A Guidebook for Expectant Parents We’Re Having a Baby 29Th Edition

We’re having a baby

A guidebook for expectant parents We’re having a baby 29th edition

THL National Institute for Health and Welfare

Illustrations by Taru Castrén

Layout by Hanna Tennilä, Textop Oy

ISBN 978-952-245-256-6 978-952-245-331-0 (e-version)

Erikoismedia Graphic Oy Helsinki 2012 Dear Reader,

Babies are born into a variety of situations and different kinds of families. The baby may be a firstborn or one of many siblings. Some babies have one parent, others have two. Some are born into traditional nuclear families, others into stepfamilies. Some pregnancies are carefully planned, while others may come as quite a surprise. This booklet contains information on pregnancy, birth and parenting. It also gives advice on how to take care of your baby and where you can find help and support. In addition to this guide, your local prenatal and child health clinics are there on-hand to offer support and advice on good parenting. For further assistance, you can also contact your maternity hospital, as well as the many other organisations mentioned in this booklet that are dedicated to child and family support. We hope that this booklet will be a useful guide in the preparations for a new addition to your family.u

3 Contents

Pregnancy From conception to birth.. . . . 5 Signs of pregnancy...... 10 Nutrition and pregnancy...... 13 Risk factors ...... 17 Exercise and fitness...... 19 Preparing for parenthood...... 20 You and your partner...... 23 Antenatal care in Growth and development...... 70 the prenatal clinics...... 26 Daily routines...... 76 Pregnancy at work and at home. . . 30 Safety...... 79 What does a baby need?. . . . . 32 Starting supplementary food. . . .. 81 When the baby is ill...... 84 The birth Organizing childcare...... 88 Preparing for birth...... 34 C-section...... 35 Services for families Onset of labour...... 38 with children The stages of labour...... 39 Prenatal and child health clinics . . . 90 Labour pains and pain relief.. . . . 42 Social services centre...... 91 The newborn...... 44 Municipal day care...... 92 Recovering from the delivery.. . . . 48 Organisations...... 94 Special situations...... 96 Baby care First month ...... 54 Social protection for families Breastfeeding...... 60 with children Hygiene...... 64 Social protection for families Sleep...... 68 with children...... 99

4 From conception to birth

Conception can occur during ovulation, your last menstruation. A normal pregnan- which takes place approximately two cy lasts between 32 and 42 weeks. To cal- weeks after the first day of menstruation. culate the expected date of delivery, add 40 The ovum can be fertilised by male sperm weeks (= 9 months and 7 days) to the date for 24 hours. Fertilisation happens when when your period last began. Most babies the male sperm cell penetrates the female are born during week 39 or 40. If your ovum. The sperm can survive in the wom- menstruation cycle is longer than 28 days, an’s body for 2-4 days. The male sperm de- then conception will have taken place termines the sex of your baby. more than two weeks after the first day of your latest period. Most pregnant women The expected date of delivery have an ultrasound scan in week 20. The The due date, or expected date of delivery EDD is checked against the size of the ba- (EDD), is calculated from the first day of by. In later scans, the EDD will not be revised. Placenta The placenta begins to develop when the fertilised ovum is embedded in the lining of the uterus a few days after conception. A well-functioning placenta provides the basis for the healthy development of the foetus. The placenta acts as the lungs, liver, in- testines, kidneys and source of nutrition for the foetus. Nutrients and oxygen travel from the placenta to the foetus via the umbilical cord. The veins in the umbilical cord carry the baby’s blood to be oxidised in the placenta and transfer the waste to the mother’s circulation. The metabolism takes place through a thin membrane: the blood circulations of the mother and the baby, although very close to each other, remain separate. A fully developed placenta weighs about 500 to 800 grams, and is shaped like a flat disc. Many substances harmful to the foetus, such as nicotine and alcohol, can pass

Pregnancy 5 through the placenta. (See page 17.) tions prepare the cervix for delivery. During Uterus the final weeks of pregnancy, the cervix The uterus of a woman who is not preg- may dilate a little, more if the pregnancy is nant weighs 50 to 70 grams and is 7 to 9 not the first. Experiencing painful contrac- cm long. At the end of pregnancy, it weighs tions during the second trimester may be a nearly 1 kg and has a volume of about 5 li- sign of an infection, and you should con- tres. During pregnancy, the uterus grows tact your prenatal clinic immediately. with the baby. During the fourth month of pregnancy, the uterus rises from the pelvis, Pregnancy and well-being which results in visible changes in the Although pregnancy is a natural condition, mother’s body: in week 16 the fundus of it is nevertheless a strain on the mother. the uterus is halfway between the pelvis The entire body must adapt to the new sit- and the navel, by week 24 it is up to the uation. Metabolism is enhanced, breathing navel, and by week 36 it is up to the dia- and circulation become more efficient, and phragm. Accelerated growth of the uterus the uterus grows. During pregnancy the may indicate a multiple pregnancy. The placenta secretes enzymes and hormones fundus of the uterus usually drops a couple which, together with the corpus luteum of weeks before delivery and becomes and pituitary gland, regulate these chang- round in shape. At the same time the baby es. Changes in the body also affect the usually turns head down ready for delivery. mental state, or moods, of the pregnant woman. (See ”Preparing for parenthood” Movements on page 20.) Women who are having their first baby Pregnancy affects women in different usually feel its movements by week 20 or ways: some suffer from several signs and 21. Mothers who have had previous preg- symptoms while others experience very nancies can already feel the movements little discomfort. Some symptoms are around week 18. At first, the movements common at the beginning, while others may feel like ”bubbling” or ”fluttering”, are typically experienced at later stages. before they develop into gentle kicks and Although the symptoms may cause serious bumps. discomfort to the mother, they seldom pose any threat to the baby. Contractions During pregnancy, it is recommended The uterus prepares gradually for the deliv- not to take any medications or natural ery. During the last weeks the uterus tight- health products, not even cough drops, ens in ”practice contractions”. In the be- without first consulting a doctor or a ginning, the contractions only last for a few nurse, because some drugs will be harmful seconds, but towards the end of pregnancy to the baby. When at the doctor’s or den- they can last for up to 30 seconds. Contrac- tist’s, always remember to tell them that you are pregnant so that they can adjust the treatment accordingly. Avoid x-rays. u

6 Pregnancy Pregnancy Calendar Weeks Pregnancy timeline To do list conception Takes place roughly two weeks Stop smoking and give up from the start of your period. alcohol! If you need support, contact your prenatal clinic. weeks 0-4 At two weeks, the embryo is Do not take any medications the size of a pinhead. during pregnancy without first consulting a doctor or nurse! Check that your medications can be safely used during pregnancy. weeks 5-8 The foetus is now 1.5 cm long and has the The baby is well if the beginnings of arms and legs. The heart, mother is well: nose, ears and eyelids, the nervous system, healthy food, sufficient rest spine and umbilical cord start developing. and plenty of outdoor activities are good for both. weeks 9-12 When the foetus is 10 weeks old, it is approx- The early pregnancy imately 3 cm long and weighs 20 grams. The ultrasound scan is done baby’s heartbeats can be heard. The foetus between the weeks 10 and floats in amniotic fluidprotected by the foetal 14, and is usually an internal membrane and gets its food through the scan done through the vagina. umbilical cord. The foetus now has an upper and lower jaw and the beginning of a tongue. Teeth are beginning to develop in the gums. weeks 13-16 When the foetus is 14 weeks old, it is ap- To qualify for the maternity proximately 9 cm long, and weighs about benefit the mother must 100 grams. The uterus is now about the size have a medical examination of a fist. The head is big, almost half the either at the prenatal clinic length of the foetus, and the facial features or by a doctor before the end start developing. The ears and genitals de- of week 16. velop. The foetus practices swallowing and breathing. It kicks, wiggles its toes and thumbs, and turns its head, but the mother is not yet able to feel these tiny movements. weeks 17-20 When the foetus is 18 weeks old, it is 25 - 27 Talk to the nurse about cm long andweighs 250 - 300 grams. The antenatal classes. foetus has its own circulatory system, and its

Pregnancy 7 Weeks Pregnancy timeline To do list

heart beats twice as fast as that of an adult. Most women have an A very fine down, known as lanugo, is now external scan some time covering the baby’s entire body. Most of this during weeks 18 - 21. will disappear before birth. The baby has The external scan is done eyebrows. The placenta is almost as big as by rolling a transducer the foetus. It protects the foetus from some across your tummy. but not all harmful substances. If this is not her first pregnancy, the mother will now be able to feel the movements of the baby. weeks 21-24 When the foetus is 22 weeks old, it is ap- In week 22, you can proximately 30 cm long and weighs 400 - apply for maternity, 600 grams. At his time even women who are paternity and parental having their first baby can feel the move- allowance as well as for ments. The heartbeat is clearly audible. By the maternity benefit week 24, the fundus of uterus is up to the (See “Benefits for families navel. Accelerated growth of the uterus may with children”.) indicate a multiple pregnancy. The foetus practices sucking, and its thumb often finds Avoid excessive strain. its way into its mouth. The hair and nails are Do not take the growing, and the protective membrane is contractions lightly. starting to develop into skin. Most of the time the baby is asleep, but it can be awak- ened by noise or vibration. A pregnancy terminating before week 22 is called a spontaneous abortion, or miscarriage. If born during weeks 23 or 24, the baby may survive in intensive care, although it is very premature. Developmental risks are great, and the selection of a treatment regime must often be given due consideration. weeks 25-28 When the foetus is 26 weeks old, it is ap- Be alert to the reactions proximately 35 cm long and weighs about a of your body. Remember kilogram. The foetus moves a lot. It turns to get enough rest! and kicks so hard that the movements are visible. The baby can open and close its eyes Avoid any unnecessary and has a firm grip. The fundus is up to the strain, especially if you navel now. You may be experiencing your have contractions. first contractions: your belly tightens for a few seconds and then relaxes. The foetus now looks like a real baby, but is a lot thin-

8 Pregnancy Weeks Pregnancy timeline To do list

ner. A baby born before 28 weeks is considered extremely premature. The lungs and other organs are not yet fully developed. With intensive care the baby often survives, and the prognosis is better due to improved treatment methods. weeks 29-32 When the foetus is 30 weeks old, it is ap- Avoid standing work, proximately 40 cm long and weighs about lifting heavy objects and 1.5 kg. Most children born during weeks other strenuous tasks. 29 - 32 survive with intensive care, and their risk of handicap is small. weeks 33-36 When the foetus is 34 weeks old, it is ap- Now is the perfect time proximately 47 cm long and weighs about to get everything ready 2.7 kg. It gains weight rapidly. The baby has for the baby. less room in the uterus and moves around less than before. At this stage, most babies In many municipalities, turn head down ready for delivery. The ba- you can visit the maternity by’s skin is covered with a creamy film hospital in advance. called vernix. The uterus reaches its highest point and is up to your ribs. If there is risk of premature birth, the delivery will take place close to the neonatal intensive care unit. Ba- bies born in week 35 seldom need intensive care. Babies born before week 37 are considered premature, and the mother and child may need to stay at the postnatal ward for an extended period of time. weeks 37-40 The uterus drops and the baby’s head will Go to the hospital if your become engaged into your pelvis. Contrac- water breaks, you have tions will become more frequent. The baby contractions at regular is kicking so hard that he or she can push intervals, you are experienc- away a book resting on your tummy. At ing pains, or if you are birth, most babies are 49 - 52 cm long and bleeding. (See “Birth”.) weigh 3000 - 4000 grams. The average pregnancy lasts for 40 weeks, but deviating from When the baby is ten days the average by one week is very common. over the expected date of delivery, the mother will go to the hospital for a post-term follow-up check.

Pregnancy 9 Signs of pregnancy

Feeling tired Some expectant mothers are vital and en- ergetic, while others feel very tired during the first and last months of pregnancy. If possible, rest during the working day. If you feel extremely tired for more than two weeks, discuss it with your prenatal clinic’s nurse or doctor. (See ”Anaemia”.)

Body temperature During the early stages of pregnancy, the body temperature may rise slightly. This is quite normal and does not need medical attention. However, if you have a fever during pregnancy, contact the prenatal clinic or your doctor.

Nausea and vomiting Almost one in every two expectant moth- your stomach becomes empty. This can be ers suffer from nausea or ”morning sick- prevented by having snacks during the ness” during the first trimester (the first day. Violent vomiting is not a normal sign three months of pregnancy), especially in of pregnancy and should always be treated the morning when the stomach is empty. by a doctor. It may be accompanied by dizziness and fainting when getting up. Nausea may be Breasts triggered by certain smells or tastes, be- Your breasts will grow and they might feel cause the sense of taste and smell is tender and tight. Beginning from the sec- heightened during pregnancy. The morn- ond month, it is possible for your breasts ing sickness and vomiting usually stop af- to leak milk. At this stage your breasts will ter the first three months. It might help to be very sensitive to cold and should be drink a glass of water or juice before get- kept warm at all times. You should buy a ting out of bed and eat something small supportive maternity bra by the middle of such as a biscuit or slice of bread as soon your pregnancy. During the winter, wear a as possible after getting up. Get out of bed warm woollen scarf around your breasts. It slowly, taking your time. You may be over- might be wise to avoid swimming in cold come by nausea during the day as well, if water. Massage your nipples with a mois-

10 Pregnancy turising lotion available from the chemist Sweating to prepare the skin for breastfeeding. If Sweating increases during pregnancy as your nipples are small or turned inwards, metabolic activity increases. Pay special at- stretch them daily starting a few months tention to your personal hygiene. before the expected date of delivery so that the baby will be able to get a good grip. Heartburn Heartburn is a common ailment towards Vaginal discharge the end of pregnancy. It is caused by regur- The normal amount of vaginal discharge gitation of gastric acid. Heartburn is a tends to increase during pregnancy. If the painful burning feeling in your throat, discharge smells bad or itches, consult chest or upper abdomen. It can be alleviat- your doctor as it may be a sign of an infec- ed by avoiding spicy and fried foods, coffee tion. When washing, use only water as and strong tea. The prenatal clinic will be soap may irritate the mucous membrane. able to suggest safe medications to treat heartburn. It will discontinue as soon as Vaginal bleeding the baby is born. Periods will stop during pregnancy because the lining of the womb that is dis- Anaemia charged during menstruation is vital for Anaemia may be the reason for feeling ex- pregnancy. Slight vaginal bleeding is extremely tired. Other symptoms include perienced by approximately 25% of wom- paleness, palpitations, shortness of breath en around the time of normal menstrua- during exercise and dizziness. Anaemia tion. The bleeding is explained by the fer- occurs when there is not enough haemo- tilised ovum being embedded in the lining globin in your blood. Haemoglobin levels of the uterus. If the bleeding is heavy and often decrease during pregnancy because similar to regular menstruation, it may be there is more blood in your circulation. In a sign of miscarriage and you should con- a sense, your blood is ”diluted”. If neces- tact the nurse or doctor at the prenatal sary, your doctor or nurse will prescribe clinic. iron supplements. Vegetables and fruit rich in vitamin C as well as meat and fish en- Urinating hance iron absorption. In the early stages of pregnancy, and especially before the time of the normal men- Varicose veins struation period, you may experience a Varicose veins are enlarged veins that are vague feeling of heaviness in the lower ab- swollen and raised above the surface of the domen. This is caused by the expanding skin. The condition tends to get worse dur- veins and enhanced circulation. Toward ing pregnancy when the expanding uterus the end of pregnancy, the need to urinate puts pressure on the veins. Wearing spe- is more frequent as the uterus is pressing cialised compression stockings, which you against the bladder. A swift kick from the put on before getting out of bed, help to baby may cause the mother to have an alleviate the problem. It also helps if you ”accident”. can put your feet up during the day and

Pregnancy 11 place a pillow under your feet at night. that supports your back without being too Avoid wearing high-heeled shoes or shoes hard. Gentle massaging and rest will relax that are too tight. Wear different shoes tense back muscles. Light exercise to during the day to give your feet a rest. strengthen the abdominal muscles is recommended. Ask the prenatal clinic for ex- Cramps ercise instructions. During pregnancy women tend to have leg cramps. Painful leg cramps often occur at Swelling night. The best way to relieve a cramp is to Some degree of swelling is normal unless stretch the cramping muscles: straighten it is accompanied with rising blood pres- your leg, take hold of your big toe and pull sure and protein discharges in urine. A your leg up, or press it against the bed. You sudden increase in weight (over 500 g per can try to relax the cramp by massaging week in a woman of normal weight) or the muscle lightly. Use a cold pack (e.g. a swelling accompanied by severe itching bag of frozen vegetables) for first aid. Keep may be symptoms of a liver condition your feet warm during the night. (hepatosis gravidarum). Contact the prenatal clinic or your doctor. Constipation and piles As the uterus grows, it presses against the Skin blemishes rectum and thus increases the tendency to The skin can get darker during pregnancy, develop piles. As piles are aggravated by especially the tips of the breasts and constipation, pay special attention to what around the genitals. A brown line often you eat and make sure that you exercise appears stretching from the lower abdo- sufficiently. Fibre-rich foods and sufficient men to the naval, and brown spots (ch- liquid intake help prevent constipation. loasma) appear on the face. These marks Wholemeal bread and porridge, vegeta- will fade after delivery. bles, berries and fruit are all good sources of fibre. If necessary, add bran or wheat Stretch marks germ and dried fruit to your diet to en- Pregnant women may develop stretch courage regular bowel movements. Exer- marks on their breasts, abdomen and cise and other physical activities will also thighs, caused by tearing of the dermis. help. Massaging stretch marks with a moisturis- ing lotion may help during the early stages Backache of pregnancy. The red lines will usually As the tummy grows, the back muscles fade after delivery. u have to take a lot of strain, which may result in back pain. Good posture and support by the abdominal muscles (hold your navel in as much as possible) will alleviate the pain. Wearing a supportive maternity bra and comfortable shoes with flat heels will ease the backache. Find a mattress

12 Pregnancy Nutrition and pregnancy

Eating a well-balanced and varied diet keeps the expectant mother healthy, contributes to the healthy development of the baby, and prevents nutritional problems. It also accelerates recovery from the birth and supports breastfeeding. A healthy woman who has been eating a balanced and varied diet does not need to make any major dietary adjustments during pregnancy. Some women will need iron, folic acid and calcium supplements to meet the added demand during pregnancy. Multivita- min-mineral supplements are necessary recommended that pregnant women eat only if the diet is not balanced. It is recom- several times a day: breakfast, lunch, din- mended that all pregnant women take ner, and 2 to 4 snacks in between. supplemental vitamin D. It is advisable to avoid supplements containing vitamin A. Weight gain The average total weight gain during preg- Energy requirements nancy is 12.5 kg. Weight gain is caused by During the first three months of pregnan- the growth of the uterus, foetus, placenta cy (the first trimester), there is virtually no and breasts, and the increased amount of need for extra food. During the second and blood and amniotic fluid. However, during third trimester the need for extra energy the first trimester it is common to lose so can be met with a slice of bread with a me weight. Women gain different amounts spread, a glass of milk, and an one piece of of weight, and recommendations are based fruit. Often the physical activity of the on the weight prior to pregnancy. pregnant women decreases towards the Weight gain should be monitored for end of pregnancy, which further decreases several reasons: Insufficient weight gain the need for additional energy. Thus, there may be an indication that the foetus is de- is no need to ”eat for two”, but to eat a veloping too slowly. A steady excessive in- well-balanced and varied diet, and eat at crease in weight is a strain on the expect- regular intervals. ant mother. A sudden increase may be a It is very important to maintain regular sign of too much fluid collecting in the meal times. Feeling tired or nauseous may body (see ”Swelling”). Excessive weight indicate that the expectant mother should gain during pregnancy may predispose the get more rest and eat more regularly. It is woman to gestational diabetes, which is a

Pregnancy 13 disorder of carbohydrate metabolism that they contain little energy, they are not fat- can result in the excessive growth of the tening. Vegetables, fruit and berries should baby and low blood sugar levels at birth. be eaten in large quantities, preferably at (See ”Weight control” on page 50.) every meal, and at least 5 portions a day. Putting on a lot of weight during preg- Favour uncooked vegetables and include nancy predisposes the woman to being vegetables of different colours in your diet. overweight after delivery as well. Obesity Use vegetables and fruit to increase the va- is a risk factor for many chronic diseases, riety of flavours in your diet and to cut the such as Type 2 diabetes. Healthy eating amount of calories. Beans, lentils, seeds, habits and sufficient exercise help in con- peas and nuts all contain a lot of protein. trolling weight, and a positive mood will Remember to rinse salads and other vege- support these efforts. tables carefully in order to avoid listeria. Meats and fish are rich in protein, A well-balanced diet during pregnancy which is important for the healthy devel- Every family has its own eating habits. opment of the baby. Choose products Pregnant women should, however, pay at- which are low in fat and salt. Avoid eating tention to their eating habits and be pre- liver and liver products during pregnancy pared to make some adjustments to im- because they contain high levels of vita- prove the well-being of the developing ba- min A. It is advisable not to eat more than by and herself. It will benefit the whole 200 g of liver pâté or sausage per week family to pay attention to the type and and to eat a maximum of 100 g at a time. amount of fats they eat and their sugar and The recommendation is to eat fish 2 to 3 salt intake. times a week. Avoid pike during pregnan- Milk, cheese and other dairy prod- cy and while you are breastfeeding be- ucts are important sources of protein, cal- cause it contains high levels of mercury. cium and other nutrients. There is an in- Because of the risk of listeria, avoid vacu- creased need for these during pregnancy, um-packed raw-cured and cold-smoked and it is recommended that pregnant fish products as well as unripened chees- women eat dairy products even if they are es, blue cheese and cream cheeses made not normally part of the usual eating hab- from unpasteurised milk. its. To ensure a sufficient supply of calcium, pregnant women should drink Salt 4 glasses (8 dl) of milk or other liquid dairy Use as little salt as possible, because it products daily. Select the non-fat or low- causes swelling, burdens the kidneys and fat alternatives. raises your blood pressure. Food cravings Bread and porridge, especially those made from wholemeal, contain lots of minerals and vitamins. Wholemeal products are also rich in fibre, which helps di- gestion and prevents constipation. Vegetables, fruit and berries are rich in vitamins, minerals and fibre. Because

14 Pregnancy during pregnancy may considerably in- Fat crease the amount of salt intake, if the Use low-fat spreads on bread and toast. craving is for salted snacks or other foods For cooking, use low-fat spreads, vegeta- with high levels of salt, such as salted ble oils and vegetable oil blends. gherkins, pickles or salami-type sausage. Most seasoned salts and stock cubes con- Liquids tain 50% salt. In addition to salt, soup mix- Drink sufficient liquids during pregnancy tures and marinated poultry and meats al- and while breastfeeding. Fresh water and so contain soy or sodium glutamate. For diluted juice are the best alternatives for added flavour and to reduce your salt in- quenching thirst. Current recommenda- take, include plenty of vegetables and frui- tions suggest that pregnant women should tin your diet. limit their coffee consumption to 3 cups a day. For many, coffee is a cause of heart- Sugar burn. Reducing your sugar intake helps prevent excessive weight gain and helps Vitamins and minerals protect against tooth decay. Soft drinks The developing baby takes all the nutrients have high levels of sugar but contain none it needs from the mother’s body, and rare- of the nutrients you need, which is why ly suffers from any deficiencies. The preg- soft drinks are not part of a balanced diet. nant women needs a rich supply of vita- According to current recommendations, mins and minerals for the safe develop- drinks with artificial sweeteners, such as ment of the baby and for her own health. aspartame, acesulfame, taumatine and su- The need for vitamin D increases dur- cralose, are not forbidden during pregnan- ing pregnancy. The best sources of vitamin cy and breastfeeding. The only exceptions D include fortified dairy products, marga- to this rule are cyclamate and saccharin, rines and fish. Using dairy products and which are not recommended during preg- margarines fortified with vitamin D is safe nancy and breastfeeding. Liquorice should and there is no danger of overdose. It is be eaten only in moderate amounts, as it recommended that all pregnant and contains high levels of glycyrrhizin, which breastfeeding women take supplemental may cause swelling and raise blood pres- vitamin D. sure. Folic acid or folate is a form of vitamin B. The need for folic acid increases

Pregnancy 15 during pregnancy. Wholemeal and whole- pregnancy. Iron is needed for making red grain products and uncooked vegetables, blood cells and oxygen transport and for fruit and berries are rich in folic acid. Sup- the development and proper functioning plemental folic acid is not needed if the of the placenta. These are also very impor- mother is eating a well-balanced and var- tant for the baby. The main sources of iron ied diet that includes wholemeal products include meat, fish and wholemeal grains. and 5–6 portions of fruit and vegetables The iron from meat and fish is easily ab- every day. sorbed. Foods rich in vitamin C enhance Folate deficiency may be a contributing iron absorption from wholemeal grains factor in neural tube defects (NTD) in de- and vegetables. Sometimes even a well- veloping embryos. To ensure a sufficient balanced diet cannot supply a sufficient supply of folic acid in early pregnancy, it is amount of iron during pregnancy. Usually, recommended to choose a multivitamin half of the needed iron is from food and product containing 0.4 mg of folic acid. the other half from the mother’s iron re- Women are recommended to begin taking serves or from iron supplements. The need a folic acid supplement at the time when for iron supplements is individually as- they stop using birth control or, at the lat- sessed at the prenatal clinic. est, at the start of the menstrual period af- Calcium is necessary for the develop- ter which they are hoping to become preg- ment of the baby’s bones. The calcium in- nant. The recommendation is to continue take of most women is sufficient. If your to take a folic acid supplement until week diet does not include any dairy products, 12+0 of the pregnancy. More information you need to take calcium supplements. If on the recommendations on folic acid sup- the need for calcium is satisfied by supple- plements is available in Finnish in the Min- ments only, the daily dose is 1000 mg. Cal- istry of Social Affairs and Health publica- cium and iron supplements should be tak- tion ‘The Child, Family and Food’ (Lapsi, en at different times. perhe ja ruoka STM Julkaisuja 2004:11: pp.76-77; http://www.stm.fi/c/document_ Dental care and fluoride library/get_file?folderId=28707&name=DL Pregnant women should take extra care of FE-3555.pdf&title=Lapsi__perhe_ja_ruo- their teeth. This is important for both the ka_fi.pdf). mother and the baby, as tooth develop- The need for iron multiplies during mentstarts while the foetus is in the womb.

