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The Pregnancy Book 2005

05
20
Pre nancy g
byw gyda’ch babi newydd
the
yr esgor a’r geni

feichiogrwydd iach

Arweiniad cyflawn i:
book

Your complete guide to:


Misa Mwy a healthy pregnancy

labour and giving birth

life with your new baby


Naw Naw Mis a Mwy 2005
2005
Addasiad yw’r llyfr hwn o The Pregnancy Book gan Yr Adran lechyd. Hoffai Adran in Wales.
Hybu Iechyd, Cynulliad Llywodraeth Cymru ddiolch am y caniatâd i’w addasu i’r This book is given free to all first-time mothers
Gymraeg.
RHIFAU DEFNYDDIOL
Hoffem ddiolch i bob mam a thad a gymerodd ran yn y gwaith ymchwil ar gyfer the time of going to press, but again may change. organisations to take action to build a healthier nation.
argraffiadau cynharaf o’r llyfr hwn, ac i’r holl bobl hynny mae eu sylwadau defnyddiol The information on rights and benefits is correct at efforts to improve health and well-being in Wales. It is a challenge to all individuals and
yn parhau i lunio’i ddatblygiad. Meddyg: be incorporated into the text at the next reprint. response to Health Challenge Wales. Health Challenge Wales is the national focus for
and other health professionals at once.They will then This publication has been produced by the Welsh Assembly Government as part of its
Hoffem ddiolch hefyd i’r holl sefydliadau a’r unigolion hynny a gyfrannodd at significant changes will always be notified to doctors
gynhyrchu’r llyfr hwn, ac yn enwedig: of publication. Because developments can be very rapid, CF10 3NQ
Adran Iechyd y Llywodraeth the most up-to-date medical advice available at the time Cardiff,
Ambiwlans Sant Ioan Every effort has been made to ensure this book reflects Cathays Park,
Coleg Brenhinol y Bydwragedd Welsh Assembly Government,
Bydwraig: Office of The Chief Medical Officer,
Coleg Brenhinol y Meddygon Teulu Public Health Strategy Division,
Coleg Brenhinol y Pediatryddion ac Iechyd Plant
Open daily from 12 noon to 9 pm.
Coleg Brenhinol yr Obstetryddion a’r Gynecolegwyr © Crown copyright January 2005
Cymdeithas yr Ymarferwyr Cymunedol ac Ymwelwyr Iechyd
0800 169 9 169 ISBN 0 7504 3687 5
Y Gynghrair Mamolaeth
Yr Ymddiriedolaeth Genedigaeth Genedlaethol. Health, 2004
NHS Pregnancy Smoking Helpline
Dr Petra Clarke, Christine Gowdridge, yr Athro David Harvey, Dr Sheila Macphail, Assembly Government, based on the original version produced by The Department of
Ros Meek, Jeanne Langford, Dr Lindsay Smith, Dr David Sowden, Ros Steele a Ysbyty: This revised edition published by the Office of The Chief Medical Officer,Welsh
Glenys Sykes.
Revised edition published by Health Promotion England, 2001
Atgynhyrchwyd y ffotograffau gyda chaniatâd y canlynol: First published by Health Education Authority, 1999
information and advice.
Angela Hampton, tudalennau 91 canol a gwaelod, 98 canol a thudalennau 107 a 119. 24 hour nurse-led helpline providing health Cover design: Persona Grata
Bubbles, tudalennau 4 canol a de, 6 top canol a de, 6 gwaelod ar y dde a’r chwith, 8
top, 16, 19, 20 top a gwaelod, 33 top a gwaelod, 35, 37, 42, 45, 47 a’r clawr, 50, 56 NHS Direct 0845 4647 This edition: Dr Virginia Beckett, Sue Latchem
gwaelod, 65 gwaelod, 66 top, 70 top, 71, 77, 79 a’r clawr, 80, 85 gwaelod, 87 a’r clawr, Revised text: Sally Burningham, Karen Ford, Angela Phillips
Cyfeirnod yr ysbyty:
88 top, 94 gwaelod, 95, 96, 98 top ar y chwith, 99 gwaelod ar y dde, 100 top a Original text: Nancy Kohner
gwaelod, 102 top a gwaelod, 103, 104, 110 top a gwaelod, 111, 113, 114 top, 115, 116 Annabel Milne, pages 16, 17, 21, 22, 23, 28, 29, 30, 31, 32, 55, 61, 70, 75, 76, 82 and 123.
gwaelod, 120, 124, 125 gwaelod, 128 top, 130. Collections, tudalennau 70 gwaelod, 117, 120, 124 and 128.
73, 86 gwaelod, 91 top ar y chwith, 92, 98 gwaelod, 99 top ar y chwith, 110 yr ail i Rachel Busch, pages 8, 11, 13, 26, 37, 39, 40, 41, 43, 48, 64, 69, 78, 87, 90, 111, 115,
lawr, 122 a’r clawr, 125 top, 127 chwith a’r dde. Cow & gate, tudalen 74. Format, Ilustrations
tudalennau 6 top ar y chwith, 34, 48, 49, top 51, 54, 85 top, 86 top, 89, 93, 94, top, 108,
top, 121, 128 gwaelod. The Foundation for the Study of Infant Deaths Health visitor: and bottom, 57, 58, 59, 97 left.
(ffotograffydd: Sandra Lousada) tudalen 86 gwaelod ar y dde. Health Promotion Ymwelydd Iechyd: Library, pages ii, 5 top left, 21, 24 top and bottom, 28, 29, 30 top and bottom, 31 top
England, tudalennau iii, 4 chwith, 5 top ar y dde, 7, 8 gwaelod, 10, 12, 15 gwaelod ar y right, 100 left middle, 108 bottom, 110 3rd down, 112, 114 bottom, 118. Science Photo
dde, 17, 39, 52, 56, 63, 66 gwaelod, 67, 68, 83, 88, de, 116 top. Images, clawr blaen. top right, 44, 49 left, 53, 55, 62 top and bottom, 65 top, 72, 81, 84, 97 top right, 99 top
National Meningitis Trust, tudalen 126. Sally and Richard Greenhill, tudalennau 5 page 126. Sally and Richard Greenhill, pages 5 bottom left and right, 9 top, 15 left and
gwaelod ar y dde ac ar y chwith, 9 top, 15 chwith, a’r top ar y dde, 44, 49 chwith, 53, bottom, 67, 68, 83, 88 right, 116 top. Images, front cover. National Meningitis Trust,
55, 62 top a gwaelod, 65 top, 72, 81, 84, 97 top ar y dde, 99 top ar y dde, 100 canol ar y pages iii, 4 left, 5 top right, 7, 8 foot, 10, 12, 15 bottom right, 17, 39, 52, 56, 63, 66
chwith, 108 gwaelod, 110, trydydd i lawr, 112, 114 gwaelod, 118. Science Photo Hospital ref no: (photographer: Sandra Lousada) page 86 bottom right. Health Promotion England,
Library, tudalennau ii, 5 gwaelod ar y chwith, 21, 24 top a gwaelod, 28, 29, 30 top a top, 108 top, 121, 128 bottom. The Foundation for the Study of Infant Deaths
gwaelod, 31 top a gwaelod, 57, 58, 59, 97 chwith. Galw Iechyd Cymru 0845 46 47 Gate, page 74. Format, pages 6 top left, 34, 48, 49 top, 51, 54, 85 top, 86 top, 89, 93, 94
bottom, 99 top left, 110 2nd down, 122 and cover, 125 top, 127 left and right. Cow &
Darluniau Llinell gymorth 24 awr a reolir bottom, 128 top, 130. Collections, pages 70 bottom, 73, 86 bottom, 91 top left, 92, 98
Rachel Busch, tudalennau 8, 11, 13, 26, 37, 39, 40, 41, 43, 48, 64, 69, 78, 87, 90, 111, gan nyrsys sy’n darparu cyngor a 103, 104, 110 top and bottom, 111, 113, 114 top, 115, 116 bottom, 120, 124, 125
115, 117, 120, 124 a 128. gwybodaeth ar iechyd. bottom, 95, 96, 98 top left, 99 bottom right, 100 top and bottom, 102 top and bottom,
Annabel Milne, tudalennau 16, 17, 21, 22, 23, 28, 29, 30, 31, 32, 55, 61, 70, 75, 76, 82 a 123. bottom, 66 top, 70 top, 71, 77, 79 and cover, 80, 85 bottom, 87 and cover, 88 top, 94
Hospital: 20 top and bottom, 33 top and bottom, 35, 37, 42, 45, 47 and cover, 50, 56 bottom, 65
Testun gwreiddiol Saesneg: Nancy Kohner Llinell Gymorth y GIG i Ysmygwyr Beichiog pages 4 middle and right, 6 top, middle and right, 6, bottom left and right, 8 top, 16, 19,
Testun diwygiedig Saesneg: Sally Burningham, Karen Ford, Angela Phillips Angela Hampton, pages 91 middle and bottom, 98 middle, 107 and 119. Bubbles,
Testun Saesneg yr argraffiad hwn: Dr Virginia Beckett, Sue Latchem The photographs have been reproduced with the permission of the following:
0800 169 9 169
Dyluniwyd y clawr gan: Persona Grata Glenys Sykes.
Ar agor o 12 pm i 9 pm bob dydd. Ros Meek, Jeanne Langford, Dr Lindsay Smith, Dr David Sowden, Ros Steele and
Cyhoeddwyd y fersiwn cyntaf gan yr Awdurdod Addysg Iechyd, 1999. Dr Petra Clarke, Christine Gowdridge, Professor David Harvey, Dr Sheila Macphail,
Midwife:
Cyhoeddwyd yr argraffiad diwygiedig hwn gan Swyddfa’r Prif Swyddog Meddygol, St John Ambulance
Gwnaed pob ymdrech i sicrhau bod y llyfr hwn yn
Llywodraeth Cynulliad Cymru, yn seiliedig ar y fersiwn gwreiddiol a gynhyrchwyd Royal College of Paediatrics and Child Health
adlewyrchu’r cyngor meddygol diweddaraf oedd ar gael
gan yr Adran Iechyd, 2004. Royal College of Obstetricians and Gynaecologists
adeg ei gyhoeddi. Gall datblygiadau ddigwydd yn gyflym Royal College of Midwives
ISBN 0 7504 3687 5 iawn ac felly hysbysir meddygon a gweithwyr iechyd Royal College of General Practitioners
© Hawlfraint y Goron, 2005 proffesiynol eraill ar unwaith am unrhyw newidiadau National Childbirth Trust
sylweddol.Yna, fe’u hymgorfforir yn y testun yn yr argraffiad
Adran Strategaeth Iechyd y Cyhoedd Maternity Alliance
nesaf. Mae’r wybodaeth ar hawliau a budd-daliadau yn
Swyddfa’r Prif Swyddog Meddygol Community Practitioners and Health Visitors Association
gywir adeg mynd i’r wasg, ond fe allai newid. Doctor:
Llywodraeth Cynulliad Cymru individuals who contributed to the making of this book and, in particular:
Parc Cathays, Caerdydd, CF10 3NQ The Department of Health would also like to thank all those organisations and
Rhoddir y llyfr hwn am ddim i bob merch sy’n disgwyl ei
phlentyn cyntaf yng Nghymru. USEFUL NUMBERS comments continue to shape its development.
part in research for the earlier editions of this book, and all those people whose helpful
The Department of Health would like to thank all the mothers and fathers who took
the

g
Pre nancy
book

Your complete guide

to pregnancy, childbirth

and the first few weeks

with a new baby


Contents
YOUR PREGNANCY 4 Couples 41
AT A GLANCE Sex in pregnancy 42
Families and friends 43
INTRODUCTION 7 Work 44
Coping alone 45
Domestic violence 46
1 YOUR HEALTH IN PREGNANCY Bereavement 46
What should you eat? 8
The balance of good health 8 6 MAINLY FOR MEN
Smoking 13 Your feelings about pregnancy 47
Alcohol 14 Supporting your partner 48
Pills, medicines and other drugs 14 Becoming a father 50
Physical activity 15
Infections 17
Animals 19 7 ANTENATAL CARE AND
Inherited conditions 19 ANTENATAL CLASSES
Work hazards 20 The first visit 51
Coping at work 20 Later visits 56
Tests to detect abnormalities
in the baby 57
2 CONCEPTION Making the most of
The man’s sexual organs 21 antenatal care 60
The woman’s sexual organs 21 Your antenatal notes 60
The woman’s monthly cycle 23 Who’s who 62
Conception 23 Antenatal classes 64
Hormones 24
Heredity 24
The best time to get pregnant 25 8 FEEDING YOUR BABY
Twins 25 Breastfeeding 67
Finding out if you’re pregnant 26 Bottle feeding 73
Knowing that you’re pregnant 27

9 PROBLEMS
3 HOW THE BABY DEVELOPS Common minor problems 77
How the baby develops 28 More serious problems 83

4 DECIDING WHERE TO 10 WHAT YOU NEED FOR


HAVE YOUR BABY THE BABY
The basic options 34 Nappies 85
Birth plan 37 Bathing 86
Sleeping 86
Out and about 87
5 FEELINGS AND RELATIONSHIPS In the car 88
Feelings 39 Feeding 88
Worrying about the birth 40 Clothes for the baby 88
Worrying about abnormality 41
11 LABOUR AND BIRTH 16 THE EARLY WEEKS:
Getting ready for the birth 89 YOUR BABY
How to recognise when Registering the birth 119
labour starts 90 Crying 119
Pain relief in labour 91 Sleeping 120
When to go into hospital or Reducing the risk of cot death 121
GP or midwife unit 94 Nappies 122
At the hospital 95 Washing and bathing 125
What happens in labour 96 Illness 126
Afterwards 100 Where to get support 127
Special cases 100 Enjoying your baby 127
What your companion can do 103 Raising your child bilingually 127

17
12 WHEN PREGNANCY THINKING ABOUT
GOES WRONG THE NEXT BABY?
Ectopic pregnancy 104 Fathers too 128
Miscarriage 104 Getting and staying healthy 128
Termination 105 Work hazards 129
Losing a baby 106
18
RIGHTS AND BENEFITS
13 THE FIRST DAYS Benefits for all 130
WITH YOUR NEW BABY Benefits if your income is low 131
You 107 Maternity benefits 136
Your baby 110 If you are unemployed 138
Maternity leave 139
Other employment rights 142
14 BABIES WHO NEED Other types of leave 143
SPECIAL CARE Return to work on child
Contact with your baby 112 friendly working hours 144
Feeding 112
Incubators 113 USEFUL ORGANISATIONS 147
Newborn babies with jaundice 113
A baby with disabilities 113 INDEX 151

15 THE EARLY WEEKS: YOU


Coping 114
Looking after yourself 115
Your relationships 116
The ‘baby blues’ and postnatal
depression 117
Sex and contraception 117
The postnatal check 118
The Pregnancy Book

Your pregnancy
at a glance
0-8 weeks 8-12 weeks 12-16 weeks
• Pregnancy test – you can have
one from the first day of a
• You’ll probably attend your first • Find out about antenatal classes
antenatal appointment. if you have not already done so
missed period, if you wish Appointments will usually be (see Antenatal care and
(see Finding out, page 26). monthly at first (see Antenatal antenatal classes, page 51).
care and antenatal classes,
• Make an early appointment to
see your GP or a midwife if you
page 51). • want
Begin to think about how you
to feed your baby
know you’re pregnant or think
you may be (see Finding out,
• and
Ask about your rights at work
the benefits available
(see Feeding your baby,
page 66).
page 26). Begin to think about (see Rights and benefits,
where you want your baby to
be born (see Deciding where
page 130). • Make sure you’re wearing a bra
which supports well.
to have your baby, page 33). • Iforyou’re on Income Support
Ask about antenatal care (see
Antenatal care and antenatal
income-based Jobseeker’s
Allowance, you can claim free
• You may be offered an
ultrasound scan which will
classes, page 51). milk tokens (see Rights and show your baby moving. Your
benefits, page 136). partner may like to see this too
• Some mothers start to feel sick (see Antenatal care and
or tired around this time or
have other minor physical
• Make a dental appointment.
Dental care is free during
antenatal classes, page 51).

problems for a few weeks (see


Common minor problems,
pregnancy and for a year after
the birth of your baby.
• Iftiredyou’ve been feeling sick and
in the early weeks, you
page 77). will probably start to feel better
around this time.
• Take a folic acid supplement
and try to eat a balanced diet
(see pages 8-12).
• You may be offered tests to
check for abnormalities in the
baby (see pages 57-9).

4
Your pregnancy at a glance

16-20 weeks 20-24 weeks 24-28 weeks


• You may start to feel your baby • Your womb will begin to
move (see How the baby enlarge more rapidly and you’ll
• Get your maternity certificate,
form MAT B1, from your
develops, page 31). really begin to look pregnant. doctor or midwife (see Rights
and benefits, pages 136–38).
• Your tummy will begin to get • You may feel hungrier than
bigger and you’ll need looser
clothes.
before. Stick to a sensible
balanced diet (see Your health
• Ifinform
you’re taking maternity leave,
your employer in
in pregnancy, page 8). writing at least three weeks
• You may feel a new surge of before you stop work (see
energy around this time. • Make sure you’ve booked into
antenatal classes if you wish to
Rights and benefits, page
140).
• Try to do your pregnancy attend (see pages 64–5).
exercises regularly (see Your
health in pregnancy, page 16).
• IfMaternity
you’re claiming Statutory
Pay (SMP), write to
Ask your doctor or midwife to your employer at least three
let you hear your baby’s weeks before you stop work
heartbeat. (see Rights and benefits,
pages 137–138).

• IfAllowance,
you’re claiming Maternity
do so as soon as you
can after you are 26 weeks
pregnant (see Rights and
benefits, pages 136–137).

5
Your pregnancy at a glance

28-32 weeks 32-36 weeks


• Ifincome-based
you’re on Income Support,
Jobseeker’s
• Make arrangements for the
birth, in hospital or at home.
Allowance or Working Families’ If you have children already,
Tax Credit, you can claim a decide who will look after
lump sum Sure Start Grant to
help buy things for your new
baby (see Rights and benefits,
them.

• Pack your bag ready for the


36 weeks onwards
pages 131-2). hospital, or make sure that you
have been provided with a
• You’ll probably be attending
antenatal care weekly until your
• Think about what you need for
the baby, if you have not already
home delivery pack. baby is born.

done so (see What you need


for the baby, pages 85-8).
• You’ll probably be attending
antenatal classes now (see
• Make sure you have all
important telephone numbers
Antenatal care and antenatal handy in case labour starts (see
• Ifspend
you have young children,
time getting them used to
classes, page 51). Labour and birth, page 89).

the idea of a new baby. • You may be more aware of your • The last few weeks can seem
womb tightening from time to very long. Plan some interesting
• Check that your shoes are
comfortable. If you get tired, try
time. These are mild
contractions (see Labour and
things to do to take your mind
off waiting.
to rest with your feet above the birth, page 90).
level of your heart. • Telephone your hospital or
• You may feel quite tired. Make midwife if you have any worries
• You’ll probably now attend for
antenatal care every fortnight.
sure you get plenty of rest. about labour or the birth.

6
Introduction
Every parent is different, just as every baby is different. So there
can’t be many rules to having a baby. But you will find a lot of
information in these pages which should help you to decide what
you will do, how you will cope and, most of all, how you can best
enjoy both pregnancy and your baby.

Chapter 1 is about what you can do to make sure you and your
baby stay healthy during your pregnancy. The book then takes
you through pregnancy, birth and the first two weeks of caring for
your baby. You may want to read some chapters several times, or
look up specific things which interest or concern you. To find a
topic quickly, just look at the index at the back of the book.

If there is anything which puzzles you, or if you need further


explanation, don’t hesitate to ask your doctor, midwife or
health visitor.

7
1 Your health
in pregnancy
T
his chapter describes some of the things you should think about
to make sure you and your baby stay healthy during pregnancy.

W H AT S H O U L D YO U E AT ?
A healthy diet is an important part There’s no need to ‘eat for two’ when
of a healthy lifestyle at any time, you are pregnant. It’s the quality not the
but particularly if you are pregnant quantity that’s important. With a few
or are planning a pregnancy. exceptions you can continue to eat all
Eating healthily during pregnancy the foods you enjoy (see Take care with
will help your baby develop and some foods, page 11). Eating healthily
grow and will help keep you fit often means just changing the amounts
and well. You don’t need to go of different foods that you eat rather
on a special diet, but make sure than cutting out all your favourites.
that you eat a variety of different The Balance of Good Health illustrates
foods every day in order to get the mixture of different foods you
the right balance of nutrients need in your diet and the proportions
that you and your baby need. you should eat them in. This is
You should also avoid certain illustrated below.
foods to be on the safe side.

THE BALANCE OF GOOD HEALTH


Fruit and vegetables Bread, other cereals
and potatoes
Try to eat at least five servings
a day. This can include a Make these the main part of
glass of pure fruit juice. every meal, eat wholegrain
This food group includes varieties when you can.
fresh, frozen and canned This food group includes
fruit and vegetables, salads, bread, potatoes, breakfast
dried fruit, fruit juices. cereals, pasta, rice, oats,
noodles, maize, millet, yams,
cornmeal, sweet potatoes.

Meat, fish and alternatives

Eat one or two servings a day.


Choose lean meat, remove the
skin from poultry and cook using
the minimum of fat. Try to eat
oily fish at least once a week.
This food group includes
meat (except liver), fish,
poultry, eggs, beans, pulses, Milk and dairy foods
nuts (except peanuts). Foods containing fat, foods containing sugar
Try to eat several servings a day,
Limit the amount you eat. This food group includes all spreading using low-fat varieties whenever
8 fats, oils, salad dressings, cream, chocolate, crisps, biscuits, pastries, you can. This food group includes
ice-cream, cake, puddings, fizzy drinks. milk, yoghurt, fromage frais.
Your health in pregnancy

• Eat plenty of fruit and vegetables


as these provide the vitamins and
• Lean meat, fish, poultry, eggs,
cheese, beans and pulses are all
minerals, as well as fibre which helps good sources of nutrients. Eat some
digestion and prevents constipation. every day.
Eat them lightly cooked in a little
water or raw to get the most out
of them. Frozen, tinned and dried
• Dairy foods like milk, cheese
and yoghurt are important as they
fruit and vegetables are good too. contain calcium and other nutrients
needed for your baby’s development.
• Starchy foods like bread,
potatoes, rice, pasta, chapatis,
Choose low-fat varieties wherever
possible. You can get seven pints of
yams and breakfast cereals are an milk free per week if you are on
important part of any diet and Income Support or income-based
should, with vegetables, form the Jobseeker’s Allowance (see page 131).
main part of any meal. They are
satisfying, without containing too
many calories, and are an important
• Try to cut down on sugar and
sugary foods like sweets, biscuits
source of vitamins and fibre. and cakes and sugary drinks like cola.Have drinks which contain
Try eating wholemeal bread and Sugar contains calories without caffeine – coffee, tea and colas
wholegrain cereals when you can. providing any other nutrients the – in moderation, as there
body needs. It also adds to the risk may be a slight risk that too
of tooth decay. much caffeine will affect your
baby’s birthweight. Try
• Cut down on fat and fatty foods decaffeinated tea and coffee,
as well. Most of us eat far more fat fruit juice or mineral water.
than we need. Fat is very high in
calories and too much can cause
excess weight gain and increase
the risk of heart disease and it can
contribute to being overweight.
Avoid fried foods, trim the fat off
meat, use spreads sparingly and go
easy on foods like pastry, chocolate
and chips which contain a lot of fat.
Choose low-fat varieties of dairy
products, for example semi-skimmed
or skimmed milk, low-fat yoghurt
and half-fat hard cheese. 9
Your health in pregnancy

VITAMINS AND MINERALS


VITAMIN
SUPPLEMENTS
It’s best to get the vitamins
• Green, leafy vegetables, lean meat,
dried fruit and nuts (see page 12
and minerals you need on peanuts) contain iron. If you
from the food you eat. are short of iron you’re likely to
Some people, like those on get very tired and may suffer
a restricted diet, need extra, from anaemia.
especially vitamin D.
Ask your doctor whether
you should take vitamin
• Citrus fruit, tomatoes, broccoli,
blackcurrants and potatoes are
supplements. Don’t take good sources of vitamin C,
extra vitamin A supplements which you need to help you to
without advice as too much absorb iron.
could harm your baby.

FOLIC ACID
• Dairy products, fish with edible
bones like sardines, bread, nuts
This vitamin is special (see page 12) and green vegetables These are available from pharmacies
(see this page). You need to are rich in calcium, which is vital and supermarkets or your GP may
take a 400 microgram (0.4 for making bones and teeth. be able to prescribe them for you.
milligram) tablet every day Ask your GP or pharmacist for
from the time you start
trying to conceive. Continue
• Margarine, oily fish (like sardines)
and taramasalata contain vitamin
advice if you are unsure.

taking the supplement right D to keep your bones healthy


up until you’re 12 weeks and to provide your baby with WELFARE FOOD SCHEME
pregnant. Even if you didn’t vitamin D to last during the first
take folic acid before few months of life. The best If you receive Income Support
conceiving, it’s worth starting source of vitamin D is summer Credit, Income Based Jobseeker’s
as soon as you find out that sunlight, but make sure that you Allowance or Pension Credit
you’re pregnant and you wear a high protection sunblock Guarantee you are entitled to:
should still continue until when you are in the sunlight, and
you’re 12 weeks pregnant.
If you have had a baby
never burn. If you have dark skin,
or always cover your skin, you
• supplements of vitamins A,
C and D if required;
with spina bifida before, are may be particularly at risk of
taking medication for epilepsy,
are diabetic or have coeliac
vitamin D deficiency. Ask your
doctor if you need to take a
• four litres or seven pints of cow’s
milk per week.
disease, you will need to vitamin D supplement.
These are free to pregnant and
take a bigger dose of folic
breastfeeding mothers and
acid. Speak to your doctor
about this.
• You need extra folic acid
from the time you start trying supplements are available at very
to conceive until the 12th week low cost to all mothers from
of pregnancy. This can help prevent maternity and child health clinics.
birth defects, which are known as For further information see leaflet
neural tube defects, such as spina Welfare Food Scheme Free Milk and
bifida. You can get folic acid from Vitamins (WMV:G1) available from
Foods carrying this mark green, leafy vegetables, but don’t your Jobcentre Plus/Social Security
have added folic acid. overcook them as this destroys the Agency.
vitamin. Some breakfast cereals and
breads have had folic acid added to
them, so look at the label. Regardless
of what you eat, always take a
400 microgram (0.4 milligram)
folic acid tablet every day.
10
Your health in pregnancy

VEGETARIAN, VEGAN AND TAKE CARE WITH SOME FOODS


SPECIAL DIETS PREGNANCY AND
Besides eating a wide variety of WEIGHT
Providing a vegetarian diet is varied foods, there are certain precautions Most women gain between
and balanced, it will provide adequate you should take in order to safeguard 10 and 12.5 kg (22–28 lb).
nutrients for you and your baby your baby’s well-being as well as Weight gain varies a great deal
during pregnancy. However, iron your own. and depends on your weight
and vitamin B12 can be hard to before pregnancy. If you’re
obtain from a vegetarian diet. Talk to
your doctor or midwife about ways
• Cook all meat and poultry
thoroughly so that there is
concerned, talk to your midwife
or GP. They may have special
to increase intakes of these important no trace of pink or blood and advice for you if you weigh
nutrients. If you are vegan (i.e. you wash all surfaces and utensils more than 100 kg or less
cut out all animal products from after preparing raw meat. than 50 kg.
your diet), or you follow another This will help to avoid infection
type of restricted diet such as gluten with Toxoplasma, which may
free, for example, because of food cause toxoplasmosis and can
intolerance (e.g. coeliac disease) or harm your baby (see page 18).
for religious reasons, talk to your
doctor or midwife. Ask to be
referred to a dietitian for advice on
• Wash fruit, vegetables and
salads to remove all traces of soil
how to eat healthily during which may contain Toxoplasma.
pregnancy.
• Make sure eggs are thoroughly
cooked until the whites and
HEALTHY SNACKS yolks are solid, to prevent
the risk of Salmonella food
• Sandwiches or pitta bread filled
with grated cheese, lean ham,
poisoning, and avoid foods
containing raw and undercooked
mashed tuna, salmon or sardines eggs like home-made mayonnaise,
and salad ice-cream, cheesecake or mousse.

• Salad vegetables washed thoroughly


• Low-fat yoghurt and fromage frais
• Hummus
sticks
and bread or vegetable

• Ready-to-eat
prunes
apricots, figs or

• Vegetable and bean soups


• Unsweetened breakfast cereals or
porridge and milk

• Milky drinks or unsweetened


fruit juices

• Fresh fruit
• Baked beans on toast or
baked potato
11
Your health in pregnancy

FURTHER READING
• Avoid eating all types of
paté and mould-ripened
soft cheese, like Brie and
• The Food Standards
Agency publishes some
Camembert, and similar blue-
veined varieties, like Stilton or
useful leaflets, including Danish blue, because of the risk
Thinking of having a of Listeria infection. You can
baby and While you eat hard cheeses such as cheddar
are pregnant. and parmesan, and other cheeses
Contact: made from pasteurised milk such
Food Standards Agency as cottage cheese, mozzarella
PO Box 369 cheese and cheese spreads.
Hayes UB3 1UT Although Listeria is a very rare
tel. 0845 6060667 disease, it is important to take
special precautions during
• Folic acid: what all
women should know
pregnancy because even the mild
form of the illness can lead to
is available free from miscarriage, stillbirth or severe
your doctor, clinic or illness in the newborn. FOR GENERAL HYGIENE
pharmacist.
(In Northern Ireland ask • Drink only pasteurised or
UHT milk which has had the • Wash your hands before
for Folic Acid: one of harmful germs destroyed. If only and after handling any food.
life’s essentials) raw or green-top milk is available,
boil it first. Don’t drink
• Thoroughly wash all fruit and
vegetables, including ready-prepared
unpasteurised goat’s or sheep’s salads, before eating. Peel and top
milk or eat their milk products. carrots before eating them.

• Don’t eat liver or liver


products, like liver paté or liver
• Cook raw meat and poultry
thoroughly and make sure that
sausage, as they may contain a lot ready-to-eat poultry and cooked
of vitamin A. Too much vitamin chilled meals are reheated
A could harm your baby. thoroughly and are piping hot
before they are eaten.
• Avoid eating peanuts and foods
containing peanut products
(e.g. peanut butter, unrefined
• Always wash your hands after
handling raw meat or poultry
groundnut oil, some snacks, and make sure that raw foods are
etc.) if you or your baby’s father stored separately from prepared
or any previous children have a foods. Otherwise there is a risk
history of hayfever, asthma, of contamination. This is to avoid
eczema or other allergies. This other types of food poisoning
may reduce the risk of your baby from meat (salmonella,
developing a potentially serious campylobacter and E.coli
allergy to peanuts. Read food 0157). Use a separate chopping
labels carefully and, if you are still board for raw meats.
in doubt about the contents,
avoid these foods. • Wear gloves and wash them and
then your hands thoroughly after
• Avoid eating shark, marlin and
swordfish, as these types of fish
gardening or handling soil.

contain high levels of mercury


which can damage your baby’s
developing nervous system.
12
Your health in pregnancy

SMOKING
YOUR ACTION PLAN

Stop completely – it’s


never too late.
• Choose a day. Will the
first few days be easier
during a working week
or over a weekend? When
you’re busy or relaxed?
Whatever you choose, stop
completely on that day.

• The day before. Get


• your baby is less likely to be born
underweight and have extra problems
everything ready; review
your plan. Get rid of
in keeping warm. Babies of mothers cigarettes.
who smoke are, on average, 200 g
(about 8 oz) lighter than other babies. • understanding
Get help. Ask friends for
and
These babies may have problems support. Consider asking
during and after labour and are your midwife, health
more prone to infection; visitor or practice nurse
for advice. People who
• itlaterwilltoo.be Children
better for your baby
whose parents
use professional support
are more likely to succeed
SMOKING smoke are more likely to suffer in their attempts to
later on from illnesses which stop smoking.
When you smoke, carbon monoxide need hospital treatment (such as
and other poisons pass into your asthma); It might help to:
lungs. This means that:
a) your baby gets less oxygen and • you will reduce the risk of • change the habits you
associate with smoking;
cannot grow as well as it should, and cot death.
b) the nicotine makes your baby’s
heart beat faster. Breathing in other
• anticipate problems –
plan to deal with difficult
people’s smoke makes the baby more The sooner you stop, the better. But situations without the use
likely to suffer from asthma attacks, stopping even in the last few weeks of cigarettes;
chest infections, coughs and colds, of pregnancy can be beneficial. If
and to be admitted to hospital. any members of your household • take one day at a time and
reward yourself for success.
smoke, their smoke can affect you
IF YOU STOP SMOKING NOW: and the baby both before and after You may need extra help:
birth. They can help you and the Phone Smokers’ Helpline
• you’re more likely to have a healthier
pregnancy and a healthier baby;
baby by giving up now. Perhaps
you could try to stop together.
Wales for support on
0800 169 0 169 or the NHS
Protecting the fetus and the new Pregnancy Smoking Helpline
• you’ll cope better with the birth; baby from tobacco smoke is one of
the best things you can do to give
on 0800 169 9 169 from
12noon to 9p.m. every day.
• your baby will cope better with
any birth complication;
your child a healthy start in life. In Northern Ireland phone the
Ulster Cancer Foundation on
028 9066 3281 for details
• your baby is less likely to be born
too early and have to face the
of local services.
additional breathing, feeding and
health problems which so often
go with prematurity (see page 112); 13
Your health in pregnancy

ALCOHOL
There is no evidence that light or If you have difficulty cutting down,
IF YOU’RE DRINKING occasional drinking in pregnancy talk to your doctor or midwife.
WITH FRIENDS: will harm your baby. But research Confidential help and support is
shows that heavy or frequent available from local counselling
• find a non-alcoholic
drink you enjoy;
drinking can seriously harm your
baby’s development. To be on the
services (look in the telephone
directory or contact Alcohol
safe side, stop altogether or stick to Concern). See page 147 for
• ifsipyouit slowly
drink alcohol,
to make
no more than one or two ‘units’ of
alcohol once or twice a week.
national agencies who can help.

it last;
1 UNIT EQUALS
• ifyoupeople try to pressure
into drinking,
refuse politely but or or or
firmly;
1/
2pint ordinary a single measure of a small (125ml) a small glass of
strength beer, spirit (whisky, gin, glass of wine sherry or a measure
• avoid getting drunk. lager or cider bacardi, vodka, etc.) (9% ABV) of vermouth

These units apply to the 25 ml measure used in most of England and Wales. In some places,
pub measures are larger than this. In Northern Ireland, a pub measure is 35 ml or 11/2 units.
In Scotland, it can either be 35 ml or 25 ml. Home measures are usually more generous.

HERBAL AND P I L L S, MEDICINES AND


HOMEOPATHIC
REMEDIES AND OT H E R D RU G S
AROMATHERAPY

Not all ‘natural’ remedies are Some pills and medicines can harm those used to treat epilepsy and
safe in pregnancy. Make sure your baby’s health so, to be on the diabetes, than to leave the illness
that your practitioner is safe side, you should: untreated.
qualified (contact the Institute Illegal drugs (street drugs) can
for Complementary Medicine,
see page 147) and tell him or
• assume that all medicines are
dangerous until a doctor or
harm your baby. Taking cocaine or
smoking crack may be especially
her that you are pregnant. pharmacist can tell you they are harmful because both cause a sudden
Tell your midwife or doctor safe; drop in blood and oxygen to the
which remedies you are using. placenta. It’s important to talk to your
• make sure your doctor or dentist
knows you’re pregnant before
doctor or midwife straightaway so
they can refer you to a maintenance
prescribing anything or giving reduction programme. For more
you treatment; information contact one of the
organisations on page 148, or the
• talk to your doctor at the first
possible moment if you take
Drugs Information Helpline on 0800
776600.
regular medication. X-rays should be avoided in
pregnancy if possible. Make sure
But do remember that it is safer to your dentist knows you are pregnant.
14 take some medicines, for example
Your health in pregnancy

P H YS I C A L AC T I V I T Y

The more active and fit you are


during pregnancy, the easier it will
• Try to keep active on a daily basis.
Building in half an hour of
be for you to adapt to your changing activities like walking can help to
shape and weight gain. It will also keep you active. If you can’t
help you to cope with labour and manage that, any amount is
get back into shape after the birth. better than nothing.
If you feel tense after a hard day’s
work, physical activity is an excellent
way of relaxing and it will help you
• Avoid any strenuous exercise in
hot weather.
to sleep soundly.
Keep up your normal daily
physical activity or exercise (sport, or
• Drink plenty of fluids.
dancing, or just walking to the shops
and back) for as long as you feel
• Ifsureyouyour
go to exercise classes, make
teacher is properly
comfortable. Don’t exhaust yourself qualified, and knows that you’re
and remember that you may need to pregnant and how far your
slow down as your pregnancy pregnancy has progressed.
progresses, or if your doctor advises
you to. If in doubt, consult your
doctor or midwife.
• You might like to try swimming
because the water will support
your increased weight. Some
• Ifwere
you were inactive before you
pregnant, don’t suddenly
local swimming pools provide
aquanatal classes with qualified
take up strenuous exercise. instructors.
Remember, exercise doesn’t have
to be strenuous to be beneficial.

15
Your health in pregnancy

EXERCISES FOR A
FITTER PREGNANCY Pelvic floor exercises help
strengthen the muscles of the pelvic
Every pregnant woman should try floor which come under great strain
to fit these exercises into her daily in pregnancy and childbirth.
routine. They will strengthen The pelvic floor consists of layers
muscles to take a bigger load, make of muscles which stretch like a
joints stronger, improve circulation, supportive hammock from the
ease backache and generally make pubic bone (in front) to the end of
you feel well. the backbone. If your pelvic floor
muscles are weak, you may find that
Stomach strengthening exercises you leak urine when you cough or
These strengthen abdominal muscles sneeze. This is quite common and
and ease backache, which can be a you needn’t feel embarrassed.
problem in pregnancy. As your baby
gets bigger you may find that the However, you can strengthen the
hollow in your lower back increases. muscles by doing the following
This can give you backache. exercise:

• fours)
Start in a box position (on all
with knees under hips,
• close up your back passage as if
trying to prevent a bowel
hands under shoulders with movement;
fingers facing forward and
abdominals lifted to keep the
back straight;
• atvagina
the same time, draw in your
as if you are gripping a
tampon, and your urethra as if
• pull in the abdominals and raise
the back up towards the ceiling,
to stop the flow of urine;

curling the trunk and allowing


the head to relax gently forward.
• do this exercise quickly –
tightening and releasing the
Don’t allow elbows to lock out; muscles immediately;

• hold for a few seconds then


slowly return to the box position;
• then do the exercise slowly
holding the contractions for as
long as you can (not more than
• take care not to hollow the back.
The back should always return to
ten seconds) before you relax;

a straight/neutral position; • repeat both exercises ten times,


four to six times a day.
• do this slowly and rhythmically
ten times, making your muscles
work hard and moving your back
carefully. Only move your back as
far as you can comfortably.

Pelvic tilt exercises. Stand with


your shoulders and bottom against a
wall. Keep your knees soft. Pull your
belly button towards your spine, so
that your back flattens against the
wall. Hold for four seconds and
release. Repeat up to ten times.
16
Your health in pregnancy

Foot exercises can be done sitting INFECTIONS


or standing. They improve blood
circulation, reduce swelling in the
ankles and prevent cramp in the RUBELLA
calf muscles.
Rubella (or German measles) can
• Bend and stretch your foot
vigorously up and down 30 times.
seriously affect your baby’s sight and
hearing and cause brain and heart
defects in your baby if you catch it in
• Rotate your foot eight times one
way and eight times the other way.
the first four months of pregnancy.
All children are now immunised
against rubella at 12 to 15 months
and again before they start school.
If you’re not immune and you do
come into contact with rubella, tell
your doctor at once. Blood tests will
show whether you have been infected,
and you will then be better able to
think about what action to take.

SEXUALLY TRANSMITTED
INFECTIONS

Sexually transmitted infections


(STIs) are very common and often
Protect your back there are no symptoms, so you may
not know if you have one. However,
• Sit up straight with your bottom
against the back of your chair.
many STIs can affect your baby’s
health during pregnancy and after
Tuck a small cushion behind birth. If you have any reason to
your waist if you wish. believe that you or your partner
could have an STI which was not
• When you pick something up,
bend your knees, not your back.
diagnosed before pregnancy, you
should go for a check-up as soon
as you can. You can ask your GP
• Try to stand tall. or midwife or, if you prefer, go to
a hospital clinic where you will also
be guaranteed strict confidentiality.
You can find your nearest clinic in
your phone book, listed under the
name of your local NHS Trust as
genito-urinary medicine (GUM)
clinic, or ‘special’ clinic, or the old
name of venereal disease (VD) clinic.

17
Your health in pregnancy

HUMAN IMMUNO-DEFICIENCY HERPES


VIRUS (HIV) AND ACQUIRED
REMEMBER THAT IMMUNE DEFICIENCY
Genital herpes infection can be
YOU CAN GET SYNDROME (AIDS)
dangerous for a newborn baby. It can
INFECTED BY HIV be caught through genital contact
OR HEPATITIS B Current evidence suggests that an with an infected person or from oral
IF YOU: HIV positive mother in good health sex with someone who has oral herpes
and without symptoms of the (cold sores). Initial infection causes
infection is unlikely to be adversely
• have intercourse without
using a condom, with
affected by pregnancy. However, 1 in
very painful blisters or ulcers on the
genitals. Less severe recurrent attacks
every 6 babies born to HIV positive
anyone who is infected; usually occur for some years afterwards.
mothers are likely to be infected.
HIV positive mothers may also pass If you, or your partner, are infected,
• use injectable drugs and
share equipment with an
on the virus through breast milk. If
you’re HIV positive, talk to your
use condoms or avoid sex during an
attack. Avoid oral sex if you or your
infected person. doctor about your own health and partner have cold sores or active
the options open to you, or contact genital herpes. Tell your doctor or
the organisations listed on page 143 midwife if either you or your partner
IN ADDITION YOU for advice and counselling. It is have recurring herpes or develop the
MAY HAVE BEEN possible to substantially reduce the symptoms described above. If your first
INFECTED WITH risk of transmitting HIV to your baby infection occurs in pregnancy there is
HEPATITIS B during pregnancy and after birth (see a treatment available, although its use
box page 54). is controversial.
IF YOU:
You should be offered and If the infection is active during
recommended a named confidential
• were born or spent your
childhood outside the
HIV test as part of your routine
labour, a Caesarean section may be
recommended to reduce the risk of
antenatal care (see page 53). Before
United Kingdom in a the test, your doctor or midwife will transmission to the baby.
country where hepatitis B discuss the test with you and
is common. (You may counselling will be available afterwards
have acquired the to explain the result and the CHICKEN POX
infection at birth.) implications if it is positive. You can
also go to a Genito-urinary medicine Around 95% of women are immune
clinic for an HIV test and advice. to chicken pox. If you have never had
chicken pox, or are unsure, and come
into contact with a child or adult who
HEPATITIS B has it, speak to your GP, midwife or
Hepatitis B is a virus that infects the obstetrician at once. A blood test will
liver. Many people with hepatitis B, establish if you are immune. Chicken
even if they show no sign of illness, pox infection in pregnancy can be
can be carriers and may infect dangerous for both mother and baby
others. The virus is spread by sex so seek advice early.
without a condom with an infected
person and by direct contact with
infected blood. If you are a carrier, TOXOPLASMOSIS
or are infected during pregnancy,
you can pass the infection to your This infection can damage your baby
baby at birth. All pregnant women if you catch it during pregnancy, so
are offered a blood test for hepatitis take precautions (see page 19). Most
B as part of their antenatal care (see women have already had the infection
page 53). Babies who are at risk can before pregnancy and will be
be immunised at birth to prevent immune. If you feel you may have
infection (see page 101). been at risk, discuss the matter with
your GP, midwife or obstetrician. If
you do catch toxoplasmosis while you
are pregnant, treatment is available.
18
Your health in pregnancy

ANIMALS
Cats’ faeces may contain an
organism which causes
toxoplasmosis – a disease which can
damage your baby. Avoid emptying
cat litter trays while you’re pregnant
or, if no one else can do it, use
disposable rubber gloves. Trays
should be cleaned daily and filled
with boiling water for five minutes.
Avoid close contact with sick cats
and wear gloves when gardening –
even if you don’t have a cat – in case
the soil is contaminated with faeces.
PARVOVIRUS B19 (SLAPPED Wash your hands and gloves after
gardening. If you do come into
CHEEK DISEASE)
contact with cat faeces, make sure
you wash your hands thoroughly.
Parvovirus B19 infection is common Follow the general hygiene rules
in children and causes a characteristic under Take care with some foods
red rash on the face, so is often
(page 11). For further information
called ‘slapped cheek disease’.
on toxoplasmosis contact Tommy’s
Although 60% of women are immune
Campaign (see page 149).
to this infection, since parvovirus is
highly infectious and can be harmful Lambs and sheep can be a source
to the baby, any pregnant woman of an organism called Chlamydia
who comes into contact with psittaci which is known to cause
someone who is infected should seek miscarriage in ewes. They also carry
advice from the doctor. Immunity Toxoplasma. Avoid lambing or
can be checked with a blood test. In milking ewes and all contact with
most pregnant women who are newborn lambs. If you experience
infected with parvovirus flu-like symptoms after coming into
the baby is not affected. contact with sheep, tell your doctor.

GROUP B STREPTOCOCCUS INHERITED


Group B Streptococcus is a bacteria CONDITIONS
that many women carry in their
intestine or vagina without any Some diseases or conditions,
symptoms. In rare cases it can infect like cystic fibrosis, haemophilia,
the baby just before or during the muscular dystrophy, sickle cell disease
and thalassaemia, are inherited from
delivery and cause serious infection.
parents or grandparents. If you,
This is most likely to happen if the
your partner or any relative has a
baby is premature or if your waters condition which you know or
break early. Inform your midwife or suspect is inherited, or if you already
doctor if a previous baby had the have a baby with a disability, talk to
infection as there may be a higher your doctor about it. You may be
risk. If necessary you can be tested in able to have tests to check whether
late pregnancy using swabs, or your your baby is affected (see pages
baby can be tested at birth. 57–9). Ask your GP to refer you to
Depending on the test results, a genetic counsellor for specialist
antibiotics can then be given to you advice, if necessary, preferably before
during delivery and then to your you conceive or in the early weeks
newborn baby. of pregnancy. 19
Your health in pregnancy

WO R K HAZARDS
VDUS

Some women are concerned If you work with chemicals, lead or


about reports of the effects of X-rays, or in a job with a lot of
VDUs (visual display units lifting, you may be risking your
on computer terminals and health and the health of your baby.
word processors) in If you have any worries about this,
pregnancy. The most recent you should talk to your doctor,
research shows no evidence midwife, occupational health nurse,
of a risk. union representative or personnel
department.
If it is a known and recognised
risk, it may be illegal for you to
FAILURE TO PAY continue and your employer must
offer you suitable alternative work
If your employer fails to pay on terms and conditions that are not
you during your suspension substantially less favourable than your
you can bring a claim in original job. If no safe alternative is
an employment tribunal available your employer should
or in Northern Ireland an suspend you on full pay (ie give you
Industrial Tribunal (within paid leave) for as long as necessary to
3 months). This would not avoid the risk. (see also page 129)
affect your maternity pay
and leave.

