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Fantastic free app with built in parent-friendliness

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Kids & kitties: Heart-warming stories of cats and babies

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The arrival of a new baby in the home shouldn’t mean that you need to say goodbye to another member of the family: your cat.

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Expecting a baby? Here's how to get your cat ready for your expanding family.

Counting down to the arrival of your new baby is an exciting time, but as you start to buy bottles and babygrows and decorate the nursery keep in mind that they you'll need to prepare your cat too.

Cats like routine so it's important to help them adjust to the new sights and sounds that come with a new baby in the home to prevent them from becoming stressed.

To help you get them ready for a new addition to the family, we've put together a helpful visual guide full of tips and tricks you can follow during each stage of your pregnancy.

We've also created a free download of baby crying sounds that you can play for your cat to get them used to your little one's wails. Find it, and instructions on how to use it, here.

Cats Protection's Behaviour Officer Daniel Cummings also has some reassuring advice on how to reduce the risk of your cat becoming stressed by your new arrival in the video below.

By taking these simple steps to make sure your beloved moggy is happy, they will in turn be a wonderful calming influence during your pregnancy and make a purrfect companion for your child as they grow up.

A recent survey carried out by Cats Protection found that 9 in 10 expectant parents said their cat was a good companion during pregnancy and 96% of people agreed that there were benefits to children growing up with cats.
For more advice on kids and kitties, visit https://www.cats.org.uk/help-and-advice/cats-and-your-family/cats-and-children

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Kids and kitties: How to prepare your cat for your baby's arrival

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Counting down to the arrival of your new baby is an exciting time, but as you start to buy bottles and babygrows and decorate the nursery keep in mind that they you'll need to prepare your cat too.

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Keeping babies and cats content

Some people mistakenly think they should give up their cat when expecting a baby. In fact, in a survey by Cats Protection in 2018, 54% of expectant parents had concerns but only 30% of those sought advice. If you're worried about your new arrival sharing your household with your cat, take a look at some of our top tips in our video.

Our behaviourist, Daniel, gives advice on how to keep your cat and baby safe around each other.

Will my cat be a danger to my baby?

Your cat will inherently not be a danger to your baby. If you prepare everything in advance and set your cat up to succeed by preparing them for the arrival of the baby, there shouldn't be an issue.

Cat as a species, given the opportunity, will choose to move away from a situation rather than escalate it by fighting. However, both cats and children are living things and there is always going to be an element of unpredictability. It is vitally important that you supervise any interactions between your baby and cat.

Should the nursery be out of bounds for my cat?

Absolutely. It is a good idea to do this sooner rather than later. As soon as you've dedicated a room for the nursery, make sure it is off limits to the cat, so the cat can get used to the fact that it can't go into somewhere it previously had access to.

How can I keep my baby safe around my cat?

The most important thing you can do to keep your baby safe around the cat is to always supervise. Particularly when the baby gets a little bigger and is beginning to crawl around a bit more. That's often when cats can struggle and become more fearful, because of the added element of not just the noise but the movement!

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Cats and Babies - Information and Advice | Cats Protection

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Some people mistakenly think they should give up their cat when expecting a baby. In fact, in a survey by Cats Protection in 2018, 54% of expectant parents had concerns but only 30% of those sought advice. If you're worried about your new arrival sharing your household with your cat, take a look at some of our top tips in our video.

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Preparing for a new arrival? Take a look at our tips on how to help your cat cope with a baby in the home.

Getting you and your cat ready for your baby

Expecting a baby is an exciting time with lots of change and preparation and helping your cat adjust to the change of routine is important too. For tips on how to prepare your cat for your baby, watch our video below. You can also download our pregnancy planner on how to prepare your cat and help your cat adjust to baby noises with our MP3 playlist.

Preparing your cat for your baby's arrival

Unsure how to best prepare your cat for the arrival of your little one? Find out more from Behaviourist, Daniel, as he shares his top tips for cats and pregnant women.

How can I prepare my cat for my baby?

Cats are wonderful, stress-reducing companions, so they can be a very welcome, calming influence during pregnancy.

There are some steps you can take to ensure everyone is prepared for your new arrival:

take your cat to the vet for a check-up

get your cat neuteredif they aren't already

introduce your cat to new baby equipment, such as nursery furniture or a pram. Let your cat investigate but don't let them climb on them and then keep them shut away. It's important to keep baby items off limits as they will be very tempting places for your cat to sleep

get your cat used to hearing baby sounds

consult your doctor or health visitor about any other steps that you need to take

Download the pregnancy planner

Do cats know you're pregnant?

Although we can't be completely sure if cats can sense pregnancy in humans, we do know that they are very sensitive to changes in routine.

Pregnancy comes with many adjustments, including mental and physical changes. Because cats have a keen sense of smell, they notice when their owner's body odour changes, which can happen due to hormones, especially in the early stages of pregnancy. Your daily routines may also become different, or you may reorganise your home to prepare for the birth and arrival of your baby.

All of these things can be unfamiliar or unsettling to your cat and their behaviour can change.

Depending on your cat's personality, they might bond with you and show more affection, or you may find that they become withdrawn and prefer to spend more time alone.

There are measures you can take to help your cat adjust by making any changes gradually and giving the cat more hiding places. You can also help your cat feel more relaxed by trying to fit into a regular routine as much as possible and showing the attention they are used to.

If your cat enjoys it, getting more interactive toys such as fishing rod toys with feathers on a string or offering their food in a puzzle feeder can be helpful. Find out more about the benefits of cats and play.

Should I worry about toxoplasmosis when I'm pregnant?

Some people believe - mistakenly - that cats can be bad for pregnant women. This belief stems from concerns about toxoplasmosis, a micro-organism that can affect the foetus if a pregnant woman is infected. However, a major study in the British Medical Journal concluded that contact with cats was not a significant risk factor for toxoplasma infection.

Pregnant women should wear disposable gloves and an apron when cleaning litter trays - or get someone else to do this. Litter trays should be cleaned daily to reduce the possibility of toxoplasmosis spores developing from infected faeces.

Find out more about cats and toxoplasmosis

Before and after your baby arrives

Cats are creatures of habit, so the biggest challenge for your cat might be the changes to routines that occur with the arrival of a baby. You can help your cat adjust by making some changes before your baby arrives. Follow our top tips.

Make the nursery off-limits, particularly if your cat is used to having free rein in your home

Reduce the amount of lap time your cat enjoys (you won't have as much time for your cat when your baby arrives)

If you need to move your cat's feeding or toileting spots, do this gradually so your cat can adjust

When your baby arrives:

use a safe cot or pram net to keep the cat away and pull it taut to deter your cat from using it as a bed

make sure the nursery is inaccessible while your baby sleeps and make sure any windows are cat-proof

keep baby's feeding utensils out of your cat's reach

keep baby and cat food separate - you don't want to mix them up in a sleep-deprived moment!

try to save a little time to give your cat attention daily. This will help you both remain relaxed

remember your cat should be treated regularly for fleas and worms and their litter tray kept clean

And never:

leave your baby and cat together alone, even if you trust your cat completely

leave children's sandboxes uncovered in case a cat uses it as a litter tray

How to keep your cat out of a cot or pram

A warm, comfortable cot is often an attractive place for a cat to rest. They might also take a shine to moses baskets, next-to-me cots, prams and anywhere else meant for your baby.

It's important to keep your cat away from where your baby sleeps and instead offer them a cosy place of their own. Make sure to give your cat lots of different places to sleep so they can choose their favourite. Some cats prefer igloo beds because they are enclosed and many like to be up high on a shelf or bed.

Try to keep your cat away from your baby's pram or cot by making sure they're in a room your cat can't get in to. You could also fill them with objects that stop your cat from settling and aren't comfy to sleep on to put your cat off. If your cat does get into your baby's cot or pram, encourage them away from the cot or pram, or if necessary gently remove them and try to encourage them to a different sleeping spot.

There are some so-called 'cat nets' on the market designed to go around cots and prams to stop cats getting in them. These are often ineffective as the cat will still climb on the net and it could harm your cat if they get tangled, or even harm your baby if the cat were to get on the net and it collapsed. We would not recommend using these but instead follow our advice above.

How to prepare your cat with baby sounds

Before your baby arrives, introduce your cat to baby-crying noises in a safe and controlled way. To help you, we've created an MP3 of baby cries to download.
Our guide:

1. At a time when nothing else stressful is going on in the home, choose a room that the cat is naturally relaxed in.

2. Find a device on which you can play the crying audio.
Test the sound volume when the cat is not in the room, so as not to spook them and set the volume to a very low level so that it is barely audible.

3. When the cat chooses to enter the room, start playing the audio at the original, low volume for approximately two minutes - this may need to be shortened depending on your cat's reaction. You can interact with your cat as normal at this time but don't do anything that will make them stressed.

4. If the cat does not appear fazed by the noise, repeat steps 1-3 at the same volume level on two more separate occasions. If the cat remains unfazed by the noise, you can then progress to step five.

5. Increase the volume by a small amount and repeat steps 1-4. If your cat is happy with the volume then slightly increase it again and continue this process over time until the volume is as loud as a normal baby's cry.

Remember, if at any stage your cat looks uncomfortable or fearful, return to a lower volume.

Never make a sudden jump in volume as this could spook your cat - it needs to be gradual for it to work.

The entire point of this exercise is for your cat to have no reaction to the sound, so don't panic if you don't see your cat react - this is what is supposed to happen. If you increase the volume gradually over time, hopefully you'll never see a reaction!

Download baby sounds MP3

Concerned about your cat's behaviour?

If you are concerned about your cat's behaviour following your baby's arrival, please seek advice from a qualified cat behaviourist who may be able to pinpoint a trigger and help you resolve the issue.

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Cats and Your Pregnancy - Help & Advice | Cats Protection

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If you are preparing for a new arrival then we have put together some tips that could help get your cat ready for having a new baby in the home.

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“Invisible” Signals - Why Parental Supervision isn’t enough -…

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“Invisible” Signals - Why Parental Supervision isn’t enough

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Experts recommend that you prepare the family dog ives. It is a very hectic time and a time of many changes when a baby arrives. In order to minimize stress for the dog and reduce the chance of an accident you can make many changes and preparations ahead of time so that the transition is easier for you and the dog. before the baby arr

Below we give some tips for preparing the dog before the baby arrives and for after the baby arrives as a newborn.
Tips for Preparing Your K9 Family Member Before the Baby Arrives

Review all your pet dog's "manners" training.

Parents should practice giving cues comfortably in any position. Ex: sitting back on a couch, lying in bed, sitting on the floor. If your dog does not respond to familiar cues such as "sit" and "down" when you are resting in various positions, then you will need to teach him so that he understands no matter what. Sometimes it is not the word "sit" that the dog is responding to, sometimes it is a hand or body signal that you are giving that you don't even know about!

Socialize your dog around children in a positive and controlled environment.

Observe and become aware of how the dog seeks your attention.

Know your dog's sensitivities. Research the breed or mixes. Does he startle with fast motion, noises etc.

Allow your dog to become familiar with the baby equipment.

Teach your dog the behaviors you want around the equipment vs. what you do not want. Doing this ahead makes a world of difference!

Parents can use the baby carrier they plan to use with their baby and put a teddy bear in it to get the feeling of what it will be like moving with this.

Work with your dog while you wear this.

Walk your dog with an empty stroller or one with some weight to it to get a feel for this and what needs to be worked on NOW.

Use a CD of baby noises to introduce and create a positive experience prior to the baby's arrival.

Get the baby lotion and put it on the baby carrier, car seat etc. and the teddy you carry in the sling. Bring the same lotion with you to put the same familiar scent on the baby's clothing for the dog to be familiar with.

Have Dad bring home a blanket with the baby's scent on it. Although Dad will have the scent all over him. The blanket can go in the car seat, swing etc.

Schedule your vet visit well ahead of time to be sure to have all meds available.

Familiarize your dog with the person that may care for them.

Plan a good and safe spot for your diapers!

Never leave the baby alone with the dog even for a second. Dogs can become agitated by the sounds and movements of a baby. Dogs have been know to try to move a baby by carrying the baby in their mouths the way a mother dog might do with her puppies. Other dogs have hurt babies because the baby moves and sounds like prey.

If you have to go to answer the phone or the door or just get the baby bottle from the other room, take the baby with you or take the dog with you or close a door or a gate to keep them apart. Even 1 second is too long to leave a dog alone with a baby.

Keep your baby off the floor when the dog is around.

Avoid face to face contact between dog and baby.

Keep the dog well exercised. Hire someone to watch the baby or exercise the dog if you can't manage.

Be sure the dog has at least 10-15 minutes of one-on-one training time with someone each day.

Be sure that the dog has a crate or other safe place where he can be content to be away from the baby. He should have a special bone and chews toys to enjoy in this space.

Use only positive reinforcement-based training methods with the dog. Never punish or scold the dog in the presence of the baby. You want all associations with the baby to be positive in the dog's mind.

Be very careful with moving baby items such as swings. Some dogs can very excited by these. Never leave the baby in the swing alone with the dog in the room even if the baby is asleep, even if they are both asleep!

If you have any concerns at all about your dog's behavior or attitude towards the baby, seek professional help right away.

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Baby Safety Around Dogs | Prepare the family dog for life with a baby

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Prepare your dog for life with a new baby and keep the baby safe around dogs

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PDF Downloads

These are helpful Family Paws, LLC visual handouts for everyone to share and post. We hope you find them helpful! We love the illustrations by Lili Chin!

Doggie Detective® Activity Sheets

Watch this short video to learn how you and your kids can become Doggie Detectives! Send us your coloring pages and videos to jen@familypaws.com.

Support Line

Dog and Baby Support hotline for immediate support and referrals through our Family Paws Parent Education network. Locate one of our Family Paws Educators near you!

We are excited to offer these Webinars in 2021:

Dogs & Storks and Dogs & Toddlers

Every Young Family Needs a Support System.

Find a Family Paw's Educator near you and get the support you need to safely and happily raise your dogs and children, together.

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies.

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Resources - Family Paws Parent Education

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These are helpful Family Paws, LLC visual handouts for everyone to share and post. We hope you find them helpful! We love the illustrations by Lili Chin! Watch this short video to learn how you and your kids can become Doggie Detectives! Send us your coloring pages and videos to jen@familypaws.com.

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How to keep your baby safe around your dog

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How to keep your baby safe around dogs and puppies. Read our top tips and advice.

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More information & support on the APP website;

https://www.app-network.org/

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Information about ECV (turning a breech baby)  - Why & How?

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Information about ECV (turning a breech baby)  - Why & How?

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Liverpool Women's External Cephalic Version (ECV)

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This Trello card has a collection of information you might want to have a read of if induction is being suggested because your baby is outside of 'average' growth lines.

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This Trello card has a collection of information you might want to have a read of if induction is being suggested because your baby is outside of 'average' growth lines.

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https://trello.com/c/m8wrxMSo

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These are intended to help you look at some of the facts and figures around induction for prolonged pregnancy, and help you use your BRAIN tool.

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Made by a mum - sharing with you all :-)

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Caesarean Birth with General Anaesthetic

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Caesarean Birth with General Anaesthetic

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C/B with a GA may not always be planned, but this document might help you think through some things to consider if this is likely to be your journey.

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Caesarean Birth with GA - things to think about

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Do you have any questions about general anaesthetic caesarean birth? 

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This an informative and helpful video to watch if your journey might involve a General Anaesthetic

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Do you have any questions about general anaesthetic caesarean birth? #pregnant #pregnancy #havingababy #midwife #mumtobe #antenatal #antenatalclass #studentmidwife #studentmidwives #studentmidwifelife #parenttobe #caesarean #caesareansection #caesareanbirth #csection #csectiondelivery #csectionmom 

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@theecomidwife
Do you have any questions about general anaesthetic caesarean birth? #pregnant #pregnancy #havingababy #midwife #mumtobe #antenatal #antenatalclass #studentmidwife #studentmidwives #studentmidwifelife #parenttobe #caesarean #caesareansection #caesareanbirth #csection #csectiondelivery #csectionmom
♬ original sound - Angie

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A beautiful description of the natural physiology of undisturbed birth.

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A beautiful description of the natural physiology of undisturbed birth.

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found here; https://tinyurl.com/2fr7kkre

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Responsive relationships builds strong brains | Serve & Return | NSPCC

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Reusable Nappy Hire | Liverpool Cloth Nappy Library

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Liverpool Cloth Nappy Library is making reusable nappies accessible to everyone. We hire out kits and give support to families getting started with cloth.

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A selection of Mindfulness Recovery Activities

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Help for Dads | Postpartum Support International 

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Help for Dads | Postpartum Support International 

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This site is American, but offers an online support group for new Dads

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Postpartum Mental Health is a Men's Issue

Whether you are a dad trying to support a partner or you think you may be experiencing a perinatal mood or anxiety disorder, we are glad you are here. We want you to know that you are not alone and that by getting the right kind of support, you will get better.

One in ten dads gets postpartum depression, and up to 18% develop a clinically significant anxiety disorder such as generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder at some point during the pregnancy or the first year postpartum.

As part of our commitment to a whole-family, father-inclusive approach to perinatal mental health, Postpartum Support International is proud to sponsor the annual International Fathers' Mental Health Day in order to raise awareness and decrease stigma that these dads often face. You can get more information about IFMHD on our Twitter feed as well as our Facebook page.

Call or Text our HelpLine

1-800-944-4773 (4PPD) - English and Spanish

When you call the HelpLine you will be asked to leave a confidential message, and a trained and caring volunteer will listen and return your call or text during business hours. They will listen, answer questions, offer encouragement, and connect you with local resources as needed.

Dad Support Group

Our online groups are here to help you connect with other dads who have newborns up to toddlers. Our groups allow you to talk and listen to other dads as they process their experiences. Whether you are going through stress, feeling overwhelmed as you adjust to parenting, or trying to figure out how best to support your partner, our groups are here for you.You will learn about helpful tools/resources and realize you are not alone. We do not allow group observation by students or professionals. Thank you for your cooperation and understanding.

Times Vary.
Register Here
Chat with a Fatherhood Expert

Join our monthly Just for Dads Chat. On the first Mondays of every month PSI hosts a free call-in forum for dads facilitated by a perinatal mood disorders expert and PSI Board Member Dr. Daniel Singley. Call for information, support, and connection with other dads. There is no need to pre-register or give your name.

Connect with our Specialized Coordinator for Dads

Perinatal Mood and Anxiety Disorders are not only experienced by moms, and PSI's Specialized Coordinator for Dads provides understanding and support for fathers who are struggling. (not for clinical consultation)
Connect with a Dads Specialized Coordinator
Connect with a Local PSI Volunteer near you.

We have more than 400 Local Volunteers who provide support, information, encouragement, and connection with local providers and support groups.

Closed Facebook Group for Dads

PSI has a closed Facebook Group for dads, where members can get a lot of great support and information from other dads: https://www.facebook.com/groups/682525349518226

Additional Resources for Dads

Fathers Respond to Perinatal and Postpartum Mood & Anxiety Disorders Video

When we filmed our new DVD, Healthy Mom, Happy Family, we had the opportunity to speak with the dads and we made a video where they shared their experiences. We hope their stories can support you and give you hope through this difficult time. Download the Order Form and send to psioffice@postpartum.net if you'd like to purchase the Father's Respond video.

Wade Bowen "Turn on the Lights"

Country Music Artist Wade Bowen wrote "Turn on the Lights" after going through PPD with his wife Shelby. The Bowen family turned this into a benefit for Postpartum Support International, creating a CD with help from many families and PSI Volunteers. Wade has done so much to help PSI - what a talented and generous man. He helps us help families every day.

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Help for Dads | Postpartum Support International (PSI)

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The resources listed on this page provide fathers and postpartum partners informed support and connection at no charge.

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Help for Dads | Postpartum Support International 

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Help for Dads | Postpartum Support International 

# data[].attributes.body
This site is American, but offers an online support group for new Dads

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Postpartum Mental Health is a Men's Issue

Whether you are a dad trying to support a partner or you think you may be experiencing a perinatal mood or anxiety disorder, we are glad you are here. We want you to know that you are not alone and that by getting the right kind of support, you will get better.

One in ten dads gets postpartum depression, and up to 18% develop a clinically significant anxiety disorder such as generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder at some point during the pregnancy or the first year postpartum.

As part of our commitment to a whole-family, father-inclusive approach to perinatal mental health, Postpartum Support International is proud to sponsor the annual International Fathers' Mental Health Day in order to raise awareness and decrease stigma that these dads often face. You can get more information about IFMHD on our Twitter feed as well as our Facebook page.

Call or Text our HelpLine

1-800-944-4773 (4PPD) - English and Spanish

When you call the HelpLine you will be asked to leave a confidential message, and a trained and caring volunteer will listen and return your call or text during business hours. They will listen, answer questions, offer encouragement, and connect you with local resources as needed.

Dad Support Group

Our online groups are here to help you connect with other dads who have newborns up to toddlers. Our groups allow you to talk and listen to other dads as they process their experiences. Whether you are going through stress, feeling overwhelmed as you adjust to parenting, or trying to figure out how best to support your partner, our groups are here for you.You will learn about helpful tools/resources and realize you are not alone. We do not allow group observation by students or professionals. Thank you for your cooperation and understanding.

Times Vary.
Register Here
Chat with a Fatherhood Expert

Join our monthly Just for Dads Chat. On the first Mondays of every month PSI hosts a free call-in forum for dads facilitated by a perinatal mood disorders expert and PSI Board Member Dr. Daniel Singley. Call for information, support, and connection with other dads. There is no need to pre-register or give your name.

Connect with our Specialized Coordinator for Dads

Perinatal Mood and Anxiety Disorders are not only experienced by moms, and PSI's Specialized Coordinator for Dads provides understanding and support for fathers who are struggling. (not for clinical consultation)
Connect with a Dads Specialized Coordinator
Connect with a Local PSI Volunteer near you.

