Posts Tagged ‘babies’

In this case, give the fruit before (or if necessary, after) the third feed and the vegetables before (or if necessary, after) the second feed generic viagra discussion forum . Start with carrots mirtazapine in cats .
Gradually increase the quantity from two teaspoonfuls to two dessertspoonfuls light ongoing period after provera .
Once the baby has got used to carrots, you can also gradually introduce cauliflower, broccoli and pumpkin, either combined with the familiar carrots, or on their own amitriptyline pain protocol .
A taste of fruit
Raw purled apple: peel the apple and grate it finely with a nutmeg grater lithium motorsports promotional code . If you use an ordinary grater this usually produces slivers rather than smooth puree metformin 500mg cost .
Boiled apple puree: cook the
peeled, finely diced apple in a little bit of water and puree the apple with the cooking liquid side efffects of actonel .
A taste of vegetables
Boil or steam (see p gum with caffeine .44) pieces of vegetable in a little bit of water until they are thoroughly cooked and pass them through a sieve ibuprofen dose for kids . If necessary, make the puree slightly thinner with some boiled water watertown ma lithium batteries .
1 glucotrol extended release .
Bottle-feeding
Feeding schedule
7am—bottle of 170-200 nil
(6-7 fl oz)
11 am—vegetables + bottle of approx information on ultram tab 50 medication . 170 ml (6 fl oz) 3pm—fruit + bottle of approx plavex paxeva altace .
170 nil (6 fl oz)
7pm—bottle of 170-200 ml
(6-7 fl oz)
11 pm—bottle of 170-200 ml
(6-7 fl oz)
These times serve as a guideline and will differ from child to child social anxiety disorder zoloft .
In general, the last feed can be dropped between the ages of five and six months multiple sclerosis valtrex . This feed is then divided over the four bottles which the child has during the daytime indocin gout .
If a child receiving formula milk indicates that she is no longer satisfied by the bottle during the course of this period, you can add some rice flour to the bottle coumadin fall . This can be the flour used for bottles which you prepare yourself eating broccoli and testosterone .
For bottle-feeding with bottles you prepare yourself, you can use the recipe, Bottle feeding based on almond paste (see p ivax tramadol capsules .61), up to four months spironolactone to control oily skin .
From four months, add flour to this bottle so that the baby will be satisfied about ranitidine 150mg . This recipe is shown opposite pill description paxil .
Weaning with bottle-feeding
Up to three months, bottle-fed babies are given only carrot juice or fruit juice as supplements trazodone used as a sleep aid . Now it is possible to go on to pur6ed vegetables and fruit nolvadex andriol . For this, see the advice
given under Solids with breastfeeding (see p normal fsh estradiol and lh values .65) For a child who is bottle fed it is possible to deduct one month from the indicated age, because weaning started at a much earlier stage pravachol online .
Bottle-feeding based on almond paste for 4-6 months Ingredients per 100 ml (per 8 fl oz):
50 nil (4 fl oz) full-fat cow’s milk
50 ml (4 fl oz) water
2 g (1 tsp) rice flour
4 g (2 tsp) lactose
3 g (11/2 tsp) almond paste
Preparation with rice flour:
Cook the flour in the water until it is cooked (see instructions on the packaging) and dilute the lactose and almond paste in the warm liquid drug evista mg . Stir in the milk and pour everything through a tea strainer singulair canine . If necessary, add cooled boiled water to replace the evaporated water up to original quantity deltasone for premature ejaculation .
Practical Advice for
Six to Nine Months
Psychomotor development
Now that the baby has gained control of his head, arms and trunk to some extent, he has a degree of freedom of movement does estrace cause bloating . First, he discovers his feet as enjoyable toys tetracycline treat pneumonia . The child can experience his whole body from head to feet, though still with a rather dreamy consciousness zetia blood sugar levels . The child starts to move about, first by rolling over, and later on, at approximately nine months, by crawling loratadine causes acid base imbalance .
During this stage, many children learn to raise themselves up into a stable sitting position coumadin and muscle relaxers counterindication . Some children move about on their front or shift themselves on their back
sides, another method of exploring space barbara schmidt caffeine american 2006 .
The child’s sounds can start to incorporate words such as gaga, dada or baba user reviews on fluoxetine .
During this stage, the child learns to distinguish between familiar people — usually the mother and father, and others incontinence discussion urispas psychological . It is typical of this stage for the baby to start to cling to a particular person, and seek security with those people to whom he is most attached maximum zoloft dosage .
Sleeping and waking
The pattern of sleeping and waking still largely follows the pattern of feeding news on otc prilosec . There are usually four meals in the day, at seven and eleven o’clock in the morning, and at three and seven o’clock in the afternoon and evening what is levaquin for .
Most children still like to have a nap after the first and second feeds clomid after lupron . The nap between three in the afternoon and seven o’clock gradually becomes shorter or disappears altogether zocor and hair loss . Many children like to be put in bed for a while, even if they do not sleep glucophage for polycystic ovaries . For children who do not like this, the day is often just a little bit too long, which means they start to grizzle by teatime viagra auxiliary labels . In this case, try to give the seven o’clock feed slightly earlier herbs with same effects as clomid . Most children will now sleep through the night claritin azo vitamin c .
Care
Washing and bathing
At this age it is not really necessary to bath the baby with soap every day discount depression medications prozac . However, when a child starts to crawl on the floor, it is important to devote extra attention to hygiene does cocoa butter have caffeine .
Many children catch colds during the crawling stage because the floor is cold and there is often a draught close to the ground propranolol . Children cannot blow their noses at this age, so treat the face with an oily ointment such as calendula baby cream, so that the skin does not dry out too much sarafem unavailable .
The playpen
As the baby’s freedom of movement and exploratory drive increases, it is quite an art to arrange the time spent in the playpen and outside to meet the child’s needs dexamethasone average dosage . The playpen provides support for sitting and standing up, and gives the child an opportunity to examine and discover toys in a quiet place safty of drugs during pregnancy zoloft . Outside the playpen, the big world beckons, and the child is able to roll over and crawl about freely alternative herbal viagra .
Do not put too many toys in the playpen, but make sure they are regularly changed prednisone and high blood glucose level . It is often useful to have a bag hanging from the wooden rungs to put the toys in effects of bupropion . The baby should play with other toys outside the playpen, as this will increase the attraction of being put back in the playpen elavil causes rl .
Toys and playing
When the child is in the playpen, he will not just look at and explore the toys, he will also use them cheap cialis . For example, he will hit a ball so that it rolls away, or grab hold of a rattle and hit it against the rungs of the playpen how often liver enzymes diflucan . The child can use any objects which are used for his daily care, such as a soap dish or flannel, or a spoon and beaker, provided they are safe can you take phentermine and prozac .
Playing with adults, the child really enjoys games which involve moving, such as ‘horsey games’ or ‘Round and round the garden poster american society hypertension labetalol .
Once the child is crawling, the voyages of discovery really expand; it feels everything around it and often hits things with a flat hand zestoretic identification . The child likes to hold something in his hand when crawling, and a wooden spoon or a lid of a jam jar can be used to make surprising sounds, for example, by hitting it on a wooden or tiled floor smoking on cardizem .
Every crumb, piece of fluff, bead or pin will be carefully picked up from the floor with the thumb and index finger and put into the mouth seroquel used as a sleep aid . Therefore it is important to pay attention to what is left on the floor, and remove anything that is dangerous k2 lithium 4.0 .
Safety
The most common accidents during this period are caused by falls, knocks and bumps, burns, poisoning, drowning, strangulation and suffocation neutropenia and renagel . Take the following precautions lithium ion hammer drill .
Falls
— From the dressing table, out of the high chair and the pram amoxycillin common dosages . Make sure that the chair or pram is stable and use a harness orlistat and cholecystectomy .
— From the stairs, install stair gates at the top and bottom of the stairs trim spa diet pill finasteride .
Knochsftmps
— If necessary, place protective corners on sharp edges and points cavaties and zoloft .
Burns/poisoning
— Keep hot drinks out of the child’s way; use place mats rather that a tablecloth, so that baby cannot pull hot drinks and food over himself if he pulls on the tablecloth, make sure that electric cables are out of reach, for example; for a kettle order soma online cheap .
— Make sure that toxic substances and plants, or any stray ashtray are kept out of the way bad side effects of topamax .
Drowning
— Never leave the baby in the bath on his own, and place an anti-slip mat on the bottom of the bath caffeine libido .
Strangulation/suffocation
— Do not use a clamp to keep the blankets in place, or a harness in bed actonel and teva patent . However, many children no longer want to lie down in bed once they have learnt to stand up pet health insurance tramadol . This can lead to great drama at bedtime, and indicates that it is now time to lower the cot mattress caffeine and affect on the bladder . Use a baby’s sleeping bag or make a warm overall, and make sure that the side of the bed is high enough so that the baby cannot fall out generic lithobid er prescribing information . If necessary, discuss this with the baby clinic mdx caffeine .
— Once a baby reveals a tendency to stand up, remove everything from the playpen which could lead to strangulation or with which the child
could hang himself; lines stretched across the playpen are also dangerous fosamax without prescription . Cords for Venetian blinds pose a very real risk and should be tied up out of reach prozac albendazole .
A number of the safety measures described here apply for children who can sit or stand up zocor skin reaction . Because of the safety aspect, these situations are discussed at this stage, although many babies do not sit or stand up until the next stage, between nine and twelve months novartis lamisil coupon .
Feeding
During this stage, the feeding pattern does not usually change very much mixing zovirax and benadryl . Usual feeding times are on waking, late morning, during the afternoon and early evening (see also Sleeping and waking, pp coumiden warfarin risk hazards .69f) ibuprofen doctor free .
However, there is a change in the actual diet who prescribes metformin . Often, breastfeeding comes to an end during this period, there is more variation in vegetables and fruit, and cereals and sour milk products such as live yoghurt can be introduced feel high on abilify . A general diet could be as follows:
On waking
breastfeeding or bottle-feeding or porridge
Late morning
vegetables + cereals + pudding (breastfeeding, bottle or sour milk products)
Afternoon
fruit (+ cereal flakes) combined with breastfeeding, bottle-feeding or dairy products lithium 3.6 volt colombia .
Early evening
breastfeeding or bottle-feeding or porridge
Breastfeeding
At the start of this stage, many babies are still breastfed four times a day straterra and prozac together . When the sucking reflex diminishes, two of the feeds can be dropped, that is, at 11 am and 3pm cipro indicated uses . Gradually, the morning and evening feeds can be replaced with a bottle or with porridge nexium lcd .
When you want to stop feeding, you should gradually reduce the number of feeds avandia medication recall . The pressure and the increased chance of mastitis often determine the rate at which you stop depression effects lamictal medication side . It takes approximately five days to stop one feed info on actonel . When you stop the last feed, it is not necessary to wait until the breasts are completely empty glaxo epivir . When you no longer feel the milk coming in, you can stop feeding boniva versus calcium supplements . Any milk that remains will be assimilated by the body tramadol antacid safe .
Bottle-feeding
For bottle-feeding with bottles that you prepare yourself, you should now use the following ingredients:
Flour, milk, water, sweetener and cold-pressed sunflower or olive oil proscar finasteride louisiana . At this age it is no longer necessary to add almond paste amoxicillin instructions dosage . The quantity can always be found on the packaging of the type of flour that was chosen imitrex imatrax . The milk is still diluted zyrtec syrup for allergies in children .
In our opinion, it is not necessary to give healthy children next stage milk rather than cow’s milk (see also p aleve causes heart attacks .40) imodium results .
Note: The instructions on some baby cereals state that the (diluted) milk should be cooked with the flour order omeprazole free shipping . It is better to boil the flour in enough water to produce a sort of paste, and then add the milk interaction carbamazepine propoxephine . Make sure that the baby gets 450 to 500 ml (’/2 quart) of milk products per day, if necessary, by adding some extra sour milk products (also see Weaning below) cefaclor titration .
Porridge
Porridge which is eaten with a spoon can be made with cereal flakes or flour carisoprodol carisoprodol onlinefrontru onlinefrontru .
The advantage of porridge made of cereal flakes is that you can vary these with different flakes and the child becomes used to a coarser type of porridge tramadol hydrochloride 2c acetaminophen . Furthermore, cereal flakes are cheaper than flour plavix and indocin . Buy the flakes in small quantities at a time so that they are always fresh altace canada .
Flakes which are suitable (in order from easily digestible flakes to slightly more difficult to digest flakes) include rice, buckwheat, millet, oat and barley flakes claritin doses for dogs . Oat flakes have a laxative effect and sometimes give the baby a red bottom depakote kruszewski .
Porridge made with cereal flakes
1 buy fluoxetine online no prescription . Soak the flakes for thirty minutes (or longer) in a small but sufficient amount of water diabetes caused by prednisone usage .
2 molybdenum lithium grease . Bring the flakes in the water to the boil, stirring all the time with a wooden spoon xenical co uk .
3 ambien and wellbutrin more depression . Leave the flakes to soak for twenty or thirty minutes with the lid on
the pan on the hob or to warm in a pan of hot water (au bain marie) most effective dose of robaxin . You can also leave the flakes to soak overnight in a preheated thermos flask (with a wide mouth) what is brethine .
4 tinnitis zocor . Place the pan on a low heat and add milk at a temperature of approximately 60°C (140°F), stirring with a whisk effect alcohol sertraline . Leave the porridge to soak with the lid on the pan, off the heat for about fifteen minutes zocor questions efficacy .
5 warfarin ppi . Liquidize the porridge if needed albuterol dosing .
6 pictures of ranitidine . Sweeten the porridge with unrefined sugar, baby malt, rice or barley malt syrup or maple syrup, approximately one teaspoon per bowl premarin vaginal cream libido .
No quantities are given for the preparation of the porridge made of cereal flakes coffee caffeine in tea . The total quantity per bowl is approximately 200 ml (7 fl oz) aristocort 0.1 cream usual dose . After a while, you will know exactly how much you need of all the different sorts of flakes to prepare porridge of the right consistency red meat and norvasc . Experience and a good quality pan also contribute greatly to the success of your porridge reviews on clomid for men .
Weaning
Vegetables
The composition of the vegetables is two thirds cooked vegetables to one third cooked cereal flakes and one teaspoon of cold-pressed sunflower or olive oil danazol purpura . Altogether make 150 to 200 ml (5-7 fl oz) of pureed vegetables, or if they are soft and prepared with cereal flakes, they can be mashed amantadine hydrochloride 100mg shingles . You can also add a teaspoon of almond paste to the vegetables to give it a richer mixture steroid clomid .
When the baby has got used to the vegetables mentioned for three to six months (see p coumadin hair loss .66), you can start to vary them with other vegetables u s airways lithium ion batteries . A summary of vegetables is included again on p popping promethazine pills .75 to show the possibilities arava border terminal .
The vegetables are shown in the order of the ease with which they can be digested, from those, which are easy to digest to those which are more difficult rude viagra jokes . The vegetables marked with an asterix (*) are rich in nitrates and should not be given more than twice a week trial generic viagra . However, they do not have to be left out of the diet altogether as they make a healthy change from the other vegetables what is the generic for prevacid .
Flakes
The flakes which were mentioned above (p propranolol adverse effects .73) for the porridge can also be added to the vegetables snort lexapro . To prepare them, follow the recipe for the porridge with cereal flakes up to step 4 tramadol dogs post . If you like, you can also prepare the flakes for two days and keep them in the fridge dosage size for amoxicillin .
Tip: If you have little time, you can also add instant cereals used for bottle-feeding to the green vegetables gabapentin suicide .
Dessert
If the baby is not breast or bottle fed after the vegetables, a dessert made of dairy products can complete the meal seroquel dose .
Types of dairy products
Give approximately 100 nil live yoghurt or approximately 40 ml of curds, diluted with water why tenormin vs lopressor . It can be sweetened with concentrated apple or pear juice, maple syrup, or rice or barley malt syrup celexa monograph . Curds are diluted because they contain two to three times as many proteins as full-fat milk mudvayne prozac .
Fruit
The fruit consists of purled fruit with cereal flakes, which may or may not be combined with some dairy products celexa birth defect lawsuit . Again the ratio is 2/3 fruit to ‘/3 flakes (together 100-150 ml, 3-5 fl oz), supplemented to 150-200 ml (5-7 fl oz) with sour milk products do testosterone supplements work .
Types of fruit
Apple, pear, tangerine, blueberry, raspberry, blackberry, peach, orange fish flex cephalexin 500mg .
In moderation: strawberry, plum, and banana, as these might lead to a hypersensitive reaction or influence bowel movements cheap injectable depo provera .
Bread
Your child can start to eat bread from about eight months vytorin class action law suits . To get used to it, give the baby a crust to munch and gnaw on, closely supervised effects zoloft and alcohol . From nine months, when the child can sit on his own, he can also start to join you at the table to eat bread neurontin via peg .
Root Stem/leaves Flower/fruit
carrot cauliflower broccoli
*beetroot *spinach pumpkin
Jerusalem artichoke *endive courgette
parsnip *lettuce peas
*salad greens french beans
*leaf beet runner beans
*fennel mangetout
*kohlrabi fruit *lamb’s lettuce
*pak choi
AI I vegetables are cooked avelox patient information . Green vegetables can be added to the carrot, pumpkin etc use diphenhydramine with allegra d . when it is nearly done, and cooked with it fora short while ivermectin kills fleas .
* Vegetables rich in nitrates; do not give more than twice a week generic lipitor drugs .

