Blooming Birth: How to get the pregnancy and birth you want

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 can be extremely useful, and it’s definitely worth enrolling in one if this is your first baby (see different classes in Chapter 5: Your Options, page (#litres_trial_promo)). But be aware that some classes may give you the impression that the birth will follow a pre-arranged, easily identifiable pattern of three distinct ‘stages’ (see above). Most of us, before giving birth, actually learn little more than what really ought to happen on a good day. This, of course, is immensely seductive to your average squeamish worrier. We all want nice, manageable, safe facts to cling to when facing an abyss of bodily lunacy. And once a week, as our bellies swell to alarming proportions, this is exactly what we get. We learn nice round facts about drugs, plugs and pushing. We look at neat diagrams. And if we’re lucky we learn some useful relaxation techniques.

‘After I gave birth the first time, I realised my childbirth class had been useless,’ says Saadia, 35, mother of Imaan (4) and Zahra (2 months). ‘The birth was nothing like what I’d been taught it should be – I ended up with an emergency caesarean and I was totally shocked by it.’ Second time around, Saadia took a very different approach. ‘I read tons, I did a prenatal yoga class, built up an honest picture of birth, hired a doula, worked on my emotions and fears, made conscious choices about my care and ended up having faith in my body. Zahra’s birth was phenomenal.’

My own experience was a lot like Saadia’s. I remember that in my first antenatal classes there seemed to be no doubt in anyone’s mind that, around my due date, labour would begin spontaneously. I’d have a ‘bloody show’ in my knickers, move seamlessly into ‘pre-labour’ experiencing manageable, erratic, early contractions which would, after a bit, settle into a regular pattern of painful contractions (known as Stage One, page (#ulink_3d8aaf28-ee27-5fc7-af3a-a42d4d4cacdc) above). I’d then go to hospital with my beanbag and CD player. My cervix would proceed to dilate at 1 cm per hour. My waters, at some point (probably early on), would break and labour would speed up. I might choose analgesia. And after a tricky period of ‘transition’ (during which I might – good Lord – swear and be sick), I would push my baby out of my vagina (Stage Two), preferably standing and making grunting noises, possibly sustaining a tear to the perineum (the skin between your vagina and anus). I would then, about 20 minutes later, push out a placenta, thereby completing Stage Three.

What really happened bore little relation to this. No one talked about emergency caesarean in our antenatal class. Half the class, including me, ended up with one. My experience – the ‘failure to progress’, the drugs, hormone drips, monitors and interventions – is a surprisingly common one for first time mothers. It’s really not that normal, first time round, to have a straightforward, nicely timed birth. In Julia’s 14 years as a doula, she’s only attended a couple of births that followed this neat, regular childbirth-education pattern. So, use your childbirth class as a starting point: follow up issues raised with reading, research and discussions. Your teacher, if she’s good, will be able to help you with this.

A WORD ABOUT HOSPITALS | Many of us have never stayed in a hospital before. If we have, chances are it was because something rather unpleasant was happening. Hospitals can smell, look and feel intimidating. Taking a tour of your hospital is a good idea because you do not want the surroundings to panic you when you come in to give birth. On the tour, they will show you the clinical equipment in the labour room. This can be worrying, particularly if you’re scared of hospitals. I remember going home from my first hospital tour in tears: I found all the medical paraphernalia deeply scary. I couldn’t help but picture myself in the midst of a medical crisis. I’m slightly hysterical about this sort of thing, but even if you’re not, it’s better to look at the hospital in advance. Being somewhat familiar with your surroundings will help you feel safer, and more confident. (See Chapter 5: Your Options for tips for hospital tours, page (#litres_trial_promo))

Labour: the real woman’s version

So, you’ve had the official version of birth. And we hope you will end up with one. But it is equally likely that your labour will have quirks and kinks all of its own. Many of the women we spoke to for this book used words like ‘panic’ ‘excitement’, ‘confusion’, ‘fear’ or even ‘demoralisation’ when talking about their first experiences of labour. Most said that much of what they learned in their childbirth classes seemed inadequate on the day. They felt they’d not been ‘warned’ in advance of how painful, difficult and confusing labour could be, or how it could deviate from the ‘safe’ pattern they’d memorised. So here goes.

Nesting

This is your inner cavewoman speaking to you: you get a primal urge to make your ‘nest’ clean, safe and warm for the baby. This usually happens in the last weeks of the pregnancy, escalating just before you go into labour. It can take many forms but it usually involves you doing something domestic that is completely out of character. Before Izzie, my first baby, was born, I sewed curtains, something I’d now rather die than attempt. A friend of mine who can’t cook a boiled egg found herself trying to prepare elaborate meals involving tons of obscure ingredients. ‘I’m not into excessive cleaning,’ says midwife Jenny Smith, ‘but before Oliver, my first baby, was born, I decided to clean the outdoor step. This took all day and involved a multitude of cleansing preparations and an old type of scrubbing brush. I remember showing my husband the step at 10 p.m. I slept deeply to be woken at 6 a.m. with contractions.’ You may not nest at all. Or you may behave like a deranged Mrs Beeton. If you do, you’ll think it’s normal. Everyone who knows you will, of course, know you’re crazed.

