Patient Information
Maternity pack
Author: Maternity
Produced and designed by the Communications Team
Issue date May 2014 - Review date May 2017 - Expiry date May 2018
Version 5
Ref no. PILCOM1574
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Congratulations on your pregnancy
This booklet contains lots of information about your healthcare during pregnancy (antenatal care),
and giving birth. Hopefully, by now, you will have been contacted by your community midwife who is
based at your GP surgery. She will have visited you at home or invited you to the clinic for a ‘booking’
appointment.
During this appointment, your midwife will discuss your antenatal care with you; including your antenatal
visits, ultrasound scanning, blood tests and, if needed, consultant appointments at the maternity unit.
We would like to take this opportunity to stress the importance of regularly attending your planned
antenatal appointments. Research shows that there is a strong relationship between poor antenatal
appointment attendance and problems during labour and delivery. Having the recommended
examinations during pregnancy can help to provide vital information to reduce or even prevent problems.
If you do not attend a planned appointment your midwife will telephone you or send you a letter to
arrange another appointment.
Please remember, regular antenatal check-ups reduce the chances of something going wrong during
your pregnancy and delivery. Although it is your midwife’s duty to ensure that you are seen – it is also
your responsibility to ensure that you inform your midwife if you are unable to attend an appointment so
that a further appointment can be arranged.
Your midwife will make every effort to accommodate any circumstances that may make attending an
appointment difficult, such as travel problems or a language barrier. All problems can be addressed if
you maintain contact with your midwife.
If you do not attend your antenatal appointments, even after other appointments have been arranged,
then it may become necessary to inform Children’s Social Care. This is intended as a further resource
to help establish whether you are experiencing any problems during your pregnancy and provides an
opportunity for Social Care to assess whether further support may be necessary.
If you have any questions or concerns, at any time, please contact your Community Midwife. You
will also find several contact numbers in your hand-held hospital notes.
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Screening Tests for Down’s Syndrome and Spina Bifida
Combined Screening Test and Quad Test
Why do I need a screening test?
Most babies develop normally, but unfortunately a small number have significant problems.
The Combined Test and Quad Test can help identify conditions such as Down’s Syndrome and
Spina Bifida.
What is Down’s Syndrome?
Down’s Syndrome is one of the most common causes of severe learning disability in children and affects
about 1 in 800 babies. It is the result of a chromosomal abnormality.
Every human cell contains chromosomes. In each normal human cell there are 46 chromosomes
(arranged in 22 pairs, with a final pair determining male or female). However, in Down’s Syndrome there
is an extra chromosome of number 21, which is why Down’s Syndrome is called Trisomy 21. There are
other chromosomal abnormalities, but Down’s Syndrome is the most common.
All pregnant women are at the risk of carrying a baby affected by Down’s Syndrome, but the risk
increases with the mother’s age. The risk is approximately 1:1,500 at the age of 20, 1:895 at the age
of 30 and approximately 1:97 at the age of 40.
What is Spina Bifida?
Spina Bifida is a neural tube defect. Neural tube defects are birth defects that affect the head and spine
of the baby. They occur when the neural tube (the structure that later develops into the brain and spinal
cord) remains open instead of closed during growth in the first month of pregnancy. Neural tube defects
affect 2 or 3 in every 1,000 pregnancies.
There are three types of defect:
z Open Spina Bifida - This is an opening in the spine of the baby. Open spina bifida is often
accompanied by several disabilities which can include paralysis of the legs, lack of bowel or bladder
control and excess fluid in the brain.
z Closed Spina Bifida - This is similar to open spina bifida, but the opening is covered by skin or thick
membrane tissue.
z Anencephaly - This is a disorder where the brain and head are not properly formed. These babies die
before or very soon after they are born.
What is the Combined Test?
The Combined Test is offered at your first (early) scan, between 11 and 14 weeks. The test is made up of
two parts:
z Nuchal Translucency Scan
z Blood Test
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Nuchal translucency is a pocket of fluid at the back of the baby’s neck. This can become enlarged if
there are problems associated with chromosomal abnormalities such as Down’s Syndrome, or heart
problems. The nuchal translucency measurement is taken from the picture of your baby on the screen,
by the sonographer (the person doing the scan). The scan also measures the baby’s heart rate and the
baby’s length. You will then have a blood test.
The blood test measures two chemicals in the blood - Papp A and bHCG Beta human chorionic
gonadotrophin. The nuchal translucency measurement and the blood test results are then combined to
give one ‘risk’ result.
The Combined Test is a screening test. The test itself does not give a definite answer, but identifies
whether you will be offered further investigations. A ‘high risk’ result does not mean that the baby has
Down’s Syndrome. A ‘low risk’ result does not mean that the baby does not have Down’s Syndrome.
How do I know when to go for the Combined Test?
When we receive the referral letter from your GP or via Maternity Direct we book you a scan and refer
you to a Community Midwife. He/she will then contact you, usually by telephone, to arrange a booking
visit. The Community Midwife will give you the first scan date and it is at this scan appointment that the
Combined Test is carried out.
How do I find out the results of the Combined Test?
If you are ‘low risk’ you will receive a letter by post within two weeks.
If you are at a higher risk, you will be contacted by telephone by the screening midwife within three
working days to arrange a visit to the hospital where your options will be discussed with you. These
could include:
z To take no further action
z Chorionic Villus Sampling (diagnostic test - see page 6 of this leaflet)
z Amniocentesis (diagnostic test - see page 6 of this leaflet)
z Detailed anomaly scan at a Fetal Medicine Unit.
What is the Quad Test?
Pregnant women who miss the Combined Test will be offered a blood test between 14 and 20 weeks.
This blood test measures the levels of four chemicals in the blood - AFP, (alpha-feta protein) Beta
HCG (human chorionic gonadotrophin) and UE3 (unconjugated estradiol) and Inhibin A, which appear
naturally in women’s blood during pregnancy.
The Quad Test is a screening test. The blood test itself does not give a definite answer, but identifies
whether further investigations are offered. A ‘high risk’ result does not mean that the baby has
Down’s Syndrome or Spina Bifida. A ‘low risk’ result does not mean that the baby does not have
Down’s Syndrome or Spina Bifida.
How can I find out the result of the Quad Test?
The result of the blood test is sent to the Antenatal Clinic at Basildon University Hospital. If you are ‘low
risk’ you will receive a letter confirming the Quad Test result. Our aim is that every woman will know their
result two weeks after testing.
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If the result places you in the ‘higher risk’ group, further tests will be offered. A Screening Specialist
Midwife will telephone you to inform you of the result, within seven days. You will be offered an
appointment to discuss the result with a specialist midwife.
How accurate is the Combined Sceening Test and the Quad Test ?
Both of the tests have been shown to identify problems with 75% accuracy, and have a 3% false positive
rate.
Are the screening tests safe?
Both the Combined Test and the Quad Test are safe for mother and baby. The benefit of having these
tests are that you can be offered further diagnostic testing if you are found to be at higher risk.
If my test result is ‘high risk’, what is the next step?
We understand that a ‘high risk’ result may cause anxiety, but please remember that many women with
a ‘high risk’ result will not have an affected pregnancy. You will be contacted by a Midwife from Basildon
University Hospital Antenatal Clinic and asked to come and discuss the result with our midwife specialist
or a consultant. They will discuss the options available to you.
What is Chorionic Villus Sampling?
