The Pregnancy Book

Your complete guide to: A healthy pregnancy Labour and childbirth The first weeks with your new baby The Department of Health would like to thank all those involved in shaping the updated edition of The Pregnancy Book, including the mothers and fathers, medical and health professionals, and the many individuals and organisations. In particular, the Department extends thanks to:

Community Practitioners’ and Health Visitors’ Association Department for Children, Schools and Families Department for Work and Pensions Food Standards Agency NCT National Institute for Health and Clinical Excellence Royal College of Anaesthetists Royal College of General Practitioners Royal College of Midwives Royal College of Obstetricians and Gynaecologists Royal College of Paediatrics and Child Health UK Medicines Information Sheena Byrom, Jill Cooper, Anne Edington, Dr David Elliman, Kathryn Gutteridge, Sue Henry, Dr Judy Shakespeare and Dr Helen Scholeﬁeld.

This book is given free to all expectant mothers.

Every effort has been made to make this book reflect the most up-to-date medical advice at the time of publication. Because developments can be very rapid, significant changes will always be notified to doctors and other health professionals at once. They will then be incorporated into the text for the next reprint. For the most up-to-date information and advice, visit the online version of the book (pregnancy planner) at www.nhs.uk/pregnancyplanner

The information on rights and beneﬁts is correct at the time of going to press but may change and should be checked against the latest information.

Produced by COI for the Department of Health. Design and layout by the Rafferty Consultancy. Cartoons by Alex Hallatt. Medical illustrations by Anne Wadmore and Florence Woolgar.

The photographs have been reproduced with the permission of the following:

Alamy – front cover (bottom left), 1, 2 (bottom), 4 (middle left), 10, 13 (top and bottom), 14 (bottom), 15 (middle left and bottom right), 17 (top), 18, 23, 40 (top and bottom), 47, 49 (middle left), 51, 55 (bottom left), 58, 60 (bottom), 66 (top), 67 (bottom), 68 (top), 69, 72 (top left and bottom), 75 (top), 76 (middle and bottom), 78 (bottom), 89 (middle), 90 (top and middle), 94 (bottom), 95 (bottom), 99 (bottom), 101 (top and bottom middle), 107 (top), 110 (bottom left), 118 (top), 121 (middle right), 129, 134 (bottom), 137 (bottom), 142 (bottom middle), 144 (middle), 145 (top), 155, 156 (top), 161, 162 (top); Banana Stock – 146 (bottom); Bubbles Photo Library – 89 (top); Corbis – front cover (middle), 93 (bottom right), 147 (middle); Department of Health – 2 (top), 4 (bottom left), 15 (bottom), 28 (top right), 29 (bottom), 35, 36, 40 (middle left and right), 42 (top), 44 (top and bottom middle), 45 (middle), 46, 48 (bottom right), 52, 54, 56 (top), 60 (middle), 67 (top), 68 (bottom right), 70 (bottom), 71 (middle), 73, 74, 77, 78 (middle), 79 (top), 81 (bottom), 86 (middle), 87 (top), 88 (top), 91 (top), 92 (top and middle right), 94 (middle left), 96 (top), 97, 99 (top), 102 (top), 103 (top middle and bottom), 104, 106 (top), 109 (bottom left), 110 (top right), 111 (top and middle), 114 (top middle and bottom), 115, 116 (top), 120 (middle and bottom), 121 (bottom), 126 (middle right), 127 (bottom), 128 (top left), 130, 131, 134 (top right), 136, 141 (bottom right), 142 (middle right), 152 (top), 156 (bottom middle), 158 (top), 172 (bottom), 176, 177; Digital Vision – 33, 113; Dreamstime – 5 (top), 66 (bottom); East Essex Hospital – 72 (top right); The Food Standards Agency – 25 (middle); Getty Images – front cover (top left), 15 (top middle), 16 (top right), 17 (middle left), 44 (middle), 48 (top), 61 (top), 68 (bottom left), 71 (top), 83, 91 (bottom middle), 94 (top), 98 (top), 101 (bottom right), 102 (middle), 122, 124, 127 (top), 137 (top), 141 (bottom middle), 147 (bottom), 148 (top); Harlow Printing – 123; Image Dictionary – 160 (middle); Image Source – 3, 13 (middle right), 92 (middle); Ingram Publishing – 27, 28 (top middle), 29 (top), 38 (top), 111 (top left and bottom), 139 (middle left); Istock Photo – front cover (top right), 4 (top right and bottom right), 5 (middle right and left, bottom), 6, 7, 8, 9, 13 (middle left), 14 (middle left), 16 (top left), 17 (middle right), 24, 25 (bottom), 29 (middle left), 34, 37, 38 (bottom), 42 (middle), 43, 44 (middle left), 45 (bottom), 48 (bottom left), 49 (middle), 56 (bottom), 57, 59, 60 (top), 61 (middle and bottom), 62, 63 (top and bottom), 64, 65, 70 (top), 75 (bottom), 76 (top), 79 (middle and bottom), 81 (top), 82, 84, 85, 86 (top and bottom), 87 (bottom), 88 (middle and bottom), 90 (bottom), 91 (middle right and bottom left), 93 (top and middle left), 96 (middle and bottom), 98 (middle and bottom), 99 (middle left), 100, 103 (top right), 105 (middle), 106 (bottom), 107 (bottom right), 108, 109 (top), 114 (top left), 116 (bottom), 118 (bottom), 119, 120 (top), 121 (top), 126 (top), 128 (top right), 132, 133, 134 (top left), 135, 138, 139 (top and middle right), 140, 143, 144 (top and bottom), 146 (top and middle), 147 (top), 148 (bottom), 149, 150, 151, 152 (bottom), 154, 156 (bottom right), 157, 158 (bottom), 159, 160 (top), 162 (middle), 163, 166, 167, 170, 171, 172 (top), 173, 174, 175; Italia Stock – 44 (bottom left); Jupiter Images – 128 (bottom); Masterﬁle – 16 (bottom); The Meningitis Trust – 145 (bottom); Photo Library – 32; Q Box – GU – 30–31; Science Photo Library – 19, 20, 21; Shutterstock – front cover (bottom right), 125; Superstock Images – 41 (bottom right), 63 (middle), 101 (middle left); Unicef – 95 (top), 105 (bottom) The Pregnancy Book

Your complete guide to: A healthy pregnancy Labour and childbirth The first weeks with your new baby your complete guide pregnancy

INTRODUCTION 4 Work hazards ...... 39 Flying and travel ...... 39 YOUR PREGNANCY 5 AT A GLANCE 4 ANTENATAL CARE 40 Antenatal appointments ...... 41 1 BECOMING PREGNANT 10 Early antenatal appointments ...... 44 Male sex organs ...... 10 Regular checks at every antenatal Female sex organs ...... 11 appointment ...... 45 The female monthly cycle ...... 12 Appointments in later pregnancy .... 46 Conception ...... 12 Blood tests ...... 46 Hormones ...... 13 Ultrasound scans ...... 48 Boy or girl? ...... 13 Tests to detect abnormalities ...... 49 The best time to get pregnant ...... 14 Tests for Down’s syndrome Twins, triplets or more ...... 14 and other genetic disorders ...... 50 The signs of pregnancy ...... 15 Diagnostic tests for Down’s syndrome and other genetic disorders ...... 51 Pregnancy tests ...... 15 If a test detects an abnormality ...... 51 Finding out that you are pregnant .. 16 Making the most of antenatal care .. 52 Accessing antenatal care ...... 16 Your antenatal team ...... 54 Help for young mums ...... 17 Antenatal education ...... 56 2 HOW YOUR BABY 18 DEVELOPS 5 CONDITIONS AND 58 PROBLEMS IN PREGNANCY Measuring your pregnancy ...... 18 Common minor problems ...... 58 Week 3 ...... 19 More serious problems ...... 67 Weeks 4–5 ...... 19 Weeks 6–7 ...... 19 6 CHOOSING WHERE 70 Weeks 8–9 ...... 19 TO HAVE YOUR BABY Weeks 10–14 ...... 20 Safety ...... 70 Weeks 15–22 ...... 21 Making an informed decision ...... 70 Weeks 23–30 ...... 22 Home births ...... 71 Weeks 31–40 ...... 23 Midwifery units or birth centres ...... 72 Birth in hospital ...... 73 3 YOUR HEALTH 24 IN PREGNANCY Birth plans ...... 74

What should you eat? ...... 24 7 FEELINGS AND 75 Foods to avoid ...... 26 RELATIONSHIPS Preparing food ...... 26 Feelings ...... 75 Vitamins and minerals ...... 27 Depression and mental health Vegetarian, vegan and special diets .. 28 problems ...... 76 Smoking ...... 30 Worrying about the birth ...... 77 Alcohol ...... 32 Concerns about disabilities ...... 77 Pills, medicines and other drugs ...... 33 Couples ...... 78 Illegal drugs ...... 33 Sex in pregnancy ...... 78 X-rays ...... 34 Single parents ...... 79 Keeping active ...... 34 Family and friends ...... 80 Infections ...... 36 Work ...... 80 Inherited conditions ...... 38 After the birth ...... 81 Mood changes that can develop THE EARLY WEEKS: 137 13 after the birth of a baby ...... 81 YOUR BABY Domestic abuse ...... 83 Enjoying your baby ...... 137 Bereavement ...... 84 Registering the birth ...... 138 8 LABOUR AND BIRTH 85 Crying ...... 138 Sleep ...... 140

Getting ready ...... 85 CONTENTS 142 The signs of labour ...... 87 Changing your baby ...... 144 Types of pain relief ...... 88 Washing and bathing ...... When to go to hospital Illness ...... 145 or your midwifery unit ...... 90 Getting support ...... 146 Arriving at the hospital or 14 BABIES WHO NEED 147 midwifery unit ...... 91 ADDITIONAL CARE What happens in labour ...... 92 Why babies need additional care ...... 147 Special cases ...... 96 Contact with your baby ...... 148 Twins, triplets or more ...... 100 Feeding ...... 148 What your birth partner can do ...... 101 Incubators ...... 148 9 FEEDING YOUR BABY 102 Newborn babies with jaundice ...... 149 Breastfeeding ...... 103 Babies with disabilities ...... 149 Formula feeding ...... 115 15 THE LOSS OF YOUR BABY 150 10 THE FIRST DAYS WITH 120 Ectopic pregnancy ...... 151 YOUR BABY Miscarriage ...... 151 How you feel ...... 120 Abnormal test results ...... 152 Postnatal care ...... 121 Stillbirth and neonatal death ...... 153 Stitches ...... 122 THINKING ABOUT THE 154 Bleeding ...... 122 16 NEXT BABY? Sex and contraception ...... 122 It takes two ...... 154 Your body ...... 123 Folic acid ...... 154 Your baby’s health ...... 124 Things to consider ...... 155 Your baby’s appearance ...... 124 Work-related risks ...... 155 What your newborn baby can do .... 126 17 RIGHTS AND BENEFITS 156 11 WHAT YOU NEED FOR 127 YOUR BABY Benefits for everyone ...... 157 Nappies ...... 127 Tax credits ...... 158 Bathing ...... 128 Benefits if your income is low ...... 159 Sleeping ...... 129 Maternity benefits ...... 163 Out and about ...... 130 If you are unemployed ...... 166 In the car ...... 130 Maternity leave ...... 167 Feeding ...... 131 Rights during maternity leave ...... 168 Clothes ...... 131 Returning to work ...... 169 Other employment rights ...... 170 12 THE EARLY WEEKS: YOU 132 Other types of leave ...... 171 Partners ...... 132 Your rights under sex Help and support ...... 133 discrimination law ...... 174 Looking after yourself ...... 133 The NHS Constitution 176 Your relationships ...... 134 Glossary of useful terms 178 The ‘baby blues’ and postnatal depression ...... 136 Useful organisations 182 Your postnatal check ...... 136 Index 189 introduction

ﬁnd everything you need to know in this book

Having a baby is one of the most exciting things that can happen to you. But you might be feeling nervous as well. If it’s your ﬁrst baby, it’s hard to know what to expect.

Your mum, colleagues, friends and relations might all be giving you advice. And then there is all the information on the internet as well as in magazines and books. At times it can feel overwhelming and it’s hard to know who is right when people say different things.

This book brings together everything you need to know to have a healthy and happy pregnancy, and to make sure you get the care that is right for you. The guidance about pregnancy and babies does change. The information in So it’s important to get this book is also available online from the NHS up-to-date, trusted advice interactive pregnancy so that you can make planner, which is the right decisions available at www.nhs.uk/ and choices. pregnancyplanner You can download an If you have any interactive widget at www.nhs.uk/ questions or concerns pregnancywidget – no matter how trivial that delivers weekly they may seem – talk to information and your midwife or doctor. tips tailored to They are there to you and your pregnancy. support you.

4 YOUR PREGNANCY introduction AT A GLANCE

Before you get pregnant 5 28 weeks 8 0–8 weeks 6 31 weeks 8 8 –12 weeks 6 34 weeks 8 ﬁnd everything you 12–16 weeks 7 36 weeks 9 16–20 weeks 7 38 weeks 9 need to know in this book 20 –25 weeks 7 40 weeks 9 25 weeks 7 41 weeks 9

BEFORE YOU – You should avoid drinking • Take 400 micrograms of folic GET PREGNANT alcohol if you are pregnant or acid a day. You should continue trying to conceive. If you do to take this until you are 12 choose to drink, then protect weeks pregnant (see page 27). your baby by drinking no more than one to two units of alcohol once or twice a week and don’t get drunk (see page 32). – Take exercise. • If you or your partner take any medication, talk to your doctor about whether it will • If you have a health condition, affect your pregnancy. for example mental health problems, diabetes or a family history of any inherited diseases, • Think about the lifestyle factors talk to your GP that might affect your ability to or a specialist get pregnant and have a healthy before you try pregnancy (see Chapter 3). This to get pregnant. applies to men too. You are more likely to get pregnant if you are • Talk to your both in good health. GP or a healthcare – If you smoke, get advice professional about stopping. You can if you have talk to your doctor, visit any concerns www.nhs.uk/smokefree or or need call the free NHS smoking support. helpline on 0800 022 4 332. – Eat a balanced diet. – Maintain a healthy weight.

5 0–8 WEEKS 8–12 WEEKS

• You can take a pregnancy • You will usually attend your • You will usually be offered • Make a dental appointment. test from the first day that first appointment by 10 an ultrasound scan between NHS dental care is free you miss your period (see weeks and your booking eight and 14 weeks. This during pregnancy and for Finding out that you are appointment by 12 weeks. will check the baby’s a year after the birth of pregnant on page 16). measurements and give your baby. • At the booking appointment, an accurate due date. • As soon as you know you your weight, height and • Just 12 weeks after The scan can also detect are pregnant, get in touch body mass index will be conception, your baby is abnormalities and check with a midwife or your GP measured. You will be fully formed. It has all its if you are carrying more to organise your antenatal asked about your health organs, muscles, limbs and than one baby. Your partner care (see Finding out that and family history as well as bones, and its sex organs can come along to the you are pregnant on page about your baby’s father’s are well developed. scan (see Antenatal care 16 and Antenatal care on family history. This is to on page 40). • Your baby is already moving page 40). Begin to think find out if you are at risk of about but you cannot feel about where you want certain inherited conditions. • If you get Income Support, the movements yet. your baby to be born (see income-based Jobseeker’s • Your hand-held notes and Choosing where to have Allowance or income- plan of care will be completed. your baby on page 70). related Employment and • Your midwife will discuss Support Allowance or • Some pregnant women various tests you will are on a low income and start to feel sick or tired or be offered during your receive Child Tax Credit, you have other minor physical pregnancy, one of which should complete a Healthy problems for a few weeks is an ultrasound scan to Start application form (see (see Common minor check for abnormalities page 28). This is to claim problems on page 58). in your baby (see page vouchers to spend on milk, • Take 10 micrograms of 48). You will be offered fruit and vegetables. Healthy vitamin D per day, which information about what to Start vitamin supplements is in Healthy Start vitamin expect during pregnancy (containing vitamin D) are supplements or other and how to have a healthy free without prescription for supplements recommended pregnancy. Ask if you are any pregnant woman, new by your midwife. You unsure about anything. mother or child who gets should continue to take Healthy Start vouchers • You can ask your midwife vitamin D throughout your (see Rights and benefits about your rights at work pregnancy and while you on page 156). and the benefits available are breastfeeding. (see Rights and benefits on page 156). growing anddeveloping >> >>

6 12–16 WEEKS 16–20 WEEKS 20–25 WEEKS 25 WEEKS (if this is your ﬁrst baby)

• Find out about antenatal • You may start to feel • Your uterus will begin to • Your baby is now moving YOUR PREGNANCY AT A GLANCE education (see Antenatal your baby move (see get bigger more quickly and around vigorously and care on page 40). How your baby develops you will really begin to look responds to touch and on page 18). pregnant. sound. • Start to think about how you want to feed your baby • Your tummy will begin to • You may feel hungrier than • If this is your first baby, (see Feeding your baby get bigger and you will before. Stick to a sensible your midwife or doctor on page 102). need looser clothes. balanced diet (see Your should: health in pregnancy on • Make sure you are wearing • You may feel a surge of – check the size of page 24). a supportive bra. Your energy. your uterus breasts will probably – measure your blood • Try to do your pregnancy increase in size during pressure and test exercises regularly (see pregnancy so you need to your urine for protein. Your health in pregnancy make sure you are wearing on page 24). • If you are taking maternity the right sized bra. leave, inform your employer • Your midwife or doctor • If you have been feeling sick in writing 15 weeks before should: and tired, you will probably the week your baby is due. start to feel better around – review, discuss and You can claim for Statutory this time. Maternity Pay (SMP) record the results of any • Ask your midwife about screening tests and the Health in Pregnancy • At 14 weeks, your baby‘s antenatal education (see – measure your blood Grant at the same heartbeat is strong and Antenatal education on pressure and test your time (see Rights and can be heard using an page 56). urine for protein benefits on page 156). ultrasound detector. – consider an iron • You will begin to feel your • If you are entitled to • Your pregnancy may just supplement if you baby move. Maternity Allowance, you be beginning to show. are anaemic. • Get your maternity can claim from when you This varies a lot from • Your midwife or doctor certificate (form MAT are 26 weeks pregnant woman to woman. should give you information B1) from your doctor or (see Rights and benefits about the anomaly scan midwife (see Rights and on page 156). you will be offered at benefits on page 156). • If your partner plans to 18–20 weeks and answer take paternity leave, any questions you have. they will need to inform • Your baby is now growing their employer. quickly. Their face becomes much more defined and their hair, eyebrows and eyelashes are beginning to grow.

• Ask your doctor or developing midwife to let you hear your baby’s heartbeat. >>

7 28 WEEKS 31 WEEKS 34 WEEKS (if this is your ﬁrst baby)

• Your baby will be perfectly • Think about what you • If this is your first baby, your • Your midwife or formed by now, but still need for the baby (see midwife or doctor should: doctor will give you quite small. What you need for your information about – review, discuss and baby on page 127). preparing for labour and • You may find that you are record the results of any birth, including how to getting more tired. • If you have young children, screening tests from the recognise active labour, it’s good to talk to them last appointment • Your midwife or doctor ways of coping with pain about the new baby. – measure the size of your should: in labour and developing uterus and check which • Make sure your shoes are your birth plan. They – use a tape to measure way up the baby is comfortable. If you get should also: the size of your uterus – measure your blood tired, try to rest with your – measure your blood pressure and test your – review, discuss and record feet up. pressure and test your urine for protein. the results of any urine for protein screening tests from the – offer more blood last appointment screening tests – measure the size of – offer your first anti-D your uterus treatment if your blood – measure your blood type is rhesus negative. pressure and test your urine for protein • If you are claiming Statutory – offer your second anti-D Maternity Pay (SMP), you treatment if your blood must inform your employer type is rhesus negative at least 28 days before you (see page 46). stop work (see Rights and benefits on page 156). excitement and • Make arrangements for the birth. You can • You can claim a lump sum give birth at home, in Sure Start Maternity Grant apprehension a midwifery unit or in to help buy things for your hospital. If you have new baby if you get one of children already, you may the following: want to make childcare – Income Support arrangements for when – income-based Jobseeker’s you go into labour. Allowance • You may want to ask about – income-related whether tours of maternity Employment and Support facilities for birth are Allowance available. – Pension Credit – Working Tax Credit where the disability or severe disability element is included in the award – Child Tax Credit payable at a rate higher than the family element (see Rights and benefits on page 156). >> >>

8 36 WEEKS 38 WEEKS 41 WEEKS

• Think about who you • Make sure you have all • Most women will go into • If your pregnancy lasts YOUR PREGNANCY AT A GLANCE would like to have with your important telephone labour spontaneously longer than 41 weeks, you during labour. numbers handy in case between 38 and 42 weeks. you may be induced. labour starts (see Labour Your midwife or doctor Your midwife or doctor • Get your bag ready if and birth on page 85). should give you information will explain what this you are planning to give about your options if your means and what the birth in hospital or in a • Your midwife or doctor pregnancy lasts longer than risks are. midwifery unit. should give you information 41 weeks. about: • Your midwife or doctor • You will probably be • Your midwife or doctor should: attending antenatal – feeding your baby should: classes now (see – caring for your – measure the size of Antenatal care on newborn baby – measure the size of your uterus page 40). – vitamin K and screening your uterus – measure your blood tests for your pressure and test your • You may be more aware – measure your blood newborn baby urine for protein of your uterus tightening pressure and test your – the ‘baby blues’ and – offer a membrane sweep from time to time. These urine for protein. postnatal depression. (see page 96). are mild contractions • Call your hospital or known as Braxton Hicks • Your midwife or doctor midwife at any time if • Discuss options and choices contractions (see Labour should: you have any worries for induction of labour. and birth on page 85). – measure the size of about your baby or about • Call your hospital or • You may feel quite tired. your uterus labour and birth. midwife if you have any Make sure you get plenty – check the position of worries about your baby of rest. your baby or about labour and birth. – measure your blood • See www.nice.org.uk/ pressure and test your 40 WEEKS Guidance/CG70 urine for protein. (if this is your ﬁrst baby) for guidelines on induction • Sleeping may be • Your midwife or doctor of labour. increasingly difﬁcult. should give you more information about what happens if your pregnancy lasts longer than 41 weeks.

• Your midwife or doctor should:

– measure the size of your uterus – measure your blood pressure and test your urine for protein.

9 BECOMING PREGNANT

Male sex organs 10 Twins, triplets or more 14 Female sex organs 11 The signs of pregnancy 15 The female monthly cycle 12 Pregnancy tests 15 Conception 12 Finding out that you are pregnant 16 Hormones 13 Accessing antenatal care 16 Boy or girl? 13 Help for young mums 17 The best time to get pregnant 14

This chapter describes the physical process of getting pregnant and includes information about the male and female sex organs, the female monthly cycle and when you are most likely to conceive. It also explains what you should do when you ﬁnd out you are pregnant and how you might feel when you ﬁrst conceive.

MALE SEX ORGANS E L AM 1 1 Bladder 2 2 Vas deferens The two tubes called the vas deferens carry sperm from the testes (testicles), where sperm are made, to the prostate and other glands. These glands add secretions that are ejaculated along with the sperm. 5 3 Urethra The urethra is a tube running down the length 3 of the penis from the bladder, through the prostate gland, to an opening at the tip of the penis. Sperm travel down the urethra to be ejaculated.

4 Penis The penis is made of erectile tissue, which acts like 4 6 7 a sponge. When it becomes ﬁlled with blood, the penis becomes hard and erect.

5 Prostate gland This is a gland at the base of the penis.

6 Scrotum The testes are contained in a bag of skin called the scrotum, which hangs outside the body. The scrotum helps to keep the testes at a constant temperature, just below body temperature. This is necessary for sperm to be produced. When it is warm, the scrotum hangs down parts of away from the body to keep the testes cool. When it is cold, the scrotum draws up closer to the body for warmth.

7 Testes Men have two testes, which are glands where the sperm are made and stored. body 10 FEMALE 1 4 7 2 4 1 6 5 3 2 3 7 6 4 2 6 5 10 8 5 3 9 1 FEMALE SEXORGANS 1 1 4 5 4 3 2 3 2 1 6 5 4 3 2 Vulva Urethra Clitoris Hood ofclitoris Cervix Bladder Womb oruterus Ovary Fallopian tube or around ababyduring labour. can easilystretch around aman’s penisduringsex between the legs. Thevaginaisveryelastic, soit from thecervixdowntovulva,where itopens which isatubeabout8cm (3inches)long.Itleads Vagina Most babies are through born thevagina, let thebabymovefrom theuterusintovagina. periods. Duringlabour, thecervixwilldilateto through whichbloodpassesduringmonthly normally almostclosed,withjustasmallopening Cervix Thecervixistheneckofuterus.It size ofawalnut.Theyproduce theeggsorova. Ovaries There are twoovaries,eachaboutthe This iswhere fertilisationtakesplace. the ovariesintofallopiantubeseachmonth. the ovariestouterus.Eggsare released from Fallopian tubesThefallopianleadfrom of muscleandincreases in size asthebabygrows. and shapeofasmall,upsidedownpear. Itismade Womb oruterus baby willpassthrough when itisborn. pelvisisthebonystructure thatthe The Pelvis The uterus is about the size Theuterusisaboutthesize 10 7 6 5 9 8 7 6 Anus Perineum Opening ofvagina Perineum Anus Rectum Urethra Vagina

1 11 PREGNANT BECOMING The female monthly cycle

1 B 2 3 A E

C F

A Egg being released E Egg progressing down the F Uterus lining being shed B Fallopian tube fallopian tube C Vagina D Ovary Ovulation occurs each month when The egg begins to travel down If the egg is not fertilised, it will pass an egg (ovum) is released from the fallopian tube. If a man and out of the body during the woman’s one of the ovaries. Occasionally, woman have recently had sex, the monthly period along with the lining more than one egg is released, egg might be fertilised here by of the uterus, which is also shed. usually within 24 hours of the ﬁrst the man’s sperm. The lining of the The egg is so small that it cannot egg. The ‘ﬁngers’ at the end of the uterus is now thick enough for be seen. fallopian tubes help to direct the egg the fertilised egg to be implanted. down into the tube. At the same time, the lining of the uterus begins to thicken and the mucus in the cervix becomes thinner so that sperm can swim through it more easily.

Conception Conception is the process that begins with the fertilisation of an egg and ends with the implantation of an egg into a woman’s uterus.

1 A 2 D 3 F

B E C

A Egg D Egg being fertilised F Attached embryo B Sperm being ejaculated E Sperm C Penis Ovulation Fertilisation Implantation A woman conceives around the During sex, sperm are ejaculated from During the week after fertilisation, time when she is ovulating; that a man’s penis into a woman’s vagina. the fertilised egg (which is now an is, when an egg has been released In one ejaculation there may be more embryo) moves slowly down the from one of her ovaries into one than 300 million sperm. Most of the fallopian tube and into the uterus. of her fallopian tubes. sperm leak out of the vagina but It is already growing. The embryo some begin to swim up through the attaches itself ﬁrmly to the specially cervix. When a woman is ovulating, thickened uterus lining. This is called the mucus in the cervix is thinner implantation. Hormones released than usual to let sperm pass through by the embryonic tissue prevent the more easily. Sperm swim into the uterus lining from being shed. This uterus and into the fallopian tubes. is why women miss their periods Fertilisation takes place if a sperm when they are pregnant. joins with an egg and fertilises it. 12 Sperm is about 1/25th of a millimetre long and has a head, neck and tail. 1 The tail moves from side to side so that the sperm can swim up the vagina into the uterus and fallopian tubes. BECOMING PREGNANT One egg or ovum (occasionally two or more) is released from the woman’s ovaries every month. It moves down into the fallopian tube where it may be fertilised by a man’s sperm.

HORMONES Both men and women have hormones, which are chemicals that circulate in the bloodstream. They carry messages to different parts of the body and result in certain changes taking place. Female hormones, which include oestrogen and progesterone, control many of the events of a woman’s monthly cycle, such as the release of eggs from her ovaries and the thickening of her uterus lining. During pregnancy, your hormone levels change. As soon as you have conceived, the amount of oestrogen and progesterone in your blood increases. This causes the BOY OR GIRL? the mother’s egg is always the same uterus lining to build up, the blood and is known as the X chromosome. supply to your uterus and breasts Every normal human cell contains But the sex chromosome from to increase and the muscles of your 46 chromosomes, except for male the father’s sperm can be an X or uterus to relax to make room for sperm and female eggs. These a Y chromosome. the growing baby. contain 23 chromosomes each. If the egg is fertilised by a sperm When a sperm fertilises an egg, the containing an X chromosome, 23 chromosomes from the father the baby will be a girl (XX). If the pair with the 23 from the mother, sperm contains a Y chromosome, making 46 in all. the baby will be a boy (XY). Chromosomes are tiny, thread-like structures which each carry about 2,000 genes. Genes determine a baby’s inherited characteristics, such as The increase in hormone levels hair and eye colour, can affect how you feel. You may blood group, height have mood swings, feel tearful or and build. A fertilised be easily irritated. For a while you egg contains one sex may feel that you cannot control chromosome from your emotions, but these symptoms its mother and one should ease after the ﬁrst three from its father. The months of your pregnancy. sex chromosome from

13 This chart shows a 28-day cycle. Yours may be longer or shorter.

Ovulation Most women ovulate between 12 and 14 days before their next period. DAYS

27 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

First day of last period You are most likely to conceive if you have intercourse about this time.

TWINS, TRIPLETS • you seem bigger than you should OR MORE be for your ‘dates’ • twins run in your family, or Identical twins occur when one • you have had fertility treatment. fertilised egg splits into two; each baby will have the same genes It is usually possible to find out – and therefore they will be the through your dating ultrasound same sex and look very alike. scan, which happens between eight Non-identical twins are more and 14 weeks (see page 48). common. They are the result of You should be told at this point THE BEST TIME TO two eggs being fertilised by two whether the babies share a placenta GET PREGNANT sperm at the same time. The babies (are identical) or if they have two may be of the same sex or different separate placentas, in which case You are most likely to get pregnant sexes, and will probably look no they can be either identical or if you have sex within a day or so of more alike than any other brothers non-identical. If this cannot be ovulation (see chart). This is usually and sisters. A third of all twins determined, you should be offered about 14 days after the first day of will be identical and two-thirds a further scan. A third of identical your last period. non-identical. twins have two separate placentas. This happens when the fertilised An egg lives for about 12–24 hours Twins happen in about 1 in every egg splits in the first 3–4 days after after it is released. For you to get 65 pregnancies. A couple is more conception and before it implants pregnant, the egg must be fertilised likely to have twins if there are in the uterus. by a sperm within this time. Sperm twins in the woman’s family. can live for up to seven days inside Triplets occur naturally in 1 in a woman’s body. So if you have 10,000 pregnancies and quads had sex in the seven days before are even rarer. Nowadays, the use ovulation, the sperm will have of drugs in the treatment of had time to travel up the fallopian infertility has made multiple tubes to ‘wait’ for the egg to births more common. be released. Are you carrying twins? You might suspect that you are carrying more than one baby if: • you are very sick in early pregnancy

14 What is different about PREGNANCY TESTS being pregnant with 1 twins or more? Pregnancy tests can be carried out on a sample of urine from the All multiple pregnancies have first day of a missed period, which a higher risk of complications BECOMING PREGNANT THE SIGNS OF means that, if you are pregnant, – particularly premature birth. you are about two weeks after If your babies share a placenta PREGNANCY conception. Some very sensitive (identical twins) it is recommended For women who have a regular tests can be used even before you that you are scanned every two monthly cycle, the earliest and miss a period. weeks from 16 weeks onwards, most reliable sign of pregnancy You can collect urine at any time and every four weeks if your babies is a missed period. Sometimes of the day. Use a clean, soap-free, have separate placentas. You may women who are pregnant have a well-rinsed container to collect it. be advised to have a caesarean very light period, losing only a little You can get pregnancy tests free section. You should discuss this blood. Other signs of pregnancy of charge from your GP or family with your doctor, but it is your are as follows: choice. It is possible to breastfeed planning clinic. Pregnancy tests are twins and triplets and there is more • Feeling sick – you may feel sick, also available at NHS walk-in centres. information about how you can do or even be sick. This is commonly Many pharmacists and most this in Chapter 9. You may find that known as ‘morning sickness’ but pregnancy advisory services also a combination of breast and formula it can happen at any time of the offer tests, usually for a small feeding is best for you – particularly day. If you are being sick all the fee. You can buy do-it-yourself if you have triplets or more. time and cannot keep anything pregnancy testing kits from down, contact your GP. pharmacists. They can give you Help and support • Changes in your breasts – your a quick result and you can do breasts may become larger and the test in private. There are a feel tender, like they might do range of tests that are available. before your period. They may also How they work varies, so check tingle. The veins may show up the instructions. more and the nipples may darken and stand out. Results of the test • Needing to pass urine more A positive test result is almost often – you may find that you certainly correct. A negative result is have to get up in the night. less reliable. If you still think you are pregnant, wait a week and try again • Being constipated. or go and see a midwife or GP. • An increased vaginal discharge without any soreness or irritation. • Feeling tired. •Having a strange taste in your You might find it helpful to mouth – many women describe contact support groups like it as metallic. Tamba (Twins and Multiple •‘Going off’ certain things, for Births Association) and the example tea, coffee, tobacco Multiple Births Foundation smoke or fatty food. (see pages 188 and 183) before your babies are born.

See your midwife or doctor as soon as possible if you are currently being treated for a long-term disease such as diabetes or epilepsy, or you have serious mental health problems.

15 or family planning clinic, who will try to help you to adjust or will give you advice if you don’t want to continue with your pregnancy. FINDING OUT Men may also have mixed feelings ACCESSING when they find out that their THAT YOU ARE partner is pregnant. They may ANTENATAL CARE find it hard to talk about these PREGNANT When you find out that you feelings because they don’t want are pregnant, it’s important to When you find out that you are to upset their partner. Both partners contact an NHS professional pregnant, you may feel happy and should encourage each other to as soon as possible. excited or even shocked, confused talk about their feelings and any and upset. Everybody is different worries or concerns that they have You can book an appointment and you should not worry if you are at this stage. directly with a midwife. Your GP not feeling as happy as you might surgery will be able to put you However you are feeling, you have expected. Even if you have in touch with your nearest should contact an NHS professional been trying to get pregnant, your midwife service. feelings may take you by surprise. (see Chapter 4) so that you can start Some of these feelings may be to receive antenatal care. This is the If you have special health needs, caused by changes in your care that you will receive leading up your midwife, GP or other doctors hormone levels, which can to the birth of your baby. may take shared responsibility for your maternity care. make you feel more emotional. Telling people Your first or second meeting Even if you feel anxious and You may want to tell your family with your midwife is the booking uncertain now, your feelings may and friends immediately or wait appointment. This will last for up to change. Talk to your midwife, GP a while until you have sorted out two hours and could take place at how you feel. Many women wait a hospital, in a clinic or a Children’s until they have had their first scan Centre, in a GP surgery or at home. before they tell people that they Your midwife will ask you many are pregnant. questions about your health, the Members of your family/extended health of your family and your family may have mixed feelings or preferences in order to develop your react in unexpected ways to your own plan of care. Your midwife news. You may wish to discuss this will order a number of blood tests with your midwife. and scans, which will be done throughout your pregnancy. The results of these tests may affect your choices later in pregnancy, so it’s important not to miss them. Your midwife will also ask about any other help or social care support you may have or need – for example support from social workers or family liaison officers. For more information about the booking appointment, see your pages 42 and 44–45. feelings

16 HELP FOR can offer you support. Sorting out problems, whether personal or 1 YOUNG MUMS medical, is often difﬁcult when you If you are a young mum, there are are by yourself, and it is better to ﬁnd someone to talk to rather than a wide range of services to support Education Maintenance Allowance BECOMING PREGNANT you when you are pregnant and let things get you down. For more (EMA), which is available for young after you have had your baby. Your information on coping on your own, people between 16 and 18. midwife or health visitor will be able see page 79. EMA provides up to £30 a week. to give you details of local services. Carrying on with For more information about your education EMA and Care to Learn, phone 0800 121 8989 or visit http:// Becoming a mother certainly does moneytolearn.direct.gov.uk not have to mean the end of your education. If you are still of compulsory school age, your school should not exclude you Somewhere on grounds of pregnancy or health to live and safety issues connected with Many young mothers your pregnancy. However, they may want to carry on living talk to you about making alternative with their own family until they arrangements for your education. are ready to move on. If you are You will be allowed up to 18 unable to live with your family, calendar weeks off school before your local authority may be and after the birth. able to help you with housing. After your return to education, you Some local authorities provide If you are on your own can get help with childcare costs specialised accommodation where young mothers can live If you are pregnant and on your through the Care to Learn scheme. independently while getting own, it is even more important that Care to Learn also provides support support and advice from trained there are people with whom you with childcare costs for teenage workers. For more information can share your feelings and who parents above the compulsory schooling age who want to study. about housing, contact your You may also be eligible for the local authority. Help and support

The following national Connexions The young woman’s organisations can also give Teenagers in England can get help guide to pregnancy you help and advice: and advice from the Connexions The young woman’s guide to Sexwise helpline service. You have the offer of pregnancy is written specifically support from a personal adviser to for women under the age of 20 If you think you may be pregnant, help deal with a variety of issues so and includes the real pregnancy you can get confidential advice that you can make the best choices experiences of young mums. from the Sexwise helpline on for your future. You can find It is produced by Tommy’s and is 0800 282930 or get further Connexions advisers in a variety of available free to teenagers from information from places, including schools, colleges the Tommy’s website at www.ruthinking.co.uk and one-stop shops and through www.tommys.org/publications Brook centres youth and community projects. For information on sex and If you are under 25, you can visit a For confidential personal advice, contraception, see page 122. Brook centre for free, confidential practical help or details of your advice. To find your nearest centre, local Connexions service, phone go to www.brook.org.uk or call Connexions Direct, on 080 800 the national Ask Brook helpline on 13219, text 07766 4 13219 or go 0808 802 1234. to www.connexions-direct.com

17 HOW YOUR BABY DEVELOPS

Measuring your pregnancy 18 Weeks 15–22 21 Week 3 19 Weeks 23–30 22 Weeks 4–5 19 Weeks 31–40 23 Weeks 6–7 19 Weeks 8–9 19 Weeks 10–14 20

This chapter describes how your baby develops from the day you conceive until you give birth.

Week 3 MEASURING YOUR PREGNANCY

1 Ovary Doctors and midwives in the UK If you are not sure about the date measure the duration of pregnancy of your last period, then your early 2 Egg is released from from the ﬁrst day of your last scan (see page 48) will give a the ovary menstrual period, not from the good indication of when your day you conceive. So when you baby will be due. 3 Egg is fertilised are ‘four weeks pregnant’, it is In the very early weeks, the actually about two weeks after developing baby is called an 4 Fertilised egg divides you conceived. Pregnancy normally embryo. From about eight weeks, and travels down lasts for 37–42 weeks from the it is called a fetus. fallopian tube ﬁrst day of your last period. The average is 40 weeks. 5 Embryo implants itself in uterus lining

1 5

18 WEEK 3 Already your baby’s nervous system is starting to develop. A groove 2 This is three weeks from the ﬁrst forms in the top layer of cells. The day of your last period. The cells fold up and round to make a fertilised egg moves slowly along hollow tube called the neural tube. HOW YOUR BABY DEVELOPS your fallopian tube towards your This will become your baby’s brain Week 7 uterus. It begins as one single cell, and spinal cord, so the tube has a The actual size from head which divides again and again. ‘head end’ and a ‘tail end’. Defects to bottom is about 10mm By the time the fertilised egg in this tube are the cause of spina reaches your uterus, it has become biﬁda (see page 49). The heart is a mass of over 100 cells, called an also forming and your baby already embryo. It is still growing. Once in has some blood vessels. A string of your uterus, the embryo attaches these blood vessels connects your itself into your uterus lining. baby to you – this will become the This is called implantation. umbilical cord.

WEEKS 4–5 WEEKS 6–7 There is now a large bulge where Week 4 your baby’s heart is and a bump MEASURING YOUR PREGNANCY for the head because the brain is The actual size of the embryo developing. The heart begins to WEEKS 8–9 is about 5mm beat and can be seen beating on an ultrasound scan. Dimples on the side Your baby’s face is slowly forming. of the head will become the ears The eyes are more obvious and and there are thickenings where the have some colour in them. The eyes will be. On the body, bumps are fetus has a mouth with a tongue. forming that will become muscles There are the beginnings of hands and bones. And small swellings and feet, with ridges where the (called ‘limb buds’) show where the ﬁngers and toes will be. The major arms and legs are growing. At seven internal organs – the heart, brain, weeks, the embryo has grown to lungs, kidneys, liver and gut – are all about 10mm long from head to developing. At nine weeks, the baby bottom. This measurement is called has grown to about 22mm long the ‘crown–rump length’. from head to bottom. The embryo now settles into your uterus lining. The outer cells reach Week 6 Week 9 out like roots to link with your blood supply. The inner cells form The actual size from head The actual size from head two – and then later three – layers. to bottom is about 8mm to bottom is about 22mm Each of these layers will grow to be different parts of your baby’s body. One layer becomes their brain and nervous system, skin, eyes and ears. Another layer becomes their lungs, stomach and gut. The third layer becomes their heart, blood, muscles and bones. The ﬁfth week is when you will miss your period. At this time, most women are only just beginning to think they may be pregnant.

19 1 The umbilical cord The umbilical cord is a baby’s lifeline. It is the link between you and your baby. Blood circulates through the cord, carrying oxygen and food to the baby and carrying waste away again. 2 2 The placenta The placenta is attached to the lining of the uterus and separates your baby’s circulation from your circulation. In the placenta, oxygen and food from your bloodstream pass into your baby’s bloodstream and are carried to your baby along the umbilical cord. Antibodies 1 that give resistance to infection pass to your baby in the same way. Alcohol, nicotine and other drugs can also pass to your baby this way. 3 3 The amniotic sac Inside the uterus, the baby floats in a bag of fluid called the amniotic sac. Before or during labour the sac, or ‘membranes’, break and the fluid drains out. This is known as the ‘waters breaking’.

WEEKS 10–14 Week 14 Just 12 weeks after conception, the The actual size from head fetus is fully formed. Your baby has to bottom is about 85mm all of their organs, muscles, limbs and bones, and their sex organs are developed. From now on your baby will grow and mature. Your baby is already moving about, but you will not be able to feel movements yet. By about 14 weeks, your baby’s heartbeat is strong and can be heard by an ultrasound scanner. The heartbeat is very fast – about twice as fast as a normal adult’s heartbeat. At 14 weeks, the baby is about 85mm long from head to bottom. Your pregnancy may start to show, but this varies a lot from woman to woman.

20 WEEKS 15–22 2 Your baby is growing faster than at any other time in their life. Their body grows bigger so that HOW YOUR BABY DEVELOPS their head and body are more in proportion, and they don’t look so ‘top heavy’. The face becomes much more defined and the hair, eyebrows and eyelashes are beginning to grow. Their eyelids stay closed over their eyes. Your baby already has their own individual fingerprints, as the lines on the skin of their fingers are now formed. Their fingernails and toenails are growing and their hands can grip. At about 22 weeks, your baby becomes covered in a very fine, soft hair called lanugo. We don’t know what this hair is for, but it is thought that it may keep the baby at the right temperature. The lanugo disappears before birth or soon after. Week 22 Between 16 and 22 weeks, you The actual size from head will usually feel your baby move for to bottom is about 27cm the first time. If this is your second baby, you may feel it earlier – at about 16–18 weeks. At first, you feel a fluttering or bubbling, or a very slight shifting movement. This can feel a bit like indigestion. Later, you will be able to tell that it is the baby’s movements and you may even see the baby kicking about. Sometimes you will see a bump that is clearly a hand or a foot.

21 WEEKS 23–30 Your baby is now covered in a white, greasy substance called Your baby is now moving about vernix. It is thought that this may vigorously, and responds to touch be to protect its skin as it floats in and sound. A very loud noise close the amniotic fluid. The vernix mostly by may make them jump and kick. disappears before the birth. They are also swallowing small From 24 weeks, your baby has a amounts of the amniotic fluid in chance of survival if it is born. Most which they are floating, and are babies born before this time cannot passing tiny amounts of urine back live because their lungs and other into the fluid. Sometimes your baby vital organs are not developed well may get hiccups, and you can feel enough. The care that can now the jerk of each hiccup. Your baby be given in neonatal units means may also begin to follow a pattern that more and more babies born for waking and sleeping. Very often this early do survive. Babies born this is a different pattern from at around this time have increased yours. So when you go to bed at risks of disability. night, your baby may wake up and start kicking. Your baby’s heartbeat can be heard through a stethoscope. Later, your partner may be able to hear the heartbeat by putting their ear to your abdomen, but it can be difficult to find the right place.

Week 30

The actual size from head to bottom is about 33cm

22 At around 26 weeks your baby’s eyelids open for the ﬁrst time. Babies’ eyes are almost always blue or dark blue, 2 although some babies do have brown eyes at birth. It is not until some weeks after they are born that your baby’s eyes will become the colour that they will stay. HOW YOUR BABY DEVELOPS The head-to-bottom length at 30 weeks is about 33cm.

WEEKS 31– 40 Your baby continues to grow. Their skin, which was quite wrinkled before, becomes smoother, and both the vernix and the lanugo begin to disappear. By about 32 weeks, the baby is usually lying with its head pointing downwards, ready for birth. The baby’s head can ‘engage’, or move down into the pelvis, before birth. Sometimes the head doesn’t engage until labour has started. bonding with your

Helpful tips

Regularly talking, reading and singing to your bump while you are pregnant will help you to bond with your baby before birth.

2323 YOUR HEALTH IN PREGNANCY

What should you eat? 24 Smoking 30 Keeping active 34 Foods to avoid 26 Alcohol 32 Infections 36 Preparing food 26 Pills, medicines and Inherited conditions 38 Vitamins and minerals 27 other drugs 33 Work hazards 39 Vegetarian, vegan Illegal drugs 33 Flying and travel 39 and special diets 28 X-rays 34

A healthy diet and lifestyle can help you to keep well during pregnancy and give your baby the best possible start in life. This chapter explains some of the things you can do to stay healthy.

WHAT SHOULD YOU EAT?

A healthy diet is very important if You will probably find that you are More information you are pregnant or trying to get more hungry than normal, but you pregnant. Eating healthily during don’t need to ‘eat for two’ – even if pregnancy will help your baby to you are expecting twins or triplets. Visit www.eatwell.gov.uk develop and grow and will help to Have breakfast every day – this will for useful information on what keep you fit and well. You don’t need help you to avoid snacking on foods you should eat when you are to go on a special diet, but make that are high in fat and sugar. You pregnant or trying for a baby. sure that you eat a variety of different may have to change the amounts of The leaflets Eating while you foods every day in order to get the different foods that you eat, rather are pregnant and Thinking right balance of nutrients that you than cutting out all your favourites. of having a baby? are also and your baby need. You should also available in several languages. avoid certain foods – see ‘Foods to Both leaflets are available avoid’ on page 26. online at www.food.gov.uk or can be ordered on 0845 606 0667.

nutritious and delicious

24 The eatwell plate The ‘eatwell plate’ below shows how much of each type of food you need to 3 have a healthy and well balanced diet. Fruit and vegetables Bread, rice, potatoes, YOUR HEALTH IN PREGNANCY As well as vitamins and pasta and other minerals, fruit and vegetables starchy foods provide fibre, which Carbohydrates are helps digestion and satisfying without prevents constipation. containing too many Eat at least five calories, and are an portions of fresh, important source of frozen, canned, vitamins and fibre. dried or juiced fruit They include bread, and vegetables potatoes, breakfast each day. Always cereals, pasta, rice, wash them oats, noodles, maize, carefully. To get millet, yams, cornmeal the most out and sweet potatoes. of vegetables, These foods should eat them raw be the main part or lightly cooked. For more of every meal. Eat information and portion sizes, wholegrain varieties visit www.5aday.nhs.uk when you can. Foods and drinks that are high in Meat, fish, eggs, fat and/or sugar Milk and dairy foods beans and other This food group includes all Dairy foods like milk, cheese, non-dairy sources spreading fats, oils, salad yoghurt and fromage frais of protein dressings, cream, chocolate, are important because they Protein includes meat (except crisps, biscuits, pastries, ice contain calcium and other liver), fish, poultry, eggs, cream, cake, puddings and nutrients that your baby beans, pulses and nuts (for fizzy drinks. You should only needs. Eat two or three information on peanuts see eat a small amount of these portions a day, using low-fat page 112). These foods are all foods. Sugar contains calories varieties whenever you can good sources of nutrients. without providing any other – for example, semi-skimmed Eat moderate amounts each nutrients that the body needs. or skimmed milk, low-fat day. Choose lean meat, Having sugary foods and drinks yoghurt and half-fat hard remove the skin from poultry too often can cause tooth decay, cheese. However, there are and cook using only a little especially if you have them some cheeses that you fat. Make sure eggs, poultry, between meals. If we eat more should avoid – see ‘Foods pork, burgers and sausages than we need, this can lead to to avoid’ on page 26 for more are cooked all the way through. weight gain. Eating more fatty information. Check that there is no pink foods is likely to make you put meat and that juices have no on weight. Having too much pink or red in them. Try to eat saturated fat can increase the two portions of fish a week, amount of cholesterol in the one of which should be oily blood, which increases the fish. There are some fish that chance of developing heart you should avoid – see ‘Foods disease. Try to cut down on to avoid’ on page 26 for more food that is high in saturated information. fat and have foods rich in unsaturated fat instead.

25 FOODS TO AVOID • Raw or partially cooked eggs. balanced diet, unless you are Make sure that eggs are thoroughly allergic to them or your health There are some foods that you cooked until the whites and yolks professional advises you not to. should not eat when you are are solid. This prevents the risk You may have heard that some pregnant because they may of salmonella food poisoning. women have, in the past, chosen make you ill or harm your baby. Avoid foods that contain raw and not to eat peanuts when they undercooked eggs, such as home- You should avoid: were pregnant. This is because the made mayonnaise. government previously advised • Some types of cheese. Don’t • Raw or undercooked meat. women that they may wish to eat mould-ripened soft cheese, Cook all meat and poultry avoid eating peanuts during like Brie, Camembert and others thoroughly so that there is no pregnancy if there was a history with a similar rind. You should trace of pink or blood. Take of allergy in their child’s immediate also avoid soft blue-veined cheese, particular care with sausages and family (such as asthma, eczema, like Danish blue. These are made minced meat. It is fine to eat steaks hayfever, food allergy or other with mould and they can contain and other whole cuts of beef and types of allergy). But this advice listeria, a type of bacteria that can lamb rare, as long as the outside has now been changed because harm your unborn baby. Although has been properly cooked or sealed. the latest research has shown that listeriosis is a very rare infection, • Liver products. Don’t eat liver, or there is no clear evidence to say it is important to take special liver products like liver pâté or liver if eating or not eating peanuts precautions during pregnancy sausage, as they may contain a lot during pregnancy affects the because even the mild form of of vitamin A. Too much vitamin A chances of your baby developing the illness in the mother can lead can harm your baby. a peanut allergy. to miscarriage, stillbirth or severe • Supplements containing • Unpasteurised milk. Drink only illness in a newborn baby. You can vitamin A. Don’t take high- pasteurised or UHT milk which eat hard cheeses such as cheddar dose multivitamin supplements, has been pasteurised. If only raw and parmesan, and processed fish liver oil supplements or any or green-top milk is available, boil cheeses made from pasteurised supplements containing vitamin A. it first. Don’t drink unpasteurised milk such as cottage cheese, goats’ or sheep’s milk or eat mozzarella and cheese spreads. • Some types of fish. Don’t eat certain food that is made out of shark, marlin and swordfish, and • Pâté. Avoid all types of pâté, them, e.g. soft goats’ cheese. limit the amount of tuna you eat including vegetable pâtés, as to no more than two tuna steaks they can contain listeria. a week (about 140g cooked or Your weight 170g raw each) or four medium- Most women gain between sized cans of tuna a week (about 10kg and 12.5kg (22–28lb) while PREPARING FOOD 140g when drained). These types pregnant. Weight gain varies of fish contain high levels of a great deal and depends on • Wash fruit, vegetables and salads mercury, which can damage your weight before pregnancy. your baby’s developing nervous to remove all traces of soil, which Much of the extra weight is due system. Don’t eat more than two may contain toxoplasma. This can to the baby growing. Putting portions of oily fish per week. cause toxoplasmosis, which can on too much weight can affect Oily fish includes fresh tuna harm your baby (see page 37). your health and increase your (but not canned tuna), salmon, • Heat ready-meals until they are blood pressure. Equally, it is mackerel, sardines and trout. piping hot all the way through. important that you do not This is especially important for • Raw shellfish. Eat cooked rather diet, but eat healthily. Try and meals containing poultry. than raw shellfish as they can stay active by keeping up your contain harmful bacteria and viruses normal daily activity or exercise. • Keep leftovers covered in the that can cause food poisoning. If you are concerned, talk to fridge and use within two days. • Peanuts. If you would like to your midwife or GP. They may • Wash all surfaces and utensils, eat peanuts or foods containing give you advice if you weigh and your hands, after preparing peanuts (such as peanut butter) more than 100kg (about 15½ raw meat. This will help to avoid during pregnancy, you can choose stone) or less than 50kg (about infection with toxoplasma. to do so as part of a healthy 8 stone).

