Patient Information
Postnatal information pack
Author: Maternity
Produced and designed by the Communications Team
Issue date Oct 2015 - Review date Oct 2018 - Expiry date Oct 2019
Version 2
Ref no. PILCOM1707
Contents
Page
Adjusting to your new role
4
Caring for yourself
4
Child Health Record book (‘the red book’)
4
What happens if my baby needs a BCG?
4
If I have my baby in hospital how long will I have to stay?
4
Leaving hospital
4
Women living outside the Basildon and Thurrock area
4
Community midwives
5
Birth afterthoughts
5
If you need a midwife and you are not being visited
5
GP follow-up
5
Emotional wellbeing
5
Postnatal advice - vaginal discharge
6
Perineal care
6
Perineal tears
6
Contraception
8
Registering your baby’s birth
9
Feeding your baby
10
Baby skin, bathing and cord care
10
What’s in a nappy?
11
e
Flat Head Syndrome
12
Newborn Blood Spot Screening (‘Heel Prick Test’)
12
About jaundice
12
Reducing the risk of cot death (keeping your baby close and safe)
14
Serious illness
14
Further information
16
Useful contact details
17
2
Congratulations on the birth of your baby
Many new parents are anxious about going home with their baby. This information pack aims to provide
information to support you during this special time.
Please read and discuss with your midwife if you have any concerns or questions.
Contact information
Community Office: 01268 394599 (Monday – Friday, 8.30am – 4pm)
Cedar Suite: 01268 394596 (weekends, evenings and bank holidays)
Willow Suite: 01268 394597 (weekends, evenings and bank holidays)
3
Adjusting to your new role
What happens if my baby needs a BCG?
There is a lot to adjust to when you have a baby.
The experience of giving birth can be physically and
emotionally demanding and it may take you some
time to recover. At the same time you have to look
after your new baby. Here are some tips to help you
adjust to your new role:
You will be contacted by telephone and an
appointment date and time to attend the BCG clinic
will be given to you.
get enough rest – sleep when your baby sleeps
Depending on the type of birth you have, and if both
you and your baby are well, you can go home as
early as six hours after the birth, or you may need to
stay 1–2 days.
If I have my baby in hospital how long will I
need to stay?
put your own needs and those of your baby first –
if you don’t want any visitors, say so
if possible have someone at home to help in the
first few days / weeks
Some women who have ad a caesarean section may
need to be seen by an obstetrician on the following
day.
don’t try to be a superwoman
Remember: Looking after yourself is just as important
as looking after your baby.
So that you can get home with the least amount of
delay, please make sure that you plan ahead:
arrange for someone to pick you up from the
hospital by car (make sure you have a car seat for
the baby). Never use a rear-facing baby seat in the
front of a car where an airbag is fitted (unless it is
switched off);
Caring for yourself
It is important to look after yourself. Sometimes there
seems to be no time to eat or sleep but if you don’t
take care of yourself you will end up run down and
exhausted.
where possible have help available to you at home;
In the immediate days after having a baby there is
increased chance of infection in the vaginal area.
Very occasionally this can lead to life threatening
infectious illness. It is important to wash your hands
both before and after going to the toilet or changing
your sanitary pads. This is especially necessary when
you or someone close to you amongst your family
or friends has a sore throat or an upper respiratory
infection.
ensure that you have everything ready for you and
your baby;
make sure you have some paracetamol in your
medicine cabinet at home;
check that the midwives know which address you
will be staying at.
Leaving hospital
We aim to discharge you by early afternoon and
ask for your patience if there is a delay. The midwife
will give you your postnatal notes and the postnatal
information pack which will include contact numbers.
Please ensure you have both before you leave the
hospital.
Child Health Record book (‘the red book’)
All babies will need to have a full newborn
examination within 72 hours of birth. This will be
undertaken by a paediatrician or midwife who has
advanced training
You will be given a personal ‘Child Health Record’
book for your baby. This is a way of keeping track of
your baby’s progress. The baby’s details are recorded
at birth and at the first examination.
Women living outside the Basildon and
Thurrock area
You will be seen by a community midwife working for
another Trust – one local to the area you are going
home to.
Your baby’s weight and immunisations are recorded
as well as other details about childhood illnesses and
milestones. For information about the screening tests
offered to your baby (newborn and six to eight week
infant Physical Examination, Hearing Tests), see
‘Further information’, ‘Screening tests for your baby’.
The schedule of visiting may differ from ours and their
first visit at home may not necessarily be the day
after you go home. However be assured that your
local Trust will contact you within a few days of your
discharge home.
