Posts Tagged ‘enzyme’

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

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

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

KEEPING BOTTLES CLEAN:

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

The end of pregnancy

When will I start my antenatal classes and what types are there?
Antenatal, or parent education, classes start around 32 weeks and, if you are attending classes run by your local NHS trust, are free. The classes may run for 4-6 weeks, or some trusts have a monthly afternoon session. Some hospitals provide women-only classes evening or weekend classes and yoga and pilates classes (see p 60). There are also private or independent, midwives in most areas who may offer antenatal classes on a one-to-one or small group basis.
Antenatal classes are also available from the National Childbirth Trust (NCT), run by trained NCT teachers Classes are usually held in the evenings, making them more accessible to partners and friends, and they often provide ongoing postnatal support for up to six months after the birth. There is a fee, although in some cases a reduced fee or assisted places may be offered
Aquanatal classes are also popular These are gentle exercises in the swimming pool along with other pregnant women and often the teacher is a midwife who also provides antenatal information. Also many obstetric physiotherapists run relaxation and breathing technique sessions; your hospital antenatal clinic may have information on these.
What will I learn in my hospital antenatal classes?
Antenatal classes usually cover a different topic each week, including the physical changes that occur in pregnancy, the three stages of labour; hospital, home, and water births; pain relief, which should include breathing and relaxation techniques; breastfeeding; postnatal care of the baby; and changes in your relationships The most popular topics tend to be the stages of labour and pain relief, along with a tour of the maternity unit
Is it useful to learn and practise breathing and relaxation exercises before the birth?
Preparation before labour and delivery is
for most women and their partners, and breathing relaxation techniques in particular help you to focus on your breathing. which in turn can help you to fee- less tense and increase your confidence for dealing with the contractions Antenatal classes teach you
specific techniques and antenatal yoga (see p 60) also helps you to gain control through breathing
Should I practise positions for labour and birth beforehand?
Practising for labour is a good idea as you may find some positions suit you and others don’t (see below). This information can be documented in a birth plan (see p.149) so that it is available for your midwife to discuss with you. It’s also good for your partner to know your preferred positions during labour
Do you have any suggestions for labour positions?
Some popular positions for labour area
* Leaning on a work surface or the back of
a chair. Putting your arms round your partner’s neck or waist to lean against.
•    Leaning on to the bed in the delivery room
•    Kneeling on a large cushion or pillow on the floor and leaning forwards on to the seat of a chair * Sitting astride a chair and resting on a pillow placed across the top
* Sitting on the toilet; leaning forwards, or sitting astride. leaning on to the cistern.
•    Kneeling on all fours.
•    Kneeling on one leg with the other bent
•    Rocking your hips backwards and forwards or in a circled this can also be done using a birthing ball Ally of these positions can make your contractions Breech presentation
Breech position is when your baby is bottom first instead of head first. Breech babies lie in one of three positions: a flexed, or ”complete’ , breech, when the hips are bent, the thighs against the chest, and the knees bent with the calves against the back of the thighs and feet above the bottom; an extended. or
‘frank”, breech when the hips are flexed or bent the thighs against the chest, and the feet by the ears; and a ”footling” breech, like a flexed breech, but the hips aren’t so bent and the feet are below the bottom If your baby is breech at term, your doctor may recommend delivery by Caesarean section
more efficient and help you feel in control When you are in strong labour, you may find that you don’t want to move around much and will find a position that suits you If possible, keep rocking, leaning forwards during contractions, and straightening up in between. If you get tired, lie down on your left-hand side, rather than propped up on your back, which stops the pelvis being able to open effectively. Lying on your left side is much better for your baby than lying on your back because he receives more oxygen, and the contractions are still effective in this position. If you feel rested after a while, push yourself up with your hands into a sitting position and get up again
I’m 36 weeks and my baby is breech. Is this a concern?
