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

1 Consult your doctor with a list of all your questions, and make sure you understand the answers.

2 Wait until you feel physically and emotionally ready before getting pregnant again. It is not a good idea to rush into another pregnancy before you have recovered.

3 Use the time before you get pregnant again to build yourself up physically. Eat as well as you can, start practising relaxation techniques, and get regular exercise.

4 Get emotional support and information from organizations that specialize in this (see below).

5 Join a support group for women who’ve been through it.

6 Remember that your partner may need support and information too.

7 Make sure you really trust your doctor – if you do not feel they take your fears seriously, consider changing doctors.

A WORD ABOUT A PREVIOUS TERMINATION | Roughly 17 per 1000 women aged 15–44 have a termination each year

. If you have had a previous termination (or more than one) it is extremely unlikely to affect this pregnancy. However, it is crucial that you tell your midwife, even if you find this difficult to do, as she needs to know your entire gynaecological history.

Where to go for help:

The Miscarriage Association Helpline can give you support and information. If you are worried about miscarriage – for whatever reason – even if you have not had one yourself, you can also contact them. 01924 200799 www.miscarriageassociation.org.uk

Fear of having a big baby

It is common to be ‘warned’ by doctors or midwives at some time during pregnancy that your baby’s a whopper. The first thing you should know is that all ways of estimating a baby’s weight during pregnancy are just that – estimates. The technical term for a big baby is ‘macrosomic’ – that is, more than about 9lb at birth. Such information may be presented to you as ‘fact’ but it is usually nothing of the kind. Your midwife will measure the size of your belly and feel your uterus during each check up. But this ‘manual palpitation’ can be around 10 per cent wrong in either direction. The latest ultrasound technology can also be up to a couple of pounds out and is generally considered to be better at ‘predicting’ small babies than large ones.

There is some evidence that steep weight gain in the last trimester may be a ‘contributing factor’ in having a bigger baby. But do not beg for a caesarean if you find yourself gaining more than about 1lb a week: much weight gain in the final trimester can be fluid retention. You might, however, want to cut down on sugary foods if you’re gaining very fast (as this may, possibly, affect your baby’s weight). ‘I was told by the hospital that my first baby was big,’ says Kaitlin, 36, mother of three. ‘This panicked me completely – I was scared enough of the birth. It never occurred to me they might be wrong, they seemed so sure. In the end, I had an emergency caesarean because of failure to progress: she was 7lb2oz. I ignored all comments about baby size in my next two pregnancies.’

Even if your baby does turn out to be big, your body will probably cope perfectly well with giving birth to it. Some women will have bigger babies but James Walker, Professor of obstetrics and gynaecology at the University of Leeds Medical School says: ‘Plenty of women give birth to 10lb babies with absolutely no complications.’ He says, ‘Shetland ponies have Shetland ponies’ (in less equine terms this means your baby is likely to be in proportion with you). ‘Both my sons were nearly 10lb,’ says Sarah, who is 5ft 6in. ‘And both births were great. With my second I did not even tear. What’s more, I am not – despite my friends’jokes – the size of the Mersey Tunnel down there.’ Giving birth to a big baby can be tough, but so can giving birth to a 6lb one. So don’t get hung up on your baby’s size. Julia attended a birth where the mother, Grace, a nineteen year old, delivered a 10lb 5oz baby with no drugs. ‘She was so young, and just hadn’t heard all those dramatic birth stories – she just focused on giving birth. And it went just fine, partly I think, because nobody had told her she couldn’t do it.’

POSSIBLE BIG BABY COMPLICATIONS | With big babies there is a slightly higher risk of failure to progress during labour (i.e. when labour stalls or slows down). We talk more about this in Chapter 5: Your Options. There is also a slightly higher risk of shoulder dystocia (where the baby’s shoulder gets stuck) at birth. Delivering your baby on your hands and knees, or in a kneeling position might help (see Chapter 5 for good positions for pushing). But the truth is complicated – births can happen to babies of any size. Risks, with big babies, tend to occur when a baby is particularly fat, not merely large. This mostly happens to diabetic women who can have fatter babies because of higher blood sugar levels during pregnancy. Head size (another myth shattered) is only very rarely a concern. Even big heads fold (normal, honestly: see Chapter 2) as the baby comes out of your vagina, and despite what many of us think about our brainy offspring, it is actually extremely rare for a baby to have a genuinely humungous head.

