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Need help with breastfeeding? The Breastfeeding Friend from Start for Life is ready to help. All the information provided is NHS-approved and based on questions asked by thousands of new mums. Whether you're experiencing breastfeeding difficulties, you've got sore nipples, or you want to know about vitamins and what you should include in your diet - if it's a breastfeeding related question, the Breastfeeding Friend is ready to help you. HOW TO USE Once you've enabled the Breastfeeding Friend you can get to know the skill by saying 'Alexa, open Breastfeeding Friend'. Then explore the 5 key features: 1 - Listen to the Breastfeeding support guide for help with: - Benefits of breastfeeding - Attachment - Positioning your baby - How to express milk - Breastfeeding and Covid 19 - Breastfeeding at work - Stopping breastfeeding Just say: "Alexa, ask Breastfeeding Friend for the guide" 2 - Ask Breastfeeding Friend a direct question about breastfeeding, for example: * "How do I breastfeed?" * "Is my baby getting enough milk?" * "Why is my baby feeding all the time?" * "How will I know if I have milk?" * "Why is my baby crying?" * "When should I stop breastfeeding?" 3 - Listen to quick breastfeeding tips on things like: * Comforting your newborn * Feeding frequency * What to do if your baby cries during feeds Just say: "Alexa, ask Breastfeeding Friend for a quick tip" For more information on breastfeeding visit https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/ We hope the Breastfeeding Friend helps you on your breastfeeding journey. Please leave us a review on the skill store - we value your feedback! The information in this skill is provided for informational and educational purposes only.

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Breastfeeding Friend from Start for Life

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Breastfeeding Friend from Start for Life

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Ask Teddi - Early years support it comes up

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Your AI-Powered Early Years (0-5) Robo-Support. Raising a child can be really tough and the early years between 0-5 are formative. Teddi is there for you with advice and support to empower you to give your child the best start in life. Teddi has been built on evidence-based data, resources from trus…

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Using smart technology, we provide parents and parents-to-be with vital support on their breastfeeding and parenting journey, anytime, anywhere.

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We welcome your feedback! Please let us know how you feel about any interactions with us!

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Your feedback is important to us; we will use it to celebrate what we are doing well, share learning, replicate successful initiatives where appropriate and to make improvements where you think we could do better.

At the Royal Free London NHS Foundation Trust we have a number of surveys designed to find out what our patients think of our services.

Our surveys
Friends and Family Test (FFT)
The FFT is an important feedback tool that provides people who use NHS services an opportunity to give feedback on their experience. Listening to the views of our patients helps us identify what is working well, what can be improved and how.

The FFT asks you to rate your overall experience of the care you have received on a scale from very good to very poor. You will then be asked to explain why you chose that answer and what matters most to you when you're in hospital. You should be given the opportunity to complete this before you leave hospital, but if you aren't, you can complete one of our local surveys (see below).

The patient experience teams ensure that the results of the FFT are collated, reported on and shared with the relevant departments and management teams, so that action can be taken and the results fed into improvement plans. View the national Friends and Family Test results

Local surveys

We want to ensure that giving us feedback is as easy as possible and so we have provided various ways for you to tell us what you think. Many areas have an electronic device or kiosk which you can use to tell us about your experience. You will be encouraged to use this device before you are discharged, but you can give feedback at any time during your stay so please ask a member of staff if you would like to do so.

There are also devices located in many of the outpatient areas across our hospitals, or you can scan one of the QR codes you will see on posters using the camera on your smartphone. Please speak with a member of staff if you need more information or support to complete the survey.

All of our local surveys start with the Friends and Family Test and then give you the option of answering more questions should you wish.

If you have recent experience of our services, why not complete one of our surveys below:

Outpatient services
Inpatient wards
Emergency department

Clinical Nurse Specialists (CNS)
Antenatal friends and family test
Postnatal community friends and family test
Paediatrics
Neonatal (Starlight ward at Barnet hospital)
Neonatal (6 North ward at Royal Free hospital)
Royal Free Hospital ICU

If you experience any difficulties accessing the above surveys, please email us.
NHS patient survey programme
The NHS patient survey programme is part of the government's commitment to ensure patient feedback informs the continued development and improvement of healthcare services. The programme is delivered by the Care Quality Commission (CQC) on behalf of NHS England and the Department of Health and Social Care.

The trust takes part in four national surveys:

Adult inpatient survey (carried out every year)

Maternity survey (carried out every year)

Urgent and emergency care survey (carried out every two years)

Children and young people's patient experience survey (carried out every two years)

Read about the NHS national patient survey programme Read previous RFL survey results Royal Free London privacy statement National Cancer Patient Experience Survey
Although not part of the CQC NHS patient survey programme, the trust also participates in the annual national cancer patient experience survey (NCPES). This survey is an important part of the national NHS cancer programme, which places patient experience on par with clinical effectiveness and safety as a key strategic priority. Read about the National Cancer Patient Experience Survey

If you are invited to take part in one of these surveys, we would encourage you to do so.

If you experience any difficulties accessing the above surveys, please email us.

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Your feedback is important to us; we will use it to celebrate what we are doing well, share learning, replicate successful initiatives where appropriate and to make improvements where you think we could do better. At the Royal Free London NHS Foundation Trust we have a number of surveys designed to find out what our patients think of our services.

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Feedback - Friends and Family Test

What is the NHS Friends and Family Test?

The NHS Friends and Family Test is based on one straightforward question that we are asking people who are accessing a wide range of NHS services. It means you can give your feedback about the care you have received. The NHS wants to make sure that you have the best possible experience of care and the NHS Friends and Family Test is a way of gathering your feedback, so we can understand what has worked well and, where necessary, make improvements.

How does it work?

By clicking the links below, you will be able to tell us about your experience of our on antenatal, labour and postnatal care both within the hospital and with your community midwifery team.

Antenatal Care Survey

Labour Care Survey

Postnatal Care Survey

You can also provide us with your feedback by vising our website. www.royalfree.nhs.uk/maternity

How will the results be used?

Your feedback will help us to learn more about our services.

We want you to tell us what we are doing well - so we can do more of it, but it's also important that you tell us what you didn't like and where we can do better. We'll use your feedback to make changes that will help us to offer a continually improving standard of maternity care.

If you would like any help, advice or have any concerns about your care, you can also contact our Patient Advise and Liaison service (PALS) either via email: rf.pals@nhs.net or telephone on 020 7472 6446. In addition to our PALS team, if you have concerns about your care you can also ask to speak to a Senior Midwifery Manager.

If you would like to be more involved in the maternity care provided by the Royal Free, you can join the Royal Free Maternity Voices. Please email: royalfreematernityvoices@gmail.com

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Pregnancy and parenthood can be just as confusing and emotional for partners! There isn't a lot of focus on them but we have put together some information and places that offer support.

