Government of Western Australia North Metropolitan Health Service Have this book with you at your appointments and when you have your baby , Birth and your Baby A guide to your care with King Edward Memorial Hospital | Family Birth Centre | Community Program

WNHS Community Advisory Council your voice 1 Pregnancy, Birth and your Baby Pregnancy, Birth and your Baby

Table of Contents

Important Information and Contacts...... 4 Taking care of yourself Giving birth 7 Breastfeeding About this book...... 4 3 5 Nutrition for you and your baby...... 19 Preparing for labour...... 59 Benefits of breastfeeding...... 96 Morning Sickness...... 21 What to bring to hospital...... 59 Getting started...... 96 1 Pregnancy care options Food safety and hygiene...... 22 Medications...... 60 The first few days...... 97 Exercise...... 23 What to pack for your stay...... 60 Feeding cues...... 99 Welcome...... 6 Managing common aches and pains...... 24 Your birth plan...... 61 How breastfeeding works...... 99 Pregnancy care options...... 7 Medications and alternative medicines...... 26 Support in labour...... 61 Signs your milk is flowing...... 100 Community Midwifery Program...... 7 Midwifery Group Practice...... 7 Common concerns in pregnancy...... 27 How do I know I’m in labour?...... 62 How long to feed your baby...... 100 Hospital Antenatal Clinic ...... 7 Drugs and alcohol in pregnancy...... 27 When labour begins...... 62 Signs baby is getting enough...... 101 Shared Care...... 7 Smoking...... 27 Stages of labour...... 64 Helping your baby to breastfeed...... 101 GP Shared Care...... 7 Dental care...... 28 Delivering your after the birth of your baby.....65 Nipple care...... 102 Private Practicing ...... 7 Cytomegalovirus (CMV) and pregnancy...... 28 Keeping your placenta...... 65 Hand expressing...... 102 Antenatal Clinic – Obstetric Doctor Care ...... 8 Immunisations and vaccines ...... 29 Pain management in labour...... 66 Expressing with an electric breast pump...... 103 Private Obstetric Care...... 8 Work and pregnancy...... 29 Pain relief...... 66 Storage of breast milk...... 105 Family Birth Centre...... 8 Air travel ...... 29 Monitoring your baby during labour...... 68 Thawing and warming of breast milk...... 105 Wearing seat belts...... 29 Assisted birth...... 68 Engorgement...... 106 2 Services and support Emotional ‘ups and downs’...... 30 Water birth...... 70 Blocked ducts...... 107 Depression and anxiety...... 30 ...... 108 Visiting Hours...... 10 Emotional health and wellbeing...... 31 Dummy use while breastfeeding...... 108 Aboriginal Liaison Officer at KEMH...... 10 Your partner’s feelings...... 31 6 After the birth Agnes Walsh House Lodge...... 10 Abuse...... 32 Immediately after birth...... 74 Crèche...... 10 Sex during pregnancy ...... 32 Your baby...... 74 8 Unexpected outcomes Interpreters – Language Services...... 10 Coping alone...... 32 You...... 74 Bleeding during pregnancy...... 110 Outpatient Pharmacy...... 11 Preventing falls after you have had your baby...... 75 ...... 110 Pastoral Care Services...... 11 Tests and medications for your baby during the first Problems with the placenta ...... 110 Women and Newborn Health Library...... 11 Your visits few weeks of life...... 76 4 Breech baby...... 110 Are you or your baby of Aboriginal or Torres Strait What is a routine check up?...... 34 Newborn spot screening test...... 77 Islander origin?...... 11 High blood pressure...... 110 Tests available in pregnancy...... 34 Hearing screen...... 77 Department of Psychological Medicine...... 12 Pre-...... 110 Screening tests...... 34 Pain relief after the birth of your baby...... 77 Violence and sexual assault...... 12 ...... 111 Diagnostic tests...... 35 Going home...... 78 Providing feedback...... 12 Premature labour and birth...... 111 Gestational Diabetes screening...... 35 Discharge medications at KEMH...... 78 Social Work Department...... 12 Non-elective caesarean...... 112 Your first appointment...... 35 Support at home...... 79 Women living with a disability ...... 12 Jaundice...... 112 What happens at the first visit? ...... 35 Postnatal care and the first six weeks...... 79 Privacy of your personal information...... 13 Intensive and Special Care...... 112 Rhesus D negative in pregnancy...... 36 After pains...... 79 Public or private admission at KEMH only...... 13 When a baby dies...... 112 Between 12 and 20 weeks...... 37 Bleeding...... 79 If you don’t have a Medicare card...... 13 Women and Infants Research Foundation...... 112 Thinking about breastfeeding...... 38 Pelvic floor exercises...... 81 Student health professionals...... 13 Find out more...... 114 What is the placenta?...... 38 Caesarean wound care...... 81 Women and Newborn Health Service contact details.....114 Community Advisory Council...... 13 Braxton Hicks contractions...... 39 Contraception...... 82 Parent Education...... 14 Ultrasound booking...... 39 Sexual intercourse...... 82 Websites about pregnancy and parenting...... 115 Obstetric Medicines Information Service...... 14 Between 21 and 33 weeks...... 41 Six week postnatal check...... 82 Glossary...... 116 Breastfeeding Support and Information...... 15 At 26 weeks...... 42 Contraceptive Methods...... 84 Find out more...... 118 Ten Steps to Successful Breastfeeding...... 15 At 30 weeks...... 42 Sexuality and ...... 86 Are you worried?...... 119 King Edward Memorial Hospital (KEMH) special Preparing you for your hospital stay...... 42 Physical factors...... 86 services...... 16 Diabetes in pregnancy...... 43 Emotional factors:...... 86 Parent Education...... 16 Between 33 and 40 weeks...... 48 When is it okay to start having sex?...... 86 Antenatal classes...... 16 At 36 weeks...... 48 Postnatal depression and anxiety...... 88 Hospital tours...... 16 Group B Streptococcus (GBS)...... 48 Childbirth and Parenting Courses...... 16 Monitoring your baby during your pregnancy...... 50 Community Child Health Nurse...... 89 Breastfeeding workshop...... 17 Things to talk about with your midwife or doctor....51 All About Me - Personal Health Record Physiotherapy classes...... 17 Between 40 and 42 weeks...... 52 (the purple book)...... 90 Vaginal birth after caesarean (VBAC) class...... 17 Management of Prolonged Pregnancy ...... 54 Settling your baby...... 90 Planning a positive caesarean birth class...... 17 Induction of labour...... 55 Financial support and benefits...... 91 class...... 17 Safe Infant Sleeping...... 92 Family Birth Centre...... 17 Sudden Unexpected Death in Infants (SUDI)...... 94 Community Midwifery Program...... 17 2 3 Pregnancy, Birth and your Baby Pregnancy, Birth and your Baby

Important Information and Contacts Outpatient Clinics: To change your appointment or check on the progress of your referral, please phone Outpatient Direct (OPD) 1300 855 275. Community Midwifery Program (CMP) or Midwifery Group Practice (MGP), phone your midwife on his/her mobile.

In the first 20 weeks After 20 weeks If you are in your first 20 weeks of pregnancy and If you need urgent care contact the you experience pain or bleeding you can contact Maternal Fetal Assessment Unit (MFAU) on the King Edward Memorial Hospital Emergency (08) 6458 2199 anytime day or night. Centre on (08) 6458 1431 anytime day or night.

When to contact us: King Edward Parking Memorial Hospital Call your midwife, doctor or MFAU Two hour parking is (24-hours-a-day) if you experience KEMH is located at permitted on a number of any of the following. Do not wait 374 Bagot Road, Subiaco. streets surrounding the until your next appointment. Hospital. It is recommended How to get here you park your car in the • Unusually strong patient/visitor carpark • Vision problems Public transport located on Hensman Road • pain Bus Route 27 stops right or one of the Subiaco City outside the front door of the Council’s carparks, as your • Swollen hands and/or face hospital on Bagot Road. appointment or visit may • and with or take longer than the parking The closest train stations without diarrhoea time allows. to KEMH are at Daglish • You think you are in labour (670 metres) and There are two ACROD/ • Very itchy skin Subiaco (1 km). disabled parking bays located at the front of the • Fever Planning your trip by Hospital and two in the public transport is made • Urinary problems Hensman Road carpark. • Watery and/or greenish vaginal easy by using the website discharge www.transperth.com.au Please be aware, not or calling 13 62 13 for following parking signs at • Reduced baby movements information on bus/train KEMH and/or in the City of • Any concerns or worries routes and timetables. Subiaco may result in a fine.

About this book The information provided in this book has been supplied with the aim of providing you with health information and information about the choices you have once pregnant. If you read this book and decide you need further information on any topic please talk to your doctor or midwife or visit us at: www.kemh.health.wa.gov.au and www.healthywa.wa.gov.au 1 Please note that if you wish to contact King Edward Memorial Hospital via telephone our switchboard number is (08) 6458 2222. Pregnancy care Fact sheets and brochures More information can be found at: www.kemh.health.wa.gov.au KEMH Family Birth Centre Community Midwifery Program options (08) 6458 2222 (08) 6458 1800 (08) 9301 9227 4 5 Pregnancy, Birth and your Baby

Pregnancy care options 1

This first section outlines the types of care and birthing locations available to you with the Women and Newborn Health Service (WNHS). Depending on the reasons for your referral you may have the opportunity to choose pregnancy care options at King Edward Memorial Welcome Hospital, The Family Birth Centre (FBC) or with the Community Midwifery Program (CMP). Congratulations on your pregnancy and welcome to The Women and Newborn Women and Newborn Health Service, incorporating King King Edward Memorial Hospital Midwifery Group Practice Health Service respectfully Edward Memorial Hospital, the Family Birth Centre and King Edward Memorial Hospital (KEMH) Midwifery Group Practice (MGP) provides acknowledges the Noongar the Community Midwifery Program. offers world-class care and wide-ranging women with pregnancy care from the same people, both past and present, support services to WA women with small group of midwives. This booklet is designed to give you information about complicated , infants born the traditional owners of the Women are cared for by the same midwives the care you will receive with us. Keep it with you prematurely and those who live locally. land on which we work. for the duration of their pregnancy, labour throughout your pregnancy and following the birth of your Women experiencing a complex or and birth and in the postnatal period. The Women and Newborn baby as it contains lots of information and advice you Health Service also ‘high-risk’ pregnancy may be referred to Women choosing this model of care might find useful. KEMH for their pregnancy care. Women recognises, respects and may birth in the Family Birth Centre We encourage you, your partner and support people who are not high-risk but want to receive (FBC) for low risk pregnancies, or in the values Aboriginal & Torres care at KEMH must live within specific to be involved in your care. We want to give you the main hospital. Strait Islander cultures as we postcodes. To view a current list visit walk a new path together. support, information and care you need to feel confident healthywa.wa.gov.au and ready for your baby’s birth. Hospital Antenatal Clinic Midwives Depending on your individual needs Women with uncomplicated pregnancies Every birth is a special and unique event and you should and where you wish to give birth may choose to have their care with receive care that meets your needs throughout pregnancy, WNHS has a variety of pregnancy midwives at the Antenatal Clinic and birth and in the days after you and your baby go home. care options available: deliver in the hospital. Clinic appointments are available Monday Community Midwifery Program to Saturday including Wednesday evening. The Community Midwifery Program (CMP) can support you to have your baby in a public Shared Care hospital, at the Family Birth Centre or in your This option enables you to continue own home within the metropolitan area. appointments with your General The CMP offers a unique service available Practitioner (GP) or an eligible privately to Perth women experiencing a low risk practicing midwife (EPPM) during pregnancy. The CMP provides safe, your pregnancy. evidence-based, continuity of care from known midwives throughout pregnancy, GP Shared Care labour, birth and for two to four weeks in After seeing the midwife/doctor at KEMH the post natal period. for your hospital booking visit, you are The CMP midwives hold antenatal/ then seen by a GP of your choice who is postnatal clinics and classes in various eligible to participate in shared care until locations across Perth in order to keep approximately 36-38 weeks. A list of GP your care within the community. These Shared Care providers is available on the locations include Joondalup, Kalamunda, KEMH website. Subiaco, Cockburn and Rockingham. Private Practicing Midwife The CMP pride themselves in protecting, promoting and supporting natural birth with Alternatively you may wish to consider a high percentage of clients choosing to a privately practicing midwife who is self give birth in water. employed and can admit pregnant women under their care. For more information about the Community Midwifery Program, visit our website at www.kemh.health.wa.gov.au 6 7 Pregnancy, Birth and your Baby

Pregnancy care options 1

Antenatal Clinic – Family Birth Centre More information? Obstetric Doctor Care The Family Birth Centre (FBC) This type of antenatal care is only provides care for healthy women for A range of online fact available to women who have: whom a straight forward, low-risk sheets, brochures pregnancy and birth is anticipated. and booklets about • A complicated medical history pregnancy and birth • Had a previous pregnancy The Centre is a home-like are available. requiring specialist care environment, care is midwifery led only and available to women Ask your midwife and/or hospitalisation from anywhere in the Perth or doctor if there is • A pregnancy that is not metropolitan area. more information progressing normally available about • A multiple pregnancy e.g. twins Due to high demand, it is your care or visit recommended women book early as Some women are transferred from www.kemh.health. midwifery or shared care to obstetric places at the FBC are limited. wa.gov.au and view doctor care if problems occur. the brochures and Certain health issues may preclude information online. some women from attending the FBC. Private Obstetric Care You can also contact If you’re unsure about whether you the Women and Women who wish to be cared for by can attend please check with the FBC Newborn Health an obstetrician with private admission midwives. For further information call Library for further rights at KEMH can be admitted as the FBC or visit the KEMH website. information and a private patient. More information is resources on available on page 13. (08) 6458 1100.

National Women Held Pregnancy Record (NWHPR)

You will be given a NWHPR at your first appointment. You must bring it with you to ALL your visits to the hospital, your midwife or doctor, your local GP and when you come to have your baby. You are encouraged to read this record 2 and ask questions during your pregnancy. Services and support 8 9 Pregnancy, Birth and your Baby 2

Services and Support The services listed below are available to women birthing with the Outpatient Pharmacy Are you or your baby of Aboriginal or Visiting Hours Women and Newborn Health Service (WNHS), whether it be at Lower Ground Floor, B Block, Torres Strait Islander origin? King Edward Memorial Hospital, the Family Birth Centre or with the 374 Bagot Road, SUBIACO WA 6008 You will be asked this question when you attend King Edward Community Midwifery Program (with KEMH as their nominated hospital). King Edward Memorial Hospital (KEMH). Memorial Hospital Tel: (08) 6458 2722 Visitors are welcome Agnes Walsh House Lodge is located Monday to Friday Why will I be asked? Aboriginal Liaison Officer 8.30am - 5pm to visit maternity at KEMH next door to the main hospital and The four main reasons are: wards 3, 4, and 5 provides single rooms with shared 1. Deciding the origin of a person based on their looks each day from: Aboriginal Liaison Officer kitchen and bathroom facilities. Pastoral Care Services Tel: (08) 6458 2777 Tel: (08) 6458 1036 or (08) 6458 1726 is not reliable, the only way to find out is by asking. 3pm – 8pm Speak to your midwife if you need (Wednesday, Thursday, Friday) 2. The WA Department of Health collects data on the support with accommodation. This is a free confidential service offering Visitors outside these Aboriginal and Torres Strait Islander status of every Coming to a large hospital, especially emotional and spiritual support to all women, hours will not be Crèche person attending any health service in WA. permitted on the wards. from a rural or remote area, can be a their family and friends. difficult experience. We want to make www.kemh.health.wa.gov.au/ 3. The answer provides information on the health After hours pastoral support is available to One nominated services/facilities/ status of all Australians and helps improve health sure your time with us is positive and all inpatients in cases of emergency and support person, such culturally respectful. care for everyone. as a partner, is able to Tel: (08) 6458 1370 bereavement. You do not have to be a 4. If there are culturally specific services available visit any time between KEMH has an Aboriginal Liaison The King Edward Crèche is a free churchgoer or have any religious beliefs to receive pastoral or spiritual support. Speak such as an Aboriginal Liaison Officer, they can 8am and 8pm. Officer (ALO) available to provide child-minding service based at to your midwife or doctor or contact Pastoral be offered. Partners are unable support to you during your stay KEMH, next door to the East Wing Care directly. to stay overnight at at KEMH. Our ALO can assist by Clinic, on the Hensman Road side of Respecting your privacy KEMH. talking to staff, including doctors the Hospital. and midwives, on your behalf if you Women and Newborn KEMH has the responsibility to protect any information Family Birth Centre wish. They can also assist you in The crèche accepts children of Health Library you provide and is bound to privacy rules which protect parents/guardians who: a person’s identity. If you are unsure, please ask about Visitors are welcome to linking up with other services that This is a free library service which provides the privacy policy before answering the question. visit at any time during might be able to help you when you • Have an outpatient appointment health information from published sources your stay in the FBC. are ready to go home. before 2pm, or to WNHS patients, their families and carers, You may also be asked other important health professionals and the general public of Ngalla Mia and Moort Mandja Mia • have a baby in the special care questions such as: nursery/neonatal intensive Western Australia. The collection specialises at KEMH • Your age care unit. in women’s health, pregnancy, childbirth, Asking for a Ngalla Mia is a meeting place for and infant care. As well as books, the library • where you were born has an extensive range of DVDs and health female doctor Aboriginal women and is located Interpreters • where you live on the lower ground floor of Agnes pamphlets including many specifically written • your state of health In order to provide Walsh House at KEMH. – Language Services for Aboriginal clients. the best possible Tel: (08) 6458 2802 • your GP details. Moort Mandja Mia is an outdoor Items can be borrowed for a two week period care, staff are Professional interpreters who and the library service can be accessed These questions are not discriminatory and do not mean allocated on the basis family gathering place, located on Hensman Rd, designed to are accredited through National online even once you have returned home. you will be treated differently. Australian state and territory of skills required to Australian Authority for translators The library also provides free Wi-Fi. governments and Aboriginal and Torres Strait Islander care for our patients. acknowledge the traditional custodians of this land, the Noongar and interpreters can be provided The service does not provide medical organisations need to know all they can about the health We are unable to (Whadjuk) people and welcome to patients and their families who or counselling advice, but can provide of people in WA to assist with planning and providing provide doctors, women and their families to KEMH. are non-English speaking or have a contact details for appropriate services and appropriate health services. The information you provide midwives or nurses hearing impairment. support groups. enables policies to be created, funds to be allocated and on the basis of race, services to be developed in areas of most need. Agnes Walsh House Lodge If you would like an interpreter, The library is located on the ground floor gender or religion. WNHS provides short-term temporary please call the Language Services in the main corridor of KEMH next door to Your answers may also help KEMH refer you to accommodation for women from Department before your appointment. the café. appropriate services when you are discharged. regional or remote areas who are The aim of asking these questions is to work together to Opening hours are 9am -12noon Monday to required to be in Perth for care achieve better health for everyone. Friday excluding public holidays. at KEMH. 10 11 Pregnancy, Birth and your Baby

Services and Support 2

Department of Psychological Social Work Department Privacy of your personal student observes or participates in your More information? Medicine Tel: (08) 6458 2777 care and you have the right to say no. Your information wishes will be respected at all times and Tel: (08) 6458 1521 The HEALTHY WA Pregnancy and childbirth can be WNHS protects privacy by keeping this will not affect your care. 8.30am – 5pm website provides a very challenging time. You may your personal information secure from families with information The Department of Psychological be feeling overwhelmed, isolated, unauthorised access, use or loss. All Community Advisory Council anxious or stressed. Perhaps you staff employed by WNHS have a duty to on pregnancy, birth and Medicine provide expertise in the The WNHS Community Advisory are experiencing problems with protect your personal information. Strict beyond and general field of women’s mental health. We Council (CAC) is a group of community relationships, childcare, immigration, policies and guidelines are in place for the health information. assess, treat and assist patients of representatives, from all walks of life, who money or housing. collection, use, release and disposal of www.healthywa.wa.gov.au King Edward Memorial Hospital whose provide feedback on ways to improve medical condition is affecting their We can provide support, advice and your information. services from a consumer’s perspective. The Pregnancy, Birth & emotional health, or whose emotional referrals to services in your local area If you would like to join our Community is a free Baby helpline health is affecting their medical to help you manage these issues. Public or private admission at Advisory Council (CAC) please contact the national 24-hour helpline condition. Please contact us directly or ask to KEMH only Customer Service Unit to register your interest. for women and families. see a social worker when you attend You must be a patient of KEMH to Under the requirements of the Medicare Tel: 1800 882 436 qualify for access to services. Services the clinic. We are always willing to talk about issues that may be worrying Agreement, all eligible patients, regardless are available for up to six months of insurance status, being admitted to a you and affecting your pregnancy after discharge or clinic attendance public hospital, have the right to choose experience. and for up to one year for parents of whether to be admitted as a public or The Community Advisory Council babies hospitalised in the Special Care private patient. There are no out-of-pocket Nursery. Women living with a disability expenses if you elect to use your private The Community Advisory Council (CAC) represents the Did you know? interests of patients, their support people and carers Concerns about mental health in Tel: (08) 6458 2870 health insurance. Suggestion boxes (Occupational Therapy) who use services at KEMH, the Family Birth Centre or pregnancy and in the early postnatal Patients with private health insurance can Community Midwifery Program. Membership of the CAC is and feedback forms period can be discussed and a referral WNHS is committed to ensuring that contact the Private Patient Liaison Officer broadly based. are found around to Psychological Medicine services people with disabilities, their families on (08) 6458 1066 or email Members of the CAC are interested in receiving feedback the hospital or ask made by your health care provider, and carers are not discriminated [email protected] a staff member midwife or doctor. against in any way and that they have about services from people of all ages, cultures and regions of Western Australia. They meet regularly to about how you can the same opportunities as other people If you don’t have a provide information to WNHS’s Executive on ways to provide feedback. Violence and sexual assault to access the hospital’s facilities, Medicare card improve services. The Sexual Assault Resource Centre receive the same level of care and (SARC) 24-hour Emergency Line information. More about disability KEMH, FBC and CMP are public health The role of the CAC is to: (08) 6458 1828 or Freecall access is available on the KEMH services. All patients must have a Medicare 1. Advise and facilitate to WNHS on ways to increase 1800 199 888 website www.kemh.health.wa.gov.au card to receive free health care. Patients community participation not eligible for Medicare benefits will need 2. Assist WNHS in monitoring quality of service and Domestic violence and sexual assault, Women living with a disability or to organise payment before receiving care accessibility whether they are past experiences or chronic health condition who need and services. current, can make pregnancy and birth extra support may be referred to 3. To advocate on behalf of consumers, carers and a traumatic time. KEMH can provide the KEMH Occupational Therapy If you are a resident of a country that has community you with support and assistance that is Department. Occupational Therapy a health care agreement with Australia 4. To provide a consumer perspective on activities, private and respectful of your situation. may include help to adapt your home (known as a Reciprocal Health Care initiatives and projects that impact on WNHS services. Talk to your doctor or midwife, the environment, advice about assistive Agreement) you are entitled to limited subsidised health services for ‘necessary There are many different ways to contact the CAC. Social Work Department or the SARC. equipment and modifying everyday These include: activities during pregnancy and the treatment’ while visiting Australia. • In a letter, explain your issue and address the letter to early months following birth. Please call Medicare on 13 20 11 for more Providing feedback CAC Chairperson Tel: (08) 6458 1444 Occupational Therapists also have information. Customer Service Unit (Customer Service Unit) resources to help carers understand the Women and Newborn Health Service practical challenges associated with a Student health professionals Feedback is valuable in improving PO Box 134, disability and ways to assist. They can WNHS has a major teaching focus and services and ensuring we are providing Subiaco WA 6904 also link you to Carers WA for advice provides important training opportunities a high quality service. We encourage and support. for health care providers. Students are • Send an email to [email protected] and put you to contact the customer service always under the direct supervision of an ‘CAC issue’ as the subject heading. unit if you have any concerns or wish to experienced practitioner. • Telephone the Customer Service Unit on (08) 6458 1444 compliment a staff member. You will be asked permission before a 12 13 Pregnancy, Birth and your Baby

Services and Support 2

No Smoking at KEMH Parent Education Obstetric Medicines Breastfeeding Support Benefits of breastfeeding • Breastfeeding reduces risk of Sudden Unexpected Death of Tel: (08) 6458 1368 There are many emotional and Patients are able to Information Service and Information an Infant (SUDI/SIDS). access support to The KEMH Parent Education Tel: (08) 6458 2723 physical benefits for both you and manage their smoking Breastfeeding Centre of WA your baby from breastfeeding. Health benefits for you department offers a wide range of For expert, current practice when they are admitted Tel: (08) 6458 1844 classes, both in person and online, information on: Some of these are listed below. • Breastfeeding will make your to hospital. Pamphlets plus our KEMH Parent Education Following the birth of your baby, (womb) contract, which on the Quit Program are • Medicine use during pregnancy website has links to online your midwife will assist you Health benefits for your baby helps reduce the risk and available from hospital resources and the KEMH Library. • Medicine effects on the with breastfeeding advice and • Breast milk has all the nutrients amount of bleeding after birth. staff or visit These resources will help prepare and neonate support. There are also lactation for growth and development. www.quitwa.com or women and their support person for • Neonatal medicine therapy consultants available at KEMH to Importance of skin-to-skin contact Quit on 13 78 48. the birth of their baby, ongoing care • Breast milk helps prevent and infant doses advise hospital patients on how contact after birth and the transition to parenthood. respiratory and intestinal In the interest of your • FAQs on medicine and to manage any breastfeeding , and allergies. Keeping your baby with you own health and the The Parent Education department is breastfeeding. difficulties you may experience. promotes a feeling of closeness, health of others in the located on the first floor of A Block. • Babies fed only breast milk which produces a strong hormonal hospital, smoking is Student midwives are allocated to are less likely to develop response for both you and your Parent Education as part of their NOT PERMITTED inside inflammatory bowel disease baby that is linked to greater midwifery training. and diabetes. the buildings or on breastfeeding success as close the grounds of KEMH. Had previous contact stimulates your baby’s There are no designated breastfeeding instincts to breastfeed. smoking areas and on- the-spot fines may be challenges or concerns? Ten Steps to Successful Breastfeeding issued. Ask your midwife to refer you KEMH is a Baby Friendly Health Initiative (BFHI) Accredited Hospital where a mothers informed to the Breastfeeding Centre choice of feeding is encouraged, respected and supported. BFHI accredited hospitals follow the for advice and support. Ten Steps to Successful Breastfeeding.

a Comply fully with the International Code of Marketing of Breast-Milk Substitutes and relevant World Health Assembly Resolutions. 1 b Have a written infant feeding policy that is routinely communicated to staff and parents. c Establish ongoing monitoring and data-management systems. 2 Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding. Discuss the importance and Facilitate immediate and uninterrupted skin- 3 management of breastfeeding with 4 to-skin contact and support mothers to initiate pregnant women and their families. breastfeeding as soon as possible after birth.

