No Pain, No Gain The Midwives

Hello, Ward Four. Midwife speaking.

SHE SCREAMS

Don't panic, it's going to be over soon.

With the highest birth rate in 40 years...

Look what you've done! Oh, my God!

Oh, congratulations!

BABY CRIES

..midwives are under more pressure than ever before.

You are kidding me!

We have a lady on the table in theatre waiting to come out.

We filmed in busy maternity departments

in Birmingham, Manchester and Cardiff...

6.11, I reckon.

He's about 6.11 and a half.

Oh, wow!

..as the midwives deliver the next generation...

The scary bit is, you're all going to be midwives.

THEY CHEER

..with care...

Oh, please help me.

We're here, we're here, we're here.

..and dedication.

My baby's life is in your guys' hands. That's it now.

Not good for the stress levels, this job, at all.

You'll be absolutely fine, I told you I'll be with you, OK?

It does touch you.

This is the reason we do what we do.

It's all right, it's OK.

You smell nice.

It's more than a job, it's...

you're part of somebody's life and they never forget you.

It's the start of the week on the delivery unit

at the University Hospital of Wales, in Cardiff.

WOMAN SCREAMS

It's the busiest labour ward in Wales,

delivering up to 100 babies a week.

OK, baby, welcome to Cardiff.

BABY CRIES Oh, he doesn't like that.

'Ultimately, our aim is to achieve'

a vaginal birth for women, keep them nice and healthy,

with the end result being a lovely, healthy baby.

But we're a nation struggling to cope

with the pain of natural delivery. WOMAN SCREAMS

OK, don't panic, I know it's sore, it's going to be over soon.

It's so bad! It's really bad,

but it's going to be over really soon, OK?

SHE CRIES

An increasing number of women

want drugs and anaesthetics to take the pain away.

There are women that come through the door here

who have made the decision before labour that they want an epidural.

Like maternity units across the UK,

Cardiff has seen epidurals double over the last 20 years.

Nobody wants to feel pain nowadays.

Only a quarter of women having an epidural

go on to have a natural, unassisted delivery.

I think epidurals can be seen as the easy option,

but it's not always the best option for your labour.

It prolongs labour,

and the chances for instrumental delivery is very high.

For the midwives, it's a battle to persuade women

to suffer the pains of labour.

I always say to women that, you know,

this is the only time in your life that pain's a good thing

and you get something at the end of it.

You're hurting me.

You do forget about it. Otherwise, you wouldn't come back.

Every day, women arrive on the unit believing they're in labour.

Midwife Karen Lonsdale has been a senior coordinator

for over ten years. Karen's job is to assess

which expectant mothers are actually in labour

and those who are not.

The general rule, I suppose, as a midwife,

is if you look at somebody and they're flushed,

they can't speak through their contractions,

they're bent over at the desk unable to walk,

generally, you would assume that they are in labour.

That's not always the case, the only way that you can really tell

is by examining women and seeing how dilated the cervix is.

Ruth Leonard is one of the team's most experienced midwives,

working alongside Karen for the last 15 years.

It says here... Can I just have a quick look?

She's awaiting the arrival of a young woman

who's phoned to say she's in labour.

Ten o'clock, she's contracting,

so she could well...come in and deliver the baby.

In the middle of the night,

Kayleigh and her partner, Dan, have rushed in by taxi.

Hello, Kayleigh, I'm Ruth. Pleased to meet you.

We're just down this end, would you like to follow me?

This is the second time in the last three days that Kayleigh's come in

believing she's about to have her baby.

How many false alarms have you had?

You've been in once, have you? Once, yeah. OK.

OK, let's hope it's the real thing this time. Feel good?

Yeah, fingers crossed.

I'm not going home without a baby.

Kayleigh isn't due for another two weeks,

but both her previous two children came early.

Contractions feel good.

Woo-hoo! It could be this time,

but we won't know for sure until I assess things

and see what's happening.

I think this is labour.

The contractions are good, it just feels right,

the baby's head is low...

But obviously, I won't be able to say 100%

until I examine her internally and find out how open her cervix is.

But I think this is it.

This birth, I'd like it to be like my last one.

An hour and 40 minutes, or less.

Recently married,

this will be Kayleigh's first baby with care worker Dan.

We met a year ago on social networking sites.

On Facebook. Yeah, Facebook.

SHE LAUGHS

Facebook, then Starbucks. Yeah. And now here.

I want to cut the cord, if I can, if they let me.

I'm quite nervous about that,

but if they let me cut the cord, I'll be ecstatic with that.

Just don't pass out.

Amy Simes is a newly qualified midwife

and has been on the delivery unit for less than a year.

Hiya, Leah, is it? Yeah.

She's been assigned to 20-year-old care assistant Leah

and her partner, Bobby.

So this is your second baby? Yeah. Yeah?

So what are you feeling at the moment, then?

What... You know, you've rang up and you've said that

you're feeling contractions and things.

Yeah, every three to five minutes.

If it's OK with you, I'd like to have a feel of your tummy.

If you're not in labour at the moment,

we would probably recommend at this stage

that you go back home... Yeah. ..and try to relax

until things really increase more again, all right? Yeah.

Well, you seem to be coping really well, you know...

That makes me think that I'm not in labour then.

No, not necessarily.

Everyone copes differently,

and I think sometimes on your second baby, third baby,

you're more experienced then.

So you've had one delivery, you know what the pain's going to feel like,

you know what to expect,

and so often, you can deal with it a little bit better.

