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How can I manage an existing mental health problem?

If you become pregnant, or are planning to become pregnant, it's important to think about how you can manage your mental health during this time. Whatever your feelings are about being pregnant or becoming a parent, this can be a stressful time for everyone.

Talk to your doctor as soon as possible. They will be able to help you make plans to manage your mental health during pregnancy. See our page on support and services for more information, and our pages on different mental health problems for more information on treatment and support.

I had been diagnosed with PTSD prior to my pregnancy. When I became pregnant with my daughter I had 'crisis' episodes and was referred to a consultant who helped me to identify my triggers.

Infant loss and mental health

Experiencing infant loss (for example, through miscarriage, still birth or sudden infant death syndrome (SIDS)) can be extremely traumatic and can have a big effect on your mental health. You don't have to cope alone, and there is support out there. You can find further information from:

If I became unwell last time I was pregnant, will it happen again?

If you've previously experienced a mental health problem during or directly after pregnancy, then you are at an increased risk of becoming unwell again - but this doesn't mean you definitely will. You might:

feel reluctant or anxious about having another baby

feel more confident about spotting any symptoms, and how to look after yourself

If you do become pregnant again, it's important to talk to your doctor about how you can look after your mental health, and find out about what support you can get. See our pages on support and services and self-care for more information.

This information was published in July 2016. We will revise it in 2019.

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Postnatal depression and perinatal mental health

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If you become pregnant, or are planning to become pregnant, it's important to think about how you can manage your mental health during this time. Whatever your feelings are about being pregnant or becoming a parent, this can be a stressful time for everyone. Talk to your doctor as soon as possible.

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Your baby's development: Check progress against our milestone chart. - BabyCentre UK

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Congratulations! Preparing for the arrival of a baby is one of the most exciting times of your life. Use this handy checklist to make sure you have all those little things ahead of time, then put your feet up and relax while you wait for the big day!

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1 bag with for labour stuff, 1 bag with after you baby is born stuff to keep in the car and grab.

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"In most parts of the world... babies sleep close to their mothers, as they have through most of history." - The Womanly Art of Breastfeeding
A baby is born expecting to stay in close contact with his mother night and day, in order to keep safe, warm and well-fed.
It is perfectly normal for babies-especially breastfed babies-to wake and feed at night throughout at least the first year. Bedsharing when breastfeeding is a traditional way of caring for a baby at night-breastfeeding at night can be a whole lot easier when you take your baby into bed with you and feed lying down.

Breastfeeding mothers who bedshare get more sleep than bottlefeeding mothers and breastfeed for longer. Alternatively, co-sleeping may give your baby the closeness he craves and make breastfeeding easier without sharing the same sleep surface as you.

It is possible to bedshare with twins, but co-sleeping rather than bedsharing is recommended if they were premature or low birth-weight.

Infant sleep-what are the risks?

Accidents

Babies sleep in a variety of places at different times. Wherever a baby sleeps an accidental injury is possible. A baby could become wedged between furniture or against a parent's body, fall off the sleep surface or risk suffocation or strangulation by pillows, cords or blankets.

Anything that reduces your alertness or ability to respond to your baby, such as alcohol, drugs or certain medications, can pose a risk and may impair your judgement.

Breastfed babies orient themselves near their mother's breast in bed. Research shows that mothers who bedshare with their breastfed babies adopt a naturally protective position, making smothering unlikely. This has been referred to as the 'cuddle curl' position.

SIDS

Sudden Infant Death Syndrome (SIDS), or cot death, is a sudden unexpected infant death (usually occurring during sleep) that can't be explained by a medical condition, infection, intentional harm, or accidental causes.

What makes a baby vulnerable
SIDS can happen in any sleep situation, but research has shown that SIDS only happens to baby who are vulnerable. We don't know exactly which factors cause vulnerability, but they include:

baby being less than four months old

prenatal exposure to harmful chemicals including smoke and alcohol

preterm or low brith weight baby (under 2.5kg).

SIDs risk factors
The following factors increase the risk of SIDS for a vulnerable baby, wherever they sleep.

1. Exposure to smoke can affect a baby's ability to rouse from sleep. The risk is related to how much exposure a baby has. It is always a good idea to reduce your baby's exposure to smoke wherever they sleep, but if you are a smoker you should not share a sleep surface with your baby. Smoking is the biggest SIDS risk.

2. Placing a baby on his front to sleep may affect his ability to arouse and to breathe. 'Back to Sleep' campaigns have reduced SIDS in many Western countries. Bedsharing breastfeeding mothers often nurse in a side-lying position-when a baby comes off the breast they naturally rolls onto their back. A baby who can roll back and forth can choose his own sleep position.

3. Being unattended.
During all sleep (daytime and nightime), a baby's risk of SIDS is lower if they are in the same room as you.

4. Formula-feeding (including combi-feeding) imposes a statistically significant higher risk of SIDS.

The Safe Sleep Seven

Breastfeeding mothers who meet the criteria below are statistically low risk and can bedshare with confidence.
You need to be:

1. A non-smoker

2. Sober (no drugs, alcohol, or medications that could make you drowsy)

3. Breastfeeding

Your baby needs to be:

1. Healthy and full term (with a birth weight above 2.5kg)

2. Sleeping on their back when they are not breastfeeding

3. Unswaddled and lightly dressed

You both need to be:

On a safe surface. Never sleep with your baby on a sofa or armchair.

Make an informed decision
Use the information above along with our checklist below to evaluate your baby's different sleeping places and your own family circumstances, to reduce the risk of an accident or SIDS wherever you and your baby sleep.

Meeting Everyone's Needs

If you are struggling to reconcile your own sleep needs with those of your baby, then talking with an LLL Leader may be helpful. At an LLL meeting you can find out how other families meet the sleep needs of their sleep needs in different ways and at different stages.
Find local support here. Call our helpline: 0345 120 2918

Co-sleeping or bedsharing?

Bedsharing: adults and infants sharing the same surface for sleep.

Co-sleeping: parents and infants sleeping in close proximity, but not necessarily on the same surface eg in a bedside cot or a sidecar cot attached to the bed.

Some studies combine sofa sleeping with bedsharing, making it more difficult to separate the risk factors for each scenario. See Further Reading for more details, or for more information on these definitions, see here.