We have more than 400 Local Volunteers who provide support, information, encouragement, and connection with local providers and support groups.

Closed Facebook Group for Dads

PSI has a closed Facebook Group for dads, where members can get a lot of great support and information from other dads: https://www.facebook.com/groups/682525349518226

Additional Resources for Dads

Fathers Respond to Perinatal and Postpartum Mood & Anxiety Disorders Video

When we filmed our new DVD, Healthy Mom, Happy Family, we had the opportunity to speak with the dads and we made a video where they shared their experiences. We hope their stories can support you and give you hope through this difficult time. Download the Order Form and send to psioffice@postpartum.net if you'd like to purchase the Father's Respond video.

Wade Bowen "Turn on the Lights"

Country Music Artist Wade Bowen wrote "Turn on the Lights" after going through PPD with his wife Shelby. The Bowen family turned this into a benefit for Postpartum Support International, creating a CD with help from many families and PSI Volunteers. Wade has done so much to help PSI - what a talented and generous man. He helps us help families every day.

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Help for Dads | Postpartum Support International (PSI)

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The resources listed on this page provide fathers and postpartum partners informed support and connection at no charge.

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Helping Men Beat The Baby Blues And Overcome Depression

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After you've answered each of the 10 questions, add together the numbers from each of your responses.

If the total number is 5 to 8, it is likely that you have an anxiety disorder. If the total number is 9 to 10 or more, it is likely that you have depression.
If the total number is five or more, further assessment by a licensed mental health professional is recommended. If any number other than "0" is circled for question 10, you should contact a mental health professional immediately. The EPDS is an assessment tool and should not take the place of clinical judgment. A comprehensive clinical assessment by a licensed mental health professional should confirm your findings.
If there's a chance that your partner is depressed, it's important that she complete the EPDS as well. However, the instructions for completing the EPDS are different for women and men. Please suggest to your partner that she go to The Postpartum Stress Center online ( www.postpartumstress.com) to obtain a copy of the EPDS, with specific instructions for women.

Sources:Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Goodman, J.H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Lane A., Keville R., Morris, M., Kinsella, A., Turner, M., & Barry, S. (1997). Postnatal depression and elation among mothers and their partners: prevalence and predictors.Matthey S, Barnett B, Kavanagh DJ, Howie P (2001). Validation of the Edinburgh postnatal depression scale for men, and comparison of item endorsement with their partners. Matthey S., Barnett B., Ungerer J., Waters B. (2000). Paternal and maternal depressed mood during the transition to parenthood.
British Journal of Psychiatry, 150, 782-786.
Journal of Advanced Nursing. 45: 26-35.
British Journal of Psychiatry. 171: 550-555.
Journal of Affective Disorders, 64, 175-184.
Journal of Affective Disorders. 60: 75-85.

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After you've answered each of the 10 questions, add together the numbers from each of your responses. If the total number is 5 to 8, it is likely that you have an anxiety disorder. If the total number is 9 to 10 or more, it is likely that you have depression.

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Fathers mental health - Dr Andrew Mayers

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Fathers mental health - Dr Andrew Mayers

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All too often, husbands and partners are overlooked when it comes to providing support and information on mental health. Evidence suggests that the risk factors, and impact, of perinatal mental health are reduced when mums have a supportive partner. Furthermore, fathers can develop 'perinatal mental health' problems (either as a result of their spouse's/partner's illness or independently). There is often little guidance available for men to understand the causes, risk factors, treatments and prognosis of perinatal mental illness, quite apart from what support they can give to their partner. Fathers also need information on how to improve their own mental health. On this page, you will find some information about the latest campaigns that I am involved with, some media stories that have been run about that, and an overview of resources and support for fathers.

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Fathers mental health - Dr Andrew Mayers

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This page describes the work I do for fathers' mental health, focusing on education, research, campaigning and advisory roles

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Perinatal mental health - Dr Andrew Mayers

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Perinatal mental health - Dr Andrew Mayers

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Perinatal mental health

This page provides an overview of the perinatal mental health campaigns that I am privileged to be a part of, and the research and professional work that I undertake. This typically focuses on antenatal and postnatal depression, postpartum psychosis (including bipolar disorders), maternal OCD, birth trauma and PTSD, and perinatal eating disorders. I have worked with maternal mental health since 2003 but, more recently, this work has also incorporated fathers' mental health. The term 'perinatal' refers to the period from pregnancy to one year after the birth. Mental health affects the mother, the father, and the child. We need to consider the entire family. I have been associated with perinatal mental health services since 2003, when I started work as a research co-ordinator for a team based near the New Forest in Hampshire (operated by what was then Hampshire Partnership NHS Trust, now Southern Health NHS Foundation Trust). Under the inspirational supervision of Dr Alain Gregoire, I soon developed a passion for maternal mental health.

Much of my current work focuses on campaigning for better services (through national groups such as the Maternal Mental Health Alliance and the Perinatal Mental Health Partnership. You will find a summary of that work on this page, with more detail on the campaigns page. I also promote awareness about perinatal mental health, mostly through social media. I deliver mental health training programmes for health professionals (including health visitors and midwives).

Raising awareness, campaigning and peer support

Working with some truly great people, I am part of some highly influential perinatal mental health campaigns. Through these, we have several aims: to raise public awareness; encourage people to talk freely about perinatal mental health (and seek support); provide better support for families (by improving NHS and community services, and funding charitable groups); help educate key health professionals (such as GPs, midwives, health visitors and obstetricians); and foster better communication between services and professionals.

DorPIP
Related to the above, a consequence of poor perinatal mental health is the impact it can have on the attachment between the parent and child. Poor attachment can contribute to developmental problems in children. To address this, I am a Trustee for DorPIP, a Dorset-based charity seeks to provide therapeutic support for parent-infant relationships.

Peppy Health
Although we have made good progress with establishing the need for better perinatal mental health services in secondary care, there is much still to do for those who do not need such intense intervention. One of the places we can help parents during the perinatal period is through their employer. Peppy Health is a new-start company providing access to perinatal support through businesses. Peppy is also developing community mental health support services. I provide advice and guidance to Peppy on mental health matters, including service design, research and help with screening potential counsellors to ensure they have the appropriate experience.

Make Birth Better
Make Birth Better is a network of perinatal mental health professionals, campaigners, academics and researchers who have come together to influence better understanding and support. I am a Champion for the great network, drawing on my expertise especailly in matters relating to birth trauma and fathers' mental health.

Maternal Mental Health Alliance
The Maternal Mental Health Alliance (MMHA) is a coalition of over 70 national organisations, for whom improving perinatal mental health is central to the work that they do. MMHA is leading several key projects, focused on improving services, education and information (as well as raising awareness). The most long-standing of those projects is the #everyonesbusiness campaign, which calls for all women throughout the UK, who experience perinatal mental health problems, to receive the care they and their families need, wherever and whenever they need it. The campaign has launched two major reports: a mapping of (the very limited) services across the UK; and the economic impact of perinatal mental illness. An independent review of that work (funded by Comic Relief) confirms what a major impact the campaigns have had on perinatal mental health.

Have you seen latest MMHA maps? Encouraging progress, but there are still huge gaps in perinatal mental health services across the UK. We MUST change this

Perinatal Mental Health Partnership
The Perinatal Mental Health Partnership is a group of health professionals, charity leaders, mental health campaigners, and advocates with lived experience of perinatal mental illness. We have several very exciting projects in the planning stage, all intended to influence significant changes to perinatal mental health services nationally and locally. We are a member of MMHA. Each year (in early May), we run Maternal Mental Health Awareness Week. In September 2018, our work challenging perinatal mental health stigma was recognised with an award from MMHA. ince it's inception in 2015, the awareness week has grown in recognition. These campaigns receive a great deal of media attention and encourage groups and individuals to engage in many activities that raise awareness for maternal mental health.

1001 Critical Days
' 1001 Critical Days' is an All-Party Parliamentary Group (APPG) committed to ensuring that children get the very best start in life (1001 days represents the period from pregnancy to the child's second birthday). This cross-party initiative involves several MPs including Tim Loughton, Frank Field, and Norman Lamb. A central theme is improving perinatal and infant mental health. The 1001 Critical Days APPG manifesto was relaunched on December 14th 2015. I was privileged to be at that launch in Parliament. You can read the report here along with a media feature from Dorset Eye.

NHS England
Early in 2019, the UK Government announced the new NHS Long-Term Plan. Within that, there are proposals to fundamentally improve perinatal mental health services at the community level, through NHS England. Within that provision, fathers' mental health will be more seriously considered than ever before. This outcome has come about after years of campaigning. To help develop that provision, I was included on a new Expert Reference Group for fathers to help take these proposals forward.

Other charities and support groups
I have the honour and privilege to work with some of the most inspiring charities and support groups, along with some great social media initiatives. These provide valuable, and safe, support services across the UK. You can discover more about these on the perinatal mental health support pages.

Research

It is essential that we continually expand our knowledge about perinatal mental health. We can do that by designing, implementing and reporting high quality research. You can read about some of my own research in this area. In short, my recent work has focused on a number of aspects relating to this important topic. Some projects have examined health professionals' perceptions of how well educated and trained they are on perinatal mental health (separate studies for health visitors, midwives, and GPs). Another study explored perceptions of fathers who had witnessed the wife/partner's birth trauma (in respect how they coped with that experience, what information they received, and what support they were given: a similar study focused on mothers' experiences. Some studies have focused on general aspects of fathers' mental health.

Perinatal mental illnesses

A common perception is that maternal mental health is all about postnatal depression. Although that is the most common concern for a mother's mental health after having a baby, there are many other conditions. You can read an overview of those on the perinatal mental illnesses page.

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Perinatal mental health - Dr Andrew Mayers

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This page provides an overview of the perinatal mental health campaigns that I am privileged to be a part of, and the research and professional work that I undertake. This typically focuses on antenatal and postnatal depression, postpartum psychosis (including bipolar disorders), maternal OCD, birth trauma and PTSD, and perinatal eating disorders.

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Hub of Hope - Mental Health Support Network provided by Chasing the Stigma

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Chasing the Stigma (CTS) has launched the Hub of Hope - a national mental health database, bringing help and support together in one place, with a focus on grassroots organisations.

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We aim to help dads have successful relationships with their families, and to support dads with anxiety, stress and mental health issues.

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We aim to help dads have successful relationships with their families, and to support dads with anxiety, stress and mental health issues.

We hope to get dads engaged with services that have traditionally been targeted at mums, and to train & support volunteer dads to work with us.

We work directly with services that support Dads, families and especially babies to increase engagement and knowledge across the sector.

We want to make sure dads know how important they are, how to access support when they need it and why it's essential for baby's development.

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VOLUNTEER WITH US EVENTS REGISTRATION FIND SUPPORT IN YOUR AREA DONATE HERE We aim to help dads have successful relationships with their families, and to support dads with anxiety, stress and mental health issues. We hope to get dads engaged with services that have traditionally been targeted at mums,

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One in 10 new fathers say they feel low, anxious or depressed after having a baby - and in reality the figure is probably higher.

We've been supporting dads for over a decade. Some are experiencing their own mental health difficulties or are dealing with trauma related to the birth of their child. Others may be struggling to support a partner who's unwell. Sometimes, both parents might be finding it hard to adapt to their new lives with a baby.

Our Dads in Mind service offers vital one-to-one support over the phone, text and online. There are also opportunities to meet face-to-face for support - a walk in the park, for example, can be a great chance to offload and get fresh air and exercise at the same time.

Dads looking for group support can get together online, while Bluebell Place provides an ideal venue for face-to-face group meet ups. Here, comfy sofas and free pizza create a safe, relaxed atmosphere. A member of our team leads informal discussions about coping strategies and self care. Dr Karl Scheeres, a Bluebell trustee, often comes along to offer information about perinatal mental health. Dads share their experiences, listen to others and give each other vital moral support.
We work in partnership with Vitaminds to deliver our Dads in mind services, to access these services you can make a referral here.
You can also read more about what we're doing to make sure everyone feels welcome.

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Lots of good links here...

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All too often, husbands and partners are overlooked when it comes to providing support and information on mental health. Evidence suggests that the risk factors, and impact, of perinatal mental health are reduced when mums have a supportive partner. Furthermore, fathers can develop 'perinatal mental health' problems (either as a result of their spouse's/partner's illness or independently). There is often little guidance available for men to understand the causes, risk factors, treatments and prognosis of perinatal mental illness, quite apart from what support they can give to their partner. Fathers also need information on how to improve their own mental health. On this page, you will find some information about the latest campaigns that I am involved with, some media stories that have been run about that, and an overview of resources and support for fathers.

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Fathers mental health - Dr Andrew Mayers

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This page describes the work I do for fathers' mental health, focusing on education, research, campaigning and advisory roles

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It can be difficult for women to advocate for themselves in labour. Adrenalin plays a big role in everyone's actions when things move away from plan A. I may important to have conversations ahead of time.
In this video, Penny suggest having a code word as a way to communicate a signal.

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The Code Word - Ensure Your Pain Management Wishes Are Followed

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Gestational diabetes and pregnancy | Rei’s story | Diabetes UK

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NCT Parent Hub - Pregnancy and parenting information exclusively for NCT Antenatal course attendees.

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Gestational diabetes is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth.
It can happen at any stage of pregnancy, but is more common in the second or third trimester.

It happens when your body cannot produce enough insulin - a hormone that helps control blood sugar levels - to meet your extra needs in pregnancy.

Gestational diabetes can cause problems for you and your baby during pregnancy and after birth. But the risks can be reduced if the condition is detected early and well managed.

Who's at risk of gestational diabetes

Any woman can develop gestational diabetes during pregnancy, but you're at an increased risk if:

you are over 40

your body mass index (BMI) is above 30 - use the BMI healthy weight calculator to work out your BMI

you previously had a baby who weighed 4.5kg (10lb) or more at birth

you had gestational diabetes in a previous pregnancy

1 of your parents or siblings has diabetes

you are of south Asian, Black, African-Caribbean or Middle Eastern origin (even if you were born in the UK)

you have had a gastric bypass or other weight-loss surgery

If any of these apply to you, you should be offered screening for gestational diabetes during your pregnancy.

Symptoms of gestational diabetes

Gestational diabetes does not usually cause any symptoms.

Most cases are only discovered when your blood sugar levels are tested during screening for gestational diabetes.

Some women may develop symptoms if their blood sugar levels gets too high (hyperglycaemia), such as:

increased thirst

needing to pee more often than usual

a dry mouth

tiredness

blurred eyesight

genital itching or thrush

But some of these symptoms are common during pregnancy and are not necessarily a sign of gestational diabetes. Speak to your midwife or doctor if you're worried about any symptoms you're experiencing.

How gestational diabetes can affect your pregnancy

Most women with gestational diabetes have otherwise normal pregnancies with healthy babies.

However, gestational diabetes can cause problems such as:

your baby growing larger than usual - this may lead to difficulties during the delivery and increases the likelihood of needing induced labour or a caesarean section

polyhydramnios - too much amniotic fluid (the fluid that surrounds the baby) in the womb, which can cause premature labour or problems at delivery

premature birth - giving birth before the 37th week of pregnancy

pre-eclampsia - a condition that causes high blood pressure during pregnancy and can lead to pregnancy complications if not treated

your baby developing low blood sugar or yellowing of the skin and eyes (jaundice) after he or she is born, which may require treatment in hospital

the loss of your baby (stillbirth) - though this is rare

Having gestational diabetes also means you're at an increased risk of developing type 2 diabetes in the future.

Screening for gestational diabetes

During your first antenatal appointment (also called a booking appointment) at around week 8 to 12 of your pregnancy, your midwife or doctor will ask you some questions to determine whether you're at an increased risk of gestational diabetes.

If you have 1 or more risk factors for gestational diabetes you should be offered a screening test.

The screening test is called an oral glucose tolerance test (OGTT), which takes about 2 hours.

It involves having a blood test in the morning, when you have not had any food or drink for 8 to 10 hours (though you can usually drink water, but check with the hospital if you're unsure). You're then given a glucose drink.

After resting for 2 hours, another blood sample is taken to see how your body is dealing with the glucose.

The OGTT is done when you're between 24 and 28 weeks pregnant. If you've had gestational diabetes before, you'll be offered an OGTT earlier in your pregnancy, soon after your booking appointment, then another OGTT at 24 to 28 weeks if the first test is normal.
Find out more at Lab Tests Online: Glucose Tests.

Treatments for gestational diabetes

If you have gestational diabetes, the chances of having problems with your pregnancy can be reduced by controlling your blood sugar levels.

You'll be given a blood sugar testing kit so you can monitor the effects of treatment.

Blood sugar levels may be reduced by changing your diet and being more active if you can. Gentle activities such as walking, swimming and prenatal yoga can help reduce blood sugar. But tell your midwife or doctor before starting an activity you haven't done before.

However, if these changes don't lower your blood sugar levels enough, you will need to take medicine as well. This may be tablets or insulin injections.

You'll also be more closely monitored during your pregnancy and birth to check for any potential problems.

If you have gestational diabetes, it's best to give birth before 41 weeks. Induction of labour or a caesarean section may be recommended if labour does not start naturally by this time.

Earlier delivery may be recommended if there are concerns about your or your baby's health or if your blood sugar levels have not been well controlled.

Find out more about how gestational diabetes is treated.

Long-term effects of gestational diabetes

Gestational diabetes normally goes away after birth. But women who've had it are more likely to develop:

gestational diabetes again in future pregnancies

type 2 diabetes - a lifelong type of diabetes

You should have a blood test to check for diabetes 6 to 13 weeks after giving birth, and once every year after that if the result is normal.

See your GP if you develop symptoms of high blood sugar, such as increased thirst, needing to pee more often than usual, and a dry mouth - do not wait until your next test.

You should have the tests even if you feel well, as many people with diabetes do not have any symptoms.

You'll also be advised about things you can do to reduce your risk of getting diabetes, such as maintaining a healthy weight, eating a balanced diet and exercising regularly.

Some research has suggested that babies of mothers who had gestational diabetes may be more likely to develop diabetes or become obese later in life.

Planning future pregnancies

If you've had gestational diabetes before and you're planning to get pregnant, make sure you get checked for diabetes. Your GP can arrange this.

If you do have diabetes, you should be referred to a diabetes pre-conception clinic for support to ensure your condition is well controlled before you get pregnant.

Read more about diabetes in pregnancy.

If you have an unplanned pregnancy, talk to your GP and tell them you had gestational diabetes in your previous pregnancy.

If tests show you do not have diabetes, you'll be offered screening earlier in pregnancy (soon after your first midwife appointment) and another test at 24 to 28 weeks if the first test is normal.

Alternatively, your midwife or doctor may suggest you test your blood sugar levels yourself using a finger-pricking device in the same way as you did during your previous gestational diabetes.
Community content from HealthUnlocked

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Find out what gestational diabetes is, what problems it can cause, how it's diagnosed, and what the treatments are.

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I created Gestational Diabetes UK in 2014 as a GD Mum, for other Mums. I'm dedicated to providing information, research and support on gestational diabetes, from diagnosis through to birth and beyond.

I do not show any ads on my website, or have any annoying pop-ups. There are no affiliate links and no financial gain for any products that are mentioned within the content. All links shown are purely for information purposes.

GD UK does not sell any physical products, instead, it is funded by an optional subscription to the website for additional GD UK recipes and 7-day meal plans.

By selling recipe subscriptions, it has meant that the Gestational Diabetes UK website can remain free for all to use.

If you would like to subscribe to the GD UK Recipe Subscription, please use the link below

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Gestational Diabetes UK * Gestational Diabetes UK

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Gestational Diabetes UK is dedicated to offering support and evidence based research to women diagnosed with gestational diabetes in the UK and Ireland

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A little download to help you consider how to help your baby's sleep safer.

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Newborn baby tests and checks - BabyCentre UK

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Newborn baby tests and checks - BabyCentre UK

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This is a detailed explanation of the newborn checks that are usually done within 72 hours of birth.

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istock.com / Lisa Eastman

In the hours, days and weeks after he is born, your baby will have several routine tests and examinations to check that he is healthy and that all is well. Here's an outline of what to expect and what your midwife and doctor will be looking for when they carry out the tests.

The number of tests and examinations may seem alarming, but don't worry. All babies, born in hospital, at a birth centre, or at home, will be having the same checks.

What are the first tests my baby will have?

Your baby will have a few checks and examinations in the first hours of his life. The first is the Apgar score, which your midwife will record at one minute, then again at five minutes, after your baby's born (NICE 2014).

Your midwife can do this test by watching your baby's colour, breathing, behaviour, activity and posture. This will tell her whether your baby has any immediate problems that need medical support (NICE 2014).

Most babies are fine, or may just need to be watched for a while. If your baby does need some help, your midwife may give him some air or clear out his airways to help him breathe (NICE 2014).

About an hour after the birth, after you've had a cuddle with your baby and, ideally, some skin-to-skin contact, your midwife will also:

weigh your baby

check his temperature

measure the circumference of his head (NICE 2014)

These measurements will later be added to his developmental charts in his red book (personal child health record). Your health visitor will give you your baby's red book shortly before or after your baby is born.
During this time a doctor or midwife will also offer to give your baby a dose of vitamin K to protect him from vitamin K deficiency bleeding (VKDB) (NHS 2018a).

What is the newborn examination?

The newborn examination is a full physical check of your baby for any problems or conditions. A health professional will offer to examine your baby within 72 hours of his birth (NHS 2018c, NICE 2015). This gives your baby time to adjust to the outside world and means he can get treatment quickly in the unlikely event that any problems are found.

If your baby was born in a hospital or birth centre, a midwife or paediatrician will usually examine your baby before you both go home. If you had a home birth, your midwife or GP may carry out the newborn examination.

