We’re having a baby

A guidebook for expectant parents Dear Reader,

Babies are born in many different situations, into different kinds of families: The baby can be the first born or be born into a group of siblings. Some ba- bies have one parent while others have two. Some are born into traditional nuclear families, others in- to stepfamilies. Some pregnancies have been care- fully planned while others come as quite a sur- prise. This booklet contains information on pregnan- cy, birth and parenting. It also gives advice on how to take care of the baby and where to find help and support. We hope that this booklet will provide you with good advice and useful information. The prenatal and child health clinics are there to offer support and advice on good parenting. You can also contact the maternity hospital and organisa- tions dedicated to issues concerning children and families for further support. u

We’re having a baby 27. edition

STAKES National Research and Development Centre for Welfare and Health

Illustrations by Taru Castrén

Layout by Hanna Tennilä, Textop Oy

ISBN 978-951-33-2176-5 Erikoispaino Oy Helsinki 2008

3 Content From conception to birth

Pregnancy Conception takes place during ovulation, your last menstruation. A normal pregnan- which is approximately two weeks after cy lasts between 32 and 42 weeks. To cal- From conception to birth...... 5 the first day of menstruation. The ovum culate the expected date of delivery, add 40 Signs of pregnancy...... 10 can be fertilised by male sperm for 24 weeks (= 9 months and 7 days) to the date hours. Fertilisation happens when the when your periods last began. Most babies Nutrition and pregnancy...... 13 male sperm cell penetrates the female are born during week 39 or 40. If your Risk factors...... 17. ovum. The sperm can survive in the wom- menstruation cycle is longer than 28 days, Exercise and fitness...... 19 an’s body for 2-4 days. The male sperm de- then conception took place more than two termines the sex of your baby. weeks after the first day of your latest peri- Preparing for parenthood...... 20. od. Most pregnant women have an ultra- You and your partner...... 23 The expected date of delivery sound scan in week 20. The EDD is Antenatal care in Growth and development...... 70. The due date, or expected date of delivery checked against the size of the baby. In lat- (EDD), is calculated from the first day of er scans, the EDD will not be revised. the prenatal clinics...... 26. Daily routines...... 76 Pregnancy at work and at home. . . . 30. Safety...... 79 Placenta What does a baby need?...... 32 Starting supplementary food ...... 81 The placenta begins to develop when the fertilised ovum is embedded in the lining When the baby is ill...... 84. of the uterus a few days after conception. A The birth Organizing childcare...... 88. well-functioning placenta provides the ba- Preparing for birth...... 34. sis for the healthy development of the foe- tus. The placenta acts as the lungs, liver, in- C-section...... 35 Services for families testines, kidneys and source of nutrition Onset of labour...... 38. with children for the foetus. Nutrients and oxygen travel from the placenta to the foetus via the um- The stages of labour...... 39. Prenatal and child health clinics. . . . 90. bilical cord. The veins in the umbilical cord Labour pains and pain relief. . . . . 42. Social services centre...... 91 carry the baby’s blood to be oxidised in the The newborn...... 44. placenta and transfer the waste to the Municipal day care...... 92. mother’s circulation. The metabolism takes Recovering from the delivery. . . . . 48. Organisations...... 94. place through a thin membrane: the blood Special situations...... 96. circulations of the mother and the baby, al- Baby care though very close to each other, remain separate. A fully developed placenta First month...... 54. Social protection for families weighs about 500 to 800 grams, and is Breastfeeding...... 60. with children shaped like a flat disc. Many substances harmful to the foe- Hygiene...... 64. Social protection for families tus, such as nicotine and alcohol, can pass Sleep...... 68. with children...... 99. through the placenta. (See page 17.)

4 Pregnancy 5 Pregnancy Calendar Uterus The uterus of a woman who is not preg- may dilate a little, more if the pregnancy is Weeks Pregnancy development Todo list! nant weighs 50 to 70 grams and is 7 to 9 not the first. Experiencing painful contrac- cm long. At the end of pregnancy, it weighs tions during the second trimester may be a conception Takes place roughly two weeks Stop smoking and give up nearly 1 kg and has a volume of about 5 li- sign of an infection, and you should con- from the start of your period. alcohol! If you need support, tres. During pregnancy, the uterus grows tact your prenatal clinic immediately. contact your prenatal clinic. with the baby. During the fourth month of pregnancy, the uterus rises from the pelvis, Pregnancy and well-being weeks 0-4 At two weeks, the embryo is Do not take any medications which results in visible changes in the Although pregnancy is a natural condition, the size of a pinhead. during pregnancy without mother’s body: in week 16 the fundus of it is nevertheless a strain on the mother. first consulting a doctor or uterus is halfway between the pelvis and The entire body must adapt to the new sit- nurse! Check that your the navel, by week 24 it is up to the navel, uation. Metabolism is enhanced, breathing medications can be safely and by week 36 it is up to the diaphragm. and circulation become more efficient, and used during pregnancy. Accelerated growth of the uterus may indi- the uterus grows. During pregnancy the cate a multiple pregnancy. The fundus of placenta secretes enzymes and hormones weeks 5-8 The foetus is now 1.5 cm long and has the The baby is well if the uterus usually drops a couple of weeks be- which, together with the corpus luteum beginnings of arms and legs. The heart, mot­her is well: fore delivery and becomes round in shape. and pituitary gland, regulate these chang- nose, ears and eyelids, the nervous system, healthy food, sufficient rest At the same time the baby usually turns es. Changes in the body also affect the spine and umbilical cord start developing. and plenty of outdoor head down ready for delivery. mental state, or moods, of the pregnant activities are good for both. woman. (See ”Preparing for parenthood” Movements on page 20.) weeks 9-12 When the foetus is 10 weeks old, it is approx- The early pregnancy Women who are having their first baby Pregnancy affects women in different imately 3 cm long and weighs 20 grams. The ultrasound scan is done usually feel its movements by week 20 or ways: some suffer from several signs and baby’s heartbeats can be heard. The foetus between the weeks 10 and 21. Mothers who have had previous preg- symptoms while others experience very floats in amniotic fluidprotected by the foetal 14, and is usually an internal nancies can already feel the movements little discomfort. Some symptoms are membrane and gets its food through the scan done through the vagina. around week 18. At first, the movements common at the beginning, while others umbilical cord. The foetus now has an upper may feel like ”bubbling” or ”fluttering”, are typically experienced at later stages. and lower jaw and the beginning of a tongue. before they develop into gentle kicks and Although the symptoms may cause serious Teeth are beginning to develop in the gums. bumps. discomfort to the mother, they seldom pose any threat to the baby. weeks 13-16 When the foetus is 14 weeks old, it is ap- To qualify for the maternity Contractions During pregnancy, it is recommended proximately 9 cm long, and weighs about benefit the mother must The uterus prepares gradually for the deliv- not to take any medications or natural 100 grams. The uterus is now about the size have a medical examination ery. During the last weeks the uterus tight- health products, not even cough drops, of a fist. The head is big, almost half the either at the prenatal clinic ens in ”practice contractions”. In the be- without first consulting a doctor or a nurse, length of the foetus, and the facial features or by a doctor before the end ginning, the contractions only last for a few because some drugs will be harmful for the start developing. The ears and genitals de- of week 16. seconds, but towards the end of pregnancy baby. When at the doctor’s or dentist’s, al- velop. The foetus practices swallowing and they can last for up to 30 seconds. Contrac- ways remember to tell them that you are breathing. It kicks, wiggles its toes and tions prepare the cervix for delivery. During pregnant so that they can adjust the treat- thumbs, and turns its head, but the mother is the final weeks of pregnancy, the cervix ment accordingly. Avoid x-rays. u not yet able to feel these tiny movements.

weeks 17-20 When the foetus is 18 weeks old, it is 25 - 27 Talk to the nurse about cm long andweighs 250 - 300 grams. The antenatal classes. foetus has its own circulatory system, and its

6 Pregnancy Pregnancy 7 Weeks Raskauden kehitys Todo list! Weeks Raskauden kehitys Todo list!

heart beats twice as fast as that of an adult. Most women have an ner. A baby born before 28 weeks is consid- A very fine down, known as lanugo, is now external scan some time ered extremely premature. The lungs and covering the baby’s entire body. Most of this during weeks 18 - 21. other organs are not yet fully developed. will disappear before birth. The baby has The external scan is done With intensive care the baby often survives, eyebrows. The placenta is almost as big as by rolling a transducer and the prognosis is better due to improved the foetus. It protects the foetus from some across your tummy. treatment methods. but not all harmful substances. If this is not her first pregnancy, the mother will now be weeks 29-32 When the foetus is 30 weeks old, it is ap- Avoid standing work, able to feel the movements of the baby. proximately 40 cm long and weighs about lifting heavy objects and 1.5 kg. Most children born during weeks other strenuous tasks. weeks 21-24 When the foetus is 22 weeks old, it is ap- In week 22, you can 29 - 32 survive with intensive care, and their proximately 30 cm long and weighs 400 - apply for maternity, risk of handicap is small. 600 grams. At his time even women who are paternity and parental having their first baby can feel the move- allowance as well as for weeks 33-36 When the foetus is 34 weeks old, it is ap- Now is the perfect time ments. The heartbeat is clearly audible. By the maternity benefit proximately 47 cm long and weighs about to get everything ready week 24, the fundus of uterus is up to the (See “Benefits for families 2.7 kg. It gains weight rapidly. The baby has for the baby. navel. Accelerated growth of the uterus may with children”.) less room in the uterus and moves around indicate a multiple pregnancy. The foetus less than before. At this stage, most babies In many municipalities, practices sucking, and its thumb often finds Avoid excessive strain. turn head down ready for delivery. The ba- you can visit the maternity its way into its mouth. The hair and nails are Do not take the by’s skin is covered with a creamy film hospital in advance. growing, and the protective membrane is contractions lightly. called vernix. The uterus reaches its highest starting to develop into skin. Most of the point and is up to your ribs. If there is risk of time the baby is asleep, but it can be awak- premature birth, the delivery will take place ened by noise or vibration. A pregnancy ter- close to the neonatal intensive care unit. Ba- minating before week 22 is called a sponta- bies born in week 35 seldom need intensive neous abortion, or miscarriage. If born dur- care. Babies born before week 37 are con- ing weeks 23 or 24, the baby may survive in sidered premature, and the mother and intensive care, although it is very premature. child may need to stay at the postnatal ward Developmental risks are great, and the se- for an extended period of time. lection of a treatment regime must often be given due consideration. weeks 37-40 The uterus drops and the baby’s head will Go to the hospital if your become engaged into your pelvis. Contrac- water breaks, you have weeks 25-28 When the foetus is 26 weeks old, it is ap- Be alert to the reactions tions will become more frequent. The baby contractions at regular proximately 35 cm long and weighs about a of your body. Remember is kicking so hard that he or she can push intervals, you are experienc- kilogram. The foetus moves a lot. It turns to get enough rest! away a book resting on your tummy. At ing pains, or if you are and kicks so hard that the movements are birth, most babies are 49 - 52 cm long and bleeding. (See “Birth”.) visible. The baby can open and close its eyes Avoid any unnecessary weigh 3000 - 4000 grams. The average preg- and has a firm grip. The fundus is up to the strain, especially if you nancy lasts for 40 weeks, but deviating from When the baby is ten days navel now. You may be experiencing your have contractions. the average by one week is very common. over the expected date of first contractions: your belly tightens for a delivery, the mother will go few seconds and then relaxes. The foetus to the hospital for a post-term now looks like a real baby, but is a lot thin- follow-up check.

8 Pregnancy Pregnancy 9 turising lotion available from the chemists Sweating to prepare the skin for breastfeeding. If Sweating increases during pregnancy as Signs of pregnancy your nipples are small or turned inwards, metabolic activity increases. Pay special at- stretch them daily starting a few months tention to your personal hygiene. before the expected date of delivery so that the baby will be able to get a good grip. Heartburn Feeling tired Heartburn is a common ailment towards Some expectant mothers are vital and en- Vaginal discharge the end of pregnancy. It is caused by regur- ergetic, while others feel very tired during The normal amount of vaginal discharge gitation of gastric acid. Heartburn is a the first and last months of pregnancy. If tends to increase during pregnancy. If the painful burning feeling in your throat, possible, rest during the working day. If discharge smells bad or itches, consult chest or upper abdomen. It can be alleviat- you feel extremely tired for more than two your doctor as it may be a sign of an infec- ed by avoiding spicy and fried foods, coffee weeks, discuss it with your prenatal clinic’s tion. When washing, use only water as and strong tea. The prenatal clinic will be nurse or doctor. (See ”Anaemia”.) soap may irritate the mucous membrane. able to suggest safe medications to treat heartburn. It will discontinue as soon as Body temperature Vaginal bleeding the baby is born. During the early stages of pregnancy, the Periods will stop during pregnancy be- body temperature may rise slightly. This is cause the lining of the womb that is dis- Anaemia quite normal and does not need medical charged during menstruation is vital for Anaemia may be the reason for feeling ex- attention. However, if you have a fever pregnancy. Slight vaginal bleeding is ex- tremely tired. Other symptoms include during pregnancy, contact the prenatal perienced by approximately 25% of wom- paleness, palpitations, shortness of breath clinic or your doctor. en around the time of normal menstrua- during exercise and dizziness. Anaemia tion. The bleeding is explained by the fer- occurs when there is not enough haemo- Nausea and vomiting tilised ovum being embedded in the lining globin in your blood. Haemoglobin levels Almost one in every two expectant moth- your stomach becomes empty. This can be of the uterus. If the bleeding is heavy and often decrease during pregnancy because ers suffer from nausea or ”morning sick- prevented by having snacks during the similar to regular menstruation, it may be there is more blood in your circulation. In ness” during the first trimester (the first day. Violent vomiting is not a normal sign a sign of miscarriage and you should con- a sense, your blood is ”diluted”. If neces- three months of pregnancy), especially in of pregnancy and should always be treated tact the nurse or doctor at the prenatal sary, your doctor or nurse will prescribe the morning when the stomach is empty. by a doctor. clinic. iron supplements. Vegetables and fruit rich It may be accompanied by dizziness and in vitamin C as well as meat and fish en- fainting when getting up. Nausea may be Breasts Urinating hance iron absorption. triggered by certain smells or tastes, be- Your breasts will grow and they might feel In the early stages of pregnancy, and espe- cause the sense of taste and smell is tender and tight. Beginning from the sec- cially before the time of the normal men- Varicose veins heightened during pregnancy. The morn- ond month, it is possible for your breasts struation period, you may experience a Varicose veins are enlarged veins that are ing sickness and vomiting usually stop af- to leak milk. At this stage your breasts will vague feeling of heaviness in the lower ab- swollen and raised above the surface of the ter the first three months. It might help to be very sensitive to cold and should be domen. This is caused by the expanding skin. The condition tends to get worse dur- drink a glass of water or juice before get- kept warm at all times. You should buy a veins and enhanced circulation. Toward ing pregnancy when the expanding uterus ting out of bed and eat something small supportive maternity bra by the middle of the end of pregnancy, the need to urinate puts pressure on the veins. Wearing spe- such as a biscuit or slice of bread as soon your pregnancy. During the winter, wear a is more frequent as the uterus is pressing cialised compression stockings, which you as possible after getting up. Get out of bed warm woollen scarf around your breasts. It against the bladder. A swift kick from the put on before getting out of bed, help to slowly, taking your time. You may be over- might be wise to avoid swimming in cold baby may cause the mother to have an alleviate the problem. It also helps if you come by nausea during the day as well, if water. Massage your nipples with a mois- ”accident”. can put your feet up during the day and

10 Pregnancy Pregnancy 11 place a pillow under your feet at night. that supports your back without being too Avoid wearing high-heeled shoes or shoes hard. Gentle massaging and rest will relax that are too tight. Wear different shoes tense back muscles. Light exercise to Nutrition and pregnancy during the day to give your feet a rest. strengthen the abdominal muscles is rec- ommended. Ask the prenatal clinic for ex- Cramps ercise instructions. Eating a well-balanced and varied diet During pregnancy women tend to have leg keeps the expectant mother healthy, con- cramps. Painful leg cramps often occur at Swelling tributes to the healthy development of the night. The best way to relieve a cramp is to Some degree of swelling is normal unless baby, and prevents nutritional problems. It stretch the cramping muscles: straighten it is accompanied with rising blood pres- also accelerates recovery from the birth your leg, take hold of your big toe and pull sure and protein discharges in urine. A and supports breastfeeding. A healthy your leg up, or press it against the bed. You sudden increase in weight (over 500 g per woman who has been eating a balanced can try to relax the cramp by massaging week in a woman of normal weight) or and varied diet does not need to make any the muscle lightly. Use a cold pack (e.g. a swelling accompanied by severe itching major adjustments during pregnancy. bag of frozen vegetables) for first aid. Keep may be symptoms of a liver condition Some women will need iron, folic acid your feet warm during the night. (hepatosis gravidarum). Contact the pre- and calcium supplements to meet the add- natal clinic or your doctor. ed demand during pregnancy. Multivita- Constipation and piles min-mineral supplements are necessary As the uterus grows, it presses against the Skin blemishes only if the diet is not balanced. It is recom- rectum and thus increases the tendency to The skin can get darker during pregnancy, mended that all pregnant women take recommended that pregnant women eat develop piles. As piles are aggravated by especially the tips of the breasts and supplemental vitamin D during the winter several times a day: breakfast, lunch, din- constipation, pay special attention to what around the genitals. A brown line often months. It is advisable to avoid supple- ner, and 2 to 4 snacks in between. you eat and make sure that you exercise appears stretching from the lower abdo- ments containing vitamin A. sufficiently. Fibre-rich foods and sufficient men to the naval, and brown spots (ch- Weight gain liquid intake help prevent constipation. loasma) appear on the face. These marks Energy requirements The average total weight gain during preg- Wholemeal bread and porridge, vegeta- will fade after delivery. During the first three months of pregnan- nancy is 12.5 kg. Weight gain is caused by bles, berries and fruit are all good sources cy (the first trimester), there is virtually no the growth of the uterus, foetus, placenta of fibre. If necessary, add bran or wheat Stretch marks need for extra food. During the second and and breasts, and the increased amount of germ and dried fruit to your diet to en- Pregnant women may develop stretch third trimester the need for extra energy blood and amniotic fluid. However, during courage regular bowel movements. Exer- marks on their breasts, abdomen and can be met with a slice of bread with the first trimester it is common to lose so­ cise and other physical activities will also thighs, caused by tearing of the dermis. spread, a glass of milk, and one piece of me weight. Women gain different amounts help. Massaging stretch marks with a moisturis- fruit. Often the physical activity of the of weight, and recommendations are based ing lotion may help during the early stages pregnant women decreases towards the on the weight prior to pregnancy. Backache of pregnancy. The red lines will usually end of pregnancy, which further decreases Weight gain should be monitored for As the tummy grows, the back muscles fade after delivery. u the need for additional energy. Thus, there several reasons: Insufficient weight gain have to take a lot of strain, which may re- is no need to ”eat for two”, but to eat a may be an indication that the foetus is de- sult in back pain. Good posture and sup- well-balanced and varied diet, and eat at veloping too slowly. A steady excessive in- port by the abdominal muscles (hold your regular intervals. crease in weight is a strain on the expect- navel in as much as possible) will alleviate It is very important to maintain regular ant mother. A sudden increase may be a the pain. Wearing a supportive maternity meal times. Feeling tired or nauseous may sign of too much fluid collecting in the bra and comfortable shoes with flat heels indicate that the expectant mother should body (see ”Swelling”). Excessive weight will ease the backache. Find a mattress get more rest and eat more regularly. It is gain during pregnancy may predispose the

12 Pregnancy Pregnancy 13 woman to gestational diabetes, which is a Wholemeal products are also rich in fibre, um-packed raw-cured and cold-smoked sulfame, taumatine and sucralose, are not disorder of carbohydrate metabolism that which helps digestion and prevents consti- fish products as well as unripened chees- forbidden during pregnancy and breast- can result in the excessive growth of the pation. es, blue cheese and camembert made from feeding. The only exceptions to this rule baby and low blood sugar levels at birth. Vegetables, fruit and berries are rich unpasteurised milk. are cyclamate and saccharin, which are not (See ”Weight control” on page 50.) in vitamins, minerals and fibre. Because recommended during pregnancy and Putting on a lot of weight during preg- they contain little energy, they are not fat- Salt breastfeeding. Enjoy only moderate nancy predisposes the woman to being tening. Vegetables, fruit and berries should Use as little salt as possible, because it amounts of liquorice, because it contains overweight after delivery as well. Obesity be eaten in large quantities, preferably at causes swelling, burdens the kidneys and high levels of glycyrrhizin, which may is a risk factor for many chronic diseases, every meal, and at least 5 portions a day. raises your blood pressure. Food cravings cause swelling and raise blood pressure. such as Type 2 diabetes. Healthy eating Prefer uncooked vegetables and try differ- during pregnancy may considerably in- habits and sufficient exercise help in con- ent colours. Use vegetables and fruit to crease the amount of salt intake, if the Fat trolling weight, and a positive mood will add taste and to cut down the amount of craving is for salted snacks or other foods Use low fat spreads on bread and toast. support these efforts. calories. Beans, lentils, seeds, peas and with high levels of salt, such as salted Prefer low fat spreads, vegetable oils and nuts all contain a lot of protein. Remember gherkins, pickles or dried sausages. Most vegetable oil blends in cooking. A well-balanced diet during pregnancy to rinse salads and other vegetables care- seasoned salts and stock cubes contain Every family has its own eating habits. fully in order to avoid listeria. 50% salt. In addition to salt, soup mixtures Liquids Pregnant women should, however, pay at- Meats and fish are rich in protein, and marinated poultry and meats also Drink sufficient liquids during pregnancy tention to their eating habits and be pre- which is important for the healthy devel- contain soy or sodium glutamate. Improve and while breastfeeding. Fresh water and pared to make some adjustments to im- opment of the baby. Choose products taste and use less salt by using plenty of diluted juice are the best alternatives for prove the well-being of the developing ba- which are low in fat and salt. Avoid eating vegetables and fruit. quenching thirst. Current recommenda- by and herself. It will benefit the whole liver and liver products during pregnancy tions suggest that pregnant women should family to pay attention to the type and because they contain high levels of vita- Sugar limit their coffee consumption to 3 cups a amount of fats they eat and their sugar and min A. It is advisable not to eat more than Reduced consumption of sugar helps to day. For many, coffee is a cause of heart- salt intake. 200 g of liver pâté or sausage per week prevent putting on a lot of weight and pro- burn. Milk, cheese and other dairy prod- and to eat a maximum of 100 g at a time. tects teeth. Soft drinks have high levels of ucts are important sources of protein, cal- The recommendation is to eat fish 2 to 3 sugar but contain none of the necessary Vitamins and minerals cium and other nutrients. There is an in- times a week. Avoid pike during pregnan- nutrients, and this is why soft drinks are The developing baby takes all the nutrients creased need for these during pregnancy, cy and while you are breastfeeding be- not part of a balanced diet. According to it needs from the mother’s body, and rare- and it is recommended that pregnant cause it contains high levels of mercury. current recommendations, drinks with ar- ly suffers from any deficiencies. The preg- women eat dairy products even if they are Because of the risk of listeria, avoid vacu- tificial sweeteners, such as aspartame, ace- nant women needs a rich supply of vita- not normally part of the usual eating hab- its. To ensure a sufficient supply of calcium, pregnant women should drink 4 glasses (8 dl) of milk or other liquid dairy products daily. Select the non-fat or low- fat alternatives. Bread and por- ridge, especially those made from whole- meal, contain lots of minerals and vitamins.

14 Pregnancy Pregnancy 15 Risk factors

Infections During pregnancy, it is especially impor- Note! For the sake of the child’s health tant to avoid infections that could be as well as for the sake of their own harmful to the foetus. The risk of infection health, both parents should give up mins and minerals for the safe develop- grains. The iron from meat and fish is eas- can be considerably reduced by carefully smoking at the early stages of pregnan- ment of the baby and for her own health. ily absorbed. Foods rich in vitamin C en- following the protective instructions. Tox- cy, if not before. The need for vitamin D increases dur- hance iron absorption from wholemeal oplasmosis is a parasite that causes infec- ing pregnancy. The best sources of vitamin grains and vegetables. Sometimes even a tions. It is found in cats, guinea pigs and They also impair the normal functioning of D include fortified dairy products, marga- well-balanced diet cannot supply a suffi- laboratory animals. To prevent infection, the placenta. rines and fish. Using dairy products and cient amount of iron during pregnancy. avoid contact with cat litter trays or soil Nicotine levels are higher in the foetus margarines fortified with vitamin D is safe Usually, half of the needed iron is from that may have been fouled by cats or other than in the mother. Babies born to smok- and there is no danger of overdose. It is food and the other half from the mother’s animals. Do not let the cat sleep in your ers have low birth weight and are restless recommended that all pregnant and iron reserves or from iron supplements. bed. and irritable more often than those born to breastfeeding women take supplemental The need for iron supplements is individu- For pregnant women, listeria is a dan- non-smokers. Smoking during pregnancy vitamin D during the winter months (Oc- ally assessed at the prenatal clinic. gerous bacteria found in food products. may have harmful effects on the develop- tober through March). Calcium is necessary for the develop- The best way to avoid listeriosis is by ment of the brain and lungs, and also in- Folic acid or folate is a form of vita- ment of the baby’s bones. The calcium in- washing your hands thoroughly after han- creases the risk of infection after birth. min B. The need for folic acid increases take of most women is sufficient. If your dling meat, and storing raw meat away Support for giving up smoking is avail- during pregnancy. Wholemeal and whole- diet does not include any dairy products, from cooked food. Follow the instructions able from the prenatal clinic and through grain products and uncooked vegetables, you need to take calcium supplements. If when heating processed foods and frozen the Internet (www.stumppi.fi). Nicotine fruit and berries are rich in folic acid. Sup- the need for calcium is satisfied by supple- vegetables. Fresh vegetables should be replacement products other than the patch plemental folic acid is not needed if the ments only, the daily dose is 1000 mg. Cal- carefully rinsed. Avoid vacuum-packed can be used, if necessary. mother is eating a well-balanced and var- cium and iron supplements should be tak- cold-smoked and raw-cured fish products, ied diet including wholemeal products and en at different times. blue cheese and camembert, and cheeses Alcohol 5 to 6 portions of fruit and vegetables eve- made from unpasteurised milk. Alcohol causes foetal damage. When a ry day. To secure the sufficient supply of Dental care and fluoride Sexually transmitted diseases and in- pregnant woman drinks alcohol, so does folic acid, it is recommended to choose a Pregnant women should take good care of fections can be prevented by using a con- her foetus, because alcohol passes through multivitamin product containing 0.4 mg their teeth. This is important for both the dom. the placenta and travels via the umbilical folic acid. mother and the baby; tooth development cord into the foetus. The blood alcohol lev- The need for iron multiplies during starts while the foetus is in the womb. For Smoking el can be higher in the foetus than in the pregnancy. Iron is necessary for making teeth, the most important mineral is fluo- Smoking is harmful for both the mother mother. red blood cells and oxygen transport and rine. Fluorinated toothpaste strengthens and the baby. Cigarette smoke often caus- for the development and proper function- the teeth when used daily. When neces- es nausea in expectant mothers. The nico- Note! Pregnant and breastfeeding wo­ ing of the placenta. These are also very im- sary, the dentist might recommend fluo- tine and carbon monoxide in the smoke men should avoid alcohol completely to portant for the baby. The main sources of ride tablets. Health care centres arrange are absorbed into the mother’s blood and prevent its harmful effects. iron include meat, fish and wholemeal dental care for pregnant women. u transfer via the placenta into the foetus.

