Recently, an acquaintance who was due to give birth asked me for advice.  I think my husband had told her that I’d done a lot of research about it or something.  I tend not to be too forward on these occasions.  I’m kind of uncomfortable about influencing people about something so personal, and I’m not even sure if it can work.  But in retrospect, I kind of wished I had said a whole lot more.  She is fine, the baby is fine, but things could have been better frankly.  How often have I felt that?

Then Humble at Free Range came up with this, and nudged my conscience some more. So, here is all I have to say on the subject, for what my views are worth.  When I had my single child, I did indeed do a huge amount of research on pregnancy and birth, and made decisions which are relatively uncommon, but turned out perfectly for me and my child.  However, this is not about promoting my choices to other people, so I’m not going to even say what they were.  This is about more generic issues. I really believe the world would be a better place if all women (and men) knew about, or would at least give serious consideration to these points:

1. Early miscarriages are very common. Having a miscarriage when you wanted a baby is always going to be upsetting, but realising that it’s a distinct possibility before you begin may help, at least I think so.  It’s difficult to say exactly how common miscarriages are. For the part of the first trimester in which a woman already knows she is pregnant, about 20%?  The probability of a miscarriage in this time frame may be even higher with a first pregnancy.  The majority of women have probably had at least one miscarriage.
2. We’ve all heard that birth is a dangerous process that claimed the lives of droves of women and infants in the past and continues to do so in third world countries?  It’s worth knowing that the most common cause of death ‘in childbirth’ in these contexts is infection in the days following the birth.  The second most common cause is attempted abortion (yes, this is classed as death in childbirth).  The third most common cause is blood loss from the detachment of the placenta immediately after the birth.  None of these dangers are currently a matter of great concern to western women giving birth to full-term infants.  Risks tied up with labour and birth  as we experience them exist, but are very rare.
3. Although many women report finding labour and birth to be painful, uncomfortable and exhausting, it is extremely rare for there to be any relationship between these discomforts and a real danger to mother or child.  There is no need to be scared as well as uncomfortable.
4. Not all women find labour to be painful.  One of the most common causes of pain in labour is the position of the mother, and/or the position of the foetus within the womb.  It is easy to change the former, and there are some possibilities for changing the latter, before or even during labour.
5. The phase of pushing the baby into the outside world is more likely to be painful than the earlier stages of labour, yet there is almost universal agreement that this is not a phase in which it helpful to have our sensations deadened by painkillers like epidurals.
6. In case the only births you’ve ever seen before your own are in movies, all that screaming and agonised face-twisting on the part of the mother is just put there for melodrama.  At the point at which these actresses are usually screaming, I was inquiring of my husband whether he had indeed given the midwife a parking permit as previously arranged.  That sort of thing just doesn’t feel right to movie producers.
7. Everybody seems to go on about the size and estimated weight of their babies compared to their own and the impact it’s going to have on the birth.  It’s obviously ludicrous to be concerned about any measurement except the circumference of the baby’s head.  Even that’s not so relevant when you consider that the baby’s skull plates are designed to reshape themselves for the birth, whilst the ligaments in the mother’s pelvis are designed to allow the bones to separate.  Yes, it is true, they will only do it as a result of significant pressure, but they will do it, and it is safe.
8. Natural births are pretty rare these days, and the medical professionals working with us are unlikely to know what levels of variation occur normally and safely within a natural birth process (length of gestation, length of labour, …).  It has become difficult even to research such a thing.  Some of the research that has been done seems to be suspect.  Interventions intended to keep our pregnancies and labours ‘normal’ may not be based on valid evidence of what normal is.  I am talking particularly about things like induction and augmentation, but also various types of monitoring.
9. Most hospitals measure cervical dilation to see how labour is progressing.  There seems to be an assumption that the cervix dilates in a linear fashion.  I have read a lot of anecdotal evidence that suggests this is not the case.  It seems like the cervix can stay exactly where it is for hours, then reach full dilation in minutes.  That’s worth thinking about and researching, especially before we allow ourselves to be encouraged/discouraged by our cervical dilation.
10. The WHO believes that the rate of cesarean section should never need to be higher than 10 to 15% of births.  In my view, this already allows a lot of safety margin to include borderline cases.  The actual rate is much higher in a lot of countries.  Planned cesareans account for some of this figure. Planned cesareans are not at all in the interest of the mother or the foetus, except in very, very rare cases.  They do seem to be in the interest of the medical profession.  There are almost certainly ‘too many’ emergency cesareans, yet nearly everyone who’s ever had one believes it was necessary in their case.  Other people implicate mismanagement of natural birth processes, see point 8.  Cesareans cannot always be avoided, but they are more dangerous and more uncomfortable post-partum than natural birth.  They arrest the processes surrounding birth in both the mother’s and babies’ bodies, with possible negative consequences.  They leave scars, yet apparently fail to protect womens’ bodies from some of the less desired effects of motherhood.  It seems sensible to take steps to avoid them, sensible too to consider under what circumstances you might need one, and how you might minimise their impact before labour starts.
11. A woman in our society may give birth to two/three children on average.  Even if she has a dozen, each birth is still an extraordinary and incredibly special moment in her life.  That is as it should be.  Birth and the immediate aftermath may also represent her (and the father’s) first acts of conscious parenting.  Medical professionals involved with birth may attend a dozen a day (or more?).  There is a big risk that birth becomes banal for many of them.   As authority figures with a lot of things to see to, they may not be very sensitive to ‘acts of parenting’.  There is the potential for a major clash of perceptions and interests here.
12. The post-partum phase merits more attention than women sometimes seem to give it.  Breast-feeding is often not completely problem-free, especially the first time.  I believe it’s worth planning to have help available beforehand, such as from the LaLeche league or an experienced friend.  Physically, you may feel uncomfortable for some time.  In past times, women were expected to spend a day or two in bed after a birth.  I ignored this because I felt just fine, and subsequently wished I hadn’t.  It’s unlikely that our bodies will ever feel or look exactly as they did before a first pregnancy.  Mood swings in early post-partum are normal, but look out for the rarer post-partum depression.
13. The intensity with which a mother bonds with her child, and the length of time it takes to do so varies.  It may be virtually instantaneous, even in a mother who was previously ambivalent about the expected child.  It may take months, even with a planned and desired birth.  I don’t think anyone really understands this process completely.
14. In many cultures birth has been treated as a victory for the mother.  I think it should be, no matter how easy, how difficult or how it eventually happened.  It’s a pity that our whole entourage comes mostly to coo at the baby, who does not give a damn about anyone except his/her mother.