Sleep safely

Sleep tips

Do
✔ Place your baby to sleep on their back.
✔ Keep your sleeping baby close day and night, not in a room alone.
✔ Avoid exposing your baby to cigarette smoke at any time as this increases the risk of SIDS.
✔ Place your baby with his feet to the foot of any cot, crib or pram.
✔ Sleep facing your baby in bed (your thigh should prevent him slipping under the covers).
✔ Check your baby's sleeping place for hazards:

Choose a firm, flat, clean, well-fitting mattress and cover with a close-fitting sheet.

Check for gaps that they might get trapped in..

Ensure they can't fall out.

Choose clothes without strings or ties that could cause strangulation.

✔ Check your baby does not get too hot or too cold whilst sleeping. In hot weather, open a window or use a fan.
✔ Keep pets out of your baby's bed.

NEVER leave your sleeping baby:

✘ Near a fire or radiator, or in full sun.
✘ Wearing warm outdoor clothing when indoors.

NEVER sleep with your baby:

✘ On a sofa or armchair.
✘ If he is swaddled.

Bedsharing tips

Once you can safely and comfortably feed your baby while lying down, you've elimated much of the work of mothering for eight of the 24 hours in a day.

Easy Nights

You may find that different sleeping arrangements work at different times. Being inventive and focusing on how you and your family can get the most sleep tonight can help. Some of these ideas may work for you, but because only you know your own circumstances, always keep safety in mind.

Avoid tumbles by:
* Using a mesh guard rail - but make sure there is no gap between the rail and the bed.
* Taking the legs off the bed or putting the mattress on the floor.

Learn to feed lying down by:
* Practising in the daytime!
* Keeping a low light on.
* Going to a La Leche League meeting and learning from other mothers.
* Watching our video on breastfeeding while lying on your side:

These safety tips apply to healthy full-term breastfed infants. Preterm and low birth weight babies are more vulnerable. If your baby seems unwell, seek medical advice promptly. Remember that safety tips can help reduce the risk of SIDS and accidents wherever your baby sleeps, but cannot eliminate the risk altogether.

Written by Sue Cardus, Karen Butler, Sue Upstone, Bronwyn Davies & mothers of La Leche League GB.

Further Reading

Sweet Sleep: Nighttime & Naptime Strategies for the Breastfeeding Family Wiessinger, West, Smith, Pitman, LLLI. London: Pinter & Martin, 2014.
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Why Your Baby's Sleep Matters, Ockwell-Smith, S. London: Pinter & Martin, 2016.

LLL links:
Rhythms & Routines
Smoking & Breastfeeding
I need some sleep
Other Online information:
Baby Sleep Info Source
UNICEF: Caring for your baby at night. (link to UNICEF PDF)
References
1Sleep patterns and fatigue in new mothers and fathers. Gay et al, 2004.
2Ball, H. L. et al (2016). Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration? Acta
Paediatrica, DOI: 10.1111/apa.13354.
3Ball, H. L. Parent-infant bed-sharing behaviour: Effects of feeding type, and presence of father. Human Nature 2006; 17(3):301-18.
4Basis. The Triple Risk Model, www.basisonline.org.uk/hcp-the-triple-risk-model/ (accessed 16 Feb 2022)
5SWEET SLEEP: NIGHTTIME AND NAPTIME STRATEGIES FOR THE BREASTFEEDING FAMILY, LLLI. London: Pinter & Martin, 2014; 345-348.
6SWEET SLEEP: NIGHTTIME AND NAPTIME STRATEGIES FOR THE BREASTFEEDING FAMILY, LLLI. London: Pinter & Martin, 2014; 9.
7Basis. Definitions of Terms Used on This Site, www.basisonline.org.uk/hcp-definitions-of-terms-used-on-this-site/ (accessed 16 Feb 2022)

ACADEMY OF BREASTFEEDING MEDINCINE. ABM Clinical Protocol #6: Bedsharing and Breastfeeding 2019., Accessed 16th Aug 2020

You can buy this information in printed form from the LLLGB shop .

Copyright LLLGB 2022 (updated March 2022)

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Safer Sleep & the Breastfed Baby - La Leche League GB

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"In most parts of the world... babies sleep close to their mothers, as they have through most of history." - The Womanly Art of Breastfeeding A baby is born expecting to stay in close contact with his mother night and day, in order to keep safe, warm and well-fed.

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You won't need to bath your baby in the early days because you will probably be giving them a top and tail wash. But when you do start to bath your newborn baby, it can be a lovely experience although it may feel stressful at first. Some babies take to baths well and others don't seem to like them.

"Your little one may really enjoy their first bath. But don't worry if they don't like it straight away."

Most babies grow to enjoy bath time as they get more familiar with the experience.

You might find it helpful to watch this video from the NHS about how to bath your baby.

Safety tips for bath time

It's important to keep safety in mind at bath time. Babies and young children should never be left unattended in a bath, not even for a second (NHS, 2021). Here are some bath time tips:

Get everything ready ahead of your baby's bath, so you have everything you need to hand.

Make sure you always use the hot and cold taps at the same time when you run the bath.

Check the bath water temperature first before putting your baby in. The standard way to check is to put your elbow in the water because your hand can cope with high temperatures. The water should feel neither warmer or colder than your elbow.

Don't be distracted away by another child, a phone call or doorbell. What feels like a couple of seconds can turn into a minute or two. Leaving your little one even for a few moments could be enough time for them to seriously hurt themselves or drown.

If you forget anything - ask your partner or another family member to grab it for you. Or take your baby with you to get what you need. (NHS, 2021)

"Never leave your baby alone in the bath, not even for a second (NHS, 2021)."

When should I give my baby a bath?

There is no set age when you should give your baby a bath. Babies get cold quickly, and that's more risky for them than being a bit dirty.

If you're anxious about bathing your little one, you don't need to put them into a bath until you feel confident about it.

You may prefer to just wash your little one's face and bottom to begin with. This is sometimes called 'topping and tailing'.

If you're feeling confident about bathing your baby you can do so when you wish.

Choose a bath time when your little one is content and awake. It's better not to bathe your baby straight after a feed or when they're hungry or tired.

Some babies love bath time to begin with, others don't. You may need to try different ways of bathing your baby and at different times of day, to find out what suits you both. Choose a time of day when your baby is happy and awake (NHS, 2021).

How often can I give my baby a bath?

Your little one won't need a bath every day but if they enjoy it, there's no reason why you can't.

If you'd prefer to top and tail your newborn, you can do this every day or every few days or as needed.

Every baby is different - you will soon find out what works best for you and your little one.

How do I wash my baby?

