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Where and how you have your baby is a very personal choice. It's a good idea to think about what you want well in advance of your due date.

There are various options, from hospitals to midwife-led units to home births. Some people feel most comfortable giving birth at home in familiar surroundings, while others prefer to know they are with or near doctors. Your needs, risk factors and what services are available where you live (NHS, 2018) are likely to influence your decision.

Where can I give birth?

In the UK, there are three main options for where to give birth:

All of these planned places of birth can be discussed with your midwife but if an anaesthetic or surgery is required, then a hospital birth is the only option.

A planned birth at home

You may plan to give birth at home (NHS, 2018). Not all trusts are able to provide midwives to support homebirths, but your midwife will be able to give you up-to-date information about the services available where you live. You might like to take a look at our page about planning a home birth.

If your pregnancy is low risk and it's not the first time you're giving birth, research shows that it's just as safe for your baby as a planned birth in hospital (NICE, 2017, Scarf et al, 2018; Homer et al, 2019; Hutton et al, 2019).

With a planned home birth, there is still a chance of transferring to an obstetric unit during labour or afterwards. The chances of transfer are higher for first births (45%) than subsequent births (12%) (NPEU, 2017).

A planned birth at a midwife-led unit or birth centre

You can choose to give birth at a midwife-led unit, sometimes called birth centres. Midwife-led units can either be located alongside a hospital maternity unit or can be freestanding from the hospital. Both types of midwife-led unit are designed to feel less clinical, with softer colours, lighting, and more home-like furnishings. Many also have additional active labour aids, such as birth balls, birth stools and birth pools.

If your pregnancy is low risk, a planned birth in either an alongside or freestanding midwife-led unit is associated with fewer interventions for women than a planned birth in a hospital obstetric unit, and is as safe for the baby as planned birth in a hospital obstetric unit (Birthplace in England Collaborative Group, 2011).

A planned birth in hospital

You may choose to give birth in hospital. Having the option of immediate access to medical support can be reassuring for some parents, especially if it is your first time.

If you have certain medical conditions, it might be recommended to have your baby in hospital. This is because hospitals have specialists who can help you if you need any treatment when you're in labour (NHS, 2018).

Unless you have been advised to attend hospital early, it is beneficial to stay at home until labour is established. This can help to keep you comfortable, and research shows that going into hospital in early labour can increase the length of time you spend in hospital overall (Miller et al, 2020).

Transfers to hospital

Sometimes, a transfer from home, a freestanding midwife-led unit, or an alongside midwife-led unit to a hospital labour ward is needed after labour has started. Some transfers are made before the baby is born and some after. Transfers are more likely for first-time births (NICE, 2014).

At home and in freestanding birth centres, you won't have access to immediate obstetric, neonatal or anaesthetic care (NHS, 2018). So when you're planning where to have your baby, a consideration might be your chances of being transferred to an obstetric unit during labour or after birth.

Some transfers are made because a woman decides that she wants to move, for a reason such as wanting different pain relief. Other transfers may be for the midwife to feel more supported with additional care in case a problem emerges, while more rarely some transfers are due to an actual problem during labour (NICE, 2014).

For first-time births, 36 in 100 of those planned at freestanding units are transferred, compared with 40 in 100 births for planned births in alongside midwife-led units. Second time or subsequent births have a 9 in 100 chance of transfer from freestanding midwife-led units, with 13 in 100 transferring from an alongside unit (NPEU, 2017).

How do I choose where to give birth?

You could research possible choices for where to give birth in your local area, to help you make an informed decision. There is a lot of evidence available to help you weigh up the advantages and disadvantages of giving birth at each location (NHS, 2018).

You can ask your midwife for information and discuss the options available to you in your area. It's also good to get information from other sources, such as by attending an antenatal course, like our NCT Antenatal courses. Talking to other parents can be really helpful, too.

If you are considering a birth centre or hospital birth, you may be able to arrange a visit ahead of your expected due dateor take a virtual tour online (Which?, 2018a). This can help to familiarise yourself with the location and facilities.

Other things to consider include the type of facilities available. For example, you might be considering a water birth in a birthing pool (Which?, 2018b). You can plan to have a birthing pool at home and they might be available at some birth suites and hospitals. It's best to ask in advance about the type and number of birthing pools available.

Where you decide to give birth will depend on your wishes and any need for clinical support that you may have. Wherever you choose -  hospital, midwife-led unit or  home  - the place should feel right for you (NHS, 2018).

The tool below from Which? will help you think about your choices by combining your preferences with research evidence.

What questions should I ask?

When discussing where to give birth, you might like to think about asking or researching the following:

What pain relief options will be available to me during labour? You can check out your options in our articles about pain relief for home births, midwife-led units and hospitals.

Will there be an option for having a water birth or using water for pain relief?

Who will look after me during pregnancy and labour? Find out more in our articles about who looks after you at home, in a midwife-led unit and in hospital.

How far would I have to travel when I'm in labour?

Is it possible for me to access specialist medical care or facilities if I need them? You could take a look at our articles about what happens if you have complications at home, in a midwife-led unit or at hospital.

What postnatal care services will be available to me?

(Which? 2018b)

Having done your research, you will hopefully feel more confident in your birth choices.

If you need to or want to change your mind about where to give birth, you can do this at any point in the pregnancy. You may find later on in the pregnancy, or even as your labour progresses, that your birth options or your choices change (NHS, 2018). Researching and understanding your options in advance will help you to feel confident in the decisions you are making for you and your baby.

Where can I find more information?

Children's centres

Your GP surgery

NHS postcode search which lists maternity services in your area (England only)

Local maternity units

Maternity Voice Partnerships (MVPs) - you need to ask your local hospital's maternity unit

The Birthplace Study

Your family or friends

This page was last reviewed in August 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 pregnancy, labour and life with a new baby.

Birthplace in England Collaborative Group (2011) 'Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study', BMJ, 343(nov23 4), pp. d7400-d7400. Available at: https://doi.org/10.1136/bmj.d7400

Homer C, Cheah S, Rossiter C, Dahlen H, Ellwood D, Foureur M, Forster D, McLachan H, Oats J, Sibbritt D, Thornton C, Scarf V. (2019) Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study. BMJ. Available from: https://bmjopen.bmj.com/content/bmjopen/9/10/e029192.full.pdf [Accessed 29th March 2021].

Hutton E, Reitsma A, Simioni J, Brunton G, Kuafman K. (2019) Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. The Lancet. Available from https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext [Accessed 29th March 2021].

Miller Y, Armanesco A, McCosker L, Thompson R. (2020) Variations in outcomes for women admitted to hospital in early versus active labour: an observational study. BMC Pregnancy and Childbirth. Available from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03149-7 [Accessed 29th March 2021].

NFWI; NCT. (2013) Support overdue: women's experiences of maternity services. Available from: https://www.nct.org.uk/sites/default/files/related_documents/Support%20Overdue%20Report.pdf [Accessed 29 March 2021]

NHS. (2018) Where to give birth: the options. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth/ [Accessed 29 March 2021]

NICE. (2014) Choosing place of birth : Resource for midwives. Available from: https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiA6qCDotXvAhWEoXEKHXM9BEwQFjAAegQIAhAD&url=https%3A%2F%2Fwww.nice.org.uk%2Fguidance%2Fcg190%2Fresources%2Fchoosing-place-of-birth-resource-for-midwives-msword-248730877&usg=AOvVaw2Zn9QlGQTjr5tGOSWyBryy [Accessed 29th March 2021].

NICE. (2017) Intrapartum care for healthy women and babies. Available from: https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#place-of-birth [Accessed 29 March 2021]

NPEU. (2017) Birthplace in England Research Programme. Available from: https://www.npeu.ox.ac.uk/birthplace [Accessed 29 March 2021]

Scarf V, Rossiter C, Vedam S, Dahlen H, Ellwood D, Forster D, Foureur M, McLachan H, Oats F, Sibbritt D, Thornton C, Homer C. (2018) Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery. Available from https://www.sciencedirect.com/science/article/pii/S0266613818300974. [Accessed 29th March 2021].

Which? (2018a) Birth Choice. Visiting your local maternity unit - checklist. Available from: https://www.which.co.uk/birth-choice/choosing-where-to-give-birth/visiting-your-local-maternity-unit-checklist [Accessed 29 March 2021]

Which? (2018b) Birth Choice. Why choosing where to give birth matters. Available from: https://www.which.co.uk/birth-choice/choosing-where-to-give-birth/why-choosing-where-to-give-birth-matters [Accessed 29 March 2021]

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Birth options - planning where to give birth | Labour & birth articles & support | NCT

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Where and how you have your baby is a very personal choice. It's a good idea to think about what you want well in advance of your due date.   There are various options, from hospitals to midwife-led units to home births.

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NCT, Brunel House, 11 The Promenade, Clifton Down, Bristol BS8 3NG Reg Charity No (England and Wales): 801395, (Scotland): SC041592. Reg Company No: 2370573.

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Spinning Babies® is a physiological approach to preparing for and caring for birth. During birth, babies descend through the pelvis by turning to fit each curve in the passage. Baby's turns are "fetal rotation." If fetal rotation can be made easier, birth is easier for everyone. Spinning Babies® has become a paradigm, or a new view on childbirth. By understanding birth physiology better we can help birth be easier. Spinning Babies® is how we are Changing Birth on Earth.

Spinning Babies® is a unique approach to birth created by midwife, Gail Tully

Spinning Babies ® offers a third perspective to the "natural vs. managed" childbirth today. In reality, we don't pick all one or all the other. Technology and Nature aren't teams in a sport to which we must be loyal. Medicine and Midwifery are professions developed to serve Nature when the body needs support.

So, rather than increasing technology or medication to help childbirth, we activate nature within the body by working with the body in new ways. We begin with physiology and move to interventions if and when needed.

The assumption that birth is a passenger powered through the pelvis (The old 3Ps paradigm) seems to make the passenger and pelvis static. The power of the body is replaced with medication and if that doesn't work, then surgery. Physiology allows for more creative, body-centered options.

Self-care and specific body activities restore body balance and make room for the baby. Babies then put themselves into the best positions possible for childbirth - within the anatomical space available.

We off a unique pregnancy preparation program with labor activities that have been shown to ease birth. Spinning Babies ®can be used with any childbirth method or none at all. Spinning Babies ® approach is good in any childbirth setting, home, hospital, and independent birth center.

Parent Class - Not your usual childbirth class!

Our Spinning Babies® Parent Class Video shows you what to do for an easier birth with practical and detailed preparation to help baby in the best position to fit the pelvis and solutions when labor seems long, painful, or has a stall! And, if practiced daily, an easier labor and birth are likely." Download today!

As a doula, Gail noticed that some births were short and some were long and that most parents couldn't see what was coming for them, as far as ease of birth. Doctors seemed to think women had small pelvises and babies were too often too big; and midwives seemed to think long labors were usually due to psychological mindsets. Gail sought a third explanation.

As a midwife, Gail noticed that fetal positioning was often a leading reason for long labor. So why would some babies be posterior and not be able to turn to anterior? For that matter, why were some posterior labors straightforward while others were complicated?

Gail's learned first hand from mentors such as the late midwife Jan Hofer. And Carol Phillips, DC, taught her that birth is "easier" when we have balance in the pelvis (including ligaments, fascia, and muscles with the pelvis) than when we have tension, torsion, or a closed pelvic position.Balance first.

Gail facilitates a release to the connections around the hip ball and socket on a woman carrying a breech baby at 34 weeks with a breech baby to restore body balance. Combined with other techniques, her 45-minute appointment gave her baby room to turn head down within the hour. No manipulation of the baby was attempted or needed in this case. While this quick result is occasional, body balance for optimal positioning is shown in how fast baby moved into a head down position. Gravity works better when there is room to accommodate baby's head! We reveal which birth positions opens the pelvis where baby waits.

Some posterior births are relatively easy, that's true. A very few anterior babies need help to come out. Fetal position shares a stage with several leading actors, such as Flexion, Body Balance, and, don't forget the importance of the Parasympatheticsin the ease of birth. Reducing force requires an invitation to more players than just "size." There's more to the ease of birth than the size of the baby! You can get the overview of this new paradigm right now in the Spinning Babies® Parent Class.

Daily Essentials can be practiced daily throughout pregnancy to help bring balance and comfort - and an easier, shorter birth.

Spinning Babies® Parent Class

Spinning Babies® Parent Class provides clear instructions on how to use Spinning Babies® for a more comfortable and confident pregnancy and labor.

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What is Spinning Babies? - A New Paradigm of Birth - Spinning Babies

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Spinning Babies® is a physiological approach to preparing for and caring for birth. During birth, babies descend through the pelvis by turning to fit each curve in the passage. Baby's turns are "fetal rotation." If fetal rotation can be made easier, birth is easier for everyone.

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The final moment - how does birth feel? Induction - what you need to know Zheela's VBAC story - Leena's birth I made very different decisions the first time around. Back then, I trusted others more than I trusted myself.

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Birth partners can help a woman feel supported in labour and make the experience more positive. Here are some top tips for being a brilliant birth partner.

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Cochrane review of position during labour

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Cochrane review of position during labour

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Mothers' position during the first stage of labour

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To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on duration of labour, type of birth and other important outcomes for mothers and babies.

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A plan to fill in during pregnancy to help with postnatal wellbeing

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A lovely quote from Dr Sara Wickham - remember that becoming a parent is a huge change. Be kind to yourselves

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A wellbeing plan for parents to fill in during pregnancy, slightly different to the Tommy's plan, made by Tina Gibbs

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Free NHS talking therapies for self referral

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How to access free psychological therapies (talking therapies) like cognitive behavioural therapy (CBT), counselling and guided self-help on the NHS.

