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Royal College of Obstetricians & Gynaecologists

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Assisted vaginal birth (ventouse or forceps)

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An assisted vaginal birth (ventouse or forceps) patient information leaflet

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What's in a nappy (ENGLISH VERSION) FINAL WITHOUT BLEED

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You don't need to bathe your baby every day. You may prefer to wash their face, neck, hands and bottom carefully instead. This is often called "topping and tailing".
Choose a time when your baby is awake and content. Make sure the room is warm. Get everything ready beforehand. You'll need a bowl of warm water, a towel, cotton wool, a fresh nappy and, if necessary, clean clothes.

Topping and tailing tips

You may find the following step-by-step guide to washing your baby useful:

Hold your baby on your knee or lay them on a changing mat. Take off all their clothes, apart from their vest and nappy, and wrap them in a towel.

Dip the cotton wool in the water (make sure it doesn't get too wet) and wipe gently around your baby's eyes from the nose outward, using a fresh piece of cotton wool for each eye. This is so that you don't transfer any stickiness or infection from one eye to another.

Use a fresh piece of cotton wool to clean around your baby's ears, but not inside them. Never use cotton buds to clean inside your baby's ears. Wash the rest of your baby's face, neck and hands in the same way and dry them gently with the towel.

Take off the nappy and wash your baby's bottom and genital area with fresh cotton wool and warm water. Dry very carefully, including between the skin folds, and put on a clean nappy.

It will help your baby to relax if you keep talking while you wash them. The more they hear your voice, the more they'll get used to listening to you and start to understand what you're saying.

Bathing your baby safely

You don't need to bathe your baby every day, but if they really enjoy it, there's no reason why you shouldn't.

It's best not to bathe your baby straight after a feed or when they're hungry or tired. Make sure the room you're bathing them in is warm.

Have everything you need at hand: a baby bath or clean washing-up bowl filled with warm water, two towels, a clean nappy, clean clothes and cotton wool.

The water should be warm, not hot. Check it with your wrist or elbow and mix it well so there are no hot patches.

Hold your baby on your knee and clean their face, as described above.

Next, wash their hair with plain water, supporting them over the bowl.

Once you've dried their hair gently, you can take off their nappy, wiping away any mess.

Lower your baby gently into the bowl or bath using one hand to hold their upper arm and support their head and shoulders.

Don't add any liquid cleansers to the bath water. Plain water is best for your baby's skin in the first month.

Keep your baby's head clear of the water. Use the other hand to gently swish the water over your baby without splashing.

Never leave your baby alone in the bath, not even for a second.

Lift your baby out and pat them dry, paying special attention to the creases in their skin.

This is a good time to massage your baby. Massage can help them relax and sleep. Avoid using any oils or lotions until your baby is at least a month old.

If your baby seems frightened of bathing and cries, try bathing together. Make sure the water isn't too hot. It's easier if someone else holds your baby while you get in and out of the bath.

Cutting your baby's nails

Some babies are born with long nails and it's important to cut them in case they scratch themselves. You can buy special baby nail clippers or small, round-ended safety scissors. If you find the idea of cutting your baby's nails too nerve-wracking, you could try filing them down with a fine emery board instead.

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You don't need to bathe your baby every day. You may prefer to wash their face, neck, hands and bottom carefully instead. This is often called "topping and tailing". Choose a time when your baby is awake and content. Make sure the room is warm. Get everything ready beforehand.

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Attaching Your Baby at the Breast – Breastfeeding Series

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Rethinking swaddling

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NHS OpenAthens

You can access a range of bibliographical databases with your NHS OpenAthens account. Sign in to see what you can access.

You can access bibliographic databases from the providers' websites. For example:

Health Education England provides links to these databases and materials to help you search effectively.

You will need to sign in to the databases with your NHS OpenAthens account.

NHS Knowledge and Library Hub

Visit Health Education England's NHS Knowledge and Library Hub for:

A single search of all the knowledge and library resources available to you, whether purchased nationally or locally.

Links to database provider websites for advanced literature searching.

A browsable list of all the journals you can access.

A list of all resources purchased nationally for the NHS in England.

You'll need to sign in with your NHS OpenAthens account to access the resources.

Help and support

For help and support using the resources listed here, or for further information, contact your local healthcare library. You can find details in the Health Library and Information Service Directory.

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Evidence search service closure information

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You can access a range of bibliographical databases with your NHS OpenAthens account. Sign in to see what you can access. You can access bibliographic databases from the providers' websites. For example: Health Education England provides links to these databases and materials to help you search effectively.

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Mattresses and bedding - The Lullaby Trust

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It’s hard to know which baby mattress and baby bedding to buy. Which is safest? Does it reduce the risk of SIDS? Here you’ll find…

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Home :: North West London Clinical Commissioning Groups

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NHS VIDEOS | How do I change a dirty nappy? - NHS

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Watch this film to learn how to change a dirty nappy

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

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

So when might you be offered treatment for an overdue baby and what happens? Well, the story starts with the due date...

