Tips

  • Informations
  • How to write a birth plan
  • Preparation for birth
  • Where to have your birth
  • What to take with you to hospital
  • When to go to hospital
  • Having your partner at the birth
  • What to expect from your midwife
  • Coping with birth when you have children at home
  • Having your baby induced
  • Caesarean birth
  • Pain relief
  • Birth - what really happens
  • Birth stories
  • Birth faqs
  • Recovering from birth
  • premature babies
  • Newbirth examination

Tips and Information

"41WEEK PREGNANT"- EVERYTHING YOU DO FROM NOW ON IS FOR TWO. LET'S TAKE CARE OF YOURSELF WITH OUR PRODUCTS.

Congratulations! You will be hearing that word a lot. In these 41 weeks, everything you do is for two, so take a deep breath and let your body perform its miraculous work.

You will experience some discomfort. The following information is about the sequence of your body changed as well as your baby's. Remember if there is anything abnormal consult your doctor immediately. They'll be very pleased to explain anything that you're unsure of.

PHYSIOLOGICAL & PSYCHOLOGICAL CHANGES DURING & AFTER PREGNANCY

Normally, pregnancy is arbitrarily divided into three trimester periods, as a mean to simplify reference to the different stages of prenatal development. From the table below, we showed you the symptoms along with the changes to your body during pregnancy.

How to write a birth plan

A birth plan is the document of birth choices you'll take with you to the hospital or hand to the midwife, when you go into labour. It outlines your hopes about the birth and gives the midwife an idea of the kind of birth you'd prefer.

There may be a section in your hospital notes for a birth plan, or simply write a list on a piece of paper - there's no set format. Chat it over with your birth partner so he or she can speak up for you on the day, and discuss your options with your midwife at antenatal appointments. Don't be afraid to include anything important to you, however much foolish it may sound

But do be flexible - things may go very differently on the big day.

What to include:

Birth partner – who will be with you? Are you happy for them to make decisions on your behalf?

Environment – would you like to try the birthing pool? Will you be bringing your own music to play? Is there any other than the birthing equipment you'd like to use?

Pain relief – which options would you prefer to use? In which order of preference? Are there any method you want to use, only if absolutely necessary? Are you planning to use any alternative remedies too?

Intervention – you have the right to refuse any 'routine' interventions (such as your waters being broken artificially, your labour being induced, an episiotomy, forceps) and should outline your preferences here. But consider the pros and cons carefully before making any decision during the birth.

Positions – if you want to move about freely during labour, state that here. It is your right to have an active birth if you wish.

After the birth – say whether you want to hold your baby immediately, or whether you want him or her cleaned and wrapped in a towel first. Also mention if you'd like your partner to cut the umbilical chord (he can change his mind if he's not so sure on the day). And say if you'd like help to start breastfeeding straight away.

Delivery of the placenta – you will be offered a synthetic hormone, Syntometrine or Syntocinon, to speed delivery of your placenta. If you'd prefer not to, state that here.

Vitamin K- shortly after your baby is born, you will be asked for permission for him to be given with vitamin K. It's up you to decide whether let him o have it, and how you want him to be given it (via an injection or orally). It is not an easy choice to make as even experts disagree over how Vitamin K should be given. Unless you express a preference, the hospital will probably follow its own policy. It is usual to give several doses if given orally, since it is less well absorbed than by injection. If you would like more information before making your decision, talk to your doctor or midwife.

preparation for birth

It's a good idea to get yourself prepared for the first few days at home with your baby, as it will make adapting to life as a parent less stressful and give you more time to enjoy the new arrival. Bear in mind that some babies arrive early, so don't leave everything to the last minute.

six weeks before the birth

Start to thinking about the equipment you will be needing. You'll need a pram/pushchair, and a Moses basket or crib for your baby to sleep in. You'll also need nappy changing equipment, plenty of nappies (either washable or disposable) and an assortment of delightful little baby clothes. Even if you don't intend to buy the big items right now, it's well worth having a little browse to get an idea of what's available and will suit your lifestyle.

If you plan to take your baby home from hospital by car you will need a car seat as it's against the law for a baby to travel without one. Our "Choosing a car seat" article will give you good advice on it. Practice fitting it into the car, and ensure that your partner too knows how to do it too (it's not as easy as it looks!).

Keep the hospital phone number pinned on to a notice board and in to your bag, and make it a point to carry your notes around with you just in case.

Make sure you have informed your employer in writing of your intention to take maternity leave.

A month before the birth

Stock up on frozen food and storeroom basics, so you don't have to drag your precious newborn around a supermarket too soon.

Make sure there's enough petrol in the tank for an emergency dash. Put aside change for the hospital car park and the pay phone.

Arrange for someone to take and collect you from hospital, whether it's a partner, family member or friend. Make sure you know where to reach them and arrange a back-up just in case.

If you have another child, arrange for a trusted friend or relative to look after them while you are in hospital and run through with your child what will happen when you go in.

Have a little present wrapped and ready for your older child or children 'from the baby', so they don't feel left out.

Have a stock of children's videos and new books ready, which you could watch or read with your older child while feeding the new baby.

Make a present list so you can be sure of getting items you really want. You may want to ask several people to club together for larger items.

If you know you are having a Caesarean, try to arrange plenty of support afterwards as you will not be able to drive, lift heavy objects or do strenuous housework. It generally takes longer time to recover from the operation than from a normal birth.

Whatever type of birth you are having, you may be glad of some additional help, so ask friends and family to help out and specify what would be useful. People will offer, so make a vow to always say 'yes' when someone asks, 'Is there anything I can do to help?'

Where to have your baby

When you first find out you're expecting, the birth will seem a lifetime away. But it's worth thinking about where you'd like to have your baby, as there are pros and cons with each option, and your choice could affect the antenatal care you receive.

Step one is to see your GP or local Midwife (usually based at your GP surgery) . It pays to do a little research first. You should know that you have the right to give birth anywhere and can change your mind at any time. Your GP/Midwife can refer you to the next stage, or you can contact your chosen option directly. If you're having problems of getting what you want, or there don't seem to be many choices available to you, the Association for Improvements in the Maternity Services (www.aims.org.uk) should be able to advise you.

The basic choices are hospital, birth unit, or home delivery. For information on local hospitals and units, check out www.drfoster.co.uk andwww.birthchoiceuk.com - but be aware that things may change. You may have booked a home birth only to find you'd kill for an epidural. Or be hoping for a high-tech delivery, only to give birth in the bedroom. So check your choices, but be prepared – at the end of the day - to go with the flow!

Consultant-led hospital unit

What? You'll give birth in a hospital, under the care of a named obstetrician but will see a midwife for ante-natal appointments and the birth unless there are problems. Remember that different hospitals have different facilities and approaches to birth, so check out details like Caesarean rates, numbers of birthing pools and so on. You don't have to go the nearest hospital, but can chose one you prefer (NEAR YOU?) For example, some areas will offer team midwifery, where you get to know a small group of midwives, or (more rarely these days) "domino care", where the same midwife sees you antenatally, attends the birth, and brings you home afterwards. Pros? In an emergency, a doctor is on site and can be with you instantly. If a Caesarean is needed, it'll be done swiftly. You'll also have access to all forms of pain relief, including an epidural.

Cons? You'll probably see different midwives throughout the pregnancy and during the birth so you may not be able to get to know anyone properly (some studies show mums are more relaxed and have easier births if they know the midwife who is attending them). The impersonal hospital environment can make some mums nervous – which can make labour harder and longer.

birth unit

What? These are specially created buildings either attached to a hospital, or situated on their own, where the focus is entirely on birth. They are run by midwives or GPs and form a popular halfway house between high-tech hospital and a home birth, and are often good for mums without complications.