16 Pregnancy For teeth, the most important mineral is Smoking fluorine. Fluorinated toothpaste strength- Smoking is harmful for both the mother ens the teeth when used daily. When nec- and the baby. Cigarette smoke often caus- essary, the dentist might recommend fluo- es nausea in expectant mothers. The nico- ride tablets. Health care centres arrange tine and carbon monoxide in the smoke dental care for pregnant women. u are absorbed into the mother’s blood and transfer via the placenta into the foetus. Note! For the sake of the child’s health as well as for the sake of their own health, both parents should give up Risk factors smoking at the early stages of pregnancy, if not before.

Infections They also impair the normal functioning of During pregnancy, it is especially impor- the placenta. tant to avoid infections that could be Nicotine levels are higher in the foetus harmful to the foetus. The risk of infection than in the mother. Babies born to smok- can be considerably reduced by carefully ers have low birth weight and are restless following the protective instructions. Tox- and irritable more often than those born to oplasmosis is a parasitic infection that can non-smokers. Smoking during pregnancy be passed on from cats, guinea pigs and may have harmful effects on the develop- laboratory animals. To prevent infection, ment of the brain and lungs, and also in- avoid contact with cat litter trays or soil creases the risk of infection after birth. that may have been fouled by cats or other Support for giving up smoking is avail- animals. Do not let the cat sleep in your able from the prenatal clinic and through bed. the Internet (www.stumppi.fi). Nicotine For pregnant women, listeria is a dan- replacement products other than the patch gerous bacteria found in food products. can be used, if necessary. The best way to avoid listeriosis is by washing your hands thoroughly after han- Alcohol dling meat, and storing raw meat away Alcohol causes foetal damage. When a from cooked food. Follow the instructions pregnant woman drinks alcohol, so does when heating processed foods and frozen her foetus, because alcohol passes through vegetables. Fresh vegetables should be the placenta and travels via the umbilical carefully rinsed. Avoid vacuum-packed cord into the foetus. The blood alcohol lev- cold-smoked and raw-cured fish products, el can be higher in the foetus than in the blue cheese, cream cheeses, and cheeses mother. made from unpasteurised milk. Sexually transmitted diseases and in- Note! Pregnant and breastfeeding wo fections can be prevented by using a con- men should avoid alcohol completely to dom. prevent its harmful effects.

Pregnancy 17 Binge drinking (consuming large quan- Drug abusers often neglect their own well- tities of alcoholic beverages) is particularly being, are in bad physical condition, and dangerous for the foetus. The body parts suffer from malnutrition and infections. All and organs develop during the first trimes- of these pose particular risk during preg- ter (the first three months of pregnancy), nancy. The newborn may suffer from with- and a dangerous drinking pattern during drawal symptoms and later defects. If the the first trimester can result in foetal mal- expectant mother is a substance abuser formations, e.g. a congenital heart defect. (drugs or alcohol), she should seek help as Excessive alcohol use should be avoided soon as possible. The prenatal cclinic will whenever there is a possibility of pregnan- assist in finding appropriate support. cy. Pregnant women should avoid alcohol Huumeambulanssi ry (www.huume completely. ambulanssi.fi) is an organisation providing Alcohol slows down foetal growth support and advice on substance abuse throughout the pregnancy and may result and assists people in finding help. The hel- in low birth weight. The foetal central pline service at (09) 278 7727 is available nervous system (CNS) is very vulnerable, from Monday to Thursday 5 pm to 12 am, and at worst the baby may suffer from and at weekends from Friday 6 pm to Sun- mental retardation. Alcohol-related foetal day 12 am. defects may cause problems associated Irti Huumeista ry (www.irtihuumeista. with attention span, learning, and linguis- fi) is a non-governmental organisation tic development. that provides information on drugs and There is no safe amount of alcohol that drug addiction and their effects on the a woman can drink while pregnant. Exces- substance abuser and his or her family. The sive alcohol consumption during pregnan- organisation provides advice, support and cy increases the risk of miscarriage. Other information by phone and email. The Na- risks include malfunctions of the placenta, tional Drug Service line (0203 22388) bleeding and the resulting infections, and maintained by the organisation is available the premature detachment of the placenta. Mon-Fri from 9 am to 3 pm and 6 pm to 9 Caesarean sections (C-sections) are more pm. common among heavy drinkers. There are several sources of support Medication and advice on giving up alcohol, such as Do not take any medications or natural the prenatal clinic, the A-Clinic Founda- health products during pregnancy without tion (www.a-klinikka.fi, tel. [09] 6220 290) first consulting a doctor or nurse. Further and Alcoholics Anonymous (www.suome- information on the effects of drugs on the naa.fi). foetus is provided by the Teratology Infor- mation Service of the Hospital District of Illegal drugs Helsinki and Uusimaa, available Mon-Fri 9 All drugs pass through the placenta into am - 12 pm (tel. [09] 471 76500). The Tera- the foetus. Drugs restrict the growth of the tology Information Service is a national baby and may cause premature detach- freephone helpline aimed at preventing ment of the placenta and premature birth. foetal defects. The helpline also provides

18 Pregnancy information on infections, radiation and Motorcycling is not recommended for other external risk factors during pregnan- pregnant women. Travelling by planes that cy and breastfeeding. are not pressurised may cause the foetus to suffer from oxygen deficiency. Airlines Travelling have strict rules regarding travelling and Wearing a seatbelt is compulsory, also in pregnancy. It is advisable to check with the back seat. Towards the end of pregnan- your airline restrictions they impose for cy, wearing a seatbelt might feel uncom- long-haul flights.u fortable, but it is essential for the safety of the mother and the baby in case of accident. If you will be travelling long distan- ces by car, be prepared to stop every few hours for a quick stroll to stretch the legs.

Exercise and fitness

Get as much exercise and fresh air as possible during pregnancy. When the mother is in good physical condition, this will contribute to the healthy development of the baby. Usually, the mother will be able to THE MOTHER’S FITNESS CONTRIBUTES TO THE remain physically active throughout most of the pregnancy. BABY’S HEALTH AND DEVELOPMENT During pregnancy your ligaments will loosen and your centre of gravity will move forward, which may cause backache. Be sensitive to your body’s reactions and work is excellent exercise, but strenuous modify your exercise accordingly. It is ad- chores, such as washing rugs and moving visable to avoid activities involving leaps, furniture, increase contractions and in- stretching and other sudden movements. crease the risk of miscarriage. Ask the pre- It might be wise to avoid swimming in natal clinic for exercise instructions. The cold water, because of the risk of infections training programmes of pregnant athletes and contractions. Walking is an ideal daily should always be prepared in close co-op- activity during pregnancy. Light house- eration with a doctor. u

Pregnancy 19 Preparing for parenthood

Having a baby will affect family life Having a baby is an enormous change for First-time parents are often unaware of all members of the family. Pregnancy is the the complete change in life and routines time to prepare: hormonal and physical that having a baby brings. The new baby changes help the mother adjust to the will demand the parents’ full attention. All coming change. For the dads, one way of thoughts, talk and actions will revolve preparing is to support the mum and focus around the baby. You will therefore need to on her experiences and feelings. The prepare as much as possible for the baby mothers are, in turn, encouraged to share during pregnancy. Make room for the baby their feelings and experiences with their in your home and buy or borrow all of the partners and to encourage the dad-to-be basic things that the baby will need, such to put his hand on her tummy to feel the as clothes and a cot or crib. Think about movements of the baby. how you want to arrange day care. Preg-

20 Pregnancy nancy is also the time to prepare mentally and feelings; processing your thoughts and for the coming life change. However, it is feelings is all part of becoming a parent. not possible to be prepared for everything – some things will always come as a sur- Becoming a mother prise! Becoming a parent brings a long- For many women, pregnancy is a wonder- term responsibility to care for your baby. ful and cherished time without any nega- Having worries or fears about the baby tive experiences or complications. The ba- and how you are going to cope is perfectly by grows in the safety of the womb and normal. Yet, having a baby is one of the the mother can continue with her normal most natural and richly rewarding experi- activities. However, as a mother, you will ences life can bring. Having an open mind need to review some of your choices and will help in solving many questions and habits concerning food, drink, exercise and problems during pregnancy and after the rest. You will start seeing things from a new baby is born. perspective now that you are also responsible for the well-being and healthy devel- Fears and concerns opment of your unborn baby (see ”Preg- During pregnancy the parents may be nancy and well-being” on page 6). worried about many different things: Will the child be healthy? How will I know Mood swings how to take care of a baby? What to do Hormonal changes can bring about severe when the baby cries? Will I make a good mood swings in the mother, causing her to mum/dad? Will I love my child? How will become exceptionally emotional, tearful or we manage financially? A single parent sensitive. The first pregnancy is especially might also worry about being ”shorthand- testing. The pregnant mother needs to be ed” and how she will manage alone with assured and reassured that her partner still the baby. loves and supports her. The developing ba- Even when the pregnancy has been by exhausts the mother’s energy resources, planned, it is quite common that the par- and she will need a lot of rest. However, ents have second thoughts at some point. pregnancy is a natural condition, not an ill- You may be overwhelmed by the thought ness. Sharing your thoughts and feelings of being responsible for the life of another with your partner and other close friends human being and wish you could just can- will help. cel the whole thing. These feelings are very common and Physical changes they will pass in time. The female body goes through tremen- Find someone who dous changes during pregnancy. Skin and you can share your other tissues are stretched to their limits. fears and concerns Breasts usually grow during pregnancy by with. Remember at least one cup size, and the pelvis that there is no spreads. The body acquires a feminine need to feel guilty softness and lustre - the characteristic about such thoughts “glow” of the expectant mother. The centre

Pregnancy 21 tional. If the dad-to-be is aware of the hormonal changes and other pregnancy-related changes, it will be easier to understand the pregnant mother. Attending an ultrasound scan is just as important for the father as it is for the mother: they will both see their baby for the first time. The father may also have questions and doubts about the life ahead of him. Men often wonder if they will be good fathers and a good example to their children, and how the family will cope financially in the new situation. The responsibility may feel overwhelming. Some men may feel the need to savour their ‘freedom’ for as long as possible. It is recommended that the dads-to-be share their feelings with other prospective fathers or experienced dads.

Support networks For the mother, late pregnancy, childbirth and maternity leave constitute a time of gravity changes as pregnancy progress- when socialising with colleagues and es and this will affect balance. The changes friends decreases. Nursing and caring for are great, but they happen slowly as preg- the baby at home may make the mother nancy progresses. Your general mood de- feel isolated, especially if there are no oth- pends greatly on how well you will be able er mothers with babies in the neighbour- to accept these inevitable changes. The fa- hood or among her friends. Fathers on ther can be a huge support during this long-term parental leave may also en- time by complimenting the mother on her counter similar feelings of isolation. Since growing tummy and appearance and by there is less contact with other adults than enjoying together the changes that take before, great expectations fall on the part- place as the pregnancy advances. ner to listen and provide companionship. Start building your social network al- Pregnancy and the father ready during pregnancy and actively seek Pregnancy and having a baby are demand- to make friends with people in the same ing for the father as well. He is expected to situation, e.g. with the parents in your an- be supportive and understanding. During tenatal class. Maternity and parental leave the very early pregnancy, in particular, it provide a chance to make new friends. can sometimes be difficult to understand Find peer support in parenting clubs, par- why the mother is becoming so and emo- ent nights and family cafeterias organised

22 Pregnancy by the municipalities, church and the Mannerheim League for Child Welfare MOTHERS NEED SPECIAL ATTENTION (MLL). You can meet other parents with AND SUPPORT DURING PREGNANCY . young children in parks, playgrounds and open day care centres. page 90). Single parents will find peer sup- Mothers, particularly single mothers, port from the association for single parents need special attention and support during (visit ”Yksin- ja yhteishuoltajien liitto” at pregnancy. In addition to friends and rela- www.yyl.fi). If you are pregnant without a tives, the prenatal clinic’s nurse, a social partner, you can invite a doula (a trained worker and health care centre psychologist support person) to attend the birth. For are available to provide support. You can more information, please visit the Federa- also contact helplines, the child guidance tion of Mother and Child Homes and and family counselling centre, or the Shelters’ site at www.ensijaturvakotienliit- church’s family guidance centres (see to.fi. For contact details type ”doula” in the ”Services for families with children” on- search field. u Relationship with your partner

Cherish the love you have Housework Having a good, loving relationship with Couples without children generally split your partner is one of the most important housework evenly without argument, but and rewarding things in life. in families with young children housework Such a relationship does not just hap- is a major source of disagreement. House- pen on its own, though. Firstly, to be able work is the responsibility of each and eve- to love another, you need to accept and ry family member; it should not be consid- love yourself. Secondly, a good relation- ered as ”helping mum”. If not before, dur- ship must be nurtured: be caring and at- ing pregnancy all family members should tentive, show affection, listen and interact. participate in housework – not just the At best, pregnancy can be a shared experi- parents but the older children as well. ence that strengthens your relationship Dad’s share of housework increases and enhances the feminine and masculine during pregnancy, especially if the mother traits of both parents. On the other hand, is suffering with contractions. During late unpleasantness, insults and unfair behav- pregnancy, the mother should avoid phys- iour during pregnancy will be forever re- ical strain, such as lifting heavy objects. membered unless they are talked through During the first week after birth, the and forgiven. baby needs round-the-clock attention.

Pregnancy 23 If all housework is left to the mother, she will become over-exhausted.

Sharing your feelings In a good relationship, you can openly share everything that is on your mind: joys, sorrows, concerns, fears, hopes and dreams. Sharing your feelings and thoughts is not always easy and requires practice.

The following advice might be helpful: 1) Listen to what your partner is saying. What is he/she feeling? What is his/her intention? Try not to take immediate offence. Was what he/she said actually intended to offend, or was it just worded a bit clumsily? 2) The individual is the best judge of his/ IF HOUSEWORK IS LEFT ONLY TO THE MOTHER, her own feelings. If your partner says SHE WILL BECOME OVER-EXHAUSTED he/she is afraid or troubled, don’t tell him/her that there is nothing to be afraid of. Rather, ask what it is specifi- 4) Respect each other. cally he/she is afraid of. Allow you part- Never say things that you know are the ner to have the feelings he/she is expe- most hurtful to your partner, even riencing and say, for example, ”You when angry. must have felt terrible when you were 5) Digging up past faults is easy to do, but being got at by your boss” etc. is poisonous to your relationship. 3) Tell your partner how you feel. If you Learn to forgive and forget. are angry, say ”Having to clean up after you makes me angry”, for example. Try Pregnancy and sexuality not to blame your partner, and avoid Pregnancy may change the way you feel the word ”always” in phrases such as about sex in one way or another. Nausea, ”You are always so careless”. If you fatigue and breast tenderness during early want something, state it clearly. For ex- pregnancy may cause your desires to de- ample, ”Could you vacuum the house?” cline. However, you might find that the lit- (instead of ”You never do anything”). tle secret you are carrying makes sex during

24 Pregnancy early pregnancy thrilling in a new way. you are feeling unusually emotional. Hav- For many expectant mothers, the se- ing a satisfactory sex life in your relation- cond trimester is a sexually fulfilling time. ship is a shared responsibility – it takes The increased blood flow to the vagina two to tango! causes a feeling of fullness and heightened sensitivity. During this time, it is not un- Abuse is unacceptable common for women to masturbate more It is good to be an understanding partner, than ever before. For many women, this is but there are limits as to what should be a peak erotic time in their life. tolerated. Physical and mental abuse are Many men enjoy their sexually more crimes against another person and should active partner. However, the new situation not be tolerated. Heavy blows to the area is likely to be confusing for the man as of the abdomen may damage the womb well. He might worry about harming the and the foetus. At worst, this may cause unborn child and avoid situations that will the pregnancy to terminate. If you are be- lead to sex. A normal pregnancy does not ing abused, turn to your neighbours or prevent the couple from having sex. friends for help, or call the police, social During late pregnancy, many women services or a mother and child shelter. feel awkward and sexually unattractive, Sometimes the first priority is to remove while others enjoy sex right up to birth. yourself from the abusive partner into a Remember that sexual intercourse is just safe environment. one aspect of sexuality. During this time The emergency phone number is 112. when your shared life is taking on new The Emergency Response Centre staff will forms,, maintain intimacy and affection by tell you what you need to do and will alert saying and doing things you know will the necessary authorities. For the Police, give pleasure to your partner. dial 10022. Girls and women who have ex- After the child is born, there will be a perienced violence or the threat of vio- period when your sex life will have to be lence can receive help from the National on hold. The parents can decide the length Women’s Line in Finland (www.naisten- of that period, but it is recommended to linja.com) by calling the national tele- put off sex for a couple of weeks, until the phone helpline (tel. 0800 02400). Help for vaginal discharge ends. However, there is men in finding an alternative to intimate no need to refrain from showing affection! partner violence is provided by the Hugs, caresses, kisses and nice words are ”Lyömätön Linja” organisation. If you need especially important when your means of help, call tel. (09) 612 66 212, or email ly- expressing your sexuality are limited and [email protected]

Pregnancy 25 Antenatal care in theprenatal clinics

Antenatal care is provided by prenatal clinics to maintain the good health of the expectant mother and the unborn child, to promote a healthy lifestyle for the whole family and to help the family prepare for the new baby. The aims of antenatal care include promoting the well-being and good health of the prospective parents, supporting the parents in their growth towards parenthood and family life, and providing tools for pre- pression, or is having a multiple pregnancy. venting and solving possible problems in Care during pregnancy and childbirth is re- their relationship. In particular, support is alised in close collaboration between the needed in families expecting their first ba- prenatal clinics and the hospital maternity by. The prenatal clinics are organised unit. around the whole family, not just the A nurse or midwife and a doctor work mother. Dads receive support in their per- at the prenatal clinic. Antenatal care in- sonal growth towards becoming fathers cludes physical examinations, screening and advice on a healthy lifestyle and how tests, personal guidance and antenatal to best support the mother. Additional classes. Your nurse or midwife may also support and advice is also provided by on- visit you at home. During the course of a line clinics. normal pregnancy, the expectant mother Antenatal care monitors possible prob- makes 12 to 15 visits to the prenatal clinic. lems during pregnancy, takes action to Of these, 2 to 3 are doctor’s appointments. prevent them and refers the mother for Most health care centres offer ultrasound further examinations and treatment in scans at 12 to 16 weeks. The services of a hospital, if necessary. The prenatal clinics psychologist, a nutritional therapist, a and hospital maternity units also support physiotherapist and a social worker are al- the family if and when the mother has so available for families. fears relating to childbirth, suffers from de-

26 Pregnancy First visit The mother’s overall health and possible testing. Topics concerning pregnancy, risk factors are assessed at the prenatal childbirth and parenting are discussed clinic through examinations and a person- with both the mother and father during al interview. A blood sample is taken at the follow-up visits. the first appointment to determine your blood group, Rhesus factor and blood It is recommended that the expectant haemoglobin concentration. The sample mother pays attention to the baby’s will also be tested to rule out syphilis. A movements, especially in late pregnan- urine sample is tested for sugar levels, cy. If you are worried about the well- protein and bacteria. The expectant moth- being of you or your baby, share your er will be weighed, her height measured concerns with your nurse or doctor. You and her blood pressure checked. With the can discuss, in complete confidence, is- mother’s permission, the blood sample sues concerning pregnancy, including can also be tested for HIV antibodies and depression, family problems and fears hepatitis. Visits to the prenatal clinic al- with the doctors and nurses at the pre- ways include personal discussions and ad- natal clinic. If necessary, further support vice. is available through social workers, Your doctor will perform an internal psychologists and specialists. examination at the first appointment to determine the position of the womb and check that the size of the uterus corre- Intensive antenatal care sponds to the pregnancy weeks. Some expectant mothers receive intensive antenatal care in, for example, the follow- Follow-up visits ing situations: Follow-up appointments at the prenatal u when the mother suffers from clinic are at early pregnancy every four prolonged or chronic diseases, weeks, every two weeks from week 28, and u multiple pregnancy, once a week from week 35. u mother having first baby at a very During each visit, the mother is young or relatively old age, weighed, her blood pressure is taken and u raised blood pressure and protein her urine is tested for sugar. Blood haemo- found in urine (signs of pre-eclampsia, globin is determined at least three times a condition requiring doctor’s during pregnancy. The average weekly attention), weight gain is determined to ensure the u itching or yellow skin pregnancy is progressing normally. Swell- (signs of hepatosis gravidarum), ing is monitored, if present. Foetal heart- u certain inflammatory diseases at beat will be monitored at each visit and the the beginning of pregnancy, baby’s position will determined by external u birth canal infections. examination. If the need arises, the exam- ining doctor or nurse will refer the mother to the hospital maternity unit for further

Pregnancy 27 The majority of babies born in Finland normality is only found in a small percent- are healthy. This is mostly due to the age of pregnancies, it is important that the good health of Finnish women and the parents-to-be discuss the risk of such a re- regular visits to the prenatal clinic and sult and how they will feel about any fur- maternity unit where the health and ther tests, and about continuing the preg- well-being of the mother and baby are nancy and having a child with a dis-ability, closely monitored. or about terminating the pregnancy. The early pregnancy ultrasound scan is performed at weeks 10+0–13+6, either ex- Screening programmes for chromo- ternally or internally. The primary purpose somal and structural anomalies of this scan is to confirm the weeks of ges- In compliance with a national screening tation and to verify the number of foetus- programme, all Finnish municipalities are es. Structural abnormalities may be re- now (as of 2010) required to offer their res- vealed by the scan. idents screenings to determine foetal chro- The risk of chromosome abnormalities mosome abnormalities and severe struc- can be assessed by performing an early tural abnormalities (the Government De- pregnancy combined screening. The blood cree on Screenings (1339/2006) and test needed for early pregnancy serum amendments to it, http://finohta.stakes.fi/ screening is taken at weeks 9+0–11+6, and FI/sikioseulonnat/index.htm). Additional the NT scan (nuchal translucency scan) of tests offered include ultrasound scans and the foetus is carried out at the same time tests on maternal serum, as well as tests on as the early pregnancy general ultrasound the amniotic fluid and the placenta, all of scan, in week 11+0–13+6 of the pregnancy. which are voluntary. The pregnant woman If the first prenatal clinic appointment is decides whether or not she wants to un- after week 11+6, a blood test may be of- dertake the screening tests and any addi- fered as an alternative, for use in the sec- tional tests. She also decides which screen- ond trimester serum screening in week ing programme she wishes to take part in. 15+0–16+6. However, the second trimester Screening tests are performed to de- serum screening is not as reliable in the tect any increased risk of disease or disa- assessment of the risk of chromosomal ab- bility or other health problems, so that the normalities as the early pregnancy com- birth and aftercare of the newborn can be bined screening. The results from screen- planned well in advance. The vast majori- ing tests for chromosomal abnormalities ty of babies develop normally without se- and data on factors such as the duration of vere injury or disease. the pregnancy and the mother’s age are A screening result that indicates an in- added up in a special calculation pro- creased risk does not necessarily mean gramme to yield a risk factor, which indi- that the baby will be born with a disability cates the probability for chromosomal ab- or disease. Furthermore, not all conditions normality in the foetus. The probability show up in screenings, and no test can that the foetus has a specific abnormality is guarantee that the child will be healthy. given as a ratio, for example 1:100, 1:250, Although an increased risk of foetal ab- 1:1000 etc. If the probability of chromo-

28 Pregnancy somal abnormality is greater than the risk Usually there are 4 to 5 meetings, some of limits set, the pregnant woman is offered them preferably after the baby is born. The further tests where the foetal chromo- antenatal classes are usually held by a somes can be tested through placental nurse or some other health care profes- tests or amniocentesis. Examinations are sional, and the topics covered include voluntary and carry a slight risk of causing what happens during labour and how to a miscarriage (at most 1 out of every 100 prepare for it, breastfeeding and caring for pregnancies). the newborn. Antenatal classes provide a Many municipalities offer amniocen- chance to learn how to care for the baby, tesis or placental tests to women over 40 to discuss changes in daily routines when without the preliminary screenings, as the there is a new baby in the house, to talk risk of chromosomal abnormalities in- about parenthood and relationships with creases with age. other prospective parents, and to learn The second ultrasound scan is a more about the services and benefits available detailed scan called a fetal structural sur- for families with children. Antenatal class- vey, the baby’s major organs and skeleton es often include a visit to the hospital ma- are checked for severe structural abnor- ternity unit. malities in week 18+0–21+6, or alternatively after week 24+0. At this time, the Prenatal clinics and dads number of foetuses and their status is also Dads are welcome to attend each appoint- checked, and the duration of pregnancy, ment as well as the antenatal classes. the amount of amniotic fluid, and the po- Dads bring the male perspective into the sition and condition of the placenta are pregnancy discussion. The child will be- verified. The mother may be accompanied come attached to both the mother and the to each scan by the father or some another father, so it is only natural that parenting support person. Pregnancy can be termi- is shared. A child needs the support and nated up until the end of week 24 (24+0) assurance of both mum and dad for his/ by permission of the National Supervisory her development. Shared parenting re- Authority for Welfare and Health (Valvira) sponsibility gives dad a chance to realise if the foetus has been reliably tested to himself in new ways, while mum can have have a severe disease or structural anoma- some private time on her own. When both ly. parents participate in caring for the chil- Guides for parents on the screening dren, the relationship tends to be happier. tests are available at http://finohta.stakes. However, as much as the dad might wish fi/FI/sikioseulonnat/index.htm. to be a caring and actively participating father, it is not always easy; changing your Antenatal classes lifestyle and starting to live on the baby’s Every prenatal clinic organises antenatal terms may be difficult. classes to prepare the prospective parents Prenatal clinics help mums and dads for labour, childbirth and parenthood. It is form a positive yet realistic picture of life recommended that you attend your first with a new baby. The clinics strive to pro- antenatal class during weeks 20 to 30. mote the mother’s and father’s commit-

Pregnancy 29 ment to caring for the baby. Prenatal clinics Many prenatal clinics organise meetings for also accommodate the men’s views and just the dads where they can share their ex- needs as parents. Dads are advised on how periences with other men in the same situ- they can best support their partners during ation. When the nurse comes to meet you labour and how they can participate in ca- at home, schedule it so that the father will ring for the baby. be present as well. u Pregnancy at work and at home The Older siblings and jealousy If the baby is not the first child in the fam- our baby, and mummy and daddy will love ily, it is a good idea to start preparing the you and the baby just as much.” other children for the new baby in advance. The age of the child dictates when Older children to tell about the baby: immediately when For children over 10 years, the idea of a the pregnancy has been confirmed, or lat- new baby may be very difficult to accept. er when the pregnancy clearly begins to They might have thought that ”my mum show in the mother’s body, for example. and dad don’t have sex”. The older chil- Regardless of the moment, pregnancy will dren might also be uneasy about their sta- last for a long time from the child’s per- tus and fear losing their parents to the ba- spective. However, the child should first by. In such a situation, some children hear about the pregnancy from his/her freeze completely while others begin to own parents, not from other people. exhibit problem behaviour. Talk with your For a first born, having a new baby in children about their feelings, expectations the family is a huge experience and can and fears. Sometimes, talking with a friend cause envy and jealousy. These feelings will of the family or a health care professional pass sooner if the older sibling is invited to or social worker can help both the child participate in caring for the baby. If the and the parents. child’s cot or other items are to be handed down to the baby, this should be done well Sort your priorities in advance before the baby moves in. When The new baby drains energy from the the child asks you a question, try to give a whole family during pregnancy and espe- simple and straightforward answer. If the cially in the first weeks after birth. Think in first child is very young, you can say, for ex- advance what is important and what can ample, that ”Daddy gave mummy a baby wait until later. The well-being of the seed and now there is a little baby growing mother is a prerequisite for the well-being in mummy’s tummy. When the baby is and healthy development of the baby. ready, he or she will come out through a Work, cleaning, guests and travel can wait special opening (different from the ones for – the baby cannot. When the parents get pee-pee and poo-poo) and the baby will be enough rest, they will be able to better

30 Pregnancy enjoy and care for the baby. It is recommended that you begin your maternity leave at least a month before the expected date of delivery. Remember, giving birth demands more energy than running a marathon!