When is a baby overdue or late?

Pregnancy normally lasts about 40 weeks, and that's when it's called a full-term pregnancy or term. This is calculated as 280 days from the first day of your last menstrual period (IQWiG, 2018).

A pregnancy that continues for longer than 42 weeks is called post-term, prolonged or overdue (IQWiG, 2018). Many heavily-pregnant, exhausted mums-to-be have a few choice names for it themselves!

How accurate are due dates?

It depends. Using early ultrasound scans rather than the date of the last menstrual period can be a better way to predict your due date (Whitworth et al, 2015). One study suggested that 55% of women gave birth within seven days either side of the due date predicted by ultrasound, and 70% of women gave birth within 10 days either side of that date (Mongeli et al, 1996).

When pregnancies are dated by ultrasound (and not induced), one study suggested that 7% of pregnancies progress beyond 294 days (42 weeks) and 1.4% beyond 301 days (43 weeks) (Mandruzatto, 2010).

Why are some babies overdue or late?

We don't fully understand why some babies are overdue. You might be more likely to have an overdue baby if you're older, heavier, more educated, expecting your first baby or having a boy (Oberg et al, 2013). You're also more likely to have an overdue baby if your mum or sister had this too (Oberg et al, 2013).

What is a membrane sweep?

If your baby is overdue, the first thing you might be offered is a membrane sweep. The membrane sweep makes it more likely that you will go into labour naturally. So it reduces the chances you'll need to have your labour induced by other means, such as oxytocin or prostaglandins.

If this is your first pregnancy, you should be offered a membrane sweep at your 40 and 41 week appointments. If you've already had a baby before, you will be offered a sweep at your 41 week appointment (NICE, 2008a).

Although a sweep is offered, you don't have to accept the offer. Healthcare professionals should support you in whatever decision you make (NICE, 2008a).

What happens during a membrane sweep?

During a sweep, the midwife will put a finger inside your vagina to reach the cervix. They will make a circular or sweeping movement with their fingers. The point of it is to separate the sac surrounding your baby from the cervix. Doing a sweep helps to release natural hormones that stimulate contractions, so it may get labour started. A membrane sweep can be uncomfortable for some women and there may be some vaginal bleeding afterwards (Tommy's, 2015).

Membrane sweeps have been shown to increase the likelihood of either spontaneous labour within 48 hours or delivery within one week. They are generally safe where there are no other complications.

Membrane sweeps can be uncomfortable, and can cause bleeding and irregular contractions. You have to consider these factors against being more likely to need a more formal method of induction later down the line.

How likely is a membrane sweep to start labour?

Just because you have a membrane sweep, it doesn't mean that labour will happen spontaneously. In fact, only one out of eight women who have a membrane sweep avoid formal induction of labour (Boulvain et al, 2005).

If labour doesn't start after this process, you can have multiple sweeps or you may be offered an induction of labour by other means.

Can I do anything to start labour myself?

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

What is induced labour?

Labour is a natural process that usually starts on its own. But sometimes labour needs to be started artificially. This is called 'induced labour' (NICE, 2008a).

When and why would I be offered an induction?

Induction of labour is offered in the following conditions:

If a pregnancy lasts longer than 42 weeks, because of the increased risk of stillbirth and complications of labour.

If an expectant mum's waters break but labour does not start.

If you have specific conditions, such as diabetes, high blood pressure, obstetric cholestasis or pre-eclampsia.

If there are concerns about the growth of your baby and your healthcare team feel this would be the safest option for you and your baby.

You are also likely to be offered an induction of labour in the tragic event of your baby dying in the womb.

In special circumstances, induction may be considered at the mum's request.

(NICE, 2008; Thomas et al, 2014).

Around 95% of women who are full term and whose waters break will go into labour within the next 24 hours (Middleton, 2017). If you're not in labour after 24 hours of your waters breaking, you should be offered a choice of induction or waiting for labour to start naturally (expectant management) (NICE, 2008a).

If after 24 hours you're still not in labour, your baby may have a lower risk of infection and of being admitted to a neonatal unit if you're induced (Middleton, 2017).

What happens in an induction of labour?

Induction of labour can be carried out in a hospital maternity unit in different ways.

One way is by inserting hormones such as prostaglandins as a tablet (pessary) or gel into the vagina. Prostaglandins are hormones produced in the body (Thomas et al, 2014). Prostaglandins are used in inductions to encourage the cervix to soften, shorten and open, and the uterus to start to contract regularly (Thomas et al, 2014).