One or two breasts
As indicated above, breastfeeding is a matter of supply and demand reverse thyroxine . The more often you breastfeed the baby, the better lactation is stimulated side effects of diovan hct . In principle, it is therefore advisable for the baby to drink from both breasts during every feed diflucan online dream pharmaceutical . It is important that at least one of the breasts is completely emptied so that the baby gets some of the more fatty milk which is produced after the colostrum and is more nourishing lithium basic information . If the baby appears to be hungry fairly soon after the previous feed, start with the emptiest breast, and then go back to the full breast as the first one at the normal feeding time medil journals on pregnancy and zoloft .
Night feeds
The baby often develops an awareness of night and day for the first time at about six weeks, and the gap between the night feeds can be gradually increased temp soma memory foam mattress topper .
Parents can work towards this by feeding the baby briefly and in a ‘businesslike manner’ at night, and by keeping the light and sound low, that is, by feeding in a very different atmosphere from the daytime endep type . When the baby shows that it can sleep for five or six hours at a time, but still wakes up too early, for example, at 5 o’clock instead of 7 o’clock, there are several ways to help it take the last step in the right direction:
— only change the baby’s nappy and then place him back in the cot-,
— give a bottle with approximately 100 ml (3′/2 fl oz) of fennel or camomile tea (see the recipes on p avodart aloe .1 10) public chapter 279 actos of 2003 . The baby is satisfied because he has had something, but will wake up for the next feed within two hours, so that his routine is maintained online mexico pharmacy ultram .
— move the cot from the parents’ bedroom to another room; very often, parents who have become used to night feeds will prevent the baby from sleeping because they are tossing and turning flomax avadart .
It is certainly advisable to give the first morning feed at a set time, or to work towards this, even if the night feed changes, for example, from 3 o’clock in the morning to 5 o’clock in the morning cialis user reviews . In this way, a routine is maintained side effects of fexofenadine hydrochloride .
Crying with hunger
As you get to know your baby, you will also start to recognise why he is crying (see also p rockstar caffeine content .48) lanzoprazol vs esomeprazole . Crying with hunger is one reason to forget about the pattern of feeding and to feed the baby more often, particularly when this happens several times causes of low testosterone inmen . Usually, by feeding the baby quite often it takes one or two days to establish a new pattern, which will be enough for the amount of milk to adapt to the baby’s needs lovastatin effects on uric acid . Then it is possible to return to the first feeding pattern off label use of abilify .
Bowel movements
A baby’s stools are black and sticky for the first few days (meconium) viagra solid food . Then the stools of breastfed babies usually acquire a creamy yellow, sometimes green consistency coumadin glaucoma . A baby may have from seven dirty nappies a day to just one a week zithromax one day shipping . Different colours and amounts can also be quite normal accutane oily skin returned . There may also be quite a difference in the thickness of the stools, but in babies who are breastfed they are usually thinner, and never really very thick mylan and estrace . It is quite normal for a baby to be completely covered with excrement when it has pushed hard for a while suggested substitutes for zelnorm . It can only really be characterised as diarrhea when it is very watery with just a few solid bits, and occurs more than six times a day prednisone what is . If a baby only moves its bowels once or a few times a week, it may become a problem and have a negative influence on the drinking pattern, while the stools that are produced are rarely very thick is risperdal effective . In this case, mildly laxative foods may help testosterone cyp 200mg ml water . The mother could eat some dried prunes, or drink some orange juice drug interaction and levonorgestrel and topamax . If this does not help, or if the orange juice causes cramps or gives the baby a red bottom, give the baby some of the water in which the prunes were soaked, and discuss the problem at the baby clinic energizer lithium recharger .
Weighing the baby
In the UK, it is recommended that babies are weighed at birth, at two weeks and at six weeks cardizem xt . The birth weight should be regained within two or at most three weeks doxycycline for sale . If a good feeding pattern is established in the following period, the baby should
FEEDING 57
have at least six very wet nappies per day, and if he is happy, then it is no longer necessary to weigh him at home does insurance cover cialis . If you use disposable nappies it is difficult to assess how wet they are — particularly when you have your first child low dose naltrexone drink alcohol . If you have any doubts about whether the amount of food that the baby is receiving is sufficient, don’t look only at whether or not the baby is happy but also use the scales how long clomid can be used . There are babies who remain quiet even if they are hungry cold medicine albuterol . Therefore we advise weighing the baby naked twice a week until the first visit to the baby clinic drug voltaren .
Yellow skin
Many babies have a slightly yellow colour in the first few days after they are born because of the increased bilirubin content of the body buy soma from mexico onli . This usually disappears without any problems within a few days aciphex canada . If the baby is very yellow and seems sleepy and difficult to wake up, it is important to make sure he comes into contact with daylight, for example, by placing the cot by a (closed) window with the hood back propranolol sleep . In addition, it is important for the child to drink a lot naltrexone use . Feed him at least eight times a day, even when this may be difficult because the baby is sleepy wellbutrin xl 30 mg . It is not advisable to supplement the feed with water, tea or glucose water zyrtec advertisements . Breastfeeding, particularly the first feed, has a laxative effect, so that the meconium containing the bilirubin is soon removed from the intestines lipitor alternaive drug .
The mother’s diet
Altogether drink approximately one litre more per day than you usually do; for example, herbal teas, fruit juice, milk and milk products and tea which stimulates lactation medical acyclovir . Approximately 500ml (half quart) of dairy products per day is sufficient generic sample viagra .
If possible, eat foods which have not been sprayed, and have been thoroughly cooked; for example, easily digestible cereals, bread, sufficient dairy products, cheese or meat, nuts (almonds) norvasc nebenwirkungen . For the first six weeks, avoid vegetables which cause wind or are difficult to digest (brassicas and leeks), spicy meals and citrus fruits minimum dose of enalapril for dogs . After this, you can gradually see whether the baby will tolerate these foods indirectly through the mother’s milk restless leg syndrome and ibuprofen . If the baby suffers from cramp, wind or posseting, it is also possible to see whether coarse, indigestible muesli, wholemeal bread or rye bread, which are difficult to digest, or raw vegetables and whole grains of wheat, rye or barley, should be removed from the diet fora while pravachol foradil diflucan .
Avoid alcohol and nicotine (inhibits breastfeeding), as well as icy and/or carbonated drinks soma strength . Do not drink a lot of coffee or black tea does prilosec cause anemia . Always consult the doctor if you are taking medication purchase aleve at discount .
Some practical tips
— If you have the impression that the baby does not have a good sucking technique or is too tired to drink, ask your midwife or health visi-
tor for advice wholesale lithium aa batteries . For these questions, members of the National Childbirth Trust or the La Leche League, or a lactation expert, can give good advice; see the Useful Organizations on p proscar side effects . 119 clomipramine premature ejaculation side effects .
— If you would like to give the baby his last feed just before you go to bed yourself, and it is difficult to wake him up, try to feed him while he is still asleep what’s better sulcrafate or carafate . Some babies can drink while they are asleep downs syndrome and cancer and celebrex .
— Only use water to wash your nipples, not soap zithromax and pneumonia .
— Make sure that you are dressed warmly and that your arms are covered, when you are feeding prophalytic indocin in prematures . This helps to prevent mastitis positive reviews on lexapro .
— If you are troubled by constipation, there is usually no objection to eating some soaked dried prunes contraindications for zocor . If this does not help, and you are really drinking enough (2 litres / quarts or more per day), ask the doctor for advice drug fluoxetine .
— During the time that you are breastfeeding, try not to lose too much C~
weiaht terbutaline brain damage law firm . All the harmful sub- stances that we ingest with our food are stored in the form of fat lipitor and red yeast rice . If a lot of fat is broken down — because you are slimming — these substances will find their way directly into the milk prozac and menstrual disturbances .
— If you plan to go back to work, it is best to discuss this at the baby clinic in good time, so you can ask for advice, for example, about expressing milk nexium and prevacid which is better . It is quite an art to learn how to do this drug olmesartan . In addition, the baby will have to learn to accept a bottle allergic reaction mobic capsules . From six weeks, give him a bottle of expressed milk once every one or two days, so that the baby is really used to the bottle by the time you start work endometriosis low testosterone women .
Problems with breastfeeding
Cracked nipples
Cracked nipples are usually the result of breastfeeding incorrectly, or a poor sucking technique as a result of thrush, and sometimes as a result of’ the mother’s sensitive skin seroquel treatment . Thrush in particular is an increasingly common cause, which is not always recognised (see ‘white spots’ p lexapro and bladder .99) order flagyl without a prescription . Ask your health professional for help in good time, rather than endlessly trying to solve the matter yourself with nipple pads etc 2.5 benzoyl peroxide kit .
It is a good idea to feed the baby often and for short periods sertraline for sale . Whatever you do, do not postpone feeding the baby because it hurts; in fact, a baby does not suck so hard if the breast is less full nephrocaps renagel .
After feeding the baby, rub the last drops of milk over the nipples with clean hands, as this can have a healing effect (do not do this if the baby has thrush) nb-2lh lithium . Make sure that the nipples are thoroughly dry, possibly by drying them with a hair dryer, and if necessary, wear a small metal sieve (without a handle) in your bra so that air can get to the nipples asacol drug .
In addition, there is a whole series of ointments and tinctures such as Weleda calendula ointment, or mecurialis ointment or tincture albuterol and hes . The
FEEDING 59
advantage of tinctures is that the nipples do not become soft and the air can get to them phenergan prolactin increase . An ointment can be helpful for dry nipples, provided it is applied thinly after feeding the baby what kind of vagina infection clindamycin . Discuss this with your health professional clomid hot flashes .
Mastitis
If you suffer flu-like symptoms, have a fever and feeding the baby hUrtS, you are probably suffering from incipient mastitis nokia lithium battery . You can get mastitis if you are extremely tired, in combination with catching cold, as a result of cracked nipples, if the breast is not properly emptied, and also when you reduce the number of feeds, for example, when the night feed comes to an end allegra cadence horse feed .
It is never possible to completely empty the breast — you can always express some more milk — but it is not good if dried milk remains on the nipples after the feed mobic anti-inflammatory generic . You must certainly go on feeding following the same pattern as before, or even slightly more often anhydrous thyroxine . If possible, start with the painful breast depakote side effects bi polar . However, if this is really too painful or if the milk does not come through, start with the healthy breast until the milk comes through, and then change to the painful breast compazine toxicity .
Other remedies are:
— Before feeding, direct a hot shower at the breast or place something hot on it while you are feeding, so that milk flows more easily uses for nexium . — After every feed place a compress of curds on the painful spot for about thirty minutes grease lithium nlgi 1 synthetic . To do this, spread some curds at room temperature on a piece of muslin or thin handkerchief, and fold over the material zyrtec drug tests .
— Instead of using a curd compress, you can also place some slightly bruised cabbage leaves (green or white cabbage) on the painful spot omeprazole ku 118 . Leave the leaves in position for a number of hours by placing them inside your bra orthotrycyclen and prednisone .
— Ring the doctor if your fever has not gone down after one day zantac and anesthesia . Mastitis can be easily treated with anthroposophical medicines without influencing milk production and without any harmful effects for the baby tamoxifen and weight .
Too little milk
If the breasts do not feel really full, or if they produce a rather glassy, bluish milk rather than white milk, this does not mean that breastfeeding is inadequate cheep kamagra . The composition of the mi lk changes over the months, and in principle, the quality is always good what is in zantac . After a while, the pressure in the breasts disappears once a good balance has been achieved between supply and demand information on lipitor . If the quantity of milk is not enough, you will see this more accurately from the baby’s crying, the number of wet nappies per day and/or the baby’s increase in weight chemical name and penicillin . (See also p cetirizine and sulfides .57 under Weighing the baby) prescription drugs sumatriptan .