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Pregnancy and parenthood can be just as confusing and emotional for partners! There isn't a lot of focus on them but we have put together some information and places that offer support.

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Please follow the link above to view current Unicef guidance on infant feeding in several different languages.

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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Unicef UK Baby Friendly Initiative | Hand expression

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The Breastfeeding Network has produced a leaflet to help you to understand more about expressing and storing breast milk. Their whole website has a wealth of breastfeeding information and tips and a helpline.

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It's important to sterilise all your baby's feeding equipment, including bottles and teats, until they're at least 12 months old.
This will protect your baby against infections, in particular diarrhoea and vomiting.

Before sterilising, you need to:

Clean bottles, teats and other feeding equipment in hot, soapy water as soon as possible after feeds.

Use a clean bottle brush to clean bottles (only use this brush for cleaning bottles), and a small teat brush to clean the inside of teats. You can also turn teats inside out then wash them in hot soapy water. Do not use salt to clean teats, as this can be dangerous for your baby.

Rinse all your equipment in clean, cold running water before sterilising.

You can put your baby's feeding equipment in the dishwasher to clean it if you prefer. Putting feeding equipment through the dishwasher will clean it but it does not sterilise it. Make sure bottles, lids and teats are facing downwards. You may prefer to wash teats separately by hand to make sure they are completely clean.

The advice about how to clean your baby's feeding equipment applies to all of the equipment, and whether you are using expressed breast milk or formula milk.

How to sterilise baby feeding equipment

There are several ways you can sterilise your baby's feeding equipment. These include:

cold water sterilising solution

steam sterilising

boiling

Cold water sterilising solution

Follow the manufacturer's instructions.

Leave feeding equipment in the sterilising solution for at least 30 minutes.

Change the sterilising solution every 24 hours.

Make sure there are no air bubbles trapped in the bottles or teats when putting them in the sterilising solution.

Your steriliser should have a floating cover or a plunger to keep all the equipment under the solution.

Steam sterilising (electric steriliser or microwave)

It's important to follow the manufacturer's instructions, as there are several different types of sterilisers.

Sterilising by boiling

Make sure the items you want to sterilise in this way are safe to boil.

Boil the feeding equipment in a large pan of water for at least 10 minutes, making sure it all stays under the surface.

Set a timer so you do not forget to turn the heat off.

Remember that teats tend to get damaged faster with this method. Regularly check that teats and bottles are not torn, cracked or damaged.

After you've finished sterilising

It's best to leave bottles and teats in the steriliser or pan until you need them.

If you do take them out, put the teats and lids on the bottles straight away.

Wash and dry your hands before handling sterilised equipment. Better still, use some sterile tongs.

Assemble the bottles on a clean, disinfected surface or the upturned lid of the steriliser.

Find out more about expressing breast milk and how to make up formula feeds.

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How to sterilise your baby's bottles and other feeding equipment safely and effectively, whether you're using boiling, steam or cold water sterilising equipment.

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Vitamin supplements

The government recommends all children aged 6 months to 5 years are given vitamin supplements containing vitamins A, C and D every day.

Babies who are having more than 500ml (about a pint) of infant formula a day should not be given vitamin supplements. This is because formula is fortified with vitamins A, C and D and other nutrients.

Babies who are being breastfed should be given a daily vitamin D supplement from birth, whether or not you're taking a supplement containing vitamin D yourself.

Where you can get baby vitamin drops

Your health visitor can give you advice on vitamin drops and tell you where to get them.

You're entitled to free vitamin drops if you qualify for Healthy Start.

The Department of Health and Social Care only recommends vitamin supplements containing vitamins A, C and D.

But some supplements you can buy contain other vitamins or ingredients. Talk to a pharmacist about which supplement would be most suitable for your child.

Having too much of some vitamins can be harmful. Keep to the dose recommended on the label, and be careful not to give your child 2 supplements at the same time.

For example, do not give them cod liver oil and vitamin drops because cod liver oil also contains vitamins A and D. One supplement on its own is enough, as long as it contains the recommended dose of vitamin D.

Vitamin D

Vitamin D is only found in a few foods, such as oily fish and eggs. It's also added to some foods, such as fat spreads and breakfast cereals. But it's difficult to get enough vitamin D from food alone.

The main source of vitamin D is summer sunlight on our skin. But it's important to keep your child's skin safe in the sun.

Children should not be out in the sun too long in hot weather. Remember to cover up or protect their skin before it turns red or burns.

Young children should still have vitamin drops, even if they get out in the sun.

The Department of Health and Social Care recommends:

Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D to make sure they get enough. This is whether or not you're taking a supplement containing vitamin D yourself.

Babies fed infant formula should not be given a vitamin D supplement if they're having more than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D and other nutrients.

Children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D.

Vitamin A

Vitamin A is important for babies and young children, and some may not be getting enough.

It's needed for a healthy immune system, can help their vision in dim light, and keeps skin healthy.

Good sources of vitamin A include:

dairy products

fortified fat spreads

carrots, sweet potatoes, swede and mangoes

dark green vegetables, such as spinach, cabbage and broccoli

Vitamin C

Vitamin C is important for your child's general health and immune system. It can also help their body absorb iron.

Good sources of vitamin C include:

A balanced diet for babies and young children

It's important for children to eat a wide variety of foods to make sure they're getting all the energy and nutrients they need to grow and develop properly.

Get more advice and information on a balanced diet for babies and young children:

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Find out why vitamins are important for the health of your baby or young child, and which vitamin supplements they should take.

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Cookies on GOV.UK

We use some essential cookies to make this website work.

We'd like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services.

We also use cookies set by other sites to help us deliver content from their services.

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You get Child Benefit if you're responsible for bringing up a child who is:

Only one person can get Child Benefit for a child.

There's no limit to how many children you can claim for.

By claiming Child Benefit, you can get:

an allowance paid to you for each child - you'll usually get it every 4 weeks

National Insurance credits which count towards your State Pension

a National Insurance number for your child without them having to apply for one - they'll usually get the number shortly before they turn 16 years old

If you choose not to get Child Benefit payments, you should still make a claim to get the other advantages.

If your circumstances change

You must report any change of circumstances to the Child Benefit Office.

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Child Benefit - child benefit rates, eligibility, how to claim, child benefit claim form CH2.

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After your baby is born, and depending on the type of delivery that you had, you may stay in the hospital for a few days if necessary. If everything was uncomplicated, natural and straight forward, you may be discharged from hospital within the first 6 hours. There are private rooms at both Barnet & Royal Free which you can pay for. All room at private are the Edgware birth centre and these are free of charge.

Before you leave the hospital your baby will have the NHS newborn and infant physical examination (NIPE) and a hearing test.

