Early labour checks

First checks

You may already know the midwife who greets you when you arrive at hospital, especially if you're booked into a birth centre or have seen the same group of midwives throughout your pregnancy. If you have a private obstetrician or you're not in a midwifery program it's more likely that you won't know the midwife on duty.

If you’re having your baby in hospital, many birth units have a special room called an admission room for women who have just arrived. Here your midwife will ask you to tell her how you are and what has happened so far, such as:

• Have you had a show (a brownish or blood-tinged mucus discharge)?
• Have your waters broken?
• What colour were they?
• Have contractions started?
• How frequent are they?
• How many weeks pregnant are you?
• Have you had any problems in your pregnancy?

She'll also need to see your maternity notes, so don't forget to bring them with you!

Next she'll check your:

• blood pressure
• temperature
• pulse
• urine

She'll measure and feel your bump to find out which way round your baby is and whether your baby's head is engaged in your pelvis or not. She'll also assess how long, strong and frequent your contractions are and how much pain you're in.

The midwife will want to check that your baby is okay so she may ask to see your sanitary pad if you've had a show, or if your waters have already broken. She'll be checking for bleeding or meconium (your baby's first bowel movement) in the amniotic fluid. She'll also listen to your baby's heart rate just after a contraction using a Doppler.

If there have been any concerns with your pregnancy, the midwife will probably ask your permission to continuously monitor the baby at this time to make sure everything is okay. The monitoring is done with a belt that goes around your bump and you will need to be lying down while this is done. If everything's okay with your baby, this monitoring should only be for 20 minutes at this time. You probably don't need to be monitored if your pregnancy has been problem free.

After she's made these checks and assessments, your midwife may ask your permission to do an internal (vaginal) examination, explaining why she wants to do one. If you don't want to have an internal exam, say so. This will mean that you won't know how many centimetres your cervix has opened up (dilated), but a skilled midwife will still be able to tell you roughly how far on in labour you are, just from observing you and listening to you.

Everything your midwife does once you are in established labour is written down on your partogram. This is a special chart with different symbols and sections to record every detail of your labour. If your midwife goes off duty, the next midwife will be able to see at a glance how you're getting on.

Your birth plan

If you're in early labour and not having to cope with strong contractions every few minutes, your midwife should go through your birth plan with you. Even if you aren't asked, this is a good time to show her your birth plan if you've prepared one. If you haven't written a birth plan, you can still ask her to write down if you have any special preferences for labour.

Tell her whether there are certain procedures or types of pain relief you'd like to avoid. Or if there's anything that you'd especially like during labour or after your baby is born. If you have a disability, tell your midwife how she can help you. If you want to observe certain religious rituals, make sure you mention them. Your midwife's job is to make your labour a safe and positive experience for you.

Monitoring your baby

It used to be the case that every woman arriving in hospital in labour was monitored with electronic sensors strapped to her tummy for about 20 minutes. This was called the "admission CTG" or "admission trace". Midwives and doctors thought it was useful to have a record of a baby's heartbeat in early labour so comparisons could be made later on.

Research overseas, however, showed that the trace may not be helpful for many women. Doing it meant that women had to lie down with tight belts pulled round them just when they wanted to be upright and moving around. Women who had an admission CTG were more likely to have continuous electronic monitoring during labour, and may have been more likely to have a caesarean section (Blix et al 2005, Devane et al 2012, Ministry of Health 2012).

So an admission CTG is no longer automatic for women with a low-risk pregnancy (RANZCOG 2014). Your baby's wellbeing can still be monitored on admission by your midwife listening to his heartbeat using a hand-held monitor called a Doppler. This uses ultrasound waves to "bounce" back the sound of your baby's heartbeat.

With a Doppler, your midwife, you and your birth partner can hear the heartbeat, as the device has a speaker.

What happens next

If your midwife tells you that you're in very early labour, you might choose to go home again and wait for contractions to get stronger. Some research suggests that women in early labour who go home and don't stay in hospital have fewer interventions during birth and are happier with their experience (Klein 2004).

You might prefer to stay in hospital, in which case you will probably be sent to the antenatal ward, or perhaps to a special waiting area on the delivery suite. Your partner might not be able to stay with you on the antenatal ward if it's night-time. If you're in strong labour, you'll be taken to a room where you'll stay until your baby is born.

Homebirth

If you've chosen a homebirth, you will know the midwife who looks after you during labour, and she'll be a friendly, familiar face when she arrives at your house.

You may have some of the same checks that you would have in hospital. Your midwife may take your temperature, pulse and blood pressure. She might test your urine and feel your bump to check your baby's position. With your permission, she'll probably carry out a vaginal examination but often not straight away. She'll listen to your baby's heart with a Doppler or a Pinard stethoscope.

If you're in very early labour, she may then go away. She'll tell you to call her when contractions are stronger, or if there's anything worrying you. Before she leaves, she'll probably check that her equipment is at your house and in working order. Seeing your midwife will be reassuring, and you'll be able to relax until labour has progressed and it's time to ring her again.