Breech position is when your baby is bottom first instead of head first (see above) Quite a lot of
babies sit in the breech position in pregnancy and there is still a chance your baby will turn. It’s not until about 37 weeks that your midwife or doctor will focus on your baby’s position.
Is there anything I can do to help my baby turn?
If your baby is breech towards the end of pregnancy there are some exercises you can try in an attempt to turn your baby A ‘knee-chest” position can help To do this, kneel on your bed with your bottom in the air and your hios bent at just over 90 degrees Try to keep your head, shoulders and upper chest flat on the mattress Adopt this position for 15 minutes every two waking hours for five days If you feel nauseous or light-headed, do not continue. Positions in which the buttocks are elevated can also help, and sleeping with a pillow under your buttocks or kneeling on all fours so the weight of your pregnancy is unsupported may help You can combine ”all fours’ positions with household chores, such as cleaning the floor. If these are not successful, there are other ways to try to turn your baby (see below).
I’ve heard about doctors “turning” breech babies. How does this work?
Some obstetricians may try to turn a breech baby in late pregnancy, known as external cephalic version (ECV), which has a success rate of around 50 per cent. During an ECV, an obstetrician gently moves your baby by pressing his hands on your abdomen, using an ultrasound as a guide You may be given a drug to relax the uterine muscles You will be scanned first and if the baby is in an awkward position the procedure may not continue. Also, if your baby is large this can affect the procedure, as can the amount of fluid around the baby, as a low amount of fluid offers less protection to the baby, If you are Rhesus negative, you will have an injection of anti-D after the ECV (see p.79) because of a small risk of a bleed around the placenta An ECV is not recommended if you have a multiple pregnancy, have had bleeding in pregnancy, your placenta is low-lying, your membranes have ruptured, or there is a known problem with the baby
The procedure is not without risk and some think it only works with babies who would have turned anyway. If your baby remains breech, a Caesarean may be advised, although some obstetricians are willing to try a vaginal delivery You are not obliged to have an ECV and should discuss your options.
Finally, a form of acupuncture called
I f moxibustion”is sometimes used, whereby a fragrant herb is held over an acupuncture point, the aim being to relax the uterine muscles to help the baby turn Talk to your doctor or midwife before trying this and seek advice from a qualified acupuncturist.
What triggers labour?
While there are many theories, no one really knows what triggers labour One is that the mother’s pituitary gland secretes oxytocin, the hormone that
stimulates contractions, when the baby is ready to be born Others now believe that the baby starts labour by sending a signal to the mother’s body One theory is that a baby’s lungs secrete an enzyme when they are developed that causes a substance called prostaglandin, which triggers contractions, to be released into the mother’s body. Another theory is that, when the baby is ready to be born, its adrenal glands produce hormones; these cause hormonal changes in the mother that start labour
I don’t want to go overdue. How can I help labour to start?
Various methods have been tried, although none is proven. Popular methods include having sex, as the prostaglandins in semen are similar to the ones used to induce labour; stimulating your breasts to trigger the release of the hormone oxytocin, which stimulates the uterus; eating spicy food to bring on a loose bowel movement, thought to stimulate labour (see p 48) ; and taking long walks to help the baby move down in the pelvis and put pressure on the cervix Homeopathic remedies are also available; consult a registered practitioner for advice.
I’ve heard that raspberry leaf tea can start labour. Is this true?
Unfortunately this is a misconception as raspberry leaf tea doesn’t actually help to bring on labour, but it may help to reduce the length of labour In a study m Sydney, 192 first-time mums were given either a 1.2g raspberry leaf tablet or a placebo twice a day from 32 weeks. The tablet had no harmful effects. and the women who had taken the supplement had a shorter second stage of labour and a lower rate of assisted delivery (19.3 per cent to 30.4 per cent).
Raspberry leaf tea contains an alkaloid, ”fragine”, said to strengthen and tone uterine muscles, helping them to contract more efficiently. You should start taking raspberry leaf tea during the last eight weeks of pregnancy At 32 weeks, you could have one cup of raspberry leaf tea a day, gradually increasing to four cups or tablets a day (depending on the strength of the blend). The tea can be sipped in labour, too.

