Archive for June, 2009

What will happen at my postnatal checkup?  q2whn78ivz
Around six weeks after the birth of your baby, you will need to see your doctor for your postnatal checkup. During this appointment, the doctor will ensure that your body is returning to normal after the pregnancy and birth.

How long do I have to wait after my Caesarean before I can drive again?
It is generally thought best to wait for around four to six weeks before driving again following a Caesarean section. although there are no specific guidelines based on research on the subject. We would suggest that you wait until you feel that you have totally recovered from the operation and that you would be able to perform driving manoeuvres such as reversing and parking, as well as an emergency stop, without experiencing pain or discomfort. You would also need to feel comfortable with the car seat belt around you, as this will be directly over the area of your wound.
You should contact your insurance company as well to check their criteria, as some do not insure women to drive within a certain period following a major operation such as a Caesarean.

Postnatal exercise
You can exercise as soon as you warm to after your baby’s birth. The amount you do and how strenuous the exercise will depend on the type of birth you had and how much you exercised before you had your baby. Other considerations are whether you are breastfeeding and the amount of discomfort you feel. Always listen to your body as you will become uncomfortable if you do too much. Your body has just undergone an enormous change throughout the course of pregnancy and childbirth, particularly if you had a Caesarean section. There are also high levels of hormones still in your body, which can make you more supple and prone to injury If you are breastfeeding, you may just want to do gentle exercising until feeding is established. It’s a good idea to wear a supportive bra while exercising, and exercise following a feed rather than before one, which may make it more comfortable for you.
Exercises for 0-6 weeks
Always yarn up, wear” dthe correct footwear, and drink plenty of fluids while you are exercising. Stop and seek medical advice if you feel unwell or experience any severe pain or your bleeding increases. Although getting back to your pre-pregnancy shape is important for your wellbeing, do be patient with yourself as it will take time.
Which exercises can I do? Pelvic floor exercises can be commenced straight after the birth (see p.57). These important exercises help prevent you from leaking urine when you laugh, cough, or sneeze. The exercises involve drawing up and holding the pelvic floor muscles, tightening around the back and front passages, and then letting go. Make sure that you are tightening the pelvic floor (not your buttocks, thighs, or tummy muscles). Keep breathing and relax your other muscles.

Pelvicexercises can also be done lying on your side or ack with the knees bent and slightly apart.
Othe gentle exercises. like lying on your back with your kn.~es bent and doing pelvic tilts (pulling your belly-b !ton in and upwards towards your spine), are reco    ended in the first few days after the birth (not if you h. d a Caesarean).Your abdominal muscles may have separated in pregnancy, so doing these gentle exercises will help them to reunite. The exercises
below will help strengthen abdominal muscles (avoid after a Caesarean and follow the exercise advice given by the hospital). Buildup exercises gradually, starting with one cycle and then repeating this as many times as you feel comfortable. Always breathe normally. Walking and swimming are excellent ways to build up your fitness levels once you have stopped bleeding.
What should I avoid in the first six weeks? Full impact and resistance exercising should only be done about six weeks after the birth, to prevent any strain on the pelvic floor area. Ask your fitness instructor for advice and gradually increase your exercise. Always let your instructor know that you have just had a baby, so exercises can be tailored to your needs. If you had
a Caesarean, your hospital will have given you a leaflet describing the sort of exercises you can do safely, and before you carry out abdominal exercises, such as situps, check with your doctor first: these are usually safe to do around 6-8 weeks after the birth.You can gently introduce single leg-raises while lying on your back once you feel ready probably after about a month.

I developed piles at the end of my pregnancy - will they go now the baby has been born?
haemorrhoids, are swollen veins in or around the anus. They are fairly common in pregnancy and after childbirth due to the weight and pressure of the baby s head pressing down. Most women find that haemorrhoids disappear within a month of giving birth, although a very small minority of women are not so fortunate and will need to discuss treatment optio-is with their doctor. In the meantime, if you are finding the haemorrhoids uncomfortable or itchy, there area few things you can try Applying a mate-nity cool pad to the area can be soothing (you can make your own by freezing a folded wet flannel), or you- doctor or pharmacist may be able to recommend a cream that can ease the discomfort. You should also try to avoid becoming constipated as straining to go to the toilet will make the piles
After an episiotomy
How to ease the discomfort of stitches
If you had an episiotomy, you may find that your perineum is quite uncomfortable after the birth, as the surrounding skin can swell, causing the stitches to become tighter, and sitting down becomes increasingly difficult. Here are some ways to relieve this discomfort. * Sit on a rubber ring to take the pressure off your sti hes and enable you to relax.
pply a cooling gel pack to the area, or ask your midwife or doctor to recommend an anaesthetic worse. so drink plenty of water and eat lots of fresh fruit and vegetables as well as wholegrains.
I had an episiotomy and am terrified of going to the loo. Do you have any advice?
Many women who have had a cut or tear to the perineal area experience discomfort for a while after the birth. There may also be some pain or “stinging” when passing urine or opening the bowels, but this should last only for a few days. You may find it helpful to tip a jug of warm water over the area when you pass urine, as this helps to dilute the urine and reduce the stinging sensation acidic urine can cause. If your loo is near the shower, you may be able to use the shower head over the toilet. A bidet, of course, is ideal, though not many people have these. Drinking plenty of fluids will also help to dilute your urine.
It is normal not to open your bowels for a day or two after the birth. Many women feel anxious the first time they pass a bowel motion, but it is very unlikely that this will damage your stitches. However, if you become constipated, this could cause discomfort. Make sure you drink plenty of water, and eat fresh fruit and vegetables to help prevent this. If you find that you are still feeling constipated, your midwife can give you a mild stool softener if necessary.
I had a long delivery and I’m
worried that my vagina has
stretched. Will it get back to normal?
‘I!ry not to worry. Although at first you may notice changes to your body as a result of the pregnancy and birth, a woman’s body is designed to give birth and return to normal afterwards. To help the muscles around your vagina to tighten after the birth, do some pelvic floor exercises as you did in pregnancy (see p.57). These involve identifying which muscles you need to exercise by tightening the muscles around your vagina and back passage and lifting up just as if you were trying to stop yourself passing urine and wind at the same time. You should practise 5-6 at a time, ideally several times a day If at first you are not able to hold the muscles tight for 5 seconds.

Your body after the birth
I’ve heard about “afterpains”, but what exactly are they?
The term “afterpains” refers to the discomfort felt after the birth as the uterus starts to contract back down  to its normal, pre-pregnancy size. These pains are often described as feeling similar to period pains. So times, women having their first baby may not notice any afterpains, or they are fairly mild; they are more commonly felt by women having their second or subsequent baby. due to the fact that the uterus has to work harder to regain its usual size after being stretched on more than one occasion. who are    also tend to be felt more in women
are breastfeeding their babies, as breastfeeding stim ates the release of the hormone oxytoch which in turn triggers the uterine contractions that are I elt as afterpains.
Getting enough rest
helping  your body to X recover
0    Whether you had a vaginal or
Caesarean birth, you are likely to feel exhausted in the first few weeks. It’s important that you don’t take on too much and give yourself time to recover. * Rather than try and catch up on chores while your baby sleeps, have a nap to catch up on sleep lost through interrupted nights.
•    Avoid heavy lifting as much as possible.
•    It’s fine to stay indoors at first and take things at your own pace while you get used to life with your new baby.
* Don’t feel you have to entertain visitors — 13k them to make you a cup of tea!
If you experience particularly uncomfortable afterpains, it is perfectly safe to take a mild analgesic or a painkiller such as paracetamol. You should find that the discomfort disappears after a few days. Taking warm baths can also be soothing.
I’m still bleeding heavily. How long will this last?
The bleeding you experience after birth is known
as lochia, which is a heavy, bloody vaginal discharge made up of blood and tissues from the uterus and from the site where the placenta was attached to the wall of the uterus. This is how your body gets rid of I he lining of the uterus that supported your baby. Most women find that the bleeding looks initially
like a “period” type of blood loss, and then gradually turns to a brownish or pinkish, watery discharge. The final colour may be yellowish and the discharge quite scanty This bleeding can last for anything from two to six weeks after giving birth. If you are breastfeeding it may finish sooner as the let-down reflex stimulates oxytocin, which in turn triggers uterine contractions.
Is it safe to use tampons while I’m bleeding?
It is not advised to use tampons for around six weeks after giving birth. This is because you are more vulnerable to contracting an infection during this period, so it is important to pay close attention to personal hygiene at this time to keep your vaginal area free from any bacteria, which can be introduced through the use of a tampon. So you should avoid using tampons while you have the post-pregnancy bleed known as lochia.
You can start to use tampons again for your first period after the birth, as long as this occurs at least six weeks after the birth.

LABOUR AND BIRTH
A NEW LIFE
Ouch! My stitches are really uncomfortable. What’s the best way to ease the pain?
Stitches do cause discomfort fora few days after giving birth, so keep the area as clean as possible as this will help prevent infection and minimize your discomfort. You should wash the area with warm water several times a day and make sue you change your pad frequently. Many women find the following techniques for reducing discomfort helpful: * Using a cold pad. You can use a cooling gel pad that has been specially designed for the purpose of soothing the discomfort caused by stitches in the perine area. These have been demonstrated to effectively reduce swelling, briusing, and pain. Or make y:)ur own cool pad by placing crushed ice in a pla tic bag and wrapping this in a dry flannel. * Taking the homeopathic remedy arnica, which is thou ht to help reduce bruising.
* Having a warm bath with a few drops of lavender or camomile essential oil.
* Taking painkillers such as paracetamol or ibuprof n. Ask your doctor or midwife for advice.
take a f w months or more. whichever category you fall to, it is important not to adopt a strict diet during e early weeks and months of parenthood, especi y if you are breastfeeding. However, it is sensib14 to eat a healthy, balanced diet and take some e ercise.You should aim to lose your “baby weight” ,gradually as this will ensure that you are receiv’ g enough nutrition in the postnatal period, and wi give your tummy more time to adjust its shape. eome women do attend professional sessions such as Weight %Vatchers, but it is important that you inform , e trainer or person in charge that you have recentl had a baby.
Coping with constipation Helping your bowels ‘Lo work after the birth
It’s common for bowel movements to be fairly sluggish after giving birth as your abdominal muscles have been stretched during the pregnancy and so exert less pressure, which slows down the movement of faeces through the bowels causing constipation.
You may also feel uncomfortable after the birth and be anxious that opening your bowels, and possibly straining, could damage stitches if you had any However, this is extremely unlikely. The best way to avoid constipation is to drink plenty of fluids each day, preferably water (also important if you are breastfeeding), and to eat tots of fibre-rich foods, such as fresh and dried fruits, cereals, and other wholegrain foods. Once you have recovered from the birth, gentle exercise that tones the abdominal muscles may also help your bowels to become more efficient (see pp.268-269).
How can I get rid of my stretchmarks?
Unfortunately, there is no magic way to get rid of stretchmarks, which affect a large number of pregnant women and seem to be influenced by genes as they often run in families. You will find that the marks fade over time from bright red to a paler pink, and then to a silvery colour that blends in with your skin tone. Massaging a natural oil into your skin may help them to fade.
If, after time, your stretchmarks are still troubling you, you could discuss treatment options with your doctor, which include Laser treatments to reduce the redness of stretchmarks. However, you should be warned that treatments for getting rid of
stretchmarks are often not completely effective and simply speed up the natural fading process rather than eradicate the stretchmarks altogether. Also you would have to pay for these treatments privately
varies widely.
How quickly will I lose the weight I put on during pregnancy?

I’m losing weight fast, but my tummy is really flabby - how can I tighten it up?
This i . a common problem after giving birth. The flabb i ess you are experiencing is caused by the muse :-s and skin having stretched to accommodate your bregnancy and baby After the birth, these muse  es relax and have lost their tone. However, you shoule find that the muscle tone gradually returns, altho gh it may never be quite the same as it was befor’ your pregnancy.
Yo u can try some gentle toning exercises (see pp.2t8-269) as soon as you feel able to after the birth,although you should wait for at least six weeks if yo ‘have had a Caesarean. Your midwife will be able io give you more information about what is safe to do land what is not. If you do go to a professional exert se class or gym, make sure you inform the train4 that you have recently given birth and what type of birth you had so he or she can give you appropriate advice and guidance.
I’ve still got a huge appetite - is this because I’m breastfeeding? Ho much should I be eating now?
This ould be because you are breastfeeding, which requi es an extra 500 calories each day However. this iay not equate to as much food as you think -it wo s out at about two slices of toast with baked bean ! Your big appetite therefore isn’t a problem
in itself, but how you satisfy it can be! As long as you are eating a healthy, balanced diet. you shouldn’t find that ou gain weight (and you definitely shouldn’t be tryinsi to diet while you are breastfeeding). Ensure
that our diet is providing sufficient quantities of prole and carbohydrates and plenty of fresh fruit and –getables. Also avoid filling up on “empty calor es” such as sweets, biscuits, and crisps, and insle.: d try to snack on foods such as fruit, nuts, and seed.. This will ensure that you receive the best nutri on during such an important time, which will bene it you and your baby, and will also help you to lose ..ny extra weight you have gained during the co -e of your pregnancy.
I’ve heard that breastfeeding helps you to lose the weight quicker. Is this true?
Breastfeeding can help you to lose weight moi e quickly after the birth as your body is using up energy to provide an adequate milk supply for
your baby. Some of the 500 extra calories a day you need may be taken from fat supplies deposited in pregnancy Often, extra fat laid down on the hips and thighs in pregnancy is lost first, providing the “fuel” required to make milk and breastfeed your baby. Gentle exercise such as walking and swimming will also help to shift the pregnancy pounds.
I’m not breastfeeding my baby at all - when will my periods start again?
If you are not breastfeeding, you can expect your first period to arrive any time from four weeks after the birth. Most women find that the first period is a little different from normal. It may be heavier or Lighter and it may last for longer or shorter than usual. A more regular pattern should establish itself over the next few months.

I’m still scared I’ll drop the baby. Do other dads feel like this? q2whn78ivz
This is a normal and natural feeling and affects the majority of all new dads (and many mums!) Babies
seem to be such fragile little creatures, especially because of their size compared to you. However.
they are in fact quite resilient to inept handling and are a lot stronger than they look Remember the
tough journey they have just undergone to be born! If you have so far avoided handling your baby much,
try to overcome your fears by watching your partner or midwife change your baby or bathe him, then
offer to help so that you can give your partner a rest Once you have changed a few nappies, or done
some winding sessions, you will find that your confidence in handling your baby begins to grow quickly.
The more contact you have with your baby, the more confident over time you will become, and your
partner will also benefit from the added support and help you are providing and from knowing that she
can feel confident leaving -you in charge of the baby sometimes.
Our baby screams whenever he goes near water. How can we make bathing him less stressful?
There is no right or wrong way to bathe a baby
but with a little care and organization it can actually become quite a playful and fun experience (see
p 250-251). This may seem hard to believe at the moment, and it is certainly the case that many newborn
babies initially scream throughout their bathtime. However the main reason why babies do this is
because they don’t like to feel cold. To keep your baby comfortable during a bathing session, make sure
that the room you bathe him in is sufficiently warm and draught-free, which will
help him to relax and feel less distressed. Also always gather everything you need ready before the
bathing session so that you don’t have to go and fetch items mid-way through a session, leaving your
baby lying on a towel and letting him get cold.
If you are feeling stressed during your baby’s bathtime, he may be sensing this, which could be adding
to his upset. The biggest fear that mums and dads have is of dropping their baby while bathing him, so
you could initially try bathing at ground level to help you to build your confidence Also, remember to
communicate with your baby all the time while you are bathing him — talking to him constantly in a
soothing tone, or singing to him, will help to distract and reassure him and in turn you are likely to
feel far more relaxed, which will have a positive effect on your baby
If you are still concerned about handling your baby, then seek help from your partner. if he or she is
more confident, or talk to -your community midwife who will be more than happy to offer you additional
advice and support
Our newborn sleeps so much -it’s wonderful, but should I be waking him for a feed?
While many newborn babies sleep for what seems to be a very short amount of time, some do sleep for
quite long periods. One factor that may influence how long your baby sleeps is how he is fed. The
makeup of formula milk is very different to that of breast milk and sits in a baby’s stomach for
longer. So formula-fed babies tend to sleep for longer periods and are, in fact, encouraged to do so to
prevent overfeeding and constipation. However, a bottlefed baby shouldn’t be left without a feed for
more than six hours and it is recommended that bottlefed babies should have no fewer than six feeds.

Holding your newborn
New parents, particularly first-timers, sometimes worry about picking their baby up or carrying them
properly. However, newborn babies are not as fragile as you think. Although, of course, you still need
to take care when handling your baby, it’s best to trust in your ability The more you practise, the
easier it will become and you will find that your confidence will soon grow with experience The main
point to remember is that babies need to be supported at the head and lower body as their muscle tone
is not developed enough to support themselves The same principle applies if you are cradling your baby,
holding your baby upright over your shoulder, or sitting him on your lap.
Once you have been shown the
technique by your midwife, you might like to practise without being watched

Bathing and washing

There are differing views on how to bathe and wash a baby, but the general opinion seems to be that
less is more. Some say it is unnecessary to bathe your baby for the first month, others say if you want
to, just use water and, if you wish, pH-neutral balanced products. Always read the label and avoid
anything with sulphur in it Your baby’s newborn skin is so delicate and thin that if you use harsh or
highly perfumed products the skin’s protective barriers can be damaged: skin may then become dry and
more vulnerable to infection. A baby’s skin also absorbs certain chemicals that may contribute to
conditions like eczema and asthma later in life.
When should I bathe my baby?

The vernix, the waxy-like substance that covers your baby at birth, should
be left to absorb into his skin as it is
Topping and tailing
the most amazing moisturizer. If your baby’s hair needs a wash, just use water and a baby comb to
remove any debris. You can ”top and tail’ your baby in the first few days of life, using cotton wool
(organic if possible) and water, gently washing his face (being careful around the delicate area of the
eyes) and nappy area. This allows your baby’s skin to adjust to the outside world Later, when you bathe
your baby, hold him gently in water two or three times a week.
What should I use to clean my baby? Use water and cotton wool in the first month. If your baby’s eyes
become sticky, use cotton wool dipped in cooled boiled water to clean them - gently wipe the eyes with
an in-to-out movement, using a new piece of cotton wool for each wipe. Use cotton wool to wipe around
the outside of the ears and nose.