OK. All right? So if you're not in labour yet,

you're sort of making slow progress towards the way. OK.

All right? So don't be too disheartened.

'Some people, I think they tend to worry a little bit.'

I mean, nobody wants to deliver a baby at home, do they, really?

And I think there's a security feeling of being in hospital,

if that was your planned intention.

Women contract very well in their own environment

and then any transfer to hospital or any kind of emotional stress

and those contractions then taper off

and the process of labour actually slows down,

so any woman that comes in and isn't in labour,

then home is certainly the best place for them to be.

Ruth must examine Kayleigh to see if she's in established labour.

So, obviously, if you're not in labour,

then you're going home, I think.

I hope this is it now for you.

Yeah.

If you can bend your knees up.

That's your toe, sorry, Dan. I'm standing on his foot.

Right, so what I can feel is your waters are still there.

The baby's head is down, your cervix is open a little bit,

but, unfortunately...

I don't think you're in established labour. Yeah.

So if you wanted to go off for a little walk

and see what happens for a little bit,

if you wanted to go back home, you can.

OK, I'll just go for a walk, if that's OK?

That's fine, that's fine.

Are you disappointed?

A little. Aw!

Leah's mum, Maggie, has arrived,

anticipating the arrival of another grandchild.

Have the assessment and we'll have an indication of what's happening.

So excited!

Keep breathing, Leah, nice deep breaths.

So I'm just going to do a little assessment now, OK?

It's just a gentle internal examination.

I'll do it between contractions.

So I'll just get my bits ready.

So established labour's beyond four centimetres dilated.

Yeah, I think that's the biggest question that any, like,

any woman in labour, they just want to know.

Just give me the good news.

Do you want it to be as high a number as possible?

I think if I'm three or four, I'll be really happy with that.

Do you want to be four? Yeah.

Can you lift the sheets up for me?

So I've got some cold jelly on my fingers now,

so it's a bit of a strange sensation.

Try and relax for me, it makes the examination easier, all right? OK...

You're doing so well. OK.

You're seven centimetres dilated.

Seven? I know, I was in shock myself, cos you seem so calm.

I thought, "OK." But, yeah...

Oh, my gosh. That's really good news though.

So that means you're in labour and obviously,

you're not going to be going home. Do you want to start gas now?

Yes, please. Yeah?

Just a little.

That's amazing!

That's literally...

All on your own, you are just amazing, aren't you?

Oh, don't rub my make up off.

I thought I was taking her home. She seems so calm and relaxed.

I was ready to come home though.

I bet you haven't been this calm and relaxed at home though, have you?

Flippin' hell. THEY CHUCKLE

Wow!

I totally didn't expect her to be seven centimetres, that's amazing.

Just goes to show sometimes, women can come in

and really look so calm and cool...

She's seven, so I'm just going to go and tell everyone what's happening

and then I'll come back and finish off with her.

Kayleigh has spent the last couple of hours doing laps of the hospital

in the hope of stimulating labour.

I think she just feels a bit deflated,

because you think, "Oh, I'm having pain,

"I've had pain since 11 o'clock last night,"

and no baby yet.

And when she had such a quick delivery with the second baby,

I think she just thought she was established in labour

when she came in and she's just a bit gutted, really.

Three hours later, Kayleigh is re-examined.

Fingers crossed.

Yeah, hopefully.

It's more or less the same as when I examined you three hours ago,

so I think what I'll do is send you down to the ward

and I'll take you off the monitor. OK. All right?

Right, are you going to come to the ward with me, then?

'I'm taking her down to the ward'

because she is frightened to go home.

Just basically, she knows we're here,

she's got a cubicle on her own and she's got midwives round her.

With Leah's labour progressing,

midwife Amy runs through her birth plan.

Leah's determined to have a natural delivery

with only gas and air for pain relief.

If you feel that the gas doesn't become enough,

the only other available options at the moment would be pethadine,

which is the injection in the leg,

and then progressing from that would be an epidural,

which is the spinal in your back that makes you numb

from the tummy down. So if you feel that the gas and air

is not enough for you at any point,

then let me know and we can talk about other options.

Leah's tag team of support has been boosted

by the arrival of her sisters, Athena and Sarah.

How you doing on there, then?

Me and my other sisters didn't look like this.

How many kids have you got?

I've got one, my other sister's got two.

We didn't look like this.

Yesterday, last night, I did my fake tan

cos I was like, "It could be any minute."

THEY LAUGH

Obviously, I'm overdue.

And then this morning, I just plastered my make up on.

I said, "As long as I can do my make up, I don't care."

I think a woman should be presentable. I don't know...

Hello. Hello.

Leah must continue with a new midwife.

Just having a contraction a minute.

Amy's shift is ending and she hands over to Cara.

She's declined any other analgesia,

she's only using entonox intermittently,

not with every contraction. OK.

You're going to come right in now and steal my lovely delivery.

THEY LAUGH

You can stay if you want! No, it's all right.

Aw!

Best of luck, guys, both of you, all right?

ALL: Bye!

Cara is also newly qualified,

starting on this unit just seven months ago.

Well done.

You're doing fab, you're doing really well.

Well done.

But just ten minutes into Cara's shift,

Leah wants to change her birth plan.

You're doing fab.

Can I have an epidural?

Do you want an epidural?

You sure, Leah? You sure?

Yeah, I think I need one.

Why? Why's that? It's so painful.

Sometimes, when you're coming up to being fully dilated,

you get this feeling of, "Oh, I can't do this any more."

