We know that babies can’t control their body temperatures and that we need to make sure they are wearing the right amount of layers for the weather conditions. It is important your baby doesn’t get too hot as this can increase the risk of SIDS (Sudden Infant Death Syndrome).

The optimum temperature for a bedroom is 16-20°C and many parents invest in a room thermometer which helps you keep an eye on this. Remember not to put the thermometer above a radiator or in direct sunlight though.

You should also keep bedding light and have a well-fitting swaddle or sleeping bag. 

How do I know if my baby is too hot or cold?

It is recommended that your baby sleeps in the same room as you for the first six months when the risk of SIDS is highest. This should mean it will also be easy for you to check if they are too warm or too cold.

Hands and feet are often the coldest body parts so to get a true picture check your baby’s chest or the back of their neck. If they are sweaty, have flushed cheeks and damp hair remove one layer, or more. Check them again in 10 minutes to see if they have cooled down.

Hats should not be worn indoors as babies maintain their body temperature through their heads - and duvets are also not safe for babies. 

Swaddles and sleeping bags

In the early weeks and months you may choose to swaddle your baby at night to help them feel safe and warm. 

Swaddles will come in a range of thicknesses and if it is very cold, a cellular blanket can also be placed over your baby and tucked into the cot mattress tightly. 

Sleeping bags are great for babies and again keep your baby warm and snug. They are wearable blankets which come in a range of togs meaning there is one for every type of temperature, from summer months to winter. They can be used once your baby is 8lbs (4kg). If your baby’s head passes through the neck-hole when the poppers are fastened at the shoulders, the sleeping bag should not be used.

Babycentre.co.uk has these recommendations for dressing in different temperatures:

 15°C or cooler experts recommend you dress your baby in a vest, sleepsuit and 3.5tog sleeping bag.

15-17°C your baby should wear a vest, sleepsuit and 2.5tog sleeping bag.

18-21°C they should wear a vest, sleepsuit and 1tog sleeping bag.

 22-23°C if the room is 22-23°C put your baby in a vest and 1tog sleeping bag.

 24-25°C at 24-25°C a baby should be in a vest and 0.5tog sleeping bag.

 26°C or over it is recommended that your baby just wears a vest.

Other tips for keeping cool or warm:

• If it is very hot you can open a window or door to help circulate the air and use a fan, as long as it’s not pointing directly at your baby.

• Keep curtains and blinds closed during the day.

• Never use a hot water bottle or electric blanket in your baby’s cot. You can put your heating on to help warm your baby’s room but try not to let it go over 20°C. 

• If your baby has a fever don’t be tempted to layer them up. They are likely to be hotter than usual so will in fact need fewer layers so their body temperature can lower. Every baby is different but a fever is usually considered to be 38°C or higher.

Final thoughts

It may be a case of trial and error to work out what sleeping arrangement works best for your baby. Like adults, some babies get hot more easily, and others will feel the cold. The key is to check your baby regularly and like everything else with parenting, listen to your intuition.

Lullabytrust.org.uk has more guidance on keeping babies cool or warm. 

The frenulum is the membrane which extends from the underside of the tongue, to the bottom of the inside of the mouth. The presence of a frenulum is normal anatomy. Tongue tie (ankyloglossia) occurs when the frenulum is abnormally short, or tight, restricting movement sufficiently to affect normal tongue function.

How common is it?

Estimates vary, it may be around 1 in 10-20. It is thought to be more common in boys and there may be other members of the family with a tongue tie.

What are the signs?

Tongue tie may be suspected in the presence of a number of signs which are present as a result of a baby having difficulty latching deeply, maintaining a deep latch or, in some cases, an inability to latch at all. These may include, but are not exclusive to:

For the mother/person breast or chest feeding:

• Painful, pinched, blistered/cracked/bleeding nipples when optimising positioning has been addressed

• Nipples which look misshapen, pinched or blanched after feeds, as above re positioning

• Mastitis or blocked ducts

• An impacted low milk supply due to poor milk removal

• Feeds where the baby is not effectively removing milk and so taking longer than they would otherwise, thus impacting mum by way of exhaustion.

For baby:

• Restricted tongue movement where baby may not be able to extend their tongue, lick their lips, during crying their tongue may remain in the floor of their mouth, or just the edges may curl up forming a ‘dish’ shape.

• A tongue that appears ‘forked’ in shape when elevated or extended.

• An inability to open their mouth wide when attaching to the breast even when in an optimum position.

• Unsettled/fussy behaviour when latching and during feeds when positioning and attachment has been addressed.

• Behaviours that suggest they are unable to control the milk flow

• Difficulty maintaining an optimal latch

• Falling asleep at the breast due to tiring during a feed

• Excessively frequent feeds

• Early weight loss or poor weight gain where no other causes are present

• Clicking noises &/or dribbling during feeds

• Swallowing air excessively during a feed causing wind, hiccoughs, or ‘colic’

• Reflux in excess of what is considered normal posseting

Any of the above issues may present for other reasons and so in order to make an accurate diagnosis it is important to be seen by someone who is suitably qualified to explore all that is going on and carry out a full assessment.

How is it diagnosed?

While a number of Health Care Practitioners may be able to suspect there is some involvement of tongue tie, in order to make a definitive diagnosis you will need to be seen by someone who is qualified to assess for tongue tie as this is not routinely part of Midwives, Paediatricians, Health Visitors, Neonatal Nurses, Lactation Consultants or breastfeeding supporters training as it requires further study and an extended role.

Diagnosis involves taking a full history and assessment of breastfeeding, including pregnancy and birth as this can impact breastfeeding. Most tongue tie practitioners use some form of assessment tool in order to determine how function might be impaired and the many use the Assessment Tool for Lingual Frenulum Function (ATLFF) developed by Alison Hazelbaker (1993) which looks at areas of function and, as a secondary factor, the tongue’s appearance, in order to determine a score. Scores of 10 and below for function & 8 or below for appearance indicate that frenulotomy may be beneficial.

How is it managed?

If a tongue tie is diagnosed a frenulotomy (tongue tie division) can be carried out if it is felt by the parents that, on the balance of risks and benefits, they wish to go ahead with this surgical procedure. This is a very individual decision so there needs to be time for all factors to be considered and a full discussion of options to be explored and these may include various feeding strategies.

The most commonly used method for dividing a tongue-tie in the UK involves cutting the frenulum with a pair of sterile scissors. This procedure is known as a frenulotomy. The baby is wrapped securely in a towel or blanket so they cannot wriggle or put their hands to their mouth. Their head is then held still by a parent, nurse or other helper. The practitioner performing the procedure lifts the tongue using the finger or fingers of one hand. (Some practitioners prefer to use a Brodie Director, a small metal spade shaped instrument with a central slit to isolate the frenulum and lift the tongue). With the scissors in the other hand the practitioner slides the blades under the tongue so they are on either side of the frenulum and snips. Some tongue-ties divide well with just one snip, others will require 2 or 3 snips depending on how tight, thick and far forward the frenulum is.

Do you need me to go into more detail about parents’ common concerns, risks etc?

Where can people go for help?

If you are experiencing breastfeeding difficulties where you are suspicious that tongue tie may be involved you should ask your Midwife, Health Visitor of GP for a referral to your NHS specialist clinic. These clinics are run by various disciplines nationally so there may be breastfeeding support alongside the treatment but not always.