Support mothers to initiate and Do not provide breastfed newborns any 5 maintain breastfeeding and manage 6 food or fluids other than breast milk, unless common difficulties. medically indicated.

Enable mothers and their infants Support mothers to recognise and respond to to remain together and to practice 7 8 their infants’ cues for feeding. rooming-in 24 hours a day.

Foster the establishment of breastfeeding Counsel mothers on the use and risk support groups and refer mothers to them 9 of feeding bottles, teats and pacifiers. 10 on discharge.

If you have any questions or concerns about breastfeeding, talk about them now with your midwife or doctor. It is very helpful to attend an antenatal breastfeeding class, so speak to your midwife or book in with the KEMH Parent Education department if you are having your baby at KEMH. This booklet contains more information on breastfeeding on page 96. 14 15 Pregnancy, Birth and your Baby 2

Don’t forget: Occasionally skin to skin contact may be The Parent Education department is Topics include: Planning a positive caesarean delayed for medical reasons. In these located on the first floor of A Block in • When to come to hospital, normal birth class Bookings with the circumstances you will be supported to the hospital and is staffed by clinical labour and active birth. For women and their support person who Parent Education commence skin to skin contact as soon midwives. Student midwives are • Methods of pain relief, induction of are booked for a caesarean birth. as possible. allocated to Parent Education as part Department are labour and assisted birth. essential so call of their midwifery training. If you are having breastfeeding problems • Introduction to breastfeeding. Multiple birth class (08) 6458 1368 to following discharge from hospital, please Please book early to avoid An evening specifically designed call the Breastfeeding Centre of WA. disappointment. • Parenting and postnatal issues. book your place. for women and their support person Lactation consultants can help women It is recommended that you attend the expecting twins or triplets. who are having breastfeeding problems. Breastfeeding and Physiotherapy Antenatal classes classes also. Please ring the Parent Education Appointments are essential (see contact Department on (08) 6458 1368 for details. details in the back of this booklet). Healthy pregnancy discussion for Breastfeeding workshop Antenatal classes pregnant women between 12 and Bookings are essential for classes and The following services & support 20 weeks The breastfeeding workshop provides hospital tours. TO BOOK - Please the opportunity for all pregnant women are available specifically for An enjoyable evening for women and use the QR code to practise positioning and attachment of Family Birth Centre provided, use the patients at: their partner or support person about the baby at the breast in a small group link on the KEMH understanding the physical changes setting. In this women-only environment, The Family Birth Centre and Midwifery – Parent Education King Edward Memorial pregnancy brings. This session involves open discussion of breastfeeding is Group Practice midwives hold their own web page or ring the Hospital (KEMH) discussion with the midwife, dietitian and supported and encouraged. parent information sessions. physiotherapist. Parent Education special services The FBC sessions will cover: team on • Preparation for parenthood. (08) 6458 1368. Parent Education Hospital tours Physiotherapy classes • Breastfeeding. The KEMH Parent Education department During COVID hospital tours are provided Skills for birth and beyond. as an online video and can be found offers a wide range of classes to help • Preparation of labour and birth. under Parent Education on our website. This class involves learning about prepare and assist women for the birth relaxation, breathing awareness, • Discussion forums. of their baby, ongoing care and the Childbirth and Parenting Courses massage and positioning to improve your Women who have their babies with the transition to parenthood. Your partner or comfort during pregnancy and childbirth. support person are welcome. Courses are offered to first time mothers FBC can also access the Antenatal and their partner or support person. Each Sessions are held in the Physiotherapy Breastfeeding Classes through the Please book Bookings are essential so please weekly session lasts for two hours or as a Department. Breastfeeding Centre. All the KEMH early to avoid contact the Parent Education team on condensed two-day workshop. To book, please use the QR code specific services are available to the disappointment. (08) 6458 1368 between Monday and provided, use the link on the KEMH FBC women on request. Friday, 8am - 9am, or 3pm - 4pm (except Parent Education web page or ring Wednesdays) to book your place. the Parent Education team on Community Midwifery Program (08) 6458 1368. The Community Midwifery Program classes are designed to inspire and inform expectant couples for the birth and to assist new parents during the first few weeks and months of their baby’s life. Classes are for all women and their Vaginal birth after caesarean partners or support person and (VBAC) class workshops are conducted by midwives or For women and their support person trained childbirth educators experienced planning a vaginal birth after a previous in all types of birth. caesarean birth. Please note that only women who have Tel: (08) 6458 1368 for details. KEMH as their supporting hospital can access the KEMH specific services.

16 17 Pregnancy, Birth and your Baby Pregnancy, Birth and your Baby

Taking care of yourself 3

The following information is about the things you can do to help you and your baby stay healthy during pregnancy.

Nutrition for you These drinks are not recommended and your baby during pregnancy. Helpful hints Eating well Do I need extra vitamins Good sources of or minerals? folate include green During pregnancy it is important for both leafy vegetables, you and your baby that you eat well. You Folate-rich foods oranges and nuts. need more nutrients but not necessarily more calories. This means you need to Folate (or folic acid) is a vitamin found Folate is added focus on the quality and variety of foods in a variety of foods. It is recommended to some breakfast you eat. that you take a folate supplement for cereals, juices two months before you get pregnant and and bread. If you eat regular meals and include for the first three months of pregnancy, fruit and vegetables, wholegrain breads to reduce the risk of your baby having Iron is found in red and cereals, dairy foods and lean meats neural tube defects such as spina bifida meat, chicken and (or other protein alternatives), you will (a type of ). As well as eating fish with smaller be getting most of the nutrients that foods such as leafy vegetables and amounts in beans, you need. beans, a daily supplement containing pulses, nuts and During pregnancy your body needs 500mcg folic acid is recommended. seeds and green folate, iron, calcium, vitamin D and leafy vegetables, iodine. Sometimes these need to be Iron wholemeal breads taken as additional supplements. It is important to eat a healthy and and cereals. A vegetarian diet can be very healthy well-balanced diet during pregnancy to Calcium is present if care is taken to replace meat with ensure an adequate supply of iron. Iron in dairy foods another protein. If you do not eat any is needed to make red blood cells that like milk, cheese, meat, eggs or dairy you may need a carry oxygen around the body. During yoghurt and most Vitamin B12 supplement while you are pregnancy you need more iron because soy milks. pregnant and breastfeeding. Vitamin the volume of your blood increases and B12 is an important vitamin for brain your baby’s blood is also developing. Vitamin D is mostly development in your baby. Healthy iron levels are important made in the skin Advice about food, diet, nutrition, during pregnancy and may reduce from exposure to supplements and weight during pregnancy complications, like anaemia. If a woman sunlight, but a small is available from your midwife, doctor becomes anaemic while pregnant, it will amount comes or a dietitian. Dietitians have specialist make her even more tired than expected. from diet, such as knowledge about nutrition during oily fish, egg yolks, Your Doctor or Midwife will guide you if pregnancy and can provide expert advice margarine and some additional iron is required in the form of about any problems with your diet. You brands of milk. tablets or liquid. It is important to take can see a dietitian any time during your your iron supplements as instructed and pregnancy. (See back of this booklet for inform your Doctor or Midwife if you are contact details). unable to take them due to side effects. Caffeine Iron is normally absorbed by your Tea, coffee, cola drinks, iced coffee and body from the food you eat. For an 3 iron rich diet: energy drinks all contain caffeine. • include at least two serves of meat, There is mixed evidence about the chicken, fish, eggs, legumes or nuts effects of large amounts of caffeine on Taking care every day, and the developing baby, however moderate amounts appear safe. This is up to three • eat wholegrain breads, cereals and cups of coffee or five cups of tea per day. green leafy vegetables regularly. of yourself Guarana is a caffeine substance used in many brands of energy drinks. 18 19 Pregnancy, Birth and your Baby

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The iron in animal-based foods is Always speak to your doctor, If you are worried about your weight Things that can make nausea and Remember easier to absorb than the iron in plant- midwife, dietitian or pharmacist if and diet, talk to your midwife or vomiting worse could include: rich or Helpful hints based foods. If you are a vegetarian you are unsure about taking your contact the dietitian (see page fatty food, strong food smells, spicy • Eat a range of foods: or vegan, you will need to take extra supplements, if you have stopped 114 for contact details). If your food, chocolate, cigarettes, coffee, Morning sickness grains, vegetables, care with your diet to get enough iron. taking any medicine or are still having Body Mass Index (BMI) is more tea, cola and iron tablets. Tips for relief: fruit, dairy, meats and problems taking it. than 40 you will be referred to a Some women can’t get enough iron There is some evidence that pulses. dietitian. Ask your midwife or doctor • Eat small meals and from food. Blood tests are performed helps settle pregnancy nausea. at your appointment. snacks frequently • Quality not quantity. at different stages throughout Calcium Ginger can be taken as: • Drink plenty of water • Make sure your hands, your pregnancy to check for iron Calcium is important for developing • Half a teaspoon of powdered ginger food and utensils are deficiency. Your doctor, midwife your baby’s bones. If you don’t eat Morning Sickness dissolved in herbal tea • Get plenty of rest or dietitian will let you know if you calcium rich foods regularly you may well washed to avoid Pregnancy nausea and vomiting (or • Grated ginger root in hot water (can need an iron supplement and advise need a calcium supplement. • Avoid triggers like contamination. Morning Sickness) is common, and strain and serve cold with honey) rich foods and strong you on the recommended form normally occurs early in pregnancy • Talk to you doctor, • Ginger beer (non-alcoholic) check smells of iron supplement. Iodine and improves by the second trimester. dietitian or midwife the ingredients label to see it If nothing works see It is important to remember that some It does not impact your chances of about supplements. Iodine is needed for normal mental contains ginger root your midwife or doctor. foods help your body absorb iron and development of your baby. The having a healthy pregnancy. It can • Fish is a good source occur at any time of the day, and • Crystallised or glace ginger There are medications some have the opposite effect. amount of iodine needed increases available for controlling of omega 3 but some during pregnancy, but only small for some women it can continue • Ginger biscuits Supplements (if advised by your morning sickness types should be amounts are found in most foods. The throughout the whole pregnancy. doctor or midwife) should be taken Other helpful tips: that are safe during limited. NHMRC recommends that all women Although we are uncertain about the one hour prior to food. pregnancy. take a daily pregnancy vitamin that cause, we know that changing your • Cold food is better tolerated than contains 150μg of iodine. diet may relieve your discomfort. Here hot food, because there is less are some great tips. odour Fish If you are vomiting continuously it is • Space out food and drinks so you’re not overfilling Fish is a good source of omega 3 fatty very important to drinks fluids to avoid acids, which your baby needs for brain dehydration. Drinks that contain some • Avoid skipping meals and snacks Take care! and development. sugar are better tolerated. Try to sip as an empty stomach can increase Australian Guide to Healthy Eating something every 15 minutes. The nausea These foods Enjoy a wide variety of nutritious foods Eating fish is encouraged during from these five food groups every day. best drinks for this are: electrolyte or Drink plenty of water. Vegetables and pregnancy, however some types • Eat slowly and sit upright may upset your legumes/beans should be restricted as they may sports drinks (Hydralyte, Gastrolyte, • Practice relaxation techniques stomach: Grain (cereal) foods, Powerade, Gatorade), lemonade, mostly wholegrain contain higher levels of mercury. You and/or high cereal • Wear loose clothing • Fatty or fried foods fibre varieties Muesli may eat one to three serves per week ginger beer, mineral water, juices Polenta of any fish or seafood not listed below (diluted) or cordial. You could also try • Get fresh air – try eating outside • Thick, creamy Quinoa (an average serve is 150 grams). ice cubes or icy poles. • Rest after meals but avoid lying flat gravies or soups

Fettuccine Penne • Overly sweet foods Red kidney Aim to eat small and often, e.g. • Chew foods well beans Fish with high mercury levels something every 30 minutes. • Keep something next to your bed like chocolate, rich Wheat flakes Limit shark (flake), broadbill, swordfish, Red lentils Chickpeas desserts, cakes and marlin, orange roughy (sea perch) or Try the following foods: and eat something before you get catfish as all contain higher levels of up in the morning pastries • Crackers or bread or dry toast mercury. You can eat one serve of • Cook and freeze meals when • Strong smelling

Red kidney • Jelly foods beans these per fortnight, provided you do not you’re feeling well, ready for when Lentils Mixed nuts eat any other fish that week. you’re having a bad day Chickpeas • Popcorn or dry breakfast cereal • Coffee, tea, cocoa, cola drinks • Fruit – fresh or tinned A small number of women may Weight • Spicy or rich foods Fruit • Plain rice, pasta, experience more severe nausea and Weight gain varies between women Lean meats and prolonged vomiting that requires • Wholemeal / high poultry, fish, eggs, potatoes or noodles tofu, nuts and seeds and may depend on your pre- and legumes/beans medical attention. Contact your fibre bread • Soups – fresh, tinned Milk, yoghurt, cheese and/or pregnant weight. Weight gain in midwife or doctor if you experience alternatives, mostly reduced fat pregnancy averages from 10 to 16 or cup-a-soups signs of dehydration (dark urine or Use small amounts Only sometimes and in small amounts kilos. If you were underweight at the • Dairy foods – milk, yoghurt, dizziness with standing), repeated start of your pregnancy you can afford cheese, smoothies or custard vomiting throughout the day to gain more than the average. If you (especially if you see blood in the • Nuts or a trail mix were overweight you should aim to vomit), pain or cramping, or weight

gain 5-9kg; however, strict dieting is loss over 2-3kg. 20 Source: National Health and Medical Research Council not recommended. 21 Pregnancy, Birth and your Baby

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Food safety and hygiene • soft serve ice cream and Exercise Pelvic floor exercises thick shakes Helpful hint Exercise can help you physically and There are two infections of particular • Sit with an upright posture. As • tofu, both soft and hard types, mentally during pregnancy and the you become better you can Avoid high risk concern during pregnancy. Although and tempeh (cooked tofu is period after birth. It is best to check progress to standing. foods such as soft these are extremely rare, they considered safe) with your doctor or midwife before cheeses like brie or can harm your developing baby. you commence exercise as there are • “Squeeze and lift” – close your front feta, cold meats, pate, • unpasteurised milk and certain conditions where exercise is and back passages and gently uncooked or smoked Toxoplasmosis unpasteurised milk products not suitable and others where you draw them up inside you. Imagine seafood, pre-prepared Toxoplasmosis is caused by a parasite Refrigerate leftover food as soon as it need to be cautious. that you are trying to stop urine salads and soft-serve found in raw meat and in cat faeces. has stopped producing steam and eat midstream or trying to hold in wind. ice-cream. within 24 hours. When you reheat food Staying fit To reduce the risk of toxoplasmosis: • Try to hold this contraction for make sure it is piping hot, as heat kills • Choose exercises such as walking, approximately five seconds whilst • Wash your hands well after handling Listeria. swimming (not frog kick), low impact you breathe normally. pets or gardening To prevent infections including aerobics and yoga. • Relax and feel your muscles let go. • Wash salad vegetables listeria infection: • Avoid hot temperatures (spas and • Cook meat thoroughly • Rest for 10 seconds. • Thoroughly wash your hands, saunas) and don’t do vigorous • Avoid contact with cat faeces, wear cooking utensils and chopping exercise in crowded rooms or hot/ • Repeat this exercise 5-10 times gloves to dispose of cat litter boards humid conditions (over 37 degrees) (one set). as this can affect your baby. • Wash raw vegetables and fruit • Aim for two or three sets per day. Listeria • Drink plenty of fluids, especially Do your pelvic floor exercises anytime • Refrigerate all food, including water. Listeria is a bacteria that can of the day and during everyday contaminate food and cause infection. leftovers, as soon as the food is cool enough to touch You can still play sport during activities such as watching TV, Although listeria infection is rare, it is pregnancy if it is not too strenuous, cooking or standing in a queue. very dangerous for pregnant women • Throw out food left at room but avoid contact sports or excessive and their unborn babies. temperature for long periods twisting, jumping and bouncing Listeria bacteria can survive and (more than four hours), movements. grow at low temperatures. Keep your especially in summer fridge as cold as possible (below 5ºC) • Defrost frozen food in your fridge or Pelvic floor muscles without freezing the food. Many ready- microwave, rather than on the bench Your Pelvic Floor muscles are a to-eat foods are considered high risk group of muscles that form a sling foods for Listeria infection. Excess Vitamin A across the floor of your pelvis. People at risk of Listeria infection Too much Vitamin A can be harmful to They have a number of important should avoid the following foods: your developing baby. As liver contains functions: very large amounts of Vitamin A, limit • paté • Prevent urgency and leakage your intake to small amounts (50g per of urine • cold ready-to-eat chicken week at most). There is no danger of excessive Vitamin A intake from other • Maintain bowel control • manufactured ready-to-eat meats, foods. However, it is often present in • Better sexual function including polony, ham and salami multivitamin supplements so before • Prevent or reduce prolapse • soft cheeses, including brie, buying them ask the pharmacist if the camembert, fetta and ricotta supplements are recommended for • Back support • Strengthen core muscles • pre-packed, pre-prepared or self- pregnancy. serve fruit or vegetable salads It is important to maintain good • freshly squeezed fruit and strength and control of your pelvic vegetable juices floor muscles. These muscles stretch during the 2nd stage of • ready-to-eat cold, smoked or raw labour as they relax to allow the seafood, including smoked salmon, delivery of your baby. oysters, sashimi and cooked prawns • sushi 22 23 Pregnancy, Birth and your Baby

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Physiotherapy at KEMH Managing common aches and pains Tel: (08) 6458 2790 Posture and back care Discomfort Self- Help The Physiotherapy Department can Your posture changes during pregnancy and your joints are Carpal Tunnel • Reduce swelling by elevating hand and using more vulnerable due to softening ligaments. Good posture is offer KEMH patients the following (Hand pain, cold packs. classes and appointments: the key to preventing and managing back pain: numbness or • A wrist splint may be helpful (see Physiotherapist). • Stand tall – lengthen your spine tingling) • Pregnancy ‘walk in’ clinic: • Avoid prolonged repetitive activities. Monday to Friday 11am – • Feel your shoulders relax back and (typing, cleaning). 12noon. down • TENS for pain relief in labour: • Sit tall with your back supported Muscle • Try stretching your calf before bed and as how to use TENS during labour Cramps cramps start. for pain relief and options for Discomfort Self- Help • Seek medical advice for calcium and magnesium equipment hire. sources. • Postnatal education class: Pelvic Girdle • Avoid lifting and carrying heavy things. Pain Varicose veins • Wear support stockings (chemist) for varicose veins. including information and • Change your regularly. exercises designed to help your (Very low and vulval • Try a sanitary pad in firm underwear for body recover after pregnancy back, buttocks, • Stand with equal weight on both feet. varicosities vulval varicosities. and childbirth. This class groin or pubic • Sit to put on your pants. • Avoid prolonged standing. can be attended at any time bone) • Walking – slow down! after delivery and includes • Walk regularly. information relevant to the early • Avoid twisting your body • Elevate the legs and vulva where possible. postnatal period. - Try a pillow between your knees • Avoid constipation/ straining. • Postnatal exercise class: when sleeping exercise classes with your baby Swelling in • Avoid prolonged standing. - Move onto your side first when getting aged between six weeks and legs • Exercise in water. six months (corrected age for in and out of bed, keeping your • Walk regularly. premature babies). This class knees together. can be attended after you have • Getting in and out of the car • Rest with feet elevated. attended the Postnatal - Pivot, keeping your knees and ankles Constipation • Increase soluble fibre and fluid intake. Education Class. together, a plastic bag on the seat • Increase activity (exercise, walking). • Pregnancy Aqua Aerobics: may help. Classes held at Lords • Try toilet position in diagram. • Stairs – avoid if possible. If you can’t, take Recreation Centre from the 14th one step at a time. • Avoid straining. week of pregnancy. Patients • Change iron supplement – seek medical advice. must be cleared by midwife to • Sex – try side-lying. • Aim for a soft, formed stool. attend. Cost: $6.50 for • Exercise – keep moving but avoid high pool entry. impact activities. Walking in water can be Haemorrhoids • Medication – seek medical advice from GP • Individual consultations: very beneficial. or pharmacist. Physiotherapists are on the postnatal ward Back Ache • Have work surfaces at waist height. • Ice packs. from Monday to • Avoid lifting heavy objects. • Pad for support. Friday and will • Keep the objects close to you. • Avoid constipation. see patients if required. See a Physiotherapist if you are unable to manage your discomfort Our Physiotherapy with the above tips. after Childbirth booklet is also available online.

Physio after Childbirth - 0556

24 25 Pregnancy, Birth and your Baby

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Medications and alternative Managing constipation Stay out of direct sunlight in the Common concerns during pregnancy middle of the day and do not stay in Remember medicines the sun long enough for your skin to in pregnancy Helpful hints for Constipation is common during become red. In summer, many fair when you feel the • When you are pregnant General medication pregnancy. There are a number of Drugs and alcohol in pregnancy skinned people are able to attain urge to smoke or breastfeeding, do information ways to help reduce and manage Illicit or illegal drugs are harmful to not take medication enough Vitamin D from exposure of constipation, these include: your developing baby. If you are Things you can do: without first asking your their hands, face and arms in the sun Before taking your medication pregnant and using illegal drugs you pharmacist, midwife or • Increased exercise – at least for a few minutes. People with darker • Distract yourself Medicines include those that are will need professional support to help doctor if it is safe. 30 minutes of moderate physical skin may require more sunlight and for the five to ten prescribed by your doctor, purchased activity everyday. will be required to spend a longer you stop safely. minutes it takes for • Illicit drugs are dangerous over-the-counter at pharmacies or at period of time in the sun. As there is no known safe level of a craving to pass. for your unborn baby. a supermarket, health food stores, a • Adequate fluid intake – at least Contact the Women two litres a day. If you have had skin cancer before, alcohol consumption in pregnancy, • Relax, take several naturopath and herbal medicines. deep breaths with a and Newborn Drug discuss Vitamin D and sun exposure or while breastfeeding, the safest • Adequate fibre intake – 30g of fibre pause between each and Alcohol Service Throughout the course of a with your doctor. approach is to not drink alcohol at all. pregnancy, it may not be possible to everyday including wholegrain breath. (WANDAS) on The Women and Newborn Drug avoid all medications. Some women cereals, fruit, vegetables and (08) 6458 1582 for Testing and treating for and Alcohol Service (WANDAS) can • Drink a glass of have existing medical conditions legumes. water slowly (this assistance and support. low vitamin D assist women who need support that require treating whilst others really works!). • Respond to the urge to empty your during pregnancy (contact details are may experience new conditions It is important to have good levels of bowels immediately. on page 114 of this booklet). • Use nicotine patches during pregnancy, such as morning Vitamin D as your baby’s Vitamin D or gums. If the above methods are not helpful levels will be the same as yours. sickness or heartburn, which may Smoking require treatment. Before starting in reducing the constipation, speak • Call a friend or Vitamin D levels can be tested using family member. any new medications or stopping to your doctor, pharmacist or midwife If you stop smoking during pregnancy for alternatives. a blood test. This is done as part regular medications ask your doctor, of your antenatal assessment in your baby will immediately feel • Practise your pelvic pharmacist or midwife for advice. the benefits. It is never too late floor exercises. Vitamin D pregnancy and may be done again post-delivery. in pregnancy to stop. Smoking • Change any habits Complementary and Vitamin D is an important vitamin increases the risk of miscarriage, you associate with alternative medicines for both mother and baby. It is If you have low Vitamin D you will premature birth or having a low birth- smoking. be advised to take a Vitamin D weight baby. Herbal, traditional medicines and essential in maintaining muscle • Take it a day at a and bone strength and helps your supplement and increase your sun therapies are called complementary exposure during pregnancy and Babies are also more at risk of time and reward and alternative medicines. These body absorb calcium from food, infections and long-term health yourself for success. increasing bone and teeth strength. breastfeeding. may include therapies such problems. Smoking in pregnancy and • Call the Quitline on It can also decrease the risk of some as acupuncture, chiropractic, Vitamin D supplements are taken after the birth increases the risk of 13 78 48. osteotherapy, naturopathy and pregnancy related conditions such every day. Sudden Unexpected Death in Infants meditation. They may also include as pre-eclampsia, hypertension, (SUDI) also known as SIDS or cot herbal teas, homeopathic remedies, cardiovascular disease and death. There should be no smoking in herbal medicines, nutritional and pre-term labour. your baby’s environment including in, other supplements. or near, the house or car. How does my body get There is limited evidence available vitamin D? Your midwife or doctor can give you regarding the safety of most free information, advice and support complementary and alternative 90% of Vitamin D is made from direct about quitting or you can find more skin exposure to sunlight and only medications in pregnancy and information at www.quitwa.com or breastfeeding. Speak to your doctor, 10% is available from some foods contact the Quitline on 13 78 48. such as oily fish and eggs. pharmacist or midwife before starting any of these medications. Exposure to sunlight is important to produce Vitamin D, however should be done without increasing the risk of skin cancer.