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One of the first signs that labour may soon be starting is a “show”. This is a blood stained mucous plug which is passed out of the vagina when your cervix (the neck of the womb) begins to change. This is not a reliable sign and not all women will have this. For those women who do see a “show” labour may be as much as two weeks away.

The most common indication that labour has begun is the start of contractions. These can range in intensity from mild irritation to strong pain and may be felt down in your back or like waves moving across your abdomen. It is important to time how often these come and for how long they last.

When contractions are regular (coming every 3-5 minutes), and lasting 45-60 seconds, we would advise you to call triage or the on call labour phone if you are delivering at Edgware or home.

If your waters break, this may also be a sign that you are going into labour. But it can often happen before your labour starts, when you are not having contractions. Sometimes this can be confused with a loss of urine. If your waters break you may need to be seen and assessed by a midwife. Always call your if you feel your waters may have broken. Your waters should be clear or straw like colour however sometimes the waters can be a different colour. If you notice the waters are brown, green or red please contact triage ASAP.

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At the Royal Free London we are lucky to be able to offer you a number of places for you to birth your baby.

What do we offer:
* Home births
* Edgware birth centre - a midwifery led unit
* 2 along side birth centre's at Royal Free & Barnet
* 2 delivery suits at Royal Free & Barnet

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We hold antenatal classes twice a month at the Edgware birth centre. If you would like to book onto these please speak to your midwife.

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Pregnancy remains very safe in the UK but not equal. There are differences in maternity outcomes for women and their babies, from different ethnic groups and those who live in more deprived areas.

In order to improve outcomes Royal Free London have developed tailored antenatal education classes, currently specifically designed to support black women and birthing people.

Over 3 weeks, the classes will cover lots of useful information regarding pregnancy, labour, infant feeding, and caring for your baby. Facilitated by our midwives in a safe, supportive environment.

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Royal Free Maternity is using Eventbrite to organize upcoming events. Check out Royal Free Maternity's events, learn more, or contact this organizer.

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If you are unable to book onto our face to face classes we hold online classes and you can book these directly via the Royal Free website or using the link attached. There are 3 workshops
Workshop 1: Becoming a parent
Workshop 2: Preparing for birth
Workshop 3: Infant feeding and caring for your baby

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Parenthood education | Antenatal care | Maternity services | Services A-Z | Services | The Royal Free

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Congratulations on your pregnancy. We are offering three workshops to help prepare you for the birth of your baby and beyond. These will be led by a specialist midwife and will be delivered via Microsoft Teams. Please click the links below to book your slot for each workshop. There is a morning and…

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Some pregnant women are at risk of developing pre-eclampsia (a serious condition which usually presents as high blood pressure and protein in the urine) and intrauterine growth restriction (when the baby is smaller than usual due to not growing at a normal rate in the womb). There is evidence to suggest that this group of women are at reduced risk of developing these conditions if they take a low dose of aspirin during their pregnancy.

Why might I need aspirin during my pregnancy?

If you have one of the following risk factors, aspirin may be recommended during your pregnancy:

Hypertensive disease during your previous pregnancy

Chronic kidney disease

Autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome

Type 1 or Type 2 diabetes

Chronic hypertension

Low Pregnancy Associated Plasma Protein (PAPP-A) screening blood test

Previous Intrauterine growth restriction (IUGR) (either birth weight <2.5kg or <10th centile)

Previous stillbirth

Previous pre-eclampsia/eclampsia

If you have two of the following risk factors, aspirin may be recommended during your pregnancy:

First pregnancy

Pregnancy interval of more than 10 years

Family history of pre-eclampsia

IVF pregnancy

Age 40 years or older

Multiple pregnancy

Body Mass index (BMI) of 35Kg/m2 or more at first contact

How much aspirin will I be advised to take?

You will be prescribed 150mg of aspirin to take once daily (although a small number of women may be prescribed a larger dose). You should take this as soon as you receive the prescription (as this is associated with better outcomes) until the birth of your baby.

How will I receive the prescription?

Most risk factors will be identified by your midwife at your first booking appointment. The midwife will send a letter to your doctor to request the prescription which you can collect from your doctor’s surgery.

Some risk factors may be identified later in your pregnancy, for example following an ultrasound scan. If this is the case your midwife or doctor will inform you at that time and will notify your doctor in the same manner.

Are there any contraindications to taking aspirin?

There are some rare medical conditions were aspirin would not be recommended. You doctor will advise you if this applies to you.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact your midwife or doctor.

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The Maternity Certificate (MAT B1) enables a pregnant woman to claim:

Statutory Maternity Pay (SMP) from her employer

Maternity Allowance (MA) from Jobcentre Plus

The certificate:

verifies the pregnancy

confirms the date of the expected week of confinement (EWC)

confirms the actual date of birth when completed after delivery

MAT B1s are issued by your midwife, but will not be provided prior to 20 weeks of pregnancy. Generally they are provided at the 25 or the 28 week antenatal appointment.

If you have any queries regarding your Mat B1 certificate, please contact your named midwife or another member of the team. These will not be provided by the inpatient services.

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Once you decide that you would like to have your baby with us we will arrange your booking appointment with a midwife. This appointment will either be done face to face or over the telephone and this is the opportunity to work with your midwife to begin planning your antenatal care. This appointment usually take place prior to 10 weeks of pregnancy.

At this appointment the midwife will take a detailed medical and social history, including details of any previous pregnancies. At the appointment you can discuss whether you would prefer to have your baby at home, at one of our birth centres or on one of our delivery suites. You will also discuss whether you would like to have any antenatal screening tests.

You will also be given the contact details of your named midwife and buddy midwife who will have overall responsibility for co-ordinating your care and supporting your choices throughout your pregnancy.

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You can sign up to the Royal Free Patient Portal which enables our patients to view their appointments and letters online in one place, anytime and anywhere

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Wherever possible, our midwives will provide an interpreter in languages that are suitable for the women in our caseload. All of the information on the Royal Free Maternity Services website can also be translated if they are accessed using Google Chrome. Those who have difficulty with reading printed text can also use 'Browse Aloud' which is available by clicking the icon on the bottom right hand corner of the page. (see attached photograph).

Using this link to another site will provide access to other maternity resources available in different languages and BSL.

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Overview

If you are planning a homebirth around this time, your midwife will speak to you about what this means for your care.

We are proud to provide supportive, personalised and high-quality maternity care to more than 10,000 women living in and around Barnet, Camden, Enfield, Haringey, Hertfordshire, Islington, and Middlesex.

If you would like to have your baby with us, please fill out our online self-referral form.

We offer maternity care from several hospitals and community hubs. Our two main maternity hospitals are Barnet Hospital and the Royal Free Hospital. We also provide maternity services at Chase Farm Hospital, Edgware Community Hospital, Cheshunt Community Hospital, Finchley Memorial Hospital and a range of health centres, GP practices, children's centres and other community locations.