16 Pregnancy Pregnancy 17 Binge drinking (consuming large quan- ment of the placenta and premature birth. freephone helpline aimed at preventing travelling long distances by car, be pre- tities of alcoholic beverages) is particularly Drug abusers often neglect their own well- foetal defects. The helpline also provides pared to stop every few hours to walk dangerous for the foetus. The body parts being, are in bad physical condition, and information on infections, radiation and around a bit. and organs develop during the first trimes- suffer from malnutrition and infections. All other external risk factors during pregnan- Motorcycling is not recommended for ter (the first three months of pregnancy), of these pose particular risk during preg- cy and breastfeeding. pregnant women. Travelling by planes that and a dangerous drinking pattern during nancy. The newborn may suffer from with- are not pressurised may cause the foetus to the first trimester can result in foetal mal- drawal symptoms and later defects. When Travelling suffer from oxygen deficiency. Airlines formations, e.g. a congenital heart defect. the expectant mother is a substance abus- Wearing a seatbelt is compulsory in the have rules regarding travelling and preg- Excessive alcohol use should be avoided er (drugs or alcohol), she should seek help back seat of the car as well. Towards the nancy. Most airlines have an upper limit whenever there is a possibility of pregnan- as soon as possible. The prenatal clinic will end of pregnancy, wearing a seatbelt might beyond which they refuse to carry a preg- cy. Pregnant women should avoid alcohol be able to assist in finding appropriate feel uncomfortable, but it is important for nant woman. It is advisable to check with completely. support. the safety of the mother and the baby in your airline what they use as the upper Alcohol slows down foetal growth Huumeambulanssi ry (www.huume­ case there is an accident. If you will be limit on long-haul flights.u throughout the pregnancy and may result ambulanssi.fi) is an organisation providing in low birth weight. The foetal central support and advice on substance abuse nervous system (CNS) is very vulnerable, and assists people in finding help. Thehel- and at worst the baby may suffer from pline service at (09) 278 7727 is available mental retardation. Alcohol-related foetal from Monday to Thursday 5 pm to 12 am, defects may cause problems associated and at weekends from Friday 6 pm to Sun- with attention span, learning, and linguis- day 12 am. tic development. Irti Huumeista ry (www.irtihuumeista. There is no safe amount of alcohol that fi) is a non-governmental organisation Exercise and fitness a woman can drink while pregnant. Exces- that provides information on drugs and sive alcohol consumption during pregnan- drug addictions and their effects on the cy increases the risk of miscarriage. Other substance abuser and his or her family. The Get as much exercise and fresh air as pos- risks include malfunctions of the placenta, organisation provides advice, support and sible during pregnancy. When the mother bleeding and the resulting infections, and information by phone and email. The Na- is in good physical condition, it will con- the premature detachment of the placenta. tional Drug Service line (0203 22388) tribute to the healthy development of the Caesarean sections, or C-sections, are maintained by the organisation is available baby. It should be possible to enjoy your more common in heavy drinkers than in Mon-Fri from 9 am to 3 pm and 6 pm to 9 sport throughout most of your pregnancy. other women. pm. During pregnancy your ligaments will MOTHER’S GOOD CONDITION WILL CONTRI­BUTE There are several sources of support loosen and the centre of gravity will move and advice to help in giving up alcohol: for Medication forward, which may cause backache. Be TO THE BABY’S HEALTH AND DEVELOPMENT. example, the prenatal clinic, the A-Clinic Do not take any medications or natural sensitive to your body’s reactions and Foundation (www.a-klinikka.fi, tel. [09] health products during pregnancy without modify your exercise accordingly. It is ad- 6220 290) and Alcoholics Anonymous first consulting a doctor or nurse. Further visable to avoid activities involving leaps, chores, such as washing rugs and moving (www.suomenaa.fi). information on the effects of drugs on the stretching and other sudden movements. furniture, increase contractions and in- foetus is provided by the Teratology Infor- It might be wise to avoid swimming in crease the risk of miscarriage. Ask the pre- Illegal drugs mation Service of the Hospital District of cold water, because of the risk of infections natal clinic for exercise instructions. The All drugs pass through the placenta into Helsinki and Uusimaa, available Mon-Fri 9 and contractions. Walking is an ideal daily training programmes of pregnant athletes the foetus. Drugs restrict the growth of the am - 12 pm (tel. [09] 471 76500). The Tera- activity during pregnancy. Light house- should always be prepared in close co-op- baby, and may cause premature detach- tology Information Service is a national work is excellent exercise, but strenuous eration with a doctor. u

18 Pregnancy Pregnancy 19 change of life. However, it is not possible Becoming a mother to be prepared for everything – some For many women, pregnancy is the time of Preparing for parenthood things will always come as a surprise! Be- their life and everything is just wonderful. coming a parent brings a lasting responsi- The baby grows in the safety of the womb bility for caring for the baby. Worries and and the mother can continue with her nor- even fears concerning the baby and how mal activities. However, women will need Having a baby will affect family life you are going to cope are quite common- to review some of their choices and habits Having a baby is an enormous change for Usually, first time parents cannot fully place. Nevertheless, having a baby is an in- concerning food, drink, exercise and rest. all members of the family. Pregnancy is the appreciate how completely a baby changes finitely rich experience, one of the most You will start seeing things from a new time to prepare: hormonal and physical their life. At the beginning, the baby will precious and natural in your life. Having perspective now that you are also respon- changes help the mother adjust to the require the parents’ full attention. All an open mind will help in solving many sible for the well-being and healthy devel- coming change. For the dads, who are not thoughts, talk and actions revolve around questions and problems during pregnancy opment of your unborn baby (see ”Preg- pregnant, one way of preparing is to sup- the baby. Prepare everything ready for the and after the baby is born. nancy and well-being” on page 6). port the mum and focus on her experienc- baby during pregnancy. Make room for the es and feelings. It is recommended that baby in your home and buy or borrow the Fears and concerns Mood swings women share their feelings and experienc- items that the baby needs, such as clothes During pregnancy the parents may be Hormonal changes may cause severe es with their partners and encourage the and a cot or crib. Think about how you worried about many different things: Will mood swings in the mother. She might be dad-to-be to put his hand on her tummy want to arrange day care. Pregnancy is al- the child be healthy? How will I know how extremely weepy and be deeply hurt by to feel the movements of the baby. so the time to prepare mentally for the to take care of a baby? What to do when offhand remarks. The first pregnancy is es- the baby cries? Will I make a good mum/ pecially testing. A pregnant woman needs dad? Will I love my child? How will we to be assured and reassured that her part- manage financially? A single parent might ner still loves and supports her. The devel- also worry about being ”shorthanded” and oping baby exhausts the mother’s energy how she will manage alone with the baby. resources, and she will need a lot of rest. Even when the pregnancy has been However, pregnancy is a natural condition, planned, it is quite common that the par- not an illness. Sharing your thoughts and ents have second thoughts at some point. feelings with your partner and other close You may be overwhelmed by the thought friends will help. of being responsible for the life of another human being and wish you could just can- Physical changes cel the whole thing. These feelings are very The female body goes through tremen- common and they will pass in time. It will dous changes during pregnancy. Skin and help if you can share these fears other tissues are stretched to their limits. and concerns with some- Breasts usually grow during pregnancy by one. Remember that at least one cup size, and the pelvis there is no need to spreads. Pregnant woman acquire femi- feel guilty about nine softness and sensuality. The centre of such thoughts and gravity changes as pregnancy progresses feelings; process- and this will affect balance. The changes ing your thoughts are great, but they happen slowly as preg- and feelings is part nancy progresses. Your general mood de- of becoming a parent. pends greatly on how well you will be able

20 Pregnancy Pregnancy 21 The father may also have questions tives, the prenatal clinic’s nurse, a social and doubts about the life ahead of him. worker and health care centre psychologist MOTHERS NEED SPECIAL ATTENTION Men often wonder if they will be good fa- are available to provide support. You can AND SUPPORT DURING PREGNANCY. thers and a good example to their children, also contact helplines, the child guidance and how the family will cope financially in and family counselling centre, or the the new situation. The responsibility may church’s family guidance centres (see feel overwhelming. Some men try to es- ”Services for families with children” on support person) to attend the birth. For cape: they might work late hours or spend page 90). Single parents will find peer sup- more information, please visit the Federa- all of their spare time ”with the lads” trying port from the association for single parents tion of Mother and Child Homes and to savour freedom as long as possible. It is (visit ”Yksin- ja yhteishuoltajien liitto” at Shelters’ site at www.ensijaturvakotienliit- recommended that the dads-to-be share www.yyl.fi). If you are pregnant without a to.fi. (Find contact details by typing ”dou- their feelings with other prospective fa- partner, you can invite a doula (a trained la” in the search field.) u thers or experienced dads. Support networks For the mother, late pregnancy, childbirth and maternity leave constitute a time when socialising with colleagues and friends decreases. Nursing and caring for The relationship with the baby at home might make the mother feel isolated, especially if there are no oth- er mothers with babies in the neighbour- your partner hood or among her friends. Since there is to accept these inevitable changes. Often less contact with other adults than before, pregnant women expect their partners to great expectations fall on the partner to lis- admire the growing tummy and altered ten and keep company. Cherish the love you have appearance. Start building your social network al- Your relationship with your partner is one if they have not been talked through and ready during pregnancy and actively seek of the most important relationships in forgiven. Pregnancy and the father to make friends with people in the same your life. Pregnancy and having a baby are demand- situation, e.g. with the parents in your an- A source of joy and mutual satisfac- Housework ing for the father as well. He is expected to tenatal class. Maternity and parental leave tion, it does not flourish if left unattended. Couples without children generally split be supportive and understanding. Espe- provide a chance to make new friends. Firstly, to be able to love another, you need housework evenly without argument, but cially during early pregnancy, it might be Find peer support in parenting clubs, par- to accept and love yourself. Secondly, a in families with young children housework difficult to understand why the mother is ent nights and family cafeterias organised good relationship must be nurtured: be is a major source of disagreement. House- so tired and emotional. If the dad-to-be is by the municipalities, church and the caring and attentive, show affection, listen work is the responsibility of each and eve- aware of the hormonal changes and other Mannerheim League for Child Welfare and interact. At best, pregnancy can be a ry family member; it should not be consid- pregnancy-related changes, it will be easi- (MLL). You can meet other parents with shared experience that strengthens the re- ered as ”helping mum”. If not before, dur- er to understand the pregnant mother. At- young children in parks, playgrounds and lationship and enhances the feminine and ing pregnancy all family members should tending an ultrasound scan is just as im- open day care centres. masculine traits of the parents. On the participate in housework – not just the portant for the father as it is to the mother: Mothers, particularly single mothers, other hand, unpleasant experiences, in- parents but the older children as well. they will both see their baby for the first need special attention and support during sults and unfair behaviour experienced Dad’s share of housework increases time. pregnancy. In addition to friends and rela- during pregnancy are forever remembered during pregnancy, especially if the mother

22 Pregnancy Pregnancy 23 is suffering from contractions. Dur- fatigue and breast tenderness during early especially important when your means of ing late pregnancy, the mother pregnancy may cause your desires to de- expressing your sexuality are limited and should avoid physical strain, such cline. However, you might find that the lit- you are feeling unusually emotional. Hav- as lifting heavy objects. tle secret you are carrying makes sex during ing a satisfactory sex life in your relation- During the first week after early pregnancy thrilling in a new way. ship is a shared responsibility – it takes birth, the baby needs round- For many expectant mothers, the sec- two to tango! the-clock attention. If all house- ond trimester is a sexually fulfilling time. work is left to the mother, she The increased blood flow to the vagina Abuse is unacceptable will become over-exhausted. causes a feeling of fullness and heightened It is good to be an understanding partner, sensitivity. During this time, it is not un- but there are limits as to what should be Sharing your feelings common for women to masturbate more tolerated. Physical and mental abuse are In a good relationship, you than ever before. For many women, this is crimes against another person and should can openly share every- a peak erotic time in their life. not be tolerated. Heavy blows to the area thing that is on your mind: Many men enjoy their sexually more of the abdomen may damage the womb joys, sorrows, concerns, active partner. However, the new situation and the foetus. At worst, this may cause fears, hopes and dreams. is likely to be confusing for the man as the pregnancy to terminate. If you are be- Sharing your feelings and well. He might worry about harming the ing abused, turn to your neighbours or thoughts is not always easy unborn child and avoid situations that will friends for help, or call the police, social and requires practice. lead to sex. A normal pregnancy does not services or a mother and child shelter. prevent the couple from having sex. Sometimes the first priority is to remove The following advice During late pregnancy, many women yourself from the abusive partner into a might be helpful: feel awkward and sexually unattractive safe environment. 1) Listen to what your partner is saying. while others enjoy sex right up to birth. The emergency phone number is 112. What is he/she feeling? What is his/her IF ALL HOUSEWORK IS LEFT TO THE Remember that sexual intercourse is just The Emergency Response Centre staff will intention? Could it be just bad phras- MOTHER, SHE BECOMES OVER-EXHAUSTED. one aspect of sexuality. In this phase when tell you what you need to do and will alert ing and that he/she is not trying to of- your sex life takes on new forms, maintain the necessary authorities. For the Police, fend intentionally? intimacy and affection by saying and doing dial 10022. Girls and women who have ex- 2) The individual is the best judge of his/ ”You are always so careless”. If you things you know will give pleasure to your perienced violence or the threat of vio- her own feelings. If your partner says want something, state it clearly. For ex- partner. lence can receive help from the National he/she is afraid or troubled, don’t tell ample, ”Could you vacuum the house?” After the child is born, there will be a Women’s Line in Finland (www.naisten- him/her that there is nothing to be (instead of ”You never do any­thing”). period when your sex life will have to be linja.com) by calling the national tele- afraid of. Rather, ask what it is specifi- 4) Do not injure the other person’s self re- on hold. The parents can decide the length phone helpline (tel. 0800 02400). Help for cally he/she is afraid of. Allow you part- spect. Even when you are terribly angry, of that period, but it is recommended to men in finding an alternative to intimate ner to have the feelings he/she is expe- don’t say the things you know will hurt put off sex for a couple of weeks, until the partner violence is provided by the riencing and say, for example, ”You the most. vaginal discharge ends. However, there is ”Lyömätön Linja” organisation. If you need must have felt terrible when you were 5) Bringing up past arguments is human, no need to refrain from showing affection! help, call tel. (09) 612 66 212, or email lyo- being reproached by your boss” etc. but it is detrimental to your own life. Hugs, caresses, kisses and nice words are [email protected] 3) Tell your partner how you feel. If you Can you forgive and forget? are angry, say ”Having to clean up after you makes me angry”, for example. Try Pregnancy and sexuality not to blame your partner, and avoid Pregnancy may change the way you feel the word ”always” in phrases such as about sex in one way or another. Nausea,

24 Pregnancy Pregnancy 25 clinic through examinations and a person- It is recommended that the expectant al interview. A blood sample is taken at mother pays attention to the baby’s Antenatal care in theprenatal the first appointment to determine your movements, especially in late pregnan- blood group, Rhesus factor and blood cy. If you are concerned about the well- haemoglobin concentration. The sample being of you or your baby, share it with clinics will also be tested to rule out syphilis. A your nurse or doctor. You can discuss, in urine sample is tested for sugar levels, complete confidence, issues concerning protein and bacteria. The expectant moth- pregnancy, including depression, famil- er will be weighed, her height measured ial problems and fears with the doctors Antenatal care is provided by the and her blood pressure checked. With the and nurses at the prenatal clinic. If nec- prenatal clinics to maintain the mother’s permission, the blood sample essary, further support is available good health of the expectant moth- can also be tested for HIV antibodies and through social workers, psychologists er and the unborn child, to promote hepatitis. Visits to the prenatal clinic al- and specialists. a healthy lifestyle for the whole ways include personal discussions and ad- family and to help the family pre- vice. pare for the new baby. The aims of Your doctor will perform an internal Intensive antenatal care antenatal care include promoting examination at the first appointment to Some expectant mothers receive intensive the well-being and good health of the determine the position of the womb and antenatal care in, for example, the follow- prospective parents, supporting the check that the size of the uterus corre- ing situations: parents in their growth towards par- sponds to the pregnancy weeks. u when the mother suffers from enthood and family life, and provid- prolonged or chronic diseases, ing tools for preventing and solving Follow-up visits u multiple pregnancy, possible problems in their relationship. In close collaboration between the prenatal Follow-up appointments at the prenatal u a very young or a relatively old women particular, support is needed in families clinics and the hospital maternity unit. clinic are at early pregnancy every four having her first baby, expecting their first baby. The prenatal A nurse or midwife and a doctor work weeks, every two weeks from week 28, and u raised blood pressure and protein clinics are organised around the whole at the prenatal clinic. Antenatal care in- once a week from week 35. found in urine (signs of pre-eclampsia, family, not just the mother. Dads receive cludes physical examinations, screening During every visit, the mother is which is a condition that requires a support in their personal growth towards tests, personal guidance and antenatal weighed, her blood pressure is taken and doctor’s attention), becoming fathers and advice on a healthy classes. Your nurse or midwife may also her urine is tested for sugar. Blood haemo- u itching or yellow skin lifestyle and how to best support the visit you at home. During the course of a globin is determined at least three times (signs of hepatosis gravidarum), mother. Additional support and advice is normal pregnancy, the expectant mother during pregnancy. An average weekly u certain inflammatory diseases at provided by online clinics. makes 12 to 15 visits to the prenatal clinic. weight gain is determined to ensure the the beginning of pregnancy, Antenatal care monitors possible prob- Of these, 2 to 3 are doctor’s appointments. pregnancy is progressing normally. Swell- u birth canal infections. lems during pregnancy, takes action to pre- Most health care centres offer ultrasound ing is monitored, if present. Foetal heart- vent them and refers the mother for further scans at 12 to 16 weeks. The services of a beat will be monitored at each visit and the The majority of babies born in Finland examinations and treatment in a hospital, psychologist, a nutritional therapist, a baby’s position will determined by external are healthy. This is mostly due to the if necessary. The prenatal clinics and hospi- physiotherapist and a social worker are al- examination. If the need arises, the exam- good health of Finnish women and the tal maternity units also support the family so available for families. ining doctor or nurse refers the mother to regular visits to the prenatal clinic and if and when the mother has fears relating the hospital maternity unit for further test- maternity unit where the health and to childbirth, suffers from depression, or is First visit ing. Topics concerning pregnancy, child- well-being of the mother and baby are having a multiple pregnancy. Care during The mother’s overall health and possible birth and parenting will be discussed with closely monitored. pregnancy and childbirth is realised in risk factors are assessed at the prenatal both the mother and father.

26 Pregnancy Pregnancy 27 Screening programmes with your partner about the possibility of is a more detailed scan called a structural for families with children. Antenatal class- (to be harmonised across the nation by 2010) increased risks and how you feel about scan. The number of foetuses and their es often include a visit to the hospital ma- Screening tests performed at prenatal terminating the pregnancy or having a status is checked, the age of the foetus ternity unit. clinics vary greatly between different mu- handicapped child. and the amount of amniotic fluid are de- nicipalities. According to the recently The early pregnancy ultrasound scan termined, and the position and condition Prenatal clinics and dads passed Screenings Decree, municipalities is performed at 10 to 14 weeks, either in- of the placenta are verified. The baby’s Dads are welcome to attend every ap- are obliged to arrange screenings to deter- ternally or externally. The primary purpose major organs and skeleton are checked for pointment as well as the antenatal classes. mine foetal chromosome abnormalities of the scan is to confirm the weeks and to structural abnormalities. The mother may Dads bring the male perspective into the and severe structural abnormalities by the check the number of foetuses. Structural be accompanied to each scan by the father pregnancy discussion. The child will be- beginning of 2010. (A guide on screening abnormalities may be revealed by the or some other person. come attached to both the mother and the programmes can be found in Finnish at scan. The risk of chromosome abnormali- Pregnancy can be terminated until the father, so it is only natural that parenting http://www.stm.fi/Resource.phx/publish- ties can be assessed by performing an ul- end of week 23 (24+0), if the foetus has is shared. A child needs the support and ing/store/2007/05/pr1178537602112/pass- trasound scan at 10 to 12 weeks. At this been reliably tested to have a severe dis- assurance of both mum and dad for his/ thru.pdf). time, the nuchal fold at the back of the ba- ease or handicap. her development. Shared parenting re- Ultrasound scans and tests on mater- by’s neck is also measured. Blood samples sponsibility gives dad a chance to realise nal serum, amniotic fluid and the placenta for chromosome screening tests are taken himself in new ways, while mum can have are all voluntary. Screening tests are per- at 8 to 11 weeks. If the first prenatal clinic DADS ARE WELCOME TO ATTEND EVERY some private time on her own. When both formed to detect increased risk of certain appointment is after week 11, a blood test APPOINTMENT IN PRENATAL CLINICS. parents participate in caring for the chil- conditions so that the birth and aftercare called the triple test is offered at weeks 14 dren, the relationship tends to be happier. of the newborn can be planned well in ad- or 15. However, the triple test is not as re- However, as much as the dad might wish vance. The majority of babies develop nor- liable in the assessment of the risk of Antenatal classes to be a caring and actively participating mally without severe injuries or diseases. chromosomal abnormalities as the earlier Every prenatal clinic organises antenatal father, it is not always easy; changing your An increased risk does not necessarily screening test. Women at increased risk classes to prepare the prospective parents lifestyle and starting to live on the baby’s mean that the baby will be born with a are offered placental tests and an amnio- for labour, childbirth and parenthood. It is terms may be difficult. handicap or disease. Furthermore, not all centesis (amniocentesis is a diagnostic test recommended that you attend your first Prenatal clinics help mums and dads conditions show up in screenings, and no where a fine needle sample of amniotic antenatal class during weeks 20 to 30. form a positive yet realistic picture of life test can guarantee that the child will be fluid is taken). Examinations are voluntary Usually there are 4 to 5 meetings, some of with a new baby. The clinics strive to pro- healthy. Before going to a screening, talk and carry a slight risk of causing a miscar- them preferably after the baby is born. The mote the mother’s and father’s commit- riage (at most 1 out of every 100 pregnan- antenatal classes are usually held by a ment to caring for the baby. Prenatal clin- cies). nurse or some other health care profes- ics also accommodate the men’s views Several municipalities offer amniocen- sional, and the topics covered include and needs as parents. Dads are advised on tesis or placental tests to women over what happens during labour and how to how they can best support their partners 40 without the preliminary prepare for it, breastfeeding and caring for during labour and how they can partici- screenings, because the risk of the newborn. Antenatal classes provide a pate in caring for the baby. Many prenatal chromosomal abnormalities chance to learn how to care for the baby, clinics organise meetings for just the dads increases with age. to discuss changes in daily routines when where they can share their experiences The second ul- there is a new baby in the house, to talk with other men in the same situation. trasound scan at about parenthood and relationships with When the nurse comes to meet you at 18 to 23 weeks other prospective parents, and to learn home, schedule it so that the father will be or after week 24 about the services and benefits available present as well. u

