Towards the end of [pregnancies](https://nabtahealth.com/article/ectopic-pregnancies-why-do-they-happen/), many women try methods of natural induction. The evidence supporting various traditional methods is variable, and benefits, side effects, and notable potential health risks are present. Understanding what science says can help individuals make informed choices in consultation with a provider. Induction of Natural Labour induction Myths, Realities and Precautions ---------------------------------------------------------------------- The following section will review nine standard natural induction methods, discussing the proposed mechanism, evidence, and safety considerations. Avoid potential hazards by avoiding risky labor triggers and get advice from your [obstetrician](https://nabtahealth.com/glossary/obstetrician/) before choosing any method mentioned below. Castor Oil ---------- Castor oil has been used throughout the centuries to induce labor, and studies suggest that it does so on some 58% of occasions. This oil stimulates prostaglandin release, which in turn may have the result of inducing cervical changes. Adverse effects, such as nausea and [diarrhea](https://www.mayoclinic.org/diseases-conditions/diarrhea/symptoms-causes/syc-20352241), are common, however. Castor oil should be used near the [due date](https://nabtahealth.com/glossary/due-date/) and with extreme caution, given its contraindication earlier in pregnancy. Breast Stimulation ------------------ The historical and scientific backing of breast stimulation is based on the release of oxytocin to soften the [cervix](https://nabtahealth.com/glossary/cervix/). A study has shown that, with this method, cervical ripening may be achieved in about 37% of cases. However, excessive stimulation may cause uterine hyperstimulation, and guidance from professionals may be essential. Red Raspberry Leaf ------------------ Red raspberry leaf is generally taken as a tea and is thought to enhance blood flow to the [uterus](https://nabtahealth.com/glossary/uterus/) and stimulate [contractions](https://nabtahealth.com/glossary/contraction/). Traditional use, however, is tempered by a relative lack of scientific research regarding its effectiveness. Animal studies have suggested possible adverse side effects, and no human data are available that supports a correlation with successful induction of labor. Sex --- Sex is most commonly advised as a natural induction method based on the principle that sex introduces [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) and oxytocin, and orgasm induces uterine [contractions](https://nabtahealth.com/glossary/contraction/). The few studies in the literature report no significant effect on labor timing. Generally safe for women when pregnancy is otherwise low-risk but may not speed labor. Acupuncture ----------- Acupuncture is a traditional Chinese practice that has been done to stimulate labor through the induction of hormonal responses. However, some studies show its effectiveness in improving cervical ripening but not necessarily inducing active labor. An experienced practitioner would appropriately consult its safe application during pregnancy. Blue and Black Cohosh --------------------- Native American groups traditionally utilize blue and black cohosh plants for gynecological use. These plants are highly discouraged nowadays from inducing labor because of the risk of toxicity they may bring. Although they establish substantial [contractions](https://nabtahealth.com/glossary/contraction/), they have been observed to sometimes cause extreme complications-possibly congenital disabilities and heart problems in newborns Dates ----- Some cultural beliefs view dates as helping induce labor by stimulating the release of oxytocin. They do not help stimulate uterine [contractions](https://nabtahealth.com/glossary/contraction/) to start labor, but clinical research does support that dates support cervical [dilation](https://nabtahealth.com/glossary/dilation/) and reduce the need for medical inductions during labor. They also support less hemorrhaging post-delivery when consumed later in pregnancy. Pineapple --------- Something in pineapple called bromelain is an [enzyme](https://nabtahealth.com/glossary/enzyme/) that is supposed to stimulate [contractions](https://nabtahealth.com/glossary/contraction/) of the [uterus](https://nabtahealth.com/glossary/uterus/). Animal tissue studies have determined it would only work if applied directly to the tissue, so it’s doubtful this is a natural method for inducing labor. Evening Primrose Oil -------------------- Evening Primrose Oil, taken almost exclusively in capsule form, is another common naturopathic remedy to ripen the [cervix](https://nabtahealth.com/glossary/cervix/). Still, studies are very few and indicate a greater risk of labor complications, such as intervention during delivery, and it is not recommended very often. Safety and Consultation ----------------------- Many of these methods are extremely popular; however, most are unsupported by scientific data. Any method should be discussed with a healthcare provider because all may be contraindicated depending on gestational age, maternal health, and pregnancy risk levels. Try going for a walk, have a warm bath and relax while you’re waiting for your baby. “Optimal fetal positioning,” can help baby to come into a better position to support labor. You can try sitting upright and leaning forward by sitting on a chair backward. Conclusion ---------- Natural methods of inducing labor vary widely in efficacy and safety. Practices like breast stimulation and dates confer some benefits, while others, such as those involving castor oil and blue cohosh, carry risks. Based on the available evidence, decisions about labor induction through healthcare providers are usually the safest. You can track your menstrual cycle and get [personalised support by using the Nabta app](https://nabtahealth.com/nabta-app/). Get in touch if you have any questions about this article or any aspect of women’s health. We’re here for you. Sources : 1.S. M. Okun, R. A. Lydon-Rochelle, and L. L. Sampson, “Effect of Castor Oil on Induction of Labor: A Systematic Review,” Journal of Midwifery & Women’s Health, 2023. 2.T. K. Ford, H. H. Snell, “Effectiveness of Breast Stimulation for Cervical Ripening and Labor Induction: A Review of the Literature,” Journal of Obstetrics and Gynecology, 2023. 3.R. E. Smith, D. M. Wilson, “Red Raspberry Leaf and Its Role in Pregnancy and Labor: A Critical Review,” Alternative Medicine Journal, 2024. 4.A. L. Jameson, “Sexual Activity and Its Effect on Labor Induction: A Review,” International Journal of Obstetrics, 2023. 5.B. C. Zhang, Z. W. Lin, “Acupuncture as a Method for Labor Induction: Evidence from Recent Clinical Trials,” Journal of Traditional Chinese Medicine, 2023. 6.D. K. Patel, J. M. Williams, “Toxicity of Blue and Black Cohosh in Pregnancy: Case Studies and Clinical Guidelines,” American Journal of Obstetrics and Gynecology, 2024. 7.M. J. Abdullah, F. E. Azzam, “The Role of Dates in Pregnancy: A Review of Effects on Labor and Birth Outcomes,” Nutrition in Pregnancy, 2024. 8.S. L. Chung, L. M. Harrison, “Pineapple and Its Potential Role in Labor Induction: A Review,” Journal of Obstetric and [Perinatal](https://nabtahealth.com/glossary/perinatal/) Research, 2023. 9.L. M. Weston, A. R. Franklin, “Evening Primrose Oil for Labor Induction: A Comprehensive Review,” Journal of Alternative Therapies in Pregnancy, 2024. Patient Information Induction of labour Women’s Services. (n.d.). Retrieved November 9, 2024, from https://www.enherts-tr.nhs.uk/wp-content/uploads/2019/10/Induction-of-Labour-v5-09.2020-web.pdf