Chorionic Villus Sampling (CVS) is a diagnostic test carried out at 11-15 weeks, where a small part of
the placenta (afterbirth) is taken and the cells grown, so that the chromosomes can be examined. It is
not a procedure carried out at Basildon University Hospital. If CVS is offered, our Midwife Specialist will
discuss this with you and provide further information, and you will be referred to a Fetal Medicine Unit.
What is Amniocentesis?
Amniocentesis is a diagnostic test which can determine if a baby has a chromosomal abnormality, such
as Down’s Syndrome, or not. It is carried out in the Ultrasound Department at Basildon Hospital at
16-18 weeks, and up to 22 weeks at Kings College Hospital in London. Further information can be found
on the National Screening Committee website - www.screening.nhs.uk.
Are these further tests safe?
The Midwife Specialist will explain to you the specific risks associated with any further testing you are
offered. If you have any questions please ask your midwife or doctor.
Where can I find out more information?
z National Childbirth Trust: www.nct.org.uk
z Childbirth.org: www.childbirth.org
z MIDIRS (Midwives Information and Resource Service) Informed Choice: www.infochoice.org
z National Screening Committee: www.screening.nhs.uk
z Wolfson Institute of Preventive Medicine: www.wolfson.qmul.ac.uk
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Are there any support groups?
Association for Spina Bifida and Hydrocephalus (ASBAH)
42 Park Road, Peterborough,PEH 2UQ.
www.asbah.org
Down’s Syndrome Association
155 Mitcham Road, London, SW17 9PG.
www.dsa-uk.com
Antenatal Results and Choices (ARC)
73 Charlotte Street, London W1T 4PN
www.arc-uk.org
Blood Tests and Blood Transfusion
Why do I need blood tests?
We offer all pregnant women blood tests at the beginning and during pregnancy to check for potential
problems.
What blood tests will I be offered?
The tests listed here are ones we offer, but it is your choice which tests you have. Please ask your
midwife if you have any questions. Other blood tests may be offered as necessary and the midwife or
doctor will explain these to you at the time. If you are unsure, please ask what each test means before it
is carried out.
z Haemoglobin (Hb)
Haemoglobin (Hb) carries oxygen and nutrients around your body and to the baby. Anaemia is caused
when there is not enough Hb in the red blood cells. Anaemia can make you feel very tired and you
will be less likely to cope with blood loss following delivery. If you are anaemic at any time during your
pregnancy you will be offered iron tablets and advice on diet.
z Blood Group and Antibodies
This blood test is to tell whether you are Blood Group A, B, O or AB and whether you are Rhesus
Positive or Rhesus Negative. It also shows if you have any antibodies (foreign blood proteins).
If you are Rhesus Negative, you will be offered further blood tests to check for antibodies during
pregnancy. If your baby has inherited the Rhesus Positive gene from its father, antibodies to the
baby’s blood cells can develop in the blood. To prevent this you will be advised to have an Anti D
injection at 28-32 weeks of pregnancy.
If you need to have a blood transfusion during or after your pregnancy, by knowing your blood group
and Rhesus factor we are able to give the correct matching blood.
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z Rubella (German measles)
Rubella infection in early pregnancy can affect your baby. A test is offered to check your immunity
(ability to fight infection). Most women are protected by rubella vaccinations given in childhood, but if
you are not immune you will be advised to be immunised after the birth.
z Hepatitis B
This is a virus which affects the liver. If you are a carrier of the virus or become infected during
pregnancy, you will be advised to have your baby immunised after the birth to avoid infection.
z Syphilis
This is a sexually transmitted disease which can seriously affect your baby if left untreated. If
detected, treatment will be offered with antibiotics to control the infection and help protect your baby.
z HIV
The Department of Health recommends that all pregnant women should be tested for HIV (Human
Immunodeficiency Virus) at the same time they have other antenatal screening blood tests. This is
because many pregnant women do not know they are infected and a mother may pass the virus to her
baby without being aware of it.
If a woman is diagnosed as HIV Positive early in her pregnancy she can be offered treatment to
reduce the risk of passing the virus to her baby. This will also improve her chances of staying well.
Alternatively, after counselling, she may decide not to continue with the pregnancy.
The service is strictly confidential.
HIV can be passed on in four main ways:
ΠHaving sexual intercourse (vaginal or anal) without a condom, with an infected partner.
ΠSharing drug-injecting equipment with someone who is HIV positive.
ΠReceiving infected bloods or blood products.
ΠFrom an HIV Positive mother to her unborn baby, or, if she breastfeeds her baby.
If you have any concerns and would like to talk to someone in confidence about HIV in pregnancy, this
can be arranged. We have a midwife, consultant and clinical-nurse specialist with an interest in HIV
available.
To make arrangements, please contact a specialist screening midwife on 01268 524900 ext 3732.
Are there any side-effects or possible complications from the blood tests?
You may have some bruising in the area where blood is taken. This will go down after a few days. There
may be a risk to you or your baby’s health and wellbeing if you do not have the blood tests.
How will I get the results of my blood tests?
All blood test results are sent to the Antenatal Clinic at the hospital. If your results are normal they will
be available at your next antenatal appointment. We will only contact you if the results indicate that there
may be a problem or you need to be offered further treatment.
Your midwife or doctor will be happy to discuss this further with you.
What if I do not wish to have a blood transfusion?
Some women do not want a blood transfusion because of religious or personal beliefs. We usually
only advise blood transfusions in cases of extreme blood loss during or following delivery (post partum
haemorrhage) and in cases of severe anaemia.
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If you do not want a blood transfusion for any reason, please discuss this with your midwife early in your
pregnancy and they will arrange for you to discuss the risks and benefits further with your doctor.
Where can I get further information?
z National Childbirth Trust (NCT), 0844 243 6000 - www.nct.org.uk
z Childbirth - www.childbirth.org
z BirthChoice UK - www.birthchoiceuk.com
z Midwives Information and Resource Service (MIDIRS) - www.infochoice.org
Ultrasound scans
Why do I need an ultrasound scan?
There are six reasons for having an ultrasound scan:
z To check the viability of your pregnancy (to check a heart beat is present)
z To check the expected date of delivery of your baby
z To check that your baby is developing normally
z To check the position of the placenta (afterbirth)
z To check how many babies you are expecting
z To check for abnormalities
These are explained further below.
How do you check the date of delivery?
During a scan your baby’s body is measured. The Sonographer (the person doing the scan) can work
out when your baby is likely to be born. This is more exact than working out the date using a calendar
and your last period date.
Knowing your expected delivery date is very useful - if you choose to have a screening test, for example
a blood test, we can provide you with more accurate information if we know your expected date. It
means we know how many weeks old your baby is if you go into early labour and you are less likely to
be offered an induction of labour (artificial starting of your labour) too early.
Is my baby developing normally?
At the first (early) scan we offer the Nuchal Translucency measurement, which is then combined with a
blood test to give a ‘risk result’ for Down’s Syndrome. The test itself does not provide a definite answer
but identifies whether further investigations are needed. For further information please see our Screening
Tests Patient Information Leaflet.
Where is the placenta (afterbirth)?
A scan can tell you where the placenta is in the uterus (womb). It is particularly helpful to see if the
placenta is lower in the uterus than normal. A low placenta can cause problems during pregnancy. For
example you may experience some vaginal bleeding, or later in your pregnancy the placenta may block
the entrance to the uterus and stop the baby coming out.
