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https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/

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Choosing your birth location

You can give birth at home, in a unit run by midwives (a midwifery unit or birth centre) or in hospital.

Your options about where to have your baby will depend on your needs, risks and, to some extent, on where you live.

If you're healthy and have no complications (low risk) you could consider any of these birth locations. If you have a medical condition, it's safest to give birth in hospital, where specialists are available. This is in case you need treatment during labour.

If you give birth at home or in a unit run by midwives, you're less likely to need assistance such as forceps or ventouse (sometimes called instrumental delivery).

Wherever you choose, the place should feel right for you. You can change your mind at any point in your pregnancy.

Find out what's in your area

Your midwife will discuss the options available in your area but, if you're willing to travel, you're free to choose any maternity services.

As well as from your midwife, you can get information from:

children's centres

your GP surgery

local maternity units - find maternity services near you

Maternity Voices Partnerships (MVPs) - ask at your local hospital's maternity unit

You may also want to get advice from your friends and family.

Talk to your midwife about going to have a look around the local maternity services, and ask questions if you do not understand something or think you need to know more.

Home birth

If you have a straightforward pregnancy, and both you and the baby are well, you might choose to give birth at home.

Giving birth is generally safe wherever you choose to have your baby.

But if you're having your first baby, home birth slightly increases the risk of serious problems for the baby - including death or issues that might affect the baby's quality of life - from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth.

If you're having your second baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.

It's rare but, if something goes seriously wrong during your labour at home, it could be worse for you or your baby than if you were in hospital with access to specialised care.

If you give birth at home, you'll be supported by a midwife who will be with you while you're in labour. If you need any help or your labour is not progressing as well as it should, your midwife will make arrangements for you to go to hospital.

Advantages of home birth

The advantages of giving birth at home include:

being in familiar surroundings, where you may feel more relaxed and better able to cope

not having to interrupt your labour to go into hospital

not needing to leave your other children, if you have any

not having to be separated from your partner after the birth

increased likelihood of being looked after by a midwife you have got to know during your pregnancy

lower likelihood of having an intervention, such as forceps or ventouse, than giving birth in hospital

Considerations

There are some things you should think about if you're considering a home birth.

You may need to transfer to a hospital if there are complications.

Epidurals are not available at home, but you can use gas and air, a warm bath, a birth pool, TENS and any relaxation techniques you've learned. Find out about pain relief in labour.

Your doctor or midwife may recommend you give birth in hospital - for example, if you're expecting twins or if your baby is lying feet first (breech). Your midwife or doctor will explain why they think a hospital birth is safer for you and your baby.

If you choose to give birth at home or in a unit run by midwives, you should be given information by your midwife or GP about what would happen if you had to be transferred to hospital during labour and how long this would take.

Planning a home birth

Ask your midwife whether a home birth is suitable for you and your baby.

If it is, your midwife will arrange for members of the midwifery team to help and support you. Here are some questions you might want to ask:

how long would it take if I needed to be transferred to hospital?

which hospital would I be transferred to?

would a midwife be with me all the time?

how do I obtain a birthing pool?

Midwifery units or birth centres

Midwifery units or birth centres are more comfortable and homely than a maternity unit in a hospital. They can be:

part of a hospital maternity unit, where pregnancy (obstetric), newborn (neonatal) and anaesthetic care is available

separate from a hospital, and without immediate obstetric, neonatal or anaesthetic care

Advantages of a midwifery unit or birth centre

The advantages of giving birth at a midwifery unit include:

being in surroundings where you may feel more relaxed and better able to cope with labour

being more likely to be looked after by a midwife you have got to know during your pregnancy

the unit potentially being much nearer your home

lower likelihood of having an intervention such as forceps or ventouse than giving birth in hospital

Considerations

There are some things to think about if you're considering giving birth in a midwifery unit or birth centre.

You may need to be transferred to a hospital if there are any complications.

In a unit that's completely separate from a hospital, you won't be able to have certain kinds of pain relief, such as an epidural. Ask your midwife whether the unit or centre is part of a hospital or completely separate.

Your doctor or midwife may feel it's safer for you to give birth in hospital

Planning a birth in a midwifery unit or birth centre

Ask your midwife if there are any midwifery units or birth centres in your area. There may be others you can use if you're prepared to travel.

Hospital birth

Most births happen in an NHS hospital maternity unit. If you choose to give birth in hospital, you'll be looked after by midwives, but doctors will be available if you need their help.

You'll still have choices about the kind of care you want. Your midwives and doctors will provide information about what your hospital can offer.

Advantages of hospital birth

The advantages of giving birth in hospital include:

direct access to obstetricians if your labour becomes complicated

direct access to anaesthetists, who give epidurals and general anaesthetics

there will be specialists in newborn care (neonatologists) and a special care baby unit if there are any problems with your baby

Considerations

There are some things you should think about if you're considering a hospital birth:

you may go home directly from the labour ward or you may be moved to a postnatal ward

in hospital, you may be looked after by a different midwife from the one who looked after you during your pregnancy

you're more likely to have an epidural, episiotomy, or a forceps or ventouse delivery in hospital

Planning a hospital birth

Your midwife can help you decide which hospital feels right for you. If there's more than one hospital in your area, you can choose which one to go to. Find out more about the care provided in each so you can decide which will suit you best.

Birth questions to ask

Here are some questions you might want to ask if you're considering having your baby in a midwifery unit or birth centre, or in hospital:

Are tours of the maternity facilities available before the birth?

When can I discuss my birth plan?

Are TENS machines available for pain relief or do I need to hire one?

What equipment is available - for example mats, a birthing chair or bean bags?

Are there birthing pools?

Are fathers, close relatives or friends welcome in the delivery room?

Are they ever asked to leave the room - if so, why?

Can I move around in labour and find my own position for the birth?

What is the policy on induction, pain relief and routine monitoring?

Are epidurals available?

How soon can I go home after the birth?

What services are provided for premature or sick babies?

Who will help me if I choose to formula feed?

Will my baby be with me all the time or is there a separate nursery?

Are there any special rules about visiting?

How long would it take if I needed to be transferred to hospital from a birth centre?

Which hospital would I be transferred to?

Would a midwife be with me all the time?

Wherever you decide to give birth, you can change your mind at any stage of pregnancy. Talk to your midwife if there's anything you're not sure or want to know more about.

For more information visit birthrights.

If you are thinking about unassisted birth

You can choose to have a home birth without a midwife with you (unassisted birth). This is sometimes called freebirth.

Talk to a midwife if you are worried about your care.

They can:

discuss with you the role of the midwife and help you make an informed choice

personalise your care and support so it's right for you.

If you decide to have an unassisted birth, you can change your mind at any time during your pregnancy or labour. NHS midwives will always be available to support you.

A midwife can offer you support and advice during labour, and check on the health of you and your baby. They'll know if you or your baby need help, and can arrange for medical attention if needed.

If you have an unassisted birth, you'll need to tell a GP or local maternity services about your baby's birth as soon as they've been born. This is because by law every birth in the UK needs to be recorded (notified) within 36 hours. A GP or midwife will need to see you before they can notify the birth.

When the birth has been notified, your baby will get an NHS number for their NHS care.

Further information:

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Find out about your options for where to give birth: at home, in hospital or at a midwife-led (midwifery) unit. Learn more about which pain relief methods will be available.

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https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/how-to-make-a-birth-plan/

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A birth plan is a record of what you would like to happen during your labour and after the birth. You don't have to create a birth plan but, if you would like one, your midwife will be able to help.

Discussing a birth plan with your midwife gives you the chance to ask questions and find out more about what happens in labour.

It also gives your midwife the chance to get to know you better, and understand your feelings and priorities, and allows you to think about or discuss some things more fully with your partner, friends and relatives.

You can change your mind about your wishes for labour and birth at any time.

Your personal circumstances

Your birth plan is personal to you. It depends on what you want, your medical history, your circumstances and what is available at your maternity service.

You might be given a special form for your birth plan, or there may be room in your notes. It's a good idea to keep a copy of your birth plan with you.

The maternity team who care for you during labour will discuss it with you so they know what you want.

Be flexible

You need to be flexible and prepared to do things differently from your birth plan if complications arise with you or your baby, or if facilities such as a birth pool aren't available.

The maternity team will tell you what they advise in your particular circumstances. Don't hesitate to ask questions if you need to.

Things to consider

You can find out more about the things you need to think about when making a birth plan, such as:

You can work out whether there's anything you feel strongly about and might wish to include.

You can also show your birth partner these tips to support you.

Download a birth plan template

You can download a birth plan template (Word document 65KB, opens in a new window) to fill in and save.

Get Start4Life pregnancy and baby emails

Sign up for Start4Life's weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

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Find a birth plan template and learn about making a birth plan, including where to give birth, pain relief options, who to have with you and your feelings on intervention.

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Dr Sara Wickham - what is a stretch and sweep? 

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Dr Sara Wickham - what is a stretch and sweep? 

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https://www.sarawickham.com/articles-2/what-is-a-stretch-and-sweep/

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https://www.nhs.uk/pregnancy/your-pregnancy-care/screening-tests/

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Find out about screening tests in pregnancy. These include ultrasound scans and blood tests to try to find any health conditions that could affect you or your baby.

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Numbers to Call if you are looking for Immediate Support.

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Numbers to Call if you are looking for Immediate Support.

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PANDAS (Pre and Postnatal Depression Advice and Support):

Free Support Line 0808 196 1776 (11am - 10:00pm Mon-Sun)
Text PANDAS to 85258 (24hrs/7days)

Samaritans: 116 123 (24hrs/day)

Mind: 0300 123 3393 (9am-6pm Mon-Fri)

NHS Choices: 111 (24hrs/7days)

SANDS: 0808 164 3332 (10am to 3pm Monday to Friday and 6pm to 9pm Tuesday and Thursday evenings).

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https://www.nhs.uk/pregnancy/finding-out/your-first-midwife-appointment/

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Your first midwife appointment (also called the booking appointment) should happen before you're 10 weeks pregnant. This is because you'll be offered some tests that should be done before 10 weeks.

If you're more than 10 weeks pregnant and haven't seen a GP or midwife, contact a GP or midwife as soon as possible.

You'll still have your first midwife appointment and start your NHS pregnancy journey.

Coronavirus update

If you're well, it's really important you go to all your appointments and scans for the health of you and your baby.

Hospitals and clinics are making sure it's safe for pregnant women to go to appointments.

If you get symptoms of coronavirus, or you're unwell with something other than coronavirus, speak to your midwife or maternity team. They will advise you about what to do.
Find out more about pregnancy and coronavirus

Where the first appointment happens

Your first appointment may take place in:

your home

a hospital

a GP surgery

a Children's Centre

Where the appointment happens depends on the pregnancy services in your area.

How long the appointment lasts

The appointment usually takes around an hour.

What your midwife may ask

Your midwife will ask some questions to help find out what care you need.

They may ask about:

where you live and who you live with

the baby's father

any other pregnancies or children

smoking, alcohol and drug use

your physical and mental health, and any issues or treatment you've had

any health issues in your family

domestic abuse

female genital mutilation (FGM)

your job, if you have one

whether you have people around to help and support you, for example a partner or family members

The first appointment is a chance to tell your midwife if you need help or are worried about anything that might affect your pregnancy. This could include domestic abuse or violence, sexual abuse, or female genital mutilation (FGM).

FGM can cause problems during labour and birth. It's important you tell your midwife or doctor if this has happened to you.

Tests at your first appointment

Your midwife will ask if they can:

They'll also offer you a blood test for sickle cell and thalassaemia (blood disorders that can be passed on to the baby) if they think there's a high chance you might have them. They'll work out your chance by asking some questions.

Things your midwife may discuss with you

Your midwife may give you information about:

how the baby develops during pregnancy

a healthy pregnancy diet and foods to avoid in pregnancy

pregnancy exercise and pelvic floor exercises

your NHS pregnancy (antenatal) care

breastfeeding

antenatal classes

benefits you can get when you're pregnant, such as free prescriptions and free dental care

your options for where to have your baby

the tests and scans you'll be offered in pregnancy

Ask questions if you want to know more or don't understand something.

Your maternity notes

At the end of the first appointment, your midwife will give you your maternity notes in a book or a folder.

These notes are a record of your health, appointments and test results in pregnancy. They also have useful phone numbers, for example your maternity unit or midwife team.

You should carry these notes with you all the time until you have your baby. This is so health care staff can read about your pregnancy health if you need urgent medical care.

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Your first midwife appointment (also called the booking appointment) should happen before you're 10 weeks pregnant. This is because you'll be offered some tests that should be done before 10 weeks. If you're more than 10 weeks pregnant and haven't seen a GP or midwife, contact a GP or midwife as soon as possible.

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https://www.nhs.uk/pregnancy/finding-out/due-date-calculator/

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The calculator on this page can help you work out when you might expect your baby to arrive.