I’m scared to touch my baby’s cord stump - should I clean it?
The cord stump is the end of the umbilicus that housed the arteries and veins that fed your baby and
removed his waste products in pregnancy It is common for parents to not want to touch the stump.
However, the stump can become infected as its base can become moist. and harmful bacteria that live
naturally on our skin may grow in this moist area before it falls off, usually by the tenth day, If the
cord stump is clean, there is no need to touch it, but if it becomes soiled, it should be cleaned with
damp cotton wool. Once the stump has fallen off, the “wound” needs cleaning until it heals, as the
navel and surrounding area can also become inflamed. If the stumps smells offensive or is sticky,
contact your midwife or doctor.
What is meconium?
Meconium is a waste product from your baby’s bowels It is dark brown/green in colour and its texture is
quite sticky and globular. Meconium is formed from as early as 12 weeks gestation and contains dead
skin cells and debris from the amniotic fluid that the baby swallows and digests throughout pregnancy.
It is usually expelled after birth in the first few stools, but it can be passed in pregnancy or labour
when it may be a sign that the baby is distressed. If meconium is seen before the birth, the baby will
be monitored carefully during the labour and birth
How often should I change my baby’s nappy?
Your baby’s own toilet habits will dictate how often to change his nappies However, you should check
his nappy fairly regularly, as wetness and the ammonia contained in urine and the digestive enzymes in
stools can quickly irritate a baby’s sensitive skin Some babies need changing around 6-8 times a day,
while others require a nappy change as often as 10-12 times a day, for example, breastfed babies who
poo much more frequently than bottlefed babies As your baby gets older, he will need changing less
frequently.
Is there anything I should look out for when changing his nappy?
A baby’s urine is pale after birth and then darkens within the next few days. There may be a
pinky-orange stain in your baby’s nappy, which is concentrated urine from when he was in the uterus and
is quite normal. As long as your baby passes urine at least four times a day and there is no blood
present, there is nothing for you to worry about The black-green meconium passed after the birth (see
left) gradually changes to a yellow colour as normal digestion begins.
Breastfed babies tend to pass stools that are runny and mustard-yellow, which can look similar to
diarrhoea, while a formula-fed baby’s stools will be much firmer and a seedy pale yellow. Some babies
have a bowel movement with every feed, as feeding stimulates peristalsis, or muscular contractions, in
the gut; others, particularly bottledfed babies, may only pass a stool once a week. If your baby’s
stool is hard and dry, or there is any mucus or blood in the stool, talk to your doctor.
How should we deal with nappy rash?
Nappy rash is sore for the baby, but also distressing for parents, who may feel that they should have
been able to prevent it. There are several reasons for nappy rash, including if the baby’s urine or
stools are concentrated, causing them to be more of an irritant; if a barrier cream has not been used;
or if the baby has a thrush infection that is irritating the nappy rash Also, changing a baby’s nappy
too regularly can sometimes be harmful as the baby may be sensitive to the wipes being used.
The most usual way to deal with nappy rash is to “air” the bottom as often as is practical. After
thorough handwashing, clean your baby’s bottom carefully with cotton wool and warm tap water and/or
emollient creams, which lubricate the skin and stop it becoming too dry and avoid soaps or wipes Then
leave your baby without a nappy on an absorbent mat or towel for a while When you change his nappy.

Nappy changing
Although you may feel a bit hesitant at first about changing your baby’s nappies, and many babies
protest strongly when having their nappy changed, you will soon master the technique and learn how to
change his nappy quickly and with the minimum of
fuss. The key to successful and stress-free changing is to have everything ready before you start.
Choose somewhere warm and draught-free to change your baby; you may also want to lay down a towel on
top of the changing mat for extra comfort
CLEANING THE NAPPY AREA:
apply an emollient or barrier cream thinly so that it protects the skin but does not prevent the nappy
from soaking up urine. Suitable ointments and creams include zinc oxide or petroleum jelly. Another
ointment called metanium ointment contains titanium dioxide, which seems to be effective in healing
Happy rash, although it does have a strange smell and can stain fabric.
Occasionally, a moderate or severe nappy rash may be infected In this case, treatment with antibiotics
may be necessary Also, to reduce inflammation, a corticosteroid cream may be suggested for application
once a day, to reduce the inflammation of the nappy rash and give the rash a better chance to heal. An
antifungal cream will also be recommended as many moderate to severe rashes are infected with the
bacteria Candida albicans. If the rash persists after 7-10 days, the doctor may recommend an antifungal
syrup to try
to treat the whole bowel for thrush infection. If this occurs, you should also apply an antifungal
cream to your nipples if you are breastfeeding. Although unusual, if the nappy rash still shows no sign
of healing, your doctor may refer your baby to a dermatologist.
Should we use baby wipes or just cotton wool when changing a nappy?
Most midwives would advise that you stick to warm water and cotton wool balls, preferably organic, to
clean your newborn baby when changing his nappies Any soaps, perfumed or otherwise, or baby wipes
should be used with caution as, although baby products are designed to be kinder on a baby’s sensitive
skin, they can still irritate the skin if overused or not washed off and dried properly. It’s best to
avoid baby wipes altogether until your baby is a few months old.

My baby’s scalp has become scaly. Is this cradle cap and what should I do about it?
Cradle cap, or seborrhoeic dermatitis, is a common condition in young babies, appearing as yellow,
scaly patches on the scalp. This condition is harmless and will clear up on its own over time However,
if you are concerned that it is unsightly gently massage some olive oil into the scalp, leave this on
overnight, and then wash your baby’s hair in the morning with a mild baby shampoo: most of the flakes
should disappear Don’t pick at the scales as this could damage the skin and increase the chance of
infection.
What temperature should our house be when we bring our new baby home?
Babies find it hard to maintain their body temperature Maternity units are notoriously hot as they are
dealing with babies who have just been born and are still quite wet from the delivery. Once you are
home, the guidelines are to maintain room temperature at around 16-20°C (62-68°F) and you may find
purchasing a room thermometer helpful. Babies are at risk of cot death (see p.276) if they become too
hot due to being in a warm room or being overwrapped.
However, the room temperature is a guideline only and you should learn to check for other signs that
your baby is too hot or too cold. As a guide, a baby’s hands and feet feel cool and their heads feel
hot as they tend to lose heat through their heads Check his temperature by feeling your baby’s chest
with the back of your hand, not your fingers, as these may be cold. If your baby feels warm to touch,
he is probably warm enough If he is hot or sweaty, remove a layer of clothing or a blanket or sheet. If
he is cold, add a layer. Duvets are not recommended until your baby is at least a year old, to avoid
overheating.
If your baby is unwell, hot, and shivery, your immediate reaction may be to wrap and cuddle him, but
this can make him too hot Instead, remove a few layers so that your baby can cool down. Seek medical
help straight away if your baby has a temperature over 39°C (102 2°F) or if he is particularly
unresponsive and listless.
How should I place my baby in the cot?
The Foundation for Sudden Infant Death (FSID) recommends that your baby should be placed with his feet
towards the bottom of the cot to prevent him wriggling under the blankets and possibly suffocating
himself (see p 276). Light cotton blankets and sheets, available in cot sizes, should be used rather
than quilts or duvets, so that layers can be built up or taken off. The blankets and sheets should be
tucked under the baby’s arms so that your baby is less likely to pull them over his face. Swaddling is
another method of wrapping your baby which some babies find comforting (see p.257).
Is it OK to swaddle our baby? There seem to be conflicting opinions.
Swaddling means wrapping your baby in a light cotton blanket or sheet, the idea being to keep him
feeling warm and secure in the outside world (see p 257). The baby is so well wrapped that his arms and
legs are ‘’strapped” to his sides, restricting movement of the limbs. There are differing views as to
whether a baby should be swaddled The practice is very popular in Asian and Eastern European areas. Its
popularity is also on the rise in the UK, especially since parents have been encouraged to put babies
in their own cots to sleep rather than bedsharing to prevent cot death. It is also thought that the
swaddling may help a baby to sleep comfortably on his back.
The FSID warns of the risks of overheating a baby so any swaddling should be done with a light cotton
sheet or blanket and the room must not be too warm. On the other hand, some believe that swaddled
babies risk getting cold as they cannot maintain their temperature by moving.
Should my baby wear his hat indoors?
One factor known to increase the risk of cot death
is an overheated baby Although babies lose excess heat from their heads and it is a good idea to cover
a baby’s head outside if it is cold or windy, the baby’s hat should be removed indoors or when you
enter an area that is warm, such as on a bus or going into a shop, even if it means waking your baby
There are some exceptions. If a baby was born prematurely, had a very low birth weight, or has
difficulty maintaining his temperature, then they may need to wear a hat indoors. However, once these
babies area healthy weight or able to maintain their body temperature, this no longer applies
He screams when I undress him. What can I do?
Babies use crying as their means of communication. It may be that when you undress him, he is either
protesting that he is cold or that he does not like the feeling of air on his skin, which he is unused
to after been snuggled in the womb for nine months Try to keep the changing time as short as possible,
making sure he is not in a draughty or cold environment. Afterwards, comfort your baby by rocking him;
swaddling and keeping him in an upright position can also soothe him
When can we take him out?
Some recommend waiting for 1-2 weeks before going out, but this will depend on individual
circumstances. When you feel well enough, you could try going out for a short walk, but bear in mind it
will be the same distance to get back. so do not overdo it. You may have a local park you could visit
or simply have a walk round the block - it’s best to keep it simple at first until you get used to
being out together. You are likely to feel rather nervous at first about taking your baby outside of
the home, but, as with most aspects of baby care, once you get used to going out you will probably lose
much of your anxiety. As you start to increase the distance and time away from home, make sure you have
taken everything you will need to care for your baby while you are out. This will include changing equipment,
and blankets, pram covers, or parasols to protect your baby from different weather conditions The time
of year will also affect how long you stay out.
Can he sleep for long in his car seat?
There are no laws to state how long a baby should remain in a car seat, but bear in mind that being
fixed in one position for long periods of time would be uncomfortable for anyone, regardless of age
Generally, it is not recommended that babies are left for a long period of time in car seats because if
they fall asleep curled up in this position it may affect their breathing, and can encourage wind to
get trapped causing discomfort You should also take care when carrying your baby around in a car seat
as they tend to be heavy and you are more prone to back injuries in the postnatal period.
My wife won’t let me do a thing but I want to get better at it. How can I help?
Some women do feel that it is their responsibility to care for the baby, but it is well documented that
a couple’s relationship is strengthened when the care is shared This involves joint decision-making and
making choices regarding care together Babies can pick up on positive and negative feelings expressed
by their parents, and it is important for all concerned that both the mother and the father bond with
the child. Offer to perform routine tasks in front of her to instil her confidence in your ability.
This may take time, but the reward is worth it. She will also benefit from being able to take breaks,
confident in the knowledge that you can cope as well as she can.
My friend’s baby had colic and she had a miserable few months with it. Will my baby get it?
The term “colic refers to when babies cry continually for around three hours each day and cannot be
soothed (see p,274) Although obviously
distressing for the baby, it is equally upsetting for the parents to listen to their baby crying so
painfully for so long. As no-one knows exactly why colic occurs, it is impossible to say whether or not
your baby will suffer with it. However. there are several theories as to what causes colic One is that
the baby’s intestines are immature and working too hard, causing a cramp. Another is that the bowel
movements are too slow and the air in the bowel is trapped. Another theory is that the baby is eating
too much, too fast, and has air trapped None of these is proven and all we know is that colic occurs in
around 10-15 per cent of babies
My baby cries continually. I’m not having much success with breastfeeding - is he hungry?
Newborn babies cry on average for two and a half hours each day Crying is your baby’s only means of
communication and so he cries to get you to respond to his needs, whether he is hungry, wet, or just
wants a cuddle Some babies cry more and may struggle when you try to comfort them, which can make you
anxious If you are anxious about breastfeeding, your baby may sense this and begin to cry Sometimes, it
is necessary to take a step back and try to relax. Having a warm bath with your baby skin-to-skin,
sometimes called ”rebirthing’ , can help to calm you both and may help you to relax more while
feeding. Once warm and calm, your baby may try to get into a good position to feed Ensure he latches on
well and does not cause pain after the first few sucks (see p 228). Allowing your baby to feed as and
when he wants is also important As your baby gets older, the regularity of feeds will settle and
feeding will change
Other reasons why babies cry include being overstimulated (try rebirthing); being uncomfortable (try
winding) ; being wet or dirty (change his Happy) being cold or hot (change the clothing and room
temperature); wanting comfort (try swaddling); or boredom (talk to your baby. sing, and play with him)
My midwife says that our baby comfort sucks. I’m reluctant to introduce a dummy - should we?
If a baby has latched on well at the breast and has sucked and swallowed well during a long feed, and
then settles on the breast taking small sucks and not swallowing, he is comfort sucking. Many babies
like to comfort suck, not just breastfed ones If your baby falls asleep. you may be able to gently ease
him off the breast, or if you are comfortable, leave him there.
Your baby may comfort suck for many reasons He may be stimulating the breast to increase your milk
supply; he may be ”cluster” feeding and is dozing before the next feed; or he may want to snuggle
close. Comfort sucking is thought to steady the baby’s heart rate, relax his stomach, and help him to
settle.
Introducing a dummy is your choice. Some parents think they are the best way to get a baby to sleep,
day or night; others think they should be used only at night and some believe they should not be used
at all The Foundation for Sudden Infant Death (FSID) suggested in June 2007 that using a dummy can
reduce the risk of cot death, but that breastfed babies should not be given one until over a month old
and feeding is established This advice is based on studies suggesting a lower incidence of cot death in babies given a
dummy.
If your baby likes to suck, you can also offer him a clean finger to suck on; later on, some babies
comfort themselves by sucking on their own thumb or finger
What does swaddling mean?
Swaddling is an old practice of wrapping a baby snugly in cloths or blankets so that movement of the
limbs is restricted. Many midwives swaddle infants soon after birth and it is now a standard newborn
care practice in many hospitals Research has found that swaddling may help newborns to sleep as it prevents
the “morn ‘, or startle reflex - the tendency for newborns to startle themselves by moving their arms
suddenly.
CHANGING YOUR BABY’S CLOTHES:
Dressing and undressing
Your baby is likely to wear vests and sleepsuits, or babygrows Choose vests with envelope necks that
are easy to get on and off and opt for sleepsuits with front-opening poppers
* Lie your baby down. Put the vest on by holding the neck opening wide and gathering the rest of the
vest. Gently lift the back of his head and ease the back of the vest behind his head Lift the front
over the head, avoiding his face. Gently lift the sleeve down over the hand and arm, stretching the
vest rather than pulling your baby’s arm. * Lay the sleepsuit out with the poppers undone Place your
baby on top, then gently insert his legs, then his arms into the suit and do up the poppers.

Do other dads feel like this?
This is a normal and natural feeling and affects the majority of all new dads (and many mums!) Babies
seem to be such fragile little creatures, especially because of their size compared to you. However.
they are in fact quite resilient to inept handling and are a lot stronger than they look Remember the
tough journey they have just undergone to be born! If you have so far avoided handling your baby much,
try to overcome your fears by watching your partner or midwife change your baby or bathe him, then
offer to help so that you can give your partner a rest Once you have changed a few nappies, or done
some winding sessions, you will find that your confidence in handling your baby begins to grow quickly.
The more contact you have with your baby, the more confident over time you will become, and your
partner will also benefit from the added support and help you are providing and from knowing that she
can feel confident leaving -you in charge of the baby sometimes.
Our baby screams whenever he goes near water. How can we make bathing him less stressful?
There is no right or wrong way to bathe a baby
but with a little care and organization it can actually become quite a playful and fun experience (see
p 250-251). This may seem hard to believe at the moment, and it is certainly the case that many newborn
babies initially scream throughout their bathtime. However the main reason why babies do this is
because they don’t like to feel cold. To keep your baby comfortable during a bathing session, make sure
that the room you bathe him in is sufficiently warm and draught-free, which will
help him to relax and feel less distressed. Also always gather everything you need ready before the
bathing session so that you don’t have to go and fetch items mid-way through a session, leaving your
baby lying on a towel and letting him get cold.
If you are feeling stressed during your baby’s bathtime, he may be sensing this, which could be adding
to his upset. The biggest fear that mums and dads have is of dropping their baby while bathing him, so
you could initially try bathing at ground level to help you to build your confidence Also, remember to
communicate with your baby all the time while you are bathing him — talking to him constantly in a
soothing tone, or singing to him, will help to distract and reassure him and in turn you are likely to
feel far more relaxed, which will have a positive effect on your baby
If you are still concerned about handling your baby, then seek help from your partner. if he or she is
more confident, or talk to -your community midwife who will be more than happy to offer you additional
advice and support
Our newborn sleeps so much -it’s wonderful, but should I be waking him for a feed?
While many newborn babies sleep for what seems to be a very short amount of time, some do sleep for
quite long periods. One factor that may influence how long your baby sleeps is how he is fed. The
makeup of formula milk is very different to that of breast milk and sits in a baby’s stomach for
longer. So formula-fed babies tend to sleep for longer periods and are, in fact, encouraged to do so to
prevent overfeeding and constipation. However, a bottlefed baby shouldn’t be left without a feed for
more than six hours and it is recommended that bottlefed babies should have no fewer than six feeds.

Holding your newborn
New parents, particularly first-timers, sometimes worry about picking their baby up or carrying them
properly. However, newborn babies are not as fragile as you think. Although, of course, you still need
to take care when handling your baby, it’s best to trust in your ability The more you practise, the
easier it will become and you will find that your confidence will soon grow with experience The main
point to remember is that babies need to be supported at the head and lower body as their muscle tone
is not developed enough to support themselves The same principle applies if you are cradling your baby,
holding your baby upright over your shoulder, or sitting him on your lap.
Once you have been shown the
technique by your midwife, you might like to practise without being watched

Bathing and washing
There are differing views on how to bathe and wash a baby, but the general opinion seems to be that
less is more. Some say it is unnecessary to bathe your baby for the first month, others say if you want
to, just use water and, if you wish, pH-neutral balanced products. Always read the label and avoid
anything with sulphur in it Your baby’s newborn skin is so delicate and thin that if you use harsh or
highly perfumed products the skin’s protective barriers can be damaged: skin may then become dry and
more vulnerable to infection. A baby’s skin also absorbs certain chemicals that may contribute to
conditions like eczema and asthma later in life.
When should I bathe my baby? The vernix, the waxy-like substance that covers your baby at birth, should
be left to absorb into his skin as it is
Topping and tailing
the most amazing moisturizer. If your baby’s hair needs a wash, just use water and a baby comb to
remove any debris. You can ”top and tail’ your baby in the first few days of life, using cotton wool
(organic if possible) and water, gently washing his face (being careful around the delicate area of the
eyes) and nappy area. This allows your baby’s skin to adjust to the outside world Later, when you bathe
your baby, hold him gently in water two or three times a week.
What should I use to clean my baby? Use water and cotton wool in the first month. If your baby’s eyes
become sticky, use cotton wool dipped in cooled boiled water to clean them - gently wipe the eyes with
an in-to-out movement, using a new piece of cotton wool for each wipe. Use cotton wool to wipe around
the outside of the ears and nose.
I’m scared to touch my baby’s cord stump - should I clean it?
The cord stump is the end of the umbilicus that housed the arteries and veins that fed your baby and
removed his waste products in pregnancy It is common for parents to not want to touch the stump.
However, the stump can become infected as its base can become moist. and harmful bacteria that live
naturally on our skin may grow in this moist area before it falls off, usually by the tenth day, If the
cord stump is clean, there is no need to touch it, but if it becomes soiled, it should be cleaned with
damp cotton wool. Once the stump has fallen off, the “wound” needs cleaning until it heals, as the
navel and surrounding area can also become inflamed. If the stumps smells offensive or is sticky,
contact your midwife or doctor.
What is meconium?
Meconium is a waste product from your baby’s bowels It is dark brown/green in colour and its texture is
quite sticky and globular. Meconium is formed from as early as 12 weeks gestation and contains dead
skin cells and debris from the amniotic fluid that the baby swallows and digests throughout pregnancy.
It is usually expelled after birth in the first few stools, but it can be passed in pregnancy or labour
when it may be a sign that the baby is distressed. If meconium is seen before the birth, the baby will
be monitored carefully during the labour and birth
How often should I change my baby’s nappy?
Your baby’s own toilet habits will dictate how often to change his nappies However, you should check
his nappy fairly regularly, as wetness and the ammonia contained in urine and the digestive enzymes in
stools can quickly irritate a baby’s sensitive skin Some babies need changing around 6-8 times a day,
while others require a nappy change as often as 10-12 times a day, for example, breastfed babies who
poo much more frequently than bottlefed babies As your baby gets older, he will need changing less
frequently.
Is there anything I should look out for when changing his nappy?
A baby’s urine is pale after birth and then darkens within the next few days. There may be a
pinky-orange stain in your baby’s nappy, which is concentrated urine from when he was in the uterus and
is quite normal. As long as your baby passes urine at least four times a day and there is no blood
present, there is nothing for you to worry about The black-green meconium passed after the birth (see
left) gradually changes to a yellow colour as normal digestion begins.
Breastfed babies tend to pass stools that are runny and mustard-yellow, which can look similar to
diarrhoea, while a formula-fed baby’s stools will be much firmer and a seedy pale yellow. Some babies
have a bowel movement with every feed, as feeding stimulates peristalsis, or muscular contractions, in
the gut; others, particularly bottledfed babies, may only pass a stool once a week. If your baby’s
stool is hard and dry, or there is any mucus or blood in the stool, talk to your doctor.
How should we deal with nappy rash?
Nappy rash is sore for the baby, but also distressing for parents, who may feel that they should have
been able to prevent it. There are several reasons for nappy rash, including if the baby’s urine or
stools are concentrated, causing them to be more of an irritant; if a barrier cream has not been used;
or if the baby has a thrush infection that is irritating the nappy rash Also, changing a baby’s nappy
too regularly can sometimes be harmful as the baby may be sensitive to the wipes being used.
The most usual way to deal with nappy rash is to “air” the bottom as often as is practical. After
thorough handwashing, clean your baby’s bottom carefully with cotton wool and warm tap water and/or
emollient creams, which lubricate the skin and stop it becoming too dry and avoid soaps or wipes Then
leave your baby without a nappy on an absorbent mat or towel for a while When you change his nappy.