28 Pregnancy Pregnancy 29 Pregnancy at work and at home

The elder siblings and jealousy They might have thought that ”my mum poses risks such as chemical substances, If the baby is not the first child in the fam- and dad don’t have sex”. The older chil- radiation or infectious diseases. If this is ily, it is a good idea to start preparing the dren might also be uneasy about their sta- not possible, the mother can apply for spe- other children for the new baby in ad- tus and fear losing their parents to the ba- cial maternity allowance from the Social vance. The age of the child dictates when by. In such a situation, some children Insurance Institution (KELA) to begin ma- to tell about the baby: immediately when freeze completely while others begin to ternity leave at an earlier date. the pregnancy has been confirmed, or lat- exhibit problem behaviour. Talk with your Pregnant women should not do jobs active virus. Pregnancy should be taken in- er when the pregnancy clearly begins to children about their feelings, expectations involving exposure to radiation (e.g. X- to account when dividing the daily tasks show in the mother’s body, for example. and fears. Sometimes, talking with a friend rays). They should also avoid physical in, for example, infectious disease depart- Regardless of the moment, pregnancy will of the family or a health care professional strain, such as lifting or moving heavy ob- ments in hospitals. last for a long time from the child’s per- or social worker can help both the child jects. According to current knowledge, If you work in the health care sector, spective. However, the child should first and the parents. working by a computer monitor and using you might become infected with hepatitis hear about the pregnancy from his/her physical therapy equipment do not pose a B or HIV via the blood or excretions of in- own parents, not from other people. Sort your priorities radiation risk. If your job involves coming fected patients. In the cleaning business, For the first born, a new baby is a tre- The new baby drains energy from the into contact with anaesthetic gases, lead, syringes and needles in waste bags may mendous experience which causes envy whole family during pregnancy, especially mercury, cytostatic agents, carbon monox- present a risk. Usually, a biohazard does and jealousy. These feelings will pass soon- in the first weeks after birth. Think in ad- ide or carcinogens (cancer-causing sub- not exist unless the patient’s blood comes er if the elder sibling is invited to partici- vance what is important and what can wait stances), consult your occupational health into contact with the worker’s circulation pate in caring for the baby. If the cot or oth- until later. The well-being of the mother is care representative to ensure the safety of via a wound or a needle prick. Reduce the er things are handed down to the baby, this a prerequisite for the well-being and your working environment. risk by wearing protective gloves, using should be done well in advance before the healthy development of the baby. Work, Pregnant women should also carefully disposable instruments and avoiding baby moves in. When the child asks you a cleaning, guests and travel can wait – the investigate any social risks relating to pa- mouth pipetting in the laboratory. There is question, try to give a simple and straight- baby cannot. When the parents get enough rental leaves, discuss the statutory rights a risk of cytomegalovirus infection if you forward answer. If the first child is very rest, they will be able to better enjoy and and benefits with their superiors and have are working in an institution where you young, you can say, for example, that ”Dad care for the baby. It is recommended that a preliminary discussion about returning to come into contact with infant excreta. gave mum a baby seed and now there is a you begin your maternity leave at least a work from maternity leave (see ”Benefits Pregnant women should be removed from little baby growing in mum’s tummy. When month before the expected date of deliv- for families with children” on page 99). these environments. However, for most in- the baby is ready, he or she will come out ery. Remember, giving birth demands fections, it is sufficient to be aware of the through a special opening (different from more than running a marathon! Infectious diseases and vaccinations risks and to protect yourself adequately. u the ones for pee-pee and poo-poo) and the If a pregnant woman has never had the baby will be our baby, and mum and dad Risks at work common pox diseases or been vaccinated Learn the policies and procedures in will love you and the baby just as much.” The superiors of expectant mothers are re- against them, she might become infected use at your workplace. Discuss risks sponsible for ensuring safe working condi- when working with children. If you have and biohazards with your superior, Older children tions and methods. A pregnant woman is never had chicken pox, you should be vac- occupational health care services, or oc- For children over 10 years, the idea of a entitled to request being transferred to cinated against it before becoming preg- cupational safety personnel. new baby may be very difficult to accept. other jobs if the working environment nant. Avoid contact with people with an

30 Pregnancy Pregnancy 31 Somewhere to sleep What does a baby need? The maternity package comes in a carton three pieces of everyday clothing, such as that is designed to double as a baby basket jumpsuits, pants and body suits: one to when it is lined with cloth (e.g. a sheet). wear, one in the wash, and one drying. As Dark red is a soothing colour that reminds for other clothes, such as hats and over- Maternity package the baby of the womb. At first, the baby clothes, three is often too many. However, The Finnish maternity package delivered can also sleep in a crib, carrycot, basket or if washing clothes is not easily accom- free of charge to expecting mothers is the other baby bed. A cot with bars will be plished, it is wise to have several pieces of only one of its kind in the world. The ma- necessary by the time the baby starts turn- clothing, since babies tend to use up at ternity package is a complete baby gear ing and moving around and the previous least one outfit per day. The first year is a ”starter pack”. The pack includes useful, sleeping arrangement is no longer safe. time of rapid growth, and your child will high-quality clothes and other necessary When the child is 1.5 to 2 years old, he/she quickly grow into and out of clothes. A items. Pregnant women must apply for the will be able to climb out from the cot. At 1-year-old child is 73 to 80 cm and weighs maternity package from the Social Insur- this time, the child can start sleeping in a 10 to 12 kg. ance Institution (KELA). The application children’s bed. The essential bigger purchases for the can be sent together with the application The contents of the maternity package baby include a tub, a pram and a car safety for maternity allowance. Another alterna- and the fabrics for clothes and bed linen Acquiring and storing baby gear seat, if the family travels by car. Use the tive is to fill in an online application at change from time to time, but there are no Despite the maternity package, it is advis- carrycot that fits inside the pram to trans- www.kela.fi/asiointi. You can log yourself major changes. able to acquire more clothes and linens, if port the baby when the pram does not fit in with Finnish banks’ net bank user IDs, The clothes come in different sizes (60 possible, since babies tend to use up inside the house or cannot be pushed all but please note that the service is only to 70 cm). A newborn is about 50 cm. If the clothes quickly. It is not necessary to buy the way to the front door. When buying available in Finnish and Swedish. You can sleeves or pant legs are too long, shorten all items new; there are charity and sec- prams, pay attention to safety, durability claim your maternity package from Kela or them temporarily by sowing folds on the ond-hand shops selling baby wear and and size (will it fit into the elevator?). Most retrieve it from the post office a few outside or tying a knot at the end of very gear at reduced prices, and you can also modern additional features, such as air months before the estimated date of deliv- long legs. You can also shorten pant legs by look for baby gear for sale in local news- conditioning, have little effect on the well- ery (see ”Maternity grant” on page 99). using socks or booties. papers, market notice boards and online being of the baby. If it is possible to sleep shops. There is a variety of online auc- the baby on a balcony, you can get a used tions and second-hand shops. It is also pram in good condition at a very reasona- The package contains: relatively simple to make bed linen your- ble price to keep on the balcony. (For photos of the contents, please visit www.kela.fi). self. Friends, relatives and neighbours A couple of shelves or drawers is may be willing to lend you some items. enough space for storing the baby’s clothes. u Baby wear: wrap-tops, body suits, u Baby care: a mattress, a mattress There are also national organisations that It is possible to change nappies whilst pants, jumpsuits, a top and pants set, protec­tor, a hairbrush, disposable lend baby gear, such as the Mannerheim holding the baby in your lap, but in many baby hats, socks, mittens, overalls, warm nappies, a tooth brush, nail clippers, League for Child Welfare (MLL) and cases a proper changing mat or changing booties, padded mittens, a pramsuit bath water thermometer, basic lotion, Folkhälsan. Recycling is beneficial, since top can be very useful (see ”A place for a bib, a book, a toy changing” on page 57). A baby carrier, sling u Linens, towels, nappies: terry most clothes and items can be used by and baby sitter allow you to keep your nappies, a cloth nappy set, a bath towel, u Other: sanitary pads, condoms, several babies. a sheet, a blanket cover, a blanket, bra pads, lubricant lotion, and pamphlets Remember that the baby does not hands free. Baby carriers and slings are er- a sleeping bag (turns into a padded on relationships, breastfeeding, nutrition, need massive amounts of toys, equipment gonomically designed for the comfort of blanket) cloth nappies and safety while travelling and clothing. As a rule of thumb, have both the mother and the baby. u

32 Pregnancy Pregnancy 33 mother can decide which of the available assessed prior to birth, but cannot be abso- options she is willing to use, while the care lutely determined as some situations may Preparing for birth personnel will assist and give advice on change quickly. It may become necessary suitable alternatives. The mother is free to to induce labour, or there might be com- move around during labour and has the plications requiring specific procedures Antenatal classes right to decide on the position most suita- during labour. Intervention is required in Preparing for birth is one of the topics cov- ble for delivery. Alternative forms of pain approximately 15% of births. Intervention ered in antenatal classes, with the aim of relief are also discussed with the mother. methods include Caesarean section (C- providing both the mother and the father section), vacuum extraction, forceps and with information and guidance on birth Father’s role assisted breech birth. and delivery so that when the time comes It is the role of the father (or some other they will be able to make informed deci- companion) to support, encourage and sions. Being prepared both physically and rally the mother during labour. Giving THE PRESENCE OF A CLOSE COMPANION mentally will help the mother stay in con- birth usually takes several hours, and sup- IS A COMFORT TO THE MOTHER . trol of the situation during delivery. It is port and encouragement is much needed. important that the mother feels in control, Some very concrete supportive measures and that the baby’s birth is as positive an include, for example, massaging the moth- In approximately 3 percent of deliver- experience as possible. er’s aching back, fetching something to ies, the baby is in the breech position (the To act purposefully during birth, both drink, wiping away sweat and helping the baby is head up instead of head down). A parents must be familiar with the three mother to relax. The presence of a close breech position (or any other abnormal stages of labour, know about operations companion is a comfort to the mother and presentation) is usually detected at the and standard procedures, and have infor- helps her keep her spirits up. prenatal clinic. You may be referred to the mation on controlling one’s own body. La- event. Hospital maternity unit staff aim to Furthermore, this shared experience hospital, where a doctor will try to turn the bour, as the name implies, is hard work and create a calm and comfortable atmosphere often strengthens the relationship. baby from the breech position to a head- requires a great deal of mental and physical for the family, and provide the mother When the father has witnessed the down position. This procedure is also energy. Being able to relax in between and with sufficient space to focus on the deliv- birth of his own child, the relationship be- called external cephalic version. However, during contractions preserves the mother’s ery. In many units, a member of staff will tween the father and the child forms im- if this is not successful and the baby re- strength. Preparing for birth in advance hold a discussion with the parents before- mediately when the baby is lying on its mains in the breech position, the final de- usually eases the delivery process. hand on their thoughts and wishes related mother’s breast, seeking contact with its cision on the delivery method is made af- It is not always possible for the father to the oncoming birth. This discussion is parents. A strong bond is created when the ter a thorough check at the hospital mater- to attend the birth and, when this is possi- then continued during labour when con- baby first opens its eyes and makes eye nity unit, where the baby’s size and moth- ble, it is ultimately the father’s own choice. sidering the available options and proce- contact with the faces close by. Some fa- er’s pelvic dimensions are carefully meas- Alternatively, the mother can also have dures that might assist in the delivery. Be- thers find they feel a stronger sense of ured. A baby in the breech position is often some other person as a companion, a close ing prepared is important, but it should be closeness - as if the baby was more their born by caesarean section (C-section), es- friend, a relative or a doula (a person borne in mind that giving birth is always a ”own” - when they have been present dur- pecially when it is the mother’s first deliv- trained in labour support), for example. unique experience and that the parents ing the birth. Fathers who have seen their ery, the mother has had previous caesar- Whatever the decision, it should be made will be facing issues that cannot be consid- baby being born describe it as one of the ean sections or when the baby is prema- as early as possible. ered in advance, but must be decided upon finest moments of their lives. ture. as the situation arises. How to plan in advance Maternity units are equipped with dif- Anticipating the delivery method An elective caesarean section In recent years, the emphasis has been ferent kinds of birth stools and rocking Most babies (85%) are vaginally delivered In Finland, approximately every sixth child placed on the fact that birth is a natural chairs, birth pools and deep baths. The in a head down position. Presentation is is born by caesarean section and of those

34 The birth The birth 35 been no complications. As in all deliveries, Overdue pregnancy What to take to hospital the mother and baby are the centre of at- If your pregnancy lasts over 10 days beyond Pack your hospital bag ready with the tention and their well-being takes prece- the estimated delivery date based on meas- items you will need well in advance. You dence over everything else. urements taken from an early pregnancy can pack your own robe and nightgown to ultrasound scan, it is considered overdue. wear at the hospital. Giving birth before reaching the hospital You or your health nurse should make an approximately 50% are elective caesarean Sometimes the baby is born so fast that the appointment at the hospital maternity unit Include: u your current and any previous sections. Typical reasons for a caesarean in- mother cannot make it in time to the hos- where a doctor will examine the mother maternity cards clude breech presentation, abnormal pla- pital. Each year, some 50 women deliver and the baby and, based on the well-being u pre-filled personal data form cental position, the large size of the baby, a their baby on the way to the hospital and of them both, decide how to proceed. (received from the prenatal clinic) decelerated growth rate and previous cae- another 50 have an unplanned home birth. Overdue pregnancies are closely mon- u your Social Security Card (Kelakortti) sareans. Sometimes the mother experienc- In these cases, the first stage of labour pro- itored to detect any signs of possible risks u toiletries and other personal items, es such fear of giving birth that vaginal de- ceeds quickly to the second stage and the as early as possible. The most common such as a toothbrush and toothpaste, livery is not possible. mother feels the need to push suddenly, complication in overdue pregnancies is deodorant, body lotion, hairbrush A caesarean section is scheduled for a while still at home or on her way to the placental insufficiency, other problems in- (shampoo and soap are usually time when the baby is most likely to be hospital. Hence, the father or other com- clude foetal oxygen deficiency, a decreas- available at the unit) best prepared for life outside the womb, panion has to play the midwife’s role. The ing amount of amniotic fluid, and changes u nursing bras. i.e. when the lungs have matured and oth- first priority is to stay calm. If possible, the in the foetal heart rate. It is recommended er risks remain as small as possible. How- father should contact the hospital where that the expectant mother pay attention to Unless the hospital accepts payment in ar- ever, a child born by elective caesarean they will be able to give advice over the the baby’s movements, following the in- rears, you are expected to pay for your stay section is at a higher risk of being slow to phone. Once the baby is born, he or she is structions given at the hospital or prenatal upon leaving the hospital. Other than that, adapt and to develop wet lung syndrome, bathed and then placed on the mother’s clinic. you will not need large amounts of cash. It because the complicated mechanisms that breast. Remember to ensure that the baby is also advisable to leave any valuables, mature the lungs and are naturally activat- is kept warm. It is advisable to prepare for such as expensive watches and jewellery, ed during vaginal delivery do not have such a delivery, especially when the hospi- at home. enough time to function adequately dur- tal is far away or when previous births The father can bring any gear and ing a caesarean. Further, both the mother have been quick. items you need for the journey home on and the baby need more time to recover. the day before you leave the hospital. In the case of an elective caesarean, the Home birth hospital maternity unit staff provide advice Home birth is very rare in Finland, al- The baby will need: u undergarments (e.g. a body suit), well in advance. Fathers are welcome to though it is also an option. Each year, u a shirt and pants or a jumpsuit, participate in elective caesarean sections. about 10 mothers decide to give birth at u a hat and a sleeping bag and, if the (For more information on Caesarean sec- home. Home births require somewhat weather is cold, the baby will also need tions, see page 40.) more initiative and activeness from the a cardigan and a pram suit or padded mother. She will need to book a midwife overalls, A policlinic delivery and acquire the necessary equipment. u a car safety seat, if the family The inpatient period following delivery has Mothers choosing home birth are also re- travels by car. become shorter, and so called ”polyclinic sponsible for all of the related expenses deliveries” have become possible, although and any unexpected consequences. If you Before the baby is born, make sure you have they are still quite rare. In a polyclinic de- are interested in home birth, be sure to in- small nappies for the newborn and sanitary livery, the family can take the baby home 6 vestigate the option thoroughly before pads for yourself, for heavy bleeding after hours after birth, provided that there have making your final decision. the birth, kept in readiness at home. u

36 The birth The birth 37 Onset of labour The stages of labour

Onset of labour As the estimated delivery date ap- There are three stages of labour: the first With mothers Labour usually begins at 38 to 42 weeks, proaches, the father or other companion stage is the dilation of the cervix, the sec- who have had previ- with contractions or with your water should never be more than a phone call ond is the delivery of the baby, and the ous pregnancies, the breaking. However, it is not yet fully un- away. If the maternity unit is far away or third is the delivery of the placenta. For cervix begins dilating even before the cervi- derstood what triggers the onset of labour. the journey is otherwise demanding, re- first-time mothers, labour often takes be- cal canal has fully effaced. Labour often The loss of the pink mucus, ”the plug”, member to plan accordingly. tween 6 and 20 hours. For women who starts to progress faster when the cervix is 4 that keeps the cervix closed, is a sign that If your water starts to leak during the have already given birth, labour may only to 5 cm dilated. labour is approaching. Labour usually be- night, the amniotic fluid is colourless and take 3 to 12 hours. For some women, At the beginning of the first stage, gins with irregular contractions which you are not having contractions, you can though, labour may last much longer, contractions are experienced approximate- gradually become stronger and more fre- wait until morning to go to the hospital. If while for others it’s over much sooner. ly every five minutes, lasting for 30 sec- quent. Labour can also begin with your the amniotic fluid is green, it means that Midwives are skilled professionals and onds at a time, but as the labour progress- water breaking either suddenly or in a the baby has emptied his or her bowels you can talk with your midwife about your es, contractions become more frequent gradual trickle. It can also be induced us- and you should go to the hospital without views, hopes, wishes and feelings during and last longer. ing medication. delay. Although your waters have broken, labour. She is there to support, encourage During the first stage, the midwife will you do not need an ambulance to go to and give advice to both the mother and check the cervix’s status, the baby’s posi- When to go to the hospital hospital. If an elective caesarean section her companion. Together with the mother, tion in the birth canal and the mother’s has been scheduled for you and your water the midwife will try to find comfortable blood pressure every one or two hours. Women who are having their first breaks or you are having regular contrac- positions and suitable forms of pain relief, Technical devices are usually applied to baby should go to the hospital when tions, go to the hospital in order to reas- and will place all of her skill at the dispos- monitor the well-being of the baby (CTG, u contractions come regularly sess the urgency of the operation. al of the mother during the course of the cardiotocography) and to listen to the ba- after every 5 to 10 minutes, labour. by’s heartbeat through the mother’s abdo- u contractions last at least Admission process men. An electrode may be attached to the 45 seconds at a time, When you arrive at the hospital, a midwife The first stage of labour: baby’s head which records the trend in the u you have had contractions for will welcome you and request your mater- the dilation of the cervix mother’s contractions and the foetal heart- two hours. nity card. Any patient data on the mother The uterus is a very strong organ and its beat. The colour, odour and amount of am- Mothers who have had previous will be retrieved from the hospital records. muscular activity will push the baby niotic fluid are also monitored. If neces- pregnancies should leave earlier, when The mother’s blood pressure is taken and through the birth canal and into the world. sary, the baby may be further monitored u contractions are regular, and her urine tested for protein and sugar. The During the first stage of labour the cervix via ultrasound scans, taking blood samples u last at least 30 seconds. midwife will then perform an external and dilates to 10 cm. For a first-time mother, or using a STAN device which records the internal examination. The external exami- the cervix only begins to dilate after the baby’s ECG in addition to its heartbeat. nation is performed to determine the sta- cervical canal has gradually effaced During this stage, the mother can as- Go to the hospital immediately, if Note! tus, position, size and presentation of the (thinned out) due to contractions. This sist the uterus by staying relaxed. Moving you have vaginal bleeding or experi- baby. An internal examination is per- might take 8 to 9 hours. Once the cervical around and staying in an upright position ence severe pain. formed to determine the stage of labour, canal has effaced, the cervix dilates about 1 will further accelerate the dilation. The If your waters have broken or your the extent to which the cervix has dilated to 2 cm per hour. If the contractions are mother should remember to empty her baby is in the breech position, it is ad- and the placement of the presenting part not sufficiently effective, they can be stim- bladder sufficiently often so that a full visable to travel lying down. (usually the baby’s head). u ulated with a hormone drip (oxytocin). bladder does not hinder the delivery.

38 The birth The birth 39 Many mothers find that the presence At some point, the midwife asks the the baby’s well-being is believed to be de- Having a caesarean section does not of the baby’s father or other companion is mother to stop pushing altogether for a teriorating or when the delivery stops pro- prevent the mother from having a vaginal especially important during this stage, as while so that she can help the baby’s head gressing as it should. A swift deterioration birth in the future. However, it is recom- he will be there to encourage and support emerge from the birth canal. Next, the ba- in the baby’s condition will require an mended that there is an interval of at least the mother, offer something to drink, mas- by’s shoulders will emerge one at a time emergency caesarean so that the baby will one full year before the next pregnancy, in sage her aching back and create a general and the mother will be encouraged to be delivered as fast as possible. If a caesar- order to ensure the uterus has sufficient sense of security. In many cases, this will push yet again, until the baby is fully born. ean section has been scheduled in ad- time to heal properly. If the mother has ease the pain as well. For a first-time mother, the second stage vance, it’s called an elective caesarean (see had two caesarean sections, vaginal birth is takes 20 to 30 minutes, for others only ”Anticipating the delivery method” on most likely no longer an option. The second stage of labour: about 10 minutes. page 35). the delivery of the baby A caesarean section is performed under The second stage begins when the cervix is The third stage of labour: general anaesthesia or using an epidural or MIDWIFES ARE SKILLED PROFESSIONALS fully dilated and the baby’s head is turned the delivery of the placenta spinal anaesthetic. Usually the method saf- WHO ARE THERE TO SUPPORT YOU. into the correct position. The mother will As soon as the baby is born, the mother is est for the mother and baby is selected, but feel a very strong urge to push downwards. given an oxytocin injection that stimulates in an emergency the fastest method is ap- Some mothers may feel the urge to push at the uterus to contract. The contractions will plied. The surgeon makes an incision in the Vacuum extraction and forceps delivery an earlier stage, but the personnel will ad- cause the placenta to be expelled from the mother’s abdominal wall and cuts through Vacuum extraction is performed using a vise her to refrain from pushing too early uterus, usually in about 5 to 10 minutes. the uterus. The baby is then helped out. The ventouse which is often the best way to ac- to prevent prolonged delivery due to a The midwife helps the placenta to be deliv- placenta and the membranes are removed celerate delivery when the baby is showing swollen cervix. Many women find this the ered by pressing the uterus lightly with one in the same way. The whole operation takes signs of distress or when contractions slow most painful and unpleasant stage of de- hand and pulling lightly on the umbilical 30 to 45 minutes. If the mother is con- down during the second stage of labour. livery, but luckily it is usually quickly over. cord. The foetal membranes will also come scious, she will be able to experience the The doctor fixes a silicone or metal cup The atmosphere in the delivery room is out at this time. The placenta and mem- birth of her baby. over the baby’s head which remains in kept peaceful and calm, avoiding unneces- branes are then examined, weighed and Recovery after a caesarean section place through suction. sary fuss and bright lights. measured. If the placenta does not come takes somewhat longer than after a vaginal In this way, the doctor has a firm grip When a contraction comes, the moth- out by itself, the midwife will assist the de- birth, because having a C-section is a seri- on the baby. By pulling the ventouse as the er will have a strong urge to push. She will livery by pressing the uterus and tugging ous surgical operation compared to vaginal mother pushes, the doctor can help the have time to push 3 to 5 times during one the umbilical cord. Sometimes the placenta delivery. The mother will usually be able to mother deliver the baby. Vacuum extraction contraction, taking a quick breath in be- needs to be removed manually. This will be get up within one day of the caesarean, is used in about 5% to 7% of all deliveries. tween each push. When to push depends done under a general anaesthetic, or very and is allowed to go home with the baby Vacuum extraction causes swelling of the on the mother, but when the baby’s head effective local anaesthesia. when she is feeling well enough. The baby’s head, which disappears within a starts to press against the perineum and The episiotomy cut and any tears will stitches are removed after one week. week, but can be painful during the first stretches it, pushing may be guided by the be stitched under local anaesthesia. Before During the weeks following the C-sec- few days. midwife, who can see what’s happening. being transferred to the postnatal ward, tion, the mother will need extra help Forceps used to be a commonly used The midwife monitors the stretching of the the mother and baby will remain under around the house as she is not allowed to aid in deliveries, but today they are seldom perineum and the pressure caused by the surveillance at the delivery room for ap- lift anything heavier than the baby. To en- used. Forceps are used in similar situations baby’s head and assesses the need for an proximately two hours. sure proper healing of the incision, exer- to vacuum extraction, but especially in cases episiotomy to prevent the perineum from cise and the heavier household chores where, towards the end of the delivery, the tearing. An episiotomy - an operation in C section must be entered into with care. The moth- baby’s heartbeat suddenly slows down and which the perineum is cut to widen the Approximately every sixth baby is born by er may find many movements painful or there is a sudden danger of oxygen deficien- opening - is performed on only on one out caesarean section (C-section). A caesarean difficult. However, staying up and mobile cy. In such circumstances forceps provide a of every three mothers. section might be needed if, during labour, will enhance recovery. faster method than vacuum extraction. u

40 The birth The birth 41 access the baby’s circulation through the tion, the mother may experience back pain placenta. If the baby is born 2 to 3 hours around the injection area, and sometimes Labour pains and pain relief after the last dosage, the pain killer may have a severe headache. The pain is be- paralyse the breathing of the newborn. lieved to be caused by spinal fluid leaking Hence, these drugs are generally not ad- from the needle hole in the dura mater. Labour pains ministered during the later stages of la- First aid for headaches involves drinking Labour is a massive strain on the mother and singing, pillows, a bean bag, a rocking bour. large amounts of fluids, taking painkillers and baby, both physically and mentally. chair or gymnastic ball can be used as re- and resting in a darkened room. If the When discussing pain relief with the par- laxation aides. Many mothers find relief in Nitrous oxide headache persists, an anaesthesiologist ents, the doctor and midwife consider the warm water or a warm wrap that relaxes A mixture of oxygen and nitrous oxide can may need to asses the situation. If neces- benefits and disadvantages to the mother the muscles. During the first stage of la- be safely administered throughout the first sary, a special procedure called a ”blood as well as the baby. bour the mother can shower her back and stage of labour because it is quickly ex- At the beginning, pain occurs as a sign abdomen or relax in a delivery pool or pelled from the circulation. The mixture is of the onset of labour. It is caused by the deep bath. The mother is not allowed to go inhaled through a mask in periods timed RHYTHMIC BREATHING HELPS TO RELAX muscles and tissue stretching as the baby’s into the water if her water has broken over with the contractions. It takes effect slowly AND CONSERVES MOTHER’S ENERGY. head descends in the birth canal. During 24 hours beforehand or if labour is not and must therefore be inhaled before the the second stage of labour, the urge to progressing as expected. contraction begins. push usually surpasses the pain caused by Aqua acupuncture is a form of natural patch”, an injection of the patient’s own contractions. During the third stage of la- pain relief where water blisters are injected Anaesthesia blood into the epidural space where it bour, when the placenta is delivered, the under the skin to enhance the mother’s An epidural is the safest and most effec- forms a ”patch” over the hole, can be per- pain has usually subsided. endorphin secretion. Endorphins are the tive form of nerve block anaesthesia. It formed to relieve the headache. Women experience labour pains differ- body’s own painkiller and their effect lasts eliminates the first stage labour pains al- Anaesthetics travel through the pla- ently. It will depend on her pain threshold from 1 to 2 hours. most completely, if not completely. The an- centa and may slow down the baby’s heart and overall tiredness, but also on fear and During labour it is recommended that aesthetic drug is injected into the epidural rate. Further, anaesthetics may temporari- uncertainty. Fear of the unknown and not you move around and try different posi- space to the side of the spinal cord and a ly affect blood circulation in the womb and knowing what’s happening or what to ex- tions to find the ones that are most com- catheter is left in place so that additional placenta, leaving the baby at risk of oxygen pect is common for all of us, and when we fortable. Swaying your hips removes some medication can be given throughout the deficiency. Because of these risks, the doc- are frightened our sense of pain is height- of the pressure against your lower back delivery. An epidural may only be given by tor needs to check from the baby’s ECG ened. and helps to control the pain caused by an anaesthesiologist, and is therefore not that he or she is in excellent condition pri- contractions. available in every hospital. or to the administration of any anaesthetic Natural pain relief The father or other companion may Spinal anaesthesia is a very effective agents. Furthermore, the mother and baby Knowledge is the basis for all pain relief. further help by massaging the painful are- form of pain relief and commonly used in must be closely monitored while the an- Being familiar with the stages of labour al- as during contractions. quickly progressing, fierce deliveries to in- aesthetic is effective. so assists the mother in coping with labour Drugs injected into muscle tissue or duce adequate pain relief with just one pains. The correct breathing and being able administered intravenously dose. Spinal anaesthesia may also be given Hypnosis to relax during each stage of labour are Labour pains have a purpose: they only by an anaesthesiologist. In Finland, hypnosis and the power of sug- helpful to the mother and optimal for the keep the mother informed of the labour Your doctor may introduce a local cer- gestion are rarely used for pain relief. baby, as these forms of pain relief have no process. However, one in five mothers ex- vical anaesthetic during an internal ex- However, both methods are safe for the adverse effects on the baby. periences such pain that she will need amination. Its effect will last for about an baby. Hypnosis is best achieved if the hyp- Rhythmic breathing decreases muscu- some form of effective pain relief. Each hour. notherapist will participate in the birth. If lar strain, conserves the mother’s energy mother is entitled to receive effective drugs It is very rare for anaesthetics to cause you wish to use hypnosis, arrange this and helps the mother stay focused. Music for pain relief, but drugs will also quickly complications. As a side effect of the injec- with the hospital in advance. u