This imagery has been provided by NHMRC Centre of Research Excellence in (Stillbirth CRE) 26 See page 46 for full poster 27 Pregnancy, Birth and your Baby

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“I think you have Hair dyes and hair removers Cytomegalovirus (CMV) Immunisations and vaccines Infections – Working in health Air travel care, or with animals, for more extreme Little research is available on the use Before you fall pregnant it is good The safest time for a and pregnancy instance, can increase the risk of of hair dyes or cream hair removers to check with your doctor that your pregnant woman to travel emotions. You get CMV is a common viral infection, infections that may affect the baby. during pregnancy. Although generally especially among young children. immunisations (vaccinations) are by air is after 20 weeks and easily upset about considered safe (as very little is Congenital CMV occurs when the up to date. If you do not get that Chemicals – Health care, dental care, before 32 weeks, providing things and just as absorbed through the skin), we suggest infection is passed across the placenta chance before you fall pregnant, talk veterinary care, manufacturing and you are well. You should you avoid using hair dye or remover easily you’re happy from a pregnant woman to her to your doctor and midwife about pest control are just some areas that think about the standard of products in the first three months. again!” JESSICA developing baby. Some babies with immunisations in pregnancy. may involve risk. medical care in the country If you do dye your hair when you are congenital CMV infection show signs A blood test may be taken to see if Radiation – Working around x-rays to which you are travelling. “I didn’t understand pregnant we advise you to: of disability at birth, while others are you are immune to measles, mumps or radioactive material is not harmful In some developing countries the quality of the feelings, let • Go to a hairdresser rather than doing born healthy. and rubella. There is no blood test if normal occupation, health and to check for immunity to diphtheria, medical facilities are lower it at home. There is no licensed vaccine against safety measures are taken. Radiation alone tell anyone”. tetanus and whooping cough (dTPa) and the risk of disease is • If you do it at home, always remain in CMV currently available. from electrical appliances is not ESTHER higher than in Australia. a well-ventilated area. only vaccination history. harmful. Pregnant women are recommended • Wear gloves or ask someone else to It is also recommended that anyone Remember to get travel to take steps to reduce their risk of Other risks – In jobs that that apply it for you. who will be in regular contact with insurance and make sure it exposure to CMV and so reduce the involve heavy lifting or standing for your newborn get a Whooping Cough will cover you for pregnancy • Follow the instructions on the risk of their developing baby becoming long periods of time, make sure you booster vaccination. related emergencies. package and do an allergy test infected. Preventative steps include: take the chance to sit down during beforehand. breaks (if possible, put your feet up Air travel in the later • Wash hands often with soap and Whooping cough vaccine Dental care on another chair). Standing for long stages of pregnancy can running water for at least 20 seconds This vaccination is recommended for periods may increase your chance of trigger premature labour. In pregnancy, dental care is important. and dry them thoroughly. This all pregnant women between 20 and getting varicose veins in pregnancy. Your midwife or doctor will Due to hormonal changes, you are should be done especially after 32 weeks of pregnancy to ensure advise you about travel more likely to develop tooth decay and If you sit at a desk or computer most close contact with young children, optimal protection from birth to six and vaccinations. Individual gingivitis (where gums become red, of the day, take a few minutes every changing nappies, blowing noses, months when baby is most at risk of airlines also have policies on swollen and bleed easily). It’s a good hour to get up and walk around. Care feeding a young child, and handling whooping cough complications. pregnancy and travel. When idea for all pregnant women to see children’s toys, dummies/soothers. for your back by: a dentist, especially if they have any travelling on a plane drink • Do not share food, drinks, eating Flu Vaccine • Being aware of your posture – sit dental concerns during their pregnancy. plenty of fluids and move and utensils or toothbrushes with young and stand tall Always let your dentist know that you Symptoms of the flu such as high stretch your legs often. children. • Using a chair that gives you good are pregnant. temperature can be harmful to Ask your travel insurer about back support. • Avoid contact with saliva when you and your baby when you are cover for you and your baby. kissing a child. pregnant. If you are pregnant over Avoid heavy lifting or climbing • Use simple detergent and water to the flu season, the influenza vaccine ladders and try to bend over carefully clean toys, countertops and other is recommended regardless of which - especially in late pregnancy when Wearing seat belts trimester you are in. Research has surfaces that come into contact with body changes can make these things No matter what stage you children’s urine, mucous or saliva. shown the flu vaccines to be widely difficult. safe in pregnancy and a mother is are in your pregnancy, it is Child care workers who are pregnant able to pass her antibodies to the To make sure your work is safe essential that you always or are considering pregnancy should baby, increasing their protection. during pregnancy, ask your midwife, wear a seat belt. By wearing pay particular attention to good Always speak to your doctor or doctor, occupational health and a seat belt you are protecting hygiene, especially after changing midwife regarding your flu vaccine safety officer, union representative yourself and your unborn nappies or assisting with blowing noses requirements. or employer. You can also contact baby in the event of an or toileting. WorkCover WA for assistance 1300 accident. Remember, it is Work and pregnancy 794 744 or go to illegal not to wear a seat belt, unless you have a current www.workcover.wa.gov.au Unless your job involves heavy medical certificate from your physical work or occupational doctor. hazards that may affect your baby, there’s no reason why you can’t work while you are pregnant. Some jobs bring you into contact with things that may harm an unborn baby. These are some examples, but it’s not a full 28 list of risks. 29 Pregnancy, Birth and your Baby

Taking care of yourself Taking care of yourself

Emotional Depression and anxiety • ‘Spaced-out’, ‘on-edge’ Emotional health • If you’ve experienced mental “Sometimes it draws us or restless health conditions in the past, The of ‘ups and downs’ and wellbeing discuss this with your health together and sometimes depression and anxiety can go • Feeling the need for control During pregnancy and after Having a baby is a life changing professional. This can help you it pulls us apart. When unnoticed or excused as part of or perfection giving birth women experience a experience and can affect your identify and respond early if we first found out about becoming a new mother. A little • Having a sense of dread, range of physical and emotional emotional health and overall symptoms return. reactions. This can be a time worry or anxiety is normal during or imagining something bad wellbeing. the baby, we were edgy. of much joy and satisfaction; pregnancy. For some people happening We snapped at each Here are some tips to help you look however there are often many however, feelings of depression • Having thoughts of harming other a lot. Then it got and anxiety can start to interfere after yourself and your emotions Your partner’s feelings physical and lifestyle changes yourself or your baby better, but it can still be to adjust to. Hormonal changes with day to day life. when you’re expecting a baby. Your partner may be feeling very may be responsible for some of • Not coping/overwhelmed excited about the new baby, but they up and down”. KEN It is important to keep a check on • Don’t expect too much of yourself the emotional ups and downs you might also be feeling a bit confused how you are feeling emotionally • Experiencing significant fear of – make time to slow down, rest may experience. pregnancy or childbirth and relax. about how you both feel and the and to let someone know if changes that are happening. Try to Other stresses can affect your you are: • Re-triggering of past trauma • If you have a partner, talk about keep talking to your partner about Remember emotions at this time, such the difference a baby will make to • Not coping, feeling guilty or like what you are both experiencing. as moving house, changing Talk to your midwife or doctor if you your lives. Partners or support jobs, relationship troubles you need someone to be with This can help you adjust to the think you might be experiencing • Arrange as much time as you can people can: and not having much practical you all the time changes happening in your life. depression or anxiety. They can for both you and your partner to or emotional support. If you • Feeling that things are hopeless About 10 percent of new fathers • Be there for make sure that you get the support be at home after the baby is born. have a personal or family report experiencing mental health appointments and • Not enjoying things you used you need. Government-funded Dad and history of depression, anxiety issues after having a baby. This ultrasounds to enjoy Partner Pay provides up to two or other mental health issues means fathers are experiencing • Participate in decisions • Crying a lot weeks paid leave, and you may be you may also find pregnancy depression and anxiety at similar about your care more emotionally challenging. • Experiencing loss of appetite or able to negotiate additional time off rates to mothers. • Talk to other friends comfort eating with your employer. Talking to your partner, In men, symptoms of depression who are parents supportive friends, family or a • Irritable and snappy • Set up extra support for the may include feeling moody or • Go with you to health professional and sharing first few weeks after the baby’s • Finding it hard to sleep, irritable – which might come childbirth education experiences and feelings can often birth – longer if you‘re expecting concentrate or make decisions across as anger or aggression. classes help get you through this time. more than one baby, or if there • Avoiding others and withdrawing are other things going on in your Unfortunately men are more likely • Feel the baby kick than women to have their depression from friends and family life that may make this a difficult • Support you through adjustment. go unrecognised and untreated. your labour and birth This can also lead some men to try • Talk to someone you trust about managing their symptoms by using • Get involved with the your feelings. Sharing your alcohol or other drugs. There are care of the baby as concerns can be really helpful. Mental Health Services contact numbers at the back of this soon as possible after the birth Pregnancy and the early months after birth are times when anxiety, depression or other mental health • Extend your support network – booklet for services that can support problems can begin or become worse (even if you’ve never experienced them before). If problems or other expectant parents can be a new dads. valuable resource. emotional reactions feel ‘out of control’ or are getting in the way you can get help from the Department of You can support your partner by Psychological Medicine at KEMH. Your midwife or doctor may recommend a referral for an assessment. • Don’t be afraid to ask questions encouraging them to be involved when you visit your GP, You can also call direct on (08) 6458 1521 and ask to speak to a triage nurse about your concerns. right from day one and giving them obstetrician or midwife. space to explore parenthood. • Be careful what you read – some It’s also important to remember websites and articles might make your partner may parent differently you feel worse. Look at who is to you, and there is nothing wrong writing it. Can you trust the source with that. In fact, it can actually help of the information? a child’s emotional development • Be aware of any changes from to be exposed to different styles of how you normally feel. If your parenting. emotions are starting to interrupt your day-to-day life, talk to your GP, obstetrician or midwife – the 30 earlier the better. 31 Pregnancy, Birth and your Baby

Sex during pregnancy Coping alone Women and their partners are often concerned that If you are pregnant and on your own it can be difficult having sex will harm their developing baby. If you are to find people to share your feelings with and who experiencing a normal healthy pregnancy and you can offer you support. Sorting out problems, whether want to have sex, there is no reason not to. It will not personal, medical or financial is often more difficult by harm you or your baby. yourself. It is better to find someone to talk to rather Some women don’t want to have sex during than let problems get you down. pregnancy. You may prefer just to be held, touched Things to think about: or massaged by your partner. Later in pregnancy, • Choose a friend or family member to come to sex may not be that easy and you may have to find appointments and childbirth education classes different positions that feel comfortable. with you. This can be a time to experiment and explore together. • Is there a particular person who is close by and able to be there to support you after having Always ask your midwife or doctor for advice if: your baby? • Spotting occurs following sex • Will your baby need child care if you go back • There is heavy bleeding to work? • You’ve had previous • What family benefits are you entitled to and for how long? • Your waters have broken (this can increase the risk of infection to the baby) • What services are available in your local community that can help to support you and your baby? Abuse At KEMH the Social Work Department can help put you in contact with support services that might Doesn’t have to be part of be helpful for you (see contacts at the back of your pregnancy this booklet). If you are in a relationship where you feel scared or frightened by a family member, or you feel you Will you need help when are unsafe, talk to your midwife or doctor who you go home? can refer you to support services. Abuse can Support services are available in your local take many forms including physical, emotional, community. Talk to a midwife or social worker if you sexual, financial or psychological. It can have an need extra support with caring for other children or enormous impact on you, your pregnancy, your others dependent on you. baby’s health and the wellbeing of other children. KEMH and Family Birth Centre patients can contact Pregnancy can be a time of abuse beginning in a the Social Work Department via our website. relationship for the first time.

Support and information Domestic Violence Advocacy and Support KEMH Social Work Department – (08) 6458 Central – (08) 9227 5852 2777 Family Helpline (24 hours) – Sexual Assault Resource Centre 24 hour helpline (08) 9223 1100 or 1800 643 000 (free call) – Women’s Council for Domestic and Family (08) 6458 1828 or 1800 199 888 (free call from Violence Services – (08) 9420 7264 landlines) 4 Women’s Domestic Violence Helpline (24 hours) You can also contact the following – community services: (08) 9223 1188 or 1800 007 339 (free call) Your visits Crisis Care (24 hours) – Men’s Domestic Violence Helpline (24 hours) – (08) 9223 1111 or 1800 199 008 (free call) (08) 9223 1199 or 1800 000 599 (free call)

32 33 Pregnancy, Birth and your Baby

Your visits Your visits 4

In this section we give you an overview of the recommended visits Diagnostic tests Your first appointment Non-invasive prenatal you will have, at KEMH, at the Family Birth Centre, with your shared Helpful hint Chorionic Villus Sampling (CVS) – When is the first appointment? testing (NIPT or care doctor or with the Community Midwifery Program. This is only 11-12 weeks of pregnancy Did you know it is Harmony Test) a guide, some women will have fewer visits and some will need to Your first appointment could be any In this test a small sample is taken time between 12 weeks and 22 safe for most women PathWest and most private have more. The visits will vary according to your needs. Try to use from the placenta and is used to weeks, depending on your pregnancy to have a pap smear providers offer this section to make sure you are on track with tests, discussions diagnose Down syndrome or in up to 24 weeks NIPT. It is not currently needs. It is our aim to see all women with the midwives and the things you need to organise. some cases other conditions such as by 14-20 weeks. gestation? funded by Medicare and cystic fibrosis. CVS has a one in one patients are required to hundred or one percent (1%) risk of What you will need for pay out of pocket for this What is a routine check up? Screening tests causing a miscarriage. service. KEMH does not your first appointment At each visit a midwife or doctor will: offer NIPT except in a First trimester combined – • Medicare card strictly limited number • Follow-up and discuss any tests screening test 15-18 weeks of pregnancy Things to of high risk women with • Health Care card (if you have one) you may have had or are about A sample of (the talk about contraindications to This test combines the results of • Your appointment letter to have. ‘waters’) is collected and can invasive diagnostic testing, a blood test taken at around The following topics • Check that you are physically well be used to diagnose Down • A copy of any test results from where it is considered on 10-12 weeks and an ultrasound at will be discussed at (e.g. blood pressure check). syndrome or some other genetic your GP (if you have any) a case-by-case basis. 11-14 weeks. The test will show your your first visit: conditions. Amniocentesis has Turnaround times are up • Answer any of your questions chance of having a baby with • Your local doctor’s contact details a one in two hundred risk of • Your pregnancy to 14 days from sample (you may like to write any Down syndrome, Trisomy 18 or causing a miscarriage. • If you are from overseas, you will health record collection. questions down before your visit). Trisomy 13. It will not tell you if your need to bring details of your private • Your pregnancy care • Check how your baby is growing baby has Down syndrome. Ultrasound scans health insurance and your passport options Maternal serum and positioned by feeling your (some countries have Reciprocal If you are at increased risk you will A second trimester scan is • Breastfeeding – the screening (Triple Test) stomach and listening to your Health Care Arrangements with be offered a diagnostic test, either undertaken at about 18-20 weeks benefits for you and baby’s heartbeat. Australia). This test involves a blood a CVS (Chronic Villus Sampling) or of pregnancy. This scan is used to your baby test which is performed • Talk about preparing for your amniocentesis (see below). identify some problems with your What happens at the • Diet and nutrition between 15 and 17 weeks labour and birth and taking your baby including spina bifida or heart gestation. No pre-test baby home. This test may not be available first visit? • Genetic advice at KEMH in all cases. You can and limb defects. ultrasound is required • Physical and arrange the test through your local All women (including those who unless the Estimated Date Tests available in Additional scans in the third trimester are doing shared care) will have emotional changes doctor (GP) which will involve some of Delivery (EDD) needs pregnancy to check baby’s growth and wellbeing their first visit either at the hospital, in pregnancy to be confirmed. The test out-of-pocket expense. For more maybe required if your midwife or During your pregnancy you will Family Birth Centre or with your • Your birthing options gives two results: information visit www.kemh.health. doctor has any concerns about the be offered tests to make sure community midwife. if you have had a wa.gov.au progress of your pregnancy. • the risk of a everything is going well for you and The midwife or doctor will ask previous caesarean chromosomal your baby. The types of tests will Second trimester screening Gestational Diabetes you questions about your health, birth abnormality (Down depend on how your pregnancy is illnesses, medications that you are • Things that can syndrome most progressing. Some tests need to This is a blood test collected screening taking, operations you have had and potentially harm between 15-20 weeks of pregnancy. commonly) be done by your GP or doctor in Oral Glucose Tolerance Test any previous pregnancies. your baby – The test shows your chance of • the risk of an open early pregnancy before your first (OGTT) smoking, drug having a baby with Down syndrome, They will discuss: neural tube defect - antenatal appointment. and alcohol use, Trisomy 18, Trisomy 13 or neural This is a diagnostic test to screen for based on the maternal • When your baby is due sexually transmitted You can choose whether or not you tube defects such as spina bifida. Gestational Diabetes. Your doctor or serum alpha fetoprotein • Information that may affect infections. want to have any tests after talking If the test shows you are at an midwife will advise the best timing of level (MSAFP). with your midwife or doctor. Genetic your pregnancy such as your increased risk you will be offered this test. Services of WA provides information amniocentesis or ultrasound. family’s health The test requires fasting for 10 for women who are thinking about • Whether you are likely to have This test is not required if you having tests done (see contacts at hours (generally overnight, missing a straight forward pregnancy or have had the first trimester the back of this booklet). breakfast). A fasting blood test is whether you have more complex combined screening. taken followed by a 75g glucose Below are some of the tests you pregnancy needs drink and then blood tests at 1 and may be offered or recommended 2 hours after the drink. You will be • You will also be asked about your to have. required to remain at the laboratory family’s medical history which for the 2 hour duration of the test. includes diabetes, blood pressure, 34 35 Pregnancy, Birth and your Baby Pregnancy, Birth and your Baby 4 Between heart problems and even a history The following blood tests are also of twins. offered to women who are at risk: Why we test urine 12 and 20 We also ask all women about: • Vitamin D deficiency (that can We routinely test occur from lack of exposure urine after the first • Alcohol and illicit drug usage to sunlight) visit to see if you have weeks • Family and domestic violence medical problems such • Thalassaemia (an inherited as an increased risk • Previous miscarriages or disorder that affects the production of developing pre- Apart from your first visit, you may • Smoking of haemoglobin) eclampsia or if your have up to two other visits during this • Whether they have support from blood pressure is high. time. For most women this visit will family and friends Rhesus D negative in pregnancy be with your GP. • Whether they are Aboriginal or Test results At your first pregnancy visit you will Torres Strait Islander We do not give test You be offered a test to determine if your results over the • Emotional wellbeing and anxiety blood has the Rh factor. Most women • may be feeling tired and irritable telephone. Test results (85%) have the Rh factor and their • may feel your breasts have grown in This is to make sure that all women can only be given blood type is called Rh (D) positive. size and have become more sensitive are offered appropriate information, in person or if your If you don’t have the Rh factor, support and referral. You will also be midwife or doctor has • may have cravings for different foods your blood type is Rh (D) negative. offered the following tests by your any concerns with If you are Rh (D) negative you will • might be worried about having sex referring health professional: results they will contact be given further information and (but don’t worry, it is fine any time you by telephone, email Breast Blood tests/screening required offered preventative treatment with during your pregnancy as long as or letter. Areola before your first appointment: an injection of RhD Immunoglobulin you are comfortable). • Blood group, antibodies, (commonly referred to as Anti-D) at Nipple haemoglobin and iron levels 28 and 34 weeks in case your baby Your baby has Rh (D) positive blood group. • is about 5cm long • Immunity to rubella (German measles) • weighs about 15 grams • Blood borne virus screening, • is forming fingers and toes including Hepatitis B, Hepatitis C Calculating your due date Stomach • is developing facial features and Human Immunodeficiency The average length of pregnancy (or gestation) is counted as Virus (HIV) (AIDS). 40 weeks. • is forming organs, the heart, • Sexually transmitted infections Pregnancy is counted from the first day of your last period, not brain and the nervous system. including Syphilis, Chlamydia the date of conception. Your midwife or doctor will work out and Gonorrhoea. your due date at your first visit. • Cervical Screening Test if you A baby is considered full-term if its birth falls between 37 and have not had one in the past 42 weeks. five years (you can also choose Uterus to have this test after your baby If you have a regular 28-day cycle, a simple method to calculate is born). when your baby is due is to add seven days to the date of the Embryo/baby first day of your last period, then add nine months. Placenta For example, if the first day of your last period was February 1, Cervix add seven days (February 8), and then add nine months for a due date of November 8. Bladder Some women are unsure of the date of their last period. An Vagina ultrasound can show how far along your pregnancy is if you are not sure about your dates.

36 37 Pregnancy, Birth and your Baby

Between 12 and 20 weeks 4 Between 12 and 20 weeks

Thinking about breastfeeding At 20 weeks Things to What is the placenta? Pelvic power Breast milk provides all the You Helpful hint talk about nutrition your baby needs for the The placenta (or afterbirth) is Your pelvic floor muscles make up the • may feel flutters (small, fast Relaxation • Exercise, posture first six months of life and can form responsible for the growth of the base of your pelvis and support your movements) from your baby and back care the major part of its nutritional baby. It supplies the baby with organs and uterus. and the Now is the best time requirements throughout the first • may feel your morning sickness to learn how to relax. • Diet and nutrition nutrients and oxygen, removes weight of the baby can stretch these year and beyond. waste products and acts as a is getting better muscles and may cause you to leak It will help you cope • Work with stress, tiredness At your first appointment you will barrier against some harmful • can feel the top of your uterus at urine when you cough, sneeze or laugh. • Travel and ease pain in have an opportunity to start talking substances. your belly button. Try the following pelvic floor exercise: • Sex labour. Learning about feeding your baby with Substances such as alcohol, breath awareness and • Rest Your baby Step 1 a midwife. nicotine and other drugs can pass relaxation will also To start sit comfortably with feet slightly • Booking your to the developing baby through • is about 16cm long benefit you after your This will help to inform your decision apart. childbirth education about breastfeeding. If you have the placenta. It also produces • weighs around 300 grams baby is born. classes hormones that help to maintain the any questions or concerns about • curled up, is about the size of Step 2 Childbirth education pregnancy. • Things that can breastfeeding, talk about them now your hand Tighten the muscles you would use to and physiotherapy harm you and your with your midwife or ask a lactation The placenta is commonly called • has formed organs stop yourself from passing wind and ‘to classes are available baby – such as consultant at the Breastfeeding the afterbirth because it is expelled hold on’ when you need to pass urine. for you to practice smoking, drugs and Centre of WA. Call to make an from the uterus after the baby is • is growing rapidly You will feel a closing and lifting around these techniques with alcohol use appointment (see back page born. • is being provided for by the vaginal area. If you cannot feel a your support person. • Breastfeeding for contact details), or book for distinct tightening of these muscles, try The placenta begins to form the placenta. breastfeeding classes through the a different position, such as laying on soon after conception and is well Parent Education Department. your side or standing. established after the tenth day. Braxton Hicks contractions Before each hospital visit You can also talk to experienced There is good circulation through Most women start to feel Braxton Step 3 “I want to know if the breastfeeding mothers at you might like to write the by the tenth Hicks contractions about halfway Now that you can feel the pelvic floor baby is alright. I think the Australian Breastfeeding down questions to ask week of pregnancy. through their pregnancy. These muscles working, tighten them around it’s always in the back Association on telephone 1800 weak, usually painless contractions your midwife or doctor. your front passage, vagina and back of your mind, you mum 2 mum (1800 686 2 686). Position will help to prepare your uterus for passage as strongly as possible and worry about what you There is a breastfeeding positioning The placenta usually attaches the birth of your baby. They might hold for three to five seconds. Fully Join Parent and attachment session held on the itself to the top wall of the uterus. become more intense and frequent relax for 5 seconds. By doing this you do and whether it will Education wards at 10.30 - 11.30am. However, sometimes the placenta the closer you get to the birth. should feel your pelvic floor muscles hurt the baby”. SARAH ‘lift up’ inside you and feel a definite for a ‘Healthy If you plan to formula feed your attaches to the lower part of the Ultrasound booking ‘let go’ as the muscles relax. If you can Pregnancy’ baby you will be shown how to uterus very near or over the cervix hold longer (up to 10 seconds), then do Did you know that discussion safely prepare your formula and (this is called ). An ultrasound is usually done at so. Remember, the lift must stay strong when you attend between 12 and feed your baby during your visit to This may lead to complications around 18-20 weeks of pregnancy and you should feel a definite ‘let go’. KEMH for your 20 weeks the hospital. and sometimes causes bleeding to check the development of your in pregnancy and it may be baby. Most women will have had a Repeat up to ten times or until you feel pregnancy care, we An enjoyable necessary to deliver the baby by scan before their first antenatal visit. your pelvic floor muscles fatigue. welcome you and evening for women your support persons. caesarean. If you haven’t already organised This is one exercise set. If you can, do and their partner or If you have chosen to an ultrasound appointment through three sets per day in different positions. In many cases the problem will engage the services support person about your local doctor (GP), you will correct itself in late pregnancy. Your midwife or physiotherapist will of a , they too understanding the need to make one as early as help you with these exercises. Women will be welcome. For physical changes possible. booked at KEMH or FBC can attend more information pregnancy brings. a range of classes at the Hospital’s This session involves about , please Physiotherapy Department, bookings visit our website. discussion with the are essential, please call 6458 2790. midwife, dietitian and physiotherapist. Call (08) 6458 1368.

38 39 Pregnancy, Birth and your Baby 4 Between 21 and 33 weeks

Most women have three routine visits during this time. If you are doing shared care, these visits will be mostly with your GP, otherwise you will go to the hospital clinics, or see your midwife at the Family Birth Centre (FBC) or as part of the Community Midwife Program (CMP). Most women will also have one longer visit during this time to prepare for their hospital stay. This visit is always at the hospital, FBC or with your community midwife.

