Posts Tagged ‘baby sleep’

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.

General Points of View
In this section we describe a number of points of view which serve as a guideline for the way we view, and relate to, young children.
The child’s development and care, sleeping and waking, play and toys, safety and feeding are subjects which will be tackled in this section in terms of content. A practical approach to these subjects can be found under the advice for every stage (see Chapters 3-6).
The child’s development
From the moment the child is born, the parents have the important task of monitoring his or her development. This gives rise to many questions. How can we best prepare for the child’s future? Should we, or should we not, familiarize the child with elements of adult life at an early stage, so that she will be prepared for this later on? The answers to these questions will depend on your view of the child’s developmental stages.
We proceed on the assumption that the more successfully a child is able to fully develop at a particular stage, the more harmonious the development will be. This also applies for future development.
Fora baby and young child, this means that we must create the conditions in which a baby can most successfully be a baby, and a young child can most successfully be a young child.
The first developmental stage after birth is strongly centred on the child’s physical and motor development. Growth is quite exceptional during the first year of life, and is still rather like the growth of the embryo. The development and growth, which takes place outside the womb in humans, takes place completely inside the womb in other mammals. When the child is one year old, the development has reached a level comparable to the birth level of other mammals.
For the baby’s development, it is good if the conditions after birth are still quite similar to the situation in the womb. This particularly concerns the protective cocoon around the child. Warmth, a sense of security and some protection against environmental influences promote the baby’s health. It is extremely important for the baby’s physical development for her to have physical contact — rocking, cuddling or simply holding the baby in your arms. Children who lack this physical contact do not develop well, even if they have ‘the best feeding.’ These babies immediately start to grow again when attention and care is devoted to physical contact. Satisfying the need for physical contact gives the child a basis for the rest of his or her life.
Nevertheless, in humans, a good environment alone does not guarantee development. Every person has his own rate of development and his own way of developing. For example, there are babies who develop motor skills very quickly, sit up at an early stage, roll over, stand and walk. On the other hand, other children appear to ’stand still’ in their development fora long time, then seem to miss out a few stages and can suddenly walk, even though they never crawled. Some children start to develop speech very early, while others remain unintelligible for a long time.
It is important to be aware of a child’s own way of developing. There may be a tendency to a certain one-sidedness. This sort of one-sidedness — for example, the slow development of speech — can be regarded as the child’s own way of developing. It is only when this one-sidedness is particularly strong that it may be seen as a developmental disorder.
Thus, the first year of the child’s development can be seen as a continuation of the embryonic stage.
During this first year of life, the body matures to the extent that the child becomes able to control it for herself. A one-year-old child can stand and go where she likes and move about freely in space. It is as though she is taking charge of her own physical body. This stage of development depends on healthy physical growth and development. Illness and malnutrition will immediately delay the process. Development at this stage is mainly influenced by the physical organism and the care of this organism.
The basis for the later development of speech is laid during the first year of life. Talk to, and with, the baby, and play with her. She sees the gestures which accompany words, and hears the songs. All this contributes to the child becoming increasingly familiar with human language. The clearest sign of this is contented baby talk by the end of the first year of life.
After the first year, the child depends on being able to imitate what she has heard. She will start to copy the words herself, first words of one syllable and then words of several syllables. She then begins to combine words, and finally produces short sentences. In this way, the child enters a second area in which she can move about freely — the field of language. By mastering speech and language, the child takes part in social life in her own way, and becomes able to express herself through the spoken word.

