To be able to prepare yourself for childbirth as well as possible, we recommend that you discuss your expectations and also your fears regarding the upcoming birth with your gynaecologist or midwife early on. Knowing when you should go to the maternity hospital, what awaits you when you give birth, what you should bring with you and what actions you need to take after the birth of the baby also helps to increase your confidence.
In which medical institution is it possible to give birth?
You can give birth in a maternity hospital as well as at home if the decision has been made carefully and the risks have been adequately assessed. Read more about home birth here . You are free to choose the place of birth, for example, you do not necessarily have to give birth in the same hospital where you are registered (except in the case of premature or higher-risk births or other exceptional cases).
If you have health insurance, the Health Insurance Fund pays for maternity care. Please note that the Health Insurance Fund does not pay for additional services such as a family ward, the use of a private midwife during childbirth, etc. In the case of planned home birth, the mother pays for receiving obstetric care based on the price list of the home birth care provider.
In hospitals, 24/7 doctor supervision and the possibility to use family wards as a paid service are guaranteed. In the family ward, the support person has the opportunity to stay with the family 24/7. It is possible to be with the child in all general wards of maternity hospitals. If the newborn needs intensive care, it may be necessary to temporarily separate the mother and the child and transfer the child to the intensive care unit. In this case, it is possible to visit the newborn or stay with the newborn 24 hours a day, depending on the work organisation of the hospitals and the space solution. For example, some hospitals have family wards, while others take the child to another clinic or hospital.
All Estonian hospitals allow you to arrive together with a support person - the child’s father, another family member or a loved one. In emergencies (e.g. in the event of a COVID-19 emergency), work organisation changes may occur in hospitals, so follow the current information on the respective hospital’s website.
Everything you should know before going to the hospital
Admission of the woman in labour to the maternity ward
Before you are admitted to the maternity ward, several procedures will be performed on you. For everything to go as expected, it is suggested that you familiarise yourself with these procedures before going to the maternity hospital. You can find this information on the website of your chosen maternity hospital.
Birth survey
When you arrive at the maternity ward, you will be asked:
- about the beginning of labour, the frequency, strength and duration of contractions, the secretion of amniotic fluid and the nature of foetal movements;
- duration and termination of previous pregnancies;
- about the progression of this pregnancy;
- about previous illnesses, chronic diseases and allergies that may affect the risk of childbirth (if they have not been documented in advance).
Maternal examination
During the examination, your objective status (i.e. your general condition and obstetric status), are assessed, by uterine palpation, a vaginal examination to assess the opening of the cervix and an assessment of the condition of the foetus.
Assessment of the general condition includes:
- measurement of arterial blood pressure,
- pulse assessment,
- body temperature measurement,
- blood tests if necessary.
The vaginal examination is documented in writing and includes, for example, the evaluation of the opening and maturity of the cervix, the position of the head of the foetus and other information that helps to assess the progress of labour.
To assess the condition of the foetus, you will undergo a cardiotocography (a test that simultaneously measures the frequency of the heartbeat of the foetus and the contractions of the uterus), which lasts about 20-30 minutes.
Preparation and documentation of a birth plan
Based on the data, a preliminary birth plan is drawn up and/or your birth plan is discussed. You will also be questioned about your expectations and fears related to childbirth and the real options will be explained. Then you will discuss the procedures for you and the baby, such as vaccinations, screenings, etc., including protocol for children with special needs and disabilities.
When is the right time to go to the maternity hospital?
If this is your first birth and you are not sure of the right moment to go to the maternity hospital, the best thing to do is to call your midwife or the staff on duty at the maternity ward. Several signs will help you to recognise the right moment.
How to tell the difference between false contractions and real labour?
Most women have experienced so-called false or Braxton-Hicks contractions during pregnancy. Generally, they start in the second third of pregnancy, becoming more and more noticeable towards the end of pregnancy. In this case, the contraction of the uterus usually lasts from a few seconds to a few minutes, which can occur within a few hours and then disappear for a week. A few weeks or days before delivery, these contractions can become more frequent, regular and quite painful, making it difficult to distinguish them from real labour. However, unlike real childbirth, false contractions do not become stronger, more lasting and more frequent, and tend to pass over time.
