Preparing for labour and birth

You have options for deciding where to have your baby. These include having a home birth, going to a primary birthing centre, or having your baby at our Tauranga or Whakatāne hospitals.

You should discuss your preferred place of birth with your midwife as part of your planning in early pregnancy. Women who have complications in pregnancy are encouraged to give birth at hospital. 

Visit the Ministry of Health website for extra information about where to give birth.

Home birth

Home birth is a safe choice for many women, and may suit you if you have no complications during pregnancy and want to stay in a familiar place close to whānau/family. Talk to your midwife about your options.

Primary maternity facilities

Primary birthing centres are a safe choice for many women, they may suit you if you have no complications during pregnancy and want to have home comforts in a relaxed atmosphere.

In the Bay of Plenty, you have the option to birth at any of the following birthing centres. You can arrange to visit any of these places during your pregnancy, to see what they are like and get more information.

Secondary maternity facilities, Tauranga and Whakatāne hospitals

You can choose to give birth at Tauranga Hospital or Whakatāne Hospital, where we have seven birthing rooms and an emergency obstetric theatre available 24/7.   

If you have pregnancy complications or need specialist support, you will be encouraged to give birth at hospital. In some cases, you may need to be under the care of a medical specialist. More information on giving birth at hospital can be found below.

There are no tertiary maternity facilities in the Bay of Plenty. If you have more complex maternity needs which require specialist, multidisciplinary care, that is not available at our hospitals you’ll generally be referred to a maternity facility in the Waikato instead.

We have two secondary care maternity facilities at Whakatāne and Tauranga Hospitals, with primary birthing units at Murupara and Ōpōtiki. Tauranga Hospital and Whakatāne Hospital are also equipped with Wāhanga Piripoho / Neonatal Units.

We are proud of maintaining our Baby Friendly Hospital Initiative (BFHI) status in the Tauranga, Whakatāne and Ōpōtiki facilities.

Our maternity services are committed to supporting you to incorporate your cultural values into your birth experience, labour and maternity care. This is because we acknowledge and understand that kaupapa Māori traditions and practices will have an influence and an impact on your childbirth experience.

Our experienced team are here to make sure you receive the best care possible

• Anaesthetist Specialists in providing pain relief in labour, and anaesthesia when surgical procedures are required.
• Obstetricians specialists in the care of complications during pregnancy (antenatal period), childbirth and the postnatal period. Midwives can refer to obstetricians if the need arise.
• Paediatricians doctors specialist in the medical care of infants, children, and adolescents.
• Midwives offer care to childbearing women during pregnancy, labour and birth, and during the postpartum (after birth) period.
• Nurses work with midwives in postnatal areas of the maternity service to provide care to women and babies. They also work in the special care baby units.
• Lactation Consultants (LCs) staff qualified in all aspects of breastfeeding support and education. The LC usually sees those mothers and babies who are having particular issues with breastfeeding. Phone support is also available for any issues or questions regarding breast feeding.

Childbirth education is also sometimes called antenatal classes, or Hapū Wānanga classes.

Attending childbirth education classes can help you learn more about pregnancy and how to prepare for labour, birth and the first few weeks after your baby is born. You’ll also meet other pregnant women. Many people in these groups become friends during their classes and go on to have regular catch-ups.

You can take your partner, support people and whānau/family with you to classes.

Courses that are provided by organisations funded by Te Whatu Ora - Health New Zealand are free. There may be a cost for other courses.

Free courses in the Bay of Plenty

Parents Centre

Parents Centre provides free childbirth education classes where you can:

• meet other expectant parents
• learn about the exciting and complex pregnancy period
• become equipped to have a positive birth experience
• begin your parenting journey feeling informed and confident.

Visit the Parents Centre website to find out more.

Parents Centre offer courses in the following locations:

• Tauranga Parents Centre
• Whakatāne Parents Centre
• Rotorua Parents Centre
• Taupō Parents Centre

Kaupapa Māori antenatal education

Huria Trust offers a unique and extremely important Kaupapa Māori Antenatal programme known as 'Hei Tiki Pumau'.  The programme focuses on improving health outcomes for māmā hapū (pregnant women) and their whānau. For further information visit huriatrust.co.nz or phone 07 578 7838 (ext.218).

Other free class providers in the Bay of Plenty

Bethlehem Birthing Centre

Ph 07 570 6106
birthingcentre.co.nz

Plunket

Ph 07 5760698
plunket.org.nz

Pirirakau Hauora

Te Haa Ora. Day, evening & weekend classes available.
Ph 07 552 4573
pirirakauhauora.org.nz

Home Birth Trust

Ph 07 544 9817
facebook.com/groups/trusthomebirth

Huria Marae

Hei Tiki Pumau. Supporting wahine through their birthing journey.
Ph 07 578 7838

Labour is the process where your cervix (neck of the womb) gradually stretches open to let your baby be born. Labour happens in three stages.