Contractions after vaginal prostaglandins have been inserted usually begin within a few hours, reaching a peak after five to six hours (NICE, 2008a). They increase the likelihood of vaginal birth within 24 hours (Thomas et al, 2014).

Many hospitals may be happy for you to go home after the procedure if you are induced via a pessary, tablet or gel (Sharp et al, 2016). They should let you know who to contact if you have any concerns (NICE, 2014). If you don't begin to have contractions, you might be offered another tablet or gel (NICE, 2008a).

What happens if the prostaglandins don't work?

If labour doesn't start after you've been given prostaglandins, other hormones such as oxytocin may be used. Oxytocin is released naturally from the pituitary gland, stimulating the contraction of the uterus during labour (NICE, 2008a). An artificial form can be swallowed, inserted into the vagina in the form of tablets or fed into a vein using an IV drip (IQWiG, 2018).

Along with other methods of induction, your midwife might ask to break your waters themselves. This is called an artificial rupture of the membranes and its aim is to shorten your labour. Yet this should not be offered routinely as a primary method of induction on its own as there may be some risks (such as infections) (NICE, 2008a; Tommys 2019).

Double balloon catheters can also be used to safely induce labour in pregnant women who have not had a previous caesarean section. A double balloon catheter is another way to try to help the cervix to soften and dilate.

If a double balloon catheter is used to induce your labour, the catheter is inserted so that one balloon is in your uterus and one is in your vagina. The balloons are slowly and alternately inflated with saline. The device is left in place for up to about 12 hours and removed if labour begins, the device comes out, the waters break, or the baby seems to be in distress (NICE, 2015).

What happens once labour starts?

Once you're in labour, you'll be offered a check of your baby's heart rate every so often (NICE, 2008b). If you have certain risk factors, you'll be offered continuous electronic foetal heart rate and uterine contraction monitoring (NICE, 2008b).

Is it more painful to induce labour?

Induced labour is likely to be more painful than spontaneous labour. So you should be offered appropriate pain relief (Kelly and Tan, 2001; NICE, 2008a). This can range from simple pain relief, such as distraction, aromatherapy, hypnotherapy, acupuncture, to an epidural (NICE, 2014). You should be encouraged to use your own coping skills too, and birth attendants should offer support; ideally, you'd also be offered the opportunity to labour in water (NICE, 2008a)

Labour after induction may be more painful because a labour that starts spontaneously usually builds up gradually, giving you time to get used to each new sensation. You get used to the sensation because your body has the chance to release pain-relieving substances called endorphins.

How else does induction affect labour?

The amount of monitoring used in induced labour means that a woman's movement may be restricted. On the other hand, some women like induction because it enables them to have control over knowing roughly when their baby will be born. They also feel reassured that they'll be closely monitored throughout (Wickham, 2018).

Induction at or beyond term might lead to a reduced rate of caesarean section but a slightly higher rate of instrumental birth with forceps or ventouse.

What happens if labour induction doesn't work?

If your induction does not work, your midwife or doctor will discuss other options with you and support you. Other options include another attempt to induce labour or having a caesarean section (NICE, 2008a). Your wellbeing should be considered and the wellbeing of your baby should be assessed using electronic fetal monitoring (with your consent).
This page was last reviewed in June 2018.
Further information

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

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

Information from NHS choices on being overdue and on induced labour.

Find out more about NICE guidance on the induction of labour

Boulvain M, Stan M, Irion O. (2005) Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews. (1):CD000451. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000451.pub2... [accessed 2nd January 2019]

IQWiG (Institute for Quality and Efficiency in Health Care). (2018) Informed health online: pregnancy and birth: when your baby's due date has passed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279571/. [accessed 3rd January 2019].

Kelly A, Tan B. (2001) Intravenous oxytocin alone for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews. (3):CD003246. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003246/epdf... [accessed 2nd January 2019]

Middleton P, Shepherd E, Flenady V, McBain R, Crowther C. (2017) Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database of Systematic Reviews. (1):CD005302. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005302.pub3... [accessed 2nd January 2019]

NICE. (2008a) Inducing labour [CG70]. Available at: https://www.nice.org.uk/guidance/cg70/resources/inducing-labour-pdf-975... [accessed 3rd January 2019]

NICE. (2008b) Antenatal care for uncomplicated pregnancies [CG62]. Available at: https://www.nice.org.uk/guidance/cg62/resources/antenatal-care-for-unco... [accessed 2nd January 2018]

NICE. (2014) Inducing labour (QS60). Available at: https://www.nice.org.uk/guidance/qs60/chapter/Quality-statement-2-Safet... [accessed 3rd January 2019]

NICE. (2015) Insertion of a double balloon catheter for induction of labour in pregnant women without previous caesarean section (IPG528). Available at: https://www.nice.org.uk/guidance/ipg528/ifp/chapter/The-procedure [accessed 3rd January 2019]

