Medical professionals do tend to scare pregnant women, usually without intending to. Perhaps one of the most common ways is to suggest, even very subtly, that this thing which the woman has to push out of her vagina is “too big”. Eek, a big baby! It only takes a radiographer to raise an eyebrow, or a midwife to mutter “hmm, are you SURE you are only 32 weeks? Oh my goodness me” for the woman to begin panicking.
The idea that “something huge is coming out of a small opening” is a primal fear in childbirth. It goes back to our childhood. As little girls we contemplated our tiny “front bottoms” and shook our heads in disbelief at the idea that a baby could possibly come out of them. We do not give it another thought until later when we become sexually active. Even a woman who has never been the victim of any kind of abuse may have memories of “it” “hurting a bit” at first. She won’t be thinking of how in fact this discomfort may have as much to do with her anxiety and lack of lubrication as size.
The Wise Hippo Hypnobirthing course features a wonderfully funny mini-lecture by the Wise Hippo founder Dani which humorously asks women to turn the tables on their “big thing coming out of a small opening” fear and imagine they felt this way about what Dani calls “having a poo”.
“You’ve done it all your life, so you don’t give it any thought,” she points out. None of us thinks, every time we repair to the bathroom with some light reading matter , “I may never be the same again”. We just sit on the loo and get on with it, using patience and relaxation.
When we were little girls we had no idea that our vaginas were constructed to be very expandable on the inside thanks to the little circular rugae (Latin for creases) which run up and down its length. Our pelvis opens up especially effectively thanks to the hormone relaxin. And the baby’s head, which normally comes out first, is perfectly constructed to change shape, without harming the baby in any way, on coming through the birth canal.
When we were kids we didn’t know any of this – we just looked at a plastic doll and thought, “no way is that coming out of me!” And nobody put us right.
So even a normal-sized baby looks scarily, and misleadingly, big to many women. Being told “you are having a big baby” makes things even worse. This is a case where knowledge just does not help because it increases fear.
The fear of the baby suffering “shoulder dystocia” – in other words, having one shoulder caught under the mum’s pubic bone – is something I often hear women speak of. Well, back in the day I gave birth to two fairly large babies and then two really large babies before I had ever heard the words “shoulder dystocia”. If I had known after the birth of my 8lb 11oz and 8lb 3 oz babies that I was likely to give birth to babies at increased risk of shoulder dystocia I would have been very afraid. I would have brooded, worried, Googled (except there was no internet – that’s how old I am) and I might have decided not to have baby number 4, who proved the biggest of the lot, at home. And my fear might have made me so scared that I couldn’t handle the pain, so I might have asked for an epidural on this occasion. And then things might have been very different.
Because as long as the baby’s presentation is nice and normal, the biggest problem in birthing a big baby is not the size of the child – the baby isn’t coming out sideways, you know! – but whether or not the mum is mobile. If she is keeping mobile, upright and changing position she can help her baby descend and be born because her mobile pelvis will shift around the baby. If she is lying on her back, however, she is closing up her pelvis and using massive effort to push uphill instead of with gravity. Therefore she is increasing the risk of her “big baby” having shoulder dystocia.
This blog does not contain medical advice. It is the blog of a sceptical old bat with an insatiable curiously about pregnancy, birth and the world of new parenthood. I am not medically qualified. I am an antenatal teacher, hypnobirthing practitioner, resting doula, mum of four, Oxford graduate and author.