I'm seven months pregnant and scared of the birth. This is what every mother should ask

Telegraph

23-07-2025

In 1928, my great-grandmother, Bertha, died from puerperal fever after giving birth. She was 32. Her baby, Audrey, also died. My grandmother, then two years old, was subsequently raised by her aunt.
That same year, penicillin was discovered – and in the ensuing decades we entered a golden age of maternity care where the maternal mortality rate dropped significantly.
When I was born in 1984 and my mother contracted a post-partum infection, the consequences were very different.
Childbirth remains though, a complex and necessary fact of life. Women are not ignorant that it will be painful, that the unexpected will happen, that things might rip and tear. However, today they face significant other anxieties, about the very nature of the care they might receive.
Maternity care services in the UK are facing significant staffing shortages, and as a result there are very real concerns about the safety and quality of care provided. Indeed, last year a study found the number of women in the UK who have died during pregnancy or soon after has risen to its highest levels for 20 years.
Meanwhile, last year 41 per cent of all compensation pay outs by the NHS related to maternity care, equating to a staggering £1.15 billion.
And now, Health Secretary Wes Streeting has announced a national inquiry into maternity care in England, saying there is 'too much passing the buck'.
It is in this unfavourable climate that I find myself seven months pregnant.
'Fear of birth' is the label applied by the NHS for those women who are anxious about childbirth. Mine might be more reasonably called, 'Fear of bad maternity care'.
Most women don't need to read about the horror in the news, they have friends and loved ones who've been snapped at by midwives, denied pain relief and been made to feel like a failure when they struggle to breast-feed.
When GP Clara Doran gave birth to her son 11 years ago, she found herself in a hospital ward at 5am, crying, her baby dehydrated and losing weight, feeling like a total failure. She realised that even with all her medical training, she still needed support and hadn't been told what to actually expect.
Dr Doran has written a memoir, Doctor, Interrupted, which is both a powerful and, at times, funny account of the gap between what the NHS says it offers new mums – and what they really get.
Of NHS maternity care, she says: 'We do have to have trust that today's health care is guided by the right things. That healthy baby, healthy mum is the driving force. But there are unfortunately, like in any work place, other factors that can influence how that translates to your experience.'
So how can pregnant women like me get the best from the NHS in this unfavourable climate? On the basis that forewarned is forearmed, here are the questions to ask your midwife ahead of giving birth.
What signs should prompt me to go to the hospital urgently?
Blood spotting, baby not moving, waters broken; whatever the issue, this can be a hard question for expectant mums to ask.
Darcey Croft is a specialist midwife who helps women advocate for themselves and navigate the maternity system.
In her experience, women feel embarrassed because the NHS is so busy. 'They don't want to make a nuisance of themselves, and they definitely should,' she says.
'I would give triage a call to the maternity unit and if you're not getting the right response, insist. Say, 'I'm still feeling very concerned, and I would like to be reviewed'.
'We know that women asking questions have safer outcomes. Even if someone is tutting at them. They will be seen.'
Should I request a C-section?
Requests are increasing for planned caesareans. According to Croft: 'It is a sad reflection of the confidence women have in maternity systems at the moment.'
Every women has the right to ask for a planned caesarean. The reason can be medical or psychological.
I knew I wanted to request a caesarean almost immediately, for a variety of reasons. One is that big babies run in my family. I was 10lb 12oz at birth, my poor mother gave birth vaginally.
The main reason though is my age. Women aged over 40 are significantly more likely to have an emergency C-section compared to younger mothers. A study showed a 22.4 per cent emergency caesarean rate for women over 40, compared to 6.7 per cent for those aged 20-24.
Dr Lucy Lord MBE is an obstetrician and founder of private clinic, Central Health London.
She says: 'You can be lucky and labour like a 25 year old, but the chances of that are one in 10. You can be moderately lucky and labour like a 35 year old, but still over half of births in this age group end in a C-section.'
She adds: 'If you're under 25, and so is your BMI, and you've got a normally growing baby and no other complications, you can be pretty sure no matter how c--p the labour ward is, you'll be OK.'
The subject can be an emotive issue, with a perception that a vaginal birth is more natural. In Dr Lord's opinion good obstetric care is about risk stratification. 'I say to women, don't think with your heart, think with your head.'
Not all NHS hospitals are equipped to perform immediate emergency C-sections. So if you're high risk it's worth checking, so you can move to another hospital if necessary.
Am I a good candidate for a home birth or would the hospital be safer?
One in 50 births each year in England and Wales take place at home. There has been a small increase in recent years and Dr Doran wonders if this is part of a trend towards expecting mothers trying to avoid any intervention.