Using the due date calculator

To find your due date, enter the date of the first day of your last period, and select 'show your due date'. Pregnancy normally lasts from 37 weeks to 42 weeks from the first day of your last period.

You need to know the first day of your last period to use this calculator. If you do not know it or are unsure, speak to a midwife or GP.

As part of your pregnancy (antenatal) care, your midwife will offer you a 12-week scan that may give you a more accurate date for the birth of your baby.

Find out about:

Find out about what's happening when you're:

Sign up for Start4Life's pregnancy and baby emails for expert advice, videos and tips on pregnancy, birth and beyond.

Unplanned or unsure? Find out Sexwise has more information and support.

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The calculator on this page can help you work out when you might expect your baby to arrive. To find your due date, enter the date of the first day of your last period, and select 'show your due date'. Pregnancy normally lasts from 37 weeks to 42 weeks from the first day of your last period.

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https://www.sarawickham.com/articles-2/nice-guideline-on-inducing-labour/

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Sefton: Breastfeeding Support Sefton | Facebook
Lancashire: FAB Lancs Breastfeeding Support | Faceboo

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https://www.nhs.uk/pregnancy/finding-out/your-nhs-pregnancy-journey/

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If you have a health condition, for example diabetes or asthma, these can affect your pregnancy. Pregnancy can also affect any conditions you have.

Don't stop taking your medicine until you've talked with your doctor.

Find out more about:

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If you have a health condition, for example diabetes or asthma, these can affect your pregnancy. Pregnancy can also affect any conditions you have. Don't stop taking your medicine until you've talked with your doctor. Find out more about:

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Maternity - Southport & Ormskirk Hospital - Southport & Ormskirk Hospital (southportandormskirk.nhs.uk)

Booking Line 01695 656924

Early Pregnancy Unit 01695 656064 (Monday to Friday 9am to 5pm)

G Ward (emergency gynaecology problems or early pregnancy out of hours) 01695 656901

16-weeks pregnant or over maternity triage 01695 656604 (24 hours)

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Sefton Peer Support Group:
(1) Pandas Sefton | Facebook

Perinatal Mental Health Support Group
Every Monday 10-12pm
The Feel Good Factory, Glovers Lane, Netherton, L30 5QW

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https://www.birthrights.org.uk/factsheets/

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Knowing your rights and the law in pregnancy and childbirth is important. Our factsheets provide you with the latest information on your rights, where they come from in law, and how they are backed up in guidance.

Each link below goes to a new page where you can read the information or download a printable PDF document.

We do not deal with maternity-related employment or benefits issues. Maternity Action provide comprehensive information on your rights at work, access to benefits, breast-feeding and chest-feeding rights.

Birthrights is a UK-based organisation and our factsheets cover the law in the UK, except where stated. They were last updated in August 2021 (written in May 2021).

Read our legal statement and copyright for terms and conditions of use of these factsheets.

If there's an area we've missed that you would like to see covered, please get in touch.
We are grateful to Looseleaf Productions, the Hollick Family Foundation, the Baring Foundation and the National Lottery Community Fund for supporting our factsheets.
Do you work with pregnant women and birthing people?

Our training equips doctors, midwives and other birth workers with knowledge of the law and human rights principles, an understanding of how to apply it in practice, and the ability to communicate effectively with women and birthing people in a way that upholds their human rights. We offer a 10% discount to multidisciplinary teams.

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Knowing your rights and the law in pregnancy and childbirth is important. Our factsheets provide you with the latest information on your rights, where they come from in law, and how they are backed up in guidance. Each link below goes to a new page where you can read the information or download a printable ...

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https://www.miscarriageassociation.org.uk/

If you’ve been affected by miscarriage, molar pregnancy or ectopic pregnancy, we hope this website will provide the information that you’re looking for.

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After thirty years of service our very first National Director, Ruth Bender Atik is retiring and we are recruiting for a new CEO. Our next Chief Executive will have the full support of the trustees to develop the strategy that will take the Miscarriage Association through the next chapter of its journey, based on a [...]
Continue reading "

We are so thankful to everyone who contributes to Baby Loss Awareness Week. Sharing stories, raising funds and getting involved on social media - it all helps us to spread the word and raise awareness of the impact of miscarriage, ectopic and molar pregnancy. Crucially, you help us all create and maintain this special opportunity [...]
Continue reading "

The Royal College of Obstetricians and Gynaecologists (RCOG) has updated its guidance for doctors on caring for people with recurrent miscarriage. They have also published a patient information leaflet. What is new? There is a change in the definition of recurrent miscarriage more consideration of the occasions where someone might be offered tests after two [...]
Continue reading "

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The Miscarriage Association:Pregnancy Loss Information & Support

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Learn about the Miscarriage Association, how to cope, and support those experiencing pregnancy loss. Access vital resources and information.

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https://elsiesmoon.co.uk/

Supporting families when pregnancy doesn't go to plan

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Breast Feeding Network:
Home - The Breastfeeding Network
Helpline; We're open 9.30am-9.30pm every single day of the year on 0300 100 0212.
National Breastfeeding Helpline UK | Facebook

LaLeche League:
https://www.laleche.org.uk
LLLI Breastfeeding Support | Facebook

NHS:
Breastfeeding | Feeding Your Baby | Start4Life (www.nhs.uk)
Breastfeeding: the first few days - NHS (www.nhs.uk)

Best Beginnings:
Breastfeeding Videos | Best Beginnings

BFF Accreditation, What does it mean:
Breastfeeding in the UK - Baby Friendly Initiative (unicef.org.uk)

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Columns are titled for ease of search
- click on the website link (if present) or photograph to open the link/webpage/document/video
- scroll right to see all topics
- scroll down each column to find additional links/information

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This padlet is a work in progress designed with local families to help make local maternity care the best it can possibly be.
If you have any suggestions for resources that can be added or spot any errors or broken links, please let us know by emailing voices.mvp@gmail.com.

Thank you!

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Click the link below the picture for resources about who to contact regarding comments, compliments, concerns and complaints.

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Please complete the survey below regarding your recent maternity experience. You can skip any questions that you do not wish to answer or feel you are not able to answer, and you are welcome to complete the surveys as many times as you would like to. All feedback is valuable to us.

Your feedback is gathered by Southport Ormskirk Sefton Maternity Voices Partnership (MVP), service user representatives and volunteers. It is shared with the Southport and Ormskirk NHS Trust Hospital Maternity Leadership Team to help develop and improve Maternity services.

Any personal information that you provide will be treated in accordance with applicable data protection laws and our Privacy Policy - available at www.nationalmaternityvoices.org.uk/privacy.

We work proactively towards a better future for local maternity care. Whilst it is important that we learn from all experiences, whether positive or negative, SOS MVP is not part of the complaints process.

If you have concerns regarding your care, please contact soh-tr.pals@nhs.net or telephone 01704 704703.

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Please complete the survey below regarding your recent maternity experience. You can skip any questions that you do not wish to answer or feel you are not able to answer, and you are welcome to complete the surveys as many times as you would like to. All feedback is valuable to us.

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https://www.achingarms.co.uk/

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Aching Arms - the charity bringing comfort after baby loss

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The charity Aching Arms is here to support and help you if you've suffered the loss of a baby during pregnancy, at birth or soon after.

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https://4louis.co.uk/

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SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS

SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS

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SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS SUPPORTING FAMILIES THROUGH MISCARRIAGE, STILLBIRTH AND CHILD LOSS

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https://www.lighthousestherapyservices.co.uk/

Support for stillbirth, miscarriage, neonatal loss, ectopic pregnancy and compassionate induction/termination of pregnancy

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Lighthouses Therapy Services | Post Infant Loss Support Service

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Have you suffered a miscarriage or another form of infant loss? Or have you experienced the trauma of a termination of pregnancy? Lighthouses Therapy Services are here to help.

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Abigail's Footsteps
https://www.abigailsfootsteps.co.uk

Beyond Bea
https://www.beyondbea.co.uk

Cradle Early Loss Support
http://www.cradlecharity.org/
Cradle | Facebook

Child Bereavement UK
How we can support you | Child Bereavement UK

Love Jazmine
Bereavement Support | Merseyside | Love, Jasmine (lovejasmine.org.uk)

Lullaby Trust
Bereavement support after the death of a baby or child - The Lullaby Trust

Miscarriage Association
Your feelings after miscarriage and pregnancy loss - The Miscarriage Association

SANDS
http://www.sands.org.uk/

Tommy's Baby Loss Support
Baby loss information and support | Tommy's (tommys.org)

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Twins Trust:
Resources for parents (twinstrust.org)

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https://www.nct.org.uk/labour-birth/different-types-birth/caesarean-birth/vaginal-birth-after-caesarean

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What is a VBAC?

A vaginal birth after caesarean (VBAC) is when a woman gives birth vaginally, after having had a caesarean previously. Vaginal birth includes a straightforward vaginal delivery and a birth assisted by forceps or ventouse (RCOG, 2016).

"You might be able to have a VBAC even if you've had more than one previous caesarean."

What are the advantages and risks of having a VBAC?

What are the advantages of a VBAC?

VBAC is an option for most women, and research shows that when a VBAC is successful it has fewer complications than an elective repeat caesarean section (ERCS). Most women are able to have a successful VBAC without any complications (NHS Choices, 2017).

The advantages of a successful vaginal birth are:

A greater chance of a vaginal birth in future pregnancies.

Recovery and returning to everyday activities is likely to be quicker.

Your stay in hospital might be shorter.

You are more likely to be able to have skin-to-skin contact with your baby immediately after birth, which might help you to establish breastfeeding successfully.

By having a VBAC you avoid the risks of an operation.

Your baby will have less chance of initial breathing problems. (RCOG, 2016)

What are the risks of VBAC?

The risks vary and depend on your obstetric history, the reasons for any previous caesarean(s), and whether you have previously given birth vaginally.

Risks of VBAC include the scar from the previous caesarean birth opening up (uterine rupture). This affects around one in 200 women trying for a VBAC. That risk is increased two to three fold if labour is induced.

Not everyone who plans a VBAC will succeed in having one. Out of 100 women attempting a VBAC, 25 will need an emergency caesarean.

Sometimes opting for a VBAC isn't advised. For example, if you've previously had a uterine rupture, significant uterine stretching or uterine surgery, or have a vertical scar on your uterus or placenta praevia. (RCOG, 2016; NHS Choices, 2017)

Will I need extra monitoring during a VBAC?

If you're having a VBAC, you will usually be offered extra monitoring during labour (NHS Choices, 2016). This will include the baby's heartbeat being monitored continuously once you're having regular contractions (RCOG, 2016). Extra monitoring checks everything is progressing well and detects any early signs of problems with your previous caesarean scar (RCOG, 2016).

Due to the risks, you'll be advised to give birth in a hospital labour ward with facilities for immediate caesarean and blood transfusion (NICE, 2012).

What if my midwife says I shouldn't have a VBAC?

If you choose to plan a vaginal birth after previously giving birth by caesarean, your preferences and priorities should be taken into account (NICE, 2012). A woman in the UK who is deemed to have capacity to consent has the right to refuse a caesarean, and this should be respected (NICE, 2012).

Where it is difficult to agree a mutually acceptable solution between you and your healthcare professionals, you might choose to request a second opinion (NHS Choices, 2016b). Depending on your local area, you might be able to request a discussion with a specialist midwife to discuss your birth plan (NICE, 2012).

Can I have a VBAC if I've had more than one caesarean birth?

Even if you've had up to four previous caesarean sections, there is no difference in the risk of fever or injuries between a VBAC and a planned caesarean. Your risk of risk of uterine rupture is higher but it's still rare (NICE, 2012).

There is a slightly increased risk of hysterectomy and blood transfusion in women having a VBAC after two previous caesarean births, compared with one previous caesarean birth (RCOG, 2015b). If you're considering a vaginal birth after more than one caesarean birth, do discuss the potential risks, benefits and success rates with a senior obstetrician (RCOG, 2015b).

Can I plan for a VBAC home birth?

It'll be recommended that you give birth in hospital because you'd have immediate access to caesarean section and on-site blood transfusion facilities if you needed it (North Lincolnshire NHS Trust, 2011; NICE, 2012). You can ask to discuss whether a home birth might be suitable for your particular situation with your midwife and obstetrician (North Lincolnshire NHS Trust, 2011).

How likely am I to have a successful vaginal birth after a caesarean?

Research suggests that the chances of a successful VBAC are:

85% to 90% if you have had a previous baby vaginally in the past

58% to 75% after one or two previous caesarean births.(RCOG, 2015a; NMPA, 2018)

Statistics for local maternity services including VABC success rates can be found via WHICH Birth Choice and are listed for each NHS maternity site at the end of the NMPA report.

The success rates for VBAC are lower if you have:

your labour induced or speeded up

only ever given birth by caesarean

a BMI greater than 30 at that start of pregnancy

previously had a caesarean section because of a difficult labour. (RCOG, 2015a)

If all four of these apply to you, the chance of having a successful VBAC is reduced to 40% (RCOG, 2015a).

