When I market-tested this chapter, some readers assumed it was about home birth. It’s not. It’s about birth — what has happened when women have had babies since time immemorial. I gave it a historical setting because it’s a primal creation myth: the story of a maiden, a mother, and a crone. Oh, and I also wanted to be able to draw women with hairy fannies without it being a political statement. Let us introduce the principal actors in this birth story. Once again, the womb is the star of the show. Hasn’t she put on weight since we last saw her? Just wait — she’s about to really let herself go. In a supporting role, the pelvis, with its bouncy, supple-yet-stretchy pelvic floor. The fun bits also play a larger part than you’d expect. Also starring: the baby! It’s a rites-of-passage movie for our baby here — rites of birth passage, to be precise — and the baby will make a surprising twist in the plot. To make this easier, the maternal pelvis is not one solid ring of bone, but three separate pieces, linked together with extra-stretchy ligaments. The baby’s skull is not one bone but seven, which can meld and move over each other as they pass through the birth canal. While the baby has been fattening up in the mother’s belly, so has the pituitary gland deep within her brain. Both mother and baby are about to get the hormone rush of their lives. Beta-endorphin is a natural opiate, which works on the same brain receptors as morphine and heroin. It is the hormone of transcendence, produced in response to pain. Catecholamines (adrenaline and noradrenaline) enforce a fight-or-flight response to fear or stress. In early labour they quell contractions, diverting energy from the womb to the mother’s limbs so she can run to safety. At the peak of birth, they perform a different function, as we shall see. Oxytocin is the hormone of love. It makes us feel calm, connected and empathetic. It is the chemical that makes contractions happen, and its name comes from the Greek for “quick birth.” Prolactin is the hormone that makes breastmilk. As well as promoting relaxing, loving feelings, it fosters a sense of vigilance in the new mother. Here is monkey mum-to-be. She hasn’t given birth before. At the end of her pregnancy, her progesterone levels fall and her oestrogen levels surge, activating the oxytocin receptors in her womb. The womb begins painless practice contractions, coordinating its movements for the effort ahead. Prostaglandins soften the fibres in her cervix, and the amniotic sac around the baby swells and weakens. As the baby drops down within her, pressure on her cervix sends a signal up her spine to the pituitary to release more oxytocin. These trigger more movements in her womb — a little less painless, a little more purposeful. The plug of jellylike juices that sealed the womb comes away: a “show.” Labour is near. The baby has hormones too. A surge of catecholamines matures his lungs and liver in readiness. These hormones from the baby also give the mother a burst of energy. Like most animals, she needs to prepare a safe, private space for the birth. Like whales, elephants and gorillas, the human monkey seeks a birth companion — someone she knows and trusts. A woman with wisdom born of many births. A midwife: a profession as old as humanity itself. The midwife brings the tools of her trade: her hands, her brain, and her heart. When monkey mama feels anxious, catecholamines rush through her, suppressing her contractions. It is the job of the midwife to seek out and soothe such stresses. Kindness and humour can instantly dispel fear. To enter into the state of birthing, monkey mama needs privacy. Oxytocin, a sex hormone, comes on stronger in a dark, private place. Being undisturbed by strangers is as important for giving birth as it is for making love. In the first part of labour, the womb creates expansion (not contraction!) in the cervix, to let the baby out. As the cervix has been locked tight for nine months, holding back the weight of the baby and the waters, it takes time to soften and retract. With each wave, the muscle fibres in the top half of the womb thicken and pull towards each other, easing open the gates below. The bulging bag of waters presses more incessantly upon the cervix. More oxytocin is released. The waves grow stronger. As oxytocin floods the baby’s system, neurons in his brain quieten down so he can survive with less oxygen during the rigours of birth. How long does this first stage of labour take? It can be stunningly quick, or timelessly slow. In response to pain, monkey mama’s brain sends out beta-endorphins, spacing her out so time loses its meaning. When