The Birth Plan is an essential document listing all your preferences and options for labour. It will be the guide used by the professionals to help you and your baby during labour and to know your expectations. This enables us to provide you with completely personalised and comprehensive care.

Writing up your Birth Plan is a dynamic process during which both the professionals of the ASSIR and those from the hospital will inform you about everything you need to know and advise you on all the options available to you, so that you can make well-informed decisions.

It is a dynamic document because you are entitled to change your opinion at any stage and about any of the decisions you have made, both prior to and during labour. If the circumstances change at any stage, the professionals will provide you with all the information necessary and will support you in making shared decisions.

Download the Birth plan

How do I know if I am in labour:

• When your contractions are regular and increasing in intensity, every 3 or 5 minutes for at least 2 hours or, if it is not your first labour, every 5 minutes for 1 hour.
• If your waters break and they are transparent, you can feel foetal movements and you feel well, you can wait at home until your contractions start (maximum 12 hours). If the waters are not transparent or you have any doubts, come to the hospital.
• If you have abundant vaginal bleeding, continuous abdominal pain or a reduction in foetal movements you need to go to the Emergency Department.

Support during labour

Continuous support during labour can help you to feel less anxious and scared and reduce the need to take pharmacological treatments to relieve pain.

To create the calm, intimate space labour requires and to respect your privacy, you can choose who you want to support you during your labour.

The dilation stage

When labour starts you will be admitted to the Delivery Room. The dilation stage is the first stage of labour when the cervix dilates to 10cm. It is the stage prior to birth. It is important that you are aware of the information below:

The birth is also known as the expulsive stage. The majority of births are vaginal, and only in some cases will a caesarean section be required. There are three types of births: 

• Vaginal birth with no instrumental intervention.
• Vaginal birth with instrumental intervention (vacuum, spatulas or forceps).
• Caesarean section, in which the baby is born by a surgical intervention which consists of an incision in the mother’s abdominal wall and another in the uterine wall to extract the baby.

Just after the birth, the placenta is delivered. This stage coincides with the skin-to-skin contact and the type of cord-clamping you have chosen.

The spontaneous delivery of the placenta (without medication) has been associated with an increase in postpartum bleeding. Following the WHO recommendations, the active management of the placenta delivery with the administration of a low dose of oxytocin through an IV or intramuscular facilitates and speeds up its delivery, thereby reducing the risk of postpartum bleeding.

If you want to take your placenta home, you will have to sign an informed consent form after the birth and you will need to have a container to transport it. Remember to bring cold bags/packs to preserve it.

Placenta prints: the placenta is a very important ephemeral organ, as it provides the baby with everything it needs to live and grow during pregnancy. It is in charge of exchanging the substances necessary for foetal development such as oxygen and food, and of eliminating waste substances, such as carbon dioxide, among others.

To have a souvenir of this organ that is so essential for life in utero, you can do a print of your placenta. This technique consists of applying one or various paints on the placenta and part of the cord, and then placing them on a sheet of paper and pressing down to obtain an image similar to that of a tree. Each family can personalise it with the name and date, conserving an eternal memory of the placenta.

The Hospital de Sant Pau is one of the hospitals in Barcelona with the lowest rates of caesarean sections. A caesarean section is a major surgical intervention that entails more risks for the woman than a vaginal birth, and therefore we only perform this operation when necessary.

There are three types of caesarean: 

• Elective caesarean: this is performed on women with an underlying condition or on women whose babies have a condition for which a vaginal birth is not recommended. It is a scheduled intervention.
• Caesarean during labour: this is performed for different problems that can arise during labour (failure to dilate, baby not descending the birth canal, etc.).
• Urgent caesarean: this is performed quickly and is required when there is a threat to the life of the mother or the baby.

We want to look after your physical and emotional wellbeing, to respect your privacy and to ensure that you have a positive experience if you need a caesarean section.

The team of professionals is aware of the benefits of a humanised or pro-family caesarean section, and therefore we promote this technique that encourages your participation and that of the person accompanying you, and improves the birth experience for you.

We ensure that you are accompanied by a midwife at all times. She will be your link to the surgical team.

We use a type of epidural anaesthesia that we can leave for up to 30 hours after the birth, so that you do not have pain in those immediate hours and can take part in looking after your baby from the very start, and start bonding and breastfeeding.