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Useful information about the different types of mental health conditions that can be present during the perinatal period. Support information,, further info and videos.

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Support and information for parents experiencing perinatal mental ill health

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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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The queer parenting partnership offer groups and support for anyone identifying as LGBTQ+

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Support Groups | The Queer Parenting Partnership

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We offer a number of online support group spaces for families to build community and gain support from others.

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Although extremely rare, postnatal or postpartum psychosis awareness is needed. This website has resources and information on the topic as well as peer support if needed.

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The charity for mums and families affected by postpartum psychosis

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Supporting and advocating for mums and families affected by postpartum psychosis (PP) - a severe but treatable mental illness that begins in the days and weeks after giving birth.

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Wellbeing support, information and resources for single parents

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Single Parents Wellbeing | Single Parents Advice, Health & Wellbeing

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Single Parents Wellbeing - empowering single parents to get involved and empower other single parents too. We think single parents are superheroes. Get involved, feel part of our growing community and never feel alone.

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Link to the birth trauma association, provides information and support for birthing people and their partners who have experienced birth trauma.

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"I was broken after the birth of my son. My journey to healing started after finding the BTA. It was the first time I felt hope that I would get better, and that I wasn't alone."

- BTA Facebook group member, 2023

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BTA is the only charity in the UK solely dedicated to supporting women and families who have experienced traumatic birth. We work to support parents and families, improve parents' experience of birth, and engage with health professionals and research.

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Find a local group and see what's on offer near you

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From coffee groups to meet-ups for new dads, our local groups and activities can help you build up a supportive social network.

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AIMS Journal, 2011, Vol 23 No 4 Sarah Buckley shows us what is stopping birth working
In modern Western countries, including Australia and the UK, rates of obstetric intervention have reached extreme levels, such that very few mothers and babies experience labour and birth without drugs and procedures to assist or hasten the process. This has led to the erroneous belief that human birth is an intrinsically faulty system, and that modern women have lost the ability to give birth.

However, our women's bodies have their own wisdom, and our innate system of birth, refined over one hundred thousand generations, is not so easily overpowered. This system, which I am calling undisturbed birth, has the evolutionary stamp of approval not only because it is safe and efficient for the vast majority of mothers and babies, but also because it incorporates our hormonal blueprint for ecstasy in birth. When birth is undisturbed, our birthing hormones can take us into ecstasy - outside (ec) our usual state (stasis) - so that we enter motherhood awakened and transformed. This is not just a good feeling; the post-birth hormones that suffuse the brains of a new mother and her baby also catalyse profound neurological changes. These changes give the new mother personal empowerment, physical strength, and an intuitive sense of her baby's needs, and they prepare both partners for the pleasurable mutual dependency that will ensure a mother's care and protection and her baby's survival.

Undisturbed birth represents the smoothest hormonal orchestration of the birth process, and therefore the easiest transition possible; physiologically, hormonally, psychologically, and emotionally, from pregnancy and birth to new motherhood and lactation, for each woman. When a mother's hormonal orchestration is undisturbed, her baby's safety is also enhanced, not only during labour and birth, but also in the critical postnatal transition from womb to world. Furthermore, the optimal expression of a woman's motherhood hormones, including the fierce protectiveness of her young, will ensure that her growing child is protected and well nurtured, adding another layer of evolutionary fitness to the process of undisturbed birth.

The hormones of birth

There are many hormones involved in mammalian birth, and our understanding of their complex orchestration is limited. This article focuses on the hormones oxytocin; beta-endorphin; the catecholamines (adrenaline and noradrenaline); and prolactin. As the hormones of love, pleasure and transcendence, excitement, and tender mothering, respectively, these form the major components of an ecstatic cocktail of hormones that nature prescribes to aid birthing mothers of all mammalian species. An optimal hormonal orchestration provides ease, pleasure, and safety during this time for mother and baby. Conversely, interference with this process will disrupt this delicate hormonal orchestration, making birth more difficult and painful, and potentially less safe. All of these hormones are produced primarily in the middle or mammalian brain, also called the limbic system or emotional brain. For birth to proceed optimally, this more primitive part of the brain needs to take precedence over our neocortex - our 'new' or higher brain - which is the seat of our rational mind. This shift in consciousness, which some have called 'going to another planet', is aided by (and also aids) the release of birthing hormones such as beta-endorphin, and is inhibited by circumstances that increase alertness, such as bright lighting, conversation, and expectations of rationality.

Mother Nature's pragmatic and efficient principles dictate that these hormones should also help the baby at birth, and this is being increasingly confirmed by scientific research. This hormonal interdependence contradicts the common medical response to natural birth as the mother's prizing of her own experience over her baby's safety, and underlines the mutual dependency of mother and baby, even as they begin their physical separation.

Oxytocin

Oxytocin has been called the hormone of love because of its connection with sexual activity, orgasm, birth, and breastfeeding. In addition, oxytocin is produced in social situations such as sharing a meal, making it a hormone of altruism or, as Michel Odent regularly suggests, of 'forgetting oneself '.

Oxytocin is also the most powerful uterotonic (contraction-causing) hormone, and its release is associated with the contractions of labour and birth in all mammalian species. Oxytocin is made in the hypothalamus, deep in the middle brain, and is released in pulses from the posterior pituitary into the bloodstream every three to five minutes during early labour, becoming more frequent as labour progresses.

The number of oxytocin receptors in a pregnant woman's uterus increases substantially late in pregnancy, increasing her sensitivity to oxytocin. Oxytocin has also been shown to have a painkilling effect in rats and mice. Oxytocin catalyses the final powerful uterine contractions that help the mother to birth her baby quickly and easily. At this time, the baby's descending head stimulates stretch receptors in a woman's lower vagina, which trigger oxytocin release from her pituitary. This oxytocin release causes more contractions that promote more fetal descent, inducing more stretchreceptor stimulation and therefore even more release of pituitary oxytocin. This 'positive feedback loop' is also known as the Ferguson reflex.

After the birth, ongoing high levels of oxytocin, augmented by more pulses released as the baby touches, licks, and nuzzles the mother's breast, help to keep her uterus contracted and so protect her against postpartum haemorrhage. Skin-to-skin and eye-to-eye contact between mother and baby also help to optimise oxytocin release. Blood oxytocin levels peak at around thirty minutes postpartum and subside towards the end of the first hour. Oxytocin levels in the brain, which switch on instinctive maternal behaviour, may be elevated for substantially longer.

Newborn oxytocin levels also peak at around thirty minutes after birth so that during the first hour after birth, both mother and baby are saturated with high levels of oxytocin, the hormone of love. Newborn babies have elevated levels of oxytocin for at least four days after birth, and oxytocin is also present in breastmilk.

During breastfeeding, oxytocin mediates the milkejection, or letdown, reflex and is released in pulses as the baby suckles. During the months and years of lactation, oxytocin continues to act to keep the mother relaxed and well nourished, by enhancing the efficiency of her digestion. Other studies indicate that oxytocin is also involved in cognition, tolerance, and adaptation, and researchers have recently found that oxytocin also acts as a cardiovascular hormone, with effects such as slowing the heart rate and reducing blood pressure.

Uvnas-Moberg describes a 'relaxation and growth response' to oxytocin release, which reflects its ability to turn on the parasympathetic nervous system, which is involved with digestion and growth, and to reduce activity in the sympathetic 'fight-or-flight' system. Malfunctions of the oxytocin system have been implicated in conditions such as schizophrenia, autism, cardiovascular disease, and drug dependency, and it has been suggested that oxytocin may mediate the antidepressant effect of drugs such as Prozac.

Beta-endorphin

Beta-endorphin is one of a group of naturally occurring opiates (drugs derived from the opium poppy), with properties similar to pethidine, morphine, and fentanyl, and has been shown to work on the same receptors of the brain. It is secreted from the pituitary gland under conditions of pain and stress, when it acts to restore homeostasis (physiological balance); for example, by acting as a natural painkiller. Beta-endorphin also activates the powerful mesocorticolimbic dopamine reward system, producing reward and pleasure in association with important reproductive activities including mating, birth, and breastfeeding. Beta-endorphin is also released during episodes of social and physical contact, reinforcing pro-social behaviours among all mammals.

Like the addictive opiates, beta-endorphin reduces the effects of stress and induces feelings of pleasure, euphoria, and dependency. Beta-endorphin levels, as measured in the mother's bloodstream, increase throughout labour, peaking at the time of birth, and subsiding in the first one to three hours. Levels in the new mother's limbic system are elevated for much longer, as beta-endorphin takes more than twenty-one hours to break down within the brain and cerebrospinal fluid (CSF).

In labour, such high levels help the labouring woman to transcend pain, as she enters the altered state of consciousness that characterises an undisturbed birth. In the hours after birth, elevated beta-endorphin levels reward and reinforce mother-baby interactions, including physical contact and breastfeeding, as well as contributing to intensely pleasurable, even ecstatic, feelings for both.

Beta-endorphin is also important in breastfeeding. Levels peak in the mother twenty minutes after commencement, and beta-endorphin is also present in breastmilk. Researchers have found higher levels, at four days postpartum, in the breastmilk of mothers who have had a normal birth, compared with caesarean mothers; they speculate that this extra dose of beta-endorphin is designed to help the newborn with the stressful transition to life outside the womb.

Beta-endorphin, as a component of ongoing motherbaby interactions, induces a pleasurable mutual dependency for both partners, reinforcing and rewarding behaviours such as breastfeeding and physical contact that are associated with long-term well-being and survival.

Catecholamines

The fight-or-flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine in US literature) are part of the group of hormones known as catecholamines (CAs) and are produced by the body in response to stresses such as hunger, fear, and cold, as well as excitement. Together they stimulate the sympathetic nervous system for fight or flight.

During labour, maternal CA levels slowly and gradually rise, peaking around transition. However, high adrenaline levels in early labour, which reflect activation of the woman's fight-or-flight system in response to fear or a perception of danger, have been shown to inhibit uterine contractions, therefore slowing or even stopping labour. Noradrenaline also acts to reduce blood flow to the uterus and placenta and therefore to the baby.

This reflex makes sense for mammals birthing in the wild, where the presence of danger would activate the fight-or-flight response, inhibiting labour and diverting blood to the major muscle groups so the mother can fight or, more likely, flee to safety. In humans, high levels of adrenaline have been associated with longer labour and adverse fetal heart rate (FHR) patterns, which indicate that the baby is low in oxygen (hypoxic), consistent with CA-mediated reductions in uterine blood flow.

Research has also shown that very high CA levels can paradoxically stimulate uterine contractions, which may contribute to the fetus ejection reflex. According to Odent, this reflex occurs at transition, or perhaps even earlier in labour, and almost always follows an undisturbed birth, perhaps because low CA levels in early labour are necessary for its full expression. The mother experiences a sudden and enormous increase in CA levels, giving her a rush of energy and strength; she will be upright and alert, with a dry mouth and shallow breathing and perhaps the urge to grasp something. She may express fear, anger, or excitement, and the CA surge will produce, in concert with high oxytocin levels (associated with the Ferguson reflex), several very strong and irresistible contractions that will birth her baby quickly and easily.

After the birth, the new mother's CA levels drop steeply. If she is not helped to warm up, the cold-related stress will keep her CA levels high, which will inhibit her uterine contractions and therefore increase her risk of postpartum haemorrhage.

For the baby also, labour is an exciting and stressful event, reflected in increasing CA levels. In labour these hormones have a very beneficial effect, protecting the baby from the effects of hypoxia (lack of oxygen) and subsequent acidosis by redistributing cardiac output (blood supply) and by increasing the capacity for anaerobic glycolysis (metabolism of glucose at low oxygen levels).

The baby experiences a marked surge in CA hormones, especially noradrenaline, close to the time of birth, probably triggered by pressure on the head. This surge plays a very important role in the baby's adaptation to extrauterine life. It aids newborn metabolism by increasing levels of glucose and free fatty acids, which protect the newborn's brain from the low blood sugar that can occur in the early newborn period when the baby loses the placental supplies of glucose.

In addition, catecholamines enhance respiratory adaptation to life outside the womb by increasing the absorption of amniotic fluid from the lungs and stimulating surfactant release. Surfactant is essential for smooth inflation of the newborn lungs. CAs also assist with the necessary newborn shift to nonshivering thermogenesis (heat production), increase cardiac contractility, stimulate breathing, and enhance responsiveness and tone in the newborn.

High CA levels at birth also ensure that the baby is wide-eyed and alert at first contact with the mother. The baby's CA levels also drop steeply after an undisturbed birth, being soothed by contact with the mother, but noradrenaline levels remain elevated above normal for the first twelve hours. High newborn noradrenaline levels, triggered by a normal birth, have been shown to enhance olfactory learning during this period, helping the newborn to learn the mother's smell.

Prolactin

Prolactin, known as the mothering or nesting hormone, is released from the pituitary gland during pregnancy and lactation. Prolactin is named for its well-known prolactation effects, preparing a pregnant woman's breasts for lactation and acting postnatally as the major hormone of breastmilk synthesis.

Prolactin levels increase throughout pregnancy, helping to organise the expectant mother's brain for maternity. Prolactin's lactogenic (milk-producing) effect is blocked during pregnancy by high levels of progesterone, produced by the baby's placenta. When progesterone levels drop with the birth of the placenta, prolactin can begin stimulating milk production.

Prolactin levels decline during labour, reaching the lowest point when the labouring woman's cervix is fully dilated. Prolactin then rises again steeply in the moments after birth, perhaps due to stimulation of the mother's cervix during birth, reaching peak levels in the following two to three hours. After this, levels decline again slowly and reach another nadir from nine to twenty-four hours postpartum.