Fetal positions
Your baby in the uterus
Your baby can lie within your uterus in many different positions. Your midwife or doctor will palpate your abdomen (gently feel your tummy) to identify which way your baby is lying. There are two main positions in which your baby will lie: with his head downwards (cephalic presentation) or with his buttocks downwards (breech presentation). Occasionally your baby will lie across your uterus in a transverse position or even diagonally across you in an oblique position, particularly if there is too much fluid around the baby or you have had several babies previously. In about 17 per cent of cases, the midwives and doctors do not identify a breech presentation until the labour itself
What is LOA and ROA? Once your midwife has identified how your baby is lying, she will also try to determine whether the baby is lying on your right or left side The midwife will track where
Your baby’s position
your baby’s back is, and you will generally feel kicks on the opposite side. The midwife will describe your baby as being LOA or ROA, which stands for left or right occipital anterior -the occiput being the back of your baby’s head facing forwards, so your baby is actually facing backwards These are the best positions for your baby to lie in for labour.
What if the baby isn’t anterior? Sometimes babies lie in a posterior position, which means that their back is lying against your back and they are looking upwards This position may prolong your labour, which can be tiring If this is the case, you can try the same exercises for turning a breech baby (see p.143) to encourage your baby to turn to be in an anterior position towards the end of pregnancy Sometimes your baby will only turn with the help of strong, effective contractions when you are in fully established labour.

What is the “nesting instinct” and is this just a myth?
The nesting instinct is a well-documented natural phenomenon In the final weeks of pregnancy, many women have an uncontrollable urge to clean their house and to prepare and make the ”nest’ safe for the new arrival This is a primal instinct and females of the animal kingdom are all equipped with this need. Just as birds make their nests preparing for their young, mothers-to-be do exactly the same.
The act of nesting puts you in control and gives
•    sense of accomplishment You may also become
•    homebody and want to retreat into the comfort of your home and familiar people The nesting urge can be an indicator that labour is not too far away If you have the energy, take advantage and get on with tasks that you won’t have time for after the birth
Is it true that first babies are often late?
Birth normally occurs at a gestational age of 37 to 42 weeks and, while it certainly isn’t the case that all first babies are late, many do arrive after the predicted
due date. From the point of view of waiting if you approach the end of your pregnancy expecting your baby to be a couple of weeks late, then you may avoid feelings of frustration. It is worth considering that your body has never done this before and that your “due date” is an estimate, the majority of babies do not arrive on this date
I’m 39 weeks and my baby’s head isn’t engaged. Should I be worried?
Not all babies engage into the pelvis before
the beginning of labour It is likely, from about 36 weeks onwards of -your pregnancy, that you may experience your baby moving lower down in your abdomen, causing your baby’s head to enter the pelvis. This process is known as ”engagement’I and simply means that the leading part of the baby has ”engaged” the pelvic brim (see p.148) This is normal and helps to position your baby in preparation for the birth later on.
Engagement often happens earlier with first
babies because the uterine muscles have not been
Your hospital bag
Although hospital visits tend to be short, with many women staying around 24 hours or less after a normal delivery you will need a few essential items. Many mums have a bag for themselves and one for the baby, while others organize a labour bag and postnatal bag for mum and baby. It’s up to you. Basic requirements include:
•    Clothing for labour (including socks and/or footwear).
•    Nightwear.
Toiletries
A towel, sanitary pads disposable pants and a bra.
iIc Music, books, and magazines, as well as money, telephones, phone numbers, and cameras.
* A food bag with nutritious snacks to keep you going
For your baby you will need:
* Clothing, cleaning materials, and some clothes for returning home * Nappies (check with your midwife if the hospital provides these or whether you need to supply your own).