First stage

The first stage of labour can last 4-36 hours for a first baby. This is when your cervix gradually gets short (effaces), thins out, comes forward and opens to about 10cm.

Your baby’s head comes down further and further into your birth canal as the opening happens.

Second stage

This is the part where your baby is born. The second stage of labour may last just a few minutes, or up to 2-3 hours for a first baby.

Your baby comes right down, and you push them out. Most women feel a strong urge to push at this time. The midwives and doctors may encourage you to try different positions to help make this stage easier.

Third stage

The third stage of labour is when the placenta comes out, sometimes called the afterbirth and known to Māori as the whenua. This stage can take just 5-7 minutes or up to one hour after your baby is born.

This may happen on its own, or an injection is sometimes recommended if there is a risk of you bleeding heavily. The injection will make the muscles in your womb clamp down very hard and help release the placenta. It then slithers out – this stage is not usually painful for most women.

The cord from the placenta, which is attached to the baby, may be clamped or left until the cord has stopped pulsating. If you wish to use a clamp alternative, such as a muka tie, you can bring one to the delivery suite.

Our hospital staff recognise that some people place special significance on the whenua/afterbirth/placenta. We encourage women who are keeping their placenta to find a family member to take the placenta home directly from the delivery suite. If you could please make sure your midwife is aware of this in your birthing plan and if you are unsure please always ask our staff.

If you are birthing at a primary birthing centre talk to your midwife about the process of taking your placenta home, or ask at the centre when you visit.

When complications, such as infections, bleeding, prematurity, or a sick baby, occur in your pregnancy or at the time of birth, the doctor may recommend and request your permission to send your placenta for examination. This may give important information that can help to explain what has happened and to improve the care we give you in subsequent pregnancies.

These tests require your informed consent so an explanation about them will be provided before any testing is carried out. We will try to return the placenta to you as soon as we can. Testing of the placenta usually takes about seven days. Please let staff know if you need your placenta returned quickly and they will clearly document this on the request form that goes with the placenta to the laboratory.   

How will I know I’m in labour?

Discuss the signs of labour with your midwife well before you are due. Only about five per cent of babies arrive on their due date, meaning labour often starts in the week before, or up to two weeks after you are due.

You will probably know when you go into labour. For a first baby, the start of labour is usually gradual – it can last for hours, and may stop and start over several days. There are many signs of labour starting.  

• A ‘show’ – the mucus plug that seals your cervix closed may come out of your vagina. It looks like mucus mixed with red or brown blood. This can happen several days before you go into labour.
• Your waters breaking – your waters can break before labour, right at the end of labour, or anywhere in between. If the water coming out is green/brown, or quite red like blood, then call your midwife immediately. If there seems to be a lot of blood, dial 111 for an ambulance too.
• Contractions beginning – contractions might feel like a strong, crampy, pulling sensation with pain (maybe like period pain) low down in your belly. These get stronger and closer together as labour progresses.

Visit the Ministry of Health website for more information about the signs of labour.

Coping with labour

Having someone with you is usually very helpful – don’t labour alone!

Walking or being upright, maybe leaning over something, can help ease the pain of labour, as can rocking. The National Childbirth Trust in the UK has some information on positions to make your labour shorter and easier.

Visit the Maternity Services Consumer Council website for more information about coping with the pain of labour.

Things to do during labour at home

• Once contractions become fairly regular, write down the time between each contraction, and how long each contraction lasts.
• Call your midwife when you are fairly sure you are in labour.
• Distract yourself with television or Netflix, play a board game, or do crosswords.
• Relaxation and visualisation – breathe in gently, sigh out slowly, think positive thoughts.
• Stay mobile, go for short walks.
• Release tension with a massage for your neck and shoulders.
• Have a warm bath or shower.
• Eat small frequent meals, such as fruit, nuts, carbohydrates (bread, pasta, rice, cereal), plus small amounts of sugary foods.
• Drink water or herbal teas. Sports drinks aren’t needed, and can make some women feel sick.
• Try to empty your bladder often.
• Rest and sleep between contractions where possible.
• Use warm packs such as a warm hot water bottle or wheat pack over a towel (not directly on your skin) for helpful heat on your back and belly.
• A TENs machine for pain relief can be hired - talk to your midwife.
• Have positive, supportive people around you.

