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The

Pregnancy
Book
Your complete guide to:
A healthy pregnancy
Labour and childbirth
The first weeks with your new baby
The Department of Health would like to thank all those involved in shaping the updated edition of
The Pregnancy Book, including the mothers and fathers, medical and health professionals, and the
many individuals and organisations. In particular, the Department extends thanks to:

Community Practitioners and Health Visitors Association


Department for Children, Schools and Families
Department for Work and Pensions
Food Standards Agency
NCT
National Institute for Health and Clinical Excellence
Royal College of Anaesthetists
Royal College of General Practitioners
Royal College of Midwives
Royal College of Obstetricians and Gynaecologists
Royal College of Paediatrics and Child Health
UK Medicines Information
Sheena Byrom, Jill Cooper, Anne Edington, Dr David Elliman, Kathryn Gutteridge, Sue Henry,
Dr Judy Shakespeare and Dr Helen Scholefield.

This book is given free to all expectant mothers.

Every effort has been made to make this book reflect the most up-to-date medical advice at the time
of publication. Because developments can be very rapid, significant changes will always be notified to
doctors and other health professionals at once. They will then be incorporated into the text for the next
reprint. For the most up-to-date information and advice, visit the online version of the book (pregnancy
planner) at www.nhs.uk/pregnancyplanner

The information on rights and benefits is correct at the time of going to press but may change and
should be checked against the latest information.

Crown copyright 2009

Produced by COI for the Department of Health.


Design and layout by the Rafferty Consultancy.
Cartoons by Alex Hallatt. Medical illustrations by Anne Wadmore and Florence Woolgar.

The photographs have been reproduced with the permission of the following:

Alamy front cover (bottom left), 1, 2 (bottom), 4 (middle left), 10, 13 (top and bottom), 14 (bottom),
15 (middle left and bottom right), 17 (top), 18, 23, 40 (top and bottom), 47, 49 (middle left), 51, 55
(bottom left), 58, 60 (bottom), 66 (top), 67 (bottom), 68 (top), 69, 72 (top left and bottom), 75 (top),
76 (middle and bottom), 78 (bottom), 89 (middle), 90 (top and middle), 94 (bottom), 95 (bottom), 99
(bottom), 101 (top and bottom middle), 107 (top), 110 (bottom left), 118 (top), 121 (middle right), 129,
134 (bottom), 137 (bottom), 142 (bottom middle), 144 (middle), 145 (top), 155, 156 (top), 161, 162
(top); Banana Stock 146 (bottom); Bubbles Photo Library 89 (top); Corbis front cover (middle),
93 (bottom right), 147 (middle); Department of Health 2 (top), 4 (bottom left), 15 (bottom), 28
(top right), 29 (bottom), 35, 36, 40 (middle left and right), 42 (top), 44 (top and bottom middle), 45
(middle), 46, 48 (bottom right), 52, 54, 56 (top), 60 (middle), 67 (top), 68 (bottom right), 70 (bottom),
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(top and middle right), 94 (middle left), 96 (top), 97, 99 (top), 102 (top), 103 (top middle and bottom),
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115, 116 (top), 120 (middle and bottom), 121 (bottom), 126 (middle right), 127 (bottom), 128 (top
left), 130, 131, 134 (top right), 136, 141 (bottom right), 142 (middle right), 152 (top), 156 (bottom
middle), 158 (top), 172 (bottom), 176, 177; Digital Vision 33, 113; Dreamstime 5 (top), 66
(bottom); East Essex Hospital 72 (top right); The Food Standards Agency 25 (middle); Getty
Images front cover (top left), 15 (top middle), 16 (top right), 17 (middle left), 44 (middle), 48 (top),
61 (top), 68 (bottom left), 71 (top), 83, 91 (bottom middle), 94 (top), 98 (top), 101 (bottom right),
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Printing 123; Image Dictionary 160 (middle); Image Source 3, 13 (middle right), 92 (middle);
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bottom), 6, 7, 8, 9, 13 (middle left), 14 (middle left), 16 (top left), 17 (middle right), 24, 25 (bottom),
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70 (top), 75 (bottom), 76 (top), 79 (middle and bottom), 81 (top), 82, 84, 85, 86 (top and bottom), 87
(bottom), 88 (middle and bottom), 90 (bottom), 91 (middle right and bottom left), 93 (top and middle
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(middle), 106 (bottom), 107 (bottom right), 108, 109 (top), 114 (top left), 116 (bottom), 118 (bottom),
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The
Pregnancy
Book
Your complete guide to:
A healthy pregnancy
Labour and childbirth
The first weeks with your new baby

your complete guide


pregnancy
INTRODUCTION 4 Work hazards ................................... 39
Flying and travel................................. 39
YOUR PREGNANCY 5
AT A GLANCE 4 ANTENATAL CARE 40
Antenatal appointments . ................. 41
1 BECOMING PREGNANT 10
Early antenatal appointments............ 44
Male sex organs . .............................. 10 Regular checks at every antenatal
Female sex organs ............................ 11 appointment...................................... 45
The female monthly cycle ................. 12 Appointments in later pregnancy ..... 46
Conception ....................................... 12 Blood tests......................................... 46
Hormones ......................................... 13 Ultrasound scans .............................. 48
Boy or girl? .................................... 13 Tests to detect abnormalities ............ 49
The best time to get pregnant .......... 14 Tests for Downs syndrome
Twins, triplets or more ...................... 14 and other genetic disorders ............. 50
The signs of pregnancy...................... 15 Diagnostic tests for Downs syndrome
and other genetic disorders ............. 51
Pregnancy tests ................................. 15
If a test detects an abnormality.......... 51
Finding out that you are pregnant ... 16
Making the most of antenatal care .. 52
Accessing antenatal care .................. 16
Your antenatal team.......................... 54
Help for young mums . ..................... 17
Antenatal education.......................... 56
2 HOW YOUR BABY 18
DEVELOPS 5 CONDITIONS AND 58
PROBLEMS IN PREGNANCY
Measuring your pregnancy................ 18
Common minor problems................. 58
Week 3 ............................................. 19
More serious problems...................... 67
Weeks 45........................................ 19
Weeks 67........................................ 19 6 CHOOSING WHERE 70
Weeks 89........................................ 19 TO HAVE YOUR BABY
Weeks 1014 . ................................. 20 Safety . .............................................. 70
Weeks 1522 . ................................. 21 Making an informed decision ........... 70
Weeks 2330 . ................................. 22 Home births ...................................... 71
Weeks 3140 ................................... 23 Midwifery units or birth centres......... 72
YOUR HEALTH 24 Birth in hospital . ............................... 73
3 Birth plans . .......................................
IN PREGNANCY 74

What should you eat?....................... 24 7 FEELINGS AND 75


Foods to avoid .................................. 26 RELATIONSHIPS
Preparing food .................................. 26 Feelings ............................................. 75
Vitamins and minerals ...................... 27 Depression and mental health
Vegetarian, vegan and special diets .. 28 problems . ......................................... 76
Smoking ........................................... 30 Worrying about the birth................... 77
Alcohol ............................................. 32 Concerns about disabilities................ 77
Pills, medicines and other drugs ....... 33 Couples ............................................ 78
Illegal drugs ...................................... 33 Sex in pregnancy .............................. 78
X-rays . .............................................. 34 Single parents.................................... 79
Keeping active................................... 34 Family and friends . ........................... 80
Infections .......................................... 36 Work . ............................................... 80
Inherited conditions .......................... 38 After the birth . ................................. 81
Mood changes that can develop THE EARLY WEEKS: 137
13
after the birth of a baby ................... 81 YOUR BABY
Domestic abuse................................. 83
Enjoying your baby............................ 137
Bereavement . ................................... 84
Registering the birth.......................... 138
8 LABOUR AND BIRTH 85 Crying................................................ 138

Getting ready..................................... 85 Sleep ................................................. 140


Changing your baby.......................... 142

CONTENTS
The signs of labour............................ 87
Types of pain relief............................. 88 Washing and bathing........................ 144

When to go to hospital Illness ................................................ 145


or your midwifery unit ...................... 90 Getting support................................. 146
Arriving at the hospital or
midwifery unit .................................. 91 14 BABIES WHO NEED 147
ADDITIONAL CARE
What happens in labour.................... 92
Why babies need additional care....... 147
Special cases...................................... 96
Contact with your baby..................... 148
Twins, triplets or more ...................... 100
Feeding.............................................. 148
What your birth partner can do......... 101
Incubators ......................................... 148
9 FEEDING YOUR BABY 102 Newborn babies with jaundice.......... 149
Breastfeeding..................................... 103 Babies with disabilities....................... 149
Formula feeding................................. 115 15 THE LOSS OF YOUR BABY 150

10 THE FIRST DAYS WITH 120 Ectopic pregnancy ............................ 151


YOUR BABY
Miscarriage........................................ 151
How you feel..................................... 120 Abnormal test results......................... 152
Postnatal care ................................... 121 Stillbirth and neonatal death ............ 153
Stitches.............................................. 122
THINKING ABOUT THE 154
Bleeding............................................. 122 16 NEXT BABY?
Sex and contraception....................... 122
It takes two........................................ 154
Your body.......................................... 123
Folic acid............................................ 154
Your babys health ............................ 124
Things to consider.............................. 155
Your babys appearance..................... 124
Work-related risks.............................. 155
What your newborn baby can do .... 126
17 RIGHTS AND BENEFITS 156
11 WHAT YOU NEED FOR 127
YOUR BABY Benefits for everyone......................... 157
Nappies . ........................................... 127 Tax credits.......................................... 158
Bathing.............................................. 128 Benefits if your income is low............ 159
Sleeping............................................. 129 Maternity benefits............................. 163
Out and about .................................. 130 If you are unemployed....................... 166
In the car .......................................... 130 Maternity leave.................................. 167
Feeding ............................................. 131 Rights during maternity leave............ 168
Clothes ............................................. 131 Returning to work............................. 169
Other employment rights.................. 170
12 THE EARLY WEEKS: YOU 132
Other types of leave........................... 171
Partners ............................................ 132 Your rights under sex
Help and support .............................. 133 discrimination law.............................. 174
Looking after yourself........................ 133
The NHS Constitution 176
Your relationships.............................. 134
Glossary of useful terms 178
The baby blues and
postnatal depression . ....................... 136 Useful organisations 182
Your postnatal check......................... 136 Index 189
introduction
find everything you
need to know in this book

Having a baby is one of the most exciting things that


can happen to you. But you might be feeling nervous
as well. If its your first baby, its hard to know what
to expect.

Your mum, colleagues, friends and relations might all


be giving you advice. And then there is all the information
on the internet as well as in magazines and books. At times
it can feel overwhelming and its hard to know who is
right when people say different things.

This book brings together everything you need to know


to have a healthy and happy pregnancy, and to make sure
you get the care that is right for you. The guidance about
pregnancy and babies does change.
The information in
So its important to get
this book is also available
online from the NHS up-to-date, trusted advice
interactive pregnancy so that you can make
planner, which is the right decisions
available at www.nhs.uk/ and choices.
pregnancyplanner
You can download an If you have any
interactive widget at
www.nhs.uk/ questions or concerns
pregnancywidget no matter how trivial
that delivers weekly they may seem talk to
information and your midwife or doctor.
tips tailored to
you and your
They are there to
pregnancy. support you.

4
YOUR PREGNANCY
AT A GLANCE
Before you get pregnant 5 28 weeks 8
08 weeks 6 31 weeks 8
8 12 weeks 6 34 weeks 8
1216 weeks 7 36 weeks 9
1620 weeks 7 38 weeks 9
20 25 weeks 7 40 weeks 9
25 weeks 7 41 weeks 9

BEFORE YOU You should avoid drinking Take 400 micrograms of folic
GET PREGNANT alcohol if you are pregnant or acid a day. You should continue
trying to conceive. If you do to take this until you are 12
choose to drink, then protect weeks pregnant (see page 27).
your baby by drinking no more
than one to two units of alcohol
once or twice a week and dont
get drunk (see page 32).
Take exercise.
If you or your partner take
any medication, talk to your
doctor about whether it will
If you have a health condition,
affect your pregnancy.
for example mental health
problems, diabetes or a
family history of any
inherited diseases,
Think about the lifestyle factors
talk to your GP
that might affect your ability to
or a specialist
get pregnant and have a healthy
before you try
pregnancy (see Chapter 3). This
to get pregnant.
applies to men too. You are more
likely to get pregnant if you are T alk to your
both in good health. GP or a
healthcare
If you smoke, get advice
professional
about stopping. You can
if youhave
talk to your doctor, visit
any concerns
www.nhs.uk/smokefree or
orneed
call the free NHSsmoking
support.
helpline on 0800022 4 332.
Eat a balanced diet.
Maintain a healthy weight.

5
08 WEEKS 812 WEEKS

You can take a pregnancy You will usually attend your You will usually be offered Make a dental appointment.
test from the first day that first appointment by 10 an ultrasound scan between NHS dental care is free
you miss your period (see weeks and your booking eight and 14 weeks. This during pregnancy and for
Finding out that you are appointment by 12 weeks. will check the babys a year after the birth of
pregnant on page 16). measurements and give your baby.
At the booking appointment,
an accurate due date.
As soon as you know you your weight, height and Just 12 weeks after
The scan can also detect
are pregnant, get in touch body mass index will be conception, your baby is
abnormalities and check
with a midwife or your GP measured. You will be fully formed. It has all its
if you are carrying more
to organise your antenatal asked about your health organs, muscles, limbs and
than one baby. Your partner
care (see Finding out that and family history as well as bones, and its sex organs
can come along to the
you are pregnant on page about your babys fathers are well developed.
scan (see Antenatal care
16 and Antenatal care on family history. This is to
onpage 40). Your baby is already moving
page 40). Begin to think find out if you are at risk of
about but you cannot feel
about where you want certain inherited conditions. If you get Income Support,
the movements yet.
your baby to be born (see income-based Jobseekers
Your hand-held notes and
Choosing where to have Allowance or income-
plan of care will be completed.
your baby on page 70). related Employment and
Your midwife will discuss Support Allowance or
Some pregnant women
various tests you will are on a low income and
start to feel sick or tired or
be offered during your receive Child Tax Credit, you
have other minor physical
pregnancy, one of which should complete a Healthy
problems for a few weeks
is an ultrasound scan to Start application form (see
(see Common minor
check for abnormalities page 28). This is to claim
problems on page 58).
in your baby (see page vouchers to spend on milk,
Take 10 micrograms of 48). You will be offered fruit and vegetables. Healthy
vitamin D per day, which information about what to Start vitamin supplements
is in Healthy Start vitamin expect during pregnancy (containing vitamin D) are
supplements or other and how to have a healthy free without prescription for
supplements recommended pregnancy. Ask if you are any pregnant woman, new
by your midwife. You unsure about anything. mother or child who gets
should continue to take Healthy Start vouchers
You can ask your midwife (see Rights and benefits
vitamin D throughout your
about your rights at work on page 156).
pregnancy and while you
and the benefits available
are breastfeeding. (see Rights and benefits
on page 156).

growing
and
developing
> > > >

6
1216 WEEKS 1620 WEEKS 2025 WEEKS 25 WEEKS
(if this is your first baby)

Find out about antenatal You may start to feel Your uterus will begin to Your baby is now moving

YOUR PREGNANCY AT A GLANCE


education (see Antenatal your baby move (see get bigger more quickly and around vigorously and
care on page 40). How your baby develops you will really begin to look responds to touch and
on page 18). pregnant. sound.
Start to think about how
you want to feed your baby Your tummy will begin to You may feel hungrier than If this is your first baby,
(see Feeding your baby get bigger and you will before. Stick to a sensible your midwife or doctor
on page 102). need looser clothes. balanced diet (see Your should:
health in pregnancy on
Make sure you are wearing You may feel a surge of check the size of
page 24).
a supportive bra. Your energy. your uterus
breasts will probably measure your blood
Try to do your pregnancy
increase in size during pressure and test
exercises regularly (see
pregnancy so you need to your urine for protein.
Your health in pregnancy
make sure you are wearing
on page 24). If you are taking maternity
the right sized bra.
leave, inform your employer
Your midwife or doctor
If you have been feeling sick in writing 15 weeks before
should:
and tired, you will probably the week your baby is due.
start to feel better around review, discuss and You can claim for Statutory
this time. record the results of any Maternity Pay (SMP)
Ask your midwife about
screening tests and the Health in Pregnancy
At 14 weeks, your babys antenatal education (see
measure your blood Grant at the same
heartbeat is strong and Antenatal education on
pressure and test your time (see Rights and
can be heard using an page 56).
urine for protein benefits on page 156).
ultrasound detector.
consider an iron You will begin to feel your
If you are entitled to
Your pregnancy may just supplement if you baby move.
Maternity Allowance, you
be beginning to show. are anaemic.
Get your maternity can claim from when you
This varies a lot from
Your midwife or doctor certificate (form MAT are 26 weeks pregnant
woman to woman.
should give you information B1) from your doctor or (see Rights and benefits
about the anomaly scan midwife (see Rights and on page 156).
you will be offered at benefits on page 156).
If your partner plans to
1820 weeks and answer
take paternity leave,
any questions you have.
they will need to inform
Your baby is now growing their employer.
quickly. Their face becomes
much more defined and
their hair, eyebrows and
eyelashes are beginning
to grow.

Ask your doctor or


midwife to let you hear
your babys heartbeat.

> >

7
28 WEEKS 31 WEEKS 34 WEEKS
(if this is your first baby)

Your baby will be perfectly Think about what you If this is your first baby, your Your midwife or
formed by now, but still need for the baby (see midwife or doctor should: doctor will give you
quite small. What you need for your information about
review, discuss and
baby on page 127). preparing for labour and
You may find that you are record the results of any
birth, including how to
getting more tired. If you have young children, screening tests from the
recognise active labour,
its good to talk to them last appointment
Your midwife or doctor ways of coping with pain
about the new baby. measure the size of your
should: in labour and developing
uterus and check which
Make sure your shoes are your birth plan. They
use a tape to measure way up the baby is
comfortable. If you get should also:
the size of your uterus measure your blood
tired, try to rest with your
measure your blood pressure and test your review, discuss and record
feet up.
pressure and test your urine for protein. the results of any
urine for protein screening tests from the
offer more blood last appointment
screening tests measure the size of
offer your first anti-D your uterus
treatment if your blood measure your blood
type is rhesus negative. pressure and test your
urine for protein
If you are claiming Statutory offer your second anti-D
Maternity Pay (SMP), you treatment if your blood
must inform your employer type is rhesus negative

excitement and
at least 28days before you (see page 46).
stop work (seeRights and
benefits on page 156). Make arrangements

apprehension
for the birth. You can
You can claim a lump sum give birth at home, in
Sure Start Maternity Grant a midwifery unit or in
to help buy things for your hospital. If you have
new baby if you get one of children already, you may
the following: want to make childcare
Income Support arrangements for when
income-based Jobseekers you go into labour.
Allowance You may want to ask about
income-related whether tours of maternity
Employment and Support facilities for birth are
Allowance available.
Pension Credit
Working Tax Credit where
the disability or severe
disability element is
included in the award
Child Tax Credit payable
at a rate higher than
the family element (see
Rights and benefits
on page 156). > > > >

8
36 WEEKS 38 WEEKS 41 WEEKS

Think about who you Make sure you have all Most women will go into If your pregnancy lasts

YOUR PREGNANCY AT A GLANCE


would like to have with your important telephone labour spontaneously longer than 41 weeks,
you during labour. numbers handy in case between 38 and 42 weeks. you may be induced.
labour starts (see Labour Your midwife or doctor Your midwife or doctor
Get your bag ready if
and birth on page 85). should give you information will explain what this
you are planning to give
about your options if your means and what the
birth in hospital or in a Your midwife or doctor
pregnancy lasts longer than risks are.
midwifery unit. should give you information
41 weeks.
about: Your midwife or doctor
You will probably be
Your midwife or doctor should:
attending antenatal feeding your baby
classes now (see should: measure the size of
caring for your
Antenatal care on newborn baby measure the size of your uterus
page 40). vitamin K and screening your uterus measure your blood
tests for your measure your blood pressure and test your
You may be more aware
newborn baby pressure and test your urine for protein
of your uterus tightening
the baby blues and urine for protein. offer a membrane sweep
from time to time. These
postnatal depression. (see page 96).
are mild contractions Call your hospital or
known as Braxton Hicks Your midwife or doctor midwife at any time if Discuss options and choices
contractions (see Labour should: you have any worries for induction of labour.
and birth on page 85). about your baby or about
measure the size of Call your hospital or
You may feel quite tired. your uterus labour and birth. midwife if you have any
Make sure you get plenty check the position of worries about your baby
of rest. your baby or about labour and birth.
measure your blood
pressure and test your 40 WEEKS See www.nice.org.uk/
(if this is your first baby) Guidance/CG70
urine for protein.
for guidelines on induction
Sleeping may be Your midwife or doctor of labour.
increasingly difficult. should give you more
information about what
happens if your pregnancy
lasts longer than 41 weeks.

Your midwife or doctor


should:

measure the size of


your uterus
measure your blood
pressure and test your
urine for protein.

> >

9
BECOMING
PREGNANT
Male sex organs 10 Twins, triplets or more 14
Female sex organs 11 The signs of pregnancy 15
The female monthly cycle 12 Pregnancy tests 15
Conception 12 Finding out that you are pregnant 16
Hormones 13 Accessing antenatal care 16
Boy or girl? 13 Help for young mums 17
The best time to get pregnant 14

This chapter describes the physical process of getting pregnant and includes
information about the male and female sex organs, the female monthly cycle and
when you are most likely to conceive. It also explains what you should do when you
find out you are pregnant and how you might feel when you first conceive.

MALE SEX ORGANS


MALE

1
1 Bladder
2 2 Vas deferens The two tubes called the vas deferens
carry sperm from the testes (testicles), where sperm are
made, to the prostate and other glands. These glands add
secretions that are ejaculated along with the sperm.
5
3 Urethra The urethra is a tube running down the length
3
of the penis from the bladder, through the prostate gland,
to an opening at the tip of the penis. Sperm travel down
the urethra to be ejaculated.

4 Penis The penis is made of erectile tissue, which acts like


4
6 7 a sponge. When it becomes filled with blood, the penis
becomes hard and erect.

5 Prostate gland This is a gland at the base of the penis.


6 Scrotum The testes are contained in a bag of skin called
the scrotum, which hangs outside the body. The scrotum
helps to keep the testes at a constant temperature, just

parts of
below body temperature. This is necessary for sperm to
be produced. When it is warm, the scrotum hangs down
away from the body to keep the testes cool. When it is cold,

the
the scrotum draws up closer to the body for warmth.

7 Testes Men have two testes, which are glands where

body
sperm are made and stored.

10
FEMALE SEX ORGANS
FEMALE
1
1 Hood of clitoris 5 Opening of vagina 1
2 2 Clitoris 6 Perineum
3 Urethra 7 Anus
3

BECOMING PREGNANT
4 Vulva
4

5
6

1 Fallopian tube 6 Vagina


1
2 Ovary 7 Urethra
2 3 Womb or uterus 8 Rectum

3
4 Bladder 9 Anus
5 Cervix 10 Perineum
5
4

6 8
7
9
10

1 Pelvis The pelvis is the bony structure that the


baby will pass through when it is born.
2 Womb or uterus The uterus is about the size
and shape of a small, upside down pear. It is made
1 of muscle and increases in size as the baby grows.
3 Fallopian tubes The fallopian tubes lead from
the ovaries to the uterus. Eggs are released from
3 the ovaries into the fallopian tubes each month.
4 2 This is where fertilisation takes place.
4 Ovaries There are two ovaries, each about the
5 size of a walnut. They produce the eggs or ova.
6 5 Cervix The cervix is the neck of the uterus. It is
normally almost closed, with just a small opening
through which blood passes during monthly
periods. During labour, the cervix will dilate to
let the baby move from the uterus into the vagina.
6 Vagina Most babies are born through the vagina,
which is a tube about 8cm (3 inches) 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 mans penis during sex
or around a baby during labour.
11
The female monthly cycle
1 B
2 3
A E

C
F

A Egg being released E Egg progressing down the F Uterus lining being shed
B Fallopian tube fallopian tube
C Vagina
D Ovary
Ovulation occurs each month when The egg begins to travel down If the egg is not fertilised, it will pass
an egg (ovum) is released from the fallopian tube. If a man and out of the body during the womans
one of the ovaries. Occasionally, woman have recently had sex, the monthly period along with the lining
more than one egg is released, egg might be fertilised here by of the uterus, which is also shed.
usually within 24 hours of the first the mans sperm. The lining of the The egg is so small that it cannot
egg. Thefingers at the end of the uterus is now thick enough for be seen.
fallopian tubes help to direct the egg the fertilised egg to be implanted.
down into the tube. At the same
time, the lining of the uterus begins
to thicken and the mucus in the
cervix becomes thinner so that sperm
can swim through it more easily.

Conception
Conception is the process that begins with the fertilisation of an egg and ends with the implantation
of an egg into a womans uterus.

1 A
2 D
3
F

B
E
C

A Egg D Egg being fertilised F Attached embryo


B Sperm being ejaculated E Sperm
C Penis
Ovulation Fertilisation Implantation
A woman conceives around the During sex, sperm are ejaculated from During the week after fertilisation,
time when she is ovulating; that a mans penis into a womans vagina. the fertilised egg (which is now an
is, when an egg has been released In one ejaculation there may be more embryo) moves slowly down the
from one of her ovaries into one than 300 million sperm. Most of the fallopian tube and into the uterus.
of her fallopian tubes. sperm leak out of the vagina but It is already growing. The embryo
some begin to swim up through the attaches itself firmly to the specially
cervix. When a woman is ovulating, thickened uterus lining. This is called
the mucus in the cervix is thinner implantation. Hormones released
than usual to let sperm pass through by the embryonic tissue prevent the
more easily. Sperm swim into the uterus lining from being shed. This
uterus and into the fallopian tubes. is why women miss their periods
Fertilisation takes place if a sperm when they are pregnant.
joins with an egg and fertilises it.
12
Sperm is about 1/25th of a millimetre long and has a head, neck and tail.
1
The tail moves from side to side so that the sperm can swim up the vagina
into the uterus and fallopian tubes.
One egg or ovum (occasionally two or more) is released from the

BECOMING PREGNANT
womans ovaries every month. It moves down into the fallopian tube
where it may be fertilised by a mans sperm.

HORMONES
Both men and women have
hormones, which are chemicals that
circulate in the bloodstream. They
carry messages to different parts
of the body and result in certain
changes taking place. Female
hormones, which include oestrogen
and progesterone, control many of
the events of a womans monthly
cycle, such as the release of eggs
from her ovaries and the thickening
of her uterus lining.
During pregnancy, your hormone
levels change. As soon as you
have conceived, the amount of
oestrogen and progesterone in your
blood increases. This causes the
uterus lining to build up, the blood
BOY OR GIRL? the mothers egg is always the same
and is known as the X chromosome.
supply to your uterus and breasts Every normal human cell contains But the sex chromosome from
to increase and the muscles of your 46 chromosomes, except for male the fathers sperm can be an X or
uterus to relax to make room for sperm and female eggs. These a Y chromosome.
the growing baby. contain 23 chromosomes each.
If the egg is fertilised by a sperm
When a sperm fertilises an egg, the
containing an X chromosome,
23 chromosomes from the father
the baby will be a girl (XX). If the
pair with the 23 from the mother,
sperm contains a Y chromosome,
making 46 in all.
the baby will be a boy (XY).
Chromosomes are tiny, thread-like
structures which each carry about
2,000 genes. Genes determine
a babys inherited
characteristics, such as
The increase in hormone levels hair and eye colour,
can affect how you feel. You may blood group, height
have mood swings, feel tearful or and build. A fertilised
be easily irritated. For a while you egg contains one sex
may feel that you cannot control chromosome from
your emotions, but these symptoms its mother and one
should ease after the first three from its father. The
months of your pregnancy. sex chromosome from

13
This chart shows a 28-day cycle. Yours may be longer or shorter.

Ovulation Most women ovulate between


12 and 14 days before their next period.
DAYS

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, TRIPLETS you seem bigger than you should


be for your dates
OR MORE twins run in your family, or
Identical twins occur when one you have had fertility treatment.
fertilised egg splits into two; each
baby will have the same genes It is usually possible to find out
and therefore they will be the through your dating ultrasound
same sex and look very alike. scan, which happens between eight
Non-identical twins are more and 14 weeks (see page 48).
common. They are the result of You should be told at this point
THE BEST TIME TO two eggs being fertilised by two whether the babies share a placenta
sperm at the same time. The babies
GET PREGNANT may be of the same sex or different
(are identical) or if they have two
separate placentas, in which case
You are most likely to get pregnant sexes, and will probably look no they can be either identical or
if you have sex within a day or so of more alike than any other brothers nonidentical. If this cannot be
ovulation (see chart). This is usually and sisters. A third of all twins determined, you should be offered
about 14 days after the first day of will be identical and two-thirds a further scan. A third of identical
your last period. non-identical. twins have two separate placentas.
Twins happen in about 1 in every This happens when the fertilised
An egg lives for about 1224 hours
65 pregnancies. A couple is more egg splits in the first 34 days after
after it is released. For you to get
likely to have twins if there are conception and before it implants
pregnant, the egg must be fertilised
twins in the womans family. in the uterus.
by a sperm within this time. Sperm
can live for up to seven days inside Triplets occur naturally in 1 in
a womans body. So if you have 10,000 pregnancies and quads
had sex in the seven days before are even rarer. Nowadays, the use
ovulation, the sperm will have of drugs in the treatment of
had time to travel up the fallopian infertility has made multiple
tubes to wait for the egg to births more common.
be released. Are you carrying
twins?
You might suspect that you
are carrying more than
one baby if:
you are very sick in
early pregnancy

14
What is different about PREGNANCY TESTS 1
being pregnant with
twins or more? Pregnancy tests can be carried
out on a sample of urine from the
All multiple pregnancies have
first day of a missed period, which
a higher risk of complications THE SIGNS OF means that, if you are pregnant,

BECOMING PREGNANT
particularly premature birth.
If your babies share a placenta PREGNANCY you are about two weeks after
conception. Some very sensitive
(identical twins) it is recommended For women who have a regular tests can be used even before you
that you are scanned every two monthly cycle, the earliest and miss a period.
weeks from 16 weeks onwards, most reliable sign of pregnancy
and every four weeks if your babies You can collect urine at any time
is a missed period. Sometimes
have separate placentas. You may of the day. Use a clean, soap-free,
women who are pregnant have a
be advised to have a caesarean wellrinsed container to collect it.
very light period, losing only a little
section. You should discuss this You can get pregnancy tests free
blood. Other signs of pregnancy
with your doctor, but it is your of charge from your GP or family
are as follows:
choice. It is possible to breastfeed planning clinic. Pregnancy tests are
twins and triplets and there is more Feeling sick you may feel sick, also available at NHS walk-in centres.
information about how you can do or even be sick. This is commonly
Many pharmacists and most
this in Chapter 9. You may find that known as morning sickness but
pregnancy advisory services also
a combination of breast and formula it can happen at any time of the
offer tests, usually for a small
feeding is best for you particularly day. If you are being sick all the
fee. You can buy do-it-yourself
if you have triplets or more. time and cannot keep anything
pregnancy testing kits from
down, contact your GP.
pharmacists. They can give you
Help and support Changes in your breasts your a quick result and you can do
breasts may become larger and the test in private. There are a
feel tender, like they might do range of tests that are available.
before your period. They may also How they work varies, so check
tingle. The veins may show up the instructions.
more and the nipples may darken
and stand out. Results of the test
Needing to pass urine more A positive test result is almost
often you may find that you certainly correct. A negative result is
have to get up in the night. less reliable. If you still think you are
pregnant, wait a week and try again
Being constipated.
or go and see a midwife or GP.
An increased vaginal discharge
without any soreness or irritation.
Feeling tired.
Having a strange taste in your
You might find it helpful to mouth many women describe
contact support groups like it as metallic.
Tamba (Twins and Multiple
Going off certain things, for
Births Association) and the
example tea, coffee, tobacco
Multiple Births Foundation
smoke or fatty food.
(see pages 188 and 183) before
your babies are born.

See your midwife or doctor as soon as possible if you are


currently being treated for a long-term disease such
as diabetes or epilepsy, or you have serious mental
health problems.

15
or family planning clinic, who will
try to help you to adjust or will give
you advice if you dont want to
continue with your pregnancy.

FINDING OUT Men may also have mixed feelings


when they find out that their
ACCESSING
THAT YOU ARE partner is pregnant. They may ANTENATAL CARE
PREGNANT find it hard to talk about these
When you find out that you
feelings because they dont want
When you find out that you are are pregnant, its important to
to upset their partner. Both partners
pregnant, you may feel happy and contact an NHS professional
should encourage each other to
excited or even shocked, confused as soon as possible.
talk abouttheir feelings and any
and upset. Everybody is different worriesor concerns that they have You can book an appointment
and you should not worry if you are at this stage. directly with a midwife. Your GP
not feeling as happy as you might surgery will be able to put you
have expected. Even if you have However you are feeling, you
in touch with your nearest
been trying to get pregnant, your should contact an NHS professional
midwife service.
feelings may take you by surprise. (see Chapter 4) so that you can start
Some of these feelings may be to receive antenatal care. This is the If you have special health needs,
caused by changes in your care that you will receive leading up your midwife, GP or other doctors
hormone levels, which can to the birth of your baby. may take shared responsibility for
make you feel more emotional. your maternity care.
Telling people
Even if you feel anxious and Your first or second meeting
You may want to tell your family
uncertain now, your feelings may with your midwife is the booking
and friends immediately or wait
change. Talk to your midwife, GP appointment. This will last for up to
a while until you have sorted out
two hours and could take place at
how you feel. Many women wait
a hospital, in a clinic or a Childrens
until they have had their first scan
Centre, in a GP surgery or at home.
beforethey tell people that they
Your midwife will ask you many
are pregnant.
questions about your health, the
Members of your family/extended health of your family and your
family may have mixed feelings or preferences in order to develop your
react in unexpected ways to your own plan of care. Your midwife
news. You may wish to discuss this will order a number of blood tests
with your midwife. and scans, which will be done
throughout your pregnancy. The
results of these tests may affect your
choices later in pregnancy, so its
important not to miss them. Your
midwife will also ask about any other
help or social care support you may
have or need for example support
from social workers or family liaison

your
officers. For more information about
the booking appointment, see
pages 42 and 4445.

feelings
16
HELP FOR can offer you support. Sorting out
1
problems, whether personal or
YOUNG MUMS medical, is often difficult when you
If you are a young mum, there are are by yourself, and it is better to
a wide range of services to support find someone to talk to rather than Education Maintenance Allowance
let things get you down. For more

BECOMING PREGNANT
you when you are pregnant and (EMA), which is available for young
after you have had your baby. Your information on coping on your own, people between 16 and 18.
midwife or health visitor will be able see page 79. EMA provides up to 30 a week.
to give you details of local services. Carrying on with For more information about
EMA and Care to Learn, phone
your education
0800 121 8989 or visit http://
Becoming a mother certainly does moneytolearn.direct.gov.uk
not have to mean the end of
your education. If you are still
of compulsory school age, your
school should not exclude you Somewhere
on grounds of pregnancy or health to live
and safety issues connected with Many young mothers
your pregnancy. However, they may want to carry on living
talk to you about making alternative with their own family until they
arrangements for your education. are ready to move on. If you are
You will be allowed up to 18 unable to live with your family,
calendar weeks off school before your local authority may be
and after the birth. able to help you with housing.
After your return to education, you Some local authorities provide
If you are on your own can get help with childcare costs specialised accommodation
through the Care to Learn scheme. where young mothers can live
If you are pregnant and on your
Care to Learn also provides support independently while getting
own, it is even more important that
with childcare costs for teenage support and advice from trained
there are people with whom you
parents above the compulsory workers. For more information
can share your feelings and who
schooling age who want to study. about housing, contact your
You may also be eligible for the local authority.
Help and support

The following national Connexions The young womans


organisations can also give Teenagers in England can get help guide to pregnancy
you help and advice: and advice from the Connexions The young womans guide to
Sexwise helpline service. You have the offer of pregnancy is written specifically
support from a personal adviser to for women under the age of 20
If you think you may be pregnant,
help deal with a variety of issues so and includes the real pregnancy
you can get confidential advice
that you can make the best choices experiences of young mums.
from the Sexwise helpline on
for your future. You can find It is produced by Tommys and is
0800 282930 or get further
Connexions advisers in a variety of available free to teenagers from
information from
places, including schools, colleges the Tommys website at
www.ruthinking.co.uk
and one-stop shops and through www.tommys.org/publications
Brook centres youth and community projects.
For information on sex and
If you are under 25, you can visit a For confidential personal advice, contraception, see page 122.
Brook centre for free, confidential practical help or details of your
advice. To find your nearest centre, local Connexions service, phone
go to www.brook.org.uk or call Connexions Direct, on 080 800
the national Ask Brook helpline on 13219, text 07766 4 13219 or go
0808 802 1234. to www.connexions-direct.com

17
HOW YOUR BABY
DEVELOPS
Measuring your pregnancy 18 Weeks 1522 21
Week 3 19 Weeks 2330 22
Weeks 45 19 Weeks 3140 23
Weeks 67 19
Weeks 89 19
Weeks 1014 20

This chapter describes how your baby develops from the day you conceive until
you give birth.

Week 3 MEASURING YOUR PREGNANCY


1 Ovary Doctors and midwives in the UK If you are not sure about the date
measure the duration of pregnancy of your last period, then your early
2 Egg is released from from the first day of your last scan (see page 48) will give a
the ovary menstrual period, not from the good indication of when your
day you conceive. So when you baby will be due.
3 Egg is fertilised are four weeks pregnant, it is
In the very early weeks, the
actually about two weeks after
4 Fertilised egg divides
developing baby is called an
you conceived. Pregnancy normally
embryo. From about eight weeks,
and travels down lasts for 3742 weeks from the
it is called a fetus.
fallopian tube first day of your last period.
The average is 40 weeks.
5 Embryo implants
itself in uterus lining

1
5

18
WEEK 3 Already your babys nervous system
2
is starting to develop. A groove
This is three weeks from the first forms in the top layer of cells. The
day of your last period. The cells fold up and round to make a
fertilised egg moves slowly along hollow tube called the neural tube.
your fallopian tube towards your This will become your babys brain Week 7

HOW YOUR BABY DEVELOPS


uterus. It begins as one single cell, and spinal cord, so the tube has a
which divides again and again. The actual size from head
head end and a tail end. Defects
By the time the fertilised egg to bottom is about 10mm
in this tube are the cause of spina
reaches your uterus, it has become bifida (see page 49). The heart is
a mass of over 100 cells, called an also forming and your baby already
embryo. It is still growing. Once in has some blood vessels. A string of
your uterus, the embryo attaches these blood vessels connects your
itself into your uterus lining. baby to you this will become the
This is called implantation. umbilical cord.

WEEKS 45 WEEKS 67
There is now a large bulge where
Week 4 your babys heart is and a bump
for the head because the brain is
The actual size of the embryo
is about 5mm
developing. The heart begins to WEEKS 89
beat and can be seen beating on an
ultrasound scan. Dimples on the side Your babys face is slowly forming.
of the head will become the ears The eyes are more obvious and
and there are thickenings where the have some colour in them. The
eyes will be. On the body, bumps are fetus has a mouth with a tongue.
forming that will become muscles There are the beginnings of hands
and bones. And small swellings and feet, with ridges where the
(called limb buds) show where the fingers and toes will be. The major
arms and legs are growing. At seven internal organs the heart, brain,
weeks, the embryo has grown to lungs, kidneys, liver and gut are all
about 10mm long from head to developing. At nine weeks, the baby
bottom. This measurement is called has grown to about 22mm long
the crownrump length. from head to bottom.
The embryo now settles into your
uterus lining. The outer cells reach Week 6 Week 9
out like roots to link with your
blood supply. The inner cells form The actual size from head The actual size from head
two and then later three layers. to bottom is about 8mm to bottom is about 22mm
Each of these layers will grow to be
different parts of your babys body.
One layer becomes their brain and
nervous system, skin, eyes and ears.
Another layer becomes their lungs,
stomach and gut. The third layer
becomes their heart, blood, muscles
and bones.
The fifth week is when you will
miss your period. At this time, most
women are only just beginning to
think they may be pregnant.

19
1 The umbilical cord
The umbilical cord is a babys lifeline. It is the link between you
and your baby. Blood circulates through the cord, carrying oxygen
and food to the baby and carrying waste away again.
2
2 The placenta
The placenta is attached to the lining of the uterus and separates
your babys circulation from your circulation. In the placenta, oxygen
and food from your bloodstream pass into your babys bloodstream
and are carried to your baby along the umbilical cord. Antibodies
1 that give resistance to infection pass to your baby in the same way.
Alcohol, nicotine and other drugs can also pass to your baby this way.
3 3 The amniotic sac
Inside the uterus, 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 known as the waters breaking.

WEEKS 1014 Week 14


Just 12 weeks after conception, the The actual size from head
fetus is fully formed. Your baby has to bottom is about 85mm
all of their organs, muscles, limbs
and bones, and their sex organs are
developed. From now on your baby
will grow and mature. Your baby
is already moving about, but you
will not be able to feel movements
yet. By about 14 weeks, your babys
heartbeat is strong and can be
heard by an ultrasound scanner.
The heartbeat is very fast about
twice as fast as a normal adults
heartbeat. At 14 weeks, the baby
is about 85mm long from head to
bottom. Your pregnancy may start
to show, but this varies a lot from
woman to woman.

20
WEEKS 1522 2
Your baby is growing faster than
at any other time in their life.
Their body grows bigger so that
their head and body are more in

HOW YOUR BABY DEVELOPS


proportion, and they dont look
so top heavy. The face becomes
much more defined and the
hair, eyebrows and eyelashes are
beginning to grow. Their eyelids stay
closed over their eyes. Your baby
already has their own individual
fingerprints, as the lines on the skin
of their fingers are now formed.
Their fingernails and toenails are
growing and their hands can grip.
At about 22 weeks, your baby
becomes covered in a very fine,
soft hair called lanugo. We dont
know what this hair is for, but it
is thought that it may keep the
baby at the right temperature.
The lanugo disappears before
birth or soon after. Week 22
Between 16 and 22 weeks, you The actual size from head
will usually feel your baby move for to bottom is about 27cm
the first time. If this is your second
baby, you may feel it earlier at
about 1618 weeks. At first, you
feel a fluttering or bubbling, or a
very slight shifting movement. This
can feel a bit like indigestion. Later,
you will be able to tell that it is the
babys movements and you may
even see the baby kicking about.
Sometimes you will see a bump
that is clearly a hand or a foot.

21
WEEKS 2330 Your baby is now covered in a
white, greasy substance called
Your baby is now moving about vernix. It is thought that this may
vigorously, and responds to touch be to protect its skin as it floats in
and sound. A very loud noise close the amniotic fluid. The vernix mostly
by may make them jump and kick. disappears before the birth.
They are also swallowing small
From 24 weeks, your baby has a
amounts of the amniotic fluid in
chance of survival if it is born. Most
which they are floating, and are
babies born before this time cannot
passing tiny amounts of urine back
live because their lungs and other
into the fluid. Sometimes your baby
vital organs are not developed well
may get hiccups, and you can feel
enough. The care that can now
the jerk of each hiccup. Your baby
be given in neonatal units means
may also begin to follow a pattern
that more and more babies born
for waking and sleeping. Very often
this early do survive. Babies born
this is a different pattern from
at around this time have increased
yours. So when you go to bed at
risks of disability.
night, your baby may wake up and
start kicking.
Your babys heartbeat can be heard
through a stethoscope. Later,
your partner may be able to hear
the heartbeat by putting their ear
to your abdomen, but it can be
difficult to find the right place.

Week 30

The actual size from head to bottom


is about 33cm

22
At around 26 weeks your babys eyelids open for the
first time. Babies eyes are almost always blue or dark blue, 2
although some babies do have brown eyes at birth.
It is not until some weeks after they are born that your
babys eyes will become the colour that they will stay.
The head-to-bottom length at 30 weeks is about 33cm.

HOW YOUR BABY DEVELOPS


WEEKS 31 40
Your baby continues to grow. Their skin, which was quite
wrinkled before, becomes smoother, and both the vernix
and the lanugo begin to disappear.
By about 32 weeks, the baby is usually lying with
its head pointing downwards, ready for birth.
The babys head can engage, or move down
into the pelvis, before birth. Sometimes the
head doesnt engage until labour has started.

bonding
with your

Helpful tips

Regularly talking, reading


and singing to your bump
while you are pregnant will
help you to bond with your
baby before birth.

23
23
YOUR
HEALTH
IN PREGNANCY
What should you eat? 24 Smoking 30 Keeping active 34
Foods to avoid 26 Alcohol 32 Infections 36
Preparing food 26 Pills, medicines and Inherited conditions 38
Vitamins and minerals 27 other drugs 33 Work hazards 39
Vegetarian, vegan Illegal drugs 33 Flying and travel 39
and special diets  28 X-rays 34

A healthy diet and lifestyle can help you to keep well during pregnancy and give your
baby the best possible start in life. This chapter explains some of the things you can
do to stay healthy.

