We're Having a Baby

We’re having a

Updated newBABY version here: This guidebook is intended for all parents expecting a http://urn.fi/URN:ISBN:978-952-343-575-9 child. It contains up-to-date information on pregnancy, delivery and caring for your baby, as well as services for families with children. It also addresses parenthood, the relationship between the parents, the child’s development and interaction with the child.

This guidebook provides information and practical tips for daily life and parenthood.

This revised edition is based on previous editions and has been produced through collaboration between experts and parents.

Publication sales National Institute for Health and Welfare www.thl.fi/bookshop P.O. Box 30 (Mannerheimintie 166) .!7BC5<3"DFLGFJ! 00271 Helsinki Phone: 029 524 7190 ISBN 978-952-302-832-6 Phone: 029 524 6000 www.thl.fi

A guidebook for expecting and looking after a baby This guidebook has been published since the beginning of the 1980s. Sirpa Taskinen, Psychologist at the then National Board of Social Welfare, had the main responsibility for the texts in the original guidebook. Over the years, the contents Each child is unique of this guidebook have been edited and supplemented several times. We would like to extend our warmest thanks to the experts and parents who have shared During the first year, the child has transformed from a their knowledge with us and contributed to this new edition of the guidebook. helpless infant to a little person learning to walk. This would not have been possible without interaction with other people. Each child is unique. Children develop in their own time according to their genetic and environmental influences. Editors: Tuovi Hakulinen, THL Comparing your child to others is unnecessary. Being happy Marjaana Pelkonen, Ministry of Social Affairs and Health about your child and how he or she grows and develops is Jarmo Salo, THL very important for your child. Maria Kuronen, THL Children also grow and change quickly after their first birthday. Every stage of development can be very rewarding for the parents and give them great joy.

Enjoy your child! © THL Graphic design and layout: Seija Puro Cover image: Vastavalo.fi

ISBN (printed) 978-952-302-832-6 ISBN (online) 978-952-302-833-3 ISBN (epub) 978-952-343-006-8 http://urn.fi/URN:ISBN:978-952-302-833-3

MUU 315

PunaMusta OY Helsinki, FINLAND 2019 Dear Reader,

Babies are born into a variety of situations and different kinds of families. The baby may be a firstborn or one of many siblings. Some pregnancies are carefully planned, while others may come as quite a surprise.

This guidebook contains up-to-date information on pregnancy, birth and parenthood, taking care of your baby, services for families with children and social security. We hope that this information and practical advice will support your own thinking and make your daily life smoother.

You can get more personal guidance and support for good parenting from your local maternity clinic, child health clinic and the maternity hospital. Organisations dedicated to child and family support provide reliable information that you can find easily on the Internet. For tips on sources of information, see the end of this booklet.

Enjoy your reading!

The editors

WE´RE HAVING A BABY 3 CONTENTS

PREGNANCY From conception to birth 6 Pregnancy calendar 8 Pregnancy and well-being 10 Signs of pregnancy 15 Risk factors during pregnancy 19 Maternity clinic 23 Preparing for parenthood 28 Relationship with your partner 31 What does a baby need? 33

THE BIRTH Preparing for birth 36 The stages of labour 39 Postnatal ward 45 Recovering from the delivery 46

BABY CARE First month 52 Baby´s nutrition 58 Hygiene 69 Baby sleep 71 Growth and development 73 Daily routines 79 Safety 82 When the baby is ill 83

SERVICES FOR FAMILIES WITH CHILDREN Child health clinic 88 Social service 90 Other services for families 92 Social security for families with children 93 Special situations 94 Investigation of paternity 96 Child´s custody, child support and child maintenance allowance 97 Organisations supporting families with children 98

EACH CHILD IS UNIQUE 99

4 WE´RE HAVING A BABY PREGNANCY Placenta FROM CONCEPTION The placenta begins to develop when the fertilised ovum is embedded in TO BIRTH the lining of the uterus a few days after conception. A well-functioning placenta provides the basis for the healthy development of the foetus. The placen- onception can occur during ta acts as the lungs, liver, intestines, ovulation, which takes place kidneys and source of nutrition for the C approximately two weeks af- foetus. Nutrients and oxygen travel ter the first day of menstruation. The from the mother’s circulation through ovum can be fertilised by male sperm the placenta to the foetus via umbilical for 24 hours. Fertilisation happens cord veins. The veins in the umbilical when the male sperm cell penetrates cord carry the baby’s blood to be oxi- the female ovum. A sperm cell can sur- dised in the placenta and transfer the vive in the woman’s body for 2–4 days. waste to the mother’s circulation. The The male sperm cell determines the sex metabolism takes place through a thin of your baby. membrane: the blood circulations of the mother and the baby, although very close to each other, remain separate. The expected date of delivery At the end of pregnancy, the placenta The due date, or expected date of de- weighs about 500 to 800 grams, and is livery (EDD), is calculated from the first shaped like a flat disc. day of your last menstruation. A nor- Many substances harmful to the foe- mal pregnancy lasts between 37 and 42 tus, such as nicotine and alcohol, can weeks. To calculate the expected date pass through the placenta. (See pages of delivery, add 40 weeks (= 9 months 19–20.) and 7 days) to the date when your period last began. Most babies are born during week 39 or 40. If your menstruation Uterus cycle is longer than 28 days, then con- The uterus of a woman who is not preg- ception will have taken place more than nant weighs 50 to 70 grams and is 7 to two weeks after the first day of your lat- 9 cm long. At the end of pregnancy, it est period. Most pregnant women have weighs nearly 1 kg and has a volume an ultrasound scan before week 20. The of about 5 litres. During pregnancy, the EDD is checked against the size of the uterus grows with the baby. During the baby. In later scans, the EDD will not be fourth month of pregnancy, the uterus revised. rises from the pelvis, which results in visible changes in the mother’s body. In week 16, the fundus of the uterus is halfway between the navel and the pu-

6 WE´RE HAVING A BABY | Pregnancy bic symphysis, by week 24 it is up to Monitoring your pregnancy the navel, and by week 36 it is up to the For more detailed information on the dif- diaphragm. Accelerated growth of the ferent stages of pregnancy, see the preg- uterus may indicate a multiple pregnancy calendar on the next page spread nancy. The fundus of the uterus usually of this booklet. It briefly describes the drops a couple of weeks before deliv- different stages of foetal development, ery and becomes round in shape. At the the most important examinations car- same time, the baby usually turns head ried out at the maternity clinic and oth- down ready for delivery. er important matters, such as applying for the maternity grant. The calendar also specifies the most important safe- Movements ty factors related to the foetus and the Women who are having their first baby mother, such as the use of medication usually feel its movements by week 20 or dietary supplements during pregnan- or 21. Mothers who have had previous cy (see also Risk factors during preg- pregnancies can already feel the move- nancy, p. 19). At www.folkhalsan.fi/ ments around week 18. At first, the raskauspaivakirja, you can find a new movements may feel like “bubbling” or kind of pregnancy diary (in Finnish, “fluttering”, before they develop into Swedish and English) for monitoring gentle kicks and bumps. yourself, your family and your baby even more closely, week by week. You can keep the diary fully private, share it Contractions with your loved ones or, if you so wish, The uterus prepares gradually for the discuss the thoughts provoked by it delivery. During the final weeks, the with the maternity clinic public health uterus tightens in “practice contrac- nurse. tions”. In the beginning, the contractions only last for a few seconds, but towards the end of pregnancy they can last for up to 30 seconds. Contractions prepare the cervix for delivery. During the final weeks of pregnancy, the cervix may dilate a little, more if the pregnancy is not the first. Experiencing painful contractions during the second trimester may be a sign of an infection, and you should contact your maternity clinic immediately.

Pregnancy | WE´RE HAVING A BABY 7 PREGNANCY CALENDAR

WEEK PREGNANCY TIMELINE TO DO LIST Con- Takes place roughly two weeks from the start of your period. See the guidelines for healthy ception food. Stop smoking and give up alcohol! If you need support, contact your maternity clinic.

Week At two weeks, the embryo is the size of a pinhead. Do not take any medications 0–4 during pregnancy without first consulting a doctor or public health nurse or pharmacy. Check first that your medications can be safely used during pregnancy. Week The foetus is now 1.5 cm long and has the beginnings of arms The baby is well if the mother is 5–8 and legs. The heart, nose, ears and eyelids, the nervous sys- well: healthy food, sufficient rest tem, spine and umbilical cord start developing. and plenty of outdoor activities are good for both. Week When the foetus is 10 weeks old, it is approximately 3 cm The baby’s heartbeats can be 9–12 long and weighs about 20 grams. heard. The foetus floats in amniotic fluid, protected by the foetal membrane and gets its food through the umbilical cord. The foetus now has an upper and lower jaw and the beginning of a tongue. Teeth are beginning to develop in the gums. The early pregnancy ultrasound scan is done between the weeks 10 and 14, and is usually an internal scan done through the vagina. Week When the foetus is 14 weeks old, it is approximately 9 cm To qualify for the maternity 13–16 long, and weighs about 100 grams. The uterus is now about benefit, the mother must have the size of a fist. The head is big, almost half the length a medical examination either at of the foetus, and the facial features start developing. The the maternity clinic or by a doc- ears and genitals develop. The foetus practices swallowing and tor before the end of week 16. breathing. It kicks, wiggles its toes and thumbs, and turns its head, but the mother is not yet able to feel these tiny movements. Week When the foetus is 18 weeks old, it is 25–27 cm long and Talk to the public health nurse 17–20 weighs 250–300 grams. The foetus has its own circulatory about antenatal classes. Most system, and its heart beats twice as fast as that of an adult. A women have an external scan at very fine down, known as lanugo, is now covering the baby’s some time during weeks 18–21. entire body. Most of this will disappear before birth. The baby The external scan is done by has eyebrows. The placenta is almost as big as the foetus. It rolling a transducer across your protects the foetus from some but not all harmful substances. tummy. If this is not her first pregnancy, the mother will now be able to feel the movements of the baby.

8 WE´RE HAVING A BABY | Pregnancy WEEK PREGNANCY TIMELINE TO DO LIST

Week When the foetus is 22 weeks old, it is approximately 30 cm In week 22, you can apply for 21–24 long and weighs 400–600 grams. At this time even women maternity, paternity and parental who are having their first baby can feel the movements. The allowance as well as for the heartbeat is clearly audible. By week 24, the fundus of the maternity benefit (for more infor- uterus is up to the navel. Accelerated growth of the uterus mation visit www.kela.fi). may indicate a multiple pregnancy. The foetus practices sucking, and its thumb often finds its way into its mouth. The hair Avoid excessive strain. Do not and nails are growing, and the protective membrane is start- take the contractions lightly. ing to develop into skin. Most of the time the baby is asleep, but it can be awakened by noise or vibration. A pregnancy terminating before week 22 is called a spontaneous abortion, or miscarriage. If born during weeks 23 or 24, the baby may survive in intensive care, although it is very premature. De- velopmental risks are great, and the selection of a treatment regime must often be given due consideration. Week When the foetus is 26 weeks old, it is approximately 35 cm Be alert to the reactions of your 25–28 long and weighs about a kilogram. The foetus moves a lot. body. Remember to get enough It turns and kicks so hard that the movements are visible. rest! Avoid any unnecessary The baby can open and close its eyes and has a firm grip. The strain, especially if you have fundus is up to the navel now. You may be experiencing your contractions. first contractions: your belly tightens for a few seconds and then relaxes. The foetus now looks like a real baby, but is a lot thinner. A baby born before 28 weeks is considered extremely premature. The lungs and other organs are not yet fully developed. With intensive care the baby often survives, and the prognosis is better due to improved treatment methods. Week When the foetus is 30 weeks old, it is approximately 40 cm Avoid standing work, lifting 29–32 long and weighs about 1.5 kilograms. Most children born heavy objects and other strenu- during weeks 29–32 survive with intensive care, and their risk ous tasks. of handicap is small. Week When the foetus is 34 weeks old, it is approximately 47 cm Now is the perfect time to get 33–36 long and weighs about 2.7 kilograms. It gains weight rapidly. everything ready for the baby. The baby has less room in the uterus and moves around less In many municipalities, you can than before. At this stage, most babies turn head down ready visit the maternity hospital in for delivery. The baby’s skin is covered with a creamy film advance. called vernix. The uterus reaches its highest point and is up to your ribs. If there is risk of premature birth, the delivery will take place close to the neonatal intensive care unit. Babies born in week 35 seldom need intensive care. Babies born before week 37 are considered premature, and the mother and child may need to stay at the postnatal ward for an extended period of time. Week The uterus drops and the baby’s head will become engaged Go to the hospital if your water 37–40 into your pelvis. Contractions will become more frequent. The breaks, you have contractions at baby is kicking so hard that he or she can push away a book regular intervals, you are experi- resting on your tummy. At birth, most babies are 49–52 cm encing pains, or if you are bleed- long and weigh 3,000–4,000 grams. The average pregnancy ing. (See “Birth”.) When the baby lasts for 40 weeks, but deviating from the average by one is ten days over the expected week is very common. date of delivery, the mother will go to the hospital for a post-term follow-up check.

Pregnancy | WE´RE HAVING A BABY 9 family, see the guidebook Eating togeth- PREGNANCY AND er – food recommendations for families with children. WELL-BEING A healthy woman who has been eating a balanced diet does not need to change her diet during pregnancy. Eat- ealthy eating habits, exercise, ing a well-balanced and varied diet con- sufficient sleep and relaxation tributes to the healthy development of H improve the well-being of the baby as well as accelerates recovery both the mother and the baby. Although from the birth and supports breastfeed- pregnancy is a natural condition, it is ing. nevertheless a strain on the mother. During the first three months of preg- The entire body must adapt to the new nancy (the first trimester), there is virtu- situation. Metabolism is enhanced, ally no need for extra food. During the breathing and circulation become more second and third trimesters the need efficient, and the uterus grows. During for extra energy can be met with a slice pregnancy the placenta secretes en- of bread with a spread, a glass of milk, zymes and hormones which, together and one piece of fruit. Thus, there is with the corpus luteum and pituitary no need to “eat for two”, but to eat a gland, regulate these changes. Changes well-balanced and varied diet, and eat in the body also affect the mental state, at regular intervals. During the breast- or moods, of the pregnant woman. (See feeding period, the mother gets energy “Preparing for parenthood” on page 28.) from the fat stored in her body during Pregnancy often makes the mother pregnancy, and the need for extra ener- think about the effects of her own life- gy is the same as during pregnancy. style, such as exercise and eating habits, Regular meals are important for a on the baby. They influence the growth pregnant and breastfeeding woman. and development of the foetus but, first Feeling tired or nauseous may indicate and foremost, the mother’s own coping. that the expectant mother should get It will benefit the whole family to pay more rest and eat more regularly. It is attention to a health-promoting life- recommended that pregnant women eat style. several times a day: breakfast, lunch, dinner, and 2 to 4 snacks in between.

Energy requirements during pregnancy and breastfeeding The diet of a pregnant and Every family has its own eating habits. breastfeeding woman This guidebook presents the most im- Most mothers get all the nutrients they portant elements in the nutrition of a need from their food. However, it is rec- pregnant and breastfeeding woman. For ommended that all pregnant and breast- food recommendations for the whole feeding women take supplemental vita-

10 WE´RE HAVING A BABY | Pregnancy min D and folic acid when planning for Five steps to a healthier future pregnancy and during early pregnancy. For some women, the maternity clinic 1. Eat five portions of fruit, berries and can recommend iron and calcium sup- vegetables every day. plements, in addition to healthy food. 2. Choose soft vegetable fats. Multivitamin-mineral supplements are 3. Eat less food containing high amounts of necessary only if the diet is not bal- sugar or salt. anced. Supplements containing vitamin A must be avoided during pregnan- 4. Drink water. cy. We recommend that you discuss the 5. Enjoy meals with your family. use of any dietary supplements with the maternity clinic. Fat, fish, meat and dairy products Vegetables, fruit, berries and In the use of fat, you should pay atten- wholemeal grains tion both to its quantity and quality. We Vegetables, fruit and berries are rich in recommend that you use soft vegetable important vitamins, minerals and fibre, fats and avoid animal fats and other but poor in energy. Vegetables, fruit and hard fats (coconut and palm oil). Use berries should be eaten in large quan- low-fat (60–80%) spreads on bread and tities, preferably at every meal, and at toast. For cooking, use low-fat spreads, least 5 or 6 portions a day (one portion vegetable oils and vegetable oil blends. is roughly the size of your fist). Colour- Fish contains healthy fats, and preg- ful vegetables of the season are availa- nant women are recommended to eat ble both fresh and frozen, and you can different types of fish (such as saithe, use them both raw and cooked. Vegeta- trout or rainbow trout, Arctic char, bles and berries add flavour to food and whitefish and vendace) 2 to 3 times a reduce its energy content. Beans, lentils week. Avoid pike during pregnancy and and peas all contain a lot of vegetable while you are breastfeeding because it protein. Seeds and nuts contain healthy contains high levels of mercury. It is fats. Nuts, almonds, berries, fruit and recommended that pregnant women vegetables also make healthy snacks. should not eat fish from the Baltic Sea, Wholemeal food, such as bread and such as salmon, trout and large Baltic porridge made of rolled barley, oats and herrings (size over 17 cm) more than rye, contains plenty of fibre, iron and B once or twice a month. You should vitamins. We recommend that you eat also avoid raw-cured or cold-smoked grain products with every meal. Bis- fish products, and dishes containing cuits, Danish and other pastries contain raw fish, such as sushi. You can eat hard fat, sugar and a lot of energy, so these if properly heated, i.e. if treated they should not be consumed every day. to a temperature of at least 70° Celsius throughout. White meat and fish is recommended.

Pregnancy | WE´RE HAVING A BABY 11 Choose products which are low in fects on the pregnancy and the child’s fat and salt. Avoid eating liver and liv- development. er products during pregnancy because they contain high levels of vitamin A. It Sugar and sweeteners is advisable not to eat more than 200 g Reducing your sugar intake helps pre- of liver pâté or sausage per week and to vent excessive weight gain and helps eat a maximum of 100 g at a time. Only protect against tooth decay. There is a choose meat and meat products that are lot of added sugar in products such as properly and thoroughly cooked. soft drinks and fruit drinks, and a lot Milk, cheese and other dairy prod- of natural sugar in juices (100% fruit ucts are important sources of protein, juices). You should drink these only vitamin D, calcium, iodine and oth- occasionally, and drink no more than er nutrients. During pregnancy, it is one glass of fruit juice a day. During beneficial to include 5–6 dl of liquid pregnancy and breastfeeding, you can dairy products and 2–3 slices of low-fat drink juices and other drinks that are cheese in your daily diet. Cheese is a sweetened with steviol glycoside, as- good source of calcium and can replace partame, acesulfame K, thaumatin and milk, but its iodine content is low com- sucralose. For daily use, you should pared to liquid dairy products. Remem- rather choose unsweetened products. ber that many dairy products, such as Liquorice should be eaten only in mod- flavoured yogurts and quarks, contain erate amounts, as it contains high lev- high amounts of sugar. Because of the els of glycyrrhizin, which may cause risk of listeria, avoid blue cheese and swelling and raise blood pressure. Eat cream cheese made from unpasteurised any sweets only moderately. milk. Salt Liquids Use as little salt as possible, because The best drink to quench your thirst is it causes swelling, burdens the kid- water. For your meals, choose fat-free neys and raises your blood pressure. milk or buttermilk or water. During Read package labels and choose the pregnancy and breastfeeding, drink alternatives with less salt. Avoid salted moderate amounts of coffee (no more snacks and other foods with high levels than 3 dl per day) due to its high caf- of salt, such as pickled cucumbers or feine content. For the same reason, salami-type sausage. Many spice mix- energy and cola drinks are not recom- es, spice sauces, seasoning cubes and mended for pregnant women. A high other seasoning products contain high intake of caffeine-containing products amounts of salt. Marinated chicken may cause heart palpitation and shak- and meat products, cold cuts, sausages, ing for the mother. Caffeine passes cheese, bread and many snacks contain through the placenta and breast milk a lot of salt. Choose iodised salt, but into the baby and may have adverse ef- use it only in moderation. Instead of or

12 WE´RE HAVING A BABY | Pregnancy in addition to salt, you can add more folate intake, they should eat whole- flavour to food by adding basic spices, meal products and plenty of uncooked herbs, root vegetables and fruit. vegetables, fruits and berries throughout the pregnancy. It is recommended that all mothers Vitamins and minerals take a folic acid supplement from the The pregnant woman needs a rich sup- planning of the pregnancy until the end ply of vitamins and minerals since the of pregnancy week 12 in order to avoid developing baby takes all the nutrients neural tube defects in the developing it needs from the mother’s body. The embryo. In addition to folate from food, foetus rarely suffers from any deficien- an amount of 0.4 mg or 400 µg a day cies, but an unbalanced diet can affect is recommended. In some situations, a the mother’s well-being. larger amount is used, often in connection with certain medications or illness- Vitamin D es or if the family has a history of neu- The need for vitamin D increases dur- ral tube defects. For further information ing pregnancy and breastfeeding. The on folic acid and an individual blend best sources of vitamin D include for- of vitamins, consult your physician or tified dairy products, margarines and maternity clinic. fish. Using dairy products and margarines fortified with vitamin D is safe Iron and there is no danger of overdose. It The need for iron increases during is recommended that all pregnant and pregnancy. Iron is needed for making breastfeeding women take supplemen- red blood cells and oxygen transport tal vitamin D (10 µg/400 IU per day) and for the development and proper around the year, in addition to a bal- functioning of the placenta. The main anced diet. sources of iron include meat, fish and wholemeal grains. The iron from meat Folic acid and fish is easily absorbed. Foods rich Folic acid or folate is a form of vitamin in vitamin C enhance iron absorption B. The need for folic acid increases dur- from wholemeal grains and vegetables. ing pregnancy, and it is an important Your iron intake may be insufficient nutrient for foetal development. Folate even if you have a well-balanced diet. deficiency may be a contributing fac- Usually, half of the needed iron is from tor in neural tube defects (NTD) in de- food and the other half from the moth- veloping embryos. The recommended er’s iron reserves or from iron supple- daily intake of folate for pregnant and ments. The maternity clinic will assess breastfeeding women is 0.5 mg (= 500 whether you need an iron supplement. micrograms, µg). An average young Breastfeeding does not increase your Finnish woman only gets half of this need for iron. from food. In order to improve their

Pregnancy | WE´RE HAVING A BABY 13 Calcium may be a sign of too much fluid collect- Calcium is necessary for the developing in the body (see also “Swelling” on ment of the baby’s bones. Most women page 18). Excessive weight gain during get enough calcium. You need to take pregnancy may predispose the woman calcium supplements if your diet in- to gestational diabetes, which is a dis- cludes only a few or no dairy products order of carbohydrate metabolism that or calcium-enriched foods. In such a can result in the excessive growth of case, the daily dose of calcium is 500– the baby and low blood sugar levels at 1000 mg. Do not take iron and calcium birth. supplements together since calcium in- Putting on a lot of weight during preg- hibits iron from absorbing. Calcium is nancy predisposes the woman to being also needed during the breastfeeding overweight after delivery as well. Obe- period. If you needed a calcium sup- sity is a risk factor for many chronic dis- plement during pregnancy, continue eases, such as Type 2 diabetes. Healthy taking 500–1000 mg of it a day when eating habits and sufficient exercise breastfeeding. help in controlling weight, and a positive mood will support these efforts. Iodine An iodine supplement is necessary if you do not use liquid dairy products. Dental care and fluoride You should plan this in cooperation Pregnant and breastfeeding women with your maternity clinic. should take extra care of their teeth. This is important for both the mother and the baby, as tooth development Weight gain during pregnancy starts while the foetus is in the womb. The average total weight gain during For teeth, the most important miner- pregnancy is 14 to 15 kg. Weight gain al is fluorine. Fluorinated toothpaste is caused by the growth of the uterus, strengthens the teeth when used daily. foetus, placenta and breasts, and the Health care centres arrange dental care increased amount of blood and am- for pregnant women. niotic fluid. However, during the first trimester it is common to lose some weight. Women gain different amounts Physical exercise of weight, and recommendations are Get as much exercise and fresh air as based on the weight prior to pregnancy. possible during pregnancy. The moth- Weight gain should be monitored for er’s fitness contributes to the baby’s several reasons: insufficient weight gain health and development. Exercise is re- may be an indication that the foetus is freshing and makes you feel better and developing too slowly. A steady exces- helps you in controlling your weight. It sive increase in weight is a strain on the may also alleviate certain pregnancy-re- expectant mother. A sudden increase lated symptoms, such as back prob-

14 WE´RE HAVING A BABY | Pregnancy lems, constipation, tiredness and feet swelling. In a normal pregnancy, a healthy SIGNS OF PREGNANCY woman will be able to remain physically active throughout most of the pregnancy. You can also begin a new sport or exercise during pregnancy. Exercises regnancy affects women in suitable for pregnant women include different ways: some suffer walking, Nordic walking, skiing, swim- P from several signs and symp- ming and gym workouts. Be sensitive to toms while others experience very lit- your body’s reactions and modify your tle discomfort. Some symptoms are exercise accordingly. After mid-preg- common at the beginning, while others nancy, you should avoid sports involv- are typically experienced at later stag- ing jumping, stretching or other sudden es. Although the symptoms may cause movements or a risk of injuries. serious discomfort to the mother, they If you have not exercised at all be- seldom pose any threat to the baby. fore your pregnancy, then start carefully. A suitable amount for a beginner is 15 minutes of exercise at a time, three Feeling tired times a week. The intensity of exercise Some pregnant mothers are vital and is correct if you are slightly breathless energetic, while others feel very tired but can still talk. during the first and last months of preg- Gradually extend the duration of ex- nancy. If possible, rest during the work- ercise to 30 minutes at a time and in- ing day. If you feel extremely tired for crease the number of sessions per week. more than two weeks, discuss it with The goal – the recommended minimum your maternity clinic’s public health amount of exercise – is 150 minutes a nurse or doctor. (See “Anaemia” on week (30 min. x 5). page 17.) If you have any problems with your pregnancy, such as contractions requiring treatment (risk of premature birth) Body temperature or vaginal bleeding, you should avoid During the early stages of pregnancy, exercise and intense physical activity. the body temperature may rise slightly. This is quite normal and does not need medical attention. If you have a fever during pregnancy, contact the maternity clinic or your doctor.