Risks at work The superiors of expectant mothers are responsible for ensuring safe working condi- Infectious diseases and vaccinations tions and methods. A pregnant woman is If a pregnant woman has never had the entitled to request being transferred to common pox diseases or been vaccinated other jobs if the working environment against them, she might become infected poses risks such as chemical substances, when working with children. If you have radiation or infectious diseases. If this is never had chicken pox, you should be vac- not possible, the mother can apply for spe- cinated against it before becoming preg- cial maternity allowance from the Social nant. Avoid contact with people with an Insurance Institution (KELA) to begin ma- active virus. Pregnancy should be taken in- ternity leave at an earlier date. to account when dividing the daily tasks Pregnant women should not do jobs in, for example, infectious disease depart- involving exposure to radiation (e.g. X- ments in hospitals. rays). They should also avoid physical If you work in the health care sector, strain, such as lifting or moving heavy ob- you might become infected with hepatitis jects. According to current knowledge, B or HIV via the blood or excretions of in- working by a computer monitor and using fected patients. In the cleaning business, physical therapy equipment do not pose a syringes and needles in waste bags may radiation risk. If your job involves coming present a risk. Usually, a biohazard does into contact with anaesthetic gases, lead, not exist unless the patient’s blood comes mercury, cytostatic agents, carbon monox- into contact with the worker’s circulation ide or carcinogens (cancer-causing sub- via a wound or a needle prick. Reduce the stances), consult your occupational health risk by wearing protective gloves, using care representative to ensure the safety of disposable instruments and avoiding your working environment. mouth pipetting in the laboratory. There is Pregnant women should also carefully a risk of cytomegalovirus infection if you investigate any social risks relating to are working in an institution where you parental leaves, discuss the statutory rights come into contact with infant excreta. and benefits with their superiors and have Pregnant women should be removed from a preliminary discussion about returning to these environments. However, for most in- work from maternity leave (see ”Benefits fections, it is sufficient to be aware of the for families with children” on page 99). risks and to protect yourself adequately. u

Pregnancy 31 What does a baby need?

Learn the policies and procedures in use at your workplace. Discuss risks and biohazards with your superior, occupational health care services, or occupational safety personnel.

Maternity package The Finnish maternity package delivered free of charge to expecting mothers is the only one of its kind in the world. The maternity package is a complete baby gear but please note that the service is only ”starter pack”. The pack includes useful, available in Finnish and Swedish. You can high-quality clothes and other necessary claim your maternity package from KELA items. Pregnant women must apply for the or retrieve it from the post office a few maternity package from the Social Insur- months before the estimated date of deliv- ance Institution (KELA). The application ery (see ”Maternity grant” on page 99). can be sent together with the application The contents of the maternity package for maternity allowance. Another alterna- and the fabrics for clothes and bed linen tive is to fill in an online application at change from time to time, but there are no www.kela.fi/asiointi. You can log yourself major changes. in with Finnish banks’ net bank user IDs, The clothes come in different sizes (60 to 70 cm). A newborn is about 50 cm. If the

The package contains: (For photos of the contents, please visit www.kela.fi). u Baby wear: wrap-tops, body suits, u Baby care: mattress, mattress protector, trousers, jumpsuits, top and trousers set, hairbrush, disposable nappies, toothbrush, baby hats, socks, mittens, overalls, warm nail clippers, bath water thermometer, booties, padded mittens, pramsuit basic lotion, bib, book, toy u Linens, towels, nappies: terry u Other: sanitary pads, condoms, nappies,cloth nappy set, bath towel, sheet, bra pads, lubricant lotion, and pamphlets blanket cover, blanket,sleeping bag (turns on: relationships, breastfeeding, nutrition, into a padded blanket) cloth nappies, and safety while travelling

32 Pregnancy suit sleeves or legs are too long, shorten used by several babies. them temporarily by sowing folds on the Remember that the baby does not outside or tying a knot at the end of very need massive amounts of toys, equipment long legs. You can also shorten pant legs and clothing. As a rule of thumb, have by using socks or booties. three pieces of everyday clothing, such as jumpsuits and body suits: “one for wear- Somewhere to sleep ing, one for the wash, and one for drying” The maternity package comes in a box As for other clothes, such as hats and over- that is designed to double as a baby basket clothes, three is often too many. However, when it is lined with fabric (e.g. a sheet). if washing clothes is not easily accom- Use of a dark red fabric provides a sooth- plished, it is wise to have several pieces of ing colour that reminds the baby of the clothing, since babies tend to use at least womb. At first, the baby can also sleep in a one outfit per day. The first year is a time of crib, carrycot, basket or other baby bed. A rapid growth, and your child will quickly cot with bars will be necessary by the time grow into and out of clothes. A 1-year-old the baby starts turning and moving child is 73 to 80 cm and weighs 10 to 12 kg. around and the previous sleeping ar- The essential bigger purchases for the rangement is no longer safe. When the baby include a tub, a pram and a car safety child is 1.5 to 2 years old, he/she will be seat, if the family travels by car. Use the able to climb out of the cot. At this time, carrycot that fits inside the pram to trans- the child can start sleeping in a children’s port the baby if the pram does not fit in- bed. side the house or cannot be pushed all the way to the front door. When buying prams, Acquiring and storing baby gear pay attention to safety, durability and size In addition to the maternity package, it is (will it fit into the lift?). Most modern ad- advisable to acquire additional clothes ditional features, such as air conditioning, and linens, if possible, since babies tend have little effect on the well-being of the to use up clothes quickly. It is not neces- baby. If it is possible to sleep the baby on a sary to buy all items new; charity and sec- balcony, you can get a used pram in good ond-hand shops sell baby wear and gear condition at a very reasonable price to at reduced prices, and you can also look keep on the balcony. for baby gear for sale in local newspapers, A couple of shelves or drawers is market notice boards as well as from on- enough space for storing the baby’s clothes. line auctions and second-hand shops. It is It is possible to change nappies whilst also relatively simple to make bed linen holding the baby in your lap, but in many yourself, or friends, relatives and neigh- cases a proper changing mat or changing bours may be willing to lend you some top can be very useful (see ”A place for items. There are also national organisa- changing” on page 57). A baby carrier, sling tions that lend baby gear, such as the and baby sitter allow you to keep your Mannerheim League for Child Welfare hands free. Baby carriers and slings are er- (MLL) and Folkhälsan. Recycling is bene- gonomically designed for the comfort of ficial, since most clothes and items can be both the mother and the baby. u

Pregnancy 33 Preparing for birth

Antenatal classes Preparing for birth is one of the topics covered in antenatal classes, with the aim of providing both the mother and the father with information and guidance on birth and delivery so that when the time comes they will be able to make informed decisions. Being prepared both physically and mentally will help the mother stay in control of the situation during delivery. It is important that the mother feels in control, and that the baby’s birth is as positive an experience as possible. In order to be able to function as effec- tively as possible during labour and delivery, both parents must be familiar with the three stages of labour, the standard labour and delivery procedures involved, and the How to plan in advance recommended breathing and relaxation In recent years, the emphasis has been techniques and pain control options. La- placed on the fact that birth is a natural bour, as the name implies, is hard work and event. Hospital maternity unit staff aim to requires a great deal of mental and physical create a calm and comfortable atmosphere energy. Being able to relax between and for the family, and provide the mother during contractions conserves the mother’s with sufficient space to focus on the deliv- strength. Preparing for birth in advance ery. In many units, a member of staff will usually eases the delivery process. hold a discussion with the parents before- It is not always possible for the father hand on their thoughts and wishes related to attend the birth and, when this is possi- to the oncoming birth. This discussion is ble, it is ultimately the father’s own choice. then continued during labour when con- Alternatively, the mother can also have sidering the available options and proce- some other person as a companion, a close dures that might assist in the delivery. Be- friend, a relative or a doula (a person ing prepared is important, but it should be trained in labour support), for example. borne in mind that giving birth is always a Whatever the decision, it should be made unique experience and that the parents as early as possible.

34 The birth will be facing issues that cannot be consid- baby being born describe it as one of the ered in advance, but must be decided upon finest moments of their lives. as the situation arises. Maternity units are equipped with dif- Anticipating the delivery method ferent kinds of birth stools and rocking Most babies (85%) are vaginally delivered chairs, birth pools and deep baths. The in a head down position. Presentation is mother can decide which of the available assessed prior to birth, but cannot be abso- options she is willing to use, while the care lutely determined as the situation can may personnel will assist and give advice on change quickly. It may become necessary suitable alternatives. The mother is free to to induce labour, or there might be com- move around during labour and has the plications requiring specific procedures right to decide on the position most suitable for delivery. Alternative forms of pain THE PRESENCE OF A CLOSE COMPANION relief are also discussed with the mother. IS A COMFORT TO THE MOTHER

Father’s role during labour. Intervention is required in It is the role of the father (or some other approximately 15% of births. Intervention companion) to support, encourage and methods include Caesarean section (C- rally the mother during labour. Giving section), vacuum extraction, forceps and birth usually takes several hours, and sup- assisted breech birth. port and encouragement is much needed. In approximately 3 percent of deliver- Some very concrete supportive measures ies, the baby is in the breech position (the include, for example, massaging the moth- baby is head up instead of head down). A er’s aching back, fetching something to breech position (or any other abnormal drink, wiping away sweat and helping the presentation) is usually detected at the mother to relax. The presence of a close prenatal clinic. You may be referred to the companion is a comfort to the mother and hospital, where a doctor will try to turn the helps her keep her spirits up. baby from the breech position to a head- Furthermore, this shared experience down position. This procedure is also often strengthens the relationship. called external cephalic version. However, When the father has witnessed the if this is not successful and the baby re- birth of his own child, the relationship be- mains in the breech position, the final de- tween the father and the child forms im- cision on the delivery method is made af- mediately when the baby is lying on its ter a thorough check at the hospital mater- mother’s chest, seeking contact with its nity unit, where the baby’s size and mot- parents. A strong bond is created when the her’s pelvic dimensions are carefully meas- baby first opens its eyes and makes eye ured. A baby in the breech position is often contact with the faces close by. Some fa- born by caesarean section (C-section), es- thers find they feel a stronger sense of pecially when it is the mother’s first deliv- closeness - as if the baby was more their ery, the mother has had previous caesa- ”own” - when they have been present dur- rean sections or when the baby is ing the birth. Fathers who have seen their premature.

The birth 35 deliveries” have become possible, although they are still quite rare. In a polyclinic delivery, the family can take the baby home 6 hours after birth, provided that there have been no complications. As in all deliveries, the mother and baby are the centre of at- An elective caesarean section tention and their well-being takes prece- In Finland, approximately every sixth child dence over everything else. is born by caesarean section and of those approximately 50% are elective caesarean Giving birth before reaching the hospital sections. Typical reasons for a caesarean in- Sometimes the baby is born so fast that the clude breech presentation, abnormal pla- mother cannot make it in time to the hos- cental position, the large size of the baby, a pital. Each year, some 50 women deliver decelerated growth rate and previous cae- their baby on the way to the hospital and sareans. Sometimes the mother experienc- another 50 have an unplanned home birth. es such fear of giving birth that vaginal de- In these cases, the first stage of labour pro- livery is not possible. ceeds quickly to the second stage and the A caesarean section is scheduled for a mother feels the need to push suddenly, time when the baby is most likely to be while still at home or on her way to the best prepared for life outside the womb, hospital. Hence, the father or other com- i.e. when the lungs have matured and oth- panion has to play the midwife’s role. The er risks remain as small as possible. How- first priority is to stay calm. If possible, the ever, a child born by elective caesarean father should contact the hospital to re- section is at a higher risk of being slow to ceive advice over the phone. Once the ba- adapt and to develop wet lung syndrome, by is born, he or she is bathed and then because the complicated mechanisms that placed on the mother’s chest. Remember mature the lungs and are naturally activat- to ensure that the baby is kept warm. It is ed during vaginal delivery do not have advisable to prepare for such a delivery, es- enough time to function adequately dur- pecially when the hospital is far away or ing a caesarean. In addition, both the when previous births have been quick. mother and the baby need more time to recover. Home birth In the case of an elective caesarean, the Home birth is very rare in Finland, al- hospital maternity unit staff provide advice though it is also an option. Each year, well in advance. Fathers are welcome to about 10 mothers decide to give birth at participate in elective caesarean sections. home. Home births require considerable (For more information on Caesarean sec- pro-activeness and initiative from the tions, see page 40.) mother. She will need to book a midwife and acquire the necessary equipment. Policlinic delivery Mothers choosing home birth are also res- The inpatient period following delivery has ponsible for all of the related expenses and become shorter, and so-called ”polyclinic any unexpected consequences. If you are

36 The birth interested in home birth, be sure to inves- to the baby’s movements, following the in- tigate the option thoroughly before mak- structions given by the hospital or prenatal ing your final decision. clinic.

Overdue pregnancy What to take to hospital If your pregnancy exceeds the estimated Pack your hospital bag with items you will delivery date by more than 10 days, based need well in advance. You can pack your on the measurements taken from an early own dressing gown and nightgown to pregnancy ultrasound scan, it is considered wear at the hospital. overdue. You or your health nurse should make an appointment at the hospital ma- Include: u your current and any previous ternity unit where a doctor will examine maternity cards the mother and the baby and, based on the u pre-filled personal data form well-being of them both, decide how to (received from the prenatal clinic) proceed. u your Social Security Card (Kelakortti) Overdue pregnancies are closely mon- u toiletries and other personal items, itored to detect any signs of possible risks such as a toothbrush and toothpaste, as early as possible. The most common deodorant, body lotion, hairbrush complication in overdue pregnancies is (shampoo and soap are usually placental insufficiency, other problems in- available at the unit) clude foetal oxygen deficiency, a decreas- u nursing bras. ing amount of amniotic fluid, and changes in the foetal heart rate. The expectant Unless the hospital accepts payment in ar- mother is recommended to pay attention rears, you are expected to pay for your stay upon leaving the hospital. Other than that, you will not need large need a large amount of cash. It is also advisable to leave any valuables, such as expensive watches and jewellery, at home. The father can bring any gear and items you need for the journey home on the day before you leave the hospital.

The baby will need: u undergarments (e.g. a body suit), u a shirt and pants or a jumpsuit, u a hat and a sleeping bag and, if the weather is cold, the baby will also need a cardigan and a pram suit or padded overalls, u a car safety seat, if the family travels by car.

The birth 37 Before the baby is born, make sure you have Note! Go to the hospital immediately if small nappies for the newborn and sanitary you have vaginal bleeding or experi- pads for yourself, for heavy bleeding after the ence severe pain. birth, kept in readiness at home. u If your waters have broken or your baby is in the breech position, it is advisable to travel lying down. Onset of labour As the estimated delivery date approach- es, the father or other birthing companion should never be more than a phone call away. If the maternity unit is far away or the journey Onset of labour is otherwise demanding, remember to plan Labour usually begins at 38 to 42 weeks, with accordingly. contractions or with your water breaking. How- If your water starts to leak during the ever, it is not yet fully understood what triggers night and the amniotic fluid is colourless and the onset of labour. Loss of the pink mucus, ”the you are not having contractions, you can wait plug”, that keeps the cervix closed, is a sign that until morning to go to the hospital. If the am- labour is approaching. Labour usually begins niotic fluid is green, it means that the baby has with irregular contractions which gradually be- emptied his or her bowels and you should go come stronger and more frequent. Labour can to the hospital without delay. Although your also begin with your water breaking either sud- waters have broken, you do not need an am- denly or in a gradual trickle. It can also be in- bulance to go to hospital. If an elective caesar- duced using medication. ean section has been scheduled for you and your water breaks or you are having regular When to go to the hospital contractions, go to the hospital in order to re- assess the urgency of the operation. Women who are having their first baby should go to the hospital when Admission process u contractions come regularly every 5 to When you arrive at the hospital, a midwife 10 minutes, will welcome you and request your materni- u contractions last at least ty card. Any patient data on the mother will 45 seconds at a time, be retrieved from the hospital records. The u you have had contractions for mother’s blood pressure is taken and her two hours. urine tested for protein and sugar. The mid- Mothers who have had previous wife will then perform an external and inter- pregnancies should leave earlier, when nal examination. The external examination is u contractions are regular, and performed to determine the status, position, u last at least 30 seconds. size and presentation of the baby. The internal examination is performed to determine the stage of labour, the extent to which the cervix has dilated and the placement of the presenting part (usually the baby’s head). u

38 The birth The stages of labour

There are three stages of labour: the first With mothers stage is the dilation of the cervix, the sec- who have had previ- ond is the delivery of the baby, and the ous pregnancies, the third is the delivery of the placenta. For cervix begins dilating even before the cer- first-time mothers, labour often takes be- vical canal has fully effaced. Labour often tween 6 and 20 hours. For women who starts to progress faster when the cervix is have already given birth, labour may only 4 to 5 cm dilated. take 3 to 12 hours. For some women, la- At the beginning of the first stage, bour may last much longer, while for oth- contractions are experienced approximate- ers it will be over much sooner. ly every five minutes, lasting for 30 sec- Midwives are skilled professionals and onds at a time, but as the labour progress- you can talk with your midwife about your es, contractions become more frequent views, hopes, wishes and feelings during and last longer. labour. She is there to support, encourage During the first stage, the midwife will and give advice to both the mother and check the cervix’s status, the baby’s posi- her companion. Together with the mother, tion in the birth canal and the mother’s the midwife will try to find comfortable blood pressure every one or two hours. positions and suitable forms of pain relief, Technical devices are usually applied to and will place all of her skill at the dispos- monitor the well-being of the baby (CTG, al of the mother during the course of the cardiotocography) and to listen to the ba- labour. by’s heartbeat through the mother’s abdomen. An electrode may be attached to the The first stage of labour: baby’s head which records the trend in the the dilation of the cervix mother’s contractions and the foetal heart- The uterus is a very strong organ and its beat. The colour, odour and amount of muscular activity will push the baby amniotic fluid are also monitored. If nec- through the birth canal and into the world. essary, the baby may be further monitored During the first stage of labour the cervix via ultrasound scans, taking blood samples dilates to 10 cm. For a first-time mother, or using a STAN device which records the the cervix only begins to dilate after the baby’s ECG in addition to its heartbeat. cervical canal has gradually effaced During this stage, the mother can as- (thinned out) due to contractions. This sist the uterus by staying relaxed. Moving might take 8 to 9 hours. Once the cervical around and staying in an upright position canal has effaced, the cervix dilates about 1 will further accelerate the dilation. The to 2 cm per hour. If the contractions are mother should remember to empty her not sufficiently effective, they can be stim- bladder sufficiently often so that a full ulated with a hormone drip (oxytocin). bladder does not hinder the delivery.

The birth 39 Many mothers find that the presence At some point, the midwife asks the of the baby’s father or other companion is mother to stop pushing altogether for a especially important during this stage, as few moments so that she can help the ba- he will be there to encourage and support by’s head emerge from the birth canal. the mother, offer something to drink, mas- Next, the baby’s shoulders will emerge one sage her aching back and create a general at a time and the mother will be encour- sense of security. In many cases, this will aged to push again, until the baby is fully ease the pain as well. born. For a first-time mother, the second stage takes 20 to 30 minutes, for others The second stage of labour: only about 10 minutes. delivery of the baby The second stage begins when the cervix is The third stage of labour: fully dilated and the baby’s head is turned delivery of the placenta to the correct position. The mother will feel As soon as the baby is born, the mother is a very strong urge to push downwards. given an oxytocin injection that stimulates Some mothers may feel the urge to push at the uterus to contract. The contractions an earlier stage, but the midwives will ad- cause the placenta to be expelled from the vise her to refrain from pushing too early uterus, usually within about 5 to 10 min- to prevent prolonged delivery due to a utes. The midwife helps the placenta to be swollen cervix. Many women find this the delivered by pressing the uterus lightly most painful and unpleasant stage of de- with one hand and pulling lightly on the livery, but it is usually over fairly quickly. umbilical cord. The foetal membranes will The atmosphere in the delivery room is also come out at this time. The placenta kept peaceful and calm, avoiding unneces- and membranes are then examined, sary fuss and bright lights. weighed and measured. If the placenta When a contraction comes, the moth- does not come out by itself, the midwife er will have a strong urge to push. She will will assist the delivery further by pressing have time to push 3 to 5 times during one the uterus and tugging the umbilical cord. contraction, taking a quick breath in be- Sometimes the placenta needs to be re- tween each push. When to push depends moved manually. This is done under a gen- on the mother, but when the baby’s head eral anaesthetic, or very effective local an- starts to press against the perineum and aesthetic. stretches it, pushing may be guided by the The episiotomy cut and any tears are midwife, who can see what’s happening. stitched under local anaesthetic. Before The midwife monitors the stretching of the being transferred to the postnatal ward, perineum and the pressure caused by the the mother and baby will remain under baby’s head and assesses the need for an surveillance at the delivery room for ap- episiotomy to prevent the perineum from proximately two hours. tearing. An episiotomy - an operation in which the perineum is cut to widen the C-section opening - is performed in only one in Approximately every sixth baby is born by three deliveries. caesarean section (C-section). A caesarean

40 The birth section may be needed if, during labour, Having a caesarean section does not the baby’s well-being is believed to be de- prevent the mother from having a vaginal teriorating or if the delivery stops pro- birth in the future. However, it is recom- gressing as it should. A swift deterioration mended that there is an interval of at least in the baby’s condition requires an emer- one full year before the next pregnancy, in gency caesarean to ensure that the baby is order to ensure the uterus has sufficient delivered as fast as possible. If a caesarean time to heal properly. If the mother has section has been scheduled in advance, it had two caesarean sections, vaginal birth is is called an elective caesarean (see ”Antic- most likely no longer an option. ipating the delivery method” on page 35). A caesarean section is performed under general anaesthesia or using an epidural or MIDWIVES ARE SKILLED PROFESSIONALS spinal anaesthetic. Usually the method saf- WHO ARE THERE TO SUPPORT YOU . est for the mother and baby is selected, but in an emergency the fastest method is applied. The surgeon makes an incision in the Vacuum extraction and forceps delivery mother’s abdominal wall and cuts through Vacuum extraction is performed using a the uterus. The baby is then helped out. The ventouse which is often the best way to ac- placenta and the membranes are removed celerate delivery when the baby is showing in the same way. The whole operation takes signs of distress or when contractions slow 30 to 45 minutes. If the mother is con- down during the second stage of labour. scious, she will be able to experience the The doctor fixes a silicone or metal cup birth of her baby. over the baby’s head which remains in Recovery after a caesarean section place through suction. takes somewhat longer than after a vaginal In this way, the doctor has a firm grip birth, because having a C-section is a seri- on the baby. By pulling the ventouse as the ous surgical operation compared to vaginal mother pushes, the doctor can help the delivery. The mother will usually be able to mother deliver the baby. Vacuum extraction get up within one day of the caesarean, is used in about 5% to 7% of all deliveries. and is allowed to go home with the baby Vacuum extraction causes swelling of the when she is feeling well enough. The baby’s head, which disappears within a stitches are removed after one week. week, but can be painful during the first During the weeks following the C-sec- few days. tion, the mother will need extra help Forceps used to be a commonly used around the house as she is not allowed to aid in deliveries, but today they are seldom lift anything heavier than the baby. To en- used. Forceps are used in similar situations sure proper healing of the incision, exer- to vacuum extraction, but especially in cases cise and heavier chores must be entered where, towards the end of the delivery, the into with care. The mother may find many baby’s heartbeat suddenly slows down and movements painful or difficult. However, there is a sudden danger of oxygen deficien- staying up and mobile will enhance recov- cy. In such circumstances forceps provide a ery. faster method than vacuum extraction. u

The birth 41 Labour pains and pain relief

Labour pains Labour is a massive strain on the mother and singing, pillows, a bean bag, a rocking and baby, both physically and mentally. chair or gymnastic ball can be used as re- When discussing pain relief with the par- laxation aides. Many mothers find relief in ents, the doctor and midwife consider the warm water or a warm wrap that relaxes benefits and disadvantages to the mother the muscles. During the first stage of la- as well as the baby. bour the mother can shower her back and At the beginning, pain occurs as a sign abdomen or relax in a delivery pool or of the onset of labour. It is caused by the deep bath. The mother is not allowed to go muscles and tissue stretching as the baby’s into the water if her water has broken over head descends in the birth canal. During 24 hours beforehand or if labour is not the second stage of labour, the urge to progressing as expected. push usually surpasses the pain caused by Aqua acupuncture is a form of natural contractions. During the third stage of la- pain relief where water blisters are injected bour, when the placenta is delivered, the under the skin to enhance the mother’s pain has usually subsided. endorphin secretion. Endorphins are the Women experience labour pains differ- body’s own painkiller and their effect lasts ently. It will depend on her pain threshold from 1 to 2 hours. and overall tiredness, but also on fear and During labour it is recommended that uncertainty. Fear of the unknown and not you move around and try different posi- knowing what’s happening or what to ex- tions to find the ones that are most com- pect is common for all of us, and when we fortable. Swaying your hips removes some are frightened our sense of pain is height- of the pressure against your lower back ened. and helps to control the pain caused by contractions. Natural pain relief The father or other companion may Knowledge is the basis of all pain relief. further help by massaging the painful are- Being familiar with the stages of labour al- as during contractions. so assists the mother in coping with labour pains. The correct breathing and being able Drugs injected into muscle tissue or to relax during each stage of labour are helpful to the mother and optimal for the administered intravenously baby, as these forms of pain relief have no Labour pains have a purpose: they adverse effects on the baby. keep the mother informed of the labour Rhythmic breathing decreases muscu- process. However, one in five mothers ex- lar strain, conserves the mother’s energy periences such pain that she will need and helps the mother stay focused. Music some form of effective pain relief. Each