The next stage of development is the time at which the child starts to say ‘U Prior to that stage the child called herself by her own name. This can be seen as an expression of the fact that the child was not yet deeply connected with her own body; thus in a sense the child saw herself from outside, as other people see her.
When she becomes more closely connected with her own body, the first, still primitive, sense of self-consciousness emerges and the child experiences a sense of self; she starts to say ‘F and experiences herself as a centre. As a result of this process, the child may also feel cut off from the world around her.
By the age of three or four, the child has gone through a sort of first cycle of development. By learning to stand and walk, she has achieved a certain degree of freedom in space. By learning to speak and understand, she can develop socially and communicate with others. With the deeper connection of the self and the body, self-consciousness emerges for the first time, and this is expressed when the child uses the word ‘I’ to talk about herself.
Learning to use language independently is an important psychological development, as is developing a sense of individuality. However, healthy physical development is always a prerequisite for this. Motor development is particularly important for the development of psychological functions later on. Playing
THE CHILD’S DEVELOPMENT    21
with bricks, simple ball games, finger games, circle games — in short, everything we do with the physical organism of the child as the point of contact — will have a positive influence on development.
The behaviour of the people in the child’s direct environment is very important for development. A small child learns and develops by imitating what she sees, hears, feels and so on. In this way the child learns to walk, speak and think, and during this first learning process carefully assimilates all the details — particularly during the first three years. This once again underlines the importance of being conscious of our own behaviour as well as the material environment of the child (see also Impressions, p.25).
Admittedly, the aspects of child development described here are very general, but they can still provide a direction for the way in which we behave with the child. The care for the physical processes of growth and development are of central importance. We can measure and weigh growth, while we can assess development from the development of the motor system, the mastery of language, and the birth of the ’self’ when the child starts to say ‘F.
Sleeping and waking
During the course of life a person’s need for sleep undergoes great changes. A newborn baby often sleeps for between eighteen and twenty hours out of every twenty-four. A one-year-old can sleep for fourteen hours, while an adult needs between six and eight hours of sleep. Therefore, in the first year of life, the child should spend a great deal of the time asleep.
We have seen that there are two important things in this first year — growth (a baby’s weight triples in the first year) and development. Growth takes place particularly during sleep, while development is stimulated during the waking hours. The various organs ‘learn’ to operate in a sense, with the use of the body during, the daytime (by eating, moving, etc.). What the organs ‘learn’ during the day continues to have an effect while the baby sleeps, and is assimilated in the body’s growth activity.
A one-sided predominance of growth and excessive stimulation to develop both have a negative effect. There should be a healthy balance between the two processes; an alternation between waking and sleeping which is suitable for each stage. When the child is about one year old, this balance will have become established in the operation of the organs, in a particular day/night rhythm — the biological clock.
For good health and for the child to be able to make use of his physical capabilities properly, it is essential for this day/night rhythm to become well established. Therefore, it is literally of vital importance for a small child to establish a steady pattern during the day with regard to sleeping, eating and waking.

A steady pattern of set times in the life of a child promotes growth and development and helps to establish a healthy rhythm of sleeping and waking. Too much stimulation during the day may prevent the child from falling asleep; however, a completely unstimulating environment, without healthy challenges for the child, can also lead to problems with sleep because the child is not sufficiently tired. A healthy routine in the day, alternating challenges and periods of quiet, being together and being alone, can help to correct sleeping problems. Rituals for going to sleep can also be helpful — rocking, singing lullabies, the use of musical boxes or a prayer for the child are methods used by many families.
Sleeping well means that the child must be able to surrender and ‘let go.’ This is not as easy for some children as for others. It is helpful to give the child a sense of security, for example, in the enclosed space of the cradle (possibly with a hood) or lying against the mother. Warmth promotes a sense of comfort and relaxation; a bonnet, a sleeping bag, some drops of lavender water on the pillow, or a hot water bottle can sometimes help babies who find it difficult to fall asleep. Hot water bottles should always be removed before the baby is placed in the warm cradle. A light silk bonnet is appropriate for indoor use, but be aware of the risk of overheating. Wrapping the child up firmly pro-
SLEEPING AND WAKING    23
vides a sense of security as well as a feeling of warmth.
However, there are babies who assimilate everything that happens around them so greedily that they actively seem to suppress their feelings of tiredness and the need for sleep. The more stimulation they are given, the hungrier they seen to be. They are unable to set their own boundaries. Increasingly, we see babies who spend many hours of the day — and sometimes the night —awake, constantly asking for attention from the environment. For these children, the parents must learn to see when they show signs of being sleepy. The fact that this is quite an art is clear from the many stories told about this problem. If you miss the right moment, the child appears to go past his sleepiness and will keep going for many hours. Signs of sleepiness are restlessness or agitation, looking away, rubbing the eyes and face, warm hands and red ears, grizzling and crying. By responding to these signs of sleep immediately and consistently, by placing the baby in his cot, it is possible to create a healthy need for sleep. By not responding straightaway every time the baby cries, he will learn to resolve minor discomfort for himself. It is important to realize that any attention wakes the baby up. All the extra attention and special behaviour associated with going to sleep often achieve quite the opposite of what the parents hope to achieve.

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.