26 The best source of vitamin D is summer sunlight. The amount of 3 time you need in the sun to make enough vitamin D is different for every person and depends YOUR HEALTH IN PREGNANCY on things like skin type, time of day and time of the year. But you don’t need to sunbathe: the amount of sun you need to make enough vitamin D is less than the amount that causes tanning or burning. If you have dark skin or always cover your skin, you may be at particular risk of vitamin D deficiency. Talk to your midwife or doctor if you are worried about this. (See also ‘Vitamin VITAMINS More information supplements’ on page 28.) AND MINERALS • Iron. If you are short of iron, For more you will probably get very Eating a healthy, varied diet will information tired and you can become help you to get all the vitamins about folic anaemic. Lean meat, green, leafy and minerals you need while you acid, read vegetables, dried fruit and nuts are pregnant. There are some Folic acid: (see page 26 about avoiding vitamins and minerals that are An essential peanuts) all contain iron. Many especially important: guide for making babies at breakfast cereals have iron www.breastfeeding.nhs.uk/en/ added. If the iron level in your • Folic acid. Folic acid is important materialforclients/dl_13.asp blood becomes low, your GP or for pregnancy as it can reduce midwife will advise you to take the risk of neural tube defects Foods carrying the iron supplements. These are such as spina bifida. If you are mark on the right available as tablets or a liquid. thinking about getting pregnant, have added • Vitamin C. You need vitamin C you should take a 400 microgram folic acid. as it may help you to absorb iron. folic acid tablet every day until Citrus fruits, tomatoes, broccoli, you are 12 weeks pregnant. If peppers, blackcurrants, potatoes you did not take folic acid before • Vitamin D. You need vitamin D and some pure fruit juices are you conceived, you should start to keep your bones healthy and good sources of vitamin C. as soon as you find out that you to provide your baby with enough If your iron levels are low, it may are pregnant. You should also eat vitamin D for the first few months help to drink orange juice with foods that contain folic acid, such of their life. Vitamin D regulates an iron-rich meal. as green leafy vegetables, fortified the amount of calcium and breakfast cereals and brown rice. • Calcium. Calcium is vital for phosphate in the body, and these Some breakfast cereals, breads making your baby’s bones and are needed to help keep bones and margarines have folic acid teeth. Dairy products and fish and teeth healthy. Deficiency of added to them. If you already with edible bones like sardines vitamin D can cause children’s have a baby with spina bifida, are rich in calcium. Breakfast bones to soften and can lead or if you have coeliac disease or cereals, dried fruit such as figs to rickets. You should take a diabetes or take anti-epileptic and apricots, bread, almonds, supplement of 10 micrograms of medicines, ask your GP or midwife tofu (a vegetable protein made vitamin D every day. Only a few for more advice. You will need to from soya beans) and green foods contain vitamin D, including take a bigger dose of folic acid. leafy vegetables like watercress, oily fish like sardines, fortified broccoli and curly kale are other margarines, some breakfast good sources of calcium. cereals and taramasalata.

27 Vitamin supplements It is best to get vitamins and minerals from the food you eat, but when you are pregnant you will need to take some Healthy Start supplements as well: Healthy Start is a scheme that provides vouchers that can be • 10 micrograms of vitamin D exchanged for milk, fresh fruit and vegetables and infant formula throughout your pregnancy milk. You can also receive free vitamins. and if you breastfeed. • 400 micrograms of folic acid You qualify for Healthy Start if you are pregnant or have a child – ideally this should be taken under four years old, and you and your family receive one of from before you get pregnant the following: until you are 12 weeks • pregnant. • If you are vegetarian or vegan, • you may need to take a vitamin less (2008/09). B12 supplement as well as other supplements. Talk to your doctor • or midwife about this. four weeks immediately after you have stopped working for If you have a special or restricted 16 hours or more per week. diet, you may need additional Or you qualify if you are pregnant and under 18 years of age. supplements. Talk to your doctor or midwife about this. week for children under one year old. Do not take vitamin A supplements, or any supplements For further information: containing vitamin A, as too • A Healthy Start for Pregnant much could harm your baby. Women and Young Children from your local health centre or call Which supplements? 0845 607 6823 to request a free copy. You can get supplements from • pharmacies and supermarkets or • your GP may be able to prescribe them for you. If you want to get your folic acid or vitamin D from a multivitamin tablet, make sure VEGETARIAN, VEGAN AND SPECIAL DIETS that the tablet does not contain A varied and balanced vegetarian to a dietician who can give you vitamin A (or retinol). diet should give enough nutrients advice on how to get the nutrients Healthy Start vitamins for women for you and your baby during you need for you and your baby. contain the correct amount of pregnancy. However, you might folic acid and vitamin D and are ﬁnd it hard to get enough iron and More information free from the NHS without a vitamin B12. Talk to your doctor or prescription to pregnant women midwife about how you can make For further information, visit: receiving Healthy Start vouchers. sure that you are getting enough Ask your GP or pharmacist of these important nutrients. • the Vegetarian Society website for advice if you are unsure at www.vegsoc.org You should also talk to your doctor or (see ‘Healthy Start’ on this page). midwife if you have a restricted diet • the Vegan Society website at Your primary care trust and because you have a food intolerance www.vegansociety.com local pharmacies may sell this (such as coeliac disease) or for supplement to women who religious reasons. Ask to be referred don’t receive it free.

28 Healthy snacks Caffeine 3 You may find that you get hungry High levels of caffeine can result in babies between meals. Avoid snacks that having a low birth weight, which can increase are high in fat and/or sugar. the risk of health problems in later life. Instead you could try the following: Too much can also cause miscarriage. YOUR HEALTH IN PREGNANCY • Fresh fruit. Caffeine is naturally found in lots of foods, such as coffee, tea and • Sandwiches or pitta bread filled chocolate, and is added to some soft drinks with grated cheese, lean ham, and energy drinks. It can also be found in certain cold and flu mashed tuna, salmon or sardines remedies. Talk to your midwife, pharmacist or another health and salad. professional before taking these remedies. You don’t need to cut caffeine out completely, but you should limit how much you have to no more than 200mg a day. Try decaffeinated tea and coffee, fruit juice or water and limit the amount of ‘energy’ drinks, which may be high in caffeine. Don’t worry if you occasionally have more than this, because the risks are quite small. Caffeine content in food and drink • 1 mug of instant coffee: 100mg • 1 mug of filter coffee: 140mg • Salad vegetables. • 1 mug of tea: 75mg • Low-fat yoghurt or fromage frais. • 1 can of cola: 40mg • Hummus and bread or vegetable • 1 can of ‘energy’ drink: up to 80mg sticks. • 1 x 50g bar of plain chocolate: up to 50mg • Ready-to-eat apricots, figs or • 1 x 50g bar of milk chocolate: up to 25mg prunes. • Vegetable and bean soups. So if you eat... • Unsweetened breakfast cereals • one bar of plain chocolate and one mug of filter coffee or porridge and milk. • two mugs of tea and one can of cola, or • Milky drinks or unsweetened • one mug of instant coffee and one can of energy drink fruit juices. you have reached almost 200mg of caffeine. • Baked beans on toast or VEGETARIAN, VEGAN AND SPECIAL DIETS a baked potato. healthy options

29 Help and support SMOKING Getting help with Every cigarette you smoke harms your baby. Cigarettes restrict the essential stopping smoking oxygen supply to your baby. So their tiny heart has to beat harder every time you smoke. Cigarettes contain over 4,000 chemicals. Protecting your baby from tobacco smoke is one of the best things you can do to give your child a healthy start in life. It’s never too late to stop. If you stop smoking now Stopping smoking will beneﬁt both you and your baby immediately. The Smokefree Pregnancy Carbon monoxide and chemicals will clear from the body and oxygen Support DVD will show you all levels will return to normal. the free NHS support available to help you to stop and stay stopped. To order your free DVD, call the NHS Pregnancy Smoking Helpline on 0800 169 9 169, or visit www.nhs.uk/smokefree The NHS Pregnancy Smoking Helpline on Stopping smoking action plan 0800 169 9 169 is open from 12pm to 9pm 1 Think every day and offers free Think about: help, support and advice on stopping smoking • what you and your baby will gain if you stop smoking (see above) when you are pregnant. • how much smoking costs you. You can also sign up to receive ongoing advice and support at a time that suits you. • What else could you spend your money on? How can you treat yourself or your baby with the money you save? You can also ask your midwife, health visitor, practice nurse or pharmacist for advice and for the details of your local NHS • What is keeping you smoking? Stop Smoking Service. They offer one-to-one or group sessions with trained stop smoking advisers and List your top ﬁve reasons for going smokefree; e.g. protecting your may even have a pregnancy health or the health of your baby. stop smoking specialist. They can offer advice 1 about dealing with stress, weight gain and nicotine 2 replacement therapy to help 3 you manage your cravings. 4

30 If you stop smoking: • Your baby is less likely to be born • You will reduce the risk of cot 3 • You will have less morning too early and have to face the death (see page 129 for more sickness and fewer complications additional breathing, feeding information about how to in pregnancy. and health problems which reduce the risk of cot death). often go with being premature It will also be better for your baby YOUR HEALTH IN PREGNANCY • You are more likely to have (see Chapter 14). a healthier pregnancy and a later in life. Children whose healthier baby. • Your baby is less likely to be born parents smoke are more likely to underweight and have a problem suffer from illnesses which need • You will reduce the risk of stillbirth. keeping warm. Babies of mothers hospital treatment (such as asthma). • You will cope better with the birth. who smoke are, on average, 200g The sooner you stop, the better. • Your baby will cope better with (about 8oz) lighter than other But stopping even in the last few any birth complications. babies. These babies may have problems during and after labour weeks of pregnancy will beneﬁt and are more prone to infection. you and your baby.

2 Get help Take advantage of the free NHS support that is available to you. You are four times more likely to quit successfully with NHS support. See the ‘Help and support’ box on the left for more information. Ask your friends and family to help and support you. 3 Prepare If you understand why you smoke and what triggers your smoking, you will be able to prepare yourself so that you can cope when you quit. It can help to: • give up with somebody else, so that you can support each other • change the habits you associate with smoking, and • plan how you will deal with difﬁcult situations without the use of cigarettes. Choose a day to stop. Will the ﬁrst few days be easier during a working week or over a weekend? When you are busy or relaxed? Whatever you choose, stop completely on that day. Review your plan and get rid of all of your cigarettes the day before your day for stopping. My chosen day for stopping smoking is:

4 Stop smoking Lots of people start smoking again because they feel they cannot cope with the withdrawal symptoms. The first few days may not be much fun but the symptoms are a sign that your body is starting to recover. Take one day at a time and reward yourself for success. Go through your list of reasons for going smokefree to remind yourself why you have given up. If you have had a scan, use your scan images to keep you going through the times when you are finding it tough. 31 Secondhand smoke Drinking is not just dangerous for If your partner or anyone else who the baby in the first three months: lives with you smokes, it can affect alcohol can affect your baby you and your baby both before throughout pregnancy. And if you and after birth. You may also find drink heavily during pregnancy, a it more difficult to quit. particular group of problems could develop that are known as Fetal Secondhand smoke can cause low Alcohol Syndrome (FAS). Children birth weight and cot death. Infants with this syndrome have: of parents who smoke are more likely to be admitted to hospital for • restricted growth bronchitis and pneumonia during ALCOHOL • facial abnormalities the first year of life, and more than • learning and behavioural When you drink, alcohol reaches 17,000 children under the age of disorders. five are admitted to hospital every your baby through the placenta. Drinking more than 1 to 2 units year because of the effects of Too much exposure to alcohol once or twice a week, as well as secondhand smoke. can seriously affect your baby’s development. binge drinking, may be associated with lesser forms of FAS. The risk is Because of this risk, pregnant likely to be greater the more women or women trying to conceive you drink. should avoid drinking alcohol. If you do choose to drink, then protect If you are drinking with friends: your baby by not drinking more • find a non-alcoholic drink that than 1 to 2 units of alcohol once or you enjoy twice a week, and don’t get drunk. Additional advice from the National • sip any alcohol you do drink slowly Institute for Health and Clinical to make it last Excellence (NICE) advises women • don’t let people pressure you into to avoid alcohol in the first three drinking, and months in particular, because of the • avoid getting drunk. increased risk of miscarriage. When you drink, alcohol passes from your blood, through the placenta, to Help and support your baby. A baby’s liver is one of the last organs to develop fully and does Getting help with What is a not mature until the latter half of drinking pregnancy. Your baby cannot process unit of alcohol? If you have difficulty cutting alcohol as well as you can. One UK unit is 10ml, or 8g, down what you drink, talk to of pure alcohol. A unit is: your doctor, midwife, pharmacist or other healthcare professional. Confidential help and support is available from local counselling or or services (look in the telephone directory or contact Drinkline on 0800 917 8282). You should talk to your midwife 1 1 /2 pint of beer, lager a single measure (25ml) /2 standard (175ml) if you have any concerns you or cider of spirit (whisky, gin, glass of wine have about your drinking around at 3.5% ABV bacardi, vodka, etc.) at 11.5% ABV the time of conception and early at 40% ABV pregnancy. You can get more To find out more about units, visit the Know Your Limits website advice from www.nhs.uk/units at www.nhs.uk/units

32 they prescribe you anything or ILLEGAL DRUGS give you treatment 3 PILLS, MEDICINES • talk to your doctor if you take Illegal drugs like cannabis, ecstasy, regular medication – ideally before cocaine and heroin can harm your AND OTHER DRUGS baby. If you use any of these drugs, you start trying for a baby or YOUR HEALTH IN PREGNANCY Some medicines, including some as soon as you find out you are it is important to talk to your doctor common painkillers, can harm your pregnant, and or midwife so that they can provide baby’s health but some are safe, for you with advice and support to • use as few over the counter example medication to treat long- help you stop. They can also refer medicines as possible. term conditions such as asthma, you for additional support. Some thyroid disease, diabetes and epilepsy. Medicines and treatments that are dependent drug users initially need To be on the safe side, you should: usually safe include paracetamol, drug treatment to stabilise or come most antibiotics, dental treatments off drugs to keep the baby safe. • always check with your doctor, (including local anaesthetics), some For more information, contact midwife or pharmacist before immunisations (including tetanus Narcotics Anonymous (see page taking any medicine and flu injections) and nicotine 183) or talk to FRANK, the drugs • make sure that your doctor, replacement therapy. But you information line, on 0800 77 66 00. dentist or other health professional should always check with your GP, knows you are pregnant before pharmacist or midwife first.

Medicines for minor ailments when pregnant • Make sure the medicine is safe to take when pregnant. • For further information, speak to your pharmacist or NHS Direct on 0845 4647.

Minor ailment First choice Second choice Do not use Constipation Eat more ﬁbre. Bulk laxatives On your doctor’s advice: that contain ispaghula. bisacodyl or lactulose. Cough Honey and lemon in hot water. Medicines that contain codeine, Simple linctus. unless advised by your doctor. Diarrhoea Oral rehydration sachets. Loperamide. Haemorrhoids Soothing creams, ointments Ice pack. (piles) or suppositories.

Hayfever, house dust Antihistamine nasal sprays and On your doctor’s advice: occasional Other antihistamines. mite and animal eye drops. Steroid nasal sprays. doses of the antihistamines loratadine hair allergy or chlorphenamine. Head lice Wet combing. Dimeticone lotion. If ineffective, head lice treatments containing malathion in water (aqueous lotion). Indigestion Antacids (indigestion mixtures). On your doctor’s advice: medicines that reduce acid production, e.g. omeprazole. Nasal congestion Steam inhalation (e.g. over If severe, occasional doses of oxymetazoline Phenylephrine or (stuffy or runny a bowl of hot water) or a or xylometazoline nasal spray. pseudoephedrine, especially nose) hot shower. in the 1st trimester. Pain (e.g. headache, Paracetamol. Ibuprofen may be taken in the 2nd trimester Medicines that contain toothache) (weeks 14 to 27) but avoid taking it in the codeine (e.g. co-codamol, 1st or 3rd trimesters unless advised by your co-dydramol, dihydrocodeine), doctor. unless advised by your doctor. Threadworms Pharmacists cannot supply On your doctor’s advice: mebendazole, but threadworm medicines to preferably not in the 1st trimester. pregnant women without a prescription. Vaginal thrush Pharmacists cannot supply On your doctor’s advice: clotrimazole Fluconazole. medicines for vaginal thrush pessaries or cream. Do not use the pessary to pregnant women without applicator if you are near term (at the end a prescription. of your pregnancy). Acknowledgement: United Kingdom Medicines Information (UKMi) 33 Herbal and homeopathic Exercises for a fitter remedies and pregnancy aromatherapy Try to fit these exercises into your Not all ‘natural’ remedies are daily routine. They will strengthen safe in pregnancy. Contact the Exercise tips your muscles so that you can carry Institute for Complementary extra weight, make your joints and Natural Medicine to make • Exercise doesn’t have to be stronger, improve your circulation, sure that your practitioner strenuous to be beneficial. ease backache and generally is qualified (see page 183). • Make sure that you warm up make you feel well. Tell your practitioner that you are and cool down. Stomach-strengthening pregnant, and tell your midwife • Try to keep active on a daily basis. exercises or doctor and pharmacist which Half an hour of walking each day remedies you are using. These strengthen your stomach can be enough. If you cannot (abdominal) muscles and ease manage that, any amount is backache, which can be a X-RAYS better than nothing. problem in pregnancy. As your • Avoid any strenuous exercise baby gets bigger you may X-rays should be avoided in in hot weather. find that the hollow in your pregnancy if possible. Make sure that • Drink plenty of water and lower back becomes more your dentist knows you are pregnant. other fluids. pronounced, which can lead to backache. • If you go to exercise classes, KEEPING ACTIVE make sure that your teacher is • Start in a box position (on all The more active and fit you are properly qualified and knows that fours), with your knees under during pregnancy, the easier it will you are pregnant and how far your hips, your hands under be for you to adapt to your changing your pregnancy has progressed. your shoulders, your fingers shape and weight gain. It will also • You might like to try swimming, facing forward and your help you to cope with labour and to because the water will support stomach muscles lifted so that get back into shape after the birth. your increased weight. Some local your back is straight. swimming pools provide aquanatal Keep up your normal daily physical classes with qualified instructors. activity or exercise (sport, dancing or just walking to the shops Exercises to avoid and back) for as long as you • Lying flat on your back – particularly feel comfortable. Don’t exhaust after 16 weeks. The ‘bump’ presses yourself, and remember that you on the big blood vessels and can may need to slow down as your make you feel faint. pregnancy progresses or if your • Contact sports where there doctor advises you to. As a general is a risk of being hit, such as • Pull in your stomach muscles rule, you should be able to hold kickboxing, judo or squash. and raise your back up a conversation as you exercise. towards the ceiling, curling • Horse riding, downhill skiing, ice If you become breathless as your trunk and allowing your hockey, gymnastics and cycling, you talk, then you are probably head to relax gently forward. because there is a risk of falling. exercising too strenuously. Don’t let your elbows lock. If you were inactive before you were • Scuba diving, because the pregnant, don’t suddenly take up baby has no protection against strenuous exercise. If you start an decompression sickness and aerobic exercise programme, begin gas embolism. with no more than 15 minutes’ • Exercising at heights over continuous exercise, three times per 2,500 metres until you have week. Increase this gradually to a acclimatised. This is because maximum of 30-minute sessions, you and your baby are at risk four times a week. Inform the of acute mountain sickness instructor that you are pregnant. (decrease in oxygen). 34 • Hold for a few seconds then • Close up your back passage Foot exercises slowly return to the box position. as if trying to prevent a bowel Foot exercises can be done sitting 3 • Take care not to hollow your movement. or standing. They improve blood back – it should always return • At the same time, draw in your circulation, reduce swelling in the

to a straight or neutral position. vagina as if you are gripping ankles and prevent cramp in the YOUR HEALTH IN PREGNANCY calf muscles. • Do this slowly and rhythmically a tampon, and your urethra 10 times, making your muscles as if to stop the flow of urine. • Bend and stretch your foot work hard and moving your back • First do this exercise quickly – vigorously up and down 30 times. carefully. Only move your back tightening and releasing the • Rotate your foot eight times as far as you can comfortably. muscles straight away. one way and eight times the Pelvic tilt exercises • Then do it slowly, holding the other way. Stand with your shoulders and contractions for as long as you • Repeat with the other foot. bottom against a wall. Keep your can before you relax. Try to count knees soft. Pull your belly button to 10. towards your spine, so that your • Try to do three sets of eight back flattens against the wall. squeezes every day. To help you Hold for four seconds and release. remember, you could do them Repeat up to 10 times. once at each meal. Pelvic floor exercises As well as these exercises, you Pelvic floor exercises help to will also need to practise tightening strengthen the muscles of the up the pelvic floor before and pelvic floor, which are placed during coughing and sneezing. under great strain in pregnancy Ask your midwife or doctor and childbirth. about these exercises. The pelvic floor consists of layers Your local maternity To protect your back of muscles which stretch like a unit should run • Sit up straight with your bottom supportive hammock from the classes where against the back of your chair. pubic bone (in front) to the a specialist Tuck a small cushion behind your base of the backbone. During physiotherapist waist if you wish. pregnancy you may find that attends. you leak urine when you cough They can • When you pick something up, or strain. This is known as instruct you bend your knees, not your back. stress incontinence of urine in groups or • Try to stand tall. and it can continue after individually. pregnancy. By performing Feel free to pelvic floor exercises, you ask them strengthen the pelvic for advice floor muscles and this and help. helps to reduce or avoid this problem after pregnancy. It is important to do them even if you gentle are young and not suffering from stress incontinence exercise now.

35 INFECTIONS Sexually transmitted HIV and AIDS infections You will be offered a confidential Rubella Sexually transmitted infections HIV test as part of your routine If you catch rubella (or German (STIs) are on the increase. The most antenatal care (see page 47). measles) in the first four months common is chlamydia. Up to 70% Your doctor or midwife will discuss, of pregnancy it can seriously affect of women and 50% of men who the test with you, and counselling your baby’s sight and hearing and have an STI show no symptoms, so will be available if the result is cause brain and heart defects. All you may not know if you have one. positive. You can also go to a GUM children are now offered a vaccine However, many STIs can affect your clinic for an HIV test and advice. against rubella through the MMR baby’s health during pregnancy and Current evidence suggests that immunisation at 13 months and a after birth. If you have any reason an HIV positive mother in good second immunisation before they to believe that you or your partner health and without symptoms start school. has an STI, you should go for a of the infection is unlikely to be check-up as soon as you can. You If you are not immune and you adversely affected by pregnancy. can ask your GP or midwife, or go do come into contact with rubella, HIV positive mothers can pass to a genitourinary medicine (GUM) tell your doctor at once. Blood on the virus through breastmilk. or sexual health clinic. You will be tests will show whether you have However, it is possible to reduce the guaranteed strict confidentiality. You been infected. risk of transmitting HIV to your baby can find your nearest GUM clinic or during pregnancy and after birth sexual health clinic in your phone (see box on page 47). book listed under the name of your primary care trust or at If you are HIV positive, talk to your www.nhsdirect.nhs.uk or you can doctor about your own health and call the Sexual Health Helpline free the options open to you, or contact on 0800 567 123. the organisations listed on page 185 for advice and counselling. If you are under 25, you can visit a Brook centre to get free, confidential advice. To find your More information nearest centre, visit www.brook.org. uk or call the Ask Brook national For more information, read helpline on 0808 802 1234. the information on screening tests in Chapter 4 or go to You can contact the National www.screening.nhs.uk Chlamydia Screening Programme for a free, confidential test. Visit www.chlamydiascreening.nhs.uk seek medical advice

36 Hepatitis C labour, a caesarean section may 3 Hepatitis C is a virus that infects the be recommended to reduce the liver. Many people with hepatitis C risk of transmission to your baby. may have no symptoms and be Chickenpox

unaware that they are infected. If YOUR HEALTH IN PREGNANCY Around 95% of women are Hepatitis B you have hepatitis C, you might pass immune to chickenpox. If you Hepatitis B is a virus that infects the the infection to your baby, although have not had it and you come liver. Many people with hepatitis B, the risk is much lower than with into contact with someone who will have no signs of illness, but hepatitis B or HIV. This cannot be has it, speak to your GP, midwife they might infect others. If you prevented at present. Your baby can or obstetrician at once. A blood have hepatitis B, or are infected be tested for hepatitis C. If they are test will establish whether you are during pregnancy, you can pass infected, they can be referred for immune. Chickenpox infection in the infection to your baby at birth. specialist assessment. You will be offered a blood test for pregnancy can be dangerous for hepatitis B as part of your antenatal Herpes both mother and baby, so seek care (see page 47). Babies who Genital herpes infection can be advice as soon as possible. are at risk should be immunised caught through genital contact with Toxoplasmosis at birth. This is 90–95% effective an infected person or from oral sex This infection can damage in preventing them from getting with someone who has oral herpes your baby if you catch it during hepatitis B and developing long- (cold sores) and can be dangerous pregnancy, so take precautions term infection. The first dose is given for a newborn baby. Initial infection (see page 38). Most women within 24 hours of birth and two causes very painful blisters or have already had the infection more doses are given at one and ulcers on the genitals. Less severe before pregnancy and will be two months, with a booster dose attacks usually occur for some years immune. If you feel you may at 12 months. A few babies may afterwards. If you or your partner have been at risk, talk to your GP, also need an injection of hepatitis are infected, use condoms or avoid midwife or obstetrician. If you do B immunoglobulin soon after birth. sex during an attack. Avoid oral catch toxoplasmosis while you are Your baby will be tested for sex if either of you have cold sores pregnant, you can get treatment. hepatitis B infection at 12 months. or active genital herpes. Tell your Any babies who have become doctor or midwife if either you Parvovirus B19 infected should be referred for or your partner have recurring (slapped cheek disease) specialist assessment and follow-up. herpes or develop the symptoms Parvovirus B19 infection is described above. If your first common in children and causes infection occurs in pregnancy, there a characteristic red rash on the is treatment available. If your first face, so it is often called ‘slapped infection occurs towards the end cheek disease’. You can get infected of your pregnancy or during with HIV, hepatitis B, 60% of women are immune to or hepatitis C if you: this infection. However, parvovirus B19 is very infectious and can be • have sex with someone who harmful to your baby. If you come is infected without using a You may have been into contact with someone who condom infected with hepatitis is infected you should talk to your • use injectable drugs and share C if you: doctor, who can check whether equipment with an infected • received a blood transfusion you are immune through a blood person. in the UK prior to September test. In most cases, the baby is not affected when a pregnant woman You may have already been 1991, or blood products prior is infected with parvovirus. infected with hepatitis B if to 1986 you were born or spent your • received medical or dental childhood outside the UK in treatment in countries a country where hepatitis B where hepatitis C is common is common. (You may have and the infection is not acquired the infection at birth.) controlled properly.

37 Group B streptococcus Group B streptococcus (GBS) is a bacterium carried by up to 30% of people which causes no harm or symptoms. In women it is found in the intestine and vagina and causes no problem in most pregnancies. In a very small number it infects the baby, usually just before or during labour, leading to serious illness. If you have already had a baby who had group B streptococcal Infections transmitted Sheep infection, you should be offered by animals Lambs and sheep can be a source of an organism called Chlamydia antibiotics during labour to reduce Cats the chances of your new baby psittaci, which is known to cause Cats’ faeces can contain getting the infection. If you have miscarriage in ewes. They also an organism which causes had a group B streptococcal urinary carry toxoplasma. Avoid lambing or toxoplasmosis. Avoid emptying cat tract infection with GBS (cystitis) milking ewes and all contact with litter trays while you are pregnant. If during the pregnancy, you should newborn lambs. If you experience no one else can do it, use disposable also be offered antibiotics in flu-like symptoms after coming into rubber gloves. Trays should be labour. Group B streptococcal contact with sheep, tell your doctor. cleaned daily and filled with boiling infection of the baby is more likely water for five minutes. Pigs if your labour is premature, your Research is going on to see if pigs waters break early, you have a Avoid close contact with sick cats can be a source of hepatitis E fever during labour or you currently and wear gloves when gardening infection. This infection is dangerous carry GBS. Your midwife or doctor – even if you don’t have a cat – in in pregnant women, so avoid will assess whether you need case the soil is contaminated with contact with pigs and pig faeces. antibiotics during labour to protect faeces. Wash your hands and gloves There is no risk of hepatitis E from your baby from being infected. after gardening. If you do come eating cooked pork products. into contact with cat faeces, make It is possible to be tested for GBS late sure that you wash your hands in pregnancy if you have concerns. thoroughly. Follow the general INHERITED Talk to your doctor or midwife. hygiene rules under ‘Preparing food’ CONDITIONS (page 26). Some diseases or conditions are inherited from one or both parents. These include cystic fibrosis, haemophilia, muscular dystrophy, sickle cell disorders and thalassaemia. If you, your baby’s father or any of your relatives has an inherited condition or if you already have a baby with a disability, talk to your doctor. You may be able to have tests early in pregnancy to check whether your baby is at risk or affected (see page 49). Ask your GP or midwife to refer you to a genetic counsellor (a specialist in inherited diseases) for advice. Ideally, you should do this before you get pregnant or in the early weeks of pregnancy.

38 WORK HAZARDS Computer screens You can buy a pair of support stockings in the pharmacy over 3 The most recent research If you work with chemicals, lead the counter, which will reduce shows no evidence of a risk or X-rays, or in a job with a lot of leg swelling. from visual display units on

lifting, you may be risking your YOUR HEALTH IN PREGNANCY computer terminals and Before you travel, think about your health and the health of your baby. word processors. destination. Could you get medical If you have any worries about this, help if you needed it? Are any you should talk to your doctor, immunisations needed which might midwife, occupational health be harmful to the pregnancy? nurse, union representative or FLYING AND personnel department. TRAVEL If you are travelling to Europe, make sure that you have a If it is a known and recognised risk, Flying is not harmful for you or European Health Insurance it may be illegal for you to continue, your baby, but some airlines will Card (formerly known as E111), and your employer must offer you not let you fly towards the end of which entitles you to free treatment suitable alternative work on the same your pregnancy, and you should while abroad. You can get this from: terms and conditions as your original check conditions with them. job. If no safe alternative is available, • a post office your employer should suspend you • by calling 0845 606 2030, or on full pay (give you paid leave) for as long as necessary to avoid the risk. • from www.ehic.org If your employer fails to pay you during your suspension, you can bring a claim in an employment tribunal (within three months). This will not affect your maternity pay and leave. See also pages 168–169. Long distance travel (longer than Coping at work five hours) carries a small risk of You might get extremely tired – thrombosis (blood clots) in pregnant particularly in the first few and last women. If you fly, drink plenty of few weeks of your pregnancy. Try to water to stay hydrated and do the use your lunch break to eat and rest, recommended calf exercises. not to do the shopping. If travelling in rush hour is exhausting, ask your employer if you can work slightly different hours for a while. Don’t rush home and start another job cleaning and cooking. If you have a partner, ask them to take Safety on the move over. If you are on your own, keep Road accidents are among the housework to a minimum, and most common causes of injury go to bed early if you can. in pregnant women. To protect Your rights to antenatal care, yourself and your baby, always leave and benefits are set wear your seatbelt with the out in Chapter 17. diagonal strap across your body between your breasts and with the lap belt over your upper thighs. The straps should lie above and below your bump, not over it.

39 ANTENATAL CARE Antenatal appointments 41 Tests for Down’s syndrome and other Early antenatal appointments 44 genetic disorders 50 Regular checks at every antenatal Diagnostic tests for Down’s appointment 45 syndrome and other genetic disorders 51 Appointments in later pregnancy 46 If a test detects an abnormality 51 Blood tests 46 Making the most of antenatal care 52 Ultrasound scans 48 Your antenatal team 54 Tests to detect abnormalities 49 Antenatal education 56

Antenatal care is the care that you receive from healthcare professionals during your pregnancy. You will be offered a series of appointments with a midwife, or sometimes with a doctor (an obstetrician). They will check that you and your baby are well, give you useful information about being pregnant and what to expect as well as answering any questions you may have. As soon as you know you are pregnant, you should get in touch with a midwife or your GP to organise your antenatal care. It’s best to see them as early as possible. Let your midwife know if you have a disability that means you have special requirements for your antenatal appointments or labour. If you don’t speak English, let your midwife know and arrangements will be made for an interpreter.

It is important to tell your midwife or doctor if: • there were any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth • you are being treated for a chronic disease such as diabetes or high blood pressure • you or anyone in your family has previously had a baby with an abnormality, for example spina biﬁ da • there is a family history of an inherited disease, for example sickle cell or cystic ﬁ brosis.

If you are working, you have the right to paid time off for your antenatal care (see page 170). 40 Information ANTENATAL 4 An important part of antenatal APPOINTMENTS care is getting information that will help you to make informed If you are expecting your ﬁ rst choices about your pregnancy. child, you are likely to have up to ANTENATAL CARE Your midwife or doctor should 10 appointments. If you have had give you information in writing a baby before, you should have If you cannot keep an antenatal or some other form that you around seven appointments. appointment, please let the clinic can easily use and understand. In certain circumstances, for or midwife know and make Your midwife or doctor should example if you have or develop another appointment. provide you with information a medical condition, you may in an appropriate format if you: have more appointments. What should happen at the appointments • have a physical, learning or Your appointments may take The aim is to check on you and sensory disability place at your home, in a Children’s Centre, in your GP’s surgery or in your baby’s progress and to • do not speak or read English. hospital. You may be asked to provide clear information and explanations about your care. You may have lots of things go to hospital for your scans. At each appointment you should you want to ask the midwife. Your antenatal appointments have the chance to ask questions It’s a good idea to write your should take place in a setting and discuss any concerns or issues questions down, so you where you feel able to discuss with your midwife or doctor. don’t forget. sensitive problems that may affect you (such as domestic violence, Each appointment should have sexual abuse, mental illness or a speciﬁ c purpose. You will need recreational drug use). longer appointments early in pregnancy to allow plenty of time Early in your pregnancy your for your midwife or doctor to midwife or doctor should give assess you, discuss your care and you information about how many give you information. Wherever appointments you are likely to possible, the appointments have and when they will happen. should include any routine tests. You should have a chance to discuss the schedule with them. The table on pages 42–43 gives a brief guide to what usually happens at each antenatal appointment.

Help and support

If you have any questions or worries, talk to your midwife or doctor. Talking is as much a part of antenatal care as tests and examinations.

41 Antenatal appointments schedule

Appointment What should happen First contact This is the appointment when you tell your midwife or doctor that you are pregnant. with your They should give you information about: midwife or • folic acid and vitamin D supplements doctor • nutrition, diet and food hygiene • lifestyle factors, such as smoking, drinking and recreational drug use • antenatal screening tests. It is important to tell your midwife or doctor if: • there were any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth • you are being treated for a chronic disease such as diabetes or high blood pressure • you or anyone in your family has previously had a baby with an abnormality, for example spina biﬁda • there is a family history of an inherited disease, for example sickle cell or cystic ﬁbrosis.

Booking Your midwife or Your midwife or doctor should: appointment doctor should give you • give you your hand-held notes and plan of care (8–12 weeks) information about: • see if you may need additional care or support • how the baby develops • plan the care you will get throughout your pregnancy during pregnancy • identify any potential risks associated with any work you • nutrition and diet may do • exercise and • measure your height and weight and calculate your pelvic floor exercises body mass index • antenatal screening • measure your blood pressure and test your urine tests for protein • your antenatal care • find out whether you are at increased risk of gestational • breastfeeding, including diabetes or pre-eclampsia workshops • offer you screening tests and make sure you understand • antenatal education what is involved before you decide to have any of them • maternity benefits • offer you an ultrasound scan at eight to 14 weeks to • planning your labour estimate when your baby is due • your options for where • offer you an ultrasound scan at 18 to 20 weeks to to have your baby. check the physical development of your baby and screen for possible abnormalities.

8–14 weeks Ultrasound scan to estimate when your baby is due, check the physical development (dating scan) of your baby and screen for possible abnormalities.

16 weeks Your midwife or doctor should give you information about the ultrasound scan you will be offered at 18 to 20 weeks and help with any concerns or questions you have. Your midwife or doctor should: • review, discuss and record the results of any screening tests • measure your blood pressure and test your urine for protein • consider an iron supplement if you are anaemic.

18–20 weeks Ultrasound scan to check the physical development of your baby. (Remember, the main (anomaly scan) purpose of this scan is to check that there are no structural abnormalities.)

42 25 weeks* Your midwife or doctor should: 4 • check the size of your uterus • measure your blood pressure and test your urine for protein.

28 weeks Your midwife or doctor should: ANTENATAL CARE • use a tape to measure the size of your uterus • measure your blood pressure and test your urine for protein • offer more screening tests • offer your ﬁrst anti-D treatment if you are rhesus negative.

31 weeks* Your midwife or doctor should: • review, discuss and record the results of any screening tests from the last appointment • use a tape to measure the size of your uterus • measure your blood pressure and test your urine for protein.

34 weeks Your midwife or doctor should give you information about preparing for labour and birth, including how to recognise active labour, ways of coping with pain in labour and your birth plan. Your midwife or doctor should: • review, discuss and record the results of any screening tests from the last appointment • use a tape to measure the size of your uterus • measure your blood pressure and test your urine for protein • offer your second anti-D treatment if you are rhesus negative.

36 weeks Your midwife or doctor should give you information about: • feeding your baby • caring for your newborn baby • vitamin K and screening tests for your newborn baby • your own health after your baby is born • the ‘baby blues’ and postnatal depression. Your midwife or doctor should: • use a tape to measure the size of your uterus • check the position of your baby • measure your blood pressure and test your urine for protein.

38 weeks Your midwife or doctor will discuss the options and choices about what happens if your pregnancy lasts longer than 41 weeks. Your midwife or doctor should: • use a tape to measure the size of your uterus • measure your blood pressure and test your urine for protein.

40 weeks* Your midwife or doctor should give you more information about what happens if your pregnancy lasts longer than 41 weeks. Your midwife or doctor should: • use a tape to measure the size of your uterus • measure your blood pressure and test your urine for protein.

41 weeks Your midwife or doctor should: • use a tape to measure the size of your uterus • measure your blood pressure and test your urine for protein • offer a membrane sweep • discuss the options and choices for induction of labour.

* Extra appointment if this is your first baby 43 EARLY ANTENATAL Your booking APPOINTMENTS appointment Most women have their ‘booking In early pregnancy (up until 20–24 appointment’ between the 8th and weeks), your antenatal appointments 12th week of pregnancy. This can will take longer than those in mid- take a couple of hours. You will see pregnancy. This is because your a midwife and sometimes a doctor. midwife or doctor will need time to You should also be offered an assess you and your baby, discuss ultrasound scan. your care and give you information. At each appointment you should • breastfeeding, including have the chance to ask questions workshops and discuss any concerns or issues. • antenatal education Your first appointment • maternity benefits with your midwife or GP • planning your labour As soon as you think you are • your options for where pregnant, you should make an to have your baby. appointment to see your midwife or GP. The earlier you do More information this, the better. At this appointment you will See the NHS Choices be given information pregnancy planner at about: www.nhs.uk/pregnancyplanner • folic acid and vitamin D supplements Weight and height • nutrition and diet You will be weighed at the booking appointment, but you probably will • food hygiene You should be given information not be weighed regularly during • lifestyle factors that about: your pregnancy. Your height will be may affect your health or the measured along with your weight health of your baby, such as • how the baby develops during so that your midwife can calculate smoking, recreational drug use pregnancy your BMI (body mass index). Most and alcohol consumption • nutrition and diet women put on between 10 and • antenatal screening tests • exercise and pelvic floor exercises 12.5kg (22–28lbs) in pregnancy, most of it after the 20th week. (see page 49 for more about • antenatal screening tests these tests). Much of the extra weight is due to • your antenatal care the baby growing, but your body will also be storing fat ready to make breastmilk after the birth. Eating sensibly and taking regular exercise can help. See Chapter 3 for what you should eat and for advice about exercise. In some areas, height, weight and BMI are used to produce a personalised growth chart for your baby’s development. However, other areas will use an average growth chart instead.

44 Questions at the If you are going to have your baby with booking appointment midwifery care in a midwifery unit, 4 in hospital or at home You will be asked a lot of questions to build up a picture You will probably see your own midwife for most of your antenatal of you and your pregnancy. care. You may be offered a visit at the hospital for an initial assessment ANTENATAL CARE This is so that you are given and perhaps for an ultrasound scan or for special tests. Sometimes the support you need and any your midwife may visit you at home. risks are spotted early. You will If you are going to have your baby in hospital probably want to ask a lot of questions yourself. Antenatal care varies around the country. In some areas, the booking appointment is at the hospital, then all or most of the remaining You may be asked about: appointments are with a midwife or GP. However, if there are • the date of the ﬁrst day of your complications, all appointments will be at the hospital. In other areas, last period, to help work out all care is given by a midwife or GP unless there are complications, when your baby is due which mean a referral to the hospital antenatal clinic. • your health • any previous illnesses and operations REGULAR CHECKS Blood pressure • any previous pregnancies AT EVERY or miscarriages ANTENATAL • your and your baby’s father’s origins. This is to ﬁnd out if APPOINTMENT your baby is at risk of certain Your urine and blood pressure inherited conditions, or if there will be checked at every antenatal are other factors, such as a appointment. history of twins Urine • your work or your partner’s work and what kind of Your urine is checked for a number accommodation you live in, of things, including protein or ‘albumin’. If this is in your urine, to see if there is anything A rise in blood pressure later in it may mean that you have an about your circumstances that pregnancy could be a sign of pre- infection that needs to be treated. might affect your pregnancy eclampsia (see page 67). It is very It may also be a sign of pre- • how you are feeling and if you common for your blood pressure eclampsia (see ‘High blood pressure have been feeling depressed. to be lower in the middle of your and pre-eclampsia’ on page 67). pregnancy than at other times. At the end of your booking This is not a problem, but may appointment, you should make you feel light-headed if you understand the plan of care for get up quickly. Talk to your midwife your pregnancy and have your if you are concerned. hand-held notes to carry with you at all times. Your booking appointment is an opportunity to tell your midwife or doctor if you are in a vulnerable situation or if you need extra support. This could be because of domestic violence, sexual abuse or female genital mutilation.

45 APPOINTMENTS You can also ask questions or talk about anything that is IN LATER worrying you. You should be PREGNANCY given information about: From 20–24 weeks, your antenatal • your plan of birth BLOOD TESTS appointments will become more • how to prepare for labour frequent. If your pregnancy is and birth As part of your antenatal care, you will be offered a number of uncomplicated and you are well, • how to tell if you are in blood tests. Some are offered to all you may not be seen as often. active labour women and some are only offered Your later appointments are usually • induction of labour if your if it is thought that you are at risk quite short. Your midwife or baby is late of a particular infection or inherited doctor will: • the ‘baby blues’ and postnatal condition. All of the tests are done • check your urine, blood pressure, depression to help make your pregnancy safer or to check that your baby is healthy. and sometimes your weight • feeding your baby Talk to your midwife or doctor • feel your uterus to check your • screening tests for newborn so that you understand why the baby’s position babies blood tests are being offered and • measure your uterus to check • looking after yourself and so that you can make an informed your baby’s growth your new baby. choice about whether or not you • listen to your baby’s heartbeat want them. Your midwife or doctor if you want them to. Checking your baby’s should also give you information development and about the tests. Below is an outline well-being of all the tests that can be offered. At each antenatal appointment Your blood group and from 24 weeks, your midwife or doctor should check your baby’s rhesus factor growth. To do this, they will Your blood will be tested to check measure the distance from the top your blood group and to see of your uterus to your pubic bone. whether you are rhesus negative or The measurement will be recorded positive. Some women are rhesus in your notes. negative. This is usually not a worry for a first pregnancy but it may In the last weeks of pregnancy, affect the next child. you may also be asked to keep track of your baby’s movements. People who are rhesus positive have If your baby’s movements a substance known as D antigen on become less frequent, slow down the surface of their red blood cells. or stop, contact your midwife or Rhesus negative people do not. doctor immediately. A woman who is rhesus negative can carry a baby who is rhesus You will be offered an ultrasound positive if the baby’s father is scan if your midwife or doctor rhesus positive. During pregnancy has any concerns about your or birth, small amounts of the baby’s growth. baby’s blood can enter the mother’s bloodstream. This can cause the mother to produce antibodies. This usually doesn’t affect the existing pregnancy, but the woman becomes ‘sensitised’. This means that if she gets pregnant with another rhesus positive baby, the immune response will be quicker and much greater. The antibodies produced by the 46 mother can cross the placenta and Hepatitis B If you are HIV positive attach to the D antigen on her 4 This is a virus that can cause serious If you are HIV positive, your baby’s red blood cells. This can be liver disease. If you have the virus doctor will need to discuss harmful to the baby as it may result or are infected during pregnancy, it the management of your in a condition called haemolytic may infect your baby (see page 37). pregnancy and delivery ANTENATAL CARE disease of the newborn, which can Your baby will not usually be ill but with you. lead to anaemia and jaundice. has a high chance of developing long-term infection and serious • There is a one in four chance Prevention of liver disease later in life. Your baby of your baby being infected rhesus disease can start a course of immunisation if you and your baby don’t Anti-D injections prevent at birth to help prevent infection. have treatment. rhesus negative women If you have hepatitis B, you will be • Treatment can significantly producing antibodies against referred to a specialist. reduce the risk of transmitting the baby and reduce the risk Hepatitis C HIV from you to your baby. of a rhesus negative woman 20% of HIV-infected babies This virus can cause serious liver becoming sensitised. develop AIDS or die within disease and there is a small risk that it the first year of life, so it’s Rhesus negative mothers may be passed to your baby if you are important to reduce the risk who are not sensitised are infected. This cannot be prevented at of transmission. offered anti-D injections at present. Tests for hepatitis C are not 28 and 34 weeks as well as usually offered routinely as part of • Your labour will be managed after the birth of their baby. antenatal care. If you think you may to reduce the risk of infection This is quite safe for both the be at risk (see page 37), talk to your to your baby. This may mother and her baby. midwife or GP. They can arrange a include an elective caesarean test. If you are infected, your baby delivery (see page 98). Anaemia can be tested within a few days of • Your baby will be tested for birth. If you have hepatitis C, you Anaemia makes you tired and HIV at birth and at intervals will be referred to a specialist. less able to cope with for up to two years. If your any loss of blood when HIV baby is found to be infected with HIV, paediatricians you give birth. If tests This is the virus that causes AIDS. will be able to anticipate show you are anaemic, If you are infected you can pass certain illnesses that occur you will probably be given the infection to your baby during in infected babies, and treat iron and folic acid. pregnancy, at delivery, or after birth by them early. All babies born breastfeeding. As part of your routine antenatal care, you will be offered a to HIV positive mothers will confidential test for HIV infection. If appear to be HIV positive Immunity to rubella you are HIV positive, both you and at birth, because they (German measles) your baby can have treatment and have antibodies from their mother’s infection. If the If you get rubella in early pregnancy, care that reduce the risk of your baby baby is not affected, the it can seriously damage your unborn becoming infected. If your test result is test will later become baby. Your midwife or doctor will negative, the fact that you had the test negative because the talk to you about what happens as part of your antenatal care should antibodies will disappear. if your test results show low or not affect your ability to get insurance. no immunity. You will be offered • You will be advised not to a rubella immunisation after breastfeed because HIV your baby is born. For more can be transmitted to your information about rubella, visit baby in this way. www.immunisation.nhs.uk Help and support

Syphilis If you think that you are at risk of getting HIV or know you are You will be tested for this sexually HIV positive, talk to your midwife or doctor about HIV testing transmitted infection because if and counselling. You can also get free confidential advice from left untreated, it can lead to the National AIDS Helpline on 0800 567 123 or you can talk in miscarriage and stillbirth. confidence to someone at Positively Women (see page 185). 47 Sickle cell and Cystic fibrosis thalassaemia disorders Cystic fibrosis is an inherited disease Sickle cell and thalassaemia that affects vital organs in the body, disorders are inherited blood especially the lungs and digestive conditions that mainly affect the system, by clogging them with thick way oxygen is carried around sticky mucus. The sweat glands are the body. You will be offered a usually also affected. The disease blood test early in pregnancy is inherited and both parents must for thalassaemia and asked for be carriers of the gene variation for information about your and their baby to be born with cystic your baby’s father’s family origin fibrosis. Testing is offered if there to decide if any other tests are is a family history of cystic fibrosis. required. The information you give Tay-Sachs disease will help your midwife or doctor to offer the correct tests and will also Testing for Tay-Sachs disease should help to give you the correct results be offered if you or your partner of the test. It is very important is of Ashkenazi Jewish origin and ULTRASOUND that you tell the midwife, doctor if you consider yourself or your or person doing the test if you partner to be at risk. SCANS think you or your baby’s father Cervical cancer Most hospitals will offer women have an ancestor who came from Cervical smears detect early changes at least two ultrasound scans outside northern Europe (for in the cervix (the neck of the uterus), during their pregnancy. The first example, someone who is Italian, which could later lead to cancer if is usually around eight to 14 Maltese, Portuguese, Spanish, left untreated. Routine smears are weeks and is sometimes called Indian, Chinese, African or only offered to women over 25. the dating scan because it can African-Caribbean). If you are due to have a cervical help to determine when the Healthy people can be carriers of smear (if you have not had one baby is due. The second scan sickle cell or thalassaemia without in the last three years), you will usually takes place between 18 knowing it and can pass it on to probably be told to wait until and 20 weeks and is called the their children. It’s possible for you or three months after your baby is anomaly scan because it checks your baby’s father to be carriers of born unless you have a history for structural abnormalities. these disorders without it affecting of abnormal smears. This is Ultrasound scans use sound your baby at all. Carriers cannot based on guidance by the NHS waves to build up a picture develop the disorders, but if both cervical screening programme. of your baby in your uterus. of you are carriers there is a risk For more information, go to They are completely painless, that your baby could have a sickle www.cancerscreening.nhs.uk have no known serious side cell or thalassaemia disorder. Your effects on mothers or their midwife or doctor will discuss Herpes babies, and may be carried out the implications for your baby. If you, or your partner, have ever for medical need at any stage For further information contact had genital herpes, or you get your of pregnancy. If you the Sickle Cell Society (www. first attack of genital blisters have any concerns sicklecellsociety.org) or the UK or ulcers during about having a scan, Thalassaemia Society (www.ukts. your pregnancy, talk it overov with org) for more details. let your midwife your midwife, GP or doctor know. or obstetrician. Herpes can be dangerous for your newborn baby and it may need treatment.

48 What do scans tell us? The sound is reflected back and TESTS TO DETECT 4 • Check your baby’s measurements. creates a picture that is shown on ABNORMALITIES This gives a better idea of when a screen. It can be very exciting your baby was conceived and to see a picture of your own baby You will be offered screening moving about inside you. when it is likely to be born. tests that can detect structural ANTENATAL CARE This can be useful if you are Ask for the picture to be explained abnormalities like spina bifida, which unsure about the date of your to you if you cannot make it out. is a defect in the development of last period or if your menstrual It should be possible for your the spine, or some chromosomal cycle is long, short or irregular. partner to come with you and disorders like Down’s syndrome, Your due date may be adjusted see the scan. Although scans are which is caused by an abnormal depending on the ultrasound medical procedures, many couples number of chromosomes. Different measurements. feel that they help to make the maternity services may use different • Check whether you are carrying baby real for them both. Ask if tests, but all tests carried out in the more than one baby. it’s possible to have a copy of the NHS will meet national standards. picture. There may be a small Discuss the tests and what they • Detect some abnormalities, charge for this. mean with your midwife. particularly in your baby’s head or spine. Screening tests can: • Show the position of your • reassure you that your baby baby and your placenta. has no detected structural Sometimes a caesarean section abnormalities is recommended – for example • provide you with an opportunity if your placenta is low lying in to see your baby during the scan late pregnancy. • give you time to prepare for the • Check that your baby is growing arrival of a baby with special needs and developing as expected (this is particularly important • allow you to consider the if you are carrying twins termination of an affected baby. or more). Tests can also provide valuable information for your care during Fetal movement the pregnancy. However, no test You will usually start feeling can guarantee that your baby will some movements between 16 be born without an abnormality. and 22 weeks. Later in pregnancy No test is 100% accurate and some your baby will develop its own abnormalities may remain undetected. pattern of movements – which you will soon get to know. Deciding whether to have tests These movements will range from kicks and jerks to rolls and You may not want to have a ripples and you should feel them screening test if you think that you At the scan every day. At each antenatal would continue your pregnancy You may be asked to drink a lot of appointment, your midwife will whatever the results. If you do have fluid before you have the scan. A full talk to you about the pattern of a screening test and it suggests an bladder pushes your uterus up and movements. A change, especially increased chance of a chromosomal this gives a better picture. You then a reduction in movements, may abnormality, you will be offered lie on your back and some jelly is put be a warning sign that your diagnostic tests, which will give on your abdomen. An instrument baby needs further tests. Try to a more definite diagnosis. These is passed backwards and forwards become familiar with your baby’s diagnostic tests carry a small risk over your skin and high-frequency typical daily pattern and contact of miscarriage, so you may decide sound is beamed through your your midwife or maternity unit not to have them. Discussing the abdomen to the uterus and pelvis. immediately if you feel that the issues with your partner, midwife, movements have changed. doctor and friends may help you in deciding what is right for you.