You can choose to see a private tongue tie practitioner who may have Nursing or Midwifery qualifications and may also be a certified Lactation Consultant also. Some surgeons offer private treatment too. A search on the Association of Tongue-tie Practitioners website will enable you to find your closest service: https://www.tongue-tie.org.uk/find-a-practitioner/

Carole Goddard (RM, BSc, IBCLC)

August 2020

Vaccines are one of the best ways of protecting your baby against infectious diseases and preventing the spread to other children. It is important babies are protected as early as possible.

The NHS’s child immunisation programme is free for all babies and covers diseases such as measles, rubella, tetanus and meningitis.

Your baby will be given these at eight weeks, 12 weeks, 16 weeks and one year at your GP surgery.

You will be given a Red Book when your baby is born which should be taken to all appointments as it will contain a record of all of the jabs your baby has had and will tell you when the next is due.

Obviously these injections will not be enjoyable for your baby and you may also find it hard seeing them in pain. However, they are safe and should only cause mild side effects such as restlessness or irritability.

BCG

In some parts of England babies are given the BCG when they are born which protects against tuberculosis (TB).

TB is very rare and your hospital will tell you at your baby’s birth if the vaccine is recommended. It will depend on the prevalence of the disease in your local area. A baby may also be given it if they have a parent or grandparent who was born in a country where there is a high rate of TB.

It is given in the upper left arm and usually leaves a little scar.

Eight weeks

Your baby will receive the 6-in-1 vaccine at this age which protects against diphtheria, hepatitis B, polio, Hib (haemophilus influenza type b), tetanus and whooping cough.

The meningitis B (MenB) vaccine is also given, which protects against meningococcal infections which can be very serious.

This vaccine can give your baby a high fever (over 37.5C) and it is recommended that you give your baby paracetamol straight after they receive the jab. Ask the nurse for more information about the dose and how often to give it.

These injections are usually given in your baby’s upper thighs.

Finally, your baby will also receive an oral immunisation for rotavirus - a highly infectious stomach bug - which is squirted straight into their mouth.

12 weeks

At this stage your baby will receive a second dose of the 6-in-1 and rotavirus vaccines. They will also be given the PCV (pneumococcal) vaccine which protects against pneumonia and other infections such as septicaemia and meningitis.

16 weeks

At 16 weeks your baby will receive a third dose of the 6-in-1 vaccine. They will also receive a second dose of MenB.

One year

Soon after your baby has turned one they will need to receive some more doses of the jabs they have already had, plus the MMR (measles, mumps and rubella) vaccine.

They will be given the Hib and MenC as a combined single jab - this will be the first dose of meningitis C and fourth of Hib.

They will also receive the second dose of PCV and a third dose of MenB.

What if I miss an appointment?

If your baby is ill with a fever you will be advised to wait until they are well again before having their jabs. Make another appointment as soon as you can - rotavirus can only be started in babies up to 15 weeks and no later than 24 weeks.

What if my baby was premature?

Babies born prematurely may be at greater risk of infection. They should be immunised in line with the NHS schedule, from eight weeks, no matter how premature they were.

More information

If you have any questions about the vaccines speak to your GP or go to the NHS website.

There are no alternatives to having these vaccinations and every child should be protected from serious diseases which could be fatal.

When you were pregnant you probably enjoyed being told by friends and family how glossy your hair looked or how clear your skin was. This is due to an increase in the hormones oestrogen and androgen which give you healthier-looking hair. Unfortunately, all good things must come to an end and after the birth of your baby your hair will change again and at around the three months-mark it may start to fall out.

Why does your hair fall out?

The hormonal changes in your body during pregnancy cause an increase in the percentage of hair in the ‘growth’ phase. This is why women typically enjoy thicker hair for nine months.

Once you have had your baby and your hormone levels have started to return to normal, more of your hair enters the ‘resting’ phase. This phase is followed by the ‘shedding’ phase which is why new mothers find they are losing more hair than normal.

When does it happen?

It usually starts around three months after you’ve had your baby. It will be more obvious if you have long hair or your hair grew a lot during pregnancy. Your hair growth cycle should return to normal when your baby is around six months old. But if you think your hair loss is abnormal and it is still falling out at 12 months then speak to your GP. Excessive hair loss can be due to issues such as anaemia or hypothyroidism (low thyroid hormone).

Is there anything I can do?

The short answer is no. You will just have to let it happen and feel reassured that it will grow back again. You may have heard new mothers talk about ‘baby hair’. This isn’t the hair on their baby’s head, but actually the short fluffy hairs that indicate regrowth of their hair which fell out earlier in the postpartum phase. It might be most obvious in the hairline around the forehead.

Experiment with different hair styles, different types of hair products and avoid using brushes or combs which may pull at the strands unnecessarily. Maintain a healthy diet and take postnatal vitamins if you think you need them.

There is some evidence that breastfeeding may delay hair loss but it is likely that your hair will still fall out at some point.

Final thoughts:

The loss of your shiny, bouncy pregnancy locks may feel like a kick in the teeth after birthing a baby but your hair will grow back. This is just another example of what your body has been through in its pregnancy and postpartum journey.

Want to know more?

• Kelly Mom

• Pampers

Unfortunately we live in a country with a temperate climate where babies generally need to be wearing nappies and clothes 24 hours a day. Their bodies are protected from the elements but their bottoms can get sore from all of the nappy wearing.

Nappy rash is very common in young babies and there are a number of causes. Usually it is easy to treat with cream and will clear up quickly.

Causes

•   Irritation from wee or poo if they have been wearing the same nappy for a while

•   Not cleaning the nappy area well enough

•   Using wipes which contain alcohol - water wipes are the safest for small babies

•   Taking antibiotics

•   Irritation from the nappy itself

•   Washing your baby with bubble bath or soap.

What does it look like?

It will be obvious if your baby has nappy rash. The nappy area may look red and sore. It may be hot to touch and your baby may be irritable or fussy.

In some cases your baby may have spots, pimples or blisters on the area.

How do I treat it?

The most important thing to do to avoid or treat nappy rash is to make sure you change your baby’s nappy as soon as it gets wet or dirty. Yes, you will get through a lot of nappies, especially in those first few weeks!

When changing your baby’s nappy, make sure you use alcohol-free, water-based wipes or use warm water and cotton wool.

Try to give your baby some nappy-free time so their skin can air dry. Lay down a towel and let them kick about for a little while in the nude.

 Use a barrier cream to protect their skin - apply a thin layer after you have cleaned the nappy area.

 If the rash isn’t clearing up ask a pharmacist or your GP if a different type of cream might help.

 Also always make sure your baby is wearing the right size nappy to avoid any chafing against their skin.

When to speak to a doctor

 If your baby’s nappy rash has lasted for more than a few days it could be a bacterial or fungal infection. Signs of this include pus-filled blisters or bright red, moist patches and your baby appearing distressed.

You may need an anti-fungal cream or some medicine to treat this. It should clear up quickly once diagnosed and treated.

What if it isn’t nappy rash?

If you don’t know what is causing the nappy rash, speak to your GP or health visitor. Other causes of rashes in the nappy area include eczema, cradle cap and oral thrush.

Always seek immediate medical help if your baby has a rash on their body which doesn’t fade under pressure from a glass. This could be a sign of meningitis which needs to be treated urgently.

Cradle cap is a harmless and common skin condition which appears as greasy, flaky skin on young babies’ scalps. Research shows it affects around 4 in 10 babies under three months.

It will usually develop in the baby’s first few months and in many cases will go away on its own without needing treatment. In less common instances your baby may also develop it on their face, neck, nappy area and armpits or backs of their knees.

It might look unsightly but is does not hurt and is not usually itchy. It is not contagious and has usually cleared up by the time your baby reaches six months.