42 The birth The birth 43 frequent, which will require closer surveil- its condition is stabilised. The units en- lance and be assessed by a paediatrician. courage ”kangaroo care” where the baby is The newborn Infections passed on from the mother dur- placed on the mother’s or father’s bare ing birth, gestational diabetes, pre-ec- chest, under the shirt. This will help the lampsia and other diseases or medication premature baby adapt to life outside the Birth is a miraculous event touching the all have an impact on how the newborn is womb. Skin-to-skin contact is soothing to hearts of everyone present. Months of ex- monitored after birth. The breathing and the baby and will help the baby maintain pectation climax in pushing the baby out general well-being of premature (born be- its body temperature. and into the world. Love is in the air, but fore week 37) and low-weight (under there is also a mixture of relief, exhaustion, 2,500 g) babies are monitored particularly Postnatal ward anxiety and joy. closely. The more preterm the baby is, the The staff at the postnatal care monitor the Immediately after birth the baby is lift- more likely it is to be transferred to the well-being of the newborn baby and en- ed onto the mother’s chest to provide skin- paediatric ward. sure that the mother recuperates well from to-skin-contact. The baby is then dried and need reviving, others’ noses and mouths the delivery. They will also guide the par- the umbilical cord is cut and tied. The have been suctioned (if the amniotic fluid Premature birth ents on how to take care of their baby. The mother and baby are allowed to rest under was green) before being lifted onto the When a preterm birth between 24 and 34 objective is to give as positive an experi- a warm blanket. After a little while, curios- mother’s chest. weeks is expected, corticosteroids are given ence as possible of the birth, and breast- ity surpasses fatigue and the parents start Soon after the birth, before the umbil- to the mother to speed up the foetus’s lung feeding and caring for the baby. caressing the baby, peeking under the ical cord is cut, a name tag is placed around development. Preterm deliveries (baby blanket to wonder at the tiny fingers and the baby’ wrist or a necklace with an ID born before 35 weeks) are located near the Successful breastfeeding is important to toes. This is the beginning of parent-child plate is put on the baby bearing the moth- neonatal intensive care unit (NICU). Today, the well-being of both the mother and interaction. er’s name and social security ID. This pro- very premature and low weight babies can the baby. Breastfeeding provides suffi- After a moment of rest the baby will cedure ensures that there can be no mix- survive with the help of intensive care. cient nutrition for the baby and also open its eyes and seek eye contact with the ups. The newborn receives a vitamin K The more premature the baby is, the gives the mother a sense of security in people close by. Slowly the little fists relax, shot in the leg in order to prevent bleed- longer he or she will need intensive care her ability to feed her baby. the mouth opens and a tiny tongue peeks ing. After birth the baby’s health is as- and incubator treatment. With each week, out. The baby is now ready to start feeding. sessed using the so-called APGAR score. A the risks associated with premature birth In the postnatal ward, the mother stays He or she will nudge towards the numerical value (max. 10) is awarded for decrease and the need for supplemental in the same room as the baby. Milk pro- breasts and start feeding within 30 minutes skin colour, heart rate, breathing, reflex ir- oxygen decreases. A premature baby usu- duction begins in the delivery room where to one hour after birth. The baby will ob- ritability and muscle tone. The APGAR ally spends the first days or weeks of its life the baby’s sucking has stimulated the re- serve the world around him or her with scores are a tool used by health care pro- in an incubator, where the temperature lease of hormones (oxytocin). This close bright eyes, stimulating the parents’ nursing fessionals to assess the well-being of the and humidity is controlled and the baby interaction between mother and child con- instincts. At this point, the midwife will newborn and to forward this information can be better monitored. If the baby is un- tinues in the postnatal ward. The mother monitor the well-being of the baby with as to others. APGAR scores cannot be com- able to feed, it is fed through a feeding will care for her baby according to her own little disturbance as possible. The baby is pared between babies. tube. Premature babies born after 35 strength and following the rhythm of the kept warm, bathed, dried, weighed and Provided that everything is alright, the weeks usually survive in the postnatal child. Other family members are welcome measured. The father will be given the op- mother and baby are transferred to the ward, although feeding may take longer to to visit the mother and newborn baby. portunity to be the first to care for his baby. postnatal ward two hours after birth. Fol- accomplish than with full-term babies. The first breast milk is called colostrum. Each birth has a different story. Some lowing a caesarean section, the father is the The parents are welcome staying with It is a rich milk providing all the required births need to be assisted using vacuum first to witness his baby’s first minutes. their premature baby in hospital as much nutrition for full-term babies. Milk produc- extraction, while others may have ended in Sometimes the baby’s breathing may as possible. Parents may hold the baby as tion is enhanced by frequent feedings. Pre- an emergency caesarean. Some babies have a wheezing quality or become overly soon as its vital signs have developed and mature, low-weight babies and high birth

44 The birth The birth 45 weight babies (over 4,500 g) need large ceuticals) can prevent breastfeeding, and in baby can maintain a normal body temper- formation. Some hospitals may provide amounts of milk from the beginning, and such a case the proper treatment of the ature, normal breathing and normal heart the parents with eye drops, a saline solu- supplemental milk is often required to mother takes priority. Sometimes, the baby rate, express hunger, and suck, urinate and tion for the stuffy nose and solution for maintain the baby’s blood glucose at the has an injury or defect (e.g. cleft palate) that defecate normally. Also, by this time stuff- cleaning the navel. Parents receive infor- normal level. Glucose levels are also moni- makes sucking difficult. The nurses will as- iness of the nose, swelling around the eyes mation on possible follow-up appoint- tored when the baby is at a higher risk due sist the parents in bottle-feeding expressed and burping amniotic fluid will have clear- ments and the postnatal ward’s contact in- breast milk or formula milk to the baby. ly diminished. The baby will burp less milk formation if the mother or baby encounter Many hospitals have family suites de- and gain weight following the dip after problems during the first weeks. IN THE POSTNATAL WARD, THE MOTHER signed to accommodate both parents. birth. The paediatrician will have examined STAYS IN THE SAME ROOM AS THE BABY. Family suites enable both parents to share the baby earlier, if any problems were de- the first days with the new baby, practice tected. Both parents usually attend the When leaving the hospital, the parents baby care under the guidance of profes- paediatrician’s examination. should feel secure and content and to the mother’s diabetes or gestational dia- sional midwives, and become familiar with This examination usually includes as- have confidence in their ability to take betes, for example, since low glucose levels the baby’s communication. When the fam- sessing the baby’s skin colour, muscle tone, care of the baby. will have a negative effect on the baby’s ily goes home, both parents know the baby reflex irritability and sucking reflex. The central nervous system. Supplemental milk well, which will facilitate settling in. There doctor will listen for sounds made by the It should be remembered that families is not a dairy product and is used only tem- are several ways in which the father can heart and lungs, press the baby’s abdomen and their situations in life vary greatly. porarily. Donated breast milk is given first contribute to successful breastfeeding. By and feel the baby’s pulse. The baby’s hips, Some parents are experienced in caring for to premature or low birth weight babies. remaining calm and having complete faith skull (fontanel), clavicles, eye fundus, pal- babies, while for others this may be their Some babies have a strong sucking re- in milk production, by caressing and pam- ate, testicles (if the baby is a boy) and ex- first contact with a baby. If the baby is in- flex immediately after birth. However, it is pering the mother and the baby, and by ternal genital organs (if it’s a girl) are ex- jured or suffers from a disease, it is impor- not uncommon for the mother and baby to changing nappies and offering a helping amined. If the doctor needs a blood sam- tant that both parents discuss the issue need some help in learning the correct hand the father can help the mother relax ple from the baby, a mixture rich in sugar with the doctor. This discussion can also feeding technique. It is very important that and not lose faith in breastfeeding. Staying will be given to the baby for pain relief. be scheduled to take place after the exam- the mother and baby practice the correct in a family suite is never compulsory and Based on information provided by the ination. The staff of the neonatal ward of- breastfeeding technique while still at the does not necessarily meet the needs of all nurse, the doctor will consider the baby’s ten includes a social worker who will hospital. Mothers are entitled to receive all families. Issues to be considered when milk consumption, weight and skin colour provide support and guidance when the of the support and guidance they need for making arrangements for baby care include (yellow tint). Some of these symptoms are family needs special attention (single par- successful breastfeeding. Once breastfeed- a possible operation or illness affecting the merely signs of slow adaptation and will ent families, a very young mother, the ing begins to roll, the mother and baby can mother, or the mother feeling very faint or pass in the course of the first week. Howev- family has considerable financial or other be discharged. Milk production will con- weak, or if the baby needs to be monitored. er, they may necessitate keeping the baby in problems etc.). The social worker will in- tinue to increase during the following Whatever the situation, the parent-child hospital under surveillance for a few days vestigate the social benefits and support weeks. At this stage, the main considera- relationship is encouraged early on. longer than originally planned. A jaundiced available to the family and become in- tion is to ensure that the baby receives ad- On the third day of birth, the baby will baby’s skin will appear yellow and can be volved in child welfare situations when equate nutrition. The key to successful, be examined by a paediatrician. At this assessed by a simple fingertip test or by tak- the family has problems involving drug long-term breastfeeding lies in keeping time it will be apparent how well the baby ing a blood sample to measure the bilirubin abuse, violence or mental health, for ex- the baby alert while feeding. has adapted to living outside the womb, level. Treatment includes phototherapy with ample. In situations governed by the Child Breastfeeding soon after birth will cause how breastfeeding is going, whether the blue light and feeding the baby well. Welfare Act, the social worker is often re- the uterus to contract. This decreases bleed- mother’s milk production is sufficient, and garded as a threat. However, the main ob- ing and aids the recuperation from preg- how well the parents can interpret the sig- Leaving the hospital jective of social work is to support the nancy and birth. Some medications (e.g. nals the baby gives them. Already, at the When the family is leaving the hospital family in establishing safe routines guar- drugs for hypertension and psychopharma- age of three days, it is evident whether the they will receive feeding and baby care in- anteeing good care of the children. u

46 The birth The birth 47 It is recommended that you defer sex taining only progesterone and sterilisa- until the vaginal discharge ends and both tion are safe while breastfeeding, because Recovering from delivery parents feel ready for it. However, there is they have no effect on milk production or no need to refrain from showing affection! the baby. If you opt for sterilisation, bear Both parents need love and attention, ca- in mind that this is an irreversible opera- resses and cuddling; now maybe more tion. Puerperium - the first weeks after birth than ever as there is an extra person shar- If you are not breastfeeding, you may The period of time after delivery, during weeks after delivery in the prenatal clinic. ing the ”cuddling resources”. Having a ovulate as soon as 30 days after delivery. which your body recovers from the chang- You will receive a certificate to this effect to satisfactory sex life in your relationship is In this case, you can start using contra- es caused by pregnancy and childbirth and be included in your parental allowance ap- a shared responsibility – it takes two to ceptive pills three weeks after the deliv- returns to its normal pre-pregnancy condi- plication. tango! ery or when you have your first period. It tion, is called the puerperium. This usually is not advisable to start using contracep- tive pills any earlier due to the elevated takes 6 to 12 weeks. The uterus will return Sex life and showing affection Note! Remember to use contraception to its normal size and may contract during Once the baby is born, the parents will when you start having sex. Even if you risk of thrombosis. feeding, particularly if the baby is not your find that they have little time to spend are breastfeeding it doesn’t mean you The condom is a highly suitable meth- first. Lochia is the bloody discharge after alone with each other, especially if there can’t immediately become pregnant od of contraception after birth, protecting birth. It is more abundant than your usual are other children in the family. There will again. the uterus from infection. Using a lubricant period and turns pale after two weeks. If be a period when their sex life will have to during the first few months may help if the the discharge smells bad, continues to be be put on hold. The length of this period is vagina is tender and irritable. Polyurethane bloody and doesn’t seem to diminish, you for the parents to decide. The mother may Contraception condoms are sold at the chemist’s for peo- may have an infection. have scars which make sexual intercourse Think about contraception before having ple allergic to natural rubber. Getting up soon after the delivery will painful, and witnessing the birth of his ba- sex for the first time after delivery, as ovu- The copper IUD is an intrauterine de- improve the circulation and promote bow- by might have affected the father’s libido. lation is possible before your first period. vice that can be placed in the uterus im- el movements and bladder activity. Sitting The hormonal surge following delivery Breastfeeding will normally postpone your mediately after birth (10 to 30 minutes af- down may be painful, if you have had an may cause a decline in the mother’s libido, periods, but is not in itself a reliable con- ter the placenta is expelled). It is, however, episiotomy. Showering the area with warm but not in her need for love and affection. traceptive. recommended that the copper IUD be water will help the stitches dissolve and How soon you can expect to return to your Breastfeeding will protect you against placed during the postnatal medical exam- the cut to heal. Wash and dry your intimate usual sex life will depend on you and your conception if less than six months have ination to ensure it stays in place properly. areas with special care. Take showers but partner, and it is recommended that you passed since the birth, your periods have It can also be placed at a later stage, even if avoid bathing. If you enjoy going to the both share your thoughts with each other. not yet started and your baby feeds at least your periods have not yet started due to sauna, you can go when you are feeling There is, however, no reason why you eight times a day at regular intervals and breastfeeding. A pregnancy test will be well enough. should not have sex if you both want to. does not receive supplementary nutrition. performed before placing a copper IUD at After birth the woman may suffer from The contraceptive effect of breastfeeding a later stage. A copper IUD can be used for Postnatal medical examination vaginal dryness for a long period. Dryness diminishes rapidly if you feed your baby five years. Mothers remain clients of the prenatal will make the vagina irritable and tender, less than seven times a day. If you do not Hormonal contraceptives containing clinic until the postnatal medical examina- especially when using a condom. Using want to become pregnant, remember to only progesterone include mini-pills, hor- tion. During this examination, the doctor the lubricant lotion delivered in the mater- use contraception whenever you have sex. mone implants placed under your skin, checks that there are no ulcers in the cervix nity package or some other lubricant By the time the baby starts having supple- hormone IUDs and progesterone injec- and no signs of infection, since problems (cooking oil, body lotion without a fra- mental food, contraception is necessary to tions. The advantage of a hormonal IUD tend to be minor and almost without grance or Vaseline) may prove helpful. Lu- avoid becoming pregnant. is that its hormonal effect is local and only symptoms at the beginning. A postnatal bricants are also sold at the chemist’s and Condoms, copper IUDs, pills and oth- a small amount of hormone is released in- medical examination is performed 5 to 12 in department stores. er types of hormonal contraceptive con- to the circulation. The conventional com-

48 The birth The birth 49 bined oral contraceptive pills (COCP) are a milk production dwindles you will notice mothers of young children, and many need training and long walks are examples of combination of oestrogen and progester- how your breasts have lost some of their support either from a professional or a activities not recommended prior to the one, which decreases milk production. previous pertness. Stretch marks may be peer group. If you are having weight prob- postnatal examination. Chemical contraceptives, such as visible on the abdomen, thighs and lems, identify the options available in your You will find a balanced exercise re- foams, gels and sticks, may irritate the mu- breasts. community. gime in this leaflet. Start by doing each ex- cous membranes. If you have been using a Women often tend to be overly critical ercise once or twice a day (following vagi- pessary, you may need to refit it and use it of the changes in their appearance and Exercise helps in getting back into shape nal delivery). Remember to breathe evenly in combination with contraceptive gel. might consider themselves far from the It is best to rest and relax on the day after and pause between exercises, if you feel Emergency contraception is also current notion of beauty. Changes result- delivery, but start getting back into shape like doing so. called post-coital contraception or the ing from pregnancy and birth are visible on the next day. Some health care centres Abdomen: Contract your abdominal morning-after pill. It stops you from be- signs of being a mother and should be car- and maternity units organise postnatal ex- muscles and press the small of your back coming pregnant if contraception failed or ried with pride. When you are a mother, ercise for groups, but you can also exercise against the floor. Hold this position for a wasn’t used. You can buy these pills from you have the right to look as if you have daily at home. Ask for exercise instructions while, and relax. the chemist’s without a prescription. The given birth. from the hospital or from your prenatal Buttocks and sides: Lay on your side. pills are taken as a single dose, preferably Some women are able to return to clinic. Exercise will make your muscles Lift your topmost leg up, heel first. Keep within 12 hours, but no later than 72 their pre-pregnancy shape quickly, and not firm, improve your posture and lift your your body straight. hours, from having unprotected sex. When all women carry the signs of pregnancy spirits. It also eases back and shoulder taken within the recommended time and delivery. But most importantly, be easy pains and improves continence. frame, this method is 98 percent effective. on your body shape. The well-being of the If you have had a caesarean section, be You can continue breastfeeding after tak- mother and child is far more important sure to begin exercising slowly while pay- ing the emergency contraceptive. Emer- than your physical appearance. On the ing close attention to your body. Fitness gency contraceptives contain progesterone other hand, spending a little time pamper- which has no known effect on the baby. ing and caring for yourself will be a wel- However, if you want to be on the safe come change and help you cope with your side, express milk from your breasts and baby with renewed energy. throw it away for 1 to 2 days before breast- feeding again. As the name ”emergency Weight control contraceptive” implies, these pills are in- About 50% of women gain excessive tended for occasional use, not as a regular weight during pregnancy. This excessive form of contraception. weight gain is not easily lost after the birth, A copper IUD can also be used as demanding persistence and hard work. Di- post-coital contraception, if it is placed eting during pregnancy, immediately after within five days of unprotected sex. A cop- birth or while breastfeeding is not recom- Pakara- ja Vatsalihakset per IUD is more effective than pills and mended. kylkilihakset provides optimum contraception when left Instead, it is advisable for everyone to in place. maintain a healthy diet and exercise regu- larly. These are also the cornerstones of Changes in shape lasting weight control. Results are seen Pregnancy and birth will inevitably change only gradually, but are the more rewarding the shape of the mother’s body. After birth for this. In addition, breastfeeding pro- the skin around the abdomen is stretched motes weight control. Finding time, and the breasts are bursting with milk. As strength and motivation are a challenge to

50 The birth The birth 51 Abdomen and thighs: Press the small have had a multiple pregnancy, or your every now and then is worthwhile be- Strength exercises: Imagine a white of your back against a wall and contract second stage of labour was lengthy. Being cause strong muscles are always an ad- ball at the entrance to the vagina. Haul the your abdominal muscles. Bend your knees overweight and smoking additionally bur- vantage. imaginary ball as fast and as far as possi- and stay in this position for a while. den the pelvic floor muscles. If you suffer If you did not feel a squeeze, suffer ble inside the vagina and hold it there Straighten your knees and relax. from varicose veins or piles, your muscles from incontinence (you have difficulties while counting to five. Slowly release the Pelvic floor muscles: Press your an- may be predisposed to slackening. And if controlling your bladder) or if your sensa- ball. Relax, counting to ten. Repeat three kles, knees, thighs and buttocks firmly to- you engage in a form of sport involving tions seem weak during sexual inter- times. Gradually increase the number of gether. Hold this position for a while, and jumping, the slackened pelvic floor mus- course, make an appointment to see your repetitions. relax. cles may give in and cause incontinence. gynaecologist. You can begin exercising your pelvic If you are having difficulties identifying Endurance exercises Pelvic floor muscles floor muscles on the day following the the correct muscles, tighten and relax your Imagine a white ball at the entrance to the Your pelvic floor muscles will be severely birth. tummy, thigh and buttock muscles a few vagina. Pull the ball as slowly and as far as strained if you have given birth to several First perform a finger test: wash your times and then try again. It will help if you possible inside the vagina. Contract your children, your babies have been large, you hands and rub your index and middle fin- insert a couple of fingers into your vagina muscles and hold the ball inside. Hold gers with a non-irritating lubricant (e.g. while you are trying to identify the correct cooking oil). Press your fingers together muscles. Try different positions; sitting, ly- and gently push them 3 to 5 cm into your ing on your side, tummy and back, and SPENDING A LITTLE TIME CARING FOR vagina. Relax for a moment, and then squatting. After you have found the mus- YOURSELF WILL BE A WELCOME CHANGE.. squeeze your fingers with your vagina. cles and can do the exercise without using Relax. Remove and wash your fingers. If your fingers, you can perform these exer- you felt an upward and inward contrac- cises without anyone noticing. your urine and clench your anus while tion, your pelvic floor muscles are strong. Identification exercises: Clench your counting to five. Slowly release the ball Nevertheless, exercising your muscles anus, while gently squeezing your mus- and relax, counting to ten. Repeat three cles and counting to five. Then slowly re- times. Gradually increase the number of Vatsa- ja lax the muscles, while counting to ten. Re- repetitions. peat three times. Clench your anus and at Perform these exercises five times a day reisilihakset the same time clench your vagina and as part of your daily routine, on your way to hold your urine while counting to five (the work, during coffee breaks, while cleaning contraction will proceed like a wave from or queuing in a shop. Remember to take back to middle to front) and relax while one day of rest each week. Perform one counting to ten (front-middle-back). Re- type of exercise at a time, otherwise you peat three times. will tire. If you feel you are not making Speed exercises: You need quick pelvic progress, consult an expert. Many health muscle reflexes when you cough or sneeze care centres and private medical centres and to hold your urine. Exercise your re- have equipment and medical staff trained flexes by making brisk contractions in a se- to diagnose and treat dysfunctions of the ries. Start by doing this ten times. Gradual- pelvic muscles. You can also buy exercise ly increase the number of repetitions. kits with instructions. u Lantionpohjan lihakset

52 The birth The birth 53 parents; their methods may be different symptoms can last for several months. If but equally correct - there is no need for the depression is not severe, the symptoms First month the mother to act as an interpreter be- may go unnoticed or the mother may be tween the baby and the father. This will al- ashamed and try to hide them. However, so be beneficial to the future father-child you should seize the opportunity to talk The most important person for the baby is relationship. about your feelings with the clinic’s nurse the person caring for him. Without that The baby demands around-the-clock or your doctor. If untreated, postnatal de- person, the baby cannot survive. The baby attention which can leave both parents ex- pression can develop into long-term severe makes eye contact with its carer, simulta- hausted. When either of the parents is at depression. In addition to caring for the neously pleading and demanding care and the end of his or her tether, the other mother, treatment is also vitally important attention. This gives the carer a sense of should take over. Going outside for a walk, to securing the well-being of the baby. self-esteem and confidence, yet the re- taking a long shower or reading the paper Some health care centres organise sponsibility may at the same time feel while enjoying a cup of coffee can work meetings where mothers receive peer sup- overwhelming, even frightening. miracles. Another tip is to swap roles so port and encouragement from mothers in that the parent usually in control plays the the same situation (See also ”ÄIMÄ - the Motherly and fatherly love part of assistant. Caring for the baby to- Association for mothers suffering from de- For most parents, their baby is the most pointment and jealousy. Learn to accept all gether strengthens the relationship be- pression” on page 96). wonderful thing in the world. However, it of the feelings you and your partner may tween the parents as they share the love When the mother is depressed, the fa- is not always a case of love at first sight. experience. Give yourself time to adjust. You and joy the baby brings. ther’s role becomes even more important. Giving birth to a baby is exhausting and have an entire lifetime to love your child. On the other hand, fathers may also have looking after the baby takes all of your Maternal depression problems after the birth. Prenatal and spare energy. Since the mother is absorbed Both parents participate Postnatal hormonal activity may cause child health clinics offer support for both in breastfeeding, the father may feel reject- In our culture, both the mother and the fa- emotional instability and mood swings. parents. ed and left out. Having a baby may also be ther are responsible for taking care of their The mother may feel depressed and weepy, totally different to what the parents had children. Looking after the newborn is a although everything seems to be going Being a single parent anticipated. A little individual enters the rich, fulfilling experience for both parents. well. This is quite natural. Four out of five Divorce, the death of a partner or being parents’ life, changing everything, making The baby may evoke powerful emotions mothers suffer from ”baby blues”, a mild left alone in some other way can make its demands known with loud authority. that can take the parents by surprise. Being case of postnatal depression which starts 3 parenting a heavy burden. If you are the This noisy little person may be a source of indispensable to another human being to 5 days after birth and lasts for a few sole parent, do not make unreasonable de- confusion and even irritation, one’s feel- makes the parent view his or her life from weeks. Symptoms include being tearful mands on yourself - don’t expect to make ings towards the demanding little bundle a new perspective and often inspires him and irritable, mood swings, and sometimes up for two parents. Accept help from your may not always be entirely warm. or her to see the world differently. This also loss of appetite and sleeping prob- family, relatives and friends, and take ad- Becoming acquainted with your new provides a new source of energy for coping lems. This condition does not require med- vantage of family workers and the profes- family member may be a slow process, but with daily demands. ical treatment. Support and compassion sionals at the child health clinic. eventually you will become attached to Apart from breastfeeding, there is from family and friends is enough. Talking Sometimes a baby is born into a single your child. Love develops gradually while nothing the father cannot learn to do just about the situation with your partner or a parent family. In single parent families, it is caring for your baby. as well as the mother. At first, parents take trusted friend usually helps, and the baby advisable that a close friend, or the baby’s Parents vary in the way they take to care of the baby together. Later on, it is im- blues pass as the mother’s general condi- grandmother or godparent, be invited as a new things. Experiencing extreme emo- portant that they take turns. This will give tion improves due to sufficient sleep and ”trusted adult” who will learn to know the tional fluctuations is quite normal. Sudden- one parent the opportunity to relax while healthy nutrition. child from infancy. A good relationship be- ly amidst love, affection and joy, you may the other is having some private time with Approximately one in 5 women suffer tween the baby and the trusted adult will be stuck by exhaustion, concern, disap- the baby. The baby will get used to both from postnatal depression (PND). The lower the threshold for getting help, if the