This information has been provided by NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE)

40 41 Pregnancy, Birth and your Baby

Between 21 and 33 weeks Between 21 and 33 weeks

At 26 weeks At 30 weeks Diabetes in pregnancy • Maternal age >35 Things to talk about • Previous large baby >4kg at term or Oral Glucose You You What is Gestational Diabetes • What to bring to hospital a baby large for . Tolerance Test • may feel Braxton Hicks • may get breathless Mellitus? • Plans for your hospital • Pre-pregnancy obesity (OGTT) contractions (sometimes called • may have indigestion Gestational Diabetes Mellitus (GDM) stay • Polycystic ovarian syndrome The Oral Glucose practice contractions) and heartburn is a type of diabetes which occurs in • Breastfeeding pregnancy and goes away after the Tolerance Test (OGTT) • may have a little more discomfort • Ethnicity: Asian, Indian • might have leg cramps baby is born. GDM usually occurs requires fasting for • Child safety and car as your uterus is now under Subcontinent, Aboriginal, • may find it hard to get after the 24th week of pregnancy 10 hours (generally restraints your ribs Torres Strait Islander, Pacific comfortable. and is due to placental hormones Islander, Maori, Middle Eastern, overnight missing • Smoking • may have heartburn interfering with how insulin works. Non-White African breakfast). Your baby Insulin is a which enables • Community support and indigestion • Some Medications, e.g. You will be required to glucose to enter your body cells services such as the • may have backache • is 38cm long , antipsychotics. remain at the laboratory child health nurse. e.g. muscle cells to provide you with for the two hour duration • are having check-ups every two • weighs 1400 grams energy. During pregnancy the body • If you are Rh negative, What are the risks associated of the test, which to four weeks. • has lungs and a digestive system needs to make 2-3 times more insulin Rh immunoglobulin is with GDM? involves an initial fasting which is almost mature to overcome this resistance. discussed. Your baby Most of the following risks can be blood test, then drinking • has fat building up under the skin, An oral glucose tolerance test (OGTT) minimised or avoided with good a 75g glucose drink, • is about 33cm long giving your baby a chubby look is needed to diagnose GDM as most diabetes and antenatal care once a and then blood tests • weighs about 800 grams when it is born. women do not have any symptoms. diagnosis is made. one and two hours after Between 5-7% of pregnant women drinking the drink. • is moving more and the Preparing you for your Risks to the baby: (may need Meals movements are stronger and will develop GDM. The incidence of hospital stay to be admitted to the special Breakfast, lunch and usually in a regular pattern gestational diabetes is increasing due to higher rates of obesity in care nursery) dinner are provided to Between 28 and 36 weeks your • is usually awake when you want the general population and more all inpatients. Please midwife will talk with you about • Macrosomia (large baby) which to sleep pregnancies in older women (NICE, advise staff of any special preparing for your hospital or Family may lead to a difficult birth 2015). requirements or food • responds to sound and light Birth Centre stay. • (excess fluid Developing GDM in pregnancy may allergies when you are • has the first signs of hair growth During your routine check, you can around the baby whilst in the womb) result in a change to your planned admitted to the ward or • has a protective substance called discuss a plan for your birth and • Premature labour (prior to 37 weeks place of birth. For example if you FBC. If you are not on vernix covering the skin your return home. of pregnancy) the ward when a meal were planning to birth in the Family • can swallow fluid and • Stillbirth can occur particularly if is delivered, please You will also be offered a blood Birth Centre or at home, you may be may get hiccups diabetes is poorly controlled. advise staff when you test for gestational diabetes (a required to birth in the main hospital return so that a meal can • practices sucking temporary form of diabetes that instead – should more monitoring of • Breathing difficulties at birth occurs during pregnancy) and your you and your baby be required. be arranged. • has working kidneys. • Low blood sugar levels after birth iron levels and antibodies will be Prevention is the Key which must be treated early. You will not have access re-checked. This visit will be longer • Childhood and adolescent obesity to a fridge, microwave than other visits. Healthy lifestyle choices can reduce and type 2 diabetes. or oven during your stay the risk of developing GDM and type in hospital. Preparing for a 2 diabetes later in life. Eating a well- Risks to the mother: balanced diet, taking regular exercise Please note that meals are Your midwife will talk to you about • Pre-eclampsia risk is higher in not supplied for support and maintaining the correct weight for preparing for your home birth and your height is essential. women with diabetes people but the Women the equipment you may need. It • Induction of labour, caesarean and Infants Research is a good idea to check you have Risk factors for developing GDM section is more likely Foundation café is open adequate ambulance cover in • GDM in a previous pregnancy daily at KEMH. case you or your baby need to be • Possible birth injury if baby is big transported to hospital. • Family history of diabetes mellitus • GDM will most likely reoccur in • A mother or sister who have future pregnancies had GDM • The risk of Type 2 diabetes later in • Previous raised blood life is high. glucose levels 42 43 Pregnancy, Birth and your Baby

Between 21 and 33 weeks 4

Who should be tested for GDM? What is the treatment for GDM? Remember The Australasian Diabetes in All women diagnosed with GDM Pregnancy Society (ADIPS) are invited to attend an education It’s ok to ask recommends early testing those class/ session with the diabetes questions women who are at risk (as listed educator/midwife and dietitian to above) and routine testing for all learn how to manage the diabetes. Asking questions women between 26 – 28 weeks This will include learning to check helps you understand of pregnancy. blood glucose levels at home and more about your care. understanding the results. Diagnosis of GDM Remember it’s your If blood glucose levels are The diagnosis of GDM at any time right to: high despite changes to diet, in pregnancy is made if any one of • Be fully informed medication, usually insulin, will be the following values is elevated as about any tests or recommended to keep levels within follows treatments you’re the normal range. asked to have Fasting – equal to or greater than 5.1 mmol/L Women diagnosed with GDM • Refuse any treatment attending KEMH antenatal clinics will or tests you’re offered 1hour level equal to or greater than 10.0 mmol/l continue with their usual antenatal • Ask your Midwife care. All women with diabetes have 2 hour level equal to or greater than about antenatal ongoing review and support by 8.5 mmol/L colostrum expression the diabetes educator/midwives There is no upper cut off in GDM. and dietitians. Even if levels are in the diabetes range and the woman is pregnant the Women with GDM who are diagnosis remains GDM. If ongoing receiving antenatal care through diabetes mellitus is suspected this the CMP must have a plan of care should be reviewed and diagnosed including the place of birth made in after the birth of the baby. collaboration with the client, midwife and obstetrician. To ensure the best Ask your midwife What are the advantages of available care for you and your baby, about the brochure: the test? it is possible that your planned place Antenatal Early detection and diagnosis of of birth may need to change when expression of GDM provides the opportunity to you have GDM. colostrum for appropriately monitor and manage women with blood glucose levels through diet and The future with GDM diabetes. exercise alone. Well controlled GDM Approximately 50% of women who significantly reduces the risks. have had GDM will develop type 2 What are the disadvantages diabetes in 10 – 20 years. It is also of the test? likely that the GDM will return in a subsequent pregnancy. There are no risks to the mother or baby from having the test. The Most women will return to normal majority of women will experience glucose tolerance after the baby is born little or no side effects. however, it is recommended that an oral glucose tolerance test is performed Can testing for GDM be declined? around 8 weeks after the baby is born As with all tests in pregnancy to check that the diabetes has gone. screening for GDM is optional. This test should be repeated every However, it is recommended that two years. all women are screened therefore Exclusively breastfeeding your baby declining testing may affect your can reduce the risk of developing type choice of place of birth. This will 2 diabetes in the future. If you would need discussion with a midwife like antenatal discussion /postnatal This information has been provided by NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) or obstetrician. support contact the Breastfeeding 44 Centre on (08) 6458 1844. 45 This information has been provided by NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) This information has been provided by NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) 46 47 Pregnancy, Birth and your Baby Between 4

33 and 40 Are there any tests and Are there alternative treatments treatment for GBS? to antibiotics? Helpful hint Routine testing for GBS is There is no reliable research weeks recommended in Australia. Swabs evidence to prove the effects of Pack your bag for your are collected from your vagina and alternative therapies in treating GBS hospital stay. Refer can cross to the baby during labour to What to bring to Most women have four visits over rectum between 35 and 37 weeks of prior to birth. and birth and occasionally cause hospital on page 59. Pet Safety this time. They are mostly routine pregnancy. You may be shown how serious illness and even death Many pets are tolerant checks. For women doing shared to take your own swabs. Risks from antibiotics of small children in the newborn. This is known as care you will attend the hospital The results take 48 hours and are It is important to note that the and babies, but early onset GBS. either positive or negative to GBS. administration of intravenous it’s important to be for all your appointments after Thousands of newborn babies come They are considered reliable for up to antibiotics doesn’t come without risks. aware of the potential 36 weeks. into contact with GBS during birth five weeks. With a positive result it is These risks include: Did you know? dangers. Pets can each year and remain well. Why recommended you receive antibiotics be jealous of having At 36 weeks some babies become sick from • Even with no prior history of It is normal for your in labour. With this approach to share you and not GBS is unknown. GBS is the most allergies 1 in 10 people can baby to be born any You approximately 25% of women will receiving the same common cause of severe infection develop mild side effects such as time between 37 receive antibiotics in labour, and this diarrhoea, nausea or a rash; level of attention. • may find it harder to move around in the newborn and can occur in the and 42 weeks. is estimated to reduce the rate of Getting prepared because of your size first seven days of life. Of the small • Between 4 in 10,000 and 4 in GBS infection in newborn babies by for when you bring number of babies who do become 100,000 develop a life threatening • may have trouble sleeping approximately 80%. your baby home, sick, 90% will show signs of GBS allergic reaction (known as is something that • may feel like cleaning and changing infection within the first 12 hours Antibiotics will be given at the anaphylaxis) to penicillin based When labour rooms around. you can do during of life. Despite not knowing exactly hospital or in the FBC once your antibiotic if there is no history of an starts too early – allergy to penicillin. Your midwife pregnancy. which babies are likely to become labour establishes or if your waters preterm labour Your baby is trained to respond to any sick from GBS, risk factors have have broken. If you recognise Things to consider are: • is 47cm long such situation; been identified. If you choose to birth at home with any signs of labour • Where will your • An increased likelihood of strains • weighs 2500 grams the CMP antibiotics can be given at before 37 weeks baby sleep and how of bacteria becoming resistant • has changing movements because Risk factors of GBS infection in home by your midwife and are given you should contact can you keep your to antibiotics from such a large there is less space to move around the newborn into the vein either by a cannula in the hospital, Family pet away from this number of women receiving Birth Centre or your • You have had a child who has been your arm or back of your hand which area? • has fingernails that reach the ends antibiotics for GBS; and midwife straight remains throughout your labour, or by of the fingers sick with GBS as a newborn; • Antibiotics given to women during away. • How will you ensure a fine butterfly needle that is inserted that your pet is not • should be in a head down position • You have screened positive to GBS labour may pass through the only for the administration of each placenta. This may affect the left unsupervised ready to be born during this pregnancy; dose of antibiotic. balance of a baby’s bacterial with your baby? • has a mature heart, digestive • GBS found in a urine sample during Benzylpenicillin is the antibiotic of flora in their gut which can affect • Good hygiene when system and lungs. your pregnancy; choice and is usually prescribed four immune development and may handling your pet, • Preterm labour hourly until your baby is born. If you lead to an increased likelihood of especially when Group B Streptococcus (GBS) (<37 weeks pregnant); are allergic to Penicillin, Clindamycin allergies and asthma later in life. washing your hands What is Group B streptococcus? • A fever in labour >38°C; or is the recommended alternative and e.g. reptiles carry a • Your waters breaking for more than is administered eight hourly. 80% of bacteria (germ) called Group B streptococcus (GBS) is a 18 hours. GBS bacteria will be susceptible to salmonella that is very common bacterium that is found in It was found in the UK that 60% of treatment with Clindamycin. hard to kill. the body and is usually harmless. 10- 30% of pregnant women carry GBS early onset GBS had one or more • Ensure that your To achieve the maximum preventative in their vagina and/or rectum where of these risk factors. If you are GBS pets are up to date effect from the antibiotics the first colonisation is transient i.e. it comes negative or have chosen not to have with vaccinations. dose of antibiotics should be given at and goes. It is important to note that routine screening and develop any of least four hours before birth. GBS is not sexually transmissible. the above risk factors your midwife or doctor will recommend treatment with Between 15 and 25% of pregnant antibiotics in labour. women show no signs of carrying GBS. Sometimes GBS bacteria 48 49 Pregnancy, Birth and your Baby

Between 33 and 40 weeks 4

What are the signs and Monitoring your baby during Remember symptoms of GBS infection in your pregnancy Things to talk about with your midwife or doctor Remember a baby? It’s important to check your baby’s Children are not allowed • Results of tests and investigations from your last visit. In Australia, babies In many cases symptoms of GBS heartbeat throughout pregnancy and in the Labour and Birth • Premature labour – what to look out for. are not permitted by infection are recognised at or not long when you are in labour to make sure Suite at KEMH or in • Who and when to call when you’re in labour. law to travel in a car after birth. Most babies show signs of your baby is ok. theatre. • Labour and birth, what to expect and making a birth plan. without a restraint that GBS infection within the first 12 hours The heartbeat can be monitored by: is suitable for their The crèche is not • Planning for your hospital stay and going home with your baby. of life. age and weight. This available to patients at • Listening (see page 69 for more information) includes for the trip the time of birth so if If you developed any risk factors The midwives and doctors check home from hospital. you are going to require before or during your labour, even if your baby’s heartbeat with a child care when you you received antibiotics, your midwife Doppler monitor. This is placed You should begin are in hospital now is or doctor may advise you to be aware on your abdomen to listen to the making plans for your a good time to make of the following signs and symptoms: heartbeat. The midwife or doctor return home before the arrangements and have • High or low temperature - a well will do this at most routine visits and • Baby tests: Vitamin K, Hepatitis B and the Neonatal Screening Test. birth of your baby. the peace of mind that baby has a temperature between while you are in labour. • Pain management in labour – what you can do at home. your other children will For more information 36.5 and 37.4 degrees Celsius; • Planning for an elective caesarean birth. be well cared for whilst • Recording about child safety you are away. • Breathing faster than normal or A CTG is a cardiotograph which is • Smoking. restraints in WA visit very slowly- a well baby breathes a recording of your unborn baby’s • Breastfeeding, including: www.kidsafe.com.au The Family Birth Centre between 40 and 60 breaths heartbeat. A graph is produced – the importance of ‘skin-to skin’ contact after the birth has a different policy per minute; from the recording and your on children and families – demand feeding • Floppy and listless and unable baby’s heartbeat response to your and children are able to womb’s contractions or the baby’s – getting positioning and attachment right be with you during your to feed; movements can be seen. – ask your midwife about an information session you can attend birth at your request. • Pale; – exclusive breastfeeding to six months Examples of situations where you will • Irritable; or be offered a CTG include: – how often does a newborn baby feed • High or low heart rate - a well – the importance of ‘rooming in’. • You are past your due date baby’s heart beats between 110 and 160 beats per minute. • You have high blood pressure Are you planning to use If your baby displays any of these • You have diabetes your phone in labour? signs or symptoms call the hospital, • Your baby has been growing slowly things to consider... your midwife or GP immediately • Your baby seems to be moving less and go to your local emergency department as soon as possible. • Your doctor or midwife is If you are in hospital notify staff concerned about your baby If you are filming or taking photos, immediately. please check with staff whether they are happy to be in them.

Please don’t make staff wait to give you care whilst you speak or text on your phone.

Remember you might not be able to record your birth if an emergency situation arises.

If you are asked to turn your phone off by a member of staff, please turn it off.

Thank you

50 51 Pregnancy, Birth and your Baby Pregnancy, Birth and your Baby

4 Between 40 and 42 weeks Between You will have a routine check At 40 weeks and the results of your Group Things to talk about 40 and 42 You B Streptococcus (GBS) test • How do you know will be discussed. • may have vaginal discharge around when you are in labour? this time. This could be a ‘show’ • When to come to weeks which is a small amount of mucous hospital and blood. It leaves the entrance of the womb (cervix) before labour • The possibility of begins. Sometimes you won’t even caesarean notice that it has happened. • Plan for a repeat elective caesarean birth Your baby • The possibility of an • is 47-54cm long induction (helping the • weighs about 3400 grams labour to start) • is fully matured • Breastfeeding • Support at home • will decide when labour starts by sending a chemical signal to • Contraception and if it your womb. can be arranged before you leave hospital This visit will take place at the hospital • Postnatal depression clinic. You will have a routine check and anxiety with a midwife and/or assessment by a • Birth plan and doctor. Any tests and investigations will expectations of labour be reviewed. General management of prolonged pregnancy and your options, will also be discussed with you at this visit. Do you have questions about breastfeeding? If you want to talk to a lactation consultant during your pregnancy or you have had a problem with breastfeeding in the past, an appointment can be made with the Breastfeeding Centre of WA (see contacts at the back of this booklet).

52 53 Pregnancy, Birth and your Baby

Between 40 and 42 weeks 4

Management of • beyond 42 weeks however, the Induction of labour If your cervix is ‘unripe’ it is firm, risks are increased further (to long and closed and will need to Prolonged Pregnancy When labour starts by itself it is called about 3 in 1,000) be softened. What is prolonged pregnancy? spontaneous labour. This is when you • there is no perfect way to monitor experience regular painful contractions A hormone-based vaginal gel After 41 weeks your pregnancy is the health of every baby that of the uterus that open the cervix (neck prostaglandin or Foley’s Catheter is considered prolonged (overdue). is overdue of the uterus) to allow the baby to used to soften and open an ‘unripe’ Approximately 10 per cent of all pass through. cervix, enough for the doctor or midwife • an induction of labour when pregnancies are prolonged. to break your membranes. your pregnancy is prolonged (at A labour that is started by another Current evidence on management 41 weeks gestation) decreases method is said to be induced.

of prolonged pregnancy the chance you will need a . Why may I need an induction? The evidence available suggests that: The most common reasons for • there are very small additional If your pregnancy is healthy, but induction are: risks to the baby after 41 weeks of clearly prolonged, you will be • There is a medical condition affecting pregnancy (the risk of stillbirth is offered an induction of labour. If you either yourself or your baby that about 1 in 1,000) choose not to be induced at this necessitates birth. stage, you will be offered increased fetal monitoring. • Your baby is overdue (pregnancy of 41 or more weeks).

Women wishing to await • Your baby is small for its age. spontaneous labour • Your membranes have ruptured If your pregnancy is healthy but (waters have broken) and labour has prolonged AND you do not wish to not started by 18 hours after your have labour induced we recommend water breaking. • fetal heart rate monitoring two • Your blood pressure is high. times a week, and When do I come to hospital? • an ultrasound scan to assess the amount of amniotic fluid around Your doctor or midwife will discuss the the baby. reason for the induction and will book a date for this to occur. At these visits your well-being is also assessed. Types of Induction If you were planning a birth at home and your pregnancy goes beyond What type of induction am I likely 42 weeks, a hospital birth is advised. to have? The type of induction you will have will depend on whether your cervix is ‘ripe’ or ‘unripe’. You may need a combination of methods. If your cervix is ‘ripe’ it has been naturally thinned and softened by the hormones present in your body and is ready to be opened by your contractions. Your doctor or midwife will break your membranes and/or administer a Oxytocin infusion.

54 55 Pregnancy, Birth and your Baby

Between 40 and 42 weeks 4

Methods of induction by the above methods, a decision you may be sent home and re-booked Will I need pain relief during my if cervix is unripe to break your membranes and or to for a second attempt at a later date. If induction? commence Oxytocin will be made by not you may be offered an alternative An induction can be a lengthy process. Most women do not find the early your medical team. induction method or you may require a It may be started in the morning or stages of the induction process too Caesarean section. afternoon depending on what method uncomfortable. Paracetamol and natural Methods of induction if for induction is chosen. Your support pain relief such as hot packs and warm cervix is ripe Overstimulation of the uterus persons may be advised to go home as showers are helpful for period-type there are no facilities to accommodate Artificial A rare side-effect of the vaginal gel and/ cramps. Discuss your options with your them overnight. (ARM) or Oxytocin infusion can be a strong and midwife as you go along. prolonged contraction. If your cervix is already ‘ripe’ it may be Occasionally an induction of labour may Foley Catheter possible for your doctor or midwife to be delayed when labour and birth suite (a thin hollow soft tube) Cord prolapse break your membranes using a small is busy. • Baby’s heartrate is monitored for hooked device. This is extremely rare. When the waters 20 minutes using a CTG machine. are broken there is a very small risk of This may trigger your body into going the umbilical cord slipping below the • The catheter is inserted through the into labour, if not, an intravenous baby’s head with the fluid. This requires opening of the cervix. Oxytocin (hormone) infusion will be an immediate Caesarean section. • The catheter is taped to the thigh with started to bring the labour on. moderate traction on the cervix. This Failure to establish labour helps to soften and partially open Oxytocin your cervix. Oxytocin is a synthetic form of hormone. This sometimes occurs when the Oxytocin infusion fails to produce • If the catheter has not fallen out It stimulates contractions of the uterus in order to start labour. To administer contractions that open your cervix. in 12 hours the medical team You may need a Caesarean section. will be advised and a review and this a doctor or midwife will insert an management plan will be actioned. intravenous cannula (small plastic The catheter can be left in place for tube) into a vein in your forearm. This is up to 24 hours. attached to an infusion line and a pump. This method is likely to be used if this is The Oxytocin infusion is then started your first baby. at a low rate which is increased every 15 minutes until your contractions are Prostaglandin Hormone gel or tape strong and regular. The infusion is • Baby’s heartrate is monitored continued until your baby is born. The for 20 minutes using a CTG baby’s heart rate will be monitored (cardiotocograph) machine. throughout this process. • You will have a vaginal examination and insertion of gel or tape What risks are involved with an near cervix. induction of labour? • Your baby’s heart rate will be monitored at intervals Failure to ripen the cervix • You will be assessed to identify if the The process used to ripen the cervix prostaglandin hormone is ripening occasionally fails. This means your your cervix. cervix may not soften or open enough • Once your cervix has been ‘ripened’ for the membranes to be ruptured. If this happens and the induction is not urgent

56 57 Pregnancy, Birth and your Baby Pregnancy, Birth and your Baby

Giving birth 5

Preparing for labour Mother At around 30 weeks we encourage you • Current medications Who to call when you are in labour to start thinking about your baby’s birth • Medicare card and/or private health and your needs and expectations. This insurance membership information If you think you are in can help increase your confidence, to • Health Care card (if you have one) labour and you want know what to expect and to prepare for to talk to a midwife the unexpected. Your midwife will talk • Loose, comfortable day clothes you can contact to you about pain relief and answer any • Nighties or pyjamas, dressing gown the Maternal Fetal questions you have. and slippers Assessment Unit on Childbirth education classes can help • Maternity bras and one box of (08) 6458 2199 or for a lot with your labour plans. They can disposable breast pads those in the MGP call help to reduce your fears and worries • Maternity (large) sanitary pads – your midwife on his/ by giving you good information and several packets her mobile. building your knowledge about what is • Toiletries including soap, shampoo, For women booked going on and what you may experience. deodorant, toothbrush, toothpaste, to Family Birth brush/comb etc. Centre call your What to bring to hospital Please leave jewellery, credit cards midwife on his/her There is limited storage space and other valuables at home and do mobile. available for your belongings in not bring in large amounts of cash. For women booked hospital, please consider this when Please also note that there are no to Community packing. facilities available for heating food Midwifery Program brought into the Hospital. – phone your midwife During labour on his/her mobile. • Comfortable clothes for labour Baby - a t-shirt, warm socks, knickers and • Nappies for use during your stay tracksuit for afterwards in hospital • Oil or lotion for massage • Baby soap • Spray water bottle (non aerosol) • Baby wipes for cooling • Clothes and a blanket to take the • Tissues baby home in • Toiletries - soap, shampoo, • A rear facing baby car seat (suitable toothpaste, toothbrush for a newborn) must be fitted • Energy food such as barley sugar, into your car before taking your jelly beans, fruit bars baby home • Thongs or slippers During your stay the Hospital or • Lip balm for dry lips Birth Centre will supply: • Camera • Sanitary pads and nappies for use • Own pillow (labelled) if desired two hours after birth • Clothes and beanies for your baby to Support person wear whilst in hospital 5 • Blankets for your baby • Bathers and towel if you use the bath and shower during labour • Towels and other linen Giving birth • Coins for phone or parking meter If you are planning to use formula • Food – snacks, juice, special teas etc. to feed your baby additional information will be provided for you. • Please note there are no meals Please ask your midwife if you do provided for your support person not receive this information. 58 59 Pregnancy, Birth and your Baby

Giving birth 5

What to pack for your stay Medications during your expectations are, the birth plan also Helpful hint hospital stay: helps you and your support person to explore what you might want in a When you come to the hospital, you • Keep a list of important variety of situations. might be asked some questions in telephone numbers in relation to medications: Some of the things you might like your handbag, on the to consider and discuss with your fridge or next to the • What medications are you midwife or doctor include: telephone. are taking? • What you will bring to hospital to • Work out how you will • What is the dosage of personalise your environment get to the hospital and that medication? • Methods of pain relief during labour where to park • How often do you take and birth • Stock-up on things you the medication? • Positions for labour and giving birth may need after the baby • When was the last time you took is born like toilet paper, your medication? • Options for labour and birth in water pads and nappies • Who is your community doctor • Your preferences if there are • Make extra meals and and pharmacist? complications or unexpected events freeze them Once health care providers know You should discuss your birth plan which medications you are taking, with your midwife or doctor during a process called Medication your antenatal appointments. Birth Reconciliation is completed. Hospital can be unpredictable and while your wishes will be respected, it may pharmacists are available to assist become necessary to change from Medications you with information about your your plan to protect the health of medications and answer your What to bring when coming you or your baby. Being prepared to the hospital: questions during your hospital stay. and having back up plans can help Please BRING ALL YOUR The pharmacists also: to reduce disappointment should MEDICATIONS INCLUDING this happen. Formula, if you have • Review your medications and INSULIN with you to hospital chosen to formula feed. in their ORIGINAL packaging work with your doctor to maximise Rear facing the benefits and the safety of the if possible, including vitamins, baby seat Support in labour herbal medicines, eye drops, medications you are receiving. creams, patches, puffers etc. It is important to have a support Please also bring any Webster • Explain your medicines, including person during labour, preferably packs, Dosettes or other dose the purpose of your medications, someone who can stay with you the administration aids you may how to take them, possible side whole time. Research shows that be using. If you have a list effects, and any other important a support person who is present of your current medications, information you may need to know. throughout labour can reduce the please bring this with you as need for pain relief, assisted vaginal well. Medications brought into • Dispense your medications while birth and caesarean section. the hospital should be handed you are on the ward, and may Women and Newborn Health Service to the ward midwifery staff to dispense the medications you will The right support person can make a be stored in your medication (WNHS) will not take any responsibility for the loss or theft of valuables, jewellery, need when you are going home. difference to your labour and how you cupboard. On discharge, your feel, so choose them carefully. medications will be returned monies and personal electronic devices. These items should be given to a relative to you. Your birth plan Being upright and active during or friend on admission to KEMH and in the your labour can assist with your Please also bring with you, event that you choose to retain them at your Writing a birth plan can be a useful your MEDICARE CARD, bedside then the hospital does not bear any thing to do to help prepare you for baby’s birth. along with your Concession responsibility in the event of a loss. birth. You can find a birth plan in your Choose someone who will help you card, Health Care Card, National Women’s Health Pregnancy do this, but who will also respect your Repatriation Health Care Record (NWHPR) which should wishes and speak up for you. Card or Safety Net card if have been given to you at your first applicable. appointment. As well as letting your partner and midwife know what your