Watch a video about our maternity services.

This film highlights the maternity services available at our hospitals. If you are pregnant and deciding which hospital to have your baby at, watch this film to see our maternity team explain the services we offer and the different sorts of births available.

National maternity safety strategy

The Government asked all organisations with maternity services to make a commitment to contribute towards achieving the national ambition and improve maternity outcomes. The Royal Free London NHS Foundation Trust maternity services are part of this National Maternity Safety Strategy and has implemented a Maternity Safety Improvement Plan to support the national Maternity Safety Ambition.

Your feedback matters: compliments, comments, and complaints

If you would like to speak with us about your maternity visit or stay, please contact PALS.

Please debrief about your birth experience or aspects of your maternity journey please inform your community midwife who should be able to facilitate this for you or will liaise with the maternity team on your behalf.

To send us feedback about our website or if you have spotted an error, please contact our website team.

Referrals

Referral details
If you are a GP and would like to refer to our service, please use our online GP referral form.

If you are pregnant and would like to have your baby with us, please fill out our online self-referral form.

If this form does not display properly, please access it as a standalone web page.

The Team

Consultant

Consultant Midwife

Consultant Obstetrician and Gynaecologist, Lead for Fetal Medicine/ Recurrent Miscarriage

Phone number: 020 7794 0500 ext 34939

Email address: demetrios.economides@nhs.net

Private practice phone number: 020 7435 5417 / fax: 020 7472 6154

Consultant Obstetrician and Gynaecologist, Clinical Director/ Lead for Gynae Cancer

Email address: heatherevans@nhs.net

PA/secretary phone number: 020 7830 2566

PA/secretary email address: maureen.cumberbatch@nhs.net

Fax: 020 7830 2562

Consultant Obstetrician and Gynaecologist, Lead for Urogynaecology including perineal care, Undergraduate Lead, Women's Health Module

Phone number: 020 7830 2563

Email address: Joanne.hockey@nhs.net

Consultant Obstetrician and Gynaecologist, Special interest in Benign Advanced Laparoscopic Surgery and Fibroid

PA/secretary phone number: 0207 830 2566

PA/secretary email address: maureen.cumberbatch@nhs.net

Private practice phone number: 020 7794 0500 ext 35874

Consultant Obstetrician and Gynaecologist, special interest in Preterm Birth Screening

Phone number: 020 7830 2566

Email address: hmohiudin@nhs.net

PA/secretary phone number: maureen.cumberbatch@nhs.net

Consultant Obstetrician and Gynaecologist, special interest in colposcopy and Vulva Disease

Phone number: 020 7830 2566

Email address: rf.obstetricsandgynaeadmin@nhs.net

PA/secretary email address: Maureen.Cumberbatch@nhs.net

Fax: 020 7830 2562

Management team

Divisional Director of Operations, Women and Children

Senior Operations Manager, Women's Directorate

Other key team members

Patient leaflets

Read our patient leaflets and publications

.pdf (379 KB)

.pdf (188 KB)

Approved: 26/11/2020

.pdf (310 KB)

View all patient resources

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The Royal Free is fully committed to providing the best possible antenatal care. Learn more about having a baby at the Royal Free London.

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Mill Hill Team Office - 0203 7582489

Justyna Fenrych-Fahy (Team Leader) - 07773583088

Amanda Bateman - 07929791033

For urgent medical concerns please contact triage or maternity day unit as per the hospital contact details below.

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General Contact Details for Royal Free Site

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General Contact Details for Royal Free Site

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Switchboard: 020 7794 0500
Department extension numbers:
Appointment line - 0203 758 2022 - option 2 Sapphire team
Scans - 35644
Triage - 36208
Maternity Day Unit - 33845
Antenatal/Postnatal Ward - 33845
Labour Ward - 020 7830 2721

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We are a team of midwives who offer an individualised care package that meet the specific needs of each woman and her family. Our clinic is based in Fairway Children's Centre and we offer care to the women within our caseload, providing support through pregnancy and postnatally.

Together, we aim to make your transition into parenthood as stress free and enjoyable as possible and to support you through your pregnancy by providing you with up to date, relevant information that you need to make the choices that are right for you and your baby.

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There are a few things that you need to look out for after you have been discharged home. See the document below for a quick reference guide.

If you are concerned, please ring triage or if you feel that it is an emergency, dial 999.

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On day 5 after you've had your baby we offer the heel prick test, also known as the NewBorn Blood Spot (NBBS). It screens for various disorders, please click here to find it more about it.

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Every baby is offered newborn blood spot screening, also known as the heel prick test, ideally when they're 5 days old.

What is the blood spot test?

Newborn blood spot screening involves taking a blood sample to find out if your baby has 1 of 9 rare but serious health conditions.

Most babies won't have any of these conditions but, for the few who do, the benefits of screening are enormous.

Early treatment can improve their health, and prevent severe disability or even death.

What does the blood spot test involve?

When your baby is 5 days old, a healthcare professional will prick their heel and collect 4 drops of blood on a special card.

You can ease any distress for your baby by cuddling and feeding them, and making sure they're warm and comfortable.

Occasionally, the sample may need to be taken when your baby is 6, 7 or 8 days old.

Sometimes a second blood spot sample is needed. The reason for this will be explained to you. It doesn't necessarily mean there's something wrong with your baby.

The test doesn't carry any known risks for your baby.

Which conditions is the blood spot test for?

The blood spot test screens for the following 9 rare but serious conditions.

If you, your partner or a family member already has one of these conditions (or a family history of it), tell your healthcare professional straight away.

Sickle cell disease

About 270 babies are born with sickle cell disease in the UK each year. This is a serious inherited blood disease.

Sickle cell disease affects haemoglobin, the iron-rich protein in red blood cells that carries oxygen around the body.

Babies who have this condition will need specialist care throughout their lives.

People with sickle cell disease can have attacks of severe pain and get serious, life-threatening infections. They're usually anaemic because their blood cells have difficulty carrying oxygen.

The blood spot screening test means that babies with sickle cell disease can receive early treatment to help them live healthier lives. This may include vaccinations and antibiotics to prevent serious illnesses.

Pregnant women are also routinely tested for sickle cell disease early in pregnancy.

Read more about sickle cell disease.
GOV.UK also has a factsheet about sickle cell disease
Cystic fibrosis

About 1 in 2,500 babies born in the UK has cystic fibrosis. This inherited condition affects the digestion and lungs.

Babies with cystic fibrosis may not gain weight well and are prone to chest infections.

Babies with the condition can be treated early with a high-energy diet, medicines and physiotherapy.

Although children with cystic fibrosis may still become very ill, early treatment can help them live longer, healthier lives.

Read more about cystic fibrosis.
GOV.UK also has a leaflet for parents whose baby has suspected cystic fibrosis
Congenital hypothyroidism

About 1 in every 2,000 to 3,000 babies born in the UK has congenital hypothyroidism. Babies with congenital hypothyroidism don't have enough of the hormone thyroxine.