What we don’t know:

How it is caused. Experts say it might be more likely if your baby has particularly oily skin. Some research has also found that it could be linked to a type of yeast called malassezia.

Cradle cap has nothing to do with how clean your baby is so it is no reflection on your hygiene!

How can it be treated?

• Regularly wash your baby’s hair with baby shampoo and use a soft brush to gently brush the loose flakes out. You can buy special cradle cap brushes from your pharmacy but any soft brush should do the trick.

• If shampooing and brushing isn’t working try using a mild baby oil, vegetable oil or coconut oil on your baby’s scalp before putting them down for the night. This should soften the flakes so that you can shampoo and brush them out in the morning. Avoid using sunflower or olive oil as these are not good for babies’ skin.

• If the methods above aren’t working, speak to your pharmacist who may be able to recommend an emollient cream or cradle crap treatment you can use.

• Don’t worry if hair comes away with the flakes, it will grow back.

What not to do?

• Try to resist the temptation to pick off the flakes. This could irritate your baby’s scalp, causing redness or for it to even bleed.

• Don’t use peanut oil due to the risk of an allergic reaction

• Don’t use adult shampoo

• Don’t use soap

• Avoid using shampoo if your baby has eczema.

See your doctor if:

• The cradle cap is all over your baby’s body

• The scalp looks swollen

• The crust is leaking fluid or bleeding

• Treatment is not working.

A GP might be able to prescribe an anti-fungal cream to treat it in these cases.

Final thoughts:

There is no miracle treatment for cradle cap and although it might look unsightly, it should clear up on its own.

Want to know more?

• NHS

Many parents-to-be will have heard stories about babies with colic and it can prompt some concerns during your pregnancy. Colic is very common but it can be quite stressful for new parents. It is usually when a baby cries a lot but there may not be an obvious reason why.

It can start when your baby is a few weeks old and will last until they are around four months old. It usually goes away on its own.

How do I know if it’s colic or not?

All babies cry so it may be difficult to tell if your baby has colic or not. However, if your baby cries for more than three hours a day, for three days a week during the afternoons and evenings then this could be a sign of colic. The crying will sound different to your baby’s other cries, and may be more intense and continuous.

Your baby may also be hard to soothe, clench their fists and go red, be very windy or bring their knees up to their tummy or arch their back.

What causes it?

It is not known what causes colic. Some medical professionals say it could be caused when babies find it hard to digest their milk.

Researchers have also found that some babies have a high concentration of certain bacteria which can cause intestinal inflammation and pain.

In some cases your baby might have a cow’s milk allergy which aggravates their digestive system but you need to speak to a medical specialist about this. In this instance breastfeeding mothers may have to swap to a dairy-free diet.

What can I do to help?

Your baby should not need medical attention if they have colic but there are some things you can do to help soothe them:

•  Hold and cuddle your baby when they’re uncomfortable

•  Wind your baby after feeds

•  Try to hold your baby more upright when feeding to stop them swallowing air

•  Rock your baby on your shoulder

•  Give them a warm bath

•  Try some baby massage

There is little evidence that anti-colic drops or other supplements work for colic.

When to seek medical help

•  If your baby isn’t feeding

•  If your baby is floppy or unresponsive

•  If they have blood in their poo

•  If they have a fit or seizure

•  Has a weak or high-pitched continuous cry

Call NHS 111 or speak to your GP if you are worried about your baby.

Looking after yourself

Soothing a baby who is crying inconsolably can be very tiring and stressful. If you are finding it overwhelming make sure you ask for some support from family and friends. It is important that you also look after yourself, as well as your baby.

Speak to your health visitor or GP and you can also call the Cry-sis helpline on 0845 122 8669.

We’ve outlined some of the benefits and schemes which are available. Many of them are means-tested, with strict eligibility criteria. You can find out more at the gov.uk website. 

Maternity Pay

If your employer will not pay you Statutory Maternity Pay (SMP) while you are on maternity leave you may be entitled to the Maternity Allowance.

This is a payment of £151.20 a week or 90% of your average weekly earnings (whichever is less) for 39 weeks.

You can claim it from 26 weeks pregnant but you will have to prove your income, pregnancy and that you have been refused SMP by your employer. 

If you are self-employed and were worried you wouldn’t have an income during your maternity leave you should definitely investigate if you are eligible for the Maternity Allowance.

Sure Start Maternity Grant

This is a one off payment of £500 from the Social Fund to help you buy things you may need for your baby. 

You will be eligible for the grant if it is your first child, or you are expecting multiples and have children already and if you or your partner already receive certain benefits such as Universal Credit or Jobseeker’s Allowance.

You do not have to pay the grant back. 

Child Benefit

Anyone who has a child under 16 can claim Child Benefit but you will have to meet a number of criteria. Only one parent can claim for a child but you can claim for every child you have.

The rates for the 2020/21 tax year are:

• £21.05 per week for the eldest or only child

• £13.95 per week for each additional child.

However, if either you or your partner earns more than £50,000 a year, you’ll have to pay back some or all of your Child Benefit in the form of extra Income Tax. It could still be worth applying to help protect your state pension as you will earn National Insurance points.

Tax Credits

This is quite complicated to explain so always check gov.uk for the latest information and to check what your individual circumstances entitle you to.

Universal Credit has replaced child tax credits for most people. It is means-tested and can top up your income if you are responsible for one or more children. You don’t have to be working to claim it and you get it until the September following your child’s 16th birthday.

As of 6 April 2017, you can only get child tax credits for a child if they're your first or second child. You could get £2,830 a year for each child. There are some exceptions to this rule, for example if you’re expecting twins or triplets but check gov.uk for more information.

To get the maximum your annual income needs to be less than £16,385 in the 2020/21 tax year. The more you earn the less you can claim.

Junior ISAs (Individual Savings Accounts)

A Junior ISA is a long-term, tax-free way of saving money for your child. It can be set up by a parent or guardian and can only be withdrawn by your child when they turn 18.

In 2020/21 the maximum amount that can be saved is £9,000.

The ISA can either be in cash or in the form of stocks and shares. It is favoured by parents because you do not have to pay tax on it or on any growth or dividends you receive.

Shop around for the best interest rate. Some banks and building societies will give you 2.5-3.5%.

Help if you have a disabled child

You local council will be able to help if you are caring for a child who has disability.

You may also be able to apply for the Disability Living Allowance which is offered to families where a child needs much more looking after than a child without a disability or if your child cannot walk.

The DLA is between £23.60 and £151.40 a week, depending on the level of help you child needs.

More information

As mentioned above everyone’s circumstances are different so always check on the gov.uk or your local council website to see what support you might be entitled to.

Happy Parents. Happy Baby’s Imogen Unger, a certified lactation consultant, has cleared up some of the most common breastfeeding myths for us.

1.     I can’t express much so my supply must be low

How much milk you can express is just that. It is only an indicator of how much milk you can express. It’s not an indicator of how much milk your body is making. Your baby is much more efficient than any pump. There are many women who breastfeed for years with no problems but can’t express more than a few drops.

If you have any concerns about your supply or are wanting to express then seek out specialist support.

2. My milk supply must be dropping as my breasts don’t feel full anymore

Just because your breasts feel softer than they have previously does not mean you have low milk supply. The longer you breastfeed for, the cleverer your breasts get at milk storage and don’t forget that milk is also made when your baby breastfeeds. Lots of mothers start to worry about their supply when their breasts no longer feel full or engorged. Try remembering the things that let you know your baby is getting the milk the need to grow. If your baby has adequate wet and dirty nappies for their age and is growing along their own curve then they are getting enough.