Oberg A, Frisell T, Svensson A, Iliadou A. (2013) Maternal and fetal genetic contributions to postterm birth: familial clustering in a population-based sample of 475,429 Swedish births. American Journal of Epidemiology. 177(6):531-537. Available at: https://academic.oup.com/aje/article/177/6/531/160108 [accessed 3rd January 2019]

Sharp A, Stock S, Alfirevic Z. (2016) Outpatient induction of labour in the UK: a survey of practice. European Journal of Obstetrics and Gynaecology and Reproductive Biology. 204:21-23 Available at: https://www.ejog.org/article/S0301-2115(16)30305-0/fulltext [accessed 3rd January 2019]

Thomas J, Fairclough A, Kavanagh J, Kelly A. (2014) Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database of Systematic Reviews. (6):CD003101. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003101.pub3... [accessed 3rd January 2019]

Tommy's. (2015) What is a membrane sweep? Available at: https://www.tommys.org/pregnancy-information/labour-birth/what-membrane.... [accessed 3rd January 2019].

Whitworth M, Bricker L, Mullan C. (2015) Ultrasound for fetal assessment in early pregnancy. Cochrane Database of Systematic Reviews. (7):CD007058. Available at: https://www.cochrane.org/CD007058/PREG_routine-compared-selective-ultra... [accessed 3rd January 2019]

Wickham S. (2018) Inducing Labour: Making Informed Decisions. 2nd ed. UK: Birthmoon.
Further reading
Caughey A, Stotland N, Washington A, Escobar G. (2007) Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. American Journal of Obstetrics and Gynecology. 196(2):155. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941614/ [accessed 2nd January 2019]

Decker R. (2019) The evidence on: due dates. Available at: https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-pas... [accessed 2nd January 2019]

Kavanagh J, Kelly A, Thomas J. (2005) Breast stimulation for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews. (3):CD003392. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003392.pub2... [accessed 3rd January 2019]

Mandruzzato G, Alfirevic Z, Chervenak F, Gruenebaum A, Heimstad R, Heinonen S, Levene M, Salvesen K, Saugstad O, Skupski D, Thilaganathan B. (2010) Guidelines for the management of postterm pregnancy. Journal of Perinatal Medicine. 38(2010):111-119. Available at: https://pdfs.semanticscholar.org/7e17/c75025c5476e37e98d9372605f026873f... [accessed 3rd January 2019]

Middleton P, Shepherd E, Crowther C. (2018) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews. (5):CD004945 . Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004945.pub4... [accessed 2nd January 2019]

Mongelli M, Wilcox M, Gardosi J. (1996) Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. American Journal of Obstetrics and Gynecology. 174(1):278-281. Available at: https://www.ajog.org/article/S0002-9378(96)70408-8/fulltext [accessed 3rd January 2019]

Morken N, Klungsøyr K, Skjaerven R. (2014) Perinatal mortality by gestational week and size at birth in singleton pregnancies at and beyond term: a nationwide population-based cohort study. BMC Pregnancy and Childbirth. 14(172). Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-... [accessed 2nd January 2019]

NHS Digital. (2018) NHS maternity statistics, England 2017-18. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nh.... [accessed 3rd January 2019].

NICE. (ND). Dinoprostone. Available at: https://bnf.nice.org.uk/drug/dinoprostone.html [accessed 3rd January 2019]

NICE. (NDb). Oxytocin. Available at: https://bnf.nice.org.uk/drug/oxytocin.html#sideEffects. [accessed 3rd January 2019].

Rosenstein M, Cheng Y, Snowden J, Nicholson J, Doss A, Caughey A. (2012) The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. American Journal of Obstetrics and Gynecology. 206(4):309. Available at: https://www.ajog.org/article/S0002-9378(12)00026-9/fulltext [accessed 3rd January 2019]

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

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You feel like you've swallowed a whole watermelon and getting anywhere feels like a feat of Herculean proportions. Your baby must surely be ready to come out, right? You're definitely not alone if you've been focusing on your due date throughout your pregnancy and counting down to it in the latter stages.

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This guidance has been updated and replaced by caesarean birth and twin and triplet pregnancy

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We worked with NHS England to assess digitally enabled therapies that:

What is digitally enabled therapy?

Digitally enabled therapy is therapy content delivered online or through mobile applications which allows learning to be achieved through patient self-study. This is reinforced and supported by trained therapists.

View a list of the digital therapies that have been assessed by the programme.

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Improving Access to Psychological Therapies (IAPT)

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We worked with NHS England to assess digitally enabled therapies that: Digitally enabled therapy is therapy content delivered online or through mobile applications which allows learning to be achieved through patient self-study. This is reinforced and supported by trained therapists. View a list of the digital therapies that have been assessed by the programme.