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BSUH
https://www.bsuh.nhs.uk/maternity/about-us/covid-19/
East Sussex (Conquest and Eastbourne)
https://www.esht.nhs.uk/service/maternity/
Crow borough birthing centre
http://www.crowboroughbirthingcentre.co.uk/

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Navigating the ‘in between  time’ at the end of pregnancy 

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Navigating the ‘in between  time’ at the end of pregnancy 

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The last days of pregnancy are a distinct time of in-between. It's a tricky time for mothers, as these last few days are biological and psychological events.
She's curled up on the couch, waiting, a ball of baby and emotions. A scrambled pile of books on pregnancy, labor, baby names, breastfeeding &#8230; not one more word can be absorbed. The birth supplies are loaded in a laundry basket, ready for action. The freezer is filled with meals, the car seat installed, the camera charged. It's time to hurry up and wait. Not a comfortable place to be, but wholly necessary.

The last days of pregnancy - sometimes stretching to agonizing weeks - are a distinct place, time, event, stage. It is a time of in between. Neither here nor there. Your old self and your new self, balanced on the edge of a pregnancy. One foot in your old world, one foot in a new world.

Related: Pregnancy Week by Week

Shouldn't there be a word for this state of being, describing the time and place where mothers linger, waiting to be called forward?

Germans have a word, zwischen, which means between. I've co-opted that word for my own obstetrical uses. When I sense the discomfort and tension of late pregnancy in my clients, I suggest that they are now in The Time of Zwischen. The time of in between, where the opening begins. Giving it a name gives it dimension, an experience closer to wonder than endurance.

I tell these beautiful, round, swollen, weepy women to go with it and be okay there. Feel it, think it, don't push it away. Write it down, sing really loudly when no one else is home, go commune with nature, or crawl into your own mama's lap so she can rub your head until you feel better. I tell their men to let go of their worry; this is an early sign of labor. I encourage them to sequester themselves if they need space, to go out if they need distraction, to enjoy the last hours of this life-as-they-now-know-it. I try to give them permission to follow the instinctual gravitational pulls that are at work within them, just as real and necessary as labor.

The discomforts of late pregnancy are easy to Google: painful pelvis, squished bladder, swollen ankles, leaky nipples, weight unevenly distributed in a girth that makes scratching an itch at ankle level a feat of flexibility. "You might find yourself teary and exhausted," says one website, "but your baby is coming soon!" Cheer up, sweetie, you're having a baby. More messaging that what is going on is incidental and insignificant.

Related: Use of Marijuana During Pregnancy

What we don't have is reverence or relevance - or even a working understanding of the vulnerability and openness a woman experiences at this time. Our language and culture fails us. This surely explains why many women find this time so complicated and tricky. But whether we recognize it or not, these last days of pregnancy are a distinct biologic and psychological event, essential to the birth of a mother.

We don't scientifically understand the complex hormones at play that loosen both her hips and her awareness. In fact, this uncomfortable time of aching is an early form of labor in which a woman begins opening her cervix and her soul. Someday, maybe we will be able to quantify this hormonal advance - the prolactin, oxytocin, cortisol, relaxin. But for now, it is still shrouded in mystery, and we know only how to measure thinning and dilation.

"You know that place between sleep and awake, the place where you can still remember dreaming? That's where I'll always love you, Peter Pan. That's where I'll be waiting." -Tinkerbell

I believe that this is more than biological. It is spiritual. To give birth, whether at home in a birth tub with candles and family or in a surgical suite with machines and a neonatal team, a woman must go to the place between this world and the next, to that thin membrane between here and there. To the place where life comes from, to the mystery, in order to reach over to bring forth the child that is hers. The heroic tales of Odysseus are with us, each ordinary day. This round woman is not going into battle, but she is going to the edge of her being where every resource she has will be called on to assist in this journey.

We need time and space to prepare for that journey. And somewhere, deep inside us, at a primal level, our cells and hormones and mind and soul know this, and begin the work with or without our awareness.