3. Your baby is a ‘lazy’ feeder

I’ve heard this a lot recently. What a ridiculous word to use when describing a baby. Your baby isn’t lazy. Your baby loves flow and your baby responds to flow. If for some reason there is no flow or that flow slows then your baby may not suck and swallow or they may fall asleep. Rather than use the term lazy let’s look at why they might be doing this. Do they need support with attachment? Could you use breast compressions or swap to the other breast? If someone is telling you your baby is lazy and that someone is supporting you with feeding I’d say they are probably not the right person for the job.

4. Feeding patterns will be the same every day

Don’t forget that your baby is a little person. I know it sounds silly but they are. People don’t do the same things every day. People don’t eat at the same times every day. Sometimes we’re grumpy, sometimes we’re sad, sometimes we’re really really hungry and other days not so much. Expecting a baby to feed the same every day is just crazy. Try and go with the flow and remember that we as adults behave and eat differently every day.

5. My baby is waking a lot at night so my supply must not be satisfying them

It is normal for your baby to wake at night. Breastmilk is absorbed very quickly and your baby only has a tiny stomach. They have shorter sleep cycles than adults and frequent wake ups can be protection against SIDS (sudden infant death syndrome).

6. My breasts aren’t leaking anymore so my supply must be low

None of these things indicate low supply:

• your breasts feel soft

• your breasts don't leak

• you don't feel a let down

• you have little to no pump output

• your baby breastfeeds frequently

• your baby starts to breastfeed more frequently or for longer

• your baby fusses at the breast

• your baby breastfeeds for shorter periods

• your baby wakes frequently at night

7. Breastfeeding to sleep is a bad habit to get into

Hands up if you breastfeed your little one to sleep? Isn’t it a wonderful mothering tool?! But how often have you been told that this is something you should most definitely not be doing? Some people will want you to encourage your baby to self soothe and sleep alone as soon as possible even though this is not developmentally appropriate. Try asking them if they sleep alone, or if they have strong feelings about adults sleeping with someone even if they can self soothe.

There are many advantages of mothering this way:

1. It is a great opportunity for your baby to get extra calories.

2. It will help your baby fall asleep quickly, at any time of the day or night due to the rhythmic action of sucking and the sleep inducing hormones in breast milk. These hormones help establish their circadian rhythms—their internal body clocks affecting sleeping and eating cycles.

3. It helps your baby’s emotional health. It makes them feel safe, secure, calm and content which are perfect for their developing brain.

:: Imogen has more information about breastfeeding and support on her Instagram account @imogenibclc

Group B streptococcus (GBS) is one of the many bacteria that normally live in our bodies and which usually causes no harm and has no symptoms. GBS is found in the rectum or vagina in 20-40% of women, but most will not know that they have it. Very occasionally it can cause serious infection in newborn babies if they are exposed to it during labour.

It is not routinely tested for by the NHS, however may be detected during a vaginal swab or a urine test.

Who is at risk?

GBS infection is more likely if:

• Your baby is born before 37 weeks

• You have previously had a baby affected by a GBS infection

• You show signs of infection in labour, such as a high temperature

• You had a positive GBS swab or urine test during your pregnancy

• Your waters have broken more than 24 hours before labour

What does GBS mean for my baby?

Around 1 in every 1,750 newborn babies in the UK and Ireland is diagnosed with early-onset GBS infection, according to the Royal College of Obstetricians and Gynaecologists (RCOG). GBS most commonly causes sepsis, pneumonia and meningitis. Obviously, these are very serious infections but most babies recover fully with the right treatment. However, 5.2% will die and 7.4% will be left with disabilities such as hearing or vision loss.

I’ve tested positive for GBS, what next?

If you have tested positive for GBS, you will be recommended to have antibiotics during labour, which are given through a drip to reduce the risk of the infection passing to your baby. Tell your midwife as soon as your waters break or you go into labour. You should still be able to move around during labour even if you require the antibiotics and can still have a water birth.

If you tested positive for GBS from a urine sample during your pregnancy, you may have a urinary tract infection and your medical team will advice if you require a course of antibiotics to treat.

The antibiotics given are usually penicillin so it is important to tell your midwife if you are allergic or have had a reaction to any antibiotics before, so they can give you the safest option.

Is GBS screened for during pregnancy?

Routine screening to test all pregnant women for GBS is not currently offered in the NHS as GBS is an infection that comes and goes. Therefore, if you tested negative on a swab at 34 weeks, you may be falsely reassured by this and actually have the infection by the time you go into labour. Conversely, you may test positive on a swab at 34 weeks and the infection may have cleared by the time you go into labour, yet you would have been recommended to have antibiotics during labour.

Although it is not offered on the NHS routinely, if you are concerned and want to have a test, it is possible to order a home testing kit online. Make sure you choose a supplier which uses the ‘gold standard’ Enriched Culture Medium (or ECM) test for group B Strep. If this shows a positive result then you should inform your midwife who will give you advice.

How will my baby be monitored?

If your baby is born at full term and you received IV antibiotics at least four hours before giving birth, they will not need special monitoring for GBS after birth, however will routinely check your baby for any signs of distress. If you did not get IV antibiotics at least four hours before giving birth, it is usually advised that your baby is monitored closely for signs of infection for at least 12 hours after birth. Midwives will check their general wellbeing plus their heart rate, temperature breathing and feeding.

What about when we take our baby home?

Most babies who develop a GBS infection will become unwell in the first week after their birth. This is called early-onset GBS infection and signs to look out for are:

• Baby is very sleepy or unresponsive

• Baby is unusually floppy

• Inconsolable crying

• Not feeding well

• A high or low temperature, hot or cold to touch

• Grunting or noisy breathing, struggling to breathe

• Changes in skin colour

• Abnormally fast or slow heart rate.

• Low blood pressure and blood sugar (tested at hospital)

Late on-set GBS infection can affect babies up to three months after their birth but this is less common. The signs are similar to those of early-onset but may also include symptoms associated with meningitis such as turning away from bright light or a bulging fontanelle (the soft spot on babies’ heads). Having intravenous antibiotics during labour does not prevent late-onset GBS infection.

 Call 999 or go to A&E if you see any of these symptoms.

Can I breastfeed my baby?

The benefits of breastfeeding greatly outweigh any risks of transmitting group B strep through breastmilk. Maintain good hygiene standards by keeping your hands and nipples clean. The intravenous antibiotics to protect newborn babies are also safe for breastfeeding mothers.

Final thoughts:

Many cases of GBS cause no harm but sometimes babies can become seriously unwell.

Early detection of a GBS infection with your baby is crucial as a delay could be very serious, so if you notice any of the signs above after your baby is born you should contact your healthcare professional immediately.

Want to know more?

Group B Strep Support

Royal College of Obstetricians and Gynaecologists

NHS Website

Vaccines are a key way of protecting ourselves and our families from infectious diseases. All vaccines have to pass tests and trials before they are approved, meaning they are safe for you and your child.

Some vaccines will have mild side effects such as a sore arm or perhaps a high temperature for children for one or two days. The benefits of having them outweighs the risks of getting any disease, especially when pregnant.

Whooping cough

It is recommended that all pregnant women receive the whooping cough vaccine between 20 and 32 weeks. This vaccine will give your unborn baby immunity until it develops it’s own, which will protect it from whooping cough in the first few weeks after it is born. Babies receive their first immunisations at eight weeks old and whooping cough is included in the NHS schedule.

If you miss your vaccine for any reason, it is safe to receive it right up until you go into labour. It is usually given by your GP, although you may be offered it at an antenatal appointment.