Is Performing a C-Section Better Than Inducing Labour, when it comes to giving birth, usually the preferred option is to let labour proceed naturally. However, there are times when it is not in the mother or baby’s interest for this to happen. When the health of either is at risk, or if gestation has exceeded [41 weeks duration,](https://nabtahealth.com/articles/doctor-tips-weeks-27-40/) then it is highly probable that an alternative strategy will need to be implemented. There are two options available, [inducing labour](../) or performing a [C-section](../). With an induction, the [uterus](https://nabtahealth.com/glossary/uterus/) is artificially stimulated to contract, and it is then hoped that labour will proceed as per a natural delivery. In contrast, a C-section is a surgical procedure, whereby a cut is made in the abdomen and the baby is removed that way, rather than via the [vagina](https://nabtahealth.com/glossary/vagina/). Sometimes the only safe option is to perform a C-section, for example if the baby is breach, or when an emergency situation arises. However, there are other times when you may be presented with a choice and if this happens, what is the correct answer? Unfortunately there is no definitive right answer. An induction can be at least as safe as spontaneous labour and, if performed in the week prior to the [due date](https://nabtahealth.com/glossary/due-date/), it is thought to reduce [the risk of](https://nabtahealth.com/articles/what-is-preeclampsia/) [preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) in the mother and respiratory distress in the child, possibly as a result of the [placenta](https://nabtahealth.com/glossary/placenta/) remaining fully functional. Unlike C-sections, inductions are not surgical procedures and thus, if all goes to plan, the recovery period is shorter. It is however, a big ‘IF’. [Induced labours](https://nabtahealth.com/articles/induction-of-labour/) are typically more painful, meaning more women will request stronger pain relief including epidurals, and there is a greater likelihood of assisted delivery, such as the use of forceps or ventouse. There is also an increased [risk of hyperstimulation](https://nabtahealth.com/articles/what-is-ovarian-drilling/) of the [uterus](https://nabtahealth.com/glossary/uterus/)., Uterine hyperstimulation causes more frequent, longer [contractions](https://nabtahealth.com/glossary/contraction/), which can [lead](https://nabtahealth.com/glossary/lead/) to complications such as foetal heart rate abnormalities and, in rare cases, uterine rupture. In a significant number of women, induction does not work and a C-section becomes necessary. The advent of the C-section was undoubtedly a medical revolution, instantly saving the lives of millions of women and children. However, C-sections bring with them all the risks of regular surgery, including blood clots, wound infection and bleeding. The recovery period is typically longer after a C-section than after a natural birth, driving restrictions are enforced and a scar remains, although this will fade over time. Whilst current guidelines stipulate that an induction should only be performed when [the risks of continuing the pregnancy](https://nabtahealth.com/articles/complications-during-pregnancy-polyhydramnios/) outweighs the benefits, with more women than ever requesting elective C-sections, the World Health Organisation has highlighted an urgent need for medical assessment efforts to address the risks of induced labour compared to elective C-section. Until such work is undertaken, it becomes a matter of individual circumstance, personal choice and ultimately weighing up what is best for you and your baby. **Sources:** * Grobman, W A, et al. “Labor Induction versus Expectant Management in Low-Risk Nulliparous Women.” _The New England Journal of Medicine_, vol. 379, no. 6, 9 Aug. 2018, pp. 513–523., doi:10.1056/NEJMoa1800566. * WHO Recommendations for Induction of Labour. World Health Organisation, [http://apps.who.int/iris/bitstream/handle/10665/44531/9789241501156\_eng.pdf?sequence=1](http://apps.who.int/iris/bitstream/handle/10665/44531/9789241501156_eng.pdf?sequence=1). Accessed on 23/01/2019. * _Inducing Labour. Clinical Guideline \[CG70\]_. NICE (National Institute for Care and Health Excellence), July 2008, www.nice.org.uk/guidance/cg70/chapter/Introduction. Accessed on 23/01/2019
* Jasmine Collin from [Love Parenting UAE](https://www.loveparentinguae.com/), Nabta Health’s hypnotherapy partner, takes us through her guide to all things Hypnobirthing. * Learn how Hypnobirthing supports natural birth, reducing pain and creating an optimal environment during labour. * Nabta’s aim to empower women to reach their health goals as naturally as possible is very much in line with Jasmine’s approach and the benefits of hypnotherapy in labour. * Book Jasmine’s popular online Hypnobirthing course [here.](https://nabtahealth.com/product/the-love-birthing-hypnobirthing-course/) You may have heard of hypnobirthing due to its increasing popularity with expecting parents and [celebrities such as Jessica Alba and Angelina Jolie.](https://www.madeformums.com/pregnancy/celebrity-mums-who-used-hypnotherapy-in-labour/) It’s even been suggested that royal family members, Kate Middleton and Meghan Markle used it to prepare for their births – but what exactly is it and why are so many women turning to Hypnobirthing? **What is Hypnobirthing?** Hypnobirthing is a childbirth preparation method taken as a set of weekly classes either in groups or privately, any time between 20-35 weeks of pregnancy. There are lots of styles of Hypnobirthing available today but they all originate from the Mongan Method, which is over 30 years old. There are also online Hypnobirthing classes available too There are a lot of [misconceptions as to what Hypnobirthing](https://www.loveparentinguae.com/single-post/2019/10/07/why-there-is-no-such-thing-as-a-hypnobirth) is and the type of person who chooses it. Many think it’s just for hippy types wanting a home or [water birth](https://nabtahealth.com/glossary/water-birth/) or those seemingly crazy women who want to do it without pain relief, but the truth is, all women can use it to have a calmer more positive birth experience, no matter what birth they choose or what path it takes. **What is the aim of Hypnobirthing?** One of the aims of Hypnobirthing is to support and increase the likelihood of physiological birth with the least amount of chemicals and interventions wherever possible. However if drugs or medical interventions are truly needed it enables the couple to remain calm and make informed evidence based decisions for themselves and their baby. #### **What are the benefits of natural physiological birth?** Studies have shown us that women and babies who have natural physiological births benefit from better health outcomes, adjustment to life outside the womb, emotional satisfaction with the birth experience and being able to cope well with the transition to motherhood. Read more about [physiological birth](http://www.birthtools.org/What-Is-Physiologic-Birth) and its benefits for families and society as a whole. Hypnobirthing promotes births that mirror nature as closely as possible so that babies and families can get off to the best start possible. #### **What if natural birth is not possible?** Unfortunately, natural physiological birth is not always possible in our current birth culture. There are a large number of influencing factors that we can’t control and birth can be quite unpredictable. So it’s important to acknowledge the wide range of birthing styles, combinations of drugs, interventions and different experiences that can happen, so we can fully prepare couples for all eventualities. The great news is that the knowledge and techniques learnt in Hypnobirthing classes are applicable in all situations and in all types of birth. In fact the tools can be even more useful in assisted births like C- sections, epidurals and inductions etc. because they keep the mother and baby calm during potentially more stressful events. #### **Real Hypnobirthing stories** Here are a few birth stories from parents who had all types of birthing experiences and how Hypnobirthing helped them through. [The induction for](https://babyandchild.ae/uae-birth-guide/article/1523/labour-was-more-powerful-and-beautiful-than-i-could-have-imagined) [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) one [The induction and low](https://www.jasminecollin.com/single-post/2019/05/06/Taylors-Birth---A-calm-positive-tale-of-thrombocytopenia-induction-low-fluid-and-more) [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/) one [The planned gentle