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It is better to know this early, so that we can make an appointment for you to see an obstetrician
(pregnancy and childbirth specialist), who will plan your care.
How will I know if I am having more than one baby?
A scan looks at how many babies you are expecting, and will identify if you are expecting twins, triplets
or more. If you are found to be expecting more than one baby an appointment will be made for you with
an obstetrician to plan your care. Your midwife can also put you in touch with other professionals or
support groups who may be able to offer help.
Are there any side-effects or possible complications?
Having a scan is easy, painless and safe for the mother, although you may feel anxious about the scan
and what it will show. There is no evidence that scans do or do not cause any problems for the baby, but
current evidence suggests that scans do not cause any serious problems.
It is your choice whether you have a scan or not. Please ask your midwife or doctor if you have any
further questions.
Where can I find more information?
z National Childbirth Trust - www.nct.org.uk
z Childbirth.org - www.childbirth.org
Alcohol use in pregnancy
Alcohol can cause damage to your baby at all stages of pregnancy. If you drink, alcohol reaches your
baby through the placenta.
Drinking alcohol during pregnancy has been associated with:
z miscarriage
z low birth weight
z heart defects
z learning and behavioural disorders
The most severe of the alcohol-related conditions, normally due to heavy drinking in pregnancy, is Fetal
Alcohol Syndrome (FAS), which causes:
z facial deformities
z problems with physical and emotional development
z poor memory or short attention span
The National Institute for Health and Clinical Excellence (NICE) advises that women who are pregnant or
trying to conceive should avoid alcohol. However, if you choose to drink, to reduce the risk to the baby,
you should not drink more than one to two units of alcohol once or twice a week and you should not
binge drink.
Binge drinking in women is defined as drinking more than six units on one occasion.
Miscarriage, stillbirth, premature birth and low birth weight have all been associated with binge drinking
during pregnancy.
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A wider range of learning and physical disabilities occurs in babies born to mothers who drink alcohol at
some time in the pregnancy. These are known as Fetal Alcohol Spectrum Disorders (FASD).
These disabilities are more common in babies born to heavy drinkers, but can occur at much lower
drinking levels. It is not clear whether it is safe to drink even a small amount of alcohol during
pregnancy. FASD and FAS-related disabilities carry on into adulthood. The effects on the baby depend
on how much the mother drinks and at what point in her pregnancy. FAS and FASD are preventable by
not drinking alcohol at all during pregnancy. If you have drunk alcohol in early pregnancy before realising
you were pregnant, you should avoid alcohol as soon as you find out.
How many units of alcohol are in popular drinks?
z Double measure of spirits
z Alcopop 275mls
z Shot 25mls
z Wine 250mls (12%)
2 units
1.4 units
1 unit
3 units
z Wine 750ml bottle (13%)
9.8 units
z Lager pint (5%)
2.8 units
z Cider pint (6%)
3.4 units
Where to get help
If you are concerned about having drunk alcohol at any point in your pregnancy or if you feel you are
drinking too much and need support to cut down or stop:
z Talk to your midwife or GP and ask to be referred to the Specialist Midwife for Substance and Alcohol
Misuse at Basildon Hospital who can offer personal support and referral to support agencies if
required.
z Visit www.nhs.uk/units
z For more information and advice on Fetal Alcohol Syndrome or Spectrum Disorder visit www.nofas-uk.
org or call their helpline on 08700 333.
Where can I find more information?
z National Institute of Clinical Excellence - www.nice.org.uk
z NOFAS-UK National Organisation on Fetal Alcohol Syndrome - www.nofas-uk.org
z NHS Choices, Alcohol in pregnancy - www.nhs.uk
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Choice of birth
Birth Choices Clinic
You may be offered an appointment to the birth choices clinic. This may be because you have had a
previous caesarean section and are deciding on how you would want to give birth in this pregnancy,
or are keen to have an elective caesarean section with no medical reason for it, or you are requesting
choices around your pregnancy and/or birth which is against medical advice.
The appointment will last for one hour with a specialist midwife who will discuss your choices with you
and help provide you with information to help you make an informed choice.
Breech Presentation
Breech means that your baby is lying bottom first or feet first in the womb (uterus) instead of the usual
head first position. In early pregnancy breech is very common. As pregnancy continues, a baby usually
turns by itself into the head first position. Between 37 and 42 weeks (term) most babies are lying head
first ready to be born.
Vaginal breech birth is more complicated than normal birth. Your obstetrician or midwife may advise
trying to turn your baby to a head first position. This technique is called external cephalic version (ECV).
Gentle pressure is applied on your abdomen which helps the baby turn a somersault in the womb to lie
head first.
ECV increases the likelihood of having a vaginal birth and is tried after 36 weeks. If the baby does not
want to turn, it is possible to have a second attempt on another day. If the baby does not turn after a
second attempt your obstetrician or midwife will discuss your options of a vaginal birth or Caesarean
Section.
Reduced Fetal Movements
During your pregnancy, feeling your baby move gives you reassurance of his or her wellbeing.
If you notice your baby is moving less than usual or if you have noticed a change in the pattern of
movements, it may be the first sign that your baby is unwell and therefore it is essential that you contact
your midwife or local maternity unit immediately so that your baby’s wellbeing can be assessed.
There is no specific number of movements which is normal. During your pregnancy, you need to
be aware of your baby’s individual pattern of movements. A reduction or a change in your baby’s
movements is what is important.
You are less likely to be aware of your baby’s movements when you are active or busy.
If the placenta (afterbirth) is at the front of your uterus (womb), it may not be so easy for you to feel your
baby’s movements.
Your baby lying head down or bottom first will not affect whether you can feel it move. If your baby’s
back is lying at the front of your uterus, you may feel fewer movements than if his or her back is lying
alongside your own back.
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Place of birth
Whether or not this is your first baby, you can choose to give birth at home or in hospital.
When your midwife completes your booking, depending on your medical and obstetric history, you will
either be assigned to the care of a midwife or a consultant obstetrician as your lead professional.
At your booking visit you will meet one of our midwives. The community team will care for you throughout
your pregnancy and in the postnatal period.
How can I decide where it is best to give birth to my baby?
The main factor when deciding where to have your baby is the safety of both you and your baby. There
is still not enough research to say which place will be the safest to give birth to your baby, but evidence
does show if your pregnancy is normal there is no difference between home and hospital.
The majority of women who choose to give birth at home feel they will be more in control and feel more
relaxed in familiar surroundings. A home birth may be right for you if, for example you don’t like hospitals
and feel you would have more privacy at home. Other women will decide a hospital birth is right for them
because they feel safer knowing all the equipment and additional staff are at hand.
Another place that you may want to consider giving birth is the Willow Suite - a midwife-led birthing unit
at Basildon University Hospital.
Home Birth
z What are the advantages of a Home Birth?
ΠYou may feel more relaxed and in control in your own home.
ΠYou can move about freely and have your family/friends around you.
ΠIn healthy women with anticipated uncomplicated pregnancies, delivering at home reduces the
likelihood of Caesarean Section.
z What are the disadvantages of a Home Birth?
ΠYou cannot have an epidural for pain relief.
ΠYou may have to be transferred to hospital if there are any problems.
Hospital Birth
If you decide to have your baby at Basildon University Hospital, you may be able to choose to have your
baby in The Willow Suite, or in The Delivery Suite.
z What are the advantages of The Willow Suite?
