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

Put on real clothes if allowed to move. You aren’t ill, so try and do the little things that will help you remember this.

Practise relaxation techniques and do any doctor-approved stretches to keep your blood flowing.

This would be a great time to learn to knit (yes, really: bizarre as this may seem to the non-knitter), or to address baby announcements, read War and Peace or do your Christmas cards (even in July). If you fancy having a go at knitting try: www.ethknits.co.uk, www.bust.com/knithappens

Bed rest may affect your finances. Let your mortgage/loan officers and credit card companies know. Arrange new payment schedules if necessary that will keep you from lying there worrying.

BLEEDING IN PREGNANCY | Twenty per cent of us have early pregnancy ‘blood spotting’ or light bleeding. Dark red bleeding with tummy cramps can mean the start of a miscarriage, though not always. Call your GP/midwife if you experience bleeding – even if just for reassurance.

DIABETES | If you are a diabetic you need special care in pregnancy as you need to control your blood sugar carefully (there is an increased risk of miscarriage or complications with the pregnancy if it is poorly controlled). Discuss this with your doctor/midwife early in pregnancy.

GESTATIONAL DIABETES | About three to five per cent of pregnant women develop this kind of diabetes during pregnancy and it can usually be controlled by diet. It goes away afterwards. There may be no symptoms except sugar in your urine. There is an increased risk that you will have a big baby if you develop the condition. Policies on screening for gestational diabetes vary across the country. In many hospitals, your pee will be tested for sugar at your antenatal check-ups. Or you may be screened in your second trimester. Do talk to your midwife/doctor about screening, if you have any of the risk factors, or are worried about this. Risk factors include previous gestational diabetes, family history, a previous big baby, a previous stillbirth, obesity and certain medical conditions.

HIV | All health authorities in the UK have to offer you an HIV screening at your booking-in blood test. Treatment is available if you are HIV positive and there are important steps you can take to minimise the chances of passing on HIV to your baby (during pregnancy, birth and afterwards). Your doctor or midwife will give you more information and help. Or try the support organisation Positively Women: 020 7713 0444 (www.positivelywomen.org.uk).

INFECTIONS | Colds, flu and general tummy bugs will not harm the baby. Catching rubella or chickenpox, however, might. An early blood test at your booking in should assess your rubella immunity. For chickenpox, there are drugs that can reduce the effect of the virus so see your GP immediately if you think you’re at risk (i.e. you have never had it, and have been exposed to someone with active chickenpox).

PRE-ECLAMPSIA | This is high blood pressure in the mother than can harm the baby. Mild pre-eclampsia affects about 10 per cent of pregnancies, but only 2 per cent of pregnancies severely (about three to five mothers in the UK die of it each year). There are no overt symptoms in the early stages but it can be detected by regular antenatal checks on your blood pressure and urine. It is curable only by having the baby, so some babies may have to be delivered – by caesarean – prematurely. You are more at risk if: you have had it before, are pregnant for the first time by a new partner, are over 40, overweight (BMI of 35 or more), suffering from other chronic medical problems, including hypertension, kidney problems, diabetes or are carrying twins or multiples. If you have a family history of preeclampsia, have had it before or have waited ten years or more since your last baby you are also at a slightly higher risk. For more information, ask your doctor/midwife or try Action on Pre-Eclampsia (APEC): Helpline: 020 8427 4217 www.apec.org.uk.

Busy woman’s look at pregnancy stages

First trimester (1–12 weeks)

YOUR BODY | You may feel tired, nauseated, constipated, bloated, achy (pelvis and breasts). You may notice more vaginal discharge, more prominent veins, crave odd foods and have an acute sense of smell. Sickness usually peaks about Week 8. You may have fainting spells and headaches. Your waistband may feel tight as early as Week 4 (especially if this is not your first pregnancy, you may look five months pregnant at three months if you’ve stretched before). Your breasts may tingle, ache and the nipples may get darker and bigger. For most women, sickness abates around Week 12. You may be disconcerted that you ‘just look fat’, not pregnant. This won’t last.

YOUR EMOTIONS | Mood swings can shock you and your partner but should level out around the end of the trimester. Erratic feelings are common: elation, anxiety, hope, panic, ambivalence, fear of miscarriage or gaining weight, depression. As you approach your second trimester your hormones calm down and you should think more clearly. First trimester may seem to drag on but enjoy the feel of a non-elasticated waistband while you can.