C-section one](https://www.jasminecollin.com/single-post/2017/04/16/Hanis-Birth---A-Family-Centred-Cesarean) [The one with no progress](https://www.jasminecollin.com/single-post/2017/05/04/Charleys-Birth) [The big baby one](https://babyandchild.ae/uae-birth-guide/birth-stories/article/1372/how-hypnobirthing-helped-me-give-birth-to-my-5kg-baby-drug-free) [The unplanned C-section one](https://www.jasminecollin.com/single-post/2015/05/10/10-Healthy-Foods-That-Calm-DeStress) [The VBA2C (Vaginal Birth after 2 C sections) one](https://www.jasminecollin.com/single-post/2017/04/23/Marsels-Birth---A-VBA2C-Story) [The planned vaginal](https://www.jasminecollin.com/single-post/2017/08/13/Phoenix-Willows-Breech-Birth) [breech](https://nabtahealth.com/glossary/breech/) one [The unplanned vaginal](https://www.jasminecollin.com/single-post/2017/01/26/Georges-Breech-Birth) [breech](https://nabtahealth.com/glossary/breech/) one As you can read in the birth stories, Hypnobirthing can benefit mothers and babies in all situations – but it’s not just them that benefit. Let’s not forget the partners. These days’ partners are not just welcome in the delivery room; they are expected to support the mother during labour and birth. However, without adequate training this can throw them into an environment and situation that they are not adequately prepared for. In Hypnobirthing classes partners gain invaluable knowledge and skills that they can apply in the birthing room to ensure a positive birth experience for the mother, baby and themselves. And the benefits don’t just stop in the birthing room. Lots of couples continue to use the tools for relaxing the mind and body long after the birth is over. Read- [7 surprising reasons to do Hypnobirthing that have nothing to do with birth](http://www.loveparentinguae.com/single-post/2017/08/02/7-Surprising-Reasons-To-Do-Hypnobirthing-Classes-That-Have-Nothing-To-Do-With-Birth) #### **So how does Hypnobirthing work exactly?** **During pregnancy** It empowers couples with the knowledge and belief that women’s bodies are designed to grow and birth their babies and that childbirth is a natural physiological process. It promotes healthy nutrition and physical exercise in pregnancy as being key factors in having a safe and easier birth as well sharing top tips on how to get the baby into the optimal position for birthing. Like any big physical event such as running a marathon or climbing a mountain, it’s not just physical preparation that makes the difference. Yes, physical fitness plays a big part, but a positive mindset and being emotional fit is just as important, and this is where Hypnobirthing comes in. Hypnobirthing de-hypnotises couples from all the negative information and fear that they’ve been conditioned with all their lives and updates their mindset through guided visualisations, affirmations and fear release work, all while they are very deeply relaxed or ‘in hypnosis’. Being in a natural state of hypnosis, promotes deep relaxation and being open to suggestion, so during pregnancy we can give the mind set an upgrade by accessing the sub conscious mind and reprograming it with more positive beliefs, thoughts and feelings about birth. When pregnant woman are calm and feel fully supported, their babies, who are literally swimming in their emotions, also feel the benefits. During classes there is also a focus on pre birth family bonding and this helps couples to adjust to their new roles and embrace early parenthood more easily. #### **Hypnobirthing during labour & birth** When a woman goes into labour with less fear and more understanding of how her body works and what it’s doing at each stage she can accept it more easily and experience it in a more positive way. When she relaxes and welcomes the sensations, rather than fighting them, they can then become easier to manage. Practically speaking Hypnobirthing teaches couples how to maximize the normal physiological birth process by creating the optimal environment for birth. Humans are biologically programmed in the same way that all mammals are and our birth environment needs are very similar. All mammals birth more easily in safe, warm, dark, private, quiet and undisturbed settings where there is no rush and no feeling of being watched or observed. In this ideal setting the perfect and natural combination of birthing hormones can be released and labour can progress. If however there is any sense of a potential threat or disturbance, our fight or flight response can release hormones that will slow or even stop labour. Even a bright light or a cold room is enough to slow down labour. It’s not always possible to control the external environment though, for example when driving to the hospital or in a typical hospital room, where it’s normally bright, busy and rushed, with lots of observation, disturbances and possible fear triggers. Hypnobirthing skills are crucial in these less than optimal settings because they enable the mother to create a calm and resourceful internal mental state. Using her practiced breathing, visualisations, affirmations and hypnosis she can bring her body and mind into a deep state of relaxation as if she were in the ideal environment. The body cannot tell the difference between real and imagined, so she can use this mind-body hack to convince her body that it’s a safe space and a good time to be birthing her baby. The body then continues releasing the perfect cocktail of hormones for a quicker, easier and more natural birth. #### But what about the pain? A birthing mother automatically reduces pain by being calmer and less frightened of the birth, and in calm, safe settings the birthing body naturally produces [endorphins](https://nabtahealth.com/glossary/endorphins/), our own natural pain relief, to help us cope with the intense physical sensations. In addition, Hypnobirthing mums can use hypnosis to disrupt and change the way that their brain processes pain signals. They also learn mental coping strategies and physical comfort tools to deal with any discomfort that they feel. All these factors make it less likely that they will need pain relieving drugs or unnecessary interventions and they tend to have more straightforward and quicker labours. Of course if a woman is struggling then there is a selection of pain relieving drugs that the hospital can offer. The aim of Hypnobirthing however is to ensure the couple have a complete toolbox of skills and techniques that they can utilize before getting to that point, so that it can be delayed or avoided all together. But, no matter how a baby is born or whatever interventions or drugs are used, the most important elements for every birthing mother are that: * She feels calm, safe, and supported throughout. * She feels that she did her best and gave it all she had. * She feels treated with dignity and respect. * And she was able to make her own informed choices about her baby, body and birth, every step of the way. These are the key ingredients to a positive birth experience and what Hypnobirthing is all about. Surely every mother and her family deserves this birth experience…not just the hippies. \_\_\_\_\_ Jasmine Collin is a mother of two, a qualified Hypnotherapist, NLP Practitioner, Childbirth Educator and Doula who specialises in Hypnobirthing and Parenting Originally from the UK she is the longest running teacher in the UAE and has been teaching her award winning ‘Love Birthing’ classes since 2009. She is the co founder of Love Parenting UAE, winner of the 2018 Time Out Kids Award for ‘Special recognition for pre and post natal care’ and is dedicated to helping couples have calmer, more positive births so that they can ‘Love Birthing’ no matter what kind of birth they choose or what path birth takes. For more information contact: [\[email protected\]](/cdn-cgi/l/email-protection) You can book Jasmine’s popular online Hypnobirthing services on the [Nabta Women’s Health Shop.](https://nabtahealth.com/product/the-love-birthing-hypnobirthing-course/) \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#acd5cdc0c0cdecc2cdced8cdc4c9cdc0d8c482cfc3c1) if you have any questions about this article or any aspect of women’s health. We’re here for you.
