Mid Cheshire Hospitals
NHS
NHS Foundation Trust
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Pregnancy Information
Index
Page
1.0 Your pregnancy at a glance
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
0-8 weeks
Blood Transfusion
8-12 weeks
12-16 weeks
16-20 weeks
20-24 weeks
24-28 weeks
28-32 weeks
32-37 weeks
37-40 weeks
40-41 weeks
2.0 Antenatal Care
Appointments at the hospital
Staff identity
Your first antenatal visit
Medication
Your named midwife
What does having a complicated
pregnancy mean?
2.7 Importance of antenatal care
2.8 Maternity benefits and travelling
expenses
2.9 Car parking
2.10 Concessionary Passes
2.1
2.2
2.3
2.4
2.5
2.6
3.0 Ultrasound screening
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
Screening information
Dating scan
Mid pregnancy ultrasound scan
What happens during your scan
Photographs
Personal camera/video equipment
Sex of babies
4D Scans
Subsequent ultrasound scans
Customised antenatal growth charts
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4.0 Your health in pregnancy
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
5.0 Lifestyle advice
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
5.10
5.11
5.12
Alcohol
Drug abuse
Smoking in pregnancy
Nicotine Replacement Therapy (NRT)
Carbon monoxide monitoring
Pets
Allergies
Sex
Travel
Seat belt advice
Work and Benefits
Domestic abuse
6.0 Infections in pregnancy
-Chlamydia
-Syphilis
-MRSA (Methicillin-resistant
Staphylococcus aureus)
-Tuberculosis (TB)
7.0 Pregnancy complications
7.1
7.2
7.3
2
What should you eat
Anaemia in pregnancy
Take care with some foods
Vitamin D
Folic acid
Other sources of information
Exercise and pregnancy
Pelvic floor exercises
Baby’s well-being
Common pregnancy symptoms
Blood pressure
What if your blood pressure is high?
What are the causes of raised blood
pressure
-Hypertension
-Pre-eclampsia
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Pregnancy Information
Page
7.4
7.5
7.6
7.7
7.8
7.9
7.10
7.11
Symptoms
Urine checks
What if protein is found?
Blood clots (Deep Vein Thrombosis)
-Risk factors
Severe itching and obstetric cholestasis
Vaginal bleeding
Malposition
Mental Health problems during
pregnancy and after birth
8.0 Deciding where to have your baby
8.1
8.2
At home
Hospital birth
9.0 Deciding how to feed your baby
9.1
9.2
9.3
9.4
9.5
Putting your baby to the breast
Attaching your baby to the breast
Recognising your baby’s feeding cues
and feeding frequency in the early days
How do I know my baby is getting
enough milk?
Dummies and teats
10.0 Getting ready for birth
10.1
10.2
10.3
10.4
Parent Education
Young parents group
Preferences for birth
Packing for hospital
11.0 Signs of labour
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25
25
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28
28
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11.1 The show
11.2 The waters breaking
11.3 Contractions
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12.0 Optimal Fetal Positioning
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13.0 The latent phase of labour
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When to go into hospital
Having a home birth
What happens if my baby is overdue?
How will my labour be started?
Labour and birth
-What happens when I get to hospital?
-What happens in labour?
First stage of labour
-How long will labour last?
-How your baby is monitored
-Continuous monitoring of your baby’s heart beat
-Eating or drinking in labour
-Acceleration labour
13.7 Second stage
-Positions for second stage
-Pushing
13.1
13.2
13.3
13.4
13.5
13.6
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13.8
13.9
Page
Third stage
-An active third stage
-A physiological third stage
Postnatal check following delivery
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14.0 Skin to Skin contact
36
15.0 Assisted birth (operative vaginal delivery)
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15.1
15.2
15.3
15.4
What happens?
What happens when the baby is born?
Will I need assisted birth next time?
How will I feel after I leave hospital?
16.0 Pain relief
16.1
Types of pain relief:
-Self help
-Water
-TENS
-Gas and Air (Entonox)
-Pethidine
-Epidural Anaesthesia for Labour
-Can anyone have an epidural?
17.0 Caesarean Section
17.1 Planned caesarean section
17.2 Emergency caesarean section
18.0 Vitamin K
-What is vitamin K?
-Why gives babies vitamin K?
-Which babies are more at risk?
-How is vitamin K given?
-What are the recommendations?
-Bruising and minor warning bleeds
19.0 Transferring to the postnatal ward
19.1 Amenity beds
19.2 Visitors in hospital
19.3 Security in hospital
20.0 After you have had your baby
20.1 What to expect
20.2 Baby blues
20.3 Family planning advice
21.0 Caring for your baby
21.1
21.2
21.3
21.4
21.5
21.6
21.7
Your baby’s health
Newborn hearing screening programme
Newborn blood spot screening
Cord care
Transfer to community care
Registration of births
Bounty services
22.0 Useful organisations
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Pregnancy Information3
Mid Cheshire Hospitals Maternity Services
Congratulations on your pregnancy.
The staff of the Maternity Unit extend a warm welcome to you and your family. We wish to offer a safe and highquality service. Our aim is to be sensitive to your physical and emotional needs and to be flexible in our care so that
your individual wishes are met.
We want to keep you well-informed so that you can make informed choices. Please do not hesitate to ask
questions and seek advice at any time. We hope that this booklet will be helpful to you during your pregnancy.
Here at Leighton hospital, we have a Consultant led unit and midwifery led care in a semi-rural area undertaking
approximately 3000 births per annum.
The Maternity Unit provides services for all women. The unit consists of:
• A Community Team providing antenatal and
postnatal care for all women who live locally to the
hospital. Care is primarily provided in Children’s
Centres and GP Practices.
• A specialist team of midwives who provide
additional advice and support to women and their
families around problems with drugs, alcohol,
mental health, domestic violence and abuse. We
appreciate it may be difficult to think about these
issues but we are committed to making sure you
get the help you are entitled to. Contact: 07793
579 545 or 07919 395 941.
• A dedicated Home Birth Team to support and
guide you through your pregnancy, childbirth and
postnatal periods.
• Leighton Hospital provides training for student
midwives and student doctors. You will be asked
if they may participate in your care throughout
your pregnancy, birth and the postnatal period
as part of their training. Your cooperation would
be appreciated. If you have any worries, please
discuss them with your midwife. The students will
be under the supervision of a qualified midwife or
doctor.
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• An Antenatal Clinic for women who may require
additional care or observation during their
pregnancy.
• A multidisciplinary diabetic antenatal clinic for
women with pre-existing diabetes and those who
develop gestational diabetes. The team includes a
Consultant Obstetrician, Consultant Diabetologist,
Diabetes Specialist Nurse, midwife for the diabetes
clinic and a Dietician.
• The Antenatal Day Assessment Unit (ANDAU) is
a day unit for women to be reviewed in order to
prevent unnecessary hospital admission.
• A Triage system operates within the Labour Ward
to assess women in order to provide appropriate
advice and care.
• The Labour Ward has dedicated labour and
delivery rooms including one with a birthing pool.
There are also 2 maternity theatres on the ward.
• We also have a Neonatal Unit with experienced
neonatal nurses and neonatologists if required.
Pregnancy Information
Pregnancy Information:
q As well as this Pregnancy Information Booklet,
you can access the NHS interactive pregnancy
care planner online, which contains videos and
interactive planning tools. It contains all you need
to know to have a healthy pregnancy and to make
sure you get the care that is right for you.
www.nhs.uk/planners/pregnancycareplanner/
Pages/PregnancyHome.aspx
q We also have our hospital information leaflets
displayed on the hospital website for you to read
or print.
www.mcht.nhs.uk
Then click on –
• The patient and visitor tab at the top of the
page
• Patient leaflets on the left hand side
• Women’s health unit from the list
• Pick your chosen leaflet
q If there is anything you are not sure about, or you
need more information, please do not hesitate to
ask your midwife, doctor or health visitor.
Clinical Research at Women’s Health - Mid Cheshire Hospitals NHS Foundation Trust
What is clinical research?
Do I have to take part?
Clinical Research helps us understand how to
diagnose, treat, cure or prevent disease. In Women’s
Health it may help us to progress and develop,
ultimately providing improved patient care.
It is entirely up to you whether or not to take part
and your care will not be affected if your decide no
to.
The research could be a drug trial, a screening study,
a questionnaire or a combination of these and
participation is entirely voluntary.
How can I find out more information?
You may be approached by staff during or after your
pregnancy regarding studies that you are eligible to
take part in.
If you would like to know more about getting
involved in research, please contact the Research
Midwives who are based at Leighton Hospital on
01270 273745.
Pregnancy Information5
1.0 Your pregnancy at a glance
1.1 0-8 weeks
• Make an early appointment with your midwife.
Don’t forget once you realise you are pregnant you
can contact a midwife by phoning 01270 612177
/ 612141. An answer phone is available if nobody
can take your call and you will be contacted at the
number you leave at the earliest opportunity. After
obtaining your details you will be given a booking
appointment at approximately 7 weeks gestation.
• You will attend your first antenatal appointment
with a midwife, often called your “booking
visit” at a local Children’s Centre, GP surgery or
antenatal clinic between 6-8 weeks of pregnancy.
At this appointment all the antenatal screening
tests will be discussed and offered to you.
• Take folic acid supplement (400mcg) and try to eat
a balanced diet. Your midwife will tell you if you
need a higher dose. e.g. if you have diabetes.
• Get a maternity Exemption Certificate (FW8)
from your midwife or GP. This entitles you to
free prescriptions and dental treatment from
confirmation of your pregnancy until a year after
the baby is born.
• Healthy Start vouchers are available to pregnant
women who are on certain benefits. All pregnant
women under the age of 18 qualify for Healthy
Start vouchers – whether or not they are on
benefits. Vouchers can be exchanged for milk,
fresh fruit and vegetables.
• You will be offered blood tests to check your blood
group, iron levels, to see if you are immune to
rubella (German measles) and to check if you have
any other infections which could affect the baby. If
you are under 25 years of age you will be offered
chlamydia screening. You can have this at any age
if you feel you are at risk.
• Contact your GP as well if you have any medical
condition e.g. diabetes, epilepsy.
• Ensure you have an appointment for the 12 weeks
ultrasound scan and consider whether you would
like to be screened for Down’s syndrome.
1.2 Blood Transfusion
1.4 12-16 weeks
At your booking appointment a midwife will discuss
your preferences with regards to blood transfusion.
If you have any objections to having a transfusion,
for personal or religious beliefs, a management
plan will be made by a consultant obstetrician and
anaesthetist for your pregnancy, labour and birth.
• You will be offered an ultrasound dating scan.
As part of this scan you can opt for screening for
Downs syndrome (It’s called combined nuchal
translucency screening). This first scan provides
an early view of baby. We don’t expect to see
anything abnormal but if there are problems then
we would not ignore them. You are welcome to
bring someone with you to see this and it may also
be possible to buy a photograph of the scan.
Please note: Anti D immunoglobulin offered to
Rhesus negative (Rh-) women is a blood product
made from plasma collected from donors. We can
give you more information if this affects you.
1.3 8-12 weeks
• If you have not previously had your “booking visit”
you will be given an appointment with a midwife
before your 12th completed week of pregnancy.
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• If you have been feeling sick and tired in the early
weeks, you may be feeling better around this time.
• If you have consented to tests, previously discussed
with your midwife, they will be taken at this
appointment.
Pregnancy Information
1.5 16-20 weeks
1.9 32-37 weeks
You may start to feel your baby move.
• Make arrangements for the birth, whether it is in
hospital or at home. If you have children arrange
who will look after them when you are in labour
and during your stay in the hospital.
• Your tummy will begin to get bigger and you will
need to wear looser clothing.
• Book onto antenatal/Parent Education classes if
you wish to attend. Details about the hospital
classes are on the hospital website (www.
mcht.nhs.uk/pregnancy) and there is further
information later on in this booklet. To book a
place ring 01270 273756.
1.6 20-24 weeks
• You will be offered fetal anomaly screening.
This is an ultrasound scan that looks for
abnormalities within the baby. You are welcome
to bring someone with you to see this. Feel free to
ask any questions or concerns you may have.
• After 20 weeks of pregnancy you can get your
certificate of pregnancy form for you employers
(Mat B1) from your midwife or GP.
1.7 24-28 weeks
• You can listen to the baby’s heart beat from
25 weeks gestation at your antenatal
appointment.
• According to whether it is your first or subsequent
baby, you will be given an appointment to see
your midwife.
• Arrange your own transport to the hospital.
Remember, ambulances are for emergencies only.
• Pack a small bag with essentials ready for the
hospital (see list of items later in this booklet).
• You may be aware of your uterus tightening from
time to time. These are mild contractions, also
known as Braxton Hicks, and are normal.
1.10 37-40 weeks
• If you are having a home birth, the equipment will
be delivered to your home at 37 weeks.
• Make sure you have all the important telephone
numbers handy in case labour starts.
• Telephone the Labour Ward on 01270 612144 if
you think your labour has started or your waters
break.
1.11 40-41 weeks
• You may be offered a membrane sweep (vaginal
examination to stretch and sweep the neck of
womb to stimulate labour) and will be given a
date to attend the hospital for induction of labour
if you have not delivered by 42 weeks.
1.8 28-32 weeks
• You will be offered a blood test to check your iron
level and antibody levels.
• If you are Rhesus negative (Rh-) you will be given
an Anti D injection at 28 weeks.
Pregnancy Information7
2.0 Antenatal Care
Throughout your pregnancy you will need regular appointments with your midwife. A list of routine antenatal visits
can be seen in your Pregnancy Health Record but your care will be designed around your individual needs. These
appointments check that you and your baby are well and that any problems can be picked up as early as possible.
2.1 Appointments at the hospital
2.4 Medication
Whilst every effort is made to improve efficiency
in the hospital clinic to ensure the length of time
taken is as short as possible, please appreciate that
medical staff are sometimes called away to deal
with emergencies. When this occurs, some delay is
inevitable. An appointment system is in operation
and we would greatly appreciate you keeping to your
appointment times. It is advisable to arrive fifteen
minutes before your appointment to enable you to
park your car, but please do not arrive earlier as you
will not be seen ahead of schedule. While we try
to give you the time that is convenient to you, we
hope you appreciate that we can only make a limited
number of early morning appointments.
It is important for you to let your doctor and midwife
know if you are using any type of medication
whether it is prescribed, purchased from a pharmacy
or recreational throughout your pregnancy and
during breastfeeding.
