Posts Tagged ‘vagina’

Black Cohosh
One of the most popular herbal supplements used to alleviate hot flashes is black cohosh. This plant is native to North America and was used by Native Americans for a range of medicinal purposes. The botanical name has been changed in recent years, so some references refer to this plant as Cimicifuga racemosa whereas others use the current term, Actaea racemosa. The famous 19th-century patent medicine promoted for “women’s problems,” Lydia E. Pinkham’s Vegetable Compound, contained black cohosh as a prominent ingredient.
A standardized extract of black cohosh called Remifemin has been studied in Europe and found to effectively reduce Remifemin
This standardized extract of black cohosh is consistent and widely available. The recommended dose is 40 to 80 milligrams per day.
Side effects: Digestive upset
Downside: Not to be taken during pregnancy; monitor for liver toxicity
Cost: Approximately $15 to $30 per month
hot flashes.739 Physicians who scoff at herbal remedies appreciate that this research was published in a highly respected peer-reviewed journal, Obstetrics and Gynecology (May 2005). In one trial, Remifemin was compared to a low-dose transdermal estrogen preparation.”O The treatments were equally effective in reducing hot flashes, and neither one was associated with serious side effeCtS.141
Most reviews suggest that the side effects of black cohosh are infrequent and generally mild—mostly digestive upset with some headache or dizziness reported. 42 Just the same, we think that women should discuss this supplement with their doctor. Although recent studies of black cohosh have monitored liver enzymes and found no changes, there are reports of liver toxicity among women taking black cohosh.741 Women who have had hepatitis or other liver problems might want to consider a different approach. For most healthy women, 6 months or so of black cohosh may be worth trying, and it seems fairly safe.744 Unfortunately, black cohosh does not relieve hot flashes that result from breast cancer treatment with tamoxifen.
The Soy Solution
One of the other popular approaches to managing hot flashes is soy. Isoflavones such as genistein and daidzein are phytoestrogens, estrogen-like compounds derived from plants. Even though they are far weaker than the estrogen a woman’s own ovaries make before menopause, it seems logical to use these compounds to ease hot flashes. Studies from cultures like Japan, where women consume soy products such as tofu and ** Soy
The results of studies on soy have been inconsistent. Soy may be consumed as shakes, bars, or more traditional soy foods such as tofu or tempeh. Women who have more hot flashes may derive more benefit.
Side effects: Unpalatable taste, digestive distress Downside: Not advised for women being treated for breast cancer; excess soy may interfere with the production of thyroid hormone
Cost: Approximately $15 to $50 per month
tempeh as part of their normal diet, suggest that hot flashes and other menopausal symptoms may be less common there. 745
Despite the epidemiological promise, research on soy against hot flashes has been disappointing overall.746.747 One review of many trials, however, found that women who began the studies with frequent hot flashes got more relief from soy foods or isoflavone supplementation than did women who rarely had hot flashes.’ 48 A different systematic review delivered a lessthan-ringing endorsement of the effectiveness of soy preparations against hot flashes, but the authors did conclude that the risks appear to be low. 74″ As the authors of one pilot study concluded, a soy extract (they were testing Phytosoya) appears to reduce hot flashes and night sweats and is probably worth a try if women don’t want to take standard HRT.750
Red Clover
Another source of isoflavones that is marketed for perimenopausal women is red clover (Trifolium pratense). Although this plant is native to North America, its extracts are sold by an Australian firm as Promensit and Rimostil. Most of the research on red clover isoflavones has been funded by the manufacturer Novogen. Nonetheless, the results vary. One small Dutch study found a significant effect, with Promensil reducing hot flashes by 44 percent more than placebo.”‘ But a larger, multicenter trial in the United States found no clinically significant effect on hot flashes with either Promensil or out of the study, and no side effects were significantly more common among those taking red clover extracts than among those on placebo. Analyzing the data for subgroups uncovered a trend toward heavier women getting more benefit from Promensil.153 Overall, however, red clover does not seem very impressive.
Vitamin E
-the North American Menopause Society suggests taking vitamin E along with keeping cool, exercising, not smoking, eating soy isoflavones, and taking black cohosh as inexpensive,.probably helpful nonprescription measures to alleviate hot flashes. Quite a few women have heard that vitamin E can be helpful for this symptom, and some have passed the advice along to their friends.    9
A. I’m 53 and haven’t had a period for a year. I have no problems other than hot sweats.
I recently started taking 400 IU of vitamin E each day and, much to my amazement, it really works. Is there anything I should know about this vitamin?
A. Many women tell us that vitamin E can be helpful for hot flashes. Don’t count on it to protect you against cancer, though. Smokers should probably not take vitamin E supplements, because there is some fear it may actually increase their risk of lung cancer. For others, moderate doses of vitamin E seem safe for short periods of time.