Some women find it hard to decide what to plan for or find it very emotional, after having a caesarean birth, especially if it was an emergency caesarean. There is plenty of perinatal support available if you need it.

It's a good idea to talk through your birth options with your partner. You can also discuss any medical concerns with your midwife, health visitor or GP.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

NHS Choices has an article that you might find useful, called How do I get a second opinion?

You can look at the statistics for your local hospital on caesarean section rates and VBAC rates on the Which? Website.

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Vaginal birth after a caesarean | Labour & birth, Different types of birth articles & support | NCT

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We discuss the advantages and risks of a vaginal birth after a caesarean and answer questions you might have about vaginal births after caesarean.

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RCOG - birth options after previous caesarean

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RCOG - birth options after previous caesarean

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https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/birth-after-previous-caesarean-patient-information-leaflet/

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This information is for you if you have had one caesarean section and want to know more about your birth options when having another baby.

It may also be helpful if you are a partner, relative or friend of someone who is in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information covers:

Choices for birth after having one previous caesarean

The chances of a successful vaginal birth after caesarean (VBAC)

The advantages and disadvantages of VBAC and when it isn't advisable

The advantages and disadvantages of an elective (planned) repeat caesarean (ERCS)

What happens during labour if you're planning a VBAC

What happens if you are planning a VBAC but you don't go into labour

What happens if you have an ERCS planned but you go into labour

See full glossary of terms.
Key points

If you are fit and healthy, both VBAC and ERCS are safe choices with very small risks.

3 out of 4 women who have had one caesarean section and then have a straightforward pregnancy and go into labour naturally give birth vaginally.

9 out of 10 women will have a successful VBAC if they have ever given birth vaginally. Successful VBAC has the fewest complications.

Giving birth vaginally carries small risks for you and your baby but, if you have a successful vaginal birth, future labours are less complicated with fewer risks for you and your baby.

Having a caesarean section makes future births more complicated.

Most women who have a planned caesarean section recover well and have healthy babies, but it takes longer to get back to normal after your baby is born.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Clinical Guideline Birth after Previous Caesarean Birth which you can find online here.

This leaflet was reviewed before publication by women attending clinics in Raigmore Hospital, King's College Hospital, Queen's Hospital, St Mary's Hospital, University Hospital Lewisham and Wrexham Maelor Hospital, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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Birth after previous caesarean patient information leaflet

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This information is for you if you have had one caesarean section and want to know more about your birth options when having another baby. It may also be helpful if you are a partner, relative or friend of someone who is in this situation.

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https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/forceps-or-vacuum-delivery/

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Find out about assisted birth or assisted delivery, which uses forceps or vacuum (ventouse) to help deliver the baby.

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https://www.tommys.org/pregnancy-information/giving-birth/forceps-or-vacuum-delivery-assisted-birth

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Forceps or vacuum delivery (assisted birth)

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An assisted vaginal birth is where the doctor uses special instruments to help deliver the baby during the last stage of labour.

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NCT - First stage of labour: signs, coping and when to go to hospital

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NCT - First stage of labour: signs, coping and when to go to hospital

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https://www.nct.org.uk/labour-birth/your-guide-labour/first-stage-labour-signs-coping-and-when-go-hospital

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First stage of labour: a definition

As labour can be a long, complex process, it's handily referred to as happening in three stages (NICE, 2017).

"The first stage of labour is made up of contractions that will get longer, stronger and more frequent."

These contractions will help to push your baby down and your cervix to open (dilate) so that your baby can come into the world. When your cervix has dilated to about 4cm, you're in 'established labour' (NICE, 2017).

If this is your first baby, the first stage of established labour usually lasts between eight and 18 hours. If it's not, it's more likely to be around five to 12 hours (NICE, 2017).

What do contractions feel like?

Ah, the big question. Trouble is, contractions can feel completely different from woman to woman and even in different pregnancies. So the way your friend describes hers may be a world away from your own experience.

Some ways you might describe the feeling are:

discomfort or a dull ache in your back or lower stomach

pressure in the pelvis

stomach becoming hard, then soft again

wave-like motion from the top of the uterus to the bottom

similar to period pain.

If you're wondering what early labour feels like, watch our video where new mums talk about what it felt like for them.

The good news is that contractions will come and go so - if you can - try and relax in between them (WebMD, 2018).

Contractions versus Braxton Hicks contractions

The contractions you'll experience during established labour are different from the Braxton Hicks contractions (false contractions) that you probably felt while you were pregnant. Unlike Braxton Hicks, they don't go away when you change your position or relax.

Early labour pain management and calling your midwife

Your midwife will know how far on you are and whether you need to be in hospital or at your birthing centre yet. So before you head off anywhere, give them a call.

Your midwife will then ask questions and assess you based on your:

movements

breathing

ability to hold a conversation

emotional state.

Call your midwife or a doctor straight away if:

you have a heavy 'show'

your waters break

your baby's moving less than usual

you're less than 37 weeks pregnant.

(NHS Choices, 2017)

First stage of labour: managing pain at home

In the early part of labour, you're likely to be at home. Try the following if you can:

walk or move around

drink a lot of fluids and healthy snacks

have a warm bath

do some relaxation or breathing exercises

ask your birth partner to rub your back

manage the pain with paracetamol (if needed)

stay in an upright position.

When your contractions start coming every five minutes and last at least 60 seconds, give your midwife a call (NHS Choices, 2017).

Early labour and your birth partner

Having a supportive birth partner can give you a sense of control, comfort and competence and make complications less likely (Hodnett et al, 2013). So (no pressure), choose carefully...

Things your birth partner can do to help you are:

Speaking to midwives or doctors if you're not able to.

Encouraging you (especially through contractions...) and reassuring you.

Massaging your back (if you can bear it... some women can't).

Getting you those crucial energy-boosting drinks and snacks.

Speaking to you about pain-relief options.

Helping you with relaxation and breathing techniques.

Supporting you while you try different positions.

First stage of labour: how it will progress

When you meet your midwife, they will:

Ask you about the length, strength and how often your contractions are coming.

Possibly conduct a vaginal examination and record your pulse, blood pressure and temperature.

Ask about your baby's movement in the last 24 hours.

Examine your stomach.

Monitor your baby's heart rate.

(NICE, 2017; Which?, 2018)

First stage of labour: what happens at the end

Toward the end of the first stage of labour, your cervix will be about 7cm to 8cm dilated.

A lot of women find this the hardest, most painful part of giving birth and you might feel like you are out of control. If this happens to you, don't worry: it's totally normal.

If you want to give birth without pain relief, this might also be the part when you find it the trickiest to stick to your plan. It's absolutely fine, of course, if you do change your mind but if you do want to still avoid pain relief, it is possible to use self-help methods like hypnobirthing instead.

Then you'll be on to the second stage of labour, which will last until you have your baby, normally for two to three hours at the most. (NICE, 2017)

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth and life with a new baby.

You will also find useful information on NHS Choices in a guide to labour.

More information on stages of labour can be found in NICE guidelines.

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. (2013) Continuous support for women during childbirth. Cochrane Database Syst Rev.(7):CD003766. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003766.pub5/pdf [Accessed 3rd August 2018].

NHS Choices. (2017) Signs that labour has begun. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/labour-signs-what-happens/ [Accessed 3rd August 2018].

NICE. (2017) Intrapartum care for healthy women and babies. Available from: https://www.nice.org.uk/guidance/cg190/ifp/chapter/what-happens-during-labour [Accessed 3rd August 2018].

RCM. (2012) Evidence based guidelines for midwifery-led care in labour: assessing progress in labour. Available from: https://www.rcm.org.uk/sites/default/files/Assessing%20Progress%20in%20Labour.pdf [Accessed 3rd August 2018].

WebMD. (2018) Pregnancy and signs of labor. Available from: https://www.webmd.com/baby/labor-signs#1 [Accessed 3rd August 2018].

Which? (2018) Stages of labour. Available from: https://www.which.co.uk/birth-choice/getting-ready-to-give-birth/stages-of-labour [Accessed 3rd August 2018].

WHO. (2013) Counselling for maternal and newborn health care: a handbook for building skills. Available from : https://www.ncbi.nlm.nih.gov/books/NBK304186/ends [Accessed 3rd August 2018].

Further reading

Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. (2013) Maternal position and mobility during first stage labour. Cochrance Database Syst Rev.(8):CD003934. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164173/ [Accessed 3rd August 2018].

Which? (2018b) Choosing your birth partner. Available from: https://www.which.co.uk/birth-choice/getting-ready-to-give-birth/choosing-your-birth-partner [Accessed 3rd August 2018].

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First stage of labour: signs, coping and when to go to hospital | Labour & birth articles & support | NCT

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The first stage of labour - when things start happening - can be daunting. Here's you're guide to everything from contractions to when to call the midwife.

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NCT - Second stage of labour: how and when to push

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NCT - Second stage of labour: how and when to push

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https://www.nct.org.uk/labour-birth/your-guide-labour/second-stage-labour-how-and-when-push

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Second stage of labour: what is it?

The second stage of labour starts when your cervix is open (dilated) fully and ends when your baby is born (NICE, 2017; Hofmeyr and Singata-Madliki, 2020; Häggsgård et al, 2021).

There may be some time between when the cervix is open and when the pushing contractions begin, and this is known as the passive second stage of labour. Once the baby is visible and the pushing contractions begin, that is known as the active second stage of labour (NICE, 2017).

While most people feel the urge to push in the second stage of labour, not everyone experiences this. For some the first and second stages of labour may be a continuous, rather than a two-stage, process (Häggsgård et al, 2021).

For those who do notice a difference in the second stage of labour, it can feel intense and powerful, as you experience a strong pressure pushing the baby downwards. Some people find these contractions easier to cope with as they follow their body's impulses. Others can feel overwhelmed and out of control as their body takes over (Häggsgård et al, 2021).

How long does the second stage of labour last?

Usually, your baby will be born within three hours of active pushing if it's your first baby, and within two hours for second and subsequent births (NICE, 2017; Hofmeyr and Singata-Madliki, 2020). But it can be much quicker.

What can I do to make the second stage of labour easier?

Finding the right position in the second stage of labour may be beneficial and your midwife and birth partner can support you to move into the most comfortable position.

Getting into an upright or side-lying position could help to make the second stage of labour shorter and more comfortable (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020). These positions aid gravity, and mean your pelvis can be more flexible so movement will help your baby out.

Examples of upright positions include:

kneeling

squatting (either independently or using a hammock, rope or bar to dangle from)

standing

using a birthing stool

leaning over a birthing ball.

If you are experiencing back pain then a position that gets you on all fours, like using the birthing ball, can help with that (Hunter et al, 2007). Being in water can help, too.

In the end, follow your instincts and get in whatever position feels right for you, asking your midwife or birth partner to support you to move (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020).

It may help if the midwife and your birth partner offer physical support or positive updates about your baby's progress during the pushing stage of labour. Feeling cared for is particularly important at this time (Häggsgård et al, 2021). Some women may like to be told what is happening, (Häggsgård et al, 2021) while some may not.

It could be a good idea to discuss beforehand how you think you'd like your birth partner to care for you and how much you'd like them to tell you about what they can see happening. Remember, however, that this might change in the moment, so acknowledge that possibility too.

When the time comes, you might want to reach down so you can feel your baby's head. Some people find this boosts their energy levels and can make the birth seem more real (Häggsgård et al, 2021). If things are going slowly, you could ask to be supported to change positions or go to the toilet to create more space for the baby to be born (NICE, 2017).

You might have seen on TV or heard of midwives telling women when or how to push. But this is no longer done as it makes the pushing stage longer, more tiring and can make the experience feel more negative rather than listening to your own body (Prins et al, 2011; Ibrahim et al, 2017; Häggsgård et al, 2021). Instead, your midwife will encourage you to work with your body (Häggsgård et al, 2021).

What if I have an epidural?

If you're experiencing the second stage of labour with an epidural, it may be harder to recognise the changing sensations. So this is when it might help to be guided by your midwife. Once the cervix is open, you could be encouraged to wait for an hour or until the baby's head is visible before beginning to push (NICE, 2017).

You should be supported to find a position that is comfortable for you, such as lying on your side, or leaning over the end of the bed (NICE, 2017; Walker et al, 2018). For more about epidurals and their effect on labour, read our article.

The last push

As your baby's head comes down ready to be born, you may experience a burning or stinging pain in the soft tissue between vagina and anus. You might have concerns about perineal tearing (Häggsgård et al, 2021).

At this point you can slow down your pushing efforts so that your baby's head is born slowly. Your midwife may suggest gently blowing out (like cooling a hot drink) as this can protect the perineum and reduce the chance of tearing (Ibrahim et al, 2017).

Some midwives might use a warm compress on the perineum or support the baby's head as they are born, but others will be more hands-off (NICE, 2017). Neither approach has been shown to be better, and you can say what your preference is. You may find it helpful to have a mirror to see what's happening, as this can help you to feel more in control.

