has all been a terrible error. You can’t stop the contractions because you don’t like them, there are no guarantees that your efforts will lead you exactly where you want to go, and there are no meaningful ‘standards’ by which to measure yourself.
This is worth embracing if you possibly can: actively losing control – at least of your conscious, rational brain – can be a good thing in childbirth. It allows your body to really get on with giving birth. In the final stages of producing Ted, my third baby, I felt like there was some huge force field coursing through my body, ushering him out of me. I just had to surrender to it. This kind of experience, if you’re used to calling the shots, can be unsettling to say the least – and deeply shocking if you’re not prepared for it.
This loss of control turns many sorted, empowered women into fatalistic loons when it comes to childbirth. You’ll hear women who mastermind multimillion pound deals, fire and hire staff, make momentous professional decisions and run their families like clockwork, tell you that birth is all about ‘luck’ and there’s nothing you can do with the ‘cards you’re dealt’.
This is not wholly true. Yes, certain aspects of birth cannot be controlled. And yes, your options are limited somewhat if your baby really does want to enter the world bottom first; or if you develop pre-eclampsia or some other medical complication. But you can exert a vast amount of influence over the hundreds of variables that will make up your so-called ‘birth experience’. Your willpower, endurance, courage, confidence and determination can make a huge difference not just to what happens during childbirth, but how you handle the more unforeseen aspects of it. The choices you make – 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