4
Community midwives
If you need a midwife and you are not being
visited
The midwife will usually visit you at home the day
after you leave hospital* and will discuss future visits
with you according to your specific needs.
If you are not expecting a visit or telephone call from
your midwife but you have concerns and need to
speak to him/her, please do not hesitate to phone
his/her mobile phone. If the midwife is not available,
please phone the Community Office or Cedar Suite.
If you have had a homebirth the midwife will discuss
future visits prior to leaving your home.
This care will continue for at least 10 days – longer if
necessary. When visits by your midwife are no longer
necessary, your care will be transferred to the health
visitor, who will continue to provide support as your
baby grows and develops, until your child goes to
school.
GP follow-up
So you can be sure your body is recovering after
having your baby and that your baby is thriving, you
should arrange to have a six week postnatal check
with your GP. You will need to make the appointment
yourself. If you need to be seen at the hospital an
appointment will be sent to you.
* If the midwife does not visit
If the midwife has not visited you by 4.30pm, please
contact Cedar Suite on 01268 394596.
If you have not had a cervical smear in the last three
years it is a good idea to have one three months after
you have had your baby. You will need to organise
this with your GP or practice nurse.
What can I expect from my community midwife?
The midwife will ask you about your health and
wellbeing, and that of your baby. He/she will offer
information and guidance on:
Your baby will also need to have an appointment
at six – eight weeks to check they are well. You will
need to make this appointment with your GP.
the expected normal recovery from childbirth;
Emotional wellbeing
a range of commonly experienced health concerns
after birth, for example tiredness, perineal
discomfort, mood changes;
Most women experience an assortment of feelings
in the first few days after they have had a baby.
These can range from extreme happiness to mood
swings of anxiety, exhaustion and tearfulness. These
feelings are often part of the ‘baby blues’, which affect
around 50-80% of women. It is not known why the
blues occur but they are very common and can occur
anytime within the first 10 days after birth. These
feelings are usually short lived and most women
describe feeling more like themselves within a few
hours or days.
how to assess your baby’s general health and
where to get help if needed;
feeding your baby;
all aspects of baby care, for example skin care and
cord care;
contraception.
As part of the assessment of you and your
baby’s health the midwife will carry out a physical
examination, for example undressing the baby,
checking healing if you have any stitches.
Some women may experience severe mood
changes, often described as postnatal depression.
Characteristics may include:
The midwife is able to discuss your birth experience
with you and can answer any questions you may
have about your care during labour and birth.
feeling low most days
lack of interest or pleasure in normal activities
loss of appetite
Birth afterthoughts
difficulty sleeping
If at any time you have any unanswered questions
after your birth experience that you would like to
discuss with a midwife please contact 01268 524900
ext 3458 or email [email protected]
tearfulness
irritability
anxiety
5
This list is not exhaustive. If you think you are
suffering from postnatal depression or have concerns
about any symptoms you may be experiencing, seek
advice from your doctor, midwife or health visitor.
How do I know if I have an infection?
Postnatal advice – vaginal discharge
Fever, shivering, abdominal (tummy) pain and/
or vaginal discharge, may suggest there is
an infection in the perineum or in your uterus
(womb). Bleeding from the tear or stitches may
be significant. It is important that you seek advice
about your perineum or your stitches from your GP
or midwife as soon as possible if you experience
any of these symptoms.
It is normal to feel some pain and discomfort
immediately and for some days following the birth
of your baby, but as time goes by this will improve.
Over the next few weeks you will continue to lose
blood from your vagina. This is normal following
childbirth, as your womb returns to its normal size.
The blood loss will initially be heavy and bright
red. Over time this will change to a more watery
consistency and then change to brown.
How will I know if there is a possible problem?
Can I take pain relief?
Rarely, the blood loss can remain heavier than
normal, become brighter/fresher, or smell offensive.
If you need pain relief, you can take paracetamol
every four – six hours to a maximum of eight in
twenty four hours. It is safe to take paracetamol
while breastfeeding. If you are on any other
medication, please check that you are able to
take paracetamol with them. Cold compresses,
for example gel pads, can also be used to relieve
perineal pain.
You may pass some blood clots. This can be due
to small pieces of afterbirth remaining inside the
womb.
This is sometimes called ‘ragged membranes’ and
may be highlighted on the paperwork you are given
when you leave hospital.
Can I use tampons?
Should you find that you are experiencing any of
the above, please contact your doctor or midwife
as soon as you can.