Pros? The environment is homely and you'll see a team of midwives and get to know them. Your birth experience will be similar to a home birth, but without the mess.

Cons? Interventions like Caesareans and epidurals probably won't be available unless the unit is attached to a hospital, so in an emergency you may need to be ambulanced elsewhere.

home birth

What? A midwife visits you at home for antenatal appointments and delivers your baby when you go into labour. Sometimes it can be difficult to convince your GP that a home birth is an option. If your GP isn't keen, contact the community midwives direct at your local hospital to see if they can help. Pros? Statistics show a planned home birth to be as safe as a hospital birth if your pregnancy has no complications. You'll get 'continuity of care' – see the same midwife throughout the birth and preferably antenatal - which is known to lower the need for pain-relief and interventions like forceps. And of course, you'll be in a safe, familiar environment.

Cons? You won't be able to have an epidural, and if you need more high-tech care you'll be rushed to hospital mid-labour.

what to take with you to hospital

Don't wait until the first contraction before wondering what to take with you to hospital. By week 36 you really should have a bag packed and waiting by the front door. Actually, you'll need two bags – one for labour, and one for your hospital stay. Here's what you'll need - and what you definitely won't need - to put in them.

labour bag

Whatever you do, don't forget your hospital notes. It might be best to carry them with you in your handbag from 36 weeks. You never know! In fact, strictly speaking, if you arrive in hospital with nothing but your notes, you will be fine. But there are a few things you can take along that will make your birthing experience better.

Birth plan

magazines (early labour can be slow)

TENS machine for early pain relief

big old T-shirt or nightshirt for giving birth

socks (in case your feet get cold)

food and drink for your partner

coins, phone card or mobile to announce your news

camera with battery charged, memory empty (if digital) or a new film

lipbalm

hospital bag

After the birth you'll be wheeled up to the ward with your new baby. That's the point where you can make the swap from labour bag to hospital bag, which should hold everything you need for your stay in hospital.

Special soap and flannel – after the birth you'll either be invited to have a shower, or you'll be sponged down by a midwife. And it's great to smell nice

wash bag with your normal favourite toiletries

pyjamas with baggy bottoms and front-opening top for easy breastfeeding (bring a spare in case of leakage accidents)

lightweight dressing gown (hospitals are hot) and slippers

a bath towel

tissues

feeding bras, breast pads and Lansinoh nipple cream

paper knickers (bleeding after birth makes disposables best)

maternity sanitary towels (longer, softer and more comfortable than normal pads and midwives recommend - as they can monitor the blood loss more accurately with maternity pads than with normal ultra absorbent pads).

sanitary towels (the largest you can find or special maternity pads)

eye mask and ear plugs so you can get some sleep

phone card (you're unlikely to be able to use your mobile in hospital)

address book

newborn nappies and wipes for sensitive skin

vests (2-3), sleepsuits (2-3) and warm going-home outfit for baby

something for you to wear to come home in (it'll need to be front fastening as you may need to breastfeed and won't want to lift a maternity dress over your head! Also, don't take your skinny jeans – they won't fit yet!)

When to go to hospital

Going from being pregnant to being in labour can be an exciting but confusing transition for many women. Every labour is different, and some women even have 'false labour' - like a false start - before the real thing actually begins. The emotional changes during labour can also be strong. After all, it means you are about to become a mother. So go easy on yourself and let your midwife and partner help you - it's what they're there for!

having a 'show'

Several events occur before labour actually begins. The first is usually a 'show' - a plug of mucus that resembles stringy egg-white and is streaked with blood. A show is a normal, healthy event showing your cervix is preparing for birth, and it appears sometime after about 36 weeks. It can be a single incident, or a continuous low trickle - in the latter case, just wear a panty-liner. A show usually happens up to 3 weeks before labour - but there's no such thing as 'normal' here. Some women never get a show. You don't need to ring the hospital when you get a show. Just go about your day as usual, or, if it's night-time, have a hot, milky drink and go to bed. However, if you have a lot of fresh blood, like a period, ring your midwife or hospital, as you may need some tests.

When your waters break

Waters breaking is a normal event, but when it happens call your midwife. Unfortunately, knowing your waters have broken can be tricky. The membrane around the baby breaks, releasing fluid. You may feel a 'popping' sensation, or nothing at all, and it can happen before or during labour.

Waters can break quickly, in a big gush, or so slowly that you may not realize what's happened - you may think you've wet your pants! If you're not sure, put in a panty liner. If after 1 hour it's wet, your waters have broken. When your waters break, you're usually within 24 hours of going into labour. The waters should be clear or honey-coloured. Greenish water means that meconium - the first discharge from the baby's intestine - has passed; this is not serious, but you need to call the midwife immediately and prepare to go in.

When contractions start

Your first contractions will usually be widely spaced. At this point, you don't need to get to the hospital. Just get comfortable. If it's the middle of the night, take a couple of paracetamol (if you're not allergic), have a warm drink and go back to bed. If it's daytime, go for a walk, drink fluids and have something light to eat, such as a banana or yoghurt. Glucose tablets and Lucozade can help keep up your energy. You may also vomit and have diarrhoea - this is normal.

How long will contractions last?

You may contract irregularly for several days. Just ensure you get plenty of rest, and keep your midwife informed. If this is your first baby, you're more likely to have contractions on and off, from every half hour to every few hours; your body has not yet got used to being in labour. But some women go straight into full labour - you simply can't predict.

things to do while you're waiting

You may be contracting for a short or long time before you're ready to go to hospital. In the meantime try doing something to help you relax, such as

Have a warm bath.

Have your partner massage your feet or neck and shoulders.

Make sure your bag is packed with everything you need for the hospital.

Go over your travel route - is there is some Perahera or election rally that will hold up traffic?

If you have other children, make sure your babysitter or childminder is ready.

If you've hired a TENS machine - an electrical device that gives safe, drug-free pain relief - now is a good time to try it out. TENS machines are very useful being inexpensive to hire with no side effects to mother or baby.

Signals to go to hospital right away

If any of the following apply to you, call the hospital right away and prepare to go in:

You are contracting and are less than 37 weeks pregnant.

You are not coping well with the pain of contractions.

You haven't felt the baby move recently (within 8-10 hours) - if you're worried or unsure about this, ring your midwife.

Ringing for an ambulance is perfectly acceptable in any of these situations.

Talk to your midwife during a contraction

Your midwife will probably want to speak to you during a contraction so she can tell from your breathing and the tone of your voice how you're coping and also determine how strong your contractions are. She'll also ask when the baby last moved. If you're worried about your baby's movements, your midwife may ask you to go to the hospital for tests to monitor baby's heartbeat.

How you know it's time to go

If this is your first delivery, call your midwife or the hospital when contractions are every 5 minutes and last 30-40 seconds - it will soon be time to go. If you've had a previous delivery, ring when you're contracting every 7 minutes. If your previous labour was long, you may be advised to remain at home longer. If you had a Caesarean section or problems with a past pregnancy, you may go in earlier.

If you're delivering at home

If you're delivering at home, your midwife will have started coaching you about delivery at around 34 weeks. Call your midwife when your contractions are coming every 10 minutes. If your midwife lives far away, or if it's rush hour, you might want to call her sooner, so she can pick up her equipment.