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Unfortunately, there appears to be very little research on the effectiveness of vitamin E. Some of the buzz may have come from a study done more than 50 years ago.7-14 Usually we would like to see more recent research to back up a recommendation, but little seems to have been done.— Nonetheless, the North American Menopause Society considers vitamin E, like black cohosh and isoflavones, safe enough to be worth a try.
Vitamin E has performed poorly in several recent studies of cancer prevention, and women who are at particularly high risk of lung cancer—smokers, for example—should probably avoid taking large doses of vitamin E without other antioxidant nutrients. But healthy women planning to take vitamin E for a year or two to ease hot flashes probably will not notice any unpleasant effects. The best product is a combination of natural tocopherols. As with other products, start with the lowest dose available and gradually increase it to find the lowest dose that helps with your symptoms.
It is disappointing that vitamin E has received so little scientific attention over the years. That hasn’t stopped women from trying it, though. Of course, we frequently hear about other interesting nutritional supplements that have worked for a few women but have no scientific evidence to support or refute their effectiveness. If they are otherwise safe, we see no harm in experimenting.
/ can’t help but wonder why most doctors do not treat hot flashes and night sweats with bioflavonoids. As a retired registered nurse, I have found that daily use of bioflavonoids will relieve both the hot flashes and the night sweats. It saves the worry of cancer threats from hormones and is much less expensive. I use Citrus Bioflavonoid Complex, 1,9W milligrams, providing 35 percent hesperidin, 350 milligrams. [Hesperidin is a compound found in citrus fruits that has anti-inflammatory activity.]
At one time, I was hesitant to suggest this to my daughter-in-law because she had been successfully treated for breast cancer When we were visiting and she was showing the lack of sleep front hot flashes and night sweats, I finally bought bioflavonoids for her She often thanks me for the relief that it has given.
Nonhormonal Therapies
For years, women have worried about the possibility that estrogen and progesterone could increase their risk of breast cancer. Women who have already been treated for breast cancer can’t take these hormones safely. As a result, and in light of the negative results from the WHI research, physicians have been looking for other ways to alleviate hot flashes. One approach that seems to help is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) family.
PAXII.
Some doctors now prescribe antidepressants like Paxil (paroxetine) to help women deal with hot flashes. A recent study found that Paxil was significantly better than placebo in reducing the number of hot flashes and easing their intensity. 755 Low-dose Paxil (10 milligrams per day) was also better than placebo in preventing nighttime awakening, presumably due to night sweats. Women in this study did not have to be depressed to get benefit. That also seems to be the case for drugs such as Effexor (venlafaxine).71
Such medications are not without their own drawbacks, though. They can cause sweating, nausea, dry mouth, constipation, insomnia, jitteriness, and sexual problems such as difficulty achieving orgasm. Both Paxil and Effexor also can be difficult to discontinue. Stopping suddenly can lead to odd and distressing symptoms such as dizziness, sensations similar to electric shock, and a peculiar feeling that has been described as “brain sloshing” or “head in a blender.” If antidepressants are taken for hot flashes, they should be taken at the lowest dose that works for the shortest time needed, just like hor-
** Paxil (paroxetine)
Paroxetine eases hot flashes due to menopause or associated with breast cancer drugs such as tamoxifen. The effect on hot flashes is independent of its antidepressant activity. Women found a lower dose easier to tolerate.
Side effects: Nausea, digestive problems, weakness, sleep disturbances, dizziness, nervousness, sexual difficulties, hyqe.m )siio% we*ig1ht gain
Downside: Paxil can be hard to stop taking. You may need your doctor to switch you to a longer-acting drug such as Prozac and then decrease the dose gradually over several weeks or months.
Cost: Approximately $75 to $90 per month move replacement therapy. And, also like HRT, they may need to be tapered off gradually.
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Q. 1 have been having hot flashes, night sweats, mood swings, and other change-of-life problems for more than a year. I had hoped these problems would eventually go away, but so far they haven’t.
My doctor wants me to consider Premarin, but I worry about side effects, especially breast cancer. It runs in my family.
The other drug my doctor has suggested is Zoloft. But I am not depressed and don’t want to deal with side effects from that drug either. Do you have information on natural alternatives that might help me withstand hot flashes, night sweats, and interrupted sleep?
A. Black cohosh extract has been recommended for hot flashes. A double-blind study published in Obstetrics and Gynecology (May 2005) showed that the standardized product Remifemin was significantly more effective than placebo.
Another reader shared her experience with a different herb: “I have been using St. John’s wort since discontinuing hormone replacement therapy. It has relieved many symptoms, including sleeplessness, stress, and fits of temper.”
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NEURONTI N