The Willow Suite offers midwife-led care for women with an uncomplicated pregnancy and labour.
ΠYou can choose to use the birthing pool and natural methods of pain relief such as music, relaxation
techniques and birthing balls.
Œ In healthy women with anticipated uncomplicated pregnancies, planned delivery in a ‘midwifery-led
unit’ reduces the likelihood of Caesarean Section.
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z What are the disadvantages of The Willow Suite?
ΠThe Willow Suite is not suitable if you have experienced complications during your pregnancy or you
have a medical problem which may affect your labour.
ΠYou may need to move to The Delivery Suite if you decide you would like epidural pain relief or if
there are complications during your labour.
z What are the advantages of The Delivery Suite?
ΠYou can choose any type of pain relief, including epidural.
ΠThere is a Maternity operating theatre.
Œ Everything is available. If there are any problems you won’t have to move.
z What are the disadvantages of The Delivery Suite?
ΠYou are more likely to have continuous monitoring and/or a drip.
Œ You may not feel as ‘in control’ of your labour and birth.
What will happen if I have a problem at home?
The midwife caring for you at home will monitor you in exactly the same way that he/she would monitor
a woman on the Willow Suite. If your midwife is concerned at any time, he/she will recommend you
transfer to the hospital to give birth. The most common reasons for transferring to hospital are concern
about the baby’s wellbeing or if labour is not progressing normally.
There is also a small risk that you may need to transfer after giving birth, for example, if you or your baby
are unwell.
When do you not recommend a home birth?
Although we always support your choice, there are some circumstances when we would recommend a
hospital birth:
z Previous Caesarean Section delivery
z Pre-existing medical conditions
z Problems which develop during pregnancy, such as high blood pressure, premature delivery - less
than 37 weeks pregnancy or after term (40 weeks) + 12 days.
z Anticipated problems with your baby, eg. very small baby
z Breech delivery
However, if you decide you would like your baby at home, we will offer you an appointment to see your
consultant to discuss your decision further and arrange an individualised plan of care.
Can I change my mind about where I want to give birth?
Yes, but please let your midwife know as soon as possible.
You can discuss your choice for place of birth at anytime with a midwife or doctor.
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Where can I find further information?
z National Childbirth Trust (NCT), 0844 243 6000 - www.nct.org.uk
z Childbirth.org - www.childbirth.org
z BirthChoice UK - www.birthchoiceuk.com
z Midwives Information and Resource Service (MIDIRS) - www.infochoice.org
z National Institute for Health and Clinical Excellence (NICE) - www.nice.org.uk
Types of birth
Most women who choose to give birth at Basildon Hospital’s Maternity Unit have a normal birth. Some
need a ventouse or forceps delivery and about one quarter of babies are delivered by Caesarean
Section.
Each woman’s labour and birth is different and unique.
Normal (Vaginal) Birth
There are three stages to normal labour and delivery.
They are:
z First Stage: When contractions make the cervix (neck of the womb) open (dilate) from 4 to 10
centimetres. This is usually the longest stage and the time it takes is different for every woman. It can
take up to 24 hours.
z Second Stage: This is the pushing part of labour (10cm to birth) when you deliver your baby. This
stage can last up to 2-3 hours, depending on how your labour is progressing and whether you have
had an epidural.
z Third Stage: This is when the placenta or afterbirth comes out of the uterus (womb), following the
delivery of your baby.
There are two ways to deliver the placenta:
z Naturally: You can wait for your uterus to contract and push the placenta out with contractions. This
usually takes 10 to 20 minutes, but can take up to one hour.
z Managed (with help): As your baby is being born, a midwife will give an injection of a drug called
syntometrine, into your thigh. The midwife clamps and cuts the baby’s cord, and then watches closely
for the remaining cord to lengthen. This is a sign the placenta has come away from the wall of the
womb and the midwife then gently pulls the placenta and remaining cord out of the vagina. This
usually takes about 10 minutes.
You can discuss these methods of delivering the placenta further with your midwife.
z Are there any possible problems?
The most common problem with normal vaginal delivery are that you may need stitches, you may be
bruised and you may bleed heavily. We will offer you treatment for these as needed.
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Instrumental Deliveries
You may need some help to deliver your baby vaginally. This may be:
z When you have been pushing for a long time.
z If you are exhausted.
z Your baby’s heart rate is abnormal and your baby is showing signs of distress. This is known as an
instrumental delivery.
There are two ways to do this.
z Ventouse (Suction or Vacuum) Delivery: Ventouse is a small plastic cup attached to your baby’s
head. A suction is formed between the cup and your baby’s head. Your midwife will help you put your
legs up into stirrups. If you have not had an epidural for pain relief, you will be given local anaesthetic.
You may need an episiotomy (cut) to enlarge the vaginal opening. Once the cup is applied to the
baby’s head your midwife will encourage you to push, with the next contraction and at the same time
the doctor will pull on the ventouse. You still need to push to deliver your baby; it cannot just be pulled
out. Your midwife will support you and help you to push with your contractions.
Are there any possible problems?
Your baby’s head may be bruised and swollen for a few days following delivery. A paediatrician
(specialist children’s doctor) will prescribe pain relief for your baby if necessary.
z Forceps Delivery: Forceps look like stainless steel salad servers and the curved ends cradle the
baby’s head. They are used in a similar way to ventouse, and the process is the same.
Are there any possible problems?
Your baby’s head may be bruised, but we can prescribe pain relief for the baby following delivery.
Occasionally, there can be bruising to the bladder, which needs to be treated with antibiotics and pain
relief.
Caesarean Section
A Caesarean Section is when your baby is delivered by an operation. It may be planned - agreed to
during your pregnancy and with no attempt at labour, or an emergency - decided during labour. There
are many reasons why you may be offered a Caesarean Section.
z Planned
ΠYour placenta (afterbirth) is blocking the exit to your uterus (womb)
ΠYou have had one or more caesareans before and do not wish to have a vaginal birth
ΠYou have a serious medical condition
z Emergency
Œ Your baby’s heart rate is abnormal and your baby is distressed
ΠYour labour is not progressing normally
If you need a planned Caesarean Section your midwife and doctor will discuss this with you during your
pregnancy. If you have previously had a Caesarean Section and wish to try for a vaginal birth, more
information can be found at the National Institute for Clinical Excellence website - address can be found
below.
If you have previously had a caesarean section and wish to try for a vaginal birth see Patient Information
Leaflet - Vaginal Birth after Caesarean and discuss it with your midwife and doctor.
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Are there any possible problems?
It may be that in an emergency situation you have very little choice because the risks associated with
Caesarean Section are outweighed by the risks associated with the health of you and your baby.
Caesarean Section is major abdominal surgery and you will not be up and about as quickly as you
would following a vaginal birth. It can take up to six weeks to return to normal. There is a higher risk of
bleeding, and you will have a scar on your tummy, but this is usually low down on your bikini line.
Recommendations for reducing the likelihood of Caesarean Section
z In healthy women with anticipated uncomplicated pregnancies, delivering at home reduces the
likelihood of Caesarean Section.
z In healthy women with anticipated uncomplicated pregnancies, planned delivery in a ‘midwifery-led
unit’ reduces the likelihood of Caesarean Section.
z The effects of complementary therapies used during labour (such as acupuncture, aromatherapy,
hypnosis, herbal products, nutritional supplements, homeopathic medicines, and Chinese medicines)
on the likelihood of Caesarean Section have not been properly evaluated and further research is
needed before such interventions can be recommended.