The causes of not having enough milk can be incorrect breastfeeding or sucking technique, stress in the
mother, too much restlessness when feeding, not giving enough feeds, giving only one breast every feed, the mother not drinking enough and overtiredness professional cialis .
What can be done? Feed the baby more often, always give him both breasts information on prescription celebrex . Make sure you rest enough yourself, and also eat enough strattera adderall . Do not start bottle-feeding too quickly, because the more often and the more powerfully the baby sucks, the better the breastfeeding will be metoprolol 100 mg .
Remedies which help the milk to flow include special teas, or Weleda’s Species lactagogae (tea), oil to rub on the breasts (available on prescription from the doctor), sloe celebrex and hyaluronic acid .juice or elixir and almonds celebrex 20 mg . Avoid parsley, sage and lemons as they reduce the flow of milk what is amitriptyline used for .
In some cases, none of this will help, for example, in a busy family with lots of children paxil and vitamin b-complex . In this case, accepting the fact and introducing bottle-feeding will relax everyone singulair doesn’t work .
Too much milk
If there is always pressure on the breasts there is a danger of mastitis, or if the baby cannot cope with the supply of milk, drink slightly less and try to change to giving one breast every feed sustained release prednisolone tablet . If there is a lot of pressure, use cabbage leaves in the way described for mastitis ic carisoprodol . If this does not help, ask the nurse for advice buy viagra in new zealand .
Bottle-feeding
The advice given below applies for babies who are completely bottle fed fentanyl and quetiapine . If you breastfeed as well as giving the bottle, you can see how much milk the baby is drinking from the breast, for example, by weighing the baby once a week, before and after a number of feeds zetia studies . Adapt the amount given in the bottle accordingly what are testosterone metabolites .
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Amount
During the first three months, the average requirement per day is 150 to 175 nil per kg of body weight (about 21/2 oz per lb) tacrolimus topical . In other words, for a
baby weighing 4 kg, this amounts to 600 to 700 ml per day (20-24 fl oz) penicillin for animals . Obviously this quantity is gradually built up, starting on the first day after birth with six to seven times 10 to 15 ml (2-3 tsp), then six to seven times 20 to 30 ml (4-6 tsp) on the second day, and so on hidrocloruro de bupropion .
If you make use of formula milk, follow the instructions on the packaging soma troll .
A recipe for bottle-feeding based on almond paste and cow’s milk is given below (see box below) foreign pharmacy viagra . If you change from formula milk to bottles you have prepared yourself, this must be done gradually, for exam-pie, by replacing one bottle per day actigall veterinary .
Bottle-feeding based on almond paste for 0-3 months
Ingredients for 100 nil (or for 8fl oz) bottle-feeding: 2 parts water, (65-70 nil, 5-51/2 fl oz)
1 pan full-fat cow’s milk (30-35 nil, 2′/2-3 fl oz) 4 g (2 tsp) white almond paste
6 g (1 tbsp) lactose
Boil the water lansoprazole solutabs and clooged feeding tubes . Remove the pan from the hob taking levothyroxine before bed . Whisk the almond paste and lactose into the water so that the ingredients are thoroughly dissolved cyclosporine symptoms . Stir in the milk and pour everything through a tea strainer so that the bottle teat will not be obstructed by any lumps can you get high on prozac .
The full amount for the day can be prepared at the same time ranitidine erectile . Immediately after preparing the bottles, cool them down under cold running water and keep them carefully sealed in the fridge transition effexor to cymbalta . Before feeding the baby, bring the desired quantity up to body temperature by heating the bottle in a pan of hot water or in a bottle warmer amiodarone versus ablation .
NB: This bottle-feeding is only adequate if fruit and vegetables are given from two months of age is there asprin in ibepropin .
TIP: It is useful to weigh a spoonful of lactose or almond paste once, so that you can then use that particular spoon to measure the quantities in future migraine atenolol tapering .
The recipe for this type of bottle-feeding does not change for the next three months, although the quantity has to be adapted regularly (see Feeding Table, p effexor with tranzene .114) side effects of crixivan . From about six weeks the night feed can be dropped, and five feeds should be sufficient zyrtec infant .
Hygiene
For the first six months, it is particularly important to ensure hygiene as carefully as possible when cleaning the bottles and preparing the bottle feeds requip patirnts review .
Immediately after use, rinse out the bottles with water fluconazole drug interactions . Boil the bottles once every two to three days in boiling water for ten minutes abbott laboratories life cycle leader gengraf . Also rinse the teat after every feed with hot water, and boil them every two or three days for three minutes ratiopharm salbutamol hfa . Always keep the teats in a sealed jam jar imipramine and migraines . Replace the bottle teats every six weeks chlorthalidone sexual side effects .
Bowel movements
In principle, a baby who is bottle fed should move his bowels every day, in contrast with a child who is breastfed zyprexa 50 mg . If he does not move his bowels as often as this, real problems can arise with constipation (see also p effects of bulemia with bupropion sr .101) Discuss this at the baby clinic in good time so that feeding can be adapted prilosec diarrhea colitis .
Solids with bottle-feeding
If the baby is not breastfed at all, but is fed with bottles prepared with almond paste, start with carrot juice, possibly mixed with apple juice, at about two months of age reglan and wbc . Fresh juice is easy to make yourself, by grating a carrot or apple very finely and expressing the juice with the rounded side of a spoon extraction caffeine green tea . You can also use a piece of muslin or clean handkerchief and place the grated carrot or apple on this taking yasmin and abilify together . Make it into a little bag and press out the juice drug screening tramadol .
Start with a few teaspoons, possibly diluted with water, and give this before the second or third bottle prozac mania . At a later stage, this can be increased to a maximum of two dessertspoonfuls per day urinary tract infection providium and bactrim . Depending on the season, it is then possible to add juice made from blackcurrants, rose hips or tangerines ginkgo biloba and prozac . The juice of blueberries has a constipating effect cymbalta who should not take it .
Always makes sure that the solids are at body temperature ranitidine rantidine .
Vaccinations
Discuss the subject of inoculations during one of your first visits to the baby clinic so that you have time to form an opinion (see also p enrica soma .87ff) can you split cialis in half .
Practical Advice for
Three to Six Months
Psychomotor development
During this stage, learning to use the arms, hands and trunk area priority lithium ion aircraft batteries .
From about four months the baby learns to use her hands, lying on her back — first just one hand, and then both hands at the same time what company makes the drug cymbalta . The child learns to move objects from one hand to the other lipitor causes shoulder damage . She will put everything she takes hold of into her mouth and explore it with great joy cipro current medical warnings . The child learns that every object feels or tastes different, that there are different shapes, sizes and weights, and that some toys are warm while others are cold ultram er 300mg .
At about six months the child learns to raise herself up to her navel
when she is lying on her stomach medication relafen . The head is stable, and in this position she can look around at the world until she accidentally rolls over 90 tramadol pills cheapest .
Supported by her father’s or mother’s arm, the child can sit up briefly, but is still much too small to be put in a baby chair or any other type of chair zydus pharm metformin . During this stage, she learns to respond to the environment in a clear and focused way, and demonstrates this contact by gurgling contentedly starting cymbalta temporary morning drowsiness .
Sleeping and waking
A day and night routine has usually been established by now, as the night feed stops chlamydia treatment with tetracycline . By the end of these months when the late feed has also been dropped, the baby will sleep through the night claritin d vs zyrtec d .
The rest of the sleeping and waking routine is still entirely related to the pattern of feeding cipro wide spectrum antibiotic . The baby will always sleep for two or three hours between feeds oxcarbazepine pakistan . The night starts after the 7 o’clock feed in the evening,
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and may be briefly interrupted for the late feed, as long as this remains necessary methyl prednisone without a prescription .
Care
The playpen
From four months it advisable to place the playpen in the living room prednisone high white count . A playpen is a safe environment with firm boundaries for the child, and they can be contained with in their own area 4 hydroxy diclofenac . Experiencing a boundary works psychologically by creating a shelter, which influences physical development in a positive way (See also p what does viagra pill look like .3 1) hydroxyzine popped .
Dribbling
From the age of three months, many babies start to dribble, and by five months may dribble a lot tadalafil cipla pharmacy . This dribbling does not always indicate that they are teething, but is usually a sign of developing salivary glands citalopram withdrawa . A bib will keep the baby’s top dry and prevent the child from cooling down cialis separate bath tubs .
Toys and playing
Now that the baby can hold something in her hand, a rattle, a knitted woollen ball with a bell inside her, or a cuddly toy are suitable toys low price evista .
The cuddly toy does not have to be any more than a square piece of cloth tied together glyburide and sex . The baby explores everything with her mouth to find out about the world, bit by bit tizanidine hcl 4mg . In this way, she learns where her own body ends and the world begins provera clomid and tanning .
Itsy bitsy spider’ is a favourite finger game about soma .
Safety
The most common accidents during this period are the same as those during the period between birth and three months (see p prednisone is .54) cialis for hape .
However, we would like to mention a few further points for attention: during this period, the baby learns to take hold of things, and it is therefore even more important to be careful with loose covers over the cot, pieces of cord and small objects in the cot, on the dressing table or in the playpen cipro and fetal deformities . The playpen must be safe lawyer for boniva case evaluation . Take care to check the hinges viagra patent expires .
Feeding
The pattern of feeding
In most cases, a clear feeding pattern has become established by the age of three months try levitra sample pack . The usual feeding times are 7 and 1 I o’ clock in the morning, 3 o’ clock in the afternoon, and 7 and I I o’ clock in the evening connecticut generic meltabs viagra . By the end of this stage, the I I o’clock feed in the evening is usually dropped zantac muscle .
Breastfeeding
By the age of three months, the baby may no longer breastfeed quite as well gallbladder removal quit alcohol caffeine . This is related to her growing interest in everything around her depot provera . It is typical for the baby to drink for a little bit, and then look at the mother with the breast still half in her mouth, laughing radiantly, then taking another sip, laughing again, and so on zetia tab 10mg .
It helps if the mother does not give up and does not become irritated or angry amoxicillin 875 prescribed . If possible, feed the baby in a quiet place with as few distractions as possible, and while the baby is feeding, do not respond to her beaming attempts to make contact pictures of lamictal rash .
Weaning
In the UK, health visitors advise that solids are given from six months if possible, and that babies are breast-fed on demand red yeast lovastatin quantity lovastatin equivalents .
To teach a baby to learn to eat from a spoon, it is useful to start
FEEDING 65
with a small flat spoon, and to offer it only when the baby opens her mouth identification of carbamazepine in water . Place the spoon horizontally in the mouth and then remove it horizontally without emptying it against the upper lip amoxicillin and diet pills interaction . This means that the baby will be more inclined to empty the spoon herself and swallow, rather than slurping and sucking fluconazole ear infections . In the beginning she may well choke on the food a little oxybutynin pill . As the food is in a Soft pureed form, there is no danger of really choking kamagra india . After coughing a bit, most babies will be prepared to take further spoonfuls ibuprofen harmful to dogs .
As soon as you start giving solids, the colour and smell of the stools will change omeprazole rebates . Vegetables will particularly change the colour cr123a lithium batteries .
Start with fruit: Raw, pureed apple or pear, and then add some juice from a sweet orange, a little bit of banana, or depending on the season, some blackcurrant or blueberry juice apri seiu stern . If the baby finds it difficult to digest, start with cooked apple for the first two weeks caffeine cafe restaurant . If this does not lead to any problems with breastfeeding, the food can be given before the third or fourth feed finasteride result . However, if the baby no longer wants to drink from the breast or drinks significantly less after this supplement, give the food after breastfeeding prozac trazadone sleep .
Gradually increase the quantity from two teaspoonfuls to two dessertspoonfuls paroxetine pharmacy .