I call out Zwischen in prenatals as a way of offering comfort and, also, as a way of offering protection. I see how simple it is to exploit and abuse this time. A scheduled induction is seductive, promising a sense of control. Fearful and confused family can trigger a crisis of confidence. We are not a culture that waits for anything, nor are we believers in normal birth; waiting for a baby can feel like insanity. Giving this a name points her toward listening and developing her own intuition. That, in turn, is a powerful training ground for motherhood.

Today, I am waiting for a lovely new mother named Allison to call me, to announce that her Zwischen is ended and labor has begun. I am in my own in between place, waiting. My opportunity to grow and open is a lovely gift she gives me, in choosing me to attend her birth.

Jana Studelska CPM/LM, is a licensed midwife practicing in northern Minnesota and Wisconsin. She has been working with babies and mothers since 1998--as a La Leche leader, a certified doula, a childbirth educator, a regional birth network board member, and finally as a credentialed midwife. She is an author and writer, and has won several national awards for her work. Currently, she is the MANA Region 4 Representative for the Midwives Alliance, representing the upper midwest. She lives in Duluth, MN, with her husband, teen-aged boys, and a herd of dogs.

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The Last Days of Pregnancy: A Place of In-Between

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The last days of pregnancy are a distinct time of in-between. It's a tricky time for mothers, as these last few days are biological and psychological events. She's curled up on the couch, waiting, a ball of baby and emotions. A scrambled pile of books on pregnancy, labor, baby names...

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Just a little taster of life as a new parent!

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Just a little taster of life as a new parent!

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What every new parent should know: Diana Eidelman at TEDxBGU

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The role of oxytocin before, during and after birth

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The role of oxytocin before, during and after birth

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Editor's note: This article first appeared in Midwifery Today, Issue 125, Spring 2018.
Subscribe to Midwifery Today Magazine

A doula is a person "experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during, or just after childbirth" (Klaus, Kennell, and Klaus 1993).

Introduction

In the 1980s and early 1990s several seminal events occurred that affected me deeply: the publication of John Kennell's and Marshall and Phyllis Klaus's first papers and books showing the positive impact on birth outcomes when women receive continuous labor support by a kind encouraging lay person (Sosa et al. 1980; Klaus et al. 1986); the publication of Michel Odent's book Birth Reborn, which eloquently described the instinctual and labor-promoting behavior of laboring women when they feel free, safe, and undisturbed (1984); and a qualitative study that I conducted, which showed that women remember their first childbirths vividly, accurately, and poignantly for at least 15 to 20 years (Simkin 1991 and Simkin 1992). The long-term satisfaction of these women was associated much more with how they recalled being treated by their caregivers than with whether their births were easy, difficult, or complicated.

These events, combined with my own early experience as a childbirth educator attending the labors of some of my students, helped me see how different women are during labor than how they are in daily life. The more I witnessed this, the more curious I became. Having now attended hundreds of births as a doula, I have thought a lot about the unique role of doulas compared to others who attend births. I want to share those thoughts in this paper.

Research on Doulas' Impact on Birth Outcomes

As doulas have increased in numbers, they have drawn the attention of researchers around the world, who have compared birth outcomes when women had continuous labor support in any form (nurse, midwife, partner, family, friends, doula) or no support (Bohren et al. 2017).

My question is: What is it about the doula that improves outcomes more than any other person who provides labor support? The opening sentence of this paper, which defines the birth doula very simply, leaves us with the question, "How and why does a doula make such a difference?" To find out, let's explore the role of the doula in more detail.

The Changing State of Mind of the Laboring Woman and the Role of the Doula

Women in labor are in a fluid state of consciousness, which shifts as they respond to the changing sensations and demands of labor. For example, at various times they may exhibit any of the following states of mind: alert, thoughtful, sociable, upset, angry, frightened, calm, withdrawn, quiet, active, vocal, dependent, overwhelmed, tense, peaceful, instinctive, or more.