Losing of the mucus plug and the rupture of amniotic fluid
During pregnancy, a dense plug of mucus closes the cervix. Just before delivery, the mucus plug separates and during this process a reddish-to-black jelly-like discharge may occur from the vagina. Childbirth can follow the separation of the mucus plug quickly, but it can also take several days. Some women do not even notice the separation of the mucus plug.
Amniotic fluid usually breaks during labour, but it can also happen before labour begins. If you feel something oozing or flowing from your vagina and you cannot control it, it is probably the breaking of the amniotic fluid. Amniotic fluid is usually uncoloured, in the case of greenish amniotic fluid or amniotic fluid mixed with blood, your baby may need urgent help. If the amniotic fluid breaks before the start of labour, it is best to call your midwife or go to the maternity hospital.
If the amniotic fluid is clear, the foetus is moving normally and you feel well, you can stay at home and despite the presence or absence of uterine contractions go to the hospital after 6-8 hours.
If the amniotic fluid stains the laundry, brown or green, go to the hospital as soon as possible. Amniotic fluid mixed with a lot of blood needs faster action.
If the amniotic fluid has not broken, but you have painful uterine contractions, it is time to go to the maternity hospital when the uterine contractions:
- have become regular,
- have become painful
- occur approximately every three to five minutes,
- last about 60 seconds.
Remember that the second and third children can be born much faster than the first, and therefore, if necessary, you can contact the midwife or go to the maternity hospital earlier.
To go to the maternity hospital, you can use a private car, a taxi or an ambulance by calling 112. The driver could be either your partner or a support person who comes with you because in such a situation it is not wise for you to drive yourself.
What to bring to the maternity hospital?
It makes sense to prepare a few things to take with you a few weeks before the due date. These things can include:
- Light and comfortable clothing to wear during and/or after childbirth. If you wish, you will be given a nightgown and a robe in the hospital. During childbirth, clothes get dirty, and therefore many mothers prefer the clothing provided by the hospital.
- A dressing gown and slippers.
- Two or three pairs of supportive, comfortable bras. Bras that open at the front, which facilitate breastfeeding, are well suited.
- Breast pads.
- A larger pack of highly absorbent sanitary napkins.
- Personal hygiene items such as a toothbrush, toothpaste, hairbrush, etc.
- A personal towel or a larger sauna towel.
- Objects that help you relax, such as a good book, a magazine or your favourite music.
- Several pairs of underwear (just in case you need to consider a hospital stay longer than a few days).
- Diapers and clothes for the baby (according to the season), and a blanket or sleeping bag for taking the baby home.
- Be sure to bring your pregnancy card and your ID card or passport.
What awaits you in the maternity hospital?
To reduce the fear of going to the hospital, it would be good to talk to your midwife in advance about everything, including your fears, and if possible, visit the maternity ward, for example, during a family educational session, so that you can see what will happen in the hospital and how to arrive at the hospital. Also, tell the midwife about all your wishes and expectations concerning childbirth. If not all your wishes can be fulfilled, it is good to understand why it cannot be done.
Admission to the maternity ward is open 24 hours a day. Upon arrival, you will be guided to the reception room, where you can change into your hospital clothes or your clothes, and the labour will begin.
Stages of labour
Labour is divided into three stages:
- the first or dilation stage, during which the cervix gradually opens;
- the second, or expulsion stage, during which the foetus descends into the pelvis and childbirth begins;
- the third or placental stage, when the placenta is birthed.
During the dilation stage of labour, it is best to stand up and move around. If you are thirsty, you can drink water or isotonic (sports) drinks, which help to maintain the necessary energy. If you are hungry, eat something light. If uterine contractions become stronger and more painful, use relaxation and breathing exercises. To relieve pain, a support person can massage your back.
Relief of labour pains
Childbirth is always painful, so it is important to know what options are available to relieve labour pains. Next, we will describe some options for pain relief.
Using different positions
- Before giving birth, try to learn more about the nature of childbirth. The more you know, the less afraid you are. Try to find answers to your questions either from the midwife or by visiting family school lectures.