Pregnancy | WE´RE HAVING A BABY 15 Nausea and vomiting If your nipples are small or turned in- Half of all pregnant women suffer from wards, stretch them daily starting a few nausea or vomiting during the first months before the expected date of de- months of pregnancy, especially in the livery so that the baby will be able to get morning when the stomach is empty. It a good grip. may be accompanied by dizziness and one’s vision going black when getting up. Nausea may be triggered by certain Vaginal discharge smells or tastes, because these senses The normal amount of vaginal dis- are heightened during pregnancy. The charge tends to increase during preg- morning sickness and vomiting usual- nancy. If the discharge smells bad or ly stop after the first three months. It itches, consult your doctor as it may be might help to drink a glass of water or a sign of an infection. When washing, juice before getting out of bed and eat use only water, as soap may irritate the something small, such as a biscuit or mucous membrane. slice of bread as soon as possible after getting up. Get out of bed slowly, taking your time. You may be overcome by Vaginal bleeding during early nausea during the day as well, if your pregnancy stomach becomes empty. This can be Slight vaginal bleeding is experienced prevented by having snacks during the by approximately 25% of women day. Violent vomiting is not a normal around the time of normal menstrua- sign of pregnancy and should always be tion. The bleeding is explained by the treated by a doctor. fertilised ovum being embedded in the lining of the uterus. It is recommended that you avoid sexual intercourse if you Breasts have bleeding. If the bleeding contin- Your breasts will grow and they might ues, you should contact your maternity feel tender and tight. Beginning from clinic within a few days. the second month, it is possible for your Vaginal bleeding may be caused by breasts to leak milk. At this stage your several reasons. If the bleeding is heav- breasts will be very sensitive to cold ier than your normal period and in- and should be kept warm at all times. cludes contraction-like pain, it may be You should buy a supportive materni- a sign of miscarriage. In this case, it is ty bra by the middle of your pregnancy. advisable to consult a doctor but there During the winter, wear a warm wool- is no need to do it at night or during len scarf around your breasts. It might the weekend. If vaginal bleeding dur- be wise to avoid swimming in cold wa- ing early pregnancy is accompanied by ter. Massage your nipples with a mois- strong or one-sided abdominal pain, turising lotion available from the chem- pain in the tip of your shoulder or faint- ist to prepare the skin for breastfeeding. ing, these may be caused by an ectopic

16 WE´RE HAVING A BABY | Pregnancy pregnancy. In this case, consult a hospi- Anaemia tal outpatient clinic. Anaemia may be a reason for feeling extremely tired. Other symptoms include paleness, palpitations, shortness Urinating of breath during exercise, and dizzi- In the early stages of pregnancy, and es- ness. Anaemia occurs when there is pecially before the time of the normal not enough haemoglobin in your blood. menstruation period, you may expe- Haemoglobin levels often decrease dur- rience a vague feeling of heaviness in ing pregnancy because there is more the lower abdomen. This is caused by blood in your circulation. In a sense, expanding veins and enhanced circula- your blood is “diluted”. If necessary, tion. Toward the end of pregnancy, the your doctor or public health nurse will need to urinate is more frequent as the prescribe iron supplements. Vegetables uterus is pressing against the bladder. A and fruit rich in vitamin C as well as swift kick from the baby may lead to the meat and fish enhance iron absorption. mother needing to urinate, or even an “accident”. Varicose veins Varicose veins are enlarged veins on the Sweating surface of the leg. They may get worse Sweating increases during pregnancy as during pregnancy when the expanding metabolic activity increases. Pay spe- uterus puts pressure on the veins. Wear- cial attention to your personal hygiene. ing specialised compression stockings, which you put on before getting out of bed, alleviates the problem. It also Heartburn helps if you can put your feet up dur- Heartburn is a common ailment to- ing the day and place a pillow under wards the end of pregnancy. It is caused your feet at night. Avoid wearing high- by regurgitation of gastric acid. Heart- heeled shoes or shoes that are too tight. burn is a painful burning feeling in Wear different shoes during the day to your throat, chest or upper abdomen. It give your feet a rest. can be alleviated by avoiding spicy and fried foods, coffee and strong tea. The maternity clinic will be able to suggest Cramps safe medications to treat heartburn. The During pregnancy women tend to have heartburn will discontinue as soon as leg cramps. Painful leg cramps often oc- the baby is born. cur at night and affect your calf or thigh muscle. The best way to relieve a cramp is to stretch the cramping muscles: straighten your leg, take hold of your big toe and pull your foot up, or press it

Pregnancy | WE´RE HAVING A BABY 17 against the bed. You can try to relax the Swelling cramp by massaging the muscle light- Some degree of swelling is normal un- ly. Use a cold pack (e.g. a bag of frozen less it is accompanied with rising blood vegetables) for first aid. Keep your feet pressure and protein discharges in the warm during the night. urine. A sudden increase in weight (over 500 g per week in a woman of normal weight) or swelling accompanied Constipation and piles by severe itching may be symptoms of a As the uterus grows, it presses against liver condition (hepatosis gravidarum). the rectum and thus increases the ten- Contact the maternity clinic or your dency to develop piles or enlarged doctor. blood vessels in the anus. As piles are aggravated by constipation, pay special attention to what you eat and make Skin blemishes sure that you exercise sufficiently. To The skin can get darker during preg- reduce constipation, eat plenty of fi- nancy, especially the tips of the breasts bre – wholemeal bread and porridge, and around the genitals. A brown line fruit, berries and vegetables – and drink often appears stretching from the lower enough during the day. If necessary, abdomen to the naval, and brown spots add bran or wheat germ and dried fruit (chloasma) may appear on the face. to your diet to encourage regular bowel These marks will fade after delivery. movements. Exercise and other physical activities will also help. Stretch marks Pregnant women may develop stretch Backache marks on their breasts, abdomen and As the tummy grows, the back muscles thighs, caused by skin stretching and must take a lot of strain, which may by tearing of the connective tissue un- result in back pain. Good posture and der the skin. Massaging stretch marks support by the abdominal muscles will as early as possible with a moisturising alleviate the pain. Wearing a supportive lotion may help. The red lines will usu- maternity bra and comfortable shoes ally fade after delivery. with flat heels will ease the backache. Find a mattress that supports your back without being too hard. Gentle massaging and rest will relax tense back muscles. Light exercise to strengthen the abdominal and back muscles is recommended. Ask the maternity clinic for exercise instructions.

18 WE´RE HAVING A BABY | Pregnancy Sexually transmitted diseases and RISK FACTORS infections can be prevented by using a DURING PREGNANCY condom.

Smoking Infections Smoking is harmful for both the moth- During pregnancy, it is especially im- er and the baby. Cigarette smoke often portant to avoid infections that could causes nausea in expectant mothers. be harmful to the foetus. The risk of The nicotine and carbon monoxide in infection can be considerably reduced the smoke are absorbed into the moth- by carefully following the protective er’s blood and transfer via the placen- instructions. Toxoplasmosis is a par- ta into the foetus. They also impair the asitic infection that can be passed on normal functioning of the placenta. from cats, guinea pigs and laboratory Nicotine levels are higher in the foe- animals. To prevent infection, avoid tus than in the mother. Babies born to contact with cat litter trays or soil that smokers have low birth weight and are may have been fouled by cats or other restless and irritable more often than animals. Do not let the house cat sleep those born to non-smokers. Smoking in your bed. during pregnancy may have harmful ef- Continue to follow normal food hy- fects on the development of the brain giene (www.ruokavirasto.fi/en/private and lungs, and also increases the risk of -persons/information-on-food). For infection after birth. pregnant women, listeria is a dangerous Support for giving up smoking is bacterium found in food products. The available from the maternity clinic and best way to avoid listeriosis is by wash- through the Internet (in Finnish and ing your hands thoroughly after han- Swedish: www.stumppi.fi, helpline dling meat. Due to the risk of cross-con- 0800 148 484). Nicotine replacement tamination, do not handle raw and products other than the patch can be cooked products with the same uten- used during pregnancy, if necessary. sils. To eliminate the risk of listeria, For the sake of the child’s health as heat food properly so that its internal well as for the sake of their own health, temperature is over +70 °C throughout. both parents should give up smoking Follow the instructions when heating at the early stages of pregnancy, if not processed foods and frozen vegetables. before. Fresh vegetables should be carefully rinsed to remove soil. Avoid vacuum-packed cold-smoked and raw-cured fish products, blue cheese, cream cheeses, and cheeses made from unpasteurised milk.

Pregnancy | WE´RE HAVING A BABY 19 Alcohol Alcohol causes foetal damage. When a pregnant woman drinks alcohol, so You should reduce does her foetus, because alcohol pass- your alcohol consumption es through the placenta and travels via when trying to conceive and the umbilical cord into the foetus. The when pregnancy is possible. blood alcohol level can be higher in the Pregnant women should avoid foetus than in the mother. alcohol completely. There is no Binge drinking (consuming large safe mount of alcohol that quantities of alcoholic beverages) is a woman can drink particularly dangerous for the foetus. The body parts and organs develop while pregnant. during the first trimester (the first three months of pregnancy), and a dangerous drinking pattern during the first trimester can result in foetal malformations, Pregnancy is an excellent opportuni- e.g. a congenital heart defect. Excessive ty to change your drinking patterns and alcohol use should be avoided when- other aspects of your life in the best in- ever there is a possibility of pregnancy. terests of your future child. There are Pregnant women should avoid alcohol several sources of support and advice completely. on giving up alcohol, such as the mater- Alcohol slows down foetal growth nity clinic or your local health centre or throughout the pregnancy and may A-Clinic (Finnish website: www.a-klin- result in low birth weight. The foetal ikka.fi). At www.addictionlink.fi, you central nervous system (CNS) is very can find information on alcohol and vulnerable, and at worst the baby may other substances as well as peer sup- suffer from mental retardation. Alco- port websites that promote life without hol-related foetal defects may cause intoxicants. problems associated with attention span, learning, and linguistic development. Drugs There is no safe amount of alcohol All drugs pass through the placenta into that a woman can drink while pregnant. the foetus. Drugs restrict the growth of Excessive alcohol consumption during the baby and may cause premature de- pregnancy increases the risk of mis- tachment of the placenta and premature carriage. Other risks include malfunc- birth. Drug abusers often neglect their tions of the placenta, bleeding and the own well-being, are in bad physical resulting infections, and the premature condition, and suffer from malnutrition detachment of the placenta. Caesarean and infections. All of these pose a par- sections (C-sections) are more common ticular risk for the pregnancy and the among heavy drinkers. well-being of the unborn baby. Alcohol

20 WE´RE HAVING A BABY | Pregnancy and drug-abusing mothers often need Information Service is a national free- help with tackling their problem. They phone helpline aimed at preventing should seek help as early as possible, foetal defects. The helpline also pro- for example, at the maternity clinic or vides information on infections, radia- directly from nationwide mother and tion and other external risk factors dur- child homes and open service units ing pregnancy and breastfeeding. specialising in substance abuse treatment (www.ensijaturvakotienliitto.fi/ en). Päihdeneuvontapuhelin, a help- Travelling line for substance abusers, their family Wearing a seatbelt is compulsory, also members, and professionals, is availa- in the back seat. Towards the end of ble on a 24/7 basis (in Finnish) at 0800 pregnancy, wearing a seatbelt might feel 900 45. A social and healthcare profes- uncomfortable, but it is essential for the sional will answer your call. safety of the mother and the baby in Irti Huumeista (Free from Drugs) case of accident. If you will be travel- (www.irtihuumeista.fi) is a non-gov- ling long distances by car, be prepared ernmental organisation that provides to stop every few hours for a quick stroll information on drugs and drug addic- to stretch the legs. tion and their effects on the substance Motorcycling is not recommended for abuser and his or her family. The organ- pregnant women. Travelling by planes isation provides advice, support and that are not pressurised may cause the information by phone and email (check foetus to suffer from oxygen deficiency. the website for contact details). Drug Airlines have recommendations and re- Helpline 010 80 4550 (in Finnish). strictions regarding travelling and pregnancy. It is advisable to check with your airline regarding the restrictions they Medication and examinations impose for long-haul flights. Do not take any medications or natural health products during pregnancy without first consulting a doctor or public Risks at work health nurse. Follow the dosage in- The supervisors of expectant moth- structions. When at the doctor’s or den- ers are responsible for ensuring safe tist’s, always remember to tell them that working conditions and methods. A you are pregnant so that they can adjust pregnant woman is entitled to request the treatment accordingly. a transfer to other jobs if the working Further information on the effects environment poses risks, such as from of drugs on the foetus is provided by chemical substances, radiation or in- the Teratology Information Service of fectious diseases. If this is not possible, the Hospital District of Helsinki and the mother can apply for a special ma- Uusimaa, available Mon–Fri 9 am–12 ternity allowance from the Social Insur- pm (tel. 09 471 76500). The Teratology ance Institution (Kela) to begin mater-

Pregnancy | WE´RE HAVING A BABY 21 ance Institution (Kela) to begin mater- should be taken into account when di- nity leave at an earlier date (see “Social viding the daily tasks in, for example, security for families with children” on infectious disease departments in hos- page 93). pitals. Pregnant women should not do jobs If you work in the health care sector, involving exposure to radiation (e.g. you might become infected with hep- X-rays). They should also avoid phys- atitis B or HIV via the blood or excre- ical strain, such as lifting or moving tions of infected patients. In the clean- heavy objects. According to current ing business, syringes and needles in knowledge, working by a computer waste bags may present a risk. Usually, monitor and using physical therapy a biohazard does not exist unless the equipment do not pose a radiation risk. patient’s blood comes into contact with If your job involves coming into contact the worker’s circulation via a wound or with anaesthetic gases, lead, mercury, a needle prick. Reduce the risk by wear- cytostatic agents, carbon monoxide or ing protective gloves, using disposable carcinogens (cancer-causing substanc- instruments and avoiding mouth pipet- es), consult your occupational health ting in the laboratory. There is a risk of care representative to ensure the safety cytomegalovirus infection if you are of your working environment. working in an institution where you Pregnant women should also con- come into contact with infant excreta. sider the effect of parental leave on Pregnant women should be removed their individual careers, discuss their from these environments. However, statutory rights and benefits with their for most infections, it is sufficient to be supervisors and have a preliminary dis- aware of the risks and to protect your- cussion about returning to work after self adequately (see also “Infections” on parental leave (see “Social security for page 19). families with children” on page 93). Learn the policies and procedures in use at your workplace. Discuss risks and biohazards with your superior, oc- Infectious diseases cupational health care services, or oc- If a pregnant woman has never had the cupational safety personnel. common pox diseases or been vaccinated against them, she might become infected when working with children. If you have never had chicken pox, you should be vaccinated against it before becoming pregnant. Avoid contact with people with an active virus. Pregnancy

22 WE´RE HAVING A BABY | Pregnancy A public health nurse and a doctor work at the maternity clinic. Antenatal care includes MATERNITY CLINIC • health examinations • screening tests • personal and group guidance and counselling ost babies born in Finland are • home visits and antenatal classes. healthy and the mothers do M well. This is mainly due to During the course of a normal preg- the good health of women, the regular nancy, the expectant mother and her visits to the maternity clinic, where the partner make at least 8 to 9 visits to the health and well-being of the mother and maternity clinic. These visits include baby are closely monitored, in addition a extensive health examination of the to the high-quality childbirth care in expecting family and two doctor’s ap- the maternity unit. pointments. During each visit, the pub- The maternity clinic promotes a lic health nurse evaluates whether the healthy lifestyle for the parents and mother needs intensive antenatal care supports the resources of the whole and support. If yes, she can visit the family. Parents get support in matters maternity clinic more frequently or get such as preparing for childbirth, growth other individual support. After deliv- into parenthood, baby care and family ery, the mother will have at least two life, and preventing and solving possi- health examinations, one of which is a ble problems in their relationship. All so-called postnatal medical examina- families need support at some point tion. Ultrasound scan is normally per- especially those expecting their first formed at weeks 10 to 14. child. There are also private maternity clin- Maternity care monitors possible ics. If the mother visits a private doctor problems during pregnancy, takes ac- during pregnancy, she can still partic- tion to prevent them, and refers the ipate in antenatal classes and visit the mother for further examinations and public health nurse at the municipal treatment in hospital, where necessary. maternity clinic. Mothers who have un- The maternity clinics and hospital ma- dergone a medical examination through ternity units also support the family if a doctor’s appointment or have visited and when the mother has fears relating the maternity clinic before the end of to childbirth, suffers from depression, the 16th week of pregnancy are entitled or is having a multiple pregnancy. The to a maternity grant (in cash or goods, maternity clinics and hospital mater- see “Social security for families with nity units monitor and take care of the children” on page 93). pregnancy and childbirth in close cooperation.

Pregnancy | WE´RE HAVING A BABY 23 First visit to a maternity clinic nation is to strengthen the resources of The purpose of the first visit is to assess the whole family in the best interests of the pregnant woman’s general health the baby. The examination will be per- and any risk factors for pregnancy. A formed by a public health nurse and a public health nurse interviews the fu- doctor. The topics of the visit include ture mother and performs a basic exam- the health and mood of the parents, any ination. The visit also includes person- illnesses, health-related behaviour, the al discussions and advice on matters interaction and relationship between such as nutrition and exercise as well the parents, the parents’ expectations as the adverse effects of alcohol and regarding childbirth and parenthood, other intoxicants during pregnancy. and the family’s support network and During the first visit, the public health finances. These areas can be discussed nurse also provides information about based on the individual needs of each screening the foetus for abnormalities family. The parents are also informed of (see Screening programmes on page medical factors related to the progress 25) and about periodic health examina- of the pregnancy (including risks) and tions. Both parents will be invited to a they also get advice on the self-moni- extensive health examination of an ex- toring of the pregnancy. Other topics pecting family. of discussion include foetal abnormality screening and factors related to the Examinations during the first visit: mother’s work from the viewpoint of • A blood sample is taken to determine your pregnancy. blood group, Rhesus factor and blood haemoglobin concentration. The sample will also be tested to rule out syphilis. Other periodic check-ups • A urine sample is tested for sugar levels, Check-ups at the maternity clinic are protein and bacteria. aimed at monitoring the physical and • The expectant mother will be weighed, her psychological well-being of the preg- height measured and her blood pressure nant woman. Based on her individual checked. needs, the discussions can cover mat- • With the mother’s permission, the blood ters related to pregnancy, childbirth and sample can also be tested for HIV antibod- future parenthood, preparing for family ies and hepatitis. life and a change in the use of time, as well as perceptions related to the baby, and baby care. It is important that the Extensive health examination mother tells the public health nurse and of an expecting family doctor about any serious mood prob- An extensive health examination of an lems or intimate relationship problems, expecting family is typically performed such as intimate partner violence. at weeks 13 to 18. Both parents will be invited since the purpose of the exami-

24 WE´RE HAVING A BABY | Pregnancy The following are monitored at check-ups: Pregnant woman’s illnesses and other • weight, blood pressure and sugar levels in problems that may require extra follow- urine up: • blood haemoglobin • problems with earlier pregnancy • average weekly weight gain • family diseases and the possibility of a • swelling, if any hereditary disease • foetal heart rate • mother’s chronic diseases, such as • foetal position and movement. asthma, diabetes, epilepsy, thyroid gland dysfunction The mother-to-be is taught how to • mother’s disability monitor foetal movement, especially • infections, such as urinary tract infection, during late pregnancy. genital infection or systemic infection that may cause foetal damage • mental health problems Intensive antenatal care • substance abuse problem in the family If needed, intensive antenatal care is • domestic violence. provided to a pregnant woman and her family. Experts such as a family worker, social worker, psychologist or physio- Screening programmes for therapist can be invited to the treatment chromosomal and structural team. The examining doctor or public anomalies health nurse can also refer the mother The maternity clinic offers all pregnant to the hospital maternity unit for fur- women the opportunity for foetal anom- ther examinations. The number of addi- aly screening. This includes ultrasound tional visits to the maternity clinic and scans, and a maternal serum screening any follow-up at the hospital maternity from a blood sample. Any screening unit will be agreed based on the moth- tests and possible further examinations er’s individual needs. are voluntary. The pregnant woman can change her mind and discontinue her Special situations or problems requiring participation in screening tests at any extra follow-up: time. The mother can be accompanied • multiple pregnancy to each scan by the partner or some an- • pre-eclampsia and high blood pressure other support person. (gestational hypertension) The vast majority of babies develop • gestational diabetes normally. However, a small percentage • itching or yellow skin (gestational of foetuses and newborns have a chro- cholestasis) mosomal or structural anomaly. The • abnormal uterine growth purpose of screening tests is to find any • abnormal foetal heart rate or movement severe anomalies already during preg- • risk of premature birth nancy in order to prepare for them as • bleeding during late pregnancy well as possible. Some of the anomalies • passing the due date. Pregnancy | WE´RE HAVING A BABY 25 may cause the newborn to die, or re- Combined first-trimester screening quire treatment immediately after birth. test With certain anomalies, identifying If the pregnant woman decides she them will benefit the child since their wants to undertake the screening tests treatment can be started already during to determine foetal chromosome abnor- pregnancy. Awareness about a foetal malities, a blood sample will be taken anomaly gives the parents time to pre- at weeks 9–11 for serum screening and pare for the birth or death of a severely the NT scan (nuchal translucency scan) ill child. It also gives them the oppor- of the foetus is carried out at the same tunity to decide on the termination of time as the early pregnancy general pregnancy up until the beginning of ultrasound scan, at week 11–13 of the week 24 (24 weeks + 0 days). pregnancy. Together, these two consti- It is important that the parents-to-be tute a so-called combined first-trimester discuss the risk of abnormal screening screening test. results already before participating in The risk factor, which indicates the the screening tests. In the case of an probability for chromosomal abnormal- abnormal result, they will have to con- ity in the foetus, is obtained by com- sider whether or not they want to take bining the results from the screening any additional tests. After taking the tests (serum markers and the thickness screening tests, the parents may have of nuchal translucency) with factors to reflect on continuing the pregnancy such as maternal age and the duration and having a child with a disability or of pregnancy. terminating the pregnancy. If the risk factor exceeds the risk Screening tests always involve un- threshold, the pregnant woman is of- certainties. A screening result that fered the opportunity to have further indicates an increased risk does not examinations. Any further examina- necessarily mean that the baby will be tions are voluntary, and the maternity born with a disability or disease. Fur- clinic will provide advice on these. thermore, not all conditions show up If the first maternity clinic appoint- in screenings, and no test can guarantee ment is after week 11, a blood test in that the child will be healthy. week 15–16 may be offered as an alternative screening method. However, the Early pregnancy ultrasound scan second-trimester serum screening is not The early pregnancy ultrasound scan as reliable in the assessment of the risk is performed at weeks 10–13, either ex- of chromosomal abnormalities as the ternally or internally. The primary pur- early pregnancy combined screening. pose of this scan is to confirm the weeks of gestation and to verify the number of foetuses. Structural abnormalities may be revealed by the scan.