And you just lose it and you think,

"Oh, I need more pain relief," or, "I don't want to do it any more,"

and you just start to feel like you're giving up.

But then, shortly after that... And we call that a transitional phase...

That's where she's reaching now?

And just shortly after that, all of a sudden,

they just start pushing.

Go on, breathe, Leah, please breathe.

I don't want to do it. Go on, breathe, Leah, come on.

You can do it, you have been doing it and you are doing it.

I want an epidural, please. I can't cope.

What I'll do... All right, darling. You're doing absolutely fab.

What I need to do, I'm just going to pop out.

Press that if you need me, and I'll just be outside having a quick chat.

That's fine. OK?

My lady is now requesting an epidural.

OK, has she been examined again? No, I was going to say,

should I just examine her again and find out what's going on?

Examine her again and see what she's doing,

then we'll have a little chat with her

and decide about what we're going to do, OK?

Baby's head is so close to delivering and it's nice and low,

so the overwhelming urge to push is going to be there.

If you start an epidural, that urge isn't always there.

In fact, in my experience, more often than not, it's not there.

'It does increase your chances of having an assisted delivery

'because she won't have the urge to push

'and she won't be doing what her body's naturally telling her to do.

'You've got to sort of feel out whether that is actually'

what she had in mind for herself because you don't want somebody

saying something in the heat of the moment

'and then you going ahead with something

'and it not actually being what they wanted,

'and for them to feel disappointed afterwards.

'And if you're responsible for that, it's not a nice feeling.'

Because initially, she didn't want to have to, you know,

have an epidural if she didn't think she needed it.

I think she would always kick herself if she had an epidural.

Well, I've just spoken to my...

Are you OK if I just explain to you?

It might be a good idea for us

to actually just re-examine first, just to see where we're at.

Because you might feel completely different

when you know there's some light at the end of the tunnel.

I'll just bring this sheet back a little

and have a little look, OK, hun?

SHE MOANS

Sorry, sweetie, I know that's not very nice.

Just having a good feel around baby's head.

I can't feel any cervix there at all and your waters have just gone.

SHE SCREAMS

Your waters have just gone. OK? OK?

So I think you're well on your way.

Leah, don't be frightened of it,

if you need to push, you just go with it.

SHE SCREAMS

Leah sets about pushing without an epidural.

Just go with it, you're doing fab.

SHE MOANS

Where's the epidural?

Well, you're pushing now

and by the time we get an anaesthetist down here,

you'll probably have delivered this baby.

Don't be frightened. I can't do it! You can, you can. Leah, you can.

Just go with what your body's telling you to do.

Oh, I'm so tired. I know, I know you are, but this is the final bit,

you haven't got long to go at all.

SHE MOANS

But after 40 minutes, there's still no sign of the baby's head.

I just need to keep the doctors informed just so they know,

cos if you're getting exhausted as well,

your pushing isn't going to be as good.

She started pushing at quarter past eight. OK, so she's been pushing

about 45 minutes now, OK, so I'll have a little look in.

Hi, Leah, you're doing really well, I hear.

I'll just have a little look and see where this baby's head is,

if that's OK with you? Yeah.

Big push down. Big, big push. Come on, really big push.

Excellent, well done. Keep pushing, and again, another push down.

That's it.

Leah, we're just going to change your position, OK?

Sometimes, when we change position,

it just sort of helps the baby's head move

and hopefully, it will come down a little more,

cos you've been pushing for quite a while now. OK?

Just roll over towards me.

That's it. Right, right over.

That's it, there we are.

That's it, big push down. Big, big push. That's it.

Let's have this leg up here. Well done.

That's it, big push. Big, big push. Well done.

Excellen! Well done. Well done.

Big, big push down. Nice long pushes, Leah.

Well done. That's it.

Can you just pop over there? That's it.

SHE GROANS

Just go with it.

Well done! Fabulous!

SHE SCREAMS

Go on, Leah! Come on, you're doing fab. That's it, well done!

That's it. Big push now.

Looking up at us, this baby. He's looking up? Yeah. Well done!

SHE MOANS

The reason for the difficult birth is now clear -

the baby is positioned back to back,

which is much more difficult for the mother to push out.

Looking up at his mum.

So next pain, big push and he'll be here.

That's it. Here he comes...

There he is!

There he is! Lovely, congratulations!

Oh, he's here!

BABY CRIES

Well done!

Let's just have a little look at him,

and Dad's going to cut the cord as well.

Just check it's a boy. He is a boy. Hello.

Right, Dad, you're going to cut between the yellow bit.

Sorry, honey.

Look at you...

There you are.

Amazing!

Hello.

BABY CRIES

Sorry, honey.

You're an absolute star.

Pushing a baby out facing up is hard work, really hard work,

so that's why it just took that little bit extra time.

That was incredible. Yeah.

You were so amazing. Brave. You were absolutely amazing, Leah.

There we are.

BABY CRIES

Oh, he doesn't like that.

8.13.

Oh, he wants to give you a kiss, he's all pouting ready. Mwah. Oh!

Isn't he lovely? Is that your baby brother?

My first boy, we haven't got boys in the family, so it's so nice.

And that's enough now, no more. We don't need more now, do we?

A boy and a girl.

I just don't want to do that again.

'I was just really pleased'

cos she got the delivery that she deserved and that she wanted.

She had a normal vaginal delivery.

So had she had the epidural,

who knows whether she would have been able to have

the vaginal delivery that she had.

To be part of making that possible for her

is kind of what the job's about, really, isn't it?