- Learn relaxation and breathing exercises.
- During childbirth, try to be active and move a lot, the perception of pain and the feeling of strength depends on the position of the body. Try kneeling, leaning forward, walking or rocking yourself back and forth.
- If possible, take a support person with you.
- Ask a support person to massage you.
- Use a bath or shower to relieve pain.
Water as a pain reliever
Water helps you relax and makes uterine contractions less painful. The water must be warm, but not over 37.5 C.
Laughing gas
Laughing gas uses a mixture of oxygen and nitrous oxide. Inhaling the gas relieves pain, and takes effect within 15-20 seconds. Therefore, you should inhale through a mask as the pain starts. It is more effective with slow, calm breathing. The gas is not harmful to your baby, but it can make you a little drowsy, and it has a slightly sweet taste.
Epidural analgesia
In the case of epidural analgesia, the anaesthesiologist places a special catheter in your back, close to the nerve roots, and a special painkiller is injected into it as needed, which blocks the pain from moving forward from the birth canal to the brain. After the epidural is placed, the baby’s heartbeat needs constant monitoring, often with a sensor attached to the baby’s head. An epidural can lower blood pressure somewhat, so a venous catheter is placed in a blood vessel to give the woman more fluid, which prevents a possible fall in blood pressure due to epidural analgesia.
TENS
TENS is transcutaneous electrical nerve stimulation, for which a special device is used. Some hospitals do not have it, but you can take your device with you to the hospital. TENS is particularly effective in relieving back pain during the dilation stage.
Foetal heart rate monitoring
Your baby’s condition will be monitored throughout the delivery. The midwife watches for any changes in the baby’s heart rate, which may indicate a lack of oxygen and the need to end the labour more quickly. There are different ways to monitor the baby’s heartbeat, such as:
- The midwife occasionally listens to the heartbeat using a doppler or small ultrasound monitor, for at least 1 minute in every 15-30 minutes.
- Your baby’s heartbeat and uterine contractions are monitored electronically using a CTG (cardiotocograph) machine. The sensors are attached to your stomach using special belts.
- In some cases, it may be necessary to monitor the baby’s heartbeat using a special sensor attached to the baby’s head. The sensor is placed on the skin of the child’s head during a vaginal examination, the amniotic fluid must have broken for this, and the water bag is opened if necessary. The midwife or doctor will explain to you the necessity of such monitoring.
Acceleration of childbirth or stimulation
Labour can be delayed if uterine contractions are not strong or frequent enough, or if the baby’s movement through the birth canal is slower than expected. In such cases, the midwife or the doctor will explain to you the need to intensify labour activity using various possible methods.
The expulsion stage of childbirth
During the expulsion stage, your baby’s head moves down and you feel the urge to push until the baby’s head is visible through the vaginal opening. If the head is visible, the midwife may ask you to stop pushing and advises you to breathe shallowly, similarly to panting, blowing air out through your mouth. In this way, the baby’s head is born slowly and gently, allowing the perineal membrane and muscles of the perineum to stretch without tearing, causing minimal damage to the birth canal.
The perineum usually stretches well, but it can also tear. Sometimes, to prevent tearing of the perineum or, if necessary, to speed up the birth of the head, the midwife can cut the perineum, or have an episiotomy. Later, the wound is sutured under local anaesthesia and the perineum heals quickly.
After the baby’s head is born, most of the hard work is behind you. With one or two light presses, the baby's body is born quickly and easily. A newborn is usually covered with vernix caseosa, which protects the baby inside the womb.
Skin-to-skin contact between mother and baby and the first breastfeeding
After birth, the midwife dries the baby and places it on the mother for skin-to-skin contact. It helps establish contact between mother and child, provides warmth to the child and reduces heat loss. The newborn is then covered with a warm towel or, if necessary, a blanket. The umbilical cord is clamped and cut while the baby is on the mother’s stomach. This is usually done by a midwife or partner.
The first breastfeeding of the child takes place in the delivery room. The newborn must be allowed to crawl on the breast and grab the breast. The baby should be placed on the breast as soon as possible, this promotes later breastfeeding and improves the contraction of the uterus.