At Leighton Hospital there is a play area available in
the Antenatal Clinic for young children, but this is not
supervised. You will need to bring a relative or friend
to care for your child during your appointment.
2.5 Your named midwife
2.2 Staff Identity
During your visits to hospital you will meet a number
of staff who are all part of the team looking after
you. All staff should wear a name badge with
photographic ID to help you identify them.
2.3 Your first antenatal visit
It is important that you see a midwife as early as
possible in your pregnancy. Women have their first
and longest antenatal appointment between 6-12
weeks of pregnancy with their midwife. This is called
the “booking” visit and involves questions about
your health, any illnesses or previous pregnancies.
This helps us to see if there may be any possible
problems during your pregnancy.
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To manage your care more effectively whilst in
hospital please bring in with you all medication that
you are taking in their original containers and if
possible a copy of your repeat prescription.
On admission your medication must be handed in to
the midwife looking after you who will ensure it is
safely stored whilst you are on the ward.
You will have a “named “midwife and be given
contact details if you have any questions or concerns.
If your named midwife is not available due to shift
patterns or annual leave another midwife will be able
to talk to you and offer help or advice.
2.6 W
hat does having a complicated
pregnancy mean?
Some women with medical conditions e.g.
diabetes, severe asthma or epilepsy, or who have a
previous complicated obstetric history e.g. recurrent
miscarriages, caesarean section, large or small babies,
and premature births, may require extra care during
their pregnancy.
Your midwife will be able to discuss with you
whether your pregnancy is straightforward (low
risk) or complicated (high risk). If you are high risk
you may be seen more often and be referred to the
hospital Antenatal Clinic where your care will be
Pregnancy Information
shared between your obstetrician, specialist teams
and community midwife. Your midwife will discuss
an individualised plan of care with you and once you
have agreed the pattern of your appointments with
your midwife, she will let you know how to make
these arrangements.
2.7 Importance of Antenatal care:
• Regular antenatal care is important for the health
of you and your baby.
• Always bring your pregnancy health record with
you.
During an antenatal assessment the health of
you and your baby is checked by:
• Testing your urine
• Measuring your blood pressure
• Measuring your abdomen at every visit from 24
weeks to make sure baby is growing well and
plotted on an individual growth chart from 28
weeks
No charge for the first 25 minutes
£3.00 for between 25 minutes and 4 hours
£5.00 for between 4 and 24 hours
£10.00 for parking in excess of 24 hours
These charges will also apply to disabled drivers.
There is an intercom fitted to each car park barrier
which is linked directly to the Security Control Room
at Leighton Hospital. Please press this intercom for
security and car parking assistance.
2.10 Concessionary Pass Card
A £10 concessionary pass card is available for regular
visitors wishing to park their vehicles on site. Each
card is valid for a period of up to 7 days from the
date of issue and can be used for multiple visits each
day. To obtain a pass card, visitors must be parked on
a car park with a barrier entry system. The visitor then
uses the barrier ticket to obtain the pass card from
the Pay On Foot (POF) Paystations. The procedure is
as follows:
1 The visitor presses for a regular ticket when
entering the car park.
• Listening to your baby’s heartbeat from 25
weeks onwards
2 The regular ticket which is issued from the barrier
is taken to a Paystation.
• Testing you blood, with your consent, at your
first visit with the midwife and at 28 weeks
3 The visitor presses the ‘weekly ticket’ button on
the Paystation.
• Discuss any concerns you may have
4 The visitor inserts the regular ticket issued from the
barrier into the Paystation.
Please keep all antenatal appointments or, if
you have to cancel or rearrange, please tell
us as soon as possible so we can give the
appointment to someone else and rearrange
yours.
2.8 Maternity benefits and travelling
expenses
5 The visitor inserts £10 into the Paystation.
6 The regular ticket is then encoded for 7 days and is
issued back to the visitor.
7 The expiry date is printed on the ticket.
8 There is no need for a form to be completed.
Your midwife can give you advice regarding
maternity benefits and leaflets are available. If you
receive Income Support you may be entitled to
claim various travelling expenses while attending the
Antenatal Clinic. For information regarding these and
other maternity benefits, ask at the Antenatal Clinic.
2.9 Car parking
Leighton Hospital operates a barrier entry system
on specific car parks in the Trust. These are at the
Main Entrance, Maternity, Treatment Centre and
Emergency Department. The driver will take a ticket
on entering the car park to raise the barrier. The
ticket is then placed in a Pay Station at one of the
Hospital entrances before they leave, where the
appropriate charge is displayed. The ticket is then
used to raise the barrier at the exit.
Pregnancy Information9
3.0 Ultrasound Screening
Ultrasound scans use sound waves to build a picture of your baby in your uterus. To date, there is no evidence that
ultrasound scans such as those used during pregnancy, does any harm to the baby or mother.
At Leighton Hospital, the Maternity Ultrasound Scan Department offers every pregnant woman a scan at around
12 weeks (dating scan/nuchal translucency) and 20 weeks (detailed scan) of pregnancy.
3.1 Screening information
Screening information, including screening tests for
Down’s syndrome and spina bifida is contained in the
‘Screening tests for you and your baby’ leaflet which
your midwife will give you at your first antenatal
appointment. It is important that you read and
understand this information so that you can make
an informed choice. Your midwife will discuss this
with you. If you are considering chorionic villus
sampling or amniocentesis, your midwife can give
you a separate leaflet or you can get the leaflets
from the hospital website in the patient information
section.
3.2 Dating scan
This scan checks the number of babies, the heartbeat
and the baby’s measurements to give a better idea
of when the baby is likely to be born. The scan does
not attempt to examine the baby in detail, but as a
screening test, it may sometimes detect abnormalities
of your baby, if this is the case you will be
informed whether you have opted for screening
tests or not. You will need a full bladder at the
dating scan to get good images of your baby but it
won’t be necessary for the mid pregnancy scan.
3.3 Mid pregnancy ultrasound scan
This scan may also be called a fetal anomaly scan
or structural survey. It is done at around 20 weeks
of pregnancy and takes approximately 30 minutes.
The purpose of the scan is to look at the baby in
detail to check if your baby is developing normally. In
most cases the scan confirms that nothing unusual
can be seen and most women are reassured to see
the normal development of their baby. But the scan
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is a screening test which looks for abnormalities in
the baby.
The success of the scan is affected by the position
of the baby and the size of the mother and in some
cases cannot be fully done. Some scans can be
difficult to interpret and this could cause anxiety. If a
problem is found, you will be referred to a Consultant
for further explanation and discussion.
Some babies can be born with problems that the
scan was unable to pick up.
More information including information regarding
the safety of the scan and the expected rates
of detection for abnormalities can be found
at http://fetalanomaly.screening.nhs.uk/
publicationsandleaflets
3.4 What happens during your scan?
One person may come with you to watch the scan,
but please remember that, although the scan is an
exciting event for the family, the purpose is to see if
your baby has any problems.
Please understand that the Sonographer or doctor
scanning you may not be able to discuss things
during the scan. They need to concentrate on
getting the correct views. However, once your scan is
completed we will answer any concerns.
3.5 Photographs
You can buy photographs of your baby’s scan. Please
tell the Sonographer during the scan that you want
a photograph (check current prices at the time).
Photographs are available throughout pregnancy.
Please ensure you have change to purchase a token
from the machine, which is situated in the waiting
room in the Antenatal Clinic.
Pregnancy Information
Scan photographs cannot be laminated but they can
be photocopied. They should be kept in a dark place,
but will still fade with time. If you are not happy with
the quality of the picture you must mention this at
the time, as it cannot be repeated for this purpose, as
we must reiterate that the purpose of the scan is for
medical reasons.
3.6 Personal camera/video equipment
This equipment cannot be used in the ultrasound
room as they are likely to cause lack of concentration
to the Sonographer and detract from your personal
involvement in the examination.
3.7 Sex of babies
This is not offered routinely, however as part of
your scan if you wish to know the sex of your baby
you need to make it clear to the Sonographer at
that time, as further scans are not offered for this
purpose. It may not be possible to always determine
the sex of the baby. You should be aware that this
not a definite indication of the sex.
3.8 4D Scans
3.9 Subsequent ultrasound scans
Sometimes ultrasound scans are performed later in
pregnancy and are used to look at the growth of
the baby and assess if any problems are developing.
We are not looking for abnormalities during these
scans however very occasionally something may
be discovered that has not previously been seen.
Similarly the 4D ultrasound scan offered by the
hospital as an extra service are designed to show you
a 3D picture of baby moving. They are not designed
to assess growth or look for abnormalities.
3.10 C
ustomised antenatal growth
charts
It is important that your baby’s growth is monitored
accurately during pregnancy. Your baby’s growth is
assessed by measuring your abdomen during your
pregnancy and the measurements taken during the
ultrasound scan. The chart is calculated using your
height, weight, ethnic origin and details about any
previous babies you may have had. The chart shows
your baby’s expected growth curve and as your baby
grows, the measurements should be similar to the
slope of the curves of the chart.
4D Scans are available at Leighton Hospital on a
private basis, ideally performed between 27 and 32
weeks of pregnancy. 4D scanning lets parents see
their baby moving in three dimensions. They are not
designed to assess growth or look for abnormalities.
You can see a clearer and detailed view of your
baby’s face for the first time and check the sex of
baby. There are various packages available. If you are
interested, leaflets are available from your midwife
or antenatal clinic with more details regarding what
is on offer and prices. As this is a non clinical scan,
several family members or friends may attend.
Pregnancy Information11
4.0 Your health in pregnancy
This section describes some of the things you should think about to make sure you and your baby stay health
during pregnancy.
4.1 What should you eat?
A healthy diet is an important part of a healthy
lifestyle at any time, but particularly if you are
pregnant or planning a pregnancy. Eating healthily
during pregnancy will help your baby develop and
grow and will help keep you fit and well. Make sure
you eat a variety of different foods every day in order
to get the right balance of nutrients that you and
your baby need.
Your GP or midwife will work out your Body Mass
Index (BMI) (your weight in relation to your height)
at your first visit. This information will be recorded
in your notes and used to help guide and plan your
care. If your BMI is below 18 or 30 and above you
will be offered advice and guidance.
• Eat plenty of fruit and vegetables and aim for at
least five portions a day. Pure fruit juice can only
count once towards the five a day.
• Starchy foods like bread, potatoes, rice, pasta,
chapattis, yams and breakfast cereals are
an important part of any diet. They contain
important vitamins and fibre. Try eating
wholemeal bread and cereals when you can.
• Lean meat, fish, poultry, eggs, cheese, beans and
pulses are good sources of nutrients.
• Dairy foods like milk, cheese and yoghurt contain
calcium and other nutrients needed for your baby’s
development. Choose low fat varieties wherever
possible.
• Try to cut down on sugar and sugary foods – sugar
contains calories without providing any other
nutrients.
12
• Cut down on fat and fatty foods as well. Fat is
very high in calories and can contribute to weight
gain and increase the risk of heart disease. Avoid
fried foods and go easy on foods like pastry,
chocolate and chips which contain a lot of fat.
• Citrus fruit, tomatoes, broccoli and potatoes are
goods sources of vitamin C which you need to
help you to absorb iron.
• Fish contains the important Omega 3 essential
fatty acids which are needed for a baby’s
development and is also a rich source of vitamin
B12.
4.2 Anaemia in pregnancy
Iron is essential for the production of haemoglobin
(Hb), which helps store and carry oxygen in red blood
cells. Without enough iron, your blood cells will be
able to carry less oxygen around your body to your
organs and tissues. This condition is called anaemia.
During pregnancy your Hb levels will be lower than
usual. This is normal and is due to the fact that your
blood volume increases. However, if they fall too
low you may look pale, feel tired, have shortness of
breath and feel faint. Your Hb levels are normally
checked at booking and when you are 28 weeks
pregnant.
If your Hb level is below 11g/dl or your iron store
levels (ferritin) are low, you may be advised to take
iron supplements but this will be discussed with you
on an individual basis. Taking iron supplements will
turn your stools black and some women find they
have digestive problems such as nausea, diarrhoea
and constipation. If the iron supplements are causing
you discomfort, please talk to your midwife who may
suggest different dosages or iron supplements.
Pregnancy Information
It’s also important to make sure that your diet
contains lots of iron-rich foods, such as those listed
below.
• To avoid the risk of Listeria infection
q Avoid eating all types of pâté including
vegetable
• Dark green leafy vegetables such as spinach,
broccoli, cabbage and watercress
q Avoid mould-ripened soft cheese like Brie or
Camembert
• Lean meat – especially red meat. Avoid liver
and liver products as they contain high levels
of vitamin A which could harm your baby (see
below)
q Avoid blue-veined cheese such as Stilton or
Shropshire Blue
• Fish, particularly oily fish and can be canned
(such as mackerel, sardines and pilchards)
• Eggs
• Pulses – such as chick peas, canned baked
beans and lentils
• Bread, especially wholemeal
• Dried fruit such as apricots, prunes and raisins
• Cereals fortified with iron
Vitamin C may help the body to absorb iron, so to
get the most from the food you eat, have vitamin C
rich foods with meals; e.g., fresh vegetables or fruit
or drinks such as fresh orange juice. Tea may reduce
absorption of iron from foods so avoid drinking tea
directly before, during or after meals.
4.3 Take care with some foods
There are certain precautions you should take in
order to safeguard your baby’s well-being as well as
your own:
• Make sure you wash your hands before preparing
any food.
• Drink only pasteurised or UHT milk which has
had harmful germs destroyed. Don’t drink
unpasteurised goat’s or sheep’s milk or eat their
milk products.
• Avoid uncooked or undercooked ready-prepared
meals and uncooked or cured meat, such as
salami.
• Don’t eat liver or liver products such as liver
sausage as they may contain high amounts of
vitamin A which could harm your baby. Avoid
high dose multivitamin supplements, cod liver
oil supplements or any supplements containing
vitamin A.
• You can eat hard cheeses such as Cheddar
and parmesan and other cheeses made from
pasteurised milk such as cottage cheese,
mozzarella and processed cheese.
• Make sure you cook eggs well until the whites and
yolks are solid to avoid the risk of salmonella food
poisoning. Mayonnaise bought in a jar is fine as it’s
made from pasteurised (heat-treated) eggs.
• Make sure all your meat is well cooked – especially
poultry.
• Avoid soft-whipped ice-cream from kiosks or vans
as it may contain salmonella or other bacteria
which can cause food poisoning.