In early labor, they are likely to behave in their "usual ways"-being conversational, being social, asking and answering questions, making decisions, using humor, etc. They are engaging their neocortex-the thinking/reasoning part of the brain-which is the site of most higher brain functioning. As labor advances and intensifies, they begin to recognize that they have no control over the labor, their affect changes, and they may express self-doubt, fatigue, fear, or dread. This change in mood indicates that older, more "primitive" parts of the brain-the limbic system and brain stem-are activated. These parts govern instinct, mood, basic emotions (such as fear, pleasure, anger), drives related to self-preservation (such as hunger, sex, care of offspring), and basic physiology (such as blood pressure, pulse, sleep/wake states, breathing), and more. If the laboring woman feels safe and supported, she stops trying to control the labor and lets her body take over. If she feels alone, criticized, endangered, frightened, or threatened, she goes into "fight or flight" mode, and produces catecholamines (stress hormones-epinephrine and others) that interfere with maternal and fetal well-being and labor progress (Buckley 2015).

In active labor, women are vulnerable and less engaged with those around them, focus inward, use few words, and behave instinctually. They may rock, vocalize with moans or repeated phrases ("I can do it, I can do it"), count, or tap-in a rhythm. With good support and little disturbance, they find their own best way to get through the contractions. I call this their unplanned "spontaneous ritual." They are in an altered state (sometimes referred to as "the zone," "la la land," "labor land"). Ina May Gaskin says the woman lets her "monkey do it," (Gaskin 2003, 253) referring to the parts of the brain-the limbic system and brain stem-that govern feelings of well-being and guide instinctual behavior, including the birth process. When in labor, women deal with intense emotions, along with physical sensations of pain and extreme effort. Sometimes the doula or a confident partner is an essential part of the ritual, using a soothing tone of voice and murmuring or vocalizing along with her, or silently rocking with her or holding or stroking her. These actions allow release of oxytocin, which enhances contractions along with feelings of well-being. (If there is a disturbance, or a person comes in or asks questions, the laboring mother may snap out of the ritual temporarily, and then resume it after the interruption has passed.)

If, however, the laboring woman feels "unsafe"-from being ignored, criticized, distracted, or treated disrespectfully-or if problems develop for mother or baby-she may be too frightened or distressed to release control. This can lead to "fight or flight" mode, which causes release of high levels of stress hormones (epinephrine, norepinephrine, and others) that may interfere with oxytocin production, labor progress, and fetal well-being (Buckley 2015).

It seems to me that a major part of our role as doulas is to facilitate the laboring woman's instinctive ability to labor and to help her feel safe to let go. If we doulas are to help, we must "speak to her condition"; in other words, recognize and match her state of mind. Rather than using words, explanations, and detailed discussions, doulas are likely to sit quietly close by; entrain ourselves to the birthing person-mirroring or modeling rhythmic movements, rocking and swaying; make eye contact; touch; or vocalize in a calm soothing voice. I call this "being in the woman's rhythm." We communicate at an instinctual level and, because we are there continuously and have no clinical role, we focus mainly on the emotional state and physical comfort of the birthing woman and can recognize and respond to changes in progress and mood better than if we go in and out of the room. As needed, of course, we also assist with positions, movements, comfort measures, and strategies to improve labor progress.

Research Findings on Continuous Labor Support by Doulas and Others

The most recent Cochrane Review of 26 randomized controlled trials of continuous support in labor (compared to no labor support) reported that when women had continuous support of any kind-from loved ones, midwives, or other hospital staff or doulas-they were less likely to:

have an epidural or other regional analgesia to manage pain.

use any type of pain medication (including narcotics).

give birth by c-section.*

give birth with vacuum extraction or forceps.

give birth to a baby with a low Apgar score at five minutes after birth.

be dissatisfied with or negatively rate their childbirth experience"* (Bohren et al. 2017).