Where can I find further information?
z National Childbirth Trust (NCT), 0844 243 6000 - www.nct.org.uk
z Childbirth.org - www.childbirth.org
z BirthChoice UK - www.birthchoiceuk.com
z Midwives Information and Resource Service (MIDIRS) - www.infochoice.org
z National Institute for Health and Clinical Excellence (NICE) - www.nice.org.uk
Induction of labour
Induction of labour means deliberately attempting to start labour artificially.
This will only be performed when there is a benefit to either the mother or the baby from delivering early,
rather than waiting for labour to start naturally.
Approximately 20% of women (1 in 5) will have their labour induced for various reasons.
What are the main reasons for induction?
Induction of labour may be recommended for a variety of reasons, the most common of which are:
z If the pregnancy is prolonged. You will be offered an induction after term (40 weeks) between 41-42
weeks. Induction of labour at this stage has not been shown to increase the need for a Caesarean
Section.
z If you are over 37 weeks pregnant and your waters break before labour starts, you will be offered the
choice of being induced or to wait up to 96 hours to see if labour commences. By this time the majority
of women will have gone into labour naturally. Both options are considered safe providing you follow
advice. Neither option increases the need for a Caesarean Section.
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z If there is a concern about your baby’s growth. This will be discussed with you.
z If you have medical problems such as diabetes.
z If you develop pre-eclampsia.
The recommendation for induction will depend on many factors, which will be discussed with you.
What if I choose not to be induced?
z If you choose not to be induced, you will be referred to a consultant obstetrician where a plan of care
will be discussed and you will be asked to attend the maternity assessment centre daily to assess
the wellbeing of you and your baby until delivery. During this time you will be offered further tests/
investigations which the obstetrician will discuss with you.
How will the labour be induced?
There are a variety of ways to induce labour, they are:
z Prostaglandin - A gel containing the drug prostaglandin is given into the vagina.
This encourages the cervix to soften and shorten (ripen). You may need more than one dose of this at
regular intervals.
z ARM - Once the cervix is ripened and has started to open your waters will be broken.
This is known as ARM (artificial rupture of membranes). This is done during a vaginal examination
with a small plastic instrument.
z Oxytocin - You may then need a drip containing a hormone drug called oxytocin, which will
encourage contractions. The rate of this can be altered until the contractions are regular.
Every individual responds differently and you may not need all of the above measures. The whole
process of induction can take up to a few days.
z Propess - Propess looks like a very small tampon which is inserted into your vagina during a vaginal
examination. It contains dinoprostone, more commonly known as prostaglandin. Once inserted into the
vagina, Propess will stay there for a maximum of 30 hours.
Please be aware that induction of labour can be a long process. It may take 12-48 hours.
Before you are admitted for induction you will be offered a procedure called membrane sweeping.
This procedure is carried out during a vaginal examination and involves the midwife making a circular
sweeping movement with her finger to separate the membranes from the cervix. It does not involve any
risk to your baby but it has been shown to increase the chance of you starting labour naturally within
24 hours, but this is not guaranteed. First time mums will be offered a membrane sweep at around
40 and 41 weeks. Women who have delivered one or more babies will be offered a membrane sweep
around 41 weeks.
This may mean you will not need the induction process already described.
The vaginal examination may cause you some discomfort and mild vaginal bleeding. If you wish this
procedure to be done you will need to tell the midwife or doctor and this will be done in the antenatal
clinic, either in hospital or in the community.
Where will the induction take place?
This will depend on why you are being induced. Some women may have prostaglandin given on the
Antenatal Ward and move to the Delivery Suite just before the next stage (either ARM or syntocinon
drip).
Where it is necessary to monitor both you and the baby more closely, the whole process of induction will
take place on the Delivery Suite. This will be discussed with you at the time you are admitted.
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Will the baby be monitored?
If you are having prostaglandin, the midwife will need to monitor your baby for at least 20 minutes
beforehand and 45 minutes after. You will be attached to the CTG machine (fetal heart rate monitor). If
there is no concern about the baby after this time, the monitoring will be discontinued and you will be
able to move around.
Once the oxytocin drip has started you will need to be continuously monitored by the CTG until the baby
is delivered. (Please see patient information on baby’s heart rate monitoring - page 24).
What are the risks from induction of labour?
z Occasionally prostaglandin can cause the uterus to contract too frequently and this may affect the
baby’s heart rate. If this happens the midwife may try to remove the gel from the vagina or very
occasionally you may need to be given other medication to relax the uterus.
z If you have oxytocin you are more likely to have an epidural for pain relief.
z Oxytocin may also cause your uterus to contract too frequently. If this happens the drip can either be
slowed down or stopped altogether.
The midwife or doctor will be happy to discuss any aspect of induction with you or answer any questions
you have.
Where can I find further information?
z National Childbirth Trust (NCT), 0844 243 6000 - www.nct.org.uk
z Childbirth.org - www.childbirth.org
z BirthChoice UK - www.birthchoiceuk.com
z Midwives Information and Resource Service (MIDIRS) - www.infochoice.org
Reference:
D/word/patientinformation/inductionoflabour.doc
Inherited Clinical Guideline D. Induction of labour. National Institute for Clinical Excellence.
Pain relief in labour
There are several types of pain relief available at Basildon Hospital’s Maternity Unit. The choice of pain
relief is yours, but it is a good idea to think about the different types before your labour starts.
What does labour feel like?
Labour is painful, but it feels different for every woman.
Towards the end of pregnancy most women will feel tightening across their abdomen. When labour starts
the tightening becomes stronger and more regular. The pain may feel like period pain at first, and usually
gets stronger as labour progresses. The amount of pain varies with every labour and every woman.
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What can I do to prepare for labour?
You may find it helpful to attend parentcraft classes run by midwives at the hospital, or in your
community. They will give you a greater understanding of what may happen during labour and delivery.
This will help you to feel less anxious and more relaxed when labour starts because you will have some
idea of what to expect. The midwife at parentcraft classes will discuss pain relief, or alternatively you can
ask your community midwife.
Active Birthing Classes are run by a physiotherapist covering breathing and positioning in labour. Ask
your community midwife for information on how to register.
What are the different types of pain relief?
No single method for coping with labour will suit every woman. You should consider a range of options
and coping strategies you can use rather than deciding on one method. The midwives will assist and
support you in your decision.
z Support in labour
Having someone you know to support you in labour helps you feel more yourself and more relaxed.
Research shows that women who have the support of someone familiar in labour use less drugs to
cope with the pain. Your birth partner may be your partner/husband or it may be a friend or family
member. It may also be your midwife.
z Making yourself comfortable
Pain in labour is not usually just in one area. It can affect several different parts of your body, either
all at the same time or coming and going. You may find it difficult to get comfortable and find that
different positions make you comfortable at different stages of labour. Try to feel in control and think
positively, for example, holding your baby in your arms.
Having parts of your body massaged can help and it is a good idea to get your birth partner to practice
before your labour starts. Hot and cold flannels can help relieve muscle tension, especially in your
lower back.
z TENS (Transcutaneous Electrical Nerve Stimulation)
This is a small battery-powered machine that sends weak amounts of electrical current to electrodes
taped to your back. TENS works by stimulating the release of your body’s natural painkillers called
endorphins. It is most effective when started in early labour.