42 The birth mother is entitled to receive effective drugs It is very rare for anaesthetics to cause for pain relief, but drugs will also quickly complications. As a side effect of the injec- access the baby’s circulation through the tion, the mother may experience back pain placenta. If the baby is born 2 to 3 hours around the injection area, and sometimes after the last dosage, the pain killer may have a severe headache. The pain is believed paralyse the breathing of the newborn. to be caused by spinal fluid leaking from the Hence, these drugs are generally not ad- needle hole in the dura mater. First aid for ministered during the later stages of la- headaches involves drinking large amounts bour. of fluids, taking painkillers and resting in a darkened room. If the headache persists, an Nitrous oxide anaesthesiologist may need to asses the sit- A mixture of oxygen and nitrous oxide can be safely administered throughout the first stage of labour because it is quickly ex- RHYTHMIC BREATHING HELPS pelled from the circulation. The mixture is RELAXATION AND CONSERVES ENERGY inhaled through a mask in periods timed with the contractions. It takes effect slowly and must therefore be inhaled before the uation. If necessary, a special procedure contraction begins. called a ”blood patch”, an injection of the patient’s own blood into the epidural space Anaesthesia where it forms a ”patch” over the hole, can An epidural is the safest and most effec- be performed to relieve the headache. tive form of nerve block anaesthesia. It Anaesthetics travel through the placenta eliminates the first stage labour pains al- and may slow the baby’s heart rate. Anaes- most completely, if not completely. The an- thetics can also may temporarily affect blood aesthetic drug is injected into the epidural circulation in the womb and placenta, leav- space to the side of the spinal cord and a ing the baby at risk of oxygen deficiency. Be- catheter is left in place so that additional cause of these risks, the doctor needs to medication can be given throughout the check from the baby’s ECG that he or she is delivery. An epidural may only be given by in excellent condition prior to the adminis- an anaesthesiologist, and is therefore not tration of any anaesthetic agents. Further- available in every hospital. more, the mother and baby must be closely Spinal anaesthesia is a very effective monitored while the anaesthetic is effective. form of pain relief and commonly used in quickly progressing, fierce deliveries to in- Hypnosis duce adequate pain relief with just one In Finland, hypnosis and the power of sug- dose. Spinal anaesthesia may also be given gestion are rarely used for pain relief. How- only by an anaesthesiologist. ever, both methods are safe for the baby. Your doctor may introduce a local cer- Hypnosis is best achieved if the hypnothera- vical anaesthetic during an internal ex- pist is present at the birth. If you wish to use amination. Its effect will last for about an hypnosis, arrange this with the hospital in hour. advance. u

The birth 43 The newborn

Birth is a miraculous event touching the hearts of everyone present. Months of ex- pectation climax in pushing the baby out and into the world. Love is in the air, but there is also a mixture of relief, exhaustion, anxiety and joy. Immediately after birth the baby is lifted onto the mother’s chest to provide skin- to-skin-contact. The baby is then dried and need reviving, others’ noses and mouths the umbilical cord is cut and tied. The will have been suctioned (if the amniotic mother and baby are allowed to rest under fluid was green) before being lifted onto a warm blanket. After a little while, curios- the mother’s chest. ity surpasses fatigue and the parents start Soon after the birth, before the umbil- caressing the baby, peeking under the ical cord is cut, a name tag is placed blanket to wonder at the tiny fingers and around the baby’s wrist, or a necklace with toes. This is the beginning of parent-child an ID plate is put on the baby bearing the interaction. mother’s name and social security ID. This After a moment of rest the baby will procedure ensures that there can be no open its eyes and seek eye contact with the mix-ups. The newborn receives a vitamin people close by. Slowly the little fists relax, K shot in the leg in order to prevent bleed- the mouth opens and a tiny tongue peeks ing. After birth the baby’s health is as- out. The baby is now ready to start feeding. sessed using the so-called APGAR score. A He or she will nudge towards the numerical value (max. 10) is awarded for breasts and start feeding within 30 minutes skin colour, heart rate, breathing, reflex ir- to one hour after birth. The baby will ob- ritability and muscle tone. The APGAR serve the world around him or her with scores are a tool used by health care pro- bright eyes, stimulating the parents’ nursing fessionals to assess the well-being of the instincts. At this point, the midwife will newborn and to forward this information monitor the well-being of the baby with as to others. APGAR scores cannot be com- little disturbance as possible. The baby is pared between babies. kept warm, bathed, dried, weighed and Provided that everything is alright, the measured. The father will be given the op- mother and baby are transferred to the portunity to be the first to care for his baby. postnatal ward two hours after birth. Fol- Each birth has a different story. Some lowing a caesarean section, the father is the births need to be assisted using vacuum first to witness his baby’s first minutes. extraction, while others may have ended in Sometimes the baby’s breathing may an emergency caesarean. Some babies have a wheezing quality or become overly

44 The birth frequent, which will require closer surveil- its condition is stabilised. The units en- lance and be assessed by a paediatrician. courage ”kangaroo care” where the baby is Infections passed on from the mother dur- placed on the mother’s or father’s bare ing birth, gestational diabetes, pre-ec- chest, under the shirt. This helps the pre- lampsia and other diseases or medication mature baby adapt to life outside the all have an impact on how the newborn is womb. Skin-to-skin contact is soothing to monitored after birth. The breathing and the baby and will help the baby maintain general well-being of premature (born be- its body temperature. fore week 37) and low-weight (under 2,500 g) babies are monitored particularly Postnatal ward closely. The more preterm the baby is, the The staff at the postnatal care monitor the more likely it is to be transferred to the well-being of the newborn baby and en- paediatric ward. sure that the mother recuperates well from the delivery. They also guide the parents Premature birth on how to take care of their baby. The ob- When a preterm birth between 24 and 34 jective is to give as positive an experience weeks is expected, corticosteroids are given as possible of the birth and of breastfee- to the mother to speed up the foetus’s lung ding and caring for the baby. development. Preterm deliveries (baby born before 35 weeks) are located near the Successful breastfeeding is important to neonatal intensive care unit (NICU). Today, the well-being of both the mother and very premature and low weight babies can the baby. Breastfeeding provides suffi- survive with the help of intensive care. cient nutrition for the baby and also The more premature the baby is, the gives the mother a sense of security in longer he or she will need intensive care her ability to feed her baby. and incubator treatment. With each week, the risks associated with premature birth In the postnatal ward, the mother stays decrease and the need for supplemental in the same room as the baby. Milk pro- oxygen decreases. A premature baby usu- duction begins in the delivery room where ally spends the first days or weeks of its life the baby’s suckling stimulates the release in an incubator, where the temperature of hormones (oxytocin). This close interac- and humidity is controlled and the baby tion between mother and child continues can be better monitored. If the baby is un- in the postnatal ward. The mother cares for able to feed, it is fed through a feeding her baby as much as her strength allows tube. Premature babies born after 35 and following the sleeping and feeding weeks usually survive in the postnatal pattern of the child. Other family members ward, although feeding may take longer to are welcome to visit the mother and and accomplish than with full-term babies. her newborn.. The parents are welcome to stay with The first breast milk is called colostrum. their premature baby in hospital as much It is a rich milk providing all the required as possible. Parents may hold the baby as nutrition for full-term babies. Milk produc- soon as its vital signs have developed and tion is enhanced by frequent feedings. Pre-

The birth 45 mature, low-weight babies and high birth hypertension and psychopharmaceuticals) weight babies (over 4,500 g) need large can prevent breastfeeding, and in such a amounts of milk from the beginning, and case the proper treatment of the mother supplemental milk is often required to takes priority. Sometimes, the baby has an maintain the baby’s blood glucose at the injury or defect (e.g. cleft palate) that makes normal level. Glucose levels are also moni- sucking difficult. The nurses will assist the parents in bottle-feeding expressed breast milk or formula milk to the baby. IN THE POSTNATAL WARD, THE MOTHER Many hospitals have family suites de- STAYS IN THE SAME ROOM AS THE BABY . signed to accommodate both parents. Family suites enable both parents to share the first days with the new baby, practice tored when the baby is at a higher risk due baby care under the guidance of profes- to the mother’s diabetes or gestational dia- sional midwives, and become familiar with betes, for example, since low glucose levels how their baby communicates. When the will have a negative effect on the baby’s family goes home, both parents know the central nervous system. Supplemental milk baby well, which will facilitate settling in. is not a dairy product and is used only tem- There are several ways in which the father porarily. Donated breast milk is given first can contribute to successful breastfeeding. to premature or low birth weight babies. By remaining calm and having complete Some babies have a strong sucking re- faith in milk production, by caressing and flex immediately after birth. However, it is pampering the mother and the baby, and not uncommon for the mother and baby to by changing nappies and offering a helping need some help in learning the correct hand the father can help the mother relax feeding technique. It is very important that and not lose faith in breastfeeding. Staying the mother and baby practice the correct in a family suite is never compulsory and breastfeeding technique while still at the does not necessarily meet the needs of all hospital. Mothers are entitled to receive all families. Issues to be considered when the support and guidance they need for making arrangements for baby care include successful breastfeeding. Once breastfeed- a possible operation or illness affecting the ing is established, the mother and baby mother, or the mother feeling very faint or can be discharged. Milk production will weak, or if the baby needs to be monitored. continue to increase during the following Whatever the situation, the parent-child weeks. At this stage, the main considera- relationship is encouraged early on. tion is to ensure that the baby receives ad- On the third day of birth, the baby will equate nutrition. The key to successful, be examined by a paediatrician. At this long-term breastfeeding lies in keeping time it will be apparent how well the baby the baby alert while feeding. has adapted to living outside the womb, Breastfeeding soon after birth will cause how breastfeeding is going, whether the the uterus to contract. This decreases bleed- mother’s milk production is sufficient, and ing and aids recuperation from pregnancy how well the parents can interpret the sig- and birth. Some medications (e.g. drugs for nals the baby gives them. Already, at the

46 The birth age of three days, it is evident whether the will be provided with an information pack baby can maintain a normal body temper- on feeding and baby care. Some hospitals ature, normal breathing and normal heart may provide the parents with eye drops, a rate, express hunger, suck, urinate and def- saline solution for the stuffy nose and so- ecate normally. Also, by this time stuffiness lution for cleaning the navel. Parents also of the nose, swelling around the eyes and receive information on possible follow-up burping amniotic fluid will have clearly di- appointments and the postnatal ward’s minished. The baby will burp less milk and contact information if the mother or baby gain weight following the dip after birth. encounter problems during the first The paediatrician will have examined the weeks. baby earlier, if any problems were detected. Both parents usually attend the paediatrician’s examination. When leaving the hospital, the parents This examination usually includes as- should feel secure and content and sessing the baby’s skin colour, muscle tone, have confidence in their ability to take reflex irritability and sucking reflex. The care of the baby. doctor will listen for sounds made by the heart and lungs, press the baby’s abdomen It should be remembered that families and feel the baby’s pulse. The baby’s hips, and their life situations vary greatly. Some skull (fontanel), clavicles, eye fundus, pal- parents are experienced in caring for babies, ate, testicles (if the baby is a boy) and ex- while for others this may be their first contact ternal genital organs (if it’s a girl) are ex- with a baby. If the baby is injured or suffers amined. If the doctor needs a blood sam- from a disease, it is important that both par- ple from the baby, a mixture rich in sugar ents discuss the issue with the doctor. This will be given to the baby for pain relief. discussion can also be scheduled to take place Based on information provided by the after the examination. The staff of the neona- nurse, the doctor will consider the baby’s tal ward often includes a social worker who milk consumption, weight and skin colour will provide support and guidance if the fam- (yellow tint). Some of these symptoms are ily needs special attention (single parent fam- merely signs of slow adaptation and will ilies, a very young mother, the family has con- pass in the course of the first week. Howev- siderable financial or other problems etc.). The er, they may necessitate keeping the baby in social worker will investigate the social bene- hospital under surveillance for a few days fits and support available to the family and longer than originally planned. A jaundiced become involved in child welfare situations baby’s skin will appear yellow and can be when the family has problems involving drug assessed by a simple fingertip test or by tak- abuse, violence or mental health, for example. ing a blood sample to measure the bilirubin In such situations the intervention of a social level. Treatment includes phototherapy with worker may be regarded by the family as a blue light and feeding the baby well. threat. However, the main objective of the social worker is to support the family in estab- Leaving hospital lishing safe routines that guarantee good care When the family leaves the hospital they of the child. u

The birth 47 Recovering from delivery

Puerperium - the first weeks after birth The period of time after delivery, during You will receive a certificate to this effect to which your body recovers from the chang- be included in your parental allowance ap- es caused by pregnancy and childbirth and plication. returns to its normal pre-pregnancy condition, is called the puerperium. This usually Sex life and showing affection takes 6 to 12 weeks. The uterus will return Once the baby is born, the parents will to its normal size and may contract during find that they have little time to spend feeding, particularly if the baby is not your alone with each other, especially if there first. Lochia is the bloody discharge after are other children in the family. There will birth. It is more abundant than your usual be a period when their sex life will have to period and turns pale after two weeks. If be put on hold. The length of this period is the discharge smells bad, continues to be for the parents to decide. The mother may bloody and doesn’t seem to diminish, you have scars which make sexual intercourse may have an infection. painful, and witnessing the birth of his ba- Getting up soon after the delivery will by might have affected the father’s libido. improve the circulation and promote bow- The hormonal surge following delivery el movements and bladder activity. Sitting may cause a decline in the mother’s libido, down may be painful, if you have had an but not in her need for love and affection. episiotomy. Showering the area with warm How soon you can expect to return to your water will help the stitches dissolve and usual sex life will depend on you and your the cut to heal. Wash and dry your intimate partner, and it is recommended that you areas with special care. Take showers but both share your thoughts with each other. avoid bathing. You can also begin sauna There is, however, no reason why you bathing as soon as you feel well enough. should not have sex if you both want to. After birth the woman may suffer from Postnatal medical examination vaginal dryness for a long period. Dryness Mothers remain clients of the prenatal will make the vagina irritable and tender, clinic until the postnatal medical examina- especially when using a condom. Using tion. During this examination, the doctor the lubricant lotion delivered in the mater- checks that there are no ulcers in the cervix nity package or some other lubricant and no signs of infection, since problems (cooking oil, body lotion without a fra- tend to be minor and almost without grance or Vaseline) may prove helpful. Lu- symptoms at the beginning. A postnatal bricants are also sold at the chemists and medical examination is performed 5 to 12 department stores. weeks after delivery in the prenatal clinic. It is recommended that you defer sex

48 The birth until the vaginal discharge ends and both sterilisation are safe while breastfeeding, parents feel ready for it. However, there is because they have no effect on milk pro- no need to refrain from showing affection! duction or the baby. If you opt for sterili- Both parents need love and attention, ca- sation, bear in mind that this is an irre- resses and cuddling; now maybe more versible operation. than ever as there is an extra person shar- If you are not breastfeeding, you may ing the ”cuddling resources”. Having a ovulate as soon as 30 days after delivery. satisfactory sex life in your relationship is In this case, you can start using contra- a shared responsibility – it takes two to ceptive pills three weeks after the deliv- tango! ery or when you have your first period. It is not advisable to start using contraceptive pills any earlier due to the elevated Note! Remember to use contraception when you start having sex. Even if you risk of thrombosis. are breastfeeding it doesn’t mean you The condom is a highly suitable meth- can’t immediately become pregnant od of contraception after birth, protecting again. the uterus from infection. Using a lubricant during the first few months may help if the vagina is tender and irritable. Polyurethane Contraception condoms are sold at chemists for people al- Think about contraception before having lergic to natural rubber. sex for the first time after delivery, as ovu- The copper IUD is an intrauterine de- lation is possible before your first period. vice that can be placed in the uterus im- Breastfeeding will normally postpone your mediately after birth (10 to 30 minutes af- periods, but is not in itself a reliable con- ter the placenta is expelled). It is, however, traceptive. recommended that the copper IUD be Breastfeeding will protect you against placed during the postnatal medical exam- conception if less than six months have ination to ensure it stays in place properly. passed since the birth, your periods have It can also be placed at a later stage, even if not started, and your baby feeds at least your periods have not yet started due to eight times a day at regular intervals and breastfeeding. In that case a pregnancy test does not receive supplementary nutrition. will be performed before fitting the IUD. A The contraceptive effect of breastfeeding copper IUD can be used for five years. diminishes rapidly if you feed your baby Hormonal contraceptives containing less than seven times a day. If you do not only progesterone include mini-pills, hor- want to become pregnant, remember to mone implants placed under your skin, use contraception whenever you have sex. hormone IUDs and progesterone injec- By the time the baby starts having supple- tions. The advantage of a hormonal IUD mental food, contraception is necessary to is that its hormonal effect is local and only avoid becoming pregnant. a small amount of hormone is released. Condoms, intrauterine devices (IUDs), Conventional combined oral contraceptive pills and other types of hormonal contra- pills (COCP) are a combination of oestro- ceptive containing only progesterone and gen and progesterone, which decreases

The birth 49 milk production. Stretch marks may be visible on the abdo- Chemical contraceptives, such as men, thighs and breasts. foams, gels and sticks, may irritate the mu- Women often tend to be overly critical cous membranes. If you have been using a of the changes in their appearance and pessary, you may need to refit it and use it may view themselves as falling short of the in combination with contraceptive gel. current popular notions of beauty. Howev- Emergency contraception is also er, changes resulting from pregnancy and called post-coital contraception or the birth are visible signs of being a mother morning-after pill. It stops you from be- and should be carried with pride. When coming pregnant if contraception failed or you are a mother, you have the right to was not used. You can buy the pills from look as if you have given birth. the chemist without a prescription. The Some women are able to return to pills are taken as a single dose, preferably their pre-pregnancy shape quickly, and not within 12 hours, but no later than 72 all women carry the signs of pregnancy hours, from having unprotected sex. When and delivery. But most importantly, be easy taken within the recommended time on your body shape. The well-being of the frame, this method is 98 percent effective. mother and child is far more important You can continue breastfeeding after tak- than your physical appearance. On the ing the emergency contraceptive. Emer- other hand, spending a little time pamper- gency contraceptives contain progesterone ing and caring for yourself will be a wel- which has no known effect on the baby. come change and help you cope with your However, if you want to be on the safe baby with renewed energy. side, express milk from your breasts and throw it away for 1 to 2 days before breast- Weight control feeding again. As the name ”emergency About 50% of women gain excessive weight contraceptive” implies, these pills are in- during pregnancy. This excessive weight gain tended for occasional use, not as a regular is not easily lost after the birth, and demands form of contraception. persistence and hard work. Dieting during A copper IUD can also be used as pregnancy, immediately after birth or while post-coital contraception if it is fitted with- breastfeeding is not recommended. Instead, in five days of unprotected sex. A copper it is advisable for everyone to maintain a IUD is more effective than pills and pro- healthy diet and exercise regularly. These are vides optimum contraception when left in also the cornerstones of lasting weight con- place. trol. Results are seen only gradually, but are the more rewarding for it. In addition, Bodily Changes breastfeeding promotes weight control. Pregnancy and birth will inevitably change Finding time, strength and motivation are a the shape of the mother’s body. After birth challenge to mothers of young children, and the skin around the abdomen is stretched many need support either from a profession- and the breasts are bursting with milk. As al or a peer group. If you are having weight milk production dwindles your breasts will problems, identify the options available in lose some of their previous pertness. your community.

50 The birth Getting back into shape It is best to rest and relax on the day after nal delivery). Remember to breathe evenly delivery, but you can start getting back in- and pause between exercises, if you feel to shape on the next day. Some health care like doing so. centres and maternity units organise post- Abdomen: Contract your abdominal natal exercise for groups, but you can also muscles and press the small of your back exercise daily at home. Ask for exercise in- against the floor. Hold this position for a structions from the hospital or from your while, and relax. prenatal clinic. Exercise will make your Buttocks and sides: Lay on your side. muscles firm, improve your posture and lift Lift your topmost leg up, heel first. Keep your spirits. It also eases back and shoul- your body straight. der pains and improves continence. Abdomen and thighs: Press the small If you have had a caesarean section, be of your back against a wall and contract sure to begin exercising slowly, paying your abdominal muscles. Bend your knees close attention to your body. Fitness train- and stay in this position for a while. ing and long walks are examples of activi- Straighten your knees and relax. ties not recommended prior to the postna- Pelvic floor muscles: Press your an- tal examination. kles, knees, thighs and buttocks firmly to- You will find a balanced exercise re- gether. Hold this position for a while, and gime in this leaflet. Start by doing each ex- relax. ercise once or twice a day (following vagi-

Buttocks Abdominal and sides muscles

The birth 51 Pelvic floor muscles You can begin exercising your pelvic Your pelvic floor muscles will be severely floor muscles on the day following the strained if you have given birth to several birth. children, your babies have been large, you First perform a finger test: wash your have had a multiple pregnancy, or your hands and rub your index and middle fin- second stage of labour was lengthy. Being gers with a non-irritating lubricant (e.g. overweight and smoking additionally bur- cooking oil). Press your fingers together den the pelvic floor muscles. If you suffer and gently push them 3 to 5 cm into your from varicose veins or piles, your muscles vagina. Relax for a moment, and then may be predisposed to slackening. As a squeeze your fingers with your vagina. result, when doing sports or exercise in- Relax. Remove and wash your fingers. If volving jumping, your slackened pelvic you felt an upward and inward contrac- floor muscles may give in, causing incon- tion, your pelvic floor muscles are strong. tinence. Nevertheless, exercising your muscles every now and then is worthwhile because strong muscles are always an advantage. If you did not feel a squeeze, suffer from incontinence (you have difficulties controlling your bladder) or if your sensa- tions seem weak during sexual intercourse, make an appointment to see your gynaecologist.

Abdomen and thighs

Pelvic floor muscles

52 The birth If you are having difficulties identifying Endurance exercises the correct muscles, tighten and relax your Imagine a white ball at the entrance to the tummy, thigh and buttock muscles a few vagina. Pull the ball as slowly and as far as times and then try again. It will help if you possible inside the vagina. Contract your insert a couple of fingers into your vagina muscles and hold the ball inside. Hold while you are trying to identify the correct your urine and clench your anus while muscles. Try different positions; sitting, ly- counting to five. Slowly release the ball ing on your side, tummy and back, and and relax, counting to ten. Repeat three squatting. After you have found the mus- times. Gradually increase the number of cles and can do the exercise without using repetitions. your fingers, you can perform these exer- Perform these exercises five times a day cises without anyone noticing. as part of your daily routine, on your way to Identification exercises: Clench your work, during coffee breaks, while cleaning anus, while gently squeezing your mus- or queuing in a shop. Remember to take cles and counting to five. Then slowly relax the muscles, while counting to ten. Re- peat three times. Clench your anus and at SPENDING A LITTLE TIME CARING FOR the same time clench your vagina and YOURSELF IS IMPORTANT . hold your urine while counting to five (the contraction will proceed like a wave from back to middle to front) and relax while one day of rest each week. Perform one counting to ten (front-middle-back). Re- type of exercise at a time, otherwise you peat three times. will tire. If you feel you are not making Speed exercises: You need quick pelvic progress, consult an expert. Many health muscle reflexes when you cough or sneeze care centres and private medical centres and to hold your urine. Exercise your re- have equipment and medical staff trained flexes by making brisk contractions in a se- to diagnose and treat dysfunctions of the ries. Start by doing this ten times. Gradual- pelvic muscles. You can also buy exercise ly increase the number of repetitions. kits with instructions. u Strength exercises: Imagine a white ball at the entrance to the vagina. Haul the imaginary ball as fast and as far as possible inside the vagina and hold it there while counting to five. Slowly release the ball. Relax, counting to ten. Repeat three times. Gradually increase the number of repetitions.

The birth 53 First month

The most important person to the baby is the person caring for him. Without that person, the baby cannot survive. The baby makes eye contact with its carer, simultaneously pleading and demanding care and attention. This gives the carer a sense of self-esteem and confidence, yet the responsibility may at the same time feel overwhelming, even frightening.