You should not use tampons until at least
six weeks after the birth to reduce the risk of
developing an infection.
Perineal care
Perineal tears
The perineum is the area of skin between the vagina
and the anus.
What are the types of tears that might occur
during childbirth?
It is important to keep your perineum clean especially
after you have had a baby. Daily baths or showers
are very important, particularly if you have had a tear
or needed stitches. You should ensure you change
your sanitary pads frequently and it is extremely
important to wash your hands before and after
changing your pads or going to the toilet to avoid
infection. When you go to the toilet take care to pat or
wipe the area dry from the front to the back.
Most women, up to nine in ten (90%), tear to some
extent during childbirth.
Most tears occur in the perineum, the area
between the vaginal opening and the anus (back
passage). They may be:
- first degree tears – small, skin deep tears which
usually heal naturally;
- second degree tears – deeper tears affecting the
muscle of the perineum as well as the skin. These
usually require stitches.
Sometimes passing water can make the area sting. It
is a good idea to take a jug of warm water with you to
the bathroom to pour over the perineum whilst on the
toilet. This dilutes the urine and makes it less likely to
sting as well as keeping the area clean. Try to avoid
constipation as this can put strain on the wound area.
Eating a diet high in fibre (salad, fruit and brown
bread) and drinking plenty of water (a minimum of
eight glasses a day) will help.
6
For some women with a tear, up to nine in 100
(9%), the tear may be more extensive. This may
be:
need an anaesthetic. This is usually an epidural or
a spinal injection (an injection into the back which
numbs the lower half of the body) but occasionally
may be a general anaesthetic. The obstetrician will
then suture (stitch) the damaged anal sphincter
and the tear in an operating theatre.
- a third-degree tear extending downwards from the
vaginal wall and perineum to the anal sphincter,
the muscle that controls the anus;
- a fourth-degree tear extending to the anal canal
as well as the rectum (further into the anus).
What treatment will I be offered after surgery?
What is the difference between an episiotomy
and a tear?
- Antibiotics
You will be advised to take a course of antibiotics
to reduce the risk of infection because the
stitches are very close to the anus.
An episiotomy is a cut made by a doctor or midwife
through the vaginal wall and perineum to make
more space to deliver the baby. A tear happens as
the baby stretches the vagina during the birth.
- Pain relief
You will be offered pain relief such as
paracetomol or ibuprofen.
- Laxatives
You will be advised to take laxatives to make
it easier and more comfortable to open your
bowels. A drip in your arm will give you fluids until
you feel able to eat and drink. A catheter (tube) in
your bladder will collect urine until you feel able
to walk to the toilet. None of the treatments will
prevent you from breastfeeding.
Can a third or fourth degree tear be predicted?
It is not possible to predict or prevent these types
of tears. There are some factors that may indicate
when a third- or fourth-degree tear is more likely.
This is when:
- one of your baby’s shoulders becomes stuck
behind your pubic bone
What can I do to speed up healing of the tear?
- the second stage of labour is longer than
expected (the time from when the cervix is fully
dilated to birth)
- Keep the area clean. Have a bath or shower at
least once a day and change your sanitary pads
regularly.
- this is your first vaginal birth and you have a large
baby (over 8 pounds 13 ounces or 4 kg)
- Drink at least 2-3 litres of water every day and eat
a healthy balanced diet (fruit, vegetables, cereals,
wholemeal bread and pasta). This will ensure that
your bowels open regularly and prevent you from
becoming constipated.
- labour needs to be started (induced)
- you have an assisted birth (forceps or ventouse).
Could anything be done to prevent it?
- Do pelvic floor exercises as soon as you can after
birth. This will increase the circulation of blood to
the area and aid the healing process. You will be
offered physiotherapy advice about pelvic floor
exercises to do after surgery.
A third or fourth degree tear cannot be prevented in
most situations because it cannot be anticipated.
Research has shown that, although an episiotomy
makes more space for the baby to be born, it
does not prevent a third or fourth degree tear from
occurring.
What are the long-term effects of a third or
fourth degree tear?
What happens after birth?
Most women make a good recovery, particularly
if the tear is recognised and repaired at the time.
During recovery, some women may have:
If your obstetrician or midwife suspects a third or
fourth degree tear, or if you had an episiotomy, you
will have a detailed examination of your perineum
and anus. The obstetrician will confirm the extent
of the tear and provide you with information about
surgery or any other treatment needed. You will
- pain or soreness in the perineum which can be
eased by taking pain relief;
7
- fears and apprehension about having sex – many
women worry about this even if they have not had
a third or fourth degree tear;
tear has healed completely and you do not have
any symptoms, then you should be able to have a
vaginal birth.