At the moment of the birth, if you want and if the circumstances allow, the curtain will be lowered so that you and the person accompanying you can watch the birth. We will start skin-to-skin contact without cutting the umbilical cord for at least one minute (delayed clamping if that is what you have chosen).

We avoid strapping down the arms and we minimise the use of electrodes and devices on the arms or chest so you can be comfortable and can hold your baby.

We encourage the family to stay together, and skin-to-skin contact can be initiated by you or your companion. If a general anaesthetic was required (<5% of caesareans), the immediate post-surgery phase will be in the recovery room, where we will try to ensure the whole family can stay together.

The mechanical induction of labour is a procedure that is used to start labour in a controlled way. It may be recommended for different reasons, such as a pregnancy of more than 41 weeks, medical complications with the mother or baby or anomalies in foetal growth. Below, we explain what it consists of and how it is performed:

How is the mechanical induction performed?

The mechanical induction is performed using a balloon catheter. Below we explain the process step by step:

1. Preparation

• Medical appointment: The medical team will explain the procedure, answer your doubts and ask for your consent.
• Physical examination: An examination will be conducted to assess the cervix and the position of the baby.

2. Insertion of the balloon catheter

• Device: A catheter with a small balloon at the tip (similar to a slim tube) is inserted through the cervix.
• Inflation of the balloon: Once it has been placed in position, the balloon is filled with sterile water so it applies pressure between the baby’s head and the internal part of the cervix. This pressure causes a natural release of prostaglandins, which provoke the physiological initiation of the ripening of the cervix. This process can be performed with the help of nitrous oxide to relieve the uncomfortable sensation during insertion.
• Monitoring: You will be monitored to ensure that the balloon is in the correct position and to assess your wellbeing as well as that of your baby.

3. Dilation process

• Time: The balloon can stay in place for 6-8 hours. In women of low or medium risk (e.g. post-term pregnancy, small foetus, macrosomia, maternal gestational diabetes, among others) this process is performed at home, as it is a completely safe process, it causes very little discomfort and performing it in a non-hospital setting improves the experience for the woman and the baby. In those cases where the mother and/or baby need to be monitored, the process will be conducted during admission to the maternity ward.

4. Removal of the catheter

Natural progress: In many cases, labour will continue naturally after the catheter has been removed, as no medicine that would cause an increase in contractions has been administered.

Benefits

• Controlled and safe: It is a physiological, safe and effective way to induce labour.
• Non-chemical: No medication is used, thereby preventing risks such as overstimulation of the uterus or foetal distress, and it is recommended in cases of previous scarring of the womb.

Conclusion

The mechanical induction of labour is a safe and effective option to commence labour when necessary. It is always important to discuss all the options and concerns with the professional team to ensure that you understand the procedure and feel comfortable with the birth plan.

If you have any questions or need more information, please talk to your team. They are there to support and guide you every step of the way.

Recommendations at home:

• The balloon must remain in place for approximately 6-8 hours. Once it has been put in place, the mother and the baby’s wellbeing will be assessed, and then you can go home.

• You can eat and drink, but we recommend eating light meals.

• You can remain active, as this will help labour to commence.

• If you start having contractions you can use a ball or apply heat to relieve any discomfort. You can take 1 g of paracetamol if you need it.

• Try to rest as much as you can.

• If at any time you expel the balloon or your waters break spontaneously, don’t worry.  You can contact the staff in the maternity ward by phone, and they will give you instructions.

• During the hours you are at home you can contact the labour ward if you have any doubts.

During your hospital stay we make every effort to ensure that you feel as comfortable and accompanied as possible:

• We avoid unnecessary interruptions, scheduling visits at times that respect your rest and that of your baby.
• We never separate you from your baby. All the check-ups are performed in your room.
• We have bedside co-sleeper cots so you can have your baby as near to you as possible. We especially recommend this in the case of birth by caesarean.

We ask you for your collaboration in maintaining a quiet and relaxed atmosphere in your room, avoiding as much as possible the use of screens, electronic devices and noise, to help you and your family with the bonding process.

To help you to adapt to this new stage, if the circumstances allow, we discharge women 12-24 hours after vaginal births and 48 hours after caesarean births.