Writing Pregnancy, Labor, and Birth in your Fiction

I’ve come across this issue a surprising amount in my editing. Writing something you’ve never experienced can be a challenge, but adequate research can do wonders. In many areas, writers know this and do it as a matter of course. But rampant, inaccurate media portrayal of the process of pregnancy, labor, and birth has not only filled the general public’s brains with wrong information, but seemingly given writers an excuse to do as they think it probably happens as opposed to how it actually happens.

Well, never fear. I’m here to give you a basic run down of how to accurately portray the whole process. I will cover the most common issues and mistakes but I am always willing to answer questions you have in addition to what I’ve provided here.

You’re also about to hear a lot more than you might be bargaining for, both about birth in general and about my experiences.

Starting out

Talk to a woman who has given birth. If you have someone you feel comfortable talking to about the subject, then do it! It’s amazing what a little experience adds to the mix.

Do some basic internet research. The internet won’t provide all the answers, but imagine that you are the newly pregnant mother and scan through websites such as Baby Center or What to Expect. You can begin to understand the process of pregnancy and labor the way that new moms these days often do.

If you have a OB/GYN, midwife, or doula friend, talk to them! I have several midwife and doula friends and they love to talk about their jobs. They’ve seen tens, often hundreds, of births and can be an invaluable resource for solid information.

Things to consider in your story

The setting, culture, and world of your story will have a huge impact on how your write about pregnancy, labor, and child birth. The number one issue I’ve encounter in reading client’s work is that their story is set in a medieval period or in a “frontier America” type world and yet their child birth settings resemble late 20th century hospital births (because that’s basically what we’ve seen on television). If your setting is historical or is an analogue to a specific period, then you need to do a bit of research to know how the baby process was handled in such time periods.

For example, did you know that it was common practice for royal marriages to be consummated in the presence of multiple family members, or friends, and sometimes clergy? There are so many weird possibilities for how a culture handles such things…just make sure your decisions are based on “this is how it happens in my fictional world” and not “this is how I think maybe it happened in 1990s America.”

The biggest issue with writing about ill-researched pregnancy, labor, and childbirth is that nearly half of all humans have or will give birth at some point in their lives. And a decent number of your readers will have. Portraying this process badly will betray your lack of knowledge and possibly make readers assume you’re too lazy to do actual research. A badly betrayed labor experience, for me, is enough for me to dismiss your work. Researching labor and childbirth is easy. So what else might you have decided not to research? If you don’t want to research it…great! Don’t include it in your story.

If you want to include it, I urge you to keep reading. Along with my own advice, I will offer many outside resources to help round out your knowledge and point you in the right direction.

Pregnancy

In so many ways, this should be the easiest one to write because it’s the one people are the most apt to talk about. However, accurately writing it is very elusive for some reason. Mostly because the stereotypes and caricatures of what pregnancy is like is not incredibly true for most people. I wrote a character who was pregnant and had a baby a few years back, before I had my own kids, and I thought I did a pretty good job. After carrying a little monster around for nine months and then proceeding to squeeze him out a tiny hole, I went back and rewrote the entire portrayal of my character’s pregnancy. Not because it was incorrect, necessarily, it was just distant. It was based on stereotypes and I had not worked to overcome that. I had not made it personal to her. I very likely could have done that without being pregnant myself (every pregnancy is different, so just because I made hers a little more like mine doesn’t mean I made it more correct), but I just needed some help with the little details.

  • Morning sickness
    • Not everyone has it.
    • It is by no means restricted to mornings.
    • It might last for a few weeks during your first trimester and then let up, or it might never let up and last all the way through birth, or anywhere in between.
    • It can be a mild inconvenience or it can make you so consistently sick that you require IV fluids to prevent dehydration.
  • On that note, a woman’s body prioritizes the fetus over her own. Any nutrients she intakes first go to the developing baby and then to her. So during sickness or anything, if the mother seems malnourished, it’s still likely that the baby is okay because her body is selflessly giving everything it has to the baby.
  • Your character’s health and fitness before pregnancy will have a great impact on how they feel throughout their pregnancy.
  • Your character’s height and build will have a huge impact on how the physical aspects of being pregnant affect them. Taller women have more abdominal room and tend to show later, as the baby has lots of vertical space inside. Women with shorter torsos have nowhere to go but out.
  • Not everyone’s feet/legs swell. Some women’s swell so bad they can’t walk.
  • If your character was in great shape before getting pregnant, it’s very likely that they can keep up your normal routine while being pregnant, from jogging to yoga to aerobics to martial arts.
  • Women’s bellies don’t obviously show their pregnancy right away. In fact, depending on their build, it can be as late as 24-30 weeks (3/4s of the way through!) before it’s obvious to those around them that they’re pregnant.
  • Women are usually 5-6 weeks pregnant before they find out (that week count begins at the start of menstruation before sex->conception->implantation->missed period even occurs). You can get a positive through an at-home pregnancy test usually around two weeks after the sex that led to conception. If pregnancy tests aren’t a thing in your world, then they can begin assuming around that two-week point when they miss their period, but might not know for sure for several more weeks.
  • Women can begin to feel movement of the fetus around 15-18 weeks (early to mid-second trimester). First time moms won’t be sure of that movement because it feels like little flutters and it’s difficult to tell if you’re really feeling movement or not. Women who’ve had babies before might feel it earlier, as they know what to look for.
  • Braxton Hicks are “practice contractions” that feel like a tightening of the abdominal muscles. Sometimes they hurt and sometimes they don’t. Some women don’t have them at all. They were named for the doctor that first described them as a thing in 1872. That term did not exist before and might not exist in your world, but the phenomenon is still likely to happen.