49 Haemophilia and measures two pregnancy-associated If the screening test shows the risk muscular dystrophy blood chemicals. At the scan, the of the baby having Down’s syndrome radiographer measures the thickness is lower than the recommended Some disorders, such as of the nuchal translucency at the national cut-off, this is known as haemophilia and muscular back of your baby’s neck. This having a ‘low-risk’ result. A low-risk dystrophy, are only found in boys information is used to calculate your result means that you are at a (although girls may carry the individual statistical chance of having low-risk of having a baby with disorder in their chromosomes a baby with Down’s syndrome. Down’s syndrome, but it does not and pass it on to their sons). Tell This nuchal translucency scan can mean there is no risk. your midwife or doctor if these or be used in multiple pregnancies. other genetic disorders run in your If the result shows the risk of the For more information about family, as it may then be important baby having Down’s syndrome is screening for anomalies, visit www. to know your baby’s sex. greater than the recommended fetalanomaly.screening.nhs.uk/ national cut-off, this is known as an publicationsandleaflets ‘increased risk’ or ‘higher risk’ result. TESTS FOR DOWN’S Serum screening An increased risk means you will be Serum screening is a blood test offered diagnostic test but it does SYNDROME AND that screens for Down’s syndrome, not mean that your baby definitely OTHER GENETIC usually at about 16 weeks into your has the condition. The diagnostic DISORDERS pregnancy. It measures three or procedure you will be offered is four pregnancy-associated blood either chorionic villus sampling (CVS) These tests are offered to all pregnant chemicals to give your individual (see next page) or amniocentesis to women. There are different ways statistical chance of having a give you a definite answer about of carrying out screening. baby with Down’s syndrome. Down’s syndrome. Your midwife or Serum screening on its own is not doctor will explain the result to you Combined screening recommended for twin and other and help you decided whether you Combined screening involves a multiple pregnancies. want to have further tests. blood test and an ultrasound scan. All women should have dating and Screening results More information nuchal translucency scans between Some maternity services give the • www.library.nhs.uk eight and 14 weeks. These scans result as ‘lower risk/screen negative’ may be combined. The blood test or ‘higher risk/screen positive’. • www.screening.nhs.uk

50 Amniocentesis DIAGNOSTIC TESTS Sometimes a fine tube is passed 4 Amniocentesis can be offered FOR DOWN’S through the vagina and cervix from 15 weeks of pregnancy if: into the uterus instead. A tiny SYNDROME AND piece of the developing placenta, • you have a positive or higher known as chorionic tissue, is taken. OTHER GENETIC ANTENATAL CARE risk Down’s syndrome screening The chromosomes in the cells of result DISORDERS this tissue are examined. As with • an ultrasound scan detects an These tests will give you a definite amniocentesis, a rapid result can be abnormality that is associated diagnosis of Down’s syndrome and obtained, but if all the chromosomes with a genetic disorder sometimes other abnormalities. are going to be checked the results may take up to two weeks. •your past history or family Your midwife or doctor will explain history suggests that there may what is involved and you will usually The risks be a risk of your baby having be offered counselling. CVS has a 1–2% risk of miscarriage. a genetic or chromosomal This is slightly higher than disorder such as Down’s Chorionic villus amniocentesis. syndrome, sickle cell disorder sampling (CVS) or thalassaemia. CVS can be carried out at around IF A TEST DETECTS What happens 11 weeks. It can give you an earlier diagnosis if you are at risk of having AN ABNORMALITY Using ultrasound as a guide, a child with an inherited disorder, a fine needle is passed through It is always difficult when you are such as cystic fibrosis, sickle cell the wall of the abdomen told there is something wrong disorder, thalassaemia or muscular into the amniotic fluid that with your baby, especially if you dystrophy. surrounds your baby. Within are faced with a painful decision the fluid are cells that contain What happens? about the future of your pregnancy. the same chromosomes as The test takes 10 to 20 minutes Your midwife or doctor will make your baby. A small sample of and may be a little uncomfortable. sure you see the appropriate health this fluid is drawn off and sent Using ultrasound as a guide, a professionals to help you get all the to a laboratory for testing. fine needle is passed through the information and support you need Most women feel only mild abdomen into the uterus. so you can make the choices that discomfort. are right for you and your family.

Usually, the ﬂuid will be tested Help and support for Down’s syndrome and other serious syndromes. The Antenatal Results and Choices (ARC) (see page 186) helps parents results should be available with all issues associated with antenatal testing and its implications. within three working days. They can give you more information or put you in touch with parents If all the chromosomes have to who decided to continue with a pregnancy in which an abnormality be looked at, it can take up to had been detected or those who decided to have a termination. three weeks. This test will reveal Go to www.arc-uk.org for more information. your baby’s sex, so tell your midwife or doctor whether, at this stage, you want to know if your baby is a boy or a girl. The risks Amniocentesis has a 0.5–1% risk of miscarriage. At most, one test in 100 will result in pregnancy loss. When deciding whether or not to go ahead with this test, try to balance the risk of miscarriage against the value of the result to you.

51 MAKING THE MOST OF ANTENATAL CARE

Having regular antenatal care is important for your health and the health of your baby. Most antenatal services are now provided in easily accessible community settings. Waiting times in clinics can vary, and this can be particularly difﬁcult if you have young children with you. Try to plan ahead to make your visits easier. Here are some suggestions: • In some clinics you can buy refreshments. If not, take a snack with you if you are likely to get hungry. • Write a list of questions you want to ask and take it with you to remind you. Make sure you get answers to your questions or the opportunity to discuss any worries. • If your partner is free, they may be able to go with you. This can help them feel more involved in the pregnancy.

Your hand-held antenatal notes

At your ﬁrst antenatal visit, your midwife will DATE WEEKS WEIGHT URINE ALB BP HEIGHT PRESENTATION RELATION FH OEDEMA Hb NEXT SIGN. NOTES enter your details in a record book and add SUGAR FUNDUS OF PP TO to them at each visit. You should be asked to BRIM keep your maternity notes at home with you 1 2 3 4 5 and to bring them along to all your antenatal appointments. Take your notes with you u/s arranged for wherever you go. Then, if you need medical 15/6/09 13 58kg Nil 110/60 15 – ––– 12.0 20/7 JS 17/7 to check maturity attention while you are away from home, you will have the information that is needed with you. 20/7/09 18 59.2kg Nil 125/60 18–20 – – FMF –– 21/8 JS

The chart on the right gives a sample of 21/8/09 22 61kg Nil 135/65 20 –––– 18/9 JS taking iron the information your card or notes may contain, but each clinic has its own system. 18/9/09 26+ 64kg Nil 125/75 24–26 –H– 11.2 28/10 JS Health in Pregnancy Grant Always ask your midwife or doctor to explain MAT B1 given, 28/10/09 30 66kg Nil 125/70 30 ceph 5/5 FHH –– 27/11 JS anything they write on your card. Hb taken

1 Date. This is the date of your antenatal visit. 27/11/09 34 – Nil 115/75 34 ceph 4/5 FHH – 11.0 15/12 JS 2 Weeks. This refers to the length of your pregnancy in weeks from the date of your last menstrual period. Blood pressure (BP). This should stay at about the same 3 Weight. This is your weight. 5 level throughout your pregnancy. If it goes up a lot in the last 4 Urine. These are the results of your urine tests for half of your pregnancy, it may be a sign of pre-eclampsia protein and sugar. ‘+’ or ‘Tr’ means a quantity (or trace) (see page 67). has been found. ‘Alb’ stands for ‘albumin’, a name for one of the proteins detected in urine. ‘Nil’ or a tick or ‘NAD’ all mean the same: nothing abnormal has been discovered. ‘Ketones’ may be found if you have not eaten recently or have been vomiting. 52 38 MAKING THE MOST OF 24 6 Height of fundus. By gently pressing on your abdomen, the midwife or doctor can feel your 4 ANTENATAL CARE uterus. Early in pregnancy the top of the uterus, or ‘fundus’, can be felt low down, below your 12 navel. Towards the end it is well up above your navel, just under your breasts. The ﬁgure should be roughly the same as the ﬁgure in the ‘weeks’ column. If there is a big difference (more than two weeks), ask your midwife what action is appropriate. ANTENATAL CARE

CEPHALIC BREECH PRESENTATION PRESENTATION

2 /5 felt

3 /5 engaged

2 /5 felt

3 /5 engaged 7 Presentation. This refers to which way up your 8 Relation to brim. At the end of pregnancy, your baby’s baby is. Up to about 30 weeks, your baby moves head (or bottom, or feet if they are in the breech position) about a lot. Then they usually settle into a head- will start to move into your pelvis. Professionals ‘divide’ the downward position, ready to be born head first. baby’s head into ‘fifths’ and describe how far it has moved This is recorded as ‘Vx’ (vertex) or ‘C’ or ‘ceph’ down into the pelvis by judging how many ‘fifths’ of the (cephalic). Both words mean the top of the head. head they can feel above the brim (the bone at the front). If your baby stays with its bottom downwards, They may say that the head is ‘engaged’ – this is when this is a breech (‘Br’) presentation. ‘PP’ means 2/5 or less of your baby’s head can be felt (‘palpated’) presenting part, which is the part (head or bottom) above the brim. This may not happen until you are in of your baby that is coming first. ‘Tr’ (transverse) labour. If all of your baby’s head can be felt above the means your baby is lying across your abdomen. brim, this is described as ‘free’ or ‘5/5 palpable’.

DATE WEEKS WEIGHT URINE ALB BP HEIGHT PRESENTATION RELATION FH OEDEMA Hb NEXT SIGN. NOTES SUGAR FUNDUS OF PP TO BRIM

6 7 8 9 10 11

u/s arranged for 15/6/09 13 58kg Nil 110/60 15 – ––– 12.0 20/7 JS 17/7 to check maturity

20/7/09 18 59.2kg Nil 125/60 18–20 – – FMF –– 21/8 JS

21/8/09 22 61kg Nil 135/65 20 –––– 18/9 JS taking iron

18/9/09 26+ 64kg Nil 125/75 24–26 –H– 11.2 28/10 JS Health in Pregnancy Grant

MAT B1 given, 28/10/09 30 66kg Nil 125/70 30 ceph 5/5 FHH –– 27/11 JS Hb taken

27/11/09 34 – Nil 115/75 34 ceph 4/5 FHH – 11.0 15/12 JS

9 Fetal heart (FH). ‘FHH’ or just ‘H’ means ‘fetal heart heard’. ‘FMF’ means ‘fetal movement felt’. 10 Oedema. This is another word for swelling, often of the feet and hands. Usually it is nothing to worry about, but tell your midwife or doctor if it suddenly gets worse as this may be a sign of pre-eclampsia (see page 67). 11 Hb. This stands for ‘haemoglobin’. It is tested in your blood sample to check if you are anaemic. 53 YOUR ANTENATAL The people you are most • An obstetrician is a likely to meet are listed doctor specialising in the care TEAM below of women during pregnancy and labour and after the birth. While you are pregnant you should • A midwife is specially trained normally see a small number of to care for mothers and babies healthcare professionals, led by your throughout pregnancy and labour midwife or doctor, on a regular and after the birth. Midwives basis. They want to make you feel provide care for the majority of happy with all aspects of the care women at home or in hospital. you receive, both while you are Increasingly, midwives will be pregnant and when you have working both in hospitals and in your baby. the community, so that the same Many mothers would like to be able midwife can provide antenatal to get to know the people who care and be present at the birth. You should know the name of the care for them during pregnancy and Your midwife or GP will refer midwife who is responsible for the birth of their baby. The NHS is you for an appointment with your care. working to achieve this but you may an obstetrician if they have still ﬁnd that you see a number of A midwife will look after you a particular concern, such different carers. The professionals during labour and, if everything is as previous complications in you see should introduce themselves straightforward, will deliver your pregnancy or chronic illness. and explain who they are, baby. If any complications develop You can request to see an but if they forget, during your pregnancy or delivery, obstetrician if you have any don’t hesitate to you will also see a doctor. You particular concerns. ask. It may help may also meet student midwives to make a note and student doctors. After the • An anaesthetist is a of who you birth, you and your baby will doctor who specialises in providing have seen and be cared for by midwives and pain relief and anaesthesia. If you what they have said maternity support workers. decide to have an epidural, it will in case you need to be set up by an anaesthetist. discuss any point later on. care from your midwife If you require a caesarean section or an instrumental delivery (e.g. using forceps or ventouse), an anaesthetist will provide the appropriate anaesthesia. In many hospitals your midwife can arrange for you to talk to an anaesthetist about analgesia or anaesthesia if you have medical or obstetric problems. Before or during labour you will be able to speak to your anaesthetist. 54 • An obstetric • Dieticians may be available physiotherapist is specially to advise you about healthy eating 4 trained to help you cope with or special diets, for example if you physical changes during pregnancy, develop gestational diabetes.

childbirth and afterwards. Some ANTENATAL CARE provide antenatal education and teach antenatal exercises, Research relaxation and breathing, active positions and other ways you You may be asked to • A paediatrician is a can keep yourself fi t and healthy participate in a research project doctor specialising in the during pregnancy and labour. during your antenatal care or care of babies and children. After the birth, they advise on labour or after you have given A paediatrician may check postnatal exercises to tone up your birth. This may be to test a your baby after the birth to muscles. Your midwife can help new treatment or to fi nd out make sure all is well and will you with these exercises. your opinions on an aspect be present when your baby of your care. Such projects is born if you have had a are vital if professionals are diffi cult labour. If your baby to improve maternity care. has any problems, you will be The project should be fully able to talk this over with the explained to you and you are paediatrician. If your baby is free to say no. born at home or your stay in hospital is short, you may not see a paediatrician at all. Your Students midwife or GP will check that all is well with you and your baby. Some of the health • Health visitors are specially professionals you see will trained nurses who offer help and have students with them. • A sonographer is support with the health of the The students will be at various specially trained to carry whole family. You may meet your stages of their training but out ultrasound scans. A health visitor before the birth of will always be supervised. You sonographer will perform your baby and you will be visited can say no, but if you let a your dating and nuchal by a member of the team in the student be present it will help translucency or anomaly scan. fi rst few weeks after your baby their education and may even Some women are scanned is born. You may continue to see add to your experience of at other points in their your health visitor or a member pregnancy and labour. pregnancy. of the health visiting team at home or at your child health clinic, Children’s Centre, health centre or GP’s surgery.

55 ANTENATAL EDUCATION Antenatal education (sometimes called antenatal classes) can help to prepare you for your baby’s birth as well as for looking after and feeding your baby. It can help you to keep yourself fit and well during pregnancy and give you confidence as well as information. You can find out about arrangements for labour Choosing an The classes and birth and the sorts of choices antenatal class During pregnancy, you may be able available to you (see page 74 for Think about what you hope to gain to go to some introductory classes information about birth plans). from antenatal classes so that you on babycare. Most start about eight You may also meet some of the can find the sort of class that suits to 10 weeks before your baby is people who will look after you you best. You need to start making due. If you are expecting a multiple during labour. enquiries early in pregnancy so pregnancy, try to start your classes You will be able to talk over any that you can be sure of getting at around 24 weeks, because your worries and discuss your plans, a place in the class you choose. babies are more likely to be born not just with professionals but You can go to more than one class. earlier. Ask your midwife, health visitor or with other women and their Classes are normally held once a GP about what is available in your partners as well. Classes are also week, either during the day or in area, or contact the NCT (see next a really good way to make friends the evening, for about two hours. page). Speak to your community with other parents expecting babies Some classes are for pregnant midwife if you cannot go to classes. at around the same time as you. women only. Others will welcome The midwife may have DVDs to These friendships often help you partners or friends, either to all lend you, or you may be able through the first few months the sessions or to some of them. to hire or buy one. with a baby. Classes are usually In some areas there are classes for informal and fun. women whose first language is not English, classes for single mothers and classes for teenagers. The kinds of topics covered in antenatal relaxed education are: • health in pregnancy and fun • exercises to keep you fit during pregnancy and help you in labour • what happens during labour and birth • coping with labour and information about different types of pain relief • how to help yourself during labour and birth

56 The NCT Children’s Centres (sometimes called 4 The NCT (also known as Sure Start Children’s the National Childbirth Trust) Centres) runs a range of classes. The groups tend to be smaller Children’s Centres also support ANTENATAL CARE and may go into more depth, families with children under the often allowing time for age of ﬁve. They can provide: discussion and for practising • easy access to antenatal care physical skills. For details of • relaxation techniques antenatal courses, along with • health services • how to give birth without any information on local support • parenting and family support intervention, if that is what groups, visit www.nct.org.uk • drop-in sessions you want • outreach services • information on different kinds of birth and intervention • early education and childcare, and • caring for your baby, including feeding • links to training and employment opportunities. • your health after the birth • ‘refresher classes’ for those who have already had a baby • emotions during pregnancy, birth and the early postnatal period. Some classes will try to cover all of these topics. Others will concentrate on certain aspects, such as exercises and relaxation or caring for your baby. For more information on Children’s Centres, including The number of different antenatal meet ﬁnding centres in your area, classes available varies from visit www.surestart.gov.uk place to place. other parents-to-be

57 CONDITIONS AND PROBLEMS IN PREGNANCY

Common minor problems 58 More serious problems 67

Your body goes through a lot of changes during pregnancy. Sometimes these changes can cause you discomfort or irritation, and you may be worried about what is happening to you. There is usually nothing to worry about, but you should mention anything that concerns you to your midwife or doctor. If you think that something may be seriously wrong, trust your own judgement and get in touch with your midwife or doctor straight away. This chapter describes some of the minor and more serious health problems and gives advice on how to deal with them and when you should get help. These problems are listed in alphabetical order.

COMMON MINOR How to avoid backache PROBLEMS • Avoid lifting heavy objects. • Bend your knees and keep your back Backache straight when lifting or picking something As your baby grows, the hollow up from the ﬂoor. in your lower back may become • Move your feet when turning round to more pronounced, and this can avoid twisting your spine. also cause backache. During • Wear ﬂat shoes that allow your weight pregnancy, your ligaments to be evenly distributed. become softer and stretch to prepare you for • Work at a surface that is high enough labour. This can put a so that you don’t stoop. strain on the joints • Try to balance the weight between of your lower two bags when carrying shopping. back and pelvis, • Sit with your back straight and which can cause well supported. backache. • Make sure you get enough rest – particularly later in pregnancy.

58 How to ease backache • A ﬁrm mattress can help to 5 prevent and relieve backache. If your mattress is too soft, put

a piece of hardboard under it CONDITIONS AND PROBLEMS IN PREGNANCY to make it firmer. • Massage can help. When to get help If your backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital. They will be able to give you some advice and may suggest some helpful exercises. Constipation You may become constipated very early in pregnancy because of the hormonal changes taking place in How to ease cramp Feeling hot your body. It usually helps if you pull your During pregnancy you are likely toes hard up towards your ankle How to avoid constipation to feel warmer than normal. This or rub the muscle hard. is due to hormonal changes and • Eat foods that are high in to an increase in the blood supply fibre, like wholemeal breads, Feeling faint to your skin. You are also likely to wholegrain cereals, fruit and You may often feel faint when sweat more. vegetables, and pulses such as you are pregnant. This is because beans and lentils. of hormonal changes taking place How to avoid feeling hot • Exercise regularly to keep your in your body and happens if your • Wear loose clothing made of muscles toned. brain is not getting enough blood natural fibres, as these are more and therefore enough oxygen. • Drink plenty of water. absorbent and ‘breathe’ more If your oxygen level gets too low, than synthetic fibres. • Avoid iron supplements. Ask your you may actually faint. You are most • Keep your room cool. You doctor whether you can manage likely to feel faint if you stand still without them or change to a could use an electric fan to for too long or get up too quickly cool it down. different type. from a chair or out of a hot bath. • Wash frequently to help you Cramp It can also happen when you are lying on your back. to feel fresh. Cramp is a sudden, sharp pain, usually in your calf muscles or feet. How to avoid feeling faint It is most common at night, but • Try to get up slowly after sitting nobody really knows what causes it. or lying down. How to avoid cramp • If you feel faint when standing Regular, gentle exercise in still, find a seat quickly and the pregnancy, particularly ankle and feeling should pass. If it doesn’t, leg movements, will improve your lie down on your side. circulation and may help to • If you feel faint while lying on prevent cramp occurring. your back, turn on your side. It is advisable not to lie flat on your back at any time in later pregnancy or during labour.

59 Headaches Some pregnant women find they get a lot of headaches. How to ease headaches • Try and get more regular rest and relaxation. • Paracetamol in the recommended dose is generally considered safe for pregnant women but there are some painkillers that you should avoid. Speak to your pharmacist, nurse, midwife, health visitor or GP about how much paracetamol you can take and for how long. When to get help Indigestion and In many cases incontinence is heartburn curable, so if you have got a problem talk to your midwife, Indigestion is partly caused by hormonal changes and in later doctor or health visitor. pregnancy by your growing uterus pressing on your stomach. Help and support Heartburn is more than just indigestion. It is a strong, burning pain in the chest caused by stomach You could also call the acid passing from your stomach into When to get help confidential Continence the tube leading to your stomach. If you often have bad headaches, Foundation helpline on This is because the valve between tell your midwife or doctor. Severe 0845 345 0165 (9.30am your stomach and this tube relaxes headaches can be a sign of high to 1pm Mon to Fri) or during pregnancy. blood pressure (see page 67). visit www.continence- foundation.org.uk How to avoid indigestion Incontinence • Try eating smaller meals Incontinence is a common more often. problem. It can affect you during • Sit up straight when you are and after pregnancy. eating, as this takes the pressure Sometimes pregnant women are off your stomach. unable to prevent a sudden spurt • Avoid the foods which affect of urine or a small leak when they you, e.g. fried or highly spiced cough, sneeze or laugh, or when food, but make sure you are still moving suddenly or just getting up eating well (see pages 24–25 for from a sitting position. This may be information on healthy eating). temporary, because the pelvic floor muscles relax slightly to prepare for How to avoid heartburn the baby’s delivery. • Heartburn is often brought on by lying flat. Sleep well propped up Some women have more severe with plenty of pillows. incontinence and find that they cannot help wetting themselves. • Avoid eating and drinking for a few hours before you go to bed. • Your midwife or GP may prescribe an antacid if the problem is persistent.

60 How to ease heartburn Nausea and • Drink a glass of milk. Have one by morning sickness 5 your bed in case you wake with Nausea is very common in heartburn in the night. the early weeks of pregnancy. • Note that you should not take Some women feel sick, and CONDITIONS AND PROBLEMS IN PREGNANCY antacid tablets before checking some are sick. It can happen with your midwife, doctor or at any time of day – or even pharmacist that they are safe for all day long. you to take. Hormonal changes in the Itching first three months are probably one cause. Nausea Mild itching is common in pregnancy usually disappears around because of the increased blood the 12th to 14th weeks. supply to the skin. In late pregnancy It can be one of the most the skin of the abdomen is stretched trying problems in early and this may also cause itchiness. pregnancy. It comes at a time when you may be feeling tired and emotional, and when many people around you may not realise that you are pregnant. How to avoid nausea and morning sickness • If you feel sick first thing in the morning, give yourself time to get up slowly. If possible, eat something like dry toast or a plain biscuit before you get up. • Get plenty of rest and sleep whenever you can. Feeling tired can make the sickness worse. • Eat small amounts of food often rather than several large meals, but don’t stop eating. • Drink plenty of fluids. • Ask those close to you for extra help and support. • Distract yourself as much as you can. Often the nausea gets worse the more you think about it. • Avoid foods and smells that make you feel worse. It helps if someone else can cook. If not, go for bland, non-greasy foods, How to avoid itching such as baked potatoes, pasta and milk puddings, which are • Wearing loose clothing may help. simple to prepare. • You may also want to avoid • Wear comfortable clothes. Tight waistbands can make you synthetic materials. feel worse. Leaking nipples When to get help Leaking nipples are normal and If you are being sick all the time and cannot keep anything down, usually nothing to worry about. tell your midwife or doctor. Some pregnant women experience The leaking milk is colostrum, which severe nausea and vomiting. This condition is known as is the first milk your breasts make hyperemesis gravidarum and needs to feed your baby. specialist treatment. When to get help See your midwife or doctor if the milk becomes bloodstained.

61 Nose bleeds Passing urine often Ask a midwife or obstetric Nose bleeds are quite common Needing to pass urine often may physiotherapist (see pages 54 and in pregnancy because of start in early pregnancy. Sometimes 55) for advice. hormonal changes. They don’t it continues right through Pelvic joint pain usually last long but can be quite pregnancy. In later pregnancy it’s If during or after your pregnancy heavy. As long as you don’t lose the result of the baby’s head you have pain in your pelvic joints a lot of blood, there is nothing pressing on the bladder. when walking, climbing stairs or to worry about. You may also How to reduce the need turning in bed, you could have find that your nose gets more to pass urine pelvic girdle pain (PGP) or symphysis blocked up than usual. • If you find that you have to get up pubis dysfunction (SPD). This is How to stop nose bleeds in the night try cutting out drinks a slight misalignment or stiffness of • Sit with your head forward. in the late evening, but make sure your pelvic joints, at either the back or front. It affects up to one in four • Press the sides of your nose you keep drinking plenty during pregnant women to a lesser or together between your thumb the day. greater extent. Some women have and forefinger, just below the • Later in pregnancy, some women minor discomfort, others may have bony part, for 10 minutes and find it helps to rock backwards much greater immobility. try not to swallow the blood. and forwards while they are on • Repeat for a further 10 the toilet. This lessens the pressure When to get help minutes if this is unsuccessful. of the uterus on the bladder so Getting diagnosed as early as that you can empty it properly. possible can help to minimise • If the bleeding continues, Then you may not need to pass the pain and avoid long-term seek medical advice. water again quite so soon. discomfort. Treatment usually When to get help involves gently pressing on or moving the affected joint so that If you have any pain while passing it works normally again. water or you pass any blood, you may have a urine infection, which Ask a member of your maternity will need treatment. Drink plenty team for a referral to a manual of water to dilute your urine and physiotherapist, osteopath or reduce pain. You should contact chiropractor who is experienced your GP within 24 hours. in treating pelvic joint problems. They tend not to get better The growing baby will increase completely without treatment from pressure on your bladder. If you an experienced practitioner. find this a problem, you can improve the situation by doing Contact the Pelvic Partnership exercises to tone up your for support and information pelvic floor muscles (see page 187). (see page 35). coping with the symptoms

62 5 CONDITIONS AND PROBLEMS IN PREGNANCY Piles Piles, also known as haemorrhoids, are swollen veins around your anus (back passage) which may itch, ache or feel sore. You can usually feel the lumpiness of the piles around your anus. Piles may also bleed a little and they can make going to the toilet uncomfortable or even painful. They occur in pregnancy because certain hormones make your veins relax. Piles usually resolve within weeks after birth. How to ease piles • Eat plenty of food that is high in fibre, Skin and hair changes like wholemeal Hormonal changes taking place bread, fruit and in pregnancy will make your vegetables, and nipples and the area around drink plenty them go darker. Your skin of water. This colour may also darken a little, will prevent either in patches or all over. constipation, Birthmarks, moles and freckles which can make may also darken. Some women piles worse. develop a dark line from their • Avoid standing belly buttons down to the for long periods. top of their pubic hair. These changes will gradually fade • Take regular exercise to improve after the baby has been born, your circulation. although your nipples may • You may find it helpful to use remain a little darker. a cloth wrung out in ice water. If you sunbathe while you are • Push any piles that stick out pregnant, you may find that gently back inside using a you tan more easily. Protect lubricating jelly. your skin with a good, high- • Ask your midwife, doctor or factor sunscreen. Don’t stay pharmacist if they can suggest in the sun for very long. a suitable ointment. Hair growth is also likely to increase in pregnancy. Your hair may also be greasier. After the baby is born, it may symptoms seem as if you are losing a lot of hair. In fact, you are simply losing the extra hair that you grew during pregnancy. 63 It might be more comfortable to lie on one side with a pillow under your tummy and another between your knees.

Sleep Swollen ankles, feet Suggestions for swollen Late in pregnancy it can be very and fingers ankles, feet and fingers difficult to get a good night’s Ankles, feet and fingers often swell sleep. It can be uncomfortable a little in pregnancy because your • Avoid standing for long lying down or, just when you get body is holding more water than periods. comfortable, you find that you usual. Towards the end of the day, • Wear comfortable shoes. have to get up to go to the toilet. especially if the weather is hot or • Put your feet up as much as Some women have strange dreams if you have been standing a lot, you can. Try to rest for an hour or nightmares about the baby the extra water tends to gather in a day with your feet higher and about the birth. Talking the lowest parts of your body. than your heart. about them can help you. • Do foot exercises (see page 35). Stretch marks put your feet up and rest

These are pink or purplish lines which usually occur on your abdomen or sometimes on your upper thighs or breasts. Some women get them, some don’t. It depends on your skin type. Some people’s skin is more elastic. You are more likely to get stretch marks if your weight gain is more than average. It is very doubtful whether oils or creams help to prevent stretch marks. After your baby is born, the marks should gradually pale and become less noticeable.

64 Teeth and gums 5 Bleeding gums are caused by a build-up of plaque (bacteria) on your teeth. During pregnancy, hormonal changes in your body can CONDITIONS AND PROBLEMS IN PREGNANCY cause plaque to make your gums more inﬂamed. They may become swollen and bleed more easily. When your baby is born your gums should return to normal. How to keep teeth and gums healthy • Clean your teeth and gums carefully. Ask your dentist to show you a good brushing method to remove all the plaque. • Avoid having sugary drinks and foods too often. Try to eat them at mealtimes only. Tiredness Towards the end of pregnancy you • Go to the dentist for a check-up. In the early months of pregnancy may feel tired because of the extra NHS dental treatment is free while you may feel tired or even weight you are carrying. Make sure you are pregnant and for a year desperately exhausted. The only that you get plenty of rest. after your baby’s birth. answer is to try to rest as much • Ask your dentist if any new or as possible. Make time to sit with replacement ﬁllings should be your feet up during the day and delayed until after your baby accept any offers of help from is born. colleagues and family. free NHS dental treatment

65 Vaginal discharge If you have varicose veins Almost all women have more • Try to avoid standing for long vaginal discharge in pregnancy. periods of time. It should be clear and white and • Try not to sit with your legs should not smell unpleasant. If crossed. the discharge is coloured or smells • Try not to put on too much strange, or if you feel itchy or sore, weight, as this increases the you may have a vaginal infection. pressure. The most common infection is thrush, which your doctor can treat • Sit with your legs up as often as easily. You can help to prevent you can to ease the discomfort. thrush by wearing loose cotton • Try support tights, which may underwear. also help to support the muscles of your legs. When to get help Tell your midwife or doctor if the • Try sleeping with your legs higher discharge is coloured, smells strange, than the rest of your body – use or if you feel itchy or sore. pillows under your ankles or put books under the foot of your bed. Tell your midwife or doctor if • Do foot exercises (see page 35) vaginal discharge, of any colour, and other antenatal exercises such increases a lot in later pregnancy. as walking and swimming, which Varicose veins will help your circulation. Varicose veins are veins which have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in exercise the vulva (vaginal opening). They usually get better after delivery. helps your circulation

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Contact Netmums, a unique local network and source of discussion – www.netmums.com

66 The symptoms rest at home, but some women Some of the symptoms need admission to hospital and 5 of pre-eclampsia are: medicines that lower high blood pressure. Occasionally, pre-eclampsia • bad headaches is a reason to deliver the baby early CONDITIONS AND PROBLEMS IN PREGNANCY • problems with vision, such as – this may be either by induction of blurred vision or lights flashing labour or by caesarean section. before the eyes When to get help • bad pain just below the ribs If you get any of the symptoms MORE SERIOUS • vomiting described here, or have any reason PROBLEMS • sudden swelling of the to think that you have pre-eclampsia, face, hands or feet. contact your midwife, doctor or the hospital immediately. High blood pressure However, you can have severe and pre-eclampsia pre-eclampsia without any Placenta praevia During pregnancy your blood symptoms at all. Placenta praevia (or a low-lying pressure will be checked at placenta) is when the placenta is Although most cases are mild and every antenatal appointment. attached in the lower part of the cause no trouble, it can be serious This is because a rise in blood uterus, near to or covering the cervix. for both mother and baby. It can pressure can be the first sign of a cause fits in the mother (called condition known as pre-eclampsia The position of your placenta is eclampsia) and affects the baby’s – also called pregnancy-induced recorded at your 18 to 21-week growth. It is life-threatening if left hypertension (PIH) or pre-eclamptic ultrasound scan. If it is significantly untreated. That is why routine toxaemia (PET). It can run in families low you will be offered an extra antenatal checks are so important. and affects 10% of pregnancies. ultrasound scan later in your pregnancy (usually at around Your urine is checked for protein Pre-eclampsia usually happens 32 weeks) to recheck its position. at every visit, as this is a sign towards the end of pregnancy, but For 9 out of 10 women the of pre-eclampsia. it may happen earlier. It can also placenta has moved into the upper happen after the birth. It is likely to part of the uterus by this time. be more severe if it starts earlier in pregnancy. Treatment may start with If the placenta is still low in the uterus, there is a higher chance that you could bleed during your pregnancy or at the time of birth. This bleeding can be very heavy and put you and your baby at risk. You may be advised to come into hospital at the end of your pregnancy so that emergency treatment can be given very quickly if you do bleed. If the placenta is near or covering the cervix, the baby cannot get past it to be born vaginally and a caesarean section will be recommended.

67 Severe itching and obstetric cholestasis Severe itching can be a sign of a condition called obstetric cholestasis. This is a potentially dangerous liver disorder that seems to run in families, although it can occur even if there is no family history. The main symptom is severe generalised itching without a rash, most commonly in the last four months of pregnancy. Obstetric cholestasis can lead to premature birth, stillbirth or serious health problems for your baby. It can When to get help also increase the risk of maternal Slow-growing babies haemorrhage after the delivery. Many of the tests in pregnancy In the last weeks of pregnancy, check that your baby is growing. you should keep track of your When to get help If you have previously had a baby’s movements. If you notice You should see your doctor if: very small baby, or if you smoke your baby’s movements becoming less frequent or stopping, it may • the itching becomes severe – heavily, the midwives and doctors be a sign that your baby is unwell. particularly if it affects your hands will already be monitoring your You should contact your midwife and feet pregnancy closely. Blood pressure checks may also pick up signs that or doctor immediately. • you develop jaundice (yellowing there are complications. If there is of the whites of the eyes and skin) If tests show that your baby is concern about your baby’s health, not growing well in the uterus, • you get itching and a severe rash. further tests might be carried out your midwife and doctor may and your baby will be monitored recommend early delivery by more frequently. induction of labour or caesarean section (see page 98).

Seek medical help You should contact your GP if you have a sudden ‘acute’ illness like diarrhoea, vomiting, abdominal pain or a high fever.

68 Vaginal bleeding 5 Bleeding from the vagina at any time in pregnancy can be a dangerous sign. Some causes of vaginal bleeding are more serious CONDITIONS AND PROBLEMS IN PREGNANCY than others, so it’s important to More information find the cause straight away. For more information see the Bleeding after sex Deep vein thrombosis Royal College of Obstetricians The cells on the surface of the Deep vein thrombosis is a and Gynaecologists’ guideline cervix often change in pregnancy serious condition where clots Thromboprophylaxis during and make it more likely to bleed develop, often in the deep veins pregnancy, labour and after – particularly after sex. This is of the legs. It can be fatal if the vaginal delivery at called a cervical ectropion. Vaginal clot travels from the legs to the www.rcog.org.uk/womens- infections can also cause a small lungs. The risk may increase if health/clinical-guidance/ amount of vaginal bleeding. you are on a long-haul flight thromboprophylaxis-during- (over five hours), where you sit Ectopic pregnancy pregnancy-labour-and-after- still for a long time. vaginal-deliver In early pregnancy, bleeding may be a sign of an ectopic pregnancy When to get help or a miscarriage (see page 151), If you develop swollen and although many women who bleed painful legs or have breathing at this time go on to have normal difficulties, go to your GP and successful pregnancies. or your nearest accident and emergency department Bleeding in late pregnancy immediately. The most common sort of bleeding in late pregnancy is the small amount of blood mixed with mucus that is known as a Vasa praevia ‘show’. This is a sign that the cervix is changing and becoming ready Vasa praevia is a rare condition Problems in early for labour to start. It may happen (occurring in about 1 in 3,000 pregnancy to 1 in 6,000 births). It occurs a few days before contractions Most women feel well in when the blood vessels of the start or during labour itself. early pregnancy but it can be umbilical cord run through the uncomfortable. Some women membranes covering the cervix. describe a pain low down in Help and support Normally the blood vessels would the abdomen similar to a period be protected within the umbilical pain. This does not necessarily Always contact your cord. When the membranes mean that something is wrong, midwife or doctor rupture and the waters break, but if the pain is more than immediately if you have these vessels may be torn, causing discomfort or if there is any vaginal bleeding at any vaginal bleeding. The baby can bleeding, your midwife or stage of pregnancy. lose a life-threatening amount of GP should refer you for a blood and die. It is very difficult to scan in the early pregnancy diagnose but it may occasionally assessment unit. This scan be spotted before birth by an will show whether the ultrasound scan. Vasa praevia pregnancy is growing in the should be suspected if there is uterus. Sometimes you need bleeding and the baby’s heart a second scan to check that rate changes suddenly after all is well. rupture of the membranes. It is linked with placenta praevia (see page 67).

69 CHOOSING WHERE TO HAVE YOUR BABY

Safety 70 Midwifery units Making an informed or birth centres 72 decision 70 Birth in hospital 73 Home births 71 Birth plans 74

You can give birth at home, in a unit run by midwives or in a hospital. This chapter gives information about each of these options so that you can choose what is best for you.

SAFETY MAKING AN Giving birth is generally very safe, INFORMED wherever you choose to have your DECISION baby. There is not much evidence that compares how safe different It is important that you and your places are. However, women partner make an informed choice who have their baby in a unit about where you would like to run by midwives or at home are give birth. less likely to need assistance, It is your choice, and even after for example through the use of you have decided where forceps or a ventouse. you want to have your If you choose to have your baby baby you can still at home or in a unit run by change your mind. midwives, you should be given Your midwife will information about what would discuss the options happen if you need to be that are available transferred to hospital during to you locally, labour and how long this though you are would take. You should also be free to choose aware that if something goes any maternity seriously wrong during your labour services if (which is rare) it could be worse you are for you and your baby than if prepared you were in hospital with access to travel. to specialised care. You may be advised to give birth in hospital if you have, or develop, certain medical conditions.

70 As well as getting information from your midwife, you can get 6 information from: • local maternity units • Children’s Centres CHOOSING WHERE TO HAVE YOUR BABY • your GP surgery • the NCT, which can put you in touch with local mothers (see page 57) • Maternity Services Liaison Committees (www.csip.org.uk/~mslc) HOME BIRTHS The things you should consider • a supervisor of midwives include the following: If you have a straightforward (see page 74). • You may need to transfer pregnancy and both you and the to a hospital if there are any You may also want to seek the baby are well, you might choose complications. views of your friends and family. to give birth at home. In England, See also Chapter 4 on antenatal approximately 1 in 50 babies is • Epidurals are not available care and Chapter 8 on labour born at home. at home. and birth. If you give birth at home, you • Your doctor or midwife may will be supported by a midwife, recommend that you give More information who will support you while you are birth in hospital, for example in labour. If you need any help or if you are expecting twins or your labour is not progressing as if your baby is breech. Your well as it should, your midwife will midwife or doctor will explain make arrangements for you to be why they think hospital is transferred to hospital. safer for you and your baby. The advantages of giving birth at Planning a home birth home include the following: Ask your midwife whether or not • You can give birth in familiar a home birth is suitable for you surroundings where you may feel and your baby or available to you. more relaxed and able to cope. If it is, your midwife will arrange for members of the midwifery • You don’t have to interrupt your team to support and help you. labour to go into hospital. • You will not need to leave your Here are some of the questions www.nhs.uk/pregnancyplanner other children. that you might want to ask: www.birthchoiceuk.com • You will not have to be separated • How long would it take if www.drfoster.co.uk/Guides/ from your partner after you needed to be transferred BirthGuide/ the birth. to hospital? www.nct.org.uk/home • You are more likely to be looked • Which hospital would you be after by a midwife who you transferred to? have got to know during your • Would a midwife be with you pregnancy. all the time? • How do you obtain a birthing pool?

71 The advantages of giving birth at a midwifery unit include the following: • You can give birth in surroundings where you may feel more relaxed and able to cope with labour. • You are more likely to be looked Planning a birth in after by a midwife who you a midwifery unit have got to know during your pregnancy. or birth centre Midwifery care is available at The things you should consider home, in a midwifery unit and include the following: in hospital. Ask your midwife if • You may need to transfer there are any midwifery units to a hospital if there are any or birthing centres in your area. complications. There may be others that you can use if you are prepared to travel. MIDWIFERY UNITS • Epidurals are not available in OR BIRTH CENTRES a midwifery unit. Here are some of the questions that • Your doctor or midwife may you might want to ask: Birth centres and midwifery recommend that it is safer for • How long would it take if you units are home-from-home places you and your baby to give birth needed to be transferred to where you can go to have your in hospital. hospital? baby. These units can be part of a general hospital maternity unit, • Which hospital would you be in a smaller community hospital transferred to? or completely separate. • Will a midwife be with you all the time? • Can you visit the unit before you give birth? the • What facilities are available? Are there birthing pools, choices for example? that are right for you

72 BIRTH IN 6 HOSPITAL Most women give birth in an

NHS hospital maternity unit. CHOOSING WHERE TO HAVE YOUR BABY If you choose to give birth in Planning a hospital birth hospital, you will be looked after Your midwife can help you decide at which hospital you want to have by a midwife but doctors will be your baby. If there is more than one hospital in your locality you can available if you need their help. choose which one to go to. Find out more about the care provided You will still have choices about in each so that you can decide which will suit you best. the kind of care you want. Your midwife and doctors will Here are some of the questions that you might want to ask: provide information about what • Are tours of maternity facilities for birth available before the birth? your hospital can offer. • When can I discuss my birth plan? • Are TENS machines available (see page 89) or do I need to hire one? • What equipment is available – e.g. mats, a birthing chair or beanbags? • Are there birthing pools? • Are partners, close relatives or friends welcome in the delivery room? • Are birthing partners ever asked to leave the room? Why? • Can I move around in labour and ﬁnd my own position for the birth? The advantages of giving birth • What services are provided for sick babies? in hospital include the following: • Who will help me breastfeed my baby? • You have direct access to • Who will help me if I choose to formula feed? obstetricians, anaesthetists and neonatologists. • How long will I be in hospital? • You can access other specialist • What are the visiting hours? services, such as epidurals for relief of pain. • There will be a special care baby unit if there are any problems. The things you should consider include the following: • You may go home directly from the labour ward or you may be moved to a postnatal ward. for you • In hospital, you may be looked after by a different midwife from the one who looked after you during pregnancy.

73 BIRTH PLANS If you don’t have access to a more fully with the baby’s father computer, ask your midwife to print and friends and relatives. And you A birth plan is a record of what out a copy of a birth plan from the can change your mind at any time. you would like to happen during NHS Choices website. Discussing Your birth plan is personal to you. your labour and after the birth. a birth plan with your midwife will It will depend not only on what To see an example of a birth plan, give you the chance to you want, but also on your medical visit the online pregnancy planner at ask questions and history, your own circumstances and www.nhs.uk/birthplan. You don’t find out more about what is available at your maternity have to create a birth plan, but if what happens service. What may be safe and you want to, your midwife will be when you are in practical for one pregnant woman able to help. labour. It also gives may not be a good idea for another. your midwife the chance to get to You may be given a special form know you better for a birth plan, or there may be and understand room in your notes. It’s a good your feelings and idea for you to keep a copy of your priorities. birth plan with you. The maternity team who care for you during You will probably labour will discuss it with you so want to think that they know what you want. But about or discuss remember, you need to be flexible if some things complications arise with you or the baby. The maternity team will be able to give advice on your particular What is a midwife? circumstances. Don’t hesitate to ask questions if you need to. A midwife is a healthcare professional who is qualified to care for women during pregnancy, Read the chapters on labour and labour and after the baby is born. They also birth (page 85) and the first days care for newborn babies until they are 28 days with your new baby (page 120) old, if necessary. Midwives provide care for before talking to your midwife, all women and involve other members of the to see if there is anything you feel team, including doctors when necessary. strongly about and want to include. Midwives help women prepare for birth through antenatal education and provide advice about common problems. A nursing qualification is not necessary to become a midwife, although some midwives have one. What is a supervisor of midwives? A supervisor of midwives is an experienced midwife who has had extra PALS training and education to assist and support midwives in providing the The Patient Advice and Liaison best quality maternity care. Supervisors of midwives aim to make sure Service, known as PALS, has been that you receive the best guidance and information about the right introduced to ensure that the NHS type of care for you. They are there to help and support you if you are listens to patients, their relatives, having any problems with your care, or if you feel that your wishes and carers and friends and answers requests are not being considered. and resolves their concerns as The telephone number for your supervisor of midwives should be in quickly as possible. If you have any your pregnancy information details (or hand-held notes), or you can suggestions or complaints about call your hospital’s labour ward/birthing room or your local birth centre. your care, make contact with the Discussing issues with the supervisor of midwives will not affect your PALS service based in hospitals care or influence how you are further supported in your pregnancy, in the first instance. For more birth and aftercare. information visit www.pals.nhs.uk

74 GETTING PREGNANT 75 81 80 80 81 83 84

Family and friends Domestic abuse Work After the birth that can develop Mood changes a baby after the birth of Bereavement

75 76 77 77 78 78 79 on your health in pregnancy). Hormonal changes taking place in your body can make you feel tired, nauseous, emotional and upset – months.particularly in the ﬁrst three may ﬁnd that you cry more You sometimes for no reason, easily, and lose your temper more. and run down canBeing tired to look Try make you feel low. after your physical health and get plenty of sleep (see Chapter 3 Hormonal changes and tiredness

If you are feeling very anxiousIf you are – talk to– for whatever reason your midwife or doctor as soon as possible.

Help and support

time. You too may think that time. You and downs, just like any other be excited and to ‘bloom’ all the this is the way you ought to feel. likely to have upsIn fact, you are nine months in your life. you to look forward to the baby, to the baby, you to look forward You may ﬁnd that people expect You have to be happy all of the time. sometimes seem as though you When you are pregnant it can pregnant When you are FEELINGS

Depression and mental health problems Depression and about the birth Worrying disabilities Concerns about Couples Sex in pregnancy Single parents Feelings

FEELINGS FEELINGS AND RELATIONSHIPS This chapter is about some of the worries that may come up in pregnancy and suggestionsThis chapter is about some of children and also with your parents and friends. Coping with these changes is not always easy. easy. and friends. Coping with these changes is not always children and also with your parents about the baby and about your future. Your relationships change: with your partner, other partner, relationships change: with your future. Your about the baby and about your From the minute you know you are pregnant, your feelings change: feelings about yourself,From the minute you know you is a problem for one person may not be a problem for you,on how to handle them. What

pages what you find useful. and what is helpful advice for some people may not be right for you. So take from theseand what is helpful advice for DEPRESSION AND MENTAL HEALTH PROBLEMS It’s normal to have some worries while you are pregnant and to feel a bit down from time to time. But it is a cause for concern if you are feeling down most of the time. Whatever the reason for your unhappiness, or even Anxiety Dreams if there doesn’t seem to be any It is quite normal to feel anxious It is normal to have dreams about reason at all, explain how you feel and worried when you are pregnant your baby. Sometimes your dreams to your midwife, doctor or health – especially if this is your first may reflect your anxieties. This is visitor (see page 54 to find out pregnancy. There are a number of often because you are thinking who is who). Make sure that they things that you may feel anxious much more about your pregnancy understand that you are talking about. You may find antenatal tests and the changes that are happening stressful – because of the possibility in your body. Talk to your midwife if that something may be wrong. you are worried by this. You may be worried about practical Ways of coping things like money, work or where • Sometimes it helps to share you are going to live. You may be anxieties with other pregnant anxious about whether you will women. cope as a parent, or about whether you are ready to be a parent. • Discuss any worries, concerns or Some of these anxieties could be anxieties you have with someone about something more than just shared by your partner, friends you feel you can talk to. This could feeling low. Some women do get or family. It is a good idea to talk be your midwife, your partner, depressed during pregnancy and through these feelings together. your friends or family. you may need treatment to help you deal with it. If you have had a mental health problem in the past, then you might be at risk of becoming ill with a depressive illness during pregnancy and childbirth. It is important that you tell your midwife at the start of your pregnancy about any previous illness. If your mood changes throughout the pregnancy then let someone know how you discuss are feeling; don’t suffer alone your – you can be helped. feelings

76 Antenatal education will Talk to your partner or someone also help to prepare you close to you. They may be feeling 7 for labour and the birth anxious too – particularly if they and to know what to are going to be with you in labour. expect (see page 56). Together, you can then work out FEELINGS AND RELATIONSHIPS ways that will help you to cope. You will have an opportunity to discuss this in more detail with your midwife, and to draw up a birth antenatal plan, during the later months of pregnancy (see page 74). education will help prepare you

CONCERNS ABOUT DISABILITIES At some time during pregnancy, most expectant parents worry WORRYING that there may be something wrong with their baby. Some people ABOUT THE BIRTH find that talking openly about their fears helps them to cope. Others prefer not to think about the possibility that something Many women worry about could be wrong. whether they can cope with the pain they will experience during Some women worry because they are convinced that if something labour and while giving birth. does go wrong it will be their fault. You can increase your baby’s It is difficult to imagine what a chances of being born healthy by following the advice outlined contraction is like and no one can in Chapter 3. But there are certain problems which cannot be really tell you – though they may prevented. This is either because the causes are not known or try! Exploring ways of coping with because they are beyond your control. labour may help you to feel more Of all the babies born in the UK, 97% are healthy and 1% of confident and more in control. babies will be born with abnormalities that can be partly or You can begin by reading the completely corrected, such as extra fingers or toes. About 2%, chapter on labour and birth however, will suffer from some more severe disability. Regular (page 85) with your partner or antenatal care and careful observation during labour helps to a friend or relative who will be pick up any potential problems and allow appropriate action with you for the birth. Ask your to be taken. midwife or doctor for any further If you are particularly concerned – perhaps because you or information, and look on the someone in your family has a disability – talk to your midwife internet (www.nhs.uk/pregnancy). or doctor as soon as possible. They may be able to reassure you or offer you helpful information about tests which can be done during pregnancy (see Chapter 4). If you have previously had a baby with an abnormality or disability, talk to your midwife or doctor and see if you need any additional care during this pregnancy.

77 COUPLES you is worried about the future baby’s birth. The chapter on labour and how you are going to cope. and birth (page 85) gives some Pregnancy will bring about big It’s important to realise that during suggestions for ways in which changes to your relationship, pregnancy there are understandable fathers can help, and what it can especially if this is your first baby. reasons for the odd difficulty mean for them to share Some people cope with these between you, and good reasons for this experience. changes easily, others find it harder. feeling closer and more loving. If your relationship is particularly Everybody is different. One practical question you will need problematic, or is abusive, do get It is quite common for couples to to discuss is how you will cope with help. For sources of confidential find themselves having arguments labour, and whether your partner support, like Relate or Women’s every now and then during wants to be there. Many fathers Aid, refer to the list of useful pregnancy, however do want to be present at their organisations featured at the back much they of the book (see page 182). are looking It may be that you do not forward to the have a partner in this baby. Some pregnancy and you need arguments extra support from family may be or friends. You may wish nothing to to talk to your midwife do with the about services that may pregnancy, but be available. See ‘Single others may be parents’ opposite. because one of

SEX IN PREGNANCY It is perfectly safe to have sex during normal for your sex drive to change while others simply feel that they pregnancy. Your partner’s penis and you should not worry about this, don’t want to have sex. You can cannot penetrate beyond your but do talk about it with your partner. find other ways of being loving vagina, and the baby cannot tell or of making love. The most Later in pregnancy, an orgasm what is going on! However, it is important thing is to talk about – or even sex itself – can set off your feelings with each other. contractions (known as Braxton Hicks contractions – see page 87). While sex is safe for most You will feel the muscles of your couples in pregnancy, it may not uterus go hard. There is no need for be all that easy. You will probably alarm, as this is perfectly normal. need to find different positions. If it feels uncomfortable, try your This can be a time to explore relaxation techniques or just lie and experiment together. Even quietly till the contractions pass. early in pregnancy it can become uncomfortable to have sex with Your midwife or doctor will probably your partner on top. This can advise you to avoid sex if you have be because of your bump or any heavy bleeding in pregnancy, because your breasts are tender. since this risks infection in the baby It can also be uncomfortable if – especially if your waters have your partner penetrates you too broken (see page 87). deeply. So it may be better to lie Some couples find having sex on your sides. very enjoyable during pregnancy,

78 Help and support 7 thecoupleconnection.net thecoupleconnection.net

is an innovative new service FEELINGS AND RELATIONSHIPS developed by One Plus One, the UK’s leading relationships research organisation. thecoupleconnection.net has been designed to help couples to cope with changes and to strengthen their relationships. Visit www.thecoupleconnection.net

SINGLE PARENTS with labour on your own. You have as much right as anyone else to If you are pregnant and on your take whoever you like – a friend, own, it is important that there sister, or perhaps your mum. Involve are people who can support you. your ‘labour partner’ in antenatal Sorting out problems, whether classes if you can, and let them personal or medical, is often know what you want from them. difficult when you are by yourself, Ask your midwife if there are and it’s better to find someone antenatal classes in your area that to talk to rather than to let things are run especially for single women. get you down. You may find Think about the people who can it encouraging to meet other help and support you. If there is no mothers who have also gone one who can give you support, it through pregnancy on their own. might help to discuss your situation Don’t feel that, just because you with a social worker. Your midwife don’t have a partner, you have to can refer you or you can contact go to antenatal visits and cope the social services department of your local council directly. Help and support

One Parent Families/Gingerbread One Parent Families/Gingerbread (see page 184) is a self-help organisation for one-parent families that has a network of local groups which can offer you information and advice. They will be able to put you in touch with other mothers in a similar situation. If money is an immediate concern, see the chapter on rights and beneﬁts (page 156) for information on what you can claim and your employment rights. Your local Jobcentre Plus or Citizens Advice Bureau (CAB) will be able to give you more advice. If you have housing problems, contact your local CAB or your local housing advice centre. Ask your local authority at the town hall for the address. Lone Parent Helpline Call free on 0800 018 5026 (9am–5pm, Mon–Fri; 9am–8pm, Wed).