Nappy changing
Although you may feel a bit hesitant at first about changing your baby’s nappies, and many babies
protest strongly when having their nappy changed, you will soon master the technique and learn how to
change his nappy quickly and with the minimum of
fuss. The key to successful and stress-free changing is to have everything ready before you start.
Choose somewhere warm and draught-free to change your baby; you may also want to lay down a towel on
top of the changing mat for extra comfort
CLEANING THE NAPPY AREA:
apply an emollient or barrier cream thinly so that it protects the skin but does not prevent the nappy
from soaking up urine. Suitable ointments and creams include zinc oxide or petroleum jelly. Another
ointment called metanium ointment contains titanium dioxide, which seems to be effective in healing
Happy rash, although it does have a strange smell and can stain fabric.
Occasionally, a moderate or severe nappy rash may be infected In this case, treatment with antibiotics
may be necessary Also, to reduce inflammation, a corticosteroid cream may be suggested for application
once a day, to reduce the inflammation of the nappy rash and give the rash a better chance to heal. An
antifungal cream will also be recommended as many moderate to severe rashes are infected with the
bacteria Candida albicans. If the rash persists after 7-10 days, the doctor may recommend an antifungal
syrup to try
to treat the whole bowel for thrush infection. If this occurs, you should also apply an antifungal
cream to your nipples if you are breastfeeding. Although unusual, if the nappy rash still shows no sign
of healing, your doctor may refer your baby to a dermatologist.
Should we use baby wipes or just cotton wool when changing a nappy?
Most midwives would advise that you stick to warm water and cotton wool balls, preferably organic, to
clean your newborn baby when changing his nappies Any soaps, perfumed or otherwise, or baby wipes
should be used with caution as, although baby products are designed to be kinder on a baby’s sensitive
skin, they can still irritate the skin if overused or not washed off and dried properly. It’s best to
avoid baby wipes altogether until your baby is a few months old.

My baby’s scalp has become scaly. Is this cradle cap and what should I do about it?
Cradle cap, or seborrhoeic dermatitis, is a common condition in young babies, appearing as yellow,
scaly patches on the scalp. This condition is harmless and will clear up on its own over time However,
if you are concerned that it is unsightly gently massage some olive oil into the scalp, leave this on
overnight, and then wash your baby’s hair in the morning with a mild baby shampoo: most of the flakes
should disappear Don’t pick at the scales as this could damage the skin and increase the chance of
infection.
What temperature should our house be when we bring our new baby home?
Babies find it hard to maintain their body temperature Maternity units are notoriously hot as they are
dealing with babies who have just been born and are still quite wet from the delivery. Once you are
home, the guidelines are to maintain room temperature at around 16-20°C (62-68°F) and you may find
purchasing a room thermometer helpful. Babies are at risk of cot death (see p.276) if they become too
hot due to being in a warm room or being overwrapped.
However, the room temperature is a guideline only and you should learn to check for other signs that
your baby is too hot or too cold. As a guide, a baby’s hands and feet feel cool and their heads feel
hot as they tend to lose heat through their heads Check his temperature by feeling your baby’s chest
with the back of your hand, not your fingers, as these may be cold. If your baby feels warm to touch,
he is probably warm enough If he is hot or sweaty, remove a layer of clothing or a blanket or sheet. If
he is cold, add a layer. Duvets are not recommended until your baby is at least a year old, to avoid
overheating.
If your baby is unwell, hot, and shivery, your immediate reaction may be to wrap and cuddle him, but
this can make him too hot Instead, remove a few layers so that your baby can cool down. Seek medical
help straight away if your baby has a temperature over 39°C (102 2°F) or if he is particularly
unresponsive and listless.
How should I place my baby in the cot?
The Foundation for Sudden Infant Death (FSID) recommends that your baby should be placed with his feet
towards the bottom of the cot to prevent him wriggling under the blankets and possibly suffocating
himself (see p 276). Light cotton blankets and sheets, available in cot sizes, should be used rather
than quilts or duvets, so that layers can be built up or taken off. The blankets and sheets should be
tucked under the baby’s arms so that your baby is less likely to pull them over his face. Swaddling is
another method of wrapping your baby which some babies find comforting (see p.257).
Is it OK to swaddle our baby? There seem to be conflicting opinions.
Swaddling means wrapping your baby in a light cotton blanket or sheet, the idea being to keep him
feeling warm and secure in the outside world (see p 257). The baby is so well wrapped that his arms and
legs are ‘’strapped” to his sides, restricting movement of the limbs. There are differing views as to
whether a baby should be swaddled The practice is very popular in Asian and Eastern European areas. Its
popularity is also on the rise in the UK, especially since parents have been encouraged to put babies
in their own cots to sleep rather than bedsharing to prevent cot death. It is also thought that the
swaddling may help a baby to sleep comfortably on his back.
The FSID warns of the risks of overheating a baby so any swaddling should be done with a light cotton
sheet or blanket and the room must not be too warm. On the other hand, some believe that swaddled
babies risk getting cold as they cannot maintain their temperature by moving.
Should my baby wear his hat indoors?
One factor known to increase the risk of cot death
is an overheated baby Although babies lose excess heat from their heads and it is a good idea to cover
a baby’s head outside if it is cold or windy, the baby’s hat should be removed indoors or when you
enter an area that is warm, such as on a bus or going into a shop, even if it means waking your baby
There are some exceptions. If a baby was born prematurely, had a very low birth weight, or has
difficulty maintaining his temperature, then they may need to wear a hat indoors. However, once these
babies area healthy weight or able to maintain their body temperature, this no longer applies
He screams when I undress him. What can I do?
Babies use crying as their means of communication. It may be that when you undress him, he is either
protesting that he is cold or that he does not like the feeling of air on his skin, which he is unused
to after been snuggled in the womb for nine months Try to keep the changing time as short as possible,
making sure he is not in a draughty or cold environment. Afterwards, comfort your baby by rocking him;
swaddling and keeping him in an upright position can also soothe him
When can we take him out?
Some recommend waiting for 1-2 weeks before going out, but this will depend on individual
circumstances. When you feel well enough, you could try going out for a short walk, but bear in mind it
will be the same distance to get back. so do not overdo it. You may have a local park you could visit
or simply have a walk round the block - it’s best to keep it simple at first until you get used to
being out together. You are likely to feel rather nervous at first about taking your baby outside of
the home, but, as with most aspects of baby care, once you get used to going out you will probably lose
much of your anxiety. As you start to increase the distance and time away from home, make sure you have
taken
everything you will need to care for your baby while you are out. This will include changing equipment,
and blankets, pram covers, or parasols to protect your baby from different weather conditions The time
of year will also affect how long you stay out.
Can he sleep for long in his car seat?
There are no laws to state how long a baby should remain in a car seat, but bear in mind that being
fixed in one position for long periods of time would be uncomfortable for anyone, regardless of age
Generally, it is not recommended that babies are left for a long period of time in car seats because if
they fall asleep curled up in this position it may affect their breathing, and can encourage wind to
get trapped causing discomfort You should also take care when carrying your baby around in a car seat
as they tend to be heavy and you are more prone to back injuries in the postnatal period.
My wife won’t let me do a thing but I want to get better at it. How can I help?
Some women do feel that it is their responsibility to care for the baby, but it is well documented that
a couple’s relationship is strengthened when the care is shared This involves joint decision-making and
making choices regarding care together Babies can pick up on positive and negative feelings expressed
by their parents, and it is important for all concerned that both the mother and the father bond with
the child. Offer to perform routine tasks in front of her to instil her confidence in your ability.
This may take time, but the reward is worth it. She will also benefit from being able to take breaks,
confident in the knowledge that you can cope as well as she can.
My friend’s baby had colic and she had a miserable few months with it. Will my baby get it?
The term “colic refers to when babies cry continually for around three hours each day and cannot be
soothed (see p,274) Although obviously
distressing for the baby, it is equally upsetting for the parents to listen to their baby crying so
painfully for so long. As no-one knows exactly why colic occurs, it is impossible to say whether or not
your baby will suffer with it. However. there are several theories as to what causes colic One is that
the baby’s intestines are immature and working too hard, causing a cramp. Another is that the bowel
movements are too slow and the air in the bowel is trapped. Another theory is that the baby is eating
too much, too fast, and has air trapped None of these is proven and all we know is that colic occurs in
around 10-15 per cent of babies
My baby cries continually. I’m not having much success with breastfeeding - is he hungry?
Newborn babies cry on average for two and a half hours each day Crying is your baby’s only means of
communication and so he cries to get you to respond to his needs, whether he is hungry, wet, or just
wants a cuddle Some babies cry more and may struggle when you try to comfort them, which can make you
anxious If you are anxious about breastfeeding, your baby may sense this and begin to cry Sometimes, it
is necessary to take a step back and try to relax. Having a warm bath with your baby skin-to-skin,
sometimes called ”rebirthing’ , can help to calm you both and may help you to relax more while
feeding. Once warm and calm, your baby may try to get into a good position to feed Ensure he latches on
well and does not cause pain after the first few sucks (see p 228). Allowing your baby to feed as and
when he wants is also important As your baby gets older, the regularity of feeds will settle and
feeding will change
Other reasons why babies cry include being overstimulated (try rebirthing); being uncomfortable (try
winding) ; being wet or dirty (change his Happy) being cold or hot (change the clothing and room
temperature); wanting comfort (try swaddling); or boredom (talk to your baby. sing, and play with him)
My midwife says that our baby comfort sucks. I’m reluctant to introduce a dummy - should we?
If a baby has latched on well at the breast and has sucked and swallowed well during a long feed, and
then settles on the breast taking small sucks and not swallowing, he is comfort sucking. Many babies
like to comfort suck, not just breastfed ones If your baby falls asleep. you may be able to gently ease
him off the breast, or if you are comfortable, leave him there.
Your baby may comfort suck for many reasons He may be stimulating the breast to increase your milk
supply; he may be ”cluster” feeding and is dozing before the next feed; or he may want to snuggle
close. Comfort sucking is thought to steady the baby’s heart rate, relax his stomach, and help him to
settle.
Introducing a dummy is your choice. Some parents think they are the best way to get a baby to sleep,
day or night; others think they should be used only at night and some believe they should not be used
at all The Foundation for Sudden Infant Death (FSID) suggested in June 2007 that using a dummy can
reduce the risk of cot death, but that breastfed babies should not be given one until over a month old
and feeding is
established This advice is based on studies suggesting a lower incidence of cot death in babies given a
dummy.
If your baby likes to suck, you can also offer him a clean finger to suck on; later on, some babies
comfort themselves by sucking on their own thumb or finger
What does swaddling mean?
Swaddling is an old practice of wrapping a baby snugly in cloths or blankets so that movement of the
limbs is restricted. Many midwives swaddle infants soon after birth and it is now a standard newborn
care
practice in many hospitals Research has found that swaddling may help newborns to sleep as it prevents
the “morn ‘, or startle reflex - the tendency for newborns to startle themselves by moving their arms
suddenly.

CHANGING YOUR BABY’S CLOTHES:
Dressing and undressing
Your baby is likely to wear vests and sleepsuits, or babygrows Choose vests with envelope necks that
are easy to get on and off and opt for sleepsuits with front-opening poppers
* Lie your baby down. Put the vest on by holding the neck opening wide and gathering the rest of the
vest. Gently lift the back of his head and ease the back of the vest behind his head Lift the front
over the head, avoiding his face. Gently lift the sleeve down over the hand and arm, stretching the
vest rather than pulling your baby’s arm. * Lay the sleepsuit out with the poppers undone Place your
baby on top, then gently insert his legs, then his arms into the suit and do up the poppers.

Losing a baby
What is a stillbirth?
A stillbirth is when a baby dies in the uterus after 24 weeks’ gestation before it is born. Losing a
baby is very different to other losses which may be partly due to the fact that we do not expect to
lose babies in this day and age of technology and healthcare advancements The cruel contrast between
birth and death occurring at the same time and having no physical live memories of this person that you
have bonded with during the pregnancy and looked forward so much to meeting is very difficult to
comprehend. Parents often search for answers to questions that may be unexplainable, and this can often
delay the whole grieving process. The important thing for couples who experience such a loss is to try
not to dwell on the ifs, buts, and maybes and remember it was not their fault.
How likely is a baby to die in labour or shortly after birth?
The death of a baby during labour is known as interpartum death; this is usually caused by a lack of
oxygen during labour, possibly due to a problem with the placenta, or an injury to the baby during
labour and birth. However, this is extremely rare today thanks to improvements in monitoring the mother
and baby during labour and dealing with signs of distress. When a baby dies in the first four weeks of
life, this is known as neonatal death, which affects around 3 out of 1000 babies. Neonatal deaths
usually occur in babies who are very premature who may have breathing difficulties, or in babies who
have severe chromosomal or genetic abnormalities Infection used to be a more significant cause of
neonatal death, but this is now rare. For couples who lose a baby in these circumstances, it’s
important to accept that it was extremely unlikely to be related to anything they did or didn’t do.
I feel like there is a big empty hole where my baby was. I’m devastated - will I get over this?
Losing a baby is extremely difficult and overwhelming. Some people say that time is a good healer, but
others find it hard to make sense of it all If you have been given a possible cause as to why your baby
died, this may help you to understand that it was not your fault and to be able, in time to move on.
Keep hold of any precious memories or keepsakes you may have been given at the hospital such as a
photograph or a lock of hair, and seek support from your loved ones and counsellors, if necessary The
Stillbirth and Neonatal Death Society (SANDS) (see p 310) can offer you support and put you in touch
with other families who are in a similar position You may find that sharing your thoughts and feelings
with people who have been through the same tragedy helps you to process your grief and, over time to
move forwards, although of course the sadness will never leave you.
I’m so busy being a shoulder for her to cry on, but I don’t know how to cope myself.
Often the effects of the loss of a baby on the father are not considered. This may be because
of outdated notions about the way men react to grief, in particular by not letting their emotions show.
It is also common for men to feel that they have to be the stronger party and to feel that it is not
masculine to express their feelings openly, Fathers often throw themselves back into their work to take
their mind off things, or distract themselves with other activities and pursuits. It’s important that
you recognize that this is a difficult time for both of you and that you
may not be able to support each other by yourselves, particularly if you are grieving in different
ways. You may need to consider counselling and approaching support groups, such as SANDS, as well as
friends and family
I want to find out more about why my baby died-how could I go about this?
Seeking answers to your questions may be a positive part of the grieving process and can help you begin
to move forward During the delivery of your baby and shortly afterwards, you may have consented to
having certain tests performed These may have included blood tests, swabs, an analysis of the placenta,
and a postmortem of your baby Once the results of these have been gathered, along with your case notes,
the consultant will usually make an appointment for you to come in and discuss the results and any
possible explanations as to why this may have happened. It is often the case that there are no obvious
reasons as to why this tragedy has occurred. This can be both frustrating and upsetting and you may
feel that counselling or a support group may be able to help you.
The hospital won’t admit they made mistakes when our baby died - where can we get help?
You are likely to be experiencing great emotional turmoil and it is extremely important that you seek
as much information as you can before you take matters further. I would suggest that first you write to
the Head of Midwifery and request a meeting as this may answer some or all of your questions.
If you are still not satisfied, very occasionally, parents may feel that they need to seek legal advice
if they think that negligence was the cause of their baby’s death. If you feel this is the case, then
you could talk to the Citizens’ Advice Bureau or find a solicitor to discuss your case with. Some
solicitors and the Citizens’ Advice Bureau offer a half-hour appointment to discuss the situation and
advise whether they think your case is worth pursuing before you make a commitment in terms of time and
money. If you do decide to take a case forward, you should be aware that the procedure can be
frustrating, stressful, and upsetting. As before, you may also benefit from some counselling or by
talking to the support group SANDS.
I never held my baby after she was stillborn. I couldn’t face it and now I regret it. What can I do?
Losing your baby is a devastating experience and the grieving process can be made more difficult by the
fact that you did not get to know your baby and have no memories of her to hold on to. Seeing and
holding your baby after the birth and taking photos can help in the grieving process as it enables you
to give your baby an identity and to visualize her, and medical staff often encourage couples to spend
time with their baby to enable them to say goodbye.
However, at the time of losing a baby, there are many things that you have to deal with physically and
emotionally and making decisions while you are in a state of shock and grieving is a very difficult
thing to do Try to understand this and accept that you felt unable to hold your baby after the birth,
and instead think of other ways to remember and cherish her You may have been given a keepsake, such as
a photograph, a hand- or footprint, or a lock of hair to remind you of your baby, but if this wasn’t
possible, you could make a special box of toys clothes that you had bought for your baby, and scan
pictures in memory of her. You may also like to plant a tree or a shrub in honour of your baby or
create a special
Losing a twin
Losing one twin, or triplet, is extremely hard and can be a very bitter-sweet experience. Parents who
lose one twin are likely to have many conflicting emotions as they are faced with the prospect of
grieving for their lost baby, while welcoming the surviving twin into the world. Some may find that
they are unable to do both at once, and so the grieving process is put on hold in order to care for the
other baby This can lead to feelings of guilt and anxiety and can cause a great deal of stress. Parents
may also be made to feel that the dead twin is compensated for by the surviving one and therefore may
feel that they cannot express the devastation they feel at losing a baby It is therefore extremely
important that parents who lose a twin or triplet seek help and advice if they feel they are unable to
cope with their grief, or need support caring for the surviving baby
place to visit to remember her Sometimes, writing down your thoughts and feelings in a diary can be a
personal tribute to your baby and can help you to deal with your grief
I feel so angry; I can’t even cry. It’s affecting my relationship with my wife - is this part of grief?
Yes, this is a very normal part of the grieving process. which is a natural phenomenon that helps us
move forwards and can include sorrow, guilt, anger, blame and depression. It is very common for men to
show their emotions in different ways to women, often feeling it is not ”masculine” to cry and that
they have to be the stronger of the two. You will both be grieving in different ways and will enter and
leave some or all of the stages of grief at different times, and the whole experience is likely to put
a great strain on your relationship as your different emotional responses can lead to misunderstanding
and resentment. You may find it helpful for both of you to see a counsellor as an independent trained
person may be able to offer you the additional support that you need. You may also need some specific
help to help you to deal with your anger, and an anger management course may be suggested
How long should we wait before we try for another baby?
Following the tragic loss of a baby there is no set time when a couple should try for another baby This
will largely depend on when you both feel mentally ready What stage your pregnancy loss occurred and
how you delivered your baby may also affect how ready you are to consider trying again; often, a loss
in the later stages of pregnancy can take longer to recover from From a physical point of view, it is
usually better to give your body six weeks to return to its normal state. If you had a Caesarean
section, it is recommended that you wait for a year for your scar to heal before getting pregnant again
Counselling and support can help you decide when you are psychologically ready to try again Your doctor
or midwife can refer you for this.

