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

Deep pelvic pain

Waters breaking

More bloody show

Breathing changes

Tender belly or back

Curling toes

Making animalistic noises

Perspiration, shaking legs, chattering teeth

Thirst

Loss of appetite, nausea, vomiting

Hiccups/burping

Intense concentration on contractions

Not wanting to be touched

Not wanting to be left alone

Tiredness

Asking for medication/help

Emotional signs:

Anger/frustration/demoralisation

Confusion or apprehension

Surprising lack of modesty

Obsession with ritual

General irritability

Amnesia between contractions

Restlessness

‘Hard’ labour is usually shorter than early labour, thank goodness. If you don’t have drugs or clocks you may not have any idea of how long it lasts. You may get into a trance-like state, needing weird rituals or objects. This is when you really rely on your birth partner(s) and midwife: they’ll help you with positions, find ways with you to keep the labour progressing, and will keep you confident and calm. You might sound odd at this point. During the hardest part of Ted’s birth my husband John says I sounded like an old drunkard. I’d be moaning ‘Penny, is ‘e ok?’ and Penny (my midwife) would say ‘Yes, he’s doing very well. He’s fine.’ And two minutes later I’d slur, ‘Is ’e ok Penny?’ Lucky midwives are so patient.

Your waters might break (if they haven’t already) during this phase. This can help your labour to progress. This is why sometimes your midwife might want to break your waters for you – ‘artificial rupture of membranes’ – to help the birth along. You may become irritable or even angry between contractions. ‘Many of my clients are totally bitchy here,’ says Julia ‘and I’m usually relieved – it’s a sign that they are moving to the next part of labour. Most also tear at their clothes and become naked as this part of labour goes on.’ If you’re shy about nudity, wear a sports bra. Do not let incidental worries like baring your boobs stand in the way of this birth.

Many women begin to lose touch with what is going on around them during hard labour. This sounds scary for the control freaks among us, but it can be strangely liberating. With Sam, I was extremely concerned not to go to the hospital too soon (as I did in my first labour). It took John nearly two hours to get me from the bathroom in our house to the hospital car park (a five minute car ride away). Julia watched through the hospital window as it took me another 20 minutes to get from the car to the door of the hospital. I arrived on the labour ward in the lift on hands and knees, baying like a cow. If you find this disturbing remember: the midwives, doctors and nurses (and, presumably your husband) have seen it all before. They do not care what parts of your anatomy are showing or what noises you are making.

Hard labour tip:

‘Labour hurts,’ says Chari, 30, mother of two. ‘Why don’t women speak realistically about that? My mother said it felt like menstrual cramps – but if that’s what her cramps felt like, she should have had a hysterectomy. I had trouble catching my breath; they started with BAM! one on top of the other, and all my natural childbirth plans flew out the window. Labour hurts but it doesn’t have to be scary, that’s what I tell my friends.’

TEN WAYS TO COPE WITH HARD LABOUR

1 Move around and change positions often. You can walk around then stop and lean against someone when the next contraction comes.

2 Don’t lie on your back. This can slow things up and lead to other interventions.

3 See each contraction as a separate entity – not as part of a chain. This can stop you getting too demoralised.

4 Try every comfort measure you can, and do what works, while it works.

5 Relax between contractions: try not to stay braced for the next one as this can really tire you out.

6 Drink and pee regularly. Sometimes just moving to the loo can move things along.

7 Wear something you are comfortable in – if you’re shy about showing your bottom, wear a longer nightie or robe. Your knickers will be lost at some point. Make your ‘outfit’ something you don’t mind ruining.

8 Make sure your partner knows you may yell at him and other people so you can just do it if you feel the need.

9 Do not be afraid to make a lot of noise if it helps.

10 Do not be afraid to be quiet either, if that helps.

GETTING YOUR HEAD AROUND HARD LABOUR | One of the most important aspects of hard labour is your head. Women in hard labour often say things like ‘I can’t go on’, ‘How will I do this?’, ‘Make it stop’. This may sound a bit scary when you’re sitting reading this in the real world. Indeed, the immediate injection of large quantities of narcotics might seem like the obvious answer. This is usually an option. But many women say that they knew they were coping, internally, at the time they said these things and were glad no one gave them the epidural so late in the day. I know that when I was in the peak of labour with Ted, a small part of my logical brain was still up there, calmly narrating events to myself. At one point I heard the noises I was making turn from high pitched squealing to low grunts. I’d been working on this chapter before Ted’s birth, and the little logical narrator in me said, ‘Right, good – a sign that you’re ready to push.’ Weird, this split personality thing, but it shows that even when you are in the height of labour, it is possible also to feel you are on top of things.

Most experienced midwives will look on your yells and demands, in the later stages of labour, as excellent signs. But don’t panic – any request for drugs at this stage will not go unheeded; if you are clear about your needs, and have good support, you will end up with what you want. (See Chapters 5 and 9.) Support is crucial here. Your midwife and birth partner should have techniques for helping your body and your head get through this part of labour. But you – and your partner – need to know that expressing doubts and despair are totally normal and in fact a good sign at this stage. Hard labour is hard. But the good thing about it is that your baby is really on its way.