In the beginning: labour kicks off

WHEN TO CALL YOUR MIDWIFE

You feel firm, fairly regular contractions (e.g. contractions that come three to four minutes apart, lasting about a minute each, over the course of an hour).

You are leaking fluid from your vagina (with or without contractions).

You have any vaginal bleeding.

You have had a bloody show in your knickers (can be pinkish, brown, yellowy-green).

You feel headachy, dizzy or your vision is blurred.

You feel burning or stinging when you pee, or feel a frequent urge to pee.

You feel abdominal pain.

You have diarrhoea or backache that may come and go.

You have a slight fever.

You feel anything unusual to you – any sensations that concern you. Labour comes in different packages, so don’t be afraid to call.

‘Latent labour’

Your labour may not begin with thunderclaps, a strike-me-down contraction, and the gushing of broken waters. And it may not begin when you think it should. Roughly three out of ten babies come before their due date, and seven out of ten are born after it.

How the earliest bit of labour feels and how long it takes varies greatly from woman to woman and from pregnancy to pregnancy. Your labour may actually have begun days before you realise it. You can be watching a movie, going to the hairdressers, cleaning your loo, and all the while your cervix is slowly opening – without a twinge. If only this pattern went on until it was time to push, you’d have no need for a book like this. But things do hot up – eventually.

VAGINAL CHECK-UPS | Some women ask for a vaginal exam around their ‘due date’, so that they have something to report. This may not be helpful. First of all, the fewer checks you have the lower your risk of infection, and secondly, the numbers at this stage really don’t mean much in an average pregnancy. You can dilate rapidly or slowly no matter when the process begins. Latent labour may take a couple of hours or it may go on – literally – for days. It may be unnoticeable at first, or really quite painful. There are, however, a few signs that indicate some action:

BLOODY SHOW | The ‘mucous plug’ which blocks your cervix, keeping it sealed, falls out when the cervix starts to stretch. This appears in your knickers (painlessly) as brownish discharge. If you see red, or fresh blood, call your midwife straight away (but do not panic, it may be perfectly fine). Do not, however, assume you’re about to be instantly ravaged by contractions if you see your ‘show’. Many women have ‘a show’ up to two or three weeks before they go into labour. For some it’s a matter of hours.

WATERS BREAKING | ‘When my waters broke with my first baby I was shocked,’ says Sandy, 33, and 5 months pregnant with her second baby, ‘I had no idea that one cup or more of clear fluid would pop out of me.’ Your waters may break suddenly to be followed swiftly by contractions and a baby. This can be a surprising (though not painful) moment, particularly if it’s earlier than you’d expected: ‘Celeste came three weeks early,’ says Mary, mother of Celeste and Nell. ‘My waters broke at four in the morning and I felt all this water just gushing and gushing out – I was certainly not prepared for that.’ But the breaking of waters is not the Biblical sign of labour’s onset that popular myth implies. Many women’s waters break ages before they feel any contractions. ‘My waters broke at 11 p.m. and I couldn’t sleep all night, out of excitement and fear,’ says Jennie, 28, mother of Poppy, 3. ‘I was beside myself when nothing had happened by the morning. Eventually, my labour was induced – 24 hours later.’ About nine out of ten women go into labour naturally within 24–48 hours of their waters breaking. If your waters break and labour doesn’t begin, you should call your midwife. The hospital will want to assess you and the baby for any signs of infection if labour doesn’t start soon. They’ll check whether your waters were clear (i.e. there were no signs of ‘meconium’ or baby’s first poo. This makes the waters look green or brownish and can signal that the baby is in distress). They’ll also check the baby’s heart rate and whether you have any temperature, and they’ll do a vaginal swab. The official government guidelines are that if you are having a healthy pregnancy and are ‘at term’ (i.e. your waters have not broken prematurely) you can be monitored like this for up to 72 hours (at which point, they will have to induce labour as the risk of infection rises).

For other women, the waters don’t break until they are well into established labour. Once in a while babies can even be born with the bag of waters intact.

Word of caution: if you think at any time in pregnancy that fluid is coming out of you (even if it’s just a dribble) then call your midwife. It might be a little leaking pee, but it needs to be checked.

IT COULD BE LABOUR IF:

You have been pregnant for at least 38 weeks

You have an increased backache or feel pressure in your pelvis or bottom

Your nesting urge skyrockets

You have soft poos, or diarrhoea

You have a bloody show

Your vaginal discharge changes (more thick and mucous like)

You feel a manageable, but slightly painful tightening in your abdomen that may not be an intermittent Braxton Hicks contraction

You are restless and feel fluey or have much pinker cheeks than usual (!).

Real birth tip:

Don’t assume you’re in labour just because you feel you should be. Sticking rigidly to a preconceived idea about when and how your labour will kick off may be hard to handle, emotionally. Julia had one client, Tia, who insisted (at just 37 weeks) that she was overdue.

‘Her doctor had ventured a guess months before that this small-boned woman would deliver early, and so Tia just moved her due date. By the time her real due date came, she was telling everyone she was two weeks overdue. Eventually her somewhat harassed doctor checked her: her cervix was tight and there was no effacement. Tia was absolutely devastated. Days later, her labour gently and normally began but she would not distract herself and went straight to the hospital, soon becoming frantic about her ‘failure to progress’ (she said this, not her doctor). She relied so much on a perceived timescale for her own labour, that she let it rule her birth.’