Postnatal exercise can help you recover after childbirth, make you stronger and improve your mood. Even if you’re tired and not feeling motivated, there’s plenty you can do to get your body moving. But no 2 pregnancies are the same. How soon you’re ready to start exercising depends on your individual circumstances. You should always check with a health professional first. When you feel ready to exercise, it’s very important to not overdo it. [Your body](https://www.pregnancybirthbaby.org.au/what-happens-to-your-body-in-childbirth) has been through some big changes. You will need time to recover, even if you’re feeling great after having your baby. **Why should I do pelvic floor exercises after birth?** Pelvic floor exercises are important at all stages of life to prevent bladder and bowel problems, such as incontinence and prolapse, and improve sexual function. Your [pelvic floor](https://www.pregnancybirthbaby.org.au/anatomy-of-pregnancy-and-birth-perineum-pelvic-floor) is a group of muscles which support your bladder, [](https://www.pregnancybirthbaby.org.au/anatomy-of-pregnancy-and-birth-uterus)[uterus](https://nabtahealth.com/glossary/uterus/) and bowel. These muscles form a ‘sling’ which attaches to your pubic bone at the front and your tailbone at the back. Your urethra, [vagina](https://nabtahealth.com/glossary/vagina/) and anus, all pass through the pelvic floor. In pregnancy, hormonal changes cause your muscles to soften and stretch more easily. These changes, along with the weight of your growing baby, put extra strain on the pelvic floor. Labour and birth can also weaken your pelvic muscles. This can increase the chance of suffering from [bladder or bowel problems](https://www.pregnancybirthbaby.org.au/bladder-and-bowel-problems-during-pregnancy) during pregnancy and after birth. Gentle exercise to restore your pelvic health is the best way to begin and you can gradually increase the intensity [](https://nabtahealth.com/wp-content/uploads/2023/03/Kegel-Exersices-PNG-1024x647-1.png) **What type of exercises can I do?** Do More: 1. Gentle exercise such as walking can be done as soon as you feel comfortable after giving birth 2. Start with easy exercises and gentle stretches and slowly build up to harder ones 3. Other safe exercises include swimming (once bleeding has stopped), yoga, pilates, low impact aerobics and cycling Avoid: 1. Any high intensity exercises or sports that require rapid direction changes 2. Stretching and twisting too vigorously to prevent injury 3. Heavy weights, sit ups, crunches and planks for 3 months #### Goals of a well designed Postpartum Exercise program 1. Rest and recover 2. Maintain good posture and alignment 3. Rehabilitate the pelvic floor muscles 4. Increase strength especially in the core muscles At Nabta Health Clinic, we have specialized exercise packages which include pelvic floor rehabilitation and pilates exercise program for pregnancy and the postnatal period to help you in your well being and recovery. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can [email us](/cdn-cgi/l/email-protection#235a424f4f42634d424157424b46424f574b0d404c4e) or call us at **+971 4 3946122** for more information
Many women are choosing to have a [doula](https://nabtahealth.com/what-is-a-doula-2020) present with them when they give birth. Here are some of the reasons why. **1.** **They inform you**. Having the right information about pregnancy and birth ensures you are empowered to make informed decisions for your pregnancy and birth. Prenatally, a doula will spend time with you to fill any gaps in your knowledge. They will ensure you have the information necessary to navigate birth and all the many decisions that come with. **2.** **They put your mind at ease**. Many times, all a woman needs during labour is to hear that what is happening is normal and that she is doing a great job. That can be enough to get the mother-to-be through the next contraction and on to a happy delivery. It sounds simple, but when considering the science behind hormones, it makes sense. For example, if you’re concerned that your labour is taking too long and you feel you’re not handling it well, your body will tense and release [adrenaline](https://nabtahealth.com/glossary/adrenaline/). Getting validation that everything looks normal and being reassured that you are doing an amazing job, will cause your body to relax and release [endorphins](https://nabtahealth.com/glossary/endorphins/), which act as natural painkillers and mood enhancers. A few simple words of reassurance might be all you need to release more of the right ‘helpful’ hormones and fewer stress hormones; helping you relax and ending your concerns that something is not right. At a time when you may feel quite vulnerable, having someone there who knows birth and is familiar with you, can help you feel more at ease. **3.** **Focused on you**. All their attention is on helping you achieve an empowering experience. Anyone will perform better at a task with the right encouragement and support. Doulas are trained specifically in how to make **you** the most comfortable and how to help **you** have the most positive birth experience possible. Their focus will be entirely on you and helping any other birth partners support you effectively. **4.** **The evidence of effectiveness**. The evidence behind having a doula present during labour and birth supports all the following claims : * Decrease in the risk of [Caesarean](https://nabtahealth.com/glossary/caesarean/) Section\* * Increase in the likelihood of a spontaneous vaginal birth\* * Decrease in the use of any medications for pain relief * Decrease in the baby’s risk of a low five minute [Apgar score](https://nabtahealth.com/glossary/apgar-score/) * Decrease in the risk of being dissatisfied with the birth experience\* * Shorter labours by 41 minutes on average The above results were obtained by investigating the beneficial effects of having someone present with the mother throughout her labour and delivery; this is called continuous support. Starred results indicate those where improvements were seen with a doula specifically, over all other types of continuous support, for example having a mother or sister present throughout. Comprehensive reviews on the topic of support during labour have found no evidence of any harm in having continuous labour support. However, try the Nabta [Birth Doula Package](https://nabtahealth.com/product/birth-doula-package/), and try the [Postpartum Doula Package](https://nabtahealth.com/product/postpartum-doula-support-package/) after birth. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#5029313c3c31103e313224313835313c24387e333f3d) if you have any questions about this article or any aspect of women’s health. We’re here for you. **About the author:** Yasmin loves the beauty and power of birth and wishes for every mother to experience the journey as an empowering one. Her favourite moments as a birth doula and breastfeeding counsellor are when mothers recognise and embrace their own strength. She is passionate about birth rights for women and believes the more information a mother has and the more involved she can be in the decision making around birth, the more positive her experience will be. Yasmin is a community activist in the United Arab Emirates and is running a volunteer Covid-19 Support group with over 20 professionals. Yasmin is a pioneer in change, she’s working on making birth centres a reality in the UAE, to shift the mindset around birth to one of empowerment instead of fear. She can be contacted through [DeltaStrengthDoula.com](http://deltastrengthdoula.com/). **Sources:** * Bohren, Meghan A, et al. “Continuous Support for Women during Childbirth.” _Cochrane Database of Systematic Reviews_, vol. 7, no. 7, 6 July 2017, doi:10.1002/14651858.cd003766.pub6. * Dekker, R. “Evidence on: Doulas.” _Evidence Based Birth®_, 12 Aug. 2019, evidencebasedbirth.com/the-evidence-for-doulas/.