YOUR PARTNER AND HARD LABOUR | When your cries meet your partner’s high emotions head on it can be a powerful cocktail. He wants you out of pain, and now, finally you’re asking to be. There is one crucial thing he needs to know and remember: comfort is essential in the early stages of labour but sometimes pain, towards the end, can turn labour into motherhood. Drugs can actually slow and complicate things, so they’re not always your best policy if labour is progressing well (see Chapter 5: Your Options).

Dilated, effaced and ready to push

POOS AND WHY THEY ARE GOOD | Your cervix is now fully dilated (which means it is 10 cm open, ready to have a baby pass through it). Your mood may be dramatic; you could be laughing, sobbing or both. Some women throw up, or start to shake or suddenly need to poo. This is your body’s way of getting rid of anything that may hinder the baby’s progress. Poo is progress. Sometimes moving to the loo helps – it’s a place where we are used to pushing and you can totally empty your bladder and bowels before the birth. You may, however, poo without being able to stop yourself. For many women this can be a traumatic thought. Mary, who gave birth in Belgium says, ‘I sat on a birthing chair and kept saying “je ne veux pas faire kaka” because for me that would have been so embarrassing. They thought I didn’t want the baby to be born, but really it was the idea that I’d crap myself in public!’ You have to get past this one. Pooing happens at some point in virtually every birth. Your midwife will have seen women pooing several times a day, virtually every day of her career. The amount of poo is usually very small, she’ll be ready for it, and she’ll whisk it away without a second thought. Indeed, uniquely, she’ll probably be pleased you’ve done it: pooing is a fantastic and normal sign that you’re finally ready to get that baby out.

‘I CAN’T COPE’ AND HOW YOU WILL | You are probably tired or restless now, and you may doubt your ability to cope. ‘I couldn’t believe I still had the baby in there,’ says Sophia, 29, of her first birth. ‘I’d been in labour for nearly 36 hours and I was exhausted. I cried for a bit and asked if I needed a caesarean (I didn’t). With my second baby, also a long birth, I recognised that “downtime” and used it: I actually fell asleep for 5 or 10 minutes and woke up with some energy to push.’

This is a fairly common experience – your body may have a natural ‘rest’. (Though make no assumptions here either: you may well continue with the normal pattern of contractions with no break.) Take advantage of this ‘rest’ if you get one: many women panic thinking their labour has stalled and that they’re going to need intervention to get the baby out. ‘The midwife and her student wouldn’t leave me alone, insisting I start pushing, while all I wanted to do was sleep and wait for the urge to push,’ says Clare (28), mother of Siri (2). Your midwife should be monitoring you and the baby closely, but unless there is cause for concern, she should not be pressurising you to push, if your body is saying sleep. Julia attended one birth where the rest period was freakishly long but ‘Everything was just fine with Ana and the baby – she peed, ate, sang and laughed. When it came, her pushing stage was relatively short and she had plenty of energy for it, despite a long previous dilating stage.’

ABNORMAL FEELINGS AND WHY THEY’RE NORMAL | Some women, at this time in labour, feel surprisingly serene. Others feel relieved and suddenly more human. You may start joking with your partner, who will then wonder if you’ve become delusional, having got used to you incoherent, grumpy or focused. There may be downsides to this renewed lucidity: worries about how you are going to achieve the unthinkable next bit can flood in. You may simultaneously worry that you don’t feel normal. You are not normal – a large baby is about to come out of your vagina. There is, and should be, a phenomenal amount of lower pressure on your back and pelvis (though this may – honestly – not feel painful). If you can, at this point, shove aside your worries and rational thought. Focus on the fact that you’re about to meet your baby. The only way out is THROUGH. And you can do it.

PUSHING YOUR BABY OUT | Your cervix is fully effaced and dilated. Your body is ready to start active pushing. Many midwives now encourage women to give birth on hands and knees, or squatting – gravity can work in our favour this way.

Loads of us have preconceived ideas about the length of time we’ll push for. You may only push once or twice. Then again, it may take you much longer to get the baby out. If your body and baby are coping well, being closely monitored, and you are not obsessed with the clock this might not feel particularly relevant. Sometimes it just takes a while to get the hang of pushing. It is worth checking with your hospital, in advance, whether they have policies about how long you are ‘allowed’ to push for (see Chapter 5: Your Options, page (#litres_trial_promo)). Most midwives will start to keep track of time when you start active pushing (that is, giving hard pushes during every contraction). The general policy is to let you push like this for about an hour. If you’re in a good pushing position, have waited until you get the urge to push before you start pushing, and have got the hang of how to do it, this should be fine. If you are still pushing like this after an hour the midwife will examine you to see how well the baby’s head is descending, to check what position the baby is in and to assess how you are both coping. If there are not enough signs of progress, she may suggest that you need some interventions to deliver the baby (see Chapter 5: Your Options, page). Though you’ve grown up hearing comparison jokes about pooing watermelons many women say the pushing part of labour was actually the least painful. It can actually feel empowering or productive to be doing something this active. This isn’t to say it won’t hurt. But the key thing about this stage is that you’re almost there.