Antenatal classes - what do you wish they had told you?

[Nettee]

I am a midwife and am going to lead two antenatal classes shortly (first time since I was a student ages ago) one on normal labour/pain relief and one on interventions in labour.

I went along to another midwife's sessions an wondered if she glossed over things a bit - episiotomies with instrumental deliveries, what pushing is actually like, pain the day after a caesarean etc but on the other hand I don't want to scare people.

So - what do you think would be useful to know for your first birth that you didn't learn at antenatal class?

We also touch on the first few days with the baby so anything about that would also be useful (breast feeding is a seperate class run by someone else)

Thanks

i know this is going to sound silly but i was totally unprepared for how hard pushing would be - i know - "labour" - there's a clue in the name (i had my first six weeks ago)!!

i listened to a hypnobirthing/relaxation cd millions of times because i was really scared about giving birth and it helped a lot but that was mainly with dealing with contractions. when it was time to push, i thought my body would automatically do the work for me. instead i had to push when i really didn't feel the urge. in fact the main time i had a massive urge to push was when he was crowning and the midwife told me to stop pushing!!

maybe that was a problem with my labour and contractions not being strong enough or something, but i was quite shocked at how exhausting it was!

How to push - I know it sounds stupid but I was "pushing" by clenching my stomach muscles, my pelvic floor, my vaginal muscles, everything but pushing the right way, ie like doing a big poo. I was pushing all the wrong way for about 1.5 hours and nearly exhausted myself. And stupid doctors kept putting their fingers up me and saying "Push here" and I was thinking I AM TRYING!!

OK so looking back it would have been better not to push at all and let my body do it naturally when it came to it but nothing could have stopped me trying to push at that time, so it would have been better if I was pushing in the right way as I would actually have been helping things along rather than exhausting myself for no reason.

Oh and also I wish I'd been told that sometimes your body can go into a little bit of a rest mode between getting to 10cm dilated and the pushing stage and so just because I'd been sick it didn't mean I was in transition and I could push straight away

I am glad I didn't know that if the baby does not present properly that crowning can take longer - I was expecting 2 pushes and the crowning part lasted about 7. I think I would have insisted on an episiotomy if I'd known this, as it was I just took it as it came and I did cope and didn't tear badly.

I was glad to have been told about waterbirth and labouring in water as I found that very useful, and I had to ask for it in hospital, it wasn't presented to me as an option on the day.

I was incredibly exhausted after labour as well - you hear of people going shopping etc the day after their baby is born so I was not expecting it at all. I would have liked to have been told it's ok to do nothing at all for the first few days except get to know your baby.

I think it is good if they are perfectly upfront about how varying people's experiences can be. I had a vaginal labour that left me in pain for a year after (not because things went wrong, just the stitching), and then an emergency caesarian that was like a day at the seaside. Didn't even notice any pain afterwards, because at least this time I didn't have to sit on it!

Useful information for afters: the MESS. Don't bring in a pretty pink nightie to wear in bed the next day, have something cheap and second-hand that will wash up well.

Please try to be objective about the different types of pain relief. I came away from my ante-natal class feeling like I'd been given the hard sell on natural birth. The worst thing is that DH was there as well and is now concerned that any pain relief that crosses the placenta cannot be good for the baby so I am expecting some subtle pressure about a "natural" birth between now and the kid actually turning up. Since I am a great believer in medical intervention if necessary, I can see a massive argument on the horizon (which I will win of course )

Thanks for your feedback, that is helpful - you are right that is is very different for everyone so hard to cover all bases. I will be objective about pain relief benjsmum (and I am sure you will win the argument when you are the one in labour!)

That if you have an epidural they might well decide to let it wear off long before the pushing stage so you end up suddenly feeling the pain again, begging to be given more pain relief and being refused.

That they won't even top it up when they do the forceps, episiotomy and stitches.

And that nobody you know will have any sympathy for you as they will assume that epidural = total pain relief for the whole birth.

Please make sure that women know there isn't any such thing as true pain relief unless they have an epidural. There are tools/drugs/strategies/hypnobirthing/water etc which can all help the mother cope, - but the mother ultimately will have to work with the tool, not expect it to relieve the pain all by itself.

I have suffered PTSD from not coping with the pain as I stupidly believed that if I couldn't cope there would be help/drugs. As it turns out, - once I had lost it mentally to fear and pain, there was no climbing out of the hole, except via epidural which isn't (and wasn't in my case) always available. And I can't stress how important it is not to accept pethidine when in a dodgy mental state!

Yes, that pushing feels like a big poo.

And that you will use a TON of pads after (and that regular pads won't work - you need mini mattresses)

UM..... Tell them about the bloodclots

I wish someone would have told me that if I have a long labour, obv so does the baby, and baby may not want to BF right away, and not to worry.