Seasonal Flu

All pregnant women are offered the ‘flu jab because you are at an increased risk of catching the ‘flu and of getting more sick if you catch it.

It can be given safely at any time during the pregnancy but the ‘flu season in the UK usually runs from October to February.

Hepatitis B

Pregnant women are tested for hepatitis B as part of the routine blood tests carried out at your booking appointment. You contract the disease by having contact with an infected person’s blood or other body fluids. It can cause severe disease in adults and a chronic infection for infants so women who are at high-risk of contracting it will be given the vaccine.

You will need to have three injections of the vaccine at recommended intervals to be fully protected from the disease.

Your baby will be given three doses of the hepatitis B vaccine during the NHS schedule at eight, 12 and 16 weeks old.

Tetanus

Tetanus, which is caused when bacteria gets into a wound. It is rare in England because a preventive injection is given as part of the childhood vaccination programme. The vaccine is safe to be given during pregnancy.

Travel vaccinations

If you are planning a “babymoon” before your baby is born, you will need to check which vaccinations are recommended and if these are safe during pregnancy.

Many of the required vaccines, including yellow fever, BCG (tuberculosis) and oral typhoid are “live”. This means the vaccine contains a small amount of the virus, which could pass to your baby.

Pregnant women can also be more susceptible to malaria so it is best to avoid countries where instances of it are high if you can. If you are travelling to a country with a high level of malaria, make sure you get advice about which anti-malarials are safe to take whilst you are pregnant.

Medical advice

Speak to your GP or midwife for more information about vaccines. In some cases “live” vaccines can be given if the risk of infection is higher than the risk from the jab.

A non-invasive pre-natal test (NIPT) is an extra screening test some couples choose to have to check for chromosomal abnormalities at 10-14 weeks, alongside the NHS Dating & Nuchal Translucency scan. It is also known as cell-free DNA screening and the two most common types of NIPT are called the Harmony and Panorama Tests.

The NIPT assesses the risk of your baby having certain conditions, such as Down Syndrome (Trisomy 21), Edwards Syndrome (Trisomy 18), and Patau’s Syndrome (Trisomy 13).

The NIPT is not offered routinely in most NHS hospitals and is an additional test that women can choose to get privately if they wish. The cost of the test varies between each clinic, but usually costs between £400-600.

How does it work?

You can have the NIPT from around 9-10 weeks of your pregnancy, when a small amount of your baby’s DNA will have entered your bloodstream. This means a blood sample can be taken from a vein in your arm and the DNA of your baby can be analysed.

An NIPT can also tell you the sex of your baby, if you want to find out and don’t want to wait until your Anomaly scan at 20 weeks.

As the NIPT test involves only a blood test for you, there is no risk to the baby, unlike other more invasive procedures.

But won’t I be screened for this anyway?

Yes, the NHS screening programme offers all pregnant women blood tests and a scan at 10-14 weeks to assess your chance of having a baby with these conditions.

The sonographer will look at the baby’s nose and skin fold at the back of the neck to check for any abnormalities. These results will be combined with some blood test results and combined to give you a risk of your baby having different chromosomal abnormalities.

This method of screening for these conditions is less accurate than the NIPT test. Some people choose to pay for an NIPT due to the increased accuracy rate, or if they are at any increased risk of having a baby with one of these conditions, e.g. if they are above 35 years old or have a personal or family history of these disorders.

The Harmony and Panorama tests

These are the names of two of the most common types of NIPT that clinics may offer. They both involve a blood test for mum and have very similar accuracy rates. The clinic you are visiting will explain which test they offer and why.

You will need to sign consent forms before having an ultrasound to check the baby is healthy and growing well and a blood test. The blood sample is then packaged and sent to a laboratory for analysing.

The time it takes to get your results back will depend on the clinic you visited, but it usually takes between 3-7 days. Occasionally, you will get an inconclusive or failed result, meaning it cannot give you a clear answer. Your clinical team will explain what the next steps would be in this instance, but usually they recommend having a repeat test.

The tests can also tell you the gender of your baby by looking at their X or Y chromosomes, if you wish to find out.

The NIPT tests can also be used for twin pregnancies, donor and surrogate pregnancies.

Are there any risks in having this test?

There is no increased miscarriage risk to your baby from having the NIPT as it only involves a blood test for the mum.

What if an abnormality is found?

An NIPT is a screening test rather than a diagnostic test, which means it evaluates the risk of there being a disorder – so the result will be either “Low Risk” or “High Risk” of having a condition. If it is deemed high risk the team will explain what your further options are, which may involve offering further tests to confirm the findings. You will be given support by the team to understand your options and to make any decisions.

Where can I get further information and support?

Antenatal Results and Choices (ARC) runs a helpline 0845 077 2290 or 020 7137 7486.

The Down’s Syndrome Association

SOFT UK offers support and information for families affected by Edward’s syndrome (T18) or Patau’s syndrome (T13).

In the first 72 hours after your baby is born they will be physically examined by doctors or midwives to check for any issues.

This will usually take place in hospital after you have given birth and preferably both parents will be there for it. If you give birth at home, a midwife or health visitor will carry out the check.

The person carrying out the newborn physical examination will explain clearly to you what is happening and of course, you can ask questions or tell them any concerns you have.

It is important any problems with your baby’s health are picked up early. However, while this check is recommended, it is not compulsory.

What does it involve?

Whoever is carrying out the examination will ask you how your baby is feeding and sleeping and if you have noticed anything which worries you.

Your baby will need to be undressed for some of the check as their heart and pulse rate will be listened to.

It should not cause your baby any discomfort. You will be told straight away if your baby needs to be referred for more tests. The results will be recorded in your baby’s Red Book which you will need to take to every medical appointment you attend.

Heart

It is important your baby’s heart is checked in the first days after they are born. A heart murmur could be picked up at this point but this does not always indicate that there is a problem with the heart.

In 1 in 200 cases a baby may have a heart problem which needs treating, according to the NHS.

Hips

Your baby’s hips will be checked for developmental dysplasia of the hips (DDH) which can lead to issues later in life.

If a problem is suspected you may be advised to book an ultrasound before your baby is 6 weeks which will show for certain if it is unstable.

If your baby was in the breech position in the womb or was born breech they may be at higher risk of DDH. This is also the case if you have twins because they may have had less room to stretch out during the pregnancy. Twins will be given ultrasounds before they are 6 weeks old.

Eyes

The movement and appearance of your baby’s eyes will be checked. They will also be looked at in case of cataracts.

The NHS says that 2 or 3 in 10,000 babies have a problem with their eyes.

Testicles

If you have had a boy a health professional will check that their testicles have descended into their scrotum.

In some cases it may take a few months after the birth for your baby’s testicles to drop. In 1 in 100 cases they may not descend properly, or at all. This will need to be treated in order to prevent potential problems with fertility later in life.

Hearing

If you give birth in hospital you may be offered a hearing test for your baby. This is called automated otoacoustic emission (AOAE) test and it only takes a few minutes. This is separate from the checks already outlined.

Gentle clicking sounds are played in your baby’s ears to get a response which is detected by a microphone within the earpiece.

The earpiece will show a result of ‘pass’ or ‘refer’. Most babies pass but around 2% of babies are referred for more assessment.

Heel prick test

Your baby will also be given a heel prick test which involves taking droplets of blood from their heels to screen for 9 health conditions. These conditions, which include sickle cell disease and cystic fibrosis, are serious but rare.

This test is usually carried out on day five by a midwife or health visitor. The blood samples are squeezed on to a card which is then sent off for analysis. The test may cause your baby some mild discomfort but it is very quick.