Helping and consoling
The death of a baby in pregnancy or, more rarely, in labour or shortly after the birth, is a
devastating loss and couples who experience this will have to cope with feelings of shock, confusion.
anger, guilt, sadness, and regret. It will take time to work through all of these emotions and it’s important
that you allow yourself this time to grieve and don’t feel under pressure from others to ”move on”
before you feel ready Both of you may benefit from a period away from work For the mother, this allows
time for her body to recover from the pregnancy and birth: and for both partners, this time may be
needed to recover from the initial debilitating shock of losing their baby.
How can we help each other? Although you may feel that you don’t have the resources to help anyone else you and your partner can help each other by recognizing that you may be dealing with your loss in
different ways. You may not be at the same stage of the grieving process as each other and may also
display your emotions differently Understanding this can help to avoid feelings of resentment building
up between you. The best way to appreciate how you both feel is to keep the channels of communication
open. Although grief can be an intensely private experience and it is easy to withdraw from others,
talking about your shared loss can help to ensure that your relationship remains supportive.
Will friends and family help? Although having the support of family and friends is important at this
difficult time, you will probably find that there area variety of responses to your grief. You may find
that close family and friends are unable to offer the level of support you need as they are possibly
grieving your loss too. On the other hand, you may find that when you talk to others, they reveal their
own tales of grief and suffering and are able to empathize with your loss Sometimes people are unsure
about how to respond to your loss; they may feel embarrassed and at a loss for words of comfort, or
fear that they will upset you if they talk about what has happened, and sometimes may even avoid
interacting with, or seeing, you Unfortunately, this can leave you feeling more isolated and lacking in
support, and emphasizes the importance of finding someone you can talk to, such as a professional grief
counsellor who deals with miscarriage and stillbirth, who can help you to channel your grief, There are
also plenty of support groups where you can share your experience with other bereaved parents.

Coping
death of a baby
The death of a baby is one of the most devastating experiences. Although you will never forget your
loss, there are ways to help you cope.
* The most important thing is to talk about what has happened, whether to your partner, family,
friends, counsellor, or supportive organization
* Recognize that you and your partner need time to work through your feelings and that you may not
always feel the same thing at the same time.
* Be prepared for some people’s inability to talk about what has happened.

How Soon Can I Go Home with My Baby? FAQ
I just want to go home
I hate the thought of being in hospital for long - how soon can I go home with my baby?
In most maternity units, there is a degree of flexibility as to how long you remain in hospital after
the birth If you wish to stay for as brief a period as possible, talk to your midwife about this. In
the past, postnatal stays tended to be longer - in 1997-98, the average stay in England was 2.2 days,
and was 5.5 days in 1981 Nowadays, the minimum length of time in hospital is about six hours and many
mothers just stay overnight to rest and gain some confidence. In some areas, you can move to a doctor’s
unit or birthing centre. To help make the transition home as smooth as possible plan your return,
making sure you have plenty of support in place.
How long you stay in hospital will largely depend on your type of delivery If you have a vaginal
delivery, you should be able to return home fairly soon, but a Caesarean may mean you need to stay in
for about three days Also, if your baby is born early, or is unwell, or struggling to feed or maintain
his temperature, then you will be advised to stay in hospital until your baby is ready When babies are
premature, mothers may have to leave them in the special care unit and visit regularly
Will I have any privacy in hospital? I don’t want to be on a ward.
There is usually an attempt to make maternity wards as cheerful as possible, although the reality is
they are often busy and lacking privacy. Your delivery room is likely to be a single room and may have
ensuite facilities. Postnatal ward facilities vary tremendously in different locations: there may be
single rooms, small rooms, or traditional Nightingale wards with a corridor of beds Each bed will have
curtains to pull around it for extra privacy, and bathroom facilities can vary.
Where will my baby sleep when we’re in the hospital?
Mothers and babies usually remain together for 24 hours a day You should only be separated from your
baby if there is a medical reason for this, for example your baby needs special care, and you should be
fully informed before agreeing to this. Your baby will usually sleep in a cot attached to the bed or
next to it This is recommended by the World Health Organization (WHO) and UNICEF who run a programme
called The Baby Friendly Initiative This works with healthcare systems to ensure a high standard of
care for mothers and babies, and many maternity units are guided by their advice.
My friend’s baby slept almost continuously for the first day or so. Is this normal?
The birth process is tiring for the baby as well as the mother and so it is not unusual for the first
24 hours to be fairly quiet, as your baby rests after the birth Babies are often very alert and ready
for a feed immediately after the birth, but then have a long sleep. Also, if you had drugs such as
pethidine or diamorphine, during labour: these can linger in the baby’s system and contribute to the
drowsiness. If your baby does sleep a lot at first, make the most of the opportunity to rest while
still offering regular feeds — your midwife will advise you. After the first 24 hours, you may still
find that your baby is feeding erratically, maybe every hour for five hours, and then having a
four-hour sleep. Rest assured there is no set pattern in the early days; your baby should feed when she
wants to and you shouldn’t expect any routine to emerge at this stage.
Will the hospital help me with the everyday care of my baby if I’m having problems?
While -you are in hospital there will be midwives and maternity support workers to help you They have
plenty of advice and information to offer so don’t be afraid to ask about anything that is worrying
you, such as specific questions about your baby, or any aspects of baby care (see below). However do
bear in mind that maternity units tend to be extremely
busy and this, coupled with the fact that presently there is a shortage of midwives nationwide, means
you may have to be patient and prepared to wait a while at times before someone is free to help you
Before you go home you will also be given contact numbers in case you need help or advice in between
your postnatal checks.
Once you are home, your community midwife and your health visitor will be available to offer advice and
support They will also be able to give you details of local mother and baby groups, and postnatal
drop-in clinics, all of which offer support and information for new mums and their families and give
you the chance to meet other mums.
Do we need a car seat straight away or can I hold my baby in the car?
If you intend to take your baby home in the car, it is a legal requirement for them to travel in a car
seat appropriate for their age. Indeed, it is illegal for children to travel in a car without a
correctly fitting and fitted car or booster seat until they are over
Getting advice in hospital
Although the arrival of your baby is a time of incredible excitement, it can also seem overwhelming and
you may feel daunted by the enormous task of looking after and meeting the needs of this tiny new baby.
One of the benefits of your stay in hospital, as well as recovering from the birth, is to help you feel
confident in the care of your baby, There are several aspects of baby care and feeding that the
hospital midwives can help with.
* Staff can help you to establish breastfeeding by
guiding you on technique. Some hospitals have a    BATHING HELP: dedicated breastfeeding counsellor on
site.
* The midwives can help you with everyday care by
demonstrating topping and tailing, bathing techniques,
changing a nappy, and dressing and undressing.
Small babies and children need the protection that baby seats and child seats are designed to provide.
So, yes, you do need to get your car seat ready before the birth to take your baby home from the
hospital.
I’m going to be on my own when I go home and I’m worried I won’t manage.
It’s only natural to feel anxious about your new responsibilities when you arrive home with your baby
Being a single parent is increasingly common so don’t be afraid to ask for help. Your midwife and
health visitor will visit you to help with any baby-care problems and you will be given contact
telephone numbers before your discharge from hospital in case you experience problems or need advice in
between postnatal visits and checks
When you are on your own, it’s a good idea to arrange for a group of reliable friends or family members
who are willing to assist you with babysitting, morale boosting, and provide general all-round back-up
in the early days. Over time you
can establish a network of other single parents in your area with whom you can share your problems and
solutions. Also, ask your midwife or health visitor for contact details of local postnatal groups and
organizations that support single parents.
My mum is coming to stay with me but I don’t want her to take over. How should I approach this?
Overbearing mothers and mothers-in-law can be a problem, however well-intentioned they are. You will
find it’s not just mothers who insist on issuing lots of advice and information, but friends and other
relatives can be just as vocal Although this advice is often useful, some of it may be old-fashioned or
simply conflict with -your own ideas on how to care for your baby
Even though -you may be feeling vulnerable after the birth, practise being clear and assertive about
the way in which you want to do things and make sure that people understand and respect your views and
that your partner supports you in this too. It may help to pass on leaflets or books that you have read
so your mother can see how things have changed since she brought up her children, and what advice you
are following. You could suggest other ways in which she could help, such as shopping, cooking, and
cleaning, so that you are left with the care of your baby Most mums just want to help in some way, so
it’s up to you to channel her enthusiasm
Will I get any sleep at all in the early days?
You will get sleep but whether it is of the same quantity and quality that you are used to is
questionable. Although young babies need a lot more sleep than adults, approximately 16 hours each day,
they do not take all of this sleep in one long stretch as they need to wake up for frequent small feeds
Up to the age of three months, babies have ‘’sleep—wake” cycles throughout the day with longer spells
of sleep at night
The length of these cycles varies from baby to
baby, but on average your baby will sleep about two hours at a time in the day, and four to six hours
at night. All babies wake up a number of times throughout the night. The length of time your baby
sleeps for during the night may also be affected by how she is fed. Several studies suggest that
breastfed babies take longer than formula-fed babies to develop a pattern of sleeping through the
night. This is because breast milk is easier to digest than formula milk, so babies get hungry more
quickly and wake more often in the night Most babies are physically capable of sleeping through the
night from the age of six months.
Should my baby be in her own room or in with us and, if so, for how long?
In the early days, when your baby is fed frequently, often every two to three hours, you may find it
more convenient to have her closer to you. UNICEF recommends that babies share their mother’s room for
the first six months of life as this helps to sustain breastfeeding and is also thought to help protect
babies against cot death (see p.276).
As -your baby grows and develops, her needs and sleeping patterns will change One of the main changes
is that your baby will start to sleep longer between feeds at night and often this is the stage that
many parents decide is a good time to move their baby into their own room. You may also find that, if
your baby is a light sleeper, she may sleep better in her own room as she is less likely to be
disturbed by you and your partner
I’m a really deep sleeper and I’m worried that I won’t hear my baby crying. Is this likely?
This is a common worry for many new parents,
but you should rest assured that it is highly unlikely you will sleep through your baby crying Many new
parents find that they do not sleep as deeply following the birth of their baby, which may be partly an
unconscious worry about sleeping too deeply and not attending to their baby’s needs Having your baby
sleep in the same room as you to begin with and using a baby monitor later if your baby moves into her
own room will help you to feel confident about hearing your baby at night It’s a good idea to try to
catch up on some sleep during the day-time and take a nap while your baby is sleeping, as this will
mean that you are not totally exhausted when you go to bed at night. You should also learn to trust the
greatest prompt of all, your natural inbuilt maternal instincts!
Who can I turn to if I have problems with breastfeeding?
Although breastfeeding comes naturally to some mums, for many others it can prove surprisingly
difficult. Initially you will have midwives and maternity care assistants on hand in the hospital to
assist you with breastfeeding. Once you return home, your community midwife and health visitor can
continue to advise you, but obviously they will not be available 24 hours a day If you continue to have
problems with breastfeeding, there are many helplines and local support groups available for which your
hospital, doctor’s surgery, and health centre should have contact details. Also, there are plenty of
Internet sites that have forums, which are useful for discussing problems and comparing experiences.
Some midwives and health visitors run local drop-in breastfeeding sessions, and some breastfeeding
groups meet informally in cafes, so enquire whether there are any of these groups locally The National
Childbirth Trust (NCT) (see p 310) also has a national network of trained breastfeeding counsellors and
a helpline for you to call.

Leaving hospital

Each hospital varies, but generally, before being discharged from the hospital, several checks take
place. *You will be examined by a midwife or doctor to check that your uterus is starting to return to
its pre-pregnancy size.
* If you had stitches, these will be checked to see if they are healing properly.
*Your baby will undergo various newborn checks (see p.220) and will need to be signed off by a
paediatrician.
* If you need to take any medication home, this will be dispensed and you will be told how to arrange
your postnatal check.

First days at home
Regardless of whether or not this is your first baby, on your return home you are likely to be both
physically and mentally exhausted. If this is your first baby, although the transition to motherhood is
exciting, it can be daunting and, once home, you may be surprised at how big an adjustment this is.
While some families want to share their joy with family and friends as soon as possible, others decide
to have some quiet time together at first to get to know the new arrival and get used to their new
roles Try to put worries about housework and clearing up to the back of your mind – these will keep
Hormonal changes may mean that you feel quite low and weepy about three days after the birth, known as
the ”baby blues” (see p.281). Getting as much rest as possible will help you to recuperate and begin
to feel normal once more.
I don’t want to go home too soon - can I stay in hospital if I want to?
When you leave hospital is something that you will agree with the hospital midwives and doctors, and it
will be dependent on your particular needs and circumstances. Although you obviously can’t remain in
hospital indefinitely, generally you won’t be transferred home until you feel ready to return The
midwife will ensure that you are confident feeding -your baby, whether this be breastfeeding or
bottlefeeding and that you are confident providing everyday care for your baby, which is good
preparation for returning home.
When you go home, your care will be transferred back to the community midwife, so you will continue to
receive support, information, and advice as necessary Also, planning in advance support for when you
return home may help you to feel more confident about leaving the hospital As well as support from your
partner, try to enlist the help of family, friends, and close neighbours to help you cope in the first
few weeks after the birth.

BEING TOGETHER:
We had so many visitors in hospital last time it was exhausting. Can I stop this?
Many people seem to believe that if you are in hospital then they can visit whenever they want to,
whereas most people, even close family. wouldn’t just turn up on your doorstep unannounced if you were
at home with your baby If you know in advance how you will feel then you really need to be assertive
this time and let people know your wishes It is possible to do this in a diplomatic way without
offending people by simply telling friends and maybe family too that you would prefer to have some
quiet time with your partner and children during the first few days to recuperate and get to know your
new baby. Most people will understand this sentiment and will be more than happy to wait for a few days
until you are feeling ready to see them.
If you are discharged fairly early from hospital
it may be easier to control the flow of visitors as you will be able to dictate visiting on your own
terms. You can then take the time that you need to settle down to a new family life.

I don’t want to breastfeed
bottlefeeding your baby
I don’t want to breastfeed - can you tell me what to do?
If you do not want to breastfeed, you can either bottlefeed your baby expressed breast milk or formula milk. There are many women who do not breastfeed because they receive a lack of support and find that the advice available is insufficient. However, having a go at breastfeeding, even if this is just for one week, will benefit your baby.
If you have chosen to bottlefeed you will need to decide on a few things. First, you need to work out which type of formula you want to use. Take some time to look at the many brands on the market and opt for one that you feel will be right for your baby Ask your midwife or health visitor for advice if you are not sure You will also need to purchase bottles, teats, and a sterilizing unit. This can be confusing as there are lots to choose from, so you will need to take some time to find out about the available options and which unit will work best for you (see p.239)
Bottlefeeding sounds so complicated. Are there “dos” and “don’ts” to remember?
Yes, it is important to bottlefeed safely. The NHS provides guidelines for safe bottlefeeding
* Always make sure you use a sterilized bottle. cap, and teat for each feed
* Ideally, make up one feed at a time and discard any leftover milk at the end of a feed.
* Use boiled tepid water that has been left to cool for up to half an hour before making up a feed.
Put the water into the bottle before the formula.
Don’t pack the formula into the scoop: instead, level it off gently with a knife.
* Warm the feed — not in a microwave, but in a bowl of hot water — and test the temperature before giving it to your baby
* Avoid swapping scoops from different makes of infant formula milk as different scoops may be different measurements.
I feel guilty for not breastfeeding - should I?
No! The main thing is to ensure that your baby receives the best possible care in life that you are able to provide. If it is not possible for you to breastfeed, then formal milk feeds are a safe option. However, you need to feel comfortable with your decision and not be swayed by others. You may want to look at the advantages and disadvantages of both breast- and bottlefeeding. That way you’ll be sure you’ve made the right decision for you and your baby without feeling guilty Once you have made an informed decision, communicate this confidently to family, friends, and your healthcare provider.
Is formula milk as good as breast milk?
Breast milk is universally considered the ideal nutrition for your baby, and the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life as it provides all the nutrients a baby needs However,

Bottles and teats
Getting ready to bottlefeed your baby
There area variety of bottles and teats available in different styles.
You will need between four and six bottles and teats As well as larger bottles measuring 250ml (8fl oz), you may also want a couple of smaller bottles of 125 ml (4fl oz). Teats come with different sized holes to make the flow of milk faster or slower to suit your baby’s needs. Some teats are therefore recommended for newborns and some for hungrier older babies,
there area variety of high-quality, nutritional baby formula milks available that scientists and medical experts have spent years developing. Most infant formula milks are derived from cow’s milk, but are modified to resemble breast milk as closely as possible. If you feel confused, discuss the different brands with your midwife or health visitor.
What exactly is in formula milk and how similar is this to breast milk?
If you read the labels on different brands of formula, there are not many variances. The Infant and Dietetic Association website (see p 310) provides a table comparing the contents of the five main brands
available in the UK. Baby milk must provide energy, fat, protein, carbohydrate, vitamins, minerals, and trace elements, and the quantity of each nutrient is specified by law. The proportions of energy supplied by protein, fat, and carbohydrate in infant formulas are similar to those in mature breast milk
* The fat content. In infant formulas this is based on blends of dairy or vegetable fats that are chosen partly depending on their levels of unsaturated fat. Omega 3 fats may be added as these are vital nutrients for growing brains and bodies Formula milk does not have the fat-digesting enzyme, lipase, which accounts for the unpleasant-smelling stools of formula-fed babies.
* The protein source. In formula milk, this is either cow’s milk, in the form of casein or whey, or soya (see p,240) The amino acid content of formula is equivalent to that of breast milk to meet the needs of the rapidly growing baby.
* Lactose. This may be included in formula; mature breast milk contains about 7 per cent carbohydrate in the form of lactose, which is thought to be important for brain development.
* Vitamins, minerals, and trace elements. These are added to formulas to meet the nutritional needs of the baby and to comply with legal requirements. * Iron. This is vital to your baby’s wellbeing, being essential for healthy blood, growth, and development, and this is added to formula brands.
* Other components. Infant formula may contain other components that are found naturally in breast milk, such as long-chain polyunsaturated fatty acids (for brain and membrane development), oligosaccharides (to aid digestion and immunity), or nucleotides (to promote healthy growth and development and to help the immune system).
There are some components of breast milk that cannot be replicated in formulas For example, breast milk contains important antibodies that help protect babies against infection and illness and these are not present in formula milk. However, prebiotics, which are nutrients found in breast milk that strengthen a baby’s natural immune system, may be added to some brands of formula

How to bottlefeed
Preparing and giving feeds
Bottlefeeding, using formula or expressed breast milk, can seem daunting at first, but becomes easier once you get into a routine.
How do I start?You will need at least 4-6 bottles and teats, with at least one or two sterilized and ready. You can sterilize by steaming, microwaving, boiling, or using a sterilizing liquid. Your choice will depend on the cost and what you find easiest. Before sterilizing, rinse a bottle first with warm soapy water using a bottle brush, taking care to clean the top of the bottle and inside the teat.
How do I make up a feed? Wash your hands and make up a feed according to the instructions. Put the correct amount of tepid boiled tap water
into the sterilized bottle first and then add the right number of level scoops of powder, Never add extra powder as this could make your baby ill. Don’t put a half finished feed back in the fridge - throw it away and use a fresh bottle next time
How do I give the feed? Test that the milk is not too hot by putting some on the inside of your wrist (never use a microwave to warm up milk) Find a comfortable position and always hold your baby’s head slightly higher than his body. Put the teat gently into his mouth and slowly tip the bottle so that only milk, not air, gets into the teat You can wind your baby - gently pat or rub your baby’s back - halfway through the feed, or wait until the end. Throw away any milk that is left over.