54 Baby care Baby care 55 need arises later on. Being a single parent ments of joy - it will not be the cause of The parents nourish, nurture and protect nappies, bathing and feeding, and it will is not uncommon and there are peer any disappointments tomorrow. A sick ba- the baby. They comfort the baby with soft feel wanted and safe. This will provide a groups which can offer invaluable support by needs the love and attention of the en- touches, gentle smiles and soft voices. And sound basis for future development. (see ”Support Networks” on page 78 and tire family even more than a healthy baby the baby responds with eye contact, facial ”Organisations” on page 94). would. Becoming attached to your baby expressions and movements. A place for changing will not cause you to lose it; and trying Early interaction refers to reciprocal It is possible to change nappies whilst Visitors hard not to become attached will not save and synchronic interaction between the holding your baby in your lap, but in many Friends and relatives will be eager to come you from the consequent pain. parent and the child. Early interaction con- cases a proper changing mat or changing for a visit to meet the new baby. However, if The hospital staff, prenatal and child tributes to the baby’s sense of security, top is very convenient. Make sure the your visitors are suffering from a cold or health clinics, social workers and organisa- happiness and capabilities, supporting the changing top has edges that prevent the other illness, do not let them near the baby. tions for the disabled and their parents offer baby’s development in several ways. It is baby from falling. Ideally, the top should If you feel too tired to entertain, you can ask information and support in coping with this important to the baby that an adult is able be placed at a height where there is no the visitors to come at a later date or agree kind of situation. Many hospitals will also to identify, share and name the feelings of need to bend, because the mother’s back on a very short visit. You can also tell your know the contact details of support families joy, fear, anxiety and hurt the baby is expe- in particular will be sensitive to strain dur- visitors that you will not be offering tea or who have been in the same situation and riencing. Eye contact, physical contact and ing the first weeks after delivery. coffee. If the visitors want to have a little will be able to comfort and encourage the speech are all important to the baby. When Arrange the changing corner close to something, they can bring it themselves. parents. (See ”Services for chronically ill or this interaction functions well, the parent the baby’s cot or near the bathing area. You disabled children” on page 92.) will be able to enjoy his or her relationship can place the changing mat on a regular If there is a problem with the child and the child will feel secure table or on a changing top. The changing Having a disabled or ill baby is an unex- Early interaction in the knowledge that the parent under- gear can also be in the bathroom, where pected, painful reality parents can never be No other human relationship is quite as stands and accepts its feelings and needs. you can place the changing top on top of fully prepared for. Nevertheless, even if dif- intimate and positive as the relationship A baby never accuses its carer, never the washing machine or over the bath tub. ferent, the baby is your own and in these between a baby and the person caring for criticises and never makes comparisons. A Attach pads on the underside of the top to situations parents often discover strength it. From the moment of birth, the baby baby needs looking after and will always prevent it from sliding. The bathroom is an they never believed they possessed. seeks to interact with those around him. accept and become attached to the person optimal place, since water is close to hand Feelings of bitterness, anger, disap- caring for it. From the very first week, the and getting wet is not a problem. pointment and guilt are quite common baby will want to be where the family is. However, the most important thing is and sometimes your anger may be direct- Do not leave the baby in its cot. Holding, to have all the changing gear within reach, ed at your partner or the personnel. caressing and cuddling the baby will not because you cannot leave the baby unat- Good days are not enjoyed for fear of spoil it. Touching the baby will help it grow tended while fetching something from an- disappointments. Parents may strug- accustomed to its own body and learn to other room. The changing area does not gle against becoming attached to control it. Some clinics will teach you how need to be heated, normal room tempera- the child in the hope that to give a gentle baby massage. ture is sufficient (20 - 22°C). should the baby not survive Start talking to your baby during the the loss would somehow be pregnancy. Although it will not be able to Crying and comforting easier to bear. understand you words for some months, it Crying is the way babies express them- Allow yourself will understand your tone of voice. A soft, selves. By crying, the baby may communi- to love your calm voice creates a sense of security and cate hunger, a wish to see familiar faces, a sick baby just hearing people talk will help the baby wet diaper or some other discomfort. Par- as you would learn how to speak. The way you handle ents will gradually learn to interpret the a healthy one. your baby is extremely important. Smile at movements and sounds the baby makes. Savour the mo- your baby and talk to it while changing Healthy babies cry during the initial

56 Baby care Baby care 57 months. Babies start to cry more frequent- to the stomach). If colicky crying has been appointment to give the baby suitable in the house. When the moment has ly at the age of two weeks, peaking at interpreted as hunger, this has caused a medication that brings the temperature passed, talk to your baby to let her around 1.5 months and gradually decreas- cycle of over-feeding. Try prolonging the down. Take your baby to the doctor, if she know that it was only temporary and ing after that. This period is called the col- time between feeds using a dummy, taking is under 2 months old and has a fever, that now you are back to being your fa- ic period. It is sometimes called the three the baby outside in the pram or carrying it even when other members of the family miliar self. Don’t feel angry with your- month colic as it is usually over by the time in a baby carrier. also have a fever. self; everybody loses their temper at your baby is 4 months old. Night-time crying is usually the hard- some point. Rather concentrate on how When a baby cries long and hard for est to bear and often makes the parents to cope in the future and how to secure several hours a day, each day of the week, BABIES CRY EVEN WHEN THEY ARE feel helpless and worried. Babies cry even enough sleep for yourself. Discuss this the baby is said to be ”colicky”. Despite BEING WELL CARED FOR. when they are being well cared for. Parents with your child health clinic’s nurse. the long and hard crying, colicky babies are of colicky babies should not accuse them- usually healthy babies growing and devel- selves of being bad or inexperienced par- Never shake your baby! oping normally. Colic crying is mostly dis- Help your baby to burp after feeding. ents. Sometimes, the crying may seem Never shake or manhandle your baby, no content whining and there are pauses. Some babies swallow a lot of air while never-ending and nothing seems to com- matter how upset or tired you may be. Constant crying or screaming starts sud- feeding, resulting in wind and regurgita- fort the baby. Nevertheless, stay close to Shaking the baby is life threatening, be- denly without any apparent reason. De- tion. The frequency of bowel movements the baby while it is not well. It is important cause a baby’s head is large and heavy spite the long crying periods, colicky ba- varies individually. However, if you do not to identify solutions that will help every- compared to the rest of its body and its bies do get enough sleep. Breastfed babies find stools in your baby’s nappies every one cope during this trying period. Once neck muscles are not fully developed. are as likely to become colicky as babies other day and it is crying a lot, contact your the colic period is over, things will calm When a baby is vigorously shaken, the receiving formula milk. Although colic and child health clinic nurse. Increased regurgi- down and taking care of the baby will be- head moves rapidly back and forth with adding supplemental vitamin D to the ba- tation requires medical attention, especially come even more enjoyable. great force. This sudden motion can cause by’s nutrition may coincide, giving your if your baby is not gaining weight properly. bleeding inside the brain and behind the baby vitamin D supplement is not the It may be a case of reflux, where milk flows Comforting a crying baby eyes. Immediately after being shaken, the cause of the colic. back into the tube that connects the mouth u Carrying your baby close, making hush- baby may be sleepy, have trouble feeding Crying usually signals hunger or dis- to the stomach (also called GER, Gastro Es- ing sounds, giving a gentle massage and and difficulty in breathing, or lose con- comfort, but sometimes there may be rea- ophageal Reflux) or pyloric stenosis. soft purring sounds are comforting. Tak- sciousness. The long term consequences of son to investigate the matter further. Hun- A rash may be the reason for crying, ing your baby into a quieter room and shaking a baby, such as total or partial ger is a common reason for crying. Visit the especially in allergic families. Child health swaddling her in a blanket may also be blindness, learning difficulties and epilep- child health clinic to weigh your baby and clinics provide skin care information. Milk soothing. tic seizures, can be severe and permanent. compare your baby’s growth to the clinic’s allergy is a rare condition that causes skin u Try to stay calm while your baby is cry- Never let the situation reach the point reference charts together with the nurse. If rash. If milk allergy is suspected, treat the ing. If you find you can’t stand the cry- where you feel desperate. It is not a weak- your baby seems to be growing slowly, try rash and feed your baby special formula ing any more, let your partner or some ness to admit that you are exhausted and giving supplemental milk and see how it milk according to your doctor’s instruc- other trusted adult look after the baby need help; seeking help is the mature, re- affects your baby. The amount of breast tions. When the rash is better, the allergy for a while. Go out for a walk, for exam- sponsible thing to do. If you feel at the milk intake can be estimated at the child can be confirmed with a challenge test. Ba- ple, and then give your partner a chance end of your tether, contact your child health clinic via test weighing (weighing bies allergic to dairy products may have ei- to rest. health clinic’s nurse or the family workers the baby before and after feeding). If the ther skin or bowel reactions. u Caring for a crying baby is very trying. in your municipality for help. Other sourc- weight gain is excessive in relation to the Consult your doctor, if your baby has Take turns and ask friends and relatives es of help include organisations and hel- baby’s height, the reason for crying may be sudden or exceptional crying fits accompa- for help. plines, such as the Family Federation’s too much feeding. Too much feeding nied by a fever, cough or respiratory symp- u Don’t get upset with your baby. If you Family Network (see ”Contact details” on causes tummy ache and reflux (milk flows toms. If your baby is running a tempera- feel you’re going to lose your temper page 96). If your baby has been shaken, back into the tube that connects the mouth ture, you do not need to wait for a doctor’s with your baby, take time out elsewhere take it to the doctor immediately! u

58 Baby care Baby care 59 milk flow. Supporting your head and Expressing (i.e. milking your breasts) is shoulders with pillows during breastfeed- not usually necessary but sometimes it Breastfeeding ing might help. helps to empty your breast if it is too ten- Start each feed with a different breast der for feeding or is still packed tight after first. You can press your breast to have a your baby has finished. You should never Breast milk provides the optimal nutrition few drops of milk ready. Offer your nipple throw breast milk away. If you produce for your baby. Except for vitamin D, breast to the baby so that it goes far back, touch- more milk than your baby needs, you can milk supplies all the nutrients a healthy ing the roof of its mouth. Do not force the express and freeze your breast milk for lat- baby with a normal birth weight needs baby against your breast by pushing it er use or donate it to your hospital’s milk during the first six months. Exclusive from the cheeks or head. If your baby bank. It is also possible that your clinic’s breastfeeding means that the infant needs seems hungry after feeding on the first nurse knows someone needing breast no supplemental nutrition (except for sup- breast, offer the second. However, before milk. Make sure that the breast milk you plemental vitamin D) and ensures that nu- changing breasts make sure the first one is donate is clean. trients are absorbed as well as possible and fully discharged and that the baby has re- Sore or cracked nipples make breast- the baby is protected against diseases. This ceived the nutritious hind-milk. At the be- feeding very painful. Using nipple shields feeding method has a positive long-term ginning, the baby will easily fall asleep may ease the pain. Nipple shields are sold impact on the baby’s health. while feeding. You can carefully try to at the chemist’s and in department stores. Nearly all mothers can produce breast awaken him or her in order to finish the If your breasts become red and tender and milk. In the beginning, the milk supply is feed. you have a fever, you may have a breast small but usually sufficient for the baby. In Milk may often seep from your breasts, infection. Despite the infection, you can most cases, the size or shape of your even when you are not breastfeeding, es- continue breastfeeding. Contact your child breasts does not have any impact on milk pecially during the first weeks. Seepage health clinic or hospital maternity unit production. Successful breastfeeding re- may also occur from the other breast while and follow their treatment instructions. quires some learning and practising the duced. Oxytocin is a hormone that causes the baby is feeding. Use breast pads in correct technique. Information and guid- the milk to trickle down the milk ducts. your bras to absorb milk which has seeped Take care of your liquid intake ance provided in problem situations will This is called the let-down or milk ejection out. If you want to collect seeping milk, While breastfeeding you need to drink help the mother to get started. If you are reflex. Let-down often occurs when you place a milk collector inside your bra over more than you are perhaps used to. Water, unable to breastfeed for whatever reason, think about your baby, are watching your the nipple. Milk collected during the day diluted juice and drinks with artificial it is advisable to start giving your baby for- baby or hear your baby cry. Exclusive may be refrigerated in a separate dish and sweeteners (aspartame and acesulfame) mula milk and secure the baby’s nourish- breastfeeding and letting your baby set combined into a plastic bag to be frozen. are suitable alternatives during breast- ment in this way, rather than fretting and the pace of feeding will ensure that the Breast milk can be stored in the freezer for feeding. Drinks sweetened with sugar are worrying over breastfeeding. quantity of produced milk increases dur- several months. bad for your teeth, especially if consumed ing the first couple of days after birth to several times during a day. Such drinks are Breast milk production meet your baby’s needs. Once milk pro- Take good care of your breasts an unnecessary calorie supply and tend to The breast prepares for breastfeeding dur- duction has started, it will not stop sud- When your baby has finished, squeeze a raise your blood sugar levels. ing pregnancy. Milk production is initiated denly. drop of milk over your nipple and leave it by delivery and maintained by frequent to dry. This will protect your nipple better Do not smoke while you are breastfeeding. A hormone called prolac- than any lotion. Keeping your breasts Technique breastfeeding! tine causes milk production in the breast, Breastfeeding can be done in several posi- clean is important. However, it is not nec- Both parents should give up smoking the baby’s suckling stimulating the release tions. Try different positions to find the essary to wash them before and after eve- while pregnant and breastfeeding, if of such hormones, so that the more often ones most comfortable for you and your ry feed. Excessive washing will erode the not for good. you feed your baby the more milk is pro- baby. Being relaxed will contribute to the skin’s own protective agents.

60 Baby care Baby care 61 Nicotine reduces the secretion of hor- package at room temperature until the ex- any wind. Burping may be facilitated by your nipples are getting sore, carefully re- mones (prolactin) needed to produce milk, piry date. An opened package can be softly patting the baby’s bottom, and is move the nipple and replace it with a which may lead to a decrease in your milk stored in the fridge (+2°C to 5°C); its con- performed equally well by both parents. dummy. Remove the dummy after the ba- supply. Nicotine levels in breast milk are tents must be used within 24 hours. Warm Burping will radically decrease tummy by falls asleep. In some special cases, such three-fold compared to blood nicotine lev- formula by standing the bottle (or cup) in a trouble. If the baby has gobbled his food as preterm babies and babies with a cleft els. Furthermore, the presence of nicotine bowl of warm water, running the bottle (or down and swallowed a lot of air, it may in breast milk causes restlessness and met- cup) under warm tap water or carefully in bring up some of the milk. If your baby has abolic problems, disrupts the baby’s sleep- a microwave oven. To distribute the heat a tendency to regurgitate, try burping it in NOT ALL BABIES WILL EVER NEED ing patterns and makes the baby cry. If you evenly, stir the formula milk after warming the middle of feeding to expel the air from OR WANT A DUMMY. are unable to quit smoking completely, it. Test a drop of heated formula on your its tummy. Once it is started on solid foods, avoid smoking 2 to 3 hours before and wrist to make sure the milk is not too hot. this will happen less frequently. during a feed. The same safety period of 2 Powdered formulas are not sterile. palate or lip, dummies are used to encour- to 3 hours also applies, if you are using Therefore, it is important that you follow Soothers, dummies, pacifiers age sucking and to learn the correct feed- nicotine gum or other nicotine replace- these instructions: Babies explore the world though their ing technique. ments. Never expose your baby to cigarette u Run cold tap water into a clean pot and mouths by sucking on everything they can Foreign micro-organisms easily smoke. Babies exposed to cigarette smoke let it boil. (After you have started giving reach. The mouth is the baby’s most cause diarrhoea so remember to have recurring respiratory problems, a your baby supplemental foods, there is sensitive body part. Fingers will keep dummies as clean as bot- cough and a much higher risk of develop- no need to boil the water if your tap slip easily into the mouth. When tles and bottle-feeding teats. ing asthma. water quality is good.) the sucking instinct is strong, it Never suck a dummy For more information on breastfeed- is better for the baby to suck on clean in your own mouth. u Let the water cool. ing, breast milk and weaning, see the ma- a pacifier than on a finger, be- Otherwise, the micro-or- ternity package’s breastfeeding leaflet. For u Add powder and mix with water. Care- cause the skin on the fingers ganisms in your mouth further help and support in breastfeeding, fully follow the instructions on the may become chapped due to will be passed on to contact the national Breastfeeding Support package. energetic sucking and break- your baby. For the same Line (tel. 041-528 5582) or search the In- u Always prepare the quantity needed for ing the habit is easier with reason, take care other ternet (visit www.imetys.fi). one feeding; never prepare large quan- dummies. Not all babies children do not share tities of formula milk in advance. will ever need or want a your baby’s dummy. Ster- Formula milk dummy. ilise bottles, teats and If you stop breastfeeding before your baby Water It may be wise to wait dummies in boiling wa- is one year old, start using industrially pre- Run your tap on COLD for a while before until you feel breastfeeding is ter until your baby is six pared infant formulas. There are powdered taking water for the baby’s food or to give well established and your ba- months old. After- and ready-to-use liquid formulas; follow as a drink. Always use cold tap water; by has adopted a good tech- wards, washing with the instructions on the package carefully. warm or hot tap water may contain micro- nique before trying a dummy. warm water is suffi- For the safety of the child, formula organisms and other contaminants. There Rather than automatically cient. Make sure the milk should never be warmed and stored is no need to give your baby juice or water offering the dummy, wait for hole of the bottle-teat in a thermos flask or prepared in advance sweetened with sugar; such drinks will on- your baby to be fussy or dis- is not too large or your for night-time feeds. Warm the formula to ly harm the budding teeth and accustom contented and in need of baby is liable to suck ex- body temperature (approximately 37°C). the baby to sweets. soothing. Once the baby has cess air which in turn will Taste the formula milk before giving it to fallen asleep, take the cause tummy trouble. The the baby. Discard any left-over formula. Burping and regurgitating dummy gently away. If hole size is correct when Ready-to-use liquid formula can be When the baby has finished feeding, lift your baby is sucking hard the milk flows out in stored in its original unopened and intact him up against your shoulder to bring up even after feeding and drops. u

62 Baby care Baby care 63 Hygiene

Baby urine and stools Nappy changing Babies have an active metabolism and may absorbing insert. There are one-piece nap- Change your baby’s nappy about as often Bathing is recommended every 2 to 5 wet their nappies a dozen times a day. The pies, pocket models and nappies where as you feed him - newborn babies wet days. More frequent bathing will dry the frequency of bowel movements varies in- each layer is separate. The cotton squares their nappies frequently. Rinse your baby’s baby’s skin. Soap is not necessary since it dividually. Some babies have bowel move- in the maternity package are suitable for a bottom with warm water (soap is seldom will only remove the baby’s natural oils ments several times a day while others on- newborn. Change the cloth insert fre- needed). Carefully dry your baby’s bottom. and cause the skin to dry. If your baby has ly a few times per week. For the first cou- quently, otherwise your baby might feel Apply a barrier cream after washing. Use a very dry skin, add a drop of oil to the bath ple of days after the birth, your baby will uncomfortably wet. To make the nappies basic lotion. Do not rub it in forcefully, but water. Do not use bathing salts. Never pass a sticky, greeny-black substance called leak proof, you need to fasten them prop- pat it gently onto your baby’s skin. bathe a sick child, a quick wash will be suf- meconium. After a short while the stools erly. Fibre cloth inserts transfer moisture Washing is not required during each ficient. will turn brownish or yellow. into the absorbing portion of the nappy nappy change. Change nappies as soon as If the baby’s nappy was dirty, wash its Normal stools smell sour but not un- and stools wash off these more easily than you can to protect your baby’s skin from bottom before bathing. Wash the new- pleasant. Often the stools of breastfed ba- from cloth. The outer part of the nappy the irritating effect of urine and stools. If born’s face separately with a cotton pad bies are greenish and runny. This is not a does not need frequent washing, only the your baby has very sensitive skin, change and lukewarm water. Wash the eyes from symptom of diarrhoea. If your baby has di- absorbent inserts must be washed after nappies frequently and apply barrier the outer side towards the inner corner arrhoea, the stools will have a terrible each use. Woollen nappies are particularly cream upon each change. Should your and clean the baby’s ears (from the out- smell and be completely absorbed into the warm and breathable. When opting to use baby’s bottom become red or sore when side). Do not dig into the ear canal or nos- nappy, leaving a green stain. reusable nappies, you will need at least 20 you have been using reusable nappies, try trils as they are very sensitive and are usu- inserts and a couple of nappies per size. using disposable nappies for a while. Also, ally cleaned naturally. Nappies For more information, please refer to be sure to rinse the reusable nappies very At first the bathing time will be very Disposable nappies are very convenient to the nappy guide in the maternity package or carefully. short, but after a couple of week babies use, but expensive over the two or three the Internet (www.kestovaippayhdistys.fi). Let the baby be without a nappy every usually start to enjoy bathing and are hap- years that your child is in them. Slow to now and then as constant dampness only py to take longer baths. Often babies find decompose, disposable nappies burden irritates the skin more. Let him or her have bathing very soothing. Bathe your baby us- the environment. The advantages of dis- a good kick without a nappy in a warm ing calm, confident movements. Avoid posable nappies include very good ab- place. If your baby’s skin has spots or the sudden movements which will alarm the sorbance, leaving the baby’s skin dry skin is broken, sprinkle baby powder or baby. Take care the baby does not swallow and thus preventing the risk of nap- potato flour over the area. For further in- any bath water. There may be times when py rash. If your baby has sensi- structions, contact your child health clinic. your baby will refuse to bathe. Do not force tive skin or severe nappy rash, bathing. You can take a break and wash the disposable nappies will facili- Bathing baby using other methods. tate skin care. Your baby will need a bath tub that is not Make sure your hands are warm. Take There is a large vari- used for any other purpose. This will help off your watch, rings and bracelets to avoid ety of reusable nappies. to prevent skin complaints, for example. scratching your baby. Place the baby’s Inside reusable nappies Bath water should be at body temperature clothes somewhere warm, on a radiator, there is usually a layer of (37°C). Check the temperature using a for example. Warm the bath towel either surface-dry cloth and an thermometer. on a radiator or by tying it around your

64 Baby care Baby care 65 other creases. If your baby’s skin is smooth child’s hand as you trim its nails. If your and does not seem dry, there is no need for baby is restless or fussy, wait for a better body lotion. If the skin is dry or red and moment. chapped, apply a thin layer of baby barrier cream. Sauna Do not take a baby under six months old Hair, scalp and nails into the sauna. Under six months old, ba- Wash your baby’s hair during the bath. bies cannot control their body temperature Many babies develop cradle cap, an oily, by sweating. If your baby enjoys a sauna yellowish crust on the newborn’s scalp. To when it is older (6 to 12 months), you can remove the crust, apply basic lotion or ba- sit with it on the lower bench if water is by oil to the scalp and let it soak for a few not thrown on the stove. Splash lukewarm minutes. After washing the baby, scrape water over the baby’s head. the crust gently off using a baby brush or comb. Brush the baby’s hair daily. The soft Laundering your baby’s clothes spots on the baby’s head where the skull The best detergent for washing baby has not yet fused (fontanel) do not need clothes is fragrance-free or only mildly special attention. scented. Wash new baby clothes before The nails of a newborn are often too they are worn for the first time. When long. However, due to the risk of cuticle measuring the detergent, follow the in- infection it is not recommended to trim structions on the detergent carton to en- your baby’s nails during the first week. If sure clean clothes without traces of deter- own waist. Lift the baby out of the tub and need to turn it over for washing. Later, you you worry about scratching, use cotton gent. Using extra-gentle detergent will wrap it inside the warm towel. can proceed as follows: mittens on its hands. leave the clothes extra soft. Nappies in Holding your baby: Hold the baby Wash the tummy side first. Then turn Trim you baby’s nails after about one particular must be washed and thoroughly with its back on your arm. Support the ba- the baby onto its tummy by taking hold of week. A good time to check if your baby’s rinsed to remove all detergent. For more by’s head and neck with your arm and the baby’s upper arm with your free hand nails need trimming is after a bath. To keep information on washing clothes, please re- grasp its arm, placing your hand just under and turning it gently over. Keep your ba- it from wriggling, keep a firm hold of your fer to the maternity package leaflet.u the armpit and hooking your thumb over its shoulder. This will give you a firm hold of the baby. BATHE YOUR BABY USING CALM, Bathe your baby from the head down- CONFIDENT MOVEMENTS. wards. With your free hand, gently wash your baby’s head taking care not to splash water into its eyes. Wash its neck, armpits by’s arm in a firm grip but do not use ex- and folds in the skin with special care, as cessive force. Wash your baby’s back side they tend to gather lint. from head to toes. If you didn’t use soap, At first, many mothers and fathers are separate rinsing is not necessary. nervous about bathing their baby and es- When you’ve finished, take your baby pecially about turning the baby onto its out and pat him or her dry with a towel. tummy. However, until the baby’s muscles Use your baby’s own towel. Pay special at- develop and it can lift its head, there is no tention to the elbows, knees, armpits and