26 WE´RE HAVING A BABY | Pregnancy Second ultrasound scan The antenatal classes usually start at The second ultrasound scan is a more 20–30 weeks of pregnancy and are held detailed scan called a foetal structural by a public health nurse or some oth- survey, in which the baby’s major or- er health and social care professional. gans and skeleton are checked for severe Usually there are 4 to 5 meetings, some structural abnormalities in week 18–21, of them preferably after the baby is or alternatively in week 24–28. At this born. time, the number of foetuses and their status is also checked, and the duration of pregnancy, the amount of amniotic Maternity clinics and dads fluid, and the position and condition of Dads are welcome to attend each ap- the placenta are verified. Pregnancy can pointment as well as the antenatal be terminated up until the end of week classes. The child will become attached 24 (24+0) by permission of the National to both the mother and the father and Supervisory Authority for Welfare and needs the love and care of both parents. Health (Valvira) if the foetus has been When parenting is shared, the child reliably tested to have a severe disease gets support and assurance from both or structural anomaly. mum and dad for his/her development. Guides for expectant parents on foetal Being a father is very important for the abnormality screening tests are availa- man himself. When both parents par- ble at ticipate in the care and upbringing of http://urn.fi/URN:NBN:fi-fe201205085260 the children, the relationship tends to and be happier. Maternity clinics help both http://urn.fi/URN:NBN:fi-fe201205085039. parents form a positive yet realistic picture of life with a new baby. The clinics strive to promote the mother’s and Antenatal classes father’s commitment to caring for the The topics covered in antenatal classes baby. Many maternity clinics organise include what happens during labour meetings for just the dads where they and how to prepare for it, breastfeeding, can share their experiences with other and caring for the newborn. Antenatal men in the same situation. Dads are ad- classes provide a chance to learn how vised on how they can best support their to care for the baby, to discuss changes partners during labour and how they in daily routines when there is a new can participate in caring for the baby. baby in the house, to talk about par- When the public health nurse comes to enthood and relationships with other meet you at home, schedule it so that prospective parents, and to learn about both parents will be present. If the preg- the services and benefits available for nant woman’s partner is a woman, or if families with children. Antenatal class- the baby is born to a family with more es often include a visit to the hospital than two parents, the maternity clinic maternity unit. will equally support them.

Pregnancy | WE´RE HAVING A BABY 27 Overdue pregnancy Overdue pregnancies are closely If your pregnancy exceeds the estimat- monitored to detect any signs of pos- ed delivery date by more than 10 days, sible risks as early as possible. The based on the measurements taken from most common complication in overdue an early pregnancy ultrasound scan, pregnancies is placental insufficiency, it is considered overdue. You or your other problems include foetal oxygen public health nurse should make an deficiency, a decreasing amount of am- appointment at the hospital maternity niotic fluid, and changes in the foetal unit, where a doctor will examine the heart rate. The pregnant mother is rec- mother and the baby and, based on the ommended to pay attention to the baby’s well-being of them both, decide on how movements, following the instructions to proceed. given by the hospital or maternity clinic.

PREPARING FOR PARENTHOOD

Having a baby will affect family become a father and a mother? What do life you expect from your daily life with a Having a baby is a change for all mem- child? bers of the family. Pregnancy is the Pregnancy is also the time to prepare time to prepare: hormonal and physical mentally for the coming life change. changes help the mother adjust to the Yet, having a baby is one of the most coming change. For the father or part- natural and richly rewarding experi- ner, the future baby becomes more real ences life can bring. However, it is not as the pregnancy progresses and they possible to be prepared for everything – will be able to feel the baby’s move- some things will always come as a sur- ments. The mothers are, in turn, en- prise! Having an open mind will help in couraged to share their feelings and ex- solving many questions and problems periences with their partners. Discuss during pregnancy and after the baby is the future baby and parenthood already born. during pregnancy. How does it feel to

28 WE´RE HAVING A BABY | Pregnancy Fears and concerns and other close friends will help. Becoming a parent brings a long-term The developing baby exhausts the responsibility towards your baby. The mother’s energy resources, and she will parents may be worried about many dif- need a lot of rest. The female body ferent things: Will the child be healthy? goes through tremendous changes dur- How will I know how to take care of a ing pregnancy. Skin and other tissues baby? What to do when the baby cries? are stretched to their limits. Breasts Will I make a good parent? Will I love grow and the pelvis spreads. The cen- my child? How will we manage finan- tre of gravity changes as pregnancy pro- cially? A single parent might also worry gresses and this will affect balance. The about being “shorthanded” and how she changes are significant, but they happen will manage alone with the baby. You slowly. However, pregnancy is a natural may be overwhelmed by the thought of condition, not an illness. Your general being responsible for the life of another mood depends greatly on how well you human being and wish you could just will be able to accept these inevitable cancel the whole thing. These feelings changes. The partner can be a huge sup- are very common and they will pass in port during this time by complimenting time. Find someone who you can share the mother on her growing tummy and your fears and concerns with. Remem- appearance. ber that there is no need to feel guilty about such thoughts and feelings; pro- cessing your thoughts and feelings is all Pregnancy and the partner part of becoming a parent. Pregnancy and having a baby are demanding for the other parent as well. He is expected to be supportive and under- Becoming a mother standing. During very early pregnancy, The first pregnancy is especially test- in particular, it can sometimes be dif- ing. You will start seeing things from ficult to understand why the mother is a new perspective now that you are becoming so tired and emotional. If the also responsible for the well-being and partner is aware of the hormonal chang- healthy development of your unborn es during pregnancy, it will be easier baby (see “Pregnancy and well-being” to understand the pregnant mother. on page 10). Attending an ultrasound scan is just as Hormonal changes can bring about important for the partner as it is for the severe mood swings in the mother, mother: they will both see their baby for causing her to become exceptional- the first time. ly emotional, tearful or sensitive. The The father may also have questions pregnant mother needs to be assured and doubts about the life ahead of him. and reassured that her partner still Men often wonder if they will be good loves and supports her. Sharing your fathers and a good example to their thoughts and feelings with your partner children, and how the family will cope

Pregnancy | WE´RE HAVING A BABY 29 financially in the new situation. The Mothers, particularly single mothers, responsibility may feel overwhelming. need special attention and support dur- It is recommended that the dads-to-be ing pregnancy. In addition to friends share their feelings not only with their and relatives, the maternity clinic’s partner but also with other prospective public health nurse, a social worker, fathers or experienced dads. and health care centre psychologist are available to provide support. You can also contact helplines, the child guid- Support networks ance and family counselling centre, or For the mother, late pregnancy, child- the church’s family guidance centres birth and maternity leave constitute a (see “Services for families with chil- time when socialising with colleagues dren” on page 87). Single parents will and friends decreases. Nursing and car- find peer support from the association ing for the baby at home may make the for single parents (visit “Yhden van- mother feel isolated, especially if there hemman perheiden liitto” at www.yvpl. are no other mothers with babies in the fi). If you are pregnant without a part- neighbourhood or among her friends. ner, you can invite a doula (a trained The father/other parent on long-term support person) to attend the birth. For parental leave may also encounter sim- more information, please visit the Fed- ilar feelings of isolation. Since there eration of Mother and Child Homes and is less contact with other adults than Shelters’ site at www.ensijaturvako- before, great expectations fall on the tienliitto.fi/en. For contact details type partner to listen and provide compan- “doula” in the search field. ionship. You can also keep contact with your Start building your social network al- friends and peers through social me- ready during pregnancy. Parental leaves dia. However, no virtual contacts can provide a chance to make new friends. replace a face-to-face presence and in- You can meet people in the same stage teraction. These are important not only of life in the maternity clinic’s antenatal for the wellbeing of parents but also to class, in parental clubs and family cafe- the development of the child. It is im- terias organised by municipalities, par- portant that you reflect already during ishes and numerous associations, such pregnancy on the use of social media as the Mannerheim League for Child and how the stay-at-home parent will Welfare (MLL) and the Martha Organisa- be able to maintain contact with adults. tion, as well as in residents’ parks and clubs and open day care centres.

30 WE´RE HAVING A BABY | Pregnancy ner says he/she is afraid or troubled, RELATIONSHIP WITH don’t tell him/her that there is nothing to be afraid of. Rather, ask what YOUR PARTNER it is specifically he/she is afraid of. Allow you partner to have the feelings he/she is experiencing and say, Cherish the love you have for example, “You must have felt ter- Such a relationship does not just hap- rible when you were being got at by pen on its own, though. Firstly, to be your boss” etc. able to love another, you need to accept 3) Tell your partner how you feel. If and love yourself. Secondly, a good re- you are angry, say “Having to clean lationship must be nurtured: be caring up after you makes me angry”, for and attentive, show affection, listen example. Try not to blame your part- and interact. At best, pregnancy can ner, and avoid the word “always” be a shared experience that strength- in phrases such as “You are always ens your relationship and enhances the so careless”. If you want something, feminine and masculine traits of both state it clearly. For example, “Could parents. On the other hand, unpleasant- you vacuum the house?” (instead of ness, insults and unfair behaviour dur- “You never do anything”). ing pregnancy will be forever remem- 4) Respect each other. Never say things bered unless they are talked through that you know are the most hurtful to and forgiven. your partner, even when angry. 5) Digging up past faults is easy to do, but is poisonous to your relation- Sharing your feelings ship. Learn to forgive and forget. In a good relationship, you can openly share everything that is on your mind: joys, sorrows, concerns, fears, hopes Pregnancy and sexuality and dreams. Sharing your feelings and Pregnancy may change the way you thoughts is not always easy and re- feel about sex in one way or another. quires practice. Nausea, fatigue and breast tenderness during early pregnancy may cause your The following advice might be helpful: desires to decline. For others, early 1) Listen to what your partner is saying. pregnancy is very thrilling in terms of What is he/she feeling? What is his/ sex life. her intention? Try not to take imme- For many expectant mothers, the diate offence. Was what he/she said second trimester is a sexually fulfilling with the intention of offending, or time. For many women, this is a peak was it just worded a bit clumsily? erotic time in their life. Some partners 2) The individual is the best judge of enjoy their sexually more active spouse, his/her own feelings. If your part- while others may find it confusing. He

Pregnancy | WE´RE HAVING A BABY 31 might worry about harming the unborn Abuse is unacceptable child and avoid situations that will It is good to be an understanding part- lead to sex. A normal pregnancy does ner, but there are limits as to what not prevent the couple from having sex. should be tolerated. Physical and men- During late pregnancy, many women tal abuse are crimes against another per- feel awkward and sexually unattractive, son and should not be tolerated. Heavy while others enjoy sex right up to birth. blows to the area of the abdomen may Remember that sexual intercourse is damage the womb and the foetus. At just one aspect of sexuality. Maintain worst, this may cause the pregnancy to intimacy and affection by saying and terminate. doing things you know will give pleas- If you are being abused, call the ure to your partner. This can enrich Emergency Response Centre as soon as your sex life and give it new forms. possible. The emergency phone number is 112. The Emergency Response Centre staff will tell you what you need Housework to do and will alert the necessary au- Couples without children generally thorities. Sometimes the first priority split housework evenly without argu- is to remove yourself from the abu- ment, but in families with young chil- sive partner into a safe environment. dren housework is a major source of In such a case, you can go to a mother disagreement. Having a baby increases and child shelter. Contact details for the amount of housework. If not before, the shelters are available at www.thl. during pregnancy all family members fi/fi/palvelut-ja-asiointi/valtion-sosiaa- should participate in housework – not li-ja-terveydenhuollon-erityispalvelut/ just the parents but the older children turvakotipalvelut (in Finnish) or at the as well. Online Family shelter at www.turvako- The partner’s share of housework ti.net/en_onlineshelter/. (For a more increases during pregnancy, especial- detailed description, see Mother and ly if the mother is suffering with con- child homes on page 92). tractions. During late pregnancy, the mother should avoid physical strain, such as lifting heavy objects. During the first weeks after birth, the baby needs round-the-clock attention.

32 WE´RE HAVING A BABY | Pregnancy WHAT DOES A BABY NEED? THE FINNISH MATERNITY PACKAGE Maternity package IS WORLD FAMOUS! Apply for a maternity package from Kela when the pregnancy has lasted at least 154 days. Adoptive parents are also entitled to the maternity package. The pack includes useful, high-quality clothes and other necessary items. Fur- can also easily acquire baby wear and ther information on the contents of the gear second hand. Recycling is sensible, package and on applying for it is avail- since baby wear and gear hardly wear able on Kela’s website (www.kela.fi/ out at all. Some associations, such as web/en/maternity-grant) or from the the Mannerheim League for Child Wel- local Kela offices. fare (MLL) and Folkhälsan, lend baby gear. Remember that the baby does not need massive amounts of toys, equip- Somewhere to sleep ment and clothing. You will need a few The maternity package comes in a box pieces of everyday clothing, such as that is designed to double as a baby bas- body suits and jumpsuits, and one set ket. At first, the baby can also sleep in a of outdoor wear for each weather type. crib, carrycot, basket or other baby bed. The first year is a time of rapid growth, A cot with bars will be necessary by the and your child will quickly grow into time the baby starts turning and moving and out of clothes. A 1-year-old child around and the previous sleeping ar- is already 73 to 80 cm and weighs 10 rangement is no longer safe. When the to 12 kg. child is 1.5 to 2 years old, he/she will The essential bigger purchases for the be able to climb out of the cot. At this baby include a bath tub, a pram and a time, the child can start sleeping in a car safety seat, if the family travels by children’s bed. car. Use the carrycot that fits inside the pram to transport the baby if the pram does not fit inside the house. When Baby gear buying prams, pay attention to safety, In addition to the maternity package, durability and size (will it fit into the it is advisable to acquire additional lift or the car?). You can acquire a sepa- clothes and linens, if possible, since ba- rate (second-hand) pram for the baby to bies tend to use up clothes quickly. You sleep in on the balcony. It is possible

Pregnancy | WE´RE HAVING A BABY 33 to change nappies on the bed or whilst to keep your hands free. Baby carriers holding the baby in your lap, but in should be ergonomically designed for many cases a proper changing mat or the comfort of both the mother and the changing top can be very useful (see “A baby. place for changing” on page 53). A baby carrier, sling and baby sitter allow you

34 WE´RE HAVING A BABY | Pregnancy THE BIRTH How to plan in advance PREPARING FOR Although it is impossible to fully antic- BIRTH ipate the birth process beforehand, it is a good idea to reflect on how you would like the birth to proceed. What is important for you during childbirth? What he oncoming birth occupies helps you to relax? Discuss your wishes the minds of expectant par- with your spouse or birth companion. T ents, particularly if this is You can also write down your wishes your first child. It is difficult to imagine if you are worried about not being able what giving birth feels like and how to communicate them to the attending you can go through it. During pregnan- midwife after the onset of labour. cy, it is a good idea to acquire informa- The attending midwife will take the tion on childbirth and to reflect on your family’s wishes into account during the own ways to relieve labour pain. birth process. Any pain relief alterna- The birth is discussed during visits tives and non-urgent procedures will be to the maternity clinic and in antenatal decided in cooperation with the moth- classes. Do not hesitate to ask the mater- er. There are various kinds of assistive nity clinic nurse any questions that you items in the delivery room to help the may have regarding childbirth. mother to relax. Normally, the mother Some maternity hospitals arrange can move freely during the birth pro- advance visits for expectant parents. cess and, for example, take a shower. Furthermore, maternity hospital web- However, childbirth does not always sites provide information on childbirth, go as planned. Sometimes, quick deci- local treatment practices, the various sions must be made without being able pain-relief alternatives available and to discuss them in advance. In such a the stay in the postnatal ward after de- case, the attending midwife and some- livery. times also the obstetrician will meet Antenatal classes form part of fami- the mother after delivery and explain ly training. The topics covered include the decisions and procedures taken, if the normal stages of labour, the various needed. pain relief alternatives, the role of the father or other support person during the birth and what happens after the Father’s role birth. The purpose of this is to strength- It is the role of the father (or birth com- en the skills and resources of the moth- panion) to support, encourage and rally er and her partner for childbirth. the mother during labour. The presence of a close companion is a comfort to the mother and helps her keep her spirits

36 WE´RE HAVING A BABY | The birth up. Giving birth usually takes several What to take to hospital? hours, and support and encouragement Pack your hospital bag with the items is much needed. Some very concrete that you will need well in advance. You supportive measures include, for ex- can pack your own clothes and slippers ample, massaging the mother’s aching to wear at the hospital. back, fetching something to drink, wip- ing away sweat and helping the mother Include: to relax. • your current and any previous maternity When the father has witnessed the cards birth of his own child, the relationship • toiletries and other personal items, such as between the father and the child forms a toothbrush and toothpaste, deodorant, immediately when the baby is lying body lotion, hairbrush, shampoo, etc. on its mother’s chest, seeking contact • any regular medication with its parents. A strong bond is cre- • nursing bras. ated when the baby first opens its eyes and makes eye contact with the faces It is advisable to leave any valuables close by. Some fathers find they feel a at home, since there is not necessarily stronger sense of closeness – as if the any locked storage facilities in patient baby was more their “own” – when rooms. The father can bring any gear they have been present during the birth. and items you need for the journey Fathers who have seen their baby being home on the day that you leave the hos- born describe it as one of the finest mo- pital. ments of their lives. However, some fathers are unable or The baby will need: unwilling to attend the birth. In such • undergarments (e.g. a body suit), a case, the mother can ask her mother, • a shirt and pants or a jumpsuit, sister or a close friend to accompany her • a hat and a sleeping bag and, if the during labour and childbirth. You can weather is cold, the baby will also need also invite a doula (a trained birth com- a cardigan and a pram suit or padded panion) from the Federation of Mother overalls, and Child Homes and Shelters or from • a car safety seat or a carrycot. Folkhälsan to attend the birth (Further information www.ensijaturva kotienli- Further, the mother needs clean itto.fi/en or www.folkhalsan.fi/en/. If clothes for leaving the hospital. Before the arriving baby will have a two-moth- the baby is born, make sure you have er family or several parents, they are all small nappies for the newborn and san- welcome to attend the birth. Whatever itary pads for yourself, for heavy bleed- the decision, it should be made as early ing after the birth, as well as bra pads as possible. kept in readiness at home.

The birth | WE´RE HAVING A BABY 37 Onset of labour Labour usually begins at 38 to 42 weeks, with contractions or with your water breaking. Sometimes, irregular contrac- Go to the hospital tions may be the first sign of the onset of immediately if you labour. Some mothers may experience have vaginal bleeding occasional irregular contractions for or experience several days before the actual onset of severe pain. labour. These contractions prepare the cervix for birth. If the contractions remain occasional and are of short duration and not too painful, the mother can from the cervix. The discharge is harm- continue her normal life: eat, do house- less unless accompanied by increased work, go for a walk, or rest. bleeding or severe continuous pain. Labour is considered to have begun Labour can also begin with your water when contractions are less than 10 min- (amniotic fluid) breaking either sudden- utes apart, last 45–60 seconds and are ly or in a gradual trickle. Amniotic fluid clearly painful. When contractions be- does not discharge fully from the uterus come painful, you should be alert to the but continues leaking throughout the reactions of your body and try different labour process. Contractions typically positions to find the ones that are most begin within a few hours of your wa- comfortable. Warmth helps you relax ters breaking. If you suspect that your and alleviates contraction pain during water has broken, contact your hospital early labour. Try holding a warm grain maternity unit for further instructions. bag or similar against your lower back If needed, labour can be induced us- or on your lower abdomen. You can ing medication or by artificial rupture also take a warm shower. of amniotic membranes. Induction of Many women have mucus discharge labour requires a medical reason, such in connection with contractions and as overdue pregnancy or problems with the onset of labour. This discharge pregnancy. may contain some blood that originates

When to go to the hospital If the amniotic Below are a few general guidelines on fluid is green, when to go to the maternity hospital. If contact the hospital you have received specific instructions from your maternity clinic or maternity as soon as hospital, please follow them. possible. If you have had previous pregnancies, you can estimate, based on your experience, when to leave for hospital.