The advantage of TENS is that the effect is immediate and you are in control of the settings. You can
use it at home and in the hospital.
We do not provide TENS machines and you will need to hire one for a small charge. They are
available to hire at Boots and Mothercare stores, locally.
Should you need to be continuously monitored you may need to remove the TENS because it can
interfere with the CTG machine (fetal heart rate monitor). TENS would also need to be removed if you
decide to use the birthing pool.
z Gas and Air (Entonox)
This is a mixture of oxygen and a gas called nitrogen oxide, which you breathe in through a
mouthpiece. It works in about 30-40 seconds, but with no lasting effect. There is no evidence that it
affects your baby and it can be used throughout labour and delivery.
The disadvantage is, it does take a bit of practice to co-ordinate your breathing in time with your
contractions, but your midwife will help you. It can also make you feel sick, dizzy and lightheaded.
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z Pethidine
The most common drug used to relieve pain in labour is pethidine. It is given by injection. Pethidine
takes about 20 minutes to start working. It helps your muscles relax and helps to ease the pain.
Some women find it helps them sleep and rest early on in labour.
The disadvantages are that it may make you feel sleepy and sick. Pethidine also crosses through the
placenta (afterbirth) to the baby and if you have it near to delivery (within two hours) it can make your
baby sleepy and it may need an injection to reverse the effects. Sometimes the baby stays sleepy for
about 24 hours and this may make your baby slow to breastfeed.
z Diamorphine
Diamorphine is a similar drug to Pethidine in that they both belong to the opiate family. Like Pethidine
it is given as an injection, along with another drug to ease any sickness.
Diamorphine can be given in either a small or larger dose every four hours depending on the stage
of labour. It is fast acting and whilst like Pethidine it crosses the placenta to the baby, Diamorphine is
excreted from you and your baby’s system faster than Pethidine. This is very beneficial if you wish to
breast feed your baby as they are often more alert after delivery than if you had Pethidine.
z Epidural
Please see our ‘Epidural Pain Relief’ Patient Information Leaflet.
z Aromatherapy and Homeopathy
These are not provided by staff at Basildon Hospital and therefore your birth partner would need to
provide these. Candles are not permitted in the Labour Ward, due to the fire risk.
Who can I contact if I have any questions?
If you have any questions, please ask your midwife or doctor.
Where can I find more information?
z National Childbirth Trust: 0844 243 6000 - www.nct.org.uk
z Childbirth.org - www.childbirth.org
z Birth Choice UK - www.birthchoiceuk.com
z MIDIRS (Midwives Information and Resource Service) Informed Choice - www.infochoice.org
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Am I in labour?
How can I tell if I am in labour?
If you are having irregular, short contractions (30 seconds or less) that are not getting closer together, or
stronger, you are in the early stages of labour.
If you have had no complications during your pregnancy, and you are over 37 weeks pregnant, the
most appropriate place for you to be when you are in the early stages of labour is at home.
During this time you can speak with a midwife over the phone who will listen, support and reassure you.
They will also give you advice on what you should be doing.
What can I do while I am at home and in the early stages of labour?
If you feel able to, take short walks. Walking around may encourage the contractions to become
stronger and more regular.
z Eat light meals, and drink plenty of clear fluids (i.e. fruit squash diluted with water).
z Have a warm shower or bath, as this may provide some pain relief.
z You can have a massage and back rub to help with pain relief and ease your back pain.
z Take paracetamol (1 gram = 2 x 500mg tablets) every six hours to ease pain.
z You can use a TENS machine during the early stages of labour and keep it on throughout your labour.
You can hire these before labour - ask at your parent-craft class for further information.
z You can have a nap and rest if you feel tired.
When should I come into hospital?
If you are over 37 weeks pregnant and have had an uncomplicated pregnancy, please call the Willow
Suite if:
z Your waters have broken.
z You are contracting regularly, once every five minutes, and they are lasting for 40 seconds.
z You feel you require stronger pain relief.
Please call the Delivery Suite if:
z You are bleeding vaginally.
z If your baby’s usual pattern of movements have changed, please telephone if your baby’s movements
have reduced or if you do not feel any movements.
z You are under 37 weeks pregnant and are in labour.
z You have had problems and/or a complicated pregnancy.
What contact details do I need?
z Willow Suite:
01268 524 900 ext 3560
Located on Willow Ward, Maternity Unit, Level D.
z Delivery Suite:
01268 524 900 ext 3553
Located in the Maternity Unit, Level C.
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Patient Controlled Epidural Analgesia (PCEA) for Women
in Labour
We provide a 24-hour PCEA service for high-risk patients on the Delivery Suite.
What is Patient Controlled Epidural Analgesia (PCEA)?
Patient Controlled Epidural Analgesia (PCEA) allows patients to manage their own pain relief when in
labour.
Patients have a handset attached to a machine (PCEA pump). When the button on the handset is
pressed, a small amount of pain relief is given.
How does PCEA work?
The anaesthetist inserts a very fine plastic tube in the epidural space in your back. The epidural space
contains nerves which carry pain messages to your brain.
The anaesthetist programs the PCEA pump to deliver a small amount of pain relief through the tube,
whenever the button is pressed. This reduces the sensitivity of the nerves in your back.
Is it possible to give yourself too much pain relief?
The pump is programmed to ensure that you cannot give yourself too much pain relief, even if you keep
pressing the button. Therefore, if you are still in pain, you can press the button as often as you think you
need to.
The anaesthetist and midwife will always be able to help and support you. You must inform the midwife
when you press the button so that they can monitor your vital signs and progress.
How long will I need to use the PCEA?
This depends on how long you are in labour. Following the delivery of your baby, the anaesthetist and
midwife will discuss with you the best time to finish using the PCEA pump.
What happens if I still have pain?
Please tell your anaesthetist or midwife who will try other ways of relieving your pain. It may take a short
time to meet the best level of pain relief for you, as this differs with each patient.
What do I do if I want to get out of bed or go to the bathroom?
You should always check with your anaesthetist or midwife before trying to get out of bed. You will not be
able to walk outside of the labour ward without assistance.
References:
Mackie, A.M. et.al (1991) Adolescents use Patient Controlled Analgesia Effectively for relief from
prolonged oropharyngeal mucositis pain. Pain: 46: 265-69.
Ready, L.B. (1990) Patient-controlled analgesia - does it provide more than comfort? Canadian Journal
Anaesthesia 37 (7): 719-21.
Youkhana, I. (2005) Procedure for Epidural Infusion and Patient Controlled Epidural Analgesia (PCEA).
Basildon and Thurrock University Hospitals NHS Foundation Trust.
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Monitoring your baby’s heart rate
What happens to my baby during labour?
Most babies are born without problems, but there are some who do not cope as well. During contractions
blood cannot get through the placenta so easily. This is normal. If a baby is not coping well, this may be
reflected in the pattern of their heartbeat.
What is fetal monitoring?
One of the best ways of finding out if your baby may be having difficulties is to listen to their heartbeat
regularly throughout your labour. This is known as fetal monitoring.
There are two main ways this may be done:
z Intermittent auscultation
This is when the midwife listens to your baby at intervals during your labour.
