The Modern Midwife's Guide to Pregnancy, Birth and Beyond

Introduction

AS A MIDWIFE I get asked a lot of questions. Sometimes questions can be answered easily, but often I feel as though we just don’t have enough time to really explain everything properly. I hope this book will fill in those gaps, and provide the key information you really need to know about all the common questions that are on most pregnant women’s minds. It will also help you go into your midwife appointments feeling like you know what to expect!

My aim is to help you understand and manage each stage of your transition into mumhood so that you can make informed choices every step of the way, understand what is happening in your body, be in control and feel powerful. I want to share with you the most important and amazing things I have learned during my time as a midwife.

Having a baby is hands-down one of the biggest events that will ever happen in your life.

It probably feels as though there is so much you need to know, so many changes going on, and so much to plan for and consider. At times, knowing what’s right for you and your baby, planning your birth and becoming someone’s mum can all be very overwhelming. Know that this is totally normal.

One of the biggest problems for the modern mum is not scarcity of information but actually an information overload. And much of the information we are exposed to, particularly in the media, is not always reliable. The information in this book is based on the latest research and evidence, real mum stories and my years of experience as a midwife working with hundreds of women throughout their pregnancy and birth journeys.

Modern mums are faced with an overwhelming amount of options, opinions and advice, and are asked to make a lot of complex decisions. It can be hard to take it all in and process it. But there’s really no rush. Take your time. Read about what you need or want to know in this book when the time feels right for you.

Understanding what really goes on in pregnancy, birth and in those early days as a new mum makes a big difference to how you feel about it. Knowledge is power, after all. How you give birth matters and planning for your time as a postnatal woman will change your entire experience of it. Most people’s version of birth is what they see in films and on TV, which generally looks something like this: a woman lying on her back under bright lights screaming, a doctor delivers the baby, she stops screaming and holds the baby wrapped in a towel, everyone smiles.

Birth doesn’t usually look like that. We need to create a more realistic – and positive – view of birth.

I hope that The Modern Midwife’s Guide peels back the layers to help you easily navigate pregnancy, birth and your postnatal period.

My background

As a child I can remember meeting my siblings for the first time and thinking my mum had this superpower. She could grow people! As I got older and learned that pregnancy is something women have been doing for millennia, I was shocked that this wasn’t something I was taught properly about in school. A human can grow another human, inside them? With no instruction? The body does this on its own? I was mind-blown by how the heart, brain and genitals just appear and know what they are meant to do. I once asked my science teacher, ‘Isn’t that like leaving a load of ingredients in the kitchen and coming home to a baked cake? That can take itself out of the oven?’

My parents and teachers assumed I’d be a teen mum, but I didn’t want a baby right then myself; I just had to know more about how humans grow humans. At one point in my teenage years I felt like I was the only person to have all these questions about how we are all here. Until I found midwifery. It was only then that my fascination with pregnancy and birth was satisfied through learning.

But I have to admit I am still disappointed by the serious lack of education surrounding women’s health, periods, pregnancy, birth and the postnatal period. This lack of basic yet revolutionary education can lead to women being concerned about things that are normal, and ignoring things that are abnormal. It’s vital we all address this with the seriousness it deserves and start talking, educating and sharing information about women’s health.

After reading this book I hope you feel how I felt the day I became a midwife. Equipped, still ready to learn, yet also excited about this whole new section in your life.

I want to share with you the most up-to-date evidence and accurate information and hope to give you a few moments of ‘oh that makes so much sense …’ and get excited!

You may know me from Instagram or the Modern Midwives and Modern Mums Meet Ups. I wanted to create a community and network for both midwives and mothers on- and offline. I use these platforms for midwives to find like-minded birth experts and for mums to share their stories and talk openly to other mums. As much as I love the digital world and how far you can reach people, nothing really beats communication and face-to-face interaction. So I decided to launch meet up events around the UK.

The Modern Midwives Meet Up launched in February 2019 and has quickly grown into a much bigger national event that I didn’t plan for, but I’m grateful to have the opportunity to bring so many birth experts together and talk honestly to improve our practice and therefore the care women receive.

I also thought it was important to bring mums together so they can create their own tribe and build friendships. Loss of identity and loneliness are two common problems new mums face and finding other new mums that share these problems helps to solve them. I often tag mums in my Instagram Sunday Birth Stories (see page 306) and mums then talk directly to each other and follow each other after seeing that someone had a similar birth or problem to them. We can all learn from, and look after, each other!