The examination will be done while you, and ideally your partner, are present, so you'll be able to ask questions as it happens (NHS 2018c, NICE 2015). The health professional doing the exam may ask you questions about your family's medical history. So now's the time to mention any childhood medical conditions in your or your partner's family, such as eczema or asthma.

Your midwife or doctor will check your baby from head to toe, so your baby will need to be undressed for part of the examination (NHS 2018c).

Head

The doctor or midwife will look at the shape and size of your baby's head (NHS 2018c, NICE 2015). A squashed or moulded head is a common feature in newborns. If you had a vaginal birth, the gentle pressure that happens when your baby is squeezed through the birth canal may have resulted in your baby's head becoming misshapen.

Your baby's head can mould in this way because there are soft spots, called fontanelles, between the bones in his skull. This will even out as the soft spots close, and the bones in his head meet and fuse. Your doctor or midwife will check these soft spots.

If your baby needed help to be born with ventouse or forceps, there's a small risk of bruises appearing on his head or skull bone (cephalhaematoma). These will soon disappear, but ask your midwife if you're worried about them (NHS 2018a).

Ears and eyes

Your midwife will have already looked at your baby's eyes to check for any obvious problems at birth. During the newborn physical examination, your doctor or midwife will shine a light from an ophthalmoscope in your baby's eyes to check they have something called a red reflex (NHS 2018f). This looks similar to the red eye effect from a camera flash. Checking that your baby has this reflex helps your doctor or midwife to rule out certain eye conditions, such as cataracts (NHS 2018f).

Your GP will also examine your baby's eyes when he is between six weeks and eight weeks old. This may be combined with your postnatal check (NHS 2016b).

If you are worried about your baby's sight at any time, mention it to your doctor or health visitor.

Get tips on how to monitor your baby's eyesight as he grows.

Mouth

Your doctor or midwife will put a finger in your baby's mouth to check that the roof of his mouth (palate) is complete and his sucking reflex is working (Tidy 2016a). A gap in the palate, called cleft palate, will need surgery and may make feeding difficult.

Learn more about what support you will receive if your baby is diagnosed with a cleft palate.

Your doctor or midwife may also check your baby's tongue for tongue-tie. This happens when his tongue remains more anchored to the bottom of his mouth than it should be, restricting movement. It may only be checked for if your baby has persistent problems latching on to breastfeed (NICE 2015).

Read how tongue-tie can affect your baby's feeding and how it can be treated.

Heart

Your doctor or midwife will listen to your baby's heart with a stethoscope. This will help her to identify any potential heart problems, and to check if your baby has a heart murmur (an extra or unusual sound made by the heart) (PHE 2017, Tidy 2016a).

Try not to worry if your midwife or doctor detects a heart murmur. These are common in newborns, and may be caused by how your baby's heart adapts to the world outside your womb (PHE 2014). The vast majority of babies with heart murmurs have no heart problems (Archer 2015). But your doctor or midwife may arrange for a follow-up check to be carried out in six weeks to eight weeks' time (Roy et al 2017).

Your midwife or doctor will also feel for a pulse in your baby's groin (the femoral pulse) to check for any heart defects. Some hospitals also offer to test how much oxygen is in your baby's blood (oxygen saturation levels). Your doctor or midwife will carry out this test by placing a probe on your baby's fingers and toes.

Lungs

Your doctor or midwife will listen to your baby's breathing with a stethoscope and make sure both of his lungs are working properly (Tidy 2016a).

Genitals

Baby genitals are often swollen and dark-coloured in the first few days. This is nothing to worry about. It may be down to a surge of hormones, passed from you to your baby before he was born. Or it may be a build-up of extra fluid in his body, which is common in babies.

For boys, the scrotum is checked for undescended testicles (NHS 2018c, PHE 2017).

If your baby has an undescended testicle it's likely the testicle will come down on its own before he's six months. For this reason, doctors usually wait to start any treatment. However, if your baby's testicle has not descended by six months, your doctor is likely to recommend surgery to move the testicle down (NHS 2018c, PHE 2017).

Your baby's penis will also be checked to ensure the opening is at the tip of the penis, and not on the underside.

The doctor or midwife will check your baby's bottom to ensure the opening to his back passage is normal. They will probably ask if your baby has had a wee or passed a dark-coloured poo (meconium) (NICE 2014, Tidy 2016a).

Skin

Your baby's skin will be checked for birthmarks (Tidy 2016a), including:

stork marks: reddish or purple V-shaped marks that can appear on your baby's eyelids, in the middle of his forehead or at the back of his neck.

blue spots (congenital dermal melanocytosis): a bluish patch of darker pigment, most commonly over the lower back or bottom. They used to be known as Mongolian blue spots and you may still hear them called by this name.

strawberry marks: raised red areas

Most birthmarks are completely harmless, and will fade during childhood. Ask your doctor for advice if you are worried.
Hands and feet

The doctor or midwife will check your baby's arms, hands, legs and feet. His fingers and toes will be counted and checked for webbing.

Your baby's palms will be checked to see if two creases, called palmar creases, run across them. About four per cent of the population have just one palmar crease on one hand and it's even rarer to have one line on both hands (Sharma and Sharma 2011).

Single palmar creases are sometimes associated with Down's syndrome (Tidy 2016a). But in the unlikely event of your baby having Down's syndrome, there would be other clear physical signs (Tidy 2016b).

The doctor or midwife will look at your baby's feet and ankles. This is to check for talipes (clubfoot), where the front half of the foot turns in and down. You may already know your baby has talipes if it was shown on an ultrasound scan.

Get the facts on talipes and how it can be treated.

Spine

Your doctor or midwife will look at how straight your baby's spine is. It is quite common for babies to have a tiny dimple at the base of the spine, called a sacral dimple (Tidy 2016a). In most cases this will cause no problems. Occasionally, a deep sacral dimple may indicate a problem with your baby's nerves in his lower spinal cord.

If your baby has a deep sacral dimple, he will be checked for other nerve problem symptoms such as leg weakness, cold and bluish soles of feet, and difficulties pooing and weeing.

Hips

Your doctor or midwife will gently move your baby's hips to check how stable the joints are (PHE 2017, Tidy 2016a). She will open his legs wide, and then bend and unbend them. If your doctor or midwife finds any instability, she will carry out further tests to check for hip problems.

Reflexes

Your newborn baby has several reflexes such as sucking, rooting and grasping. Your doctor or midwife will check these by safely encouraging your baby to show his reflexes (PHE 2017).

The most commonly tested reflex during the examination is the Moro reflex (also called the startle reflex). Your baby's head is allowed to gently and safely fall for a short distance. He'll respond by flinging out both arms with his fingers spread and legs outstretched. He may also cry a little. Rest assured your baby will be fine, and his responses are simply showing that all is well.

Jaundice check

Your doctor or midwife will examine your baby for signs of jaundice. This is a common condition that causes a yellowish tinge on babies' skin. Most cases will clear up on their own within 10 to 14 days, but if tests show your baby has a lot of bilirubin (the substance that causes jaundice) in his blood, he may be given light treatment (phototherapy) to reduce it (NHS 2015).

There are different levels of treatment, depending on how jaundiced your baby is. Read our article on jaundice for more information.

Bear in mind that screening tests may not pick up every problem. But if your baby does have a problem that's picked up during the newborn examination, there are many benefits to having this identified early on. Your doctor or midwife should give you information about the suspected problem and answer any questions you may have.

You should also be offered advice about where to find more information and support. Your doctor or midwife will let you know straight away if she has any concerns and will advise you on what is likely to happen next. Your baby may need further tests or he may be referred directly for specialist treatment.

What other tests will my baby have in the first six weeks?
Hearing test
Your baby may have a hearing test shortly after birth, either in hospital, a community clinic, or at home (NHS 2018b, PHE 2017). It's called an automated otoacoustic emission (AOAE) test. It only takes a few minutes and doesn't hurt your baby.

If the test doesn't show a clear result, you may be asked to come back for another test. This doesn't necessarily mean that there's a problem. Your baby may have been unsettled when the test was first carried out, or there may be fluid or a temporary blockage in his ear. Or there may have been background noise during the screening (NHS 2018b).

Find out more about what happens during the second hearing test in our article on baby hearing.

Heel-prick test

The next routine test your baby will have is a heel-prick test. This will be carried out around five days to eight days after the birth, usually at home (PHE 2017). Your midwife will carry out this test. She'll take a tiny amount of blood from your baby's heel.

This blood sample will be tested for the following conditions. These conditions are rare and early detection will give your baby the best chance of successful treatment:

An inherited condition called phenylketonuria (PKU), which affects the way proteins are metabolised.

Cystic fibrosis, which affects the lungs and digestive system.

MCADD, a condition that affects the way the body converts fat into energy.

Sickle cell disease, a genetic blood disorder.

Thyroid deficiency.

Homocystinuria, an inherited metabolic disorder.

Maple syrup urine disease, glutaric aciduria type 1, and isovaleric acidaemia, which are all inherited disorders in which the body is unable to process certain protein building (amino acids) (NHS 2018e, PHE 2014).

Your baby may cry a little when the blood is taken, but he will recover very quickly with a cuddle.
You will get the results of the heel-prick test by the time your baby is eight weeks old. You will either get a letter or a health professional will contact you. In the unlikely event that your baby has any of these conditions he will be referred to a specialist who can carry out further investigations and plan his treatment.

Ten to 14-day review

Your health visitor will visit you at home 10 to 14 days after the birth. She will carry out a top-to-toe check of your baby, and ask you about your own physical and emotional health (NHS 2016a).

This is the perfect time to discuss any issues you may have been having since the birth. If you don't already have it, she will also give you your baby's red book (personal child health record).

Healthcare after the birth
Six to eight week check
The next screening test you and your baby will have will be at six to eight weeks, and may be combined with your postnatal check with your doctor (NHS 2016b).

If you have any concerns about your baby before then, don't hesitate to call your midwife, health visitor or doctor. Your midwife will also give you information on signs and symptoms to look out for in your newborn and who to contact for help.

When your baby's eight weeks old, you'll also be offered the first set of immunisations to protect him against common infectious diseases. Find out what they protect against in our immunisations chart.

References

Archer. 2015. Heart murmur in children. DynaMed Plus. www.dynamed.com [Accessed October 2018]

iHV. 2017. Why a health visitor? Institute of Health Visiting. https://ihv.org.uk/ [Accessed June 2018]

NHS. 2015. Newborn jaundice. NHS Choices, Health A-Z. www.nhs.uk [Accessed June 2018]

NHS. 2016a. Services and support for parents. NHS Choices, Health A-Z. www.nhs.uk [Accessed July 2018]

NHS. 2016b. Your six-week postnatal check. NHS Choices, Health A-Z. www.nhs.uk [Accessed December 2018]

NHS. 2017. Getting to know your newborn. NHS Choices, Health A-Z. www.nhs.uk [Accessed April 2018]

NHS. 2018b.Newborn hearing screening. NHS Choices, Health A-Z. www.nhs.uk [Accessed April 2018]

NHS. 2018c.Newborn physical examination. NHS Choices, Health A-Z. www.nhs.uk [Accessed April 2018]

NHS 2018d.Undescended testicles. NHS Choices, Health A-Z. www.nhs.uk [Accessed October 2018]NHS. 2018e. Newborn blood spot test. NHS Choices, Health A-Z. www.nhs.uk [Accessed April 2018]

NHS. 2018f.Eye tests for children. NHS Choices, Health A-Z. www.nhs.uk [Accessed September 2018]

NICE. 2014.Intrapartum care for healthy women and babies. Last updated February 2017. National Institute for Health and Care Excellence, Clinical guideline 190. www.nice.org.uk [Accessed April 2018]

NICE. 2015.Postnatal care up to 8 weeks after birth. Last updated February 2015. National Institute for Health and Care Excellence, Clinical guideline, 37. www.nice.org.uk [Accessed April 2018]

PHE 2017.Screening tests for you and your baby. Public Health England. www.gov.uk/government/organisations/public-health-england [Accessed April 2018]

Roy R, Clarke P, Daniels R, et al. 2017.Heart murmurs: information for parents/carers. Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals. www.nnuh.nhs.uk [Accessed December 2018]

Sharma DK, Sharma V. 2011. Prevalences of Simian, Sydney and Suwon creases and their association with each other, body sides, handedness, sex and anomalies/diseases/syndromes in a population of central India.Int J Morphol 29(3):1069-75

Tidy C. 2016a.Neonatal examination. Patient.Info. https://patient.info [Accessed April 2018]

Tidy C. 2016b.Down's syndrome. Patient.Info. https://patient.info [Accessed April 2018]

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istock.com / Lisa Eastman In the hours, days and weeks after he is born, your baby will have several routine tests and examinations to check that he is healthy and that all is well. Here's an outline of what to expect and what your midwife and doctor will be looking for when they carry out the tests.

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This book will give you the facts to help you reach an informed decision, should you be offered induction of labour.

From a review...

"This book is easy to read, quite short, and gives all the research and statistics that were available at the time of writing for all the various reasons why induction might be proposed, for example older mothers , IVF pregnancies, breech babies, twins, etc. etc. etc. "

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Why Induction Matters (Pinter & Martin Why it Matters Book 14)

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Shared via Kindle. Description: In modern maternity systems one in four women have their labour induced. Why Induction Matters provides a comprehensive, evidence-based guide to this common intervention. The induction process is explained in detail, and reas...

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Inducing Labour: making informed decisions: Amazon.co.uk: Wickham, Sara: 9781999806439: Books

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Inducing Labour: making informed decisions: Amazon.co.uk: Wickham, Sara: 9781999806439: Books

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Dr Sara Wickham PhD, RM, MA, PGCert, BA(Hons) is an author, educator and researcher who works independently.

Sara's career has been varied and includes more than twenty five years of experience as a midwife, lecturer and researcher. She is the author/editor of seventeen books, has lectured in more than thirty countries, edited midwifery journals and provides consultancy services for midwifery and health-related organisations around the world.

Sara can be found online at www.sarawickham.com

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Inducing Labour: making informed decisions

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When is it better to induce labour than to let a woman's body or baby decide the best time for birth? What are the pros and cons of waiting and of being induced? What about after the due date? When the baby is thought to be bigger than average?

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Information I have put together on different forms of pain management available (including non-pharmacological)

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Information I have put together on different forms of pain management available (including non-pharmacological)

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This resource can be printed back-2-back, or multiple pages per sheet - however you find it most helpful to use.

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Information that I have put together on different methods of induction & augmentation (including non-medical).

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Information that I have put together on different methods of induction & augmentation (including non-medical).

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This leaflet has some very helpful recovery information, if Caesarean Birth is your journey.

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PPS have a skilled and experienced team who can offer one-to-one and group support to new mums, dads and carers. They are also able to refer to other Specialist Perinatal (Mental Health) Services.

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PSS Parent and Baby Wellness is a service in Liverpool that supports parents and carers who are experiencing challenges surrounding pregnancy, birth and parenthood, during pregnancy and the first two years of your baby's life.

How can we help?

We've got a skilled and experienced team who can offer one-to-one and group support to new mums, dads and carers.

Our team can help you to manage difficult feelings during pregnancy and for the first 2 years of your baby's life, including depression or anxiety that happens during or after pregnancy.

We can support you during or after your pregnancy if you are experiencing any of these symptoms:

A regular sad, anxious or 'empty' mood.

Feelings of guilt and hopelessness.

Loss of interest in hobbies and activities.

Struggling to enjoy your experience with your baby.

The ways we can support you
Our team will take the time to understand you and your family and find ways to support you in a way that works for you.

Some of the support options we offer:

Enhanced listening - using music to manage your mood.

Support with self-esteem and confidence building.

Education on perinatal and postnatal depression to help you understand what you are experiencing and find ways to manage it.

Relaxation and mindfulness exercises to support more positive mental health and wellbeing.

Signposting to other groups and services where you can meet other people with shared experiences in your local community.

We can support you with:

Feeling happier and more mentally well during pregnancy or in the first two years of your baby's life.

Building stronger, healthier relationships with your baby so that they get the best start in life.

Can I get support from Parent and Baby Wellness?

If you're a new or expectant parent or carer living in Liverpool who is experiencing mental health challenges related to becoming a parent, our service could support you.

Get in touch:

For more information about Parent and Baby Relationships, contact our team on:

Email: parentandbaby@pss.org.uk

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When you're a new or expectant parent/carer living in Liverpool experiencing feelings of anxiety or depression (Parent and Baby Wellness) | PSS

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What is PSS Parent and Baby Wellness? PSS Parent and Baby Wellness is a service in Liverpool that supports parents and carers who are experiencing challenges surrounding pregnancy, birth and parenthood, during pregnancy and the first two years of your baby's life. How can we help?

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What if we told women the truth about birth... 

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What if we told women the truth about birth... 

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A beautiful, raw writing on birth.

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View this post on Instagram

A post shared by Catie Atkinson (@spiritysol)

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Click the pop-out window to view on Vimeo.

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A photographic collage of a beautiful hospital birth. Possibly an induction.

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A photographic collage of a beautiful hospital birth. Possibly an induction.

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This little baby is born while his Mum is standing...

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A beautiful video of a 4.2kg OP baby's birth - at home

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Ten Things...I wish every woman knew about induction of labour (Sara Wickham)

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Ten Things...I wish every woman knew about induction of labour (Sara Wickham)

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Dr Sara Wickham is a midwife, educator and researcher, who has been working in and informing the world of maternity care for over twenty years.

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A helpful little reminder to remember your umbrella! ...

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A helpful little reminder to remember your umbrella! ...

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American based website offering great information and support around Perinatal Mental Health issues.

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Mind the Gap is a collective impact initiative to address America's silent health crisis: untreated and unaddressed perinatal mental health disorders. Through policy, practice, and partnerships, we are advancing the first national, Strategic Roadmap to ensure perinatal mental health is a priority.

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Postpartum Support International is dedicated to helping families suffering from postpartum depression, anxiety, and distress.

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Edinburgh Postnatal Depression Scale (EPDS)

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Edinburgh Postnatal Depression Scale (EPDS)

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A quick online test that might help you know whether it's time to get some help.

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About Maternal Mental Health Disorders — 2020 Mom

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About Maternal Mental Health Disorders — 2020 Mom

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A few more stats ;-)

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An overview of maternal mental health disorders including postpartum depression, statistics, symptoms, and support.

Maternal Mental Health (MMH) disorders include a range of disorders and symptoms, including but not limited to depression, anxiety and psychosis. These disorders and symptoms can occur during pregnancy and/or the postpartum period (together often referred to as the perinatal period).

When left untreated these disorders can cause devastating consequences for the mother, her baby, her family and society.

These illnesses can be caused by a combination of biological, psychological and social stressors, such as lack of support, a family history, or a previous experience with these disorders.

Maternal anxiety and maternal depression are the most common complications of childbirth, impacting up to 1 in 5 ¹⁻³ women, yet they are not universally screened for, nor treated.

The good news is that risk for both depression and anxiety can be reduced and sometimes prevented, and with treatment women can recover.

Maternal Mental Health and COVID

The COVID pandemic has exacerbated the already high rates of maternal mental health disorders. While research is still emerging on the impact of the pandemic on maternal mental health disorders, here are some initial facts:

One study noted maternal depression and anxiety rates increasing by 64% ¹ and others, like the University of Michigan's 2022 study showed a 40% increase² in maternal depression and anxiety. Many other studies³ have reported a doubling in rates of depression and anxiety in pregnant women when compared to studies prior to the pandemic.

Higher acute stress was documented in mothers delivering during compared to before the pandemic ⁴ which was in turn related to increased symptoms of Post-Traumatic Stress Disorder (PTSD) and challenges with mother-infant bonding and breastfeeding.⁵

Trauma-related symptoms, including PTSD and dissociative symptoms, as well as thoughts of self-harm, were higher in pregnant women during the pandemic than before the pandemic. 6,7

Moms reported increased difficulty in bonding with their infant during the pandemic. ⁸

Women in the first trimester of pregnancy had higher anxiety and depression ⁹ and experienced more severe psychological¹⁰ impact during the pandemic compared to women in the second or third trimesters or the postpartum period.¹¹

First-time pregnancy status emerged as a significant risk factor for maternal mental health disorders during the pandemic. ¹²

Learn More about Each Disorder by Watching/Reading Below

Overview of Maternal Mental Health Conditions

The Baby Blues

Up to eighty percent (80%) of women will experience the "baby blues" after giving birth, tied to sudden shifts in hormones. ⁴

Women who experience the baby blues may feel sad, have mood swings and crying episodes.

The Blues are not considered a disorder as the symptoms often resolve within a few days. If symptoms persist, beyond two weeks, it's likely the mother is suffering from depression.

Pregnancy and Postpartum Depression

(Also referred to as maternal depression, peripartum depression or perinatal depression.) A Major Depressive Disorder with onset during pregnancy or within 4 weeks of birth though in practice it is applied to depression occurring within the first year from birth. Up to twenty percent (20%) of women experience clinical depression during and/or after pregnancy. 1-3, 5

Maternal depression is treatable during pregnancy and postpartum.

Symptoms can range from mild to severe and, mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression.

Maternal depression is treatable and risk can also be mitigated.

Symptoms generally include sadness, trouble concentrating, difficulty finding joy in activities once enjoyed, and difficulty bonding with the baby.

Maternal Dysthymia

Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression.

Women with pre-existing dysthymia may be at a higher risk for severe symptoms/depression during the perinatal period.

Pregnancy and Postpartum Anxiety

Up to fifteen percent (15%) of women will develop anxiety during pregnancy or after childbirth. ²

Anxiety is treatable during pregnancy and postpartum.

Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the "what if's" - like what if my baby experiences SIDS, what if my baby falls, what if my baby has autism, etc.; extreme worry about not being a good parent/being able to provide for her family.