60 61 Pregnancy, Birth and your Baby

Giving birth 5

“I felt like I was Discuss with relatives and friends how blood loss you should call KEMH or your It is important that you have your Your waters break in control, but I you would like them to receive any news midwife immediately, depending where emergency contact numbers readily (ruptured membranes) during your labour. You probably won’t you had planned to give birth. available in your homes and that Remember also felt secure This means the sac that your baby feel much like entertaining visitors and you call either the Maternal Fetal Ring the hospital and the midwife will ask has been growing in has broken. Will you need child in the knowledge lots of phone calls can be distracting. Assessment Unit (KEMH patients) you where you feel your contractions, The water that has been surrounding care after the baby is Some people organise a contact person or your midwives on their mobiles that I was in the how often the contractions come and your baby now starts to come away. born? who delivers the news to everyone and immediately if you experience any of best possible how long they last. This will help the You may have either a sudden gush manages visits and phone calls. the following: Child care can be in hands if there was midwife to know how much your labour or a slow trickle. Once your waters Privacy laws prevent midwives from have broken, one of your baby’s short supply in some an emergency”. has progressed. Contractions giving any information about you without barriers against infection is gone. It areas. You may need to SUSANNAH your permission, even to family or Depending on what is happening, the Your uterus (womb) has already is important to phone the hospital or book a place well before close friends. midwife may reassure you that it is okay been practising with toning up your midwife as soon as this happens. the baby is born. Contact to stay at home or she may ask you to contractions called ‘Braxton Hicks’ You will need to be assessed even if your local council for How do I know I’m in labour? come in to KEMH so that you and your contractions. These contractions can your contractions have not started. more information. Labour can be difficult to describe baby can be checked. be either irregular or regular and may continue for hours without changing in Vaginal bleeding because it’s different for every woman. Usually, on arrival, you will be seen by a strength, frequency or duration. These It may help to understand what is midwife or doctor in the Maternal Fetal It is not normal to bleed during contractions don’t last very long but happening to your body. Assessment Unit and then admitted to pregnancy. If you experience any can be uncomfortable. In the very early stages your cervix the Labour and Birth Suite. bleeding it is important that you phone begins to soften and thin. During this Contractions that mean labour has the hospital and come in straight If you are not in labour or if the labour is started are different. These early away. Please save and bring with you early stage you may experience some not yet established you may be advised pain and discomfort, but often your contractions are usually (though any pads or blood-stained clothing so to go home at this time. Research tells contractions are not regular. Most women not always) short and mild. They the midwives and doctors can check us that women labour much better if they stay at home during this time. can last 30 to 40 seconds (the gap the amount you have lost. stay at home in the early stages. between them may be as long as 15 In early labour you may have: Change in pattern of or 20 minutes) and can be painful. baby movements • A blood stained mucous discharge Community Midwifery Program However, some labours begin with If you have noticed that your baby isn’t called a ‘show’ If you are having your baby with contractions closer together and moving as much as it normally does • Lower back pain a Community Midwife through the rather intense. As labour advances please telephone the hospital, FBC, Community Midwifery Program you you will feel the contractions in • Period-like pain which comes and goes CMP, MGP or your midwife. should contact your midwife on his/her your abdomen or in your lower • Loose bowel motions back, or both. This pattern varies mobile at the first sign of labour. between women. Any persistent • ‘Breaking waters’ (ruptured Your midwife will ask you where you membranes), which may occur with Especially if this is associated with feel your contractions, how often the The length of time between a sudden gush or a slow leak; the bleeding. contractions come and how long they last. contractions is from the start of one fluid should be clear or slightly pink. This just helps the midwife to know how contraction to the start of the next. If you think your waters have broken Contractions become stronger and Symptoms of high blood pressure please call the hospital or your much your labour has progressed and what the next course of action will be. last longer as labour progresses. Some swelling of the hands and feet midwife immediately. During contractions you usually have is normal in pregnancy. If any of the • A desire to vomit (it is quite common to Family Birth Centre to concentrate and use the relaxation following occur please phone the vomit during labour) techniques and positions of comfort hospital, FBC or your midwife: If you are booked at the Family Birth you have learned at preparation for When labour begins Centre call your midwife on his/her childbirth classes. • Significant and sudden swelling of mobile. Once she has asked you a your face and hands You may be asked to observe your It can be difficult to tell when labour has range of questions, depending what is contractions to see whether they are • Headaches started. If you are unsure and you are happening, the midwife may reassure getting closer together. If you would • Blurred vision booked to have your baby at KEMH you that it is okay to stay at home, or they like to discuss how your labour is you can telephone the hospital. If there • Upper abdominal pain may ask you to come into the FBC so that progressing, please ring the hospital. are strong signs of labour, such as your you and your baby can be checked. waters breaking, regular contractions or

62 63 Pregnancy, Birth and your Baby

Giving birth 5

Stages of labour In the later stages of labour you may Third stage • Increased risk of blood and or experience: iron infusion This stage lasts from the birth of Helpful hints First stage • More intense contractions, • Increased risk of anaemia (this becoming stronger and closer your baby until after the delivery of Regular, usually painful, contractions the placenta. can make you tired and short • Try to breathe deeply together; they may be three to five cause the cervix to thin and open of breath). • Follow your body’s minutes apart (this is the time to You may experience: to 10cm. Your midwife or doctor will record urge to push come into hospital) • More contractions to expel your decision in your notes. In the early stages you may experience: • Find a position that is the placenta • Vaginal discharge such as thick • Tiredness and restlessness comfortable Delayed cord clamping mucous stained with blood – • Feelings of soft fullness in • Listen to your midwife ‘a show’ Second stage the vagina At some point after your baby is born who will guide you • Ruptured membranes (breaking of This is from when the cervix is fully Delivering your placenta the umbilical cord will be clamped • Concentrate on one the waters) dilated (completely open), until the birth and cut, separating your baby from contraction at a time after the birth of your baby the placenta which has nourished • Diarrhoea of the baby. • Rest between To assist delivering the placenta, a and provided oxygen to your baby • Lower abdominal, period-like You may experience: contractions contractions that may be 10 to 30 hormone injection, ‘oxytocin’, is given during your pregnancy. The World • Longer and stronger contractions to a woman after the baby is born, Health Organization recommends • Change positions from minutes apart with a one to two minute break sitting, standing and this is known as ‘active management that clamping of the umbilical cord is • Dull backache walking • Pressure in your bottom of the third stage’. Oxytocin is the delayed for at least a minute post birth same hormone produced by the brain • If you are hot, a cold What to do • The desire or urge to push for all babies (WHO 2014). Delaying to get the uterus to contract in labour. face washer on the • Have regular drinks and small meals clamping of the umbilical cord post • Nausea and vomiting The oxytocin is usually given in an neck and face can be or snacks birth will enable your baby to receive injection in the thigh or arm. soothing • Call the hospital or contact • Stretching and burning in more of the oxygen and nutrient rich your vagina In addition to giving the oxytocin, cord blood and ease its transition into • Continue to drink plenty your midwife of water and eat light the cord is clamped and cut and the life outside of the uterus. In some • A bath or shower can be helpful snacks if you feel like it Pushing delivery of the placenta is helped by cases babies may require assistance • Go to the toilet regularly; pulling (often called traction) on the to breathe (resuscitation) post birth. • A bath or shower can every two hours The pushing stage may last for more be helpful than an hour, but the length of time cord by the midwife or doctor. Your midwife is available to answer • Try to rest if it’s during the night any specific questions you may is different for each woman. The time Why do we recommend active • Stay at home for as long as you can spent pushing is usually quicker if you have regarding delayed clamping of management of the third stage the cord. have had a baby before. of labour? The urge to push can be overwhelming. Active management of the third Keeping your placenta Try to relax and allow your body to stage reduces the risk of maternal Once you have birthed your placenta control its own breathing pattern. postpartum haemorrhage (PPH) and and the midwife has checked that it is If you decide you'd If possible, get off the bed or try shortens the third stage of labour. complete, you may choose to keep it. like to take your different positions on the bed. The recommendation for active If you choose to keep your placenta placenta home, it management of third stage is based there are many things to consider is recommended As baby’s head moves down you on current evidence for best practice. including issues around storage and you bring with you may experience: disposal and the potential risk of Do I have to have active a small cooler bag infection. Please discuss this with • Pressure, the feeling of wanting to go management of my third to transport the your midwife. You will be required to the toilet stage of labour? placenta home. • Stretching and burning in your vagina to sign a form confirming you will No, if you choose not to have an comply with the correct procedures. active management of the third stage Please be aware that The Department your decision will be respected. of Health does not endorse the This is called expectant third stage consumption of . management and it is associated with: • A two fold increase in postpartum haemorrhage (PPH) leading to possibility of blood transfusion

64 65 Pregnancy, Birth and your Baby

Giving birth 5

Pain management in labour TENS machine Epidural • Usually you can move about and Natural pain relief still be able to push your baby out. and active birth Your experience of pain in labour can TENS stands for Transcutaneous Setting up your epidural be influenced by a number of things Electrical Nerve Stimulation. TENS • In general epidurals do not affect • Move around and like the environment in which you give is a small machine that is attached to • You will need to have an your baby. change positions birth, the support you receive, the your back and sends small electrical intravenous cannula and • Can be topped up for caesarean frequently. This can position of your baby and the method pulses through the skin and helps intravenous fluids running prior to section if required. help you to cope with of pain relief that you use. decrease the pain messages your insertion of the epidural. Disadvantages of an epidural contractions. If you Find out your options for pain relief brain receives. You can control the • While the epidural is being put in, stay upright gravity before your labour and make sure TENS machine yourself throughout it is important that you keep still • Repeated top-ups with stronger will help your baby to your midwife or doctor knows what your labour. TENS classes are and let the anaesthetist know if local anaesthetic may cause move down through you want. available through the Physiotherapy you are having a contraction. temporary leg weakness and your pelvis. There are a number of natural and Department. • It usually takes 10-20 minutes to increase the risk of forceps or ventouse delivery (i.e. assisted • Heat and water may medical methods available for you to TM set up and insert the epidural, and help to ease tension use in labour. Gas (known as Entonox ) a further 5-10 minutes before it vaginal delivery). · and backache in Although some of the non-medical Available at: KEMH, FBC starts to work. • The epidural may slow down the second stage of labour slightly. labour. Apply heat methods have not been subjected The gas given to women in labour • Some epidurals do not work and cold packs or try to rigorous research, you may find is a mixture of nitrous oxide and fully and need to be adjusted • You may develop low blood a shower or bath. them helpful and they are unlikely to oxygen, sometimes known as or replaced pressure, itching or a fever during • Touch and massage cause harm. ‘laughing gas’. Gas may reduce the • Continuous CTG monitoring will be the epidural. can reduce muscle intensity of pain during a contraction required post insertion. • The epidural site may be tender tension. Practice with Pain relief and is found to be helpful by some but usually only for a few days. Source: Epidural Information Card. Advantages of an epidural http://ww\lv.labourpains.com your partner during women. It is inhaled through a mask Backache is not caused by Warm bath or shower your pregnancy and or a mouthpiece during a contraction. • Usually provides excellent epidurals but is common after any LabourPains.com is the find out what you like. Available at: KEMH, FBC, CMP You may experience nausea, light pain relief. pregnancy. public information website of • Use music to Some women find a warm bath headedness and a dry mouth for a • Sometimes a spinal is given first the Obstetric Anaesthetists’ short time and become drowsy with Association distract you. or shower can help ease the pain for a quicker effect. of labour. frequent use. • Some people find Risks of having an epidural or spinal to reduce labour pain complementary therapies helpful. Type of risk How often does this happen? How common is it? Some complementary therapies, such as Significant drop in blood pressure One in every 50 women Occasional acupuncture should Not completely relieving the pain of labour, requiring only be undertaken adjustment, extra doses, re-siting, or consideration One in every 10 women Common by a qualified of other pain management techniques practitioner. One in every 100 women (epidural) Severe Uncommon • Eat and drink One in every 500 women (spinal) for energy. Nerve damage caused by the epidural (numb batch on a leg Temporary- One in every 1,000 women Rare or foot or having a weak leg)

Nerve damage effects lasting more than six months Permanent - One in every 13,000 women Rare

Epidural abscess (infection) Permanent - One in every 13,000 women Very rare

Meningitis One in every 50,000 women Very rare

Epidural haematoma (blood clot) One in every 100,000 women Very rare

Accidental unconsciousness One in every 170,000 women Very rare

Severe injury, including being paralysed One in every 250,000 Extremely rare 66 67 Pregnancy, Birth and your Baby

Giving birth 5

Monitoring your baby Assisted birth during labour Caesarean birth • As much as possible your midwife Forceps birth will stay and look after you and your All babies will be monitored during labour A caesarean section is a major surgical Forceps are a special instrument placed baby in the theatre and the recovery by checking the baby’s heartbeat. The operation in which your baby is born around the baby’s head, inside the vagina level of monitoring will depend on your through a cut in your abdomen. It is area before taking you both to the medical history, whether there are any to help guide the baby out. They may be usually performed under a spinal or postnatal ward. problems with your baby or whether used when the mother is too exhausted to epidural anaesthetic. Sometimes it is • You midwife will apply white TED there are any expected problems with push, the baby is in an awkward position necessary to give a general anaesthetic Stockings to prevent blood clots the birth. Monitoring can be done in or there are concerns for your baby’s to make you go to sleep. forming in your legs (Deep Vein these ways: wellbeing. Sometimes the forceps leave Thrombosis - DVT). You will be marks on the baby’s cheeks, but these Some caesarean births are planned in advance during pregnancy, if this is expected to wear these during the Listening soon fade. You will usually need length of your hospital stay. an . the safest option for giving birth. This The midwife or doctor places a Doppler is called an ‘elective caesarean’. In • The midwife will help you monitor on your abdomen and listens Vacuum (ventouse) birth other cases, the decision to perform a with breastfeeding. to the baby’s heartbeat through your caesarean is made during labour. This is abdomen. This is more commonly used instead called a ‘non elective’ caesarean. of forceps. The vacuum cup is made of A non-elective caesarean is Important information - Caesarean admission Continuous external monitoring either plastic or metal and is attached to a pump. The cup is inserted into the recommended for the following: For Caesareans scheduled Tuesday to Friday, please This is when an electronic monitor is vagina and creates a vacuum against the • Concern for your baby’s wellbeing call the Day Surgery Unit (DSU) between 5.00pm and attached to a belt around your abdomen. baby’s head. This lets the doctor gently • Your labour is not progressing 6.00pm, the evening before your admission, on The monitor continuously records the pull the baby out. It may cause a raised (08) 6458 1459 baby’s heartbeat and any contractions on bruise on the baby’s head, but this soon • There are maternal complications, such Day Surgery Unit (DSU) will: a paper printout. Some monitors restrict fades, usually within a day. You may also as severe bleeding or severe pre- your movements, so ask if there’s one need an episiotomy. eclampsia (high blood pressure) • confirm your admission available that lets you move around. • There is a life threatening emergency • tell you what time to arrive for your Caesarean Episiotomy for you or your baby Internal monitoring • provide fasting instructions. This is a cut made in the perineum What to expect if you need a This uses an electronic monitor that (tissue between the vagina and the caesarean: For Caesareans scheduled on a Monday please call attaches a small clip to the baby’s head. anus). Sometimes it is necessary to make between 5.00pm - 6.00pm on the Friday before. • You are likely to be in the operating It is mostly used if the quality of the the vaginal opening bigger, especially if theatre for well over an hour. Special instructions external monitoring is poor. you need a forceps birth or if the baby is distressed. It is usually done with a • Your baby will remain with you during • Have your blood test to check your blood group at Fetal scalp pH local anaesthetic. You will need stitches that time where possible and you are the date and time discussed with your midwife in This is when a few drops of blood are afterwards. The stitches will dissolve by encouraged to share skin-to-skin time your Caesarean clinic or with your doctor. taken from your baby’s scalp (like a themselves and you will be offered ice in both the operating theatre • Do not shave, wax or use hair removal cream prior pinprick). It gives an immediate result packs to reduce swelling and pain. and recovery. to your Caesarean surgery. on the baby’s condition in labour. This • Unless you are having a general • Shower with soap on the morning of your test is done if the doctors need more anaesthetic, in most cases, your operation but do not use talcum powder, deodorant information than just continuous heart partner can be with you in the or perfume. rate monitoring. The result will show if operating theatre. • Remove all jewellery and nail polish. the baby needs to be born immediately. • Your anaesthetist will look after you continuously from when you arrive until when you reach the recovery room.

We are committed to reducing third and fourth degree tears during your birth. For more information about third and fourth degree tears, please visit the publications section of our website.

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• If your baby is unwell or needs to be monitored they Common concerns about using • Your baby’s heart rate must remain Enhanced Recovery After Surgery will go to the Intensive or Special Care Nursery whilst water for labour and/or birth within the normal range. you are still in theatre or recovery. • You must not enter water until four (ERAS) You and your baby may get too hot • After surgery a number of different pain relieving hours after receiving an injection for Enhanced Recovery After Surgery medications will be offered to you by the anaesthetist. If your body overheats your baby may pain relief. (ERAS) is the innovative approach to also get too hot and this can cause the improve your experience and recovery Water birth baby’s heart rate to increase. You should Conditions for using water during following caesarean section. You may be considering using water for pain relief during feel comfortable in the water but not too your labour King Edward Memorial Hospital for the first stage of your labour or having a waterbirth. hot. Your midwife will check the water • You must never be alone while temperature regularly while you are in Women has an ERAS program for The Western Australian Women and Newborn Health immersed in the water. the water during labour and/or birth. women undergoing caesarean section. Network has developed statewide guidelines to enable • You must not require continuous This is an evidence-based approach fetal monitoring (often required with midwives and doctors to provide care that is considered Infection Control designed to help you recover from safe for healthy pregnant women choosing to use water induction of labour). surgery sooner so that your life can during labour and/or birth. There are strict guidelines for keeping • The midwife or doctor will advise you return to normal as quickly as possible the water clean during labour and for about the best time to enter the water. and you are better able to care for your cleaning the bath or pool to minimise the Benefits for you and your baby • The bath or pool must be filled with new baby. possibility of infection. • Water immersion in a bath or a pool during the first only pure tap water with no additives As part of this program we will: such as bath oils, gels, soaps or salt. stage of labour has been shown to decrease the need Prevention of water inhalation • Encourage you to eat and drink for pain relieving drugs and make the experience • When sitting in the bath or pool the normally the day before your more enjoyable for women. If you choose to stay in the water to water should reach the level of your operation. birth, your baby should be born under breasts. • Waterbirths are associated with minimal risks for the water, then gently but immediately • You should feel comfortably warm. • Facilitate skin to skin contact with your both the woman and baby when care is provided lifted out into the air. Your baby’s head baby in theatre, if you are both well. by midwives and/or doctors who follow best should then be kept above the water so • You can leave the water at any time. practice guidelines. • Encourage you to eat and drink as that breathing can start and potential • You must leave the water to urinate. soon as you feel able after your Exploring your choices inhalation of water can be prevented. operation. • Write down what you would like in your birth plan. Who can use water for labour • Remove the tube (cannula) from your • Talk to a midwife and/or doctor to find out more and/or birth? vein as soon as you are drinking information, in particular: normally. You and your baby must fit all of the - whether there are any reasons why immersion in following criteria to use a bath or pool for • Assist you to get up and about after water is not advisable for you your labour and/or birth: your operation. This is important as it can aid your recovery, and help - the benefits and risks to you and your baby • Be healthy with no medical or pregnancy complications. reduce the chance of developing a - details about when you would be required to leave blood clot in your legs. the water. • Be having only one baby who is presenting head first. • Ensure you have adequate pain relief • You will be asked to sign to move easily and we expect you an agreement form if you • Be at least 37 weeks pregnant. to be able to get out of bed on the choose to use water for your • Not be a carrier of, or infected with, evening of your operation. labour and/or birth. HIV, Hepatitis B or C virus. • Remove the tube (catheter) from your • Not be excessively bladder once you are able to walk to overweight at booking. the toilet.

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• You should keep well hydrated Further information throughout labour to avoid dehydration. You may wish to seek out more information about the use of water for • You must leave the water when labour and/or birth which will help you advised to do so by the midwife and/ to be fully prepared for the experience. or doctor: - If there are changes in the baby’s If you have any further questions or heartrate require additional information please discuss the use of water during labour - If the colour of your waters are not and/or birth with your midwife or doctor. clear. • You cannot have an injection for pain relief or an epidural when in the water but it is possible to use Entonox (gas and air) if desired.

If you choose to birth in water • All the conditions for using water during labour must be met at all times. • You must leave the water if the midwife or doctor is concerned about you or your baby’s well being and safety. • You must be assisted when you leave the water to avoid any injury to you or your baby. • Your baby must be brought to the surface as soon as he/she is born and the head must then remain above the water at all times. • The baby must be kept warm after birth using skin-to-skin contact, drying the head and keeping the rest of the body under water. • The baby must be removed from the water immediately if he/she needs help to breathe. • You must leave the water for the delivery of the placenta after the baby is born unless you want to have a natural third stage. • If you require stitches this procedure 6 will be delayed for at least one hour after you leave the water. After the birth 72 73 Pregnancy, Birth and your Baby

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After the birth you will hopefully have the chance to spend some quiet • Will be offered pain relief if you Government of Western Australia need it. North Metropolitan Health Service Did you know? moments cuddling and enjoying skin-to-skin contact with your baby. Women and Newborn Health Service Skin-to-skin contact Parents are often filled with wonder when they meet their new baby If you are transferred to the postnatal after birth helps baby: and find themselves counting fingers and toes and examining their ward this will usually be within 2-3 hours after the birth of your baby. Preparing to go home after the • Regulate breathing baby for family resemblances. Enjoy these special moments together You and your baby will stay together birth of your baby • Maintain blood as a family and take time to get to know each other. The health and safety of you and your baby is our priority. Discharge will only occur during your hospital stay. A midwife when it is clinically appropriate and safe to go home. sugar levels will care for you and will help you with You may notice that your baby has You will be ready to go home when these things are done: Immediately after birth looking after your baby. When you • Encourages some swelling or bruising, or your After the birth of your baby the arrive in the ward the midwife will show Mother ready 9 Health check instinctive feeding baby’s eyes may look a little puffy. 9 Eating and drinking midwife or doctor will examine you you around and explain what you need behaviours Babies who have been born with the 9 Passing urine and your baby to make sure you are to know. 9 Any pain managed help of forceps or vacuum suction 9 Moving/walking both well. 9 Understanding of any ongoing healthcare needs may also have a slightly misshapen If you and your baby are well enough, 9 Social, cultural and emotional needs have been considered • Uninterrupted skin-to-skin contact head from the birth. This is all very you can expect to go home from 9 Awareness of your baby’s physical, social and emotional needs 9 Received referrals/instructions for follow up treatment and checks. Visiting Hours should be maintained with your normal and is only temporary. 4 hours after an uncomplicated vaginal baby for at least an hour, and then birth, and between 24-72 hours after King Edward Baby ready as often as possible. Other things you may notice a caesarean birth. At the Family Birth 9 Health check Memorial Hospital Centre you can expect to go home at 9 Have a feeding plan include: 9 Vitamin K and Hepatitis B considered Visitors are welcome • Common practices such as early around 4 hours after birth unless you or 9 Birth registration paperwork and purple Health Record given and weighing, bathing or passing • The baby’s first poo (called explained to visit maternity wards your baby need to be transferred to the 9 Received referrals/instructions for follow up treatment and checks. 3, 4, and 5 each day around your baby should be meconium) will be black and very main hospital for additional care. from: delayed until after the first sticky. After a few days it will turn If you are having a home birth your Home ready 9 feed if possible. yellow. Discharge medication arranged 3.00 pm – 8.00 pm midwife will leave you between 9 Transport and baby car seat arranged • There is a soft spot on top of the 9 Understanding and awareness of available support services Visitors outside these 2-3 hours after birth. Your midwife 9 Discharge paperwork completed Your baby baby’s head (called the fontanelle) will return to check on you within 9 Social and home environment have been considered hours will not be 9 Safe sleeping environment for baby discussed. where the bones have not yet come permitted on the wards. • The umbilical cord is clamped and 12-24 hours. cut. This does not hurt your baby. together. It is safe to touch this spot Before leaving hospital, make sure that any questions or concerns are addressed by your One nominated Eventually the dried piece of cord gently. Preventing falls after you healthcare team. support person, such turns black, dries up and usually • The genitals can sometimes be have had your baby The length of your hospital stay will vary depending on your individual circumstances and healthcare needs. as a partner, is able to You will be ready to go home when all of the above things are done, which could be: falls off five to seven days later. swollen in boys and girls. Girls may visit any time between Some mothers may have a risk of h From 4 hours after a vaginal birth. h From 24 – 72 hours after a caesarean birth. 8am and 8pm. • The Apgar score is recorded. This also have some white or bloody falling after having a baby. vaginal discharge caused by NMHS 104 - 0717 Partners are unable is a check of your baby’s health As a new mother you have an increased mothers hormones. 104 Length of stay A3 poster_Development V4.indd 1 26/03/2018 1:38:00 PM to stay overnight at including breathing, heart rate and risk of falling if you: colour. This is done at one minute • A rash can appear on the face KEMH. • Are very tired, disorientated or drowsy and at five minutes after birth. or body in the first days after Family Birth Centre The Apgar score simply tells your birth. This is common and will • Have had an epidural, spinal, general Visitors are welcome to carers how well your baby has fade away but your baby will be anaesthetic, sedation or other visit at any time during made the journey from inside the checked everyday. pain relief your stay in the FBC. womb to outside life. • Have had bleeding during pregnancy, You • The baby’s weight is recorded. birth or in the postnatal period • Will frequently have your pulse and • Have certain medical conditions • Your midwife will apply an external blood pressure taken. such as epilepsy, low blood pressure oxygen saturation probe on your or diabetes baby’s right wrist, to monitor • Will have your uterus checked. The oxygen levels and heart rate while midwife will gently push on your • Are wearing badly fitting shoes breastfeeding. abdomen to feel if it is firm and has or socks contracted. • Have a visual or physical disability • Two identification bands with your details will be applied on your baby’s • May need stitches in your perineum • Use your call bell if you require feet. These must stay on at all times or labia. assistance during your hospital stay and if they • May be offered icepacks if you have fall off, let your midwife know and had stitches. 74 your baby will have them replaced. • Can shower and use the toilet. 75 Pregnancy, Birth and your Baby