Next day, Kayleigh is being monitored on the ward,

but her contractions seem to have subsided.

Frustrated, more than anything, cos it keeps starting and stopping.

That's what's so frustrating.

She's just not moving.

I was hoping to have my baby daughter in my hands right now,

but, no.

Thank you very much...

Later that morning, it's decided

Kayleigh's labour isn't progressing and she's sent home.

Safety briefing, girls.

Neo-natal units have got one crash space. Room Four is high risk...

Every day, the coordinators assess the current cases on the ward

and assign one of their midwives to each,

making decisions about the kind of support

and level of pain relief each expectant mother needs.

Pain is individual to everybody.

You know, there are some people that can cope very well with pain.

It's a different thing for every person.

Women regarded as low risk can go to a midwifery lead room

to have a birth without anaesthetics or medical intervention.

For these women, the popular way to alleviate pain

is with a birthing pool and soothing music.

What we listening to, then?

Relaxing... Chill-out music.

Midwife Sian Jones has just been assigned to Emma

and her husband, Bill.

'Emma's arrived, it's her second baby.'

She actually had her last baby in the exact same room

three years ago, which was a nice, normal delivery in the pool,

and she's hoping to have the same this time.

It helps them relax and it keeps them mobile.

It's not always good for women to be flat on their backs during labour,

so it's good for them to sort of be a bit more mobile around the pool.

And water's good for pain relief as well.

Is that all right?

Yeah, it is really chilled out, actually.

We had a really nice experience in here last time, didn't we?

Do you both do the same job?

We're both lawyers, but we do quite different...

Different sorts of law. So you met through work?

We met at uni, yeah.

Sian usually works upstairs on the high-risk delivery unit.

WOMAN: Do you prefer working down here or upstairs?

I prefer working upstairs. Do you? Yeah.

It's quite different down here, it's a different vibe.

It's completely different. Yeah.

I quite like the excitement of being upstairs, really.

Not that it's not exciting here, it's lovely.

We're not here for excitement.

You're not here for excitement, are you? No, exactly. Yeah.

Outside the main delivery unit, there's a new arrival.

Tara has come in three days before her due date,

accompanied by her mother, Ann-Marie, and her partner, Brian.

She's experiencing severe contractions,

and immediately assigned to midwife Laura Terry.

OK... Going to find baby again.

This will be Tara's second child,

the first being a low-risk birth in a pool.

That's it, really focus on your breathing now.

But this time round, she's being monitored more closely.

Well done, Tara.

So a lot of mums put on weight with each pregnancy,

so therefore, because they're more high risk,

they need to be under the care of the doctors and the midwives,

because the risks are greater for both mums and the babies.

You do have more intervention. You've got less likelihood

of delivering vaginally and more naturally,

and you've got higher risk of needing Caesarean section

or medical intervention.

TARA PANTS That's it. Don't panic.

TARA MOANS

OK, darling, so just a little bit of touching, all right?

Relax your bum down for me... That's it, well done.

Just focus on your breathing.

Before midwife Laura can proceed with the birth plan,

she needs to confirm that Tara is in labour.

Is that a contraction, or is it me? No, it's you. It's me!

You are...5cm! Shut up!

Well done! Yeah!

You can have some pain relief. Thank God for that.

There we go, hold on to it for me.

That's it, keep it in your mouth all the way through.

To relieve the pain,

Tara had been hoping she could use the birthing pool.

Did you have a water birth last time, hun? Yeah.

So, ideally, Tara did want a water birth,

but we won't be able to do this because she needs

continuous monitoring, and that's quite difficult in the water,

and it's quite hard for mums who've had a previous water birth

to accept this.

Hello!

Tara has asked for confirmation that she can't use the pool.

No. Sorry, darling.

Oh!

Sorry, darling. OK?

Right, if it's OK with you,

can I put a little clip on baby's head,

and I'll monitor on her head rather than on your tummy,

purely because I'm getting lots and lots of contact

on the monitoring, so I can't quite see what she's doing.

OK, yeah, if you think it's best, you do it.

Perfect. Thank you, hun.

'You do have problems sometimes with monitoring those babies'

'heartbeats through the abdomen, so we do tend to...'

move more towards putting a foetal scalp electrode

on the baby's head to get a direct contact.

But if Laura's going to apply the scalp monitor,

she's going to have to be quick.

OW!

Well done.

TARA MOANS

I need to push, I think! OK, hun.

TARA SCREAMS

Tara should only push once her cervix is fully dilated,

at 10cm.

That's it, use the gas.

I'm going to have a little look, Tara, OK?

I'm just going to have a little peep, OK? Quick!

Use the gas, come on.

Keep breathing, hun. Well done. Keep still a minute, hun.

TARA SCREAMS

Can I just... Can we just stop? OK.

TARA MOANS Tara, try and stay in the bed, hun.

Tara, you're about 7cm to 8cm, OK?

So you're progressing really, really quickly.

So try not to push.

TARA MOANS

That's it. Use that gas.

Emma has also progressed - to 6cm dilated.

But she's now so relaxed,

her contractions have nearly vanished,

so midwife Sian has moved her out of the pool.

If you want to get back in at any point, that's fine, just say.

OK?

'She's very calm,'

and you'd never think she was 6cm in labour,

so I think she's going to be someone who takes us by surprise

when we're not looking.

TARA MOANS

With Tara in so much pain, Laura can't attach the monitor

and doesn't know if the baby is getting distressed.

I'm trying! Argh!

Give a push, then, hun. Agh!

You're making my job quite easy here. I'm not doing a lot, am I?