After your baby's head comes out, there could be a pause between contractions before the shoulders are born. When they are fully born, you can then bring your baby to your chest or tummy for skin-to-skin contact, or ask the midwife to do that for you.

What can my birth partner do

Your birth partner might help with physical support or massage, encouragement, or just to sit quietly by if you prefer. They can also make sure your views are heard and acted upon (Bohren et al, 2017). Not to mention providing constant drinks and food when you need them to keep your strength up.

How can I prepare for the second stage of labour?

Some research has found that using breathing techniques involving deep breaths in and out can shorten the second stage of labour and reduce pain (Yuksel et al, 2017). You may wish to practise these techniques in advance.

Perineal massage in the last month of pregnancy can reduce the likelihood of tearing or needing an episiotomy (a cut made in the tissue between the vaginal opening and the anus during childbirth) (Beckman and Stock, 2013).

What if I still feel anxious about the second stage of labour?

Some people may feel particularly apprehensive about the second stage of labour, for example if you have had a previous difficult birth or have experienced sexual violence. Talk to your midwife about your concerns and they will give you information, options and support you in your decisions (NICE, 2017).
This page was last reviewed in September 2022.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

You will also find useful information on NHS Choices here.

Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available at: https://doi.org/10.1002/14651858.CD005123.pub3

Berta M, Lindgren H, Christensson K, Mekonnen S, Adefris M. (2019) Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis. BMC Pregnancy Childbirth. 19(1):466. Available at: https://doi.org/10.1186/s12884-019-2620-0

Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. (2017) Continuous support for women during childbirth. Cochrane Database Syst Rev. (7):CD003766. Available at: https://doi.org/10.1002/14651858.CD003766.pub6

Ibrahim H, Ghattas V, Abd H, Kandeel E. (2017) Effect of breathing technique (blowing) on the integrity of perineum and duration of the second stage of labor among primiparous women. World Journal of Nursing Sciences. 3(3). https://www.researchgate.net/publication/348610324_Effect_of_Breathing_Technique_Blowing_on_the_Integrity_of_Perineum_and_Duration_of_the_Second_Stage_of_Labor_among_Primiparous_Women

Häggsgård C, Nilsson C, Teleman P, Rubertsson C, Edqvist M. (2021) Women's experiences of the second stage of labour. Women Birth. 35(5):e464-e470. Available at: https://doi.org/10.1016/j.wombi.2021.11.005

Hofmeyr G, Singata-Madliki M. (2020) The Second Stage of Labour. Best Practice Research Clinical Obstetrics Gynaecology. 67:53-64. Available at: https://doi.org/10.1016/j.bpobgyn.2020.03.012

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. (4):CD001063. Available at: https://doi.org/10.1002/14651858.CD001063.pub3

NICE. (2017) Intrapartum care: care of healthy women and their babies. Available from: https://www.nice.org.uk/guidance/cg190 [Accessed 6th August 2022]

Prins M, Boxem J, Lucas C, Hutton E. (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG. 118(6):662-670. Available at: https://doi.org/10.1111/j.1471-0528.2011.02910.x

Walker K, Kibuka M, Thornton J, Jones N. (2018) Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev. 11(11):CD008070. Available at: https://doi.org/10.1002/14651858.CD008070.pub4

Yuksel H, Cayir Y, Kosan Z, Tastan K. (2017) Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med. 15(6):456-461. Available at: https://doi.org/10.1016/S2095-4964(17)60368-6&nbsp;

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Second stage of labour: how and when to push | Labour & birth articles & support | NCT

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How will you know when to push and how long does the second stage of labour last? Here's what you need to know about the stage when your baby will be born.

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https://www.nct.org.uk/labour-birth/your-guide-labour/third-stage-labour-delivering-placenta-and-cord-clamping

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What is the third stage of labour?

The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out (Begley et al, 2011; NICE, 2017).

Once your baby's born, the release of the hormone oxytocin will make the uterus contract and become smaller. This'll make the placenta start to separate.

You will have some bleeding during the third stage of labour as you pass the placenta (Begley et al, 2011).

Active management versus physiological management

Generally, you have two options for how you do the third stage of labour: active management and physiological management. But there's also a third option - mixed management - combining active and physiological approaches (Begley et al, 2011; NICE, 2017).

Physiological management:

It's generally practised in midwife-led units and in home births.

It allows the placenta to be ready to come out mainly by pushing, gravity, contractions and sometimes by nipple stimulation.

It doesn't use oxytocin injections.

The umbilical cord is clamped and cut once it has stopped pulsing or when the placenta has come out.

It can take up to one hour (and shouldn't take more).

Skin-to-skin contact and breastfeeding can help it along, by making your body produce more oxytocin.

It involves sitting in an upright position to encourage the placenta to come out.

Your midwife will monitor your blood loss and keep you and your baby warm.

You'll push the placenta out once it has separated and moved down to your vagina.

It's mostly used if you're at low risk of heavy blood loss.

You can change to active management at any time if needed. (Begley et al, 2011; NICE, 2017)

When the placenta is out, your midwife will clamp and cut the cord. But if you want, you can ask them to wait until it has finished pulsating (RCM, 2013a). Delaying cord clamping for at least a minute has been shown to be beneficial for babies(Science Direct, 2021).

Active management:

Involves an injection of a drug called syntocinon or ergometrine in your thigh soon after your baby's born.

It speeds up the delivery of the placenta - it usually happens within 30 minutes of having your baby. Your midwife will apply some pressure to your belly and pull gently on the umbilical cord to ease the placenta out.

You'll have the umbilical cord cut between one and five minutes after you give birth.

It lowers the risk of heavy blood loss.

It might make you feel sick or vomit, and can increase your risk of high blood pressure.

(Begley et al, 2011; RCM 2013b; NICE, 2017)

Should I have active management or physiological management?

Generally, active management is recommended for all women, to avoid severe haemorrhage. Though this is more of an issue in low-income countries where women are more likely to be poorly nourished, anaemic or have infectious diseases (Begley et al 2015).

If you do go through a haemorrhage though, you'll need to be transferred to a hospital if you're not already there. You'll then be offered treatment that involves:

oxytocin or another drug called ergometrine, which helps the womb to contract and stop the bleeding

your placenta being removed if it hasn't been delivered already

fluids through a drip

oxygen through a facemask.

If the bleeding continues, you'll be given more oxytocin, ergometrine or other drugs. In some cases, an examination under anaesthesia and surgery and/or a blood transfusion might be needed (NICE, 2017).

Retained placenta and problems after birth

If all or some of your placenta has not come out within one hour of you having your baby, this is called a retained placenta.

If that happens to you, you'll need to be put on an intravenous drip. You might also be offered a vaginal examination to see whether you need an operation to remove the placenta. You'll also be offered pain relief (NICE, 2017).

If you do have the placenta removed under anaesthesia, you'll need to have it done within a few hours of the birth to avoid haemorrhage (Weeks, 2001). You'll then need to be transferred to an obstetric unit if you are not already there and might be advised to have an epidural or spinal anaesthetic when the placenta is actually removed (NICE, 2017).
This page was last reviewed in July 2018.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Important information on the third stage of labour can be found in NICE guidelines.

Begley CM, Gyte GML, Murphy DJ, et al. (2011) Active versus expectant management of women in the third stage of labour. Cochrane Database Syst Rev.(11):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

NICE. (2017) Intrapartum care for healthy women and babies. Available from: https://www.nice.org.uk/guidance/cg190/ifp/chapter/delivering-the-placenta [Accessed: 13th August 2018]

Rabe H, Gyte GML, Díaz‐Rossello JL, Duley L. (2019) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews. Available from: (9):CD003248. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003248.pub4... [Accessed: 4th October 2019]

RCM. (2013) How to conduct active management of the third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-conduct-active-management-of-the-third-stage-of-labour [Accessed: 13th August 2018]

Weeks AD. (2001) The retained placenta. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704447/] African Health Sciences. 1(1):36-41. [Accessed: 13th August 2018]

Science Direct (2021) A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns [Accessed: 27 August 2021] https://www.sciencedirect.com/science/article/abs/pii/S0301211521002098...
Further reading
Begley CM, Gyte GML, Devane D, McGuire W, Weeks A. (2015) Delivering the placenta with active, expectant or mixed management in the third stage of labour. Cochrane Database Syst Rev. 2015.(3):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

Jangsten E, Mattsson LA, Lyckestam I, Hellstrom AL, Berg M. (2011) A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial. British J Obst Gynaecol. 118(3):362-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21134105 [Accessed: 13th August 2018]

RCM. (2013) How to promote a physiological third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-promote-a-physiological-third-stage-of-labour [Accessed: 13th August 2018]

Midwife thinking An actively managed placental birth might be the best option for most women https://midwifethinking.com/2015/03/11/an-actively-managed-placental-bi...

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Third stage of labour: delivering placenta and cord clamping | Labour & birth articles & support | NCT

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The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out.

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Birth Trauma Association:
www.birthtraumaassociation.org.uk

Make Birth Better
Make Birth Better

Unfold Your Wings:
UNFOLD YOUR WINGS – Hope, Support and Awareness for Birth Trauma and Perinatal PTSD

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Weaning and feeding - NHS (www.nhs.uk)

Weaning your premature baby | Bliss

Baby-led weaning: pros and cons | NCT

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What is weaning?

Introducing your baby to solid foods, also referred to as weaning or complementary feeding, starts when your baby is around 6 months old.

Your baby should be introduced to a varied diet, alongside their usual breast milk or first infant formula.

It can be confusing knowing when and how to start introducing solid foods. We're here to guide you through the weaning journey and explain what it all means.

We've got expert NHS advice, helpful videos, tips from other parents, and lots of simple, healthy weaning recipe and meal ideas.

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Weaning means introducing your baby to solid foods alongside their usual breast milk or infant formula. We're here to guide you through the journey.

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Covid-19 Vaccine, Pregnancy & Breastfeeding Evidence Based information & Resources

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Covid-19 Vaccine, Pregnancy & Breastfeeding Evidence Based information & Resources

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If you're pregnant, it's important to protect yourself and your baby from coronavirus. The vaccines are safe, effective and save lives.

Here, healthcare professionals answer key questions about the COVID-19 vaccine and pregnancy.

NHS Q&A: https://t.co/iQTWbC83DM

Improving ME Webinar: https://youtu.be/NHKtPaXjbOw

NHS England & NHS Improvement North West:  https://youtu.be/utmqOcAPky0

Further Resources & Information can be found here:

RCOG: Vaccination (rcog.org.uk)

NHS England & NHS Improvement North West: https://www.england.nhs.uk/north-west/north-west-services/north-west-maternity-services/maternity-safety-information/

RCOG Decision Tool: Combined info sheet and decision aid 11.10.2021 (rcog.org.uk)

British Islamic Medical Association: https://britishima.org/operation-vaccination/hub/

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Pregnancy, birth and beyond for dads and partners

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Pregnancy, birth and beyond for dads and partners

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https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/tips-for-your-birth-partner/

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Whoever your birth partner is - the baby's parent, a close friend, partner, or a relative - there are many practical things they can do to help you.

The most important thing your birth partner can do is just be with you.

Talk to your birth partner about the type of birth you'd like and the things you prefer not to do so they can help support your decisions. It can help to go through your birth plan together.

There's no way of knowing what your labour is going to be like or how each of you will cope, but there are many ways a partner can help.

Whatever kind of birth you're planning for, your birth partner can:

keep you company and help pass the time during the early stages

hold your hand, wipe your face and give you sips of water

massage your back and shoulders, and help you move about or change position

comfort you as your labour progresses and your contractions get stronger

remind you how to use relaxation and breathing techniques, perhaps breathing with you if it helps

support your decisions, such as the pain relief you choose, even if they're different from what's in your birth plan

help you explain to the midwife or doctor what you need - and help them communicate with you - which can help you feel more in control of the situation

tell you what's happening as your baby is being born if you cannot see what's going on

Your birth partner may be able to cut the umbilical cord - you can talk to your midwife about this.

You can also read about feelings and relationships in pregnancy, including worries about the birth and sex in pregnancy.

Make sure you and your birth partner both know what to pack for the birth, and what to expect at the hospital or maternity unit if you're planning to have your baby there.

Find maternity services near you.
Community content from HealthUnlocked

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Find out how your birth partner can help during labour, such as reminding you of relaxation techniques, massaging you and holding your hand.

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http://www.nctmatters.org.uk/articles/birth/whats-it-like-being-a-birth-partner/?utm_source=NCT&utm_medium=email&utm_campaign=9392911_April%20NCT%20matters%202018&utm_content=Birth%20partner%20article&dm_i=C2A,5LBM7,GSKQYK,LQ0PJ,1

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When mums are about to go through an event as life-changing and unknown as childbirth, it's no wonder that most of them want their partner, friend or close family member by their side.

But what's it like for the birth partner themselves? Mums can feel like they're doing the 'hard' bit (and yes, let's face it, they are!) but the huge contribution that birth partners make to their experience shouldn't be downplayed.