KEEPING BOTTLES CLEAN:

Sterilizing equipment
Before using new bottles and teats, and each time you use them, wash and sterilize them. Wash them in warm, soapy water with a bottle brush, and rinse thoroughly. Sterilizing methods include: * Electric steam sterilizing, which takes about 10 minutes, plus the time it takes for equipment to cool
* Microwave steamers, which take around 5 minutes. The equipment remains sterile for up to 3 hours if the lid is left on. * Equipment can be sterilized by boiling, which takes around 10 minutes. The pan must not be used for another purpose and you may find that teats wear out more quickly
* Cold water sterilizing tablets can be used either in a special sterilizer, or in a suitable clean container with a lid. This takes around 30 minutes and the equipment can be left in the solution for up to 24 hours; the solution needs to be changed each day. * Dishwashers need to be set on a high temperature and some parents prefer to wait until after a year before using these.
Is it OK to combine breast-and bottlefeeding?
Yes, it is possible to combine breastfeeding with bottles of expressed breast milk or formula, and many women choose to do this rather than stop breastfeeding altogether.You may also decide to do this if you are returning to work.
Feeding from a bottle uses a different technique to feeding from the breast, and your baby may take a little time to get used to it, which can make it quite a struggle to introduce bottles It may help to warm the teat and to get someone else to offer the bottle the first time, as your baby may be able to smell your milk if you hold him and will be likely to want to be breastfed instead Holding him in a different position, such as propped up against your front and facing away from you, may also help
Before deciding to introduce the bottle, it’s worth considering that breastfeeding does get easier and that there is a lot of extra work involved with bottlefeeding in terms of preparing feeds. Also, as your breast milk is produced on a supply and demand basis, introducing bottles for some feeds
will affect your milk production. If you do want to combine the two, talk to your health visitor or a breastfeeding counsellor about how to manage this so that you can maintain breastfeeding
Will people treat me like a failure if I can’t breastfeed and have to use formula?
Many mothers do feel pressure from friends and family to breastfeed their newborns It is unlikely that you will be treated as a failure, as Western society is very accepting of bottlefeeding and, on the contrary, it is a continual effort to try to promote breastfeeding in our society. In November 2007, the Department of Health actually banned baby milk manufacturers from advertising infant formula for children under six months old on television and in parenting magazines.
Guidelines aside, although breastfeeding is a wonderful experience, it can sometimes be very hard work to establish If you find that you are struggling to establish breastfeeding, it’s worth seeking help from your midwife, health visitor, or breastfeeding counsellor before giving up
completely. However, if you find you simply cannot breastfeed, or you choose not to, you should try not to feel guilty as formula-fed babies grow and develop perfectly well. This is your baby and you will have your baby’s best interests foremost whatever action you decide to take.
Which formula milk should I buy?
There area number of brands that have a very similar nutritional content and you may need to chat to your local midwife or health visitor, or even family and friends with little ones, when trying to decide which one to use. Sometimes, babies are born prematurely and may need a special formula, or occasionally may react to a particular brand. If your baby was born full-term and is healthy, it is usually down to personal preference.
Manufacturers modify cow’s milk to make formula for human babies by adjusting carbohydrate, protein, and fat levels, and adding vitamins and minerals. There are two main types of formula milk, which have different ratios of the two proteins in milk: whey and casein. Those that are suitable for babies from birth contain more whey than casein The ratio of whey to casein in these milks is similar to that of breast milk, so it is thought to be easier for new babies to digest Milks that are marketed for the ”hungrier” baby (known as ”follow-on” milk) are casein-dominant and take longer to digest.
Why do some people use soya-based formula and is it safe?
Soya-based formula is made from soya beans, which are modified for use in formula with vitamins, minerals, and nutrients. Some parents consider giving a soya-based formula if their baby has an intolerance or sensitivity to cow’s milk formula. Soya infant formulas are nutritionally similar to cow’s milk-based formulas. The protein used in soya formulas is an extract of the soya bean, which has a high protein content. However, the UK government recommends that you should always seek the advice of a health professional before giving soya-based formula to
your baby. The current Department of Health advice is that soya formula milk should not be given automatically to babies with a sensitivity to cow’s milk, as there are other types of formula that are suitable for most babies with an allergy or intolerance that may be more favourable than soya. So if you are considering soya milk, make sure you seek medical advice first.
The carbohydrates used in soya milk contain glucose syrup, which may damage your baby’s teeth over a period of time, so if you are using soya formula, make sure you take your baby to the dentist once his teeth come through and tell the dentist that your baby has a soya formula. The Food Standards Agency also highlights concerns that soya-based formula could affect reproductive health. This is because soya contains phytoestrogens, substances found naturally in some plants, which may mimic cr block the action of the hormone oestrogen As this is a potentially sensitive time in a baby’s development, it is not clear whether soya-based infant formula could affect a baby’s reproductive development.
How should I hold my baby when I’m giving him the bottle?
Bottlefeeding can be a wonderful time for bonding with your baby by holding him close. Find a position that both you and your baby like — think about whether you are right- or left-handed and the age and size of your baby. You can cradle your baby or simply sit your baby on your lap. You will help reduce wind by giving your baby his bottle in as upright a position as possible. Also take care to tilt the bottle so that the teat and neck are always filled with formula and never leave your baby to feed unattended by propping the bottle up. Ask your midwife or health visitor for further advice
How long do you need to sterilize bottles for?
The recommendation is that you sterilize bottles and teats for at least the first year of your baby’s life. It is during this time that they are most vulnerable to germs and viruses, which if contracted could cause illness and possibly dehydration.
Can I make up feeds in advance?
Ideally, you should make up each feed fresh. The Department of Health and Food Standards Agency’s recommendations on the preparation and storage of formula milk advise that the risks associated with using powdered infant formula milk are reduced if each feed is made up fresh, as the longer the formula is stored, the greater the risk of bacterial growth. They do acknowledge that there are times when this is not practical, for example if you are going to leave the house for an extended period, or if you are dropping off a baby at a childminder’s or nursery. In this case, you should prepare the feeds in separate bottles as instructed and then store them in the fridge (see below). This is a departure from previous information so can seem unusual to mothers who have previously bottlefed Discuss this with your midwife and health visitor
How long can pre-made feeds stay in the fridge?
Although it is not recommended that you make up bottles of infant formula milk in advance to store in the fridge because of the risk of bacteria developing, if you need to do this, store them in the back of the fridge, not the door, to ensure they are below 5°C (4 PF) and never store feeds for longer than 24 hours (although this is considered too long for young babies). Formula milk is not suitable for freezing.
Taking a break
Is it safe to warm a bottle and take it out to use later on?
Carrying warm formula milk in an insulated carrier is not safe, as warm milk is a good breeding ground for bacteria The safer option is to make a feed up fresh for your baby just before it is required If you are out, you can carry boiled water in an insulated container ready to mix with formula powder when you need it Ready made-up milk feeds that come in little cartons are a more expensive option, but are handy for instantly decanting into a sterilized feeding bottle. If your baby is reluctant to take milk at room temperature, you could use a travel bottle-warmer, which can also be used to heat up containers and jars of baby food
What precautions should I take making feeds with bottled water when I’m travelling?
When using bottled water to make up a feed, make sure the seal is still intact. Use still, not sparlding, water, and avoid water with high concentrations of the minerals sodium, nitrate, or flouride. Boil the
One of the major plus points of bottlefeeding is that anyone can feed your baby, allowing you to have some time off and rest.
* Getting your partner involved in feeding is a great way to help him bond with and feel close to your baby
* Sharing feeds gives you a break and you can take it in turns to do night feeds
* If you are switching from breast- to bottlefeeding, it may be easier to get someone else to give your baby the bottle, as your baby may reject the bottle from you wanting to be breastfed instead water in a kettle in exactly the way you would boil tap water at home and wash and sterilize your feeding equipment as usual Large bottles of mineral water should be stored in a fridge after opening For convenience, you may prefer to use smaller bottles of mineral water if you are travelling from place to place. For extra convenience, ready-to-feed milks are available in cartons so you do not have to carry bulky tins of powdered milk with you. Although more expensive, these cut down on the amount of work you have to do and mean that you can be sure of good hygiene in the absence of adequate facilities
I’ve heard that bottlefed babies have smellier poo - is this true?
This does seem to be the case Bottlefed babies may have one bowel movement a day or only have a bowel movement once every three or four days.
Avoiding tummy upsets
Small babies are more susceptible to gastrointestinal infections so it’s important to observe strict hygiene while bottlefeeding. One of the most important aspects while bottlefeeding is to ensure that all the equipment involved in the bottlefeeding process is sterilized properly and spotlessly clean with no trace of old milk. This means sterilizing the bottles, teats, and lids (see p.239). If your baby doesn’t complete a feed, don’t be tempted to give it to him later to finish as germs that are present in the baby’s mouth may have transferred to the bottle and can then breed in the milk When you are travelling or out for the day, you need to take care transporting feeds Ready-made formula is probably the safest way to feed your baby while on the move, or adding formula to the water when you need it. Changes in water in different regions sometimes cause tummy upsets in bottlefed babies.
are normal. A bottlefed baby’s stools are pale brown smelly, and more formed than those of a breastfed baby. Some baby formula milks give a greenish tinge to the stool. It is thought that unabsorbed fat causes the unpleasant-smelling stools in formula-fed babies. Breast milk is better absorbed, which means the stools usually have less odour
Will my baby get more wind if he is bottlefed?
Wind refers to the air in your baby’s tummy. It is swallowed along with milk during feeds, but also when he cries. It will fill his tummy before he has drunk enough milk and be uncomfortable Also the faster flow of milk from a bottle can make babies take in more gulps of air. Some babies suffer with wind and need burping after every feed Breastfed babies tend to get fewer problems with wind than bottlefed ones as they control the flow of milk at the breast and so suck at a slower pace, swallowing less air with the milk They also have smaller and more frequent feeds and may be fed in an upright position, both of which can reduce wind
Some babies have trouble bringing up wind and their discomfort is obvious You can reduce wind by feeding your baby in an upright position and tilting the bottle so that the teat is full of milk and not air. If your baby doesn’t burp after a couple of minutes, he probably doesn’t need to. Wind your baby by gently rubbing his back or placing him over your shoulder Some babies only seem to be able to get rid of wind through hiccuping. If the wind is severe, your health visitor or doctor may suggest medication.
Is it OK to give my baby water as well as milk?
Formula milk does tend to be less thirst-quenching than breast milk as the strength of formula doesn’t vary whereas breast milk varies in consistency, with the beginning of a feed tending to be more watery If your bottlefed baby still seems hungry after a feed, it could therefore be that he is thirsty and some cooled boiled water may help to placate him In hot weather he may need regular top-ups of water.

Breastfeeding your baby
why breast is best
Can I get breastfeeding advice before the birth and will I get help in hospital?
If you are planning to breastfeed, ask about specific breastfeeding support or sessions available in your area prior to the birth (see opposite), as having additional information beforehand is extremely useful and will help you in the first few weeks when you are trying to get breastfeeding established
You should get breastfeeding support while in hospital, both in the delivery suite and on the wards; this may come from a variety of sources, not just from the midwife Many maternity units have

Benefits of breastfeeding
Giving your baby the healthiest start in life
There are several unique advantages to breastfeeding, the main one being that breast milk arrives on demand as the perfect food for your baby. Other benefits of breast milk

include the following:
•    Breast milk protects babies from infection.
•    It reduces the risk of some diseases.
•    Breastfeeding is thought to increase a child’s IQ later in life.
* It can reduce the risk of allergies. It has also been reported that babies who are formula-fed are more likely to have breathing problems such as asthma, and gastric problems
such as colic. Constipation is also more common among formula-fed babies, and hence there are more hospital admissions from bottlefed babies.
* There are greater benefits for the mother if she breastfeeds, such as increased weight loss.
maternity support workers who offer support with breastfeeding. Other units encourage local voluntary breastfeeding support workers to come into hospital to offer women guidance
while they are staying in hospital and then afterwards at home. Some babies will breastfeed well without problems, while others take a little while to learn, so ask for help and
assistance as and when you need it. There are a few tips to remember to help you make a good start: * Skin-to-skin contact at birth is recommended to encourage milk production.
* Good positioning and attachment at the breast is very important Hold your baby close to you and facing your breast, with her head, shoulders, and body in a straight line (see
p.225-229), and make sure that her nose or her top lip is opposite your nipple, so she is able to latch on easily
* Ensure your baby can reach the breast easily, without having to stretch or twist
* Always move your baby towards the breast rather than your breast towards the baby
* Feed your baby on demand, allowing her to feed as often as needed for as long as she wishes * Avoid supplements of water or formula milk unless there is a medical reason for
this that has been fully explained to you.
* Avoid giving your baby bottles or dummies while you are establishing feeding as this can create nipple confusion” as nipples and teats require different sucking techniques.
* Try to relax and enjoy your baby’s feeds
Should I put my baby to the breast as soon as she is handed to me after the birth?
Holding your baby close to you as soon as possible after the birth is recommended, partly to encourage breastfeeding and skin-to-skin contact.

Thinking ahead being practically and emotionally prepared
It’s wise to think about how to prepare for breastfeeding before the birth. * Address your perceptions about breastfeeding and those of your partner and family, and deal with
negative stories This is because some of the problems associated with breastfeeding include embarrassment and a lack of confidence in your ability to produce enough milk.
* Purchase nursing bras and try to attend your antenatal classes, where breastfeeding will be discussed. The National Childbirth Trust (NCT) and La Leche League (LLL) also run
classes on breastfeeding (see p 3 10).
that your baby is close to the breast. Your baby may root for the nipple and some babies will latch on instinctively, while others may just sniff and lick the nipple. Don’t be
worried if your baby does not latch on straight away as babies are born with enough nutrients to last several hours before getting hungry.
What is colostrum?
Colostrum, commonly called the first milk or premilk, is a watery, white/yellow substance produced by the breasts for the first few days. Most women do not notice it until after
the birth, although it starts being produced from as early as 20 weeks in pregnancy and may leak during pregnancy. Although colostrum is not abundant, it has a high
concentration of nutrients. It is high in protein and vitamin K and it also contains antibodies and white blood cells to protect your baby against infection. Colostrum helps
your baby to excrete waste products and lines the stomach with a protective layer that helps fight against foreign substances, such as bacteria, in the body. It is also thought
that colostrum helps to prevent allergies
Help! My breasts are like huge beach balls. Will they stay like this if I carry on breastfeeding?
Between three and six days after birth, your breasts prepare to increase their milk production and may be tender, throbbing, lumpy, and uncomfortably full This is due to the
blood and lymphatic flow to the breasts increasing and a larger volume of milk being produced This is normal, but if milk isn’t effectively removed at each feed, breasts can
become swollen, or engorged. This should be a temporary condition, as long as your baby latches on well and feeds on demand for as long as she needs. Some mothers find it
helpful to massage the breast during feeds to encourage milk flow Wearing a supportive feeding bra and alternating hot and cold flannels can relieve the discomfort
When will my milk come in?
After the birth, your body produces the hormone prolactin, which tells your brain to produce milk, and most women start to produce breast milk between days three and six Which
day your milk comes in may also depend on the type of birth you had, as some studies suggest that milk production is delayed if you have a Caesarean. A delay can also occur if a
woman is on medication, such as insulin, to control blood sugar levels. Also, although this is a natural process, certain factors can affect when, and how much, milk is
produced, such as a woman’s thoughts on breastfeeding and how relaxed she feels, and if a mother is undergoing any stress or anxiety.
There are so many different formula feeds around nowadays - is breast really still the best?
It’s true that there are many types of formula milk, with each one striving to be as close to breast milk as possible. However, there are some nutrients and bacteria-fighting
cells present in breast milk that cannot be artificially produced. Breast milk contains everything a baby needs for at least the first three months As well as promoting the
benefits of their own brand, all formula brands also acknowledge that breastfeeding is the best option.