The midwife will either use a trumpet-shaped device (Pinard stethoscope) or a hand-held microphone
(Doppler) which means you can also hear your baby’s heartbeat. The midwife will do this for long
enough to check your baby’s heart rate, and the pattern of your baby’s heart rate.
The midwife will place her hand on your tummy and feel when your uterus (womb) contracts and
relaxes again. As your labour progresses, the midwife will do this more frequently.
This method of monitoring your baby is recommended if you are healthy and have had a trouble-free
pregnancy.
Benefits of intermittent auscultation
ΠYou can move around freely during labour.
ΠYou can use the pool for labour and delivery, as the monitoring is suitable for use in the water.
ΠWhen pregnancy has been straightforward, intermittent auscultation reduces the chances of
unnecessary intervention.
Risks or disadvantages
Œ Very sudden changes in your baby’s heart rate will not be detected. However, these are very rare
in healthy babies. If there is a concern about your baby’s heart rate, continuous electronic fetal
monitoring will be advised.
z Electronic Fetal Monitoring (EFM)
This is when your baby’s heart rate is monitored continuously, using a cardiotocograph (CTG)
machine.
Attached to the CTG are two sensors which are held in place by elasticated belts. One sensor is
placed at the top of your tummy where the top of the womb is situated, and will monitor how often your
womb contracts. The other is held in place where your baby’s heart beat can be heard clearly. The
CTG machine produces a printed graph to show the pattern of your baby’s heart rate. Your midwife will
explain the pattern to you.
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Continuous monitoring is recommended if:
Πyou have medical conditions such as diabetes or high blood pressure
Πyou had complications during the pregnancy
Πyour baby is premature (less than 37 weeks) or you are more than 12 days over your due date and
are being induced
Πyou have previously had a Caesarean Section
Πyou have a multiple pregnancy
Πyou have epidural pain relief for labour
Other situations may arise where the doctor or midwife feel you should be monitored continuously.
This will be explained to you and discussed at the time.
Benefits of EFM
Œ You will be able to see the pattern of your baby’s heart rate.
ΠEFM is very useful when there is an existing reason for the midwife or doctor to be concerned about
your baby.
Risks or disadvantages
ΠYour freedom of movement will be limited with EFM, so you may feel restricted.
Monitoring with a Fetal Scalp Electrode (FSE)
Where EFM is not being reliable or there is any concern about the baby’s heart rate, the midwife or
doctor may suggest using a fetal scalp clip/electrode (FSE). This a small, circular needle attached to a
coated wire. The clip is guided up through the vagina and attached to the top of the baby’s head .
This procedure should not be any more uncomfortable than a normal vaginal examination. If your waters
are not already broken, they will need to be broken to attach the FSE to your baby’s head.
Fetal Blood Sampling (FBS)
There are occasions when the midwife may be concerned about your baby’s heart rate pattern, and will
ask a senior midwife and doctor to see you.
A sample of blood (FBS) may be taken from the top of your baby’s head. The sample is then tested to
measure the oxygen level in your baby’s blood. The result will assist the doctors to know the best way to
help your baby through labour.
Sometimes, the graph gives the doctors some concern, but the FBS shows that your baby is actually
coping very well. Sometimes, the FBS will help the doctor to decide that your baby needs to be delivered
quite quickly, for example by Caesarean Section.
This procedure is usually very safe, but there is a small risk of infection or bruising of the baby’s head.
Further Information
If you would like any further information, please ask your midwife or doctor.
References
National Institute for Health and Clinical Excellence, 2007 Intrapartum Care; Care of the healthy women
and their babies during childbirth. London: NICE
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Your baby and vitamin K
Why is vitamin K important?
Vitamin K helps blood to clot and is essential to prevent serious bleeding. Babies need extra vitamin K
until they build up their own supplies as they do not have enough at birth.
Giving vitamin K prevents a very rare disorder called Vitamin K Deficiency Bleeding (VKDB) in newborn
babies. This can cause internal bleeding, which can jeopardise the baby’s health and in extreme cases
can cause death. The incidence of vitamin K deficiency bleeding is 1:10,000 births.
Does my baby have to have vitamin K?
It is strongly recommended by doctors and the Department of Health that all newborn babies receive
vitamin K. The choice is entirely yours once you know the available facts and recommendations.
Does vitamin K have any side effects?
Vitamin K has been used in the UK for over 30 years and there are no recorded problems. A few years
ago one research study suggested that injections of vitamin K might be linked to childhood leukaemia,
but more recent studies could find no link. The National Health Council has looked carefully at these
studies and has concluded that vitamin K is not associated with childhood cancer, whether it is given
orally or by injection.
Signs of VKDB – What should I look out for?
z Unexplained bruising
z Bleeding which does not stop for example from nose, cord, any blood test site or surgical site.
z Blood in the nappy or vomit (although babies sometimes have blood in the nappy due to normal
hormonal changes).
z Jaundice (yellowing of the skin or eyes) beyond two weeks from birth.
Please inform your GP, midwife or health visitor if your baby has any of these signs and tell them
whether your baby has had vitamin K or not.
How is vitamin K given?
z Injection: The most reliable recommended method to give vitamin K is by an injection in to the baby’s
thigh soon after birth.
z Oral: Oral vitamin K is not suitable for some babies if:
ΠYour baby was premature or sick at birth
ΠYou took medication for epilepsy, blood clots or tuberculosis during pregnancy
ΠYou plan on having him circumcised
ΠYour baby is not feeding well
ΠYour baby was born by forceps or ventouse
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If you want your baby to have vitamin K, but not by injection, it can be given by mouth in three doses (as
below). This is because the oral preparation is not absorbed as well as an injection and the effect does
not last long. The first dose is given at birth, the second at around seven days old by your community
midwife, and the third is given when the baby is four weeks old, but only if your child has been breastfed.
If your child has been receiving formula milk, the third dose is not required.
If your baby vomits within an hour of receiving one of the doses, they will need to have the dose given
again. Please inform your midwife if this happens.
You should think about your options while you are pregnant and discuss any concerns you have with
your midwife or health professional.
Where can I find more information?
z National Childbirth Trust - www.nct.org.uk
z Childbirth.org - www.childbirth.org
z Birth Choice UK - www.birthchoiceuk.com
z MIDIRS (Midwives Information and Resource Service) Informed Choice - www.infochoice.org
Supporting your feeding choice
Basildon Hospital supports the right of all parents to make informed choices about infant feeding. All our
staff will support you in your decision.
We believe that breastfeeding is the healthiest way to feed your baby and we recognise the important
benefits which breastfeeding provides for both you and your child.
Ways in which we will help you to breastfeed successfully include:
z We provide training in breastfeeding care to all our clinical staff.
z During pregnancy you will be able to discuss breastfeeding individually with a health professional.
z You will be encouraged to spend time holding your baby, skin-to-skin.
ΠThis promotes bonding
ΠHelps keep baby warm
ΠCalming for both mother and baby
These benefits continue throughout your time breastfeeding. Staff will not interfere or hurry you during
this important time.
z When you and baby are ready, you will be helped by a skilled practitioner to initiate the first breastfeed.
z Staff will continue to support and help you with feeds.
z You will be shown how to express and store your breastmilk and you will be given written information.
The benefits of breastmilk are even more important if your baby is small, ill or premature.
z Most babies do not need to be given anything other than breastmilk for the first six months. If for
medical reasons your baby requires anything other than breastmilk, this will be explained to you.