- a feeling that they need to rush to the toilet to
open their bowels urgently;
If you have any concerns please discuss with your
midwife or consultant in the perineal care clinic.
- fear about future pregnancy and birth. The
consultant will discuss future pregnancies at the
perineal care clinic;
Contraception
Contraception may be the last thing on your mind
when you have just had a baby, but it is something
you need to think about if you want to delay or avoid
another pregnancy. A lot of unplanned pregnancies
happen in the first few months after childbirth, so
even if you’re not interested in sex at the moment, it
is better to be prepared.
- very rarely, you may develop a fistula (hole)
between your anus and vagina after the tear has
healed. This can be repaired with further surgery.
The material used to repair the tear is designed to
dissolve slowly (up to 6 months) and should not be
removed.
How soon can I have sex again?
Your follow-up appointment
You can have sex as soon as you and your partner
want to. However, having a baby causes many
physical and emotional changes for both partners,
and it may take some time before you feel ready to
have sex. It is common to feel nervous, but there
is usually no reason why you should not enjoy
sex just as much as before. It can help if you and
your partner talk about any worries you have. If
you have any discomfort which might affect your
enjoyment of sex, such as stitches which have not
healed, discuss this with your midwife, GP, practice
nurse, or health visitor.
You will be offered a follow-up appointment at the
hospital for the perineal care clinic twelve weeks
after you have given birth to check that your
stitches have healed properly. You will be asked
questions about your urine and bowel functions. If
there are any complications, you may be referred
to a specialist.
This appointment offers you the opportunity to
discuss any concerns that you may have, such as
sexual intercourse. This could also be discussed
with your GP.
Certain lubricating jelly can help but only use once
your stitches have healed.
Contact your midwife
You should contact your midwife if:
When will my periods start again?
- your stitches become more painful or smell
offensive – these may be signs of an infection;
Should you have any problems an appointment
can be made for you to attend the clinic earlier for
advice and support.
If you formula feed, or combine formula and
breastfeeding, your first period could start as
early as 5-6 weeks after the birth. If you are
breastfeeding, your periods may not come back
until you stop. However, you can be fertile before
you get your first period. This is because you
ovulate (release an egg) about two weeks before a
period so you are able to become pregnant without
having had a period.
Can I have a vaginal birth in the future?
How soon do I need to use contraception?
This depends on a number of factors. Your
obstetrician will discuss these with you at
your follow-up appointment or early in your
next pregnancy. If you continue to experience
symptoms from the third or fourth degree tear, you
may want to consider a caesarean delivery. If your
You can become pregnant again quickly after the
birth whether you breast or formula feed. Therefore
you must use contraception every time you have
sex. Do not wait for your periods to return, or until
you have your postnatal check before you use
contraception as you could become pregnant again
before then.
- you cannot control your bowels or flatus (passing
wind);
- you feel a need to rush to the toilet to open your
bowels.
8
When can I start to use contraception?
Registering your baby’s birth
You can use male and female condoms as soon as
you want to. Other methods of contraception will
need to be discussed with your GP.
Registration has to be in person at the Register
Office. If the parents were married at the time of the
birth, only one parent is required to attend. If the
parents were not married to each other at the time of
birth, both will need to attend to enable both parents’
details to be recorded. Single mothers attending on
their own can still register the birth but the father’s
details will not be recorded.
Which contraceptive method will be suitable for
me?
This depends on what you and your partner prefer,
your medical history, any problems you had in the
pregnancy and if you are breastfeeding. Your GP
should be able to advise you on this. There are
three main methods of contraception:
By law, the birth must be registered within six weeks
(42 days).
There is no charge to register a child’s birth, and a
short certificate is issued free of charge. You may
wish to purchase a full copy birth certificate at the
time of registration. Details of fees and charges can
be obtained from the Register Office.
- Hormonal methods, such as oral contraceptive
pills, patches, implants, and injections.
- Barrier methods include the diaphragm and
condoms. Male and female condoms are easy
over the counter choices.
To register the birth of your baby, you will need
to contact the Register Office and make an
appointment.
- The IUCD, intrauterine contraceptive device (coil).
The main registration offices for babies born locally
are:
Will breastfeeding act as a contraceptive?
Breastfeeding is not 100% effective in avoiding
pregnancy.
Basildon District
Basildon Registration Office
Basildon Centre
St Martins Square
Basildon
Essex SS14 1DL
Tel: 0845 603 7632
Can I use emergency contraception after the
birth?