38 WE´RE HAVING A BABY | The birth If your previous delivery was quick, Admission process you should go to hospital as soon as When you arrive at the hospital, a mid- your contractions have become regular wife will welcome you. She will assess and painful. the stage of labour and ask you ques- It is advisable to call the maternity hos- tions such as when the contractions be- pital before you leave. This enables the gan, how long apart they are, and how midwife to evaluate the situation over long they last. You can begin to take the phone and give you instructions. notes about these already before leaving for the hospital. The midwife performs Normally, you should go to the hospital when an external examination to determine • you have had contractions for at least two the position and size of the baby. The hours baby’s well-being is checked by listen- • contractions are less than five minutes apart ing to its heart rate. An internal exam- • contractions last at least 45 seconds at a ination is performed to determine the time extent to which the cervix has dilated. • contractions are so strong that you no The mother and the midwife discuss longer feel comfortable staying at home. the mother’s wishes regarding childbirth and together plan how to proceed. Remember to take account of the travel time when deciding when to leave for the hospital.

THE STAGES OF LABOUR

here are three stages of labour: the third stage, the mother delivers the the first stage is the dilation of placenta and membranes. For first-time T the cervix, the second is the mothers, labour often takes between 6 delivery of the baby, and the third is and 20 hours. For women who have al- the delivery of the placenta. During the ready given birth, labour may only take first stage of labour, the cervix dilates 3 to 12 hours. However, every labour is and the baby lowers down in the pel- individual and the given times are only vis. During the second stage of labour, indicative. the mother pushes the baby out. During

The birth | WE´RE HAVING A BABY 39 The first stage of labour: stage, as he will be there to encourage the dilation of the cervix and support the mother, offer some- Labour is considered to have begun thing to drink and massage her aching when contractions are less than 10 min- back. However, mothers are different: utes apart, last 45–60 seconds and are many women do not like to be touched clearly painful. The dilation stage ends or massaged during contractions. Even when the mother begins active pushing. if the birthing companion cannot do For a first-time mother, the cervix only anything concrete for the mother, often begins to dilate after the cervical canal the mere presence of a close and relia- has gradually effaced, which may take ble person is important. several hours. The midwife guides the mother in With mothers who have had previous the use of different positions and relax- pregnancies, the cervix begins dilating ation methods and aides. The midwife even before the cervical canal has fully also guides the father or other support effaced. The cervix may be a few cen- person. The use of any pain relief med- timetres dilated before labour has even ication is decided in cooperation with begun. The speed of dilation varies the mother. During the dilation stage, from person to person. Normally, the the midwife monitors the progress of cervix initially dilates more slowly but labour by observing the mother and by begins to dilate more rapidly as the la- making both external and internal ex- bour progresses. In the first childbirth, aminations. The baby’s well-being is cervical dilation is typically slower monitored by regularly listening to its than in subsequent childbirths. heartbeat. During the first stage of labour, the mother can assist the uterus by moving around and by staying relaxed. You Pain relief medication should be alert to the reactions of your Various types of medication are avail- body and try different positions. You able to relieve labour pain, such as can use different kinds of aides, such as drugs injected into muscle tissue, ni- a gymnastic ball or a bean bag. Swaying trous oxide and anaesthesia. Pain relief your hips removes some of the pressure medication does not take the pain away against your lower back and helps to completely but can clearly relieve it. control the pain caused by contractions. The mother needs the sensations of her You can use music, singing, warmth body to be able to push the baby out. and water as relaxation aides. You can Drugs injected into muscle tissue are shower your back and abdomen with typically used in the first stage of labour warm water or relax in a delivery pool if contractions are already painful but or deep bath. not yet strong enough to dilate the cer- Many mothers find that the presence vix. This will help the mother to relax of the baby’s father or birth compan- or even fall asleep. However, it is im- ion is especially important in the first portant to monitor the baby’s heartbeat

40 WE´RE HAVING A BABY | The birth after administering the drug since it the second stage of labour to alleviate will also reach the baby. The drug will the pain associated with pushing. All exit the baby at the same rate as it exits anaesthetics require the use of intrave- the mother. However, if the baby is born nous hydration, as well as continuous soon after the medicine was admin- monitoring of the baby’s heart rate. istered, it may have difficulties with sucking and breathing. A mixture of oxygen and nitrous ox- The second stage of labour: ide can be safely administered through- delivery of the baby out the first stage of labour. The mixture The second stage begins when the cer- is inhaled through a mask in periods vix is fully dilated and the baby’s head timed with the contractions. Nitrous is turned to the correct position. The oxide kills pain quickly and also wears mother will feel the need to push. Nor- off quickly from the body. Therefore, it mally, this develops gradually, eventu- has no permanent effects on the moth- ally turning into an urge to push: the er or the baby. The use of nitrous oxide mother feels compelled to push during may require some practice so that you contractions. For a first-time mother, will reach optimum pain relief at the the second stage takes around half an peak of each contraction. Usually, find- hour, for others only about 10 minutes. ing the right rhythm is easy. An upright position facilitates and Anaesthetic drugs are the most ef- speeds up the birth. Women can give fective pain reliefs during the labour birth in a number of positions, includ- process. Epidural and spinal anaesthe- ing standing, kneeling, squatting or sia are injected to the side of the spi- on all fours, and use various types of nal cord and may only be given by an birthing aides to support their position, anaesthesiologist. These often take the such as a bean bag or a stool. The mid- pain away from the entire pelvic area. wife helps the mother to find a suitable However, you will sense a feeling of birthing position. In particular, first- weight during contractions. The effect time mothers often have time to try dif- of anaesthetics lasts for one to three ferent positions. hours. Epidural and spinal anaesthesia are normally given with the mother lying down on her side, and she must Vacuum extraction remain lying down for at least half an If the second stage of labour (pushing hour afterwards. After this, the mother stage) is prolonged and uterine contrac- can get up if she so wishes. tions are weak or the baby’s heart rate An obstetrician may also administer slows down, this stage can be accelerat- a paracervical block through the vagi- ed by using a vacuum suction cup. The na around the cervix. Its effect lasts for doctor attaches the cup to the baby’s one to two hours. A pudendal block can head by suction and pulls as the mother be injected into the vaginal wall during pushes during a contraction. When vac-

The birth | WE´RE HAVING A BABY 41 uum extraction is used, the mother is After a moment of rest the baby will in a semi-sitting position in the birthing open its eyes. It opens and closes its fists bed. and puts its fist into its mouth. With- Vacuum extraction is used in about in 30 minutes, the newborn begins to 5% to 7% of all deliveries. Vacuum ex- nudge towards the breast. When next to traction causes swelling of the baby’s the breast, the baby continues its hand head, which disappears within a week, and mouth movements and pushes its but can be painful during the first few tongue out, preparing to attach to the days. Pain medication can be given to breast. Every now and then, the baby the baby. stops and looks around, seeking human faces. Normally, a newborn is ready to breastfeed within an hour of birth. The third stage of labour: Soon after the birth, a name tag is delivery of the placenta placed around the baby’s wrist bearing After the baby is born, the contractions the mother’s name and personal iden- continue but are weaker than during tity code. This procedure ensures that the second stage. They cause the pla- there can be no mix-ups. Right after centa to be expelled from the uterus, birth (at the age of 1, 5 and 10 minutes), usually within half an hour. The foetal the baby’s health is assessed using the membranes will also come out at this so-called APGAR score. This indicates time. The placenta and membranes are how well the baby adapts to life outside then examined, weighed and measured. the womb. The baby’s body does not Sometimes the placenta needs to be re- immediately produce vitamin K, which moved manually. This is done under a prevents bleeding. This is why the baby general anaesthetic. After the delivery receives a vitamin K injection right after of the placenta and membranes, the birth. midwife will stitch any tears and the After the first breastfeeding, the baby’s possible episiotomy cut under local height, weight and head circumference anaesthetic. are measured. The baby is also bathed if needed. The father is welcome to participate in these baby care moments. Getting to know your baby Provided that everything is alright, the Once the baby is born, he or she is dried mother and baby are transferred to the and then placed on the mother’s chest. postnatal ward two hours after birth. This enables the parents to start getting The midwife will monitor the baby’s to know their child right after birth. well-being after birth. Some newborns Birth is a miraculous event touching may have breathing difficulties during the hearts of everyone present. After the first hours. If needed, a paediatri- months of waiting, the parents meet cian examines the baby. their child for the first time. Sometimes, the condition of the mother or baby prevents a peaceful

42 WE´RE HAVING A BABY | The birth bonding moment in skin-to-skin con- The surgeon makes an incision in tact immediately after birth. In such a the mother’s abdominal wall and cuts case, the first meeting will be arranged through the uterus. The baby is then as soon as possible. The baby’s intuitive helped out. The placenta and the mem- breast-seeking behaviour will prevail branes are also removed. The baby is for several weeks. Also, the father can shown to the parents, after which the hold the baby in skin-to-skin contact if midwife and sometimes a paediatrician the mother cannot do so. will examine the baby. In some hospitals, the mother may hold the baby in skin-to-skin contact while the surgical C-section incision is stitched up. Approximately every sixth baby is born Recovery after a caesarean section by caesarean section (C-section), and of takes somewhat longer than after a vag- those just over a third are elective cae- inal birth, because having a C-section is sarean sections. Typical reasons for a a major surgical operation. The mother caesarean include breech presentation, will usually be able to get up within one abnormal placental position, the large day of the caesarean, and can go home size of the baby, a decelerated growth with the baby when she is feeling well rate and previous caesareans. Some- enough. The stitches are removed after times the mother experiences such fear one week. of giving birth that vaginal delivery is During the weeks following the C-sec- not possible. tion, the mother will need extra help A caesarean section may be needed around the house as she is not allowed if, during labour, the baby’s well-being to lift anything heavier than the baby. is believed to be deteriorating or if the To ensure proper healing of the inci- delivery stops progressing as it should. sion, exercise and heavier chores must A swift deterioration in the baby’s con- be entered into with care. The mother dition requires an emergency caesarean may find many movements painful or to ensure that the baby is delivered as difficult. However, staying up and mo- fast as possible. bile will enhance recovery. A caesarean section is usually per- Having a caesarean section does not formed using an epidural or spinal prevent the mother from having a vag- anaesthetic. If this is not possible or inal birth in the future. However, it is if an emergency caesarean is needed, recommended that there is an interval a general anaesthesia may have to be of at least one full year before the next used. Usually, the father is welcome pregnancy, in order to ensure the uterus to participate in an elective caesarean has sufficient time to heal properly. If section. He will be seated next to the the mother has had two caesarean sec- mother where he cannot see the surgi- tions, vaginal birth is most likely no cal area. longer an option.

The birth | WE´RE HAVING A BABY 43 Polyclinic delivery should contact the hospital to receive The inpatient period following deliv- advice over the phone. Once the baby is ery has become shorter, and so-called born, he or she is dried and then placed “polyclinic deliveries” have become on the mother’s bare chest. The mother possible. In a polyclinic delivery, the and child are covered to keep the new- family can take the baby home six born warm. It is advisable to prepare hours after birth, provided that there for such a delivery, especially when the have been no complications and the hospital is far away or when previous baby is doing well. A paediatrician will births have been quick. examine the baby and a midwife will examine the mother before they leave the hospital. Normally, the family will Home birth have to return to the maternity hospi- Home birth is very rare in Finland, al- tal for another paediatric examination though it is also an option. Each year, when the baby is at least two days old. about 10 mothers decide to give birth at home. Home births require considerable pro-activeness and initiative Giving birth before reaching from the mother. She will need to book the hospital a midwife and acquire the necessary Sometimes the baby is born so fast that equipment. Mothers choosing home the mother cannot make it in time to the birth are also responsible for all the hospital. In these cases, the first stage of related expenses and any unexpected labour proceeds quickly to the second consequences. If you are interested in stage and the mother feels the need to home birth, be sure to investigate the push suddenly, while still at home or option thoroughly before making your on her way to the hospital. Hence, the final decision. father or birth companion has to play the midwife’s role. The first priority is to stay calm. If possible, the father

44 WE´RE HAVING A BABY | The birth after every visit to the toilet and change to a clean sanitary pad. A midwife will POSTNATAL WARD monitor the decrease in size of your uterus during your stay at the hospital. Learning to breastfeed requires a lot n the postnatal ward, the of attention during the first few days. mother and baby can stay to- At the postnatal ward, the staff guides I gether all the time. This is the mother in beginning to breastfeed. the best way for the mother to learn to In the case of in-hospital outpatient know her baby and to learn baby care. childbirth, the public health nurse will It also helps the start of breastfeeding, support the mother during a home visit. since the mother is able to quickly re- For more information on breastfeeding, spond to the baby’s needs. The father see page 58. and normally also the siblings are A paediatrician will examine the welcome to the postnatal ward. Some baby before you leave the hospital. The hospitals have family suites where the doctor will assess the baby’s general father can also stay and participate in well-being and listen to its heartbeat baby care around the clock from the and lungs. The doctor will also check very beginning. the newborn’s reflexes and that the hips The postnatal ward staff guide the are in the correct position. parents in breastfeeding and taking Some newborns’ skin will appear care of the baby. Particularly with first- yellow at the age of 2–4 days. Known time parents, this may include matters as neonatal jaundice, this is caused by such as practicing bathing the baby and the accumulation of bilirubin, a nor- cleaning its navel. The staff will also mal breakdown product of haemoglo- provide information on recuperating bin in red blood cells. If needed, the from the delivery. baby’s bilirubin level is checked with The whole labour process and the a jaundice meter and by taking blood delivery method have a major impact samples. Jaundice usually cures itself, on the mother’s well-being. The mother may need pain relief for post-delivery contractions and perineal pain. If the mother has had a Caesarean section, she Contact the child will need strong pain relief. However, health clinic when you this medication does not harm the baby, are leaving the maternity and the mother can breastfeed normally. hospital or on the following day. The mother will experience heavy Your nurse will visit you vaginal discharge for the first few days at home within approximately after delivery. To avoid uterine infection, a week of your call. it is important to take care of your personal hygiene. Wash your intimate areas

The birth | WE´RE HAVING A BABY 45 but some newborns need phototherapy with blue light. Before leaving the hospital, the par- RECOVERING FROM ents will receive verbal and written in- THE DELIVERY structions and information on baby care and the recovery of the mother. Puerperium – the first weeks after birth Transfer of the baby to The period after delivery, during which a neonatal ward your body recovers from the changes Some newborns require treatment at caused by pregnancy and childbirth the neonatal ward. Typical reasons for and returns to its normal pre-pregnan- this include premature birth, infections cy condition, is called the puerperium. or breathing difficulties. Full-term ba- During this period, you should take it bies recover quickly from any initial easy and focus on getting to know your difficulties, and treatment at the neona- baby. Getting help and attention from tal ward may last only a few hours or your loved ones will speed up your re- days. Very premature babies may have covery. to spend several weeks in hospital. Lochia is the bloody discharge af- Even if newborns need intensive care ter birth. It is initially more abundant at the beginning of their life, they also than your usual period but decreases need the presence and care provided in a few days and turns pale in about by their parents. Many neonatal wards two weeks. The discharge may become have developed family-centred care, more bloody if the mother is physically enabling the parents to stay at the ward more active, for example, goes out for with their baby and take care of its ba- a walk for the first time after delivery. sic needs, such as feeding and nappy However, this will pass in a few hours. changing. Lochia discharge typically continues Often the parents can give the baby for 4 to 6 weeks. “kangaroo care” where the baby, wear- If the discharge continues to be heavy ing only a nappy, is placed on the moth- and bloody for a long time or increases er or father’s bare chest, under the shirt. considerably, contact your local health Kangaroo care supports in particular centre or the hospital maternity unit. If the well-being of premature babies and the discharge turns foul-smelling, the the start of breastfeeding and enables uterus feels sore and the mother has a parents to provide closeness to their fever, this may indicate a uterus infec- baby. tion. If the symptoms are minor and the mother has only a small fever, you can contact the local health centre. If the mother’s symptoms are severe and she has high fever, you must immediately

46 WE´RE HAVING A BABY | The birth contact the maternity hospital’s emer- has a thin and fragile vaginal mucosa, gency clinic. which affects sex life. When milk begins to form and the mother begins to breastfeed, her breasts may feel sore Postnatal medical examination and touching them may feel painful. Mothers remain clients of the maternity Witnessing the birth of his baby might clinic until the postnatal medical exam- have affected the father’s libido. You ination. This examination is performed should remember that intimacy goes 5 to 12 weeks after delivery. During beyond sexual intercourse. After child- the examination, a public health nurse birth, sex may mean physical closeness and possibly a doctor checks how the and caressing yourself and your partner. mother has recovered from pregnancy The hormonal surge following deliv- and childbirth and discusses with her ery may cause a decline in the mother’s the changes brought on by the arrival libido, but not in her need for love and of a baby. The examination includes affection. How soon you can expect to a gynaecological examination for the return to your usual sex life will de- identification of any damage caused by pend on you and your partner, and it is delivery. Furthermore, contraception is recommended that you both share your discussed. You must undergo this med- thoughts with each other. ical examination before you can apply It is recommended that you defer sex for parental allowance. until the vaginal discharge ends and both parents feel ready for it. To treat vaginal dryness, a lubricant lotion or Sexuality, sex and showing some other lubricant (cooking oil, body affection after childbirth lotion without a fragrance or Vaseline) The arrival of a baby will significant- may prove helpful. Lubricants are also ly change your family life. In addition sold at chemists, department stores, or to joy and happiness, this also means sex stores. At the postnatal medical ex- more work and less sleep than before. amination, you can ask the doctor for a Parents typically have less opportuni- prescription for a vaginal cream. ties to spend time together. If the baby However, there is no need to refrain already has siblings, you will have even from showing affection! Both parents less time for the two of you. This often need love and attention, caresses and means that you put your sex life on cuddling, now maybe more than ever, hold and have sex less frequently or not as there is an extra person sharing the at all. The situation will return to nor- “cuddling resources”. Having a satis- mal gradually – within a year or so. factory sex life in your relationship is Childbirth may have caused vaginal a shared responsibility – it takes two to tears to the mother, and the scars make tango! sexual intercourse painful. Due to hor- In a single-parent family, it is im- monal reasons, a breastfeeding woman portant that the parent gets support,

The birth | WE´RE HAVING A BABY 47 Condoms, intrauterine devices (IUDs), pills and other types of hor- Remember to use monal contraceptive containing only contraception when you progesterone, as well as sterilisation start having sex unless you are safe while breastfeeding, since they want to become pregnant. have no effect on milk production or Even if you are breastfeeding the baby. If you opt for sterilisation, it doesn’t mean you can’t bear in mind that this is an irreversible operation. immediately become If you are not breastfeeding, you may pregnant again. ovulate as soon as 30 days after delivery. In this case, you can start using contraceptive pills three weeks after attention and affection from his or her the delivery or when you have your first friends and loved ones. period. It is not advisable to start using contraceptive pills any earlier due to the elevated risk of thrombosis. Contraception The condom is a highly suitable Think about contraception before hav- method of contraception after birth, ing sex for the first time after delivery, protecting the uterus from infection. as ovulation is possible before your first Using a lubricant during the first few period. Breastfeeding will normally months may help if the vagina is tender postpone your periods, but is not in it- and irritable. Polyurethane condoms self a reliable contraceptive. Breastfeed- are sold at chemists for people allergic ing will protect you against conception to natural rubber. if less than six months have passed The copper IUD is an intrauterine since the birth, your periods have not device that can be placed in the uterus started, and your baby feeds at least immediately after birth (10 to 30 min- eight times a day at regular intervals utes after the placenta is expelled). It is, (the gap between feedings should never however, recommended that the cop- exceed four hours) and does not receive per IUD be placed during the postnatal supplementary nutrition. The contra- medical examination to ensure it stays ceptive effect of breastfeeding dimin- in place properly. It can also be placed ishes rapidly if you feed your baby less at a later stage, even if your periods than seven times a day. If you do not have not yet started due to breastfeed- want to become pregnant, remember to ing. In that case a pregnancy test will use contraception whenever you have be performed before fitting the IUD. A sex. By the time the baby starts having copper IUD can be used for five years, supplemental food, contraception is but you can have it removed earlier if necessary to avoid becoming pregnant. you wish.

48 WE´RE HAVING A BABY | The birth Hormonal contraceptives containing within five days of unprotected sex. A only progesterone include mini-pills, copper IUD is more effective than the hormone implants placed under your pills and provides optimum contracep- skin, hormone IUDs and progesterone tion when left in place. injections. The advantage of a hormonal IUD is that its hormonal effect is local and only a small amount of hormone is Physical exercise released. Conventional combined oral After delivery, you can continue your contraceptive pills (COCP) are a com- normal exercise when you are feeling bination of oestrogen and progesterone, well enough. If you have had a caesar- which decreases milk production. ean section, be sure to begin exercising Chemical contraceptives, such as slowly, paying close attention to your foams, gels and sticks, may irritate the body. Regular exercise is refreshing and mucous membranes. If you have been helps in coping with your daily life and using a pessary, you may need to refit it in controlling your weight. If you are and use it in combination with contra- breastfeeding, physical exercise has no ceptive gel. effect on the quality or quantity of your Emergency contraception is also breast milk. called post-coital contraception or the Your pelvic floor muscles will be se- morning-after pill. It stops you from verely strained if you have given birth becoming pregnant if contraception to several children, your babies have failed or was not used. You can buy the been large, you have had a multiple pills from the chemist without a pre- pregnancy, or your second stage of la- scription. The pills are taken as a single bour was lengthy. Being overweight dose, preferably within 12 hours, but and smoking additionally burden the no later than 72 hours, from having un- pelvic floor muscles. If you suffer from protected sex. When taken within the varicose veins or piles, your muscles recommended time frame, this method may be predisposed to slackening. As is 98 percent effective. If possible, take a result, when doing sports or exercise an eight-hour break from breastfeeding involving jumping, your slackened pel- after taking an emergency contracep- vic floor muscles may release, causing tive pill. During this time, you can ex- incontinence. press milk from your breasts if needed You can begin exercising your pelvic and throw it away. After this break, the floor muscles on the day following the medicine level in your breast milk will birth. Additional information is availa- be very low. As the name “emergency ble on the websites of most maternity contraceptive” implies, these pills are hospitals. intended for occasional use, not as a As pregnancy progresses, the enlarg- regular form of contraception. ing uterus and the increasing pressure A copper IUD can also be used as in the abdominal cavity mechanically post-coital contraception if it is fitted stretch straight and other abdominal

The birth | WE´RE HAVING A BABY 49 muscles, causing the midline abdomi- your abdominal oblique muscles and, nal connection – the linea alba (white finally, your straight abdominal mus- line) – to stretch and expand. The muscles. cular separation can be small or large, up to over 10 centimetres. This is a nat- Further information (In Finnish): ural phenomenon that affects nearly all Jenni Tuokko & Mari Camut (2015). women during pregnancy. Liikkuva äiti – liikuntaa raskauden ja When exercising your muscles, it is vatsalihasten erkaantuman ehdoilla. important to proceed in the right order. www.trainingcorner.fi/Raskausliikunta Begin the exercises from the transverse Opas.pdf abdominal muscle. After this muscle has strengthened, proceed to exercise

50 WE´RE HAVING A BABY | The birth BABY CARE Start talking to your baby during the pregnancy. Although it will not be able FIRST MONTH to understand your words for some months, it will understand your tone of voice. A soft, calm voice creates a sense of security and hearing people talk will he most important person to help the baby learn how to speak. The the baby is the person caring way you handle your baby is extremely T for him. Without that person, important. Smile at your baby and talk the baby cannot survive. The intimate to it while changing nappies, bathing and positive relationship between a and feeding, and it will feel wanted and baby and the person caring for it is safe. This will provide a sound basis for unique. future development.