If you want to top and tail your newborn, you can do this by washing them using cotton wool or a soft cloth and bowls of warm water. Warm tap water is probably fine but if you want to be particularly careful, use cooled boiled water to reduce the chance of infections in the first week or until your baby's cord drops off.

You can wash your newborn in a small baby bath.

If you'd prefer to share a bath with your little one, see below for more details.

It can help to have an extra pair of hands at bath time, if available, until you feel confident about bathing your baby on your own.

You don't need any special products to bathe your baby; only mild, non-perfumed soap can be used where needed. Plain water is best for your baby's skin during in the first month (NHS, 2021).

To find out more about caring for your newborn baby's umbilical cord, see our article on topping and tailing.

Can I take a bath with my baby?

Babies love to lie on a parent's chest in the bath.

Having a bath with your baby can help you both relax and encourage breastfeeding.

Remember, your baby might have a wee or poo while in the bath with you!

Baths are slippery, so it's not a good idea to get into or out of a bath carrying your baby. It's better to bath with your baby when there's someone else to hand them to you and take them from you. This could be your partner, your parent or a friend.

Tips for co-bathing

Get yourself settled and relaxed in the bath. Check the temperature is not too hot with your elbow.

Ask your partner, parent or friend to pass you your baby and lay them on your legs facing you.

Now you can lower as much of them into the water as you and they want by straightening your legs.

You might want to chat or sing to your baby to help soothe them.

Remember that your baby will get cold more quickly than you.

When you want to get out, make sure you pass your baby back to your helper before getting out yourself.

As your little one gets more used to bath time and you become more confident handling them, bathing with your baby becomes lots more fun.
This page was last reviewed in November 2021.
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.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

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

NHS Choices Birth to Five section.

Public Health England (PHE) provides guidelines about bathing children under two safely.

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Bathing your baby | Baby & toddler articles & support | NCT

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You won't need to bath your baby in the early days because you will probably be giving them a top and tail wash. But when you do start to bath your newborn baby, it can be a lovely experience although it may feel stressful at first.

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On days 5-6

Wees: Five or more heavy nappies per day.

Poos: At least two soft, yellow poos per day. They're yellow, because there is no more 'mec' in the bowel.

False menstruation or pseudo menstruation is harmless. It is a very light bleed from the vagina in some baby girls. It comes from the effects of your own hormones on her system, and it soon stops.

After the first week: babies continue to wee and poo several times each day for the first few weeks.

After about six weeks, some (not all) babies poo much less often. Breastfed babies may go many days without producing any poo at all after this time - that's normal, too. As long as your baby is growing well, and the poo he produces is soft, you don't need to be worried. Ask your health visitor about this, if you need to.

What's a 'heavy nappy'?

Try this test - pour three tablespoons of water (45ml) into a dry nappy, and pick it up. That's how heavy your baby's nappy will be, after the first five to six days.

How do I know if my baby is weeing often enough when disposable nappies just absorb the wee?

All babies should produce several heavy nappies every day. If you use disposable nappies, do the 'heavy nappy' test with water so you know what you are looking for. You can also place a cloth inside the nappy, which will stay wet when your baby wees. Any questions about your baby's health or feeding, just ask your midwife.

Urates, sometimes known as brick dust because that's what it looks like: tiny orange or pinkish crystals. They are harmless: they are salts in the urine, and tend to show up in the very early days. Most babies will pass them once only. They can be a sign your baby needs a little help to feed more often or more effectively. Ask you midwife.

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.

You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

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

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Newborn baby poo in nappies: what to expect | Baby & toddler articles & support | NCT

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Wees: Five or more heavy nappies per day. Poos: At least two soft, yellow poos per day. They're yellow, because there is no more 'mec' in the bowel. False menstruation or pseudo menstruation is harmless. It is a very light bleed from the vagina in some baby girls.

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Hampshire Breastfeeding Counselling. 3,114 次赞 · 17 人在谈论. We provide FREE breastfeeding support currently by Zoom for Hampshire women (some face to face appts in Winchester), antenatal education...

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Sleepy babies

Sleepy Babies at KellyMom.com

Wondering about baby poop? (yes, everyone does!)

What Are Baby's Stools Supposed to Look Like and How Often Should Baby Wet? by Paula Yount

Connect with a local provider to
receive your FREE
Swiss Breast Pump, the Ardo Calypso through insurance.
Thanks to Ardo for supporting KellyMom.

What if baby's stools are consistently green? by Paula Yount

The Diaper Diary. by Kay Hoover, M Ed, IBCLC and Barbara Wilson-Clay, BS, IBCLC. Check out the photos.

The Importance of Newborn Stool Counts by Denise Bastien, from Leaven, Vol. 33 No. 6, December 1997-January 1998, pp. 123-6.

What causes blood in baby's stool? @

Diaper Rash and other rashes

Diaper Rash by William Sears, MD

Diaper Rash from MedicineNet.com

Diaper Dermatitis from eMedicine.com

Go 'under cover' to get to the bottom of painful diaper rash by Rochelle Nataloni

Baby Acne from IndiaParenting.com

Diapers/Diaper Rash from Lucile Packard Children's Hospital

Is your baby nursing all the time?

See Frequent Nursing

Should baby be on a schedule?

Scheduling Feeds by Diane Wiessinger, MS, IBCLC

Chang SR, Chen KH. Demand feeding for healthy premature newborns: a randomized crossover study. J Formos Med Assoc. 2004 Feb;103(2):112-7.

Other common concerns

Colic in the Breastfed Baby by Jack Newman, MD

Tips for Handling Separation Anxiety by Paula Yount

Tips for juggling a newborn & toddler @

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Common Questions in the Early Weeks * KellyMom.com

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Sleepy Babies at KellyMom.com What Are Baby's Stools Supposed to Look Like and How Often Should Baby Wet? by Paula Yount Connect with a local provider to receive your FREE Swiss Breast Pump, the Ardo Calypso through insurance.Thanks to Ardo for supporting KellyMom. What if baby's stools are consistently green?

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The importance of responsive feeding in establishing a good breastmilk supply
by Dr. Amy Brown

Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development ¹. When babies feel secure in the care of a primary caregiver, they go on to have better outcomes socially, educationally and emotionally ².

There are many elements to responsive parenting but one of the central aspects within this relationship is the importance of responsive feeding. Responding to a baby's feeding cues (both of hunger and satiation), whether they are breast or bottle fed is an important step to helping a baby develop not only a secure attachment relationship, but in establishing longer term positive eating behaviours. Responsive feeding takes advantage of a young baby's natural ability to regulate their intake of calories - something that can disappear when a baby gets older ³. Feeding when they are hungry and being able to stop when they are full helps them to retain this ability ⁴.