• Avoid eating shark, marlin and swordfish as these
types of fish contain high levels of methyl mercury
which can damage your baby’s nervous system.
Also try not to each more than 4 medium size cans
or 2 portions of fresh tuna steak per week.
• Don’t have more than 2 portions of oily fish a
week. Oily fish includes tuna (not canned tuna,
which does not count as oily fish), mackerel,
sardines, salmon or trout.
• Choose cooked shellfish rather than raw as raw
shellfish (e.g. oysters) could contain harmful
bacteria that can cause food poisoning.
• Wash all your fresh fruit and vegetables.
• Limit your intake of caffeine to 2-3 cups per day. See your NHS ‘The Pregnancy Book’ for more
details.
• Some women choose not to eat peanuts when
they’re pregnant or breastfeeding. However, it
isn’t clear from the latest research if eating peanuts
affects the chances of your baby developing a
peanut allergy. Unless you are allergic to peanuts
you can choose to eat peanuts or foods containing
peanuts (such as peanut butter) when you’re
pregnant.
• Listeria is very rare but it is important to take
precautions as an infection during pregnancy can
lead to miscarriage, stillbirth or severe illness in the
newborn.
Pregnancy Information13
4.4 Vitamin D
4.7 Exercise and pregnancy
It’s important that you get enough vitamin D during
your pregnancy and while you are breastfeeding.
The following women are at a greater risk of having
lower levels of vitamin D if:
It is important to keep active during your pregnancy
to keep you healthy, control weight gain, help you
cope in labour and to get back into shape after birth.
If you haven’t been used to a lot of exercise before
you got pregnant it is advisable not to start any
strenuous exercise during pregnancy.
• Your family origin is South Asian, African,
Caribbean or Middle Eastern
• You stay indoors for a good deal of time and if
you usually cover your skin when outdoors
Exercise tips
• You have a diet that is low in vitamin D
• Warm up and cool down
• Your pre-pregnancy body mass index (BMI) is
above 30
• Drink plenty of fluids
The best source of vitamin D is sunlight but having a
vitamin D rich diet also helps – oily fish, eggs, meat
and fortified cereals and margarine. However, you
may choose to take a vitamin D supplement (10
micrograms a day) to ensure you get enough
vitamin D.
4.5 Folic acid
From the time you stop using contraception and for
the first 12 weeks of pregnancy, it’s recommended
that you take a supplement of 400mcg of folic acid
each day (available from any chemist and some
supermarkets) as well as eating plenty of folate-rich
foods such as green leafy vegetables, pulses and
fortified breakfast cereals. This is to help prevent
neural tube defects such as spina bifida. Current
national guidelines recommend that you take a
higher level of 5mg of folic acid if you have a family
history of spina bifida, multiple pregnancy, have
diabetes, certain other medical conditions or your
BMI is above 30.
4.6 Other sources of information:
www.food.gov.uk/aboutus/publications
nutritionpublications/
www.eatwell.gov.uk/agesandstages/pregnancy/
Health Eating Before, During and After Pregnancy,
University of Sheffield, Centre for Pregnancy
Nutrition, order via
www.eatingforpregnancy.org.uk
14
• Try and be active on a daily basis
• Avoid contact sports and others sports where
there is a risk of being hit or falling e.g. Kick
boxing, horse riding and gymnastics
• Make sure you tell your teacher or instructor
that you are pregnant if you attend any classes
4.8 Pelvic floor exercises
The pelvic floor is a group of muscles which span the
area underneath the pelvis. During pregnancy it is
under great strain, which if not exercised, can mean
you could leak urine after pregnancy.
How to do your pelvic floor exercises
• First squeeze the muscles that you use to
prevent a bowel movement
• At the same time squeeze the muscles you use
to stop the flow of urine
• Do this exercise quickly tightening and releasing
the muscles straight away
• Next do this slowly trying to tighten the muscles
and counting up to 10 before releasing. Repeat
up to 10 times
• Try and do 3 sets a day
• Make sure you continue doing your pelvic floor
exercises following birth
If you need any advice or have any lasting urinary
problems following birth, please contact your
midwife or GP as you may need referral to a
physiotherapist.
Pregnancy Information
4.9 Baby’s well-being
4.10 Common pregnancy symptoms
It is important for you to monitor your baby’s
movements after 28 weeks of pregnancy, as this is an
indication of your baby’s health. Should your baby’s
pattern of movements change, or if you feel your
baby’s movements have reduced, please contact the
Labour Ward on 01270 612144.
As your body changes in pregnancy, you can
experience some minor problems which can cause
irritation and some discomfort. If you are at all
concerned, please discuss these with your midwife
or doctor. You may feel some tiredness, nausea,
backache and other mild aches and pains, or have
heartburn, constipation or haemorrhoids (piles). You
may also experience swelling of your hands or ankles,
or varicose veins. The NHS ‘The Pregnancy Book’
contains lots of information on how to cope with
these symptoms.
Pregnancy Information15
5.0 Lifestyle advice
There are a number of things you can do to stay healthy while you are pregnant.
5.1 Alcohol
It is best to avoid alcohol completely if you are trying
to become pregnant and during the first 3 months of
pregnancy because of the risk of miscarriage. If you
do choose to drink, to protect your baby, you should
not drink more than one or two ‘units’ of alcohol
once or twice a week.
1 UK unit of alcohol is 10ml, or 8g of pure
alcohol.
A unit is:
½ a standard (175ml) glass of wine at 11.5%
ABV or
½ a pint of ordinary strength beer, cider or
lager at 3.5% ABV or
A single measure (25ml) of spirits (whisky, gin,
Bacardi, vodka, etc) at 40% ABV
Alcohol reaches your baby through the placenta
and because your baby cannot process alcohol as
fast as you do, your baby is exposed to alcohol for a
longer period of time. Too much alcohol can harm
your baby’s development and in excessive cases the
baby may have physical or mental problems known
as Fetal Alcohol Syndrome (FSA). FSA can affect your
baby at anytime during your pregnancy and binge
drinking is especially harmful.
If you have difficulty in reducing your alcohol intake,
a referral can be made to alcohol services, who can
provide additional help and support.
5.2 Drug use
Some women misuse illicit drugs whilst pregnant.
It is ok to ask for help so you and your baby receive
the best care by helping you to stabilise, stop or
reduce your use.
16
5.3 Smoking in pregnancy
• Cigarettes contain around 4000 chemicals and
at least 80 of them are known to cause cancer.
• Smoking during pregnancy exposes the baby to
these harmful chemicals at a vital time in their
development.
• This can result in higher risk of stillbirth,
miscarriage, cot death, premature birth
and problems with the baby’s growth and
development, including cleft lip.
• Babies who have been born too early or
underweight are more likely to face problems
with breathing, feeding and infection.
• Smoking in pregnancy can cause permanent
cardiovascular damage to children putting them
at a higher risk of cardiovascular disease in later
life.
• Smoking in pregnancy has been linked to the
development of Attention Deficit Hyperactivity
Disorder (ADHD) in children.
• Smoking causes premature ageing, i.e. wrinkles
and dry course hair, as well as bad breath,
yellow teeth and unhealthy gums.
• Secondhand smoke is also very harmful, as up
to 75% of the cigarette is spread into the air
and can cause cot death, respiratory infections
and ear infections in babies.
• Smoking cannabis can increase the risk of a low
birth weight. A ‘spliff’ can give as much nicotine
and tar as 10 cigarettes.
• Stopping smoking at any time during your
pregnancy will increase your chances of having
a healthier baby.
Pregnancy Information
Cigarette smoking is the single largest risk factor
for pregnancy related complications and mortality.
If a pregnant woman smokes, it is very important
for her to quit, for her own health and the health
of the baby. Every cigarette you smoke harms your
baby – stopping smoking will benefit both you and
your baby immediately. If you smoke and would like
help to stop smoking or a chat about what support
is available, speak to your midwife who can refer you
to the Stop Smoking Service on 01606 841768.
5.4 Nicotine Replacement Therapy
(NRT)
Ideally, pregnant women should stop smoking
without using Nicotine Replacement Therapy (NRT)
but, if this is not possible, NRT may be recommended
to help you stop smoking.
You can also find useful information on the dangers
of smoking during pregnancy and tips for quitting at
this website: www.gosmokefree.co.uk.
5.5 Carbon monoxide monitoring
At your booking appointment your midwife may
measure your carbon monoxide level with a simple
breath test. As a non-smoker you would expect a
reading of below 5 parts per million (ppm). If you
have a higher reading than this it could be due to car
exhaust fumes, a faulty gas fire or boiler, smoking or
passive smoking. If you have a reading above 5ppm
and you don’t smoke you should get your car and
gas appliances checked for defects urgently. You
should consider fitting a carbon monoxide alarm in
your home.
5.6 Pets
There is no reason not to have a pet at home
whilst you are pregnant; however there are certain
precautions you should take with certain animals.
Cats – Cat faeces can contain an organism that
causes toxoplasmosis. This can be harmful to the
unborn baby.
To minimise the risk you should ideally avoid cleaning
litter trays or use disposable rubber gloves.
Sheep – Lambs and sheep can be a source of an
organism called chlamydia psittaci which is known to
cause miscarriage and toxoplama in ewes. You must
avoid lambing and milking ewes and all contact with
new born lambs.
5.8 Sex
It is perfectly safe to have sex during your pregnancy.
It will not harm you or your baby. However you
should refrain if you have had any bleeding or your
waters have broken or you have been advised not to
for any other reason by your midwife or doctor.
For further help and advice try
www.thecoupleconnection.net
5.9 Travel
If you are planning to travel abroad during your
pregnancy you need to discuss flying, vaccinations
and travel insurance with your midwife or doctor.
There is evidence to suggest that periods of inactivity
such as long journeys will increase the risk of
developing blood clots. It’s recommended that you
do some leg exercises to encourage blood circulation
and wear compression stockings/tights on long drives
or flights. Drink plenty of fluids and walk around the
cabin to encourage good blood circulation.
5.10 Seat belt advice
• All pregnant women by law must wear a seatbelt
for protection of the baby and themselves.
• The correct way is with the lap strap across the hip
below the bump and the diagonal strap between
the breasts, above the bump.
• Wearing the lap strap alone, or across the bump,
is not advised as this can cause harm to you or the
baby.
5.11 Work and Benefits
If you are an employee, you have the right to
take reasonable time off work for your antenatal
appointments, including antenatal classes, without
loss of pay.
It is usually safe to continue working whilst you are
pregnancy but your employer should carry out a
risk assessment at your workplace and do all that is
reasonable to remove any risks to your or your baby’s
health. If you are at all concerned, please discuss
this with your midwife – any potential risks to your
pregnancy must be discussed with your employer.
The Health and Safety Executive (www.hse.gov.uk)
can provide further information.
Please see your NHS ‘The Pregnancy Book’ for further
details on work and maternity benefits.
5.7 Allergies
It is important you inform us of any known allergies
you have as it may affect your pregnancy or the way
we deliver our care.
Pregnancy Information17
5.12 Domestic abuse
Pregnancy can be the happiest time of a woman’s
life but for some women it is the most vulnerable.
Domestic abuse often starts or intensifies during
pregnancy with the risk increasing after the baby
is born, you may not recognise that you are being
abused.
Domestic violence is the largest unreported crime,
affecting 1 in 4 women. It can have a long-term
impact on you, your unborn and other children in the
home. It is a learned, intentional behaviour and not
as a result of stress, alcohol, drugs, a ‘bad childhood’
or an ‘anger’ problem.
There are a number of recognised signs that may
indicate that your partner or another family member
is abusing you:
• Are you afraid of your partner?
• Do you feel as if you are walking on “eggshells”?
• Do they control you? Financially, tell you what to
wear or keep you isolated?
• Do they get jealous?
Keeping Safe – you and your children have a right
to be safe.
• In an emergency ring 999
• Choose someone to talk to. If you are
pregnant – talk to your midwife
• Talk with a specialist worker (Domestic Abuse
family Safety Unit or Refuge)
• If you need to leave try to plan it by talking to
staff at a refuge or homeless agency or a friend
• Take important records with you e.g.
any medical, school, personal or financial
documents, children’s toys and your precious
things
• Tell someone who cares about you that you are
safe
• Be careful after you have left
• Get legal advice (contact police or NCDV)
• Talk with your children about how they keep
safe
• Do they blame you/others for their behaviour?
• Are they physically violent to you or others? Do
they use weapons? Or have they been in a violent
relationship before?
• Do they tell you no one else would want you?
Threaten that if you leave you will be unable to
cope. They’ll take the children. They’ll find you/kill
you (or them self) or somebody else?
BE SAFE …
GET HELP WITH DOMESTIC ABUSE.
National 24hour helpline –
0808 2000 247
Accepting that you are not to blame
It may be difficult for you to understand the abusive
behaviour and you may be feeling ashamed or blame
yourself, however:
• No one should be frightened. • You cannot change an abuser’s behaviour. Only
they can do that if they choose to do so.
Ignoring abuse is dangerous so it is important
to talk to someone about what is happening to
you.
18
Pregnancy Information
6.0 Infections in pregnancy
If you come into contact with or develop any infectious disease, including tuberculosis, or develop a rash please
seek advice.
Information on infections can be found in your
NHS ‘The Pregnancy Book’ and the National
Screening committee’s “Screening Tests for You
and Your Baby”. These include:
• Chicken pox
• Toxoplasmosis
• Rubella
• Parvovirus B19 (slapped cheek disease)
• Group B Haemolytic streptococcus (GBS)
• Hepatitis B and C
• HIV
MRSA
(Methicillin-resistant Staphylococcus aureus)
Staphylococcus aurous is a bacterium that lives
harmlessly on the skin and in the nose of 30% of
the UK population (this is called being colonised).
Staphylococcus aurous can cause an infection
if it enters the body, for example, wound sites.
Staphylococcus is usually treated with flucloxacillin
but MRSA is resistant to flucloxacillin and some other
antibiotics.
In order to reduce the risk of MRSA being spread
in hospital, women who are booked for an Elective
Caesarean Section will be screened from 34 weeks by
offering a nasal swab and treated as appropriate.
• Sexually transmitted infections
Tuberculosis (TB)
Chlamydia
If you are under 25 years of age, you will be offered
screening for chlamydia, the most common sexually
transmitted infection in the UK. This is usually an
infection which does not have any symptoms and
is easily treatable. Your midwife or GP will give you
further information, including a leaflet.