I might get some more towels.

'You get used to being upstairs

'and women being on the continuous monitoring.'

You sort of rely on that, then down here, you don't do that.

Sometimes, you feel you're not doing something that

you should be doing, but you realise

you don't need to do it down here because it's a lot more low risk.

I'm in agony, I'm in agony!

Really focus on your breathing, hun.

Ow, ow, ow!

Use that gas. I'm just going to buzz for the coordinator

to come in to give me a hand popping that clip on,

if that's all right with you, hun?

Keep breathing that gas, I'll be two seconds.

Just going to get someone to give me a hand. Keep using that gas.

TARA SCREAMS

Ange, could you get someone to give me a hand in here? Yeah.

That's it, use the gas, use the gas.

Argh!

Hello!

Suck on that gas, really deep breaths. Well done.

'When I entered the room, Tara was starting to lose the plot.'

A lot of the time, it's the fear of pain and the loss of control.

'Some women do panic'

when they get to the second stage of their labour

that they're not going to be able to cope,

or be able to deliver their babies.

Breathe on that gas nice and slow, well done.

'And as midwives, it's your job to calm them down and reassure them'

that it's all going to be over soon and everything's going to be fine.

Tara? Are you listening? Can you hear me?

We need to pop a clip on your baby's head, lovely.

Because we just can't monitor your baby.

We need to know what baby's doing and if baby's happy.

Is that OK? It just means an internal examination again. Argh!

She might well be fully...

Tara, just suck on that gas, lovely.

Tara, we can see the baby's head, just breathe a minute, Tara.

Just suck on the gas, I don't want you to do anything else.

That's it, lovely, look at this baby.

Come on. Come on, lovely.

Tara, Tara,

just suck on that gas, that's all I need you to do.

Come on, lovely. It's hurting like mad cos there's a baby here.

It's going to be over with any minute.

Agh! Just breathe, Tara, just breathe.

Just breathe, hun. Don't panic. I know it's sore.

It's going to be over soon. It's so bad!

It's really bad, but it's going to be over really soon, OK?

Tara, all you need to do is you need to breathe on that gas.

Your body's doing it, OK?

Don't panic. It's going to be over soon.

TARA SCREAMS

Tara, open up your legs for me, hun.

Tara, listen... Open your eyes and look at me.

Slow, deep breaths, slow your breathing.

Bend your leg, bend your leg up. Slow your breathing.

That's baby's head, that's baby's head. That's it, darling.

Give me a little push. Good girl.

Agh! Tara. Tara, listen to me. Stop panicking. I'm so sorry.

Just breathe on your gas, darling. You're doing really well.

Just stop panicking and breathe on the gas and listen.

All right, darling, baby's head's out now,

so on the next contraction, baby's body will be out.

That's it, big push for me. That's it, Tara.

Tara, open your eyes. Tara, open your eyes. Agh!

Hello! TARA WAILS

Tara, you've got a baby. Well done, darling.

I'm sorry.

You're all right, darling. It's hard when it's quick. Congratulations.

Ooh, she's not impressed.

She's not impressed. Hello! Hello, darling.

Who's going to cut the cord? Dad, yeah?

Come on, Dad. There you go. Cut between those two.

In the middle, yeah? Yeah. Could I go home today?

Can we get your placenta out first?

Oh, no, I don't like that bit.

Oh, we can't keep it in.

Say hi, Mum!

Bit quick, wasn't it? That's the way to do it.

You haven't even been in here an hour.

Shall we weigh her quickly?

6.11, I reckon.

Oh, 30/50, it's about 6.11 and a half.

Did you just say...? She said 6.11!

Do I get a prize? Yeah, you do. Do I get to keep her?

I can't believe you guessed the weight.

Well done, congratulations. All right, then, bye.

Thank you.

I work in a pub and we were going to set up a thing

with all the customers and ask everyone how much they thought

she'd weigh, see how much we'd raise.

And whoever won, they could have won the money.

Who was the closest, then? Did anyone say 6.11?

I said ten. I thought she was going to be absolutely massive.

All done. That was easy, wasn't it? Huh!

SHE MOANS

After nearly three hours in established labour,

Emma is ready to push.

So go with it now, OK? If your body's telling you...

Do you feel that urge to push all the way through a contraction? No.

Just when it's at its most painful? Mmm. OK. Hold on for a minute.

That urge to push there now? Yeah. OK.

SHE GROANS

Just shuffle forward a little bit, Emma, for me.

Sorry. Just so I can see a bit better.

Well done, Emma.

Senor midwife Sarah Spencer has come in for the final stages.

Just breathe a minute now, just blow it out a sec.

I think we're seeing some of baby's head.

Go on, then, a nice big push.

With the head under water,

the midwives are struggling to see what's happening.

Fab, that's it.

Just breathe now, Emma.

That's it.

The baby's head is almost out, but the shoulders may be stuck.

Shall we try standing up a minute?

Em, do you want to stand up?

Shall we stand you up a sec?

I can't stand up.

Yes, you can.

Baby's fine.

Let's stand you right up, then.

Big push into your bum for me.

That's it, well done.

There we go.

We're going to pass baby through.

There we are, Mum, there we go.

Do you want to go back into the water?

Yeah. Hello. Are you OK?

Yeah. Can't you hear him coughing?

Hello! Have you got him?

Is it definitely a boy? Have a look, any danglers?

It's definitely a boy, yeah.

He's a big boy.

Has he got a name? Griff.

Aw! Look at you!

He looks a nice size.