WHAT SHOULD YOU EAT?


A healthy diet is very important if You will probably find that you are
More information
you are pregnant or trying to get more hungry than normal, but you
pregnant. Eating healthily during dont need to eat for two even if
pregnancy will help your baby to you are expecting twins or triplets. Visit www.eatwell.gov.uk
develop and grow and will help to Have breakfast every day this will for useful information on what
keep you fit and well. You dont need help you to avoid snacking on foods you should eat when you are
to go on a special diet, but make that are high in fat and sugar. You pregnant or trying for a baby.
sure that you eat a variety of different may have to change the amounts of The leaflets Eating while you
foods every day in order to get the different foods that you eat, rather are pregnant and Thinking
right balance of nutrients that you than cutting out all your favourites. of having a baby? are also
and your baby need. You should also available in several languages.
avoid certain foods see Foods to Both leaflets are available
avoid on page 26. online at www.food.gov.uk
or can be ordered on
0845 606 0667.

nutritious
and
delicious
24
The eatwell plate
The eatwell plate below shows how
much of each type of food you need to 3
have a healthy and well balanced diet.
Fruit and vegetables Bread, rice, potatoes,
As well as vitamins and pasta and other

YOUR HEALTH IN PREGNANCY


minerals, fruit and vegetables starchy foods
provide fibre, which Carbohydrates are
helps digestion and satisfying without
prevents constipation. containing too many
Eat at least five calories, and are an
portions of fresh, important source of
frozen, canned, vitamins and fibre.
dried or juiced fruit They include bread,
and vegetables potatoes, breakfast
each day. Always cereals, pasta, rice,
wash them oats, noodles, maize,
carefully. To get millet, yams, cornmeal
the most out and sweet potatoes.
of vegetables, These foods should
eat them raw be the main part
or lightly cooked. For more of every meal. Eat
information and portion sizes, wholegrain varieties
visit www.5aday.nhs.uk when you can.
Foods and drinks
that are high in
Meat, fish, eggs, fat and/or sugar Milk and dairy foods
beans and other This food group includes all Dairy foods like milk, cheese,
non-dairy sources spreading fats, oils, salad yoghurt and fromage frais
of protein dressings, cream, chocolate, are important because they
Protein includes meat (except crisps, biscuits, pastries, ice contain calcium and other
liver), fish, poultry, eggs, cream, cake, puddings and nutrients that your baby
beans, pulses and nuts (for fizzy drinks. You should only needs. Eat two or three
information on peanuts see eat a small amount of these portions a day, using low-fat
page 112). These foods are all foods. Sugar contains calories varieties whenever you can
good sources of nutrients. without providing any other for example, semi-skimmed
Eat moderate amounts each nutrients that the body needs. or skimmed milk, low-fat
day. Choose lean meat, Having sugary foods and drinks yoghurt and half-fat hard
remove the skin from poultry too often can cause tooth decay, cheese. However, there are
and cook using only a little especially if you have them some cheeses that you
fat. Make sure eggs, poultry, between meals. If we eat more should avoid see Foods
pork, burgers and sausages than we need, this can lead to to avoid on page 26 for more
are cooked all the way through. weight gain. Eating more fatty information.
Check that there is no pink foods is likely to make you put
meat and that juices have no on weight. Having too much
pink or red in them. Try to eat saturated fat can increase the
two portions of fish a week, amount of cholesterol in the
one of which should be oily blood, which increases the
fish. There are some fish that chance of developing heart
you should avoid see Foods disease. Try to cut down on
to avoid on page 26 for more food that is high in saturated
information. fat and have foods rich in
unsaturated fat instead.

25
FOODS TO AVOID Raw or partially cooked eggs. balanced diet, unless you are
Make sure that eggs are thoroughly allergic to them or your health
There are some foods that you cooked until the whites and yolks professional advises you not to.
should not eat when you are are solid. This prevents the risk You may have heard that some
pregnant because they may of salmonella food poisoning. women have, in the past, chosen
make you ill or harm your baby. Avoid foods that contain raw and not to eat peanuts when they
undercooked eggs, such as home- were pregnant. This is because the
You should avoid: made mayonnaise. government previously advised
Some types of cheese. Dont Raw or undercooked meat. women that they may wish to
eat mould-ripened soft cheese, Cook all meat and poultry avoid eating peanuts during
like Brie, Camembert and others thoroughly so that there is no pregnancy if there was a history
with a similar rind. You should trace of pink or blood. Take of allergy in their childs immediate
also avoid soft blue-veined cheese, particular care with sausages and family (such as asthma, eczema,
like Danish blue. These are made minced meat. It is fine to eat steaks hayfever, food allergy or other
with mould and they can contain and other whole cuts of beef and types of allergy). But this advice
listeria, a type of bacteria that can lamb rare, as long as the outside has now been changed because
harm your unborn baby. Although has been properly cooked or sealed. the latest research has shown that
listeriosis is a very rare infection, Liver products. Dont eat liver, or there is no clear evidence to say
it is important to take special liver products like liver pt or liver if eating or not eating peanuts
precautions during pregnancy sausage, as they may contain a lot during pregnancy affects the
because even the mild form of of vitamin A. Too much vitamin A chances of your baby developing
the illness in the mother can lead can harm your baby. a peanut allergy.
to miscarriage, stillbirth or severe Unpasteurised milk. Drink only
Supplements containing
illness in a newborn baby. You can pasteurised or UHT milk which
vitamin A. Dont take high-
eat hard cheeses such as cheddar has been pasteurised. If only raw
dose multivitamin supplements,
and parmesan, and processed or green-top milk is available, boil
fish liver oil supplements or any
cheeses made from pasteurised it first. Dont drink unpasteurised
supplements containing vitamin A.
milk such as cottage cheese, goats or sheeps milk or eat
mozzarella and cheese spreads. Some types of fish. Dont eat certain food that is made out of
shark, marlin and swordfish, and them, e.g. soft goats cheese.
Pt. Avoid all types of pt,
limit the amount of tuna you eat
including vegetable pts, as
to no more than two tuna steaks
they can contain listeria. Your weight
a week (about 140g cooked or
170g raw each) or four medium- Most women gain between
sized cans of tuna a week (about 10kg and 12.5kg (2228lb) while
140g when drained). These types pregnant. Weight gain varies
PREPARING FOOD of fish contain high levels of a great deal and depends on
Wash fruit, vegetables and salads mercury, which can damage your weight before pregnancy.
to remove all traces of soil, which your babys developing nervous
Much of the extra weight is due
may contain toxoplasma. This can system. Dont eat more than two
to the baby growing. Putting
cause toxoplasmosis, which can portions of oily fish per week.
on too much weight can affect
harm your baby (see page 37). Oily fish includes fresh tuna
your health and increase your
(but not canned tuna), salmon,
Heat ready-meals until they are blood pressure. Equally, it is
mackerel, sardines and trout.
piping hot all the way through. important that you do not
This is especially important for Raw shellfish. Eat cooked rather diet, but eat healthily. Try and
meals containing poultry. than raw shellfish as they can stay active by keeping up your
contain harmful bacteria and viruses normal daily activity or exercise.
Keep leftovers covered in the that can cause food poisoning. If you are concerned, talk to
fridge and use within two days. your midwife or GP. They may
Peanuts. If you would like to
Wash all surfaces and utensils, eat peanuts or foods containing give you advice if you weigh
and your hands, after preparing peanuts (such as peanut butter) more than 100kg (about 15
raw meat. This will help to avoid during pregnancy, you can choose stone) or less than 50kg (about
infection with toxoplasma. to do so as part of a healthy 8 stone).

26
The best source of vitamin D is
summer sunlight. The amount of 3
time you need in the sun to make
enough vitamin D is different
for every person and depends
on things like skin type, time of

YOUR HEALTH IN PREGNANCY


day and time of the year. But
you dont need to sunbathe: the
amount of sun you need to make
enough vitamin D is less than the
amount that causes tanning or
burning. If you have dark skin or
always cover your skin, you may
be at particular risk of vitamin D
deficiency. Talk to your midwife
or doctor if you are worried
about this. (See also Vitamin
supplements on page 28.)
VITAMINS More information
Iron. If you are short of iron,
AND MINERALS For more you will probably get very
Eating a healthy, varied diet will information tired and you can become
help you to get all the vitamins about folic anaemic. Lean meat, green, leafy
and minerals you need while you acid, read vegetables, dried fruit and nuts
are pregnant. There are some Folic acid: (see page 26 about avoiding
vitamins and minerals that are An essential peanuts) all contain iron. Many
especially important: guide for making babies at breakfast cereals have iron
www.breastfeeding.nhs.uk/en/ added. If the iron level in your
Folic acid. Folic acid is important materialforclients/dl_13.asp blood becomes low, your GP or
for pregnancy as it can reduce midwife will advise you to take
the risk of neural tube defects Foods carrying the iron supplements. These are
such as spina bifida. If you are mark on the right available as tablets or a liquid.
thinking about getting pregnant, have added
folic acid. Vitamin C. You need vitamin C
you should take a 400 microgram
as it may help you to absorb iron.
folic acid tablet every day until
Citrus fruits, tomatoes, broccoli,
you are 12 weeks pregnant. If
peppers, blackcurrants, potatoes
you did not take folic acid before
Vitamin D. You need vitamin D and some pure fruit juices are
you conceived, you should start
to keep your bones healthy and good sources of vitamin C.
as soon as you find out that you
to provide your baby with enough If your iron levels are low, it may
are pregnant. You should also eat
vitamin D for the first few months help to drink orange juice with
foods that contain folic acid, such
of their life. Vitamin D regulates an iron-rich meal.
as green leafy vegetables, fortified
the amount of calcium and Calcium. Calcium is vital for
breakfast cereals and brown rice.
phosphate in the body, and these making your babys bones and
Some breakfast cereals, breads
are needed to help keep bones teeth. Dairy products and fish
and margarines have folic acid
and teeth healthy. Deficiency of with edible bones like sardines
added to them. If you already
vitamin D can cause childrens are rich in calcium. Breakfast
have a baby with spina bifida,
bones to soften and can lead cereals, dried fruit such as figs
or if you have coeliac disease or
to rickets. You should take a and apricots, bread, almonds,
diabetes or take anti-epileptic
supplement of 10 micrograms of tofu (a vegetable protein made
medicines, ask your GP or midwife
vitamin D every day. Only a few from soya beans) and green
for more advice. You will need to
foods contain vitamin D, including leafy vegetables like watercress,
take a bigger dose of folic acid.
oily fish like sardines, fortified broccoli and curly kale are other
margarines, some breakfast good sources of calcium.
cereals and taramasalata.

27
Vitamin supplements
It is best to get vitamins and
minerals from the food you eat,
but when you are pregnant
you will need to take some
Healthy Start
supplements as well:
Healthy Start is a scheme that provides vouchers that can be
10 micrograms of vitamin D
exchanged for milk, fresh fruit and vegetables and infant formula
throughout your pregnancy
milk. You can also receive free vitamins.
and if you breastfeed.
400 micrograms of folic acid You qualify for Healthy Start if you are pregnant or have a child
ideally this should be taken under four years old, and you and your family receive one of
from before you get pregnant the following:
until you are 12 weeks Income Support.
pregnant.
Income-based Jobseekers Allowance.
If you are vegetarian or vegan, Child Tax Credit and have an annual family income of 16,040 or
you may need to take a vitamin less (2008/09).
B12 supplement as well as other
supplements. Talk to your doctor Working Tax Credit run-on (but not Working Tax Credit). Working
or midwife about this. Tax Credit run-on is the Working Tax Credit you receive in the
four weeks immediately after you have stopped working for
If you have a special or restricted 16 hours or more per week.
diet, you may need additional
Or you qualify if you are pregnant and under 18 years of age.
supplements. Talk to your doctor
or midwife about this. You can receive vouchers that are worth 3.10 per week or 6.20 per
week for children under one year old.
Do not take vitamin A
supplements, or any supplements For further information:
containing vitamin A, as too
Pick up the Healthy Start leaflet HS01, A Healthy Start for Pregnant
much could harm your baby.
Women and Young Children from your local health centre or call
Which supplements? 0845 607 6823 to request a free copy.
You can get supplements from Ask your health visitor for more information.
pharmacies and supermarkets or Visit www.healthystart.nhs.uk
your GP may be able to prescribe
them for you. If you want to get
your folic acid or vitamin D from
a multivitamin tablet, make sure VEGETARIAN, VEGAN AND SPECIAL DIETS
that the tablet does not contain
A varied and balanced vegetarian to a dietician who can give you
vitamin A (or retinol).
diet should give enough nutrients advice on how to get the nutrients
Healthy Start vitamins for women for you and your baby during you need for you and your baby.
contain the correct amount of pregnancy. However, you might
folic acid and vitamin D and are find it hard to get enough iron and More information
free from the NHS without a vitamin B12. Talk to your doctor or
prescription to pregnant women midwife about how you can make For further information, visit:
receiving Healthy Start vouchers. sure that you are getting enough
Ask your GP or pharmacist of these important nutrients. the Vegetarian Society website
for advice if you are unsure at www.vegsoc.org
You should also talk to your doctor or
(see Healthy Start on this page). the Vegan Society website at
midwife if you have a restricted diet
Your primary care trust and www.vegansociety.com
because you have a food intolerance
local pharmacies may sell this
(such as coeliac disease) or for
supplement to women who
religious reasons. Ask to be referred
dont receive it free.

28
Healthy snacks
You may find that you get hungry
Caffeine
3
High levels of caffeine can result in babies
between meals. Avoid snacks that having a low birth weight, which can increase
are high in fat and/or sugar. the risk of health problems in later life.
Instead you could try the following: Too much can also cause miscarriage.

YOUR HEALTH IN PREGNANCY


Fresh fruit. Caffeine is naturally found in lots
of foods, such as coffee, tea and
Sandwiches or pitta bread filled chocolate, and is added to some soft drinks
with grated cheese, lean ham, and energy drinks. It can also be found in certain cold and flu
mashed tuna, salmon or sardines remedies. Talk to your midwife, pharmacist or another health
and salad. professional before taking these remedies.
You dont need to cut caffeine out completely, but you
should limit how much you have to no more than 200mg a
day. Try decaffeinated tea and coffee, fruit juice or water and
limit the amount of energy drinks, which may be high in
caffeine. Dont worry if you occasionally have more than this,
because the risks are quite small.
Caffeine content in food and drink
1 mug of instant coffee: 100mg
1 mug of filter coffee: 140mg
Salad vegetables. 1 mug of tea: 75mg
Low-fat yoghurt or fromage frais. 1 can of cola: 40mg
Hummus and bread or vegetable 1 can of energy drink: up to 80mg
sticks.
1 x 50g bar of plain chocolate: up to 50mg
Ready-to-eat apricots, figs or
1 x 50g bar of milk chocolate: up to 25mg
prunes.
Vegetable and bean soups. So if you eat...

Unsweetened breakfast cereals one bar of plain chocolate and one mug of filter coffee
or porridge and milk. two mugs of tea and one can of cola, or
Milky drinks or unsweetened one mug of instant coffee and one can of energy drink
fruit juices.
you have reached almost 200mg of caffeine.
Baked beans on toast or
a baked potato.

healthy
options

29
Help and support
SMOKING
Getting help with
Every cigarette you smoke harms your baby. Cigarettes restrict the essential
stopping smoking
oxygen supply to your baby. So their tiny heart has to beat harder every time
you smoke. Cigarettes contain over 4,000 chemicals. Protecting your baby
from tobacco smoke is one of the best things you can do to give your child
a healthy start in life.
Its never too late to stop.

If you stop smoking now


Stopping smoking will benefit both you and your baby immediately.
The Smokefree Pregnancy Carbon monoxide and chemicals will clear from the body and oxygen
Support DVD will show you all levels will return to normal.
the free NHS support available
to help you to stop and stay
stopped. To order your free
DVD, call the NHS Pregnancy
Smoking Helpline on
0800 169 9 169, or visit
www.nhs.uk/smokefree
The NHS Pregnancy
Smoking Helpline on Stopping smoking action plan
0800 169 9 169
is open from 12pm to 9pm 1 Think
every day and offers free
Think about:
help, support and advice
on stopping smoking what you and your baby will gain if you stop smoking (see above)
when you are pregnant.
how much smoking costs you.
You can also sign up to receive
ongoing advice and support
at a time that suits you. What else could you spend your money on? How can you treat
yourself or your baby with the money you save?
You can also ask your
midwife, health visitor,
practice nurse or pharmacist
for advice and for the
details of your local NHS What is keeping you smoking?
Stop Smoking Service.
They offer one-to-one or
group sessions with trained
stop smoking advisers and
List your top five reasons for going smokefree; e.g. protecting your
may even have a pregnancy
health or the health of your baby.
stop smoking specialist.
They can offer advice 1
about dealing with stress,
2
weight gain and nicotine
replacement therapy to help 3
you manage your cravings.
4

30
If you stop smoking:
You will have less morning
Your baby is less likely to be born
too early and have to face the
You will reduce the risk of cot
death (see page 129 for more 3
sickness and fewer complications additional breathing, feeding information about how to
in pregnancy. and health problems which reduce the risk of cot death).
often go with being premature
You are more likely to have It will also be better for your baby
(see Chapter 14).

YOUR HEALTH IN PREGNANCY


a healthier pregnancy and a later in life. Children whose
healthier baby. Your baby is less likely to be born parents smoke are more likely to
underweight and have a problem suffer from illnesses which need
You will reduce the risk of stillbirth. keeping warm. Babies of mothers hospital treatment (such as asthma).
You will cope better with the birth. who smoke are, on average, 200g
(about 8oz) lighter than other The sooner you stop, the better.
Your baby will cope better with
babies. These babies may have But stopping even in the last few
any birth complications.
problems during and after labour weeks of pregnancy will benefit
and are more prone to infection. you and your baby.

2 Get help
Take advantage of the free NHS support that is available to you. You are four times more
likely to quit successfully with NHS support. See the Help and support box on the left for
more information.
Ask your friends and family to help and support you.

3 Prepare
If you understand why you smoke and what triggers your smoking, you will be able to prepare
yourself so that you can cope when you quit. It can help to:
give up with somebody else, so that you can support each other
change the habits you associate with smoking, and
plan how you will deal with difficult situations without the use of cigarettes.
Choose a day to stop. Will the first few days be easier during a working week or over a weekend?
When you are busy or relaxed? Whatever you choose, stop completely on that day.
Review your plan and get rid of all of your cigarettes the day before your day for stopping.
My chosen day for stopping smoking is:

4 Stop smoking
Lots of people start smoking again because they feel they cannot cope with the withdrawal
symptoms. The first few days may not be much fun but the symptoms are a sign that your body
is starting to recover.
Take one day at a time and reward yourself for success.
Go through your list of reasons for going smokefree to remind yourself why you have given up.
If you have had a scan, use your scan images to keep you going through the times when
you are finding it tough.
31
Secondhand smoke Drinking is not just dangerous for
If your partner or anyone else who the baby in the first three months:
lives with you smokes, it can affect alcohol can affect your baby
you and your baby both before throughout pregnancy. And if you
and after birth. You may also find drink heavily during pregnancy, a
it more difficult to quit. particular group of problems could
develop that are known as Fetal
Secondhand smoke can cause low Alcohol Syndrome (FAS). Children
birth weight and cot death. Infants with this syndrome have:
of parents who smoke are more
likely to be admitted to hospital for restricted growth
bronchitis and pneumonia during ALCOHOL facial abnormalities
the first year of life, and more than learning and behavioural
17,000 children under the age of When you drink, alcohol reaches
disorders.
five are admitted to hospital every your baby through the placenta.
Too much exposure to alcohol Drinking more than 1 to 2 units
year because of the effects of
can seriously affect your babys once or twice a week, as well as
secondhand smoke.
development. binge drinking, may be associated
with lesser forms of FAS. The risk is
Because of this risk, pregnant likely to be greater the more
women or women trying to conceive you drink.
should avoid drinking alcohol. If you
do choose to drink, then protect If you are drinking with friends:
your baby by not drinking more find a non-alcoholic drink that
than 1 to 2 units of alcohol once or you enjoy
twice a week, and dont get drunk.
Additional advice from the National sip any alcohol you do drink slowly
Institute for Health and Clinical to make it last
Excellence (NICE) advises women dont let people pressure you into
to avoid alcohol in the first three drinking, and
months in particular, because of the avoid getting drunk.
increased risk of miscarriage.
When you drink, alcohol passes from
your blood, through the placenta, to Help and support
your baby. A babys liver is one of the
last organs to develop fully and does Getting help with
What is a not mature until the latter half of drinking
unit of alcohol? pregnancy. Your baby cannot process
If you have difficulty cutting
alcohol as well as you can.
One UK unit is 10ml, or 8g, down what you drink, talk to
of pure alcohol. A unit is: your doctor, midwife, pharmacist
or other healthcare professional.
Confidential help and support is
available from local counselling
or or services (look in the telephone
directory or contact Drinkline
on 0800 917 8282).
You should talk to your midwife
1/2 pint of beer, lager a single measure (25ml) 1/2 standard (175ml) if you have any concerns you
or cider of spirit (whisky, gin, glass of wine have about your drinking around
at 3.5% ABV bacardi, vodka, etc.) at 11.5% ABV the time of conception and early
at 40% ABV pregnancy. You can get more
To find out more about units, visit the Know Your Limits website advice from www.nhs.uk/units
at www.nhs.uk/units
32
they prescribe you anything or ILLEGAL DRUGS 3
give you treatment
PILLS, MEDICINES talk to your doctor if you take Illegal drugs like cannabis, ecstasy,
cocaine and heroin can harm your
AND OTHER DRUGS regular medication ideally before
baby. If you use any of these drugs,
you start trying for a baby or
it is important to talk to your doctor

YOUR HEALTH IN PREGNANCY


Some medicines, including some as soon as you find out you are
common painkillers, can harm your pregnant, and or midwife so that they can provide
babys health but some are safe, for you with advice and support to
use as few over the counter help you stop. They can also refer
example medication to treat long-
medicines as possible. you for additional support. Some
term conditions such as asthma,
thyroid disease, diabetes and epilepsy. Medicines and treatments that are dependent drug users initially need
To be on the safe side, you should: usually safe include paracetamol, drug treatment to stabilise or come
most antibiotics, dental treatments off drugs to keep the baby safe.
always check with your doctor, For more information, contact
(including local anaesthetics), some
midwife or pharmacist before Narcotics Anonymous (see page
immunisations (including tetanus
taking any medicine 183) or talk to FRANK, the drugs
and flu injections) and nicotine
make sure that your doctor, replacement therapy. But you information line, on 0800 77 66 00.
dentist or other health professional should always check with your GP,
knows you are pregnant before pharmacist or midwife first.

Medicines for minor ailments when pregnant


Make sure the medicine is safe to take when pregnant.
For further information, speak to your pharmacist or NHS Direct on 0845 4647.

Minor ailment First choice Second choice Do not use


Constipation Eat more fibre. Bulk laxatives On your doctors advice:
that contain ispaghula. bisacodyl or lactulose.
Cough Honey and lemon in hot water. Medicines that contain codeine,
Simple linctus. unless advised by your doctor.
Diarrhoea Oral rehydration sachets. Loperamide.
Haemorrhoids Soothing creams, ointments Ice pack.
(piles) or suppositories.

Hayfever, house dust Antihistamine nasal sprays and On your doctors advice: occasional Other antihistamines.
mite and animal eye drops. Steroid nasal sprays. doses of the antihistamines loratadine
hair allergy or chlorphenamine.
Head lice Wet combing. Dimeticone lotion. If ineffective, head lice treatments containing
malathion in water (aqueous lotion).
Indigestion Antacids (indigestion mixtures). On your doctors advice: medicines that
reduce acid production, e.g. omeprazole.
Nasal congestion Steam inhalation (e.g. over If severe, occasional doses of oxymetazoline Phenylephrine or
(stuffy or runny a bowl of hot water) or a or xylometazoline nasal spray. pseudoephedrine, especially
nose) hot shower. in the 1st trimester.
Pain (e.g. headache, Paracetamol. Ibuprofen may be taken in the 2nd trimester Medicines that contain
toothache) (weeks 14 to 27) but avoid taking it in the codeine (e.g. co-codamol,
1st or 3rd trimesters unless advised by your co-dydramol, dihydrocodeine),
doctor. unless advised by your doctor.
Threadworms Pharmacists cannot supply On your doctors advice: mebendazole, but
threadworm medicines to preferably not in the 1st trimester.
pregnant women without
a prescription.
Vaginal thrush Pharmacists cannot supply On your doctors advice: clotrimazole Fluconazole.
medicines for vaginal thrush pessaries or cream. Do not use the pessary
to pregnant women without applicator if you are near term (at the end
a prescription. of your pregnancy).
Acknowledgement: United Kingdom Medicines Information (UKMi) 33
Herbal and homeopathic Exercises for a fitter
remedies and pregnancy
aromatherapy
Try to fit these exercises into your
Not all natural remedies are daily routine. They will strengthen
safe in pregnancy. Contact the Exercise tips your muscles so that you can carry
Institute for Complementary extra weight, make your joints
and Natural Medicine to make Exercise doesnt have to be stronger, improve your circulation,
sure that your practitioner strenuous to be beneficial. ease backache and generally
is qualified (see page 183). Make sure that you warm up make you feel well.
Tell your practitioner that you are and cool down.
Stomach-strengthening
pregnant, and tell your midwife Try to keep active on a daily basis. exercises
or doctor and pharmacist which Half an hour of walking each day
remedies you are using. These strengthen your stomach
can be enough. If you cannot (abdominal) muscles and ease
manage that, any amount is backache, which can be a
better than nothing.
X-RAYS problem in pregnancy. As your
Avoid any strenuous exercise baby gets bigger you may
X-rays should be avoided in in hot weather. find that the hollow in your
pregnancy if possible. Make sure that Drink plenty of water and lower back becomes more
your dentist knows you are pregnant. other fluids. pronounced, which can lead
to backache.
If you go to exercise classes,
KEEPING ACTIVE make sure that your teacher is Start in a box position (on all
The more active and fit you are properly qualified and knows that fours), with your knees under
during pregnancy, the easier it will you are pregnant and how far your hips, your hands under
be for you to adapt to your changing your pregnancy has progressed. your shoulders, your fingers
shape and weight gain. It will also You might like to try swimming, facing forward and your
help you to cope with labour and to because the water will support stomach muscles lifted so that
get back into shape after the birth. your increased weight. Some local your back is straight.
swimming pools provide aquanatal
Keep up your normal daily physical
classes with qualified instructors.
activity or exercise (sport, dancing
or just walking to the shops Exercises to avoid
and back) for as long as you Lying flat on your back particularly
feel comfortable. Dont exhaust after 16 weeks. The bump presses
yourself, and remember that you on the big blood vessels and can
may need to slow down as your make you feel faint.
pregnancy progresses or if your
Contact sports where there
doctor advises you to. As a general Pull in your stomach muscles
is a risk of being hit, such as
rule, you should be able to hold and raise your back up
kickboxing, judo or squash.
a conversation as you exercise. towards the ceiling, curling
If you become breathless as Horse riding, downhill skiing, ice
your trunk and allowing your
you talk, then you are probably hockey, gymnastics and cycling,
head to relax gently forward.
exercising too strenuously. because there is a risk of falling.
Dont let your elbows lock.
If you were inactive before you were Scuba diving, because the
pregnant, dont suddenly take up baby has no protection against
strenuous exercise. If you start an decompression sickness and
aerobic exercise programme, begin gas embolism.
with no more than 15 minutes Exercising at heights over
continuous exercise, three times per 2,500 metres until you have
week. Increase this gradually to a acclimatised. This is because
maximum of 30-minute sessions, you and your baby are at risk
four times a week. Inform the of acute mountain sickness
instructor that you are pregnant. (decrease in oxygen).
34
Hold for a few seconds then
slowly return to the box position.
Close up your back passage
as if trying to prevent a bowel
Foot exercises
Foot exercises can be done sitting 3
Take care not to hollow your movement. or standing. They improve blood
back it should always return At the same time, draw in your circulation, reduce swelling in the
to a straight or neutral position. vagina as if you are gripping ankles and prevent cramp in the

YOUR HEALTH IN PREGNANCY


a tampon, and your urethra calf muscles.
Do this slowly and rhythmically
10 times, making your muscles as if to stop the flow of urine. Bend and stretch your foot
work hard and moving your back First do this exercise quickly vigorously up and down 30 times.
carefully. Only move your back tightening and releasing the Rotate your foot eight times
as far as you can comfortably. muscles straight away. one way and eight times the
Pelvic tilt exercises Then do it slowly, holding the other way.
Stand with your shoulders and contractions for as long as you Repeat with the other foot.
bottom against a wall. Keep your can before you relax. Try to count
knees soft. Pull your belly button to 10.
towards your spine, so that your Try to do three sets of eight
back flattens against the wall. squeezes every day. To help you
Hold for four seconds and release. remember, you could do them
Repeat up to 10 times. once at each meal.
Pelvic floor exercises As well as these exercises, you
Pelvic floor exercises help to will also need to practise tightening
strengthen the muscles of the up the pelvic floor before and
pelvic floor, which are placed during coughing and sneezing.
under great strain in pregnancy
Ask your midwife or doctor
and childbirth.
about these exercises.
The pelvic floor consists of layers Your local maternity
To protect your back
of muscles which stretch like a unit should run
classes where Sit up straight with your bottom
supportive hammock from the
a specialist against the back of your chair.
pubic bone (in front) to the
physiotherapist Tuck a small cushion behind your
base of the backbone. During
attends. waist if you wish.
pregnancy you may find that
you leak urine when you cough They can When you pick something up,
or strain. This is known as instruct you bend your knees, not your back.
stress incontinence of urine in groups or Try to stand tall.
and it can continue after individually.
pregnancy. By performing Feel free to
pelvic floor exercises, you ask them
strengthen the pelvic for advice
floor muscles and this and help.
helps to reduce or
avoid this problem

gentle
after pregnancy. It
is important to do
them even if you

exercise
are young and
not suffering
from stress
incontinence
now.

35
INFECTIONS Sexually transmitted HIV and AIDS
infections You will be offered a confidential
Rubella Sexually transmitted infections HIV test as part of your routine
If you catch rubella (or German (STIs) are on the increase. The most antenatal care (see page 47).
measles) in the first four months common is chlamydia. Up to 70% Your doctor or midwife will discuss,
of pregnancy it can seriously affect of women and 50% of men who the test with you, and counselling
your babys sight and hearing and have an STI show no symptoms, so will be available if the result is
cause brain and heart defects. All you may not know if you have one. positive. You can also go to a GUM
children are now offered a vaccine However, many STIs can affect your clinic for an HIV test and advice.
against rubella through the MMR babys health during pregnancy and
Current evidence suggests that
immunisation at 13 months and a after birth. If you have any reason
an HIV positive mother in good
second immunisation before they to believe that you or your partner
health and without symptoms
start school. has an STI, you should go for a
of the infection is unlikely to be
If you are not immune and you check-up as soon as you can. You
adversely affected by pregnancy.
do come into contact with rubella, can ask your GP or midwife, or go
HIV positive mothers can pass
tell your doctor at once. Blood to a genitourinary medicine (GUM)
on the virus through breastmilk.
tests will show whether you have or sexual health clinic. You will be
However, it is possible to reduce the
been infected. guaranteed strict confidentiality. You
risk of transmitting HIV to your baby
can find your nearest GUM clinic or
during pregnancy and after birth
sexual health clinic in your phone
(see box on page 47).
book listed under the name
of your primary care trust or at If you are HIV positive, talk to your
www.nhsdirect.nhs.uk or you can doctor about your own health and
call the Sexual Health Helpline free the options open to you, or contact
on 0800 567 123. the organisations listed on page 185
for advice and counselling.
If you are under 25, you can
visit a Brook centre to get free,
confidential advice. To find your
More information
nearest centre, visit www.brook.org.
uk or call the Ask Brook national
For more information, read helpline on 0808 802 1234.
the information on screening
tests in Chapter 4 or go to You can contact the National
www.screening.nhs.uk Chlamydia Screening Programme
for a free, confidential test. Visit
www.chlamydiascreening.nhs.uk

seek
medical
advice
36
Hepatitis C
Hepatitis C is a virus that infects the
labour, a caesarean section may
be recommended to reduce the 3
liver. Many people with hepatitis C risk of transmission to your baby.
may have no symptoms and be Chickenpox
unaware that they are infected. If
Hepatitis B Around 95% of women are

YOUR HEALTH IN PREGNANCY


you have hepatitis C, you might pass
Hepatitis B is a virus that infects the immune to chickenpox. If you
the infection to your baby, although
liver. Many people with hepatitis B, have not had it and you come
the risk is much lower than with
will have no signs of illness, but into contact with someone who
hepatitis B or HIV. This cannot be
they might infect others. If you has it, speak to your GP, midwife
prevented at present. Your baby can
have hepatitis B, or are infected or obstetrician at once. A blood
be tested for hepatitis C. If they are
during pregnancy, you can pass test will establish whether you are
infected, they can be referred for
the infection to your baby at birth. immune. Chickenpox infection in
specialist assessment.
You will be offered a blood test for pregnancy can be dangerous for
hepatitis B as part of your antenatal Herpes both mother and baby, so seek
care (see page 47). Babies who Genital herpes infection can be advice as soon as possible.
are at risk should be immunised caught through genital contact with Toxoplasmosis
at birth. This is 9095% effective an infected person or from oral sex
This infection can damage
in preventing them from getting with someone who has oral herpes
your baby if you catch it during
hepatitis B and developing long- (cold sores) and can be dangerous
pregnancy, so take precautions
term infection. The first dose is given for a newborn baby. Initial infection
(see page 38). Most women
within 24 hours of birth and two causes very painful blisters or
have already had the infection
more doses are given at one and ulcers on the genitals. Less severe
before pregnancy and will be
two months, with a booster dose attacks usually occur for some years
immune. If you feel you may
at 12 months. A few babies may afterwards. If you or your partner
have been at risk, talk to your GP,
also need an injection of hepatitis are infected, use condoms or avoid
midwife or obstetrician. If you do
B immunoglobulin soon after birth. sex during an attack. Avoid oral
catch toxoplasmosis while you are
Your baby will be tested for sex if either of you have cold sores
pregnant, you can get treatment.
hepatitis B infection at 12 months. or active genital herpes. Tell your
Any babies who have become doctor or midwife if either you Parvovirus B19
infected should be referred for or your partner have recurring (slapped cheek disease)
specialist assessment and follow-up. herpes or develop the symptoms
Parvovirus B19 infection is
described above. If your first
common in children and causes
infection occurs in pregnancy, there
a characteristic red rash on the
is treatment available. If your first
face, so it is often called slapped
infection occurs towards the end
cheek disease.
You can get infected of your pregnancy or during
with HIV, hepatitis B, 60% of women are immune to
or hepatitis C if you: this infection. However, parvovirus
B19 is very infectious and can be
have sex with someone who harmful to your baby. If you come
is infected without using a You may have been into contact with someone who
condom infected with hepatitis is infected you should talk to your
use injectable drugs and share C if you: doctor, who can check whether
equipment with an infected received a blood transfusion you are immune through a blood
person. in the UK prior to September test. In most cases, the baby is not
1991, or blood products prior affected when a pregnant woman
You may have already been is infected with parvovirus.
infected with hepatitis B if to 1986
you were born or spent your received medical or dental
childhood outside the UK in treatment in countries
a country where hepatitis B where hepatitis C is common
is common. (You may have and the infection is not
acquired the infection at birth.) controlled properly.

37
Group B streptococcus
Group B streptococcus (GBS) is a
bacterium carried by up to 30% of
people which causes no harm or
symptoms. In women it is found in
the intestine and vagina and causes
no problem in most pregnancies.
In a very small number it infects
the baby, usually just before or during
labour, leading to serious illness.
If you have already had a baby
who had group B streptococcal Infections transmitted Sheep
infection, you should be offered by animals Lambs and sheep can be a source
antibiotics during labour to reduce of an organism called Chlamydia
Cats
the chances of your new baby psittaci, which is known to cause
Cats faeces can contain miscarriage in ewes. They also
getting the infection. If you have
an organism which causes carry toxoplasma. Avoid lambing or
had a group B streptococcal urinary
toxoplasmosis. Avoid emptying cat milking ewes and all contact with
tract infection with GBS (cystitis)
litter trays while you are pregnant. If newborn lambs. If you experience
during the pregnancy, you should
no one else can do it, use disposable flu-like symptoms after coming into
also be offered antibiotics in
rubber gloves. Trays should be contact with sheep, tell your doctor.
labour. Group B streptococcal
cleaned daily and filled with boiling
infection of the baby is more likely Pigs
water for five minutes.
if your labour is premature, your
Research is going on to see if pigs
waters break early, you have a Avoid close contact with sick cats
can be a source of hepatitis E
fever during labour or you currently and wear gloves when gardening
infection. This infection is dangerous
carry GBS. Your midwife or doctor even if you dont have a cat in
in pregnant women, so avoid
will assess whether you need case the soil is contaminated with
contact with pigs and pig faeces.
antibiotics during labour to protect faeces. Wash your hands and gloves
There is no risk of hepatitis E from
your baby from being infected. after gardening. If you do come
eating cooked pork products.
into contact with cat faeces, make
It is possible to be tested for GBS late
sure that you wash your hands
in pregnancy if you have concerns.
Talk to your doctor or midwife.
thoroughly. Follow the general INHERITED
hygiene rules under Preparing food CONDITIONS
(page 26).
Some diseases or conditions are
inherited from one or both parents.
These include cystic fibrosis,
haemophilia, muscular dystrophy,
sickle cell disorders and thalassaemia.
If you, your babys father or any
of your relatives has an inherited
condition or if you already have a
baby with a disability, talk to your
doctor. You may be able to have tests
early in pregnancy to check whether
your baby is at risk or affected (see
page 49). Ask your GP or midwife
to refer you to a genetic counsellor
(a specialist in inherited diseases) for
advice. Ideally, you should do this
before you get pregnant or in the
early weeks of pregnancy.

38
Computer screens
WORK HAZARDS
The most recent research
You can buy a pair of support
stockings in the pharmacy over 3
If you work with chemicals, lead the counter, which will reduce
shows no evidence of a risk
or X-rays, or in a job with a lot of leg swelling.
from visual display units on
lifting, you may be risking your
computer terminals and Before you travel, think about your

YOUR HEALTH IN PREGNANCY


health and the health of your baby.
word processors. destination. Could you get medical
If you have any worries about this,
help if you needed it? Are any
you should talk to your doctor,
immunisations needed which might
midwife, occupational health
nurse, union representative or FLYING AND be harmful to the pregnancy?
personnel department. TRAVEL If you are travelling to Europe,
make sure that you have a
If it is a known and recognised risk, Flying is not harmful for you or European Health Insurance
it may be illegal for you to continue, your baby, but some airlines will Card (formerly known as E111),
and your employer must offer you not let you fly towards the end of which entitles you to free treatment
suitable alternative work on the same your pregnancy, and you should while abroad. You can get this from:
terms and conditions as your original check conditions with them.
job. If no safe alternative is available, a post office
your employer should suspend you by calling 0845 606 2030, or
on full pay (give you paid leave) for
as long as necessary to avoid the risk. from www.ehic.org
If your employer fails to pay you
during your suspension, you can
bring a claim in an employment
tribunal (within three months).
This will not affect your maternity pay
and leave. See also pages 168169.
Long distance travel (longer than
Coping at work five hours) carries a small risk of
You might get extremely tired thrombosis (blood clots) in pregnant
particularly in the first few and last women. If you fly, drink plenty of
few weeks of your pregnancy. Try to water to stay hydrated and do the
use your lunch break to eat and rest, recommended calf exercises.
not to do the shopping. If travelling
in rush hour is exhausting, ask your
employer if you can work slightly
different hours for a while.
Dont rush home and start another
job cleaning and cooking. If you
have a partner, ask them to take Safety on the move
over. If you are on your own, keep Road accidents are among the
housework to a minimum, and most common causes of injury
go to bed early if you can. in pregnant women. To protect
Your rights to antenatal care, yourself and your baby, always
leave and benefits are set wear your seatbelt with the
out in Chapter 17. diagonal strap across your body
between your breasts and with
the lap belt over your upper
thighs. The straps should lie
above and below your
bump, not over it.

39
ANTENATAL
CARE
Antenatal appointments 41 Tests for Downs syndrome and other
Early antenatal appointments 44 genetic disorders 50
Regular checks at every antenatal Diagnostic tests for Downs
appointment 45 syndrome and other genetic disorders 51
Appointments in later pregnancy 46 If a test detects an abnormality 51
Blood tests 46 Making the most of antenatal care 52
Ultrasound scans 48 Your antenatal team 54
Tests to detect abnormalities 49 Antenatal education 56

Antenatal care is the care that you receive from healthcare professionals during
your pregnancy. You will be offered a series of appointments with a midwife,
or sometimes with a doctor (an obstetrician). They will check that you and
your baby are well, give you useful information about being pregnant and
what to expect as well as answering any questions you may have.
As soon as you know you are pregnant, you should get in touch with a
midwife or your GP to organise your antenatal care. Its best to see them
as early as possible. Let your midwife know if you have a disability that
means you have special requirements for your antenatal appointments
or labour. If you dont speak English, let your midwife know and
arrangements will be made for an interpreter.

It is important to tell your


midwife or doctor if:
there were any complications
or infections in a previous
pregnancy or delivery, such as
pre-eclampsia or premature birth
you are being treated for a
chronic disease such as diabetes
or high blood pressure
you or anyone in your family
has previously had a baby with
an abnormality, for example
spina bifida
there is a family history of an
inherited disease, for example
sickle cell or cystic fibrosis.

If you are working, you have the right to paid time off
for your antenatal care (see page 170).
40
Information ANTENATAL 4
An important part of antenatal APPOINTMENTS
care is getting information that
will help you to make informed If you are expecting your first
choices about your pregnancy. child, you are likely to have up to

ANTENATAL CARE
Your midwife or doctor should 10 appointments. If you have had
give you information in writing a baby before, you should have If you cannot keep an antenatal
or some other form that you around seven appointments. appointment, please let the clinic
can easily use and understand. In certain circumstances, for or midwife know and make
Your midwife or doctor should example if you have or develop another appointment.
provide you with information a medical condition, you may
in an appropriate format if you: have more appointments. What should happen
Your appointments may take
at the appointments
have a physical, learning or
place at your home, in a Childrens The aim is to check on you and
sensory disability
Centre, in your GPs surgery or in your babys progress and to
do not speak or read English. hospital. You may be asked to provide clear information and
go to hospital for your scans. explanations about your care.
You may have lots of things
At each appointment you should
you want to ask the midwife. Your antenatal appointments have the chance to ask questions
Its a good idea to write your should take place in a setting and discuss any concerns or issues
questions down, so you where you feel able to discuss with your midwife or doctor.
dont forget. sensitive problems that may affect
you (such as domestic violence, Each appointment should have
sexual abuse, mental illness or a specific purpose. You will need
recreational drug use). longer appointments early in
pregnancy to allow plenty of time
Early in your pregnancy your for your midwife or doctor to
midwife or doctor should give assess you, discuss your care and
you information about how many give you information. Wherever
appointments you are likely to possible, the appointments
have and when they will happen. should include any routine tests.
You should have a chance to discuss
the schedule with them. The table
on pages 4243 gives a brief guide
to what usually happens at each
antenatal appointment.

Help and support

If you have any questions


or worries, talk to your
midwife or doctor. Talking
is as much a part of
antenatal care as tests
and examinations.

41
Antenatal appointments schedule

Appointment What should happen


First contact This is the appointment when you tell your midwife or doctor that you are pregnant.
with your They should give you information about:
midwife or folic acid and vitamin D supplements
doctor nutrition, diet and food hygiene
lifestyle factors, such as smoking, drinking and recreational drug use
antenatal screening tests.
It is important to tell your midwife or doctor if:
there were any complications or infections in a previous pregnancy
or delivery, such as pre-eclampsia or premature birth
you are being treated for a chronic disease such as diabetes or high blood pressure
you or anyone in your family has previously had a baby with an abnormality,
for example spina bifida
there is a family history of an inherited disease, for example sickle cell or cystic fibrosis.

Booking Your midwife or Your midwife or doctor should:


appointment doctor should give you give you your hand-held notes and plan of care
(812 weeks) information about: see if you may need additional care or support
how the baby develops plan the care you will get throughout your pregnancy
during pregnancy identify any potential risks associated with any work you
nutrition and diet may do
exercise and measure your height and weight and calculate your
pelvic floor exercises body mass index
antenatal screening measure your blood pressure and test your urine
tests for protein
your antenatal care find out whether you are at increased risk of gestational
breastfeeding, including diabetes or pre-eclampsia
workshops offer you screening tests and make sure you understand
antenatal education what is involved before you decide to have any of them
maternity benefits offer you an ultrasound scan at eight to 14 weeks to
planning your labour estimate when your baby is due
your options for where offer you an ultrasound scan at 18 to 20 weeks to
to have your baby. check the physical development of your baby and
screen for possible abnormalities.