Tuberculosis (TB) is still prevalent in many countries. As a result some parents are more at risk of
contacting this disease, which therefore increases the
risk to babies. TB is a difficult infection to catch and
usually requires prolonged or repeated contact with
someone who is infectious
For further information:
Syphilis
www.immunisation.nhs.uk
Syphilis is a sexually transmitted infection. The
number of people infected by this is increasing. Most
infected people do not have any obvious symptoms.
Syphilis is treatable with antibiotics, which helps
to protect your unborn baby from developmental
problems. All pregnant women are offered a blood
test as part of their antenatal care. Occasionally,
pregnancy itself gives a ‘false positive’ result and your
community midwife may need to repeat the sample.
www.hpa.org.uk
Pregnancy Information19
7.0 Pregnancy complications
There are certain problems that can happen in pregnancy which your midwife and doctor will be checking for.
Contact your midwife or doctor if you’re worried about your health for any reason or if you experience any of the
following:
• Vaginal bleeding
7.2 What if your blood pressure is high?
• Recurring headaches
Stress, worry or activity may all affect your blood
pressure for a while. There is no clear line between
normal and high blood pressure, although doctors
and midwives may be concerned if your reading is
140/90 or higher or significantly higher than your
normal blood pressure.
• Blurred or altered vision or flashing lights
• Abnormal swelling of the face, hands or feet
• Abdominal pain
• Pain in your calf or chest pain
• Feeling unwell
• Reduction in your baby’s movements
7.3 W
hat are the causes of raised blood
pressure?
• Your waters break
Hypertension
• Itching to hands and feet.
• Chronic hypertension (may be called essential
hypertension or pre-existing hypertension).
Hypertension or high blood pressure that exists
prior to 20 weeks pregnancy.
If you need urgent help phone the Labour Ward
on 01270 612144
7.1 Blood Pressure
• Your blood pressure will be measured at every
antenatal appointment
• Raised blood pressure can be a sign of a
pregnancy problem called pregnancy induced
hypertension (may be called gestational
hypertension)
• If you have raised blood pressure and protein
in your urine you may be developing preeclampsia
• Most women with pre-eclampsia feel perfectly
well, that’s why these checks are important.
• Pregnancy induced hypertension (may be called
gestational hypertension). Hypertension that is
new to pregnancy and resolves after delivery but
is not associated with proteinuria (protein in the
urine).
Your blood pressure will be closely monitored if you
have chronic or pregnancy induced hypertension.
If you have significantly high blood pressure your
obstetrician may consider giving you medication to
lower your blood pressure.
Pre-eclampsia
Pre-eclampsia is the most common of the serious
complications of pregnancy. It is caused by a problem
in the placenta, which joins the mother and baby and
supplies the baby with nutrients and oxygen from the
mother’s blood.
Your midwife will routinely test your urine and blood
pressure for signs of pre-eclampsia.
20
Pregnancy Information
7.4 Symptoms
If blood pressure increases and/or protein in the urine
are found this may indicate pre-eclampsia. Sudden
swelling of the hands, feet and face caused by fluid
retention may be seen but this may also occur in
normal pregnancy. Other symptoms include a severe
headache, problems with vision (such as blurring or
“flashing lights”), severe pain just below the ribs and
vomiting. As pre-eclampsia may present in a variety
of ways, any unusual signs or symptoms should be
checked.
7.5 Urine checks
At booking your midwife will discuss urine checks in
pregnancy. You will be provided with a sample bottle
to take with you to your first scan appointment.
A mid-stream specimen of urine (MSSU) will be sent
to the laboratory to look for asymptomatic bacteria.
At ALL other appointments please provide a urine
sample which will be tested by the midwife.
7.6 What if protein is found?
If protein is found in your urine, a MSSU will be sent
to the laboratory to check for infection. If infection
is ruled out and proteinurea persists then you will be
investigated further for pre-eclampsia.
7.7 Blood clots (Deep Vein Thrombosis)
Risk factors
There are certain factors which might increase a
woman’s risk of developing a blood clot during
pregnancy and afterwards. These include:
You can reduce the risk of having a blood clot during
pregnancy and afterwards in a number of different
ways, these include:
• Wear compression stockings if you have varicose
veins. These are available free on prescription from
your GP.
• You will be given compression stockings and/or
medication in hospital if you have an operative
birth and you will be encouraged to get up and
about.
• See travel section if making long journeys or
travelling by air.
• Try to stop smoking.
Signs and symptoms of a blood clot in the leg
include:
• Swollen painful calf or thigh
• Redness over the area
• The area may feel hot
Sometimes part of the blood clot breaks free from
the veins and can cause a pulmonary embolism in
the lungs.
Signs and symptoms of a blood clot in the
lung include:
• Chest pain
• Shortness of breath
If you experience any of the above contact your
midwife or GP urgently. With prompt treatment
any complication arising from the blood clot can
be reduced.
q Previous history or family history of a blood clot
q Severe varicose veins
q Being overweight (Body Mass Index 30 or above)
q Prolonged immobility
q Aged 35 or more
q Having an operative birth
q Having more than one baby
qSmoking
q Long distance travel including air travel
7.8 S
evere itching and obstetric
cholestasis
It is not uncommon to experience some itching in
pregnancy. Severe itching of the hands and feet,
particularly in the last four months of pregnancy,
may be the sign of an uncommon condition
called obstetric cholestasis. If you do experience
troublesome itching please contact your midwife
or GP. To exclude this condition a blood test is
performed and if necessary treatment may be
required.
q Some blood disorders
Pregnancy itself is an associated risk factor because
pregnancy hormones relax the muscles in the veins
and can reduce good blood circulation. Blood clots
can develop from the beginning of pregnancy until
well after the baby is born.
Pregnancy Information21
7.9 Vaginal Bleeding
It is important to report any bleeding to your midwife
or GP, as bleeding in pregnancy requires a medical
review. In early pregnancy it could be a sign of
miscarriage, although many women who do bleed go
on to have successful pregnancies. Bleeding in later
pregnancy can indicate problems with the placenta or
trauma to the cervix (e.g. erosion). A minor blood loss
mixed with mucous is referred to as a “show” and is
normal in late pregnancy. It is important to identify
the cause so that appropriate care can be given.
7.11 M
ental Health problems during
pregnancy and after birth
Most women go through pregnancy and the first
year after giving birth without any mental health
problems, but some women do have problems.
These are the same as for other people, but they can
develop differently at this time.
If you are taking medication for any mental health
problems, please see your GP for a medical review.
If you have any concerns, please speak to your
midwife.
7.10 Malposition
Normally by the time you reach 36 weeks pregnant
your baby should be in a cephalic position which
means it is lying head down. However, occasionally
your baby may be lying in a different position which
may increase the risk of complications during labour
and birth. If this happens you will usually be offered
the option of external cephalic version (ECV). This
is where an obstetrician will put pressure on your
abdomen to try and turn the baby to a head down
position. If this does not work then you will be
offered a caesarean section.
For further information please ask for our ECV
information leaflet or get it from the hospital website
under patient information
22
Pregnancy Information
8.0 Deciding where to have your baby
It’s important for you to have all the information you need so that you can decide where you would like to give
birth. Don’t hesitate to ask questions if you don’t understand something or if you think you need to know more.
Talk things over with your partner and your midwife. She will be able to offer you advice based on your individual
needs, your medical history and any previous pregnancies you may have had. It is always possible to change your
mind at any time during your pregnancy.
You should be offered a choice of where to have your baby
• At home OR • In the hospital
8.1 At home
Home birth is becoming increasingly popular. For
women experiencing a straightforward pregnancy
with no major complications anticipated during the
birth, the option of having a homebirth is a real
alternative to going into hospital.
Giving birth is generally very safe for both you and
your baby. Research has also shown that those
women who plan to have a home birth are more
likely to have a normal vaginal birth, with less
intervention.
Some women want to have their babes at home
because:
• They will feel happier, more in control and better
able to cope in a place they know with their family
around them.
• They will be looked after by midwives in the
comfort and relaxation of their own home.
• They feel they will have more freedom to do as
they wish rather than having to fit into a hospital
routine.
• They feel they will have more privacy.
• If they have other young children, there would be
no need to leave them to go into hospital.
• They don’t have to decide when to go into
hospital.
• They won’t be separated from their partner after
birth.
Pain relief available includes gas and air (Entonox)
and Pethidine. If you are considering a water birth
at home please discuss this with your midwife or
Supervisor of Midwives.
Disadvantages:
• You may have to transfer to hospital should
problems arise. You should be given information
about the likelihood of this during your labour and
estimate of how long this should take. The most
common reasons for transferring to hospital are
when your labour does not seem to be progressing
or if there is concern about you and/or the baby. If
you need to transfer to hospital an ambulance will
be arranged for transport by the midwife.
• Some women may wish to go into hospital for an
epidural during labour.
If you are considering a home birth, talk to your
midwife who will be able to give you more
information. If you have had no complications during
your pregnancy, home birth may be an option you
would like to consider and is suitable for first time
mums too.
Pregnancy Information23
8.2 Hospital Birth
Disadvantages:
Women can choose to give birth in the hospital or
this may be advised due to previous complications
during pregnancy or birth or due to a pre-existing
medical condition.
• Women may not be relaxed as not in their own
environment.
Advantages:
• Women’s expectations are not always achieved
resulting in reduced satisfaction for the birth
experience.
• Direct access to obstetrician, anaesthetists and
neonatologists.
• Separated from partner and family after delivery
outside of visiting hours.
• The option of having an epidural for pain relief. An epidural is a special type of local anaesthetic
given into your back which can numb the feelings
of pain. It needs to be given in hospital as it
involves an anaesthetist and means you have to be
closely monitored during your labour.
• You will not need to transfer if there are problems
during the labour.
24
Pregnancy Information
9.0 Deciding how to feed your baby
The time when your baby is very young, is brief and very precious. Spending a lot of time close together in the first
few weeks helps you get to know one another and builds the love that keeps your baby safe and secure.
Holding your baby next to your skin soon after the
birth may help ease the transition into independence
for your baby and helps calm and comfort you. It
can also help to get breastfeeding off to a good start.
Before your baby is born you may not have decided
how you would like to feed your baby but this does
not matter. Hold your baby close and see how you
feel when your baby responds to the touch of your
skin and the sound of your voice.
Breastfeeding your baby gives you and your baby
many short and long term health benefits.
Breast milk contains antibodies that protect your
baby from infection. Babies who are fed with
formula milk do not receive this protection and are
therefore more likely to suffer from diarrhoea and
vomiting, urine infections, chest infections and if
born prematurely, serious bowel infections. Research
also suggests that formula fed babies are more likely
to suffer from asthma, eczema, obesity, diabetes,
high blood pressure and have poorer dental health.
Breastfeeding is good for mother’s health too. It
helps protect you from breast and ovarian cancer,
gives you stronger bones in later life and helps you
lose weight.
This hospital believes that breastfeeding is the
healthiest way for a woman to feed her baby. For this
reason all women are encouraged to breastfeed or
give as much breast milk as they can or as they feel
able.
Parent Education classes are available to mothers
(and their partner/support person) which include
information about breastfeeding. This information
can also be accessed via your hospital antenatal clinic
or community midwife.
For mums who breastfeed or choose not to due to
personal or medical reasons, you will be given help
and support with your chosen feeding method in
the postnatal period. As you grow more familiar with
your chosen feeding method you will gain confidence
and learn to relax and enjoy seeing your baby thrive
and grow.
9.1 Putting your baby to the breast
Your Position
It is important that you find a comfortable position. If
you are sitting down to feed, try to make sure that:
• Your back is straight and supported
• Your lap is almost flat
• Your feet are flat (you may need a footstool or a
thick book)
• You have extra pillows to support your back and
arms or to help raise your baby if needed
Breastfeeding lying down can be very comfortable.
It is especially good for night feeds as you can rest
while your baby feeds.
• Try to lie fairly flat with a pillow under your head
and your shoulder on the bed.
• Lie well over on your side. A pillow supporting
your back and another between your legs can help
with this.
• (Once your baby is feeding well, you will be able
to feed him/her comfortably anywhere without
needing pillows.)
Pregnancy Information25
Your baby’s position
There are various ways that you can hold your baby
for breastfeeding.
Whichever way you choose, here are a few guidelines
to help make sure that your baby is able to feed well:
1. Your baby should be held close to you.
2. He/she should be facing the breast, with head,
shoulders and body in a straight line.
3. His/her nose or top lip should be opposite the
nipple.
4. He/she should be able to reach the breast easily,
without having to stretch or twist.
5. His/her mouth should be wide open
6. Remember always to move your baby towards the
breast rather than your breast towards the baby.
So:
9.2 Attaching your baby to the breast
It is important to make sure that your baby attaches
on to the breast properly, otherwise he/she may not
get enough milk during the feed and your nipples
could become sore.
• Position your baby as described above with his/
her nose or top lip opposite your nipple.
• Wait until he/she opens his mouth really wide
(you can gently brush his/her lips with your nipple
to encourage him/her to do this).
• Quickly move him/her on to your breast, so that
his/her bottom lip touches the breast as far away
as possible from the base of the nipple. This way,
your nipple will be pointing towards the roof of
his mouth.
When your baby is properly attached to your breast
you will notice that:
• His/her mouth is wide open
• Head and body in a straight line
• He/she has a big mouthful of breast
• Mouth wide
• His/her chin is touching the breast
• Cheeks full
• His/her bottom lip is curled back
• Nipple to nose
• If you can see any of the areola (the brown skin
around the nipple), more is visible above his/her
top lip than below his bottom one
• Baby to breast, not breast to baby
• His/her sucking pattern changes from short sucks
to long deep sucks with pauses
Feeding should not be painful. However, while
you and your baby are learning to breastfeed you
may feel some pain or discomfort when the baby
first attaches to the breast. This sensation should
fade quickly and then the feed will not be painful.
If it continues to hurt, this probably means that
your baby is not attached properly. In this case,
take him off by gently pressing your breast away
from the corner of his mouth so that the suction is
broken and then help him to re-attach. If the pain
continues, ask a midwife for help.
You will receive breastfeeding support once you
have had your baby. We will provide you with
information about expressing your breast milk if this
is something you feel would be useful or necessary.