Motherly and fatherly love For most parents, their baby is the most pointment and jealousy. Learn to accept all wonderful thing in the world. However, it of the feelings you and your partner may is not always a case of love at first sight. experience. Give yourself time to adjust. You Giving birth to a baby is exhausting and have an entire lifetime to love your child. looking after the baby takes all of your spare energy. Since the mother is absorbed Both parents participate in breastfeeding, the father may feel reject- In our culture, both the mother and the fa- ed and left out. Having a baby may also be ther are responsible for taking care of their totally different to what the parents had children. Looking after the newborn is a anticipated. A little individual enters the rich, fulfilling experience for both parents. parents’ life, changing everything, making The baby may evoke powerful emotions its demands known with loud authority. that can take the parents by surprise. Being This noisy little person may be a source of indispensable to another human being confusion and even irritation, one’s feel- makes the parent view his or her life from ings towards the demanding little bundle a new perspective and often inspires him may not always be entirely warm. or her to see the world differently. This Becoming acquainted with your new provides a new source of energy for coping family member may be a slow process, but with daily demands. eventually you will become attached to Apart from breastfeeding, there is your child. Love develops gradually while nothing the father cannot learn to do just caring for your baby. as well as the mother. At first, parents take Parents vary in the way they take to care of the baby together. Later on, it is im- new things. Experiencing extreme emo- portant that they take turns. This will give tional fluctuations is quite normal. Sudden- one parent the opportunity to relax while ly amidst love, affection and joy, you may the other is having some private time with be stuck by exhaustion, concern, disap- the baby. The baby will get used to both

54 Baby care parents; their methods may be different symptoms can last for several months. If but equally correct - there is no need for the depression is not severe, the symptoms the mother to act as an interpreter be- may go unnoticed or the mother may be tween the baby and the father. This will al- ashamed and try to hide them. However, so be beneficial to the future father-child you should seize the opportunity to talk relationship. about your feelings with the clinic’s nurse The baby demands round-the-clock or your doctor. If untreated, postnatal de- attention which can leave both parents ex- pression can develop into long-term severe hausted. When either of the parents is at depression. In addition to caring for the the end of his or her tether, the other mother, treatment is also vitally important should take over. Going outside for a walk, to securing the well-being of the baby. taking a long shower or reading the paper Some health care centres organise while enjoying a cup of coffee can work meetings where mothers receive peer sup- miracles. Another tip is to swap roles so port and encouragement from mothers in that the parent usually in control plays the the same situation (See also ”ÄIMÄ - the part of assistant. Caring for the baby to- Association for mothers suffering from de- gether strengthens the relationship be- pression” on page 96). tween the parents as they share the love When the mother is depressed, the fa- and joy the baby brings. ther’s role becomes even more important. On the other hand, fathers may also have Maternal depression problems after the birth. Prenatal and Postnatal hormonal activity may cause child health clinics offer support for both emotional instability and mood swings. parents. The mother may feel depressed and weepy, although everything seems to be Being a single parent going well. This is quite natural. Four out Divorce, the death of a partner or being of five mothers suffer from ”baby blues”, a left alone in some other way can make mild case of postnatal depression which parenting a heavy burden. If you are the starts 3 to 5 days after birth and lasts for a sole parent, do not make unreasonable de- few weeks. Symptoms include being tear- mands on yourself - don’t expect to make ful and irritable, mood swings, and some- up for two parents. Accept help from your times also loss of appetite and sleeping family, relatives and friends, and take ad- problems. This condition does not require vantage of family workers and the profes- medical treatment. Support and compas- sionals at the child health clinic. sion from family and friends is enough. Sometimes a baby is born into a single Talking about the situation with your part- parent family. In single parent families, it is ner or a trusted friend usually helps, and advisable that a close friend, or the baby’s the baby blues pass as the mother’s gener- grandmother or godparent, be invited as a al condition improves due to sufficient ”trusted adult” who will learn to know the sleep and healthy nutrition. child from infancy. A good relationship be- Approximately one in 5 women suffer tween the baby and the trusted adult will from postnatal depression (PND). The lower the threshold for getting help, if the

Baby care 55 need arises later on. Being a single parent ments of joy - it will not be the cause of is not uncommon and there are peer any disappointment tomorrow. A sick baby groups which can offer invaluable support needs the love and attention of the entire (see ”Support Networks” on page 78 and family even more than a healthy baby ”Organisations” on page 94). would. Becoming attached to your baby will not cause you to lose it; and trying Visitors hard not to become attached will not save Friends and relatives will be eager to visit you from consequent pain. and meet the new baby. However, if your The hospital staff, prenatal and child visitors are suffering from a cold or other health clinics, social workers and organisa- illness, do not let them near the baby. If you tions for the disabled and their parents offer feel too tired to entertain, you can ask the information and support in coping with this visitors to come at a later date or agree on a kind of situation. Many hospitals will also very short visit. You can also tell your visi- know the contact details of support families tors that you will not be offering tea or cof- who have been in the same situation and fee. If the visitors want to have a little will be able to comfort and encourage the something, they can bring it themselves. parents. (See ”Services for chronically ill or disabled children” on page 92.) If there is a problem Having a disabled or ill baby is an unex- Early interaction pected, painful reality parents can never be No other human relationship is quite as fully prepared for. Nevertheless, even if dif- intimate and positive as the relationship ferent, the baby is your own and in these between a baby and the person caring for situations parents often discover strength it. From the moment of birth, the baby they never believed they possessed. seeks to interact with those around him. Feelings of bitterness, anger, disappointment and guilt are quite common and sometimes your anger may be direct- ed at your partner or the hospital.. Good days are not enjoyed for fear of disappointment. Parents may strug- gle against becoming attached to the child in the hope that should the baby not survive the loss would somehow be easier to bear. Allow yourself to love your sick baby just as you would a healthy one. Savour the mo-

56 Baby care The parents nourish, nurture and protect nappies, bathing and feeding, and it will the baby. They comfort the baby with soft feel wanted and safe. This will provide a touches, gentle smiles and soft voices. And sound basis for future development. the baby responds with eye contact, facial expressions and movements. A place for changing Early interaction refers to reciprocal It is possible to change nappies whilst and synchronic interaction between the holding your baby in your lap, but in many parent and the child. Early interaction con- cases a proper changing mat or changing tributes to the baby’s sense of security, top is very convenient. Make sure the happiness and capabilities, supporting the changing top has edges that prevent the baby’s development in several ways. It is baby from falling. Ideally, the top should important to the baby that an adult is able be placed at a height where there is no to identify, share and name the feelings of need to bend, because the mother’s back joy, fear, anxiety and hurt the baby is expe- in particular will be sensitive to strain dur- riencing. Eye contact, physical contact and ing the first weeks after delivery. speech are all important to the baby. When Arrange the changing corner close to this interaction functions well, the parent the baby’s cot or near the bathing area. You will be able to enjoy his or her relationship can place the changing mat on a regular with the child and the child will feel secure table or on a changing top. The changing in the knowledge that the parent under- gear can also be in the bathroom, where stands and accepts its feelings and needs. you can place the changing top on top of A baby never accuses its carer, never the washing machine or over the bath tub. criticises and never makes comparisons. A Attach pads on the underside of the top to baby needs looking after and will always prevent it from sliding. The bathroom is an accept and become attached to the person optimal place, since water is close to hand caring for it. From the very first week, the and getting wet is not a problem. baby will want to be where the family is. However, the most important thing is Do not leave the baby in its cot. Holding, to have all the changing gear within reach, caressing and cuddling the baby will not because you cannot leave the baby unat- spoil it. Touching the baby will help it grow tended while fetching something from an- accustomed to its own body and learn to other room. The changing area does not control it. Some clinics will teach you how need to be heated, normal room tempera- to give a gentle baby massage. ture is sufficient (20 - 22°C). Start talking to your baby during the pregnancy. Although it will not be able to Crying and comforting understand your words for some months, Crying is the way babies express them- it will understand your tone of voice. A selves. By crying, the baby may communi- soft, calm voice creates a sense of security cate hunger, a wish to see familiar faces, a and hearing people talk will help the baby wet diaper or some other discomfort. Par- learn how to speak. The way you handle ents will gradually learn to interpret the your baby is extremely important. Smile at movements and sounds the baby makes. your baby and talk to it while changing Healthy babies cry during the initial

Baby care 57 months. Babies start to cry more frequent- connects the mouth to the stomach). If ly at the age of two weeks, peaking at colicky crying has been interpreted as hun- around 1.5 months and gradually decreas- ger, this has caused a cycle of over-feeding. ing after that. This period is called the col- Try prolonging the time between feeds us- ic period. It is sometimes called the three ing a dummy, taking the baby outside in month colic as it is usually over by the time the pram or carrying it in a baby carrier. your baby is 4 months old. When a baby cries long and hard for several hours a day, each day of the week, BABIES CRY EVEN WHEN THEY ARE the baby is said to be ”colicky”. Despite BEING WELL CARED FOR . the long and hard crying, colicky babies are usually healthy babies growing and developing normally. Colic crying is mostly dis- Help your baby to burp after feeding. content whining and there are pauses. Some babies swallow a lot of air while Constant crying or screaming starts sud- feeding, resulting in wind and regurgita- denly without any apparent reason. De- tion. The frequency of bowel movements spite the long crying periods, colicky ba- varies individually. However, if you do not bies do get enough sleep. Breastfed babies find stools in your baby’s nappies every are as likely to become colicky as babies other day and it is crying a lot, contact your receiving formula milk. Although colic and child health clinic nurse. Increased regurgi- adding supplemental vitamin D to the ba- tation requires medical attention, especially by’s nutrition may coincide, giving your if your baby is not gaining weight properly. baby vitamin D supplement is not the It may be a case of reflux, where milk flows cause of the colic. back into the tube that connects the mouth Crying usually signals hunger or dis- to the stomach (also called GER, Gastro Es- comfort, but sometimes there may be rea- ophageal Reflux) or pyloric stenosis. son to investigate the matter further. Hun- A rash may be the reason for crying, ger is a common reason for crying. Visit the especially in allergic families. Child health child health clinic to weigh your baby and clinics provide skin care information. Milk compare your baby’s growth with the clin- allergy is a rare condition that causes skin ic’s reference charts together with the rash. If milk allergy is suspected, treat the nurse. If your baby seems to be growing rash and feed your baby special formula slowly, try giving supplemental milk and milk according to your doctor’s instruc- see how it affects your baby. The amount of tions. When the rash is better, the allergy breast milk intake can be estimated at the can be confirmed with a challenge test. Ba- child health clinic via test weighing bies allergic to dairy products may have ei- (weighing the baby before and after feed- ther skin or bowel reactions. ing). If the weight gain is excessive in rela- Consult your doctor if your baby has tion to the baby’s height, the reason for sudden or exceptional crying fits accompa- crying may be too much feeding. Too nied by a fever, cough or respiratory symp- much feeding causes tummy ache and re- toms. If your baby is running a tempera- flux (milk flows back into the tube that ture, you do not need to wait for a doctor’s

58 Baby care appointment to give the baby suitable in the house. When the moment has medication that brings the temperature passed, talk to your baby to let her down. Take your baby to the doctor if she is know that it was only temporary and under 2 months old and has a fever, even that now you are back to being your fa- when other members of the family also miliar self. Don’t feel angry with your- have a fever. self; everybody loses their temper at Night-time crying is usually the hard- some point. Instead, concentrate on est to bear and often makes the parents how to cope in the future and how to feel helpless and worried. Babies cry even secure enough sleep for yourself. Dis- when they are being well cared for. Parents cuss this with your child health clinic’s of colicky babies should not accuse them- nurse. selves of being bad or inexperienced parents. Sometimes, the crying may seem Never shake your baby! never-ending and nothing seems to com- Never shake or manhandle your baby, no fort the baby. Nevertheless, stay close to matter how upset or tired you may be. the baby while it is not well. It is important Shaking the baby is life threatening, be- to identify solutions that will help every- cause a baby’s head is large and heavy one cope during this trying period. Once compared to the rest of its body and its the colic period is over, things will calm neck muscles are not fully developed. down and taking care of the baby will be- When a baby is vigorously shaken, the come even more enjoyable. head moves rapidly back and forth with great force. This sudden motion can cause Comforting a crying baby bleeding inside the brain and behind the u Carrying your baby close, making hush- eyes. Immediately after being shaken, the ing sounds, giving a gentle massage and baby may be sleepy, have trouble feeding soft purring sounds are comforting. Tak- and difficulty in breathing, or lose con- ing your baby into a quieter room and sciousness. The long-term consequences swaddling her in a blanket may also be of shaking a baby, such as total or partial soothing. blindness, learning difficulties and epilep- u Try to stay calm while your baby is cry- tic seizures, can be severe and permanent. ing. If you find you can’t stand the cry- Never let the situation reach the point ing any more, let your partner or some where you feel desperate. It is not a weak- other trusted adult look after the baby ness to admit that you are exhausted and for a while. Go out for a walk, for exam- need help; seeking help is the mature, re- ple, and then give your partner a chance sponsible thing to do. If you feel at the to rest. end of your tether, contact your child u Caring for a crying baby is very trying. health clinic’s nurse or the family workers Take turns and ask friends and relatives in your municipality for help. Other sourc- for help. es of help include organisations and hel- u Don’t get upset with your baby. If you plines, such as the Family Federation’s feel you’re going to lose your temper Family Network (see ”Contact details” on with your baby, take time out elsewhere page 96). If your baby has been shaken,

Baby care 59 Breastfeeding take it to the doctor immediately! u Breast milk provides the optimal nutrition for your baby. Except for vitamin D, breast milk supplies all the nutrients a healthy baby with a normal birth weight needs during the first six months. Exclusive breastfeeding means that the infant needs no supplemental nutrition (except for supplemental vitamin D) and ensures that nutrients are absorbed as well as possible and the baby is protected against diseases. This feeding method has a positive long-term impact on the baby’s health. Nearly all mothers can produce breast milk. In the beginning, the milk supply is small but usually sufficient for the baby. In most cases, the size or shape of your breasts has no impact on milk production. Successful breastfeeding requires some often you feed your baby the more milk is learning and practising the correct tech- produced. Oxytocin is a hormone that nique. Information and guidance provided causes the milk to trickle down the milk in problem situations will help the mother ducts. This is called the let-down or milk to get started. If you are unable to breast- ejection reflex. Let-down often occurs feed for whatever reason, it is advisable to when you think about your baby, are start giving your baby formula milk and watching your baby or hear your baby cry. secure the baby’s nourishment in this way, Exclusive breastfeeding and letting your rather than fretting and worrying over baby set the pace of feeding will ensure breastfeeding. that the quantity of produced milk increases during the first couple of days af- Breast milk production ter birth to meet your baby’s needs. Once The breast prepares for breastfeeding dur- milk production has started, it will not ing pregnancy. Milk production is initiated stop suddenly. by delivery and maintained by frequent breastfeeding. A hormone called prolac- Technique tine causes milk production in the breast, Breastfeeding can be done in several posi- tand the baby’s suckling stimulates the re- tions. Try different positions to find the lease of such hormones, so that the more ones most comfortable for you and your

60 Baby care baby. Being relaxed will contribute to the skin’s own protective agents. milk flow. Supporting your head and Expressing (i.e. milking your breasts) is shoulders with pillows during breastfeed- not usually necessary but sometimes it ing might help. helps to empty your breast if it is too ten- Start each feed with a different breast der for feeding or is still packed tight after first. You can press your breast to have a your baby has finished. You should never few drops of milk ready. Offer your nipple throw breast milk away. If you produce to the baby so that it goes far back, touch- more milk than your baby needs, you can ing the roof of its mouth. Do not force the express and freeze your breast milk for lat- baby against your breast by pushing it er use or donate it to your hospital’s milk from the cheeks or head. If your baby bank. Your clinic’s nurse may know of seems hungry after feeding on the first someone in need of breast milk. Make sure breast, offer the second. However, before that the breast milk you donate is clean. changing breasts make sure the first one is Sore or cracked nipples make breast- fully discharged and that the baby has re- feeding very painful. Using nipple shields ceived the nutritious hind-milk. At the be- may ease the pain. Nipple shields are sold ginning, the baby will easily fall asleep at chemists and department stores. If your while feeding. You can carefully try to breasts become red and tender and you awaken him or her in order to finish the have a fever, you may have a breast infec- feed. tion. Despite the infection, you can con- Milk may often seep from your breasts, tinue breastfeeding. Contact your child even when you are not breastfeeding, es- health clinic or hospital maternity unit pecially during the first weeks. Seepage and follow their treatment instructions. may also occur from the other breast while the baby is feeding. Use breast pads in Take care of your liquid intake your bras to absorb milk which has seeped While breastfeeding you need to drink out. If you want to collect seeping milk, more than you are perhaps used to. Water, place a milk collector inside your bra over diluted juice and drinks with artificial the nipple. Milk collected during the day sweeteners (aspartame and acesulfame) may be refrigerated in a separate dish and are suitable alternatives during breast- combined into a plastic bag to be frozen. feeding. Drinks sweetened with sugar are Breast milk can be stored in the freezer for bad for your teeth, especially if consumed several months. several times during a day. Such drinks are an unnecessary calorie supply and tend to Take good care of your breasts raise your blood sugar levels. When your baby has finished, squeeze a drop of milk over your nipple and leave it Do not smoke while you are to dry. This will protect your nipple better breastfeeding! than any lotion. Keeping your breasts Both parents should give up smoking clean is important. However, it is not nec- while pregnant and breastfeeding, if essary to wash them before and after eve- not for good. ry feed. Excessive washing will erode the

Baby care 61 Nicotine reduces the secretion of hor- stored in its original unopened and intact mones (prolactin) needed to produce milk, package at room temperature until the ex- which may lead to a decrease in your milk piry date. An opened package can be supply. Nicotine levels in breast milk are stored in the fridge (+2°C to 5°C); its con- three-fold compared to blood nicotine lev- tents must be used within 24 hours. Warm els. Furthermore, the presence of nicotine formula by standing the bottle (or cup) in a in breast milk causes restlessness and met- bowl of warm water, running the bottle (or abolic problems, disrupts the baby’s sleep- cup) under warm tap water or carefully in ing patterns and makes the baby cry. If you a microwave oven. To distribute the heat are unable to quit smoking completely, evenly, stir the formula milk after warming avoid smoking 2 to 3 hours before and it. Test a drop of heated formula on your during a feed. The same safety period of 2 wrist to make sure the milk is not too hot. to 3 hours also applies if you are using nic- Powdered formulas are not sterile. otine gum or other nicotine replacements. Therefore, it is important that you follow Never expose your baby to cigarette these instructions: smoke. Babies exposed to cigarette smoke u Run cold tap water into a clean pot and can develop recurring respiratory problems let it boil. (After you have started giving and coughing, and have a much higher your baby supplemental foods, there is risk of developing asthma. no need to boil the water if your tap For more information on breastfeed- water quality is good.) ing, breast milk and weaning, see the ma- u Let the water cool. ternity package’s breastfeeding leaflet. For further help and support in breastfeeding, u Add powder and mix with water. Care- contact the national Breastfeeding Support fully follow the instructions on the Line (tel. 041-528 5582) or search the In- package. ternet (visit www.imetys.fi). u Always prepare the quantity needed for one feeding; never prepare large quan- Formula milk tities of formula milk in advance. If you stop breastfeeding before your baby is one year old, start using commercially Water prepared infant formulas. There are pow- Run your tap on COLD for a while before dered and ready-to-use liquid formulas; taking water for the baby’s food or to give follow the instructions on the package as a drink. Always use cold tap water; carefully. warm or hot tap water may contain micro- For the safety of the child, formula organisms and other contaminants. There milk should never be warmed and stored is no need to give your baby juice or water in a thermos flask or prepared in advance sweetened with sugar; such drinks will on- for night-time feeds. Warm the formula to ly harm the budding teeth and accustom body temperature (approximately 37°C). the baby to sweets. Taste the formula milk before giving it to the baby. Discard any left-over formula. Burping and regurgitating Ready-to-use liquid formula can be When the baby has finished feeding, lift

62 Baby care him up against your shoulder to bring up your baby is sucking hard even after feed- any wind. Burping may be facilitated by ing and your nipples are getting sore, care- softly patting the baby’s bottom, and is fully remove the nipple and replace it with performed equally well by both parents. a dummy. Remove the dummy after the Burping will radically decrease tummy baby falls asleep. In some special cases, trouble. If the baby has gobbled his food down and swallowed a lot of air, it may bring up some of the milk. If your baby has NOT ALL BABIES WILL NEED a tendency to regurgitate, try burping it in OR WANT A DUMMY . the middle of feeding to expel the air from its tummy. Once it is started on solid foods, this will happen less frequently. such as preterm babies and babies with a cleft palate or lip, dummies are used to en- Soothers, dummies, pacifiers courage sucking and to learn the correct Babies explore the world though their feeding technique. mouths by sucking on everything Foreign micro-organisms easily they can reach. The mouth is the cause diarrhoea so remember to baby’s most sensitive body part. keep dummies as clean as Fingers will slip easily into the bottles and bottle-feeding mouth. When the sucking in- teats. Never suck a dummy stinct is strong, it is better for clean in your own mouth. the baby to suck on a pacifier Otherwise, the micro-or- than on a finger, because the ganisms in your mouth skin on the fingers may be- will be passed on to your come chapped due to ener- baby. For the same rea- getic sucking and breaking son, take care that other the habit is easier with children do not share your dummies. Not all babies baby’s dummy. Sterilise will ever need or want a bottles, teats and dum- dummy. mies in boiling water un- It may be wise to wait until your baby is six til you feel breastfeeding is months old. After- well established and your ba- wards, washing with by has adopted a good tech- warm water is suffi- nique before trying a dummy. cient. Make sure the Rather than automatically of- hole of the bottle-teat is fering the dummy, wait for not too large or your baby is your baby to be fussy or dis- liable to suck excess air contented and in need of which in turn will cause soothing. Once the baby tummy trouble. The hole has fallen asleep, take the size is correct when the dummy gently away. If milk flows out in drops. u

Baby care 63 Hygiene

Baby urine and stool Babies have an active metabolism and may and an absorbing insert. There are one- wet their nappies a dozen times a day. The piece nappies, pocket models and nappies frequency of bowel movements varies in- where each layer is separate. The cotton dividually. Some babies have bowel move- squares in the maternity package are suit- ments several times a day while others on- able for a newborn. Change the cloth in- ly a few times per week. For the first cou- sert frequently, otherwise your baby might ple of days after the birth, your baby will feel uncomfortably wet. To make the nap- pass a sticky, greeny-black substance pies leak proof, you need to fasten them called meconium. After a short while the properly. Fibre cloth inserts transfer mois- stools will turn brownish or yellow. ture into the absorbing portion of the nap- Normal stools smell sour but not un- py and stools wash off these more easily pleasant. Often the stools of breastfed ba- than from cloth. The outer part of the nap- bies are greenish and runny. This is not a py does not need frequent washing, only symptom of diarrhoea. If your baby has di- the absorbent inserts must be washed after arrhoea, the stools will have a terrible each use. Woollen nappies are particularly smell and be completely absorbed into the warm and breathable. When opting to use nappy, leaving a green stain. reusable nappies, you will need at least 20 inserts and a couple of nappies per size. Nappies For more information, please refer to Disposable nappies are very convenient to the nappy guide in the maternity package or use, but expensive over the two or three the Internet (www.kestovaippayhdistys.fi). years that your child is in them. Slow to decompose, disposable nappies burden the environment. The advantages of disposable nappies include very good ab- sorbance, leaving the baby’s skin dry and thus preventing the risk of nappy rash. If your baby has sensitive skin or severe nappy rash, disposable nappies will facilitate skin care. There is a large variety of nappies to choose from. Inside reusable nappies there is usually a layer of surface-dry cloth

64 Baby care Nappy changing Change your baby’s nappy about as often Bathing is recommended every 2 to 5 as you feed him - newborn babies wet days. More frequent bathing will dry the their nappies frequently. Rinse your baby’s baby’s skin. Soap is not necessary since it bottom with warm water (soap is seldom will only remove the baby’s natural oils needed). Carefully dry your baby’s bottom. and cause the skin to dry. If your baby has Apply a barrier cream after washing. Use a very dry skin, add a drop of oil to the bath basic lotion. Do not rub it in forcefully, but water. Do not use bathing salts. Never pat it gently onto your baby’s skin. bathe a sick child, a quick wash will be suf- Washing is not required during each ficient. nappy change. Change nappies as soon as If the baby’s nappy was dirty, wash its you can to protect your baby’s skin from bottom before bathing. Wash the new- the irritating effect of urine and stool. If born’s face separately with a cotton pad your baby has very sensitive skin, change and lukewarm water. Wash the eyes from nappies frequently and apply barrier the outer side towards the inner corner cream upon each change. Should your and clean the baby’s ears (from the out- baby’s bottom become red or sore when side). Do not dig into the ear canal or nos- you have been using reusable nappies, try trils as they are very sensitive and are usu- using disposable nappies for a while. Also, ally cleaned naturally. be sure to rinse the reusable nappies very At first the bathing time will be very carefully. short, but after a couple of week babies Let the baby be without a nappy every usually start to enjoy bathing and are hap- now and then as constant dampness only py to take longer baths. Often babies find irritates the skin more. Let him or her have bathing very soothing. Bathe your baby us- a good kick without a nappy in a warm ing calm, confident movements. Avoid place. If your baby’s skin has spots or the sudden movements which will alarm the skin is broken, sprinkle baby powder or baby. Take care the baby does not swallow potato flour over the area. For further in- any bath water. There may be times when structions, contact your child health clinic. your baby will refuse to bathe. Do not force bathing. You can take a break and wash the Bathing baby using other methods. Your baby will need a bath tub that is not Make sure your hands are warm. Take used for any other purpose. This will help off your watch, rings and bracelets to avoid to prevent skin complaints, for example. scratching your baby. Place the baby’s Bath water should be at body temperature clothes somewhere warm, on a radiator, (37°C). Check the temperature using a for example. Warm the bath towel either thermometer. on a radiator or by tying it around your

Baby care 65 own waist. Lift the baby out of the tub and need to turn it over for washing. Later, you wrap it inside the warm towel. can proceed as follows: Holding your baby: Hold the baby Wash the tummy side first. Then turn with its back on your arm. Support the ba- the baby onto its tummy by taking hold of by’s head and neck with your arm and the baby’s upper arm with your free hand grasp its arm, placing your hand just under and turning it gently over. Keep your ba- the armpit and hooking your thumb over its shoulder. This will give you a firm hold of the baby. BATHE YOUR BABY USING CALM, Bathe your baby from the head down- CONFIDENT MOVEMENTS . wards. With your free hand, gently wash your baby’s head taking care not to splash water into its eyes. Wash its neck, armpits by’s arm in a firm grip but do not use ex- and folds in the skin with special care, as cessive force. Wash your baby’s back side they tend to gather lint. from head to toes. If you didn’t use soap, At first, many mothers and fathers are separate rinsing is not necessary. nervous about bathing their baby and es- When you’ve finished, take your baby pecially about turning the baby onto its out and pat him or her dry with a towel. tummy. However, until the baby’s muscles Use your baby’s own towel. Pay special at- develop and it can lift its head, there is no tention to the elbows, knees, armpits and