Without thyroxine, babies don't grow properly and can develop learning disabilities.

Babies who have the condition can be treated early with thyroxine tablets, and this allows them to develop normally.
The British Thyroid Foundation has more information about congenital hypothyroidism
Inherited metabolic diseases

It's important to let your healthcare professional know if you have a family history of a metabolic disease (a disease that affects your metabolism).

Babies are screened for 6 inherited metabolic diseases. These are:

About 1 in 10,000 babies born in the UK has PKU or MCADD. The other conditions are rarer, occurring in 1 in 100,000 to 150,000 babies.

Without treatment, babies with inherited metabolic diseases can become suddenly and seriously ill. The diseases all have different symptoms.

Depending on which one affects your baby, the condition may be life threatening or cause severe developmental problems.

They can all be treated with a carefully managed diet and, in some cases, medicines as well.

Severe combined immunodeficiency (SCID)

In some areas of England, screening for a condition called severe combined immunodeficiency (SCID) is also being offered as part of the newborn blood spot test. This is to help the NHS decide if screening for SCID should be offered to all babies in England.

SCID causes problems with the immune system. It makes it very hard for a baby to fight off infections like meningitis and pneumonia, which can be life-threatening. About 14 babies born each year in England have SCID.

Ask your midwife if screening for SCID is being offered in your area.
Great Ormond Street Hospital for Children has more information on severe combined immunodeficiency

Does my baby have to have the blood spot test?

The blood spot test is not compulsory, but it's recommended because it could save your baby's life.

You can choose to have screening for sickle cell disease, cystic fibrosis or congenital hypothyroidism individually, but you can only choose to have screening for all 6 inherited metabolic diseases or none at all.

If you don't want your baby to be screened for any of these conditions, discuss it with your midwife.

You should be given information about the blood spot test and the diseases it screens for in advance so you can make an informed decision for your baby.

If you change your mind, babies can be screened up to the age of 12 months for all the conditions except cystic fibrosis. Cystic fibrosis can only be screened for up to 8 weeks of age.

If you have any concerns about the tests, speak to your midwife, health visitor or GP.

When will we get the results?

You should receive the results either by letter or from a healthcare professional by the time your baby is 6 to 8 weeks old.

The results should be recorded in your baby's personal child health record (red book). It's important to keep this safe and take it with you to all your baby's appointments.

If you haven't received your baby's results, speak to your health visitor or GP.

You'll be contacted sooner if your baby screens positive. This means they're more likely to have one of the conditions tested for.

You'll be contacted:

the day the result is available, or the next working day, if your baby is thought to have congenital hypothyroidism (CHT) - you'll be given an appointment to see a specialist

before your baby's 4 weeks old if they're thought to have cystic fibrosis

before your baby's 6 weeks old if they're thought to have sickle cell disease

Screening for cystic fibrosis finds some babies who may be genetic carriers of the condition. These babies may need further testing.

Screening for sickle cell disease also finds babies who are carriers of this or other red blood cell diseases.

Carriers are healthy, although they can experience problems in situations where their bodies aren't getting much oxygen - for example, if they're having an anaesthetic.

Parents of babies who are found to be carriers should be told by the time they're 6 to 8 weeks old.

What do the results mean?

Most babies will have a normal result, which means it's unlikely that they have any of the conditions.

A small number of babies will screen positive for one of the conditions. This doesn't mean they have the condition, but they're more likely to have it. They'll be referred to a specialist for more tests.

It's important to know that screening isn't 100% certain. A baby with a negative screening result may later turn out to have the disease screened for. This is known as a false negative.

Babies with a positive result sometimes turn out not to have the disease - what's known as a false positive.

Occasionally, other medical conditions are picked up by blood spot test screening. For example, babies with beta thalassaemia major, a serious blood disease, will usually be detected. These babies also need to be referred for early treatment.

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Your guide to the newborn blood spot (heel prick) test, including which diseases it screens for and when to expect the results

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Baby Basics is a volunteer-led project aiming to support new mothers and families who are struggling to meet the financial and practical burden of looking after a new baby. Baby Basics started in Sheffield in the spring of 2009, this centre continues to support families across Sheffield working with a wide range of frontline health and social care professionals. There is an ever increasing network of Baby Basics centres across the country each staffed by a committed team of volunteers. For your nearest Baby Basics please click here.

Baby Basics provides much needed essentials and equipment to mothers and families who are unable to provide these items for themselves; including but not limited to teenage mums, people seeking asylum and women fleeing domestic abuse and trafficking.

Working with midwives, health visitors and other professional groups to provide support directly where it is most needed, Baby Basics volunteers lovingly collect, sort and package a 'Moses Basket' of clothing, toiletries and essential baby equipment as an attractive gift to new mothers.

The aim is to help these new mothers practically and generously, demonstrating the love of God through our care. God is at the centre of Baby Basics as we are inspired and motivated by His heart for everyone. Every day we continue - and every item we send out, is thanks to His kindness, grace and provision.

Our vision is based on Matthew 25:37-40:

Then the righteous will answer him, 'Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?'
The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.'

Do You Know Someone Who Needs Our Help?

If you work with vulnerable women or families who are struggling to provide for their newborn baby please get in touch with us.

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Before you leave the hospital your baby will have the NHS newborn and infant physical examination (NIPE) this is carried out by either a pediatrician or a specially trained midwife.

A hearing test will also be offered while you are in hospital, if you are discharged before this is carried out or deliver at home or Edgware birth centre and outpatient appointment will be made for you. Ideally, the test is done in the first 4 to 5 weeks, but it can be done at up to 3 months of age.

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This handbook informs and supports best clinical practice and should be used in conjunction with the NIPE programme standards and the NIPE screening pathways. It relates to the screening elements of the top-to-toe physical examination of the baby.

1. NIPE screening examination

The NHS newborn and infant physical examination ( NIPE) programme's main aims are to:

These ages are recommended based on best practice and current evidence and should facilitate a prompt referral for early clinical assessment.

The NIPE programme screens babies (ideally) within 72 hours of birth ( NIPE newborn screening examination) and again at 6 to 8 weeks of age ( NIPE infant examination) for conditions relating to the:

All references to the NIPE examination in this document relate to the 4 screening elements above. References to parent(s) also relate to carer(s), if appropriate.

1.1 NIPE infant screening examination

The infant examination should be performed at 6 to 8 weeks of age for all 4 conditions (as some conditions can develop or become apparent after the newborn screen). This is usually undertaken in a primary care setting.

There are no NIPE national standards for the infant screening examination, as there is no way of systematically measuring them. This document includes good practice guidance and recommended referral timescales for the infant examination until there is a reliable method of recording, measuring and reporting on this part of the NIPE programme.