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• Take your time when getting up from Tests and medications How does your baby get Hep B? About one in 1,000 babies will be born sitting or lying down. Let staff know if with one of these conditions but most will If your baby is • From even a very small amount of you feel unwell or unsteady on your for your baby during the first seem healthy, showing no early signs unwell blood e.g. through contact between feet. Use stable objects for support. few weeks of life of the underlying illness. Without early If your baby is open sores or wounds. • Wear safe footwear. Only walk You will be asked for your permission treatment these conditions can cause premature or unwell around in non-slip shoes before any special treatments or tests • Through other body fluids including irreversible physical and/or intellectual you will receive saliva e.g. a human bite. • Use a shower chair when showering are done. If you don’t understand why disability – even death. additional advice and the test or treatment is needed, ask for • By sharing any personal items You do not need to have a family history support. • Use the rails to get off the chair or more information. such as a toothbrush with someone of these conditions for your baby to be at We will encourage the toilet. If you feel unsafe in the bathroom, remain seated and call infected with Hep B. risk – most babies with these conditions you to express breast for assistance Newborn Vitamin K come from families with no history of milk if your baby is Why vaccinate your baby? It is recommended that babies be given the condition. unable to feed from • Familiarise yourself with your room a single dose of Vitamin K injection or • The Hepatitis B vaccination provides the breast, starting as and bathroom. Be aware of any The screening test is strongly three doses orally, the first within a few immunity to the disease. soon as you can after hazards (e.g. spills and clutter) and recommended for all newborns. Your hours of birth. Newborns may be low in birth and within tell staff when you see them • Hepatitis B is much more likely to doctor or midwife will seek your consent Vitamin K in the first eight days of life. 3 hours and then • At night. Use the light button on the develop into a long term infection in to perform the test and can answer any Vitamin K is needed to help the blood about 8 to 10 times call bell to turn the light on before people who are infected at birth or further questions you may have about clot and to prevent bleeding. per day. The midwife getting out of bed. Turn the light on when very young. the program. will assist you with in the bathroom Hepatitis B • Up to 90% of infants infected at birth The test is provided free to all babies expressing. If you have a fall, do not try to get up, remain infected for many years – and has been a routine part of Australian call for assistance. What is Hepatitis B? i.e. they become carriers and can newborn care for more than 50 years. Do not get up on your own, wait for • Hepatitis B (Hep B) is a viral infect others. It currently finds about 35 babies with a condition in WA each year. staff to help you. infection that attacks the liver and • Most of the serious complications can cause serious illness. that can occur with Hep B occur There are 25 conditions covered by • Hep B can lead to scarring of the in carriers. this screening including congenital liver, liver cancer or even death. hypothyroidism, galactosaemia, cystic • While most adults will recover Hepatitis B vaccine fibrosis, amino acid disorders, fatty completely from Hep B and can’t • The Hep B vaccine is known to be acid oxidation disorders and organic catch the disease again, most both safe and effective. acid disorders. babies who are infected with Hep B will become long term carriers. • Since 1982 over one billion doses Hearing screen of Hep B vaccine have been given A small number of babies are born with • Carriers may have no symptoms worldwide. and feel well, but they can a hearing loss that could affect their infect others. • Side effects are not common - there speech and language skills. Hearing loss may be soreness at the injection site may not be obvious in the first few weeks How do you get Hepatitis B? and in a very small number of babies, of life, but can be detected by a hearing • Hep B is much easier to catch than a mild fever. screen. You will be given the results HIV/AIDS. as soon as the screen is completed. • The virus can live outside the body Newborn blood spot Ongoing hearing tests will also be part of for more than seven days. screening test your care in the community via your local Child Health Clinic. • It is spread by: Bloodspot screening – often referred to – Blood-to-blood contact - only as the “Guthrie” or “heel-prick” test – is an important health check for your baby that Pain relief after the birth needs a tiny amount of your baby – Bodily fluids can help detect serious genetic conditions that may not be obvious at birth. A number of pain medications may be • Hep B is not spread by safely used whilst you are breastfeeding. The test can detect conditions in your contaminated food or water and Paracetamol is recommended for baby before he or she becomes ill and cannot be spread casually in mild pain and is safe to use. Anti- while there is still time for treatment to the workplace. inflammatories such as ibuprofen and make a difference. diclofenac are also considered safe to use. 76 77 Pregnancy, Birth and your Baby

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Going home Discharge medications Support at home • Sleep when baby sleeps Childbirth is a natural process and one at KEMH When planning to go home from hospital it is a • Accept help from friends and family which mothers, family and friends share Any medications you require when you good idea to organise an extra support person to • Tell people what you need together. Planning to go home as soon as go home can be provided by the KEMH be with you for the first week. Talk to your partner possible means that the experience of the Pharmacy. Getting your medications from and family about rearranging household tasks and Postnatal care and new baby is shared in the comfort of your the hospital pharmacy is likely to cost making sure you find time to be together with the the first six weeks own home. new baby. around the same amount as having it After giving birth to your baby, your body may take Once you and your baby have been dispensed at your community pharmacy. Your partner or support person can help with: up to six weeks or more to feel normal again. This checked, the doctor or midwife will inform All discharge and outpatient prescriptions • Answering the phone/door six week period can be a lovely opportunity for you of when you may go home. at KEMH will require a payment. The • Keeping visitors to a short stay bonding and spending time with your baby. It is If you and your baby are well enough, cost of these medications will be as per • Ensuring you get enough rest during also a time when you may feel very up and down you can expect to go home from 4 hours the Patient Contribution set out by the the day emotionally. Allow yourself time to recover; accept after an uncomplicated vaginal birth, and Pharmaceutical Benefits Scheme and the any help that is offered and use every opportunity between 24-72 hours after a caesarean Health Department in January each year. • Caring for other children and keeping their daily activities as normal as possible to rest. birth. At the Family Birth Centre you can The pharmacist, midwife or doctor will • Preparing meals expect to go home at around 4 hours discuss the payment process with you. After pains after birth unless you or your baby need When you receive your discharge or • Shopping to be transferred to the main hospital for You may experience contraction-like pains for the outpatient medications, you will be given • Housework additional care. first couple of days after the birth, especially while an invoice and may go to the hospital breastfeeding and more so if this is not your first Following discharge, you will receive cashier to pay for your medications on your Visiting Midwifery Service baby. This is quite normal. After pains can usually continued care from the Visiting Midwifery way home. The Visiting Midwifery Service (VMS) is available to Service for up to 5 days following birth. be helped with ordinary pain relief tablets. Alternatively you can choose to be invoiced, most women attending KEMH and the Family Birth This service offers postnatal care for you Centre who reside within approximately a 40km and an account will be sent to your home Bleeding and your baby in your home environment. address. You may then pay according to the radius from the hospital. Women who live outside For those outside the hospital boundaries, directions on the payment advice. Options this limit can see their GP, Child Health Nurse or You will experience vaginal bleeding after the follow up care can be received from your include paying over the phone, B-Pay and local hospital for postnatal support. birth of your baby, this is normal in the first few local hospital, Child Health Nurse and/or credit card billing. The VMS operates seven days a week (including weeks and can last up to six weeks. At first it will GP. Other support services are available be heavier than a normal period and then turn a If you believe you will experience public holidays) and can be contacted on depending on individual circumstances and pinkish-brown colour. difficulty in paying for your prescribed (08) 6458 1530. these will be discussed with your midwife medications please talk to your midwife Contact your local doctor (GP) or the KEMH if required. They will also answer any questions you may have or doctor, or contact the KEMH Social and provide advice and support about care for you Emergency Centre if you experience the following: If you have changed your address or Work department. and your baby. telephone number recently, or intend to • You are concerned about the amount of bleeding stay at a different address, you need to Cashier opening hours: The midwife will visit you at home each day until • You pass clots larger than a 50 cent coin your baby is five days old, or longer if needed. The let your midwife know to update your Monday - Friday , 8:45am – 4:45pm • The bleeding stops and then starts again community child health nurse will then be available contact information. (Closed weekends and public holidays) suddenly, and becomes bright red again to continue your care at clinic visits. In some instances when a hospital stay is • You have a fever, chills or generally feel unwell extended, you may be required to transfer At the time of discharge The service operates seven-days-a-week including • Your vaginal discharge has a bad odour to another hospital for postnatal care. At the time of discharge you may receive public holidays. Please be available for the midwife’s visit between 8.00am to 4.30pm each day. Due to • You have increasing pain in your wound or your Once you and your baby have been a supply of medications dispensed by the distance and time constraints we are unable to give stitches are hot and red checked and the doctor or midwife has hospital pharmacy for you to take home, allocated times for each visit. decided that it is clinically safe and especially if your medications have been Codeine – containing products are not appropriate for you to be discharged, you changed during your admission. Please recommended whilst breastfeeding. will be informed that you may go home. read the labels on your medicines carefully Things you can do at home to ensure you are not taking duplicates of to relax If you have difficultly managing your pain, We ask that you have made suitable contact your doctor, pharmacist or midwife for medication previously prescribed by your • Take 30 minutes time out just for you arrangements for going home so that community doctor (GP). more information. you can leave soon after being formally • Have a bath Your pharmacist or midwife will explain discharged by your healthcare team. • Go for a walk your medications and provide additional counselling and/or an updated medication • Keep a journal to write in list if required. • Read the paper or a book 78 79 Pregnancy, Birth and your Baby

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The perineum using the shower hose or pouring water please speak to your midwife. Let Pelvic floor exercises over the area every time you go to your midwife know if you have any: The perineum is the skin between the The muscles in your pelvic floor have Remember the toilet. vagina and the anus, which thins out • increase in pain or bleeding been stretched after the birth of your • Avoid – using soap Before you go home and stretches as the baby is born. Many • smelly discharge baby, so it is an important part of your women will need stitches (sutures) to • Keep dry – pat gently with a clean towel recovery to help them return to normal. be sure to speak to repair any tears or cuts (episiotomy) of • Change pads – every two to three hours • bladder discomfort or burning when If you have had stitches, you may feel your midwife about: passing urine reluctant to start exercising your pelvic the perineum that occur during childbirth. • For six weeks avoid: Soaking in baths, • Positioning Perineal tears are graded by the extent of floor muscles. Whether you have had creams, powders, tampons • pain or difficulty using your bowels. your baby for the tear. stitches or not, you should be able to After discharge from hospital see start your exercises between one and breastfeeding These are: Reducing discomfort and swelling your doctor if you have any of the two days after the birth. If you have • How you will know • 1st degree tear is a small skin-deep • Crushed ice – place in a plastic above problems. been doing these exercises during if your baby is tear which usually heals naturally bag, wrap in a damp clean cloth and your pregnancy, you will notice that getting enough without stitches apply directly to swollen area for 10 What to expect after 3rd or they may feel very different (Refer to breast milk minutes, every two hours until swelling • 2nd degree tear involves skin and 4th degree tears your ‘Physio after Childbirth’ book). • Expressing breast has resolved. muscles of the perineum (pelvic 1. Early management milk either by floor muscles) • Position – lie flat on your bed or rest on Caesarean wound care hand or pump your side every few hours. Avoid sitting • Antibiotics – You will be given a • Episiotomy is an intentional cut made After you have had a caesarean birth • Changing nappies for long periods. course of antibiotics to reduce the there will be a dressing covering through the vaginal wall and perineum • Bathing your baby • Compression – wear a double pad risk of infection your wound. extends from the • 3rd degree tear pulled up with firm fitting underwear. • Laxatives – You may need to • How to settle your vaginal wall and perineum to the anal Contact the hospital or your local • Ultrasound therapy – contact the take laxatives for 4 to 6 weeks to baby sphincter, which controls the anus. doctor (GP) if you notice any of ward physiotherapist or Physiotherapy prevent constipation. A soft-formed • Exercises for your A 3a or 3b tear involves the external the following: Department if discharged (see stool makes it easier to open back and pelvic anal sphincter and a 3c involves the Physiotherapy After Childbirth booklet). your bowels. However, if the stool • Wound redness or discharge floor external and internal anal sphincters becomes loose or runny it can be • Pelvic floor exercise – four or five • Fever or you are feeling • Postnatal • 4th degree tear extends from the difficult to control and you will need gentle squeezes and lifts every generally unwell depression and vaginal wall and perineum, through to reduce the laxatives. time you feed your baby will help • Increasing pain anxiety the anal sphincters to the lining of the reduce bruising and swelling. See 2. Long-term effects • How to take care anal canal Physiotherapy After Childbirth booklet. Always wash your hands before and • Most women who experience tears after touching your wound. of yourself • Pain relief – take two paracetamol Caring for your stitches will be back to normal after • Who to call if you tablets, no more often than every 12 months. Once your wound dressing has • Keep clean – by showering daily, plus six hours. been removed: need help • Having a 3rd or 4th degree tear • Bowels – avoid straining. Support • Support services puts you at increased risk of: • Gently wash with water when close to home area between vagina and anus with in the shower. a wad of toilet paper with your first – reduced control over wind • Safe sleeping • Leave it to ‘air dry’ or gently bowel motion. See Physiotherapy After – urgency to open bowels environment Clitoris Childbirth booklet. – leakage (incontinence) of urine dry around your wound with a for baby. or faeces clean towel. Urethra Healing – perineal pain • If your clothes are rubbing your Labia • The perineum usually heals in two to – pain during sexual intercourse. wound, place a clean sanitary three weeks. pad between the wound and your 3. Vaginal births Vagina clothing. You may wish to purchase • Stitches can take between 10 and 90 • When planning future births we underwear and clothing with a days to dissolve. This will depend on recommend seeking advice from an higher waistband to prevent rubbing. the type of material they are made Perineum obstetrician – Advice will vary with • Staples/ Stitches will be removed as from. Your stitches will not need to be individual circumstances, the reason External anal sphincter removed and small pieces may fall instructed by the doctor. They may for your tear and your subsequent Internal anal sphincter away from time to time, when they are be removed at hospital or at home pregnancy. Anus ready to come out. by the visiting midwife • In hospital your stitches should be checked daily. If you have a concern 80 81 Pregnancy, Birth and your Baby

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If you have concerns about you or “My GP put me in Contraception Sexual intercourse 4. Discuss immunisations your baby’s health within the first 3. Discuss your baby’s touch with a range of Your options for contraception will Women resume sexual intercourse six weeks, please arrange to see immunisations for you community services. be discussed with you before you at varying times, this may be around your GP sooner. Some mothers need a booster leave hospital. It’s safe to have sex six weeks or whenever you feel The first immunisations are due It made me feel vaccination against: following the birth of your baby once comfortable. If you experience any During your check-up, your GP will: when your baby is eight weeks like I wasn’t alone any bleeding has stopped. You may discomfort, Physiotherapy can help. old. Your baby will be immunised • Rubella and that there were feel reluctant to have sex even after For contact details of Womens Health 1. Check your baby for: It is also recommended that all people out there a number of months, especially if you Physiotherapists see ‘Physiotherapy Some serious medical conditions • Diphtheria, Tetanus and new parents and people who will have had problems with your pelvic After Childbirth’ booklet. who could help me”. can be picked up early at the six Whooping Cough be caring for newborns babies floor or stitches. Discuss any problems THUY week check, such as: • Hepatitis B get a Whooping Cough booster that continue after six weeks with your Your extras vaccination to help prevent them family doctor or child health nurse. • Hip problems • Polio Six week postnatal check from passing Whooping Cough to After you have given birth pregnancy • Eye problems • Haemophilus influenzae type the baby. can still occur, even when you are After you leave hospital, your Child B (Hib) • Heart problems You can discuss this with your GP. breastfeeding. We encourage you to Health Nurse or General Practitioner • Pneumococcal disease • Developmental problems think about contraception before you (GP) will be able to provide you • Rotavirus give birth and discuss with your midwife with ongoing care and advice or doctor the methods of contraception about your baby. These vaccines are given in 5. Discuss that are suitable for you after birth. 2. Check yourself two injections and the rotavirus At six to eight weeks after the birth of vaccine is given by mouth. This is a good time to discuss your baby you will need to make an Your six week check is a good what contraception you would like appointment with your GP for a check- time to discuss your health When your baby is older to use. up for both you and your baby. and wellbeing after the birth of immunisations are given for: Options include the contraceptive your baby. • Measles, Mumps, Rubella pill, hormonal implant or injection, Your GP will check: (German Measles) an intra-uterine device (IUD) • Meningococcal C (one form of • Your healing after labour or and barrier methods. The meningitis) caesarean section choice will depend on if you are • Varicella (Chicken Pox) breastfeeding, if you have any • Your mental health for signs of medical conditions, and on your For more information call the postnatal depression or anxiety personal preferences. • If you need cervical screening Immunisation Information Line on 1800 671 811 or visit If you had diabetes during your www.immunise.health.gov.au 6. Answer your questions pregnancy, let your GP know. You will need to have a blood You can discuss any issues test to check for diabetes about you are having with parenting six to eight weeks after having your baby, such as sleep or your baby, then every one to two feeding difficulties. years. Your GP will give you a request form for this test. Your GP is able to refer you to many different services to assist

you, including your local child health nurse.

Remember to take your baby’s purple ‘All About Me’ book to your doctor’s appointment.

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Contraceptive Methods Perfect use – when the rules are Typical use – real life use where mistakes can sometimes happen Contraceptive methods that you have to use and think about followed perfectly EVERY time. (for example: forgetting a pill or condom not used correctly). regularly or each time you have sex.

Contraceptive methods that don’t depend on you remembering What is it? Effectiveness Advantage Disadvantage to take or use them. A pill containing Perfect use: Can be used if you Late pills, - only Pill progesterone, over 99% smoke and are over vomiting or What is it? Effectiveness Advantage Disadvantage (POP) taken orally, each Typical use: 35 years of age. severe diarrhoea day around 91% can make it less Contraceptive A small, flexible rod Perfect use: Effective for 3 Irregular bleeding effective. Implant inserted under the over 99% years but can be is common in Combined Pill A pill containing Perfect use: Often reduces Missing pills, (Implanon®) skin of the upper removed sooner. first few months. Typical use: (CHC) and over 99% bleeding and period vomiting or arm that releases over 99% Scarring can progesterone, pain. May help severe diarrhoea progesterone. occur. Typical use: taken orally. around 91% with premenstrual can make it Hormonal A small “T” Perfect use: Works for 5 years Irregular bleeding symptoms. less effective. Intrauterine – shaped, over 99% but can be removed or spotting is Not suitable if System progesterone Typical use: sooner. Mirena® common up to the breastfeeding. (Mirena®, releasing plastic can be used to first 6 months. Kyleena®) over 99% Condoms Female – loose Perfect use: Best way to help Female – skin device which is treat heavy periods. (male and fitting sheath sits in 95% female protect yourself irritation, clicking inserted into the female) vagina and outer 98% male from sexually noise and spillage. uterus (womb). ring over vulva. Typical use: transmitted Male – May slip off A low dose option Male – A thin latex, infections (STI’s). or split if not used (Kyleena®) is 79% female polyurethane sheath 82% male correctly. available. put over the erect Non- A small plastic Perfect use: Works for 5 or 10 Periods may be penis. Hormonal and copper device over 99% years but can be heavier, longer or Diaphragm A flexible silicone Perfect use: Can be put in any Lower Intrauterine which is inserted Typical use: removed sooner. more painful. (Caya®) device is put into over 86% time before sex. effectiveness. Device into the uterus (Copper over 99% the vagina to cover Non hormonal Requires lubricant (womb). Typical use: IUD) the cervix. over 82% method. gel for insertion. Contraceptive An injection of Perfect use: Works for 12 week Can’t be removed Injection progesterone into over 99% routine cycles. from the body so Contraceptive A small, flexible, Perfect use: One ring stays in You must be (Depo) vaginal ring plastic ring put into over 99% for 3 weeks, you comfortable the muscle. Typical use: side effects may (Nu-Va Ring) the vagina that don’t need to think inserting and over 94% continue while Typical use: it works and for releases estrogen around 91% about contraception removing it. some time after. and progesterone. every day. Not suitable if Permanent The fallopian tubes Overall failure rate Sterilisation is Should not be breastfeeding. (Sterilisation) in women or the is about 1 in 200 permanent with no chosen if in any Fertility Ovulation times Perfect use: No physical side Need to avoid sex (Tubal tubes carrying for females and 1 in serious side effects. doubt about having Awareness of the menstrual over 99% effects, can also or use a condom Ligation/ sperm in men (vas 2,000 for males. children in the (Basal cycle are identified be used to plan at fertile times of Vasec- Temper- Typical use: deferens) are cut, future. by noting different as well as prevent the cycle. -tomy) -ature) around 76% sealed or blocked. fertility indicators. pregnancy.

Original: WNHS0687_1200 Data, graphics and information collected from contraception.org.au and sexwise.org.uk 84 85 Pregnancy, Birth and your Baby

After the birth of your baby 6

Sexuality and Childbirth • Tight pelvic floor muscles – if you have a history of Having a baby brings many physical, emotional and painful sex, difficulty using tampons or very painful social changes that will be experienced differently papsmears, your pelvic floor muscles may not by everyone. Sexual desire and response often relax fully. Focus on fully relaxing and lengthening change after childbirth and it is common to have less the muscles between each contraction when you frequent sexual activity. Here are some reasons and do your exercises. suggestions: • Although it may be common to have some Physical factors discomfort with sex after childbirth, it is not normal. Talk with your partner and perhaps try other forms Many couples are just too tired for Tiredness: of intimacy that are acceptable and enjoyable for sex. Try making time to rest or sleep when baby is you both. These may include kissing, cuddling or sleeping. Time out alone or with your partner may also help - perhaps a trusted friend or baby-sitter oral sex. can look after baby for an hour or two. • Women’s health physiotherapists are very Breastfeeding: breasts can be tender or leak with experienced in treating women experiencing pressure or arousal, which can be off putting for painful sex– you can ring the women’s health some women. Oestrogen levels are also lower, physiotherapist at KEMH or OPH (wherever sometimes causing vaginal dryness and tenderness. you delivered) or talk with your doctor or child Consider using a water-based lubricant. health nurse. Pelvic floor muscles: The muscles that surround the vagina are designed to stretch in pregnancy and childbirth. Pelvic floor exercises can help tone Emotional factors: the muscles again – see your “Physiotherapy After The months following the birth of your baby can be Childbirth” booklet. It is also important that these very emotional. Changes in body image, mood and muscles can relax to allow comfortable sex – please the relationship with your partner may impact on see below. your sexual relationship. Eating healthily, exercising and communicating with your partner may all help. Pain: Several factors can cause pain with sex Although it is common to feel a bit stressed or tired, after childbirth. deeper anxiety, tearfulness, lack of interest in life or • Hormonal changes can cause vaginal dryness. a sense of panic may indicate postnatal depression. You can try a waterbased lubricant or you may This commonly starts itwo to four weeks after birth. just need to wait a little longer while hormones Please seek help from your childhealth nurse, GP normalise. Talk to your GP as sometimes an or counsellor. oestrogen cream may be helpful. When is it okay to start having sex? • Stress or anxiety may make the pelvic floor If you have had a third or fourth degree tear or a muscles contract instead of relaxing with sex – caesarean section, you will be advised not to have this feels as if the entrance to the vagina is too sex for 6 weeks – until you’ve had your 6 week check tight or has a burning sensation. Notice whether with your GP. you feel emotionally ready for sex. Check you are If the doctor or midwife has not given a time-frame, well aroused before trying penetrative sex. it is best to wait until all stitches are healed and • Stitches are usually completely healed by 6 comfortable and until you feel both physically and weeks, but some women experience pain at the emotionally ready for sex. site of the scar tissue. Gentle massage can help Remember that your sexual relationship includes all and trying different positions. A tender caesarean forms of intimacy, such as spending time together, scar may make it difficult to relax, thereby causing massage, kissing and cuddling. discomfort with attempted sex. Avoid positions that put pressure on your stomach.

