By Andri Johnston

You still can’t believe it: The blue line on the pregnancy test showed positive and changed your whole world overnight. You are so excited and there is so much to plan and remember. One thing that all foreigners are unsure about is how exactly the birthing process works in a foreign country. And let me tell you, giving birth in England is very different from what you and your family are used to in South Africa. So here is everything you need to know.

As I write here, our little girl is three months old. I struggled to understand the birth process with the help of the British National Health Service (NHS). Everything was strange and frustrated me. And explaining to my family in South Africa how a system with midwives works was even more difficult. That’s why I want to make a how-to list for future South African mums who have to give birth in England. Maybe it can make the process a little less stressful for you.

PLEASE NOTE: The British NHS processes in England described here differ from those in Wales and Scotland.

You are pregnant. What now?

The first thing you need to know about pregnancy and childbirth in England is that you will not be seeing a gynaecologist during your pregnancy. A midwife will examine you and provide all support.

Trusting a midwife with everything if you are used to a gynaecologist is quite difficult. Some of their procedures are strange and can feel a bit old-style. For example, they measure your stomach with a tape measure.

So, how and where do you meet the midwife? The first thing you should do when you find out you are pregnant is to call your GP to get the number of your area’s midwife. Call her and make your first appointment. She will ask you how far along your pregnancy is and refer you to your nearest hospital. You must phone or email the hospital and make an appointment for your 10-week appointment. At 10 weeks you visit the hospital where you will give birth and speak to a midwife for the first time. This is not your area’s midwife to whom you will speak every month but a general midwife who works at the hospital.

You will see a lot of different people, and most of them you will only see once during your entire pregnancy. I found it quite impersonal and didn’t like telling my whole story to a new person every time. However, slowly but surely you build up a history in your green file.

What is your green file?

Your green prenatal file is your most important possession from the day of your first hospital visit and scans until the day you are discharged after the birth. It contains all your personal information, medical history and information about every medical visit you’ve had and are yet to have, all tests and scans you’ve had and are yet to undergo – literally everything to do with your pregnancy.

This is the one thing you should have with you at all times, especially when you travel. You will use this file until the day approximately two weeks after your baby’s birth when you are discharged by your midwife, and it will be retained for 25 years so that you or your doctor can revisit any aspect of your pregnancy later. If you want to have a birth debriefing after a bad or traumatic birth, you can also ask to see the notes about your birth.

Your midwife is your everything

This is really true. During your pregnancy, you will be in contact with your midwife most of the time. If everything indicates that your birth process will be low risk and you decide to give birth naturally (not with a C-section of your own choice), a midwife will also be assisting you. They can support you in the hospital’s midwifery unit or at home if you prefer a home birth.

Each NHS association or area has different rules regarding midwives. Some have a group of midwives and you will see someone different each time. With others, you may find one midwife who will assist you throughout your pregnancy if you are lucky.

Tip: You have every right to ask for another midwife if you don’t get along with the one assigned to you or even if you just don’t feel comfortable with her. I did this in the middle of my pregnancy, and it made all the difference to the support I received in the latter part of my pregnancy and during my postnatal care.

Pregnancy care by a midwife

You can expect the following, among other things, from your midwife during your pregnancy:

• From 28 weeks, you may visit her once a month if it is your first baby; for subsequent babies you can visit her less often.
• She will measure your stomach with a tape measure at each visit. If she feels it is too small, she will refer you to go for a scan within 48 hours.
• She will listen to your baby’s heartbeat at each visit.
• Remember to take your green file with you every time so she can make notes in it.
• She will do a urine test at each visit.
• She can refer you to any extra NHS services, such as physiotherapy or support for your mental health.
• She will discuss all the birth options with you. Don’t be influenced to choose anything you don’t want to do.
• Usually, she gives you her number so you can message her at any time if you are unsure about something. If it is serious, she will refer you to triage.

Postnatal care by a midwife

The hospital will notify your midwife when you are discharged from the hospital, and she will visit you at home the next day. If you have a home birth, she will also visit you the day after the birth. She will then visit you again five days later and two weeks after the birth of your baby. If there are no complications, the midwife’s services will end one month after your baby’s birth. Then the focus shifts to caring for the baby and a health visitor will visit you.

You can expect the following, among other things, from your midwife after the birth of your baby:

• She will start with your purple postnatal file. Keep it with your green file.
• She will ask you about your wounds to determine if you needed stitches or had a C-section, and she can examine them if you want her to.
• She will inform you how to let your baby sleep safely.
• During her visit five days after the birth or five days after you have come home, she will weigh your baby and give you advice about your baby’s nutrition.
• If she has the necessary knowledge, she will advise on breastfeeding. If not, she will refer you to a specialist in the NHS if you need breastfeeding advice.
• If your baby suffers from tongue tie or ankyloglossia, your midwife, the breastfeeding specialist or your home nurse can refer you to the NHS tongue tie service.
• Your midwife will prick your baby’s heel during her visit five days after the birth and have the blood tested for a number of baby diseases.
• She will discuss your mental state with you and refer you for postnatal depression treatment if you need support.

Tip: Even though you may simply feel a little down after your baby’s birth, it’s worth asking to be referred to postnatal or postpartum care. They will support you by giving you tips to improve your situation. They can also help you get medication for postnatal depression.

Your birth plan

The midwife will ask you to write down your birth plan in the run-up to your baby’s birth. It is simply your preferences and how you would like everything done during the birth. It was a new concept for me because it’s not something that happens in South Africa as your gynaecologist advises you and actually works out your birth plan for you. But because you are handled by such a multitude of medical staff during your pregnancy in England and don’t necessarily know the midwife or doctor who assists you during the birth, a birth plan is your way of ensuring that your wishes are met. Write everything down as you progress through your pregnancy and discuss it with the midwife during your last appointment. Of course, the plan will be adjusted where necessary to ensure you and your baby are safe, but the midwife or doctor will first discuss any intervention that is not part of your birth plan with you and your other half.

ALSO READ: Everything you need to know about giving birth in England – Part 2