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After the first six months, breastmilk can continue to be a part of your baby’s diet for at least the first
year.
z You and your baby will remain together. If medical procedures are necessary you will be invited to
accompany your baby whenever possible.
z You will be encouraged to feed your baby whenever he/she seems to be hungry.
z We recommend that you avoid using teats, dummies and nipple shields while your baby is learning
to breastfeed. This is because they can make it more difficult for your baby to learn to breastfeed
successfully and for you to establish a good milk supply.
z Before leaving hospital, you will be given a list of telephone numbers of people who can provide extra
help and support with breastfeeding when you are at home.
z Breastfeeding is welcome in all health care areas.
z This is your guide to the breastfeeding policy. Please ask a member of staff if you wish to see the full
policy.
Staff will ensure that all mothers who have chosen to feed their newborn with infant formula are able to
correctly sterilise equipment and make up a bottle of infant formula during the early postnatal period and
before discharge from hospital.
Staff will ensure that mothers are aware of effective techniques for formula feeding their baby and
community midwives will check and reinforce learning following the mother’s transfer home.
Mothers who have chosen to feed their baby with infant formula will need to bring a supply of formula
feed into hospital.
Keeping our youngest patients safe and secure
Guidelines for parents
We want our hospital to provide a safe and secure environment for your baby or child. Please find below
guidelines about security in our Maternity and Children’s Departments, for your information.
z Security guards are in attendance on Cedar Suite every day, 4pm - 8pm.
z The doors to our Maternity and Children’s Departments are locked at all times. Visitors will need to use
the intercom system to gain access.
z All visitors are asked to comply with the Maternity and Children’s Department visiting times.
z Only two visitors to a bed please (on the Maternity Ward this does not include husband / partner).
z Please ask all of your visitors to report to a member of staff when arriving on the ward.
z All Trust employees wear an identity badge which includes their photograph. In addition, all our ward
staff also wear a Trust name badge.
z All staff will introduce themselves at the beginning of each shift - morning, afternoon and evening.
z Please do not leave your baby unattended, at any time, without informing a member of staff.
z Please do not hand your baby or child to anyone not known to yourself, or not wearing a name badge
and identity badge. Do not remove your baby’s name bands until you go home.
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z If your baby or child needs any tests or investigations that cannot be carried out by the bedside, insist
on accompanying them during the test. If you are confined to bed, and the test or investigation is
not urgent, you should ask to wait until another member of your family, or a friend, arrives who can
accompany your baby or child.
z Meals can be taken at the bedside.
z The name of your baby or child will not be displayed in obvious places.
z Should you have any ideas or suggestions that will help us to improve security please do not
hesitate to inform the midwife or nurse on duty.
z We recommend that all babies travel home from hospital securely in a car seat.
Caring for your premature or sick newborn baby
We are very fortunate at Basildon University Hospital to have a highly skilled team of staff, who are able
to care for very premature and sick babies in our Neonatal Intensive Care Unit (NICU).
There is a very high demand for neonatal services locally. This means that, at times, we have to make
difficult decisions about which babies stay at Basildon Hospital and which are transferred to other
hospitals where there are available intensive care cots.
We do, at times, have to close our Neonatal Intensive Care Unit because it is full.
The following explain some of the choices we then have to make:
z Transfer the mother-to-be to another maternity unit, where they can safely deliver the baby, and
where there is a vacant intensive care cot.
z Transfer the newborn baby to another unit.
z Transfer one of the more stable babies, who may have been with us for some time, to another unit.
This would allow us to keep the sickest baby, who would be too unstable to transfer.
We realise that this poses difficulties to families – possible separation from your baby, difficulty in visiting
the other unit, family arrangements etc. However, we will, at all times, act in the best interest of the baby
even if this goes against the family’s wishes.
We do our very best to keep local babies at Basildon Hospital and we will never make arrangements to
transfer your baby to another unit without discussing the need to do so with you first.
Thank you for your understanding and co-operation.
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Supervisors of Midwives: How they can help you
Who are Supervisors of Midwives?
Supervisors of Midwives (SoMs) help midwives provide safe care for you, your baby and your family.
They make sure that the care you receive from your midwife is right for you and will meet your needs.
They also make sure the care is given in the right place and by the right person.
SoMs are experienced midwives who have had additional training and education to enable them to help
midwives provide the best quality midwifery care. They oversee the work of the midwives and meet with
them regularly to ensure high standards of care are provided. They also guide and support midwives in
developing their skills and expertise.
All midwives must have a SoM. This includes those who work in independent or private maternity units
and any who are self-employed or independent midwives.
How they can help you
A SoM can offer guidance and support about any aspect of your midwifery care. This includes:
z creating a comfortable and confidential environment for you to discuss your care with your midwife (for
example, whether you would prefer to have your baby at home, in a birthing centre or in a hospital)
z providing advice about the various options for care available to you and any support you may need
during your pregnancy and birth
z monitoring the ability and behaviour of your midwife to ensure she meets the standards set by the
Nursing and Midwifery Council (NMC)
z listening to any concerns you may have about the level of care you receive from your midwife, for
example, you may have concerns about your birthing experience and then the SoM can discuss these
concerns with the midwife, if appropriate.
How do you contact a Supervisor of Midwives?
You can contact a SoM at any time, day or night by contacting the Trust switchboard on 01268 524900
and asking to be connected to a Supervisor of Midwives.
If for any reason you are unable to speak to a SoM, you can ask the maternity unit to ask the Local
Supervising Authority Midwifery Officer (LSAMO) to call you back. The LSAMO is an experienced
practising midwife who has a leadership role and he/she is based at the Strategic Health Authority
(SHA). The LSAMO is responsible for appointing SoMs and can give advice on the supervision of
midwives.
You can also contact your LSAMO directly if you wish on [email protected]
If things go wrong
SoMs have a number of options available to them if things go wrong, they may decide to deal with the
problem locally, at your hospital for example, or they may refer the midwife to the Local Supervising
Authority (LSA).
Where a SoM may have serious concerns about the ability and behaviour of a particular midwife, the
SoM could refer that midwife to the Nursing and Midwifery Council (NMC), where the midwife’s fitness to
practise may be investigated.
Raising your concerns with a SoM does not prevent you making a formal complaint about a midwife,
directly to the NMC yourself.
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Reference
Nursing and Midwifery Council. Supervisor of
Midwives, www.nmc-uk.org
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Not to be photocopied
Maternity visiting times
Visiting Times - Cedar Suite
Partners and own children only: 7am - 12 midnight
Open visiting: 4pm - 7pm
z New mothers and babies need their rest, so we ask visitors to please observe the visiting times above.
z We will try to accommodate visitors outside of these times where requested in advance by the new
parents. This is at the discretion of the midwife in charge.
z Only two visitors to a bed at any time please (excluding husband / partner).
z We ask that only the new parents’ children come to visit. No other children under the age of 16 years
should visit the Maternity Ward.
z Where a new parent is under the age of 16 years, we will accommodate visitors of a similar age.
Visiting Times - Delivery Suite
z Birth Partners only.
Visiting Times - The Willow Suite
z Partners can visit at any time during your stay.
Open visiting: 4pm - 7pm
How to contact us
Cedar Suite:
01268 394596
Delivery Suite:
01268 394598
Willow Suite:
01268 394597
Visiting in all areas will be at the discretion of the midwife or doctor, depending on the mother’s condition.
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.