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“It’s one of those things Postnatal depression The KEMH Psychological Medicine The Unit “I don’t think you Department has expertise in perinatal They can also assist with many that I never imagined The eight bed, free-standing unit is realise how valuable and anxiety mental health. It assesses, treats aspects of parenting and family health situated in Subiaco within the campus would happen to me. With around one in seven women and assists patients of KEMH whose and are able to link you to doctors, offers of help and of the Women and Newborn Health I was so in control of suffering from postnatal depression medical condition is affecting their hospitals and other health professionals support can be Service. It includes: my life, so organised, and even more suffering postnatal emotional health, or whose emotional when needed. during those first few anxiety it is essential to recognise the health is affecting their medical • Eight single rooms with ensuite until my baby came weeks. ROSE symptoms. Becoming a mother for condition. Community Child Health Nurses along. I felt so angry • Facilities for partners to provide information and support about the first time or adding a new baby to These are some of the areas that we stay when appropriate and spending time your other family responsibilities can health, development and behaviour of Nothing can specialise in: • A nursery and sleep rooms for with my baby became be stressful. A few days after the baby babies and young children. They home prepare you for • Emotional distress, trauma or babies when they are not rooming-in visit and see families in child health stressful. Then it just hit is born nearly all women experience the overwhelming some low mood, tearfulness, anxiety anxiety around pregnancy and birth • A laundry centres, parenting groups and other me, I realised, I have community venues. tiredness and the or irritability called ‘baby blues’ which • Depression • A kitchen and milk postnatal depression generally fade after a few days. Some • Anxiety preparation kitchen They can help with a range of stress you feel when women may develop more serious you find yourselves and I went to see my • Adjustment to parenthood and • Several living rooms issues including: depression or anxiety. GP.” positive approaches to your baby • Feeding your baby, introducing solids yelling at one Admission Criteria You might experience: • Adjustment to gynaecological and family nutrition another at four in the cancer Women who are pregnant or who have • Crying more frequently than usual • Sleep and settling morning, when the Postnatal a baby or babies aged 12 months of or for no reason • Management of medications baby won’t feed or depression and around pregnancy age or younger and have moderate to • Growth, development and play • Excessive worry or hypervigilance sleep.” ELLIE anxiety • Psychological preparation and severe mental illness that impacts on or • Injury prevention and child safety about the baby inhibits their level of functioning and/or If you feel you need support for medical procedures • Postnatal anxiety, stress • Feeling flat or emotionally ability to parent are eligible for referral help or support • Grief and loss and depression to Moderate to severe mental illness in you can call these disconnected • Psychological management of pain this sense may include a diagnosis of. • Immunisations and free access to services: • Feeling sad, anxious and irritable related to obstetric issues Moderate to severe mental illness in some of them Post and Antenatal • Poor appetite or overeating • Sexual health problems and this sense may include a diagnosis of: • Playgroups and other community Depression their impact on adjustment to • Trouble sleeping or sleeping • Psychosis resources Association (PaNDA) parenthood and relationships too much • Referrals to Aboriginal and ethnic helpline 1300 726 306 • Bipolar Mood Disorder • No energy health workers, lactation consultants, 9.30am to 4.30pm Mother Baby Unit • Schizophrenia • Trouble coping with the baby physiotherapists and speech Mental Health Pregnant women and women and • Schizo-Affective Disorder pathologists among others. • Low libido (less interest in sex) their babies 0-12 months may be Emergency Response • Severe Anxiety Disorders Line on 1300 555 788 admitted to the inpatient program if KEMH will notify your local Child Health • Avoiding seeing family and friends • Major Depressive Disorder (including (metro) or they have significant mental health Nurse about the birth of your baby. The • Feelings of wanting to harm Perinatal Depression) 1800 676 822 (rural) problems following the birth of a baby Child Health Nurse will then contact yourself or the baby such as severe depression, anxiety or Community Child you and arrange your first appointment. Crisis Care on a psychotic illness such as a bipolar Most Child Health Centres operate an (08) 9223 1111, Every woman will have their own mood disorder or schizophrenia. Health Nurse appointment system Monday to Friday, 24 hours, 7 days a reactions to postnatal depression or Community Child Health Nurses work in but some are only open part time. All week. anxiety. This is just a guide to help local child health centres. As Registered services are free. you recognise symptoms. If you are Nurses with qualifications in child To find your local child health centre, concerned, try to talk openly about health, they offer an initial home visit look in your baby’s purple All About Me your feelings and seek help. to all parents of a new baby in WA as book (on page 8), in the phone directory well as health and development checks or visit www.health.wa.gov.au/services at key stages of your child’s first three and, click on ‘Maternal, Child and years of life. Family Health’ and enter your suburb

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All About Me - The Next Nine Months You could try: Remember Open House Personal Health Record Join in a series of informal • Feeding again Never shake your baby as your baby’s brain is easily Postnatal Program bruised and damaged. (the purple book) discussions led by Parent Educators • Relaxing your baby by bathing, gently and Baby Massage and guest speakers every second Your baby’s purple Personal Health massaging, cuddling, walking around If you need any help and support with coping or (KEMH patients only) and fourth Tuesday of the month looking after your baby, there are a number of options Record book will be given to before • Taking your baby for a walk in fresh air exploring a range of topics relating to in the community. All new parents and you go home from hospital. It is an their babies up to newborns and women’s health. • Singing or talking to your baby important record for you to use and These include: nine months old are keep for your child. It includes health Share your experiences, get advice • Settling in a quiet and dark room invited to come back • Your local doctor (GP) or Child Health Nurse information for parents and is a from the experts and socialise with • Giving your baby to another person to to KEMH to meet and • Ngala Helpline (8am – 8pm, 7 days a week) record of your child’s health, growth, other new parents. hold and settle socialise with other development and immunisations from 9368 9368 (metro), 1800 111 546 (rural) If your baby keeps crying try to stay new parents and share birth to three years of age. Who • Midwife or obstetrician calm. If you are worried, speak to your experiences. New parents and their babies up to It is important to take your baby’s Child Health Nurse, GP or call the Ngala • Private practitioner such as a psychologist, nine months old Personal Health Record with you Helpline on (08) 9368 9368 (metro), psychiatrist or counsellor when you visit the following: What 1800 111 546 (rural). If you need • Post and Antenatal Depression Association Family Birth Centre (PANDA) helpline • Child Health Nurse Refer to the WNHS website to immediate assistance telephone the Morning Tea Parenting WA Line on (08) 6279 1200 or • GP or hospital confirm topics for discussion at the • 1300 726 306 (9.30am to 4.30pm) • Community Open House Program 1800 654 432 (24 hours). • All immunisation sessions If you require assistance after hours please call Midwifery Program When If you are feeling tired and frustrated with one of the following services: • Midwifery Group • Community Health Centre your crying baby, it is ok to make sure 1.30pm every SECOND and • Emergency 000 Practice • Any time you are seeking advice your baby is safe in its cot and walk away FOURTH Tuesday of the month • Pregnancy Birth and Baby Helpline (24 hours) • FBC about your baby with a health for a few minutes until you feel calmer. professional. Where 1800 882 436 Mothers who have Financial support and benefits • Mental Health Emergency Response Line (24 hours) Agnes Walsh House (next door to given birth at any of Settling your baby Once you have your baby, you will receive 1300 555 788 (metro) 1800 676 822 (rural) these will be invited KEMH, Bagot Road) a package at the hospital which includes • Parenting WA Line (24 hours) 6279 1200 (metro) to return to FBC for Baby Massage Course claim forms for government payments 1800 654 432 (rural) a supportive chat Your crying baby Time used for massage can benefit that you may be entitled to now you and catch up with • Lifeline 131 114 both you and your baby, come and All babies cry. Crying is your baby’s are a parent. For the most up-to-date midwives and other learn the correct techniques from a way of communicating. Your baby will information, contact: • Lifeline Suicide Helpline 1300 651 251 mums. trained infant massage instructor. cry because of hunger, a full nappy, • Men’s line 1300 789 978 sickness, pain, feeling tired or lonely. Family Assistance Office and Who Often it’s unclear why your baby Centrelink Parenting Payment Line Parents and their babies between is crying which can be frustrating Telephone 13 61 50 and upsetting. six and twelve weeks (3 months) Web www.familyassist.gov.au When Try to respond in a consistent way when your baby cries. Start Medicare Birth registration Once a week for four weeks by checking that your baby is Telephone 13 20 11 You are required by law to register the birth of your (1-1.5 hours per session). comfortable, not hungry or thirsty, Bookings essential Web www.hic.gov.au baby within 60 days. The hospital will provide you with then help them settle. Settling may a Birth Registration Statement. Once registered, a birth Where take longer than you expect and can certificate will be issued. This is an important document be stressful. There are a number of KEMH Parent Education that should be stored in a safe place. things you can try when your baby Department, 1st Floor, A Block has been fed, changed and cuddled For more information, contact: but still continues to cry. Registry of Births, Deaths and Marriages 10/141 St Georges Terrace Perth WA 6000 Telephone 1300 305 021

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Safe Infant Sleeping If you choose to share the same Other children or Information for Wrapping and clothing: sleep surface with your baby Room-sharing RECOMMENDED Mattress, cot and bassinette: after four months of age pets should never Parents, Carers and • Wrapping your baby may help them Room-sharing is when your baby • The mattress should be firm, flat share the same Families Where to place your baby: sleeps in their own cot next to your and fit the cot/bassinette without to settle and stay on their back. sleep surface with Six ways to sleep your bed for the first 6 to 12 months of life. any gaps around the edges. • The wrap should be loose enough to • Place your baby on their back and your baby. allow your baby’s hips to bend and baby safely and reduce • Make sure your baby’s cot meets beside one parent/carer (not in- Any benefits the risk of sudden This can help you to: chest to expand. between), so they do not overheat, the Australian Standards for cots of co-sleeping unexpected death in • Respond quickly to your become covered, or slip underneath AS2172, second hand cots older • Do not wrap your baby when they must be carefully infancy (SUDI): baby’s needs. are unwell. pillows, adult bedding or covers. than 10 years will not be safe. considered with 1. Sleep baby on back* • Settle and comfort your baby more • Make sure your baby is not too There should be no large gaps • To stop your baby from overheating, the risk factors conveniently than if sleeping in a close to the edge of the sleep stated above. 2. Keep baby’s head and between the bars which could trap do not over dress your baby and separate room. keep their head uncovered (no surface where they could roll off. face uncovered your baby’s head. The safest place 3. Keep baby smoke free • Bond with your baby. beanies). • Do not place pillows at the side of for your baby to • If you are using a portacot, it is your baby to prevent them from before and after birth • Maintain breastfeeding. sleep is in its own important it meets Australian Co-sleeping is NOT rolling off. 4. Safe sleeping • Reduce the risk of your baby dying cot by the side of Standard AS2195. Portacot’s recommended • If the mattress is put on the floor as environment night and from Sudden Unexpected Death of your bed. are not suitable for babies 15kg Co-sleeping is when a parent or carer a safer option, make sure it is away day Infants (SUDI), including Sudden Infant Death Syndrome (SIDS) or and over. Only use the firm, is asleep with a baby on the same from the wall and other furniture, so 5. Sleep baby in a safe fatal sleep accidents. thin, well-fitting mattress that is sleep surface, such as a bed, couch, there are no gaps for your baby to cot in parent’s room slip into. supplied with the portable cot. or beanbag. Your baby should 6. Breastfeed baby** Safety tips for cot sleeping Never add a second mattress Mattress and bedding or covers: NOT be left to sleep * Medical advice may be or additional padding under or unsupervised in Where to place your baby: • The mattress must be firm and flat. needed for babies with a severe over the mattress, as baby may a pram, stroller or disability • Place your baby in the cot with become trapped face down in • Pillows, adult bedding or covers, bouncinette. ** While breastfeeding is best, their feet close to the bottom end. gaps between the mattress and and any other soft items, should be it may not be possible for every kept away from your baby. Soft toys, cot mother What bedding or covers to use: the sides. bumpers, pillows, There are some situations when • Make sure there is nothing sleep positioning To sleep your baby • Baby sleeping bag with fitted neck • These two Australian Standards soft underneath your baby e.g. co-sleeping is associated with aids, sheepskin rugs safely follow these and arm holes OR for cots are the only two that sheepskin rug or a wool underlay an increased risk of Sudden or wool underlays recommendations • Lightweight bed covers (not a meet the mandatory standards for wherever your baby Unexpected Death in Infants: • Your baby should be dressed in a should NOT be doona) that are tucked in firmly and long term unsupervised sleep in sleeps, including at baby sleeping bag with fitted neck placed in your baby’s only come up to your baby’s chest. Australia according to ACCC. • Babies under four months of age, the home of friends or and arm holes, so they can lie cot as they may relatives. and when your baby is premature or outside the adult bedding or covers, very small. cause suffocation or only use light weight blankets and reduce airflow. • Where your baby would share the (not a doona) that won’t cover your same sleep surface with a parent/ baby’s face. carer who is a smoker. Wrapping: • Where there are pillows, adult • Your baby should not be wrapped bedding or covers that may cover when sharing the same sleep your baby’s face. surface as a parent/carer to prevent • Where your baby could become overheating. trapped between the wall and bed, could fall out of bed, or could be For more information, talk to your Child rolled on. Health Nurse, or contact Red Nose on 1300 308 307. • Where the parent/carer is overly tired or has been drinking alcohol www.rednose.com.au or using drugs that may make them sleepy. • Where your baby would share the same sleep surface with other 92 children or pets. 93 Pregnancy, Birth and your Baby Having your baby at King Eddy’s

After the birth of your baby 6

Sudden Unexpected Death Where to get help when your What is SUDI? in Infants (SUDI) baby is sick SUDI is short for The following is a list of ways that • Healthdirect (24-hours) on ‘Sudden Unexpected have been shown to reduce the 1800 022 222 Death in Infants’ and risk of SUDI. • Poisons Information Centre is the most common • Breastfeed your baby on 131 126 cause of death in • Your local doctor (GP) babies between one • Put your baby on his/her back month and one year • Keep your baby’s face uncovered • Public hospital with paediatric of age. Most babies and with blankets tucked in facilities – Armadale Hospital who die of SUDI are • Place your baby at the bottom of under six months. the cot – Fiona Stanley Hospital – Joondalup Health Campus • Make sure your baby is not too hot – Princess Margaret Hospital or cold – Rockingham Hospital Immunisation is • Do not use doonas, bumpers or – Peel Health Campus not linked to SUDI. pillows in the cot – St John of God Midland • Do not let anyone smoke near your baby – babies need a smoke free • Emergency 000 environment. Babies can become ill quite quickly; when this happens immediate action is required. See your doctor immediately if your baby: • Is pale, drowsy and hot • Is lethargic and crying • Is vomiting green fluid • Will not feed • Has convulsions • Stops breathing for more than 15 seconds. 7 Breastfeeding 94 95 Pregnancy, Birth and your Baby

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Benefits of breastfeeding Formula Feeding of healthy The first few days • Getting some rest during the day will help you manage these night time Remember breastfed babies is best avoided • Skin-to-skin contact during this time There are many emotional and feeds. Reducing or limiting the number physical benefits for both you and because: can help you to bond with your baby. Breastfeeding is a skill of visitors you have during the day your baby from breastfeeding. It can also help calm your baby. that needs to be learnt 1. Formula can interfere with the may also help. protection against infection that • After an initial alert period some over time and requires Some of these are listed below. • If you have other small children, try colostrum/breast milk is creating in babies become very sleepy for the patience and support. to get some extra help with them if your baby’s gut. next 24 hours or so. This may be Health benefits for your baby you can. due to the birth experience and/ The midwife on the 2. Formula is more slowly digested • Breast milk has all the nutrients for or pain relieving drugs given to the • A breastfed baby may feed between ward can assist than breast milk and increases growth and development. mother during labour. If this happens, 8 to 12 times, or more, in a 24 hour you, we also have a the time between feeds. This may colostrum/breast milk will need to be period. This is normal. breastfeeding class • Breast milk helps prevent prevent full drainage of your breast expressed and given to the baby if he/ for you and your baby respiratory and intestinal infections, at feeds and give less stimulation The best way for a mother and baby she is not interested in feeding. weekday mornings at and allergies. to your breast. This often leads to a to learn to breastfeed is to let the 10.30am ‘P&A Everday’ • Babies fed only breast milk are less reduced breastmilk supply. • The early use of teats and dummies, baby follow their natural instincts. This – Ask your midwife especially before the first breastfeed, is called ‘baby-led attachment’ and likely to develop inflammatory bowel 3. Frequent full drainage of your can interfere with breastfeeding. can be done straight after birth or at disease and diabetes. breast prevents engorgement. any time later. • Breastfeeding reduces risk of SUDI Formula (or water) feeds can • Some babies may have periods interfere with breast drainage and of wishing to feed very frequently, Many babies are born able to search for Health benefits for you thus contribute to engorgement. especially at night, in the early days. the breast without much help. This is normal, and your baby is A mother’s role is mainly to support and • Breastfeeding will make your uterus 4. If your family has a strong history helping your milk supply establish by encourage her newborn. (womb) contract, which helps of allergy, formula can create an stimulating your breasts regularly. reduce the risk and amount of allergic response in your infant. bleeding after birth. 5. Babies who have bottle feeds in • Breastfeeding reduces the risk the first month of life have a shorter of breast cancer and epithelial duration of breastfeeding. ovarian cancer. If you choose for personal reasons to Benefits to your family and give your breastfed baby a formula feed, you will be asked to indicate community your consent by signing your baby’s • Breastfed babies have less medical record. infections because of the protective Formula feeds ordered for individual qualities of breast milk. medical reasons will only be given • The cost of extra food required after a full discussion with you. by you to breastfeed is small in comparison to the large cost of Getting started formula and equipment needed for Skin-to-skin contact between mother its preparation. and baby is important after birth to: • Encourage bonding and release Vulnerable babies of hormones. • Some babies need more support • Help keep your baby warm and to establish breastfeeding. Your adapt to life outside your womb/ midwife will give you an information uterus. leaflet and a feeding plan if your Keeping babies skin to skin baby requires extra assistance. encourages breastfeeding instincts in your newborn.

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Start when your baby is awake and • Gently support your baby behind Rooming in – feeding are produced at first as this is calm and remove his clothes, except his shoulders and under his bottom, all your baby needs. The milk for the nappy. but allow him to move freely when according to need gradually becomes thinner and he wants. He may ‘bob’ his head on If both you and your baby are • Take off your bra and top – you could more watery looking and the your chest and then move across to well, you should remain together wear something over your shoulders amount you produce increases. one breast. 24 hours a day whilst establishing for warmth or privacy. This is normal; your milk contains breastfeeding. This allows • When his chin contacts the breast, everything your baby needs to • Sit comfortably, leaning back a little, unrestricted breastfeeding and he may attach by himself. Don’t be in grow and satisfy hunger. with your back well-supported. a hurry. Let your baby take his time helps you learn about your baby’s • Place your baby skin-to-skin on your to attach when he is ready. Enjoy feeding and behaviour patterns. chest. Talk to him, look into his eyes your baby! and gently stroke him. Feeding cues Babies should be allowed to feed Place your baby upright skin-to-skin, 2 Baby starts to follow their instincts, allow your as often as they need. There 1 supported, calming him/her by gentle baby to ‘bob’ their head around on your chest, should be no limit on the number rocking, stroking and talking. they may look at you. of feeds you give your baby. In a 24 hour period a well newborn will feed at least 8 to 12 times or more. Do not wait until your baby is crying for a feed; be aware of early signs of hunger such as: • mouth opening • hand to mouth movements • rapid eye movement Baby may nuzzle your breast and lick for a Baby is using his/her cheek to feel their way. 3 little while. That is fine. 4 This is a learning process for both of you. It is • shallow state of sleep after one okay to take your time. or two hours of deep sleep. How breastfeeding works The more your baby feeds, the more milk you make. When your baby sucks at the breast, hormones are released. These hormones make the milk and cause the milk to ‘let down’ or flow. The first milk you produce looks thick and yellowish. This first milk Digging in his/her chin, the baby reaches up If the baby’s back is straight, their body (colostrum) is important for your 5 with an open mouth, and attaches to the breast. 6 touching yours, and you are both feeling comfortable, that is all that matters. baby as it contains substances to nourish and protect from disease. Only small amounts of colostrum

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Signs your milk is flowing Gently press with your hand around Signs baby is getting enough the breast, and close to your chest • A change in your baby’s sucking rate Fully breastfed babies will have one to two wall, without causing pain. When from rapid sucks to suckling and wet nappies and have passed meconium in your baby is no longer drinking swallowing rhythmically, at about one the first 24 hours. Following this the number release the pressure. suckle per second. of bowel actions and wet nappies will • While feeding on one side your other When your baby starts to suckle again gradually increase. In addition, your babies breast may start to leak milk. he/she may be drinking but if he/she bowel movements will increase in number doesn’t resume suckling well, compress and change in colour as your milk supply • Sometimes there is a sudden feeling your breast again. Keep doing this increases in volume. of fullness in the breast. until your breast feels soft and drained Once your baby is receiving mature breast • You may become thirsty. and baby is no longer drinking. Then milk then expect: • Some mothers feel a tingling or pins offer your baby the other breast and • Five or more wet nappies every and needles sensation in the breast. if he/she becomes tired start your compressions again. 24 hours Your milk flow can be affected by • Clear or pale urine emotions like anxiety, embarrassment, How your milk supply increases tension or extreme tiredness. Being As your baby grows their appetite • Soft yellow bowel action – at least relaxed when breastfeeding helps your increases and he/she will demand two to three per day for the first six to milk flow. more feeds. These appetite increases eight weeks or growth spurts may last a few days. • An alert, healthy baby with good skin tone How long to feed your baby Your breast milk will increase to match • An average weight gain of 150gm or more The length of time a baby feeds will your baby’s needs if you breastfeed per week in the first three months vary. A newborn baby is often sleepy more frequently. Growth spurts occur at and may need waking during a feed anytime but are often around six weeks, For more information about signs baby is and encouragement to fully drain the three months and six months. getting enough go to: breast (having your baby unwrapped Remember your breasts are never Breastfeeding Centre of WA Website. during feeds will help). Most babies empty. As your baby feeds, your body take both breasts at each feed. Seek makes more breast milk. Helping your baby to breastfeed assistance if you don’t think your baby • How you and your baby are positioned is having adequate feeds or is unsettled You can build up your milk supply by: may help him/her to latch on more easily. between feeds. • Feeding more often • Make yourself comfortable, If you feel pain after you start to feed, • Offering both breasts twice unwrap your baby and remove clothing your baby is not attached correctly and that may come between you both. Leave this may cause sore or cracked nipples. • Putting baby back to the breast 20 to baby’s hands free to move. 30 minutes after a feed If pain is experienced put a clean finger • Lie baby on your chest or next to your into the side of your baby’s mouth • Expressing breast milk after feeds breast. Baby’s whole body needs to be between the gums to break the suction. facing you. Gently take the baby off the breast and • Not giving baby formula feeds, water • Baby’s chin is on the breast and your reposition and reattach him/her. or juice nipple is above baby’s top lip, opposite After the feed your breast should feel • Resting as much as possible – a few the nose. lighter with no lumps. quiet days at home are helpful • Baby’s bottom lip and chin should be firmly • Eating well and drinking when thirsty Breast compression contacting the breast below the nipple. • Gently stroking or compressing Breast compressions can help if your • Wait for baby to respond with a wide-open your breasts during feeds and when mouth and latch on. baby is sleepy while feeding or slow expressing to gain weight. By compressing your • If baby is unable to latch on, seek help breast you will encourage your milk to from a midwife or lactation consultant. flow which will provide your baby with more milk. Go to the Breastfeeding Centre of WA website, in the resources section there is a short video to show positioning and attachment. As an inpatient, you may also attend the breastfeeding 100 positioning and attachment session. Ask your midwife for details. 101 Pregnancy, Birth and your Baby

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Nipple care • If your baby is unable to attach Visit the KEMH website on the 5. Allow the baby to begin sucking your to your breast, it is important to Breastfeeding Centre WA page to view finger (with your finger pad towards Common questions: • Do not use soap or shampoo on your nipples. continue expressing regularly, a short video on hand expressing and the top of baby’s mouth). every three hours or eight times in using a breast pump. My baby gets fussy 6. If your baby is sleepy gently • Harsh abrasive conditioning or 24 hours, including during the night. and wants to feed very introduce your finger into their often, especially around treatment of nipples is not required. • This will help your body to produce mouth. If baby’s lower lip is sucked dinner time, is that • If you think your nipples are flat or milk, even if your baby is not ready Expressing with an electric in pull down gently on their chin to normal? inverted, seek advice. to feed yet. breast pump release the lip. Yes, all babies can have • If baby is correctly attached at the 1. Wash hands with soap and water 7. Insert the large end of the tube into fussy periods and may breast you won’t experience any Hand expressing and dry well. have several feeds close discomfort. the bottle below the milk line. Gently together. Expressing may be used to: 2. Assemble clean expressing equipment. insert the tube along side your finger • After each breastfeed, express a to the finger tip and raise the bottle Today my baby seems few drops of milk to smooth over • help you attach your baby to the 3. Ensure the correct size breast shield to want to feed all the your nipple and allow to dry. The breast when your breast is full, or is used. so that the milk flows down the tube. time, much more than milk moisturises the nipple and • give your baby expressed milk 4. Double pump until milk slows or 8. The technique is working if the baby other days, why? provides a barrier against infection. when breastfeeding is not possible. stops, then single pump each is drinking. If the feeding is very As your baby grows, his/ • Ensure you change your nursing breast. Gentle breast compression slow – but the baby is swallowing her appetite increases. pads regularly. Procedure to assist letdown until breast is soft well – raise the bottle to increase the He/she will demand more and light. flow. If your baby is gulping, lower • If your nipples are sore or 1. Wash hands with soap and water feeds during growth 5. You need to express your breastmilk the bottle to slow the flow. damaged, it is important to seek and dry well. spurts which may last a as often as you expect your baby few days. assistance. Purified lanolin may be 2. Use a clean container. applied to nipples, using a cotton to feed, at least eight times a day bud, if they are damaged. 3. Stimulate the letdown reflex by if your baby is not breastfeeding, gently stroking your breast towards or between feeds if you need to • Always handle breasts with your nipple. increase your milk supply. clean hands. 4. Place your fingers underneath your See page 105 - Storage of breast milk. • Causes of sore nipples can be breast so that the first finger is just related to any of the following: below and the thumb is just above Feeding baby with - poor positioning of baby the areola, about three to four cm expressed breast milk - tongue-tie back from the nipple. - infection 5. Gently PRESS the fingers and Finger feeding - dermatitis or eczema thumb pads (not fingertips) Finger feeding is a way of giving your - vasospasm (tightening of the back towards your chest. Then COMPRESS the breast tissue and baby expressed breast milk without blood vessels in the nipple) hold briefly. Release your breast using a bottle teat, as some babies • If your nipples become damaged, tissue. Do not squeeze or pinch may start to prefer a teat and refuse the express milk to feed your baby your nipple breast. Finger feeding uses a bottle with while you seek assistance. a thin tube rather than a teat. 6. Repeat the action in a rhythm Expressing for a preterm similar to the baby’s sucking, about Note: Nails should be trimmed short once a second. and artificial nails should be secure. baby or baby who is unable 7. Rotate the position of the finger and How to finger feed to breastfeed thumb around the breast, so that all 1. After washing your hands, securely • If possible, it is important to start the milk ducts are expressed. wrap your baby. expressing milk within one to three 8. When colostrum is pearling or hours after the birth of your baby - dripping easily, it is time to collect 2. Sit in a comfortable position. Visit the KEMH website on the Breastfeeding Centre WA page to even if your baby is moved to to the the colostrum. 3. Support your baby with a pillow. view a short video on how to finger Neonatal Clinical Care Unit or away 9. Express both breasts in turn whilst 4. Rest index or middle finger on feed you baby from you to receive special care. the colostrum is dripping. the ridge between nose and If regular expressing is required top lip (philtrum) until baby’s to give extra breast milk to your mouth is open. baby, an electric breast pump is 102 recommended. 103 Pregnancy, Birth and your Baby

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Cup feeding Method Storage of breast milk Thawing and warming of Cup feeding is an alternative means of 1. Place your baby in a more upright Freshly expressed breast milk should breast milk When you need breastfeeding help providing colostrum or expressed breast position than ‘traditional’ bottle be cooled before being added to Do not leave frozen expressed milk (not formula) to babies unable feeding techniques. previously expressed chilled or milk to stand at room temperature Following the birth frozen milk. to attach and/or suck at the breast 2. Support the baby’s back so the to thaw, either: of your baby, your successfully. It is most successful when midwife will assist you baby’s head can extend into a • Thaw the milk in the fridge your baby is wide awake and interested. with breastfeeding natural drinking position. Freshly expressed into overnight or. Breast milk advice and support. 1. Wash hands in soap and water and 3. Use a slow-flow round teat. a clean container dry well. • Hold the container under running There are also lactation 4. Rest teat on ridge between nose 6 to 8 hours cold water, gradually make the consultants available in 2. Wrap your baby securely. and top lip (philtrum). When baby’s Room (26°C or lower) water warmer until the milk the hospital to advise 3. Support your baby in an upright mouth is wide open, place entire teat temperature Store in refrigerator if becomes liquid. do not use boiling you on how to manage sitting position. into his/her mouth. Important: Avoid one is available water, this can cause loss of any breastfeeding pushing the teat into a baby’s mouth vital nutrients and minerals in difficulties you may 4. Fill a small clean medicine cup half 3 to 5 days (4°C or that is not open. breast milk. experience. full with expressed milk. lower) 5. Hold the bottle horizontally so there Refrigerator Store in back of Warm the container of chilled or If you are having 5. Tip the cup so that the milk is is just enough milk in the teat. This refrigerator where it is thawed milk in a jug of hot water until breastfeeding touching your baby’s lips. Do not will ensure no air is in the tip of the coldest it is body temperature. challenges following pour the milk into baby’s mouth. teat. This will encourage your baby Two weeks in freezer Microwave ovens should never be discharge – all 6. Tilt the rim of the cup touching the to suck on the teat without gulping or compartment inside used to thaw or heat milk. Their women can call the baby’s bottom lip, towards the upper using their tongue to slow the flow. a refrigerator (store safety is unknown and heating is Breastfeeding Centre lips and gums. of WA (BFC). Lactation 6. Withdraw the teat slightly every few in the back to prevent uneven. Microwaves also reduce consultants can help 7. As your baby’s jaw is lowered, a minutes to allow your baby to take thawing while the door the anti-infection properties in women who are small amount of feed will be taken a pause as they would naturally is open) breast milk. Freezer having breastfeeding and swallowed. on the breast. Three months in Expressed milk cannot be reheated if challenges. freezer section of 8. Leave the cup in the correct position 7. Switch sides to assist with eye your baby doesn’t finish the feed – so refrigerator (with Women who gave during the feed as this allows stimulation and to prevent preference warm only a small amount at a time. separate door) birth at KEMH, FBC or your baby to self regulate the for one side. Note: with CMP and KEMH feed as desired. 6 to 12 months in deep Thawed expressed breast milk: 8. As the amount of milk in the bottle freeze (-18°C or lower) as their supporting 9. After use, wash the cup in warm decreases, gradually lean your • that has not been warmed can be hospital, can make an soapy water and rinse well. baby backward. appointment to visit stored in the refrigerator for 24 hours the BFC and see a Feeding older babies How long should a ‘paced’ bottle Lactation Consultant. feed take? • that is not refrigerated must be Using a bottle is another method of used within four hours Appointments are giving your baby expressed milk. You should aim for the feed to take at essential. A bottle teat does not always allow a least 20 minutes. If a feed takes less • must not be re-frozen. baby to ‘pace’ their intake as they do time than this the flow is too fast and if when breastfeeding. If the bottle is held the feed takes more than 45 minutes vertically, the milk pours out. then the flow is too slow. It is important to adjust the angle of Watch your baby’s cues to know when to the bottle to allow your baby to ‘pace’ finish the feed rather than encouraging themselves. them to finish the bottle.