Please note that the infant examination is not a formally managed part of the national programme and local commissioners will provide scrutiny (as required) to oversee this part of the examination. It is recommended that all screening results are recorded on the GP IT system and in the personal child health record ( PCHR), the 'red book'.

1.2 NIPE screening pathways

For further information please refer to the NIPE newborn and infant screening pathways.

2. Information for parents

It is important that all parents receive Public Health England's ( PHE's) screening tests for you and your baby information about antenatal and newborn screening. PHE has more guidance on how to provide information to the parents effectively, including a range of resources to support health professionals which can be requested from the PHE screening helpdesk.

This information should be given:

during the antenatal period

before offering the NIPE newborn and infant screening examination

Screening tests for you and your baby: babies in special care units has more information for parents of babies in:

Healthcare professionals should inform parents of findings at each examination and advise them to report any concerns about their baby's wellbeing at any time.

2.1 NIPE examination declined

When the NIPE examination is declined:

parent(s) should be fully informed of the NIPE newborn and infant screening examinations and why screening is being offered and undertaken

consent should be obtained and recorded

Parent(s) have the right to decline all or part of the NIPE newborn or infant examination.

If they decline all or part of the NIPE newborn screening examination, this should be documented on the NIPE national IT system (SMaRT4NIPE ( S4N)), communicated to the GP and health visitor and recorded in the PCHR. The parent(s) should be reminded that their baby will remain eligible for NIPE newborn screening until 6 weeks of age and will be offered NIPE infant screening at 6 to 8 weeks of age. Contact details should be provided for the parent(s) from the discharging service, in case they change their mind.

If they decline all or part of the NIPE infant screening examination, the reason should be documented in the GP IT system and in the PCHR. The examination can be undertaken later. See section 7: Babies who have missed screening below for clinical information regarding screening older children.

3. Screening tests

3.1 NIPE newborn screening examination

This examination should ideally take place before 72 hours of age. For babies born in hospital, it is recommended that the examination is completed before transfer home. This will maximise the opportunity for completing the examination within 72 hours of age.

There must be a local follow-up pathway to ensure screening takes place, ideally within 72 hours of age or as soon after this as possible.

Local arrangements should be in place to meet national timescales when babies are:

born at home

transferred home before NIPE newborn screening is completed

This could be by attending a designated NIPE clinic or arrangements being made for the examination to take place at home or in the primary care setting. It is the responsibility of the care provider to ensure the NIPE newborn screening is completed.

Local arrangements should also be in place to meet national timescales when babies are transferred from one acute provider to another before NIPE newborn screening is completed or there are screen positive results requiring follow-up.

Babies in neonatal units

If a baby is receiving care in a neonatal unit, this is not an automatic reason to delay screening. NIPE newborn screening should be undertaken as soon as the baby is well enough and, or has reached 34 weeks plus 0 days (34⁺⁰) weeks corrected age (see below).

'Too young' for NIPE newborn screening

If a baby is born before 34⁺⁰ weeks gestation, screening can be delayed to 34⁺⁰ weeks corrected age. The baby continues to remain eligible for NIPE newborn screening and the examination should be performed as soon as the baby is deemed old enough and is well enough. The screening of babies before 34⁺⁰ weeks corrected age is a local clinical decision. The result should be recorded on S4N.

Please note that the terminology used has changed from 'too preterm' to 'too young' for NIPE newborn screening in national standards and guidance.

'Too ill' for NIPE newborn screening

Screening may be delayed if a baby is too ill for screening. These babies should be accounted for in key performance indicator ( KPI) data, giving the reason for delay as a mitigation against the screening by the 72 hours of age performance threshold.

Possible clinical reasons for this delay include:

respiratory support (other than low flow oxygen), including the presence of chest drains for the first 72 hours

any cardiovascular support, for example, inotropes, prostin

ventilated infant until extubated

baby on continuous positive airway pressure (CPAP)

therapeutic hypothermia

intense phototherapy (double or more, need for immunoglobulin or exchange transfusion)

chest drain in place (without additional respiratory support)

umbilical lines and, or arterial lines in place

post-operative, until off analgesia

unstable hypoglycaemia until off intravenous dextrose

where active reorientation of care to comfort or palliative care is taking place

Trusts can use the above reasons to mitigate against performance thresholds for .

This is not an exhaustive list and clinical judgement should also be used when assessing suitability for newborn NIPE screening.

Screening results - NIPE newborn screening examination

All screening and outcome results should be recorded on S4N and in the baby's PCHR.

Screen negative

Following the NIPE newborn screening examination, the parent(s) should be informed of the results. For babies who have transferred into the area or between care providers with a screen negative result, no further action is required.

The parent(s) should be informed that the NIPE infant screening examination will be undertaken in the primary care setting at 6 to 8 weeks of age (as some conditions can develop or become apparent later).

Screen positive

The parent(s) should be informed of the results and of any referral process that may be required, including expected appointment timescales.

If a baby was not brought for any follow-up appointment, further appointments should be made in line with the trust did not attend (DNA) or was not brought (WNB) policy.

If the baby is in a treatment pathway for one of the screening elements, the NIPE infant 6 to 8-week screening will still need to be completed for the remaining screening elements.

Where there is a screen positive result and NIPE newborn screening examination has been undertaken after the target timescale, a specialist appointment should be arranged without delay.

3.2 NIPE infant 6 to 8-week screening examination

Information about the NIPE infant screening examination should be given to the parent(s) during the postnatal period and again before the NIPE infant screening examination is offered and undertaken. This examination typically takes place in a primary care setting.

There should be timely checks to ensure that:

If the baby is screen positive for any element of the NIPE newborn screening examination, the practitioner undertaking the NIPE infant screening examination should check the progress along the care pathway to ensure required actions have taken place.

Screening results - NIPE infant screening examination

All screening and outcome results should be recorded on the GP IT system and in the baby's PCHR.

Screen negative

Following the NIPE infant screening examination the parent(s) should be informed of the results. For babies who have transferred into the area or between care providers with a screen negative result, no further action is required.

The parent(s) should be advised that the baby will follow the Healthy Child Programme.

Screen positive

The parent(s) should be informed of the results and of any referral process that may be required, including expected appointment timescales.

Where there is a screen positive result and NIPE infant screening examination has been undertaken after the target timescale, a specialist appointment should be arranged without delay.

4. Record keeping

Providers should obtain verbal consent for screening from parent(s), which should be documented, and a record should be made of the screening result and any referrals following screen positive result(s). The above information should be recorded in:

S4N (NIPE newborn screening examination) or GP IT system (NIPE infant screening examination)

baby's clinical notes

baby's PCHR

local clinical data collection system (where appropriate)

There should be:

local arrangements to ensure all babies with screen positive results are referred and seen in line with national standards

regular feedback of attendance at appointment or specialist review after screen positive referrals to enable recording of outcomes in S4N

a local process to follow up all non-attendance of appointments after screen positive referral

a process to record all screening results and outcomes (including post referral outcomes on S4N)

5. Babies who move in and out of area

5.1 Babies who move into the area

Babies who move into the area (move into the country or county) and are unscreened are the responsibility of the current care provider.