Yes. If you have unprotected sex you can use
emergency contraception. If you are breastfeeding,
using the emergency pill will not harm the baby or
affect the breastmilk Your GP or pharmacist will be
able to provide further information on this.
Opening times: Monday to Friday, 9am-5pm.
Where can I get advice?
Thurrock District
Thameside Complex
2nd Floor
Orsett Road
Grays
Essex RM17 5DX
Tel: 01375 372822 or 01375 375245
You and your partner can visit your doctor, practice
nurse or family planning clinic.
Will contraception protect me from sexually
transmitted infections?
Most methods of contraception do not protect you
from sexually transmitted infections. However
male and female condoms, when used correctly
and consistently, can help protect against sexually
transmitted infections. Diaphragms and caps may
also protect against some sexually transmitted
infections.
Opening Times: Monday to Friday, 9am-5pm.
9
Feeding your baby
Baby skin, bathing and cord care
Basildon and Thurrock University Hospitals
NHS Foundation Trust is a UNICEF Baby Friendly
accredited hospital.
Babies are born with very delicate skin and are less
able to withstand the sensitising effects of modern
detergents. Maintenance of the skin’s natural
protective barrier is paramount. To do this you should
use water only for baby skincare for at least the first
month of life. When carrying out any baby care you
should wash your hands before and after.
We are proud that all our health professionals have
the information and skills to support your feeding
choices.
If you have any questions or need extra support with
feeding we have two specialist midwives for infant
feeding.
Your baby’s cord will dry and fall off between five and
ten days after birth.
Infant Feeding Specialist Midwife Team
There are some basic rules to follow to reduce the
risk of problems:
[email protected]
Tel: 01268 524900 ext 8830
hand washing before and after all baby care
leave the cord open to air or cover with clean,
loose clothing
Geraldine Purver
[email protected]
fold nappies down below the cord until it falls off
Lisette Harris
[email protected]
leave the cord alone unless contaminated by
faeces or urine
Take a look at our mobile app which is in a magazine
format. Our specialist midwives are also active on
Twitter (@FeedingTogether) and Facebook
(www.facebook.com/FeedingTogether).
clean, if necessary with plain water
contact your midwife if you have any concerns
about the cord area
Our website is www.feedingtogether.com
Please note it is normal for the cord stump to look a
bit ‘mucky’ or appear to have pus at the base as it
dries up and heals. This does not mean it is infected.
It is also normal for the cord to smell slightly offensive
as it separates. This is because the cord separates
by a process of dry gangrene and is effectively dying
tissue. Ask your midwife to check your baby’s cord
stump if you are worried about its appearance or
smell.
10
What’s in a nappy?
If your baby has nappy rash, the following possible
causes should be considered:
For the first couple of days after birth your baby will
pass meconium. This is the earliest stool (poo) and
is made up of materials ingested during the time your
baby spent in the womb. Meconium is a black, sticky,
tar-like substance that has no odour. Its appearance
is a good sign that your baby’s bowels are working
properly.
hygiene and skin care;
sensitivity to detergents, fabric softeners or other
chemical products that have contact with the skin;
presence of infection.
If painful nappy rash persists it is usually caused
by thrush and treatment with antifungal medication
should be considered. If after a course of treatment
the rash does not disappear contact your health
visitor.
After a day or two, as feeding is established and the
last of the meconium passes out, the poo will turn a
browny-green colour. Stools will be looser and have
a grainy texture. After about three days, your baby’s
poo will gradually change to a mustard yellow colour.
It is not unusual for breastfed babies to have several
mustard coloured, loosely formed or even watery,
stools a day, sometimes after each feed. If you notice
any inconsistencies or problems with your baby’s
bowel movements like constipation (hard stools) or
diarrhoea (watery poo) speak to your midwife, health
visitor or GP for advice.
Your baby will normally pass urine two times during
the first day. The amount and frequency of urine
passed gradually increases with the quantity of feed
taken during the first week.
You may notice an orange or red brick-dust coloured
stain in your baby’s nappy in the first couple of days
after birth. Often mistaken for blood, this stain is from
urate crystals; a sign of over-concentrated urine,
which is normal at this time. As your baby increases
their feeds the urine will become less concentrated
and the staining will disappear. If you can still see this
on day three your baby will need to be weighed as
this may mean that your baby is not taking enough
milk.
It is also common for girls to have vaginal discharge
in the first few days after birth. At times this may be
slightly blood stained and is due to the presence
of your hormones in your daughter’s body. This is
entirely normal but if in any doubt please check with
your midwife.