66 Baby care Baby care 67 Sleep

During the first weeks, most babies sleep Sleeping position through most of the time they are not According to current research, placing your feeding. The safest position for a newborn baby on its side or back to sleep until it is 6 is on its side, older babies should sleep on months old reduces the risk of cot death, their back. At first, your baby will wake up or SIDS (sudden infant death syndrome). 2 to 3 times a night for feeding. At two weeks, babies usually start staying awake Cot toy to socialise for longer time periods. A At a few months old, many babies like to three-month-old is awake for 6 to 8 hours have a soft toy or blanket to cuddle when attention, babies also need peace and qui- in a cool, shady place and make sure it a day. Try to teach the baby a sleeping they go to bed. Sleep is a form of et according to their individual needs. cannot tip over or start rolling downhill. pattern that matches the sleep-wake parting and may some- A child’s sleep is often disturbed when Draping a mesh net over the pram will routines of the other members of times be difficult to en- it learns to crawl and walk. Excited by new protect your baby from insects and other the family. dure. A soft toy or blan- experiences and skills, the baby is slow to animals. ket will soothe your baby relax and calm down. Changing from crib In the winter, wait until your baby is Settling to sleep to sleep. Remember the cot to cot may also cause sleeping problems. If about two weeks old before starting to When you’re trying to settle your toy when your baby is stay- the baby is used to sleeping in a crib, try sleep it outdoors. Do not sleep your baby baby to sleep (or back to sleep af- ing overnight at some draping the sides of the cot to pacify it. Ba- outdoors if the temperature is under ter a night feed) be careful not to other place or when bies do not usually require absolute silence -10°C. In cold weather, be careful not to excite it. Loud voices, bright someone other than a in order to be able to sleep, but it will be apply cream or lotion containing water to lights and playing with the baby parent puts it to bed. Dur- prove to be difficult to sleep if the televi- your baby’s cheeks as it will freeze and by trying to make it laugh will ing changes such as wean- sion is blaring. Falling asleep in a very light damage the skin. Tuck the baby tight inside wake a baby that was already half asleep. ing, the cot toy provides comfort and secu- room may be difficult for older children in its sleeping bag and check that its cheeks Rocking the baby in your arms and hum- rity, substituting to some extent for the particular. stay warm. The baby can sleep outdoors a ming quietly will help your baby fall asleep. carer’s presence. little longer every day until it eventually It is not necessary to hold your baby until Night-time nappy changes takes all day-time naps outdoors. it is fast asleep. Instead, you can put it to Sleeping problems If your baby needs changing during the In rainy and windy weather, put the bed when it’s sleepy and relaxed, but still Tummy troubles and wind are the most night, be as quick as possible and then re- hood up and pull a rain cover over the awake. common reasons for sleeping problems. turn it to bed. Keep the lights dim and pram. Place the pram in a sheltered place. Prams are the modern alternative to Sleeping problems may also be caused by speak softly, but do not engage in play that Strong wind will make temperatures be- cradles and swaying the pram or moving it letting the baby stay for long periods of will stimulate the baby. Otherwise, nightly low freezing even more chilling. During back and forth will help your baby fall time in bed while awake. On the one hand, entertainment will become a habit. the spring and summer months, take care asleep. Watch your baby for signs that it’s not receiving sufficient attention during not to place the pram in direct sunlight in tired. Putting your baby to bed while it is the day may lead the baby to demand its Sleeping outdoors order to prevent the baby from suffering wide awake and sociable will not make it share at night. On the other, excessive Many babies sleep best outdoors where heat suffocation. sleep. You can’t force sleep, but you can en- stimulation and too much attention will the fresh air enhances deep, sound sleep. Discuss sleeping a preterm baby out- tice it. A dummy, a blanket or a musical toy prevent the baby from sleeping and it will Summer babies can be put outdoors to doors with your child health clinic’s nur­ may prove comforting. become overtired. In addition to care and sleep during the first week. Place the pram se. u

68 Baby care Baby care 69 negative feelings, curiosity, courage and When you are holding your baby, for ex- being shy or reserved in new situations are ample, it will feel his own weight against Growth also components of temperament. From yours. Such experiences will gradually the parents’ viewpoint the child may have a make it aware that it is an entity separate sweet or difficult temperament depending from its environment. on how easy or demanding the baby is. and development Height and weight The baby enjoys company At birth, babies usually weigh 3,000 to Your baby will closely observe its environ- 4,000 grams and are 49 to 52 cm tall. Dur- Children develop in their own time ment from birth. There are many things it ing the first few days their weight drops by Children develop in their own time ac- will only be able to learn from others and 6 to 8%, but is regained in a couple of cording to their genetic and environmen- your company is therefore very important. weeks. Afterwards, the weight should in- tal influences. The following table depict- To secure your baby’s healthy develop- crease by 150 to 200 grams per week. By ing child development provides a rough ment, you only need to do what comes the age of one year, most children weigh guide as to the order and age in which very naturally to most parents: talk to the roughly three times their birth weight (10 children will reach a certain stage or learn child, hold it, rock it in your arms, move its to 12 kg) and are about 1.5 times as tall a particular new skill. However, there is arms and legs, sing, hum, show it the (73 to 80 cm). great variation between different chil- things in your home, introduce it to other However, there is great variation in dren. The same child may be fast to devel- people etc. There is no need to ”train” your this. A newborn can weigh anything be- op in one area and slower than average in baby or invent abundant stimuli. tween 400 and 6,000 grams and future another. Or, one week may be a week of growth and development expectations de- several new skills, and then these skills are Allowing for the baby’s needs pend on the birth weight. Growth charts practiced throughout the following To secure your child’s development, allow are an important tool when monitoring weeks. for its needs and show that you accept and your baby’s growth and its relation to the Noticing and being happy about how more important that the baby is develop- love it just the way it is. Feed your baby size of the parents. your child grows and develops and offer- ing and that things are not completely for- when it is hungry and let your baby sleep ing support and encouragement in learn- gotten once learned. when it is tired. If your baby shows interest Learning to talk ing new skills is very important to the Problems at birth or later infections in some object, encourage him or her to One of the most important things a child healthy development of your child. When may slow down your baby’s development. examine it. Since your baby will mainly ex- learns from others is how to speak. Before your baby has just learned how to roll over, Therefore, the so-called corrected age is amine the object with its mouth, make learning to talk, it will need to hear people play with it on the floor instead of sitting it applied when assessing the development sure that the things you give it are safe. talking. Therefore, it is vitally important in the baby bouncer. Allowing the baby to of preterm babies. that you talk to your baby. At first, your grasp objects that interest it is a kind of di- Babies are strangers to themselves baby will respond with baby sounds. At alogue with the baby. You can try to allure Children are born unique During the initial months, the baby’s con- six months, your child may know a few a baby who is slow to warm up to new Each baby has his own, unique features cept of itself is very vague. It cannot distin- words even though it cannot speak yet it- things, but too much ambition and paren- and habits which are permanent. These guish itself from its environment, and self. It may, for example, know how to tal desire to speed up the baby’s natural personal traits are called temperament. thinks it is part of its mother and the sur- point to its own mouth if asked to do so, course of development may be harmful. If Temperament includes characteristics such rounding environment. The baby is not provided the parts of its body have fre- the baby is overweight, stabilising its as patterns (sleeping pattern), patience, fully aware that its hands and legs are part quently been pointed out to it. At 7 to 8 weight curve may promote its motoric de- calmness, activity, restlessness and the of it, but that its mother’s breast and its months, your baby will start to repeat syl- velopment. Making comparisons between ability to adapt and concentrate. Different own blanket are not. In order to discover lables and will be able to chatter by itself different children is seldom fruitful. It is moods such as being irritable or prone to its boundaries, it will need your help. for long stretches at a time. Children nor-

70 Baby care Baby care 71 Infant development (deviation from this table is common) mally utter their first word when they are its linguistic skills may have developed in 10 to 13 months old. many ways. By singing, playing, looking at Speech is central to the child’s devel- picture books and reading fairy tales - just Age Sociability Movements Hand movements Eye sight opment. Being able to express itself in to mention a few. There may come a time and speech and hearing words and understanding speech help it when the bilingual child refuses to use one gain a better understanding of the world. of the languages. This may be a real trial A child who understands what is said to it for the parent concerned. Nevertheless, 0-1 random, moves arms hands mostly cannot see is easier to guide and will learn things continue speaking your own language months involuntary and legs clenched in a fist clearly, starts at more quickly. In many instances, a child even if your child does not answer in it. smiles, direct simultaneously loud noise and who can talk and has a large vocabulary Learning two languages takes more eye contact bright light will perform better than other children. time and effort. Be patient and give the Just talking to the baby is, however, not child time. Also, show that you are inter- 2-3 first real smile, holds head up, catches hold of turns head sufficient for teaching it to speak; you need ested in both languages. For more infor- months makes baby kicks with things using both towards sound, to have a conversation adapted to the situ- mation on bilingualism, contact your child sounds (ah, goo), both legs hands, studies follows moving ation and feelings at hand. In practice, this health clinic. For more information on the is sociable simultaneously own hands object with eyes might be interpreting the baby’s feelings Swedish language, contact the Swedish aloud, putting questions to the baby and language day-care centres and the Sven- 4-6 laughs out loud, pushes arms up picks things up recognises a explaining things. Use rich, versatile and ska Finlands Folkting (www.folktinget.fi). months recognises the straight, turns, with one hand, picture of a face, correct language when talking to a baby. person caring sits supported palm grip studies colourful Besides baby talk, your child needs to hear Sight for him, first images ordinary speech in order to learn to pro- A newborn does not see very clearly. What attemps at play nounce words correctly. it sees best are the eyes of a person close by. Babies enjoy looking at things. Hang 7-8 distinguishes sits without moves toy from no longer Bilingual families colourful objects (such as pieces of cloth) months between familiar support, rolls one hand to squints, If you and your partner do not share the or a mobile about 50 cm above the crib. and unfamiliar over, crawls the other, seeks hidden same mother tongue, you may be consid- The baby enjoys seeing them move, but people, knows (some­times pats table with objects ering having your child grow up bilingual. remember to remove them when it is time 2 to 3 simple backwards) hands Children are usually able to learn two lan- to go to sleep. The baby will first learn to words, repeats guages, provided that their parents are recognise human faces. A 3 to 4-month- sound s such willing to invest some time in teaching the old enjoys looking at a very simple, smiley as dadada etc. child and know how to go about it in the face. Most babies squint during the first right way. For the child’s linguistic devel- months. However, their sight develops 9-10 is shy of crawling on all picks up objects looks at images, opment, it is vital it learns to distinguish fast and the child enjoys observing its en- months strangers, four, pulls up to between thumb notices objects between the two languages. Both parents vironment. first words stand and walks and forefinger sized 1 to 2 cm must consistently speak only their own Babies usually find pictures of familiar with support mother tongue with the child. In their dis- everyday items very interesting. You can cussions with each other and other people start ”reading” picture books with a 11-12 can say 2 to stands with throws objects turns towards the parents may use the language they are 2-month-old, but if it is not interested, months 3 words, support, about, a whisper, accustomed to. stop and try again a few weeks later. Chil- interested in first steps claps hands recognises objects It is usually the case that one of the dren only learn through curiosity; forcing other children from images languages develops more quickly than the things on your child usually only serves to other. By the time your child is a toddler, slow down this process.

72 Vauvan hoito Baby care 73 You can make your own picture books Touch and grasping different textures, letting your baby touch not to let your baby be in a baby carrier, a by cutting simple pictures out of maga- The mouth is the baby’s most sensitive smooth, hairy, soft and hard surfaces, feel baby swing or walker for extended periods zines, gluing them onto cardboard and body part. Babies explore the world wood and stones etc. In this way, your ba- at a time. Being in the same - possibly in- covering the pages with adhesive plastic though their mouths by sucking on every- by will learn what the world feels like. correct - position for a long time is a strain film. Your baby will also be delighted with thing they can reach. A newborn holds its on your baby’s back and hips. If you wish its own little photo album with pictures of hands clenched in a fist. Later, its hands Toys to promote your baby’s development, al- mum and dad, its sisters and brothers, will relax and the fingers splay out. At the You can make baby toys yourself. Under low it to be on a blanket that is spread out grandparents and other familiar people. age of 2 to 3 months, babies start grasping two-year-olds like to play with rattles, soft on the floor as much as possible. Babies are especially interested in por- objects with both hands, putting them in- toys and balls. Many of your household Babies enjoy being held, bounced and traits. to their mouths. Make sure that the things items are suitable as toys, such as plastic lifted, and like swinging and having their your baby can reach are not toxic or dirty, containers and their covers, empty plastic hands and legs moved. However, babies Hearing and that they are big enough not to suffo- bottles, scoops, cotton reels and so on. do not enjoy sudden movements, loud Newborn babies have very good hearing. cate it (avoid string, rubber bands, buttons noises and rough handling. For more in- Most babies can recognise their mother’s etc.). formation on how to encourage your ba- and father’s voice before the age of two When a little older, the baby will grasp Make sure they do not have: by’s motoric development, contact your u sharp edges, weeks. By 2 to 3 months, the baby will start an object with one hand and move it from child health clinic. Many gymnastics asso- u little pieces that can become loose, turning its head towards a sound, but will one hand to the other. A further develop- ciations organise parent and baby fitness u toxic paint, not be able to hear whispers until towards mental stage is for the baby to pick up ob- classes. Baby swimming is also a fun form u strings or bands, or the end of the first year. Babies are easily jects between its thumb and forefinger. of family time. The ideal time to start is u anything that will break or crack. startled by loud noises. This is called the pincer grasp. Play with when your baby is 3 to 5 months. Babies usually enjoy music and are an appreciative audience for any musical per- Movements Take notes and pictures formances by other family members. Do Your baby will start lifting its head during It is interesting for both the parents and not hesitate to make up your own songs, the first months. It will learn how to turn child that its development has been docu- however silly this might feel. And your ba- onto its tummy at the age of 3 to 5 months mented in notes and pictures and by sav- by won’t mind even if your singing or and sit up at the age of 6 to 8 months. Af- ing early drawings and toys, for example. playing is somewhat off pitch. By the time ter 6 months, your baby will start crawling Parents caring for their first baby often im- they are a few months old, babies are on its tummy. Some babies may start by agine they will remember until their dying aware of rhythm and dance and jiggle in crawling backwards. A short while after days what their child did and what it time to music. However, do not leave a ra- this, your baby will learn to crawl on all looked like at every age. Yet the details are dio or television on all the time. Constant fours and will be very quick at moving in fact soon forgotten. Therefore, it is a noise is stupefying and makes music less around. At 7 to 9 months, your baby will good idea to write down some of the mile- enjoyable. pull itself up to stand using support, and stones, such as when your baby had its succeed without support after a few first tooth, how it chattered, what made it Sense of smell months of practice. About one in every two laugh, which books and toys it liked, what Newborns have a keen sense of smell. Ba- babies takes its first steps before its first its first words were etc. If you take pictures, bies smell breast milk which helps in find- birthday. remember to mark them with a date and ing the nipple and starting to feed. When You can sit your baby in a baby bounc- the child’s name. When there are more the baby is fussy at night and feeds at fre- er for short periods at a time as long as its children in the family, it is not always easy quent intervals, it might sleep better when position is relaxed and its head is support- to remember later who was in the picture its father is holding it and the smell of milk ed. A car safety seat is not a baby bouncer and when it was taken, or which of the doesn’t activate the feeding instinct. and should only be used in the car. Be sure children used a funny word. u

74 Baby care Baby care 75 Daily routines

New challenges Being a new parent is a wonderful, happy the working day you still have time and experience, but it also means facing new energy to enjoy your family. challenges. Your daily routines need to be Avoiding major changes and ”projects” rearranged, requiring cooperation from all during the early months with a new baby members of the family. The baby cannot be will make family life much less demand- left alone anywhere and its needs must be ing. Most things can be postponed, but attended to. You can take your baby along caring for your baby cannot. Of course, it is to most places, as long as you are able to not always possible to anticipate overlap- accommodate its sleeping and feeding ping changes such as moving to a new patterns. When you have a baby, you need home or sickness in the family. However, to accept certain limitations. Leaving the the fewer major distractions there are, the house will generally take much longer easier it will be to arrange your time and try to divide them into tasks that can be may be very enthusiastic and eager to par- than before. You need to plan and then daily routines. left for later and tasks that must absolute- ticipate in caring for the new baby, while pack the baby gear accordingly, and just as All in all, you will need to pay more at- ly be done now. In addition to caring for also being jealous. Children’s feelings of you’re ready to step out your baby may tention to how you are spending your the baby, you need to save your energy for jealousy have been compared to a situa- need a feed or nappy change. time. Your friends and relatives can be of caring for yourself and your relationship tion where your partner would bring home Caring for your baby comprises repeti- great help when you need the occasional with your partner. Do not make unreason- a new husband or wife. tive routines which enhance the baby’s helping hand, but most arrangements able demands on yourself or on your part- Due to such jealousy, older children sense of security, but which are very bind- must be negotiated within your own fami- ner; perfection is not a requirement for may be very angry at the baby whereas ing for the parents. Feeding, burping, ly. You will need to agree on ”my time”, good parenting. Remember that your life others may start pretending to be babies changing, washing and sleeping the baby ”your time ” and ”our time”. need not be a sequence of exhausting rou- themselves. Such reactions include want- often interrupt other activities. This can Be patient. Taking care of a baby in- tines. Little surprises and shared moments ing to sit on your lap when you start feed- sometimes be very frustrating. Although volves routines and changes. On the one with your partner will break up the routine ing the baby. An older child may start wet- rewarding, caring for your baby can also be hand, it is the parent’s job to create a nicely. ting its pants again and demand to be exhausting, especially if your baby wakes sense of stability and security for the baby. treated like a baby. The child may become up many times per night leaving you with Yet on the other, parents need to adapt to Brothers and sisters tearful, demand a dummy, want to sleep insufficient sleep, cries a lot or has a de- the constant changes as their baby grows. When the baby arrives, your older children beside the parents or be very quarrel- manding temperament. Both parents must be flexible and adapt may suddenly seem very competent. Do some. During the baby’s first year, it is very quickly to the big and small changes in not expect them to suddenly be more ma- An older child may try to hurt the baby important that both parents have some daily routines. It is important that neither ture just because they seem so much big- by hitting or pinching it. Naturally, broth- time to themselves to rest and enjoy a of the parents expects the other - nor ger than the baby. A new baby in the fam- ers and sisters cannot be allowed to tor- hobby, sports for example. However, do himself or herself! - to carry on with the ily is a change for the older children as ment the baby and you must put and end not fool yourself into thinking that you can same responsibilities as before the baby’s well, not just for the parents. For some, the to such behaviour very determinedly. The participate in activities and go out with birth. most trying time is when the baby is born, child may also express hopes of the baby friends as actively as before. Also try to If you begin to feel that your daily while for others the difficulties begin when dying or being given away. This may sound balance work and family life so that after tasks and chores are becoming a burden, the baby starts moving around. The child terrible to the parents, but it helps the

76 Baby care Baby care 77 child to let off steam. This stage passes the older child a baby doll which it can they did their own children. If doting turns they will both need to attend. However, not more quickly, if the parents understand the nurture while mum or dad is looking after into spoiling, it may cause friction between all families have close relatives living near- older child’s pain and find the time to lis- the baby. the parents and grandparents. Tactful by and even if they do, they may be very ten. When your child says, ”I wish the ba- Refer to the baby as ”our baby” to em- grandparents will understand that the much engaged in their work and social life. by were dead”, you can reply by saying, for phasise that the baby is a family member. young parents need to make their own de- In such cases, the availability of other forms example, ”I know you’re angry with the Remember to frequently tell your children cisions, and will not interfere unless invit- of support is particularly important. Fami- baby and wish it had never arrived. Do you that you love them and that they are very ed to do so. In conflict situations, each par- lies with young children can agree to ba- feel like I’m not spending enough time important to you. Praise the older children ent should carefully broach the subject bysit each other’s children. In many loca- with you? I love you just as much, but I do for the things they can already do and with his or her own parents. tions, organisations such as MLL (the need to take care of the baby as well”. which the baby is only just learning. Mannerheim League for Child Welfare) Older children may be cross just be- Short-term child care and Väestöliitto (the Family Federation of cause the parents no longer spend so Support networks Friends and relatives can offer invaluable Finland) offer short-term child care for a much time with them - which is true. This In addition to your relationship as a cou- help when the parents have something fee (see ”Organisations” on page 94). u passes more quickly if they are allowed to ple, the new baby has an impact on other pretend being a baby for a while, although people as well. A new baby creates grand- this may feel like a nuisance. Make an ef- parents, aunts, uncles, cousins and god- fort to spend time with the new big sister parents. Parenthood is an experience that or big brother. Set aside a time of the day binds different generations but also poses to be with him or her, while the baby is new challenges. Society as well as beliefs sleeping or with the other parent. Also, al- and views on child rearing and baby care Safety low the child to participate in taking care have changed during the years, which may of the baby. He or she can sort out the ba- create conflicts between the new parents by’s things or hold the baby while sitting and the older generation. Despite the Accidents often take place in the home. If your baby is sitting on your lap at the on the floor, a chair or on the sofa. Give number of differences there are also many For safety in the home, read the following table, ensure that he or she cannot pull hot opinions that are shared. precautions. drinks or hot food onto him or herself and When you become a parent, you begin be scalded. to view your own parents from a new per- Never leave a child unattended spective. At best, the relationship is one of u on a changing top or a bed without Always place the following out mutual respect. Becoming a parent often sides. of reach of children stirs up feelings and memories from your u in a bath. Always make sure the wa- own childhood. Talk about them with ter is not too hot and that hot water u plastic foil and plastic bags someone and, if they are very distressing, does not drip from a leaking tap on- (risk of suffocation). seek professional help. to your baby’s head. u sharp or fragile objects. Place knives In many families, grandparents are u in a room where a window or balco- and other tools out of the reach of child. naturally an important part of the family ny door is open. Place guards on the Use locks or guards in cabinets and and are glad to participate in caring for windows. drawers. If this is not possible, tie the the baby. Often, caring for their cabinet doors and drawers with string u in the kitchen when something is grandchild brings back memo- or remove all handles. ries from the time their own cooking on the stove or in the oven. u cigarettes, alcohol, medication, cleaning children were small. It is often Always turn pot and pan handles in- agents, paint, detergents, insect repel- easier for grandparents to dote wards. Buy a cooker guard to cover lent and other toxic materials. over their grandchildren than the stove’s burner knobs.

78 Baby care Baby care 79 u nails and other thin objects the child out and fall. Make sure no animals get in- might stick into electric outlets. Use to the pram. u plugs in unused outlets or install safety Starting supplementary food sockets. Safety in the car u toys with small, loose parts and button u The safest place for a child aged 1 cell batteries which can block the to 3 years old is a rear-facing baby Exclusive breastfeeding is recommended child’s airways. seat. Just hitting the brakes can be for the first six months, if possible. At six enough for your child to be injured. months you can start introducing solids Check that your baby gear, such as the into your baby’s diet, but it is recommend- u Fasten baby and child seats accord- changing top and pram, are safe and in ed that you continue breastfeeding until ing to their instructions. Children good condition. your baby is 1 years old or beyond, if you must travel with the appropriate Be aware of any heavy objects the child both enjoy it. However, a one-year-old will restraints and sitting in their own could pull on top of it from the table or receive all the necessary nutrients from seats (travelling by car sitting on an shelves. Make sure the child cannot over- other foods and his or her digestive system adult’s lap is forbidden). Never use turn the bookcase. will be ready for other nutrition in addition rear-facing baby seats in a seat fit- Keep a keen eye on your child when to breast milk or formula. Once your baby ted with an active front airbag. An you are visiting. If your hosts do not have has reached its first birthday, you can be- inflating airbag can be life threat- young children, they will most likely not gin to give it skimmed milk and milk- ening to a baby. be prepared for little explorers eager to based foods. touch and taste everything. u Never leave your child unattended The correct time to start introducing Never leave a child who can move in the car. On a very warm day in solid foods into your baby’s diet depends around alone in the pram. It could climb particular, this could be fatal. on its growth and overall development, and breastfeeding. However, you should not wait long after your baby has turned portion. It is wise to introduce foods one at six months to supplement breastfeeding a time as this can help identify food aller- with other food. Delaying solids may cause gies or intolerances. At the age of six eating problems and slow down its months, offer your baby puréed food at growth. several meals. If your breast milk is scant, you can Getting used to solid foods takes time, start introducing solids at the age of four so be patient. If your baby refuses a new months. To ensure breastfeeding, it is rec- food, try it again a few days later. There is ommended that you give puréed food in- no point in making haste when your child stead of bottle-feeding formula or baby ce- is slowly learning to eat and getting used real. If you are not breastfeeding, begin to new tastes and textures. supplementing formula with solid foods at Start by offering puréed potatoes, veg- the age of 4 to 6 months. etables, fruit or berries. You can make a large amount of purée at once and freeze Introducing new foods into your suitable portions in e.g. an ice cube tray. baby’s diet Meat, fish, poultry, eggs and baby cere- Try adding 1 to 2 new foods every week. als should not be introduced until your ba- Start by offering your baby small quantities by is five months old. When you start in- at first and then gradually increase the troducing solids at the age of six months,

80 Baby care Baby care 81 move from one food group to the next af- Vegetables and potato der 12 months Chinese cabbage, swede, Dairy products ter trying 1 or 2 different foodstuffs: after Mild in flavour, mashed potato is a good turnip, beetroot or spinach because they Towards the end of your baby’s first year, starting with two different vegetables, food to begin with. Introduce other vege- are rich in nitrates. you can start giving it dairy products. Start move on to meats or cereals. In this way tables into your baby’s diet gradually. Serve with cultured dairy products such as low- you can ensure a varied selection of foods vegetables boiled and puréed. Wash the Fruit and berries fat or non-fat curdled milk, natural yo- that meets your baby’s growing needs. potato/vegetable well and cook it in water. All fruit and berries are suitable. Serve ghurt or buttermilk. During meals, your When you return to fruit and vegetables, Do not add salt. Purée or mash the potato/ them puréed, grated or as a compote. Pre- child can drink skimmed milk. try something new! vegetable using a fork. Add boiled water or fer domestic berries. Wash and peel foreign When you are cooking, set aside a breast milk. fruit carefully before use. You can add a small portion for your baby before adding Cooked vegetables can gradually be moderate amount of sugar or fructose to GETTING USED TO SOLID FOODS spices (salt) and purée it if necessary. supplemented with finely grated raw veg- sweeten sharp or sour fruit and berries. TAKES TIME, SO BE PATIENT. When your baby begins teething, mash the etables and purées. Your baby will thus get However, take care that your baby does food more coarsely to promote chewing. used to a wide variety of vegetables. Suita- not get used to very sweet food. Honey Towards the end of its first year, your baby ble vegetables include carrots, cauliflower, should not be given to children under one can start eating the same food as the rest zucchini, sweet corn, sweet potato, cucum- year of age. Fats of the family. ber and tomatoes. Do not offer babies un- Rapid growth demands a lot of energy. Meat, fish, poultry and eggs Breast milk and formulas are rich in fat. From five months at the earliest, add a When the child starts eating the same small amount of finely chopped meat, food as the rest of the family, choose soft chicken or egg (one teaspoon) to the pota- vegetable fats. As the proportion of solid Age and food to or vegetable purée. Serve fish only 2 to 3 foods in the child’s diet increases and it times a week because of the oily fat it con- starts drinking skimmed milk, its fat in- 0-4 over 4 months over 6 months over 8 months over 10 months tains. For under one-year-olds, 1 to 1.5 ta- take decreases. Add a small amount of months blespoons of meat or fish per meal is suffi- cooking oil or soft vegetable fats (2 tea- cient. Liver is not recommended for under spoons per day) to your child’s porridge, Exclusive breastfeeding 6 months Continue breastfeeding until 12 months one-year-olds because of its high vitamin for example. A content. Depending on Solid foods Coarse mash Same as rest Salt and new foods: of the family or the baby new for everyone Baby cereal and porridge Do not add any salt to your baby’s food foods puréed: puréed - potatoes, coarse mash: Ideally, offer your baby full grain cereals during the first year. Avoid foods with a - potatoes - potatoes vegetables and - baby cereal, bread cooked in water without salt. Add puréed high salt content such as sausages, cold - vegetables - vegetables meat/fish - potatoes fruit or berries for taste. Next to home- cuts, marinated meat/poultry, ready-pre- - berries - berries - baby cereal - vegetables made porridge, you can give your baby in- pared foods and cheese as they also con- - fruit - fruit - berries and fruit - raw vegetables dustrial baby cereals. Breastfeed or bottle- tain high levels of additives and preserva- - meat or fish - fine grated raw grated feed your baby after a porridge meal. tives. over 5 months - baby cereal vegetables - berries and fruit From six months, part of the formula meat or - meat and fish baby cereal - dairy products can be replaced with industrial baby cere- Vitamin D and milk-based al. Industrial baby cereals are not recom- Children need supplemental vitamin D foods mended for children under five months in from two weeks until three years of age. In order to maintain breastfeeding. Finland, supplemental vitamin D is also Vitamin D supplement in all age groups, according to instructions .