This postpartum maternal surge in prolactin provides maximum levels, available to brain and body, in the hour or so after birth. This elevation may be important in optimising maternal behaviours at this time, as well as ensuring successful lactation.

Animal studies show that prolactin release is also increased by carrying infants, and its association with paternal nurturing (including in humans) has earned it the added title 'the hormone of paternity.' Human studies have shown that just before the birth, fathers-to-be have elevated prolactin levels, which parallel the rise of prolactin in their partners. New fathers with higher prolactin levels are more responsive to newborn cries.

In summary

Mother Nature's superb design is hard-wired into our female bodies, providing an elaborate orchestration of hormones to enhance ease, pleasure and safety in labour, birth and postpartum. These hormones also ensure an ideal start to, and ongoing pleasure and reward from, breastfeeding and attachment, optimising well-being and survival for mother and offspring in the medium and long terms.

The full expression of these labouring hormones requires specific conditions: that the labouring mother feels private, safe and unobserved. This basic need is recognised by traditional systems of maternity care, which prioritise the emotional well-being of the labouring woman and ensure that she is cared for in a familiar place with known and trusted helpers. These factors will keep her as calm and relaxed as possible, and her adrenaline levels low.

Conversely, if she is not feeling private, safe and unobserved in labour, her adrenaline levels will increase, slowing labour and decreasing blood and oxygen supply to the baby and leading to fetal distress for vulnerable babies. Our current maternity care system does not done for slow labour and fetal distress. Interventions used for these indications such as synthetic oxytocin and caesarean surgery can further interfere with the hormonal orchestration for mother and baby, creating a cascade of intervention and depriving both of the ideal start that Mother Nature intends.

As Professor Kloosterman states so eloquently: 'Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine - nil nocere [do no harm].'

Following her recent UK seminars (recorded and available on DVD) Sarah adapted Chapter 6, Undisturbed Birth: Mother Nature's Blueprint for Safety, Ease, and Ecstasy, of her book Gentle Birth, Gentle Mothering, to produce this article for AIMS. Sarah's books, DVDs and articles are available at www.sarahbuckley.com
References
1. Buckley, SJ (2009) Gentle Birth, Gentle Mothering. Celestial Arts Buckley, SJ (2009) Gentle Birth, Gentle Mothering. Celestial Arts
2. Uvnas-Moberg, K (2011) The Oxytocin Factor : Tapping the Hormone of Calm, Love and Healing. 2nd edition. Pinter & Martin Ltd.

Further references and additional reading suggestions are available at www.sarahbuckley.com/undisturbed-birth-aims-reference

The AIMS Journal spearheads discussions about change and development in the maternity services..

AIMS Journal articles on the website go back to 1960, offering an important historical record of maternity issues over the past 60 years. Please check the date of the article because the situation that it discusses may have changed since it was published. We are also very aware that the language used in many articles may not be the language that AIMS would use today.

We make the AIMS Journal freely available so that as many people as possible can benefit from the articles. If you found this article interesting please consider supporting us by becoming an AIMS member or making a donation. We are a small charity that accepts no commercial sponsorship, in order to preserve our reputation for providing impartial, evidence-based information. You can make donations at Peoples Fundraising. To become an AIMS member or join our mailing list see Join AIMS
AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.
Published on 1st December 2011

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AIMS Journal, 2011, Vol 23 No 4 Sarah Buckley shows us what is stopping birth working In modern Western countries, including Australia and the UK, rates of obstetric intervention have reached extreme levels, such that very few mothers and babies experience labour and birth without drugs and procedures to assist or hasten the process.

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c-section — Positive Birth Stories From Our Community - Read Now

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The Positive Birth Company is on a mission to support you from the moment you start thinking about planning for a baby, to the day they eventually go to school. We do this through life-changing online courses, incredible online communities and access to some of the best minds in the fields of birth, health and psychology. Our resources are affordable and accessible to all, no matter where you are or how busy your life is.

We are The Positive Birth Company and we are your virtual village.

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Top tips for recovery after a caesarean birth | NCT

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Having a caesarean is a major operation so you’ll need to take it easy afterwards. Here we share some caesarean birth recovery tips to help you heal.

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The natural caesarean - a woman centred technique

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Kingston and Richmond NHS Foundation Trust

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Scar after caesarean

When a scar is formed, fibres are laid down in many directions. These fibres can sometimes stick (''adhere'') to surrounding tissues. For a few people, too much scar tissue (also called "adhesions") can form and leave the scar feeling tight and sore.

Following a caesarean, too much scar tissue around the operation scar is often described as a pulling and tugging sensation. This can make daily activities and sex uncomfortable and may affect bladder and bowel function. It can also slow the recovery of your tummy (abdominal) muscles and contribute to backache. ​​​​​​​

Scar massage can help recovery

Once your scar has fully healed, your midwife may suggest you massage it. Scar massage is simple and aims to break up the scar tissue. This can reduce any itching and swelling and improve its appearance.

Not much research has been done to find out how well this massage works, but some people find it helpful.

When to start

If you feel comfortable and ready, you can start massaging your scar once your wound has fully healed. There should be no scabs or openings left. Scars are usually fully healed 6 to 8 weeks after a caesarean birth. If you are unsure, check with your health visitor, midwife or GP before starting any massage.

It is important to get the timing right. Massaging your scar too soon could cause it to reopen or tear, leading to an infection. But it is never too late to start.

How to do the massage

It is normal to feel a pulling or burning sensation when you start massaging your scar. Increase the pressure gradually and spend a couple of minutes on each technique. You may find it easier to massage your scar whilst having a bath, or try after a shower using any oil of your choice (if you are not allergic).

If you get any pain whilst massaging your scar, stop and leave it for a few weeks. Then come back to it. If the pain persists, speak to your GP.

Feeling your scar

Your scar may feel sensitive or tender. Or you may have less sensation or even numbness in some areas.

When you first start the massage, it may help to touch the surrounding skin without touching the scar itself. Try tracing small circles with your fingers, or moving the skin around. Then gently move towards the scar itself. If the skin is particularly sensitive, try all this with a cotton ball at first.

The scar tissue is not limited to the scar. So it is important to work around the scar too.

When you feel comfortable doing so, you can move on to massage the scar.

Massage your scar with the pads of 2 or 3 fingers together

Circle: make circular movements above, below and on the scar itself, if you can tolerate it. Repeat clockwise and anti-clockwise, 5 to 10 times.

Vertical: Pull across the scar, up and down, with short then longer strokes. Repeat 5 to 10 times.

Left and right: rest your hand or fingers on your scar and encourage your scar to move left and right (along the scar) for 10 to 15 secs. Then using your other hand encourage it in the opposite direction.

Pinch some tissue around or on the scar then roll the pinched skin up and down and side to side for about 10 to 15 seconds. Move along the entire length of the scar, repeat every 1/2 inch to 1 inch.

How often

We recommend doing theses stretches at least 4 times a week. At first, do it for 5 to 10 minutes each time. Then, when it feels less uncomfortable and the scar movement increases, you can gradually reduce how often you do it. Scar tissue continues to form for up to 2 years after an injury or surgery so regular massage is a good idea.

When to get advice

Remember to be kind and patient with yourself. Birth recovery is about caring for your body as well as processing your birth experience. If you are having difficulties with this, you can contact a healthcare professional such as your midwife, health visitor or your GP for support.

You can also get in touch with the NHS Talking Therapies programme.

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Scar massage after caesarean birth :: Scar massage after caesarean birth :: Kingston and Richmond NHS Foundation Trust

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Patient information: how to massage your caesarean scar to break up scar tissue and improve recovery

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Discover here, in our informative website the benefits and reasons behind the push towards the mindset of "WaitforWhite and Optimal Cord Clamping" in new born babies.

How can it benefit our children?

Why should it become the normal procedure in child birth?

What can you do to ensure a healthy start for your baby?

Find out here the answers to these questions and many more...

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Discover here, in our informative website the benefits and reasons behind the push towards the mindset of "WaitforWhite and Optimal Cord Clamping" in new born babies. How can it benefit our children? Why should it become the normal procedure in child birth? What can you do to ensure a healthy start for your baby?

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Vitamin K and newborns: what you need to know | NCT

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If you’ve heard people talk about Vitamin K but are feeling a bit clueless, here’s the information you’ll need.

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Welcome Birth stories can be really inspiring when you're preparing for your own induction. I remember searching for positive induction stories before my first birth and struggling to find th...

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Overview | Inducing labour | Guidance | NICE

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This guideline covers the circumstances for inducing labour, methods of induction, assessment, monitoring, pain relief and managing complications. It aims to improve advice and care for pregnant women who are thinking about or having induction of labour

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Patient information leaflet - Kingston hospital

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Patient information leaflet - Kingston hospital

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Kingston and Richmond NHS Foundation Trust

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Induction of labour, your options :: Induction of labour, your options :: Kingston and Richmond NHS Foundation Trust

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Patient information: Link to a booklet explaining your options when considering an induction of labour

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Consent means saying yes. You have the right to make your own decisions about your body, just as you do at any other time.

It is against the law to give you medical treatment unless you agree to it. It is also against the law for treatment to be given to your baby without your consent or the consent of another person with parental responsibility.

Agreeing to treatment is known legally as giving consent. In law, your consent must be genuine. This means you must understand the treatment well enough to make a decision. It also means that no one, including your family or healthcare professionals must put pressure on you or bully you into agreeing to have the treatment.

If you are a surrogate you have the same rights as any other woman or birthing person to make decisions about your body.
You cannot be treated unless you agree
No one can treat or touch you against your will. Even if health professionals don't agree with your decisions about your body, they must respect them. Health professionals must ask if you agree to any medical treatment. For example, they must ask before examining you, before taking your blood pressure, and before giving you pain relief. This is the law.

If you do not agree to treatment, but health professionals still treat you, they may have broken the law.

The only time health professionals do not need your consent to treatment is when you are not able make a decision. It is very rare in law for someone to be unable to make their own decisions.

It could be because it is an emergency and you are unconscious. In this situation healthcare professionals must only give you treatment and care that you need to stay alive and safe.

Very rarely, you may not be able to give consent because you cannot understand the choice you need to make even when it is very clearly explained. This is called not having mental capacity. Our factsheet Mental capacity and maternity careexplains.

If you have particular communication needs or are worried about communicating, talk to your doctors and midwives so you can plan the best way for you to give or not give consent.

A healthcare professional must ask you before they examine you, investigate anything, or give you any care or treatment. You must be asked whether or not you agree to every medical procedure, even if it is as minor as taking your blood pressure. You don't have to speak to show that you agree. You could simply hold your arm out for the blood pressure cuff.

Remember that you do not have to agree. It is not your role to please healthcare professionals. It is their role to look after you in the way that you want. They must ask you every time they carry out a procedure (this includes things like blood tests, monitoring your blood pressure, internal examinations or offering you medication). Even if you consented to this examination or treatment before, they must ask you again. They must be clear about what they are asking.

For example, if your midwife wants to carry out a vaginal examination, they need to tell you in language that makes it clear that they will be putting their fingers inside you. Saying something like, 'Can you just hop up on the bed and we'll have a look and see how you are doing' is not clear. In addition, it is wrong for a healthcare professional to carry out further interventions; for example, I just did a "sweep" while I was there'. They should ask your permission in advance. (A sweep is an internal procedure which is intended to start labour.)

Making a birth plan and having respectful conversations with your healthcare professionals early in your pregnancy can help you think about the treatment and care you may be offered. You can specify in your birth plan any treatment you do not want.
For example, if you do not want vaginal examinations during your care, talk to your midwife about this during your antenatal care. Make sure your choice is written in your notes and birth plan. You do not have to say why you do not want to have vaginal examinations. If you are comfortable explaining why, this can help your midwives suggest care that may work for you.

If y ou do not think your healthcare professionals are listening to you when you refuse consent, you can contact us for advice.

At some point in your pregnancy and labour your healthcare professionals may think your care or treatment should change. If anything changes, they must tell you what is different and ask you again. If the treatment could now bring new risks or new benefits, they must ask your consent again.

You need to know who is giving you maternity care and agree. You must be asked before a medical student can be part of your care.

In some cases you might be asked for consent ahead of time. You can still change your mind afterwards.

If you are going to have an operation such as a planned caesarean section, the doctors should offer you a proper conversation about the risks and benefits ahead of time. They cannot do anything during the operation that you haven't agreed to unless it will save your life or prevent serious harm.

Even if you have discussed your care in advance, you should still be offered another discussion at the time of the procedure in case things have changed or you have changed your mind.
For example, if you have been booked for an induction you can change your mind and decline the induction at any time, including on the day of the procedure.
You do not have to agree to procedures simply because they are standard in this particular hospital or birth centre.

Before you decide about any care or procedure the healthcare professionals must give you information about what will happen.

The information should tell you about any risks that will be important to you. It should tell you if there are other treatments you could have instead and the risks and benefits of those. It should tell you what could happen if you don't have the treatment.

Your doctor should listen to you and find out what matters to you. For example, if a treatment or procedure might make future pregnancies complicated, they need to talk to you about how important it is to you to have more children so that you have the information you need to make a decision.

It is not enough just to give you a leaflet or a link to a website. You should also have a personal discussion with your healthcare professional.

You might want to use the BRAIN framework to help you get the answers you want:

B - What are the B enefits?

A - What are the A lternatives?

I - What does your I ntuition (gut) say about what's right for you?

N - What would happen if I said No or N ot now?

Your healthcare professional must not give you misleading information. The information must be up to date and based on the most recent evidence. They should give you as much information as they can to help you need to make a decision.