Anoffier approach that may help some women who are suffering with hot flashes is an anticonvulsant drug called Neuron-tin (gabapentin). Pilot studies show that 900 milligrams daily of Neurontin reduces both the frequency and intensity of hot
flashes, and that it works better than placebo.757 Because Neurontin, like the SSRI antidepressants, does not have any estrogenic activity, it may be especially helpful for women who have had breast cancer and must avoid HRT. This medicine * Neurontin (gabapentin)
Gabapentin eases hot flashes due to menopause or associated with breast cancer drugs such as tamoxifen. The effect on hot flashes is not related to its anticonvulsant effects.
Side effects: Drowsiness, dizziness, problems with balance, fatigue, swelling of the feet, nausea or vomiting, depression, reduction in white blood cells
Downside: Neurontin should not be discontinued suddenly. You should ask your doctor for help in reducing the dose gradually over several weeks or months.
Cost: Approximately $60 to $150 per month, depending on whether you get a brand-name or generic product
has been associated with some potentially serious adverse reactions, such as a reduction in white blood cells that could leave a woman susceptible to infection. We recommend having a thorough discussion of its likely benefits and risks with the prescribing doctor. This is good advice for any medication, of course, but especially for one being used for an “off-label” condition like this.
Relieving Vaginal Dryness
Hot flashes may be the most obvious symptom of menopause, but for many women, vaginal dryness is just as troublesome. And despite our culture’s greater acceptance of public discussion of sexual issues such as erectile dysfunction, for example, vaginal dryness is often too personal and too embarrassing to bring up. When the WHI highlighted the potential dangers of long-term use of oral estrogen, millions of women stopped their HRT and then searched high and tow lot a personal lubricant that would be safe and effective.
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Q. 1 know this is a sensitive issue, but it affects a lot of women. Vaginal dryness is ruining our sex lives. I had breast cancer, so hormones are out. I’m embarrassed to ask my doctor about this.
My husband works long hours, and our opportunities for intimacy are unpredictable. Is there any natural lubricant I could use just at that time?
A. Readers have suggested olive, almond, and vitamin E oils. Some people are allergic to topical vitamin E, though, and it can cause a nasty rash. In addition, using any oil in combination with latex condoms may weaken them. One woman breaks a leaf off her aloe vera plant and uses the slippery gel that oozes out.
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For some women, this problem is an issue only for sexual relations, but others find that dryness is uncomfortable throughout the day. Oral HRT generally relieves this symptom along with hot flashes, but just as sudden sweats may return when HRT is stopped, so can vaginal dryness.
Olive Oil
No studies have identified diets, exercises, or other lifestyle approaches that work for vaginal dryness. We. have heard from many women who have found remedies that work for them, however. One of the simplest is olive oil. Other women have found that almond oil has a more pleasant aroma and that it still helps with everyday moisturizing.
*** Olive Oil
If it’s safe to eat, it’s safe enough for vaginal lubrication, too. The oil is applied to the vagina with a fingertip. At first, daily application may provide the best results. Later, lessfreqxiem applications may be eileefive.
Side effects: Some women notice oily spots on their underwear. If this happens, apply less.
Downside: Some women are squeamish about fingertip application. In addition, using any oil in combination with latex condoms can weaken them.
Cost: A few dollars, or less, per month I would like to suggest a natural lubricant that is not greasy but is good for your body. It is pure olive oil. (it can be edible, too.) I have been using olive oil for this purpose for a couple of years. When my doctor did a pelvic exam, he thought I was taking hormones although I am not. I think olive oil has natural compounds to keep women youthful.
There is, unfortunately, no research to show whether any kind of oil applied topically will moisturize vaginal tissues. Our reader got a lot of other people interested in using olive oil for this purpose, though, and some of them contacted us to tell us that it helped. We really don’t know of any hazard to this one except for people who are allergic to olive oil. It doesn’t take very much, so use the best-quality extra-virgin olive oil you can find, or substitute almond oil or another vegetable oil if you
prefer.
Vitamin E
The underground popularity of vitamin E capsules taken orally for hot flashes has apparently inspired some women to try this dietary supplement “off-label.” We don’t think any vitamin manufacturer envisioned women using the contents of a vitamin E capsule for personal lubrication, but some are enthusiastic about it. They prick the capsule and squeeze out the oil for application by hand. Others use the capsule as a vaginal suppository. We caution, though, that some people are sensitive to vitamin E and might develop a rash. In addition,
** Vitamin E
Squeeze the vitamin E oil out of the capsule and apply it to either partner for lubrication “at the moment.” A capsuke may be used as avdiffinal suppository for lasting lubrication.
Side effects: Rash. Test the oil on your inner arm first, to make sure you aren’t sensitive to it.
Downside: Effectiveness has not been scientifically tested. Also, using oil in combination with latex condoms may weaken them so that they aren’t effective.