814 weeks Ultrasound scan to estimate when your baby is due, check the physical development
(dating scan) of your baby and screen for possible abnormalities.

16 weeks Your midwife or doctor should give you information about the ultrasound scan you will
be offered at 18 to 20 weeks and help with any concerns or questions you have.
Your midwife or doctor should:
review, discuss and record the results of any screening tests
measure your blood pressure and test your urine for protein
consider an iron supplement if you are anaemic.

1820 weeks Ultrasound scan to check the physical development of your baby. (Remember, the main
(anomaly scan) purpose of this scan is to check that there are no structural abnormalities.)

42
25 weeks* Your midwife or doctor should:
check the size of your uterus
4
measure your blood pressure and test your urine for protein.

28 weeks Your midwife or doctor should:

ANTENATAL CARE
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein
offer more screening tests
offer your first anti-D treatment if you are rhesus negative.

31 weeks* Your midwife or doctor should:


review, discuss and record the results of any screening tests from the last appointment
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein.

34 weeks Your midwife or doctor should give you information about preparing for labour and birth,
including how to recognise active labour, ways of coping with pain in labour and your
birth plan. Your midwife or doctor should:
review, discuss and record the results of any screening tests from the last appointment
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein
offer your second anti-D treatment if you are rhesus negative.

36 weeks Your midwife or doctor should give you information about:


feeding your baby
caring for your newborn baby
vitamin K and screening tests for your newborn baby
your own health after your baby is born
the baby blues and postnatal depression.
Your midwife or doctor should:
use a tape to measure the size of your uterus
check the position of your baby
measure your blood pressure and test your urine for protein.

38 weeks Your midwife or doctor will discuss the options and choices about what happens if your
pregnancy lasts longer than 41 weeks. Your midwife or doctor should:
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein.

40 weeks* Your midwife or doctor should give you more information about what happens if your
pregnancy lasts longer than 41 weeks. Your midwife or doctor should:
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein.

41 weeks Your midwife or doctor should:


use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein
offer a membrane sweep
discuss the options and choices for induction of labour.

* Extra appointment if this is your first baby


43
EARLY ANTENATAL Your booking
APPOINTMENTS appointment
Most women have their booking
In early pregnancy (up until 2024 appointment between the 8th and
weeks), your antenatal appointments 12th week of pregnancy. This can
will take longer than those in mid- take a couple of hours. You will see
pregnancy. This is because your a midwife and sometimes a doctor.
midwife or doctor will need time to You should also be offered an
assess you and your baby, discuss ultrasound scan.
your care and give you information.
At each appointment you should
breastfeeding, including
have the chance to ask questions
workshops
and discuss any concerns or issues.
antenatal education
Your first appointment maternity benefits
with your midwife
planning your labour
or GP
As soon as you think you are your options for where
pregnant, you should make an to have your baby.
appointment to see your midwife
or GP. The earlier you do More information
this, the better. At this
appointment you will See the NHS Choices
be given information pregnancy planner at
about: www.nhs.uk/pregnancyplanner

folic acid
and vitamin D
supplements Weight and height
nutrition and diet You will be weighed at the booking
appointment, but you probably will
food hygiene not be weighed regularly during
You should be given information
lifestyle factors that about: your pregnancy. Your height will be
may affect your health or the measured along with your weight
health of your baby, such as how the baby develops during so that your midwife can calculate
smoking, recreational drug use pregnancy your BMI (body mass index). Most
and alcohol consumption nutrition and diet women put on between 10 and
antenatal screening tests exercise and pelvic floor exercises 12.5kg (2228lbs) in pregnancy,
(see page 49 for more about most of it after the 20th week.
antenatal screening tests
these tests). Much of the extra weight is due to
your antenatal care the baby growing, but your body
will also be storing fat ready to
make breastmilk after the birth.
Eating sensibly and taking regular
exercise can help. See Chapter 3
for what you should eat and for
advice about exercise.
In some areas, height, weight
and BMI are used to produce a
personalised growth chart for your
babys development. However, other
areas will use an average growth
chart instead.

44
Questions at the
booking appointment
If you are going to have your baby with
midwifery care in a midwifery unit, 4
in hospital or at home
You will be asked a lot of
questions to build up a picture You will probably see your own midwife for most of your antenatal
of you and your pregnancy. care. You may be offered a visit at the hospital for an initial assessment

ANTENATAL CARE
This is so that you are given and perhaps for an ultrasound scan or for special tests. Sometimes
the support you need and any your midwife may visit you at home.
risks are spotted early. You will
If you are going to have your baby in hospital
probably want to ask a lot of
questions yourself. Antenatal care varies around the country. In some areas, the booking
appointment is at the hospital, then all or most of the remaining
You may be asked about:
appointments are with a midwife or GP. However, if there are
the date of the first day of your complications, all appointments will be at the hospital. In other areas,
last period, to help work out all care is given by a midwife or GP unless there are complications,
when your baby is due which mean a referral to the hospital antenatal clinic.
your health
any previous illnesses and
operations REGULAR CHECKS Blood pressure
any previous pregnancies AT EVERY
or miscarriages
ANTENATAL
your and your babys fathers
origins. This is to find out if
APPOINTMENT
your baby is at risk of certain Your urine and blood pressure
inherited conditions, or if there will be checked at every antenatal
are other factors, such as a appointment.
history of twins
your work or your partners
Urine
work and what kind of Your urine is checked for a number
accommodation you live in, of things, including protein or
to see if there is anything albumin. If this is in your urine,
A rise in blood pressure later in
about your circumstances that it may mean that you have an
pregnancy could be a sign of pre-
might affect your pregnancy infection that needs to be treated.
eclampsia (see page 67). It is very
It may also be a sign of pre-
how you are feeling and if you common for your blood pressure
eclampsia (see High blood pressure
have been feeling depressed. to be lower in the middle of your
and pre-eclampsia on page 67).
pregnancy than at other times.
At the end of your booking This is not a problem, but may
appointment, you should make you feel light-headed if you
understand the plan of care for get up quickly. Talk to your midwife
your pregnancy and have your if you are concerned.
hand-held notes to carry with
you at all times.
Your booking appointment
is an opportunity to tell your
midwife or doctor if you are
in a vulnerable situation or
if you need extra support.
This could be because of
domestic violence, sexual abuse
or female genital mutilation.

45
APPOINTMENTS You can also ask questions or
talk about anything that is
IN LATER worrying you. You should be
PREGNANCY given information about:

From 2024 weeks, your antenatal your plan of birth BLOOD TESTS
appointments will become more how to prepare for labour
frequent. If your pregnancy is and birth As part of your antenatal care,
uncomplicated and you are well, you will be offered a number of
how to tell if you are in
you may not be seen as often. blood tests. Some are offered to all
active labour
women and some are only offered
Your later appointments are usually induction of labour if your if it is thought that you are at risk
quite short. Your midwife or baby is late of a particular infection or inherited
doctor will: condition. All of the tests are done
the baby blues and postnatal
check your urine, blood pressure, depression to help make your pregnancy safer
and sometimes your weight or to check that your baby is healthy.
feeding your baby
Talk to your midwife or doctor
feel your uterus to check your screening tests for newborn so that you understand why the
babys position babies blood tests are being offered and
measure your uterus to check looking after yourself and so that you can make an informed
your babys growth your new baby. choice about whether or not you
listen to your babys heartbeat want them. Your midwife or doctor
if you want them to. Checking your babys should also give you information
development and about the tests. Below is an outline
well-being of all the tests that can be offered.
At each antenatal appointment
Your blood group and
from 24 weeks, your midwife or
doctor should check your babys
rhesus factor
growth. To do this, they will Your blood will be tested to check
measure the distance from the top your blood group and to see
of your uterus to your pubic bone. whether you are rhesus negative or
The measurement will be recorded positive. Some women are rhesus
in your notes. negative. This is usually not a worry
for a first pregnancy but it may
In the last weeks of pregnancy, affect the next child.
you may also be asked to keep
track of your babys movements. People who are rhesus positive have
If your babys movements a substance known as D antigen on
become less frequent, slow down the surface of their red blood cells.
or stop, contact your midwife or Rhesus negative people do not.
doctor immediately. A woman who is rhesus negative
can carry a baby who is rhesus
You will be offered an ultrasound positive if the babys father is
scan if your midwife or doctor rhesus positive. During pregnancy
has any concerns about your or birth, small amounts of the
babys growth. babys blood can enter the mothers
bloodstream. This can cause the
mother to produce antibodies. This
usually doesnt affect the existing
pregnancy, but the woman becomes
sensitised. This means that if she
gets pregnant with another rhesus
positive baby, the immune response
will be quicker and much greater.
The antibodies produced by the
46
Hepatitis B If you are HIV positive
mother can cross the placenta and
attach to the D antigen on her This is a virus that can cause serious If you are HIV positive, your
4
babys red blood cells. This can be liver disease. If you have the virus doctor will need to discuss
harmful to the baby as it may result or are infected during pregnancy, it the management of your
in a condition called haemolytic may infect your baby (see page 37). pregnancy and delivery
disease of the newborn, which can

ANTENATAL CARE
Your baby will not usually be ill but withyou.
lead to anaemia and jaundice. has a high chance of developing
long-term infection and serious There is a one in four chance
Prevention of liver disease later in life. Your baby of your baby being infected
rhesus disease can start a course of immunisation if you and your baby dont
Anti-D injections prevent at birth to help prevent infection. have treatment.
rhesus negative women If you have hepatitis B, you will be Treatment can significantly
producing antibodies against referred to a specialist. reduce the risk of transmitting
the baby and reduce the risk HIV from you to your baby.
of a rhesus negative woman
Hepatitis C
20% of HIV-infected babies
becoming sensitised. This virus can cause serious liver
develop AIDS or die within
disease and there is a small risk that it
Rhesus negative mothers the first year of life, so its
may be passed to your baby if you are
who are not sensitised are important to reduce the risk
infected. This cannot be prevented at
offered anti-D injections at of transmission.
present. Tests for hepatitis C are not
28 and 34 weeks as well as usually offered routinely as part of Your labour will be managed
after the birth of their baby. antenatal care. If you think you may to reduce the risk of infection
This is quite safe for both the be at risk (see page 37), talk to your to your baby. This may
mother and her baby. midwife or GP. They can arrange a include an elective caesarean
test. If you are infected, your baby delivery (see page 98).
Anaemia can be tested within a few days of Your baby will be tested for
birth. If you have hepatitis C, you HIV at birth and at intervals
Anaemia makes you tired and
will be referred to a specialist. for up to two years. If your
less able to cope with
any loss of blood when HIV baby is found to be infected
you give birth. If tests with HIV, paediatricians
This is the virus that causes AIDS.
show you are anaemic, will be able to anticipate
If you are infected you can pass
you will probably be given certain illnesses that occur
the infection to your baby during
iron and folic acid. in infected babies, and treat
pregnancy, at delivery, or after birth by
them early. All babies born
breastfeeding. As part of your routine
antenatal care, you will be offered a to HIV positive mothers will
confidential test for HIV infection. If appear to be HIV positive
Immunity to rubella you are HIV positive, both you and at birth, because they
(German measles) your baby can have treatment and have antibodies from their
care that reduce the risk of your baby mothers infection. If the
If you get rubella in early pregnancy,
becoming infected. If your test result is baby is not affected, the
it can seriously damage your unborn
negative, the fact that you had the test test will later become
baby. Your midwife or doctor will
as part of your antenatal care should negative because the
talk to you about what happens
not affect your ability to get insurance. antibodies will disappear.
if your test results show low or
no immunity. You will be offered You will be advised not to
a rubella immunisation after breastfeed because HIV
your baby is born. For more can be transmitted to your
information about rubella, visit baby in this way.
www.immunisation.nhs.uk Help and support
Syphilis If you think that you are at risk of getting HIV or know you are
You will be tested for this sexually HIV positive, talk to your midwife or doctor about HIV testing
transmitted infection because if and counselling. You can also get free confidential advice from
left untreated, it can lead to the National AIDS Helpline on 0800 567 123 or you can talk in
miscarriage and stillbirth. confidence to someone at Positively Women (see page 185).
47
Sickle cell and Cystic fibrosis
thalassaemia disorders Cystic fibrosis is an inherited disease
Sickle cell and thalassaemia that affects vital organs in the body,
disorders are inherited blood especially the lungs and digestive
conditions that mainly affect the system, by clogging them with thick
way oxygen is carried around sticky mucus. The sweat glands are
the body. You will be offered a usually also affected. The disease
blood test early in pregnancy is inherited and both parents must
for thalassaemia and asked for be carriers of the gene variation for
information about your and their baby to be born with cystic
your babys fathers family origin fibrosis. Testing is offered if there
to decide if any other tests are is a family history of cystic fibrosis.
required. The information you give
will help your midwife or doctor to
Tay-Sachs disease
offer the correct tests and will also Testing for Tay-Sachs disease should
help to give you the correct results be offered if you or your partner
is of Ashkenazi Jewish origin and
of the test. It is very important
that you tell the midwife, doctor if you consider yourself or your ULTRASOUND
or person doing the test if you partner to be at risk. SCANS
think you or your babys father Cervical cancer Most hospitals will offer women
have an ancestor who came from
Cervical smears detect early changes at least two ultrasound scans
outside northern Europe (for
in the cervix (the neck of the uterus), during their pregnancy. The first
example, someone who is Italian,
which could later lead to cancer if is usually around eight to 14
Maltese, Portuguese, Spanish,
left untreated. Routine smears are weeks and is sometimes called
Indian, Chinese, African or
only offered to women over 25. the dating scan because it can
African-Caribbean).
If you are due to have a cervical help to determine when the
Healthy people can be carriers of smear (if you have not had one baby is due. The second scan
sickle cell or thalassaemia without in the last three years), you will usually takes place between 18
knowing it and can pass it on to probably be told to wait until and 20 weeks and is called the
their children. Its possible for you or three months after your baby is anomaly scan because it checks
your babys father to be carriers of born unless you have a history for structural abnormalities.
these disorders without it affecting of abnormal smears. This is
Ultrasound scans use sound
your baby at all. Carriers cannot based on guidance by the NHS
waves to build up a picture
develop the disorders, but if both cervical screening programme.
of your baby in your uterus.
of you are carriers there is a risk For more information, go to
They are completely painless,
that your baby could have a sickle www.cancerscreening.nhs.uk
have no known serious side
cell or thalassaemia disorder. Your
midwife or doctor will discuss Herpes effects on mothers or their
babies, and may be carried out
the implications for your baby. If you, or your partner, have ever
for medical need at any stage
For further information contact had genital herpes, or you get your
of pregnancy. If you
the Sickle Cell Society (www. first attack of genital blisters
have any concerns
sicklecellsociety.org) or the UK or ulcers during
about having a scan,
Thalassaemia Society (www.ukts. your pregnancy,
talk it over with
org) for more details. let your midwife
your midwife, GP
or doctor know.
or obstetrician.
Herpes can be
dangerous for
your newborn
baby and it may
need treatment.

48
What do scans tell us? The sound is reflected back and TESTS TO DETECT 4
creates a picture that is shown on
Check your babys measurements.
a screen. It can be very exciting ABNORMALITIES
This gives a better idea of when
your baby was conceived and to see a picture of your own baby You will be offered screening
when it is likely to be born. moving about inside you. tests that can detect structural

ANTENATAL CARE
This can be useful if you are Ask for the picture to be explained abnormalities like spina bifida, which
unsure about the date of your to you if you cannot make it out. is a defect in the development of
last period or if your menstrual It should be possible for your the spine, or some chromosomal
cycle is long, short or irregular. partner to come with you and disorders like Downs syndrome,
Your due date may be adjusted see the scan. Although scans are which is caused by an abnormal
depending on the ultrasound medical procedures, many couples number of chromosomes. Different
measurements. feel that they help to make the maternity services may use different
Check whether you are carrying baby real for them both. Ask if tests, but all tests carried out in the
more than one baby. its possible to have a copy of the NHS will meet national standards.
picture. There may be a small Discuss the tests and what they
Detect some abnormalities, mean with your midwife.
charge for this.
particularly in your babys head
orspine. Screening tests can:
Show the position of your reassure you that your baby
baby and your placenta. has no detected structural
Sometimes a caesarean section abnormalities
is recommended for example
provide you with an opportunity
if your placenta is low lying in
to see your baby during the scan
late pregnancy.
give you time to prepare for the
Check that your baby is growing
arrival of a baby with special needs
and developing as expected
(this is particularly important allow you to consider the
if you are carrying twins termination of an affected baby.
or more). Tests can also provide valuable
information for your care during
Fetal movement the pregnancy. However, no test
You will usually start feeling can guarantee that your baby will
some movements between 16 be born without an abnormality.
and 22 weeks. Later in pregnancy No test is 100% accurate and some
your baby will develop its own abnormalities may remain undetected.
pattern of movements which
you will soon get to know. Deciding whether to
have tests
These movements will range
from kicks and jerks to rolls and You may not want to have a
ripples and you should feel them screening test if you think that you
At the scan every day. At each antenatal would continue your pregnancy
You may be asked to drink a lot of appointment, your midwife will whatever the results. If you do have
fluid before you have the scan. A full talk to you about the pattern of a screening test and it suggests an
bladder pushes your uterus up and movements. A change, especially increased chance of a chromosomal
this gives a better picture. You then a reduction in movements, may abnormality, you will be offered
lie on your back and some jelly is put be a warning sign that your diagnostic tests, which will give
on your abdomen. An instrument baby needs further tests. Try to a more definite diagnosis. These
is passed backwards and forwards become familiar with your babys diagnostic tests carry a small risk
over your skin and high-frequency typical daily pattern and contact of miscarriage, so you may decide
sound is beamed through your your midwife or maternity unit not to have them. Discussing the
abdomen to the uterus and pelvis. immediately if you feel that the issues with your partner, midwife,
movements have changed. doctor and friends may help you in
deciding what is right for you.
49
Haemophilia and measures two pregnancy-associated If the screening test shows the risk
muscular dystrophy blood chemicals. At the scan, the of the baby having Downs syndrome
radiographer measures the thickness is lower than the recommended
Some disorders, such as
of the nuchal translucency at the national cut-off, this is known as
haemophilia and muscular
back of your babys neck. This having a low-risk result. A low-risk
dystrophy, are only found in boys
information is used to calculate your result means that you are at a
(although girls may carry the
individual statistical chance of having low-risk of having a baby with
disorder in their chromosomes
a baby with Downs syndrome. Downs syndrome, but it does not
and pass it on to their sons). Tell
This nuchal translucency scan can mean there is no risk.
your midwife or doctor if these or
be used in multiple pregnancies.
other genetic disorders run in your If the result shows the risk of the
For more information about
family, as it may then be important baby having Downs syndrome is
screening for anomalies, visit www.
to know your babys sex. greater than the recommended
fetalanomaly.screening.nhs.uk/
national cut-off, this is known as an
publicationsandleaflets
increased risk or higher risk result.
TESTS FOR DOWNS Serum screening An increased risk means you will be
offered diagnostic test but it does
Serum screening is a blood test
SYNDROME AND that screens for Downs syndrome, not mean that your baby definitely
OTHER GENETIC usually at about 16 weeks into your has the condition. The diagnostic
procedure you will be offered is
DISORDERS pregnancy. It measures three or
either chorionic villus sampling (CVS)
four pregnancy-associated blood
These tests are offered to all pregnant chemicals to give your individual (see next page) or amniocentesis to
women. There are different ways statistical chance of having a give you a definite answer about
of carrying out screening. baby with Downs syndrome. Downs syndrome. Your midwife or
Serum screening on its own is not doctor will explain the result to you
Combined screening recommended for twin and other and help you decided whether you
Combined screening involves a multiple pregnancies. want to have further tests.
blood test and an ultrasound scan.
All women should have dating and Screening results More information
nuchal translucency scans between Some maternity services give the
www.library.nhs.uk
eight and 14 weeks. These scans result as lower risk/screen negative
may be combined. The blood test or higher risk/screen positive. www.screening.nhs.uk

50
Amniocentesis DIAGNOSTIC TESTS Sometimes a fine tube is passed
4
through the vagina and cervix
Amniocentesis can be offered FOR DOWNS into the uterus instead. A tiny
from 15 weeks of pregnancy if:
SYNDROME AND piece of the developing placenta,
you have a positive or higher
risk Downs syndrome screening
OTHER GENETIC known as chorionic tissue, is taken.
The chromosomes in the cells of

ANTENATAL CARE
result DISORDERS this tissue are examined. As with
an ultrasound scan detects an These tests will give you a definite amniocentesis, a rapid result can be
abnormality that is associated diagnosis of Downs syndrome and obtained, but if all the chromosomes
with a genetic disorder sometimes other abnormalities. are going to be checked the results
may take up to two weeks.
your past history or family Your midwife or doctor will explain
history suggests that there may what is involved and you will usually The risks
be a risk of your baby having be offered counselling. CVS has a 12% risk of miscarriage.
a genetic or chromosomal This is slightly higher than
disorder such as Downs Chorionic villus amniocentesis.
syndrome, sickle cell disorder sampling (CVS)
or thalassaemia. CVS can be carried out at around IF A TEST DETECTS
What happens 11 weeks. It can give you an earlier
diagnosis if you are at risk of having AN ABNORMALITY
Using ultrasound as a guide,
a child with an inherited disorder, It is always difficult when you are
a fine needle is passed through
such as cystic fibrosis, sickle cell told there is something wrong
the wall of the abdomen
disorder, thalassaemia or muscular with your baby, especially if you
into the amniotic fluid that
dystrophy. are faced with a painful decision
surrounds your baby. Within
the fluid are cells that contain What happens? about the future of your pregnancy.
the same chromosomes as The test takes 10 to 20 minutes Your midwife or doctor will make
your baby. A small sample of and may be a little uncomfortable. sure you see the appropriate health
this fluid is drawn off and sent Using ultrasound as a guide, a professionals to help you get all the
to a laboratory for testing. fine needle is passed through the information and support you need
Most women feel only mild abdomen into the uterus. so you can make the choices that
discomfort. are right for you and your family.
Usually, the fluid will be tested Help and support
for Downs syndrome and other
serious syndromes. The Antenatal Results and Choices (ARC) (see page 186) helps parents
results should be available with all issues associated with antenatal testing and its implications.
within three working days. They can give you more information or put you in touch with parents
If all the chromosomes have to who decided to continue with a pregnancy in which an abnormality
be looked at, it can take up to had been detected or those who decided to have a termination.
three weeks. This test will reveal Go to www.arc-uk.org for more information.
your babys sex, so tell your
midwife or doctor whether, at
this stage, you want to know
if your baby is a boy or a girl.
The risks
Amniocentesis has a 0.51%
risk of miscarriage. At most,
one test in 100 will result in
pregnancy loss. When deciding
whether or not to go ahead
with this test, try to balance
the risk of miscarriage against
the value of the result to you.

51
MAKING THE MOST OF
ANTENATAL CARE
Having regular antenatal care is important for your health
and the health of your baby. Most antenatal services are
now provided in easily accessible community settings.
Waiting times in clinics can vary, and this can be particularly
difficult if you have young children with you. Try to plan
ahead to make your visits easier. Here are some suggestions:
In some clinics you can buy refreshments. If not, take
a snack with you if you are likely to get hungry.
Write a list of questions you want to ask
and take it with you to remind you.
Make sure you get answers to your
questions or the opportunity to
discuss any worries.
If your partner is free, they may
be able to go with you. This can
help them feel more involved
in the pregnancy.

Your hand-held antenatal notes

At your first antenatal visit, your midwife will DATE WEEKS WEIGHT URINE ALB BP
enter your details in a record book and add SUGAR
to them at each visit. You should be asked to
keep your maternity notes at home with you 1 2 3 4 5
and to bring them along to all your antenatal
appointments. Take your notes with you
wherever you go. Then, if you need medical 15/6/09 13 58kg Nil 110/60
attention while you are away from home,
you will have the information that is needed
with you. 20/7/09 18 59.2kg Nil 125/60

The chart on the right gives a sample of 21/8/09 22 61kg Nil 135/65
the information your card or notes may
contain, but each clinic has its own system. 18/9/09 26+ 64kg Nil 125/75
Always ask your midwife or doctor to explain
anything they write on your card. 28/10/09 30 66kg Nil 125/70

1 Date. This is the date of your antenatal visit. 27/11/09 34 Nil 115/75

2 Weeks. This refers to the length of your pregnancy in


weeks from the date of your last menstrual period.
3 5 Blood pressure (BP). This should stay at about the same
Weight. This is your weight.
level throughout your pregnancy. If it goes up a lot in the last
4 Urine. These are the results of your urine tests for half of your pregnancy, it may be a sign of pre-eclampsia
protein and sugar. + or Tr means a quantity (or trace) (see page 67).
has been found. Alb stands for albumin, a name for
one of the proteins detected in urine. Nil or a tick or
NAD all mean the same: nothing abnormal has been
discovered. Ketones may be found if you have not
eaten recently or have been vomiting.
52
38

24
6 Height of fundus. By gently pressing on your abdomen, the midwife or doctor can feel your
uterus. Early in pregnancy the top of the uterus, or fundus, can be felt low down, below your
4
12 navel. Towards the end it is well up above your navel, just under your breasts. The figure should
be roughly the same as the figure in the weeks column. If there is a big difference (more than
two weeks), ask your midwife what action is appropriate.

ANTENATAL CARE
CEPHALIC BREECH
PRESENTATION PRESENTATION

/5 felt
2

/5 engaged
3

/5 felt
/5 engaged 7 Presentation. This refers to which way up your 8 Relation to brim. At the end of pregnancy, your babys
baby is. Up to about 30 weeks, your baby moves head (or bottom, or feet if they are in the breech position)
about a lot. Then they usually settle into a head- will start to move into your pelvis. Professionals divide the
downward position, ready to be born head first. babys head into fifths and describe how far it has moved
This is recorded as Vx (vertex) or C or ceph down into the pelvis by judging how many fifths of the
(cephalic). Both words mean the top of the head. head they can feel above the brim (the bone at the front).
If your baby stays with its bottom downwards, They may say that the head is engaged this is when
this is a breech (Br) presentation. PP means 2/5 or less of your babys head can be felt (palpated)
presenting part, which is the part (head or bottom) above the brim. This may not happen until you are in
of your baby that is coming first. Tr (transverse) labour. If all of your babys head can be felt above the
means your baby is lying across your abdomen. brim, this is described as free or 5/5 palpable.

HEIGHT PRESENTATION RELATION FH OEDEMA Hb NEXT SIGN. NOTES


FUNDUS OF PP TO
BRIM

6 7 8 9 10 11

u/s arranged for


15 12.0 20/7 JS
17/7 to check maturity

1820 FMF 21/8 JS

20 18/9 JS taking iron

2426 H 11.2 28/10 JS Health in Pregnancy Grant

MAT B1 given,
30 ceph 5/5 FHH 27/11 JS
Hb taken

34 ceph 4/5 FHH 11.0 15/12 JS

9 Fetal heart (FH). FHH or just H means fetal heart


heard. FMF means fetal movement felt.
10 Oedema. This is another word for swelling, often of the
feet and hands. Usually it is nothing to worry about, but
tell your midwife or doctor if it suddenly gets worse as
this may be a sign of pre-eclampsia (see page 67).
11 Hb. This stands for haemoglobin. It is tested in your
blood sample to check if you are anaemic.
53
YOUR ANTENATAL The people you are most An obstetrician is a
likely to meet are listed doctor specialising in the care
TEAM below of women during pregnancy
While you are pregnant you should and labour and after the birth.
A midwife is specially trained
normally see a small number of to care for mothers and babies
healthcare professionals, led by your throughout pregnancy and labour
midwife or doctor, on a regular and after the birth. Midwives
basis. They want to make you feel provide care for the majority of
happy with all aspects of the care women at home or in hospital.
you receive, both while you are Increasingly, midwives will be
pregnant and when you have working both in hospitals and in
your baby. the community, so that the same
Many mothers would like to be able midwife can provide antenatal
to get to know the people who care and be present at the birth.
care for them during pregnancy and You should know the name of the
Your midwife or GP will refer
the birth of their baby. The NHS is midwife who is responsible for
you for an appointment with
working to achieve this but you may your care.
an obstetrician if they have
still find that you see a number of A midwife will look after you a particular concern, such
different carers. The professionals during labour and, if everything is as previous complications in
you see should introduce themselves straightforward, will deliver your pregnancy or chronic illness.
and explain who they are, baby. If any complications develop You can request to see an
but if they forget, during your pregnancy or delivery, obstetrician if you have any
dont hesitate to you will also see a doctor. You particular concerns.
ask. It may help may also meet student midwives
to make a note and student doctors. After the An anaesthetist is a
of who you birth, you and your baby will doctor who specialises in providing
have seen and be cared for by midwives and pain relief and anaesthesia. If you
what they have said maternity support workers. decide to have an epidural, it will
in case you need to be set up by an anaesthetist.
discuss any point
later on.

care from
your
midwife If you require a caesarean section
or an instrumental delivery
(e.g. using forceps or ventouse),
an anaesthetist will provide
the appropriate anaesthesia.
In many hospitals your midwife
can arrange for you to talk to an
anaesthetist about analgesia or
anaesthesia if you have medical
or obstetric problems. Before
or during labour you will be able
to speak to your anaesthetist.
54
Dieticians may be available
An obstetric
physiotherapist is specially to advise you about healthy eating 4
trained to help you cope with or special diets, for example if you
physical changes during pregnancy, develop gestational diabetes.
childbirth and afterwards. Some

ANTENATAL CARE
provide antenatal education
and teach antenatal exercises, Research
relaxation and breathing, active
positions and other ways you You may be asked to
A paediatrician is a participate in a research project
can keep yourself fit and healthy
doctor specialising in the during your antenatal care or
during pregnancy and labour.
care of babies and children. labour or after you have given
After the birth, they advise on
A paediatrician may check birth. This may be to test a
postnatal exercises to tone up your
your baby after the birth to new treatment or to find out
muscles. Your midwife can help
make sure all is well and will your opinions on an aspect
you with these exercises.
be present when your baby of your care. Such projects
is born if you have had a are vital if professionals are
difficult labour. If your baby to improve maternity care.
has any problems, you will be The project should be fully
able to talk this over with the explained to you and you are
paediatrician. If your baby is free to say no.
born at home or your stay in
hospital is short, you may not
see a paediatrician at all. Your Students
midwife or GP will check that all
is well with you and your baby. Some of the health
Health visitors are specially professionals you see will
trained nurses who offer help and have students with them.
A sonographer is support with the health of the The students will be at various
specially trained to carry whole family. You may meet your stages of their training but
out ultrasound scans. A health visitor before the birth of will always be supervised. You
sonographer will perform your baby and you will be visited can say no, but if you let a
your dating and nuchal by a member of the team in the student be present it will help
translucency or anomaly scan. first few weeks after your baby their education and may even
Some women are scanned is born. You may continue to see add to your experience of
at other points in their your health visitor or a member pregnancy and labour.
pregnancy. of the health visiting team at
home or at your child health clinic,
Childrens Centre, health centre
or GPs surgery.

55
ANTENATAL
EDUCATION
Antenatal education (sometimes
called antenatal classes) can help
to prepare you for your babys birth
as well as for looking after and
feeding your baby. It can help you
to keep yourself fit and well during
pregnancy and give you confidence
as well as information. You can find
out about arrangements for labour Choosing an The classes
and birth and the sorts of choices antenatal class During pregnancy, you may be able
available to you (see page 74 for Think about what you hope to gain to go to some introductory classes
information about birth plans). from antenatal classes so that you on babycare. Most start about eight
You may also meet some of the can find the sort of class that suits to 10 weeks before your baby is
people who will look after you you best. You need to start making due. If you are expecting a multiple
during labour. enquiries early in pregnancy so pregnancy, try to start your classes
You will be able to talk over any that you can be sure of getting at around 24 weeks, because your
worries and discuss your plans, a place in the class you choose. babies are more likely to be born
not just with professionals but You can go to more than one class. earlier.
with other women and their Ask your midwife, health visitor or
Classes are normally held once a
partners as well. Classes are also GP about what is available in your
week, either during the day or in
a really good way to make friends area, or contact the NCT (see next
the evening, for about two hours.
with other parents expecting babies page). Speak to your community
Some classes are for pregnant
at around the same time as you. midwife if you cannot go to classes.
women only. Others will welcome
These friendships often help you The midwife may have DVDs to
partners or friends, either to all
through the first few months lend you, or you may be able
the sessions or to some of them.
with a baby. Classes are usually to hire or buy one.
In some areas there are classes for
informal and fun. women whose first language is not
English, classes for single mothers

relaxed and classes for teenagers. The


kinds of topics covered in antenatal
education are:

and fun health in pregnancy


exercises to keep you fit during
pregnancy and help you in labour
what happens during labour
andbirth
coping with labour and
information about different types
of pain relief
how to help yourself during
labour and birth

56
The NCT Childrens Centres
(sometimes called 4
The NCT (also known as Sure Start Childrens
the National Childbirth Trust) Centres)
runs a range of classes.
The groups tend to be smaller Childrens Centres also support

ANTENATAL CARE
and may go into more depth, families with children under the
often allowing time for age of five. They can provide:
discussion and for practising
easy access to antenatal care
physical skills. For details of
relaxation techniques antenatal courses, along with health services
how to give birth without any information on local support parenting and family support
intervention, if that is what groups, visit www.nct.org.uk drop-in sessions
you want
outreach services
information on different kinds
of birth and intervention early education and childcare,
and
caring for your baby,
including feeding links to training and
employment opportunities.
your health after the birth
refresher classes for those
who have already had a baby
emotions during pregnancy, birth
and the early postnatal period.
Some classes will try to cover
all of these topics. Others will
concentrate on certain aspects,

meet
such as exercises and relaxation
or caring for your baby. For more information on
Childrens Centres, including
The number of different antenatal finding centres in your area,

other
classes available varies from visit www.surestart.gov.uk
place to place.

parents-to-be

57
CONDITIONS AND
PROBLEMS
IN PREGNANCY
Common minor problems 58
More serious problems 67

Your body goes through a lot of changes during pregnancy. Sometimes these changes
can cause you discomfort or irritation, and you may be worried about what is happening
to you. There is usually nothing to worry about, but you should mention anything that
concerns you to your midwife or doctor. If you think that something may be seriously
wrong, trust your own judgement and get in touch with your midwife or doctor
straight away.
This chapter describes some of the minor and more serious health problems and gives
advice on how to deal with them and when you should get help. These problems are
listed in alphabetical order.

COMMON MINOR How to avoid backache


Avoid lifting heavy objects.
PROBLEMS
Bend your knees and keep your back
Backache straight when lifting or picking something
As your baby grows, the hollow up from the floor.
in your lower back may become Move your feet when turning round to
more pronounced, and this can avoid twisting your spine.
also cause backache. During
Wear flat shoes that allow your weight
pregnancy, your ligaments
to be evenly distributed.
become softer and stretch
to prepare you for Work at a surface that is high enough
labour. This can put a so that you dont stoop.
strain on the joints Try to balance the weight between
of your lower two bags when carrying shopping.
back and pelvis, Sit with your back straight and
which can cause well supported.
backache.
Make sure you get enough rest
particularly later in pregnancy.

58
How to ease backache
A firm mattress can help to
5
prevent and relieve backache.
Ifyour mattress is too soft, put
a piece of hardboard under it

CONDITIONS AND PROBLEMS IN PREGNANCY


tomake it firmer.
Massage can help.
When to get help
If your backache is very painful,
ask your doctor to refer you to an
obstetric physiotherapist at your
hospital. They will be able to give
you some advice and may suggest
some helpful exercises.

Constipation
You may become constipated very
early in pregnancy because of the
hormonal changes taking place in How to ease cramp Feeling hot
your body. It usually helps if you pull your During pregnancy you are likely
toes hard up towards your ankle to feel warmer than normal. This
How to avoid constipation
or rub the muscle hard. is due to hormonal changes and
Eat foods that are high in
to an increase in the blood supply
fibre, like wholemeal breads, Feeling faint
to your skin. You are also likely to
wholegrain cereals, fruit and You may often feel faint when sweat more.
vegetables, and pulses such as you are pregnant. This is because
beans and lentils. of hormonal changes taking place How to avoid feeling hot
Exercise regularly to keep your in your body and happens if your Wear loose clothing made of
muscles toned. brain is not getting enough blood natural fibres, as these are more
and therefore enough oxygen. absorbent and breathe more
Drink plenty of water.
If your oxygen level gets too low, than synthetic fibres.
Avoid iron supplements. Ask your you may actually faint. You are most
doctor whether you can manage Keep your room cool. You
likely to feel faint if you stand still could use an electric fan to
without them or change to a for too long or get up too quickly
different type. cool it down.
from a chair or out of a hot bath.
It can also happen when you are Wash frequently to help you
Cramp to feel fresh.
lying on your back.
Cramp is a sudden, sharp pain,
usually in your calf muscles or feet. How to avoid feeling faint
It is most common at night, but Try to get up slowly after sitting
nobody really knows what causes it. or lying down.
How to avoid cramp If you feel faint when standing
Regular, gentle exercise in still, find a seat quickly and the
pregnancy, particularly ankle and feeling should pass. If it doesnt,
leg movements, will improve your lie down on your side.
circulation and may help to If you feel faint while lying on
prevent cramp occurring. your back, turn on your side.
It is advisable not to lie flat on
your back at any time in later
pregnancy or during labour.

59
Headaches
Some pregnant women find they
get a lot of headaches.
How to ease headaches
Try and get more regular rest
andrelaxation.
Paracetamol in the recommended
dose is generally considered safe
for pregnant women but there are
some painkillers that you should
avoid. Speak to your pharmacist,
nurse, midwife, health visitor or
GP about how much paracetamol
you can take and for how long. When to get help Indigestion and
In many cases incontinence is heartburn
curable, so if you have got a
problem talk to your midwife, Indigestion is partly caused by
hormonal changes and in later
doctor or health visitor.
pregnancy by your growing
uterus pressing on your stomach.
Help and support Heartburn is more than just
indigestion. It is a strong, burning
pain in the chest caused by stomach
You could also call the acid passing from your stomach into
When to get help confidential Continence the tube leading to your stomach.
If you often have bad headaches, Foundation helpline on This is because the valve between
tell your midwife or doctor. Severe 0845 345 0165 (9.30am your stomach and this tube relaxes
headaches can be a sign of high to 1pm Mon to Fri) or during pregnancy.
blood pressure (see page 67). visit www.continence-
foundation.org.uk How to avoid indigestion
Incontinence Try eating smaller meals
Incontinence is a common more often.
problem. It can affect you during
Sit up straight when you are
and after pregnancy.
eating, as this takes the pressure
Sometimes pregnant women are off your stomach.
unable to prevent a sudden spurt Avoid the foods which affect
of urine or a small leak when they you, e.g. fried or highly spiced
cough, sneeze or laugh, or when food, but make sure you are still
moving suddenly or just getting up eating well (see pages 2425 for
from a sitting position. This may be information on healthy eating).
temporary, because the pelvic floor
muscles relax slightly to prepare for How to avoid heartburn
the babys delivery. Heartburn is often brought on by
lying flat. Sleep well propped up
Some women have more severe
with plenty of pillows.
incontinence and find that they
cannot help wetting themselves. Avoid eating and drinking for a
few hours before you go to bed.
Your midwife or GP may
prescribe an antacid if the
problem is persistent.

60
Nausea and
How to ease heartburn
Drink a glass of milk. Have one by morning sickness
5
your bed in case you wake with Nausea is very common in
heartburn in the night. the early weeks of pregnancy.
Note that you should not take Some women feel sick, and

CONDITIONS AND PROBLEMS IN PREGNANCY


antacid tablets before checking some are sick. It can happen
with your midwife, doctor or at any time of day or even
pharmacist that they are safe for all day long.
you to take. Hormonal changes in the
Itching first three months are
probably one cause. Nausea
Mild itching is common in pregnancy
usually disappears around
because of the increased blood
the 12th to 14th weeks.
supply to the skin. In late pregnancy
It can be one of the most
the skin of the abdomen is stretched
trying problems in early
and this may also cause itchiness.
pregnancy. It comes at a time when you may be feeling tired and
emotional, and when many people around you may not realise
that you are pregnant.
How to avoid nausea and morning sickness
If you feel sick first thing in the morning, give yourself time to get
up slowly. If possible, eat something like dry toast or a plain biscuit
before you get up.
Get plenty of rest and sleep whenever you can. Feeling tired can
make the sickness worse.
Eat small amounts of food often rather than several large meals,
but dont stop eating.
Drink plenty of fluids.
Ask those close to you for extra help and support.
Distract yourself as much as you can. Often the nausea gets worse
the more you think about it.
Avoid foods and smells that make you feel worse. It helps if
someone else can cook. If not, go for bland, non-greasy foods,
How to avoid itching
such as baked potatoes, pasta and milk puddings, which are
Wearing loose clothing may help. simple to prepare.
You may also want to avoid Wear comfortable clothes. Tight waistbands can make you
synthetic materials. feel worse.
Leaking nipples When to get help
Leaking nipples are normal and If you are being sick all the time and cannot keep anything down,
usually nothing to worry about. tell your midwife or doctor. Some pregnant women experience
The leaking milk is colostrum, which severe nausea and vomiting. This condition is known as
is the first milk your breasts make hyperemesis gravidarum and needs
to feed your baby. specialist treatment.
When to get help
See your midwife or doctor if the
milk becomes bloodstained.

61
Nose bleeds Passing urine often Ask a midwife or obstetric
Nose bleeds are quite common Needing to pass urine often may physiotherapist (see pages 54 and
in pregnancy because of start in early pregnancy. Sometimes 55) for advice.
hormonal changes. They dont it continues right through Pelvic joint pain
usually last long but can be quite pregnancy. In later pregnancy its
If during or after your pregnancy
heavy. As long as you dont lose the result of the babys head
you have pain in your pelvic joints
a lot of blood, there is nothing pressing on the bladder.
when walking, climbing stairs or
to worry about. You may also
How to reduce the need turning in bed, you could have
find that your nose gets more
to pass urine pelvic girdle pain (PGP) or symphysis
blocked up than usual.
If you find that you have to get up pubis dysfunction (SPD). This is
How to stop nose bleeds in the night try cutting out drinks a slight misalignment or stiffness of
Sit with your head forward. in the late evening, but make sure your pelvic joints, at either the back
you keep drinking plenty during or front. It affects up to one in four
Press the sides of your nose
the day. pregnant women to a lesser or
together between your thumb
greater extent. Some women have
and forefinger, just below the Later in pregnancy, some women
minor discomfort, others may have
bony part, for 10 minutes and find it helps to rock backwards
much greater immobility.
try not to swallow the blood. and forwards while they are on
Repeat for a further 10 the toilet. This lessens the pressure When to get help
minutes if this is unsuccessful. of the uterus on the bladder so Getting diagnosed as early as
that you can empty it properly. possible can help to minimise
If the bleeding continues, Then you may not need to pass the pain and avoid long-term
seek medical advice. water again quite so soon. discomfort. Treatment usually
When to get help involves gently pressing on or
moving the affected joint so that
If you have any pain while passing
it works normally again.
water or you pass any blood, you
may have a urine infection, which Ask a member of your maternity
will need treatment. Drink plenty team for a referral to a manual
of water to dilute your urine and physiotherapist, osteopath or
reduce pain. You should contact chiropractor who is experienced
your GP within 24 hours. in treating pelvic joint problems.
They tend not to get better
The growing baby will increase
completely without treatment from
pressure on your bladder. If you
an experienced practitioner.
find this a problem, you can
improve the situation by doing Contact the Pelvic Partnership
exercises to tone up your for support and information
pelvic floor muscles (see page187).
(see page 35).

coping
with the
symptoms
62
5

Piles

CONDITIONS AND PROBLEMS IN PREGNANCY


Piles, also known as haemorrhoids,
are swollen veins around your
anus (back passage) which may
itch, ache or feel sore. You can
usually feel the lumpiness of the
piles around your anus. Piles may
also bleed a little and they can
make going to the toilet
uncomfortable or even painful.
They occur in pregnancy because
certain hormones make your veins
relax. Piles usually resolve within
weeks after birth.
How to ease piles
Eat plenty of
food that is
high in fibre, Skin and hair changes
like wholemeal Hormonal changes taking place
bread, fruit and in pregnancy will make your
vegetables, and nipples and the area around
drink plenty them go darker. Your skin
of water. This colour may also darken a little,
will prevent either in patches or all over.
constipation, Birthmarks, moles and freckles
which can make may also darken. Some women
piles worse. develop a dark line from their
Avoid standing belly buttons down to the
for long periods. top of their pubic hair. These
changes will gradually fade
Take regular exercise to improve after the baby has been born,
your circulation. although your nipples may
You may find it helpful to use remain a little darker.
a cloth wrung out in ice water.
If you sunbathe while you are
Push any piles that stick out pregnant, you may find that
gently back inside using a you tan more easily. Protect
lubricating jelly. your skin with a good, high-
Ask your midwife, doctor or factor sunscreen. Dont stay
pharmacist if they can suggest in the sun for very long.
a suitable ointment.
Hair growth is also likely to
increase in pregnancy. Your
hair may also be greasier.
After the baby is born, it may
seem as if you are losing a lot
of hair. In fact, you are simply
losing the extra hair that you
grew during pregnancy.
63
It might be more comfortable to lie on one side with a pillow
under your tummy and another between your knees.