You should receive the results in the post by the time your baby is 6-8 weeks old.

6-8 weeks check

You will be advised to book an appointment with your GP at 6-8 weeks where they will again check your baby’s heart, eyes, hips and testicles (for a boy). The reason for this second check is because some conditions can take a while to develop.

More information

This list may leave you feeling like your baby will be having a lot of checks but they are all very quick and are important for the potential diagnosis of very rare health conditions. None of them are compulsory but are highly recommended as they could save your baby’s life.

Always ask a midwife, health visitor or GP if you have any questions or concerns.

Postnatal depression (PND) is a common illness which can affect mothers and fathers after the birth of their baby. NHS figures show it can affect more than 1 in 10 women within a year of the birth.

It often starts in the first one or two months after a baby is born. However, it can start at any time and sometimes it may even start in pregnancy.

PND can range in severity from a woman needing extra support from friends and family - to requiring treatment in a specialist mental health facility. It is incredibly important that you seek help quickly if you think you might be depressed. 

Symptoms

It is normal to feel high and low emotions in the days and weeks after your baby is born. Labour is a physical trauma for your body and the flood of hormones after your baby is born will leave you feeling very emotional. Couple this with sleep deprivation and any other issues such as establishing breastfeeding and it’s going to leave you feeling a bit wrung out.

But if you find you are feeling persistently low then it could be more than so-called ‘baby blues’ and you may have PND

Other symptoms include:

• Lack of enjoyment or interest in the wider world

• Trouble sleeping at night but feeling tired all of the time

• Anxiety which can be overwhelming

• Problems bonding with your baby

• Frightening thoughts which could involve hurting your baby

• Loss of appetite

• Irritability with family and friends

• Avoiding socialising or seeing other people.
  

It may take some time to realise you have PND as some of the symptoms can come on gradually.

Causes

There may not be one single cause of PND and it could be a combination of factors. However, there are a few triggers which could make you more likely to have it:

• Previous mental health problems, including depression

• Depression or anxiety during pregnancy

• Lack of support from your family 

• A traumatic event which could include the labour, a death of someone close to you, job loss 

• Experiencing abuse such as domestic violence
  

Treatment

Do not struggle alone if you think you have PND. Speak to your GP or health visitor as soon as possible. They have often been trained to spot the first signs of it or will be able to refer you to someone in your area who can help.

In some cases PND can be treated with self-help techniques such as getting support from family, taking time to rest, eating and sleeping well and making time to do things you enjoy.

Some women will need therapy such as cognitive behavioural therapy and if the depression is more severe, antidepressants may be prescribed. 

Remember, it is not your fault if you have PND, it does not mean you are a bad parent or that your baby will be taken away from you. 

Most women will recover within 3-6 months and many do not need any treatment. However, being depressed will affect your experience of being a new mother and in some cases it can affect your baby’s development. Always seek help.

Antidepressants

What is most important for your baby is that you are well and feel supported, even if this means having to stop breastfeeding.

Make sure you tell your GP if you are breastfeeding so they can check with the UK Drugs in Lactation Advisory Service if the pills are safe to take.

To decide whether to take antidepressants and continue breastfeeding you will want to weigh up how serious your illness is, the drug’s side-effects, the benefits of breastfeeding and whether your baby was premature or not. 

How can partners/family help?

• Listen to your partner and reassure her that she is supported and will get better.

• Try not to use language such as ‘snap out of it’ or ‘just think positively’.

• Help as much as you can with the baby and other practical things around the house such as cooking and laundry.

• Take any worrying comments or behaviour seriously and seek help immediately.

• Make sure you also have support and someone to talk to.
  

Postpartum psychosis

Postpartum psychosis is a serious mental illness which needs urgent treatment. It occurs in around 1 in 1000 women and can start soon after a baby is born.

Symptoms include mood swings, hallucinations, delusions, a low mood and behaving in a way which is out of character.

See a GP as soon as possible or call 111 if you can’t get an appointment. Go to A&E or ring 999 if you think a person is at risk of imminent harm. Women who have postpartum psychosis may not realise they have it.

Most women who have this condition will need treatment in a specialist Mother and Baby Unit (MBU) where the baby stays with the mother. 

Treatment may include antidepressants, antipsychotics and CBT.

It can take 6-12 months to recover from postpartum psychosis but most women do make a full recovery.

Help and support

• Association for Postnatal Illness 

• Pre and Postnatal Depression Advice and Support (PANDAS) 

Unfortunately 6 in 100 (6%) women will experience a third or fourth degree tear during their first vaginal labour and less than 2 in 100 for a second vaginal birth. This kind of tear is also known as an obstetric anal sphincter injury (OASI). A third degree tear will extend down from the vagina to the perineum and anal sphincter and a fourth degree tear will extend into the back passage.

Both of these injuries will require surgery in an operating theatre as soon as possible after the birth of your baby. You will be given an anaesthetic in the form of a spinal or epidural but very occasionally the surgery may need to be carried out under general anaesthetic.

What happens after surgery?

You will be offered some of the following treatments as you start to recover:

•  Antibiotics to prevent the risk of infection

•  Painkillers such a paracetamol or ibruprofen

•  Laxatives to help you open your bowels without risking damage to your stitches

•  A drip to give you fluids until you feel ready to eat and drink

•  A catheter for 12-24 hours to help you pass urine if you are unable to walk to the toilet

You will still be able to breastfeed your baby while receiving these treatments. You may also be offered a follow-up appointment with a physiotherapist.

How do I care for my wound?

•  Avoid sitting or standing for long periods of time

•  Keep the area clean at all times

•  Change your sanitary pad regularly, at least every four hours

•  Wear breathable materials and avoid tight clothing

•  Drink plenty of water and eat a balanced diet to keep your bowels loose so you don’t have to strain when you go to the toilet

•  Start doing pelvic floor exercises to start to strengthen the area again

•  You could apply cold/ice packs wrapped in a cloth to the area for half an hour

•  Take regular pain relief

•  Your stitches will gradually dissolve but you may still be able to feel them up to 3 months after the birth.

Contact your midwife or GP if:

•  You have a temperature or start to feel ill

•  Your wound is throbbing or starts to swell

•  Your stitches become more painful, or the wound starts to smell as this could be a sign of an infection

•  Your stitches are coming apart

•  You have problems controlling your urine or bowel movements

•  You pass faeces through your urine

What are the long-term effects?

You will be given a checkup at 6-12 weeks and you must always tell your doctor if you have any concerns about the healing of your wound or any issues with your bladder or bowels. You may be offered an endoanal scan (anal muscle scan) and perineal nerve function test to check that the nerves damaged during birth are recovering. Avoid any strenuous activity or heavy lifting for 4-6 weeks.

A small number of women will experience difficulty in controlling their bowels or holding in wind. This is called anal incontinence. In very rare cases a fistula (hole) or rectal buttonhole may be left between your anus and vagina after the tear has healed. This will need to be repaired by further surgery as soon as possible.

There is no reason to suggest a straightforward vaginal birth will not be possible after a tear but speak to your obstetrician about your options. It is natural that you may feel apprehensive about going through the same experience again. If you are feeling abnormally anxious or have a low mood speak to your GP. Some women develop post-traumatic stress disorder (PTSD) after having a perineal tear.

When can I have sex?

Everyone is different and for many women the thought of having sex after having been through birth and surgery will be far from their minds. Wait until your stitches have healed and you have stopped bleeding. Discuss it with your partner and do what feels right for you both. You might experience some discomfort for the first few times but this should ease. If you are experiencing any pain, raise your concerns with your doctor.

