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The first, perhaps most important, step in preparing to give birth is to understand what childbirth, in its raw state, can really be like. We’re going to give you a realistic picture in this chapter of birth in the real world – a picture that goes beyond the textbook version of what birth should be like. If you want to know more about birth in nice safe clinical stages (and it’s a good idea to be well-informed), pick up any one of the medically orientated childbirth books you probably own already (Further reading) or see below. Our aim, in this chapter, is to stop you becoming freaked out during labour by helping you to understand what can actually happen when it’s going well; your emotions, the smells, sight, feel and occasionally the sheer extremity of the whole endeavour. This chapter, then, will reach the parts that the other books don’t touch.

But it’s worth getting to grips with the text book facts first. These are the nuts and bolts of birth. Knowing them will help you understand the terms and assumptions that will be used about your body and baby when you are in labour. They’ll help you navigate labour when you’re in it – providing you understand the other possibilities too.

A WORD ABOUT ‘HIGH RISK’ PREGNANCIES | There is no formal, or universally accepted, definition of a ‘high-risk’ pregnancy. At its most general, it means that you or the baby is more likely to become ill or die than usual, or that complications before or after delivery are more likely to occur than usual. Doctors will identify ‘risk factors’ which roughly fall into these categories:

1 Whether you have a significant medical condition before your pregnancy, such as diabetes

2 Whether you have developed a significant disease during the pregnancy, for example pre-eclampsia

3 Whether there is a problem with the baby, such as growth restriction

4 Whether you have a history of a previous problem with a baby, for example a previous premature labour

They use a scoring system to determine your degree of risk. If you’re classified ‘high risk’, you’ll need extra medical attention during pregnancy and birth.

This is not a diagnosis that should be given lightly, or received casually. Nor is it a status given by any past doctor making a prediction about your future or by self-diagnosis. So, if your midwife or doctor mentions the words ‘high risk’, ask the following questions, and feel free to get a second opinion:

 Define high risk

 Explain why you classify me in this group. What has lead to this?

 Explain what this means to my current pregnancy and my everyday activities?

 How will this affect my birth plan?

 Is there anything I can do to improve my status or to get myself removed from this classification?

 What are the risks to me and my baby in regard to my ‘high risk’ status during pregnancy, labour and postpartum?

If necessary, get them to write things down for you. It is really important to be totally clear about any ‘high risk’ label. If you are having twins, or multiples, you may be classified as ‘high risk’. This, for many mothers, is demoralising. But there are still choices you can make, and things you can do to have a better birth. Keep reading.