79 FAMILY AND More information WORK Families Information FRIENDS If you work, and you like the people Service Pregnancy is a special time for you you work with, you may have mixed Your local Families Information and your partner, but there may feelings when you go on maternity Service (which may be called be a lot of people around you who leave. Try to make the most of these something else in your local are interested in your baby, such few weeks to enjoy doing the things area) can provide information as your parents, sisters, brothers you want to do at your own pace. about registered childcare, and friends. It is also a good opportunity to make free early education places some new friends. You may meet People can offer a great deal of help and other services available other mothers at antenatal classes in all sorts of ways, and you will in your area. (see page 56) or you may get to probably be very glad of their interest know more people living close by. You can contact them on and support. Sometimes it can feel 0800 2 346 346. You can also as if they are taking over. If so, it can You may have decided that you are search www.childcarelink. help everyone if you explain gently going to spend some time at home gov.uk for your local Families that there are some decisions that with your baby, or you may be Information Service or look on only you and your partner can take, planning to return to work, either your local authority’s website and some things that you would full or part-time, fairly soon after the for more details. prefer to do on your own. birth. If you think that you will be going back to work, you need You may also find that being to start thinking about who will pregnant puts you on the receiving look after your baby in advance. end of a lot of advice, and perhaps It is not always easy to find a bit of criticism too. Sometimes satisfactory childcare arrangements, the advice is helpful, sometimes and it may take you some time. not. Sometimes the criticism can really hurt. The important thing is You may have a relative willing to decide what is right for you – it is to look after your child. If not, your pregnancy and you should contact your Families your baby. Information Service for a list of registered childminders and nurseries. You may also want to think about organising care in your own home, either on your own or sharing with other parents. Care in your own home does not need to be registered, but you should make sure that your carer is experienced and trained to care for babies. However, if you are to claim financial help with the costs, either through tax credits or tax relief on help from your employer, the carer must be approved through the government’s Childcare Approval Scheme. You can find out more at www. childcareapprovalscheme.co.uk

80 MOOD CHANGES 7 THAT CAN DEVELOP AFTER

THE BIRTH FEELINGS AND RELATIONSHIPS OF A BABY If you experience any of the following mood changes, do not feel ashamed of how you are feeling. You are not alone: asking for and accepting help is the first stage of recovery – particularly for the more serious conditions. If you think you are in any way depressed, talk to a healthcare professional as soon as you can. Your midwife, health visitor and GP are all trained to help you, and many voluntary organisations offer advice (see the list of useful organisations on page 182). The baby blues AFTER THE BIRTH Whether this is your first, second or As many as 8 out of 10 women third baby, the first few weeks of get what is commonly called Having a baby and becoming a parenthood are both physically and ‘the baby blues’. It normally parent are major events for both emotionally tiring. It can be difficult begins within a few days of the you and your partner. Becoming to find time for yourself, your partner baby’s birth. a parent usually brings changes or your family when you have the How does it affect you? to your home life, social life and 24-hour demands of a new baby to relationships. Parents of a new baby deal with. Meeting the needs of a Common reactions are to burst experience a variety of emotions baby can be rewarding, but in the into tears for no obvious reason, after the birth. You will feel happy weeks and months following the or to feel on top of the world one and proud of yourself, or possibly birth of a baby you can feel stressed. minute and miserable the next. It is relieved that it is all over. not unusual to feel anxious or tense, It is likely that during the first few lacking in confidence or worried. weeks and months of parenthood you will feel a mixture of emotions. Remember that having a baby Your health visitor will be available can turn your world upside down. to talk to you, but it is important In the first few weeks and months that you talk honestly to your you are likely to feel emotionally partner, friends or family about and physically drained. Becoming how you feel. a parent for the first time can feel like an overwhelming Being a parent means constantly responsibility and it is very easy experiencing new events and to feel inadequate when other carrying out new tasks. You will parents around you seem to be have to learn a new set of skills to coping well. You may expect to cope with these situations. Women love your baby immediately, but do not automatically know how this can take a while and is not to be a mother and men do not always instinctive, and does not automatically know how to be mean that you are not a ‘good’ a father. It is something that you or ‘natural’ mother. Many women learn over time. experience these feelings.

81 If you have twins or triplets, you are more likely to experience postnatal and longer-term depression. This is mainly because of the additional stress of caring for more than one baby. Getting out of the house can be difﬁcult and this can make you feel isolated. Tamba (see page 188) can help you to make contact with other mothers through local twins clubs and through their helpline, Tamba Twinline (0880 138 0509).

Postnatal post When you have a baby your life Postnatal depression traumatic stress disorder and changes, so don’t be too hard on Postnatal depression affects 1 in 10 yourself – you are only human. We women following the birth of their birth trauma all learn to be a parent when we baby. It usually begins in the first six Post traumatic stress disorder actually have a baby, not before. months after childbirth, although symptoms may occur on Give yourself plenty of time to for some women the depression their own or with postnatal adjust to your new life. Find time begins in pregnancy. It can occur at depression. The reasons women to rest and eat a good diet, as this any time within the first year of the develop this are unclear, but will help you to become and stay birth of your baby. women often describe feeling physically and emotionally healthy. ‘out of control’ and very afraid How does it affect you? Talk to someone you can trust during the birth. This condition If you get postnatal depression, you such as your partner, your mum, a can be caused by: can feel as if you are taken over by a friend, or to your midwife or health • a fear of dying or your baby feeling of hopelessness. You may feel visitor, about how you are feeling. dying, or angry, but more often you will feel It can help a lot just to confide in too exhausted to be angry or even someone else. Once they know how • life-threatening situations. to cope with the simplest tasks. you are feeling, they will be able to How does it affect you? give you support. Postnatal depression is serious, and if The symptoms include flashbacks, it is left untreated it can last for longer If you become more unhappy or nightmares, panic attacks, than a year. However, early diagnosis upset, or if your low mood lasts numbed emotions, sleeping and treatment of postnatal depression more than a week, then you are problems, irritable, angry and will result in a faster recovery. Quite probably experiencing something irrational behaviour. often a partner or close family friend other than the baby blues. In these will recognise that there is something If you get any of these symptoms, circumstances, you should talk wrong before you do. you need to talk to someone to your midwife, health visitor or about how you are feeling; doctor – especially if you have had If you think you are depressed, your midwife, GP or health depression before. contact your GP, midwife or health visitor will be able to advise visitor and explain how you are where to get help. feeling. Your partner or a friend could contact them for you if you want. You can also contact the Association for Post-Natal Illness (see page 186) for more information.

82 Puerperal psychosis DOMESTIC ABUSE Help and support 7 This is a much more rare and serious One in four women experience condition, which affects about 1 in Domestic abuse domestic abuse at some point in 500 new mothers. Women with a their lives. This may be physical, If you are in immediate family history of mental illness or FEELINGS AND RELATIONSHIPS sexual, emotional or psychological danger, call 999. who have suffered from puerperal abuse. Of this, 30% starts in psychosis in previous pregnancies For information and support pregnancy, and existing abuse may are at a higher risk of developing call the freephone, 24-hour get worse during pregnancy or this illness. National Domestic Violence after giving birth. Domestic abuse Helpline, run in partnership Symptoms include hallucinations during pregnancy puts a pregnant between Refuge and Women’s (seeing or hearing things that others woman and her unborn child in Aid: 0808 2000 247 cannot), delusions (incredible beliefs danger. It increases the risk of such as thinking you must save miscarriage, infection, premature Refuge the world) and mania (extremely birth, low birth rate, fetal injury www.refuge.org.uk and fetal death. Domestic abuse energetic and bizarre activity like Women’s Aid should not be tolerated. washing and ironing clothes in the www.womensaid.org.uk middle of the night). If you are pregnant and being How does it affect you? abused, there is help available. The symptoms of this illness can You can speak in confidence to your be very severe and sometimes very GP, midwife, obstetrician, health frightening for you, your partner, visitor or social worker. Or call the and your family. In fact, your partner confidential National Domestic may be the first to notice that you Violence Helpline number (see are unwell. It is important that your right) for information and support. partner or someone close to you For further sources of confidential knows the symptoms to look out support, refer to page 184. for. They will appear suddenly, often within the first two weeks following the birth of the baby. Seeking help quickly will ensure that you are treated as early as possible, to help you get well again. Women with this illness are often treated in hospital. Mother and baby units are available so that you will not be separated from your baby.

there is help available

83 Benefits and advice BEREAVEMENT Don’t be afraid to lean on your if your partner family and friends. If your partner has died The death of someone you love was going to be with you at the can turn your world upside down, birth, you will need to think about The following leaflets are and is one of the most difficult who will be with you instead. produced by the Department experiences to deal with. This may Try to choose someone who knows for Work and Pensions be harder to cope with if you are you very well. (www.dwp.gov.uk): pregnant or have just had a baby. Financially, you may need urgent • What to do after a death in Family and friends can help you advice and support. You can get England and Wales (DWP1027) by spending time with you. the recommended leaflets (see box) • The Social Fund (DWP1007) A sympathetic arm around the from your local Jobcentre Plus. (available from www.dwp.gov. shoulders can express love and As well as speaking to friends, family uk to download only) support when words are not enough. and social services, you may like to • A guide to the Social Fund Grief is not just one feeling but a contact Cruse (see page 186). (SB16) whole succession of feelings, which take time to get through and which • Having a baby (DWP1031) cannot be hurried. If you need Read Chapter 17 for advice help or advice, contact your GP or about the following: midwife or any of the organisations listed on page 186. • Income Support If your partner dies • Housing Benefit If your partner dies during your • Working Tax Credit pregnancy or soon after childbirth, you will feel emotionally numb. • Council Tax Benefit It may not be something that you • Child Benefit get over – more something that you eventually learn to live with. • Child Tax Credit • If you were married and your partner worked, you may be entitled to Widowed Parent’s Allowance, based on your partner’s National Insurance contributions. • If you were not married, you will not be classed as a widow and will therefore be dependent on your private arrangements, on Income Support or on Working Tax Credit. • If you are on a low income you may be able to get some help with the funeral expenses from the Social Fund. It is always worth talking to your undertaker or religious adviser to see if they can help. For more information, contact your local Jobcentre Plus or look at www.jobcentreplus.gov.uk

84 LABOUR AND BIRTH

Getting ready 85 Arriving at the hospital or The signs of labour 87 midwifery unit 91 Types of pain relief 88 What happens in labour 92 When to go to hospital Special cases 96 or your midwifery unit 90 Twins, triplets or more 100 What your birth partner can do 101

Going into labour is exciting, but you may also feel apprehensive, so it helps to be prepared well in advance. Knowing all about the stages of labour and what to expect can help you to feel more in control when the time comes.

GETTING READY • Two or three comfortable • Towels. and supportive bras, including • Things that can help you pass Whether you are having your nursing bras if you are planning the time and relax, e.g. books, baby at home, in hospital or at a to breastfeed. Remember, your magazines, MP3 player. midwifery unit, you should get a breasts will be much larger few things ready at least two weeks than usual. • A sponge or water spray to cool you down. before your due date. • About 24 super-absorbent sanitary towels. • Front-opening nightdresses Packing your bag if you are going to breastfeed. • Your wash bag with toothbrush, If you plan to give birth in hospital • Dressing gown and slippers. or a midwifery unit, your midwife will hairbrush, ﬂannel, etc. probably give you a list of what you • Five or six pairs of pants. will need to pack. You may want to • A loose, comfortable outﬁt to include the following: wear after you have given birth and to come home in. • Something loose and comfortable to wear during labour. It should not • Clothes (including a hat) and restrict you from moving around or nappies for the baby. make you too hot. You may need • A shawl or blanket to wrap about three changes of clothes. the baby in.

85 Mobile phones Stocking up Some hospitals and midwifery units When you come home you will allow you to use your mobile will not want to do much phone. Check with your midwife. If more than rest and care for you cannot use your mobile, make your baby, so do as much sure that you have a phone card or planning as you can in change for the phone. advance: • Stock up on basics, such as toilet paper, sanitary Transport towels and nappies. If labour starts early Work out how you will get to • Buy tinned and dried food hospital or the midwifery unit, as it Labour can start as early as like beans, pasta and rice. could be at any time of the day or 24 weeks. If this happens, • If you have a freezer, cook night. If you are planning to go by call your midwife or some meals in advance. car, make sure that it’s running well hospital immediately. and that there is always enough petrol in the tank. If a neighbour has said that they will take you, make an alternative arrangement just in case they are not in. If you have not got a car, you could call a taxi. Or call your maternity unit, which can arrange for an ambulance to pick you up. Try to do so in good time. Home births If you are planning to give birth at home, discuss your plans and what you need to prepare with your midwife. You are likely to need the following: •clothes (including a hat) and nappies for the baby • about 24 super-absorbent sanitary towels. Important numbers Keep a list of important numbers in your handbag or near your phone. There is space for you to write them down at the back of this book. You need to include the following: • Your hospital and midwife’s phone numbers. • Your partner and birth partner’s phone numbers. • Your own hospital reference number (it will be on your card or notes). You will be asked for this when you phone in. • A local taxi number, just in case you need it.

86 THE SIGNS OF • The ‘show’. The plug of mucus in the cervix, which has helped to 8 LABOUR seal the uterus during pregnancy, You are unlikely to mistake the comes away and comes out of the vagina. This small amount of signs of labour when the time LABOUR AND BIRTH really comes, but if you are in any sticky pink mucus is called the doubt, don’t hesitate to contact ‘show’. It usually comes away your midwife. before or in early labour. There should only be a little blood mixed Regular contractions in with the mucus. If you are During a contraction, your uterus losing more blood, it may be a gets tight and then relaxes. You may sign that something is wrong, so have had these throughout your phone your hospital or midwife pregnancy – particularly towards the straight away. end. Before labour, these are called • Your waters break. The bag Braxton Hicks contractions. When of water surrounding your baby you are having regular contractions may break before labour starts. that last more than 30 seconds and To prepare for this, you could keep begin to feel stronger, labour may a sanitary towel (not a tampon) have started. Your contractions handy if you are going out, and will become longer, stronger and put a plastic sheet on your bed. Pain relief in labour more frequent. If your waters break before labour starts, you will notice either a Labour is painful, so it is important Other signs of labour slow trickle from your vagina to learn about all the ways you can • Backache or the aching, heavy or a sudden gush of water that relieve pain. Whoever is going to be feeling that some women get you cannot control. Phone your with you during labour should also with their monthly period. midwife when this happens. know about the different options, as well as how they can support • Nausea or vomiting. you. Ask your midwife or doctor • Diarrhoea. to explain what is available so that you can decide what is best for you. Write down what you want in your birth plan, but remember that you should keep an open mind. You may ﬁnd that you want more pain relief than you had planned, or your doctor or midwife may suggest more effective pain relief to help the delivery. has the time come?

87 TYPES OF PAIN • Have a partner, friend or relative to support you during labour. RELIEF If you don’t have anyone, don’t Self-help worry – your midwife will give you all the support you need. The following techniques can help you to be more relaxed in labour, • Ask your partner to massage you and this can help you to cope (although you may ﬁnd that you with the pain. don’t want to be touched). • Have a bath. • Learn about labour. This can make you feel more in control and less frightened about what is going to happen. Read books like this one, talk to your midwife or doctor and attend ‘Gas and air’ (Entonox) antenatal classes if they are This is a mixture of oxygen and available in your area. another gas called nitrous oxide. ‘Gas and air’ will not remove all • Learn how to relax and stay the pain, but it can help to reduce calm. Try breathing deeply. it and make it easier to bear. Many • Keep moving. Your position women like it because it’s easy to can make a difference. Hydrotherapy use and you control it yourself. Try kneeling, walking around Water can help you to relax or rocking back and forwards. How it works and can make the contractions You breathe it in through a mask seem less painful. Ask if you or mouthpiece which you hold can have a bath or use a yourself. You will probably have a birth pool. The water will be chance to practise using the mask kept at a temperature that is or mouthpiece if you attend an comfortable for you but antenatal class. it will not be above 37°C. Your temperature will be The gas takes 15–20 seconds to monitored closely. work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths. Side effects There are no harmful side effects for you or the baby, but it can make you feel lightheaded. Some women also ﬁnd that it makes them feel sick or sleepy or unable to concentrate on what is happening. If this happens, you can simply staying stop using it. calm will help

88 TENS Intramuscular 8 TENS stands for transcutaneous injections of pain- electrical nerve stimulation. Some relieving drugs hospitals have TENs machines. If not, Injections of drugs like pethidine or you can hire your own machine. diamorphine can help you to relax, LABOUR AND BIRTH TENS has not been shown to be and this can lessen the pain. effective during the active phase of How it works labour. It is probably most effective You are given an intramuscular during the early stages, when many injection. It takes about 20 minutes women experience lower-back pain. to work and the effects last TENS may be useful if you plan to between two and four hours. give birth at home or while you Side effects are at home in the early stages of labour. If you are interested in TENS, • It can make some women feel • A very small tube will be placed you should learn how to use it in very ‘woozy’, sick and forgetful. into your back near the nerves the later months of your pregnancy. • If it has not worn off towards that carry pain from the uterus. Ask your midwife or physiotherapist. the end of labour, it can make it Drugs (usually a mixture of local difficult to push. You might prefer How it works anaesthetic and opioid) are then to ask for half a dose initially, to administered through this tube. Electrodes are taped onto your back see how it works for you. and connected by wires to a small, It takes about 20 minutes to get • If pethidine or diamorphine are battery-powered stimulator known the epidural set up and then given too close to the time of as an ‘obstetric pulsar’. Holding the another 10–15 minutes for it to delivery, it may affect the baby’s pulsar, you give yourself small, safe work. Occasionally it doesn’t work breathing. If it does, an antidote amounts of current. You can move perfectly at first, and needs to may be given. around while using it. be adjusted. • The drugs can interfere with • After it has been set up, the breastfeeding. epidural can be ‘topped up’ by Epidural analgesia an anaesthetist or midwife, or you may be given a machine An epidural is a special type of which will let you top up the local anaesthetic. It numbs the epidural yourself. nerves which carry pain from the birth canal to the brain. For most • Your contractions and the baby’s women, an epidural gives complete heart will need to be continuously pain relief. It can be very helpful for monitored by a machine. This women who are having a long or means having a belt round your particularly painful labour, or who abdomen and possibly a clip are becoming very distressed. attached to your baby’s head. An anaesthetist is the only person Side effects who can give an epidural. If you • Epidurals may make your legs heavy. It depends on the type It is believed that TENS works by think you are going to want one, of epidural that you have. stimulating your body to produce check whether anaesthetists are more endorphins, which are the always available at your hospital. • An epidural should not make body’s own natural painkillers. How it works you feel drowsy or sick. It also reduces the number of pain • A drip will run fluid into a vein in • Your blood pressure can drop. signals that are sent to the brain your arm. This is rare, as the drip in your by the spinal cord. arm will help you to maintain • While you lie on your side or good blood pressure. will help Side effects sit up in a curled position, an There are no known side effects anaesthetist will clean your back • Epidurals can prolong the second for either you or the baby. with antiseptic and numb a small stage of labour. If you can no area with some local anaesthetic. longer feel your contractions, 89 the midwife will have to tell you Alternative methods WHEN TO GO when to push. This may mean of pain relief that instruments are used to help TO HOSPITAL you deliver your baby. However, OR YOUR when you have an epidural, your MIDWIFERY UNIT midwife or doctor will wait longer before they use instruments If it is your first pregnancy, you may as long as your baby is fine. feel unsure about when you should Sometimes, less anaesthetic is go into hospital. The best thing given towards the end so that the to do is call your hospital or unit effect wears off and you can push for advice. the baby out naturally. • You may find it difficult to pass water, and a small tube called a catheter may be put into your bladder to help you. • About 1 in 100 women gets a headache after an epidural. If you develop a headache afterwards, it can be treated. Some women want to avoid the • Your back might be a bit sore for above methods of pain relief and a day or two, but epidurals do not choose acupuncture, aromatherapy, cause long-term backache. homeopathy, hypnosis, massage and reflexology. Most of these • About 1 in 2,000 mothers gets techniques do not provide very • If your waters have broken, you a feeling of tingling or pins and effective pain relief. However, if will probably be told to go in to needles down one leg after having you would like to use any of these be checked. a baby. This is more likely to result methods it is important to discuss it from childbirth itself than from an • If it is your first baby and you with your midwife or doctor and to epidural. You will be advised on are having contractions but your let the hospital know beforehand. when you can get out of bed. waters have not broken, you may Most hospitals do not offer them be told to wait. You will probably for the relief of pain during labour. be told to come in when your If you want to try one of these contractions are regular, strong, alternative techniques, make sure are about five minutes apart and that the practitioner you use is are lasting about 60 seconds. properly trained and experienced • If you don’t live near to your and check with your midwife that hospital, you may need to go this will be available in the maternity in before you get to this stage. unit. For advice, contact the Institute for Complementary and Natural • Second and later babies often Medicine (see page 183). arrive more quickly, so you may need to contact the hospital, midwifery unit or your midwife sooner. Keep active Keep active in labour for as Don’t forget to phone the hospital long as you feel comfortable. or unit before leaving home, and This helps the progress of remember your notes. the birth. Don’t do anything Home birth strenuous but try and move You and your midwife should have or walk around normally. agreed what you will do when labour starts.

90 • probably do an internal examination to ﬁnd out how 8 much your cervix has opened. Tell her if a contraction is coming so that she can wait until it has LABOUR AND BIRTH ARRIVING AT passed. She will then be able to tell you how far your labour THE HOSPITAL OR has progressed. If you would MIDWIFERY UNIT prefer not to have an internal examination you don’t have Delivery rooms Hospitals and midwifery units vary, to have one. so the following is just a guide Delivery rooms have become to what is likely to happen. Your These checks will be repeated at more homelike in recent years. midwife will be able to give you intervals throughout your labour. Most have easy chairs, beanbags more information about your local If you and your partner have and mats so that you can move hospital or unit. made a birth plan, show your about in labour and change midwife so that she knows what position. Some have baths, If you carry your own notes, take kind of labour you want and can showers or birthing pools. them to the hospital admissions help you to achieve it. You should feel comfortable desk. You will be taken to the in the room where you are labour ward or your room, where giving birth. you can change into a hospital gown or a nightdress of your own. Choose one that is loose and Water births preferably made of cotton, because you will feel hot during labour and Some hospitals have birthing will not want something tight. pools (or you can hire one if there is not one available), Examination by so that you can be in water the midwife during labour. Many women The midwife will ask you about ﬁnd that this helps them to what has been happening so far relax. It is possible to deliver and will examine you. If you are the baby in the pool. Speak having a home birth, then this to your midwife about the examination will take place at advantages and disadvantages home. The midwife will: of a water birth. If you want one, you will need to make • take your pulse, temperature arrangements in advance. and blood pressure and check your urine • feel your Bath or shower abdomen to check the baby’s Some hospitals may offer you position and a bath or shower. A warm bath record or listen can be soothing in the early to your baby’s stages of labour. Some women heart, and like to spend much of their labour in the bath as a way of easing the pain.

91 To help yourself get over the urge to push, try blowing out slowly and gently or, if the urge is too strong, in little puffs. Some people ﬁnd this easier lying on their side, or on their knees and elbows, to reduce the pressure of the baby’s head on the cervix.

WHAT HAPPENS If you can, try to sleep. A warm bath or shower may help you to relax. IN LABOUR During the day, keep upright and There are three stages to labour. gently active. This helps the baby In the first stage the cervix gradually to move down into the pelvis and opens up (dilates). In the second helps the cervix to dilate. stage the baby is pushed down the vagina and is born. In the third stage the placenta comes away from the wall of the uterus and is also pushed out of the vagina. The first stage of labour – dilation Fetal heart monitoring The dilation of the cervix Your baby’s heart will be monitored The cervix needs to open to throughout labour. Your midwife about 10cm for a baby to pass will watch for any marked change through. This is called ‘fully dilated’. in your baby’s heart rate, which Contractions at the start of labour could be a sign that the baby is help to soften the cervix so that it distressed and that something gradually opens. Sometimes the needs to be done to speed up the process of softening can take many delivery. There are different ways hours before what midwives refer of monitoring the baby’s heartbeat. to as ‘established labour’. This is Once labour is established, the If you don’t feel comfortable with when your cervix has dilated to at midwife will check you from one of these, tell your midwife. least 4cm. time to time to see how you are • Your midwife may listen to your progressing. In a first labour, the If you go into hospital or your baby’s heart intermittently, but time from the start of established midwifery unit before labour is for at least one minute every labour to full dilation can be established, you may be asked if 15 minutes when you are in between 6 and 12 hours. It is you would prefer to go home again established labour, using a often quicker in subsequent for a while, rather than spending hand-held ultrasound monitor pregnancies. extra hours in hospital. (often called a Sonicaid). This Your midwife should be with method allows you to be free If you go home, you should make you all the time to support you. to move around. sure that you eat and drink, as you She will tell you to try not to push will need energy. At night, try to until your cervix is fully open and get comfortable and relaxed. the baby’s head can be seen.

92 • Alternatively, a clip can be put • Your waters will be broken on your baby’s head to monitor (if this has not already 8 the heart rate. The clip is put on happened) during a vaginal during a vaginal examination examination. This is often and your waters will be broken enough to get things moving. LABOUR AND BIRTH if they have not already done so. • If this doesn’t speed up labour, Ask your midwife or doctor to you may be given a drip explain why they feel that the containing a hormone, which clip is necessary for your baby. is fed into a vein into your arm Speeding up labour to encourage contractions. You may want some pain relief Your labour may be slower than before the drip is started. expected if your contractions are not frequent or strong enough • After the drip is attached, or because your baby is in an your contractions and your awkward position. baby’s heartbeat will be continuously monitored. • Your baby’s heartbeat and your If this is the case, your doctor or contractions may also be followed midwife will explain why they electronically through a monitor think labour should be sped up linked to a machine called a CTG. and may recommend the following The monitor will be strapped to techniques to get things moving: your abdomen on a belt.

support and

Coping at the beginning encouragement • You can be up and moving about if you feel like it. • You can drink ﬂuids and may ﬁnd isotonic drinks (sports drinks) help to keep your energy levels up. You can also snack, although many women don’t feel very hungry and some feel nauseated. • As the contractions get stronger and more painful, you can try relaxation and breathing exercises. Your birthing partner can help by doing them with you. • Your birthing partner can rub your back to relieve the pain if that helps.

93 The second stage of labour – the baby’s birth This stage begins when the cervix is fully dilated, and lasts until the birth of your baby. Your midwife will help you to ﬁnd a comfortable position and will guide you when you feel the urge to push.

Pushing When the head is visible, the When your cervix is fully dilated, midwife will ask you to stop you can start to push when you feel pushing, and to pant or puff you need to during contractions: a couple of quick short breaths, blowing out through your mouth. • Take two deep breaths as This is so that your baby’s head the contractions start, and can be born slowly and gently, push down. giving the skin and muscles of the •Take another breath when you perineum (the area between your need to. vagina and back passage) time to • Give several pushes until the stretch without tearing. contraction ends. • After each contraction, rest and Find a position get up strength for the next one. Find a position that you prefer and which will make labour easier This stage is hard work, but your for you. midwife will help and encourage you all the time. Your birth partner • You might want to remain in bed can also give you lots of support. with your back propped up with This stage may take an hour or pillows, or you may wish to stand, more, so it helps to know how you sit, kneel or squat. Squatting are doing. may be difﬁcult if you are not used to it. The birth • If you are very tired, you might During the second stage, the be more comfortable lying on baby’s head moves down until your side rather than propped up it can be seen. with pillows. This is also a better position for your baby. • You may ﬁnd kneeling on all fours might be helpful if you suffer from backache in labour. It can help if you have tried out some of these positions beforehand.

94 The skin of the perineum usually stretches well, but it may tear. 8 Sometimes to avoid a tear or to speed up the delivery, the midwife or doctor will inject local anaesthetic LABOUR AND BIRTH and cut an episiotomy. Afterwards, the cut or tear is stitched up again and heals. Once your baby’s head is born, most of the hard work is over. With one more gentle push the body is born quite quickly and easily. You can have your baby lifted straight onto you before the cord is cut by your midwife or birthing partner. The third stage of prevent the heavy bleeding which Your baby may be born covered labour – the placenta some women experience. with some of the white, greasy vernix, which acts as a protection After your baby is born, the uterus Let your baby breastfeed as soon in the uterus. can contract to push out the after birth as possible. It helps with placenta. Your midwife will offer breastfeeding later on and it also Skin-to-skin contact you an injection in your thigh just as helps your uterus to contract. Skin-to-skin contact really helps the baby is born, which will speed Babies start sucking immediately, bonding, so it is a good idea to up the delivery of the placenta. although maybe just for a short have your baby lifted onto you time. They may just like to feel The injection contains a drug before the cord is cut so that you the nipple in the mouth. called Syntocinon, which makes can feel and be close to each other the uterus contract and helps to straight away. The cord is clamped and cut, the baby is dried to prevent them from becoming cold, and you will be able to hold and cuddle your baby. Your baby may be quite messy, skin with some of your blood and perhaps some of the vernix on their skin. If you prefer, you can to ask the midwife to wipe your baby and wrap him or her in a blanket skin before your cuddle. Sometimes mucus has to be cleared out of a baby’s nose and mouth. Some babies need additional help to establish breathing and may be taken to the resuscitor in the room to be given oxygen. Your baby will not be kept away from you any longer than necessary.

95 SPECIAL CASES Overdue pregnancies Pregnancy normally lasts about Labour that starts 40 weeks, which is approximately too early (premature 280 days from the ﬁrst day of your labour) last period. Most women will go About 1 baby in every 13 will into labour within a week either side of this date. After the birth be born before the 37th week of pregnancy. In most cases If your labour does not start by Skin-to-skin contact with your labour starts by itself, either with baby is important and helps with 41 weeks, your midwife will contractions or with the sudden offer you a ‘membrane sweep’. bonding. Your baby will like breaking of the waters or a ‘show’ being close to you just after birth. This involves having a vaginal (see page 87). About one early baby examination, which stimulates the The time alone with your partner in six is induced (see next page) and your baby is very special. neck of your uterus (known as the and about one early baby in ﬁve is cervix) to produce hormones which Your baby will be examined by a delivered by caesarean section may trigger natural labour. midwife or paediatrician and then (see page 98). If your labour still doesn’t start, your weighed (and possibly measured) and If your baby is likely to be born given a band with your name on it. midwife or doctor will suggest a early, you will be admitted to a date to have your labour induced Vitamin K hospital with specialist facilities for (started off). If you don’t want labour premature babies. Not all hospitals You will be offered an injection of to be induced and your pregnancy have these facilities, so it may be vitamin K for your baby, which is continues to 42 weeks or beyond, necessary to transfer you and your the most effective way of helping you and your baby will be monitored. baby to another unit, either before to prevent a rare bleeding disorder Your midwife or doctor will check delivery or immediately afterwards. (haemorrhagic disease of the that both you and your baby are newborn). Your midwife should healthy by giving you ultrasound have discussed this with you scans and checking your baby’s beforehand. If you prefer that your movement and heartbeat. If your baby doesn’t have an injection, oral baby is showing signs of distress, doses of vitamin K are available. your doctor and midwife will again Further doses will be necessary. suggest that labour is induced. Stitches Small tears and grazes are often left to heal without stitches because they frequently heal better this If contractions start prematurely, the way. If you need stitches or other doctors may be able to use drugs to treatments, it should be possible stop your contractions temporarily. to continue cuddling your baby. You will probably be given injections Your midwife will help with this as of steroids that will help to mature much as they can. your baby’s lungs so that they are If you have had a large tear or an better able to breathe after the episiotomy, you will probably need birth. This treatment takes about stitches. If you have already had an 24 hours to work. epidural, it can be topped up. If Many multiple birth babies are born you have not, you should be offered prematurely. The normal delivery a local anaesthetic injection. date for twins is 37 weeks and for The midwife or maternity support triplets 33 weeks. worker will help you to wash and If you have any reason to think that freshen up, before leaving the your labour may be starting early, labour ward to go home or to the get in touch with your hospital or postnatal area. midwife straight away.

96 Induction As the baby is being born, a cut Forceps 8 Labour can be induced if your (episiotomy) may be needed to Forceps are smooth metal baby is overdue or there is any enlarge the vaginal opening. instruments that look like large sort of risk to you or your baby’s Any tear or cut will be repaired spoons or tongs. They are curved with stitches. health – for example, if you have to fit around the baby’s head. LABOUR AND BIRTH high blood pressure or if your Depending on the circumstances, The forceps are carefully positioned baby is failing to grow and thrive. your baby can be delivered onto your around your baby’s head and joined Induction is always planned in abdomen and your birthing partner together at the handles. With a advance, so you will be able to talk may still be able to cut the cord, contraction and your pushing, an over the benefits and disadvantages if they want to. obstetrician gently pulls to help with your doctor and midwife and deliver your baby. find out why they recommend There are many different types your labour is induced. Ventouse of forceps. Some forceps are Contractions are usually started A ventouse (vacuum extractor) specifically designed to turn the by inserting a pessary or gel into is an instrument that has a baby to the right position to be the vagina, and sometimes both soft or hard plastic or metal born, for example if your baby are used. Induction of labour may cup which is attached to your is ‘back to your back’. take a while, particularly if the neck baby’s head by a tube that is Forceps can leave small marks of the uterus (the cervix) needs fitted to a suction device. The on your baby’s face. These will to be softened with pessaries or cup fits firmly onto your baby’s disappear quite quickly. gels. Sometimes a hormone drip head and, with a contraction is needed to speed up the labour. and your pushing, the Afterwards Once labour starts it should proceed obstetrician or midwife gently You will sometimes be fitted with a normally, but it can sometimes take pulls to help deliver your baby. catheter (a small tube that fits into 24–48 hours to get you into labour. The suction cup (ventouse) your bladder) for up to 24 hours. Assisted birth (forceps can leave a small mark on your You are more likely to need this if or ventouse delivery) baby’s head called a chignon you have had an epidural, as you and it may also cause a bruise may not have full feeling back. About one in eight women have an on your baby’s head called a assisted birth, where forceps or a cephalhaematoma. A ventouse ventouse are used to help the baby is not used if your baby is less out of the vagina. This can be because: than 34 weeks old, because • your baby is distressed the head is too soft. • your baby is in an awkward A ventouse is less likely to cause position vaginal tearing than forceps. • you are too exhausted. Both ventouse and forceps are safe and are used only when necessary for you and your baby. A paediatrician may be present to check your baby’s health. A local anaesthetic will usually be given to numb the birth canal if you have not already had an epidural or spinal anaesthetic. If your obstetrician has any concerns, you may be moved to a theatre so that a caesarean section can be carried out if needed.

97 If you are expecting twins, triplets The operation or more, it is more likely that you In the UK, most caesarean sections will be advised to have a caesarean are performed under epidural or section. This will depend on how spinal anaesthesia, which minimises your pregnancy progresses, the risk and means that you are awake position of your babies and whether for the delivery of your baby (see the babies share a placenta. page 89). A general anaesthetic is Whenever a caesarean is suggested, sometimes used – particularly your doctor will explain why it if the baby needs to be delivered is advised and any possible side very quickly. effects. Do not hesitate to If you have an epidural or spinal Caesarean section ask questions. anaesthesia, you will not feel pain There are situations where the Urgent (emergency) – just some tugging and pulling as safest option for you or your baby caesareans your baby is delivered. A screen will be put up so that you cannot see is to have a caesarean section. Urgent (emergency) caesarean what is being done. The doctors will As a caesarean section involves sections are necessary when talk to you and let you know what major surgery, it will only be complications develop and delivery is happening. performed where there is a real needs to be quick. This may be clinical need for this type of delivery. before or during labour. If your Your baby is delivered by cutting midwife and doctor are concerned through your abdomen and then about your or your baby’s safety, into your uterus. The cut is made they will suggest that you have a across your abdomen, just below caesarean straight away. Sometimes your bikini line. The scar is usually your doctor or midwife may suggest hidden in your pubic hair. an emergency caesarean if your cervix does not dilate fully during labour.

Planned (elective) caesareans A caesarean is ‘elective’ if it is planned in advance. This usually happens because your doctor or midwife thinks that labour will be dangerous for you or your baby.

98 Once a caesarean 8 always a caesarean? If you have your first baby by caesarean section, this does LABOUR AND BIRTH not necessarily mean that any future baby will have to be delivered in this way. Vaginal birth after a previous caesarean can and does happen. This will depend on your own particular circumstances (see page 155). It takes about 5–10 minutes to Depending on the help you have at Discuss your hopes and plans deliver the baby and the whole home, you should be ready to leave for any other deliveries with operation takes about 40–50 hospital within two to four days. your doctor or midwife. minutes. One advantage of an You will be encouraged to become epidural or spinal anaesthetic is mobile as soon as possible, and your that you are awake at the moment midwife or hospital physiotherapist of delivery and can see and hold will give you advice about postnatal your baby immediately. Your birth Help and support exercises that will help you in your partner can be with you. recovery. As soon as you can move Contact the Caesarean After a caesarean section without pain, you can drive – as Support Network for After a caesarean section, you long as you are able to make an information and support will be uncomfortable and will be emergency stop. This may be six (see page 182). offered painkillers. You will usually weeks or sooner. be fitted with a catheter (a small tube that fits into your bladder) for up to 24 hours and you may be prescribed daily injections to prevent blood clots (thrombosis). first moments together

99 Breech birth If your baby is breech, it means that it is positioned with its bottom downwards. This makes delivery more complicated. Your obstetrician and midwife will talk to you about the best and safest way for your breech baby to be born. You will be advised to have your baby in hospital.

TWINS, TRIPLETS If the second baby is in a good position to be born, the waters OR MORE surrounding the baby will be broken, If you are expecting twins, labour and the second baby should be born may start early because of the very soon after the first because increased size of the uterus. the cervix is already fully dilated. It is unusual for multiple pregnancies If contractions stop after the first to go beyond 38 weeks. More birth, hormones will be added to health professionals will usually be the drip to restart them. present at the birth. For example, Triplets or more are almost there may be a midwife, an always delivered by elective obstetrician and two paediatricians caesarean section. (one for each baby). External cephalic version The process of labour is the same You will usually be offered the but the babies will be closely Help and support option of an external cephalic monitored. To do this, an electronic version (ECV). This is when pressure monitor and a scalp clip might be Contact the Multiple is put on your abdomen to try fitted on the first baby once the Births Foundation (MBF) or to turn the baby to a head waters have broken (see page 87). Twins and Multiple Births down position. You will be given a drip in case it Association (Tamba) for Caesarean section is needed later, and an epidural is advice and support usually recommended. Once the first (see pages 183 and 188). If an ECV doesn’t work, you will baby has been born, the midwife probably be offered a caesarean or doctor will check the position section. This is the safest delivery of the second by feeling method for breech babies but there your abdomen and doing is a slightly higher risk for you. a vaginal examination. See the section on caesarean sections for more information (see pages 98–99). If you choose a caesarean delivery and then go into labour before the operation, your obstetrician will assess whether to proceed with an emergency caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.

100 WHAT YOUR BIRTH PARTNER CAN DO 8 Whoever your birth partner is – your partner, your baby’s father, a close friend or a relative – there are quite a few practical things that he or she can do to help you. The most important thing will probably be just being with LABOUR AND BIRTH you. Beforehand you should talk about what you want, and what you don’t want, so that they can support your decisions. There is no way of knowing what your labour is going to be like or how each of you will cope, but there are many ways in which a partner can help.

They can: For many couples, being • Help you to make it clear to together during labour and • Keep you company and help the midwife or doctor what welcoming their baby together to pass the time in the you need – and the other way is an experience that they early stages. round. This can help you to cannot begin to put into words. • Hold your hand, wipe your feel much more in control And many fathers who have face, give you of the situation. seen their baby born and who sips of water, have played a part themselves massage your • Tell you what is happening say they feel much closer to back and as your baby is born if you the child from the very start. shoulders, help cannot see what is going on you move about for yourself. or change position, or anything else that helps. • Comfort you as your labour progresses and your contractions get stronger. • Remind you how to use relaxation and breathing techniques, perhaps breathing with you if it helps. • Support your decisions, for example about pain relief.

101 FEEDING YOUR BABY

Breastfeeding 103 Formula feeding 115

It’s never too early to start thinking about how you are going to feed your baby. Breastfeeding gives your baby the best possible start in life as it has lots of beneﬁts for both you and your baby that last a lifetime. Discuss it with your partner as their help is important. You both might like to watch the Bump to Breastfeeding DVD to see what feeding your baby might be like. If you have not received a copy of the DVD, ask your midwife for one.

• Your breastmilk is the only food designed for your baby. It contains everything your baby needs for What does breastfeeding around the first six months of life. help protect against? After that, giving your baby breastmilk alongside solid food Your baby: You: will help them continue to grow and develop. The World Health Ear infections Breast cancer Organization recommends Asthma Weak bones breastfeeding for two years later in life or longer. Eczema Ovarian Chest infections • Breastfeeding protects your cancer baby from infections and Obesity Women who diseases. It also offers health Gastro- breastfeed benefits for mums. Every day intestinal get their makes a difference to your baby, infections figures and the longer you breastfeed, back faster Childhood the longer the protection lasts. diabetes And it reduces your chance of getting some illnesses later in life. Urine Formula milk cannot give your infections baby the same ingredients or provide the same protection. Help and support • Breastfeeding helps build a strong Midwives, health visitors and trained volunteers – or peer supporters bond between mother and baby, – can all offer advice and practical help with breastfeeding. Peer both physically and emotionally. supporters are mothers who have breastfed their own babies and have • Breastfeeding reduces the risk had special training to help them support other mothers. Talk to your of cot death. midwife or health visitor about the help that is available in your area.

102 9 FEEDING YOUR BABY BREASTFEEDING needs. Around days two to four, you may notice that your breasts become ‘Liquid gold’: the Just like any new skill, breastfeeding fuller and warmer. perfect food for your takes time and practice to work. newborn This is often referred to as your milk In the first few days, you and your ‘coming in’. To keep yourself as Colostrum is sometimes baby will be getting to know each comfortable as possible, feed called ‘liquid gold’. This other. Close contact and holding your baby as often as they want. extra-special breastmilk is full your baby against your skin can Your milk will vary according to of germ-fighting antibodies really help with this. your baby’s needs. It will look quite that will help protect your baby The more time you spend with thin compared with colostrum, but against infections that you have your baby, the quicker you will gets creamier as the feed goes on. had in the past. The first few learn to understand each other’s Let your baby decide when they feeds ‘coat’ your baby’s gut to signs and signals. The next few have had enough. protect them from germs and pages will help you to understand reduce the chances of them Sometimes, breastmilk may leak how breastfeeding works. And developing allergies as they from your breast – try gentle but remember, it’s OK to ask for help. get older. firm hand pressure on your nipple Immediately after whenever this happens. Later on, your breastmilk will your baby is born This usually helps very quickly. still contain antibodies, and as If you decide to buy breast pads, you come across new infections Every pregnant woman has milk it is necessary to change them you will have new antibodies ready for her baby at birth. This at each feed. Plastic-backed ones in your milk. This means that if milk is called colostrum and it is can make you even soggier. you get colds or flu while you sometimes quite yellow in colour. are breastfeeding, your baby It is very concentrated, so your will automatically get some baby only needs a small amount immunity from those illnesses. at each feed, which might be quite frequent. It is full of antibodies to boost your baby’s ability to fight off infection. Holding your baby against your skin straight after birth will calm them, steady their breathing and keep them warm. It will also encourage them to breastfeed. Babies are often very alert in the first hour after birth and keen to feed. Your midwife can help you with this. The first few days Each time your baby feeds, they are letting your body know how much milk it needs to produce. The amount of milk you make will increase or decrease in line with your baby’s

103 In the beginning, it can seem that First steps: starting you are doing nothing but feeding, to breastfeed but gradually your baby will get You can breastfeed in a number into a pattern of feeding and the of different positions. Finding one amount of milk you produce will that is comfortable for both of settle. Your baby will be happier if you will help your baby feed as you keep them near you and feed well as possible. them whenever they are hungry. This will quickly help your body to If you are lying back in a well produce the amount of milk your supported position with your 1 baby needs. At night, your baby Hold your baby’s whole body close with baby lying on your tummy, they the nose level with your nipple. will be safest sleeping in a cot in the will often move themselves onto same room as you. This will make your breast and begin to feed. feeding easier and will reduce the Remember at all times to keep risk of cot death. Try to take each your baby safe. day as it comes. If you are very You can try feeding lying on your uncomfortable or sore, ask for help. side or in a chair, supported in an upright position. This will make it easier to hold your baby so their neck, shoulders and back are supported and they can reach your 2 breast easily. Their head and body Let your baby’s head tip back a little so should be in a straight line. that their top lip can brush against your nipple. This should help your baby to make a wide open mouth.

Partners and breastfeeding As a partner, you can bond with your baby in lots of different ways, like bathing, changing nappies and carrying your baby 3 in a sling close to you. You can also help by bringing your baby When your baby’s mouth opens wide, the chin is able to touch the breast ﬁrst, with to their mother when it’s time for a feed. Some parents worry the head tipped back so that the tongue that breastfeeding will make it harder for their partner to bond can reach as much breast as possible. with the baby. But this doesn’t have to be the case. You have an important role to play in supporting your partner, for example by preparing meals or providing extra help so she can get some rest. You can do small, practical things like making sure she has a cool drink to hand while she is feeding, and later you can even give some feeds yourself, using expressed milk. 4 With the chin ﬁrmly touching, and with the nose clear, the mouth is wide open, and there will be much more of the darker skin visible above your baby’s top lip than below their bottom lip – and their cheeks will look full and rounded as your baby feeds.

104 Your baby’s sucking causes milk If you have any concerns about any stored in your breasts to be How do I know that of these points, talk to your peer 9 squeezed down ducts inside your my baby is feeding supporter, midwife, GP or health breasts towards your nipples. This well? visitor, or contact the National is called the ‘let-down’ reflex. Some Breastfeeding Helpline on • Your baby has a large FEEDING YOUR BABY women get a tingling feeling which 0300 100 0212. mouthful of breast. can be quite strong, while others Note that if your baby seems feel nothing at all. You will see your • Your baby’s chin is firmly unusually sleepy and/or is slow to baby respond and their quick sucks touching your breast. start feeding, they may be ill, so change to deep rhythmic swallows • It doesn’t hurt you to feed contact your GP as soon as possible. as the milk begins to flow. Babies (although the first few sucks often pause after the initial quick may feel strong). sucks while they wait for more • If you can see the dark skin Helpful tips milk to be ‘delivered’. If your baby around your nipple, you falls asleep quickly before the deep should see more dark skin Breastfeeding should swallowing stage, check that they above your baby’s top lip feel comfortable. Your are properly latched on. It might be than below their bottom lip. easier to get someone else to check baby should be relaxed. for you. Sometimes you will notice • Your baby’s cheeks stay You should hear a soft your milk flowing in response to rounded during sucking. swallowing. If it doesn’t your baby crying or when you have • Your baby rhythmically takes feel right, start again. a warm bath. long sucks and swallows Slide one of your fingers (it’s normal for your baby to into your baby’s mouth, pause from time to time). gently break the suction and try again. • Your baby finishes the feed and comes off the breast on their own.

After your baby has ﬁnished feeding, you can hold them upright on your shoulder to wind them – that is, until they burp. Breastfed babies don’t usually get as much wind as formula-fed babies.

a strong bond

105 How do I know my baby is getting enough milk? • Your baby should be healthy and gaining weight. Tips for breastfeeding By the time a newborn baby starts • In the first 48 hours, your • Make sure your baby is well crying, they will normally have baby is likely to have only two attached to your breast (see pictures been hungry for a while. or three wet nappies. Wet on page 104). This will help your • Try not to give your baby any nappies should then start to body make the right amount of other food or drink before the become more frequent, with milk and stop your breasts getting age of about six months. This will at least six every 24 hours sore. The more you breastfeed reduce your milk supply and could from day five onwards. your baby, the more milk you will increase the chance of your baby • Most babies lose weight produce. When your baby comes getting ill. initially. They should be off the first breast, offer the • Try not to give your baby a dummy weighed by a health second. It doesn’t matter if they until breastfeeding is going professional some time are not interested or don’t feed well, as this can also reduce your around day three to five. for long, or even if they feed for milk supply. longer on the second breast. This From then on, they should • When you are out and about, is fine – just start with this breast start to gain weight. Most wear something that will make it next time. Sometimes your baby babies regain their birth easier for you to breastfeed. weight in the first two weeks. might seem hungrier than usual and feed for longer or • At the beginning, your more often. Your body baby will pass a black Colour guide responds automatically tar-like stool (poo) called and makes more milk meconium. By day three, for a baby’s don’t forget stools for to provide the extra this should be changing needed. This is why you to a lighter, runnier, the first to ask few days can feed more than one greenish stool that is baby at the same time easier to clean up. (see next page). for help From day four and for Day 1 the first few weeks, • There is no need to if you need it! your baby should pass offer formula milk in at least two yellow addition to breastmilk. stools every day. These If your baby feels hungrier, feed more stools should be at least Day 2–3 the size of a £2 coin. often, rather than Dummies Remember, it’s normal offer formula milk. for breastfed babies to • After a while, you will Try not to give your baby a pass loose stools. get to know the signs dummy until breastfeeding is • Your breasts and nipples Day 4 that mean your baby established, usually when your should not be sore. If they is ready to feed. Most baby is a month old. Using are, do ask for help. babies will signal that dummies has been shown they are hungry by to reduce the amount of • Your baby will be opening and closing milk that is produced. If your content and satisfied their mouths, making baby becomes accustomed after most feeds and sucking noises, to using a dummy while will come off the breast opening their eyes or sleeping, it should not be on their own. turning their heads to stopped suddenly in the first If you are concerned bring their mouths six months. But you should about any of these points, towards you. stop using a dummy when speak to your midwife or your baby is between six and health visitor. 12 months old.