Labour induction is when the [uterus](https://nabtahealth.com/glossary/uterus/) is artificially stimulated to start contracting. The [World Health Organisation](http://apps.who.int/iris/bitstream/handle/10665/44531/9789241501156_eng.pdf?sequence=1) recommends that labour is only induced when the expected benefits outweigh the harm, and when there is a clear medical indication for doing so; for example: * If the pregnancy reaches 42 weeks gestation. No woman should be forced to have a induction, however, all women will be offered one if their pregnancy reaches this stage. * Risk to the health of the mother; the most common being high blood pressure, which can be a warning sign of [](../what-is-preeclampsia)[preeclampsia](https://nabtahealth.com/glossary/preeclampsia/). * Risk to the health of the baby, such as a slowing in [growth rate](https://nabtahealth.com/articles/baby-development-your-newborn/). * Waters have broken, but there are no [contractions](https://nabtahealth.com/glossary/contraction/). Once the waters break, the protective barrier of the amniotic sack is lost and the risk of infection increases. An attempt should be made to artificially [induce labour](https://nabtahealth.com/articles/what-is-induced-labor/) within 24 hours. Whilst it does happen, labour should not be induced on non-medical grounds, such as a desire to deliver on a certain day. This is because with an induced labour, there is always a slightly increased risk of complications, including uterine hyperstimulation (the duration of each contraction exceeds two minutes, or the frequency of [contractions](https://nabtahealth.com/glossary/contraction/) increases to more than five in a 10 minute timespan), this can cause foetal heart rate abnormalities and a risk of uterine rupture; maternal bleeding and, in very rare cases, [foetal distress](https://nabtahealth.com/articles/conditions-that-cause-dry-skin/). Furthermore, inductions are not always successful and can be more painful than natural labour. Prior to _labour induction_ via mechanical or pharmaceutical means, a membrane sweep will usually be offered. This is where a doctor or midwife runs their finger around the neck of the [cervix](https://nabtahealth.com/glossary/cervix/), in an attempt to separate the amniotic sack from the wall of the [uterus](https://nabtahealth.com/glossary/uterus/). If successful, the release of naturally occurring [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) will trigger labour. [Prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) are hormone-like compounds that have a role in the inflammatory response. When released by the [uterus](https://nabtahealth.com/glossary/uterus/) they stimulate it to contract. If the sweep is unsuccessful, a formal induction of labour might be offered. This can be mechanical, whereby a balloon catheter is inserted into the [](https://nabtahealth.com/articles/vaginal-discharge-during-pregnancy/)[vagina](https://nabtahealth.com/glossary/vagina/) to stretch the [cervix](https://nabtahealth.com/glossary/cervix/), or pharmaceutical, whereby medication is given in oral, topical (gel) or pessary form. The two most commonly used are oxytocin, which is given orally and works well if used alongside mechanical interventions; and [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/), given topically as a gel, via a pessary, or orally. Sometimes both are given; [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) first to ripen the [cervix](https://nabtahealth.com/glossary/cervix/), they cause it to soften and thin; and then oxytocin to stimulate uterine [contractions](https://nabtahealth.com/glossary/contraction/). Additionally, if labour is slow to progress, oxytocin may be administered via a drip to increase the frequency and duration of [contractions](https://nabtahealth.com/glossary/contraction/). The safety of mother and baby remains of the utmost importance. Your health care practitioner will discuss with you the available options, including whether [induction or C-Section](https://nabtahealth.com/is-caesarean-considered-a-better-choice/) would be best. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Enjoy Nabta’s [the love birthing course](https://nabtahealth.com/product/the-love-birthing-course/) and learn more. Get in [touch](/cdn-cgi/l/email-protection#463f272a2a270628272432272e23272a322e6825292b) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Pierce, S, et al. “Clinical Insights for Cervical Ripening and Labor Induction Using [Prostaglandins](https://nabtahealth.com/glossary/prostaglandins/).” _AJP Reports_, vol. 8, no. 4, Oct. 2018, pp. e307–e314., doi:10.1055/s-0038-1675351. * _Inducing Labour_. NHS, 27 Feb. 2017, [www.nhs.uk/conditions/pregnancy-and-baby/induction-labour/](http://www.nhs.uk/conditions/pregnancy-and-baby/induction-labour/). * WHO Recommendations for Induction of Labour. World Health Organisation, [http://apps.who.int/iris/bitstream/handle/10665/44531/9789241501156\_eng.pdf?sequence=1](http://apps.who.int/iris/bitstream/handle/10665/44531/9789241501156_eng.pdf?sequence=1). Accessed on 23/01/2019.
\***_According to Patient Feedback_** “Who are the best gynaecologists in Dubai? Can anyone recommend an OBGYN?” You asked us and we turned the question back to you. We have compiled the top 10 gynaecologists in Dubai, based only on real patient recommendations, experience and feedback. No healthcare professionals were questioned. Gathered from exemplary recommendations across Dubai social media forums, these top 10 gynaecologists in Dubai not only have a wealth of clinical expertise in their field, they also stand out for the overwhelmingly positive comments from their patients. #### **Dr Salma Ballal, Consultant Obstetrics and Gynaecology, [Genesis Healthcare Center](https://www.genesis-dubai.com/our_doctors/dr-salma-ballal/)** Having delivered well over 1000 babies, Dr Salma Ballal has extensive experience in managing normal and complex pregnancies and deliveries. Dr Salma trained in obstetrics and gynaecology with the UK’s NHS where she developed a strong interest in maternal medicine, high-risk pregnancies, and labour care. She completed advanced maternal medicine and labour ward practice training with the Royal College of Obstetrics and Gynaecology (RCOG) before moving to Dubai in 2014. Dr Salma was most recently at Mediclinic Parkview hospital before joining the Genesis Healthcare Center team. Dr Salma believes in open communication with her patients and that “women should be kept informed through every step of what is the most amazing experience in any woman’s life.” She also offers pre-pregnancy counselling to patients with complicated or traumatic pregnancy history. Patients describe Dr Salma as “refreshingly honest”, and “very safe hands”, saying she “totally respected my wishes”. #### **Dr Esra Majid, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Kings’ College Hospital Dubai**](https://kingscollegehospitaldubai.com/dr/esra-mejid/) Based in Dubai since 2016, Dr Esra has built a reputation for her management of high-risk pregnancies and gynaecological conditions. She worked at Al Zahra Hospital Dubai, where she regularly received excellent feedback from her patients, before moving to King’s College Hospital Dubai. At Kings’ College Hospital Dubai Dr Esra “performs major surgical procedures, follow up of high-risk pregnancies and deliveries, along with natural and water births.” Dr Esra qualified in Baghdad and went on to complete her Board Certificate in Obstetrics and Gynaecology in Sweden. She worked at the teaching hospital