5.2 Transfer of unscreened baby to another care provider

If a baby is transferred to another care provider before the NIPE newborn screening has been undertaken or completed, the transferring care provider should formally hand over responsibility and communicate this to the receiving care provider both verbally and using S4N.

After transfer, the receiving care provider should undertake the NIPE examination. This may be a maternity, neonatal or paediatric service. Screening results for these babies should be recorded on S4N wherever possible.

5.3 Babies with screen positive results who transfer between care providers

The transferring provider is responsible for communication with the receiving provider to ensure completion of any outstanding elements of the screening pathway.

If there is an agreement, the record is formally transferred on S4N. The receiving provider is then responsible for follow-up and recording of post referral outcomes. If the birth unit chooses to keep the responsibility for follow-up appointment (due to local decision) they should ensure outcomes are known, recorded and communicated to the responsible care provider.

If there is not a prior agreement and formal transfer of care, the assurance of the completion of the screening pathway and recording of the outcome remains the responsibility of the birth unit.

6. Communication pathways following bereavements

There should be local systems to identify deceased babies and inform other relevant screening and clinical services without delay. If a baby dies before NIPE newborn screening has been completed, this should be marked on the baby's S4N record.

7. Babies who have missed screening

The following clinical guidance outlines the appropriate screening tests depending on age for babies found to have missed NIPE screening. If the missed screen is due to a screening pathway failure, then actions should be taken in line with national screening incident guidance.

7.1 Classification of missed NIPE newborn screening examination

All babies should have all elements of the NIPE newborn screening examination before being fully discharged from the care of any maternity, neonatal or paediatric inpatient services.

A NIPE newborn screening examination is classified as 'missed' if it is not completed:

At 6 weeks of age, babies become eligible for the NIPE infant screening examination.

7.2 Infants who have missed NIPE screening

Up to and including 3 months of age

NIPE newborn screening examinations not undertaken by 72 hours of age should be completed as soon as possible after this time by the current care provider (see the NIPE newborn screening examination section above for reasons screening can be delayed).

Babies remain eligible for NIPE newborn screening examination until 6 weeks of age, but the examination should be completed as close to the 72-hour target as possible. This includes unscreened babies who 'move in' to an area or between care providers.

Eligible babies who move into the area who have not been screened should be offered screening by the responsible service provider. This may be by the maternity, neonatal or paediatric services or in primary care depending on the age and condition of the baby. For these babies, screening results will, in practice, only be recorded on S4N if the NIPE newborn screening examination is undertaken by the maternity or neonatal service.

If NIPE newborn screening is performed at or after 6 weeks of age, it is not necessary to do the NIPE infant screening examination.

Older than 3 months of age

If the NIPE infant screening examination is overdue (after 6 to 8 weeks of age), it should be done as soon as possible.

The screening examination for unstable hips using the Barlow and Ortolani manoeuvres is no longer accurate at this age. Any asymmetry of leg length or restricted hip abduction should be assessed, and the child's gait observed, if walking.

In line with advice in the PCHR, the parent(s) should be advised to contact their GP or health visitor if they have any concerns regarding their child's wellbeing.

7.3 Completing a missed NIPE examination

The relevant examination or observation must be undertaken by a NIPE qualified practitioner.

8. Screening examination of the eyes

Eye development is complex, and a wide range of structural abnormalities may occur if the process is disturbed either due to genetic, infective or sporadic causes.

The primary purpose of the NIPE newborn and infant eye screening examination is to identify congenital cataract(s). Some abnormalities, particularly congenital cataract, are treatable but require early detection, rapid referral and management to prevent lifelong visual impairment.

8.1 Incidence

Around 2 to 3 in every 10,000 babies (200 per year in England) are born with cataracts. In over 50% of these, both eyes will be affected. One fifth of affected babies will have a family history of cataracts. Cataract is the most common treatable cause of blindness in childhood in the UK and worldwide.

A congenital cataract is an opacity within the lens of the eye, which is located behind the pupil. It can occur in one or both eyes and range in severity. A severe cataract blocks light and images from reaching the retina, preventing visual pathway development at a critical stage. Although rare, it is the most common, treatable, visually significant condition identified during NIPE eye screening.

The screening practitioner should be alert to risk factors, such as genetic syndrome, pre-natal infection, sensorineural hearing loss, neurodevelopmental issues or a family history of an eye condition with onset in infancy or early childhood.

Babies with other eye abnormalities, incidental findings or risk factors identified at the NIPE newborn or infant screening examination should be referred for specialist review according to locally agreed pathways.

Please note the guidance below relates to both the NIPE newborn and infant eye screening examinations unless otherwise stated.

8.2 Before the NIPE eye screening examinations

Before the examinations, practitioners should:

Risk factors for congenital cataracts

Babies with a family history of bilateral congenital or hereditary cataracts in a first-degree relative are at risk of developing early cataracts. Even if the NIPE screening examination is normal, these babies may be considered for referral for early specialist opinion, via locally agreed pathways.

Risk factors for other eye or visual problems

Risk factors include:

a first-degree relative with an ocular condition which was congenital or developed in early childhood, for example aniridia (absent iris), coloboma (malformation of the eye) or retinoblastoma (malignant retinal tumour) childhood

prematurity

genetic syndromes, such as trisomy 21, associated with eye and vision disorders

extensive port wine stain involving the eyelids, which can cause glaucoma

maternal exposure to viruses during pregnancy, including rubella and cytomegalovirus

neurodevelopmental conditions or sensorineural hearing loss (deafness caused by abnormal nerve function in the inner ear)

Although practitioners should be aware of these risk factors, they do not alter the NIPE national eye screening pathway. Babies identified with such risk factors should be managed via locally agreed pathways.

8.3 The eye examination

NIPE newborn eye screening examination

The primary aim of the NIPE eye screening examination is the detection of congenital cataracts. In addition, although not part of the screening programme, it is considered good practice to include assessment of the:

NIPE infant eye screening examination

In addition to the assessment described for the newborn eye screening examination, the 6 to 8-week infant eye screening examination should also include checking:

The red reflex examination

The red reflex should be assessed. This is the normal reflection of white light from the back of the eye which is seen as a red glow in the pupil on ophthalmoscopy and is like the red-eye effect seen on flash photography.

To undertake the examination, the practitioner should:

The examination can be repeated by an experienced practitioner if the examination is equivocal. This should ideally be within the 72-hour guideline period of the NIPE newborn examination.