66 Baby care other creases. If your baby’s skin is smooth child’s hand as you trim its nails. If your and does not seem dry, there is no need for baby is restless or fussy, wait for a better body lotion. If the skin is dry or red and moment. chapped, apply a thin layer of baby barrier cream. Sauna Do not take a baby under six months old Hair, scalp and nails into the sauna. Under six months old, ba- Wash your baby’s hair during the bath. bies cannot control their body temperature Many babies develop cradle cap, an oily, by sweating. If your baby enjoys a sauna yellowish crust on the newborn’s scalp. To when it is older (6 to 12 months), you can remove the crust, apply basic lotion or ba- sit with it on the lower bench if water is by oil to the scalp and let it soak for a few not thrown on the stove. Splash lukewarm minutes. After washing the baby, scrape water over the baby’s head. the crust gently off using a baby brush or comb. Brush the baby’s hair daily. The soft Laundering your baby’s clothes spots on the baby’s head where the skull The best detergent for washing baby has not yet fused (fontanels) do not need clothes is fragrance-free or only mildly special attention. scented. Wash new baby clothes before The nails of a newborn are often too they are worn for the first time. When long. However, due to the risk of cuticle measuring the detergent, follow the in- infection it is not recommended to trim structions on the detergent carton to en- your baby’s nails during the first week. If sure clean clothes without traces of deter- you worry about scratching, use cotton gent. Using extra-gentle detergent will mittens on its hands. leave the clothes extra soft. Nappies in Trim your baby’s nails after about one particular must be washed and thoroughly week. A good time to check if your baby’s rinsed to remove all detergent. For more nails need trimming is after a bath. To keep information on washing clothes, please re- it from wriggling, keep a firm hold of your fer to the maternity package leaflet.u

Baby care 67 Sleep

During the first weeks, most babies sleep Sleeping position through most of the time they are not According to current research, placing your feeding. The safest position for a newborn baby on its back until he/she is able to turn is on its back. At first, your baby will wake over independently reduces the risk of cot up 2 to 3 times a night for feeding. At two death, or SIDS (sudden infant death syn- weeks, babies usually start staying awake drome). to socialise for longer time periods. A three-month-old is awake for 6 to 8 hours Cot toy a day. Try to teach the baby a sleeping pat- At a few months old, many babies like to tern that matches the sleep-wake rou- have a soft toy or blanket to cud- tines of the other members of the dle when they go to bed. family. Sleep is a form of part- ing and may sometimes Settling to sleep be difficult to to endure When you’re trying to settle your ba- for the baby. A soft toy or by to sleep (or back to sleep after a blanket will help soothe night feed) be careful not to ex- your baby to sleep. Re- cite it. Loud voices, bright lights member the cot toy and playing with the baby by when your baby is stay- trying to make it laugh will wake ing overnight some- a baby that was already half asleep. where else or when Rocking the baby in your arms and hum- someone other than a parent puts it to ming quietly will help your baby fall bed. During changes such as weaning, the asleep. It is not necessary to hold your ba- cot toy provides comfort and security, sub- by until it is fast asleep. Instead, you can stituting to some extent for the carer’s put it to bed when it’s sleepy and relaxed, presence. but still awake. Prams are the modern alternative to Sleeping problems cradles and swaying the pram or moving it Tummy troubles and wind are the most back and forth will help your baby fall common reasons for sleeping problems. asleep. Watch your baby for signs that it is- Sleeping problems may also be caused by tired. Putting your baby to bed while it is letting the baby stay for long periods of wide awake and sociable will not make it time in bed while awake. On the one sleep. You can’t force sleep, but you can en- hand, not receiving sufficient attention tice it. A dummy, a blanket or a musical toy during the day may lead the baby to de- may prove comforting. mand its share at night. On the other, excessive stimulation and too much atten-

68 Baby care tion will prevent the baby from sleeping the fresh air enhances deep, sound sleep. and it will become overtired. In addition to Summer babies can be put outdoors to care and attention, babies also need peace sleep during the first week. Place the pram and quiet according to their individual in a cool, shady place and make sure it needs. cannot tip over or start rolling downhill. A child’s sleep is often disturbed when Draping a mesh net over the pram will it learns to crawl and walk. Excited by new protect your baby from insects and other experiences and skills, the baby is slow to animals. relax and calm down. Changing from crib In the winter, wait until your baby is to cot may also cause sleeping problems. If about two weeks old before starting to sleep it the baby is used to sleeping in a crib, try outdoors. Do not sleep your baby outdoors if draping the sides of the cot to pacify it. Ba- the temperature is under -10°C. In cold bies do not usually require absolute silence weather, be careful not to apply cream or lo- in order to be able to sleep, but it will be tion containing water to your baby’s cheeks as prove to be difficult to sleep if the televi- it will freeze and damage the skin. Tuck the sion is blaring. Falling asleep in a very light baby tight inside its sleeping bag and check room may be difficult for older children in that its cheeks stay warm. The baby can sleep particular. outdoors a little longer every day until it eventually takes all day-time naps outdoors. Night-time nappy changes In rainy and windy weather, put the hood If your baby needs changing during the up and pull a rain cover over the pram. Place night, be as quick as possible and then re- the pram in a sheltered place. Strong wind turn it to bed. Keep the lights dim and will make temperatures below freezing even speak softly, but do not engage in play that more chilly. During the spring and summer will stimulate the baby. Otherwise, nightly months, take care not to place the pram in di- entertainment will become a habit. rect sunlight in order to protect the baby from heat suffocation. Sleeping outdoors Discuss sleeping a preterm baby out- Many babies sleep best outdoors where doors with your child health clinic’s nurse. u

Baby care 69 Growth and development

Children develop in their own time Children develop in their own time according to their genetic and environmen- tal influences. The following table depict- ing child development provides a rough guide as to the order and age in which children will reach a certain stage or learn a particular new skill. However, there is great variation between different children. The same child may be fast to develop in one area and slower than average in another. Sometimes several new skills may be learned in a single week, and these same skills then practiced over the following weeks. Noticing and being happy about how more important that the baby is develop- your child grows and develops and offering and that things are not completely for- ing support and encouragement in learn- gotten once learned. ing new skills is very important to the Problems at birth or later infections healthy development of your child. When may slow your baby’s development. For your baby has just learned how to roll over, this reason, a, the so-called corrected age play with it on the floor instead of sitting it is applied when assessing the develop- in the baby bouncer. Allowing the baby to ment of preterm babies. grasp objects that interest it is a kind of di- alogue with the baby. You can try to allure Children are born unique a baby who is slow to warm up to new Each baby has his own, unique features things, but too much ambition and paren- and habits which are permanent. These tal desire to speed up the baby’s natural personal traits are called temperament. course of development may be harmful. If Temperament includes characteristics such the baby is overweight, stabilising its as patterns (sleeping pattern), patience, weight curve may promote its motoric de- calmness, activity, restlessness and the velopment. Making comparisons between ability to adapt and concentrate. Different different children is seldom fruitful. It is moods such as being irritable or prone to

70 Baby care negative feelings, curiosity, courage and When you are holding your baby, for ex- being shy or reserved in new situations are ample, it will feel his own weight against also components of temperament. From yours. Such experiences will gradually the parents’ viewpoint the child may have a make it aware that it is an entity separate sweet or difficult temperament depending from its environment. on how easy or demanding the baby is. Height and weight The baby enjoys company At birth, babies usually weigh 3,000 to Your baby will closely observe its environ- 4,000 grams and are 49 to 52 cm tall. Dur- ment from birth. There are many things it ing the first few days their weight drops by will only be able to learn from others and 6 to 8%, but is regained in a couple of your company is therefore very important. weeks. Afterwards, the weight should in- To secure your baby’s healthy develop- crease by 150 to 200 grams per week. By ment, you only need to do what comes the age of one year, most children weigh very naturally to most parents: talk to the roughly three times their birth weight (10 child, hold it, rock it in your arms, move its to 12 kg) and are about 1.5 times as tall arms and legs, sing, hum, show it the (73 to 80 cm). things in your home, introduce it to other However, there is great variation in people etc. There is no need to ”train” your this. A newborn can weigh anything be- baby or invent abundant stimuli. tween 400 and 6,000 grams and future growth and development expectations de- Allowing for the baby’s needs pend on the birth weight. Growth charts To secure your child’s development, allow are an important tool when monitoring for its needs and show that you accept and your baby’s growth and its relation to the love it just the way it is. Feed your baby size of the parents. when it is hungry and let your baby sleep when it is tired. If your baby shows interest Learning to talk in some object, encourage him or her to One of the most important things a child examine it. Since your baby will mainly ex- learns from others is how to speak. Before amine the object with its mouth, make learning to talk, it will need to hear people sure that the things you give it are safe. talking. Therefore, it is vitally important that you talk to your baby. At first, your Babies are strangers to themselves baby will respond with baby sounds. At During the initial months, the baby’s con- six months, your child may know a few cept of itself is very vague. It cannot distin- words even though it cannot speak yet it- guish itself from its environment, and self. It may, for example, know how to thinks it is part of its mother and the sur- point to its own mouth if asked to do so, rounding environment. The baby is not provided the parts of its body have fre- fully aware that its hands and legs are part quently been pointed out to it. At 7 to 8 of it, but that its mother’s breast and its months, your baby will start to repeat syl- own blanket are not. In order to discover lables and will be able to chatter by itself its boundaries, it will need your help. for long stretches at a time. Children nor-

Baby care 71 Age Sociability Movements Hand movements Eye sight and speech and hearing

0-1 random, moves arms hands mostly cannot see months involuntary and legs clenched in a fist clearly, starts at smiles, direct simultaneously loud noise and eye contact bright light

2-3 first real smile, holds head up, catches hold of turns head months makes baby kicks with things using both towards sound, sounds (ah, goo), both legs hands, studies follows moving is sociable simultaneously own hands object with eyes

4-6 laughs out loud, pushes arms up picks things up recognises a months recognises the straight, turns, with one hand, picture of a face, person caring sits supported palm grip studies colourful for him, first images attemps at play

7-8 distinguishes sits without moves toy from no longer months between familiar support, rolls one hand to squints, and unfamiliar over, crawls the other, seeks hidden people, knows (sometimes pats table with objects 2 to 3 simple backwards) hands words, repeats sound s such as dadada etc.

9-10 is shy of crawls on all fours, picks up objects looks at images, months strangers, pulls up to stand between thumb notices objects first words and walks with and forefinger sized 1 to 2 cm support

11-12 can say 2 to stands with throws objects turns towards months 3 words, support, about, a whisper, interested in first steps claps hands recognises objects other children from images

72 Baby care mally utter their first word when they are may have developed in many ways. By 10 to 13 months old. singing, playing, looking at picture books Speech is central to the child’s devel- and reading fairy tales - just to mention a opment. Being able to express itself in few. There may come a time when the bi- words and understanding speech help it lingual child refuses to use one of the lan- gain a better understanding of the world. guages. This may be a real trial for the par- A child who understands what is said to it ent concerned. Nevertheless, continue is easier to guide and will learn things speaking your own language even if your more quickly. In many instances, a child child does not answer in it. who can talk and has a large vocabulary Learning two languages takes more will perform better than other children. time and effort. Be patient and give the Just talking to the baby is, however, not child time. Also, show that you are inter- sufficient for teaching it to speak; you need ested in both languages. For more infor- to have a conversation adapted to the situ- mation on bilingualism, contact your child ation and feelings at hand. In practice, this health clinic. For more information on the might be interpreting the baby’s feelings Swedish language, contact Swedish lan- aloud, putting questions to the baby and guage day care centres and the Swedish explaining things. Use rich, versatile and Assembly of Finland (Svenska Finlands correct language when talking to a baby. Folkting, www.folktinget.fi) Besides baby talk, your child needs to hear ordinary speech in order to learn to pro- Sight nounce words correctly. A newborn does not see very clearly. What it sees best are the eyes of a person close Bilingual families by. Babies enjoy looking at things. Hang If you and your partner do not share the colourful objects (such as pieces of cloth) same mother tongue, you may be consid- or a mobile about 50 cm above the crib. ering having your child grow up bilingual. The baby enjoys seeing them move, but re- Children are usually able to learn two lan- member to remove them when it is time to guages, provided that their parents are go to sleep. The baby will first learn to rec- willing to invest some time in teaching the ognise human faces. A 3 to 4-month-old child and know how to go about it in the enjoys looking at a very simple, smiley face. right way. For the child’s linguistic devel- Most babies squint during the first months. opment, it is vital that it learns to distin- However, their sight develops fast and the guish between the two languages. Both child enjoys observing its environment. parents must consistently speak only their Babies usually find pictures of familiar own mother tongue with the child. In their everyday items very interesting. You can discussions with each other and other start ”reading” picture books with a people the parents may use the language 2-month-old, but if it is not interested, they are accustomed to. stop and try again a few weeks later. Chil- Usually, one of the languages develops dren only learn through curiosity; forcing more quickly than the other. By the time things on your child usually only serves to your child is a toddler, its linguistic skills slow down this process.

Baby care 73 You can make your own picture books Touch and grasping by cutting simple pictures out of maga- The mouth is the baby’s most sensitive zines, gluing them onto cardboard and body part. Babies explore the world covering the pages with adhesive plastic though their mouths by sucking on every- film. Your baby will also be delighted with thing they can reach. A newborn holds its its own little photo album with pictures of hands clenched in a fist. Later, its hands mum and dad, its sisters and brothers, will relax and the fingers splay out. At the grandparents and other familiar people. age of 2 to 3 months, babies start grasping Babies are especially interested in por- objects with both hands, putting them in- traits. to their mouths. Make sure that the things your baby can reach are not toxic or dirty, Hearing and that they are big enough not to suffo- Newborn babies have very good hearing. cate it (avoid string, rubber bands, buttons Most babies can recognise their mother’s etc.). and father’s voice before the age of two When a little older, the baby will grasp weeks. By 2 to 3 months, the baby will start an object with one hand and move it from turning its head towards a sound, but will one hand to the other. A further develop- not be able to hear whispers until towards mental stage is for the baby to pick up ob- the end of the first year. Babies are easily jects between its thumb and forefinger. startled by loud noises. This is called the pincer grasp. Play with Babies usually enjoy music and are an appreciative audience for any musical per- formances by other family members. Do not hesitate to make up your own songs, however silly this might feel. And your baby won’t mind even if your singing or playing is somewhat off pitch. By the time they are a few months old, babies are aware of rhythm and dance and jiggle in time to music. However, do not leave a ra- dio or television on all the time. Constant noise is stupefying and makes music less enjoyable.

Sense of smell Newborns have a keen sense of smell. Ba- bies smell breast milk which helps in finding the nipple and starting to feed. When the baby is fussy at night and feeds at frequent intervals, it might sleep better when its father is holding it and the smell of milk doesn’t activate the feeding instinct.

74 Baby care different textures, letting your baby touch not to let your baby be in a baby carrier, a smooth, hairy, soft and hard surfaces, feel baby swing or walker for extended periods wood and stones etc. In this way, your ba- at a time. Being in the same - possibly in- by will learn what the world feels like. correct - position for a long time is a strain on your baby’s back and hips. If you wish Toys to promote your baby’s development, al- You can make baby toys yourself. Under low it to be on a blanket that is spread out two-year-olds like to play with rattles, soft on the floor as much as possible. toys and balls. Many of your household Babies enjoy being held, bounced and items are suitable as toys, such as plastic lifted, and like swinging and having their containers and their covers, empty plastic hands and legs moved. However, babies bottles, scoops, cotton reels and so on. do not enjoy sudden movements, loud noises and rough handling. For more information on how to encourage your ba- Make sure they do not have: by’s motoric development, contact your u sharp edges, child health clinic. Many gymnastics asso- u little pieces that can become loose, ciations organise parent and baby fitness u toxic paint, classes. Baby swimming is also a fun form u strings or bands, or of family time. The ideal time to start is u anything that will break or crack. when your baby is 3 to 5 months.

Movements Take notes and pictures Your baby will start lifting its head during It is interesting for both the parents and the first months. It will learn how to turn child that its development has been docu- onto its tummy at the age of 3 to 5 months mented in notes and pictures and by sav- and sit up at the age of 6 to 8 months. Af- ing early drawings and toys, for example. ter 6 months, your baby will start crawling Parents caring for their first baby often im- on its tummy. Some babies may start by agine they will remember until their dying crawling backwards. A short while after days what their child did and what it this, your baby will learn to crawl on all looked like at every age. Yet the details are fours and will be very quick at moving in fact soon forgotten. Therefore, it is a around. At 7 to 9 months, your baby will good idea to write down some of the mile- pull itself up to stand using support, and stones, such as when your baby had its succeed without support after a few first tooth, how it chattered, what made it months of practice. About one in every two laugh, which books and toys it liked, what babies takes its first steps before its first its first words were etc. If you take pictures, birthday. remember to mark them with a date and You can sit your baby in a baby bounc- the child’s name. When there are more er for short periods at a time as long as its children in the family, it is not always easy position is relaxed and its head is support- to remember later who was in the picture ed. A car safety seat is not a baby bouncer and when it was taken, or which of the and should only be used in the car. Be sure children used a funny word. u

Baby care 75 Daily routines

New challenges Being a new parent is a wonderful, happy the working day you still have time and experience, but it also means facing new energy to enjoy your family. challenges. Your daily routines need to be Avoiding major changes and ”projects” rearranged, requiring cooperation from all during the early months with a new baby members of the family. The baby cannot be will make family life much less demand- left alone anywhere and its needs must be ing. Most things can be postponed, but attended to. You can take your baby along caring for your baby cannot. Of course, it is to most places, as long as you are able to not always possible to anticipate overlap- accommodate its sleeping and feeding ping changes such as moving to a new patterns. When you have a baby, you need home or sickness in the family. However, to accept certain limitations. Leaving the the fewer major distractions there are, the house will generally take much longer easier it will be to arrange your time and than before. You need to plan and then daily routines. pack the baby gear accordingly, and just as All in all, you will need to pay more at- you’re ready to step out your baby may tention to how you are spending your need a feed or nappy change. time. Your friends and relatives can be of Caring for your baby comprises repeti- great help when you need the occasional tive routines which enhance the baby’s helping hand, but most arrangements sense of security, but which are very bind- must be negotiated within your own fami- ing for the parents. Feeding, burping, ly. You will need to agree on ”my time”, changing, washing and sleeping the baby ”your time ” and ”our time”. often interrupt other activities. This can Be patient. Taking care of a baby in- sometimes be very frustrating. Although volves routines and changes. On the one rewarding, caring for your baby can also be hand, it is the parent’s job to create a exhausting, especially if your baby wakes sense of stability and security for the baby. up many times per night leaving you with Yet on the other, parents need to adapt to insufficient sleep, cries a lot or has a de- the constant changes as their baby grows. manding temperament. Both parents must be flexible and adapt During the baby’s first year, it is very quickly to the big and small changes in important that both parents have some daily routines. It is important that neither time to themselves to rest and enjoy a of the parents expects the other - nor hobby or sport, for example. However, do himself or herself! - to carry on with the not fool yourself into thinking that you can same responsibilities as before the baby’s participate in activities and go out with birth. friends as actively as before. Also try to If you begin to feel that your daily balance work and family life so that after tasks and chores are becoming a burden,

76 Baby care try to divide them into tasks that can be may be very enthusiastic and eager to par- left for later and tasks that must absolute- ticipate in caring for the new baby, while ly be done now. In addition to caring for also being jealous. Children’s feelings of the baby, you need to save your energy for jealousy have been compared to a situa- caring for yourself and your relationship tion where your partner would bring home with your partner. Do not make unreason- a new husband or wife. able demands on yourself or on your part- Due to such jealousy, older children ner; perfection is not a requirement for may be very angry at the baby, whereas good parenting. Remember that your life others may start pretending to be babies need not be a sequence of exhausting rou- themselves. Such reactions include want- tines. Little surprises and shared moments ing to sit on your lap when you start feed- with your partner will break up the routine ing the baby. An older child may start wet- nicely. ting its pants again and demand to be treated like a baby. The child may become Brothers and sisters tearful, demand a dummy, want to sleep When the baby arrives, your older children beside the parents or be very quarrelsome. may suddenly seem very competent. Do An older child may try to hurt the baby not expect them to suddenly be more ma- by hitting or pinching it. Naturally, broth- ture just because they seem so much big- ers and sisters cannot be allowed to tor- ger than the baby. A new baby in the fam- ment the baby and you must put and end ily is a change for the older children as to such behaviour very determinedly. The well, not just for the parents. For some, the child may also express hopes of the baby most trying time is when the baby is born, dying or being given away. This may sound while for others the difficulties begin when terrible to the parents, but it helps the the baby starts moving around. The child child to let off steam. This stage passes

Baby care 77 more quickly if the parents understand the nurture while mum or dad is looking after older child’s pain and find the time to lis- the baby. ten. When your child says, ”I wish the ba- Refer to the baby as ”our baby” to em- by were dead”, you can reply by saying, for phasise that the baby is a family member. example, ”I know you’re angry with the Remember to frequently tell your children baby and wish it had never arrived. Do you that you love them and that they are very feel like I’m not spending enough time important to you. Praise the older children with you? I love you just as much, but I do for the things they can already do and need to take care of the baby as well”. which the baby is only just learning. Older children may be cross just because the parents no longer spend so Support networks much time with them - which is true. This In addition to your relationship as a cou- passes more quickly if they are allowed to ple, the new baby has an impact on other pretend at being a baby for a while, al- people as well. A new baby creates grand- though this may feel like a nuisance. Make parents, aunts, uncles, cousins and god- an effort to spend time with the new big parents. Parenthood is an experience that sister or big brother. Set aside a time of the binds different generations but also poses day to be with him or her while the baby is new challenges. Society as well as beliefs sleeping or with the other parent. Also, al- and views on child rearing and baby care low the child to participate in taking care have changed over the years, which may of the baby. He or she can sort out the ba- create conflicts between the new parents by’s things or hold the baby while sitting and the older generation. Despite the on the floor, a chair or on the sofa. Give number of differences there are also many the older child a baby doll which it can opinions that are shared. When you become a parent, you begin to view your own parents from a new perspective. At best, the relationship is one of mutual respect. Becoming a parent often stirs up feelings and memories from your own childhood. Talk about them with someone and, if they are very distressing, seek professional help. In many families, grandparents are naturally an important part of the family and are glad to participate in caring for the baby. Often, caring for their grandchild brings back memories from the time their own children were small. It is often easier for grandparents to dote over their grandchildren than they did their own children. If doting

78 Baby care turns into spoiling, it may cause friction families have close relatives living nearby between the parents and grandparents. and even if they do, they may be very much Tactful grandparents will understand that engaged in their work and social life. In the young parents need to make their own such cases, the availability of other forms of decisions, and will not interfere unless in- support is particularly important. Families vited to do so. In conflict situations, each with young children can agree to babysit parent should carefully broach the subject each other’s children. In many locations, with his or her own parents. organisations such as MLL (the Manner- heim League for Child Welfare) and Short-term child care Väestöliitto (the Family Federation of Fin- Friends and relatives can offer invaluable land) offer short-term child care for a fee help when the parents have something (see ”Organisations” on page 94). u they both need to attend. However, not all Accidents often take place in the home. Safety

For safety in the home, read the following table, ensure that he or she cannot pull hot precautions. drinks or hot food onto him or herself and be scalded. Never leave a child unattended u on a changing top or a bed without Always place the following out sides. of reach of children u in a bath. Always make sure the water is not too hot and that hot water u plastic foil and plastic bags does not drip from a leaking tap on- (risk of suffocation). to your baby’s head. u sharp or fragile objects. Place knives u in a room where a window or balco- and other tools out of the reach of child. ny door is open. Place guards on the Use locks or guards on cabinets and windows. drawers. If this is not possible, tie the cabinet doors and drawers with string u in the kitchen when something is or remove all handles. cooking on the stove or in the oven. Always turn pot and pan handles in- u cigarettes, alcohol, medication, cleaning wards. Buy a cooker guard to cover agents, paint, detergents, insect repel- the stove’s burner knobs. lent and other toxic materials. If your baby is sitting on your lap at the u nails and other thin objects the child

Baby care 79 might stick into electric outlets. Use to the pram. u plugs in unused outlets or install safety sockets. Safety in the car u toys with small, loose parts and button u The safest place for a child aged 1 cell batteries which can block the to 3 years old is a rear-facing baby child’s airways. seat. Just hitting the brakes can be enough for your child to be injured. Check that your baby gear, such as the u Fasten baby and child seats accord- changing top and pram, are safe and in ing to their instructions. Children good condition. must travel with the appropriate Be aware of any heavy objects the child restraints and sitting in their own could pull on top of it from the table or seats (travelling by car sitting on an shelves. Make sure the child cannot over- adult’s lap is forbidden). Never use turn the bookcase. rear-facing baby seats in a seat fit- Keep a keen eye on your child when ted with an active front airbag. An you are visiting. If your hosts do not have inflating airbag can be life threat- young children, they will most likely not ening to a baby. be prepared for little explorers eager to touch and taste everything. u Never leave your child unattended Never leave a child who can move in the car. On a very warm day in around alone in the pram. It could climb particular, this could be fatal. out and fall. Make sure no animals get in-

80 Baby care Starting supplementary food

Exclusive breastfeeding is recommended for the first six months, if possible. At six months you can start introducing solids into your baby’s diet, but it is recommended that you continue breastfeeding until your baby is 1 year old or beyond, if you both enjoy it. However, a one-year-old will receive all the necessary nutrients from other foods and his or her digestive system will be ready for other nutrition in addition to breast milk or formula. Once your baby has reached its first birthday, you can begin to give it skimmed milk and milk- based foods. The correct time to start introducing solid foods into your baby’s diet depends on its growth and overall development, and breastfeeding. However, you should not wait long after your baby has turned a time as this can help identify food aller- six months to supplement breastfeeding gies or intolerances. At the age of six with other food. Delaying solids may cause months, offer your baby puréed food at eating problems and slow its growth. several meals. If your breast milk is scanty, you can Getting used to solid foods takes time, start introducing solids at the age of four so be patient. If your baby refuses a new months. To ensure breastfeeding, it is rec- food, try it again a few days later. Do not ommended that you give puréed food in- rush things - your child is slowly learning stead of bottle-feeding formula or baby ce- to eat and getting used to new tastes and real. If you are not breastfeeding, begin textures. supplementing formula with solid foods at Start by offering puréed potatoes, veg- the age of 4 to 6 months. etables, fruit or berries. You can make a large amount of purée at once and freeze Introducing new foods into your suitable portions, for example in an an ice baby’s diet cube tray. Try adding 1 to 2 new foods every week. Meat, fish, poultry, eggs and baby cere- Start by offering your baby small quantities als should not be introduced until your ba- at first and then gradually increase the by is five months old. When you start in- portion. It is wise to introduce foods one at troducing solids at the age of six months,

Baby care 81 move from one food group to the next af- Vegetables and potato ter trying 1 or 2 different foodstuffs: after Mild in flavour, mashed potato is a good starting with two different vegetables, food to begin with. Introduce other vege- move on to meats or cereals. In this way tables into your baby’s diet gradually. you can ensure a varied selection of foods Serve vegetables boiled and puréed. Wash that meets your baby’s growing needs. the potato/vegetable well and cook it in When you return to fruit and vegetables, water. Do not add salt. Purée or mash the try something new! potato/vegetable using a fork. Add boiled When you are cooking, set aside a water or breast milk. small portion for your baby before adding Cooked vegetables can gradually be spices (salt), and purée it if necessary. supplemented with finely grated raw veg- When your baby begins teething, mash the etables and purées. In this way, your baby food more coarsely to promote chewing. will get used to a wide variety of vegeta- Towards the end of its first year, your baby bles. Suitable vegetables include carrots, can start eating the same food as the rest cauliflower, courgette, sweet corn, sweet of the family. potato, cucumber and tomatoes. Do not

Age and food

0-4 over 4 months over 6 months over 8 months over 10 months months

Depending on Solid foods Coarse mash Same as rest the baby, new for everyone, and new foods: of the family or foods puréed: puréed: - potatoes, coarse mash: - potatoes - potatoes vegetables and - baby cereal, bread - vegetables - vegetables meat/fish - potatoes - berries - berries - baby cereal - vegetables - fruit - fruit - berries and fruit - raw vegetables - meat or fish - fine grated raw grated over 5 months: - baby cereal vegetables - berries and fruit meat or - meat and fish baby cereal - dairy products and milk-based foods Vitamin D supplement in all age groups, according to instructions .