How to use this book

To keep it simple I have separated the book into three parts:

You’re Pregnant! Now What?

Your Positive Birth

Becoming Mum

At the end of each section I’ve listed the key points to help summarise the information for you. This will also help you to easily identify what each section is about, so you can dip in and out as you need and go to the sections that are most relevant to you at each stage of your pregnancy – but also feel free to read from page one right through to the end if that is what works best for you!

You’re Pregnant! Now What?

Pregnant. That one little word changes your world. Regardless of whether your pregnancy is planned, the unexpected result of one night, or you have had fertility treatment, most women are in shock the moment they find out they are having a baby. ‘Oh my god, there’s a baby in there!? I’m pregnant …? Am I really pregnant? Let me just …’

You may find yourself feeling confused. Maybe you didn’t want to be in this position, or maybe you did but now you’re not so sure. Maybe you’ve been trying for such a long time, it seems unreal now that it’s actually happened. Or maybe you have started to worry about the fact you got drunk a couple of days ago or that you ate something that isn’t recommended in pregnancy.

STOP! Don’t beat yourself up, there’s nothing you can do about that now, so stop worrying. Millions of healthy babies have been born under exactly these circumstances. Relax and take a breath while you get your head around your news.

No doubt soon though you’ll start to wonder ‘what do I need to do now?’ And if you haven’t already, you’ll begin wondering if the symptoms you’re experiencing are normal. So, we’ll start this section by running through the things you need to know in the first instance. Don’t worry about the rest for now, there’s plenty of time for that. I’ll share some handy tips and some fascinating facts about your pregnancy. Then we’ll move on to the common concerns most woman have during their pregnancy.

Always check with your midwife or GP

The following pages should not be treated as a diagnostic tool. Instead, consider it more of a ‘what to expect’ guide. Any symptoms or concerns that you have should always be checked by your midwife or GP.

The first thing to do

There is something you need to do as soon as you find out you are pregnant; it’s not normally spoken about at your first medical appointment, and healthcare professionals sometimes forget to tell you to do this:

Draw an imaginary circle around yourself and promise now to protect, nourish and look after yourself. This is your sacred circle. As hippy dippy as that sounds, it is honestly one of the best things you can do. If you have ever been meaning to start that yoga class (which will now be a yoga for pregnancy class), spend a little more time on self-care, meditate or do more of the things that actually make you happy – now is the time to start. I’m not saying this because I’m a millennial jumping on the self-care band wagon. I’m saying this because, as a midwife, I know just how much of an impact pregnancy has on the mind, body and relationships.

Pregnancy is such unique time in your life, it is important that you give yourself a lot of regard for what your body is doing. Your baby receives cues from you about the outside world and starts to develop their own body and nervous system in response to those cues. We’ll go into some more detail about this on page 273 but for now, you, your body and your mind need to come before anything else. It’s not easy when you’re working, have projects on the go and a social life. But as my nan used to say, ‘If you look after the corners, my darling, the middle will look after itself.’ Wise old words.

That said, I know how those first few weeks can feel a little stressful and overwhelming at times. Don’t worry, these are perfectly normal reactions and you won’t be doing your baby any harm; just aim to relax and look after yourself as much as you can.

Booking appointment

The next thing you need to do is arrange your ‘booking appointment’. This is the term we use for the first time you meet your midwife, and it will last for around an hour. You can usually self-refer online these days by using the postcode tool on Find Maternity Services (www.nhs.uk/service-search/other-services/Maternity%20services/LocationSearch/1802).

But traditionally, women booked through their GP and you can still choose this option if you like.

Ideally, you want to be around 8–10 weeks pregnant at your first appointment but it’s not a problem if you’re further on in your pregnancy. You’ll be offered the routine antenatal care and further input from other specialists may be recommended depending on your personal circumstances – we’ll cover this fully in ‘You’re a parent not a patient’ on page 32.

Once you’re booked, you will be monitored and supported throughout your pregnancy, labour and birth and the postnatal period. While you are in ‘a system’ you are not just a number, you are an individual and you are unique. You are about to embark on the most exciting and incredible journey of your life. As a pregnant woman, you need to be empowered with confidence and self-belief as well as up-to-date knowledge to help you to make informed choices.