COPING AT WO R K

If you’re at work during pregnancy


SAFETY ON you need to know your rights to
THE MOVE antenatal care, leave and benefits
which are set out on pages 130-140.
Road accidents are among You may get extremely tired,
the most common causes of particularly in the first and last
injury in pregnant women. weeks of your pregnancy. Try to
To protect both you and use your lunch break to eat and rest,
your unborn baby, always not to do the shopping. If travelling
wear a seatbelt with the in rush hour is exhausting, ask your
diagonal strap across your employer if you can work slightly
body between your breasts different hours for a while.
and the lap belt over your Don’t rush home and start
upper thighs. The straps another job cleaning and cooking.
should lie above and below If possible, ask your partner to take
your ‘bump’, not over it. over. If you’re on your own, keep
housework to a minimum, and
go to bed early if you can.

20
2 Conception
T
o understand about conception and pregnancy, it helps to know
about the male and female sexual organs. This information is
useful in pregnancy too, when you want to ask questions and
be clear about what you are told.

THE M A N ’ S S E X UA L O R G A N S
Bladder Prostate gland

Vas deferens This tube carries Scrotum This is the bag of


sperm from the testes to the skin which hangs outside the
prostate and other glands. body and contains the testes.
These glands add secretions It helps to keep the testes at a
which are ejaculated along constant temperature, just
with the sperm. below the temperature of the
rest of the body. This is
Urethra The urethra is a necessary for sperm to be
tube running down the length produced. In heat, the
of the penis from the bladder, scrotum hangs down, away
through the prostate gland to from the body, to keep the
an opening at the tip of the testes cool. When it is cold,
penis. Sperm travel down the the scrotum draws up closer to
urethra to be ejaculated. the body for warmth.

Penis The penis is made of Testes There are two testes.


erectile tissue. This tissue acts These are where sperm are
like a sponge and, when it made.
becomes filled with blood, the
penis becomes hard and erect.
THE WO M A N ’ S S E X UA L O R G A N S

Hood of clitoris

Clitoris

Urinary opening

Vulva

Opening of vagina

Perineum

Anus 21
Conception

Fallopian tube
Ovary
Womb or uterus
Bladder
Cervix
Vagina
Urethra or water passage
Rectum
Anus
Perineum
Pelvis The baby will pass
through the pelvis when he
or she is born.

Womb or uterus The womb


is about the size and shape of
a small upside down pear. It
is made of muscle. It grows in
size as the baby grows.

Fallopian tubes These lead


from the ovaries to the womb.

Ovaries There are two


ovaries, each about the size of
an almond. They produce the
eggs, or ova.

Cervix This is the neck of


the womb. It is normally all
but closed, with just a small
opening through which blood
passes during the monthly
period.

Vagina The vagina is a tube


about 8 cm (3 ins) long. It
leads from the cervix down to
the vulva, where it opens
between the legs. The vagina
is very elastic so it can easily
stretch around a man’s penis,
or around a baby during
labour.

22
Conception

THE WO M A N ’ S M O N T H LY C Y C L E
Egg being released Fallopian tube Egg progressing down the fallopian tube

Ovary
Vagina Womb lining
being shed

1. Each month a ripe egg or ovum 2. The ripe egg begins to travel down 3. If the egg is not fertilised by a
(occasionally two) is released from one the fallopian tube. It is here that it sperm, it passes out of the body
of the ovaries. This is called ovulation. may be fertilised by a man’s sperm if through the vagina. It is so small that
The ‘fingers’ at the end of the fallopian a couple have intercourse at this time. it cannot be seen. The lining of the
tube help to direct the egg down into By now the lining of the womb is womb is also shed in the monthly
the tube. At the same time, the lining thick enough for the egg, if it is period of bleeding.
of the womb begins to thicken and the fertilised, to be implanted in it.
mucus in the cervix becomes thinner so
that sperm can swim through it more
easily.

CONCEPTION
Egg Egg being fertilised Attached embryo

Sperm being ejaculated


Sperm

Penis

1. A woman is most likely to conceive 2. Most of the sperm leak out of the 3. During the week after fertilisation,
just after the time when she ovulates – vagina again, but some begin to swim the fertilised egg, or embryo, moves
when an egg has been released from up through the cervix. At the time of slowly down the fallopian tube and
one of her ovaries. During sexual ovulation the mucus in the cervix is into the womb. It is already growing.
intercourse, sperm are ejaculated from thinner than usual to let the sperm pass The embryo attaches itself firmly to
a man’s penis into the woman’s vagina. through more easily. The sperm swim the specially thickened womb lining.
In one ejaculation, there may be more into the womb and so into the fallopian Hormones released by the embryo
than 300 million sperm. tube. One sperm may then join with and by the woman’s ovary prevent
the egg and fertilise it. Conception is shedding of the womb lining.
said to have taken place. The woman ‘misses’ her period.

23
Conception

One ripe egg or ovum (occasionally two)


is released from one of the woman’s
ovaries every month. It moves down
into the fallopian tube where it may
be fertilised by a man’s sperm.

the events of the monthly cycle such


as the release of the egg from the ovary
and the thickening of the womb lining.
Once conception has occurred,
the amount of oestrogen and
progesterone increases. This causes
the womb lining to build up, the
blood supply to the womb and
breasts to increase, and the muscles
of the womb to relax to make room
for the growing baby.

HORMONES HEREDITY
Hormones are chemicals which Every normal human cell contains
circulate in the blood of both men 46 chromosomes, except for the
and women. They carry messages to male sperm and female eggs. They
different parts of the body, regulating contain 23 chromosomes each.
certain activities and causing certain When the sperm fuses with the egg
changes to take place. The female and fertilisation takes place, the 23
hormones, which include oestrogen chromosomes from the father pair
and progesterone, control many of with the 23 from the mother,
making 46 in all.
The chromosomes are tiny thread-
A sperm is about 1/25 th of a like structures which each carry
millimetre long and has a about 2000 genes. It is the genes
head, neck and tail. The tail that determine the baby’s inherited
moves from side to side so characteristics, such as hair and eye
that the sperm can swim up colour, blood group, height and
the vagina into the womb and build.
fallopian tubes. The fertilised egg contains one sex
chromosome from the mother and
one from the father. The sex
chromosome from the mother’s egg
is always the same and is known as
the X chromosome. But the sex
chromosome from the father’s sperm
may be an X or a Y chromosome.
If the egg is fertilised by a sperm
containing an X chromosome,
the baby will be a girl (XX). If the
sperm contains a Y chromosome,
24 then the baby will be a boy (XY).
Conception

THE B E S T T I M E TO G E T P R E G N A N T

An egg lives for about 12 to 24 a day or so before ovulation, the


hours after it is released from the sperm will have time to travel up the
ovary. If conception is to take place fallopian tubes and will be waiting
it must be fertilised within this time. when the egg is released. So the
Sperm can live for several days inside chances are highest if you make love
the woman’s body. If you make love on the day before ovulation (see chart).

THIS CHART SHOWS


A 28 DAY CYCLE.
Most women ovulate between 12–14 days
YOURS MAY BE LONGER before their next period.
Days OR SHORTER. Ovulation

27 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

• • • • • •
First day of last period
You are most likely to conceive
if you have intercourse
about this time.

TWINS
Identical twins are the result of one to find out by about the end of the
fertilised egg splitting into two second month of your pregnancy.
separate cells. Each cell grows into a An ultrasound scan is needed (see
baby. Because they originally came page 56) to make the diagnosis at this
from the same cell, the babies have stage. You should be told at this point
the same genes – they are the same whether the babies are in separate
sex and look very like each other. sacs or offered a further scan to
Non-identical twins are common. determine this. Twin and other
They are one result of two eggs being multiple pregnancies (e.g. triplets)
fertilised by two sperm at the same carry a higher risk of most of the
time. The babies may not be the same complications associated with
sex and will probably look no more pregnancy, particularly premature birth.
alike than any other brothers and sisters. You will probably be encouraged to
Twins happen about once in every have regular scans during your
80 pregnancies. A couple is more likely pregnancy to check the babies’
to have twins if there are twins in the growth. You may be advised to
woman’s family. Triplets are much more have a Caesarean section. Discuss
rare and quads rarer still, although this with your doctor. You can still
nowadays the use of drugs in the breastfeed with twins. With triplets,
treatment of infertility has made or more, this may be more difficult.
multiple births more common. You It is a good idea to contact
may suspect that you are carrying twins support groups like TAMBA (Twins
if you are very sick in early pregnancy, and Multiple Births Association)
seem bigger than your ‘dates’, they and the Multiple Births Foundation
run in your family or you have had (see pages 141 and 142) before the
fertility treatment. It is usually possible babies are born. 25
Conception

FINDING OUT IF
YO U ’ R E P R E G N A N T

SEE YOUR DOCTOR THE SIGNS OF PREGNANCY

Whether or not you have The earliest and most reliable sign of
had a pregnancy test, you pregnancy, for women who have a
should see your doctor as regular monthly cycle, is a missed
soon as you think you are period. Sometimes women who are
pregnant. Being pregnant pregnant have a very light period,
may affect your GP’s losing only a little blood. Other signs
treatment of any current or of pregnancy are listed below.
future illness. Your GP will
also be able to advise you
about antenatal care in your
• even
Feeling sick – you may feel sick, or
be sick, not necessarily in the
area and put you directly in morning, but at any time. If you
touch with a midwife if you are being sick all the time and can’t
wish. keep anything down, tell your
doctor.
Information about the
services available is given in
the chapters on Deciding
• Changes in your breasts – often
the breasts become larger and feel
PREGNANCY TESTS

where to have your baby tender, rather as they may do before Pregnancy tests can be carried out
and Antenatal care and a period. They may tingle. The on a sample of urine from the first
antenatal classes (see pages veins may show up more and the day of a missed period – that is,
33 and 51). It may help to nipples may darken and stand out. about two weeks after conception.
look at these chapters before You can collect urine at any time of
you talk to your doctor. • Needing to pass water more
often. You may find that you have
the day. Use a clean, soap-free, well-
rinsed container to collect it. You can
to get up in the night to do so. get pregnancy tests free or for a small
charge from your GP or family
• Being constipated. planning clinic. Many pharmacists and
most pregnancy advisory services also
• An increased vaginal discharge
without any soreness or irritation.
offer tests, usually for a small fee. You
can also buy do-it-yourself pregnancy
testing kits from pharmacists. They
• Feeling tired. can be expensive but give you a
quick result and you can do the test
• Having a strange taste in your
mouth – many women describe
in private. Follow the instructions to
be sure of a reliable result.
it as metallic.
THE RESULTS OF THE TEST
• ‘Going off ’ certain things like
tea or coffee, tobacco smoke or A positive test result is almost
fatty food, for example. certainly correct. A negative result is
less reliable. You could wait a week
Some women don’t even need these and try again, or go straight to your
signs. They just ‘know’ that they are doctor.
pregnant.

26
Conception

K N OW I N G T H AT YO U ’ R E P R E G N A N T
You may feel very happy or excited pregnancy, or, in England and Wales, ‘I thought when I first
when you discover that you are will give you advice if you are not got pregnant, ‘‘This is
pregnant, but you shouldn’t worry happy to continue with it. You may fantastic, it’s really
if you don’t. Even if you have been want to share the news with family different, it’s never
looking forward to pregnancy, it is not and friends immediately or wait a while happened to me before.” ’
unusual for your feelings to take you until you’ve sorted out how you feel.
by surprise. And if your pregnancy was Others in your family/extended ‘I wasn’t very pleased at
unplanned, then you may feel quite family may have mixed feelings. first. I was a bit shocked,
confused. Give yourself a little time to You’ll need to talk about these I think, more than
adjust to the idea of being pregnant. feelings. But do begin to think anything, and it took me
Even though you may feel rather about your antenatal care (that is, about three months to get
anxious and uncertain now, this does the care you’ll receive leading up to used to the idea that
not mean that you won’t come to the birth of your baby) and where I was pregnant.
enjoy your pregnancy or to welcome you would like to have your baby. I don’t think I could
the idea of the baby. Discuss your The earlier you begin to organise believe it at first.’
feelings with your midwife or doctor this, the more chance you will have
who will help you to adjust to your of getting what you want.

HELP A N D A DV I C E F O R T E E N AG E R S

Life as a young mother can be Practical advice on things like SOMEWHERE TO LIVE
difficult, especially if your partner or benefits, education, employment
family are unable to give much help. and childcare are available from Many young mothers want
However, there are a wide range of the Maternity Alliance on to carry on living with their
services you can draw on. 020 7490 7638 or own family until they are
If you think you may be pregnant, www.maternityalliance.org.uk ready to move on. If you
you can get confidential advice are unable to do so, your
from the Sexwise helpline on 0800 CARRYING ON WITH local authority will take
282930 and further information from YOUR EDUCATION responsibility for housing
the website www.ruthinking.co.uk you. In some cases it may be
Becoming a teenage mother need possible to provide specialised
not mean the end of your education. accommodation where
If you become pregnant while still at young mothers can live
school, your school will not exclude independently while getting
you on grounds of pregnancy, and support and advice from
should keep you in learning even if trained workers. Seek advice
you are unable to attend for a while. from your local authority.

27
3 How the
baby develops
Week 1

D
octors and midwives in the UK time pregnancy from the first
day of a woman’s last menstrual period, not from conception.
So what is called ‘four weeks’ pregnant’ is actually about two
First day of your last
menstrual period weeks after conception. Pregnancy normally lasts for 37 to 42 weeks
Week 2 from the first day of your last period. The average is 40 weeks. If you’re
not sure about the date of your last period, then an ultrasound scan (see
page 56) may give a good indication of when your baby will be due.

You conceive at
about this time
Week 3
H OW THE BABY DEVELOPS

In the very early weeks, the WEEK 3


Week 4
developing baby is called an
embryo. Then, from about eight (Three weeks from the first day of
weeks onward, it is called a fetus, your last menstrual period.) The
meaning ‘young one’. fertilised egg moves slowly along
the fallopian tube towards the
At this point you will be Fertilised egg dividing and womb. The egg begins as one single
called 4 weeks’ pregnant travelling down fallopian tube cell. This cell divides again and
again. By the time the egg reaches
Egg being fertilised the womb it has become a mass of
over 100 cells, called an embryo, and
is still growing. Once in the womb,
the embryo burrows into the womb
lining. This is called implantation.

Egg being
released from
ovary Embryo implanting
in womb lining
28 Ovary
How the baby develops

WEEKS 4-5 WEEKS 6-7 Week 7


ACTUAL SIZE HEAD TO BOTTOM
Week 4 There is now a large bulge where ABOUT 10 MM
ACTUAL SIZE ABOUT 5 MM the heart is and a bump for the
head because the brain is
developing. The heart begins to
beat and can be seen beating on an
ultrasound scan.
Dimples on the side of the head
will become the ears and there are
thickenings where the eyes will be.
On the body, bumps are forming
which will become muscles and
bones. And small swellings (called
‘limb buds’) show where the arms
and legs are growing.
At seven weeks the embryo has
grown to about 10 mm long from
The embryo now settles into the head to bottom. (This WEEKS 8-9
womb lining. The outer cells reach measurement is called the
out like roots to link with the ‘crown–rump length’.) A face is slowly forming. The eyes
mother’s blood supply. The inner are more obvious and have some
cells form into two and then later colour in them. There is a mouth,
into three layers. Each of these with a tongue.
layers will grow to be different Week 6 There are now the beginnings of
parts of the baby’s body. One layer ACTUAL SIZE HEAD TO BOTTOM hands and feet, with ridges where
becomes the brain and nervous ABOUT 8 MM the fingers and toes will be.
system, the skin, eyes and ears. The major internal organs are all
Another layer becomes the lungs, developing – the heart, brain,
stomach and gut. The third layer lungs, kidneys, liver and gut.
becomes the heart, blood, muscles At nine weeks, the baby has
and bones. grown to about 22 mm long from
The fifth week is the time of the head to bottom.
first missed period when most
women are only just beginning to
think they may be pregnant. Yet Week 9
already the baby’s nervous system is ACTUAL SIZE HEAD TO BOTTOM
starting to develop. A groove forms ABOUT 22 MM
in the top layer of cells. The cells
fold up and round to make a hollow
tube called the neural tube. This
will become the baby’s brain and
spinal cord, so the tube has a ‘head
end’ and a ‘tail end’. Defects in this
tube are the cause of spina bifida.
At the same time the heart is
forming and the baby already has
some of its own blood vessels.
A string of these blood vessels
connects baby and mother and
will become the umbilical cord.

29
How the baby develops

The umbilical cord


The umbilical cord is the baby’s lifeline, the link between
baby and mother. Blood circulates through the cord,
carrying oxygen and food to the baby and carrying waste
away again.

The placenta
The placenta is rooted to the lining of the womb and
separates the baby’s circulation from the mother’s. In the
placenta, oxygen and food from the mother’s bloodstream
pass across into the baby’s bloodstream and are carried to
the baby along the umbilical cord. Antibodies, giving
resistance to infection, pass to the baby in the same way,
but so too can alcohol, nicotine and other drugs.

The amniotic sac


Inside the womb the baby floats in a bag of fluid called
the amniotic sac. Before or during labour the sac, or
‘membranes’, break and the fluid drains out. This is
called the ‘waters breaking’.

Week 14
ACTUAL SIZE HEAD TO BOTTOM
ABOUT 85 MM

WEEKS 10-14

Just 12 weeks after conception the


fetus is fully formed. It has all its
organs, muscles, limbs and bones,
and its sex organs are well
developed. From now on it has to
grow and mature.
The baby is already moving about,
but the movements cannot yet be felt.
By about 14 weeks, the heartbeat
is strong and can be heard using an
ultrasound detector. The heartbeat
is very fast – about twice as fast as a
normal adult’s heartbeat.
At 14 weeks the baby is about
85 mm long from head to bottom.
The pregnancy may be just
beginning to show, but this varies
a lot from woman to woman.
30
How the baby develops

WEEKS 15-22
The baby is now growing quickly.
The body grows bigger so that the
head and body are more in
proportion and the baby doesn’t
look so top heavy. The face begins
to look much more human and the
hair is beginning to grow as well as
eyebrows and eyelashes. The
eyelids stay closed over the eyes.
The lines on the skin of the fingers
are now formed, so the baby already
has its own individual fingerprint.
Finger and toenails are growing Week 22
and the baby has a firm hand grip. ACTUAL SIZE HEAD TO BOTTOM
At about 22 weeks, the baby ABOUT 27 CM
becomes covered in a very fine, soft
hair called ‘lanugo’. The purpose
of this isn’t known, but it is thought
that it may be to keep the baby at
the right temperature. The lanugo
disappears before birth, though
sometimes just a little is left and
disappears later.
At about 16 to 22 weeks you
will feel your baby move for the
first time. If this is your second
baby, you may feel it earlier – at
about 16 to 18 weeks after
conception. At first you feel a
fluttering or bubbling, or a very WEEKS 23–30
slight shifting movement, maybe a
bit like indigestion. Later you can’t The baby is now moving about
mistake the movements and you vigorously and responds to touch
can even see the baby kicking and to sound. A very loud noise
about. Often you can guess which close by may make it jump and
bump is a hand or a foot and so on. kick. It is also swallowing small
amounts of the amniotic fluid in
which it is floating and passing tiny
amounts of urine back into the
fluid. Sometimes the baby may get
hiccups and you can feel the jerk of
each hiccup. The baby may also
begin to follow a pattern for waking
and sleeping. Very often this is a
different pattern from yours so,
when you go to bed at night, the
baby wakes up and starts kicking.
The baby’s heartbeat can now be
heard through a stethoscope. Your
partner may even be able to hear it
by putting an ear to your abdomen,
31
How the baby develops

but it can be difficult to find the


right place. The baby is now
covered in a white, greasy
substance called ‘vernix’. It is
thought that this may be to protect
the baby’s skin as it floats in the
amniotic fluid. The vernix mostly
disappears before the birth.
At 24 weeks, the baby is called
‘viable’. This means that the baby
is now thought to have a chance of
survival if born. Most babies born
before this time cannot live
Week 30 because their lungs and other vital
ACTUAL SIZE HEAD organs are not well enough
TO BOTTOM ABOUT 33 CM developed. The care that can now
be given in neonatal units means
that more and more babies born
early do survive.
At around 26 weeks the baby’s
eyelids open for the first time. The
eyes are almost always blue or dark
blue. It is not until some weeks
after birth that the eyes become
the colour they will stay, although
some babies do have brown eyes at
birth. The head to bottom length
at 30 weeks is about 33 cm.

WEEKS 31-40

The baby is growing plumper


so the skin, which was quite
wrinkled before, is now
smoother. Both the vernix
and the lanugo begin to
disappear.
By about 32 weeks
the baby is usually
lying downwards
ready for birth.
Some time before
birth, the head may
move down into the
pelvis and is said to be
‘engaged’, but sometimes the
baby’s head does not engage
until labour has started.

32
4 Deciding
where to have
your baby
T
he choice you have about where to have your baby and how
you are cared for will depend to some extent on where you live. SEE YOUR MIDWIFE
But what should be the same everywhere is that the care and OR DOCTOR AS SOON
the place should feel right for you. AS POSSIBLE IF:

It’s important for you to make


• you are currently being
treated for a chronic
informed choices about the sort disease, such as diabetes
of care you would like and where or epilepsy;
you would like to give birth. Try to
get information from as many
sources as possible. You can go and
• you are over 35, so that
you can be offered
look round the local hospital where additional tests for
there will probably be information abnormalities in the
leaflets about the services on offer. baby;
Midwives and your GP’s surgery
should also be able to tell you
about the different options for
medical history and any previous
pregnancies you may have had but,
• you are a teenager – there
may be services available
care available in your area. remember, the choice is yours. to you specifically for
Don’t hesitate to ask questions if Don’t forget, if you make your your age group;
you don’t understand something choice and then think that some
or if you think that you need to
know more. Midwives and doctors
other sort of care would be better
for you and your baby, you can
• ayoubabyhavewithpreviously had
spina bifida
are there to help and support you. change your mind. or Down’s syndrome, or
They want to make you feel as you have a family history
comfortable as possible with all Your basic options will be to have of a genetic disorder such
aspects of the care you receive, your baby: as cystic fibrosis or sickle
both while you are pregnant and cell disease – additional
when you have your baby.
When you find out (or think) that
• inwitha hospital (a specialist unit
consultant obstetricians);
tests will be offered to
you; or
you are pregnant, you can go either
to your GP or direct to a midwife to
discuss and arrange your care. Once
• at home; or • you have previously had
an ectopic pregnancy –
you have found out what’s available
locally, talk things over with your
• inparta GP/midwife unit (either as
of a large general hospital, in
you may be able to have
an ultrasound scan to
GP or midwife. They will be able a smaller community hospital, or check that the pregnancy
to offer you advice based on your completely separate). is in the womb.

33
Deciding where to have your baby

THE BASIC OPTIONS

Spend some time thinking about the


HOW TO BOOK IN following options. Discuss them
FOR A HOSPITAL before you come to a decision.
DELIVERY

Your GP or midwife will IN HOSPITAL


either send a letter to the
hospital or give you one For the last 30 years most babies
to take there. This is best have been born in hospital. Many
done as early in your hospitals have tried hard to meet
pregnancy as possible. parents’ wishes and to make labour experiences at local hospitals. You
and delivery as private and special as can contact other mothers through
possible. All over the country your local branch of the National
maternity care staff are working even Childbirth Trust, your local
harder to make sure that women get Community Health Council and
kind, sympathetic and sensitive care. AIMS (the Association for
Hospital maternity units should Improvements in the Maternity
become friendlier, more comfortable Services), see page 147.
places, where you will be able to get
to know the people who are caring
for you. You will probably be asked AT HOME
many questions about your wishes so
you should feel more in control over Some women want to have their
what’s happening to you. babies at home because:
If there is more than one hospital
in your district, and you can choose
which to go to, try to find out about
• they feel they will be happier and
better able to cope in a place they
the practice in each so that you can know and with their family
decide which will suit you best. around them;
Team midwifery may be in
operation which means that you will
see a midwife from the same team
• ifthere
they have other young children,
will be no need to leave
each time you visit the hospital, them to go into hospital;
including at the delivery of your
baby. Or there may be a Domino
Scheme which means that your
• they will have more privacy;
midwife will attend you at home in
labour, accompany you to hospital
• they will be able to relax more
and will not have to fit into a
to deliver your baby, and then hospital routine;
accompany you home after the
delivery (usually six hours later).
Midwifery care will then continue
• they are more likely to get to
know the midwife who will be
to be provided as necessary for 10 with them during the delivery.
to 28 days.
Use the checklist on page 36 as a One or two midwives will stay with
guide to the sort of questions to ask. you while you’re in labour and, if
Talk to your doctor or midwife. any help is needed or labour is not
It’s also a good idea to talk to other progressing as well as it should,
mothers who have recently had will summon a doctor or transfer
34 babies and ask them about their you to hospital by ambulance.
Deciding where to have your baby

YOU CAN ALSO ASK


FOR INFORMATION
ON YOUR OPTIONS
FROM:

• any other health


professional, particularly
your midwife or health
visitor – your GP or
the Child Health Clinic
can put you in touch
with them;

HOW TO ARRANGE FOR


• midwives,
the local supervisor of
who is also
A HOME DELIVERY usually a senior midwife
at the local maternity or
If you are considering a home arrange for a midwife to visit you at district general hospital –
delivery, first talk to your midwife home to discuss home delivery. The you can get in touch
and GP. Some people think that midwife may also be able to provide through your health
women should not have home births most or all of your antenatal care at authority or hospital and
because they argue that they are home. You can contact her directly the addresses and
unsafe. In fact, research suggests when labour starts and she will stay telephone numbers will
that a home delivery is as safe as a with you during labour and the birth be in your local phone
hospital delivery for women who of your baby. book;
have uncomplicated pregnancies.
You have the right to choose to
have your baby at home. Your IN A GP OR MIDWIFE UNIT
• your local Community
Health Council (see
doctor or midwife may advise page 141);
against this if they think that you This may be part of the hospital’s
are at risk of complications during
labour. However, this may be
ordinary maternity wards or a
separate unit. Your baby can be
• your local branch of the
National Childbirth
difficult to judge if this is your delivered here by your community Trust (see page 147);
first baby. midwife, who has been involved in
Find out whether your own GP
will be prepared to care for you
your antenatal care, and your GP
(or sometimes by a hospital midwife).
• Improvements
the Association for
in the
during your pregnancy and a home Some areas operate a team Maternity Services
delivery. If he or she cannot help, midwifery system (see page 34), (AIMS) (see page
there may be another in the district so you may get to know who will 141);
who can. You can then register with deliver your baby.
this GP just for your maternity care
and continue to see your own GP
Care in a GP or midwife unit can
be more personal since you will
• friends.
for any other medical treatment. usually be looked after by people
The local supervisor of midwives you know. If the unit is part of the
(see box) or Local Health Board can main hospital, then emergency
give you the names of GPs with a facilities are there, should an
special interest in pregnancy and unforeseen problem arise. This type
childbirth. of unit is generally used for women
Alternatively, it is possible to who are likely to have a normal
arrange for maternity care to be delivery. The length of time you
led by a team of midwives. Contact will remain in the unit after the
the local supervisor of midwives at birth depends on how well you
your nearest hospital who will and your baby are. 35
Before you try to get answersTheto your questions
Pregnancy Book and make your decision,
it will help to read the chapter on Labour and birth (page 89).

THESE ARE THE KINDS OF QUESTIONS YOU MAY WISH TO ASK ABOUT A HOSPITAL

Would I go to the hospital antenatal clinic for all or just some of my antenatal care appointments?

Does the antenatal clinic run an appointments system?

Does the hospital run antenatal classes?

Does the hospital offer team midwifery care or the Domino Scheme for delivery (see page 34)?

Will I be shown round the labour and postnatal wards before the birth?

Is there a chance for me to discuss and work out a birth plan?

Can I be seen by a woman doctor if I prefer?

ABOUT LABOUR AND DELIVERY


Are fathers, close relatives or friends welcome in the delivery room?

Are they ever asked to leave the room, and why?

Does the hospital encourage women to move around in labour and find their own position for
the birth, if that is what they want?

What is the hospital policy on induction, pain relief, routine monitoring, diet or any other aspect
of labour that concerns me?

AFTERWARDS
Are babies usually put to their mother’s breast immediately after birth?

What services are provided for sick babies?

Are babies with their mothers all the time or is there a separate nursery?

Will the hospital encourage (and help) me to feed my baby ‘on demand’ if this is what I want to do?

Who will help me breastfeed my baby?

Will I get help if I choose to bottle feed?

What is the normal length of stay?

What are visiting hours?

Are there any special rules about visiting?


36
Deciding where to have your baby

B I RT H PLAN

A birth plan is a record of what you


would like to happen during your
labour and after the birth. You may
be given an opportunity to draw up
a birth plan during your antenatal
care. If not, ask your midwife if you BREASTFEEDING
can do so. Discussing a birth plan
with your midwife, preferably over If you have decided to
several meetings, will give you the breastfeed, your birth plan
chance to ask questions and find out should note that you want to
more information. It also gives the put your baby to your breast
midwife the chance to get to know Read the chapters on Labour straight after birth. This
you better and understand your and birth (page 89) and The helps to get breastfeeding
feelings and priorities. You will first days with your new baby started. It should also note
probably want to think about or (page 107) before talking to your that you do not want your
discuss some points more fully with midwife, to see if there is anything baby to be given any extra
your partner, or friends and relatives, you feel strongly about and might formula milk feeds, as this
before reaching a decision. And you wish to include. You may find it can hinder successful
can, of course, change your mind at useful to think about some of these breastfeeding.
any time. things. You may want to take this
There is no one, correct way to book with you to discuss with your
give birth. All birth plans have to midwife.
be drawn up individually and then
discussed with your midwife. They
depend not only on your own
wishes, but also on your medical
history and your own circumstances,
and on what is available at your own
hospital or unit. What may be safe
and practical for one mother may
not be a good idea for another.
You may be given a special form
for a birth plan, or there may be
room in your notes. You could use
page 38 of this book as a guide. It’s a
good idea for you to keep a copy of
your birth plan with you. The
midwife or doctor who cares for
you during labour will discuss it
with you so they know your wishes.
But remember, you may need to
be flexible if complications arise
with you or the baby. The doctor
or midwife will tell you what
they advise in your particular
circumstances. Don’t hesitate to
ask questions if you need to.

37
Deciding where to have your baby

BIRTH PLAN

Do you want your partner, or a chosen Do you want your baby delivered straight on to your
companion(s), to be with you during labour? tummy or do you want your baby cleaned first?

Do you want your partner or companion to Do you have any feelings about the injection
be with you if you have a Caesarean section Syntocinon or Syntometrine usually given to you
or forceps delivery, for example? after the birth to help the womb contract?

Is equipment such as mats, a birthing chair or How do you wish to feed your baby?
beanbags available to you if you want it, or can
you bring your own?
Do you want your baby close to you all the time?
If you intend to breastfeed you should make a note
Are there special facilities, like special that you want your baby close by you all the time
rooms or birthing pools? or brought to you when hungry so that you can
feed on demand.

How do you want your baby’s heart


monitored if everything is straightforward? Do you want your baby to have vitamin K, and by
which route (see page 110)?

Do you prefer to be cared for and


delivered by women only? Is there anything you feel you may
need extra help with?

Is it important for you to be able to move


around when you’re in labour? Do you mind if students are present?

What position would you like Do you need someone who speaks your
to be in for the birth? first language?

If you think you would like pain relief, which sort Do you need a sign language interpreter?
do you want to try (see page 91)? If you want to
try to manage without pain relief, it’s a good idea
to note this in the birth plan too. Do you need a special diet?

Are epidurals available at all times


should you want one? Do you or your partner or companion have special
needs that should be considered, for example, do
you or your partner normally use a guide dog or a
Are there other means, such as warm baths, wheelchair?
massage or other therapies, that you would like
to use to help you cope with labour?

Are there special religious customs you wish to be


What do you feel about an episiotomy? observed?

38
5 Feelings and
relationships
‘I think you have

F
rom the minute you know you’re pregnant, things begin to change.
Your feelings change – feelings about yourself, about the baby, more extremes of
about your future. Your relationships change – with your partner, emotion. You get
other children and also with parents and friends. more easily upset
But you’re still yourself, and you still have to get on with your life, about things,
whether pregnant or not. For this reason, adjusting to the changes that and you can more
pregnancy brings isn’t always easy. This chapter is about some of easily get very happy
the worries that may crop up in pregnancy and some suggestions on about things.’
how to handle them. But, of course, what may be a problem for one
person may not be a problem for another. And what is helpful advice
for some people may not be right for you. So take from these pages
what you find useful, and don’t bother about the rest.

FEELINGS
When you’re pregnant it can feeling worried or down, just as it
sometimes seem as though you are brings many reasons for happiness. ‘It frightens me,
not allowed to have other feelings as Hormonal changes taking place in wondering what I’ve
well. People expect you to be looking your body are responsible for much got to go through.
forward to the baby, to be excited and of the tiredness and nausea that some People say different
to ‘bloom’ all the time. You, yourself, women feel in the early months and things, you know, so
may think that this is the way you for some of the emotional upsets you don’t know
ought to be. In fact, just like any other which can happen. You may find what to think.’
nine months in your life, you’re likely you cry more easily, lose your
to have times when you feel low. And temper more, and so on.
pregnancy does bring extra reasons for Of course, there are many other
‘I think it’s a lot to
do with mind over
matter. I think the
thing to do is just
try and relax and
not be frightened.
I mean, it’s happened
to thousands and
millions of people
before you.’

39
Feelings and relationships

‘I've enjoyed it. I’ve reasons why you may feel rather yourself well and get plenty of sleep
enjoyed the newness down. You may have money worries will also help. Anyone who is tired
of it. I’ve enjoyed or worries about work or where you and run down is likely to feel rather
thinking of the baby. are going to live. You may be low, whether they are pregnant or
The only thing I anxious about whether you will cope not. And don’t let the pregnancy take
haven’t enjoyed as a parent, or about whether you’re over your life. Keep on doing the things
is getting so big.’ really ready to be a parent at all. And you enjoy. Although it’s normal to have
many of these anxieties may be shared some worries while you are pregnant
by your partner or family as well. and to feel a bit down from time to
‘I loved every minute This may be your first baby but not time, it’s a real cause for concern if
of being pregnant your partner’s so you may see and feel you’re feeling depressed for most of
and went through a things differently. Talk through these the time. Whatever the reason for your
wonderful experience feelings together. unhappiness, or even if there doesn’t
with labour.’ Talking about your feelings to your seem to be any reason at all, explain
partner, or to someone who is close to how you feel to your doctor, midwife
you, is often a relief and can help you or health visitor. Make sure they
‘Antenatal classes really get things in proportion. It may help understand that you’re talking about
helped. I met lots of your partner too. Making sure you keep something more than just feeling low.
women there who had the
same fears as me.The
midwife made us more
confident by telling us W O R RY I N G A B O U T T H E B I RT H
what happens in labour.
I felt well prepared.’
One worry that a lot of women have be with you in labour. Remember
in pregnancy is whether labour and they may be anxious also. Together
birth will be painful and how they you can then work out ways in
will cope. It is difficult to imagine which to cope.
what a contraction might be like
and no one can tell you – though
many will try. However, factual
information about the options open
to you can help you to feel more
confident and more in control.
Begin by reading the chapter on
Labour and birth (page 89) with
your partner, or a friend or relative
who will be with you for the birth,
if possible. Ask your midwife or
doctor for any further information.
Antenatal classes will also help to
prepare you for labour and the
birth (see pages 64–5).
Think about the sort of labour
and birth you would like to have.
You will probably have an
opportunity to discuss this in more
detail with your midwife and to
draw up a birth plan during the later
months of pregnancy (see page 38).
Talk to your partner too, or to
someone close to you, and
40 particularly to the person who will
Feelings and relationships

W O R RY I N G ABOUT ABNORMALITY

Everyone worries at some time that normal, although some of these


there may be something wrong with may have birthmarks or some other
their baby. Some people find that small variations. A further 1% of
talking openly about their fears helps babies will be born with ‘I want to know if it’s all
them to cope. Others prefer not to abnormalities that can be partly or right. I think that’s
dwell on the possibility of something completely corrected. About 2%, always at the back of
being wrong. however, will suffer from some more your mind – you
Some women continue to worry severe disability. Regular antenatal don’t know whether
because they are convinced that if care and careful observation during it’s all right. It’s a worry
something does go wrong it will be labour help so that action can be that’s always there.’
their fault. While you can increase taken if necessary.
your baby’s chances of being born If you are particularly concerned,
healthy by following the advice perhaps because someone in your ‘I feel guilty at times.
outlined in Chapter 1 (see pages family has a disability, or because It’s not just worrying
8–20), you cannot cut out the risk someone you know has had a about what you do and
entirely. There are certain problems difficult birth, or even if you just whether it will damage
which cannot be prevented, either feel very anxious, talk to your doctor the baby. Sometimes I
because the causes are not known or midwife as soon as possible. feel I just haven’t
or because they are beyond anyone’s They may be able to reassure you or thought about the
control. offer you helpful information about baby, cared about it
It may reassure you to know that tests which can be done in enough. I ought to
97% of babies born in the UK are pregnancy (see pages 53–9). be loving it more.’

‘You hear such a lot


COUPLES and read such a lot in
the newspapers about
spina bifida and
Pregnancy is bound to bring about backward children and
some quite big changes in a couple’s all that. You can’t
relationship, especially if this is your help but wonder
first baby. For some people these about your own.’
changes happen easily, others find it
harder to change. Everybody is
different. ‘Now that I’ve felt
It’s quite common for couples to it move and I’ve
find themselves having arguments heard the heartbeat,
every now and then during I feel happier. Early
pregnancy, however much they are on we worried
looking forward to the baby. Some much more.’
of these may be nothing to do with
the pregnancy, but others may be
caused by one or other partner
feeling worried about the future and
how they are going to cope. Perhaps
the most important thing to realise
is that during pregnancy there are

41
Feelings and relationships

‘You’ve got a bond Later in pregnancy, an orgasm, or


between you. It’s even sexual intercourse itself, can set
something that belongs off contractions (known as Braxton
to both of you.’ Hicks’ contractions, see page 90).
You will feel the muscles of your
womb go hard. There is no need
‘Sometimes it draws us for alarm as this is perfectly normal.
together and sometimes If it feels uncomfortable, try your
it sets us apart. When relaxation techniques or just lie
we first found out quietly till the contractions pass.
about the baby, we If you have had a previous
were on edge. We miscarriage, ask your doctor or
snapped at each midwife for advice. Your doctor or
other a lot. Then it understandable reasons for the midwife will probably advise you to
got better. We really odd difficulty between you and avoid intercourse if you have had
wanted each other and also good reasons for feeling closer heavy bleeding in pregnancy, and
we were really looking and more loving. you should definitely not have
forward to the baby One practical question you will intercourse once the waters have
coming. It’s up need to discuss is how you will cope broken (see page 90) since this
and down.’ with labour and whether your risks infection in the baby.
partner will be there. Many fathers While sex is safe for most couples
do want to be present at their baby’s in pregnancy, it may not be all that
birth. The chapter on Labour and easy. You will probably need to
birth (page 89) gives some find different positions. This can
suggestions on ways in which fathers be a time to explore and experiment
can help and what it can mean to together. The man on top can
them to share this experience. become very uncomfortable for the
woman quite early in pregnancy, not
just because of the baby, but because
of tender breasts as well. It can also
SEX IN be uncomfortable if the man’s penis
penetrates too deeply. So it may be
PREGNANCY better to lie on your sides, either
facing or with the man behind.
Many couples find that a position in
Many people worry about whether which the woman is on top is most
it is safe to have sex during comfortable.
pregnancy. There is no physical Some couples find making love
reason why you shouldn’t continue extra enjoyable during pregnancy
to have sexual intercourse right while others simply feel that they
through a normal pregnancy, if you don’t want to have intercourse and
wish. It doesn’t harm the baby prefer to find other ways of being
because the penis cannot penetrate loving or of making love. It’s
beyond the vagina. The muscles of important to talk about your
the cervix and a plug of mucus, feelings with each other.
specially formed in pregnancy, seal
off the womb completely.

42
Feelings and relationships

FA M I L I E S AND FRIENDS

In some ways pregnancy is very there are some decisions that only ‘There’s the feeling that
private, just to do with you and your you can take and some things that you’re being looked after.
partner, but there may be a lot of you prefer to do on your own. Not just by your husband
people around you who are also You may also find that being and your parents and the
interested and concerned about your pregnant puts you on the receiving hospital, but by your
baby – parents, sisters, brothers and end of a lot of advice, and perhaps friends, by everybody.
friends. a bit of criticism too. Sometimes They’re there behind
People can offer a great deal of the advice is helpful, sometimes you. I suppose they’re
help in all sorts of ways and you will not. Sometimes the criticism can wrapping me up in cotton
probably be very glad of their really hurt. The important thing is wool, but it’s still a nice
interest and their support. But to decide what is right for you. feeling.’
sometimes it can feel as if you’re After all, it is your pregnancy and
being taken over. If so, it can help your baby.
everyone if you explain gently that
‘My mother starts telling
me “You must have this
for the baby, you must
have that”, and trying to
tell me what I should do.
And bringing things like
nappy pins and saying
“I didn’t think you’d
remember to get them.”
It’s irritating.’

‘We seem to have got


a lot closer. We often
sit and talk and my
mum remembers when
I was tiny.’

‘It’s no good listening to


other people. They only
tell you about what
happened to them. They
tell you the bad parts too,
not the good.’

43
Feelings and relationships

WO R K
If you enjoy your work and the satisfactory childcare arrangement
company of those you work with, and it may take you some time.
you may have rather mixed feelings Any decision you make about
when the time comes to stop work childcare will be determined both by
before your baby is born. Try to your income and by the kind of
make the most of these few weeks facilities available locally. You may
to enjoy doing the things you want be lucky enough to have a relative
to do at your own pace. It is also a willing to provide care. If not, you
good opportunity to make some should contact your local Children’s
new friends. You may meet other Information Service (CIS) for a list
mothers at your antenatal classes (see of registered childminders and
pages 64–5) or you may get to know nurseries. Few nurseries take babies
more people living close by, now and prices are usually high. You may
that you have more time to stop also want to consider organising care
and chat. in your own home, either on your
You may have decided that you own or sharing with other parents.
are going to spend some time at Care in your own home does not
home with your baby or you may be need to be registered but you should
planning to return to work, either satisfy yourself that your carer is
full or part time, fairly soon after the experienced and trained to care for
birth. If you know that you will be babies. Contact the National
going back to work, or even if you Childminding Association (see page
think you might be, you will need to 142) for more information.
start thinking about who will look
after your baby well in advance.
It is not always easy to find a

44
Feelings and relationships

COPING ALONE

‘The baby’s dad has


If you’re pregnant and on your own Northern Ireland Housing Executive). gone. He wanted the
it’s even more important that there are The National Council for One baby at first but when
people with whom you can share your Parent Families can also supply things started to happen
feelings and who can offer you information on a range of topics he didn’t like it, so he’s
support. Sorting out problems, whether from benefits to maintenance (see gone. But my mum has
personal or medical, is often difficult page 148). There may be a local been to all my antenatal
when you are by yourself and it’s support group in your area. Ask classes with me and
better to find someone to talk to your midwife or health visitor. everything, so she knows
rather than to let things get you down. Don’t feel that, just because you what’s going on.’
You may find it encouraging to don’t have a partner, you have to go
meet other mothers who have also to antenatal visits and cope with labour ‘Sometimes I feel
gone through pregnancy on their own. on your own. You have as much right really low and think,
Gingerbread (see page 148) is a self- as anyone else to be accompanied by “Oh God, I’m only
help organisation for one-parent the person you choose – a friend, sister, 18 and it’s for the rest of
families which has a network of local or perhaps your mother. Involve your my life”. Every time I go
groups and can offer you information ‘labour partner’ in birth classes if you out I’ve got to get a baby
and advice. They will be able to put can and let him or her know what you sitter and things.’
you in touch with other mothers in want from them. There may be antenatal
a similar situation if you wish. classes in your area run especially for
If money is an immediate concern, single women. Ask your midwife. ‘I talked to the hospital
read Rights and benefits (page 130) Think about how you will manage social worker about things
for information on what you can after the birth. Will there be people and she told me all about
claim and your employment rights. around to help and support? If there managing on my own.’
Your local social security office, is no one who can give you support
Benefits Agency/Social Security it might help to discuss your situation
Agency (Northern Ireland) or local with a social worker. Your doctor or L ONE PARENT
Citizens Advice Bureau (CAB) will hospital can refer you or you can H ELPLINE
be able to give you more advice. If contact the social services department call free on 0800 018 5026
you have housing problems, contact of your local council directly. (9am–5pm Mon-Fri)
your local CAB or your local housing If you’re considering adoption
advice centre. Ask for the address or fostering you should discuss
from your local authority at the town this with a social worker.
hall (in Northern Ireland contact the 45
Feelings and relationships

D OMESTIC V IOLENCE DOMESTIC BEREAVEMENT


If you need urgent help the VIOLENCE
following helplines are The death of someone you love can
available: turn your world upside down and is
One in four women experience one of the most difficult experiences
domestic violence at some point in to endure. This may be harder to
Welsh Women’s Aid their lives. This may take the form of
(029) 2039 0874 cope with if you are pregnant or
physical, sexual, emotional or have just had a baby.
Referrals to local Women’s psychological abuse. Thirty per cent
Aid Offices in Wales. Family and friends can help you
of this abuse starts in pregnancy and by spending time with you if you
Open 10am–3pm with out existing abuse may worsen during
of hours message service have been bereaved. A sympathetic
pregnancy or after birth. Domestic arm around the shoulders can
violence should not be tolerated. express love and support when
Women’s Aid Federation It risks your health and that of your
of England words are not enough.
baby before and after birth. Grief is not just one feeling but a
(0845) 7023468 You can speak in confidence
24-hour helpline whole succession of feelings which
to your GP, midwife, obstetrician, take time to get through and which
health visitor or social worker. cannot be hurried. If you need help
Northern Ireland If you wish, they can help you
Women’s Aid Federation or advice, you can contact your GP
take steps to stop the abuse or to or any of the organisations listed on
(028) 9033 1818 seek refuge. You may prefer to
24-hour helpline page 149.
contact one of the organisations
listed under domestic violence at
the back of this book (page 142), IF YOUR PARTNER DIES
again in confidence.
If your partner dies during your
BENEFITS AVAILABLE IF YOUR PARTNER HAS DIED pregnancy or soon after childbirth you
will feel emotionally numb. It is like
• For advice, you may find the following leaflets produced
by the Department for Work and Pensions (Social Security no other loss. It is not something you
Agency in Northern Ireland) helpful: get over, more that you learn,
What to Do after Death in England and Wales (D49) eventually, to live with.
Widowed? (GL14) Don’t be afraid to lean on family
Help from the Social Fund (GL18) and friends. If your partner was
New Bereavement Benefits (Northern Ireland) going to be with you at the birth
Your guide to Our Services (Northern Ireland) you will need to think about who
will be with you instead. Try to
• Read Chapter 18 for advice about the following:
Income Support Housing Benefit choose someone who knows you
Working Families’ Tax Credit Council Tax very well.
Child Benefit Financially, you may need urgent
advice and support. You can get
• Ifentitled
you were married and your husband worked, you may be
to Widowed Parent’s Allowance, based on his National
the leaflets suggested (see box)
from your local social security
Insurance contributions. office/Benefits Agency/Social
• Ifwillyoutherefore
weren’t married, you will not be classed as a widow and
be dependent on your private arrangements or
Security Agency.
As well as speaking to friends, family
Income Support or Working Families’ Tax Credit, if you work. and social services, you may like to
• IfExpenses
you are very short of money you may be able to get a Funeral
Payment from the Social Fund. It is always worth talking
contact WIDWODS, a small support
group set up by young widows (see
to your undertaker or religious adviser to see if they can help. page 149).
For more information, contact your Jobcentre Plus, Social
Security Agency or look at www.jobcentreplus.gov.uk/
cms.asp?page=/home/partners/allowancesandbenefits
6 Mainly
for men
S
ome pregnancies have been planned for months or years, but
many are unexpected. Either way, you’ll probably feel pretty
mixed up. A baby means new responsibilities which, whatever
your age, you may feel unready for.