Having a baby can be hard work, and most women like to have someone they know very well with them. This could be your baby’s father, your partner, a friend, sister or mother – whoever you want. You may like to have more than one person with you.

Having a trusted, calm support person is proven to help labour and birth along. If there is no one you can ask to be with you, or if you would like another person, you can ask your midwife if there is a student midwife available.

How many support people can you have?

If you are birthing at home you can have as many or as few people there as you want – it’s your house.

At primary birthing centres or a rural birthing unit the staff might suggest you limit the number of people in the birthing room to just a few. 

If you are birthing in either of our hospitals because you have pregnancy complications it can be tricky to manoeuvre equipment that might be needed around lots of people on the floor or in chairs, particularly in an emergency. Discuss the right number of support people for you with your midwife ahead of time.

Advice for support people

Support in labour is much more than just being there for the birth. Talk with the mama-to-be about what she might need and want from you. 

• Physical support – someone to lean on, rub her back or help with warm packs.
• Emotional support – encouraging words, helping her breathe and keep calm, telling her she is doing a great job.
• Advocacy – helping her with decisions, especially if she is tired or upset.
• Celebrating with her.
• Keeping her company – especially in early labour, it can be long and boring at times.

It can be hard to see a woman you care about working hard and in pain. Sometimes support people may get worried or even a bit angry if they think a woman needs pain relief and none seems to be coming. Keep talking with the midwives about what’s happening and what you are feeling. It’s okay to take a break, and make sure you keep yourself fed and watered too.

If you are really scared of blood or other body fluids, or would be embarrassed to see a naked woman, you may want to ask if there are other ways you can support the family.

Find more information

• A childbirth cheat sheet for dads-to-be.
• Birth support tips and suggestions.

An induction of labour (IOL) is a process to start labour artificially, rather than waiting for it to start naturally on its own.

Induction may be recommended for:

• women who are overdue (more than 41 weeks)
• growth issues with your baby
• diabetes in pregnancy
• other conditions that may affect you or your baby’s health.

Generally, induction is planned in advance during an appointment at the antenatal clinic. A date and time will be discussed for you to come in to hospital. We also recommend you discuss your midwife’s involvement in the process with them.  

For a small group of women the decision to have an induction may be made quite quickly following an urgent assessment with a doctor at Women’s Assessment Unit.

Once you reach 40 weeks of pregnancy your midwife will discuss an induction with you, in case you do not go into labour on your own.

If you decide you would like to book an induction date and you have had no health issues during your pregnancy, your midwife will make an appointment for you to have a scan to check on your baby and book a date for induction at hospital. This will be a date of your choice (depending on availability of induction spaces at the hospital) from 41 weeks and 1 day. If you go in to labour before the date booked, the induction will be cancelled. 

For women who reach 40 weeks of pregnancy and who may have had some health issues during pregnancy, your midwife will talk to you about being reviewed by the doctor and to discuss an induction of labour date.

Before your induction

Before your induction starts, we will monitor your baby with a cardiotocograph (CTG), insert an IV line to administer fluids and medications as needed, and do blood tests to confirm your blood group, haemoglobin and platelet levels. All of this information helps us provide you with safe and appropriate care during your induction.

Induction methods

There are a range of methods that may be used to induce labour, and you will move between areas of the women’s health service as things progress. The process for you will depend on your individual care plan, medical needs and the availability of delivery suite and staff. 

Cervical ripening

Cervical ripening involves the softening and opening your cervix before induction of labour. Depending on your needs, cervical ripening can be medical (using a synthetic hormone gel called prostaglandin) or mechanical (using a balloon catheter). This process will take place on the antenatal ward.

Artificial rupture of membranes (ARM)

Once your cervix has been ripened – softened, shortened and partially open (dilated) – you will be ready for ARM or breaking of your waters. This will take place in the delivery suite, carried out by a staff midwife, obstetrician or your own midwife. After the ARM, your contractions may start spontaneously, or you may need an oxytocin infusion before this happens.

Oxytocin

Oxytocin is a hormone your body produces that causes your uterus to contract. A synthetic form of this hormone may be used after an ARM has been performed, to produce effective, strong and regular contractions that help your cervix dilate.

Care during your induction

Everyone’s induction is different. It can take several hours to several days, depending on your reason for induction, the method used and how your body responds.

During your induction you will receive one-to-one care in the delivery suite from your midwife or a staff midwife. They will observe and assess the progress of your labour, understand your care plan and support you during your labour and the delivery of your baby. Your midwife may also ask an obstetrician to make assessments and carry out examinations, with your consent.

As staff midwives work rostered shifts, you may have more than one staff midwife care for you and support your midwife through the course of your labour.