Information obtained from UNICEF UK baby friendly
initiative: Breastfeeding your baby
www.babyfriendly.org.uk
26
Pregnancy Information
9.3 Recognising your baby’s feeding
cues and feeding frequency in the
early days
Cues
Crying is a late sign that your baby needs feeding
and if you wait until this point your baby:
9.4 H
ow do I know my baby is getting
enough milk?
• In the first 48 hours your baby will have 2 or 3
wet nappies. These will become more frequent
and by day 5 onwards there will be at least 6 wet
nappies every 24 hours
• Will need to be calmed before they will be able
to feed
• From day 4 and for the first few weeks your baby
should pass at least 2 yellow stools every day. Its
is normal for breastfed babies to pass loose stools
• May have tired from crying and not take a full
feed
• Your baby should be healthy and gaining weight
after the first 2 weeks
Earlier signs that your baby is ready for a feed
include:
• Restlessness and wakefulness
• Your baby will be content and satisfied after most
feeds
• Making small noises or movements with their
mouth
• Your breasts and nipples should not be sore. If
they are please ask for advice and support.
• Baby will come off the breast on their own
• Smacking their lips or sucking their fists
• Rooting or turning towards the breast when
being held
It is important to keep your baby close both day and
night as:
• You and your baby will get to know each other
• You will recognise your baby’s feeding cues
• Allows feeding when either mother or baby want
to
Frequency
Frequent feeding is very important in the early
weeks and this is especially important in the first
few days. This early frequent feeding will ensure
that maximum milk production is established.
9.5 Dummies and teats
It is not advisable to use dummies or teats when
you are breastfeeding as research has shown that
they can interfere with a baby’s ability to feed
effectively due to the different sucking action used.
Dummies and teats can also interfere with demand
feeding if they are used to settle or pacify a baby
rather than a breastfeed being offered if a feeding
cue has been misinterpreted (see above for feeding
cue advice). Frequent baby-led feeding is essential
to establish and maintain a good milk supply.
Anything which interferes with this will result in
poor milk production. (UNICEF UK 2008)
UNICEF UK, 2008. UNICEF UK Baby Friendly
Initiative statement on dummy use
Babies who are over 48 hours old will feed at least 8
times in 24 hours – however there is no upper limit
and initially many babies will feed more frequently.
Babies will also want to feed during the night.
Pregnancy Information27
10.0 Getting ready for birth
10.1 Parent Education
10.3 Preferences for birth
The midwives here at Mid Cheshire Women’s Health
Unit view pregnancy and childbirth as normal life
events and therefore aim to respect the needs of
women to assist them to fulfill their expectations.
It’s a good idea to write a birth plan, which is a
written record of what you would like to happen
during your labour and afterwards. Thinking about
your birth preferences encourages you to look at
all the birth options available and you can include
anything you feel strongly about. Your birth plan will
be discussed with you throughout pregnancy but
confirmation of your preferences will be documented
by your midwife at your antenatal appointment at
approximately 36 weeks of pregnancy.
We would like you to be well informed to enable you
to make informed and appropriate choices. Our aim
is to give individualised care that is sensitive to both
your emotional and physical needs.
We provide a number of different classes at Leighton
Hospital to meet your needs. For further information
you can look at our web page:
www.mcht.nhs.uk/pregnancy or to book a class
you can email via the web page or
[email protected]
However, if you would prefer to talk to someone
please phone 01270 273756 (the phone is not
staffed at all times so please leave a message and we
will endeavour to return your call within 3 working
days).
PLEASE NOTE: Please book early for classes to
commence when you are approximately 32 weeks as
the places get filled very quickly. When contacting us
please state your name, contact number, date your
baby is due and course preference.
When writing your birth preferences, it is important
to take into account your medical history and the
facilities available at your home or hospital. Once in
labour, the midwife who cares for you will discuss
your preferences and agree a plan of care with you.
However, if complications arise, your midwife and
doctor will discuss these with you and will be able
to let you know your options in these particular
circumstances.
Remember to be flexible, especially if this is your first
baby. What might appeal to you now might not
be what you actually want when you’re in labour.
Write out your birth preferences, discuss it with your
partner and keep a copy of it with your Pregnancy
Health Record.
10.2 Young parents group
Parent education groups designed to meet the
needs of young parents are provided on a group or
individual basis. For more information, contact your
named midwife.
28
Pregnancy Information
10.4 Packing for hospital
Below is a general guide of items you will require during your stay in hospital. It’s best to pack 2 medium sized
bags – one for mum and one for baby.
We advise you to leave valuables such as handbags and credit cards at home as we cannot accept responsibility
for loss or damage. Mobile phones may only be used in the designated areas outside the hospital as they may
interfere with patient care.
For Mum:
For Baby:
m Wash bag with toiletries such as – soap/shower
gel, toothbrush and toothpaste, deodorant,
shampoo, etc.
mVests
mTowels
m Knickers (at least 6) old or disposable
m Sanitary pads for heavy/maternity use (NOT
tampons)
m Light and comfortable day clothes
m 2-3 nighties or pyjamas – include one old short
sleeved nightie or large t-shirt to wear in labour
which you don’t mind if it gets soiled. If you are
breastfeeding choose front-opening nighties.
m Dressing gown and slippers (if these are new,
ensure they still fit at the end of your pregnancy as
your feet may be swollen)
m One or two feeding bras
m Stretch suits or similar
mCardigans
m Bonnet/hat
m Socks and scratch mitts
m 1 pack of disposable nappies (no terry nappies
please as we have no laundry facilities)
m Cotton wool
The hospital do not routinely supply nappies,
sanitary pads or formula milk. Please ensure you
bring your own supply to last you the length of
your stay. If you wish to bottle feed your baby,
you need to bring pre-made formula milk cartons
and the hospital will provide you with disposable
sterile bottles.
m Breast pads
mCamera
m Any medication you normally take (such as asthma
inhalers or tablets). Please let your midwife know
of any medication you are taking
m Music CD’s for labour (the hospital have a limited
supply of CD players. Therefore, you may need to
bring in your own battery operated one)
m Books or magazines
m Money (small change for the pay phone and
League of Friends shop)
Visitors can bring in extra clothing if you find you need it.
Pregnancy Information29
11.0 Signs of labour
You’re not likely to mistake the signs of labour when the time really comes, but if you’re not sure, contact your
hospital or midwife for advice.
11.1 The show
11.3 Contractions
Either before labour or early in labour, the plug of
mucus in the cervix, which has helped to seal the
uterus during pregnancy, comes away and comes out
of the vagina. This sticky mucus is called a ‘show’
and it may be mixed with a little blood. This can
happen several times. However, if you are losing a lot
of blood please telephone the hospital straight away.
It is possible to have a show and not experience
contractions immediately. Some women can have
a show several days before they start labour, or may
not have a show at all.
A contraction is when your uterus tightens and
your abdomen (tummy) feels hard. The uterus
then relaxes and your abdomen feels soft again.
Labour contractions do feel different to Braxton
Hicks (painless, irregular tightening), which you may
have felt during your pregnancy. There are three
main differences between Braxton Hicks and labour
contractions. Labour contractions are:
11.2 The waters breaking
• Painful (for most women)
• Regular
• Become longer and stronger and more frequent
The bag of water which surrounds your baby may
break before labour starts. This can be a slow trickle
or felt as a gush of water. Phone the hospital for
advice. It is useful if you wear a sanitary pad to see if
there are any further trickles and to check the colour
of the water.
Not all women start contracting after the waters
break and if this is the case you will be given an
antenatal check and the baby’s heartbeat will be
monitored. If contractions have not started within
24 hours you will be offered the option of induction
because of a possible risk of infection.
30
Pregnancy Information
12.0 Optimal Fetal Positioning
The baby’s back is forward with the chin tucked in so that it can enter your pelvis. This is a good position for labour,
it is easier for the baby to birth in this way
Modern Lifestyle
Today we are less active than women used to be. We
have more time to recline on furniture designed to
enable us to relax.
Postures that may help in the last six weeks of
your pregnancy
Watching television can be done sitting astride a
chair.
Be careful how you sit
When you sit in a soft armchair your pelvis tips
backwards and your baby has no alternative but to
lie towards your back. Crossing your legs and long
journeys in cars can also encourage your baby to stay
at your back.
If the baby stays towards your back this can
mean:
• Increased pain as baby’s head tries to enter your
pelvis.
• Aches and pains due to pressure on ligaments and
bladder.
Always try to have your knees lower than your
hips
Try using these positions as frequently as possible
throughout the day as this may help to keep the baby
in an optimal position.
• Backache before and during labour.
• A long labour whilst baby turns towards your
front.
• The need for stronger pain relief which could lead
to a loss of control in your birth experience.
• Medical intervention is more likely such as the
need for an instrumental delivery of baby and
possible trauma for you.
Sometimes baby may remain in a posterior position
even after doing these exercises but your midwife will
discuss this in more detail with you.
Pregnancy Information31
13.0 The latent phase of labour
In the early stages of labour, often known as the
‘latent phase’ the contractions are softening your
cervix (neck of the womb) and making it ready to
dilate (open up). Some women have backache or
have contractions that last only a few hours which
then stop and start again hours later. This is perfectly
normal.
Labour can be a lengthy process, so if possible it’s
best to stay in your own surroundings as long as you
can during this early part of labour. Relax as much
as possible, have a warm bath or listen to music. It is
important to make sure you eat and drink normally.
You can take Paracetamol as directed as a simple
form of pain relief but contact your midwife if you
need advice or reassurance.
Your birthing partner can help you keep calm and
relaxed. It can be helpful if they massage your back if
you have backache or suggest alternative positions to
encourage labour to continue. Keep upright as much
as possible as this will encourage labour and gravity
helps the baby go down into your pelvis. Swaying
or rocking your hips can also help. You can also try
a TENS machine now if you have one. However,
although this can be an exciting time, remember to
rest and not get overtired as you will need lots of
energy later on.
The latent or early stages of labour last until your
cervix is about 4cm dilated and you have regular
strong contractions, sometimes this can take a
long time. If you go to hospital before you are in
established labour you may be asked if you would
prefer to go and enjoy the comfort of your own
home again for a while, rather than spending many
extra hours in hospital. Being relaxed and confident
helps labour to progress but if you are feeling very
uncomfortable at this point please discuss this with
your midwife
Sometimes labour starts early before
37 weeks. If this happens, phone the Labour
Ward immediately on 01270 612144.
32
13.1 When to go into hospital
If your waters have broken, you have any fresh
red bleeding or you are concerned your baby isn’t
moving as much as normal, you need to telephone
the hospital as soon as possible and they will
probably advise you come in for a check. If your
contractions start but your waters have not broken,
wait until the contractions are coming regularly,
about 4-5 minutes apart and lasting for about 60
seconds and/or that they feel so strong that you want
support from a midwife. If you live far away from
hospital, make sure you leave plenty of time. Second
and later babies often arrive more quickly.
Don’t forget to phone the hospital first and
bring your pregnancy health record with you.
It is natural that your family and friends are keen to
know what’s happening when you go into hospital.
Please tell them not to ring the hospital but to wait
for you or your partner to ring them with any news.
It is important to keep the hospital phone line free
for emergencies and staff are unable to give out any
details due to confidentiality.
13.2 Having a home birth
Telephone the Labour Ward and they will arrange for
a midwife to come to your home.
13.3 W
hat happens if my baby is
overdue?
Most women will go into labour by themselves by
42 weeks of pregnancy. At term your midwife will
offer you a vaginal examination/cervical sweep in an
attempt to encourage labour to start naturally. This is
repeated one week later if required.
If your pregnancy lasts longer then 41-42 weeks you
will be offered induction of labour where your labour
is started artificially. Induction is always planned in
advance so you will be able to discuss the advantages
and disadvantages with your doctor or midwife.
Pregnancy Information
13.4 How will my labour be started?
If you need to be induced, prostaglandins which act
like natural hormones, can be used to start labour.
They can be used in the form of a pessary (tablet) and
is inserted into the vagina to help soften the cervix.
This process, especially for first time women, may
need to be repeated after 6 hours. If labour fails to
start spontaneously after 2 doses this process can be
repeated, one more time, following medical review
the following day. The baby’s heart beat is monitored
continuously for 30 minutes before insertion of the
pessary and again following this procedure.
Once the cervix has opened (dilated) you will be
transferred to the labour ward. If you are not already
in labour, your waters will be artificially broken
and a drug called syntocinon will be given into a
vein in your arm or hand to help start or make the
contractions stronger.
From this point on, the baby’s heart beat will be
monitored continuously until delivery. You will require
vaginal examinations to assess the progress of labour
and pain relief will be discussed and administered
as required. Induction of labour may take several
days. The process may be delayed due to workload
within the unit. You will remain informed if this is the
case and the safety of you and your baby will not be
compromised.
13.5 Labour and birth
What happens when I get to hospital?
When you arrive, you will be welcomed and the
midwife will ask you about what has been happening
during your early labour. The midwife will:
• Take your pulse, temperature and blood pressure
and check your urine.
• Feel your abdomen to check baby’s position and
will listen to your baby’s heartbeat.
• She may do an internal examination with your
consent to find out how much your cervix has
opened and how far your labour has progressed.
These checks will be repeated at intervals throughout
your labour, with your consent – always ask about
anything you want to know.
If you and your birth partner have made a birth
plan, your midwife will discuss this with you. Any
information and discussions you have with your
midwife or doctor about the care offered should
include explanations and possible advantages and
disadvantages. You can always change your mind
about any decisions you make.
Once you are in established labour you will receive
care from a midwife. Having discussed your birth
preferences, your midwife will be able to use this
information to help and support you during labour.
You should be encouraged to move around and
change position to increase your comfort and assist
your labour and birth.
What happens in labour?
The latent phase of labour (discussed above) can
vary from a few hours up to several days. Both are
normal and you can call the labour ward at any point
for advice if you need it.
Once established, there are three stages to labour.
In the first stage the cervix gradually dilates (opens
up) to 10 cm. In the second stage the baby is slowly
pushed down the vagina and is born. In the third
stage the placenta comes away from the wall of the
womb and is also pushed out of the vagina.
13.6 First stage of labour
• How long will labour last?
The length of the first stage of labour varies
between each woman. On average, labour will
last about 8 hours for women who are having
their first baby and are unlikely to last over
18 hours. For women having their second or
subsequent baby, labours on average take 5 hours
and are unlikely to last over 12 hours.
• How your baby is monitored
It is important to monitor the heart rate of your
baby during labour. The method of doing this will
depend on you and your baby’s individual needs.