Sleep Swollen ankles, feet


and fingers Suggestions for swollen
Late in pregnancy it can be very
ankles, feet and fingers
difficult to get a good nights
Ankles, feet and fingers often swell
sleep. It can be uncomfortable Avoid standing for long
a little in pregnancy because your
lying down or, just when you get periods.
body is holding more water than
comfortable, you find that you Wear comfortable shoes.
usual. Towards the end of the day,
have to get up togo to the toilet.
especially if the weather is hot or Put your feet up as much as
Some women have strange dreams if you have been standing a lot, you can. Try to rest for an hour
or nightmares about the baby the extra water tends to gather in a day with your feet higher
and about the birth. Talking the lowest parts of your body. than your heart.

put
about them can help you.
Do foot exercises (see page 35).

Stretch marks

your feet
up and rest
These are pink or purplish lines
which usually occur on your
abdomen or sometimes on your
upper thighs or breasts. Some
women get them, some dont.
It depends on your skin type.
Some peoples skin is more elastic.
You are more likely to get stretch
marks if your weight gain is more
than average. It is very doubtful
whether oils or creams help to
prevent stretch marks. After
your baby is born, the marks
should gradually pale and
become less noticeable.

64
Teeth and gums
Bleeding gums are caused by a
5
build-up of plaque (bacteria) on
your teeth. During pregnancy,
hormonal changes in your body can

CONDITIONS AND PROBLEMS IN PREGNANCY


cause plaque to make your gums
more inflamed. They may become
swollen and bleed more easily.
When your baby is born your gums
should return to normal.
How to keep teeth and
gums healthy
Clean your teeth and gums
carefully. Ask your dentist to show
you a good brushing method to
remove all the plaque.
Avoid having sugary drinks and
foods too often. Try to eat them
at mealtimes only. Tiredness Towards the end of pregnancy you
Go to the dentist for a check-up. In the early months of pregnancy may feel tired because of the extra
NHS dental treatment is free while you may feel tired or even weight you are carrying. Make sure
you are pregnant and for a year desperately exhausted. The only that you get plenty of rest.
after your babys birth. answer is to try to rest as much
Ask your dentist if any new or as possible. Make time to sit with
replacement fillings should be your feet up during the day and
delayed until after your baby accept any offers of help from
is born. colleagues and family.

NHS
free
dental
treatment

65
Vaginal discharge If you have varicose veins
Almost all women have more Try to avoid standing for long
vaginal discharge in pregnancy. periods of time.
It should be clear and white and Try not to sit with your legs
should not smell unpleasant. If crossed.
the discharge is coloured or smells
Try not to put on too much
strange, or if you feel itchy or sore,
weight, as this increases the
you may have a vaginal infection.
pressure.
The most common infection is
thrush, which your doctor can treat Sit with your legs up as often as
easily. You can help to prevent you can to ease the discomfort.
thrush by wearing loose cotton Try support tights, which may
underwear. also help to support the muscles
of your legs.
When to get help
Tell your midwife or doctor if the Try sleeping with your legs higher
discharge is coloured, smells strange, than the rest of your body use
or if you feel itchy or sore. pillows under your ankles or put
books under the foot of your bed.
Tell your midwife or doctor if
Do foot exercises (see page 35)
vaginal discharge, of any colour,
and other antenatal exercises such
increases a lot in later pregnancy.
as walking and swimming, which
Varicose veins will help your circulation.

exercise
Varicose veins are veins which have
become swollen. The veins in the
legs are most commonly affected.
You can also get varicose veins in
the vulva (vaginal opening). They
usually get better after delivery. helps your
circulation
Help and support

Contact Netmums,
a unique local network
and source of discussion
www.netmums.com

66
The symptoms
Some of the symptoms
rest at home, but some women
need admission to hospital and 5
of pre-eclampsia are: medicines that lower high blood
pressure. Occasionally, pre-eclampsia
bad headaches is a reason to deliver the baby early
this may be either by induction of

CONDITIONS AND PROBLEMS IN PREGNANCY


problems with vision, such as
blurred vision or lights flashing labour or by caesarean section.
before the eyes
When to get help
bad pain just below the ribs If you get any of the symptoms
MORE SERIOUS vomiting described here, or have any reason
to think that you have pre-eclampsia,
PROBLEMS sudden swelling of the
contact your midwife, doctor or the
face, hands or feet.
High blood pressure hospital immediately.
However, you can have severe
and pre-eclampsia pre-eclampsia without any Placenta praevia
During pregnancy your blood symptoms at all. Placenta praevia (or a low-lying
pressure will be checked at placenta) is when the placenta is
Although most cases are mild and
every antenatal appointment. attached in the lower part of the
cause no trouble, it can be serious
This is because a rise in blood uterus, near to or covering the cervix.
for both mother and baby. It can
pressure can be the first sign of a
cause fits in the mother (called The position of your placenta is
condition known as pre-eclampsia
eclampsia) and affects the babys recorded at your 18 to 21-week
also called pregnancy-induced
growth. It is life-threatening if left ultrasound scan. If it is significantly
hypertension (PIH) or pre-eclamptic
untreated. That is why routine low you will be offered an extra
toxaemia (PET). It can run in families
antenatal checks are so important. ultrasound scan later in your
and affects 10% of pregnancies.
Your urine is checked for protein pregnancy (usually at around
Pre-eclampsia usually happens
at every visit, as this is a sign 32 weeks) to recheck its position.
towards the end of pregnancy, but
of pre-eclampsia. For 9 out of 10 women the
it may happen earlier. It can also
placenta has moved into the upper
happen after the birth. It is likely to
part of the uterus by this time.
be more severe if it starts earlier in
pregnancy. Treatment may start with If the placenta is still low in the
uterus, there is a higher chance
that you could bleed during your
pregnancy or at the time of birth.
This bleeding can be very heavy
and put you and your baby at
risk. You may be advised to come
into hospital at the end of your
pregnancy so that emergency
treatment can be given very quickly
if you do bleed. If the placenta is
near or covering the cervix, the
baby cannot get past it to be born
vaginally and a caesarean section
will be recommended.

67
Severe itching and
obstetric cholestasis
Severe itching can be a sign
of a condition called obstetric
cholestasis. This is a potentially
dangerous liver disorder that seems
to run in families, although it can
occur even if there is no family
history. The main symptom is severe
generalised itching without a rash,
most commonly in the last four
months of pregnancy. Obstetric
cholestasis can lead to premature
birth, stillbirth or serious health
problems for your baby. It can
also increase the risk of maternal Slow-growing babies When to get help
haemorrhage after the delivery. Many of the tests in pregnancy In the last weeks of pregnancy,
check that your baby is growing. you should keep track of your
When to get help If you have previously had a babys movements. If you notice
You should see your doctor if: very small baby, or if you smoke your babys movements becoming
heavily, the midwives and doctors less frequent or stopping, it may
the itching becomes severe
will already be monitoring your be a sign that your baby is unwell.
particularly if it affects your hands
pregnancy closely. Blood pressure You should contact your midwife
and feet
checks may also pick up signs that or doctor immediately.
you develop jaundice (yellowing there are complications. If there is
of the whites of the eyes and skin) If tests show that your baby is
concern about your babys health, not growing well in the uterus,
you get itching and a severe rash. further tests might be carried out your midwife and doctor may
and your baby will be monitored recommend early delivery by
more frequently. induction of labour or caesarean
section (see page 98).

Seek medical help


You should contact your
GP if you have a sudden
acute illness like diarrhoea,
vomiting, abdominal pain
or a high fever.

68
Vaginal bleeding
Bleeding from the vagina at
5
any time in pregnancy can be a
dangerous sign. Some causes of
vaginal bleeding are more serious

CONDITIONS AND PROBLEMS IN PREGNANCY


than others, so its important to More information
find the cause straight away.
Deep vein thrombosis For more information see the
Bleeding after sex
Royal College of Obstetricians
The cells on the surface of the Deep vein thrombosis is a and Gynaecologists guideline
cervix often change in pregnancy serious condition where clots Thromboprophylaxis during
and make it more likely to bleed develop, often in the deep veins pregnancy, labour and after
particularly after sex. This is of the legs. It can be fatal if the vaginal delivery at
called a cervical ectropion. Vaginal clot travels from the legs to the www.rcog.org.uk/womens-
infections can also cause a small lungs. The risk may increase if health/clinical-guidance/
amount of vaginal bleeding. you are on a long-haul flight thromboprophylaxis-during-
(over five hours), where you sit pregnancy-labour-and-after-
Ectopic pregnancy still for a long time. vaginal-deliver
In early pregnancy, bleeding may
be a sign of an ectopic pregnancy When to get help
or a miscarriage (see page 151), If you develop swollen and
although many women who bleed painful legs or have breathing
at this time go on to have normal difficulties, go to your GP
and successful pregnancies. or your nearest accident
and emergency department
Bleeding in late pregnancy immediately.
The most common sort of
bleeding in late pregnancy is the
small amount of blood mixed
with mucus that is known as a
show. This is a sign that the cervix
Vasa praevia
is changing and becoming ready Vasa praevia is a rare condition Problems in early
for labour to start. It may happen (occurring in about 1 in 3,000 pregnancy
a few days before contractions to 1 in 6,000 births). It occurs
Most women feel well in
start or during labour itself. when the blood vessels of the
early pregnancy but it can be
umbilical cord run through the
uncomfortable. Some women
membranes covering the cervix.
Help and support describe a pain low down in
Normally the blood vessels would
the abdomen similar to a period
be protected within the umbilical
pain. This does not necessarily
Always contact your cord. When the membranes
mean that something is wrong,
midwife or doctor rupture and the waters break,
but if the pain is more than
immediately if you have these vessels may be torn, causing
discomfort or if there is any
vaginal bleeding at any vaginal bleeding. Thebaby can
bleeding, your midwife or
stage of pregnancy. lose a lifethreatening amount of
GP should refer you for a
blood and die. It is very difficult to
scan in the early pregnancy
diagnose but it may occasionally
assessment unit. This scan
be spotted before birth by an
will show whether the
ultrasound scan. Vasa praevia
pregnancy is growing in the
should be suspected if there is
uterus. Sometimes you need
bleeding and the babys heart
a second scan to check that
rate changes suddenly after
all is well.
rupture of the membranes.
It is linked with placenta
praevia (see page 67).

69
CHOOSING
WHERE TO HAVE
YOUR BABY
Safety 70 Midwifery units
Making an informed or birth centres 72
decision  70 Birth in hospital  73
Home births 71 Birth plans 74

You can give birth at home, in a unit run by midwives or in a hospital. This chapter gives
information about each of these options so that you can choose what is best for you.

SAFETY MAKING AN
Giving birth is generally very safe, INFORMED
wherever you choose to have your DECISION
baby. There is not much evidence
that compares how safe different It is important that you and your
places are. However, women partner make an informed choice
who have their baby in a unit about where you would like to
run by midwives or at home are give birth.
less likely to need assistance, It is your choice, and even after
for example through the use of you have decided where
forceps or a ventouse. you want to have your
If you choose to have your baby baby you can still
at home or in a unit run by change your mind.
midwives, you should be given Your midwife will
information about what would discuss the options
happen if you need to be that are available
transferred to hospital during to you locally,
labour and how long this though you are
would take. You should also be free to choose
aware that if something goes any maternity
seriously wrong during your labour services if
(which is rare) it could be worse you are
for you and your baby than if prepared
you were in hospital with access to travel.
to specialised care. You may be
advised to give birth in hospital
if you have, or develop, certain
medical conditions.

70
As well as getting information
from your midwife, you can get 6
information from:
local maternity units
Childrens Centres

CHOOSING WHERE TO HAVE YOUR BABY


your GP surgery
the NCT, which can put you
in touch with local mothers
(see page 57)
Maternity Services
Liaison Committees
(www.csip.org.uk/~mslc) HOME BIRTHS The things you should consider
a supervisor of midwives include the following:
(see page 74). If you have a straightforward
You may need to transfer
pregnancy and both you and the
You may also want to seek the to a hospital if there are any
baby are well, you might choose
views of your friends and family. complications.
to give birth at home. In England,
See also Chapter 4 on antenatal approximately 1 in 50 babies is Epidurals are not available
care and Chapter 8 on labour born at home. at home.
and birth. If you give birth at home, you Your doctor or midwife may
will be supported by a midwife, recommend that you give
More information who will support you while you are birth in hospital, for example
in labour. If you need any help or if you are expecting twins or
your labour is not progressing as if your baby is breech. Your
well as it should, your midwife will midwife or doctor will explain
make arrangements for you to be why they think hospital is
transferred to hospital. safer for you and your baby.

The advantages of giving birth at Planning a home birth


home include the following: Ask your midwife whether or not
You can give birth in familiar a home birth is suitable for you
surroundings where you may feel and your baby or available to you.
more relaxed and able to cope. If it is, your midwife will arrange
for members of the midwifery
You dont have to interrupt your
team to support and help you.
labour to go into hospital.
You will not need to leave your Here are some of the questions
www.nhs.uk/pregnancyplanner other children. that you might want to ask:
www.birthchoiceuk.com You will not have to be separated How long would it take if
www.drfoster.co.uk/Guides/ from your partner after you needed to be transferred
BirthGuide/ the birth. to hospital?

www.nct.org.uk/home You are more likely to be looked Which hospital would you be
after by a midwife who you transferred to?
have got to know during your Would a midwife be with you
pregnancy. all the time?
How do you obtain a
birthing pool?

71
The advantages of giving birth
at a midwifery unit include the
following:
You can give birth in surroundings
where you may feel more relaxed
and able to cope with labour.
You are more likely to be looked Planning a birth in
after by a midwife who you
have got to know during your
a midwifery unit
pregnancy. or birth centre
Midwifery care is available at
The things you should consider home, in a midwifery unit and
include the following: in hospital. Ask your midwife if
You may need to transfer there are any midwifery units
to a hospital if there are any or birthing centres in your area.
complications. There may be others that you can
use if you are prepared to travel.
MIDWIFERY UNITS Epidurals are not available in
a midwifery unit. Here are some of the questions that
OR BIRTH CENTRES you might want to ask:
Your doctor or midwife may
Birth centres and midwifery recommend that it is safer for How long would it take if you
units are home-from-home places you and your baby to give birth needed to be transferred to
where you can go to have your in hospital. hospital?
baby. These units can be part of
a general hospital maternity unit, Which hospital would you be
in a smaller community hospital transferred to?
or completely separate. Will a midwife be with you all
thetime?

the Can you visit the unit before you


give birth?
What facilities are available?

choices
Arethere birthing pools,
for example?

that are right


for you

72
BIRTH IN 6
HOSPITAL
Most women give birth in an
NHS hospital maternity unit.

CHOOSING WHERE TO HAVE YOUR BABY


If you choose to give birth in Planning a hospital birth
hospital, you will be looked after
Your midwife can help you decide at which hospital you want to have
by a midwife but doctors will be
your baby. If there is more than one hospital in your locality you can
available if you need their help.
choose which one to go to. Find out more about the care provided
You will still have choices about
in each so that you can decide which will suit you best.
the kind of care you want.
Your midwife and doctors will Here are some of the questions that you might want to ask:
provide information about what
Are tours of maternity facilities for birth available before the birth?
your hospital can offer.
When can I discuss my birth plan?
Are TENS machines available (see page 89) or do I need to hire one?
What equipment is available e.g. mats, a birthing chair or
beanbags?
Are there birthing pools?
Are partners, close relatives or friends welcome in the delivery room?
Are birthing partners ever asked to leave the room? Why?
Can I move around in labour and find my own position for the birth?
The advantages of giving birth
What services are provided for sick babies?
in hospital include the following:
Who will help me breastfeed my baby?
You have direct access to
Who will help me if I choose to formula feed?
obstetricians, anaesthetists and
neonatologists. How long will I be in hospital?
You can access other specialist What are the visiting hours?
services, such as epidurals for
relief of pain.
There will be a special care baby
unit if there are any problems.
The things you should consider
include the following:
You may go home directly from
the labour ward or you may be
moved to a postnatal ward.
In hospital, you may be looked
after by a different midwife
from the one who looked after
you during pregnancy.

73
BIRTH PLANS If you dont have access to a more fully with the babys father
computer, ask your midwife to print and friends and relatives. And you
A birth plan is a record of what out a copy of a birth plan from the can change your mind at any time.
you would like to happen during NHS Choices website. Discussing
Your birth plan is personal to you.
your labour and after the birth. a birth plan with your midwife will
It will depend not only on what
To see an example of a birth plan, give you the chance to
you want, but also on your medical
visit the online pregnancy planner at ask questions and
history, your own circumstances and
www.nhs.uk/birthplan. You dont find out more about
what is available at your maternity
have to create a birth plan, but if what happens
service. What may be safe and
you want to, your midwife will be when you are in
practical for one pregnant woman
able to help. labour. It also gives
may not be a good idea for another.
your midwife the
chance to get to You may be given a special form
know you better for a birth plan, or there may be
and understand room in your notes. Its a good
your feelings and idea for you to keep a copy of your
priorities. birth plan with you. The maternity
team who care for you during
You will probably
labour will discuss it with you so
want to think
that they know what you want. But
about or discuss
remember, you need to be flexible if
some things
complications arise with you or the
baby. The maternity team will be
able to give advice on your particular
What is a midwife? circumstances. Dont hesitate to ask
questions if you need to.
A midwife is a healthcare professional who is
qualified to care for women during pregnancy, Read the chapters on labour and
labour and after the baby is born. They also birth (page 85) and the first days
care for newborn babies until they are 28 days with your new baby (page 120)
old, if necessary. Midwives provide care for before talking to your midwife,
all women and involve other members of the to see if there is anything you feel
team, including doctors when necessary. strongly about and want to include.
Midwives help women prepare for birth
through antenatal education and provide
advice about common problems. A nursing
qualification is not necessary to become a
midwife, although some midwives have one.
What is a supervisor of midwives?
A supervisor of midwives is an experienced midwife who has had extra PALS
training and education to assist and support midwives in providing the
The Patient Advice and Liaison
best quality maternity care. Supervisors of midwives aim to make sure
Service, known as PALS, has been
that you receive the best guidance and information about the right
introduced to ensure that the NHS
type of care for you. They are there to help and support you if you are
listens to patients, their relatives,
having any problems with your care, or if you feel that your wishes and
carers and friends and answers
requests are not being considered.
and resolves their concerns as
The telephone number for your supervisor of midwives should be in quickly as possible. If you have any
your pregnancy information details (or hand-held notes), or you can suggestions or complaints about
call your hospitals labour ward/birthing room or your local birth centre. your care, make contact with the
Discussing issues with the supervisor of midwives will not affect your PALS service based in hospitals
care or influence how you are further supported in your pregnancy, in the first instance. For more
birth and aftercare. information visit www.pals.nhs.uk

74
FEELINGS
AND RELATIONSHIPS

GETTING PREGNANT
Feelings 75 Family and friends 80
Depression and mental health problems 76 Work 80
Worrying about the birth 77 After the birth 81
Concerns about disabilities 77 Mood changes that can develop
Couples 78 after the birth of a baby  81
Sex in pregnancy 78 Domestic abuse 83
Single parents 79 Bereavement 84

From the minute you know you are pregnant, your feelings change: feelings about yourself,
about the baby and about your future. Your relationships change: with your partner, other
children and also with your parents and friends. Coping with these changes is not always easy.

This chapter is about some of the worries that may come up in pregnancy and suggestions
on how to handle them. What is a problem for one person may not be a problem for you,
and what is helpful advice for some people may not be right for you. So take from these
pages what you find useful.

FEELINGS Hormonal changes


and tiredness
When you are pregnant it can
Hormonal changes taking place in
sometimes seem as though you
your body can make you feel tired,
have to be happy all of the time.
nauseous, emotional and upset
You may find that people expect
particularly in the first three months.
you to look forward to the baby,
You may find that you cry more
be excited and to bloom all the
easily, sometimes for no reason,
time. You too may think that
and lose your temper more.
this is the way you ought to feel.
Being tired and run down can
In fact, you are likely to have ups
make you feel low. Try to look
and downs, just like any other
after your physical health and
nine months in your life.
get plenty of sleep (see Chapter 3
on your health in pregnancy).

Help and support

If you are feeling very anxious


for whatever reason talk to
your midwife or doctor as soon
as possible.

75
Depression AnD
mentAl heAlth
problems
Its normal to have some worries
while you are pregnant and to
feel a bit down from time to
time. But it is a cause for concern
if you are feeling down most of
the time. Whatever the reason
for your unhappiness, or even
Anxiety Dreams if there doesnt seem to be any
It is quite normal to feel anxious It is normal to have dreams about reason at all, explain how you feel
and worried when you are pregnant your baby. Sometimes your dreams to your midwife, doctor or health
especially if this is your first may reflect your anxieties. This is visitor (see page 54 to find out
pregnancy. There are a number of often because you are thinking who is who). Make sure that they
things that you may feel anxious much more about your pregnancy understand that you are talking
about. You may find antenatal tests and the changes that are happening
stressful because of the possibility in your body. Talk to your midwife if
that something may be wrong. you are worried by this.
You may be worried about practical Ways of coping
things like money, work or where Sometimes it helps to share
you are going to live. You may be anxieties with other pregnant
anxious about whether you will women.
cope as a parent, or about whether
you are ready to be a parent. Discuss any worries, concerns or
Some of these anxieties could be anxieties you have with someone about something more than just
shared by your partner, friends you feel you can talk to. This could feeling low. Some women do get
or family. It is a good idea to talk be your midwife, your partner, depressed during pregnancy and
through these feelings together. your friends or family. you may need treatment to help
you deal with it.
If you have had a mental health
problem in the past, then you
might be at risk of becoming ill
with a depressive illness during
pregnancy and childbirth. It is
important that you tell your midwife
at the start of your pregnancy about
any previous illness. If your mood

discuss
changes throughout the pregnancy
then let someone know how you
are feeling; dont suffer alone

your you can be helped.

feelings
76
Antenatal education will
also help to prepare you
Talk to your partner or someone
close to you. They may be feeling 7
for labour and the birth anxious too particularly if they
and to know what to are going to be with you in labour.
expect (see page 56). Together, you can then work out
ways that will help you to cope.

FEELINGS AND RELATIONSHIPS


You will have an
opportunity to discuss
this in more detail with your
midwife, and to draw up a birth antenatal
plan, during the later months of
pregnancy (see page 74). education
will help
prepare
you
CONCERNS ABOUT DISABILITIES
At some time during pregnancy, most expectant parents worry
WORRYING that there may be something wrong with their baby. Some people
ABOUT THE BIRTH find that talking openly about their fears helps them to cope.
Others prefer not to think about the possibility that something
Many women worry about could be wrong.
whether they can cope with the
pain they will experience during Some women worry because they are convinced that if something
labour and while giving birth. does go wrong it will be their fault. You can increase your babys
It is difficult to imagine what a chances of being born healthy by following the advice outlined
contraction is like and no one can in Chapter 3. But there are certain problems which cannot be
really tell you though they may prevented. This is either because the causes are not known or
try! Exploring ways of coping with because they are beyond your control.
labour may help you to feel more Of all the babies born in the UK, 97% are healthy and 1% of
confident and more in control. babies will be born with abnormalities that can be partly or
You can begin by reading the completely corrected, such as extra fingers or toes. About 2%,
chapter on labour and birth however, will suffer from some more severe disability. Regular
(page 85) with your partner or antenatal care and careful observation during labour helps to
a friend or relative who will be pick up any potential problems and allow appropriate action
with you for the birth. Ask your to be taken.
midwife or doctor for any further If you are particularly concerned perhaps because you or
information, and look on the someone in your family has a disability talk to your midwife
internet (www.nhs.uk/pregnancy). or doctor as soon as possible.
They may be able to reassure you or offer you helpful information
about tests which can be done during pregnancy (see Chapter 4).
If you have previously had a baby with an abnormality or disability,
talk to your midwife or doctor and see if you need any additional
care during this pregnancy.

77
COUPLES you is worried about the future babys birth. The chapter on labour
and how you are going to cope. and birth (page 85) gives some
Pregnancy will bring about big Its important to realise that during suggestions for ways in which
changes to your relationship, pregnancy there are understandable fathers can help, and what it can
especially if this is your first baby. reasons for the odd difficulty mean for them to share
Some people cope with these between you, and good reasons for this experience.
changes easily, others find it harder. feeling closer and more loving.
If your relationship is particularly
Everybody is different.
One practical question you will need problematic, or is abusive, do get
It is quite common for couples to to discuss is how you will cope with help. For sources of confidential
find themselves having arguments labour, and whether your partner support, like Relate or Womens
every now and then during wants to be there. Many fathers Aid, refer to the list of useful
pregnancy, however do want to be present at their organisations featured at the back
much they of the book (see page 182).
are looking
It may be that you do not
forward to the
have a partner in this
baby. Some
pregnancy and you need
arguments
extra support from family
may be
or friends. You may wish
nothing to
to talk to your midwife
do with the
about services that may
pregnancy, but
be available. See Single
others may be
parents opposite.
because one of

SEX IN PREGNANCY
It is perfectly safe to have sex during normal for your sex drive to change while others simply feel that they
pregnancy. Your partners penis and you should not worry about this, dont want to have sex. You can
cannot penetrate beyond your but do talk about it with your partner. find other ways of being loving
vagina, and the baby cannot tell or of making love. The most
Later in pregnancy, an orgasm
what is going on! However, it is important thing is to talk about
or even sex itself can set off
your feelings with each other.
contractions (known as Braxton
Hicks contractions see page 87). While sex is safe for most
You will feel the muscles of your couples in pregnancy, it may not
uterus go hard. There is no need for be all that easy. You will probably
alarm, as this is perfectly normal. need to find different positions.
If it feels uncomfortable, try your This can be a time to explore
relaxation techniques or just lie and experiment together. Even
quietly till the contractions pass. early in pregnancy it can become
uncomfortable to have sex with
Your midwife or doctor will probably
your partner on top. This can
advise you to avoid sex if you have
be because of your bump or
any heavy bleeding in pregnancy,
because your breasts are tender.
since this risks infection in the baby
It can also be uncomfortable if
especially if your waters have
your partner penetrates you too
broken (see page 87).
deeply. So it may be better to lie
Some couples find having sex on your sides.
very enjoyable during pregnancy,

78
Help and support
7
thecoupleconnection.net
thecoupleconnection.net
is an innovative new service

FEELINGS AND RELATIONSHIPS


developed by One Plus One,
the UKs leading relationships
research organisation.
thecoupleconnection.net
has been designed to help
couples to cope with
changes and to strengthen
their relationships. Visit
www.thecoupleconnection.net

SINGLE PARENTS with labour on your own. You have


as much right as anyone else to
If you are pregnant and on your take whoever you like a friend,
own, it is important that there sister, or perhaps your mum. Involve
are people who can support you. your labour partner in antenatal
Sorting out problems, whether classes if you can, and let them
personal or medical, is often know what you want from them.
difficult when you are by yourself, Ask your midwife if there are
and its better to find someone antenatal classes in your area that
to talk to rather than to let things are run especially for single women.
get you down. You may find
Think about the people who can
it encouraging to meet other
help and support you. If there is no
mothers who have also gone
one who can give you support, it
through pregnancy on their own.
might help to discuss your situation
Dont feel that, just because you with a social worker. Your midwife
dont have a partner, you have to can refer you or you can contact
go to antenatal visits and cope the social services department of
your local council directly.
Help and support

One Parent Families/Gingerbread


One Parent Families/Gingerbread (see page 184) is a self-help organisation
for one-parent families that has a network of local groups which can offer
you information and advice. They will be able to put you in touch with
other mothers in a similar situation.
If money is an immediate concern, see the chapter on rights and benefits
(page 156) for information on what you can claim and your employment
rights. Your local Jobcentre Plus or Citizens Advice Bureau (CAB) will be
able to give you more advice. If you have housing problems, contact your
local CAB or your local housing advice centre. Ask your local authority at
the town hall for the address.
Lone Parent Helpline
Call free on 0800 018 5026 (9am5pm, MonFri; 9am8pm, Wed).

79
More information
FAMILY AND WORK
FRIENDS Families Information
If you work, and you like the people
Service
Pregnancy is a special time for you you work with, you may have mixed
Your local Families Information feelings when you go on maternity
and your partner, but there may
Service (which may be called leave. Try to make the most of these
be a lot of people around you who
something else in your local few weeks to enjoy doing the things
are interested in your baby, such
area) can provide information you want to do at your own pace.
as your parents, sisters, brothers
about registered childcare, It is also a good opportunity to make
and friends.
free early education places some new friends. You may meet
People can offer a great deal of help and other services available other mothers at antenatal classes
in all sorts of ways, and you will in your area. (see page 56) or you may get to
probably be very glad of their interest know more people living close by.
You can contact them on
and support. Sometimes it can feel
0800 2 346 346. You can also You may have decided that you are
as if they are taking over. If so, it can
search www.childcarelink. going to spend some time at home
help everyone if you explain gently
gov.uk for your local Families with your baby, or you may be
that there are some decisions that
Information Service or look on planning to return to work, either
only you and your partner can take,
your local authoritys website full or part-time, fairly soon after the
and some things that you would
for more details. birth. If you think that you will be
prefer to do on your own.
going back to work, you need
You may also find that being to start thinking about who will
pregnant puts you on the receiving look after your baby in advance.
end of a lot of advice, and perhaps It is not always easy to find
a bit of criticism too. Sometimes satisfactory childcare arrangements,
the advice is helpful, sometimes and it may take you some time.
not. Sometimes the criticism can
really hurt. The important thing is You may have a relative willing
to decide what is right for you it is to look after your child. If not,
your pregnancy and you should contact your Families
your baby. Information Service for a list
of registered childminders and
nurseries. You may also want to
think about organising care in
your own home, either on your
own or sharing with other parents.
Care in your own home does not
need to be registered, but you
should make sure that your carer
is experienced and trained to care
for babies. However, if you are to
claim financial help with the costs,
either through tax credits or tax
relief on help from your employer,
the carer must be approved
through the governments
Childcare Approval Scheme.
You can find out more at www.
childcareapprovalscheme.co.uk

80
MOOD CHANGES 7
THAT CAN
DEVELOP AFTER
THE BIRTH

FEELINGS AND RELATIONSHIPS


OF A BABY
If you experience any of the
following mood changes, do not feel
ashamed of how you are feeling.
You are not alone: asking for and
accepting help is the first stage of
recovery particularly for the more
serious conditions. If you think you
are in any way depressed, talk to a
healthcare professional as soon as
you can. Your midwife, health visitor
and GP are all trained to help you,
and many voluntary organisations
offer advice (see the list of useful
organisations on page 182).

The baby blues


AFTER THE BIRTH Whether this is your first, second or As many as 8 out of 10 women
third baby, the first few weeks of get what is commonly called
Having a baby and becoming a parenthood are both physically and the baby blues. It normally
parent are major events for both emotionally tiring. It can be difficult begins within a few days of the
you and your partner. Becoming to find time for yourself, your partner babys birth.
a parent usually brings changes or your family when you have the
24-hour demands of a new baby to How does it affect you?
to your home life, social life and
relationships. Parents of a new baby deal with. Meeting the needs of a Common reactions are to burst
experience a variety of emotions baby can be rewarding, but in the into tears for no obvious reason,
after the birth. You will feel happy weeks and months following the or to feel on top of the world one
and proud of yourself, or possibly birth of a baby you can feel stressed. minute and miserable the next. It is
relieved that it is all over. not unusual to feel anxious or tense,
It is likely that during the first few lacking in confidence or worried.
weeks and months of parenthood
you will feel a mixture of emotions. Remember that having a baby
Your health visitor will be available can turn your world upside down.
to talk to you, but it is important In the first few weeks and months
that you talk honestly to your you are likely to feel emotionally
partner, friends or family about and physically drained. Becoming
how you feel. a parent for the first time can
feel like an overwhelming
Being a parent means constantly responsibility and it is very easy
experiencing new events and to feel inadequate when other
carrying out new tasks. You will parents around you seem to be
have to learn a new set of skills to coping well. You may expect to
cope with these situations. Women love your baby immediately, but
do not automatically know how this can take a while and is not
to be a mother and men do not always instinctive, and does not
automatically know how to be mean that you are not a good
a father. It is something that you or natural mother. Many women
learn over time. experience these feelings.

81
If you have twins or triplets, you are
more likely to experience postnatal
and longer-term depression. This
is mainly because of the additional
stress of caring for more than one
baby. Getting out of the house can
be difficult and this can make you
feel isolated. Tamba (see page 188)
can help you to make contact with
other mothers through local twins
clubs and through their helpline,
Tamba Twinline (0880 138 0509).

Postnatal post
When you have a baby your life Postnatal depression traumatic stress
changes, so dont be too hard on disorder and
Postnatal depression affects 1 in 10
yourself you are only human. We women following the birth of their
birth trauma
all learn to be a parent when we baby. It usually begins in the first six Post traumatic stress disorder
actually have a baby, not before. months after childbirth, although symptoms may occur on
Give yourself plenty of time to for some women the depression their own or with postnatal
adjust to your new life. Find time begins in pregnancy. It can occur at depression. The reasons women
to rest and eat a good diet, as this any time within the first year of the develop this are unclear, but
will help you to become and stay birth of your baby. women often describe feeling
physically and emotionally healthy. out of control and very afraid
How does it affect you? during the birth. This condition
Talk to someone you can trust
If you get postnatal depression, you can be caused by:
such as your partner, your mum, a
can feel as if you are taken over by a
friend, or to your midwife or health a fear of dying or your baby
feeling of hopelessness. You may feel
visitor, about how you are feeling. dying, or
angry, but more often you will feel
It can help a lot just to confide in
too exhausted to be angry or even life-threatening situations.
someone else. Once they know how
to cope with the simplest tasks.
you are feeling, they will be able to How does it affect you?
give you support. Postnatal depression is serious, and if The symptoms include flashbacks,
it is left untreated it can last for longer nightmares, panic attacks,
If you become more unhappy or
than a year. However, early diagnosis numbed emotions, sleeping
upset, or if your low mood lasts
and treatment of postnatal depression problems, irritable, angry and
more than a week, then you are
will result in a faster recovery. Quite irrational behaviour.
probably experiencing something
often a partner or close family friend
other than the baby blues. In these If you get any of these symptoms,
will recognise that there is something
circumstances, you should talk you need to talk to someone
wrong before you do.
to your midwife, health visitor or about how you are feeling;
doctor especially if you have had If you think you are depressed, your midwife, GP or health
depression before. contact your GP, midwife or health visitor will be able to advise
visitor and explain how you are where to get help.
feeling. Your partner or a friend
could contact them for you if you
want. You can also contact the
Association for Post-Natal Illness (see
page 186) for more information.

82
Puerperal psychosis DOMESTIC ABUSE Help and support
7
This is a much more rare and serious
One in four women experience Domestic abuse
condition, which affects about 1 in
domestic abuse at some point in
500 new mothers. Women with a If you are in immediate
their lives. This may be physical,
family history of mental illness or danger, call 999.
sexual, emotional or psychological

FEELINGS AND RELATIONSHIPS


who have suffered from puerperal
abuse. Of this, 30% starts in For information and support
psychosis in previous pregnancies
pregnancy, and existing abuse may call the freephone, 24-hour
are at a higher risk of developing
get worse during pregnancy or National Domestic Violence
this illness.
after giving birth. Domestic abuse Helpline, run in partnership
Symptoms include hallucinations during pregnancy puts a pregnant between Refuge and Womens
(seeing or hearing things that others woman and her unborn child in Aid: 0808 2000 247
cannot), delusions (incredible beliefs danger. It increases the risk of
such as thinking you must save miscarriage, infection, premature Refuge
the world) and mania (extremely birth, low birth rate, fetal injury www.refuge.org.uk
energetic and bizarre activity like and fetal death. Domestic abuse
Womens Aid
washing and ironing clothes in the should not be tolerated.
www.womensaid.org.uk
middle of the night).
If you are pregnant and being
How does it affect you? abused, there is help available.
The symptoms of this illness can You can speak in confidence to your
be very severe and sometimes very GP, midwife, obstetrician, health
frightening for you, your partner, visitor or social worker. Or call the
and your family. In fact, your partner confidential National Domestic
may be the first to notice that you Violence Helpline number (see
are unwell. It is important that your right) for information and support.
partner or someone close to you For further sources of confidential
knows the symptoms to look out support, refer to page 184.
for. They will appear suddenly, often
within the first two weeks following
the birth of the baby. Seeking help
quickly will ensure that you are
treated as early as possible, to help
you get well again.
Women with this illness are often
treated in hospital. Mother and
baby units are available so that
you will not be separated from
your baby.

there is
help
available
83
Benefits and advice BEREAVEMENT Dont be afraid to lean on your
if your partner family and friends. If your partner
has died The death of someone you love was going to be with you at the
can turn your world upside down, birth, you will need to think about
The following leaflets are
and is one of the most difficult who will be with you instead.
produced by the Department
experiences to deal with. This may Try to choose someone who knows
for Work and Pensions
be harder to cope with if you are you very well.
(www.dwp.gov.uk):
pregnant or have just had a baby. Financially, you may need urgent
What to do after a death in advice and support. You can get
Family and friends can help you
England and Wales (DWP1027) the recommended leaflets (see box)
by spending time with you.
The Social Fund (DWP1007) A sympathetic arm around the from your local Jobcentre Plus.
(available from www.dwp.gov. shoulders can express love and As well as speaking to friends, family
uk to download only) support when words are not enough. and social services, you may like to
A guide to the Social Fund Grief is not just one feeling but a contact Cruse (see page 186).
(SB16) whole succession of feelings, which
take time to get through and which
Having a baby (DWP1031) cannot be hurried. If you need
Read Chapter 17 for advice help or advice, contact your GP or
about the following: midwife or any of the organisations
listed on page 186.
Income Support
If your partner dies
Housing Benefit
If your partner dies during your
Working Tax Credit pregnancy or soon after childbirth,
you will feel emotionally numb.
Council Tax Benefit
It may not be something that you
Child Benefit get over more something that you
eventually learn to live with.
Child Tax Credit
If you were married and your
partner worked, you may be
entitled to Widowed Parents
Allowance, based on your
partners National Insurance
contributions.
If you were not married, you will
not be classed as a widow and
will therefore be dependent on
your private arrangements, on
Income Support or on Working
Tax Credit.
If you are on a low income
you may be able to get some
help with the funeral expenses
from the Social Fund. It is
always worth talking to your
undertaker or religious adviser
to see if they can help.
For more information, contact
your local Jobcentre Plus or look
at www.jobcentreplus.gov.uk

84
LABOUR
AND BIRTH
Getting ready 85 Arriving at the hospital or
The signs of labour 87 midwifery unit 91
Types of pain relief 88 What happens in labour 92
When to go to hospital Special cases 96
or your midwifery unit 90 Twins, triplets or more 100
What your birth partner can do 101

Going into labour is exciting, but you may also feel apprehensive, so it helps to be
prepared well in advance. Knowing all about the stages of labour and what to expect
can help you to feel more in control when the time comes.

GETTING READY Two or three comfortable Towels.


and supportive bras, including Things that can help you pass
Whether you are having your nursing bras if you are planning the time and relax, e.g. books,
baby at home, in hospital or at a to breastfeed. Remember, your magazines, MP3 player.
midwifery unit, you should get a breasts will be much larger
few things ready at least two weeks than usual. A sponge or water spray to cool
before your due date. you down.
About 24 super-absorbent
sanitary towels. Front-opening nightdresses
Packing your bag if you are going to breastfeed.
If you plan to give birth in hospital Your wash bag with toothbrush,
hairbrush, flannel, etc. Dressing gown and slippers.
or a midwifery unit, your midwife will
probably give you a list of what you Five or six pairs of pants.
will need to pack. You may want to A loose, comfortable outfit to
include the following: wear after you have given birth
and to come home in.
Something loose and comfortable
to wear during labour. It should not Clothes (including a hat) and
restrict you from moving around or nappies for the baby.
make you too hot. You may need A shawl or blanket to wrap
about three changes of clothes. the baby in.

85
Mobile phones Stocking up
Some hospitals and midwifery units When you come home you
will allow you to use your mobile will not want to do much
phone. Check with your midwife. If more than rest and care for
you cannot use your mobile, make your baby, so do as much
sure that you have aphone card or planning as you can in
change for the phone. advance:
Stock up on basics, such
as toilet paper, sanitary
Transport towels and nappies.
Work out how you will get to If labour starts early
Buy tinned and dried food
hospital or the midwifery unit, as it Labour can start as early as like beans, pasta and rice.
could be at any time of the day or 24 weeks. If this happens,
night. If you are planning to go by If you have a freezer, cook
call your midwife or
car, make sure that its running well some meals in advance.
hospital immediately.
and that there is always enough
petrol in the tank. If a neighbour has
said that they will take you, make
an alternative arrangement just in
case they are not in. If you have not
got a car, you could call a taxi. Or
call your maternity unit, which can
arrange for an ambulance to pick
you up. Try to do so in good time.

Home births
If you are planning to give birth at
home, discuss your plans and what
you need to prepare with your
midwife. You are likely to need
the following:
clothes (including a hat) and
nappies for the baby
about 24 super-absorbent
sanitary towels.
Important numbers
Keep a list of important numbers in your handbag
or near your phone. There is space for you to write
them down at the back of this book.
You need to include the following:
Your hospital and midwifes phone numbers.
Your partner and birth partners phone numbers.
Your own hospital reference number (it will be
on your card or notes). You will be asked for
this when you phone in.
A local taxi number, just in case you need it.

86
THE SIGNS OF The show. The plug of mucus
8
in the cervix, which has helped to
LABOUR seal the uterus during pregnancy,
You are unlikely to mistake the comes away and comes out of
signs of labour when the time the vagina. This small amount of
sticky pink mucus is called the

LABOUR AND BIRTH


really comes, but if you are in any
doubt, dont hesitate to contact show. It usually comes away
your midwife. before or in early labour. There
should only be a little blood mixed
Regular contractions in with the mucus. If you are
During a contraction, your uterus losing more blood, it may be a
gets tight and then relaxes. You may sign that something is wrong, so
have had these throughout your phone your hospital or midwife
pregnancy particularly towards the straight away.
end. Before labour, these are called Your waters break. The bag
Braxton Hicks contractions. When of water surrounding your baby
you are having regular contractions may break before labour starts.
that last more than 30 seconds and Toprepare for this, you could keep
begin to feel stronger, labour may a sanitary towel (not a tampon)
have started. Your contractions handy if you are going out, and
will become longer, stronger and put a plastic sheet on your bed.
more frequent. Ifyour waters break before labour
Pain relief in labour
starts, you will notice either a Labour is painful, so it is important
Other signs of labour slow trickle from your vagina to learn about all the ways you can
Backache or the aching, heavy or a sudden gush of water that relieve pain. Whoever is going to be
feeling that some women get you cannot control. Phone your with you during labour should also
with their monthly period. midwife when this happens. know about the different options,
as well as how they can support
Nausea or vomiting. you. Ask your midwife or doctor
Diarrhoea. to explain what is available so that
you can decide what is best for you.
Write down what you want in your
birth plan, but remember that you
should keep an open mind. You
may find that you want more pain
relief than you had planned, or your
doctor or midwife may suggest
more effective pain relief to help
the delivery.

has
the time
come?
87
TYPES OF PAIN Have a partner, friend or relative
to support you during labour.
RELIEF If you dont have anyone, dont
worry your midwife will give you
Self-help all the support you need.
The following techniques can help
you to be more relaxed in labour, Ask your partner to massage you
and this can help you to cope (although you may find that you
with the pain. dont want to be touched).
Have a bath.
Learn about labour. This can
make you feel more in control
and less frightened about what
is going to happen. Read books
like this one, talk to your
midwife or doctor and attend Gas and air (Entonox)
antenatal classes if they are This is a mixture of oxygen and
available in your area. another gas called nitrous oxide.
Gas and air will not remove all
Learn how to relax and stay
the pain, but it can help to reduce
calm. Try breathing deeply.
it and make it easier to bear. Many
Keep moving. Your position women like it because its easy to
can make a difference. Hydrotherapy use and you control it yourself.
Try kneeling, walking around
Water can help you to relax How it works
or rocking back and forwards.
and can make the contractions
You breathe it in through a mask
seem less painful. Ask if you
or mouthpiece which you hold
can have a bath or use a
yourself. You will probably have a
birth pool. The water will be
chance to practise using the mask
kept at a temperature that is
or mouthpiece if you attend an
comfortable for you but
antenatal class.
it will not be above 37C.
Your temperature will be The gas takes 1520 seconds to
monitored closely. work, so you breathe it in just as
a contraction begins. It works best
if you take slow, deep breaths.
Side effects
There are no harmful side effects
for you or the baby, but it can
make you feel lightheaded. Some
women also find that it makes
them feel sick or sleepy or unable to
concentrate on what is happening.

staying
calm
If this happens, you can simply
stopusingit.

will help
88
TENS Intramuscular
TENS stands for transcutaneous injections of pain-
8
electrical nerve stimulation. Some relieving drugs
hospitals have TENs machines. If not, Injections of drugs like pethidine or
you can hire your own machine. diamorphine can help you to relax,

LABOUR AND BIRTH


TENS has not been shown to be and this can lessen the pain.
effective during the active phase of How it works
labour. It is probably most effective
You are given an intramuscular
during the early stages, when many
injection. It takes about 20 minutes
women experience lower-back pain.
to work and the effects last
TENS may be useful if you plan to between two and four hours.
give birth at home or while you
Side effects
are at home in the early stages of
labour. If you are interested in TENS, It can make some women feel
very woozy, sick and forgetful. A very small tube will be placed
you should learn how to use it in
into your back near the nerves
the later months of your pregnancy. If it has not worn off towards
that carry pain from the uterus.
Ask your midwife or physiotherapist. the end of labour, it can make it
Drugs (usually a mixture of local
difficult to push. You might prefer
How it works anaesthetic and opioid) are then
to ask for half a dose initially, to
Electrodes are taped onto your back administered through this tube.
see how it works for you.
and connected by wires to a small, It takes about 20 minutes to get
If pethidine or diamorphine are the epidural set up and then
battery-powered stimulator known
given too close to the time of another 1015 minutes for it to
as an obstetric pulsar. Holding the
delivery, it may affect the babys work. Occasionally it doesnt work
pulsar, you give yourself small, safe
breathing. If it does, an antidote perfectly at first, and needs to
amounts of current. You can move
may be given. be adjusted.
around while using it.
The drugs can interfere with After it has been set up, the
breastfeeding. epidural can be topped up by
an anaesthetist or midwife, or
Epidural analgesia
you may be given a machine
An epidural is a special type of which will let you top up the
local anaesthetic. It numbs the epidural yourself.
nerves which carry pain from the
birth canal to the brain. For most Your contractions and the babys
women, an epidural gives complete heart will need to be continuously
pain relief. It can be very helpful for monitored by a machine. This
women who are having a long or means having a belt round your
particularly painful labour, or who abdomen and possibly a clip
are becoming very distressed. attached to your babys head.