You just cut in between them...

Ten minutes old, baby Griff has a surprise in store.

It's a little girl.

It's a girl.

THEY GASP

Not Griff, then.

Oh, there we are!

Oh, I'm so sorry, little lady.

Oh, how bad are we?

No wonder you're not very happy with us!

Have you got a name ready for a girl?

Gwen. Nice.

That was funny.

Well, it was Emma's fault really, because she...

She thought she saw boy parts

and about ten minutes later, when we cut the cord,

we realised that there were no boy parts, it was a girl.

So, erm, she's not going to be Griff...

..is she?

She is four kilograms,

4.08 kilograms,

which is nine pounds exactly.

Nine pounds.

She did brilliantly. No gas... No, no gas and air...

No, nothing.

It's four o'clock in the morning and midwife Amy has been told that

Kayleigh is on her way back to the delivery unit

for the third time,

just over a week since her last visit.

She's coming in by ambulance because they were querying

whether she might actually deliver at home.

She's been in several times throughout this pregnancy,

querying whether she's in labour or not,

and she's been sent home each time.

So, hopefully, she'll make it in time really for this delivery now,

if this is the real thing.

Hello...

Hello, I'm Amy, come on through.

Hi...

I'll show you where we're going, we're going left, guys, please.

We're going to Room 9, which is the last one on your right, guys.

Thank you very much.

OK. Come on in.

All right? Do you want to have a sit down for me

and you can give me a bit of a story about what's been happening.

Bye.

Are you all right?

So has it got worse? It's got worse, yeah.

Is that why you've come in now? Yeah.

In what way has it got worse? I've got a lot more pain.

So just stronger? Stronger.

OK. Let's pop you on the monitor, then, all right?

BABY'S HEART BEATS

I'm just going to leave you on this now for about 15, 20 minutes

and then we'll look at examining you, all right?

'I've got some concern about the fact that that she's'

a frequent readmission

because that shows that she's, obviously, A, been having pain

for quite a long time, so she's tired,

and B, that she's maybe not going to cope very well with the labour.

I think lots of women are anxious about going into labour.

However, I do think that Kayleigh's been exceptionally anxious.

Kayleigh also has to worry about a lifelong condition,

one that severely limits the pain relief she can have.

Kayleigh's got a neurological condition which means that

she can't have any analgesia in the spine.

So in some scenarios, women choose to have an epidural,

Kayleigh can't have that because of the condition that she has.

It's called a Chiari malformation.

It's the low part of your brain sits lower down in your spinal chord.

It limits your time of pushing

and it limits you with an epidural and things like that.

An epidural would reduce the pressure in the spinal column,

drawing the brain down into the spine, which could be fatal.

It's only me, Kayleigh.

All right?

Just try and relax for me, OK?

OK... Probably still the same, more or less

what they told you last time, all right?

About 3cm dilated, all right?

But at the moment, it's not really showing that you're in labour.

OK. All right?

I'm really sorry. It's OK.

You must be so tired, bless you. Yes. All right.

I give up.

Same as previous findings.

So she came by ambulance, so she's no transport or anything...

As it's the middle of the night,

it's decided Kayleigh can stay until the morning.

She seems awful disappointed, bless her. Yeah, I can imagine.

All right, brilliant. OK, I'll let her know. Thanks, Libby. Thanks.

It's only me, Kayleigh.

I've spoken to the midwife in charge, OK?

We'll probably keep you in, you know, for a while,

possibly till the morning.

And then the doctors will review you in the morning. All right?

Are you happy with that plan? Yeah.

Dan, happy with that? Yeah. Yeah?

It's a tricky one, isn't it?

Just find the light switch.

Later that morning, Kayleigh is again sent home.

It's nearly the end of Amy's shift

when she's assigned to a mum already in established labour.

Chelsea is 21 and a full-time mum expecting her third child

with gardener Sean.

She's been transferred from low to high-risk care,

as it's been over 24 hours since her waters broke.

That's a big one. Sorry, I thought that was Sean's hand,

that's why I was squeezing it. You can squeeze my hand.

Sorry. It's OK.

Are you all right? Yeah, that was a big one. Big one.

Chelsea's last birth was an unpleasant experience.

My body last time just shut down, I couldn't push the placenta out.

OK. So obviously, because you've had a retained placenta before,

I don't know whether anyone's told you,

but that means that it may happen again. Yeah.

OK, you do know that, do you? Yeah. Yeah, OK.

Did it happen the first time? No. No, just the second. Yeah.

You're neat. This is the biggest I've ever been,

I've never been this big.

Do you know what you're having? Girl. Another little girl.

What have you got at home? Two little girls.

Oh, that will be lovely.

The day staff will be coming on shortly in the next ten minutes.

All right? OK. And then I'll leave you to them.

You'll probably have a baby about half an hour after I go, I expect.

Ah, I know, probably, just my luck.

We told you we'd have a May 5th baby, didn't we?

All right?

Chelsea's sister, Kari-Ann, has arrived to lend support.

My second was really quick, they even missed it.

They were... She was so quick, they induced me in the morning,

nothing happened at all, day or night, so they sent him home.

And then as soon as they sent him home,

I had her literally in a matter of seconds.

So he's been hanging round the hospital all night.

Making sure he doesn't miss this one.

Hello, hi.

Good morning, everyone.

My name is Tatiana, I'm going to look after you. Hiya.

OK, how are you? I'm OK.

OK, is gas and air working for you at the moment? Yeah. OK.