YO U R FEELINGS ‘When the test was


positive, I felt really
ABOUT PREGNANCY excited, on a real high.
We couldn’t wait to tell
Your partner may have similar usually no medical reason to avoid everyone.’
feelings. It’s normal for both of you sex, but keep in mind: (A FATHER)
to feel like this. Your first pregnancy
is a very important event. It will • her breasts in the early weeks may
be extremely painful; ‘It was a shock at first,
change your life and change can be but now I’m getting used
frightening even if it’s something
you’ve been looking forward to.
• ifavoid
there’s any bleeding or pain
intercourse (and consult
to the idea. We didn’t
plan it, but there’s no
Money problems may be nagging at your doctor); problem with that. If it
you – the loss of an income for a had been three years ago,
while, extra expenses for the baby
and, if your partner returns to work,
• make sure your partner is
comfortable – you may need to
when we first started
living together, obviously
the cost of childcare. You may be try different positions as the it would have been a lot
worrying that your home isn’t right pregnancy progresses. worse financially.
or that you’ll feel obliged to stay in a That’s the main factor.’
job you don’t like. (It might help to If she’s not interested in sex, try to
look at the Rights and benefits
(A FATHER)
find other ways of being close, but
section on page 130 and start do talk about it. If she feels that
planning ahead.) you’re trying to persuade her to do
Some men feel left out. Your something she doesn’t want, she may
partner’s attention will be on what’s withdraw completely leaving both of
happening inside her and she may you lonely.
want you to pay a lot more attention WHAT’S RIGHT FOR
to her needs than usual. You may YOU?
Some men find it hard to make
not have realised how much you love during pregnancy. They feel Employees have the right to
relied on her to make you feel cared strange doing it with ‘someone else paid paternity leave provided
for and now that her attention is there’ or may find their partner’s that they give their employers
elsewhere you may feel quite lonely. changing shape disturbing. This is notice (see page 143). You
Your loneliness may be increased if one situation when it helps to be can also ask for flexible
your partner doesn’t want to make careful what you say. Your partner working hours. For further
love, although some women find sex information see
may well feel uneasy about her
www.dti.gov.uk/er/workingpa
more enjoyable than ever. It varies changing body and may be very hurt
rents.htm
from person to person. There’s if she thinks that you don’t like it
either.

47
Mainly for men

TALK ABOUT IT PHYSICAL FEELINGS

‘She became very Confide in friends who are already Believe it or not, men can get
absorbed in her own fathers and will know what you’re symptoms of pregnancy too! The
body, separate. I felt going through. You may want to most commonly reported ones are
lonely and frightened protect your partner from your sleeplessness, indigestion and nausea.
of not doing the worries but she will almost certainly They are probably caused by stress,
right thing.’ sense your concern. The more you but are no less uncomfortable for
keep it to yourself, the more she’ll that.
(A FATHER) feel that you’re moving away from
her – just when she badly needs you
to be there. If you’re giving her the
‘My worries are to support she needs, then there’s no
do with making sure need to leave your feelings out of
that she’s happy and the picture.
comfortable and that.’

(A FATHER)
S U P P O RT I N G YO U R PA RT N E R

Something amazing is happening If your partner is anxious, encourage


inside your partner’s body. The her to talk about it. Many women are
closer you can get to her, the more used to listening than being
more you’ll be able to share this listened to, so it may take a while
experience. But at times before she feels able to open up. Be
closeness will seem impossible. patient – the better you can learn to
support each other now, the stronger
In the early weeks she may be your relationship will be when the
prickly and irritable about the baby arrives.
slightest things. Certain smells
and tastes may make her nauseous.
‘My wife one day She may want only to sleep.
couldn’t stand the
smell of me. I tried In the middle months you’ll
every different kind probably find that much of her
of soap, but it made energy returns and she may resent
no difference. In the being treated ‘like china’.
end I asked the
doctor about it.’ Towards the end the weight of
the baby may drag her down.
(A FATHER) The tiredness and irritability of
the early weeks often return and
she may start feeling quite frightened
‘I am happy to be of the birth and be lonely without
involved. I want to the company of friends at work.
know what she has
to do. I like to feel
involved, contributing
to this, not just
starting it.’

48 (A FATHER)
Mainly for men

PRACTICAL SUPPORT

Your partner may be used to doing


most of the housework as well as
• Go with her to the doctor if she’s
worried, or be sure to talk it
going out to work. If she continues through when she gets home.
to do all this work she’ll tire herself
out. Now is the time to start sharing • Be there if she has a scan (see
page 56) and see your baby on
the housework if you don’t already
do so. There are two areas where the screen.
you can really help:
• If(seeshepages
needs to have extra tests
53-9) your support is
• cooking – in the early months the
smell may put her off and if you
especially important.
cook she’s more likely to eat what
she needs;
• Find out about antenatal classes
for couples, or fathers’ evenings
at the hospital (see pages 64-5).
• carrying heavy shopping can put
a lot of strain on her back, so try
The more you know about labour,
the more you’ll be able to help.
to do the shopping yourself or THE BIRTH – BEING
together. • Most men stay with their partners
during labour but it’s important
PREPARED

that you’re both happy about it. A checklist for the final
If you prefer not to be present, weeks
talk to your partner. You may
be able to think of a friend or
relative who could accompany
• Make sure your partner
can contact you at all
her instead. times.

• Talk about what you both expect


in labour (see page 36 and • Decide how you’ll get to
A FRIEND IN NEED the hospital (if you’re
chapter 11). having a hospital birth).
Pregnancy can be frightening so it
will help if she knows that she’s not • Talk about the birth plan (see
page 38). Fill it in together so • Ifcar,you’re using your own
alone. Start by reading the rest of you know what she wants and make sure it works
this book with her so that you’re how you can help her achieve it. and has petrol, and do a
both well informed. Some of the Support her if she changes her trial run to see how long
basic health advice is just as mind during labour. Be flexible. it takes.
important for you as it is for her.
• During labour she’ll be far too • Remember to pack a bag
• Good eating is much easier if
you’re doing it together, so read
involved with what’s happening
inside to pay much attention to
for yourself including
snacks, a camera and
pages 8-12 and start picking up the people around her. You can film, and change for the
the food habits you’ll want to pass be her guide and interpreter. telephone.
on to your child.
PATERNITY LEAVE ‘From time to time
• Cigarette smoke is dangerous for
babies. If you are a smoker read Speak to your human resources
I became angry. She
was complaining too
page 13 on how to stop. department or your boss about your much, but millions of
paternity leave entitlement. You may women become pregnant
• Ifsmoke
you continue to smoke, don’t
near your partner, don’t
be entitled to one or two weeks’ paid
leave following the birth (see page
don’t they?’

offer her cigarettes and don’t leave 143). (A FATHER)


your cigarettes lying around. 49
Mainly for men

BECOMING
A FAT H E R

‘A lot of men don’t like Watching your baby coming into


to ask questions. That’s the world is the most incredible
one of the things that experience. The midwives will give
causes problems, that you the baby to hold. Some men
some men won’t even ask feel afraid of hurting such a tiny
their girlfriends questions.
Some don’t want to go to
creature. Don’t be. Hold the baby
close to your body. Feel the softness
• try to use this time to get to
know your baby – you could
the scan or see their baby of the head against your cheek. learn to change nappies and bath
being born. I love it. It’s Many fathers experience very your baby as well as cuddling and
going to be brilliant.’ strong emotions; some cry. It can be playing with him or her; if your
very difficult to go home and rest partner is breastfeeding you could
(A FATHER) after such an intense experience, so bring her a snack and a drink
think through what your needs while she feeds the baby; if bottle
‘I’m pretty scared about might be at this time. You may need feeding, you could sterilise and
going. I’m a bit of a to tell someone all about the birth make up the bottles (see page 73)
wimp. I’ve never been to before you can rest, but then sleep and share the feeding;
hospital in my life, so if you can. You need to recover from
going through the
screaming will be hard.
the birth too and, when the baby
comes home (if the birth took place
• when you go back to work you
may have to make up for her lost
But I suppose it will in hospital), you can expect broken earnings, but keep overtime to
be an amazing nights for some time to come. a minimum – you will want to
experience because it’s continue learning about your
your own partner that’s baby and being there so you can
going through it.’ BRINGING THEM HOME watch your child grow and develop;

(A FATHER) You may find that relatives and friends


are able to help in the early days so
• betakeconsiderate about sex – it may
many weeks or months
‘I went home tired that your partner can rest and feed before she stops feeling sore;
and anxious about the your baby. This is especially necessary you could discuss other ways of
future. It didn’t seem after a difficult birth. However, you showing your love for each other
like the greatest moment may live far from relatives and she until intercourse is comfortable.
in my life. I was just may only have you. It’s a good idea
glad it was over.’ to have a week or so off work if you
can. Think about the following: FEELING LOW
(A FATHER)
• too many visitors may exhaust her
and interfere with this special
Some mothers become depressed
and need a lot of extra support,
The law is changing to make
time when you are learning about both practical and emotional (see
it easier for unmarried fathers
being parents and a family; The baby blues and postnatal
to get equal parental
responsibility: from depression, page 117). You may also
1 December 2003, • you could look after the baby so
she can get a good rest each day;
get depressed. Your partner is facing
the biggest changes but that doesn’t
all you have to do is for both
parents to register the birth mean that you should ignore your
of your baby together • take over the basic housework,
but don’t feel you must keep the
own feelings. You need support too.
Keep talking and listening to each
(see page 119).
place spotless – no one should other, talk to friends too, and be
50 expect it; patient – life will get easier in time.
7 Antenatal
care and
antenatal classes
Remember that, if you’re

T
hroughout your pregnancy you will have regular care, either at a
hospital antenatal clinic or with your own GP or community working, you have the right
midwife. This is to check that you and the baby are well and so to paid time off for your
that any problems can be picked up as early as possible. This is the time antenatal care (see page 142).
to get answers to any questions or worries and to discuss plans for your
baby’s birth.
If you don’t speak English,
telephone your clinic so that an
interpreter can be arranged for
THE FIRST VISIT when you have an appointment.

Most women have their first, and pregnancy are more common in
longest, antenatal check-up around some ethnic groups. LET YOUR MIDWIFE
the 8th to 12th week of pregnancy. There may also be questions about OR DOCTOR
The earlier you go the better. You your work or your partner’s work KNOW IF:
should allow plenty of time as you and what kind of accommodation
will probably see a midwife and a
doctor, and may be offered an
you live in, to see if there is anything
about your circumstances that might
• there were any
complications in a previous
ultrasound scan. affect your pregnancy. pregnancy or delivery,
All this information will help to such as pre-eclampsia or
build up a picture of you and your premature delivery;
QUESTIONS pregnancy so that any special risks

You can expect a lot of questions


can be spotted and support provided.
The midwife or doctor will want
• you are being treated for
a chronic disease such as
on your health, on any illnesses to know the date of the first day of diabetes or high blood
and operations you have had, and your last period, to work out when pressure;
on any previous pregnancies or the baby is due. You will probably
miscarriages. You will be asked for
any information you have on your
want to ask a lot of questions
yourself. This is a good opportunity
• you, or anyone in your
family, have previously had
own family and your partner’s family and it often helps if you can write a baby with an abnormality,
(whether there are twins on your down what you want to say in for example spina bifida,
side or any inherited illness, for advance, as it’s easy to forget once or there is a family history
example). You will also be asked you are there. It’s important to find of an inherited disease
about your ethnic origin. This is out what you want to know and to such as thalassaemia or
because certain inherited conditions express your own feelings and cystic fibrosis.
that need attention in early preferences.

51
Antenatal care and antenatal classes

IF YOU’RE GOING TO
HAVE YOUR BABY IN
HOSPITAL,

your GP or midwife will


send or give you a letter for
the hospital. Antenatal care
varies around the country.
In some areas, the first
(booking) appointment is at
the hospital then all or most
subsequent appointments are
with the GP or community
midwife unless the
pregnancy is complicated,
when all appointments are
at the hospital. In other WEIGHT URINE
areas, all care is given by the
GP and/or midwife unless You’ll be weighed. From now on, You will be asked to give a sample of
there is a reason for referral your weight gain will probably be urine each time you visit. This will
to the hospital antenatal checked regularly, although this is be checked for a number of things
clinic. not done everywhere. Most women including:
put on between 10 and 12.5 kg

IF YOU’RE GOING TO
(22–28 lbs) in pregnancy, most of
it after the 20th week. Read pages
• have
sugar – pregnant women may
sugar in their urine from
HAVE YOUR BABY IN 8-12 on what to eat in pregnancy, time to time but, if it is found
A GP OR MIDWIFE and take regular exercise. Much of repeatedly, you will be checked
UNIT OR AT HOME, the extra weight is due to the baby for diabetes (some women
growing, but your body will also be develop a type of diabetes in
then you will probably go storing fat ready to make breast milk pregnancy known as ‘gestational
to your own GP and after the birth. diabetes’ which can be controlled
community midwife for during pregnancy usually by a
most of your antenatal care. change of diet and, possibly,
You may need to visit the HEIGHT insulin; the condition usually
hospital for an initial disappears once the baby is born);
assessment and perhaps for Your height will be recorded on the
an ultrasound scan or for
special tests. Sometimes your
first visit because it is a rough guide
to the size of your pelvis. Some small
• protein, or ‘albumin’, in your
urine may show that there is an
midwife may visit you at women have small pelvises and infection that needs to be treated;
home. although they often have small it may also be a sign of
babies they may need to discuss their pregnancy-induced hypertension
baby’s delivery with their doctor or (see High blood pressure and
midwife. pre-eclampsia on page 84).

GENERAL PHYSICAL BLOOD PRESSURE


EXAMINATION
Your blood pressure will be taken at
The doctor will check your heart every antenatal visit. A rise in blood
and lungs and make sure your pressure later in pregnancy could be
general health is good. a sign of pre-eclampsia (see page 84).

52
Antenatal care and antenatal classes

TESTS

A number of tests will be


offered at your first visit,
and some of these will be
repeated at later visits. You
are under no obligation to
have any test, although they
are all done to help make
your pregnancy safer or to
help assess the well-being of
your baby. Discuss the
reasons for tests with your
midwife or doctor so that you
can make an informed choice
about whether or not to have
BLOOD TESTS them. There is also written
information available about
You will be offered a blood test to
carry out a number of checks.
• your immunity to rubella
(German measles) – if you get
the tests. Ask to have the
results explained to you if
Discuss these with your doctor (see rubella in early pregnancy, it can you do decide to go ahead.
box). The tests are for: seriously damage your unborn
baby and if you are not immune
• your blood group; to rubella and come into contact
with it, blood tests will show
• whether your blood is rhesus
negative or positive – a few
whether you have been infected;
if so, you’ll be offered the option
mothers are rhesus negative of ending your pregnancy after
(usually this is not a worry for discussing the possible problems
the first pregnancy. Some rhesus your baby might have;
negative mothers will need an
injection after the birth of their
first baby to protect their next
• for syphilis – it is vital to detect
and treat any woman who has this
baby from anaemia; in some sexually transmitted infection as
units, rhesus negative mothers early as possible;
are given injections called ‘anti-
D’ at 28 and 34 weeks as well as
after the birth of their baby – this
• for hepatitis B – this is a virus
that can cause liver disease and
is quite safe and is done to make may infect the baby if you are a
sure that the blood of future carrier of the virus or are infected
babies is not affected by rhesus during pregnancy (see page 18).
disease – see page 110); Your baby can be immunised at
birth to prevent infection (see
• you
whether you are anaemic – if
are, you will probably be
page 101), so you will be offered
a test to check if you are carrying
given iron and folic acid tablets to the virus.
take (anaemia makes you tired
and less able to cope with losing
blood at delivery);

53
Antenatal care and antenatal classes

IF YOU ARE FOUND


• for HIV – this is the virus that
causes AIDS. If you are infected
display. Unlinked Anonymous testing
involves testing blood left over after
TO BE HIV POSITIVE, you can pass the infection to your completion of the routine checks for
or already know that you baby during pregnancy, at delivery HIV and other infectious diseases.
are, your doctor will need to or after birth by breastfeeding. As Details that could identify you are
discuss the management of part of your routine antenatal care permanently removed before the
your pregnancy and delivery a named confidential test for HIV testing, so that there is no possibility
with you. infection will be offered and that your result can be traced back to
recommended. If you are HIV you. (Some general information, like
• There is a 1 in 6 chance
of your baby being infected.
positive, both you and your baby
can have treatment and care that
your age group, will be connected to
the sample.) You can ask for your
reduces the risk of your baby specimen to be excluded from the
• 20% of HIV infected
babies develop AIDS or becoming infected (see box). If survey if you so wish. Whether you
die within the first year your test result is negative, the fact take part, or not, will not affect your
of life, so it’s important that you accepted the test as part antenatal care in any way.
to reduce the risk of of your antenatal care should not
transmission. affect your ability to obtain SICKLE CELL DISEASE AND
insurance. THALASSAEMIA
• Treatment may reduce
the risk of transmitting If you think that you are at risk of Sickle cell disorders and thalassaemia
HIV from you to the getting HIV, or know you are HIV are common inherited blood
baby. positive, ask your doctor or midwife conditions that mainly affect people
for the opportunity to discuss HIV who have originated from Africa,
• Your labour will be
managed to reduce the risk
testing and counselling. You can also the Caribbean, the Middle East, Asia
get free confidential advice from the and the Mediterranean, but are also
of infection to your baby. National AIDS Helpline. You can found in the Northern European
This may include an also talk in confidence to someone at population. You may be offered a
elective Caesarean delivery Positively Women (see page 148). blood test to find out whether you
(see pages 101-2). are a carrier of these disorders. It is
UNLINKED ANONYMOUS possible for either you or your
• Your baby will be tested
for HIV at birth and
SURVEYS partner to be a carrier without it
affecting your baby at all. But if both
at intervals for up to two In addition to named testing, some
of you are carriers, or if either of
years. If the baby is antenatal clinics are taking part in you suffer from the disorders, you
found to be HIV unlinked anonymous surveys to find should discuss the implications for
infected, paediatricians out how widespread HIV and other the baby with your doctor or
will be able to anticipate infectious diseases are in the general midwife. For further information
certain illnesses which population. If your antenatal clinic is contact the Sickle Cell Society or
occur in infected babies, one of these, leaflets and posters the UK Thalassaemia Society (see
and so treat them early. explaining the survey should be on page 149).
All babies born to HIV
positive mothers will
appear to be HIV
positive at birth but
many later test negative
because antibodies passed
to them by their mothers
disappear.

• You will be advised not


to breastfeed because
HIV can be transmitted
to your baby in this way.

54
Antenatal care and antenatal classes

CYSTIC FIBROSIS doctors prefer to use an ultrasound


scan for this purpose (see page 56)
Cystic fibrosis is an inherited disease either at the first or a later visit.
which affects vital organs in the
body, especially the lungs and CERVICAL SMEAR
digestive system, by clogging them You will be offered a cervical smear
with thick sticky mucus. The sweat test now if you haven’t had one in
glands are usually also involved. The the last three years. The test detects
disease is inherited and both parents early changes in the cervix (the neck
must be carriers of the faulty gene
of the womb) which could later lead
for a baby to be born with cystic
fibrosis. A test is offered to mothers to cancer if left untreated. By sliding
who are at high risk early in an instrument called a speculum
pregnancy to find out if the baby has into your vagina, the doctor can
cystic fibrosis. look at your cervix. A smear is then
taken from the surface of the cervix
INTERNAL EXAMINATION and will be examined under a
microscope. The test may feel a bit
uncomfortable but it is not painful
and won’t harm the growing baby.

HERPES

If you, or your partner, have ever


had genital herpes, or you get your
first attack of genital blisters or ulcers
during your pregnancy, let your
doctor or midwife know. This is
important because herpes can be
Occasionally, the doctor might dangerous for your newborn baby
consider it necessary to do an and he or she may need treatment
internal examination. Discuss the (see page 18).
reasons for this with the doctor. By
putting one or two fingers inside
your vagina and pressing the other
hand on your abdomen, your doctor
can judge the age of your baby. Most
55
Antenatal care and antenatal classes

L AT E R VISITS

Later visits are usually shorter. Your


urine and blood pressure, and often
• detect some abnormalities,
particularly in the baby’s head or
your weight, will be checked. Your spine;
abdomen will be felt to check the
baby’s position and growth. And the
doctor or midwife will listen to your
• show the position of the baby and
the placenta – in some cases, for
baby’s heartbeat. You can also ask example where the placenta is
questions or talk about anything that low in late pregnancy, special care
is worrying you. Talking is as much may be needed at delivery or a
a part of antenatal care as all the tests Caesarean section may be advised;
and examinations.
From now on, antenatal checks
will usually be every four weeks
• check that the baby is growing
and developing normally (this is
until 28 weeks, every two weeks particularly important if you are
until 36 weeks, and then every carrying twins or more).
week until the baby is born. If
your pregnancy is uncomplicated, The scan is completely painless, has no
you may be offered the option of known serious side-effects on
less frequent antenatal appointments. mothers or their babies (although
If you can’t keep an antenatal research is continuing), and can be
appointment, let the clinic, GP or carried out at any stage of pregnancy.
midwife know, and make another Most hospitals scan all women at 18
appointment. to 20 weeks to check for certain
abnormalities.
You will probably be asked to drink
ULTRASOUND SCAN a lot of fluid before you have the scan.
A full bladder pushes your womb up
This test uses sound waves to build and this gives a better picture. You then
up a picture of the baby in the lie on your back and some jelly is put
womb. Most hospitals will offer on your abdomen. An instrument is
women at least one ultrasound scan passed backwards and forwards over
during their pregnancy. An your skin and high-frequency sound
ultrasound scan can be used to: is beamed through your abdomen into
the womb. The sound is reflected back
• check the baby’s measurements –
this gives a better idea of the
and creates a picture which is shown
on a TV screen. It can be very exciting
baby’s age and can help decide to see a picture of your own baby
when your baby is likely to be before birth, often moving about inside.
born – this can be useful if you Ask for the picture to be
are unsure about the date of your explained to you if you can’t make it
last period or if your menstrual out. It may be possible for your
cycle is long, short or irregular; partner to come with you and see
your due date may be adjusted the scan. Many couples feel that this
according to ultrasound helps to make the baby real for them
measurements; both. Ask if it’s possible to have a
copy of the picture (there may be a
• check whether you are carrying
more than one baby;
small charge for this).
If you feel doubtful about having a
scan, talk it over with your GP,
56 midwife or obstetrician.
Antenatal care and antenatal classes

TESTS TO D E T E C T A B N O R M A L I T I E S
IN THE BABY
It is important to realise that no test IF A TEST DETECTS AN
can guarantee that your baby will be ULTRASOUND (see also page 56) ABNORMALITY,
born without abnormality. No test is
100% accurate and some abnormalities Since ultrasound provides an image you may like to contact the
may remain undetected. of the baby in the womb, it detects appropriate organisation
The tests below are designed to structural abnormalities, particularly (see page 147–150) for
detect structural abnormalities like of the spine and head. Recently, further information. They
spina bifida or genetic disorders like however, it has been found to be may be able to put you in
Down’s syndrome. Down’s syndrome useful in screening for Down’s touch with parents who have
is caused by an abnormal number of syndrome and some other decided to continue with a
chromosomes. Chromosomes are the abnormalities of chromosome pregnancy in which an
structures within every cell of a person’s number. Several research studies have abnormality has been
body which carry the individual shown that the thickness of the detected. ARC (Antenatal
genetic code or recipe to make that ‘nuchal fold’ at the back of the baby’s Results and Choices; see
person. Conditions like cystic fibrosis neck is related to the risk of Down’s page 149 under ‘Loss and
and achondroplasia (dwarfism) are syndrome. An ultrasound scan at 11 Bereavement’) will offer
caused by abnormalities within the to 14 weeks enables a measurement support and information if
chromosomes (so causing a ‘mistake’ to be taken. This measurement then you are considering
in the recipe). Talk to your midwife, allows a risk factor to be calculated. termination for abnormality.
GP or obstetrician about the tests The nuchal translucency scan is not
mentioned below as they are not widely available at present but it is
available in all hospitals. becoming more so.
When you are deciding whether
or not to have a test, think what you ALPHA-FETOPROTEIN (AFP) TEST
might do if the test suggests that
your baby has an abnormality. If a This test is performed at
screening test (serum screen or about 15 to 20 weeks to
nuchal translucency) suggests a find out the level of
‘high’ risk of genetic abnormality, alpha-fetoprotein (AFP)
you will be offered amniocentesis in your blood. This
or chorionic villus sampling protein is made by your
(CVS) to give a definite diagnosis. baby and passes into your
Since these carry a risk of blood during pregnancy.
miscarriage, you may decide not to High levels are associated with spina
have these tests or even a screening bifida and so an ultrasound scan will
test if you would choose to continue then be offered to check for this.
with the pregnancy. Having a test, High levels may be seen in normal
however, may reassure you that your pregnancy and also in twin
baby is likely to be born healthy, pregnancy. Low levels of AFP are
allow you to consider the associated with Down’s syndrome
termination of an affected baby or pregnancies. Ultrasound and
give you time to prepare for the amniocentesis will then be suggested
arrival of a baby with special needs. to achieve a diagnosis.
Discuss the issues with your partner, Some hospitals routinely offer the
midwife, doctor and friends. AFP test to all women; others don’t,
or restrict the test to older women
since the risk of Down’s syndrome,
and some other abnormalities of
chromosome number, increases with age. 57
Antenatal care and antenatal classes

SERUM SCREENING

By 2004 all women should be offered


serum screening as part of their
antenatal care. Serum screening is the
term used for a test of the mother’s
blood which screens for Down’s
syndrome. It combines the AFP result
(and so gives information about the
risk of spina bifida) with the
measurement of other blood
chemicals to give the relative risk of
having a baby with Down’s syndrome.
There are various tests available
(‘double test’, ‘triple plus test’, etc.)
which differ slightly from each other,
but they are all types of serum
screening. They are not helpful in
twin or other multiple pregnancies.
Some maternity units give the • when an ultrasound scan detects
an abnormality which is associated
result as ‘low-risk/screen negative’
with a genetic disorder;
or ‘high-risk/screen positive’. A
negative result means that you are
at a low risk of having a baby with • when a woman’s past or family
history suggests that there may be
Down’s syndrome. A positive result a risk of her baby having a genetic
means that you are at a higher risk or chromosomal disorder such as
of having a baby with Down’s Down’s syndrome.
syndrome. For example, any level
higher than 1: 250 is usually said It should always be performed using
to be a high risk. This is the ultrasound to check the position of
recommended cut off level. the baby and placenta. Whilst
However, a risk of 1:100 is still only continuing to scan with the
a 1% chance of the baby having ultrasound probe, a fine needle is
Down’s syndrome, and 99% chance passed through the wall of the
of it not. An amniocentesis or CVS abdomen into the amniotic fluid
will be offered to give you a definite which surrounds the baby. A small
diagnosis. You may compare this sample of this fluid is drawn off and
risk to that for your age (about 1: 900 sent to the laboratory for testing.
at 30) or to the risk of miscarriage Most women feel only mild
with amniocentensis (about 1:100). discomfort.
Your doctor or midwife will explain Within the fluid are cells which
the significance of the result to you. contain the same chromosomes as
the baby. Looking at these
AMNIOCENTESIS chromosomes is a complex process
which is why the results take up to
This test may be offered from 14 three weeks. This test will reveal
weeks of pregnancy: your baby’s sex. Tell your doctor
whether or not you want to know
• toserum
women who have an AFP,
screening or nuchal
what it is. Some disorders such as
haemophilia and muscular dystrophy
translucency scan result which are only found in boys (although
indicates an increased risk of girls may carry the disorder in their
58
Down’s syndrome or spina bifida; chromosomes and pass it on to their
Antenatal care and antenatal classes

sons). Tell your doctor if these or risk of limb deformities. Women at


other genetic disorders run in your risk of having a child with an Further information about
family as it may then be important inherited disorder such as cystic screening in pregnancy can
to know your baby’s sex. fibrosis or muscular dystrophy may be found on the National
Amniocentesis is associated with a accept the increased risk of Electronic Library for
0.5–1% risk of miscarriage. At most, miscarriage in order to obtain an Health website at
one test in a hundred will result in earlier diagnosis. www.NeLH.nhs.uk/screening
pregnancy loss. When deciding The test takes 10 to 20 minutes and the National Screening
whether or not to go ahead with this and may be a little uncomfortable. Committee website at
test try to balance the risk of Using ultrasound as a guide, www.NSC.NHS.uk
miscarriage against the value of the a fine needle is passed through the
result to you. Remember that a woman’s abdomen, or sometimes a
normal result only reassures you fine tube through the vagina and
about the number of chromosomes cervix, into the womb. A tiny piece
unless specific tests for disorders such of the developing placenta, known
as cystic fibrosis have been done. as chorionic tissue, is withdrawn.
Again, the chromosomes in the
CHORIONIC VILLUS SAMPLING cells of this tissue are looked at.
(CVS) The results take up to two weeks.
However, some results from
This test is usually only available amniocentesis and CVS can be
in large hospitals but smaller units are available as early as 48 hours. This
able to refer to these units if necessary. is offered privately in some areas.
It also tests for chromosomes and can If you feel the test would be
test for genetic disorders if requested. helpful, talk over the matter carefully
It does not give information about with your GP or midwife early in
spina bifida. your pregnancy or before conception,
CVS can be carried out earlier as well as with your partner or a
than amniocentesis at around eleven close friend. You can also contact
weeks but may carry a slightly your regional genetic centre direct
higher risk of miscarriage, at about (telephone the Genetic Interest
1%. CVS before ten weeks has been Group for details of your nearest
associated with a slightly increased centre, see page 149).

59
Antenatal care and antenatal classes

MAKING THE MOST


O F A N T E N ATA L C A R E

‘There were some things Having regular antenatal care is answers to your questions or
that really annoyed me – important for your health and the the opportunity to discuss any
the gowns, and the health of your baby. However, worries. Sometimes this can take
lavatories, and one sometimes antenatal visits can seem quite a lot of determination.
midwife who called quite an effort. If the clinic is busy
everyone “sweetie”.
But there were other
or short-staffed you may have to wait
a long time and, if you have small
• Ifableyourto gopartner is free he may be
with you. He’ll be able
things I wouldn’t have children with you, this can be very to support you in discussing any
missed – like hearing exhausting. By increasing the worries or in finding out what
my baby’s heart beating, number of women that are cared for you want to know. It will also
and well, just knowing by their GP and community help him to feel more involved
she was all right. midwife, antenatal care should in your pregnancy.
Knowing I was all right become more convenient. Try to
too, come to that.’ plan ahead to make your visits easier
and come prepared to wait. Here are
• Ifperiods
you regularly wait for long
at your clinic, bring this
some suggestions. to the attention of the hospital
management.
‘I think it’s up to you to
make the most of it. You
• Inrefreshments.
some clinics you can buy
If not, take a snack
can find out a lot, but with you if you are likely to get
you have to ask. When hungry.
your blood pressure’s
taken, you have to say,
“Is that all right?”.
• Write a list of any questions you
want to ask and take it with you
Then they’ll tell you. to remind you. Make sure you get
And if it’s not all right,
you have to ask why not,
and talk about it. It’s the
same for everything. It’s
not being a nuisance, it’s
being interested. I think YO U R A N T E N ATA L N OT E S
the staff like it if you’re
interested.’
At your first antenatal visit, your while you are away from home,
doctor or midwife will enter your you will have the information
details in a record book and add to that’s needed with you.
them at each visit. Many hospitals The page opposite gives a
If you have a disability ask women to look after these notes sample of the information your
which means that you have themselves. Other hospitals keep the card or notes may contain, as each
special requirements for your notes and give you a card which clinic has its own system. Always
antenatal appointments or records your details. Take your notes ask your doctor or midwife about
for labour, let your midwife or card with you wherever you go. anything on your card which you
know so that arrangements Then, if you need medical attention would like to have explained.
can be made in advance.

60
Antenatal care and antenatal classes

R.O.L. or R.O.T. L.O.P RELATION TO BRIM


At the end of pregnancy your baby’s head
(or bottom, or feet if it is in the breech position)
will start to move into your pelvis. Doctors and
midwives ‘divide’ the baby’s head into ‘fifths’
and describe how far it has moved down into
the pelvis by judging how many ‘fifths’ of the 2
L.O.A. head they can feel above the brim (the bone /5 felt
at the front). 3
/5 engaged
They may say that the head is ‘engaged’ – this is
when 2/5 or less of the baby’s head can be ‘felt’
(palpated) above the brim. This may not happen
until you are in labour. If all of the baby’s head
L.O.L. can be felt above the brim, this is described as
or
L. O.T R.O.A. R.O.P. ‘free’ or 5/5 ‘palpable’.

BLOOD PRESSURE FETAL HEART ‘FHH’ or OEDEMA This is another


(BP) This usually stays at just ‘H’ means ‘fetal heart word for swelling, most often
about the same level heard’. ‘FMF’ means ‘fetal of the feet and hands. Usually
POSITION throughout pregnancy. If it movement felt’. it is nothing to worry about,
The above abbreviations are goes up a lot in the last half but tell your doctor or
used to describe the way the of pregnancy, it may be a midwife if it suddenly gets
baby is lying – facing sideways, sign of pre-eclampsia worse as this may be a sign of
for example, or frontwards which can be dangerous pre-eclampsia (see page 84).
or backwards. Ask your midwife for you and your baby (see
to explain the way your baby page 84).
is lying.
Hb This stands for
‘haemoglobin’. It is tested in
your blood sample to check
you are not anaemic.

DATE WEEKS WEIGHT URINE ALB BP HEIGHT PRESENTATION RELATION OF FH OEDEMA Hb NEXT SIGN. NOTES
SUGAR FUNDUS AND POSITION PP TO BRIM

15/6/99 13 58 kg nil 110/60 15 – – – – 12.0 20/7 CS u/s arranged for 17/7 to check
maturity
20/7/99 18 59.2 kg Nil 125/60 18–20 – – FMF – – 21/8 CS

21/8/99 22 61 kg Nil 135/65 20 - – - – 18/9 CS taking iron

18/9/99 26+ 64 kg Nil 125/75 24–26 – H – 11.2 28/10 CS

28/10/99 30 66 kg Nil 125/70 30 ceph 5/5 FHH - - 27/11 CS Mat B1 given, Hb taken

27/11/99 34 - Nil 115/75 34 ceph 4/5 FHH - 11.0 15/12 CS

PRESENTATION This refers to which way up the baby is. Up to about 30


DATE This is WEEKS This refers to weeks, the baby moves about a lot. Then it usually settles into its head
the date of the length of your downward position, ready to be born head first. This is recorded as ‘Vx’ (vertex)
your antenatal pregnancy in weeks or ‘C’ or ‘ceph’ (cephalic). Both words mean the top of the head. If your baby
visit. from the date of your stays with its bottom downwards, this is a breech (‘Br’) presentation. ‘PP’ means
last menstrual period. presenting part, that is the bit of the baby that is coming first. ‘Tr’ (transverse)
means your baby is lying across your tummy.

URINE These are the


results of your urine tests for HEIGHT OF FUNDUS By gently pressing on your abdomen, the
protein and sugar. ‘+’ or ‘Tr’ doctor or midwife can feel your womb. Early in pregnancy the top of the
means a quantity (or trace) womb, or ‘fundus’, can be felt low down, below your navel. Towards the 38
has been found. ‘Alb’ stands end it is well up above your navel, just under your breasts. So the height
for ‘albumin’, a name for one of the fundus is a guide to how many weeks pregnant you are.
of the proteins detected in This column gives the length of your pregnancy, in weeks, estimated 24
urine. ‘Nil’ or a tick or according to the position of the fundus. The figure should be roughly
‘NAD’ all mean the same: the same as the figure in the ‘weeks’ column. If there’s a big difference
nothing abnormal discovered. (say, more than two weeks), ask your doctor about it. Sometimes the
‘Ketones’ may be found if height of the fundus may be measured with a tape measure and the 12
you have not eaten recently result entered on your card in centimetres.
or have been vomiting.

61
Antenatal care and antenatal classes

WHO’S WHO

Many mothers would like to be able


to get to know the people who care
• Aprobably
community midwife will
get to know you before
for them during pregnancy and the your baby is born and will visit
birth of their baby. The NHS is now you at home, after you leave
working to achieve this. However, hospital during the early weeks.
you may still find that you see a Community midwives are
number of different carers. sometimes attached to GPs’
Professionals should, of course, practices and may be involved in
introduce themselves and explain giving antenatal care. They are
what they do but, if they forget, also involved in delivering babies
don’t hesitate to ask. It may help to in community and GP or midwife
make a note of who you have seen units and are responsible for
and what they have said in case you home deliveries. Some
need to discuss any point later on. community midwives also
Below are the people you’re most accompany women into the
likely to meet. Some may have hospital maternity unit to be
students with them who are being with them for the birth.
trained and you will be asked if you
mind them being present. • Your general practitioner (GP)
can help you to plan your
• care
A midwife is specially trained to
for mothers and babies
antenatal care. This may be given
at the hospital, but it is quite
throughout normal pregnancy, often shared with the GP.
labour and after the birth, and Sometimes the GP may be
therefore provides all care for the responsible for all your antenatal
majority of women at home or in care and in some areas may be
hospital. Increasingly, midwives responsible for your care in
will be working both in hospital hospital. If you have your baby in
and in the community so that a GP or midwife unit or at home,
they can provide better continuity your GP may be involved in your
of care. You should know the name baby’s birth. If your baby is born
of the midwife who is responsible in hospital, your GP will be
for your midwifery care. notified of your baby’s birth and
will arrange to see you soon after
• Aprobably
hospital midwife will
see you each time you
you return home. Don’t forget to
register your baby with your GP.
go to a hospital antenatal clinic.
A midwife will look after you
during labour and will probably
• specialising
An obstetrician is a doctor
in the care of women
deliver your baby, if your delivery during pregnancy, labour and
is normal. If any complications soon after the birth. If you are
develop during your pregnancy or having a hospital birth you will
delivery, a doctor will become usually be under the care of a
more closely involved with your consultant and the doctors on his
care. You and your baby will be or her own team, together with
cared for by midwives on the other professionals such as
postnatal ward until you go midwives. In some hospitals you
home. You will probably also will routinely see an obstetrician;
meet student midwives and in others, your midwife or GP
62 student doctors. will refer you for an appointment
Antenatal care and antenatal classes

if they have a particular concern antenatal classes and teach


such as previous complications of antenatal exercises, relaxation RESEARCH
pregnancy or labour or chronic and breathing, active positions
illness. If everything is and other ways you can help You may be asked to
straightforward, a midwife will yourself during pregnancy and participate in a research
usually deliver your baby. You labour. Afterwards, they advise project during your antenatal
should ask to see your consultant on postnatal exercises to tone care, labour or postnatally.
if you wish to discuss any matter up your muscles again. When This may involve a new
you think is important. no obstetric physiotherapist is treatment or be to find out
available your midwife can help your opinions on an aspect
• specialising
A paediatrician is a doctor
in the care of babies
you with these exercises. of your care, for example.
The project should be fully
and children. The paediatrician
may check your baby after the
• Health visitors are specially
trained nurses concerned with
explained to you and you
are free to decline, but your
birth to make sure all is well the health of the whole family. participation will be most
and will be present when your You may meet yours before the welcome. Such projects are
baby is born if you have had a birth of your baby. The health vital if professionals are to
difficult labour. If your baby visitor will contact you to arrange improve maternity care.
should have any problems, you a home visit when your baby is
will be able to talk this over with ten days old to offer help and
the paediatrician. If your baby is support. You may continue to STUDENTS
born at home or your stay in see your health visitor either at
hospital is short, you may not see home, or at your Child Health Many of the professionals
a paediatrician at all. Your GP can Clinic, health centre or GP’s mentioned have students
check that all is well with you and surgery, depending on where accompanying them at times.
your baby. they are based. They will be at various
stages of their training but
• An obstetric physiotherapist
is specially trained to help you
• you
Dietitians are available to advise
on healthy eating or if you
will always be supervised.
You can choose not to be
cope with the physical changes need to follow a special diet such seen by a student at any
of pregnancy, childbirth and as that recommended for women time but agreeing to their
afterwards. Some attend with gestational diabetes. presence helps in their
education and may even
add to your experience of
pregnancy and labour.

63
Antenatal care and antenatal classes

A N T E N ATA L CLASSES

Think about what you Antenatal classes can help to prepare to some of them, or you can go
hope to gain from antenatal you for your baby’s birth and for alone or with a friend. In some
classes so that, if there is a looking after and feeding your baby. areas there are classes especially for
choice, you can find the sort They can also help you to keep women whose first language is not
of class that suits you best. yourself fit and well during English, classes for single mothers
You need to start making pregnancy. They are often called and classes for teenagers. The kinds
enquiries early in pregnancy parentcraft classes and may cover of topics covered by antenatal classes
so that you can be sure of relaxation and breathing, and are:
getting a place in the class antenatal exercise. They’re a good
you choose. You can go to
more than one class. Ask
chance to meet other parents, to talk
about things that might be worrying
• health in pregnancy;
your midwife, or health
visitor, your GP, or the local
you and to ask questions – and to
make new friends. They are usually
• what
birth;
happens during labour and

branch of the National informal and fun.


Childbirth Trust (see
page 147).
You may be able to go to some
introductory classes on babycare
• coping with labour and
information about pain relief;
early in pregnancy. Otherwise, many

‘My midwife told me


classes will start about eight to ten
weeks before your baby is due.
• exercises to keep you fit during
pregnancy and help you in labour;
about a class specially for Classes are normally held once a
teenagers. It was great
being with girls my age.’
week, either during the day or in
the evening and last one or two
• relaxation;
hours. Some classes are for expectant
women only. Others will welcome
• caring
feeding;
for your baby, including

‘It really helped me partners, either to all the sessions or


to make up my mind
about how I wanted
to have my baby.’

64
Antenatal care and antenatal classes

• your own health after the birth; of the professionals involved in your
care and to ask questions and talk
‘It was great meeting
people who were going
• ‘refresher classes’ for those who
have already had a baby;
over any worries you may have. You
can find out about arrangements for
through the same things
I was.’
labour and birth and the sort of
• emotions surrounding pregnancy,
birth and the early postnatal
choices available to you. This can
help you in thinking about making
period. your own birth plan (see page 38).
You’ll usually be able to look round
Some classes will try to cover all the labour and postnatal wards. You
these topics. Others will concentrate may also be able to meet some of
more on certain aspects, such as the people who will be looking after
exercises and relaxation or babycare. you when the time comes for your
The number of different antenatal baby to be born.
classes available varies very much Classes can give you confidence ‘It was brilliant having
from place to place. Classes may be as well as information. You’ll be classes in the evening
run by your hospital, by your local able to talk over any worries and because it meant Phil
midwives or health visitors, by your discuss your plans, not just with could help me during
own GP or health centre. The professionals, but with other labour.’
National Childbirth Trust also runs parents as well.
classes, usually in the evenings and Speak to your community ‘Being shown the
in the leader’s home. The groups midwife if you can’t go to classes. delivery suite helped
tend to be smaller and may go into The midwife may have videos to us – just knowing
more depth. lend you or you may be able to what to expect made
Antenatal classes may give you the hire or buy one. it less scary.’
opportunity to get to know some

Classes may be available


in your area for specific
groups such as single women
and teenagers. Ask your
midwife for details.

If either you or your partner


is bilingual, why not begin
talking in both languages to
your unborn baby? ‘It is a
good way to let your baby
get used to two languages
and for you to start using
them with your baby’.

65
8 Feeding your
baby
‘It was so easy. I suppose

I
t’s never too early to start thinking about how you’re going to feed
it took me about a couple your baby. Once your baby is born there will be lots to occupy you!
of weeks to get used to it, You’ll need to discuss it with other people, the baby’s father, your
and from then on I just midwife, health visitor or other mothers.
didn’t have to think. Breastfeeding gives your baby the best possible start in life. Almost
It was the one thing that all women can breastfeed successfully and find it an easy and enjoyable
wasn’t any effort at all.’ experience. Breast milk is the best form of nutrition for babies as it
provides all the nutrients a baby needs, and is the natural way for your
baby to carry on feeding from your body as a continuation of the
previous nine months. Most babies need no other food or drink until
they are six months old.
Your baby does not need water between feeds. Even in very hot
countries no water is needed. This is true for both breast and bottle-fed
If you’re HIV positive, you babies. If your baby cries, offer another feed even if he or she has been
will be advised not to fed recently. It is important to feed on demand since babies often don’t
breastfeed because follow a routine. This is particularly important for breastfed babies
of the risk of passing the because they increase the milk supply by increasing the frequency
virus on to your baby of feeds.
through the milk. It is Exclusive breastfeeding is recommended for the first six months of a baby’s life.
a good idea to discuss this After six months your baby should be given breast milk, along with appropriate
with your midwife or doctor. first foods, until they are at least a year old. Breastfeeding has lots of benefits for
both mother and baby. These are explained in more detail later in this chapter. If
you like, you can breastfeed your baby for a year or more, but you may
decide to breastfeed for a shorter time, if for example you are returning
to work, and then change to bottle feeding. Whatever method of
feeding you choose, your midwife, health visitor, or breastfeeding
counsellor can explain how to do it.
It’s important to know that if you decide not to breastfeed, it’s very
difficult to change from bottle to breastfeeding if you change your mind
later.
The following information should help you decide what’s best for
you and your baby.

Across Wales, a growing number of NHS Trusts are taking part in the
UNICEF UK Baby Friendly Initiative which sets out clear standards for
providing support for mothers in the feeding choices they make for their
babies. Ask your midwife about this.

66
Feeding your baby

BREASTFEEDING
WHY BREAST IS
GOOD FOR BABIES
• Breast milk contains growth
factors and hormones to assist
your baby’s development.
• Breast milk is the only food
naturally designed for your baby. WHY BREAST IS
‘I didn’t want to
breastfeed. It was as
It contains all the nutrients your GOOD FOR MOTHERS simple as that. The
baby needs in the right amounts whole idea of it put me
for the first six months of life, and As one mother said, ‘It was feeling off and I just couldn’t
they are in a form that is very close, and being together, that was have done it.’
easily absorbed. Its composition what I liked’, but there are other
even changes as your baby grows. advantages to consider:
‘I had quite a few
• Breastfeeding helps to protect
your baby from infection because
• Breast milk costs nothing. problems at first with
sore nipples and one
antibodies are passed into the
milk. Your baby will be less likely
• There’s no need to prepare feeds
or wash and sterilise bottles, and
thing and another. It
made it difficult. I think
to get coughs and colds and other your baby isn’t kept waiting. I’d have given up if it
infections than bottle- fed babies. hadn’t been for the
The longer you breastfeed, the
longer this protection will last.
• Breastfeeding helps your womb
return to its normal size more
midwife. She was ever
so good. And after a
quickly and, because it uses up while it all sorted out
• Breast milk is easily digested and
absorbed and is less likely to cause
calories, it will help you to lose
some of the weight gained in
and now I’m glad
I did it.’
stomach upsets or diarrhoea. It pregnancy.
will also help to avoid
constipation in your baby. • It’s so much easier and more
practical in the middle of
• Breastfed babies are less likely to
get allergies like eczema, for
the night.

example. • Breastfeeding reduces the risk of


pre-menopausal breast cancer and
ovarian cancer.