Cost: Approximately $2 to $5 per month using any oil in combination with latex condoms may weaken them.
Improbable Lubricants
Whoever said “necessity is the mother of invention” must be smiling at the ingenuity of women who have taken common, inexpensive cleansers or moisturizers and tried them to combat vaginal dryness. But some household products have been especially popular. Some years ago, we heard from a couple in their seventies who were using Corn Huskers Lotion, an old-fashioned hand lotion, as a sexual lubricant. Other readers were interested in their experience and tried the product out.
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A. 1 suffered for years from vaginal dryness and tried a lot of treatments for it. Then I read about using Corn Huskers Lotion. The results have been incredible! The lotion is inexpensive and works better than a progesterone cream my doctor prescribed. .
A. We’ve heard from others who have found that this old-fashioned hand moisturizer can be helpful for vaginal dryness. Some of the ingredients are identical to those in pricier personal lubricants.
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Corn Huskers Lotion contains glycerin, guar gum, and methylparaben, as well as a few other ingredients. It is not dissimilar to K-Y Jelly (glycerin, hyd roxymethylcel I u lose, methylparaben), Astroglide (glycerin, propylene glycol, parabens), or Replens (glycerin, mineral oil, methylparaben). All of these drugstore products are designed specifically as vaginal lubricants. Although they are a bit pricier, such products are certainly worth a try. Corn Huskers is promoted as an oil-free hand treatment lotion. The manufacturer makes no claims regarding this “off-label” use. Do keep in mind that mineral oil, as found in Replens, could compromise latex condoms.
We have also heard from many readers who sing the praises of an old-time facial cleanser for this purpose.
Q. My husband and I have used Albolene as a sexual lubricant since the early 1970s. I’m not sure how we heard about it, but it’s great: odorless, tasteless, slick, but not messy.
It comes in a white tub you can keep by the bed without embarrassment. A 12-ounce jar costs about $11, but a little goes a long way. We’ve purchased five jars in 27 years of marriage. I haven’t seen this anywhere else and wanted to share our secret.
A. Thanks for the tip. Finding a sexual lubricant that suits both partners can be challenging.
Albolene is a moisturizing cleanser that contains mineral oil, petrolatum, paraffin, ceresin, and beta-carotene. It should not be used with condoms or a diaphragm since petroleum jelly degrades latex.
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Albolene is certainly cost-effective. Although it is solid in its container, a small amount applied to the skin soon liquefies and becomes slippery. One drawback, though, is the mineral oil and petrolatum base. These petroleum products will destroy latex, so they must not be used with barrier contraceptives such as condoms or a diaphragm. (The postmenopausal woman may not need to worry about contraception, but many perimenopausal women still need to be vigilant.) Alboleneis available in pharmacies and online: for more information, you can contact the manufacturer, Numark Laboratories, at 800-338-8079.
I’ve been using a product from New Zealand named Sylk for over a year ear now and find it does a great job in lubricating and relieving pain associated with vaginal dryness during relations.
Quite a few people these days are reluctant to introduce petroleum-based products into their bodies, and they also worry about the effect of such products on latex condoms. Many of them have been pleased to learn about Sylk, a natural lubricant from New Zealand. It contains kiwifruit vine extract and, more importantly, does not contain petroleum products. As a result,  Sylk
This natural personal lubricant contains kiwifruit vine extract, citrus seed extract as a preservative, and vegetable glycerine. It is water-based, so it can be used with condoms. It is not sticky.
Side effects: None known
Downside: Effectiveness has not been scientifically tested. Cost: One bottle costs $22 to $23 and lasts 3 to 4 months.
it is safe to use with barrier contraceptives. Sylk is not available in most drugstores, but it can be ordered by telephone at 602957-7955 or on the Web at www.sylkusa.com.
People have devised a number of other clever ways to use natural products as lubricants. Some people have found that the gel from an aloe plant is ideal. It certainly is inexpensive! A few drugstore lubricants contain aloe as one of the ingredients, so presumably this is usually well tolerated.
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O. My husband and / can’t use K-Y Jelly or any other brand of lubricant we have tried. They make me itch and burn.
We have found, though, that the slimy gel that oozes from an aloe leaf when you break off a piece is a very good lubricant. I hope this will add to your uses of aloe vera and help another couple.
A. This is a most unusual sexual lubricant. Aloe vera get has been used for centuries to help burns heal and ease skin irritation.
Others who would like to try this should test the gel on the inside of the elbow first. If there is no allergic reaction, the slippery texture should make it a surprisingly effective sexual lubricant.
Hormonal Approaches
For decades, when women complained of vaginal dryness as a symptom of menopause, doctors prescribed estrogen, often as a vaginal cream. Most of the time when a vaginal cream or tablet was prescribed, the doctor would point out that it would have local effects and would not be absorbed into the bloodstream. Although vaginal estrogen creams can often help alleviate dryness, the dogma that the estrogen in the cream stays put and doesn’t get into the rest of the body is bogus. The delicate tissue of the vagina is quite efficient at absorbing estrogen and passing it into the bloodstream.758