Taking over from Amy's shift is Tatiana. Ukrainian born,

she has nearly ten years' experience as a midwife in Cardiff,

but Chelsea seems to have her doubts.

Getting that ready already?

Well, I'm going to check it anyway because I don't know when

baby's going to come exactly, so I want all the equipment to be ready.

You got excited then, didn't you?

OK... I'm going to leave you with Tatiana,

she's going to come back in a minute.

Oh, thank you, is she nice? She's lovely.

It's just cos you know me now, but you'll know her soon.

What's her name? Tatiana. OK.

You'll be great. Take care. Bye. Bye.

I'm so disappointed not to be able to see this birth

all the way through. I've built a really good relationship

with Chelsea very quickly and she's quite anxious about

somebody else taking over her care.

That was a big one, yeah?

'It's often really difficult as a midwife to make that bond

'really very quickly with someone

'and I think it's difficult for the woman to emotionally let go of

'one midwife and then attach herself to another.'

I'm just going to get ready, just in case.

She had quick delivery before

and I do expect her to deliver quickly this time, as well.

Positive thinking, it's going to be absolutely fine.

It's up to me to make this change in the room,

to make this atmosphere comfortable for them.

I mean, I'm a stranger, you need to establish this relationship

with women and make sure they trust you.

Chelsea, try to take gas and air

only when you have a contraction, OK?

If you're comfortable in-between, just close your eyes and rest. OK?

That's it, in and out with the gas and air.

It's going to go in a second. OK?

Contraction is easing off now, good.

You've got such a calming voice.

Who, me? Yeah, it's really calming when you talk.

Wow, that's the last thing you want, somebody to scream

when you are in labour, isn't it?

We are getting ready, slowly, slowly. Well done.

Your muscles are getting ready, they're stretching slowly, slowly

because she is descending, as we say,

she's coming lower and lower and lower. OK?

'I do believe that pain is a state of mind

'and fear can cause anxiety'

and anxiety can cause pain,

so if we will break this chain, that is going to make a huge difference

on the outcome of the childbirth.

Just listen with your body and go with it, OK?

'Our body is perfectly designed to achieve this natural'

and calm and beautiful birth.

And your body produces these natural pain killers,

endorphins, they're the strongest than whatever I can offer here. OK?

'I'm trying to make them realise that it can be comfortable,'

and it usually works.

Sometimes, you can see them, like they're deep in really,

and they go within themselves

and just keep really, really quiet,

and I call it silence before storm.

And sometimes, they feel like they're losing the world,

everything is, you know, just too much.

She is... She is doing well.

Now, listen to your body and go with it.

If you feel you want to push, just go with it.

At some point, I'll tell you not to. OK?

It's really hurting. KARI-ANN: It's up to you now, Chel.

I am trying.

She's waiting for you. She's not going to understand.

She is, I do understand. Sweetie, keep going with gas and air,

keep going with gas and air.

With birth imminent, Tatiana has her own special pain relief technique.

So I'm going to put some warm gauze on your labia.

Is it OK? Is it nice and... OK.

I don't want it to be too hot,

but this is going to relax the muscles down below.

Is it OK? It feels so nice.

It feels nice, it's OK, I know it feel nice.

I do that because it helps a lot,

this warmth on the area

helps the muscles to relax and contract.

Sean, can you just ask her to turn towards you? Towards you.

I can't. You can. Come on. You can.

That's it, my darling.

This next contraction, just open up

and pull your thigh towards your chest. That's it.

In this position, she will be born quickly and easier, OK?

Well, this is the silence before the storm, I'm telling you.

Yeah, it's...

She's, like, getting her strength back, yeah.

Come on, sweetheart, you can do it, not much longer now.

It's really hurting me. I know.

Chelsea, next contraction, she will be out. OK?

OK, come on, gentle, nice and steady push.

OK, the head is out. OK?

The worst is behind, OK? Her head is delivered.

With the next contraction, we will deliver her body. OK, darling?

KARI—ANN: Oh, my God!

- Can you open your eyes, Chel. - Don't panic, Sean, she's all right.

Chelsea, next contraction.

Come on, darling. Ready, one, two, three, go.

Chelsea, she's there now.

Chelsea she's out, her head's out.

She's coming, it's her arms. Give it all you've got.

OK, give me a towel.

OK...

Oh, my God!

Baby, welcome to Cardiff.

You've done it, babe.

She's gorgeous. Look at her, Sean.

Oh, my gosh, she's the spitting image of Rhianna, Chel.

That's perfect.

Say "hello" to Mummy.

BABY CRIES

Come on, baby, give her a cuddle.

That's it. Give her a cuddle and I'll get her a clean towel.

You've done it!

Hello, beautiful. OK...

BABY CRIES

Are you ready to cut this cord?

OK, in between my fingers and the clamp... Just there?

Yeah, straight there.

What?

What? Oh, dear!

Well, I've had five

and I don't think I've had any of that sort of treatment.

So... Come again. Yeah. No!

The baby has been delivered, but it's not over for Chelsea.

Let's see if this placenta is ready.

Do you feel like to push something out? Yeah.

You do, OK.

The last birth, it got stuck, so she had to be rushed to theatre,

so we're hoping...

we don't have a repeat.

Placenta is coming, OK? Well done, Chel.

No complications.

OK, just push it gently for me, it's ready to come.

Slowly, love.

Well done. Well done, Chel.

BABY CRIES

- Good girl. - It's done.

'Chelsea delivered her baby by herself'

and she was wonderful.

She was... It was very quick, she listened to what I was saying.