106 More information is and how many feeds they need while you are apart, but it’s often 9 easier to manage than people The Equality Bill think. Your peer supporter, midwife, The Equality Bill offers mothers health visitor, local support group or stronger protection when FEEDING YOUR BABY Breastfeeding more the National Breastfeeding Helpline breastfeeding. The Equality Bill than one baby (0300 100 0212) can explain the will make it clear that it is unlawful options and talk them through to force breastfeeding mothers Twins, triplets or more can be with you. and their babies out of places breastfed. Because multiple like coffee shops, public galleries babies are more likely to be born If you stop breastfeeding, it can and restaurants. prematurely and to have a low be difficult to start again. Giving birth weight, breastmilk is especially formula milk to a breastfed For further information go to important for their well-being. baby can reduce your supply www.equalities.gov.uk To start with, you may find it of breastmilk. easier to feed each of your babies separately, until you feel confident about handling them at the same time and feeding is well established. This may take some time, so it can be really helpful to accept any offers positive of help around the house from family and friends. Over time, you will learn what feeding works best for you and your babies. don’t forget Triplets can be breastfed either two together and then one after, or all three rotated at each feed. Alternatively, you can use a combination of breast and formula, depending on the babies and your milk supply. How long should I breastfeed? Exclusive breastfeeding (with no other food or drink) is recommended for around the first six months of a baby’s life. After this, you can carry on giving your baby breastmilk alongside other foods for as long as you and your baby want. This can be into the second year or beyond. Every day you breastfeed makes a difference to you and your baby. There is no need to decide at the beginning how long you will breastfeed. Many mothers continue to breastfeed if or when they return to work or college. The practicalities will depend on how old your baby

107 Expressing milk 3 Using your thumb and the rest of Expressing milk if your Expressing milk means removing your fingers in a C shape, squeeze baby is premature or ill milk from your breast. You may gently about 3 to 6cm behind the It is important to start expressing want to express milk if your breasts nipple – this should not hurt. your milk as soon as possible are feeling uncomfortably full, after your baby is born. To ensure or if your baby is not sucking that you produce plenty of milk, well but you still want to give you will need to express at least them breastmilk. six to eight times in 24 hours, including during the night, just as If you have to be away from your your baby might be doing if they baby – for example, because your were able to feed directly. Ask the baby is ill or premature, or because hospital staff about having skin- you are going back to work – you to-skin contact with your baby as may wish to express milk so that soon as possible after the birth. somebody else can feed your baby. This will help with bonding and You can express milk by hand or STEP 3 keeping up your milk supply. with a breast pump. Different pumps suit different women, so ask 4 Release the pressure then repeat, for information to compare them. building up a rhythm. Avoid A pump needs to be clean and sliding your fingers over the skin. sterilised each time it is used. At first, only drops will appear, but just keep going as it will Expressing by hand help build up your supply. It is more effective to express milk With practice, and a little time, by hand than to use a pump in the milk will flow freely. first few days. If you want to collect the milk, you will need a sterilised container. The following suggestions should help: 1 Before you start, wash your hands thoroughly then gently massage your breast. 2 Cup your breast and feel back Hospitals often have machines from the end of the nipple to for expressing milk, and will where the texture of your breast show you how to use one. feels different. Alternatively, you can hire an STEP 4 electric breast pump. Contact breastfeeding organisations 5 When no more drops are or pump companies directly to coming, move your fingers round find out about pump hire in to try a different section of your your area (see page 114 for breast and repeat. contact details). 6 When the flow slows down, If you are freezing breastmilk swap to the other breast. Keep because your baby is premature changing breasts until the milk or ill, ask the staff caring for your is dripping very slowly or stops baby for support and information. altogether. Also see opposite for guidance 7 If the milk doesn’t flow, try on storing breastmilk. moving your fingers slightly Your midwife, health visitor or towards the nipple or further peer supporter can give you away, and try giving your breast practical help and answer any a gentle massage. questions. STEP 2 108 Cup feeding The following suggestions may Sometimes, your baby might also help: 9 need some extra milk, or find it • Try squeezing out a drop or two hard to feed from your breast. Milk that has been frozen is still of your milk at the end of a feed

In this case, your midwife might good for your baby and better than and gently rubbing it into your FEEDING YOUR BABY suggest that you give your baby formula milk. Milk should not be skin. Let your nipples dry before some expressed milk in a cup. refrozen once thawed. Don’t use covering them. Ask her to show you how. In this a microwave oven to warm or way, your baby is able to taste defrost breastmilk. • If you are using breast pads, and begin drinking your milk. they need to be changed at You should not pour milk directly Some common each feed (if possible, use pads into your baby’s mouth. breastfeeding without a plastic backing). problems and how •Avoid soap as it dries your Storing breastmilk to solve them skin out. You can store breastmilk for: It can be hard to ask for help, • Wear a cotton bra, so air can • up to five days in the fridge at but tackling any problems as soon circulate. as they start will give you more 4ºC or lower. This means putting • Some mothers treat any cracks time to enjoy these early days. the milk in the coolest part of or bleeding with a thin smear of In lots of cases, the solution is as the fridge, usually at the back white soft paraffin or purified simple as changing your baby’s (do not keep it in the door) lanolin. Put the ointment on the position slightly or feeding them • up to two weeks in the freezer crack (rather than the whole a bit more often. compartment of a fridge, or nipple) to help it heal and prevent a scab forming. • up to six months in a domestic Unsettled feeding freezer, at minus 18ºC or lower. If your baby is unsettled at the Tender breasts, blocked breast and doesn’t seem satisfied ducts and mastitis Breastmilk must always be stored by feeds, it may be that they are Milk can build up in the ducts for in a sterilised container. If you use sucking on the nipple alone, and a variety of reasons. The most a pump, make sure you wash it so are not getting enough milk. common are wearing a too-tight thoroughly after use and sterilise Ask for help to get your baby into bra, missing a feed, or a blow to it before use. a better feeding position. the breast. It’s important that you Milk should be defrosted Sore or cracked nipples deal with a blocked duct as soon as in the fridge. Once possible so that it doesn’t lead to If your nipples hurt, take your it’s defrosted, mastitis (inflammation of the breast). baby off the breast and start you will need again. If the pain continues or If you have mastitis, your breasts will to use it your nipples start to crack or feel hot and tender. You may see straight bleed, ask for help so you get a red patch of skin which is painful away. your baby latched on comfortably to touch. You can feel quite ill, as if (see page 114 for information on you have flu, and you may have a how to get help). It can sometimes temperature. This can happen very take a little while to sort out how suddenly. It is very important to carry to prevent the soreness, but it on breastfeeding as this will help is important to get support you get better more quickly. as soon as possible. If you think you might have mastitis (or a blocked duct), try the following: • Take extra care to make sure your baby is attached well to your breast. •Feed your baby more often. • Let your baby feed on the tender breast first. 109 • If your breasts still feel full after a without problems for a while, you Your milk feed, or your baby cannot feed, might have an infection known as is good express your milk (see page 108 thrush. Ask for help to check that for your baby for more information on how to your baby is latched on properly, and whatever you eat, but do this). make an appointment with your GP. there are foods to avoid (see next page). Being a new • Warmth on your breast before a You and your baby will both need mother is hard work though, so it’s feed can help milk flow and make treatment. You can easily give important to look after yourself and you feel more comfortable. thrush to each other, so if your try to eat as varied and balanced a baby has it in their mouth you • While your baby is feeding, gently diet as you normally would. Aim to will still need some cream for stroke the lumpy area with your eat healthily as a family. A healthy your nipples to stop it spreading fingertips towards your nipple. range of food includes: This should help the milk to flow. to you. You may want to ask your pharmacist for advice. Some • at least five portions of a variety • Get lots of rest. Go to bed if antifungal creams can be bought of fruit and vegetables a day you can. over the counter from a pharmacy. (including fresh, frozen, tinned, • Take a painkiller such as dried and juiced) paracetamol or ibuprofen. Tongue-tie • starchy foods such as wholemeal Some babies are born with a tight • Ask for help with how you get bread, pasta, rice and potatoes your baby latched on properly piece of skin between the underside • plenty of fibre, found in (see page 114 for information of their tongue and the floor of wholegrain bread and breakfast on where to get help). their mouth. This is known as tongue-tie, and it can affect feeding cereals, pasta, rice, pulses (such Mastitis may also be a sign of by making it hard for your baby to as beans and lentils) and fruit infection. If there is no improvement attach to your breast. Tongue-tie and vegetables. After childbirth, within 12 to 24 hours, or you start can be treated easily, so if you have some women experience bowel to feel worse, contact your GP or any concerns talk to your midwife problems and constipation – fibre healthcare professional. If necessary, or health visitor or contact the helps with both of these they can prescribe antibiotics that National Breastfeeding Helpline • protein, such as lean meat and are safe to take while breastfeeding. on 0300 100 0212. poultry, fish, eggs and pulses Thrush • at least two portions of fish each If you suddenly get sore, bright pink Staying healthy week, including one portion of nipples after you have been feeding You don’t need to eat oily fish, and anything special while • dairy foods, such as milk, cheese you are breastfeeding, just and yoghurt, which contain calcium make sure you have a and are a useful source of protein. varied and balanced diet. It’s also important to drink plenty of fluid. Aim for at least 1.2 litres (six to eight glasses) each day. It’s a good idea to have a drink beside you when you settle down to breastfeed. Water, milk and unsweetened fruit juices are all good choices. To find out more about healthy eating, go to www.eatwell.gov.uk healthy

110 eating Healthy snack ideas marlin a week, because of the levels of mercury in these fish. 9 The following snacks are Avoid these fish altogether during quick and simple to make pregnancy or if you are trying to and will give you the energy get pregnant. and strength you need: FEEDING YOUR BABY Small amounts of whatever you are • eating and drinking can pass to your baby through your breastmilk, so it’s a good idea to think about how Vitamins much alcohol and caffeine you are While you are breastfeeding (just having. These may affect your baby as when you were pregnant) in the same way they affect you. you should take supplements If you think a food or foods that you containing 10 micrograms (mcg) of are eating are affecting your baby, vitamin D each day. You should be talk to your GP or health visitor, or • able to get all the other vitamins contact the National Breastfeeding filled with salad vegetables, and minerals you need by eating a Helpline on 0300 100 0212. grated cheese, salmon or varied and balanced diet. Your skin sardine or cold meat. Drinks containing caffeine can also makes vitamin D naturally when it’s affect your baby and may keep • exposed to the sun between April them awake, so drink them only • and September. occasionally rather than every day vegetable sticks. Ask your GP or health visitor while your baby is young. • where to get vitamin D See page 112 for more information dried apricots, supplements. You may be on alcohol and breastfeeding. figs or prunes. able to get free vitamin Caffeine • supplements without a bean soups. prescription if you are Caffeine occurs naturally in lots of eligible for Healthy Start foods and drinks, including coffee, • (see page 28). tea and chocolate. It’s also added to unsweetened some soft drinks and energy drinks Foods to avoid breakfast cereals, and to some cold and flu remedies. muesli or other Eating fish is good for your In the early days, it is important that wholegrain cereals health. But don’t have more than you don’t have too much caffeine. with milk. two portions of oily fish a week. Try decaffeinated tea and coffee, • This includes fresh tuna (not canned fruit juice or fruit juice. tuna, which doesn’t count as oily water and limit fish), salmon, mackerel, sardines the number of • and trout. or baked potato. energy drinks, The general advice for all adults which might be is to avoid eating more than one high in caffeine. portion of shark, swordfish or

Helpful tips • Try to eat a wide variety •Keep your alcohol intake low. of foods (see page 25). Alcohol in breastmilk can • Eat when you feel hungry, and affect your baby’s feeding choose healthy snacks. • Try not to restrict your or sleeping. Avoid drinking diet unless you think a food •You will probably feel quite alcohol shortly before is upsetting your baby. Always thirsty. Have a drink beside feeding your baby. talk to your health visitor or you before you sit down to doctor before cutting out foods. • Avoid drinking too much breastfeed. strong tea or coffee. eating 111 Peanuts Alcohol If you drink alcohol and breastfeed, Peanuts are one of the most Generally, adult women should it can affect your baby in a number common causes of food allergy. not regularly drink more than two of ways: Peanut allergy affects about to three units of alcohol per day. • your milk may smell different and 1% of people and can cause During pregnancy, women are put your baby off feeding severe reactions. Your baby may advised to avoid drinking. If they be at higher risk of developing a do drink, they are advised to drink • the alcohol may make your baby peanut allergy if you, the baby’s no more than one to two units once too sleepy to feed, or father, brothers or sisters have or twice a week, and are advised • your baby may have difficulties a food allergy or other allergic not to get drunk. with digestion and problems with condition such as hayfever, their sleeping patterns. By breastfeeding, you are giving asthma and/or eczema. your baby the best possible start in • If you would like to eat peanuts life. It’s very unlikely that having an Smoking or foods containing peanuts occasional drink will harm you or (such as peanut butter) while your baby. However, we do know Smoking is bad for you, bad for breastfeeding, you can choose that alcohol passes through to the your partner and especially bad for to do so as part of a healthy baby in very small amounts in your your baby. One of the best things balanced diet, unless you are breastmilk. Because of this, if you you can do for your own and your allergic to them or your health are breastfeeding it is sensible to baby’s health is to stop smoking. professional advises you not to. limit your drinking and to keep Each year, more than 17,000 children under the age of five are • You may have heard that some within the limits recommended for pregnant women. admitted to hospital because of women have, in the past, the effects of secondhand smoke. chosen not to eat peanuts while One unit of alcohol is approximately they were breastfeeding. This equal to a single (25ml) measure Avoid smoking in the home or car, is because the government of spirits, half a pint of beer, or half and ask your partner, friends and previously advised women a 175ml glass of wine, although family to do the same when they that they may wish to avoid it depends on the strength of are around your baby. eating peanuts while they were the drink. If you do smoke and you are breastfeeding if there was a finding it difficult to quit, history of allergy in their child’s The website www.nhs.uk/units contains more information on breastfeeding will still protect immediate family (such as your baby from infections and asthma, eczema, hayfever, food units, including the units found in typical drinks. give them nutrients they cannot allergy or other types of allergy), get through formula milk. in case small amounts of peanut Smoking after feeds, rather than in their breastmilk increased the Helpful tips before, will help reduce your chance of the baby developing baby’s exposure to nicotine. a peanut allergy. But this advice Breastfeeding and has now been changed because alcohol You are up to four times more likely to stop smoking successfully the latest research has shown If it’s a special occasion and with NHS support. Call the NHS that there is no clear evidence you know you are going to be Smoking Helpline on 0800 022 to say that eating or not eating drinking, consider expressing 4 332, or the NHS Pregnancy peanuts while breastfeeding milk in advance. To reduce Smoking Helpline on 0800 169 9 has any effect on your baby’s the exposure of your baby 169 for information about the wide chances of developing a to alcohol: peanut allergy. range of free specialist support • avoid breastfeeding for at available and for details of your • If you have a child under least two to three hours after local NHS Stop Smoking Service. six months and are not drinking, or breastfeeding (for example You can also speak to your GP because you are feeding your • have your drink after the last or pharmacist about the nicotine baby on formula), then there feed of the day – if you can replacement therapy available to is no reason why you should predict when that will be! help you manage your cravings avoid consuming peanuts or and become smokefree. foods containing peanuts. 112 Medicines and •cough medicines (provided they health visitor, GP or pharmacist breastfeeding don’t make you drowsy) if this is a concern. 9 Many illnesses, including depression • asthma inhalers, and More information (see page 76), can be treated while • normal doses of vitamins. you are breastfeeding without FEEDING YOUR BABY harming your baby. Small amounts You can use some methods of For more information go to of whatever medicines you take will contraception but not all, so check www.breastfeedingnetwork.org. pass through your breastmilk to with your GP or pharmacist. Some uk/drugline.html, or call the your baby, so always tell your doctor, cold remedies are not suitable. Drugs in Breastmilk Helpline dentist or pharmacist that you It’s fine to have dental treatments, on 0844 412 4665. are breastfeeding. local anaesthetics, injections Your GP or pharmacist may like to Medicines that can be taken while (including mumps, measles and look at the information from the breastfeeding include: rubella (MMR), tetanus and flu National Formulary for Children injections) and most types of (www.bnfc.org) to see what • most antibiotics operations. You can also dye, medicines can be given to babies • common painkillers such as perm or straighten your hair, and children, as these are likely paracetamol and ibuprofen use fake tan and wear false nails. to be safe for mothers to take (but not aspirin) Illegal drugs are dangerous for when breastfeeding. • hayfever medicines such as your baby, so talk to your midwife, Clarityn and Zirtek

Medicines for minor ailments when breastfeeding • Make sure the medicine is safe to take when breastfeeding. • Watch your baby for side effects such as poor feeding, drowsiness and irritability. Stop taking the medicine if your baby gets side effects. • For further information, speak to your pharmacist or NHS Direct on 0845 4647.

Minor ailment First choice Second choice Do not use Constipation Eat more ﬁbre Bisacodyl Bulk laxatives that contain ispaghula Senna Lactulose Cough Honey and lemon in hot water Medicines that contain Simple linctus codeine or guaifenesin Diarrhoea Oral rehydration sachets Occasional doses of loperamide Haemorrhoids (piles) Soothing creams, ointments or suppositories Ice pack Hayfever, house Antihistamine eye drops or nasal sprays Antihistamines – cetirizine Other antihistamines unless dust mite and Steroid nasal sprays or loratadine advised by your doctor animal hair allergy Head lice Wet combing If ineffective, then head lice lotions Dimeticone lotion that contain permethrin Indigestion Antacids (indigestion mixtures) On your doctor’s information: medicines that reduce acid production, e.g. omeprazole Nasal congestion Steam inhalation Oxymetazoline or xylometazoline Medicines that contain (stuffy or nasal sprays. Occasional doses phenylephrine runny nose) of pseudoephedrine

Pain Paracetamol Ibuprofen Medicines that contain aspirin (e.g. headache, Medicines that contain codeine mastitis, toothache) (e.g. co-codamol, co-dydramol), unless advised by your doctor Threadworms Mebendazole Vaginal thrush Clotrimazole pessaries or cream Fluconazole 113 Help and support

Breastfeeding To find out what is available in The Unicef Baby Friendly site at help and support your area, talk to your midwife www.babyfriendly.org.uk provides or health visitor, or contact the information and links to useful Don’t be afraid to ask for the National Breastfeeding Helpline resources about the benefits of support and information you need on 0300 100 0212 (lines are breastfeeding. to make breastfeeding work for you open from 9.30am to 9.30pm) The Breastfeeding Network’s and your baby. No problem is too or go to the website at Drugs in Breastmilk Helpline can small – if something is worrying you, www.nationalbreastfeeding provide information about the chances are that other mothers helpline.org.uk will have felt the same. breastfeeding and medicines. You can also get information Call 0844 412 4665. You can get help from a peer online from the Association All these voluntary organisations supporter, your midwife or health of Breastfeeding Mothers provide training for peer supporters. visitor. You might also want to join (www.abm.me.uk) and the a local breastfeeding group. It’s a Breastfeeding Network The Bump to Breastfeeding (Best great way of making new friends as (www.breastfeedingnetwork.org.uk). Beginnings) DVD is a useful source well as sharing the ups and downs The Breastfeeding Network of information and will give you of looking after a new baby. Most runs a Supporterline on an insight into other mothers’ groups usually include a mix of 0300 100 0210, and also offers experiences of breastfeeding. healthcare professionals and local a helpline for speakers of You should have been given a copy trained volunteer mothers (peer Bengali/Sylheti on 0300 456 2421. of the DVD during your pregnancy. supporters). These mothers have Lines are open from 9.30am If not, ask your health visitor or visit breastfed their own babies and to 9.30pm. www.bestbeginnings.info have had some training in basic breastfeeding techniques. Some NHS guidance on breastfeeding peer supporters will have had more is available at www.breastfeeding. in-depth training to help them nhs.uk support new mothers. The following voluntary There may be specialist drop-ins in organisations can also provide your area where you can go if you information and advice: have a specific concern or difficulty. La Leche League 0845 120 2918 www.laleche.org.uk NCT Breastfeeding Line 0300 330 0771 www.nct.org.uk support for you

114 Types of milk to avoid 9 Cows’ milk should not be given as a main drink to a child under the age of one year. Small amounts of cows’ milk can be used for FEEDING YOUR BABY cooking after six months of age. Condensed milk, evaporated milk, dried milk, sheep’s milk, goats’ milk, or any other type of ‘milk’ drink (such as rice, oat or almond drinks, often known as ‘milks’) should never be given to a baby under the age of one year. You should not use soya formula unless it has been prescribed by your GP. Choosing a formula Whey-dominant milk is thought to be easier to digest than casein- You can find more information Infant formula milk usually comes in powder form and is based on dominant milk, so should always be on rice drinks at www.food. the first formula you give your baby. gov.uk/science/surveillance/ processed, skimmed cows’ milk, fsisbranch2009/survey0209 and is treated so babies can digest There is little nutritional difference in it. Vegetable oils, vitamins, minerals the two forms of milk, so if whey- Follow-on formula is not suitable and fatty acids are added to make dominant formula milk suits your for babies under six months. sure the milk contains the vitamins baby, they can stay on it for the first and minerals that young babies year or even longer. need. This information will be FORMULA on the contents list on the pack. ‘Ready-to-feed’ infant formula Infant formula powders are not milk in cartons is also available. FEEDING sterile, so it is important to follow This is generally more expensive the cleaning and sterilising than powdered milk. Once opened, The following new advice is based instructions on page 116. the carton should be stored in the on guidance from the Department fridge with the cut corner turned of Health and the Food Standards Formula is either ‘whey dominant’ down. Do not store it for longer Agency. It may differ from what you or ‘casein dominant’, depending than 24 hours. have done before if you have older on the balance of proteins it children, but to minimise any risk contains. It may also be referred to You can continue giving your baby it is recommended that you follow as stage one or stage two milk. infant formula when they are older this new advice. than six months. If you have any worries Helpful tips about the infant formula milk you are There are a number of Vitamin drops giving your baby, different brands of infant ask your midwife, If your baby is formula fed, formula milk available in the health visitor or you should give them vitamin shops. All should meet the GP for advice. drops from the age of six legal standards for formula months or if they are drinking milk, and it’s up to you to less than 500ml of formula decide which one to use. a day. You can buy suitable In the past it was thought drops at any pharmacy. better to stick to one brand, Ask your midwife or health but there is no evidence visitor where you can get to suggest that changing vitamin drops. brands does any good or any harm.

115 Using formula Preparing a feed milk safely STEP 1: Before making up a feed, Powdered infant formula milk clean and disinfect the surface must be prepared as carefully as you are going to use. Wash your possible. It is not a sterile product, hands carefully. If you are using a and even though tins and packets cold water steriliser, shake off any of milk powder are sealed, they excess solution from the bottle and can contain bacteria such as Sterilising the teat or rinse the bottle with Cronobacter sakazakii (formerly All the equipment used for feeding cooled boiled water from the kettle known as Enterobacter sakazakii) your baby must be sterilised. By (not the tap). Stand the bottle on a and, more rarely, salmonella. sterilising your feeding equipment, clean surface. Keep the teat and cap washing your hands and keeping on the upturned lid of the steriliser. If the feed is not prepared safely, the preparation area clean, you will Don’t put them on the work surface. these bacteria can cause infections. reduce the chance of your baby Infections are very rare, but can getting sickness and diarrhoea. STEP 2 be life-threatening. Formula must The following cleaning and therefore be made up with water hot enough to kill the bacteria – at sterilising instructions apply whether least 70ºC. In practice, this means you are using expressed breastmilk boiling the kettle and leaving it to or infant formula milk. cool for no longer than 30 minutes. 1 Clean and rinse. Clean the Very young babies are at most risk, bottle and teat in hot soapy and it is better to use sterile, liquid water as soon as possible after a ready-to-feed products for premature feed, using a clean bottle brush. or low birth weight babies. If you are Rinse all equipment in cold, clean using formula, mix the formula and running water before sterilising. water and cool quickly to feeding temperature in cold water. 2 Cold water sterilising. Follow the manufacturer’s instructions. It’s also essential to make up a Change the sterilising solution fresh bottle for each feed. Throw every 24 hours, and leave away unused formula within two feeding equipment in the STEP 2: Use fresh tap water to fill hours. Bacteria multiply rapidly at solution for at least 30 minutes. the kettle. After it has boiled, let room temperature and can even Make sure there is no air trapped the water cool for no more than survive and multiply slowly in some in the bottles or teats when 30 minutes. Don’t use artificially fridges, so storing formula milk for putting them in the sterilising softened water or water that has any length of time increases the risk. solution. Keep all the equipment already been boiled. If you have under the solution with a to use bottled water, you will still floating cover. need to boil it. The water must 3 Steam sterilising (electric still be hot, otherwise any bacteria or microwave). Follow the in the milk powder might not manufacturer’s instructions. be destroyed. Make sure the openings of the bottles and teats are facing For information about using bottled down in the steriliser. Any water, go to www.eatwell.gov.uk equipment not used straight Always put the partially cooled away should be re-sterilised boiled water in the bottle first. before use. Be careful – at 70°C, water is still hot enough to scald. Always check that the water level is correct. careful Failure to follow the manufacturer’s preparation instructions may make your baby ill.

116 STEP 3 STEP 4 STEP 5 9 FEEDING YOUR BABY

STEP 3: Loosely fill the scoop STEP 4: Add the milk powder to the STEP 5: Holding the edge of with milk powder and level it water. Repeat, until you have added the teat, put it on the bottle. off using the flat edge of a the number of scoops specified in Screw the retaining ring onto clean, dry knife or the leveller the manufacturer’s instructions. the bottle. Cover the teat with provided. Do not pat it down. a cap. Shake the bottle until It is important to use only the scoop the powder dissolves. that is enclosed with that milk powder. Using too much powder can Make sure you make up a fresh give your baby constipation and lead bottle each time you feed your to dehydration; too little could mean baby and throw away unused that your baby is not getting the feed after two hours. Using stored nutrients they need. Don’t add sugar formula milk can increase the or cereals to the feed in the bottle. chance of your baby becoming ill.

Feeding your baby Always cool your baby’s milk down The milk inside may be very hot You should check regularly that before feeding. At 70°C, it is still and could scald your baby’s mouth. teats are not torn or damaged. hot enough to scald. To cool it, hold Get everything you need ready When feeding, make sure you keep the bottle, with the cap covering before you start feeding. Find a the teat full of milk, otherwise your the teat, under cold running water. comfortable position to hold your baby will take in air and get wind. Test the temperature of the feed by baby while you are feeding. You If the teat becomes ﬂattened while dropping a little onto the inside of may need to give your baby time. you are feeding, pull gently on the your wrist. It should just feel warm Some babies take some milk, corner of your baby’s mouth to to the touch, not hot. pause for a nap, and then wake release the vacuum. If the teat gets If the milk is too cool, and your baby up for more. So you might have blocked, replace it with another doesn’t like it that way, you can to be patient. Remember, feeding sterile teat. warm it up a little by putting the is an opportunity to feel close to bottle upright in some hot water, your baby and get to know them. Help and support keeping the teat out of the water. Even when your baby is a little Never warm milk in a microwave older, they should never be left If you want help or advice on oven. It will continue to heat up for alone to feed with a propped-up formula feeding, talk to your a time after you take it out of the bottle, as they may choke. midwife or health visitor. See microwave, even though the outside the list of useful organisations of the bottle may feel cold. at the back of this book.

117 Bottles and teats Feeding away You might find it useful to have from home about six bottles and teats, so The safest way of feeding your you can always have at least one baby away from home is to carry a or two bottles clean, sterilised measured amount of milk powder and ready for use. Ask your in a small clean and dry container, midwife or health visitor for a flask of boiled hot water and an more information. empty sterilised feeding bottle. Make up a fresh feed whenever You should always buy new you need it. The water must still teats. They come in different be hot when you use it, otherwise shapes and with different hole any bacteria in the milk powder sizes, and you may have to try At the end of the feed, sit and might not be destroyed. Remember several before you find the one hold your baby upright and gently to cool the bottle under cold that suits your baby. If the hole rub or pat their back for a while running water before you use it. is too small, your baby will not to bring up any wind. There is no get enough milk. If it’s too big, need to overdo it – wind is not as Alternatively, you could use the milk will come too fast. big a problem as many people think. ready-to-drink infant formula milk when you are away from home. It’s best if you can buy new Talk to your baby as you rub or pat. bottles too. Check regularly to This will help them feel closer to you If it’s not possible to make up a fresh make sure the bottles are in and get them used to listening to feed, or if you need to transport a good condition. If they are badly your voice. Don’t forget to throw feed – for example to a nursery or scratched, you will not be able to away any milk that is not used childminder – you should prepare sterilise them properly. If in doubt, within two hours. the feed at home and cool it in the ask your midwife or health visitor Most babies gradually settle into back of the fridge for at least one for more information. a pattern. Babies vary in how hour. Take it out of the often they want to feed and how fridge just before you much milk they want to take. leave, and carry it in Bottled water Feed your baby when they are a cool bag with an ice pack and Bottled water is not a healthier hungry, just as you would if you were breastfeeding, and don’t try use it within choice than tap water and four hours. usually is not sterile. In fact, to force your baby to finish a bottle. some natural mineral waters are They may have had enough for the not suitable for babies because time being or just want a rest. of the amount of minerals they contain. If you need to use bottled water, remember that any bottled water that is labelled ‘natural mineral water’ might out contain too much sodium and for babies. If you are giving bottled water about to babies under six months, you should boil and cool it just like tap water. If you need to use bottled water to make up infant formula (for babies of any age), you should boil it and allow it to cool for no more than half an hour.

118 If you reach your destination Coping with allergies infant formulas, too. Babies who 9 within four hours, take it out of If you think your baby might be are allergic to cows’ milk may also the cool bag and store it at the allergic to formula milk, talk to be allergic to soya. back of a fridge for a maximum your GP. They can prescribe formula Babies sometimes grow out of of 24 hours. Re-warm for no feeds called extensively hydrolysed allergies, and you may ﬁnd that FEEDING YOUR BABY more than 15 minutes. protein feeds. you can introduce cows’ milk into Some formulas are labelled as your baby’s diet as they get older. Helpful tips hypoallergenic, but they are not Always ask your GP or health suitable for babies with a diagnosed visitor for advice before making any changes to your baby’s diet. It is always safer to make up a cows’ milk allergy. Talk to your GP fresh feed whenever possible. before using this milk. Always get When this is not possible, feeds their advice before using soya-based should never be stored for longer than 24 hours.

Some common As long as Constipation problems with your baby Always formula feeding is gaining stick to the weight, there recommended is usually nothing amount of infant to worry about. But formula milk powder. if your baby is violently sick or Using too much can make your appears to be in pain, or you are baby constipated or thirsty. worried for any other reason, talk Breastfed babies don’t usually to your health visitor or GP. get constipated. If your baby is Cover your baby’s front when under eight weeks old and has not feeding and have a cloth or paper passed a stool for a few days, talk towels handy to mop up any mess. to your health visitor or GP. Check too that the hole in your Water baby’s teat is not too big, as giving In very hot weather, babies fed on milk too quickly can cause sickness. infant formula milk can get thirsty. Sitting your baby upright in a baby If this happens, you can give them chair after a feed can also help. Crying and colic cool boiled tap water if they seem The problem usually stops after For information about crying and unsettled between feeds. Talk to six months when your baby is colic, see pages 138–139. your health visitor or GP if you starting on solid foods and drinking have any concerns. Sickness and vomiting less milk. Breastfed babies do not need any Some babies bring up more milk If your baby brings up a lot of milk, water. Instead, you may notice that than others during or just after a remember that they are likely to they have shorter, more frequent feed. This is called ‘possetting’, be hungry again quite quickly. feeds if the weather is hotter. ‘regurgitation’ or ‘gastric reﬂux’. Don’t force your baby to take It is not unusual for babies to on more milk than they want bring up quite a lot, but it can during a feed. Remember, every be upsetting when it happens baby is different. Some prefer and you may be worried that to feed little and often. something is wrong.

119 THE FIRST DAYS WITH YOUR BABY

How you feel 120 Your body 123 Postnatal care 121 Your baby’s health 124 Stitches 122 Your baby’s appearance 124 Bleeding 122 What your newborn baby can do 126 Sex and contraception 122

The first few days with your baby can be a very emotional time for you and your partner. There is a lot to learn and do. There is the excitement of getting to know your baby, but you will also be tired and your body will be recovering from labour and the birth. Keep your baby close to you as much as you can. Your partner should also spend time holding and being close to your baby. They may feel a little left out, especially if they have to leave you and the baby in hospital and return to an empty home. They may need support and encouragement to get involved. The more you can both hold and cuddle your baby, the more confident you will all feel. holding your babyclose HOW YOU FEEL You may feel tired for the first few days, so make sure you get plenty of rest. Even just walking and moving about can seem like hard work. For a lot of mothers, the excitement and the pleasure of the new baby far outweigh any problems. But you can begin to feel low or rather depressed, especially if you are very tired or feel you cannot look after your baby in the way you would like.

120 Giving birth is an emotional and tiring experience and your 10 hormones change dramatically in the first few days. Some women get the ‘baby blues’ and feel rather THE FIRST DAYS WITH YOUR BABY weepy around three to five days after giving birth (see page 136). This can be worse if your labour was difficult, you are very tired or you have other worries. Some women worry because they don’t love their baby immediately. It is not always love at first sight. You may just need to give yourself time – you can still care for your baby and provide all the warmth and security they need.

POSTNATAL CARE If you have your baby in hospital, you may be able to return home with your baby straight from the labour ward or you may be moved You are likely to need quite a lot of to a transfer lounge or a postnatal help and advice with your ﬁrst baby. ward where you will be with other Whether you are in hospital or at mothers and babies. home, the midwives are there to guide and support you as well as You should discuss your postnatal to check that you are recovering care with your midwife during from the birth. Don’t hesitate pregnancy so you know what to ask for help if you need it. to expect. A midwife will be available in your community to help you look after yourself and your baby.

121 STITCHES Going to the toilet You may also feel cramps like period pain, known as ‘after pains’. These If you have had stitches, bathe the The thought of passing urine can are both because feeding causes the area often in clean warm water be a bit frightening at first if you are uterus to contract. to help it to heal. Have a bath or sore or cannot feel what you are Gradually, the discharge will shower with plain warm water. doing. Drinking lots of water dilutes become a brownish colour and may Afterwards, dry yourself carefully. your urine, but if it is difficult to pass continue for some weeks, getting In the first few days, remember urine, tell your midwife. less and less until it stops. If you find to sit down gently and lie on your You probably will not need to open you are losing blood in large clots, side rather than on your back. your bowels for a few days after the you should save your sanitary towels Pelvic floor exercises can also help birth, but it’s important not to let to show the midwife as you may you to heal (see page 35). yourself become constipated. Eat need some treatment. If the stitches are sore and fresh fruit, vegetables, salad and uncomfortable, tell your midwife wholemeal bread, and drink plenty SEX AND as they may be able to recommend of water. Whatever it may feel like, CONTRACEPTION treatment. Painkillers will also it’s very unlikely that you will break help. If you are breastfeeding, the stitches or open up the cut or Soon after your baby is born, a check with your midwife, GP tear again. midwife or doctor will talk to you or pharmacist before you buy about contraception. If this doesn’t over the counter products like BLEEDING happen, ask. You can become ibuprofen or paracetamol. After the birth you will bleed from pregnant straight away, even if your vagina. This will be quite you are breastfeeding or have not Usually stitches just dissolve by heavy at first, which is why you had a period. the time the cut or tear has healed, will need super-absorbent sanitary but sometimes they have to be Make sure you are using a reliable towels. Do not use tampons until taken out. form of contraception before you after your postnatal check, as and your partner have sex again, they can cause infections. While unless you want to get pregnant breastfeeding you may notice that (see page 135 for your different the discharge is redder or heavier. contraceptive options). If you are breastfeeding, you may not have another period until you stop feeding, or even for some weeks or months after that. If you are not breastfeeding, your first period might start as early as a month after the birth, or it might be much later.

recoveryand healing

122 Helpful tips YOUR BODY Breastfeeding helps because it makes the uterus contract. 10 Postnatal exercises Your body will have gone through Sometimes, because this is some major changes over the past happening, you may feel a quite Postnatal exercises few days. painful twinge in your abdomen (see page 133) will THE FIRST DAYS WITH YOUR BABY or period-type pain while you help to tone up the Your breasts are breastfeeding. muscles of your pelvic Many women experience changes floor and abdomen. in the size of their breasts during Your bladder They will also get you pregnancy and breastfeeding. It’s quite common after having a moving and feeling See Chapter 9 for more information baby to accidentally leak urine if generally fitter. You about this. you laugh, cough or move suddenly. may be able to attend Pelvic floor exercises (see page 35) If you don’t intend to breastfeed a postnatal exercise will help with this. If the problem from the start, you need not do class at your hospital. persists after three months, see anything. But on the third or fourth Ask your midwife or your doctor, who may refer you day, your breasts may be tender physiotherapist to help to a physiotherapist. as the milk is still being produced. you organise this. Wearing a firm, supportive bra Your bowels may help. Your breasts will reduce Piles (see page 63) are very in size in a week or so. common after delivery but they Speak to your midwife if you are usually disappear within a few Personal child health very uncomfortable. days. Eat plenty of fresh fruit, vegetables, salad, brown bread record (PCHR) Your abdomen and wholegrain cereals, and drink You will be given a PCHR Your abdomen will probably be plenty of water. This should make for your baby within a few days quite baggy after delivery. it easier and less painful when you of their birth. This book records Despite having delivered your pass a stool. Try not to push or important information about baby plus the placenta and a lot strain as this will make the piles your child. Take it with you of fluid, you will still be quite a worse. Let the midwife know whenever you see anyone lot bigger than you were before if you feel very uncomfortable. about your child’s health pregnancy. This is partly because They will be able to give you an or development. This is your your muscles have stretched. ointment to soothe the piles. record, so do add information If you eat a balanced diet and yourself. This could be a note exercise, your shape should of when your child does soon return to normal. something for the first time or advice given to you by a healthcare professional.

Rhesus negative mothers If your blood group is rhesus negative and your baby’s father’s is rhesus positive, blood samples healing will be taken after the delivery to see whether your baby is rhesus positive. You may need an injection to protect your next baby from anaemia. This should be given within 72 hours of delivery.

123 Although this is rare, it can YOUR BABY’S cause them to bleed dangerously into the brain. To prevent this, APPEARANCE your baby should be offered vitamin K. You will be offered an injection of vitamin K for your baby, as this is the most effective way of helping to prevent a rare bleeding disorder (haemorrhagic disease of the newborn). If you prefer that your baby doesn’t have an injection, oral doses of vitamin K are available. Further doses will You will probably spend the first be necessary. few days looking at your baby. Newborn hearing You will notice every detail – the YOUR BABY’S screening colour and texture of their hair, programme the shape of their hands and feet, HEALTH and the different expressions on A small number of babies are their face. If you notice anything When your baby is born, they born with hearing loss. Your that worries you, however small, will have a quick physical baby will be given a quick ask your midwife. Your baby examination to check that there are and simple test to check their will be examined by a midwife, no major problems that need urgent hearing. Finding out about paediatrician or neonatal nurse treatment. Within 72 hours of hearing loss early means that practitioner to make sure birth, another more detailed babies and parents can get everything is all right. examination will be carried out. the support they need. This You can find more information can help the development The fontanelle at www.screening.nhs.uk of the child’s language On the top of your baby’s head, Your baby will also have some and social skills. See near the front, is a diamond-shaped other routine health checks www.hearing.screening.nhs.uk patch where the skull bones have and care. for further information. not yet fused together. This is called Newborn blood the fontanelle. It will probably be a Cord care year or more before the bones close (belly button) spot screening over. You may notice the fontanelle Shortly after birth, the midwife will (heel prick test) moving as your baby breathes. clamp the umbilical cord close to When your baby is between Don’t worry about touching it or your baby’s navel with a plastic clip. five and eight days old, your washing the area. There is a tough They then cut the cord, leaving a midwife will ask to take a layer of membrane under the skin. small bit of cord with the clamp sample of blood from their attached. The cord will take about a heel. This is used to test for week to dry out and drop off. Keep rare but potentially serious More information the navel clean and dry until this illnesses. All babies are tested happens. If you notice any bleeding for phenylketonuria (PKU – a metabolic disorder), cystic For more information or discharge from the navel, tell your on blood spot screening: midwife, health visitor or doctor. fibrosis, sickle cell disorders and congenital hypothyroidism http://newbornbloodspot. Vitamin K (CHT – low thyroid hormone). screening.nhs.uk We all need vitamin K to make our Some babies are also tested For more information on blood clot properly so that we will for MCADD, an inherited sickle cell screening: not bleed too easily. Some newborn problem with the metabolism. www.sct.screening.nhs.uk babies have too little vitamin K.

124 Bumps and bruises Your baby’s skin Breasts and genitals 10 It is quite common for a newborn At birth, the top layer of your A newborn baby’s breasts can be a baby to have some swelling and baby’s skin is very thin and easy little swollen and ooze some milk, bruises on its head, and perhaps to to damage. Over the first month whether the baby is a boy or a girl. have bloodshot eyes. This is just the (longer in premature babies) your Girls also sometimes bleed a bit or THE FIRST DAYS WITH YOUR BABY result of the squeezing and pushing baby’s skin matures and develops have a white, cloudy discharge from that is part of being born and will its own natural protective barrier. their vagina. These are a result of soon disappear. Vernix (the white sticky substance hormones passing from the mother Birthmarks and spots that covers your baby’s skin in the to the baby before birth and are no cause for concern. The genitals of Once you begin to look closely at uterus) should always be left to male and female newborn babies your baby, you will probably find absorb naturally. This is nature’s often appear rather swollen, but lots of little marks and spots, mainly own moisturiser and gives added they will look in proportion to their on their head and face. Some protection against infection in the bodies in a few weeks. babies have larger marks. Most of first few days. them will go away eventually. Ask Premature babies’ skin is even Jaundice the doctor who examines your baby more delicate. Staff in a specialised When they are about three days if they will disappear completely. neonatal area will advise you on old, many babies develop mild Most common are the little pink or skin care. jaundice. This will make their skin and the whites of their eyes look red marks some people call ‘stork If your baby is overdue, their skin a bit yellow. This usually fades marks’. These V-shaped marks on may well be dry and cracked. This within 10 days or so. But more the forehead and upper eyelids is to be expected, as the protective severe jaundice may gradually fade, though it may be vernix has all been absorbed. need treatment some months before they disappear Don’t be tempted to use any (see page 149). altogether. Marks on the nape of creams or lotions as they the neck can stay for much longer, may do more harm than but they will be covered by hair. good. The top layer Strawberry marks are also quite of your baby’s skin common. They are dark red and will peel off over slightly raised. They sometimes the next few days, appear a few days after birth and leaving perfect skin gradually get bigger. They may take underneath. Wash a while to go away. your baby with plain water only for at least Spots and rashes are very common the first month. in newborn babies and may come and go. You should tell your doctor or midwife immediately if you also notice a change in your baby’s behaviour, for example if your baby is not feeding properly or is very sleepy or very irritable.

getting to know each other 125 Rubella If you were not immune to rubella (German measles) when tested early in your pregnancy, you will usually be offered the MMR (measles, mumps and rubella) immunisation. You should get this before you leave hospital, or shortly afterwards from your GP. If it is not offered, speak to your doctor or midwife, as it’s a good opportunity to get it done. You should not get pregnant again for one month after the injection. For more information about rubella, visit www.immunisation.nhs.uk WHAT YOUR Tests for hepatitis B NEWBORN BABY and C CAN DO All babies born to mothers There is one important skill that who are infected with hepatitis your baby will not have to learn. B should receive a course of They are born knowing how to immunisation to prevent them suck. During the first few days they getting hepatitis B. Your baby learn to co-ordinate their sucking will be offered immunisation and their breathing. soon after birth and at one, Newborn babies also automatically two and 12 months old. turn towards a nipple or teat if it is Your baby should be tested brushed against their cheek, and at 12 months to check that they will open their mouths if their immunisation has worked. upper lip is stroked. They can also For more information about grasp things (like your finger) with hepatitis B immunisation, refer either their hands or feet, and they to page 37. will make stepping movements If you are infected with if they are held upright on a flat hepatitis C when your baby surface. Apart from sucking, these is born, there is a small risk automatic responses will go, and that you could pass on the your baby will begin to make infection. Your baby will be controlled movements instead. tested at an appropriate time. Newborn babies can use all of their senses. They will look at people and things, especially if they are near, and particularly at people’s faces. They will enjoy gentle touch and the sound of a soothing voice, and they will react to bright light and noise. Very soon they will also know their mother’s special smell.

126 WHAT YOU NEED FOR YOUR BABY

Nappies 127 In the car 130 Bathing 128 Feeding 131 Sleeping 129 Clothes 131 Out and about 130

It can be easy to get confused about what you really need for your baby. You can always ask your midwife or health visitor for advice on what to buy, and you may be given a list of essentials at your antenatal classes or by your maternity service. There are some essentials that every new mother needs, as well as extras that you might want to think about. You may be able to borrow some items, and then pass them on later to another mother or keep them for a second child.

For cloth nappies, you will need: NAPPIES More information • nappy pins for nappies without Disposable nappies Velcro or fasteners For information about Disposable nappies are convenient choosing and using • nappy liners – either disposable to use and are available from cloth nappies, visit or cloth, which you can wash and supermarkets and other retail outlets. www.wen.org.uk, or visit use again www.goreal.org.uk to ﬁnd Cloth nappies • a bucket with a lid and nappy local suppliers. Washable cloth nappies are cheaper sterilising powder or liquid for than disposable nappies, even when sterilising nappies, and you take into account the cost of • about four pairs of plastic washing them at home or getting pants that are either tie-on or them washed by a laundry service. elasticated. Tie-on ones will ﬁt They are more environmentally small babies better. Some cloth friendly and are easily laundered in nappies have the waterproof a 60ºC wash. You can get shaped wraps attached. cloth nappies with Velcro or popper fastenings and waterproof wraps.

127 Nappy services Nappy laundry services deliver freshly laundered nappies to your home and take away the soiled ones to wash each week. They supply everything you need – wraps, liners and storage bins. Nappy changing

BATHING It is a personal choice how Remember to wrap a towel frequently you bathe your baby; round the taps for safety a wash will often be enough to • two towels, the softer the better. keep your baby clean and ensure To change nappies, you will need: Keep them only for your baby’s they are comfortable. A warm bath use. There is no need for special • cotton wool. Always choose may help your baby to sleep. baby towels, unless you want them white. Rolls are usually cheaper You will need: • unperfumed soap – although than balls washing your baby with just • a baby bath or any large, • a changing mat water is ﬁne. clean bowl, such as a sink, • baby lotion or wipes as long as it’s not metal. See page 144 for how to bathe • baby barrier cream to help your baby. prevent nappy rash, and • a bag to carry all the nappy- changing equipment when you go out. A carrier bag will do but you can get special bags that whose include a changing mat. turn?

Safety The safest place to change a nappy is on a mat on the ﬂoor. If you use a higher surface, keep your hand on your baby at all times to stop them rolling off. See page 144 for how to change your baby’s nappy.

128 SLEEPING 11 For the ﬁrst few months, you will need a crib, a carry cot or a Moses basket (a light, portable bassinet).

Your baby needs somewhere to WHAT YOU NEED FOR YOUR BABY sleep that is safe and warm and not too far away from you. If you are borrowing a crib or cot, or if you have one that has been used The baby on the left is sleeping in the ‘feet to foot’ position (also by another of your children, you see page 140). This means that the baby’s feet are right at the end of the will need a new mattress. See the cot to prevent the baby wriggling under the covers and overheating. section on reducing cot death on the right. Cot safety Reducing the risk of Your baby will spend many hours cot death alone in a cot, so make sure it’s safe. The Foundation for the Study • The mattress must fit snugly with of Infant Deaths (FSiD) has no space for your baby’s head to developed important key get stuck. messages for parents to help to reduce the risk of cot death. • The bars must be smooth and securely fixed, and the distance • Place your baby on their back between each bar should be not to sleep, in a cot in a room less than 1 inch (25mm) and not with you. You will also need: more than 2 ½ inches (60mm) • Do not smoke in pregnancy • a firm mattress that fits the cot so that your baby’s head cannot or let anyone smoke in the snugly without leaving spaces become trapped. same room as your baby. round the edges so that your • The cot should be sturdy. • Do not share a bed with baby cannot trap their head your baby if you have been and suffocate • The moving parts should work smoothly so that fingers or drinking alcohol, if you take • sheets to cover the mattress. clothing cannot get trapped. drugs or if you are a smoker. You need at least four because • Never sleep with your baby they need to be changed • Cot bumpers are not on a sofa or armchair. often. Fitted sheets make recommended as babies can life easy but they are quite overheat or become entangled • Do not let your baby get expensive. You could use in the fastenings. too hot – keep your baby’s pieces of old sheet • Never leave anything with ties – head uncovered – and place your baby in the ‘feet to foot’ • light blankets for warmth. for example, bibs or clothes – in the cot in case they get caught position. around your baby’s neck. • If you are buying a new cot, look for the British Standard Pillows and duvets are not mark BS 1753. safe for babies less than a year old because of the risk of suffocation. Duvets can also make the baby too hot. Baby nests and quilted sleeping bags are not suitable for your baby to sleep in when you are not there because of the danger of suffocation.

129 If you have a car, look for a pram that can be dismantled easily. Buy a pram harness at the same time, as you will soon need it. Carrycot on wheels. Your baby can sleep in the carrycot for the first few months and the cot can be attached to the frame to go out. It can also be taken in a car with appropriate restraints. Three-in-one. This is a carrycot and transporter (set of wheels) OUT AND ABOUT that can be converted into a pushchair when your baby Spend some time looking at what outgrows the carrycot. is available for getting around with your baby. Think about what will Shopping trays that fit under suit you best. You could always the pushchair or pram can be very ask other mothers what they have useful when you are out. found useful. Baby carriers (also called slings) carry your baby in front of you. Checks IN THE CAR Most babies like being carried like this because they are close to you Before buying a pushchair or If you have a car, you must have a and warm. The back part of the pram, check that: car seat. This is also called a safety carrier must be high enough to • the brakes are in good restraint. Your baby must always go support your baby’s head. Check working order in their seat, including when you that the buckles and straps that bring them home from the hospital. • the handles are at the right attach the carrier to you are secure. It’s very dangerous – and illegal – height for pushing, and Older babies who can hold up their to carry your baby in your arms. heads and whose backs are stronger • the frame is strong The best way for your baby to (at about four months) can be enough. travel is in a rear-facing infant carried in backpacks. car seat, on either the front Pushchairs are only suitable for or back seat. This is held young babies if they have fully in place by the adult reclining seats that let your baby safety belt. lie flat. Wait until your baby can sit up before using any other type of pushchair. You should also consider the weight of the pushchair if you use public transport as you might have to lift it onto trains or buses. Prams give your baby a lot of space to sit and lie comfortably, although they take up a lot of space and are hard to use on public transport.

130 • breast pads. You put these into • a shawl or blanket to wrap If you have a car with your bra to prevent milk from your baby in 11 air bags in the front, your leaking onto your clothes. • a wool or cotton hat, mittens baby should not travel in If you are going to formula feed, and socks or bootees for going the front seat, even if they you will need: out if the weather is cold. WHAT YOU NEED FOR YOUR BABY are facing backwards, It’s better to choose close-knitted because of the danger of • six bottles with teats and caps patterns for safety suffocation if the bag inflates. • sterilising equipment • a sun hat for going out if the • a bottle brush weather is hot or the sun • infant formula milk. Avoid buying is bright. To keep your baby as safe as this too far in advance, as instant possible: formula milk has a ‘use by date’ • Make sure the car seat is printed on the package. fitted correctly. See Chapter 9 for how to feed • Do not place a rear-facing infant your baby. car seat in the front passenger seat if your car is fitted with an CLOTHES air bag. Babies grow very quickly. All you need for the first few weeks are enough clothes to make sure that your baby will be warm and clean. You will probably need:

• six stretch suits for both day and Washing night or four stretch suits and baby clothes two nighties for the night. Use socks or bootees with the If you use a washing • Don’t buy a second-hand car nightie if it’s cold machine, don’t use washing seat as it may have been powders with enzymes damaged in an accident. • two cardigans. They should be (bio powders) or fabric wool or cotton rather than • Look for United Nations ECE conditioner, as they may nylon, and light rather than irritate your baby’s skin. Regulation number R44.03, or heavy. Several light layers of a later version of this standard, Always rinse clothes clothing are best for keeping very thoroughly. when you buy a car seat. This your baby warm is the standard for new seats. However, if you have car seats that • four vests conform to a British Standard or to an earlier version of R44, you can continue to use them. for tiny FEEDING toes If you are going to breastfeed, you will probably want: • nursing bras that open at the front and have adjustable straps. Cotton is best because it allows air to circulate. If you try on bras at about 36–38 weeks, they should ﬁt when you need them

131 THE EARLY WEEKS: YOU

Partners 132 Your relationships 134 Help and support 133 The ‘baby blues’ and postnatal depression 136 Looking after yourself 133 Your postnatal check 136

Your first few weeks at home can be an exciting but anxious time for parents as you get used to caring for your new baby. If you have been in hospital or a midwifery unit, you may feel apprehensive about being on your own without staff on call to help you. The more you handle your baby, the more your confidence will increase. And your community midwife, health visitor and GP are there to support you if you have any worries or problems. Ask your midwife or health visitor for a copy of the book Birth to Five, which has advice on looking after your child up to the age of five.

PARTNERS – getting specialist help and information on breastfeeding if the mother has As the mother’s partner, you any concerns can get involved in caring • provide emotional support and for your baby from day one. encouragement In the ﬁrst weeks, you can: • make nutritious meals and snacks for • help your baby’s mother to your baby’s mother breastfeed by: • change your baby’s nappies – spending time with her • bathe and dress while the baby is feeding your baby – bringing your baby • cuddle and play to their mother when with your baby they need feeding in the night • clean the house, go shopping – helping to wind and do other your baby household chores.

You may feel quite nervous about handling the baby at ﬁrst but you will get more conﬁdent. Don’t be embarrassed to ask for help or encouragement.

132 HELP AND It’s tempting to use your baby’s sleep times to catch up on 12 SUPPORT chores, but try to have a sleep You will probably need a lot of or a proper rest at least once during the day. practical help, as well as emotional THE EARLY WEEKS: YOU support. You are bound to feel up Exercise and down and to get tired easily in Continue with any postnatal the first few weeks. Many women exercises you have been shown want to have their partner around by your midwife. You can also do so that you get to know the baby Too many visitors in a short time this deep stomach exercise when together and have help with the can be very tiring. If visitors do you feel well enough. work. Being together at this time come, don’t feel you have to tidy helps you to start to adjust to the up or lay on a meal. Let them do changes in your life. If you are on 1 Lie on your side with your things for you, like the washing your own, or your partner cannot knees slightly bent. up, making a meal or bringing be with you, ask your mother or a some groceries. 2 Let your tummy relax and close friend to be there. breathe in gently. • If you need extra help, ask. Friends Even with help, you will probably or neighbours will probably be 3 As you breathe out, gently feel tired. Here are some things you very willing to help you by doing draw in the lower part of could try: things like shopping. your stomach like a corset, narrowing your waistline. • Cut down on cleaning – a bit of dust will not hurt. LOOKING AFTER 4 Squeeze your pelvic floor. • Keep meals simple but healthy. YOURSELF 5 Hold for a count of 10 You need to eat well but this then gently release. Although you may feel like your need not involve a great deal of 6 Repeat 10 times. preparation and cooking. every waking hour is spent caring for your baby, it’s important to look • Try to space visitors out and say no after yourself as well. You should not move your back to visitors if you feel too tired or at any time. After six weeks, need some time with your baby. Rest progress to the box position While you are feeding your baby at (see page 34). night and your body is recovering from childbirth, it is essential to Besides these exercises, try to catch up on rest. fit in a walk with your baby every day. This can help you lose weight and feel better.

133 YOUR RELATIONSHIPS After you have had a baby, the relationships around you can change. Many women find that they turn to their own mother for help and support. But your mother may not be sure about how much Your relationship with your baby to get involved. You may find that may not be easy either, particularly she is trying to take over or that she if you are not getting much sleep. is so anxious not to interfere that Don’t feel guilty if you sometimes she doesn’t help at all. Try to let her feel resentful at the demands your and others know what help and baby makes, or if your feelings are support you want from them. not what you expected them to be. Talk to your midwife or health Your relationship with your partner visitor if you are upset or worried. Eating properly will also change. It is very easy in But remember, many mothers find those exhausting early weeks just their babies difficult at first and It’s very important to eat properly to leave things to sort themselves come to love them gradually over (see Chapter 3). If you want to lose out. You may wake up six months some weeks. weight, don’t rush it. A varied diet later to find that you have not spent without too many fatty foods will an hour alone together and have If you are on your own and help you lose weight gradually. Try lost the knack of easily talking your don’t have family to support you, to make time to sit down, relax and problems through. You both need ask a friend to help you in the enjoy your food so that you digest time alone, without the baby, to early weeks. it properly. It doesn’t have to be recharge your own batteries. You Sex and contraception complicated. Try food like baked also need time together, without There are no rules about when to potatoes with baked beans and the baby, to keep in touch with start having sex again. Don’t rush cheese, salads, pasta, French bread each other. pizza, scrambled eggs or sardines on into it – if it hurts, it will not toast, followed by fruit mixed with be pleasurable. You may want yoghurt or fromage frais. to use a lubricating jelly the first time because hormone changes A healthy diet is especially may make your vagina feel drier important if you are breastfeeding. than usual. Breastfeeding can help mothers to lose weight. Some of the fat you put on in pregnancy will be used to help produce milk, but the rest of the nutrients will come from your diet. This means that you may be hungrier than usual. If you do need a snack, try having beans on toast, sandwiches, bowls of cereal or fruit (see page 29). Sure Start Children’s Centres give advice about healthy eating plans for mothers, as well as support for breastfeeding. You can find out more about the services offered in Children’s Centres in your area by visiting www.surestart.gov.uk

134 THE EARLYEARLY WEEKS: WEEKS: YOU YOU 135 12

This contains a

acting contraceptive. have to use some other form of some other form have to use (like a condom)contraceptive evidence is no as well. There that this pill affects to suggest Even so, your baby in any way. not to take some women prefer breastfeeding it while they are ofand use another form contraception instead. The contraceptive implant (Implanon). andlong-lasting progestogen years. for three is effective It can be fitted 21 days after you give birth or earlier in some fitted after If it’s circumstances. 21 days, you will have to use another contraceptive for seven days. The contraceptive implant your milk supplywill not affect breastfeeding. if you are The contraceptive injection. that you waitIt is recommended until six weeks after you give given this. you are birth before It can be given earlier in some The contraceptivecircumstances. your milkinjection will not affect breastfeeding. supply if you are The IUD (intra-uterine device) or IUS (intra-uterine system). theThese can be fitted from fourth week after you give birth. They can be fitted at your postnatal check-up when your uterus is back to its normal size. TheseThe cap or diaphragm. aftercan be used six weeks had a capyou give birth. If you will not be it probably before, You the right size any longer. can have a new one fitted at your postnatal check-up.