Medication

The other important thing to do at this stage is, if you are taking any medication which you think would not be advised in pregnancy, check in with your GP as soon as possible. You can also check BUMPS website (Best Use of Medicines in Pregnancy) as they have a brilliant FAQ section that you may find really useful (www.medicinesinpregnancy.org). Finally, make sure that you are taking 400mcg folic acid supplement or the active form Methylfolate.

For now, those are the only immediate things you need to do.

The normal stuff that happens to your body and how to deal with it

THE HUMAN BODY is one of the most complex organisms on the planet; during pregnancy your entire body is affected! It’s amazing to think that there are about seven billion people on the planet and although we are all unique, the way we are grown is the same!

To make room for your growing baby your internal organs need to move and adapt. For example, your stomach, intestines and kidneys will all need to share space with their new neighbours – your baby and placenta.

New hormones quickly appear on the scene, causing changes that can feel a bit chaotic to you. It may not feel like it right now but, I promise, the hormones know what they’re doing; they’re preparing your body to create the best nest ever. Without any of your conscious control, your hormones have got to work growing your placenta, increasing your flexibility to prepare for birth and stopping your periods – you don’t need those right now. You are probably starting to get the picture – and we haven’t really scraped the surface yet – that it’s totally understandable if you are feeling anything from slightly out-of-sorts to fully derailed.

I have the thickest book ever that runs through each physiological change that occurs during pregnancy, and honestly, it is like reading a science-fiction book. It is surreal what your body is doing.

WELCOME TO THE FIRST TRIMESTER

We talk about three trimesters during pregnancy. The first trimester takes you up to 12 weeks, the second trimester is from 13–27 weeks and the third trimester from 28–42 weeks. In this section we will focus on the most common concerns that women have in each trimester.

Finding out you’re pregnant can be exciting but you can also have mixed feelings and/or feel worried and nervous; more than 1 in 10 women feel anxious during pregnancy. The cocktail of hormones now pumping through your body may have some effect on your mood. It’s easy to blow things out of proportion, especially if you’re feeling physically and emotionally tired.

If you feel overwhelmed or feel anxious daily, don’t bottle it up – talk to someone you trust, whether it’s your partner, midwife or GP. It may also be a good time to start learning and practising yoga breathing techniques to help you to relax. The more you practise these techniques, the easier and more effective they become. This will give you a tool to help you to manage stress or anxiety as well as prepare you for labour and birth. It will be time and effort well invested (see page 115 for yoga in pregnancy).

Morning sickness

Why it’s called morning sickness, I don’t know. Well I do, as it is more common in the morning, but for many of you, it can go on all day. It is often worse first thing in the morning because you’ve not eaten all night and your blood sugar level has dropped. On a positive note, the hormone hCG (human chorionic gonadotropin) that confirms your pregnancy (in a urine test), is mainly responsible for making you feel sick. Higher levels are actually a sign of a healthy pregnancy. Knowing this may not make you feel better but it may make the sickness feel worth it. That is not to say that if you don’t feel sick, something is wrong; generally this means you’ve just got away with it! Morning sickness is so common that it affects up to 80 per cent of women and can vary in severity from mildly queasy to full-on vomiting.

As morning sickness is so common, the effects of how the nausea and tiredness makes you feel can be dismissed by people around you. It’s bloody miserable, I know. Not only that, it’s a right nuisance if you’ve decided not to tell your colleagues you’re pregnant but have to swiftly go to the loo or try and pull off the ‘peaky look’. If you’re really struggling with keeping the secret (and the vomit down) give yourself permission to take a day off and call in sick. Remember your sacred circle.

If you can’t keep anything down, you need to see your GP as you might have a condition called hyperemesis gravidarum. Hyperemesis gravidarum can usually be treated with anti-sickness drugs prescribed by your GP, but if it gets out of hand you can become dehydrated and malnourished. For this reason, you will probably need an admission to hospital for a fluid drip and possibly some vitamins. This affects less than 1 per cent of women though.

The good news is if you’ve got nausea and some vomiting, it usually self-resolves by 16 weeks although some women get it up for up to 20 weeks. That might feel like a lifetime away if you are 10 weeks, so here are some suggestions to help you self-manage until it has subsided:

Rub fresh lemon peel on your hands as the citrus aroma can really help ward off nausea, especially if other smells set you off.

