A midwife for 12 years, Pam Wild is currently an independent midwife at The Birth Centre in London. On Monday 21st June, she took part in the iVillage virtual maternity ward tour, answering questions from pregnant mums on the Babies Due July-September 2002 board.

Vicky: I am planning on having an epidural. I really don't want gas and air or pethidine, as everyone I know who has used these has been really sick. How soon after coming into the hospital can I have an epidural? Can I have one straight away or do you have to reach a certain level? Also, I have heard conflicting information regarding how long you can have it topped up - can we have pain relief until baby is delivered or does it have to wear off to get baby out?
Pam: If you are wanting an epidural I suggest you do not have it until your labour is established as if it is sited too early it can slow your labour down, then intervention may start. There are different ways of topping up your epidural by individual topping up or by continuous infusion. Also there is a mobile epidural. With discussion with your midwife who is looking after you can alter the dose of the epidural, etc. But it is entirely up to you. For instrumental deliveries they will always top it up so you are pain-free.

Frizz100: I am thinking about a home birth and just wondered if the fatality rate was higher than hospital. I know that I will be told to have a hospital birth if I have any problems during my pregnancy, but people tend to think I'm a bit screwy for wanting a home birth and start telling me stories about problematic home births.
Pam: Actually research has proven that home birth is safe or even safer than a hospital birth as long as you have a midwife who is competent and confident in home births and who has good communication with the hospital. I would ask everyone who wants to tell you any horror home birth stories to not too.

angeliquecarroll: This is my first pregnancy. Assuming no complications, how long should I expect to be in hospital after the birth?
Pam: If everything is OK, usually the minimum is six hours. You generally think that you will rest in hospital but that is not really the case. So the best place is at home in your own bed, getting well fed and looked after by your family. In hospital the wards are usually very busy and noisy even at night. So if everything is OK with you and the baby, go home as soon as you feel able.

lisajulia: I think I'm loosing my mucus plug. It's my third child (although I have forgotten most things in six years) and I have terrible back pain, but there is no blood so it's not a show - or is it? Is there a difference and could things be beginning to happen or could it still take a long time? My first baby was 2hrs 20mins and 9lb 2oz and second was 1hr 10mins and 10lb 3oz. I have been told this one is smaller but am scared it could all happen very quickly again. I'm also finding the Braxton Hicks a lot more painful this time too.
Pam: Women usually think a show has to be bloody or old blood but that is not always the case. It can be a clear mucousy plug. We know that it does not always mean that labour is imminent for first-time mums. But with some one who has had a baby before often labour is not too far away, a day or two. But who knows? Just be more aware of your Braxton Hicks - how often they are coming and the strength, especially as you have had quick labours before. Does a bath slow the Braxton Hicks down? If it's real labour they continue usually and you notice that the intensity is greater when getting out.

lewis_gourdie: I am a home birth hopeful, however also very aware that there is a reasonably high rate of transfer for primigravidae. In the event that meconium was found in my waters during labour, what action would I reasonably expect my midwife to take?
Pam: Meconium often can be a sign that the baby is in distress so transfer is usually the option. There can be different types of meconium, old, fresh and thick. Sometimes the meconium is only noticed as the head is crowning - it is not safe to transfer then, but there are then some better positions to deliver in to aid drainage, etc. However, this is all dependent on the experience of the midwife looking after you and the circumstances at the time. Perhaps bring this up as a question next time you see her - ask her when and under what circumstances she would advise transfer to hospital.

kaz-je: I am just over 38 weeks and the baby is posterior - what are the chances of it turning and, if it does, what are the chances of it turning posterior again?
Pam: It is never too late. A midwife called Jean Sutton has a very good book on fetal optimal positioning. You may be able to get a copy from your library or if you are a member of the NCT from them. She suggests briefly to lie on your left side; do not sit slouched or in a reclining chair (so your pelvis is not tilted), but always sit upright. Do not go on long journeys especially in the car as you tilt your pelvis sitting. Walk around on your hands and knees for quite a few times during the day to encourage the back to rotate to the front (gravity). Also maybe read or watch TV for short periods on your knees leaning forward on cushions or a chair/settee. Hope this helps. If baby is still like this, even do the all fours, etc., in labour. You make look funny or they may think you are mad, but it will still help.

march02: Could you tell us how to identify the various bits of the baby? I can feel hard bits sticking out at the top of my uterus, which I assume is either the baby's head or bottom - does the head feel harder than the bottom, or is there another way of identifying body parts?

Pam: Sometimes it is even difficult for me to figure out which way a baby is lying.But if you feel across from side to side and feel something hard, that is usually the back. The head does usually feel much harder and rounder than the bottom. Midwives can usually determine the position of the baby from 28 weeks. At your antenatals with your midwife start asking her to tell you what position your baby is lying in so you can get it or keep it in a good position. Why not ask your midwife to demonstrate the best positions.

Mancinwales: My midwife has told me that my baby's head is low down, right by my pelvis. I also have explained the pains I have been having around my pelvis and my midwife said that either the baby is just bobbing up and down in there or is near to coming out. This quite concerns me as I am only just coming up to 29 weeks. Is it likely the baby may come early? I can't walk too far either as the pain is quite bad. I would be grateful for any advice.
Pam: It sounds like you might be suffering from something called Symphysis Pubis Dysfunction. The support group has an excellent website which will tell you everything you need to know www.spd-uk.org.

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