It's been shown that having a birth partner present at the birth can lead to a better birthing experience and can even make labour progress more quickly.

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What's it like being a birth partner? - NCT Matters

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When mums are about to go through an event as life-changing and unknown as childbirth, it's no wonder that most of them want their partner, friend or close family member by their side. But what's it like for the birth partner themselves? Mums can feel like they're doing the 'hard' bit (and yes, let's face it, they are!)

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Interactive Map to search for Local Perinatal Mental Health Support by Postcode:

Hearts and Minds (heartsandmindspartnership.org)

Further information and Resources
Hearts and Minds (heartsandmindspartnership.org)

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Hearts & Minds Partnership:
Hearts and Minds (heartsandmindspartnership.org)

Smile UK
www.thesmilegroup.org

Maternal OCD
www.maternalocd.org

Action on Postpartum Psychosis: www.app-network.org

Motherwell Cheshire
Motherwell Cheshire CIO – Encourage, Inspire, Empower

Association for Postnatal Illness:
http://apni.org/

Anxiety UK
www.anxietyuk.org.uk

Bipolar UK
www.bipolaruk.org

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https://www.youtube.com/watch?v=Dqb-n_L5hIA&t=2s

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How to talk to your GP about your mental health | Find the Words

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https://www.lullabytrust.org.uk/safer-sleep-advice/

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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An easy guide to practicing safer sleep for your baby and reducing the risk of sudden infant death syndrome (SIDS, or cot death).

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NHS:
Helping your baby to sleep - NHS (www.nhs.uk)

The Lullaby Trust:
The Lullaby Trust - Safer sleep for babies, Support for families

The Sleep Charity:
Children - The Sleep Charity

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https://www.nhs.uk/conditions/baby/support-and-services/your-6-week-postnatal-check/

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Find out about the postnatal check that happens around 6 weeks after the birth, where you can discuss any health issues you may have, including contraception.

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https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/your-body/

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Advice about stitches, piles, bleeding and other physical changes after birth, plus tips to help you make a healthy recovery.

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https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/early-days/

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Sickness Support
Home (pregnancysicknesssupport.org.uk)

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https://thedadpad.co.uk/

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I was a bit scared when we found out we were having a baby, obviously happy, but a bit scared and in the beginning I was a bit clueless. The child development part is my favourite bit, but there's things in there, like things about mental health, that I didn't know about and that I didn't know you needed to know about.

Ross, 22

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DadPad | The Essential Guide for New Dads | Support Guide for New Dads

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Developed with the NHS, DadPad gives new dads and dads-to-be the knowledge and skills needed to gain confidence and give their baby the best start in life.

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https://www.nct.org.uk/life-parent/bonding-and-caring-for-your-baby/how-can-dads-bond-their-baby

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http://www.fatherhoodinstitute.org/

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Building a society that supports men as hands-on fathers and father-figures

The Fatherhood Institute is a UK charity working to build a society that values, prepares, and supports men as involved fathers and caregivers.

Evidence shows that involved fatherhood has unique and significant impacts on children, mothers, and fathers themselves; improves children's wellbeing and outcomes; and helps progress towards gender equality at home and in the workplace.

Our work focuses on research, policy, and practice. We publish research reviews, take part in new studies and test promising family interventions; advocate for policy change; produce practice resources; and train practitioners in perinatal, early years, education, and social care services.

In July 2023 we started a Parliamentary petition calling on the Government to improve its statutory paternity offer, by:

​

Paying employed fathers two weeks' paternity leave at 90% of salary

​

Introducing a 'daddy month' of four weeks' parental leave, paid at the same rate

​

Introducing a Paternity Allowance for fathers who are not employees

If 10,000 people sign the petition by 11 January 2024, the Government will have to respond to this proposal.

Our policy work streams

Discover our work to create more father-inclusive policies and services

Our research

Read our high-quality research reviews, co-investigations with eminent universities, and empirical research

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The Fatherhood Institute is a UK charity working to build a society that values, prepares, and supports men as involved fathers and caregivers. Our work focuses on research, policy, and practice.

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https://www.tommys.org/pregnancy-information/blogs-and-stories/premature-birth/top-5-tips-nicu-dads

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https://www.tommys.org/pregnancy-information/im-pregnant/exercise-in-pregnancy/pelvic-floor-exercises

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https://www.nhs.uk/pregnancy/keeping-well/exercise/

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The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour.

Keep up your normal daily physical activity or exercise (sport, running, yoga, dancing, or even walking to the shops and back) for as long as you feel comfortable.

Exercise is not dangerous for your baby. There is evidence that active women are less likely to experience problems in later pregnancy and labour.

Exercise tips for pregnancy

Do not exhaust yourself. You may need to slow down as your pregnancy progresses or if your maternity team advises you to. If in doubt, consult your maternity team.

As a general rule, you should be able to hold a conversation as you exercise when pregnant. If you become breathless as you talk, then you're probably exercising too strenuously.

If you were not active before you got pregnant, do not suddenly take up strenuous exercise. If you start an aerobic exercise programme (such as running, swimming, cycling or aerobics classes), tell the instructor that you're pregnant.

Remember that exercise does not have to be strenuous to be beneficial.

Exercise tips when you're pregnant:

always warm up before exercising, and cool down afterwards

try to keep active on a daily basis - 30 minutes of walking each day can be enough, but if you cannot manage that, any amount is better than nothing

avoid any strenuous exercise in hot weather

drink plenty of water and other fluids

if you go to exercise classes, make sure your teacher is properly qualified and knows that you're pregnant, as well as how many weeks pregnant you are

you might like to try swimming because the water will support your increased weight. Some local swimming pools provide aqua-natal classes with qualified instructors. Find your local swimming pool

exercises that have a risk of falling, such as horse riding, downhill skiing, ice hockey, gymnastics and cycling, should only be done with caution. Falls carry a risk of damage to your baby

Exercises to avoid in pregnancy

do not lie flat on your back for long periods, particularly after 16 weeks, because the weight of your bump presses on the main blood vessel bringing blood back to your heart and this can make you feel faint

do not take part in contact sports where there's a risk of being hit, such as kickboxing, judo or squash

do not go scuba diving, because the baby has no protection against decompression sickness and gas embolism (gas bubbles in the bloodstream)

do not exercise at heights over 2,500m above sea level - this is because you and your baby are at risk of altitude sickness

Exercises for a fitter pregnancy

If you are pregnant, try to fit the exercises listed in this section into your daily routine. These types of exercise will strengthen your muscles to help you carry the extra weight of pregnancy. They'll also make your joints stronger, improve circulation, ease backache, and generally help you feel well.

Stomach-strengthening exercises

As your baby gets bigger, you may find that the hollow in your lower back increases and this can give you backache. These exercises strengthen stomach (abdominal) muscles and may ease backache, which can be a problem in pregnancy:

start in a box position (on all 4s) with knees under hips, hands under shoulders, with fingers facing forward and abdominals lifted to keep your back straight

pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward. Do not let your elbows lock

hold for a few seconds then slowly return to the box position

take care not to hollow your back: it should always return to a straight/neutral position

do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully

only move your back as far as you can comfortably

Pelvic tilt exercises

stand with your shoulders and bottom against a wall

keep your knees soft

pull your tummy button towards your spine, so that your back flattens against the wall: hold for 4 seconds then release

repeat up to 10 times

Pelvic floor exercises

Pelvic floor exercises help to strengthen the muscles of the pelvic floor, which come under great strain in pregnancy and childbirth. The pelvic floor consists of layers of muscles that stretch like a supportive hammock from the pubic bone (in front) to the end of the backbone (spine).

If your pelvic floor muscles are weak, you may find that you leak urine when you cough, sneeze or strain. This is quite common, and there is no reason to feel embarrassed. It's known as stress incontinence and it can continue after pregnancy.

You can strengthen these muscles by doing pelvic floor exercises. This helps to reduce or avoid stress incontinence after pregnancy. All pregnant women should do pelvic floor exercises, even if you're young and not suffering from stress incontinence now.

How to do pelvic floor exercises:

make yourself comfortable by sitting or lying down with your knees bent

squeeze in and tighten the muscles around your back passage as if you were trying to stop yourself peeing and farting

breathe in as you squeeze in and tighten the muscles, and then breathe out while relaxing the muscles

at first, try to do this exercise quickly

then do it slowly, holding the squeezes for as long as you can before you relax: try to count to 10

try to do 3 sets of 8 squeezes every day: to help you remember, you could do a set at each meal

As well as these exercises, practice tightening the pelvic floor muscles before and during coughing and sneezing.

Find out more about incontinence.

Find out more about keeping fit and healthy after you've had your baby.

How and when should I do pelvic floor exercises?

In this video, a midwife explains how to do pelvic floor exercises and when you can practise them.

Need activity ideas for the rest of the family?

For ideas to help get your family more active visit the Better Health - Healthier Families website.

Please bear in mind that the activity plans are not designed for use during pregnancy but can be useful for your partner, children and other family members.

Video: What can I do during pregnancy to make birth easier?

In this video, a midwife describes things women can do during pregnancy to help make giving birth easier.

Get Better Health: Start for Life pregnancy and baby emails

Sign up for Better Health: Start for Life weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

Community content from HealthUnlocked

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Find out about the benefits of exercise in pregnancy, including which kinds of exercise you can do, such as yoga and swimming, and which you should avoid.

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https://www.tommys.org/pregnancy-information/im-pregnant/exercise-in-pregnancy/easy-pregnancy-workout

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These simple pregnancy-friendly exercises don’t take very long to do and you can fit them into your everyday life, at work or at home.

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https://www.nhs.uk/start4life/pregnancy/exercising-in-pregnancy/

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Gentle exercise during pregnancy is good (and safe) for you and your baby. Not only does it help you maintain a healthy weight, it also helps prepare your body for labour.

Did you know that 150 minutes of exercise each week has loads of benefits for pregnant mums? It doesn't have to be in one go - even bouts of 10 minutes can make a difference!

If you are used to doing regular exercise, keep it up, but do what feels comfortable for your body and don't push yourself too much - exercise doesn't have to be strenuous to be beneficial.

If you're not used to exercising, or haven't done any for a while, now is a good time to start. Try starting off with 10 minutes of daily activity - perhaps take a brisk walk, or go for a swim. You can then build up to 150 minutes of weekly exercise.

Remember, whatever your fitness level, it's really important that you listen to your body and do what feels right for you.

As a general guideline, you should be able to hold a conversation while exercising. If you can't, you need to slow down.

Which types of exercise can I do?

Walking is a great form of exercise. Not only is it free, but you can easily incorporate it into your everyday life. If you didn't exercise before, this is a great way to get you started.

Running is fine as long as you're experienced. If you are new to running, it's not a good idea to take it up now.

Swimming is a good all-round exercise because it uses all your muscles. It also feels good as your body is completely supported in the water. You could also try aquanatal classes.

Prenatal yoga will help you relax and ease body tension with gentle stretching and breathing techniques.

Aerobics classes (or DVDs) created for pregnant women include low-impact exercises.

Pelvic floor and abdominal exercises are really important in pregnancy. Try to fit them into your daily routine as there are many benefits, including strengthening your muscles and joints.

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Exercising in pregnancy is good for you and your baby! Have a look at which types of exercise you can do

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Gentle exercise during pregnancy is good (and safe) for you and your baby. Not only does it help you maintain a healthy weight, it also helps prepare your body for labour. Did you know that 150 minutes of exercise each week has loads of benefits for pregnant mums? It doesn't have to be in one go - even bouts of 10 minutes can make a difference!

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https://www.happymumhappybaby.com/

Lots of great information all about motherhood

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Happy Mum Happy Baby - Online Parenting Community - Giovanna Fletcher

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From listening to a relatable podcast to meeting other mums and dads at community events, Happy Mum Happy Baby is all about connecting with other parents.

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AIMS - Twins and Multiples: More Babies, More Decisions, Same Rights

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AIMS - Twins and Multiples: More Babies, More Decisions, Same Rights

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https://www.aims.org.uk/journal/index/29/4

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Journal Vol. 29, No. 4 - Twins and Multiples: More Babies, More Decisions, Same Rights

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Journal Vol. 29, No. 4 - Twins and Multiples: More Babies, More Decisions, Same Rights

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https://twinstrust.org/

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Breastfeeding Twins - Association of Breastfeeding Mothers

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Breastfeeding Twins - Association of Breastfeeding Mothers

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https://abm.me.uk/breastfeeding-information/breastfeeding-twins/

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs. With two babies, more milk is removed from the breasts, so more milk is made. The best way to make sure you establish a good supply is to feed your babies often in the early weeks and to ask someone knowledgeable to help you check that they are attached and breastfeeding correctly.

During the first few days and weeks, babies send signals to your milk supply and may sometimes feed more frequently. This frequent feeding is sometimes perceived as a sign of a lack of milk but, if feeds happen responsively, milk supply will swiftly increase, and feeding will settle into a pattern again. Your babies' weight gain and their nappies will reassure you that they are getting the milk they need.