However, the notion of responsive feeding can lead to significant concerns for new parents, particularly in relation to how often breastfed babies feed. One concern is whether feeding frequently is a sign that the baby isn't getting enough milk, exacerbated by not being able to see how much milk the baby is consuming. Others may worry about whether babies need to learn to feed less frequently in a set pattern. However, responding to a baby's natural cues is a critical step in establishing milk supply and encouraging healthy weight gain and development in babies.
How often do babies breastfeed?
As with everything, how often a baby naturally wants to feed will vary amongst individuals. However studies that explore how often babies breastfeed find that most do so between 8 - 12 times per 24 hours, although some feed much more than that (up to around 18 times in some studies). Most tend to feed towards the latter part of that range, with around 11 - 12 feeds per 24 hours ⁵.

Notably, babies calorie needs do not change vastly after the first few weeks, but they become able to take bigger feeds. This means that from around 8 - 12 weeks some babies start feeding in longer intervals. However, this pattern doesn't necessarily remain. Studies that have tracked this longitudinally find that many babies do start to feed less often but then start feeding again more frequently (akin to a newborn) around 4 months of age, before dropping down again. This fits with the commonly observed 'four month growth spurt', which is often seen as a mistaken need for solid foods ⁶. However, as with everything, some babies will continue to take smaller feeds more often until they move to solid foods (and, still even then). Just as with adults, some of us prefer set meals a day whereas others prefer to graze.

As well as being little and often, most babies don't naturally breastfeed to a set pattern e.g. every three hours. If allowed to feed whenever they want to, many breastfed babies are good at feeding according to hunger, which doesn't fit into a set pattern (how many adults truly eat or drink at precise set intervals?). Things like growth spurts and cluster feeding (where babies feed numerous times over a period of up to a few hours) are common and are thought to stimulate the body to produce more ⁷.

Variations will also occur according to the content of the mothers milk. Research has shown that fat content can vary between mothers. Mothers who produce milk with a higher fat content are more likely to have babies that have shorter feeds e.g. they take in a similar energy density to those with lower fat content in their milk who take a little longer to consume it ⁸.

Breastmilk also changes in content, particularly in terms of calories and fat. During a feed, milk becomes denser in fat as the feed progresses. Fat content and energy density are also higher during the day than the night. In hot weather breastmilk can also be less energy dense, encouraging infants to consume more of a higher water content milk ⁹. Again, this can affect the amount or frequency of how often babies feed. Generally, the less energy dense the milk, the more they take in.

Feeding frequency is also context dependent. In Western culture our norm is to separate from our babies to some extent. Baby wearing for most of the day and co-sleeping are normal from an evolutionary perspective but not common in our society today. Put simply, this means that babies do not always have easy and unfettered access to the breast. However, in cultures where co-sleeping and carrying infants in a sling are common, and babies therefore have free access to the breast, they feed far more frequently than this. An observational stud of the rural hunter- gatherer tribe known as the !Kung, found that babies breastfed on average four times an hour, with an average feed being two minutes or less ¹⁰. Other studies show less frequent feeds, but sill significantly more than in Western cultures. For example one study in rural Thailand found babies averaged 15 feeds over 24 hours ¹¹. In the UK, when babies do co-sleep, they feed more per night ¹².
Why do babies need to breastfeed so often?
Firstly, breastmilk is low in fat and protein but high in carbohydrates and lactose, which makes it easy - and quick - to digest. It is more easily digested than formula milk, which means that breastfed babies often feed more frequently than formula fed babies (approximately every two hours compared to three hour for formula fed babies) ¹³. Breastfed babies reach a fasting state quicker than formula fed infants, with 75% of breastfed infants reached a fasting state within 3 hours from the last feed compared to 17% of formula fed babies ¹⁴.

Breastfed babies also tend to consume less milk than formula fed babies at each feed, preferring to feed little and often compared to many formula fed babies. A baby's tummy has a maximum capacity of 90ml. Breastfed babies tend to take smaller feeds, not completely filling their stomach. In the first six months babies need around 750ml of milk a day meaning that even at maximum capacity that equates to feeding around every three hours ¹⁴. Research has shown that formula fed babies take in more milk from the first day of life (about twice as much on day one and three times as much by day two) ¹⁵.
Why is responsive feeding so important?
Meeting the frequent and unpredictable feeding needs of a breastfed baby can feel challenging and is a common reason why mothers stop breastfeeding - either through anxiety that something is wrong, or a belief that formula will offer a more convenient feeding schedule ¹⁶. However, responsive feeding is not only normal but important for a number of reasons.

Feeding responsively is particularly important when a baby is breastfed because it is intrinsically linked to establishing and maintaining a good supply of breastmilk. Breastmilk starts to be produced in small amounts during pregnancy. Once the placenta is removed after birth this production shoots up, supported by rises in the hormones prolactin and oxytocin ¹⁷.

However, once this initial surge has occurred, one of the most important things for breast milk supply is frequent feeding. Simply, the more milk is removed from the breast (either by a baby or by expressing), the more milk is produced. The human body is very clever at matching how much milk is removed (e.g. how much the body believes the baby needs) to how much it produce ¹⁸. One study that asked mothers to either feed their newborn baby responsively or to feed to a set 3 - 4 schedule found that babies who were fed responsively consumed a third more milk ¹⁹.

Because responsive feeding is linked to a better milk supply, it has a knock on effect onto outcomes for babies. Responsive feeding is associated with mature milk coming in quicker after the birth ²⁰, regaining birth weight faster ¹⁹, and a lower risk of jaundice ²¹. Conversely, supplementing with formula milk, particularly in the early days and weeks, can lead to a drop in supply, or difficulties with latch ²². Using a pacifier can also reduce milk intake as it can lead to a delay in how often babies are fed. Babies who use a pacifier feed on average for half an hour less each day which equates to one fewer feed< ²³.