82 Baby care Baby care 83 recommended for children over 3 years old Some babies sound wheezy, particu- without fever may be a sign of an ear in- during the dark months (October through larly after feeding, until they are about one fection or feverless pneumonia. March). Enquire about the dosage instruc- year old. This is due to their soft windpipe tions from your prenatal clinic or chem- cartilage. A baby may experience its first Fever ist’s. viral infection early on, if family members On average, under three-year-olds have 5 to 6 common colds or respiratory infec- Teething tions per year. Give your child antipyretics The first teeth (milk teeth) appear when VACCINATIONS PROTECT THE CHILD (drugs that reduce a fever), if he or she is the baby is about six months old. Children FROM INFECTIOUS DISEASES. running a fever and his or her food and will usually have all their 20 milk teeth by drink intake is inadequate, or the child is the time they are three years old. It is pos- restless, irritable or in pain, or if the tem- sible to keep the child’s teeth healthy and are suffering from colds or the baby is perature rise is significant (38.5°C to free of cavities, if looked after properly. Do born during an epidemic. Saline drops, 39°C). Paracetamol is available as a syrup not encourage the growth of bacteria nose drops, an elevated position and fre- and suppositories from the chemist’s, based on sugar. Start to brush your baby’s quent feedings will make the baby feel without a prescription. The usual dose of teeth as soon as they appear. You will re- better. See your doctor, if your baby is very paracetamol is 10 to 15mg per kg of body ceive advice on the need for fluoride from small or your firstborn, or if the symptoms weight every 6 to 8 hours (100 to 150 mg the prenatal clinic. u persist. if the baby weighs over 10 kg). If a baby Smoking should be avoided in fami- under two months old is running a fever, lies with children, as cigarette smoke irri- see your doctor even if the temperature tates the mucous membranes. drops with medication. Contact your doc- Cough Colds are frequently accompanied by a cough. When something irri- tates the throat, the baby When the baby is ill will try to remove it by coughing. Cough drops will help the baby sleep, but will not Common colds and stuffiness cure the symptom. of the nose Contact your Newborn babies breathe through their Stuffiness will pass with time, but doctor, if your ba- nose. If the nose is stuffy, feeding be- some children tend to get milk up their by has a barking comes problematic as it is difficult to nose while feeding. Accompanying stuff- cough accompa- suckle and breathe at the same time. In iness, yellow mucus can build up in the nied by shortness of maternity clinics, saline drops and some- corner of the eye and the eyelids may breath and a high fe- times a small pump to remove mucus are stick together as blocked tear ducts pre- ver, as you may need used to relieve stuffiness of the nose. Sa- vent normal flow. If stuffiness continues, respiratory medica- line drops may help feeding at home – af- contact your doctor as prolonged stuffi- tion. A cough following ter a good sneeze your baby’s nose will be ness may cause ear infections, even in ba- a common cold may last clear. bies. for weeks. A prolonged cough

84 Baby care Baby care 85 tor, if the temperature persists even after Contact your doctor or health nurse giving your baby the correct dosage of without delay, if your baby: Childhood vaccination programme antipyretic and it refuses to drink, or if its temperature is high for several days with- is under 2 months and Vaccine Age out a cough or cold. Hospitals and health u has a fever, u care centres provide advice over the is not feeding properly, DTaP-IPV-Hib I (diphtheria, tetanus, pertussis, 3 months phone, especially during epidemics. If u is sleepy or lethargic, polio, incl. some respiratory and your baby has feverish convulsions, ask u cries or is sensitive to being touched, ear infections) for instructions from your clinic’s nurse or u has trouble breathing or shortness 5 months doctor. of breath, or DTaP-IPV-Hib II u its urine starts smelling odd. 12 months Diarrhoea DTaP-IPV-Hib III (measles, mumps, rubella) 14-18 months Baby stools tend to be rather runny and You can also phone the maternity MMR I this should not be viewed as a symptom of unit for advice. DTaP-IPV (diphtheria, tetanus, pertussis, polio) 4 years diarrhoea. During respiratory infections, (measles, mumps, rubella) 6 years baby stools are often even less solid than runs a fever over 38.5ºC and MMR II normally. If your baby has diarrhoea, its u is irritable and is easily startled, stools will have a terrible smell and be u is sleepy and vacant, completely absorbed into the nappy. Diar- u has trouble breathing or shortness rhoea is more serious the younger the of breath, child is and the major concern in such u cries and cannot be soothed, Why are vaccinations necessary? cases is dehydration. When the child has u refuses drinks, Vaccinations protect the child from infec- stead, they have rare but severe secondary diarrhoea, it will lose a lot of fluids that u its skin seems bruised, tious diseases. Vaccines are given to protect diseases which cause disability, infertility will need to be replaced by giving extra u has a severe primary disease. the child against several dangerous diseas- and death. Vaccines contain extremely drinks, such as water, juice or a special es such as diphtheria, pertussis (also called small amounts of additives, such as mer- preparation obtainable from the chemist’s. Contact your doctor when your baby whooping cough), tetanus and polio. Im- cury and aluminium, compared to the Contact your doctor or health nurse with- is running a fever (over 38.5ºC) if: proved hygiene and nutrition have had a amounts received in food, for example. The out delay, if your baby is still very young or u your baby is 2 to 5 months old, considerable effect in preventing infectious benefits of immunisation far outweigh the if diarrhoea is accompanied by prolonged u its temperature is very high diseases, but vaccination has completely very small risk of side-effects. vomiting. (over 41ºC), eliminated these diseases from Finland. Vaccines are administered by the u the baby cries when urinating, Although these diseases are a thing of the health nurse in the child health clinic. In Exanthema subitum the urine smells very bad, past in Finland, some cases have been re- addition to vaccinations, protect your child Exanthema subitum is also called roseola, u a fever has lasted for over 24 hours ported in Sweden, the Baltic countries and from diseases by avoiding contact with ill baby measles and the three day fever. It is without any apparent reason, Russia. Further abroad, the risk of infection people. Alongside the vaccination pro- a very common infectious disease in chil- u the baby has had fever convulsions is even higher. If the proportion of vacci- gramme, your child may be vaccinated dren aged six months to 2 years. It is a vi- previously, or nated children decreases, the risk of infec- against chicken pox, hepatitis A or B and ral disease characterised by an abrupt high u it has a fever for three days and then tion will also rise in Finland. tick-borne encephalitis, if considered nec- fever lasting three days. As the fever sub- begins running a temperature again. Vaccinations are voluntary. Some par- essary. sides, small spots appear on the baby’s ents wonder whether vaccinations are nec- For more information on vaccines, skin. The rash disappears in roughly 1.5 Reduce the fever by giving your child essary and may be suspicious about the contact your child health clinic’s nurse or days. Ear infections may occur as a sec- antipyretics (paracetamol) and using components they contain. Pox diseases do the National Public Health Institute at ondary illness. damp wraps before seeing the doctor. not contribute to the child’s health. In- www.ktl.fi. u

86 Baby care Baby care 87 Organising childcare

Parents need to make decisions on child- sense of security is based on the presence is ill, location, environment etc. Finding spite problems in the beginning. For day- care arrangements during the first year. of the primary carer (usually mother or well-functioning, reliable day-care is es- care to succeed, parents need to update Many families decide to care for the baby father). When separated from him or her, sential for the well-being of all family their information every day. Talk with the at home for as long as possible. Some- the child becomes distressed. For chil- members. day-care personnel to find out how your times, the mother may have agreed with dren, separation causes stress and pro- But even when the parents have done baby’s day went and what he or she has her employer on a date upon which she longed stress may impede healthy devel- their best to find an optimal solution, been up to. will return to work. In some families, the opment. A stressed child is tearful, clings something unexpected may come along In addition to preparing the child for father stays at home to care for the chil- to its parents and has difficulties adapting day-care, parents need to prepare them- dren while the mother returns to work. to day-care or accepting the new carer. selves as well. Childcare arrangements are important to The risk of such problems diminishes EACH FAMILY NEEDS THE SOLUTION Work on your ”separation anxiety” the parents and the child. Each family drastically over just a couple of months. THAT IS BEST FOR THEM. and observe your reactions and emotions needs to find the solution that best suits The child’s cognitive development when someone else is caring for your ba- their needs; no single alternative is opti- and other skills speak highly in favour of by while you are away. Placing your child mal for everyone. waiting until the child is at least one year causing a change of plan. The family needs in childcare outside the home will create old before entering day-care. However, to move, for example, or your family day- mixed feelings, and the new situation Considering day-care this is not always possible. In some fami- care provider retires, is taken ill or moves may be distressing for the parents as well. When considering day-care, parents lies, placing the child in day-care very away, there are personnel changes in the Discuss your feelings with the day-care should take their child’s developmental early is the best solution. In addition to day-care centre, or your child for one rea- personnel. u stage into account. Once the child has family finances, parental exhaustion is a son or another does not seem to adjust to reached its first birthday, many skills start very sound reason for placing the child in day-care. In such cases you will need to to develop fast. It will learn to walk, talk day-care. reassess the situation. (some words at least), eat and drink. Some children will even begin dressing Finding the right alternative Adjusting to the new situation themselves. Being in day-care is very dif- Choosing the proper day-care solution for There is great variation in how children ferent for a one-year-old than for a baby your child should be a carefully thought react to day-care, the new carers, and which still needs continuous care and as- out and researched process. Ask for infor- changes in general, which makes prepar- sistance. At the age of one, children usu- mation on day-care options available in ing for possible problems in advance dif- ally become more interested in other chil- your neighbourhood from your child ficult. Do not expect your child to adjust dren. Although one-year-olds tend to health clinic, municipal officers responsi- immediately; it is likely that problems will play by themselves and rarely engage in ble for day-care in the area, private day- occur but they usually pass with time. joint activity, they do notice and enjoy the care organisations and directly from day- Most children go through periods when presence of other children. care centres and other day-care providers. they are reluctant to go to day-care. How- When maternal and parental leave Consider in advance the things that are ever, if the problem persists find out why ends, the child is about nine months old. important to you, your family and the your child is distressed and what it is that This is a particularly challenging time to child, i.e. group size, the ages of the other frightens or perturbs it. On the other begin day-care as at this age children are children in care, the carers’ education and hand, young children are masters at ad- very selective in their affection. A child’s attitude, backup resources when the carer justing and will find the positive sides de-

88 Baby care Baby care 89 discharged from hospital earlier, many is- sues that used to be solved in the postnatal Services for families with children ward are now the responsibility of child health clinics. Supporting breastfeeding and ensuring adequate milk production, Prenatal and child health clinics monitoring skin colour (yellow tint) and Prenatal and child health clinics operate in 16 times before school-age. Families with possible infection or cardiac symptoms, and connection with health care centres. They under one-year-olds visit the clinic at least addressing tearfulness caused by hormonal offer regional health and social services 10 times. After the child has turned one, the changes, are among these new responsibil- which are voluntary and free of charge. family is invited to visit the clinic when the ities. Clinics are usually located around the city child is aged 18 months and then once a Groups for parents, mothers and fa- or municipality. Finnish prenatal and child year (usually around the child’s birthday). thers meet in most child health clinics. health clinics comprise a reliable system; Child health clinic nurses are responsi- Some clinics organise joint meetings with nearly all expectant parents and families ble for monitoring the growth and healthy more than one family, providing families with children use their services. Clinics’ development of your child. During an ap- with the opportunity to meet other parents personnel are obliged to keep their clients’ pointment, the child’s height, weight and in addition to seeing the nurse and doctor. details confidential. According to the head circumference are measured. Its health care confidentiality code, no infor- hearing and sight are controlled and psy- Social services centre mation can be forwarded to another health cho-social development supported and Families with children needing financial care unit or professional without the prior observed. Furthermore, the clinic nurse is support or home-help services (household permission of the mother or father. an invaluable source of information re- clude screening for diseases and abnormal chores, child care or help with upbringing) Child health clinics promote the garding the child’s developmental stage, development, and interpreting the devel- should contact the social services or fami- health and well-being of children and their and topics covered during visits usually in- opmental disturbances usually first detect- ly support centre without delay for long- families with the objective of reducing the clude nutrition and adherence to a healthy ed by the clinic nurse. term help or support over a shorter period health differences between families. Child diet, exercise and activities etc. Speech de- Other professionals working at the of time. Services include house calls and health clinics monitor the physical, social velopment is monitored during every visit. child health clinic include family workers, trained support persons for the family or and cognitive development of children un- Breastfeeding advice and guidance is pro- psychologists, logopaedists, physiothera- child. Discuss problems related to financ- der school age. The clinics also aim to sup- vided as long as required. The clinic’s nurse pists, nutritional experts and dental care es, housing or other family issues with a port parents in implementing safe, child- will also vaccinate your child according to professionals. In addition to this wide array social worker in order to identify viable centred upbringing strategies and caring the current Finnish vaccination programme of professionals, child health clinics also solutions. for their children and their mutual rela- and perform any screening tests required. work in close co-operation with other in- Family workers are municipal social tionship. Attention is increasingly paid to Clinic nurses offer their professional stances involved in family care such as mu- welfare professionals who may be availa- the early detection of possible problems expertise to parents, co-operating with the nicipal home-help services, child welfare, ble for support when the person normally and arranging the appropriate help for families in full confidentiality. Together with day-care and pre-schools, child guidance responsible for the family’s finances has families with children. the family, clinic nurses assess the family’s and family counselling centres, schools and fallen ill, or is injured or suffers from ex- The point of contact is your clinic’s need for further examinations or support. specialised health care. haustion. Support is provided on the nurse, who is a professional in promoting In addition to clinic nurses, child health The clinic nurse makes at least one grounds of a social risk, such as birth, lack health and family care. Clinic nurses are fa- clinic doctors are the only professionals house call when the baby is born (house of rest or some other difficult episode in miliar with the people and families living in that meet every family and their children calls are also recommended prior to birth), life. Home-help services and child care are the area. According to the national strategy within their operating area. Clinic doctors but may visit at other times as well if this subject to fees, based on the family’s finan- and based on the individual needs of fami- participate in monitoring the child’s health seems necessary or when the family so cial standing. These services are free of lies, clinic nurses meet with families at least and development. Their responsibilities in- wishes. Since mothers and newborns are charge for poor and low-income families.

90 Services for families with children Services for families with children 91 Family work by home-help services health sector. If the services provided are (Ensi- ja turvakotien liitto), tel. 09 - 4542 aims to address family problems at an ear- not adequate, they may be complemented ALL CHILDREN UNDER THE AGE OF THREE 440, or visit www.ensijaturvakotienliitto.fi. ly stage and also to offer preventive sup- with special services. For more information ARE ENTITLED TO MUNICIPAL DAY-CARE. port services. on services and benefits available for fam- Mother and child shelters ilies with disabled children, contact your Mother and child shelters help adults and Municipal day-care municipal social workers or rehabilitation family should visit the child guidance and children who have experienced domestic Municipal day-care supports and comple- counsellors. For contact details, refer to the family counselling centre, since the prob- violence or the threat of violence. Mother ments child rearing at home and is availa- municipal guidebook of your place of resi- lems of one family member tend to have and child shelters accept single adults and ble for all families with children. Day-care dence, white pages or the Internet. an impact on the whole family. parents with children, and are open applications are submitted to the social In addition to municipal services, an The centre’s psychologist, social work- around-the-clock. A phone call in advance services centre responsible for organising array of organisations and parents’ associ- er and doctor will schedule meetings and is recommended, but not necessary. Shel- the municipal day-care services. Charges ations provide services for disabled chil- appointments for examinations for the ters and their helplines are available for day-care are based on the family’s in- dren and their families. Associations or- family together or for each family member around the clock. come, family size and daily day-care hours. ganise adaptation training and various individually. Services provided at child You can stay at the shelter from a few The highest fee is €200 per month. The forms of educational and recreational ac- guidance and family counselling centres days to two months. During this time, par- family may be exempt from payment on tivities. For detailed information, please are confidential and free of charge. For ents are supported by authorities across certain grounds. contact the Central Union for Child Wel- more information, please contact the Finn- several sectors, in identifying solutions to All children under the age of three are fare (Lastensuojelun keskusliitto), tel. 09 - ish Association for Child and Family Guid- their problems. ”Out-patient” support is al- entitled to municipal day-care. Day-care is 329 6011 or visit www.lskl.fi, or contact ance, tel. 09 - 272 7470, or visit www. so provided, and receiving support does organised in various forms including day- YTRY, the union’s umbrella organisation suomenkasper.fi. not thereby necessitate staying at the shel- care centres, family day-care, group family for disabled and chronically ill children’s ter. Shelters are maintained by municipali- day-care and supervised playgrounds. Day- parents’ associations, or FAIDD (the Finn- Mother and child homes ties and member organisations of the Fed- care centres offer full and part-time care for ish Association on Intellectual and Devel- Mother and child homes provide support eration of Mother and Child Homes and children aged 0 to 6 years and supervised opmental Disabilities), tel. 09 - 348 090 or in parenting and life management. Moth- Shelters. For more information, please con- afternoons for school-aged children. Some visit at www.kehitysvammaliitto.fi. ers are welcome during pregnancy or tact your municipal social service or family day-care centres provide late night and when the baby is born. If necessary, fathers support centre. For online mother and child overnight childcare services or special needs Child guidance and family may sometimes be accommodated as well. shelters, please visit www.turvakoti.net. day-care for children with disabilities. counselling centres In mother and child homes, parents can Child guidance and family counselling practice baby care and daily routines in a Family guidance centres of Services for chronically ill or centres promote the favourable develop- supervised environment. A care plan is the Church of Finland disabled children ment of children and families. Children, drafted in co-operation with municipal The church’s family guidance centres wel- Municipalities are obliged by law to arrange teens and their families receive support child welfare according to the family’s come everyone needing help in problems services for intellectually disabled children and advice on issues relating to child rear- needs. relating to family and relationships. The whose development has been disturbed ing, development and relationships be- Mother and child homes also provide focus is on family relationships and opera- due to a congenital illness, defect or injury, tween family members. Reasons for con- around-the-clock advice on child care is- tional methods include individual discus- or one which has been detected during tacting a child guidance and family coun- sues, such as breastfeeding and caring for sion therapy as well as couples and family childhood. Support services are arranged selling centre include conflicts between a crying baby. Some mother and child therapy. Help is free of charge and offered for children with hearing, sight or motoric family members, children’s fears, inability homes specialise in problems related to to members and non-members of the disability, as laid down in the Act on Servic- to adjust, shyness and problems at school. substance abuse. Their operational area in- Church. Personnel are obliged to keep es and Assistance for the Disabled The sooner such problems are addressed, cludes all of Finland. For more informa- their clients’ details confidential. Children with a disability or injury re- the easier it is to find a satisfactory solu- tion, please contact the Federation of For contact details, please visit www. ceive services via the social services and tion. When there is a problem, the whole Mother and Child Homes and Shelters evl.fi/kkh/to/kpk/pankyhte.htm.u

92 Services for families with children Services for families with children 93 Organisations

Federation of Mother and Child Homes and Shelters The Federation of Mother and Child ports and protects breastfeeding and posi- motes the wellbeing of children and of alternative to intimate partner violence Homes and Shelters (Ensi- ja turvakotien tive attitudes towards breastfeeding. The families with children, increases respect for (”Lyömätön Linja”). If you need help, call liitto) is a national child welfare organisa- association organises breastfeeding cours- childhood and seeks to make this issue tel. 09 - 6126 6212 or email lyomaton. tion aiming to secure a child’s right to fa- es for support mums and those responsi- more prominent, and ensures that chil- [email protected]. vourable living conditions and safe devel- ble for the local support groups, distributes dren’s views are taken into account in pub- opment, support parenting and families, up-to-date information on breastfeeding lic decision-making. Visit MLL’s Web pag- Multicultural Women’s Association and prevent domestic violence. The Feder- and breast milk, assists mothers in organ- es at www.mll.fi for information on the Monika-Naiset liitto ry. is a multicultural ation provides assistance to parents in var- ising local peer support groups, and pub- growth and development of children and women’s association promoting equality, ious problem situations. Further activities lishes a newsletter on breastfeeding issues. parenting. There you will also find a guide human rights, multiculturalism and the include ”out-patient” support and devel- For support and more information on to prenatal and child health clinics intend- empowerment of women. Its objectives in- opment projects such as baby blues and breastfeeding, visit www.imetys.fi, or call ed for immigrants. clude promoting the status of immigrant the baby sleep solution. For more informa- the national Breastfeeding Support Line, MLL has 566 local associations women in Finland, offering and develop- tion, please visit www.ensijaturvakotienli- tel. 041 - 5285 582. Support groups where throughout the country providing short- ing services for immigrant women and itto.fi or call tel. 09 - 4542 440. mothers assist each other are organised term child care services when, for example, children who have experienced intimate Also visit Miesten kriisikeskus (Men in nationwide (for details, please visit www. the child is ill or the parents need a break partner violence, preventing social exclu- Crisis) at www.miestenkriisikeskus.net, or imetystukilista.net). to devote time to hobbies or spend some sion among immigrant women and pro- call tel. 09 - 6129 370. time together. moting the integration of immigrant wom- Special-interest Group of The parent helpline Vanhempainpuhe- en into Finnish society. Folkhälsan Families with Children lin (tel. 0600 - 12277) and interactive on- Services, legal advice and sheltered ac- Folkhälsan is an organisation in the social The special-interest group of families with line help Vanhempainnetti (www.mll.fi) commodation are available in several lan- welfare and health care sector that carries children (Lapsiperheiden etujärjestö) aims provide guidance and support for parents. guages. For clients, these services are free out scientific research and provides social to act as a direct channel in influencing de- Another parent who has volunteered and of charge. Contact Monika-Naiset liitto by welfare and health care services as well as cision-makers. The special-interest group is trained for the task will answer the phone, tel. 09 - 6943 485, email info@ information and counselling in order to can be joined via an online mailing list at phone or reply to your mail. Contacts are monikanaiset.fi, or visit www.monika- promote health and quality of life. Folkhäl- www.lapsiperheet.net. In some locations, confidential and anonymous. The parent naiset.fi. san provides child welfare and child day- members have formed action groups or- helpline is available on Mondays at 5 pm care services, mainly in the Swedish speak- ganising outings and special events for to 8 pm, on Tuesdays and Thursdays at 10 National Women’s Line in Finland ing regions of Finland, and organises baby families with children, and made proposals am to 1 pm and 5 pm to 8 pm. The National Women’s Line in Finland swimming in several locations. For more to develop local services and benefits. (Naisten Linja) (www.naistenlinja.com) is information, please contact Folkhälsans Men’s Association a national freephone helpline (tel. 0800 Förbund, tel. 09 - 315 000. The Mannerheim League The Miessakit Association provides peer 02400) providing information and advice for Child Welfare support for men in crisis and problem sit- for girls and women affected by violence or The Breastfeeding Support The Mannerheim League for Child Welfare uations. Visit their Web pages at www. the threat of violence. Groups intended for Association in Finland (Mannerheimin Lastensuojeluliitto, MLL) miessakit.fi, or call tel. 09 - 6126 620. The women and girls meet in the facilities of The Breastfeeding Support Association in is a non-governmental organisation and activities of the Miessakit Association in- the National Council of Women, in Helsin- Finland (Imetyksen tuki) promotes, sup- membership is open to everyone. It pro- clude providing help for men in finding an ki (address Mannerheimintie 40 A 17).

