Archive for the ‘Baby is Born. First Hours and Days’ Category

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!