Based on this, it is not surprising that babies who are fed responsively are more likely to continue being breastfeed ²⁴. Meanwhile, trying to breastfeed to a parent led routine is associated with stopping breastfeeding ²⁵. This can apply to wider parenting style; mothers who adopt a routine for feeding, sleep and day to day care of their infant are more likely to stop breastfeeding in the early days ²⁶. Notably, those who stop breastfeeding after using a routine are more likely to report breastfeeding difficulties e.g. low milk supply, pain on latch and a fussy baby - likely a knock on impact of lower milk supply from less frequent feeding ¹⁶.
What about night time feeding?
Babies' needs do not cease to exist simply because it is dark outside. One of the main needs infants have at night is to feed. A baby's stomach is still the same size and breast milk still easily digested at night as it is in the day. Research suggests that it is not until around two months that a baby's natural day and night circadian rhythm kicks in. Until that point, the concept of sleeping for an extended period of time is not something that babies are physiologically designed to do - and even then it can take a while to get into the habit ²⁷.

However, society continues to sell us the myth that babies should start sleeping through the night after the first few weeks, and that getting them to this stage is an achievement. Aside from evidence to the contrary, given that around a third of adults report at least mild insomnia, should we really believe that babies who cannot meet their own needs if they wake should be able to sleep all night? How many adults when they wake have a drink of water?

Waking at night is also thought to be protective. Babies want to be close to their mother at night and sleeping close to them helps babies maintain their temperature ²⁸, heart rate ²⁹ and have steadier breathing ³⁰. Sleeping too deeply may be a risk factor for SIDS. Babies who have died of SIDS are more likely to have longer periods of uninterrupted sleep and moved about less in their sleep ³¹.

Research exploring night waking in the first year brings estimates of between 30 - 80% of babies still waking at least once with a number of studies saying most babies continue to wake once or twice a night throughout the first year ³². Although sleep problems in older children can be an issue, waking at night as a baby has no link with later sleep problems or development ³³.

Feeding at night is also common - and important - in supporting breastfeeding. Firstly, the body takes into account feeds at night when establishing milk supply. Babies take in around a third of their milk supply at night (although in toddlers in cultures where co-sleeping is the norm, this can rise to 50% as many are busy and distracted during the day) ¹¹. Feeding at night is an important step in developing a good milk supply. Although it may be dark outside, the body still considers frequency of feeds at night when establishing milk supply.

Feeding at night is also an essential part of providing a high level of contraceptive cover through the Lactational Amenorrhea Method. This method offers 98% security of contraception as long as babies are fed responsively (and are under 6 months and receiving no formula milk or solid foods). Feeding at night is an important part of this ³⁴.

Additionally, feeding at night is important from a hormonal perspective. Prolactin is linked to milk supply; generally the higher prolactin levels you have, the more milk is made. Prolactin levels are already higher at night but also rise further when your baby feeds, so feeding at night is a great opportunity to really drive those levels higher and help your milk supply ³⁵.

Sometimes parents worry about their baby continuing to breastfeed at night based on the myths that a) babies should sleep through the night and b) breastfeeding stops babies sleeping through the night. However, rather than being something breastfed babies do more, breastfeeding at night should be recognised as something that is very normal. In countries where night-time infant care and co-sleeping is the norm, babies breastfeed around four times a night ³⁶.

Some studies do show that very young babies who are formula fed start sleeping for longer at an earlier age more, suggesting that breastfeeding was likely used as a tool to encourage the baby back to sleep quickly ³⁷ and have longer periods of deep sleep ³⁸. However once babies get a little older, this difference disappears. One study found that for babies aged 6 - 12 months, babies who were breastfed did more at night than babies who were formula fed. However they did not ³². Indeed, two studies exploring the sleep patterns of mothers who breast or formula fed found that breastfeeding mothers got more hours of sleep overall, alongside feeling in better health< ³⁹ whilst another found that mothers who were breastfeeding actually had more rest per night that those who formula fed because it took less time to resettle the baby ⁴⁰.

When parents are thinking about a routine for feeds, one of the most common places they start is by trying to reduce night feeds, and more generally encourage 'sleeping through the night'. However, sleep training can have a negative impact on breastfeeding success. One intervention to reduce night waking in babies aged 6 - 12 months found that although babies started sleeping for longer, breastfeeding rates dropped far more rapidly than expected during the course of the study ⁴¹.

Feeding responsively is therefore a critical element of establishing and maintaining milk supply, supporting weight gain and promoting positive longer term eating behaviour in children. More importantly, it is the norm and biological expectation of young babies, and a central element of a responsive parenting relationship however a baby is fed. Feeding responsively can be demanding for mothers though and as a society, rather than trying to normalise routines and scheduled feeding, we should be looking towards how we can value and support our new families better. Mothering the mother so she can breastfeed her baby, and more widely, supporting the new family and a unit makes the new responsibility of caring for a young baby that little bit easier.
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34. Labbok, M.H. et al. Multicenter study of the lactational amenorrhea method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception 1997; 55(6):327-36

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35. Riordan, J. & Wambach, K. (2010) Breastfeeding and Human Lactation 4th ed. Jones and Bartlett, p. 89
https://books.google.co.uk/books?hl=en&lr=&id=lDb3BQAAQBAJ&oi=fnd&pg=PR1&dq=Riordan,+J.+%26+Wambach,+K.+(2010)++Breastfeeding+and+Human+Lactation+4th+ed.+Jones+and+Bartlett,+p.+89&ots=NrFUzunn3I&sig=OMVyHApWEzVmFRKVEXYY4dynQeQ#v=onepage&q&f=false http://journals.sagepub.com/doi/abs/10.1177/089033440101700307 http://onlinelibrary.wiley.com/doi/10.1046/j.1523-536X.2003.00243.x/full https://www.researchgate.net/profile/Jon_Moon3/publication/21676170_Sleep_Organization_and_Energy_Expenditure_of_Breast-Fed_and_Formula-Fed_Infants/links/5543d6230cf24107d396377b/Sleep-Organization-and-Energy-Expenditure-of-Breast-Fed-and-Formula-Fed-Infants.pdf http://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00007
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41. Hall, W.A., Saunders, R.A., Clauson, M., Carty, E.M. and Janssen, P.A., 2006. Effects of an intervention aimed at reducing night waking and signaling in 6-to 12-month-old infants. Behavioral Sleep Medicine, 4(4), pp.242-261.
http://www.tandfonline.com/doi/abs/10.1207/s15402010bsm0404_4 About Amy Brown:

Dr. Amy Brown is an Associate professor in Child Public Health in the Department of Public Health, Policy and Social Sciences at Swansea University, UK. Her research explores the psychology of maternal and infant health and wellbeing, particularly during the first 1001 days of pregnancy and the first two years of life. She has a particular expertise in infant nutrition, but her research also explores the wider yet inter related issues of normal baby behaviour, sleep, parenting and postnatal depression.

