During pregnancy most women find the upcoming birth of their baby daunting to say the least, and ME/CFS sufferers find this more so as they worry how they will cope with the challenges of labour and birth when they are ill, and whether it will cause a relapse. There is no way of knowing in advance how things will go, or how well you will cope with it, but a bit of forethought and planning can help you be better prepared for what will happen.

Reading

First off I recommend that you read up about normal births, when people don't have ME/CFS. Find out about the different types of birth and pain relief that are available so you can begin to understand what options are available to you. Reading birth stories can also help you gain an understanding of the reality of births, that they don't always go as planned, and the emotional experiences that go with births.

Once you know a bit about normal births you can begin to work out how to tailor this information to suit your needs.

Cesarean Sections

Having ME/CFS does not automatically mean that an elective c-section is needed. People with ME/CFS are able to have normal vaginal births, without assistance, though women with more severe ME/CFS may want to seriously consider this option if they believe they would not be able to handle the labour and birth without having a relapse.

Even if you chose not to have an elective c-section you may find yourself needing an emergency c-section. There are several issues to consider about c-sections and ME/CFS so I have written a seperate article covering them. Cesarean Sections article

Eating during Labour

Some people find that when they are in labour they become nauseous, but if at all possible try eating sensible foods during labour. Eating helps provides the energy your muscles need and research has shown that less pain relief is needed, the birth takes less time, and that c-sections are less likely to be needed if you eat during labour. Its best not to overload your stomach, so try a snack every hour or so during early labour. Recomended food includes:

Potato
Pasta
Rice
Fruit (not acidic ones)
Bread
cereals
Yogurt

Most hospitals allow you to eat during labour, however some have a policy of nil by mouth, so eat something before you go to hospital and take along some glucose sweets or similar to keep your sugar levels up.

Positions During Labour

The key here is to try and find positions that are comfortable, not demanding of your energy and that also help the progression of labour. Research shows that upright positions, during the first stage of labour, encourage more efficient contractions, shorter labours, less need for pain relief and less need for artificial acceleration of labour.

However when you have ME/CFS walking around or standing upright may be too tiring. Using furniture or your partner as a support may help you to keep a more upright position. Try these ideas:

Sitting on a chair backwards, leaning on the back of the chair, using as many pillows as need to get comfortable. Kneeling and leaning against some pillows or a chair.

If you do need to lie down then don't lie on your back but on your left side in a position similar to the recovery position (left leg straight, right leg bent up). Use as many pillows as needed to be comfortable. See this website for some good illustrations of these and other positions Upright positions useful for labour and birth

Pain Relief

It is said that people with ME/CFS tend to be more sensitive to pain, but they are also more sensitive to pain medications, so choosing pain relief can be quite hard. For many ME/CFS sufferers epidural's are the way to go, as it doesn't enter the bloodstream like pethidine and other injected drugs do. Other sufferers may chose to go drug free completely and use TENS machines or water pools for pain relief. Being in pain does tend to be more tiring, especially if you tense up, so having the level of pain relief that you need and being relaxed are very important. I cover this in more detail here: Pain relief for Labour

Birthing Positions

As with positions for the first stage of labour, upright positions are the most helpful when it comes to giving birth. But by this point in labour you are likely to be exhausted already, so squatting may be right at the back of your mind. Strong birthing companions are useful here, to help support your weight so you can get in which ever position feels best. Alternatively you may be able to use a birthing stool, a kind of low chair that has a hole cut out of the seat, enabling you to sit supported. I've found this page about building your own that illustrates what one would resemble.

If you prefer to birth in bed then a semi-recumbant position, where you grab your ankles and push, is often used. If you need to lie flat then try lying on your left side, with your top leg held out of the way by a birthing companion or midwife.

For more info see these articles childbirth solutions , Todays Parent

Assisted Deliveries

Muscle fatigue during the second stage can lead to it taking a lot longer than normal, or to an assisted delivery being necessary. So with muscle fatigue being a large part of ME/CFS its important to read about the various sorts of assisted deliveries there are, so that if one becomes necessary for you will know what is likely to take place. Assisted deliveries are carried out by either forceps (a large instrument rather like a giant salad server) or ventouse (like a suction cap attached to the baby's head).

This babyworld article gives more detail and compares the two methods.

Writing your Birthing Plan

When you have gained enough understanding of your options in birth you can start piecing together your birth plan. I suggest that as well as the normal content of a birth plan (such as what drugs you want etc) that you mention having ME/CFS and the ways that this might affect your birth. This would include sensitivity to drugs, muscle fatigue resulting in needing more support to maintain positions, or possibly an assisted delivery. The idea with a birth plan isn't just to plan your perfect birth, but to work out what you would prefer to happen when things go slightly off track, for example if you can't cope with no drugs which ones would you prefer. Of course not all eventualities can be planned for, but if you consider the more likely avenues you wont find yourself as likely to go with whatever the midwife recommends. Don't make your birth plan to long though, your midwife needs to be able to read it quickly, too long and she might not take it all in.

Here is a link to the birth plan I used when I had my son.

Here are some links to sites about writing birth plans in general:

Interactive birth plan, Writing a meaningful birth plan for a gentle birth, Create your own birth plan