11
Flat Head Syndrome
About jaundice
Flat Head Syndrome is the mis-shaping of a baby’s
head due to the effect of the weight of the head
pressing against a flat surface or mattress causing
the skull bones to deform. It affects nearly half of the
babies born in the UK and whilst it is generally mild, it
can become severe.
Jaundice is caused by too much ‘bilirubin’ in the
blood. Bilirubin is a chemical in the body that is
normally passed out of the body in urine (wee) and
stool (poo).
Most newborn babies have jaundice. If your baby
has jaundice, their skin will look slightly yellow or
‘suntanned’.
Babies sometimes develop a flattened head when
they’re a few months old, usually from sleeping on
their back.
Sometimes the whites of the eyes or the inside of the
mouth or gums will also look yellow. If your baby has
dark skin, the main sign may be a yellowing in the
whites of their eyes or inside their mouth.
Prevention of Flat Head Syndrome
You should try and encourage the baby not to sleep
in the same position for long periods. This means:
For most babies jaundice is harmless and nothing
to worry about. But if you think that your baby has
jaundice, it is always best to let your midwife or doctor
know.
Give your baby time on their tummy during the day
and encourage them to try new positions during
play time.
Switch your baby between a sloping chair, a sling
and a flat surface, so that there isn’t constant
pressure on one part of their head.
How should I check if my baby has jaundice?
It is important that you check your baby for
jaundice, particularly during the first week of life:
Change the position of toys and mobiles in their cot
to encourage your baby to turn their head to the
non-flattened side.
- Check if your baby’s skin looks yellow. The yellow
colour usually starts on the face and forehead
and then spreads to the body, arms and legs.
You may need to try these measures for six to eight
weeks before you notice an improvement in the
shape of your baby’s head.
- Check if the whites of your baby’s eyes look
yellow.
- Check if the gums or roof of your baby’s mouth
looks yellow. The best time to do this is when
your baby is crying and their mouth is open wide.
Newborn Blood Spot Screening
(‘Heel Prick Test’)
- From time-to-time, gently press your baby’s skin
to see if there is a yellow tinge.
This is carried out by the maternity care assistant with
your consent between five and eight days after birth.
You will be given an appointment to attend a clinic by
your midwife at the first visit to your home following
your discharge from hospital.
A good time to check your baby is when you are
changing their nappy or clothes. Try to check in
bright and preferably natural light. Ask your midwife
to show you how to check your baby for jaundice, if
you are not sure. Your midwife and doctor will also
look for signs of jaundice each time they check
your baby.
This simple blood test identifies babies who may have
rare but serious conditions. Most babies screened will
not have any of the conditions but for those who do,
early treatment can improve their health and prevent
severe disability or even death. Further information
can be found in Screening Tests for Your Baby.
What should I do if I think that my baby has
jaundice?
Your baby will also be weighed at this time.
For most babies, jaundice is mild, harmless and
clears up by itself. But it is important that you tell
your midwife, your on-call midwife or your doctor if
you notice that your baby’s skin, the whites of their
eyes or the inside of their mouth or gums have a
yellow colour.
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If this happens in the first 24 hours after birth,
contact them urgently. This could be a sign of
another medical problem.
If your baby’s bilirubin level is very high, more than
one lamp will be used at the same time and your
baby will need to stay under the lamps without
breaks.
If your baby is more than 24 hours old, contact
them on the same day that you notice the change
in colour.
You can usually continue to breastfeed your baby
during phototherapy.
You should also tell your midwife or on-call midwife
or doctor if your baby passes pale, chalky coloured
stools or dark urine that stains the nappy.
Babies with extremely high bilirubin levels may
need to be treated in an intensive care unit. These
babies may need an ‘exchange transfusion’ which
involves replacing the baby’s blood with new blood
from a donor.
How will I know if my baby has jaundice?
Your doctor will discuss all treatment options with
you and answer any questions that you have.
To confirm whether your baby has jaundice, your
midwife will measure the amount of bilirubin in your
baby’s blood. This can be done by using a small
hand held device that does not puncture the skin
and is placed on your baby’s forehead or chest, or
your midwife may take a blood sample from your
baby’s heel. Your midwife may need to do this test
again six to 12 hours later.
Does jaundice cause any long-term problems?
For most babies, jaundice does not cause any
long-term problems. Very rarely, the amount of
bilirubin in a baby’s blood is so high that it does
cause long-term problems such as hearing loss or
cerebral palsy. But this is extremely rare and with
the right treatment this small risk is reduced even
further.