She was so relaxed.

I think it was a stress-free birth.

They want their lovely ones around and they were a very good team.

They think that you know everything but, to be honest,

every day, I know that I know nothing,

I learn every day here so, yeah.

But this time, I was pretty close.

I think the midwife was wonderful.

She really, really looked after Chelsea

and made sure she was nice and relaxed and wasn't worrying.

And not only that, she made sure Sean was fine as well,

which I think is a big issue for fathers,

if they don't know what's coming next, sort of thing.

SEAN: I can't wait till we leave here

and I give her a nice big kiss and a cuddle and say thank you.

She was, she was wicked.

Chelsea and baby Lydia spend a night on the ward

and are allowed to go home the next day.

A few nights later, Amy is back on shift

and joined by one of the unit's familiar faces.

Kayleigh has rushed in for the fourth time

feeling she's having frequent contractions.

Kayleigh's come in to us this evening.

She's been admitted several times over the last few weeks

querying labour, and this time, Kayleigh is established in labour.

Erm... She's pushing.

All right, Kayleigh, you'll have to get on the bed, my darling,

we don't want you to deliver on the floor, do we?

So how are you feeling when you've got those contractions now, Kayleigh?

Pressure in your bottom still? OK.

You've got urges to push, then, have you?

Don't push at the moment, Kayleigh, because I just want to make sure

that you're definitely fully dilated first. OK?

7cm already, well done.

KAYLEIGH GROANS

Because she has a neurological condition,

Kayleigh can't have an epidural, so must rely only

on gas and air for pain relief.

Do you want some water? No.

And once fully dilated, she will only be allowed to push

for a maximum of 30 minutes,

half the usual allowed time.

Kayleigh, don't push at the moment

because you're not fully dilated yet.

KAYLEIGH HOWLS IN PAIN

Kayleigh's pushing uncontrollably at the moment

so I'm just going to do another examination really,

because she shouldn't push if she's not fully dilated.

The baby's heart rate is dropping slightly, which sometimes happens

when they're pushing. I just want to see what's happening, really.

Kayleigh, Kayleigh, I'm just going to examine you for a second, OK?

OK, Kayleigh, you're fully dilated.

Kayleigh, Kayleigh, can you look at me?

OK? You're fully dilated, you've progressed really quickly

and the baby's head is just sitting there now, all right?

But what I want you to do now

is try and stay in control as much as possible.

I only want you to push when you've got a pain.

Kayleigh, there's going to come a time

when I'm going to ask you to stop pushing and to pant,

and it's important that you try to listen to me

as much as possible, OK?

Allowed to push, Kayleigh knows that if she doesn't have the baby

in the next 30 minutes,

she will have to have a C-section under general anaesthetic.

Caring for somebody in Kayleigh's scenario

does ultimately make me feel slightly under pressure

because I think when women become really distressed,

naturally, I feel distressed as well.

Kayleigh, just give us a second.

Kayleigh, Kayleigh, just breathe gently. Good girl.

Kayleigh, has the pain gone?

The contraction, not the pain down below?

OK. If the pain's there, Kayleigh,

you've got to give me a big push into your bottom.

OK, Kayleigh, Kayleigh, pant.

Kayleigh, pant.

Little tiny push.

And pant, pant, pant, pant, pant, Kayleigh.

Good girl.

That's it.

OK, little push. Pant, Kayleigh.

OK, baby's head's out now, Kayleigh, OK?

KAYLEIGH HOWLS IN PAIN

OK...

There...

Congratulations.

Oh...

Oh, my God.

Oh...

Oh, my God. You're a little bit shocked, aren't you?

Is she OK? Yeah?

She's fine, she's just a little bit shocked.

Is she... She's OK?

Yeah?

Hello. It's happened very quickly,

so I haven't given Syntometrine or anything yet. Sorry.

Thank you.

She is beautiful, OK?

Dan, do you want to cut the cord? If I could...

She is quite a big baby, Kayleigh.

BABY SQUEALS

Just between the two clamps.

Let's lift her up onto you, Kayleigh. Oh...

Let me just get a clean towel.

Oh, thank God it's over.

I think Kayleigh deserved a quick labour

after all her recent admissions and everything.

I thought I was going to be sent home again with no baby.

You did fantastic.

BABY CRIES

3.58 kilograms,

which is 7lb 14oz.

Have we got a name for this baby? Lily Rose.

Her full name is Lily Rose Saron Blue-Jay James.

Aw! That's a long one.

Thank God it's over.

Normally, when I have a delivery, I try to keep it as calm

and relaxing as possible for the women, but sometimes,

especially when labour's progressed really quickly though, Kayleigh,

all that can go out the window sometimes.

In Kayleigh's case, she was just in so much pain,

she just pushed, sort of, continuously, really.

A little bit of a crazy environment, but, you know,

we got a brilliant outcome and a beautiful baby,

so it's all worked well in the end.

The last few weeks have been quite stressful for us both.

Put pressure on family life at home, with tiredness and everything.

Yeah, really stressful, I'm glad it's all over now. No more stress.

I'm really pleased that after Kayleigh came in so many times

that when she finally came in to give birth,

it was me that was there to deliver her baby.

Ah, it's bright out here, isn't it?

Tomorrow, Dan and Kayleigh will be allowed to go home.

This time, with a baby.

What a lovely thing to end your day on.

It's just lovely, isn't it?

Bye...

Take care. Bye...

Thank you. Bye.

All right, take care, you're welcome. Bye.

Thanks. Bye-bye. Bye.

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