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Q. I have been reluctant to take estrogen because I worry about possible side effects, in particular breast cancer. The worst thing about menopause has been the lack of vaginal lubrication, which makes sex very uncomfortable.
My doctor prescribed a vaginal estrogen cream for this problem. He has assured me that it is locally acting with negligible absorption.
It certainly has helped the vaginal dryness, but my hot flashes have also dropped off considerably. Is this cream getting from the vagina to the rest of my body to control the hot flashes? And if so, what about the risk of breast cancer?
A. Estrogen is easily absorbed from the vaginal lining. In fact, one study of Premarin and Estrace creams published in the Journal of the American Medical Association (December 14, 1979) found that “estrogen vaginal cream preparations, as widely used in clinical practice for their local effects on the vagina(mucosa, actually result in sus126ned high estrogen levels in the systemic circulation.”
We suggest that you discuss your risk factors for breast cancer with your physician. If oral estrogen is inappropriate for you, a cream formulation is not likely to be much safer.
There are certainly times when a vaginal cream or tablet is :appropriate. When other approaches aren’t effective, an estrogen cream often will help. As with oral estrogen, the idea is to use the lowest effective dose for the shortest possible period of time. Frequently the prescription cream will be dispensed with an applicator. Ask the doctor if you should fill the applicator or use less cream than that. It may be possible to apply just a small dab on the tip of your finger and get adequate relief with less overall exposure to estrogen. Topically applied estradiol (a form of estrogen) is available as Estrace cream and Vagifem vaginal tablets.
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Q. A couple of years ago vaginal dryness was causing me a lot of discomfort. I am prone to blood clots, so I can’t take oral estrogen.
My doctor prescribed Estring, an estradiol vaginal ring that is inserted every 3 months. It has only 2 milligrams of estrogen and has solved my problem. Please tell others about this approach.
A. Estring has been available in Sweden since 1993 and in the United States since 1996. The 2-milligram dose of estrogen is very low, especially since it is released gradually over 3 months. This approach may solve the problem of vaginal dryness with fewer side effects than oral estrogens.
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*** Estring
Estring is a vaginal silicone ring that contains estradiol that is released at a steady, low rate over 3 months, which minimizes fussing. It is placed in the vagina, usually so that it is comfortable or almost unnoticeable.
Side effects: Stomachache, nausea, vaginal discharge, headache, insomnia
Downside: Must pay for 3 months’ treatment up front Cost: $100 to $150 for a 3-month ring There is one more way to apply estrogen topically to the vaginal tissues—with a vaginal ring. This silicone ring is inserted into the vagina, where it releases estradiol at a low but steady rate for 3 months. Like other forms of estrogen, it’s not appropriate for women who have or have had breast cancer. Because the dose at any given time is lower than if a woman were taking estrogen orally, it might be used even by women who are nervous about using estrogen.
Conclusions
Although menopause is a natural process, hot flashes and night sweats can be bothersome. Vaginal dryness also may be uncomfortable. The ideal treatment for these symptoms should be used at the lowest effective dose for the shortest possible period of time, since most symptoms will eventually fade away on their own.
Here is an overview of our recommendations.
•    Keep cool by turning down the thermostat and wearing layers that can be easily removed if you start to sweat. A tall, cool (nonalcoholic) drink is less likely to trigger a hot flash than a steaming cup of coffee.
•    Keep exercising to minimize your hot flashes and help you sleep. Then follow up with relaxation and deep breathing.
O    Try Remifemin. Black cohosh can help with hot flashes if they are not too extreme.
•    Eat moderate amounts of soy products with isoflavones. They may help reduce hot flashes.
•Take vitamin E capsules. Up to 400 IU daily should be safe and might help.
•    If nothing else helps with the hot flashes, try hormone replacement therapy at the lowest effective dose for the shortest possible time. Transdermal estrogen might be worth considering.
•    An antidepressant such as Paxil (paroxetine), Effexor (venlafaxine), or Prozac (fluoxetine) may calm hot flashes even if you are not depressed. Don’t take any of these drugs for longer than you need them; you may need help getting off them.
•7be antiseizure drug Neurontin (gabapentin) may ease hot flashes and does not have the same risks as hormone re-placement therapy. Do not stop this drug suddenly, though, since that could trigger withdrawal symptoms.
•    Vaginal dryness may respond to olive oil, almond oil, or the oil from inside a vitamin E capsule.
•    Corn Huskers Lotion or Albolene offers slippery lubrication for sexual relations.
•    For more natural lubricants, try the gel from a broken aloe vera leaf or Sylk, which has kiwifruit extract. •Estring is the most convenient form of vaginal estrogen. The need for Estring should be reevaluated every 3 or 6 months so you won’t use it for longer than necessary.