In other words, if you are told your baby is big (and you’re not diabetic), have confidence in your body’s ability to grow a baby it can cope with, prepare thoroughly for the birth and tell yourself size doesn’t matter.

Your pregnant body and what it might do

Some odd things may happen to your body over the next nine months. Here are some of the most common ones and what to do about them. Reading sections like this can be alarming but do not obsess about them. You are not ill. Some women sail through pregnancy with barely a twinge. This list can’t be comprehensive, of course, so the golden rule, again, is talk to your midwife if you’re at all concerned. During pregnancy you may experience some of the following:

CARPAL TUNNEL SYNDROME | The carpal tunnel is the tube in your wrist through which run the nerves leading to your fingers. Extra fluid in this tube can cause numbness, tingling and pain in your fingers and sometimes up your arm. What to do Try wrist splints (from your GP). Or sweeping/moving your arm above your head to let fluids return to your heart. Call your midwife if this pain keeps you from sleeping or from your daily routine, and before taking any pain medications.

CONSTIPATION | Pregnancy hormones can bung you up, and if you are prescribed iron this may not help (the majority of women do not need iron tablets in pregnancy). What to do Drink lots of water, eat fibre-rich food (fruit, whole grain cereals, brown rice). Many women swear by a spoon of flaxseed on their breakfast cereal. Granny knew best when she put prunes on her All-bran. Four floz of pure juice a day can also help.

CRAVINGS | There are no definite statistics on this, but small studies and anecdotal evidence suggest that about 60 per cent of pregnant women crave certain foods when pregnant. I spent the first three months of my third pregnancy stuffing myself with beef-flavoured hula hoops (I’m a vegetarian). Julia’s clients crave all sorts of weird things to eat but ice cubes, lemons, toothpaste and gherkins (with everything) come high on the list for many women. Cravings may be a response to unmet nutritional needs, but can also be linked to your emotions – a need for comfort, solace, treats (though where a muddy potato fits in here is anyone’s guess). Craving for things that aren’t food (e.g. coal, clay, chalk) is called ‘pica’ and is uncommon. Talk to your doctor/midwife if this happens or if you are craving anything particularly strongly. What to do Unless it’s ‘pica’, indulge in moderation. You might also want to assess how balanced your diet is.

FEELING GENERALLY UNHINGED | Your hormones have gone haywire. You may feel genuinely unbalanced. Women, looking back on their pregnancy mood swings often use words like ‘psycho’ and ‘loon’. It can feel like acid-fuelled PMT at times. What to do Talk to your midwife or GP. Make sure your partner understands it’s down to chemicals and largely out of your control. Get counselling or other professional support if extreme. Try relaxation techniques, balanced eating, sleep and regular exercise. And remember it will pass.

HEADACHES | These are common, particularly in early pregnancy. What to do Eat small amounts regularly, drink plenty of water (at least eight tall glasses a day, more if possible), avoid caffeine, get fresh air. Try not to take any headache pills in first 12 weeks if possible. The safest over-the-counter remedy – in small amounts – is paracetamol. If headaches are severe talk to your midwife or doctor as this can be a sign of high blood pressure.

HEARTBURN | Pregnancy hormones make the valve at the top of your stomach relax, allowing acid to come up into your throat. What to do Small, frequent, low fat meals and avoiding coffee might help. Some women eat ginger biscuits or drink peppermint tea. An apple after a meal may also help. A doctor can prescribe antacids or liquids like gaviscon and some people say ‘digestive enzymes’, which you can buy at a health food shop, tackle the problem well. Though check with your midwife before you take anything like this.