NURSING BRAS

A nursing bra will give you


support so that you feel
more comfortable. Ask for a
proper fitting when choosing
a bra. Choose adjustable
bras because the size of your
breasts will change (see page
88). Some women feel more
comfortable wearing a
nursing bra at night as well.

67
Feeding your baby

SOME OF YOUR short time is worthwhile, so if you


QUESTIONS ANSWERED want to breastfeed, don’t let the fact
that you are returning to work put
Can all women breastfeed? you off. You have a range of options
Almost every woman can breastfeed, to consider, including expresing
but it can sometimes take a little milk, flexible working or combining
while to get it right. Be patient and breastfeeding and formula feeding.
ask your midwife or health visitor
for help if you need it. What about feeding my baby in
front of friends or in public?
Does breast size matter? You may be quite happy about
No. All shapes and sizes make milk. feeding in front of others. If you feel
Can flat or inverted uneasy, you could feed the baby
nipples be a problem? discreetly under a loose top, T-shirt
Most women with flat or inverted or half-unbuttoned blouse. Don’t be
nipples should be able to breastfeed. embarrassed to ask if there’s a
However, you may need a little extra mother and baby room when
help in learning to position your you’re out.
baby (see page 70).
Should I give my baby
Do I need to prepare my any other drinks?
breasts for breastfeeding? Breastfed babies do not need any
Your breasts will prepare themselves other drinks, for the first six months,
naturally, although it’s a good idea to including infant fruit juices, herb
‘I didn’t realise that try to keep your skin soft and supple, teas or boiled water, providing you
bottle feeding would so avoid soaps and sprays that have a feed them whenever they ask. You
be so much trouble. drying effect. yourself may be more thirsty during
It was really hard breastfeeding, so be sure to drink
to find time to sterilise If my baby is born prematurely, enough to quench your thirst.
and make up the will it have the energy to suck
bottles. My new at the breast? How long should I breastfeed for?
baby took up Maybe not at first, but small babies You can go on as long as you want
all my time.’ will benefit if they get some to. If you continue to breastfeed,
mother’s milk as it is exactly right your baby will continue to benefit,
for them. You can express your even up to two years and beyond.
‘I really enjoy the milk and you can give it by tube, Breastfeeding for at least the first
closeness of breastfeeding syringe or cup, and later by bottle if four to six months gives your baby
and my partner says it your baby can’t take it directly from the best start in life. If you can,
makes him feel so proud, your breast. continue to give some breastfeeds
watching us together.’ How can I make sure my until your baby’s first birthday. After
that, he or she can have whole cow’s
partner feels involved?
milk as a drink. If you switch to
Breastfeeding is only one way to be
formula feeds you can still breastfeed
close to a baby. Your partner can
your baby once or twice a day. This
cuddle and bathe the baby and
way your baby will continue to
perhaps give bottles of expressed
benefit from your breast milk.
milk later on.
Can I go out without the baby? Breastfeeding a baby can be a great
Yes, you can express some of your pleasure. Even if it takes time to get
milk and leave it for someone else to it right, it’s still worth working at.
give your baby (see page 72). Although problems with
breastfeeding, even fairly small
Is it worth breastfeeding if I am problems, can be quite upsetting,
going back to work soon? they can almost always be overcome.
Yes. Any breastfeeding, even for a
68
Feeding your baby

You can get help from: needs. The make-up of the milk
gradually changes throughout the
• your midwife or health visitor; course of the feed. The first milk
which your baby takes flows quickly
Seven pints of cow’s milk
per week plus a
• asupport
breastfeeding counsellor or
group (contact your local and is thirst quenching. It means supplement of vitamins
branch of the National Childbirth your baby gets a drink at the start of are available free to
Trust, La Lèche League, the every feed. As the flow slows down pregnant and
Breastfeeding Network, or the during the feed, the amount of fat in
your milk increases and your baby breastfeeding mothers if
Association of Breastfeeding your family receives
Mothers page 147 – these will receive the necessary calories.
organisations give help and This is why you shouldn’t restrict the Income Support or
support through other mothers length of feeds or swap breasts after income based Jobseeker’s
who have experience of too short a time. Allowance or Pension
breastfeeding). Your breasts may become very Credit guarantee credit.
large and heavy for a while and may
Don’t worry if other mothers seem feel uncomfortable, or even painful, at Use the free milk as a
to be doing things differently. It is first. Milk may leak from your drink, on cereals or to
important to have confidence in nipples and you may feel more make sauces or puddings.
yourself and your baby so that comfortable wearing breast pads.
together you can work out what Change them frequently, and avoid
is best for both of you. those with plastic backs. Or you can
use clean cotton hankies, and at
STARTING BREASTFEEDING night, in bed, you could put a clean ‘I wasn’t sure if I’d be
towel under you instead of wearing able to breastfeed. My
In the beginning, it can seem that pads. Gradually the amount of milk mum bottle fed me so she
you are doing nothing but feeding, you produce will settle down and
but gradually your baby will settle your breasts will begin to feel more couldn’t help. Once I
into a pattern of feeding. Try to normal again. If you are very got going though, it was
relax into it and take each day as uncomfortable, ask your midwife, so easy. I can’t think
it comes. health visitor or breastfeeding now why I was so
You’ll want to get off to the best counsellor for help. unsure at first.’
start so, as soon as possible after the
birth, your midwife will give you
the baby to hold. It’s best if you hold HOW BREASTFEEDING WORKS
your baby, undressed, next to your Your milk supply
skin for a close, calming cuddle. Your breasts produce milk
After a while your baby will in response to your baby feeding
probably begin to look for a feed - at your breast. The more your
how long this takes varies from baby baby feeds, the more your
to baby but is usually longer than body makes milk, provided
half an hour. that your baby is correctly
It also helps in establishing positioned. If you reduce
breastfeeding if you and your baby the amount of feeding, you
aren’t separated in the early days and will make less milk.
if you avoid the use of any dummies
or bottles during the first few weeks. The ‘let-down’ reflex
For the first few days after Your baby’s sucking causes milk
birth your breasts produce a special to gather behind the nipple,
food called colostrum, which looks ready
like rich creamy milk and is for feeding. This is called the
sometimes quite yellow in colour. ‘let-down’ reflex; some mothers feel
This contains all the food your baby it as a tingling sensation. You will
needs, as well as antibodies which see your baby’s quick sucks change
pass your own resistance to certain to deep swallows once the milk
infections on to your baby. has begun to flow. Babies often
After about three days, the pause while they wait for more
change from colostrum to milk milk to be ‘delivered’. Anxiety or
begins. It becomes full breastmilk tiredness can stop the ‘let-down’
after about two weeks. The milk will reflex, so try to rest and relax as
look quite thin compared with much as you can while you are
colostrum - this is normal. It still breastfeeding.
contains all the goodness your baby
69
Feeding your baby

HOW TO BREASTFEED
1 Get comfortable. Sit 2 Turn your baby’s body
so that your back is towards your tummy.
straight and your lap Tuck your baby’s bottom
is flat. You can use under your elbow, or
a pillow to support support your baby by
your baby. using a pillow. Hold your
baby behind the neck and
shoulders.

3 Start with 4 Allow your


your baby’s nose baby’s head to tilt
opposite your back. Move your
nipple. baby’s mouth
gently across your
nipple until your
baby’s mouth
opens really wide.

5 Bring your 6 Your baby’s


baby towards chin is in close
your breast contact with
quickly. Your your breast.
baby’s bottom Your baby is
lip and chin able to breathe
should touch easily. You can
your breast first. feel your baby
has a big mouthful of breast. You may need to
support your breast.

7 Babies love to 8 If it does not


breastfeed, but they feel right …
usually come off by start again.
themselves when Slide one of
they have had your fingers
enough. into your baby’s
mouth, gently
You will know when breastfeeding is right: it will break the
feel comfortable; your baby will be relaxed; you suction and try
will hear a soft swallowing. again.

IT IS OKAY TO ASK FOR HELP.


70
Feeding your baby

HOW OFTEN AND HOW MUCH

It’s best to feed when your baby


wants to be fed. This might be very
often at first, though feeds will
become more spaced out as your
baby gets older. Some babies settle
into their own pattern quite quickly,
others take longer.
From time to time, your baby will
have a growth spurt – usually around
10 days, 6 weeks and 12 weeks. When
this happens, your baby will need
more milk and you may find that YOUR DIET WHEN BREASTFEEDING
feeds are longer and more frequent. It is important to look after yourself, so try to eat well at meal times, with
Don’t panic and feel you need to offer plenty of pasta, potatoes, bread and rice, and have healthy snacks in
bottles of infant formula milk. You’ll between (see page 11). Drink plenty of fluids, especially in hot weather and
make more milk in response to your keep your intake of alcohol low. Don’t go on a crash course to lose weight.
baby’s demands, but this may take a Your milk will be affected, and you will probably feel more tired.
day or two, so be patient. The Breastfeeding and healthy eating should help you to lose any surplus
frequency and length of feeds will pounds naturally and gradually.
then settle back down again.
The sucking process releases milk It can be difficult to make sure you get enough vitamin D; it is present in
to satisfy your baby and stimulates only a few foods, such as fortified margarines, oily fish, eggs and milk. But
the production of more. When your it’s also made by the skin when it is exposed to ‘gentle’ summer sunlight
baby is full up, he or she will stop (remember to apply a high-factor sunscreen). If you’re not sure you’re getting
feeding. Plenty of wet nappies is a enough, especially during the winter months, you may need to take vitamin
good sign that your baby is getting D supplements. They’re available cheaply from health centres, and they’re
enough fluid. If you’re worried, talk free of charge if your family receives Income Support or income-based
to your midwife, health visitor or Jobseeker’s Allowance or Pension Credit guarantee credit. Always talk to
breastfeeding counsellor. your doctor or health visitor before taking supplements.

SHOULD I AVOID ANYTHING?


HOW TO OVERCOME Breastfeeding should be an enjoyable time for you and your baby. There
COMMON DIFFICULTIES - ACT should be no need to avoid eating any foods, but if you, your baby’s father
QUICKLY! or any previous children have a history of hayfever, asthma, eczema or
other allergies, avoid eating peanuts and foods containing peanut products
The quicker you sort out any (e.g. peanut butter, unrefined groundnut oils and some snacks, etc.).
difficulties in breastfeeding, the better This may reduce the risk of your baby developing a potentially serious
for you and your baby, so don’t allergy to peanuts. Read food labels carefully, and if you are still in doubt
hesitate to ask for help immediately. about the contents, these foods should be avoided. Some mothers say that
Many women are surprised to find certain foods they eat (e.g. onions, garlic, citrus fruits and grapes) seem to
that most problems are quite easily upset their baby. However, it’s important to check with a health professional
overcome by a slight change to their before you omit foods from your diet because it is possible to become deficient
baby’s position when feeding or by in certain minerals or vitamins by doing this.
feeding their baby more often.
Small amounts of alcohol pass into the breast milk, making it smell
Feeding restlessly different to your baby, and may affect his or her feeding, sleeping or digestion.
If your baby is restless at the breast and So keep within the daily benchmark for women of between 2 and 3 units
doesn’t seem satisfied by feeds, it may or less a day (see page 14). Medicines (prescribed or over the counter) may
be that he or she is sucking on the also pass into breast milk, so check first with your GP to be quite sure.
nipple alone and so not getting enough Always tell your doctor, dentist or pharmacist that you are breastfeeding.
milk. Ask for help in making sure
your baby feeds in the right position. 71
Feeding your baby

breastfeeding counsellor about


EXPRESSING MILK recommended products that can help

Sometimes you may wish Lumpy tender breasts


to express your breast milk This can happen if a milk duct
and leave it in a bottle for becomes blocked. Milk builds up
someone else to give your because the ducts aren’t being
baby if, for example, you emptied. There are a number of
want to go out for the things you can do to help:
evening. Your midwife,
health visitor or breastfeeding
counsellor will show you how Engorged breasts
A few days after the birth, your
• letfirstyour baby feed on the tender breast
or, if he or she doesn’t want
to do it. You can do
it by hand or use a breast breasts may become very swollen to feed, try expressing some milk;
pump. There are different (engorged) and uncomfortable as
types of breast pump, so ask
advice on which to choose.
more milk is produced. The answer
is to breastfeed. If this seems difficult
• while your baby is feeding, gently
stroke the lumpy area with your
If you use a pump, make for any reason, ask your midwife for fingertips, smoothing the milk
sure you sterilise it before help or make sure you have the towards your nipple;
and after use. telephone number of a breastfeeding
To store your breast milk use counsellor. A good supporting bra
will help too, but make sure it isn’t
• try leaning over your baby as you
feed.
a sterile container with a lid,
not the collection jug. Label too tight.
it with the time and date, It’s important to deal with a blocked
and put inside a clean sealed Sore or cracked nipples duct as soon as possible to make sure
bag before storing in the If your nipples are sore when you’re that it doesn’t lead to an infection in
fridge or freezer as soon as feeding, your baby’s position may your breast (mastitis).
possible, away from meat need adjusting. If they are cracked,
products, eggs or any get advice from your midwife, health Mastitis
uncooked foods. visitor or GP as cracked nipples can If you have mastitis, your breasts will
lead to breast infection. The feel hot and tender, and you may
Safe storage following suggestions may also help: feel as though you have flu. If this
The lower the temperature, occurs, continue to breastfeed but
the longer the storage:
• You can store your breast • keep your nipples dry and expose
them to the air as much as you
get a midwife or health visitor to
check your position. Try the
milk for up to 3 days in a suggestions above for lumpy, tender
fridge running below can – try sleeping topless if it’s
warm enough, with a towel breasts and get lots of rest. Go to bed
10ºC. if you can. See your GP if there is no
under you if you’re leaking milk;
• Breast milk can be frozen
and stored in a freezer at
improvement within a day or so as
-18ºC or lower for up to • change your breast pads frequently
(use pads without plastic);
you may need antinflammatories or
antibiotics to clear the infection.
six months. Your doctor can prescribe one
• If your baby has been
ill or born prematurely, • avoid soap as it dries the skin; which is safe to take whilst
breastfeeding.
ask your midwife,
health visitor or doctor • wear a cotton bra which allows
air to circulate;
whether these storage WIND
times are suitable.

For further information


• try squeezing out a drop or two
of your milk at the end of a feed After a feed, gentle back rubbing
contact the Breastfeeding and gently rubbing it into your skin. with your baby lying against your
Network Supporterline shoulder or held a little forward on
0870 900 8787 or If you suddenly get sore and pink your lap may bring up some wind
www.breastfeedingnetwork. nipples after any first soreness has that would be uncomfortable
org.uk passed, you might have an infection otherwise. Don’t worry if you don’t
known as thrush. Go to your GP. get any up. It is not essential. It may
You and your baby will need treatment. even be that there is none to come.
If you develop a crack in the nipple, Sometimes a little milk is brought up
ask your midwife, health visitor or at the same time. This is known as
72 posset and it’s normal.
Feeding your baby

B OT T L E these at the Child Health Clinic or ‘Because Ellen was


any pharmacy. bottle-fed we both fed her.
FEEDING I used to do it in the
SOYA-BASED INFANT FORMULAE evenings and most of the
Bottle feeding may seem like hard feeds at weekends.
work at first until you get into a If you have chosen to bottle feed but We started to do it to
routine of sterilising bottles and your baby cannot tolerate cow’s milk give Karen a rest, but in
preparing feeds. Once you’re formula, your GP or health visitor the end I wanted to do it.
organised, you’ll be able to relax and may have advised that you feed your It brought the baby closer.
really enjoy feeding. Feeding is the baby with a formula based on soya. She’s very close to me
best time to hold your baby close in These formulae are made wholly now.’
your arms and one advantage of from plants and so vegan parents may
bottle feeding is that fathers can prefer to use them instead of cow’s (A FATHER)
share in this enjoyment. milk formulae. Remember though
that breast milk is the best food for
your baby.
ARTIFICIAL MILK There has recently been some ‘When I saw women
(INFANT FORMULA) concern over phytoestrogens, a breastfeeding at my
natural component of the soya postnatal group, I felt
Artificial milk, also called infant bean. There is evidence at present that we’d missed out
formula, usually comes in powder that feeding your baby with soya- by using bottles. I’ll give
form. It is usually cow’s milk that has based formulae may cause problems, breastfeeding a try
been specially treated so that babies and research is being undertaken to next time.’
can digest it. And it has the right give a better understanding of the
balance of vitamins and minerals for effects phytoestrogens have on the
a young baby. Other milks based on body. If you are using soya-based If you are bottle feeding and
soya protein are also available but formulae because of cow’s milk you’re on Income Support or
they are not usually given at this intolerance, remember that babies income-based Jobseeker’s
young age and care should be taken can grow out of allergies so it may be Allowance you can get
as they can be high in sucrose. possible to introduce cow’s milk into tokens for free milk and
Ordinary cow’s milk, condensed your baby’s diet as he or she gets vitamins for your baby (see
milk, evaporated milk, dried milk, older. Do not make any changes to page 135). Vitamins may
goat’s milk, or any other type of milk your baby’s diet without first seeking be recommended from six
should never be given to a baby. advice from your GP or health months or earlier in some
They are not suitable. If you have visitor. cases.
any worries about the milk you are
giving your baby, ask advice from
your midwife, health visitor or GP.
There are a number of different
brands of infant formula available in
the shops. ‘Ready-to-feed’ baby milks
in cartons are also available in some
places. This is generally more
expensive than powdered milk but
may be useful in an emergency or if
you’re away from home. Once opened,
the carton should be stored in the
fridge and thrown away after 24 hours.
Although infant formula contains
vitamins, you may be advised to give
your baby vitamin drops from the
age of six months onwards, or earlier
in some special cases. You can buy 73
Feeding your baby

BOTTLES AND TEATS FEEDING

You’ll need at least six bottles and Your baby will gradually settle into a
teats. This is to make sure that you routine. Babies vary in how often
Feeding is a time for getting always have at least one or two they want to feed and how much
to know your baby and bottles clean, sterilised and ready for they want to take. Some may be
feeling close. But remember, use. Ask your midwife, health visitor content with feeds every three to
even when your baby is a or other mothers if you want advice four hours and others may want
little older, he or she should on what kind to buy. smaller quantities more often.
never be left alone to feed You should always buy new Respond to your baby’s needs and
with a propped-up bottle in teats and it’s best if you can buy feed when he or she is hungry, just
case of choking. new bottles too. Check regularly as you would if you were
to make sure the bottles are in good breastfeeding. In the same way,
condition. If they’re badly scratched, don’t try to force your baby to
you won’t be able to sterilise them finish a bottle. He or she may
properly. If in doubt, ask your have had enough for the time
USING BOTTLED midwife or health visitor for advice. being or simply want a rest.
WATER
The temperature of the milk
If you use bottled water to MAKING UP THE FEED Before you start to feed your baby
make up a feed, for example always check that the milk is not too
on holiday, it must be boiled When you’re preparing infant hot by dripping some on the inside
and then cooled first. Use formula, always follow the of your wrist. Some babies don’t
spring water not mineral instructions on the tin exactly. mind cold milk. Others prefer it
water. Use still water, Remember to put the boiled water warm. If you want to warm the milk
not fizzy. into the bottle first. The milk a little, place the bottle upright in
powder has been very carefully some hot water, keeping the teat out
balanced for your baby, so don’t be of the water. Don’t keep the milk
tempted to add extra powder to warm for more than 20 minutes
make a ‘stronger feed’ as this could before the feed as germs can breed in
be harmful to your baby. Never use the warmth. Never warm the milk
less or more than instructed and in a microwave oven as this is unsafe.
don’t add any other ingredients such The milk continues to heat for a
as sugar, honey, rusks or baby rice. time after you take it out of the
If you’re worried, your midwife microwave, even though the outside
or health visitor will advise you of the bottle may feel cold. The milk
how much milk your baby is likely inside may be very hot and could
to need. If you make up more than scald your baby’s mouth.
your baby wants, throw away what is
left at the end of the feed. You will A comfortable position
probably find it suits your routine Have everything you need ready
to make up a number of feeds in before you start feeding.
advance. Cool the capped bottles Find a comfortable position in
quickly under cold running water which you can hold your baby while
and put them in the fridge as you are feeding. Give your baby
soon as possible. Don’t keep the time. Some babies take some milk,
made up milk for longer than pause for a nap and then wake up
24 hours. for more. So be patient.

74
Feeding your baby

The teat After the feed


As you feed, keep the bottle tilted so Gently rub or pat your baby’s back
that the teat is always full of milk. for a while to see whether there is
Otherwise your baby will be taking any wind to come up. There’s no
in air. If the teat becomes flattened need to overdo this. Wind is not
while you are feeding pull gently on such a problem as many people
the bottle to release the vacuum. If think. But your baby will probably
the teat becomes blocked, replace it enjoy the rubbing and closeness to
with another sterile teat. Teats do you after the feed.
come in different shapes and with Don’t forget to throw away
different hole sizes. You may have to unused milk in the bottle.
try several before you find the one
that suits your baby. If the hole is too Your midwife or health visitor will
small your baby will not get enough chat to you about feeding when they
milk. If it’s too big it will come too call at your home or you could
fast. Check that the teat is not torn telephone them or see them at your PREPARING A FEED
or damaged. Child Health Clinic. Talk to them
about any worries or problems you 1 Make sure your hands
may have. are absolutely clean.

2 Boil some water in the


kettle and let it cool.

3 Take a sterilised bottle


and teat.

4 Take the cooled water


and fill the bottle to the
right place using the
measuring marks.

5 Measure the exact


amount of powder using
the special scoop provided
with the milk. Level off
the powder in the scoop
using a clean dry knife.
Don’t pack the powder
down at all.

6 Add the powder to the


water in the bottle.

7 Screw on the cap and


shake well until the
powder has dissolved.

8 Store the bottle in the


fridge if you’re not using
it straight away.

75
Feeding your baby

CLEANING AND STERILISING

It’s important to keep bottles and Chemical sterilisation


teats, and other equipment used in
feeding, absolutely clean to protect 1 Wash the bottles, teats and other
your baby against infection. This equipment thoroughly in hot
means sterilising as well as washing. water using washing-up liquid.
There are a number of different ways Get rid of every trace of milk
to do this. You can use: using a bottle brush for the inside
of the bottles. You may have been
• several
a chemical steriliser – there are
different brands in the shops,
advised to use salt to clean the
teats, but this is no longer
and consist of a sterilising tank to recommended. Squirt water
which you add cold water and a through the teats. This will make
sterilising tablet or liquid; sure the holes are clear.

• aquick
steam steriliser – this is a very
and efficient method of
2 Rinse thoroughly in clean
running water.
sterilising;
3 To make up the solution, follow
• a microwave bottle steriliser – a
microwave alone is not enough to
the instructions that come with
the sterilising tablets or liquid.
sterilise the bottles without this Put the bottles and teats and
equipment. other equipment (but nothing
metal) in the solution and leave
Ask your midwife, health visitor or for the time given in the
other mothers about the different instructions. The tank will have a
methods and which might be most floating lid that keeps everything
appropriate for you. If you buy under the water or you can use a
equipment, make sure you follow large plate to keep the bottles
the manufacturer’s instructions. immersed. Make sure there are no
air bubbles inside the bottles. Put
the teats and caps in upside down
to prevent air being trapped.
Once the equipment is sterilised
you should not add new items or
the whole solution will be
contaminated.

4 Make sure your hands are


absolutely clean when you take
out the bottles and teats to make
up the feeds. When you take out
the bottles, shake off the water. It
is not necessary to rinse the
bottles but, if you do, use cooled
boiled water. Do not use tap
water as this will make them
unsterile again.

76
9 Problems
Y
our body has a great deal to do during pregnancy. Sometimes
the changes taking place will cause irritation or discomfort, and
on occasions they may seem quite alarming. There is rarely any
need for alarm but you should mention anything that is worrying you to
your doctor or midwife.
If you think that something may be seriously wrong, trust your own
judgement and get in touch with your doctor or midwife straight away.
We have listed, in alphabetical order, the changes you are most likely
to notice and their causes – where these are known – plus suggestions
on how to cope.

COMMON M I N O R P RO B L E M S

BACKACHE
If during or after birth you
During pregnancy ligaments become
softer and stretch to prepare you for
• work at a surface high enough
to prevent you stooping;
have pain in the hips, groin,
lower abdomen and inner
labour. This can put a strain on the thighs and have difficulty
joints of your lower back and pelvis • between
try to balance the weight
two baskets if you are
walking or climbing stairs
which can cause backache. As the you should inform your GP,
carrying shopping;
baby grows, the hollow in your midwife or hospital doctor.
lower back may increase and this
may also cause backache (see box).
• well
sit with your back straight and
supported.
This may be due to a gap in
a joint in the pelvic girdle,
which gaps naturally during
To avoid backache: A firm mattress can help to prevent the birth to allow for the
and relieve backache. If your baby’s head, not closing up.
mattress is too soft, a piece of
• avoid heavy lifting; hardboard under its length will
This condition is known
as Symphysis Pubic
• back
bend your knees and keep your
straight when lifting or
make it firmer.
Massage can also help, or you
Dysfunction (SPD).
It affects very few women
picking something up from the might like to try a support corset – but early diagnosis and
floor; these can be prescribed by your appropriate treatment will
doctor. Make sure you get enough
• heavy,
if you do have to carry something
hold it close to your body;
rest, particularly later in pregnancy.
help to minimise the pain
and avoid long term
If your backache is very painful, discomfort. If you are
• round
move your feet when turning
to avoid twisting your spine;
ask your doctor to refer you to an
obstetric physiotherapist at your
diagnosed with SPD you
can contact The Pelvic
hospital. He or she will be able to Partnership (see page 149)
• weight
wear flat shoes as these allow your
to be evenly distributed;
give you some advice and suggest for support and information.
some helpful exercises.

77
Problems

CONSTIPATION CRAMP

You may become constipated very Cramp is a sudden, sharp pain,


early in pregnancy because of the usually in your calf muscles or feet.
hormonal changes going on in your It is most common at night, but
body. It will help to: nobody really knows what causes it.
It usually helps if you pull your toes
• fibre
make sure you include plenty of
in your diet through eating
hard up towards your ankle or rub
the muscle hard. Regular, gentle
foods like wholemeal breads, exercise in pregnancy, particularly
wholegrain cereals, fruit and ankle and leg movements, will
vegetables, and pulses such as improve your circulation and may
beans and lentils; help to prevent cramp occurring.

• muscles
exercise regularly to keep your
toned up; DISCHARGE FROM BREASTS

• water;
make sure you drink plenty of You may notice a discharge from
your nipples. This is very common
and nothing to worry about.
• constipation
avoid iron pills if they cause
– ask your doctor
However, see your doctor or
midwife if it becomes bloodstained.
whether you can manage without
them or change to a different
type; if not, you may have to FAINTNESS
accept having constipation.
Pregnant women often feel faint.
This happens when not enough
blood is getting to the brain. If the
oxygen level gets too low you may
actually faint. It’s more common in
pregnancy because of hormonal
changes taking place in your body.
You’re most likely to feel faint if you
stand still for too long or get up too
quickly from a chair or hot bath. It
often happens when you are lying
on your back.

• orTrylying
to get up slowly after sitting
down.

• still,
If you feel faint when standing
find a seat quickly and the
faintness will pass. If it doesn’t, lie
down on your side.

• your
If you feel faint while lying on
back, turn on to your side.
It’s better not to lie flat on your
back in later pregnancy or during
labour.
78
Problems

FEELING HOT IN PREGNANCY

During pregnancy you’re likely to or highly spiced ones, but make


feel warmer than normal. This is sure you are still eating well
due to hormonal changes and to an (see pages 8-12 for information
increase in blood supply to the skin. on healthy eating).
You’re also likely to sweat more. It
helps if you: Heartburn is more than just
indigestion. It is a strong, burning
• natural
wear loose clothing made of
fibres, as these are more
pain in the chest. It is caused by the
valve between your stomach and the
absorbent and ‘breathe’ more tube leading to your stomach
than synthetic fibres; relaxing in pregnancy, so that
stomach acid passes into the tube.
• using
keep your room cool – consider
an electric fan;
It is often brought on by lying flat.
To avoid heartburn you could:

• wash frequently to stay fresh. • raising


sleep well propped up – try
the head of your bed with
bricks or have plenty of pillows;
HEADACHES

Some pregnant women find they get


• one
try drinking a glass of milk – have
by your bed in case you wake
a lot of headaches. A brisk walk may with heartburn in the night;
be all you need, as well as a little
more regular rest and relaxation.
Although it is wise to avoid drugs in
• few
avoiding eating or drinking for a
hours before you go to bed;
pregnancy, an occasional paracetamol
tablet is generally considered safe.
If you often have bad headaches,
• advice;
ask your doctor or midwife for

tell your doctor or midwife so that


they can advise you. Severe
headaches may be a sign of high
• mixture
don’t take antacid tablets or
before checking that they
blood pressure (see page 84). are safe in pregnancy.

INDIGESTION AND HEARTBURN ITCHING

This is partly caused by hormonal Mild itching is common in pregnancy


changes and later the growing womb because of the increased blood
pressing on the stomach. If you supply to the skin. In late pregnancy
suffer from indigestion: the skin of the abdomen is stretched
and this may also cause itchiness.
• often;
try eating smaller meals more Wearing loose clothing may help.
Itching can, however, be a sign of
a more serious problem called obstetric
• eating
sit up straight when you are
as this takes the pressure
cholestasis (see page 84). If itching
becomes severe, or you develop
off your stomach; jaundice (yellowing of the whites of
the eyes and skin), see your doctor.
• cause
avoid particular foods which
trouble, for example fried
Itching which is associated with a rash
may also need treatment if it is severe.
79
Problems

NAUSEA AND MORNING


SICKNESS
• Remedies containing ginger
may be helpful.

Nausea is very common in the early


weeks of pregnancy. Some women
• Wear comfortable clothes. Tight
waistbands can make you feel
feel sick, some are sick. Some feel worse.
sick in the mornings, some at other
times, some all day long. If you are being sick all the time and
The reasons are not fully cannot keep anything down then
understood, but hormonal changes inform your doctor or midwife.
in the first three months are probably Some pregnant women experience
one cause. Nausea usually disappears severe nausea and vomiting. This
around the 12th to 14th week. condition is known as hyperemesis
Nausea can be one of the most gravidarum. (See page 149 for
trying problems in early pregnancy. support group.)
It comes at a time when you may be
feeling tired and emotional, and NOSE BLEEDS
when many people around you may
not realise you are pregnant and Nose bleeds are quite common in
expect you to be your normal self. pregnancy because of hormonal
changes. The nose bleeds are usually
• morning,
If you feel sick first thing in the
give yourself time to
short but can be quite heavy. To help
the bleeding stop, press the sides of
get up slowly. If possible, eat your nose together between your
something like dry toast or a plain thumb and forefinger just below the
biscuit before you get up. Your bony part of your nose for ten
partner could bring you some minutes. Repeat for a further ten
sweet tea. minutes if this is unsuccessful. As
long as you don’t lose a lot of blood,
• whenever
Get plenty of rest and sleep
you can. Feeling tired
there is nothing to worry about.
Blow your nose gently and try to
can make the sickness worse. avoid explosive sneezes. You may
also find that your nose gets more
• than
Eat small amounts often rather
several large meals, but don’t
blocked up than usual.

stop eating.
PASSING WATER OFTEN
• Drink plenty of fluids. Needing to pass water often is an
early sign of pregnancy. Sometimes it
• support.
Ask those close to you for extra
continues right through pregnancy.
In later pregnancy it’s the result of
the baby’s head pressing on the
• can.
Distract yourself as much as you
Often the nausea gets worse
bladder.
If you find that you’re having to
the more you think about it.
get up in the night, you could try
cutting out drinks in the late
• make
Avoid the foods and smells that
you feel worse. It helps if
evening but make sure you keep
drinking plenty during the day.
someone else can cook but, if
Later in pregnancy, some women
not, go for bland, non-greasy
find it helps to rock backwards and
foods such as baked potatoes,
forwards while they are on the toilet.
pasta and milk puddings, which
This lessens the pressure of the
80 are simple to prepare.
womb on the bladder so that you
Problems

can empty it properly. Then you


won’t need to pass water again quite
• your
take regular exercise to improve
circulation;
so soon.
If you have any pain while passing
water, or pass any blood, you may
• slightly
sleep with the foot of the bed
raised on books or bricks;
have a urine infection which will
need treatment. Drink plenty of
water to dilute your urine and
• discomfort,
use an ice pack to ease
holding this gently
reduce irritation. You should contact against the piles, or use a cloth
your GP within 24 hours. wrung out in iced water;
Sometimes pregnant women are
unable to prevent a sudden spurt of
urine or a small leak when they
• gently
if the piles stick out, push them
back inside using a
cough, sneeze or laugh, or when lubricating jelly;
moving suddenly or just getting up
from a sitting position. This may be
temporary because the pelvic floor
• pharmacist
ask your doctor, midwife or
if they can suggest a
If you sometimes can’t help
wetting or soiling yourself,
muscles relax slightly to prepare for suitable ointment; you can get help.
the baby’s delivery. Incontinence is a very
The growing baby will increase
pressure on the bladder. If you find
• where
consider giving birth in a position
the pressure on your back
common problem. It can
affect anyone, sometimes
this a problem, you can improve the passage is reduced – kneeling, for during and after pregnancy.
situation by doing exercises to tone example. In many cases it is curable,
up your pelvic floor muscles (see so if you’ve got a problem
page 16). Ask a midwife or obstetric talk to your doctor,
physiotherapist (see pages 62 and 63) SKIN AND HAIR CHANGES midwife or health visitor,
for advice. or ring the confidential
Hormonal changes taking place in Continence Foundation
PILES pregnancy will make your nipples on 020 7831 9831
and the area around them go darker. (9.30a.m.–1p.m. Mon–Fri).
Piles, also known as haemorrhoids, Your skin colour may also darken a
are swollen veins around the back little, either in patches or all over.
passage which may itch, ache or feel Birthmarks, moles and freckles may
sore. You can usually feel the also darken. Some women develop a
lumpiness of the piles around the dark line running down the middle
back passage. Piles may also bleed a of their stomachs. These changes
little and they can make going to the will gradually fade after the baby has
toilet uncomfortable or even painful. been born, although your nipples
They occur in pregnancy because may remain a little darker.
the veins relax under the influence If you sunbathe while you are
of pregnancy hormones. Piles usually pregnant, you may find you tan
go shortly after delivery. If you suffer more easily. Protect your skin with
from piles you should: a good, high-factor sunscreen.
Don’t stay in the sun for very long.
• fibre,
eat plenty of food that is high in
like wholemeal bread, fruit
Hair growth is also likely to
increase in pregnancy. Your hair may
and vegetables, and you should also be greasier. After the baby is
drink plenty of water – this will born it may seem as if you’re losing a
prevent constipation, which can lot of hair. In fact, you’re simply
make piles worse; losing the increase that occurred
during pregnancy.
• avoid standing for long periods; 81
Problems

It might be more comfortable


to lie on one side with a
pillow under your tummy and
another between your knees.
SLEEPLESSNESS to gather in the lowest parts of the
body. You should:
Late in pregnancy it can be very
IF YOU AREN’T
SLEEPING WELL
difficult to get a good night’s sleep.
You’re uncomfortable lying down,
• periods;
try to avoid standing for long

or just when you’re beginning to get


• you.
Try not to let it bother
Don’t worry that it
comfortable you have to get up to
go to the toilet. Some women have
• wear comfortable shoes;
will harm your baby – it
won’t.
strange dreams or nightmares about
the baby and about the birth. Talking
• –puttryyour feet up as much as you can
to rest for an hour a day with
about them can help you. Just because your feet higher than your heart;
• comfortable
It might be more you dream something, it doesn’t mean
to lie on
one side with a pillow
it’s going to happen. Relaxation and
breathing which are taught in
• page
try to do your foot exercises (see
17) – these will help.
under your tummy and antenatal classes might be helpful.
another between your
knees. TEETH AND GUMS
STRETCH MARKS
• Relaxation techniques
may help. Your antenatal These are pink or purplish lines
Bleeding gums are caused by a
build-up of plaque (bacteria) on the
class (see pages 64–5) which usually occur on the tummy teeth. During pregnancy, hormonal
may teach relaxation or sometimes on the upper thighs or changes in your body can cause the
techniques, or you could breasts. Some women get them, plaque to make the gums more
borrow a cassette from some don’t. It depends on your skin inflamed. They may become swollen
your library. type. Some people’s skin is more and bleed more easily. To keep your
elastic. You are more likely to get teeth and gums healthy, you should:
• warm
A warm, milky drink, a stretch marks if your weight gain is
bath, some gentle
exercise or some restful
more than average.
It’s very doubtful whether oils or
• your
pay special attention to cleaning
teeth. Ask your dentist to
music before bedtime may creams help to prevent stretch marks. show you a good brushing
help. After your baby is born the marks method to remove all the plaque;
should gradually pale and become
• can
A rest during the day
help you to feel
less noticeable. • foods
avoid having sugary drinks and
too often. Try to keep them
less tired. only to meal times;
SWOLLEN ANKLES, FEET
• Talk to your partner,
a friend, doctor or
AND FINGERS • isremember that dental treatment
free while you are pregnant
midwife. Ankles, feet and fingers often swell a and for a year after your baby’s
little in pregnancy because the body birth, so have a check-up now;
holds more water than usual. Towards
the end of the day, especially if the
weather is hot or if you have been
• any
discuss with your dentist whether
new or replacement fillings
standing a lot, the extra water tends should be delayed until after your
82 baby is born.
Problems

VAGINAL DISCHARGE TI R E D N E S S

Almost all women have more vaginal


discharge in pregnancy. It should be
• crossed;
try not to sit with your legs In the early months of
pregnancy you may feel tired
clear and white and it should not or even desperately
smell unpleasant. If the discharge is
coloured or smells strange or if you
• weight
try not to put on too much
as this increases the
exhausted. The only answer
is to try to rest as much as
feel itchy or sore, you may have a pressure; possible. Make time to sit
vaginal infection. Tell your doctor or with your feet up during the
midwife. The most common
infection is thrush, which your
• you
sit with your legs up as often as
can to ease the discomfort;
day and accept any offers of
help from colleagues and
doctor can treat easily. You can help family. Towards the end of
prevent thrush by wearing loose
cotton underwear.
• help
try support tights which may also
support the muscles of your
pregnancy, you may feel
tired because of the extra
If vaginal discharge, of any colour, legs – you can buy them at most weight you are carrying.
increases a lot in later pregnancy, pharmacists; Make sure you get plenty
tell your doctor or midwife. of rest.
• than
try sleeping with your legs higher
the rest of your body – use
VARICOSE VEINS pillows under your ankles or put
bricks or books under the foot of
Varicose veins are veins which have your bed;
become swollen. The veins in the
legs are most commonly affected.
You can also get varicose veins in
• and
do foot exercises (see page 17)
other antenatal exercises
the vulva (vaginal opening). which will all help your
They usually get better after delivery. circulation, such as walking,
You should: cycling, and swimming.

• periods
try to avoid standing for long
of time;

MORE S E R I O U S P RO B L E M S

SLOW-GROWING BABIES

Many of the tests in pregnancy check In the last weeks of pregnancy you
the growth of your baby. If you have may also be asked to keep track of
previously had a very small baby, or if your baby’s movements. If you
you smoke heavily, the midwives and notice your baby’s movements
doctors will already be monitoring becoming less frequent or slowing
your pregnancy closely. Blood down, or if they stop, contact your
pressure checks may also pick up midwife or doctor immediately.
signs of trouble. If there is concern If tests show that your baby is not
about your baby’s health, further tests growing well in the womb, early
may be carried out and more delivery by induction of labour or
frequent monitoring of your baby Caesarean section (see pages 101–2)
may be recommended. may be recommended.

83
Problems

HIGH BLOOD PRESSURE AND Bleeding after about five months


OTHER SYMPTOMS PRE-ECLAMPSIA may be a sign that the placenta is
implanted in the lower part of the
You should contact your GP During pregnancy your blood
uterus (placenta praevia) or that it
if you have a sudden ‘acute’ pressure will be checked at every
has started to separate from the
illness like diarrhoea, antenatal appointment. This is
uterus (placental abruption). Both of
vomiting, abdominal pain or because a rise in blood pressure can
these can be dangerous for you and
a high fever. be the first sign of a condition
the baby, so contact your midwife or
known as pre-eclampsia – often
doctor immediately.
called pregnancy-induced
The cells on the surface of the
hypertension (PIH) or pre-eclampsia
cervix often change in pregnancy
(PE) – which can run in families and
and make it more likely to bleed,
affects 10% of pregnancies. Your
particularly after intercourse. This is
urine will also be checked for
called a cervical erosion. Vaginal
protein.
If you do have pre-eclampsia, you infections can also cause a small
will probably feel perfectly well. amount of vaginal bleeding.
Some women experience symptoms Some causes of vaginal bleeding
such as headaches, visual are more serious than others, so it’s
disturbances, swelling and abdominal important to find the cause straight
pain. Pre-eclampsia can still be away. The most common sort of
bleeding in late pregnancy is the
DEEP VEIN severe, however, without any
small amount of blood mixed with
THROMBOSIS (DVT) symptoms at all. Although most
cases are mild and cause no trouble, mucus, known as a ‘show’. This is a
DVT is a serious condition it can get worse and be serious for sign that the cervix is changing and
where clots develop in the both mother and baby. It can cause becoming ready for labour to start. It
deep veins of the legs. It can fits in the mother (eclampsia) and may happen a few days before
be fatal if the clot travels affect the baby’s growth, and be contractions start or during labour
from the legs to the lungs. life-threatening if left untreated. itself. You should always report this
That is why routine antenatal to your doctor or midwife as soon as
Flights over five hours where it occurs.
you sit still for a long time checks are so important.
may increase the risk. Pre-eclampsia usually happens SEVERE ITCHING AND
towards the end of pregnancy, but OBSTETRIC CHOLESTASIS
Pregnant women and women problems can occur earlier. Rarely, it
who have recently had a baby can happen after the birth. The earlier Although itching is very common
are amongst those more at in pregnancy it starts, the more severe in normal pregnancy, severe
risk. If you intend to travel by it is likely to be. If it does get worse, generalised itching, without a rash,
air consult your GP or mid- the treatment ranges from rest at particularly in the last four months
wife before the trip. Get advice home or in hospital to drugs to lower of pregnancy, may be the only sign
on in-seat exercises to keep the high blood pressure or, of an uncommon condition called
your circulation active. After occasionally early delivery of the baby. obstetric cholestasis. This is a
the 28th week of pregnancy potentially dangerous liver disorder
most airlines require a letter
VAGINAL BLEEDING which seems to run in families,
from your GP or midwife to Bleeding from the vagina at any time although it can occur without any
say that you are fit to travel. in pregnancy can be a danger signal. In family history. It is important to
early pregnancy, bleeding may be a contact your doctor if you have
If you develop swollen troublesome itching because
sign of an ectopic pregnancy or a
painful legs or have breathing obstetric cholestasis may lead to
miscarriage (see page 104), although
difficulties after the trip go to premature labour, stillbirth or serious
many women who bleed at this time
your doctor or your nearest health problems for the baby, and
go on to have normal and successful
Accident and Emergency to an increased risk of maternal
pregnancies. If you have bleeding with
department immediately. haemorrhage after the delivery.
pain contact your GP straight away.
84
10 What
you need
for the baby
T
his is a list of essential items you need to get before your baby is
born, and some others that you may want to think about. You NAPPY LAUNDERING
may be able to borrow some of these items and then pass them SERVICE
on later to another baby. Look out for secondhand equipment too but There may be a nappy
do check that it is safe. Ask your health visitor if you’re in doubt. laundering service near you.
They deliver freshly
laundered nappies to your
NAPPIES Some cloth nappies have the
waterpoof wraps attached; home and take away the
soiled ones to wash each week.
CHOOSING NAPPIES • sterilising
a bucket with a lid and nappy
powder or liquid for
They supply everything you
need – wraps, liners and
There is a range of nappies to choose sterilising nappies. storage bin. See page 149
from. You can buy washable cloth for suppliers.
nappies to wash at home or send CHANGING NAPPIES
to a nappy laundry service or buy
disposable nappies. You’ll need:

Disposable nappies cost more to


use but they save time and are useful • white,
cotton wool – always choose
and rolls are cheaper;
if washing and drying are a problem
where you live. • useful
a plastic changing mat is very
and convenient but you
Washable cloth nappies are
cheaper to use, even taking into can make do with a piece of
account the cost of washing them. waterproof sheet over an old towel;
They are more environmentally
friendly and are easily laundered in a
• water
baby lotion or baby wipes –
is fine and cheap for
60 degree wash. You can get shaped cleaning your baby’s bottom, but
washable nappies with velcro or lotion or wipes can be convenient, SA F E T Y
popper fastenings and waterproof especially when you’re out; The safest place to change a
wraps.
For cloth nappies you will need:
• prevent
baby barrier cream to help
nappy rash – though the
nappy is on a mat on the
floor. If you use a higher
best way to prevent this is by surface keep your hand on
• nappy pins; changing and cleaning your baby’s your baby at all times in
• ornappy liners – either disposable
cloth, which you can wash and
bottom well and often; case he or she rolls off.

use again; • nappy-changing


a changing bag to carry all the
equipment when
• either
plastic pants – about four pairs,
tie-on or elasticated. Tie-
you go out. A carrier bag will do
but you can get special changing
on ones fit small babies better. bags that include a changing mat. 85
What you need for the baby

COT SAFETY
B AT H I N G
Your baby will spend many hours
• long
Any large, clean bowl will do as
as it’s not metal. Or you can
alone in a cot so make sure it’s safe.

always use the sink, but


remember to wrap a towel round
• noThespace
mattress must fit snugly with
for a baby’s head to get
the taps for safety. stuck.