Establishing breastfeeding
Each mother has a different experience when starting to breastfeed Both you and your baby
will be learning and practising together, which can seem quite strange for something that is supposed to be so natural. Some babies will simply attach themselves onto the nipple
(”latch on”) straight away, while others will take longer and may need help from a midwife Sometimes, the type of labour and birth that you experienced can affect how quickly
you establish breastfeeding.
a store of water and fat in her body to provide nourishment until milk is available She will. however, have a strong urge to suckle.
How should I position myself for feeds? For subsequent feeds, it is worth taking the time to check that you are in a comfortable position (see below, right). It might help if
someone holds your baby while you make yourself comfortable -perhaps with cushions behind your back, or a cushion to lie your baby on.
How should I start the first feed? Many babies begin to breastfeed if left ‘’skin-to-skin”, lying directly on you near your breasts, for about 45 minutes Your baby can smell
your milk and will naturally start to make mouthing movements and turn her head to your nipple At first, your baby will need only a small amount of food because she has
Latching on
How should I position my baby? The key to successful breastfeeding is ensuring that your baby is in the right position and has a good ”latch”. Move your baby so that her nose
is opposite your nipple and “tummy to mummy” (your baby’s tummy is lying across your tummy) in a straight line and held close to you (see below). Wait until she opens her mouth
Structure of breasts really wide (this ensures that her tongue is in the right
position) and then move her mouth onto the breast.
How do I know if my baby has latched on properly? It is important to make sure that the whole of the nipple and areola are in your baby’s mouth. This enables your baby to get a
good sucking action and prevents your nipples from getting sore or cracked. The baby’s bottom lip should be curled back, and sucking will be long and deep (rather than little
chomping movements). You may also notice that her ears move
as she sucks. When your baby has latched on correctly,    I fatty tissue
you shouldn’t feel any pain (or, possibly, only a slight
During pregnancy pain when she first starts to suck). If it still hurts after she
has begun sucking, she is not latched on correctly and
you should ease her off the breast and start again after adjusting her position
How do I take my baby off the breast? Do this by sliding your finger gently inside your baby’s mouth - this will break the seal it forms around your breast
I’m expecting twins - can I still breastfeed?
Lots of women successfully breastfeed with twins, although it may take extra planning, as life is easier if both babies adopt the same routine and are fed together. Most women
think that they won’t produce enough milk to satisfy twins; however, milk production works on on a supply and demand basis, so the more your babies suckle, the more milk you
produce You can either fully breastfeed with both babies latching on. or express milk (see p 234-235) and alternate when each baby latches on Expressed milk may be cup-fed to
minimize the risk of a baby taking to a teat and possibly preferring this to the nipple The Twins and Multiple Births Association has plenty of advice on caring for twins (see
p.310).
I’ve heard that it’s harder to breastfeed straight after a Caesarean - is this true?
Women who undergo a Caesarean are likely to be
in more pain than those who have had a vaginal birth, and studies have also shown that postoperative pain
can affect breastfeeding. Also, following major surgery, it’s not easy to move around for a day or so These factors make feeding more challenging initially. However, most
hospitals provide good post-delivery pain relief, which helps women to breastfeed Adopting feeding positions that don’t
put pressure on your stitches also helps (see below). Even if breastfeeding does not happen in the first 24 hours, it is important to allow skin-to-skin contact between you and
your baby as soon as possible.
Will I need a special bra?
It is important that your breast is free during feeding With a normal bra, you would have to remove a garment, so yes, it is advisable to purchase at least two nursing bras.
Nowadays there are lots of attractive bras available. The bra should have a zip or drop-cup fastening to allow one cup at a time to be undone. Ask a trained assistant to measure
you, as a poorly fitted bra can contribute to problems such as mastitis (see p.233) It’s best to wait until 36 weeks before choosing a bra as your breasts continue to grow, The
average increase is around two cup sizes.
Breastfeeding after a Caesarean
Breastfeeding after a Caesarean section can be more challenging than following a vaginal birth as your baby may be sleepy from the effects of the drugs and you will be feeling
uncomfortable from the stitches. If your baby is asleep most of the time, do encourage her to wake for a feed every couple of hours Finding a comfortable position to feed is
important for the let-down reflex.You may find lying on your side facing your baby easier and this is a recommended position after a Caesarean In the days following the
operation, when you are more mobile, you can try feeding sitting up with your baby lying on a pillow to alleviate pressure on your wound.
Breastfeeding is such a struggle. What are we doing wrong?
Although breastfeeding is supposed to be a natural process, for some mothers and babies it can be a challenge. There are a few basic guidelines to help you relax your baby and
get her to latch on properly (see p.228). First, try not to force the nipple into your baby’s mouth. Instead, wait for your baby to lean towards the nipple. For this to happen,
your baby must be turned towards you with her head, shoulders, and body in a straight line (see p,229). Your baby’s lower lip should be below your nipple. To soothe your baby,
you can try stroking her lip with your nipple, or squeeze a few drops of milk onto her lips If your baby wants to feed, she will open her mouth to receive the nipple If so. draw
her closer so that she can latch on across the nipple and around the areola (the darker skin around the nipple) Once she is in the right position, you shouldn’t be able to see
any of your nipple, just a small area of the areola. It should also feel comfortable. Although you shouldn’t force the nipple on your baby you can move her towards the breast so
that her mouth touches the nipple and is encouraged to open wide. Avoid bending forwards, as this can give you backache and may encourage a poor feeding technique.
There are key signs that your baby is properly latched on. These are that the bottom lip is curled back, the chin touches the breast, the mouth is wide open, your areola shows
more above her top lip than under her bottom lip, and the sucking pattern changes to long deep sucks.
How often should I breastfeed my baby?
This is commonly asked by mothers as they feel that the baby should have a routine or pattern. However, it is best not to schedule feeding times and force your baby into a
pattern of, say, every 3-4 hours All babies, but particularly breastfed ones, should be fed on demand. All babies are different and you will soon become familiar with your
baby’s signs of hunger. For example, your baby may ”root”, or search, for the nipple, may not settle, and may make crying or
Troubleshooting
Sore, cracked nipples area common complaint among breastfeeding women and a source of great distress, often leading women to abandon breastfeeding altogether. Knowing what steps
you can take to prevent this happening, or how to alleviate any discomfort, will help to make breastfeeding a more relaxing experience. * Make sure your baby latches on properly
and is removed from the breast gently (see p 228). If your breasts are engorged, expressing some milk first helps your baby to latch on more easily
* Keep your nipples dry between feeds Let the air get to your nipples and use breast pads to soak up leaks of breast milk.
* Relieve sore nipples with a chilled cabbage leaf. You can use a nipple cream if necessary, although most midwives suggest avoiding these if possible.
whimpering sounds. A baby can only hold about 1-2 ounces of milk in their stomach, so some babies may be hungry after an hour, while others may hold out a bit longer. If your
baby dirties a nappy just after a
feed, it is likely that she will become hungry again sooner, usually within an hour of the feed It is also important to allow your baby to feed for as long as possible on each
breast before changing side, to
ensure that she gets the full benefits of the milk
What can I do to help my baby get enough milk?
There are steps you can take to ensure successful breastfeeding and that your baby gets enough milk. * Hold your baby close to you as soon as possible after the birth She will
start to ”root” for your nipple when she is ready to feed.
* Feed your baby as often as she demands in the first few hours and days after the birth This will enable your body to synchronize with your baby’s needs. Feeding on demand in
this way also helps your milk to come in around days 3-5.
* Check that your baby is latched on correctly (see p.228). When your baby is in the correct position, you will both feel comfortable and relaxed. If the baby is not latched on
correctly, it may become painful for you, and you are more likely to stop breastfeeding earlier.
* Allow your baby to feed on one side as long as possible This is because the consistency of breast milk changes during the feed The first part, or foremilk, is lower in fat
compared to the hindmilk The longer she feeds, the more milk you will produce. * Avoid giving your baby a bottle and/or a dummy until feeding is established as this may lead to
nipple confusion. In some cases, a baby may find it hard to latch on, or reject the nipple in favour of a teat. If this continues, your milk production will fall significantly *
Some women believe they should not exercise as it may affect milk production, but this is not the case Studies have revealed that even high-intensity exercise does not affect
breast milk production.
How will I be able to tell that my baby has had enough milk?
Although you can’t measure the exact amount of milk your baby gets, the breasts work on a supply and demand basis, so your body responds to your baby’s sucks and the amount of
milk she takes and produces more according to her needs. Usually, babies feed for at least 10 minutes each feed in the first few days after the birth and you may need to offer
both breasts before she is satisfied. You can tell that your baby is feeding well as her lower jaw will move steadily while she is on the breast. When she is full, she will fall
asleep or release the nipple and be contentedly awake. You should not break the feed, even to change breasts. Your breasts may feel softer and less tense after a feed. Another
sign that your baby has enough milk is the amount of wet and dirty nappies she produces (Breastfed babies tend to have runnier poo than bottlefed ones, see p 242) If you think
that your baby is not satisfied, ask your midwife or health visitor for advice and support before using formula milk.
I get wet patches on my clothes and find breastfeeding so messy. Do you have any advice?
Your breasts leak when they are full and overflow, or when the let-down reflex kicks in, for instance when another baby in the room cries or when you feed from the other breast.
To avoid this, try expressing to stop your breasts becoming too full. Breast pads can help there are disposable and washable ones available. If one breast leaks when your baby
feeds on the other, put a plastic, washable breast shell inside your bra before you start to feed. If the shell
is sterilized, you can save the milk that it collects and freeze it This can be given to your baby at a later date or donated to a milk bank at your local hospital, if you have
one. When you’re out, carry a change of clothes, bra, and breast pads. If you feel a let-down, cross your arms and hug yourself, pressing gently against your breasts, which may
stop the flow. You will probably leak most in the first few weeks of breastfeeding, while you are establishing the right supply for your baby Many women find that the problem
disappears after the first six weeks
Do I have to watch what I eat and drink if I’m breastfeeding?
Yes. Generally, it is important to remember that your baby receives all the nutrition she needs through your breast milk, so having a well-balanced diet is really important (see
p.50). However, there are certain foods and drinks that will affect your baby’s digestion. For example, if you eat lots of fruits, such as grapes and oranges, it can cause loose
stools or diarrhoea in your baby You are advised to avoid high amounts of salt as this can cause your baby to become dehydrated It is also advisable to avoid alcohol Not only
can it make your baby quite sleepy, but there have been studies linking this to cot death
Can all women breastfeed? My mum says she wasn’t able to.
The majority of women are able to breastfeed. You may find that the system of maternity care hindered your mother’s breastfeeding, as there was a time when mothers were told to
feed only every four hours. Learning as much as -you can about breastfeeding in advance makes you more likely to succeed. A common myth is that breast size affects the ability
to feed, but this is not the case. Breast surgery may affect breastfeeding, but even after the most invasive surgery, it is possible that a portion of the original glands and
ducts remain intact. Hopefully you will feel confident enough to give breastfeeding a try.
I want to go back to work six weeks after the birth. Is it worth starting to breastfeed?
Yes, most certainly. Even if you only breastfed for the first week, your baby would benefit from the colostrum. So continuing breastfeeding up to six weeks is good It is
estimated that around 40 per cent of women stop breastfeeding at around six weeks, which may also coincide with the fact that they are no longer receiving visits from a midwife
or health visitor and therefore have a lack of support. Once back at work, you can express your milk, either at work, depending on the facilities, or in the mornings and
evenings at home
What are the benefits of expressing milk?
Expressing breast milk (squeezing milk out of your breasts, see left) enables your baby to receive all the benefits of breastfeeding if you are unable to be with your baby for
every feed. Mothers express their milk for many reasons Some like to give their baby breast milk from a bottle if they are going out when a feed would normally take place, while
others who are going back to work express several feeds’ worth so they can continue to breastfeed their baby, Mothers of premature babies being cared for in a special care baby
unit might express all their baby’s feeds
When can I start expressing?
You can start expressing as soon as is practical after your baby is born. Also, studies have shown that expressing as soon as possible can greatly increase long-term milk
production. For mothers who breastfeed and are returning to work, expressing should start at least a week before so that the baby can get used to receiving the milk from a
bottle or cup. Once you start expressing, if possible, you should express around every three hours, including once in the night when prolactin levels are highest, aiming to
express 6-8 times in a 24-hour period. As breast milk is made on a supply and demand basis, the better your baby feeds, or the more often you express, the more milk you will
make for your baby. An Australian study found that women who express milk are more likely to continue breastfeeding for up to six months.

Expressing breast milk
Providing additional milk supplies
You can express breast milk as soon as you feel ready after the birth, although some women prefer to wait until breastfeeding is established, at around four weeks. Expressing
milk means your partner can start to help with feeds and you may be able to get out for periods.
How is it done? Most women use a pump to express their milk There are many different types available, ranging from manual to electric ones. The other way to express your milk is
manually. To do this, support your breast with one hand, making a c-shape towards the back of your breast and gently squeeze in a downward motion, moving towards the nipple;
stop, and then repeat until you have enough milk You will soon learn where the
best place is to put your finger and thumb. Sometimes it is difficult to get a”let-down reflex” when you are expressing – try thinking of your baby and you should soon be making lots of milk.
How should breast milk be stored? It is important that you put the expressed breast milk into a sterile bottle liner or a sterile bottle. This can then be stored in the fridge
for 24 hours, or in the freezer for up to three months Label each bottle or container with your name (if your baby will be with others at a nursery), and the date and time you
expressed it. To defrost the milk, warm it gently in a bowl of hot water – don’t use your microwave Do not keep milk in the fridge door, as the temperature fluctuates.

First Hours After Birth. FAQ.

Will they clean up my baby first?
This is something to discuss with your midwife before the birth. She will ask your preferences
for whether to deliver your baby straight on to your tummy or, as some women prefer, on to the bed to be cleaned and dried before being handed to you.
When will my baby be weighed?
Your baby will have a head-to-toe check, be weighed, and have his head circumference and body length measured This may be done very quickly after the birth, but more usually it is done once you have had the opportunity to cuddle your baby.
What is vernix?
Most babies born before 40 weeks have some vernix, a white waxy substance, on their skin that protects them while they are in the amniotic fluid. After 40 weeks this begins to disappear. If it is present after birth, it doesn’t need to be wiped off as it will gradually be absorbed into the skin.
How will the cord be cut?
Once your baby is born, the usual practice is to place a plastic cord clamp on the cord about lcm (i3 in) away from the baby’s tummy, and then to clamp another about 3cm (I in) away from the
first cord clamp using artery forceps; the cord in between the clamps is then cut using cord scissors. Recently there has been some debate about the best timing for clamping and cutting the cord. The most recent research suggests that delaying the clamping of the cord for 2-3 minutes is most beneficial for the baby. This is because the cord continues to pulsate for several minutes after the birth and so delaying cutting it allows more blood to pass from the placenta to the baby This boosts the baby’s oxygen supply and blood volume, which in turn raises iron levels and reduces the risk of anaemia developing.
Although some maternity units are changing their policies in line with this research, most are continuing with the practice of clamping and cutting immediately If you have a preference as to the timing of clamping and cutting the cord, you can include this in your birth plan If your birth partner would like to be involved in cutting the cord with the midwife, discuss this prior to the birth; this should be possible, providing all is well at the delivery.
Do all newborn babies look the same?
Babies vary in appearance at birth and a variety of factors play a part. Sometimes parents are surprised that instead of a soft-skinned baby they are faced with a red-faced,  wet, screaming individual. Some aspects of your baby’s appearance may be temporary and related to the birth or your baby adapting to life in the outside world, such as the shape of his head, which may have been affected by the birth, or the colour of his skin (see p.219). If your baby is born late, at around 42 weeks, he may have drier, flakier skin than babies born around 40 weeks if he is born prematurely, he may still be covered in the fine downy hair called lanugo, which will gradually disappear. Also the type of delivery can affect the way your baby looks after birth. If you have a Caesarean, your baby is less likely to have a distorted or ‘’squashed” appearance to his head as he has not had to squeeze through the birth canal.
I’ve heard that sometimes the genitals are quite swollen. Why is this?
The hormones produced by your body in pregnancy namely oestrogen and progesterone, cross the placenta and so are present in the baby during pregnancy and immediately after the birth. One of the side effects of these hormones can be swollen genitals in both newborn boys and girls In girls, the swelling can be accompanied by a reddening of the skin and some baby girls may have a vaginal discharge. As the hormone levels drop, the discharge may include a small amount of blood, all of which is normal. Hormone levels can also cause swelling of the breasts in both boys and girls. After the birth, any swelling and discharge settles quite quickly as the baby does not produce hormones and levels drop to zero in the first week
Will he be wrinkly?
A newborn baby’s appearance changes over the first hours and days of life Immediately
after birth, babies tend to have a wrinkly appearance because they have been in a bag of fluid for the last nine months, much the same as we get if we stay in the bath for too long As their skin adapts to being in the outside world, the wrinkles disappear If a baby is very overdue, the skin can appear quite dry and in most cases will flake off In this situation, it will also appear wrinkly due to a lack of moisture Once a newborn baby’s skin starts to flake, there is nothing that can be done to stop it, and you should not use
any moisturizing products to try to prevent it. Rest assured that the layer of skin underneath will be fine.
My baby’s face is covered in spots. Will they go?
Newborn babies have very sensitive skin. They have been protected in a safe environment in pregnancy and following the birth their skin needs to adjust to the outside world That is why rashes and spots may occur. The most common rash in newborns is called erythema toxicum neonatorum, which occurs in around 50 per cent of newborn babies and is usually noticeable around 1-5 days after the birth This consists of small red spots that appear and disappear all over the skin apart from on the palms continuing with the practice of
clamping and cutting immediately If you have a preference as to the timing of clamping and cutting the cord, you can include this in your birth plan If your birth partner would like to be involved in cutting the cord with the midwife, discuss this prior to the birth; this should be possible, providing all is well at the delivery
Do all newborn babies look the same?
Babies vary in appearance at birth and a variety of factors play a part. Sometimes parents are surprised that instead of a soft-skinned baby they are faced with a red-faced, wet, screaming individual. Some aspects of your baby’s appearance may be temporary and related to the birth or your baby adapting to life in the outside world, such as the shape of his head, which may have been affected by the birth, or the colour of his skin (see p.219). If your baby is born late, at around 42 weeks, he may have drier, flakier skin than babies born around 40 weeks, if he is born prematurely, he may still be covered in the fine downy hair called lanugo, which will gradually disappear. Also the type of delivery can affect the way your baby looks after birth. If you have a Caesarean, your baby is less likely to have a distorted or ‘’squashed” appearance to his head as he has
not had to squeeze through the birth canal.
I’ve heard that sometimes the genitals are quite swollen. Why is this?
The hormones produced by your body in pregnancy namely oestrogen and progesterone, cross the placenta and so are present in the baby during pregnancy and immediately after the birth. One of the side effects of these hormones can be swollen genitals in both newborn boys and girls In girls, the swelling can be accompanied by a reddening of the skin and some baby girls may have a vaginal discharge. As the hormone levels drop, the discharge may include a small amount of blood, all of which is normal. Hormone levels can also cause swelling of the breasts in both boys and girls After the birth, and swelling and discharge settles quite quickly as the baby does not produce hormones and levels drop to zero in the first week.
Will he be wrinkly?
A newborn baby’s appearance changes over the first hours and days of life. Immediately
after birth, babies tend to have a wrinkly appearance because they have been in a bag of fluid for the last nine months, much the same as we get if we stay in the bath for too
long As their skin adapts to being in the outside world, the wrinkles disappear If a baby is very overdue, the skin can appear quite dry and in most cases will flake off In this
situation, it will also appear wrinkly due to a lack of moisture. Once a newborn baby’s skin starts to flake, there is nothing that can be done to stop it, and you should not
use any moisturizing products to try to prevent it. Rest assured that the layer of skin underneath will be fine.
My baby’s face is covered in spots. Will they go?
Newborn babies have very sensitive skin. They have been protected in a safe environment in pregnancy and following the birth their skin needs to adjust to the outside world.
That is why rashes and spots may occur. The most common rash in newborns is called erythema toxicum neonatofurn, which occurs in around 50 per cent of newborn babies and is
usually noticeable around 1-5 days after the birth This consists of small red spots that appear and disappear all over the skin apart from on the palms.