82 Baby care offer babies under 12 months Chinese Dairy products cabbage, swede, turnip, beetroot or spin- Towards the end of your baby’s first year, ach because they are rich in nitrates. you can start giving him/her dairy products. Start with cultured dairy products Fruit and berries such as low-fat or non-fat curdled milk, All fruits and berries are suitable. Serve natural yoghurt or buttermilk. During them puréed, grated or as a compote. Fa- meals, your child can drink skimmed milk. vour domestic berries. Wash and peel im- ported fruit carefully before use. You can add a moderate amount of sugar or fruc- GETTING USED TO SOLID FOODS tose to sweeten sharp or sour fruit and TAKES TIME, SO BE PATIENT . berries. However, take care that your baby does not get used to very sweet food. Hon- ey should not be given to children under one year of age. Fats Rapid growth demands a lot of energy. Meat, fish, poultry and eggs Breast milk and formulas are rich in fat. From five months at the earliest, add a When the child starts eating the same small amount of finely chopped meat, food as the rest of the family, choose soft chicken or egg (one teaspoon) to the pota- vegetable fats. As the proportion of solid to or vegetable purée. Serve fish only 2 to 3 foods in the child’s diet increases and they times a week because of the oily fat it con- start drinking skimmed milk, their fat in- tains. For under one-year-olds, 1 to 1.5 ta- take decreases. Add a small amount of blespoons of meat or fish per meal is suffi- cooking oil or soft vegetable fats (2 tea- cient. Liver is not recommended for under spoons per day) to your child’s porridge, one-year-olds because of its high vitamin for example. A content. Salt Baby cereal and porridge Do not add any salt to your baby’s food Ideally, offer your baby full grain cereals during the first year. Avoid foods with a cooked in water without salt. Add puréed high salt content such as sausages, cold fruit or berries for taste. In addition to cuts, marinated meat/poultry, ready-pre- homemade porridge, you can give your pared foods and cheese as they also con- baby commercial baby cereals. Breastfeed tain high levels of additives and preserva- or bottle-feed your baby after a porridge tives. meal. From six months, part of the formula Vitamin D can be replaced with commercial baby ce- Children need supplemental vitamin D real. Commercial baby cereals are not rec- from two weeks until three years of age. In ommended for children under five months Finland, supplemental vitamin D is also in order to maintain breastfeeding.

Baby care 83 recommended for children over 3 years old during the dark months (October through March). Enquire about the dosage instructions from your prenatal clinic or chemist. Teething The first teeth (milk teeth) appear when the baby is about six months old. Children will usually have all their 20 milk teeth by the time they are three years old. With proper care, your child’s teeth can be kept healthy and totally free of decay. Keep harmful bacteria in check by controlling your child’s sugar intake. Start to brush your baby’s teeth as soon as they appear. You will receive advice on the need for fluoride from the prenatal clinic. u

When the baby is ill

Common colds and stuffiness of the nose Newborn babies breathe through their Stuffiness will pass with time, but nose. If the nose is stuffy, feeding be- some children tend to get milk up their comes problematic as it is difficult to nose while feeding. Accompanying stuff- suckle and breathe at the same time. In iness, yellow mucus can build up in the maternity clinics, saline drops and some- corner of the eye and the eyelids may times a small pump to remove mucus are stick together as blocked tear ducts pre- used to relieve stuffiness of the nose. Sa- vent normal flow. If stuffiness continues, line drops may help feeding at home – af- contact your doctor as prolonged stuffi- ter a good sneeze your baby’s nose will be ness may cause ear infections, even in ba- clear. bies.

84 Baby care Some babies sound wheezy, particu- without fever may be a sign of an ear in- larly after feeding, until they are about fection or feverless pneumonia. one year old. This is due to their soft windpipe cartilage. A baby may experi- Fever ence its first viral infection early on if fa- On average, under three-year-olds have 5 to 6 common colds or respiratory infections per year. Give your child antipyretics VACCINATIONS PROTECT THE CHILD (drugs that reduce a fever) if he or she is FROM INFECTIOUS DISEASES . running a fever and his or her food and drink intake is inadequate, or the child is restless, irritable or in pain, or if the tem- mily members are suffering from colds or perature rise is significant (38.5°C to the baby is born during an epidemic. Sa- 39°C). Paracetamol in the form of a syrup line drops, nose drops, an elevated posi- or suppositories is available from the tion and frequent feedings will make the chemist without prescription. The usual baby feel better. See your doctor if your dose of paracetamol is 10 to 15mg per kg baby is very small or your firstborn, or if of body weight every 6 to 8 hours (100 to the symptoms persist. 150 mg if the baby weighs over 10 kg). If a Smoking should be avoided in fami- baby under two months old is running a lies with children, as cigarette smoke irri- fever, see your doctor even if the temper- tates the nose, throat and respiratory tract. ature drops with medication. Contact your Cough Colds are frequently accompanied by a cough. When something irritates the throat, the baby will try to remove it by coughing. Cough drops will help the baby sleep, but will not cure the symptom. Contact your doctor if your baby has a barking cough accompanied by shortness of breath and a high fever, as you may need respiratory medication. A cough following a common cold may last for weeks. A prolonged cough

Baby care 85 doctor if the temperature persists even af- Contact your doctor or health nurse ter giving your baby the correct dosage of without delay if your baby: antipyretic and he/she refuses to drink, or if their temperature is high for several is under 2 months and days without a cough or cold. Hospitals u has a fever, and health care centres provide advice u is not feeding properly, over the phone, especially during epidem- u is sleepy or lethargic, ics. If your baby has feverish convulsions, u cries or is sensitive to being touched, seek advice from your clinic’s nurse or u has trouble breathing or shortness doctor. of breath, or u its urine starts smelling odd. Diarrhoea Baby stools tend to be rather runny and You can also phone the maternity this should not be viewed as a symptom of unit for advice. diarrhoea. During respiratory infections, baby stools are often even less solid than runs a fever over 38.5ºC and norma. If your baby has diarrhoea, their u is irritable and easily startled, stool will have a terrible smell and be u is sleepy and vacant, completely absorbed into the nappy. Diar- u has trouble breathing or shortness rhoea is more serious the younger the of breath, child is and the major concern in such u cries and cannot be soothed, cases is dehydration. When the child has u refuses drinks, diarrhoea, it will lose a lot of fluids that u its skin seems bruised, will need to be replaced by giving extra u has a severe primary disease. drinks, such as water, juice or a special preparation obtainable from the chemist. Contact your doctor when your baby Contact your doctor or health nurse with- is running a fever (over 38.5ºC) if: out delay if your baby is still very young or u your baby is 2 to 5 months old, if diarrhoea is accompanied by prolonged u its temperature is very high vomiting. (over 41ºC), u the baby cries when urinating, Exanthema subitum the urine smells very bad, Exanthema subitum is also known as rose- u a fever has lasted for over 24 hours ola, baby measles and the three-day fever. without any apparent reason, It is a very common infectious disease in u the baby has had fever convulsions children aged six months to 2 years. It is a previously, or viral disease characterised by an abrupt u it has a fever for three days and then high fever lasting three days. As the fever begins running a temperature again. subsides, small spots appear on the baby’s skin. The rash disappears in roughly 1.5 Reduce the fever by giving your child days. Ear infections may occur as a sec- antipyretics (paracetamol) and using ondary illness. damp wraps before seeing the doctor.

86 Baby care Childhood vaccination programme Vaccine Age

DTaP-IPV-Hib I (diphtheria, tetanus, pertussis, 3 months polio, incl. some respiratory and

ear infections)

DTaP-IPV-Hib II 5 months DTaP-IPV-Hib III 12 months MMR I (measles, mumps, rubella) 14-18 months DTaP-IPV (diphtheria, tetanus, pertussis, polio) 4 years MMR II (measles, mumps, rubella) 6 years

Why are vaccinations necessary? Vaccinations protect the child from infec- stead, they have rare but severe secondary tious diseases. Vaccines are given to protect diseases which cause disability, infertility the child against several dangerous diseas- and death. Vaccines contain extremely es such as diphtheria, pertussis (also called small amounts of additives, such as mer- whooping cough), tetanus and polio. Im- cury and aluminium, compared to the proved hygiene and nutrition have had a amounts received in food, for example. The considerable effect in preventing infectious benefits of immunisation far outweigh the diseases, but vaccination has completely very small risk of side-effects. eliminated these diseases from Finland. Vaccines are administered by the Although these diseases are a thing of the health nurse in the child health clinic. In past in Finland, some cases have been re- addition to vaccinations, protect your ported in Sweden, the Baltic countries and child from diseases by avoiding contact Russia. Further abroad, the risk of infection with ill people. Alongside the vaccination is even higher. If the proportion of vacci- programme, your child may be vaccinated nated children decreases, the risk of infec- against chicken pox, hepatitis A or B and tion will also rise in Finland. tick-borne encephalitis, if considered nec- Vaccinations are voluntary. Some par- essary. ents wonder whether vaccinations are For more information on vaccines, necessary and may be suspicious about the contact your child health clinic’s nurse or components they contain. Pox diseases do the National Public Health Institute at not contribute to the child’s health. In- www.ktl.fi. u

Baby care 87 Organising childcare

Parents need to make decisions on child- sense of security is based on the presence care arrangements during the first year. of the primary carer (usually mother or Many families decide to care for the baby father). When separated from him or her, at home for as long as possible. Some- the child becomes distressed. For chil- times, the mother may have agreed with dren, separation causes stress and pro- her employer on a date upon which she longed stress may impede healthy devel- will return to work. In some families, the opment. A stressed child is tearful, clings father stays at home to care for the chil- to its parents and has difficulties adapting dren while the mother returns to work. to day care or accepting the new carer. Childcare arrangements are important to The risk of such problems diminishes the parents and the child. Each family drastically over just a couple of months. needs to find the solution that best suits The child’s cognitive development their needs; no single alternative is opti- and other skills speak highly in favour of mal for everyone. waiting until the child is at least one year old before entering day care. However, Considering day care this is not always possible. In some fami- When considering day care, parents lies, placing the child in day care very ear- should take their child’s developmental ly is the best solution. In addition to fam- stage into account. Once the child has ily finances, parental exhaustion is a very reached its first birthday, many skills start sound reason for placing the child in day to develop fast. It will learn to walk, talk care. (some words at least), eat and drink. Some children will even begin dressing Finding the right alternative themselves. Being in day care is very dif- Choosing the proper day-care solution for ferent for a one-year-old than for a baby your child should be a carefully thought which still needs continuous care and as- out and researched process. Ask for infor- sistance. At the age of one, children usu- mation on day care options available in ally become more interested in other chil- your neighbourhood from your child dren. Although one-year-olds tend to health clinic, municipal officers responsi- play by themselves and rarely engage in ble for day care in the area, private day joint activity, they do notice and enjoy the care organisations and directly from day presence of other children. care centres and other day care providers. When maternal and parental leave Consider in advance the things that are ends, the child is about nine months old. important to you, your family and the This is a particularly challenging time to child, i.e. group size, the ages of the other begin day-care as at this age children are children in care, the carers’ education and very selective in their affection. A child’s attitude, backup resources when the carer

88 Baby care is ill, location, environment etc. Finding despite problems in the beginning. For well-functioning, reliable day care is es- day care to succeed, parents need to up- sential for the well-being of all family date their information every day. Talk with members. the day care personnel to find out how But even when the parents have done your baby’s day went and what he or she their best to find an optimal solution, has been up to. something unexpected may come along In addition to preparing the child for day care, parents need to prepare themselves as well. EACH FAMILY NEEDS THE SOLUTION Work on your ”separation anxiety” THAT IS BEST FOR THEM . and observe your reactions and emotions when someone else is caring for your baby while you are away. Placing your child causing a change of plan. The family needs in childcare outside the home will create to move, for example, or your family day mixed feelings, and the new situation care provider retires, is taken ill or moves may be distressing for the parents as well. away, there are personnel changes in the Discuss your feelings with the day care day care centre, or your child for one rea- personnel. u son or another does not seem to adjust to day care. In such cases you will need to re- assess the situation.

Adjusting to the new situation There is great variation in how children react to day care, the new carers, and changes in general, which makes preparing for possible problems in advance difficult. Do not expect your child to adjust immediately; it is likely that problems will occur but they usually pass with time. Most children go through periods when they are reluctant to go to day care. How- ever, if the problem persists find out why your child is distressed and what it is that frightens or perturbs it. On the other hand, young children are masters at adjusting and will find the positive sides

Baby care 89 Prenatal and child health clinics

Prenatal and child health clinics Prenatal and child health clinics operate in 16 times before school-age. Families with connection with health care centres. They under one-year-olds visit the clinic at least offer regional health and social services 10 times. After the child has turned one, the which are voluntary and free of charge. family is invited to visit the clinic when the Clinics are usually located around the city child is aged 18 months and then once a or municipality. Finnish prenatal and child year (usually around the child’s birthday). health clinics comprise a reliable system; Child health clinic nurses are responsi- nearly all expectant parents and families ble for monitoring the growth and healthy with children use their services. Clinics’ development of your child. During an ap- personnel are obliged to keep their clients’ pointment, the child’s height, weight and details confidential. According to the head circumference are measured. Its health care confidentiality code, no infor- hearing and sight are controlled and psy- mation can be forwarded to another health cho-social development supported and care unit or professional without the prior observed. Furthermore, the clinic nurse is permission of the mother or father. an invaluable source of information re- Child health clinics promote the garding the child’s developmental stage, health and well-being of children and their and topics covered during visits usually in- families with the objective of reducing the clude nutrition and adherence to a healthy health differences between families. Child diet, exercise and activities etc. Speech de- health clinics monitor the physical, social velopment is monitored during every visit. and cognitive development of children un- Breastfeeding advice and guidance is pro- der school age. The clinics also aim to sup- vided as long as required. The clinic’s nurse port parents in implementing safe, child- will also vaccinate your child according to centred upbringing strategies and caring the current Finnish vaccination programme for their children and their mutual rela- and perform any screening tests required. tionship. Attention is increasingly paid to Clinic nurses offer their professional the early detection of possible problems expertise to parents, co-operating with the and arranging the appropriate help for families in full confidentiality. Together with families with children. the family, clinic nurses assess the family’s The point of contact is your clinic’s need for further examinations or support. nurse, who is a professional in promoting In addition to clinic nurses, child health health and family care. Clinic nurses are fa- clinic doctors are the only professionals miliar with the people and families living in that meet every family and their children the area. According to the national strategy within their operating area. Clinic doctors and based on the individual needs of fami- participate in monitoring the child’s health lies, clinic nurses meet with families at least and development. Their responsibilities in-

90 Services for families with children discharged from hospital earlier, many issues that used to be solved in the postnatal ward are now the responsibility of child health clinics. Supporting breastfeeding and ensuring adequate milk production, monitoring skin colour (yellow tint) and possible infection or cardiac symptoms, and addressing tearfulness caused by hormonal changes, are among these new responsibilities. Groups for parents, mothers and fathers meet in most child health clinics. Some clinics organise joint meetings with more than one family, providing families with the opportunity to meet other parents in addition to seeing the nurse and doctor.

Social services centre Families with children needing financial support or home-help services (household clude screening for diseases and abnormal chores, child care or help with upbringing) development, and interpreting develop- should contact the social services or fami- mental disturbances, which are usually ly support centre without delay for long- usually first detected by the clinic nurse. term help or for support over a shorter pe- Other professionals working at the riod of time. Services include house calls child health clinic include family workers, and trained support persons for the fami- psychologists, logopaedists, physiothera- ly or child. Discuss problems related to fi- pists, nutritional experts and dental care nances, housing or other family issues professionals. In addition to this wide array with a social worker in order to identify of professionals, child health clinics also viable solutions. work in close co-operation with other par- Family workers are municipal social ties involved in family care such as munici- welfare professionals who may be availa- pal home-help services, child welfare, day ble for support when the person normally care and pre-schools, child guidance and responsible for the family’s finances has family counselling centres, school health fallen ill, or is injured or suffers from ex- care and specialised health care. haustion. Support is provided on the The clinic nurse makes at least one grounds of a social risk, such as birth, lack house call when the baby is born (house of rest or some other difficult episode in calls are also recommended prior to birth), life. Home-help services and child care are but may visit at other times as well if this subject to fees, based on the family’s finan- seems necessary or when the family so cial standing. These services are free of wishes. Since mothers and newborns are charge for poor and low-income families.

Services for families with children 91 Family work by home-help services vices via the social services and health sec- aims to address family problems at an ear- tor. If the services provided are not ade- ly stage and also to offer preventive sup- quate, they may be complemented with port services. special services. For more information on services and benefits available for families Municipal day care with disabled children, contact your mu- Municipal day care supports and comple- nicipal social workers or rehabilitation ments child rearing at home and is availa- counsellors. For contact details, refer to the ble for all families with children. Day care municipal guidebook of your place of resi- applications are submitted to the social dence, the phone book or the Internet. services centre responsible for organising In addition to municipal services, an the municipal day care services. Charges array of organisations and parents’ associ- for day care are based on the family’s in- ations provide services for disabled chil- come, family size and daily day care hours. dren and their families. Associations or- The highest fee is €233 per month. The ganise adaptation training and various family may be exempt from payment on forms of educational and recreational ac- certain grounds. tivities. For detailed information, please All children under the age of three are contact the Central Union for Child Wel- entitled to municipal day care. Day care is fare (Lastensuojelun keskusliitto), tel. 09 - organised in various forms including day- 329 6011 or visit www.lskl.fi, or contact care centres, family day care, group family YTRY, the union’s umbrella organisation day care, supervised playgrounds and other for disabled and chronically ill children’s open early childhood education. Day-care parents’ associations, or FAIDD (the Finn- includes full and part-time care for children ish Association on Intellectual and Devel- aged 0 to 6 years as well as supervised af- opmental Disabilities), tel. 09 - 348 090 or ternoons for school-aged children. Late visit at www.kehitysvammaliitto.fi. night and overnight childcare services and special needs care are also available under Child guidance and family day care. counselling centres Child guidance and family counselling Services for chronically ill or centres promote the favourable develop- disabled children ment of children and families. Children, Municipalities are obliged by law to arrange teens and their families receive support services for intellectually disabled children and advice on issues relating to child rear- whose development has been disturbed ing, development and relationships be- due to a congenital illness, defect or injury, tween family members. Reasons for con- or one which has been detected during tacting a child guidance and family coun- childhood. Support services are arranged selling centre include conflicts between for children with hearing, sight or motoric family members, children’s fears, inability disability, as laid down in the Act on Servi- to adjust, shyness and problems at school. ces and Assistance for the Disabled Chil- The sooner such problems are addressed, dren with a disability or injury receive ser- the easier it is to find a satisfactory solu-

92 Services for families with children Mother and Child Homes and Shelters ALL CHILDREN UNDER THE AGE OF THREE (Ensi- ja turvakotien liitto), tel. 09 - 4542 ARE ENTITLED TO MUNICIPAL DAY CARE . 440, or visit www.ensijaturvakotienliitto.fi. Mother and child shelters tion. When there is a problem, the whole Mother and child shelters help adults and family should visit the child guidance and children who have experienced domestic family counselling centre, since the prob- violence or the threat of violence. Mother lems of one family member tend to have and child shelters accept single adults and an impact on the whole family. parents with children, and are open The centre’s psychologist, social work- around the clock. A phone call in advance er and doctor will schedule meetings and is recommended, but not necessary. The appointments for examinations for the shelters and their helplines are available family together or for each family member 24/7. You can stay at the shelter from a few individually. Services provided at child days to two months. During this time, par- guidance and family counselling centres ents are supported by authorities across are confidential and free of charge. For several sectors in identifying solutions to more information, please contact the Finn- their problems. ”Out-patient” support is al- ish Association for Child and Family Guid- so provided, and receiving support does ance, tel. 09 - 272 7470, or visit www. not thereby necessitate staying at the shel- suomenkasper.fi. ter. Shelters are maintained by municipalities and member organisations of the Fed- Mother and child homes eration of Mother and Child Homes and Mother and child homes provide support Shelters. For more information, please con- in parenting and life management. Moth- tact your municipal social service or family ers are welcome during pregnancy or support centre. For online mother and child when the baby is born. If necessary, fathers shelters, please visit www.turvakoti.net. may sometimes be accommodated as well. In mother and child homes, parents can Family guidance centres of practice baby care and daily routines in a the Church of Finland supervised environment. A care plan is The church’s family guidance centres wel- drafted in co-operation with municipal come everyone needing help in problems child welfare according to the family’s relating to family and relationships. The needs. focus is on family relationships and opera- Mother and child homes also provide tional methods include individual discus- round-the-clock advice on child care is- sion therapy as well as couples and family sues, such as breastfeeding and caring for therapy. Help is free of charge and offered a crying baby. Some mother and child to members and non-members of the homes specialise in problems related to Church. Personnel are obliged to keep substance abuse. Their operational area in- their clients’ details confidential. cludes all of Finland. For more informa- For contact details, please visit www. tion, please contact the Federation of evl.fi/kkh/to/kpk/pankyhte.htm.u

Services for families with children 93 Organisations

Federation of Mother and Child Homes and Shelters The Federation of Mother and Child ports and protects breastfeeding and posi- Homes and Shelters (Ensi- ja turvakotien tive attitudes towards breastfeeding. The liitto) is a national child welfare organisa- association organises breastfeeding cours- tion aiming to secure a child’s right to fa- es for support mums and those responsi- vourable living conditions and safe devel- ble for local support groups, distributes opment, support parenting and families, up-to-date information on breastfeeding and prevent domestic violence. The Feder- and breast milk, assists mothers in organ- ation provides assistance to parents in var- ising local peer support groups, and pub- ious problem situations. Further activities lishes a newsletter on breastfeeding issues. include ”out-patient” support and devel- For support and more information on opment projects such as baby blues and breastfeeding, visit www.imetys.fi, or call the baby sleep solution. For more informa- the national Breastfeeding Support Line, tion, please visit www.ensijaturvakotienli- tel. 041 - 5285 582. Support groups where itto.fi or call tel. 09 - 4542 440. mothers assist each other are organised Also visit Miesten kriisikeskus (Men in nationwide (for details, please visit www. Crisis) at www.miestenkriisikeskus.net, or imetystukilista.net). call tel. 09 - 6129 370. Association for Families with Children Folkhälsan The special-interest group of families with Folkhälsan is an organisation in the social children (Lapsiperheiden etujärjestö) aims welfare and health care sector that carries to act as a direct channel in influencing de- out scientific research and provides social cision-makers. The special-interest group welfare and health care services as well as can be joined via an online mailing list at information and counselling in order to www.lapsiperheet.net. In some locations, promote health and quality of life. Folkhäl- members have formed action groups or- san provides child welfare and child day- ganising outings and special events for care services, mainly in the Swedish speak- families with children, and made proposals ing regions of Finland, and organises baby to develop local services and benefits. swimming in several locations. For more information, please contact Folkhälsans The Mannerheim League Förbund, tel. 09 - 315 000. for Child Welfare The Mannerheim League for Child Welfare The Breastfeeding Support (Mannerheimin Lastensuojeluliitto, MLL) Association in Finland is a non-governmental organisation and The Breastfeeding Support Association in membership is open to everyone. It pro- Finland (Imetyksen tuki) promotes, sup- motes the wellbeing of children and of

94 Services for families with children families with children, increases respect for (”Lyömätön Linja”). If you need help, call childhood and seeks to make this issue 09 - 6126 6212 or email lyomaton. more prominent, and ensures that chil- [email protected]. dren’s views are taken into account in public decision-making. Visit MLL’s Web pag- Multicultural Women’s Association es at www.mll.fi for information on the Monika-Naiset liitto ry is a multicultural growth and development of children and women’s association promoting equality, parenting. There you will also find a guide human rights, multiculturalism and the to prenatal and child health clinics intend- empowerment of women. Its objectives in- ed for immigrants. clude promoting the status of immigrant MLL has 566 local associations women in Finland, offering and develop- throughout the country providing short- ing services for immigrant women and term child care services when, for example, children who have experienced intimate the child is ill or the parents need a break partner violence, preventing social exclu- to devote time to hobbies or spend some sion among immigrant women and pro- time together. moting the integration of immigrant wom- The parent helpline Vanhempainpuhe- en into Finnish society. lin (tel. 0600 - 12277) and interactive on- Services, legal advice and sheltered ac- line help Vanhempainnetti (www.mll.fi) commodation are available in several lan- provide guidance and support for parents. guages. For clients, these services are free Another parent who has volunteered and of charge. Contact Monika-Naiset liitto by is trained for the task will answer the phone, tel. 09 - 6943 485, email info@ phone or reply to your mail. Contacts are monikanaiset.fi, or visit www.monika- confidential and anonymous. The parent naiset.fi. helpline is available on Mondays at 5 pm to 8 pm, on Tuesdays and Thursdays at 10 National Women’s Line in Finland am to 1 pm and 5 pm to 8 pm. The National Women’s Line in Finland (Naisten Linja) (www.naistenlinja.com) is Men’s Association a national freephone helpline (tel. 0800 The Miessakit Association provides peer 02400) providing information and advice support for men in crisis and problem sit- for girls and women affected by violence or uations. Visit their Web pages at www. the threat of violence. Groups intended for miessakit.fi, or call tel. 09 - 6126 620. The women and girls meet in the facilities of activities of the Miessakit Association in- the National Council of Women, in Helsin- clude providing help for men in finding an ki (address Mannerheimintie 40 A 17). alternative to intimate partner violence