BIRTH PREPARATION | Think about your carers: change your GP if you are not happy with him/her, look at what options are available for antenatal care/birth in your area (see Chapter 5: Your Options). If you are booking an independent midwife, you can see her throughout all antenatal checks etc., so do this now. Otherwise, it is really too early to be obsessing on the birth itself. If you feel scared of the birth, write down all the things you fear: you’ll deal with these later.

EXPERIENCED MOTHERS ADVISE | Give yourself a break. Go to bed at 7pm if you want to. Don’t be afraid to whinge or cry. Take time off work if you need to. Let yourself be pampered (or pamper yourself if no one will do it for you).

YOUR BABY | Month 1 The size of a little grain of rice. It’s developing a spinal cord, nervous system, gastrointestinal system and heart and lungs. Your placenta is forming and creating the umbilical cord. You may spot a heartbeat on an ultrasound, but it could be too soon even for this. Month 2 Less than one inch long. Her face is forming with tiny eyes, ears, mouth and tooth buds. Her arms and legs are moving (you won’t feel them yet). Her brain is forming and you can see her heartbeat on a scan. Month 3 Three inches long and 1 oz, with wiggling fingers and toes and even tiny fingerprints. She can even pee. Unbelievably, scans can show smiles, frowns, swallows and sucking.

Second trimester (13–25 weeks)

YOUR BODY | Risk of miscarriage drops considerably, nausea usually lessens and you may be lucky enough to get an energy surge. Abdominal pains and twinges (your ligaments are stretching), tender breasts, heartburn, bleeding gums, cramps, a dark line down middle of belly (linea negra), food cravings, nasal congestion, leg cramps, occasional nosebleeds and constipation are all normal. If this is not your first pregnancy you may feel the baby move as early as the start of the trimester.

YOUR EMOTIONS | Placenta Brain starts creeping in: forgetfulness and disorganization are common, as are creativity and insanely vivid dreams. Your belly should finally start looking like a pregnancy not a surfeit of pies. Start talking to your partner about how a baby might affect your relationship, budget, lifestyle: big issues need to be dealt with. Also talk about how your new girth is affecting your sex life (many men can be scared of hurting the baby and need reassurance).

BIRTH PREPARATION | Book maternity leave. Start to focus on your feelings about the birth, beginning to resolve past birth experiences if this isn’t your first; work out what preconceptions you have about birth, from family, friends, media images. Read Chapter 5 carefully: visit your hospital and other birth-place options in your area. Consider hiring a doula (see Chapter 9). By end of trimester: register for childbirth classes.

EXPERIENCED MOTHERS ADVISE | Wear tight clothes to show off your belly (tents will just make you look fat). Hide bathroom scales. Take advantage of energy if you have it. Start dealing with emotional issues around childbirth: it can be a long haul.

YOUR BABY | Month 4 About five inches long and 4 oz, strong heartbeat, thin transparent skin, soft hair over body. Little finger- and toenails are forming and he’s moving well in an increasing amount of amniotic fluid. Month 5 Ten to 12 inches, with hair, eyelashes, eyebrows and even the occasional hiccup. He can hear your voice and you will probably start feeling him move (about 18–22 weeks). A scan around 20 weeks can tell you the baby’s sex. Month 6 Eleven to 14 inches, about 1lb, his eyes are open. Pruny skin covered in ‘vernix’. Now looks like a small, very real baby. Ten to 20 per cent of babies if born now will survive.

Third trimester (26–40 weeks)

YOUR BODY | Interrupted sleep, nasal congestion, shortness of breath, heartburn, itchy skin (it’s stretching), stretchmarks, abdominal aches, backache, varicose veins, feeling hotter, bleeding gums, swollen ankles and feet and haemorrhoids: it’s a laugh a minute. Then again you may feel on top of the world. ‘Braxton hicks’ contractions can start now (a tightening feeling in belly: just practice contractions that are not labour). Your sex drive may evaporate or accelerate. Incontinence and frequent peeing are common. Do your pelvic floor exercises (#ulink_87ecdb55-51b1-58e4-8b79-d0a39821021c).

YOUR EMOTIONS | Anxiety about birth is normal. But really get on top of your fears. Keep talking to your partner about all of this. You may feel more vulnerable (or, conversely, powerful). You’ll probably get increasingly tired. If you have other children, start preparing them now for their sibling’s arrival. You may start ‘nesting’ furiously towards the end and everyone will think you’ve gone mad.