Pregnancy and Postpartum OCD

More studies are needed to identify a consistent rate of prevalence for perinatal OCD. One study found that perinatal OCD affects 2 in 100 women during pregnancy and 2-3 in every 100 women in the year after giving birth. Perinatal OCD is present in about 2-3% of all parents, though recent studies believe the number may actually be higher. ⁶

OCD includes obsessions (an unwanted thought or feeling) that a person has an urge to relieve through an action or a "compulsion." OCD "obsessions" can include intrusive thoughts (see below for more information about intrusive thoughts). About 50% of women with OCD have intrusive/unwanted thoughts about intentionally harming their infant (e.g., throwing the baby). ⁶ It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children.

The prevalence of postpartum PTSD is 3.1%. ⁷ Most often, this illness is caused by a real or perceived trauma during delivery or the postpartum period.

These women are plagued with intrusive memories and flashbacks of the event.

Mental Health Questionnaires

Questionnaires called "screening tools" are used to determine if someone may be suffering from a maternal mental health disorder. You can find these screening tools here.

Other Features and Factors:

Birth Loss and Grief

Expectant mothers who experience miscarriage or stillbirth are also at risk for postpartum mental health disorders including PTSD in addition to grief or complicated grief. In the U.S. 10-15 percent of known pregnancies, end in miscarriage and 1 percent of all pregnancies end in still birth (March of Dimes). According to the CDC Black mothers face double the stillbirth rate as White women in America. Native Americans face the second highest stillbirth rates.

Postpartum Mania

Women may suffer from an extreme inability to sleep, where a mother simply isn't tired. She generally feels elated, and enthusiastic about completing tasks and motherhood. This is considered a state of hypomania or mania which may or may not be tied to an underlying bipolar disorder.

A state of mania is not in and of itself dangerous but because mania/severe lack of sleep may lead to impulsive and high risk behavior and can be a precursor to psychosis, it's critically important that the mother receive clinical support from a psychiatric provider experienced in reproductive mental health.

Postpartum Psychosis

Postpartum psychosis is a rare/disorder symptom and occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately 1 -.2% of births. ³

The onset is usually sudden, most often within the first 2 weeks postpartum.

The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.

Postpartum Psychosis is considered a medical emergency due to the potential for a mom to harm herself or her baby.

Intrusive Thoughts

70-100% of women (and their partners) have "intrusive" thoughts surrounding childbirth/the postpartum period. ⁶ These thoughts may include thoughts of infant harm (e.g., dropping the baby or a woman herself harming her baby). These thoughts are unwanted (ego-dystonic) and recognized by the woman as inappropriate and concerning, (which is why these thoughts alone are not cause for alarm). It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children. Intrusive thoughts are not considered a "disorder." When symptoms become persistent and are disabling, they are generally thought to be tied to OCD.

Facts About Maternal Mental Health and Substance Use Disorder

National Maternal Mental Health Hotline:

Health Resources & Services Administration

Free, 24/7, confidential support, resources and referrals to any pregnant and postpartum mothers facing mental health challenges and their loved ones.

The National Maternal Mental Health Hotline's counselors provide real-time emotional support, encouragement, information, and referrals. Pregnant and postpartum women can get the help and resources they need, when they need it.

Call or text, 1-833-9-HELP4MOMS ( 1-833-943-5746) to connect with counselors at the National Maternal Mental Health Hotline. Learn more at www.MCHB.HRSA.gov/national-maternal-mental-health-hotline

Support for Those Not in Crisis:

Postpartum Support International
NOTE: Postpartum Support International is not a crisis hotline and does not handle emergencies.

Support for those Who Are Suicidal or in Severe Distress:

The National Suicide Prevention Lifeline
The Lifeline is a United States-based suicide prevention network of over 160 crisis centers that provides 24 hour 7 day-a-week live service with a trained counselor, via a toll-free hotline with the number 1-800-273-8255.

(A new toll-free nationwide telephone number, 9-8-8 will be implemented by July 16, 2022.)

The line is available to anyone in suicidal crisis or emotional distress.

Callers are routed to their nearest crisis center to receive immediate counseling and local mental health referrals.

A chat feature is available on the website: https://suicidepreventionlifeline.org/

The lifeline supports people who call for themselves or someone they care about.

References

¹Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071-83. doi:10.1097/01.AOG.0000183597.31630.db.
²Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH. Perinatal anxiety disorder prevalence and incidence. J Affect Disord. August 2016;200:148-55. doi:10.1016/j.jad.2015.12.082.
³Ryan D, Kostaras X. Psychiatric disorders in the postpartum period. British Columbia Medical Journal. 2005;47(2):100-103. http://www.bcmj.org/article/psychiatric-disorders-postpartum-period.
⁴Massachusetts General Hospital. Postpartum psychiatric disorders. MGH Center for Women's Mental Health. Published 2015. https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/?doing_wp_cron=1485807063.98182391.
⁵Committee on Obstetric Practice. Screening for perinatal depression: committee opinion no. 630. Washington, DC: American Congress of Obstetrics and Gynecology; 2015:1-4. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co630.pdf?dmc=1&ts=20161227T1417252146.
⁶Collardeau, F., Corbyn, B., Abramowitz, J. et al. Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol. BMC Psychiatry 19, 94 (2019). https://doi.org/10.1186/s12888-019-2067-x
⁷Grekin, R., & O'hara, M. W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clinical Psychology Review, 34(5), 389-401. doi:10.1016/j.cpr.2014.05.003

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About Maternal Mental Health Disorders - 2020 Mom

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An overview of maternal mental health disorders including postpartum depression, statistics, symptoms, and support. Maternal Mental Health (MMH) disorders include a range of disorders and symptoms, including but not limited to depression, anxiety and psychosis. These disorders and symptoms can occur during pregnancy and/or the postpartum period (together often referred to as the perinatal period).

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https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-natal-depression

Lots of detailed information here, + links to information on perinatal OCD, PND for carers, & Postpartum Psychosis

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Perinatal Depression Awareness & Support

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Perinatal Depression Awareness & Support

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Postnatal depression (PND) is a type of depression that many parents experience after having a baby. It can affect any parent, regardless of whether they've suffered from a mental health condition before. Postnatal depression is linked directly to giving birth and is a common problem, affecting 1 in 10 women within a year of giving birth.

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It's not just mothers who can suffer from PND...

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It's not just mothers who can suffer from PND...

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A lenghty but informative document on PostNatal Depression

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A lenghty but informative document on PostNatal Depression

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Local information from Liverpool Women's Hospital

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Local information from Liverpool Women's Hospital

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Induction of labour is becoming increasingly common for a wide range of reasons. Our previous methods of induction were less efficient and offered little choice for women.

The new induction process at Liverpool Women's Hospital will reduce waiting times; increase the chance of normal birth for those who have had a previous caesarean and means women can start the induction process in the comfort of their own homes.

Inpatient induction of labour

If you are a high risk woman and require induction to help start labour the hormone pessary will be placed in the vagina near the neck of the womb for up to 24 hours and you will stay in hospital to await labour. The change to this drug will help to bring labour on quicker.

Outpatient induction of labour

If you are a low risk woman and require induction to help start labour the hormone pessary will be placed in the vagina near the neck of the womb, you will then go home to await labour. If labour has not happened within 24 hours we will review you in hospital.

This method is safe and has been used for several years for low risk women; and will now be offered to more.

If labour starts whilst at home you may even deliver on the Midwife Led Unit (MLU) or have a pool birth.

Induction of labour with ruptured membranes

If your waters go and you do not have contractions you will now be offered up to 24 hours to await labour or immediate induction of labour. If you choose to be induced you will go home with a hormone pessary in the vagina for up to 24 hours. If labour starts whilst at home you may even be suitable to deliver on the MLU or have a pool birth.

Induction of labour following previous Caesarean Section

A new technique is used to stretch the neck of the womb with a soft balloon, rather than the use of hormones to start labour. This is useful for women with a previous scar from a caesarean section; it reduces the chance of the scar breaking during labour. As contractions are not being started off we will let you go home and come back in 24 hours.

We believe these changes to how your labour is induced will be more effective and promote a more normal labour process.

If you have any questions on your induction of labour please speak with your midwife.

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The new induction process at Liverpool Women's Hospital will reduce waiting times; increase the chance of normal birth for those who have had a previous caesarean and means women can start the induction process in the comfort of their own homes.

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Dr Rachel Reed is a Senior Lecturer and Discipline Leader in Midwifery at the University of the Sunshine Coast, Australia. 

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"This book is easy to read, quite short, and gives all the research and statistics that were available at the time of writing for all the various reasons why induction might be proposed, for example older mothers , IVF pregnancies, breech babies, twins, etc. etc. etc. " - Katharine Graves KGHypnobirthing

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Why Induction Matters (Pinter & Martin Why it Matters: 14)

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Buy Why Induction Matters (Pinter & Martin Why it Matters: 14) 1 by Rachel Reed (ISBN: 9781780666006) from Amazon's Book Store. Everyday low prices and free delivery on eligible orders.

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Another Dr Sarah Wickham recommendation - perhaps a bit more 'technical' and meaty than 'Inducing Labour'

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Another Dr Sarah Wickham recommendation - perhaps a bit more 'technical' and meaty than 'Inducing Labour'

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"In this book, Dr Sara Wickham demystifies the evidence and highlights the significant discrepancies between guidelines and what we really know about the benefits of supporting women to birth spontaneously. With her renowned ability to make complex issues understandable, her holistic approach and more than twenty-five years’ experience as a midwife and researcher, Dr Wickham draws on a wide range of evidence, including the voices of women and practitioners, to answer vital questions such as: How accurate are due dates? Is it really that risky to wait? Does induction make a difference? And, perhaps most importantly, what can we do about this situation?"

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Pregnant women and maternity services are facing an induction epidemic. As medical guidelines include more "at risk" categories, women and our already overwhelmed and under resourced maternity systems are increasingly pressured to induce birth before labour begins spontaneously. Women are deemed to be too large and too old, while babies are estimated to be too big and too overdue. But is 'better-out-than-in' really a safer option than waiting to birth in your own time?

Staggeringly, over a third of all pregnant women have their labour medically induced, and this is accompanied by a tsunami of avoidable medical interventions. Worldwide, this trend is growing at an alarming rate. This is despite both a lack of evidence demonstrating its benefits and a wealth of evidence indicating the significant short- and long-term negative impacts of induction on the health and wellbeing of mothers and their babies.

In this timely book, Dr Sara Wickham demystifies the evidence and highlights the significant discrepancies between guidelines and what we really know about the benefits of supporting women to birth spontaneously. With her renowned ability to make complex issues understandable, her holistic approach and more than twenty-five years' experience as a midwife and researcher, Dr Wickham draws on a wide range of evidence, including the voices of women and practitioners, to answer vital questions such as: How accurate are due dates? Is it really that risky to wait? Does induction make a difference? And, perhaps most importantly, how can we address the induction epidemic?

In Your Own Time is both a masterclass in what the evidence really says about induction of labour and a fascinating insight into how birth has come to be controlled by Western medicine.

"This is such a vitally important book. With her brilliant brain and extensive experience, Dr Sara Wickham has pulled together and clearly interpreted the complex evidence about induction of labour. This book provides clarity about why increasing numbers of women are having their labours induced, and the problems with current guideline recommendations. It also offers suggestions about what we can all do to reclaim the parameters of normal and support women to birth in their own time. Anyone who cares about women and their experiences of birth needs this book." Dr Rachel Reed, midwife and researcher.

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In Your Own Time: How western medicine controls the start of labour and why this needs to stop

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In Your Own Time: How western medicine controls the start of labour and why this needs to stop : Wickham, Sara: Amazon.co.uk: Books

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Another Dr Sarah Wickham recommendation - perhaps a bit more 'technical' and meaty than 'Inducing Labour'

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Another Dr Sarah Wickham recommendation - perhaps a bit more 'technical' and meaty than 'Inducing Labour'

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"In this book, Dr Sara Wickham demystifies the evidence and highlights the significant discrepancies between guidelines and what we really know about the benefits of supporting women to birth spontaneously. With her renowned ability to make complex issues understandable, her holistic approach and more than twenty-five years’ experience as a midwife and researcher, Dr Wickham draws on a wide range of evidence, including the voices of women and practitioners, to answer vital questions such as: How accurate are due dates? Is it really that risky to wait? Does induction make a difference? And, perhaps most importantly, what can we do about this situation?"

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Pregnant women and maternity services are facing an induction epidemic. As medical guidelines include more "at risk" categories, women and our already overwhelmed and under resourced maternity systems are increasingly pressured to induce birth before labour begins spontaneously. Women are deemed to be too large and too old, while babies are estimated to be too big and too overdue. But is 'better-out-than-in' really a safer option than waiting to birth in your own time?

Staggeringly, over a third of all pregnant women have their labour medically induced, and this is accompanied by a tsunami of avoidable medical interventions. Worldwide, this trend is growing at an alarming rate. This is despite both a lack of evidence demonstrating its benefits and a wealth of evidence indicating the significant short- and long-term negative impacts of induction on the health and wellbeing of mothers and their babies.

In this timely book, Dr Sara Wickham demystifies the evidence and highlights the significant discrepancies between guidelines and what we really know about the benefits of supporting women to birth spontaneously. With her renowned ability to make complex issues understandable, her holistic approach and more than twenty-five years' experience as a midwife and researcher, Dr Wickham draws on a wide range of evidence, including the voices of women and practitioners, to answer vital questions such as: How accurate are due dates? Is it really that risky to wait? Does induction make a difference? And, perhaps most importantly, how can we address the induction epidemic?

In Your Own Time is both a masterclass in what the evidence really says about induction of labour and a fascinating insight into how birth has come to be controlled by Western medicine.

"This is such a vitally important book. With her brilliant brain and extensive experience, Dr Sara Wickham has pulled together and clearly interpreted the complex evidence about induction of labour. This book provides clarity about why increasing numbers of women are having their labours induced, and the problems with current guideline recommendations. It also offers suggestions about what we can all do to reclaim the parameters of normal and support women to birth in their own time. Anyone who cares about women and their experiences of birth needs this book." Dr Rachel Reed, midwife and researcher.

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In Your Own Time: How western medicine controls the start of labour and why this needs to stop

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In Your Own Time: How western medicine controls the start of labour and why this needs to stop : Wickham, Sara: Amazon.co.uk: Books

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Another  Dr Sarah Wickham recommendation...

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What's Right For Me?: Making decisions in pregnancy and childbirth

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Buy What's Right For Me?: Making decisions in pregnancy and childbirth 2 by Sara Wickham (ISBN: 9781999806415) from Amazon's Book Store. Everyday low prices and free delivery on eligible orders.

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Inducing Labour: making informed decisions. 

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This book (by Sara Wickham) is definitely worth a read if you find yourself facing the decision whether to be induced - or not. 

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This book (by Sara Wickham) is definitely worth a read if you find yourself facing the decision whether to be induced - or not. 

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"Inducing Labour: making informed decisions explains the process of induction of labour and shares information from research studies, debates and women’s, midwives’ and doctors’ experiences to help women and families become more informed and make the decision that is right for them."

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Dr Sara Wickham PhD, RM, MA, PGCert, BA(Hons) is an author, educator and researcher who works independently.

Sara's career has been varied and includes more than twenty five years of experience as a midwife, lecturer and researcher. She is the author/editor of seventeen books, has lectured in more than thirty countries, edited midwifery journals and provides consultancy services for midwifery and health-related organisations around the world.

Sara can be found online at www.sarawickham.com

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Inducing Labour: making informed decisions

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When is it better to induce labour than to let a woman's body or baby decide the best time for birth? What are the pros and cons of waiting and of being induced? What about after the due date? When the baby is thought to be bigger than average?

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An induced labour is one that's started artificially.

It's common for labour to be induced if your baby is overdue or there's any risk to you or your baby's health.

This risk could be if you have a health condition such as high blood pressure, for example, or your baby is not growing.

Induction will usually be planned in advance. You'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced.

It's your choice whether to have your labour induced or not.

If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.

Why you might be induced

if you're overdue

if your waters have broken

if you or your baby have a health problem

If you're overdue

Induction will be offered if you do not go into labour naturally by 41 weeks, as there will be a higher risk of stillbirth or problems for the baby.

If your waters break early

If your waters break more than 24 hours before labour starts, there's an increased risk of infection to you and your baby.

If your waters break after 34 weeks, you'll have the choice of induction or expectant management.

Expectant management is when your healthcare professionals monitor your condition and your baby's wellbeing, and your pregnancy can progress naturally as long as it's safe for both of you.

Your midwife or doctor should discuss your options with you before you make a decision.

They should also let you know about the newborn (neonatal) special care hospital facilities in your area.

If your baby is born earlier than 37 weeks, they may be vulnerable to problems related to being premature.

If your waters break before 34 weeks, you'll only be offered induction if there are other factors that suggest it's the best thing for you and your baby.

If you have a health condition or your baby is not thriving

You may be offered an induction if you have a condition that means it'll be safer to have your baby sooner, such as diabetes, high blood pressure or intrahepatic cholestasis of pregnancy.

If this is the case, your doctor and midwife will explain your options to you so you can decide whether or not to have your labour induced.

Membrane sweep

Before inducing labour, you'll be offered a membrane sweep, also known as a cervical sweep, to bring on labour.

A membrane sweep would usually be offered to you after 39 weeks.

To carry out a membrane sweep, your midwife or doctor sweeps their finger around your cervix during an internal examination.

This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour.

Some women find the procedure uncomfortable or painful. You may get some cramping and vaginal bleeding afterwards.

If labour does not start after a membrane sweep you may be offered an additional sweep or induction of labour.

Induction is always carried out in a hospital maternity unit. You'll be looked after by midwives and doctors will be available if you need their help.

How labour is induced

If you're being induced, you'll go into the hospital maternity unit.

There are 2 main ways labour can be induced:

Hormones can be put inside your vagina using a vaginal tablet (pessary) or a gel, or given as tablets that you swallow.

Devices such as balloon catheter (a small balloon, full of water) or an osmotic dilator (a type of sponge) can be used to widen your cervix.

You'll usually be offered hormones first to see if they work, unless there's a medical reason you cannot take hormones.

It usually takes many hours for these treatments to start working. You will usually stay in the hospital maternity unit, though you may be able to go home in some cases.

Sometimes a hormone drip is needed to speed up the labour. You may also need to have your waters broken artificially.

What induced labour feels like

If you need to be induced it may affect where you can give birth. You may need to stay in hospital for longer and have more examinations.

Induced labour is usually more painful than labour that starts on its own.

Your pain relief options during labour are not restricted by being induced.

You should have access to all the pain relief options usually available, such as an epidural or water birth.

If you are induced you'll be more likely to have an assisted delivery, where forceps or ventouse suction are used to help the baby out.

If induction of labour does not work

Induction is not always successful, and labour may not start.

Your obstetrician and midwife will assess your condition and your baby's wellbeing. You may be offered another method of induction or a caesarean section, or you may be able to wait a few hours and then be assessed again.

Your midwife and doctor will discuss all your options with you.

Natural ways to start labour

There are no proven ways of starting your labour yourself at home.

You may have heard that certain things can trigger labour, such hot baths, certain food or drinks, having sex or herbal supplements. But there's no evidence that these work. Also there's no information about the safety of herbal supplements and they could be harmful to you or your baby.

Having sex will not cause harm, but you should avoid having sex if your waters have broken as there's an increased risk of infection.

For more information on induction, you can read the NICE information for the public on induction of labour.

Community content from HealthUnlocked

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Find out about induction of labour, where the midwife or doctor starts labour artificially using a membrane sweep, pessary or hormone drip.

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Patient Education: Induction of Labour  

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Patient Education: Induction of Labour  

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This is an American website, but it has some good images and information.

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Patient education: Induction of Labour - TVASurg - The Toronto Video Atlas of Surgery

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Illustrated patient guide on going through an induction of labour.

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BabyCentre mums tell: what I wish I'd known about induced labour - BabyCentre UK

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BabyCentre mums tell: what I wish I'd known about induced labour - BabyCentre UK

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If you've gone past your due date you may be wondering if your labour will end up being induced. Here, mums from our community share their top tips on induced labour, based on their own experiences.

Does induced labour hurt more than natural labour?

"I wasn't really prepared for how uncomfortable it would be when the midwife examined me and inserted the pessary. It felt like I was having a membrane sweep at the same time."
Emmalou

"My first child was born naturally, but I was induced for my second. It's a really intense experience and doesn't have the slow build-up of pain like a natural labour. I don't know if it actually hurts more, but you don't have time to get used to the pain."
Becca

"I wish I'd known about the intensity of induced contractions. Mine came one on top of another, with no 'rest' period as there is with natural contractions to let me catch my breath."
Lindsay

"If you want an epidural, ask for it early on, preferably before you have the drip. By the time my midwife accepted how bad my pain was, it was too late."
Victoria

Will being induced limit my labour options?

"You may not be able to move around. I'd been to hypnobirthing classes, which focused on having a natural birth using lots of upright positions. But in the end, I was induced by drip and needed a lot of monitoring, so I couldn't really move around much at all."
Leah

"Being induced can reduce your options for a water birth. I started out with a pessary and was told I might still be able to get in the birth pool. But when I needed the drip, that meant goodbye to my water birth dreams. Though by that point, I didn't really care - I just wanted to meet my baby!"
Shanice

"I wish I'd known beforehand that the midwives wouldn't let me eat anything once I got to the hospital. I'd been quite nauseous in the week leading up to the date and hadn't eaten enough. If I'd known, I would have forced something down to keep my energy up. Having said that, my best mate was allowed a few munchies during her induction, so I'd ask your midwife what the policy is at your hospital."
Stephanie

Does induction always result in a slow labour?

"I was induced using a Propess pessary and it took a while for my contractions to kick in, but once they did my son was born in just over an hour."
Jojo

"I was fully expecting a slow labour, and had planned to be in hospital for quite a while. In the end, it was all over in a few hours! However, I know that's not always the case. It's best to prepare for all possibilities."
Jane

Is every induction the same?