"I found out at an antenatal scan that I was expecting twins. I asked if I could breastfeed them and was told that I would have to give bottles as well. This upset me as I'd really enjoyed breastfeeding my other two children. The twins were born at 36 weeks (though I nearly had them earlier than that). They never had bottles. I'm glad I found out in advance that it's possible to breastfeed twins."
How can I breastfeed two babies?
Confidence and the belief that it can be done are important. Attend a breastfeeding support group or workshop while you're pregnant to increase your confidence and find out where to get support locally. If you have any questions after your babies are born, you'll know who to ask. Perhaps you can be put in touch with someone who has breastfed twins (or see the Facebook group mentioned below).

"The twins were our first children and I thought I'd like to try to breastfeed. I read a little and a friend invited me to watch her breastfeed her baby. Most of the mums I met at a twins' club hadn't tried, but I decided to give it a go. Our babies were born at 37 weeks after a straightforward labour and the hospital staff were generally encouraging. I wish I'd known a bit more about growth spurts though and how to let the babies increase my milk supply at these times. I also wish I had known about antenatal hand expressing."

Twins can be fed separately or together. Many mums find that they do both in different situations and when their twins are at different stages of development. Feeding babies together can be a good way to establish a plentiful milk supply quickly and can save time. While mum and each baby are still learning about breastfeeding, it may be easier to spend some time feeding separately. As the babies grow and their head control develops, it will be easier to breastfeed them together. Later still, the babies will be able to position themselves. Decisions like when to swap breasts and which positions work best, will vary from family to family.

"Don't be afraid to ask for help positioning the second twin in the early days, so you can have a go at feeding two babies together."

Rugby hold, Parallel and Crossover holds
Breastfeeding cushions designed with twins in mind are more likely to enable a mum to tandem feed and even feed hands-free. However, some mums find they prefer to use V-shaped or normal pillows or cushions or use positions where no cushions are needed. If you have someone to assist you in the early days, they can help you position a second baby after the first one has started feeding.

"After a couple of weeks, I got the hang of feeding lying down and that made things a lot easier at night. When they were a little older, I managed to find a way of feeding both lying down. You get inventive about using different positions and doing things like answering the phone while breastfeeding."

"Our girls are now 17 months old and I'm still enjoying breastfeeding them. Now they are toddlers, I tend to feed them separately, but I used to do a mixture of breastfeeding separately and together."

What if my babies are born early?
Twins are more likely to be born early than single babies. If babies are born early, their mother's milk will be different to full-term milk and have specific advantages for pre-term babies. Breastmilk reduces a baby's chances of becoming ill and some conditions can be particularly serious in a pre-term baby. If twins are born very early, they may need to be fed by tube or special cup until they are able to breastfeed. Expressing breastmilk for premature babies will mean a mother is making a valuable contribution to her children's welfare, especially as hospital staff are responsible for other aspects of their care. Donor milk can also be an option.
Won't I be too tired to breastfeed?
Tiredness is sometimes given as a reason not to breastfeed twins, but there's no evidence that breastfeeding in itself is tiring. In fact, breastfeeding mums can make the most of opportunities to sit or lie down. It's important to eat a balanced diet and to rest when your babies sleep.

Once breastfeeding is established, it gets easier to go out or travel with twins, because breastmilk is available immediately and at the right temperature. Imagine the sheer number of bottles to be washed, sterilised, made up with hot water then cooled down for bottle-fed twins, and the cost of formula.

Breastfeeding involves the release of specific hormones that help a mother to feel relaxed. This is particularly beneficial for mums of twins who are likely to have an even busier time than other mothers. Also breastfeeding will help your uterus (particularly enlarged after having twins) to contract back to its pre-pregnancy shape and size and will help you lose weight more quickly.

If families feed their babies at the same time, they may choose to wake the other twin at night to minimise the number of night feeds. Breastfeeding at night can be done lying down and can help to establish a good supply of milk.
But my family and friends want to help
Grandparents or others might ask if they can help by giving a baby a bottle, but if bottles are introduced early on, this may make breastfeeding more difficult to establish and reduce a mother's milk supply. Dummies may also mean the demand on your milk is reduced so the supply reduces. However, some mothers of twins do find that expressing breastmilk can be useful and allows someone else to feed the babies occasionally.

There are lots of other things that family and friends can offer to do to help parents of newborn twins e.g. cuddling a baby, changing a nappy, offering mum a drink or sandwich, helping at bath time if needed, or hanging out washing. The support and encouragement of friends and family is an important aspect to breastfeeding twins successfully.
More information:

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Many new mums worry about whether they will have enough milk, but in fact there are very few women who don't have enough.

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http://www.multiplebirths.org.uk/index.asp

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https://www.lullabytrust.org.uk/safer-sleep-advice/twins/

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You may like to sleep your twins in their own Moses baskets or cots from birth, or you may decide to co-bed them in the early weeks and months.

Co-bedding means siblings share the same sleep surface during any sleep period, for example by being in the same cot together.

Whichever you decide, all The Lullaby Trust advice for safer sleep should be followed for each baby, for each day and night time sleep.

This includes, for example:

Please have a read of our other safer sleep guidance for information on sleeping babies as safely as possible.

Safer sleep for twins: FAQs

Can I bed-share/co-sleep with my twins?

The safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. Sharing a bed with an adult is a significant risk for babies born prematurely or at a low birth-weight, which is common in multiples.

Co-sleeping is particularly dangerous if either you or your partner smokes (even if you do not smoke in the bedroom), has drunk alcohol or taken drugs (including medications that may make you drowsy), or are very tired.

If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

You can find further information on our co-sleeping page.

If my twins were slept close together on the NICU, shouldn't I be continuing this at home?

Premature or low birth-weight twins are often slept in close proximity on the Neonatal Intensive Care Unit to model the intrauterine environment and improve the development of vital functions like heart rate and breathing.

Once your babies are discharged, they should be ready to be slept according to the safer sleep advice for all babies. You can also phone our information line with any queries on 0808 802 6869.

My health visitor told me it's better for twins to sleep in the same cot together than to sleep separately. Why is this?

At The Lullaby Trust, we often will promote co-bedding your twins so that you can share a room with them, if you have restricted space. Sharing a room with your babies is a really important measure you can take to reduce the chance of SIDS.

However, there are other reasons you might want to co-bed your twins that you might want to look into. Various areas of research have suggested that putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe them and their twin.

I've read that babies need separate sleep spaces once they can roll and move about the cot. What is the best thing to do if I don't have space for two cots in my room?

Sometimes it can be tough in a practical sense to adhere to all of the safer sleep messages, particularly if you are short on space.

If you can't fit two cots in your bedroom for your twins, make the advice work for you - you may like to leave doors open between your rooms, or perhaps take in turns with a partner to sleep with the twins in a nursery room.

If possible, you may even be able to borrow something smaller than a second cot for a couple of months, such as a crib. Give our information line a call to have a chat about any further options.

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You may like to sleep your twins in their own Moses baskets or cots from birth, or you may decide to co-bed them in the early weeks and months. Co-bedding means siblings share the same sleep surface during any sleep period, for example by being in the same cot together.

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https://www.nhs.uk/conditions/baby/newborn-twins-and-multiples/twins-and-sleep/

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Problems getting twins to sleep

There are several reasons why 2 or more babies may be more difficult to get into a good sleeping routine.

Twins and triplets are more likely to be born prematurely and spend time in neonatal care, where they're used to being touched and nursed frequently.

They may miss this contact and find it hard to settle when they come home.

If you're still visiting 1 baby in hospital, it can be hard to establish a good routine with the other baby at home.

Other things to note:

Newborn babies, in particular premature babies, have tiny stomachs and need to feed frequently.

It may take longer to get into a routine with 2 babies to care for.

More than 1 person may be caring for your babies, and they'll take a while to get used to being handled in different ways by different people.

You may want to comfort a restless twin faster than you would a single baby, as you're worried they may wake up their twin.

But there are plenty of ways to encourage a good sleeping routine so everyone gets enough rest.

Can my twins sleep in 1 cot?

You can put your twins to sleep in a single cot while they're small enough. This is called co-bedding and is perfectly safe.

In fact, putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe them and their twin.

If you put your twins in the same cot, follow the same safe sleeping advice as for a single baby.

They should be placed on their backs with the tops of their heads facing one another and their feet at opposite ends of the cot, or side by side on their backs, with their feet at the foot of the cot.

Use a single cot for co-bedding, but not a Moses basket, as it'll be too small for 2 babies.

Co-bedding means you can keep your babies with you in your room for longer.

With triplets, you can place them next to each other across a cot while they're still small enough to fit.

They should be laid on their backs with their feet touching the side of the cot.

When your twins are older, you may choose to put them in separate cots placed close together so they can continue to comfort each other.

If older twins are disturbing one another, you may think about giving them separate rooms if you have enough space.

It's recommended that babies sleep in the same room as their parents for the first 6 months, as this is known to reduce the risk of cot death.

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There are several reasons why 2 or more babies may be more difficult to get into a good sleeping routine. Twins and triplets are more likely to be born prematurely and spend time in neonatal care, where they're used to being touched and nursed frequently.

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https://www.arc-uk.org/

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PADS Poster

A great community to join if your little one has a diagnosis of Down's Antenatally or Postnatally

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Check out this Website designed by PADS.

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https://www.bestbeginnings.org.uk/watch-small-wonders-online

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Reducing the risk of SIDS for premature babies

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Reducing the risk of SIDS for premature babies

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https://www.lullabytrust.org.uk/safer-sleep-advice/premature-babies/

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Babies who are born prematurely (before 37 weeks) or of low birth weight (under 2.5kgs) are particularly vulnerable and it is important that all the safe sleep advice is followed. Premature babies are sometimes slept on their front in hospital for special medical reasons. When they are getting ready to go home these babies should always sleep on their back to reduce the risk of sudden infant death.

Download our Safer Sleep Advice for Premature Babies guide below for further information on reducing the risk of SIDS.

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Babies who are born prematurely (before 37 weeks) or of low birth weight (under 2.5kgs) are particularly vulnerable and it is important that all the safe sleep advice is followed. Premature babies are sometimes slept on their front in hospital for special medical reasons. When they are getting ready to go home these babies should [...]

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The Smallest Things - Dad's stories of NICU

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The Smallest Things - Dad's stories of NICU

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https://www.thesmallestthings.org/dads-do-nicu

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News About us Get involved Run For Us Picnic Meet with your MP to ask for Neonatal Leave Now How to Fundraise You give | we do Subscribe to our newsletter Who We Are Our Mission After NICU: A post pandemic report 2021 Prem Aware Award Your premature child at

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https://connectnw.baby/

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Connect North West is the neonatal transport service for the North West of England and North Wales. We take referrals via our 24 hour cot bureau for both antenatal and postnatal transfers. Contact Details Connect North West St Marys HospitalOxford RoadManchesterM13 9WL0300 330 9299 Making a referral Contact us assoon as you suspecta neonate needs transfer for intensivecare, specialistcare or repatriation.

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NHS
Special care: ill or premature babies - NHS (www.nhs.uk)

Bliss
www.bliss.org.uk

Tommy's
Support for you and your premature baby at home | Tommy's (tommys.org)

Everything you need to know about Premature Babies (premature-babies.co.uk)

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A stay in neonatal care - An animated guide

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A stay in neonatal care - An animated guide

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https://youtu.be/ARYFMnXhmLw

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A stay in neonatal care - An animated guide

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https://www.thesmallestthings.org/who-we-are-1

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We've been there too

It's impossible to know what it's like behind NICU doors unless you've walked those corridors, scrubbed your hands, heard the alarms and felt the fear of losing the most precious thing in the world to you. We get it because we've been there too. The Smallest Things is run entirely by volunteers who've had premature babies. And that's exactly what inspires us to support families, raise awareness and instigate change. We believe in a better world for families of premature babies. A world in which parents have the time they need before returning to work, without money worries; the support they need after they leave the hospital; and the reassurance that they are not alone on their journey. Because prematurity doesn't end when you leave NICU.

Founder and chair
Catriona is a paediatric occupational therapist, with nearly twenty years experience working with children, young people and families. She was chair of the Royal College of Occupational Therapists Specialist Section for Children and Young People (2009 - 2011) and founded the Smallest Things premature baby charity in September 2014 following the premature birth of both her sons. Having worked in NHS hospitals, including in neonatal intensive care units, for many years, Catriona now works with children and young people in the community, specialising in Special Educational Needs.

Communications director
Sarah cut her teeth as a journalist at the BBC in 2002 and now works in content marketing for global brands with a focus on health and family. As Editor of Tesco Magazine she oversaw Cancer Research UK's Race for Life magazine and ran communications workshops for CLIC Sargent. A former parent adviser for Bliss, she currently volunteers for TAMBA (Twins and Multiple Birth Association) Bereavement Support Group. Sarah gave birth to premature twins at 28 weeks and spent over six months in NICU before her youngest died from surgical complications.