A final word

Remember, labour is variable - some women go fast, some slow - there's no way to know. And don't let other women's labour stories scare you - people will always tell you the worst of their labour, never the best - it's often a lot better than you expect!

having your partner at the birth

The vast majority of men attend the birth of their children. Men themselves may want to attend the birth to provide as much support as they can for their partner and to welcome their baby into the world. Many men describe seeing their children born as the most moving moments of their lives. Some men are very active, encouraging their partner, and becoming excited and emotionally caught up in the whole event. Others are quieter, observing more passively, while others, much to the annoyance of mothers-to-be, become very interested in the machinery and equipment of the hospital rooms where babies are born. While it is more common than not for men to be present when their partner is giving birth, it is not compulsory. A few men, although not as many as you may think, may faint at the site of blood. For other women, the presence of an over-anxious father-to-be may cause them added stress. Or the couple may have other children who need looking after. For these sorts of reasons, a significant minority of couples agree that the man will not be present. Men who see their babies being born find their partner just as sexy afterwards, if not more so. Some men find seeing their partner give birth traumatic and find it distressing to see the woman they love in such pain. It is important for the man to be prepared for the enormity of seeing their child being born, and antenatal classes will help with this. "A small proportion of men say they find sex difficult afterwards" says Melanie Every of the Royal College of Midwives, but she adds that these problems do not seem to be affected by the actual birth: "They do not relate to how traumatic the birth is". When the baby is being delivered by Caesarean section, men can still attend, reassure and comfort, particularly if the woman is having an epidural anaesthetic. If the mother is having a general anaesthetic for her Caesarean, her partner will probably be unable to help out very much in the delivery room. The woman will be oblivious to his presence, so it might be best in this situation for the man to wait outside the delivery room. "Some women say they would prefer to be on their own", says Ms Every. According to Dr Maureen Marks, perinatal psychologist at Kings College Hospital, London: "All the research seems to show that women are glad that their partner is present because of the help and support they can provide." But she adds that there shouldn't be any hard and fast rules. Men, she says should not feel under pressure to be at a birth, if they really don't want to be there. Couples, she says, should decide themselves and not expect midwives and doctors to make the decision for them. As well as the emotional support a woman may feel from her partner being with her during childbirth, a man can also play a practical role: giving a back massage and stroking and holding at appropriate moments can help a woman greatly during labour. Husbands and partners may want to reduce the mother-to-be's discomfort by sponging them with a damp flannel or sponge. If the couple have made a birth plan, about what they want to happen during the birth, the partner can help ensure that it is followed as much as possible. But, of course, women may change their minds about how they are going to give birth. Women, who beforehand say they are going to have a 'natural' birth without painkillers, may change their mind. That change may be difficult to accept by a man attending a birth. Sometimes midwives have to diplomatically intervene and negotiate a way forward. Such arguments are rare and mostly women feel supported when their partner attends a birth. "Men can do a lot to help women", says Ms Every. "Many women like to hold their partner's hand tight, squeezing hard at the peak of contractions. It helps", she jokes, "to share the pain!"

What to expect from your midwife

A midwife or team midwives will look after you throughout your entire pregnancy and until your baby is between 10-28 days old. Midwives are trained specialists in normal pregnancy and childbirth - if you develop any complications you will be referred to a doctor (obstetrician) as appropriate.

Who is who?

Community midwives - Although employed by local hospitals, community midwives work within specific geographical areas and offer care to all pregnant women. They attend home-births in that area and also go to local maternity units to deliver babies. They will visit you regularly once you are at home with your new baby, and will continue to make visits until you and your baby are ready to be transferred to the care of your health visitor.

Independent midwives - Independent midwives are midwives who have chosen to work as self-employed, independent, practitioners offering a private midwifery service to mums-to-be. They usually charge a fee in the region of about £2 000 to look after you for the duration of your pregnancy, labour and post-natal period.

Team midwives - Team midwives are a group of midwives who work in the community and hospital, looking after mums-to-be in a specific geographical area. There will usually be one member of the team who can be contacted at all times to answer queries, deal with problems, and deliver babies, either at home or in the local maternity unit. Hospital midwives - Hospital midwives may work in the hospital antenatal clinic, labour ward or post-natal ward. As well as being skilled in looking after women in labour, these midwives may also assist with Caesarean operations.

When you will see your midwife?

0-8 Weeks - Make an early appointment with your GP who will refer you to your midwife or midwifery team. If you prefer, you can begin with the midwife alone - she will give you health advice relevant to early pregnancy, such as the importance of taking folic acid as well as information on early screening tests.

8-12 Weeks - If you are unsure of your dates or have had a small bleed, you midwife will be able to refer you for an ultrasound scan. If you wish to have a special scan to exclude Down's Syndrome (known as nuchal fold scan), you will need to be referred by your midwife before the 13th week of pregnancy.

12-16 Weeks - During this time you will be 'booked-in' with your local maternity unit so they know that you are expecting a baby. Your midwife will either visit you at home or you may need to attend a booking clinic at your local hospital or health centre. The process may take about an hour (or longer) and includes giving information about your health, having blood taken and giving a urine sample. Your midwife will explain what is going to happen during your pregnancy, discuss any worries you may have and give you your own personal set of antenatal notes.

16-24 Weeks - Your second antenatal session with your midwife will probably be at about 24 weeks, and will set the pattern for future appointments. She will check your blood pressure, test your urine and measure your 'bump'. She will also check the baby's movement and will be able to check your baby's heart rate.

24-30 Weeks - You should have an antenatal appointment with your midwife or doctor (depending on the arrangement) once a month from 24-32 weeks, and then every 2 weeks after that, although this does depend on the area you live in. Usually, the total number of antenatal appointments is around 6, unless there is a problem with the pregnancy. By 28 weeks you should have received your 'MatB1' form from your midwife, enabling you to claim maternity benefits.

30-36 Weeks - Most mums-to-be start antenatal classes around this time, run by local midwives, however, you could opt to attend those run by the National Childbirth Trust or by an Active Birth Centre. 36 Weeks onwards - You are likely to have an appointment every week from 36 weeks, when a close check will be made on the size and position of your baby. If your midwife has any concerns she will refer you for a scan or to see the obstetrician.

During labour

A midwife will be responsible for you for the whole of your labour. Providing everything progresses normally, you will not see a doctor as midwives are qualified to deal with all aspects of normal labour and birth.

On the post-natal ward

Midwives and maternity care assistants will help you with your new baby, showing you how to change and bathe them. Your midwife will make sure you are recovering from the birth and will offer pain relief and medication if needed. Your midwife will also help you with breastfeeding, showing you the correct position for feeding your baby and making sure your baby is latching on correctly. Don't be afraid of asking lots of questions at this stage, however silly they may seem to be - the midwives are there to help you!

At home with baby

A community or team midwife will visit you every day for the first 7-10 days and will check that your womb is shrinking back to normal, your stitches are healing and blood loss is not too much. They will also make sure your baby is feeding well and will carry out a variety of screening tests, including weighing your baby. The Guthrie test is carried out when your baby is 7 days old and involves taking a small blood sample from your baby's heel. Once your midwife is happy that you are recovering normally and baby is doing well, she will transfer you over to a health visitor. This handover usually happens at around the 10th day after the birth of your baby.

Coping with birth when you have children at home

Your pregnancy and the arrival of a new baby can be a big adjustment for your little ones at home; however, if you prepare carefully you can ensure that things run smoothly and that your children look forward to the new addition to the family.

Before the baby is born

Community midwives - Although employed by local hospitals, community midwives work within specific geographical areas and offer care to all pregnant women. They attend home-births in that area and also go to local maternity units to deliver babies. They will visit you regularly once you are at home with your new baby, and will continue to make visits until you and your baby are ready to be transferred to the care of your health visitor.

Independent midwives - Independent midwives are midwives who have chosen to work as self-employed, independent, practitioners offering a private midwifery service to mums-to-be. They usually charge a fee in the region of about £2 000 to look after you for the duration of your pregnancy, labour and post-natal period.