Sundsvall County Hospital and as a specialist at Sodra Alv Bord Hospital in Gothenburg before moving to Dubai. Patients have praised Dr Esra for her expertise and skill, describing her as “straight to the point, warm and approachable.” #### **Dr Vibha Sharma, Specialist [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Prime Medical Center**](https://www.primehealth.ae/prime-medical-centers/medical-centers/prime-medical-center-sheikh-zayed-road/dr-vibha-sharma) Working in Dubai since 2004, Dr Vibha is known for her commitment to supporting women with a range of gynaecological and women’s health problems. In the UAE she worked at Ministry of Health and Tertiary Care hospitals prior to joining Prime Medical Center. Dr Vibha specialises in areas of women’s health requiring specialist gynaecological expertise. Qualified in India at Jammu Medical College, Dr Vibha went on to do her post-graduate at King George’s Medical College in Lucknow. She worked at Queen Mary’s Hospital Lucknow and Willingdon and Batra Hospitals and Research Centre in New Delhi before moving to the Middle East. Patients have described Dr Vibha as “consistent”, “approachable”, and “professional”. **Dr Aisha Alzouebi, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic Parkview Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/aisha-alzouebi-dr.html) Dr Aisha Alzouebi has more than 15 years of experience in obstetrics and gynaecology in the UK and the UAE, with specialist expertise in “early pregnancy, management of complications in early pregnancy, family planning and sexual health, [benign](https://nabtahealth.com/glossary/benign/) open and laparoscopic surgery and hysteroscopy.” A member of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), Dr Aisha attended medical school at Sheffield University and completed her Masters in Surgical Education at Imperial College London. Patient social media feedback on Dr Aisha said, “she was brilliant”, “I would highly recommend her”, “Dr Aisha is great”. #### **Dr Reeja Mary Abraham, Specialist in Obstetrics and Gynaecology,** [**Medcare Women and Children Hospital**](https://www.medcare.ae/en/physician/view/reeja-mary-abraham.html) A specialist in high-risk pregnancies, Dr Reeja takes an “evidence-based” approach to complex and low risk gynaecological issues. Dr Reeja is based at Medcare Women and Children Hospital, where she also “performs and assists in major and minor gynaecological procedures”. A member of the Indian Medical Association (IMA) and the Kerala Federation of Obstetricians and Gynaecologists (KFOG), Dr Reeja began her medical career at Christian Fellowship Hospital in Oddanchatram, Tamil Nadu and worked in hospitals in Kerala and Tamil Nadu before moving to Dubai to work at Medcare Women and Children Hospital. Patients recommending Dr Reeja describe her as “kind and attentive”, “highly professional”, and “detail-oriented”. #### **Dr Nashwa Abulhassan, Head of Obstetrics and Gynaecology, Dr** [**Sulaiman Al Habib Hospital Healthcare City**](https://www.hmguae.com/doctor/dr-nashwa-abul-hassan/) Dr Nashwa is a specialist in normal and complex pregnancies and deliveries, as well as “acute gynaecology and early pregnancy complications management” based at Dr Sulaiman Al Habib Hospital Healthcare City. A member of the Royal College of Obstetricians and Gynaecologists (RCOG) and an accredited member of the British society of colposcopists and cervical pathologists, Dr Nashwa has more than 15 years of experience in the UK and the UAE. Dr Nashwa has been featured in the UAE media discussing pregnancy complications and was most recently in [Gulf News](https://gulfnews.com/uae/health/step-by-step-guide-to-dealing-with-covid-19-during-pregnancy-1.80112211), offering advice for pregnant women who have tested positive for Covid-19. Dr Nashwa’s patients describe her as “kind and caring”. #### **Dr Samina Dornan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/) and sub specialist in Maternal Fetal Medicine, [Al Zahra Hospital](https://azhd.ae/doctors/dr-samina-dornan/#:~:text=Consultant%20Maternal%20and%20Fetal%20Medicine,London%20to%20come%20to%20Dubai.)** An established international voice on maternal and fetal health issues, Dr Samina Dornan has extensive experience in fetal medicine. At Al Zahra Hospital she works as a consultant [obstetrician](https://nabtahealth.com/glossary/obstetrician/) and gynecologist with a sub-specialty in Maternal Fetal Medicine. Dr Samina qualified at Queen’s University Belfast. She received a fellowship from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2017 and is the “first female Maternal Fetal Medicine sub-specialist \[at RCOG\]” to work with patients in Dubai. Frequently quoted in the media, Dr Samina is “extensively published in complex twin pregnancies”. Patient feedback on Dr Samina is overwhelmingly positive, describing her as “wonderful”, “absolutely fantastic”, “caring” and “amazing”. #### **Dr Sarah Francis, Consultant Obstetrics and Gynaecology,** [**American Hospital Dubai and American Hospital Al Khawaneej Clinic**](https://www.ahdubai.com/doctors-profile/sarah-francis) With clinical expertise in general and [benign](https://nabtahealth.com/glossary/benign/) gynaecology, adolescent gynaecological issues, polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), and low and high-risk pregnancies, Dr Sarah supports patients at American Hospital Dubai and American Hospital Al Khawaneej Clinic. A member of the Royal College of Obstetricians and Gynaecologists (RCOG), Dr Sarah qualified in Sierra Leone and practised in NHS hospitals and trusts across the UK before moving to the UAE. She worked with patients at Drs Nicholas and Asp clinics before joining the team at American Hospital. Patients say that Dr Sarah is “wonderful” and “exceptionally supportive”. #### **Dr Dragana Pavlovic-Acimovic, Specialist Obstetrics and Gynaecology,** [**Mediclinic Meadows**](https://www.mediclinic.ae/en/corporate/doctors/8/dragana-pavlovic-acimovic.html) Dr Dragana has “a special interest in obstetrics” and consults on “adolescent gynaecology, [menopause](https://nabtahealth.com/glossary/menopause/), family planning” and various gynaecological conditions. Dr Dragana qualified in Serbia and started her career at University Hospital Narodni Front in Belgrade, “the largest specialised obstetrics and gynaecology centre in South-East Europe”. She moved to Dubai in 2015 and worked at Drs Nicholas and Asp before joining Mediclinic. Patients’ experience with Dr Dragana is “great”. #### **Dr Alessandra Pipan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic City Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/alessandra-pipan.html) With more than 30 years’ experience in gynaecology and obstetrics Dr Alessandra treats a range of gynaecological conditions, is a specialist in [infertility](https://nabtahealth.com/glossary/infertility/) and oncology, and works with high-risk pregnancies at Mediclinic City Hospital. A member of the Royal College of Obstetrics and Gynaecology (RCOG), the European Society of Reproduction and Embryology, and the European Society of Gynaecological Endoscopy, Dr Alessandra qualified at Cattolica University of Rome, Italy and has developed extensive sector experience in positions across the Italian and UAE healthcare institutions. Patients of Dr Alessandra have described her as “great” and “amazing”. \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#fc859d90909dbc929d9e889d94999d908894d29f9391) if you have any questions about this article or any aspect of women’s health. We’re here for you.