Care
Boundaries
Birth is an immense change for the baby. Her whole physiology changes fundamentally and she experiences a completely new environment. The boundaries of the womb are left behind and she enters a ‘boundless’ world. In the womb, the child was able to grow harmoniously, protected from the world.
This reveals that everything that is developing requires a protective environment. With a newborn baby, and actually throughout childhood, this protective environment is constantly provided to establish firm foundations for later life. Unconsciously, the child is constantly reminded of the situation in the womb, which is related to an experience of security, safety, protection and fundamental confidence.
Warmth
The womb not only protects the embryo from the world; it also surrounds it with an even temperature of 37°C (98.6°F). A ‘warm environment’ is provided in the best possible way.
After birth, a child has to learn to maintain her own body temperature at a constant level, at first with the help of adults. She must interrelate the warm and cold parts of the body. This is achieved by means of a sensitive metabolic process which generates heat.
Normal growth and the development of the normal physical processes are also dependent on this metabolism. All the heat which the baby does not have to produce herself in order to maintain her temperature at the right level will benefit growth.
It takes the child a long time to regulate her own temperature; the normal difference of PC (2°F). between the body temperature during the night and the day is achieved by most children between their fifth and ninth months. Up to that time they are extremely dependent on the extra warmth provided in the form of good physical care, clothes, and hot water bottles used to warm the cradle before they are placed in it.
The ability to distinguish whether something is hot or cold is learnt during the initial period. The better this ability has been developed by providing sufficient warmth in childhood, the better the child can use it at a later age.
Cold feet are an important sign that extra attention should be devoted to regulating the child’s temperature. A baby should have warm feet, warm legs, a warm body and warm arms.
Special attention to warmth also has another significance. A warm environment helps the child to ‘warm up’ for life on earth. However, our motto is not ‘the warmer, the better,’ because always being dressed in too many clothes or being covered up can actually make a child either drowsy or very restless, and overheating can be very dangerous. Detailed research has revealed that there is a relationship between overheating and cot death. Duvets and synthetic materials can especially cause overheating. Therefore we certainly advise against using these.
In our view, the important thing is to learn to observe the needs of the child with regard to warmth, and to read the signs when more or less warmth needs to be provided in the form of clothes, bedding or ambient heating. The body temperature of the child is the most important thermometer, and in a healthy baby, this fluctuates around 37°C (98.6°F). You can learn to take the baby’s temperature with your hands so that you can literally feel how the child is regulating its own temperature. In the first week or two after birth, take the baby’s temperature every day, as well as feeling how warm she is. Then start testing yourself: feel how warm the baby is, then predict her temperature and check with the thermometer for a few days. If your predictions are correct, you will only have to take the baby’s temperature when you are doubtful or if she is sick.
Impressions
Everything we do, feel and think around the child is assimilated by the child. She is still completely open and has a boundless trust in the environment. The buffer which
we have between ourselves and the world as adults is formed by recognising and understanding that world. A small child is not yet able to do this. Up to about the third year, the child identifies with the environment in which she is living in a very natural way. This is followed by a stage in which thinking gradually assumes set patterns, and the child leans to distinguish herself from the outside world. For the first time, she makes a distinction between her own individuality and the world which is perceived. In this light it is understandable that first memories only go back to the third year, and there are no, or very few, memories before this.
The child is one big sensory organ. Up to the third year, all impressions are assimilated in an uninhibited way and disappear into the subconscious. There they are combined with other physical processes, and a sort of print is made; it is as though the child models the influences of the environment in its own `clay.’ Therefore, it is important that we are aware of what ‘goes into’ the child — also for later on.
Example. A child in a boat on the water, experiences the swell, feels the sunlight on her skin and the wind in her hair, smells the odour of water and fish, is taking in healthy impressions which build up the whole organism. The situation is quite different for a child at a department store who is placed in a rotating ship, which goes round and round when a coin is placed in the machine. The child will enjoy both these experiences, but they affect the organism in significantly different ways. The ‘boat on the water’ situation sounds idyllic; this is usually a vacation experience. However, there are also impressions closer to home, which can be constructive and have the above-mentioned character
Positive, constructive impressions are those impressions in which the natural origin of materials, sounds etc, can be perceived by the child. For hearing, these are the sounds of people and animals, and natural sounds such as the rustling of the wind. For sight, they are natural colours. For the sense of touch, they are materials such as wool, cotton, silk, wood, sand and water.
Many domestic appliances such as vacuum cleaners, washing machines, radio, television and plastic toys were created as a result of human technical ingenuity. For children, these are actually an abstraction, lacking in natural connection.
Radio, television and plastic toys are things you can consciously choose to have or not to have in a small child’s immediate environment. With household appliances, you can take care to minimize the sound in the baby’s immediate environment. So-called ‘white noise’
from household appliances is not a good idea for the young child as it blocks out normal impressions. Autistic children can also become obsessed by white noise. Playing a lyre, humming or singing are better background sounds for the child.
Simple actions such as washing hands, or sweeping up with a dustpan and brush in the child’s presence show how things are done. These actions are enjoyable and you can invite children to imitate them.
The feelings of people around the child also have an effect. It is obvious that a child will thrive best in a genuine atmosphere of joy and warmth. This has a positive effect. But there is not a parent in the world that is always cheerful and relaxed at every moment of the day (and night). It is worth aiming to achieve these qualities, but at times when you do not succeed, you must take them for what they are — also real human emotions. In every family there are days when everything goes pear-shaped and the ideal image of a happy family seems a long way off. Humour is always a good remedy. It can be a relief if you can laugh about yourself and the situation.
The needs which were mentioned above — that is, the need for boundaries, warmth and positive impressions — make great demands on the environment. It means that parents must have clear insight and a good level of empathy to get things right: too cold or too warm, too many im-pressions or too quiet, well-protected or not enough room to breathe?
From this point of view, we would like to discuss a number of practical aspects of childcare.
Clothes
Clothes are like a second skin, which support the functions of the skin. The skin helps to regulate body temperature and protects us from infections. In addition, the skin is a sensory organ with which we perceive the environment. These three functions are most effectively supported with clothes made of wool, silk, cotton or hemp. These fibres are preferable as they provide sense impressions from a natural source via the skin, which help the child to build up its body. Other fibres are more alien, and even viscose, which is made from cotton or wood, is processed quite strongly, in a way which is now known to be quite polluting.
Wool
Sheep’s wool protects the sheep from heat and cold, rain and toxic waste. The curls trap the warm air around the sheep’s skin. The wool keeps out the rain, and waste products are absorbed and emitted through the wool via perspiration.
All these qualities are found in woollen clothes. The warmth of the wool protects the child from cooling down too quickly and supports her unstable heat regulation system which cannot yet retain body heat.
Its absorbent capacity (30 to 40%) ensures that the child remains comfortably dry. The quality of the wool depends on the age of the sheep, the animal’s diet and health, as well as the way in which the wool was turned into clothing.
Finely knitted woollen vests are available, which forma soft, flexible outer skin. Woollen jumpers and cardigans should be loose fitting so that they are easy to put on and take off. Woollen pants are wonderful to use over cotton nappies. They can be knitted easily, preferably from slightly greasy sheep’s wool, and are ideal for absorbing moisture and neutralizing the waste products in urine.
A woollen shawl will keep the baby warm when there are fluctuations in temperature. Woollen socks will also keep the feet nice and warm. Furthermore, wool does not attract dirt, and therefore woollen clothes do not have to washed as often as cotton clothes, though they do have to be aired regularly.
Silk
The silkworm spins its cocoon of silk thread, in which the worm is sealed off from any negative external influences. The silk is made under the influence of sunlight — at sunset, the silkworm stops spinning, and at sunrise, it starts work again.
If you use silk in clothes, you will feel its enclosing qualities. Furthermore, silk can absorb 30% of its weight in moisture without feeling damp. In addition, silk retains heat when it is cold and releases heat when it is warm. That is why silk is worn especially in summer. Silk and, in particular, knitted silk is an excellent basic material for vests, but it is advisable to put a woollen vest over the silk vest as well.
Children who are sensitive to wool against the skin, and children who are very sensitive to impressions and consequently become restless, will benefit from wearing a silk vest.
Cotton
Cotton is widely used nowadays for children’s clothes, especially as this material can be washed so easily in the washing machine. At the same time, it should be said that it actually has to be washed often because it attracts dirt easily. Cotton can absorb 20% of its own weight in moisture.
As cotton cannot absorb heat, this passes easily through the material to the outside air. Consequently, this material is not the best choice for a child’s underclothes throughout the year. Furthermore, the way in which cotton is grown is not particularly environmentally friendly, and chemical products are often used in the treatment of the material. Fortunately, there are several eco-cotton projects which now promote its environmentally-friendly cultivation and processing, and eco-cotton is becoming increasingly available in shops and over the internet.
We suggest dressing the baby in at least two layers of clothing, covering the whole body, including the arms, legs and feet. This produces a layer of air between the two layers which retains heat. In a temperate climate, a long-sleeved woollen vest — or a vest of wool and silk — can be worn for most of the year.
In practice, we regularly find that babies are not dressed warmly enough, and they are often restless and troubled by stomach cramps, or they are constantly crying. The simple remedy of dressing the child more warmly, in better fitting clothes, will do wonders for this.
Bonnets
Unfortunately, bonnets are no longer in fashion. In comparison with the rest of their bodies, little babies often have an enormous — and sometimes rather bald — head. The head is constantly losing heat, which should really be retained for the development of the brain and organs. On the one hand, a silk bonnet will retain the baby’s heat, and oil the other hand, it protects the head and the open fontanel from a restless environment. It is important for the forehead to be free, because this part of the body acts as a sort of thermostat for regulating body heat. Where it is often windy, it may also be necessary for the baby to wear a second bonnet made of wool. There are wonderful bonnets on sale, or they can be knitted in material which is so soft that it is like a second skin.