Your midwife will discuss this with you. Although
most babies cope extremely well during labour,
there are a few babies who have difficulties and
the best way to check on how they are coping is
to listen to their heartbeat. There are different
ways of monitoring the baby’s heartbeat.
NICE Guidelines recommend that there is no need
for you to be connected to a monitoring machine
even for a short period unless there are concerns
about your baby. The midwife will check your
pulse rate to ensure there is no confusion between
your heart rate and your baby’s. Your baby’s
heartbeat will be listened to at regular intervals by
one of the following methods.
• Pinard – Trumpet shaped instrument which
helps the midwife to listen to the heart rate
• Sonicaid – a handheld monitor which can
also be used during a water birth. You
can listen to your baby’s heartbeat too if a
sonicaid is used.
This type of monitoring allows you to move
around freely.
Pregnancy Information33
• Continuous monitoring of your baby’s
heart beat
If you have had complications during your
pregnancy or if there are any concerns about
how your baby will cope with labour or you are
being induced, it may be advisable that your
baby’s heartbeat be monitored continuously. For
example, your baby may be premature or smaller
than expected.
Continuous monitoring may also be recommended
during labour if complications arise. These
complications could be for example - abnormal
changes in the baby’s heartbeat, if your baby has
opened its bowels (passed meconium) or you start
bleeding. Continuous monitoring is also advisable
if you need to have syntocinon to encourage
contractions or if you want an epidural for pain
relief.
• CTG – an electronic fetal monitoring machine
which produces a printed recording of your
baby’s heartbeat and your contractions
called a cardiotocograph (CTG) or sometimes
called a ‘trace’. Two small pads held in place
with two elastic straps are placed on your
abdomen. Information about your baby’s
heartbeat and your contractions will then
be printed onto graph paper. The midwife
or doctor can then interpret the trace to see
how well your baby is coping with labour.
Your ability to move around during labour
will be limited but you can still stand or sit in
a rocking chair or on a birth ball.
• Fetal Scalp Electrode – sometimes it may be
suggested that a clip is put onto your baby’s
scalp instead of using one of the pads on
your abdomen, so that the heartbeat can be
picked up directly. The reasons for doing this
should be discussed with you. The electrode
is put on during a vaginal examination
and the waters are broken if they have not
already done so. The baby may have a small
mark from the clip which should heal quickly.
If there is any concern about your baby’s
heartbeat, the obstetrician may recommend taking
a blood test from your baby’s scalp (called fetal
blood sampling). This involves taking a few drops
of blood from your baby’s scalp and testing how
much oxygen is in it. This is a more accurate way
of checking your baby’s well being. Your midwife
and doctor will discuss this with you.
• Eating or drinking in labour
You can eat and drink during labour although it is
best to concentrate on light, energy giving foods,
e.g. toast, biscuits or cereal. If you don’t feel like
eating, high energy drinks and glucose tablets may
be useful. If you are giving birth in hospital you
need to bring these with you.
It is a good idea to regularly empty your bladder
during the first stage of labour to protect it from
damage and to allow the decent of your baby’s
head. The midwife may need to insert a catheter
to empty your bladder.
• Acceleration labour
If your labour is progressing normally and you
and your baby are well, any clinical intervention
is not recommended. However, if your labour is
slower than what may be considered normal your
midwife or doctor may recommend that your
labour is accelerated. You will be given a clear
explanation of why this has been suggested and
your consent will be needed.
If your waters have not broken, the midwife or
doctor will break them using a small plastic hook
during a vaginal examination. This is sometime
called ‘artificial rupture of membranes’. Doing
this may make your contractions stronger. If not,
you may be offered a drip containing a hormone
(syntocinon) which will make the contractions
more effective. If you have the drip, the hormone
will be fed into a vein in your hand or arm. You
will need to be monitored all the time using the
CTG machine to check the baby’s heart beat and
the frequency of contractions.
13.7 Second stage
This stage begins when the cervix is fully dilated and
your baby’s head starts moving down your vagina.
• Positions for second stage
Mothers are encouraged to find whatever position
feels natural and the midwife will discuss with
you which positions are best in helping you to
give birth to your baby. Upright positions such
as kneeling, squatting or standing are more
comfortable, less painful and pushing may be
easier. Research has also shown that there is less
chance of needing an assisted delivery. If you feel
tired you can always lie on your side.
• Pushing
You will feel a strong urge to push with the
contractions and the baby will gradually descend
with your pushing efforts. Sometimes a woman
might not have the urge to push and it is best to
wait until her body is ready. Your midwife will give
you lots of help and support.
34
Pregnancy Information
When the baby is about to be born, the midwife will
tell you to stop pushing. This is so that your baby’s
head can be born slowly, giving the skin and muscles
of the perineum (the area between your vagina
and back passage) time to stretch without tearing.
Sometimes the skin of the perineum won’t stretch
enough and may tear or if medically necessary, a
surgical cut called an episiotomy is made.
Following either it is recommended that this damage
is repaired using dissolvable stitches (or you may
hear them being called sutures) to minimise future
problems.
This entails numbing the area with either a local
anaesthetic or if you already have an epidural this
might be adequate enough. Your midwife will
observe the area to ensure it is healing well.
If you have had stitches you need to keep the area
clean, bathe/shower regularly with plain water and
dry carefully afterwards. It will also help with healing
if you do your pelvic floor exercises.
Disadvantages:
• It can make you feel sick, vomit and have a
headache.
It is recommended that you have an active third stage
if you have had any problems during labour, any
history of bleeding in this or previous pregnancies,
any problems with delivering the placenta in previous
labour or you are having more than one baby in this
pregnancy.
A physiological third stage
This is when the placenta is delivered naturally by
the uterus contracting without the injection. The
midwife will not cut the cord until it has stopped
pulsating and you will need to give a few gentle
pushes to help push the placenta out.
Advantages:
• This is a natural way to deliver the placenta
If you feel that your stitches are sore and
uncomfortable or swollen, tell your midwife as you
may need treatment to help with the healing process.
• You won’t experience any side effects such as
nausea from the injection
Once the head is born, most of the hard work is
done and you will be asked to give one more push to
deliver your baby. The baby will be dried and lifted
onto your tummy so that you can hold him/her and
be close to each other immediately. This is called skin
to skin contact. You and your baby will be covered
with a towel or blanket to keep you both warm.
Usually a baby is very keen to breastfeed at this time
and your midwife can help you if you wish.
Disadvantages:
13.8 Third stage
After your baby is born, more contractions will
push out the placenta. This usually takes between
10 minutes and 60 minutes depending on how
you choose to deliver the placenta. You should be
offered a choice of:
An active third stage
• It may take longer to deliver the placenta
• There is a higher risk of bleeding heavily
13.9 Postnatal check following delivery
Your midwife will take your blood pressure, pulse,
and temperature. She will also monitor your blood
loss.
Your baby will be examined, weighed and dressed
and for security reasons, given 2 name bands
showing his/her date and time of birth and hospital
number. If breastfeeding, so not to disrupt skin to
skin contact which may disrupt initiation, your baby
may be weighed immediately after birth, after their
first feed or quickly prior to transfer home or to the
ward.
A drug called syntometrine or syntocinon is given by
injection into your leg to help the uterus contract.
The contractions will help to separate the placenta
from the wall of the uterus. The midwife will clamp
and cut the baby’s umbilical cord and gently pull the
cord to help deliver the placenta.
Advantages:
• The injection can help prevent heavy bleeding
which some women may experience without it.
• It will shorten the time taken to deliver the
placenta
Pregnancy Information35
14.0 Skin to Skin contact
Following birth, all new mothers and their babies should remain together in skin-to-skin contact no matter which
way you decide to feed.
At birth, your naked baby is dried and placed on your naked chest. The mother and baby should be covered with a
blanket to maintain their temperature.
Benefits of early skin contact:
Physiological Effects of skin-to-skin contact
• Promotes bonding
Skin to skin contact stimulates a woman’s powerful “mothering” hormone prolactin, which is
triggered by touch.
• Regulates baby’s heart rate
• Regulates baby’s breathing
• Controls baby’s body temperature
• Emotional benefits for the mother
• Facilitates breastfeeding
• Stimulates the baby’s digestive system
• Introduces the baby to the mothers friendly
bacteria
Skin to skin contact should be initiated in an
unhurried environment from the moment of
birth for as long as the mother wishes. Skin to
skin contact can be carried out at any time (for
example on the postnatal or at home) and as often
as the mother chooses. Both mother and baby
will continue to gain the hormonal benefits of skin
to skin contact.
36
Prolactin prepares her body for making milk and
stimulates intense motherly and protective feelings. The nearness of her baby also stimulates
oxytocin which calms her. Skin to skin contact
may therefore be of great benefit to all women
and their babies, even where the mother decided
not to breastfeed.
Babies are also calmed and relaxed by being in
skin contact with their mothers. Rooting and
nuzzling stimulate the baby’s digestion, even if
the baby does not feed.
This calming effect helps the baby to regulate its
heart rate and breathing. A baby in skin contact
with its mother is receiving the best temperature
regulation possible.
The baby is also colonized by the mother’s skin
bacteria and family bacteria which the baby will
be exposed to when they leave hospital. Breast
milk contains antibodies to any harmful bacteria,
so the baby will receive targeted protection at the
same time.
Pregnancy Information
Instinctive Newborn Behaviour
As the baby is stimulated by its mother’s touch and
smell, the baby engages in a series of pre-feeding
behaviours. These inborn reflexes occur in stages
and will happen without intervention if the baby
remains in skin contact with its mother.
Birth Cry
Relaxation
Awakening
Activity
Crawling
Resting
Familiarisation
Sucking
PLEASE NOTE: Your baby will be
covered with a blanket and a hat
applied during skin contact to keep
your baby warm
Sleeping
It can be easy to want to help by hurrying the baby through the stages, however this may cause further
problems with breastfeeding.
The use of certain drugs in labour may affect the ability of the baby to go through these stages immediately
after being born.
Also, some mothers and babies may need medical attention immediately after birth. As soon as the need for
this is past, whether it is 20 minutes, 2 hours, 2 days or two weeks, the two can be brought together and
encouraged to enjoy skin to skin contact.
Pregnancy Information37
15.0 Assisted birth (operative vaginal delivery)
Your midwife will give you care and support to encourage the normal birth of your baby. Being upright or lying
on your side during labour and avoiding an epidural will reduce the chance of needing an assisted birth. However,
if your midwife has concerns about the progress of your labour or the wellbeing of your baby, she will refer to an
obstetrician (doctor). The obstetrician and midwife will always discuss their concerns with you and it may be that
the obstetrician recommends that you are given help to birth your baby during the last part of labour when the
cervix is fully dilated.
The most common reasons for needing an assisted
birth are:
• The baby is not moving down the birth canal
• The baby is in distress during the birth
• You are unable or have been advised not to
push during birth
The purpose of an assisted birth is to mimic a normal
(spontaneous) birth with minimum risk to you and
your baby. To do this, an obstetrician uses special
instruments (ventouse or forceps) to help the baby to
be born.
15.1 What happens?
Before an assisted birth, your obstetrician will check
to make sure that your baby can be safely delivered
vaginally. This involves feeling your abdomen and
performing an internal examination.
You should be given pain relief during an assisted
birth. This will either be a local anaesthetic injection
inside the vagina (pudendal block) or a regional
anaesthetic injection given into the space around the
nerves in your back (an epidural or a spinal). Your
bladder needs to be empty for an assisted birth and
your obstetrician may pass a small tube (catheter)
into your bladder to empty it. Your legs will need to
be supported by the use of leg rests attached to short
poles positioned on either side of the bed.
If your obstetrician is not sure that the baby can
be born vaginally, your delivery may be carried out
in theatre so that a caesarean section can quickly
be undertaken if needed. A caesarean section is
a surgical operation where a cut is made in your
abdomen and the baby’s delivered through that cut.
38
What is a ventouse delivery?
A ventouse (vacuum
extractor) is an
instrument that uses
suction to attach a
plastic cup on your
baby’s head. With
a contraction and a
woman’s pushing, the
obstetrician pulls to
help deliver the baby.
What is a forceps delivery?
Forceps are smooth
metal instruments that
look like large spoons
or tongs. They are
curved to fit around
the baby’s head. The
forceps are carefully
positioned around the
baby’s head and joined
together at the handles.
With a contraction and
a woman’s pushing, the obstetrician pulls to help
deliver the baby.
There are many different types of forceps. Some
forceps are specifically designed to turn the baby
round, for example, if the baby has its back to your
back. Your obstetrician will choose the type of
forceps to best suit your situation.
Pregnancy Information
15.2 What happens when the baby is
born?
15.3 W
ill I need an assisted birth next
time?
As the baby is being born, a cut (episiotomy) may be
needed to enlarge the vaginal opening. If you have a
vaginal tear or cut, this will be repaired with stitches.
If you need an assisted birth in your first pregnancy,
it is unlikely that you will need one in your next
pregnancy. Most women have a normal birth next
time.
A paediatrician may attend the birth to check the
baby to see if there are any concerns about the
baby’s wellbeing. If not, see skin to skin contact.
The suction cup (ventouse) can leave a mark on
the baby’s head called a chignon. The suction cup
may also cause a bruise on the baby’s head called a
cephalohaematoma. Both will disappear with time. Your midwife will explain these.
Forceps can leave small marks on the baby’s face.
These will disappear.
15.4 H
ow will I feel after I leave
hospital?
After a normal or assisted birth, you may feel some
bruising and soreness. The stitches and swelling
may make it painful when you go to the toilet. Any
stitches will heal within a few weeks. Pain relief will
help.
A small tube (catheter) from your bladder may be
needed for up to 24 hours after you have given birth
while you are recovering. Women who have had
an epidural are most likely to need a catheter after
delivery.
Pregnancy Information39
16.0 Pain relief
Labour is painful so it is important to find out about all the different ways pain in labour can be reduced. Talk to
your midwife and you can decide what is best for you. However, be flexible as you might find you need more or
less pain relief than you had planned.
16.1 Types of pain relief:
Water
Self Help
Being in water during labour; in a bath or birthing
pool is recommended for pain relief.
The most important thing you can do to help
yourself is learning to relax and having confidence
in your own body. Being anxious can make pain
worse, especially when you don’t understand what’s
happening or don’t feel in control. Antenatal classes
will help you understand about labour and birth.
Controlling your breathing and the use of massage
can help you relax your muscles and help labour to
progress.