Team midwives - Team midwives are a group of midwives who work in the community and hospital, looking after mums-to-be in a specific geographical area. There will usually be one member of the team who can be contacted at all times to answer queries, deal with problems, and deliver babies, either at home or in the local maternity unit.

When you will see your midwife?

Prepare your child for the arrival of a new brother or sister. Talk to them about having a new member of the family and what this is going to mean. It's probably better not to introduce this too early on in the pregnancy because children can get very impatient. Wait until you are about 4 or 5 months pregnant

Depending on the age of your child you may like to settle them into a playgroup or nursery before the new baby is born if they are not already going to one. Leaving this until after the baby is born may seem like you are trying to get rid of them

If your child is already attending a nursery because you have been working, try to keep them going for at least a few sessions during your maternity leave. This will give you some structure to each day after the baby is born and also give your child some continuity of care. Children do not like too much change all at once and if you are planning on going back to work after your maternity leave you don't want to have to settle them into nursery all over again

Get organized. Sort out your old baby clothes and equipment such as baby baths, blankets and carrycot. Including your older child in this activity can help them get used to the idea of another child in the family

As the birth approaches you may wish to fill your freezer with a few home-cooked meals to take the pressure off you after the birth

If your children are going to be quite close in age you may need a double buggy. Although you may not need this immediately after the birth, think about buying one

Planning the birth

Children dislike disruption to their routine, so try to plan the birth around them as much as possible. Do take some time to think about what arrangements you can make.

You will need to organize who will look after your child while you are in hospital or, if you are planning a home birth, who will supervise your child. Choose someone they know well, like a grandparent or an aunt or uncle. Have someone lined up in case this person cannot make it on the day

Discuss your child's usual routine with whoever is going to be caring for them. For example, if you want your child to go to playgroup or nursery while you are in labour or in hospital make sure the person who is taking care of them knows where to go, and drop off and pick up times. Ensure that the playgroup or nursery are also aware that if it is not you picking them up, who it will be

After the birth

Try to have someone at home for the first few days or weeks if possible to give you a helping hand

Spend lots of time with your older child and include them in your activities with the new baby. For example, you can ask them to help change nappies by passing you the wipes and cream or by getting the baby bath out and towel ready at bath time

Do not leave your toddler or older child alone with the new baby

When the new baby is asleep try and put them somewhere out of sight so that you have some time with your older child that has nothing to do with baby. Having a baby monitor makes this much easier. You can leave the baby upstairs and know that they are safe while you read a book or share some other activity with your older child

Looking after a newborn baby and another child can be exhausting. Get as much rest as you can and accept offers of help. Don't expect the house to look clean all the time

Enjoy your new baby. Once your older child has gone to bed you will usually have time to spend with the new baby on its own You will soon find that having more than one child brings more than twice the fun and joy!

Having your baby induced

As you near the end of your pregnancy, you will be eagerly awaiting the arrival of your baby and probably can't wait to finally hold the 'tenant' you have had in your womb for 9 months. But sometimes your baby can be slow arriving and, in this case, your midwife or doctor may recommend your baby be induced. Inducing labour involves helping the labour process using medical means. Common reasons for inducing a baby include: passing the due date; waters breaking before contractions start; or developing a condition called pre-eclampsia (characterized by high blood pressure).

Passing the due date

Your doctor will have based your due date on the time of your last period or an ultrasound scan of the baby. Alternatively, if you know the date you conceived, the due date can be worked out from this. This due date is only a rough estimation of when you will give birth. Although the average length of a pregnancy is 9 months, pregnancies last anything from 37-42 weeks.

Medical research suggests that the placenta does not function as well as it should after 41 weeks, and its functioning deteriorates with longer pregnancies. Many doctors, therefore, recommend babies should be induced if the pregnancy reaches 41 or 42 weeks.

Waters break before contractions start

The 'waters' are the bag of fluid that protects your baby during its development in the womb. The waters have to break before a baby can be delivered, and, when they break, it is usually a sign of imminent delivery. Once your waters have broken, regular contractions usually start soon afterwards.

However, some women do not begin regular contractions until 1 or 2 days after their waters have broken. Once the waters break, your baby is exposed to the outside world and is at risk of infection. For the first day or two after your waters break, your doctor will probably give you antibiotics to protect against infection, after that it is likely that your doctor will recommend that the baby is induced.

Pre-eclampsia

Pre-eclampsia is a condition that occurs in late pregnancy. Signs of pre-eclampsia include high blood pressure, protein in the urine, headaches, swelling, and stomach pain. Women with pre-eclampsia are advised to seek medical advice immediately. Pre-eclampsia can develop into eclampsia and both your health and your baby's health will be at risk. Your doctor will probably want to ensure your baby is born as soon as possible, either through induction or Caesarean section.

Medical methods of induction

Each hospital has its own protocols for inducing pregnancy. The method used for inducing a baby and the time when the baby will be induced varies according to the hospital you go to. If you have any questions, ask the midwife or doctor at the hospital.

Pessaries containing prostaglandin gel (a naturally-occurring substance in the body) are the simplest method of inducing a baby. Pessaries are placed in the cervix and successfully induce labour in around half of the women given them by softening the cervix. This method, however, can take some time to induce the baby (up to 2 days).

Waters are broken forcibly. If you have had a few contractions and your cervix has begun to open, it is possible for your doctor or midwife to insert an instrument and nick the bag containing the protective fluid around your baby. Once the waters have been broken, strong contractions usually follow.

A syntocinon drip is usually used if a previous attempt at inducing your baby has not worked properly. The drip is put in your arm and delivers a gradually increasing amount of oxytocin (a hormone that induces the womb to contract). The amount of oxytocin given is gradually increased to mimic the gradual build up of the hormone that would occur naturally in the body prior to labour.

Inducing labour the natural way

As you approach your due date, there are several things that you can do to encourage the birth process. Women may consider trying these methods just before their due date. However, before trying any of these methods, talk to your doctor to ensure there is no medical reason why you should not attempt them.

Have sex with your partner. Before labour can begin, your cervix has to soften. Exposing your cervix to natural substances (prostaglandins) helps this softening process occur. Semen is a rich source of prostaglandins. If your pregnancy has reached around 40 weeks, you may be able to trigger labour by exposing your cervix to prostaglandins through having sex several times over a couple of days

Have an orgasm because it can induce labour. If you don't feel like having sex, get your partner to try massaging particular areas of your body, such as your breasts or clitoris, to stimulate you sexually. Stimulate your nipples to encourage your body to release the hormone oxytocin, which stimulates your womb to contract.

If it is necessary to have your baby induced, don't worry. It won't mean an increased risk of complications, nor will it affect your baby. It just means your baby is feeling a little too comfortable in your womb and needs some coaxing to come out into the world!

Caesarean birth

Almost 23% of babies are born by Caesarean, 9.4% elective (planned before the birth) and 13.6% are called emergency (which means they were recommended during the actual labour).

A planned or elective Caesarean is essential for mums who have placenta praevia (when the placenta is covering the cervix, blocking the baby's route to the outside world), and also for mums who are HIV-positive (a c-section lowers the risk of the baby becoming infected). It is also common to be offered a planned Caesarean if your baby is breech or transverse lie (feet or bottom downwards or baby lying across your tummy instead of head down). The main reason for an emergency Caesarean is 'failure to progress' (when you've been in labour a long time but haven't got very far). There may also be signs your baby is in distress and needs to be born quickly.

The rocketing caesarean rate

Though a Caesarean can be a life-saver, the 23% c-section rate is way above the 10-15% limit recommended by the World Health Organisation. In the 1950s, less than 3% of births were Caesareans. So why are more mums going under the knife? Are we simply too posh to push?

In fact, mothers' requests account for few Caesareans, but other factors contribute to the rising rate:

Many Caesarean mums automatically have a second c-section, even though it isn't strictly necessary.