"Your doctor or midwife may need to try a few different methods before they find one that works. I was getting pessaries, having my waters broken and so on for days, but once I was put on a drip I gave birth in five and a half hours."
Erica

"Induction doesn't always work! I had two sweeps and five inductions, but still ended up having a caesarean section. I'd still try for an induction again if I need one though."
Dee

Do I have to do everything the midwives say?

"You don't have to agree to induction straight away. I was put under a lot of pressure to be induced earlier this year, but I decided to wait and in the end it was unnecessary. As long as you and the baby are both doing well, you can choose to just be very closely monitored for a while instead."
Jo

"If you feel like your labour is further along than your midwife thinks, don't let her fob you off. Mine was so sure I wasn't ready that she barely had time to get her gloves on before my baby popped out!"
Anna

Can induction really be boring?

"I wish I'd known that I'd have to go through at least some of it alone. After my induction, I was put on a ward while we waited for things to get going. Unfortunately, I still wasn't in active labour when visiting hours ended, so my husband had to go home."
Katie

"I was surprised by how long it took, and how bored and lonely I felt at times. If I'd known it could take a couple of days for things to really get going, I would have taken a good book! I might also have been a bit less shy when it came to asking for painkillers for my back pain, and then I could have had some sleep."
Zoe

Is there anything I can do to feel better about induction?

"In the end, it's all what you make of it! Our birth was highly medicalised and at times it could easily have been dramatic. However we went in with no expectations, so we were able to go with the flow. Joking with each other and bantering with the staff really helped me stay calm."
Heather

"You may end up being more OK with induction than you'd think. I'd really hoped for a natural water birth, and was heartbroken when I had to be induced. But when my baby girl was born safe and well, I could see that nothing really mattered but that!"
Kelly

For more stories about induced labour, why not check out why these mums loved their inductions?

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BabyCentre mums tell: what I wish I'd known about induced labour

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If you've gone past your due date you may be wondering if your labour will end up being induced. Here, mums from our community share their top tips on induced labour, based on their own experiences. "I wasn't really prepared for how uncomfortable it would be when the midwife examined me and inserted the pessary.

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Optibreech Service is being trial at LWH

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What is a cervical sweep? (Video) - BabyCentre UK

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What is a cervical sweep? (Video) - BabyCentre UK

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Midwife Tracey Owen describes what happens during a sweep.

Tracey: A sweep is offered to you when your baby is overdue. If it's your first baby, you're looking at around 40 weeks and if it's your second baby, you're looking at seven days past that time.

It's a vaginal examination and it's where they try and put their fingers through the cervix to release the oxytocin. The sweep is not a comfortable experience but you'll know it's been successful if you start to get period pains. Now and again, your waters may break or you may find you lose a little bit of blood in the show. That's all normal and that's what we'd be looking for. If your sweep's been successful, you'll find you'll start to have contractions within 24-48 hours. Your hormones are working well and your contractions are beginning.

A sweep is not something we would recommend as a DIY procedure. It's something that should be done by a professional. Sweeps aren't always successful and you may need a couple to get your contractions starting. At the end of the day, it's a means to an end and you need your baby of yours to come out.

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Midwife Tracey Owen describes what happens during a sweep. Tracey: A sweep is offered to you when your baby is overdue. If it's your first baby, you're looking at around 40 weeks and if it's your second baby, you're looking at seven days past that time.

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Why can induction of labour take so long? 

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Why can induction of labour take so long? 

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A midwife explains why it can sometimes take longer to give birth if you've had your labour induced.

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Why can induction of labour take so long? (Video)

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If you’re baby’s overdue, your midwife may recommend that you have your labour induced. Find out why this can sometimes take longer than natural labour.

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If you are nearing your due date and trying to get your baby to engage this might be worth a try...

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View this post on Instagram

A post shared by Liesel Teen BSN, RN | Pregnancy + Birth (@mommy.labornurse)

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6 Ways to Induce Labor Naturally — Nichole Joy

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6 Ways to Induce Labor Naturally — Nichole Joy

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There is a lot of information out there about medical inductions. The Health and safety of mom and baby are always the top priority. Sometimes a medical induction is needed, and that's okay, but adding ways to induce labor naturally should be in everyone's toolkit (not sure what else to put in your birth toolkit? Check out my freebie library .)

Here are six approaches to try:

1. Sex

And not just sex. Sex with semen inside of you, and ideally, where you orgasm.

Because semen contains natural prostaglandins , and prostaglandins are the active 'ingredient' in the medical induction drug, Cervidil. It's believed that 3x the natural form of prostaglandins (found in semen) has a comparable effect on ripening your cervix (effacement during labor) as Cervidil.

Also, orgasms (& the love hormone oxytocin) are great for encouraging the uterus to contract.
Side note: if your water has broken, do not have sex to speed up labor due to the risk of infection.
2. Nipple Stimulation

Unfortunately, nipple stimulation when trying to induce labor is not as fun as it sounds ( especially if you have sensitive nipples with pregnancy).

The idea is to recreate the feeling of a baby nursing on your breast, which signals your body to release oxytocin. Remember that oxytocin encourages your uterus to contract. After birth, this is to help the uterus return to its original size, but during birth, oxytocin=contractions to get the baby out.

There is solid that shows nipple stimulation can be an effective way to:
Tip: Try putting on a breast pump for nipple stimulation. Bonus points if you're bouncing on the yoga ball at the same time.
3. Move Your Body

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6 Ways to Induce Labor Naturally - Nichole Joy

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Are you worried about a medical induction? You may be able to give your body & baby a gentle nudge and induce labor naturally. Adding ways to induce labor naturally should be in everyone's toolkit. Here are six natural ways to keep in mind.

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Can I make myself go into labour: myths or truths? | NCT

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Can I make myself go into labour: myths or truths? | NCT

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Can I make myself go into labour: myths or truths? | Pregnancy, Your pregnancy week by week articles & support | NCT

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We discuss myths about what brings on labour to find out what’s true and what, if anything, might actually work.

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Overdue baby: induced labour pros and cons | NCT

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Overdue baby: induced labour pros and cons | NCT

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Should I choose to have my labour induced?

You might want to consider some of the risks and benefits of induction before you make a decision about it. Inductions are offered for various reasons, which include:

longer pregnancy

pre-labour rupture of membranes (PROM) after 37 weeks

a baby that's expected to be larger

health complications for the mother or baby

when the baby has died

when the baby is unable or unlikely to survive outside the womb.

(NHS, 2020; Fisher, 2021; NICE, 2021a)

Many hospitals offer inductions from 41 weeks of pregnancy, or earlier if there are other medical conditions or complications for either mother or baby (NICE, 2021a). No test can predict whether an individual baby would be better to wait for labour to start or if labour should be induced (Middleton, 2020).

Your healthcare providers will provide you with information, so read below to find out what questions to ask.

Why the concern about a longer pregnancy?

Most pregnancies come to a natural end with birth between 37 and 42 weeks. Some end earlier and some are a little longer. Over 80 in 100 babies arrive before 41 weeks of pregnancy and 99 in 100 by 42 weeks of pregnancy (NICE, 2021a). The length of pregnancy can be a family trait. So you may want to consider how long your previous pregnancies and those of your female relatives were (Oberg et al, 2013).

Induction is offered in longer pregnancies because, after 41 weeks, there is a higher chance of a baby being admitted to a neonatal intensive care unit, and the rate of stillbirth increases from less than one in 1,000 at 40 weeks to three in 1,000 (Middleton, 2020; NICE, 2021a). After pregnancies lasting over 41 weeks, more women have a caesarean birth (NICE, 2021a).

While these risks are still comparatively low at 41 weeks, some research has found that the increased risk of stillbirth is higher for people from a minority ethnic background or those who live in deprived areas. So you may wish to discuss this with your healthcare provider (NICE, 2021a).

In mothers over 40 years old, induction is likely to be offered earlier, although this does not form part of national guidance. This is because as we age, we can accumulate other health conditions that may affect pregnancy. Such offers should be individualised, because for example, a fit and healthy 42-year-old may have a healthier pregnancy than a woman of 35 with additional health issues. If someone declines an induction, they will be offered additional monitoring of the baby, which can also be declined (NICE, 2021a).

Why is induction offered if my waters go?

Depending on when the waters break during pregnancy, an induction may be offered. When the amniotic sac of waters around the baby ruptures before contractions have started, it slightly increases the chance of infection for the baby, and giving birth reduces this risk (NICE, 2021a).

It is unlikely that an induction would be offered before 34 weeks of pregnancy unless there is an additional complication for the baby. Your carers may recommend waiting until 37 weeks for an induction if there are no other complications and the baby is doing well (NICE, 2021a).

If someone is over 37 weeks pregnant and their waters break with no signs of labour, they may be offered the choice of an induction or 24 hours to wait and see if labour starts (NICE, 2021a). It always remains the woman's decision to accept or decline an induction. If you decline, then your carers will explain how to reduce the chance of infection.

Why is induction offered for a larger baby?

Induction may be offered if a baby seems to be growing larger than expected, although there is little evidence around the benefits and risks of induction in this situation (NICE, 2021a). A larger baby in this situation is considered to be one with an estimated weight in the largest five in 100 babies (NICE, 2021a). However, the baby's size is difficult to determine accurately (RCOG, 2012).

When a baby may be larger, it slightly increases the chance of the mother finding it harder to birth them without injury to herself. For this reason, caesarean birth may also be considered as an option (NICE, 2021a).

Shoulder dystocia is where the baby's shoulders are not born by the mother's efforts in the next contraction after the head is born (Menticoglou, 2018). For women who do not have diabetes, there is a slightly increased chance of this happening with expectant management of a longer pregnancy (NICE, 2021a). (See our articles on diabetes in pregnancy if that applies to you.) It's useful to know that almost half of the cases of shoulder dystocia occur in smaller babies (RCOG, 2012), which is why there is no national guidance to always induce or move to a caesarean birth when the baby is suspected to be larger.

When might an induction be offered due to health complications?

There are many reasons why an induction could be considered. For example, if a pregnant woman has high blood pressure or if a baby is not growing as expected (NHS, 2020). There may be many factors to consider, and you could ask why an induction is being recommended.

Induction for a baby that has died or is unable or unlikely to survive outside the womb

Sometimes a baby has died before being born, or tests show that they will be unable or unlikely to survive outside the womb. In this situation, an induction may be offered as an option for birth, alongside waiting for labour to start or giving birth by caesarean (NICE, 2021a).

In these difficult circumstances, maternity units offer specialist support to the family (NICE, 2021a). There is plenty of time for the different options to be explored, and suggestions for how to say goodbye to the baby are offered.

What are the pros and cons of membrane sweeps?

A 'membrane sweep' or 'stretch and sweep' might make it more likely that labour starts without a formal induction (NICE, 2021a). It involves a midwife inserting one or two fingers into the vagina and using a circling motion sweeping the cervix to free the membranes (Finucane et al, 2020). The risks of this are pain, discomfort and possible vaginal bleeding, along with irregular or regular contractions that may not lead to established labour (Madeley, 2021; NICE, 2021a). You can ask the midwife for a vaginal examination before proceeding with the sweep, as that may tell you that labour is already starting.

In three studies that asked the question, the majority of women found a sweep to be an acceptable way to prevent a formal induction of labour (Finucane et al, 2020). However, a systematic review showed that seven women would need sweeps to prevent a single induction (Boulvain et al, 2005).

Women may experience repeated sweeps as physically and emotionally exhausting (Madeley, 2021). The procedure could also cause an accidental rupture of the membranes protecting the baby, which would lead to an offer of induction within 24 hours as there would then be a risk of infection (Avdiyovski et al, 2019; NICE, 2021a).

What happens when labour is induced?

To begin with, you will be offered a vaginal examination and monitoring of your baby's heart rate (NICE, 2021a). This may be a good time to ask any further questions that you have. Different forms of inductions may be offered depending on your NHS trust and how dilated your cervix is.

A chemical induction involves the use of artificial hormones inserted as a gel, tablet or 'tampon' into the vagina. A mechanical induction instead uses a catheter or small rods placed in the cervix which slowly expand, stretching it open (NICE, 2021a). These methods are both known as cervical ripening and can take several days. Women often describe this as a negative experience, particularly if they were staying on their own in hospital or were unsure what to expect (Brown and Furber, 2015).

If labour is progressing, the midwife may suggest breaking the waters, and then setting up a drip of synthetic oxytocin to stimulate stronger contractions (NICE, 2021a). You can postpone or decline these suggestions (NICE, 2021a).

What are the disadvantages of induced labour?

A chemical induction can cause the uterus to contract strongly in a way that the mother or baby find difficult, so both you and your baby will be continuously monitored using a machine connected to straps around the abdomen (NICE, 2021a). This may affect your ability to move and might be uncomfortable.

Induction of labour will affect your birth options (NICE, 2021a). Birth will be arranged for a hospital setting and it may not be possible to use a birth pool. This could be because your NHS trust doesn't have the facilities to monitor you in the pool, or because your labour is more complicated, so the pool is not recommended.

Some people report an induced labour to be more painful, and the hospital stay during and after birth may be longer. It is also associated with a more negative birth experience (Adler et al, 2020; NICE, 2021a).

There may be a higher chance of complications during an induced labour if it is your first baby (Dahlen et al, 2021). One sixteen-year study has found that babies whose birth was induced were more likely to experience hospitalisation for infections up until 16 years of age, particularly if born before 41 weeks gestation (Dahlen et al, 2021).

Do I have a say in the decision to have an induction?

Yes, it's good to remember that your views, beliefs and values are central to decisions about your care. This includes whether you want to accept the offer of induction (Dekker, 2020; NICE, 2021a,b). You can also talk to your healthcare provider if you wish to request an induction for any reason (Dekker, 2020; NICE, 2021a).

For example, a healthy first-time mum who wants an unmedicated birth might feel strongly that they want a spontaneous labour. At the same time, it may be very important to someone who has experienced miscarriages in the past to lower the risk of stillbirth by any means necessary.

You may have preferences over what methods are used during induction, and you can talk to your healthcare professional about this (NICE, 2021a). Some hospitals offer outpatient induction where the start of the process can happen at home. Current research has found this to be as safe and effective as being in hospital and may cause less discomfort, but it may not be offered everywhere (Dong et al, 2020).

Your midwife or obstetrician should explain why you are being offered an induction and the methods, risks, benefits and alternatives. They should also encourage you to look at information about it and give you time to discuss your decision with your partner or family. Midwives or obstetricians should support you in whatever decision you make (NICE, 2021a).

Take a look at Dr Sara Wickham's Five Questions to ask if you're offered induction of labour (Wickham, 2022).

What are the side effects of being induced?

Severe side effects of the drugs used for cervical ripening are very rare. But general side effects can include nausea, vomiting, diarrhoea and headaches (uncommon) (NICE, 2022a).

Similarly, syntocinon, which is given by drip to augment or strengthen labour, can cause headaches, nausea, vomiting and very occasionally a rash. It can also have a negative effect on breastfeeding (Cadwell and Brimdyr, 2017).

Induction is an increasingly common process carried out in the UK. NHS data show that 34% of labours were induced in 2020 to 2021 (NHS Digital, 2021). Almost two-thirds (60 in 100) of these induced women gave birth without forceps/ventouse or caesarean. About 17 in 100 had births assisted with forceps or ventouse and 22 in 100 had an unplanned caesarean birth (NHS Digital, 2021).

These figures apply to all inductions for all reasons, not just those performed for longer pregnancies. The national rates for all births in 2020 to 2021 were: 54 in 100 births did not involve forceps/ventouse or caesarean sections; 13 in 100 were assisted births; and 33 in 100 were caesarean births (which includes planned and unplanned caesareans) (NHS Digital, 2021).

Weighing up the pros and cons...

Feeling like they have plenty of information can help some people to weigh up the benefits of induction against any potential risks. Other people can find it a bit overwhelming.

With most decisions about giving birth, you only have to decide one small thing at a time. One of the things you can ask your healthcare providers is: 'Can I stop at this point if I change my mind?' and 'Which avenues am I closing by making this decision?'

You can consider what kind of information will help you feel you've made the decision that's best for you and your baby.
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.

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.

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Induced labour: reasons, pros and cons | Pregnancy, Your pregnancy week by week articles & support | NCT

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You might want to consider some of the risks and benefits of induction before you make a decision about it. Inductions are offered for various reasons, which include: longer pregnancy pre-labour rupture of membranes (PROM) after 37 weeks a baby that's expected to be larger health complications for the mother or baby when the baby has died when the baby is unable or unlikely to survive outside the womb.

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Overdue baby – what happens if my baby is late? | NCT

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Overdue baby – what happens if my baby is late? | NCT

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You feel like you've swallowed a whole watermelon and getting anywhere feels like a feat of Herculean proportions. Your baby must surely be ready to come out, right?

You're not alone if you've been focusing on your due date throughout your pregnancy and counting down to it in the latter stages. And it's understandable that you might feel disappointed or worried if you approach that date with no sign of your baby.

So when might you be offered treatment for a longer pregnancy and what happens? Well, the story starts with the due date...

When is a baby overdue or late?

Pregnancy normally lasts anywhere between 37 and 42 weeks, and that's when it's called a full-term pregnancy or term. An estimated due date, or EDD, is calculated as 40 weeks from the first day of your last menstrual period (Dekker, 2019).

A pregnancy that continues for longer than 42 weeks is called post-term, prolonged or overdue (Dekker, 2019). Over 80 in 100 babies arrive before 41 weeks of pregnancy and 99 in 100 arrive by 42 weeks of pregnancy (NICE, 2021). This may feel fine, or you may feel like you've had enough well before that date.

How accurate are due dates?

Estimates of the length of pregnancy are based on a woman having a menstrual cycle of 28 days. And because not everyone has that, and because we don't all remember the date of our last period, ultrasound is considered more accurate at predicting pregnancy length (Reddy et al, 2014). An ultrasound can give an accuracy of plus or minus seven to 10 days (Reddy et al, 2014).

Why are some pregnancies longer?

We don't fully understand why some pregnancies are shorter or longer, but we do know it can run in families (Oberg et al, 2013).

Longer pregnancies may be associated with first pregnancies, being older, having a boy and being heavier (Caughey et al, 2009; Oberg et al, 2013). Having African, Asian, or Latinx ethnic origins may make it less likely that you'll have a longer pregnancy (Caughey et al, 2009).

Can I do anything to start labour myself?

For mums who'd prefer to have some control over the process, there are said to be some traditional ways of trying to induce labour at home. See more in our article about whether you can really kick-start your own labour or not.

What is induced labour?

Labour is a process that usually starts on its own. But sometimes labour will be started with the help of health professionals. This is called induced labour.

Find out more in our article about induction.
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 labour and life with a new baby.

Information from NHS on being overdue and on induced labour.

Find out more about NICE guidance on the induction of labour

Caughey AB, Stotland NE, Washington AE, Escobar GJ. (2009) Who is at risk for prolonged and postterm pregnancy? AJOG. 200(6):683.e1-5. Available at: https://doi.org/10.1016/j.ajog.2009.02.034

Dekker R. (2019) The evidence on: due dates. Available at: https://evidencebasedbirth.com/evidence-on-due-dates/ [Accessed 27th September 2022]

NICE. (2021) Inducing labour [NG207]. Available at: https://www.nice.org.uk/guidance/ng207 [Accessed 27th September 2022]

Oberg A, Frisell T, Svensson A, Iliadou A. (2013) Maternal and fetal genetic contributions to postterm birth: familial clustering in a population-based sample of 475,429 Swedish births. Am J Epidemiol. 177(6):531-537. Available at: https://doi.org/10.1093/aje/kws244

Reddy UM, Abuhamad AZ, Levine D, Saade GR. (2014) Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol. 210(5):387-397. Available at: https://doi.org/10.1016/j.ajog.2014.02.028

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Overdue baby - what happens if my baby is late? | Labour & birth articles & support | NCT

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Many women hope for a birth around their baby's due date. Find out here what happens if your baby is overdue and you are offered an induction of labour.

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Natural ways to bring on labour: photos - BabyCentre UK

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Natural ways to bring on labour: photos - BabyCentre UK

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Are you overdue and desperate for labour to start? Check out our top tips on natural ways to get things going.

Eat pineapple

Pineapple contains an enzyme (bromelain) that is said to soften your cervix and trigger labour. Eating pineapple will also stimulate your stomach which is thought to get your contractions going. The amount you would need to eat to have an effect would upset your tummy, however. And there is no evidence pineapple works to bring on labour in practice. If you still fancy giving pineapple a go, opt for fresh pineapple. Tinned or juiced varieties do not contain the crucial enzyme. If nothing else, it's a delicious healthy snack!

Acupuncture

Acupuncture is the insertion of very fine needles into specific parts of the body in order to trigger a reaction. It may be effective for starting labour, although there isn't much evidence. If you want to try acupuncture, find a qualified practitioner and consult your GP or midwife beforehand.

Take a bumpy ride

There's not much scientific evidence for a bumpy car ride triggering labour but it certainly won't hurt to try! Some mums believe that bouncing around in a car seat puts pressure on your cervix which will stimulate labour. This won't hurt your baby who is safely cushioned in your womb.

But if you want to try cruising over a few speed bumps or tackling a rutted track, check with your GP or midwife first. This is especially important if you have a medical condition or have been advised to have an induction.

Eat curry

A hot curry is often recommended to kick-start labour! It's believed that the spices can set off contractions by stimulating your tummy. So, although we can't guarantee it will get things going, it's a good excuse to have a takeaway or cook up your favourite curry. And don't hold back on the chilli!

Stimulate your nipples!