Piles! Noone mentioned that all that pushing can give you haemorhoids (sp?). They did go away eventually, but that was the most painful result of both my births (worse than the stitches!) Lots of people have told me they had the same problem - but why does noone tell you before?

oh and i found gas and air a bit of a con - i remember inhaling and going 'are you sure there's anything in this??'. still it does give you something to do

and i've just thought of something else that i'd NEVER heard of, despite all my reading and research: i ended up with a REALLY sore coccyx (still a bit uncomfortable now, although much improved), worse than the episiotomy aftermath, from several hours of trying to push out a big baby ... never expected that in a million years. had i known, i'd have had a coccyx cushion on order!

Things like piles though, - it would be helpful to know, but not at the expense of bumping other more relevant information to the actual birth. These women are only getting two sessions, and birth is a massive subject.

I wish a bit more time had been spent on coping strategies for the latent stages. A lot of time was spent on pain relief in active labour, but very little on how to cope if the early stages were very painful and long.

Our midwife talked about distracting yourself - e.g. watching a DVD, etc- on the assumption that it would be mildly uncomfortable. I wish someone had suggested thinking about things like taking long showers or a bath, massage, etc and that I had acknowledged mentally that I might need pain coping strategies for that bit too!

Camflower,
Well I've never heard of that either & I teach antenatal classes! What's a 'coccyx cushion' & where do you get it?

How long do you have?

Emphasising the variety of experience sounds good. Also encourage people to decide what is important to them and if they want to write it in a birth plan keep it under 1 side of A4 in idiot-proof bullet points.

What I'd've liked would be more info on the postnatal ward - luckily the antenatal teacher happened to mention in passing at the end that your partner will be chucked out at 10pm even if you've given birth an hour earlier and are still attached to a drip so can't reach your baby, so I could make arrangements for an interpreter, but ending up there for 3 days with no info about getting food and suddenly going from excellent care for 2 days in the MLU and del suite to being neglected was an enormous shock.

I agree that 2 sessions isn't very many - I think they used to do more but with staff shortages and all that it has been cut down. I want to do group activities so that the parents get to know each other a bit but will be very short on time to do much of that - Don't want to just lecture to them though.

Lots of good suggestions, thank you - keep them coming!

2 x 90 minutes sessions

At the end of the session hand round a bit of paper for phone-numbers/email addresses if they want to be contacted. Get someone to volunteer to organise a 'meet up' using said list.

Don't use terminology like if you 'end up with a c/section/ff/forceps/tear'. It makes it sound like a 2nd best outcome. It would be better to say If you need a c/section/forceps/to ff/ etc.

um, try to give the positives of the less than natural birth so that women can go into it positively whatever situation they are in. i.e. well, you won't be able to go into the mlu ward if you are higher risk, but they do try hard on the consultant led to keep it as calm and relaxed, and you can still have a say in how things are managed etc etc.

I kind of see the whole point of antenatal classes, not so much to pass on information, but to remove fear, and give people a positive outlook to their oncoming birth. This comes with giving information of course, but they WAY it is given is also really important.

How long lochia lasts for
that baby poo is watery/runny - I though my 3 day old had got dystnry as it was coming out so runny. Midwife reassured me it was normal
Think about breastfeeding tops - ie comfortable, baggy, easy access, buttons etc - i didn't have anything suitable yet couldn't get to the shops.
Have a variety of cotton wool at home - pads, balls, large roll of it. Useful for different things ie wiping bum with balls, wiping eyes with pads.
Fennel tea for bfing

Definitely agree about pushing.

I wish I had known how different first and second stages are. first stage is all about breathing through the pain, trying to relax, not be tense, and let the contractions wash over you. Second stage is damn hard work! And yes, I was pushing ineffecually for about an hour and a half before I finally cottoned on it's like a huge great poo!

And agree with the point about pain relief - that there are some great things out there, water, aromatherapy, gas and air, but essentially unless you want the epidural route, they won't block the pain - you have to work with them.

For me, how to use G&A whilst panting to help prevent pushing. I wanted to push really early (induction) and I didn't seem to be able to co-ordinate it all!

I didn't really get pushing either but I don't think it was for want of my NCT teacher describing it I just don't think I got it!

The one thing I can think of is women need to be told before they give birth that it does not matter how your baby comes out you are not failure. A number of ladies in our antenatal class had forceps, c/sections or epidurals are were left feeling as if they had failed because it turned very medical. Birth plans are all well and good but if things need to change then you need to be flexible too.

See you have to actually SAY it is like doing a poo out of your bottom. My ineffectual pushing was because I was trying to do a poo out of my fanjo, by clenching my buttocks.

definitel agree with the pushing thing
they say it's "like" having a poo which I took to mean similar in some ways but not the same
if they'd just been more graphic and said "there are no differences. same part of body, same muscles, you will indeed think you are having a poo till the penny drops" my first labour would have been faster

no
do not use the word LIKE
that's what confused me!