94 Services for families with children Services for families with children 95 Save the Children Finland Sexual Health Clinic and is based on volunteer work. Mothers and needs to give his consent. Counselling appointments tel. 09 - 6162 2267, Save the Children Finland (www.pela.fi) is who have suffered and recovered from is provided free of charge to the parents. helpline tel. 09 - 644 066 a non-profit, non-governmental Finnish postnatal depression form a peer group organisation which fights for children’s Medical Genetics Clinic supporting mothers with PND and their Miscarriage rights and aims to improve children’s lives. tel. 09 - 6162 2246, friends and family. ÄIMÄ offers an addi- Miscarriage or spontaneous abortion is the Activities include volunteer work; chil- email [email protected] tional service that complements profes- spontaneous end of a pregnancy prior to dren’s holiday housing, support families, sional aid. 22 weeks. In addition to early stage mis- foster care and group homes in several lo- The Single Parents’ Association For more information on postnatal de- carriages (when the mother doesn’t even cations, domestic and international adop- The single parents’ association Yksin- ja pression, please visit the association’s know she has been pregnant), every tenth tions, sponsor activities, children emer- yhteishuoltajien liitto provides information website at www.aima.fi. In addition to peer pregnancy ends spontaneously in a mis- gency help, and local and regional devel- and useful tips for pregnant single mums support, the association organises meet- carriage. Most miscarriages occur prior to opment projects. and parents facing a divorce, via the asso- ings and training sessions and publishes 12 weeks. ciation’s Web pages at www.yyl.fi. Advice its own magazine. Helpline 040-7467 424, Miscarriage usually begins with bleed- The Family Federation of Finland and support is also available by phone. email [email protected]. ing accompanied by pain in the lower ab- (Väestöliitto) is an organisation in the so- Southern Finland tel. 09 - 8777 884, East- domen and lower back. In most cases, the cial welfare and health care sector provid- ern Finland tel. 017 - 2622 644, Northern cause of the miscarriage cannot be deter- ing versatile services for families. Visit the Finland tel. 08 - 334 912. mined. Sometimes the foetus never began Väestöliitto at www.vaestoliitto.fi. The Single Parents’ Association aims to developing (this is called empty sac), while Central Office improve the quality of life of single parent in other instances the miscarriage may have is located in Helsinki, tel. 09 - 228 050 families. The association comprises about been caused by a severe developmental dis- 50 local associations, clubs and meeting order. The mother’s age, chronic diseases Child Care Special situations – short-term child care, tel. 09 - 6126 130 places. Member families organise free- and structural weaknesses of the uterus in- form activities for single parents, meeting crease the risk of miscarriage. Also, some

Family Network parents, biological parents, widows and Giving your baby up for adoption external factors (e.g. strong medications, ra- − services for families with young widowers. If you decide to give your baby up for diation, solvents) may increase the risk. children, tel. 09 - 6127 102, Member associations organise divorce A miscarriage is confirmed by an ultra- email [email protected] adoption, you will receive counselling pro- seminars for adults and children, meeting vided either by the Save the Children or- sound scan performed in a hospital. After a

A Functioning Couple Relationship places for single parents, field trips, theatre ganisation (for more information, please miscarriage, a D&C (dilatation and curet- – relationship support and advice, visits, supported holidays, training, shared visit www.pela.fi) or your local Social Wel- tage) or evacuation is carried out to reduce tel. 010 - 3093 900 mother’s/father’s days, Christmas parties fare office. If necessary, the baby will be the chance of infection and to ensure that Family Clinic etc. One in every two associations organis- placed in a children’s home or a private you do not continue bleeding. If you expe- – expertise counselling (psychologist) for es peer support, meetings for the divorced, child care home. It is possible to transfer rience heavy bleeding or if your tempera- families, appointments tel. 050 - 4403 977 child care networks and supervised kid’s the baby directly from the hospital, which ture rises after having a miscarriage, con- Kotipuu corners. will give the mother time to consider her tact the hospital as soon as possible. – multicultural family work, tel. 09 - decision. Miscarriage is a devastating experience 2280 525, email [email protected] ÄIMÄ - the Association for Mothers If the mother decides to give her baby and stirs up an array of emotions ranging Men’s Moment Suffering from Depression up for adoption, formal consent to adop- from sadness and guilt to anger and de- – service for men, The ÄIMÄ Association offers support to tion cannot take place until at least eight pression. Sometimes it may be advisable to email [email protected] mothers suffering from postnatal depres- weeks after the baby is born. If paternity go over the experience with a trained pro- sion and to their friends and family. ÄIMÄ has been confirmed or the baby is born to fessional or with someone else who has al- Open-Door Youth Service – services for young people free of charge, is a member organisation of the Federation parents who are married to one another, so had a miscarriage (visit www.enkelisi- tel. 09- 6162 2267 of Mother and Child Homes and Shelters the father is also entitled to counselling vut.net). Ask your nurse if there is a mis-

96 Services for families with children Services for families with children 97 carriage support group in your neighbour- drome (SIDS). KÄPY ry, the Association for hood. Väestöliitto, the Family Federation of SIDS and child death families in Finland, Finland, has a support group within its fer- was established to support families who Social protection for tility clinic in Helsinki for couples who have lost their child. Visit KÄPY ry. at www. have lost one or more babies to miscar- kapy.fi. The association’s helpline (0800- riage (for more information, please visit 95959) is available on Mondays and Thurs- families with children www.vaestoliitto.fi). days from 8:30 am to 11:30 am. KÄPY ry. publishes material intended (Dated 1 January 2008) The death of a child for families who have lost a child and for The death of a child must be one of the the people supporting those families. Ac- most painful experiences in life. It can hap- tivities include providing trained peer sup- Up-to-date information on benefits for Information on family benefits can al- pen quite unexpectedly or you may have port (individuals or families) for parents families with children is provided by the so be found online at www.kela.fi/asiointi. some time to prepare. The sudden and un- who have lost their child. The association local offices of the Social Insurance Institu- You can log in using net bank user IDs explained death of an apparently healthy also organises regional get-togethers and tion of Finland (KELA) and the municipal provided by Finnish banks, but please note infant is called sudden infant death syn- family weekends. u social services department. The informa- that the service is only available in Finnish tion presented herein was correct on 1 Jan- and Swedish. The online service also pro- uary 2008. vides the chance to monitor the applica- For further information, please see tion’s progress and the related fees. Families with children at www.kela.fi. For details on parental leave and parental al- Maternity grant in goods or cash lowance periods and employment, please The maternity grant is intended to be used visit www.mol.fi and www.tyosuojelu.fi, for the baby. You can choose between a cash respectively. benefit (EUR 140) and a maternity package BENEFITS APPLIED FOR THROUGH KELA ToDo list during pregnancy: Make an appointment with your doctor or the prenatal clinic before Pregnancy diagnosed the end of the fourth month of pregnancy . Is your work dangerous? Grounds for special maternity allowance? Pregnancy certificate for maternity allowance, maternity Pregnancy has lasted 154 days grant and family allowance 2 months in advance Notify your employer (if the intended leave is no more than 12 days, 1 month in advance is sufficient) At least 2 months before Apply for maternity allowance, maternity grant and family the estimated date of delive allowance from kela 50 to 31 weekdays before the estimated date of delivery Early maternity allowance period 30 weekdays before the estimated date of delivery Maternity allowance period

98 Services for families with children Social protection for families with children 99 containing clothes and child care items. child’s country of origin (Estonia EUR titled to take leave from work for this peri- Mothers who have undergone a medical 1,900; China and Columbia EUR 4,500; od. Maternity leave can begin a maximum examination through a doctor’s appoint- other countries EUR 3,000). In internation- of 50 weekdays and no later than 30 week- ment or have visited the antenatal clinic al adoptions, the permission of the Council days before the estimated date of delivery. before the end of the fourth month of on International Adoption (lapseksiot- pregnancy are entitled to a maternity tamisasioiden lautakunta) is required. Special maternity allowance grant. If a pregnant woman needs to be absent In cases of multiple birth (twins, tri- Family allowance from work, because her duties or working plets, quadruplets...), the number of ma- Family allowance (lapsilisä) is sometimes conditions present a danger to her own or ternity grants increases. This increase also also called ”Child allowance” or ”Child to the baby’s health and if suitable alterna- applies to families which adopt several Benefit”. It is paid for children under 17 tive work cannot be found nor the risk fac- children at the same time. You can choose years of age who are living in Finland. tors eliminated, she may be entitled to a to receive cash, packages or a combination Family allowance is paid once a month in- special maternity allowance (erityisäitiys- of both. to the bank account of the child’s legal raha) paid until the maternity allowance Adoptive parents are also entitled to a guardian. Payments begin in the month period begins. The special maternity allow- maternity grant. Furthermore, parents following birth and continue until the end ance can be backdated by up to 4 months. leave (äitiysvapaa) during the period that adopting a child from abroad can claim an of the month in which the child reaches If the expectant mother is employed, she is they receive maternity allowance. adoption grant (adoptiotuki) from KELA. the age of 17. Family allowance is untaxed entitled to take leave from work for the pe- This adoption grant is a tax-free, one-time and the amount per child increases with riod during which she received a special Parental allowance payment. Its amount depends on the each child: maternity allowance. Parents are entitled to 158 weekdays of pa- The first maternity allowance instal- rental allowance (vanhempainraha) and ment is paid for a 30-day period and sub- parental leave (vanhempainvapaa) after Child First Second Third Fourth Fifth sequent instalments after each 25-day pe- the maternity allowance period and ma- EUR/month 100,00 110,50 131,00 151,50 172,00 riod. Employees are entitled to maternity ternity leave have ended.

Single parents receive an increase of EUR 46.60 for each child. Applications for family allowance and raised family allowance should Maternity, paternity and parental allowance payments be submitted to the Social Insurance Institution’s (KELA) local office. Father’s month = the last 12 weekdays of parental Maternity allowance Parental allowance leave + 1 to 12 weekdays Maternity allowance 105 weekdays 158 weekdays Expectant mothers are entitled to mater- (EDD), and is entitled to receive Finnish nity allowance (äitiysraha) when the preg- benefits. nancy has lasted 154 days and providing Apply for maternity allowance at least that the mother has been resident either two months before the estimated date of in Finland or in another member state of delivery, from your local KELA office or Paternity allowance Extended parental allowance perio 18 weekdays in total + 60 weekdays for each the European Economic Area (EEA) or the employer’s benefit fund (työpaikkakassa). EDD during maternity and additional child European Union (EU) for 180 days pre- Maternity allowance is paid for 105 week- parental allowance periods ceding the estimated date of delivery days. If the mother is employed, she is en-

100 Social protection for families with children Social protection for families with children 101 For the parents of twins, the parental allowance to begin. The father’s month work is made with the employer, for a If the parents wish to combine the last allowance period is extended by 60 week- (isäkuukausi) is exceptional in that appli- minimum period of two months. 12 days of parental allowance with a sub- days, and for the parents of triplets by 120 cations must be submitted 2 months be- sequent father’s month, they must notify weekdays. It is possible for the father to fore the desired start date. Employees Benefits for fathers KELA of this at least 2 months before the take these extra days at the same time as must inform their employers about the Fathers participating in the care of the end of the parental allowance period. the mother is on maternity or parental planned leave of absence at least 2 months child are entitled to paternity allowance Paternity allowance is paid retrospec- leave. in advance. (isyysraha) and parental allowance (van- tively for one or more periods, as request- Adoptive parents receive parental al- Parental allowance is paid retrospec- hempainraha). These allowances can be ed. The application period lasts for 2 lowance for at least 200 weekdays for an tively for 25 weekdays at a time. Payments paid to the father if he is married to the months after the parental allowance peri- adopted child under 7 years of age when begin only after the mother has undergone child’s mother and they are not separat- od has ended. For a father’s month that the adoptive parent leaves his or her work a post-natal medical examination within 5 ed. They can also be paid to a spouse co- has been flexibly moved, paternity and pa- to take care of the child. Adoptive parents to 12 weeks after childbirth and has pre- habiting with the mother. rental allowances must be applied for 2 must apply for parental allowance within 2 sented a certificate to this effect from a Adoptive parents can apply for pa- months in advance from your local KELA months of receiving the child. Parents liv- doctor or nurse. rental and paternity allowances from the office or employer’s benefit fund. Fathers ing in a registered partnership (rekisteröi- Social Insurance Institution KELA. Adop- must inform their employers about pater- ty parisuhde) must decide on how to di- Partial parental allowance tive fathers have the same rights regard- nity leave at least 2 months in advance. If vide the parental allowance period among Partial parental allowance (osittainen van- ing paternity allowance and the father’s the period is no more than 12 days, em- themselves, when a child is born or adopt- hempainraha) is half of the full allowance. month as other fathers. ployers must be informed 1 month in ad- ed after the partnership has been regis- The amount is calculated separately for Fathers are entitled to paternity al- vance. tered. each parent. Partial parental allowance is lowance for a total of up to 18 weekdays The parents must decide whether pa- paid for a maximum of 158 weekdays for in up to 4 segments during the maternity Maternity, paternity and parental rental allowance is paid to the mother or the birth of one child. It is possible for the allowance or mother’s parental allowance allowances are subject to tax father taking leave from work to care for parents to share responsibility for taking period. Fathers are entitled to paternity Maternity, paternity and parental allow- the baby. If both parents take parental care of the baby by agreeing part-time leave during the time they receive pater- ances are subject to tax, which is usually leave and apply for parental allowance, working arrangements with their employ- nity allowance. withheld by KELA. As a rule, the amount they both receive a raised allowance pay- ers for the same period of time and taking of the allowance is calculated based on the ment for up to 30 weekdays (60 weekdays turns in caring for the child. Work is con- Father’s month earned income confirmed in the tax re- in total). sidered part-time work when the total Paternity leave now provides more possi- turn. To calculate an estimate, please visit Apply for parental allowance no later working hours and salary are reduced by bilities due to additional flexibility in the www.kela.fi/laskennat where you can than 1 month before the date you wish the 40% to 60%. The agreement on part-time dates of the father’s month (isäkuukausi), find online calculation tools. Please note provided that either the father or mother that, so far, these tools are available only cares for the baby at home during the in- in Finnish. Fathers month termittent period. The amount of maternity allowance is Fathers can use the last 12 or more raised during the first 56 days (over 9 Timing chosen by family days at the end of the parental allowance weeks). Normal maternity allowance is period instead of the mother, and com- paid for the subsequent 49 days. However, Maternity Parental bine them with an extension of 1 to 12 the increase is only added to allowances allowance Parental allowance Home care allowance Bonus weekdays. This father’s month must be based on confirmed income. The paternity 105 days 158-12=146 days allowance 12 days 12 days taken within 180 days of the last day of allowance paid for the father’s month can the parental allowance period immedi- be raised if the father did not use up all of ately following the maternity allowance the 30 days during the parental allowance Mother Mother or father Mother or father Father period. period.

102 Social protection for families with children Social protection for families with children 103 The maternity, paternity and parental the requirements of a normal child of the allowances are paid to the employer if the same age, for a period of over 6 months. Supplement criteria (EURO/month) employee receives normal wages during his or her maternity/paternity and parental Child care leave and reduced Family members Income limit Decrease Income exceeding Income exceeding leave. Should the allowance be greater working hours (number) for full persentage the limit for chil home care the limit for private than his or her salary, the difference be- After the parental allowance period has amount allowance supplement day care supplement longs to the employee. ended, parents can take child care leave If the mother is at work during her (hoitovapaa) with full employment securi- 2 1 160 EURO/month 11,5 2 622,48 EURO/month 2 329,96 EURO/month maternity or parental allowance period, ty to look after a child under 3 years old. her allowance is EUR 15.20 per day during Both parents cannot be on full-time leave 3 1 430 EURO/month 9,4 3 219,21 EURO/month 2 861,33 EURO/monthk working days. If the father is on paternity at the same time. The minimum length of 4 or more 1 700 EURO/month 7,9 3 828,93 EURO/month 3 403,11 EURO/month leave during his military or civilian service, his allowance is EUR 15.20 per weekday. Care benefits for young children If the family’s income exceeds the limit entitling to a full supplement, the full amount of the supplement is reduced by the cited percentage calculated based on the part exceeding the limit . Only 2 parents and 2 An ill or disabled child children under school age are included in the calculations . Should your child be ill, you can apply for Child home care allowance compensation from KELA. Benefits to se- One family member must be a child under 3 years The private day care allowance and an earnings-related supplement cure the family’s income include special are paid for each eligible child. care allowance (erityishoitoraha) and child Basic allowance EURO/month home care allowance (lapsen kotihoidon- - for one child under 3 years 294.28 tuki). For more information, please visit - for each subsequent child child care leave is 1 month. Parents must care at the same time. They may, for exam- the ”Sickness and disability” section at under 3 years old 84.09 inform their employers of the intended ple, share the responsibility so that one www.kela.fi. Disabled children and chil- under school age 50.46 child care leave and its duration a mini- parent looks after the child in the morning dren suffering from a severe illness may be mum of 2 months before it begins. Em- and the other in the afternoon. Parents entitled to rehabilitation. Detailed infor- Supplement (income dependent) ployers are not required to compensate may also agree on caring for the child on mation has been published in Finnish in - paid for one child only, max. 168.19 employees who are on child care leave. alternate days or weeks. the brochure Kuntoutukseen. Credits for paid annual leave do not accrue Request partial child care leave from Parents are not required to care for the child themselves. Special care allowance (erityishoito- during child care leave. your employer no later than 2 months be- raha) can be paid to the parents of under Parents are entitled to an unpaid re- fore starting to work reduced hours. For 16-year-old children resident in Finland Private day care allowance duction in working hours (also called part- more information on reduced working who, on account of participating in the One family member must be a child under school age time or partial child care leave (osittainen hours and partial child care leave, please treatment of the child, can not carry out hoitovapaa) up to the end of the second contact your occupational health and safe- their regular work and are not paid during Basic allowance EURO/month school year (third school year when the ty inspector (työsuojelutarkastaja). the leave of absence. Special care allow- - for each child child is in the extended compulsory educa- ance is paid for care given at home only in under school age 137.33 tion system). The related arrangements are Child home care allowance and private day care allowance the case of a severe illness. agreed between the parent and the em- Disability allowance (vammaistuki) Supplement ployer. In practice, reduced working hours After the parental allowance period ends, for persons under the age of 16 is paid to - for each child under often translate into 6 hours per day or 30 parents can choose between municipal day children aged 16 or under and living in school age, max. 134.55 hours per week. care, home care allowance (lasten koti- Finland, whose disability or illness requires Both parents can be on partial child hoidon tuki) if the child is under 3 years The benefit is paid to a private child care provider care, attention and rehabilitation causing designated by the parents. care leave during the same calendar peri- old, and private day care allowance (yk- the family stress and limitations exceeding od, but they may not both provide child sityisen hoidon tuki) if day care for chil-

104 Social protection for families with children Social protection for families with children 105 dren under school age is provided by a pri- Students subsidies are available to all those who If either of the parents is performing vate child care provider approved by the Full-time study is considered full-time em- have a low income, provided that interest is military or civilian service, the family may local authorities. ployment. When the parent is a student, he not being capitalised for market-rated stu- apply for conscript’s allowance (sotilasa- The adoptive parents of a child over 3 or she can receive both the study grant dent loans or provided that the claimant vustus) for housing and living costs from years old may receive child home care al- (opintoraha) as specified in the Act on Stu- has not received financial aid during the KELA. For more information, please visit lowance until 2 years have passed from the dent Financial Aid, and maternity and pa- five months preceding the due month for www.kela.fi. date on which parental allowance was first rental allowance of EUR 15.20 per week- interest-subsidised loans. For more infor- A parent receiving unemployment paid. However, this right ends when the day. If the parent decides not to draw his or mation on eligibility criteria and applica- benefit is entitled to a child supplement child begins school. her study grant, parental allowance can be tion instructions, please visit KELA at (lapsikorotus) from the date of birth on- It is possible for a family to receive calculated on the basis of earned income. www.kela.fi or read the related brochure. wards. To receive the supplement, the child home care allowance and private day Your local KELA office will assist in com- child’s birth is indicated on unemployment care allowance at the same time, but for paring available alternatives and determine Other forms of benefits notification form TT2, which needs to be different children. how they will affect other income, such as Families whose income is insufficient to delivered to the local KELA office or un- The child home care allowance consists the housing supplement (asumistuki). pay the rent or other fees for an owner-oc- employment fund (työttömyyskassa). of a basic allowance (hoitoraha) and a If both parents are employed and they cupied home can apply for housing al- A retired parent can receive a child supplement (lisäosa) paid for one child have agreed that the parental allowance is lowance (asumistuki) from KELA. For supplement for his or her pension, begin- only. Eligibility for the supplement and the to be paid to the father, he will receive a more information, please visit KELA at ning on the month following the baby’s amount paid depend on the family’s in- parental allowance of EUR 15.20 per www.kela.fi or read the brochure on birth. A child supplement is applied for come. weekday. housing benefits. through your local KELA office. As a rule, the allowance is not paid for In addition to income subject to tax children permanently or temporarily resid- and other forms of income benefits, ma- ing abroad. However, a child residing in a ternity and parental allowances, together member state of the European Economic with the child home care allowance, are Area (EEA) or the European Union (EU) considered when awarding a study grant. may be eligible for home care allowance. A Students have personal limits for annual family receiving maternity and parental al- income based on the number of months lowances may receive home care or private they have drawn a study grant or housing day care allowance for its other children un- allowance. Any income exceeding the an- der school age. Child home care basic allow- nual limit affects the amount of study ance is adjusted to the parental allowance. grant and housing allowance. For more in- Partial care allowance (osittainen hoito- formation on the annual income limits, raha) is available for parents who are work- please read the KELA brochure on study ing reduced hours (max. 30 hours/week) to grants or use the online calculation tool to look after the child. When parents share determine your annual income limit at the care of the child, they are both entitled www.kela.fi/opintotuki. Please note that to partial care allowance. these online tools are so far only available Applications for child home care al- in Finnish. lowance, private day care allowance and partial care allowance are submitted to the Student loan interest subsidies Social Insurance Institution’s (KELA) of- KELA pays the interest in full on student fice. These allowances can be backdated loans guaranteed by the State. Students are up to 6 months. not obliged to repay the subsidies. Interest

106 Social protection for families with children Social protection for families with children 107 cases. Maintenance allowance (elatusapu) Notes Municipal benefits may be provided when one or both of the parents do not take care of the child’s main- tenance. The amount of maintenance al- Children born outside marriage lowance is determined through a contract The mother is always the legal guardian of or a court order. Maintenance allowance is the child, if the parents are not married. paid monthly in advance or as an one-time However, the father may choose to be- payment and is revised according to the come established as the child’s guardian cost of living index. It is recommended that either together with the mother or alone. you contact your social services department In such a case, paternity must be con- at the beginning of each year to find out the firmed and the parents need to enter into revised amount. a written agreement endorsed by the social If the liable parent cannot pay the welfare body in question or a court of law maintenance allowance agreed upon or ne- must decide on joint custody. glects the payments, the child is entitled to Paternity is confirmed either by ac- maintenance support (elatustuki). Main- knowledging paternity before a magistrate tenance support is also paid to children or through a court action. This also applies whose father has not been established and to co-habiting parents. The municipal child when the amount of maintenance allow- welfare officer is responsible for proceed- ance is smaller than maintenance support. ings confirming paternity. Paternity must be Maintenance support is EUR 118.15 per established before it can be confirmed. To month per child. It is paid from municipal establish biological paternity, the necessary funds and applied for through the social evidence is obtained through tests. If neces- service board. sary, paternity testing through forensic ge- netics is applied to establish or refute pater- Income support nity. Blood or buccal swap samples are test- Families with insurmountable financial ed at the National Public Health Institute or problems may apply for income support in the University of Helsinki Department of (toimeentulotuki). All income and assets Forensic Medicine. The mother has the right available are considered when the need for to refuse to establish the identity of the fa- support is assessed. Applications for in- ther. The child welfare officer does not have come support are submitted to the social permission to continue establishing pater- services department. nity against the mother’s wishes, except when a man has acknowledged paternity. Support for informal care Support for informal care (omaishoidontu- Child maintenance and support ki) is intended for supporting the home Children have the right to sufficient main- care of chronically ill patients, disabled tenance from their parents. Children born people and the elderly. The parents of a to unmarried parents are also entitled to disabled or ill child can apply for informal maintenance from their fathers, due to care support from the local social services which paternity must be established in such department. u

108 Social protection for families with children 109 Notes

110 111 Notes

112 113 Notes

114 “We’re having a baby” is a guidebook for expectant parents. Prenatal clinics issue all expectant mothers a copy free of charge. This guidebook is also available in Finnish (”Meille tulee vauva”) and Swedish (”Vi väntar barn”). The original guidebook text was edited by Ms. Sirpa Taskinen. This revised version is based on the original and edited by Anna Kokko (Sociologist in Family Studies, University of Helsinki) and Johanna Lammi-Taskula (Senior Researcher, STAKES). Other people who have contributed to this guidebook include Arja Haapakorva (the Development and Research Centre for Maternity and Child Health Care), Merja Kumpula (Finland’s Midwives Association), Suvi Mieskonen (Helsinki University Hospital, Jorvi Hospital), Minna Oulasmaa (the Family Federation of Finland) and Maire Kolimaa and Marjaana Pelkonen (Ministry of Social Affairs and Health). We would like to extend our warmest thanks to the experts and parents who have shared their knowledge with us! Feedback? Please contact Johanna Lammi-Taskula, address STAKES, PL 220, 00531 Helsinki, or email [email protected]. For copies of ”We’re having a baby” please contact the National Research and Development Centre for Welfare and Health, STAKES, Raija Rantamäki, PL 220, 00531 Helsinki (fax 09 - 3967 2170), email [email protected]. These guidebooks are provided free of charge for health care centres; in other instances a fee will be charged.