Rubbing your nipples may trigger labour by tricking your body into thinking that your baby is suckling. This releases the hormone oxytocin which can help your womb to contract. It will only work if your body is primed to go into labour. If you're having a healthy pregnancy, try gently rubbing and rolling your nipples between your fingers and see what happens!

Have sex

Many mums swear that having sex helped to kick off their labour.

The release of oxytocin, the stimulation of an orgasm, and the effects of semen on your cervix are all believed to help trigger labour. Even though there isn't any medical evidence to back this up, it could be a fun activity to try! Sex may be a bit tricky at this stage of pregnancy, so you and your partner may have to be imaginative. Check out our sex positions during pregnancy slideshow for ideas.

Or take a peek at our community discussion to find out whether having sex helped to kick-start labour for other women.

Go for a walk

While walking, the pressure of your baby's head on your cervix may help to set off your contractions. And if your baby hasn't moved down yet, walking could help them get into a better position so that your labour can start naturally. If you try this tip, make sure that you don't wear yourself out. You will need all your energy for labour!

Wear your best knickers

Sod's law says that your waters will break while you're wearing your favourite underwear. Even if this doesn't happen, wearing some nice underwear can get you in the mood if you decide to try having sex to get labour started.

If none of these methods work for you and you're overdue, you may be offered an induction. Learn what to expect with our photo guide.

Francesca Whiting is an editor at BabyCentre. She's responsible for making sure BabyCentre's health content is accurate, helpful and easy to understand.

Track your baby's development

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Are you overdue and desperate for labour to start? Check out our top tips on natural ways to get things going. Pineapple contains an enzyme (bromelain) that is said to soften your cervix and trigger labour. Eating pineapple will also stimulate your stomach which is thought to get your contractions going.

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In this article

When does active labour start?

Midwives and doctors say the active first stage of your labour starts when:

you are having regular, powerful contractions and

your cervix is dilating from 4cm (1.6in) onwards (NCCWCH 2014).

This may surprise you, as you may start to have strong tightenings well before reaching this point. You may have been awake all night and feeling as though labour has been under way for a while.
Pacing yourself in early labour may help you cope better when active labour gets under way (RCM 2018). Find out how to get through early labour at home.

How long is a normal labour?

Every labour is different, but there are average times that may help to guide you.

Early labour (before it gets active) often lasts about nine hours to 12 hours (Tilden et al 2019). It's common for it to be longer for first-time mums, lasting 18 hours or more (Ängeby et al 2018).

The active first stage of labour (when your cervix is dilating from 4cm and you are having regular, powerful contractions) for a first baby is usually about eight hours, but it could be shorter or longer (NCCWCH 2014).

If this isn't your first baby, you may have a shorter labour, though this isn't guaranteed. For women who have given birth before, the active first stage of labour lasts, on average, for five hours (NCCWCH 2014). It's unlikely to last for more than 12 hours (NCCWCH 2014).

The pushing phase of labour (active second stage) shouldn't usually take more than three hours, or two hours if you've had a baby before (NCCWCH 2014).

Bear in mind that a quick labour isn't necessarily better either for you or your baby (Rimmer 2014). Very fast labours can be physically and emotionally challenging (Rimmer 2014). However, a very slow labour can leave you exhausted and unwell (Harper et al 2014).

What counts as a slow labour?

During active labour there may be an hour or so of slow or little progress, followed by periods of faster progress (Ehsanipoor and Satin 2019). What matters is how your labour progresses over several hours.

If your labour is straightforward, your midwife will assess your labour every four hours (NCCWCH 2014). With your permission, she'll carry out a vaginal examination to check how open your cervix is (NCCWCH 2014, RCM 2012a, RCN 2016). She'll also listen to your baby's heartbeat using a hand-held Doppler (a Sonicaid) or an ear trumpet (a Pinard stethoscope).

A four-hourly check gives your midwife a good overview of how you're doing. Assessing you more often than that won't necessarily help her to understand more, and can lead to unnecessary intervention in your labour (NCCWCH 2014).

However, if you've had any health concerns during this or a previous pregnancy you may need continuous monitoring.

Your doctor or midwife will also want to monitor you if you've developed complications, such as meconium (your baby's first poo) in your waters, or fresh bleeding (NCCWCH 2014).

Your midwife will place two electronic sensors on your bump, one to measure contractions and one to measure your baby's heartbeat. The sensors will remain there throughout your labour. Your midwife will still only check your cervix every four hours, though.

If your cervix isn't dilating at a rate of at least 0.5cm (0.2in) an hour over a four-hour period, speeding up your labour may be an option (NCCWCH 2014). This is also called augmentation of labour. Your midwife will discuss whether or not to speed up your labour with you and your doctor.

Each woman's labour is unique. Your wishes should be taken into account, along with what your midwife and doctor recommend is best for you and your baby (Jackson et al 2014, NCCWCH 2014).

Why might my labour be slow?

Some labours are just slow for no particular reason. However, you may have a slow labour if:

You're dehydrated or exhausted (NCCWCH 2014).

The position of your baby is is making it harder for your labour to progress (NCCWCH 2014).

You feel particularly scared or anxious. These emotions tend to interfere with the release of the hormone oxytocin, which can help labour along (Aral et al 2014, Simkin and Ancheta 2011).

Your contractions are infrequent, not very strong, or staying at the same intensity rather than getting stronger (NCCWCH 2014).

You've had interventions that have slowed your contractions. These could include having to stay still for periods of time, or having an epidural (NCCWCH 2014).

Bear in mind that the first 5cm of cervix dilation nearly always takes much longer than the second 5cm (Ehsanipoor and Satin 2019, Jackson et al 2014, Simkin and Ancheta 2011). Your cervix opens more quickly as your contractions get stronger.
How is labour speeded up?

If your midwife asks whether you'd like to have your labour speeded up, take time to consider your options. If your baby is fine, and your cervix is gradually opening up, even if it's happening slowly, it may be best to leave things alone. You may be perfectly happy to take things gently, staying in tune with your body and your baby.

Or you may be so exhausted that you really want your baby to be born quickly. If that's the case, your midwife can help to move things along in the following ways:

Breaking the waters

Your midwife may suggest breaking your waters to speed up your labour (NCCWCH 2014). This isn't usually recommended near the beginning of labour, as it could increase your risk of infection if labour doesn't start right away (NCCWCH 2008).

However, if the active stage of labour slows right down, breaking your waters can help to get things going again. It may shorten labour by about an hour (NCCWCH 2014).

If you agree to the procedure, here's how your midwife will do it. Once you're on the bed, she'll remove the last section of the bed so that your bottom is right at the end. She may ask you to put your legs up in stirrups, or just hold them apart.

Your midwife will then make a small break in the membranes around your baby. She'll use a long thin probe (amnihook) or a medical glove with a pricked end on one of the fingers (amnicot). She'll scratch the membrane until it bursts and the waters flow out into a tray placed underneath the bed.

This procedure isn't painful but it can be very uncomfortable. You'll probably be glad to get up again once it's over.

Your midwife will then check your baby's heartbeat using a Sonicaid or ear trumpet, to make sure that breaking the waters hasn't distressed him.

Your contractions may become much stronger after your waters have been broken (NCCWCH 2014). Be prepared to work hard with breathing and relaxation exercises. Or you can ask your midwife for some pain relief, such as gas and air, if you need extra help.

Hormone drip

If moving around or breaking your waters doesn't speed up your labour, your doctor may suggest a hormone drip to boost your contractions (NCCWCH 2014). This will contain Syntocinon, which is an artificial form of the labour hormone oxytocin.

If you have Syntocinon, your midwife will continuously monitor your baby's heartbeat by strapping electronic sensors to your tummy (NCCWCH 2014).

Your midwife may also recommend attaching a small clip to your baby's head. The clip is called a fetal scalp electrode and it may provide a more accurate reading than placing a sensor on your tummy. It also allows you to move around more easily.

Continuous monitoring is recommended because Syntocinon can over-stimulate your womb (uterus) (NCCWCH 2014). You may get very strong, frequent contractions, which could distress your baby.

You're also more likely to need help from pain-relieving drugs to cope with these artificially induced contractions. For this reason, your midwife should offer you an epidural before she starts a Syntocinon drip (NCCWCH 2014).

Can I speed up labour myself?

If you'd prefer not to have your waters broken, or a hormone drip, there are some natural techniques you could try to speed up your labour

If you're lying on the bed, get up! Being upright and mobile may strengthen your contractions, while also helping you to cope with them (Lawrence et al 2013).

Take a walk to the toilet. A full bladder may slow down your labour by getting in the way of your baby's head descending (Simkin and Ancheta 2011).

If you have access to one, get into a warm bath or birth pool. This can reduce your need for an epidural or spinal pain relief (Cluett et al 2018).

If your baby is lying back-to-back, an experienced midwife may advise you to lie on your side or try kneeling or standing lunge positions. This may help your baby to rotate to a better position for birth (Simkin and Ancheta 2011).

Have some private time with your partner. Turn the lights down low and have a cuddle, with some nipple stroking or breast massage. This may help your body to release oxytocin, the hormone that strengthens your contractions (Simkin and Ancheta 2011).

You could also try acupuncture during your labour (Mollart et al 2015,Simkin and Ancheta 2011). Complementary therapies probably work best if used throughout labour. You may be able to request an acupuncturist if your labour has slowed down. In some areas of the UK, acupuncturists specialising in childbirth work in teams, meaning that a practitioner is always available.
You can also ask your midwife whether she's certified in any complementary therapies, such as aromatherapy massage, that could help you.

What can help me to cope with a long labour?

These methods may help you:

Use breathing and relaxation techniques to help you stay calm and focused (NCCWCH 2014). If you've been taking hypnobirthing classes, this is the time to use everything you've learned!

Ask your birth partner to massage your back, or your feet, if you're sitting in a chair (NCCWCH 2014, Smith et al 2018).

Listen to your favourite music (NCCWCH 2014).

Eat and drink when you need to. Have a small snack, such as toast, and water, or an isotonic drink, to stay hydrated (NCCWCH 2014).

Change your position. Later in labour you may not feel like walking around, but your midwife can help you to find a comfortable position (NCCWCH 2014).

Listen to your body and try different positions (Simkin and Ancheta 2011). Move around or adopt positions that feel most comfortable to you as labour progresses (NCCWCH 2014).

Ask your midwife to explain what's going on. If you feel involved and in control of your labour, you'll probably feel less anxious and more relaxed. This may make your labour easier to cope with, and you may find it a more positive experience (NCCWCH 2014).

If your midwife is caring for other women as well as you because the unit is busy, continuous support from a student midwife may help your labour to progress. Your birth partner could ask if there's any extra help available (Bolbol-Haghighi et al 2016).

Learn more about what to expect from each stage of labour.
Last reviewed: September 2019

References

Aral I, Koken G, Bozkurt M, et al. 2014. Evaluation of the effects of maternal anxiety on the duration of vaginal labour delivery. Clin Exp Obstet Gynecol 41(1):32-6

Bolbol-Haghighi N, Masoumi SZ, Kazemi F. 2016. Effect of continued support of midwifery students in labour on the childbirth and labour consequences: a randomized controlled clinical trial. J Clin Diagn Res 10(9): QC14-QC17. www.ncbi.nlm.nih.gov [Accessed September 2019]

Cluett ER, Burns E, Cuthbert A. 2018. Immersion in water during labour and birth. Cochrane Database of Systematic Reviews (5): CD000111. www.cochranelibrary.com [Accessed September 2019]

Ehsanipoor MD, Satin AJ. 2019. Normal and abnormal labor progression. UpToDate. www.uptodate.com [Accessed September 2019]

Harper LM, Caughey AB, Roehl KA, et al. 2014. Defining an abnormal first stage of labor based on maternal and neonatal outcomes. Am J Obstet Gynecol (210(6):536.e1-7. www.ncbi.nlm.nih.gov [Accessed September 2019]

Jackson K, Marshall JE, Brydon S. 2014. Physiology and care during the first stage of labour. In: Marshall JE, Raynor MD. eds. Myles Textbook for Midwives. 16th ed. Edinburgh: Churchill Livingstone, 327-66

Lawrence A, Lewis L, Hofmeyr GJ, et al. 2013. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews (10): CD003934. www.cochranelibrary.com [Accessed September 2019]

Mollart LJ, Adam J, Foureur M. 2015. Impact of acupressure on onset of labour and labour duration: a systematic review. Women Birth 28(3): 199-206

NCCWCH. 2014. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health, Clinical guideline, 190. www.nice.org.uk [Accessed September 2019]

RCM. 2012a. Assessing progress in labour. Royal College of Midwives Trust, Evidence based guidelines for midwifery-led care in labour

RCM. 2012b. Rupturing membranes. Royal College of Midwives Trust, Evidence based guidelines for midwifery-led care in labour

RCM. 2018. Midwifery care in labour guidance for all women in all settings. Royal College of Midwives, Midwifery Blue Top Guidance

RCN. 2016. Genital examination in women. Royal College of Nursing. www.rcn.org.uk [Accessed September 2019]

Rimmer A. 2014. Prolonged pregnancy and disorders of uterine action. In: Marshall JE, Raynor MD. eds. Myles textbook for midwives 16th ed. Edinburgh: Churchill Livingstone, 417-33

Simkin P, Ancheta R. 2011. The labor progress handbook: early interventions to prevent and treat dystocia. 3rd ed. Chichester: Wiley Blackwell

Smith CA, Levett KM, Collins CT, et al. 2018. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database of Systematic Reviews (3): CD009290. www.cochranelibrary.com [Accessed September 2019]

Smyth RMD, Markham C, Dowswell T. 2013. Amniotomy for shortening spontaneous labour. Cochrane Database of Systematic Reviews (6): CD006167. www.cochranelibrary.com [Accessed September 2019]

Thakar R, Sultan AH. 2014. The female pelvis and the reproductive organs. In: Marshall JE, Raynor MD. eds. Myles Textbook for Midwives. 16th ed. Edinburgh: Churchill Livingstone, 55-80

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How long is the average labour? Why might my labour be too slow? Learn more about why your labour may need to be speeded up and how your doctor or midwife will care for you and your baby during your treatment.

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Monitoring your baby's heartbeat (fetal heartrate monitoring) - BabyCentre UK

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Monitoring your baby's heartbeat (fetal heartrate monitoring) - BabyCentre UK

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by , Senior Midwife and Team Leader September 2021

In this article

Fetal heartrate monitoring, or fetal monitoring, is when your midwife listens to your baby's heartbeat in pregnancy and during labour. Fetal monitoring is carried out during pregnancy to make sure your baby is safe and well and then in labour to check how they're coping.

Why does my baby's heartbeat need to be monitored during labour?

Labour can be stressful for your baby, as well as for you. During a contraction, your baby is squeezed tightly in your womb (uterus), which interrupts the blood supply from your placenta.

The good news is that this is completely normal and your baby is likely to cope well. But some babies do find it more challenging. For example, if your baby hasn't grown well during pregnancy, they're in the breech position or you've had pre-eclampsia then labour may take more of a toll. But there are ways to monitor your baby to ensure they stay well while they make their way into the world.

During labour, your midwife will listen to your baby's heartbeat. That way she'll learn if they're coping well with labour or becoming distressed. If they get very distressed, you may be advised to have a caesarean section.

What is intermittent fetal monitoring?

During pregnancy, your midwife will listen to your baby's heartbeat at your antenatal appointments (NCCWCH 2008a). She will use a hand-held Doppler (a Sonicaid) or an ear trumpet (a Pinard stethoscope). If your midwife uses a Sonicaid then you can also hear your baby's heart beating very quickly. It sounds a bit like a racehorse at full gallop.

During labour, listening to your baby's heartbeat using a Sonicaid or Pinard is an essential part of your care. But it won't interfere too much with your comfort. You just need to keep still for a minute or so while your midwife listens, and then you can move around again.

If your labour is low-risk, your midwife will monitor your baby, for at least one minute, every 15 minutes after a contraction when you're in active labour (NCCWCH 2014). Then she'll do it once every five minutes when you're at the pushing stage (NCCWCH 2014).

What if I need continuous monitoring?

If you or your baby has had health problems during pregnancy, your labour will be monitored all the time. This is called electronic fetal monitoring (EFM) (NCCWCH 2014). Your midwife may also use the term continuous cardiotocography (CTG) monitoring.

You'll be offered EFM if:

Sometimes events can take a different turn once labour starts. Your midwife may decide to monitor your labour continuously if:

Your waters contain significant amounts of meconium (your baby's first poo) (NCCWCH 2014).

Your midwife identifies problems with your baby's heart rate during labour (NCCWCH 2014, RCM 2012).

You develop a high temperature (NCCWCH 2014).

You have fresh bleeding from your vagina during labour (NCCWCH 2014).

Your labour becomes prolonged in either the first stage or second stage (NCCWCH 2014)

Your labour is speeded up with a synthetic hormone (oxytocin) drip (NCCWCH 2014).

If you have an epidural during labour your baby will be continuously monitored for at least 30 minutes from when the epidural is administered. He'll then be monitored again each time your epidural is topped up (NCCWCH 2014).
Even if your labour is trouble-free, you could ask to be monitored continuously if it makes you feel more secure. However this option is only available in consultant units, and not midwife-led units.

What happens during continuous electronic fetal monitoring?

During EFM an electronic sensor is placed on top of your tummy to measure contractions. Then another is placed over your baby's heart to measure his heartbeat. Each sensor is attached to a wire, which is connected to the machine, and elastic belts hold the sensors in place.

The belts can feel quite tight on your tummy, so ask to have them loosened if they're uncomfortable.

The machine will give a digital reading of your baby's heartbeat. The heart rate will vary from beat to beat, and the readings will look something like this:

140 142 139 141 144 140

The monitor produces a piece of graph paper with two lines on it. One shows your baby's heartbeat and the other shows the pattern of your contractions. By studying the relationship between the two, your midwife or doctor can see how your baby's coping with labour.

Some hospitals have wireless monitoring systems called telemetry monitoring. This lets you move around more freely, as long as you stay within range (Stampalija et al 2012).

Sometimes a small clip is placed on your baby's head to monitor his heartbeat. This can only be done once your waters have broken. The clip is called a fetal scalp electrode and it may provide a more accurate reading either on its own (CMACE/RCOG 2010) or in addition to the sensors placed on your tummy (Neilson 2013). If used on its own it may also allow you to move around more easily.

If you're not sure why your doctor or midwife is recommending a fetal scalp electrode, feel free to ask.

How accurate is continuous monitoring?

Even highly trained health professionals sometimes struggle to interpret electronic monitor readings accurately and reliably, and a senior obstetrician may be called upon to help (NCCWCH 2014).

Decisions about your care in labour should not be based on the findings of EFM alone (NCCWCH 2014). Your doctor or midwife should take into account other factors, such as how you are feeling, your baby's movements and other signs of possible complications. She may suggest that they stroke your baby's scalp to produce a response in your baby's heart rate (NCCWCH 2014). Or they may take a sample of blood from your baby's scalp to test for oxygen levels, called fetal blood sampling (FBS) (NCCWCH 2014).

Fetal blood sampling

To take a fetal blood sample, your doctor passes a device into your vagina and cervix. A tiny amount of blood from your baby's head is then taken. Your baby's head is sprayed with a local anaesthetic so it should be a painless procedure for both of you.

By analysing the amount of oxygen in the blood sample, your doctor can assess more accurately how well your baby is coping with labour. If the sample is well oxygenated it means your baby, you'll be told that everything's fine. If there's less oxygen in the sample, your doctor may take another sample around 30 minutes later.

If your doctor belives that your baby needs to be born quickly, she'll advise you to have an assisted birth (NCCWCH 2014) or a caesarean section (NCCWCH 2011, 2014).

How will monitoring affect my labour?

If your baby's heartbeat is being monitored with a Sonicaid or a Pinard, your midwife just needs to be able to find the right bit of your tummy. She can easily do this, whether you're kneeling, sitting or standing or using a birth pool (see below).

Being monitored continuously using electronic sensors can make it harder for you to keep mobile, unless your hospital uses a telemetry system (NCCWCH 2014, Stampalija et al 2012).

However, monitoring doesn't mean you need to spend the whole of your labour lying down. You can still stand, kneel, sit or use a birth ball to rock your pelvis during contractions. Your midwife should help and encourage you to be as mobile as possible while you're being monitored. You could sit on a birth ball, as it's more comfortable than lying on the bed for hours. Stand up from time to time and try a different position, perhaps leaning forward onto the birth ball or the bed.

Can I be monitored in a bath or birth pool?

If you're giving birth in a bath or birth pool, your baby's heartbeat can be monitored using a special waterproof Sonicaid. You won't have to lift your bump to the surface.

If your midwife thinks your baby is having problems, she'll ask you to get out of the pool to be monitored using the electronic sensors for a while. If everything's fine, you'll then be able to get back into the pool.

Can I be monitored at home?

If you're having a home birth, your midwife will listen to your baby's heartbeat using a Sonicaid or Pinard, just as she would in a hospital. She'll be able to quickly tell if there's a problem.

Does continuous monitoring make my labour safer?

Research is ongoing about the pros and cons of EFM. That's because it's been linked to an increased number of interventions in labour, including caesareans and assisted births without any improvement in outcomes for babies (Alfirevic et al 2013, NCCWCH 2011, RCM 2012).

Continuous monitoring tends to restrict your mobility (Alfirevic et al 2013, NCCWCH 2014, RCM 2012) which may interfere with your ability to cope and so lead to more interventions.

Do I have a choice about monitoring?

The final choice is yours but try not to worry. Your midwife or doctor will talk to you and explain why they think a specific method of monitoring is best for you. In some cases, such as premature labour, there is a lack of definitive evidence on the best method of monitoring (Afors and Chandraharan 2011).

It may be that making an informed decision is hard, but discussing the options with your doctor or midwife will help.