Doctors tend to be very cautious, advising a Caesarean even when risks are slight.

Birth is more medicalised in general, with many interventions increasing.

A national shortage of midwives means fewer women are getting continuous care from another woman which makes birth easier and a c-section less likely.

What happens during a caesarean?

A planned Caesarean is done around 39 weeks, when your baby's lungs are mature (lessening the risk of breathing problems) but hopefully before labour starts naturally.

Most Caesareans are done under a spinal anaesthetic like an epidural, so you remain awake throughout. You'll also need a catheter, plus a drip containing a drug to stop your blood pressure falling too low. A screen across your tummy will stop you seeing the op, and the cut will be made along your bikini line (this looks better than a vertical scar and heals better too). After your baby is born, he'll be handed to you. Then you'll need an injection to help your womb contract and stop bleeding and the doctors will then stitch your cut.

What are the possible complications?

Caesarean babies are at greater risk of breathing difficulties at birth, because going through labour triggers the breathing process. There's also a 2% chance of the baby being cut during the op.

It is a big operation so mothers are at slight increased risk of stomach pain, bladder damage, blood clots, and infection.

What about recovery?

You'll need strong pain relief and will stay in hospital for two to four days on average.

Remember to:

be careful lifting and carrying to avoid strain on your scar.

keep moving to prevent blood clots.

ask your midwife about how to clean and dry the scar each day, and checking for signs of infection (redness or weeping).

wear loose clothing over your tummy.

You should also tell your car insurance company you've had a major op and ask them to confirm your insurance is still valid. To be insured to drive you need to be able to perform an emergency stop, without worrying about your scar - for some this takes a few weeks, others won't be able to drive for six weeks or longer.

Can you demand – or refuse – a caesarean?

Officially, there should be a medical reason for a Caesarean, but if you're terrified of birth, ask your midwife - fear is a psychological reason and, as such, counts. Your midwife or obstetrician must, though, explain the risks of Caesarean and offer counselling to help you overcome your fear. But if you're really certain, you'll probably be offered a Caesarean. Having said that, a consultant can refuse to do a c-section, but must refer you on to a colleague if he does so.

On the other hand, if you feel a Caesarean definitely isn't for you, you have the right to refuse - like any other op, a Caesarean needs your consent.

What about next time?

Though many mums who've had a c-section have their next baby by Caesarean too, having a VBAC (vaginal birth after Caesarean) is safe. The main worry is labour may make the old Caesarean scar come apart. But the risk is very small. So if you want a normal labour, and there are no other reasons for a Caesarean, stick to your guns.

pain relief

Some labours are long, some are short; some are straightforward, some more complicated. But however your labour goes there are many different ways to cope with the pain: medical methods, alternative therapies, and simple things to do yourself.

Before the birth, learn all you can about your options, chat to your partner and midwife, then keep an open mind. You never know how it will be on the day. Some mums include a list of pain relief options in their birth plan, putting these in order of preference, often with the least medical method as number one, working through to the strongest method if things get tough.

medical - entonox

What? This mix of nitrous oxide and air is breathed in through a mask or tube. You quickly feel woozy (as if you'd had a few glasses of wine), lowering your perception of pain. When you stop inhaling, the feeling subsides within one minute.

How? Entonox (also called gas and air) is available in hospital, and a midwife can bring a canister for home births.

Pros? Doesn't affect your baby and you're in control of when you use it. Cons? Can cause nausea and dry your mouth.

Medical - pethidine

What? This morphine-like sedative relaxes muscles, soothes anxiety and dulls the perception of pain. Taking 20 minutes to set in, effects last up to four hours.

How? Pethidine is injected by a midwife in hospital, or at home. Pros? Good if anxiety levels are soaring. Cons? Pethidine can make you feel out of control, spaced-out and nauseous. Pethidine babies can be sleepy at birth and find it hard to feed. Several doses may affect babies' breathing. Meptazinol (or Meptid), a similar drug, has fewer effects on the baby.

Medical - epidural

What? Anaesthetic is administered through a tube in your lower back, removing all feeling from the waist down. It can be topped up when needed. How? An anaesthetist puts in the tube, so you can't have it at home. It takes 30 minutes to work and needs topping up every 90 minutes. You'll need a drip to stop your blood pressure falling, plus a catheter as you won't know when to pee. Pros? Removes all pain; safe for your baby. Cons? You won't be able to walk around and, if the epidural hasn't worn off, you won't know when to push during the second stage (making forceps or ventouse more likely). Some hospitals offer lower-dose 'mobile epidurals', enabling mums to keep moving. Occasionally, epidurals don't remove all pain.

Self help - tens

What? A TENS (transcutaneous electrical nerve stimulation) machine is about the size of a pack of cards. It sends electrical impulses down leads attached to four sticky pads on your back, triggering the release of endorphins (natural pain-relievers).

How? Use TENS as soon as labour starts as it takes 30 minutes to take effect. When a contraction starts, turn up the dial to increase the intensity; turn it down as the contraction ebbs. Pros? Safe for your baby; good in early labour. Cons? May not be enough when labour intensifies.

Self help - breathing

What? Rhythmic breathing soothes stress and relaxes muscles (tension and stress cause panic, making pain harder to bear).

How? Attend an antenatal yoga course (find a teacher through www.activebirthcentre.com) to learn the best techniques.

Pros? Safe for you, safe for baby; can be used anywhere.

Cons? May be harder to focus on breathing, once contractions set in with a vengeance

Self help - massage

What? Massage eases the tension that slows labour down, encouraging the release of endorphins.

How? Ask your partner to massage your lower back to ease a backache labour, or to work on shoulders to lessen anxiety.

Pros? No side effects and all you need is your birth partner (for practise, do an antenatal class together).

Cons? Some mums find they can't bear to be touched during labour. self help - water

What? In a birthing pool, water supports your weight, helps you change position easily, and triggers the release of oxytocin making contractions effective. It also slows the production of stress hormones.

How? Hire a pool for a home birth or check whether your local hospitals have pools (see www.drfoster.co.uk).

Pros? Relaxing, safe and effective.

Cons? Effects last just a few hours, so don't get in too early. self help - active birth

What? Staying upright and active during labour means gravity works with you. The baby's head also presses down on the cervix, making contractions more effective.

How? Keep mobile and upright – try leaning on a birthing ball.

Pros? Drug-free and effective.

Cons? You may become tired in a long labour.

Alternative therapies - homeopathy

What? Homoeopathic remedies - such as Aconite to ease pain and soothe panic – are taken in tablet form.

How? Visit a homoeopath (see the Society of Homeopaths, www.homeopathy-soh.org) for a labour kit of remedies.

Pros? Helps with long labours, exhaustion and pain.

Cons? Ineffective for some mums.

alternative therapies - acupuncture

What? An acupuncturist inserts needles at specific points (often in the ear) to speed up labour and relieve pain.

How? You'll need to take a qualified acupuncturist (see the British Acupuncture Council, www.acupuncture.org.uk) to the birth (check first with your midwife).

Pros? Works on the same principle as TENS, and can help many women. Cons? It's hard to find someone to attend you during labour. Have some sessions ahead of the birth to prepare your womb, then use a TENS machine instead.

Alternative therapies - aromatherapy

What? Essential oils affect mind and body, inducing relaxation, triggering hormone release and soothing anxiety.

How? Oils such as lavender, clary sage and geranium can be used in a massage oil, inhaled or put in a water spritzer. See an aromatherapist (see the International Federation of Aromatherapists, www.ifaroma.org) as some oils aren't safe in pregnancy.

Pros? Studies have shown aromatherapy to be effective for pain relief. Cons? Oil quality varies so get expert advice.