Postnatal care

Once your baby is born you will either be moved to the postnatal ward, or if appropriate you may be discharged to a primary birthing centre, or home. Find out more about your postnatal care options.

Note for women planning to birth in a primary birth facility or at home:

For many women labour will start by itself and progress normally in a birth centre or at home.

The following information is to inform you of interventions that are sometimes needed if your labour is not following the pathway of normal. Birthing unit midwives are skilled at responding to unexpected changes in the course of a labour and will follow a process to ensure that you receive the safest care. Sometimes that will mean arranging transport to a hospital.

This information is not meant to discourage you from birthing at home or in a birth centre if this is a safe option for you.

Why do I need to know about possible medical interventions in labour?

Sometimes women who have a complex pregnancy and plan to have a vaginal birth or women who have a normal pregnancy may require some assistance, or interventions during labour, birth or the period immediately afterwards. It’s important to be informed about what the possible interventions could be, so if they do occur you have knowledge about what is happening.

There are several reasons why you may need an intervention during labour, including:

• concerns about the baby’s heart rate
• your baby is in an awkward position
• you’re too exhausted
• your labour has gone on too long.

Possible interventions

You should discuss these procedures with your midwife during your pregnancy so you have an understanding of what is happening if they are needed during your labour. 

Internal fetal monitoring

This is an electronic monitor that is attached to a small wire, which is inserted through the vagina to your baby’s scalp. It is only used if there is concern about your baby and external monitoring (a belt around your abdomen) is problematic and the quality of the recording is poor.

Fetal scalp blood sampling

This is used if there is concern about your baby during labour. Using a small tube which is inserted through your vagina a few drops of blood are taken from your babies scalp (like a pin prick). The blood is immediately tested and gives the doctor more accurate information on your baby’s condition or well being and will help with the decision to:

• continue in labour
• help you to quickly birth your baby via an assisted delivery or  
• move you to theatre for a caesarean section.

An episiotomy

Sometimes, a small cut, known as an episiotomy may be needed as the baby is being born to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Local anaesthetic is used to numb the area around the vagina so you will not feel pain. If you’ve already had an epidural, the dose can normally be ‘topped up’ or some local anaesthetic could also be added. Following the birth of your baby, the cut is stitched together using dissolvable stitches. Open this link for information on coping with grazes, tears and stitches.

An assisted/instrumental delivery

An assisted delivery, sometimes called an ‘instrumental delivery’, is when your doctor will help in the birthing process by using instruments such as a ventouse or forceps to help you birth your baby vaginally. Both options are safe for you and your baby and are only used when necessary. Your doctor/midwife will explain why an assisted delivery is the best option for you.

• Ventous (also called a vacuum extraction or kiwi cup)
  A ventouse is an instrument that is attached to the baby’s head by suction. A plastic or metal cup is attached by a tube to a suction device. The cup fits firmly onto your baby’s head. During a contraction and with the help of your pushing, the doctor pulls to help deliver your baby.
  The suction cup leaves a small swelling on your baby’s head, called a ‘chignon’. This disappears quickly. The cup may also leave a bruise on your baby’s head, called a ‘cephalhaematoma’. Very rarely it can be associated to more severe bleed in baby’s head. A ventouse is less likely to cause vaginal tearing than forceps but is more likely to be unsuccessful and require forceps or caesarean section to deliver the baby. 
• Forceps
  Forceps are smooth metal instruments that look like large spoons or tongs. They’re curved to fit around the baby’s head. The forceps are carefully positioned around your baby’s head and joined together at the handles. With a contraction and your pushing, the doctor pulls to help deliver your baby.
  Forceps can leave small marks on your baby’s face but these will disappear quite quickly. Very rarely it may cause further trauma in the baby. With forceps an episiotomy is almost always required and there are increased chances of maternal tears and postpartum bleeding. 

After an assisted delivery

Depending on the circumstances, your baby can be delivered and placed on your tummy, and your birthing partner may still be able to cut the cord if they want to. You will sometimes need a catheter (a small tube that drains your bladder) for up to 12 hours. You’re more likely to need this if you have had an epidural because you may not have fully regained sensation in your bladder (and therefore don’t know when it’s full).

A caesarean section

A caesarean section is a surgical procedure to deliver a baby through a cut in the mother’s abdomen (tummy) and uterus (womb). When a caesarean section is planned after labour begins, it is called an emergency caesarean section. There are different levels of 'emergency' and the doctor will decide when you will need to go to theatre, this could be immediately or within the next 30 minutes to a few hours depending on the urgency for you or your baby’s health.