The baby seeks to interact Motherly and fatherly love From the moment of birth, the baby For most parents, their baby is the most seeks to interact with those around him. wonderful thing in the world. Howev- It is important to the baby that an adult er, it is not always a case of love at first can identify, share and name the feelings sight. Giving birth to a baby is exhaust- of joy, fear, anxiety and hurt the baby is ing and looking after the baby takes all experiencing. Eye contact, physical con- of your spare energy. Since the mother tact and speech are all important to the is absorbed in breastfeeding, the father baby. When this interaction functions may feel rejected and left out. Having well, the parent will be able to enjoy his a baby may also be totally different to or her relationship with the child and what the parents had anticipated. A the child will feel secure in the knowl- little individual changes everything, edge that the parent understands and making its demands known with loud accepts its feelings and needs. authority. This noisy little person may A baby never accuses its carer, never be a source of confusion and even ir- criticises and never makes comparisons. ritation, one’s feelings towards the de- A baby needs looking after and will al- manding little bundle may not always ways accept and become attached to the be entirely warm. person caring for it. From the very first Becoming acquainted with your new week, the baby will want to be where family member may be a slow process, the family is. Do not leave the baby in but eventually, as you care for your its cot. Holding, caressing and cuddling baby, you will become attached to it. the baby will help it grow accustomed Your love with your child develops to its own body and learn to control it. gradually and at different paces with Some clinics will teach you how to give different people. Experiencing extreme a gentle baby massage. emotional fluctuations is quite normal.

52 WE´RE HAVING A BABY | |The Baby birth care Suddenly amidst love, affection and A place for changing joy, you may be stuck by exhaustion, Babies enjoy physical closeness, to concern, disappointment and jealousy. which they got accustomed during preg- Learn to accept all of the feelings you nancy. Hold your baby a lot and in dif- and your partner may experience. Give ferent positions. Every once in a while, yourself time to adjust. You have an en- you can carry your baby in a sling or tire lifetime to love your child. carrier. Remember to support the baby’s head and neck, since a baby’s head is large and heavy compared to the rest of Both parents participate its body and its neck muscles are not Caring for a child is the responsibility fully developed. Handle the baby with of both parents. Looking after the new- slow, calm movements. Never toss a born is a rich, fulfilling experience for baby around, not even during play. both parents. Apart from breastfeed- It is possible to change nappies whilst ing, there is nothing the father cannot holding your baby in your lap, but in learn to do just as well as the mother. many cases a proper changing mat or At first, parents take care of the baby changing top is very convenient. Make together. Later on, it is important that sure the changing top has edges that they take turns. This will give one par- prevent the baby from falling. Ideally, ent the opportunity to relax while the the top should be placed at a height other is having some private time with where there is no need to bend, since the baby. The baby will get used to both the mother’s back in particular will be parents; their methods may be different sensitive to strain during the first weeks but equally correct – there is no need after delivery. for the mother to act as an interpreter Arrange the changing corner close to between the baby and the father. the baby’s cot or near the bathing area. The baby demands round-the-clock It is important to have all the changing attention which can leave both parents gear within reach, because you can- exhausted. When either of the parents not leave the baby unattended on the is at the end of his or her tether, the oth- changing top or the bed. The changing er should take over. Going outside for a area does not need to be heated, normal walk, taking a long shower or reading room temperature is fine (20–22°C). the paper while enjoying a cup of coffee can work miracles. When both parents are present, it often helps if you take Crying and comforting turns and communicate it clearly. The Crying is the way that babies express other parent is available but can relax that they are uncomfortable. By crying, for a while. Caring for the baby togeth- the baby may communicate hunger, er strengthens the relationship between a wet diaper or a stomach ache. Par- the parents as they share the love and ents will gradually learn to interpret joy the baby brings. the movements and sounds the baby

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 53 makes. Healthy babies cry during the It is helpful to respond to a baby’s early initial months. However, the amount of signs of hunger (opening its mouth, put- crying can vary a lot between one in- ting hands in mouth, sucking fingers) fant and the other, depending on factors rather than waiting for the late sign of such as the child’s temperament. Babies hunger, which is crying. Waiting until start to cry more frequently at the age the baby cries can make breastfeeding of two weeks, peaking at around 1.5 more difficult. If you are concerned months and gradually decreasing after that the baby is crying because it is that. This period is called the colic pe- not getting enough breast milk, contact riod. It is sometimes called the three- your child health clinic for breastfeed- month colic as it is usually over by the ing counselling and support. You can time your baby is 4 months old. Further increase the amount of breast milk by information on colic is available from responding to the baby’s early signs of a guidebook published by Väestöliitto, hunger, breastfeeding frequently and, if the Family Federation of Finland (in needed, expressing breast milk between Finnish and Swedish). feedings. If the weight gain is excessive in re- Colic crying lation to the baby’s height, the reason When a baby cries long and hard for sev- for crying may be too much feeding. eral hours a day, each day of the week, Too much feeding causes tummy ache the baby is said to be “colicky”. Despite and reflux (milk flows back into the the long and hard crying, colicky ba- tube that connects the mouth to the bies are usually healthy babies who are stomach). If colicky crying has been growing and developing normally. Col- interpreted as hunger, this has caused ic crying is mostly discontented com- a cycle of over-feeding. Try prolonging plaining and there are pauses. Constant the time between feeds using a dummy, crying or screaming starts suddenly taking the baby outside in the pram or without any apparent reason. Despite carrying it in a baby carrier. the crying, colicky babies get enough If a breastfeeding mother produces a sleep. Both breast-fed and formula-fed lot of milk and the baby feeds frequent- babies can have colic. Although colic ly, it is possible that the baby gets a lot and adding supplemental vitamin D to of low-fat milk. This can cause stom- the baby’s nutrition may coincide, giv- ach ache to the baby. Other symptoms ing your baby vitamin D supplement is include excessive urination, greenish not the cause of the colic. stools and rapid weight gain. In such a case, the mother should feed the baby A baby cries because of hunger, 2 to 3 times from the same breast to de- discomfort or stomach pain crease milk production. Crying usually signals hunger or dis- Remember to burp the baby proper- comfort, but sometimes there may be ly after feeding. Some babies swallow reason to investigate the matter further. a lot of air while feeding, resulting in

54 WE´RE HAVING A BABY | |The Baby birth care wind and regurgitation. The frequency disease that could explain the baby’s of bowel movements varies individual- fever, the baby’s fever may be caused ly. However, if the baby does not have by some other reason or lead to a more bowel movements at least every other severe condition. day, its stools are hard and the baby is Night-time crying is usually the hard- crying a lot, contact your child health est to bear and often makes the parents clinic nurse. Increased regurgitation re- feel helpless and worried. Babies cry quires medical attention, especially if even when they are being well cared your baby is not gaining weight prop- for. Parents of colicky babies should erly. It may be a case of reflux, where not accuse themselves of being bad or milk flows back into the tube that con- inexperienced parents. Sometimes, nects the mouth to the stomach (also the crying may seem never-ending and called GER, Gastro Esophageal Reflux) nothing seems to comfort the baby. Nev- or pyloric stenosis. Lactobacillus sup- ertheless, stay close to the baby while plements have been proven to prevent it is not well. It is important to identify babies’ stomach pain. solutions that will help everyone cope during this trying period. Once the col- Other reasons why babies cry ic period is over, things will calm down A rash may be the reason for crying. and taking care of the baby will become Child health clinics provide skin care even more enjoyable. information. Skin rash may be caused by milk allergy. If milk allergy is sus- pected, treat the rash and feed your Comforting a crying baby baby special formula milk according • Carrying your baby close, or in a cling or a to your doctor’s instructions. When the baby carrier making hushing sounds, gently rash is better, the allergy can be con- rocking the baby, giving a gentle massage firmed with a challenge test. Babies al- and soft purring sounds are comforting. lergic to dairy products may have either Taking your baby into a quieter room and skin or bowel reactions. swaddling her in a blanket may also be Consult your doctor if your baby has soothing. sudden or exceptional crying fits ac- • Try to stay calm while your baby is crying. companied by a fever, cough or respira- If you find you can’t stand the crying any tory symptoms. If your baby is running more, let your partner or some other trust- a temperature, you do not need to wait ed adult look after the baby for a while. Go for a doctor’s appointment to give the out for a walk, for example, and then give baby suitable medication that brings your partner a chance to rest. the temperature down. Take your baby • Caring for a crying baby is very trying. Take to the doctor if she is under 2 months turns and ask friends and relatives for help. old and has a fever or if you feel that the • Don’t get upset with your baby. If you child is clearly ill. Even if other mem- feel you’re going to lose your temper with bers of the family have a fever-causing your baby, take time out elsewhere in the

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 55 house. When the moment has passed, talk details” on page 98). If your baby has to your baby to let him know that it was been shaken, take it to the doctor im- only temporary and that now you are back mediately! to being your familiar self. Don’t feel angry with yourself; everybody loses their temper at some point. Instead, concentrate on how Visitors to cope in the future and how to secure Friends and relatives will be eager to enough sleep for yourself. Discuss this with visit and meet the new baby. Howev- your child health clinic’s nurse. er, if your visitors are suffering from a cold or other infectious disease, do not let them near the baby. If the parents Never shake your baby! are tired and do not want visitors, they Never shake or manhandle your baby, have the right to say it and ask the visi- no matter how upset or tired you may tors to come some other time. They can be. Shaking the baby is life threaten- also agree on a brief visit with no food ing, because a baby’s head is large and or drink being offered, or ask the guests heavy compared to the rest of its body to bring food with them. If needed, vis- and its neck muscles are not fully de- itors can help in other housework, too. veloped. When a baby is vigorously shaken, the head moves rapidly back and forth with great force. This sudden Maternal depression motion can cause bleeding inside the Postnatal hormonal activity may cause brain and behind the eyes. Immediate- emotional instability and mood swings. ly after being shaken, the baby may be The mother may feel depressed and sleepy, have trouble feeding and diffi- weepy, although everything seems to be culty in breathing, have convulsions going well. This is quite natural. Four or lose consciousness. The long-term out of five mothers suffer from “baby consequences of shaking a baby, such blues”, a mild case of postnatal depres- as total or partial blindness, learning sion which starts 3 to 5 days after birth difficulties and epileptic seizures, can and lasts for a few weeks. Symptoms in- be severe and permanent. clude being tearful and irritable, mood Never let the situation reach the point swings, and sometimes also loss of ap- where you feel desperate. It is not a petite and sleeping problems. This con- weakness to admit that you are exhaust- dition does not require medical treated and need help; seeking help is the ment. Support and compassion from mature, responsible thing to do. If you family and friends is enough. Talking feel at the end of your tether, contact about the situation with your partner or your child health clinic’s nurse or the a trusted friend usually helps, and the family workers in your municipality for baby blues pass as the mother’s gener- help. Other sources of help include oral condition improves due to sufficient ganisations and helplines (see “Contact sleep and healthy nutrition.

56 WE´RE HAVING A BABY | |The Baby birth care Approximately one in 5 women suffer baby’s grandmother or godparent, be from postnatal depression (PND). The invited as a “trusted adult” who will symptoms can last for several months. If learn to know the child from infancy. A the depression is not severe, the symp- good relationship between the baby and toms may go unnoticed or the mother the trusted adult will lower the thresh- may be ashamed and try to hide them. old for getting help, if the need arises However, you should seize the opportu- later. There are peer groups which can nity to talk about your feelings with the offer invaluable support (“Support net- child health clinic’s public health nurse works” on page 80 and “Organisations” or your doctor. If untreated, postnatal on page 98). depression can develop into long-term severe depression. In addition to caring for the mother, treatment is also vitally If there is a problem important to securing the well-being of Having a baby who is ill or has a disa- the baby. bility is an unexpected, painful reality Some health centres organise meet- parents can never be fully prepared for. ings where mothers receive peer sup- Nevertheless, even if different, the baby port and encouragement from mothers is your own and in these situations, par- in the same situation (See also ÄIMÄ ents often discover strength they never – the Association for Mothers Suffering believed they possessed. from Depression, website in Finnish, Feelings of bitterness, anger, disap- Swedish and English: www.aima.fi). pointment and guilt are quite common When the mother is depressed, the and sometimes your anger may be di- partner’s role becomes even more im- rected at your partner or the hospital. portant. On the other hand, partners Good days are not enjoyed for fear of may also have problems after the birth. disappointment. Parents may struggle Maternity and child health clinics offer against becoming attached to the child support for both parents. in the hope that should the baby not survive the loss would somehow be easier to bear. Allow yourself to love your Alone sick baby just as you would a healthy Being the sole parent unintentionally one. Savour the moments of joy – it will can be very hard. If you are left alone af- not be the cause of any disappointment ter a divorce, the death of your partner tomorrow. A sick baby needs the love or for some other reason, do not make and attention of the entire family even unreasonable demands on yourself. more than a healthy baby would. Be- Seek help and support from your family coming attached to your baby will not and friends, from the child health clinic cause you to lose it; and trying hard not or from family workers. to become attached will not save you If you are a single parent by choice, from consequent pain. it is advisable that a close friend, or the

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 57 The hospital staff, maternity and who have been in the same situation child health clinics, social workers and will be able to comfort and encour- and organisations for the disabled and age the parents. (See also “Services for their parents offer information and chronically ill or disabled children” on support in coping with this kind of sit- page 91.) uation. Many hospitals will also know the contact details of support families

BABY’S NUTRITION

Breastfeeding times when breastfeeding fails. How- A breastfeeding mother provides her ever, most breastfeeding problems can child with nutrition as well as physi- be solved, so do seek help. Do not hes- cal closeness. In addition to nutrients itate to contact your child health clin- vital for the baby, breast milk contains ic or maternity hospital at any time for antibodies, enzymes and growth fac- breastfeeding counselling and guid- tors that support the baby’s growth and ance. After the initial learning stage, development and improve nutrient ab- many mothers find breastfeeding easy sorption. In Finland, breastfeeding is and convenient. recommended at least until the child The father, friends and relatives play is one year old. Exclusive breastfeed- a key role in encouraging the mother ing is recommended until the age of six in breastfeeding. The more they know months, complemented with a vitamin about breastfeeding and they support D supplement. After this, breastfeeding the mother, the more likely it is that is continued alongside complementary it will succeed. In addition to positive feeding. feedback, the mother needs practical Contrary to common perception, help, particularly in the early stages of breastfeeding does not happen auto- breastfeeding. This includes household matically. On the contrary, it requires chores such as grocery shopping and knowledge, learning and practicing cooking. to succeed. Most mothers experience

58 WE´RE HAVING A BABY | |The Baby birth care Breast milk production tion in which she can rest while breast- The breast prepares for breastfeeding feeding. Often, the baby wants to spend during pregnancy. The number of lac- almost the whole second day feeding tating cells increases and the mother with only small naps in between. This experiences hormonal changes. Breasts ensures sufficient milk intake and the produce milk, which may leak already rapid increase of milk production. Usu- during pregnancy. ally, the amount of milk clearly begins Immediately after birth, milk produc- to increase on the third day and the tion is usually low, only a few drops at baby begins to develop a feeding pat- a time. This first day’s milk or colos- tern. trum is very nutritious and contains Some newborns, such as preterm or high levels of antibodies that protect small-for-age babies or babies of diabet- the baby against environmental patho ic mothers, may need complementary gens. Thanks to the nutrition reserve milk before the mother’s milk produc- accrued by the baby during pregnancy, tion begins to increase. These babies’ the small amount of breast milk is usu- blood sugar levels are monitored during ally sufficient for a healthy, full-term the first days. Skin-to-skin contact and baby during the first days after birth. frequent breastfeeding support healthy Milk production begins to increase in blood sugar levels. Even if the baby is approximately 3 to 4 days after birth. It given complimentary milk, you should is quite normal that the baby loses some continue breastfeeding it. Relatively weight during the first days and begins small amounts of complimentary milk, to gain weight as milk production grad- in addition to breastfeeding, are usu- ually increases. ally sufficient for the baby’s nutrition. You should breastfeed your baby When the mother’s milk begins to come every time it shows feeding cues. These in, complimentary milk can normally include opening its mouth, smacking, be discontinued. sticking its tongue out and sucking on If the mother and baby need to be its hands and fingers. On its first day of separated after birth or the baby is oth- life, a newborn typically sleeps a lot – erwise unable to breastfeed, you can particularly if the birth took a long time pump your breasts to initiate milk pro- – and may feed only a few times during duction. You should begin pumping the day. If the baby sleeps long and does within six hours from birth, prefera- not seem to wake up, it is advisable to bly while still in the delivery room. At put it into skin-to-skin contact under first, many mothers can only express a the mother’s shirt. This usually entices few drops. Even if this wasn’t enough the baby to take the breast. to meet the child’s need for nutrition, Towards its second day of life, the fresh breast milk contains high lev- baby perks up and wants to feed fre- els of antibodies that are good for the quently and for a long time. The mother baby. The best way to collect the small should try to find a comfortable posi- amount of breast milk expressed during

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 59 the first day is through manual pump- with one breast during one feed in other ing. As the amount of milk begins to times of the day. increase, you can start using a breast If after your milk has come in prop- pump. If the child is completely unable erly your baby continues to feed for a to feed, you should pump 6 to 12 times long time (over an hour) during each a day. The maternity hospital staff will feed, consult your child health clinic guide you in pumping. nurse. This may be because the baby is not properly attached to the breast or is feeding inefficiently. The duration of Frequency of breastfeeding each feeding can be shortened and milk Exclusively breastfed babies typically intake increased by improving the effi- feed 8 to 12 times a day, but this is sub- ciency of breastfeeding. ject to great individual variation. Some babies feed much more frequently while others feed less frequently but for a Breastfeeding positions longer time. Frequent feeding will guar- A good breastfeeding position enables antee sufficient milk supply for the baby. the mother to maintain a relaxed neck Start each feed with a different breast and shoulder area. You can use pillows first. If your baby seems hungry after to find a good position. feeding on the first breast, offer the sec- In the so-called biological breastfeed- ond. Particularly during the first days, ing position, the mother is in a semi-re- it is advisable to change the breast if the clined position (with pillows behind baby has fed on the first one for around her back and under her arms) and the half an hour and wants to continue baby is placed on her chest. The posi- feeding. If the baby still appears hungry tion is correct when the mother feels after the second breast, you can switch relaxed and does not need to stretch her back to the first breast, since its milk neck to see her baby. The infant must ducts have already produced new milk remain on the breast without the need while your baby was feeding on the oth- for you to hold it in your arms. This po- er breast. sition strengthens the newborn’s natu- After breast milk has begun to come ral reflexes to seek out the breast and in properly, a large portion of babies nurse. The mother’s both hands are free get enough milk from one breast during and she can help the baby to attach on each feed. Occasionally, the baby may the breast if needed. feed more frequently than usual and ap- In the traditional sitting up posi- pear more hungry than usual. This nor- tion, the mother must sit with her back mally stabilises after a few days of more straight. It is recommended to support frequent feeding. Some babies become this position by placing pillows behind unsettled in the evening and want to her back and under her arms. The moth- feed a lot. You may have to feed it sev- er takes the baby in her arms so that it is eral times in a row, even if it was happy fully facing her, body to body. The baby

60 WE´RE HAVING A BABY | |The Baby birth care is correctly positioned when its mouth The latch is sufficiently wide when is slightly below the nipple. • the baby opens its mouth wide when at- It usually takes some time for a new- taching on the breast born to open its mouth wide and attach • the baby’s chin touches the breast on the breast. Before this, the baby pre- • the baby’s cheeks remain rounded during pares itself and the breast for feeding the feed (they do not move inwards) by “pecking”, licking and rubbing the • the baby takes rhythmic sucks and you can breast. The baby can also suck its fist. see its upper jaw and ear move When the baby opens its mouth wide, • breastfeeding does not hurt the mother can pull the baby towards • the mother’s nipple is round after the feed. her breast. In this way, the breast goes sufficiently deep in the baby’s mouth and the baby is able to suck efficiently. Is the amount of milk In the reclined breastfeeding position, sufficient? the mother lies on her side and places Most mothers are concerned about the the baby next to her. You can support sufficiency of their milk at some point the baby by placing a pillow or blan- of breastfeeding. Normally, the amount ket behind its back to prevent it from of milk is sufficient if you feed the baby rolling on its back during feeding. How- frequently and it is able to suck effi- ever, do not put anything behind its ciently. Once your milk production has head so that it can freely move its head. begun, it does not suddenly end if you The baby’s position is correct when its continue breastfeeding. mouth is slightly below the nipple. However, milk production can decline due to factors such as major stress or the mother’s hormonal changes. This does Baby’s latch on the breast not harm a healthy baby in any way. The baby sucks efficiently and its milk It responds to the declining amount of intake is sufficient when it has a suffi- milk by wanting to feed more frequently. ciently wide latch on the breast. This This brings the amount of milk to its pre- also ensures that breastfeeding does not vious level within a day or two. hurt the mother and prevents her nip- The primary method of monitoring ples from chafing. sufficient milk intake is to weigh the A good breastfeeding position is im- baby on a regular basis. The baby will portant to achieve an efficient latch on lose weight in the first days after birth the breast. The baby must be sufficient- but will begin to gain weight at the age ly close to the mother (usually body of 4 or 5 days. Babies normally regain to body) and at the right height, i.e. its their birth weight within approximately mouth slightly below the nipple when 10 days. During the first months, the ba- feeding begins. This ensures that the by’s weight gain may be as much as one nipple goes deep in the baby’s opened kilo per month but will begin to slow mouth. down at the age of four months.