• which
You need baby soap or liquid
can also be used on babies’
• securely
The bars must be smooth,
fixed and the distance
hair. Ordinary toilet soap may between each bar should be not
irritate your baby’s skin. It isn’t less than 25 mm and not more
necessary to use baby shampoo. than 60 mm so that your baby’s
head can’t become trapped.
• There’s
Two towels, the softer the better.
no need for special baby
towels, unless you want them.
• The cot should be sturdy.
SA F E T Y Keep the towels for your baby’s
use only.
• smoothly
The moving parts should work
and not allow fingers or
Pillows and duvets are not clothing to become trapped.
safe for babies less than a
year old because of the risk SLEEPING • recommended
Cot bumpers are not
of suffocation. Duvets can as babies can
also make the baby too hot. For the first few months, you will overheat or become entangled
Baby nests and quilted need a crib, a carry cot or a Moses in the fastenings.
sleeping bags are not suitable basket. Your baby just needs
for your baby to sleep in at
any time when you are not
somewhere to sleep that is safe and
warm and not too far away from
• bibs,
Never leave anything with ties –
clothes, etc. – in the cot in
there, again because of the you. You also need: case they get caught around your
danger of suffocation. baby’s neck.
• the
a firm mattress which must fit
cot snugly, without leaving
spaces round the edges – the baby
• for
If you’re buying a new cot, look
the British Standard mark BS
could trap his or her head and 1753.
suffocate. It’s best if the mattress
has a built-in plastic cover but, if See page 121 for more information
not, you can put a waterproof on reducing the risk of cot death.
sheet under the bottom sheet Spend some time looking at what is
(never use thin plastic or a bin
liner as your baby could suffocate
in the loose folds);

• need
sheets to cover the mattress – you
at least four because they
need to be changed so often –
fitted sheets make life easy but
they are quite expensive; you
could use pieces of old sheet or
pillow cases instead;
This baby is sleeping in the ‘feet to foot’ position (see

• and
several light blankets for safety
warmth.
page 121). This means that the baby’s feet are right at
the end of the cot to prevent the baby wriggling under
86 the covers and overheating.
What you need for the baby

OUT AND ABOUT

available for getting your baby around transport.


and thinking about what will suit Before buying a
you best before making a choice.
You could always ask other mothers
• space
Prams give your baby a lot of
to sit and lie comfortably
pushchair or pram,
etc. check that:
what they have found useful. although they take up a lot of
space and cannot be used on • the brakes are sound;
• are
Baby carriers (also called slings) public transport. If you have a car
attached with straps and your
baby is carried in front of you.
look for a pram which can be
dismantled easily. Buy a pram
• right
the handles are at the
height for pushing;
Most babies like being carried harness at the same time as you
like this because they’re close to
you and warm. The back part of
will soon need it. • enough.
the frame is strong

the carrier must be high enough


to support your baby’s head.
• baby
Carry cot on wheels – your
can sleep in the carry cot for
Check that buckles and straps are the first few months and the cot
secure. Older babies who can can be attached to the frame to
hold up their heads and whose go out. It can also be taken in a
backs are stronger (at about four car with appropriate restraints.
months) can be carried in
backpacks. • cot
Three-in-one – this is a carry
and transporter (set of wheels)
• young
Pushchairs are only suitable for
babies if they have fully
that can be converted into a
pushchair when your baby
reclining seats which let the baby outgrows the carry cot.
lie flat. Wait until your baby can
sit up before using any other type
of pushchair. You should also
• the
Shopping trays which fit under
pushchair or pram can be
consider the weight of the very useful when you’re out.
pushchair if you use public

87
What you need for the baby

IN THE CAR C L OT H E S
F O R T H E BA B Y
If you’ve got a car, you must have a
safety restraint right from the start,
even coming home from the Babies grow very quickly. All you
hospital. It’s very dangerous to carry need for the first few weeks are
your baby in your arms, and illegal. enough clothes to make sure that
The best way for your baby to travel your baby will be warm and clean.
is in a rear-facing infant baby You’ll probably need:
restraint (car seat) either on the front
or back seat. This is held in place by
the adult safety belt. Make sure it’s
• night
six stretch suits for both day and
or four stretch suits and two
correctly fitted. Do not place a rear- nighties for the night – use socks
If your car has an airbag do facing infant baby restraint in the or bootees with the nightie if it’s
not place your baby restraint front passenger seat if your car is cold;
in the front seat. fitted with an air bag.
Do not buy a secondhand car seat
as it may have been damaged in an
accident. Look for European Standard
number R44/03 when you buy.

FEEDING
If you’re breastfeeding you will
probably want nursing bras. They
WASHING BABY should open at the front and have
CLOTHES adjustable straps. Cotton is best
because it allows air to circulate. If
If you use a washing you try on bras at about 36 to 38
machine, don’t use enzyme
(bio) powders, as they may
weeks they should fit when needed
later.
• rather
two cardigans, wool or cotton
than nylon, light rather
irritate your baby’s skin. A supply of breast pads may also than heavy – several light layers
Always rinse very thoroughly. be useful. of clothing are best for warmth;
Fabric softener may also If you’re going to bottle feed, you
cause a skin reaction. will need to get: • four vests;
• six bottles with teats and caps; • baby
a shawl or blanket to wrap your
in;
• sterilising equipment;
• mittens,
a woolly or cotton hat,
• a bottle brush ; socks or bootees for
going out if the weather is cold –
• this too far in advance and
infant formula milk – don’t buy it’s better to choose close-knitted
patterns for safety;
remember to check the ‘sell by
date’ on the pack. • weather
a sun hat for going out if the
is hot or the sun is
bright.
88
11 Labour
and birth
T
his chapter describes a hospital birth because that is where most
people have their babies, but the information will also be useful if
you are having a home birth.

GETTING R E A DY F O R T H E B I RT H
IMPORTANT
NUMBERS
PACKING FOR HOSPITAL • your washbag with toothbrush,
hairbrush, flannel, etc.; Keep a list of important
Pack a bag to take to hospital well in numbers in your handbag
advance. Many hospitals have a
printed list of what to pack. If you’re
• towels in a dark colour if possible; or near the phone. There’s
space for you to write them
having your baby at home your
midwife will give you a list of things
• hospital
change or a phone card for the
payphone;
down at the beginning of
this book.You need to include
you should have ready. your hospital or midwife,
You may want to include the
following:
• stereo
a book, magazines, personal
or some knitting, for
your partner or birth
companion, and your own
example, to help you pass the hospital reference number
• going
front-opening nighties if you’re
to breastfeed and an extra
time and relax; (it will be on your card or
notes) to give when you
one if you’re going to wear your
nightie, rather than a hospital
• wear
a loose comfortable outfit to
during the day;
phone in. If you don’t have
a phone, ask neighbours for
gown, during labour; the use of theirs when the
• ora small bag for labour with one time comes.
• dressing gown and slippers; two large T-shirts, a sponge or
water spray to cool you down, a STOCKING UP
• ordinary
two or three nursing bras, or
bras if you’re not
personal stereo with your
favourite music and anything else When you come home you
breastfeeding (remember, your which you feel will make labour may not want to do much
breasts will be much larger than more pleasant for you; more than rest and care for
usual); your baby, so do as much
• clothes and nappies for the baby. planning as you can in
• absorbent),
about 24 sanitary towels (super
not tampons;
advance. Stock up on basics
such as toilet paper, sanitary
For coming home pads (for you) and nappies
• five or six pairs of old pants, or
disposables – you’ll probably want
Pack loose, easy-to-wear clothes for
yourself, baby clothes (including a
(for the baby) and, if you
have a freezer, cook some
to change often to stay fresh; bonnet), some nappies and a shawl meals in advance.
or blanket to wrap the baby in.
89
Labour and birth

TRANSPORT

Work out how you will get to the


hospital as it could be at any time
of the day or night. If you’re
planning to go by car, make sure it’s
running well and that there’s always
enough petrol in the tank. If a
neighbour has said that they will
probably be able to take you, make
an alternative arrangement just in
case they’re not in. If you haven’t
got a car, call an ambulance – try to
do so in good time.

H OW TO R E C O G N I S E
W H E N L A B O U R S TA RT S

IF LABOUR
You’re unlikely to mistake the signs
of labour when the time really
• astarts,
‘show’ – either before labour
or early in labour, the plug
STARTS EARLY comes but, if you’re in any doubt, of mucus in the cervix, which has
don’t hesitate to contact your helped to seal the womb during
Sometimes labour starts hospital or midwife and ask for pregnancy, comes away and comes
early, even as early as 24 advice. out of the vagina. This small
weeks. If this happens, get amount of sticky pink mucus is
advice immediately from the called a ‘show’ – you don’t lose a
hospital. SIGNS THAT LABOUR lot of blood with a show, just a
IS BEGINNING little, mixed with mucus. If you
are losing more blood, it may be a
Regular contractions sign that something is wrong, so
You may have been feeling telephone your hospital or
contractions (Braxton Hicks’ midwife straight away;
contractions) – when your abdomen
gets tight and then relaxes –
throughout pregnancy. Lately you
• water
the waters breaking – the bag of
in which the baby is
will have become more aware of floating may break before labour
them. When they start to come starts (you could keep a sanitary
regularly, last more than 30 seconds pad (not a tampon) handy if you’re
and begin to feel stronger, labour going out, and put a plastic sheet
may have started. Gradually they will on the bed). If the waters break
become longer, stronger and more before labour starts, you will
frequent. notice either a slow trickle from
your vagina or a sudden gush of
Other signs of labour water that you can’t control –
You may or may not also have the phone the hospital or your
following signs: midwife, and you will probably
be advised to go in at once;
• feeling
backache or that aching, heavy
that some women get
with their monthly period;
• nausea or vomiting;
90 • diarrhoea.
Labour and birth

PA I N RELIEF IN LABOUR

Labour is painful, so it’s important to You’ll probably have a chance ‘Gas and air seemed to
learn about all the ways you can to practise using the mask or work for me, provided I
relieve pain in labour and how your mouthpiece if you attend an used it at the right time.
partner or labour supporter can help antenatal class. ‘Gas and air’ won’t The midwife was really
you. Ask your midwife or doctor to remove all the pain but it can help good and helped me with
explain what is available so that you by reducing it and making it easier my timing.’
can decide what is best for you. Write to bear. Many women like it because
down your wishes in your birth plan, it’s easy to use and you control it
but remember you may need to be yourself. The gas takes 15 to 20
flexible. You may find that you want seconds to work, so you breathe it in
more pain relief than you had planned just as a contraction begins. There
and more effective pain relief may be are no harmful side-effects for you
advised to assist with delivery. or the baby, but it can make you feel
lightheaded. Some women also find
that it makes them feel sick or sleepy
TYPES OF PAIN RELIEF or unable to concentrate on what is ‘I didn’t want to
happening. If this happens you can have any injections or
Self-help simply stop using it. anything, so my midwife
If you try ‘gas and air’ and find told me about TENS. It
that it does not give you enough sounded a bit weird when
pain relief, you can ask for an she told me what it was
injection as well. but, when the time came,
it actually did seem to
TENS work.’

Using relaxation, breathing, keeping


mobile, having a partner to support
and massage you, and having confidence
in your own body will all help.

‘Gas and air’ (Entonox)

This stands for transcutaneous


electrical nerve stimulation and is
offered at some hospitals. In others
you may need to hire a machine. It
lessens the pain for many, but not all,
This is a mixture of oxygen and another women.
gas called nitrous oxide. You breathe There are no known side-effects
it in through a mask or mouthpiece for either you or the baby and you
which you hold for yourself. can move around while using it.
91
Labour and birth

Electrodes are taped on to your back always available at your hospital.


and connected by wires to a small While you lie on your side,
battery-powered stimulator known anaesthetic is injected into the space
as an ‘obstetric pulsar’. You hold the between the bones in your spine
pulsar and can give yourself small, through a very thin tube. It takes
safe amounts of current. about 20 minutes to get the tube
It is believed that TENS works by set up and then another 15 to 20
stimulating the body to increase minutes for it to work. The anaesthetic
production of its own natural can then be pumped in continuously
painkillers, called endorphins. It also or topped up when necessary.
reduces the number of pain signals
that are sent to the brain by the
spinal cord. If you’re interested in
TENS you should learn how to use
it in the later months of your
pregnancy. Ask your midwife or
physiotherapist.

‘After the first injection, Injections


I felt wonderful, there Another form of pain relief is the
was no pain and I was intramuscular injection of a pain-
on cloud nine. But after relieving drug, usually pethidine. It
the second one, and some takes about 20 minutes to work and
gas, I felt confused and the effects last between two and four
out of control, which hours. It will help you to relax and An epidural can be very helpful
I think extended some women find that this lessens for those women who are having a
the labour.’ the pain. However, it can make long or particularly painful labour or
some women feel very ‘woozy’, sick who are becoming very distressed. It
and forgetful. If it hasn’t worn off takes the pain of labour away for
when you need to push, it can make most women and you won’t feel so
it difficult. You might prefer to ask tired afterwards. But there are
for half a dose initially to see how it disadvantages:
works for you. If pethidine is given
too close to the time of delivery, it
may affect the baby’s breathing, but
• sometimes
your legs may feel heavy and that
makes women feel
if it does an antidote will be given. rather helpless and unable to get
into a comfortable position;

Epidural anaesthesia
An epidural is a special type of local
• water
you may find it difficult to pass
and a small tube called a
‘I was really scared anaesthetic. It numbs the nerves catheter may need to be put into
about the pain so which carry the feelings of pain from your bladder to help you;
I chose to have an the birth canal to the brain. So, for
epidural. It was
great – I didn’t
most women, an epidural gives
complete pain relief.
• your
you will need to have a drip on
arm to give you fluids and
feel a thing!’ An epidural is given by an help maintain adequate blood
anaesthetist so, if you think you pressure;
might want one, check with your
midwife beforehand (perhaps when
you’re discussing your birth plan)
• bed
you may not be able to get out of
during labour and for several
about whether an anaesthetist is hours afterwards;
92
Labour and birth

• heart
your contractions and the baby’s
will need to be
to let the hospital
know beforehand.
continuously monitored by a Discuss the matter
machine. This means having a with the midwife or
belt round your abdomen and doctor. And make sure
possibly a clip attached to your that the practitioner
baby’s head (see Fetal heart you use is properly
monitoring, page 96); trained and
experienced. For
• contractions,
if you can no longer feel your
the midwife will
advice, contact the
Institute for
have to tell you when to push Complementary
rather than you doing it naturally Medicine (see
– sometimes less anaesthetic is page 147).
given at the end so that the
effect of the epidural wears off
and you can push the baby out
more effectively;
WHAT YOU CAN DO FOR YOURSELF
• some
some women get backache for
time after having an Fear makes pain worse and everyone feels frightened of what they
epidural. don’t understand or can’t control. So learning about labour from
antenatal classes, from your doctor or midwife, and from books like
In some hospitals, a mobile or this, is an important first step.
‘walking’ epidural is available. The
anaesthetist gives a different
combination of drugs which allows
• can
Learning to relax helps you to remain calmer and birth classes
teach ways of breathing that may help with contractions.
you to move your legs whilst still
providing effective pain relief. Ask if
this is available in your hospital.
• kneel,
Your position can also make a difference. Some women like to
walk around or rock backwards and forwards. Some like
If you don’t want any of these to be massaged, but others hate to be touched.
kinds of pain relief, you are free to
say so. And if you decide you do
want pain relief, ask for it as soon as
• areFeeling in control of what is happening to you is important. You
working with the midwife and she with you, so don’t
you feel you need it, without hesitate to ask questions or to ask for anything you want at any
waiting for it to be offered. time.

ALTERNATIVE METHODS
• can
Having a partner, friend or relative you can ‘lean on’, and who
support you during labour certainly helps. It has been shown
OF PAIN RELIEF to reduce the need for pain relief. But if you don’t have anyone,
don’t worry – your midwife will give you the support you need.
Some mothers want to avoid the
above methods of pain relief and
choose acupuncture, aromatherapy,
• inAndadvance.
finally, no one can tell you what your labour will feel like
Even if you think you would prefer not to have any
homeopathy, hypnosis, massage and pain relief, keep an open mind. In some instances, it could help
reflexology. If you would like to use to make your labour more enjoyable and fulfilling.
any of these methods, it’s important

93
Labour and birth

COPING AT THE BEGINNING

At night, try getting comfortable and


KEEPING ACTIVE relaxed and perhaps doze off to sleep.
A warm bath or shower may help
Keep active for as long as you to relax. During the day, keep
you feel comfortable. This upright and gently active. This helps
helps the progress of the the baby to move down into the
birth. Keeping active doesn’t pelvis and the cervix to dilate. It’s
mean anything strenuous – important to have something light
just moving normally or to eat to give you energy, as labour,
walking around. particularly a first one, may last 12
to 15 hours from the early stages to
delivery.

WHEN TO G O I N TO H O S P I TA L
OR GP O R M I DW I F E U N I T

If your waters have broken you will first baby, go sooner and make sure
probably be advised to go straight in. you leave plenty of time to get to
If your contractions start but your the hospital. Second and later babies
waters have not broken and you live often arrive more quickly. Don’t
near to the hospital or unit, wait forget to phone the hospital or
until they are coming regularly, unit before leaving home and
about five minutes apart, lasting remember your notes or card.
about 60 seconds, and they feel so If you’re at all uncertain about
strong that you want to be in whether or not it is time for you to
hospital. If the journey is likely to go into hospital, always telephone
take a while, either because of traffic the hospital or unit or your midwife
or the distance, or if this is not your for advice.

HOME/DOMINO DELIVERY

Follow the procedure you have


agreed with your midwife during
your discussions about the onset
of labour.

94
Labour and birth

AT T H E H O S P I TA L

Going into hospital when you are in


labour may be frightening, but
• examination
probably do an internal
to find out
attending antenatal classes and how much your cervix
visiting the hospital during has opened (tell her if a
pregnancy should help. Hospitals and contraction is coming so
GP or midwife units all vary, so this that she can wait until it
is just a guide to what is likely to has passed), and she will
happen. Talk to your midwife about then be able to tell you
the way things are done at your local how far your labour has
hospital or unit and what you would progressed.
like for your birth. If your wishes
can’t be met, it’s important to These checks will be repeated at
understand why (see Birth plan, intervals throughout your labour –
page 37). always ask about anything you want
to know. If you and your partner
have made a birth plan, show your
YOUR ARRIVAL midwife so that she knows your
views about your labour and can
If you carry your own notes, take help you to achieve them. Many
them to the hospital admissions desk. women find that they naturally
You will be taken to the labour empty their bowels before, or very
ward, where a midwife will take you early, in labour. Very occasionally,
to your room and help you change if you are constipated, a suppository
into a hospital gown or a nightdress may be suggested.
of your own. Choose an old one
that is loose and preferably made of DELIVERY ROOMS
cotton because you’ll feel hot during
labour and won’t want something Some hospitals may have one or two delivery rooms decorated in a
tight. more homely way, with easy chairs and beanbags so that you can
easily move around and change your position during labour. Talk to
your midwife about this and write your wishes in your birth plan (see
EXAMINATION BY THE MIDWIFE page 38).

The midwife will ask you about BATH OR SHOWER


what has been happening so far and
will examine you. If you are having Some hospitals may offer you a bath or shower. A warm bath can be
a Domino or home delivery, then soothing in the early stages of labour. In fact, some women like to
this examination will take place at spend much of their labour in the bath as a way of easing the pain.
home. The midwife will:
WATER BIRTHS
• blood
take your pulse, temperature and
pressure and check your Some hospitals have birthing pools available (or you may be able to
urine; hire one) so that you can labour in water. Many women find that this
helps them to relax. If labour progresses normally it may be possible to
• baby’s
feel your abdomen to check the
position and record or
deliver the baby in the pool. This method is currently being studied,
so speak to your midwife and obstetrician about the advantages and
listen to your baby’s heart; disadvantages. You’ll need to make arrangements well in advance.

95
Labour and birth

W H AT HAPPENS IN LABOUR

There are three stages to labour. In puffs. Some people find this easier
WHAT YOU CAN DO the first stage the cervix gradually lying on their sides, or on their
opens up (dilates). In the second elbows and knees, to reduce the
• moving
You can be up and
about if you
stage the baby is pushed down the
vagina and is born. In the third stage
pressure of the baby’s head on the
cervix.
feel like it. the placenta comes away from the
wall of the womb and is also pushed Fetal heart monitoring
• You may be able to have
sips of water, but once in
out of the vagina. Every baby’s heart is monitored
throughout labour. The midwife is
established labour you watching for any marked change in
will usually be asked not THE FIRST STAGE the heart rate which could be a sign
to eat anything. This is that the baby is distressed and that
mainly in case you need The dilation of the cervix action should be taken in order to
an anaesthetic later on. Contractions at the start of labour speed delivery. There are different
Some units, however, help to soften the cervix. Then the ways of monitoring the baby’s
allow fluids and/or a cervix will gradually open to about heartbeat.
light diet. 10 cm. This is wide enough to let
the baby out and is called ‘fully • baby’s
Your midwife may listen to the
• while
If you need the midwife
she is out of the
dilated’. Sometimes the process of
softening can take many hours
heart intermittently with
a hand-held ultrasound monitor
room you will be able to before what midwives refer to as (often called a Sonicaid). This
call her by ringing a bell. ‘established labour’. This is when method allows you to be free to
your cervix has opened (dilated) to move around in labour if you wish.
• stronger
As the contractions get
and more
at least 3 cm.
If you go into hospital before
painful, you can put into labour is established, you may be
practice the relaxation asked if you would prefer to go
and breathing exercises home again for a while, rather than
you learned during spending many extra hours in
pregnancy. hospital. Once labour is established,
the midwife will check again from
• can
Your partner or friend
help by doing them
time to time to see how you are
progressing. In a first labour, the
with you and by rubbing time from the start of established
your back to relieve the labour to full dilation is between 6
pain if that helps. and 12 hours. It is often quicker for
later ones.
Towards the end of the first stage,
you may feel that you want to push
as each contraction comes. At this
point, if the midwife isn’t already
with you, ring for her to come. The
midwife will tell you to try not to
push until your cervix is fully open and
the baby’s head can be seen. To help
yourself get over the urge to push,
try blowing out slowly and gently or,
if the urge is too strong, in little

96
Labour and birth

• The heartbeat and contractions


may also be followed
electronically through a monitor
linked to a machine called a
CTG. The monitor will be
strapped on a belt to your tummy.

• Sometimes it may be suggested


that a clip is put on the baby’s
head so that its heart can be
monitored more exactly. The clip
is put on during a vaginal
examination and the waters are
broken if they have not already
done so. Ask your midwife or
doctor to explain why they feel
the clip is necessary for your baby. A drip may be used to speed up labour.

Throughout labour the heartbeat Speeding up labour


will be followed by a bleep from If your labour is slow, your doctor
the machine and a print out. You may recommend acceleration to get
cannot easily move around. Some things moving. You should be given
machines use tiny transmitters a clear explanation of why this is
which allow you to be more proposed. To start with your waters
mobile. Ask if this is available. will be broken (if this has not already
happened) during a vaginal
examination. This is often enough to
get things moving. If not, you may
be offered a drip containing a
hormone which will encourage
contractions. If you have a drip, the
hormone will be fed into a vein in
your arm. 97
Labour and birth

THE SECOND STAGE Take another breath when you need


to. Give several pushes until the
The baby’s birth contraction ends. As you push, try to
This stage begins when the cervix is let yourself ‘open up’ below. After
fully dilated and lasts until the birth each contraction, rest and get up
of the baby. Your body will tell you strength for the next one. This stage
to push. Listen to your midwife who is hard work but your midwife will
will guide you. help you all the time, telling you
what to do and encouraging you.
Position Your companion can also give you
Find the position that you prefer and lots of support. Ask your midwife to
which will make labour easier for tell you what is happening. This
you. You might want to remain in stage may take an hour or more, so it
bed with your back propped up with helps to know how you’re doing.
pillows, or stand, sit, kneel or squat
(squatting will take practice if you The birth
are not used to it). If you are very
tired, you might be more
comfortable lying on your side
rather than your back. This is also a
better position for your baby.
If you’ve suffered from backache
in labour, kneeling on all fours
might be helpful. It’s up to you. Try
out some of these positions at
antenatal classes or at home to find
out which are the most comfortable
for you. Ask the midwife to help
you.

Pushing
You can now start to push each time
you have a contraction. Your body
will probably tell you how. If not, As the baby’s head moves into the
take two deep breaths as the vaginal opening you can put your
contractions start and push down. hand down to feel it, or look at it in
a mirror. When about half the head
can be seen, the midwife will tell
you to stop pushing, to push very
gently, or to puff a couple of quick
short breaths blowing out through
your mouth. This is so that your
baby’s head can be born slowly,
giving the skin and muscles of the
perineum (the area between your
vagina and back passage) time to
stretch without tearing.
Sometimes the skin of the
perineum won’t stretch enough and
may tear. Or there may be an
urgency to hurry the birth because
the baby is getting short of oxygen.
98 The midwife or doctor will then ask
Labour and birth

You can have your baby lifted straight


on to you before the cord is cut.

Once the baby’s head is born, the body Your baby may be born still covered
usually follows quite quickly and easily with some of the white, greasy vernix
with one more push. which acts as a protection in the womb.

your permission to give you a local


anaesthetic and cut the skin to make
the opening bigger. This is called an
episiotomy. Afterwards the cut or
tear is stitched up again and heals.
Once your baby’s head is born,
most of the hard work is over. With
one more gentle push the body is
born quite quickly and easily. You
can ask to have the baby lifted
straight on to you before the cord is THE THIRD STAGE
cut, so that you can feel and be close
to each other immediately. Then the The placenta
cord is clamped and cut, the baby is After your baby is born, more
dried to prevent him or her from contractions will push out the
becoming cold, and you’ll be able to placenta. This stage can take
hold and cuddle your baby properly. between 20 minutes and an hour but
Your baby may be quite messy, with your midwife will usually give you
some of your blood and perhaps an injection in your thigh, just as the
some of the white, greasy vernix baby is born, which will speed it up.
which acts as a protection in the The injection contains a drug
womb still on the skin. If you prefer, called Syntometrine or Syntocinon
you can ask the midwife to wipe which makes the womb contract and
your baby and wrap him or her in a so helps prevent the heavy bleeding
blanket before your cuddle. which some women may experience
Sometimes some mucus has to be without it. You may prefer not to
cleared out of a baby’s nose and have the injection at first, but to wait
mouth or some oxygen given to get and see if it is necessary. You should
breathing underway. Your baby discuss this in advance with your
won’t be kept away from you any midwife and make a note on your
longer than necessary. birth plan. 99
Labour and birth

‘All I wanted A F T E RWA R D S SPECIAL CASES


afterwards was
to go to sleep.’
If you’ve had a deep tear or an LABOUR THAT STARTS TOO
episiotomy, it will be sewn up. If you EARLY (PREMATURE LABOUR)
‘I kept looking at have had an epidural you will not
him and thinking, feel this. Otherwise you should be About one baby in every ten will be
“I’ve actually got one! offered a local anaesthetic injection. born before the 37th week of
He’s mine! I’ve If it is sore during this repair, then pregnancy. In most cases labour starts
done it at last!”’ say so; it is the only way that the by itself, either with contractions or
midwife or doctor will know that with the sudden breaking of the
they are hurting you. Small tears and waters or a show (see page 90).
‘It was like being grazes are often left to heal without About one early baby in three is
drunk, I felt so special, stitches because they frequently heal induced (see page 101) or delivered
so full of myself and better this way. by Caesarean section (see pages
what I’d done.’ 101–2) because doctors feel that
early delivery is necessary for your
own or the baby’s safety.
If your baby is likely to be
delivered early, you will be admitted
to a hospital with specialist facilities
A paediatrician may for premature babies. Not all
check your baby straight hospitals have facilities for the care of
after delivery. very premature babies, so it may be
Your baby will be examined, necessary to transfer you and your
weighed and possibly measured and baby to another unit, either before
given a band with your name on it. delivery or immediately afterwards.
The midwife will then help you to If contractions start well before you
wash and freshen up. Then you are due, the doctors may be able to
should have some time alone with use drugs to stop your contractions
your baby and your partner, just to temporarily. You will probably be
be together quietly and meet your advised to have injections of steroids
new baby properly. If you find this that will help to mature your baby’s
doesn’t happen and you would like lungs so that he or she is better able
some time alone, ask for it. to breathe after the birth. This

If you’re breastfeeding, let


your baby suckle as soon
after birth as possible.
Babies do suck this soon,
although maybe just for a
short time, or they may
just like to feel the nipple
in the mouth. It helps
with breastfeeding later on
and it also helps your
womb to contract.

100
Labour and birth

treatment takes about 24 hours to FORCEPS DELIVERY OR


work. VACUUM EXTRACTION
If you have any reason to think that HEPATITIS B
your labour may be starting early, get If the baby needs to be helped out of
in touch with your hospital or the vagina – perhaps because the Some people carry the virus
midwife at once so that arrangements contractions aren’t strong enough, in their blood without
can be made. because the baby has got into an actually having the disease
awkward position or is becoming itself. If a pregnant mother
distressed, or because you have has hepatitis B, or catches it
BABIES BORN LATE become too exhausted – then during pregnancy, she can
forceps or vacuum extraction pass it on to her child. The
Pregnancy normally lasts about 40 (sometimes called Ventouse) will be child may not be ill but has
weeks, that is 280 days from the first used. a high chance of becoming a
day of your last period. Most women A local anaesthetic will usually be carrier and developing liver
will go into labour within a week given to numb the birth canal, if you disease later in life. Babies
either side of this date. If your labour haven’t already had an epidural or born to infected mothers
does not start, the doctor will want to spinal anaesthetic. should receive a course of
keep a careful check on your baby’s Forceps are placed round the vaccine to prevent them from
health. This is often referred to as baby’s head by an obstetrician and getting hepatitis B and
‘monitoring’. If there is any evidence with gentle firm pulling the baby becoming a carrier. The first
that your baby is not doing well, or if can be born. With vacuum delivery, dose is given within 24
you are overdue by a week or two, the a shallow rubber or metal cap is hours of birth, and two more
doctor will suggest that labour is fitted to the baby’s head by suction. doses are given at one and
induced (see below). You can help by pushing when the two months with a booster
obstetrician asks you to. Sometimes dose at twelve months old.
you will find red marks on your
INDUCTION baby’s head where the forceps have
been or a swelling from the vacuum.
Sometimes labour must be started They will soon fade.
artificially. This is called induction. An episiotomy (see page 98) is
Labour may be induced if there is any nearly always needed for a forceps
sort of risk to the mother’s or baby’s delivery.
health – for example, if the mother Your partner or companion ‘I wasn’t elated or
has high blood pressure or if the baby should be able to stay with you if anything like that.
is failing to grow and thrive. Induction you wish. I think it had all
is always planned in advance, so you been too much like
will be able to talk over the advantages hard work to feel
and disadvantages with your doctor CAESAREAN SECTION much after.’
and midwife and find out why
it is thought suitable in your There are situations where the safest
particular case. option for either you or your baby, ‘I was relieved. I was
Contractions can be started by or both, is to have a Caesarean section. delighted about the
inserting a pessary or gel into the As a Caesarean section involves baby, but I was more
vagina, or by a hormone drip in the major surgery, it will only be relieved than anything
arm. Sometimes both are used. performed where there is a real – that it was over,
Induction of labour may take a while, clinical need for this type of delivery. and we’d come
particularly if the neck of the womb The baby is delivered by cutting through, and
(cervix) needs to be softened with through the abdomen and then into everything was fine’.
pessaries or gels. Once labour starts it the womb. The cut is usually done
should proceed normally. crossways and low down, just below (A FATHER)
the bikini line. It is usually hidden
when your pubic hair grows back
again. 101
Labour and birth

doctors will talk to you and let you


know what is happening.
The operation takes about 30 to
40 minutes. One advantage of an
epidural or spinal anaesthetic is that
you are awake at the moment of
delivery and you can see and hold
your baby immediately. Most
hospitals are willing to let your
partner be present at a Caesarean
under epidural or spinal so that
they can give you lots of support
and welcome the baby at birth.
A Caesarean under an epidural A Caesarean section may be Please ask.
anaesthetic. ‘elective’ (that is, planned in After a Caesarean you will be
advance) or ‘emergency’. An elective uncomfortable for a few days, as you
Caesarean may be recommended if would expect to be after any major
labour is judged to be dangerous for surgery. It will be difficult to sit up
NEXT TIME you or the baby. An emergency or stand up straight and it will hurt
Once a Caesarean always a Caesarean may be necessary if to laugh. You will have to stay in
Caesarean? complications develop and delivery hospital a bit longer, about five to
If you have your first needs to be quick. This may be seven days, but this will depend on
baby by Caesarean section, before or during labour. Sometimes your condition. You will also have to
this does not necessarily the cervix does not dilate fully take it easy once you are home and
mean that any future baby during labour and an emergency you will need help. You shouldn’t lift
will be delivered in this Caesarean will be suggested but, anything heavy or drive a car for six
way.Vaginal birth after a providing you and the baby are well, weeks. Your doctor or midwife will
previous Caesarean can and there is no need to proceed with advise you on how much you can
does happen.This will great haste. do. Postnatal exercises are especially
depend on your own Whenever a Caesarean is suggested, important after a Caesarean to get
particular circumstances (see your doctor should explain why it your muscles working again, but take
page 129). You can discuss is necessary and any possible side- things at a gentle pace. The midwife
your hopes and plans for effects. Do not hesitate to ask or hospital physiotherapist will tell
any other deliveries with questions. you when you should begin them.
your doctor or midwife. Where possible, the operation is You can also contact the Caesarean
performed under epidural Support Network for information
anaesthesia (see page 92) or the and support (see page 147).
similar spinal anaesthetic. A general
anaesthetic is sometimes used,
particularly when the baby needs to BREECH BIRTH
be delivered very quickly or if there
are technical problems, but this A breech birth is when a baby is
increases the risks for you and the born bottom first. Your obstetrician
baby. This is why epidural and spinal and midwife will discuss with you
anaesthetics are recommended. the best and safest way for your
If you have an epidural, you will breech baby to be born. They may
be awake throughout the operation arrange an ultrasound scan to assess
but you won’t feel pain, just some how big your baby is. They may
tugging and pulling and wetness advise a Caesarean section, or they may
when the waters break. A screen will encourage vaginal delivery depending
be put across your chest so that you upon your individual circumstances.
cannot see what is being done. The Ultimately, the decision is yours.
102
Labour and birth

A vaginal breech delivery is a little on the first baby once the waters
more complicated than the usual have broken (see pages 96–7). You
‘head first’ delivery. An epidural is will be given a drip in case it is
usually recommended and forceps needed later and an epidural will
are often used to deliver the baby’s often be recommended. Once the
head (see page 101). In some units first baby has been born, the
you will be offered the option of an midwife or doctor will check the
external cephalic version (ECV). position of the second by feeling
The baby is turned into the usual your abdomen and doing a vaginal
head down position (cephalic) by examination. If the second baby is in
pressing on the woman’s tummy. a good position to be born, the
waters surrounding the baby will be
TWINS broken and the second baby should
be born very soon after the first
If you are expecting twins, labour because the cervix is already fully
may start early because the womb dilated. If contractions stop after the
becomes very stretched with two first birth, hormones will be added
babies. More people will usually be to the drip to restart them.
present at the birth – for example, a Triplets or more babies are almost
midwife, an obstetrician, and usually always delivered by elective
two paediatricians, one for each Caesarean section. If you’re
baby. expecting twins or more babies, you
The process of labour is the same might like to contact the Twins and
but the babies will be closely Multiple Births Association
monitored, usually by using an (TAMBA) for advice and support
electronic monitor, and a scalp clip (see page 148).

W H AT YO U R C O M PA N I O N C A N D O
Whoever your labour partner is – helps and comforts you as your
the baby’s father, a close friend, labour progresses and your
or a relative – there are quite a few contractions get stronger;
practical things that he or she can
do to help you, although probably
none of them are as important as
• and
remind you how to use relaxation
breathing techniques, perhaps
just being with you. You can’t know breathing with you if it helps;
in advance what your labour is going
to be like or how each of you will
cope. But there are many ways in
• example,
support your decisions about, for
pain relief;
For very many couples,
being together during labour
which a partner can help. and welcoming their baby

Your labour partner can:


• midwife
help you make it clear to the
or doctor what help you
together is an experience that
they can’t begin to put into
need – and the other way round – words. And many fathers
• keep you company and help pass
the time in the early stages;
which can help you to feel much
more in control of the situation;
who have seen their baby
born and who have played a
part themselves say they
• give
hold your hand, wipe your face,
you sips of water, massage
• what
as your baby is born, tell you
is happening, because you
feel much closer to the
child from the very start.
your back and shoulders, help can’t see what is going on for
you move about or change yourself.
position, or anything else that
103
12 When
pregnancy
goes wrong
U
nfortunately, not all pregnancies end well. For a few, pregnancy
ends with a miscarriage or with the death of the baby. This
chapter describes some of the things that can go wrong. If your
pregnancy ends in this way, then you will need both information and
support. Talk to the people close to you about how you feel and to your
doctor, midwife or health visitor about what has happened and why.
Sometimes it is easier to talk to someone outside your immediate circle.
Organisations offering information and support are listed on pages
147–150.

E C TO P I C like to contact the Miscarriage


Association (see page 149) who can
PREGNANCY offer support during the aftermath of
an ectopic pregnancy. Expect to feel
After fertilisation the egg should a sense of loss and give yourself time
move down into the womb to to grieve.
develop. Sometimes it gets stuck in
the fallopian tube and begins to
grow there. This is called an ‘ectopic’ M I S C A R R I AG E
or ‘tubal’ pregnancy. The fertilised
egg can’t develop properly and often If a pregnancy ends in the first six
has to be removed in an operation. months it is known as a miscarriage.
A common cause of an ectopic Miscarriages are quite common in
pregnancy is some sort of blockage the first three months of pregnancy.
in the fallopian tube, possibly as a Probably at least one in six clinically
result of an infection. Warning signs recognised pregnancies ends this way.
start soon after a missed period. At this stage a miscarriage usually
They are a severe pain on one side, happens because there is something
low down in the abdomen, vaginal wrong with the baby. A later
bleeding or brown discharge, and miscarriage may be due to the placenta
sometimes feeling faint, and women not developing or working properly,
should see their doctor immediately. or the cervix being weak and
Talk to your doctor to find out opening too early in the pregnancy.
why it happened and whether your An early miscarriage can be rather
chances of conceiving a baby have like a period, with bleeding and a
been affected. One organisation similar sort of aching pain, maybe
which can offer support is called occurring on and off, happening at
104 Child (see page 147). You may also the time when a period would have
When pregnancy goes wrong

been due. With a later miscarriage, pregnancy. Many people find it helps
bleeding is likely to be accompanied to have something to remember
by pains that feel more like the pains their baby by. In early pregnancy you
that come with labour. might be able to have a picture of a
If you bleed or begin to have scan. After about four months you
pains, you should contact the person could ask for a photograph of the
who is giving you antenatal care, baby. If your miscarriage is very late
either at the hospital or your GP’s you may be able to see and hold
surgery. You may be told to lie down your baby, if you wish, as well as
quietly or to come into hospital having a photograph. Talking also
immediately. Sometimes the helps. Talk about your feelings with
bleeding stops by itself and your your partner and those close to you.
pregnancy will carry on quite The Miscarriage Association (see
normally. But if a miscarriage is page 149) can give you information
going to happen, there is very little and put you in touch with other
that anyone can do to stop it. women who have experienced a
After a miscarriage, you may have miscarriage.
a ‘D and C’ (that is, dilatation and
curettage) to empty the womb. This
is done under anaesthetic. The T E R M I N AT I O N
cervix is gently widened and the
lining of the womb scraped or If tests show that your baby has a
sucked away. The cervix narrows serious abnormality you may
again afterwards. consider whether or not to end your
pregnancy (see page 57). It is
AFTERWARDS important to find out as much
information as you can from the
One miscarriage will not affect your doctor about the particular
chances of having a baby in the condition and how it may affect
future. Even after three miscarriages your baby, so that you can make a
you still stand a good chance of decision that is right for you and
carrying a baby to term. If you have your family.
three or more miscarriages, you You will probably be very shocked
should be referred for further when you are first told the diagnosis
investigations. In some cases, all by the consultant and may not be
investigations will be normal and no able to take very much in. You may
precise cause found. need to go back and talk again,
A miscarriage can be very difficult preferably accompanied by your
to come to terms with. You may feel partner or someone close to you.
disappointed, angry, or even guilty, You will also need to spend time
wondering what you did wrong. talking things through with your
Some people fear that the miscarriage partner or with others close to you.
may have been caused by making An early termination, before 12 to
love, though this is extremely 14 weeks, will usually be done under
unlikely. In fact, whatever the cause, a general anaesthetic. For a later
it is very rarely anyone’s fault. termination you will probably go
You will almost certainly feel a through labour as this is usually the
sense of loss. You need time to safest way for you. You may wish to
grieve over the lost baby just as you think beforehand about whether you
would over the death of anyone want to see and perhaps even hold
close to you, especially if the your baby and give your baby a
miscarriage has happened later in name. It can make the baby more
105
When pregnancy goes wrong

real for you and your family and your loss. Many hospitals have a
SAYING GOODBYE TO help you to grieve. If you don’t wish bereavement counsellor (or
YOUR BABY to see your baby, it’s still a good voluntary support from someone
idea to ask hospital staff to take a whose baby has also died) who will
A funeral or some other way photograph for you. You may find help you to find the best way for
of saying goodbye may be a this comforting at a later date. It can you and your partner to cope with
very important part of be kept in your notes in case you your loss.
coming to terms with your wish to see it. One of the first questions you are
loss, however early it You may find your feelings quite likely to ask is why your baby died.
happens. If your baby hard to cope with after a The doctors and midwives may not
dies after 24 weeks of termination, whether it has been in know. A post-mortem examination
pregnancy the hospital must early or late pregnancy. It will help is usually advised and this may help
provide a death certificate to talk about them. If you would like to find out, although it doesn’t
and arrange a burial or to talk to people who have always provide the answer. Most
cremation. If you would like undergone a similar experience you hospitals will offer you an
to arrange it yourself or can contact ARC (Antenatal Results appointment with the consultant
organise a service you can do and Choices) (see page 149). who can explain to you what is
that. Just speak to the ward known. If you are not offered an
staff and they will tell appointment, you can ask for one.
you what the arrangements LOSING A It may also help to talk about your
are in your hospital. feelings with other parents who have
BABY lost a baby in a similar way. SANDS
(the Stillbirth and Neonatal Death
In the UK about 4000 babies every Society) is an organisation that can
year are stillborn – the baby is put you in touch with other parents
already dead when it is born. About who can offer friendly help (see page
the same number die soon after 149).
birth. Often the causes of these You may well want to arrange a
deaths are not known. cremation, funeral or service. You
If you lose a baby like this, you are should be able to do so. If the baby
likely to feel very shocked. But you was lost after 24 weeks, the loss will
and your partner may find it need to be officially registered as
comforting to see and hold your either a death or a stillbirth. If you
baby and give your baby a name. want to arrange a funeral or
You may also like to have a cremation and your baby was lost
photograph of your baby and to before 24 weeks, you will need a
keep some mementos such as a lock certificate from the hospital. Talk to
of hair or the shawl the baby was your midwife or doctor about what
wrapped in. All this can help you you want to do and to find out what
and your family to remember your arrangements are available locally.
baby as a real person and can, in You could also consult the hospital
time, help in coming to terms with chaplain or rabbi or your own
religious adviser.

106
13 The first
days with your
new baby
‘I don’t think I’ll ever

I
n the first few days after the birth, you and your baby are beginning
to get to know each other. Don’t feel you have to make a great forget those first few
effort. Just have your baby close to you as much as you can. days. Feeling so happy.
Partners also need plenty of opportunity to handle the baby and feel Though I don’t know
close. Many fathers feel a little left out, especially if they have to leave why. I couldn’t sleep,
you and the baby in hospital and return to an empty home. They may the ward was so noisy.
need support and encouragement to get involved, but the more you can I was sore. I couldn’t
both hold and cuddle your baby the more confident you’ll all feel. move about very well.
I missed Alan and
home. But I felt
happier than I can
YOU ever begin to say.’
You may feel tired for the first few For a lot of mothers the excitement ‘I couldn’t believe it.
days, so make sure you get plenty of and the pleasure of the new baby far I’d never been much of
rest. Even just walking and moving outweigh any problems. But some do a one for babies. And
about can seem like hard work. If begin to feel low (see page 117) or Dean wasn’t even a
you’ve had stitches they’ll feel sore rather depressed, especially if they are pretty baby, not at first.
and you may feel worried about very tired or feel that they are not Very spotty and
going to the toilet. making any progress or can’t look blotchy. But he was
Once your breasts start to fill with after their baby as they would like. perfect to me. He
milk they may feel uncomfortable or Giving birth is an emotional and bowled me over.’
painful for a day or so. If you’re tiring experience and your hormones
breastfeeding, it will help to feed change dramatically in the first few ‘I felt awful. I was
your baby as often as he or she needs days. Some women feel rather weepy so tired, on top of
(see page 69). You might also like to around the third day, especially if the everything else. But
apply a warm cloth just before a feed labour was difficult, or if they are there was one thing
to help relieve the engorgement. If very tired or have other worries. This about it. Bob got to
you intend to bottle feed from the is known as the ‘baby blues’. Some know the baby much
start you needn’t do anything but, on women worry because they don’t better than he would
the third or fourth day, your breasts love their baby immediately but, as have done if I’d been
may be tender as the milk is still with any relationship, it’s not always more on top. He was
being produced. Wearing a firm, love at first sight. You may just need holding her and
supportive bra may help. Speak to to give yourself time – you can still cuddling her right
your midwife if you are very care for your baby and provide all the from the start.’
uncomfortable. warmth and security he or she needs.

107
The first days with your new baby

BEING IN HOSPITAL dry the vulva carefully. Pelvic floor


exercises can also help healing (see
If you have your baby in hospital, page 16). If the stitches are sore and
you’ll probably be moved to the uncomfortable, tell your midwife as
postnatal ward after the birth to be she may be able to recommend
with other mothers who have also treatment. Painkilling tablets will
had their babies. Some mothers also help. If there is swelling and
enjoy their stay in hospital and find bruising, it may be possible to have
it restful and easy. Others find it some ultrasound treatment from the
tiring and rather stressful. It depends physiotherapist. In any case,
on how you’re feeling, whether you remember to sit down gently and lie
like the company of other mothers on your side rather than your back
or miss your privacy, and on how the to start with.
ward is organised. In any case, your The thought of passing urine can
stay in hospital, if your delivery is be a bit frightening at first because
uncomplicated, is likely to be short. of the soreness and because you can’t
It helps if you’ve discussed your seem to feel what you are doing.
postnatal care with your midwife Sometimes it’s easier to pass urine
during pregnancy so you know what while sitting in a bowl of water or a
to expect. Any preferences can then warm bath. The water dilutes the
be recorded on your birth plan (see urine so that it doesn’t sting. If you
page 38) so that staff on the postnatal really find it impossible to pass urine,
ward will be aware of your wishes. tell your midwife. Also drink lots of
You’re likely to need quite a lot of water to dilute the urine.
help and advice with your first baby. You probably won’t need to open
The midwives are there to guide and your bowels for a few days after the
support you as well as checking that birth but it’s important not to let
you are recovering from the birth. yourself become constipated. Eat
Don’t hesitate to ask for help if you fresh fruit, vegetables, salad and
need it. If you do have a problem brown bread, and drink plenty of
with the way things are organised in water. This should mean that when
hospital, talk it over with one of the you do open your bowels you will
staff. Perhaps a change can be made. pass a stool more easily. Whatever it
If all is going well with both you may feel like, it’s very unlikely that
and the baby, then most hospitals you will break the stitches or open
will probably give you the option of up the cut or tear again, but it might
going home after 48 hours or even feel better if you hold a pad of clean
earlier, even if it’s your first baby. tissue over the stitches when you are
The community midwife will visit trying to pass a stool. Avoid straining
you at home and continue to help for the first few days. Sometimes
you to care for yourself and your stitches have to be taken out but
baby. You will need to make sure usually they just dissolve after a week
that your partner or someone else or so, by which time the cut or tear
can be there to help you at home will have healed.
and do the cooking and housework.