Ginger is an age-old natural anti-sickness remedy and is still popular today around the world. Leave a pack of natural ginger biscuits by your bed and nibble on them first thing in the morning to increase your blood sugar levels. Also try fresh ginger tea first thing. If you don’t like ginger, try any plain biscuits by the bed and chamomile tea instead.

Eat little and often – you might not be able to manage full meals, so stock up on snacks like nuts, dried fruit, oat cakes and fresh fruit. Peppermint tea can help to settle your stomach after eating too.

If you can manage a meal, carbs and starchy foods can help. A plain jacket potato or plain pasta can be easy to eat.

Fruit and veg smoothies, quickly whizzed up in a blender, can also help you get the nutrition you need if you can’t stomach the thought of eating vegetables – this is very common!

Sip water throughout the day. Some women say even water tastes weird or metallic; a slice of lemon, cucumber or orange in your water bottle can vary the taste.

Try a wrist acupressure band – many women I have looked after swear by them.

Fresh air can really help. Simply open the window first thing in the morning and take some slow, nice deep breaths.

Some women say having someone else prepare their food makes it easier to eat …

Try to identify triggers; this is usually a smell or even certain colours can set it off. Then it’s easier to avoid them.

If you have been vomiting, some women like to keep a bag in their handbag so they don’t feel stressed about feeling sick in public – dog poo bags work well. Having a sick bag can make you feel less worried about it, and hopefully reduce your stress.

Vomiting and your teeth

I spoke to dentist Jemma Hunter to get some advice about why it is so important to look after your teeth during pregnancy, and we go into this in more detail on page 14.

‘If you’re frequently being sick it can leave an unpleasant taste in your mouth and can potentially damage your teeth due to the acidity – repeated acid attacks may cause erosion of the surface enamel. Surprisingly, it is not a good idea to brush your teeth straight after vomiting, as the oral environment takes at least 30 minutes to recover to a neutral state; if you brush immediately after vomiting you will be rubbing acid into your teeth. But you can try these options to get rid of that icky taste and help your mouth stabilise after sickness:

Ideally rinse your mouth with an alcohol-free fluoridated mouthwash.

If you can’t tolerate mouthwash then rinse with plain tap water.

Use a small dab of toothpaste on your finger and gently smear it over your teeth to get the fresh minty taste without brushing.

Gag reflex

During pregnancy some women develop a heightened gag reflex and you may find yourself retching when trying to brush your teeth, particularly the upper back molars. Of course, you still need to brush your teeth so try:

Using a toothbrush with a small head – a children’s brush will do.

A ‘single tuft’ toothbrush can be better for reaching around the back teeth.

Some people find brushing with warm water helps.

Take your time – slow down the brushing action and concentrate on your breathing.

Try other distractions – such as tapping your feet or listening to music.’

Exhaustion

When to comes to coping with exhaustion in the first trimester, remember your sacred circle once again. Try and stay as firmly inside it as possible. Although there will be some things that you have to do, anything else can wait or be cancelled – don’t feel bad about doing this. If you need to take a nap, order take-out, or eat chips in bed until midday on the weekend, then do it. Lots of women feel the glow in the second trimester – it’s coming! – so just take the time out that you need to right now. You’ll soon start to feel less exhausted.

It’s not surprising that you feel exhausted in your first trimester. Not only is your body growing a baby, you’re also growing a whole other organ too: the placenta. By around 12 weeks the placenta has started to function and it takes over the production of the hormones needed for pregnancy. During pregnancy, we focus on growing a baby, but we sometimes forget about one of the most complex and important organs known to the human race. Your placenta acts as your baby’s heart, lungs, liver, temperature regulation and so much more. The placenta contains supply lines connecting all of this (technical term is villi) stretching to around 30 miles, and this all has to grow in the first trimester.

Approximately 20 per cent of your blood volume travels to your baby through your placenta. This is also why you are so exhausted – your body is starting to supply a significant amount of blood to a brand-new growing organ.