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 61 At home, you can ensure sufficient tion or a shallow latch on the breast. If milk intake by observing the baby’s needed, consult your child clinic nurse urine and stools. After your milk has for guidance on a good position. When come in, from the fourth day onward, the baby learns to take a deep latch on the baby should urinate at least 4 to 6 the breast, the ulcers will heal without times a day. The amount of urine should the need to discontinue breastfeeding. be such that the nappy is clearly wet If needed, the mother can use ibuprofen when you change it. On the first days, to relieve the pain. Follow the dosage the baby’s stool reflects its milk intake: instructions provided with the medi- the newborn’s green-black meconium cine. If breastfeeding hurts so that you turns yellowish at the age of four days. can no longer bear the pain, you can try If you are concerned about your ba- pumping the milk for a few feeds in- by’s milk intake, contact your child stead of breastfeeding. health clinic so that the baby can be weighed and you can receive guidance for breastfeeding. Breast engorgement, blocked milk ducts and breast inflammation Sore and chafed nipples As the amount of milk increases in the In the early stages of breastfeeding, nip- days after birth, your breasts will get ples usually get sore and your breast swollen. You can relieve this by breast- hurts when the baby begins feeding. feeding frequently. You can also wrap However, breastfeeding should not hurt a cooling gel pouch inside a towel and throughout the feed but the pain should place it on your chest. If the baby has lessen after about 10 seconds. If the difficulties in attaching to the swollen pain continues, the baby’s latch may be breast, you can soften it by manually too shallow. In such a case, gently de- pumping some milk before the feed. tach the baby from the breast and latch However, do not pump your breasts it on again. Varying your breastfeeding regularly since this may cause exces- positions may also relieve the pain. sive milk production. The symptoms After feeding, express a few drops of related to the milk coming in normally milk to protect your nipples. You can decrease in a couple of days. also treat your nipples with a special At some point, your breasts can be- cream. Choose a cream that does not come engorged with milk. This may be need to be removed before the next feed, caused by longer breastfeeding intervals since repeated washing makes your or the fact that something (such as your breast skin drier. Remember to wash bra or the strap of your bag) is pressing your hands before touching your nipples the breast, preventing it from emptying. – particularly if they are ulcerated! The symptoms of breast engorgement Ulcerated nipples are typically include the breast becoming red, warm caused by a poor breastfeeding posi- and painful. Other breast problems in-

62 WE´RE HAVING A BABY | |The Baby birth care clude a milk duct blockage. The mother (tel. 041 528 5582) and online forum. may run a fever that can be reduced by For further information and the service taking ibuprofen. The mother should hours of the helpline (in Finnish), visit also rest and drink a lot of fluids. The www.imetys.fi/in-english/. best cure is frequent breastfeeding. If the symptoms do not decrease within 1 to 2 days or they are severe (high Do not smoke or use alcohol fever and weakening of the general con- while breastfeeding! dition), the mother should seek medi- Both parents should give up smoking cal assistance. These symptoms may while pregnant and breastfeeding, if not be caused by a breast inflammation, for good. Nicotine decreases milk sup- which must be treated with antibiotics. ply. Nicotine levels in breast milk are Despite such medication, the mother three-fold compared to blood nicotine should continue frequent breastfeeding. levels. Furthermore, the presence of After a milk duct blockage or a breast nicotine in breast milk causes restless- inflammation, the breast may be sore ness and metabolic problems, disrupts for several days. the baby’s sleeping patterns and makes the baby cry. If you are unable to quit smoking completely, avoid smoking 2 Help with breastfeeding to 3 hours before and during a feed. The The mother may face challenges with same safety period of 2 to 3 hours also breastfeeding, particularly in its ear- applies if you are using nicotine gum ly stages: finding a good breastfeeding or other nicotine replacements. Never position may be difficult, the baby may expose your baby to cigarette smoke. have difficulties in achieving a deep Babies exposed to cigarette smoke can latch on the breast and breastfeeding can develop recurring respiratory problems hurt. Even if these challenges were not and coughing, and have a much higher substantial, they may cause uncertain- risk of developing asthma. ty, and knowing what is normal may be Breastfeeding women should avoid difficult. You can seek help with breast- alcohol since alcohol levels in breast feeding problems from your child health milk are similar to the blood alcohol clinic or from your peers, i.e. other moth- level. If the mother has consumed al- ers who are or have been breastfeeding. cohol, she should avoid breastfeeding Maternity hospitals and child health as long as she has alcohol in her blood. clinics provide breastfeeding support, in When breastfeeding, the baby gets ap- which a nurse specialising in breastfeed- proximately 5 per cent of the mother’s ing provides guidance and counselling. alcohol portion. The time it takes for Peer support is provided by the alcohol to leave the mother’s system Breastfeeding Support Association in depends on her weight. Although the Finland (Imetyksen tuki ry) through its baby’s exposure to alcohol remains low breastfeeding support groups, helpline in one-off or temporary consumption,

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 63 frequent and excessive use of alcohol der, prepare a fresh feed each time you by a breastfeeding mother may expose need one. the baby to harmful amounts of alcohol. Ready-to-use liquid formula can be stored in its original unopened and in- tact package at room temperature until Formula milk the expiry date. An opened package can Breastfeeding is not always possible or be stored in the fridge (+2°C to 5°C); its it ends before the child is 12 months contents must be used within 24 hours. old. Furthermore, not all mothers want Warm formula by standing the bottle to breastfeed. In such a case, feed the (or cup) in a bowl of warm water, run- child with infant formula until the ning the bottle (or cup) under warm age of 6 months and after that with a tap water or carefully in a microwave follow-on formula until the age of 12 oven. To distribute the heat evenly, stir months. Always follow the instructions the formula milk after warming it. Test on the package. To determine the right a drop of heated formula on your wrist amount of formula for your child, con- to make sure the milk is not too hot. Be- sult your child health clinic. cause milk easily goes bad and manu Feeding is a moment of care and phys- facturing defects may occur, always ical and emotional closeness for all ba- taste the formula milk before giving it to bies. For this reason, always hold your the baby. Discard any left-over formula. baby in your arms when bottle-feeding. Further information on bottle-feeding Let the baby set the pace of feeding, in is available (in Finnish) from a guide- other words, offer formula whenever the book (Pullonpyörittäjän opas) published baby shows signs of hunger (opens its by Väestöliitto, the Family Federation of mouth, puts its hand into mouth, sucks Finland, and is available online. its fingers). Do not force the baby to finish the bottle – stop feeding when you see signs that the baby is full, even if there is Burping and regurgitating still some formula left in the bottle. If the baby tends to have stomach prob- Good hygiene is very important when lems after feeding, burp it by holding it formula feeding. All feeding equipment upright against your shoulder. Burping must be kept clean. After use, rinse the may be facilitated by softly patting the bottle and teat with cold water, then wash baby’s bottom. them with warm water and dishwashing If the baby has gobbled his food down liquid. Finally, sterilise them in boiling and swallowed a lot of air, it may bring water for 5 minutes. No sterilisation is up some of the milk. If a bottle-fed baby needed after the baby starts solid food. is troubled by gas, you can try using a Read the instructions for prepara- teat with a smaller hole in it. If your tion and use on the formula package. baby has a tendency to regurgitate, try Always follow the preparation instruc- burping it in the middle of feeding to tions carefully. If you use formula pow- expel the air from its tummy. Once he

64 WE´RE HAVING A BABY | |The Baby birth care or she has started on solid foods, this Foreign micro-organisms easily cause will happen less frequently. diarrhoea so remember to keep dummies clean. Clean the baby’s dummy by boiling it in hot water for 5 minutes. Never suck a Water dummy clean in your own mouth. Other- You don’t have to give water to a ful- wise, the micro-organisms in your mouth ly breastfed baby, even in hot weather. will be passed on to your baby. For the Breast milk is the only hydration the same reason, take care that other children baby needs. Formula also provides suf- do not share your baby’s dummy. ficient hydration for the baby. Always run your tap on cold for a while before taking water for the baby’s Starting solid foods food or to give as a drink. Always use Breast milk normally provides suffi- boiled water until the baby starts solid cient nutrition for a healthy full-term food. Always use cold tap water; warm child until the age of six months. or hot tap water may contain microor- However, you should continue partial ganisms and other contaminants. There breastfeeding or formula feeding until is no need to give your baby juice or wa- the child is one year old. You can con- ter sweetened with sugar; such drinks tinue breastfeeding even longer if you will only harm the budding teeth and and your child wish to do so. accustom the baby to sweets. All children need solid food from the age of 6 months onwards. For children who do not get breast milk at all, solid Soothers, dummies, pacifiers food is started at 4–6 months of age. Pre- It may be wise to wait until you feel mature or low-weight babies may need breastfeeding is well established and complementary feeding earlier. Even if your baby is gaining weight. Rather you are exclusively breastfeeding your than automatically offering the dum- baby, you can start the introduction of my, wait for your baby to be fussy or foods at the end of a breastfeeding ses- discontented and in need of soothing. sion by offering the child tasting por- Continuous dummy use reduces breast- tions from the age of 4 months onwards. feeding, which may lead to insufficient Continue breastfeeding on your baby’s weight gain. A baby sucks the breast demand even if you start giving tasting with a different technique than its portions. Tasting portions expose the sucks a dummy. Not all babies will ever baby to new foods, which supports the need or want a dummy. maturing of the intestines and the de- In special situations, such as when the velopment of tolerance to new foods. baby is on the neonatal ward, a dummy Waiting until six months before intro- may be useful since it sooths the baby ducing solid foods may increase sus- when it is separated from its parents. ceptibility to allergies. Dummy use also promotes digestion.

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 65 An infant is ready to start tasting sold foods ing of fine motor skills of the hands and when mouth play an important role in learn- • the baby is able to control its head move- ing to eat. ments If your child starts solid foods at the • the baby is able to grab food and put it into age of four months, it is not yet able its mouth to feed itself. You can start introduc- • the baby is able to swallow solid food and ing solid foods by offering small tast- does not push it out with its tongue. ing portions of smooth pureed potato, vegetables, fruit or berries. At first, the Your child health clinic provides in- baby usually pushes the purée out of its formation and individual guidance on mouth with its tongue. It is important starting solid foods. that you do not force the child to eat but observe when the child indicates that he or she is full. Learning new tastes Getting used to solid foods takes time, From the age of 6 months onwards, you so be patient. If your baby refuses a new can offer solid food to your child at sev- food, try it again a few days later. Do eral meals of the day. The child learns not rush things – your child is slowly by imitating the other family members learning to eat and getting used to new and enjoys joint meal times with them tastes and textures. from an early age. For this reason, when the baby is learning to eat, you should bring it to the table to join in at family An expanding world of taste meal times. You can offer your baby the same foods You can start introducing solid foods as the rest of the family. When you are to your baby by offering it so-called cooking, set aside a small portion for finger foods. Give the baby soft foods your baby before adding salt and spic- that it can grasp with its fingers. Pieces es, and purée it if necessary. Do not add about the size of your own finger work any salt to your baby’s food during the well. Suitable foods include diced ba- first year. Avoid foods with a high salt nana, diced avocado, cooked parsley, content such as sausages, cold cuts, cooked carrot and fresh or frozen Finn- marinated meat/poultry, ready-pre- ish berries. Do not give hard or small pared foods and cheese as they also and slippery foods, such as nuts, whole contain high levels of additives and grapes or whole cherry tomatoes. preservatives. You can also offer spoon foods, such After the baby has eaten a few types of as pureed vegetables, berries or fruit, fruit and vegetables, you can add some and porridge. Even if an adult feeds the minced or pureed meat, fish or egg. A baby, it should be allowed to simultane- suitable first portion is approximately ously taste foods with its own hand and one teaspoon. Serve fish 2 to 3 times a own spoon. Development and practic- week because of the healthy fat it con-

66 WE´RE HAVING A BABY | |The Baby birth care tains. For under one-year-olds, 1 to 1.5 Ideally, offer your baby full grain ce- tablespoons of meat or fish per meal is reals cooked in water without salt. Add sufficient. Liver is not recommended puréed fruit or berries for taste. Whole- for under one-year-olds because of its grain pasta and rice are also suitable for high vitamin A content. children. Porridge is the most recom- Cooked vegetables can gradually be mended grain food for a small infant. supplemented with finely grated raw The infant does not need gruel at any vegetables and purées. In this way, your point, particularly when he or she is baby will get used to a wide variety of under five months old. The infant gets vegetables. Suitable vegetables include the nutrients of milk from breast milk carrots, cauliflower, sweet corn, sweet or, if not being breastfed, from formula. potato, cucumber and tomatoes. Towards the end of your baby’s first Do not offer babies under 12 months year, you can start giving him/her dairy any vegetables rich in nitrates, products. Suitable products include cultured dairy products such as low-fat including: curdled milk, natural yoghurt and but-  spinach termilk. During meals, a one-year old  beetroot child can drink skimmed milk.  various lettuces (including rocket) Rapid growth demands a lot of ener-  fresh herbs gy. Breast milk and formulas are rich  napa cabbage, kale, kohlrabi in fat. When the child starts eating  pumpkin (all types) the same food as the rest of the fami-  radish, celery, fennel ly, choose soft vegetable fats, oil and/or  sprouts low-fat (60–80%) vegetable-oil spreads.  root vegetable juices. Further information on food recommendations for infants is available All fruits and berries are suitable. in “Eating together – food recommen- Serve them puréed, grated or as a com- dations for families with children”, pote. Favour domestic berries. Wash available online at http://urn.fi/URN:IS- and peel imported fruit before use. All BN:978-952-343-264-2. imported berries must be boiled before use. You can add a moderate amount of sugar to sweeten sharp or sour fruit Vitamin D and berries. However, take care that All children need a vitamin D supple- your baby does not get used to very ment from the age of two weeks year- sweet food. Do not give honey to a child round. younger than 12 months of age because any bacterial spores contained in honey may begin to grow in the baby’s imma- ture intestinal tract. This hazard does not affect older children.

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 67 HOW TO DOSE THE VITAMIN D SUPPLEMENT?

Exclusively 10 micrograms (μg) 2 weeks – breast fed Vitamin D supplement/day* 12 months 10 micrograms (μg) A child is given less than 500 ml/day infant formula / Vitamin D supplement/day* follow-on 500–800 ml/day 6 micrograms (μg) formula** Vitamin D supplement/day*

more than 800 ml/day 2 micrograms (μg) Vitamin D supplement/day*

One year old 10 micrograms (μg) Vitamin D supplement/day*

*Vitamin D supplement throughout the year **Baby cereals (gruels) and porridges with added vitamin D are included in the quantity of infant formula/ follow-on formula. thl./d-vitamiinisuositus-vauvalle

Teething The first teeth (milk teeth) appear when the baby is about six months old. Chil- dren will usually have all their 20 milk teeth by the time they are three years old. With proper care, your child’s teeth can be kept healthy and totally free of decay. Keep harmful bacteria in check by controlling your child’s sugar intake. Start to brush your baby’s teeth as soon as they appear. You will receive advice on the need for fluoride from the child health clinic.

68 WE´RE HAVING A BABY | |The Baby birth care HYGIENE

Baby urine and stool Nappies For the first couple of days after the Disposable nappies are very convenient birth, your baby will pass a sticky, to use, but expensive over the two or greeny-black substance called meconi- three years that your child is in them. um. On approximately the fourth day Slow to decompose, disposable nappies when the amount of breast milk begins burden the environment. The advantag- to increase, the stools will turn mustard es of disposable nappies include very yellow. Babies younger than four weeks good absorbance, leaving the baby’s normally have bowel movements on a skin dry and thus preventing the risk of daily basis. Later, some babies develop nappy rash. If your baby has sensitive longer intervals and only have bowel skin or severe nappy rash, disposable movements once a week while others nappies will facilitate skin care. Many do it during or after every feed. parents choose to use both reusable and Before breast milk comes in, a new- disposable nappies on their baby, for born passes very small amounts of example, reusable nappies at home and urine. When the amount of milk begins disposable nappies when on the move. to increase 3–4 days after birth, so will There is a large variety of nappies to the amount of urine. After this, a suffi- choose from. Further information is cient amount of urine indicates that the available on baby care websites. baby is getting enough milk. It should urinate four to six times a day, the urine should be pale in colour and the nappy Nappy changing should be clearly wet when you change Change your baby’s nappy about as of- it. ten as you feed him – newborn babies Normal stools smell sour but not un- wet their nappies frequently. Rinse pleasant. Often the stools of breastfed your baby’s bottom with warm water. If babies are greenish and runny. This only urine is passed then washing is not is not a symptom of diarrhoea. If your required. Carefully dry your baby’s bot- baby has diarrhoea, the stools will have tom. Apply a thin layer of barrier cream a terrible smell and be completely ab- after washing, if needed. Use a basic lo- sorbed into the nappy, leaving a green tion. Do not rub it in forcefully, but pat stain. it gently onto your baby’s skin. Change nappies as soon as you can to protect your baby’s skin from the irritat-

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 69 ing effect of urine and stool. If your baby to splash water into its eyes. Wash its has very sensitive skin, change nappies neck, armpits and folds in the skin with frequently. When using reusable nappies special care. on your baby, make sure that the detergent When you’ve finished, take your baby you use does not irritate the baby’s skin. out and pat him or her dry with a towel. Let the baby be without a nappy every Use your baby’s own towel. Pay special now and then as constant dampness attention to the elbows, knees, armpits only irritates the skin more. Let him or and other creases. If your baby’s skin is her have a good kick without a nappy in smooth and does not seem dry, there is a warm place. no need for body lotion. If the skin is dry or red and chapped, apply a thin layer of fragrance free baby barrier cream. Baby cleaning and bathing In addition to the nappy area, clean the baby’s face and skin folds on a daily ba- Hair, scalp and nails sis. Use a small cleaning cloth or equiv- Wash your baby’s hair during the bath. alent to clean the baby’s face, armpits Many babies develop cradle cap, an and behind the ears. Also clean the ba- oily, yellowish crust on the newborn’s by’s hands every day. scalp. To remove the crust, apply basic Bathing is recommended every 2 to 5 lotion or baby oil to the scalp before days. Daily bathing may dry the baby’s bath and let it soak for a few minutes. skin too much. Do not use soap because After washing the baby, scrape the it depletes the skin’s natural oil protec- crust gently off using a baby brush or tion. If your baby has very dry skin, add comb. Brush the baby’s hair daily. The a drop of oil to the bath water. Do not use soft spots on the baby’s head where the bathing salts. Never bathe a sick child. skull has not yet fused (fontanels) do Your baby needs a bath tub that is not not need special attention. used for any other purpose. Bath water The nails of a newborn are often too should be at body temperature (37°C). long. However, due to the risk of cuticle You can check the temperature with a infection it is not recommended to trim bath thermometer. At first the bathing your baby’s nails during the first week. time will be very short, but after a cou- If you worry about scratching, use cot- ple of week babies usually start to enjoy ton mittens on its hands. After the first bathing and are happy to take longer week, trim the baby’s nails when need- baths. Often babies find bathing very ed. This is easiest to do when the baby soothing. Bathe your baby using calm, is sleeping. confident movements. Bathe your baby from the head down- wards. With your free hand, gently wash your baby’s head taking care not

70 WE´RE HAVING A BABY | |The Baby birth care Sauna Laundering your baby’s clothes Do not take a baby under six months The best detergent for washing baby old into the sauna. Under six months clothes is fragrance-free or only mildly old, babies cannot control their body scented. Wash new baby clothes before temperature by sweating. If your baby they are worn for the first time. When enjoys a sauna when it is older (6 to 12 measuring the detergent, follow the in- months), you can sit with it on the low- structions on the detergent packaging to er bench if water is not thrown on the ensure clean clothes without traces of stove. Splash lukewarm water over the detergent. baby’s head.

BABY SLEEP

here is individual variation in Settling to sleep the need for sleep and sleep- Most newborns go to sleep after feeding. T ing rhythm – even among When you’re trying to settle your baby to newborns. During the first weeks, most sleep (or back to sleep after a night feed) babies sleep a lot and only wake up be careful not to excite it. Loud voices, to feed every one to four hours. At two bright lights and playing with the baby weeks, babies usually start staying awake by trying to make it laugh will wake a to socialise for longer time periods. A baby that was already half asleep. three-month-old is awake for 6 to 8 hours Rocking the baby in your arms and a day. Try to teach the baby a sleeping humming quietly will help your baby pattern that matches the sleep-wake rou- fall asleep. It is not necessary to hold tines of the other members of the family. your baby until it is fast asleep. Instead, The best place for the baby to sleep is in you can put it to bed when it’s sleepy its own bed in its parents’ room. and relaxed, but still awake.

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 71 Prams are the modern alternative to ent puts it to bed. During changes such cradles and swaying the pram or mov- as weaning, the cot toy provides coming it back and forth will help your fort and security, substituting to some baby fall asleep. Watch your baby for extent for the carer’s presence. signs that it is tired. Putting your baby to bed while it is wide awake and sociable will not make it sleep. You cannot Sleeping problems force sleep. Tummy troubles and wind are common reasons for sleeping problems. Sleeping problems may also be caused by letting Sleeping position the baby stay for long periods of time in According to current research, placing bed while awake. On the one hand, not your baby on its back until he/she is receiving sufficient attention during the able to turn over independently reduc- day may lead the baby to demand its es the risk of cot death, or SIDS (sudden share at night. On the other, excessive infant death syndrome). If the baby’s stimulation and too much attention will head is always in the same position prevent the baby from sleeping and it when sleeping, its skull may become will become overtired. asymmetrical. You can vary the head A child’s sleep is often disturbed position by alternating which side you when it learns to crawl and walk. Ex- turn its head to when putting it to bed. cited by new experiences and skills, the Place interesting objects that the baby baby is slow to relax and calm down. likes to look at to different sides on Changing from crib to cot may also different nights, or change the place of cause sleeping problems. If the baby is the bed in the room. There is no need used to sleeping in a crib, try draping to change the baby’s position when it’s the sides of the cot to pacify it. Babies sleeping. To avoid deviations in head do not usually require absolute silence shape, do not sleep the baby in a car in order to be able to sleep, but it will safety seat except when travelling. prove to be difficult to sleep if the television is loud. Falling asleep in a very light room may be difficult for older Cot toy children in particular. At a few months old, many babies like to have a soft toy or blanket to cuddle when they go to bed. Sleep is a form of Night-time nappy changes parting and may sometimes be difficult Changing the baby’s nappy during the to endure for the baby. A soft toy or night is not necessary – at least not with blanket will help soothe your baby to every feed. If needed, change the nappy sleep. Remember the cot toy when your quietly before feeding. Keep the lights baby is staying overnight somewhere dim, minimise talking and do not en- else or when someone other than a par- gage in play that will stimulate the baby.