the outer “thinking” human brain, the neocortex, is less busy, the inner, ancient mammalian brain can take over — sending out more hormones, and making more womb-work. Part of the work of labour is endurance: how long can monkey mama go without sleep? How long can she go without food? She tries to eat, but her stomach repels food. Her energies are needed elsewhere. More babies are born at full moon, when fewer predators prowl. And what is monkey midwife doing? She listens to the mother and the baby. Much of what she hears is communicated without words. She soothes, she comforts, she understands. The midwife produces oxytocin too. The hormone of connection acts upon everyone present at the birth. Mainly, she knits. As Professor Gerrit-Jan Kloosterman said in 1982: “Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine – nil nocere [do no harm].” As monkey mama opens fully, great waves of passion come upon her. The baby’s head slips from her womb, poised for the next stage — the journey through the pelvis towards birth. And then… nothing. Monkey mama sleeps deeply. She must rest and be thankful, gathering strength for the next stage. This lull gives time for the fibres of the womb to loosen up around the baby’s body. Monkey midwife isn’t worried. She listens, and she watches, and she stokes the fire. Flames leap up. Monkey mama arises. Her womb bears down. Instinctively, the mother shifts position, helping to shape the baby’s head with the precision of a sculptor. It takes some time. Here’s the twist in the tale: the baby comes into the pelvis sideways, then wriggles a quarter-turn to slip his head under the pubic bone. As his head slips down, then back, then further down, then back again, the tension in the pelvic floor muscles gives him resistance to bounce against and complete his rotation. A delicate dance. Blood rushes down inside monkey mama. Her internal clitoris swells immensely; the erectile tissue engorges and expands. A hot, wet cloth massaged over her vulva eases and increases it. The baby moves within her, the waters gush, the womb redoubles its efforts. The intensity is immense. As the head fills the birth canal, another wave of endorphins overwhelms her, this time accompanied by an immense surge of catecholamines. Monkey mama cries out in anger and fear. Monkey midwife says nothing. A spell has been cast that must not be broken. The head is out. His eyes blink open on a new world. The pressure of the birth canal squeezes the amniotic fluid from the baby’s lungs. The mother feels for her child. His body wriggles round and, with the next surge, the baby tumbles free. Fresh, oxygenated blood pumps steadily from the placenta into the baby, perfusing pinkness into his limbs and expanding the alveoli of his lungs. Monkey baby takes his first breath. Awestruck, monkey mama touches his head, his fingers, his toes. Monkey baby gazes back calmly. The surge of catecholamines gives clarity to his first moments. The mother gathers her child in her arms. The cord still pulses between them. They are two people, yet still one. The baby rests, soothing away the stresses of his birth. The mother shivers as the catecholamines recede. Oxytocin and prolactin flood through them both. Love, relief, and wonder. Time stands still. This perfect moment stretches on for an eternity. Some time later, he sucks his hands and bobs his head. He can smell her milk and moves towards it. There it is: a dark circle on a paler background. There is a reason why this is the international symbol for a “target.” The birth isn’t yet finished. Now the placenta must detach, and it must do so perfectly. A million tiny roots must come free of their earth in the womb. To achieve this, the womb completes its last act of procreative genius. The muscular walls contract down in a mesh of crossways fibres, clamping on every tiny blood vessel, forming living ligatures. The baby helps, massaging his mother’s abdomen with his tiny feet. Here comes the placenta — a soft, warm feeling, and out it slides. He suckles contentedly. With the first drops of milk, more endorphins pass from mother to child. Monkey man is born.
How Monkey Mama does it
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Think of me like an agony aunt. Except we're not going to talk about agony. Whoops! We just did.
Will my lovely lady-parts tear?
It’s possible. There are things you can do that make it less likely. But it won’t matter.
What do you mean? OF COURSE it matters!
No, it really doesn’t. That’s how overwhelming it is having a baby. It makes something that would ordinarily matter a lot (really a lot) seem utterly insignificant.