Your position can also make a difference. Upright
positions such as kneeling, sitting, squatting, walking
around, using a birthing ball or sitting in a rocking
chair can all help. Changing position not only
makes labour less painful but can also encourage
contractions to be more effective and helps your
baby move down the pelvis. Research has also
shown that there is less need for an epidural or
Pethidine if you are mobile during labour.
Advantages:
• Encourages you to relax and reduces your pain
• Makes you feel more in control
• Gives your body support
• You can leave the water at anytime
• Reduces the need for an epidural
• No unwanted side effects
• You can use gas and air as additional pain relief
Disadvantages:
• Whilst you are in water you cannot use other
pain relief such as TENS or Pethidine
Having your partner, relative or friend to support you
during labour also helps. Your midwife is also there
to give you the support you need.
40
Pregnancy Information
TENS
Pethidine
This stands for Transcutaneous Electrical Nerve
Stimulation. A gentle electric current gives a tingling
feeling through four pads placed on your back. TENS
stimulates the release of your body’s natural painkiller
(endorphins) and also reduces the number of pain
signals to the brain.
Pethidine, a type of synthetic morphine, is given as
an injection into the muscle. It takes approximately
20 minutes to work and the effect lasts between 2-4
hours.
Advantages:
• There are no known side effects for you or your
baby
• You control the strength of the current
Disadvantages:
• You cannot use it in the pool
• You need to start using it in early labour to feel
the full effects
Gas and Air (Entonox)
This is a mixture of oxygen and nitrous oxide gases.
It is breathed in via a mouthpiece or mask which you
hold yourself.
Advantages:
• Pethidine is a muscle relaxant
• Can help you cope with the pain of labour
Disadvantages:
• Pethidine can cross over the placenta to the
baby.
• Babies whose mothers have had Pethidine
in labour may feed less frequently in the first
48 hours as it can make the baby drowsy for
several days
• Pethidine can make some women feel
lightheaded, dizzy, sleepy, nauseous and
experience difficulty in concentrating
• You should not use the pool if you have had
Pethidine
Advantages:
• It is easy to use and quick to start working
• You can control it yourself and you can stop if
you don’t like it
• You can use it at any time during your labour
• It can be used while you are in water
• It has no harmful side effects to the baby Disadvantages:
• Gas and air won’t remove all pain but it does
reduce it
• It may make you feel light-headed, nauseous or
dizzy for a short time.
To get the best out of using gas and air it is important
to breathe it in at the very beginning of each
contraction. It takes 15 to 20 seconds to work. By
doing this it will be fully effective when the pain is at
its worst.
Pregnancy Information41
Epidural Anaesthesia for Labour
An epidural is a method of pain relief for labour,
which involves administering drugs through a small
tube inserted into the middle of the back in order to
anaesthetise the nerve endings. Any woman having
an epidural will need to be on the Labour Ward in
the hospital.
The epidural will be ‘sited’ by an anaesthetist who
is a fully qualified doctor specialising in anaesthesia.
He/she will come and see you and answer any
questions before siting the epidural. It usually takes
20 minutes to set up the epidural and 20 minutes to
work.
You will need to have a drip in your arm so that fluid
can be given into the vein. This may be necessary as
1 in every 50 women experience a significant drop
in blood pressure. You will be asked to sit or lie on
your side curled up. Your back will be cleaned and
local anaesthesia injected into the skin. Sometimes it
can be difficult to site the epidural, as the tip of the
needle has to pass between the bones of your back
to find exactly the right place.
Once the epidural is in place you will be free to move
on the bed and pain killing drugs can be injected
through the small tube to provide you with pain
relief. These drugs may also affect the nerves to your
legs making them feel a bit heavy and numb.
Some epidurals do not work fully and/or need to be
adjusted or replaced.
Advantages:
• Epidural analgesia provides the most effective
method of pain relief in labour and can be
used to provide pain relief over hours without
drowsiness
• It does not increase the likelihood of a longer
first stage of labour or a caesarean section.
• Can be topped up for caesarean section if
required
• In general, epidurals do not affect your baby
Disadvantages:
• Restriction of movement
Whilst we use “low dose” epidurals which tend
to leave reasonable feeling in the legs and you
will probably be able to move around the bed,
we do not allow women to stand or walk with
epidurals. This is to prevent you falling over and
suffering injury.
• Having a catheter
You may also not feel the urge to pass urine
and the midwife may need to pass a small
tube into the bladder to let the urine out
(catheterisation). This should not cause any
discomfort with a working epidural.
• Shivering - women may feel shivery but this
does not usually last long
Can anyone have an epidural?
• The epidural does not work property
There are some medical conditions and complications
of pregnancy which make an epidural unsuitable.
In particular if you have had surgery to your back
or have a bleeding disorder, tell your midwife/
obstetrician and he/she can arrange for you to see an
anaesthetist during your pregnancy to discuss it.
Occasionally the anaesthetist may be unable to
site an epidural and may advise you to persist
with other forms of pain relief, however this
is not common. Sometimes the epidural may
numb only one side of the body or there may
be a patch that is not fully numbed. It may
be possible to resolve this by adjusting the
epidural or re-sitting it, but it can be a persistent
problem and you may need some additional
pain relief, such as Entonox. A member of the anaesthetic team needs to insert
the epidural and as the team have other emergency
commitments they may not always be immediately
available. When the labour Ward is very busy it is
not always possible to provide a fully “on demand”
epidural service.
• Prolonged second stage
The presence of an epidural may prolong the
second stage of labour and reduce the urge
to bear down, but given some time the uterus
should push the baby out. There is an increased
need for the use of instruments (including
forceps/ventouse) in patients with epidurals
compared to those without.
• Backache
This is common during and after pregnancy.
Localised tenderness at the site of the epidural
may occur and last for a few days, but there
is now good evidence that epidurals do not of
themselves cause long term backache.
42
Pregnancy Information
Other risk factors are listed below:
Type of Risk
How common is it?
How often does this happen?
Significant drop in blood pressure
Occasional
1 in every 50 women
Not working well enough to reduce
labour pain so you need other pain
relief
Common
One in every 8 women
Not working well enough for a
caesarean section so you need a
general anaesthetic
Sometimes
One in every 20 women
Severe headache
Uncommon
1 in every 100 women (epidural)
1 in every 500 women (spinal)
Nerve damage (numb patch on a leg or
foot or having a weak leg)
Rare
Temporary – 1 in every 1,000 women
Effects lasting for more then 6 months
Rare
Epidural abscess (infection)
Very rare
1 in every 50,000 women
Meningitis
Very rare
1 in every 100,000 women
Epidural blood clot
Very rare
1 in every 170,000 women
Accidental unconsciousness
Very rare
1 in every 100,000 women
Severe injury, including paralysis
Extremely rare
1 in every 250,000 women
Permanent – 1 in every 13,000 women
Pregnancy Information43
17.0 Caesarean Section
Caesarean section involves major surgery where the baby is born through a cut in the mother’s abdomen and
uterus. A caesarean section will only be performed when there is concern about you or your baby’s health, as there
are risks involved with surgery and having a caesarean section could affect future pregnancies.
There are two kinds of caesarean section – an elective or planned caesarean, where the decision is taken before
labour begins or an emergency caesarean section. The decision to have an emergency caesarean section usually
takes place when you are already in labour and there is an unexpected problem, the doctor will discuss this with
you at the time.
When might a caesarean section be performed?
You may be offered an elective caesarean if:
• Your baby is not lying head down at the end of
your pregnancy
• The placenta lies close to or covers the part or all
of the cervix
Potential risks of having a caesarean section
• It is more likely that women will take longer to
recover, both physically and emotionally after a
caesarean section
• Increased pain from the wound and reduced
mobility
• Developing severe infection
• You have had previous caesarean deliveries
• Developing a blood clot
• You or your baby have certain medical conditions
• Bladder or bowel injury
• You are expecting twins, triplets or more – you
may be offered a caesarean section, if it is not
appropriate for the babies to be born vaginally
• Unsightly wound or delayed wound healing
During labour an emergency caesarean may be
needed if there is concern about your baby’s health
or if your labour is not progressing or if an emergency
arises before you are in labour such as heavy vaginal
bleeding.
• Hysterectomy (removal of the uterus) – this is
very rare
• Increased chance of heavy bleeding and blood
transfusion
• Increased risks associated with a general
anaesthetic, if this is necessary
• Longer hospital stay
• It may be more difficult to become pregnant
again after a caesarean section than vaginal
birth
• After having a caesarean section, future
pregnancies are at increased risk of miscarriage,
ectopic pregnancy, placental problems and
unexplained stillbirth
• There is a 1.5% chance of the baby having
superficial injuries such as a small cut when the
uterus is being opened
• You will need more support to establish
breastfeeding
44
Pregnancy Information
17.1 Planned caesarean section
The Operation
Once you have an agreed date for your caesarean
section, you will be asked to come to the ANDAU
before your planned caesarean section. An antenatal
check will be carried out and your blood will be
checked for your iron levels and your blood group.
You will be seen by a doctor to discuss the operation
and gain your consent
A cut is made in the skin; this is usually crossways
below the bikini line and only very rarely, up and
down the abdomen. A screen will be put across your
chest so that you cannot see what is being done. If
you are having a spinal anaesthetic, your partner will
be able to be with you in the operating theatre and
will be given theatre clothes to wear to reduce the
risk of infection.
On the day of the operation, an anaesthetist will
discuss which type of anaesthetic is best for you.
After the operation you will be offered injections to
reduce the risk of blood clots, antibiotics may also be
offered to reduce the risk of infection. Please let your
midwife or doctor know if you are allergic to any
antibiotics.
During and after the operation you will be given
fluids through a drip in your arm until you are able
to eat and drink and a catheter will be inserted into
your bladder to allow urine to drain whilst you are
immobile.
Please be aware that although our aim is to
perform your caesarean section on the date
it is booked, it may be necessary to delay the
procedure if there is another woman with a
greater need to prevent ill heath to her or her
baby.
The doctors and midwives will talk to you and let
you know what is happening. You shouldn’t feel
any pain, just some tugging and pulling, but if you
do feel pain let your anaesthetist know immediately.
If you continue to feel pain the anaesthetist might
advise a general anaesthetic, although this is rare.
The operation takes about 30-40 minutes and if you
have a spinal anaesthetic you will be able to see and
hold your baby as soon as possible after birth.
In the recovery room
You will be closely observed in the recovery room to
make sure you recover from the anaesthetic properly
and there are no immediate complications. You will
be able to have skin to skin contact and breastfeed
your baby.
Please note, no visitors other than your partner
are allowed into the recovery room.
17.2 Emergency caesarean section
After the operation
All the procedures mentioned above will be carried
out when an emergency caesarean section is
necessary, although they might have to be done very
quickly depending on how urgently a caesarean is
needed. Everything will be explained to you and your
consent will be needed to carry out the operation.
After a caesarean you will feel uncomfortable for
a few days, as you would expect from any major
operation. After 12-24 hours any drips, catheters or
drains are usually removed and after the first day you
will be encouraged to get up and move around. The
stitches or clips on the wound can be removed after
5 days if healed well. You will be given regular pain
relief following your caesarean for as long as you
need it. Ask your midwife if you require more.
Type of Anaesthesia
An anaesthetist will discuss the best way to ensure
you do not feel any pain during the operation. A
caesarean section is usually done using a regional
anaesthetic such as a spinal anaesthetic and you
will be awake during the operation. If you have
an epidural in place this can sometimes be topped
up with more anaesthetic. If you have a General
Anaesthetic (GA), you will be asleep during the
operation and your partner can wait for you in the
waiting room until you are fully recovered from the
anaesthetic. You will then be taken to the recovery
room and you will be able to see your baby as soon
as you wake up. A spinal anaesthetic is safer for
you than a GA but in an emergency a GA may be
necessary.
You will have to take it easy once you get home and
you will need help with daily activities. You should
not lift anything heavy, e.g. prams and car seats or
do strenuous housework for up to 6 weeks. You
will not be able to drive for several weeks
following the operation – please contact your
car insurance company for advice.
Pregnancy Information45
18.0 Vitamin K
As part of your birth plan and after your baby is born you will be asked to decide whether or not you want your
baby to have vitamin K. This Trust recommends the injection preparation, as discussed below. However, vitamin K
can be given orally upon request.
What is vitamin K?
Vitamin K is found in certain foods, but bacteria
living in the gut make most of the vitamin K the body
needs. Vitamin K is essential to help the blood clot.
If blood does not clot any bleeding will not stop and
is known as a haemorrhage.
Why give babies vitamin K
Studies have found that babies naturally have low
levels of vitamin K in their blood. Very occasionally
babies can suffer from a rare but serious and
sometime fatal bleeding disorder known as
haemorrhagic disease of the newborn. This
condition is rare – about 1 in every 10,000 babies.
It most commonly happens in the first week of life
but it can happen at any time in the first six months.
Bleeding can occur from the nose, mouth or in the
brain, which can cause brain damage or death.
Which babies are more at risk?
Babies are at greater risk of bleeding who:
•Have had a complicated delivery, e.g. forceps
delivery
•Are premature
•Are ill for other reasons
•Are failing to take or absorb feeds
•Have a liver disease that may show as prolonged
jaundice
•Are born to mothers taking anti-coagulants
(blood thinning drugs), anti-convulsants (drugs
taken to control epilepsy) or drugs taken to treat
tuberculosis (TB).
46
Some babies who do not have any of these risk
factors can bleed unpredictably. As yet there is no
way of identifying these babies. The most effective
way of protecting them is to give vitamin K to all
babies.
As with any preventative treatment there are risks
and benefits to consider and it is the parent’s decision
whether or not they want their baby to have
vitamin K.
How is vitamin K given?
Vitamin K can be given by mouth or by injection.
The preparation is called Konakion MM and is the
only vitamin K preparation licensed for use in the UK.
It also contains glycocholic acid and lecithin.
By injection
Research has shown that one intramuscular
injection into the baby’s thigh, given shortly after
birth, prevents bleeding in virtually all babies. It
is estimated that less than one baby in a million
given the injection, including those at greater risk of
bleeding, will suffer a bleed. That means it is very
effective. The National Institute of Clinical Excellence
(NICE) guideline recommends the injection as the
best method to give your baby vitamin K1.
By mouth
If you don’t want your baby to have the injection,
vitamin K can also be given by mouth (orally) to your
baby. Two doses are given in the first week. If you
are breastfeeding a third dose is given when your
baby is 4 weeks old. Bottle fed babies do not need
a third dose because vitamin K is added to artificial
milk. It is estimated that 1 in 300,000 babies given a
full course of oral vitamin K will suffer bleeding.