72 WE´RE HAVING A BABY | |The Baby birth care Sleeping outdoors baby tight inside its sleeping bag and Many babies sleep best outdoors where check that its cheeks stay warm. The the fresh air enhances deep, sound baby can sleep outdoors a little longer sleep. Summer babies can be put out- every day until it eventually takes all doors to sleep during the first week. day-time naps outdoors. Place the pram in a cool, shady place In rainy and windy weather, put the and make sure it cannot tip over or start hood up and pull a rain cover over the rolling downhill. Drape a mesh net over pram. Place the pram in a sheltered the pram to protect your baby from in- place. Strong wind will make temper- sects and other animals. atures below freezing even more chilly. In the winter, wait until your baby During the spring and summer months, is about two weeks old before he/she take care not to place the pram in direct starts to sleep outdoors. Do not let your sunlight in order to protect the baby baby sleep outdoors if the temperature from heat suffocation. is under -10°C. In cold weather, be care- Discuss a preterm baby’s outdoor ful not to apply cream or lotion contain- sleeping with your child health clinic’s ing water to your baby’s cheeks as it will nurse. freeze and damage the skin. Tuck the

GROWTH AND DEVELOPMENT

The baby enjoys company There is no need to “train” your baby or Your baby will closely observe its en- invent abundant stimuli. vironment from birth. There are many A newborn needs to interact with oth- things it will only be able to learn from er people in order to develop into a bal- others and your company is therefore anced human being. When you interact very important. To secure your baby’s with the baby and respond to its com- healthy development, you only need to munications, the baby learns to observe do what comes very naturally to most its environment, structure its sensa- parents: talk to the child, hold it, rock tions, perceive its feelings and express it in your arms, move its arms and legs, itself. Gradually, the baby gets to know sing, hum, show it the things in your itself and how its actions affect others. home, introduce it to other people etc. The parents should reflect on their own

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 73 behaviour and, for example, their use of Children develop in their own media, so that they will also have time time and resources for genuine interaction To secure your child’s development, al- with the baby. low for its needs and show that you accept and love it just the way it is. Feed your baby when it is hungry and let Babies are strangers to your baby sleep when it is tired. If your themselves baby shows interest in some object, en- During the initial months, the baby’s courage him or her to examine it. Since concept of itself is very vague. It cannot your baby will mainly examine the ob- distinguish itself from its environment, ject with its mouth, make sure that the and thinks it is part of its mother and things you give it are safe. the surrounding environment. The baby Children develop in their own time is not fully aware that its hands and legs according to their genetic and environ- are part of it, but that its mother’s breast mental influences. The following table and its own blanket are not. In order depicting child development provides a to discover its boundaries, it will need rough guide as to the order and age in your help. When you are holding your which children will reach a certain stage baby, for example, it will feel his own or learn a particular new skill. However, weight against yours. Such experiences there is great variation between different will gradually make it aware that it is children. The same child may be fast to an entity separate from its environment. develop in one area and slower than average in another. Sometimes several new skills may be learned in a single week, Children are born unique and these same skills are then practiced Each baby has his own, unique features over the following weeks. and habits which are relatively perma- Noticing and being happy about how nent. These personal traits are called your child grows and develops and of- temperament. Temperament includes fering support and encouragement in characteristics such as patterns (sleep- learning new skills is very important to ing pattern), patience, calmness, activi- the healthy development of your child. ty, restlessness and the ability to adapt When your baby has just learned how and concentrate. Different moods such to roll over, play with it on the floor in- as being irritable or proneness to neg- stead of sitting it in the baby bouncer. ative feelings, curiosity, courage and Allowing the baby to grasp objects that being shy or reserved in new situations interest it is a kind of dialogue with the are also components of temperament. baby. Girls and boys should be allowed From the parents’ viewpoint, the child to play the same games. may have a sweet or difficult temper- You can try to allure a baby who is ament depending on how easy or de- slow to warm up to new things, but too manding the baby is. much ambition and parental desire to

74 WE´RE HAVING A BABY | |The Baby birth care speed up the baby’s natural course of Your baby’s senses development may be harmful. Compar- A newborn does not see very clearly. ing your child to others is unnecessary. What it sees best is the face of a person It is more important that the baby is de- close by. Babies enjoy looking at things veloping and that things are not com- and seeing them move. Hang colourful pletely forgotten once learned. objects (such as pieces of cloth) or a mo- Problems at birth or later infections bile about 50 cm above the crib. may slow your baby’s development. For Many babies squint during the first this reason, a so-called corrected age is months. However, their sight develops applied when assessing the develop- fast and the child enjoys observing its ment of preterm babies. environment. Babies usually find pictures of familiar everyday items very interesting. You Height and weight can start “reading” picture books with At birth, babies usually weigh 3,000 to a 2-month-old. You can also make your 4,000 grams and are 49 to 52 cm tall. baby its own little photo album with During the first few days their weight pictures of mum and dad, its sisters and drops by 6 to 8%, but is regained with- brothers, grandparents and other famil- in a couple of weeks. Afterwards, the iar people. weight should increase by 150 to 200 Newborn babies have rather good grams per week. By the age of one year, hearing. Many newborns recognise most children weigh roughly three their parents’ voice right from their times their birth weight and are about birth and calm down when they hear 1.5 times as tall. a soothing voice or singing. Babies are However, there is great variation in easily startled by loud noises. this. A newborn can weigh anything Babies usually enjoy music and are an from 400 to 6,000 grams, and future appreciative audience for any musical growth and development expectations performances by other family members. depend on matters such as the birth Do not hesitate to make up your own weight in relation to the weeks of preg- songs, however silly this might feel. By nancy. For a child health clinic, growth the time they are a few months old, ba- charts are an important tool when mon- bies are aware of rhythm and dance and itoring your baby’s growth and its rela- jiggle in time to music. However, do tion to the size of the parents. During not leave a radio or television on all the the baby’s first year of life, the most im- time. Constant noise is stupefying and portant growth indicator is the baby’s makes music less enjoyable. weight. Height is clearly less important Newborns have a keen sense of smell. since at infancy a child’s height growth Babies smell breast milk, and this famil- is still inconsistent. If you wish, you iar smell calms the baby. can make your child’s growth chart at www.kasvuseula.fi.

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 75 Movements ever, babies do not like rough handling, Your baby will start holding its head rough play, sudden movements or sud- up during the first months. Before that, den noises. For instructions on how to support the baby’s head whenever hold- exercise at home with your baby, con- ing it. It will learn how to turn onto its tact your child health clinic. Mother tummy at the age of 3 to 5 months and and baby exercise and yoga classes are sit up at the age of 6 to 8 months. After available in many municipalities. Baby 6 months, your baby will start crawling swimming is also a fun form of family on its tummy. Some babies may start by time. The ideal time to start is when crawling backwards. A short while after your baby is 3 to 5 months. this, your baby will learn to crawl on all fours and will be very quick at moving around. At 7 to 9 months, your baby Touch and grasping will pull itself up to stand using sup- The mouth is the baby’s most sensitive port, and succeed without support after body part. Babies explore the world a few months of practice. About one in though their mouths by sucking on every two babies takes its first steps be- everything they can reach. A newborn fore its first birthday. holds its hands clenched in a fist. Lat- You can sit your baby in a baby er, its hands will relax and the fingers bouncer for short periods at a time as splay out. At the age of 2 to 3 months, long as its position is relaxed and its babies start grasping objects with both head is supported. A car safety seat is hands, putting them into their mouths. not a baby bouncer and should only be Make sure that the things your baby can used in the car. Be sure not to let your reach are not toxic or dirty, and that they baby be in a baby swing or walker for are big enough not to suffocate it (avoid extended periods at a time. Being in the string, rubber bands, buttons etc.). same – possibly incorrect – position for Around the age of six months, the a long time is a strain on your baby’s baby will grasp an object with one hand back and hips. If you wish to promote and move it from one hand to the oth- your baby’s development, allow it to be er. A further developmental stage is for on a blanket that is spread out on the the baby to pick up objects between its floor as much as possible or carry it in thumb and forefinger. This is called the an ergonomically designed baby carrier. pincer grasp. Play with different tex- If the baby always sleeps with its head tures, letting your baby touch smooth, in the same position, for example, if hairy, soft and hard surfaces, feel wood you sleep it in a car safety seat, this can and stones etc. In this way, your baby adversely affect its head formation (see will learn what the world feels like. “Sleep” on page 71). Babies enjoy being held, bounced and lifted, and like swinging and having their hands and legs moved. How-

76 WE´RE HAVING A BABY | |The Baby birth care Baby’s development during the first year (deviations are common)

Age Sociability and Physical Hand Eye sight and speech development movements hearing 0–1 random, involun- moves arms and hands mostly cannot see clearly, months tary smiles, direct legs simultane- clenched in a fist startles at loud eye contact ously noise and bright light 2–3 first real smile, holds head up, catches hold of turns head months makes baby kicks with both things using both towards sound, sounds (ah, goo), legs simultane- hands, studies follows moving is sociable ously own hands object with eyes 4–6 laughs out loud, pushes arms up picks things up recognises a months recognises the straight, turns, sits with one hand, picture of a face, person caring for supported palm grip studies colourful him, first attempts images at play 7–8 distinguishes sits without moves toy from no longer squints, months between familiar support, rolls over, one hand to the seeks hidden and unfamiliar crawls (sometimes other, pats table objects people, knows 2 backwards) with hands to 3 simple words, repeats sounds such as dadada etc. 9–10 is shy of strangers, crawls on all picks up objects looks at images, months first words fours, pulls up to between thumb notices objects stand and walks and forefinger sized 1 to 2 cm with support 11–12 can say 2 to 3 stands without throws objects turns towards a months words, interested support, first steps about, claps whisper, recognis- in other children hands es objects from images

Learning to talk important that people taking care of the One of the most important things a baby talk a lot to it. At first, your baby child learns from others is how to will respond with baby sounds. At six speak. Before learning to talk, it will months, your child may know a few need to hear a lot of talking from peo- words even though it cannot speak yet ple around it. Therefore, it is vitally itself. It may, for example, know how to

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 77 point to its own mouth if asked to do so, just to mention a few. There may come a provided the parts of its body have fre- time when the bilingual child refuses to quently been pointed out to it. At 7 to 8 use one of the languages. Nevertheless, months, your baby will start to repeat continue speaking your own language syllables and babble. Children normal- even if your child does not answer in it. ly utter their first word when they are Learning two languages takes more 10 to 13 months old. time and effort. Be patient and give the Being able to express itself in words child time. Also, show that you are in- and understanding speech help it gain terested in both languages. For more a better understanding of the world. A information on bilingualism, contact child who understands what is said to your child health clinic. For more in- it is easier to guide and will learn things formation on the Swedish language, more quickly. Just talking to the baby is, contact Swedish language day care however, not sufficient for teaching it centres and the Swedish Assembly of to speak; you need to have a conversa- Finland (Svenska Finlands Folkting, tion adapted to the situation and feel- www.folktinget.fi) ings at hand. In practice, this might be interpreting the baby’s feelings aloud, putting questions to the baby and ex- Toys plaining things. Use rich, versatile and Infants under one year old like to play correct language when talking to a baby. with rattles, soft toys and balls. Many Besides baby talk, your child needs to of your household items are suitable hear ordinary speech in order to learn as toys, such as plastic containers and to pronounce words correctly. their covers, empty plastic bottles, scoops, cotton reels and so on.

Bilingual families Make sure they do not have: If you and your partner do not share  sharp edges, the same mother tongue, you may want  little pieces that can come loose, your child grow up bilingual. Both parents must consistently speak only their  toxic paint, own mother tongue with the child. In  strings or bands, or their discussions with each other and  anything that will break or crack. other people the parents may use the language they are accustomed to. Usually, one of the languages develops more quickly than the other. By the time your child is a toddler, its linguistic skills may have developed in many ways. By singing, playing, looking at picture books and reading fairy tales –

78 WE´RE HAVING A BABY | |The Baby birth care balance work and family life so that after the working day you still have time DAILY ROUTINES and energy to enjoy your family. Avoiding major changes and “pro- jects” during the early months with a new baby will make family life much New challenges less demanding. The fewer matters you Being a new parent is a wonderful, hap- need to attend to, the easier it will be py experience, but it also means facing to arrange your time and daily routines new challenges. The baby cannot be with the baby. All in all, you will need left alone anywhere and its needs must to pay more attention to how you are be attended to. You can take your baby spending your time. You will need to along to most places, as long as you agree on “my time”, “your time ” and are able to accommodate its sleeping “our time”. and feeding patterns. When you have a If you begin to feel that your daily tasks baby, you need to accept certain limita- and chores are becoming a burden, try to tions. Leaving the house will generally divide them into tasks that can be left for take much longer than before. You need later and tasks that must absolutely be to plan and then pack the baby gear ac- done now. In addition to caring for the cordingly, and just as you’re ready to baby, you need to save your energy for step out your baby may need a feed or caring for yourself and your relationship nappy change. with your partner. Do not make unrea- Caring for your baby involves repet- sonable demands on yourself or on your itive routines that enhance the baby’s partner; perfection is not a requirement sense of security, but which are very for good parenting. Remember that your binding for the parents. Feeding, chang- life need not be a sequence of exhausting ing, washing and putting the baby down routines. Little surprises and shared mo- to sleep often interrupt other activities. ments with your partner will break up This can sometimes be very frustrating. the routine nicely. Although rewarding, caring for your baby can also be exhausting, especially if your baby wakes up many times Brothers and sisters per night, leaving you with insufficient When the baby arrives, your older chil- sleep, if your baby cries a lot or has a dren may suddenly seem very compe- demanding temperament. tent. Do not expect them to suddenly be During the baby’s first year, it is very more mature; they do not grow bigger important that both parents have some overnight. A new baby in the family is time to themselves. However, do not a change for the older children as well, fool yourself into thinking that you can not just for the parents. For some, the participate in activities and go out with most trying time is when the baby is friends as actively as before. Also try to born, while for others the difficulties

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 79 begin when the baby starts moving This passes more quickly if they are around. The child may be very enthu- allowed to pretend to be a baby for a siastic and eager to participate in car- while, although this may feel like a nui- ing for the new baby, while also being sance. Try to spend time with the new jealous. Children’s feelings of jealousy big sister or big brother. Set aside a time have been compared to a situation of the day to be with him or her while where your partner would bring home the baby is sleeping or with the other a new husband or wife. parent. Also, allow the child to partici- Due to such jealousy, older children pate in taking care of the baby. He or she may be very angry at the baby, whereas can sort out the baby’s things or hold the others may start pretending to be babies baby while sitting on the floor, a chair themselves. Such reactions include or on the sofa. Give the older child a wanting to sit on your lap when you baby doll that it can nurture while mum start feeding the baby. An older child or dad is looking after the baby. may start wetting its pants again and Refer to the baby as “our baby” to em- demand to be treated like a baby. The phasise that the baby is a family mem- child may become tearful, demand a ber. Remember to frequently tell your dummy, want to sleep beside the par- children that you love them and that ents or be very quarrelsome. they are very important to you. Praise An older child may try to hurt the baby the older children for the things they by hitting or pinching it. Naturally, broth- can already do and which the baby is ers and sisters cannot be allowed to tor- only just learning. ment the baby and you must put an end to such behaviour very determinedly. The child may also express hopes of the Support networks baby dying or being given away. This may In addition to your relationship as a sound terrible to the parents, but it helps couple, the new baby has an impact the child to let off steam. This stage pass- on other people as well. A new baby es more quickly if the parents understand creates grandparents, aunts, uncles, the older child’s pain and find the time to cousins and godparents. Parenthood is listen. When your child says, “I wish the an experience that binds different gen- baby was dead”, you can reply by say- erations but also poses new challenges. ing, for example, “I know you’re angry Society as well as beliefs and views with the baby and that you wish it had on child rearing and baby care have never arrived. Do you feel like I’m not changed over the years, which may spending enough time with you? I love create conflicts between the new par- you just as much, but I do need to take ents and the older generation. Despite care of the baby as well”. the number of differences there are also Older children may be cross just be- many opinions that are shared. cause the parents no longer spend so When you become a parent, you begin much time with them – which is true. to view your own parents from a new

80 WE´RE HAVING A BABY | |The Baby birth care perspective. At best, the relationship is er’s children. In many locations, organ- one of mutual respect. Becoming a par- isations such as MLL (the Mannerheim ent often stirs up feelings and memories League for Child Welfare) and Väestöli- from your own childhood. Talk about itto (the Family Federation of Finland) them with someone and, if they are very offer short-term child care for a fee. distressing, seek professional help. In many families, grandparents are naturally an important part of the fam- On the move with the baby ily and are glad to participate in car- Don’t be afraid of going out with the ing for the baby. Often, caring for their baby. You can put the baby into the grandchild brings back memories from pram or carry it in a sling or a baby the time their own children were small. carrier while you walk. You can safely It is often easier for grandparents to dote transport the baby on a bike by using a on their grandchildren than they did on bike trailer or a cargo bike. When you their own children. If doting turns into go out to run errands or meet friends, spoiling, it may cause friction between make it a habit to go by foot or by bike, the parents and grandparents. Tactful at least for some of your journeys. Dai- grandparents will understand that the ly exercise will help you recover from young parents need to make their own childbirth and get some fresh air. Grad- decisions, and will not interfere unless ually familiarise the baby with different invited to do so. In conflict situations, modes of travel and transport. Remem- each parent should carefully broach the ber to dress for the weather and use the subject with his or her own parents. It appropriate safety gear. is good to remind the grandparents that, Public transport is convenient for in your family, both parents have equal longer journeys. Read the instructions responsibility in child caring and rear- of your local public transport system ing and that you respect gender equal- regarding the transport of prams and ity. pushchairs. In many major cities, children under 7 years of age and an adult with a baby in a pram or pushchair can Short-term child care use public transport free of charge. In Friends and relatives can offer invalu- local buses, a parent with a pram or able help when the parents have some- pushchair normally gets on and off the thing they both need to attend to. How- bus through the middle door. The baby ever, not all families have close relatives travels safely in its own pram. Put the living nearby and even if they do, they pram brakes on, stay close to the pram may be very much engaged in their work and make sure that it does not slide or and social life. In such cases, the avail- fall over. In long-distance buses, prams ability of other forms of support is par- are normally put into the cargo space. ticularly important. Families with young children can agree to babysit each oth-

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 81 SAFETY

ccidents often take place in and other toxic materials. the home. For safety in the • nails and other thin objects the child might A home, read the following pre- stick into electric outlets. Use plugs in un- cautions. used outlets or install safety sockets. • toys with small, loose parts and button Never leave a child unattended cell batteries which can block the child’s • on a changing top or a bed without sides. airways. • in a bath. Always make sure the water is not too hot and that hot water does not Check that your baby gear, such as the drip from a leaking tap onto your baby’s changing top and pram, are safe and in head. good condition. Be aware of any heavy • in a room where a window or balcony door objects the child could pull on top of it is open. Place guards on the windows. from the table or shelves. Make sure the • in the kitchen when something is cooking child cannot overturn the bookcase. on the stove or in the oven. Always turn Keep a keen eye on your child when pot and pan handles inwards. Buy a cooker you are visiting somewhere. If your guard to cover the stove’s burner knobs. hosts do not have young children, they will most likely not be prepared for lit- If your baby is sitting on your lap at tle explorers eager to touch and taste the table, ensure that he or she cannot everything. pull hot drinks or hot food onto him or Never leave a child who can move herself and be scalded. around alone in the pram. It could climb out and fall. Make sure no ani- Always place the following out of reach of mals get into the pram children • plastic foil and plastic bags (risk of suffo- Safety in the car cation). • The safest place for a child under three • sharp or fragile objects. Place knives and years old is a rear-facing baby or child seat. other tools out of the reach of child. Use Just hitting the brakes can be enough for locks or guards on cabinets and drawers. your child to be injured. If this is not possible, tie the cabinet doors • Fasten baby and child seats according to and drawers with string or remove all their instructions. Children must travel with handles. the appropriate restraints and sitting in • cigarettes, alcohol, medication, cleaning their own seats (travelling by car sitting agents, paint, detergents, insect repellent on an adult’s lap is forbidden). Never use

82 WE´RE HAVING A BABY | |The Baby birth care rear-facing baby seats in a seat fitted with Further information on injury preven- an active front airbag. An inflating airbag tion is available on the website of the can be life-threatening to a baby. National Institute for Health and Wel- • Never leave your child unattended in the fare at https://www.thl.fi/en/web/ car. On a very warm day in particular, this injury-prevention can be fatal.

WHEN THE BABY IS ILL

Common colds and stuffiness of one year old. This is due to their soft the nose windpipe cartilage. A baby may expe- Newborn babies breathe through their rience its first viral infection early on nose. If the nose is stuffy, feeding be- if family members are suffering from comes problematic as it is difficult to colds or the baby is born during an ep- suckle and breathe at the same time. idemic. Saline drops, nose drops, an You can treat a stuffy nose with saline elevated position and frequent feedings drops. If needed, a small nasal aspirator will make the baby feel better. See your is used to remove mucus and snot from doctor if your baby is very small or is the baby’s nose. your firstborn, or if the symptoms per- Stuffiness will pass with time, but sist. Smoking should be avoided in fam- some children tend to get milk up their ilies with children, as cigarette smoke nose while feeding. Accompanying irritates the nose, throat and respiratory stuffiness, yellow mucus can build up tract. in the corner of the eye and the eyelids may stick together, as blocked tear ducts prevent normal flow. If stuffiness con- Cough tinues and the baby is uncomfortable, Colds are frequently accompanied by contact your doctor, since prolonged a cough. When something irritates the stuffiness may cause ear infections, throat, the baby will try to remove it by even in babies. coughing. A cough following a common Some babies sound wheezy, particu- cold may last for weeks. A prolonged larly after feeding, until they are about cough without fever may be a sign of

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 83 an ear infection. Contact your doctor doctor. Children under six months of if your baby has a barking cough ac- age never have feverish convulsions, so companied by shortness of breath and a the cause for these must be diagnosed high fever, as you may need respiratory without delay, particularly with young medication. infants.

