Birth plans: The unpredictability of giving birth

While most of us have a birth plan in place, Louisa van den Bergh of Lulubaby guides you through the unpredictability of giving birth…

Even though are a huge topic, and undoubtedly the big moment you are counting down for, I tend to put off writing about labour and the reason is that my gorgeous boys didn’t come out that way. They were born by caesarean section. I often ask myself: am I qualified to write about this subject – what do I know about labour? I have never been through it myself; I haven’t even had a single contraction, for goodness sake! But do you have to have experienced labour to be able to write about it?

Arguably no. The reason I say this, and perhaps rather controversially, is that from my work and hearing thousands of birth stories from friends, family and the ladies who have been through our antenatal courses, I can honestly conclude that no two experiences of birth are the same and that is the only thing I can write with real certainty. So what other generalisations can I tentatively make about labour?

The three stages of labour

Most labours are broken into three stages. The first is what is usually understood to be labour: experiencing contractions which build in intensity and narrow in interval until your cervix is dilated to 10cm and you are ready to push your baby out. This first stage can be further divided into the latent and active phases. The latent phase is usually longer than the active and is when your cervix is dilated to 3cm or 4cm. From then until 10cm – or fully dilated – is the active phase. Some don’t even realise they are in the latent stage of labour, while others endure hours of painful contractions only to be told they are ‘just 1cm’.

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Many also experience a phase called ‘transition’ in between the first and second phases. Contractions keep coming and mums can feel shivery and anxious, even angry and aggressive. “I’d had enough and began swearing at everyone around me,” reported one mum. Our midwife, Victoria Cochrane, says she often has to turn away and smile at this stage, for the symptoms of transition are common and are simply a signal that mum is nearly ready to push.

The second stage of labour is the pushing stage and is when your baby is actually born – hurrah! The third is the delivery of the placenta which can be helped along with an injection of synthetic oxytocin – the hormone which makes your womb contract. Or you can choose to wait for nature to take its course – this may be hastened by breastfeeding, as that also releases oxytocin. Active versus physiological (or natural) management of the third stage is a hotly debated topic, but research indicates you are at a higher risk of haemorrhage if you opt for the natural route.

How long will labour take?

‘How long is a piece of string?’ is very relevant when it comes to labour. One of my closest friends had a 55-hour labour, including the latent phase. Others I know have delivered their babies at home on the bathroom floor as they didn’t even have time to get in the car (and yes, these were their first babies, too).

Time can depend on a myriad of factors including your baby’s position, whether or not you have been induced, where you are, how you feel, the care you are receiving and so on. Research has shown that active labour is eight hours on average for first-time mums, and five hours for subsequent labours, so, generally, second and subsequent labours are almost always shorter and easier than the first.

What will labour feel like?

I asked some mums this question and this is what they told me: “Really intense period pains, like you have never experienced before”, “Hours of contractions with absolutely no pain. All I could feel was pressure”, “Like a hot poker in my lower back, agony”, “I felt the contractions but it wasn’t painful”, “The epidural couldn’t come quick enough!” Such a varied response to a simple question but obviously the most subjective one in the world. Many of the positive testimonials have often been down to hypnobirthing – simple but specific self-hypnosis, relaxation and breathing techniques  – something to consider if you are particularly fearful of labour.

Labour blood, sweat and tears

If you are having a baby, be prepared for blood. And lots of it. This isn’t something that people dwell on but it is worth being prepared for. It doesn’t stop once you have had your baby either – then there is the placenta to deliver and the lochia (bleeding) afterwards for up to six weeks. Once out, baby may be bloody and covered in vernix caseosa, a waxy white substance delightfully translated from the Latin for ‘cheesy varnish’, which protects baby’s skin in the womb from the amniotic fluid and is intended to also play a role in temperature regulation and skin protection after birth, but nowadays it is often removed immediately.

Sweat. Most women choose to give birth in a hospital – commonly very warm places. Combine this with the hard work of contracting and pushing out a baby, and things can get very sweaty. Also while we are on the subject of bodily functions, let’s briefly mention that you may do a poo in the heat of the action. Midwives are very used to this and deal with it discreetly; but it’s worth noting that your dignity is something that is usually left at the door when you have your baby. For my first emergency caesarean, I remember lying naked on the operating table while a dozen medical staff buzzed around me. I didn’t mind in the slightest, all that mattered was my son’s safe arrival.

Tears. I think it is fair to say that labour is emotional, no matter what kind you have. From that first realisation that labour has begun, to the moment you hold your baby in your arms, it is hard to find a more intense and emotional experience.

To plan or not to plan your labour?

While I firmly believe that it is helpful for mums to understand what may happen, I also feel that planning too much for your baby’s birth can be setting yourself up for a fall. Labour is unpredictable and you can’t always plan for these things, and as our midwives endeavour to remind mums, there are two of you in it together – you and the baby – it’s not just in your hands. In our classes, we encourage our mums to be informed, open-minded and to consider making a list of birth ‘hopes’. That way, if these hopes fail to materialise, mothers will not be too disappointed.

So, a ‘typical labour’ is impossible to pin down: no two descriptions are ever identical, but there are common elements. Our obstetrician Dr Penny Law sums it up perfectly: “Even for women who have previously had a baby, no two births are the same. This is why I believe it is important to be as informed as possible in advance and to understand that anything can happen, because that will help you to cope with the unpredictability of giving birth.”

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