They must make it easy for you to ask questions, and they should answer your questions properly. If there is a question that they cannot answer, they should explain why (for example if the information isn't available). They may be able to help you find out information you need if it is available or point you to where that information might be.

If you need an interpreter or support to communicate the Trust should provide this.

You can ask for things to be explained again. It is ok to ask questions about what you were told and why during a previous appointment or during a previous pregnancy.

You have the right to request care but healthcare professionals do not always have to offer care if there is a good reason why they should not.

You should be listened to and taken seriously when you ask for care.
For example, if you ask for pain relief or for your pain relief to be topped up, it should be given unless there are good reasons against providing it. If there is a medical reason for refusing pain relief because it could cause you harm ('a clinical contraindication') then your doctor or midwife should explain this to you and document the discussion.
You can write a birth plan to tell people what care you want during labour and after. Your midwife or doctor should help you to make a birth plan that will be included within your maternity records.

You may also want to think about what is important to you and what you would like to happen in various situations. It can help you think about any boundaries you have, for example if you never want to be naked or be examined internally.

You can give your preferences, for example that you want your baby to be placed skin-to-skin with you after the birth.

Making your birth plan should be a collaboration between you and the health professionals supporting you, sharing information and finding out the best way to care for you and meet your wishes.

Your birth plan has no legal status, but if it has been agreed with your midwives and doctors then this should indicate that they are happy with it and will follow it. Even if you have chosen care that is not what they recommend, they should respect it and try to meet your wishes. A birth plan can be used in court as evidence of your wishes and the informed decisions you had taken at the time it was made.

If you have a disability any reasonable adjustments should be recorded in your notes/ birth plan. This could include, for example, room for your wheelchair in the birthing suite, lighting that lets you see better, a quiet or dark room to help with sensory overwhelm, or time after the birth to recover from fatigue. If you need reasonable adjustments under the Equality Act 2010, the Trust has to provide these.

No matter what you say in your birth plan you can change your mind and consent to different care at any time.

Your birth plan can include the role you want a birth partner or doula to play.

After giving birth, you can challenge the treatment you received. Your birth plan can be evidence of the consent you gave or did not give.

If there are medical reasons not to give you the treatment in your birth plan, your healthcare professionals should explain them.

Healthcare professionals have a duty to prevent suffering that can be avoided. They must not refuse you pain relief or other support simply because of a hospital guideline or policy.

Your healthcare professional's job is to explain the risks of treatment to you. They can recommend one treatment over others and give you their reasons for this. But they must not put pressure on you to choose a particular treatment for yourself or your baby.

If your healthcare professional puts pressure on you to make you choose a particular treatment, this is called undue influence.

Undue influence could mean that your healthcare professional keeps discussing risks even when you have made a decision.
For example, you may have decided that you do not want an induction. You discuss the risks and benefits with the midwife, who is worried about your decision. They call in the senior midwife, who repeats their concerns. Then the consultant obstetrician comes to see you and repeats them again. Unless the risks have changed and your health professionals want to give you new information, this may comprise undue influence.
It may also be undue influence if your health professional threatens to stop caring for you.
For example, if they said, 'Once you are 42 weeks pregnant the home birth team won't be able to come out to you and you will have to give birth in hospital' or 'If you don't agree to giving birth on the labour ward you will have to find another Trust to look after you.'
It may be undue influence if your healthcare professional tells you to make a decision by a certain time even when there is no clear medical need.
For example, they might say, 'You need to decide in the next twenty minutes' without explaining why.
They must not put pressure on people in your family to persuade you to change your mind.
For example, they might say to your partner, 'Try and talk them round. If it were my partner I wouldn't want them to do this. We only want what's best for your baby.'
They must not restrain you physically.

If your healthcare professional threatens to refer you to social services if you do not make the treatment decision they want, this is undue influence. They must never do this. If they do this, you may not legally have given consent. They could be taken to court if they went ahead and treated you.

If you have a disability or long-term illness, you may be worried that social services will take your baby away if you talk about any concerns you have about caring for your baby. They must work with you to find solutions, and you should never feel threatened.

If you are involved in the criminal justice system, you may feel worried that something you say could be used as an excuse to take your baby away. You have the same rights as everyone else and should never be threatened with social services merely because of your circumstances.

If you are in, or may go to prison during your pregnancy, the charity Birth Companions has a guide to pregnancy and early motherhood in prison.

If a woman is being treated for a mental disorder under the Mental Health Act 1983, or the Mental Health (Care and Treatment) (Scotland) Act 2003, that does not necessarily mean that she lacks capacity in relation to decisions about her maternity care. She should be treated in the same way as any other woman unless she has been assessed to lack capacity.

No. You can tell your healthcare professional that you agree to treatment. Or you can agree with a gesture, for example by holding out your arm so they can check your blood pressure.

Usually you will sign a consent form before surgery. Before you sign, you and your healthcare practitioner should talk about the treatment, the risks and the benefits.

It is important that you understand what you are consenting to, and the risks it brings.
For example, if you have a visual impairment and need to read in large print, ask for the form in large print and for plenty of time to read it.
A signed form and medical notes are evidence that you gave consent but not proof. Other evidence may show you did not have enough information or were put under pressure.

Royal College of Obstetricians and Gynaecologists guidance and guidance on consent from the Association of Anaesthetists of Great Britain and Northern Ireland state that special care must be taken when obtaining consent from women who are in labour, particularly if they are under the influence of narcotic analgesics (opiate-derived painkilling drugs).

If you can't give consent in an emergency, for example because you are unconscious, you can be treated to save your life or stop your condition getting much worse. In a situation like this, if there is time, the healthcare team should talk to your next of kin about any decisions.

It is very rare that you would be unable to give consent even if you did need emergency treatment during pregnancy or labour.

Even if healthcare professionals think your baby's life is at risk, they cannot perform procedures, such as assisted birth (forceps or ventouse), without your agreement.

If it feels like an emergency and you feel under pressure to make a decision it can be useful to ask the healthcare professional something like, 'Am I in immediate danger? Is my baby in immediate danger?' This allows you to have a conversation about what the actual risk is, and how urgently you need to make a decision.

Yes. You can refuse treatment even if your doctors or midwives think you are wrong.

If you can make decisions, you can say no to treatment for any reason. Your reason does not have to make sense to other people. You can say no to treatment even where it might lead to your death, or your baby's death.
You can say something like 'I don't want that treatment' or 'I do not consent to this treatment'.

If you need advice on refusing treatment you can contact us.

Yes. Even if you gave consent you can change your mind. This is called withdrawing consent.

You can do this at any time. If your healthcare professional suspects you may no longer want the treatment, they must stop as soon as possible. They should talk to you and only carry on if they are sure you consent.
For example, you can say 'Stop'. If you want some time to process what is happening you can say 'wait a minute, please'. You can move away, if you are able to. If you are in labour, you can ask for the healthcare professional to wait till your contraction has finished before they carry out a vaginal examination. It is always ok to say no.
Mental capacity means that you can understand the choice you need to make about treatment and can make a decision.

In law, everyone has mental capacity unless it can be shown that you do not. It is very rare to not have mental capacity.

The people caring for you cannot say you do not have capacity simply because you do not agree with them.

If you are 16 or 17 then the law presumes that you have the capacity to consent to medical treatment.

If you are 16 or 17 and you wish to decline care, then in rare and serious cases someone with parental responsibility or the Court could override your decision. This should only happen if declining care would be likely to lead to your death or severe permanent injury.

If you are under 16 then you can consent to treatment if your healthcare professionals believe that you fully understand what is involved. This is called having Gillick competence. Otherwise someone with parental responsibility can consent for you.

Labour can be tiring and hard work but it is very unlikely that giving birth will make it hard for you to give consent.

During your pregnancy you should be supported to think about what you might want during labour. You should be given plenty of time and opportunities to discuss decisions that might come up in your case.

If you are in labour your health professionals must take extra care to be sure you have consented to treatment. They must take even more care if you are given painkillers called narcotic analgesics. These are opioid drugs and can make you sleepy.

If you know you will find it hard to communicate during labour, talk to your healthcare professionals early.
For example, this could be because you use British Sign Language and need an interpreter. Or it could be because you are autistic and pain can make it very hard for you to speak or use your assistive technology.
Providing communication support is called a 'reasonable adjustment'. The Trust or Board must make sure that anyone who is disabled has equal access to all of its services. This applies throughout your pregnancy, labour and postnatal care. It includes making sure you can communicate and give informed consent when giving birth. This applies to written as well as spoken communication.

You are the expert in what you need in order to communicate and your healthcare professionals must listen to you.

Only you can give consent to your treatment or care.

You can ask a birth partner, including a doula, to support you during labour. You can ask them to communicate on your behalf to express the preferences you have made in your birth plan.

If something changes in your labour and you need to give consent to something that isn't covered in your birth plan, only you can make that decision.

Your birth partner or doula can support you in this situation. You can ask for some time to discuss the decision alone with them if you want. Or, for example, they can assist you by asking on your behalf for more information about any new risk the midwife raises, how urgent a treatment really is, and how important it is.
Some autistic people can find it very difficult to communicate during labour and to give or refuse consent. It can be hard for autistic people to show that they are in pain, and it can be hard for them to speak when in pain or experiencing sensory overload. If you are autistic, you can ask an advocate to support you from the start of your pregnancy. During labour, if your advocate recognises your personal signs that you are distressed they can ask the health professional to stop by saying, 'Stop', or 'I don't think they want you to continue'.
Yes. Before treating a baby, healthcare professionals must ask consent from a person with 'parental responsibility' for the baby.

In law, the mother always has parental responsibility for her baby. The father has parental responsibility if he meets certain criteria.

A trans man who has given birth will legally be described as the mother under current law. Non-binary birthing people are also described as mother at present.

If parents decline treatment for their baby, healthcare professionals should respect their decision.

No one should threaten parents with a referral to social services to make them consent to treatment for their baby.

A baby should only be referred to social services if health professionals think ('have reasonable belief') that the baby is at risk of significant harm.

In rare and serious cases, including if parents disagree about treatment or doctors feel that the parents' decision is not in their child's best interests, healthcare professionals may ask the High Court to decide. They can ask the High Court to declare that the treatment should be carried out, or not carried out, because it is in your baby's best interests.

Law and guidance

Everyone has the right to make decisions about their body for themselves. This is called the principle of autonomy.

The principle of autonomy is protected under Article 8 of the European Convention on Human Rights and common law of England and Wales, and common law in Scotland. You can read more on our factsheet Human Rights in Maternity Care.

The law says that pregnant women are entitled to make autonomous decisions in the same way as any other person. Even if healthcare professionals disagree with their decisions they must respect them.

The principle of autonomy creates a legal requirement to seek a person's consent whenever they are given any medical treatment.

The only exceptions are rare cases: when a person does not have the capacity to make their own decisions; or in an emergency when a person cannot consent because of their physical condition (for example when they are unconscious).

If a person's consent is not obtained, the medical treatment will be against the law. It will be negligent, and in England and Wales, it will also constitute the crime of battery, and a civil wrong of trespass to the person.

Failure to obtain consent also violates Article 8 of the European Convention. If the harm that occurs as a result is serious, it will breach Article 3 of the European Convention prohibiting inhuman and degrading treatment.
Consent includes knowing who is providing healthcare
In the case of Konovalova v Russia (2015), the European Court of Human Rights held that women's consent must be sought for all medical care provided during labour and this included consent for medical students to be present during a birth. As a result, any person who is providing maternity care should be clear about their status and explain if they are a student, so that the patient can decide whether they wish to receive care from them or to have them present.

The healthcare professional must give the person the information they need before seeking consent. The information should cover any material risks, any alternative treatments that are available, and the risks of doing nothing.

In the Supreme Court case, Montgomery v Lanarkshire Health Board (2015), the court stated that the test for whether a risk is a 'material' one is whether a reasonable patient would attach significance to the risk, or whether the doctor should be aware that the particular patient would attach significance to it. This means that there must be an honest conversation between doctor and patient and the assessment of risk must be sensitive to the individual's characteristics.

When thinking about how significant a risk is for a particular patient, statistics are only one factor. For example, the risk of complications for future pregnancies after a C-section might be statistically small, but it would be more significant for someone who wished to have multiple children than for someone who did not. Every person perceives risk differently.

Hospitals cannot only rely on printed leaflets or online material to provide relevant information; there must always be a personal discussion between the patient and the health professional ( Montgomery v Lanarkshire Health Board (2015)).

Leaflets and online material can form a useful starting point for an informed conversation. Health professionals must make sure that people have time and any support they need to understand the information, to make notes, and to think about the information. When someone finds spoken communication difficult, it is important to give support and to be flexible about their preferred means of communication, for example using a pain scale or assistive technology.

Giving misleading information about someone's medical condition or the proposed treatment, or not giving them relevant information, may mean that consent was not valid. The failure to provide appropriate information may also leave the healthcare professional open to a successful claim of negligence if the person suffers harm as a result of the treatment.

If the patient asks specific questions, a healthcare professional must give full, honest and objective answers. They should take the time that is needed to do this.

General Medical Council guidance on consent sets out how doctors should support people to make decisions about their care, including how consent should be recorded.

The Royal College of Obstetricians and Gynaecologists also provides advice on consent, and on specific procedures and the risks associated with those procedures, including caesarean section, operative vaginal delivery, and participating in research while in labour.

The National Institute for Health and Care Excellence (NICE), which makes guidelines for health and social care, has guidance on improving the experience of care for people using adult NHS services, which includes information about how healthcare professionals should communicate with patients and how to present information about risks and benefits, to enable them to make decisions about their care. NICE guidance is not law, but a hospital has to give good, clear reasons if it does not follow the guidance.