Strategy director
Matt works in the public sector and has held jobs in homelessness and children's services at Birmingham City Council during his 12 years with the local authority. He is currently Head of Business Change at Core Assets, one of the UK's largest independent providers of children's services. Matt and his wife, Sally, had their daughter Isabelle at 34 weeks' gestation back in 2011 and then twin boys Harry and Sam at 25 weeks' gestation in 2015. Sadly, Sam was too fragile and passed away at 16 days old. After various fundraising events and activities raising money as #prematurerockstar for different premature baby charities, including The Smallest Things, Matt became one of our Trustees in 2018.

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Who We Are - About - The Smallest Things

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We get it because we've been there too. The Smallest Things is run entirely by volunteers who've had premature babies. And that's exactly what inspires us to support families, raise awareness and instigate change. We believe in a better world for families of premature babies.

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Tommy's - The Neonatal Intensive Care Unit (NICU)

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Tommy's - The Neonatal Intensive Care Unit (NICU)

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https://www.tommys.org/pregnancy-information/premature-birth/how-the-baby-unit-works

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https://www.bliss.org.uk/

For babies born premature or sick

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For babies born premature or sick | Bliss

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Our vision is that every baby born premature or sick in the UK has the best chance of survival and quality of life.

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https://www.neonatalnetwork.co.uk/nwnodn/

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Find your local unit

Hospitals often have a unit or ward dedicated to caring for babies who require additional support after birth, which cannot be provided on the Maternity wards.

These are often referred to in different ways such as the Special Care Baby Unit (SCBU), Neonatal Unit (NNU) or Neonatal Intensive Care Unit (NICU)

Latest News

For the latest news, please follow us on

NWNODN working in close collaboration with

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North West Neonatal Operational Delivery Network

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Find your local unit Hospitals often have a unit or ward dedicated to caring for babies who require additional support after birth, which cannot be provided on the Maternity wards.

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https://www.tommys.org/pregnancy-information/urgent-help

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If your pregnancy is uncomplicated your risk of stillbirth is low (1 in 200 babies are stillborn). Taking these two steps below will make your risk even lower.

Knowing your baby's movements

Your baby's movements are a sign that they are well. When a baby is unwell or not receiving enough oxygen or nutrients, they move less to conserve their energy.

Being aware of their pattern of movement allows you to be aware and act if movements change in any way. Going to the hospital in time is important to make a difference.

A slow down of movement was reported by the mother in around half of stillbirths.
Read all about baby's movements and how to keep track of them.
Going to sleep on your side

Research has shown that in the third trimester (after 28 weeks of pregnancy) going to sleep on your back increases your risk of stillbirth. As the link has now been shown in four separate research trials, our advice is to go to sleep on your side in the third trimester because it is safer for your baby. The advice is the same for any type of sleep, including:

going to sleep at night

returning to sleep after any night wakenings

day time naps.

Sleep position in the third trimester is important because if you are on your back the combined weight of baby and womb puts pressure on other organs in your body.

Researchers do not know for certain what exactly is causing the increased risk of stillbirth, but we already know the following, which could play a part :

When sleeping/lying on your back the baby and womb put pressure on the main blood vessels that supply the uterus and this can restrict blood flow/oxygen to the baby.

Further recent studies have shown that when a woman lies on her back in late pregnancy (compared to lying on side) the baby is less active and has changes in heart-rate patterns. This is thought to be due to lower oxygen levels in the baby when the mother lies on her back.

Read our Q&A about sleep position and stillbirth risk here.
Other things you can do to keep your baby safe

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If your pregnancy is uncomplicated your risk of stillbirth is low (1 in 200 babies are stillborn). Taking these two steps below will make your risk even lower. Your baby's movements are a sign that they are well. When a baby is unwell or not receiving enough oxygen or nutrients, they move less to conserve their energy.

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https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby/blood-spot

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This information was created on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening.

This short video explains blood spot screening in newborn babies.
Newborn blood spot video
Blood spot screening is recommended by the NHS.

1. Purpose of screening

To find out if your baby has any of 9 rare but serious health conditions.

Early treatment can improve your baby's health and prevent severe disability or even death. If you, the baby's father, or a family member already has one of these conditions, please tell your health professional straight away.

2. About these conditions

2.1 Sickle cell disease

About 1 in 2,800 babies born in the UK has a sickle cell disease ( SCD). These are serious, inherited blood diseases. They affect haemoglobin, a part of the blood that carries oxygen around the body. Babies who have SCD will need specialist care throughout their lives.

People with SCD can have attacks of severe pain, get serious, life-threatening infections and are usually anaemic (their bodies have difficulty carrying oxygen). Babies with SCD can receive early treatment, including vaccinations and antibiotics, which, along with support from their parents, will help prevent serious illness and allow them to live a healthier life.

2.2 Cystic fibrosis

About 1 in 2,500 babies born in the UK has cystic fibrosis ( CF). This inherited condition affects the digestion and lungs. Babies with CF may not gain weight well and frequently have chest infections. Babies with CF can be treated early with a high-energy diet, medicines and physiotherapy. Although children with CF may still become very ill, early treatment can help them live longer, healthier lives.

2.3 Congenital hypothyroidism

About 1 in 2,000 babies born in the UK has congenital hypothyroidism ( CHT). Babies with CHT do not have enough of the hormone thyroxine. Without thyroxine babies do not grow properly and they can develop permanent serious physical problems and learning disabilities.

Babies with CHT can be treated early with thyroxine tablets and this will allow them to develop normally.

It is important to let your health professional know if you have a family history of a metabolic condition. Babies are screened for 6 inherited metabolic diseases (IMDs).

These are:

phenylketonuria (PKU)

medium-chain acyl-CoA dehydrogenase deficiency (MCADD)

maple syrup urine disease (MSUD)

isovaleric acidaemia (IVA)

glutaric aciduria type 1 (GA1)

homocystinuria (pyridoxine unresponsive) (HCU)

About 1 in 10,000 babies born in the UK has PKU or MCADD. The other conditions are rarer, occurring in 1 in 150,000 babies to 1 in 300,000 babies.

Babies with these inherited conditions cannot process certain substances in their food. Without treatment babies with some of these conditions can become suddenly and seriously ill. The symptoms of the conditions are different; some may be life threatening or lead to severe developmental problems.

They can all be treated by a carefully managed diet, which is different for each condition and may include additional medicines.

3. The screening test

When your baby is 5 days old the health professional will prick your baby's heel using a special device to collect some drops of blood onto a card. Occasionally this may be later than 5 days. The heel prick may be uncomfortable and your baby may cry. You can help by making sure your baby is warm and comfortable, and by cuddling and feeding them.

Sometimes, a second blood spot sample is required later on. If so, the reason will be explained. It does not necessarily mean there is something wrong with your baby.

4. Safety of the test

There are no known risks to your baby associated with having the test.

5. Screening is your choice

Screening your baby for all these conditions is recommended because it could save your baby's life but it is not compulsory. You can choose to have screening for SCD, CF or CHT individually but can only choose to have screening for all 6 IMDs or none at all. If you do not want your baby screened for any of the conditions or have any concerns about the test, please talk to your midwife.

Early screening is best as treatment can be started as soon as possible if needed. But if you choose not to have screening, your baby can have the test later if you change your mind. Babies can be screened up to 12 months of age for all the conditions except CF (only up to 8 weeks of age).

6. Possible results

Most babies will have normal results indicating that it is unlikely that they have any of the conditions. A small number of babies will screen positive for one of the conditions. This does not mean they have the condition but they are more likely to have it. They will be referred to a specialist for further tests.

Screening for cystic fibrosis finds some babies who may be genetic carriers of the condition. These babies may need further testing. Screening does not detect all carriers.

Occasionally, other medical conditions might be identified through these screening tests. For example, babies with beta thalassaemia major (a serious blood disease) will usually be detected. These children also need to be referred for lifelong treatment and care.

Screening for sickle cell disease also finds babies who are genetic carriers of these or other red blood cell diseases. Carriers are healthy although they can experience some problems in situations where their bodies might not get enough oxygen, for example, if they are having an anaesthetic.

7. Getting my results

You should receive the results from a health professional by the time your baby is 6 weeks old. The results should be recorded in your baby's personal child health record ('red book'). Please keep this safe and bring it with you to any further appointments. You will be contacted sooner if there is thought to be any problem with your baby.

8. My baby's blood spot card and data after screening

After screening blood spot cards are stored for at least 5 years and may be used:

to check the result or for other tests recommended by your doctor

to improve the screening programme

for research to help improve the health of babies and their families in the UK (this will not identify your baby and you will not be contacted)

In addition, there is a small chance that researchers may want to invite you or your child to take part in information gathering linked to the newborn blood spot screening programme. Researchers undertaking any additional studies would explain what is being done and you would then be asked if you wish to take part in that study. Please let your midwife know if you do not want to be contacted to discuss taking part in any additional information gathering.

All use of the blood spots is governed by the code of practice. Any research will have been approved by an independent research ethics committee.

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This information was created on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening. This short video explains blood spot screening in newborn babies. Newborn blood spot video Blood spot screening is recommended by the NHS.

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https://youtu.be/ipI9GOiOsWQ

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Childhood immunisation quick guide for parents of premature babies

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Childhood immunisation quick guide for parents of premature babies

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https://www.gov.uk/government/publications/a-quick-guide-to-childhood-immunisation-for-the-parents-of-premature-babies

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A leaflet for parents which describes the immunisations offered to premature babies.

Applies to England

Documents

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Details

Childhood immunisations guide for the parents of premature babies (born on or after 1 January 2020)

This leaflet features the immunisation schedule from January 2020.

Copies of this leaflet are available to download or order from the Health publications orderline, product code 2019183P.

Childhood immunisations guide for the parents of premature babies (born up to and including 31 December 2019)

This leaflet features the immunisation schedule from Autumn 2019.

Copies of this leaflet are available to download or order from the Health publications orderline, using product code 2019183A

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Childhood immunisation: quick guide for parents of premature babies

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Newborn hearing screening: your baby's visit to the audiology clinic

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Newborn hearing screening: your baby's visit to the audiology clinic

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https://www.gov.uk/government/publications/newborn-hearing-screening-first-visit-to-the-audiology-clinic/newborn-hearing-screening-your-babys-visit-to-the-audiology-clinic

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Public Health England (PHE) created this information on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening.

This leaflet explains why your baby needs to see an audiologist for more tests at an audiology clinic and what those tests involve. An audiologist is a health professional who specialises in hearing.

1. Your baby's visit to the audiology clinic

Audiology clinics have special equipment to test your baby's hearing. These tests will give better information about your baby's hearing.

Early testing means you will know if your baby has a hearing loss when they are still very young. This is important for their future development.

Your baby needs more tests because their hearing screening tests did not show a clear response in one or both ears. About 2 to 3 babies in every 100 do not show a clear response and are referred to audiology.

Most babies tested at an audiology clinic are found to have satisfactory hearing.

About 1 in 15 babies tested at the audiology clinic have a permanent hearing loss in one or both ears. Some have a temporary hearing loss. Finding out about hearing loss early gives babies a better chance of developing language, speech and communication skills as well as making sure their families receive the support they need.

It is important you bring your baby to the appointment. This is because they may need other tests to find a possible cause if they do have a hearing loss. These tests should be performed within the first few weeks of birth.

Some babies who have a hearing loss do react to sounds. The hearing loss may not be picked up without the tests in audiology.

If your baby does have a hearing loss, it is important to find out as soon as possible.

2. What happens at the clinic

The appointment will usually take about 1 to 2 hours. This includes time to settle your baby. The tests give more detailed information about your baby's hearing. They will not hurt or be uncomfortable for your baby. You can stay with your baby while they are tested.

The audiologist may use an otoacoustic emission ( OAE) test. This involves putting a small soft-tipped earpiece in the outer part of your baby's ear. The earpiece sends clicking sounds down the ear.

The inner part of the ear, known as the cochlea, usually produces a response when it receives sound. The testing equipment can pick up this response.

They may also use an auditory brainstem response ( ABR) test. This involves placing small sensors on your baby.

Sounds at different frequencies are played in your baby's ears. A computer records the response so the audiologist can measure how well your baby's ears respond.

Your audiologist will tell you what the results mean and if your baby needs any more appointments.

3. Possible results

If the tests show a hearing loss, your audiologist will explain what the results mean. Your baby may need more tests to measure the amount and type of hearing loss.

The results of the tests will help the audiologist give you and your baby the right support and information.

If you are told your baby has satisfactory hearing, this means they are unlikely to have a hearing loss. But children can develop a hearing loss later, so it is important to check their hearing as they grow up.

Your personal child health record book contains checklists of the sounds your baby should react to and the sounds they should make as they grow older.

If you have any concerns you should discuss them with your health visitor or GP. Your child's hearing can be tested again at any age.

4. More information

You can contact the audiology department that will carry out the test. You can also speak to your hearing screening team, health visitor, midwife or GP.