Your newborn’s appearance
Your baby’s appearance straight after the birth may not be what you expected. Straight after the birth, the skin can look dark red or purple, but quickly changes to a lighter
colour as he begins to breathe air through his lungs for the first time His hands and feet may look a little blue for the first 24-48 hours; this is normal, but blue-tinged skin
elsewhere at this time is0 normal and should be assessed. A baby’s head shape sometimes concerns parents; as the baby passes through the birth canal, the bones of the skull are
designed to overlap, which means that after the birth the head can looked quite pointed However, this resolves within 24 hours. Sometimes there is bruising on the scalp due to
the baby’s position in labour that tends to disappear in the first week
of the hands and soles of the feet. It isn’t harmful and it doesn’t indicate an infection. It can’t be passed on to others and it usually disappears within two weeks without any
treatment Milla is another noticeable skin change occurring in about 40 per cent of newborn babies. These are pin-head-sized white spots, which usually appear over the nose and
cheeks, but can also occur on other parts of the face. These are blocked-off pores containing some sebum (an oily substance produced by the skin) and, again, they disappear
without treatment.
My baby has a big red strawberry mark on his head. Will it be there for ever?
Birth marks are fairly common and most disappear in the first few years of life Strawberry birth marks start as a red dot and tend to grow in size for about a year, but usually  disappear by five years. Other
marks include pink patches of skin, called stork patches, and Mongolian blue spots, which are patches of skin with a bluish tinge that occur on babies of Afro-Caribbean or Asian descent. They
usually occur at the bottom of the back but
may extend over the bottom and are due to the concentration of pigment cells in the slsjn; they often disappear by three to four years of age. Port-wine stains are larger red
marks that tend to occur on the face and neck. These birth marks are permanent, so you may want to talk to a skin specialist about whether there are treatments to reduce them.
Should I be careful about using products on my baby’s skin?
Yes, you do need to exercise caution. As a baby’s skin is very sensitive, it can react to any chemicals that it comes into contact with, including some baby bath products The
very best option is to use nothing other than plain water on a baby’s skin until he is at least a month old. and to continue to take care over which products you use in the following months
You can use oils to massage your baby Pure vegetable oil or olive oil is best; avoid aromatherapy or mineral oils, which may be harmful to a baby’s skin, and nut-based oils, as
there is a possible link between these and the development of nut allergies.

Newborn tests and checks
Between 6 and 72 hours after the birth, your baby will receive a detailed examination from a doctor or midwife The aim of this is to detect any abnormalities in a baby that may
not have been picked up by the antenatal scans during pregnancy If you need to see a specialist as a result of these tests, an appointment will be made at a later date Other
tests are carried out in the couple of weeks following the birth, usually in your home by the midwife or health visitor,
The first examination During this initial examination your baby will be weighed and measured and his heart and lungs will be listened to using a stethoscope The roof of his
mouth will be checked to make sure that there is no cleft, or split, in his palate and his eyes will also be examined His limbs will be checked to ensure that they match in
How your baby is checked
length, and that his feet are properly aligned with no sign of clubfoot Your baby’s tummy will
be felt to check that the internal organs are the right size and in the right place. and the pulses in the groin will also be checked The genitals will be examined, and the
spine will be checked to make sure that all of the vertebrae are in place His hip joints will also be looked at to ensure that these are not dislocated and not ”clicky”, which
could lead to instability later on. Your baby’s reflexes will also be checked (see p.223).
The newborn blood spot test This is most commonly referred to as the Guthrie or heel-prick test. It is usually the next check that your baby will have, and it takes place
between days 5 and 7 after the birth. This newborn blood spot screening test is carried out to identify babies who may have
rare, but potentially serious, conditions and may consequently need treatment at some stage
Conditions that are identified Blood spot tests screen babies for phenylketonuria (PKU), a rare metabolic condition: congenital hypothyroidism; cystic fibrosis; sickle cell
disorders, which can lead to severe anaemia and other serious health problems.
PKU is an inherited condition in which babies are unable to process a substance in their food called phenylalanine. Early treatment involves a special diet, which can prevent
severe disability If screening has shown that your baby suffers from congenital hypothyroidism, early treatment will involve thyroxine tablets, which can prevent permanent
physical and mental disability In some areas of the UK, babies are also screened for cystic fibrosis.
How the blood test is done The blood test involves the side of your baby’s heel being pricked and four drops of blood being carefully placed on a special card. The test is often
done while your baby is feeding, as this makes it less painful or alarming for your baby You can
get the results from your doctor, although you will be contacted if anything is detected. Sometimes further testing is needed. Most babies screened will not have any of these
conditions, but, for those who do, early treatment can be vital to ensure long-term health
Your baby’s hearing test A hearing test will be carried out when your baby is around 2-3 days old Around 1 or 2 babies in every 1,000 will have some degree of hearing loss, and
90 per cent of these are born to parents without hearing problems themselves. The hearing test involves one of two checks. For the first, the specialist will put a small
earpiece with a microphone next to your baby’s ears, and, for the second test, headphones are placed over your baby’s head. Clicking sounds are then made and the brain’s
responses are recorded and a readout is given on a computer screen A very small number of babies will need further testing (around 3 per cent). It is important that any hearing
loss is picked up within the first six months of life so that special support can be given to the parents to ensure normal language development later on.

Will my baby have any blood tests before we leave the hospital?
Apart from the newborn blood spot tests (see p.220), other occasions when a blood test may be required include
* If a baby is ill and his general health needs to be assessed which is most commonly done by checking blood sugars
* If a baby shows significant signs of jaundice, to check the bilirubin levels and rule out a more serious underlying condition in the baby, such as anaemia or an infection.
* If the mother is Rhesus negative (see p 79), although blood is usually taken from the umbilical cord at birth to determine the baby’s blood group and Rhesus factor
If the hospital does suggest taking blood from your baby, then a midwife, doctor, or other health professional should clearly explain to you the reasons why they recommend this
course of action and ask for your consent prior to blood being taken from your baby

Vitamin K

After the birth, you will be asked if you would like your baby to receive a vitamin K supplement. This is an essential vitamin for helping the blood to clot, and as babies
receive very little of it from their milk diet there is a small risk that they could suffer internal bleeding. There are two ways to give babies this supplement:
* By an injection, Only one dose is needed to prevent vitamin-K deficiency.
* By mouth Two doses are given in the first week and breastfed babies may have a further dose after a month.
I’ve heard that they check babies’ hips. Why is this?
All babies have two hip checks (see p.221) as part of the recommended child health screening programme. The checks are done in the first couple of days when the baby has a
physical assessment, and at 6-8 weeks of age when the physical assessment is repeated
The two conditions that are being screened for are congenital dislocated hip and developmental dysplasia of the hip, also known as ‘clicl y hips”. The screening may be carried
out by a doctor or a midwife, or later by a health visitor. If a problem is found. a splint may be recommended to align the hip correctly and ensure the socket develops normally.
Why do they measure the baby’s head?
Measuring a baby’s head is done to assess wellbeing, development, and brain growth Many babies have their head measured straight after the birth, but this probably isn’t the
most accurate measurement as the head may have changed shape as it passed through the birth canal It is not until a few days later that it settles into its normal shape. Your
health visitor usually takes a measurement at one of her visits in the first few weeks after the birth and this is generally used as the baseline measurement on your baby’s
growth chart. Measurements taken throughout the first year are plotted on this in a personal child health record that you will be given by your health visitor
Why do some newborns have jaundice?
Just over half of all newborns suffer from jaundice Usually it isn’t noticeable until 2-3 days after the birth and clears by 14 days The most common cause is high levels of
haemoglobin (the oxygen-carrying part of the blood) before birth Once babies are born and breathe for themselves, their haemoglobin count doesn’t need to be so high; these blood
cells die off and are processed as waste by the liver. In small babies, the liver is immature and takes a while to cope with the workload. The result is that instead of this
waste product, known as bilirubin, being passed in the urine and stools, it stays in the body for a while and gives the skin a yellow/orange colour In a healthy full-term baby
who is feeding well, jaundice will resolve on its own without any treatment. Sometimes, if there has been bruising, the baby is slow to feed, or is premature, the bilirubin
levels continue to increase, and in these cases phototherapy (ultraviolet light treatment) is needed to reduce the bilirubin levels in the baby.
Any jaundice that occurs within 24 hours of birth and any that continues after 14 days is investigated to rule out and treat any medical problems.
How much will he cry, or will he be asleep all the time?
Many factors influence your baby’s sleep pattern. such as the type of delivery you had: the gestation of your baby; his health at birth; and the method of feeding your baby,
with bottlefed babies tending to sleep for longer stretches. However, all babies need a lot of sleep approximately 16 hours each day, which consists of short intervals of sleep
intermingled with shorter periods of wakefulness through the day.
My baby’s foot is turned in and we’ve been told he may need a splint. What is wrong with him?
This is known as talipes and affects 1 in 1,000 babies. It’s more common in boys and affects one or both feet. Talipes may be positional or structural. Positional talipes is
caused by pressure compressing the foot while it’s developing, as a result of its position in the womb This may be resolved with exercises to help the foot regain its natural
position. Structural talipes is more complex and is caused by several factors, including a genetic predisposition. This needs prompt treatment while the tissues are soft to
manipulate the foot Splints, strapping, or casts may be used to hold the foot in place In some cases, if this is not effective, an operation to straighten the foot may be
suggested. Both surgical and manipulation methods have a good success rate. Your child will have regular reviews in childhood and adolescence. particularly during growth spurts,
and more surgery may be needed in adolescence. There are organizations to contact for support and advice (see p 310).

Newborn reflexes
Babies have several reflexes that are present from the moment of birth and are part of their survival skills.
* Startle, or morn, reflex. If a baby’s head is not supported, this produces a falling sensation and she will fling out her limbs. It’s important that you always support your
baby’s head. * Rooting reflex. If you touch your baby’s cheek, she will turn her head in search of food
* Grasp reflex. If you put a finger in your baby’s palm, she will grip it tightly with her fingers.
* Stepping reflex. If you hold your baby upright on a surface, she will make stepping actions.

It’s hard to imagine how you will feel at the start of your life with a new baby What is more certain is that you will most likely be shattered after the birth, and will probably experience a whole range of emotions, from euphoria at meeting your new baby and relief that the labour and birth are behind you, to tearfulness brought on by sheer exhaustion and anxiety at the prospect of caring for this tiny human being You may feel incredibly protective towards your baby and overwhelmed by the immense responsibility of looking after him All of these feelings are normal and part of the huge adjustment you make after having a baby. Here is what to expect in the first 12 hours.
1-3 hours Once your baby has been delivered and providing you both are well, you should be able to hold him straight away and enjoy your first cuddle. The cord will be cut by
the midwife, or possibly by your partner. After the birth, you will need to push again to deliver the placenta (see p.188). If you had an episiotomy or tore during the birth,
you will be given an anaesthetic before being stitched Minutes after the birth, your baby’s condition will be assessed using the Apgar score (see p 2 1 Y). Within the first
hour, he will be weighed, measured, cleaned, and wrapped in a blanket
If you are planning to breastfeed, you should be able to put your baby to the breast as soon as possible, he may root for your nipple straight away, or may simply enjoy being
held close to you and having skin-to-skin contact If you had a Caesarean, you will be moved to a recovery room once the operation is completed; once in the recovery room, the
midwife will help to position you comfortably for the first breastfeed. Also, in the first few hours after the birth, you and your partner will be offered some tea and toast, which is usually extremely welcome
4-5 hours By this stage, you may be recovering on the postnatal ward. If you haven’t already done so, you may want to shower and freshen up after the birth. You may need to have
someone with you at first in case you are feeling unsteady, If you had a Caesarean, you won’t be able to shower yet, but the midwife will be able to give you a bed bath. During
this time, you are likely to have your blood pressure, temperature, and pulse rate checked by the midwives, and any stitches you have will be checked intermittently to ensure
that they are not bleeding excessively or loose, and there are no signs of infection. You will also be offered medication to help you cope with any pain. Although you may be
sore after the birth, it’s a good idea to start moving around as soon as possible as this will help your recovery by building up your strength and helping your circulation
Movement will also encourage your bladder and bowel to start working sooner, Passing urine after having stitches can sting, so you may want to try pouring a jug of warm water
over your genitals when you go to the loo If you had a Caesarean birth, moving around will be more difficult, but it is still important to start to be active to avoid the risk
of blood clots developing.
6-12 hours Your abdomen will be palpated to check that the uterus is returning to its normal pre-pregnancy size and your bleeding, known as lochia (see p.264) will be checked to
ensure that it is not excessive and there are no signs of clotting Your baby may want to
feed and you can practise positioning him at the breast so that he latches on correctly (see p 228) The midwives or maternity support staff will help you to get started with
breastfeeding.You may find you experience fairly strong afterpains while feeding as your uterus contracts down (see p.264).You should also receive practical advice on how to
change your baby’s nappy and top and tail him (see pp.250-1). Don’t worry if you feel apprehensive about the practical care of your baby and try not to feel intimidated if there
are more experienced mums on the ward; you will find that your confidence grows quickly as you become practised at handling your baby The midwives have a supportive role to play
on the postnatal ward, so don’t be afraid to ask for help
Often, a sense of camaraderie builds up on the ward, and your stay in hospital can be a good opportunity to talk to other mums and share information and experiences You may feel
well enough to start receiving visitors and, if all is well with you and your baby and you feel ready, you may be able to return home!

They said I need a Caesarean
all about Caesarean births
What’s the difference between an emergency and elective Caesarean?
Caesareans are classified as elective or emergency An elective Caesarean indicates that a pre-planned decision was made during pregnancy to deliver the baby by Caesarean before the onset of labour. An emergency Caesarean is when a situation arises, usually in labour, that means the safest route for delivery is by Caesarean section.
Is it fair to say that most doctors prefer Caesarean deliveries these days?
Although the Caesarean rate has risen over the years, it would be unfair to say that this is due to doctors’ personal preferences; it is more likely to be due to over-caution on the part of the medical staff. NICE guidelines on Caesareans are quite specific on the reasons why a Caesarean should be considered and offered as an alternative to a vaginal delivery However, they also recommend that as currently one in five women will have a Caesarean section, all women should be offered some information about the procedure in antenatal classes If a Caesarean section is considered to be the most appropriate mode of delivery for you, then you should also be made aware of the benefits and the risks to you and your baby and of the possible implications on future pregnancies before you give your consent
Are there any factors that might reduce the likelihood of having a Caesarean?
Research shows there are certain factors that decrease the likelihood of having a Caesarean section and these include!
* Having one-to-one support from another woman
during labour; whether a midwife, a doula, or a supportive friend or relative. This is thought to reduce your chances of having a Caesarean.
* Waiting until after 41 weeks to have an induction of labour, if your pregnancy has been uncomplicated. * Having a home birth reduces the likelihood of a Caesarean if you have had an uncomplicated pregnancy. * Having appropriate tests during labour, such as a fetal blood sample and fetal electronic monitoring, will confirm any indications that your baby is distressed before going ahead with a Caesarean
I’ve got a small pelvis; I’m not too posh to push, but they said I may need a Caesarean. Is this right?
Cephalopelvic disproportion (CPD) is the term used to describe a labour that is not progressing due to the size or shape of the mother’s pelvis in relation to the size and position of the baby entering it. Problems may occur if a baby is unusually large or a mother unusually small. True CPD is rare and even if it is a concern in pregnancy, it is often thought best to give labour a try, although you may be cautioned that a Caesarean is a possibility. Certain signs signify CPD in labour; for example if the baby does not descend through the pelvis, or the cervix does not dilate; in these situations, a Caesarean would be necessary.
The midwife wrote LSCS in my notes - what does that mean?
The most common type of Caesarean section is a lower segment one (LSCS). This refers to the 12-15cm (5—bin) cut made along the bikini line The other type of incision is a “classical” or vertical cut, although this is extremely rare nowadays and would only be used if, for example, there was a vertical scar from a previous Caesarean, or in an emergency situation, such as a haemorrhage, although even then it is rare.

I want to be asleep during the Caesarean section. Will I have that option?
It is preferable that you are awake in the operation as most surgeons and anaesthetists agree that it is safer for mothers and babies to have an epidural or spinal anaesthetic. Also, you will be able to have your
partner with you, and will see and hold your baby straight away. In addition some women even manage to breastfeed while the operation continues or straight after the operation in the recovery room There are also greater post-operative risks for the mother and baby with general anaesthesia, including respiratory problems. If you are afraid of the operation talk to your midwife or doctor You may be able to visit an operating theatre and discuss the procedures.
I haven’t had problems, but I just don’t want to go through birth. Can I opt for a Caesarean?
If there are no medical grounds for a Caesarean and this is purely down to your fear of labour pains, then to opt to have a Caesarean is a drastic decision A Caesarean is major abdominal surgery, and although it is sometimes preferable, it is not a favoured method for many reasons, such as the risk of post-operative problems occurring as a result of surgery; a higher risk of secondary fertility problems, or the second baby being born by Caesarean; and an increased risk of postnatal depression It would be better to talk to your midwife about the pain-relief options available and ensure you receive the most effective type for
you. Having somebody you know and trust with you in labour can reduce your anxiety levels greatly. If you still feel that you cannot go through with labour, you may need to talk to your consultant obstetrician as the final decision will probably be his or hers.
I’ve had two Caesareans and now have been advised to have an elective one. Is this necessary?
It is common practice to advise women who have had more than one Caesarean section or operation involving cutting the womb to have an elective Caesarean This is because the risk of the womb rupturing during labour is slightly higher with each of these procedures. Usually, women who have had one previous Caesarean can have a ”trial of labour’ (see p. 182), but this will depend on the reason for the last Caesarean and how your current pregnancy is going If you do have a trial of labour, this will be carefully monitored and any indications that may suggest a rupture beginning would result in a Caesarean without question It is usual to prepare the mother for a Caesarean in case an urgent one is required by having an epidural anaesthetic in place, as this will reduce the time delay if intervention is needed. Ultimately, whether you opt for an elective Caesarean or for a trial of labour is your decision and the consultant will be able to advise on the risks and benefits of each method.
I heard that Caesarean babies are brighter because they don’t have a traumatic birth. Is this true?
No. this is not the case at ail Full term, healthy babies are designed to cope with the stresses of a natural labour and birth and should not be affected in any way by this experience The type of birth on its own does not affect a baby’s abilities, although if a baby becomes” distressed” during the delivery, on rare occasions this can cause problems that persist into later life (although usually the baby is born fit and well) It is the case that you can help your baby by staying healthy in pregnancy, for example by eating well and not smoking or binge drinking.