If you are categorised as a low risk, home births are very safe, says Croft: 'The midwifery team and doctors should be assessing to say whether you are perfect for a home birth.'
The advantage is that they are less timed than hospital births, where a cascade of interventions can ensue.
During a home birth midwives can usually tell which way things are heading before there is ever an emergency, adds Croft. 'Occasionally things can escalate quickly and you would need to get an ambulance.'
How will you make sure I'm informed and involved in decision-making during labour?
Gathering as much knowledge before labour is imperative.
'I always maintain that women can go through any birth, and come out feeling positive, as long as they feel they are involved in their own care, making the decisions and that they felt listened to,' says Croft.
Trauma happens when a woman doesn't feel safe and listened to.
Don't be afraid to ask for a second opinion. 'Every shift will have a coordinator, who doesn't want poor feedback. If you're not getting the answer you want, ask to speak to the coordinator.'
Ask how birth partners and advocates are included in labour. 'Women often make better decision when they're supported and feel emotionally safe,' says Croft.
Will my birth plan be followed?
While it's a good idea to have a birth plan stating your preferences, that doesn't mean your midwife is obliged to follow it. Or indeed will be able to.
From medical complications, down to all the birthing pools being full, it's best to plan for the unexpected.
Croft advises her clients against writing 'epic novels': 'I always guide women towards condensing it down to bullet points, including what's non-negotiable. That will get read.'
However, it is important that you and your birthing partner have talked through all scenarios and you feel comfortable that they're going to emphasise your preferences.
When speaking up, Dr Doran advises leading with your vulnerability. 'Such as: the pain you are experiencing. Then it is harder for it to be ignored,' she says.
Will a consultant or senior doctor be available if complications arise during labour or before?
Yes. Every unit will have a consultant present or on call, even in the middle of the night.
'If it's a birth centre and a midwifery-led unit, there might not be any doctors there,' explains Croft. 'That woman will be transferred into the consultant-led unit.'
What if I change my mind about pain relief?
Dr Doran says: ' Pain relief will always be available as long as it is safe and appropriate for you and baby at your stage of labour. No one knows how they will cope with labour pain until they experience it so go with the flow and listen to your body. No one is keeping score.'
What are the signs of sepsis or infection I should watch for after birth?
Early signs include fever and flu-like symptoms.
'As soon as someone starts to feel unwell they should speak up,' says Croft. 'If they feel dismissed, just reiterate, 'No, I feel very unwell.' Ask for a blood test for sepsis. It's fine to ask.'
Escalation is important. 'Mums and dads can always ask for that second opinion. And if they don't feel listened to, ask for another one.'
What should I expect on a postnatal ward?
You're exhausted, you want to sleep and spend time with your new baby. And yet you are on a post-natal ward with five other women with a curtain around them.
Home is the right place for a new mum. 'As soon as you're fit for discharge, get home,' says Croft.
After a caesarean, try to mobilise as quickly as you can: 'Four to six hours after the operation try to move. You'll still have some of the pain relief onboard. If you lie there for 12 hours and then try to move, it will be a lot harder.'
Whether you gave birth by caesarean or vaginally, one night's stay in hospital as a minimum is standard, in order to access breast-feeding support. 'Six hours is on offer but normally you'd have to request an early discharge.'
Again, make a nuisance of yourself. 'Use your call bell. The women who are using it and asking for help go home feeling supported. There is an element where mums have to take responsibility or dads have to help advocate for support.'
Who should I turn to if I feel anxious or depressed after the birth?
It's not uncommon to feel depressed or anxious after giving birth. If you're blue it's important to seek help from your GP, midwife or health visitor.
As Dr Doran says: 'We talk a lot about 'getting back to normal' or feel we should be able to master everything we did in our pre-baby life when we become parents. However other cultures see this differently and encourage new mums to stay in bed or at home for as long as possible in the days after birth to rest and adjust physically and mentally to what has happened.'
At the core of the anxiety women can feel is feeding. Dr Doran speaks from experience: 'Having watched videos in antenatal class of the perfect attachment and breastfeeding experience occurring seamlessly, when it came to my turn, wondering why my baby wasn't doing this in the same way and being convinced it was my fault.'
Take the help and support, but also nourishment of your baby is the most important thing. If this needs to be with formula or mixed feeding, that is absolutely fine and the right decision for you and your baby. 'Don't let anyone guilt you or make you feel less of a mum because of it,' she says.
'These days and weeks are the most exciting and special time, but they can be extremely hard too and fraught with tiredness, fear and self doubt. Take it easy on yourself, what is right for you is right for your baby and remember this is just the beginning of your lives together.'