PILES
STITCHES
Piles (see page 81) are very common
If you’ve had stitches, bathing the after delivery but they usually
area often will help healing. Use a disappear within a few days. Eat
bath, shower or cotton wool and plenty of fresh fruit, vegetables,
108 plain warm water. After bathing, salad, brown bread and wholegrain
The first days with your new baby

cereals, and drink plenty of water. YOUR SHAPE ‘That first week was
This should make it easier and less nothing but problems.
painful when you pass a stool. Try Your breasts will be larger at first and One thing after another,
not to push or strain as this will while you are breastfeeding regularly. first me and then the baby.
make the piles worse. Let the You need to wear a supportive Everybody was very
midwife know if you feel very nursing bra if you are breastfeeding. helpful, but it was still a
uncomfortable. She will be able to If you are not breastfeeding your week or two before I got
give you an ointment to soothe them. breasts will reduce in size in a week sorted out.’
or so.
Your abdomen will seem quite
BLEEDING baggy after delivery. Despite having CONTRACEPTION
delivered your baby plus the placenta
After the birth you will lose blood and a lot of fluid, you will still be (See also page 117)
and discharge from the vagina. The quite a lot bigger than you were Before you leave hospital, a
loss will probably be quite heavy at before pregnancy. This is partly midwife or doctor will
first which is why you will need because your muscles have stretched. probably talk to you about
super absorbent sanitary towels. Do If you eat a balanced diet and contraception. If this doesn’t
not use tampons until after your exercise, your shape should soon happen, you may want to
postnatal check since they can cause return to normal. Breastfeeding ask. Although it may seem
infections in the early weeks after helps because it makes the womb very early to be thinking
the birth. During breastfeeds you contract. Sometimes, because this is about making love again, it
may notice that the discharge is happening, you may feel a quite can be easier to sort out any
more red or heavier. You may also painful twinge in your abdomen or questions about contraception
have ‘after pains’. These are both period-type pain while you are while you are in hospital
because feeding causes the womb to feeding. Breastfeeding also uses up rather than later on.
contract. They are a good sign that more calories so it can help you to
everything inside you is going back lose some of the weight gained in
to normal. Bleeding often becomes pregnancy. Some women do not
heavier around seven to ten days return to their normal weight until RUBELLA
after delivery but, if you find you are after they have finished
losing blood in large clots, you breastfeeding. If you were not immune to
should save these towels to show the Postnatal exercises (see page 115) rubella (German measles)
midwife as you may need some will help to tone up the muscles of when tested early in your
treatment. Gradually, the discharge your pelvic floor and tummy and pregnancy, you will probably
will become a brownish colour and help you find your waist again! be offered immunisation
may continue for some weeks, They will also get you moving and before you leave hospital or
getting less and less. feeling generally fitter. You may be shortly afterwards by your
If you’re breastfeeding you may able to attend a postnatal exercise GP. If this doesn’t happen,
not have another period until you class while you are in hospital and ask. This is a good
stop feeding or even for some weeks afterwards. Ask your midwife or opportunity to get it done.
or months after that. If you are not physiotherapist. You should not get pregnant
breastfeeding, your first period It is quite common after having a again for one month after
might start as early as a month after baby to find it difficult to control the injection.
the birth. But it could be much later. your bladder if you laugh, or move
You can become pregnant before suddenly, and to leak some water.
your period starts even if you are Pelvic floor exercises (see page 16)
breastfeeding, so make sure you will help with this. If the problem
decide on a reliable form of persists after three months, see your
contraception before you and doctor who may refer you to a
your partner make love again physiotherapist.
(see page 117).

109
The first days with your new baby

RHESUS NEGATIVE MOTHERS to test for rare but potentially serious


illnesses. All babies are tested for
If your blood group is rhesus negative phenylketonuria (a PKU-metabolic
and your partner’s is rhesus positive, disorder) and congenital
blood samples will be taken after hypothyroidism (low thyroid
delivery to see whether your baby is hormone). In many areas babies are
rhesus positive and whether you need tested for other conditions including
an injection to protect your next sickle cell disorders (see www.kci-
baby from anaemia. If so, the phs.org.uk/haemscreening).
injection should be given within 72
hours of delivery. Check with one of VITAMIN K
the doctors or midwives what should
happen in your particular case. We all need vitamin K to make our
blood clot properly so that we won’t
bleed too easily. Some newborn
YOUR BABY babies have too little vitamin K.
Although this is rare, it can cause
Soon after birth you’ll be able to them to bleed dangerously into the
look properly at your baby and brain. To prevent this, you should
notice every detail – the colour and be offered vitamin K which will be
texture of the hair, the shape of the given to your baby. There are two
hands and feet, and the different ways of giving vitamin K, by mouth
expressions on your baby’s face. If and by injection. Discuss with your
you notice anything that worries doctor or midwife the best method
you, however small, ask your doctor for your baby.
or midwife. Your baby will be
examined by a doctor to make sure
everything is all right. It’s a good time THE FONTANELLE
to ask any questions you might have.
On the top of your baby’s head near
the front, is a diamond-shaped patch
THE NAVEL where the skull bones haven’t yet
fused together. This is called the
Shortly after birth the midwife will fontanelle. It will probably be a year
clamp the umbilical cord close to or more before the bones close over
your baby’s navel with a plastic clip. it. You may notice it moving as your
She then cuts the cord, leaving a baby breathes. You needn’t worry
small bit of cord with the clamp about touching it. There is a tough
attached. The cord will take about a layer of membrane under the skin.
week to dry out and drop off. Keep
the navel clean and dry until this
happens. The midwife will show BUMPS AND BRUISES
you how. If you notice any bleeding
from the navel, tell your midwife, It’s quite common for a newborn
health visitor or doctor. baby to have some swelling and
bruises on the head, and perhaps to
have bloodshot eyes. This is just the
See www.newbornscreening- NEWBORN BLOODSPOT result of the squeezing and pushing
bloodspot.org.uk for more SCREENING (HEEL PRICK TEST) that is part of being born and will
information. soon disappear. But if you are at all
About a week after birth, your worried, you can always ask your
midwife will ask to take a sample of midwife.
110 blood from your baby’s heel. This is
The first days with your new baby

BIRTHMARKS AND SPOTS some babies develop a yellow colour


to their skin and a yellowness in the
Once you begin to look closely at whites of their eyes because of mild
your baby, you’ll probably find a jaundice. This usually fades within
variety of little marks and spots, ten days or so. But a baby who
mainly on the head and face, or becomes badly jaundiced may need
sometimes larger marks. Most of them treatment (see page 113).
will go away eventually. Ask the doctor
who examines your baby if they will WHAT A NEWBORN
disappear completely. Most common BABY CAN DO
are the little pink or red marks some
people call ‘stork bites’. These There is one important skill that
V-shaped marks on the forehead and babies don’t have to learn. They are
upper eyelids gradually fade, though born knowing how to suck. During
it may be some months before they the first few days they learn to
disappear. Marks on the nape of the coordinate their sucking and
neck can go on much longer, but their breathing.
they will be covered by hair. Newborn babies also automatically
Strawberry marks are quite turn towards a nipple or teat if it is
common. They are dark red and brushed against one cheek and they
slightly raised. They sometimes will open their mouths if their upper
appear a few days after birth and lip is stroked. They can also grasp
gradually get bigger. They may take things (like your finger) with either
a while to go away, but usually they hands or feet and they will make
will go away eventually. stepping movements if they are held
Spots and rashes are very common upright on a flat surface. All these NEWBORN HEARING
in newborn babies and may come automatic responses except sucking, SCREENING
and go. But if you also notice a are lost within a few months, and PROGRAMME
change in your baby’s behaviour, for your baby will begin to make
All babies are offered health
example if your baby is not feeding controlled movements instead.
checks in the first few weeks of
properly or is very sleepy or very Newborn babies can use all their
life. One of these checks is a
irritable, you should tell your doctor senses. They will look at people and
hearing screening test. This is a
or midwife immediately. things, especially if they are near, and
quick and simple test with no
particularly at people’s faces. They
risk of harm to your baby.You
BREASTS AND GENITALS will enjoy gentle touch, and the
can choose whether or not your
sound of a soothing voice and they
baby has this test.
Quite often a newborn baby’s breasts will react to bright light and noise.
One or two babies in every
are a little swollen and ooze some Very soon they will also know their
1,000 are born with a hearing
milk, whether the baby is a boy or a mother’s special smell.
loss. Most of these babies will
girl. Girls also sometimes bleed a bit
be born into families where no-one else has a hearing loss. It is not easy to tell
or have a white, cloudy discharge
if a young baby has a hearing loss. Finding out early means that you and your
from the vagina. All this is as a result
baby can be offered support and information right from the start. Screening does
of hormones passing from the
not detect all hearing loss or prevent future hearing difficulties.
mother to the baby before birth and
The test will usually be done in the first few weeks of life. If your baby is
is no cause for concern. The genitals
born in hospital, you may be offered the test before you go home. If not, it can
of male and female newborn babies
be done at home or in a local clinic.
often appear rather swollen but will
A trained screener will carry out the test. The screening test is usually done
look in proportion with their bodies
while your baby is settled or asleep. It will not hurt your baby or feel
in a few weeks.
uncomfortable. The test only takes a few minutes. You can stay with your baby
while the test is done. For further information see
JAUNDICE
www.screeningservices.org/nbhsw/
On about the third day after birth, 111
14 Babies who
need special care
S
ome babies need special care in hospital, sometimes on the
ordinary postnatal ward and sometimes in a Neonatal Unit (NNU),
also known as a Special Care Baby Unit (SCBU) or Neonatal
Intensive Care Unit (NICU). Babies who may need special care include:

• need
babies who are born early – babies born earlier than 34 weeks may
extra help breathing, feeding and keeping warm, and the earlier
they are born the more help they are likely to need;

• usually
babies who are very small or who have life-threatening conditions,
affecting their breathing, heart and circulation;

• very
babies born to diabetic mothers, or babies where the delivery has been
difficult, may need to be kept under close observation for a time;

• babies with very marked jaundice;


• babies awaiting or recovering from complex surgery.

C O N TAC T W I T H YO U R B A B Y

All babies need cuddling and visit too, to get to know the baby, if
touching, whether they are in the ward this is possible. When you first go
close by you or in an NNU. If your into the NNU you may be put off
baby is in an NNU, you and your by all the machines and apparatus.
partner should try to be with your Ask the nurse to explain what
baby as much as possible. Encourage everything is for and to show you
other members of your family to how to handle your baby.

FEEDING
Feeding is especially important for babies can’t suck properly at first and
premature babies. Those who get are fed by a fine tube which is passed
some of their mother’s milk do through the nose or mouth into the
better, so think seriously about stomach. You and your partner can
breastfeeding. Even if you can’t stay still touch and probably hold your
with your baby all the time, you can baby. The tube isn’t painful, so you
express milk for the nurses to give needn’t worry about it being in the
112 while you are away. Some small way or hurting your baby.
Babies who need special care

I N C U B ATO R S BABIES WITH JAUNDICE


AFTER TWO WEEKS WORRIES AND
Babies who are very tiny are nursed EXPLANATIONS
in incubators rather than cots to Many babies are jaundiced for up to
keep them warm. But you can still two weeks following birth. This is Always ask about the
have a lot of contact with your baby. common in breastfed babies and treatment your baby is
Some incubators have open tops but, usually it’s normal and does no being given and why,
if not, you can put your hands harm. It is not a reason to stop if it’s not explained to
through the holes in the side of the breastfeeding. But it’s important to you. It is important
incubator to stroke and touch your ensure that all is well if your baby is that you understand what
baby. You can talk to your baby too. still jaundiced after two weeks. You is happening so that you
This is important for both of you. should see your doctor within a day can work together with
You may be asked to wear a gown or two. This is particularly important hospital staff to ensure that
and mask. Carefully wash and if your baby’s stools are pale. A your baby receives the best
thoroughly dry your hands before simple urine test will distinguish possible care. It is natural
touching your baby. between ‘breast milk’ jaundice, to feel anxious if your baby
which will resolve itself, or jaundice is having special care.Talk
which may need urgent treatment. over any fears or worries
NEWBORN with the staff caring for
your baby.
BABIES WITH A BABY WITH
The consultant paediatrician
J AU N D I C E DISABILITIES will probably arrange to see
you, but you can also ask
for an appointment if you
If your baby is disabled in some way, wish. The hospital social
you will be coping with a muddle of worker may be able to
different feelings – love mixed with help with practical problems.
fear, pity mixed with anger. You will
also need to cope with the feelings
of others – your partner, relations
and friends – as they come to terms
with the fact that your baby is
Jaundice in newborn babies is different. More than anything else at
common because their livers are this time you will need to have a
immature. Severely jaundiced babies person or people to whom you can
may be treated by phototherapy. talk about how you feel and
The baby is undressed and put under information about your baby’s
a very bright light, usually with a immediate and future prospects.
soft mask over the eyes. It may be There are a number of people to
possible for your baby to have whom you can turn for help – your
phototherapy by your bed so that own GP, a paediatrician at your
you don’t have to be separated. This hospital, or your health visitor. Once
treatment may continue for several you are at home you can contact
days, with breaks for feeds, before your social services department for
the jaundice clears up. In some cases, information about local voluntary or
if the jaundice gets worse, an statutory organisations. On page 148
exchange transfusion of blood may you will find a list of organisations
be needed. Some babies have which can offer help and advice.
jaundice because of liver disease and Many are self-help groups run by
need different treatment. A blood parents. Talking to other parents
test before phototherapy is started with similar experiences can often
checks for liver disease. be the most effective help. 113
15 The early
weeks: you
G
oing home from hospital can be very exciting, but you may
feel nervous too without the hospital staff on call to help you.
The more you handle your baby, the more your confidence will
increase. Of course, the community midwife and then the health visitor
and your own GP are there to advise you should you have any worries
or problems. Ask your midwife or health visitor for a copy of the book
which follows on from this one – Birth to Five.

COPING
INVOLVING YOUR PARTNER want to have their partners with
them so that they will have a chance
‘Everybody tells you how The more you can share your baby’s to get to know the baby properly, as
much having a baby’s care, the more you will both enjoy well as helping with the work. It also
going to disrupt your life, your baby. Your partner may not be gives you some time to start
your relationships – able to breastfeed but he can help with adjusting to the changes in your life.
especially with your bathing, changing and dressing as If you’re on your own, or your
partner – but I didn’t well as cuddling and playing. He may partner is unable to be with you,
find that. Obviously, feel quite nervous of handling the perhaps your mother or a close
when you’re both tired, baby and need encouragement. Be friend can be there. Even with help
nerves get frayed, but patient if he seems awkward at first. you will probably feel tired. Cut
life’s tons better with a corners where you can.
baby than without.’

(A FATHER)
HELP AT HOME • ofCutdustdown on cleaning. A bit
won’t hurt.
You’ll probably need a lot of
full-time help at first, not just
with the chores, but also to give you
• eat
Keep meals simple. You need to
well but this needn’t involve a
emotional support. You’re bound to great deal of preparation and
feel up and down and to get easily cooking.
tired in the early days. Many women
• many
Try to space visitors out. Too
in a short time will be very
tiring. If visitors do come, don’t
feel you have to tidy up or lay
on a meal. Let them do things
for you.

• Friends
If you need extra help, ask.
or neighbours will
probably be very willing to do
114 some shopping, for example.
The early weeks: you

LOOKING A F T E R YO U R S E L F

REST

During the weeks or months that


you are feeding your baby at night
and your body is recovering from
• inas you breathe out, gently draw
the lower part of your stomach
childbirth, finding time to catch up like a corset, narrowing your
on rest is essential. It’s tempting to waistline;
use your baby’s sleep times to catch
up on chores, but try to have a sleep
or a proper rest at least once a day.
• squeeze your pelvic floor also;
• gently
hold for the count of 10 then
release;
PHYSICAL ACTIVITY
Continue with any postnatal exercises
• repeat 10 times.
you were shown in hospital. You can You should not move your back at
also do this deep stomach exercise any time. After 6 weeks progress
when you feel well enough. to the box position (see page 16).
If a gap or bulge line appears
• lie on your side with your knees
slightly bent;
Besides these exercises, try to fit in
a walk with your baby. A short
vertically down the centre of
your stomach you should ask
walk in the fresh air will make your physiotherapist for
• inletgently;
your tummy sag and breathe you feel good. special exercises.

115
The early weeks: you

FOOD

It’s very important to continue to A healthy diet is especially important


eat properly (see pages 8-10). If you if you’re breastfeeding. Breastfeeding
want to lose weight, don’t rush it. A uses up a lot of energy. Some of the
varied diet without too many fatty fat you put on in pregnancy will be
foods will help you lose weight used to help produce milk, but the
gradually. Try to make time to sit rest of the nutrients will come from
down, relax, enjoy your food and your diet. This means that you may
digest it properly. It doesn’t have to be hungrier than usual. If you do
be complicated. Try food like baked need a snack, try having cheese or
potatoes with baked beans and beans on toast, sandwiches, bowls of
cheese, salads, pasta, French bread cereal or fruit. (See Your diet when
pizza, scrambled eggs or sardines on breastfeeding, page 71).
toast, for example, followed by fruit
mixed with yoghurt or fromage frais.

YO U R R E L AT I O N S H I P S

When you bring your new baby Your relationship with the baby
home all the relationships around may not be easy either, particularly if
you will start to shift and change. you’re not getting much sleep. Don’t
Your mother, for example, may find feel guilty if you sometimes feel
the change alarming and feel quite resentful at the demands your baby
unsure of how much to get involved. makes, or if your feelings are not
You may find that she is trying to what you expected them to be. Talk
take you over or that she is so to your midwife or health visitor if
anxious to avoid bothering you that you’re upset, but remember, many
she doesn’t help at all. Try to let the mothers do not feel instant love for
people close to you know clearly just their baby. They come to love them
how much you do want from them. gradually over the weeks.
Your relationship with your
partner will also change. It’s very
easy in those exhausting early weeks
to just leave things to sort themselves
out. Take care. You may wake up six
months later to find that you haven’t
spent an hour alone together and
have lost the easy knack of talking
your problems through. You both
need time alone, without the baby,
to recharge your own batteries, and
time together to keep in touch with
each other.

116
The early weeks: you

THE ‘BABY SEX AND POSSIBLE METHODS OF


CONTRACEPTION
BLUES’ AND CONTRACEPTION
P O S T N ATA L There are no rules about when to
• beThethe condom – this may
best and simplest choice
start making love again. If you for the early weeks after
DEPRESSION haven’t had stitches you may be childbirth.
eager to share the extra love you feel
Up to 80% of mothers go through a with your partner. On the other • you’re
The combined pill – if
not breastfeeding, start
patch of what is known as the ‘baby hand, if you’re tired and sore, sex taking this pill from
blues’, often about three or four days may be the last thing you have in the 21st day after delivery. If
after the birth. You might feel very mind. Don’t rush into it. If it hurts, you start it later than the 21st
anxious about small things, for it will be no pleasure. You may want day, it won’t be reliable for the
example, or mildly depressed or just to use a lubricating jelly the first first seven days, so for this
keep bursting into tears, for no time because hormone changes may time you’ll have to use some
apparent reason. make your vagina feel drier than usual. other form of contraceptive
Baby blues may be caused by It can take some time for the old (like a condom) as well. Don’t
hormone changes, tiredness, feelings to come back but they will take this pill if you’re
discomfort from sore stitches or sore and, until they do, you may both feel breastfeeding as it
breasts or even a feeling of anti- happier finding other ways of being reduces the milk flow.
climax after all the excitement. loving and close. If you have any
Whatever the cause, you will usually worries, discuss them with your GP
find it only lasts a day or so. Have a or health visitor. • ifProgestogen-only pill –
you’re breastfeeding, you
good cry if you feel like it, and try It’s possible for a woman to may be offered a progestogen-
to sleep if you can. The best help conceive even if she has not started only pill which will not affect
your partner or someone close can her periods again or even if she is your milk supply. This is also
give is probably just to listen, give breastfeeding. Contraception should started on the 21st day after
you a reassuring hug and look after be discussed before you leave hospital delivery and has to be taken
the baby while you get some rest. If and again when you go for your at the same time every day.
these feelings do not go away, it may six-week postnatal check. In the There’s no evidence to suggest
be that you are simply not treating meantime, you could talk to your that this pill affects the baby
yourself very well. Take time out midwife or health visitor when they in any way but, even so, some
for treats, however small – a long visit you at home or you could go to women prefer not to take any
lazy bath, your favourite food or your GP or family planning clinic. form of contraceptive pill while
visit a friend. The Family Planning Association they are breastfeeding and use
Around 10% of mothers slide into (see page 148) publishes free leaflets another form of contraception
a depression which may be quite about all methods of contraception. instead.
deep. They are taken over by a
feeling of hopelessness. They may
feel angry, but more often feel too • these
Cap or diaphragm –
can be used six weeks
exhausted to be angry or even to after delivery. Your old one
cope with the simplest tasks. If you probably won’t fit. Have a
feel like this you must get help. You new one fitted at your
should contact your GP or health postnatal check-up.
visitor and explain how you are
feeling. A partner or friend might
contact them after talking to you • device)
IUD (intra-uterine
– this can be fitted
about it. You can also contact the at your postnatal check-up
Association for Post-Natal Illness when the womb is back to its
(see page 150) for more information. normal size.

117
The early weeks: you

THE P O S T N ATA L • discussed


The cervical smear test may be
if you haven’t had one
CHECK in the past three years (see page
55). This is usually delayed until
three months after delivery.
You should have your postnatal check
about six weeks after your baby’s
birth to make sure that you feel well
• (German
If you are not immune to rubella
measles) and were not
and are recovering as you should given an immunisation before
from the birth. You may go to your you left hospital, you will be
own GP or may be asked to return offered one now. You should not
to the hospital. It’s a good opportunity become pregnant for one month
to ask any questions and sort out any after this immunisation.
problems that are troubling you. You
may like to make a list of questions
to take along with you so that you
• have
The doctor will ask if you still
any vaginal discharge and
don’t forget what you want to ask. whether you have had a period yet.
If you have had a Caesarean section
you may like to ask if another one will
be needed if you have another baby.
• about
There will be an opportunity to talk
contraception. If you have
Routines do vary a little but the list any worries over contraception or,
below is probably what will be done. indeed, any aspect of sex, now is
a good time to discuss them. Tell
• beYouonmay be weighed. You may
the way to getting back to
your doctor if intercourse is painful.

your normal weight again by


now. Breastfeeding mothers tend
• orIf you’re feeling very tired, low
depressed make sure you tell
to lose weight more quickly than the doctor about this.
those who are bottle feeding.
• your
If you are having trouble holding
• Your urine may be tested to make
sure your kidneys are working
urine, or wind or are soiling
yourself tell your doctor.
properly and that there is no
infection. Your GP’s surgery or health clinic
will probably arrange for your baby’s
• checked.
Your blood pressure may be six-week check to be done at your
postnatal check. If you go to the
hospital, the baby’s check will usually
• toYouseemaywhether
be offered an examination
your stitches (if
need to be arranged separately.

you had any) have healed, whether


your womb is back to its normal
size, and whether all the muscles
used during labour and delivery
are returning to normal. Tell the
doctor if the examination is
uncomfortable.

• examined
Your breasts are unlikely to be
unless you have a
particular concern.

118
16 The early
weeks: your
baby
T
he baby’s birth must be registered within six weeks from the
date of birth at your nearest Registry Office. The address will
be in the telephone book under the name of your local
authority (in Northern Ireland, look under ‘Registration of births,
deaths and marriages’). If you are married, you or the father can
register the birth.
If you are not married you must go yourself, and if you want the
father’s name to appear on the birth certificate he must go with you.

responsibility: from 1 ‘I think there must be


REGISTERING December 2003, all you have something there even before the
birth but it builds up as well.
to do is for both parents to
T H E B I RT H register the birth of your You know it takes time to form
baby together. a bond and over the months
and years it grows stronger.
If you live in a different district
from the one where your baby
• your
Parental responsibility for
child gives you
was born, the registrar will take important legal rights as well
details from you and then send as responsibilities. Without
them to the district where the it, you don’t have any right
birth took place. You will then to be involved in decisions
be sent the birth certificate. You such as where they live, their
cannot claim benefits until you education, religion or
have a birth certificate medical treatment. With
All babies born in England parental responsibility, you
and Wales are now given a are treated in law as the
unique NHS number at birth. child’s parent, and you take
Midwives request and receive a equal responsibility for
newborn baby’s NHS number. bringing them up.
They then send this NHS
number to the Registrar of
Births and Deaths via your local
• fathers,
Unlike mothers and married
if you are not
Child Health Department. married to your baby’s
mother you do not
An important change for automatically have parental
unmarried couples responsibility for them.
the right to be responsible for your
child • could
Before this change, you
only gain parental
• itTheeasier
law is changing to make
for unmarried
responsibility by later
marrying the child’s mother,
fathers to get equal parental signing an official agreement 119
The early weeks: your baby

‘I think it has changed


me. I think I’ve got a with the mother or getting a soothing voice or singing softly
wider outlook on life now court order. You can still get will be reassuring.
responsibility in these ways - you Movement often helps to calm
than I did before. And I might want to think about this if down crying. Gently sway or rock
can speak more openly to you have other children. your baby or take your baby for a
people. I can speak more walk in the pram or baby carrier or
freely. I’m more patient, Need help to decide what to do? even for a ride in a car. Sucking can
too, whereas before I was Parentline Plus have a free helpline
very quick-tempered.’ where you can talk through the
options and ask for advice. Call them
on Parentline Plus 0808 800 2222
or Textphone 0800 783 6783

C RY I N G
All babies cry. It’s their way of saying
that something isn’t right. Sometimes also be comforting. You can put
you’ll be able to find the reason for your baby to your breast or give
your baby’s distress and deal with it. your baby a dummy if you wish. But
At other times all you can do is try if you do, make sure it is sterilised.
to comfort or distract your baby. Do not dip the dummy in honey
If it’s not obvious why your baby or sugar to make your baby suck –
is crying, think of possible reasons. he or she will suck anyway. Using
Could it be: sugar will only encourage a craving
for sweet things which are harmful
• hunger? to children’s teeth.
• wet or dirty nappy? Some babies do cry more than
• colic?
wind? others and it’s not really clear why.
• feeling hot, cold or uncomfortable? Don’t blame yourself or your baby if
• feeling tired and unable to sleep? he or she cries a lot. It can be very
• feeling lonely and wanting exhausting so try to get rest when
• company? you can. Share soothing your baby
with your partner. You could ask a
• tofeeling
play?
bored and wanting friend or relative to take over for an
hour from time to time, just to give
you a break. If there’s no one to turn
It could be none of these things. to and you feel your patience is
Perhaps your baby simply feels running out, leave your baby in the
overwhelmed and a bit frightened cot, put on some music to drown
by all the new sights, sounds and the noise, and go into another room
sensations in the early weeks of life for a few minutes. Make yourself a
and needs time to adjust. Holding cup of tea, telephone a friend or find
your baby close and talking in a some other way to unwind. You’ll
cope better if you do.
Never shake your baby. Shaking
makes a baby’s head move violently.
It can cause bleeding and damage
the brain. Put the baby down safely
in a cot or pram and calm yourself;
don’t be angry with the baby. If you
feel you’re having difficulties in
coping with your baby’s crying, talk
to your midwife or health visitor. Or
contact CRY-SIS (see page 150),
who will put you in touch with
120 other parents who’ve been in the
same situation.
The early weeks: your baby

If your baby’s crying sounds


different or unusual, it may be the
• their
always put babies to sleep on
backs;
first sign of illness, particularly if the
baby isn’t feeding well or won’t be
comforted. If you think your baby is
• warmly
avoid dressing your baby too
or overheating the room;
ill, contact your doctor immediately.
In an emergency, if you cannot
contact your doctor, take your baby
• todosmoke
not smoke or allow others
near your baby or the
to the nearest hospital Accident and room your baby sleeps in.
Emergency Department.
A SAFE PLACE TO SLEEP
SLEEPING Babies should always be put to sleep
on their backs unless there is clear
The amount babies sleep, even when medical advice to do something
they are very small, varies a lot. different. Babies sleeping on their
During the early weeks some babies backs are not more likely to choke,
sleep for most of the time between and the risk of cot death is greatly
feeds. Others will be wide awake. As increased for babies sleeping on
they grow older they begin to their fronts. Keep your baby’s head
develop a pattern of waking and uncovered and place your baby in
sleeping which changes as time goes the ‘feet to foot’ position to prevent
by. Some babies need more sleep your baby wriggling under the
than others and at different times. covers. Make the cot so that the
covers reach no higher than your
You’ll gradually begin to recognise baby’s shoulders.
when your baby is ready for sleep
and is likely to settle. Some babies
settle better after a warm bath. Most
sleep after a good feed. A baby who
wants to sleep isn’t likely to be
disturbed by ordinary household
noises, so there’s no need to keep
The ‘feet to foot’ position means
your whole home quiet while your
that the baby’s feet are right at the
baby sleeps. It will help you if your
end of the cot to prevent the baby
baby can get used to sleeping
wriggling under the covers.
through a certain amount of noise.
See below for advice on sleeping Ask your doctor or midwife for the
positions. leaflet, Reduce the risk of cot death,
published by the Department of
Health and Foundation for Study of
REDUCING Infant Death (FSID).
THE RISK OF THE RIGHT TEMPERATURE
C OT D E AT H Small babies are not very good at
controlling their own temperature.
Sadly, we don’t yet know why some It’s just as important to avoid getting
babies die suddenly and for no too hot as it is to avoid getting
apparent reason from what is called chilled. Overheating is known to be
cot death or Sudden Infant Death a factor in cot death. Remember:
Syndrome (SIDS). This section lists,
in detail, all the advice we now have
for reducing the risk of cot death as
• you
if the room is warm enough for
to be comfortable wearing
well as other dangers such as light clothing (16–20°C) then it is
suffocation. There are three ways in the right temperature for your baby;
which you can reduce the risk: 121
The early weeks: your baby

• clothing
give your baby one light layer of
(or bedding) more than
• from
remove any loose plastic covering
the mattress which could
you are wearing. If the room is come off and smother your baby.
too hot for you, keep your baby’s
clothes or bed-covering light;
CLEAN AIR
• don’t use duvets (quilts) until
your baby is a year old – they Babies should not be exposed to
get too hot; tobacco smoke, either before birth
or afterwards. If you, or anyone else
• when
keep your baby’s head uncovered
inside (unless it’s very cold)
who looks after your baby, smoke
then don’t smoke anywhere near the
as babies need to lose heat from baby. Ask friends to smoke outside
their heads and faces; or before visiting you. It would be
even better if everyone could make
• electric
never use a hot water bottle or
blanket as babies have
an effort to give up completely.
Babies and young children who
delicate skin which can scald breathe in cigarette smoke are also
easily; more likely to get coughs, asthma
and chest infections. For more advice
• any
ill or feverish babies do not need
extra bedding – in fact, they
on giving up smoking, see page 13.

usually need less;


COT MATTRESSES
• put your baby back to sleep in
their cot after a feed or a cuddle. There have been suggestions that
There is a link between sharing a toxic gases from fire-retardant
bed all night and cot death if you materials found in some cot
or your partner are smokers (no mattresses are another potential cause
matter where or when you of cot death. However, a recent
smoke), have recently drunk any report examining this link found no
alcohol, have taken medication or evidence that cot mattresses contribute
drugs that make you sleep more to cot death.
heavily, or are very tired. There is
also a risk that you might roll Following the advice given above
over in your sleep and suffocate will help to reduce the risk of cot
your baby. death.

• ornever sleep with a baby on a sofa


armchair.
If your baby seems at all unwell,
seek medical advice early and
quickly.
• wrap
babies chill easily if it’s cold, so
them up well when you go Do remember that cot death is
You can protect your out, but remember to take off rare. Don’t let worrying about cot
children by keeping their the extra clothing when you death spoil the first precious
playing, sleeping and eating come back inside, even if you months you have with your baby.
areas completely smoke free. have to wake your baby to do it;

• ribbons
avoid plastic sheets or bumpers,
and bits of string from NAPPIES
mobiles anywhere near your baby,
who could get entangled in them; Babies need their nappies changed
fairly often, otherwise they become
• the
make sure there’s no gap between
cot mattress and the sides of
sore. Unless your baby is sleeping
peacefully, always change a wet or
the cot which your baby’s body dirty nappy and change your baby
122 could slip through;
The early weeks: your baby

before or after each feed, whichever


you prefer.
• very
If you use disposable nappies, be
careful not to get cream on
PUTTING ON
A DISPOSABLE NAPPY
Organise the place where you the tabs or they won’t stick down.
change your baby so that everything
you need is handy (see page 85). If
you’re using terry nappies, your
• pants,
Put on, or tie on, the plastic
if you’re using a terry nappy.
midwife or your friends can show
you different ways of folding them.
Experiment to find out which
• Wash your hands.
method is easiest and best for you.
NAPPY HYGIENE
With disposables, the end with the
Disposable nappies sticky tapes goes under your baby’s
CHANGING NAPPIES If the nappy is dirty, flush the contents bottom. Fasten the tapes at the
down the toilet. Roll up the nappy front.
You need to clean your baby’s and re-tape it securely. Put it into a
bottom carefully each time you plastic bag kept only for this purpose. PUTTING ON
change a nappy to help prevent Fasten the bag and put it outside in A CLOTH NAPPY
soreness. your bin each day.

• wipe
Take off the nappy. If it’s dirty, Cloth nappies
away the mess from your
baby’s bottom with tissues or
• If the nappy is dirty, flush the
contents down the toilet and rinse
cotton wool. off the nappy in the flushing water.

• genitals
Wash your baby’s bottom and
with cotton wool and
• ready
Have a plastic bucket (with a lid)
filled with water and the
warm water and dry thoroughly. right amount of nappy sanitising Lay your baby carefully on to a
Or use baby lotion. For girls, powder. Follow the instructions clean nappy and liner.
wipe the bottom from front to on the packet. Make sure you
back, away from the vagina so keep the nappy powder out of
that germs won’t infect the vagina reach of small children.
or bladder. For boys, gently clean
the foreskin of the penis, but
don’t pull it back; clean under the
• bucket.
Put the dirty nappy to soak in the

penis and the scrotum.


• hot
Wash each day’s nappies in very
• such
You may want to use a cream
as zinc and castor oil cream
water. Don’t use enzyme (bio)
washing powders as these may Bring the centre of the nappy
which forms a waterproof coating irritate your baby’s skin. Rinse between your baby’s legs and then
to help protect the skin. Or you very thoroughly. Don’t use fabric bring over the first side piece.
can just leave the skin clean and conditioners as they may also
dry, especially with disposable irritate the skin.
nappies since cream may prevent
them absorbing urine so well. NAPPY RASH

• cause
Don’t use baby powder as it can
choking.
Most babies get soreness or a nappy
rash at some time, but some have
extra sensitive skins. If you notice
• fold
If you’re using a cloth nappy,
it and put a nappy liner
redness or spots, clean your baby
very carefully and change nappies
Bring over the second side piece and
fasten all three pieces together with a
inside, if you wish. Pin the more frequently. Better still, give
corners of the nappy together your baby time without a nappy nappy pin. Put on plastic pants
with a proper nappy pin or clip and let the air get to the skin (keep over the top.
which won’t spring open. a spare nappy handy to mop up).
You will soon see the rash start
to get better. 123
The early weeks: your baby

If your baby does have a rash, ask


your midwife or health visitor about
‘You can’t really explain, it. They may advise you to use a
but it’s a most wonderful protective cream. If the rash seems
thing to be a mum. to be painful and won’t go away,
To look after a baby and see your health visitor or GP.
rear her, watching the
different little things
she does every day. It’s BABIES’ STOOLS
just fantastic.’ Immediately after birth, and for the
first few days, your baby is likely to
pass a sticky black-green substance. Most small babies strain and go
This is called meconium and it is the red in the face, or even cry, when
waste that has collected in the bowels passing a stool. This is normal and
during the time spent in the womb. doesn’t mean they are constipated
As your baby begins to digest so long as the stools are soft. If you
milk, the stools will change, are worried that your baby may be
probably becoming more yellow or constipated, mention this to your
orange. The colours can be quite midwife or health visitor.
bright. Breastfed babies have quite What you find in your baby’s
runny stools. Bottle-fed babies’ nappies will probably vary from day
stools are firmer and smell more. to day and usually there is no need
Babies vary a lot in how often to worry about how runny the stools
they pass stools. Some have a bowel are, for example. But if you notice a
movement at or around each feed; marked change of any kind in your
some can go for several days without baby’s bowel movements, such as the
having a movement. Either can stools becoming very frequent and
be normal. watery or particularly smelly or if
they change colour to become
green, white or creamy, for example,
then you should get advice from
your doctor, midwife or health
visitor. See Babies with jaundice
after two weeks, page 113).

124
The early weeks: your baby

WA S H I N G A N D B AT H I N G

WASHING
You don’t need to bath your baby
1 Check that the water is not too
hot, just comfortably warm to
your wrist or elbow.
every day but you should wash your
baby’s face, neck, hands and bottom
carefully each day. You can do this
on your lap or on a changing mat.
2 Undress your baby, except for a
nappy, and wrap snugly in a
towel. Wash your baby’s face with
Choose a time when your baby is cotton wool and water as described
awake and contented and make sure above. Don’t use soap on your
the room is warm. You’ll need a baby’s face.
bowl of warm water, some cotton
wool, a towel and a fresh nappy.
3 Wash your baby’s hair with baby
soap or liquid, supporting the

1 Take off your baby’s clothes


except for the vest and nappy.
Wrap the baby in a towel.
head over the baby bath or basin.
Rinse carefully.

2 Gently wipe round each eye,


from the nose side outwards,
4 If you’re using baby soap, unwrap
your baby and soap all over, still
on your lap so you have a firm grip.
using a fresh piece of cotton wool Take the nappy off at the last minute.
for each eye. If you’re using baby bath liquid add
it to the water at this stage.

3 Using fresh, moist cotton wool


again, wipe out each ear but
don’t clean inside the ears. 5 Put your baby gently into the
water. Using one hand for
support, gently swish the water to

4 Wash the rest of your baby’s face


and neck with moist cotton wool
and gently dry. Wash and dry your
wash your baby without splashing
the face. You should never leave your
baby alone in the water even for a
baby’s hands in the same way. few seconds.

5 Take off the nappy and wash your


baby’s genitals, again with cotton
wool and warm water. Dry very
6 Lift your baby out and pat dry
with the towel. Dry carefully in
all the creases. If your baby’s skin is
carefully and put on a fresh nappy. dry, gently massage in some baby oil.
In the first week or so, you should Your baby may enjoy this anyway.
also clean round the navel each day.
Your midwife will show you how. Never leave your baby alone in
the bath.
BATHING
If your baby seems frightened of the
Bath your baby two or three times a bath and cries, it may help to try
week, or more often if your baby bathing together. You may like to do
enjoys it. Don’t bath straight after a this anyway. Make sure the water is
feed or when your baby is hungry or only warm, not hot, and don’t add
sleepy. Make sure the room is warm anything to the water unless it’s baby
and that you have everything you bath liquid.
need ready in advance.

125
The early weeks: your baby

ILLNESS Your baby may need treatment very


quickly. If you can’t get hold of your
WHAT YOU CAN DO GP at once, dial 999 for an ambulance
It’s sometimes difficult to tell at first or take your baby to the Accident
• midwife
You can contact your
or health visitor
when a baby is ill but you may have a
funny feeling that things aren’t quite
and Emergency Department of your
nearest hospital as quickly as possible.
for advice. Keep their right. If you’re at all worried, ask for
phone numbers where help. You are not fussing. It’s far better PROBLEMS THAT
they can be reached to be on the safe side, particularly with COULD BE SERIOUS
easily. a very small baby. Trust your own
judgement. You know your baby best.
• You can phone your
• cough
If your baby has a hoarse
with noisy breathing,
GP. Your GP may be VERY URGENT PROBLEMS is wheezing, or cannot breathe
able to advise you over through the nose.
the phone or may suggest Sometimes there are more obvious
signs that your baby is not well.
you bring your baby
along to the next surgery. Contact your doctor at once if your • cold
If your baby is unusually hot,
or floppy.
Most GPs will try to fit baby:
a young baby in
without an appointment, • amakes jerky movements – this is • way
If your baby cries in an unusual
or for an unusually long time
although it may mean a fit or convulsion; or seems to be in pain.
wait in the surgery.
• turns blue or very pale; • the
If you notice any bleeding from
If you’re really worried stump of the cord or from
about your baby, you • breathing,
has quick, difficult or grunting
or unusual periods of
the nose, or any bruising.
should always phone your
breathing, for example if your
GP for help immediately,
whatever the time of day or baby breathes with pauses of over • If your baby keeps refusing feeds.
20 seconds between breaths;
night. There will always be
a doctor on duty even if it
• substantial
If your baby keeps vomiting a
part of feeds or has
is not your own GP. • drowsy,
is very hard to wake, or unusually
or doesn’t seem to know
frequent watery diarrhoea.
Vomiting and diarrhoea together
you; may mean your baby is losing
too much fluid and this may
• which
develops a rash of red spots
do not fade and lose
need prompt treatment.
colour (blanch) when they are
pressed. (See the ‘Glass Test’.) • (looks
If your baby develops jaundice
yellow) when he or she is
This may be the rash of over a week old, or has jaundice
meningococcal septicaemia – an which continues for over two
infection in the blood. There weeks after birth (see page 113).
may not be any other symptoms.
THE ‘GLASS TEST’ If you have seen your GP and your
baby is not getting better or seems to
Press the side or bottom of be getting worse, tell your GP again
a glass firmly against the the same day. If you become very
rash – you will be able to worried and can’t get hold of your
see if the rash fades and GP or your GP can’t get to you quickly
loses colour under the enough, dial 999 for an ambulance
pressure (see photo). If it or take your baby to the Accident
doesn’t change colour, contact and Emergency Department of the
your GP immediately. nearest hospital.
126
The early weeks: your baby

WHERE TO G E T S U P P O RT
SUNSHINE

Everyone needs advice or Young skin is delicate and


You will also want to talk to friends,
reassurance at some time or other very easily damaged by the
relations or other mothers
when they are caring for a young sun. All children, no
in a similar situation. You’ll meet
baby, even if it’s just to make sure matter whether they tan
other mothers when you start taking
that they are doing the right thing. easily or not, should be
your baby to the Child Health
Some problems just need talking protected from the sun.
Clinic. Your health visitor will
over with someone. It’s always better Never leave your baby in a
explain where this is and when you
to ask for help than worry on your place where he or she could
should go. The health visitor can
own. Do talk to your midwife or become overheated.
also tell you about any mother and
health visitor. As you grow more baby groups in the area. Or your Always keep babies under
confident, you’ll begin to trust your local branch of the National six months out of direct
own judgement more. You will be Childbirth Trust (see page 147) or sunlight, especially around
able to decide which advice makes MAMA (Meet-A-Mum Association) midday, under trees,
most sense for you and your baby (see page 148) may be able to umbrellas, canopies or
and which suggestions you can put you in touch with other indoors.
safely ignore. mothers nearby.
A baby’s skin burns easily,
even in sun that would not
affect your own. Cover up
E N J OY I N G YO U R with hats, cool clothing and
use a high protection
BABY sunblock (at least protection
factor 15+) on any
RAISING exposed skin to help protect
your baby’s skin from the
YO U R C H I L D sun.

B I L I N G UA L LY
Being bilingual gives a child Perhaps either you and your
something special. The best partner, or both of you, speak
advice is to introduce both another language. In that case,
languages as soon as your baby is you are in an ideal position to
So far we have only talked about the born! introduce your child to two
things that have to be done to keep It is worth bearing in mind languages and to the benefits
your baby warm, fed and safe. In the that children who speak more which that brings.
first weeks those things can grow to than one language enjoy several For more information on
fill all the available time, but of advantages such as: support groups for ethnic
course they’re only a tiny part of minorities contact Race
what it means to be a parent. Every • creatively;
thinking more flexibly and Equality First (W) (see page
second that your baby is awake he or 147); or for information on
she is learning from you. Learning • more
learning other languages
easily;
using the Welsh language with
about what it feels like to be your baby contact The Welsh
touched gently, about the sound of • learning
having a head start when
to read;
Language Board (see page 148).
your voice and your very special
smell, about what the world is like • cultures;
being able to enjoy two
and whether it is a safe place to be
and, above all, what it feels like to • tests
tending to perform better in
and exams.
love and be loved. 127
17 Thinking
about the next
baby?
DIFFICULTY

A
s you hold your new baby in your arms, it may be impossible to
CONCEIVING imagine that you will ever have the energy to go through it all
again. Or you may be eager to increase your family as soon as
It can take several months you can. Either way, this is the time to stop and think about how you
or more to conceive even if it and your partner can prepare for the next pregnancy. Nobody can
happened really quickly the guarantee that a baby will be born healthy. However, if you had a low
first time. birthweight baby or a baby with a disability or special needs, or a
miscarriage or stillbirth, you may be particularly anxious to do
If you’re feeling very tired everything you can to create the best possible circumstances for your
looking after the first baby, next pregnancy. You’ll want to talk to your doctor about this. If both
it may be that you are parents are in good health at the moment of conception, that is the best
simply not making love at start you can possibly give to a new life. There are a few other steps you
the right time. Re-read the can take as well.
section on Conception
(pages 21–5) to remind
yourself when you are most F AT H E R S TO O GETTING AND
likely to succeed. If nothing
happens after a few months, A bad diet, smoking, drinking and S TAY I N G H E A LT H Y
and you feel anxious about unhealthy working conditions can
it, talk to your doctor or affect the quality of sperm and stop
family planning clinic. pregnancy from happening at all. Try
to make your lifestyle as healthy as
possible before you try to conceive.

Re-read Chapter 1, Your health in


pregnancy, about diet, smoking,
alcohol and exercise. The advice is
even more effective if you start well
before the next baby is on the way.
You will need to prepare for
pregnancy by taking extra folic acid
from the time you start trying to
conceive right up until you’re 12
128 weeks’ pregnant. Choose foods that
Thinking about the next baby?

contain this important vitamin such they are safe to take in pregnancy.
as green, leafy vegetables and Addictive drugs will affect your ability
breakfast cereals and breads with to conceive and, if you do conceive,
added folic acid. (See symbol on are likely to damage your baby’s
this page.) To make sure you get health. See page 148 for organisations
enough, you should also take a 400 which can help you to stop.
microgram (0.4 milligram) tablet Foods carrying this mark
every day. You can get these tablets Sexually transmitted infections have added folic acid.
from a supermarket or pharmacist. (STIs)
If you already have a baby with spina STIs can affect your ability to
bifida, if you have coeliac disease or conceive as well as affecting you. If
take anti-epileptic drugs, ask your GP there is any chance that either of you VAGINAL BIRTH
for more advice, since you will need has been in contact with an STI, it’s AFTER CAESAREAN
important to get it diagnosed and
to take a bigger dose of folic acid. SECTION
treated before starting another
pregnancy. STIs, including HIV and
THINGS TO THINK ABOUT hepatitis B, can be passed on through:
The majority of women who
have had a Caesarean
Here are some things that are worth section are able to aim for a
doing before having your next baby. • infected
sexual intercourse with an
person, especially vaginal delivery for their
without using a condom, and next baby. This depends,
Rubella (German measles) some STIs can be transmitted however, on the reason for
Rubella can badly damage a baby during sex without penetration; the first Caesarean section.
during pregnancy. If you were Women who are thought to
not already immune you should
have been offered immunisation
• passed
HIV and hepatitis B can also be
on by sharing equipment
have a small pelvis, for
example, may be advised to
immediately after your baby was for injecting drugs. have a ‘planned’ (elective)
born. Before trying for another baby, Caesarean section next time.
think about having a blood test to If you’re HIV positive, you could pass Your GP, or midwife, will be
check that you are immune to the virus on to your baby in the able to advise you. Most
rubella. The blood test will measure womb, at birth or by breastfeeding. women who are advised to
if you have enough protection Up to 1 in 6 children born to try for a vaginal delivery in
(antibodies) against rubella. Women mothers with the virus are likely to subsequent pregnancies do
with low or uncertain levels of be infected (see box, page 54). have normal deliveries.
antibodies can be immunised again.

