Childbirth & Birth Care

Nobody knows exactly how their labour will go. What you can know is who will be there, what the options are, and what happens if the plan changes.

Your obstetrician cares for you through the birth and the weeks that follow. If you've booked a doula, she's there too. They do different jobs, and they work alongside each other rather than in competition.

This is the part everything else has been preparing for. We'd like you to arrive at it informed rather than braced.

When labour starts

Call the hospital and the rooms when contractions become regular and strong, when your waters break, or if anything worries you at all, at any hour, including the middle of the night. You'll be assessed when you arrive: your contractions, your baby's heart rate, and how far along you are. Sometimes the right advice is to go home for a while. Early labour is usually more comfortable in your own house, and being sent home is not a failed attempt.

Your obstetrician is called for established labour and is there for the birth. Midwives provide the continuous care in the room. If you've booked Vanessa Salerno as your doula, she's with you from home through to after the birth, doing the sustained emotional and physical support that a clinical team can't always provide. These are genuinely different jobs. A doula doesn't make clinical decisions or deliver babies, and a good obstetrician is glad she's in the room.

The ways a baby can arrive

• Vaginal birth: the majority of births, with as much or as little intervention as you need
• Assisted vaginal birth: vacuum or forceps, usually when your baby needs to be born quickly or the second stage stalls
• Planned caesarean: booked in advance for reasons such as placenta praevia, breech presentation or previous surgery
• Unplanned caesarean: decided during labour, most often with time to explain what's happening before anything starts

Whichever route it takes, we'll talk you through it while it's happening, including why we're recommending it and what the alternatives are. Consent in labour is a conversation, not a form pushed across a bed.

If you've had a caesarean before, you have a real choice: a planned repeat caesarean, or a vaginal birth after caesarean. We'll go through your previous surgery, the reason for it, what your scar means for this labour, how you'd be monitored, and what the risks and success rates actually look like for someone in your situation rather than in general. Many women who attempt a VBAC in favourable circumstances achieve one. The decision is yours, and you're allowed to change your mind late.

Pain relief

Everything is available and nothing is expected. Nitrous oxide, injected opioids and epidural sit alongside the non-medical approaches (water, movement, heat, breathing, counter-pressure) that carry many women a long way. Wanting an epidural early is not a failure of will. Not wanting one is not heroism. What matters is that you know what each one does before you're in the middle of deciding.

The weeks after

The first days are their own event: afterpains, bleeding, a body that feels borrowed, feeding that may or may not come easily, and a baby with no interest in the clock. You're seen daily in hospital, and once you're home you can call the rooms rather than sitting with a worry.

Your six-week check covers healing, bleeding, contraception, sex, sleep and mood, and whether your pelvic floor needs attention. Most women benefit from a physiotherapy assessment regardless of how the birth went. We ask about your mental health properly at that visit, and again later if we're not satisfied with the answer. Psychology and women's health physiotherapy are both here in the building.