Engagement
Engagement is when your baby’s head starts to move down into the pelvic brim in preparation for birth, and this can occur any time from around 36 weeks until the start of labour In the last weeks of pregnancy, your midwife will palpate your abdomen to see if the head has started to engage. The degree to which a baby’s head is engaged is measured in fifths. If three- or four fifths of the head can be felt above the pubic bone, then
the baby is not engaged If only two-
fifths of the head can be felt, then the baby is said to be fully engaged, and if just one-fifth is felt, the baby is recorded as being deeply engaged.
previously stretched and so they tend to exert more pressure on the baby, moving it down into the pelvis earlier: whereas a second or third baby may not become engaged until your labour actually starts. When your baby’s head engages can also depend on other factors, such as the position in which your baby is lying within the womb (see p.145) and the shape of your pelvis
Am I likely to feel any different once my baby’s head has engaged?
Many women report feeling more physically at ease following the engagement of their baby’s head as there is a release of pressure within the abdomen As a result, you may find that it feels easier to breathe, sleep, and walk around
On the other hand, sometimes when the baby’s head engages this can increase the pressure on your bladder and you may experience a sensation of fullness and pressure between your legs. Many women also report shooting vaginal pains. Engagement is also likely to affect bowel sensations.
My midwife mentioned checking the position of the placenta. Is this normal?
This is not routine, but if your 20-week scan indicated that the placenta was low-lying, known as placenta praevia (see p.92), your midwife would suggest a further scan at 34 weeks to see if the placenta had moved up and away from the cervix.
My baby isn’t moving so much now - should I be worried?
There is some natural reduction in the range of your baby’s movements towards the end of pregnancy as he has less room to stretch his limbs However, you should still be familiar with your baby’s pattern of movement in later pregnancy as this is a good indicator of your baby’s health and is just as important as the number of movements a day (see p.103) You may find at this stage that your baby is developing a pattern for waking and sleeping, often different to yours, so your baby may be awake when you go to bed and may start kicking Or your baby may get the hiccups and you will feel the jerk of each hiccup, a sign that your baby is preparing for life after delivery. If your baby’s movements have reduced or stopped, contact your maternity unit. You could also try things like having a cold or hot drink, having a bath or shower or massaging your tummy. A formal assessment may be recommended and if there are concerns, you will be asked to make a conscious effort to increase your awareness of when your baby moves. There should never be fewer than 10 individual groups of movements a day between 9am. and 9pm. Some areas have walk-in antenatal day units (ANDLJ) where you can have a cardiotograph (see p.192) to record your baby’s movements.
I’m practically incontinent. Is there anything I can do to stop this?
During pregnancy, many women find that they leak urine slightly when they cough, laugh, exercise, bend over, or lift something. This is known as stress incontinence. The pelvic floor muscles are under strain during pregnancy as they have to support the weight of your growing uterus and cope with the changes caused by pregnancy hormones. As a consequence, a sharp increase in abdominal pressure when you cough and so on may be too much for the muscles to hold back the flow of urine. Stress incontinence may happen at any time in pregnancy, but is more common towards the end.
The best treatment for incontinence is regular pelvic floor exercises to keep the muscles toned (see p.57). Taking some gentle exercise each day can also help and, although you may not make a full recovery during pregnancy, regular exercise now will minimize the problem and help you towards a full recovery after your baby is born. Stress incontinence is often worse for a few days following the birth, when the muscles of the pelvic floor and other structures are recovering If it does not get better after this time, talk to your health visitor or doctor as you should not have to suffer long term without help.
Ask your midwife to refer you to your obstetric physiotherapist, who can review the problem and offer you advice and monitoring.
Birth plan
Stating your preferences for labour and birth
The purpose of a birth plan is to communicate your wishes for labour and birth.
Your plan can be as detailed or as brief as you like Do bear in mind that circumstances may dictate that not all of your preferences are met Discuss this plan with your midwife before the birth. Here are some suggestions of what to include:
* You may want to state who your birth partner will be, whether you want more than one birth partner, and if you want them present throughout. * You could include your preferences for managing labour pain Do you want to labour naturally (maybe using a birthing pool), or do you have a preferred type of medical pain relief? *You can state which positions would you like to use in the different stages of labour? Do you want to be active in the first stage, and in which position would you prefer to deliver your baby?
* Do you have concerns about being strapped to a fetal monitor? If so, do you want to request that this be done intermittently only?
* State your preferences for after the birth. Do you want your baby delivered on to your tummy, and how soon do you want to breastfeed?