[Placenta Previa](https://nabtahealth.com/glossary/placenta-previa/), or low lying [placenta](https://nabtahealth.com/glossary/placenta/), is a condition where the [placenta](https://nabtahealth.com/glossary/placenta/) either partially or completely covers the [cervix](https://nabtahealth.com/glossary/cervix/). It affects approximately 5 in every 1000 pregnancies globally, with the highest prevalence seen in Asian women, suggesting a genetic predisposition towards the condition. Alternative factors that increase the risk of [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) include uterine scarring, possibly as a result of pre-pregnancy surgery, such as [fibroid removal](../treating-fibroids); and previous [](https://nabtahealth.com/is-caesarean-considered-a-better-choice/)[caesarean](https://nabtahealth.com/glossary/caesarean/) section (C-section). The more C-sections a woman has had, the greater her risk of developing [placenta previa](https://nabtahealth.com/glossary/placenta-previa/); 1 prior C-section has an odds ratio of 4.5, however, 4 prior C-sections increases the ratio to 44.9. The association between surgical scarring of the [uterus](https://nabtahealth.com/glossary/uterus/) and [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) appears to be driven by the [placenta](https://nabtahealth.com/glossary/placenta/) preferentially implanting at these sites. Fortunately, in 90% of cases, as the pregnancy progresses, the [placenta](https://nabtahealth.com/glossary/placenta/) migrates to an area with a richer blood supply. The earlier in a pregnancy that [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) is identified, the more likely it is to self-resolve. #### **What are the risks associated with [placenta previa](https://nabtahealth.com/glossary/placenta-previa/)?** The greatest risk to a mother who develops [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) is prolonged, heavy vaginal bleeding. As well as causing emotional distress, this can have serious medical repercussions and, in cases of severe haemorrhage, necessitate a [blood transfusion](https://nabtahealth.com/glossary/blood-transfusion/). Bleeding can occur before, during or after birth. If it happens during pregnancy, it is likely that bed rest will be recommended for the remainder of the pregnancy. There is no substantial evidence to support hospitalisation; however, if there are repeated episodes of bleeding, frequent hospital trips are likely. If the bleeding becomes heavy and cannot be managed, it may be necessary for the mother to undergo an emergency C-section. All females diagnosed with [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) should be treated at high-risk labour and delivery units, with experienced staff on hand. It is difficult to ascertain precisely if and when bleeds will occur, and how serious they will be. Appropriate preparation for every eventuality is key. #### **Do all women with [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) require a C-section?** The short answer is no, not all women diagnosed with [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) will require a C-section. It largely depends on how much of the [cervix](https://nabtahealth.com/glossary/cervix/) is covered. [Placenta previa](https://nabtahealth.com/glossary/placenta-previa/) is best diagnosed using [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/), as this enables measurement to the nearest mm. The doctor will use these findings to categorise the condition as complete, partial or marginal. Marginal cases resolve themselves up to 98% of the time, meaning that in the majority of instances (assuming there are no additional complications) a vaginal birth will be possible. Women who have complete [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) will be advised to undergo an elective C-section. As the body prepares itself for birth, the [cervix](https://nabtahealth.com/glossary/cervix/) naturally starts to open. If this happens whilst the [placenta](https://nabtahealth.com/glossary/placenta/) is lying across the opening, the [placenta](https://nabtahealth.com/glossary/placenta/) may start to split, causing internal bleeding, which can be very dangerous for the mother. There is also a risk of extensive haemorrhaging during and after birth and so, in cases of complete [placenta previa](https://nabtahealth.com/glossary/placenta-previa/), a vaginal birth will be considered too risky and a C-section will be scheduled. Ideally, this will occur after 36 weeks, which is the point at which the baby’s lungs are considered to be fully developed. If an earlier delivery becomes necessary, corticosteroid injections will likely be offered, to speed up lung maturation. #### Partial [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) Partial [placenta previa](https://nabtahealth.com/glossary/placenta-previa/) is less definitive and the decision as to whether or not to undergo a C-section will likely involve significant consultation and evaluation between doctor and patient. Original guidelines stated that only if the edge of the [placenta](https://nabtahealth.com/glossary/placenta/) was more than 20 mm from the cervical opening (the internal os, also known as the orifice of the [uterus](https://nabtahealth.com/glossary/uterus/)) should natural labour be attempted. If the edge of the [placenta](https://nabtahealth.com/glossary/placenta/) is within 10 mm of the internal os, most doctors will still recommend a C-section over a vaginal delivery, as the risk of bleeding remains high. The area of uncertainty is when the [placenta](https://nabtahealth.com/glossary/placenta/) lies between 11 and 20 mm from the internal os. One study found that of the women who fell into this category and opted to attempt a natural delivery, more than 90% delivered safely without significant bleeding. One thing to bear in mind when making a decision is that elective C-sections are a far safer option than emergency C-sections. Ultimately, the health of the mother and unborn baby comes first and a good doctor will advise accordingly. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#7a031b16161b3a141b180e1b121f1b160e1254191517) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Al Wadi, K, et al. “Evaluating the Safety of Labour in Women With a Placental Edge 11 to 20 Mm From the Internal Cervical Os .” _Journal of Obstetrics and Gynaecology, Canada_, vol. 36, no. 8, Aug. 2014, pp. 674–677., doi:10.1016/S1701-2163(15)30508-9. * Eichelberger, K Y, et al. “[Placenta Previa](https://nabtahealth.com/glossary/placenta-previa/) in the Second Trimester: Sonographic and Clinical Factors Associated with Its Resolution.” _American Journal of Perinatology_, vol. 28, no. 9, Oct. 2011, pp. 735–739., doi:10.1055/s-0031-1280853. * Johnson, S. “Low-Lying [Placenta](https://nabtahealth.com/glossary/placenta/) ([Placenta Previa](https://nabtahealth.com/glossary/placenta-previa/)).” _Healthline_, 22 Sept. 2016, [www.healthline.com/health/](http://www.healthline.com/health/placenta-previa)[placenta](https://nabtahealth.com/glossary/placenta/)\-previa. * Rowe, T. “[Placenta Previa](https://nabtahealth.com/glossary/placenta-previa/).” _Journal of Obstetrics and Gynaecology, Canada_, vol. 36, no. 8, Aug. 2014, pp. 667–668., doi:10.1016/S1701-2163(15)30503-X.
If you are pregnant with your first baby, your doctor or midwife has likely told you that [contractions](https://nabtahealth.com/glossary/contraction/) can be a sign of labor and that at a certain point, you should come to the hospital to be seen. But how exactly do you time them, and how do you know when it’s the real thing? In general, most providers will go by the 5-1-1 rule. This means that if your [contractions](https://nabtahealth.com/glossary/contraction/) are 5 minutes apart (or less) and last for about 1 minute—and this has all been going on for 1 hour—then this could very well be labor, and you should give the hospital a call. It’s important to realize that this rule applies to women who are term (37 weeks or more along). Women who are preterm should check in if they are having [contractions](https://nabtahealth.com/glossary/contraction/) that are strong and somewhat regular, even if they aren’t every 5 minutes. This could be a sign of preterm labor and as such, your doctor or midwife would want to know much sooner than waiting until they are this frequent. For most women, a contraction feels like a tightening across the lower abdomen. Many describe it as a severe menstrual cramp. Pain in the lower back can also be common, and it can also be accompanied by intense vaginal pressure. True labor [contractions](https://nabtahealth.com/glossary/contraction/), in general, will be difficult to talk through, as compared to [Braxton Hicks](https://nabtahealth.com/glossary/braxton-hicks/), which might be noticeable but not really painful. To time a contraction, note the time that one begins and ends to figure out how long they last. Write down the start time of each one to figure out how often they are coming. You can do this the old-fashioned way with paper and pen, or use any pregnancy app that will automatically track this for you. The real labor is usually pretty intense. This means that while you may have an hour of [contractions](https://nabtahealth.com/glossary/contraction/) every 5 minutes that are noticeable but don’t hurt, it might not be the real thing yet. It’s perfectly OK to check in with your obstetric provider, but they may not have you come in until they really take your breath away. On the other hand, if you live very far away, have a history of fast labors, or have any high-risk complications, you may be told to come in sooner rather than later. You may notice that [contractions](https://nabtahealth.com/glossary/contraction/) start-up and really hurt for 20 minutes only to space out after that – and this might really discourage you. While this means that you are probably not in true labor yet, don’t worry! Your body is preparing, and it may start up soon. Take this time to rest up, make sure your hospital bag is packed and set up any child care that might be needed. If you are worried about managing [contractions](https://nabtahealth.com/glossary/contraction/), hypnobirthing is a way to help a woman deal with any fear or anxiety she may have around birth by using tried and test relaxation techniques. Explore [The Love Birthing Hypnobirthing course](https://nabtahealth.com/product/the-love-birthing-hypnobirthing-course/) from the comfort of home. Powered by Bundoo®