Pregnancy Information
What are the recommendations?
Bruising and minor warning bleeds
The Department of Health advises that all newborn
babies receive vitamin K to prevent the rare, but
serious disorders of vitamin K Deficiency Bleeding. They recommend vitamin K by injection for all babies
born after 36 weeks of pregnancy, with the option of
vitamin K by mouth for those parents who chose it.
• Jaundice (when the baby looks yellow) for more
than 2 weeks in formula fed babies and 3 weeks
in breastfed babies.
However, it is also the right of parents to choose no
vitamin K for their baby, but if a baby is in any of the
high risk groups, parents will be strongly advised to
allow their baby to have vitamin K by injection.
• Pale stools or dark urine.
If you would like more information or if you are
taking any drugs please talk to your midwife or
doctor.
Parents of babies who do not have vitamin K need
to be especially watchful and seek urgent medical
attention for:
Pregnancy Information47
19.0 Transferring to the postnatal ward
If you decided to have your baby in hospital, discuss
with your midwife whether you could go home
straight from the Labour Ward or be transferred up
to the postnatal ward.
When you and your midwife are happy for you to be
moved from the Labour Ward, you will be transferred
to a bed on the postnatal ward. We understand that
you may not wish to be apart from your partner but
out of visiting hours due to security reasons and to
reduce any disturbance to other mothers and babies,
especially if the transfer is during the night your
partner will have to leave you. You will also need
your rest too. Our ward has a ‘partners only’ visiting
times during the day so that you can spend time
together as a family.
On arrival at the ward, as soon as you are ready a
member of staff will show you the layout of the
ward and the facilities available. A Bedside Folder
containing useful information of the ward and the
hospital will be available at your bedside to read.
You will have an individual bedside locker for your
personal items, but storage space is limited. Please
do not bring large amounts of money or valuables
as the Mid Cheshire Hospitals NHS Foundation Trust
cannot accept responsibility for loss or damage to
patients’ money or property unless they are locked up
for safe-keeping and an official receipt obtained. All
suitcases/holdalls must be taken home and returned
only when you are discharged.
48
19.1 Amenity beds
There are a limited number of amenity beds
available. These are small single rooms that offer
no additional facilities and are subject to availability.
Enquiries should be made on admission. A charge
per day is made. All fees are used for the continued
improvement of the health service at Leighton
Hospital.
19.2 Visitors in hospital
The visiting policy limits the number of people visiting
to 2 plus your partner. This is because of security
and safety issues and also to reduce the risk of cross
infection to new babies. This is why no children,
other than your own children, will be allowed on the
Labour Ward to visit you. Please ask your visitors to
use the hand gel before entering the Labour Ward
and before handling your baby.
19.3 Security in hospital
We advise parents never to hand over their baby to
any person that is not known to them, even if they
act or look like a member of staff. All staff should be
wearing identification badges.
The doors to the antenatal and postnatal in Leighton
are kept locked and access is via a video/intercom.
All visitors need to press the intercom and identify
themselves to gain access.
Pregnancy Information
20.0 After you have had your baby
20.1 What to expect
Blood loss – You should expect to have some blood
loss after birth from the vagina. This will be heavy at
first but decreases in the following days. You should
wear super absorbent sanitary towels. We suggest
you purchase maternity pads that do not contain
plastic coatings, especially if you have had stitches.
Do not use tampons.
Breast changes – It is normal to find your breasts
changing size and shape during pregnancy and
after birth. They may also be tender. If you don’t
breastfeed you don’t need to do anything but your
breasts will still fill with milk around the 3rd day
after having your baby. It may help to wear a firm
supportive bra until the breasts settle down. Do
not express the milk as this will stimulate them to
produce more.
If you feel your blood loss is excessive or you are
passing large clots, please inform your midwife. It
may be necessary to save your pads so the blood loss
can be more accurately assessed.
Your breasts may feel lumpy in the postnatal period;
especially if you are breastfeeding, but if you are
worried or they are very painful, inflamed or have red
patches inform your midwife or doctor.
Going to the toilet – It is common to have some
discomfort when passing urine after you have had
your baby. If you are experiencing difficulty in passing
urine or are leaking urine when you cough or laugh
you should inform you doctor or midwife. It is
important that you pass urine within the first 6 hours
after delivery to prevent any problems in later life.
Please ask a midwife for a bed pan so your urine can
be measured after you have given birth.
Bowels – Piles are very common after pregnancy,
often they will disappear on their own in the
following weeks after having your baby. It will help
to have a well balanced diet and drinking plenty of
fluid to prevent constipation. If you are feeling very
uncomfortable your midwife or doctor can give you
some ointment to soothe the pain.
20.2 Baby blues
Many women can feel ‘low’ or ‘down’ after having
a baby, usually within a few days of birth. This is
commonly known as the ‘baby blues’.
You may feel well one minute and miserable the next
or burst into tears for no particular reason. This is a
normal reaction to motherhood as you adapt to less
sleep, hormonal changes and new responsibilities.
The baby blues doesn’t tend to last very long and can
be helped by talking to your partner, family, friends,
midwife or health visitor. However, if these feeling
continue longer than a week or worsen, you maybe
experiencing something other than the baby blues.
Speak to your doctor, midwife or health visitor as you
may need further support or treatment.
20.3 Family planning advice
A team midwife will ask if you wish to talk about
family planning advice and will inform you of the
family planning services available to you. She will
also ask you to attend your 6 weeks’ postnatal
appointment so that you can have a final check that
everything is normal. This will usually be with your
GP. In exceptional circumstances you may be asked to
come to the hospital for your check.
Pregnancy Information49
21.0 Caring for your baby
21.1 Your baby’s health
Following birth your midwife or a doctor will do a
visual examination on your baby at 1 and 5 minutes
of age. This is called an APGAR score and helps to
assess your baby’s health by looking at things such
as baby’s heart rate, colour and breathing rate. We
would expect a healthy baby to have a score above 6
by 5 minutes of age.
A full assessment of the baby will be carried out
anytime after 6 hours of birth. This can be performed
by a midwife, nurse or paediatrician (baby doctor).
Sudden infant death syndrome (SIDS)
This is a rare syndrome also known as cot death.
There are a few key messages for parents to help
to reduce the risk.
• Always place your baby on their back to sleep in
a cot in your room with you
• Place your baby’s feet at the bottom of the cot
the ‘feet to foot’ position
• Don’t let your baby get too hot
• Do not smoke in pregnancy
21.2 Newborn hearing screening
programme
You will be offered a hearing test for your baby. This
is not painful and allows those babies affected and
their parents the support they need.
For more information see
www.hearing.screening.nhs.uk
21.3 Newborn blood spot screening
When your baby reaches 5-7 days old your midwife
will ask to take a spot of blood from your baby’s
heal. This is used to test for some rare but potentially
serious illnesses. Please see your screening leaflet for
more information.
21.4 Cord care
The umbilical cord from the placenta to your baby’s
naval will be clamped and cut shortly after birth.
It will take about a week for this to dry out and drop
off. Whilst this process is ongoing you will need
to keep the areas clean and dry. If you notice any
bleeding or discharge or there is an offensive smell,
please inform your midwife, health visitor or doctor.
50
• Don’t let anyone smoke near your baby
• Ideally don’t handle your baby immediately after
having a cigarette
• Do not share a bed with your baby if you have
been drinking or taking drugs or are excessively
tired
• Never sleep with your baby on an arm chair or
sofa
For more information visit www.fsid.org.uk
For more information on how to look after your baby
please ask your midwife, health visitor or there is lots
of information in your NHS ‘The Pregnancy Book’.
21.5 Transfer to community care
When you leave hospital, you will continue to be
cared for by your team midwife and maternity
support worker, who will visit you at home. Details
of your transfer will be faxed to your GP. The health
visitor will visit you from approximately 10 days after
the birth.
Pregnancy Information
21.6 Registration of births
21.7 Bounty services
You must register your baby within 6 weeks (42 days)
of birth. You can either register the birth in hospital
or at your local Registry Office. You will be given
their contact details after the birth of your baby.
Bounty Photography operates in the wards; a
photographer visits every day of the week. You will
have the opportunity at the bedside to view the
photos and to place an order. Your Maternity Unit
benefits from the revenue from this service. For
further information, ring 0845 766 0665.
If you and the father were married to each other at
the time of the child’s birth either parent may register.
If you and the father were not married to each other
at the time of the child’s birth you alone may register,
but the father’s details can only be entered in the
register if he is also present at the time or the mother
and father both make a statutory declaration.
A Bounty Distributor visits this hospital on a regular
basis to distribute packs containing FREE samples and
the Child Benefits Claim Pack. The Bounty Customer
Care Line is 0800 316 9341.
The implications for you, your child and the father if
you were not married are:
• Using the father’s name as a joint registration
cannot ever be changed
• Using your surname as joint registration can only
be changed if you marry
• Using the father’s name with only your details
means the father’s details can be added
• Using your name with the only your details means
the surname can be changed and the father’s
details can be added.
General points for you to think about:
• If your current relationship is failing and your child
has a different surname to you
• Having different surnames within the family may
result in confusion and difficulties at school, at the
GP etc
• Future relationships
• The use of the birth certificate as an identification
document
• If the name of the child is changed by Deed Poll
documents need to be kept together.
If you have any queries, please contact the registrar
for help and advice.
Pregnancy Information51
22.0 Useful organisations
ACAS
(advisory, conciliation and Arbitration Service)
Care of the next infant scheme (CONI)
Tel: 08457 474747
www.acas.org.uk
Offering advice on time off for antenatal care and
on maternity rights, parental leave and matters like
unfair dismissal.
Tel: 0808 802 6868
www.fsid.org.uk
Co-ordinated help and support for advice to help
prevent and for the parents who have suffered a cot
death or infant death.
Local contact Karyn Libecans Tel: 07876 726595
APEC (action on pre-eclampsia
Child Poverty Action Group
Tel: 0208 427 4217
www.apec.org.uk
National charity offering support and information
about pre-eclampsia via its helpline and newsletters.
Tel: 0207 837 7979
www.cpag.org.uk
Campaigns on behalf of low income families.
Information and advice for parents on benefits,
housing and welfare rights etc.
Association for postnatal illness (APNI)
Tel: 0207 386 0868
www.apni.org
Network for telephone and postal volunteers who
have suffered from postnatal illness and offer
information, support and encouragement on a one
to one basis.
Blood transfusion service
Tel: 0300 123 2323
www.blood.co.uk
British HIV Association
CLAPA (Cleft Lip and Palate Association)
Tel: 0207 833 4883
www.clapa.com
Support for families of babies born with cleft lip and/
or palate. Feeding equipment available.
CRY-SIS
Tel: 08451 228 669
www.cry-sis.org.uk
Offers support for families with excessively crying,
sleepless and demanding babies.
www.bhiva.org
Caesarean Support Network
Tel: 01625 661269
Offers emotional support and practical advice to
mothers who have had or may need a caesarean
delivery.
Continued overleaf . . .
52
Pregnancy Information
22.0 Useful organisations (continued)
Disability pregnancy and parenting
international
Tel: 0800 018 4730 (freephone)
www.dppi.org.uk
A charity set up to support and advise disabled
people who are already or wish to become parents
and their families. It is also for health and social
professionals and other individuals and organisations
concerned with disability and/or pregnancy and
parenting.
Disabled parents network
Tel: 0870 241 0450
www.disabledparentsnetwork.org.uk
Domestic Abuse Partnership
Tel: 0808 2000 247
In an emergency call 999
National Childbirth Trust (NCT)
Helplines:
Enquiry line:
Breastfeeding line:
Pregnancy and birth line:
Postnatal line:
www.nct.org.uk
Tel: 0300 330 0770
Tel: 0300 330 0771
Tel: 0300 330 0772
Tel: 0300 330 0773
National Drinkline
Tel: 0800 917 8282
National Drugs Helpline
Tel: 0800 776 600
NHS Direct
Down’s Syndrome Association
Tel: 0845 46 47
www.nhsdirect.nhs.uk
24 hour nurse-led service providing health
information and advice.
Tel: 023 9285 5330
www.downs-syndrome.org.uk
NSPCC
Tel: 0300 333 111
www.mencap.org.uk
Mencap is the leading UK charity for people with a
learning disability and their families.
Child Protection Helpline
Tel: 0808 800 500
www.nspcc.org.uk
24 hour free helpline for advice and support for
anyone who is concerned about a child at risk of
abuse.
MIND (National Association for Mental Health)
Sickle cell society
Tel: 0845 766 0163
www.mind.org.uk
Tel: 0208 961 7795
www.sicklecellsociety.org
MENCAP
Continued overleaf . . .
Pregnancy Information53
22.0 Useful organisations (continued)
The Jennifer Trust for Spinal Muscular Atrophy
Breastfeeding support and advice
Tel: 0800 975 3100
www.jtsma.org.uk
www.cherubsbreastfeeding.co.uk
(available from June/July 2011)
For help/advice and local support/social groups.
TAMBA (twins and multiple births association)
NCT - Breastfeeding line:
Tel: 0300 330 0771
www.babyfriendly.org.uk
Tel: 0800 138 0509 (freephone)
www.tamba.org.uk
UK Thalassaemia Society
Tel: 0208 882 0011
National Breastfeeding Helpline:
Tel: 0300 100 0212
La Leche League:
Tel: 0845 120 2918
Breastfeeding Network
Tel: 0300 100 0210
Association of Breastfeeding Mother
Tel: 08444 122949
The section aims to direct you to quality websites that are correct and active at the time of production.
54
Pregnancy Information
Pregnancy Information55
Mid Cheshire Hospitals NHS Foundation Trust is not responsible or liable, directly or indirectly, for any form
of damages resulting from the use (or misuse) of the information contained in this booklet or found on the
web pages linked to by this booklet.
We would like to acknowledge and thank Shrewsbury and Telford Hospital NHS Trusts for their input and the
format this booklet has been based upon.
This information is available
in large print, audio, Braille and other languages.
To request a copy, please telephone 01270 273104.
Printed August 2011 Review August 2012 Ref: WCSH/MS/0300811
The contents of this booklet is subject to copyright law and should not be reproduced in any form whatsoever
without prior written approval from the Patient Experience Team at Mid Cheshire Hospital NHS Foundation Trust.