Labor

  • Contractions are incredibly unlikely to just start out excruciatingly painful. In early stages of labor, contractions are anywhere from mildly uncomfortable to momentarily intense, but a woman suddenly crying out in pain after no previous issue is not how a healthy labor begins. If she is suddenly feeling sharp or shooting pains of any kind, it’s because something is wrong.
  • Only about 10% of women have their water break before labor begins. Most break sometime during labor, a very tiny percentage don’t break at all (resulting in an en caul birth). Generally labor begins slowly and sometimes without being noticed as real labor.
  • Some women will pass their mucus plug as a sign labor is beginning soon. I never did (at least not noticeably so). That, like anything else, can vary from woman to woman.
  • In some birthing practices, the word “contraction” is not even used. Instead, they say “pressure waves” or “surges” or another less-scary sounding term. This is because–even though contraction is technically correct–our society associates that word with “pain” when it isn’t a necessary association. Contractions are not a sharp pain. They are pressing and deep. If you are a female and have experienced menstrual cramps, then you’ve had a tiny taste of labor pains. I was actually shocked during my first labor when I realized that contractions were like bad menstrual cramps on steroids. Of course, then I thought, “Duh. It’s the same organ!” (I also said, out loud, I think, that I would never complain about menstrual cramps again after feeling the things my uterus was capable of. That was a huge mistake and I still whine like a baby every four weeks.)
  • Contractions also, especially in the first two stages of labor, are not constant and unrelenting. In early labor, they will last 30 seconds to a minute and come every 3-4 or 5 minutes. During that down time, a woman will be able to act normally and carry on conversation, walk, hop, sing…pretty much anything. The closer to the real deal you get, the closer together those contractions draw and the more intense they get.
  • False alarms are totally a thing. Early labor or prodromal labor can really fake women out. (I was in prodromal labor for 11 days with my second. I wanted to die.) But often times those long, drawn out early labors make active labor a piece of freaking cake. (I was in active labor with my second for an hour and half before he just popped right out.) Labor that happens incredibly quickly is called precipitous labor. (I missed the record for fastest labor ever at my birth center by ten minutes. Dang.) You think you know your body really well until those last few days of pregnancy when you’re waiting for labor to start and suddenly you feel like maybe you don’t know yourself at all.
  • People talk about how pregnancy is 40 weeks. But there’s a lot of nuance to how long a healthy pregnancy lasts.
    • Any birth that happens before 37 weeks is considered premature. On the latter end of that (usually around 35-37 weeks) a perfectly healthy baby can be born. She’ll be small, but can be a-okay, even while still a premie. The number one issue for any premie is lung function, and can still be an issue for babies born on the early end of term.
    • 37-38 weeks is considered early term, and even though it’s technically “term” these babies can still be at risk for less-than-stellar lung development.
    • 39-41 weeks is considered full-term. Prime time for birth! (The average length for first time moms is 41 weeks, one day. The average length for been-there-done-that moms is 40 weeks, three days.)
    • 42 weeks is late term, but still usually perfectly healthy
    • 43 weeks and beyond is post-term. Can still be a perfectly healthy baby, but there’s reason to start being worried.
  • Labor induction (usually done to schedule a birth for convenience’s sake) before late-term in a healthy pregnancy is a relatively new practice and can be a terrible idea.