Long-term medication WO R K
If either of you has a chronic illness
or disability and has to take long- HAZARDS
term medication, talk to your doctor SOME WAYS OF
in advance of pregnancy about any If you think that there may be a risk AVOIDING RISK
possible effects on fertility or involved in your work ask for a
pregnancy. It may be possible to risk assessment. If a significant risk • protective clothing
cut down the dosage. is found your employer should take
reasonable steps to remove the risk
• or dust
avoiding breathing fumes

Diabetes and epilepsy or prevent your exposure to it (see • avoiding skin contact
If you have diabetes or epilepsy,
talk to your doctor in advance.
box). If the risk cannot be avoided
your employer should offer you
• working
temporarily altering your
conditions or
suitable alternative work on similar hours of work
Medicines and drugs terms and condition as your present
These may endanger your baby’s job. If no safe alternative is possible
health. Don’t take any over-the- you should be suspended on full pay
counter drugs at the time you hope (ie given paid leave) for as long as
to conceive without making sure necessary to avoid the risk. 129
18 Rights and
benefits
I
t’s very important that you get help and advice as soon as you know that
you’re pregnant, to make sure that you know your rights and that you claim
all the benefits to which you’re entitled. Benefits have to be claimed on
different forms, from different offices, depending on what you are claiming.
The benefit rates are accurate at January 2005. Maternity rights are complex
and sometimes change, so you should get further advice if you are unsure.
There are many voluntary organisations that are happy to help, so don’t hesitate
to ask for advice or get an opinion. See the box on where to get advice.

WHERE TO GET ADVICE AND HELP BENEFITS FOR ALL


PRESCRIPTIONS AND NHS
Working out what benefits and rights you are entitled to and DENTAL TREATMENT
making claims can be complicated. Get help if you need it.
You can go to your local Jobcentre Plus (look in the business These are free while you are pregnant and for 12
numbers section of the phone book under ‘Jobcentre Plus’; months after you have given birth. Your child also
in Northern Ireland ‘Social Security Office’ – soon to become gets free prescriptions until age 16. To claim for free
‘Jobs and Benefits Office’). Or go to your local Citizens
Advice Bureau or other advice centre (see page 147).
prescriptions, ask your doctor or midwife for form
FW8 and send it to your local NHS Business
Citizens Advice Bureaux, law centres and other advice Services Centre (in Northern Ireland, ask for
agencies will also be able to advise you about your rights at HC11A and send it to the Central Services
work. To find your local advice agencies, look in your Yellow Agency). You will be sent an Exemption Certificate
Pages phone book under ‘Counselling and Advice’. which lasts until a year after your due date.
Some local authorities have welfare officers. Phone your social
To claim after your baby is born (if you didn’t
services department (in Northern Ireland, local Health and claim while you were pregnant) fill in form A in
Social Services Trust) and ask. Some national voluntary leaflet P11 NHS Prescriptions (or in Northern
organisations offer information and advice on benefits and Ireland read the leaflet HC11 – Help with Health
rights at work, for example, the Maternity Alliance and the Service Costs), which you can get from your doctor
National Council for One Parent Families (see pages 147 or Jobcentre Plus/Job and Benefit office in
and 148).
Northern Ireland (social security office/Jobs and
If you are a member of a trades union, your staff Benefits office).
representative or local office should be able to advise you on To claim for dental treatment, tick a box on a
your maternity rights at work. The Equal Opportunities form provided by the dentist or show your
Commission can advise you if your problem is to do with Exemption Certificate (see above).
sex discrimination (see page 147).

The Health and Safety Executive have a new publication for


CHILD BENEFIT
women explaining the health and safety rights that apply to What is it?
pregnant women and women who have recently given birth. A tax-free benefit to help parents with the cost of
Some useful websites include:
caring for their children. It is payable for each child
www.dwp.org.uk (Department for Work and Pensions) from birth until at least age 16.
www.tiger.gov.uk (ACAS – guidance on employment rights)
www.taxcredits.inlandrevenue.gov.uk Who gets it?
www.hse.gov.uk (Health and Safety Executive) Every mother or the person responsible for the care
www.maternityalliance.org.uk of the child, but you must generally have been living
in the United Kingdom for at least six months.
130
Rights and benefits

How much is it? Who gets it?


For your first child, £16.05 per week (£17.55 per The Working Tax Credit can be claimed by
week for your first child if you are a single parent single people or couples, with or without children,
who has been claiming since before June 1998). For who work enough hours each week.
other children you get £10.75 a week per child. You must be working at least 16 hours each
week if:
How do I claim?
You may get a claim pack inside the Bounty Pack ● you have dependant children and/or
which most new mothers are given in hospital. ● you have a disability.
You can also get a claim pack from your Jobcentre
Plus/Social Security Agency (social security office) Otherwise, you must be 25 or over and work at
or post office (also from the General Registrar’s least 30 hours a week.
office in Northern Ireland). Fill in the forms and You can be treated as if you are working during
send them with your baby’s birth certificate to the Ordinary Maternity Leave if you are getting
Child Benefit Centre (Child Benefit Office in Statutory Maternity Pay or Maternity Allowance,
Northern Ireland). The birth certificate will be and were working enough hours immediately
returned to you. If you have access to the internet, before starting your maternity leave.
you can apply online using the Child Benefit Help with childcare costs?
e-service: esd.dwp.gov.uk/dwp/index.jsp. This The Working Tax Credit can include a childcare
service is not available in Northern Ireland. element to help with the cost of approved childcare
Child Benefit can be paid directly into your bank where a lone parent or both partners in a couple
account or by a book of orders which you cash at work for at least 16 hours a week, or one partner
the post office. It is usually paid every four weeks in works and the other is disabled.
arrears, but single parents and families on low The childcare element is worth up to 70% of
incomes can choose to be paid weekly. You should eligible childcare costs, up to a weekly maximum
start to claim Child Benefit within three months of of £135 for one child and £200 for two or more
your baby’s birth otherwise you will lose some of children, paid to the main carer.
the benefit.
How do I claim Tax Credits?
Anything else? Both Child Tax and Working Tax Credits can be
Child Benefit can help to protect your State claimed using the same form, obtained by phoning
Retirement Pension if you stay at home to look the helpline on 0845 300 3900 (0845 603 2000
after your child. For every complete year that you Northern Ireland) or online at
get Child Benefit, but you don’t pay enough www.inlandrevenue.gov.uk/taxcredits.
National Insurance contributions to count towards
the basic pension, you automatically get ‘Home How much will I get?
Responsibilities Protection’. The amount you get will depend on your current
circumstances, for example, the number of children
TAX CREDITS in your household, the number of hours you and
your partner work, and your household’s gross
Two new tax credits were introduced in April 2003 income for the last tax year. Claims for the tax year
– Child Tax Credit and Working Tax Credit. 2003–4 will initially be based on income for
Who gets it? 2001–2. Awards will run until the end of the tax
Child Tax Credit gives financial support for year, but if there is a change affecting the amount,
children. It can be claimed by lone parents or you can ask for the award to be adjusted from the
couples with one or more children. Nine out of ten date of the change; for example, if your wages fall
families with children will get this new tax credit. significantly during the current tax year because
The Working Tax Credit helps people in lower you are going on maternity leave, or following the
paid jobs by topping up their wages. It will be paid birth of your baby. Maternity Allowance or the first
through the wage packet. £100 a week of Statutory Maternity Pay will be
ignored as income.

131
Rights and benefits

Families with children, with an annual income of How much is it?


£50,000 or less, will get at least £545 a year. A This depends on your age and the size of your
single parent staying at home to look after one child family, and on what other income you have. If you
will get £1,990 a year (£38.27 a week). are under 25 or have more than £3000 in savings,
you get a lower rate. If you are claiming during
Anything else? pregnancy, you should let the Jobcentre Plus/Social
If you get tax credits you may also be able to get Security Office (Jobs and Benefits office) know as
the £500 Sure Start Maternity Grant, reduced soon as the baby is born, as your benefit will go up.
price formula milk for a baby under one and help For example:
with fares to hospital for treatment (including
antenatal appointments). ● If you are a single parent aged 18 or over with
one baby and no savings, you would be allowed
BENEFITS I F YO U R an income of £99 per week. This means that
any weekly income you already have (such as
I N C O M E I S L OW Child Benefit) would be topped up to the
INCOME-BASED JOBSEEKER’S ALLOWANCE Income Support level for your family.
● If you are in a couple and one or both of you
(JSA) AND INCOME SUPPORT
is aged 18 or over, you have one baby and no
What are they? savings, you would be allowed an income of
Weekly payments for people who are not in work £129.20 per week. This means that any weekly
and do not have enough to live on. If your family income you already have (such as Child Benefit)
income falls below a set level, the benefit will ‘top would be topped up to the income-based JSA
it up’. This means that you may be able to get level for your family.
Income Support even if you are already getting
How do I claim?
Statutory Maternity Pay, Maternity Allowance,
To claim income-based JSA before your baby is
Incapacity Benefit or some income from part-time
born, you or your partner must both go to the
work.
Jobcentre in person (you may be able to claim by
Who gets them? post if you live a long way from the Jobcentre).
You can claim income-based JSA if you are 18 or In Northern Ireland, claim income-based JSA at
over and you are actively seeking work. Usually you your local Social Security Office). After your baby
would claim this benefit if you are living with your is born, you will no longer need to sign on. Your
partner and you are both either unemployed or partner can continue to claim for you and the baby.
working part time. You should also claim it if you To claim Income Support, fill in form A1,
are single and unemployed but your baby has not which you may get from a post office or a
been born yet. Jobcentre Plus (or in Northern Ireland from your
If you are 16–17 and face severe hardship you Social Security Agency). Return the form to your
may be able to claim before your baby is born. local Benefits Agency/Social Security Agency
You should get further advice about this. (social security office).
You can claim Income Support if you are 16 or The benefit is paid directly into your bank
over and cannot be available for work. This would account, or by Giro, or by a book of orders which
be because you are a single parent or because you you cash at the post office. If you are claiming
are 29 weeks pregnant or more. You may also get income-based JSA, you will have to go to the
Income Support if you are single and pregnant and Jobcentre every fortnight (Social Security Office in
you are not well enough to work. Northern Ireland) to ‘sign on’ to show that you are
You cannot claim income-based JSA or available for work. If you are claiming Income
Income Support if you have a partner who lives Support, you do not need to ‘sign on’.
with you and works for 24 hours or more a week,
Anything else?
or if you work for more than 16 hours a week, or if
If you get Income Support or income-based JSA or
you have savings of more than £8000.
Pension Credit guarantee credit, you can claim
other benefits, such as a £500 Sure Start Maternity

132
Rights and benefits

Grant, free milk and vitamins, help with fares to ● Crisis loans are interest-free, repayable loans
hospital, Housing Benefit and Council Tax Benefit. for people (whether on benefits or not) unable
You may be able to get help with mortgage interest to meet their immediate short-term needs in
payments. See below for more information. a crisis.
How much are they?
£500 SURE START MATERNITY GRANT This depends on your personal circumstances, your
FROM THE SOCIAL FUND
ability to pay and on how much money is available.
What is it? Social Fund payments are not a right and there is a
A lump sum payment (a grant which you do limited amount of money to be distributed to all
not have to pay back) to help buy things for a those who apply.
new baby.
How do I claim?
Who gets it? For information about which Social Fund payment
Pregnant women and new parents who are getting to claim and how, contact you local Jobcentre Plus.
Income Support, income-based Jobseeker’s More information is also available in leaflets SB16
Allowance, Pension Credit, Working Tax Credit (Guide to the Social Fund) and GL 18 (Help from
where a disability or severe disability element is the Social Fund).
included in the award or Child Tax Credit payable Loans have to be repaid at a set amount per
at a rate higher than the family element. week, which will be taken directly from your
income if you are claiming other benefits. The
How much is it? amount you have to repay per week depends on the
£500 for each baby. size of the loan, the size of your income and any
How do I claim? other debts you may have.
Claim using form SF100 (Sure Start), which you Anything else?
can get from your local Jobcentre Plus/Social ● A Community Care Grant does not have to be
Security Agency (social security office). You can paid back.
claim any time from 11 weeks before the due date ● You cannot get a Budgeting loan or a Crisis
until three months after the birth. Loan for more than £1,000 and the total you
Part of the form will need to be completed by owe the Social Fund cannot be more than
your midwife, GP or health visitor. This is to £1,000.
confirm when your baby is due or actually born, ● Savings of more than £500 will usually affect
and that you have received advice about the health how much you can get (£1,000) if you or your
and welfare of yourself and your baby. partner are aged 60 or over.
If you can’t get Income Support, income-based
JSA, Pension Credit, Working Tax Credit or Child HOUSING BENEFIT – HELP WITH YOUR RENT
Tax Credit until after your baby is born, claim the (in Northern Ireland this will help with your rent and/or
Sure Start Maternity Grant before your baby is rates)
three months old.
What is it?
THE DISCRETIONARY SOCIAL FUND Housing Benefit will help you pay your rent (in
Northern Ireland rent and/or rates) if you are on
What is the Discretionary Social Fund?
income-based Jobseeker’s Allowance, Income
The discretionary social fund provides grants and
Support, or have a low income. If you are a
interest-free loans for needs that are difficult for
council/Housing Executive tenant it will be paid
people to meet out of their weekly benefits or
direct to the council/Housing Executive; if you are
regular income.
a private tenant, it will be paid either to you or
What are they and who gets them? direct to your landlord. In Northern Ireland if you
There are three types of payments available: are an owner occupier Housing Benefit will be paid
in the form of a rate rebate administered by the
● Community care grants for people getting
Rate Collection Agency.
income support (IS) or income-based JSA.
● Budgeting loans are interest-free, repayable
loans for people getting income support (IS)
or income-based JSA for at least 26 weeks.
133
Rights and benefits

In this box, write in the date of the


Sunday before the first day of your last THE TIMING OF YOUR RIGHTS AND BENEFITS IN PREGNANCY IS VERY
period. (If your last period started on a COMPLICATED, SO USE THIS CHART AS A ROUGH GUIDE ONLY.
Sunday, write in that date.) Then work
along the top row filling in the dates of
each successive Sunday.

Write in the first day of your last period here.


Then work along the row filling in the remaining boxes.
Each box represents a week. Write in the dates week by
week until you get to the date your baby is due.

How much is it? are an owner occupier get claim form F1 from the
It depends on the rent you pay, average rents in your Rate Collection Agency (RCA), Londonderry
area, the size of your home, your income, savings, House, 21–27 Chichester Street, Belfast BT1 4JJ,
other benefits, your age and your family size. It may tel: 02890 25 2757 or your local RCA.
not be the same amount as the rent you are actually
paying. You cannot get Housing Benefit if you have HELP WITH MORTGAGE INTEREST
savings of more than £16,000, and the amount you REPAYMENTS
get is reduced if you have savings of more than Who gets it?
£3000. If you’ve got a mortgage and you’re on income-
How do I claim? based JSA or Income Support, you may be able to
If you’re getting income-based Jobseeker’s get help with your interest payments, although there
Allowance (JSA) or Income Support you will get a is usually a waiting period during which you won’t
Housing Benefit claim pack with your JSA/Income get any help.
Support claim form. Otherwise, get a form from How much is it?
your local council. In Northern Ireland if you are a You can only get help with interest payments (not
tenant get claim form HB1 from your Northern repayments of capital or contributions to a linked
Ireland Housing Executive district office or if you PEP, endowment or insurance policy) and the

HAVE YOU CLAIMED EVERYTHING?


You can
Child Benefit

prescriptions
Free

treatment
Free dental

Grant
Start Maternity
£500 Sure

Fund loans
Social
Benefit
& Housing
Benefit (not NI)
Council Tax

with mortgage
Help

Free milk

Free vitamins

hospital
Fares to

claim

If you get

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Income-
based JSA

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Income
Support

Low
✓ ✓ ✓ X X ✓ X X X ✓
income

All ✓ ✓ ✓ X X X X X X X
mothers
Rights and benefits

You must have notified your employer of your


pregnancy, the expected week of childbirth
and the date you want to start OML. This is the earliest you can start your
This is also your ‘qualifying’ week for SMP. maternity leave and Maternity Allowance
(MA) or Statutory Maternity Pay.

You should apply for Maternity If you qualify for a Sure Start Maternity The date your baby is due.
Allowance about now. Grant from the Social Fund, claim it as
soon as possible.

amount is usually based on a standard average If you have Mortgage Protection insurance,
interest rate (which may not be the same as the contact your insurer immediately. Most insurance
interest you are paying). policies will pay out if you are receiving income-
If you took out your mortgage before 2 October based JSA or Income Support, but not if you are only
1995, you will get no help for eight weeks, half of receiving Statutory Maternity Pay or Maternity
the allowable interest for the next 18 weeks and Allowance, so check carefully.
then all the allowable interest after that.
If you took out your mortgage after 1 October COUNCIL TAX BENEFIT
1995, you will get no help for 39 weeks and then (Not applicable in Northern Ireland.)
all the allowable interest from week 40 of your What is it?
claim. If you claim benefit because of the death of A benefit to help you pay your Council Tax if your
your partner or because your partner has left you income is low.
and you have at least one child under 16, you are
treated as if you took out your mortgage before Who gets it?
2 October 1995. If your income is low or you’re getting income-
based JSA or Income Support, you may get
How do I claim? Council Tax Benefit.
Once you have claimed income-based JSA or
Income Support, your Jobcentre Plus/Social How much is it?
Security Agency (social security office) will You may get all of your Council Tax paid or just
automatically send you a form MI12 about your part of it. It will depend on your income, savings,
housing costs shortly before they become payable. whether other adults live with you, and an
You fill out part of the form and then send it to assessment of your circumstances.
your mortgage lender to fill out the rest. The How do I claim?
money will either be paid to you as part of your If you’re getting income-based JSA or Income
income-based JSA or Income Support, or it will Support, you will get a Council Tax Benefit claim
be paid directly to your mortgage lender. form with your JSA/Income Support claim form.
Anything else? Otherwise, get a form from your local council.
Tell your mortgage lender as soon as you get into FREE MILK AND VITAMINS
difficulties with your mortgage. If you are unable
to meet your repayments, you may be able to Who gets them?
negotiate a temporary agreement for reduced You can get these free if you are pregnant and in a
repayments (e.g. during your maternity leave). family receiving Income Support, income-based JSA
If you have a ‘flexible mortgage’, this should be or Pension Credit guarantee credit.
relatively easy to arrange. Some mortgage lenders If you have a child under 5, receive Child Tax
allow a few months’ ‘repayment holiday’ once Credit only and have a family income of £13,230
during the life of the mortgage. or less (2003/4) you qualify.
135
Rights and benefits

How do I claim? can cover normal public transport fares, estimated


Your local Jobcentre Plus/Social Security office will petrol costs and taxi fares if there is no alternative.
arrange for these to be issued to you once you tell You may also be entitled to help if your family has
them that you are pregnant and the date your baby a low income. You may also get help if you are in
is due. You will get milk tokens which can be receipt of tax credit or pension credit. Check your
exchanged for one pint of milk a day from most award letter for details.
shops and milkmen. From October 2004,
responsibility for issuing the tokens is transferring How do I claim?
to the Department of Health; your midwife will If you are claiming one of the benefits mentioned
be able to advise you of the new arrangements. above, you can claim at the hospital at the time
Once your baby is born you should claim Child of your visit by showing proof that you get the
Tax Credit from the Inland Revenue. They will benefit. Alternatively you can claim within three
review your financial situation, and if you fulfil the months of your visit by filling in form HC5, which
qualifying criteria, which is to receive Child Tax you can get from the hospital or the Jobcentre
Credit only with a family income of £13,230 or less Plus/Social Security Agency.
(2003/4), they will pass your details to the Token If you are not in receipt of one of the above
Distribution Unit (TDU) so that tokens can be benefits and your income is low, you must first fill
issued to you. Apart from claiming Child Tax in form HC1, which you can get from your doctor,
Credit for your baby there is nothing more you hospital or Social Security Office. Depending on
need to do. If you qualify, the TDU will send you how low your income is, you will then be given
tokens that you can use for liquid milk if you are either certificate HC2, which means you qualify for
breastfeeding or infant formula if you are bottle- free services, or certificate HC3, which means that
feeding every four weeks. When your baby is a year you qualify for some help. You show the certificate
old the tokens will change to liquid milk only. when you go to the hospital, or you can claim
Infant formula milk and vitamins are available within three months of your visit on form HC5.
form Child Health Centres/Clinics and, in some
areas, pharmacies. Your midwife/health visitor M AT E R N I T Y
should know what the local arrangements are
When obtaining supplies from the Child Health
BENEFITS
Centres/Clinics you will need to show your benefit MATERNITY ALLOWANCE (MA)
book or award letter and proof of your ● for women who have changed jobs during
child/children’s age(s) (your Child Benefit order pregnancy and/or
book, the birth certificate or your parent-held child ● for women who have had periods of low
health record). earnings or unemployment during pregnancy;
● for women who are self-employed.
REDUCED-PRICE FORMULA MILK
What is it?
You may buy infant formula milk at a reduced price A weekly allowance for women who work just
if you have a baby aged under one year and receive before or during their pregnancy but who can’t get
Working Tax Credit with a family income of Statutory Maternity Pay (see below). You may get
£14,200 or less (2003/4). The Inland Revenue will MA if you are self-employed, if you stopped work
automatically assess you for this and will arrange for or if you changed jobs during pregnancy.
you to be issued with an NHS Tax Credit
Exemption Certificate if you qualify. Who gets it?
You can claim MA if you have worked in at least
HELP WITH HOSPITAL FARES 26 of the 66 weeks before your expected week of
childbirth. You must have earned at least £30 per
Who gets it?
week for 13 weeks. You should choose the 13
If your family gets income-based JSA, or Income
weeks in which you earned the most. In your chosen
Support, you can get a refund for fares to and from
weeks, you can add together earnings from more
the hospital (including visits for antenatal care). This
than one job, including any self-employed work.

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Rights and benefits

How much is it? What is it?


MA is paid for 26 weeks at a flat rate of £100 per A weekly allowance which can be paid to women
week or 90% of your average earnings if this is less. who don’t qualify for Statutory Maternity Pay or
Maternity Allowance.
When is it paid?
MA is paid for up to 26 weeks, but only for weeks in Who gets it?
which you are not working. The earliest you can You get Incapacity Benefit (IB) if you have enough
claim MA is 15 weeks before your baby is due and National Insurance contributions in earlier tax years.
the earliest it can start is 11 weeks before your baby Claim if you have paid any National Insurance
is due. The latest it can start is your expected week contributions during the last three tax years that do
of childbirth. If you are employed or self-employed, not overlap the current calendar year. If you are not
you can choose when to start your MA, but if you sure whether or not you qualify, claim and your
are unemployed, your MA must start 11 weeks local Jobcentre Plus/Incapacity Benefits Branch will
before your baby is due. work out whether you can get the benefit.

How do I claim? How much is it and when is it paid?


The rules are complicated, so if you are not sure It is £54.40 per week. It is paid from six weeks
whether you qualify, make a claim. Your local before your baby is due until two weeks after your
Jobcentre Plus (in Northern Ireland, the Incapacity baby is actually born. You won’t get IB for any
Benefits Branch, Castle Court, Royal Avenue, week in which you work.
Belfast, BT1 1SB) will work out whether or not How do I claim?
you can get the benefit. Use the Maternity Allowance claim form MA1,
You must claim within three months of giving which you can get from your social security office
birth or you may lose the benefit. Fill in form MA1 (Jobcentre Plus/Social Security Agency) or your
(available from your social security office or antenatal clinic. You also have to send your
antenatal clinic) and send it to Jobcentre Plus (in maternity certificate (form MAT B1), which you
Northern Ireland, the Incapacity Benefits Branch). get from your midwife or GP when you are about
You must also send your maternity certificate (form 20 weeks pregnant. You don’t need to send in a sick
MAT B1), which you get from your GP or note from your doctor.
midwife; and, if you are employed, form SMP1 If you are not entitled to Maternity Allowance,
from your employer to show why you don’t qualify the social security office (in Northern Ireland
for Statutory Maternity Pay. Send in form MA1 as the Incapacity Benefits Branch) will check
soon as you are 26 weeks pregnant; you can always automatically to see if you qualify for IB.
send the other forms later. Sometimes they forget, so if you do not hear from
If you have not earned enough, have not worked them about this, contact them. It can be paid
for enough weeks or have not paid enough directly into your bank or by a book of orders that
National Insurance contributions by the time you you cash. You must claim within three months of
are 26 weeks pregnant, then you can decide to giving birth or you may lose the benefit.
apply for MA later in your pregnancy. You should
send off the MA1 form as soon as you have fulfilled STATUTORY MATERNITY PAY (SMP)
all the qualifying conditions. ● for women who have been in the same job
Maternity Allowance is paid by a book of orders throughout their pregnancy and
which you cash, or directly into your bank account. ● whose earnings average £77 per week or more.
If you are not entitled to MA, the Jobcentre
Plus/Incapacity Benefits Branch will use the same What is it?
claim form to check whether you might be entitled Maternity pay for 26 weeks. Your employer pays it
to Incapacity Benefit (see below). Sometimes they to you and claims most or all of it back from the
forget, so if you do not hear from them about this, Inland Revenue. You can get it even if you
contact them. don’t plan to go back to work. You will not
have to pay SMP back if you don’t return to
INCAPACITY BENEFIT (IB) work. You may qualify for SMP from more than
one employer.
● for women who have paid some National
Insurance contributions during the last three
years.
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Rights and benefits

Who gets it? the due date if it is a Sunday) and count back 11
You get SMP if: Sundays from there. It is for you to decide when
● you have worked for the same employer for at you want to stop work. You can even work right
least 26 weeks by the end of your qualifying up until the date the baby is due, unless:
week (the 15th week before your expected week ● you have a pregnancy-related illness/absence in
of childbirth, which is approximately the 26th the last four weeks of your pregnancy. In this
week of pregnancy), i.e. you started the job case your employer can start your maternity
before you got pregnant; leave even if you are absent for only one day.
● you are still in your job in this qualifying week However, if you are ill only for a short time
(it doesn’t matter if you are off work sick, or on your employer may agree to let you start your
holiday); maternity leave when you had planned; or
● you actually receive at least £77 (before tax) per ● your baby is born before the day you were
week in earnings, on average, in the eight weeks planning to start your leave. In this case SMP
(if you are paid weekly) or two months (if you will start on the day after the birth and maternity
are paid monthly) up to the last pay day before leave will start on the day of the birth.
the end of the qualifying week. SMP is paid for 26 weeks and usually starts on
To find out which is your qualifying week, look the Sunday after you go on maternity leave. So if
on a calendar for the Sunday before your baby is your last day of work is a Friday or Saturday, it will
due (or the due date if that is a Sunday) and count start immediately. You cannot get any SMP for any
back 15 Sundays from there. You should use the week in which you work even part of a week. So if
due date on the MAT B1 certificate which your you return to work early, your SMP will stop.
midwife or GP will give you when you are about
20 weeks pregnant. How do I claim?
If you are not sure if you’re entitled to SMP, ask To get SMP you must give your employer 28 days
anyway. Your employer will work out whether or notice of the date you want to start your pay and
not you should get it, and if you don’t qualify they you cannot then change your mind. If it is not
will give you form SMP1 to explain why. If your reasonably practicable for you to give 28 days
employer is not sure how to work out your SMP or notice, you should give it as soon as you can (e.g.
how to claim it back, they can ring 08457 143 143 you may have to go into hospital unexpectedly).
for advice. The notice should be in writing if your employer
asks for this.
How much is it?
For the first six weeks you get 90% of your average
pay. After that you get the basic rate of SMP, which
IF YO U A R E
is £100 per week (or 90% of your average earnings, U N E M P L OY E D
if that is less) for 20 weeks.
The average is calculated from the pay you CONTRIBUTION-BASED JOBSEEKER’S
actually received in the eight weeks or two months ALLOWANCE (JSA)
up to the last pay day before the end of the What is it?
qualifying week. Your employer normally pays your An allowance which lasts for up to 26 weeks for
SMP in the same way as your salary is paid. S/he people who are unemployed or working less than
deducts any tax and National Insurance 16 hours a week.
contributions.
Who gets it?
When is it paid? You get it if you have paid enough National
The earliest you can start your SMP is 11 weeks Insurance contributions during the last two tax
before the expected week of childbirth. This is years that do not overlap the current calendar year.
when you are about 29 weeks pregnant, but you You have to be available for work for as many hours
have to use the due date on your MAT B1 as your caring responsibilities permit (not less
certificate, which your midwife or GP will give than 16 hours), and you have to be actively
you. Find the Sunday before your baby is due (or seeking work.

138
Rights and benefits

How much is it?


If you are under 18, you get £32.90 a week; if you
are aged 18–24, you get £43.25 a week; if you are
M AT E R N I T Y L E AV E
25 or over, you get £54.65 a week. Your partner’s ORDINARY MATERNITY LEAVE (OML)
earnings are not taken into account, but, if you are
● 26 weeks’ leave for all employed women;
in part time work, your earnings are.
● right to return to same job.
How do I claim? What is it?
Go to your local Jobcentre Plus in person (Social OML is 26 weeks’ leave from work with the right
Security Office in Northern Ireland), or you can to return to the same job at the end of it. You
claim by post if you live too far away. You will have must give your employer the correct notice
to go to the Jobcentre Plus (Social Security Office (see How to give notice below).
in Northern Ireland) every fortnight to ‘sign on’ to
show that you are available for work. The benefit is Who gets it?
paid directly into your bank account, or by Giro All women employees are entitled to OML from
normally every two weeks. day one of their employment. It doesn’t matter
how many hours you work or how long you have
Anything else? worked for your employer, you will still be entitled
If your family has no other income, you will to OML.
probably be entitled to income-based JSA and You are usually an employee if the following
other benefits for families on low incomes arrangements exist at your work:
(see section above).
● your employer deducts tax and National
Insurance from your pay;
If I resign from my job and don’t go back to ● your employer controls the work you do, when
work after maternity leave, can I claim and how you do it;
anything? ● your employer provides all the equipment for
You may be able to claim contribution-based your work.
Jobseeker’s Allowance (JSA) for up to six months. If you work for an agency or do casual work,
However, you will have to show that you had ‘just you are probably not an employee, but you can
cause’ for voluntarily leaving your job. You will also still get maternity pay if you meet the normal
have to be available for work for as many hours a conditions (see Statutory Maternity Pay and
week as your caring responsibilities permit (and not Maternity Allowance).
less than 16).
When can I start my maternity leave?
If you haven’t paid enough National Insurance The earliest you can start your OML is 11 weeks
contributions, you may be able to claim income-based before your expected week of childbirth. This is
JSA instead (see above), depending on your personal when you are about 29 weeks pregnant, so count
circumstances. Apply in person at the Jobcentre back from the due date on your MAT B1
(Social Security Office in Northern Ireland).If you certificate, which your midwife or GP will give
are a single parent, you may be able to claim Income you. Find the Sunday before your baby is due (or
Support (see above) once the baby is born. the due date if it is a Sunday) and count back 11
If you are a couple and your partner has a low Sundays from there. It is for you to decide when
income, you may be able to claim Tax Credit. you want to stop work. You can even work right
Apply to Jobcentre Plus for Income Support or up until the date the baby is born, unless:
to the Inland Revenue for Tax Credits. ● you have a pregnancy-related illness/absence
in the last four weeks of your pregnancy.
In this case your employer can start your
maternity leave even if you are off sick for only
one day. However, if you are ill only for a short
time your employer may agree to let you start

139
Rights and benefits

your maternity leave when you had planned, for HOW TO GIVE NOTICE
example, if they have arranged maternity cover;
When do I have to tell my employer
● your baby is born before the day you were
I’m pregnant?
planning to start your leave. In this case leave
The latest time you can tell your employer that you
will start on the day of birth and you should tell
are pregnant is the 15th week before your baby is
your employer as soon as you can that you have
due. There is nothing to say that you have to tell
given birth.
your employer any earlier, although it may be to
ADDITIONAL MATERNITY LEAVE (AML) your advantage, for example, you have special
health and safety protection during pregnancy and
● 26 weeks unpaid leave from the end of OML; the right to paid time off for antenatal care once
● for employees who have been in the same job your employer knows you are pregnant. The law
for at least 26 weeks by the 15th week before protects you from being dismissed or discriminated
their baby is due; against because of pregnancy.
● right to return to the same job, or if that is not
reasonably practicable, a suitable job on very
Giving notice for OML and AML
similar terms and conditions.
To give notice that you will be taking maternity leave,
What is it? you must tell your employer the following things in
AML is a further 26 weeks leave from work, usually or before the 15th week before your baby is due (if
unpaid, after OML. It starts on the day after the your employer asks you to, you must put the notice
end of OML. in writing:
Who gets it? ● that you are pregnant;
You can take AML if you have worked for the ● the expected week of childbirth;
same employer for at least 26 weeks by the 15th ● the date on which you intend to start your
week before the expected week of childbirth. ordinary maternity leave.
This is when you are about 26 weeks pregnant.
If you want to change the date you start your
In practice, this means you must have started your
maternity leave, you must give your employer notice of
job before you got pregnant in order to qualify
the new date at least 28 days before the new date or
for AML.
the old date, whichever is earliest. If there is a good
How do I work out the 15th week before my reason why that is not possible, tell your employer as
baby is due? soon as you reasonably can.
Find the Sunday before your baby is due (or the Note: you can choose when to start getting your SMP;
due date if it is a Sunday) and count back 15 the earliest you can start getting SMP is in the 11th
Sundays from there. That is the start of the 15th week before the week your baby is due.
week before your expected week of childbirth.
You should use the due date on the MAT B1 Once you have given notice, your employer must write
certificate that your midwife or GP will give you to you within 28 days and state the date you are
when you are about 20 weeks pregnant. expected to return from maternity leave.

Do I have to tell my employer how much


maternity leave I am going to take? If you cannot give notice by the 15th week before
No, if you are entitled to AML, your employer you are due (for example, because you have to go
should assume that you will be taking it. If you into hospital unexpectedly), you must give notice
decide not to take some or all of your AML, you as soon as you reasonably can.
should simply give 28 days notice to return to
work early. RIGHTS DURING MATERNITY LEAVE
What will I get while I’m away?
During the first 26 weeks of leave (your OML
period) your contractual rights, apart from your
normal pay, continue as if you were still at work.

140
Rights and benefits

Your contractual rights are your terms and If you want to return to work before the end of
conditions, for example, a company car or your maternity leave, you must give your employer
paid holidays. at least 28 days notice of the date you will be
During OML you may be entitled to SMP or returning. If you do not give this notice and just
MA (see Maternity Benefits). After that your leave turn up at work before the end of your maternity
will usually be unpaid. Some employers offer extra leave, your employer can send you away for up
(or contractual) maternity pay, so check your to 28 days or until the end of your leave,
contract or ask the human resources department whichever is earlier.
or your union representative.
You will continue to be an employee throughout Note: if you are entitled to AML but only
your AML, but the only contractual rights that will wish to take OML, you must give 28 days
continue automatically will be: notice of your return as you are in fact
returning early.
● the notice period in your contract of The law does not allow you to work for two
employment (if either you or your employer weeks after childbirth, and this period is known as
wish to terminate your employment); Compulsory Maternity Leave. You will not be
● any entitlement to redundancy pay (after two allowed to return to work during this time.
years’ service);
● disciplinary and grievance procedures; What happens when I go back?
● if your contract has a section which states that When you go back to work after OML, you have
you must not work for any another employer, the right to return to exactly the same job.
this will still apply during maternity leave; Unless you are entitled to additional maternity
● it might be possible to negotiate with your leave (see below), you can’t stay on maternity leave
employer for other contractual rights to after the end of your OML, unless this has been
continue. agreed with your employer. You should ask your
employer to confirm this agreement in writing.
During the whole of your maternity leave you When you go back to work after AML, you have
are still entitled to your statutory rights (i.e. rights the right to return to exactly the same job. But if
that apply by law to all employees in this country). your employer can show that this is not reasonably
For example, everyone has a legal right to 20 days practicable, for example, because the job no longer
paid annual leave whether they are on maternity exists, you have the right to be offered a suitable
leave or not. Also your employer must not alternative job on very similar terms and conditions.
discriminate against you by failing to consider you
for such opportunities as promotion. What if I work for a small firm?
If you are made redundant whilst on maternity If you work for a firm that employs five people or
leave, your employer must offer you any suitable less, you still have the right to AML. However, if
alternative work that is available. If there is none, your employer can show that it is not possible to
they must pay you any notice and redundancy pay keep your job open or to offer you a very similar
that you are entitled to. job, then you cannot automatically claim that you
have been unfairly dismissed if your job is not there
RETURNING TO WORK at the end of the AML. However, you may still be
able to claim ordinary unfair dismissal and sex
Do I have to give notice of my return? discrimination, and you may be entitled to
No, unless you want to return to work before the redundancy pay.
end of your maternity leave. You simply go to work
on the day that you are due back. What happens if I need more time off work?
You cannot stay off work after your maternity leave
● If you are entitled to take OML, you will be due has ended, as you will lose your right to return to
back to work on the day after the end of the 26 your job if you do not go back at the end of your
week period. OML or AML (if you are entitled to it). If you
● If you are entitled to AML, you will be due back need more time off you could:
to work on the day after the 52-week period.

141
Rights and benefits

● Ask your employer if you can take annual leave long as you meet the normal conditions. However,
immediately after your maternity leave. Note this will mean you will have to be receiving over
that paid holiday continues to accrue during £77 per week from your employer in
maternity leave so you may have some holiday approximately weeks 18–26 of your pregnancy
owing to you. when SMP entitlement is calculated.
● Ask your employer if they will agree to a further If you have already taken OML and AML (a year
period off work. You should ask your employer off) you will be entitled to a second period of OML
to confirm this agreement in writing and to and AML. However, if you go straight onto another
confirm that you will have the right to return to period of OML without physically returning to
the same job. work and decide to return to work after the second
● Take some parental leave at the end of your period of OML, you will not have the right to
maternity leave (see below). Note that you must return to exactly the same job as you normally
give 21 days notice to take parental leave, and it would at the end of OML. However, you will have
is usually unpaid unless your employer offers the same rights as you would have had at the end of
paid parental leave. AML, which is the right to return to the same job
● If you cannot return because you are ill, you can or, if that is not reasonably practicable, a suitable
take sick leave as long as you follow your alternative job on similar terms and conditions.
employer’s sickness procedures. If you return to work after the end of your first
What should I do if I don’t want to go back period of AML and before the start of your second
to work? period of OML – even if you only return for one
You should resign in the normal way, giving the day – your rights are not affected and you would
notice required by your contract or the notice have the right to return to exactly the same job
period that is normally given in your workplace. after OML (see Return to work section).
If you do not have a contract or nothing has been
said, you should give a week’s notice.
OTHER EMPLOYMENT
Note: You do not have to repay any of the RIGHTS
SMP you received (6 weeks at 90% and 20 These rights apply no matter how long you have
weeks at £100). been employed or how many hours you work
What happens if I say I want to return to per week.
work and I change my mind?
Many women find it impossible to know before the PAID TIME OFF FOR ANTENATAL CARE
birth how they will feel afterwards, so it is always a If you are an employee, you have the right to take
good idea to say you are coming back in order to reasonable time off for your antenatal appointments,
keep your options open. If you decide later not to including time needed to travel to your clinic or
return, you can resign from your job in the normal GP, without loss of pay.
way. Your notice period can run at the same time as You should let your employer know when you
your maternity leave. need time off. For appointments after the first one,
your employer can ask to see your appointment
Can I change my working hours?
card and a certificate stating that you are pregnant.
You have the right to ask for flexible hours and
Antenatal care can include parentcraft and
your employer has a duty seriously to consider your
relaxation classes. You may need a letter from your
request. Your employer must have a good business
GP or midwife to show your employer, saying that
reason for refusing. (See Return to work on child-
these classes are part of your antenatal care.
friendly working hours below.)
My maternity leave ends soon and I’m HEALTH AND SAFETY RIGHTS
pregnant again. What rights will I have? If you are pregnant, have recently given birth or are
Maternity leave does not break your continuity of breastfeeding, your employer must make sure that
employment, so your right to maternity leave for the kind of work you do and your working
this baby will be based on your total service with conditions will not put your health or your baby’s
your employer. You may also qualify for SMP as health at risk. To get the full benefit of this legal
142
Rights and benefits

protection you must notify your employer in ● have worked for the same employer for at least
writing that you are pregnant or have recently given 26 weeks by the 15th week before your baby
birth or are breastfeeding. Your employer must: is due.
● Carry out a risk assessment at your workplace When can my partner start paternity leave?
and do all that is reasonable to remove or reduce Your husband or partner can choose to start
the risks found. paternity leave either:
● If there are still risks, your employer must alter
● from the date of your baby’s birth, or
your working conditions or hours of work to ● from a chosen number of days or weeks after the
remove the risk.
date of the child’s birth (whether this is earlier or
● If this is not possible or would not avoid the risk,
later than expected), or
your employer must offer you a suitable ● from a chosen date.
alternative job.
● If this is not possible, your employer must Paternity leave must have been taken within 56
suspend you on full pay for as long as is days of your baby’s birth or, if your baby was born
necessary to avoid the risks. If you do night early, within the period from the actual date of birth
work and your doctor advises that you should up to 56 days after the expected week of birth.
stop for health and safety reasons, you have the Your partner will be able to return to the same
right to transfer to day work or, if that is not job after paternity leave.
possible, to be suspended on full pay. You must
What is Statutory Paternity Pay (SPP)?
provide a medical certificate.
SPP is paid by employers for up to 2 weeks at a
DISMISSAL OR UNFAIR TREATMENT rate of £100 per week or 90% of average earnings,
whichever is less.
It is against the law for your employer to treat you
unfairly, dismiss you or select you for redundancy Can my partner get SPP?
for any reason connected with pregnancy, childbirth Your partner can get SPP if he or she:
or maternity leave. ● is the baby’s father or your husband/partner
If you are dismissed while you are pregnant or and is responsible for the baby’s upbringing;
during your maternity leave, your employer must ● has worked for an employer for 26 weeks by the
give you a written statement of the reasons. You 15th week before the baby is due or, if the baby
may also have a claim for compensation for sex is born before then, would have worked for an
discrimination. If you are making a claim against employer for 26 weeks by the 15th week before
your employer, you must put your claim into the the baby is due;
Employment Tribunal within three months. ● is still employed by the same employer before
the birth;
OTHER TYPES OF LEAVE ● earns at least £77 per week on average (before
tax) in the eight weeks immediately before the
PATERNITY LEAVE week your baby is born.
What is it? Your partner must give their employer notice of
Since 6 April 2003 there has been a new statutory the date they want their SPP to start at least 28 days
right to paid paternity leave. Following the birth of before or as soon as reasonably practicable.
a child, eligible employees will be able to take one
or two weeks leave to care for the child or support PARENTAL LEAVE
the mother. They must give their employer the What is it?
correct notice. The leave must be taken within 56 Parental leave is designed to give parents more time
days of the birth. with their young children. It entitles you to take 13
weeks leave per parent per child, usually unpaid, up
Who gets it?
to your child’s fifth birthday. Parents of disabled
Your baby’s biological father, your husband or your
children will be entitled to 18 weeks leave. In the
partner, including a same sex partner, will be able to
case of a child on Disability Living Allowance
take paternity leave providing they:
(DLA), the leave must be taken before the child is
● expect to have responsibility for bringing up 18. It is also available for adoptive parents, in which
the child;
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Rights and benefits

case you can take it either within five years of the THE RIGHT TO ASK FOR FLEXIBLE
placement for adoption or the child’s 18th birthday, WORKING ARRANGEMENTS
whichever is earlier.
What is it?
Who gets it? Since April 2003 parents have the right to ask their
● Parents of children born or adopted on or after employers for a change in their working patterns so
15 December 1999. that they can care for their children. The change
● Parents of children who were born or adopted requested could relate to the hours that you work,
between 15/12/94 and 14/12/99, in which case the days that you work or your place of work.
leave must be taken by 31/3/05. There is a clear procedure that you and your
● To qualify for parental leave you must be an employer must follow. Your employer must
employee, have been employed for a year (by the seriously consider your request and can only refuse
time you wish to take it) and be taking the leave for one of the business reasons set out in the
in order to care for your child. You must give legislation.
your employer 21 days notice of the dates you
Who does it apply to?
want to take your leave. Your employer can
You can ask for flexible work if:
postpone the leave, but only if their business
would be unduly disrupted. ● you are an employee;
● Fathers wanting to take time off at or around the ● you are the parent, adoptive parent, guardian or
birth of a baby can take parental leave, providing foster carer of a child under six or a disabled
they give their employers 21 days notice of the child under 18 (or you are married to, living
expected week of childbirth. An employer with or the partner of that person);
cannot postpone leave in these circumstances. ● you have worked for your employer for 26
weeks by the time you make your request;
TIME OFF FOR DEPENDANTS ● you have not made a request in the last
Every worker is also entitled to emergency unpaid 12 months.
leave to make arrangements for the care for a How do I ask to change my hours?
dependant who falls ill, gives birth or is injured. You will need to send a written request (your
This leave can be used if there is a sudden problem ‘application’) to your employer giving details of the
with care arrangements for the dependant (e.g. if new working pattern you want to work. There is a
your childminder falls ill). clear procedure that both you and your employer
must follow.
RETURN TO WORK Your application must include all of the following:
● State that this is an application for flexible work
ON CHILD-FRIENDLY and that you are applying as a parent or as
WORKING HOURS someone with parental responsibility.
● State the working pattern you are asking for and
If you need to change your working hours because
of childcare, you have the right to have your the date you want it to start.
● Explain how you think the new working pattern
request seriously considered under sex
discrimination law and, since April 2003, parents of may affect the employer and how you think it
young children have the right to ask for flexible could be dealt with.
● State whether you have asked before and, if so,
working arrangements.
It is not yet clear how the two rights will work when.
● Sign and date the application.
together. You should therefore carefully follow the
procedure for asking for flexible hours under the Your application can be by letter, fax or email
new right, and if your request is refused, you should and you should keep a copy. Some employers may
get advice about whether you have a claim for have a standard form for making an application, so
compensation under the new right and under sex you should check.
discrimination law.