What treatment will my baby be given?
Mild jaundice does not normally need any
treatment, but your midwife will need to give you
extra advice and support with feeding to make sure
that your baby is feeding adequately and correctly.
What should I do if my baby’s jaundice does
not clear up?
If the level of bilirubin in your baby’s blood is high,
they may need to go into hospital to get treatment.
Your baby may be given light treatment known as
‘phototherapy’. If your baby has to be admitted to
hospital for treatment they will be admitted to the
children’s ward.
For most babies, jaundice clears up within a few
days. If your baby has jaundice for more than two
weeks (or for more than three weeks for babies
that were born premature), make sure that you tell
your midwife or doctor. Your baby may need further
tests to check for other medical problems.
Your baby will be placed under a lamp that shines
a special type of light onto the skin. This light helps
to break down the bilirubin, which will then be
passed out of your baby’s body in their urine and
stools.
Where can I find out more information?
NHS Choices website:
www.nhs.uk/conditions/Jaundice-newborn
NICE website:
www.nice.org.uk/guidance/CG98
Your baby will be placed under the light naked,
apart from a nappy. This is to make sure that the
light shines on as much of your baby’s skin as
possible. Eye pads will be placed over your baby’s
eyes to protect them.
Children’s Liver Disease Foundation website:
www.childliverdisease.org/education/yellowalert
A doctor, nurse or another healthcare worker will
take a blood test to measure the amount of bilirubin
in your baby’s blood every six hours. You will be
encouraged to take your baby out from under the
lamp for short breaks for feeds, nappy changes
and cuddles.
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Remove hats and extra clothing as soon as you
come indoors or enter a warm bus, train or shop,
even if it means waking your baby.
Reducing the risk of cot death
(keeping your baby close and safe)
Your baby should stay with you all the time while you
are in hospital. You will get to know each other and
you will learn to recognise your baby’s feeding cues.
The safest way for your baby to sleep is on their back
and feet to the foot of the cot. It’s lovely to have your
baby with you for a cuddle or a feed but it’s safest to
put your baby back in their cot before you go to sleep.
Do not let your baby get too hot or too cold. Ideally
room temperature should be between 16 and 20
degrees centigrade,
For further information contact
http://www.lullabytrust.org.uk
At home it is recommended that your baby sleeps in
a cot in your room until at least six months old. It is
also now advised that babies should also sleep in the
same room you are in during the daytime too. The
joint UNICEF/FSID leaflet ‘Caring for your baby at
night’ provides information for parents at
www.babyfriendly.org, or ask your midwife or health
visitor about the risks and benefits of bed sharing.
If your baby is unwell seek medical advice
promptly
Babies often have minor illnesses which you do not
need to worry about. Make sure your baby drinks
plenty of fluids and is not too hot. If your baby sleeps
a lot, wake him/her regularly for a drink. It may be
difficult to judge whether an illness is more serious
and requires prompt medical attention. The following
guidelines may help you.
Do not share a bed with your baby if you or your
partner:
smoke
Serious illness
have recently drunk any alcohol
Any of the following symptoms may be signs your
baby has a serious illness:
have taken medication or drugs legal or illegal that
could make you sleepy
has a high pitched or weak cry, is less responsive,
is much less active or more floppy than usual;
are excessively tired
looks very pale all over, grunts with each breath,
seems to be working hard to breathe when you
look at their chest and tummy;
or if your baby was:
premature (born before 37 weeks)
low birth weight (less than 2.5kg)
takes less than a third of usual fluids, passes much
less urine than usual, vomits green fluid, or passes
blood in their stools;
Remember
Never fall asleep with your baby on a sofa or
armchair
has a fever of 38º or above if the baby is less than
3 months, or 39º or above if 3 to 6 months old;
Keep your baby’s head uncovered – place your
baby with their feet to the foot of the cot, to prevent
wriggling down under the covers.
is dehydrated – dry mouth, no tears, sunken eyes,
or soft spot on the baby’s head is sunken.
When you check your baby, if they are sweating or
their tummy feels hot to the touch, take off some of
the bedding. Don’t worry if hands or feet feel cool,
this is normal.
Meningitis
Early symptoms of meningitis can be like other
childhood illnesses, but can be difficult to diagnose
in a baby. A baby with meningitis will usually become
ill quickly with a rapid deterioration in the baby’s
condition.
Use lightweight blankets. If your baby feels too
warm, reduce the number of layers. Do not use
a duvet, quilt or pillow for babies under twelve
months.