Birth

  • Giving birth on one’s back is not only an unnecessary thing that modern medicine has created as “normal,” but actively a hindrance to the birth process. The birth canal points forward from your tailbone. When you’re lying on your back, you are having to work against gravity to push the baby out. Why on God’s green earth would you voluntarily do this?!?! There are so many wonderful positions to labor and birth in that assist the body and help keep a woman comfortable. Don’t add extra stress and pain to your poor birthing character by laying her on her back. Please.
  • A woman who is not medicated does not need to be coached on when to push. (I’ll say that again for those in the back.) A woman who is not medicated does not need to be coached on when to push. We see this in TV because it’s dramatic and also, it’s true for women with epidurals who cannot feel their body naturally urging them along. When it’s time to push that baby out, your body doesn’t really give you a choice (a woman’s body will birth a baby, even if she’s in a coma). The only maybe you can add to coaching a woman who is giving birth naturally, is the moment between birthing the head and birthing the body (more below). Some midwives will gently remind the woman to take a moment and wait for her body to tell her to continue instead of pushing out the body before that last contraction.
  • The baby doesn’t go from not born to born. There’s a few extra steps there.
    1. As the baby descends the birth canal, his head will begin pressing its way out. This is “crowning” and it’s when you can see the top of the baby’s head widening the vagina. My first was crowned while I pushed forever. No, like, an hour and a half. But damn, it felt like forever. My second was crowned for about thirty seconds.
    2. After crowning, the head is born. Normally, facing the mom’s buttocks. Then it’s important that the mom relax between these contractions while the baby spins around 45 degrees. Even during natural birth, the midwife might coach that relaxation here.
    3. Crowning and birthing the head will likely tear the perineum. This is possibly my least favorite part of giving birth. And yes, it’s as awful as it sounds.
    4. Then, with the next contraction, the mom pushes again and the body is born (usually quite fast). It’s at this moment when the baby will begin to breathe/cry.
  • The first cry is not only a staple in childbirth, it’s actually quite important. The first gasp of air inflates the lungs and sets baby up for a lifetime of successful breathing. Even if a healthy baby doesn’t take that first cry, intervention might be necessary to expand the lungs and make sure they can breathe well.
  • Cutting the umbilical cord does not always happen right away. In fact, it isn’t necessarily best. This will depend on your culture and how they feel about the placenta, but some cultures never cut the cord at all. It will naturally fall off (as the stump does when you cut it).
  • The placenta will be born about 5-15 minutes after the baby. Supposedly, contractions start up again and tell the woman to push the placenta out. I have had two natural births and never experienced this mythological second round of contractions (both times, my midwives thought it was odd). I eventually just pushed anyway and birthed the thing. With my first, he was still attached to it until we cut the cord after. My second, we cut the cord a little earlier, before the placenta was born, because he didn’t cry (as I discussed above) so my midwives took him to help get his lungs expanded.
  • Wrapping the baby up in a blanket right after birth is a cultural norm that is not necessarily widely shared. This will depend on your culture.

Postnatal/Postpartum

(Beware because nothing that follows is pretty or pleasant.)

  • Even after a healthy baby is born, there are still many complications that can occur.
  • It depends heavily on your culture what is expected of new moms after birth. Some give them complete rest for days, weeks, months afterward. Some birth their babies, strap ’em to their backs, and keep on working. How does your culture feel about new moms?
  • Even after baby and placenta are evicted, there is still a lot of stuff left to get out. Many women bleed for days or weeks postpartum. (I bled constantly–heavy period-like–for about 10 days with both mine, then lightly bled for about 4 more weeks after that). It varies, but it happens to everyone. It’s like your body says, “Oh, you thought you were going to get away without having a period for nine months? SUCKA.”
  • The normal uterus is about the size of an average orange. Or maybe a lemon. Once the baby is born, it doesn’t just pop back to its usual size. It still remains about the size of a basketball and women will often still look about 20-24 weeks pregnant for a few days. It take the uterus about 4-6 weeks to shrink back to its normal orangey-size.
  • There is a lot of trauma to the vagina and perineum. Your character will be sore and might waddle a bit for a while. They can still function pretty well, especially if they were healthy and in decent shape before and during pregnancy, but everything won’t be 100% for a while.
  • The first poop after childbirth is SCARY AF. Especially if there was any tearing. **shudders** After that first poop though, pooping is the best thing ever.
  • Postpartum hormones can be as insane as puberty. I never experienced mood swings during pregnancy…but postpartum?? Whole different story. There’s a reason postpartum depression is so common. (Postpartum depression can begin and persist anytime during the first YEAR of the baby’s life.)
  • And postparum psychosis? Not a fun thing.
  • Oh yeah. And if the baby never lets you sleep, it’s amazing how your body learns to survive on blinking.
  • It can be weeks or months before your undercarriage feels the same during sex. It was maybe 9-12 months after birth before I felt right again.

That’s about all I’ve got. If you have any further questions that I didn’t get to here, don’t hesitate to ask! If I don’t have an answer for you, I can direct you on where to find it or ask one of my many personal resource people. My experience and knowledge is not the end-all-be-all here, but I hope that it’s just one of the many voices you get to hear on your journey to writing about this subject.

Happy writing!

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Extra resources:

Collection of data on all things pregnancy/labor/birth (pdf)

Placenta complications

Influences of Culture and Community on Birth and Perinatal Care of Immigrant Women: Doula’s Perspective (peer-reviewed article)

The History of Midwifery and Childbirth in America

Childbirth in Medieval and Tudor Times

10 Weird Facts about Birth Throughout History

A Brief History of C-Section

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