Bonnets can be removed when the child is in the cot as long as the baby is well protected.
Wraps and swaddling
Because of the need for boundaries, it is understandable why many babies, as well as older children, calm down and fall asleep easily when they are firmly tucked in, or if they are wrapped up or swaddled.
Usually, babies have a flannel sheet wrapped around them, during the postnatal period, but this often disappears, to be replaced by a babygro/sleepsuit. We recommend continning to use a swaddling cloth and wrapping it firmly around the babygro/sleepsuit before putting the baby to bed (see illustration). As the baby still lies with its arms and legs bent, it should be swaddled in this position, to increase the sense of security. The baby can now relax and will fall asleep warm and snug. However, you must make sure that the baby is not wrapped up too warmly (see p.25).
The woollen wrap can serve as a blanket outside the cot for when the baby is fed. When the woollen cloth is no longer sufficient, use a (woollen) baby sleeping bag for in bed.

Children who remain restless and have difficulty falling asleep despite being wrapped up, as well as babies who do not establish a good rhythm of drinking/sleeping, may benefit from the old-fashioned method of swaddling in which the arms are also wrapped up so that the child cannot flail about. Flailing is often a response to crying, cramps or fright, but because it is involuntary, it can cause new restlessness. Swaddling can help to break this vicious circle.
Many parents find it difficult to restrict their baby in this way; in our age of boundless freedom, it is not so easily accepted. However, parents usually overcome their resistance when they see how the baby responds to swaddling. For most babies, it results in a much greater sense of peace, and consequently they sleep well and establish a pattern of sleeping and feeding every few hours. Nowadays, two methods of swaddling are recommended: either ready-made swaddling blankets or swaddling wraps, or using the method shown at the back of this book (see p.108). (See also Blom, Crying and Restlessness in Babies.)
The cradle
The cradle is an important successor of the smallest home in which the baby lived before birth. You can opt for a basket cradle (Moses basket), a wooden (rocking) cradle or
a cot. For safety considerations, the baby’s feet should always be placed at the end of a cot, with its head halfway down. Tuck in the blanket in such a way that the head is free and the shoulders are covered. A hood or canopy over the cradle or cot makes the space more intimate, so that the child is not distracted by the environment and can sleep more peacefully.
For the canopy, it is best to use plain materials in soft colours. A canopy made of light blue silk combined with a layer of pink silk gives a very subtle calming colour.
The mattress must be absolutely flat, providing good support, and it must be well-ventilated and warm. Our preference is for a mattress of kapok, cotton or another natural material. A sheep’s fleece can be placed on the mattress. The fleece is soft and gives a beneficial warmth so that the newborn baby is protected from cooling down too quickly. Make sure that the fleece is not too large and lies on the mattress without any folds. Cover the fleece with a sheet. The bedding should be made of cotton and wool. Do not use synthetic materials. The sheets and blankets should be big enough to tuck the baby in quite firmly. The fleece and the mattress should be regularly aired. If you use a woollen wrap there are likely to be patches of damp under the mattress. If necessary, use a waterproof sheet. There are cotton sheets available that are impregnated with rubber and do not feel clammy. We do not recommend the use of duvets, even those made of wool, because of the risk of suffocation.
If the cradle is next to the window, watch out for overheating in the sun. A baby can easily become too hot in a heated room when the sun shines through the window.
The playpen
Up to the age of four months, it is not really necessary to have a playpen. Nevertheless, when the baby is downstairs, it is a good idea to have a safe place to place it. A wicker basket with a soft cover, or the bed of a pram, are quite suitable.
We do not recommend the frequent use of a baby seat or recliner, as the baby is stimulated by the ac-
tion of sitting in an upright position at a stage when he is still physically immature. The baby can only lie passively in a baby seat, which does not matter for a short period, but is harmful to physical development in the long term.
This objection does not apply so much to the use of a recliner, but there are other objections; when the baby discovers that he can bounce the recliner with one leg, he often finds it difficult to stop, even when he gets tired of the mechanical movement.
When the baby starts to reach out for things and becomes more active in its motor development, it is time for a playpen. Quite apart from the fact that this provides a safe place for the child to learn to sit and stand, it is often a favourite place for being quiet and for playing undisturbed. A cloth cover, like a curtain, along three sides of the playpen will increase the sense of security, and is not to be confused with cot bumpers, which are not recommended as they pose a suffocation risk for the young child. For motor development, it is important that the floor of the playpen is sturdy and not too smooth (for example, a cloth folded double), so that the child can roll over and can put pressure on it.
Walkers and baby bouncers
We emphatically advise against the use of walkers and baby bouncers. These are ‘aids’ which speed up the child’s motor development in an unnatural way. Children certainly like to use these things — especially if they can move around in them quickly — and want to use them more and more. However, it is much better for a child to learn to stand and walk at his own pace. In this sense, walkers and baby bouncers do not help healthy development in any way, and are actually more of a deterrent to healthy development.
Prams and baby carriers (slings)
The pram can be a safe and sheltered place in which the baby can sleep outside during the first few months. For walking, a baby carrier is often a better alternative because it means
that the baby moves in time with the pace at which the adult is walking, and is not shaken about so much as in a pram, as it goes up and down the pavement. The child is carried in a natural position in a baby carrier (sling), (see the illustration on p. 106).
However, at this point a warning should be given. It has been shown that babies can become too hot and stuffy, particularly if carried under a coat. Unfortunately, there are even a few cases, which resulted in a baby’s death. We recommend that you keep a careful eye on a baby in a baby carrier, and if possible carry it on top of a coat rather than underneath, with, if necessary, a woollen cloth around the baby.
The disadvantage of a baby carrier in which the baby is in a vertical position is that the baby did not take up this position itself. In this sense, the baby carrier is not for babies until they reach the age of nine months. A sling is preferable, as the whole back and head are supported, although it might be tiring for the mother to carry.
When a baby has reached the age for a pram, the best model is one in which the baby faces the parent. In this way, the baby constantly has the comforting face of its father or mother in front of it, and can find out from that face what is happening in the big wide world. A traditional pram has the advantage that the child lies flat, as at this age the baby’s head is still relatively heavy and the neck cannot keep the head in a stable position. We recommend a buggy only from the age when the child is able to sit unassisted.

The Baby Clinic
When a mother is expecting a child, this is the beginning of an exciting period; a time of ‘expectation,’ followed by the birth and the baby’s first year. It is a special event every time, but particularly with a first child. Parenthood is `born’ along with the child, bringing all sorts of new tasks and experiences with it.
Baby clinics are located at health centres in virtually every town, and have the important task of monitoring the children and helping parents to look after their young children. In addition to ordinary baby clinics, there are also some clinics based on the approach used in anthroposophical medicine. In general, these are linked to anthroposophical medical practices.
All the work of these clinics is concerned with providing preventative care for children from birth to the age of four or five years. In general, this means providing help and support for parents to promote their child’s health.
The doctor and nursing staff at the clinic devote their attention to the physical and psychological development of your child. They ask questions and examine the child to check for certain disorders: for example, growth or psychomotor disorders; disorders or malfunctions of the cardiovascular system, lungs, kidneys and reproductive organs; ear, nose and throat disorders-, disorders of the abdomen, arms and legs; disorders of the teeth, and visual and hearing disorders.
At anthroposophical baby clinics, the constitutional characteristics of the child are also examined, and the personal characteristics and features, which might indicate a particular approach for medical and/or educational measures, are considered. After all, no child develops in accordance with the statistical norm. It is only by examining the individual developmental opportunities and problems of a child that it is possible to give appropriate advice. This is not so much a matter of preventing disorders, but of helping to ensure that the various developmental stages of the child follow each other in an appropriate way.
In addition, the baby clinic is an important place for parents to ask questions, as advice is offered on different subjects, including feeding and growth, upbringing and looking after the baby, physical and psychological development and the issue of inoculations.

The advice on children from birth to one year which you will find in this book is in line with the care provided by anthroposophical baby clinics, and may differ from the advice given by ordinary clinics, and is related to the views held by the doctor and nursing staff regarding the developing child. In Chapter 2 of this book you will find the viewpoints which form the background for the practical advice. This may be helpful when you want to make your own decision in a particular situation. However, this book serves to supplement rather than replace the supervision of the baby clinic. Whichever clinic you choose, it is important that you discuss any concerns you have, and express what you want, at the clinic.
We hope that the various subjects discussed will encourage a conscious approach to parenting and be helpful with regard to understanding, and living with, a developing child.

Pregnancy
Dufing pregnancy, the mother-tobe is in a very special condition, both physically and psychologically. There are all sorts of indications of a reduction in her level of consciousness, which may be manifested by drowsiness, diminished powers of concentration, dizziness, light-headedness and a floating sensation. At a physical level, there is a loss of muscular strength and a loss of tension in all the involuntary muscles. For example, the intestines work less effectively, which can result in constipation. There may also be changes in the action of the kidneys, blood pressure and pulse.
In a way, this whole condition resembles sleep. You could say that a pregnant woman floats between a waking and sleeping state and feels dreamier than she did before. Nevertheless, many women feel very well and active at the same time.
Pregnancy can be divided into three terms, each of roughly three months’ duration.
In the first three months, the woman’s organism has to be ‘transformed’ into a pregnant condition, or, as described above, the organism has to achieve a state between waking and sleeping. The fact that this is an intensive change is clear from the fact that the first three months of pregnancy are usually accompanied by nausea, vomiting and tiredness. It is during these months that the egg is fertilized, becomes embedded in the womb and the foetus starts to develop. It is a relatively vulnerable period of pregnancy in which miscarriages are fairly common (10%). See p.102 folic acid.
The second three-month term is usually the easiest. The pregnant woman becomes used to her condition, can do all sorts of things and does not experience much physical discomfort from the foetus. The foetus has become ‘firmly established,’ as is shown by the small number of problems during this period.
During the third stage, the physical manifestation of the child becomes increasingly clear, with a large stomach being the first sign of this. The discomfort which a pregnant woman experiences when bending down, urinating, feeling full after a meal, being unable to move, run, laugh and sit, reveals that the child has a clear physical presence. The foetus now becomes more vulnerable again. There may be bleeding or even a premature birth. At the end of this period, birth is often experienced as a real release.
When the woman has given birth, all the symptoms of the condition between waking and sleeping gradually disappear again. Only if she breastfeeds will this process be slightly postponed.
An overview of pregnancy reveals that the pregnant woman achieves a condition where she ‘makes way’ for the child to come; in which the child establishes a place on the way to birth. In a way, the expectant mother becomes less ‘earthly,’ while the child becomes increasingly ‘earthbound.’ From this perspective it is, therefore, not surprising that expectant mothers experience moments of contact with their unborn child. After all, both are in an ‘interim state;’ a state between the earthly world and the world that the child is coming from.
If we try to approach the woman’s pregnancy in this manner — taking the idea of ‘making way’ seriously — it is clearly understandable that during pregnancy a woman often finds it difficult to tolerate direct
confrontation with the world around her, and even tries to avoid it altogether. ‘Listening’ to her inner self is the best guideline.
It obviously goes without saying that alcohol and smoking should be avoided because they are known to affect the development and growth of the unborn child, and medicines should only be taken after consultation with the doctor. In addition, a natural, healthy and varied diet is clearly important for both mother and child.
To prepare for breastfeeding, it is a good idea to apply Weleda iris jelly to the nipples every day to prevent the skin cracking during breastfeeding. Stretch marks are largely dependant on genetic factors. However, it makes sense to keep the skin, particularly around the stomach and thighs, supple during pregnancy, by rubbing the skin twice daily with Weleda arnica massage oil. If there is a sensitivity to arnica, it is possible to use Weleda calendula massage oil.
The birth
Experiencing the birth of a child is one of the most intimate experiences in life. Feelings of astonishment, joy, anxiety, fear and fulfilment are experienced to extremes during the birth. Obviously these are most intense for the woman who is having the baby, but the family members and obstetric staff attending her fully share in the intensity of feeling.

It starts with the excitement and anticipation of what will happen when the waters break or the first contractions start. Getting everything ready, the support and help of the midwife during contractions, the constant question of how far the process has advanced — these are all part of the active and busy atmosphere of birth. However, sometimes there are also moments of near serenity and tranquillity; an atmosphere of relaxation, trust and complete surrender to what is to come.
The birth takes place in these recurrent and alternating periods of intense activity and intense tranquillity. Everyone attending the birth finds that a unique atmosphere develops as a result of these alternate emotions, which can go on for many hours. It is an incomparable atmosphere, evoking feelings of deep wonder and awe.
The focal point of everything that is going on is the mother-to-be. She is in touch with the deepest natural forces in her body, and is in danger of being overwhelmed by these natural forces, with an intensity which rarely occurs in life. She may also feel that she does not have the strength to give birth on her own, and may be very grateful to accept the instructions of the obstetric staff, so that the sense of impotence can make way for a sense of trust in the successful end of the birth.
When the cervix is fully dilated, the moment arrives when she can
THE BIRTH    15
use all her strength to help the child to be born by pushing it out. Just before this moment, it is quite common for the woman’s consciousness to be almost overwhelmed, and then return quite vivdly with the first push. This stage of pushing the baby out is extremely hard work, even though sometimes it only requires one big contraction.
From the moment that the baby’s head emerges, the atmosphere changes immediately. All attention is focused on the delivery of the rest of the baby, who eventually experiences light, air and gravity for the first time, is placed on its mother’s stomach and swaddled in warm nappies (diapers). If not giving birth at home, you should check with your midwife or consultant to see if it is possible to have a warm cloth to swaddle the baby in. All eyes are on the baby; the noises, movements, eyes and hair. Everyone feels an urge to touch the baby and stroke it.
Then the obstetrician focuses on the last part of the delivery: cutting the umbilical cord and delivering the placenta.
The whole birth is only really complete when the mother has been washed and cleaned up, and is holding the pink, warm, swaddled baby in her arms, and is surrounded by everyone who was present at the birth. The whole spectrum of emotions is experienced, together with a sense of satisfaction, gratitude and respect for the forces that play a role in the birth process.

The birth described above is probably the birth every parent dreams of. And yet, no two births are the same. The life of every person starts with a unique event; the delivery. Some children have a difficult start, for example, if the birth was induced too early, the baby was born prematurely, or if the delivery involved a great deal of medical intervention. In the UK most babies are now born in hospital, but it is possible to discuss your birth plan beforehand with your midwife or consultant.
For parents, the fear about the baby’s health or being overwhelmed by a premature birth can obstruct the feelings of wonder and gratitude described above. Sometimes it may be a while before you can start to love your child in a relaxed way and feel an obvious connection with it, particularly if you feel unsure or anxious. This takes time, so you must try and take the time that is needed. If you were admitted to hospital, you can organize a sort of second birth experience, so that when the baby comes home, you can get used to each other, feel each other, and build up a new life together. Many parents have described that this helped them to recognise the healthy aspects of the child and his lust for life.
Parenthood
The birth of a child is an intense experience for the parents, particularly
the birth of their first child. In fact, it brings about many changes. Before the birth the parents had a relationship with each other, and after the birth they have suddenly become parents and formed a family. Obviously, they still have a relationship, but the partners no longer relate exclusively to each other. In particular, the mother focuses body and soul on her child. After the birth it may be a very long time, sometimes as long as a year, before she feels her old self. Consequently, owing to the new situation in which they find themselves, parents have to redefine the way in which they relate to each other.
This process is extremely demanding because the father and mother are involved with the child in very different ways during pregnancy and birth, and during the initial period after birth. The father may have a tendency to continue his old life with some modifications, while the mother has a deep sense that everything has changed. It may be a while before the partners find a new way of relating to each other on the basis of these two different worlds of experience. It is important to take time for this process and talk about it together from time to time.
What was described above applies particularly for the situation in which mother, father and child(ren) form the family. Where there is a one-parent family from birth, this process will particularly concern the mother.