• • • you will forget to take or use a short- • Long-acting contraceptive methods Long-acting contraceptive methods last between three months and ten years. They may be suitable if you think

The condom. This may be the easiest choice for the early weeks after childbirth. best the Condoms offer against sexually protection transmitted infections (STIs) so if you think you or your partner may have been exposed to an STI you should use a condom in addition to your other choice of contraception. The combined pill. If you are you can startnot breastfeeding, taking this pill 21 days after you give birth. If you start it later it will not be than the 21st day, for the ﬁrst seven days.reliable So for this time you will have to use another contraceptive (like a take thiscondom) as well. Don’t as it breastfeeding pill if you are milk ﬂow. reduces pill.The progestogen-only you breastfeeding, If you are can take a progestogen-only yourpill, which will not affect This can also be milk supply. started 21 days after you give birth. It has to be taken at the If you same time every day. start it later than the 21st day, for twoit will not be reliable days. So for this time you will

Contraceptives Short-acting contraceptive methods Short-acting contraceptive on you taking them methods rely every day or when you have sex. • • •

soon as you start having sex again. Your midwife or Your doctor should contraceptives as

publishes free leaﬂets aboutpublishes free all methods of contraception. Association – see page 184) The FPA (Family Planning The FPA clinic). called family planning or CASH contraceptive clinic (sometimes or go to your GP or community visitor when they visit you at home could talk to your midwife or health postnatal check. Alternatively, you postnatal check. Alternatively, when you go for your six-week before you leave hospital and againbefore talk to you about contraception

It is therefore important to use It is therefore again or if you are breastfeeding. again or if you are if you have not started your periods It is possible to get pregnant even It is possible to get pregnant or health visitor. worries, discuss them with your GP If you or your partner have any ways of being loving and close. both may feel happier finding other want to have sex. Until then, you It might be some time before you It might be some time before THE ‘BABY BLUES’ Tell the doctor if the examination AND POSTNATAL is uncomfortable. • Your breasts are unlikely to be DEPRESSION examined unless you have a As many as 8 out of 10 mothers get particular concern. the ‘baby blues’, often about three • A cervical smear test may be to five days after the birth. You discussed if you have not had one might feel upset, mildly depressed, in the past three years (see page or just keep bursting into tears for YOUR POSTNATAL 48). This is usually delayed until no apparent reason. It usually only three months after delivery. CHECK lasts for a few days. • If you are not immune to rubella Around 1 in 10 mothers become You should have your postnatal (German measles) and were not depressed. This is usually mild but check about six weeks after your given an immunisation before you sometimes can be quite severe. baby’s birth to make sure that you left hospital, you will be offered You must get help if you are taken feel well and are recovering from one now. You should not become over by a feeling of sadness and the birth. You may be offered an pregnant for one month after this hopelessness, you feel irritable appointment to go back to the immunisation. and anxious, or you have difficulty hospital or midwifery unit where • You will be asked if you still have sleeping and coping with even the you gave birth, but otherwise any vaginal discharge and whether smallest task. See page 82 for you should see your GP. It’s time you have had a period yet. more information. to introduce your baby to your GP as the new member of • Tell your doctor if: Help and support your family! - you are having trouble holding in urine or wind, or you are It’s a good opportunity to ask If you think you are depressed, soiling yourself any questions and sort out any contact your GP or health problems that are troubling you. - intercourse is painful visitor and explain how you are You may like to make a list of - you are feeling very tired, feeling. Your partner or a friend questions to take along with you low or depressed, or could contact them for you if so that you don’t forget what you want. You can also contact - you are worried about anything. you want to ask. the Association for Post-Natal You can also ask your doctor about Illness (see page 186) for more What usually happens contraception. You may wish to information. • You will be weighed and can choose a different method to If you have twins or triplets, get weight loss advice if you the one you had previously used you are more likely to experience need it. (especially if your pregnancy was not planned). The doctor or postnatal and longer-term • Your urine will be tested to nurse can help you decide which depression. This is mainly because make sure your kidneys are method is right for you now. of the additional stress of caring working properly and that See the box on page 135 for for more than one baby. Just there is no infection. getting out of the house can be some of the different options. • Your blood pressure will be difficult when you have more checked. than one baby, and this can make you feel isolated. Tamba (see page • You may be offered an Your baby’s check 188) can help you make contact examination to see if: with other mothers of multiples - your stitches (if you had any) Your GP’s surgery or health via local twins clubs and through have healed clinic will probably arrange their helpline – Tamba Twinline on for your baby’s six-week - your uterus is back to its check to be done at your 0880 138 0509 – where you can normal size, and talk to other mothers of multiples. postnatal check. If you go You may also find it helpful - all the muscles used during to the hospital, the baby’s to contact the Multiple Births labour and delivery are check will usually need to Foundation (see page 183). returning to normal. be arranged separately.

136 THE EARLY WEEKS: 12 YOUR BABY THE EARLYTHE EARLY WEEKS: YOU WEEKS: YOUR BABY Enjoying your baby 137 Changing your baby 142 Registering the birth 138 Washing and bathing 144 Crying 138 Illness 145 SleepContents 140 Getting support 146

In the ﬁrst few weeks, you will be learning how to look after your baby. You will start to understand them and will learn what is normal and what may be a sign that something is wrong. But the most important thing to do in the ﬁrst few weeks is to enjoy your baby. Spending time with them is the best way to help them feel safe and loved.

ENJOYING YOUR BABY

Keeping your baby warm, fed and They are learning about what the Talking to your baby safe may seem to take up all of your world is like and, above all, what it It is very important to talk to time in the ﬁrst weeks. But they are feels like to love and be loved. It is your baby. If you or your family only a tiny part of what it means to important to talk to your baby. speak another language, use be a parent. Every second that your it to speak to your baby. It can baby is awake, they are learning help your baby to learn other from you. Learning about what it languages, and enjoy another feels like to be touched gently, the culture. You can talk to them sound of your voice and your very listening about anything and everything. special smell. Talking to young children, even to your very young babies helps them become good communicators later in life. It will also help voice your baby build their early bond with you.

137 At the moment, if you are not CRYING married, you can decide whether you want the father’s name to All babies cry. It’s their way of appear on the birth certificate. saying that something is not right. If you do not want his name to Sometimes you will be able to find appear, you can register the birth the reason for your baby’s distress by yourself. However, the and deal with it. At other times government plans to change the all you can do is try to comfort or law so that joint registration, by both distract your baby. If it’s not obvious mother and father, becomes the why your baby is crying, think of normal arrangement for unmarried possible reasons. parents. Your local register office Are they: REGISTERING will be able to provide detailed • hungry? THE BIRTH information about these changes when they come into effect. • hot, cold or uncomfortable? Your baby’s birth must be registered If you live in a different district from • feeling tired and unable to sleep? within six weeks from when they the one where your baby was born, • lonely and wanting company? were born. This will take place at you can go to your nearest register the register office in the district office. The registrar will take details • bored and wanting to play? where they were born. The contact from you and then send them to Do they have: details will be in the telephone the district where your baby was • a wet or dirty nappy? book under the name of your local born. You will then be sent the authority or you can find it online birth certificate. You cannot claim • wind? at www.direct.gov.uk benefits, such as Child Benefit, • colic? until you have a birth certificate. It could be none of these things. All babies born in England and Perhaps your baby simply feels Wales are now given a unique overwhelmed and a NHS number at birth. Midwives bit frightened by all request and receive a newborn the new sights, baby’s NHS number. They send sounds and this NHS number to the sensations. Registrar of Births, Deaths and Marriages via If you are married, you or the father your local can register the birth. If you are not child health married, you may register together department. with your baby’s father and his name will appear on the birth certificate. In most circumstances, children benefit from being acknowledged by both parents and by knowing the identity of both their mother and father. To register jointly, you must either go together to register the birth or one of you can go with an appropriate document. Including the father’s name in the birth register will usually give him parental responsibility. Your local register office will explain this process.

138 When crying gets Getting help 13 too much If you feel you are having difﬁculties Some babies do cry more than coping with your baby’s crying, talk others and it’s not really clear why. to your midwife or health visitor. Or

Don’t blame yourself, your partner contact Cry-sis on 08451 228669 – THE EARLY WEEKS: YOUR BABY or your baby if they cry a lot. It can they will put you in touch with other be very exhausting so try to get parents who have been in the same rest when you can. Share soothing situation. If you have twins or more, your baby with your partner. You the crying can seem relentless – could ask a friend or relative to take Twinline, Tamba’s helpline (see page over for an hour from time to time, 188), can offer support. just to give you a break. If there If your baby’s crying sounds is no one to turn to and you feel different or unusual, it may be the your patience is running out, leave ﬁrst sign of illness, particularly if your baby in the cot and go into they are not feeding well or will another room for a few minutes. not be comforted. If you think Put on some music to drown the your baby is ill, contact your doctor noise, take some deep breaths, immediately. If you cannot contact make yourself a cup of tea or ﬁnd your doctor and it’s an emergency, some other way to unwind. You will Comforting take your baby to the nearest cope better if you do. If you are very your baby hospital accident and emergency angry or upset, telephone someone department. Holding your baby close and who will make you feel better. talking in a soothing voice or singing softly will reassure them. Never shake your baby. Shaking makes a baby’s head move violently. Movement often helps to calm It can cause bleeding and damage down crying. Gently sway or rock the brain. your baby or take them for a walk or for a ride in a car. Sucking can also be comforting. You can put your baby to your breast or give them a dummy, as long as breastfeeding is well established (see page 106). Make sure the dummy is Colic sterilised and don’t If your baby has repeated episodes of excessive and inconsolable dip it in honey or crying but they otherwise appear to be thriving and healthy, sugar to make your baby suck. they may have colic. They will suck anyway. Using sugar will only encourage a Although it may appear that your baby is in distress, colic is not craving for sweet things, which harmful. Your baby will continue to feed and gain weight normally. are bad for their teeth. There is no evidence that colic has any long-term effects. Colic can be very upsetting for parents. You may feel like you are letting your baby down or that you are doing something wrong. Although colic can be distressing at the time, it is a common phase that should last only a few weeks at the most. It may help to remind yourself that you are not causing the crying and it is not under your control. If you are concerned, talk to your health visitor or GP.

139 Reducing the risk Place your baby on their back to sleep of cot death Sadly, we don’t know why some Place your baby on their back to babies die suddenly and for no sleep from the very beginning for apparent reason from what is both day and night sleeps. This will called ‘cot death’ or ‘Sudden reduce the risk of cot death. Side Infant Death Syndrome’ (SIDS). sleeping is not as safe as sleeping But we do know that placing on the back. Healthy babies placed a baby to sleep on their back on their backs are not more likely reduces the risk, and that to choke. When your baby is old exposing a baby to cigarette enough to roll over, they should not smoke or overheating a baby be prevented from doing so. SLEEP increases the risk. Babies may get flattening of The amount that babies sleep, even All the advice that we now the part of the head they lie on when they are very small, varies a have for reducing the risk of cot (plagiocephaly). This will become lot. During the early weeks some death and other dangers, such rounder again as they grow, babies sleep for most of the time as suffocation, is listed on this particularly if they are encouraged between feeds. Others will be page and opposite. Remember to lie on their tummies to play wide awake. As they grow older, that cot death is rare, so don’t when they are awake and being they begin to develop a pattern of let worrying about it stop you supervised. Experiencing a range of waking and sleeping. Some babies enjoying your baby’s first few different positions and a variety of need more sleep than others and at months. But do follow the advice movement while awake is also good different times. Try not to compare given here to reduce the risks as for a baby’s development. what your baby does with other much as possible. The risks of bed sharing people’s babies. All babies are To reduce the risk of cot death: The safest place for your baby to different, and their routines will sleep is in a cot in a room with you change as they grow. • Place your baby on their back for the first six months. Do not to sleep, in a cot in a room You will gradually begin to share a bed with your baby if you or with you. recognise when your baby is ready your partner: • Do not smoke in pregnancy or for sleep and is likely to settle. Some • are smokers (no matter where or babies settle better after a warm let anyone smoke in the same room as your baby. when you smoke and even if you bath. Most sleep after a good feed. never smoke in bed) A baby who wants to sleep is not • Do not share a bed with your likely to be disturbed by ordinary baby if you have been drinking • have recently drunk alcohol household noises, so there is no alcohol, if you take drugs or if • have taken medication or drugs need to keep your whole home you are a smoker. that make you sleep more heavily quiet while your baby sleeps. It will • Never sleep with your baby on • feel very tired. help you if your baby gets used to a sofa or armchair. sleeping through a certain amount of The risks of bed sharing are also noise. See the column on the right • Do not let your baby get too increased if your baby: for advice on sleeping positions. hot – keep your baby’s head uncovered. • was premature (born before Twins, triplets or more can have 37 weeks), or • Place your baby in the ‘feet to specific sleeping issues and it may • was of low birth weight foot’ position. be difficult for you to get them (less than 2.5kg or 5.5lb). into a routine. The Multiple Births Foundation and Tamba (see pages The safest place for your There is also a risk that you might 183 and 188) have information baby to sleep is on their roll over in your sleep and suffocate that you may find useful. They can back in a cot in a room your baby, or that your baby could sleep in the same cot – there is with you for the first get caught between the wall and the bed, or could roll out of an adult information from Tamba on six months. how you can do this safely. bed and be injured.

140 Never sleep with a baby on Remember, a folded blanket covers, place your baby feet to foot a sofa or armchair counts as two blankets. in the crib, cot or pram. 13 It’s lovely to have your baby with • Babies do not need hot rooms; Make the covers up so that they you for a cuddle or a feed but it’s all-night heating is rarely reach no higher than the shoulders. safest to put your baby back in their necessary. Keep the room at a Covers should be securely tucked THE EARLY WEEKS: YOUR BABY cot before you go to sleep. temperature that is comfortable in so they cannot slip over your for you at night. About 18°C Cut out smoking during baby’s head. Use one or more (65°F) is comfortable. pregnancy – partners too! layers of lightweight blankets. • If it is very warm, your baby may Smoking in pregnancy greatly Sleep your baby on a mattress that not need any bedclothes other increases the risk of cot death. is firm, flat, well fitting and clean. than a sheet. It is best not to smoke at all. The outside of the mattress should • Even in winter, most babies who be waterproof. Cover the mattress If you are pregnant and want are unwell or feverish do not with a single sheet. to give up, call the NHS need extra clothes. Pregnancy Smoking Helpline Remember, do not use duvets, on 0800 169 9 169. • Babies should never sleep with quilts, baby nests, wedges, a hot-water bottle or electric bedding rolls or pillows. blanket, next to a radiator, heater Don’t smoke near or fire, or in direct sunshine. your baby. • Babies lose excess heat from their Put your baby feet to foot heads, so make sure their heads in the crib. Don’t let anyone smoke in cannot be covered by bedclothes during sleep periods. the same room as your baby Feeding Babies exposed to cigarette smoke Breastfeeding your baby reduces the after birth are also at an increased risk of cot death. See Chapter 9 for risk of cot death. Nobody should Don’t let your baby overheat. everything you need to know about smoke in the house, including breastfeeding. visitors. Anyone who needs to Remove hats and extra smoke should go outside. Do not clothing as soon as you take your baby into smoky places. come indoors or enter If you are a smoker, sharing a bed a warm car, bus or train, with your baby increases the risk even if it means waking of cot death. your baby. Don’t let your baby get too hot (or too cold) Overheating can increase the risk of cot death. Babies can overheat because of too much bedding or clothing, or because the room is too It is possible that using a dummy at hot. Remember, a folded blanket the start of any sleep period reduces counts as two blankets. When you the risk of cot death. Do not begin check your baby, make sure they to give a dummy until breastfeeding are not too hot. If your baby is is well established, usually when sweating or their tummy feels hot your baby is around one month to the touch, take off some of the old. Stop giving the dummy when bedding. Don’t worry if your baby’s Don’t let your baby’s head your baby is between six and hands or feet feel cool – this become covered 12 months old. is normal. Babies whose heads are covered • It is easier to adjust the with bedding are at an increased temperature with changes risk of cot death. To prevent your of lightweight blankets. baby wriggling down under the

141 If your baby is unwell, seek CHANGING MEDICAL advice promptly Babies often have minor illnesses YOUR BABY that you do not need to worry Babies need their about. nappies changed fairly Make sure your baby drinks plenty often, otherwise they of fluids and is not too hot. If become sore. Unless your baby sleeps a lot, wake them your baby is sleeping regularly for a drink. peacefully, always change a wet or dirty It can be difficult to judge whether nappy and change an illness is more serious and your baby before requires prompt medical attention. or after each feed. See the section on illnesses on Organise the place where page 145 for guidance on when you change your baby so that you should get help. everything you need is handy (see Clean under the penis and the scrotum. Water is fine for cleaning Monitors page 128). The best place to change a nappy is on a changing mat or your baby’s bottom but you may Normal healthy babies do not need towel on the floor, particularly if you want to use wipes or lotion for a breathing monitor. Some parents have more than one baby. That way, convenience when you are away find that using a breathing monitor if you take your eye off your baby from home. reassures them. However, there is for a moment to look after another no evidence that monitors prevent • You may want to use a cream, such child, your baby cannot fall and as zinc and castor oil cream, which cot death. If you have any worries hurt themselves. about your baby, ask your doctor forms a waterproof coating to help about the best steps to take. Try to sit down, so you don’t protect the skin. Or you can just leave hurt your back. If you are using a the skin clean and dry, especially changing table, keep an eye on your with disposable nappies, since cream Immunisation reduces baby at all times. may prevent them absorbing urine so well. Don’t use baby powder the risk of cot death. See the next page for the different as it can cause choking. For more information kinds of nappies that are available. about immunisation, visit www.immunisation.nhs.uk How to change a nappy You need to clean your baby’s bottom carefully each time you change a nappy to help prevent More information soreness and nappy rash. STEP 1 For more information on • Take off the nappy. If it’s dirty, wipe reducing the risk of cot away the mess from your baby’s death, or to buy a simple • If you are using a cloth nappy, bottom with tissues or cotton wool. room thermometer for place it in a waterproof cover (if your baby, contact the • Wash your baby’s bottom and needed) and put a nappy liner Foundation for the Study genitals with cotton wool and warm inside. Lay your baby carefully on of Infant Deaths (FSID): water and dry thoroughly. For girls, the nappy, bring the centre of the wipe the bottom from nappy between your baby’s legs Telephone: 020 7802 3200 front to back, away and then fasten the poppers or Email: offi[email protected] from the vagina, so that Velcro. Check that it fits snugly Website: www.fsid.org.uk germs will not infect around the waist and legs. the vagina or bladder. STEP 2 For boys, gently clean • If you are using a disposable the foreskin of the nappy, put the side with the sticky penis (it can be pulled tapes under your baby’s bottom. back very gently). 142 STEP 3 nappy less absorbent. Make sure stools. Formula-fed • Fasten the tapes at the front. you use the correct amount of babies’ stools 13 Be very careful not to get cream detergent and rinse thoroughly. are firmer and on the tabs or they will not stick. smell more. Nappy rash

• Wash your hands. THE EARLY WEEKS: YOUR BABY Most babies get a sore bottom Babies vary a lot Nappy hygiene or have nappy rash at some time, in how often they pass stools. Some have a Disposable nappies but some have extra-sensitive skins. Nappy rashes are caused by contact bowel movement at or around each If the nappy is dirty, flush the between sensitive skin and soiled feed; some can go for several days contents down the toilet. Roll up nappies. If you notice redness or without having a movement. Either the nappy and re-tape it securely. spots, clean your baby very carefully can be normal, but most breastfed Put it into a plastic bag. Don’t put and change their nappies more babies produce at least one stool anything but nappies in this bag. frequently. Better still, give your a day for the first six weeks. Fasten the bag and put it outside baby time without a nappy and in your bin each day. When to get help let the air get to their skin. Keep a Most small babies strain and go spare nappy handy to mop up any Cloth nappies red in the face, or even cry, when accidents. You will soon see the rash • If the nappy is dirty, flush the passing a stool. This is normal and start to get better. contents down the toilet. doesn’t mean they are constipated Biodegradable, flushable nappy If your baby does have a rash, ask as long as the stools are soft. If you liners are available to make it easy. your midwife or health visitor about are worried that your baby may be • Have a lidded bucket ready to store it. They may advise you to use a constipated, mention this to your the dirty nappies. You can soak protective cream. If the rash seems midwife or health visitor. to be painful and will not go away, them in a nappy cleanser (follow What you find in your baby’s see your health visitor or GP. the instructions on the packet) or nappies will probably vary from day just store them here until you have Babies’ poo (stools) to day, and usually there is no need a load ready for washing. to worry. For example, it is normal Immediately after birth and for the • Wash nappies every two to three for some babies to have very runny first few days, your baby is likely days. Follow the care instructions stools. But ask your doctor, midwife to pass a sticky, greenish-black on your nappies, but a 60ºC or health visitor if you notice any substance. This is called meconium wash is usually OK. If you did not big changes, such as stools: and it is the waste that has collected soak the nappies before, add an in your baby’s bowels while they • becoming very frequent and antibacterial nappy cleanser to your were in your uterus. watery normal washing detergent (follow the instructions on the packet). As your baby begins to digest milk, • being very smelly Don’t use enzyme (bio) washing the stools will change. They will • changing colour to become powders or fabric conditioner as become more yellow or orange green, white or creamy. these may irritate your baby’s skin – and can be quite bright in colour. and the conditioner may make the Breastfed babies have quite runny See ‘Babies with jaundice after two weeks’ on page 149.

Putting on a disposable nappy

STEP 1 STEP 2 STEP 3

143 WASHING AND See page 124 on keeping your BATHING baby’s umbilical cord clean and dry. Bathing Washing Bath your baby two or three times You don’t need to bath your baby a week, or more often if they enjoy every day, but you should wash it. Don’t bath them straight after their face, neck, hands and bottom a feed or when they are hungry or carefully each day. You can do this sleepy. Make sure the room is warm on your lap or on a changing mat. and that you have everything you Choose a time when your baby need ready in advance. is awake and contented, and make sure the room is warm. 1 Check that the water is not You will need a bowl of warm too hot. Test it with your wrist water, some cotton wool, a towel or elbow. It should be just and a fresh nappy. If you want to comfortably warm. use soap, make sure that it is mild 2 Undress your baby except for 6 Lift your baby out and pat them and unperfumed. their nappy, and wrap them dry with the towel. Dry carefully snugly in a towel. Wash your in all the creases. If your baby’s baby’s face with cotton wool and skin is dry, gently massage in water as described above. There some baby oil or cream (not is no need to use any soap. aqueous cream). Your baby may 3 Wash your baby’s hair with baby enjoy this. soap or liquid, supporting their If your baby seems frightened of head over the baby bath or the bath and cries, it may help to basin. Rinse carefully. You don’t try bathing together. You may like need to use soap every time. to do this anyway. Make sure the 4 If you want to use soap water is only warm, not hot, and occasionally, use a mild, don’t add anything to the water. unperfumed soap. Unwrap your You should also think about how 1 Take off your baby’s clothes baby and soap them all over, but you are going to get out of the bath except for the vest and nappy. keep them on your lap so you with your baby. You might need Wrap your baby in a towel. have a firm grip. Take the nappy someone around who you can pass 2 Gently wipe round each eye, off at the last minute. them to. from the nose side outwards. 5 Put your baby gently into the Use a fresh piece of cotton water. Using one hand for wool for each eye, so you support, gently swish the water don’t transfer any stickiness to wash your baby without or infection. splashing their face. You should 3 Using fresh, moist cotton wool, never leave your baby alone wipe out each ear – but don’t in the water even for a few clean inside their ears. Never use seconds. For boys, gently clean cotton buds inside the ear canal. the top of the foreskin of the penis. The foreskin can be pulled 4 Wash the rest of your baby’s face back very gently to clean. and neck with moist cotton wool and dry gently. Wash and dry your baby’s hands in the same way. 5 Take off the nappy and wash your baby’s bottom (genitals), with fresh cotton wool and warm water. Dry your baby very carefully, including in skin folds, and put on a clean nappy. 144 ILLNESS If you are worried 13 It’s sometimes difficult to tell at first about your baby when a baby is ill, but you may have • Phone your midwife or health a funny feeling that things are not visitor for advice. Keep their THE EARLY WEEKS: YOUR BABY quite right. If you are at all worried, phone numbers where they ask for help. You are not fussing. can be reached easily. It’s far better to be on the safe side, particularly with a very small baby. • Phone your GP. Your GP may Trust your own judgement. You be able to advise you over the know your baby best. phone or may suggest that you bring your baby along to the Very urgent problems surgery. Most GPs will try to Sometimes there are obvious signs fit a young baby in without an that your baby is not well. Contact appointment, although it may your doctor at once if your baby: mean a wait in the surgery. • turns blue or very pale • If you are really worried about your baby, you should always • has quick, difficult or grunting phone your GP for help breathing, or unusual periods of immediately, whatever the breathing, for example breathing • If your baby cries in an unusual time of day or night. There will with pauses of over 20 seconds way or for an unusually long time always be a doctor on duty, between breaths or seems to be in pain. even if it is not your own GP. • is very hard to wake, unusually • If you notice any bleeding from If you cannot contact a drowsy or doesn’t seem to the stump of the umbilical cord GP, take your baby to an know you or from the nose, or any bruising. appropriate paediatric • develops a rash of red spots • If your baby keeps refusing feeds. emergency department. Not all that do not fade and lose colour A&E departments have resident • If your baby keeps vomiting (blanch) when they are pressed paediatricians. You need to a substantial part of feeds or (see the ‘glass test’). This may be take them to one that does. has frequent watery diarrhoea. the rash of meningococcal disease Vomiting and diarrhoea together and meningitis, which causes may mean your baby is losing too infection in the blood. There may much fluid, and this may need not be any other symptoms. The ‘glass test’ prompt treatment. Your baby may need treatment • If your baby develops jaundice very quickly. If you cannot get (looks yellow) when they are over hold of your GP at once, dial 999 a week old, or has jaundice that for an ambulance or take your continues for over two weeks baby to the nearest accident and after birth (see page 149). emergency (A&E) department with a paediatrician on site. If you have seen your GP and your baby is not getting better or seems Problems that could to be getting worse, tell your GP be serious again the same day. If you become • If your baby has a hoarse cough very worried and cannot get hold of The ‘glass test’ can help you with noisy breathing, is wheezing, your GP, dial 999 for an ambulance to tell if a rash is a symptom or cannot breathe through or take your baby to the nearest of meningitis. Press the side or the nose. A&E department with a bottom of a glass firmly against paediatrician on site. • If your baby is unusually hot, the rash. You will be able to see cold or floppy. if the rash fades and loses colour under the pressure (see photo). If it doesn’t change colour, contact your GP immediately.

145 GETTING SUPPORT Everyone needs advice or reassurance at some time when they are caring for a young baby, even if it’s just to make sure that Group B they are doing the right thing. streptococcal Some problems just need talking infection over with someone. It’s always better to ask for help than to Group B streptococcal infection worry on your own. Do talk to Your nearest Children’s Centre is a life-threatening infection in your midwife or health visitor. can be found by visiting babies. Most babies who are As you grow more conﬁdent, www.surestart.gov.uk infected show symptoms within you will begin to trust your own 12 hours of birth, but there judgement more. You will be are some who get it later. able to decide which advice The symptoms include: makes most sense for you and • being ﬂoppy and unresponsive your baby and which suggestions you can safely ignore. • not feeding well • grunting You will also want to talk to friends, relations or other mothers • high or low temperature in a similar situation. You will • fast or slow heart rate meet other mothers when you Your health visitor can tell you about any mother and baby • fast or slow breathing rate start taking your baby to the child health clinic or Sure Start groups in the area. Or your local • irritability. Children’s Centre. Your health branch of the NCT (see page Your baby may need treatment visitor will explain where 183) or MAMA (Meet A Mum very quickly. If you cannot get these are and when you Association) (see page 184) may hold of your GP at once, dial should go. be able to put you in touch with 999 for an ambulance or other mothers nearby. take your baby to the nearest accident and emergency department with a paediatrician on site. For more information, see www.gbss.org.uk

146 BABIES WHO NEED ADDITIONAL CARE

Why babies need additional care 147 Incubators 148 Contact with your baby 148 Newborn babies with jaundice 149 Feeding 148 Babies with disabilities 149

About one in eight of all babies will need extra care in hospital, sometimes on the ordinary postnatal ward and sometimes in a specialist neonatal area. Having a baby in neonatal care is naturally worrying for parents and every effort should be made to ensure that you receive the information, communication and support you need. Not all hospitals provide neonatal services, so it may be necessary to transfer your baby to another hospital for specialist care.

WHY BABIES NEED ADDITIONAL CARE

Babies can be admitted to • They have an infection. neonatal services for any of the • Their mother is diabetic. following reasons: • The delivery was very difﬁcult • They are born early. One in 10 and they need to be kept under of all babies are born prematurely. close observation for a time. Babies born earlier than 34 • They have very marked jaundice weeks may need extra help (see page 149). with breathing, feeding and keeping warm. • They are awaiting or recovering • They are very small and have from complex surgery. close a low birth weight. observation

147 CONTACT WITH FEEDING If your baby is unable to have your breastmilk to begin with, it can be YOUR BABY To begin with, your baby may be frozen and given to them when too small or sick to feed themselves. they are ready. When you go home, You may be asked to express some you can express milk for the nurses of your breastmilk, which can be to give while you are away. There given to your baby through a tube. is no need to worry about the A fine tube is passed through quantity or quality of your milk. their nose or mouth into their Some mothers find that providing stomach. This will not hurt them. breastmilk makes them feel that Breastmilk has particular benefits, they are doing something positive and especially for sick or premature for their baby. babies, as it is specially enriched See Chapter 9 for information on with fats and minerals. expressing and storing milk.

INCUBATORS Babies who are very small are nursed in incubators rather than cots to keep them warm. However, you can still have a lot of contact with your baby. Some incubators have open tops. If not, you can put your hands through the holes in the side of the incubator and touch your baby. When your baby is stable, the nurses will be able to help you take your baby out of the incubator and Your baby will beneﬁt from physical show you how to have skin to skin contact with you, even though the contact. You should carefully wash environment of the unit may seem and thoroughly dry your hands strange and confusing. When you before touching your baby. You can ﬁrst go into the unit, your baby talk to your baby as well – this can may be in an incubator and on a help both of you. breathing machine. There may also be tubes and wires attached to their face and body. Ask the nurse to explain what everything is for and to show you how you can be involved with your baby’s care. Once your baby is stable, you will be able to hold them. The nurses will show you how to do this.

148

BABIES WITH Getting information 14 DISABILITIES Hospital staff should explain what kind of treatment your If your baby is disabled, you will baby is being given and why. be coping with a lot of different If they don’t, make sure you BABIES WHO NEED ADDITIONAL CARE feelings. You will also need to cope ask. It is important that you with the feelings of others – your understand what is happening NEWBORN BABIES partner, relations and friends – as so that you can work together they come to terms with the fact to make sure that your baby WITH JAUNDICE that your baby has a disability. More gets the best possible care. Jaundice in newborn babies is than anything else at this time, you Some treatments will need common because their livers are will need to talk to people about your consent and the doctors immature. Severely jaundiced babies how you feel as well as about your will discuss this with you. may be treated with phototherapy. baby’s health and future. It is natural to feel anxious if Babies are undressed and put under your baby requires additional a very bright light, usually with care. Talk over any fears or a soft mask over their eyes. The worries with the hospital staff. special light helps to break down Hospitals often have their the chemical that causes jaundice. own counselling or support It may be possible for your baby to services, and a number of have phototherapy by your bed so charities run support and that you don’t have to be separated. advice services. This treatment may continue for The consultant neonatologist several days, with breaks for feeds, or paediatrician should before the jaundice clears up. If the arrange to see you, but jaundice gets worse, an exchange you can also ask for an transfusion of blood may be appointment at any time if needed. This is not common. Some you wish. The hospital social babies have jaundice because of worker may be able to help liver disease and need a different with practical problems such treatment. Your baby will be given as travel costs or help with a blood test before phototherapy is looking after other children. started to check for this. Babies with jaundice after two weeks Many babies are jaundiced for up Your own GP, a neonatologist or Help and support to two weeks following birth. This paediatrician at your hospital, or can be as long as three weeks in your health visitor can all help you. premature babies. This is common You can also contact the hospital Bliss, the neonatal charity, in breastfed babies and usually it is Patient Advice and Liaison Service supplies all neonatal services normal and does no harm. It is not (PALS) or your social services with a free Parent Information a reason to stop breastfeeding. But department for information about Guide, which you should be it’s important to see your doctor if local organisations that may given on admission. your baby is still jaundiced after two be able to help. In the useful For more information contact weeks. You should see them within organisations section (page 182) Bliss Family Support Helpline a day or two. This is particularly you will ﬁnd a list of organisations on freephone 0500 618 140 important if your baby’s poo (stools) that can offer help and advice. or visit the website is chalky white. A blood test will Many are self-help groups run by www.bliss.org.uk show whether your baby has parents. Talking to other parents ‘breastmilk’ jaundice, which will go with similar experiences can often away by itself, or jaundice that may be the best help. need urgent treatment.

149 THE LOSS OF YOUR BABY

Ectopic pregnancy 151 MiscarriageContents 151 Abnormal test results 152 Stillbirth and neonatal death 153

Some women may have to cope with miscarriage, ectopic pregnancy, termination, stillbirth or neonatal death (death shortly after birth). This chapter explains why some of these things may happen.

Help and support

If your pregnancy goes The following organisations Antenatal Results and Choices wrong, you will need both may help: (ARC) is a voluntary organisation that supports parents who information and support. The Ectopic Pregnancy Trust are making decisions about (www.ectopic.org.uk) offers Talk to the people close terminating or continuing their support and information for to you about how you feel, pregnancies. See page 186 for parents who have had an ectopic and to your midwife, doctor details. or health visitor about what pregnancy. They have a helpline has happened and why. on 020 7733 2653 and can Sometimes it is easier to put you in touch with other talk to someone who is not people who have had an ectopic a family member or friend, pregnancy. for example your doctor, The Miscarriage Association midwife or health visitor. can give you information and put you in touch with other parents There are also a number who have experienced of voluntary organisations a miscarriage. See page that offer support and 186 for details. information. These are often run by bereaved Sands can put you in touch parents. It can be with other parents who very helpful to talk to have had a late miscarriage, another parent who has stillbirth or neonatal death. been through a similar They also have an internet experience. forum at www.sandsforum. org and a parents’ telephone helpline on 020 7436 5881. See page 186 for details.

150 ECTOPIC Some women have no obvious signs or symptoms at all and an 15 PREGNANCY ectopic pregnancy may sometimes After fertilisation, the egg should be mistaken for irritable bowel syndrome, food poisoning or move down into the uterus to THE LOSS OF YOUR BABY develop. Sometimes it gets stuck even appendicitis. in the fallopian tube and begins to Afterwards grow there. This is called an ectopic You may feel a strong sense of loss or tubal pregnancy. Rarely, the egg and it is important to give yourself can become stuck elsewhere, time to grieve. An ectopic pregnancy such as the ovary or the cervix. involves abdominal surgery or The fertilised egg cannot develop treatment with powerful medicines. properly and your health may be It may affect your chances of at serious risk if the pregnancy becoming pregnant again. continues. The egg has to be removed. This can be done through It may be helpful to talk to an operation or with medicines. your doctor to discuss the possible causes and whether your Ectopic pregnancy can be caused chances of conceiving a baby by damage in the fallopian tube, GP before they see you). If you have been affected. possibly as a result of an infection. are more than six or seven weeks Previous abdominal surgery and pregnant, you may be referred for an previous ectopic pregnancy can also MISCARRIAGE ultrasound scan to see if your baby increase the risk. The warning signs has a heartbeat and is developing If a pregnancy ends before the 24th start soon after a missed period. normally. Sometimes the bleeding week, it is known as a miscarriage. stops by itself and your pregnancy Miscarriages are quite common in will carry on quite normally. the first three months of pregnancy. At least one in six confirmed Some women find out that their pregnancies end this way. Many baby has died only when they have early miscarriages (before 14 weeks) a routine scan. If they have had no happen because there is something pain or bleeding, this can come as wrong with the development of the a terrible shock, especially if the baby. There can be other causes, scan shows that the baby died days such as hormone or blood-clotting or weeks before. This is sometimes problems. A later miscarriage may called a missed or silent miscarriage. be due to an infection, problems These are: Treatment for in the placenta, or the cervix being miscarriage • severe pain on one side, low weak and opening too early in down in the abdomen the pregnancy. Sometimes it is preferable to wait and let the miscarriage happen • vaginal bleeding or a brown A miscarriage in the first few weeks naturally, but there are three ways watery discharge may start like a period, with spotting of actively managing a miscarriage: • pain in your shoulders or bleeding and mild cramps or •Medicine. You may be offered • feeling dizzy or faint backache. The pain and bleeding may get worse and there can be tablets or pessaries to start the • pain when you have a bowel heavy bleeding, blood clots and quite process of miscarriage. movement. severe cramping pains. With a later •Operation. If you have been If you have any of these symptoms miscarriage, you may go through an pregnant for less than 14 and you might be pregnant – even early labour. If you bleed or begin to weeks, your doctor may advise if you have not had a positive have pains at any stage of pregnancy, an operation called an ERPC pregnancy test – you should see you should contact your GP or (evacuation of retained your doctor immediately. midwife. You could also contact your products of conception). local early pregnancy unit (though This will empty your uterus. they may want a referral from your It is done under anaesthetic.

151 You may feel shocked, distressed, ABNORMAL angry, or just numb. You may feel guilty, wondering whether TEST RESULTS your miscarriage was caused When tests show that the baby by anything you did or did not has a significant abnormality, do. It is important to know that, some couples wish to continue the whatever the cause, miscarriage pregnancy and be prepared for is never anyone’s fault. If a the needs of their newborn baby. miscarriage is going to happen, Others decide to terminate the there is very little that anyone pregnancy. If tests show that your can do to stop it. baby has a serious abnormality, The cervix is gently widened and find out as much as you can from the contents of your uterus are Some people find having your doctor about the particular removed by suction. something to remember their baby by helps. In an early condition and how it might affect •Induced labour. If your baby loss, this may be a copy of a your baby, so that you can make dies after about 14 weeks, you scan picture. If you have a late a decision that is right for you may go into labour. If this doesn’t miscarriage, you may be able and your family. happen, you will be offered to see and hold your baby if you tablets that start labour. You will probably be very shocked wish. You might also be able Although some women would when you are first told the diagnosis to take photographs, footprints prefer not to go through and may find it hard to take in. and handprints as a keepsake. labour, this is safer for you than You may need to go back and talk Some hospitals offer parents an operation to remove the to the doctor with your partner or a certificate to commemorate baby. You will be cared for and someone close to you. Spend time their baby. This is done because supported throughout the labour talking things through. You may also there is no formal registration and the birth of your baby. find it helpful to contact Antenatal of a baby who dies before Results and Choices (see page 150). Afterwards 24 weeks of pregnancy. What happens One early miscarriage is unlikely Talk about your feelings with your to affect your chances of having partner and those close to you. A termination in the first three a baby in the future. If you have You might also want to contact months can be done under a general three or more early miscarriages in the Miscarriage Association or anaesthetic. A later termination a row, you should be referred to a Sands (see page 150). usually involves going through labour. specialist for further investigations. You may wish to think beforehand However, sometimes no clear about whether you want to see and cause can be found. perhaps even hold your baby, and Both women and men find it whether you want to give your baby difficult to come to terms with a a name. If you do not want to see miscarriage at any stage. You will your baby, you could ask hospital almost certainly feel a sense of loss. staff to take a photograph for you You will need time to grieve over in case you want to see it in the the lost baby just as you would over future. The photograph can be the death of anyone close to you, kept in your notes. especially if the miscarriage has Afterwards happened later in your pregnancy. You may find it hard to cope after a termination. It can help to talk, but sometimes family and friends find it difficult to understand what you are going through. If you would like to make contact with people who have undergone a similar experience, you can contact Antenatal Results and Choices (see page 150). 152 STILLBIRTH AND Post-mortems with a consultant who can 15 NEONATAL DEATH One of the first questions you explain the results to you and are likely to ask is why your baby also what these might mean In the UK about 4,000 babies are died. Sometimes a post-mortem for a future pregnancy. stillborn every year. This means that examination can help to provide Multiple births THE LOSS OF YOUR BABY the pregnancy has lasted for 24 some answers, although often no The loss of one baby from a weeks or more and the baby is clear cause is found. A post- multiple pregnancy is very difficult dead when it is born. About the mortem may, however, provide for any parent. Grieving for the same number of babies die soon other information that could be baby who has died while caring after birth. Often the causes of helpful for future pregnancies and for and celebrating the life of these deaths are not known. may rule out certain causes. If it the surviving baby brings very is thought that a post-mortem Sometimes a baby dies in the uterus mixed and complex emotions. could be helpful, a senior doctor or (an intra-uterine death or IUD) but Often the surviving baby is midwife will discuss this with you labour does not start spontaneously. premature and in a neonatal and explain the possible benefits. If this happens, you will be given unit, causing additional concern. If you decide to have a full or partial medicines to induce the labour. This For further information and post-mortem, you will be asked is the safest way of delivering the support, contact the Multiple to sign a consent form. When the baby. It also means that you and Births Foundation or Tamba post-mortem report is available, your partner can see and hold the (see pages 183 and 188 for you will be offered an appointment baby at birth if you want to. contact details).

It is shocking to lose a baby like this. You and your partner are likely to Saying goodbye to your baby experience a range of emotions that come and go unpredictably. These A funeral or some other way Alternatively, you may prefer can include disbelief, anger, guilt of saying goodbye can be a very to contact someone from your and grief. Some women think they important part of coping own religious community, the can hear their baby crying, and it is with your loss, however early Miscarriage Association or Sands not uncommon for mothers to think it happens. about the kind of funeral you want. You do not have to attend that they can still feel their baby If your baby dies before 24 weeks, the funeral if you don’t want to. kicking inside. The grief is usually the hospital may offer to arrange most intense in the early months for a cremation, possibly together Many hospitals arrange a regular after the loss. with other babies who have died service of remembrance for all Some parents find in pregnancy. If you prefer to take babies who die in pregnancy, at it helpful to create your baby home or to make your birth or in infancy. Again, you memories of their baby, own arrangements, you can do can choose to attend if you wish. that. You may need some form for example they may Many parents are surprised at of certification from the hospital see and hold their baby how much and how long they and they should provide helpful and give their baby a name. You may grieve after losing a baby. Friends information and contacts. want to have a photograph of your and acquaintances often don’t The Miscarriage Association baby and to keep some mementos, know what to say or how to offer and Sands can provide further such as a lock of hair, hand and support, and they may expect support and information. footprints or the baby’s shawl. All you to get back to ‘normal’ long this can help you and your family to If your baby dies after 24 weeks, before that is possible. You may remember your baby as a real person you will need to register your find it helpful to contact Sands and may, in time, help you to live baby’s birth (even if they were or the Miscarriage Association with your loss. You may also find it stillborn) with the Registrar of (see page 150) so that you can helpful to talk to your GP, community Births, Deaths and Marriages. talk to people who have been midwife or health visitor or to other The hospital will offer to arrange through similar experiences parents who have lost a baby. Sands a funeral, burial or cremation free and who can offer you can put you in touch with other of charge, or you may choose to support and information. parents who can offer support and organise this yourself. The hospital information (see page 150). chaplain will be able to help you. 153 THINKING ABOUT THE NEXT BABY?

It takes two 154 Folic acid 154 Things to consider 155 Work-related risks 155

Holding your new baby in your arms, it may be impossible to imagine that you will ever have the energy to go through it all again! But sooner or later, you may decide that you want another child. If you had a low birth weight baby, a baby with a disability or special needs, a miscarriage or a stillbirth, you may be particularly anxious to do everything you can to create the best possible circumstances for your next pregnancy. This chapter explains how you and your partner can prepare for your next pregnancy.

IT TAKES TWO Finding it hard You will increase your chances of to get pregnant? getting pregnant if you are in good It can take several months health – and that applies to men or more to get pregnant, too. A bad diet, smoking, drinking even if it happened really and unhealthy working conditions quickly the ﬁrst time. can affect the quality of sperm and stop you getting pregnant. You should both try to make your lifestyle as healthy as possible before you try to conceive. Chapter 3 has advice about diet, smoking, alcohol and exercise, These include green, leafy which can help you to conceive. Chapter 1 (page 14) explains vegetables, and breakfast cereals when is the best time of the and breads with added folic acid. month to have sex if you FOLIC ACID want to get pregnant. You will need a bigger dose of folic If you are still not pregnant Women should take 400 acid if: micrograms of folic acid from the after a few months, talk • you already have a baby with time you start trying to conceive to your doctor or family spina biﬁda planning clinic. right up until you are 12 weeks pregnant. You can get these tablets • you have coeliac disease from a supermarket or pharmacist. • you have diabetes Eat foods that contain this • you take anti-epileptic medicines. important vitamin as well. Ask your GP for advice as well.

154 THINGS TO If you are HIV positive, you can pass the virus on to your baby 16 CONSIDER during pregnancy, at birth or when Rubella (German breastfeeding (see box on page 47).

Medicines and drugs THINKING ABOUT THE NEXT BABY? measles) Some medicines can harm a baby Rubella in early pregnancy can WORK-RELATED in pregnancy but others are safe. damage your developing baby. RISKS If you were not immune during your If either you or your partner has a last pregnancy, you should have long-term illness or disability and has Your employer is required to take been offered a measles, mumps to take long-term medication, talk into account any work-related risks and rubella (MMR) immunisation to your doctor about any possible to new and expectant mothers. immediately after your baby was effects on fertility or pregnancy. Once you have told your employer born. Before trying for another Check with your doctor, midwife that you are pregnant, they should baby, it is important to check that or pharmacist before you take make sure that your job does not you are immune by having a blood any over the counter drugs. pose a risk to you or your baby. test. The blood test will measure Some risks can be avoided, for if you have enough protection Illegal drugs will affect your ability example by changing your working (antibodies) against rubella. Women to conceive and can damage conditions or hours of work. with low or uncertain levels of your baby’s health. See page 183 If a risk cannot be avoided, your antibodies can be immunised again. for contact details for Narcotics employer should offer you suitable Anonymous or talk to FRANK, Your weight alternative work with similar terms the drugs information line, and conditions to your present job. Maintaining a healthy weight can on 0800 77 66 00. If this is not possible, you should improve your chances of getting Diabetes and epilepsy be suspended on full pay. This pregnant. You may have put on means that you will be given paid weight during your last pregnancy If you have diabetes or epilepsy, leave for as long as necessary. and want to go back to your normal talk to your doctor before you try If you want advice on these issues, size. This is particularly important to get pregnant. speak to Citizens Advice or your if you weigh more than 100kg. union if you have one. The best way to lose weight is by Postnatal depression following a balanced low-fat diet and puerperal and doing exercise. It might help to psychosis join a slimming class with a friend If you have previously experienced or your partner to encourage and postnatal depression or puerperal Vaginal birth after support you. Speak to your doctor psychosis, talk to your doctor before a caesarean section if you need help or advice. you try to get pregnant. Most women who have Sexually transmitted had a caesarean section infections (STIs) can have a vaginal delivery STIs can affect your health and your for their next baby. This ability to conceive. If there is any depends on why you had chance that either of you has an STI, a caesarean section the it’s important to get it diagnosed ﬁrst time. Women thought and treated before you get pregnant. to have a small pelvis, for STIs, including HIV, hepatitis B example, may be advised to and hepatitis C, can be passed on have a ‘planned’ (elective) through sex with an infected person, caesarean section next time. especially if you don’t use a condom. Your GP, or midwife, will Some STIs can be transmitted be able to advise you. Most during sex without penetration. HIV, women who are advised to hepatitis B and hepatitis C can also try for a vaginal delivery in be passed on by sharing equipment subsequent pregnancies do for injecting drugs. have normal deliveries.

155 RIGHTS AND BENEFITS

Benefi ts for everyone 157 Rights during maternity leave 168 Tax credits 158 Returning to work 169 Benefi ts if your income is low 159 Other employment rights 170 Maternity benefi ts 163 Other types of leave 171 If you are unemployed 166 Your rights under sex Maternity leave 167 discrimination law 174

Make sure that you know your rights and that you claim all the benefi ts that you are entitled to when you are pregnant. Maternity rights do change and different benefi ts have to be claimed using different forms and from different offi ces. The benefi t rates in this chapter are accurate from April 2009. Get further advice if you are unsure of anything.

Help and advice •Some national voluntary Useful websites organisations offer information Working out what benefi ts www.direct.gov.uk and advice on benefi ts and and rights you are entitled rights at work, for example www.dwp.gov.uk (Department to and making claims can be Acas and One Parent for Work and Pensions) complicated. There are a number Families/Gingerbread (see of government departments pages 182 and 184). www.hmrc.gov.uk/taxcredits and voluntary organisations that can help you. •If you are a member of a trade www.hse.gov.uk union, your staff representative (Health and Safety Executive) •Your local Jobcentre Plus can or local offi ce should be able to give you advice about benefi ts. www.equalityhumanrights.com advise you on your maternity (Equality and Human Rights Look in the business numbers rights at work. section of the phone book Commission) •The Equality and Human Rights under ‘Jobcentre Plus’. www.adviceguide.org.uk Commission can advise you if (Citizens Advice Bureau) •Citizens Advice Bureaux, law your problem is to do with sex centres and other advice discrimination (see page 174). www.cmoptions.org agencies can advise you about •The Health and Safety Executive (Child Maintenance Options) your rights at work. To fi nd your has a useful booklet for women local advice agencies, look in www.acas.org.uk (Acas) explaining the health and safety your Yellow Pages phone book rights that apply to pregnant www.direct.gov.uk/employees under ‘Counselling and Advice’. women and women who have www.healthystart.nhs.uk •Some local authorities have recently given birth. welfare offi cers who can give www.workingfamilies.org.uk you advice. Phone your social services department and fi nd www.jobcentreplus.gov.uk out if your area has one.