A Caesarean birth is when your baby is born during an operation in which the surgeon lifts out your baby through a short incision made through your abdomen (generally below the bikini line) and through the wall of your womb. This operation is carried out under anaesthetic, which could be spinal anaesthesia, epidural, or occasionally by general anaesthetic. There are many different reasons why a Caesarean birth happens. Sometimes the decision can be made during the pregnancy, which is called an elective Caesarean, and sometimes the decision is made during labour, which is known as an emergency Caesarean.
Today the Caesarean birth rate is 25 per cent
in the UK and rising. Look at the statistics from your local hospitals to see what their Caesarean rates are to help you decide where to have your baby. If you are considering an elective Caesarean, you should bear in mind that this is not without risks to you or your baby, or even to your next pregnancy, The decision to have a Caesarean section should be made by weighing up all the risks and then making a decision that is right for you
Can I avoid a Caesarean? There area few things you can do to help prevent a Caesarean section, for instance having someone with you throughout your labour, especially a midwife; having a homebirth (if you have no risk factors like high blood pressure); having an external cephalic version (turning your baby while you are about 37 weeks pregnant) if your baby is in a breech position (their bottom coming first); having a senior obstetrician involved in the decision not to have a Caesarean; and, if it is thought your baby is distressed, taking a fetal blood sample before deciding to carry out an emergency Caesarean.
What type of anaesthesia will I have? There are different types of anaesthesia for Caesareans all of which prevent you from feeling the operation General anaesthetics (which make you go to sleep) are only used if your baby needs to be born quickly or you have a rare blood disorder with low levels cf platelets (these help your blood to clot) Vlore offer_, an injection is put into your back, which is either a spinal block, when the drug is injected into the spinal fluid, an epidural, or a combined spinal epidural; you are awake to experience your baby being born and there are fewer complications this way

Caesarean, and these will stay in place for about 24 hours. If you wish to breastfeed, you can feed as soon as the baby is born, while the operation is still happening It is important that you are pain-free after your Caesarean, so ask the midwives for more pain relief if you need it, ideally before the pain builds up. To prevent blood clots forming in your legs, you will be given an injection and after 24 hours or preferably sooner, you will be encouraged to get up and walk around
How much can I do after a Caesarean? Once you get home, take it easy and let the pain guide you as to how much you do. You can start gently exercising as soon as you want and most hospitals give you information as to which exercises you can do safely. Using your vacuum cleaner, driving, and strenuous exercise are definitely not recommended You can drive again after six weeks, depending on your insurance company.
Will I have to have a Caesarean next time? The reason you had a Caesarean this time will determine the advice from your doctor as to whether you have a VBAC (vaginal birth after Caesarean) or have further Caesareans for subsequent babies. If you feel negative about the birth of your baby, you should try talking to your doctor or hospital and get expert help, as it is common to feel unhappy if you had an emergency Caesarean when you were expecting a vaginal birth.

What type of pain relief will I be given before the operation?
There are two main types of anaesthesia, or pain relief, prior to a Caesarean section! general and regional. A general anaesthetic is the procedure whereby the mother is put to sleep before the
Caesarean. Although this is a relatively quick
and safe method for the mother and baby, it is not common practice as it is thought preferable for the mother to be awake during the operation so that she is able to expereince the birth of her baby, rather than having to wait until she recovers from the anaesthetic and is possibly too groggy to respond to her baby. There is also a slight risk of the mother inhaling vomit during the operation and the possibility that the anaesthetic will affect the baby’s responses after the birth (see p.207).
A regional anaesthetic is given either as an epidural (see p 176), a spinal block, where the anaesthetic drug is injected into the fluid surrounding the spinal cord, or a combined spinal epidural. In both cases, a needle is inserted into the back and medication is given through a narrow tube to numb the abdomen downwards Although this takes longer to perform than a general anaesthetic, the anaesthetist will be very skilled at inserting the needle He or she will use a cold spray to ensure that you are totally numbed and the procedure will not start until the anaesthetist is completely happy that this is the case. On very rare occasions when the procedure can be felt, a general anaesthetic will be given straight away. The regional option is safer and
the birth experience is not missed The choice will ultimately be yours, unless certain conditions dictate the safest option
Who will be in the operating theatre?
Although it may seem like a crowd, all of the people in the operating theatre have a role. An anaesthetist will be present to make sure you do not feel the procedure and he or she will be helped by an operating department assistant. The main surgeon and his or her assistant will be performing the Caesarean section A midwife and sometimes a paediatrician will receive the baby A scrub nurse will pass the instruments to the surgeon and a runner’ will be there to fetch things and count the instruments with the nurse Your permission must be gained for students to be present You may wish to have your husband partner friend, or a family member present with you, which is usually agreed with the team leader in advance (although it is very common for your partner to be there).
How will I be stitched and how long will my scar be?
If you have the most common type of Caesarean, a ”lower segment Caesarean section”, a 12-1 Scm cut is made along the bikini line. The other, less common, type is a ‘classical” or vertical incision. During a Caesarean, the surgeon needs to cut through several layers of fat and tissues before making an incision in the uterus These internal layers will then be restitched after the operation using soluble stitches and then the layer of skin will be stitched or clipped at the end. Clips, or staples, are usually removed about three days after the operation whereas stitches are left in for about five days. The removal of clips or stitches is usually a fairly painless procedure.
Can my partner still cut the cord?
It is important during a Caesarean section that the procedure is carried out under sterile conditions. This means that all of the staff around the operating table, and the instruments, will be sterile (the highest level of cleanliness). The staff have to undergo a specialized washing technique called ‘’scrubbing” and then use a gown that has been washed and packed to certain standards This is to reduce the risk of infection to the mother and baby. If your partner was allowed to cut the cord, this would mean that the same principles would apply. It would therefore not be practical or possible to ensure that every partner was trained in this technique However, it may be possible for your partner to “trim’ the cord away from the table as an alternative. This is sometimes necessary when the midwife has cut the cord and applied the cord clamp; but there is still too much cord length, and it is often a good opportunity to involve dads
Will I be able to watch my Caesarean section operation if I want to?
Usually the mother is fully awake for her Caesarean section, with the exception of some emergency situations when it might take too long for the anaesthetist to insert the spinal anaesthetic, in which case a general anaesthetic will be given However, whether the mother would literally be able to watch the Caesarean section is a different matter. During
•    Caesarean when the mother is awake, it is usual for
•    screen to be erected to stop her and her partner from seeing anything. To see the operation, the screen would have to be taken down. You would also need to have your head raised, which would present difficulties for the surgeon, as the operation requires that the mother lies fairly flat so that the surgeon can get to the baby and the abdomen. Although the operation itself may sound thrilling, you may not be thinking this when it is actually happening to you On occasion, even a planned Caesarean section can run into difficulties, and in the worst case scenario, the mother will have to be given a general anaesthetic.
Many obstetricians, however, do drop the screen, if you wish, at the point of your baby being delivered from the abdomen, and the parents are shown the baby so that they can see what the baby looks like.
Is a baby born by Caesarean section any different to a baby born vaginally?
The condition of a baby following a Caesarean section depends greatly on the reason for the operation. If the Caesarean section is being performed as an emergency situation because the baby’s wellbeing is in question, there will be differences between this baby and one born by
a planned Caesarean section or vaginal birth. For example if the baby is distressed, its skin colour, activity levels, and breathing rate may all be affected Each baby is assessed, initially by the midwife and/ or a paediatrician, and is then given a score out of 10, known as the Apgar score (see p.217).This looks at the baby’s colour, heart rate, stimulation response, how the baby is breathing and the muscle tone, and the midwife will perform a detailed examination of the baby a little later to examine the baby’s skin, fontanelles, ears, eyes, mouth, nose, body, genitals, spine, anus, and heart and breathing. A baby born by a planned Caesarean will have a nice rounded head as it hasn’t been pushed through the birth canal, and about and this will. in itself, speed up recovery and reduce the risks resulting from immobility such as deep vein thrombosis.
Will I still be able to hold my baby straight after the birth?
In most units, the midwife or paediatrician will show you your baby quickly before reviewing your baby’s condition (see p.217) Once the paediatrician and the midwife caring for you are happy that your baby is well, she will be well wrapped and placed across your chest while you are on the operating table. Although it might be hard for you to hold your baby at this point due to your position, this will be the first opportunity for you to feel and see your baby.
Once you have been transferred to the recovery area after the operation, the midwife will first make sure that you are well by checking your pulse, breathing, and blood pressure, and by looking for any signs of heavy bleeding She will then attempt
to get you into a comfortable position, probably lying on your side, to enable you to enjoy some skin-toskin contact with your baby and to breastfeed your baby should you so wish.
How soon will I be able to go home after a Caesarean section?
Only a relatively few years ago, women who had had a Caesarean were kept in hospital for around five to seven days, and a few years before that, 10 to 14 days was the average amount of time spent in hospital Nowadays, mainly due to the recognition that women do recover much better in the comfort of their own homes — where they are likely to get more sleep and rest as they are not being disturbed by other babies — and also sometimes due to economics, lack of space, and reduced maternity staffing levels, women are usually discharged from hospital at around two or three days after their Caesarean operation.
There are individual circumstances when this might not be the case, for example if the mother is not coping well after the birth, if she is on her own at home, or if she is having problems breastfeeding her baby, then her discharge home may be delayed. If a baby has been admitted to the special care unit in the hospital, many maternity units will allow the mother to stay for up to 10 days.

You may think that there is little a
partner can do during a Caesarean, but this is not the case as your birth partner still has the important job of supporting you during the operation.
* If the Caesarean is an emergency procedure, partners can make sure that the reasons why this is necessary are clear. * If you are awake for the procedure, your partner can remain in the theatre, sitting by your head and offering you reassurance throughout the operation.
* Once your baby is born, you and your partner can welcome her together,
and its gender Then the screen is put back up to deliver the placenta and stitch up the incision. If you do wish to watch more of the operation, you should discuss this with the surgeon and the anaesthetist prior to the operation Likewise, if you don’t want the screen to be lowered at all, make this clear to the operating team beforehand.
What are the reasons for Caesarean sections?
There are various reasons why a Caesarean section might be carried out. You may be advised to have a Caesarean if the baby cannot enter the pelvis due to the baby’s size or position or the shape and size of the pelvis; if you have a low-lying placenta; for a multiple pregnancy or breech baby, if your labour is not progressing; if you had a previous Caesarean section or traumatic birth: if you have severe pre-eclampsia; if the baby’s growth is severely reduced; if you have had heavy bleeding in pregnancy; and for certain other medical conditions The doctor will advise you of the reasons why a Caesarean section may be the safest option.

Recovering from a Caesarean
Although you should remain mobile after a Caesarean operation,
it is also important that you get plenty of rest A Caesarean is major surgery so you will need to avoid lifting and carrying heavy loads for the first few weeks. As this may be difficult if you have other small children or are at home alone, you should try and recruit as much help as possible after the operation You should avoid doing any shopping, which usually involves lifting, or driving for a few weeks Check with your insurance company when they are happy for you to drive again and make sure that you feel comfortable wearing a seatbelt and doing manoeuvres, including emergency stops. It is generally thought to take up to six weeks to fully recover.

Why isn’t the baby out yet?
assisting the birth
What is an assisted delivery?
An assisted delivery is one that uses either forceps or a ventouse, or suction cup (see p.204), to help extract the baby from the birth canal if the baby is not making good progress during labour or there are complications during the second stage of labour in a vaginal delivery You will still be helping to deliver your baby with your contractions, but the instrument used will be helping to guide the baby out of the birth canal.
How is an assisted delivery carried out?
Assisted deliveries are carried out using either forceps or ventouse (vacuum extraction) by a doctor (or specially trained midwife) Forceps are metal instruments specially shaped to fit around the baby’s head, whereas in the ventouse method, a vacuum is created by attaching a cup-like fitting to the head and using a mechanism to create suction to help draw your baby out.
How do they decide whether to use ventouse or forceps? Will it be my choice?
Both forceps- and ventouse-assisted births are relatively safe procedures and, although each has pros and cons, it’s best to be guided by the doctor, as the choice of instrument usually depends on the position of the baby and the doctor’s preference or experience, although your opinion will be taken into consideration. Although forceps used to be the most widely used instrument, ventouse has increased significantly in popularity. Many consider ventouse easier to use and less likely to cause damage and tearing to the mother. However, this method is also more likely to cause swelling to the baby’s head where the cup was placed
What is a “prolonged second stage” and does this mean that the delivery will be assisted?
It is difficult to define a ”prolonged second stage” as it depends on certain factors, for example if it is your first baby the position and size of the baby, if you have an epidural, if the contractions are effective and how often they are coming, how well you are pushing, and if the pelvis is an adequate size There is some evidence to suggest that if the baby has progressed further into the pelvis, and there is no sign of distress. then there is no need to put a time limit on labour. However, it does tend to be the case that hospitals have guidelines as to how long they will allow a woman to push for before deciding that intervention may be necessary Usually, after about one and a half hours, doctors may decide to assist the delivery to reduce the risk of fetal distress and of the mother becoming exhausted.
I had a forceps delivery as in the end I was too tired to push. Is this likely to happen again?
An assisted delivery is more common during a first birth than in subsequent ones. The first pregnancy and birth causes the pelvic ligaments to stretch, which can make subsequent births easier, and the uterus is often more efficient in contracting the second and subsequent times around, which also means that labour is usually shorter Often, even if the baby’s head is not in the best position for birth, for example if the baby is in a posterior position, where the back of the head is towards the mother’s spine and lower back, it may be delivered without assistance during a second delivery Therefore, it is likely, but by no means certain, that you will have a normal vaginal delivery next time.
Can I refuse to have forceps or vacuum extraction and what are the alternatives?
No-one can go against your wishes if you do not want to have a particular procedure. However, it’s usually best to have a flexible approach to labour. Although you may wish for certain things not to take place, the doctor or midwife is likely to have a good reason for wanting to carry out a procedure and has your and -your baby’s best interests at heart. If an assisted delivery is suggested, asking the midwife or doctor to explain and support this decision can help you to come to terms with it. Usually the only other alternative to an assisted delivery would be a Caesarean section: however, this may be difficult if the baby has gone too far into the pelvis
Will I have an anaesthetic before they use the forceps?
Suitable pain relief, such as a local anaesthetic injection, or an epidural, will be given before the procedure The doctor will then help to pull the baby out while the mother pushes. The forceps and ventouse cup are removed after the head has been delivered, and the body is delivered normally,
What can go wrong at an assisted birth?
Forceps and ventouse can cause bruising, swelling, and marks on the baby’s head or face, although these usually resolve without any problems within a few days In rare cases, cuts and severe bruising on
Assisted delivery
An assisted delivery, using forceps or a ventouse vacuum extraction, may be carried out for one or more of the following reasons:
* The mother is exhausted from a long labour and has insufficient energy to push.
* The baby is showing signs of distress during the second stage of labour.
* The baby’s head is in a slightly wrong position -if you are in the second stage of labour, forceps or ventouse can often be used to turn the head around and deliver the baby.
* Forceps are sometimes used to protect the delicate head of a premature baby during birth
* Forceps are sometimes used to deliver the head of a breech baby
* If the baby is particularly large - this can be the case when the mother has had gestational diabetes .
the baby can occur. The paediatrician, a doctor who specializes in babies and children, may prescribe a paracetamol-based medicine to ease any discomfort that the baby may feel There is also an increased
risk of the baby developing jaundice, where the baby looks yellow due to the presence of the waste product bilirubin (see p.164), particularly in cases of severe bruising The levels of bilirubin in the baby will be checked if the doctor is concerned and the condition can be treated, if necessary
For the mother, the two main concerns are that there is an increased risk of tearing or being cut during the procedure - and hence an increased risk of more bleeding (which can be dealt with straight away) - and, rarely, damage may occur to the tubes that lead from the bladder.
If the situation warrants an assisted delivery, the benefits of delivering babies by these methods far outweigh the risks. If the procedure is not successful, an emergency Caesarean may be necessary.

Helping your baby’s birth

A delivery may be assisted using either vacuum extraction (or ventouse), which involves a small suction cap (metal or plastic) being placed on the back of your baby’s head and very gently pulled, or forceps, metal tongs that guide the baby out.
Why might this be necessary? There are several reasons why the obstetrician, and in some units the midwife, will advise this type of birth.  Generally an assisted delivery is carried out because the mother is too tired to carry on pushing after a prolonged second stage of labour, and the ventouse suction cap or forceps can help accelerate the baby’s progress through the birth canal. An assisted delivery may also be necessary if your blood pressure has risen suddenly or if there are signs of fetal distress You will be given either an epidural or local anaesthetic before the procedure is carried out
Is it safe? This is a safe way for your baby to be born, although there is a very small chance that your baby may bleed under his scalp and may need to go to the neonatal unit to be cared for and monitored after the birth, After vacuum extraction, most babies will have a little bump (a ”chignon”) where the soft cup has been attached to the head, and the baby s head may look slightly elongated Babies delivered by forceps may have marks on the sides of the head where the tongs were. However, any swelling or marks should disappear within a few days
Will I need an episiotomy? An episiotomy - a cut made between your vagina and back passage to make more space for your baby to be born in order to prevent tearing - is sometimes carried out if you have an assisted delivery, and is more likely with a forceps delivery.

Episiotomy
An episiotomy is an incision, or cut, made with scissors into the area called the perineum, which is the piece of tissue between the vagina and the anus. This area stretches and thins during the birth to allow for the baby’s head to be born with ease An episiotomy is performed only in an emergency situation An example of this is if the baby needs to be born quickly, or sometimes during an assisted delivery for example with forceps (see opposite), to prevent uncontrolled tearing Before the procedure is performed, a local anaesthetic is gently injected into the muscle to reduce the discomfort or pain during the procedure. An episiotomy will need stitching afterwards, and this is usually done by the midwife who has been involved in your delivery or by the obstetrician involved in the birth. Although episiotomies used to be routine around 10 to 15 years ago, they are now performed only when really necessary You should be informed why one is being recommended and give your verbal consent before the procedure is carried out.

MEDIO-LATERAL CUT:
What is an episiotomy and why might this be done?
An episiotomy is a cut along the muscle between the vagina and anus, known as the perineum, to widen the area where the baby will be delivered (see above) This is done only when absolutely necessary and will not be performed without your consent. There are several reasons why an episiotomy may be recommended including if the baby is in distress, to speed up the delivery of the head; in cases of forceps or ventouse deliveries! if the baby’s head is too large to pass through the vagina; if the perineum has not stretched sufficiently by the end of the second stage of labour to allow the smooth passage of the baby’s head through the vagina; if there is a complication in the vaginal delviery of a breech baby: or if the mother is finding it difficult to control her pushing while the baby’s head is crowning (see p. 186), which means she is more likely to tear significantly during the delivery
Usually, local anaesthetic is injected into the muscular area first and the procedure is performed at the strongest part of the contraction, as this distracts you from what is being done and assists with a quick delivery
The thought of having a cut down there is terrifying. What can I do to prevent this?
Some studies have shown that massaging the perineum regularly in pregnancy, using an unscented vegetable oil, can reduce the risk of tearing (see p.111) as this helps to make the area more flexible and may consequently help to stretch the area as the head is being born Wash your hands thoroughly before massaging the perineum. Although an episiotomy may be a worrying prospect, if you are advised to have one, this may prevent uncontrolled tearing.
Why might they do an emergency Caesarean section?
Emergency Caesareans are carried out for several reasons. The baby may be showing signs of being very tired, picked up by the fetal heart monitor or a blood test carried out during labour, and this could lead to the baby being distressed, known as fetal distress, in which case a Caesarean may be recommended Rarely, the umbilical cord comes down before the baby, a condition known as cord prolapse, and this is an emergency that requires immediate delivery by Caesarean.