After the birth, another process starts as well in that all parents discover themselves in a new way. They experience new positive feelings, although they can also have a negative character. A child brings happiness and joy, but there are also moments when irritation reaches unimagined heights.
In the whole range of emotions evoked by a child, feelings of anxiety have a special place, giving rise to questions such as: Am I doing it right’? Will anything happen to my child or me? Will everything be okay?
Every step in the child’s development is another step out into the world. From the age of three, the child even ventures beyond the horizons of the parents; he walks around the block or goes to school for the first time.
Some people are more sensitive to these anxieties than others, but since this anxiety is fruitless — and can really make life difficult for a child — something should be found to counterbalance it. Sometimes gaining an insight into the situation helps to diminish the anxiety, but often this is not enough. In order to tackle the anxiety in a structured way, it may be necessary to work on strengthening the parents’ confidence. Obviously this does not mean blind faith that ‘everything will probably be alright.’ It is not as simple as that. It means that it is possible to work on the confidence about the direction in which the
PARENTHOOD    17
child is moving, even though unexpected and undesired events may play a role. White anxiety is often ,our own problem,’ confidence can become a strength, which allows the child to flourish; having confidence in someone gives them the strength to grow.
In addition, a child often gives us a new sense of self-awareness: with his behaviour and imitations, he holds up a mirror to his parents. From the age of a few months you will see that a child assimilates the world by imitating it. The child copies everything he encounters, both internally and externally. For parents, this means that what they do and how they do things is important. Whether we do things hastily or with care, whether we do things unwillingly or with joy; all these aspects permeate the actions we perform and are unconsciously assimilated and imitated by the child. This also applies to what we say. Long before the child can understand our words, he will be aware of our intentions. Experiencing this, and occasionally having the things which we do and say, and how we do and say them, reflected by a child will lead to self-awareness, and possibly to a change in our way of being and doing things.
In positive terms, a child stimulates us to develop ourselves as well. There is also a third process. By experiencing the development of a small child and feeling co-responsible for him, it is possible to focus on your own childhood. Some things from your own childhood can lead to the feeling that ‘I want to do things for my children like that as well,’ while at other moments, you feel that ‘I want to spare my children this or that.’ Sometimes this encounter with your own past can be quite intense. It’s good to know that it is not unusual.
Just as we re-examine our own past, we also start to have a different
view of the future; in a sense looking to the future through the child. The future shines through the small child and urges us to determine the structure for that future.
Above, we have highlighted a number of the issues which will confront every parent; the redefinition of the relationship with their partner and other members of the family, a redefinition of themselves, and a new view of the past and the future.

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

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

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

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.

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!

What can I do to help?
partners at the birth
Should I be with my partner as soon as she goes into labour? I’ve heard that first babies take ages.
It’s true that first labours often take quite a few hours, although this is certainly not the case with everyone! When your partner notices signs that labour is beginning, such as a mucousy ’show”, the waters breaking, or irregular period-type pains, she may wish you to be with her. On the other hand, she may be happy to be alone, or with a friend or relative,
and keep you updated by phone Whether or not -you are there really depends on how she feels so good communication between the two of you is the key.
Once your partner is having regular, painful contractions about every five minutes, it would probably be best to be with her, if you aren’t already It is usually around this time that you should be making your way to hospital, if that is where you are planning to have the baby, or contacting the midwife if you are planning a home birth.
I feel very panicky about getting my partner to hospital on time. How can I calm down?
Your anxiety is understandable. However, not many babies are born on roadsides or in hospital car parks — that’s why these stories make their way into newspapers and magazines! It is hard to advise on a definite time to go into hospital as every labour is different and follows a slightly different pattern. However, as a general rule, you should think about going in to hospital if:
•    Your partner has had any vaginal bleeding.
•    Your partner’s waters break (see p.167), She may notice this as a gush of fluid from the vagina, or a more gradual leaking.
* Your partner’s contractions (which are often described as strong period-type pains that are
accompanied by a hardening of the bump) are lasting around 45 seconds each and coming regularly, at least every five minutes.
If you or your partner are unsure about how to proceed, don’t hesitate to give the labour ward a call. An experienced midwife can tell a lot about how far into her labour a woman is likely to be just from talking to her about what is happening.
I’ve heard lots of stories about blokes in the labour ward - I want to be helpful, but I am nervous.
Many men are very anxious about being with their partners during labour and birth. This is often due to the fact that they will be watching their partner experience one of the most intense things a woman can ever do and they may be unsure of how to help
Probably the best way to help overcome your fears is to talk to your partner about how you feel and try to discuss ways in which you could help. You will probably find that there are plenty of ways in which you can support her, such as being aware of her wishes and speaking for her if she is unable to because of the pain, repeating what midwives and doctors have said if she didn’t hear or process the information, passing her a drink, rubbing her back, holding a flannel to her face, switching music on or off, and generally encouraging and reassuring her.
Attending birth preparation classes together can be very useful You will be able to learn more about the process of labour and birth, which can be helpful, and you will learn about how to support -your partner both physically and emotionally. Some classes teach birth partners massage techniques that can be an effective form of pain relief during tabour You will also be shown how you can support your partner in certain birth positions. Your partner’s midwife will be able to advise you on classes available in your area.
I really don’t want to be there - how will I tell her and who should go in my place?
Honesty is the best policy, so you need to talk to your partner about your concerns well in advance of the big day. Although she may feel disappointed at first that you don’t want to be there, she should appreciate your reasons if they are valid ones. Perhaps you could try to reach some sort of compromise whereby you will be with her during the earlier stages of labour, go out for the actual birth (if you are worried about this), and then come back in again straight afterwards to support your partner and meet your new baby
It is up to your partner who else she has with her during labour Women often choose their mum, sister, another female relative, or a close friend to be with them However, if she can’t think of anyone suitable, you may want to consider hiring a doula, who support women in labour (see p. 196); there are websites that can help you with this (see p.310). Your partner may also wish to have more than one birth partner, which most hospitals are happy to accommodate.
What should we do when my partner goes into labour?
Although it is often hard to define when labour has started, if the signs are that your partner is in the early first stages of labour (see p.167), you can both continue with normal activities as long as she feels comfortable. Being aware of how labour progresses and how contractions build up can help you to plan your course of action. For example, if your partner’s waters have broken, established labour usually follows within a few hours (although not always) and it is best to inform the hospital
While you wait for the contractions to become stronger and more regular, try to relax as much as possible between contractions You could make a healthy snack for you both to provide fuel for the hours ahead, practise breathing and relaxation techniques together, or run a warm bath to help your partner relax Once the contractions are around every five minutes and last about 45 seconds, you may wish to consider going into hospital, if that is where you are planning to have your baby. Ring the labour ward first to let them know what is happening
Is massage useful, or will my partner find it irritating when she’s trying to cope with the pain?
Many women find massage, particularly of the lower back to be very helpful during labour. The sensations of warmth and pressure can be soothing and give some relief from pain during labour. Massage stimulates the body to release endorphins, which are the body’s natural painkillers, and also acts as a ”distraction” from pain, providing another focus Communication is the key when it comes to massage. For example, your partner can tell you whether she wants to be massaged during contractions. or just between the contractions, or whether she wants firm or light pressure. You will probably learn simple massage techniques during birth preparation classes, or you may find some classes dedicated to massage techniques for labour. Ask the midwife what is available in your area
It can be the case that some women find that they do not want to be touched at all during labour If your partner feels this way, try not to take it personally -this is her way of dealing with the pain
Apart from massage, are there other ways I can help my partner cope with the pain?
Every woman’s experience of pain during labour is different, and they will have different ways of coping It can be difficult to know in advance if a particular coping technique will help, but many couples find
it helpful to talk before labour about how they might feel, and how the partner may be able to help. While some women find massage beneficial (see above). others will need help to focus on keeping their breathing slow and steady It’s worth practising labour positions that require the support of a partner before the actual birth (see p.182 and p 186). Having some favourite music on in the room may help your partner to relax Above all, most women appreciate encouragement and gentle loving support from their partner, and just the fact that you are there will go a long way in helping her to cope with the pain and exhaustion of labour and birth.
My friend’s husband won’t be at the birth. She wants me to be her birth partner. How can I prepare?
It’s a great privilege to be asked to be a birth partner for a friend and there are plenty of things you can do to prepare for the event. Obviously you will need to talk in advance about your friend’s expectations for labour and familiarize yourself with her birth plan if she has prepared one (see p 149). It’s important to be sensitive to your friend’s wishes, for example does she want you to remain with her throughout, or would she like you to leave the room if she has an internal examination? Talk to her about how she thinks she might react under stress and in pain - is she likely to shout or perhaps become more withdrawn? - so that you can prepare yourself mentally to deal with this. It would also be wise to find out as much as possible about what birth entails - the different stages of labour and what can help or hinder them. You could suggest attending antenatal classes with your friend so that you feel fully informed. It may also help to talk to someone else who has been a birth partner and who may have some useful tips. Bear in mind that you may need to be with your friend for a fairly lengthy amount of time. so you may want to have some provisions for yourself, such as snacks and drinks. You may also need periods of relief during the labour, and there may be times when you feel your morale is flagging. in which case it can be a good idea to have someone on standby who you can phone for encouragement and support.
How will I feel when I see a male doctor examine my partner? Will I feel jealous?
If labour and birth are straightforward, it is unlikely that your partner will need to be examined by a doctor. It is only if there is some concern over the wellbeing of either your partner or the baby, or both, that a doctor’s opinion is sought Even in this situation, an internal examination is not always necessary.
If your partner did need to be examined, you would probably find that you would be too worried to be aware of any feelings of jealousy Doctors, whether male or female, have only your partner’s and baby’s health in mind when they are performing any kind of examination.
I secretly want a boy - I haven’t told my partner - how will I cope if it’s a girl?
This is certainly not an unusual feeling to have and I think that many prospective parents have a preference, secret or otherwise, for a baby of a particular sex While it may take you a little while to become accustomed to having a baby of your less preferred” gender, you may well find that you have no problems at all bonding with the baby if it is a girl Seeing your own newborn baby for the first time is something that no-one can prepare for, and many parents feel a strong rush of emotion straight away. Others take a little longer to fall in love with their baby, and this is fine too.
Whichever sex your baby is, it takes time to get to know him or her. You will probably find that you relish watching every little movement and expression,
touching and stroking his or her little body, and will enjoy learning about all the different aspects of baby care. By being involved with your baby from the beginning, you will quickly experience the joy of parenting your son or daughter
I can be quite panicky in stressful situations. What if I pass out?
The image of the father-to-be fainting onto the floor of the delivery room is often portrayed in cartoons and on birth congratulation cards, but it is far from funny if it actually does happen! Fortunately, it is probably much less common than you may think.
It is understandable for any birth partner to
feel anxious and tense — you are watching someone you care about in pain, and you are m unfamiliar surroundings experiencing probably the most significant moments of your life! Focusing on your partner and attending to her needs may help to keep you occupied and distracted and less likely to dwell on your own anxieties. Also, developing a trusting relationship with your partner’s caregivers will help you feel able to express any worries you are having, and hopefully you will be given the reassurance and information you need
If you do find yourself feeling even the slightest bit woozy, try and leave the room as the midwife will be focused on caring for the mother and baby If you do not have time to leave the room to seek help, and you feel faint, dizzy, or light-headed, try to sit down immediately, with your head lower than your hips, or lie down with your feet raised Try to stop yourself “panic breathing” (breathing quickly and lightly), and take slow, deep breaths You should find that the feeling passes quite quickly. The midwife will probably ring the buzzer for assistance. A good tip is to ensure that you are not too hot — take shorts and a T-shirt with you as delivery rooms can be quite stuffy — and make sure you eat and drink regularly to prevent your feeling faint due to low blood sugar.
Our little boy suffered a lack of oxygen at his birth. He is fine, but I’m anxious about this delivery.
Unborn babies are designed to cope with a moderate lack of oxygen during the birth, which is quite normal Some babies do suffer a greater lack of oxygen, and midwives are often alerted to this by observing the baby’s heart-rate pattern If there is any cause for concern, the baby can be delivered quickly either by forceps or ventouse, or by a Caesarean section In most cases, the baby is born in a healthy condition, or responds quickly to resuscitation after the birth.
Every labour is different and there is no reason why your next baby should react to labour in the same way as your first, but your baby’s heart rate will, of course, be monitored very closely, so you should feel reassured by this.
Will I be able to help the midwife cut the cord after the birth?
It is popular for the baby’s father, or another birth partner, to cut the umbilical cord after the birth. Midwives and doctors are usually happy for this to
happen, as long as there are no problems with the mother or baby that would necessitate the cord being cut very quickly
The cord is tougher than most people think, but the midwife will guide you and show you how to cut it safely. Be warned that it usually takes quite a few attempts to sever it completely!
Will I be able to video or photograph the birth and do I need to agree this in advance?
Most hospitals are happy for you to film or photograph the birth of your baby if that is what you both want However, before you embark on this, you should first check that the midwives or doctors who will be conducting the actual delivery have no objection, as some professionals do not wish to be filmed for legal reasons.
While some couples treasure having a visual record of probably the most special and momentous time of their lives, other couples prefer to start filming or photographing their baby after the actual birth. It is important to consider the impact that being filmed or photographed at such an intimate and vulnerable time could have on your partner, and she should not feel in any way pressured to be filmed Also, it might be worth thinking about how filming the event may affect your actual participation in the birth. If you are concentrating on filming or taking photographs, you may not be as involved in the birth as you could be and may not be providing your partner with all the support that she needs.
When planning how to record the birth of your baby, bear in mind that clear communication between you and your partner before the labour, and with the midwife and doctor once labour has started, is important to ensure that everyone’s wishes in this matter are respected
Can we take food into the delivery room?
Most hospitals are happy for you to bring your
own food and drink into the delivery room, although most are able to provide your partner with light refreshments should she want something It used
to be the case that women in labour weren’t allowed to eat or drink, but nowadays this is not the case. Research on the subject has concluded that it is perfectly safe for women to control their own food and drink intake during labour
However, hospitals don’t tend to provide food for birth partners, so it would be wise to pack plenty of snacks There is usually a canteen on the hospital campus somewhere but getting supplies from there may mean you are away from your partner for a time Alternatively, vending machines may be available.
What and how much your partner eats should be guided by her appetite. She should try, however, to stick to light, easy-to-digest foods that will give her plenty of energy, such as fruit juices, bread and honey, dried fruit, digestive biscuits, or bananas. Once labour is well established, it is likely that she won’t feel much like eating as her body needs to focus on delivering the baby,
I’ve heard that natural or water births are best for the baby. Should I ask my wife to have one?
Most childbirth experts would agree that a straightforward vaginal birth is the safest form of birth for both mother and baby. It is also generally considered safe to use water as a method of relieving the pain in uncomplicated labours (see p, 156) However, it is sometimes not possible to achieve a straightforward vaginal delivery due to certain situations that can arise during pregnancy, labour, and/or the actual birth If a problem with either the mother or baby occurs, the medical team will advise on the safest way of delivering the baby.
It is important that your partner thinks herself about the type of birth she would prefer and does not try something she is uncomfortable with. So it is not really your job to make decisions on behalf of your partner, and it’s also wise to be prepared to be flexible and to see how labour unfolds.
My wife doesn’t remember much about the birth. How much should I tell her?
It’s best to be honest about your memories of the labour and birth, even if this was a daunting experience for you both. You are likely to be the best person to explain to your partner about how she coped, and sharing your memories may help her to feel comfortable about expressing her own emotions about the birth, particularly if it was fairly traumatic. In this case an important part of your partner’s (and your) acceptance of what happened during the birth is to recall the sequence of events and to try to understand why things went the way they did This is especially important if you feel that your partner’s care didn’t go according to the birth plan. If this is the case, you may even want to talk to the midwife who cared for your partner during labour and birth about what happened. You can ask her to go through your partner’s notes with you both and explain exactly what happened. You can also ask for a postnatal ”briefing” to discuss the birth by contacting the head of midwifery at -your local unit.