References

Afors K, Chandraharan E. 2011. Use of continuous electronic fetal monitoring in a preterm fetus: clinical dilemmas and recommendations for practice. J Pregnancy 2011:848794. www.hindawi.com [Accessed November 2014]

Alfirevic Z, Devane D, Gyte GML. 2013. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews (5): CD006066. onlinelibrary.wiley.com [Accessed November 2014]

CMACE/RCOG. 2010. Management of women with obesity in pregnancy. Centre for Maternal and Child Enquiries and Royal College of Obstetricians and Gynaecologists Joint Guideline. www.rcog.org.uk [Accessed November 2014]

NCCWCH. 2008a. Antenatal care: Routine care for the healthy pregnant woman. National Collaborating Centre for Women's and Children's Health. London:NICE. www.nice.org.uk [Accessed November 2014]

NCCWCH. 2008b. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Revised reprint July 2008, National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press.. www.nice.org.uk [Accessed November 2014]

NCCWCH. 2011. Caesarean section. National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. London: RCOG Press. < www.nice.org.uk [Accessed November 2014]

NCCWCH. 2014. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health, Clinical guideline, 190. www.nice.org.uk [Accessed December 2014]

Neilson JP. 2013. Fetal electrocardiogram (ECG) for fetal monitoring during labour. Cochrane Database of Systematic Reviews (5): CD000116. onlinelibrary.wiley.com [Accessed November 2014]

RCM. 2012. Intermittent auscultation (IA). Evidence based guidelines for midwifery-led care in labour. Royal College of Midwives Trust. www.rcm.org.uk [Accessed November 2014]

RCOG. 2007. Birth after previous caesarean birth. Royal College of Obstetricians and Gynaecologists, Green-top Guideline No. 45. www.rcog.org.uk [Accessed November 2014]

RCOG. 2012. Information for you: pre-eclampsia. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [Accessed November 2014]

RCOG. 2013. The investigation and management of the small-for-gestational-age fetus. 2nd edition, minor revisions January 2014. Royal College of Obstetricians and Gynaecologists, Green-top Guideline No. 31. www.rcog.org.uk [Accessed November 2014]

Redshaw M, Heikkila K. 2010. Delivered with care: a national survey of women's experience of maternity care 2010. National Perinatal Epidemiology Unit. Oxford: NPEU. www.npeu.ox.ac.uk [Accessed November 2014]

Stampalija T, Signaroldi M, Mastroianni C, et al. 2012. Fetal and maternal heart rate confusion during intra-partum monitoring: comparision of trans-abdominal fetalelectrocardiogram and Doppler telemetry. J Matern Fetal Neonatal Med 25(8):1517-20

Chess Thomas is BabyCentre's research editor and a qualified antenatal teacher.

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Monitoring your baby's heartbeat (fetal heartrate monitoring)

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by , Senior Midwife and Team Leader September 2021 In this article Fetal heartrate monitoring, or fetal monitoring, is when your midwife listens to your baby's heartbeat in pregnancy and during labour. Fetal monitoring is carried out during pregnancy to make sure your baby is safe and well and then in labour to check how they're coping.

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Membrane sweep: what it is and how it works - BabyCentre UK

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Membrane sweep: what it is and how it works - BabyCentre UK

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If you're overdue you may be offered a membrane sweep. A membrane sweep is a way of trying to bring on labour to avoid going too overdue. It'll be the first step your midwife or doctor offers, before other methods of induction, to get your labour going.

How is a membrane sweep done?

Your midwife or doctor will carry out a membrane sweep. They will give you an internal examination, try to insert a finger into the opening of your cervix (neck of your womb) and then gently but firmly move their finger around. This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation causes your body to release hormones (prostaglandins) which may kick-start your labour.

The procedure may also be called a stretch and sweep, because if a sweep isn't possible, your midwife may still try to stretch or massage your cervix. This stimulation may be enough to start the ripening of your cervix. If your cervix then starts to soften and open, your midwife may be able to do a proper sweep at your next appointment.

How effective is a membrane sweep?

A membrane sweep increases the likelihood that labour will start naturally within 48 hours. It has a higher chance of working if your cervix is already softening and preparing for labour.

Are membrane sweeps safe?

Rest assured that a membrane sweep won't increase the risk of infection for you or your baby, as long as your waters haven't broken. If your waters have broken but labour hasn't started, membrane sweeps are not recommended as, in these circumstances, they can increase your risk of infection.

What will a membrane sweep feel like?

A membrane sweep can be uncomfortable, as the cervix is often difficult to reach before your labour begins. Some women find the procedure painful. If you've been practising breathing techniques ready for labour, you may find they help you to relax while your midwife is carrying out the sweep. You may experience some slight spotting of blood, cramps or irregular contractions immediately afterwards.

If you're a first-time mum, you should be offered a membrane sweep at your antenatal appointments at 40 weeks and again at 41 weeks. Some midwives will offer a membrane sweep every 72 hours (three days). If this isn't your first baby, you should be offered a membrane sweep at your 41-week antenatal appointment.

If you've passed your due date, you should be offered a membrane sweep before other methods of induction. You may be offered two or three membrane sweeps before your doctor or midwife suggests other ways for you to be induced.

Do I have to have a membrane sweep?

If you don't want to have a sweep, you can decline the offer. Although there's no guarantee it will start your labour, it does help some women avoid having their labour induced in more invasive ways. If you don't want a sweep and don't want your labour induced, you may prefer to try some natural ways to get labour started.

Watch our video to find out if it's safe do to a DIY membrane sweep at home.

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Membrane sweep: what it is and how it works

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If you're overdue you may be offered a membrane sweep. A membrane sweep is a way of trying to bring on labour to avoid going too overdue. It'll be the first step your midwife or doctor offers, before other methods of induction, to get your labour going.

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What is the Bishop score? - BabyCentre UK

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What is the Bishop score? - BabyCentre UK

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Our panel of health writers

The Bishop score is used to assess the ripeness of your cervix. Your midwife will need to find this out before inducing labour because it helps to tell whether your body is ready to go into labour.

Your Bishop score is based on the findings of a vaginal examination by your midwife. With a gloved finger, she'll assess the condition and position of your cervix and work out where your baby is in relation to certain points on your pelvis. Your Bishop score is based on the following factors:

how dilated your cervix is (the more open the better)

how short your cervix is (the shorter the better)

how far down in your pelvis your baby's head or bottom is (the lower down the better)

the consistency of your cervix, whether it is firm or soft (the softer the better)

the position of your cervix, whether pointing backwards or pointing forwards (pointing forwards is better)

A score of eight or more indicates that your cervix is ripe and ready for labour.
A Bishop score of less than six indicates an unripe cervix. About 15 per cent of attempted inductions that start with an unripe cervix fail to work.

If you have a low Bishop score, you may decide you don't want to try any induction methods. You'll have the option to wait and see if labour starts naturally. Or you may opt for a caesarean. Your midwife or doctor will discuss your situation with you and your birth partner, to help you make the decision that's right for you and your baby.

You can also take this approach once the induction process has started. If prostaglandins (a hormone-like substance that causes your cervix to ripen) are used as a first step to get your labour started, your midwife will calculate your Bishop score again after a set time.

If your Bishop score is still low, and your labour hasn't started or progressed, you can decide whether you want to carry on trying with stronger interventions, such as a Syntocinon drip, or have a caesarean. Or, if it's safe to do so, you may want to give yourself some more time to allow your labour to start naturally.

References

Laughton SK, Zhang J, Troendle J, et al. 2011. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 117(4):805-11. www.ncbi.nlm.nih.gov [Accessed January 2015]

NCCWCH. 2008. Induction of labour. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press. www.nice.org.uk [Accessed January 2015]

NICE. 2008. Information for the public: induction of labour. National Institute for Health and Clinical Excellence. www.nice.org.uk [Accessed January 2015]

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Our panel of health writers The Bishop score is used to assess the ripeness of your cervix. Your midwife will need to find this out before inducing labour because it helps to tell whether your body is ready to go into labour. Your Bishop score is based on the findings of a vaginal examination by your midwife.

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How is an induced labour different? - BabyCentre UK

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How is an induced labour different? - BabyCentre UK

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Our panel of health writers

An induced labour can be very different from a labour that starts naturally or it may be quite similar. It really depends on how ready your body is to go into labour and why you're being induced.

If, when you're examined, your Bishop score is good, it means that your cervix is already ripening ready for labour. The first step, which is usually prostaglandin, may be all that's needed to get labour started, particularly if you're overdue. Prostaglandin is a hormone-like substance that helps your cervix to ripen. It may also stimulate contractions to start.

If possible, your midwife may suggest skipping prostaglandin and breaking your waters to get things moving along.

If you've had prostaglandin, you may be able to go home and wait for your labour to start. Once you're in labour, the care you're offered may be very similar to what it would have been if you hadn't been induced. So you may still be able to have intermittent monitoring and use a birth pool. If you need a lot of intervention to get your labour started, though, you may need more intense monitoring and a birth pool may not be an option.

If your Bishop Score is low, your midwife may need to try more than one method to encourage your labour to start. This can be frustrating if you've been told that your baby needs to be born sooner rather than later. If the maternity unit is busy, or there are other women whose inductions are more urgent, you may need to be patient and wait for your turn.

You'll need to stay on a ward while you wait for your labour to get going and that can be tiring and uncomfortable. You're unlikely to have home comforts to distract you or resources to help you cope in early labour, such as mats and birth balls or a birth pool. These tend to be reserved for labour ward rooms.

On a ward, you may feel that you don't have the space or privacy to move around and make noise as your instincts may be telling you to. Your partner may have to go home after a certain time in the evening. So if your labour gets stronger you may have to manage on your own until you're in active labour, and can move to a labour room. All of this can be difficult, particularly as it's probably very different from what you had hoped and planned for, but knowing what to expect will help you prepare.

Once you're moved to the labour ward, you'll find that the ratio of midwives to women tends to be better, compared with most standard wards. If your maternity unit has a dedicated induction suite, you'll probably get a better standard of support and care in early labour than a regular antenatal or postnatal ward. Check with the hospital where you're planning to give birth to see if they have an induction suite.

Some women find their labour intensifies quickly, and induced contractions can be harder to cope with, particularly with a Syntocinon drip. So you may be more likely to want medical pain relief, such as an epidural, but this isn't always the case. Midwives should offer you support and pain relief to help you cope as your labour progresses, just as with a spontaneous labour.

If you're being induced because of a complication, such as pre-eclampsia or diabetes, then your labour is likely to involve more intense monitoring and you'll have to stay in hospital. You'll probably be induced on a labour ward and once labour has started, you may not be able to use the birth pool because continuous monitoring will be recommended. However, some maternity units do have monitors that can be used in the pool. Check with your local hospital if this is the case.

There's some evidence to link induction of labour with an increased risk of needing forceps or ventouse to help you give birth. However, if you're near or beyond your due date, being induced won't increase your risk of needing a caesarean.

In some cases, your baby may not cope well with the intensity of contractions after your waters are broken or if you're induced by artificial oxytocin via a drip. If your baby does become distressed, your midwife or doctor may turn the drip down to help ease the pace of your contractions. However, as with any labour in which the baby becomes distressed, a caesarean may be necessary.

There is a lot to think about and you're doing the right thing in finding out about induction beforehand. Being prepared for what's likely to happen, how long it may take and your pain relief options will help you feel in control. Induction may go very smoothly or it may need several interventions. Either way, discussing your options and being involved with your doctor or midwife in the decision-making at each step will help you make the right decision for you and your baby.

See what BabyCentre mums had to say about their inductions.

Last reviewed: March 2015

References

Bailey D. 2010. Management of prolonged pregnancy: yesterday, today and tomorrow. O&G Magazine 20-21. www.ranzcog.edu.au [Accessed February 2015]

Gülmezoglu AM, Crowther CA, Middleton P et al. 2012. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews (6): CD004945 onlinelibrary.wiley.com [Accessed February 2015]

Henderson J, Redshaw M. 2013. Women's experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand 92(10):1159-67

Jay A. 2014. Women's experiences of induced labour: a qualitative study. RCM conference , Telford, United Kingdom

NCCWCH. 2008. Induction of labour. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press. www.nice.org.uk [Accessed February 2015]

NICE. 2008. Information for the public: induction of labour. National Institute for Health and Clinical Excellence. www.nice.org.uk [Accessed February 2015]

RCOG. 2013. Induction of labour at term in older mothers. Royal College of Obstetricians and Gynaecologists, Scientific impact paper, 8. London: RCOG press www.rcog.org.uk [Accessed February 2015]

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Our panel of health writers An induced labour can be very different from a labour that starts naturally or it may be quite similar. It really depends on how ready your body is to go into labour and why you're being induced.

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If you're induced it means your labour is started artificially. Labour is usually induced when doctors think it's safer for your baby to be born sooner rather than continuing with your pregnancy. This may be because you are overdue, your labour is taking longer to start, or you have medical conditions, such as gestational diabetes or pre-eclampsia. You will have a choice about whether or not to have an induction, and about which methods are used.

What does being induced mean?

Your labour is described as "induced" when it's started artificially. You'll be offered an induction of labour if your doctor thinks that it is safer for your baby to be born sooner rather than continuing with your pregnancy (NICE 2021).

Though most labours begin naturally, you may need a little help to get started.

Why might my labour need to be induced?

You're likely to be offered an induction if:

Your pregnancy has gone beyond 41 weeks (NICE 2021), though the exact timing may depend on your hospital's policy. Being overdue is the most common reason for induction (NICE 2008).

Your waters have broken, but labour hasn't started. If you don't go into labour within a day or so, there is an increased risk that you or your baby could develop an infection. So you'll be offered an induction about 24 hours after your waters break (NICE 2021, NICE 2014).

You have diabetes, which means there's a small risk that your baby will be larger than normal. If you have type 1 or type 2 diabetes and your baby is growing as expected, your doctor will recommend you have an induction between 37 weeks and 38 weeks of pregnancy. If you have gestational diabetes and your pregnancy is going well, your doctor will advise induction no later than 41 weeks (NICE 2015a). If there are signs that your baby is big, your doctor may recommend a caesarean as the best option for you.

You have a chronic or acute condition, such as pre-eclampsia or kidney disease, that threatens your wellbeing, or the health of your baby (NICE 2019).

You are 40 years of age or older, which can carry a higher risk of stillbirth. Being induced at 39 weeks to 40 weeks of pregnancy may reduce the risk, particularly if you have other complications (RCOG 2013).

You may have your own reasons for wanting an induction. For example, you may be worried about pregnancy complications, or if you've previously had a baby who was stillborn. Or you may want your labour to be induced if your partner would otherwise miss the birth.
What your doctor and midwife advise will be based on your individual circumstances, as well as checks to see if your body is ready for labour (NICE 2008, 2021).

There should be time to ask questions, and time to talk to your partner, so that you come to a decision that feels right for you (NICE 2021). Induction interventions are "offered" to you, which means that you can refuse if you want to, and your midwife or doctor should respect your decision (NICE .

How will my labour be induced?

There are a few methods your midwife can use to try to get your labour started. They'll use a vaginal examination first, called the Bishop score, to assess how ready your cervix is for labour. Depending on your Bishop score, some induction methods may need to be repeated, or you may need to try more than one before your labour progresses well.

Here's the order in which you're likely to be offered particular methods of induction and what they mean:

Membrane sweep

A membrane sweep is when a midwife or doctor sweeps their finger around the opening of your cervix. This can encourage labour to start. Your midwife may offer you a sweep if you're full term. They'll suggest a sweep at your 40-week appointment and again at 41 weeks if this is your first baby. If you've had a baby before, you should be offered a sweep at your 41-week appointment (NICE .

If your waters have broken but labour hasn't started, membrane sweeps are not recommended, as they can increase your risk of infection (NICE 2014).

The membranes are the sac that surrounds your baby and that holds the amniotic fluid in. During a sweep, your midwife tries to separate them from your cervix, to directly stimulate the production of prostaglandin, which may help to kick off contractions and labour. If your cervix is not dilated enough to do a sweep, your midwife may stretch or massage your cervix instead. This is why the procedure is sometimes called a stretch and sweep.

You may be offered several membrane sweeps before labour starts. It can be uncomfortable and even painful while you're having this done, and afterwards you may have some cramps and bleeding (Mozurkewich et al 2011, NCT 2018, NICE 2008). If you are unclear about anything, ask your midwife to explain. If you decide against a membrane sweep, you can wait for labour to start naturally or use a more formal method of induction, if it's offered to you.
Prostaglandin
Prostaglandin is a hormone-like substance that causes your cervix to ripen, and which may stimulate contractions. Before using it, your baby's heartbeat needs to be continuously monitored for 30 minutes and your Bishop score assessed (NICE .

Your midwife will insert a tablet, pessary or gel containing prostaglandin into your vagina. The slow-release pessary, Propess, looks a bit like a tampon. If you're given Propess, you have to lie on your side for 30 minutes so the pessary has time to absorb moisture and swell (EMC 2018a) . You'll then be able to move about.

While you wait for prostaglandins to work you can usually go for a walk. Depending on why you're being induced, you may even be able to go home while you wait for your contractions to start (NICE . You'll need to be examined after six hours with a tablet or gel, or after 24 hours with a Propess pessary (NICE 2008) unless your contractions start sooner.

Prostaglandins may make you feel feverish, nauseous, be sick or give you diarrhoea and they can make your vagina feel sore, although these side effects are less common with Propess (EMC 2018a,b,c).

If prostaglandins don't work at all, you may be offered induction again at a later date (NICE . If your doctor thinks that it may be safer for your baby to be born sooner, you may be offered a caesarean instead (NICE 2008, 2021).

There's a very small risk that using vaginal prostaglandins may cause your womb (uterus) to become overstimulated (NICE . This means that you may develop very intense, frequent or long-lasting contractions, which could be stressful for your baby. This is known as hyperstimulation.

If your womb does start to hyperstimulate, you can be given medication to stop or slow down your contractions. As Propess is similar to a tampon, it can simply be pulled out by your midwife. This alone can help your womb to settle (NICE .

Balloon catheter or other mechanical methods

Depending on where you live in the UK, your midwife may offer to induce your labour by inserting a balloon catheter into your womb. A balloon catheter helps to open your cervix using gradual physical pressure. The catheter is inserted into your womb while deflated, then slowly inflated with a little saline solution (Ezakoff and Kilpatrick 2013). As the balloon fills, it puts pressure on your cervix and encourages it to dilate, stimulating your labour to start.

Sometimes the catheter has a second balloon which is inserted in your vagina and inflated in the same way, gently applying pressure on both sides of your cervix. If you've had a previous caesarean section, however, you won't be offered a double balloon catheter (NICE 2015b,c).

Balloon catheters are left in place, usually for up to about 12 hours, while you are monitored. If your labour starts, your waters break, or your baby shows signs of distress the device will be removed (NICE 2015b).

Having a balloon catheter inserted may be uncomfortable but it should not be painful (Ezakoff and Kilpatrick 2013). Most women give birth within 24 hours of having a balloon catheter inserted (NICE 2015b,c).

Other mechanical methods involve dilators that swell as they absorb cervical and other fluids, putting pressure on your cervix and encouraging it to open (de Vaan et al 2019, Ezakoff and Kilpatrick 2013).

These methods appear to work just as effectively as prostaglandins and carry a lower risk of over-stimulating your womb (de Vaan et al 2019, NICE 2015b,c).

If your labour does not start using a balloon catheter, your doctor may recommend that you move on to other methods of induction (NICE 2015b).

Artificial rupture of membranes (ARM)

Also called breaking the waters, ARM is used by your midwife or doctor to speed up your labour if it's not progressing. ARM is also occasionally used earlier as part of the induction process if you're having problems with the vaginal prostaglandins, such as very frequent or very long contractions (NICE 2008).

Your midwife or doctor will make a small break in the membranes around your baby. They'll use either a long thin probe (amnihook) or a medical glove with a pricked end on one of the fingers (amnicot). It can be quite uncomfortable, so you may be offered gas and air to help you relax.

ARM is no longer recommended as a method of induction on its own as it doesn't always get labour started, and once your waters have been broken, your baby could be at risk of infection (NICE . If your midwife or doctor suspects an infection, you'll be given antibiotics.

Syntocinon

Syntocinon is a synthetic form of the hormone oxytocin, which your body releases to help labour progress. You'll only be offered Syntocinon if a membrane sweep or prostaglandin hasn't started your labour, or if you're having contractions but your labour isn't progressing.

You'll have Syntocinon through an intravenous drip. Once your contractions have begun, the rate of the drip can be adjusted. This allows contractions to happen often enough to make your cervix dilate, without becoming too powerful.

Syntocinon is started at a very low dose and increased gradually to prevent it from over-stimulating your womb or causing stress to your baby. Don't worry, your midwife will ensure that your baby is monitored continuously to make sure all is well (NICE 2014).

The contractions brought on by Syntocinon tend to be more intense than natural ones. So you should be offered an epidural for pain relief (NICE .

The risk of Syntocinon causing your womb to become overstimulated or hyperstimulated is low (NICE . If this does happen, and turning down or stopping Syntocinon isn't enough, you'll be given medication to slow your contractions.

How can I prepare for my induction?

You have a choice about whether or not to have an induction, and about which methods are used. Your midwife or doctor may suggest that one method is better than another, depending on how soft and ready for labour your cervix is.

There's some evidence that if your labour is induced, you may be slightly more likely to need instruments such as forceps or ventouse to help your baby to be born (Middleton et al 2018, NICE . However, if you are near to term, being induced should not increase your chance of needing a caesarean and may even make a caesarean less likely (Middleton et al 2018, NICE 2014, RCOG 2013, Thomas et al 2014).

Before you go into labour, you may want to consider what pain relief you may want if the induction works and makes your contractions very strong and difficult to cope with.

Find out more about how induced labour is different and what it might mean for you by reading other BabyCentre parents' tips based on their experience.

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You're offered an induction if you need help getting labour started. Get more information about what do inductions mean, why you might be induced, the methods...