An anaesthetist is the only person Side effects


who can give an epidural. If you Epidurals may make your legs
think you are going to want one, heavy. It depends on the type
It is believed that TENS works by
check whether anaesthetists are of epidural that you have.
stimulating your body to produce
more endorphins, which are the always available at your hospital. An epidural should not make
bodys own natural painkillers. How it works you feel drowsy or sick.
It also reduces the number of pain Your blood pressure can drop.
A drip will run fluid into a vein in
signals that are sent to the brain This is rare, as the drip in your
your arm.
by the spinal cord. arm will help you to maintain
While you lie on your side or
Side effects good blood pressure.
sit up in a curled position, an
There are no known side effects anaesthetist will clean your back Epidurals can prolong the second
for either you or the baby. with antiseptic and numb a small stage of labour. If you can no
area with some local anaesthetic. longer feel your contractions,
89
the midwife will have to tell you Alternative methods WHEN TO GO
when to push. This may mean of pain relief
that instruments are used to help TO HOSPITAL
you deliver your baby. However, OR YOUR
when you have an epidural, your
midwife or doctor will wait longer
MIDWIFERY UNIT
before they use instruments If it is your first pregnancy, you may
as long as your baby is fine. feel unsure about when you should
Sometimes, less anaesthetic is go into hospital. The best thing
given towards the end so that the todo is call your hospital or unit
effect wears off and you can push foradvice.
the baby out naturally.
You may find it difficult to pass
water, and a small tube called a
catheter may be put into your
bladder to help you.
About 1 in 100 women gets a
headache after an epidural. If you
develop a headache afterwards,
it can be treated. Some women want to avoid the
Your back might be a bit sore for above methods of pain relief and
a day or two, but epidurals do not choose acupuncture, aromatherapy,
cause long-term backache. homeopathy, hypnosis, massage
and reflexology. Most of these
About 1 in 2,000 mothers gets If your waters have broken, you
techniques do not provide very
a feeling of tingling or pins and will probably be told to go in to
effective pain relief. However, if
needles down one leg after having bechecked.
you would like to use any of these
a baby. This is more likely to result
methods it is important to discuss it If it is your first baby and you
from childbirth itself than from an
with your midwife or doctor and to are having contractions but your
epidural. You will be advised on
let the hospital know beforehand. waters have not broken, you may
when you can get out of bed.
Most hospitals do not offer them be told to wait. You will probably
for the relief of pain during labour. be told to come in when your
If you want to try one of these contractions are regular, strong,
alternative techniques, make sure are about five minutes apart and
that the practitioner you use is are lasting about 60 seconds.
properly trained and experienced
If you dont live near to your
and check with your midwife that
hospital, you may need to go
this will be available in the maternity
inbefore you get to this stage.
unit. For advice, contact the Institute
for Complementary and Natural Second and later babies often
Medicine (see page 183). arrive more quickly, so you may
need to contact the hospital,
midwifery unit or your
midwife sooner.
Keep active
Keep active in labour for as Dont forget to phone the hospital
long as you feel comfortable. or unit before leaving home, and
This helps the progress of remember your notes.
the birth. Dont do anything Home birth
strenuous but try and move
You and your midwife should have
or walk around normally.
agreed what you will do when
labour starts.

90
probably do an internal
examination to find out how 8
much your cervix has opened.
Tell her if a contraction is coming
so that she can wait until it has
ARRIVING AT passed. She will then be able

LABOUR AND BIRTH


to tell you how far your labour
THE HOSPITAL OR has progressed. If you would
MIDWIFERY UNIT prefer not to have an internal
examination you dont have Delivery rooms
Hospitals and midwifery units vary, to have one.
so the following is just a guide Delivery rooms have become
to what is likely to happen. Your These checks will be repeated at more homelike in recent years.
midwife will be able to give you intervals throughout your labour. Most have easy chairs, beanbags
more information about your local Ifyou and your partner have and mats so that you can move
hospital or unit. made a birth plan, show your about in labour and change
midwife so that she knows what position. Some have baths,
If you carry your own notes, take kind of labour you want and can showers or birthing pools.
them to the hospital admissions help you to achieve it. You should feel comfortable
desk. You will be taken to the in the room where you are
labour ward or your room, where giving birth.
you can change into a hospital
gown or a nightdress of your own.
Choose one that is loose and
Water births
preferably made of cotton, because
you will feel hot during labour and Some hospitals have birthing
will not want something tight. pools (or you can hire one if
there is not one available),
Examination by so that you can be in water
the midwife during labour. Many women
The midwife will ask you about find that this helps them to
what has been happening so far relax. It is possible to deliver
and will examine you. If you are the baby in the pool. Speak
having a home birth, then this to your midwife about the
examination will take place at advantages and disadvantages
home. The midwife will: of a water birth. If you want
one, you will need to make
take your pulse, temperature
arrangements in advance.
and blood pressure and check
your urine
feel your
abdomen to
Bath or shower
check the babys Some hospitals may offer you
position and a bath or shower. A warm bath
record or listen can be soothing in the early
to your babys stages of labour. Some women
heart, and like to spend much of their
labour in the bath as a way
of easing the pain.

91
To help yourself get over the urge
to push, try blowing out slowly
and gently or, if the urge is too
strong, in little puffs. Some people
find this easier lying on their side,
or on their knees and elbows, to
reduce the pressure of the babys
head on the cervix.

WHAT HAPPENS If you can, try to sleep. A warm bath


or shower may help you to relax.
IN LABOUR During the day, keep upright and
There are three stages to labour. gently active. This helps the baby
In the first stage the cervix gradually to move down into the pelvis and
opens up (dilates). In the second helps the cervix to dilate.
stage the baby is pushed down
the vagina and is born. In the third
stage the placenta comes away
from the wall of the uterus and
is also pushed out of the vagina.

The first stage of


labour dilation Fetal heart monitoring
The dilation of the cervix Your babys heart will be monitored
The cervix needs to open to throughout labour. Your midwife
about 10cm for a baby to pass will watch for any marked change
through. This is called fully dilated. in your babys heart rate, which
Contractions at the start of labour could be a sign that the baby is
help to soften the cervix so that it distressed and that something
gradually opens. Sometimes the needs to be done to speed up the
process of softening can take many delivery. There are different ways
hours before what midwives refer of monitoring the babys heartbeat.
to as established labour. This is Once labour is established, the If you dont feel comfortable with
when your cervix has dilated to at midwife will check you from one of these, tell your midwife.
least 4cm. time to time to see how you are Your midwife may listen to your
progressing. In a first labour, the babys heart intermittently, but
If you go into hospital or your
time from the start of established for at least one minute every
midwifery unit before labour is
labour to full dilation can be 15 minutes when you are in
established, you may be asked if
between 6 and 12 hours. It is established labour, using a
you would prefer to go home again
often quicker in subsequent hand-held ultrasound monitor
for a while, rather than spending
pregnancies. (often called a Sonicaid). This
extra hours in hospital.
Your midwife should be with method allows you to be free
If you go home, you should make to move around.
you all the time to support you.
sure that you eat and drink, as you
She will tell you to try not to push
will need energy. At night, try to
until your cervix is fully open and
get comfortable and relaxed.
the babys head can be seen.

92
Alternatively, a clip can be put
on your babys head to monitor
Your waters will be broken
(if this has not already 8
the heart rate. The clip is put on happened) during a vaginal
during a vaginal examination examination. This is often
and your waters will be broken enough to get things moving.
if they have not already done so.

LABOUR AND BIRTH


If this doesnt speed up labour,
Ask your midwife or doctor to you may be given a drip
explain why they feel that the containing a hormone, which
clip is necessary for your baby. is fed into a vein into your arm
Speeding up labour to encourage contractions.
You may want some pain relief
Your labour may be slower than
before the drip is started.
expected if your contractions
are not frequent or strong enough After the drip is attached,
or because your baby is in an your contractions and your
awkward position. babys heartbeat will be
continuously monitored.
Your babys heartbeat and your If this is the case, your doctor or
contractions may also be followed midwife will explain why they
electronically through a monitor think labour should be sped up
linked to a machine called a CTG. and may recommend the following
The monitor will be strapped to techniques to get things moving:
your abdomen on a belt.

supportand
Coping at the beginning encouragement
You can be up and moving about
if you feel like it.
You can drink fluids and may find
isotonic drinks (sports drinks) help
to keep your energy levels up.
You can also snack, although
many women dont feel
very hungry and some
feel nauseated.
As the contractions get stronger and
more painful, you can try relaxation and
breathing exercises. Your birthing
partner can help by doing
them with you.
Your birthing partner
can rub your back to
relieve the pain
if that helps.

93
The second stage
of labour the
babys birth
This stage begins when the cervix is
fully dilated, and lasts until the birth
of your baby. Your midwife will help
you to find a comfortable position
and will guide you when you feel
the urge to push.

Pushing When the head is visible, the


When your cervix is fully dilated, midwife will ask you to stop
you can start to push when you feel pushing, and to pant or puff
you need to during contractions: a couple of quick short breaths,
blowing out through your mouth.
Take two deep breaths as This is so that your babys head
the contractions start, and can be born slowly and gently,
push down. giving the skin and muscles of the
Take another breath when you perineum (the area between your
need to. vagina and back passage) time to
Give several pushes until the stretch without tearing.
contraction ends.

Find a position After each contraction, rest and


get up strength for the next one.
Find a position that you prefer
andwhich will make labour easier This stage is hard work, but your
for you. midwife will help and encourage
you all the time. Your birth partner
You might want to remain in bed can also give you lots of support.
with your back propped up with This stage may take an hour or
pillows, or you may wish to stand, more, so it helps to know how you
sit, kneel or squat. Squatting are doing.
may be difficult if you are not
used to it. The birth
If you are very tired, you might During the second stage, the
be more comfortable lying on babys head moves down until
your side rather than propped up it can be seen.
with pillows. This is also a better
position for your baby.
You may find kneeling on all fours
might be helpful if you suffer from
backache in labour.
It can help if you have tried out
some of these positions beforehand.

94
The skin of the perineum usually
stretches well, but it may tear. 8
Sometimes to avoid a tear or to
speed up the delivery, the midwife
or doctor will inject local anaesthetic
and cut an episiotomy. Afterwards,

LABOUR AND BIRTH


the cut or tear is stitched up again
and heals.
Once your babys 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 have your baby lifted straight
onto you before the cord iscut by
your midwife or birthing partner.
The third stage of prevent the heavy bleeding which
Your baby may be born covered some women experience.
with some of the white, greasy
labour the placenta
vernix, which acts as a protection After your baby is born, the uterus Let your baby breastfeed as soon
in the uterus. can contract to push out the after birth as possible. It helps with
placenta. Your midwife will offer breastfeeding later on and it also
Skin-to-skin contact you an injection in your thigh just as helps your uterus to contract.
Skin-to-skin contact really helps the baby is born, which will speed Babies start sucking immediately,
bonding, so it is a good idea to up the delivery of the placenta. although maybe just for a short
have your baby lifted onto you time. They may just like to feel
The injection contains a drug
before the cord is cut so that you the nipple in the mouth.
called Syntocinon, which makes
can feel and be close to each other
the uterus contract and helps to
straight away.

skin
The cord is clamped and cut, the
baby is dried to prevent them from
becoming cold, and you will be able

skin
to hold and cuddle your baby.

to
Your baby may be quite messy,
with some of your blood and
perhaps some of the vernix on
their skin. If you prefer, you can
ask the midwife to wipe your baby
and wrap him or her in ablanket
before your cuddle.
Sometimes mucus has to be
cleared out of a babys nose
andmouth. Some babies need
additional help to establish
breathing and may be taken to
the resuscitor in the room to be
given oxygen. Your baby will not
be kept away from you any longer
than necessary.

95
SPECIAL CASES Overdue pregnancies
Pregnancy normally lasts about
Labour that starts 40 weeks, which is approximately
too early (premature 280 days from the first day of your
labour) last period. Most women will go
About 1 baby in every 13 will into labour within a week either
be born before the 37th week side of this date.
After the birth of pregnancy. In most cases
Skin-to-skin contact with your If your labour does not start by
labour starts by itself, either with 41 weeks, your midwife will
baby is important and helps with contractions or with the sudden
bonding. Your baby will like offer you a membrane sweep.
breaking of the waters or a show This involves having a vaginal
being close to you just after birth. (see page 87). About one early baby
The time alone with your partner examination, which stimulates the
in six is induced (see next page) neck of your uterus (known as the
and your baby is very special. and about one early baby in five is cervix) to produce hormones which
Your baby will be examined by a delivered by caesarean section may trigger natural labour.
midwife or paediatrician and then (see page 98).
weighed (and possibly measured) and If your labour still doesnt start, your
If your baby is likely to be born midwife or doctor will suggest a
given a band with your name on it. early, you will be admitted to a date to have your labour induced
Vitamin K hospital with specialist facilities for (started off). If you dont want labour
premature babies. Not all hospitals to be induced and your pregnancy
You will be offered an injection of
have these facilities, so it may be continues to 42 weeks or beyond,
vitamin K for your baby, which is
necessary to transfer you and your you and your baby will be monitored.
the most effective way of helping
baby to another unit, either before Your midwife or doctor will check
to prevent a rare bleeding disorder
delivery or immediately afterwards. that both you and your baby are
(haemorrhagic disease of the
newborn). Your midwife should healthy by giving you ultrasound
have discussed this with you scans and checking your babys
beforehand. If you prefer that your movement and heartbeat. If your
baby doesnt have an injection, oral baby is showing signs of distress,
doses of vitamin K are available. your doctor and midwife will again
Further doses will be necessary. suggest that labour
is induced.
Stitches
Small tears and grazes are often
left to heal without stitches because
they frequently heal better this If contractions start prematurely, the
way. If you need stitches or other doctors may be able to use drugs to
treatments, it should be possible stop your contractions temporarily.
to continue cuddling your baby. You will probably be given injections
Your midwife will help with this as of steroids that will help to mature
much as they can. your babys lungs so that they are
If you have had a large tear or an better able to breathe after the
episiotomy, you will probably need birth. This treatment takes about
stitches. Ifyou have already had an 24 hours to work.
epidural, it can be topped up. If Many multiple birth babies are born
you have not, you should be offered prematurely. The normal delivery
a local anaesthetic injection. date for twins is 37 weeks and for
The midwife or maternity support triplets 33 weeks.
worker will help you to wash and If you have any reason to think that
freshen up, before leaving the your labour may be starting early,
labour ward to go home or to the get in touch with your hospital or
postnatal area. midwife straight away.

96
Induction Forceps
Labour can be induced if your
As the baby is being born, a cut
(episiotomy) may be needed to Forceps are smooth metal
8
baby is overdue or there is any enlarge the vaginal opening. instruments that look like large
sort of risk to you or your babys Any tear or cut will be repaired spoons or tongs. They are curved
health for example, if you have with stitches. to fit around the babys head.

LABOUR AND BIRTH


high blood pressure or if your Depending on the circumstances, The forceps are carefully positioned
baby is failing to grow and thrive. your baby can be delivered onto your around your babys head and joined
Induction is always planned in abdomen and your birthing partner together at the handles. With a
advance, so you will be able to talk may still be able to cut the cord, contraction and your pushing, an
over the benefits and disadvantages if they want to. obstetrician gently pulls to help
with your doctor and midwife and deliver your baby.
find out why theyrecommend
There are many different types
your labour is induced. Ventouse of forceps. Some forceps are
Contractions are usually started A ventouse (vacuum extractor) specifically designed to turn the
by inserting a pessary or gel into is an instrument that has a baby to the right position to be
the vagina, and sometimes both soft or hard plastic or metal born, for example if your baby
are used. Induction of labour may cup which is attached to your is back to your back.
take a while, particularly if the neck babys head by a tube that is
Forceps can leave small marks
of the uterus (the cervix) needs fitted to a suction device. The
on your babys face. These will
to be softened with pessaries or cup fits firmly onto your babys
disappear quite quickly.
gels. Sometimes a hormone drip head and, with a contraction
is needed to speed up the labour. and your pushing, the Afterwards
Once labour starts it should proceed obstetrician or midwife gently You will sometimes be fitted with a
normally, but it can sometimes take pulls to help deliver your baby. catheter (a small tube that fits into
2448 hours to get you into labour. your bladder) for up to 24 hours.
The suction cup (ventouse)
Assisted birth (forceps can leave a small mark on your You are more likely to need this if
you have had an epidural, as you
or ventouse delivery) babys head called a chignon
and it may also cause a bruise may not have full feeling back.
About one in eight women have an
on your babys head called a
assisted birth, where forceps or a
cephalhaematoma. A ventouse
ventouse are used to help the baby
is not used if your baby is less
out of the vagina. This can be because:
than 34 weeks old, because
your baby is distressed the head is toosoft.
your baby is in an awkward A ventouse is less likely to cause
position vaginal tearing than forceps.
you are too exhausted.
Both ventouse and forceps are
safe and are used only when
necessary for you and your baby.
A paediatrician may be present to
check your babys health. A local
anaesthetic will usually be given to
numb the birth canal if you have
not already had an epidural or spinal
anaesthetic. If your obstetrician
has any concerns, you may be
moved to a theatre so that a
caesarean section can be carried
out if needed.

97
If you are expecting twins, triplets The operation
or more, it is more likely that you In the UK, most caesarean sections
will be advised to have a caesarean are performed under epidural or
section. This will depend on how spinal anaesthesia, which minimises
your pregnancy progresses, the risk and means that you are awake
position of your babies and whether for the delivery of your baby (see
the babies share a placenta. page 89). A general anaesthetic is
Whenever a caesarean is suggested, sometimes used particularly
your doctor will explain why it if the baby needs to be delivered
is advised and any possible side very quickly.
effects. Do not hesitate to If you have an epidural or spinal
Caesarean section ask questions. anaesthesia, you will not feel pain
There are situations where the Urgent (emergency) just some tugging and pulling as
safest option for you or your baby caesareans your baby is delivered. A screen will
is to have a caesarean section. be put up so that you cannot see
Urgent (emergency) caesarean
As a caesarean section involves what is being done. The doctors will
sections are necessary when
major surgery, it will only be talk to you and let you know what
complications develop and delivery
performed where there is a real is happening.
needs to be quick. This may be
clinical need for this type of delivery. before or during labour. If your
Your baby is delivered by cutting midwife and doctor are concerned
through your abdomen and then about your or your babys safety,
into your uterus. The cut is made they will suggest that you have a
across your abdomen, just below caesarean straight away. Sometimes
your bikini line. The scar is usually your doctor or midwife may suggest
hidden in your pubic hair. an emergency caesarean if your
cervix does not dilate fully during
labour.

Planned (elective) caesareans


A caesarean is elective if it is planned in advance. This usually
happens because your doctor or midwife thinks that labour will
be dangerous for you or your baby.

98
Once a caesarean
8
always a caesarean?
If you have your first baby by
caesarean section, this does

LABOUR AND BIRTH


not necessarily mean that any
future baby will have to be
delivered in this way. Vaginal
birth after a previous caesarean
can and does happen. This will
depend on your own particular
circumstances (see page 155).
It takes about 510 minutes to Depending on the help you have at Discuss your hopes and plans
deliver the baby and the whole home, you should be ready to leave for any other deliveries with
operation takes about 4050 hospital within two to four days. your doctor or midwife.
minutes. One advantage of an
You will be encouraged to become
epidural or spinal anaesthetic is
mobile as soon as possible, and your
that you are awake at the moment
midwife or hospital physiotherapist
of delivery and can see and hold
will give you advice about postnatal Help and support
your baby immediately. Your birth
exercises that will help you in your
partner can be with you.
recovery. As soon as you can move Contact the Caesarean
After a caesarean section without pain, you can drive as Support Network for
After a caesarean section, you long as you are able to make an information and support
will be uncomfortable and will be emergency stop. This may be six (see page 182).
offered painkillers. You will usually weeks or sooner.
be fitted with a catheter (a small
tube that fits into your bladder) for

first
up to 24hours and you may be
prescribed daily injections to prevent
blood clots (thrombosis).

moments
together

99
Breech birth
If your baby is breech, it means
that it is positioned with its bottom
downwards. This makes delivery
more complicated. Your obstetrician
and midwife will talk to you about
the best and safest way for your
breech baby to be born. You will
be advised to have your baby
in hospital.

TWINS, TRIPLETS If the second baby is in a good


position to be born, the waters
OR MORE surrounding the baby will be broken,
If you are expecting twins, labour and the second baby should be born
may start early because of the very soon after the first because
increased size of the uterus. the cervix is already fully dilated.
It is unusual for multiple pregnancies If contractions stop after the first
to go beyond 38 weeks. More birth, hormones will be added to
health professionals will usually be the drip to restart them.
present at the birth. For example, Triplets or more are almost
there may be a midwife, an always delivered by elective
obstetrician and two paediatricians caesarean section.
(one for each baby).
External cephalic version
The process of labour is the same
You will usually be offered the but the babies will be closely Help and support
option of an external cephalic monitored. To do this, an electronic
version (ECV). This is when pressure monitor and a scalp clip might be Contact the Multiple
is put on your abdomen to try fitted on the first baby once the Births Foundation (MBF) or
to turn the baby to a head waters have broken (see page 87). Twins and Multiple Births
down position. You will be given a drip in case it Association (Tamba) for
Caesarean section is needed later, and an epidural is advice and support
usually recommended. Once the first (see pages 183 and 188).
If an ECV doesnt work, you will
baby has been born, the midwife
probably be offered a caesarean
or doctor will check the position
section. This is the safest delivery
of the second by feeling
method for breech babies but there
your abdomen and doing
is a slightly higher risk for you.
a vaginal examination.
See the section on caesarean
sections for more information
(see pages 9899).
If you choose a caesarean delivery
and then go into labour before the
operation, your obstetrician will
assess whether to proceed with
an emergency caesarean delivery.
If the baby is close to being born,
it may be safer for you to have
a vaginal breech birth.

100
WHAT YOUR BIRTH PARTNER CAN DO 8
Whoever your birth partner is your partner, your babys father, a close
friend or a relative there are quite a few practical things that he or she can
do to help you. The most important thing will probably be just being with
you. Beforehand you should talk about what you want, and what you

LABOUR AND BIRTH


dont want, so that they can support your decisions. There is no way
of knowing what your labour is going to be like or how each of you
will cope, but there are many ways in which a partner can help.

They can: For many couples, being


Help you to make it clear to together during labour and
Keep you company and help welcoming their baby together
the midwife or doctor what
to pass the time in the is an experience that they
you need and the other way
early stages. cannot begin to put into words.
round. This can help you to
Hold your hand, wipe your feel much more in control And many fathers who have
face, give you of the situation. seen their baby born and who
sips of water,
Tell you what is happening have played a part themselves
massage your
as your baby is born if you say they feel much closer to
back and
cannot see what is going on the child from the very start.
shoulders, help
you move about for yourself.
or change
position, or
anything else
that helps.
Comfort you as
your labour progresses and your
contractions get stronger.
Remind you how to use
relaxation and breathing
techniques, perhaps breathing
with you if it helps.
Support your decisions, for
example about pain relief.

101
FEEDING
YOUR BABY
Breastfeeding 103
Formula feeding 115

Its never too early to start thinking about how you are going to feed your baby.
Breastfeeding gives your baby the best possible start in life as it has lots of benefits for
both you and your baby that last a lifetime. Discuss it with your partner as their help is
important. You both might like to watch the Bump to Breastfeeding DVD to see what
feeding your baby might be like. If you have not received a copy of the DVD, ask your
midwife for one.

Your breastmilk is the only food


designed for your baby. It contains
everything your baby needs for What does breastfeeding
around the first six months of life. help protect against?
After that, giving your baby
breastmilk alongside solid food
will help them continue to grow
Your baby: You:
and develop. The World Health Ear infections Breast cancer
Organization recommends Asthma Weak bones
breastfeeding for two years later in life
Eczema
or longer.
Ovarian
Breastfeeding protects your Chest infections
cancer
baby from infections and Obesity
Women who
diseases. It also offers health Gastro- breastfeed
benefits for mums. Every day intestinal get their
makes a difference to your baby, infections figures
and the longer you breastfeed, back faster
Childhood
the longer the protection lasts. diabetes
And it reduces your chance of
getting some illnesses later in life. Urine
infections
Formula milk cannot give your
baby the same ingredients or
provide the same protection. Help and support
Breastfeeding helps build a strong
Midwives, health visitors and trained volunteers or peer supporters
bond between mother and baby,
can all offer advice and practical help with breastfeeding. Peer
both physically and emotionally.
supporters are mothers who have breastfed their own babies and have
Breastfeeding reduces the risk had special training to help them support other mothers. Talk to your
of cot death. midwife or health visitor about the help that is available in your area.

102
9

FEEDING YOUR BABY


BREASTFEEDING needs. Around days two to four, you
may notice that your breasts become Liquid gold: the
Just like any new skill, breastfeeding fuller and warmer. perfect food for your
takes time and practice to work. newborn
This is often referred to as your milk
In the first few days, you and your
coming in. To keep yourself as Colostrum is sometimes
baby will be getting to know each
comfortable as possible, feed called liquid gold. This
other. Close contact and holding
your baby as often as they want. extra-special breastmilk is full
your baby against your skin can
Your milk will vary according to of germ-fighting antibodies
really help with this.
your babys needs. It will look quite that will help protect your baby
The more time you spend with thin compared with colostrum, but against infections that you have
your baby, the quicker you will gets creamier as the feed goes on. had in the past. The first few
learn to understand each others Let your baby decide when they feeds coat your babys gut to
signs and signals. The next few have had enough. protect them from germs and
pages will help you to understand reduce the chances of them
Sometimes, breastmilk may leak
how breastfeeding works. And developing allergies as they
from your breast try gentle but
remember, its OK to ask for help. get older.
firm hand pressure on your nipple
Immediately after whenever this happens. Later on, your breastmilk will
your baby is born This usually helps very quickly. still contain antibodies, and as
If you decide to buy breast pads, you come across new infections
Every pregnant woman has milk
it is necessary to change them you will have new antibodies
ready for her baby at birth. This
at each feed. Plastic-backed ones in your milk. This means that if
milk is called colostrum and it is
can make you even soggier. you get colds or flu while you
sometimes quite yellow in colour.
are breastfeeding, your baby
It is very concentrated, so your
will automatically get some
baby only needs a small amount
immunity from those illnesses.
at each feed, which might be quite
frequent. It is full of antibodies
to boost your babys ability to
fight off infection.
Holding your baby against your skin
straight after birth will calm them,
steady their breathing and keep
them warm. It will also encourage
them to breastfeed. Babies are often
very alert in the first hour after birth
and keen to feed. Your midwife can
help you with this.

The first few days


Each time your baby feeds, they are
letting your body know how much
milk it needs to produce. The amount
of milk you make will increase or
decrease in line with your babys

103
In the beginning, it can seem that First steps: starting
you are doing nothing but feeding, to breastfeed
but gradually your baby will get
You can breastfeed in a number
into a pattern of feeding and the
of different positions. Finding one
amount of milk you produce will
that is comfortable for both of
settle. Your baby will be happier if
you will help your baby feed as

1
you keep them near you and feed
well as possible.
them whenever they are hungry.
This will quickly help your body to If you are lying back in a well
produce the amount of milk your supported position with your
Hold your babys whole body close with
baby needs. At night, your baby baby lying on your tummy, they the nose level with your nipple.
will be safest sleeping in a cot in the will often move themselves onto
same room as you. This will make your breast and begin to feed.
feeding easier and will reduce the Remember at all times to keep
risk of cot death. Try to take each your baby safe.
day as it comes. If you are very
You can try feeding lying on your
uncomfortable or sore, ask for help.
side or in a chair, supported in an
upright position. This will make it

2
easier to hold your baby so their
neck, shoulders and back are
supported and they can reach your
breast easily. Their head and body Let your babys head tip back a little so
should be in a straight line. that their top lip can brush against your
nipple. This should help your baby to
make a wide open mouth.

3
Partners and breastfeeding
As a partner, you can bond with your baby in lots of different
ways, like bathing, changing nappies and carrying your baby
in a sling close to you. You can also help by bringing your baby When your babys mouth opens wide, the
chin is able to touch the breast first, with
to their mother when its time for a feed. Some parents worry the head tipped back so that the tongue
that breastfeeding will make it harder for their partner to bond can reach as much breast as possible.
with the baby. But this doesnt have to be the case.
You have an important role to play
in supporting your partner, for example
by preparing meals or providing
extra help so she can get some rest.
You can do small, practical things like

4
making sure she has a cool drink to
hand while she is feeding, and later
you can even give some feeds yourself,
using expressed milk.
With the chin firmly touching, and with the
nose clear, the mouth is wide open, and
there will be much more of the darker skin
visible above your babys top lip than below
their bottom lip and their cheeks will look
full and rounded as your baby feeds.

104
Your babys sucking causes milk
stored in your breasts to be How do I know that
If you have any concerns about any
of these points, talk to your peer 9
squeezed down ducts inside your my baby is feeding supporter, midwife, GP or health
breasts towards your nipples. This well? visitor, or contact the National
is called the let-down reflex. Some Breastfeeding Helpline on
Your baby has a large
women get a tingling feeling which 0300 100 0212.

FEEDING YOUR BABY


mouthful of breast.
can be quite strong, while others
Your babys chin is firmly Note that if your baby seems
feel nothing at all. You will see your
touching your breast. unusually sleepy and/or is slow to
baby respond and their quick sucks
start feeding, they may be ill, so
change to deep rhythmic swallows It doesnt hurt you to feed
contact your GP as soon as possible.
as the milk begins to flow. Babies (although the first few sucks
often pause after the initial quick may feel strong).
sucks while they wait for more If you can see the dark skin
milk to be delivered. If your baby Helpful tips
around your nipple, you
falls asleep quickly before the deep should see more dark skin
swallowing stage, check that they Breastfeeding should
above your babys top lip
are properly latched on. It might be feel comfortable. Your
than below their bottom lip.
easier to get someone else to check baby should be relaxed.
for you. Sometimes you will notice Your babys cheeks stay You should hear a soft
your milk flowing in response to rounded during sucking. swallowing. If it doesnt
your baby crying or when you have Your baby rhythmically takes feel right, start again.
a warm bath. long sucks and swallows Slide one of your fingers
(its normal for your baby to into your babys mouth,
pause from time to time). gently break the suction
and try again.
Your baby finishes the feed
and comes off the breast
on their own.

After your baby has finished


feeding, you can hold them upright
on your shoulder to wind them
that is, until they burp. Breastfed
babies dont usually get as much
wind as formula-fed babies.

a strong
bond
105
How do I know my
baby is getting
enough milk?
Your baby should be healthy
and gaining weight. Tips for breastfeeding By the time a newborn baby starts
In the first 48 hours, your Make sure your baby is well crying, they will normally have
baby is likely to have only two attached to your breast (see pictures been hungry for a while.
or three wet nappies. Wet on page 104). This will help your Try not to give your baby any
nappies should then start to body make the right amount of other food or drink before the
become more frequent, with milk and stop your breasts getting age of about six months. This will
at least six every 24 hours sore. The more you breastfeed reduce your milk supply and could
from day five onwards. your baby, the more milk you will increase the chance of your baby
Most babies lose weight produce. When your baby comes getting ill.
initially. They should be off the first breast, offer the Try not to give your baby a dummy
weighed by a health second. It doesnt matter if they until breastfeeding is going
professional some time are not interested or dont feed well, as this can also reduce your
around day three to five. for long, or even if they feed for milk supply.
From then on, they should longer on the second breast. This
When you are out and about,
start to gain weight. Most is fine just start with this breast
wear something that will make it
babies regain their birth next time. Sometimes your baby
might seem hungrier than usual easier for you to breastfeed.
weight in the first two weeks.
and feed for longer or
At the beginning, your more often. Your body
baby will pass a black
Colour guide responds automatically
tar-like stool (poo) called
meconium. By day three, for a babys
and makes more milk dont forget
to ask
stools for to provide the extra
this should be changing needed. This is why you
the first

for help
to a lighter, runnier, can feed more than one
greenish stool that is few days
baby at the same time
easier to clean up. (see next page).
From day four and for
the first few weeks,
Day 1 There is no need to
offer formula milk in
if you need it!
your baby should pass
at least two yellow addition to breastmilk.
stools every day. These If your baby feels
stools should be at least hungrier, feed more
Day 23 often, rather than
the size of a 2 coin.
offer formula milk. Dummies
Remember, its normal
for breastfed babies to After a while, you will Try not to give your baby a
pass loose stools. get to know the signs dummy until breastfeeding is
Your breasts and nipples Day 4 that mean your baby established, usually when your
should not be sore. If they is ready to feed. Most baby is a month old. Using
are, do ask for help. babies will signal that dummies has been shown
they are hungry by to reduce the amount of
Your baby will be opening and closing milk that is produced. If your
content and satisfied their mouths, making baby becomes accustomed
after most feeds and sucking noises, to using a dummy while
will come off the breast opening their eyes or sleeping, it should not be
on their own. turning their heads to stopped suddenly in the first
If you are concerned bring their mouths six months. But you should
about any of these points, towards you. stop using a dummy when
speak to your midwife or your baby is between six and
health visitor. 12 months old.

106
More information
is and how many feeds they need
while you are apart, but its often 9
easier to manage than people The Equality Bill
think. Your peer supporter, midwife, The Equality Bill offers mothers
health visitor, local support group or stronger protection when
the National Breastfeeding Helpline

FEEDING YOUR BABY


Breastfeeding more breastfeeding. The Equality Bill
than one baby (0300 100 0212) can explain the will make it clear that it is unlawful
options and talk them through to force breastfeeding mothers
Twins, triplets or more can be with you. and their babies out of places
breastfed. Because multiple
If you stop breastfeeding, it can like coffee shops, public galleries
babies are more likely to be born
be difficult to start again. Giving and restaurants.
prematurely and to have a low
birth weight, breastmilk is especially formula milk to a breastfed For further information go to
important for their well-being. baby can reduce your supply www.equalities.gov.uk
To start with, you may find it of breastmilk.
easier to feed each of your babies
separately, until you feel confident

positive
about handling them at the same
time and feeding is well established.
Thismay take some time, so it can
be really helpful to accept any offers

feeding
of help around the house from
family and friends.
Over time, you will learn what
works best for you and your babies.
Triplets can be breastfed either
two together and then one
after, or all three rotated at each
feed. Alternatively, you can use a
combination of breast and formula,
depending on the babies and your
milk supply.

How long should


I breastfeed?
Exclusive breastfeeding (with
no other food or drink) is
recommended for around the first
six months of a babys life. After
this, you can carry on giving your
baby breastmilk alongside other
foods for as long as you and your
baby want. This can be into the
second year or beyond.
Every day you breastfeed makes
a difference to you and your baby.
There is no need to decide at
the beginning how long you will
breastfeed. Many mothers continue
to breastfeed if or when they return
to work or college. The practicalities
will depend on how old your baby

107
Expressing milk 3 Using your thumb and the rest of Expressing milk if your
Expressing milk means removing your fingers in a C shape, squeeze baby is premature or ill
milk from your breast. You may gently about 3 to 6cm behind the It is important to start expressing
want to express milk if your breasts nipple this should not hurt. your milk as soon as possible
are feeling uncomfortably full, after your baby is born. To ensure
or if your baby is not sucking that you produce plenty of milk,
well but you still want to give you will need to express at least
them breastmilk. six to eight times in 24 hours,
including during the night, just as
If you have to be away from your your baby might be doing if they
baby for example, because your were able to feed directly. Ask the
baby is ill or premature, or because hospital staff about having skin-
you are going back to work you to-skin contact with your baby as
may wish to express milk so that soon as possible after the birth.
somebody else can feed your baby. This will help with bonding and
You can express milk by hand or STEP 3 keeping up your milk supply.
with a breast pump. Different
pumps suit different women, so ask 4 Release the pressure then repeat,
for information to compare them. building up a rhythm. Avoid
A pump needs to be clean and sliding your fingers over the skin.
sterilised each time it is used. At first, only drops will appear,
but just keep going as it will
Expressing by hand
help build up your supply.
It is more effective to express milk With practice, and a little time,
by hand than to use a pump in the milk will flow freely.
first few days. If you want to collect
the milk, you will need a sterilised
container. The following suggestions
should help:
1 Before you start, wash your
hands thoroughly then gently
massage your breast.
2 Cup your breast and feel back Hospitals often have machines
from the end of the nipple to for expressing milk, and will
where the texture of your breast show you how to use one.
feels different. Alternatively, you can hire an
STEP 4 electric breast pump. Contact
breastfeeding organisations
5 When no more drops are or pump companies directly to
coming, move your fingers round find out about pump hire in
to try a different section of your your area (see page 114 for
breast and repeat. contact details).
6 When the flow slows down, If you are freezing breastmilk
swap to the other breast. Keep because your baby is premature
changing breasts until the milk or ill, ask the staff caring for your
is dripping very slowly or stops baby for support and information.
altogether. Also see opposite for guidance
7 If the milk doesnt flow, try on storing breastmilk.
moving your fingers slightly Your midwife, health visitor or
towards the nipple or further peer supporter can give you
away, and try giving your breast practical help and answer any
a gentle massage. questions.
STEP 2
108
Cup feeding
Sometimes, your baby might
The following suggestions may
also help: 9
need some extra milk, or find it Try squeezing out a drop or two
hard to feed from your breast. Milk that has been frozen is still of your milk at the end of a feed
In this case, your midwife might good for your baby and better than and gently rubbing it into your

FEEDING YOUR BABY


suggest that you give your baby formula milk. Milk should not be skin. Let your nipples dry before
some expressed milk in a cup. refrozen once thawed. Dont use covering them.
Ask her to show you how. In this a microwave oven to warm or
way, your baby is able to taste defrost breastmilk. If you are using breast pads,
and begin drinking your milk. they need to be changed at
You should not pour milk directly
Some common each feed (if possible, use pads
into your babys mouth. breastfeeding without a plastic backing).
problems and how Avoid soap as it dries your
Storing breastmilk to solve them skin out.
You can store breastmilk for: It can be hard to ask for help, Wear a cotton bra, so air can
up to five days in the fridge at but tackling any problems as soon circulate.
4C or lower. This means putting as they start will give you more
Some mothers treat any cracks
the milk in the coolest part of time to enjoy these early days.
or bleeding with a thin smear of
the fridge, usually at the back In lots of cases, the solution is as
white soft paraffin or purified
(do not keep it in the door) simple as changing your babys
lanolin. Put the ointment on the
position slightly or feeding them
up to two weeks in the freezer crack (rather than the whole
a bit more often.
compartment of a fridge, or nipple) to help it heal and prevent
Unsettled feeding a scab forming.
up to six months in a domestic
freezer, at minus 18C or lower. If your baby is unsettled at the Tender breasts, blocked
breast and doesnt seem satisfied ducts and mastitis
Breastmilk must always be stored by feeds, it may be that they are Milk can build up in the ducts for
in a sterilised container. If you use sucking on the nipple alone, and a variety of reasons. The most
a pump, make sure you wash it so are not getting enough milk. common are wearing a too-tight
thoroughly after use and sterilise Ask for help to get your baby into bra, missing a feed, or a blow to
it before use. a better feeding position. the breast. Its important that you
Milk should be defrosted Sore or cracked nipples deal with a blocked duct as soon as
in the fridge. Once possible so that it doesnt lead to
If your nipples hurt, take your
its defrosted, mastitis (inflammation of the breast).
baby off the breast and start
you will need
again. If the pain continues or If you have mastitis, your breasts will
to use it
your nipples start to crack or feel hot and tender. You may see
straight
bleed, ask for help so you get a red patch of skin which is painful
away.
your baby latched on comfortably to touch. You can feel quite ill, as if
(see page 114 for information on you have flu, and you may have a
how to get help). It can sometimes temperature. This can happen very
take a little while to sort out how suddenly. It is very important to carry
to prevent the soreness, but it on breastfeeding as this will help
is important to get support you get better more quickly.
as soon as possible.
If you think you might have
mastitis (or a blocked duct), try
the following:
Take extra care to make sure
your baby is attached well to
your breast.
Feed your baby more often.
Let your baby feed on the
tender breast first.
109
If your breasts still feel full after a without problems for a while, you Your milk
feed, or your baby cannot feed, might have an infection known as is good
express your milk (see page 108 thrush. Ask for help to check that for your baby
for more information on how to your baby is latched on properly, and whatever you eat, but
do this). make an appointment with your GP. there are foods to avoid
Warmth on your breast before a (see next page). Being a new
You and your baby will both need
feed can help milk flow and make mother is hard work though, so its
treatment. You can easily give
you feel more comfortable. important to look after yourself and
thrush to each other, so if your
try to eat as varied and balanced a
While your baby is feeding, gently baby has it in their mouth you
diet as you normally would. Aim to
stroke the lumpy area with your will still need some cream for
eat healthily as a family. A healthy
fingertips towards your nipple. your nipples to stop it spreading
range of food includes:
This should help the milk to flow. to you. You may want to ask
your pharmacist for advice. Some at least five portions of a variety
Get lots of rest. Go to bed if
antifungal creams can be bought of fruit and vegetables a day
youcan.
over the counter from a pharmacy. (including fresh, frozen, tinned,
Take a painkiller such as dried and juiced)
paracetamol or ibuprofen. Tongue-tie
starchy foods such as wholemeal
Ask for help with how you get Some babies are born with a tight
bread, pasta, rice and potatoes
your baby latched on properly piece of skin between the underside
of their tongue and the floor of plenty of fibre, found in
(see page 114 for information
their mouth. This is known as wholegrain bread and breakfast
on where to get help).
tongue-tie, and it can affect feeding cereals, pasta, rice, pulses (such
Mastitis may also be a sign of by making it hard for your baby to as beans and lentils) and fruit
infection. If there is no improvement attach to your breast. Tongue-tie and vegetables. After childbirth,
within 12 to 24 hours, or you start can be treated easily, so if you have some women experience bowel
to feel worse, contact your GP or any concerns talk to your midwife problems and constipation fibre
healthcare professional. If necessary, or health visitor or contact the helps with both of these
they can prescribe antibiotics that National Breastfeeding Helpline protein, such as lean meat and
are safe to take while breastfeeding. on 0300 100 0212. poultry, fish, eggs and pulses
Thrush at least two portions of fish each
If you suddenly get sore, bright pink Staying healthy week, including one portion of
nipples after you have been feeding You dont need to eat oily fish, and
anything special while
dairy foods, such as milk, cheese
you are breastfeeding, just
and yoghurt, which contain calcium
make sure you have a
and are a useful source of protein.
varied and balanced diet.
Its also important to drink plenty
of fluid. Aim for at least 1.2 litres
(six to eight glasses) each day.
Its a good idea to have a drink
beside you when you settle down
to breastfeed. Water, milk and
unsweetened fruit juices are all
good choices.
To find out more about healthy
eating, go to www.eatwell.gov.uk

healthy
110
eating
Healthy snack ideas marlin a week, because of the
levels of mercury in these fish. 9
The following snacks are
Avoid these fish altogether during
quick and simple to make
pregnancy or if you are trying to
and will give you the energy
get pregnant.
and strength you need:

FEEDING YOUR BABY


Small amounts of whatever you are
Fresh fruit.
eating and drinking can pass to your
baby through your breastmilk, so
its a good idea to think about how
Vitamins much alcohol and caffeine you are
While you are breastfeeding (just having. These may affect your baby
as when you were pregnant) in the same way they affect you.
you should take supplements If you think a food or foods that you
containing 10 micrograms (mcg) of are eating are affecting your baby,
vitamin D each day. You should be talk to your GP or health visitor, or
Sandwiches or pitta bread able to get all the other vitamins contact the National Breastfeeding
filled with salad vegetables, and minerals you need by eating a Helpline on 0300 100 0212.
grated cheese, salmon or varied and balanced diet. Your skin
sardine or cold meat. Drinks containing caffeine can also
makes vitamin D naturally when its affect your baby and may keep
Yoghurts and fromage frais. exposed to the sun between April them awake, so drink them only
Hummus and bread or and September. occasionally rather than every day
vegetable sticks. Ask your GP or health visitor while your baby is young.
Ready-to-eat where to get vitamin D See page 112 for more information
dried apricots, supplements. You may be on alcohol and breastfeeding.
figs or prunes. able to get free vitamin
supplements without a Caffeine
Vegetable and
bean soups. prescription if you are Caffeine occurs naturally in lots of
eligible for Healthy Start foods and drinks, including coffee,
Fortified (see page 28). tea and chocolate. Its also added to
unsweetened some soft drinks and energy drinks
breakfast cereals, Foods to avoid
and to some cold and flu remedies.
muesli or other Eating fish is good for your In the early days, it is important that
wholegrain cereals health. But dont have more than you dont have too much caffeine.
with milk. two portions of oily fish a week. Try decaffeinated tea and coffee,
Milky drinks or unsweetened This includes fresh tuna (not canned fruit juice or
fruit juice. tuna, which doesnt count as oily water and limit
fish), salmon, mackerel, sardines the number of
Baked beans on toast and trout.
or baked potato. energy drinks,
The general advice for all adults which might be
is to avoid eating more than one high in caffeine.
portion of shark, swordfish or

Helpful tips Try to eat a wide variety Keep your alcohol intake low.
of foods (see page 25). Alcohol in breastmilk can
Eat when you feel hungry, and
affect your babys feeding
choose healthy snacks. Try not to restrict your
or sleeping. Avoid drinking
diet unless you think a food
You will probably feel quite alcohol shortly before
is upsetting your baby. Always
thirsty. Have a drink beside feeding your baby.
talk to your health visitor or
you before you sit down to
doctor before cutting out foods. Avoid drinking too much
breastfeed.
strong tea or coffee.
111
Peanuts Alcohol If you drink alcohol and breastfeed,
Peanuts are one of the most Generally, adult women should it can affect your baby in a number
common causes of food allergy. not regularly drink more than two of ways:
Peanut allergy affects about to three units of alcohol per day. your milk may smell different and
1% of people and can cause During pregnancy, women are put your baby off feeding
severe reactions. Your baby may advised to avoid drinking. If they
be at higher risk of developing a do drink, they are advised to drink the alcohol may make your baby
peanut allergy if you, the babys no more than one to two units once too sleepy to feed, or
father, brothers or sisters have or twice a week, and are advised your baby may have difficulties
a food allergy or other allergic not to get drunk. with digestion and problems with
condition such as hayfever, their sleeping patterns.
By breastfeeding, you are giving
asthma and/or eczema.
your baby the best possible start in
If you would like to eat peanuts life. Its very unlikely that having an Smoking
or foods containing peanuts occasional drink will harm you or
(such as peanut butter) while your baby. However, we do know Smoking is bad for you, bad for
breastfeeding, you can choose that alcohol passes through to the your partner and especially bad for
to do so as part of a healthy baby in very small amounts in your your baby. One of the best things
balanced diet, unless you are breastmilk. Because of this, if you you can do for your own and your
allergic to them or your health are breastfeeding it is sensible to babys health is to stop smoking.
professional advises you not to. limit your drinking and to keep Each year, more than 17,000
within the limits recommended for children under the age of five are
You may have heard that some admitted to hospital because of
women have, in the past, pregnant women.
the effects of secondhand smoke.
chosen not to eat peanuts while One unit of alcohol is approximately
they were breastfeeding. This equal to a single (25ml) measure Avoid smoking in the home or car,
is because the government of spirits, half a pint of beer, or half and ask your partner, friends and
previously advised women a 175ml glass of wine, although family to do the same when they
that they may wish to avoid it depends on the strength of are around your baby.
eating peanuts while they were the drink. If you do smoke and you are
breastfeeding if there was a finding it difficult to quit,
history of allergy in their childs The website www.nhs.uk/units
contains more information on breastfeeding will still protect
immediate family (such as your baby from infections and
asthma, eczema, hayfever, food units, including the units found
in typical drinks. give them nutrients they cannot
allergy or other types of allergy), get through formula milk.
in case small amounts of peanut Smoking after feeds, rather than
in their breastmilk increased the Helpful tips before, will help reduce your
chance of the baby developing babys exposure to nicotine.
a peanut allergy. But this advice Breastfeeding and
has now been changed because alcohol You are up to four times more
the latest research has shown likely to stop smoking successfully
If its a special occasion and
that there is no clear evidence with NHS support. Call the NHS
you know you are going to be
to say that eating or not eating Smoking Helpline on 0800 022
drinking, consider expressing
peanuts while breastfeeding 4 332, or the NHS Pregnancy
milk in advance. To reduce
has any effect on your babys Smoking Helpline on 0800 169 9
the exposure of your baby
chances of developing a 169 for information about the wide
to alcohol:
peanut allergy. range of free specialist support
avoid breastfeeding for at available and for details of your
If you have a child under
least two to three hours after local NHS Stop Smoking Service.
six months and are not
drinking, or
breastfeeding (for example You can also speak to your GP
because you are feeding your have your drink after the last or pharmacist about the nicotine
baby on formula), then there feed of the day if you can replacement therapy available to
is no reason why you should predict when that will be! help you manage your cravings
avoid consuming peanuts or and become smokefree.
foods containing peanuts.
112
Medicines and
breastfeeding
cough medicines (provided they
dont make you drowsy)
health visitor, GP or pharmacist
if this is a concern. 9
Many illnesses, including depression asthma inhalers, and
(see page 76), can be treated while More information
normal doses of vitamins.
you are breastfeeding without

FEEDING YOUR BABY


harming your baby. Small amounts You can use some methods of For more information go to
of whatever medicines you take will contraception but not all, so check www.breastfeedingnetwork.org.
pass through your breastmilk to with your GP or pharmacist. Some uk/drugline.html, or call the
your baby, so always tell your doctor, cold remedies are not suitable. Drugs in Breastmilk Helpline
dentist or pharmacist that you Its fine to have dental treatments, on 0844 412 4665.
are breastfeeding. local anaesthetics, injections Your GP or pharmacist may like to
Medicines that can be taken while (including mumps, measles and look at the information from the
breastfeeding include: rubella (MMR), tetanus and flu National Formulary for Children
injections) and most types of (www.bnfc.org) to see what
most antibiotics operations. You can also dye, medicines can be given to babies
common painkillers such as perm or straighten your hair, and children, as these are likely
paracetamol and ibuprofen use fake tan and wear false nails. to be safe for mothers to take
(but not aspirin) Illegal drugs are dangerous for when breastfeeding.
hayfever medicines such as your baby, so talk to your midwife,
Clarityn and Zirtek

Medicines for minor ailments when breastfeeding


Make sure the medicine is safe to take when breastfeeding.
Watch your baby for side effects such as poor feeding, drowsiness and irritability.
Stop taking the medicine if your baby gets side effects.
For further information, speak to your pharmacist or NHS Direct on 0845 4647.

Minor ailment First choice Second choice Do not use


Constipation Eat more fibre Bisacodyl
Bulk laxatives that contain ispaghula Senna
Lactulose
Cough Honey and lemon in hot water Medicines that contain
Simple linctus codeine or guaifenesin
Diarrhoea Oral rehydration sachets Occasional doses of loperamide
Haemorrhoids (piles) Soothing creams, ointments or suppositories Ice pack
Hayfever, house Antihistamine eye drops or nasal sprays Antihistamines cetirizine Other antihistamines unless
dust mite and Steroid nasal sprays or loratadine advised by your doctor
animal hair allergy
Head lice Wet combing If ineffective, then head lice lotions
Dimeticone lotion that contain permethrin
Indigestion Antacids (indigestion mixtures) On your doctors information:
medicines that reduce acid
production, e.g. omeprazole
Nasal congestion Steam inhalation Oxymetazoline or xylometazoline Medicines that contain
(stuffy or nasal sprays. Occasional doses phenylephrine
runny nose) of pseudoephedrine

Pain Paracetamol Ibuprofen Medicines that contain aspirin


(e.g. headache, Medicines that contain codeine
mastitis, toothache) (e.g. co-codamol,
co-dydramol), unless advised by
your doctor
Threadworms Mebendazole
Vaginal thrush Clotrimazole pessaries or cream Fluconazole
113
Help and support

Breastfeeding To find out what is available in The Unicef Baby Friendly site at
help and support your area, talk to your midwife www.babyfriendly.org.uk provides
or health visitor, or contact the information and links to useful
Dont be afraid to ask for the National Breastfeeding Helpline resources about the benefits of
support and information you need on 0300 100 0212 (lines are breastfeeding.
to make breastfeeding work for you open from 9.30am to 9.30pm)
and your baby. No problem is too The Breastfeeding Networks
or go to the website at
small if something is worrying you, Drugs in Breastmilk Helpline can
www.nationalbreastfeeding
the chances are that other mothers provide information about
helpline.org.uk
will have felt the same. breastfeeding and medicines.
You can also get information Call 0844 412 4665.
You can get help from a peer online from the Association
supporter, your midwife or health All these voluntary organisations
of Breastfeeding Mothers
visitor. You might also want to join provide training for peer supporters.
(www.abm.me.uk) and the
a local breastfeeding group. Its a Breastfeeding Network The Bump to Breastfeeding (Best
great way of making new friends as (www.breastfeedingnetwork.org.uk). Beginnings) DVD is a useful source
well as sharing the ups and downs The Breastfeeding Network of information and will give you
of looking after a new baby. Most runs a Supporterline on an insight into other mothers
groups usually include a mix of 0300 100 0210, and also offers experiences of breastfeeding.
healthcare professionals and local a helpline for speakers of You should have been given a copy
trained volunteer mothers (peer Bengali/Sylheti on 0300 456 2421. of the DVD during your pregnancy.
supporters). These mothers have Lines are open from 9.30am If not, ask your health visitor or visit
breastfed their own babies and to 9.30pm. www.bestbeginnings.info
have had some training in basic
breastfeeding techniques. Some NHS guidance on breastfeeding
peer supporters will have had more is available at www.breastfeeding.
in-depth training to help them nhs.uk
support new mothers. The following voluntary
There may be specialist drop-ins in organisations can also provide
your area where you can go if you information and advice:
have a specific concern or difficulty. La Leche League
0845 120 2918
www.laleche.org.uk
NCT Breastfeeding Line
0300 330 0771
www.nct.org.uk

support
for you
114
Types of milk to avoid
9
Cows milk should not be given as
a main drink to a child under the
age of one year. Small amounts
of cows milk can be used for

FEEDING YOUR BABY


cooking after six months of age.
Condensed milk, evaporated
milk, dried milk, sheeps milk,
goats milk, or any other type of
milk drink (such as rice, oat or
almond drinks, often known as
milks) should never be given to
a baby under the age of one year.
You should not use soya formula
unless it has been prescribed by
your GP. Choosing a formula Whey-dominant milk is thought
Infant formula milk usually comes to be easier to digest than casein-
You can find more information dominant milk, so should always be
on rice drinks at www.food. in powder form and is based on
processed, skimmed cows milk, the first formula you give your baby.
gov.uk/science/surveillance/
fsisbranch2009/survey0209 and is treated so babies can digest There is little nutritional difference in
it. Vegetable oils, vitamins, minerals the two forms of milk, so if whey-
Follow-on formula is not suitable and fatty acids are added to make dominant formula milk suits your
for babies under six months. sure the milk contains the vitamins baby, they can stay on it for the first
and minerals that young babies year or even longer.
need. This information will be
Ready-to-feed infant formula
FORMULA on the contents list on the pack.
Infant formula powders are not milk in cartons is also available.
FEEDING sterile, so it is important to follow This is generally more expensive
the cleaning and sterilising than powdered milk. Once opened,
The following new advice is based the carton should be stored in the
instructions on page 116.
on guidance from the Department fridge with the cut corner turned
of Health and the Food Standards Formula is either whey dominant down. Do not store it for longer
Agency. It may differ from what you or casein dominant, depending than 24hours.
have done before if you have older on the balance of proteins it
children, but to minimise any risk contains. It may also be referred to You can continue giving your baby
it is recommended that you follow as stage one or stage two milk. infant formula when they are older
this new advice. than six months.
If you have any worries
Helpful tips about the infant
formula milk you are
There are a number of Vitamin drops giving your baby,
different brands of infant ask your midwife,
If your baby is formula fed, health visitor or
formula milk available in the
you should give them vitamin GP for advice.
shops. All should meet the
drops from the age of six
legal standards for formula
months or if they are drinking
milk, and its up to you to
less than 500ml of formula
decide which one to use.
a day. You can buy suitable
In the past it was thought
drops at any pharmacy.
better to stick to one brand,
Ask your midwife or health
but there is no evidence
visitor where you can get
to suggest that changing
vitamin drops.
brands does any good or
any harm.

115
Using formula Preparing a feed
milk safely STEP 1: Before making up a feed,
Powdered infant formula milk clean and disinfect the surface
must be prepared as carefully as you are going to use. Wash your
possible. It is not a sterile product, hands carefully. If you are using a
and even though tins and packets cold water steriliser, shake off any
of milk powder are sealed, they excess solution from the bottle and
can contain bacteria such as Sterilising the teat or rinse the bottle with
Cronobacter sakazakii (formerly All the equipment used for feeding cooled boiled water from the kettle
known as Enterobacter sakazakii) your baby must be sterilised. By (not the tap). Stand the bottle on a
and, more rarely, salmonella. sterilising your feeding equipment, clean surface. Keep the teat and cap
washing your hands and keeping on the upturned lid of the steriliser.
If the feed is not prepared safely, the preparation area clean, you will Dont put them on the work surface.
these bacteria can cause infections. reduce the chance of your baby
Infections are very rare, but can getting sickness and diarrhoea. STEP 2
be life-threatening. Formula must
therefore be made up with water The following cleaning and
hot enough to kill the bacteria at sterilising instructions apply whether
least 70C. In practice, this means you are using expressed breastmilk
boiling the kettle and leaving it to or infant formula milk.
cool for no longer than 30 minutes.
1 Clean and rinse. Clean the
Very young babies are at most risk,
bottle and teat in hot soapy
and it is better to use sterile, liquid
water as soon as possible after a
ready-to-feed products for premature
feed, using a clean bottle brush.
or low birth weight babies. If you are
Rinse all equipment in cold, clean
using formula, mix the formula and
running water before sterilising.
water and cool quickly to feeding
temperature in cold water. 2 Cold water sterilising. Follow
the manufacturers instructions.
Its also essential to make up a Change the sterilising solution
fresh bottle for each feed. Throw every 24 hours, and leave
away unused formula within two feeding equipment in the
hours. Bacteria multiply rapidly at STEP 2: Use fresh tap water to fill
solution for at least 30 minutes.
room temperature and can even the kettle. After it has boiled, let
Make sure there is no air trapped
survive and multiply slowly in some the water cool for no more than
in the bottles or teats when
fridges, so storing formula milk for 30 minutes. Dont use artificially
putting them in the sterilising
any length of time increases the risk. softened water or water that has
solution. Keep all the equipment
already been boiled. If you have
under the solution with a
to use bottled water, you will still
floating cover.
need to boil it. The water must
3 Steam sterilising (electric still be hot, otherwise any bacteria
or microwave). Follow the in the milk powder might not
manufacturers instructions. be destroyed.
Make sure the openings of the
bottles and teats are facing For information about using bottled
down in the steriliser. Any water, go to www.eatwell.gov.uk
equipment not used straight Always put the partially cooled
away should be re-sterilised boiled water in the bottle first.
before use.
Be careful at 70C, water is still

careful
hot enough to scald. Always check
that the water level is correct.
Failure to follow the manufacturers

preparation instructions may make your baby ill.

116
STEP 3 STEP 4 STEP 5
9

FEEDING YOUR BABY


STEP 3: Loosely fill the scoop STEP 4: Add the milk powder to the STEP 5: Holding the edge of
with milk powder and level it water. Repeat, until you have added the teat, put it on the bottle.
off using the flat edge of a the number of scoops specified in Screw the retaining ring onto
clean, dry knife or the leveller the manufacturers instructions. the bottle. Cover the teat with
provided. Do not pat it down. a cap. Shake the bottle until
It is important to use only the scoop
the powder dissolves.
that is enclosed with that milk
powder. Using too much powder can Make sure you make up a fresh
give your baby constipation and lead bottle each time you feed your
to dehydration; too little could mean baby and throw away unused
that your baby is not getting the feed after two hours. Using stored
nutrients they need. Dont add sugar formula milk can increase the
or cereals to the feed in the bottle. chance of your baby becoming ill.

Feeding your baby


Always cool your babys milk down The milk inside may be very hot You should check regularly that
before feeding. At 70C, it is still and could scald your babys mouth. teats are not torn or damaged.
hot enough to scald. To cool it, hold
Get everything you need ready When feeding, make sure you keep
the bottle, with the cap covering
before you start feeding. Find a the teat full of milk, otherwise your
the teat, under cold running water.
comfortable position to hold your baby will take in air and get wind.
Test the temperature of the feed by
baby while you are feeding. You If the teat becomes flattened while
dropping a little onto the inside of
may need to give your baby time. you are feeding, pull gently on the
your wrist. It should just feel warm
Some babies take some milk, corner of your babys mouth to
to the touch, not hot.
pause for a nap, and then wake release the vacuum. If the teat gets
If the milk is too cool, and your baby up for more. So you might have blocked, replace it with another
doesnt like it that way, you can to be patient. Remember, feeding sterile teat.
warm it up a little by putting the is an opportunity to feel close to
bottle upright in some hot water, your baby and get to know them. Help and support
keeping the teat out of the water. Even when your baby is a little
Never warm milk in a microwave older, they should never be left If you want help or advice on
oven. It will continue to heat up for alone to feed with a propped-up formula feeding, talk to your
a time after you take it out of the bottle, as they may choke. midwife or health visitor. See
microwave, even though the outside the list of useful organisations
of the bottle may feel cold. at the back of this book.

117
Bottles and teats Feeding away
You might find it useful to have from home
about six bottles and teats, so The safest way of feeding your
you can always have at least one baby away from home is to carry a
or two bottles clean, sterilised measured amount of milk powder
and ready for use. Ask your in a small clean and dry container,
midwife or health visitor for a flask of boiled hot water and an
more information. empty sterilised feeding bottle.
Make up a fresh feed whenever
You should always buy new you need it. The water must still
teats. They come in different be hot when you use it, otherwise
shapes and with different hole any bacteria in the milk powder
sizes, and you may have to try At the end of the feed, sit and might not be destroyed. Remember
several before you find the one hold your baby upright and gently to cool the bottle under cold
that suits your baby. If the hole rub or pat their back for a while running water before you use it.
is too small, your baby will not to bring up any wind. There is no
get enough milk. If its too big, need to overdo it wind is not as Alternatively, you could use
the milk will come too fast. big a problem as many people think. ready-to-drink infant formula milk
Talk to your baby as you rub or pat. when you are away from home.
Its best if you can buy new
bottles too. Check regularly to This will help them feel closer to you If its not possible to make up a fresh
make sure the bottles are in and get them used to listening to feed, or if you need to transport a
good condition. If they are badly your voice. Dont forget to throw feed for example to a nursery or
scratched, you will not be able to away any milk that is not used childminder you should prepare
sterilise them properly. If in doubt, within two hours. the feed at home and cool it in the
ask your midwife or health visitor Most babies gradually settle into back of the fridge for at least one
for more information. a pattern. Babies vary in how hour. Take it out of the
often they want to feed and how fridge just before you
much milk they want to take. leave, and carry it in
Bottled water Feed your baby when they are a cool bag with an
hungry, just as you would if you ice pack and
Bottled water is not a healthier use it within
choice than tap water and were breastfeeding, and dont try
to force your baby to finish a bottle. four hours.
usually is not sterile. In fact,
some natural mineral waters are They may have had enough for the
not suitable for babies because time being or just want a rest.

out
of the amount of minerals they
contain. If you need to use
bottled water, remember that
any bottled water that is labelled
natural mineral water might
and
about
contain too much sodium
for babies.
If you are giving bottled water
to babies under six months,
you should boil and cool it just
like tap water. If you need to
use bottled water to make up
infant formula (for babies of
any age), you should boil it and
allow it to cool for no more
than half an hour.

118
Coping with allergies
If you reach your destination
within four hours, take it out of If you think your baby might be
infant formulas, too. Babies who
are allergic to cows milk may also 9
the cool bag and store it at the allergic to formula milk, talk to be allergic to soya.
back of a fridge for a maximum your GP. They can prescribe formula Babies sometimes grow out of
of 24 hours. Re-warm for no feeds called extensively hydrolysed allergies, and you may find that
more than 15 minutes.

FEEDING YOUR BABY


protein feeds. you can introduce cows milk into
Some formulas are labelled as your babys diet as they get older.
Helpful tips Always ask your GP or health
hypoallergenic, but they are not
suitable for babies with a diagnosed visitor for advice before making
cows milk allergy. Talk to your GP any changes to your babys diet.
It is always safer to make up a
fresh feed whenever possible. before using this milk. Always get
When this is not possible, feeds their advice before using soya-based
should never be stored for
longer than 24 hours.

Some common Aslong as Constipation


problems with your baby Always
formula feeding is gaining stick to the
weight, there recommended
is usually nothing amount of infant
to worry about. But formula milk powder.
if your baby is violently sick or Using too much can make your
appears to be in pain, or you are baby constipated or thirsty.
worried for any other reason, talk Breastfed babies dont usually
to your health visitor or GP. get constipated. If your baby is
Cover your babys front when under eight weeks old and has not
feeding and have a cloth or paper passed a stool for a few days, talk
towels handy to mop up any mess. to your health visitor or GP.
Check too that the hole in your Water
babys teat is not too big, as giving
In very hot weather, babies fed on
milk too quickly can cause sickness.
infant formula milk can get thirsty.
Sitting your baby upright in a baby
If this happens, you can give them
Crying and colic chair after a feed can also help.
cool boiled tap water if they seem
The problem usually stops after
For information about crying and unsettled between feeds. Talk to
six months when your baby is
colic, see pages 138139. your health visitor or GP if you
starting on solid foods and drinking
have any concerns.
Sickness and vomiting less milk.
Some babies bring up more milk Breastfed babies do not need any
If your baby brings up a lot of milk,
than others during or just after a water. Instead, you may notice that
remember that they are likely to
feed. This is called possetting, they have shorter, more frequent
behungry again quite quickly.
regurgitation or gastric reflux. feeds if the weather is hotter.
Dont force your baby to take
It is not unusual for babies to on more milk than they want
bring up quite a lot, but it can during a feed. Remember, every
be upsetting when it happens baby is different. Some prefer
and you may be worried that to feed little and often.
something is wrong.

119
THE
FIRST DAYS
WITH YOUR BABY
How you feel 120 Your body 123
Postnatal care 121 Your babys health 124
Stitches 122 Your babys appearance 124
Bleeding 122 What your newborn baby can do 126
Sex and contraception 122

The first few days with your baby can be a very emotional time
for you and your partner. There is a lot to learn and do.
There is the excitement of getting to know your baby,
but you will also be tired and your body will be
recovering from labour and the birth.
Keep your baby close to you as much as you can.
Your partner should also spend time holding and
being close to your baby. They may feel a little left
out, especially if they have to leave you and the baby
in hospital and return to an empty home. They may
need support and encouragement to get involved.
The more you can both hold and cuddle your
baby, the more confident you will all feel.

holding your
babyclose
HOW YOU FEEL
You may feel tired for the first few
days, so make sure you get plenty of
rest. Even just walking and moving
about can seem like hard work.
For a lot of mothers, the excitement
and the pleasure of the new baby
far outweigh any problems. But
you can begin to feel low or rather
depressed, especially if you are very
tired or feel you cannot look after
your baby in the way you would like.

120
Giving birth is an emotional
and tiring experience and your 10
hormones change dramatically in
the first few days. Some women
get the baby blues and feel rather
weepy around three to five days

THE FIRST DAYS WITH YOUR BABY


after giving birth (see page 136).
This can be worse if your labour
was difficult, you are very tired
or you have other worries. Some
women worry because they dont
love their baby immediately. It is
not always love at first sight. You
may just need to give yourself time
you can still care for your baby
and provide all the warmth and
security they need.

POSTNATAL CARE
If you have your baby in hospital,
you may be able to return home
with your baby straight from the
labour ward or you may be moved You are likely to need quite a lot of
to a transfer lounge or a postnatal help and advice with your first baby.
ward where you will be with other Whether you are in hospital or at
mothers and babies. home, the midwives are there to
guide and support you as well as
You should discuss your postnatal
to check that you are recovering
care with your midwife during
from the birth. Dont hesitate
pregnancy so you know what
to ask for help if you need it.
to expect.
A midwife will be available in your
community to help you look after
yourself and your baby.

121
STITCHES Going to the toilet You may also feel cramps like period
pain, known as after pains. These
If you have had stitches, bathe the The thought of passing urine can are both because feeding causes the
area often in clean warm water be a bit frightening at first if you are uterus to contract.
to help it to heal. Have a bath or sore or cannot feel what you are
doing. Drinking lots of water dilutes Gradually, the discharge will
shower with plain warm water.
your urine, but if it is difficult to pass become a brownish colour and may
Afterwards, dry yourself carefully.
urine, tell your midwife. continue for some weeks, getting
In the first few days, remember
less and less until it stops. If you find
to sit down gently and lie on your You probably will not need to open you are losing blood in large clots,
side rather than on your back. your bowels for a few days after the you should save your sanitary towels
Pelvic floor exercises can also help birth, but its important not to let to show the midwife as you may
you to heal (see page 35). yourself become constipated. Eat need some treatment.
If the stitches are sore and fresh fruit, vegetables, salad and
uncomfortable, tell your midwife wholemeal bread, and drink plenty SEX AND
of water. Whatever it may feel like,
as they may be able to recommend
its very unlikely that you will break
CONTRACEPTION
treatment. Painkillers will also
help. If you are breastfeeding, the stitches or open up the cut or Soon after your baby is born, a
check with your midwife, GP tear again. midwife or doctor will talk to you
or pharmacist before you buy about contraception. If this doesnt
over the counter products like
BLEEDING happen, ask. You can become
ibuprofen or paracetamol. After the birth you will bleed from pregnant straight away, even if
your vagina. This will be quite you are breastfeeding or have not
Usually stitches just dissolve by had a period.
heavy at first, which is why you
the time the cut or tear has healed,
will need super-absorbent sanitary Make sure you are using a reliable
but sometimes they have to be
towels. Do not use tampons until form of contraception before you
taken out.
after your postnatal check, as and your partner have sex again,
they can cause infections. While unless you want to get pregnant
breastfeeding you may notice that (see page 135 for your different
the discharge is redder or heavier. contraceptive options). If you are
breastfeeding, you may not have
another period until you stop
feeding, or even for some weeks
or months after that. If you are
not breastfeeding, your first period
might start as early as a month after
the birth, or it might be much later.

recoveryand
healing

122
Helpful tips
YOUR BODY Breastfeeding helps because
10
it makes the uterus contract.
Postnatal exercises
Your body will have gone through Sometimes, because this is
some major changes over the past happening, you may feel a quite Postnatal exercises
few days. painful twinge in your abdomen (see page 133) will
or period-type pain while you

THE FIRST DAYS WITH YOUR BABY


help to tone up the
Your breasts are breastfeeding. muscles of your pelvic
Many women experience changes floor and abdomen.
in the size of their breasts during Your bladder They will also get you
pregnancy and breastfeeding. Its quite common after having a moving and feeling
SeeChapter 9 for more information baby to accidentally leak urine if generally fitter. You
about this. you laugh, cough or move suddenly. may be able to attend
Pelvic floor exercises (see page 35) a postnatal exercise
If you dont intend to breastfeed
will help with this. If the problem class at your hospital.
from the start, you need not do
persists after three months, see Ask your midwife or
anything. But on the third or fourth
your doctor, who may refer you physiotherapist to help
day, your breasts may be tender
to a physiotherapist. you organise this.
as the milk is still being produced.
Wearing a firm, supportive bra Your bowels
may help. Your breasts will reduce Piles (see page 63) are very
in size in a week or so. common after delivery but they
Speak to your midwife if you are usually disappear within a few
days. Eat plenty of fresh fruit, Personal child health
very uncomfortable.
vegetables, salad, brown bread record (PCHR)
Your abdomen and wholegrain cereals, and drink You will be given a PCHR
Your abdomen will probably be plenty of water. This should make for your baby within a few days
quite baggy after delivery. it easier and less painful when you of their birth. This book records
Despite having delivered your pass a stool. Try not to push or important information about
baby plus the placenta and a lot strain as this will make the piles your child. Take it with you
of fluid, you will still be quite a worse. Let the midwife know whenever you see anyone
lot bigger than you were before if you feel very uncomfortable. about your childs health
pregnancy. This is partly because They will be able to give you an or development. This is your
your muscles have stretched. ointment to soothe the piles. record, so do add information
If you eat a balanced diet and yourself. This could be a note
exercise, your shape should of when your child does
soon return to normal. something for the first time
or advice given to you by a
healthcare professional.

Rhesus negative
mothers
If your blood group is rhesus
negative and your babys fathers
is rhesus positive, blood samples
will be taken after the delivery
to see whether your baby is
rhesus positive. You may need
an injection to protect your
next baby from anaemia.
This should be given within
72 hours of delivery.

123
Although this is rare, it can YOUR BABYS
cause them to bleed dangerously
into the brain. To prevent this, APPEARANCE
your baby should be offered
vitamin K. You will be offered
an injection of vitamin K for
your baby, as this is the most
effective way of helping to
prevent a rare bleeding
disorder (haemorrhagic
disease of the newborn).
If you prefer that your baby
doesnt have an injection,
oral doses of vitamin K are
available. Further doses will You will probably spend the first
be necessary. few days looking at your baby.
Newborn hearing You will notice every detail the
colour and texture of their hair,
YOUR BABYS screening
the shape of their hands and feet,
HEALTH programme
and the different expressions on
A small number of babies are their face. If you notice anything
When your baby is born, they born with hearing loss. Your that worries you, however small,
will have a quick physical baby will be given a quick ask your midwife. Your baby
examination to check that there are and simple test to check their will be examined by a midwife,
no major problems that need urgent hearing. Finding out about paediatrician or neonatal nurse
treatment. Within 72 hours of hearing loss early means that practitioner to make sure
birth, another more detailed babies and parents can get everything is all right.
examination will be carried out. the support they need. This
You can find more information can help the development The fontanelle
at www.screening.nhs.uk of the childs language On the top of your babys head,
Your baby will also have some and social skills. See near the front, is a diamond-shaped
other routine health checks www.hearing.screening.nhs.uk patch where the skull bones have
and care. for further information. not yet fused together. This is called
the fontanelle. It will probably be a
Cord care Newborn blood
year or more before the bones close
(belly button) spot screening over. You may notice the fontanelle
Shortly after birth, the midwife will
(heel prick test) moving as your baby breathes.
clamp the umbilical cord close to When your baby is between Dont worry about touching it or
your babys navel with a plastic clip. five and eight days old, your washing the area. There is a tough
They then cut the cord, leaving a midwife will ask to take a layer of membrane under the skin.
small bit of cord with the clamp sample of blood from their
attached. The cord will take about a heel. This is used to test for
week to dry out and drop off. Keep rare but potentially serious More information
the navel clean and dry until this illnesses. All babies are tested
happens. If you notice any bleeding for phenylketonuria (PKU
a metabolic disorder), cystic For more information
or discharge from the navel, tell your on blood spot screening:
midwife, health visitor or doctor. fibrosis, sickle cell disorders
and congenital hypothyroidism http://newbornbloodspot.
Vitamin K (CHT low thyroid hormone). screening.nhs.uk
We all need vitamin K to make our Some babies are also tested For more information on
blood clot properly so that we will for MCADD, an inherited sickle cell screening:
not bleed too easily. Some newborn problem with the metabolism. www.sct.screening.nhs.uk
babies have too little vitamin K.

124
Bumps and bruises Your babys skin Breasts and genitals
It is quite common for a newborn At birth, the top layer of your
10
A newborn babys breasts can be a
baby to have some swelling and babys skin is very thin and easy little swollen and ooze some milk,
bruises on its head, and perhaps to to damage. Over the first month whether the baby is a boy or a girl.
have bloodshot eyes. This is just the (longer in premature babies) your Girls also sometimes bleed a bit or

THE FIRST DAYS WITH YOUR BABY


result of the squeezing and pushing babys skin matures and develops have a white, cloudy discharge from
that is part of being born and will its own natural protective barrier. their vagina. These are a result of
soon disappear. hormones passing from the mother
Vernix (the white sticky substance
Birthmarks and spots that covers your babys skin in the to the baby before birth and are no
uterus) should always be left to cause for concern. The genitals of
Once you begin to look closely at
absorb naturally. This is natures male and female newborn babies
your baby, you will probably find
own moisturiser and gives added often appear rather swollen, but
lots of little marks and spots, mainly
protection against infection in the they will look in proportion to their
on their head and face. Some
first few days. bodies in a few weeks.
babies have larger marks. Most of
them will go away eventually. Ask Premature babies skin is even Jaundice
the doctor who examines your baby more delicate. Staff in a specialised When they are about three days
if they will disappear completely. neonatal area will advise you on old, many babies develop mild
Most common are the little pink or skin care. jaundice. This will make their skin
red marks some people call stork and the whites of their eyes look
If your baby is overdue, their skin
marks. These V-shaped marks on a bit yellow. This usually fades
may well be dry and cracked. This
the forehead and upper eyelids within 10 days or so. But more
is to be expected, as the protective
gradually fade, though it may be severe jaundice may
vernix has all been absorbed.
some months before they disappear need treatment
Dont be tempted to use any
altogether. Marks on the nape of (see page 149).
creams or lotions as they
the neck can stay for much longer, may do more harm than
but they will be covered by hair. good. The top layer
Strawberry marks are also quite of your babys skin
common. They are dark red and will peel off over
slightly raised. They sometimes the next few days,
appear a few days after birth and leaving perfect skin
gradually get bigger. They may take underneath. Wash
a while to go away. your baby with plain
water only for at least
Spots and rashes are very common the first month.
in newborn babies and may come
and go. You should tell your doctor
or midwife immediately if you also
notice a change in your babys
behaviour, for example if your baby
is not feeding properly or is very
sleepy or very irritable.

getting
to know
each other 125
Rubella
If you were not immune to
rubella (German measles)
when tested early in your
pregnancy, you will usually
be offered the MMR
(measles, mumps and rubella)
immunisation. You should get
this before you leave hospital,
or shortly afterwards from your
GP. If it is not offered, speak
to your doctor or midwife, as
its a good opportunity to get
it done. You should not get
pregnant again for one month
after the injection. For more
information about rubella, visit
www.immunisation.nhs.uk
WHAT YOUR
Tests for hepatitis B NEWBORN BABY
and C CAN DO
All babies born to mothers There is one important skill that
who are infected with hepatitis your baby will not have to learn.
B should receive a course of They are born knowing how to
immunisation to prevent them suck. During the first few days they
getting hepatitis B. Your baby learn to co-ordinate their sucking
will be offered immunisation and their breathing.
soon after birth and at one,
Newborn babies also automatically
two and 12 months old.
turn towards a nipple or teat if it is
Your baby should be tested
brushed against their cheek, and
at 12 months to check that
they will open their mouths if their
immunisation has worked.
upper lip is stroked. They can also
For more information about
grasp things (like your finger) with
hepatitis B immunisation, refer
either their hands or feet, and they
to page 37.
will make stepping movements
If you are infected with if they are held upright on a flat
hepatitis C when your baby surface. Apart from sucking, these
is born, there is a small risk automatic responses will go, and
that you could pass on the your baby will begin to make
infection. Your baby will be controlled movements instead.
tested at an appropriate time.
Newborn babies can use all of their
senses. They will look at people and
things, especially if they are near,
and particularly at peoples faces.
They will enjoy gentle touch and the
sound of a soothing voice, and they
will react to bright light and noise.
Very soon they will also know their
mothers special smell.

126
WHAT YOU
NEED
FOR YOUR BABY

Nappies  127 In the car 130


Bathing  128 Feeding 131
Sleeping 129 Clothes  131
Out and about 130

It can be easy to get confused about what you really need for your baby. You can always
ask your midwife or health visitor for advice on what to buy, and you may be given a
list of essentials at your antenatal classes or by your maternity service. There are some
essentials that every new mother needs, as well as extras that you might want to think
about. You may be able to borrow some items, and then pass them on later to another
mother or keep them for a second child.

NAPPIES For cloth nappies, you will need:


More information
nappy pins for nappies without
Disposable nappies Velcro or fasteners For information about
Disposable nappies are convenient choosing and using
nappy liners either disposable
to use and are available from cloth nappies, visit
or cloth, which you can wash and
supermarkets and other retail outlets. www.wen.org.uk, or visit
use again
www.goreal.org.uk to find
Cloth nappies a bucket with a lid and nappy local suppliers.
Washable cloth nappies are cheaper sterilising powder or liquid for
than disposable nappies, even when sterilising nappies, and
you take into account the cost of about four pairs of plastic
washing them at home or getting pants that are either tie-on or
them washed by a laundry service. elasticated. Tie-on ones will fit
They are more environmentally small babies better. Some cloth
friendly and are easily laundered in nappies have the waterproof
a 60C wash. You can get shaped wraps attached.
cloth nappies with Velcro or popper
fastenings and waterproof wraps.

127
Nappy services
Nappy laundry services deliver
freshly laundered nappies to
your home and take away the
soiled ones to wash each week.
They supply everything you
need wraps, liners and
storage bins.

Nappy changing

BATHING
It is a personal choice how Remember to wrap a towel
frequently you bathe your baby; round the taps forsafety
a wash will often be enough to two towels, the softer the better.
keep your baby clean and ensure Keep them only for your babys
To change nappies, you will need: they are comfortable. A warm bath use. There is no need for special
cotton wool. Always choose may help your baby to sleep. baby towels, unless you want them
white. Rolls are usually cheaper You will need: unperfumed soap although
than balls
washing your baby with just
a baby bath or any large,
a changing mat water is fine.
clean bowl, such as a sink,
baby lotion or wipes as long as its not metal. See page 144 for how to bathe
baby barrier cream to help yourbaby.
prevent nappy rash, and
a bag to carry all the nappy-
changing equipment when you
go out. A carrier bag will do but
you can get special bags that whose
turn?
include a changing mat.

Safety
The safest place to change
a nappy is on a mat on the
floor. If you use a higher
surface, keep your hand
on your baby at all times
to stop them rolling off.
See page 144 for how to
change your babys nappy.

128
SLEEPING
For the first few months, you will
11
need a crib, a carry cot or a Moses
basket (a light, portable bassinet).
Your baby needs somewhere to

WHAT YOU NEED FOR YOUR BABY


sleep that is safe and warm and
not too far away from you. If you
are borrowing a crib or cot, or if
you have one that has been used The baby on the left is sleeping in the feet to foot position (also
by another of your children, you see page 140). This means that the babys feet are right at the end of the
will need a new mattress. See the cot to prevent the baby wriggling under the covers and overheating.
section on reducing cot death on
the right.

Cot safety Reducing the risk of


Your baby will spend many hours cot death
alone in a cot, so make sure its safe. The Foundation for the Study
The mattress must fit snugly with of Infant Deaths (FSiD) has
no space for your babys head to developed important key
get stuck. messages for parents to help
to reduce the risk of cot death.
The bars must be smooth and
securely fixed, and the distance Place your baby on their back
between each bar should be not to sleep, in a cot in a room
less than 1 inch (25mm) and not with you.
You will also need:
more than 2 inches (60mm) Do not smoke in pregnancy
a firm mattress that fits the cot so that your babys head cannot or let anyone smoke in the
snugly without leaving spaces become trapped. same room as your baby.
round the edges so that your The cot should be sturdy. Do not share a bed with
baby cannot trap their head
The moving parts should work your baby if you have been
and suffocate
smoothly so that fingers or drinking alcohol, if you take
sheets to cover the mattress. clothing cannot get trapped. drugs or if you are a smoker.
You need at least four because
Cot bumpers are not Never sleep with your baby
they need to be changed
recommended as babies can on a sofa or armchair.
often. Fitted sheets make
life easy but they are quite overheat or become entangled Do not let your baby get
expensive. You could use in the fastenings. too hot keep your babys
pieces of old sheet Never leave anything with ties head uncovered and place
for example, bibs or clothes in your baby in the feet to foot
light blankets for warmth.
the cot in case they get caught position.
around your babys neck.
If you are buying a new cot,
look for the British Standard
Pillows and duvets are not mark BS 1753.
safe for babies less than a
year old because of the risk of
suffocation. Duvets can also
make the baby too hot.
Baby nests and quilted sleeping
bags are not suitable for your
baby to sleep in when you are
not there because of the
danger of suffocation.

129
If you have a car, look for a pram
that can be dismantled easily.
Buy a pram harness at the same
time, as you will soon need it.
Carrycot on wheels. Your baby
can sleep in the carrycot for the
first few months and the cot can
be attached to the frame to go out.
It can also be taken in a car with
appropriate restraints.
Three-in-one. This is a carrycot
and transporter (set of wheels)
OUT AND ABOUT that can be converted into a
pushchair when your baby
Spend some time looking at what outgrows the carrycot.
is available for getting around with
your baby. Think about what will Shopping trays that fit under
suit you best. You could always the pushchair or pram can be very
ask other mothers what they have useful when you are out.
found useful.
Baby carriers (also called slings)
carry your baby in front of you.
Most babies like being carried like
Checks IN THE CAR
this because they are close to you Before buying a pushchair or If you have a car, you must have a
and warm. The back part of the pram, check that: car seat. This is also called a safety
carrier must be high enough to the brakes are in good restraint. Your baby must always go
support your babys head. Check working order in their seat, including when you
that the buckles and straps that bring them home from the hospital.
attach the carrier to you are secure. the handles are at the right
Its very dangerous and illegal
Older babies who can hold up their height for pushing, and
tocarry your baby in your arms.
heads and whose backs are stronger the frame is strong Thebest way for your baby to
(at about four months) can be enough. travel is in a rear-facing infant
carried in backpacks. car seat, on either the front
Pushchairs are only suitable for or back seat. This is held
young babies if they have fully in place by the adult
reclining seats that let your baby safety belt.
lie flat. Wait until your baby can sit
up before using any other type of
pushchair. You should also consider
the weight of the pushchair if you
use public transport as you might
have to lift it onto trains or buses.
Prams give your baby a lot of space
to sit and lie comfortably, although
they take up a lot of space and are
hard to use on public transport.

130
If you have a car with
breast pads. You put these into
your bra to prevent milk from
a shawl or blanket to wrap
your baby in 11
air bags in the front, your leaking onto your clothes. a wool or cotton hat, mittens
baby should not travel in If you are going to formula feed, and socks or bootees for going
the front seat, even if they you will need: out if the weather is cold.

WHAT YOU NEED FOR YOUR BABY


are facing backwards, Its better to choose close-knitted
because of the danger of six bottles with teats and caps patterns for safety
suffocation if the bag inflates. sterilising equipment a sun hat for going out if the
a bottle brush weather is hot or the sun
infant formula milk. Avoid buying is bright.
To keep your baby as safe as this too far in advance, as instant
possible: formula milk has a use by date
Make sure the car seat is printed on the package.
fitted correctly. See Chapter 9 for how to feed
Do not place a rear-facing infant your baby.
car seat in the front passenger
seat if your car is fitted with an
air bag.
CLOTHES
Babies grow very quickly. All you
need for the first few weeks are
enough clothes to make sure that
your baby will be warm and clean.
You will probably need:
six stretch suits for both day and Washing
night or four stretch suits and baby clothes
two nighties for the night.
Use socks or bootees with the If you use a washing
Dont buy a second-hand car nightie if its cold machine, dont use washing
seat as it may have been powders with enzymes
damaged in an accident. two cardigans. They should be (bio powders) or fabric
wool or cotton rather than conditioner, as they may
Look for United Nations ECE nylon, and light rather than
Regulation number R44.03, or irritate your babys skin.
heavy. Several light layers of Always rinse clothes
a later version of this standard, clothing are best for keeping
when you buy a car seat. This very thoroughly.
your baby warm
is the standard for new seats.
However, if you have car seats that four vests
conform to a British Standard or
to an earlier version of R44, you for tiny
toes
can continue to use them.