It is possible to become pregnant very early on after having a baby so remember to use contraception.

Final thoughts:

Everyone will have a different recovery from a third or fourth degree tear but always consult a healthcare professional if you have any concerns.

Balancing your physical recovery with looking after your new baby will be hard work so make sure you have support from your family and friends in the first few weeks.

Many women go on to have a normal vaginal birth after a serious tear but if you are still struggling with the effects you may be able to have a planned c-section.

Want to know more?

• Mothers with anal sphincter injuries in childbirth

• Royal College of Obstetricians and Gynaecologists

• Birth Trauma Association

Tearing during a vaginal labour is probably one of the top fears many women have before giving birth. You might be surprised to learn that 9 in 10 women will experience some kind tear, graze or episiotomy when giving birth. Midwives and doctors are used to dealing with tears and most are minor and heal quickly.

What is a tear?

A tear happens spontaneously when your baby stretches your vagina and perineum during the birth. Your perineum is the area between your vagina and back passage (anus). The type of tear a woman experiences will be graded in severity from first to fourth degree. A first degree tear, or graze, affects just the skin and can occur around the labia, clitoris or inside the vagina. It won’t usually require any stitches and heals quickly without treatment.

A second degree tear affects the muscle of the perineum and the skin and usually requires stitches under local anaesthetic. This is usually done in the same room where you had your baby. It can be very sore in the days and weeks after the birth but is unlikely to cause any long-term problems.

We will cover third and fourth degree tears in a separate article but these are when the tear is deeper and may extend to the muscles controlling the anus, the sphincter. They can occur in approximately 6% of first time births and 2% of second time. They usually require surgery in an operating theatre and will take longer to recover from than other tears.

What is an episiotomy?

An episiotomy is a cut made by your midwife or healthcare professional to help make more room for your baby to come out. It can only be done with your consent and will be stitched up in the same room after your baby is born. In some instances the cut may extend and also tear.

An episiotomy is often carried out during an assisted or instrumental birth. This is when forceps or ventouse may be needed to help bring your baby out. It may also be done if your baby needs to be born quickly or if there is a risk of a perineal tear.

How do I care for my tear or episiotomy?

It is normal to feel pain or discomfort for 2-3 weeks after the birth, especially when walking or sitting. Give yourself time to heal and don’t do anything strenuous or unnecessary. It’s another great reason to ask family and friends to help so you can focus on recovering and being with your baby. Follow these tips when caring for your tear:

•  Keep the area clean and only use water to wash

•  Change your sanitary pad regularly, at least every four hours

•  Shower or bath every day

•  Wash your hands before and after going to the toilet

•  Drink plenty of water and eat a balanced diet as this will help avoid constipation

•  Ask a health professional to check your stitches if you have any concerns

•  Pouring water over yourself while urinating can help neutralise the acid and reduce any stinging.

Can I do anything to prevent a tear?

It is impossible to predict who will tear or need an episiotomy during labour. Some factors which may increase the risk are:

•  First vaginal birth

•  The baby is over 4kg

•  The baby’s shoulder becomes stuck

•  Assistance is needed in the final stage to bring the baby’s head out

•  You can a long second stage of labour (the pushing stage).

Some midwives recommend trying perineal massage in the weeks before your due date. This can help stretch and loosen the perineal muscles. There are some positions during labour which could help reduce the risk of tearing such as all-fours or kneeling and your midwife will help you have a slow and controlled birth. They may also support your perineum as your baby is born - this is called ‘hands on birth’ and can reduce the severity of a tear. This can be done in any position, but not during a water birth.

Final thoughts:

Remember that most women will experience some kind of tear of graze during labour, especially if it is their first baby. It will be very sore but should heal quickly and without complications. If you are worried about tearing speak to your midwife who can discuss the risks and methods for preventing a serious tear.

Want to know more?

• NHS article

Skin-to-skin contact refers to the process of drying and laying a newborn baby on a mother’s bare chest immediately after birth. The longer a baby can stay there the better and ideally it should not be moved until after its first feed. But skin-to-skin contact does not have to be just after the birth, it can be done at any time the baby needs comfort and it can also help boost your milk supply in the early days. Maternity units are required to make sure mothers are given time for skin-to-skin contact with their baby after the birth.

Skin-to-skin is especially important for babies in neonatal care where it is known as ‘kangaroo care’. It helps the baby bond with their mother, reduces stress and can encourage pre-feeding.

Skin-to-skin contact with dad is just as important, especially if it is not possible with the mother.

Why is it important?

•  Improvement of heart and lung function

•  Regulates body temperature

•  Initiation of breastfeeding

•  Transfer of good bacteria from the mother’s skin which can protect against infection

•  Reduction in crying

•  Relief from pain

•  Provides an opportunity for parents to understand their baby’s needs such as comfort, hunger or tiredness

•  Less stress for your baby after the shock of leaving the womb

•  Stimulates hormones for breastfeeding and mothering.

Benefits for babies in neonatal care:

•  Improves oxygen saturation

•  Encourages pre-feeding

•  Reduces stress, especially during or after painful procedures

•  Helps with growth

•  Helps with milk production and expressing if the baby is on a feeding tube

•  May lead to them being discharged sooner.

What will my baby do during skin-to-skin contact after birth?

If your baby was born close to full term and does not need any special care it will be placed on your chest after a vaginal birth and in many cases, after a c-section too. Your baby is likely to cry immediately after it is born but once it is placed on your chest it will enter a period of relaxation where it is unlikely to move much. It will start to respond to your voice and may open its eyes and start to move its head and arms and legs.

In some cases a baby may start to move independently towards the breast and will start nuzzling and licking it. Unicef recommends the baby is given time to familiarise themselves with the breast and is not rushed into latching onto the nipple. It may start to self-feed but if not, a midwife will be able to help you with latching and positioning for this first feed.

Your baby may be a little drowsy if you had any type of pain relief during labour.

Monitoring:

Midwives will continue to monitor your baby during skin-to-skin contact to check the position and that their airway is clear. They will keep an eye on their skin colour and that they are responsive and not floppy. The baby must also be kept warm at all times.

Final thoughts:

Skin-to-skin contact will help your baby feel safe and warm. Hearing your heartbeat will soothe them and release hormones which will help their brain grow and develop. Skin contact is important long after your baby’s birth and can help mum and dad bond with and respond to their baby. And there is probably nothing better than skin-to-skin snuggles with your new baby in those first few weeks.

Want to know more?

Unicef Link

Around 1 in 4 women in the UK has a caesarean birth and this may be planned or unplanned. It is a major surgical procedure and you should always speak to your midwife or obstetrician if you have any questions or concerns about having one. A gentle c-section, or ‘natural’ c-section as it is sometimes called, is very similar to a normal c-section except that it can be made more personal for you and your partner. Some women report feeling powerless or disconnected during their traditional c-section. A gentle c-section allows you to be more in control and have some say over the birth of your baby and the immediate minutes after.

Not all hospitals offer a gentle c-section but always ask because they are becoming more common.

What happens in a traditional c-section?

Every hospital and hospital team will have different ways of performing c-sections so it is important you speak to your midwife about their processes before you have your baby.

In most cases you will be given a spinal or epidural before being laid on an operating table. A screen will be raised over your chest so you can’t see the surgical incision being made. Obviously, everyone is different and for some people this will be a relief but some mothers and their birthing partners want to see the moment their baby is born. If this is the case, you can ask them to lower the screen.