Giving birth vaginally can result in [vaginal tearing](https://nabtahealth.com/articles/how-to-care-for-an-episiotomy-or-tear-after-delivering-vaginally/) or lacerations for many women. This is part of the normal process of a baby passing through the birth canal and out the [vagina](https://nabtahealth.com/glossary/vagina/). It tends to be more common in women giving birth for the first time or among those who have larger babies. Sometimes, episiotomies are done to make delivery easier and to avoid tearing. After you give birth and the [placenta](https://nabtahealth.com/glossary/placenta/) is delivered, your doctor or midwife will look at the outside of your [vagina](https://nabtahealth.com/glossary/vagina/) (also known as the vulva and perineum) as well as the inside to see if any tears are present. This can be entirely pain-free if you have an [epidural](https://nabtahealth.com/glossary/epidural/) that is blocking these nerves or a little uncomfortable if you did not use any pain medications or if your [epidural](https://nabtahealth.com/glossary/epidural/) is not blocking this area as well (and it doesn’t always). #### Here are the different kinds of tears you can have: ##### 1\. Periurethral tears. These are [tears that are around your urethra](https://nabtahealth.com/articles/how-to-care-for-an-episiotomy-or-tear-after-delivering-vaginally/), or the opening where urine comes out. These usually only need to be sutured (or stitched up) if they are bleeding, otherwise, they often heal well on their own. Very small stitches are used so that you won’t have any difficulty urinating, but if there is any concern that you won’t be able to (either because of swelling or where the stitches are placed), a catheter may be placed in your bladder at first to help your bladder drain. ##### 2\. First-degree lacerations. These can occur inside the [vagina](https://nabtahealth.com/glossary/vagina/) or outside on the perineum. The degrees mentioned here relate to how [deep the tears](https://nabtahealth.com/articles/how-to-care-for-an-episiotomy-or-tear-after-delivering-vaginally/) are. A first-degree tear is only when the skin tears, with everything beneath it being intact. If bleeding, these can be repaired with stitches. These stitches dissolve and do not need to be removed. Many women often ask how many stitches they are getting, and usually, it is one long continuous one rather than a bunch of smaller ones, so there usually isn’t a total “number.” ##### 3\. Second-degree laceration. This is deeper than a first-degree tear and is when both the skin and muscle below tear as well. These kinds of tears are very common and again are simply repaired with a long dissolvable stitch. ##### 4\. Third-degree laceration. This deeper tear is when the skin and muscle tear, as well as part of the external anal sphincter. This sphincter is a band of muscle that functions to help hold stool in. Additional stitches are placed to help bring this sphincter back together. Women who have this kind of tear are often put on stool softeners to help avoid [constipation](https://nabtahealth.com/glossary/constipation/) since this can be painful and can disrupt the stitches. Sometimes these women also need stronger pain medication to help as they heal, too. ##### 5\. Fourth-degree laceration. This is the deepest tear of all after giving birth is when the tear extends completely into the rectum so that there is a direct passage from the [vagina](https://nabtahealth.com/glossary/vagina/) into the rectum. Additional layers of the suture are used to help close this backup and separate the [vagina](https://nabtahealth.com/glossary/vagina/) from the rectum. Since this can take longer to repair, requires the [obstetrician](https://nabtahealth.com/glossary/obstetrician/) to be able to see things very clearly, and can be painful, many times this kind of repair is done in an operating room with the woman receiving either a higher dose [epidural](https://nabtahealth.com/glossary/epidural/) or sedating pain medications. As with third-degree lacerations, avoiding [constipation](https://nabtahealth.com/glossary/constipation/) and good pain control are key. To avoid complications, most doctors will see these women in the office soon after delivery to make sure that [healing is appropriate](https://nabtahealth.com/product/wheroes-pelvic-disorder-treatment/). ##### **Sources:** * The American College of Obstetricians and Gynecologists * [Episiotomy](https://nabtahealth.com/glossary/episiotomy/): Procedure and repair techniques * 2007. Gabbe SG et al * Obstetrics: Normal and Problem Pregnancies * 5th ed. Powered by Bundoo®
Here are 5 diaper (or nappy!) changing questions every parents asks. We know this all seems basic, but if you are preparing for your newborn and you have not had much (if any !) experience changing diapers, then read on! **Do I have to use a diaper changing station every time I change my infant’s diaper?** -------------------------------------------------------------------------------------- No. While a dedicated diaper changing area in your home is nice and limits the potential spread of germs, the reality is that most parents will be changing diapers while on the go, at friend’s homes, in restaurants or the like. What is important is that you have all needed equipment with you: a large pad to spread out, [diapers](https://nabtahealth.com/articles/should-your-child-use-cloth-or-disposable-diapers/), wipes and hand sanitizer for parents. Ideally, you would also have something to wipe down the changing pad if you’ve had to lay it on the floor or on a changing station in a public bathroom. **Are there any off-limits places to change a diaper?** ------------------------------------------------------- Yes. Do not change a diaper on any surface associated with food. That includes tables, kitchen counters, and picnic blankets. Even small amounts of bacteria can be transferred from the diaper, the diaper pad, the baby, or your hands, and bacteria can put others at risk for food borne illnesses. Never take a baby out of a car seat in a moving car to change a diaper. Never leave a baby unattended or out of arm’s reach on any surface off the ground while changing a diaper. When flying, ask the flight attendant where they prefer you to change the diaper. Do the other passengers a favor and do not change the baby in a seat. **Must you wash hands after each diaper change?** ------------------------------------------------- Yes! Even with diapers that are only filled with urine, or wet diapers, we need to wash our hands afterward. Warm water and soap are ideal, but hand sanitizer works in a pinch. Once babies become squirmy toddlers, it’s also a good idea to wash their hands after diaper changes too. Use warm, soapy water, or an alcohol-free hand sanitizer on their little hands. Clean any toys that you used to keep them distracted during the diaper change. **Where do I dispose of a dirty diaper?** ----------------------------------------- It’s a great idea to keep a separate diaper disposal area when you are at home. When out of the house, keep a set of plastic bags that you can use to wrap up any used diaper, then ask where the nearest appropriate place is to put the diaper. For example, many [pediatric](https://nabtahealth.com/articles/what-is-a-pediatric-hospitalist/) offices have a specific trash bin, located out of the exam room, for dirty diapers. This keeps smell and germs isolated. **Do I need to clean my diaper bag?** ------------------------------------- Yes. It’s a good idea to periodically clean your diaper bag. For most people, diaper bags carry diapers but also snacks, toys, clothes, and other essentials. Cleaning it and the diaper pad that you use keeps germs from touching other surfaces that might wind up in or around your child’s mouth. Powered by Bundoo® — Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) [Get in touch](/cdn-cgi/l/email-protection#cce9fefcb5ada0a0ad8ca2adaeb8ada4a9ada0b8a4e2afa3a1) if you have any questions about this article or any aspect of women’s health. We’re here for you.
Many women who have a [C-section](https://nabtahealth.com/product/the-birthing-box-2/) notice a little bit of redness around their C-section incision, especially if the skin was closed with staples. Often the points where the staples enter the skin cause a small reaction and the skin may be temporarily red. However, if you notice that this redness on the C-section incision (called erythema in medical terms) is spreading or is accompanied by hardness, drainage of fluid or pus from the incision, or incisional separation, then you definitely need to be checked out to make sure you do not have a wound infection. Do not scrub at it or put on any creams or ointments in the meantime! This can often make matters worse, so it is best to talk with your [doctor or midwife](https://nabtahealth.com/articles/what-is-a-midwife/) first. Reviewed by Dr. Jen Lincoln, November 2018 Powered by Bundoo®