156 BENEFITS FOR If you get the full amount of Child How much is it? Tax Credit (CTC) because your •£20.00 per week for your 17 EVERYONE household income is at or below first child. the Child Tax Credit income limit Some benefits are available to all •£13.20 a week per child for (£16,040 in 2009/10), your child will mothers, regardless of how much any other children. RIGHTS AND BENEFITS they earn. get a further £250 paid directly into their account. Child Benefit can be paid directly Free prescriptions and into a bank, building society or At seven, children will get another TM NHS dental treatment Post Office card account. It is payment of £250 (with children usually paid every four weeks in What are they? from lower income families again arrears, but single parents and receiving a further £250). Prescriptions and NHS dental families on low incomes can treatment are free while you are You, your family, your friends and, choose to be paid weekly. pregnant and for 12 months after in time, your child can contribute How do I claim? you have given birth. Your child up to a total of £1,200 a year to the You can get claim packs: also gets free prescriptions until account tax free. The money can they are 16. only be withdrawn by your child, •in your Bounty Pack (which most and they cannot take it out until new mothers are given in hospital) How do I claim? they are 18. To claim for free prescriptions, ask •from your Jobcentre Plus office your doctor or midwife for form How do I claim? •from the post office FW8 and send it to your health All you have to do is claim •by phoning 0845 302 1444. authority. You will be sent an Child Benefit for your child. Fill in the forms and send them exemption certificate that lasts until You will automatically be sent an with your baby’s birth certificate to a year after your due date. information pack and voucher the Child Benefit Centre. The birth within a month. To claim after your baby is born certificate will be returned to you. (if you did not claim while you were From 6 April 2009, some account You need to register your baby to pregnant) fill in form A in leaflet providers will not require the Child get a birth certificate (see page 138). P11, NHS Prescriptions, which Trust Fund voucher to be handed in You can also apply online at you can get from your doctor or or posted when you are opening an www.hmrc.gov.uk/childbenefit/ Jobcentre Plus. account. However, you will still need to provide information such as your To claim for dental treatment, tick You should start to claim Child child’s unique reference number a box on a form provided by the Benefit within three months of your (printed on the voucher) to open dentist or show your exemption baby’s birth, otherwise you will lose an account. certificate (see above). some of the benefit. More information More information Child Trust Fund For more information, call Child Benefit can help to What is it? 0845 302 1470 or go to protect your State Pension if you www.childtrustfund.gov.uk A long-term savings and investment stay at home to look after your account for children. child. For every complete year that Child Benefit you get Child Benefit, but you Who gets it? What is it? don’t pay enough National All children born on or after Insurance contributions to Child Benefit is a tax-free benefit to 1 September 2002, provided they count towards the help parents with the cost of caring are eligible for Child Benefit, live basic pension, for their children. It is payable for in the UK, and are not subject to you automatically each child from birth until at least immigration control. get Home age 16. Responsibilities How much is it? Who gets it? Protection. You will get a voucher for £250 Every mother or the person from the government to start an responsible for the care of a child, account for your child. but you must generally be living in the United Kingdom. 157 TAX CREDITS What are they? Two tax credits were introduced in April 2003: •Child Tax Credit gives financial support for children. •Working Tax Credit helps people in lower-paid jobs by topping up their wages. You may not be able to get tax Help with childcare costs If there is a change in your credits if you have come to live here Many working parents can get help circumstances, for example after from another country. You should with their childcare costs through the birth of your baby, the amount get advice. tax credits. If you work at least 16 you are entitled to may change. Who gets Child Tax Credit? hours a week and use registered As long as you report the change within three months, any extra Child Tax Credit can be claimed by childcare, you could get 80% of the money can be backdated to the lone parents or couples with one costs back. This is up to a limit of date of the change. or more children. Nine out of 10 £175 a week if you have one child families with children get this credit. or £300 a week if you have two or Maternity Allowance or the first more. Your household income is £100 a week of Statutory Maternity Who gets Working Tax taken into account in working out Pay are not counted as income. Credit? what you get. Call the Tax Credits Working Tax Credit can be claimed Helpline on 0845 300 3900 to Families with children, with an by single people or couples, with or find out more. annual income of £50,000 or less, without children. will get at least £545 a year. How do I claim? You must work at least 16 hours Call the Tax Credits Helpline on More information each week if: 0845 300 3900 for a form to If you get tax credits you may also be able to get the £500 Sure Start •you have dependent children and/or claim both Child Tax and Working Tax Credits. Maternity Grant and help with fares •you have a disability to hospital for treatment (including How much will I get? or antenatal appointments). The amount you get will depend on •you must be 25 or over and work your circumstances, including: You can get help from Healthy Start at least 30 hours a week. if you get Child Tax Credit but not •the number of children in your You can be treated as if Working Tax Credit with an annual household you are working during family income of £16,040 or less the first 39 weeks of •the number of hours you and your (2009/10). your maternity leave if partner work See page 162 for more information. you were working enough •your household’s gross income for hours immediately before the last tax year. starting your maternity Claims for the current tax year will leave. initially be based on your previous tax year’s income. Awards will run until the end of the tax year. help for families 158 BENEFITS IF YOUR •you work for more than 16 hours To claim Income Support, fill in 17 INCOME IS LOW a week, or form A1, which you can get from •you have savings of more than a post office or a Jobcentre Plus. You do not need to sign on. Income-based £16,000. Jobseeker’s Allowance If you or your partner are too sick The benefit is paid directly into your RIGHTS AND BENEFITS and Income Support or disabled to work for another bank account. If you are claiming reason (not your pregnancy), you income-based JSA, you or your What are they? should get advice. You may be able partner (or both, before you are Income-based Jobseeker’s to claim Employment and Support 29 weeks pregnant) will have to Allowance (JSA) and Income Allowance instead. go to your Jobcentre Plus every Support are payments for people fortnight to ‘sign on’ to show that How much are they? who are not in work and do not you are available for work. have enough to live on. If your This depends on: family income falls below a set •your age level, the benefit will ‘top it up’. •the size of your family More information This means that you may be able If you get Income Support, to get Income Support even if •what other income you have. income-based JSA, income- you are already getting Statutory If you are under 25 or have more related Employment and Support Maternity Pay, Maternity Allowance, than £6,000 in savings, you can Allowance or Pension Credit, Employment and Support get a lower rate. If you are claiming you can claim other benefits, Allowance or some income from during pregnancy, you should let such as: part-time work. your Jobcentre Plus know as soon •a £500 Sure Start Maternity Who gets them? as the baby is born, as your benefit may go up. Grant You can claim income-based JSA if: How do I claim? •help with fares to hospital •you are 18 or over and you are •Housing Benefit capable of and actively seeking To claim income-based JSA work. You can claim this benefit before your baby is born, you or •Council Tax Benefit. your partner must both go to the if you are living with your partner You may be able to get Jobcentre Plus in person. You may as long as you are both either help with mortgage interest be able to claim by post if you live unemployed or working part time. payments. a long way from the Jobcentre. If you are 16–17 and face severe Once you are 29 weeks pregnant, You can get help from hardship you may be able to claim. you do not have to sign on if your Healthy Start. You should get further advice partner is claiming with you. See page 162 for more about this. Your partner can continue to information. You can claim Income Support if: claim for you and the baby. •you are 16 or over and cannot be available for work because you are a single parent or because you are 29 weeks pregnant or more, or •you are pregnant and not well enough to work because of your pregnancy. You cannot claim income-based JSA or Income Support if: •you live with your partner and they work for 24 hours or families more a week 159 Part of the form will need to be You have 31 days from the date completed by your midwife, your midwife or doctor signs the GP or health visitor. This is to confirm claim to get it back to Her Majesty’s when your baby is due or actually Revenue and Customs (HMRC). born, and that you have received Once HMRC receives your form, £500 Sure Start advice about the health and welfare they aim to send you a letter within Maternity Grant from of your baby and, if you claim before three weeks to tell you if your claim your baby is born, yourself. has been allowed. You will be paid the Social Fund your grant about one week after If you cannot get any of the benefits What is it? you get the letter. listed above (see ‘Who gets it?’) until The £500 Sure Start Maternity after your baby is born, you must still For more information visit Grant is a lump sum payment to claim the Sure Start Maternity Grant www.direct.gov.uk /money4mum2be help buy things for a new baby. within the three-month time limit. or call 0845 366 7885. Who gets it? The Discretionary Pregnant women and new parents Social Fund who get: Health in What is it? •Income Support Pregnancy Grant As a mum-to-be living in the The Discretionary Social Fund •income-based Jobseeker’s provides grants and interest-free Allowance UK, you can claim a one-off payment of £190 to help you. loans for needs that are difficult for •income-related Employment and You can use the grant to keep people to meet out of their weekly Support Allowance yourself healthy or for things benefits or regular income. •Pension Credit for your baby. It’s your choice. Who gets it? •Working Tax Credit where a Who gets it? There are three types of payments disability or severe disability element Almost every pregnant available: is included in the award, or woman gets it. It doesn’t •Community Care Grants are for •Child Tax Credit payable at a rate depend on your income. The people getting Income Support, higher than the family element. grant is available between the income-based Jobseeker’s 25th week and your expected How much is it? Allowance (JSA), income-related due date. You may not be Employment and Support £500 for each baby who is: able to claim if: Allowance or Pension Credit. •expected •you are subject to •Budgeting Loans are interest-free, •born immigration control, or repayable loans for people getting •adopted •you are not ordinarily Income Support, income-based resident in the UK. JSA, income-related Employment •the subject of a parental order and Support Allowance or Pension (following a surrogate birth), or How much is it? Credit for at least 26 weeks. •the subject of a residence order £190 and it’s tax free, so it •Crisis Loans are interest-free, (in certain circumstances). will not affect your tax credits repayable loans for people (on How do I claim? or any other benefits. benefits or not) who are unable to Claim using form SF100 (Sure Start), How do I claim? meet their immediate short-term needs in a crisis. which you can get from Jobcentre When you reach your 25th Plus. You can claim any time from week, ask your midwife or How much can you get? 11 weeks before your due date doctor for a claim form at This depends on your personal until three months after the birth, your next appointment. circumstances, your ability to pay adoption or date of parental or Make sure your midwife or and how much money is available. residence order. If you are adopting doctor has completed and Social Fund payments are not a right or have been granted a residence signed their part of the form. and there is a limited amount of order, your baby must be aged under If they have not, it could delay money to be distributed between 12 months when you claim. your claim. all those who successfully apply.

160 How do I claim? Help with mortgage Contact Jobcentre Plus. interest repayments 17 More information is also available Who gets it? in leaﬂets:

If you have got a mortgage and you RIGHTS AND BENEFITS •A Guide to the Social Fund (SB16, are on income-based Jobseeker’s available at www.dwp.gov.uk) Allowance (JSA), Income Support or income-related Employment and •The Social Fund (DWP1007). Support Allowance, you may be More information able to get help with your interest •Loans have to be repaid at a set payments. There is usually a waiting amount per week, which will be period during which you will not Housing Benefit – help get any help. taken directly from your income with your rent if you are claiming other benefits. How much is it? The amount you have to repay per What is it? You can only get help with interest week depends on the size of the Housing Benefit will help pay your payments (not repayments of capital loan, the size of your income and rent if you are on income-based or contributions to a linked PEP, any other debts you may have. Jobseeker’s Allowance (JSA), endowment or insurance policy) •You cannot get a Budgeting Loan Income Support or income-related and the amount is usually based or a Crisis Loan for more than Employment and Support Allowance, on a standard average interest rate £1,500 and the total you owe the or if you have a low income. If you (which may not be the same as the Social Fund cannot be more than are a council tenant it will be paid interest you are paying). £1,500. direct to the council; if you are a You usually have to wait for 13 •The amount of any Discretionary private tenant, it will be paid either weeks before you get help, but you Social Fund payment you get will to you or directly to your landlord. may have had to wait longer if you be reduced on a pound-for-pound How much is it? claimed benefits before January 2009. basis by any savings you or your It depends on: partner has. For Community Care How do I claim? Grants, savings over £500 (£1,000 •the rent you pay Once you have claimed income- if you or your partner are aged •average rents in your area based JSA or Income Support, 60 or over) will usually affect how •the size of your home your Jobcentre Plus office will much you can get. For Budgeting automatically send you form MI12 Loans, savings over £1,000 •your income about your housing costs shortly (£2,000 if you or your partner are •savings before your benefits become aged 60 or over) will usually affect •other benefits payable. You fill out part of how much you can get. the form and then send it to •your age, and •The Social Fund can only provide your mortgage lender to fill out Community Care Grants to •your family size. the rest. families receiving Income Support, It may not be the same amount as The money will either be paid income-based JSA, income- the rent you are actually paying. The to you as part of your income- related Employment and Support amount of savings you have can based JSA or Income Support, Allowance or Pension Credit also affect the amount of Housing or it will be paid directly to your under certain circumstances. Benefit you get. You cannot get mortgage lender. These could be to help pay fares Housing Benefit if you have savings to visit a mother and baby in of more than £16,000. More information hospital or to help a family under Tell your mortgage lender straight How do I claim? exceptional pressure. Grants do away if you get into difficulties not have to be repaid. If you are getting income-based JSA with your mortgage. If you are or Income Support, you will get unable to meet your repayments, a Housing Benefit claim pack with you may be able to negotiate your JSA/Income Support claim a temporary agreement for form. Otherwise, get a form from reduced repayments (e.g. your local council. during your maternity leave). 161 If you have a ‘flexible mortgage’, Council Tax Benefit this should be relatively easy to arrange. Some mortgage lenders What is it? allow a ‘repayment holiday’ of a Council Tax Benefit helps you to few months once during the life pay your Council Tax if your How much is it? of the mortgage. income is low. You may get all of your Council Tax If you have mortgage protection Who gets it? paid or just part of it. It will depend insurance, contact your insurer If your income is low or you are on your income, savings, whether immediately. Most insurance getting income-based Jobseeker’s other adults live with you, and an policies will pay out if you are Allowance (JSA), income-related assessment of your circumstances. receiving out-of-work benefits, Employment and Support Allowance How do I claim? but not if you are only receiving or Income Support, you may get If you are getting income-based JSA Statutory Maternity Pay or Council Tax Benefit. Maternity Allowance. or Income Support, you will get a Council Tax Benefit claim form with your JSA/Income Support claim form. Otherwise, get a form from your local council.

Healthy Start What is it? Healthy Start is a scheme that provides vouchers that can be exchanged for milk, fresh fruit and vegetables and infant formula milk. You can also get free vitamins. You can get vouchers that are worth £3.10 per week or £6.20 per week for children under one year old. Who gets it? You qualify for Healthy Start if you are pregnant or have a child under four years old and you and your family get one of the following: •Income Support • income-based Jobseeker’s Allowance • income-related Employment and Support Allowance • Child Tax Credit and have an annual family income of below £16,040 or less (2009/10) • Working Tax Credit run-on (but not Working Tax Credit). Working Tax Credit run-on is the Working Tax Credit you receive in the four weeks immediately after you have stopped working for 16 hours or more per week OR • you are pregnant and under 18 years of age. How do I claim? • Pick up the Healthy Start leaﬂet HS01, A Healthy Start for Pregnant Women and Young Children, from your local health centre, or call 0845 607 6823 to request a free copy. • Ask your health visitor for more information. • Visit www.healthystart.nhs.uk You will need your midwife to ﬁll in their part of the application form. You can apply as soon as you are 10 weeks pregnant. Getting vouchers and vitamins cannot be backdated, so apply as early as you can. Once your baby is born, you should claim Child Tax Credit to make sure you continue to get your vouchers, if you are still entitled. See page 158 for more information.

162 Help with hospital How much is it? fares MA is paid for 39 weeks at a standard 17 Who gets it? rate of £123.06 per week, or 90% of your gross average weekly earnings if If you or your partner gets income-

this is less than £123.06. RIGHTS AND BENEFITS based Jobseeker’s Allowance (JSA), income-related Employment and When is it paid? Support Allowance or Income The earliest that MA can start is Support, you can get a refund 11 weeks before the week your for fares to and from the hospital baby is due and the latest is the day (including for your visits for following the birth. antenatal care). This can cover normal public transport fares, If you are unemployed, your MA estimated petrol costs and taxi fares will start 11 weeks before the week if there is no alternative. You may your baby is due. also be entitled to help if your MATERNITY If you are employed or self-employed family has a low income. You may at the start of the 11th week before also get help if you get tax credits or BENEFITS the week your baby is due, you can Pension Credit. Check your award choose when to start your MA. You letter for details. Maternity Allowance can even work right up until the date How do I claim? What is it? the baby is due, unless: If you get income-based JSA, Maternity Allowance (MA) is a • you are absent from work because income-related Employment and weekly allowance paid through of a pregnancy-related reason Support Allowance or Income Jobcentre Plus. during the four weeks before the Support, you can claim when you Who gets it? week your baby is due. In this case visit the hospital. You will just need your MA will start automatically Women who cannot get Statutory to show proof that you get the on the day following the first day Maternity Pay (see page 165) get benefit. of your absence from work, or MA. These are: You can claim within three months • your baby is born before your MA • women who have changed jobs of your visit by filling in form HC5, is due to start. In this case your MA during pregnancy which you can get from the hospital will start on the day following the or Jobcentre Plus. • women who have had periods of birth and will last for 39 weeks. low earnings or unemployment How do I claim? Fill in form HC1 if you don’t get during pregnancy income-based JSA, income-related You can make a claim for MA from Employment and Support Allowance • women who are self-employed. the 14th week before the week or Income Support but your income You can claim MA if you have been your baby is due. is low. You can get this from your employed and/or self-employed in • Fill in form MA1, available from doctor, hospital or Jobcentre Plus. at least 26 of the 66 weeks before Jobcentre Plus or your antenatal Depending on how low your your expected week of childbirth. clinic. income is, you will then be given: This 66-week period is known as the test period. You must also have •Download an MA claim pack in • certificate HC2, which means you PDF format from qualify for free services, or gross average weekly earnings of at least £30. The average is taken over www.dwp.gov.uk/advisers/ • certificate HC3, which means that any 13 weeks in the test period. claimforms/ma1.pdf you qualify for some help. You should choose the 13 weeks • Contact Jobcentre Plus on You show the certificate when you in which you earned the most. 0800 055 6688. In your chosen weeks, you can go to the hospital, or you can claim You must also send your maternity add together earnings from more within three months of your visit on certificate (form MAT B1). This is than one job, including any self- form HC5. issued by your GP or midwife from employed work. You will be treated 20 weeks before the week your as earning a certain amount if you baby is due. are self-employed.

163 Jobcentre Plus will check this. If you are not sure whether or not you qualify, phone Jobcentre Plus for more information. How much is it? • £64.30 per week if you are aged 25 or over. • £50.95 if you are aged under 25. You may get more than this in some circumstances, for example if you have a partner who is not working and is not claiming benefits for If you are employed in the 15th These 10 days are called Keeping themselves. week before your baby is due in Touch (KIT) days. Once you have and do not qualify for Statutory used up your 10 KIT days, if you It is awarded from the Sunday of Maternity Pay, you must also send do any further work you will lose a the sixth week before your baby in form SMP1 from your employer day’s MA for any day on which you is due until two weeks after your to show why you don’t qualify. work. You must tell Jobcentre Plus baby’s birth. It may not be paid for You will have to provide original about any work you do. the first three days of your claim. payslips to show you meet the The amount you get paid for the How do I claim? earnings condition. days you work in your MA pay Make a claim for Maternity If you are self-employed, Jobcentre period will not affect your MA. Allowance using form MA1, which Plus will confirm this direct with Her you can get from Jobcentre Plus or More information Majesty’s Revenue and Customs. your antenatal clinic. You also have If you are not entitled to MA, to send your maternity certificate When you have completed your your Jobcentre Plus office will (form MAT B1), which is issued by claim form, send it to Jobcentre automatically check whether you your GP or midwife from 20 weeks Plus, together with your maternity might be entitled to Employment before the week your baby is due. certificate (MAT B1) and your and Support Allowance (see below). You don’t need to send in a sick original payslips. For further information about note from your doctor. Claim as soon as you can, even if MA, see leaflet NI17A, A Guide to If you are not entitled to Maternity you are still at work, do not have the Maternity Benefits, available from Allowance, Jobcentre Plus will medical certificate, or cannot provide www.dwp.gov.uk/advisers/ni17a check automatically to see if you any other information needed to qualify for Employment and Support complete the claim form. You can Employment and Allowance. It can be paid directly always send things in later. You must Support Allowance into your bank. You must claim claim within three months of the within three months of the start date your MA period is due to start. What is it? of your entitlement. If you delay, you will lose money. This is a weekly allowance that is More information How is it paid? normally paid to people whose ability to work is limited because of To find out more about Employment MA is paid directly into your bank an illness or disability. It may also be and Support Allowance: account, weekly or every four paid to women who don’t qualify weeks in arrears. for Statutory Maternity Pay or • call Jobcentre Plus on 0800 055 6688 Working during the Maternity Allowance. Maternity Allowance pay • ask for leaflet DWP 1001, or Who gets it? period • visit the website at Women who have paid enough You are allowed to work as an www.dwp.gov.uk/esa National Insurance contributions employed or self-employed person during the last three tax years or for up to 10 days during your MA women who are on a low income. pay period without losing any MA.

164 Statutory on whether you are paid weekly, Find the Sunday before your baby Maternity Pay monthly, or at other intervals. is due (or the due date if it is a 17 Sunday) and count back 11 To find out which is your qualifying What is it? Sundays from there. week, look on a calendar for the Statutory Maternity Pay (SMP) Sunday before your baby is due It is up to you to decide when you RIGHTS AND BENEFITS is money paid by your employer (or the due date if that is a Sunday). want to stop work, unless your job to help you take time off at and Count back 15 Sundays from there. finishes before your SMP starts or around the birth of your baby. It is You should use the due date on you are off work for pregnancy- paid up to a maximum of 39 weeks. the MAT B1 certificate, which your related reasons in the four weeks Your employer can claim back midwife or GP will give you when before your baby is due. some or all of it from Her Majesty’s you are 20 weeks pregnant. Revenue and Customs (HMRC). If your job finishes before the 11th SMP counts as earnings and your If you are not sure if you are entitled week before the week your baby is employer will deduct tax and to SMP, ask your employer anyway. due, your SMP must start 11 weeks National Insurance. Your employer will work out whether before the week your baby is due. or not you should get it, and if You can get it even if you don’t plan If your job finishes after the 11th you don’t qualify they will give to go back to work or you leave your week but before your SMP is due to you form SMP1 to explain why. employment after you qualify for start, your SMP must start the day If your employer is not sure how SMP. You will not have to pay SMP after you left your job. If you are still to work out your SMP or how to back if you don’t return to work. employed you can choose to work claim it back, they can ring the right up until the date the baby is You may qualify for SMP from HMRC Employer Helpline on due, unless: more than one employer. 08457 143 143 for advice. • you are absent from work because Who gets it? How much is it? of pregnancy-related reasons You get SMP if: SMP is paid for a maximum of during the four weeks before the 39 weeks. • you have been continuously week that your baby is due. In employed for at least 26 weeks • For the first six weeks you get that case your SMP should start by the same employer up to 90% of your average gross weekly automatically the day following the qualifying week. This is the earnings, with no upper limit. the first day of absence from work, or 15th week before the week your • For the remaining 33 weeks, you baby is due. This means you get a standard rate of £123.06, • your baby is born before the start must have been employed or 90% of your average gross of your SMP. In that case your by that employer before you weekly earnings if 90% is less SMP will start the day following were pregnant. Part weeks than £123.06. the birth and will be paid for count as full weeks and one day’s 39 weeks. employment in the qualifying SMP is usually paid in the same week counts as a full week, and way and at the same time as your normal wages, but your employer • you earn an average of £95 a may decide to pay differently, for week before tax. This amount is example in a lump sum. called the Lower Earnings Limit for National Insurance contributions When is it paid? and is the amount you have to The earliest you can start your SMP earn to qualify for benefits. You is 11 weeks before the week your have to earn more than this baby is due. The latest is the day amount before you actually start following the birth. paying National Insurance. To work out the earliest date, Your earnings are averaged over an use the due date on your MAT eight-week period, running up to B1 certificate, which your and including the 15th week before midwife or GP will the week your baby is due. This give you. period may vary slightly depending

165 You can work for up to 10 days for You can give notice for leave and The benefit is paid directly into the employer who pays you SMP pay together in the 15th week your bank account, normally every and still keep the SMP for the weeks before the week your baby is due. two weeks. in which you do that work. These You can change your mind about How do I claim? days are called Keeping in Touch the dates you have given for the (KIT) days. start of your SMP but you must give Go to your local Jobcentre Plus, your employer 28 days’ notice of or claim by post if you live too far After that, if you do any further this change and confirm the new away. You will have to go to your work you cannot get SMP for any date in writing. Jobcentre Plus every fortnight to week in which you work for the ‘sign on’ to show that you are employer who pays you. More information available for work. See leaflet NI17A, A Guide to If you return to work early, your More information SMP will stop. Your SMP cannot Maternity Benefits, which is If your family has no other income, start again once you have stopped available from www.dwp.gov.uk/ you will probably be entitled to your maternity leave. advisers/ni17a income-based JSA and other If after the birth you start work benefits for families on low for a new employer who did not IF YOU ARE incomes (see page 159). employ you in the 15th week before UNEMPLOYED If you resign from the week your baby was due, you must tell the employer paying your Contribution-based your job SMP. They will then stop paying Jobseeker’s Allowance If you resign from your job and don’t go back to work after your SMP. What is it? maternity leave, you may be able to How do I claim? Contribution-based Jobseeker’s claim contribution-based Jobseeker’s You must give your employer at Allowance (JSA) is an allowance that Allowance (JSA) for up to six least 28 days’ notice of the date you lasts for up to 26 weeks for people months. However, you will have to want to start your pay. They may who are unemployed or working show that you had ‘just cause’ for need this in writing. You must also less than 16 hours a week. voluntarily leaving your job. You will send your maternity certificate (MAT Who gets it? also have to be available for work B1 form), which is issued by your GP for as many hours a week as your You get it if: or midwife from 20 weeks before caring responsibilities permit. This the week your baby is due. • you have paid enough National must be at least 16 hours a week. Insurance contributions during If you have not paid enough National the last two tax years before the Insurance contributions, you may current calendar year. Tax years be able to claim income-based JSA run from April to March. instead (see page 159), depending • you are available for work for on your personal circumstances. as many hours as your caring Apply in person at your local responsibilities permit (this must Jobcentre Plus. be at least 16 hours a week), and If you are a single parent, you may • you are actively seeking work. be able to claim Income Support How much is it? (see page 159) once your baby • £50.95 a week if you are under 25. is born. • £64.30 a week if you are 25 Remember that you may still be or over. able to claim tax credits if you are unemployed (Child Tax Credit for Your partner’s earnings are not your children; Working Tax Credit if taken into account, but, if you are your partner works enough hours). in part-time work, your earnings Apply to Jobcentre Plus for Income are and will reduce how much Support or to Her Majesty’s Revenue benefit you get. and Customs for tax credits.

166 MATERNITY LEAVE 17 All employed women are entitled to 52 weeks’ maternity leave, no matter how long they have worked for their employer, or the hours they worked. This is made up of 26 weeks of Ordinary Maternity Leave (OML) and 26 weeks RIGHTS AND BENEFITS of Additional Maternity Leave (AML). You are usually considered to be an employee if: • your employer deducts tax and National Insurance from your pay • your employer controls the work you do, when and how you do it, and • your employer provides all the equipment for your work. If you work for an agency or do casual work, you are probably not an employee. However, you can still get maternity pay if you meet the normal conditions (see ‘Maternity Allowance’ on page 163 and ‘Statutory Maternity Pay’ on page 165). time with your baby

Ordinary Maternity you are about 29 weeks pregnant, on the day after you give birth. Leave so count back from the due date on You should tell your employer your MAT B1 certiﬁcate, which your as soon as you can that you All employed women: midwife or GP will give you. Find have given birth. • can take 26 weeks’ leave, and the Sunday before your baby is due (or the due date if it is a Sunday) How to give notice • have the right to return to the and count back 11 Sundays Telling your employer same job. from there. that you are pregnant Additional Maternity You can decide when you want The latest time you can tell your Leave to stop work. You can even work employer that you are pregnant is the 15th week before your baby All employed women: right up until the date your baby is born, unless: is due. However, it is best to tell • can take 26 weeks’ leave from the your employer as soon as possible end of their Ordinary Maternity • you have a pregnancy-related to make sure that you have health Leave, and illness/absence in the last four and safety protection during your weeks of your pregnancy. pregnancy and the right to paid • have the right to return to the In this case your employer can same job. If that is not reasonably time off for antenatal care. The law start your maternity leave even protects you from being dismissed practicable, then you have the if you are off sick for only one right to a suitable job on very or discriminated against because day. However, if you are ill for you are pregnant. similar terms and conditions. only a short time, your employer When does maternity may agree to let you start your If you cannot give notice by the leave start? maternity leave when you had 15th week before you are due planned, or (for example, because you have The earliest you can start your to go into hospital unexpectedly), • your baby is born before the day statutory maternity leave is you must give notice as soon as you were planning to start your 11 weeks before the expected you reasonably can. week of childbirth. This is when leave. In this case leave will start

167 Giving notice for statutory Working out the 15th week to either Statutory Maternity Pay maternity leave before your baby is due or Maternity Allowance (see pages To give notice that you will be Find the Sunday before your baby 165 and 163). After that your leave taking maternity leave, you must tell is due (or the due date if it is a will be unpaid. Some employers your employer the following in or Sunday) and count back 15 Sundays also offer extra maternity pay: check before the 15th week before your from there. That is the start of the your contract, or ask the human baby is due. It is probably best to 15th week before the expected resources department or your union put this in writing: week when your baby is due. representative. • that you are pregnant You should use the due date on If you are made redundant while on maternity leave, your employer • the expected week of childbirth, the MAT B1 certificate that your must offer you any suitable and midwife or GP will give you when you are about 20 weeks pregnant. alternative work that is available. • the date on which you intend If there is none, they must give to start your maternity leave. RIGHTS DURING you any notice and redundancy If you want to change the date pay that you are entitled to, on which you start your maternity MATERNITY LEAVE although they could offset any maternity pay you get from the leave, you must give your employer Since 5 October 2008, your notice of the new date at least 28 notice pay. Also, your employer contractual rights (that is, any must not discriminate against days before either the new date or special rights that apply to your the old date – whichever is earliest. you by failing to consider you for particular workplace, such as a opportunities such as promotion. If there is a good reason why that is company car) continue throughout not possible, tell your employer as your maternity leave (Ordinary For more information visit soon as you reasonably can. Maternity Leave (OML) and www.direct.gov.uk/workandfamilies You can choose when to start Additional Maternity Leave (AML)) Pay as if you were still at work. This maternity leave, but the earliest you During OML and the first 13 weeks includes your legal right to 5.6 can start getting Statutory Maternity of AML, you may be entitled to weeks’ paid annual leave (normally Pay is in the 11th week before the Maternity Allowance or Statutory 28 days for full-time employees and week your baby is due. Maternity Pay (see pages 163 and the pro-rata equivalent for part- 165). After that your leave will Once you have given notice, your time workers) whether you are on usually be unpaid. Some employers employer must write to you within maternity leave or not. This does offer extra (or contractual) maternity 28 days and state the date you not include your normal pay. are expected to return from pay, so check your contract or ask maternity leave. During the first 39 weeks of your the human resources department leave you will probably be entitled or your union representative.

Rights and benefits in pregnancy This guide shows you when you should claim for a range of benefits. The timing of your rights and benefits in pregnancy is very complicated, so use this chart as a rough guide only.

In this box, write in the date of the Sunday before the ﬁrst day of your last period. (If your last period started on a Sunday, write in that date.) Then work along the You can claim the Health in Pregnancy top row ﬁlling in the dates of each successive Sunday. Grant payment from this week.

Write in the first day of your last period here. Then work along the row filling in the remaining boxes. Each box represents a week. Write in the dates week by week until you get to the date on which your baby is due. 168 Discrimination get maternity pay, you must give If you need more time Your employer must not eight weeks’ notice of your return off work 17 as you will in fact be returning early. discriminate against you while you If you stay off work after your are on maternity leave. This means If you don’t give this notice and just maternity leave has ended, you will that they have to consider you for turn up at work before the end of lose your right to return to the same RIGHTS AND BENEFITS opportunities such as promotion. your maternity leave, your employer job. If you need more time off you If you are made redundant while on can refuse to allow you to work for could do one of the following: up to eight weeks or until the end maternity leave, your employer must • Ask your employer if you can take of your leave, whichever is earlier. offer you any suitable alternative annual leave immediately after If you change your mind and wish work that is available. If there is your maternity leave. Your paid to continue taking your maternity none, they must pay you any notice holiday continues to accrue during leave, you must give your employer and redundancy pay that you are maternity leave so you may have eight weeks’ notice before the entitled to. some holiday owing to you. earlier date of return. • Take some parental leave at the RETURNING The law does not allow you to end of your maternity leave (see TO WORK work for two weeks (four weeks page 172). You must give 21 days’ if you work in a factory) after notice to take parental leave, and Giving notice about childbirth. This period is known as it is usually unpaid, unless your returning to work Compulsory Maternity Leave. employer offers paid parental leave. You will not be allowed to return to Your employer should assume work during this time. • If you cannot return because you that you will be taking your full are ill, you can take sick leave as entitlement of 52 weeks unless you Your job when you go back long as you follow your tell them otherwise. You will be due When you go back to work after employer’s sickness procedures. back to work on the day after the AML, you have the right to return to If you are not able to take annual 52-week period of maternity leave. the same job. But if your employer leave and don’t have enough can show that this is not reasonably If you want to take all of your notice to ask for parental leave, you practicable, you have the right to leave, you simply go back to work can still ask your employer if they be offered a suitable alternative on that day. will agree to a further period off job on at least the same terms and work (this will usually be unpaid). If you decide not to take some or conditions. If the job no longer You should ask your employer to all of your maternity leave, whether exists, this could be a redundancy confirm this agreement in writing Ordinary Maternity Leave (OML) or situation and you should get advice. and to confirm that you will have Additional Maternity Leave (AML), You should also be offered any the right to return to the same job. you should give eight weeks’ notice suitable alternative vacancies if You should also check whether your to return to work early. Even if you your post is made redundant employer is counting this as part of only wish to take OML, or you just while you are on maternity leave. your parental leave entitlement. want to be off work while you still

You must have notiﬁed your employer of your This is the earliest you can start pregnancy, the expected week of childbirth and your maternity leave and Maternity the date you want to start Ordinary Maternity Allowance or Statutory Maternity Pay. Leave. This is also your ‘qualifying’ week for Statutory Maternity Pay.

You should apply for Maternity If you qualify for a Sure Start Maternity Grant The date your Allowance about now. from the Social Fund, claim it as soon as possible. baby is due. 169 work after your leave. You will need OTHER to agree with your employer what work is to be done on KIT days and EMPLOYMENT how much pay you will receive. RIGHTS If you don’t go back If you are These rights apply no matter to work pregnant again how long you have been You should resign in the normal Maternity leave does not break employed or how many hours way, giving at least the notice your continuity of employment, you work per week. required by your contract or the so if you are pregnant again, your Paid time off for notice period that is normally given right to maternity leave will be antenatal care in your workplace. If you don’t based on your total service with have a contract, you should give your employer. You may also If you are an employee, you at least a week’s notice. qualify for Statutory Maternity have the right to take reasonable Pay (SMP), as long as you meet time off for your antenatal If you say you are going to return to the normal conditions. However, appointments, including time work and then change your mind, this will mean you will have to be needed to travel to your clinic or you can resign from your job in the receiving an average of at least GP, without loss of pay. normal way. Your notice period £95 per week from your can run at the same time as your You should let your employer employer, worked out over maternity leave. know when you need time off. approximately weeks 18–25 For appointments after the first of your pregnancy when SMP one, your employer can ask to If you don’t go back to work, entitlement is calculated. see your appointment card and you don’t have to repay any If you have already taken Ordinary a certificate stating that you of the Statutory Maternity Maternity Leave (OML) and are pregnant. Pay you received during your Additional Maternity Leave (AML) Antenatal care can include maternity leave. (a year off) you will be entitled to a antenatal education and relaxation second period of OML and AML. If classes. You may need a letter from you go straight into another period your GP or midwife to show your Work during of OML without physically returning employer, saying that these classes maternity leave to work and decide to return to are part of your antenatal care. During maternity leave it is often work after the second period of helpful to keep in touch with your OML, you will not have the right Health and safety employer. Your employer is entitled to return to exactly the same job rights to make reasonable contact with as you normally would at the end If you are pregnant, have recently you during maternity leave. This of OML. However, you will have given birth or are breastfeeding, might be to discuss things like the same right as you would have your employer must make sure arrangements for your return to had at the end of AML. This is the that the kind of work you do and work, or to update you on any right to return to the same job or, your working conditions will not significant changes in the workplace if that is not reasonably practicable, put your health or your baby’s while you have been away. a suitable alternative job on similar health at risk. To get the full terms and conditions. benefit of this legal protection, You are entitled to do up to 10 you must notify your employer days’ work during your maternity If you return to work after the end in writing that you are pregnant, leave without losing maternity pay of your first period of AML and have recently given birth or or bringing your leave to an end. before the start of your second period of OML, your rights to are breastfeeding. These Keeping in Touch (KIT) days maternity leave are not affected. may only be worked if both you This means that you have the and your employer agree. Although right to return to exactly the particularly useful for things such as same job after your second training or team events, they may period of OML. This applies be used for any form of work and even if you only returned to should make it easier to return to work for one day.

170 • Your employer must carry out a risk assessment at your 17 workplace and do everything reasonable to remove or reduce the risks found. RIGHTS AND BENEFITS • If there are still risks, your employer must change your working conditions or hours of work to remove the risk. • If this is not possible or would not remove the risk, your employer must offer you a suitable alternative job. OTHER TYPES Your partner will be able to return to the same job after paternity leave. • If this is not possible, your OF LEAVE employer must suspend you on Statutory Paternity Paternity leave full pay for as long as is necessary Pay to avoid the risk. If you do night Paternity leave is one or two weeks’ Statutory Paternity Pay (SPP) is paid work and your doctor advises leave to care for a child or support by employers for up to two weeks. that you should stop for health their mother. and safety reasons, you have Who gets it? the right to transfer to day work Who gets it? Your partner can get SPP if they: or, if that is not possible, to be Your baby’s biological father, your suspended on full pay. You must husband or your partner, including • are the baby’s father or your provide a medical certiﬁcate. a same-sex partner, will be able to husband/partner and are take paternity leave providing they: responsible for the baby’s upbringing (your partner must • expect to have responsibility for live with you and your baby if they bringing up the child, and are not the biological father and • have worked for the same employer are not married to you or in a civil for at least 26 weeks by the 15th partnership with you) week before your baby is due. • have worked for an employer Dismissal or If your partner is not the biological for 26 weeks by the 15th week unfair treatment father and is not married to you or before the baby is due It is sex discrimination for your in a civil partnership with you, they • are still employed by the same employer to treat you unfairly, must live with you and your baby employer when the baby is born to get paternity leave. dismiss you or select you for • earn at least £95 per week on redundancy for any reason When does it start? average (before tax) in the eight connected with pregnancy, It can start: weeks immediately before the childbirth or maternity leave. week your baby is born. • from the date of your baby’s birth If you are dismissed while you are How much is it? pregnant or during your maternity • from a chosen number of days £123.06 per week or 90% of your leave, your employer must give or weeks after the date of your partner’s average weekly earnings, you a written statement of the baby’s birth (whether this is earlier whichever is less. reasons. You may also have a or later than expected), or claim for compensation for sex • from a chosen date. How do I claim? discrimination. If you are making Paternity leave must be taken within Your partner must give their a claim against your employer, 56 days of your baby’s birth or, if employer at least 28 days’ notice of you must put your claim into the your baby is born early, within the the date when they want their SPP Employment Tribunal within three period from the actual date of birth to start – or notify them as soon months of the problem arising – up to 56 days after the expected as is reasonably practicable. get advice as soon as possible. week of birth.

171 More information Flexible working Visit www.direct.gov.uk/ Flexible working covers a wide workandfamilies variety of working practices. It can be any working pattern Time off for other than the normal working Parental leave dependants pattern in an organisation. Parental leave is designed to give Every employee is also entitled to Most people are familiar with parents more time with their young emergency unpaid leave to make working part time for pro-rata children. It entitles you to take arrangements for the care of a pay or working different shift 13 weeks’ leave per parent per child, child who falls ill, gives birth or is patterns. Other ways of flexible usually unpaid, up to your child’s fifth injured. This leave can be used if working include the following: birthday. Parents of disabled children there is a sudden problem with • Flexitime. Employees may be are entitled to 18 weeks’ leave, to care arrangements for your required to work within core be taken before the child is 18. For child – for example, if your hours, but outside these times parental leave, a disabled child is childminder falls ill. a child who gets Disability Living they get flexibility in how they Allowance (DLA). It is also available Flexible working work their hours. for adoptive parents, in which case arrangements • Job sharing. Typically, two employees share the you can take it either within five Parents have the right to work normally done by one years of the placement for adoption ask for flexible working employee. or before your child’s 18th birthday, arrangements. If you need to whichever is earlier. change your working hours • Working from home. Who gets it? because of childcare, you also New technology makes work possible by telephone, fax and Employees who have been employed have the right to have your email from home, or other for a year by the time they wish to request considered seriously remote locations. take leave to care for a child. under sex discrimination law. Follow the procedure outlined • Term-time working. An You cannot usually take all your employee on a permanent 13 weeks in one go. Your employer on page 173. If your request is refused, you should get advice contract takes paid or unpaid may limit the amount of leave you leave during school holidays. can take to four weeks per child in about whether you have a claim any one year. for compensation under the • Staggered hours. Employees new right and under sex in the same workplace have How do I claim? discrimination law. different start, finish and break times – often as a way of You must give your employer Your rights 21 days’ notice of the dates covering longer opening hours. You have the right to request when you want to take your • Compressed working hours. flexible working arrangements leave. Your employer can Employees work their total if you have or expect to have postpone the leave, but only agreed hours over fewer parental responsibility for: if their business would be working days – for example, disrupted unduly. • a child under 17 a five-day working week is Fathers wanting to take (from April 2009), or compressed into four days. time off at or around • a disabled child under 18 who There is a clear procedure that the birth of their baby is entitled to Disability Living you and your employer must can take parental leave, Allowance (DLA). follow. Your employer must providing they give Parental responsibility means seriously consider your request their employers 21 days’ that you are a: and can only refuse for one of notice of the expected the business reasons set out in week of childbirth. • mother the legislation. Any reduction in An employer • father the number of hours worked will cannot postpone result in pay being reduced. leave in these • adopter circumstances. • guardian

172 • special guardian • you are an agency worker When your employer • foster parent • you are a member of the receives the application 17 Your employer must: • private foster carer, or armed forces. • person who has been granted How do I ask to change • hold a meeting with you within RIGHTS AND BENEFITS a residence order in respect my hours? 28 days of your application. of a child Your request/application must: You are allowed to bring a companion but your employer or • be in writing (whether on paper does not have to let you bring • you are married to, or the or by email). Find out if your someone who is not employed partner or civil partner of, employer has a standard form by them. This meeting should one of the above. for making an application. If not, discuss your application. If your sample letters can be downloaded employer does not think that The change that you ask for can from www.direct.gov.uk relate to the hours that you the proposed working pattern • state that the application is being work, the days that you work can be accommodated within made under the statutory right to or your place of work. the needs of the business, request a flexible working pattern they should discuss any possible Who does it apply to? • confirm that you are applying as compromise arrangements You can ask for flexible working if: someone who has or expects to • give you notice of their decision have parental responsibility for the within 14 days of the meeting • you are an employee upbringing of a child under 17 or and tell you about your right • you have worked for your a disabled child under 18 who is of appeal employer for 26 continuous entitled to DLA and that you are • give a reason for refusing, which weeks prior to your request the parent, adopter, guardian or must be one of those allowed (continuous employment generally foster parent of the child (or that by the regulations, with an means working for the same you are married to, or the partner explanation of why that reason employer without a break, or civil partner of, that person) applies in your case. but this is not always the case. • state the flexible working pattern Refusing your request Further information is available you are asking for and the date at www.direct.gov.uk you want it to start. The proposed Your employer can only refuse your • you have parental responsibility date should allow time for the request for one of the following for a child under 17 (from April application to be considered and business reasons: 2009) or a disabled child under 18 implemented. There is no set time, • the burden of additional costs who is entitled to DLA (or you are but the process can take up to married to, or the partner or civil 14 weeks or longer where • the detrimental effect on the partner of, that person). issues arise ability to meet customer demand • an inability to reorganise the You cannot ask for flexible • explain how you think your new work among existing staff working if: working pattern may affect your employer and how you think this • an inability to recruit • you have made a request in the could be dealt with additional staff last 12 months • state whether you have made • the detrimental effect on quality an application to your employer • the detrimental effect on before, and if so when performance • be signed and dated. • not enough work during the Your application should be periods when the employee as clear as possible. wants to work You should also keep • planned structural changes. a copy. Your employer must also explain why that reason applies in your circumstances.

173 Legal help Who does the law apply to? The legal help scheme allows Sex discrimination law applies to all people on a low income to get free employers and all employed parents legal advice and assistance when with childcare responsibilities. preparing for a tribunal. Funding for It only applies if you would be Appeal general legal advice (not advocacy) disadvantaged by not being allowed You have the right to appeal within is available, to those who qualify to work the child-friendly hours you 14 days of receiving notification of financially, under the legal help need. You must have a good reason your employer’s refusal. To appeal, scheme. Full representation is for asking to work differently – just you must write to your employer available under legal aid (to those as an employer must have a good stating your reasons for appealing. who qualify financially) for cases reason for refusing. A good reason You must sign and date your letter. brought in the Employment might be: Your employer must hold the appeal Appeal Tribunal. • you cannot find or afford full-time meeting within 14 days of receiving childcare your notice of appeal. You have More information is available at the right to be accompanied during www.adviceguide.org.uk • you cannot find or afford childcare the meeting if you wish, usually outside 9am–5pm, Monday–Friday by another worker employed by YOUR RIGHTS • you have to be there when your the same employer, although your UNDER SEX child or children come home employer may agree to let someone from school else attend. Your employer must: DISCRIMINATION • your parents or relatives cannot • allow your companion time off LAW look after your child full time to accompany you without it It may be indirect sex discrimination • you are suffering from severe affecting their pay if an employer refuses a woman’s stress from working long hours • hold the meeting at a convenient request to change her working • you are distressed or time and place for both parties, and pattern. It may be direct sex disadvantaged by having to work • notify you of their decision in discrimination if an employer refuses your old hours. writing within 14 days of the a man’s request when they allow a The difference between appeal meeting, giving reasons woman to work differently. rights under sex for their decision. Your employer will only know discrimination law and the Tribunals if they have a good reason for right to request flexible You can make a claim in a tribunal refusing your request if they give it working if your employer does not follow the a lot of thought. Refusing even to The new statutory right to request procedure or refuses for a reason consider your request or having a flexible working only applies to not stated in the rules or without policy of refusing part-time work employees who are parents of an explanation. could be seen as sex discrimination children under 17 (or under 18 by an employment tribunal. An if disabled), who have not made You must complete the appeal employer must consider each an application within the last procedure and wait for the individual request in order to avoid 12 months, and who have worked decision before you can make discriminating against a woman or for their employer for 26 weeks at a tribunal application. a man with childcare responsibilities. the time of making the application. An employment tribunal or an Acas People often assume that a job has Sex discrimination law may help you binding arbitration that finds in your to be done full time or at certain if you need to change your working favour can order your employer to: fixed times of day, but if you and pattern in order to care for your • reconsider your application by your employer look carefully at child but cannot use the statutory following the procedure correctly your job you may be able to work procedure. This may be because out a more child-friendly option – you have made a request under the • pay you an award (up to a perhaps one that neither of you had procedure within the last 12 months maximum of eight weeks’ pay considered before. or have worked for your employer (up to the statutory maximum of for less than 26 weeks. £350 per week) in compensation).

174 The procedure Advice Bureau or the Equality and your request. They can also award There is no specific application Human Rights Commission (EHRC). unlimited compensation for loss of 17 pay (if you had to leave your job) procedure under sex discrimination If you want advice on whether and for injury to feelings. law. If you can, initially make your you might have a good case for a request under the new right to ask tribunal, you should see a specialist You must make a tribunal claim RIGHTS AND BENEFITS for flexible working (see page 172). employment lawyer. within three months of the refusal under the new right and under sex If your employer refuses If this doesn’t work, you can make discrimination law. your request a claim in an employment tribunal If your new working pattern if your employer refuses your will cause major problems, then request without a good business your employer may be justified reason. The tribunal will look at your in refusing your request. You can employer’s reasons and will question get further advice from your trade them carefully about whether union representative or local Citizens they were justified in refusing

Have you claimed everything?

You can claim Child Free Free dental £500 Social Council Help with Healthy Fares to Benefit prescriptions treatment Sure Start Fund Tax mortgage Start** hospital Maternity loans*** Benefit If you get Grant* (not NI and Housing Benefit)

Income-based JSA YYYYYYYYY

Income Support YYYYYYYYY

Low ***** ***** * income YYYYNYNNY

All **** **** mothers YYYNNNNNN

* You can claim if you get Pension Credit, income-related Employment and Support Allowance, Working Tax Credit, where a disability or severe disability element is included in the award or Child Tax Credit at a rate higher than the family element. ** You can also claim if you get Child Tax Credit but not Working Tax Credit with an income of £16,040 or less. The qualifying criteria for Healthy Start are: Income Support /income-based JSA/income-related Employment and Support Allowance/Child Tax Credit without Working Tax Credit (unless Working Tax Credit run-on only is in payment) and annual family income of £16,040 or less. *** You have to be on Income Support, income-based JSA, income-related Employment and Support Allowance or Pension Credit to get a Social Fund loan (called a Budgeting Loan) unless there is an emergency or disaster and you are without resources to prevent risk to health (this is called a Crisis Loan). **** Free prescriptions and free dental are only available for low income/all mothers during pregnancy and for one year after birth. ***** Some people will get full help, other people may only get partial help – it all depends on how low income is.

175 THE NHS CONSTITUTION

The NHS belongs to us all. It touches our lives at times of basic human need, when care and compassion are what matter most. Pregnancy is one of these times. So it is important that you know what you and your baby can expect from the NHS, and what is expected from you in return.

The NHS Constitution was launched on 21 January 2009. It brings together for the first time in one place what staff, patients and the public can expect from the NHS. It explains that by working together we can make the very best of finite resources to improve our health and well-being, to keep our minds and bodies well, to get better when we are ill, and when we cannot recover to stay as well as we can to the end of our lives. The Constitution reaffirms that everyone has a role to play in the success of the NHS.

As well as capturing what is important to the NHS (the principles and values that determine how the NHS should act and make decisions), the Constitution brings together a number of rights, pledges and responsibilities for staff and patients alike.

These rights, pledges and responsibilities are the result of extensive discussion and research with staff, patients and the public and they reﬂect what matters to them most. Rights The NHS Constitution sets out the legal rights of the public, patients and staff. Some of the rights that may be of interest to you are listed below: • You have the right to receive NHS services free of charge, unless Parliament has sanctioned charges. • You have the right to be treated with dignity and respect. • You have the right to be treated with a professional standard of care. • You have the right to be given information about your care. • You have the right to privacy and conﬁdentiality. • You have the right to be involved in discussions and decisions about your care. • You have the right to have any complaints you make properly investigated.

176 Pledges The NHS Constitution sets out a number of pledges for the public, patients and staff. These are things that the NHS is committed to achieving. Some of the pledges that may be of interest to you are listed below: THE NHS CONSTITUTION • The NHS commits to make sure that it is easy to access health services. • The NHS commits to inform you about the services that are available to you. • The NHS commits to offer you information that helps you to take part in making decisions about your care. • The NHS commits to work in partnership with you, your family, carers Want to know more? and representatives. The NHS Constitution • The NHS commits to treat you with courtesy and to be supportive Handbook gives further when you make a complaint. information about the NHS Constitution and further advice on what to do if Responsibilities you are not happy with There are a number of things we can all do to help the NHS deliver the service you receive. quality services. These are set out as responsibilities in the NHS Constitution. The Statement of Responsibilities are the things we can all do to help the NHS work NHS Accountability effectively. You should always think about your responsibilities when you summarises how the NHS are receiving NHS services. You have nine responsibilities to keep in mind: is structured and what the responsibilities of • Do what you can yourself to stay healthy and feel well. individual parts of the • Register with a GP. NHS are. • Treat NHS staff and patients with respect. How do I get a copy of • Give accurate information about yourself. the NHS Constitution? • Keep appointments, or let the NHS know when you cannot keep them. You can get copies of the • Follow the course of your treatment, or speak to someone if you feel NHS Constitution from you cannot. libraries, doctors, dentists and town halls. You can • Take part in important public health immunisation programmes. also obtain a copy from: • Make sure people close to you know about your wishes for organ donation. Telephone: • Give feedback on your treatment and care. 0300 123 1002 Website: The NHS Constitution sets out all of these rights and pledges, together with www.orderline.dh.gov.uk the principles and values, in more detail. The NHS Constitution Handbook Email: contains further information. [email protected] Or write to: DH Publications Orderline PO Box 777 London SE1 6XH

The NHS Constitution, NHS Constitution Handbook and the Statement of NHS Accountability are also available online at www.nhs.uk/aboutnhs/ Constitution

177 GLOSSARY OF USEFUL TERMS

TERM MEANING

Albumin A protein that can appear in your urine when you are pregnant. It can be a sign of an infection or pre-eclampsia. Your midwife will test your urine for albumin at your antenatal check-ups.

Amniocentesis A test in which a thin needle is inserted into the uterus through the abdominal wall to take a sample of the fluid surrounding the baby. The fluid is then tested for certain chromosomal and genetic disorders. An amniocentesis is usually carried out between 15 and 18 weeks into your pregnancy. It may be used later in pregnancy to find out if your baby’s lungs are mature.

Amniotic sac The bag of ﬂuid that surrounds and cushions your baby in the uterus. Before or during labour the sac breaks and the ﬂuid drains out. This is called the ‘waters breaking’.

Anaesthetics Medicines that reduce or take away pain.

Antenatal This literally means ‘before birth’ and refers to the whole of pregnancy, from conception to birth.

Baby blues Feeling sad or mildly depressed a few days after your baby is born. The baby blues are very common – eight out of 10 new mothers feel like this. They can be caused by hormone changes, tiredness or discomfort and usually only last a week. More severe depression or anxiety that lasts longer than a week could be postnatal depression (see page 181).

Balanced diet A diet that provides a good balance of nutrients.

Bereavement The loss of a person. Coping with a bereavement can be particularly difﬁcult if you are pregnant or have just had a baby, and even harder if it is your baby who has died.

Birth plan A written record of what you would like to happen during pregnancy, labour and childbirth.

Breech birth When a baby is born bottom rather than head ﬁrst.

Caesarean section An operation to deliver a baby by cutting through the mother’s abdomen and then into her uterus. If you have a caesarean, you will be given an epidural or general anaesthetic.

Catheter A thin, ﬂexible, hollow plastic tube that can be used to perform various diagnostic and/or therapeutic procedures. Catheters may be used for the injection of ﬂuids or medications into an area of the body or for drainage, such as from a surgical site. They are also frequently used to allow physicians to access the body with surgical instruments.

Cervix The neck of the uterus. It is normally almost closed, with just a small opening through which blood passes during monthly periods. During labour, your cervix will dilate (open up) to let your baby move from your uterus into your vagina.

Chorionic villus A test to detect genetic disorders, particularly chromosomal disorders such as Down’s sampling syndrome. It is usually carried out at around 11 weeks.

Colostrum The milk that your breasts produce during the ﬁrst few days after your baby is born. It is very concentrated and full of antibodies to protect your baby against infections. Colostrum has a rich, creamy appearance and is sometimes quite yellow in colour.

Conception The start of a pregnancy, when an egg (ovum) is fertilised and then moves down the fallopian tube to the uterus, where it attaches itself to the uterus lining.

Contraception Contraception prevents or reduces your chances of getting pregnant. See page 135 for the (also known as different types of contraception that are available. birth control)

Cot death The sudden and unexpected death of an apparently healthy infant during their sleep. (also known as Sudden For information on what you can do to avoid cot death, go to pages 129 and 140. Infant Death Syndrome)

178 TERM MEANING

Down’s syndrome A lifelong condition caused by an abnormal number of chromosomes. People with Down’s syndrome have some degree of learning disability and an increased risk of some health problems. It also affects their physical growth and facial appearance. For more information about screening or tests for Down’s syndrome, see page 50. GLOSSARY OF USEFUL TERMS Ectopic pregnancy An ectopic pregnancy occurs when a fertilised egg begins to grow in the fallopian tube, cervix, ovaries or abdomen, not in the lining of the uterus. The fertilised egg cannot develop properly and has to be removed.

Embryo The term used for the developing baby in the very early weeks up until eight weeks of pregnancy.

Entonox A form of pain relief offered during labour. It is a mixture of oxygen and another gas called nitrous (also known as oxide, which is breathed in through a mask or mouthpiece. ‘gas and air’)

Epidural An anaesthetic that numbs the lower half of the body. It can be very helpful for women who are having a long or particularly painful labour, or who are becoming very distressed. A thin catheter is placed between the vertebrae so that medicine can be delivered to the nerves in the spinal cord.

Episiotomy A surgical incision made in the area between the vagina and anus (perineum). This is done during the last stages of labour and delivery to expand the opening of the vagina to prevent tearing during the birth of the baby.

Fallopian tubes Branch-like tubes that lead from the ovaries to the uterus. Eggs are released from the ovaries into the fallopian tubes each month. Fertilisation takes place in one of the fallopian tubes.

Fertilisation Fertilisation takes place if a man’s sperm joins with a woman’s egg and fertilises it in the fallopian tube.

Fetal alcohol A syndrome that can cause children to have restricted growth, heart defects and facial syndrome (FAS) abnormalities as well as learning and behavioural disorders. It is caused if your baby is exposed to too much alcohol (via the placenta) when they are in the uterus.

Fetus The term used for the developing baby from week eight of pregnancy onwards.