*Only when a doula provided the support were the asterisked outcomes improved.

Support from a loved one or hospital staff did not affect these outcomes, but when women had a trained doula, they were:

39% less likely to have a cesarean.

35% less likely to report their childbirth experience negatively.

15% more likely to have a spontaneous vaginal birth (no forceps or vacuum extraction) (Childbirth Connection 2017).

How Do Doulas Complement the Role of the Partner?

Doulas are often asked why they are needed if the laboring woman has a loving partner who plans to be involved. The two roles are very different. Both contribute in different ways. The partner knows the laboring woman better than anyone who is at the birth-her hopes, fears, worries, history, values, dreams. Also, the partner loves her more. Depending on the partners' personal qualities, they may find the birth invigorating and exciting or frightening and exhausting. They may feel competent and helpful, or not. The doula has training and experience from attending many births. Doulas learn the role that the couple want the partner to play and what may be needed. Partners may or may not want to play an active role. The doula may guide, feed, and relieve the partner when a break is needed; reassure, educate, assist, remind, and show the partner ways to help; and, sometimes, replace the partner. Of course, laboring women often benefit from more than one person for touch, eye contact, and physical support.

How Do Doulas Complement the Role of the Midwife or Nurse?

The clinical role of care provider prioritizes the goals of survival and good health with no lasting harm. It includes continuing observation of mother, baby, and labor progress; and, if a problem arises, the care provider employs measures to correct the problem and minimize the undesired effects of the solution. The emotional state of the mother is another priority, but of lower importance.

Mental alertness, broad knowledge, and clear, quick thinking are important qualities of the care provider, who functions at the highest level of the central nervous system-the neocortex. This is the part of the brain where thoughts, evaluation, interpretations, and judgment take place. The communication style of the caregiver often does not fit that of the laboring woman, who may be functioning at the level of the limbic system-where feelings like stress, fear, well-being, and dependency predominate over reason and judgment-or her brainstem may be activated, where instincts for survival ("fight or flight") dictate behavior.

The dilemma is that two people-caregiver and client-are trying to communicate at different levels. For example, the caregiver may ask questions during contractions or discuss facts, care strategies, decisions, "science," risks, or benefits in the same tone and words that would be used in a prenatal visit in the office when the woman is composed, thoughtful, and engaged. In labor she may respond with, "Do whatever you have to do," or "I just want it to be over!" (I often wonder if it is possible to carry on a rational, calm conversation and make truly informed decisions when in the throes of active labor! This is a topic for another time!)

The doula offers a unique form of labor support that is distinctly different from care by midwives, nurses, or birth assistants. Although there is some crossover, doulas and clinical personnel complement each other; they do not duplicate what they offer the laboring woman and partner.

The biggest differences between doulas and midwives or nurses are these: First, doulas have no clinical role in care-procedures, decisions, or advice. Clinical care providers constantly monitor maternal and fetal well-being, contraction pattern, and labor progress, as well as maternal emotions and behavior. Their main goals are survival of mother and baby without any health problems. Doulas do not have clinical responsibilities or the skills or education to perform a clinical role, which leads to the second big difference in the contributions of doulas and clinical care providers.

Because doulas are likely to be with the woman continuously (except for bathroom breaks) from early in labor until an hour or two after the birth, they can track the dynamics in the room, observe the behavior and emotional states of the birthing woman and supporters, and adapt their care accordingly. They know when to be upbeat or reassuring, when to model patience and confidence, and when to guide and educate the woman or her partner. When the parents are discouraged, demoralized, or exhausted, doulas empathize, change the circumstances, become more directive, or help the parents adjust to a change in care plan, if needed. The doula's role is challenging to describe, because the role is adapted to the birthing individual and the situation, moment by moment.