INSOMNIA
• Avoid late-night TV, alcohol, and caffeine
• Exercise during the day
• Take a hot bath 1 hour before bedtime
• Listen to soothing music or a relaxation CD
• Seek cognitive behavioral sleep therapy ***
• Eat a high-carb snack before bedtime
• Take magnesium before bedtime ***
• Scent your bedroom with lavender or jasmine
• Try melatonin
• Use acupressure
• Consider valerian ***
• Ask your doctor about Ambien CR (zolpidem) **
• Check with your doctor about Lunesta (eszopiclone) **
• Inquire about Rozerem (ramelteon)
• Ask your doctor about Sonata (zaleplon)
Whoever coined the phrase “sleeping like a baby” must have been childless makita 18v cordless drill lithium . No parent who has ever walked the floor for hours with a fussy infant or gotten up for numerous nighttime feedings would imagine that babies sleep well zocor and mlik thistle .
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Babies and senior citizens are not the only ones who suffer aripiprazole product monograph . The number of people who have intermittent or chronic sleep problems is enormous, perhaps as many as 70 million 672 That means that one in five of us is all too familiar with sleeplessness chloresterol drug tricor . 673
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NIGHT LIGHT
Epidemiologists have found that too much light at night may increase a woman’s risk of breast cancer discount vardenafil hydrochloride .”‘ Light
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• Have a consistent bedtime generic mestinon .
• Darken your bedroom remeron tab .
• Get regular exercise during the day alternative health caffeine .
• Abstain from alcohol before bed (it blocks melatonin) prothombin time coumadin .
Inviting Sleep
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Cut Out Caffeine
Most people know that caffeine is a stimulant that can keep them awake maker of flomax . They avoid that evening cup of coffee, thinking that will solve the problem diflucan over . But some people are so sensitive to the effects of caffeine that they should stay away from coffee, tea, and caffeinated soft drinks at any time in the afternoon discontinuation of bupropion . And don’t assume that decaffeinated coffee is the solution to your insomnia problems evista cod . If heartburn is contributing to your nighttime sleep woes, the culprit could be decal coffee, which can trigger acid reflux that may wake you up ic tramadol hlc .
Beware Drugs That Can Keep You Awake
Caffeine is not the only drug that can interfere with aood night’s sleep lithium polymer batteries uk . A surprising number of prescription and
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Forgo the Nightcap
And don’t forget alcohol getting a tattoo on penicillin . An evening glass of wine or a nightcap may seem relaxing and even make you drowsy solubility cefuroxime acetone . But alcohol can affect melatonin levels and interfere with dreaming sleep ship free viagra sample . Waking too early is a common consequence of having an evening cocktail dristan sinus pain with ibuprofen .677 If you’re having trouble sleeping, don’t drink after dinner meloxicam for tendonitis .
Exercise
Exercise is not only good for the heart and bones, it is also a great stress reliever will prednisone make blood sugar elevate . If you can take a brisk walk, play a couple of sets of tennis, or play a round of golf (without the golf cart), you will find that your level of anxiety will diminish allergic reactin prednisone . Do it in the afternoon and you may get some sun on your face sore leg muscles and lipitor . Bright light combined with exercise can relieve depression and insomnia buy soma online usa .678 The sun exposure can also affect melatonin levels that have an impact on sleep quality and could reduce the risk of breast cancer in women tried both diflucan and vaginally . 79
Tai chi is an ancient Chinese exercise program can you get preganant taking provera . This gentle form of activity is actually quite beautiful to watch risperdal zoloft interaction . Researchers at the Oregon Research Institute in Eugene recruited 118 men and women over 60 years old importation viagra . Half were taught tai chi and the other half had a low-impact exercise session tramadol apap opinion . The tai chi students reported that after 6 months, it took them less time to fall asleep (18 minutes less on average) and they slept longer (48 minutes longer) ivermectin injection scabies .’
Timing is everything when it comes to exercise and sleep aleve drug interaction . If you exercise in the morning or early in the day, you should have less trouble sleeping amoxicillin bloating side effect . But if you exercise in the evening, just before bedtime, you’re likely to have more trouble sleeping clavulanic acid ampicillin oral dose .681