Slternative therapies - reflexology

What? Points on the hands and feet are stimulated to help the womb contract and the body release pain-relieving endorphins.

How? Before the birth, see a reflexologist for several sessions (see the Association of Reflexologists, www.aor.org.uk). Learn the pressure points so your partner can use them. Or ask your reflexologist to be with you during the birth (check with your midwife first).

Pros? No side effects.

Cons? Some mums don't want to be touched during labour.

Alternative therapies - hypnotherapy

What? Fear produces stress hormones that halt labour in its tracks. Hypnotherapy techniques (eg visualisation or chanting) help you reach a trance-like state of fear-free relaxation, freeing your body to labour naturally.

How? Before the birth, learn to take yourself into a deeply relaxed state.

Pros? Drug-free and under your own control.

Cons? Some women can't use the techniques once labour starts.

Birth - what really happens

No two birth experiences are the same for any woman, and there's no predicting what yours is going to be like. Even so, the basic physiological process of birth has been the same since time began. One thing is for sure: you will go through three distinct stages and at the end here's how it happens.

Signs of labour

When your baby is due you'll be obsessed about whether or not labour has started. Was that a twinge? Is this it? But ask any expert and they'll tell you – you'll KNOW when labour has really started! Here are the most common signs of labour and can happen at any time after 37 weeks and would be considered 'normal'. If you have any of these symptoms before this time (or you have any concerns generally, - no matter what stage you are at) please contact your midwife or GP immediately:

A show – this is when the mucus which covers the cervix, protecting your unborn baby from the outside world, comes away. You may find a phlegmy-looking discharge, perhaps a little blood stained, either in your knickers or on the loo paper after you've had a wee. But this doesn't mean labour is imminent. You could have a couple of weeks to go yet.

ACTION: Contact your midwife if there's a lot of blood, otherwise hold tight and mention at your next appointment.

Waters breaking – this is when the bag containing the amniotic fluid your baby has been using as his own private swimming pool for the past nine months, ruptures and the fluid starts to leak out. Your waters may go with a pop and a gush - or an almost imperceptible trickle as though you've leaked a little wee. And some waters don't break until full-blown labour, or at all.

ACTION: call your midwife. Because of the risk of infection, your baby should, ideally, be born within the next 24 hours even if it means giving you a little help to get there.

Contractions starting – they may feel like backache or mild period pains under your bump (and you may experience diarrhoea at this time, it's your body's way of getting ready for birth), they are the surest sign that labour is beginning.

ACTION: relax. You've probably got plenty of time. Time the length of each contraction and the gap between them. Sometimes contractions stop for a few hours, even overnight, and this may not be your full, proper labour yet. But call the midwife when the contractions become strong and frequent (approximately 20 minutes apart) and be on your way to hospital when they are 10 minutes apart or lasting as long as 45 seconds each time.

When you get to hospital

When you arrive, a midwife will take a quick look at you and:

1. Ask about the length and frequency of your contractions and whether your waters have broken.

2. Take your blood pressure, pulse and temperature.

3. May give you an internal examination to see how dilated your cervix is.

4. Feel your bump to determine the position of the baby.

5. Strap two belts around your tummy and hook them up to a machine that monitors the baby's heart rate and your contractions (only for around 20/30 minutes so not too long).

6. Take you to a delivery room if your baby is on his way, a ward if you've got a while to go, or send you home if your labour isn't properly established yet.

What birth is like

Labour is split into three clear stages. First the contractions, next the birth, and finally delivering the placenta.

Stage 1

By the power of your contractions and the pressure of your baby, your cervix (the opening to your womb) will start to open (dilate) to its maximum 10cm. Your contractions will grow from a feeling like mild period pains to being intensely painful. And at the end of the first stage, they'll be rolling in one after the other. When your cervix is fully dilated you may go through 'transition', which is when you feel a huge pressure inside your bottom and an overwhelming urge to push.

Stage 2

Once your cervix is fully dilated, your baby can pass through it and down the birth canal (your vagina). You'll need to push very hard (as if you're doing a poo). Follow the midwives instructions, and only push when she says so (panting in-between) to prevent tearing. When the baby's head reaches the outside world the midwife may say 'it's crowning' and suggest you reach down and feel the top of the baby's head. The head is usually the toughest bit to push out and you should get a moment's respite before the rest of the body follows. The cord will then be clamped and usually cut.

Stage 3

A little while after your baby is born your womb will continue contracting and naturally push the placenta out. You may have been given an injection of syntometrine just after the birth to speed this process up. what happens next?

After he is born, your baby will have a quick check (known as the Apgar test to assess his heart rate, breathing, colour, muscle tone and reflexes). He'll also be weighed and measured, wiped and wrapped and handed back to you. Finally the midwife will check the placenta to make sure none has been left behind, and any tear or cut in your vagina will be stitched up.

Birth faqs

Your most-asked questions about giving birth – answered! Midwife Claire Friars, manager of baby charity Tommy's* Pregnancy Information Line, says: 'Often I find the same questions come up again and again, so it's great to be able to answer them, and I hope to provide, not just information but reassurance too.'

q: how i will i know when it's time to go to hospital?

A: Unless you're given special instructions by your midwife or doctor, or you're less than 37 weeks pregnant when you go into labour, there is usually no rush. Most people don't deliver in the car park like they do on TV! As a guide, if it's your first baby, head for hospital when you're contracting every five minutes and each contraction lasts more than 30 seconds. Second babies tend to be quicker, so head in when you're contracting every 10 minutes for 30 seconds or more. Whenever your waters break do go in as the midwives will need to check the baby is happy. If you are ever not sure what to do or if you are worried, call the labour ward for advice.

q: will i know the midwife delivering my baby?

A: This really depends on the system in your area. Ask your midwife during the pregnancy whether this is likely. Don't forget that like everyone else midwives have holidays and sickness, so don't be too disappointed if it doesn't happen.

q: how long will the birth take and how long will i be in pain?

A: This can vary dramatically from woman to woman. As midwives and doctors we don't usually say you're in established labour until your cervix is 3cm dilated, which can take a day or so of niggling pains. Once you are 3cm dilated, with a first baby, we would usually expect your cervix to open 1cm an hour. This would mean taking seven hours until you are 10cm (or fully dilated), when you can start pushing! Pushing your baby out can take up to two hours for a first-time mum.

q: will i be able to get an epidural?

A: If you think you might want an epidural ask your midwife during the pregnancy whether they are available 24 hours a day in your birth unit. Once in labour the best advice is to try the different methods of pain relief available. Start with natural pain relievers such as water, massage, or TENS, then move on to forms such as gas and air and see how you feel. Many women find these forms of pain relief enough. However, if you are having a long or very painful labour and decide you want an epidural ask your midwife for one as soon as possible. An anaesthetist has to come to give you the epidural and if they're busy giving epidurals to other women or are in theatre for a caesarean there could be a delay. It takes around 15 minutes to put the epidural in and another 15 minutes to fully work. If it looks like you might deliver before or soon after the epidural is working the midwife may suggest you try alternatives such as gas and air instead.

q: why might i need a caesarean or forceps delivery?

A: There are two sorts of caesarean - those that are planned and carried out before a woman goes into labour, and those that become necessary due to a complication during the labour. If the caesarean is planned it is usually due to a medical problem such as a low placenta (which may be blocking your baby's exit route) or a breech baby (which is lying across your tummy and will not descend head first as he should). If a caesarean becomes necessary during the labour it can be for a number of reasons such as if the cervix doesn't dilate in the expected time or stops dilating at a certain point, or if the baby seems to be distressed. If you are fully dilated and pushing furiously, but the baby still refuses to come out, doctors may try to help things along by using ventouse (a suction cap which sticks to your baby's head, allowing the doctor to pull in time with your pushes) or forceps (two large metal spoons that are gently put around the baby's head to pull on as you push).

q: what is a show?

