What I wish every mother knew before giving birth – frank tips from a midwife

Lesley, 51, has delivered thousands of babies over the last twenty years. Her own mum was a midwife, too. She lives in Harrogate with her husband David and their daughter Francesca, 15, and son Ruairidh, 13.

First births are a shock, as your body is doing something it’s never done before

The ligaments of our pelvis need to be stretched, everything is new and inefficient so it takes far longer than you think. Women may also come in thinking they’re almost fully dilated because they’re not anticipating the pain they’re in, or the length of time it’s taken. 

But even without a vaginal examination I can tell from the way they speak, walk and hold themselves that their baby may not be as imminent as they believe. Set the bar lower for expectations of a first birth.

Do an antenatal class – but ideally one delivered by midwives or obstetricians

Some classes run by lay people can really let mums down as the information isn’t nuanced enough. Anyone can do an online course and call themselves a birthing expert within a few days. When a woman comes in and tells me she’s been on a hypnobirthing course my heart sinks, because it’s unlikely that they’re fully prepared for how arduous labour can be. Courses that ignore or gloss over teaching about pain relief, C-sections (a caesarean section involves an operation to deliver a baby through a cut made in the tummy and womb) and inductions (when labour is induced artificially) can leave women feeling as though they are a failure if they have those.  

Giving birth might be something you only do once or twice in your life, so it’s best not to rock up and hope for the best. Research all the different types of pain relief that are on offer along with induction of labour and C-section. Make sure your research is from a reputable source.

Women shouldn’t feel like a failure if they have a C-section

Currently, approximately 35 percent of babies are born by C-section – for various reasons, most of which are beyond the mother’s control.

You have no control over your genetics – which play a huge part

You’ve inherited a certain pelvis which may make labour a breeze or, you may need a C-section (or one of the options in between).

Forget being a ‘warrior’ or a ‘wimp’

The level of pain you perceive is mostly down to the types of nerve fibres that are firing during labour. We all have the same types of nerve fibres, but if you’re fortunate your thin nerve fibres will be firing that day, if you’re less fortunate, your thick nerve fibres will be firing so you may be more likely to need pain relief. Research all options as there’s no way of predicting which fibres will fire on the day. 

Birth is an enormously empowering event and exhilarating at times – but it’s hard

It’s pretty painful but it’s not a “broken leg” pain, it’s more of an intense, stitch-like pain that goes completely and immediately once the contractions stop. Contractions build in waves so the “peak” is only around 15 seconds. Treat it like a marathon, not a sprint.  

Don’t be scared of tearing – it’s normal and heals quickly 

For 80 per cent of first time mums there will be some cuts or tears to the perineum, but that moist, warm environment is like the inside of your mouth. It’s the perfect environment to heal super quickly. For first time mums, perineal massage from week 35  – stretching the skin and the muscle – helps prepare your body and reduce your risk of needing an episiotomy. Episiotomies – cutting the perineum – are only done in the UK now in the presence of foetal distress as they generally cause more bruising and take a bit longer to heal.

Epidurals DON’T increase your risk of intervention

Older research showed C-section or forceps were more likely if you had one, but management of labour has improved since then. I can honestly say that the majority of women I’ve cared for who have them have a very pain-free and empowering birth, especially if they’ve planned mentally to have one in advance and they’re not fearing having forceps or an epidural. They do have other risks though, so make sure to do your research.

You will poo, over 90 per cent of women do

Rectums get squished during labour, so anything in the rectum will be pushed out. Mum’s poo is full of friendly bacteria which babies need entering the world as their gut has been sterile in the womb. Bacteria is key to making vitamin K and their microbiome. Back in the 80s we gave women enemas, cleaned their bottoms and put a pad over their anus thinking we were protecting baby’s face, but we’ve since realised the scientific benefits.

You will feel an overwhelming sense of doom when you ‘transition’

This is the point where your cervix is nearly completely dilated and your body pumps out hormones, such as adrenaline and cortisol, to power your abdominal muscles to push. You’ll feel out of control and want to flee. Your partner will never have seen this side to you so it’s wise to research this and prepare you both.

Diamorphine is another name for heroin

It’s medical grade and (obviously) uncut but it provides dissociation from pain and a feeling of immense wellbeing. But it can affect a baby’s breathing once born or leave them quite sleepy. Your midwife is best placed to know when it’s safe to have it. 

The latest fad is for women to bring in labour ‘combs’ which they squeeze into the palm of their hand as pain relief; it works as a distraction in a similar way to a TENS machine. Great if it works for them, but it doesn’t work for everyone.  

Most women make noises

Everyone is different, some can grunt, moo, swear, or scream. It’s a clever body design because forcefully breathing out when you make noise stops you from just ‘pushing’ from the downward force, which helps reduce tearing.  Nature doesn’t often get much wrong. 

Midwives might deliver between 2-3 babies per shift

It’s immensely rewarding to feel you’ve helped them have a better birth, and I love hearing from them afterwards. I’ve never had a mother die in my care, but I’ve cried with mums who have suffered stillborns, which thankfully are getting even rarer now women are having greater surveillance during pregnancy and early inductions are offered.

​​Thirty to forty per cent of first time mums have inductions

You don’t always have to have an epidural, but do be prepared for perhaps wanting one. So do all the research into the procedure, risks and benefits beforehand.

You might vomit

Your uterus is working so hard that other organs may shut down to allow your body to work efficiently. You probably won’t be hungry and may feel sick but it’s important to still fuel your body with sports drinks or coconut water.

Skin-to-skin contact isn’t just about breastfeeding

It colonises your baby’s skin with the family’s friendly bacteria, building their microbiome. It doesn’t really matter who does this; partner, sibling, the benefits are numerous. We only prefer the mothers to do it because it also helps to initiate breastfeeding.

Tea and toast tastes amazing after birth

Your body craves the energy. I live in Harrogate – home to Betty’s and Yorkshire tea – but nothing was on the same level as the NHS stuff I had after my own two births.

Lesley was a practising midwife for two decades before founding My Expert Midwife as its clinical director