Hot Bath
Another simple, inexpensive, and pleasant way to ward off insomnia is to take a hot bath viagra us drugs stors . Here again, though, timing is critical clindamycin for prostatitis . A hot bath or shower just before bedtime could be counterproductive naproxen complications . The trick is to schedule it about an hour before you plan to go to bed risperdal children anger .(’82 A hot bath raises the core body temperature viagra after prostrate surgery . As it drops, the signal that goes to the brain is “sleepy time dipyridamole shortage .” Body temperature normally drops in the first part of a night’s sleep, so pushing it up with a 30-minute soak, then allowing it to fall tricks the body into thinking it may already be asleep zoloft versus efflexor side effects . Combined with a regular bedtime ritual, this can really help monohydrate in cephalexin .
Winding Down
Turning off the internal dialogue is especially hard for some folks cabergoline studies . “If only” is a dangerous game effects imitrex side . People who replay the day’s events, complaining to themselves that they should have done things differently, are destined to toss and turn lamictal side effects in children . How can you stop obsessing? One way is to set aside time specifically for worrying much earlier in the day lipitor and diarrea . It sounds odd, but some people find that it helps tavist smiley atlanta .
Another way to quiet your mind at bedtime is to keep the television out of the bedroom viagra berocca cocktail . Not only will this make it easier to get to sleep, it might improve your love life liquid femara . According to an Italian researcher, Serenella Salomoni, -if there’s no television in the bedroom, the frequency (of sexual intercourse) doubles viagra slump .”683 Satisfying sex can lead to deep relaxation and make it easier to fall asleep order propecia propecia .
If your bedroom clock has a bright face that allows you to watch the minutes tick past, turn it away from the bed buy lasix from a us pharmacy . Watching the time go by is a recipe for staying awake and increasing your anxiety about falling asleep generic versions of tramadol .
Another way to relax is to listen to gentle music or guided imagery depo provera hormones . Our favorites are by Emmett Miller, MD boards clomid message . Dr herbal alternatives to paxil . Miller is one of the founding fathers of the mind-body movement caffeine effects on the bodys tissue . He is a poet, a philosopher, a musician, and a healing, caring physician is prednisone otc . Nis voice, is so soothing and reassuring that you will find yourself relaxing without even trying medlineplus cozaar . To find out more about his CDs and tapes, visit www nash trial pioglitazone .drmiller does fluconazole treat chlamydia .com or call 800528-2737 lithium quartz tumbled brazil min . Our Dr warfarin and priapism . Miller Eaves are Easing into Sleep, Letting Go of Stress, 10-Minute Stress Manager, Healing Journey, and Rainbow Butterfly slur word speech celebrex .
Lest you think this is all touchy-feely New Age nonsense, we promise you that there is actual research to support these nondrug approaches disulfiram implants visotskij . One study offered insomniacs a selection of soothing music to be played for 45 minutes at bedtime low testosterone level boys . 684 The participants selected the music they preferred and were instructed to relax in bed while listening to it gene amplification dihydrofolate reductase methotrexate . Measurements showed that they had less trouble getting to sleep, fell asleep more quickly, and had better sleep quality buy zanaflex no prescription .
Another study compared progressive relaxation to anxiety management training for 9 weeks prozac and ecstasy . Both groups of insomniacs benefited side effects remeron rare . They fell asleep faster and slept more soundly keflex and blood clotting . 685 Such behavioral training can be a little pricey, which is why we like Dr kytril billing . Miller’s CDs norm shealy lithium oxalate .
Cognitive Behavioral Therapy
People who have persistent problems with insomnia may find it well worth their while to consult a counselor who offers cognitive behavioral therapy (CBT) genetic viagra mastercard . A study compared this nondrug approach to a sleeping pill similar to Lunesta (eszopiclone) that is commonly used in Europe motrin coupon . Investigators found that CBT was more effective than either the placebo or the sleeping pill mucinex vs claritin .’ The intervention included instruction on using the bedroom only for sex and sleeping, sticking to a regular schedule for rising and retiring, avoiding naps during the day, progressive relaxation, and discussion of beliefs and fears about sleep loss recurrent utis and macrobid .