Folic acid One of the B group of vitamins, which is found naturally in foods, including green leafy vegetables, fortiﬁed breakfast cereals and brown rice. Folic acid is important for pregnancy as it can help prevent birth defects known as neural tube defects. If you are pregnant or trying to get pregnant, you should take a 400 microgram folic acid tablet every day until you are 12 weeks pregnant.

Fontanelle A diamond-shaped patch on the front and top of a baby’s head where the skull bones have not yet fused together. During birth, the fontanelle allows the bony plates of the skull to ﬂex, so that the baby’s head can pass through the birth canal. The bones usually fuse together and close over by a child’s second birthday.

Formula milk Cows’ milk that has been processed and treated so that babies can digest it. It comes in powder or liquid form.

Fundus The top of the uterus.

Haemoglobin (Hb) Haemoglobin is found in red blood cells and carries oxygen from the lungs to all parts of the body. Pregnant women need to produce more haemoglobin because they produce more blood. If you don’t produce enough, you can become anaemic, which will make you feel very tired. Your haemoglobin levels are tested during antenatal check-ups.

Home birth Giving birth at home, with care provided by a midwife. This is usually planned!

179 TERM MEANING

Induction A method of artiﬁcially or prematurely stimulating labour. A baby can be induced if they are getting too big, if the pregnancy has gone past the 42-week mark or if there are health risks to either the baby or the mother if the pregnancy continues.

Jaundice The development of a yellow colour on a baby’s skin and a yellowness in the whites of their eyes. It is caused by an excess of the pigment bilirubin in the blood. Jaundice is common in newborn babies and usually occurs approximately three days after birth. It can last for up to two weeks after birth or up to three weeks in premature babies. Severe jaundice can be treated by phototherapy, where a baby is placed under a very bright light. Babies who are jaundiced for longer than two weeks should be seen by a doctor as they may need urgent treatment. See page 149 for more information.

Lanugo Very ﬁne, soft hair that covers your baby at approximately 22 weeks. The lanugo disappears before birth.

Mastitis An infection in the breasts caused by blocked milk ducts. Symptoms include hot and tender breasts and ﬂu-like symptoms. See page 109 for how to treat it.

Maternity team A team of midwives, obstetricians, anaesthetists, neonatologists and other specialists who care provide care to women who have complex pregnancies.

Meconium The ﬁrst stools that your baby passes. Meconium is made up of what a baby has ingested during their time in the uterus, including mucus and bile. It is sticky like tar and has no odour.

Midwifery care Care for pregnant women where the midwife is the lead professional. Midwifery care is suitable for women who have an uncomplicated pregnancy.

Morning Morning sickness affects more than half of all pregnant women. Symptoms include nausea sickness/nausea or feeling sick, as well as actually being sick. Morning sickness can occur at any time of the day, though it occurs most often in the morning because blood sugar levels are low after a night without food. The symptoms usually start after the ﬁrst month of the pregnancy, peaking in weeks ﬁve to seven, and continuing until weeks 14 to 16.

Neonatal care The care given to sick or premature babies. It takes place in a neonatal unit, which is specially designed and equipped to care for them.

Nuchal An ultrasound scan to help identify whether you are at risk of having a baby with Down’s syndrome. translucency scan The scan is carried out at 11 to 13 weeks of your pregnancy and measures the amount of the nuchal translucency, which is fluid behind the neck of the baby. Babies at risk of Down’s syndrome tend to have a higher amount of fluid around their neck. The scan may also help confirm both the accuracy of the pregnancy dates and whether the baby has any other health problems.

Obstetric A potentially dangerous liver disorder. Symptoms include severe generalised itching without cholestasis a rash, particularly in the last four months of pregnancy.

Obstetrician A doctor specialising in the care of women during pregnancy and labour and after the birth.

Oedema Another word for swelling, most often of the feet and hands. It is usually nothing to worry about, but if it gets worse suddenly it can be a sign of pre-eclampsia.

Ovulation Ovulation occurs when an egg (ovum) is released from one of a woman’s ovaries during her monthly menstrual cycle. If the egg is fertilised during this time, she will get pregnant. This is the time of the month when you are most likely to conceive.

Paediatrician A doctor specialising in the care of babies and children.

Perinatal The time shortly before and after the birth of a baby.

180 TERM MEANING

Perinatal mental Mental health problems that develop during pregnancy and that can last for up to one health year after childbirth.

Placenta The organ attached to the lining of the uterus, which separates your baby’s circulation from your circulation. Oxygen and food from your bloodstream are passed to your baby’s bloodstream GLOSSARY OF USEFUL TERMS through the placenta and along the umbilical cord. Waste is also removed this way.

Postnatal The period beginning immediately after the birth of a baby until they are about six weeks old.

Postnatal care The professional care provided to you and your baby, from the birth until your baby is about six to eight weeks old. It usually involves home visits by midwives to check that both mother and baby are well. Classes may also be available.

Postnatal Feelings of depression and hopelessness after the birth of a baby. These feelings are more depression severe than the ‘baby blues’ (see page 178). Postnatal depression affects one in 10 women and can be serious if left untreated. See page 82 for more information.

Pre-eclampsia A condition that only occurs during pregnancy. Symptoms include high blood pressure, protein in urine, bad headaches, vision problems and the sudden swelling of the face, hands and feet. It usually develops after the 20th week of pregnancy but can occur earlier. Although most cases are mild and cause no trouble, it can be serious for both mother and baby. For more information, see page 67.

Premature birth The birth of a baby before the standard period of pregnancy (37 weeks) is completed.

Premature labour When labour starts before 37 weeks of pregnancy.

Rhesus disease A woman who is rhesus negative (see below) can carry a baby who is rhesus positive if the baby’s father is rhesus positive. This can cause problems in second or later pregnancies. If she gets pregnant with another rhesus positive baby, the immune response will be quicker and much greater. The antibodies produced by the mother can cross the placenta and attach to the D antigen on her baby’s red blood cells. This can be harmful to the baby as it may result in a condition called haemolytic disease of the newborn, which can lead to anaemia and jaundice.

Rhesus negative People with a certain blood type are known as rhesus negative. It means that they do not have a substance known as D antigen on the surface of their red blood cells. This can cause problems in second or later pregnancies (see above).

Rhesus positive People with a certain blood type are known as rhesus positive. This means that they have a substance known as D antigen on the surface of their red blood cells.

Rubella (German A virus that can seriously affect unborn babies if the mother gets it during the early weeks measles) of pregnancy. Most women have been immunised against rubella, so they are not at risk.

Ultrasound/scans An imaging technique that uses high-frequency sound waves to create an image of your baby in the uterus. It shows your baby’s body and organs as well as the surrounding tissues. Also called sonography, this test is widely used to estimate delivery dates and check that your developing baby is healthy and growing normally.

Umbilical cord The cord that attaches the baby to the placenta, linking the baby and mother. Blood circulates through the cord, carrying oxygen and food to the baby and carrying waste away again.

Vernix A sticky white coating that covers a baby when it is in the uterus. It mostly disappears before birth but there may be some left on your baby when they are born.

Vertebrae Your spine is made up of 33 irregularly shaped bones called vertebrae. Each vertebra has a hole in the middle through which the spinal cord runs.

181 USEFUL ORGANISATIONS INFORMATION Association of Breastfeeding Mothers Equality and Human Rights Commission (ABM) Freepost RRLL–GHUX–CTRX Acas (Advisory, Conciliation and PO Box 207 Arndale House Arbitration Service) Bridgwater Arndale Centre 23rd floor Somerset TA6 7YT Manchester M4 3AQ Euston Tower 0844 412 2949 (helpline, 9.30am–10.30pm) 0845 604 6610 (Mon–Fri 9am–5pm) 286 Euston Road [email protected] 0845 604 6620 (textphone) London NW1 3JJ www.abm.me.uk [email protected] 08457 47 47 47 (helpline, Mon–Fri 8am–8pm; Provides information and support for www.equalityhumanrights.com Sat 9am–1pm) breastfeeding mothers and their families, The helpline provides information and guidance www.acas.org.uk and training for breastfeeding counsellors on discrimination and human rights issues. Improves organisations and working life through and mother (peer) supporters. All helpline staff have been specially trained better employment relations. Provides up-to-date to provide this service. information and independent advice on a wide Caesarean Support Network range of employment relations issues, including 55 Cooil Drive Family Action the rights and issues around working parents – Douglas 501–505 Kingsland Road such as parental leave and pay and requests for Isle of Man IM2 2HF London E8 4AU flexible working. Provides high-quality training 01624 661269 (Mon–Fri after 6pm; 020 7254 6251 and works with employers and employees to weekends) www.family-action.org.uk solve problems and improve performance. Offers support and advice to women who Tackles some of the most complex and difficult An independent, publicly funded organisation; have had or may need a caesarean delivery. issues facing families today, including domestic many of its services are free. The Network can also offer advice and support abuse, mental health problems, learning to women who wish to have a vaginal delivery disabilities and severe financial hardship. Action on Pre-eclampsia (APEC) with future pregnancies. They have a directory Works with whole families to help them find 2C The Halfcroft of support groups and contacts. solutions to problems, no matter how difficult, Syston so that they become safer, stronger and more Leicestershire LE7 1LD Child Law Advice Line optimistic about their future. 020 8427 4217 (helpline, Mon–Fri 9am–5pm) Children’s Legal Centre [email protected] University of Essex Family Rights Group www.apec.org.uk Wivenhoe Park The Print House Helps to answer any questions about Colchester 18 Ashwin Street pre-eclampsia. Provides pre-eclampsia leaflets Essex C04 3SQ London E8 3DL for the general public and ships leaflet orders 0808 802 0008 (freephone, Mon–Fri 0808 801 0366 (helpline, Mon–Fri to any health organisation that asks. 9am–5pm) 10am–3.30pm) [email protected] Textphone: dial 18001 then freephone Active Birth Centre www.childrenslegalcentre.com number 25 Bickerton Road Ensures that parents, carers and professionals can [email protected] London N19 5JT get accurate information on child law and access www.frg.org.uk 020 7281 6760 (helpline, Mon–Fri 9am–5pm) the support and services to which they are entitled. Support for parents and other family members [email protected] whose children are involved with or need social www.activebirthcentre.com Citizens Advice care services. Complete preparation for active and water Myddelton House birth, including yoga for pregnancy, courses, 115–123 Pentonville Road Independent Midwives UK workshops, professional training, postnatal and London N1 9LZ PO Box 539 baby massage classes and tuition. An empowering 020 7833 2181 (administration and Abingdon OX14 9DF way to prepare for an optimal birth and early information on local Citizens Advice 0845 4600 105 (local rate) parenting. Has a complementary therapy clinic Bureaux only; no advice given) [email protected] for pregnancy and the postnatal period which www.citizensadvice.org.uk www.independentmidwives.org.uk offers acupuncture, reflexology, cranial Online advice and information services. Get help Free advice given to women thinking about osteopathy, aromatherapy, homeopathy online or find your local Citizens Advice Bureau. a home birth. Members offer woman-centred and nutritional guidance. pregnancy, birth and postnatal midwifery to Cry-sis women who book with them, mostly for Association for Improvements in the BM Cry-sis home births. Fees vary. See website to find Maternity Services (AIMS) London WC1N 3XX local midwives. 5 Ann’s Court 0845 122 8669 Grove Road (helpline, 9am–10pm seven days a week) Infertility Network UK Surbiton [email protected] Charter House Surrey KT6 4BE www.cry-sis.org.uk 43 St Leonards Road 0300 365 0663 (helpline, Mon–Fri Offers non-medical, emotional support Bexhill-on-Sea 10.30am–5.30pm) for families with excessively crying, sleepless East Sussex TN40 1JA [email protected] and demanding babies. 0800 008 7464 www.aims.org.uk www.infertilitynetworkuk.com Offers information, support and advice to Diabetes UK Provides a voice for those with fertility parents about all aspects of maternity care, Macleod House problems. Works to improve awareness including parents’ rights, the choices available, 10 Parkway and access to treatment. technological interventions, normal physiological London NW1 7AA childbirth and the complaints procedures. 020 7424 1000 (helpline, 9am–5pm) 0845 120 2960 (careline) [email protected] www.diabetes.org.uk

182 Institute for Complementary and National Childbirth Trust (NCT) Patients Association Natural Medicine (ICNM) Alexandra House PO Box 935 Can-Mezzanine Oldham Terrace Harrow 32–36 Loman Street London W3 6NH Middlesex HA1 3YJ London SE1 0EH 0300 330 0770 (enquiry line, 0845 608 4455 (helpline, Mon–Fri 10am–4pm) 020 7922 7980 (Mon–Fri 10am–4pm) Mon–Thu 9am–5pm; Fri 9am–4pm) [email protected]

[email protected] 0300 330 0772 (pregnancy and www.patients-association.com USEFUL ORGANISATIONS www.icnm.org.uk birth line, Mon–Fri 10am–8pm) A wide variety of helpful healthcare information Can provide the public with lists of members 0300 330 0771 (breastfeeding line, on the website as well as ways for patients to of the British Register of Complementary 8am–10pm seven days a week) make their views known about services. Sign up Practitioners, a professional register of [email protected] as an e-member and take part in patient surveys. practitioners and therapists who have www.nct.org.uk completed a recognised course and are Supports 1 million mums and dads every year Relate (National Marriage Guidance) insured. (Always check with your GP/midwife through helplines, courses and a network of Relate Central Office before using a complementary discipline.) local support. With evidence-based information Premier House on pregnancy, birth and early parenthood, it can Carolina Court La Leche League (Great Britain) provide support from when you first discover Lakeside PO Box 29 you are pregnant to when your baby turns 2. Doncaster DN4 5RA West Bridgford Visit the website for information on becoming 0300 100 1234 Nottingham NG2 7NP a parent or to find your nearest NCT group. www.relate.org.uk 0845 120 2918 (helpline) Offers advice, relationship counselling, sex therapy, www.laleche.org.uk NHS Direct workshops, mediation, consultations and support, An international, non-profit, non-sectarian 0845 4647 face-to-face, by phone and through its website. organisation which, for over 50 years, has www.nhsdirect.nhs.uk been dedicated to providing education, Provides a 24-hour, 365 days a year, nurse-led Royal College of Obstetricians information and mother-to-mother support health advice and information service, online and Gynaecologists (RCOG) and encouragement to women who want and over the telephone. 27 Sussex Place to breastfeed. LLL Leaders are mothers who Regent’s Park have themselves breastfed for 12 months or NSPCC (National Society for the London NW1 4RG longer and have undertaken extensive training Prevention of Cruelty to Children) 020 7772 6200 to provide telephone counselling and email (now incorporating ChildLine) [email protected] support, and to run local group meetings. Weston House www.rcog.org.uk 42 Curtain Road Life London EC2A 3NH Samaritans 1 Mill Street 0808 800 5000 (24-hour national helpline) PO Box 9090 Leamington Spa 0800 056 0566 (textphone) Stirling FK8 2SA Warwickshire CV31 1ES [email protected] 0845 790 9090 0800 915 4600 (helpline) www.nspcc.org.uk www.samaritans.org [email protected] ChildLine is a safe place where children and young A confidential emotional support service for www.lifecharity.org.uk people can share their worries with a trained anyone in the UK and Ireland. The service is Offers counselling and support for men counsellor. Children and young people can call available 24 hours a day for people who are and women in a crisis pregnancy or confidentially on 0800 1111 to find out more experiencing feelings of distress or despair, experiencing difficulties after an abortion, about how to seek help, or visit the website including those that may lead to suicide. adoption, ectopic pregnancy, miscarriage www.childline.org.uk. The NSPCC’s helpline or stillbirth. Also provides accommodation provides counselling, information and advice to Shelter for homeless and unsupported mothers. anyone concerned about a child at risk of abuse. 88 Old Street It also offers a bilingual Welsh helpline and an London EC1V 9HU Multiple Births Foundation Asian helpline in five Asian languages. 0808 800 4444 Hammersmith House, Level 4 [email protected] Queen Charlotte’s and Chelsea Hospital Patient Advice and Liaison www.shelter.org.uk Du Cane Road Services (PALS) Helps more than 170,000 people a year to fight London W12 0HS www.pals.nhs.uk for their rights, get back on their feet, and find 020 8383 3519 (helpline, 9am– 4pm) Available in every NHS trust, PALS provide and keep a home. Also tackles the root causes [email protected] information and advice about NHS and of bad housing, by campaigning for new laws, www.multiplebirths.org.uk health-related services to patients, carers, policies and solutions. Offers specialised support to parents of twins, families and the public. Staff can also help triplets and higher multiple births, and gives to resolve problems and concerns relating to ADDICTIVE DRUGS relevant advice and training to the medical, health services through liaison and negotiation. educational and other professional groups Feeds back to trusts about problems experienced Narcotics Anonymous which are concerned with them. by those using services and about gaps in 0845 373 3366 (helpline) services, and helps make changes which [email protected] benefit patients and carers. For more details, www.ukna.org contact the local NHS trust or see the website. A voluntary organisation. Membership is open to anyone with a drug problem seeking help, regardless of what drug or combination of drugs has been used. It is a completely anonymous, non-religious service, encouraging each member to cultivate an individual understanding, religious or not, of a ‘spiritual awakening’. There are no fees for membership. The primary service provided is local weekly self-governing meetings.

183 ALCOHOL National Childminding Association (NCMA) DOMESTIC ABUSE AND RAPE Royal Court Alcohol Concern 81 Tweedy Road Rape Crisis 64 Leman Street Bromley c/o WRSAC London E1 8EU Kent BR1 1TG PO Box 39 020 7264 0510 0800 169 4486 (information line) Bodmin [email protected] 0845 880 0044 (9am–5pm) Cornwall PL31 1XF www.alcoholconcern.org.uk [email protected] [email protected] Does not operate a helpline nor provide actual www.ncma.org.uk www.rapecrisis.org.uk services to individuals with alcohol problems; Charity and membership organisation supporting Supports the work of rape crisis centres for further help and advice contact Drinkline home-based childcarers in England and Wales. nationally and acts as a referral service for on 0800 917 8282 (freephone). Use the Works in partnership with government and other women seeking advice and/or support around services directory to find an alcohol advice childcare organisations to ensure that registered issues of rape or sexual abuse. Find the nearest or counselling service in your area. All information childminders, over-7s childminders and nannies Rape Crisis Centre on the website, or email for enquiries should be submitted by email. Please have access to services, training, information more information. give a brief outline of the information enquiry, and support. your telephone number and full address. Refuge A member of the team will get back to you Pre-school Learning Alliance 4th Floor, International House within 10 working days. The Fitzpatrick Building 1 St Katharine’s Way 188 York Way London E1W 1UN Alcoholics Anonymous (AA) London N7 9AD 0808 2000 247 (24-hour freephone helpline) General Service Office 020 7697 2500 www.refuge.org.uk PO Box 1 www.pre-school.org.uk The National Domestic Violence Helpline is run 10 Toft Green Delivers a full range of high-quality childcare in partnership between Refuge and Women’s York YO1 7NJ services for parents. As the largest voluntary Aid. Provides emergency accommodation and 01904 644026 sector provider of childcare services, it works support for women and children experiencing 0845 769 7555 (helpline) closely with families to offer more choice, domestic violence. www.alcoholics-anonymous.org.uk flexibility and affordability to ensure that their Has over 4,000 groups throughout the UK, which requirements are met. Women’s Aid Federation of England are designed to help those with a serious alcohol Head Office problem. Through mutual support, sufferers COPING ALONE PO Box 391 assist one another in coping with their problem. Bristol BS99 7WS There are no fees for membership and Meet A Mum Association (MAMA) 0808 2000 247 (24-hour freephone helpline) anonymity is carefully preserved. 54 Lillington Road [email protected] Radstock BA3 3NR www.womensaid.org.uk Drinkaware Trust 0845 120 3746 (helpline, Mon–Fri 7pm–10pm) The National Domestic Violence Helpline is run 7–10 Chandos Street www.mama.co.uk in partnership between Women’s Aid and Refuge. London W1G 9DG Support for mothers suffering from postnatal Provides help, information and support for women 020 7307 7450 depression or who feel lonely and isolated. It will and children experiencing domestic violence, or for www.drinkaware.co.uk try to put you in touch with another mother who their friends and families calling on their behalf. Provides consumers with information to make has experienced similar problems, or with a group informed decisions about the effects of alcohol of mothers locally, or help you to find ways FAMILY PLANNING on their lives and lifestyles. Its public education of meeting people. programmes, grants, expert information and Brook resources help to create awareness and effect One Parent Families/Gingerbread 421 Highgate Studios positive change. 255 Kentish Town Road 53–79 Highgate Road London NW5 2LX London NW5 1TL Drinkline 0800 018 5026 (Mon–Fri 9am–5pm; 0808 802 1234 (helpline, Mon–Fri 9am–5pm) 0800 917 8282 (Mon–Fri 9am–11pm) Wed extended opening to 8pm) www.brook.org.uk Freephone helpline offering free, confidential www.gingerbread.org.uk Provides free and confidential sexual health information and advice on alcohol problems, Charity for single parent families. It offers a information, contraception, pregnancy testing, support and direction to treatment services. range of support services direct to single parents, advice and counselling, testing and treatment for including a telephone helpline, publications, sexually transmitted infections and outreach and CHILDCARE training programmes and a membership scheme, education work. and campaigns on single parents’ behalf. Daycare Trust FPA (Family Planning Association) 21 St George’s Road Parentline Plus 50 Featherstone Street London SE1 6ES 520 Highgate Studios London EC1Y 8QU 0845 872 6251 (Mon, Tue, Thu, Fri 10am–1pm Highgate Road 0845 122 8690 (helpline) and 2pm–5pm; Wed 2pm–5pm) Kentish Town www.fpa.org.uk [email protected] London NW5 1TL The UK’s leading sexual health charity, enabling www.daycaretrust.org.uk 0808 800 2222 (24-hour helpline) people in the UK to make informed choices Provides information and support to parents and 0800 783 6783 (textphone) about sex and to enjoy sexual health. carers about childcare and paying for childcare. [email protected] www.parentlineplus.org.uk Families Information Service Helpline Charity providing support to parents. Gives you 0800 234 6346 the support you need, on any issue, when you www.direct.gov.uk want it and in a way to suit you.

184 Marie Stopes International ILLNESS AND DISABILITY Disability, Pregnancy and Parenthood Head Ofﬁce International (DPPI) 1 Conway Street Action for Sick Children National Centre for Disabled Parents London W1T 6LP Unit 6, High Lane Business Court Unit F9, 89–93 Fonthill Road 0845 300 80 90 (24-hour information Rear of 32 Buxton Road London N4 3JH and appointments) High Lane 0800 018 4730

[email protected] Stockport SK6 8BH 0800 018 9949 (textphone) USEFUL ORGANISATIONS www.mariestopes.org.uk 0800 074 4519 (Mon–Fri 9am–5.30pm) [email protected] Provides support for women with an unplanned [email protected] www.dppi.org.uk pregnancy and for those seeking abortion services. www.actionforsickchildren.org Provides information, awareness and support Nine clinics nationwide, with no wait for an Promotes equality of healthcare services for disabled parents/parents to be and those appointment. Counselling services, abortion pill for children in hospital, at home and in the who support them, including those with a and surgical abortion available. NHS and private. community. Gives information and support to physical or sensory impairment, deaf parents, parents and carers with a problem or query parents with learning difficulties or long-term HEPATITIS regarding their child’s healthcare, from how to illness, or those dealing with mental distress. register your child with a GP or a dentist to what British Liver Trust to expect when they need to go into hospital. Disabled Living Foundation (DLF) 2 Southampton Road 380–384 Harrow Road Ringwood BH24 1HY Assist UK (Disability Living Centres) London W9 2HU 0800 652 7330 (helpline, Mon–Fri 9am–5pm) Redbank House 0845 130 9177 (helpline, Mon–Fri [email protected] 4 St Chad’s Street 10am–4pm) www.britishlivertrust.org.uk Cheetham 020 7432 8009 (textphone) National liver disease charity for adults with all Manchester M8 8QA [email protected] forms of liver disease. It is dependent on voluntary 0870 770 2866 www.dlf.org.uk donations from individuals, companies, charitable 0870 770 5813 (textphone) A national charity that provides free, impartial trusts and legacies. It aims to reduce the incidence [email protected] advice about all types of daily living equipment of liver disease, and to help everyone affected by www.assist-uk.org for disabled adults and children, older people, it, through the provision of information, support Leads a UK-wide network of centres that their carers and families. and research. Also provides a helpline providing introduce people to products and solutions medically equipped telephone support for patients which make life easier and safer, creating Genetic Interest Group (GIG) and their carers, encourages and supports local greater choice and control. Unit 4D, Leroy House liver support groups for patients and provides 436 Essex Road funding for research into liver disease. Bliss London N1 3QP 9 Holyrood Street 020 7704 3141 (9am–5pm) Hep C Awareness London Bridge [email protected] 0800 451 451 (helpline, Mon–Fri 7am–11pm) London SE1 2EL www.gig.org.uk [email protected] 0500 618 140 (helpline, Mon–Fri 10am–10pm) A national alliance of patient organisations www.nhs.uk/hepatitisc [email protected] with a membership of over 130 charities The helpline is an information, advice and referral www.bliss.org.uk which support children, families and service for callers concerned about hepatitis C. The UK charity dedicated to ensuring that premature individuals affected by genetic disorders. line deals with avoidance, testing and treatment and sick babies survive and go on to have the enquiries and signposts individuals to local services. best possible quality of life. Provides practical and Group B Strep Support emotional support to families during an extremely PO Box 203 HIV AND AIDS difficult time, so that they can give the best care Haywards Heath to their babies. Its specialist study days and training West Sussex RH16 1GF Positively Women support doctors and nurses to develop their 01444 416176 (helpline, Mon–Fri 347–349 City Road skills and it funds research to improve the care 9.30am–3pm) London EC1V 1LR of all sick and premature babies. [email protected] 020 7713 0222 (helpline, Mon-Fri 10am–1pm www.gbss.org.uk and 2pm–4pm) Contact a Family A national charity providing information [email protected] 209–211 City Road materials to health professionals and individuals www.positivelywomen.org.uk London EC1V 1JN on how to prevent most group B Streptococcal Women who are living with HIV answer the 0808 808 3555 (helpline, Mon–Fri infection in newborn babies. helpline, and will ring you back free of charge. 10am–4pm and Mon 5.30pm–7.30pm) 0808 808 3556 (textphone) Mind (National Association for Sexual Health Line [email protected] Mental Health) 0800 567 123 (24 hours a day, seven days www.cafamily.org.uk PO Box 277 a week) UK-wide charity providing advice, information Manchester M60 3XN Free and confidential telephone helpline and support to parents of all disabled children, 0845 766 0163 (Mon–Fri 9am–5pm; BT advice about HIV, AIDS, sexual health, sexually no matter what their condition or diagnosis. textdirect users add the prefix 18001) transmitted infections, contraception, local Brings parents of children with the same www.mind.org.uk services, clinics and support services. condition together through support groups Help for people experiencing mental distress. and a one-to-one linking service. The information line offers confidential help and information.

185 Newlife Foundation for Disabled Children Compassionate Friends SMOKING Newlife Centre 53 North Street Hemlock Way Bristol BS3 1EN NHS Smoking Helpline Cannock 0845 123 2304 (helpline, 10am–4pm 0800 022 4 332 Staffordshire WS11 7GF and 6.30pm–10.30pm) www.gosmokefree.co.uk 0800 902 0095 (helpline, Mon–Fri [email protected] Counsellors offer confidential help and advice 9.30am–5pm) www.tcf.org.uk about every stage of quitting. [email protected] An organisation of bereaved parents and their www.newlifecharity.co.uk families that offers understanding, support and NHS Pregnancy Smoking Helpline Action to help disabled and terminally ill children encouragement to others after the death of 0800 169 9 169 (12pm–9pm) in the UK. Provides equipment to help individual a child or children. Also offers support, advice www.gosmokefree.co.uk children, nurse-led support services, pioneering and information to other relatives, friends and Trained advisers are available to answer any medical research, awareness and campaigning. professionals who are helping the family. questions you have about smoking during pregnancy or about the free services available Phab Cruse Bereavement Care to help you quit. Summit House PO Box 800 50 Wandle Road Richmond NHS Asian Tobacco Helpline (Bengali) Croydon Surrey TW9 1RG 0800 169 0 885 Surrey CR0 1DF 0808 808 1677 (young person’s helpline) 020 8667 9443 0844 477 9400 (Day by Day helpline, NHS Asian Tobacco Helpline (Gujarati) [email protected] Mon–Fri 9.30am–5pm) 0800 169 0 884 www.phab.org.uk [email protected] A national charity dedicated to promoting the www.crusebereavementcare.org.uk NHS Asian Tobacco Helpline (Hindi) integration of people with and without physical A nationwide service providing emotional support, 0800 169 0 883 disabilities, at all levels of society. counselling and information to anyone bereaved by death, regardless of age, race or belief. Also NHS Asian Tobacco Helpline (Punjabi) YoungMinds provides information on local groups. 0800 169 0 882 48–50 St John Street London EC1M 4DG Foundation for the Study of Infant Deaths NHS Asian Tobacco Helpline (Urdu) 0808 802 5544 (Cot Death Research and Support) 0800 169 0 881 [email protected] 11 Belgrave Road www.youngminds.org.uk London SW1V 1RB SPECIALISED ORGANISATIONS A national charity committed to improving the 020 7802 3200 mental health of all children and young people 0808 802 6868 (helpline, Mon–Fri Association for Post-Natal Illness (APNI) under 25 by giving advice, training, campaigning 9am–11pm; Sat–Sun 6pm–11pm) 145 Dawes Road and distributing publications. [email protected] Fulham www.fsid.org.uk London SW6 7EB LOSS AND BEREAVEMENT Charity working to prevent sudden deaths 020 7386 0868 (Mon–Fri 10am–2pm) and promote health. It funds research, 0808 800 2222 (Parentline 24-hour helpline) Antenatal Results and Choices (ARC) supports bereaved families and promotes www.apni.org 73 Charlotte Street safe baby care advice. Network of telephone and postal volunteers London W1T 4PN who have experienced postnatal illness, offering 020 7631 0285 (helpline, Mon–Fri Miscarriage Association information, support and encouragement. 10am–5.30pm) c/o Clayton Hospital [email protected] Northgate Association for Spina Bifida and www.arc-uk.org Wakefield Hydrocephalus (ASBAH) Non-directive support and information for parents West Yorkshire WF1 3JS ASBAH House throughout antenatal testing, especially when a 01924 200799 (helpline, Mon–Fri 9am–4pm) 42 Park Road serious abnormality has been diagnosed and a [email protected] Peterborough PE1 2UQ choice has to be made about the continuation www.miscarriageassociation.org.uk 0845 450 7755 (helpline, Mon–Fri or ending of the pregnancy. Ongoing support Information, advice and support for women 10am–4pm) given to parents via publications, a helpline, who have had, or who are having, a miscarriage. [email protected] parent contacts, email groups, parents’ meetings Local contacts and groups. www.asbah.org and newsletters. Support is offered to health Voluntary sector organisation providing professionals by way of training, conferences Stillbirth and Neonatal Death information and advice about spina bifida and publications. Society (Sands) and hydrocephalus in England, Wales and 28 Portland Place Northern Ireland. Child Death Helpline London W1B 1LY York House 020 7436 5881 (helpline) British Thyroid Foundation 37 Queen Square [email protected] 2nd Floor, 3 Devonshire Place London WC1N 3BH www.uk-sands.org Harrogate 0800 282 986 (Mon, Thu and Fri Supports anyone affected by the death of a North Yorkshire HG1 4AA 10am–1pm; Tue and Wed 10am–4pm; baby through a network of support groups run 01423 709707 every evening 7pm–10pm) by bereaved parents throughout the UK, a 01423 709448 [email protected] telephone helpline and support literature. www.btf-thyroid.org www.childdeathhelpline.org.uk Provides support and information to people Helpline for anyone affected by the death of a with thyroid disorders through literature, child of any age, from pre-birth to adult, under newsletters and information events. any circumstances, however recently or long ago. Staffed by trained volunteers, all of whom are bereaved parents.

186 Child Growth Foundation Haemophilia Society Pelvic Partnership 2 Mayﬁeld Avenue First Floor, Petersham House 26 Manor Green Chiswick 57a Hatton Garden Harwell London W4 1PW London EC1N 8JG Oxon OX11 0DQ 020 8995 0257 0800 018 6068 (helpline, Mon–Fri 01235 820921 (helpline) [email protected] 10am–4pm) [email protected]

www.childgrowthfoundation.org [email protected] www.pelvicpartnership.org.uk USEFUL ORGANISATIONS Creates awareness of child growth disorders. www.haemophilia.org.uk Provides information and advice about the Information, advice and practical help for families management of pelvic girdle pain (PGP), formerly Cleft Lip and Palate Association (CLAPA) affected by haemophilia and other bleeding known as symphysis pubis dysfunction (SPD), First Floor, Green Man Tower disorders. Some local groups. to women, their families and carers, including 332b Goswell Road healthcare professionals. It produces written London EC1V 7LQ Jennifer Trust for Spinal leaflets which are sent to all callers. The helpline 020 7833 4883 Muscular Atrophy and email support are staffed by volunteers who [email protected] Elta House all have personal experience of PGP. PGP is a very www.clapa.com Birmingham Road treatable condition if women access care early, Offers and provides support to patients, Stratford-upon-Avon and the focus is to support women to do this early their family and friends, health professionals Warwickshire CV37 0AQ in their pregnancy, as well as supporting those and anyone affected by a cleft lip and/or a 0800 975 3100 (helpline, 9am–5pm) with more long-term problems. Aims to raise cleft palate. [email protected] awareness of PGP and how treatable it is. www.jtsma.org.uk Climb (Children Living with Inherited The only charity in the UK dedicated to both Reach (Association for Children Metabolic Diseases) supporting people affected by spinal muscular with Hand or Arm Deficiency) Climb Building atrophy and investing in essential research. Reach Head Office 176 Nantwich Road PO Box 54 Crewe CW2 6BG Meningitis Research Foundation Helston 0800 652 3181 (helpline, Mon–Fri Midland Way Cornwall TR13 8WD 10am–4pm) Thornbury 0845 130 6225 (9am–5pm) 0845 241 2172 (enquiries) Bristol BS25 2BS [email protected] [email protected] 08088 00 33 44 (24-hour helpline) www.reach.org.uk www.climb.org.uk [email protected] Information and support for parents of children Supports families and professionals, with www.meningitis.org with hand or arm problems. Local groups. information on over 700 metabolic diseases. Promotes education and awareness to reduce death and disability from meningitis and Scope Cystic Fibrosis Trust septicaemia, and supports people affected by 6 Market Road 11 London Road these diseases. Funds research to prevent the London N7 9PW Bromley diseases, and to improve survival rates and 0808 800 3333 (Mon–Fri 9am–5pm) Kent BR1 1BY outcomes. Text from mobile – text SCOPE plus 020 8464 7211 (switchboard) your message to 80039 (texts are free 0845 859 1000 (helpline, 9am–5pm) Muscular Dystrophy Campaign to the sender) [email protected] 61 Southwark Street [email protected] www.cftrust.org.uk London SE1 0HL www.scope.org.uk Information and support for parents of children 0800 652 6352 (helpline, Mon–Fri A national disability organisation whose focus is with cystic fibrosis and for people worried about 9am–5pm) people with cerebral palsy. Provides information, the possibility of passing on the illness. 020 7803 4800 advice and support services. [email protected] Down Syndrome Education International www.muscular-dystrophy.org Sense (National Deafblind and The Sarah Duffen Centre Provides support, advice and information Rubella Association) Belmont Street for people with muscle disease and their 101 Pentonville Road Southsea PO5 1NA families and carers. London N1 9LG 023 9285 5330 (helpline, Mon–Fri 0845 127 0060 9am–5pm) National Society 0845 127 0062 (textphone) [email protected] for Phenylketonuria (NSPKU) [email protected] [email protected] PO Box 26642 www.sense.org.uk www.downsed.org London N14 4ZF Advice and support for families of deaf, blind Helps people with Down’s syndrome to achieve 020 8364 3010 (helpline) and rubella-disabled adults and children. more in all areas of their development, by 020 7099 7431 (recorded information line) Provides information on local groups. informing progress through research and [email protected] education. Delivers information and services www.nspku.org Sickle Cell Society to families to help them provide the best Help and support for people with phenylketonuria, 54 Station Road care and support for their children with their families and carers. London NW10 4UA Down’s syndrome. 020 8961 7795 [email protected] www.sicklecellsociety.org Information, advice and counselling for families affected by sickle cell disease or sickle cell trait. Provides financial help when needed and information on local groups.

187 Tamba (Twins and Multiple Births Association) 2 The Willows Gardner Road Guildford Surrey GU1 4PG 0800 138 0509 [email protected] www.tamba.org.uk Services include a freephone helpline, Twinline, membership and specialist support groups, including bereavement.

Tommy’s Nicholas House 3 Laurence Pountney Hill London EC4R 0BB 0870 777 30 60 (advice and information) 020 7398 3460 (donation line) [email protected] www.tommys.org Provides pregnancy health information for the public and health professionals with the aim of helping all parents to have the best possible pregnancy outcomes. Operates a pregnancy information line staffed by midwives, and publishes books and leaﬂets on pregnancy and pregnancy complications.

UK Thalassaemia Society 19 The Broadway Southgate Circus London N14 6PH 020 8882 0011 ofﬁ[email protected] www.ukts.org Information and advice for families affected by thalassaemia.

Young Minds Parents’ Information Service 48–50 St John Street London EC1M 4DG 0808 802 5544 (Mon–Fri 10am–4pm; Wed 6pm–8pm) [email protected] www.youngminds.org.uk Service for any parent who is worried about their child’s mental health.

188 INDEX

A C development of your baby 6–9, 18–23, 46, 49 abnormalities caesarean sections 15, 49, 54, 67, 68, diabetes 5, 15, 32, 42, 154, 155 tests to detect 6, 7, 49–51, 152 98–9, 100, 155 dilation of cervix 11, 92–3, 94, 98, 100 worrying about 77 caffeine 29, 111 disabilities in baby 77, 149, 172 alcohol 5, 32, 129, 140, 154 calcium 27 discrimination and work 156, 169, 171, and breastfeeding 112 cap or diaphragm 135 172, 174–5 allergies 26, 112, 119 car safety 39, 130–1 domestic abuse 41, 45, 83 amniocentesis 50, 51 car seats 130–1 down’s syndrome screening tests 49, amniotic sac/fluid 20, 22 care to learn scheme 17 50–1 anaemia 7, 27, 42, 47, 53, 123 catheters 90, 97, 99 dreams 64, 76 anaesthetists 54, 89 cervical smears 48, 136 drugs, illegal 113, 155 animals, infections transmitted by 38 cervix 11, 12, 69, 87, 91 dummies 106, 139, 141 antenatal care 6, 16, 40–56 dilation of 11, 92–3, 94, 98, 100 appointments 41–6 chickenpox 37 ‘booking appointments’ 6, 16, 42, 44–5 child benefit 83, 138, 157, 175 E antenatal education (classes) 7, 56–7, child tax credit 6, 8, 28, 158, 160 ectopic pregnancy 69, 150, 151 77 child trust fund 157 eczema 26, 112 antenatal notes, hand-held 52–3, 91 childcare approval scheme 80 education and school anxiety 75, 76 childcare arrangements 8, 80 while pregnant 17 asthma 15, 31, 32 help with costs 158 education maintenance childminders and nurseries 80 allowance (EMA) 17 B children’s centres 16, 41, 55, 57, 71, eggs 12, 13, 14, 18, 19 embryo development 12, 18–19 ‘baby blues’ 9, 81–2, 136 134, 146 employment and support allowance baby carriers (slings) 130 chlamydia 36 6, 8, 159, 160, 163, 164 backache 58–9, 87 chorionic villus sampling (CVS) 50, 51 engagement of baby’s head 23, 53 bathing the baby 128, 144 chromosomes 13, 49, 50, 51 epidurals 71, 72, 73, 89–90, 98, 99, bed sharing 129, 140 coeliac disease 27, 28, 154 100, 155 benefits and rights 6, 156–75 colic 139 epilepsy 15, 27, 33, 154 bereavement 84 colostrum 61, 103 episiotomy 95, 96, 97 birth after 41 weeks 9, 96, 125 combined pill 135 equality bill 107 birth plans 8, 74, 77, 91 conception 12, 18 exercises birth trauma 82 best time to get pregnant 14 postnatal exercises 122, 123, 133 birthing partners 73, 93, 94, 95, 97, condoms 37, 135 during pregnancy 7, 34–5, 42, 62 99, 101 constipation 15, 25, 59, 122 expressing and storing milk 108–9, 148 birthing pools 71, 72, 73, 91 of the baby 119 birthmarks 125 contraception 113, 122, 134–5, 136 bleeding 67, 69, 78, 95, 122 contractions 77, 89–90, 91, 92, 93, 94, F blood pressure tests 7, 8, 9, 42, 43, 96, 97 faintness 59 45, 67 braxton hicks 9, 78, 87 fallopian tubes 11, 12, 13, 14, 18, 19 postnatal 136 cot death, reducing risk of 31, 129, families and friends 16, 17, 71, 73, 76, blood spot screening 140–2 78, 79, 80, 83 (heel prick test) 124 cot safety 129 families information service 80 blood tests 8, 15, 36, 42, 43 council tax benefit 53, 159, 162 fathers and/or partners 6, 39, 40, 70, types of 46–8 cramp 35, 59 71, 81, 120 body mass index (BMI) 44 crying 138–9 at antenatal classes 52, 56 braxton hicks contractions 9, 78, 87 cystic fibrosis 38, 40, 42, 48, 51, 124 birthing partners 73, 93, 94, 95, 97, breast pads 103, 109, 131 cystitis 38 99, 101 breastfeeding 73, 85, 102–14 breastfeeding and 104, 132 after the birth 95, 103 D death of 84 benefits of 102, 103, 141 death early weeks with baby at home 132, food and 110–12, 134 of baby see loss of baby 133, 134 HIV positive mothers 47 of partner 84 feelings and emotions 16, 77 jaundice and 149 deep vein thrombosis 39, 69 health of 5, 6, 154 in neonatal units 148 delivery paternity leave 7, 171 pain relieving drugs and 89 home births 6, 8, 45, 70, 86, 89, 90 presence at birth 73, 77, 78, 88, 101 of twins and triplets 15, 107 hospital births 8, 9, 45, 70, 73, registering the birth and 138 while out and about 131 85–6, 90–1 feeding 7, 9 breasts 13, 109–10 midwifery unit births 8, 9, 45, 71, in neonatal units 148 babies’ 125 85–6, 90–1 see also formula feeding; breastfeeding changes in during pregnancy 7, 15, 78, delivery rooms 91 feelings and emotions 13, 16, 75–7 85, 123 delivery/due date, calculation of after the birth 81–2 breathing of newborn babies 95, 103, 6, 18, 49 in early weeks at home with baby 134 126, 142, 145, 148 dental care 6, 34, 113, 157 in first few days with baby 120–1 breech births 71, 100 depression 76, 82 loss of baby and 151, 152, 153 postnatal 9, 82, 136, 155 termination and 152

189 fertilisation 12, 13, 14, 18, 19 hydrotherapy 88 milk, free 6, 28, 162 fertility treatment 14 hyperemesis gravidarum 61 minerals 27–8 fetal alcohol syndrome (FAS) 32 hypnosis 90 miscarriages 150, 151–2 fetal heart monitoring 92–3 screening tests and 49, 51 fetus development 19–23 I MMR immunisation 36, 113, 126 flexible working arrangements 172–5 illness in the baby 108, 110, 139, 142 mobile phones 86 flying and travel 39, 69 streptococcal infection 146 monitors, breathing 142 folic acid 5, 27, 28, 42, 154 symptoms 145, 146 monthly cycle 12, 13, 14, 15, 18 fontanelle 124 implantation 12, 18, 19 ‘morning sickness’ 6, 7, 15, 31, 61 food income support 6, 8, 28, 159, 160, 163 mortgage interest repayments 161–2 after the birth 82, 134 incontinence 60, 123, 136 movements of baby in uterus 6, 20, balanced diet 5, 7, 24–5, 27, 110–11, incubators 148 21–2, 46, 49 123, 134, 155 indigestion and heartburn 60–1 multiple births 14–15, 49, 56, 82, 98, food that you should not eat 26, 111 induction 9, 67, 68, 96, 97, 152 100, 107, 140 healthy snacks 29, 111, 134 infections 36–8 death of one baby 153 healthy start vouchers 6 inherited diseases and conditions 5, 6, muscular dystrophy 38, 50, 51 high in fibre 25, 33, 59, 63, 110, 113, 123 38, 40, 42, 46, 48, 50, 80 intolerance 28 injections during labour 89 N during pregnancy 5, 7, 24–9, 59 internal examinations 91, 93, 100 nappies 85, 86, 106, 127–8 preparation 26 iron supplements 7, 27, 59 changing of 128, 142–3 sperm quality and 154 itching 61, 68 hygiene and 143 while breastfeeding 110–12, 134 nappy rash 128, 143 forceps delivery 54, 70, 97 J nausea and sickness 6, 7, 15, 31, 61 formula feeding 15, 73, 115–19, 131, 162 neonatal care 147–9 problems with 119 jaundice 47, 68, 125, 145, 149 jobseeker’s allowance neonatal death 153 while out and about 131 newborn babies FPA (family planning association) 135 contribution-based 166 income-based 6, 8, 28, 159, 160, 161, 163 appearance of 124–5 fruit and vegetables 6, 25, 27, 59, 63, early weeks at home 120–1, 127–31, 110, 123, 154, 162 L 132, 137–46 health of 124–6, 145–6 G labour immunisations 126 ‘gas and air’ (entonox) 88 after the birth 95–6 needing additional care 147–9 gender/sex of baby 13, 51 the birth 94–5 out and about 130–1 general practitioners (GPs) 5, 6, 15, 145 early starting (premature) 86, 96 six-week check 136 genetic disorders, screening tests for fetal heart monitoring 92–3 skills and senses 126 38, 48, 49, 50–1 first stage of 92–3 skin-to-skin contact 95, 96, 103, 108, german measles (rubella) 36, 47, 126, pain relief in 54, 73, 87–90 120, 148 136, 155 preparing for 85–6 support for mothers 146 gingerbread 79 recognising active labour 8 talking to 137 ‘glass test’ and meningitis 145 second stage of 94–5 newborn blood spot screening signs of 87 (heel prick test) 124 H speeding up of 93 newborn hearing screening third stage of 95 programme 124 haemophilia 38, 50 languages other than English 40, 41, 137 hair, changes in 63 NHS choices website 74 lanugo 21, 23 NHS constitution 176–7 headaches 60 loss of baby 150–3 health and safety issues 17, 39, 155, nipples grieving 151, 152, 153 changes in during pregnancy 15, 63 156, 170–1 help and support 150 health in pregnancy grant 7, 160 leaking from 61, 103 sore or cracked 109, 110 health visitors 55 M healthy start scheme 6, 28, 162 nosebleeds 62 heartbeat of fetus 7, 19, 20, 22 massage 90 nuchal translucency scans 50, 55 during labour 92–3 mastitis 109–10 hepatitis B 37, 47, 126, 155 maternity allowance 7, 158, 162, 163–4 O hepatitis C 37, 47, 126, 155 maternity certificate (form MAT B1) obstetric cholestasis 68 hepatitis E 38 7, 163, 164, 166 obstetric physiotherapists 55 herpes 37, 48 maternity facilities, tours of 9 obstetricians 40, 54, 97, 100 high blood pressure 67, 97 maternity leave 80, 167–9 oedema 53 HIV and AIDS 36, 37, 47, 155 medicines 5, 33, 113, 140, 155 oestrogen 13 home births 6, 8, 45, 70, 71, 86, 89, 90 membrane sweeps 96 ovaries 11, 12, 13, 18 homeopathy 90 meningitis 145 overdue pregnancies (after 41 weeks), hormones 13, 16, 75 mental health problems 5, 15, 76, 82 9, 96, 125 hospital births 8, 9, 45, 70, 73, 85–6, midwifery unit births 8, 9, 45, 70, 71, ovulation 12, 14 90–1 85–6, 90–1 housing benefit 83, 159, 161 midwives 6, 15, 54, 71, 74, 91 housing issues 17, 79 milk and dairy foods 25, 26, 110

190 P shaking 139 urination 15, 62, 90, 122 sickle cell disorders 38, 40, 42, 48, 51, urine tests 7, 8, 9, 42, 43, 45, 67 paediatricians 55, 96, 97, 100 124 postnatal 136 pain relief in labour 54, 73, 87–90 signs of pregnancy 15 uterus (womb) 11, 12, 13, 19 parental leave 169, 172 single parents 79, 157, 158, 159, 166 baby movements in 6, 20, 21–2, 46, 49 partners see fathers and/or partners skin, changes in 63 measurement of 7, 8, 9, 43 parvovirus B19 (slapped INDEX ‘slapped cheek disease’ position of the baby in 8, 9, 23, 46, 49, 53 cheek disease) 37 (parvovirus B19) 37 paternity leave 7, 171 sleeping 64, 75 peanuts 25, 26, 27, 112 V the baby and 104, 129, 140–1 pelvis 11, 23, 53, 60, 92, 155 vagina 11, 12, 13 sleeplessness of mother 9 pelvic floor exercises 35, 42, 62, 122, 123 vaginal bleeding 69 slings (baby carriers) 130 pelvic joint pain 62 vaginal discharge 15, 66, 136 slow-growing babies 68 pension credit 8, 159, 160, 161, 163, 175 varicose veins 66 smoking 5, 30–2, 68, 129, 140, 141, 154 personal child health record (PCHR) 123 vasa praevia 69 breastfeeding and 112 phototherapy 149 vegetarians and vegans 28 social care support 15 piles 33, 63, 123 ventouse delivery 54, 70, 97 social fund 83, 160–1, 175 placenta 20, 32, 49, 95 vernix 22, 95, 125 sonographers 55 placenta praevia 67 vitamins 26, 27–8 sperm 12, 13 position of baby in uterus 8, 9, 23, 46, for the baby 115, 124 spina bifida 19, 42, 49, 154 49, 53 vitamin D 6, 27, 28, 42, 111 statutory maternity pay (SMP) 7, 8, post-mortem examinations 153 vitamin K 9, 96, 124 158, 162, 165–6 postnatal care 121 statutory paternity pay (SPP) 171 postnatal check 122, 135, 136 W stillbirth 150, 153 postnatal depression 9, 82, 136, 155 stitches 95, 96, 122, 136 washing the baby 128, 144 postnatal exercises 55, 122, 123, 133 stools (poo) of baby 106, 143, 149 water births 71, 72, 73, 91 postnatal post traumatic streptococcal infection 38, 146 waters breaking 20, 87, 90, 93 stress disorder 82 stretch marks 64 weight 5, 6, 44, 136, 155 postnatal recovery and healing supervisors of midwives 74 gain during pregnancy 25, 26, 44, 64 120–3, 133–6 sure start children’s centres 57, 134, work prams and carrycots 130 146 dismissal due to pregnancy 167, 171 pre-eclampsia 40, 42, 45, 67 sure start maternity grants 8, 158, flexible working arrangements 172–5 pregnancy tests 6, 15 159, 160 hazards 39, 42, 155 premature births 15, 38, 108, 125 sweating and feeling hot 59 health and safety issues 39, 155, 156, smoking and 31 swollen ankles, feet and fingers 64 170–1 prescriptions, free 157, 175 syphilis 47 maternity leave 80, 167–9 presentation of the baby 53 parental leave 169, 172 problems in pregnancy 67–9 T pregnancy and 39, 45, 155 minor 58–66 resigning from 166, 170 puerperal psychosis 83, 155 tax credits or relief 6, 8, 28, 80, 83, 158, returning to 80, 166, 169 pushchairs 130 160 rights at 6, 155, 156, 167–9, 170–1, tay-sachs disease 48 172–3 R teenage mothers 17, 28, 56 sex discrimination laws 156, 168, 171, teeth and gums 65 registering the birth 138 172, 174–5 TENS machines 73, 89 relationships 78–80 working tax credit 8, 28, 158, 160 termination 16, 49, 152 after the birth 81, 134 worrying about birth 77 thalassaemia disorders 38, 48, 51 relaxation 55, 78, 88, 92, 93 thirst of baby 119 rhesus negative mothers 8, 43, X thrombosis (blood clots) 39, 69 46–7, 123 thrush 66 x-rays 34 rights and benefits 6, 156–75 in breasts 110 rubella (German measles) 36, 47, 126, tiredness 6, 7, 8, 9, 15, 39, 65, 75 Y 136, 155 tongue-tie 110 young mothers 17, 28, 56 S toxoplasmosis 26, 37, 38 the young woman’s guide to triplets 14–15, 24, 82, 96, 98, 100, 107, pregnancy 17 serum screening 50 136, 140 sex twins 14–15, 49, 71, 82, 98, 100, 107, after baby’s birth 122, 134–5 136, 140 during pregnancy 69, 78 sex discrimination laws 156, 167, U 168, 169, 171, 172, 174–5 ultrasound scans 6, 42, 44, 48–9 sex organs 10, 11 anomaly scan 7, 42, 48, 49, 55 sexual abuse 41, 45, 83 baby’s heartbeat 7, 19, 20 sexually transmitted infections (STIs) dating 14, 42, 48, 50, 55 36–7, 47, 135, 155 nuchal translucency scans 50, 55 sexwise helpline 17 umbilical cord 19, 20, 69, 95, 124

191 USEFUL NUMBERS

Doctor:

Midwife:

Partner:

Birth partner:

Hospital:

Hospital reference number:

Health visitor:

Local taxi:

NHS Direct: 0845 4647 24-hour nurse-led helpline providing health information and advice.

NHS pregnancy smoking helpline: 0800 169 9 169 Open daily from 12 noon to 9pm.

192

If you require further copies of this title visit www.orderline.dh.gov.uk and quote: 286153 The Pregnancy Book Tel: 0300 123 1002 Fax: 01623 724 524 Minicom: 0300 123 1003 (8am to 6pm, Monday to Friday) www.dh.gov.uk/publications