Watch out for tiny red or brown pin prick marks which
can change to purple blotches or blisters. If your baby
has a rash, you need to do the glass test.
Babies should never sleep with a hot water bottle
or electric blanket, next to a radiator, heater or fire,
or in direct sunshine.
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The Glass Test
Spots or a rash will still be seen when the side of a
clear drinking glass is pressed firmly against the skin.
If this happens, get medical help immediately.
Remember a very ill baby needs medical help even
if they have only a few spots, a rash that fades or no
rash at all.
Urgent medical attention is needed if your baby:
stops breathing or goes blue;
is unresponsive and shows no awareness of what
is going on;
has glazed eyes and does not focus on anything;
cannot be woken;
has a fit, even if your baby recovers without
medical attention;
DIAL 999 and ask for an ambulance
After your baby is born, if your midwife or GP has any
concerns about your baby you may be asked to bring
him/her to the Children’s Ward or to the Children’s
Emergency Department at Basildon Hospital.
You should not bring your baby back to Cedar or
Willow Suite.
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Further information
Postnatal guidance 2006
(NICE guideline NICE guideline CG37)
http://www.nice.org.uk/
Screening tests for your baby –
http://www.screening.nhs.uk/
Birth to 5
http://www.publichealth.hscni.net/
Chapter 1 ‘Feeding your baby’
Chapter 2 ‘Getting to know your baby’
Chapter 9 ‘Your own life’
UK Newborn Screening Programme Centre
(English version) –
http://newbornbloodspot.screening.nhs.uk/public
Translations for UK Newborn Screening
Programme Centre –
http://www.publichealth.hscni.net/publications/
newborn-blood-spot-screening-english-and-10translations
Reduce the Risk of Cot Death (English version) –
http://www.lullabytrust.org.uk/safer-sleep
Your guide to contraceptive choices – after you’ve
had your baby (Family Planning Association)
http://www.fpa.org.uk/contraception-help/
your-guide-contraception
Local Maternity Service Liaison Committee
(MSLC)
Have you considered sharing your views or ideas
on how to improve our maternity services locally?
If interested and you would like to join the local
maternity user groups please contact Jennie
Ponting, Head of Midwifery 01268 524900 ext 1205
or [email protected]
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Useful contact details
Meet A Mum Association
(MAMA)
www.mama.co.uk
Tel: 0845 120 3746
NHS 111
You can call 111 when you need medical help fast
but it’s not a 999 emergency. Calls are free from
landlines and mobile phones.
www.nhs.uk
National Childbirth Trust
www.nct.org.uk
Tel: 0870 444 8707
Ameda Egnell breast pump hire
http://ameda.co.uk/
Tel: 0845 009 1789
NICE postnatal guidance
www.nice.org.uk
Twins and Multiple Birth Association
(TAMBA)
www.tamba.org.uk
Tel: 0800 138 0509
Association of Breastfeeding Mothers
http://abm.me.uk/
Tel: 0300 330 5454
Association for Postnatal Depression
http://apni.org/
Tel: 0207 386 0868
Unicef UK Baby Friendly Initiative
www.babyfriendlyorg.uk
BLISS Premature Baby Charity
http://www.bliss.org.uk/
Tel: 0500 618 140
Breastfeeding Network
http://www.breastfeedingnetwork.org.uk/
Tel: 0300 100 0212
The Breastfeeding Network
PO Box 11126
Paisley
PA2 8YB
Cry-sis
http://www.cry-sis.org.uk/
Tel: 0845 122 8669
Family Planning Association
http://www.fpa.org.uk/
Tel: 0845 122 8690
The Lullaby Trust
http://www.lullabytrust.org.uk/
Tel: 0207 233 2090
Giving up smoking
www.smokefree.nhs.uk
Tel: 0800 022 4332
La Leche League GB
www.laleche.org.uk
Tel: 0845 120 2918
Medela breast pump hire
www.medela.co.uk
Tel: 0161 776 0400
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Not to be photocopied
Basildon University Hospital
Nethermayne
Basildon
Essex SS16 5NL
01268 524900
Minicom
01268 593190
Patient Advice and
Liaison Service (PALS)
01268 394440
E [email protected]
W www.basildonandthurrock.nhs.uk
The Trust will not tolerate
aggression, intimidation or
violence directed towards its staff.
This is a smokefree Trust.
Smoking is not allowed in any of our
hospital buildings or grounds.
This information can be provided in a
different language or format (for
example, large print or audio
version) on request.