FEEDING
If you are going to breastfeed, you
will probably want:
nursing bras that open at the
front and have adjustable straps.
Cotton is best because it allows air
to circulate. If you try on bras at
about 3638 weeks, they should
fit when you need them

131
THE EARLY WEEKS:
YOU
Partners 132 Your relationships 134
Help and support 133 The baby blues and postnatal depression 136
Looking after yourself 133 Your postnatal check 136

Your first few weeks at home can be an exciting but anxious time for parents as you get
used to caring for your new baby.
If you have been in hospital or a midwifery unit, you may feel apprehensive about
being on your own without staff on call to help you. The more you handle your baby,
the more your confidence will increase. And your community midwife, health visitor and
GP are there to support you if you have any worries or problems. Ask your midwife
or health visitor for a copy of the book Birth to Five, which has advice
on looking after your child up to the age of five.

PARTNERS getting specialist help and information


on breastfeeding if the mother has
As the mothers partner, you any concerns
can get involved in caring provide emotional support and
for your baby from day one. encouragement
In the first weeks, you can:
make nutritious meals and snacks for
help your babys mother to your babys mother
breastfeed by: change your babys nappies
s pending time with her bathe and dress
while the baby is feeding your baby
b
 ringing your baby cuddle and play
to their mother when with your baby
they need feeding in
the night clean the house,
go shopping
h
 elping to wind and do other
your baby household chores.

You may feel quite nervous about handling the baby at first
but you will get more confident. Dont be embarrassed to
ask for help or encouragement.

132
HELP AND Its tempting to use your babys
12
sleep times to catch up on
SUPPORT chores, but try to have a sleep
You will probably need a lot of or a proper rest at least once
practical help, as well as emotional during the day.

THE EARLY WEEKS: YOU


support. You are bound to feel up Exercise
and down and to get tired easily in
Continue with any postnatal
the first few weeks. Many women
exercises you have been shown
want to have their partner around
by your midwife. You can also do
so that you get to know the baby
Too many visitors in a short time this deep stomach exercise when
together and have help with the
can be very tiring. If visitors do you feel well enough.
work. Being together at this time
come, dont feel you have to tidy
helps you to start to adjust to the
up or lay on a meal. Let them do
changes in your life. If you are on 1 Lie on your side with your
things for you, like the washing
your own, or your partner cannot knees slightly bent.
up, making a meal or bringing
be with you, ask your mother or a 2 Let your tummy relax and
some groceries.
close friend to be there. breathe in gently.
If you need extra help, ask. Friends
Even with help, you will probably or neighbours will probably be 3 As you breathe out, gently
feel tired. Here are some things you very willing to help you by doing draw in the lower part of
could try: things like shopping. your stomach like a corset,
narrowing your waistline.
Cut down on cleaning a bit of
dust will not hurt. LOOKING AFTER 4 Squeeze your pelvic floor.
Keep meals simple but healthy. YOURSELF 5 Hold for a count of 10
You need to eat well but this then gently release.
need not involve a great deal of Although you may feel like your
6 Repeat 10 times.
preparation and cooking. every waking hour is spent caring
for your baby, its important to look
Try to space visitors out and say no after yourself as well. You should not move your back
to visitors if you feel too tired or at any time. After six weeks,
need some time with your baby. Rest progress to the box position
While you are feeding your baby at (see page 34).
night and your body is recovering
from childbirth, it is essential to Besides these exercises, try to
catch up on rest. fit in a walk with your baby
every day. This
can help you lose
weight and feel
better.

133
YOUR
RELATIONSHIPS
After you have had a baby, the
relationships around you can
change. Many women find that
they turn to their own mother for
help and support. But your mother
may not be sure about how much Your relationship with your baby
to get involved. You may find that may not be easy either, particularly
she is trying to take over or that she if you are not getting much sleep.
is so anxious not to interfere that Dont feel guilty if you sometimes
she doesnt help at all. Try to let her feel resentful at the demands your
and others know what help and baby makes, or if your feelings are
support you want from them. not what you expected them to be.
Talk to your midwife or health
Your relationship with your partner visitor if you are upset or worried.
will also change. It is very easy in But remember, many mothers find
Eating properly
those exhausting early weeks just their babies difficult at first and
Its very important to eat properly to leave things to sort themselves come to love them gradually over
(see Chapter 3). If you want to lose out. You may wake up six months some weeks.
weight, dont rush it. A varied diet later to find that you have not spent
without too many fatty foods will an hour alone together and have If you are on your own and
help you lose weight gradually. Try lost the knack of easily talking your dont have family to support you,
to make time to sit down, relax and problems through. You both need ask a friend to help you in the
enjoy your food so that you digest time alone, without the baby, to early weeks.
it properly. It doesnt have to be recharge your own batteries. You
complicated. Try food like baked Sex and contraception
also need time together, without
potatoes with baked beans and There are no rules about when to
the baby, to keep in touch with
cheese, salads, pasta, French bread start having sex again. Dont rush
each other.
pizza, scrambled eggs or sardines on into it if it hurts, it will not
toast, followed by fruit mixed with be pleasurable. You may want
yoghurt or fromage frais. to use a lubricating jelly the first
time because hormone changes
A healthy diet is especially may make your vagina feel drier
important if you are breastfeeding. than usual.
Breastfeeding can help mothers to
lose weight. Some of the fat you
put on in pregnancy will be used to
help produce milk, but the rest of
the nutrients will come from your
diet. This means that you may be
hungrier than usual. If you do need
a snack, try having beans on toast,
sandwiches, bowls of cereal or fruit
(see page 29).
Sure Start Childrens Centres give
advice about healthy eating plans
for mothers, as well as support for
breastfeeding. You can find out
more about the services offered in
Childrens Centres in your area by
visiting www.surestart.gov.uk

134
have to use some other form of
contraceptive (like a condom) 12
as well. There is no evidence
to suggest that this pill affects
your baby in any way. Even so,
some women prefer not to take

THE EARLY
it while they are breastfeeding

EARLY WEEKS:
and use another form of
contraception instead.
The cap or diaphragm. These

WEEKS:YOU
can be used six weeks after
you give birth. If you had a cap
before, it probably will not be
It might be some time before you Contraceptives the right size any longer. You

YOU
want to have sex. Until then, you can have a new one fitted at
Short-acting
both may feel happier finding other your postnatal check-up.
contraceptive methods
ways of being loving and close.
Short-acting contraceptive Long-acting
If you or your partner have any
methods rely on you taking them contraceptive methods
worries, discuss them with your GP
every day or when you have sex. Long-acting contraceptive
or health visitor.
methods last between three
The condom. This may be
It is possible to get pregnant even months and ten years. They
the easiest choice for the
if you have not started your periods may be suitable if you think
early weeks after childbirth.
again or if you are breastfeeding. you will forget to take or use
Condoms offer the best
It is therefore important to use a shortacting contraceptive.
protection against sexually
contraceptives as
transmitted infections (STIs) so The IUD (intra-uterine device)
soon as you
if you think you or your partner or IUS (intra-uterine system).
start having
may have been exposed to an These can be fitted from the
sex again.
STI you should use a condom in fourth week after you give
Your midwife or addition to your other choice birth. They can be fitted at your
doctor should of contraception. postnatal check-up when your
talk to you about contraception The combined pill. If you are uterus is back to its normal size.
before you leave hospital and again not breastfeeding, you can start The contraceptive injection.
when you go for your six-week taking this pill 21 days after you It is recommended that you wait
postnatal check. Alternatively, you give birth. If you start it later until six weeks after you give
could talk to your midwife or health than the 21st day, it will not be birth before you are given this.
visitor when they visit you at home reliable for the first seven days. It can be given earlier in some
or go to your GP or community So for this time you will have to circumstances. The contraceptive
contraceptive clinic (sometimes use another contraceptive (like a injection will not affect your milk
called family planning or CASH condom) as well. Dont take this supply if you are breastfeeding.
clinic). pill if you are breastfeeding as it The contraceptive implant
The FPA (Family Planning reduces milk flow. (Implanon). This contains a
Association see page 184) The progestogen-only pill. long-lasting progestogen and
publishes free leaflets about If you are breastfeeding, you is effective for three years.
all methods of contraception. can take a progestogen-only It can be fitted 21 days after
pill, which will not affect your you give birth or earlier in some
milk supply. This can also be circumstances. If its fitted after
started 21 days after you give 21 days, you will have to use
birth. It has to be taken at the another contraceptive for seven
same time every day. If you days. The contraceptive implant
start it later than the 21st day, will not affect your milk supply
it will not be reliable for two if you are breastfeeding.
days. So for this time you will
135
THE BABY BLUES Tell the doctor if the examination
is uncomfortable.
AND POSTNATAL
Your breasts are unlikely to be
DEPRESSION examined unless you have a
As many as 8 out of 10 mothers get particular concern.
the baby blues, often about three A cervical smear test may be
to five days after the birth. You discussed if you have not had one
might feel upset, mildly depressed, in the past three years (see page
or just keep bursting into tears for YOUR POSTNATAL 48). This is usually delayed until
no apparent reason. It usually only three months after delivery.
lasts for a few days. CHECK
If you are not immune to rubella
Around 1 in 10 mothers become You should have your postnatal (German measles) and were not
depressed. This is usually mild but check about six weeks after your given an immunisation before you
sometimes can be quite severe. babys birth to make sure that you left hospital, you will be offered
You must get help if you are taken feel well and are recovering from one now. You should not become
over by a feeling of sadness and the birth. You may be offered an pregnant for one month after this
hopelessness, you feel irritable appointment to go back to the immunisation.
and anxious, or you have difficulty hospital or midwifery unit where You will be asked if you still have
sleeping and coping with even the you gave birth, but otherwise any vaginal discharge andwhether
smallest task. See page 82 for you should see your GP. Its time you have had a period yet.
more information. to introduce your baby to your
GP as the new member of Tell your doctor if:
Help and support your family! - you are having trouble holding
in urine or wind, or you are
Its a good opportunity to ask
If you think you are depressed, soiling yourself
any questions and sort out any
contact your GP or health - intercourse is painful
problems that are troubling you.
visitor and explain how you are
You may like to make a list of - you are feeling very tired,
feeling. Your partner or a friend
questions to take along with you low or depressed, or
could contact them for you if
so that you dont forget what - you are worried about anything.
you want. You can also contact
you want to ask.
the Association for Post-Natal You can also ask your doctor about
Illness (see page 186) for more What usually happens contraception. You may wish to
information. You will be weighed and can choose a different method to
If you have twins or triplets, get weight loss advice if you the one you had previously used
you are more likely to experience need it. (especially if your pregnancy
postnatal and longer-term was not planned). The doctor or
Your urine will be tested to
depression. This is mainly because nurse can help you decide which
make sure your kidneys are
of the additional stress of caring method is right for you now.
working properly and that
for more than one baby. Just See the box on page 135 for
there is no infection.
getting out of the house can be some of the different options.
Your blood pressure will be
difficult when you have more
checked.
than one baby, and this can make
you feel isolated. Tamba (see page You may be offered an
Your babys check
188) can help you make contact examination to see if:
with other mothers of multiples - your stitches (if you had any) Your GPs surgery or health
via local twins clubs and through have healed clinic will probably arrange
their helpline Tamba Twinline on for your babys six-week
- your uterus is back to its check to be done at your
0880 138 0509 where you can normal size, and
talk to other mothers of multiples. postnatal check. If you go
You may also find it helpful - all the muscles used during to the hospital, the babys
to contact the Multiple Births labour and delivery are check will usually need to
Foundation (see page 183). returning to normal. be arranged separately.

136
THE EARLY WEEKS: 12
YOUR BABY

THE EARLY WEEKS: YOU


Enjoying your baby 137 Changing your baby 142
Registering the birth 138 Washing and bathing 144
Crying 138 Illness  145
SleepContents
 140 Getting support 146


YOUR BABY
In the first few weeks, you will be learning how to look after your baby. You will start to
understand them and will learn what is normal and what may be a sign that something
is wrong. But the most important thing to do in the first few weeks is to enjoy your
baby. Spending time with them is the best way to help them feel safe and loved.

ENJOYING
YOUR BABY
Keeping your baby warm, fed and They are learning about what the Talking to your baby
safe may seem to take up all of your world is like and, above all, what it
It is very important to talk to
time in the first weeks. But they are feels like to love and be loved. It is
your baby. If you or your family
only a tiny part of what it means to important to talk to your baby.
speak another language, use
be a parent. Every second that your
it to speak to your baby. It can
baby is awake, they are learning
help your baby to learn other
from you. Learning about what it
languages, and enjoy another

listening
feels like to be touched gently, the
culture. You can talk to them
sound of your voice and your very

to your
about anything and everything.
special smell.
Talking to young children, even
very young babies helps them

voice
become good communicators
later in life. It will also help
your baby build their early
bond with you.

137
At the moment, if you are not CRYING
married, you can decide whether
you want the fathers name to All babies cry. Its their way of
appear on the birth certificate. saying that something is not right.
If you do not want his name to Sometimes you will be able to find
appear, you can register the birth the reason for your babys distress
by yourself. However, the and deal with it. At other times
government plans to change the all you can do is try to comfort or
law so that joint registration, by both distract your baby. If its not obvious
mother and father, becomes the why your baby is crying, think of
normal arrangement for unmarried possible reasons.
parents. Your local register office
Are they:
REGISTERING will be able to provide detailed
hungry?
information about these changes
THE BIRTH when they come into effect. hot, cold or uncomfortable?
Your babys birth must be registered If you live in a different district from feeling tired and unable to sleep?
within six weeks from when they the one where your baby was born, lonely and wanting company?
were born. This will take place at you can go to your nearest register
the register office in the district office. The registrar will take details bored and wanting to play?
where they were born. The contact from you and then send them to Do they have:
details will be in the telephone the district where your baby was
book under the name of your local a wet or dirty nappy?
born. You will then be sent the
authority or you can find it online birth certificate. You cannot claim wind?
at www.direct.gov.uk benefits, such as Child Benefit, colic?
until you have a birth certificate.
It could be none of these things.
All babies born in England and Perhaps your baby simply feels
Wales are now given a unique overwhelmed and a
NHS number at birth. Midwives bit frightened by all
request and receive a newborn the new sights,
babys NHS number. They send sounds and
this NHS number to the sensations.
Registrar of Births,
Deaths and
Marriages via
If you are married, you or the father your local
can register the birth. If you are not child health
married, you may register together department.
with your babys father and his name
will appear on the birth certificate.
In most circumstances, children
benefit from being acknowledged
by both parents and by knowing the
identity of both their mother and
father. To register jointly, you must
either go together to register the
birth or one of you can go with an
appropriate document. Including
the fathers name in the birth
register will usually give him parental
responsibility. Your local register
office will explain this process.

138
When crying gets Getting help
too much If you feel you are having difficulties
13
Some babies do cry more than coping with your babys crying, talk
others and its not really clear why. to your midwife or health visitor. Or
Dont blame yourself, your partner contact Cry-sis on 08451 228669

THE EARLY WEEKS: YOUR BABY


or your baby if they cry a lot. It can they will put you in touch with other
be very exhausting so try to get parents who have been in the same
rest when you can. Share soothing situation. If you have twins or more,
your baby with your partner. You the crying can seem relentless
could ask a friend or relative to take Twinline, Tambas helpline (see page
over for an hour from time to time, 188), can offer support.
just to give you a break. If there
If your babys crying sounds
is no one to turn to and you feel
different or unusual, it may be the
your patience is running out, leave
first sign of illness, particularly if
your baby in the cot and go into
they are not feeding well or will
another room for a few minutes.
not be comforted. If you think
Put on some music to drown the
your baby is ill, contact your doctor
noise, take some deep breaths,
immediately. If you cannot contact
make yourself a cup of tea or find
your doctor and its an emergency,
Comforting some other way to unwind. You will
take your baby to the nearest
cope better if you do. If you are very
your baby angry or upset, telephone someone
hospital accident and emergency
Holding your baby close and department.
who will make you feel better.
talking in a soothing voice or
singing softly will reassure them. Never shake your baby. Shaking
makes a babys head move violently.
Movement often helps to calm It can cause bleeding and damage
down crying. Gently sway or rock the brain.
your baby or take them for a walk
or for a ride in a car.
Sucking can also be comforting.
You can put your baby to your
breast or give them a dummy,
as long as breastfeeding
is well established
(see page
106). Make
sure the
dummy is Colic
sterilised and dont
If your baby has repeated episodes of excessive and inconsolable
dip it in honey or
crying but they otherwise appear to be thriving and healthy,
sugar to make your baby suck.
they may have colic.
They will suck anyway. Using
sugar will only encourage a Although it may appear that your baby is in distress, colic is not
craving for sweet things, which harmful. Your baby will continue to feed and gain weight normally.
are bad for their teeth. There is no evidence that colic has any long-term effects.
Colic can be very upsetting for parents. You may feel like you are letting
your baby down or that you are doing something wrong. Although
colic can be distressing at the time, it is a common phase that should
last only a few weeks at the most. It may help to remind yourself that
you are not causing the crying and it is not under your control. If you
are concerned, talk to your health visitor or GP.

139
Reducing the risk Place your baby on their
of cot death back to sleep
Sadly, we dont know why some Place your baby on their back to
babies die suddenly and for no sleep from the very beginning for
apparent reason from what is both day and night sleeps. This will
called cot death or Sudden reduce the risk of cot death. Side
Infant Death Syndrome (SIDS). sleeping is not as safe as sleeping
But we do know that placing on the back. Healthy babies placed
a baby to sleep on their back on their backs are not more likely
reduces the risk, and that to choke. When your baby is old
exposing a baby to cigarette enough to roll over, they should not
smoke or overheating a baby be prevented from doing so.
SLEEP increases the risk. Babies may get flattening of
The amount that babies sleep, even All the advice that we now the part of the head they lie on
when they are very small, varies a have for reducing the risk of cot (plagiocephaly). This will become
lot. During the early weeks some death and other dangers, such rounder again as they grow,
babies sleep for most of the time as suffocation, is listed on this particularly if they are encouraged
between feeds. Others will be page and opposite. Remember to lie on their tummies to play
wide awake. As they grow older, that cot death is rare, so dont when they are awake and being
they begin to develop a pattern of let worrying about it stop you supervised. Experiencing a range of
waking and sleeping. Some babies enjoying your babys first few different positions and a variety of
need more sleep than others and at months. But do follow the advice movement while awake is also good
different times. Try not to compare given here to reduce the risks as for a babys development.
what your baby does with other much as possible. The risks of bed sharing
peoples babies. All babies are The safest place for your baby to
To reduce the risk of cot death:
different, and their routines will sleep is in a cot in a room with you
change as they grow. Place your baby on their back for the first six months. Do not
to sleep, in a cot in a room share a bed with your baby if you or
You will gradually begin to
with you. your partner:
recognise when your baby is ready
for sleep and is likely to settle. Some Do not smoke in pregnancy or
are smokers (no matter where or
babies settle better after a warm let anyone smoke in the same
room as your baby. when you smoke and even if you
bath. Most sleep after a good feed. never smoke in bed)
A baby who wants to sleep is not Do not share a bed with your
likely to be disturbed by ordinary baby if you have been drinking have recently drunk alcohol
household noises, so there is no alcohol, if you take drugs or if have taken medication or drugs
need to keep your whole home you are a smoker. that make you sleep more heavily
quiet while your baby sleeps. It will feel very tired.
Never sleep with your baby on
help you if your baby gets used to
a sofa or armchair.
sleeping through a certain amount of The risks of bed sharing are also
noise. See the column on the right Do not let your baby get too increased if your baby:
for advice on sleeping positions. hot keep your babys head
uncovered. was premature (born before
Twins, triplets or more can have 37 weeks), or
specific sleeping issues and it may Place your baby in the feet to
was of low birth weight
be difficult for you to get them foot position.
(less than 2.5kg or 5.5lb).
into a routine. The Multiple Births
Foundation and Tamba (see pages The safest place for your There is also a risk that you might
183 and 188) have information baby to sleep is on their roll over in your sleep and suffocate
that you may find useful. They can your baby, or that your baby could
back in a cot in a room
sleep in the same cot there is get caught between the wall and
with you for the first
information from Tamba on the bed, or could roll out of an adult
six months.
how you can do this safely. bed and be injured.

140
Never sleep with a baby on
a sofa or armchair
Remember, a folded blanket
counts as two blankets.
covers, place your baby feet to foot
in the crib, cot or pram. 13
Its lovely to have your baby with Babies do not need hot rooms; Make the covers up so that they
you for a cuddle or a feed but its all-night heating is rarely reach no higher than the shoulders.
safest to put your baby back in their necessary. Keep the room at a Covers should be securely tucked

THE EARLY WEEKS: YOUR BABY


cot before you go to sleep. temperature that is comfortable in so they cannot slip over your
for you at night. About 18C babys head. Use one or more
Cut out smoking during
(65F) is comfortable. layers of lightweight blankets.
pregnancy partners too!
Smoking in pregnancy greatly If it is very warm, your baby may
Sleep your baby on a mattress that
increases the risk of cot death. not need any bedclothes other
is firm, flat, well fitting and clean.
Itisbest not to smoke at all. than a sheet.
The outside of the mattress should
Even in winter, most babies who be waterproof. Cover the mattress
If you are pregnant and want
are unwell or feverish do not with a single sheet.
to give up, call the NHS
need extra clothes.
Pregnancy Smoking Helpline Remember, do not use duvets,
on 0800 169 9 169. Babies should never sleep with quilts, baby nests, wedges,
a hot-water bottle or electric bedding rolls or pillows.
blanket, next to a radiator, heater
Dont smoke near or fire, or in direct sunshine.
your baby. Put your baby feet to foot
Babies lose excess heat from their
heads, so make sure their heads in the crib.
Dont let anyone smoke in cannot be covered by bedclothes
the same room as your baby during sleep periods.
Feeding
Babies exposed to cigarette smoke Breastfeeding your baby reduces the
after birth are also at an increased risk of cot death. See Chapter 9 for
risk of cot death. Nobody should Dont let your baby
everything you need to know about
smoke in the house, including overheat.
breastfeeding.
visitors. Anyone who needs to Remove hats and extra
smoke should go outside. Do not clothing as soon as you
take your baby into smoky places.
come indoors or enter
If you are a smoker, sharing a bed
a warm car, bus or train,
with your baby increases the risk
even if it means waking
of cot death.
your baby.
Dont let your baby get too
hot (or too cold)
Overheating can increase the risk
of cot death. Babies can overheat
because of too much bedding or
clothing, or because the room is too It is possible that using a dummy at
hot. Remember, a folded blanket the start of any sleep period reduces
counts as two blankets. When you the risk of cot death. Do not begin
check your baby, make sure they to give a dummy until breastfeeding
are not too hot. If your baby is is well established, usually when
sweating or their tummy feels hot your baby is around one month
to the touch, take off some of the old. Stop giving the dummy when
bedding. Dont worry if your babys your baby is between six and
Dont let your babys head
hands or feet feel cool this 12 monthsold.
become covered
is normal.
Babies whose heads are covered
It is easier to adjust the with bedding are at an increased
temperature with changes risk of cot death. To prevent your
of lightweight blankets. baby wriggling down under the

141
If your baby is unwell, seek CHANGING
MEDICAL advice promptly
Babies often have minor illnesses
YOUR BABY
that you do not need to worry Babies need their
about. nappies changed fairly
Make sure your baby drinks plenty often, otherwise they
of fluids and is not too hot. If become sore. Unless
your baby sleeps a lot, wake them your baby is sleeping
regularly for a drink. peacefully, always
change a wet or dirty
It can be difficult to judge whether nappy and change
an illness is more serious and your baby before
requires prompt medical attention. or after each feed.
See the section on illnesses on Organise the place where
page 145 for guidance on when you change your baby so that
you should get help. everything you need is handy (see Clean under the penis and the
page 128). The best place to change scrotum. Water is fine for cleaning
Monitors
a nappy is on a changing mat or your babys bottom but you may
Normal healthy babies do not need towel on the floor, particularly if you want to use wipes or lotion for
a breathing monitor. Some parents have more than one baby. That way, convenience when you are away
find that using a breathing monitor if you take your eye off your baby from home.
reassures them. However, there is for a moment to look after another
no evidence that monitors prevent You may want to use a cream, such
child, your baby cannot fall and as zinc and castor oil cream, which
cot death. If you have any worries hurt themselves.
about your baby, ask your doctor forms a waterproof coating to help
about the best steps to take. Try to sit down, so you dont protect the skin. Or you can just leave
hurt your back. If you are using a the skin clean and dry, especially
changing table, keep an eye on your with disposable nappies, since cream
baby at all times. may prevent them absorbing urine
Immunisation reduces
so well. Dont use baby powder
the risk of cot death. See the next page for the different as it can cause choking.
For more information kinds of nappies that are available.
about immunisation, visit
www.immunisation.nhs.uk How to change a nappy
You need to clean your babys
bottom carefully each time you
change a nappy to help prevent
More information soreness and nappy rash.
STEP 1
For more information on
Take off the nappy. If its dirty, wipe
reducing the risk of cot
away the mess from your babys If you are using a cloth nappy,
death, or to buy a simple
bottom with tissues or cotton wool. place it in a waterproof cover (if
room thermometer for
your baby, contact the Wash your babys bottom and needed) and put a nappy liner
Foundation for the Study genitals with cotton wool and warm inside. Lay your baby carefully on
of Infant Deaths (FSID): water and dry thoroughly. For girls, the nappy, bring the centre of the
wipe the bottom from nappy between your babys legs
Telephone: 020 7802 3200 front to back, away and then fasten the poppers or
Email: office@fsid.org.uk from the vagina, so that Velcro. Check that it fits snugly
Website: www.fsid.org.uk germs will not infect around the waist and legs.
the vagina or bladder. STEP 2
For boys, gently clean If you are using a disposable
the foreskin of the nappy, put the side with the sticky
penis (it can be pulled tapes under your babys bottom.
back very gently).
142
STEP 3
Fasten the tapes at the front.
nappy less absorbent. Make sure
you use the correct amount of
stools. Formula-fed
babies stools 13
Be very careful not to get cream detergent and rinse thoroughly. are firmer and
on the tabs or they will not stick. smell more.
Nappy rash
Wash your hands. Babies vary a lot
Most babies get a sore bottom

THE EARLY WEEKS: YOUR BABY


in how often they
Nappy hygiene or have nappy rash at some time,
but some have extra-sensitive skins. pass stools. Some have a
Disposable nappies bowel movement at or around each
Nappy rashes are caused by contact
If the nappy is dirty, flush the feed; some can go for several days
between sensitive skin and soiled
contents down the toilet. Roll up without having a movement. Either
nappies. If you notice redness or
the nappy and re-tape it securely. can be normal, but most breastfed
spots, clean your baby very carefully
Put it into a plastic bag. Dont put babies produce at least one stool
and change their nappies more
anything but nappies in this bag. a day for the first six weeks.
frequently. Better still, give your
Fasten the bag and put it outside
baby time without a nappy and When to get help
in your bin each day.
let the air get to their skin. Keep a
Most small babies strain and go
Cloth nappies spare nappy handy to mop up any
red in the face, or even cry, when
If the nappy is dirty, flush the accidents. You will soon see the rash
passing a stool. This is normal and
contents down the toilet. start to get better.
doesnt mean they are constipated
Biodegradable, flushable nappy If your baby does have a rash, ask as long as the stools are soft. If you
liners are available to make it easy. your midwife or health visitor about are worried that your baby may be
Have a lidded bucket ready to store it. They may advise you to use a constipated, mention this to your
the dirty nappies. You can soak protective cream. If the rash seems midwife or health visitor.
them in a nappy cleanser (follow to be painful and will not go away,
What you find in your babys
the instructions on the packet) or see your health visitor or GP.
nappies will probably vary from day
just store them here until you have
a load ready for washing.
Babies poo (stools) to day, and usually there is no need
to worry. For example, it is normal
Immediately after birth and for the
Wash nappies every two to three for some babies to have very runny
first few days, your baby is likely
days. Follow the care instructions stools. But ask your doctor, midwife
to pass a sticky, greenish-black
on your nappies, but a 60C or health visitor if you notice any
substance. This is called meconium
wash is usually OK. If you did not big changes, such as stools:
and it is the waste that has collected
soak the nappies before, add an
in your babys bowels while they becoming very frequent and
antibacterial nappy cleanser to your
were in your uterus. watery
normal washing detergent (follow
the instructions on the packet). As your baby begins to digest milk, being very smelly
Dont use enzyme (bio) washing the stools will change. They will changing colour to become
powders or fabric conditioner as become more yellow or orange green, white or creamy.
these may irritate your babys skin and can be quite bright in colour.
and the conditioner may make the Breastfed babies have quite runny See Babies with jaundice after
two weeks on page 149.

Putting on a disposable nappy

STEP 1 STEP 2 STEP 3

143
WASHING AND See page 124 on keeping your
babys umbilical cord clean and dry.
BATHING
Bathing
Washing Bath your baby two or three times
You dont need to bath your baby a week, or more often if they enjoy
every day, but you should wash it. Dont bath them straight after
their face, neck, hands and bottom a feed or when they are hungry or
carefully each day. You can do this sleepy. Make sure the room is warm
on your lap or on a changing mat. and that you have everything you
Choose a time when your baby need ready in advance.
is awake and contented, and
make sure the room is warm. 1 Check that the water is not
You will need a bowl of warm too hot. Test it with your wrist
water, some cotton wool, a towel or elbow. It should be just
and a fresh nappy. If you want to comfortably warm.
use soap, make sure that it is mild 2 Undress your baby except for 6 Lift your baby out and pat them
and unperfumed. their nappy, and wrap them dry with the towel. Dry carefully
snugly in a towel. Wash your in all the creases. If your babys
babys face with cotton wool and skin is dry, gently massage in
water as described above. There some baby oil or cream (not
is no need to use any soap. aqueous cream). Your baby may
3 Wash your babys hair with baby enjoy this.
soap or liquid, supporting their If your baby seems frightened of
head over the baby bath or the bath and cries, it may help to
basin. Rinse carefully. You dont try bathing together. You may like
need to use soap every time. to do this anyway. Make sure the
4 If you want to use soap water is only warm, not hot, and
occasionally, use a mild, dont add anything to the water.
unperfumed soap. Unwrap your You should also think about how
1 Take off your babys clothes baby and soap them all over, but you are going to get out of the bath
except for the vest and nappy. keep them on your lap so you with your baby. You might need
Wrap your baby in a towel. have a firm grip. Take the nappy someone around who you can pass
2 Gently wipe round each eye, off at the last minute. them to.
from the nose side outwards. 5 Put your baby gently into the
Use a fresh piece of cotton water. Using one hand for
wool for each eye, so you support, gently swish the water
dont transfer any stickiness to wash your baby without
or infection. splashing their face. You should
3 Using fresh, moist cotton wool, never leave your baby alone
wipe out each ear but dont in the water even for a few
clean inside their ears. Never use seconds. For boys, gently clean
cotton buds inside the ear canal. the top of the foreskin of the
penis. The foreskin can be pulled
4 Wash the rest of your babys face
back very gently to clean.
and neck with moist cotton wool
and dry gently. Wash and dry your
babys hands in the same way.
5 Take off the nappy and wash
your babys bottom (genitals),
with fresh cotton wool and
warm water. Dry your baby very
carefully, including in skin folds,
and put on a clean nappy.
144
ILLNESS 13
If you are worried
Its sometimes difficult to tell at first about your baby
when a baby is ill, but you may have
Phone your midwife or health
a funny feeling that things are not
visitor for advice. Keep their
quite right. If you are at all worried,

THE EARLY WEEKS: YOUR BABY


phone numbers where they
ask for help. You are not fussing.
can be reached easily.
Its far better to be on the safe side,
particularly with a very small baby. Phone your GP. Your GP may
Trust your own judgement. You be able to advise you over the
know your baby best. phone or may suggest that you
bring your baby along to the
Very urgent problems surgery. Most GPs will try to
Sometimes there are obvious signs fit a young baby in without an
that your baby is not well. Contact appointment, although it may
your doctor at once if your baby: mean a wait in the surgery.
turns blue or very pale If you are really worried about
your baby, you should always
has quick, difficult or grunting
phone your GP for help
breathing, or unusual periods of
immediately, whatever the
breathing, for example breathing If your baby cries in an unusual time of day or night. There will
with pauses of over 20 seconds way or for an unusually long time always be a doctor on duty,
between breaths or seems to be in pain. even if it is not your own GP.
is very hard to wake, unusually If you notice any bleeding from If you cannot contact a
drowsy or doesnt seem to the stump of the umbilical cord GP, take your baby to an
know you or from the nose, or any bruising. appropriate paediatric
develops a rash of red spots If your baby keeps refusing feeds. emergency department. Not all
that do not fade and lose colour A&E departments have resident
If your baby keeps vomiting paediatricians. You need to
(blanch) when they are pressed
a substantial part of feeds or take them to one that does.
(see the glass test). This may be
has frequent watery diarrhoea.
the rash of meningococcal disease
Vomiting and diarrhoea together
and meningitis, which causes
may mean your baby is losing too
infection in the blood. There may
much fluid, and this may need The glass test
not be any other symptoms.
prompt treatment.
Your baby may need treatment If your baby develops jaundice
very quickly. If you cannot get (looks yellow) when they are over
hold of your GP at once, dial 999 a week old, or has jaundice that
for an ambulance or take your continues for over two weeks
baby to the nearest accident and after birth (see page 149).
emergency (A&E) department with
a paediatrician on site. If you have seen your GP and your
baby is not getting better or seems
Problems that could to be getting worse, tell your GP
be serious again the same day. If you become
If your baby has a hoarse cough very worried and cannot get hold of The glass test can help you
with noisy breathing, is wheezing, your GP, dial 999 for an ambulance to tell if a rash is a symptom
or cannot breathe through or take your baby to the nearest of meningitis. Press the side or
the nose. A&E department with a bottom of a glass firmly against
paediatrician on site. the rash. You will be able to see
If your baby is unusually hot,
cold or floppy. if the rash fades and loses colour
under the pressure (see photo).
If it doesnt change colour,
contact your GP immediately.

145
GETTING
SUPPORT
Everyone needs advice or
reassurance at some time when
they are caring for a young baby,
even if its just to make sure that
Group B they are doing the right thing.
streptococcal Some problems just need talking
over with someone. Its always
infection better to ask for help than to
Group B streptococcal infection worry on your own. Do talk to
is a life-threatening infection in Your nearest Childrens Centre
your midwife or health visitor.
babies. Most babies who are can be found by visiting
As you grow more confident,
infected show symptoms within www.surestart.gov.uk
you will begin to trust your own
12 hours of birth, but there judgement more. You will be
are some who get it later. able to decide which advice
The symptoms include: makes most sense for you and
being floppy and unresponsive your baby and which suggestions
you can safely ignore.
not feeding well
grunting You will also want to talk to
friends, relations or other mothers
high or low temperature in a similar situation. You will
fast or slow heart rate meet other mothers when you Your health visitor can tell you
start taking your baby to the about any mother and baby
fast or slow breathing rate
child health clinic or Sure Start groups in the area. Or your local
irritability. Childrens Centre. Your health branch of the NCT (see page
Your baby may need treatment visitor will explain where 183) or MAMA (Meet A Mum
very quickly. If you cannot get these are and when you Association) (see page 184) may
hold of your GP at once, dial should go. be able to put you in touch with
999 for an ambulance or other mothers nearby.
take your baby to the
nearest accident
and emergency
department with
a paediatrician
on site. For more
information, see
www.gbss.org.uk

146
BABIES WHO NEED
ADDITIONAL
CARE
Why babies need additional care 147 Incubators 148
Contact with your baby 148 Newborn babies with jaundice 149
Feeding 148 Babies with disabilities 149

About one in eight of all babies will need extra care in hospital, sometimes on the
ordinary postnatal ward and sometimes in a specialist neonatal area. Having a baby
in neonatal care is naturally worrying for parents and every effort should be made
to ensure that you receive the information, communication and support you need.
Not all hospitals provide neonatal services, so it may be necessary to transfer your
baby to another hospital for specialist care.

WHY BABIES NEED ADDITIONAL CARE


Babies can be admitted to They have an infection.
neonatal services for any of the Their mother is diabetic.
following reasons:
The delivery was very difficult
They are born early. One in 10 and they need to be kept under
of all babies are born prematurely. close observation for a time.
Babies born earlier than 34
They have very marked jaundice
weeks may need extra help
(see page 149).
with breathing, feeding and
keeping warm. They are awaiting or recovering
They are very small and have from complex surgery.

close
a low birth weight.

observation

147
CONTACT WITH FEEDING If your baby is unable to have your
breastmilk to begin with, it can be
YOUR BABY To begin with, your baby may be frozen and given to them when
too small or sick to feed themselves. they are ready. When you go home,
You may be asked to express some you can express milk for the nurses
of your breastmilk, which can be to give while you are away. There
given to your baby through a tube. is no need to worry about the
A fine tube is passed through quantity or quality of your milk.
their nose or mouth into their Some mothers find that providing
stomach. This will not hurt them. breastmilk makes them feel that
Breastmilk has particular benefits, they are doing something positive
and especially for sick or premature for their baby.
babies, as it is specially enriched
See Chapter 9 for information on
with fats and minerals.
expressing and storing milk.

INCUBATORS
Babies who are very small are
nursed in incubators rather than
cots to keep them warm. However,
you can still have a lot of contact
with your baby. Some incubators
have open tops. If not, you can put
your hands through the holes in the
side of the incubator and touch your
baby. When your baby is stable, the
nurses will be able to help you take
your baby out of the incubator and
Your baby will benefit from physical show you how to have skin to skin
contact with you, even though the contact. You should carefully wash
environment of the unit may seem and thoroughly dry your hands
strange and confusing. When you before touching your baby. You can
first go into the unit, your baby talk to your baby as well this can
may be in an incubator and on a help both of you.
breathing machine. There may also
be tubes and wires attached to their
face and body. Ask the nurse to
explain what everything is for and
to show you how you can be
involved with your babys care.
Once your baby is stable, you will
be able to hold them. The nurses
will show you how to do this.

148
BABIES WITH Getting information
14
DISABILITIES Hospital staff should explain
what kind of treatment your
If your baby is disabled, you will baby is being given and why.
be coping with a lot of different If they dont, make sure you

BABIES WHO NEED ADDITIONAL CARE


feelings. You will also need to cope ask. It is important that you
with the feelings of others your understand what is happening
NEWBORN BABIES partner, relations and friends as so that you can work together
they come to terms with the fact to make sure that your baby
WITH JAUNDICE that your baby has a disability. More gets the best possible care.
Jaundice in newborn babies is than anything else at this time, you Some treatments will need
common because their livers are will need to talk to people about your consent and the doctors
immature. Severely jaundiced babies how you feel as well as about your will discuss this with you.
may be treated with phototherapy. babys health and future. It is natural to feel anxious if
Babies are undressed and put under your baby requires additional
a very bright light, usually with care. Talk over any fears or
a soft mask over their eyes. The worries with the hospital staff.
special light helps to break down Hospitals often have their
the chemical that causes jaundice. own counselling or support
It may be possible for your baby to services, and a number of
have phototherapy by your bed so charities run support and
that you dont have to be separated. advice services.
This treatment may continue for The consultant neonatologist
several days, with breaks for feeds, or paediatrician should
before the jaundice clears up. If the arrange to see you, but
jaundice gets worse, an exchange you can also ask for an
transfusion of blood may be appointment at any time if
needed. This is not common. Some you wish. The hospital social
babies have jaundice because of worker may be able to help
liver disease and need a different with practical problems such
treatment. Your baby will be given as travel costs or help with
a blood test before phototherapy is looking after other children.
started to check forthis.

Babies with jaundice


after two weeks
Many babies are jaundiced for up Your own GP, a neonatologist or
to two weeks following birth. This Help and support
paediatrician at your hospital, or
can be as long as three weeks in your health visitor can all help you.
premature babies. This is common You can also contact the hospital Bliss, the neonatal charity,
in breastfed babies and usually it is Patient Advice and Liaison Service supplies all neonatal services
normal and does no harm. It is not (PALS) or your social services with a free Parent Information
a reason to stop breastfeeding. But department for information about Guide, which you should be
its important to see your doctor if local organisations that may given on admission.
your baby is still jaundiced after two be able to help. In the useful For more information contact
weeks. You should see them within organisations section (page 182) Bliss Family Support Helpline
a day or two. This is particularly you will find a list of organisations on freephone 0500 618 140
important if your babys poo (stools) that can offer help and advice. or visit the website
is chalky white. A blood test will Many are self-help groups run by www.bliss.org.uk
show whether your baby has parents. Talking to other parents
breastmilk jaundice, which will go with similar experiences can often
away by itself, or jaundice that may be the best help.
need urgent treatment.

149
THE LOSS
OF YOUR BABY
Ectopic pregnancy 151
Contents
Miscarriage 151
Abnormal test results 152
Stillbirth and neonatal death 153

Some women may have to cope with miscarriage, ectopic pregnancy, termination,
stillbirth or neonatal death (death shortly after birth). This chapter explains why some
of these things may happen.

Help and support

If your pregnancy goes The following organisations Antenatal Results and Choices
wrong, you will need both may help: (ARC) is a voluntary organisation
information and support. that supports parents who
The Ectopic Pregnancy Trust
are making decisions about
Talk to the people close (www.ectopic.org.uk) offers
terminating or continuing their
to you about how you feel, support and information for
pregnancies. See page 186 for
and to your midwife, doctor parents who have had an ectopic
details.
or health visitor about what pregnancy. They have a helpline
has happened and why. on 020 7733 2653 and can
Sometimes it is easier to put you in touch with other
talk to someone who is not people who have had an ectopic
pregnancy.
a family member or friend,
for example your doctor, The Miscarriage Association
midwife or health visitor. can give you information and put
you in touch with other parents
There are also a number
who have experienced
of voluntary organisations a miscarriage. See page
that offer support and 186 for details.
information. These are
often run by bereaved Sands can put you in touch
parents. It can be with other parents who
very helpful to talk to have had a late miscarriage,
another parent who has stillbirth or neonatal death.
been through a similar They also have an internet
experience. forum at www.sandsforum.
org and a parents
telephone helpline on
020 7436 5881.
See page 186 for details.

150
ECTOPIC Some women have no obvious
15
signs or symptoms at all and an
PREGNANCY ectopic pregnancy may sometimes
After fertilisation, the egg should be mistaken for irritable bowel
move down into the uterus to syndrome, food poisoning or
even appendicitis.