Once established, your placenta fights off and eliminates pathogens (unwanted intruders) and allows your antibodies to pass through into your baby, building your baby’s immune system. The placenta also has the ability to release some of your baby’s cells into your body in the event that you need repair to any damage to your organs. These cells can stay in your body for decades; this process is called fetal microchimerism. Another sci-fi-like fact that fascinated me was finding out that placental cells can be rather cunning as they disguise themselves as uterine cells in order to trick your uterus so that the placenta can embed itself deep into it and grow your baby. If we knew more about the placenta we would know more about organ transplants, because your placenta is part you and part your baby yet your body doesn’t reject it. Such a clever organ! No wonder you feel tired!

Bleeding and spotting

Approximately 20–25 per cent of women experience bleeding or spotting in pregnancy; I have had many tearful phone calls from women thinking the worst. Up to a quarter of women is a lot, so as scary as it can be, try not to panic. Many women also bleed later on in pregnancy; if that does happen it can be for a number of reasons, some more concerning than others. However far along you are you just need to call your midwife or doctor and let them know because you will need to be checked over. If you have a negative blood group and bleed, you may be offered an injection called Anti-D; this neutralises any RhD positive antigens that may have mixed with your blood (so your body won’t produce antibodies). If you have a negative blood group you could ask if the non-invasive prenatal testing is available to find out what blood group your baby is.

Constipation

Your digestive system gets sluggish in pregnancy; it goes from a Mercedes on the motorway speed to a coach up a hill. There is a reason for this; the gut slows down so your digestive tract can absorb more nutrients, which is great for growing a baby, but the side effects of this can be constipation and good old heartburn for you – which I will come back to in a moment.

I’m not going to sugar-coat it: constipation is horrible and can go from slightly uncomfortable to quite painful. In order to help your symptoms, you need to work with the new pace of your digestive system. Drink loads of water (two litres per day) and sip little and often throughout the day; this softens things and encourages regular movement. Eat slowly, little and often, and include plenty of wholegrains, veggies, blueberries, beans and add a few dates, figs and chia seeds to your diet.

Listen to your body’s cues and try to go as soon as your body is telling you to. I know this is a lot easier said than done sometimes and you can’t exactly say to your boss ‘sorry, but I need a poo before we start this meeting’ (although I wish we were more open in our culture about this). If possible, go as soon as you can when you need to – that email can wait.

Sore and swollen boobs

Sore and swollen boobs can be really uncomfortable in the first trimester. Women often tell me that even the pressure from the water whilst standing in the shower is too much. Your nipples can also get itchy and uncomfortable. This does get a lot better and we will talk about managing your pregnancy boobs further on, but for now wear loose clothing and a comfy bra (see page 18), and swap showers for baths if you can (but don’t make them too hot – you’ll get hotter quicker in pregnancy and a rise in core body temperature can be dehydrating and make you feel faint.)

Headaches

Headaches are common in early pregnancy and I reckon you can guess why – yup, hormones! Keeping well-hydrated really helps to prevent headaches and paracetamol is thought to be safe to take in pregnancy. Headaches tend to occur less in the second trimester, but you need to let your midwife know if you continue to get them in the second and third trimester because they can be a sign of pre-eclampsia.

THE SECOND AND THIRD TRIMESTER

Here are some of the concerns that women ask me about during their second and third trimester: everyone is different and women get symptoms at different stages, or you may escape them altogether.

Dental dos and don’ts

During pregnancy and after birth it’s more important than ever to take care of your teeth, which is why dental care is free under the NHS for pregnant women. While it’s not true that a baby steals calcium from your teeth, there are a range of oral conditions, such as inflamed or bleeding gums, that may affect mums-to-be. Book in with your local dentist for a check-up. Although I’m really interested in oral health, I’m not an expert, so I spoke to Jemma Hunter, an NHS family dentist and clinical teacher in paediatric dentistry. She runs an Instagram account @themummydentist and promotes accessible oral health advice for mums and babies. Here’s what she told me:

‘Maternal oral health is part of overall wellbeing. A baby’s milk teeth start to form during the first trimester and their adult teeth begin developing around birth, so taking care of yourself is beneficial to you and your growing baba. It is super-important to visit your dentist during pregnancy, even if you aren’t suffering from any of the below symptoms or you haven’t been for a while. We can provide routine checks, risk assessment and appropriate advice. There are some aspects of dental care that may alter when you are expecting, such as types of filling material or choosing to delay routine X-rays. We can still safely provide various treatment options, including if you have toothache and require emergency dental work. Your dental maternity exemption then lasts until baby’s first birthday, meaning you should also attend appointments after baby arrives so we can assess for any further changes and complete treatment if required. We advise bringing babies along for their first check-up before they turn one too – time for an exciting little family trip to the dentist.