Consent does not need to be recorded in writing. It may be given verbally or with a gesture. Someone might move away from a healthcare professional, shake their head, or simply say, 'No'.

It is usual practice to sign a consent form for surgical procedures, but this does not reduce the need for a fully informed dialogue between the patient and their health professional ( Montgomery v Lanarkshire Health Board (2015)).

A signed consent form and/or medical notes are evidence of consent but do not prove it was obtained: they may be contradicted by other evidence that consent was not well-enough informed or freely given.

The GMC's guidance, Department of Health's reference guide and the Scottish guide on consent contain further information on the form consent should take.

The courts in England and Wales have upheld the rights of patients to make important medical decisions affecting their lives for themselves.

A mentally competent patient has an absolute right to decline medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to his or her own death.

A mentally competent pregnant person may decline treatment during pregnancy or labour even where that might lead to death or serious harm to them or their baby.

Royal College of Obstetricians and Gynaecologists guidance states that special care must be taken when obtaining consent from women who are in labour, particularly if they are under the influence of narcotic analgesics (opiate-derived painkilling drugs).

If someone has difficulty understanding spoken English, NHS England sets out how Trusts should obtain language support. This could include hiring a professional interpreter or translating written material. Everyone needs to be able to communicate fully and understand what consent they are being asked for.

The GMC guidance on consent says that doctors should use an interpreter or translation service.

If someone's illness or disability means that they need support to communicate, this is called reasonable adjustment. The right to reasonable adjustment is set out in the Equality Act 2010.

The principle of reasonable adjustment is that the Trust must make sure that everyone has equal access to all of its services. They must put in place the support that someone needs to understand the treatment they are being offered, and to communicate their consent. This could include large print information materials for someone who needs this, lighting that enables someone to lip read, or an advocate to support understanding and communication.

The NHS has been trialling Reasonable Adjustment Flags, a way for people's needs for extra support to be highlighted to healthcare professionals every time they use the health service.
About Birthrights
Birthrights factsheets give you information about your human rights when you are pregnant and giving birth.

Birthrights champions respectful care during pregnancy and childbirth by protecting human rights. We provide advice and information to women and birthing people, train doctors and midwives, and campaign to change maternity policy and systems.

We are a charity, independent of the government and the NHS.
Disclaimer: Our factsheets provide information about the law in the UK. The information is correct at the time of writing (May 2021). The law in this area may be subject to change. Birthrights cannot be held responsible if changes to the law outdate this publication. Birthrights accepts no responsibility for loss which may arise from reliance on information contained in this factsheet. Birthrights has provided links to third party websites where these may help provide relevant further information. Birthrights takes no responsibility for the contents of linked websites and links should not be taken as an endorsement.
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Consent means saying yes Consent means saying yes. You have the right to make your own decisions about your body, just as you do at any other time. It is against the law to give you medical treatment unless you agree to it. It is also against the law for treatment to be given to ...

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Almost everyone-including doctors, midwives, and online due date calculators-uses Naegele's rule (listen to the pronunciation here to figure out an estimated due date (EDD).

Naegele's rule assumes that you had a 28-day menstrual cycle, and that you ovulated exactly on the 14th day of your cycle (Note: some health care providers will adjust your due date for longer or shorter menstrual cycles).

To calculate your EDD according to Naegele's rule, you add 7 days to the first day of your last period, and then count forward 9 months (or count backwards 3 months). This is equal to counting forward 280 days from the date of your last period.

For example, if your last menstrual period was on April 4 you would add seven days (April 11) and subtract 3 months = an estimated due date of January 11.

Another way to look at it is to say that your EDD is 40 weeks after the first day of your last period.

In cases where the date of conception is known precisely, such as with in vitro fertilization or fertility tracking where people know their ovulation day, the EDD is calculated by adding 266 days to the date of conception (or subtracting 7 days and adding 9 months). This increases the accuracy of the EDD because it no longer assumes a Day 14 ovulation based on the first day of the last menstrual period.

But where did Naegele's rule come from?

In 1744, a professor from the Netherlands named Hermann Boerhaave explained how to calculate an estimated due date. Based on the records of 100 pregnant women, Boerhaave figured out the estimated due date by adding 7 days to the last period, and then adding nine months (Baskett & Nagele, 2000).

However, Boerhaave never explained whether you should add 7 days to the first day of the last period, or to the last day of the last period.

In 1812, a professor from Germany named Carl Naegele quoted Professor Boerhaave, and added some of his own thoughts. (This is how Naegele's rule got its name!) However, Naegele, like Boerhaave, did not say when you should start counting-from the beginning of the last period, or the last day of the last period.

His text can be interpreted one of two ways: either you add 7 days to the first day of the last period, or you add 7 days to the last day of the last period.

As the 1800s went on, different doctors interpreted Naegele's rule in different ways. Most added 7 days to the last day of the last period.

However, by the 1900s, for some unknown reason, American textbooks adopted a form of Naegele's rule that added 7 days to the first day of the last period (Baskett & Nagele, 2000).

And so this brings us to today, where almost all doctors use a form of Naegele's rule that adds 7 days to the first day of your last period, and then counts forward 9 months-a rule that is not based on any current evidence, and may not have even been intended by Naegele.

What is the most accurate way to tell how far along you are?

Doctors started using ultrasound in the 1970s. Soon after, ultrasound measurement replaced last menstrual period (LMP) as the most reliable way to define gestational age (Morken et al., 2014).

A large body of evidence shows that ultrasounds done in early pregnancy are more accurate than using LMP to date a pregnancy. In a 2015 Cochrane review, researchers combined the results from 11 randomized clinical trials that compared routine early ultrasound to a policy of not routinely offering ultrasound (Whitworth et al. 2015).

The researchers found that people who had an early ultrasound to date the pregnancy were less likely to be induced for a post-term pregnancy.

In other words, using the LMP to estimate your due date makes it more likely that you will be mislabeled as "post-term" and experience an unnecessary induction.

In a large observational study that enrolled more than 17,000 pregnant people in Finland, researchers found that ultrasound at any time point between 8 and 16 weeks was more accurate than the LMP. When ultrasound was used instead of a "certain" LMP (in other words, the mother is "certain" about the date she had her last period), the number of "post-term" pregnancies decreased from 10.3% to 2.7% (Taipale & Hiilesmaa, 2001).

Why is LMP less accurate than using ultrasound?

There are several reasons why the LMP is usually less accurate than an ultrasound (Savitz et al., 2002; Jukic et al., 2013; ACOG, 2017). LMP is less accurate because it can have these problems:

People can have irregular menstrual cycles, or cycles that are not 28 days

People may be uncertain about the date of their LMP

Many people do not ovulate on the 14th day of their cycle

The embryo may take longer to implant in the uterus for some people

Research indicates that some people are more likely to recall a date that includes the number 5, or even numbers, so they may inaccurately recall that the first day of their LMP has one of these numbers in it.

What is the best time to have an ultrasound to determine gestational age?

In a 2013 study, researchers grouped ultrasound scans by <7 weeks, 7-10 weeks, 11-14 weeks, 14-19 weeks, and 20-27 weeks (Khambalia et al., 2013).

The authors found that the most accurate time to perform an ultrasound to determine the gestational age was 11-14 weeks. About 68% of people gave birth ±11 days of their estimated due date as calculated by ultrasound at 11-14 weeks. This was a more accurate result than any of the other ultrasound scans, and more accurate than the LMP.

The accuracy of the ultrasound saw a significant decline starting at about 20 weeks. Using an estimated due date from either the LMP or an ultrasound at 20-27 weeks led to a higher rate of pre- and post-term births.

Should a due date be changed based on a third trimester ultrasound?

In the Listening to Mothers III study, one in four mothers (26%) reported that their care provider changed their estimated due date based on a late pregnancy ultrasound. For 66% of the mothers, the estimated due date was moved up to an earlier date, while for 34% of the mothers, the date was moved back to a later date (Declercq et al., 2013).

Ultrasounds in the third trimester are less accurate than earlier ultrasounds or the LMP at predicting gestational age. Ultrasounds in the third trimester are not as accurate because they are measuring the size of the baby and comparing him or her to a "standard" sized baby. All babies are about the same size early in pregnancy. But if your baby will be larger than average, it will be perceived as "closer to done" when the ultrasound is done, and your due date will be moved up (incorrectly).

The reverse is also true for babies that will be smaller than average at term-their due date might be moved to a later date. This could be risky if the baby is experiencing growth restriction, as growth-restricted babies have a higher risk of stillbirth towards the end of pregnancy. Because of these problems with third trimester ultrasounds, the American College of Obstetricians and Gynecologists states that due dates should only be changed in the third trimester in very rare circumstances (2017).

They suggest that the due date should only be changed after a third trimester pregnancy ultrasound if 1) it is the pregnant person's first ultrasound, and 2) it is more than 21 days different than the due date suggested by the LMP (ACOG, 2017).

How long is a normal pregnancy? Is it really 40 weeks?

In the U.S. and other Western countries, induction is common at or even before 40 weeks, so it is impossible to know exactly what percentage of people today would naturally go into labor and give birth before, on, or after their estimated due date.

In the past, researchers figured out the average length of a normal pregnancy by looking at a large group of pregnant people, and measuring the time from ovulation (or the last menstrual period, or an ultrasound) until the date the person gave birth-and calculating the average. However, this method is wrong and does not give us accurate results.

Why is this method wrong?

This method does not work because many people are induced when they reach 39, 40, 41, or 42 weeks.

If you do include these induced people in your average, then you are including people who gave birth earlier than they would have otherwise, because they were not given time to go into labor on their own.

But this puts researchers in a bind, because if you exclude a person who was induced at 42 weeks from your study, then you are ignoring a pregnancy that was induced because it went longer-and by excluding that case, you artificially make the average length of pregnancy too short.

So how can we deal with this problem?

Researchers today use a method called "survival analysis" or "time to event analysis." This is a special method that allows you to include all of these people in your study, and still get an accurate picture of how long it takes the average person to go into spontaneous labor. There have been two studies that measured the average length of pregnancy using survival analysis:

Study finds that estimated due date is 3 to 5 days AFTER 40 weeks

In a very important study published in 2001, Smith looked at the length of pregnancy in 1,514 healthy women whose estimated due dates, as calculated by the first day of the last menstrual period, were perfect matches with estimated due dates from their first trimester ultrasound (Smith, 2001a).

The researchers found that 50% of all women giving birth for the first time gave birth by 40 weeks and 5 days, while 75% gave birth by 41 weeks and 2 days.

Meanwhile, 50% of all women who had given birth at least once before gave birth by 40 weeks and 3 days, while 75% gave birth by 41 weeks.

This means that for both first-time and experienced mothers in Smith's study, the traditional "estimated due date" of 40 weeks was wrong!

The actual pregnancy was about 5 days longer than the traditional due date (using Naegele's rule) in a first-time mother, and 3 days longer than the traditional due date in a mother who has given birth before.

Study finds that estimated due date should be closer to 40 weeks and 5 days

In 2013, Jukic et al. used survival analysis to look at the normal length of a pregnancy. This was a smaller study-there were only 125 healthy women, and they all gave birth between the years 1982 and 1985. However, this was also an important study, because researchers followed the participants even before conception and measured their hormones daily for six months (Jukic et al., 2013).

This means that the researchers knew the exact days that the participants ovulated, conceived, and even when their pregnancies implanted!

So what was the average length of a pregnancy in this study?

After excluding women who had preterm births or pregnancy-related medical conditions, the final sample of 113 women had a median time from ovulation to birth of 268 days (38 weeks, 2 days after ovulation).

The median time from the first day of the last menstrual period to birth was 285 days (or 40 weeks, 5 days after the last menstrual period).

The length of pregnancy ranged from 36 weeks and 6 days to one person who gave birth 45 weeks and 6 days after the last menstrual period. The 45 weeks and 6 days sounds really long... but this particular person actually gave birth 40 weeks and 4 days after ovulation. Her ovulation did not fit the normal pattern, so we know her LMP due date was not accurate.

The researchers also found that:

10% gave birth by 38 weeks and 5 days after the LMP

25% gave birth by 39 weeks and 5 days after the LMP

50% gave birth by 40 weeks and 5 days after the LMP

75% gave birth by 41 weeks and 2 days after the LMP

90% gave birth by 44 weeks and zero days after the LMP

Remember though, some of the participants did not ovulate on the 14 th day of their period (that's why you saw the statistic that 10% still haven't given birth by 44 weeks after the LMP!) So if we look at when people give birth after ovulation, you'll see this pattern:

10% gave birth by 36 weeks and 4 days after ovulation

25% gave birth by 37 weeks and 3 days after ovulation

50% gave birth by 38 weeks and 2 days after ovulation

75% gave birth by 39 weeks and 2 days after ovulation

90% gave birth by 40 weeks and zero days after ovulation

Women who had embryos that took longer to implant were more likely to have longer pregnancies. Also, women who had a specific sort of hormonal reaction right after getting pregnant (a late rise in progesterone) had a pregnancy that was 12 days shorter, on average.

So is the traditional "due date" really your due date?

Based on the best evidence, there is no such thing as an exact "due date," and the estimated due date of 40 weeks is not accurate. Instead, it would be more appropriate to say that there is a normal range of time in which most people give birth. About half of all pregnant people will go into labor on their own by 40 weeks and 5 days (for first-time mothers) or 40 weeks and 3 days (for mothers who have given birth before). The other half will not.

Are there some things that can make your pregnancy longer?

By far, the most important predictor of a longer pregnancy is a family history of long pregnancies- including your own personal history, your mother and sisters' history, and your baby's biological father's family history (Jukic et al., 2013; Oberg et al., 2013; Mogren et al., 1999; Olesen, et al., 1999; Olesen et al., 2003).