A: A 'show' is a plug of mucus which forms soon after you become pregnant and usually sits inside the cervix, acting as a barrier. Towards the end of your pregnancy the cervix may start to open a little and move around, this means you can lose little bits of the mucus and you may notice them in your knickers or when you wipe yourself after going to the loo. It looks like jelly and can often have streaks of blood in it. Unfortunately it isn't a sign that you are about to go into labour and you may even see it two weeks before the baby is born. Some women don't see any at all until they are in labour. If you do see a show and are less than 37 weeks you should call the labour ward for advice, otherwise they don't need to know. As at any other time, if you see bright red blood you must go to the hospital.

q: how long will i have to stay in hospital afterwards?

A: If you have had a normal delivery and you and the baby are well you may be able to go home after a few hours or the same day. If you have had a caesarean, any complications, or the baby needs monitoring you may need to stay a few days. Once you are home the community midwives will visit you regularly to check on your progress.

q: will my partner be able to cut the cord? and how soon can i hold my baby?

A: If the baby appears well at the birth then your partner should be able to cut the baby's cord, just ask the midwife during the labour. If your baby needs a little help at birth, such as a little oxygen to start his breathing the midwife may need to cut the cord for speed. Normally the baby will be delivered straight onto your chest. If you would rather the baby was given a quick wipe first ask the midwife (or write it into your birth plan).

q: how can i tell what stage of labour i am in?

A: There are three main stages of labour: the first, second and third stages. The first stage of labour is when the cervix is dilating up to 10cm (fully dilated). You will know how many centimetres you are dilated when the midwife does a vaginal examination. The second stage is when you are fully dilated and now actually pushing your baby out. This can require a lot of energy and inner strength so prepare yourself for some hard work! The third stage is after the baby is born and involves delivering the placenta or afterbirth. You may also hear some midwives mention the 'transition phase' - this is the time when you are changing to fully dilated. It is thought by some that this period of time is when women gather the strength for all the pushing. Some women (and partners) find that the woman's voice and facial expressions change and they may even say some funny things. I even had one woman get up, put her coat on and say: 'I've changed my mind, I think I'll do this another day!'

Recovering from birth

Nothing – but nothing – can prepare you for the mind-blowing impact of having a baby. Your nether regions will be very sore, your breasts will be tender, huge and unfamiliar, and you're likely to be hormonal. The next few weeks will be a strange, dreamlike twilight zone, where night and day merge into one, and you wander around in an exhausted but (hopefully) euphoric haze. You'll never know tiredness like this again, but there will be days when you'll be so bursting with love for your baby, you'll cry.

Immediately after the birth

If you gave birth in hospital, try to make the most of your time there to rest and learn about caring for your baby. The midwives will spend as much time with you as they can, helping you breastfeed and teaching you how to bathe the baby and change his nappy. But if you feel you're not getting enough attention, it is important to say so. A midwife will also visit you regularly at home over the next few days, so make the most of her experience and ask anything you need to ask.

For the 10% of mums whose baby is whisked away at birth and placed in the hospital's Special Care Baby Unit (known as SCBU), this is a worrying time, as they know doctors think their baby needs special medical attention. There's no doubt it can be scary to see your vulnerable little newborn wired up in an incubator, but don't forget your emotions are likely to be all over the place, and he really is in the best possible hands.

Back home with baby

Many mums spend a day or two in hospital after the birth, which means they get home just as their milk kicks in, the baby blues hit and everyone wants to come and visit. Try these coping tips:

Forget about housework and cooking, just sleep when you can.

Remind yourself continually that this chaos won't last.

Remind yourself that you need to rest to make milk for your baby (write it down and ask your partner to read it to you every morning).

Don't get hung up on bath times. If your baby loves a bath (and dads are just as good at doing baths as mum) then great. If he really doesn't like being bathed, just 'top and tail' (wash face and bottom) for a few days.

Don't worry about daytime versus night-time clothes - your baby won't know the difference. As long as he's clean, he doesn't need to be in a new outfit twice a day.

If your baby is fractious, experiment with different holding positions and – if that fails – hand him to someone else. Quite often a calmer pair of arms (and a body that doesn't smell of breast milk) will settle him. If there's no one else around, place him in his cot/Moses basket, check he's safe, then walk away for a few minutes. Sometimes babies get over-stimulated and just want a bit of time on their own to cool off.

Don't torture yourself by trying to remember how many times you were up during the night so you can play 'competitive exhaustion' with your partner or other mums. Far better to just float through the night in a half-sleep daze with the lights dimmed and the clock turned to the wall. After a while you'll wake up in the morning unable to remember whether you were up in the night or not

your post-birth body

Having been through birth, your body will need time to recover. You'll be bleeding quite heavily (even if you've had a c-section), and your breasts will probably leak. Don't expect to feel sexy! Your bedtime outfit will include: a sleep bra to hold breast pads in place; huge knickers stuffed with an industrial-size sanitary pad: and a big nightie to cover the whole lot up when you're pacing the corridors all night. But rest assured, it will pass. Bleeding stops after about a month (sometimes much sooner), the leaky boobs will settle down once feeding gets into a rhythm, and eventually, your baby will adopt a sleeping routine which means you can spend most of the night in bed, ideally asleep!

Two weeks later

After two weeks your midwife will discharge you and your partner will most likely go back to work. This can be a tough time, as sleep-deprivation will be building up, and that initial 'I've had a baby!' euphoria could be wearing off. A happy, snoozy baby may develop colic (see our special feature), and crying levels could significantly increase. Try these tips:

Make the most of your health visitor. She's a specialist in baby problems and will have lots of solutions for you to try.

Make use of visitors. Ask them to cuddle the baby while you have a bath. You don't have to run around after them, they should be looking after you!

Never turn down any offer of help. In fact, write a list of jobs and allocate them to anyone who asks.

If you're beginning to feel as if everyone is interested in the baby and not you, say to yourself: 'I grew this baby, I'm amazing, I matter'. And repeat it. Often.

Premature babies

While the vast majority of babies arrive within a few days of their due date, up to 10% arrive quite a bit early. It's considered a premature birth if your baby arrives before the end of your 36th week of pregnancy.

Realising your precious baby is going to arrive too soon can be very scary, but there is good news. Huge advances in technology and medical breakthroughs mean the majority of premature babies survive and grow up as healthy children.

However, while babies born after 35 weeks may well be fine without any medical intervention, most of those born earlier will need some help, and this may mean a stay in the hospital's Special Care Baby Unit (SCBU). why are babies born prematurely?

In most cases, it's not possible to predict a premature birth, and very often doctors remain puzzled as to why the pregnancy doesn't go full term. However, the most likely reason for premature birth is if you develop a condition called pre-eclampsia. Other reasons include:

cervical incompetence – the delightfully named condition where your cervix is unable to hold a full-term baby

infection of the vagina or cervix

smoking

very poor diet

twins (or more)

if you've already had a premature baby

What happens in SCBU?

Premature babies often need help keeping warm, feeding and breathing, and most will be put in an incubator for a while. This also helps protect them from infections and other illnesses. Depending on how early they are born, babies may need to be kept on a ventilator to help their breathing, often for days, but sometimes for months.

A baby born before 32 weeks will usually be too physically immature to feed from the breast or a bottle. He will need to be fed slowly by a tube that goes into the baby's nose or mouth, then into his stomach. Often mothers can pump their own breast milk or the baby can be given sterile donated milk from a milk bank. Other babies will be given special fortified milk designed for premature babies.