Fever Diarrhoea On average, under three-year-olds have Baby stools tend to be rather runny and 5 to 6 common colds or respiratory in- this should not be viewed as a symptom fections per year. A fever does not need of diarrhoea. Baby stools can be less sol- to be treated, but you can give the child id than normal during respiratory infec- pain medication if his or her food and tions. If your baby has diarrhoea, their drink intake is inadequate, or the child stool will have a horrible smell and be is restless, irritable or in pain. Paraceta- completely absorbed into the nappy. Di- mol and ibuprofen in the form of a syr- arrhoea is more serious the younger the up or suppositories is available from child is and the major concern in such the chemist without prescription. Basi- cases is dehydration. When the child cally, they are equally effective but par- has diarrhoea, it will lose a lot of fluids acetamol suppositories are not an ideal that will need to be replaced by giving alternative for pain relief since they are extra drinks: breastfeed or offer formula absorbed more slowly. Always follow more frequently. You can also give the the dosage instructions provided with baby a special preparation obtainable the medicine. The chemist’s personnel from the chemist. Contact your doctor will give you instructions if needed. or health nurse without delay if your Always see your doctor if a baby un- baby is still very young or if diarrhoea der two months old is running a fever is accompanied by prolonged vomiting, or is otherwise clearly ill. Even if the if you are unsure whether your baby is temperature drops with medication, the sufficiently hydrated, the baby is sleepy baby may have a severe bacterial infec- or if you are worried about the baby’s tion. Contact your doctor if the baby condition. refuses to drink or its temperature is high for several days without a cough or cold, if the baby is sleepy or in pain, Exanthema subitum or has breathing difficulties, or if you Exanthema subitum is also known as are worried about the baby’s condition. roseola, baby measles and the three-day Hospitals and health care centres can fever. It is a very common infectious provide advice over the phone, espe- disease in children aged six months to 2 cially during epidemics. If your baby years. It is a viral disease characterised tends to have feverish convulsions, by an abrupt high fever lasting three seek advice from your clinic’s nurse or days. As the fever subsides, small spots

84 WE´RE HAVING A BABY | |The Baby birth care appear on the baby’s skin. The rash tion is even higher. If the proportion of disappears in roughly 1.5 days. Some- vaccinated children decreases, the risk times the baby has only one symptom, of infection will also rise in Finland. either fever or spots. Vaccinations are voluntary. Some parents wonder whether vaccinations Contact your doctor or health nurse without are necessary and may be suspicious delay if your baby: about the components they contain. • is not feeding properly Pox diseases do not contribute to the • is sleepy or lethargic child’s health. Instead, they have rare • cries or is sensitive to being touched, but severe secondary diseases which • has trouble breathing or shortness of cause disability, infertility and death. breath, or The body’s response to a vaccination • is irritable and easily startled is very similar to catching the disease, • is sleepy and vacant only safer, without symptoms or with • cries and cannot be soothed minor symptoms. Vaccines contain • refuses drinks extremely small amounts of additives, • its skin seems bruised such as mercury and aluminium, com- • has a severe primary disease, pared to the amounts received in food, • is under 2 months and has a fever (rectal for example. The benefits of immunisa- temperature over 38ºC) tion far outweigh the very small risk of • if you are worried about the baby’s side-effects. condition. Vaccines are administered by the public health nurse in the child health clinic. In addition to vaccinations, pro- Why are vaccinations tect your child from diseases by avoid- necessary? ing close contact with ill people. Along- Vaccinations protect the child from inside the vaccination programme, your fectious diseases. Vaccines are given to child may be vaccinated against hepa- protect the child against several danger- titis A or B and tick-borne encephalitis, ous diseases such as diphtheria, pertus- if considered necessary. For more infor- sis (also called whooping cough), teta- mation on vaccines, contact your child nus and polio. Improved hygiene and health clinic’s nurse or the National In- nutrition have had a considerable effect stitute for Health and Welfare (website: in preventing infectious diseases, but https://thl.fi/en/web/vaccination). vaccination has completely eliminated these diseases from Finland. Although these diseases are a thing of the past in Finland, some cases have been report- ed in Sweden, the Baltic countries and Russia. Further abroad, the risk of infec-

TheBaby birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 85 Childhood vaccination programme (1.1.2017) Age Disease Vaccine

2 months Rotavirus diarrhoea Rotavirus

3 months Meningitis, pneumonia, sepsis and ear infection Pneumococcus (PCV)

3 months Rotavirus diarrhoea Rotavirus

3 months Diphtheria, tetanus, pertussis, polio and Hib diseases, such as 5-in-1 vaccine meningitis, epiglottitis and sepsis (DTaP-IPV-Hib)

5 months Meningitis, pneumonia, sepsis and ear infection Pneumococcus (PCV)

5 months Rotavirus diarrhoea Rotavirus

5 months Diphtheria, tetanus, pertussis, polio and Hib diseases, such as 5-in-1 vaccine meningitis, epiglottitis and sepsis (DTaP-IPV-Hib)

12 Meningitis, pneumonia, sepsis and ear infection Pneumococcus months (PCV)

12 Diphtheria, tetanus, pertussis, polio and Hib diseases, such as 5-in-1 vaccine months meningitis, epiglottitis and sepsis (DTaP-IPV-Hib)

12–18 Measles, mumps, rubella MPR months

18 Chicken pox Chicken pox months

6–35 Influenza (every year) Influenza months

4 years Diphtheria, tetanus, pertussis, polio DTaP-IPV

6 years Measles, mumps, rubella MPR

6 years Chicken pox Chicken pox

86 WE´RE HAVING A BABY | |The Baby birth care

SERVICES FOR FAMILIES WITH CHILDREN

Services for families withTheBaby children birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 87 this wide array of professionals, child CHILD health clinics also work in close co-op- HEALTH CLINIC eration with other parties involved in family care such as municipal home- help services, day care and early childhood education, developmental and hild health clinics monitor family counselling centres, child wel- the physical, social and cog- fare, school health care and specialised C nitive development of chil- health care. dren under school age. The clinics also Clinics’ personnel are obliged to aim to support parents in implementing keep their clients’ details confidential. safe, child-centred upbringing strate- According to the health care confiden- gies and caring for their children and tiality code, no information can be for- their mutual relationship. Attention is warded to another health care unit or increasingly paid to parental coping, professional without the prior permis- the early detection of possible problems sion of the mother or father. and arranging the appropriate help for families with children. The point of contact is your clinic’s Periodic health examinations public health nurse, who is a profes- Public health nurses are familiar with sional in promoting health and family the people and families living in the care. Public health nurses offer their area, as they meet with families at least professional expertise to parents, co-op- 15 times before school-age. Families erating with the families in full confi- with under one-year-olds visit the clin- dentiality. Together with the family, ic at least 9 times. After the child has public health nurses assess the family’s turned one, the family is invited to vis- need for further examinations or sup- it the clinic when the child is aged 18 port. months and then once a year (usually Clinic doctors participate in monitor- around the child’s birthday). ing the child’s health and development. Public health nurses at child health Their responsibilities include screen- clinic are responsible for monitoring ing for diseases and abnormal develop- the growth and healthy development of ment, and interpreting developmental your child. During an appointment, the anomalies, which are usually first de- child’s height, weight and head circum- tected by the public health nurse. ference are measured. Its hearing and Other professionals working at the sight are controlled and psycho-social health centre include family workers, development supported and observed. psychologists, logopaedists, physio- Furthermore, the public health nurse therapists, nutritional experts and den- is an invaluable source of information tal care professionals. In addition to regarding the child’s developmental

88 WE´RE HAVING A BABY | Services for families with children stage, and topics covered during visits 18-month old include the development usually include nutrition, injury pre- of the child’s own will, learning new vention, exercise, the family’s lifestyle things, parental wellbeing and health etc. Speech development is monitored behaviour and child care arrangements. during every visit. Breastfeeding ad- Topical themes in the extensive health vice and guidance is provided for as examination of a four-year old include long as is required. The clinic’s nurse the parent–child interaction, the child’s will also vaccinate your child accord- social skills, learning difficulties, ing to the current Finnish vaccination strengths and parental health behav- programme and perform any screening iour. tests required. The public health nurse makes at The check-ups involve extensive least one home visit when the baby is health examinations (at the age of 4 born (home visits are also recommend- months, 18 months and 4 years) to ed prior to birth), but may visit at other which both parents are invited. During times as well if this seems necessary or these appointments, the whole family’s when the family so wishes. Since moth- health and wellbeing are assessed, in ers and newborns are discharged early addition to those of the child. This is from hospital, the public health nurse based on discussion with the parents makes home visits to support the moth- and children (adjusted to their age) er in the early stages of breastfeeding on parental coping, health status and and to monitor the health of the mother health behaviour, as well as the fami- and baby. Groups for parents, mothers ly’s life situation and living conditions. and fathers meet in most child health Topics covered during the extensive clinics. Some clinics organise joint health examination of a four-month meetings with more than one family, old include the baby’s daily routine, providing families with the opportuni- development and interaction, as well ty to meet other parents in addition to as parental coping, moods and health seeing the nurse and doctor. behaviour. Topics covered during the extensive health examination of an

Services for families withTheBaby children birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 89 Child guidance and family counselling centres SOCIAL SERVICE Child guidance and family counselling centres promote the favourable development of children and families and support the parents in the care and up- Home-help service, family work bringing of their child. This includes and other support guidance, counselling and other sup- Families with children are entitled to port in matters related to the growth the home-help service to secure the and development of children, family well-being of children despite factors life, personal relationships and social such as illness, childbirth, disability skills. or other reason affecting the parents’ Typical reasons for contacting a child functional capacity, including fatigue guidance and family counselling centre or exceptional life or family situations include conflicts between family mem- (for example, twins). The purpose of the bers and concerns about the child’s de- home-help service is to support parent- velopment, children’s fears, difficulties hood and coping in everyday life. This in obeying rules and restrictions, shy- includes concrete help in housework ness and social anxiety. You can also and counselling the family in child care contact a child guidance and family and household chores. The home-help counselling centre if you have prob- service is subject to a fee but the fami- lems with parenthood or the family’s ly’s financial standing is taken into ac- life situation. count. Child guidance and family counsel- Family work refers to the promotion ling is provided by a multi-professional of wellbeing in situations in which a team. The centre’s psychologist, social client and his/her family or a person worker and doctor will schedule meet- in charge of the client’s care need sup- ings and appointments for examina- port and counselling to strengthen their tions for the family together or for each own resources and improve their mutu- family member individually. Working al interaction. This help and support is methods are agreed in cooperation with provided on a short- or long-term basis. the customer. The services are confi- Family work is free of charge to the cli- dential, customer-oriented and free of ent family. charge. Families can contact social welfare services regarding various types of Further information (in Finnish and problems and situations in which they Swedish) need support, such as finances and www.thl.fi/fi/web/lapset-nuoret-ja- housing. The aim is to address family perheet/peruspalvelut/sosiaalipalvelut/ problems at an early stage. kasvatus_ja_perheneuvonta

90 WE´RE HAVING A BABY | Services for families with children Services for chronically ill tions organise adaptation training and children or children with various forms of educational and recre- disabilities ational activities. Further information Municipalities are obliged by law to ar- is available from a Finnish-language range the necessary services for chron- portal based on the service path mod- ically ill children or children with dis- el (www.palvelupolkumalli.fi), from abilities and their families. Based on YTRY, a cooperation committee for the the Social Welfare Act, these families parents and associations of and chroni- are entitled to an assessment of their cally ill children and children with dis- service needs. If needed, the munici- abilities, which is coordinated by Vam- pality must appoint a personal advis- las, a supporting foundation for youth er who helps the child and family to and children with disabilities (www. identify the necessary services. These vamlas.fi) and from FAIDD, the Finnish services may be provided based on the Association on Intellectual and Devel- Health Care Act, the Social Welfare Act, opmental Disabilities, tel. 09 348 090 the Disability Services Act, the Act on (www.kehitysvammaliitto.fi). Special Care for Mentally Handicapped Persons or other legislation. It is essen- Further information tial that the service entity secures the Handbook on Disability Services (in child’s healthy development. If neces- Finnish and Swedish): sary, this may also include child wel- www.vammaispalvelujenkasikirja.fi fare services. www.thl.fi/fi/web/vammaispalvelujen- For more information on services and kasikirja/tutkimus-kehittaminen/ benefits available to families, contact vammaisalan-jarjestot your municipal social workers or reha- Handbook for Child Protection bilitation counsellors. For contact de- (in Finnish): tails, refer to the municipal guidebook www.thl.fi/fi/web/lastensuojelun- of your place of residence, the phone kasikirja/tyoprosessi/erityiskysymykset/ book or the Internet. vammainen-lapsi-ja-lastensuojelu In addition to municipal services, an array of organisations and parents’ associations provide services for disabled children and their families. Associa-

Services for families withTheBaby children birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 91

Further information OTHER SERVICES www.ensijaturvakotienliitto.fi/en FOR FAMILIES Shelters for victims of Mother and child homes and domestic violence and other other community-based community-based services to services for families with small prevent violence children Shelters for victims of domestic vio- Mother and child homes help families lence and other community-based ser- with small children who need exten- vices to prevent violence provide help sive individual support. Mother and and advice to all parties to domestic child homes strengthen the parent-ba- violence: children, women and men. by relationship and support parents Shelters provide short-term refuge if in their growth into parenthood. The staying at home is impossible or is dan- whole family is welcome during the gerous because of violence, threats or pregnancy or when the baby is born. fear. In reducing and stopping domestic A payment guarantee from the client’s violence, the focus is on safeguarding home municipality is required for a stay the security of the victim of violence at a mother and child home. and the children. Shelters for victims of Community-based services for fami- domestic violence accept single adults lies with small children are also avail- and parents with children even with- able through mother and child homes. out a referral, and are open around the The family can ask for a doula (a trained clock. The shelters and their helplines support person) to support them during are available 24/7, and personnel spe- pregnancy and to attend the birth. They cialising in anti-violence work is al- can also discuss the baby’s sleeping ways available. problems with a Baby Blues counsellor, Shelters are maintained by munici- join a day-time support group or ask for palities and member organisations of home-based Alvari family work. the Federation of Mother and Child Some mother and child homes spe- Homes and Shelters. For more infor- cialise in problems related to substance mation, please contact your municipal abuse and implement a care system de- social service or family support centre. veloped by the Federation of Mother Contact details for the shelters are avail- and Child Homes and Shelters. Their able at www.thl.fi/turvakotipalvelut or operational area includes all of Finland. www.turvakoti.net/. Girls and women A substance-abusing mother can go to a who have experienced violence or the mother and child home or seek commu- threat of violence can receive help from nity-based services either alone or with Nollalinja (https://www.nollalinja.fi/ the father already during pregnancy or in-english/) by calling the nationwide after the child has born. free-of-charge helpline (tel. 080 005 005).

92 WE´RE HAVING A BABY | Services for families with children If you are concerned about your own Family guidance centres of violent behaviour, seek help without the Church of Finland delay. Perpetrators of domestic violence The church’s family guidance centres can find help in finding an alternative welcome everyone needing help in to violence from the “Lyömätön Linja” problems relating to family and relation- organisation (Lyömätön Linja Espoo ships. The focus is on family relation- www.lyomatonlinja.fi/ or lyomaton. ships. You can make an appointment [email protected]. tel. 09 612 66 212) with a family counsellor either alone or or from the Federation of Mother and with your spouse or family. Help is free Child Homes and Shelters of charge and offered to members and www.ensijaturvakotienliitto.fi/ non-members of the Church. Personnel tyomuodot/vakivaltatyo/jussi-tyo2/ are obliged to keep their clients’ details confidential. You can find the contact details of the family guidance centres of the Church of Finland at http://evl.fi/ perheneuvonta.

SOCIAL SECURITY FOR FAMILIES WITH CHILDREN

arents are entitled to various Benefits provided by Kela include: types of benefits provided by • maternity grant, either a maternity package P Kela (the Social Insurance In- or a cash benefit at EUR 140 stitution of Finland) as well as to family • special maternity allowance and maternity leaves which are based on the Employ- allowance (until the child is 3 months) ment Contracts Act. Further informa- • paternity allowance (about 9 weeks until tion on family benefits is available on the child is 2 years) the Kela website at www.kela.fi/web/ • parental allowance to either mother or en/families. father (when the child is aged 3–9 months) • child benefit (until the child reaches the age of 17)

Services for families withTheBaby children birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 93 • child home care allowance for a child under • various types of benefits if the child is ill 3 years old not attending municipal day • adoption grant for international adoption care • conscript’s allowance for persons perform- • private day care allowance for a child ing armed or unarmed military service or under school age not attending municipal alternative service and for their spouse and day care children. Those participating in reservist • flexible care allowance for a child under 3 training and women in voluntary military years service are also treated as conscripts. • partial care allowance for a child in the 1st or 2nd year of school • child maintenance allowance for a child under 18 years

SPECIAL SITUATIONS

Giving your baby up for cision. Biological parents can express adoption wishes concerning the adoptive family, If you decide to give your baby up for and they will be offered the opportunity adoption, you will receive counselling to keep in touch with the adoptive fami- provided either by Save the Children ly after adoption. Counselling is provid- Finland (for more information, please ed free of charge to the parents. visit www.pela.fi) or your local social The parent’s formal consent to adop- welfare office. If paternity has been tion cannot take place until the parent confirmed or the baby is born to parents has had the opportunity to thoroughly who are married to one another, the fa- consider the decision and no earlier ther is also entitled to counselling and than eight weeks after the baby is born. needs to give his consent. The purpose During this eight-week consideration of counselling is to help the mother or period, the child can be placed in short- parents to make a carefully weighed de- term family care.

94 WE´RE HAVING A BABY | Services for families with children Miscarriage advisable to go over the experience with Miscarriage or spontaneous abortion is a trained professional or with someone the spontaneous end of a pregnancy pri- else who has also had a miscarriage. Ask or to 22 weeks. In addition to early stage your nurse if there is a miscarriage sup- miscarriages (when the mother doesn’t port group in your neighbourhood. Peer even know she has been pregnant), support is also available at www.kapy.fi. every tenth pregnancy ends spontane- ously in a miscarriage. Most miscarriages occur prior to 12 weeks. The death of a child Miscarriage usually begins with The death of a child is one of the most bleeding accompanied by pain in the painful experiences in life. It can hap- lower abdomen and lower back. In pen quite unexpectedly or you may most cases, the cause of the miscarriage have some time to prepare. The sudden cannot be determined. Sometimes the and unexplained death of an apparent- foetus never began developing (this is ly healthy infant is called sudden infant called empty sac), while in other in- death syndrome (SIDS). This means stances the miscarriage may have been that the cause of death cannot be deter- caused by a severe developmental dis- mined despite thorough medical inves- order. The mother’s high age, chronic tigation. diseases and structural weaknesses of Child Death Families KÄPY ry is an the uterus increase the risk of miscar- organisation that provides peer sup- riage. Also, some external factors (e.g. port for families whose child has died strong medications, radiation, solvents) – regardless of the child’s age and cause may increase the risk. of death. The association’s helpline at A miscarriage is confirmed by an ul- 045-325 9595 is available on Mondays trasound scan performed in a hospital. and Thursdays from 8.30 am to 11.30 If the uterus has emptied itself or vagi- am, email: [email protected]. Activities in- nal bleeding is not heavy, the so-called clude providing trained peer support watchful waiting (no treatment) is ap- (individuals or families) for parents plied. If the uterus does not empty itself who have lost their child. The associ- even if the foetus is dead, the uterus can ation also organises regional get-togeth- be emptied medically or through curet- ers and family weekends. tage. Curettage may also be necessary if vaginal bleeding is heavy. Miscarriage is a devastating experience and stirs up an array of emotions ranging from sadness and guilt to anger and depression. Sometimes it may be

Services for families withTheBaby children birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 95 paternity is not able to understand the INVESTIGATION significance of the acknowledgement. When paternity has been acknowl- OF PATERNITY edged during pregnancy at the maternity clinic or the child supervisor’s office, nvestigation of paternity is the child supervisor verifies the mother’s regulated by the Paternity Act marital status after the child is born and I (11/2015). When a child is draws up a record of investigation of pa- born in marriage, the husband is the fa- ternity, if the man who has acknowledged ther of the child. The paternity of a child paternity before the child’s birth does not born outside marriage can be established revoke the acknowledgement by notify- either by acknowledgement of paternity ing in writing the child supervisor who by the father or through a court decision. is attending to the investigation of pater- This applies also to cohabiting parents. nity at the latest on the 30th day after the The father is required to acknowledge pa- child’s birth. Within the same timeframe ternity before it can be legally confirmed even the child’s mother or a man who by the social security authorities (local considers that he is the child’s father may register office, maistraatti). It is possible notify the child supervisor that the man to acknowledge paternity already during who has acknowledged paternity is not pregnancy at the maternity clinic of the the child’s father. The local register office municipality where the expectant moth- must establish paternity after the time er and the man have received materni- frame indicated above if there is no rea- ty clinic services during the pregnancy. son to doubt that the man acknowledging The statement of acknowledgement may paternity is the child’s father. also be made to the child supervisor of If paternity has not been acknowledged the mother’s municipality of residence, during pregnancy or the acknowledge- after the mother has presented a certifi- ment is revoked or contested, the child cate regarding the pregnancy. supervisor invites the mother to a dis- The statement of acknowledgement cussion for the investigation of paternity. cannot be received by the public health Where possible also the man who may be nurse or midwife at the maternity clinic the father is invited to the discussion. If or the child supervisor if 1) the moth- paternity cannot be established (e.g. there er opposes the acknowledgement; 2) is more than one potential father or the the identity of the man or the expect- identity of the mother or the potential fa- ant mother has not been ascertained in ther could not be ascertained in a reliable a reliable manner; 3) there is reason to manner), a forensic genetic paternity test suspect that the man acknowledging will be performed to determine the child’s paternity is not the father of the child; biological father (Act 378/2005). If the or 4) there is reason to suspect that, due father does not voluntarily acknowledge to his mental state, linguistic difficulties paternity in the presence of the child or other reason, the man acknowledging supervisor or if no sample for a forensic

96 WE´RE HAVING A BABY | Services for families with children genetic paternity test could be obtained Further information from the child or the child’s mother when about the investigation of paternity such a test has been deemed necessary, and forensic genetic paternity testing at paternity will be established through a www.thl.fi/isyys. court decision.

CHILD´S CUSTODY, CHILD SUPPORT AND CHILD MAINTENANCE ALLOWANCE

f the parents are married when with the parent, a child support payable the child is born, they have to the child is confirmed. I joint custody of the child. If the Child support is paid monthly in ad- parents are not married, the mother is the vance or as a lump-sum payment and is legal guardian. If the man acknowledges revised according to the cost of living in- paternity in the manner described above dex. If the liable parent cannot pay the before the child is born, the man and the child support agreed upon or neglects expectant mother can at the same time the payments, the child is entitled to agree to have joint custody of the child. child maintenance allowance. Child The municipal social welfare board con- maintenance allowance is also provid- firms the agreement on joint custody after ed for children whose father has not the local register office has established been established and when the amount paternity, unless the agreement is contra- of confirmed child support is smaller ry to the best interests of the child. Cus- than the child maintenance allowance. tody can be agreed also at a later stage. The full child maintenance allowance If the parents do not live together, child is EUR 155.50 per month per child in maintenance and visiting rights can also 2017. Assistance in settling these mat- be agreed on. These agreements can be ters and making agreements is provided made at the child supervisor’s office only by the municipal child welfare officer. after the child is born. Children have a le- The Social Welfare Board affirms the gal right to sufficient maintenance, which agreements made and ensures that they the parents are responsible for providing are not against the interests of the child. according to their means. Where necessary, the child’s custody, Parents remain responsible for the fi- visiting rights and maintenance pay- nancial support of their children until ments can also be determined through a their 18th birthday. If a parent does not court decision. provide for the child’s maintenance, or if the child does not live permanently

Services for families withTheBaby children birth care | | WE´REWE´RE HAVINGHAVING AA BABYBABY 97 ORGANISATIONS SUPPORTING FAMILIES WITH CHILDREN

Federation of Mother and Child Homes www.ensijaturvakotienliitto.fi and Shelters

Folkhälsan www.folkhalsan.fi

Breastfeeding Support Association in www.imetys.fi Finland

Lapsiperheiden etujärjestö (a special-inter- www.lape.fi est group of families with children)

Mannerheim League for Child Welfare www.mll.fi (MLL)

Miessakit Association www.miessakit.fi

Multicultural Women’s Association www.monikanaiset.fi

National Women’s Line in Finland www.naistenlinja.fi

Save the Children Finland www.pelastakaalapset.fi/en/frontpage

Rainbow Families Association www.sateenkaariperheet.fi

Väestöliitto (Family Federation of Finland) www.vaestoliitto.fi

Single Parents’ Association www.yvpl.fi

ÄIMÄ - Association for Mothers Suffering www.aima.fi from Depression

98 WE´RE HAVING A BABY | Services for families with children This guidebook has been published since the beginning of the 1980s. Sirpa Taskinen, Psychologist at the then National Board of Social Welfare, had the main responsibility for the texts in the original guidebook. Over the years, the contents Each child is unique of this guidebook have been edited and supplemented several times. We would like to extend our warmest thanks to the experts and parents who have shared During the first year, the child has transformed from a their knowledge with us and contributed to this new edition of the guidebook. helpless infant to a little person learning to walk. This would not have been possible without interaction with other people. Each child is unique. Children develop in their own time according to their genetic and environmental influences. Editors: Tuovi Hakulinen, THL Comparing your child to others is unnecessary. Being happy Marjaana Pelkonen, Ministry of Social Affairs and Health about your child and how he or she grows and develops is Jarmo Salo, THL very important for your child. Maria Kuronen, THL Children also grow and change quickly after their first birthday. Every stage of development can be very rewarding for the parents and give them great joy.

ISBN (printed) 978-952-302-832-6 ISBN (online) 978-952-302-833-3 ISBN (epub) 978-952-343-006-8 http://urn.fi/URN:ISBN:978-952-302-833-3

MUU 315

Juvenes Print – Suomen Yliopistopaino Oy Helsinki, FINLAND 2017 We’re having a BABY This guidebook is intended for all parents expecting a child. It contains up-to-date information on pregnancy, delivery and caring for your baby, as well as services for families with children. It also addresses parenthood, the relationship between the parents, the child’s development and interaction with the child.

This guidebook provides information and practical tips for daily life and parenthood.

This revised edition is based on previous editions and has been produced through collaboration between experts and parents.

A guidebook for expecting and looking after a baby