In a traditional c-section you may not be given your baby straight away for skin-to-skin contact because they will want to carry out the required paediatric checks while you are stitched up. You may not be able to hold your baby or start feeding until you are in the recovery room which could be up to half an hour later.

What happens in a gentle c-section?

There is no reason why a birth in an operating theatre can’t be as personal for you as a vaginal birth in a midwife-led unit or labour ward and this is the aim of a gentle c-section.

Hospitals which offer this kind of birth might encourage you to bring your own music and will let you dim the lights - as long as the team can still see what they’re doing!

They might let you raise the bed so you can see the procedure and will lower the screen, use a clear screen or even remove it all together if that’s what you wish. Your baby will be delivered more slowly and they may leave the head and shoulders out for a minute or two to allow your uterus to contract and push the fluid out of their lungs as would happen in a vaginal delivery.

You will be able to have immediate skin-to-skin contact with your baby on your chest while they finish the procedure. You can ask for your IV to be put in your non-dominant hand so you can hold your baby without it being in the way. They can also put the EKG leads on your back or lower on your chest. You may be able to immediately start breastfeeding your baby at this time. A midwife will be by your side you help you.

A gentle c-section may take a little longer than a traditional one but only a matter of 3 or 4 minutes.

Even during an unplanned c-section there may be time for you to state your preferences for what happens after the birth, providing your baby does not need any special care.

But what if I’m really squeamish about seeing the incision?

For many women the fear of seeing the incision and inside their own abdomen may put them off asking for a screen to be lowered during a c-section. However, your bump and the baby’s head will initially block the hole and then when baby has been delivered the screen will be put back up. It comes down to your personal choice though.

Why choose a gentle c-section?

•  You will feel more connected with the birth of your baby

•  You and your partner will feel like active participants in the birth

•  You will be able to bond with your baby straight away

•  You can incorporate some of the more natural aspects of a birth that are important to you

•  Immediate skin-to-skin contact with your baby is really beneficial for their health and your bond

•  You may feel more positive about your birth experience.

Final thoughts:

Find out from your antenatal team what their set-up is and if they offer gentle c-sections, tell them how you envision yours to be. Even if your hospital doesn’t offer them, they may be happy to accommodate your requests as much as possible. There is no reason why a caesarean can’t be the same positive, bonding experience as a vaginal birth.

Want to know more?

• Baby Centre Article

• NCBI Article

A stretch and sweep, or membrane sweep, is a way of bringing on labour if you are overdue and things just aren’t happening. You may also be offered one if there is any risk to you or your baby’s health, such as high blood pressure, diabetes or obstetric cholestasis.

It will be one of the first things your midwife will offer to you, before other methods of induction.
 

When will I be offered one?

Induction is offered to all women who don’t go into labour naturally by 42 weeks as there is a higher risk of stillbirth or problems for the baby.

If you're a first-time mum, you may be offered a membrane sweep at your antenatal appointment at 40 weeks and again at 41 weeks.

Some midwives will offer a membrane sweep every 72 hours (three days). If this isn't your first baby, you should be offered a membrane sweep at your 41-week antenatal appointment.
 

What is a sweep?

A sweep is when a midwife or doctor sweeps their finger around the edges of your cervix with the aim of separating the membranes of the amniotic sac from your cervix. This can stimulate the release of hormones (prostaglandins), which may start labour.

What is a stretch?

If a sweep isn’t possible, a midwife may be able to stretch or massage your cervix which may help it soften and start to dilate. If this happens, your midwife may be able to carry out a sweep at your next appointment.

Does a sweep hurt?

Your cervix can be hard to reach before labour has started so it can be uncomfortable and will be painful for some women. If you have been practicing breathing or hypnobirthing techniques during your pregnancy you may find it useful to use these.

Some women experience spotting, cramping or contractions after a sweep. All of these are normal, and will not cause any harm to you or your baby.

Do I have to have one?

No, you can decline the offer of a sweep if you’d rather try less invasive ways of starting labour. However, if there are any health risks to you or your baby you will need to speak to your midwife or doctor about your options.

It is your birth and you can make your own choices.

How fast will labour start?

A sweep may start labour within 48 hours but it does not always work. If labour does not start you will be offered induction of labour. This will take place in a maternity unit and will involve inserting a pessary or gel into the vagina to soften the cervix.

It may take a while and some hospitals will allow you to go home while you wait for contractions to start.

Sometimes a hormone drip is needed start labour. If labour does not start you may be offered another induction or a caesarean section.

More information

• You can read more about stretch and sweeps in this NHS Article

By the time you get near the end of your pregnancy you are likely to be tired, uncomfortable and more than a little excited about meeting your baby.

As you approach your due date you can expect friends and family to start asking what you’ve done to try to bring on labour. But is there really anything you can do?

Let’s look at some of the myths.

Sex

Having sex might well be the last thing you fancy doing when you are full-term and there is little evidence it can kick-start labour. Some say the presence of prostaglandins, a hormone used in inductions, in semen can help. Others claim the release of oxytocin in an orgasm can get things going.

Like all of these myths, there is no scientific proof but if you feel up for it you can be reassured that having sex won’t harm your baby. However, don’t have sex if your waters have broken as there is a risk of infection.

Raspberry leaf tea

Raspberry leaf tea is a herbal remedy which is thought to tone the muscles of your uterus to help with contractions. Studies have shown there there is no difference in the length of labour for mums who drank the tea. If you’re going to drink it, do it regularly over weeks rather in large quantities in the days around your due date.

It is not recommended that you start drinking the tea before 32 weeks, are having twins, have had a premature labour before or have any complications.

Pineapple and dates

There is very little human research into whether eating tropical fruits or dates can help start labour. Pineapple contains bromelain - an enzyme which has historically been used to start labour. But the volume of pineapple you’d have to eat for it to do anything would need to be HUGE!

One study has shown that eating dates in the run up to your due date could help avoid induction and make labour shorter. Dates help stimulate the release of oxytocin. However, with only one study so far, more research is definitely needed.

Curry

You might have been told eating a curry can bring on labour, but in fact you’re more likely to suffer from heartburn or diarrhoea than anything else. Some people say the laxative effect of the spices may stimulate the bowel which in turn could stimulate the uterus but there is little evidence for this.

Exercise

Walking, climbing stairs or bouncing on a birthing ball may have all be recommended to you. All of these will help move your baby down into your pelvis and will keep you healthy and ready for labour. However, there haven’t been any studies confirming that they can bring on labour.

Breast/nipple stimulation

It is thought that stimulating your nipples can help trick the body into thinking your are feeding a baby which will release the oxytocin needed for labour. However, it requires quite an investment of time. Women in a study spent up to three hours a day massaging and rubbing their breasts and nipples.

It is fine to try nipple stimulation if you have a healthy pregnancy but it is not recommended if you have any risk factors such as diabetes or high blood pressure.

Having a ‘show’

A show is when the mucus plug protecting your uterus from infection comes away. It can come away in one go, or in parts. However, it does not mean labour is imminent and it may be days or even weeks before things get going.

Gushing waters breaking

Waters breaking in the middle of a supermarket are more common in films than real life. Some women may experience a slow trickle over a few hours, while others may not even notice their waters have broken. Your waters may be the first thing to signal that labour has started but in many cases they may go when you are already in labour.

There is a risk of infection 24-48 hours after they have broken so if labour hasn’t begun by then, induction may be offered.

What does work?

The most important thing is to try to remain relaxed and as healthy as possible. Maintain a healthy diet and try to keep active with a daily walk. Practice hypnobirthing techniques as these will help during whatever kind of labour you end up having.

If you are very overdue your midwife or doctor will outline the options open to you.