BIRTH PREPARATION | Start childbirth classes. Start work on your Blooming Birth Plan (Chapter 7). As you near the birth make sure you are happy with your choices (you can still swap – even late in the day), really deal with your fears and worries about birth (get professional help if you are bogged down), and solidify your plans about how you’ll cope with pain etc. Make practical plans regarding other children and the birth/work handover/finances. Work on your confidence: you can do it, you will cope.

EXPERIENCED WOMEN ADVISE | Celebrate your hugeness: get a photographer to take pics of you or an artist to sketch you, don’t try and hide your belly (it’s futile and you’ll end up looking like Hattie Jacques). Ask people for a seat on the tube or bus (they may not offer but don’t suffer in silence). Sort yourself out about the birth and talk to your midwife about all worries. A doula can be invaluable at this stage. Pack hospital bag two weeks early and buy baby clothes/cot/nappies etc. by 38 weeks.

YOUR BABY | Month 7 Fourteen to 17 inches long, 2–3lbs, she’s putting on much needed body fat and her lungs are developing. Month 8 Sixteen to 18 inches, 4–5lb, she wakes and sleeps, can respond to sounds and knows your voice. Her bones are soft and flexible and she’s starting to get into position for birth. Month 9 About 19 inches and 6+lb, she has less room to kick and wriggle, her vernix covered skin is plumped out, the fine hairs covering her body are almost gone: she’s getting ready to be born.

Overdue (41 weeks +)

This affects around 5 per cent of us. See Chapter 5: Your Options for ways to deal with this.

YOUR BODY | You may be feeling knackered and uncomfortable with all the symptoms continuing as before, possibly even more noticeably.

YOUR EMOTIONS | If you’ve prepared yourself for how common it is to go past the due date, you might be coping well (if slightly nervously or impatiently). If, however, you’re getting ten calls a day asking where the baby is, and you were convinced that by now you’d have him in your arms, you may be in despair. Fear of induction is a biggie (see Chapter 5). Know the facts about overdue babies, understand your rights and your choices and induction can be totally manageable.

BIRTH PREPARATION | Keep working on your confidence and relaxation. Rest, and work through lingering worries. Have a good induction plan.

EXPERIENCED WOMEN ADVISE | Sex (go on, force yourself), vigorous uphill walking, acupressure, acupuncture, ensuring all emotions and fears are sorted out, patience and distractions (salon appointments for manicures, pedicures, hair are one strategy to make you feel pampered when you really need it).

YOUR BABY | May be 20 inches long, and around 8lb. Regular checks by your midwife will ensure he’s safe and well. You may get some pressure to have an induction. Inform yourself fully before you make any decisions on this one.

Interestingly, blaming your partner may be legitimate at this point: Danish research published in the British Medical Journal, November 2003, suggests that a father’s genes play a major part in deciding the timing of the birth, and your chance of having a ‘prolonged pregnancy’.

Where to go for help:

For fetal development in more detail try Your Pregnancy Week by Week by Dr Glade B. Curtis and Judith Schuler (Da Capo Press, US, 2004)

Antenatal checks and tests

How many visits?

The National Institute of Clinical Excellence (NICE) guidelines say low risk pregnant women should have an antenatal appointment (with the midwife) at about ten weeks (to be booked in), then at 16 weeks, then 19–21 weeks (for a scan), then every three weeks until you are 36 weeks pregnant, then every two weeks until you are 40 weeks pregnant, then weekly until you deliver.

At each visit your urine will be tested for protein (sign of pre-eclampsia) and sugar (diabetes). Your blood is pressure taken. The midwife will feel and measure your uterus (from the outside!) and check the baby’s heartbeat. Use these visits to get to know the midwife, and talk over your worries/concerns/options generally.

Initial ‘booking’ visit

At about ten weeks: Your medical history and general health: weight, height, heart, lungs. Test for sugar and protein in urine. Blood pressure. First blood test (see below).

Ultrasound scans

These are the most common scans, though they are not offered by every hospital:

Dating: 8–12 weeks. To assess when baby due.

Nuchal fold: 11–13 weeks. Looks at thickness at back of baby’s neck. Gives a ‘risk’ of Down’s syndrome, from which you can decide if you want to take further tests (see below). About 80 per cent of Down’s babies are detected in this way.

Anomaly scan: 19–21 weeks. To assess baby’s overall development. Looks specifically at the development of the palate, brain, spine, bladder, kidneys and stomach.