INCONTINENCE | ‘Stress’ incontinence – leaking urine when you cough, jump, sneeze – and a certain lack of control, generally, over one’s bladder is incredibly common in pregnancy, though you wouldn’t think so by our buttoned lips on the subject. Indeed, about a third of us will still be experiencing some kind of urinary incontinence three months after childbirth. You are not, then, unique in your childlike ability to wet your pants: pregnancy incontinence is caused by the baby weight squashing your bladder, plus hormones which can have surprising effects on bladder control, plus (if you have given birth before) weaker pelvic floor muscles. Most pregnant women know – or find out the hard way – not to stray too far from a toilet. The more pregnancies you have, the worse this may get. What do to Do your pelvic floor exercises (#ulink_87ecdb55-51b1-58e4-8b79-d0a39821021c) , wear panty liners for mental comfort, and talk frankly to your midwife.

ITCHING | Your growing belly, breasts and sometimes the palms of your hands and soles of your feet might get itchy on and off in pregnancy. This is properly known as ‘pregnancy pruritis’ and happens as a result of your stretching skin and possibly your pregnancy hormones. Dry skin or eczema might also get worse. Severe itching during the second, or most usually during the third trimester, usually all over your body and sometimes – though not always – accompanied by nausea, vomiting, loss of appetite, fatigue, pale-coloured poos and jaundice, can be a sign of liver trouble. Called ‘obstetric cholestasis’, this affects about 0.7 per cent of pregnant women so call your midwife straightaway if the itching gets out of hand. What to do Avoid hot baths, use plenty of unscented moisturiser such as E45 cream, wear loose cotton clothing and avoid going out in the heat of the day.

Where to go for help:

The British Liver Trust 01425 463080 www.britishlivertrust.org

Itchy Moms www.itchymoms.com (US website set up by an obstetric cholestasis sufferer)

LEG CRAMPS | These happen to most women during pregnancy, often in the second trimester, sometimes because of calcium deficiency. What to do Some women say a calcium/magnesium supplement stopped them. Tonic water, containing quinine, may also help.

MORNING SICKNESS | This can range from mild nausea to repeated vomiting throughout the day and, whatever level it is, can be depressing, embarrassing and tiring. As Julia remembers, ‘I get a depression with that sickness that is scary. I’m otherwise not depressive at all, but the longer I can’t make myself better, the more down I get. I had great difficulty caring for Keaton when first pregnant with Larson and only the understanding that it would get better helped me. You just have to wait it out and believe that it’s worth it in the long run.’What to do If extreme, get help from your GP (medication is sometimes available, and you may need extra fluids by IV). Otherwise, ‘remedies’ vary from ginger biscuits or ginger ale, to frequent savoury, starchy snacks like crackers, preferably with some protein, to small regular meals, travel sickness wrist bands, acupuncture, acupressure, drinking lots of water, meditating and smelling lemons. Some women swear by porridge.

Where to go for help:

Contact Hyperemesis Education and Research Foundation (HER) for help with severe morning sickness www.hyperemesis.org

PILES (HAEMORRHOIDS) | These are varicose veins in your bottom. They can be alarming when you first feel one bulging out, and can make pooing painful. Sometimes made worse by pushing the baby out. These usually clear up soon after pregnancy. What to do Eat a high fibre diet, drink lots of water, don’t delay if you need a poo, exercise. Talk to your doctor or midwife. Over-the-counter creams such as Anusol are safe to use in pregnancy.

SKIN CHANGES | Skin tags, pigment changes, itchiness, dryness, spots, even acne and warts are all common, hormonal skin changes in pregnancy. What to do Try changing face products if you have facial acne; rub almond oil or similar into itchy/dry skin. Talk to your midwife/doctor if severe and get any new or odd-looking moles checked over. (See also Itching (#ulink_1f464576-1fd2-50fa-9665-cde1fa66e88c).)