Extra birth partners

Most hospitals are happy for women to have more than one birth partner, although some do set limits, depending on the amount of available space.
* It’s common for women to have their mum, sister, or close friend with them in addition to their partner.
* If labour is particularly long, having more than one birth partner can mean that they can relieve each other for breaks knowing that the mother has someone with her, * Some evidence suggests that having a female birth partner reduces the amount of pain relief and intervention needed.

Birth partners
The aim of a birth partner, whether this is your husband or life partner, a friend, family member, or hired doula, is to offer practical and emotional support to you throughout labour and birth.
How can birth partners help? As a birth partner’s role is to support you through labour and birth. it is important that they are aware of your wishes and are prepared to liaise on your behalf or keep track of events when you are not able to. It is important that they are knowledgeable about the stages of labour and have discussed with you in advance ways in which they might help, whether through practical support such as massage or helping you with labour positions, or by offering you encouragement and reassurance
What is a “doula”? Doula is a Greek word that means ”woman servant” or ”caregiver”. Nowadays, this refers to someone who gives emotional and practical support to a woman before, during, and after birth. The aim is for a woman to have a positive experience of
pregnancy, birth, and early motherhood This help and support is extended to the partner and other children Doulas can offer support in pregnancy which gives time for the family to get to know her, In labour and birth, she can help with massage, suggesting different positions, liaising with professionals, and giving emotional support. After birth, doulas can help with feeding and baby care, as well as care of the mother, Some do housework, prepare meals, and entertain older children.

Your role as go-between
One of the most important roles of a birth partner, whether you are the baby’s father or someone else chosen to be the birth partner, is to be aware of what is happening during the labour and birth and to liaise with the medical professionals on behalf of the mother if necessary There may be instances when you or your labouring partner don’t understand why a certain course of action is being taken, and your partner may be in too much pain, or too preoccupied with labour, to be able to ask.Your job is to talk to the midwife or doctor and gather information about what is happening. This means that you will both feel fully informed about what is happening in labour and will be able to participate in any decisions that have to be made about the labour or birth.

Remaining calm

Even though the birth of your baby is one of the most memorable and exciting events of your life, it can also be hard to witness your partner’s pain and to stay calm under pressure. * Being mentally prepared to see your partner experience considerable pain can mean that you are more likely to respond in a reassuring, rather than anxious, way. * Breathing and relaxation techniques can help you to stay calm and focused too. * If you do start to feel flustered, it may be wise to leave the room briefly, if there is an opportune moment, to refocus.

How long will it last?
all about labour
How long will my labour last?
This is hard to determine as every woman is different and every labour is different. Also, how long your labour lasts depends on when you start timing it as the start of labour can be a gradual build-up that occurs over a fairly long period of time. Usually, labour is classed as being established when the contractions are regular and getting stronger and do not stop until the baby is born. This, coupled with the cervix opening, are indicators that labour has commenced. During the gradual build-up of contractions, labour is sometimes described as being in the ”latent” phase until it becomes more established. This latent phase may last for a period of around 6-8 hours in first-time mothers.
As a general rule, if this is your first baby -you should expect to labour for around 12-24 hours in total. If you have had a baby before, your labour may be a lot quicker, providing there are no other complications, particularly if you have had a vaginal delivery in the last 2-3 years. In some cases, usually with second or subsequent babies, labours can last for only a few hours, or even minutes, and in these situations the mother may not to make it into hospital. The best advice in all cases is to speak to your midwife or hospital if you think labour has started
I like to know what to expect. What will happen when I first arrive at the hospital?
Hospital routines vary, but generally you will be shown to a room on the labour ward, and one of the midwives on duty will come to see you. As
well as asking you about your labour so far, she will probably ask to check your temperature, pulse, and blood pressure, and listen to the baby’s heartbeat. She will also feel your tummy to assess the baby’s position and how far the head has engaged or
moved down in the pelvis (see p. 148) If -your contractions are regular, an internal examination may sometimes be done to reveal how far your cervix has dilated and therefore what stage your labour is at. This information will give the midwife an insight into the wellbeing of both you and your baby. and will help you both to decide on the next course of action. If your labour is in the very early stages, your midwife may suggest that you return home for a while or spend some time on an antenatal ward If your labour is well established, a delivery room will be found for you
How will the hospital check my progress?
An experienced midwife can tell a lot about your labour just by looking at you and observing your behaviour. For example, a woman who is chatting happily during each contraction is unlikely to be in well-established labour. A woman who is in established labour and starts to be restless and nauseous may be in the ”transition” phase; approaching the second stage of labour (see p.183)
Another way in which your midwife will assess your progress is by feeling your tummy to check the strength of the contractions, and also by feeling the position of the baby’s head in your pelvis
Internal examinations also reveal a lot about how your labour is progressing. By placing two fingers gently into the vagina, the midwife or doctor can feel how far the cervix is thinning out (effacing) and opening (dilating), how the baby’s head is moving downwards, and what position the baby’s head is in.
What is ARM, and is it routine?
ARM stands for”Artificial Rupture of the Membranes”. This means that a doctor or midwife, using a plastic ”crochet hook” with a long handle, control while taking gas and air and therefore you may find that you want to stop taking it while you are pushing if it is distracting you too much and stopping you focusing on the contractions Some women manage their entire labour on gas and air alone, while others find that they need another form of pain relief in the later stages of labour.
How will I use the gas and air and is it likely to make me feel sick?
Gas and air is breathed in through a mouthpiece or mask that is connected to a cylinder or pipes in the wall that lead to larger cylinders elsewhere. You administer it yourself, so are more in control of how much you take and when.
Gas and air can make your lips and mouth feel tingly and dry, and in some cases women report feeling nauseous while taking it. Using a mouthpiece rather than a mask may help to reduce feelings of nausea brought on by the smell of the gas and the sensation of having a mask over your face, and taking sips of water may help As the effect of gas and air is short-lived, you only need to use it during contractions; taking gas and air between contractions will not help with the pain of the next contraction and is likely to increase the sensation of nausea.
I want to have a great birth but you hear such awful stories -how can I stay positive?
For every awful birth story there is an equally positive one — it does tend to be the case that you are less likely to hear about the positive birth stories as these aren’t such good topics of discussion! However your labour and birth proceeds, the birth of your baby will be amazing because you will finally meet the little person who has dominated your life for the past nine months.
It is sensible to remain open minded about labour and birth, because it’s impossible to foresee exactly how things will go on the day However, there is a lot that you and your partner can do to help prepare yourselves for labour and birth so that -you
Gas and air
A form of self-controlled pain relief in labour
A mixture of oxygen and nitrous oxide that is self-administered in labour.
Gas and air, also known as Entonox, is taken through a mask or a mouthpiece during labour. This dulls the pain centres in the brain and produce a sense of euphoria This needs to be timed with your contractions as the effects are short-lasting, with the gas being breathed in just prior to and during a contraction. You will feel normal once you stop using it.
Gas and air tends to be the preferred choice for managing pain in women who want to labour as naturally as possible The reason for this is that gas and air has several advantages, including the fact that you can remain mobile and active while using it; it can he used during a water birth; it doesn’t affect the baby in any way; and it doesn’t make you feel drowsy during labour, which allows you to feel more in control throughout and to remain as focused as possible on your contractions. However, although it is a widely available and a popular choice of pain relief in the UK, it doesn’t tend to be used in the United States
have the best chance of having a positive overall birth experience. For example, you can both learn as much as possible about the process of labour and birth so that you can make informed decisions in labour. You can chat with your midwife, read books, find information on the internet, and attend antenatal classes. Also, knowing how labour progresses helps to demystify the experience and therefore removes some of the fear that accompanies labour and birth. Learning basic relaxation and breathing exercises also helps (see p.173), as being able to relax as much as possible during labour helps you to feel less anxious, which in turn can help the labour to proceed as quickly and smoothly as possible tears a small hole in the amniotic membrane that surrounds the baby and contains the amniotic fluid and the fluid then passes out through the vagina. This procedure is also referred to as ”breaking the waters” and may be uncomfortable. ARM can be used to try to induce, or speed up, labour (see p,191). The idea is that the layer of membrane between the baby’s head and the cervix is removed. This enables the head to press directly on the cervix, which in turn releases the hormones that stimulate contractions and start, or help to speed up, labour.
ARM should not be performed routinely. In a spontaneous labour that is progressing normally, there is no need, and the membranes will usually rupture on their own.
I’m worried about being strapped to a bed and monitored. Is that essential?
If there are no complications or reasons for concern, your baby’s heartbeat will usually be monitored using a hand-held device much like the one used during your antenatal appointments to listen to your
10cm dilated
baby’s heartbeat Once your labour is well under way, your midwife will listen to your baby’s heartbeat for about 30 seconds to one minute every 15 minutes or so, which means that you can move around as much as you like in between.
If you have had complications in pregnancy, or problems develop during your labour, the midwife may recommend that your baby’s heartbeat is monitored continuously using a ‘ CTO”, which stands for ”cardiotocograph” (see p.192). This means that you will have two monitors strapped to your tummy using thick elastic belts. One measures the baby’s heartbeat and the other measures the frequency of the contractions. The monitors are attached to a machine that prints out information in the form of a graph This allows the doctors and midwives to keep a close eye on your baby’s wellbeing and how she is responding to the contractions.
A CTO does make keeping active a little more difficult but by no means impossible. Leads can be moved out of the way and adjusted, and some maternity units have a wireless CTG You can talk to your midwife about how this will be managed.