Doulas have the luxury of focusing on "matching the mood" of the laboring woman and can communicate with her in a variety of nonverbal ways, as her moods and her labor change. At the same time the doula is aware of the larger picture-environment, interactions among those in attendance, labor progress, and how all these may be affecting the laboring woman. Thus, the doula can truly be with her as she progresses through the shifts in emotions and physical sensations that occur during labor, birth, and afterward.

Conclusion: Possible Explanation for How Doulas Improve Birth Outcomes

In conclusion, the answer to the question, "What do doulas really do?" is complicated. You've read my long answer (this whole article!). My short answer is that doulas do whatever it takes for as long as it takes to see the family through a safe and satisfying birth, as defined by that family.

We do know this. When doulas are present during labor:

Oxytocin flows and causes effective contractions, more spontaneous births, and a parent who is ready (eager) to nurture and nourish the infant-who is alert, curious, and lovable.

Stress hormones are reduced, thus reducing maternal and fetal distress and slow labor.
Their non-clinical role fosters and facilitates the physiologic process and improves birth outcomes.

References:

Bohren, MA, et al. 2017. "Continuous Support for Women during Childbirth." Cochrane Database of Syst Rev 2017(7): 1-162.

Buckley, S. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. New York: Childbirth Connection.

Childbirth Connection. 2017. Research and Evidence. Retrieved on Jan. 13, 2018. childbirthconnection.org/giving-birth/labor-support/research-evidence.

Gaskin, IM. 2003. Ina May's Guide to Childbirth. New York: Bantam Books.

Klaus, MH, JH Kennell, and PH Klaus. 1993. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth. Reading, MA: Addison Wesley.

Klaus, MH, et al. 1986. "Effects of social support during parturition on maternal and infant morbidity." BMJ 293(6547): 585-87.

Odent, M. 1984. Birth Reborn: How Childbirth Can Be What Women Want It to Be-and How Mothers and Babies Both Benefit. New York: Pantheon Books.

Simkin, P. 1991. "Just Another Day in a Woman's Life? Part I. Women's long-term perceptions of their first birth experiences." Birth 18(4): 203-10.

Simkin, P. 1992. "Just Another Day in a Woman's Life? Part 2. The nature and consistency of women's long-term memories of their first birth experiences." Birth 19(2): 64-81.

Sosa, R, et al. 1980. "The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction." NEJM 303(11): 597-600.

Penny Simkin, PT, is a physical therapist who has specialized in childbirth education since 1968. She estimates she has prepared over 14,000 women, couples and siblings for childbirth, and is a co-founder of DONA International. Today her practice consists of childbirth education, birth counseling, and writing, combined with a busy schedule of conferences and workshops. Penny and her husband, Peter, have four grown children, eight grandchildren, three grandchildren-in-law, and a pug named Lola.

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What Do Doulas Really Do? - Midwifery Today

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Doula Penny Simkin discusses the positive impact that doulas have on birth outcomes. They provide a unique form of labor support that is different from that of other caregivers involved in the birth process--but complements the roles of others. Simkins describes why this is so.

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Considerations now to help you have a positive birth experience

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Considerations now to help you have a positive birth experience

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Brighton and Sussex University Hospitals NHS Trust

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What we do

We provide consultant-led maternity services at the Royal Sussex County Hospital in Brighton and the Princess Royal Hospital in Haywards Heath.

We also provide community-based maternity services, including our award-winning homebirth service.

In addition to our main services, we offer a wide range of specialist support.

For more information about our services, please visit our website.

Book your care

To book your care with us, please complete our online booking form.

Choose where to give birth

If you choose us for your birth, you can plan to give birth at home or at either of our hospitals. Read more about where to give birth.

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Maternity - Brighton and Sussex University Hospitals NHS Trust

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We provide consultant-led maternity services at the Royal Sussex County Hospital in Brighton and the Princess Royal Hospital in Haywards Heath. We also provide community-based maternity services, including our award-winning homebirth service. In addition to our main services, we offer a wide range of specialist support.

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What if my cat runs away?

If your cat prefers to run away from your baby, that's fine. Forcing your cat to interact with your baby could be very stressful.