Bleeding gums

This is perhaps one of the most common pregnancy-related dental issues that I get asked about. This is often related to your elevated hormone levels and the slight differences in your immune response whilst pregnant. As bleeding gums can be associated with various conditions like gum disease, infection or inflammation, it’s important to see your dentist so they can establish a diagnosis and devise a suitable treatment plan.’

What’s that in my knickers?

In traditional Chinese medicine pregnancy is considered a ‘damp’ condition. This is because increased discharge from your vagina is a common and normal physiological change in pregnancy. The extra discharge is defending your baby and helps prevent any infections travelling from your vagina up to your uterus. However, if you get increased discharge with any itching, pain, a bad smell or stinging/burning on peeing, you need to get it checked out as it could be a yeast infection, bacterial vaginosis or a urinary tract infection – all are common in pregnancy and are easily treated.

Talking of peeing and fluid, you’ll need to pee a lot more often during pregnancy. As your baby grows it presses on your bladder. Try not to let this put you off keeping well hydrated; you are more at risk of urine infections in pregnancy and drinking plenty of water to flush out your bladder can really help.

If you feel like you have leaked amniotic fluid, rather than discharge, you need to contact your midwife as soon as possible as there may be a chance that your waters have gone (or ‘broken’). Depending on how pregnant you are, your midwife or doctor will make a plan with you about how to manage your waters going.

Skin changes

Some women start to notice skin changes around the second trimester but some don’t have any changes at all until the third. Darkening of the skin is very common; this is due to the increase of melanocyte stimulating hormone (MSH) and thought to help darken your nipples so that your baby is able to spot their feeding target better (newborns have poor eyesight at birth). Some women get darker patches on the forehead or cheeks, which can look kind of like a butterfly effect. You may also notice a line down your stomach, called the linea nigra (‘black line’ in Latin), which is also part of normal skin pigmentation changes.

During pregnancy it is important to make sure you protect your skin from the sun as much as possible. Wear both a hat and a natural sunscreen if you go out in stronger sun, and if you go on a sunny holiday. The darkening of the skin usually subsides and returns to its normal colour about six weeks after birth but in some women the linea nigra is visible up to a year after birth. Whether yours goes or stays it’s good to use sunscreen postnatally because darkened skin patches may reappear in the sun.

Hormonal contraceptives, taken after birth, may also create more darkening of the skin. The copper coil (also known as an intrauterine device or IUD) is the only non-hormonal contraceptive available for women at the moment, should you need it.

Stretch marks in pregnancy affect up to 80 per cent of women and can appear in various areas of your body from your tummy to your upper thighs, boobs and even lower back. They usually start to appear or worsen as your pregnancy progresses because of the extra strain on the skin to provide more space. There are a lot of factors involved in why you may or may not get stretch marks, and genetics can really play a part in how your skin adapts and changes in pregnancy. You can’t change your genetics but what you can do is work with your body to help prevent them. Here are some top tips:

Stay hydrated. Water helps skin cells maintain maximum elasticity and suppleness.

Eat foods rich in vitamin E, zinc and protein that help to repair tissue. For example, almonds, hemp seed, chickpeas and broccoli.

Dry body brushing increases blood flow to the skin and is a good way to prepare the skin for moisturising. Use a brush designed for the skin and use firm but gentle upward strokes before a shower a few times a week. The brushes with the longer wooden handles are easiest to use. Dry body brushing is more of a preventive measure and you should focus on your legs, upper thighs, bum and arms.

Moisturise! Body lotions generally have a high water content and lower oil content, whereas oils and balms have the highest oil content. Lotions are probably easier to use daily as they are absorbed quicker and won’t leave marks on your clothes. Oils and balms are best in the evening as they can soak into the skin overnight and it won’t matter too much if they get on your PJs. Rosehip oil is expensive but it’s good for scars and stretchmark prevention. If it is hard to reach some areas later on in pregnancy try spraying on oil – you can put the oil of your choice in a refill spray bottles. Or if you have a