In 2013, Oberg et al. published a large study that looked at more than 475,000 Swedish births, most of which were dated with an ultrasound before 20 weeks. They found that genetics has an incredibly strong influence on your chance of having a birth after 42 weeks:

If you've had a post-term birth before, you have 4.4 times the chance of having another post-term birth with the same partner

If you've had a post-term birth before, and then you switch partners, you have 3.4 times the chance of having another post-term birth with your new partner

If your sister had a post-term birth, you have 1.8 times the chance of having a post-term birth

Overall, researchers found that half of your chance for having a post-term birth comes from genetics. This includes the baby's genetic tendency to gestate longer (due to genes the baby inherited from the mother and the father), and the mother's genetic tendency to carry a pregnancy longer. The Swedish researchers even proposed that you could call some pregnancies "resistant," because these mothers and/or fetuses have a genetically decreased tendency to start labor.

Other factors that may make your pregnancy more likely to go longer include:

Higher body mass index before you get pregnant (Halloran et al., 2012; Jukic et al., 2013; Oberg et al., 2013)

Higher weight gain during pregnancy (Halloran et al., 2012)

Longer time between when you ovulated and when your pregnancy implanted (Jukic et al., 2013)

Older maternal age (Oberg et al., 2013; Jukic et al., 2013)

Heavier birth weight of the mother (Jukic et al., 2013)

Higher education level of the mother (Oberg et al., 2013)

Being pregnant for the first time (Oberg et al., 2013)

Being pregnant with a male baby (Divon et al., 2002; Oberg et al., 2013)

Your mother had a post-term birth (Mogren et al., 1999; Olesen et al., 1999; Olesen et al., 2003)

The baby is measuring small by ultrasound at 10-24 weeks (Johnsen et al., 2008)

Experiencing environmental stress towards the end of pregnancy (at 33-36 weeks) (Margerison-Zilko et al., 2015)

What are the risks of going past your due date?

The risks of some complications go up as you go past your due date, and there are at least three important studies that have shown us what the risks are.

1. In 2003, Caughey et al. looked at 135,560 people who gave birth at term in California between the years 1995 and 1999 (Caughey et al., 2003). The participants in this sample all gave birth at Kaiser Permanente hospitals in northern California. The overall use of interventions (Cesareans and inductions) in this sample was not listed.

2. In 2004, Caughey et al. looked at the records of 45,673 people who gave birth in a single hospital in California from 1992 to 2002 (Caughey & Musci, 2004). The participants in this study were mostly well-educated. As far as intervention rates go, 18% gave birth by Cesarean and 16% with the help of vacuum or forceps. The rate of inductions was not listed.

3. In 2007, Caughey et al. studied the medical records of 119,254 people who gave birth after 37 weeks at Kaiser Permanente between the years of 1995 and 1999. This was the same time period and same hospital as his 2003 study, but this time the researchers only looked at low-risk people who had health insurance. The overall Cesarean rate was 13.8%, and 9.3% gave birth with the help of vacuum or forceps. The authors also took whether or not people had inductions into account when they calculated the risks of going past your due date (Caughey et al., 2007).

Risks for mothers:

The risk of chorioamnionitis (infection of the membranes) was lowest at 37 weeks (0.16%) and increased every week after that to a high of 6.15% at ≥ 42 weeks (Caughey et al., 2003)

The risk of endomyometritis (infection of the uterus) was lowest at 38 weeks (0.64%) and increased every week after that to a high of 2.2% at ≥ 42 weeks (Caughey & Musci, 2004)

The risk of having a placenta abruption (placenta separates prematurely from the uterus) was lowest at 37 weeks (0.09%), and increased every week to a high of 0.44% at ≥ 42 weeks (Caughey et al., 2003)

The risk of preeclampsia was lowest at 37 weeks (0.4%) and highest at 40 weeks (1.5%), after which the risk did not change (Caughey et al., 2003)

The risk of postpartum hemorrhage was lowest at 37 weeks (1.1%) and increased almost every week to a high of 5% at 42 weeks (Caughey et al., 2007)

The risk of a primary Cesarean (in people who have never had a Cesarean before) increased from 14.2% at 39 weeks to a high of 25% at ≥42 weeks (Caughey & Musci, 2004)

The risk of having a primary Cesarean for a non-reassuring fetal heart rate was lowest at 37-39 weeks (13.3-14.5%) and reached a high of 27.5% at 42 weeks (Caughey et al., 2007)

The risk of receiving forceps or vacuum assistance increased from 14.1% at 38 weeks to a high of 18.5% at 41 weeks (Caughey & Musci, 2004)

The risk of having a 3rd or 4th degree tear was lowest at 37 weeks (3.4%) and increased every week to a high of 9.1% at 42 weeks. However, these numbers are much higher than are typically seen, and are partially related to the high use of vacuum and forceps in this study.

In their 2007 study, Caughey et al. reported that high use of induction, Cesareans, and vacuum/forceps for people with increasing gestational age may contribute to an increase in maternal risks. However, when the researchers used a statistical method to control for the use of interventions, the risks still increased with gestational age.

Risks for infants:

The risk of moderate or thick meconium increased every week starting at 38 weeks, and peaked at ≥42 weeks (3% at 37 weeks, 5% at 38 weeks, 8% at 39 weeks, 13% at 40 weeks, 17% at 41 weeks, and 18% at >42 weeks) (Caughey & Musci, 2004)

Neonatal intensive care unit (NICU) admission rates were lowest at 39 weeks (3.9%) and rose to 5% at 40 weeks and 7.2% at ≥42 weeks (Caughey & Musci, 2004)

The risk of the baby being large at birth (>9 lbs 15 oz or >4500 grams) rose starting at 38 weeks (0.5%), and doubled every week after that up until 42 weeks (6%) (Caughey & Musci, 2004)

The odds of having a low 5-minute Apgar score went up starting at 40 weeks and increased each week until ≥42 weeks (exact numbers not reported; Caughey & Musci, 2004)

Other risks for post-term pregnancy include having low fluid, and something called dysmaturity syndrome (growth restriction plus muscle wasting), which happens in about 10% of babies who go past 42 weeks. For more information about meconium, see this article by Midwife Thinking about meconium stained waters.

What about the risk of stillbirth?

In this section, we will talk about how the risk of stillbirth increases towards the end of pregnancy.

There are two very important things for you to understand when learning about stillbirth rates.

First, there is a difference between absolute risk and relative risk.

Absolute risk is the actual risk of something happening to you.

For example, if the absolute risk of having a stillbirth at 41 weeks was 1.7 out of 1,000, then that means that 1.7 mothers out of 1,000 (or 17 out of 10,000) will experience a stillbirth.

Relative risk is the risk of something happening to you in comparison to somebody else.

If someone said that the risk of having a stillbirth at 42 weeks compared to 41 weeks is 94% higher, then that sounds like a lot. But some people may consider the actual (or absolute) risk to still be low-1.7 per 1,000 versus 3.2 per 1,000.

Yes-3.2 is about 94% higher than 1.7, if you do the math! So, while it is a true statement to say "the risk of stillbirth increases by 94%," it can be a little misleading if you are not looking at the actual numbers behind it.

Please see our handout on Talking about Due Dates for Providers for tips on how providers can discuss the risk of stillbirth.

The second important thing that you need to understand is that there are different ways of measuring stillbirth rates. Depending on how the rate is calculated, you can end up with different rates.

How do you measure stillbirth rates?

Up until the 1980s, some researchers thought that the risk of stillbirth past 41-42 weeks was similar to the risk of stillbirth earlier in pregnancy. So, they did not think there was any increase in risk with going past your due date.

However, in 1987, a researcher named Dr. Yudkin published a paper introducing a new way to measure stillbirth rates. Dr. Yudkin said that earlier researchers used the wrong math when they calculated stillbirth rates-they used the wrong denominator! (Yudkin, Wood et al., 1987).

Here's why this formula is wrong: We don't need to know how many stillbirths happen out of every 1,000 births at 41 weeks. Instead, we need to know how many stillbirths happen at 41 weeks compared to all pregnancies and births at 41 weeks. In other words, you have to include the healthy, living babies that have not been born yet in your denominator.

When researchers began using this new formula to figure out stillbirth rates, they found something very surprising-the risk of stillbirth decreased throughout pregnancy, until it reached a low point at 37-38 weeks, after which the risk started to rise again.

This finding-that the risk of stillbirth decreases throughout pregnancy, and then increases sometime after 37-38 weeks-has been found many times by different researchers in different countries. This phenomenon is called the "U-shaped curve" of stillbirth. In other words, there are higher rates of stillbirth earlier in pregnancy, then they go down until around 37-38 weeks, after which they rise again.

Because the risk of stillbirth starts to go up even more at 40, 41, and 42 weeks, some researchers argue that although 40 weeks and 3-5 days may be the physiological length of pregnancy, 40 weeks may be the functional length of a pregnancy.

In other words, the average pregnancy normally lasts about 40 weeks and 5 days, but in some researchers' opinion, because of the increased risk of stillbirth and newborn death, 40 weeks may be as long as a pregnancy should go.

And although the stillbirth rates may seem low overall, if you happen to be a parent who experiences the 1 in 315 event at 42 weeks (Muglu et al. 2019), then the risk doesn't seem so low anymore.

Actual stillbirth rates vs. open-ended stillbirth rates

Even after researchers began using the new way of calculating stillbirth rates, there was still controversy about the best way to calculate this new formula for measuring stillbirth rates.

Different than what Yudkin proposed in 1987, some researchers preferred an "open-ended" stillbirth rate (also known as the "prospective risk of stillbirth"). An open-ended stillbirth rate at 40 weeks would tell us what a pregnant person's risk of stillbirth was for any time after 40 weeks, if she let the pregnancy continue indefinitely.

Other researchers argued that most people (and doctors!) don't want to know what the risk of stillbirth would be if a pregnant person chose to let the pregnancy continue on and on! (Hilder et al., 2000). They just want to know what the risk would be if they waited one more week until the next appointment, or even a few days.

But the "open-ended" stillbirth rate tells you what your risk of stillbirth at 40 weeks would be if you include babies born not just at 40 weeks, but 41 weeks, 42 weeks, 43 weeks, and on! (Boulvain et al., 2000).

In the end, you will find that stillbirth rates vary from study to study, depending on whether the researchers report the actual stillbirth rate, or the open-ended stillbirth rate.

So what is the risk of stillbirth as you go past your due date?

Since the late 1980's, there have been at least 12 large studies that looked at the risk of stillbirth during each week of pregnancy. Some of the researchers used open-ended stillbirth rates, and some of them used actual stillbirth rates.

All of the researchers found a relative increase in the risk of stillbirth as pregnancy advanced.

To get an accurate picture of stillbirth in people who go past their due date, it would be best to look at studies that took place in more recent times. I've chosen 3 of the most recent studies to show you from Norway, Germany, and the U.S. To see all of the other studies, click to view the entire table here.

All 3 of these studies used the actual stillbirth rate-not the open-ended stillbirth rate. Two studies used ultrasound to calculate gestational age, and one study used the LMP.

The largest meta-analysis to date on risks of stillbirth and newborn death at each week of term pregnancies was published in 2019 (Muglu et al. 2019). A meta-analysis is when researchers take multiple studies and combine all the data together into one big "meta" study. The researchers included 13 studies (15 million pregnancies, nearly 18,000 stillbirths). All of the studies were conducted in countries defined as "high-income" by the World Bank.

The risk of stillbirth per 1,000 was 0.11, 0.16, 0.42, 0.69, 1.66, and 3.18 at 37, 38, 39, 40, 41, and 42 weeks of pregnancy, respectively. Based on their data, Muglu et al. (2019) calculated the "number needed to harm" by waiting for labor for one more week in order to experience one additional stillbirth. To experience one additional stillbirth, there would need to be at least 2,367 people waiting for labor for one more week starting at 39 weeks. At 40 weeks, 1,449 people would have to wait for labor for one more week to experience one additional stillbirth. At 41 and 42 weeks, only 604 and 315 people, respectively, would have to wait for labor for one more week to experience one additional stillbirth.

The researchers also found evidence that health care systems are failing Black mothers and babies-an alarming but common theme in health care research. Black mothers were 1.5 to 2 times more likely than White mothers to have a stillbirth at every week of pregnancy.

When they looked only at low-risk pregnancies, the risk of stillbirth was 0.12, 0.14, 0.33, 0.80, and 0.88 at 38, 39, 40, 41, and 42 weeks of pregnancy. Low-risk pregnancy was defined as pregnancies with a single baby, no congenital abnormalities, and no medical conditions in the mother.

There was no additional risk of newborn death when giving birth between 38 and 41 weeks, but the risk of newborn death did increase beyond 41 weeks.

So, although most researchers have found an increase in stillbirth rates in the late term and post term period, some might consider the "absolute" increase in risk to be small until 41 weeks, after which it reaches about 0.80-1.66 out of 1,000, depending on the mother's risk factors for stillbirth.

What factors can increase the risk of stillbirth?

Researchers have found several factors are related to a higher risk of stillbirth:

Post-term babies who are small for gestational age (body weight <10 th percentile) have a 6-7 times higher chance of stillbirth and newborn death than post-term babies who are not small for gestational age.

Also, small for gestational age babies are often growth restricted at the 18-week ultrasound. So, the gestational age for these babies is often under-estimated.

This means that babies who are small for gestational age may be more post-term than we realize they are-increasing their risk while also leaving us unaware of their true gestational age (Morken et al., 2014).