Instead, allow your cat to escape and investigate in their own time. Carry on with your normal daily duties and routine and your cat should begin to accept your new arrival.

How will your cat react to your baby?

If your pet has already experienced the arrival of a new baby, and has coped well, you shouldn't have too many problems. Most cats are extremely adaptable and will cope well with some planning, but some cats might struggle.

If they are struggling, your cat may:

become more avoidant of you or the new baby

spend more time outside than usual

hide away for long periods

become less tolerant of being handled

toilet in areas they haven't previously

start spraying

If your cat is struggling, it's best to speak with a cat behaviourist. You can find a qualified, trusted behaviourist on the Animal Behaviour and Training Council (ABTC) website.

Things to think about

There are a few things that you will need to think about and be aware of.

Safety and babies

Never put your baby on the floor with your cat. They need to be supervised at all times. This is the case for all cats, even those with a good temperament.

To keep them safe when you can't supervise, you can:

use a screen door for the baby's nursery. This will allow you to keep the door shut, but still see and hear your baby.

think about using a cot and pram net to stop your cat from investigating your sleeping baby

be mindful of the areas your cat doesn't enjoy being stroked. It's common for most cats to be sensitive around their stomach area and tail. Babies can 'grab' in their enthusiasm to want to touch and stroke, which can easily upset your cat.

Safety and toddlers

Once your baby starts crawling and toddling it's important to remain alert.

Make sure that your cat has a safe place to rest and relax, which is not accessible to your toddler. This will avoid a situation where the cat is continuously followed, cornered and pestered.

Remember to place your cat's litter tray in a quiet area away from anywhere that your infant has access to

Hygiene

It's best to:

make an effort not to leave dirty nappies on the floor. They can cause cats to wee or poo on that spot.

use antibacterial soap to clean your hands after feeding, grooming or playing with your cat

always wear rubber gloves, which are washed afterwards, to clean your cat's litter tray

have a litter tray that has a top on it, so your cat can do their business but your baby can't get in

How will I know how my cat is coping?

You'll know your cat has settled in well with your baby if they:

act the same way they did before your baby arrived

approach your baby calmly and seem relaxed around them

are able to sleep, eat, play and go about their daily business as usual

If they are struggling, you may see some key signs of stress. These can include something as subtle as grooming too much to toileting and spraying in your house.

If you feel that your cat is not settling in well to life with a baby, it's best to speak with a cat behaviourist. You can find a qualified, trusted behaviourist on the Animal Behaviour and Training Council (ABTC) website.

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If your cat prefers to run away from your baby, that's fine. Forcing your cat to interact with your baby could be very stressful. Instead, allow your cat to escape and investigate in their own time. Carry on with your normal daily duties and routine and your cat should begin to accept your new arrival.

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Mindfulness based practices for pregnancy, birth and parenting (guided audio recordings)

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Mindfulness based practices for pregnancy, birth and parenting (guided audio recordings)

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https://www.dropbox.com/sh/a3cunnxe8gwbrgg/AADHj8Ds1WVUlhG--YliqhJBa?dl=0

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Stomach strengthening exercises can make a real difference. They improve circulation, ease backache and make joints stronger. All of which helps you to feel at your best.

Doing pelvic floor muscle exercises (Kegels) from early pregnancy onwards can stop those accidental wees in late pregnancy and within six months of childbirth. Pelvic floor exercises can also prevent prolapse, which is where the pelvic organs drop down into the vagina (Hay-Smith and Dumoulin, 2006; Hay-Smith et al, 2008; Pelaez et al, 2013).

What is the pelvic floor?

Your pelvic floor is the layered muscle that stretches like a hammock from the front of your pelvis to the bottom of your backbone. Pregnancy and childbirth puts a strain on these muscles (NHS Choices, 2017).

"It is quite common to leak wee when coughing, sneezing or straining during pregnancy if you have weak pelvic floor muscles. It's known as stress incontinence."

