in advance and while giving birth – the fears you master, the facts you learn, will also make an enormous difference to the outcome. We’ve become deeply disempowered about birth and it’s time to wake up to this. Instead of thinking ‘there’s nothing I can do’, you should be preparing for childbirth as if it’s the expedition of your life. The sum of these preparations is what will make your birth acceptable, bearable – and maybe even fantastic. The birth you want, in short, is one you’re coping brilliantly with. And you’re more likely to cope brilliantly if you understand the basics about what is happening to you.
Wot no textbook?
The first, perhaps most important, step in preparing to give birth is to understand what childbirth, in its raw state, can really be like. We’re going to give you a realistic picture in this chapter of birth in the real world – a picture that goes beyond the textbook version of what birth should be like. If you want to know more about birth in nice safe clinical stages (and it’s a good idea to be well-informed), pick up any one of the medically orientated childbirth books you probably own already (Further reading) or see below. Our aim, in this chapter, is to stop you becoming freaked out during labour by helping you to understand what can actually happen when it’s going well; your emotions, the smells, sight, feel and occasionally the sheer extremity of the whole endeavour. This chapter, then, will reach the parts that the other books don’t touch.
But it’s worth getting to grips with the text book facts first. These are the nuts and bolts of birth. Knowing them will help you understand the terms and assumptions that will be used about your body and baby when you are in labour. They’ll help you navigate labour when you’re in it – providing you understand the other possibilities too.
A WORD ABOUT ‘HIGH RISK’ PREGNANCIES | There is no formal, or universally accepted, definition of a ‘high-risk’ pregnancy. At its most general, it means that you or the baby is more likely to become ill or die than usual, or that complications before or after delivery are more likely to occur than usual. Doctors will identify ‘risk factors’ which roughly fall into these categories:
1 Whether you have a significant medical condition before your pregnancy, such as diabetes
2 Whether you have developed a significant disease during the pregnancy, for example pre-eclampsia
3 Whether there is a problem with the baby, such as growth restriction
4 Whether you have a history of a previous problem with a baby, for example a previous premature labour
They use a scoring system to determine your degree of risk. If you’re classified ‘high risk’, you’ll need extra medical attention during pregnancy and birth.
This is not a diagnosis that should be given lightly, or received casually. Nor is it a status given by any past doctor making a prediction about your future or by self-diagnosis. So, if your midwife or doctor mentions the words ‘high risk’, ask the following questions, and feel free to get a second opinion:
Define high risk
Explain why you classify me in this group. What has lead to this?
Explain what this means to my current pregnancy and my everyday activities?
How will this affect my birth plan?
Is there anything I can do to improve my status or to get myself removed from this classification?
What are the risks to me and my baby in regard to my ‘high risk’ status during pregnancy, labour and postpartum?
If necessary, get them to write things down for you. It is really important to be totally clear about any ‘high risk’ label. If you are having twins, or multiples, you may be classified as ‘high risk’. This, for many mothers, is demoralising. But there are still choices you can make, and things you can do to have a better birth. Keep reading.
High risk tip:
‘High risk’ does not necessarily mean you lose all control over this birth. Midwife Jenny Smith believes it’s important for medical teams to work with the woman, when it comes to high risk births: ‘One mother I looked after was 45 years old, and pregnant from IVF. She had “white coat hypertension” – in other words, a fear of doctors – and her blood pressure would shoot up when monitored. She also had fibroids, but wanted a normal birth. Following a full check that she did not have pre-eclampsia (a high blood pressure condition that can be fatal for mother or baby), she went on to have a labour in a dimly lit room on the floor with beanbags and mats and delivered on the birthstool. We carefully prepared, with all the equipment ready, in case she should have a haemorrhage. I believe managing high risk is all about being realistic about the risk, thinking individually about every woman, listening to her and discussing her individual potential risks very fully with her before making an appropriate plan for labour that all carers are aware of.’
LABOUR AT A GLANCE: THE TEXTBOOK VERSION
First stage This stage begins when your cervix starts to open and ends when it is 10 cm or fully dilated. Often begins with a ‘bloody show’ or ‘loss of mucous plug’.
Early phase Also known as ‘latent labour’, ‘pre-labour’ and sometimes, rather tactlessly, ‘false’ labour. It can take one to 12 hours for the cervix to dilate to 3 cm and the beginnings of effacement. Mild contractions begin at 15–20 minutes apart and last 60–90 seconds. Contractions then become more regular, until they are less than five minutes apart.
Active phase The cervix dilates from about 4–10 cm. Contractions become stronger and progress to about three minutes apart, lasting about 45 seconds. Takes one to six hours.
Transition phase The cervix reaches full dilation (or about 9 cm) before there is an urge to push. Contractions happen two to three minutes apart and last about 60 seconds. Takes five minutes to two hours.
Second stage With a fully dilated cervix (10 cm), you start to push the baby out. This phase may last five minutes to an hour (or longer). Contractions may slow to two to five minutes apart and last 60–90 seconds.
Third stage This last stage of childbirth begins once the baby is born and ends with the delivery of the placenta and membranes. Usually happens within 15–30 minutes of the baby’s delivery. It is a short stage lasting 15 minutes or less. Contractions are closer together and may be less painful. The placenta separates from the uterine wall and is delivered.
Wot no drugs?
You will not find descriptions of drugs, implements and surgical procedures in this chapter. This is not because we’re trying to encourage you to give birth in a field, gnaw through your own umbilical cord and evoke only the goddess Kali for relief. We know (we’ve been there) that you may need, want, or have to have drugs or interventions at any stage of childbirth. We cover medical interventions, pain relief, and other common eventualities in Chapter 5: Your Options. However, normal birth can frankly feel anything but normal (shifting an 8lb object through your pelvis and vagina is hardly an everyday event after all). Birth can be outrageous and amazing. If you know this in advance you’re less likely to lose it when you encounter some of the weirder, less publicised ‘stages’ of childbirth.
A note to second timers
You may have been there once already but don’t think you can get away with skipping this chapter. You may experience different things this time (if you had a difficult first birth, we’re here to make sure you will have a better one this time). It’s possible you will not need the intervention you had last time, and things may be quicker or slower, or feel utterly different. So read this chapter.
A WORD ABOUT CHILDBIRTH CLASSES | Childbirth classes