Will I poo myself?
Maybe a tiny bit, but midwives are handy with a hygienic wipe. You’re actually meant to! There’s a reason for the anatomical proximity of anus and birth canal. Your intestines contain billions of good digestive bacteria, and when a tiny trace of poo gets mixed up in the birth process, your baby’s digestive system is primed with them. Babies born by caesarean miss out on the good bacteria they are meant to receive, their gut flora is different, and this could be why they are more prone to allergies and obesity.
Really, don’t worry about your body doing whatever your body needs to do. There was a point when I was in labour where I was sick over myself and peed myself simultaneously in a hospital car park. Ordinarily, I would feel a modicum of embarrassment about this, but its significance was eclipsed by the memory of giving birth to my daughter later that day.
So forget about a smudge of poo. If you can get through the birth of your child without simultaneously throwing up and wetting yourself, you’re doing better than me.
Will my partner still fancy me?
Yes. My experience is with men. Men fancy everything.
Will my fanny ever be the same again?
It will be better! It will still be the lovely sensitive flower that you have always enjoyed, but you can also be proud that it has done something useful.
Seriously?
Well, it might change shape a bit. Post-birth vaginas tend to be a little different to pre-birth ones, but neither sort is more beautiful or functional than the other.
Let’s apply the ‘what would it be like if men could do this’ test to genitalia and childbirth.Imagine if, when a man fathered his first child, his balls dropped a couple of inches. Would men be rushing off to plastic surgeons for uplift surgery? Hell no! They’d be boasting about it! They’d all be wearing MC Hammer trousers and claiming they could swing theirs into their socks.
OK, I’m not helping. Don’t worry. Nothing’s going to drop a couple of inches! But what’s important about your pleasure garden is not how it looks, but how it feels.
Will that be different after birth? Here’s a selection of quotes from an astonishingly frank internet chatroom:
“Way better. Way, way better.”
“It feels so incredibly good. The sensitivity has heightened.”
“I have more control over my vaginal muscles.”
“The best sex we had as a couple was trying for our second child.”
“A good lube will help.”
“I can’t recommend Kegels [pelvic floor exercises] highly enough.”
“Your body parts are elastic. Your free time after having a baby, not so much.”
And from their male partners:
“There has been no real change in terms of tightness or cosmetic appearance... [but] now when my wife as an orgasm it feels about ten times stronger than it used to.”
“My wife had a caesarean. Sex is somewhat different. She reports that certain positions are more pleasurable.”
“Forceps delivery with stitches, but sex now is not noticeably different. Just considerably less of it.”
The consensus here seems to be that your lady parts are likely to recover just fine from the rigours of childbirth. The passion-killing part of having a baby is having to look after a baby. All the time. Still, what you miss out on in sex, you make up for in love and cuddles.
Will labour hurt?
Hmm. There are two ways I could answer this question.
I could tell you that there are documented cases of women giving birth without pain. I could even mention that women can orgasm during birth. I could explain that there is a theory that fear and tension in labour produces pain, and so, telling you it is going to hurt could make it more likely that it will.
Or I could give you the honest answer.
Yes.
Probably.
But, uniquely among your life experience, this is good pain. You want this pain. This is pain is doing something incredible.
So maybe ‘pain’ isn’t the right word. In our society, we treat painful feelings as inconveniences, to be erased by the judicious use of painkillers. We use the same words, ‘painful feelings’, to describe negative emotions. Birth is a time for positive feelings, not negative ones.
This pain isn’t something you can pop two paracetamol for. It’s a marathon to run... a mountain to climb... an ocean to cross...
So labour hurts. So what?
This is labour girl! This is work! This is where your body goes to places you’ve never been to before and you be all you can be. It’s not fun. It can be hard. It can push you past what you thought you could endure. But in the extremes of the experience, a new person is forged.
A mother.
Bring it on!