Other factors that do not necessarily cause stillbirth but may increase the risk of stillbirth, in general, include:

Belonging to an ethnic group at increased risk for stillbirth* (Ananth et al., 2009; Stillbirth Collaborative, 2011)

Being pregnant with your first baby (Huang et al., 2000; Smith, 2001b; Stillbirth Collaborative, 2011; Flenady et al., 2011)

Fewer than four prenatal visits or no prenatal care (Huang et al., 2000; Flenady et al., 2011)

Low socioeconomic status (Huang et al., 2000; Flenady et al., 2011)

A body mass index (BMI) over 25 to 30 (Huang et al., 2000; Stillbirth Collaborative, 2011; Flenady et al., 2011)

Smoking (Morken et al., 2014; Flenady et al., 2011)

Pre-existing diabetes (Stillbirth Collaborative, 2011; Flenady et al., 2011)

Pre-existing hypertension (Flenady et al., 2011)

Older maternal age (≥40 years) (Stillbirth Collaborative, 2011)

Not living with a partner (Stillbirth Collaborative, 2011)

History of previous stillbirth (Stillbirth Collaborative, 2011)

Being pregnant with multiples (Stillbirth Collaborative, 2011)

* Racism, including the effects of prejudice and institutional racism, can increase the risk of poor outcomes, including stillbirth, in certain populations (Giscombe and Lobel, 2005).

Of course, parents can still experience the stillbirth of a child even when none of these risk factors are present. As many as a third of all stillbirths that take place before labor have no known cause (Warland & Mitchell, 2014). To read more about theories of unexplained stillbirth, read this article here.

We have heard some clinicians state that the "aging of the placenta" is a potential cause of stillbirths with no official known cause. However, up until recently, there was no research on this topic.

In 2017, researchers published the first study looking at biological markers of aging in placentas. In this study, researchers in Australia collected placentas from 34 people who gave birth between 37-39 weeks of pregnancy, 28 people who gave birth between 41-42 weeks, and 4 people who experienced stillbirths between 32 and 41 weeks (Maiti et al. 2017).

Five or more tissue samples were removed from each placenta, and the samples were analyzed using a variety of biochemical tests. For example, one of the tests looked for a marker of DNA/RNA damage that was previously observed in other aging tissues, such as the brain in Alzheimer's disease. There was a significant increase in DNA/RNA damage in late-term and stillbirth placentas compared to the placentas from 37-39 weeks.

Overall, the analysis of the placentas from the 41-42 week pregnancies and from the stillbirths showed increased signs of aging, with decreased ability to transport nutrients to the baby and waste products away from the baby, compared to the placentas from the earlier term births. The rate of placental aging varied in different pregnancies, and the authors stated that not all of the 41-42 week placentas showed signs of aging. We reached out to the authors to find out more, and they told us that one-third of the 41-42 week placentas showed increased signs of aging compared to the 37-39 week placentas. This means that two-thirds of the 41-42 week placentas did not show signs of aging.

Interestingly, the authors say that in the future it may be possible to predict which babies are at increased risk of stillbirth by measuring markers of placental aging in the mother's blood. You can watch a 10-minute video describing the findings of this emerging research here.

Induction for Going Past Your Due Date

Check out our Signature Article on Inducing for Due Dates here for more information about the Pros/Cons of induction versus waiting for labor.

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What is an estimated due date, and how is it determined? What are the risks of going past your due date? Does induction increase the risk of Cesarean? At which point do the benefits of being electively induced outweigh the risks? Does a person's goals and preferences for their births

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Can I choose where to give birth? Yes. You have the right to choose where you give birth. You can choose to give birth in a hospital, in a birth centre, or at home. A birth centre is a maternity unit that is run by midwives. It can be part of a hospital or completely ... Read more

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When meconium is noticed in amniotic fluid during labour it often initiates a cascade of intervention. A CTG machine will often be strapped onto the woman reducing her ability to move, labour in water, and increasing her chance of having a c-section or instrumental delivery ( Alfirevic et al. 2013). Time limits for labour may be tightened up further resulting in induction or augmentation, which increases the chance of fetal distress and for first time mothers, c-section. As the baby is being born he may be subjected to airway suctioning which can cause a vagal response (heart rate deceleration) and difficulties with breastfeeding. Once born, the baby is likely to have his umbilical cord cut prematurely and be given to a paediatrician who may also suction the baby's airways. In the first 24 hours after birth the baby will be disturbed regularly to have his temperature, breathing and heart rate assessed. In some hospitals the baby will be taken away from his mother to be observed in a nursery.

This is a lot of fuss for a bit of poo which in the vast majority of cases is not a problem. Indeed many of the interventions implemented because of the meconium are more likely cause complications than the meconium itself.

This post is mostly based on two journal articles. One by obstetricians in an obstetric journal ( Unsworth & Vause 2010) and the other by a midwife in a midwifery journal ( Powell 2013). Both agree that there is very little known about meconium and whether it is a problem at all.
Meconium facts
Meconium is a mixture of mostly water (70-80%) and a number of other interesting ingredients (amniotic fluid, intestinal epithelial cells, lanugo, etc.). Around 15-20% of babies are born with meconium stained liquor.

There are three reasons (theoretically) that a baby will open his/her bowels before birth ( Unsworth & Vause 2010):

1. Because their digestive system has reached maturity and the intestine has begun working ie. moving the meconium out. This is the most common reason - 15-20% of term babies and 30-40% of post-term babies will have passed meconium in-utero.

2. Because their cord or head is being compressed (during labour) ie. a vagally mediated gastrointestinal peristalsis - the same reflex which causes variable heart rate decelerations. This is a normal physiological response and can happen without fetal distress. This may be why a lot of babies pass meconium as their head is compressed during the last minutes of birth and then arrive with a trail of poo behind them.

3. Fetal distress resulting in hypoxia. However the exact relationship between fetal distress and meconium stained liquor is uncertain. The theory is that intestinal ischaemia (lack of oxygen) relaxes the anal sphincter and increases gastrointestinal peristalsis = passage of meconium. However, fetal distress can be present without meconium, and meconium can be present without fetal distress.

Bear in mind these are theories and there is no evidence to support them. Indeed in 'animal models' the theory that hypoxia results in meconium has found to be incorrect. There are also other theories about meconium in pregnancy - that the baby continually passes it - but I think this post is confusing enough with wading into them (see the key articles for further information).

Meconium alone cannot be relied on as an indication of fetal distress: "... meconium passage, in the absence of other signs of fetal distress, is not a sign of hypoxia..."( Unsworth & Vause 2010). An abnormal heart rate is a better predictor of fetal distress; and an abnormal heart rate + meconium may provide an even better indication that a baby may be in trouble. In addition, thick meconium rather than thin meconium is associated with complications. In summary, it is important to remember that:

Most babies who are born in a poor condition do not have meconium stained liquor

Most babies with meconium stained liquor are born in good condition

Despite this, babies who are known to have passed meconium (of any variety) without any other risk factors are treated as if they are in imminent danger. I am guessing this is because if a previously unstressed baby becomes hypoxic during labour it may result in the dreaded MAS.
Meconium Aspiration Syndrome (MAS)
MAS is the major concern when meconium is floating about in the amniotic fluid. It is an extremely rare complication - around 2-5% of the 15-20% of babies with meconium stained liquor will develop MAS ( Unsworth & Vause 2010). Of the 2-5% of the 15-20%, 3-5% of babies will die. OK enough %s of %s - basically it is very rare but can be fatal. For those who like numbers if you have meconium in your amniotic fluid your baby has a 0.06% (1:1667) chance of dying from MAS. This risk will go up and down depending on individual circumstances eg. prematurity, additional labour complications, etc.

MAS occurs when the baby inhales meconium stained liquor during labour, birth or immediately following birth. Babies make shallow breathing movements during pregnancy. Breathing movements slow down in response to prostaglandins before birth. In order for a baby to gasp in-utero he must be extremely asphyxiated and have gone through a number of stages. This is unlikely to happen without anyone noticing the baby is in trouble ie. an abnormal fetal heart rate during auscultation and an abnormal labour (or induced contractions). A baby is able to maintain aerobic metabolism until oxygen levels at the 'placental blood exchange site' drop 50% below normal levels. The baby then undergoes a number of physiological compensatory responses and if the oxygen level does not improve, or worsens he will descend through hypoxaemia, hypoxia, anaerobic metabolism, metabolic acidosis, asphyxia, and then become 'unconscious' at which point his limbic system will initiate a gasp in an attempt to get oxygen.

Meconium in the lungs can cause problems with respiration and increase the risk of infection. For 3-5% of these babies it can result in death... but remember there are often other issues occurring along with the MAS eg. prematurity.

So, meconium alone is not a problem. Meconium + an asphyxiated baby = the possibility of MAS
Bizarre Practice
So you would think that the sensible thing to do if a baby has passed meconium (for whatever reason) is to create conditions that are least likely to result in asphyxia and MAS. This is where I get confused because common practice is to do things that are known to cause hypoxia, for example:

Inducing labour if the waters have broken (with meconium present) and there are no contractions or if labour is 'slow' in an attempt to get the baby out of the uterus quickly.

Performing an ARM (breaking the waters) to see if there is meconium in the waters when there are concerns about the fetal heart rate.

Creating concern and stress in the mother which can reduce the blood flow to the placenta.

Directed pushing to speed up the birth.

Having extra people in the room (paediatricians), bright lights and medical resus equipment which may stress the mother and reduce oxytocin release.

Cutting the umbilical cord before the placenta has finished supporting the transition to breathing in order to hand the baby to the paediatrician.

Suctioning the baby's airways?
I am unsure whether this is common practice or not. Evidence based clinical guidelines generally recommend NOT suctioning a baby's airways unless they are unresponsive, floppy and require resuscitation. And then only to do so using a laryngoscope so that you can see what you are doing. Guidelines: NICE guideline, Resuscitation Council UK, more guidelines. Key research: Wiswell et al. 2000, Vain et al. 2004. So, I would assume that practice would be informed by this research and guidelines.

However, on my frequent youtube birth-surfing trips I encounter suctioning of babies often (without meconium present). Both 'on the perineum' and following birth. I have seen this being done at hospital births, homebirths, and even unassisted births. You can see an extreme version of suctioning in this previous post. A more conservative method using the suction bulb pictured above seems to figure in a lot of the homebirths on youtube. So, I am guessing that this is a common routine practice in the US. Therefore, I feel obliged to reiterate why this is not only invasive and pointless but may also be detrimental. Suctioning at birth does not reduce the risk of MAS but can:

In addition I am guessing it is not a very pleasant experience/welcome for the baby. Anyway, the birth process takes care of the mucous and amniotic fluid (and meconium) in the baby's airways. As you can see from the photo below the airways clear as the head is born and while waiting for the next contraction - the chest is compressed, squeezing the fluid out and gravity helps it to drain. Babies born by c-section miss out on this and are more likely to end up with problems associated with fluid in the airways and stomach.
Suggestions
All babies deserve to have the least stressful arrival possible. It is even more important that a baby who has passed meconium does not become stressed during labour and birth because it could lead to MAS. The following suggestions apply to all births including when there is meconium stained liquor:

Avoid an ARM during labour so that any meconium present is not known about until the membranes rupture spontaneously (hopefully this will happen after much of the labour is complete). If there is meconium present it will remain well diluted and the amniotic fluid will protect the baby from compression during contractions.

Ensure that the mother knows meconium is a variation and not necessarily a complication... the practitioner needs to consider the holistic picture - a post dates baby with old meconium is very different to a 38 week baby with thick fresh meconium.

If this is a concerning scenario ie. not post dates and thick meconium... or fresh meconium occurring during labour then increased monitoring and/or medical intervention may be required.

Otherwise, create a relaxing birth environment.

Avoid any interventions that are associated with fetal distress - ARM, syntocinon/pitocin, directed pushing.

In hospital do not allow others into the room unless the mother wants them there. If there is a policy to have a paediatrician present they can wait outside the room to be called if needed.

To assist with airway clearing encourage a slow birth of the baby's head in a position that allows drainage of the airways (ie. mother not lying on her back). Do not pull the baby out - allow the mother and baby to wait for the next contraction whilst the airways clear themselves.

Once baby is born leave the umbilical cord intact until it has stopped pulsing to allow a gentle transition to breathing.

Keep baby skin to skin with mother following birth.

Encourage the mother to let you know if she is concerned about her baby in any way over the next 24 hours (eg. feeling hot, noisy breathing, etc.)

Summary
Meconium in itself is not dangerous unless it is inhaled by the baby. For some babies meconium is a sign of hypoxia and they are at risk of meconium aspiration - these babies need additional monitoring and perhaps medical intervention. For most babies ie. those who are post dates, meconium is a sign of a mature digestive system that has begun to function - in these cases the aim should be to avoid hypoxia during labour and therefore meconium aspiration.

You can listen to an interview/discussion I had with Pregnancy Birth and Beyond Radio about meconium.

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When meconium is noticed in amniotic fluid during labour it often initiates a cascade of intervention. A CTG machine will often be strapped onto the woman reducing her ability to move, labour in water, and increasing her chance of having a c-section or instrumental delivery (Alfirevic et al. 2013).

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Prelabour Rupture of Membranes: impatience and risk

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This post explains what happens when the amniotic sac ruptures before labour and discusses the research about management and outcomes.

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Your birth rights - in various languages

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Your birth rights - in various languages

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Your basic birth rights - translated - Birthrights

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It’s really important that women and birthing people and those that care for them, understand basic birth rights in maternity care. It is vital that conversations that lead to decisions, start from a shared understanding of what an individual can or can’t choose to do and the obligations on maternity services to uphold human rights. ... Read more

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Welcome back to Manna Mostaghim, PhD student of Health Policy at the London School of Economics and Political Science! Last month, Manna wrote about weight loss drug Saxenda being improperly presented as a fertility aid. This guest blog post looks at the issues around egg freezing in the UK if you have a high BMI. Scrambled, ...