If the time of the appointment you have been given is not convenient, please telephone to rearrange. As you may be in the audiology clinic for a while, please make sure you have enough nappies and feeds for your baby. You may also want to bring somebody with you.

Read more about newborn hearing on the NHS website.

Contact the National Deaf Children's Society:

The NHS Screening Programmes use your personal information to ensure you are invited for screening at the right time. Public Health England also uses your information to ensure you receive high quality care. You can find out more about how your information is used and protected, and your options.

You can contact us for a Braille version of this leaflet.

Get more information about newborn hearing screening.

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Newborn hearing screening: your baby's visit to the audiology clinic

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Public Health England (PHE) created this information on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening. This leaflet explains why your baby needs to see an audiologist for more tests at an audiology clinic and what those tests involve.

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https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby/hearing-loss

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Public Health England (PHE) created this information on behalf of the NHS. In this information, the word ‘we’ refers to the NHS service that provides screening.

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https://youtu.be/Ruz0e6xg10w

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Screening tests for you and your baby: babies in special care units

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Screening tests for you and your baby: babies in special care units

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https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby-babies-in-special-care-units/screening-tests-for-you-and-your-baby-babies-in-special-care-units

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Public Health England ( PHE) created this information on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening.

This leaflet is for parents of babies who are in a special care baby unit, neonatal intensive care unit or paediatric intensive care unit.

We understand this is likely to be a stressful time for you and your family. This information will help you and your health professionals to talk through how newborn screening tests fit into all the other parts of your baby's care. This information should support, but not replace, discussions you have with health professionals.

It explains some important differences in the way newborn screening tests are carried out for babies in special care baby units. It is important you also read the Screening tests for you and your baby booklet that you received during your pregnancy. This explains all the screening tests offered for newborn babies.

The screening tests covered here should ideally be completed before you take your baby home.

If your baby was born very prematurely, born before 28 weeks, you may need to wait a few weeks for some tests. Newborn hearing screening testing can only happen once a baby reaches 34 weeks corrected age.

Corrected age is the number of weeks after becoming pregnant, rather than the number of weeks after birth.

For example, a baby born after 28 weeks of pregnancy would need to wait 6 weeks after birth to have their newborn hearing screening test.

Your baby's health care team will be able to answer any questions you might have.

It is your choice whether or not to have any of the tests described in this booklet.

The NHS Screening Programmes use your personal information to ensure you are invited for screening at the right time. PHE also uses your information to ensure you receive high quality care. You can find out more about how your information is used and protected, and your options.

1. Eyes, heart, hips and testes (physical examination)

1.1 The purpose of the screening test

All babies should be offered a newborn physical examination after birth. This includes examination of the eyes, heart, hips and testes (in boys).

1.2 How the test is different

The newborn physical examination screening tests will not be done until your baby is well enough. If you choose to have this screening test, the examination should take place before your baby goes home.

You will be offered a further examination when your baby is 6 to 8 weeks of age, as some conditions can become apparent later.

2. Blood spot

2.1 The purpose of the screening test

The test is to find out if your baby has any of 9 rare but serious health conditions. These are:

sickle cell disease (SCD)

cystic fibrosis (CF)

congenital hypothyroidism (CHT)

6 inherited metabolic diseases (IMDs):

phenylketonuria (PKU)

medium-chain acyl-CoA dehydrogenase deficiency (MCADD)

maple syrup urine disease (MSUD)

isovaleric acidaemia (IVA)

glutaric aciduria type 1 (GA1)

homocystinuria (pyridoxine unresponsive) (HCU)

Early treatment can improve your baby's health and prevent severe disability or even death. If you or a family member already has one of these conditions, please tell your baby's health care team straight away.

2.2 Why screening is different for babies in special care units

The blood spot sample is usually taken when a baby is 5 days old. However, the timing is different when a baby is ill and in a special care baby unit.

2.3 How the test is different

The blood spot sample needs to be taken as soon as possible after your baby is born to screen for SCD. This is in case your baby needs a blood transfusion - the test for SCD would be inaccurate if a sample for screening is taken after a transfusion.

Another blood spot sample to screen for the other conditions will then be taken when your baby is 5 days old. If your baby has a transfusion, this test might be delayed until they are 8 days old.

If your baby is born before 32 weeks of pregnancy, another sample should be taken to test for CHT. This should happen when your baby is 28 days old or when you take your baby home, whichever comes first.

2.4 Getting my results

You should receive your baby's results by letter or from your health visitor within 6 weeks.

3. Hearing loss

3.1 The purpose of the screening test

To find babies who have a permanent hearing loss so that support and advice can be offered right from the start.

3.2 Why screening is different for babies in special care units

1 to 2 babies in every 1,000 are born with a permanent hearing loss in one or both ears. This number increases to about 1 in every 100 babies who have spent at least 48 hours in a special care unit.

Your baby will need to be at least 34 weeks corrected age before having their hearing screening test. The test can be carried out up to 3 months of age and should be done when treatment is complete and your baby is well enough.

Your baby's health care team will advise the most appropriate time for your baby's test to take place.

3.3 How the test is different

If your baby has been in a special care baby unit for more than 48 hours, they will need to have 2 types of hearing screening tests.

These are an AOAE (automated otoacoustic emission) test and an AABR (automated auditory brainstem response) test.

If the test results do not show a clear response, an appointment will be made with a hearing specialist in the audiology department. About 9 babies in every 100 cared for in a special care unit for more than 48 hours do not show a clear response to the screening tests. It is very important that you attend the appointment in case your baby has a hearing loss.

Finding out about hearing loss early gives babies a better chance of developing language, speech and communication skills.

Screening does not pick up all types of hearing loss, so it is important to check your child's hearing as they grow up. If you have any concerns about your child's hearing, you should tell your health visitor or GP.

4. Infectious diseases

4.1 The purpose of the screening test

During pregnancy, we offer and recommend women a blood test to screen for infectious diseases like hepatitis B, HIV (human immunodeficiency virus) and syphilis.

Premature babies born to mothers who have tested positive for hepatitis B will need special monitoring and care.

4.2 How follow-on care is different

Babies born weighing less than 1500g need immunoglobulin (antibodies that fight infection) and the hepatitis B vaccination.

It is very important premature babies have all 6 recommended hepatitis B vaccinations at the right age. Very premature babies (born before 28 weeks) may need their breathing monitored for 2 to 3 days after their first vaccination.

Vaccinations should take place:

within 24 hours at birth (and immunoglobulin)

at 4 weeks of age

at 8, 12 and 16 weeks of age (part of routine childhood immunisation schedule)

at one year of age

Babies also need to have a blood test at their final vaccination at one year to check if infection has been avoided.

5. More information

Details of organisations that can provide support for parents when their baby needs special care are available on NHS.UK.

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Screening tests for you and your baby: babies in special care units

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Public Health England ( PHE) created this information on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening. This leaflet is for parents of babies who are in a special care baby unit, neonatal intensive care unit or paediatric intensive care unit.

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https://www.stonewall.org.uk/parenting-rights
Parental responsibility, adopting, fostering, co-parenting, fertility treatment and surrogacy

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Information on parenting rights, parental responsibility, adopting, fostering, co-parenting, fertility treatment and surrogacy for lesbian, gay, bisexual and trans (LGBT) people.

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https://wearefamilymagazine.co.uk/othermotherhood/

Finn Mackay is a feminist activist who doesn’t fit into society’s assumed gender codes. Her partner carried and gave birth to their son, now almost 2 years old. In her guest blog Finn explores her experience of motherhood as a lesbian parent

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https://www.familylives.org.uk/advice/your-family/parenting/parenting-in-same-sex-relationships

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Same sex parenting, gap parents | Family Lives

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Same-sex parenting advice for gay and lesbian parents on dealing with everyday family issues

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https://wearefamilymagazine.co.uk/

The magazine for LGBT families, families-to-be & families with lesbian, gay, bisexual or trans members

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The magazine for LGBT families, families-to-be & families with lesbian, gay, bisexual or trans members

* celebrating alternative & inclusive families
* offering advice, signposting, guidance & support to LGBT families
* inspiring young people & families through positive representation & role models

With thanks to our partners

Upcoming Events

Here's one for the kids from our friends Pop & Olly. Princess Aaliyah is stuck in her castle and wants to be rescued, but she's not interested in the prince who comes along. She'd rather a princess came to her rescue...

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The magazine for LGBT families, families-to-be & families with lesbian, gay, bisexual or trans members * celebrating alternative & inclusive families * offering advice, signposting, guidance & support to LGBT families * inspiring young people & families through positive representation & role models With thanks to our partners Upcoming Events Here's one for the kids from our friends Pop & Olly.

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https://asamidwives.co.uk/

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Association of South Asian Midwives (ASAM) is a platform for the South Asian Midwifery Workforce and birthing community. The company was founded by three midwives, Nafiza, Benash and Sundas after discussions relating to issues witnessed, and situations experienced in the workplace and within th

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https://www.improvingme.org.uk/community/black-mum-magic-project/

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The #BlackMumMagic Project

A Community of Women Celebrating Motherhood and Uplifting Each Other

ABOUT THE BLACK MUM MAGIC PROJECT

The Black Mum Magic Project was developed by the Cheshire and Merseyside Women's and Children's Service Partnership in response to the tragic findings of the MBRRACE Report which highlighted inequalities between BAME women in the perinatal period.

Women from ethnic minority groups are at a greater risk of dying/becoming unwell and developing mental health problems. This impacts on maternal well-being and can have devastating impacts on children and families.

The Project creates a safe space of support and networking for BAME mothers to improve mental well-being, and care experiences through community and self-development.

HEARING YOUR VOICES

The Black Mum Magic Project aims to provide a platform for women to discuss their challenges with maternity care. Learning from experiences to achieve a healthy pregnancy and baby. Topics could include; traditions for BAME women; blessing-ways and other rituals, adapting a cultural diet for a healthier pregnancy, stereotypes and unconscious bias, creating a culturally individual pregnancy and birth plan.

CO-PRODUCTION

In order to change maternity services to become more inclusive for BAME women and your families we have the opportunity to co-produce services and resources that are culturally diverse, aware and sensitive to the needs and care of BAME women. Through the Cheshire and Merseyside BAME Women's Network Group we want your input to re-design services to stop unconscious bias.

OUR VIRTUAL EVENTS

As this project is launching during the Covid-19 pandemic there will be a weekly virtual group for our BAME women to come and hold a space for the issues that matter to you. The events will be facilitated by team members who will help guide and promote the conversations.

Virtual Listening Sessions will run every Tuesday -

Starting 7th July from 1pm to 2:30pm

1. Lived Experiences of BAME mothers. SIGN UP HERE https://www.eventbrite.co.uk/e/black-mum-magic-project-improving-me-programme-tickets-109304187768

2. Implicit Bias and making a change.

3. Birthing while BAME: Breaking the stereotypes/what does culturally sensitive care look like?

4. Breastfeeding while BAME: Cultural practices/experiences/what makes it unique? How can the NHS help?

5. BAME Babies: Inequalities of BAME babies (MBRRACE) / BAME infant loss - supporting BAME families.

6. Supporting BAME fathers: An invitation for BAME fathers to discuss their experiences

7. BAME midwifery: Workforce representation and supporting continuity of carer.

8. Beyond Maternity: Sustaining BAME Voices within our communities.

Please email any questions for discussions to:
tisian.lynskey-wilkie@nhs CONTACT US .net
Twitter: @Improvingme1 and @CMBAMENet

Website: www. improvingme. org. uk

Email: General Enquiries: info@improvingme. org. uk

Project Specific enquiries: tisian. lynskey-wilkie@nhs.net

Facebook: /Improvingme1

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Welcome to the Cheshire and Merseyside Women's and Children's Services Partnership - Improving Me Programme Website. We are a partnership of 27 NHS organisations across Cheshire and Merseyside aiming to improve the experience of women and children. The Partnership is one of the Vanguard's New Care model initiatives, and one of seven maternity pioneers in the country.

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https://www.kickscount.org.uk/Pages/Category/why-movement-matters

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Kicks Count is the UK's leading baby movement resource and awareness campaign. By empowering pregnant women with knowledge and confidence, babies' lives can be saved.

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Muslim Culturally Sensitive Mental Health Support

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Muslim Culturally Sensitive Mental Health Support

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The Lantern Initiative

Inspirited Minds
Coronavirus - Inspirited Minds

Islamic Counselling Service
Islamic counselling, Muslim counselling - Incorporate Islam in Counselling (sakoon.co.uk)

Institute for Muslim Mental Health
Islam & Mental Health - Institute for Muslim Mental Health

Support for Muslim Women who are at risk of abuse
MWN Helpline UK

Support for Muslim Women Survivors of Sexual Abuse
MindWorks UK | Home

Approachable Parenting | Approachable Parenting

The Muslim Council of Britain
Mental Health Organisations - Muslim Council of Britain (MCB)