Cognitive Behavievai ‘Therapy
In a study, learning about sleep ‘hygiene, sleep restriction, and progressive relaxation and discussing fears about losing sleep worked better than a sleeping pill against insomnia how much caffeine can cause miscarriage .
Downside: It is difficult to find a trained counselor testosterone raw powder suppliers .
Cost: Approximately $125 to $140 per session is alli the same as xenical . Six sessions should last a lifetime actonel appetite suppression .
are big fans of a low-carb approach for weight loss and blood sugar control, this principle does not hold in the evening albuterol side effect erdicaria . Protein can be energizing, which is the last thing you need before bed atazanavir omeprazole interaction . Instead testosterone levels determine facial hair growth . we would recommend eating carbohydratess septra bactrim side effects . According to Judith Wurtman, PhD, a research scientist at Massachusetts Institute of Technology, “If you eat carbohydrates when your internal clock wants you to sleep, the food will act like a sleeping pill shipping lithium ion battery .”687
Relaxation foods include caramel-coated rice cakes, Cheerios with frozen fruit and honey, toasted waffles with maple syrup and half a banana, a handful of pretzels, graham crackers, fig bars, and a blueberry muffin singulair and skin test . We would never recommend this dietary approach for someone with blood sugar problems (diabetes or prediabetes) low testosterone and erectile dysfunction . And it obviously is not for someone who is trying to lose weight testosterone at home test . But such high-carbohydrate foods can boost serotonin levels in the brain and make it easier for you to relax and fall asleep when you consume them 15 to 30 minutes before bedtime pnuemonia and cephalexin .
Magnesium
A simple mineral may be just the ticket for a good night’s sleep research study risperdal conduct disorder . Magnesium is essential for good health, but often it is in short supply in the American diet ketoconazole rx . One reason many people are deficient is because of their medicine depo provera side effect . Diuretics that deplete the body of potassium also can eliminate magnesium celexa 40 mg 30 pills . Although physicians are usually good about monitoring the blood’s potassium level, they may be less diligent when it comes to magnesium estrace cream pregnant .
Several years ago, we began hearing from readers of our newspaper column that magnesium is helpful for insomniacs pravastatin muscle pain . With some searching, we discovered that there is at least a
Magnesium
This mineral is helpful for bones, nerves, muscles, and brain function evista test . The recommended dose ranges from 250 to 500 milligrams daily tetracycline calcium . If you develop loose stools, reduce the dose mixing tadalafil and sildenafil citrate .
Side effects: Diarrhea
Downside: Not safe for people with poor kidney function Cost: Approximately $2 to $3 per month little scientific basis for this benefit 6m Magnesium appears to be especially helpful for those who suffer from restless leg syndrome breastfeeding and aleve .”Mis condition can make it hard to fall asleep or can awaken you once you are sleeping sweetly caffeine and dpression .
0 caffeine nut . 1 have suffered from episodes of insomnia for years nimotop online purchase . Cutting down on caffeine didn’t work cafergot tablet . Over-the-counter sleep aids such as Benadryl made me groggy the next day prior to the introduction of penicillin . Even prescription drugs like Ambien didn’t help how to stop taking wellbutrin xl .
Then a friend suggested I try taking magnesium at bedtime levaquin lev pack . I started taking magnesium (250 milligrams) at night lithium ion battery components . Magnesium has helped my insomnia more than anything else I’ve ever tried tardive kenesis caused by lithium carbonate .
A imitrex half life . Magnesium is essential for good health effects of low testosterone on conception . This mineral plays a role in more than 300 biochemical reactions in the body and is crucial for the proper functioning of nerves, muscles, bones, and blood vessels thyroid synthroid .
Magnesium is used in some laxatives (milk of magnesia) and antacids (Maalox, Mylanta, etc fluconazole lactation .) wellbutrin side effects achole effects . This nutrient may also be helpful in preventing osteoporosis and migraines and alleviating premenstrual symptoms strattera weight loss . We’ve not heard of magnesium being used to treat insomnia, however dosges liquid cialis . We’d be interested to learn if anyone else finds this mineral helpful against insomnia interaction between acetyl l-carnitine and warfarin .
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In response, we heard from several readers wellbutrin arthritis . Some found that they could eliminate over-the-counter sleeping pills M-,eistarting magnesium supplements tetracycline treatment of acne . One reported, “I started takiIlg Citracal Plus with Magnesium at bedtime natural alternative for coumadin . Ever since, I’ve been sleeping like a baby (a lazy one, mind you, not the colicky kind) lamictal directions .” But here is a cautionary tale cipro prescribed for what infection . Timing is everything:
* 0 0
0 tired on famvir shingles . You asked if anyone has had success taking magnesium for insomnia ketoconazole gel . Years ago I was visiting my sister, who urged my husband and me to start taking magnesium in addition to vitamins dosges liquid cialis . We took the first dose the
morning we left for home nervous testosterone .
We usually split the driving side effects elavil . I drive in the evening, when I am most alert, and my husband drives in the daytime while I drowse risperdal educational video . That trip neither of us could keep our eyes open clomid succcess . We nearly pulled into a rest stop to steep, but somehow we managed to get home imigran inhalt sumatriptan .
I told my sister, who responded, “Sleepiness is a side effect amoxicillin for dental infection . We take magnesium at night boost natural testosterone levels .” I’ve used it for insomnia ever since msds samsung lithium ion batteries .
A brethine preterm labor law firm . You’ve confirmed what some other readers noted: Magnesium makes them sleepy altace pdr . Magnesium can cause diarrhea, usually at doses above 350 milligrams daily allegra medicine . People with kidney problems must avoid magnesium, because it could be harmful dizziness coumadin .
• • •

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

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

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

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

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

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

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

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

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

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.

First Hours After Birth. FAQ.

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

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

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

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

Vitamin K

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

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

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

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

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

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

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

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

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

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

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

Helping your baby’s birth

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

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

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

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

Extra birth partners

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

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

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

Remaining calm

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