SORE BREASTS | Tingling, aching, sharp pains, lumpiness, tender or sore nipples – those girls have a life of their own right now. What to do Try hot baths, showers or gentle massage, ditch your underwired bras, get fitted for a pregnancy bra and wear it at night too if it helps. Some women say avoiding caffeine helps. See your doctor/midwife if any lump, bump or sensation concerns you.

STRETCH MARKS | Generally considered to be a genetic thing, so spending hundreds of pounds at the Clarins counter, while tempting, is probably futile. They can look alarming at first (purple, red, raised), but usually fade after a few months. If at all possible, decide to wear them with pride as the alternative is futile, belly-focused self-loathing and money spent on creams that do nothing. Cocoa butter and other lotions may help with any skin-stretch related itching.

SWOLLEN FEET AND ANKLES | Known as ‘oedema’, this is essentially excess blood and water ‘pooling’ in your extremities. Don’t be alarmed. It’s common and normal and will go away after you give birth. But it can be incredibly uncomfortable and inconvenient. Your shoes may not fit anymore, and you may feel ungainly and bizarrely trapped in this new, inflatable body. What to do Elevate your feet when possible (also keep a stool or pile of books under your desk); lie on your left side when possible; put on waist-high support tights before you get out of bed in the morning so blood has no chance to pool around your ankles; drink plenty of water (surprisingly, keeping hydrated helps your body retain less water); exercise regularly; avoid salty foods. Word of warning Sudden severe swelling in your hands and face can be a sign of pre-eclampsia (#ulink_b07d3bec-cba2-5efb-a9dc-1355a83cfdab), a condition that is very serious. Call your midwife or doctor if this happens.

VARICOSE VEINS | Yes, sometimes we get these glamorous things in pregnancy, because of our increased blood volume. They are enlarged veins (blood vessels) close to your skin’s surface and usually found in your legs and feet. They can ache, itch or throb, and they can look a bit grim. What to do Talk to your midwife if you have them/think you’re getting them. She’ll suggest keeping your feet elevated, wearing support tights, moving around a lot, avoiding certain sitting positions (crossed legs, thighs pressing on edge of chair), avoiding standing for long periods.

GROUP B STREP | This is a common bacteria, harmless to you and found in your vagina. If you have it, your baby can pick up an infection on its way out and can be damaged by it. You may be screened for this in pregnancy. There is more about this in Chapter 5: Your Options, page (#litres_trial_promo).

VAGINAL YEAST INFECTIONS (OR THRUSH) | This is very common in pregnancy because of hormonal shifts and appears as a frothy, yeasty discharge accompanied by intense vaginal itching. What to do Avoiding sugar may help and ask your GP or midwife about over-the-counter creams that are safe to use in pregnancy.

More serious health worries

There are, of course, endless rare, technical problems to do with pregnancy that we just can’t cover in this book. We cover a few of the most common serious health worries below. If anything else crops up during your pregnancy, talk to your doctor, midwife or specialist: the basic advice is to become as informed about your particular issue as possible and get help from any support group you can find. The internet is always a good place to start, but ask at your hospital for recommendations too.

BED REST | If, for example, the baby looks likely to be born prematurely, you may be put on bed rest. This can range from literally not moving from the bed until the baby is born, to a low-key, temporary rest. How to cope Make sure you completely understand the reasons for your bed rest, and the extent of your limitations. Get specific information, such as how long can you stand in the shower everyday? Does this time include dressing? If allowed, sofa-rest may be more manageable (you’ll feel more normal, less ill). Ask your doctor.

TIPS FOR BED REST SURVIVAL

Create your own space: have the TV remote control, books, books on tape, drinks, wet wipes, toothbrush, chapstick, phone, pen and paper etc. all within reach.

Have something to look at that will encourage you: the baby’s scan picture, for instance.

Accept help (laundry, food, with other children).

Network: one of the best defences against depression is support from others in your circumstance (if you have a laptop it could be your cyberlifeline). Try http://fpb.cwru.edu/Bedrest.