THE LOSS OF YOUR BABY


develop. Sometimes it gets stuck
in the fallopian tube and begins to Afterwards
grow there. This is called an ectopic
You may feel a strong sense of loss
or tubal pregnancy. Rarely, the egg
and it is important to give yourself
can become stuck elsewhere,
time to grieve. An ectopic pregnancy
such as the ovary or the cervix.
involves abdominal surgery or
The fertilised egg cannot develop
treatment with powerful medicines.
properly and your health may be
It may affect your chances of
at serious risk if the pregnancy
becoming pregnant again.
continues. The egg has to be
removed. This can be done through It may be helpful to talk to
an operation or with medicines. your doctor to discuss the possible
causes and whether your
Ectopic pregnancy can be caused
chances of conceiving a baby GP before they see you). Ifyou
by damage in the fallopian tube,
have been affected. are more than six or seven weeks
possibly as a result of an infection.
Previous abdominal surgery and pregnant, you may be referred for an
previous ectopic pregnancy can also MISCARRIAGE ultrasound scan to see if your baby
increase the risk. The warning signs has a heartbeat and is developing
If a pregnancy ends before the 24th normally. Sometimes the bleeding
start soon after a missed period.
week, it is known as a miscarriage. stops by itself and your pregnancy
Miscarriages are quite common in will carry on quite normally.
the first three months of pregnancy.
At least one in six confirmed Some women find out that their
pregnancies end this way. Many baby has died only when they have
early miscarriages (before 14 weeks) a routine scan. If they have had no
happen because there is something pain or bleeding, this can come as
wrong with the development of the a terrible shock, especially if the
baby. There can be other causes, scan shows that the baby died days
such as hormone or blood-clotting or weeks before. This is sometimes
problems. A later miscarriage may called a missed or silent miscarriage.
be due to an infection, problems Treatment for
These are:
in the placenta, or the cervix being
miscarriage
severe pain on one side, low weak and opening too early in
down in the abdomen the pregnancy. Sometimes it is preferable to wait
and let the miscarriage happen
vaginal bleeding or a brown A miscarriage in the first few weeks naturally, but there are three ways
watery discharge may start like a period, with spotting of actively managing a miscarriage:
pain in your shoulders or bleeding and mild cramps or
backache. The pain and bleeding Medicine. You may be offered
feeling dizzy or faint tablets or pessaries to start the
may get worse and there can be
pain when you have a bowel heavy bleeding, blood clots and quite process of miscarriage.
movement. severe cramping pains. With a later Operation. If you have been
If you have any of these symptoms miscarriage, you may go through an pregnant for less than 14
and you might be pregnant even early labour. If you bleed or begin to weeks, your doctor may advise
if you have not had a positive have pains at any stage of pregnancy, an operation called an ERPC
pregnancy test you should see you should contact your GP or (evacuation of retained
your doctor immediately. midwife. You could also contact your products of conception).
local early pregnancy unit (though This will empty your uterus.
they may want a referral from your It is done under anaesthetic.
151
You may feel shocked, distressed, ABNORMAL
angry, or just numb. You may
feel guilty, wondering whether TEST RESULTS
your miscarriage was caused When tests show that the baby
by anything you did or did not has a significant abnormality,
do. It is important to know that, some couples wish to continue the
whatever the cause, miscarriage pregnancy and be prepared for
is never anyones fault. If a the needs of their newborn baby.
miscarriage is going to happen, Others decide to terminate the
there is very little that anyone pregnancy. If tests show that your
can do to stop it. baby has a serious abnormality,
The cervix is gently widened and
Some people find having find out as much as you can from
the contents of your uterus are
something to remember their your doctor about the particular
removed by suction.
baby by helps. In an early condition and how it might affect
Induced labour. If your baby your baby, so that you can make
loss, this may be a copy of a
dies after about 14 weeks, you a decision that is right for you
scan picture. If you have a late
may go into labour. If this doesnt and your family.
miscarriage, you may be able
happen, you will be offered
to see and hold your baby if you You will probably be very shocked
tablets that start labour.
wish. You might also be able when you are first told the diagnosis
Although some women would
to take photographs, footprints and may find it hard to take in.
prefer not to go through
and handprints as a keepsake. You may need to go back and talk
labour, this is safer for you than
Some hospitals offer parents to the doctor with your partner or
an operation to remove the
a certificate to commemorate someone close to you. Spend time
baby. You will be cared for and
their baby. This is done because talking things through. You may also
supported throughout the labour
there is no formal registration find it helpful to contact Antenatal
and the birth of your baby.
of a baby who dies before Results and Choices (see page 150).
Afterwards 24 weeks of pregnancy.
One early miscarriage is unlikely Talk about your feelings with your
What happens
to affect your chances of having partner and those close to you. A termination in the first three
a baby in the future. If you have You might also want to contact months can be done under a general
three or more early miscarriages in the Miscarriage Association or anaesthetic. A later termination
a row, you should be referred to a Sands (see page 150). usually involves going through labour.
specialist for further investigations. You may wish to think beforehand
However, sometimes no clear about whether you want to see and
cause can be found. perhaps even hold your baby, and
Both women and men find it whether you want to give your baby
difficult to come to terms with a a name. If you do not want to see
miscarriage at any stage. You will your baby, you could ask hospital
almost certainly feel a sense of loss. staff to take a photograph for you
You will need time to grieve over in case you want to see it in the
the lost baby just as you would over future. The photograph can be
the death of anyone close to you, kept in your notes.
especially if the miscarriage has Afterwards
happened later in your pregnancy.
You may find it hard to cope after a
termination. It can help to talk, but
sometimes family and friends find it
difficult to understand what you are
going through. If you would like to
make contact with people who have
undergone a similar experience, you
can contact Antenatal Results and
Choices (see page 150).
152
STILLBIRTH AND Post-mortems with a consultant who can
15
explain the results to you and
NEONATAL DEATH One of the first questions you
also what these might mean
are likely to ask is why your baby
In the UK about 4,000 babies are died. Sometimes a post-mortem for a future pregnancy.
stillborn every year. This means that examination can help to provide Multiple births

THE LOSS OF YOUR BABY


the pregnancy has lasted for 24 some answers, although often no
The loss of one baby from a
weeks or more and the baby is clear cause is found. A post-
multiple pregnancy is very difficult
dead when it is born. About the mortem may, however, provide
for any parent. Grieving for the
same number of babies die soon other information that could be
baby who has died while caring
after birth. Often the causes of helpful for future pregnancies and
for and celebrating the life of
these deaths are not known. may rule out certain causes. If it
the surviving baby brings very
is thought that a post-mortem
Sometimes a baby dies in the uterus mixed and complex emotions.
could be helpful, a senior doctor or
(an intra-uterine death or IUD) but Often the surviving baby is
midwife will discuss this with you
labour does not start spontaneously. premature and in a neonatal
and explain the possible benefits.
If this happens, you will be given unit, causing additional concern.
If you decide to have a full or partial
medicines to induce the labour. This For further information and
post-mortem, you will be asked
is the safest way of delivering the support, contact the Multiple
to sign a consent form. When the
baby. It also means that you and Births Foundation or Tamba
post-mortem report is available,
your partner can see and hold the (see pages 183 and 188 for
you will be offered an appointment
baby at birth if you want to. contact details).
It is shocking to lose a baby like this.
You and your partner are likely to Saying goodbye to your baby
experience a range of emotions that
come and go unpredictably. These A funeral or some other way Alternatively, you may prefer
can include disbelief, anger, guilt of saying goodbye can be a very to contact someone from your
and grief. Some women think they important part of coping own religious community, the
can hear their baby crying, and it is with your loss, however early Miscarriage Association or Sands
not uncommon for mothers to think it happens. about the kind of funeral you
that they can still feel their baby want. You do not have to attend
If your baby dies before 24 weeks,
kicking inside. The grief is usually the funeral if you dont want to.
the hospital may offer to arrange
most intense in the early months for a cremation, possibly together Many hospitals arrange a regular
after the loss. with other babies who have died service of remembrance for all
Some parents find in pregnancy. If you prefer to take babies who die in pregnancy, at
it helpful to create your baby home or to make your birth or in infancy. Again, you
memories of their baby, own arrangements, you can do can choose to attend if you wish.
for example they may that. You may need some form
Many parents are surprised at
see and hold their baby of certification from the hospital
how much and how long they
and give their baby a name. You may and they should provide helpful
grieve after losing a baby. Friends
want to have a photograph of your information and contacts.
and acquaintances often dont
baby and to keep some mementos, The Miscarriage Association
know what to say or how to offer
such as a lock of hair, hand and and Sands can provide further
support, and they may expect
footprints or the babys shawl. All support and information.
you to get back to normal long
this can help you and your family to If your baby dies after 24 weeks, before that is possible. You may
remember your baby as a real person you will need to register your find it helpful to contact Sands
and may, in time, help you to live babys birth (even if they were or the Miscarriage Association
with your loss. You may also find it stillborn) with the Registrar of (see page 150) so that you can
helpful to talk to your GP, community Births, Deaths and Marriages. talk to people who have been
midwife or health visitor or to other The hospital will offer to arrange through similar experiences
parents who have lost a baby. Sands a funeral, burial or cremation free and who can offer you
can put you in touch with other of charge, or you may choose to support and information.
parents who can offer support and organise this yourself. The hospital
information (see page 150). chaplain will be able to help you.
153
THINKING ABOUT THE
NEXT BABY?
It takes two 154
Folic acid 154
Things to consider 155
Work-related risks 155

Holding your new baby in your arms, it may be impossible to imagine that you will
ever have the energy to go through it all again! But sooner or later, you may decide
that you want another child.
If you had a low birth weight baby, a baby with a disability or special needs,
a miscarriage or a stillbirth, you may be particularly anxious to do everything you can
to create the best possible circumstances for your next pregnancy. This chapter explains
how you and your partner can prepare for your next pregnancy.

IT TAKES TWO
Finding it hard You will increase your chances of
to get pregnant? getting pregnant if you are in good
It can take several months health and that applies to men
or more to get pregnant, too. A bad diet, smoking, drinking
even if it happened really and unhealthy working conditions
quickly the first time. can affect the quality of sperm
and stop you getting pregnant.
You should both try to make your
lifestyle as healthy as possible
before you try to conceive.
Chapter 3 has advice about diet,
smoking, alcohol and exercise,
These include green, leafy
Chapter 1 (page 14) explains which can help you to conceive.
vegetables, and breakfast cereals
when is the best time of the and breads with added folic acid.
month to have sex if you FOLIC ACID
want to get pregnant. You will need a bigger dose of folic
If you are still not pregnant Women should take 400 acid if:
after a few months, talk micrograms of folic acid from the
you already have a baby with
to your doctor or family time you start trying to conceive
spina bifida
planning clinic. right up until you are 12 weeks
pregnant. You can get these tablets you have coeliac disease
from a supermarket or pharmacist. you have diabetes
Eat foods that contain this
you take anti-epileptic medicines.
important vitamin as well.
Ask your GP for advice as well.

154
THINGS TO If you are HIV positive, you can
16
pass the virus on to your baby
CONSIDER during pregnancy, at birth or when
breastfeeding (see box on page 47).
Rubella (German
Medicines and drugs
measles)
WORK-RELATED

THINKING ABOUT THE NEXT BABY?


Some medicines can harm a baby
Rubella in early pregnancy can
in pregnancy but others are safe.
damage your developing baby. RISKS
If you were not immune during your If either you or your partner has a
last pregnancy, you should have long-term illness or disability and has Your employer is required to take
been offered a measles, mumps to take long-term medication, talk into account any work-related risks
and rubella (MMR) immunisation to your doctor about any possible to new and expectant mothers.
immediately after your baby was effects on fertility or pregnancy. Once you have told your employer
born. Before trying for another that you are pregnant, they should
Check with your doctor, midwife
baby, it is important to check that make sure that your job does not
or pharmacist before you take
you are immune by having a blood pose a risk to you or your baby.
any over the counter drugs.
test. The blood test will measure Some risks can be avoided, for
if you have enough protection Illegal drugs will affect your ability example by changing your working
(antibodies) against rubella. Women to conceive and can damage conditions or hours of work.
with low or uncertain levels of your babys health. See page 183 If a risk cannot be avoided, your
antibodies can be immunised again. for contact details for Narcotics employer should offer you suitable
Anonymous or talk to FRANK, alternative work with similar terms
Your weight the drugs information line, and conditions to your present job.
Maintaining a healthy weight can on 0800 77 66 00. If this is not possible, you should
improve your chances of getting be suspended on full pay. This
pregnant. You may have put on Diabetes and epilepsy means that you will be given paid
weight during your last pregnancy If you have diabetes or epilepsy, leave for as long as necessary.
and want to go back to your normal talk to your doctor before you try If you want advice on these issues,
size. This is particularly important to get pregnant. speak to Citizens Advice or your
if you weigh more than 100kg. union if you have one.
The best way to lose weight is by Postnatal depression
following a balanced low-fat diet and puerperal
and doing exercise. It might help to psychosis
join a slimming class with a friend If you have previously experienced
or your partner to encourage and postnatal depression or puerperal
support you. Speak to your doctor Vaginal birth after
psychosis, talk to your doctor before
if you need help or advice. a caesarean section
you try to get pregnant.
Most women who have
Sexually transmitted had a caesarean section
infections (STIs) can have a vaginal delivery
STIs can affect your health and your for their next baby. This
ability to conceive. If there is any depends on why you had
chance that either of you has an STI, a caesarean section the
its important to get it diagnosed first time. Women thought
and treated before you get pregnant. to have a small pelvis, for
STIs, including HIV, hepatitis B example, may be advised to
and hepatitis C, can be passed on have a planned (elective)
through sex with an infected person, caesarean section next time.
especially if you dont use a condom. Your GP, or midwife, will
Some STIs can be transmitted be able to advise you. Most
during sex without penetration. HIV, women who are advised to
hepatitis B and hepatitis C can also try for a vaginal delivery in
be passed on by sharing equipment subsequent pregnancies do
for injecting drugs. have normal deliveries.
155
RIGHTS AND
BENEFITS
Benefits for everyone 157 Rights during maternity leave 168
Tax credits 158 Returning to work 169
Benefits if your income is low 159 Other employment rights 170
Maternity benefits 163 Other types of leave 171
If you are unemployed 166 Your rights under sex
Maternity leave 167 discrimination law 174

Make sure that you know your rights and that you claim all the benefits that you are
entitled to when you are pregnant. Maternity rights do change and different benefits have
to be claimed using different forms and from different offices. The benefit rates in this
chapter are accurate from April 2009. Get further advice if you are unsure of anything.

Help and advice


Some national voluntary Useful websites
organisations offer information
Working out what benefits www.direct.gov.uk
and advice on benefits and
and rights you are entitled
rights at work, for example www.dwp.gov.uk (Department
to and making claims can be
Acas and One Parent for Work and Pensions)
complicated. There are a number
Families/Gingerbread (see
of government departments www.hmrc.gov.uk/taxcredits
pages 182 and 184).
and voluntary organisations
that can help you. If you are a member of a trade www.hse.gov.uk
union, your staff representative (Health and Safety Executive)
Your local Jobcentre Plus can or local office should be able to
give you advice about benefits. www.equalityhumanrights.com
advise you on your maternity (Equality and Human Rights
Look in the business numbers rights at work.
section of the phone book Commission)
The Equality and Human Rights
under Jobcentre Plus. www.adviceguide.org.uk
Commission can advise you if
Citizens Advice Bureaux, law (Citizens Advice Bureau)
your problem is to do with sex
centres and other advice discrimination (see page 174). www.cmoptions.org
agencies can advise you about (Child Maintenance Options)
The Health and Safety Executive
your rights at work. To find your
has a useful booklet for women www.acas.org.uk (Acas)
local advice agencies, look in
explaining the health and safety
your Yellow Pages phone book
rights that apply to pregnant www.direct.gov.uk/employees
under Counselling and Advice.
women and women who have www.healthystart.nhs.uk
Some local authorities have recently given birth.
welfare officers who can give www.workingfamilies.org.uk
you advice. Phone your social
services department and find www.jobcentreplus.gov.uk
out if your area has one.

156
BENEFITS FOR If you get the full amount of Child How much is it?
17
Tax Credit (CTC) because your 20.00 per week for your
EVERYONE household income is at or below first child.
Some benefits are available to all the Child Tax Credit income limit
13.20 a week per child for
mothers, regardless of how much (16,040 in 2009/10), your child will
any other children.
get a further 250 paid directly into

RIGHTS AND BENEFITS


they earn.
their account. Child Benefit can be paid directly
Free prescriptions and into a bank, building society or
At seven, children will get another Post OfficeTM card account. It is
NHS dental treatment payment of 250 (with children usually paid every four weeks in
What are they? from lower income families again arrears, but single parents and
receiving a further 250). families on low incomes can
Prescriptions and NHS dental
treatment are free while you are You, your family, your friends and, choose to be paid weekly.
pregnant and for 12 months after in time, your child can contribute How do I claim?
you have given birth. Your child up to a total of 1,200 a year to the
You can get claim packs:
also gets free prescriptions until account tax free. The money can
they are 16. only be withdrawn by your child, in your Bounty Pack (which most
and they cannot take it out until new mothers are given in hospital)
How do I claim?
they are 18. from your Jobcentre Plus office
To claim for free prescriptions, ask
your doctor or midwife for form How do I claim? from the post office
FW8 and send it to your health All you have to do is claim by phoning 0845 302 1444.
authority. You will be sent an Child Benefit for your child.
exemption certificate that lasts until Fill in the forms and send them
You will automatically be sent an
a year after your due date. with your babys birth certificate to
information pack and voucher
the Child Benefit Centre. The birth
within a month.
To claim after your baby is born certificate will be returned to you.
(if you did not claim while you were From 6 April 2009, some account You need to register your baby to
pregnant) fill in form A in leaflet providers will not require the Child get a birth certificate (see page 138).
P11, NHS Prescriptions, which Trust Fund voucher to be handed in
you can get from your doctor or You can also apply online at
or posted when you are opening an
Jobcentre Plus. www.hmrc.gov.uk/childbenefit/
account. However, you will still need
to provide information such as your You should start to claim Child
To claim for dental treatment, tick
childs unique reference number Benefit within three months of your
a box on a form provided by the
(printed on the voucher) to open babys birth, otherwise you will lose
dentist or show your exemption
an account. some of the benefit.
certificate (see above).
More information More information
Child Trust Fund For more information, call Child Benefit can help to
What is it? 0845 302 1470 or go to protect your State Pension if you
www.childtrustfund.gov.uk stay at home to look after your
A long-term savings and investment
account for children. child. For every complete year that
Child Benefit you get Child Benefit, but you
Who gets it? dont pay enough National
What is it?
All children born on or after Insurance contributions to
Child Benefit is a tax-free benefit to count towards the
1 September 2002, provided they
help parents with the cost of caring basic pension,
are eligible for Child Benefit, live
for their children. It is payable for you automatically
in the UK, and are not subject to
each child from birth until at least get Home
immigration control.
age 16. Responsibilities
How much is it? Protection.
Who gets it?
You will get a voucher for 250
Every mother or the person
from the government to start an
responsible for the care of a child,
account for your child.
but you must generally be living
in the United Kingdom.
157
TAX CREDITS
What are they?
Two tax credits were introduced
in April 2003:
Child Tax Credit gives financial
support for children.
Working Tax Credit helps people
in lower-paid jobs by topping up
their wages.
You may not be able to get tax Help with childcare costs If there is a change in your
credits if you have come to live here circumstances, for example after
Many working parents can get help
from another country. You should the birth of your baby, the amount
with their childcare costs through
get advice. you are entitled to may change.
tax credits. If you work at least 16
Who gets Child Tax Credit? hours a week and use registered As long as you report the change
childcare, you could get 80% of the within three months, any extra
Child Tax Credit can be claimed by
costs back. This is up to a limit of money can be backdated to the
lone parents or couples with one
175 a week if you have one child date of the change.
or more children. Nine out of 10
families with children get this credit. or 300 a week if you have two or Maternity Allowance or the first
more. Your household income is 100 a week of Statutory Maternity
Who gets Working Tax taken into account in working out Pay are not counted as income.
Credit? what you get. Call the Tax Credits
Working Tax Credit can be claimed Helpline on 0845 300 3900 to Families with children, with an
by single people or couples, with or find out more. annual income of 50,000 or less,
without children. will get at least 545 a year.
How do I claim?
You must work at least 16 hours Call the Tax Credits Helpline on More information
each week if: 0845 300 3900 for a form to If you get tax credits you may also
claim both Child Tax and Working be able to get the 500 Sure Start
you have dependent children and/or
Tax Credits. Maternity Grant and help with fares
you have a disability to hospital for treatment (including
How much will I get? antenatal appointments).
or
The amount you get will depend on
you must be 25 or over and work your circumstances, including: You can get help from Healthy Start
at least 30 hours a week. if you get Child Tax Credit but not
the number of children in your Working Tax Credit with an annual
You can be treated as if
household family income of 16,040 or less
you are working during
the first 39 weeks of the number of hours you and your (2009/10).
your maternity leave if partner work See page 162 for more information.
you were working enough your households gross income for
hours immediately before the last tax year.
starting your maternity
Claims for the current tax year will
leave.
initially be based on your previous
tax years income. Awards will run
until the end of the tax year.

help for

158
families
BENEFITS IF YOUR you work for more than 16 hours To claim Income Support, fill in
17
a week, or form A1, which you can get from
INCOME IS LOW you have savings of more than a post office or a Jobcentre Plus.
16,000. You do not need to sign on.
Income-based
Jobseekers Allowance If you or your partner are too sick The benefit is paid directly into your

RIGHTS AND BENEFITS


or disabled to work for another bank account. If you are claiming
and Income Support
reason (not your pregnancy), you income-based JSA, you or your
What are they? should get advice. You may be able partner (or both, before you are
Income-based Jobseekers to claim Employment and Support 29 weeks pregnant) will have to
Allowance (JSA) and Income Allowance instead. go to your Jobcentre Plus every
Support are payments for people fortnight to sign on to show that
How much are they? you are available for work.
who are not in work and do not
have enough to live on. If your This depends on:
family income falls below a set your age
level, the benefit will top it up. More information
the size of your family
This means that you may be able
what other income you have. If you get Income Support,
to get Income Support even if
income-based JSA, income-
you are already getting Statutory If you are under 25 or have more related Employment and Support
Maternity Pay, Maternity Allowance, than 6,000 in savings, you can Allowance or Pension Credit,
Employment and Support get a lower rate. If you are claiming you can claim other benefits,
Allowance or some income from during pregnancy, you should let such as:
part-time work. your Jobcentre Plus know as soon
as the baby is born, as your benefit a 500 Sure Start Maternity
Who gets them?
may go up. Grant
You can claim income-based JSA if:
How do I claim? help with fares to hospital
you are 18 or over and you are
To claim income-based JSA Housing Benefit
capable of and actively seeking
work. You can claim this benefit before your baby is born, you or Council Tax Benefit.
if you are living with your partner your partner must both go to the
You may be able to get
as long as you are both either Jobcentre Plus in person. You may
help with mortgage interest
unemployed or working part time. be able to claim by post if you live
payments.
a long way from the Jobcentre.
If you are 1617 and face severe Once you are 29 weeks pregnant, You can get help from
hardship you may be able to claim. you do not have to sign on if your Healthy Start.
You should get further advice partner is claiming with you.
about this. See page 162 for more
Your partner can continue to
information.
You can claim Income Support if: claim for you and the baby.

you are 16 or over and cannot


be available for work because
you are a single parent or because
you are 29 weeks pregnant or
more, or
you are pregnant and not well
enough to work because of
your pregnancy.
You cannot claim income-based
JSA or Income Support if:
you live with your partner and
they work for 24 hours or
more a week

159
Part of the form will need to be You have 31 days from the date
completed by your midwife, your midwife or doctor signs the
GP or health visitor. This is to confirm claim to get it back to Her Majestys
when your baby is due or actually Revenue and Customs (HMRC).
born, and that you have received Once HMRC receives your form,
500 Sure Start advice about the health and welfare they aim to send you a letter within
Maternity Grant from of your baby and, if you claim before three weeks to tell you if your claim
your baby is born, yourself. has been allowed. You will be paid
the Social Fund your grant about one week after
If you cannot get any of the benefits
What is it? you get the letter.
listed above (see Who gets it?) until
The 500 Sure Start Maternity after your baby is born, you must still For more information visit
Grant is a lump sum payment to claim the Sure Start Maternity Grant www.direct.gov.uk /money4mum2be
help buy things for a new baby. within the three-month time limit. or call 0845 366 7885.
Who gets it?
The Discretionary
Pregnant women and new parents Social Fund
who get: Health in
Pregnancy Grant What is it?
Income Support
As a mum-to-be living in the The Discretionary Social Fund
income-based Jobseekers provides grants and interest-free
Allowance UK, you can claim a one-off
payment of 190 to help you. loans for needs that are difficult for
income-related Employment and You can use the grant to keep people to meet out of their weekly
Support Allowance yourself healthy or for things benefits or regular income.
Pension Credit for your baby. Its your choice. Who gets it?
Working Tax Credit where a Who gets it? There are three types of payments
disability or severe disability element Almost every pregnant available:
is included in the award, or woman gets it. It doesnt Community Care Grants are for
Child Tax Credit payable at a rate depend on your income. The people getting Income Support,
higher than the family element. grant is available between the income-based Jobseekers
25th week and your expected Allowance (JSA), income-related
How much is it?
due date. You may not be Employment and Support
500 for each baby who is: able to claim if: Allowance or Pension Credit.
expected you are subject to Budgeting Loans are interest-free,
born immigration control, or repayable loans for people getting
adopted you are not ordinarily Income Support, income-based
resident in the UK. JSA, income-related Employment
the subject of a parental order and Support Allowance or Pension
(following a surrogate birth), or How much is it? Credit for at least 26 weeks.
the subject of a residence order 190 and its tax free, so it Crisis Loans are interest-free,
(in certain circumstances). will not affect your tax credits repayable loans for people (on
How do I claim? or any other benefits. benefits or not) who are unable to
Claim using form SF100 (Sure Start), How do I claim? meet their immediate short-term
which you can get from Jobcentre needs in a crisis.
When you reach your 25th
Plus. You can claim any time from week, ask your midwife or How much can you get?
11 weeks before your due date doctor for a claim form at This depends on your personal
until three months after the birth, your next appointment. circumstances, your ability to pay
adoption or date of parental or Make sure your midwife or and how much money is available.
residence order. If you are adopting doctor has completed and Social Fund payments are not a right
or have been granted a residence signed their part of the form. and there is a limited amount of
order, your baby must be aged under If they have not, it could delay money to be distributed between
12 months when you claim. your claim. all those who successfully apply.

160
Help with mortgage
How do I claim?
Contact Jobcentre Plus. interest repayments
17
More information is also available Who gets it?
in leaflets: If you have got a mortgage and you

RIGHTS AND BENEFITS


A Guide to the Social Fund (SB16, are on income-based Jobseekers
available at www.dwp.gov.uk) Allowance (JSA), Income Support
or income-related Employment and
The Social Fund (DWP1007).
Support Allowance, you may be
More information able to get help with your interest
Loans have to be repaid at a set payments. There is usually a waiting
amount per week, which will be period during which you will not
Housing Benefit help get any help.
taken directly from your income
if you are claiming other benefits.
with your rent
How much is it?
The amount you have to repay per What is it?
You can only get help with interest
week depends on the size of the Housing Benefit will help pay your payments (not repayments of capital
loan, the size of your income and rent if you are on income-based or contributions to a linked PEP,
any other debts you may have. Jobseekers Allowance (JSA), endowment or insurance policy)
You cannot get a Budgeting Loan Income Support or income-related and the amount is usually based
or a Crisis Loan for more than Employment and Support Allowance, on a standard average interest rate
1,500 and the total you owe the or if you have a low income. If you (which may not be the same as the
Social Fund cannot be more than are a council tenant it will be paid interest you are paying).
1,500. direct to the council; if you are a
private tenant, it will be paid either You usually have to wait for 13
The amount of any Discretionary
to you or directly to your landlord. weeks before you get help, but you
Social Fund payment you get will
may have had to wait longer if you
be reduced on a pound-for-pound How much is it? claimed benefits before January 2009.
basis by any savings you or your It depends on:
partner has. For Community Care How do I claim?
Grants, savings over 500 (1,000 the rent you pay Once you have claimed income-
if you or your partner are aged average rents in your area based JSA or Income Support,
60 or over) will usually affect how your Jobcentre Plus office will
the size of your home
much you can get. For Budgeting automatically send you form MI12
Loans, savings over 1,000 your income about your housing costs shortly
(2,000 if you or your partner are savings before your benefits become
aged 60 or over) will usually affect payable. You fill out part of
other benefits
how much you can get. the form and then send it to
your age, and your mortgage lender to fill out
The Social Fund can only provide
Community Care Grants to your family size. the rest.
families receiving Income Support, It may not be the same amount as The money will either be paid
income-based JSA, income- the rent you are actually paying. The to you as part of your income-
related Employment and Support amount of savings you have can based JSA or Income Support,
Allowance or Pension Credit also affect the amount of Housing or it will be paid directly to your
under certain circumstances. Benefit you get. You cannot get mortgage lender.
These could be to help pay fares Housing Benefit if you have savings
to visit a mother and baby in of more than 16,000. More information
hospital or to help a family under Tell your mortgage lender straight
exceptional pressure. Grants do How do I claim?
away if you get into difficulties
not have to be repaid. If you are getting income-based JSA with your mortgage. If you are
or Income Support, you will get unable to meet your repayments,
a Housing Benefit claim pack with you may be able to negotiate
your JSA/Income Support claim a temporary agreement for
form. Otherwise, get a form from reduced repayments (e.g.
your local council. during your maternity leave).
161
If you have a flexible mortgage, Council Tax Benefit
this should be relatively easy to
arrange. Some mortgage lenders What is it?
allow a repayment holiday of a Council Tax Benefit helps you to
few months once during the life pay your Council Tax if your How much is it?
of the mortgage. income is low.
You may get all of your Council Tax
If you have mortgage protection Who gets it? paid or just part of it. It will depend
insurance, contact your insurer If your income is low or you are on your income, savings, whether
immediately. Most insurance getting income-based Jobseekers other adults live with you, and an
policies will pay out if you are Allowance (JSA), income-related assessment of your circumstances.
receiving out-of-work benefits, Employment and Support Allowance How do I claim?
but not if you are only receiving or Income Support, you may get
Statutory Maternity Pay or If you are getting income-based JSA
Council Tax Benefit.
Maternity Allowance. or Income Support, you will get a
Council Tax Benefit claim form with
your JSA/Income Support claim
form. Otherwise, get a form from
your local council.

Healthy Start
What is it?
Healthy Start is a scheme that provides vouchers
that can be exchanged for milk, fresh fruit and
vegetables and infant formula milk. You can also get
free vitamins. You can get vouchers that are worth 3.10
per week or 6.20 per week for children under one year old.
Who gets it?
You qualify for Healthy Start if you are pregnant or have a child under
four years old and you and your family get one of the following:
Income Support
income-based Jobseekers Allowance
income-related Employment and Support Allowance
Child Tax Credit and have an annual family income of below 16,040 or less (2009/10)
Working Tax Credit run-on (but not Working Tax Credit). Working Tax Credit run-on is the Working Tax Credit
you receive in the four weeks immediately after you have stopped working for 16 hours or more per week
OR
you are pregnant and under 18 years of age.
How do I claim?
Pick up the Healthy Start leaflet HS01, A Healthy Start for Pregnant Women and Young Children, from your
local health centre, or call 0845 607 6823 to request a free copy.
Ask your health visitor for more information.
Visit www.healthystart.nhs.uk
You will need your midwife to fill in their part of the application form. You can apply as soon as you are
10 weeks pregnant. Getting vouchers and vitamins cannot be backdated, so apply as early as you can.
Once your baby is born, you should claim Child Tax Credit to make sure you continue to get your vouchers, if you are
still entitled. See page 158 for more information.

162
Help with hospital
fares
How much is it?
MA is paid for 39 weeks at a standard
17
Who gets it? rate of 123.06 per week, or 90% of
your gross average weekly earnings if
If you or your partner gets income-
this is less than 123.06.
based Jobseekers Allowance (JSA),

RIGHTS AND BENEFITS


income-related Employment and When is it paid?
Support Allowance or Income The earliest that MA can start is
Support, you can get a refund 11 weeks before the week your
for fares to and from the hospital baby is due and the latest is the day
(including for your visits for following the birth.
antenatal care). This can cover
normal public transport fares, If you are unemployed, your MA
estimated petrol costs and taxi fares will start 11 weeks before the week
if there is no alternative. You may your baby is due.
also be entitled to help if your
family has a low income. You may MATERNITY If you are employed or self-employed
at the start of the 11th week before
also get help if you get tax credits or BENEFITS the week your baby is due, you can
Pension Credit. Check your award choose when to start your MA. You
letter for details. Maternity Allowance can even work right up until the date
How do I claim? What is it? the baby is due, unless:
If you get income-based JSA, Maternity Allowance (MA) is a you are absent from work because
income-related Employment and weekly allowance paid through of a pregnancy-related reason
Support Allowance or Income Jobcentre Plus. during the four weeks before the
Support, you can claim when you Who gets it? week your baby is due. In this case
visit the hospital. You will just need your MA will start automatically
Women who cannot get Statutory
to show proof that you get the on the day following the first day
Maternity Pay (see page 165) get
benefit. of your absence from work, or
MA. These are:
You can claim within three months your baby is born before your MA
women who have changed jobs is due to start. In this case your MA
of your visit by filling in form HC5,
during pregnancy will start on the day following the
which you can get from the hospital
or Jobcentre Plus. women who have had periods of birth and will last for 39 weeks.
low earnings or unemployment
Fill in form HC1 if you dont get How do I claim?
during pregnancy
income-based JSA, income-related You can make a claim for MA from
Employment and Support Allowance women who are self-employed. the 14th week before the week
or Income Support but your income You can claim MA if you have been your baby is due.
is low. You can get this from your employed and/or self-employed in Fill in form MA1, available from
doctor, hospital or Jobcentre Plus. at least 26 of the 66 weeks before Jobcentre Plus or your antenatal
Depending on how low your your expected week of childbirth. clinic.
income is, you will then be given: This 66-week period is known as
the test period. You must also have Download an MA claim pack in
certificate HC2, which means you PDF format from
qualify for free services, or gross average weekly earnings of at
least 30. The average is taken over www.dwp.gov.uk/advisers/
certificate HC3, which means that any 13 weeks in the test period. claimforms/ma1.pdf
you qualify for some help. You should choose the 13 weeks Contact Jobcentre Plus on
You show the certificate when you in which you earned the most. 0800 055 6688.
go to the hospital, or you can claim In your chosen weeks, you can
You must also send your maternity
within three months of your visit on add together earnings from more
certificate (form MAT B1). This is
form HC5. than one job, including any self-
issued by your GP or midwife from
employed work. You will be treated
20 weeks before the week your
as earning a certain amount if you
baby is due.
are self-employed.

163
Jobcentre Plus will check this. If you
are not sure whether or not you
qualify, phone Jobcentre Plus for
more information.
How much is it?
64.30 per week if you are aged
25 or over.
50.95 if you are aged under 25.
You may get more than this in some
circumstances, for example if you
have a partner who is not working
and is not claiming benefits for
If you are employed in the 15th These 10 days are called Keeping themselves.
week before your baby is due in Touch (KIT) days. Once you have
and do not qualify for Statutory used up your 10 KIT days, if you It is awarded from the Sunday of
Maternity Pay, you must also send do any further work you will lose a the sixth week before your baby
in form SMP1 from your employer days MA for any day on which you is due until two weeks after your
to show why you dont qualify. work. You must tell Jobcentre Plus babys birth. It may not be paid for
You will have to provide original about any work you do. the first three days of your claim.
payslips to show you meet the How do I claim?
The amount you get paid for the
earnings condition.
days you work in your MA pay Make a claim for Maternity
If you are self-employed, Jobcentre period will not affect your MA. Allowance using form MA1, which
Plus will confirm this direct with Her you can get from Jobcentre Plus or
More information
Majestys Revenue and Customs. your antenatal clinic. You also have
If you are not entitled to MA, to send your maternity certificate
When you have completed your your Jobcentre Plus office will (form MAT B1), which is issued by
claim form, send it to Jobcentre automatically check whether you your GP or midwife from 20 weeks
Plus, together with your maternity might be entitled to Employment before the week your baby is due.
certificate (MAT B1) and your and Support Allowance (see below). You dont need to send in a sick
original payslips.
For further information about note from your doctor.
Claim as soon as you can, even if MA, see leaflet NI17A, A Guide to If you are not entitled to Maternity
you are still at work, do not have the Maternity Benefits, available from Allowance, Jobcentre Plus will
medical certificate, or cannot provide www.dwp.gov.uk/advisers/ni17a check automatically to see if you
any other information needed to
qualify for Employment and Support
complete the claim form. You can Employment and Allowance. It can be paid directly
always send things in later. You must
Support Allowance into your bank. You must claim
claim within three months of the
What is it? within three months of the start
date your MA period is due to start.
of your entitlement.
If you delay, you will lose money. This is a weekly allowance that is
normally paid to people whose More information
How is it paid?
ability to work is limited because of To find out more about Employment
MA is paid directly into your bank
an illness or disability. It may also be and Support Allowance:
account, weekly or every four
paid to women who dont qualify
weeks in arrears. call Jobcentre Plus on
for Statutory Maternity Pay or
Maternity Allowance. 0800 055 6688
Working during the
Maternity Allowance pay ask for leaflet DWP 1001, or
Who gets it?
period visit the website at
Women who have paid enough
You are allowed to work as an www.dwp.gov.uk/esa
National Insurance contributions
employed or self-employed person
during the last three tax years or
for up to 10 days during your MA
women who are on a low income.
pay period without losing any MA.

164
Statutory
Maternity Pay
on whether you are paid weekly,
monthly, or at other intervals.
Find the Sunday before your baby
is due (or the due date if it is a 17
Sunday) and count back 11
What is it? To find out which is your qualifying
Sundays from there.
week, look on a calendar for the
Statutory Maternity Pay (SMP)
Sunday before your baby is due It is up to you to decide when you
is money paid by your employer

RIGHTS AND BENEFITS


(or the due date if that is a Sunday). want to stop work, unless your job
to help you take time off at and
Count back 15 Sundays from there. finishes before your SMP starts or
around the birth of your baby. It is
You should use the due date on you are off work for pregnancy-
paid up to a maximum of 39 weeks.
the MAT B1 certificate, which your related reasons in the four weeks
Your employer can claim back
midwife or GP will give you when before your baby is due.
some or all of it from Her Majestys
you are 20 weeks pregnant.
Revenue and Customs (HMRC). If your job finishes before the 11th
SMP counts as earnings and your If you are not sure if you are entitled week before the week your baby is
employer will deduct tax and to SMP, ask your employer anyway. due, your SMP must start 11 weeks
National Insurance. Your employer will work out whether before the week your baby is due.
or not you should get it, and if
You can get it even if you dont plan If your job finishes after the 11th
you dont qualify they will give
to go back to work or you leave your week but before your SMP is due to
you form SMP1 to explain why.
employment after you qualify for start, your SMP must start the day
If your employer is not sure how
SMP. You will not have to pay SMP after you left your job. If you are still
to work out your SMP or how to
back if you dont return to work. employed you can choose to work
claim it back, they can ring the
right up until the date the baby is
You may qualify for SMP from HMRC Employer Helpline on
due, unless:
more than one employer. 08457 143 143 for advice.
you are absent from work because
Who gets it? How much is it?
of pregnancy-related reasons
You get SMP if: SMP is paid for a maximum of during the four weeks before the
39 weeks. week that your baby is due. In
you have been continuously
employed for at least 26 weeks For the first six weeks you get that case your SMP should start
by the same employer up to 90% of your average gross weekly automatically the day following
the qualifying week. This is the earnings, with no upper limit. the first day of absence from
15th week before the week your work, or
For the remaining 33 weeks, you
baby is due. This means you get a standard rate of 123.06, your baby is born before the start
must have been employed or 90% of your average gross of your SMP. In that case your
by that employer before you weekly earnings if 90% is less SMP will start the day following
were pregnant. Part weeks than 123.06. the birth and will be paid for
count as full weeks and one days 39 weeks.
employment in the qualifying SMP is usually paid in the same
week counts as a full week, and way and at the same time as your
normal wages, but your employer
you earn an average of 95 a
may decide to pay differently, for
week before tax. This amount is
example in a lump sum.
called the Lower Earnings Limit for
National Insurance contributions When is it paid?
and is the amount you have to The earliest you can start your SMP
earn to qualify for benefits. You is 11 weeks before the week your
have to earn more than this baby is due. The latest is the day
amount before you actually start following the birth.
paying National Insurance.
To work out the earliest date,
Your earnings are averaged over an use the due date on your MAT
eight-week period, running up to B1 certificate, which your
and including the 15th week before midwife or GP will
the week your baby is due. This give you.
period may vary slightly depending

165
You can work for up to 10 days for You can give notice for leave and The benefit is paid directly into
the employer who pays you SMP pay together in the 15th week your bank account, normally every
and still keep the SMP for the weeks before the week your baby is due. two weeks.
in which you do that work. These You can change your mind about
How do I claim?
days are called Keeping in Touch the dates you have given for the
(KIT) days. start of your SMP but you must give Go to your local Jobcentre Plus,
your employer 28 days notice of or claim by post if you live too far
After that, if you do any further away. You will have to go to your
this change and confirm the new
work you cannot get SMP for any Jobcentre Plus every fortnight to
date in writing.
week in which you work for the sign on to show that you are
employer who pays you. More information available for work.
If you return to work early, your See leaflet NI17A, A Guide to
More information
SMP will stop. Your SMP cannot Maternity Benefits, which is
available from www.dwp.gov.uk/ If your family has no other income,
start again once you have stopped
advisers/ni17a you will probably be entitled to
your maternity leave.
income-based JSA and other
If after the birth you start work benefits for families on low
for a new employer who did not
IF YOU ARE incomes (see page 159).
employ you in the 15th week before UNEMPLOYED If you resign from
the week your baby was due, you
must tell the employer paying your Contribution-based your job
SMP. They will then stop paying Jobseekers Allowance If you resign from your job and
your SMP. dont go back to work after
What is it?
maternity leave, you may be able to
How do I claim? Contribution-based Jobseekers claim contribution-based Jobseekers
You must give your employer at Allowance (JSA) is an allowance that Allowance (JSA) for up to six
least 28 days notice of the date you lasts for up to 26 weeks for people months. However, you will have to
want to start your pay. They may who are unemployed or working show that you had just cause for
need this in writing. You must also less than 16 hours a week. voluntarily leaving your job. You will
send your maternity certificate (MAT Who gets it? also have to be available for work
B1 form), which is issued by your GP for as many hours a week as your
You get it if:
or midwife from 20 weeks before caring responsibilities permit. This
the week your baby is due. you have paid enough National must be at least 16 hours a week.
Insurance contributions during
If you have not paid enough National
the last two tax years before the
Insurance contributions, you may
current calendar year. Tax years
be able to claim income-based JSA
run from April to March.
instead (see page 159), depending
you are available for work for on your personal circumstances.
as many hours as your caring Apply in person at your local
responsibilities permit (this must Jobcentre Plus.
be at least 16 hours a week), and
If you are a single parent, you may
you are actively seeking work.
be able to claim Income Support
How much is it? (see page 159) once your baby
50.95 a week if you are under 25. is born.
64.30 a week if you are 25 Remember that you may still be
or over. able to claim tax credits if you are
unemployed (Child Tax Credit for
Your partners earnings are not
your children; Working Tax Credit if
taken into account, but, if you are
your partner works enough hours).
in part-time work, your earnings
Apply to Jobcentre Plus for Income
are and will reduce how much
Support or to Her Majestys Revenue
benefit you get.
and Customs for tax credits.

166
MATERNITY LEAVE 17
All employed women are entitled to 52 weeks maternity leave, no matter
how long they have worked for their employer, or the hours they worked.
This is made up of 26 weeks of Ordinary Maternity Leave (OML) and 26 weeks
of Additional Maternity Leave (AML).

RIGHTS AND BENEFITS


You are usually considered to be an employee if:
your employer deducts tax and National Insurance from your pay
your employer controls the work you do, when and how you do it, and
your employer provides all the equipment for your work.
If you work for an agency or do casual work, you are probably
not an employee. However, you can still get maternity pay if you
meet the normal conditions (see Maternity Allowance on page 163
and Statutory Maternity Pay on page 165).

time
with your baby
Ordinary Maternity you are about 29 weeks pregnant, on the day after you give birth.
Leave so count back from the due date on You should tell your employer
your MAT B1 certificate, which your as soon as you can that you
All employed women: midwife or GP will give you. Find have given birth.
can take 26 weeks leave, and the Sunday before your baby is due
(or the due date if it is a Sunday) How to give notice
have the right to return to the and count back 11 Sundays Telling your employer
same job. from there. that you are pregnant
Additional Maternity You can decide when you want The latest time you can tell your
Leave to stop work. You can even work employer that you are pregnant
right up until the date your baby is is the 15th week before your baby
All employed women:
born, unless: is due. However, it is best to tell
can take 26 weeks leave from the your employer as soon as possible
end of their Ordinary Maternity you have a pregnancy-related to make sure that you have health
Leave, and illness/absence in the last four and safety protection during your
weeks of your pregnancy. pregnancy and the right to paid
have the right to return to the In this case your employer can
same job. If that is not reasonably time off for antenatal care. The law
start your maternity leave even protects you from being dismissed
practicable, then you have the if you are off sick for only one
right to a suitable job on very or discriminated against because
day. However, if you are ill for you are pregnant.
similar terms and conditions. only a short time, your employer
When does maternity may agree to let you start your If you cannot give notice by the
leave start? maternity leave when you had 15th week before you are due
planned, or (for example, because you have
The earliest you can start your to go into hospital unexpectedly),
statutory maternity leave is your baby is born before the day
you must give notice as soon as
11 weeks before the expected you were planning to start your
you reasonably can.
week of childbirth. This is when leave. In this case leave will start

167
Giving notice for statutory Working out the 15th week to either Statutory Maternity Pay
maternity leave before your baby is due or Maternity Allowance (see pages
To give notice that you will be Find the Sunday before your baby 165 and 163). After that your leave
taking maternity leave, you must tell is due (or the due date if it is a will be unpaid. Some employers
your employer the following in or Sunday) and count back 15 Sundays also offer extra maternity pay: check
before the 15th week before your from there. That is the start of the your contract, or ask the human
baby is due. It is probably best to 15th week before the expected resources department or your union
put this in writing: week when your baby is due. representative.

that you are pregnant You should use the due date on If you are made redundant while
the MAT B1 certificate that your on maternity leave, your employer
the expected week of childbirth,
midwife or GP will give you when must offer you any suitable
and
you are about 20 weeks pregnant. alternative work that is available.
the date on which you intend If there is none, they must give
to start your maternity leave. you any notice and redundancy
RIGHTS DURING pay that you are entitled to,
If you want to change the date
on which you start your maternity MATERNITY LEAVE although they could offset any
leave, you must give your employer maternity pay you get from the
Since 5 October 2008, your notice pay. Also, your employer
notice of the new date at least 28 contractual rights (that is, any
days before either the new date or must not discriminate against
special rights that apply to your you by failing to consider you for
the old date whichever is earliest. particular workplace, such as a
If there is a good reason why that is opportunities such as promotion.
company car) continue throughout
not possible, tell your employer as your maternity leave (Ordinary For more information visit
soon as you reasonably can.