As part of her role, Dr Brown leads the MSc in Child Public Health - an interdisciplinary programme which explores the evidence base behind child public health policy in the UK and internationally. This programme is particularly popular amongst health professionals and graduate students alike and has attracted students from South Korea, Nigeria, Canada, Guatemala and Ghana to name a few.

Check out her book Breastfeeding Uncovered at:

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Importance of Responsive Feeding * KellyMom.com

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Check out stylish, functional breast pump bags and accessories from our sponsor Sarah Wells Bags. The importance of responsive feeding in establishing a good breastmilk supply by Dr. Amy Brown Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development1.

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Slide show: What a newborn really looks like

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1. McInerny TK, et al. American Academy of Pediatrics Textbook of Pediatric Care. Elk Grove Village, Ill.: American Academy of Pediatrics; 2017.

2. Kliegman RM, et al. The newborn infant. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed Feb. 19, 2017.

3. Rakel RA. Care of the newborn. Textbook of Family Medicine. 9th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed Feb. 19, 2017.

4. McKee-Garrett TM. Assessment of the newborn infant. http://www.uptodate.com/home. Accessed Feb. 19, 2017.

5. Palazzi DL, et al. Care of the umbilicus and management of umbilical disorders. http://www.uptodate.com/home. Accessed Feb. 19, 2017.

6. Gleason CA. Initial evaluation: History and physical examination of the newborn. In: Avery's Diseases of the Newborn. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Feb. 19, 2017.

7. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 21, 2017.

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Slide show: What a newborn really looks like

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Slide show: What a newborn really looks like See more Multimedia McInerny TK, et al. American Academy of Pediatrics Textbook of Pediatric Care. Elk Grove Village, Ill.: American Academy of Pediatrics; 2017. Kliegman RM, et al. The newborn infant. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016.

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There are plenty of old wives' tales and misconceptions about childbirth - the most enduring of which being that women in labour need to push.

But a new midwife-led programme is working to dispel this myth by encouraging women to slow down during delivery and consider alternative positions.

Designed by staff at Medway Foundation Trust in Kent, the protocol has reduced cases of traumatic tearing from seven per cent to just one per cent of patients, and successfully cut unintentional damage caused to the body during delivery by 85 per cent in some maternity wards.

It was initially created in response to a call for action by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives following an disturbing upsurge in severe perineal tearing affecting nearly 14,000 women in 2013 to 2014.

Nine in ten women suffer some form of tearing during childbirth and in more serious cases this can even lead to incontinence and lifelong nerve problems.

It's something that Dot Smith, head of midwifery at Medway Foundation, blames on the misconception that women in labour need to push.

"When we saw 22 cases of third-degree tears in a month, we said, ''This is not good enough," she told the Daily Mail.

Instead, the new guidelines encourage women to try alternative positions such as standing, leaning or giving birth on their knees and coaches women to breathe through contractions in place of pushing.

Midwives are also discouraged from pulling out the baby during delivery and instead supporting the baby's weight as it emerges to reduce pressure on the perineum.

With impressive results so far, the new programme has been so successful the results have been published in the European Journal Of Obstetrics & Gynaecology And Reproductive Biology and plans are in motion to roll it out nationally.

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The dangerous thing women do during childbirth that midwives are trying to stop

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There are plenty of old wives' tales and misconceptions about childbirth - the most enduring of which being that women in labour need to push. But a new midwife-led programme is working to dispel this myth by encouraging women to slow down during delivery and consider alternative positions.

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Your pain relief options

Labour can be painful - it can help to learn about all the ways you can relieve the pain.

It's also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you.

Ask your midwife or doctor to explain what's available so you can decide what's best for you.

Write down your wishes in your birth plan, but remember you need to keep an open mind. You may find you want more pain relief than you'd planned, or your doctor or midwife may suggest more effective pain relief to help the delivery.

Self-help in labour

You're likely to feel more relaxed in labour and better placed to cope with the pain if you:

learn about labour - this can make you feel more in control and less frightened about what's going to happen; talk to your midwife or doctor, ask them questions, and go to antenatal classes

learn how to relax, stay calm and breathe deeply

keep moving - your position can make a difference, so try kneeling, walking around, or rocking backwards and forwards

bring a partner, friend or relative to support you during labour, but do not worry if you do not have a partner - your midwife will give you all the support you need

ask your partner to massage you - although you may find you do not want to be touched

have a bath

Gas and air (Entonox) for labour

This is a mixture of oxygen and nitrous oxide gas. Gas and air will not remove all the pain, but it can help reduce it and make it more bearable. Many women like it because it's easy to use and they control it themselves.

You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

Side effects

there are no harmful side effects for you or the baby

it can make you feel lightheaded

some women find that it makes them feel sick, sleepy or unable to concentrate - if this happens, you can stop using it

If gas and air does not give you enough pain relief, you can ask for a painkilling injection as well.

Pethidine injections in labour

This is an injection of a medicine called pethidine into your thigh or buttock to relieve pain. It can also help you to relax. Sometimes, less commonly, a medicine called diamorphine is used.

It takes about 20 minutes to work after the injection. The effects last between 2 and 4 hours, so would not be recommended if you're getting close to the pushing (second) stage of labour.

Side effects

There are some side effects to be aware of:

it can make some women feel woozy, sick and forgetful

if pethidine or diamorphine are given too close to the time of delivery, they may affect the baby's breathing - if this happens, another medicine to reverse the effect will be given

these medicines can interfere with the baby's first feed

Epidural

An epidural is a type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It should not make you sick or drowsy.

For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour.

An anaesthetist is the only person who can give an epidural, so it will not be available at home. If you think you might want one, check whether anaesthetists are always available at your hospital.

How much you can move your legs after an epidural depends on the local anaesthetic used. Some hospitals offer "mobile" epidurals, which means you can walk around.

However, this also requires the baby's heart rate to be monitored remotely (by telemetry) and many hospitals do not have the equipment to do this. Ask your midwife if mobile epidural is available in your local hospital.

An epidural can provide very good pain relief, but it's not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that 1 in 10 women who have an epidural during labour need to use other methods of pain relief.

How does an epidural work?

To have an epidural:

a drip will run fluid through a needle into a vein in your arm

while you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back

a very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It does not always work perfectly at first and may need adjusting

the epidural can be topped up by your midwife, or you may be able to top up the epidural yourself through a machine

your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby's head

Side effects of epidurals in labour

There are some side effects to be aware of.

An epidural may make your legs feel heavy, depending on the local anaesthetic used.

Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure.

Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby (instrumental delivery).

When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing), as long as the baby is showing no signs of distress. This reduces the chance you'll need an instrumental delivery. Sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally.

You may find it difficult to pee as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.

About 1 in 100 women gets a headache after an epidural. If this happens, it can be treated.

Your back might be a bit sore for a day or two, but epidurals do not cause long-term backache.

About 1 in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You'll be advised by the doctor or midwife when you can get out of bed.

Read more about the pros and cons of epidurals.

Using water in labour (water birth)

Being in water can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water will be kept at a comfortable temperature, but not above 37.5C, and your temperature will be monitored.

The National Childbirth Trust has information on using water during labour and birth.

TENS machines

This stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines. If not, you can hire your own machine.

TENS has not been shown to be effective during the active phase of labour, when contractions get longer, stronger and more frequent. It's probably most effective during the early stages, when many women experience lower back pain.

TENS may also be useful while you're at home in the early stages of labour or if you plan to give birth at home. If you're interested in TENS, learn how to use it in the later months of your pregnancy. Ask your midwife to show you how it works.

How TENS machines work

Electrodes are taped on to your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.

TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals sent to the brain by the spinal cord.

Side effects of TENS machines

There are no known side effects for either you or the baby.

Read more about TENS.

Alternative methods of labour pain relief

Some women may choose alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques are not proven to provide effective pain relief.

If you'd like to use any of these methods, it's important to discuss them with your midwife or doctor and let the hospital know beforehand. Most hospitals do not offer them for pain relief during labour.

If you want to try any of these techniques, make sure the practitioner is properly trained and experienced. Learn more about complementary and alternative medicines and how they're regulated.

Find maternity services near you.

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Labour can be painful - it can help to learn about all the ways you can relieve the pain. It's also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you.

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years NCT has been campaigning as the voice for parents on the issues they care about

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https://www.nct.org.uk/birth/use-water-birth-pools-labour

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by , Senior midwife and team leader June 2021

iStock.com / Prostock-Studio

In this article

If you've looked into pain management for labour and you're not sure about having pethidine or an epidural, you may want to use some tried and tested natural methods of pain relief first. Natural methods like massage and breathing work by releasing pain relief and feel-good hormones, and don't have unwanted side effects. They can help you during labour and birthing. You can include any natural pain relief options you want to try in your birth plan so your hospital or birth centre can support your choices. You might also be able to practise some of the methods at your antenatal classes.

Can using warmth ease labour pain?

Applying warmth is a tried-and-tested way of relaxing aching, tense muscles. So it's no surprise that it can help provide relief from labour pain.

A warm water bottle is perfect for warming your back, tummy or groin if you're in hospital or at home. Use a hot water bottle filled with warm (not boiling) water. Take care to wrap the bottle in a towel or soft cover before you use it.

A wheat bag can also be used if you're planning a home birth. This is a bag that's been filled with wheat husks and can be heated for just a few minutes in the microwave. It shapes itself to your body and should stay warm for an hour or so. Some wheat bags are even scented with lavender, which may also help you feel calm and relaxed.

Unfortunately, hospitals, especially NHS ones, don't have the facilities to heat wheat bags, so this is only an option if you're having a home birth. Maximum heating times and instructions for use will be stated on the packet, so always be sure to follow them carefully.

A warm flannel or compress placed on the area between the back of your vaginal opening and your back passage (perineum) can be used once your baby's head emerges. It may reduce your risk of having a severe tear, and can make you feel more comfortable.

How does a birth pool relieve labour pain?

Labouring in warm water can relax you and make contractions more bearable, just as having a regular bath helps to ease tummy ache or backache. The birthing pool is kept at a warm temperature which will relax you and help you to store up energy for what's to follow.

Using a birth pool can help you cope better with the pain of labour and make you feel more in control. Research has found that spending some time labouring in water means you're less likely to need an epidural or spinal painkiller than if you spend your entire labour out of water. Using a birth pool may also shorten the first stage of your labour.

How can breathing help with contractions?

Focusing on your breathing is a really helpful way of getting through each contraction. Follow these tips to help make the most of your breathing:

As you breathe, think of the word "relax" in two stages. Take a deep breath at the beginning of the contraction and think "re-", then as you breathe out, think "-lax" and let go of any tension.

Continue by breathing in through your nose and out through your mouth, keeping your mouth soft and slightly open.

Concentrate as hard as you can on breathing in as the contraction builds up, and out as it fades away.

Keep a good rhythm going. Don't worry about how deeply you're breathing, or for how long. Just try not to let the in-breath become longer than the out-breath.

When the contraction is over, try to relax as much as possible.

This rhythmic breathing will conserve your energy and help to ease your pain, too.
Will resting help with labour pain?

In early labour you can prepare yourself for coping with pain. Make yourself as comfortable as possible in bed or on a chair. Tuck pillows all around yourself. Have a hot, sweet drink and relax. Put the television on or play some of your favourite music, and rest!

Later on, you'll find it much easier to cope with painful contractions if you haven't been rushing around during early labour.

Should I change position during labour to ease pain?

Yes, keeping mobile will help you cope as your labour progresses. There's good evidence that staying in upright positions or walking around can help to shorten your labour by over an hour.

Unless you're really tired, try not to lie on your back once you're in active labour. Doing so can make your contractions slower and more painful.

Walking around and using upright positions means you're less likely to need an epidural or a caesarean. It's good for your baby too, as it reduces the likelihood that they'll need special care.

Your midwife can guide and support you to try different positions. Some are designed to help you cope in the first stage of labour. Other positions may help your baby to descend in the second stage.

As labour progresses, lying on your side may help you to rest and keep your pelvis free and open.

Try out different positions to see what's most comfortable. You could:

Stand up and lean on the bed or your partner.

Kneel down on a mat or pillow and lean on the seat of a chair or birth ball.

Kneel with one leg raised to make lots of room in your pelvis for your baby to come out.

Get on your hands and knees. You may find this makes things easier if your baby is in the back-to-back position.

Sit for a while in a chair or on a birth ball, then get up and walk around.

Rock your hips to help your baby to move down.

Saving energy in early labour is important, but sometimes a short, gentle walk can ease pain and speed up your contractions. That's because it encourages your baby down your birth canal and put pressure on your cervix to help it dilate. Just try not to overdo it, as you'll need plenty of energy later on.
How does massage help with labour pain?

Massage may help you to keep calm and cope with labour pain.