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Engorgement Prevention Blocked ducts • Use paracetamol or anti- inflammatory tablets according to Your milk will come in around 24 to 72 • Ensure baby attaches correctly to A blocked duct causes a lump that directions until the lump clears. hours after birth. A degree of fullness the breast is tender or painful because of milk • If the lump has not cleared may be experienced at this time, when • Feed your baby often without limiting building up behind the blockage. after the next breastfeed, baby may only want one side per feed. the time at the breast therapeutic ultrasound treatment Engorgement is caused by a build-up Prevention • Ensure your baby drains the (by a physiotherapist) of the of blood, milk and other fluids in the first breast before offering the • Ensure correct positioning and affected breast may help clear breast. This occurs if the breasts aren’t second side attachment. blocked ducts – contact the drained well during a feed. • Avoid use of dummy or • Frequent drainage of the breast. Breastfeeding Centre to arrange. complimentary feed (i.e. formula) • Alter position during feed to • It is important the breast is If your breasts are very full, you include underarm position, cradle well drained within 20 minutes may need to express a little milk to position or lying on your side. of having the ultrasound soften the areola so your baby can treatment. This may be either attach well. • Check for a white ‘bleb’ or spot on by breastfeeding or expressing the nipple as this may be blocking the breast. Engorgement will occur if your baby is the milk duct. not feeding and attaching well. Less • Seek professional help if a blocked duct hasn’t cleared commonly it may occur if your body Avoid is making more milk than the baby within 24 hours. has needed. • Sudden long gaps between breastfeeds or expressing for Treatment your baby. • Ensure your baby is attached well • Tight or restrictive clothing The Perron Rotary Express Milk (PREM) Bank e.g. bra. when breastfeeding. Mothers producing more milk than their own baby needs • Feed your baby often, at least 8 to • Pressing or holding one area of may want to donate their excess milk to the Perron 12 times per 24 hours. the breast too tightly, especially Express Rotary Milk (PREM) Bank located at KEMH. • Do not limit time at the breast. close to the nipple. Breast milk is the best food for babies, especially when they are born sick or premature. Giving these babies • Express to soften areola to attach Management of blocked ducts breast milk helps reduce the number of gastro intestinal your baby to the breast. • Feed frequently from the affected infections and supplies special immuno-protective • Use cool gel packs from refrigerator side first. properties to increase their chances of survival for long- (not freezer) for comfort. term growth and development. • Gently stroke towards the nipple • If the breasts are full and heavy during the feed. This may assist Before accepting milk from donors we ensure they 24 hours after the milk comes in, the let-down reflex. are healthy by screening them through completing a a one-off complete drainage of questionnaire and undertaking a blood test. the breast is necessary. This is • For comfort and to reduce The PREM Bank welcomes enquiries from women who done by using a hospital grade swelling from excess fluid apply are breastfeeding or planning to breastfeed in the future. electric pump if possible. An electric a cold cloth or cool gel pack. pump is available at the KEMH • Express after feeding. For more information visit the website Breastfeeding Centre or KEMH www.kemh.health.wa.gov.au • If a white ‘bleb’ or spot is Emergency Centre. Ensure a present, soak the nipple with correct size breast shield is used a warm moist cloth and rub when expressing. or scratch it off using a sterile • Seek professional advice to ensure needle to allow the milk to the condition resolves. flow again.

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Mastitis • Paracetamol may be taken to ease discomfort. Mastitis occurs when there is a blockage of milk in the milk duct. Some • It is important to get extra rest. milk may leak out of the duct into the You may need household help to surrounding tissues causing inflammation achieve this. and infection. • You will need antibiotics for 10 to 14 days. Signs and symptoms • If it is too painful to feed, express your • The breast has a red, painful area. milk using a hospital grade electric pump if possible. • An aching flu-like feeling such as a fever, feeling shivery • Seek advice from a lactation and generally unwell. consultant to determine a cause and prevent a reoccurrence. Seek medical help as soon as possible if you think you have mastitis. Dummy use while breastfeeding Treatment Dummies are not recommended while • Drain the breast frequently. Attach establishing breastfeeding because: your baby to the affected side first. • Baby feed cues may be missed. • Keep the breast drained by expressing the affected breast after each feed. • Dummy use has been linked to less time spent breastfeeding which can • Cool gel packs from the refrigerator lead to and lower baby (not freezer) or cool cloths can relieve weight gain. discomfort and pain. • Anti-inflammatory medication e.g. ibuprofen, will reduce the inflammation and pain.

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Most women have a normal, healthy pregnancy. But sometimes Women with pre-eclampsia are In some cases your doctor may Remember health complications can affect the outcome for both the mother closely monitored and have access suggest that your baby is born early to extra care. In the case of severe if there is a problem. The main More information? and baby. This chapter briefly looks at some of the complications It’s important to pre-eclampsia, more intensive reasons for this are pre-eclampsia, KEMH has a number of remember that: and unexpected outcomes of pregnancy and birth. monitoring of you and your baby will infection, placenta praevia and information brochures be provided and you may have to • A healthy mother . that focus on the have your baby earlier than planned. individual needs of and baby is what Bleeding during pregnancy Breech baby If things don’t go as planned, KEMH women experiencing matters the most If you have any bleeding during your A breech baby is one with its bottom Gestational diabetes has many specialist services to pregnancy support you during this difficult time. • Sometimes things pregnancy contact your midwife, down and its head up towards the About five percent of women develop complications. happen that are doctor, or the hospital immediately so top of the uterus. Your baby may be You may have been transferred from raised glucose (sugar) levels during a regional hospital, particularly if Ask your doctor or outside your control that appropriate tests and treatment breech when you are six or seven midwife if there is more pregnancy which can potentially you are between 24 and 32 weeks can be started. months pregnant but in most cases affect the baby. Please see more information that can will turn in the last couple of months. pregnant and are at risk of having Reasons for bleeding can include information on Gestational Diabetes help you to understand If your baby does not turn, you will a premature baby. If you need to miscarriage, placental abruption on page 35. what is happening or be offered External Cephalic Version stay in hospital, the Social Work and placenta praevia. These are to help you make a (ECV) where the baby is turned by Department can help you organise decision about what to explained further on. Premature labour and birth encouraging it to do a somersault. accommodation for your partner do next. If this is not successful or the baby Premature labour is when labour and family as well as helping you Miscarriage turns back to a breech position you begins before 37 weeks gestation. organise any social support you One of the most common will need to discuss your birth options The reason for labour starting may need. You will be able to talk complications in early pregnancy with your doctor. prematurely is often not clear. to a paediatrician and take a tour is spontaneous miscarriage. A Causes can include multiple of our nurseries. If you remain miscarriage is defined as the loss High blood pressure pregnancy, fibroids, an abnormal stable and reach beyond 35-36 of pregnancy before 20 weeks cervix or uterus, urinary tract weeks in your pregnancy, you may High blood pressure (hypertension) or other infection in the mother, gestation. It is often an emotionally be transferred back to a hospital in pregnancy may develop during smoking and drug use. If you have distressing event. Hospital staff can closer to your home. If you are pregnancy or you may already have had a premature baby before, support you and your family during planning to breastfeed your baby, it is high blood pressure. It can occur your chances of having another your experience of miscarriage. important to commence expressing after 20 weeks gestation, be a one- premature baby are higher. your colostrum within the first hour off event, or part of a more complex Problems with the placenta after the birth to help build your condition such as pre-eclampsia. Problems with your placenta are a Treatment includes rest, monitoring milk supply. Ask your midwife for common cause of bleeding during of your blood pressure, monitoring assistance. the second half of your pregnancy. of your baby and your wellbeing and Both placenta praevia and placental may require medication. If your blood abruption cause bleeding with the pressure doesn’t settle then you may abruption occurring when part, or all, need to have your baby earlier. of the placenta separate from the wall of your uterus before the birth of your Pre-eclampsia baby. Placenta praevia occurs when Pre-eclampsia is one of the more the placenta implants in the lower common complications of pregnancy part of the uterus instead of being and can occur at any time during the attached to the top part of the uterus. second half of pregnancy and the first Both these conditions may involve few days after the birth. The signs of you being admitted to hospital for pre-eclampsia are severe headache, careful monitoring and could require high blood pressure, visual problems a change in your planned birth. and sudden excessive swelling of the face, hands and feet. Pre-eclampsia is a serious condition of pregnancy. It may be anywhere between mild and severe and treatment varies accordingly. 110 111 Pregnancy, Birth and your Baby Having your baby at King Eddy’s

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Non-elective caesarean Regardless of the gestation of the pregnancy, each loss is unique. Bereaved If problems develop during labour parents will react in their own individual the medical team may decide that a way depending on their personal values caesarean delivery is the safest way and beliefs. The hospital aims to respond for the baby to be born. There is more to the needs of individual women and their information about caesarean birth in the families at this time. assisted birth section, on page 69. The Perinatal Loss Service at KEMH can Jaundice offer you support and advice including: Jaundice occurs because your baby’s • Crisis counselling body has more bilirubin than it can get rid • Pastoral care of. Bilirubin is a yellow substance that’s made when the body breaks down old red • Information blood cells and causes a yellowing of the • Practical support and referral to skin and eyes. Jaundice usually appears community supports as needed about 24 hours after birth. It gets worse When a loss happens, particularly a loss until the third or fourth day, and then it in later pregnancy or a still birth, you will goes away in about a week. need to make many choices about your Some babies may need phototherapy care and how you would like us to provide treatment which involves special lights bereavement services. We encourage and controlled surroundings. you and your partner to take your time in making these decision and KEMH will Intensive and Special Care support you to do this. You will also be Some babies are born in need of special offered a follow-up visit at the hospital care or observation and may need to go with a senior doctor to discuss questions to KEMH’s Neonatal Intensive Care or you might have about your pregnancy, Special Care Units. It may be for only a the care you received and the reasons for few hours or several weeks or months if your pregnancy loss. your baby is premature. Being separated Contact details for the Perinatal Loss from your baby at this stage can be very Service can be found at the back of distressing. It may help a little to know this booklet. that your baby is receiving the very best care. If you are well enough you can visit Women and Infants Research intensive or special care. If you are not Foundation well enough your partner can visit. If your baby is sick or premature, you will receive Women and Infants Research Foundation additional advice and support. (WIRF) research focuses on the major health issues that affect newborns, Sometimes, when babies no longer need reproduction and women’s health at all our specialised care, but still need to be ages. WIRF is also the charity of King in hospital, they will be transferred to a Edward Memorial Hospital, helping to hospital that is closer to your home. raise vital funds for equipment, new initiatives and essential research studies When a baby dies 9 into women’s and infants’ health. Pregnancy loss can occur at any time, For more information or to donate call from very early in the pregnancy through (08) 6458 1437. Find out more to babies that die soon after birth. Despite advances in medicine and technology, a small percentage of pregnancies end prematurely, often for unknown reasons.

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Women and Newborn Maternal Fetal Women and Infants Research Parenting WA Line Australian Multiple Birth Having a Baby in WA Assessment Unit Foundation (WIRF) (08) 6279 1200 or 1800 654 432 Association Health Service contact (08) 6458 2199. (08) 6458 1437 (free for STD callers) www.health.wa.gov.au/ details www.amba.org.au havingababy Mother and Baby Unit Women and Newborn Drug and Perth and Districts Multiple Birth To contact any service you can call (08) 6458 1799 Alcohol Service (WANDAS) Association For families with twins, triplets, Information about pregnancy, birth the hospital switchboard on (08) 6458 1582 (08) 6458 1536 quadruplets or more. Support from and your baby’s first 12 months from (08) 6458 2222 and ask to Nutrition and Dietetics ‘those who know’. the WA Health Department. Explains be connected. (08) 6458 2795 Women and Newborn Health Poisons Information Centre the pregnancy and birth care options 13 11 26 Aboriginal Health Promotion Library Bumps - Best use of in WA. Obstetric Medicines (08) 6458 1100 (08) 6458 1123 Information Service Pregnancy, Birth & Baby helpline Medicines in Pregnancy Supports informed decision making 1800 882 436 for pregnant women and families. Aboriginal Liaison Officer (08) 6458 2723 Community support and medicinesinpregnancy.org/ It gives clear information about types (08) 6458 2777 Occupational Therapy Quitline information services of care, definitions, what is available (08) 6458 2870 (24-hour telephone and information Information about medications and Antenatal Clinic and where. It can help you decide Australian Breastfeeding service) 13 78 48 other exposures during pregnancy (08) 6458 2222 what’s right for you and how to get Outpatient appointments Association and while breastfeeding. Red Nose Grief and Loss the most out of the care you receive. Bears of Hope Pregnancy Outpatient Direct 1800 855 275 (formerly Nursing Mothers) 24-hour crisis line - 1300 308 307 & Infant Loss Support Birthrites Outpatient Pharmacy 1800 mum 2 mum Kidsafe 1300 114 673 Registry of Births, Deaths (08) 6458 2722 (1800 686 268) www.birthrites.org and Marriages Breastfeeding Centre of WA www.kidsafe.com.au Parent Education Centrelink 1300 305 021 Comprehensive resources and (08) 6458 1844 (08) 6458 1368 13 61 50 information on Vaginal Birth After Site of the Child Accident Prevention Foundation of Australia. Community Midwifery Program Relationships Australia Caesarean (VBAC). healthdirect Australia (08) 9301 9227 Pastoral Care and 1300 364 277 1800 022 222 Spirituality Services Beyondblue Lamaze Crèche (08) 6458 1036 or (08) 6458 1726 SANDS Immunisation Information Line Telephone support for loss (08) 6458 1370 www.beyondblue.org.au elearn.lamaze.org/courses/free- Patient Advocacy Service 1800 671 811 13 000 SANDS (13 000 72637) labor-confidence-with-lamaze Customer Service Unit (08) 6458 1444 Kidsafe Information about depression, (08) 6458 1444 Online classes provide an (08) 6244 4880 WorkCover WA anxiety and other mental health Patient enquiries issues, including mental health engaging and self-paced Day Surgery Unit 1300 794 744 (08) 6458 1869 learning environment, allowing (08) 6458 1459 Lifeline during pregnancy and after birth. Perinatal Loss Service 13 11 14 or suicide helpline parents-to-be and new parents Department of (08) 6458 2128 Page: 3430 1300 651 251 Websites about Cochrane Consumer to virtually interact with Lamaze Psychological Medicine educators and content experts Medicare pregnancy and parenting Network (08) 6458 1521 Perron Rotary Express through all stages of pregnancy, 13 20 11 Milk Bank Austprem www.cochrane.org/consumers preparing for labor or a VBAC, Early Pregnancy (08) 6458 1563 Assessment Service Men’s help line Comprehensive information and breastfeeding, and parenting. www.austprem.org.au (08) 6458 1431 Physiotherapy Department 1300 789 978 review of journal articles on all (08) 6458 2790 By families who have experienced aspects of birth. Maternity Coalition Inc. Emergency Centre Mental Health Emergency the challenge of parenting a (08) 6458 1431 Response Line www.maternitycoalition.org.au Private Patient Liaison Officer premature infant. Includes COPE (Centre of Perinatal (08) 6458 1066 1300 555 788 (metro) or Family Birth Centre 1800 676 822 (rural) information about emergency Excellence) National umbrella organisation committed to the advancement of (08) 6458 1800 Sexual Assault Resource Centre caesarean birth premature babies. www.cope.org.au best-practice maternity care for all (SARC) Medicine Information Service Genetic Services WA (08) 6458 2723 Australian women and their families. (08) 6458 1525 (08) 6458 1828 or 1800 199 888 Australian Breastfeeding Providing support for the emotional (24-hours 7 days a week) Ngala - Early Parenting and Association challenges of becoming a parent. KEMH tours MensLine Australia Early Childhood Services Bookings essential Social Work www.breastfeeding.asn.au (08) 9368 9368 and Hey Dad WA (08) 6458 1368 (08) 6458 2777 www.mensline.org.au (08) 9368 9379 Informative and reputable site run The national telephone support, Interpreters Visiting Midwifery Service by mothers for mothers; women PANDA information and referral service for (08) 6458 8256 (08) 6458 1530 supporting each other with a (Post and Antenatal common interest in breastfeeding. men with family and relationship concerns. The service is available Depression Association) (03) 9428 4600 or 1300 726 306 from anywhere in Australia for the

cost of a local call, 24 hours a day, 7 days a week. 114 115 Pregnancy, Birth and your Baby

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Ngala Statewide Perinatal and Chlamydia – Chlamydia is Forceps – a special instrument Maternal Serum Screening Test Prostin – a prostaglandin (synthetic www.ngala.com.au Infant Mental Health the most common sexually placed around the baby’s head, (MSST) – a blood test used to hormone, oxytocic) gel or pessary Program transmitted infection (STI) in inside the vagina to help guide the identify possible abnormalities in the that is inserted into the vagina to Ngala is a provider of early Australia and can be serious for baby out during delivery. baby. assist induction of labour. parenting and early childhood www.kemh.health.wa.gov.au both men and women. Genetic – inherited, hereditary Nitrous oxide – a gas mixed with Rubella (German measles) – a services with a passion for Information about emotional supporting and guiding families Colostrum – the first milk, which gestation – a term that refers to oxygen used in birth to help with viral disease that can cause major health for parents during can also leak from the nipples the duration (in weeks) of the pain relief. abnormalities in the unborn baby if through the journey of parenting. pregnancy and beyond. during pregnancy. It is what the pregnancy. the mother has the infection in early Obstetrician – a specialist doctor breastfed baby receives in the pregnancy. Group B Streptococcus (GBS) – with extra qualifications and training Post and Antenatal Glossary first few days following birth. It is bacteria that occur naturally in the in pregnancy and birth . Shared care – care shared Depression Association especially important and provides This section explains some of vagina and intestinal tract (anus) in between hospital and community (PANDA) nutrition and protection for the Cervical screen – a vaginal the medical terms used in this about 15 percent of women. This is carers e.g. midwife or doctor. baby against infectious diseases. examination to detect cell www.panda.org.au booklet, in your Pregnancy normal and rarely harmful when a abnormalities in the cervix. Spina bifida – a congenital Record and by your midwife Conception – when the ovum woman is not pregnant. However, in Support and information for abnormality characterised by or doctor. or egg is fertilised by the a very small number of cases Pertussis (Whooping cough) women and their families who a defect in the spinal column. male sperm. (1 in 100) the bacteria can pass – Whooping cough is a highly are affected by postnatal and Amniocentesis – a pregnancy Membranes of the spinal cord to the baby during birth and may infectious disease that can be a antenatal depression, and anxiety. diagnostic test performed to Contraction – a word used to and the spinal cord itself protrude cause an infection that makes the life threatening for babies and determine chromosomal and describe the pains felt during outside the protective bony canal of baby very sick. young child. Raising Children website genetic abnormalities and some labour as the uterus contracts and the spine. birth defects. The test involves relaxes to open up the cervix. Hepatitis B/Hep B – a viral Morphine – a medication given by www.raisingchildren.net.au Toxoplasmosis – an infection a procedure done by a doctor infection of the liver. injection to help with pain. An excellent Australian parenting inserting a needle through the Chorionic Villus Sampling caused by a parasite; can be website with parenting information abdominal and uterine wall into (CVS) – taking a small sample of Hepatitis C – Hepatitis means Phototherapy – treatment of contracted from handling raw meat from newborns to school the to retrieve a the placenta for tests, e.g. Down inflammation of the liver. Hepatitis jaundice in a newborn baby. or cat faeces. syndrome. C is a blood-borne virus. It’s age children. sample of amniotic fluid. Placenta – an organ inside the Ultrasound – a test to view the passed on by blood-to-blood Epidural – an injection of uterus that is attached to the baby internal organs of the baby in the Amniotic fluid – the clear liquid contact, when infected blood enters Relationships Australia anaesthetic into the epidural by the umbilical cord. Its function uterus. It uses sound waves that that surrounds and protects the another person’s bloodstream. It is space of the spinal cord to numb is to exchange blood, oxygen and echo off the body to create a picture www.relationships.com.au baby throughout pregnancy. sometimes called ‘hep C’. the body’s nerves below the waist. nutrients between the mother and of the baby. Anaemia – any condition in which HIV – human immunodeficiency baby. Also called afterbirth when Finding information Episiotomy – an incision of the Umbilical cord – the connection the number of red blood cells is virus, the virus that causes AIDS. it is expelled following the birth on the web perineum (tissue between the between the baby and the placenta. less than normal. The term usually of the baby. vagina and the anus) to enlarge Hypertension – high blood There is a lot of pregnancy applies to the concentration of the Uterus (womb) – a muscular organ the vaginal opening during birth. pressure Placenta praevia – low attachment information on the Internet and oxygen transporting material in in which the baby grows. This is stitched following the birth. of the placenta. Very close to or the quality can vary widely. the blood, which are the red blood Induction of labour – labour covering the cervix. Vacuum extraction – a procedure cells. Fetal heart monitoring (CTG) – brought on using a synthetic Websites often change, some will used to assist the birth of the baby a method of listening to the baby’s version of the hormone (oxytocin) Postnatal – the term used to be modified, new ones will appear Antenatal – the period of time by using gentle suction to the baby’s heartbeat during pregnancy and that starts contractions. describe the six-week period and others will be abandoned. before giving birth. Also called head. Also called ventouse. Consequently, you will need to be birth. Monitoring of the baby immediately following the birth of prenatal. Listeria – an infection usually can be through the abdomen or the baby. selective when using the Internet caused by eating food contaminated to research pregnancy and birth. Braxton Hicks contractions – internally through the vagina. irregular, painless tightening of the with bacteria known as listeria Pre-eclampsia – a condition of uterus during pregnancy. FGM – term used to describe monocytogenes. pregnancy characterised by high Red Nose types of female cutting or blood pressure and protein in Meconium – greenish black sticky rednose.com.au Caesarean section – when the knicking. the urine. baby is delivered by a doctor substance passed as baby’s first Information and support following cutting into the uterus through the Flu Vaccine – An annual bowel motion. Premature – a baby born before the loss of a baby. immunisation, speak to your 37 weeks of gestation. abdomen. Elective caesareans Midwife – a professional who, in doctor or midwife regarding your are planned during pregnancy partnership with women, provides Prenatal – the term used to flu vaccine requirements. while non elective caesareans are care, education and support. The describe the time during the planned during labour. Folate (folic acid) – a vitamin midwife works with women, partners pregnancy before the birth of the Cervix – the entrance of the that can help reduce the risk of and families during prenatal, baby. Also referred to as antenatal. birth defects of the brain and pregnancy, birth, postnatal and womb or narrow lower end of the uterus that opens into the vagina. spinal cord (also called neural early parenting. tube defects). 116 117 Pregnancy, Birth and your Baby

Find out more 9 Are you worried?

Other resources This book has been designed to provide Other resources are available for more women who visit Women and Newborn specific information and these can either be Health Service, with general information seen online via the KEMH website or in the about their pregnancy journey. Women and Newborn Health library or ask your midwife for more information.

Government of Western Australia Government of Western Australia North Metropolitan Health Service North Metropolitan Health Service Women and Newborn Health Service Women and Newborn Health Service

Physiotherapy Your Caesarean after childbirth birth and recovery

Your Caesarean Birth and Physio after Childbirth - 0556 The next nine months - 0107 Recovery - 011

After your Epidural or Birth After Caesarean Next Birth After Postnatal Physiotherapy Spinal Block - 0309 - 0498 Caesarean - 0499 Information for Aboriginal Women - 0623

118 Tell us what you think of this book Thank you Please email [email protected] Thank you to our WNHS Consumer to tell us what you think about this book and Advisory Council for their valuable whether you enjoy having it as part of your pregnancy journey. input into the creation of this book and to our King Edward Memorial Hospital patients who kindly agreed for their photos to be featured.

This document can be made available in alternative formats on request for a person with a disability.

Produced by: Women and Newborn Health Service www.kemh.health.wa.gov.au © June 2017 NMHS0588 Version No. WNHS1190_May 2021

WOMEN AND NEWBORN HEALTH SERVICE King Edward Memorial Hospital 374 Bagot Road Subiaco WA 6008 Telephone: (08) 6458 2222

Disclaimer: The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed.

Copyright information www.health.wa.gov.au/home/disclaimer.cfm Photos for illustration purposes only.

Some of the information and images used in this publication were supplied with kind permission by the Royal Women’s Hospital, Victoria.