The SCBU can be a daunting place, full of equipment, and it can be very upsetting for new mothers to see their fragile baby surrounded by sensors and tubes. But the staff understandS what an emotional time this can be, and do their best to support parents.

However tiny your baby is, he will benefit from your presence and loving touch. You may be able to stay with him and hold him, or just be allowed to touch him through the sides of the incubator. No matter how upsetting this seems, spend as much time with your baby as you're allowed to. It really can make a difference to his recovery.

Coping with a premature baby

If your baby is in the SCBU you may worry that you are less important to him than the nurses and doctors, but that's not true. Your baby will benefit from your loving touch, reassuring presence and familiar voice. Skin contact has been shown to help premature babies grow and thrive. For very young babies, you may be encouraged simply to put your hands on your baby while he is in his incubator. For stronger babies, you or your partner might be encouraged to try 'kangaroo care', in which you hold your baby on your chest, tucked inside your clothes. Some mothers find it helpful to keep a diary of their baby's stay in SCBU and to take lots of photographs.

Remember, you need care and rest too at this difficult time, so accept any help you are offered. Eat regularly and make sure you sleep, even if this means you can't spend every minute at your baby's bedside.

Looking to the future

When your baby is born prematurely it is natural to worry about his future. By the time your baby reaches the date that he was supposed to be born, he will probably look much like any other newborn. But premature babies vary in how they grow and reach milestones. Some babies may have problems due to their early arrival, but new research indicates that half of babies born before 26 weeks will have no disabilities at all when they get to the age of two and a half. Babies born early can make amazing progress with the right professional and medical support, and most of all, with the love and encouragement of their parents.

For help, information and support, contact Bliss at www.bliss.org.uk

the importance of small clothes

Each item is made from super-soft cotton jersey, and has fewer seams and no labels to chafe or scratch.

Velcro has replaced metal poppers - so you don't need to use any pressure when fastening, and so baby can stay dressed during an x-ray (metal poppers would show).

Most pieces have a wraparound design to avoid having to pull anything over your baby's head (particularly important if there are feeding or breathing tubes attached).

what does that mean?

Premature baby: born before 37 weeks

Moderately premature baby: born between 35 and 37 weeks

Very premature baby: born between 29 and 34 weeks

Extremely premature baby: born between 24 and 28 weeks

Low birthweight baby: weighs less than 2,500g (5.5 lbs)

Very low birthweight baby: weighs less than 1,500g (3lbs)

On time, but tiny

Even with full-term pregnancies, some babies are born smaller than others. In fact, 6% of babies born in the UK this year will weigh between 1 and 2.5kg (the average full-term baby weighs 3.4kg). Some mums just have small babies - if you and your partner are small, there's a chance your baby will be small too. But when a baby is smaller than expected, the reason might be a medical condition called intra-uterine growth restriction (IUGR) – sometimes referred to as 'small for dates'.

This might be caused by poor nutrition during pregnancy, drugs, smoking, high blood pressure, blood-clotting disorders, or anaemia. Or it could simply be one of those things that runs in your family. IUGR is usually picked up in pregnancy during one of your scans, but the condition may not be noticed – even at birth. An IUGR baby doesn't necessarily have to be treated like a premature baby, because, although small, all his organs should be functioning properly and, with good feeding, most catch up very quickly.

How to prepare for a premature birth

Knowing or fearing you are going to have your baby prematurely can be extremely worrying. But remember, the medical staff will be doing their very best for your baby's health. Some premature babies are delivered by caesarean section, because they are in distress or their skulls are too soft to cope with a normal birth. Alternatively, you may be induced. But sometimes the first you know is when you go into spontaneous labour.

Premature births can be faster than that of a full-term baby because the baby is so small you don't have to dilate fully for him to emerge. Babies born early are usually whisked off to the SCBU straight away. Decide if you want your partner to stay with you after the birth or go with the baby. Many hospitals will take photographs of your baby, so ask about this in advance or take a Polaroid camera into the delivery room for your partner to use.

New birth examination

All babies receive a thorough medical examination within the first couple of days of life to check for any abnormalities. This is usually done by a paediatrician before hospital discharge, but if you have a home delivery your GP will check the baby instead.

Firstly, the doctor will ask about any problems during pregnancy or delivery and about any family history that may be relevant. Then the baby will be undressed completely so the doctor can observe his or her general appearance and movements. Minor skin blemishes are common. Jaundice (a yellow discoloration of the skin and eyes) is a common finding after the first day of life, but if it occurs on day 1 or is severe, blood tests will be needed.

Head

New babies have two soft spots (fontanelle) that can be felt on their skull, which gradually close in the first year of life. The head circumference is measured and will be measured again, together with the baby's weight, at the 6 week examination to check for normal growth. The baby's eyes will be examined with an instrument that shines a light into your baby's eyes, in order to exclude a rare congenital cataract or tumour. Also, the baby's mouth will be examined to look for a small cleft at the back of the mouth (cleft palate). Additionally, a check for extra skinfolds on the neck may detect Down's syndrome.

Heart and circulation

The doctor will listen to the baby's heart early on in the examination. This is to detect a murmur, which may be a sign of a small hole between the heart chambers. Nowadays if there is any doubt, an echocardiogram can be done, which is a scan that can show clearly the anatomy of the baby's heart. The doctor will also check the baby's pulses in the groin to detect any asymmetry, which may be caused by a narrowing of the body's major artery, the aorta.

Chest and abdomen

It is more important to watch the baby's breathing than to listen to the lungs. The normal respiratory rate is less than 50 breaths per minute. If the baby is grunting or if the breathing looks laboured, further investigation is needed. The doctor will also check the belly button and feel the abdomen for any enlarged organs.

genitals

The doctor will examine a boy's scrotum to check that the testicles are fully descended. At birth around 2% of full-term male babies have an undescended testicle. If this is the case he will be carefully rechecked during the first year of life and if the testicle has not descended spontaneously, surgery will be needed.

Occasionally the foreskin may be hooded which can be a sign that the opening of the urethra in the penis is at an abnormal site. This requires surgical treatment later on, but it is very important that these boys should not be circumcised in the meantime. Girls are checked to see if their labia are fused and that their anatomy looks normal. The doctor will also look at the baby's anus to check that it is open.

hips

Gentle examination for dislocated hips (developmental dysplasia of the hip - DDH) is an essential part of the newbirth examination, but unfortunately this test often makes the baby cry. Risk factors for DDH are a breech delivery, family history and female sex. During this examination, a definite clunk indicates a dislocated hip, but slight clicks may simply be due to lax muscles. If in doubt, the doctor will organize a follow up ultrasound examination and possibly an orthopaedic check up.

Back and limbs

When the doctor checks the baby's hands, he or she is checking for extra fingers and counting the number of creases in the palm. Most (but not all) normal babies have two skin creases in their palm, whereas Down's syndrome babies usually have only one.

The doctor checks that the baby's feet are flexible and face in the right direction, in order to exclude clubfoot (talipes equinovarus), which requires orthopaedic referral. The doctor will also check for a common self-limiting condition where the heel is facing inwards and the foot is pointing downward because of the way that the baby was lying in the womb; this is called positional talipes. In contrast to clubfoot, positional talipes is easily corrected by gentle stretching exercises when you change the baby's nappy. The next part of the examination is to turn the baby over to check the spine. By handling the baby the doctor can also detect floppiness or stiffness of the limbs.

The newbirth examination is an excellent opportunity to discuss any worries with the doctor. This examination forms the first part of the Child Health Promotion programme for children up to 5-years-old, performed by doctors and health visitors. The next examination is a physical and developmental check up when the baby is around 6 weeks old and is usually done by a GP from your practice.

Text copied from www.bliss.org.uk