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

that can lead to miscarriage. Often, in the absence of a medical explanation, we blame ourselves. While this is tempting and horribly common, it is usually completely unfounded.

      WHAT IS A MISCARRIAGE LIKE? | What happens in a miscarriage can vary hugely from woman to woman and depends on how many weeks pregnant you are. Many women have heavy bleeding and cramps or even just blood spotting when miscarrying. Some describe it as being like a ‘heavy period’, others say their miscarriage was much more painful, and very shocking. Some women, however, have no symptoms at all and are appalled to discover during a routine scan that the baby has no heartbeat.

      On a reassuring note: if you get blood spotting do not assume you’re miscarrying. About 20 per cent of pregnant women have blood spotting in early pregnancy (I had it in all three of my pregnancies with no miscarriages). It’s also tempting to worry if you feel a cramp or ache in your belly in early pregnancy. But cramps/aches/pains in the lower abdomen are a normal part of pregnancy (remember: your ligaments are stretching, your organs remodelling themselves around your swelling womb). Don’t assume you are miscarrying if you get these symptoms. Do, however, call your doctor/midwife if you are at all concerned, and definitely call if you are spotting and cramping.

      In some miscarriages, the womb empties itself completely. If not, you may be offered an operation (called an ‘ERPC’ or a ‘D&C’) or treatment with pills to empty your womb. You can, however, choose to wait and let the miscarriage happen naturally. Discuss this with your doctor.

      PAST MISCARRIAGE | If you’ve miscarried in the past, early pregnancy can be one long anxiety-fuelled nightmare. ‘Every time I go to the loo I am waiting to see blood in my knickers,’ says Sophie, who had four miscarriages before her son Jack’s birth, has had one since and is pregnant again: ‘Every time I get a twinge in my belly my heart plummets. Every scan or checkup I worry there won’t be a heartbeat. I won’t discuss baby names and with Jack I did not buy any baby equipment until a week before he was due. I have to protect myself, and this is how.’ Some women wrap themselves in cotton wool, fearing that doing anything will spark a miscarriage.

       WAYS OF COPING WITH A MISCARRIAGE

      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 year⁹. 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