Massage, particularly having someone rub your back, will warm your skin and stimulate your body to release its own natural painkillers. If you're using essential oils, check with an accredited aromatherapist that they are safe to use during pregnancy.

Tell your birth partner or midwife where you'd like to be massaged. You may prefer it at the very base of your back to help with lower back pain during contractions. Or you may like your shoulders massaged between contractions to help you relax. Let them know what works for you, so you get the best out of it.

A massage that starts slowly is best. Frantic rubbing will make you feel panicky rather than relaxed! Firm pressure will help stimulate your body to release feel-good hormones (endorphins), which help to reduce pain and relax you.

Can having a supportive birth partner help me cope with pain?

If you have someone supportive to comfort and stay with you during labour, you're more likely to give birth more quickly and easily. You're also likely to use less pain relief than someone without continuous support. Overall, you're also more likely to be more satisfied with your birth experience.

Who you choose as your birth partner may make a difference too. You may want your partner, a good friend or family member to be your birth partner. But you can also choose someone who you trust but don't have a personal relationship with, and is just there to provide continuous support during your labour. For example, this could be a doula or a woman who's given birth before herself. In fact, you may find that someone outside your normal circle may be better able to offer the support you need. Don't worry if this doesn't appeal to you, though. A good friend, family member or your partner will also be able to provide excellent support as a birth partner.

Think carefully about who you want to have with you during your labour and birth. You'll need someone who won't panic, is positive, and is confident enough to talk to health professionals on your behalf.

You may like to choose two birth partners. Keep in mind that some hospitals dislike having two extra people in the birth room at the same time, due to lack of space. Your hospital may allow you to have one of your two birth partners in the room at a time, though.

Discuss this with your midwife and ask for your requests to be put in your notes well before your due date. Your preference is what matters.

How will my midwife help?

Your midwife will keep you informed about what's happening when you're in labour and listen to you to make sure you have the birth experience you choose. If you want to use natural pain relief to cope with contractions, your midwife will help you. And if you choose an epidural or other medical pain relief, they'll support you.

Some midwives are trained in complementary therapies, such as aromatherapy and shiatsu massage. It's worth asking if any of the midwives in your clinic or hospital have these extra skills.

Doulas aren't regulated in the same way. So if you employ a doula who's offering complementary therapies, it's worth checking what training they have had had to give you peace of mind.

More on natural pain relief in labour

References

Aasheim V, Nilsen A.B.V, Reiner LM et al. 2017. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews (6): CD006672 www.cochranelibrary.com [Accessed January 2021]

Bohren MA, Hofmeyr GJ, Sakala C et al. 2017. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews (7): CD003766. www.cochranelibrary.com [Accessed January 2021]

Cluett ER, Burns E, Cuthbert A. 2018. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews (8): CD000111 www.cochranelibrary.com [Accessed January 2021]

Gotter A. 2019. Treating pain with heat and cold. Healthline. www.healthline.com [Accessed January 2021]

Gupta JK, Sood A, Hofmeyr GJ, et al. 2017. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews (5): CD002006. www.cochranelibrary.com [Accessed January 2021]

Guittier MJ, Othenin-Girard V, de Gasquet B, et al. 2016. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG 123(13): 2199-2207

Harding M. 2016. Complementary and alternative medicine. patient.info [Accessed January 2021]

JMWH. 2020. Second stage of labor: pushing your baby out. Journal of Midwifery & Women's Health 65(3):439-440. onlinelibrary.wiley.com [Accessed January 2021]

Lawrence A, Lewis L, Hofmeyr GJ, et al. 2013. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews (10):CD003934. www.cochranelibrary.com [Accessed January 2021]

NCCWCH. 2017. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health, Clinical guideline, 190. www.nice.org.uk [Accessed January 2021]

OAA. nd. FAQs pain relief. Obstetric Anaesthetists Association. LabourPains.com. [Accessed January 2021]

Smith CA, Levett KM, Collins CT, et al. 2018. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database of Systematic Reviews (3): CD009290. www.cochranelibrary.com [Accessed January 2021]

Uvnäs-Moberg K, Handlin L, Petersson M. 2014. Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation. Frontiers in psychology 5, 1529.

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From massage, essential oils and applying warmth, to birth pools, birthing balls and birth partners, check out these natural ways of reducing labour pain. - BabyCentre UK

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First stage of labour: a definition

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

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

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

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

What do contractions feel like?

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

Some ways you might describe the feeling are:

discomfort or a dull ache in your back or lower stomach

pressure in the pelvis

stomach becoming hard, then soft again

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

similar to period pain.

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

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

Contractions versus Braxton Hicks contractions

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

Early labour pain management and calling your midwife

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

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

movements

breathing

ability to hold a conversation

emotional state.

Call your midwife or a doctor straight away if:

you have a heavy 'show'

your waters break

your baby's moving less than usual

you're less than 37 weeks pregnant.

(NHS Choices, 2017)

First stage of labour: managing pain at home

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

walk or move around

drink a lot of fluids and healthy snacks

have a warm bath

do some relaxation or breathing exercises

ask your birth partner to rub your back

manage the pain with paracetamol (if needed)

stay in an upright position.

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

Early labour and your birth partner

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

Things your birth partner can do to help you are:

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

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

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

Getting you those crucial energy-boosting drinks and snacks.

Speaking to you about pain-relief options.

Helping you with relaxation and breathing techniques.

Supporting you while you try different positions.

First stage of labour: how it will progress

When you meet your midwife, they will:

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

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

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

Examine your stomach.

Monitor your baby's heart rate.

(NICE, 2017; Which?, 2018)

First stage of labour: what happens at the end

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

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

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

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

Further information

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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As labour can be a long, complex process, it's handily referred to as happening in three stages (NICE, 2017). "The first stage of labour is made up of contractions that will get longer, stronger and more frequent." These contractions will help to push your baby down and your cervix to open (dilate) so that your baby can come into the world.

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Have a healthy diet in pregnancy - NHS.UK

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Find out how to eat a healthy diet in pregnancy, including plenty of fruit and vegetables, and cutting down on sugar and saturated fat.

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How to Increase Oxytocin Levels. Oxytocin is a powerful hormone in the human body. It starts contractions for pregnant mothers and gets childbirth underway. It's also thought of as the "love" or "cuddle" hormone, increasing feelings of...

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Frimley Park Labour Ward

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Mulberry Birth Centre

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https://www.facebook.com/FPHMaternity/?hc_ref=SEARCH

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http://www.which.co.uk/birth-choice