When can I start pushing?
Ideally you can start pushing as soon as you feel the urge to, assuming that your cervix is fully open. The urge to push is usually stimulated by the baby moving down the birth canal, which happens at some stage once the cervix is fully open. You may experience a sensation of needing to open your bowels and may actually pass some stools or urine, as the baby is pushing on the back passage. This is a very common occurence in labour (see p 188)
If both you and the baby are well, you will be encouraged to follow the natural urge to push. Sometimes, you can feel an urge to push before the cervix is fully open If this is the case, it is important to resist this feeling as much as possible, as pushing at this stage can cause the cervix to swell, which makes it more difficult for it to dilate. Some women find that kneeling on all fours with their head and shoulders lower than their hips is a good position for this stage of labour.
What is “crowning” and should I continue to push during this part of the labour?
This term refers to the part of birth when the widest part of the baby’s head – known as the crown –eases out of the opening of your vagina. Your midwife will encourage you not to push at this stage so that the baby’s head can be born in a slow and controlled way, which can help to prevent serious tears to your vagina and perineum (the muscle and tissue around the outside area of your vagina and anus). Although stopping pushing can be hard, -you could try short panting breaths or slow steady breaths to help you achieve this.
Although many women are worried about the possibility of tearing during the delivery of their baby it can be reassuring to remind yourself that midwives are very experienced and practised at guiding women and helping them to avoid tears whenever possible.
Positions for the second stage of labour
Although by this point in your labour you may be extremely tired and the contractions are lasting longer, it is best to resist any urge to lie down as this will not help the progress of the baby through the birth canal.Your partner can help support you while you hold certain positions and help you to remain upright if possible so that gravity can assist your baby. Many women find squatting or kneeling on all fours the most comfortable, or if you really need to lie down, get your partner to support one leg so that the pelvis can remain as open as possible.

How long will the first stage of labour last?
The first stage of labour lasts until the cervix is fully open, or ”dilated” (see p.181). Women tend to time their labour from the first contractions, but midwives and other healthcare professionals don’t start to time a labour until it is ”established” once contractions are coming regularly, roughly once every three or four minutes, and lasting for about 45 seconds to one minute, and the cervix is around 3cm dilated Due to the difference in how labours are timed, you may hear about labours that lasted 50 hours and others that lasted two! On average, for first-time mothers labour lasts around 12-14 hours. If it continues after this time, the doctor may want to investigate why labour is not progressing
Once labour is established, healthcare professionals usually expect the cervix to open at an average rate of half a centimetre an hour. However, there are huge variations in this average,
and a labour can still be progressing normally with a slower or faster rate of dilation Your midwife will keep you informed about how things are going during your labour, and don’t be afraid to ask how things are progressing.
Is it best to stay upright in early labour?
It is thought that keeping upright and mobile can help labour to progress and make the pain easier
to manage. This is because in an upright position the baby’s head can press down onto the cervix and in turn stimulate it to dilate, and also gravity helps the baby to move down through the pelvis.
I’m having a trial of labour-how long will I be allowed to be in labour for?
A trial of labour is something that is done if, for example, a woman has had problems in pregnancy.
I’m scared in case I poo in labour, how will I feel?
You are not alone — lots of women are very nervous at the idea of pooing while they are in labour. It may not be what you want to hear, but in fact a large number of women do poo, usually during the second, or pushing, stage of labour. This is totally natural and happens as the baby’s head comes down the vagina and pushes against the rectum, where faeces are stored. The faeces are then forced out of the anus and this is totally beyond your control. It is unlikely that you will be aware of pooing at this stage — the overwhelming sensations of birth will be more powerful! Midwives and doctors are very used to women pooing, and will simply wipe it away without a second thought. Also, sterile cloths will be placed around so it will be easily cleared away.
Will I tear when the baby comes out?
Some women do sustain some degree of tearing during the birth of their baby Unfortunately, it is impossible to tell whether you will tear or not until the actual delivery Some tears only involve the skin and may not require any stitches However, others can involve the skin as well as the muscle underneath and the vaginal canal, and this will require stitches Stitching will be performed by an experienced midwife or doctor after you have had a local anaesthetic injection. There is some evidence to suggest that regularly massaging the perineum, which is the area between the vagina and anus, during late pregnancy may help avoid tearing (see p.111) Allowing the baby’s head to be born slowly can also help to prevent tears (see p 186).
What does a “skin-to-skin” birth mean?
”Skin-to-skin” is a phrase that means cuddling your naked baby against your bare skin. Many women wish to have skin-to-skin contact with their baby straight after the birth. This can help with bonding, the baby’s temperature control, and the initiation of breastfeeding. As long as you and your baby are well, there should be no reason why this cannot be done — having your baby cleaned, weighed, and dressed can wait a moment. Most health professionals now recognize the importance of this early skin-toskin contact, and will help you achieve this if that is what you wish. Communicate your thoughts and desires to your midwife as early as you can following admission to the labour ward, so that the midwife can plan your birth to try and meet your wishes.
What is the third stage of labour?
The third stage of labour lasts from after the birth of the baby until the placenta, or afterbirth, and membranes (the amniotic sac your baby has been growing inside) have been delivered. This stage can last for around 10-15 minutes to an hour, depending on whether you have drugs to speed it up (see below).
How does the placenta come out?
After the birth of your baby, the uterus starts to contract again and the placenta shears away from the wall of the uterus and passes out through the vagina. This will not feel the same as giving birth to the baby as the placenta is soft and squashy and much smaller! You may have had an injection to speed up this part of labour, and this is referred to as a “managed” third stage (see below). If this is the case, your midwife will apply gentle traction to the umbilical cord to guide the placenta and membranes out. If you are having a natural third stage, you won’t need an injection, which may mean that this part of labour lasts a little longer, and the midwife will encourage you to deliver the placenta and membranes by pushing, and perhaps squatting over a bedpan Your midwife will advise you as to whether a natural or managed third stage, or a choice between the two, is most suitable for you
What happens when you have an injection for the third stage of labour?
Women are usually offered an injection of syntometrine during the baby’s birth. This is a mixture of two drugs, syntocinon and ergometrine, both of which help the uterus to contract and so speed up the delivery of the placenta and membranes This is also thought to help prevent the risk of heavy bleeding. Having this injection means that the third stage of labour lasts about 10
to 15 minutes. If you have raised blood pressure you will be offered a slightly different injection - just the syntocinon - as ergometrine is known to stimulate a rise in blood pressure.
What happens to the placenta?
checking the afterbirth
The placenta has sustained your baby during her nine months in the womb, and what happens to it after its delivery is a common question.
* The placenta will be checked to ensure it is complete and has been delivered successfully If it looks healthy, it will be disposed of in the hospital
* It may be taken away for analysis in a laboratory if there is anything untoward in its appearance.
* Some cultures perform ceremonies with the placenta; and in some parts of the world there is even a tradition of eating the placenta
However, if your pregnancy, labour, and birth have been straightforward, there is no reason why you should not have a ”physiological”, or natural, third stage of labour.
What will happen once my baby has been delivered?
Once your baby has been born, if all is well, you will be encouraged to hold him and get to know him. The placenta and membranes will be delivered and the midwife will examine your vagina and perineum to see if you need stitches, which will be done under a local anaesthetic When you are ready, your baby will be checked over (see p.217), labelled with your name and her date of birth, weighed, and dressed. If she hasn’t fed already, the midwife will help you with the first feed You and your partner may also be offered tea and toast, which is usually most welcome! Before going onto a postnatal ward, you will be helped to wash and go to the toilet. If you and the baby are fit and well, you may be able to go home within a few hours, sometimes straight from the labour ward, providing you have all the help you both need.
If you have a Caesarean, you will be moved to a ‘recovery” room near to the theatre for up to two hours to observe your breathing rate, pulse, and blood pressure. Your incision and vaginal blood loss will be checked as will your fluid levels, and the midwife will help you to breastfeed your baby. You will then be moved to a postnatal ward.
It all sounds very “busy”. Will we be left alone at all once the baby is born?
Many couples look forward to having some time alone together after the baby’s birth in order to start to get to know, and bond with, their baby in private. There shouldn’t be a problem with this, as long as neither mum nor baby has any medical problems The midwife will make sure you know how to call for assistance if you need it. You would usually be taken to a postnatal ward about two hours after your baby’s birth, if all is well Or an early discharge home may be an option.

The three stages of labour
How your labour -progresses
Your labour is divided into three stages. The first stage begins when you have regular contractions that widen your cervix: the second stage starts when your cervix is fully dilated and ends with the birth of your baby; and the third stage is the delivery of the placenta and membranes
What is the first stage of labour? The first stage of labour describes the process in which your cervix dilates (progressively opens because of the womb contracting) from being tightly closed to being around I Ocm - wide enough to get the baby out, or ”fully dilated”. During this first stage
of labour, contractions generally start off gently and don’t last very long - about 30-45 seconds. It is now recognized that you are in established labour only if you are 4cm dilated. Prior to this stage, the contractions you have been feeling have been
The birth of your baby
ripening (effacing) your cervix During the early stages of labour, it is a good idea to rest and eat carbohydrates such as toast or pasta, so that you will have some energy when the contractions really kick in. This is called the latent stage of labour. Once the contractions do start coming regularly, staying active is beneficial in that it can help labour become established, as gravity will help press your baby against your cervix Going to bed could result in labour ceasing altogether. In a first labour, the time from the start of established labour to full dilation is between 6 and 12 hours, although it is often quicker for subsequent labours.
What is “transition”? Towards the end of the first stage of labour, you may feel a great urge to push with each contraction. This period, when you are between 8-1 Ocm dilated, is called transition. It may
be brief, or could last up to an hour, and is often seen as the most challenging part of labour. You will need to resist the urge to push if you are not fully dilated, and may need to use breathing techniques - such as blowing out in little puffs - to help you.
What is the second stage of labour? Once your cervix is fully opened (fully dilated), this is known as the second s-age of labour At the beginning of the second stage, you may experience a pause in contractions, but they will resume and you will be ready to push your baby out with each contraction. Your contractions will now be very close together and very strong, lasting 60-90 seconds, for which you will probably need pain relief (see p. 174). Most hospitals will limit the length of the pushing stage to less than three hours You will soon see your baby
What is the third stage of labour? The third stage of labour is the delivery of your placenta. This is the afterbirth that has been feeding your baby during pregnancy You will be offered an injection
of syntometrine to speed this process up and reduce the risk of heavy bleeding, or you can to wait until the placenta comes away naturally If you choose a natural, or physiological, delivery of the placenta, this can take from 30 minutes to one hour, and you tend to bleed a bit more than if you have an injection.

A natural breech birth
If you are having a natural vaginal delivery with a breech birth, this will be carefully handled by an obstetrician. A vaginal breech birth can be slower than a head-first, cephalic, delivery as the bottom doesn’t push down as much The obstetrician will
guide the baby out. Usually, the buttocks are delivered first and then the legs will be carefully guided out The baby may then be rotated to deliver the shoulders as smoothly as possible Lastly, the weight of the baby helps to draw the head down for delivery
or has had a previous Caesarean. This allows a woman to be in labour long enough to determine if a vaginal birth may be possible. It is hard to say how long you will be allowed to labour for, as the length of time depends on how your labour is progressing and the opinion of the medical staff caring for you.
Your labour will be closely monitored, with your midwife regularly assessing its progress to check that the cervix is dilating as expected and that the baby is moving down through the pelvis. You may be offered continuous monitoring of the baby’s heartbeat (see p.192) and would be close to medical assistance in the event of a Caesarean being needed.
When will I be fully dilated?
”Fully dilated” means that your cervix is fully open so that your baby can move down the vagina and be born. When your labour begins, your cervix is either closed, or only one or two centimetres open The contractions of the uterus gradually open it further until it is completely open. Once this happens, you are in the second stage of labour, which lasts until the birth. The point at which your cervix is fully
dilated can occur quite quickly after the onset of strong, regular contractions, or can take many hours.
What is meant by “transition” and why do people say it’s the worst bit?
Transition describes the.period of time between the end of the first stage of labour and the onset of the second, or pushing, stage. Contractions are usually at their strongest and most frequent at this point It can last from a few minutes to over an hour, and in some cases may not happen at all. The transition period is often characterized by a woman feeling exhausted, fed up, unable to cope, shaky, or nauseous. In films and books, this is often the time when a woman swears and gets a bit mad with her partner! It is usually around this time that the first feelings that you need to push begin.
If you experience any of the unpleasant symptoms of transition, it helps to focus on the fact that your baby will soon be born. Try to keep your breathing slow and regular, and focus on your partner and midwife for additional support.

Positions for the first stage of labour
In the early stages, many women prefer to walk around, and being active helps labour progress. If you get tired, sitting on a chair leaning forwards can be comfortable, as can kneeling over a birthing ball or pillows Some women find sitting on the toilet comfy! If you want to lie down, lying on your left side is best as the pelvis isn’t restricted and can open as the baby moves down, and the blood flow to the baby is not affected

Dilatation
In the early stages of labour, the cervix begins to soften, known as effacement, and then starts to widen, or dilate, so that the baby can pass through it and out of the vagina The baby’s head cannot pass through
the cervix until it is I Ocm wide and fully dilated The time this takes varies with each labour, Some women are several centimetres dilated at the start of labour while others take several hours to reach this stage.
2CM DILATED:
6CM DILATED:
10CM DILATED: