;
- persistent pain;
- an unusual smell; and/or
- feeling generally unwell.
Please contact Telephone Triage on 01903 285 269 or contact your GP as soon as you can about any possible signs of infection, so they can make sure you get the treatment you might need
Birth after caesarean
At our hospitals the doctors and midwives want to make the birth of your baby a safe and satisfying experience whether baby is born by caesarean section or born vaginally. If you have a baby by caesarean, any babies you have in the future will not necessarily need to be born the same way. Many women/people who have a caesarean section go on to have vaginal deliveries for their next baby. This is called: Vaginal Birth after Caesarean, or VBAC. The other option is to have an elective, or planned caesarean section.
You, your midwives and doctors will discuss the advantages and disadvantages to you as an individual. They will be able to support you and help you come to a decision that feels right for you. You will need to take into account what has happened in previous pregnancies, how things are in this pregnancy and your own feelings about how you want to deliver your baby.
This will be discussed at your booking appointment with the midwife and at subsequent appointments. You will also receive an appointment with an Obstetrician or Midwife Counsellor to discuss your plan of care.
Royal College of Obstetricians -Birth options after a previous caesarean section
Click here for Tommy’s information about giving birth after a caesarean section
During pregnancy, babies often twist and turn. By the time labour begins, however, most babies settle into a position that allows them to be born headfirst through the birth canal. However, that doesn’t always happen.
If your baby is lying bottom or feet first, this is called the breech position.
If your baby is still in a Breech position at 36 weeks, you will usually be offered the option of an External Cephalic Version, or ECV, which is a safe procedure when an obstetrician tries to turn the baby into a head-down position by applying pressure on your abdomen.
If an ECV doesn’t work, you’ll need to discuss options with your midwife and obstetrician. Although breech babies can be born vaginally, you may be offered a caesarean section.
RCOG Patient information leaflet Breech baby/ECV
NHS.UK– What happens if your baby is breech?
Conditions and Considerations
Declining Blood products: We want to ensure that we treat every person in a way which recognises their individual choices and respects their religious and personal beliefs. Before giving anyone a blood transfusion the risks and benefits of having or not having blood or blood products will be discussed. As part of your first antenatal appointment with your midwife they will ask you about your religious beliefs and if you have any objections to receiving a blood transfusion or blood products. This could include the Anti D injection if your blood group is Rhesus negative. Click here for further information: Rhesus disease – Prevention – NHS (www.nhs.uk)
If you chose not to receive blood or blood products your midwife will refer you to a Consultant clinic to discuss your pregnancy and make a plan of care with you.
Although blood transfusions in Maternity are not common it is good to be aware of the risks and benefits.
Click here to see the Blood Transfusions Service’s website: Blood transfusion – NHS Blood and Transplant (nhsbt.nhs.uk)
Group B Streptococcus (GBS):
Group B Streptococcus, often abbreviated as GBS, is a common bacteria that can be present in our bodies. It usually causes no harm. This situation is called carrying GBS or being colonised with GBS.
GBS is commonly found in the digestive system and the female reproductive system. GBS is not a sexually transmitted disease and most women/people carrying GBS will have no symptoms. Most pregnant women who carry GBS bacteria have healthy babies. However, there’s a small risk that GBS can pass to the baby during childbirth. Most babies are unaffected, but a small number can become infected.
Very rarely GBS infection in newborn babies can cause serious complications that can be life-threatening.
Are pregnant women tested for GBS?
Currently the evidence suggests that screening all pregnant women routinely would not be beneficial overall. You can be tested privately for GBS but professional opinion does not recommend this because a positive test may possibly result in unnecessary and potentially harmful interventions. The test involves both a vaginal and rectal swab.
As GBS can cause urine infections in pregnant women, GBS infection may be detected by taking a mid-stream urine sample, sometimes referred to as an MSU, which is then sent to a laboratory for analysis. Urine infection caused by GBS should be treated with antibiotics. An MSU is offered routinely in early pregnancy.
GBS may sometimes be detected during pregnancy in the course of taking a vaginal swab for signs of other infections. However not all vaginal swabs will detect GBS so it is important to be aware that a negative swab test does not guarantee that you are not a carrier of GBS.
If GBS is detected either in urine or swabs during your current pregnancy you will be offered intravenous antibiotics in labour.
Click here for the NHS guide to GBS in pregnancy: What are the risks of group B streptococcus (GBS) infection during pregnancy? – NHS (www.nhs.uk)
Click here for the Royal College of Obstetricians and Gynaecologists (RCOG) guide: Group B Streptococcus (GBS) in pregnancy and newborn babies | RCOG
Click here for the Group B Streptococcus Support page: Group B Strep and pregnancy – Group B Strep Support (gbss.org.uk)
- Placenta praevia happens when your placenta (afterbirth) attaches in the lower part of your uterus (womb), sometimes completely covering the cervix (neck of the womb).
- This can cause heavy bleeding during pregnancy or at the time of birth.
- If you have placenta praevia, your baby will probably need to be born by caesarean.
- Placenta accreta is a rare but serious condition when the placenta is stuck to the muscle of your womb and/or to nearby structures such as your bladder. This is more common if you have previously had a caesarean. It may cause heavy bleeding at the time of birth.
- Vasa praevia is a very rare condition where blood vessels travelling from your baby to your placenta, unprotected by placental tissue or the umbilical cord, pass near to the cervix. If these blood vessels tear, this can be very dangerous for your baby.
Click here for the RCOG guide: Placenta praevia, placenta accreta and vasa praevia | RCOG. Click here for the Tommy’s guide: Low-lying placenta (placenta praevia) | Tommy’s (tommys.org). Steroids may be recommended as part of your care if you have this condition. Click here for the RCOG guide for this: Corticosteroids in pregnancy to reduce complications from being born prematurely patient information leaflet | RCOG
For Maternity Statistics for our hospitals (Royal Sussex County Hospital, Princess Royal Hospital, Worthing Hospital and St Richards Hospital) please see this link and search for our Trust: University Hospitals Sussex NHS Foundation Trust. Maternity Services dashboard – NHS Digital