Stress incontinence can carry on after pregnancy yet doing pelvic floor exercises can help reduce or help you avoid having this issue (Boyle et al, 2012; NHS Choices, 2017).

If you're young and not experiencing stress incontinence, pelvic floor exercises are also hugely beneficial during pregnancy. The best thing is to fit the exercises into your daily routine, perhaps when you're watching telly or just before you climb into bed (NHS Choices, 2017). Here's what you need to do.

Stomach muscle exercises

Start on all fours, making sure your knees are under your hips and hands are under your shoulders. Have your fingers facing forwards and abdominal muscles lifted to help keep your back straight.

Pull in your stomach muscles and raise your back towards the ceiling, letting your head gently relax forwards. Don't let your elbows lock.

Hold this for a few seconds and then return to the original position.

Take care not to hollow your back. Your back should always return to the straight, neutral position.

Do this rhythmically 10 times, making your muscles work hard and moving your back carefully.

Only move your back as far as you can while still feeling comfortable.

Pelvic tilt exercises

Stand with your shoulders and bottom against the wall, keeping your knees soft.

Pull your belly button towards your spine so your back flattens against the wall, hold for four seconds and release.

Repeat 10 times.

Pelvic floor exercises

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

Slow squeeze pelvic floor exercises

This exercise helps to support your pelvic organs through your pregnancy. It might be tricky at first to hold this squeeze for a long time. Try to build up the length of the hold and release the squeeze slowly.

Lift your pelvic floor muscles upwards and inwards, slowly tightening them.

Continue lifting from your pelvis up into your belly.

Hold for four seconds and release it slowly.

If it's difficult to hold the squeeze for this long and you have nothing left to release, hold for a shorter time to begin with. Don't worry, you can increase the hold length bit by bit until you manage a four second hold.

Try to keep some of the squeeze left to release so you can release it slowly when you finish the exercise. Do five squeezes at a time

Repeat this five times a day. It will get easier.
(Tommy's, 2017)

This page was last reviewed in October 2017.
Further information

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

We also offer antenatal courses which are a great way to find out more about birth, 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.

Boyle R, Hay-Smith EJ, Cody JD, Mørkved S (2012). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 10:CD007471. doi: 10.1002/14651858. Available from https://www.ncbi.nlm.nih.gov/pubmed/23076935 [Accessed 17 April 2018].

Hay-Smith EJ, Dumoulin C. (2006) Pelvic floor muscle training versus no treatment or urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Systemic Review. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16437536 [Accessed 17 April 2018].

Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP. (2008) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Systematic Review. (4):CD007471. doi: 10.1002/14651858. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18843750 [Accessed 31 October 2018].

NHS Choices. (2017) Exercises in pregnancy. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspx [Accessed 31 October 2017].

Pelaez M, Gonzalez-Cerron S, Montejo R, Barakat R (2013) Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial. Neurology and Urodynamics. 33(1):67-71. doi: 10.1002/nau.22381. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23389863 [Accessed 31 October 2017].

Tommy's. (2017) Pelvic floor exercises. Available from: https://www.tommys.org/pregnancy-information/im-pregnant/exercise-pregnancy/pelvic-floor-exercises [Accessed 17 April 2018].
Further reading
Association of Chartered Physiotherapists in Women's Health. (2010) Aquanatal guidelines: antenatal and postnatal exercises in water. Available from: www.acpwh.org.uk [Accessed 19 October 2017].

Balogh A (2008) Pilates and pregnancy Midwives Magazine. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/pilates-and-pregnancy [Accessed 17 April 2018].

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Pelvic floor and stomach exercises in pregnancy

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Stomach strengthening exercises can make a real difference. They improve circulation, ease backache and make joints stronger. All of which helps you to feel at your best. Doing pelvic floor muscle exercises (Kegels) from early pregnancy onwards can stop those accidental wees in late pregnancy and within six months of childbirth.