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Bringing on labour: an overview - BabyCentre UK

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Bringing on labour: an overview - BabyCentre UK

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by , Senior Midwife and Team Leader April, 2021

If you've got to the magical 40-week mark and there's still no sign of your baby, you're probably wondering how to bring on labour. There is something to be said for being patient though. If you can manage to stay relaxed, your body is more likely to produce the right hormones to get labour started when your baby is ready to come. It's also possible that your labour may progress more smoothly and with fewer complications. But if an induction date is looming, you may feel like giving your baby a gentle nudge.

Alternative ways to get labour started

There are many theories about how to kickstart labour naturally. Some of them have a little scientific evidence behind them. Others are just myths with no evidence at all. One or two are actually unsafe and should be avoided. Here's an overview of the methods you may come across:

Acupuncture

There's no clinical evidence that acupuncture works to bring on labour but some women who are overdue might like to try it. It's generally considered safe in late pregnancy for both you and your baby.

Acupuncture involves a practitioner inserting very fine needles just under the skin, or slightly deeper to reach muscle tissue. According to traditional Chinese philosophy, this gets energy going within the body to reach a certain organ or system. In pregnant women, acupuncture is thought to help soften the cervix to induce labour.

You will have to pay for acupuncture treatment, so decide whether it's worth a try. It's best to have a chat with your midwife or doctor before going ahead.

To try acupuncture, you need to find a qualified practitioner. The British Acupuncture Council has a searchable list.

Eating curry

Spicy food is often suggested as a means of bringing on labour, and many women swear by it. But it's based on hearsay, rather than evidence.

The theory is that a spicy curry can stimulate your gut, thereby stimulating your womb (uterus) to kickstart labour. But there's no proof this works.

If you're not used to very spicy foods, you may find they give you heartburn and irritate your tummy. You're particularly prone to heartburn while you're pregnant, because of hormonal and physical changes. So don't order a vindaloo if you usually have a korma!

Otherwise, eating spicy curry is harmless, so go ahead if you fancy trying it. It could be a good excuse for a night off from cooking, if you have a takeaway near you. Or you could find a spicy recipe in our third trimester meal planners.

Pineapple

Pineapple contains the enzyme bromelain, which is thought to help soften your cervix and bring on labour. In theory, eating large amounts may help to get things going.

Test-tube experiments using concentrated pineapple extract appear to show that bromelain works. But a technical scientific study is very different to the reality of eating pineapple and it's unlikely that it would actually help to bring on your labour. In fact, one pineapple contains a very small amount of bromelain. You would need to eat as many as eight pineapples for it to have any effect. And the most likely side-effect of eating such large amounts of pineapple would be indigestion followed by a bout of diarrhoea!

Another theory why pineapple is thought to help start labour is that eating large amounts of it stimulates your gut, which could also stimulate your womb (uterus). This, in turn, could get your labour going.

But again there's no evidence that this works. And a upset tummy is the last thing you need when labour is approaching.

Nipple stimulation

Nipple stimulation is when you gently rub or roll your nipples to encourage the start of contractions. The idea is to mimic the suckling of your baby. This releases oxytocin, a hormone that causes contractions to start.

Nipple stimulation could work if you've had a straightforward pregnancy and your body is ready for labour. But it's best not to count on it to kickstart labour. There's only a small amount of evidence to show that it works. It's also time-consuming, so you'll have to think about whether you want to invest the effort.

If you want to try it, gently rub or roll your nipples. Massage the darker area around your nipple (areola), not just the tip of your nipple. You can do this by placing your palm over the areola and moving it in a circular motion, firmly and gently. Stimulate your breasts for an hour a day. Spend 15 minutes continuously stimulating one breast, and then alternate to the other breast for 15 minutes until the hour is up.

The idea is to trick your body into thinking you are feeding your baby. This releases oxytocin, a hormone that helps contractions to start. Oxytocin also helps your labour to progress. Nipple stimulation will only work if your body is ready and primed to go into labour. If your body is ready, your cervix will have started to soften, thin and open ready for labour.

However, we don't know how safe repeated nipple stimulation is for women whose pregnancies have complications. So it's best not to try this if you've had any problems during your pregnancy, like gestational diabetes, high blood pressure or pre-eclampsia.

Sex

Sex can be tricky when you have a big bump. But enjoying sex and having an orgasm could trigger the release of oxytocin, a hormone that in large quantities causes contractions. Many women believe it helped get their labour going.

Find out more about how sex may bring on labour, or see whether it worked for other women in our friendly community discussion.

Walking

It is possible that walking could help to bring on labour. It's thought that the rhythmic pressure of your baby's head on your cervix could stimulate the release of oxytocin, a hormone that triggers contractions.

If your baby's head has not moved down into your pelvis ( engaged), when you are at, or close to, your due date, walking could encourage your baby into a better position for labour. This means labour is more likely to start on its own.

Walking is safe in late pregnancy, but be careful not to wear yourself out. Labour can be exhausting and you don't want to use up all your energy before you've even started.

A gentle stroll down round the block is probably your best bet. This may not be the moment to take up power walking, particularly if you've not done much exercise throughout your pregnancy.

Once you're in active labour, staying upright and moving around can help your labour to progress.

Hypnosis

Hypnotic relaxation has long been used to reduce pain perception in labour but there is no evidence that it works to get things going.

The theory is that it may help women who are extremely anxious about giving birth. This is because feeling very stressed may prevent us from producing oxytocin, a hormone that's needed to start labour and help it progress.

Hypnotic relaxation is therefore thought to help women with high levels of anxiety relax so labour can start. But more research is needed into how effective it is.

At the very least, using self-hypnosis podcasts, apps or downloads may help to relax you and take your mind off things if you're frustrated with being overdue.

Ways to induce labour which may be harmful

Although some mums swear by these methods, health professionals warn against their use in bringing on labour, as they all carry potential risks for you and your baby. If you're interested in any of these options, always discuss them with your midwife or GP.

Castor oil

Castor oil is not recommended for bringing on labour as it can cause nausea and diarrhoea. Having a tummy upset is the last thing you need during labour.

And, while this traditional method of inducing labour has been around for centuries, there's still no evidence to prove that it works.

There are reports of castor oil being used to bring on labour as far back as the ancient Egyptians. The theory behind it is that it may act as a powerful laxative that stimulates your gut and then also stimulates your womb (uterus) to start labour. The little research that has been done shows that, although castor oil had no lasting harmful effects either to the mums who took it or to their babies, all the women felt sick afterwards.

For this reason, castor oil is not recommended by health professionals. On top of that, it tastes revolting, even if you mix it with fruit juice, and is very oily to drink. So that may be enough to put you off trying it anyway!

Homeopathic remedies

Homeopathic remedies, such as pulsatilla and caulophyllum, are often used to try to kickstart labour. Though some mums say they found them helpful, there's no evidence they work.

Research into the use of these remedies in labour has not found any cases where they have caused harm to mum or baby. If you want to give them a try, consult a registered, qualified homeopath as well as your midwife or doctor.

You can find a registered homeopath by contacting The Society of Homeopaths.

Herbal remedies

When it comes to herbal remedies to bring on labour, experts advise against it.

Two particular ones have been used in the past. However, the science shows that they may harm you and your baby and you shouldn't take them during pregnancy. These herbal remedies are:

blue cohosh (caulophyllum thalictroides)

black cohosh (cimicifuga racemosus)

These herbal remedies are much stronger than homeopathic remedies based on the same herbs.
Blue cohosh is thought to be particularly harmful, as it has been linked to heart problems and strokes in babies at birth. It is no longer used by medical herbalists in the UK. You may also hear of evening primrose oil being used to induce labour. However, it's not safe to use in pregnancy and there's no evidence that it works anyway.

If you want to try any kind of herbal remedy while you're pregnant, talk to your midwife or doctor. Also make sure you consult a qualified, registered medical herbalist. You can find one via The National Institute of Medical Herbalists.

Raspberry leaf tea

Another herbal remedy that some women swear by is raspberry leaf tea but it's not safe to use raspberry leaf to start labour when you're already due. The sudden stimulation can cause overly strong contractions and may distress your baby.

Raspberry leaf can be taken as a tea or in tablet form earlier in your pregnancy. It's thought to prepare your body for childbirth, by helping to tone the muscles of your womb (uterus). There's little scientific evidence that it works and you would need to take it from 32 weeks in gradually increasing doses.

Find out more about raspberry leaf and labour.

What is a cervical sweep?

BabyCentre mums' unusual methods to bring on labour

Here's a selection of quirky methods that other mums said they found helpful - although frankly we're not convinced!

Blowing up balloons: the theory is that the build-up of abdominal pressure encourages labour to start.

Bouncing on your birth ball or driving your car down a bumpy road would seem to rely on the same theory of shaking things up a little.

Watching a weepy film and having a good cry. The release of hormones is supposed to help.

Wearing your best knickers (sod's law will ensure that your waters break in them!)

Visit our community

While you're waiting for your baby to make an appearance, head over to your birth club to chat to other BabyCentre mums-to-be!

References

Buckley SJ. 2015 Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Childbirth Connection, National Partnership for Women and Families. nationalpartnership.org. [pdf, accessed February 2021]

Chaudhry Z, Fischer J. Schaffir J. 2011. Women's use of nonprescribed methods to induce labor: a brief report. Birth 38: 168-171. [Accessed February 2021]

Dante G, Bellei G, Neri I et al. 2014. Herbal therapies in pregnancy: what works? Current Opinion in Obstetrics & Gynecology 26(2): 83-91. [Accessed February 2021]

Finlayson K, Downe S, Hinder S et al. 2015. Unexpected consequences: women's experiences of a self-hypnosis intervention to help with pain relief during labour. BMC pregnancy and childbirth, 15, 229. https://doi.org/10.1186/s12884-015-0659-0. [Accessed February 2021]

Hall HG, McKenna LG, Griffiths DL. 2012. Complementary and alternative medicine for induction of labour. Women Birth 25(3): 142-8. [Accessed February 2021]

Illamola SM, Amaeze OU, Krepkova LV et al. 2020. Use of herbal medicines by pregnant women: What physicians need to know. Front Pharmacol. 10: 1483. doi: 10.3389/fphar.2019.01483. [Accessed February 2021]

Kafaei Atrian M, Sadat Z, Rasolzadeh Bidgoly M et al. 2014. The association of sexual intercourse during pregnancy with labor onset. Iranian Red Crescent medical journal, 17(1), e16465. https://doi.org/10.5812/ircmj.16465. [Accessed February 2021]

Kelly AJ, Kavanagh J, Thomas J. 2013. Castor oil, bath and/or enema for cervical priming and induction of labour. Cochrane Database of Systematic Reviews 24(7): CD003099. [Accessed February 2021]

Levett KM, Smith CA, Bensoussan A et al. 2016. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open 6:e010691. [pdf, accessed February 2021]

Magon N and Kalra S. The orgasmic history of oxytocin: love, lust, and labor. Indian Journal of Endocrinology and Metabolism 15(Suppl3): S156-S161. [Accessed February 2021]

Mozurkewich EL, Chilimigras JL, Berman DR, et al. 2011. Methods of induction of labour: a systematic review. BMC Pregnancy Childbirth. 11: 84. [Accessed February 2021]

NCT. nd. Tips on encouraging a straightforward birth during labour National Childbirth Trust. www.nct.org.uk [Accessed February 2021]

NHS. 2020. Inducing labour. NHS Choices, Health A-Z. www.nhs.uk [Accessed February 2021]

NHS. 2018. Homeopathy. NHS, Health A-Z. www.nhs.uk [AccessedFebruary 2021]

NICE. 2008. Inducing labour. CG70. National Institute for Health and Care Excellence. www.nice.org.uk [pdf, ccessed February 2021]

Singh N, Tripathi R, Mala YM, Yedla N. 2014. Breast stimulation in low-risk primigravidas at term: does it aid in spontaneous onset of labour and vaginal delivery? A pilot study. Biomed research international 2014: 695037. www.ncbi.nlm.nih.gov [Accessed February 2021]

Smith C, Armour M, Dahlen HG. 2017. Acupuncture or acupressure for induction of labour. The Cochrane database of systematic reviews, 10(10), CD002962. https://doi.org/10.1002/14651858.CD002962.pub4. [Accessed February 2021]

Takahata K, Horiuchi S, Tadokoro Y et al. 2019. Oxytocin levels in low-risk primiparas following breast stimulation for spontaneous onset of labor: a quasi-experimental study. BMC pregnancy and childbirth, 19(1), 351. https://doi.org/10.1186/s12884-019-2504-3. [Accessed February 2021]

Tiran D 2011. Induction of labour - the dilemma for complementary therapists working with pregnant clients. Positive Health Online. www.positivehealth.com [Accessed February 2021]

Tiran D. 2014. Raspberry leaf tea in pregnancy. Information for mums-to-be. expectancy.co.uk [pdf, accessed February 2021]

Zamawe C, King C, Jennings HM et al. 2018. Effectiveness and safety of herbal medicines for induction of labour: a systematic review and meta-analysis. BMJ open, 8(10), e022499. https://doi.org/10.1136/bmjopen-2018-022499. [Accessed February 2021]

Lorna Marsh is senior editor at BabyCentre. She has more than 20 years' journalism and editing experience, including working for the NHS.

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by , Senior Midwife and Team Leader April, 2021 If you've got to the magical 40-week mark and there's still no sign of your baby, you're probably wondering how to bring on labour. There is something to be said for being patient though.

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This little video is SO good - just some quick tips to help the new-Mum out :-)

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A stay in neonatal care - An animated guide

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BLISS  is a charity that works towards giving every baby born premature or sick in the UK the best chance of survival and quality of life.

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Going home from the neonatal unit leaflet

Download now
This information has been written to help parents with any questions they might have when their baby is ready to leave the neonatal unit.

This guide explains how to prepare for life at home as a new family, what support is available to parents and what to do if their baby becomes unwell.

Weaning card

Download now
A double-sided A5 info card to give to parents with top tips on weaning your premature baby.

You could also direct parents to the weaning information on our website (or tell them to search on the Bliss site for 'weaning').

Weaning your premature baby

Download now

Our guide to help parents introduce their premature baby to solid foods.

You could also direct parents to the weaning information on our website (or tell them to search on the Bliss site for 'weaning').

Common infectious illnesses

Download now

Information for parents about common infectious illnesses, how you can help prevent your baby catching them, and what to do if you're worried about your baby's health.

You could also direct parents to the common infectious illnesses info on our website (or tell them to search on the Bliss site for 'common infectious illnesses').

Look at me - I'm talking to you

Download now
An A5 information guide about watching and understanding signals and cues from a premature baby.

Translated from the French publication Je vous parle, regardez-moi! Produced by SPARADRAP.

Skin to skin with your premature baby

Download now
An A5 information guide to help parents do skin-to skin with a baby in neonatal care.

You could also direct parents to the skin-to-skin information on our website (or tell them to search on the Bliss site for 'skin-to-skin').

Getting involved info card

Download now
An A5 double sided info card giving parents tips on how to get involved in their baby's care on the unit.

You could also direct parents to the looking after your baby on the neonatal unit (or tell them to search on the Bliss site for 'looking after your baby' or 'family centred care').

Mental health info card

Download now
A double sided A5 info card giving parents tips on how to look after their mental health whilst on the neonatal unit.

You could also direct parents to the information on mental health on our website (or tell them to search on the Bliss site for 'mental health').

About neonatal care leaflet

Download now
This leaflet has been written especially to answer the questions parents might have when they first arrive on the unit.

It explains how neonatal care works, who parents might see on the unit, what the equipment does, the care their baby might get, and how they can parent their baby on the unit. It also has helpful ideas for getting more support, and places to write down questions parents might have, or notes on how they're feeling.

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Download now This information has been written to help parents with any questions they might have when their baby is ready to leave the neonatal unit. This guide explains how to prepare for life at home as a new family, what support is available to parents and what to do if their baby becomes unwell.

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When I first found out I was having twins I was in complete shock, even though I knew I was high risk because twins do run in the family, my morning sickness was worse than with my first, Samuel, and mum kept saying 'you're having twins' I didn't expect my family to grow by two!

I am a midwife at Liverpool Women's and have been for the past 9 years. My mum Pat is a midwife too, growing up she definitely inspired me.

Being a midwife I know too well the complications that can occur. Having twins is high risk and having developed pre-eclampsia in my first pregnancy, a condition that can cause high blood pressure and proteinuria (protein from the kidneys in the urine), I was extremely anxious because a twin pregnancy can make conditions worse than a singleton.

With my first pregnancy I really suffered with back and pelvic pain and found acupuncture worked really, really well for me. So this time I wanted to keep on top of things before they got too bad, I had acupuncture throughout and kept myself as active as possible.

When it came to my birth plan I wanted to ensure it was as natural as possible, I knew I would have to be continuously monitored but I wanted a natural birth with minimal pain relief. My first option was to labour in one of our birthing pools, at Liverpool Women's we have a waterproof CCG (cardio-toccograph) monitor that straps around your tummy and uses wireless telemetry instead of being plugged into a monitor with wires and leads. This allows you to still be monitored whilst in the pool, shower or bath whilst being mobile. Unfortunately due to the pre-eclampsia I had an emergency induction and my plan had to change, however, I still remained calm and as mobile as possible. I used a tens machine, birthing ball and stayed upright as much as possible. All these things made me feel more in control and my plans for a natural birth.

Even though everything was going so smoothly I knew in the back of my head I had to be prepared to go to theatre in the event of an emergency. However, I stayed calm and felt confident in my body and those around me that I would achieve a natural birth, providing the babies remained happy. My midwife Ann Spofforth was absolutely amazing throughout, making my birth a wonderful experience that I will never forget. With my mum and Ann both there for me I knew that me and my babies would be ok.

With having twins it is always more of a risk for the second twin. This is mainly because twin 2 is able to move and turn in the new found space once the first has been born. Elliot, (twin one) arrived at 16:01 weighing 5lb 5oz, I kept calm and remained confident in my body's ability to give birth again. Then 13 minutes later Rory, (twin two) was born and placed in skin to skin next to his brother. Rory weighed 4lb 10oz. It was extremely emotional but the relief when they were finally here and safe was overwhelming. We had done it!

Afterwards Rory was grunting and wouldn't feed so was taken to the Neonatal unit, he stayed there for 48 hours but soon returned to Elliot and me in Transitional care. This is an amazing ward within Liverpool Women's that allows you to stay with your little ones when they are struggling to feed. This meant I was always with my boys, the specialist nurses were able to take care of feeding whilst I was able to be there for them to do everything else - we were never separated - this is a brilliant service that we are extremely lucky to have.

I am aware how lucky we have been, to have had such a positive and wonderful birth experience. Being supported to give birth naturally was so important to me and it certainly helped me achieve my goals. If there is any advice I could give to any women about to give birth I would say, stay active, calm and listen to your body and relax...My three boys keep me extremely busy...I'm lucky if I have time to go to the loo but they're truly amazing.

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When I first found out I was having twins I was in complete shock, even though I knew I was high risk because twins do run in the family, my morning sickness was worse than with my first, Samuel, and mum kept saying 'you're having twins' I didn't expect my family to grow by two!

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A useful parent-friendly pdf to download and read.

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Fertility treatments and the fact pregnancies are happening later in life has made multiple births more common.

Different types of twins

One-third of all twins will be identical and two-thirds non-identical.

Identical twins

Identical (monozygotic) twins happen when a single egg (zygote) is fertilised.

The egg then divides in 2, creating identical twins who share the same genes.

Identical twins are always the same sex, so if your twins are identical, you'll have 2 girls or 2 boys.

Non-identical twins

Non-identical (dizygotic) twins happen when 2 separate eggs are fertilised and then implant into the womb (uterus).

These non-identical twins are no more alike than any other 2 siblings.

Non-identical twins are more common. The babies may be of the same sex or different sexes.

Are you carrying twins?

You might think you're carrying more than 1 baby if:

you seem bigger than you should be for your dates

twins run in your family

you have had fertility treatment

It's usually possible to find out if you're having twins through your 12-week scan.

At the scan, you should be told whether the babies share a placenta (meaning they're identical) or if they have 2 separate placentas (meaning they can be identical or not).

If this is not clear from the first scan, you should be offered another one.

What causes twins?

Nobody knows what causes identical (monozygotic) twins. Everyone has the same chance of having identical twins: about 1 in 250.

Identical twins do not run in families. But there are some factors that make having non-identical twins more likely:

non-identical twins are more common in some ethnic groups, with the highest rate among Nigerians and the lowest among Japanese

if you're pregnant and over 35 you're more likely to have non-identical twins because you're more likely to release more than 1 egg during ovulation

non-identical twins run on the mother's side of the family, probably because of an inherited tendency to release more than 1 egg

IVF can increase the chance of twins, as more than 1 embryo may be transferred.

How can I tell if my twins are identical?

The most accurate way to tell if twins are identical is through a DNA test. This can only be done after your babies are born.

The placenta could also provide clues. If your first ultrasound scan is done before 14 weeks, it should be possible to tell accurately what kind of placenta your twins have.

Otherwise, the placenta can be examined after your babies are born.

For more information on this and birth options, read about giving birth to twins or more.

Read more about the different types of twins on the Twins Trust website.

More detailed information on DNA testing and how to find out whether twins or triplets are identical is available on the Multiple Births Foundation website.

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Fertility treatments and the fact pregnancies are happening later in life has made multiple births more common. One-third of all twins will be identical and two-thirds non-identical. Identical (monozygotic) twins happen when a single egg (zygote) is fertilised. The egg then divides in 2, creating identical twins who share the same genes.

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How will my twin or multiple births be managed? | NHS VIDEO

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How will my twin or multiple births be managed? | NHS VIDEO

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How will my twin or multiple births be managed? | NHS

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My baby is breech. What help will I get? | NHS