Services for families with children 95 Save the Children Finland Sexual Health Clinic appointments tel. 09 - 2280 5267, Save the Children Finland (www.pela.fi) is helpline tel. 09 - 644 066 a non-profit, non-governmental Finnish organisation which fights for children’s Medical Genetics Clinic tel. 09 - 6162 2246, rights and aims to improve children’s lives. email [email protected] Activities include volunteer work; children’s holiday housing, support families, foster care and group homes in several lo- The Single Parents’ Association cations, domestic and international adop- The single parents’ association Yksin- ja tions, sponsor activities, children emergen- yhteishuoltajien liitto provides information cy help, and local and regional develop- and useful tips for pregnant single mums ment projects. and parents facing a divorce, via the association’s Web pages at www.yyl.fi. Advice The Family Federation of Finland and support is also available by phone. (Väestöliitto) is an organisation in the so- Southern Finland tel. 09 - 8777 884, East- cial welfare and health care sector provid- ern Finland tel. 017 - 2622 644, Northern ing versatile services for families. Visit the Finland tel. 08 - 334 912. Väestöliitto at www.vaestoliitto.fi. The Single Parents’ Association aims to Central Office improve the quality of life of single parent is located in Helsinki, tel. 09 - 228 050 families. The association comprises about Väestöliiton Kotisisar Oy 50 local associations, clubs and meeting – short-term child care, tel. 020-799 5656 places. Member families organise free- form activities for single parents, meeting Family Network − services for families with young children, tel. parents, biological parents, widows and 040-180 1500, widowers. email [email protected] Member associations organise divorce Couple Relationship Centre seminars for adults and children, meeting – relationship support and advice, places for single parents, field trips, theatre tel. 0800-183 183 visits, supported holidays, training, shared Family Clinic mother’s/father’s days, Christmas parties – counselling and therapy services, appoint- etc. One in every two associations organis- ments tel. 09-2280 5267 es peer support, meetings for the divorced, Murkun kanssa child care networks and supervised kid’s – support for parents of teenagers, corners. [email protected] ÄIMÄ - Association for Mothers Kotipuu – support for multicultural families, tel. 09 - Suffering from Depression 2280 525, email [email protected] The ÄIMÄ Association offers support to mothers suffering from postnatal depres- Men’s Support – support service for men, sion and to their friends and family. ÄIMÄ email [email protected] is a member organisation of the Federation of Mother and Child Homes and Shelters

96 Services for families with children and is based on volunteer work. Mothers and needs to give his consent. Counselling who have suffered and recovered from is provided free of charge to the parents. postnatal depression form a peer group supporting mothers with PND and their Miscarriage friends and family. ÄIMÄ offers an addi- Miscarriage or spontaneous abortion is the tional service that complements profes- spontaneous end of a pregnancy prior to sional aid. 22 weeks. In addition to early stage mis- For more information on postnatal de- carriages (when the mother doesn’t even pression, please visit the association’s know she has been pregnant), every tenth website at www.aima.fi. In addition to peer pregnancy ends spontaneously in a mis- support, the association organises meet- carriage. Most miscarriages occur prior to ings and training sessions and publishes 12 weeks. its own magazine. Helpline 040-7467 424, Miscarriage usually begins with bleed- email [email protected]. ing accompanied by pain in the lower abdomen and lower back. In most cases, the cause of the miscarriage cannot be determined. Sometimes the foetus never began developing (this is called empty sac), while in other instances the miscarriage may have been caused by a severe developmental dis- Special situations order. The mother’s age, chronic diseases and structural weaknesses of the uterus increase the risk of miscarriage. Also, some Giving your baby up for adoption external factors (e.g. strong medications, ra- If you decide to give your baby up for diation, solvents) may increase the risk. adoption, you will receive counselling pro- A miscarriage is confirmed by an ultra- vided either by the Save the Children or- sound scan performed in a hospital. After a ganisation (for more information, please miscarriage, a D&C (dilatation and curet- visit www.pela.fi) or your local Social Wel- tage) or evacuation is carried out to reduce fare office. If necessary, the baby will be the chance of infection and to ensure that placed in a children’s home or a private you do not continue bleeding. If you expe- child care home. It is possible to transfer rience heavy bleeding or if your tempera- the baby directly from the hospital, which ture rises after having a miscarriage, con- will give the mother time to consider her tact the hospital as soon as possible. decision. Miscarriage is a devastating experience If the mother decides to give her baby and stirs up an array of emotions ranging up for adoption, formal consent to adop- from sadness and guilt to anger and de- tion cannot take place until at least eight pression. Sometimes it may be advisable to weeks after the baby is born. If paternity go over the experience with a trained pro- has been confirmed or the baby is born to fessional or with someone else who has al- parents who are married to one another, so had a miscarriage (visit www.enkelisi- the father is also entitled to counselling vut.net). Ask your nurse if there is a mis-

Services for families with children 97 carriage support group in your neighbour- drome (SIDS). KÄPY ry, the Association for hood. Väestöliitto, the Family Federation of SIDS and child death families in Finland, Finland, has a support group within its fer- was established to support families who tility clinic in Helsinki for couples who have lost their child. Visit KÄPY ry. at www. have lost one or more babies to miscar- kapy.fi. The association’s helpline (0800- riage (for more information, please visit 95959) is available on Mondays and Thurs- www.vaestoliitto.fi). days from 8:30 am to 11:30 am. KÄPY ry. publishes material intended The death of a child for families who have lost a child and for The death of a child must be one of the the people supporting those families. Ac- most painful experiences in life. It can hap- tivities include providing trained peer sup- pen quite unexpectedly or you may have port (individuals or families) for parents some time to prepare. The sudden and un- who have lost their child. The association explained death of an apparently healthy also organises regional get-togethers and infant is called sudden infant death syn- family weekends. u

98 Services for families with children Social protection for families with children (Dated 1 January 2012)

Up-to-date information on benefits for Information on family benefits can al- families with children is provided by the so be found online at www.kela.fi/asiointi. local offices of the Social Insurance Institu- You can log in using net bank user IDs tion of Finland (KELA) and the municipal provided by Finnish banks, but please note social services department. The informa- that the service is only available in Finnish tion presented herein was correct on 1 Jan- and Swedish. The online service also pro- uary 2012. vides the chance to monitor the applica- For further information, please see tion’s progress and the related fees. Families with children at www.kela.fi. For details on parental leave and parental al- Maternity grant in goods or cash lowance periods and employment, please The maternity grant is intended to be used visit www.mol.fi and www.tyosuojelu.fi, for the baby. You can choose between a cash respectively. benefit (EUR 140) and a maternity package

BENEFITS APPLIED FOR THROUGH KELA To do list during pregnancy: Make an appointment with your doctor or the prenatal clinic before Pregnancy diagnosed the end of the fourth month of pregnancy . Is your work dangerous? Grounds for special maternity allowance? Pregnancy certificate for maternity allowance, maternity Pregnancy has lasted 154 days grant and family allowance 2 months in advance Notify your employer (if the intended leave is no more than 12 days, 1 month in advance is sufficient) At least 2 months before Apply for maternity allowance, maternity grant and family the estimated date of delivery allowance from KELA 50 to 31 weekdays before the estimated date of delivery Early maternity allowance period 30 weekdays before the estimated date of delivery Maternity allowance period

Social protection for families with children 99 containing clothes and child care items. child’s country of origin (Estonia EUR Mothers who have undergone a medical 1,900; China and Columbia EUR 4,500; examination through a doctor’s appoint- other countries EUR 3,000). In internation- ment or have visited the antenatal clinic al adoptions, the permission of the Council before the end of the fourth month of on International Adoption (lapseksiot- pregnancy are entitled to a maternity tamisasioiden lautakunta) is required. grant. In cases of multiple birth (twins, tri- Family allowance plets, quadruplets...), the number of ma- Family allowance (lapsilisä) is sometimes ternity grants increases. This increase also also called ”Child allowance” or ”Child applies to families which adopt several Benefit”. It is paid for children under 17 children at the same time. You can choose years of age who are living in Finland. to receive cash, packages or a combination Family allowance is paid once a month in- of both. to the bank account of the child’s legal Adoptive parents are also entitled to a guardian. Payments begin in the month maternity grant. Furthermore, parents following birth and continue until the end adopting a child from abroad can claim an of the month in which the child reaches adoption grant (adoptiotuki) from KELA. the age of 17. Family allowance is untaxed This adoption grant is a tax-free, one-time and the amount per child increases with payment. Its amount depends on the each child:

Child First Second Third Fourth 5+ EUR/month 104 .19 115 .13 146 .91 168 27. 198 63.

Single parents receive (from 1.1.2012) an increase of EUR 48.55 for each child. Applications for family allowance and raised family allowance should be submitted to the Social Insurance Institution’s (KELA) local office.

Maternity allowance Expectant mothers are entitled to mater- (EDD), and is entitled to receive Finnish nity allowance (äitiysraha) when the preg- benefits. nancy has lasted 154 days and providing Apply for maternity allowance at least that the mother has been resident either two months before the estimated date of in Finland or in another member state of delivery, from your local KELA office or the European Economic Area (EEA) or the employer’s benefit fund (työpaikkakassa). European Union (EU) for 180 days pre- Maternity allowance is paid for 105 week- ceding the estimated date of delivery days. If the mother is employed, she is en-

100 Social protection for families with children titled to take leave from work for this period. Maternity leave can begin a maximum of 50 weekdays and no later than 30 weekdays before the estimated date of delivery.

Special maternity allowance If a pregnant woman needs to be absent from work, because her duties or working conditions present a danger to her own or to the baby’s health and if suitable alternative work cannot be found nor the risk factors eliminated, she may be entitled to a special maternity allowance (erityisäitiys- raha) paid until the maternity allowance period begins. The special maternity allowance can be backdated by up to 4 months. maternity leave (äitiysvapaa) during the If the expectant mother is employed, she is period that they receive maternity allow- entitled to take leave from work for the pe- ance. riod during which she received a special maternity allowance. Parental allowance The first maternity allowance instal- Parents are entitled to 158 weekdays of pa- ment is paid for a 30-day period and sub- rental allowance (vanhempainraha) and sequent instalments after each 25-day pe- parental leave (vanhempainvapaa) after riod. Employees are entitled to the maternity allowance period and ma-

Maternity, paternity and parental allowance payments

Father’s month = the last 12 weekdays of parental Maternity allowance Parental allowance leave + 1 to 12 weekdays 105 weekdays 158 weekdays

Paternity allowance Extended parental allowance period EDD 18 weekdays in total + 60 weekdays for each during maternity and additional child parental allowance periods

Social protection for families with children 101 ternity leave have ended. the allowance to begin. Extended paternal For the parents of twins, the parental leave, called the ‘father’s month’ (isäkuu- allowance period is extended by 60 week- kausi) is exceptional in that applications days, and for the parents of triplets by 120 must be submitted 2 months before the weekdays. It is possible for the father to desired start date. Employees must inform take these extra days at the same time as their employers about the planned leave the mother is on maternity or parental of absence at least 2 months in advance. leave. Parental allowance is paid retrospec- Adoptive parents receive parental al- tively for 25 weekdays at a time. Payments lowance for at least 200 weekdays for an begin only after the mother has undergone adopted child under 7 years of age when a post-natal medical examination within 5 the adoptive parent leaves his or her work to 12 weeks after childbirth and has pre- to take care of the child. Adoptive parents sented a certificate to this effect from a must apply for parental allowance within doctor or nurse. 2 months of receiving the child. Parents living in a registered partnership (rek- Partial parental allowance isteröity parisuhde) must decide on how Partial parental allowance (osittainen van- to divide the parental allowance period hempainraha) is half of the full allowance. among themselves when a child is born or The amount is calculated separately for adopted after the partnership has been each parent. Partial parental allowance is registered. paid for a maximum of 158 weekdays for The parents must decide whether pa- the birth of one child. It is possible for the rental allowance is paid to the mother or parents to share responsibility for taking father taking leave from work to care for care of the baby by agreeing part-time the baby. If both parents take parental working arrangements with their employ- leave and apply for parental allowance, ers for the same period of time and taking they both receive a raised allowance pay- turns in caring for the child. Work is con- ment for up to 30 weekdays (60 weekdays sidered part-time work when the total in total). working hours and salary are reduced by Apply for parental allowance no later 40% to 60%. The agreement on part-time than 1 month before the date you wish work is made with the employer, for a

Fathers month Timing chosen by family

Maternity Parental allowance Parental allowance Home care allowance Bonus 105 days 158-12=146 days allowance 12 days 12 days Mother Mother or father Mother or father Father

102 Social protection for families with children minimum period of two months. 12 days of parental allowance with a subsequent father’s month, they must notify Benefits for fathers KELA of this at least 2 months before the Fathers participating in the care of the end of the parental allowance period. child are entitled to paternity allowance Paternity allowance is paid retrospec- (isyysraha) and parental allowance (van- tively for one or more periods, as request- hempainraha). These allowances can be ed. The application period lasts for 2 paid to the father if he is married to the months after the parental allowance period child’s mother and they are not separated. has ended. For a father’s month that has They can also be paid to a spouse co- been flexibly moved, paternity and parental habiting with the mother. allowances must be applied for 2 months Adoptive parents can apply for paren- in advance from your local KELA office or tal and paternity allowances from the So- employer’s benefit fund. Fathers must in- cial Insurance Institution KELA. Adoptive form their employers about paternity leave fathers have the same rights regarding pa- at least 2 months in advance. If the period ternity allowance and the father’s month is no more than 12 days, employers must as other fathers. be informed 1 month in advance. Fathers are entitled to paternity allow- In 2010, the father’s month was extended ance for a total of up to 18 weekdays in up from 13 to 36 weekdays for families whose to 4 segments during the maternity allow- entitlement to parental allowance begins ance or mother’s parental allowance peri- in 2010. Parental benefit is used here as a od. Fathers are entitled to paternity leave collective term covering special maternity during the time they receive paternity al- allowance, maternity allowance, paternity lowance. allowance and parental allowance. For more information, please visit Father’s month www.kela.fi. Paternity leave now provides more possi- bilities due to additional flexibility in the of extended paternal leave, i.e. the ‘father’s Maternity, paternity and parental month’, provided that either the father or allowances are subject to tax mother cares for the baby at home during Maternity, paternity and parental allow- the intermittent period. ances are subject to tax, which is usually Fathers can use the last 12 or more withheld by KELA. As a rule, the amount days at the end of the parental allowance of the allowance is calculated based on the period instead of the mother, and com- earned income confirmed in the tax re- bine them with an extension of 1 to 24 turn. To calculate an estimate, please visit weekdays. This father’s month must be www.kela.fi/laskennat where you can taken within 180 days of the last day of find online calculation tools. Please note the parental allowance period immediate- that, so far, these tools are available only ly following the maternity allowance peri- in Finnish. The minimum parental allow- od. ance is EUR 22.13 per weekday. If the parents wish to combine the last The amount of maternity allowance is

Social protection for families with children 103 raised during the first 56 days (over 9 the leave of absence. Special care allow- weeks). Normal maternity allowance is ance is paid for care given at home only in paid for the subsequent 49 days. However, the case of a severe illness. the increase is only added to allowances Disability allowance (vammaistuki) based on confirmed income. The paternity for persons under the age of 16 is paid to allowance paid for the father’s month can children aged 16 or under and living in be raised if the father did not use up all of Finland, whose disability or illness requires the 30 days during the parental allowance care, attention and rehabilitation causing period. the family stress and limitations exceeding The maternity, paternity and parental the requirements of a normal child of the allowances are paid to the employer if the employee receives normal wages during his or her maternity/paternity and parental leave. Should the allowance be greater Care benefits for young children than his or her salary, the difference be- longs to the employee. Child home care allowance If the mother is at work during her One family member must be a child under 3 years maternity or parental allowance period, her allowance is EUR 22.13 per day during Basic allowance EUR/month working days. If the father is on paternity - for one child under 3 years 327 .46 leave during his military or civilian service, - for each subsequent child his allowance is EUR 22.13 per weekday. under 3 years old 98 .04 under school age 63 .60 An ill or disabled child Should your child be ill, you can apply for Supplement (income dependent) compensation from KELA. Benefits to se- - paid for one child only, max . 175 .24 cure the family’s income include special Parents are not required to care for the child themselves . care allowance (erityishoitoraha) and child home care allowance (lapsen kotihoidon- tuki). For more information, please visit Private day care allowance the ”Sickness and disability” section at One family member must be a child under school age www.kela.fi. Disabled children and children suffering from a severe illness may be Basic allowance EUR/month entitled to rehabilitation. Detailed infor- - for each child mation has been published in Finnish in under school age 166 .71 the brochure Kuntoutukseen. Special care allowance (erityishoito- Supplement raha) can be paid to the parents of under - for each child under 16-year-old children resident in Finland school age, max . 140 .19 who, on account of participating in the treatment of the child, cannot carry out The benefit is paid to a private child care provider their regular work and are not paid during designated by the parents .

104 Social protection for families with children Supplement criteria (euro/month)

Family members Income limit Decrease Income exceeding Income exceeding (number) for full persentage the limit for child home care the limit for private amount allowance supplement day care supplement

2 1 160 EUR/month 11,5 2 683 .79 EUR/month 2 329,96 EUR/month 3 1 430 EUR/month 9,4 3 294 .21 EUR/month 2 861,33 EUR/month 4 or more 1 700 EUR/month 7,9 3 918 .17 EUR/month 3 403,11 EUR/month

If the family’s income exceeds the limit entitling to a full supplement, the full amount of the supplement is reduced by the cited percentage calculated based on the part exceeding the limit . Only 2 parents and 2 children under school age are included in the calculations .

The private day care allowance and an earnings-related supplement are paid for each eligible child. same age, for a period of over 6 months. school year (third school year when the child is in the extended compulsory educa- Child care leave and reduced tion system). The related arrangements are working hours agreed between the parent and the em- After the parental allowance period has ployer. In practice, reduced working hours ended, parents can take child care leave often translate into 6 hours per day or 30 (hoitovapaa) with full employment securi- hours per week. ty to look after a child under 3 years old. Both parents can be on partial child care Both parents cannot be on full-time leave leave during the same calendar period, but at the same time. The minimum length of they may not both provide child care at the child care leave is 1 month. Parents must same time. They may, for example, share the inform their employers of the intended responsibility so that one parent looks after child care leave and its duration a mini- the child in the morning and the other in the mum of 2 months before it begins. Em- afternoon. Parents may also agree on caring ployers are not required to compensate for the child on alternate days or weeks. employees who are on child care leave. Request partial child care leave from Credits for paid annual leave do not accrue your employer no later than 2 months before during child care leave. starting to work reduced hours. For more in- Parents are entitled to an unpaid re- formation on reduced working hours and duction in working hours (also called part- partial child care leave, please contact your time or partial child care leave (osittainen occupational health and safety inspector hoitovapaa) up to the end of the second (työsuojelutarkastaja).

Social protection for families with children 105 Child home care allowance and private oraha, EUR 70 per month, taxable) is available for parents who are working reduced hours day care allowance (max. 30 hours/week) to look after the child. After the parental allowance period ends, When parents share the care of the child, they parents can choose between municipal day are both entitled to partial care allowance. care, home care allowance (lasten kotihoi- Applications for child home care allow- don tuki) if the child is under 3 years old, and ance, private day care allowance and partial private day care allowance (yksityisen hoi- care allowance are submitted to the Social In- don tuki) if day care for children under surance Institution’s (KELA) office. These al- school age is provided by a private child care lowances can be backdated up to 6 months. provider approved by the local authorities. The adoptive parents of a child over 3 Students years old may receive child home care allow- Full-time study is considered full-time em- ance until 2 years have passed from the date ployment. When the parent is a student, he on which parental allowance was first paid. or she can receive both the study grant However, this right ends when the child be- (opintoraha) as specified in the Act on Stu- gins school. dent Financial Aid, and maternity and pa- It is possible for a family to receive child rental allowance of EUR 22,13 (from home care allowance and private day care al- 1.3.2011) per weekday. If the parent decides lowance at the same time, but for different not to draw his or her study grant, parental children. allowance can be calculated on the basis of The child home care allowance consists earned income. Your local KELA office will of a basic allowance (hoitoraha) and a sup- assist in comparing available alternatives and plement (lisäosa) paid for one child only. El- determine how they will affect other income, igibility for the supplement and the amount such as the housing supplement (asumistu- paid depend on the family’s income. In addi- ki). tion, the basic allowance or care supplement If both parents are employed and they can be further supplemented by a separate have agreed that the parental allowance is to additional allowance by decision of the mu- be paid to the father, he will receive a paren- nicipality (municipal supplement). tal allowance of EUR 22,13 (from 1.3.2011) As a rule, the allowance is not paid for per weekday. children permanently or temporarily residing In addition to income subject to tax and abroad. However, a child residing in a mem- other forms of income benefits, maternity ber state of the European Economic Area and parental allowances, together with the (EEA) or the European Union (EU) may be child home care allowance, are considered eligible for home care allowance. A family re- when awarding a study grant. Students have ceiving maternity and parental allowances personal limits for annual income based on may receive home care or private day care al- the number of months they have drawn a lowance for its other children under school study grant or housing allowance. Any in- age. Child home care basic allowance is ad- come exceeding the annual limit affects the justed to the parental allowance. amount of study grant and housing allow- Partial care allowance (osittainen hoit- ance. For more information on the annual

106 Social protection for families with children income limits, please read the KELA bro- the rent or other fees for an owner-occupied chure on study grants or use the online cal- home can apply for housing allowance culation tool to determine your annual in- (asumistuki) from KELA. For more informa- come limit at www.kela.fi/opintotuki. Please tion, please visit KELA at www.kela.fi or note that these online tools are so far only read the brochure on housing benefits. available in Finnish. If either of the parents is performing military or civilian service, the family may apply Student loan interest subsidies for conscript’s allowance (sotilasavustus) KELA pays the full interest on student loans for housing and living costs from KELA. For guaranteed by the State. Students are not more information, please visit www.kela.fi. obliged to repay the subsidies. Interest subsi- A parent receiving unemployment dies are available to all those who have a low benefit is entitled to a child supplement income, provided that interest is not being (lapsikorotus) from the date of birth onwards. capitalised for market-rated student loans or To receive the supplement, the child’s birth is provided that the claimant has not received indicated on unemployment notification form financial aid during the five months preced- TT2, which needs to be delivered to the local ing the due month for interest-subsidised KELA office or unemployment fund (työttö- loans. For more information on eligibility cri- myyskassa). teria and application instructions, please vis- A retired parent can receive a child sup- it KELA at www.kela.fi or read the related plement to his or her pension, beginning on brochure. the month following the baby’s birth. A child supplement is applied for through your local Other forms of benefits KELA office. Families whose income is insufficient to pay

Social protection for families with children 107 Child maintenance and support Municipal benefits Children have a legal right to sufficient maintenance, which the parents are responsible for pro- Establishing paternity and custody viding according to their means. The parents’ child The paternity of a child born outside marriage can maintenance responsibility continues until the be established either by acknowledgement of child turns 18. If a parent does not provide for the paternity by the father or through a court decision. child's maintenance, or if the child does not live This applies also to cohabiting parents. The father is permanently with the parent, a child mainte- required to acknowledge paternity before it can be nance allowance may be provided. The provision legally confirmed by the social security authorities of maintenance allowance can be made by agree- (local register office, maistraatti). The acknowledgement or by a court decision. Maintenance allow- ment of paternity is handled by the municipal child ance is paid monthly in advance or as an one- welfare officer, who is responsible for handling all time payment and is revised according to the cost matters related to acknowledging and establishing of living index. paternity. If the father does not acknowledge If the liable parent cannot pay the maintenance paternity, the mother can request a court order to allowance agreed upon or neglects the payments, establish the paternity. The child welfare officer will the child is entitled to maintenance support then conduct a determination of paternity and, (elatustuki). Maintenance support is also provi- based on this, a court decision will be made. If ded for children whose father has not been es- necessary, paternity testing through forensic tablished and when the amount of maintenance genetics is applied using blood or buccal swab allowance is smaller than maintenance support. samples to establish or refute paternity. If the blood Maintenance support is EUR 147.96 per month and DNA tests show the man to be the father, he is per child. Responsibility for payment of mainte- given the opportunity to acknowledge paternity nance support has been transferred from munic- before the matter is taken to court. The establish- ipalities to KELA (since 1.4.2009). ment of paternity cannot be legally enforced if the mother opposes it. Income support If the parents are married when the child is Families with insurmountable financial problems born, they have joint custody of the child. If the par- may apply for income support (toimeentulotuki). ents are not married, the mother is the legal guardi- All income and assets available are considered an. However, the father may choose to become es- when the need for support is assessed. Applica- tablished as the child’s guardian either jointly with tions for income support are submitted to the so- the mother or alone. In such a case, paternity must cial services department. be confirmed and the parents must sign a written agreement, or a court of law must decide on joint Support for informal care custody. If the parents do not live together, child Support for informal care (omaishoidontuki) is maintenance and visiting rights must also be agreed intended for supporting the home care of on. Assistance in settling these matters and making chronically ill patients, disabled people and the agreements is provided by the municipal child wel- elderly. The parents of a disabled or ill child can fare officer. The Social Welfare Board affirms the apply for informal care support from the local agreements made and ensures that they are not social services department. u against the interests of the child.

108 Social protection for families with children “We’re having a baby” is a guidebook for expectant parents. This revised version is based on previous versions and edited by Tuovi Hakulinen-Viitanen (Research Manager, THL) Johanna Lammi-Taskula (Senior Researcher, THL) Annukka Ritvanen (Senior Researcher, THL) Sirpa Sarlio-Lähteenkorva (Ministerial Adviser, Ministry of Social Affairs and Health) Marjaana Pelkonen (Senior Officer, Ministry of Social Affairs and Health) Raija Rantamäki (Project Secretary, THL) We would like to extend our warmest thanks to the experts and parents who have shared their knowledge with us and contributed to earlier editions of this guidebook. Feedback? Please contact Tuovi Hakulinen-Viitanen or Raija Rantamäki at THL, P.O. Box 30, 27100 Helsinki or email [email protected].