Before going to the postpartum ward, the baby is measured and weighed, and fitted with your name tag. If possible/necessary, the baby will also be examined by a paediatrician. The first examination will be done within 12 hours at the latest.
The postpartum period
Within two hours after delivery, your general condition, complexion, breathing rate, pulse, blood pressure, body temperature, bleeding from the birth canal, uterine contractions and secretions will be monitored.
An Apgar score is given to the baby in the first and fifth minutes of life to assess the condition of the child.
After birth, the midwife recommends giving the baby a one-time injection of vitamin K, which helps prevent bleeding disorders in newborns or foetal haemorrhagic disease. If you refuse an injection, inform the midwife early.
Perineal stitches
Small tears and scratches caused during childbirth usually heal on their own and do not require stitches. However, if you have tears that need stitching, the midwife or doctor will make the necessary stitches using local anaesthesia. Your baby can be in your arms during this time.
Activities that are done with the mother and baby after giving birth
Your baby wants to be with you after birth. This time with your baby and also with your partner is very special for everyone. However, some tests will be done on your baby to ensure its well-being.
Tests for newborns
Newborns born in the hospital undergo necessary examinations and vaccinations with the consent of the parents. If necessary, you will also be advised on newborn care issues.
In the first days of life, the newborn is subjected to a hearing screening test or otoacoustic emission (OAE) recording. With early help and intervention, the negative impact of congenital hearing loss can be reduced. Screening makes it possible to identify children not only with deafness but also with minor hearing loss.
Newborns are also tested for various diseases. Babies who leave the hospital within the first two days of life (that is, younger than 48 hours) are invited back to the maternity ward for testing.
If the test results are normal, parents or family doctors will not be notified separately, but the answers will be sent to the hospital or maternity hospital that took the blood sample. All results are available in the laboratory archive. You or your family doctor will only be contacted if the test results are abnormal.
If the test card taken is of poor quality and testing is not possible or if the first test result is higher than the norm, the newborn will be invited for a repeat analysis.
Vaccination of the child
Every child’s body is protected by the immune system. It is in our power to make this system stronger, taking into account its uniqueness. With the help of vaccines received as a child, the body will be able to successfully fight pathogens and defend itself independently. Read more about vaccination here and see the vaccination schedule here .
Children with disabilities and special needs
The severity of a child’s disability can be identified during the child’s development. When a child with a known malformation is born, there is usually a clinical birth plan and a treatment plan available.
Actions after the birth of a child - what should be done and when?
Registration of the birth of a child in the case of delivery in a medical institution
To enter a personal identification code on the medical birth certificate of a child born in Estonia, the child’s code is given to the child by the health care provider who provided the obstetric care. The personal identity code is given to the child when the healthcare service provider has entered the data of the medical birth certificate into the population register.
To register a birth, the child’s legal representative must submit an application within one month from the day of the child’s birth. The registry office registers the birth of a child within seven working days from the receipt of the birth registration application. If it is not possible to apply for registering the birth of a child on time for valid reasons, the registry office where the child’s birth is to be registered must be notified, the deadline can be extended for up to two months from the day of the child’s birth.
Read more about registering a child’s birth and naming the child here.
Registration of a child’s birth in case of a home birth
Children born at home receive a personal identification number from the registry office or local government when naming the child, i.e. registering the birth. A home birth midwife issues a medical birth certificate for the child without a personal identification number. When you go to register the birth, you must take the parents’ documents (passports or ID cards) and the medical birth certificate from the midwife. If one of the married parents goes to register the birth, the written consent of the other parent must be submitted. Read more about registering a child’s birth in case of home birth here .
How does a child get health insurance and a family doctor?
The newborn is automatically assigned to the list of the mother’s family doctor, but if you wish, you can also choose another family doctor for the child.
All children have health insurance until the day they turn 19 (with the 19th year included). The Health Insurance Fund registers children under the age of 19 based on data obtained from the population register. Children whose data are correct in the population register and whose primary place of residence is in Estonia can be insured. Therefore, it is important to register the child’s place of residence in the population register.
Read more about the child’s health insurance here .