Egg freezing in the UK with a high BMI Read More "

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Welcome back to Manna Mostaghim, PhD student of Health Policy at the London School of Economics and Political Science! Last month, Manna wrote about weight loss drug Saxenda being improperly presented as a fertility aid. This guest blog post looks at the issues around egg freezing in the UK if you have a high BMI.

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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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The Infant Sleep Info website is full of helpful sleep info for parents and health practitioners, but it can be hard to read on a mobile device, especially a smart phone.

The *NEW 2017* Infant Sleep Info App provides key information from the Basis website in a handy format for mobile devices. Covering normal sleep development, sleep location and sleep safety the familiar info from the website is delivered in smaller chunks. Two features are exclusive to the app

A bed-sharing decision tool guides parents through the key considerations for safe bed-sharing, and explains when bed-sharing may be inadvisable and why.

A sleep log tool helps parents track their baby's sleep, displaying this info on a chart depicting the range of normal sleep for infants of different ages to provide reassurance!

Download here from the Apple App Store Download here from the Google Play store
Or search for 'Infant Sleep Info' or 'Infant Sleep Info Durham Uni' and locate the baby icon.

Key Features of Infant Sleep App

* Bed-sharing decision tool.

* Where will my baby sleep?

* How will my baby sleep?

* Sleep log to track baby's sleep

* Links to Basis info sheets.

* Links to Basis partner organisations

Frequently asked questions about the app

1. How much does the Basis app cost? Nothing! It is free :)

2. Is this a new app? Yes the previous version required updating for the new iOS update, so we redesigned the app, refreshed the look and the content, and added several new info sections. The old app has now been withdrawn.

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The Infant Sleep Info website is full of helpful sleep info for parents and health practitioners, but it can be hard to read on a mobile device, especially a smart phone. The *NEW 2017* Infant Sleep Info App provides key information from the Basis website in a handy format for mobile devices.

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ANDYSMANCLUB are a men’s suicide prevention charity, offering free-to-attend peer-to-peer support groups across the United Kingdom and online.

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The average baby gets through 4,000 disposable nappies by the time they're potty-trained, costing families £400 a year and creating the equivalent of half a tonne of carbon dioxide.

Most toddlers are out of nappies - during the day, at least - by the time they're two-and-a-half, by which point parents will have spent £1,000-plus on disposable nappies and upwards of £250 on the associated paraphernalia such as baby wipes, nappy bags and nappy bins.

These figures, from an Environment Agency study and consumer group Which?, may be enough to prompt parents to consider opting for reusable nappies instead. The reusable nappy information service Go Real claims parents can save at least £150 by switching away from disposables, with parents who go for the cheapest renewable brands able to save a lot more. And then there are the environmental benefits: experts claim disposable nappies take up to 500 years to break down.

Reusable nappies involve set-up costs, but while you can spend hundreds of pounds on kit, you don't have to. Go Real reckons £80 will cover a pack of 20 of the cheapest reusable nappies and three waterproof wraps. Along with the cost of washing, it says the first year's cost can be as low as £132.

By contrast, recent research by MoneySavingExpert found that using branded disposable nappies costs an average of £970 over 24 months, while own-brand nappies can cost £750.

But the decision to use disposables is not just about cost, says Rachel Burrows of UK parenting website Netmums. "Parents also factor in convenience, time and environmental ethics before deciding which works best for their family," she says. "More parents are beginning to combine cloth and disposable, using disposables when their baby is out and cloth nappies at home where they are easier to clean."

Burrows says that while cloth nappies are a lot more expensive to buy, they can save significant amounts of money if they are reused for later children. But parents must factor in laundry costs, which can range from a few pounds a week at home to £15 a week for a professional nappy laundering service.

Electricity and water bills also need to be taken into account. The Energy Saving Trust estimates that a 30C wash costs an average of 15p a cycle for water and 4p for electricity. As you turn up the heat, the cost of electricity rises: a 90C wash will cost 15p. Tumble drying costs a further 21p for each cycle.

However, many local councils offer incentives such as free trials, laundry services and cashback on reusable nappy purchases.

Guardian Money spoke to two mothers and discovered there were considerable savings to be had, even when mixing reuseables with disposables.
Michelle: £575.56 per child
Michelle Rankin, 36, is mother of three sons - Thane, six; Harris, four; and Lennox, three. They live in Bromley, Greater London.

The decision to use reusable nappies was an obvious choice, Rankin says. "From the very beginning I decided I didn't want to be filling up landfill with nappies. I got the whole pack and actually ended up using them for all three children."

The set-up cost was around £500 for 38 reusable nappies and parts, but Rankin is convinced that overall they were far cheaper than disposables, even though she used more expensive WaterWipes (£25 per calendar quarter). She also managed to recoup £80 when she resold the nappies online.

I got the whole pack and ended up using them for all three children

Michelle Rankin

Rankin used 26 Motherease pre-folded popper-fastening nappies with an outer wrap and inner liner, which she bought in bulk for £15 each, including all three parts. She also bought 12 of the cheaper terry towelling nappies and rubber pants for around £10 each, plus £6 for a pack of five crocodile clips.

The liners and nappies were washed together twice a week on average, on a 70C wash. The nappies were then line-dried, apart from the terry ones which would be given 10 minutes in the tumble dryer to avoid them becoming "cardboard-like".

Rankin says there were occasions when it was necessary to use disposable nappies."The only time I used disposable nappies was at night, as reusables were not as nice on the skin all night. I also used disposables when we were travelling up to Scotland to see my mum."

With her oldest child being out of nappies at 18 months and the other two at around two years, Rankin's largest outlay was not on energy but on wipes and washing products.

* Total estimated cost for three children from birth to potty trained (total of 5.5 years): £1,726.68, giving an average cost per child of £575.56.

Made up of: reusable nappies £436 (including £80 resale cost); disposable nappies £200.75; wipes £550; washing products £360.08 (based on two washes a week); electricity £85.80 (washing and tumble drying); water £94.05.
Sarah: £698.59 per child
Sarah*, 27, is mother of 15-month-old Theodore, from Kettering, Northamptonshire. A self-confessed "flitter" between reusable and disposable nappies, Sarah did not start using reusables until her son was six months old, and reverts to disposables in the winter or while on holiday. She uses Aldi's Mamia nappies, which average 8p a nappy.

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Reusable nappies involve a big outlay at first, but can ensure large savings. Photograph: David Cook/blueshiftstudios//Alamy

The pretty designs and comfortable fit of reusable nappies are the continued draw for Sarah now that she has ditched the disposables.

"My mum used cloth nappies with me and my two siblings. We had the terry ones with the pins. I thought I would give it a go, with the idea of saving money."

Sarah signed up to a free cloth nappy trial with Kettering borough council, which meant she had a range of different brands to try before purchasing her own. She also received a £25 rebate from the council for buying reusable nappies.

Sarah started with gNappies (nappy covers that you use with biodegradable disposable inserts) during the day and Littlelamb cloth nappies at night, but soon found they did not suit her. They cost her £50. She briefly tried rewashable wipes but found them "more trouble than they are worth", and now uses Pampers disposable wipes (£40 a year).

The gNappies include cloth pants, waterproof pouch and insert, all of which are machine-washable. Sarah spent around £140 on the gNappies pants, £28 on pouches and £30 on inserts. She also has four washable nappy bags for the wet and soiled parts, costing £16 altogether.

The pants and pouches are washed with normal loads, while Sarah washes the inserts about three times a week at 60C and once a month at 90C. These are then line-dried. She hopes to use reusable nappies when she has a second child, but thinks she will not start until he or she is around six months old, due to the quantity of nappies newborn babies go through, and the convenience of disposables.

* Total estimated cost for one child from birth to potty trained (assuming potty trained at 30 months): £698.59.

Made up of: reusable nappies £223 (including council rebate); disposable nappies £167; wipes £100; washing products £145.99 (based on three washes a week); electricity £27.70; water £34.90. (Figures based on using disposables for three winter months a year and three holiday weeks a year, plus disposables until six months old.)

* Did not wish her surname to be published
Topics

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Nappies: which are best - disposables or reusables?

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The average baby gets through 4,000 disposable nappies by the time they're potty-trained, costing families £400 a year and creating the equivalent of half a tonne of carbon dioxide.

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We’re here to keep babies safe by empowering families and professionals with trusted baby safety advice.

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Who we are

In 1981 a small group of parents, who were experiencing problems with their crying and sleepless babies, set up a support group. They discovered how important support is and how reassuring it can be to talk to someone. Today that support group has become Cry-sis, the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems. From modest beginnings Cry-sis has become a well-respected national charity which:

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Support For Crying And Sleepless Babies | Cry-sis

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Cry-sis, the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems. Call the helpline now...

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"He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on her play mat" "He hates going in his pram, he cries the second we put him in it".
If I had a pound every time I heard these from a new parent I'd be a very rich lady by now! What amazes me though is that society in general doesn't get it, they don't get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! We spend more than time though, the 'putting babies down' industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on..................having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn't enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn't consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak.
"Empathy: the intellectual identification with or vicarious experiencing ofthe feelings, thoughts, or attitudes of another."
To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world - but which world? The world they have spent most of their life in, their 'womb world' or the world they are in now - our world. To fully understand we must appreciate the enormous transition they have made - a concept known to many as 'The Fourth Trimester' -some make the womb to world transition easily, others less so and it is this latter group in particular "the clingy babies" we can learn so much from through this concept.
"Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to "behave." If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he's labeled an "easy baby"; if he does not adapt readily, he is labeled "difficult."" - Dr. William Sears.
So lets quickly compare the two different 'worlds' your baby has lived in:

Pretty different huh? On top of this the big thing to understand is that in utero the baby's world was constant, each day was the same, the stimulation didn't change, but now they are born each day is different - ever changing, ever stimulating!

The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help - but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally.

Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don't already know, you will soon learn what your baby likes best and that's what matters, that it is unique to *your* baby. Prescriptive 'do this/don't do this' baby calming lists don't help anybody - because they forget they are dealing with individuals - both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won't work, some you won't like - and that's OK! because really it isn't about these tips it's about you and your baby getting to know each other!
Movement
The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride.
Skin to Skin Contact
Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin - the love and bonding hormone - in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you.
Bed-Sharing
Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it's a subject that makes society very uncomfortable, but...it is an *amazing* baby calmer! It's really important that you think about how bedsharing will work and follow some important safety guidelines HERE.
Swaddling
Imagine how snug your baby was at the very end of your pregnancy inside of you - now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don't want to or indeed can't then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby's hunger cues if you are feeding on demand:

Never swaddle over your baby's head or near his face

Never swaddle your baby if he is ill or has a fever

Make sure your baby does not overheat and only swaddle with a breathable/thin fabric

Only swaddle your baby until he can roll over**

Always place your baby to sleep on his back

Do not swaddle tightly across your baby's chest

Do not swaddle tightly around your baby's hips and legs, his legs should be free to "froggy up" into a typical newborn position.

Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before.

** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Babywearing
Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of "quiet alertness" - a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us - yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands!

Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby's spine whilst not placing any pressure on your baby's growing hips - newborns should always be carried facing inwards with a "frog leg" pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an 'in arms' position - i.e: how your baby would be held if you were holding them! This great picture from JePorteMonBebe highlights this newborn hold position perfectly.

Babywearing is a great way for dads to bond with babies!

It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling - it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up:
Position
The "tiger in the tree" position below, taken from baby yoga, is often magical, stopping a crying baby in an instant!

Noise
Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A special white noise recording, such as , can be played on loop whilst your baby sleeps to help keep them calm.
Feed
If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine - whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby's skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier.
Deep Bathing
The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby's tears in seconds - even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer.
Outside
If all else fails many babies stop crying the minute they hit the open air - I'm not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air - but it works!
What have you found calms your newborn? The NEWLY UPDATED Gentle Sleep Book - out now! If you would like to understand and learn how to improve your baby's sleep WITHOUT cry-based conventional sleep training, this is the book for you! p.s: Come and chat with me on Facebook, Twitter and Instagram Or watch my videos on YouTube You can also sign up for my free parenting newsletter HERE.

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The Fourth Trimester - AKA Why Your Newborn Baby is Only Happy in Your Arms

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"My baby is only happy in my arms, the minute I put her down she cries" "He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on ...

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TICKS used with permission of the UK Sling Consortium, please credit when used.

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This leaflet offers advice and information for parents on getting to know their baby and setting up the foundations for a close and loving relationship.

We now know that building a strong relationship between parents and their new baby will give them the best possible start in life and will help them to grow up happy and confident. This leaflet is free to download and helps parents to develop that strong relationship, starting in pregnancy and continuing into the early days, weeks and months of a baby's life.

Health professionals may want to use this leaflet in conjunction with the Baby Friendly guide to antenatal and postnatal conversations and accompanying signature sheets.

Printed copies cost £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.
Please note: Orders for UK delivery only, and include postage and packaging costs. Orders may take up to 7 working days to process. The Baby Friendly Initiative reserve the right to re-print items at any time. If you are looking to order audit tools or e-learning please use our digital resources order form. Our myth buster posters show the key Happy Baby messages in bright and colourful poster form - find out more.

Building a Happy Baby: A Guide for Parents

Baby Friendly standards

Support to build a close and loving relationship is a key element of the Baby Friendly standards. Find out more about embedding our standards in your service.

Find more relationship building resources

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Building a happy baby: A Guide for Parents Leaflet - Baby Friendly Initiative

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This leaflet helps parents to get to know their baby and to set up the foundations for a close and loving relationship.

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How a child's brain develops through early experiences