144
Rights and benefits

What happens when my employer receives What can I do if I don’t think my employer
the application? had a good reason to refuse my request?
Your employer must follow the procedure stated in Under the new right to ask for flexible work you
the Regulations. They must: can make a claim in a tribunal if your employer
● Hold a meeting with you within 28 days of your does not follow the procedure or refuses for a
application. reason not stated in the rules or without an
● The meeting should discuss your application explanation.
and, if your employer does not think that would You must complete the appeal procedure and
work, any possible alternative compromise wait for the decision before you can make a
arrangements. tribunal application. The tribunal will not question
● Give you notice of their decision within 14 days whether your employer was justified in refusing
of the meeting and tell you about your right unless you can show that your employer got the
of appeal. facts wrong. The tribunal can only award a
● Give reasons for refusing, which must be one maximum of eight weeks pay (up to the statutory
of those allowed by the regulations, with an maximum of £260 per week) in compensation.
explanation as to why that reason applies in YOUR RIGHTS UNDER SEX
your case. DISCRIMINATION LAW
Can my employer refuse my request? What are my rights under sex
Your employer can only refuse your request for one discrimination law?
of the following business reasons: Although there isn’t an absolute legal right to change
● the burden of additional costs; your working pattern, if you need to change the way
● the detrimental effect on the ability to meet you work because of your childcare responsibilities,
customer demand; your employer must seriously consider your request
● an inability to reorganise the work among and look at how you can do your old job in a way
existing staff; that meets your childcare needs.
● an inability to recruit additional staff; Your employer can only refuse if they have a
● the detrimental effect on quality; good business reason. It may be indirect sex
● detrimental effect on performance; discrimination if an employer refuses a woman’s
● there is not enough work during the periods request to change her working pattern, and it may
the employee wants to work; be direct sex discrimination if an employer refuses
● planned structural changes. a man’s request when they allow a woman to
work differently.
Your employer must also explain why that reason Your employer will only know if they have a
applies in your circumstances. good reason for refusing your request by giving it
What can I do if my employer refuses? a lot of thought. For example, refusing even to
You have the right to appeal within 14 days of consider your request or having a policy of refusing
receiving notification of your employer’s refusal. part-time work would probably be seen as sex
To appeal, you must write to your employer stating discrimination by an employment tribunal. An
your reasons for appealing. You must sign and date employer must consider each individual request in
your letter. order to avoid discriminating against a woman or
Your employer must hold the appeal meeting man with childcare responsibilities.
within 14 days of receiving your notice of appeal. People often assume that a job has to be done
They must notify you of their decision in writing full-time or at certain fixed times of day, but if you
within 14 days of the appeal meeting, giving and your employer look carefully at your job, you
reasons for their decision. may be able to work out a more child-friendly
option – perhaps one that neither of you had
considered before.

145
Rights and benefits

Does this apply to me? old job in a way that meets your childcare needs
Yes, sex discrimination law applies to all employers and can only refuse if they have a good business
and all employed parents with childcare reason for refusing. Your employer will only know
responsibilities, but it only applies if you would be if they have a good reason for refusing your request
disadvantaged by not being allowed to work the by giving it a lot of thought. For example, refusing
child-friendly hours you need to. In other words, even to consider your request or having a policy of
you must have a good reason for asking to work refusing part-time work would probably be seen as
differently – just as an employer must have a good sex discrimination by an employment tribunal.
reason for refusing. A good reason might be:
How do I know if my employer had a good
● You can’t find or afford full-time childcare. reason to refuse my request?
● You can’t find or afford childcare outside It will largely depend on the circumstances of your
9–5 Monday–Friday. work. If your new working pattern will cause major
● You have to be there when your child or problems, then your employer may well be justified
children come home from school. in refusing. In the end it would be up to an
● Your parent or relative cannot look after your employment tribunal to decide whether your
child full time. employer did have a good reason to refuse if you
● You are suffering severe stress from working bring a claim for indirect sex discrimination.
long hours. There have been many tribunal cases under sex
● You are distressed or disadvantaged by having discrimination law in the last few years, and many
to work your old hours. of the reasons given by employers are not seen
When should I use my rights under sex as justifiable.
discrimination law instead of under the What can I do if I don’t think my employer
right to request flexible work? had a good reason to refuse my request?
The new statutory right to request flexible working You can get further advice on your employer’s
only applies to employees who are parents of reasons for refusing from your trade union
children under 6 (or under 18 if disabled), who representative or local Citizens Advice Bureau.
haven’t made an application within the last 12 If you want advice on whether you might have
months, and who have worked for their employer a good case, you should see a specialist
for 26 weeks at the time of making the application. employment lawyer.
Sex discrimination law may help you if you need Under sex discrimination law, you can make a
to change your working pattern in order to care for claim in an employment tribunal if your employer
your child but cannot use the statutory procedure, refuses without a good business reason. The
for example, because you have made a request tribunal will scrutinise your employer’s reasons and
under the procedure within the last 12 months or question your employer carefully about whether
have worked for your employer for less than they were justified in refusing. They can also award
26 weeks. unlimited compensation for loss of pay (if you had
Do I have to follow a procedure under sex to leave your job) and for injury to feelings.
discrimination law? You must make a tribunal claim within
No, there is no specific application procedure under three months of the refusal under the new right
sex discrimination law, so we suggest that, if you and under sex discrimination law.
can, you initially make your request under the
new right to ask for flexible work (see above).
Under sex discrimination law, once you have
asked your employer to work flexibly, your
employer must seriously consider your request.
Your employer must look at how you can do your

146
USEFUL ORGANISATIONS
Commission for Racial Institute for The Multiple Births
Some of these organisations are large. Many are Equality Complementary Medicine Foundation
small. Some offer advice or information face to St Dunstan’s House PO Box 194 Hamersmith House, Level 4
face or over the telephone. Others concentrate 201-211 Borough High London SE16 7QZ Queen Charlotte’s and
on providing useful leaflets or books (these are Street 020 7237 5165 Chelsea Hospital
marked *). Many have local branches or can put London SE1 1GZ www.icmedicine.co.uk Du Cane Road
you in touch with local groups or a local contact. 020 7939 0000 Charity providing information London W12 0HS
www.cre.gov.uk on complementary medicine 020 8383 3519
When you write for information it’s important to and referrals to qualified www.multiplebirths.org.uk
remember to enclose a large stamped addressed In Wales: practitioners or helpful For professional support of
envelope for a reply. CRE Wales organisations.* families with twins and multiple
3rd Floor births.*
Capital Tower La Lèche League
Greyfriars Road (Great Britain) National Childbirth Trust
SUPPORT AND Breastfeeding Network Cardiff CF1 3AG PO Box 29 (NCT)
INFORMATION 0870 900 8787 029 2072 9200 West Bridgeford Alexandra House
(breastfeeding supporter line, Encourages good relations Nottingham NG2 7NP Oldham Terrace
ACAS (Advisory, 9.30am-9.30pm every day) between people from different London W3 6NH
Conciliation and Arbitration 0845 120 2918 (24-hour
racial and ethnic backgrounds, helpline) 0870 770 3236 (admin)
Service) Caesarean Support the elimination of racial 0870 444 8707 (enquiry
Brandon House www.laleche.org.uk
Network discrimination and promotion Help and information for line)
180 Borough High Street 55 Cooil Drive of equal opportunities. 0870 444 8708 (breast
London SE1 1LW women who want to
Douglas breastfeed. Personal feeding)
020 7396 5100 Isle of Man IN2 2HF Community Relations www.nctpregnancyand
www.acas.org.uk counselling. Local groups.
01624 661 269 (Mon-Fri Council Write with SAE for details of babycare.com
Advice on time off for after 6pm and weekends) 6 Murray Street Information and support for
antenatal care and on your nearest
Offers emotional support and Belfast BT1 6DN counsellor/group.* mothers, including
maternity rights, parental leave practical advice to mothers 028 9022 7500 breastfeeding information,
and matters like unfair who have had or may need a www.community- antenatal classes, postnatal
dismissal. For your nearest Life
Caesarean delivery. Can put relations.org.uk Life House groups. Write for details of
office, look in the phone book you in touch with a local Provides advice and support your nearest branch and
or ask at your local library or Newbold Terrace
mother who has undergone a for those working in Northern Leamington Spa information pack.*
citizens advice bureau.* Caesarean and understands Ireland to develop a society Warwickshire CV32 4EA
the problems.* free from sectarianism. 01926 421587 NHS Direct Wales
Action on Pre-eclampsia 0845 4647
(APEC) 01926 311511 (helpline
Child Diabetes UK 9am-9pm) 24 hour nurse-led helpline
84-88 Pinner Road Charter House 10 Parkway providing health information
Harrow www.lifeuk.org
43 St Leonards Road London NW1 7AA Charity offering information and advice.
Middx HA1 4HZ Bexhill-on-Sea 020 7424 1000 (admin) www.nhsdirect.nhs.wales.uk
020 8863 3271 (admin) and advice pre- and after-birth
E. Sussex TN40 1JA 020 7424 1030 (careline) and after abortion. Accom-
020 8427 4217 (helpline 01424 732361 NSPCC (National Society
Mon-Fri 10am-1pm) 020 7424 1888 (text modation for homeless and
www.child.org.uk phone) for the Prevention of
www.apec.org.uk unsupported mothers.
Self-help organisation offering www.diabetes.org.uk Cruelty to Children)
National charity offering information and support to 42 Curtain Road
support and information about Local advice agencies
people coping with problems In Wales: There may be a number of London EC2A 3NH
pre-eclampsia via its helpline of infertility and childlessness. 020 7825 2500 (admin)
and newsletters. Provides a Diabetes UK Cymru helpful local advice agencies in
May be able to put you in Quebec House your district offering general 0808 800 5000 (24-hour
befriender service.* touch with a local contact national helpline)
Castlebridge advice on a range of topics, like
group.* Cowbridge Road East benefits, debts and consumer www.nspcc.org.uk
Active Birth Centre
25 Bickerton Road Cardiff CF11 9AB problems, or specialising in one
Child Poverty Action 029 2066 8276 area such as law or housing. To In Wales:
London N19 5JT Group NSPCC Cymru
020 7281 6760 Information and support for all find out what exists ask at your
94 White Lion Street people with diabetes.* library or town hall. Capitol Tower
www.activebirthcentre.com London N1 9PF Greyfriars Road
Promotes a holistic approach 020 7837 7979 Cardiff CF10 3AG
to active childbirth and Equal Opportunities Local health boards
www.cpag.org.uk Commission If you’re new to an area they 0808 100 2524 (helpline)
parenting. Antenatal and Campaigns on behalf of low-
postnatal classes (fee payable). Arndale House can give you a list of local 029 2026 7000
income families. Information Arndale Centre doctors including those with a Aims to prevent all forms of
Publishes list of UK active and advice for parents on
birth teachers.* Manchester M4 3EQ special interest in pregnancy child abuse. Look in the phone
benefits, housing, welfare 0845 601 5901 and childbirth. If you have book for the number of your
rights etc.* www.eoc.org.uk difficulty in finding a GP to nearest NSPCC office if you
Association of
Breastfeeding Mothers take you on contact the LHB. need help.*
Child Safe Wales In Wales: Look in the phone book under
PO Box 207 Llandough Hospital
Bridgewater Windsor House the name of your local health Patients’ Association
Penlan Road Windsor Lane board. PO Box 935
Somerset TA6 7YT Penarth CF64 2XX
0870 401 7711 (24-hour Cardiff CF10 3GE Harrow
029 2071 6933 029 2064 1079 Middx HA1 3YJ
voluntary helpline) www.capic.org.uk
www.home.clara.net/abm/ www.eoc.org.uk Maternity Alliance 020 8423 9111
Provides information on child Information and advice on 3rd Floor West 0845 608 4455 (helpline
Telephone advice service for safety.
breastfeeding mothers. Local issues of discrimination and 2-6 Northburgh Street Mon-Fri 10am-4pm)
support groups.* equal opportunities.* London EC1V 0AY www.patients-
Citizens Advice Bureaux 020 490 7639 (admin) association.com
National Association of Family Welfare 020 490 7638 (advice line) Advice service for patients
Association for Citizens Advice Bureaux
Improvements in the Association www.maternityalliance.org.uk who have problems relating
Myddleton House 501-505 Kingsland Road Information on all aspects of to health and health care.*
Maternity Services (AIMS) 115-123 Pentonville Road
5 Ann’s Court London E8 4AU maternity care and rights. Advice
London N1 9LZ 020 7254 6251 on benefits, maternity rights at Public libraries
Grove Road 020 7833 2181 (call for
Surbiton www.fwa.org work.* Useful starting points for
telephone number of your National charity providing free finding out addresses of
Surrey KT6 4BE local office) national and local organisations.
0870 765 1433 (helpline) social work services and Minority Ethnic
www.nacab.org.uk support for children and Community Health and
www.aims.org.uk Race Equality First
Voluntary pressure group families. Provides financial Social Wellbeing Project
Community Health support for families in need (NI) Friary Centre, The Friary
which aims for improvements Councils throughout the UK.* Cardiff CF10 3FA
in maternity services. Support Multi-Cultural Resource
The Association of Welsh Centre (MCRC) 029 2022 4097
and advice about parents’ Community Health Independent Midwives email:
rights, complaints procedures 12 Upper Crescent
Councils (AWCHC) Association Belfast BT7 1NT race.equality@enablis.co.uk
and choices within maternity Park House Now called Race Equality
care, including home birth.* 1 The Great Quarry 028 9024 4639
Greyfriars Road Guildford www.mcrc.co.uk Councils. They are concerned
Cardiff CF10 3AF Surrey GU1 3XN As part of MCRC, promotes with race and community
Benefits Agency: relations in their area and often
local offices 029 2023 5558 (24-hour 01483 821104 two-way communication
answering service) www.independentmidwives. between minority ethnic know of local minority ethnic
For general advice on all social organisations and support
security benefits, pensions and org.uk groups and health service
In Northern Ireland CHCs Free advice to women thinking providers. Provides translation groups.
National Insurance, including
maternity benefits and Income are called Health and Social about a home birth. Offers and interpreting services,
Support and Income-based Services Councils. For your maternity full care to women multilingual materials and a
Jobseeker’s Allowance, local CHC/HSSC, look in your who book with them for home reference library.
telephone, write or call in to phone book under the name births. Fees vary. Send an A5
your local social security of your district health SAE for information.*
office. The address will be in authority or local Health and
the phone book under Social Services Council.
‘Benefits Agency’. Hours are
usually 9.30am to 3.30pm. In
busy offices there may be a
very long wait if you call in.

147
RELATE (National National Drugs Helpline Wales Pre-school Rape and Sexual Abuse ILLNESS AND
Marriage Guidance) Freephone 0800 776600 Playgroups Association Line DISABILITY
(North Wales) (English and Welsh) Ladywell House In North Wales:
8 Rivieres Avenue Freephone 0800 917 6650 Newtown PO Box 4 The Association for the
Colwyn Bay (for other languages, e.g. Powys SY16 1JB 7-9 Abbey Road Welfare of Children in
LL29 7DP Bengali, Urdu, Hindi, 01686 624573 Bangor LL57 2EA Hospitals (AWCH Wales)
01492 533919920 Punjabi & Cantonese) www.walesppa.co.uk 01248 354 885 (helpline 31 Penyrheol Drive
www.relate.org.uk www.ndh.org.uk Help and advice on setting up Mon-Fri 6pm-9pm, Tue Sketty
and running parent and toddler 1pm-4pm, Wed 9am-12) Swansea SA2 9JT
(Mid and West Wales) In Northern Ireland see groups and playgroups. 01792 205 227
Tŷ Merthyr Dunlewey Substance Advice Contact with local playgroups. In South Wales: To promote equality health
Little Water Street Centre, Northlands and PO Box 338 care services for children in
Camarthen SA31 1ER NICAS under ‘Alcohol’ COPING ALONE Cardiff CF24 4XH hospital, at home and in the
01267 236737 029 2037 3181 community. Promotes
Confidential counselling on ALCOHOL Gingerbread awareness of the needs of
relationship problems of any 7 Sovereign Close Refuge children and their families in
kind. To find your local branch Alcohol Concern Sovereign Court 2/8 Maltravers Street the Health Service in Wales. To
look under RELATE or Waterbridge House London E1W 3HW London WC2R 3EE give information and support
Marriage Guidance in the 32-36 Loman Street 020 7488 9300 (admin) 0870 599 5443 (24-hour to parents and carers.*
phone book or contact the London SE1 0EE 0800 018 4318 (advice line helpline)
above addresses. 020 7928 7377 Mon-Fri 9am-5pm) Emergency accommodation BLISS
www.alcoholconcern.org.uk www.gingerbread.org.uk and advice for women and 68 South Lambeth Road
The Samaritans children experiencing domestic London SW8 1RL
08457 90 90 90 (helpline) Alcoholics Anonymous In Wales: violence in London. 0870 7700 337
www.shelter.org.uk (AA) Baltic House www.bliss.org.uk
24 hours a day, 7 days a week. AA General Service Office 4th Floor Welsh Women’s Aid Parent support network for
Confidential emotional PO Box 1 Mount Stuart Square 38-48 Crwys Road families of babies who need
support for anyone in crisis. Stonebow House Cardiff Bay Cardiff CF24 4NN intensive or special care. Local
Stonebow Cardiff CF10 5FH 029 2039 0874 branches.*
In Northern Ireland: York YO1 7NJ 029 2047 1900 (10am-3pm with out-of-
1850 60 90 90 01904 644026 Self-help association for one- hours message service) Contact a Family
0845 769 7555 (helpline) parent families. Local groups Information, support and refuge 209-211 City Road
Shelter www.alcoholics- offer support, friendship, for abused women and their London EC1V 1JN
88 Old Street anonymous.org.uk information, advice and children.* 020 7608 8700 (admin)
London EC1V 9HU practical help.* 0808 808 3555 (helpline
020 7505 4699 Drinkline FAMILY PLANNING Mon-Fri 10am-4pm)
0808 800 4444 (helpline) Alcohol Helpline Meet-a-Mum Association www.cafamily.org.uk
www.shelter.org.uk 0800 917 8282 (Mon-Fri (MAMA) Family Planning
9am-11pm, Sat, Sun 6pm- 376 Bideford Green Association In Wales:
In Wales: 11pm) Linslade D1 Rooms Trident Court
25 Walter Road Leighton Buzzard Canton House East Moors Road
Swansea SA1 5NN Welsh Substance Misuse Beds LU7 2TY 435-451 Cowbrige Rd. East Cardiff CF24 5TD
01792 469400 Intervention Branch 01525 217064 Cardiff CF5 1JH 029 2044 9569
www.sheltercymru.org.uk National Assembly for 020 8768 0123 (helpline 029 2064 4034 Links families of children with
Help for those who are Wales Mon-Fri 7pm-10pm) special needs through contact
homeless and advice on any Cathays Park www.mama.org.uk Sexual Health Helpline lines. All disabilities. Local
kind of housing problem.* Cardiff CF10 3NQ Support for mothers suffering 0800 567 123 parent support groups.*
029 2082 5111 from postnatal depression or
Twins and Multiple Births Provides a list of organisations who feel lonely and isolated Marie Stopes Clinic Council for Disabled
Association (TAMBA) offering help and advice.* looking after a child at home. Marie Stopes House Children
2 The Willows Will try to put you in touch 108 Whitfield Street 8 Wakley Street
Gardner Road CHILDCARE with another mother who has London W1P 6BE London EC1V 7QE
Guildford experienced similar problems, 020 7388 0662 020 7843 6061
Surrey GU1 4PG Daycare Trust or with a group of mothers 0845 300 8090 (booking & www.ncb.org.uk/cdc
0870 770 3305 (admin 21 St George’s Road locally. Write with SAE for appointment line) Information for parents and
Mon-Fri 9.30am-4pm) London SE1 6ES details of local groups.* www.mariestopes.org.uk details of organisations offering
(01732) 868 8000 (helpline 020 7840 3350 (helpline Registered charity providing help with particular
Mon-Fri 7pm-11pm, Sat, 10am-5pm Mon-Fri) National Council for One family planning, women’s health disabilities.*
Sun10am-11pm) www.daycaretrust.org.uk Parent Families check-ups, male and female
www.tamba.org.uk Campaigns for the provision of 255 Kentish Town Road sterilisation, pregnancy testing, Disability, Pregnancy and
Information and support for good childcare facilities. The London NW5 2LX advice on unplanned Parenthood International
parents of multiples. Network Daycare Trust gives 020 7428 5400 (admin) pregnancies and sexual (DPPi)
of local Twins Clubs.* information on all aspects of 0800 018 5026 (lone parent counselling for men and Unit F9
childcare.* helpline Mon-Fri 9am- women. You don’t need to be 89-93 Fonthill Road
Welsh Language Board 5pm) referred by your doctor, but London N4 3JH
Market Chambers Mudiad Ysgolion 0800 018 5126 you do need to book an 0800 018 4730 (freephone
5-7 St Mary Street Meithrin/The National (maintenance and money appointment. A charge is made Mon-Fri 9am-5pm )
Cardiff CF10 1AT Association of Welsh matters advice available to cover costs. 0800 018 9949 (text
029 2087 8000 Medium Nursery Schools Mon-Thu 11am-2pm, phone)
0845 607 6070 (enquiry and Playgroups Tue 3pm-6pm) HIV AND AIDS www.dppi.org.uk
line) 145 Albany Road www.oneparentfamilies.org.uk Information service on
www.bwrdd-yr-iaith.org.uk Roath Free information for one- Sexual Health Information parenting issues for disabled
Information on playgroups, Cardiff CF24 3NT parent families on financial, Line people and allied professionals.
Welsh education and 029 2043 6800 legal and housing problems.* 0800 567123
leaflets about the benefits www.mym.co.uk 0800 917 2227 (Other Disability Living Centres
of bilingualism. Help and advice on setting up Parentline languages 6pm-10pm, see Council
and running parent and toddler See Parentline Plus p.150 below) Redbank House
ADDICTIVE DRUGS groups and playgroups. 028 9024 9696 (helpline) For each of the languages 4 St Chad’s Street
Contact with local playgroups. listed below you can speak to Cheetham
Drugaid DOMESTIC VIOLENCE an operator between 6pm and Manchester M8 8QA
Drug and Alcohol Misuse National Childminding 10pm on the day shown. 0161 834 1044
Service Association NSPCC At all other times this is a 0161 839 0885 (textphone)
1a Bartlett Street 8 Masons Hill (See p. 147) multi-language line and you can www.dlcc.co.uk
Caerphilly CF83 1JS Bromley BR2 9EY hear messages in each Disabled Living Centres offer
029 2088 1000 020 8464 6164 Rape Crisis Federation language. information and advice on
Counselling and information www.ncma.org.uk Bengali Monday products, also the opportunity
to drug, alcohol and solvent Unit 7, Provident Works Urdu Tuesday to try them out and explore
misusers and the public. NIPPA–The Early Years Newdeligate Street Arabic Wednesday other solutions.*
Organisation Nottingham NG7 4FD Gujerati Thursday
Narcotics Anonymous (UK 6c Wildflower Way 0115 900 3560 Hindi Friday
service) Apollo Road (Mon-Fri 9am-5pm) Punjabi Saturday
202 City Road Belfast BT12 6TA www.rapecrisis.co.uk Cantonese Sunday
London ECIV 2PH 028 9066 2825 Acts as a referral service for
020 7251 4007 www.nippa.org women seeking advice and/or Positively Women
020 7730 0009 (helpline Information, advice and support around issues of rape 347-349 City Road
10am-10pm) training for early years staff and sexual abuse. London EC1V 1LR
www.ukna.org
and families with young 020 7713 0444 (admin)
Self-help organisations whose children.* 020 7713 1020 (helpline
members help each other to Mon-Fri 10am-4pm)
stay clear of drugs. Write or www.positivelywomen.org.uk
phone for information and the Support services for women,
address of your local group. children and families affected
Some groups have a crèche.* by HIV. Peer support, advice,
information and advocacy.

148
Disabled Living Foundation CRUSE Bereavement SPECIALISED MENCAP (Royal Society SCOPE
(DLF) Care ORGANISATIONS for Mentally Handicapped 6 Market Road
380-384 Harrow Road Ty Energlyn Children and Adults) London, N7 9PW
London W9 2HU Heol Las Association for Spina Bifida MENCAP National Centre 020 7619 7100
020 7289 6111 (admin) Caerphilly CF83 2WP and Hydrocephalus 123 Golden Lane 0808 800 3333 (helpline
0845 130 9177 (helpline 029 2088 6913 (admin) (ASBAH) Cymru London EC1Y 0RT Mon-Fri 9am-9pm,
Mon-Fri 10am-4pm ) 0870 167 1677 (all day 4 Llys Fedwen 020 7454 0454 Sat-Sun 2pm-6pm)
0870 603 9176 (text phone helpline) Parc Menai www.mencap.org.uk www.scope.org.uk
Mon-Fri 10am-4pm ) A nationwide service of Bangor
www.dlf.org.uk emotional support, counselling Gwynedd In Wales: In Wales:
Sources of information on daily and information to anyone LL57 4BL 31 Lambourne Crescent SCOPE Cwmpas Cymru
living and disability bereaved by death, regardless 01248 671345 Cardiff Business Park The Wharf
equipment.* of age, race or belief. Local Support for parents of children Llanishen Schooner Way
groups.* with spina bifida and/or Cardiff CF14 5GF Cardiff CF10 4EU
In Wales: hydrocephalus. Advice, practical 029 2074 7588 029 2046 1703
Disability Wales/Anabledd Foundation for the Study and financial help. Local Work with people with a
of Infant Deaths (Cot Offers advice and support
Cymru groups.* learning disability and their
Wernddu Court Death Research and to parents of children with
www.asbah.org families and carers. Local cerebral palsy. Local groups.*
Caerphilly Business Park Support)
Van Road Artillery House branches.*
Caerphilly CF83 3ED 11-19 Artillery Row Association of Parents of SENSE Cymru (National
029 2088 7325 London SW1P 1RT Vaccine Damaged Children Meningitis Research Deaf–Blind and Rubella
www.dwac.demon.co.uk 0870 787 0885 (admin) 78 Camden Road Foundation Association)
National association of 0870 787 0554 (24-hour Shipston-on-Stour Midland Way 5 Raleigh Walk
disability groups in Wales. helpline) Warwickshire CV36 4DH Thornbury Brigantine Place
Provide information and www.sids.org.uk 01608 661595 Bristol BS35 2BS Cardiff CF10 4LN
training.* Support and information for Advises parents on claiming 01454 281811 029 2045 7641
parents bereaved by a sudden vaccine damage payment. 080 8800 3344 (24-hour 029 2046 4125 (Minicom)
Genetic Interest Group infant death. Gives new parents national helpline) Advice and support for families
(GIG) advice on reducing risk of cot Cleft Lip and Palate www.meningitis.org of deaf–blind and rubella-
Unit 4D death.* Association (CLAPA) disabled children. Local
Leroy House 235-237 Finchley Road In Wales: groups.*
436 Essex Road Miscarriage Association London NW3 6LS Meningitis Cymru www.sense.org.uk
London N1 3QP c/o Clayton Hospital 020 7431 0033 149 Hawthorn Way
020 7704 3141 Northgate www.clapa.com Brackla Sickle Cell Society
www.gig.org.uk Wakefield Support for families of babies Bridgend CF31 2PG 54 Station Road
Umbrella body for support W. Yorks WF1 3JS born with cleft lip and/or 01656 646 414 (admin) Harlesden
groups working with those 01924 200799 (Mon-Fri 0800 652 9996 (helpline) London NW10 4UA
affected by specific genetic 9am-4pm) palate. Feeding equipment
available. Local groups.* www.meningitiscymru.co.uk 020 8961 7795/4006
disorders. www.miscarriageassociation. Education, support and www.sicklecellsociety.org
org.uk information about meningitis
Phab Information, advice and Cystic Fibrosis Trust
Summit House support for women who have 11 London Road for people in Wales. In Wales:
Wandle Road had, or who are having, a Bromley BR1 1BY Cardiff Sickle Cell and
Croydon CR0 1DF miscarriage. Local contacts and 020 8464 7211 Muscular Dystrophy Thalassaemia Centre
020 8667 9443 groups.* 0845 8591000 (helpine Campaign Butetown Health Centre
www.phabengland.org.uk Mon-Fri 9am-5pm) 7-11 Prescott Place Loundon Square Docks
Stillbirth and Neonatal www.cftrust.org.uk London SW4 6BS Cardiff CF10 5UZ
In Wales: Death Society (SANDS) 020 7720 8055 029 2047 1055
029 2075 0700 28 Portland Place Down’s Syndrome 020 7720 8055 (helpline Information, advice and
Ruthin 01824 705 859 London W1B 1LY Association Mon-Fri 9am-5pm) counselling for families affected
Newport 01633 263 015 020 7436 7940 (admin) 155 Mitcham Road www.muscular-dystrophy.org by sickle cell disease or trait.
www.phab.org.uk 020 7436 5881 (helpline London SW17 9PG Support and advice through Financial help when needed.
Promotes integration 10am-3pm, answerphone 020 8682 4001 local branches and a network Local groups.*
between disabled and non- after hours) www.downs-syndrome.org.uk of Family Care Officers.
disabled people through www.uk-sands.org Provides support for individuals In Wales:
social, leisure and educational Information and a national In Wales: and families affected by Sustainable Wales Real
activities. Local groups. network of support groups for neuromuscular conditions.
bereaved parents.* Suite 1 Nappy Campaign
LOSS AND 206 Whitchurch Road 0845 456 2447(advice line)
Cardiff CF14 3JL Nappy Laundry Service www.realnappies-
BEREAVEMENT WIDWODS 0121 693 4949
(See also ‘Child’ under c/o 60 Rocks Park 029 2052 2511 wales.org.uk
(Mon-Fri 9am-12.30pm) www.changeanappy.co.uk Provides information and
Support and information) Uckfield
Information, advice, counselling Details of local services. advice on choosing and using
East Sussex TN22 2AX
Antenatal Results and 01825 765084 (evenings) and support for parents of anppies and nappy laundering
Choices (ARC) Small support group of young The Pelvic Partnership
children with Down’s 26 Manor Green services in Wales.
73 Charlotte Street widows aiming to provide syndrome. Local groups.*
London W1T 4PN practical and emotional Harwell OX11 0DQ
www.downs-syndrome.org.uk 01235 820921 Tommy’s Campaign
020 7631 0280 (admin) support for those who 1 Kennington Road
020 7631 0285 (helpline experience the loss of a www.pelvicpartnership.org.uk
Haemophilia Society Provides information and advice London SE1 7RR
Mon-Fri 10am-5pm) partner. Please include a 08707 707070
stamped addressed envelope. Chesterfield House about the management of SPD.*
www.arc-uk.org 385 Euston Road 08707 773060 (info)
Support and information for London NW1 3AU www.tommys-campaign.org
parents throughout antenatal SMOKING Reach (The Association for
020 7380 0600 Children with Hand or Arm Information about problems in
testing, especially when a
serious abnormality has been Smokers Helpline 0800 0186068 (helpline Deficiency) pregnancy including
diagnosed and a choice has Wales (W) Mon-Fri 9am-5pm) Reach Head Office Toxoplasmosis, Pre-eclampsia,
to be made about the 0800 169 0 169 www.haemophilia.org.uk premature birth and
PO Box 54
termination of the pregnancy. Counsellors offer confidential Information, advice and Helston miscarriage. Also advice on a
Ongoing support given to help and advice. Open daily from practical help for families Cornwall TR13 8WD healthy pregnancy.*
parents who decide on 7a.m. - 11 p.m. affected by haemophilia and 0845 130 6225 (Mon 9.30-
termination. Local contacts.* other bleeding disorders. Some UK Hyperemesis
3.30pm, Tue and Wed
NHS Smoking Helplines local groups.* 9.30am-6pm, Thu 1pm- Gravidarum Awareness
Compassionate Friends NHS Pregnancy Smoking Group
53 North Street Helpline 6pm and 8pm-10pm,
Jennifer Trust for Spinal Fri 9.30am-6pm) 29 Windermere Avenue
Bristol BS3 1EN 0800 169 9 169 Muscular Atrophy
0117 966 5202 (admin) www.reach.org.uk Basingstoke RG22 5JH
Open daily from 12 noon-9pm Elta House 07020 969 728 (info)
0117 953 9639 (helpline Birmingham Road Information and support to
10am-10.30pm) parents of children with hand 07050 655094 (support)
NHS Asian Tobacco Stratford-upon-Avon
www.tcf.org.uk Helpline or arm problems. Local www.hyperemesis.org.uk
CV37 0AQ Support organisation run by
An organisation of and for 0800 169 0 881 (Urdu) 0870 774 3651 (admin) groups.*
bereaved parents and families. 0800 169 0 882 (Punjabi) volunteers.
Advice and support. Local 0800 975 3100 (helpline)
0800 169 0 883 (Hindi) www.jtsma.org.uk The Real Nappy
groups.* 0800 169 0 884 (Gujarati) Association The UK Thalassaemia
0800 169 0 885 (Bengali) Self-help group offering Society
PO Box 3704
Website: information and support to London SE26 4RX 19 The Broadway
www.givingupsmoking.co.uk parents of children with the 020 8299 4519 Southgate Circus
disease. Can put you in touch www.realnappy.com London N14 6PH
with other parents. Equipment For a FREE information pack 020 8882 0011
on loan.* send SAE (two stamps). 0800 731 1109 (24-hour
Or contact the Women’s information line)
Environmental Network on 020 www.ukts.org
7481 9004. Information, and advice for
families affected by
thalassaemia.*

149
SUPPORT FOR STRESS
AND DEPRESSION
(See also Parents Advice
Centre in the Coping Alone
Section)

Association for Post-Natal


Illness (APNI)
145 Dawes Road
London SW6 7EB
020 7386 0868
www.apni.org
Network of telephone and
postal volunteers who have
suffered from post-natal illness
and offer information, support
and encouragement on a one-
to-one basis. Send a SAE for
information pack.*

CRY-SIS
BM Cry-sis
London WCIN 3XX
020 7404 5011 (8am-
11pm)
www.our-space.co.uk/
serene.htm
Self-help and support for
families with excessively crying,
sleepless and demanding
children. Send SAE for details.*

MIND (National
Association for Mental
Health)
Granta House
15-19 Broadway
London E15 4BQ
020 8519 2122 (admin)
0845 766 0163 (Mind info
line)
www.mind.org.uk

In Wales:
3rd Floor
Quebec House
Castle Bridge
Cowbridge Road East
Cardiff CF11 9AB
029 2039 5123
Help for people experiencing
mental distress. Mind info line
offers confidential help. Local
associations.*

Parentline Plus
520 Highgate Studios
53-57 Highgate Road
London NW5 1TL
0808 800 2222 (helpline,
Mon-Fri 8am-10pm,
Sat 9.30am-5.0pm,
Sun 10am-3pm)
0800 783 6783 (text
phone)
www.parentlineplus.org.uk
Free confidential helpline
to anyone parenting a child.
Runs parenting classes and
produces a range of leaflets
and publications.*

150
INDEX clothes
for the baby 88
while you’re pregnant 8–12
foot exercises 17 Listeria 11
sex
after the birth 117
for the mother 89 forceps delivery 101 liver 12 in pregnancy 42, 47
A colostrum 69 fore milk 69 long-term medication 129 sexual organs (man’s) 21
abnormalities combined pill 117 free milk and vitamins 69, losing a baby 106 sexual organs (woman’s)
tests to detect 57–59 community midwife 62 73, 133 21, 22
worrying about 41 conception 21–23 fruit and vegetables 8, 9 M sexually transmitted
acupuncture 93 best time to get pregnant massage (for pain relief) infections (STIs) 17–18,
alcohol 14, 71, 128 25 G 93 54, 129
allergy, peanut 12 condoms 117 ‘gas and air’ (in mastitis 72 shape (after the birth) 109
alpha-fetoprotein (AFP) constipation 78, 108 labour) 91 maternity allowance 136 ‘show’ 84, 90
test 57 contraception 109, 117 general practitioners Maternity Benefits sickle cell disease 19, 54–55
alternative methods of contractions 90, 93, 94–101 (GPs) 62 133–136 signs of pregnancy 26
pain relief 93 cot death 121–122 genes 24 maternity leave 139–142 single parent 45
amniocentesis 58–59 sleeping position 121 German measles (see medicines skin and hair changes 81
amniotic fluid 31 temperature 121 rubella) before getting pregnant 129 sleeping (baby) 86, 120–121
amniotic sac 30 cot mattresses 122 going home with the baby during pregnancy 14 what you need 86
anaemia 10, 53 cot safety 86 114 midwife 62 sleeplessness (mother) 82
animals, coming into cots and cribs 86 GP/midwife unit 35 minerals 10 slow-growing babies 83
contact with during Council Tax Benefit 133 miscarriage 84, 104–105 smoking 13, 49, 121, 122,
pregnancy 19 cramp 78 H morning sickness 26, 80 128
antenatal care 51 crying 119–120 haemophilia 19 monthly cycle 25 giving up 13
antenatal classes 64–65 cystic fibrosis 19, 33 hair (changes during soft cheese 11
antenatal notes 60 pregnancy) 81 N special care (for babies)
aromatherapy 93 D headaches 79 nappies 122 112
‘D and C’ 105 health and safety rights changing nappies 123 spina bifida 10
B dairy products 9, 10, 11, 12 139 disposable 85, 123 tests for 57, 58, 59
babies with disabilities 113 death washable cloth 85, 123 starchy foods 9
babies born late 101 health visitor 63
of child 106 heartburn 79 what you need 85 Statutory Maternity Pay
babies’ stools 124 of partner 46 nappy rash 123–124 137–138
‘baby blues’ 117 hepatitis B 53
deep vein heredity 24 nausea 80 stillbirth 106
baby milk (formula) 73 thrombosis (DVT) 84 navel 110 stitches 108, 118
backache 77 herpes 18, 55
delivery high blood pressure 84 neonatal unit (NNU) 112 street drugs 14
bathing the baby 86, 125 at home 33, 34, 35, 94 nipples stretch marks 82
bilingualism 65, 127 hind milk 69
in hospital 33, 34, 35, 94 HIV and AIDS 18 cracked 72 sunshine 127
birth (see Labour) delivery rooms 95 flat 68 swollen ankles, feet and
birthmarks 111 and breastfeeding 18, 66,
development of the baby 129 sore 72 fingers 82
birth plan 37–38 28–32 nose bleeds 80
birthing pools 95 HIV positive mothers 129
diabetes 52, 129 HIV test 54 T
blood pressure 52, 61 difficulty in conceiving 128 home birth 33, 34, 35 O team midwifery 34, 35, 36
bottle feeding 73–76 disabilities (baby) 113 obstetric cholestasis 84 tear 98, 99
cleaning and sterilising 76 hormonal changes
dismissal because of after pregnancy 117 obstetrician 62 teeth and gums 82
equipment 74, 88 pregnancy 143 oedema 61 teenagers 27
making up the feed 74 during pregnancy 39, 79, 80,
domestic violence 46 81, 82 ovaries 22, 23, 24 temperature 121–122
microwaves 74, 76 Domino delivery 34 ovulation 23, 25 TENS 91–92
preparing a feed 75 hormones 24
‘double’ test (see ‘triple Housing Benefit 133 termination 105–106
bras (nursing) 67, 88 plus’ test) P thalassaemia 19, 54–55
Braxton Hicks’ hygiene during pregnancy paediatrician 63
Down’s syndrome (tests 12 thrush 83
contractions 42, 90 for) 57, 58 pain relief in labour 91–93
hyperemesis gravidarum partner (see Fathers) tiredness 83
breast pads 69, 88 duvets 86 toxoplasmosis 19
breastfeeding 37, 100, 109, 80 passing water often 80–81
E hypnosis 93 paté 12 ‘triple plus’ test 58
112 twins 25, 103
advantages for the baby 67 ectopic pregnancy 33, 104 pelvic floor exercise 16
advantages for the mother eggs 11 I pelvis 22
67 embryo 28, 29 illness pethidine 92 U
after the birth 107 engagement (of the baby’s baby 122, 126 phototherapy 113 ultrasound scan 29, 30, 33,
and contraception 117 head) 32, 61 meningococal septicaemia physical activity during 56, 57, 58, 59
and drinking 71 engorged breasts 71–72 126 pregnancy 15–16 umbilical cord 30
going back to work 68 Entonox 91 mother 77 physiotherapist (obstetric) uterus (womb) 22
help with 69 epidural 92–93 immunisation 101, 109, 118 63
how to 70 epilepsy 129 Incapacity Benefit 135 piles 81, 108–109 V
problems 71–72 episiotomy 99, 100 Income-based Jobseeker’s placenta 30, 99 vacuum extraction (or
starting off 69 exercises Allowance 131 postnatal check 118 Ventouse) 101
breasts after the birth 109, 115 Income Support 131 postnatal depression 117 vagina 22, 23, 96, 97, 98
babies’ 111 during pregnancy 15–17 incontinence 81 postnatal exercises 109, vaginal bleeding 84, 109
changes in during pregnancy expressing milk 72 incubators 113 115 vaginal discharge 83
26 indigestion 79 prams and carrycots 87 varicose veins 83
cracked nipples 72 F induction 101 pre-eclampsia 84 VDUs (using during
engorged breasts 71–72 faintness 78 inherited conditions 19 pregnancy tests 26 pregnancy) 20
lumpy, tender breasts 72 fallopian tubes 22, 23 injections (in labour) 92, premature babies 112 Ventouse extraction 101
mastitis 72 families and friends 43 100 and breastfeeding 68 vernix 32, 99
preparing for breastfeeding fathers internal examination 55, 95 presentation (of the baby) vitamin K 110
68 becoming a father 50, 128 itching 79, 84 61 vitamin supplements 10
breech birth 102–103 feelings 47, 48, 50 IUD (intrauterine device) progestogen-only pill 117 vitamins 10, 69, 73
bumps and bruises (baby) helping during labour 103 117 pushchairs 87
110 involvement 114
physical symptoms 48 J R W
practical support 49 jaundice 111, 113 reflexology 93 washing the baby 86, 125
C understanding your partner registering the birth 119 waters breaking 30, 90,
Caesarean section 101–102 48 L relationships 116 94, 97
caffeine 9 feeling hot 79 labour rest weight gain in pregnancy
cap (diaphragm) 117 feelings 27, 39–40 signs of labour 90 after the birth 115 11, 52
car safety fetal heart monitoring first stage 96–97 during pregnancy 20 wind 72
during pregnancy 20 96–97 second stage 98–99 restricted diet 11 work
with the baby 88 fetus (development of) third stage 99 rhesus negative mothers and pregnancy 20, 44
cats 19 28, 30 afterwards 100 53, 110 hazards 20, 129
cervical smear 55 fits (baby) 126 pain relief 91–93 rubella (German measles) parental leave 143
cervix 22, 23 flat nipples 68 speeding up labour 97 17, 53, 109, 129 paternity leave 49
dilation of in labour 96 folic acid 10, 128–129 starting too early 100 time off for antenatal care
chicken pox 18 fontanelle 110 labour partner 103 S 142
Child Benefit 130–131 food lanugo 31, 32 safety restraint in the car Working Families’
childcare arrangements 44 after the birth 108, 116 let-down reflex 69 88 Tax Credit 131–132
chorionic villus sampling preparing for next baby 128 Salmonella food poisoning worrying
(CVS) 59 when you’re breastfeeding 11 about abnormality 41
chromosomes 24 71, 116 serum screening 58 about the birth 40
The Department of Health would like to thank all the mothers and fathers who took
part in research for the earlier editions of this book, and all those people whose helpful
comments continue to shape its development.
USEFUL NUMBERS
The Department of Health would also like to thank all those organisations and
individuals who contributed to the making of this book and, in particular:
Community Practitioners and Health Visitors Association Doctor:
Maternity Alliance
National Childbirth Trust
Royal College of General Practitioners
Royal College of Midwives
Royal College of Obstetricians and Gynaecologists
Royal College of Paediatrics and Child Health
St John Ambulance
Midwife:
Dr Petra Clarke, Christine Gowdridge, Professor David Harvey, Dr Sheila Macphail,
Ros Meek, Jeanne Langford, Dr Lindsay Smith, Dr David Sowden, Ros Steele and
Glenys Sykes.

The photographs have been reproduced with the permission of the following:
Angela Hampton, pages 91 middle and bottom, 98 middle, 107 and 119. Bubbles,
pages 4 middle and right, 6 top, middle and right, 6, bottom left and right, 8 top, 16,
19, 20 top and bottom, 33 top and bottom, 35, 37, 42, 45, 47 and cover, 50, 56 Hospital:
bottom, 65 bottom, 66 top, 70 top, 71, 77, 79 and cover, 80, 85 bottom, 87 and cover,
88 top, 94 bottom, 95, 96, 98 top left, 99 bottom right, 100 top and bottom, 102 top
and bottom, 103, 104, 110 top and bottom, 111, 113, 114 top, 115, 116 bottom, 120,
124, 125 bottom, 128 top, 130. Collections, pages 70 bottom, 73, 86 bottom, 91 top
left, 92, 98 bottom, 99 top left, 110 2nd down, 122 and cover, 125 top, 127 left and
right. Cow & Gate, page 74. Format, pages 6 top left, 34, 48, 49 top, 51, 54, 85 top,
86 top, 89, 93, 94 top, 108 top, 121, 128 bottom. The Foundation for the Study of
Infant Deaths (photographer: Sandra Lousada) page 86 bottom right. Health
Hospital ref no:
Promotion England, pages iii, 4 left, 5 top right, 7, 8 foot, 10, 12, 15 bottom right,
17, 39, 52, 56, 63, 66 bottom, 67, 68, 83, 88 right, 116 top. Images, front cover.
National Meningitis Trust, page 126. Sally and Richard Greenhill, pages 5 bottom
left and right, 9 top, 15 left and top right, 44, 49 left, 53, 55, 62 top and bottom, 65
top, 72, 81, 84, 97 top right, 99 top right, 100 left middle, 108 bottom, 110 3rd down,
112, 114 bottom, 118. Science Photo Library, pages ii, 5 top left, 21, 24 top and
bottom, 28, 29, 30 top and bottom, 31 top and bottom, 57, 58, 59, 97 left. Health visitor:
Ilustrations
Rachel Busch, pages 8, 11, 13, 26, 37, 39, 40, 41, 43, 48, 64, 69, 78, 87, 90, 111, 115,
117, 120, 124 and 128.
Annabel Milne, pages 16, 17, 21, 22, 23, 28, 29, 30, 31, 32, 55, 61, 70, 75, 76, 82 and
123.
Original text: Nancy Kohner
Revised text: Sally Burningham, Karen Ford, Angela Phillips NHS Direct 0845 4647
This edition: Dr Virginia Beckett, Sue Latchem
24 hour nurse-led helpline providing health
Cover design: Persona Grata information and advice.
First published by Health Education Authority, 1999
Revised edition published by Health Promotion England, 2001

This revised edition published by the Office of The Chief Medical Officer, Welsh
Assembly Government, based on the original version produced by The Department of NHS Pregnancy Smoking Helpline
Health, 2004
0800 169 9 169
ISBN 0 7504 3687 5
Open daily from 12 noon to 9 pm.
© Crown copyright January 2005

Public Health Strategy Division,


Office of The Chief Medical Officer,
Welsh Assembly Government, Every effort has been made to ensure this book reflects
Cathays Park, the most up-to-date medical advice available at the time
Cardiff, of publication. Because developments can be very rapid,
CF10 3NQ significant changes will always be notified to doctors
and other health professionals at once. They will then
This publication has been produced by the Welsh Assembly Government as part of its be incorporated into the text at the next reprint.
response to Health Challenge Wales. Health Challenge Wales is the national focus for The information on rights and benefits is correct at
efforts to improve health and well-being in Wales. It is a challenge to all individuals the time of going to press, but again may change.
and organisations to take action to build a healthier nation.

This book is given free to all first-time mothers


in Wales.