WHEN TO CALL YOUR MIDWIFE Labour and Postpartum

WHEN TO CALL YOUR MIDWIFE

EARLY LABOUR

To page the midwife on call: 604-443-1982

Signs labour may be starting soon:

Loss of mucous plug or “Show” which is bloody-tinged mucous

Menstrual-like cramps

Frequent soft, loose bowel movements

Backache that comes and goes in a fairly regular pattern

Irregular contractions, usually non-painful

Contractions less than 45 seconds long and more than 5 minutes apart

• These are not urgent signs. One of these signs by itself may not be indicative

of labour starting soon. There are usually two or three of these signs

occurring at the same time. It is not necessary to call us immediately but you

may notify the midwife on call during the day or the clinic midwife if you

have an appointment scheduled.

• Early labour may take 24–48 hours to become “active labour”. Early labour

often involves periods of contractions that can become regular for a while

then will decrease in frequency and strength. A hot bath or a good walk may

resolve these “prelabour” contractions. This pattern may occur over several

days especially if it is your second (or 3

+) baby. It is your body’s way of

preparing for active labour. Some contractions may feel quite strong but if

they do not get longer and stronger and continue in a regular pattern then

you are not in established labour.

• Do not wear yourself out in early labour. Any rest you can get will benefit you

during labour. Early labour is about the cervix becoming soft, shortened and

thin. Active labour is about the cervix dilating. Be patient and do not be

anxious. Babies need active, well established labour contractions to come out.

Tips for relaxing and sleeping in early labour

• If any of these occur during the night try to get some sleep, stay in bed!

• Have a warm bath, dim the lights, light some candles, have a glass of wine

• Have a glass of hot milk, a calcium magnesium supplement, calming tea

• Try Gravol: 50 – 100mg (1-2 tabs) takes the edge off and helps you drift off

between contractions

• Use relaxation techniques; breathe deeply, consciously relax all your muscles

and then do over again for at least seven times.

• Use a heating pad or warm pack (heat in the microwave) on your lower belly

or back

• Meditate, visualize resting then waking up refreshed in labour, hypnobirthing

techniques, use your own spiritual practice such as prayer

• Ask your partner for some soft, stroking massage

• Do not call people and tell them you think you are in labour

• Listen to relaxing music

• As much as possible ignore these early labour contractions – do not think

about how much stronger they are going to get or how many hours of labour

are ahead. Stay in the now and remember babies always come out!

Early labour during the day

• Make sure you eat and drink

• Ignore your contractions until you cannot talk through them

• Start or work on a project: bake something, crafts, scrap-booking, play

scrabble, watch a funny movie,

• Have a nap

• Go for a long walk – especially out in nature

Heads up Calls:

Day: (between 9 am and 9 pm) If you are having regular contractions and

think you are in labour or if your waters have broken, page the midwife on call.

A heads up call can assist us in planning our day, arranging our visits etc.

Night: (between 9pm and 9am) We do not need a heads up call during the

night and we appreciate the opportunity to sleep if we are not needed

immediately. You will appreciate a fresh, well-rested midwife during your

labour!. If your contractions are just beginning to become established, you are

able to talk through them, and they are occurring every 5 minutes or more and

lasting less than 1 minute long you do not need to call us.

If your waters break….

… you have a large gush of fluid or persistent leaking AND ALL OF

THE FOLLOWING APPLY:

• the fluid is clear,

• the midwife has told you the head is well down and

• your baby is active and moving normally,

• you are GBS NEGATIVE

• you are 37 weeks or over

• you are not in active labour

• it is during the night

You can put on a pad, go back to bed and call us in the morning, unless we have

given you other instructions.

If your waters break….

… you have a large gush of fluid or persistent leaking AND ANY OF

THE FOLLOWING APPLY: YOU NEED TO PAGE US RIGHT AWAY:

• you are GBS positive

• the fluid is brown, green or very bloody

• the fluid has a unusual or unpleasant odour

• you develop a fever (over 38 degrees) and feel unwell

• you are less than 37 weeks pregnant

• you are having regular, strong contractions

• the baby is not moving normally

INSTRUCTIONS ONCE THE WATERS HAVE BROKEN…..

• do not put anything inside the vagina: fingers, tampon etc

• do not have intercourse

• change any pad you are wearing every two hours

• do not have a bath until you are in active labour, showers are OK

• take your temperature every two hours while you are awake, page the midwife

immediately if it is over 38 degrees celsius or 100.4 fahrenheit

If you feel something in the vagina, see something at the entrance of the vagina,

or something is hanging outside of the vagina: get in a knee chest position on the

floor and page the midwife immediately. If you are sure it is the umbilical cord,

call 911 then page the midwife.

WHEN TO CALL YOUR MIDWIFE

ACTIVE LABOUR

To page the midwife on call: 604-443-1982

Key in your telephone number followed by the pound (#) sign. Ensure your

number is correct and keep your line free for the return call. If you do not receive

a call back within 10-15 minutes, please page again. If you do not receive a call

back within 10 minutes on the second page, please page one more time and then

call your nearest hospital maternity unit.

FIRST BABY: Use the 4 – 2 – 1 rule. When you are having regular strong

contractions occurring every 4 minutes, for over 2 hours that are lasting over 1

minute long, then call the midwife.

SECOND (or more) BABY: Use the 5 -1 -1 rule unless your midwife has

instructed you otherwise. When you are having regular, strong contractions every

5 minutes, for 1 hour that are 1 minute long, page the midwife.

If you are worried about something, or think the labour is

progressing rapidly, even if it doesn’t follow the 4-2-1 or 5-1-1- rules –

please page the midwife.

Timing Contractions:

Contractions are timed from beginning of one to the beginning of the next, noting

the duration of the contraction. This will give you the frequency. For example:

These contractions are approximately 6 minutes apart;

START [ CONTRACTION ] BREAK

4.31 [……45 seconds……..] 5 minutes

4.37 [……55 seconds……..] 5 minutes

4.43 [……50 seconds…….] 5 minutes 10 seconds

Write down the start time of each contraction and the length of it.

Time about 5 -10 contractions when there is a noticeable change in the pattern or

strength of the contractions, or every few hours.

Do not start timing early labour contractions that you can talk through or do not

have to breathe through.

WHEN TO CALL YOUR MIDWIFE

POSTPARTUM

To page the midwife on call: 604-443-1982

Postpartum Situations requiring a call to the midwife:

Baby:

Difficulty waking, lethargic behaviour

Decrease in frequency of feedings, too sleepy to nurse

Temperature more than 37.6 degrees or less than 36.0 degrees

Noticeable yellow colour to skin and/or sclera (whites) of eyes

Decrease in bowel movements or wet diapers after the first few days

Mother:

Any noticeable increase in postpartum bleeding that continues

Fever of 38 degrees or more

Any tender lumps, red patches or streaks on breasts

Tenderness or pain in the pelvic area

Extreme discomfort while nursing (after initial latch)

Leg pain with or without inflammation

Pain or swelling in the vulval/perianal area

Fatigue or exhaustion, depression, feeling unable to cope