The normal red reflex varies in hue depending on the baby's ethnicity. White babies have an orange-red reflex. The reflex can be less bright and appear magnolia in colour in black, Asian or minority ethnic babies. If the assessment is difficult, it can help to assess the baby's parents' red reflexes to determine the expected reflex colour.

Examples of normal red reflex by ethnicity of baby (from left to right: black, Asian, white)

Congenital cataracts

Congenital cataracts cause a central shadow, completely obscure the red reflex or may make the reflex in one eye appear duller than the other. A severe cataract can make the pupil appear white when viewed with the naked eye.

The red reflex is abnormal if it is completely or partially obscured, is abnormal in shape (iris coloboma or aniridia), white or asymmetrical in colour or brightness to the other eye.

Examples of partially (left) and completely (right) obscured red reflexes

An example of a white 'red reflex'

8.4 Screen negative (normal red reflex assessment)

Babies with screen negative eye results for the NIPE newborn screening examination should have the NIPE infant screening examination at 6 to 8 weeks of age. Infants with screen negative eye results for the NIPE infant screening examination should follow the Healthy Child Programme.

Babies with screen negative eye results but with risk factors described above may be referred via locally agreed pathways.

8.5 Screen positive (abnormal red-reflex assessment)

Surgery for severe cataract is usually undertaken between 6 to 10 weeks of age for optimal visual outcome.

Babies with screen positive eye results following infant screening examination should be referred promptly and seen by a consultant ophthalmologist or paediatric ophthalmology service by 11 weeks of age.

8.6 Parental concerns

Parents should be advised to contact their midwife, GP or health visitor whenever they have any concerns about their baby's eyes or visual behaviour, including:

inability of their baby to fully open their eyes or if eyelid opening appears asymmetrical

apparent deterioration of visual interest

a wobbling of the eyes

a consistent eye misalignment

an abnormal appearance of the eyes

a white reflex, consistently seen on flash photography

asymmetry of the red reflex, consistently seen on flash photography

Note that a family history of an eye or vision condition developing later in life does not require a neonatal referral to ophthalmic services.

Other eye abnormalities should be managed according to local referral pathways.

9. Screening examination of the heart

The purpose of screening is early identification of congenital heart problems. Congenital heart disease ( CHD) is a term used to describe a problem with the heart's structure and function that is present at birth.

Note that the NIPE heart screening pathway will be reviewed in the tax year 2021 to 2022.

9.1 Incidence

The overall incidence of CHD ranging from non-significant to major and critical lesions, is about 8 per 1,000 (range 6 to 12 per 1,000 live births). Critical congenital heart disease ( CCHD) accounts for 15% to 25% of these and is a leading cause of morbidity and mortality. Congenital heart abnormalities can be categorised as:

CCHD, which includes all potentially life-threatening duct-dependent conditions and those conditions that require procedures within the first 28 days of life

major serious CHD, which includes defects not classified as critical but requiring invasive intervention in the first year of life

Some critical and major cardiac lesions may be detected during pregnancy as part of the NHS fetal anomaly screening programme ( FASP), during the 20-week ultrasound scan. The acceptable FASP standard target detection rate for specific cardiac abnormality is at least 50%.

Risk factors for CHD include:

family history of CHD (first-degree relative)

fetal trisomy 21 or other trisomy diagnosed (these babies have high risk of cardiac defects and require continued surveillance)

cardiac abnormality suspected from the antenatal scan

maternal exposure to viruses, for example, rubella during early pregnancy

maternal conditions, such as diabetes (type 1), epilepsy, systemic lupus erythematosis (SLE)

teratogenic drugs taken during pregnancy

Although practitioners should be aware of these risk factors, they do not alter the NIPE national heart screening pathway.

9.3 Undertaking the heart examination

Before the examination, practitioners should establish relevant information regarding:

Parents should be asked if their baby:

ever gets breathless or changes colour at rest or while feeding

is not feeding well or ever too tired to feed, quiet, lethargic, or has poor muscle tone

9.4 Observation

Observation includes reviewing the baby's:

general tone

central and peripheral colour

size and shape of chest

respiratory rate

symmetry of chest movement, use of diaphragm and abdominal muscles

signs of respiratory distress (recession or grunting)

9.5 Palpation

Palpation involves examination of the baby's:

femoral and brachial pulses for strength rhythm and volume

assessment of perfusion through capillary fill time

position of cardiac apex (to exclude dextrocardia)

palpation of liver to exclude hepatomegaly (may be present in congestive heart failure)

vibratory sensation felt on the skin (+/- thrill)

9.6 Auscultation

Auscultation includes identification of a murmur, either systolic or diastolic or loudness. It also includes the assessment of the quality of heart sounds at:

second intercostal spaces adjacent to the sternum left (pulmonary area)

second intercostal spaces adjacent to the sternum right (aortic area)

lower left sternal border in the fourth intercostal space (tricuspid area)

apex (mitral area)

midscapulae (coarctation area)

9.7 Screen negative results

Babies with screen negative heart results following the NIPE newborn screening examination should have the NIPE infant screening examination at 6 to 8 weeks of age.

Infants with screen negative heart results following the NIPE infant screening examination should follow the Healthy Child Programme. Parents should be advised to contact their healthcare professional or emergency services if they have any concerns about their baby.

9.8 Screen positive results

Babies with screen positive heart results following the NIPE newborn screening examination should be seen by a senior paediatrician with expertise in cardiology in the early neonatal period as required. The urgency will depend on suspected condition. Please note that confirmation of assessment within 24 hours of the examination will constitute an outcome in S4N.

If a suspected major or critical heart condition is found on the NIPE newborn screening examination, the baby should be seen as a matter of urgency and definitely before discharge home.

Babies with screen positive heart results following the NIPE infant screening examination should follow the locally agreed referral process. Urgency will depend on the clinical condition of the baby.

Signs and symptoms that suggest critical or major congenital heart abnormality

These include:

tachypnoea at rest

episodes of apnoea lasting longer than 20 seconds or associated with colour change

intercostal, sub-costal, sternal or supra-sternal recession, nasal flaring

central cyanosis

visible pulsations over the precordium, heaves, thrills

absent or weak femoral pulses

presence of cardiac murmurs or extra heart sounds

Significant murmurs

These are:

Benign murmurs

These are typically short, soft, systolic, and localised to the left sternal border. They have no added sounds or other clinical abnormalities associated with them.

The examining practitioner should discuss findings with a senior paediatrician or a paediatrician with expertise in cardiology and refer as appropriate. Urgency will depend on the assessment of the clinical condition of the baby.

Many babies will have cardiac murmurs in the first 24 hours of life in the absence of a cardiac defect (linked to physiological changes at birth). However, cardiac murmurs may be absent in babies with a significant cardiac defect.

9.9 Heart screening standards

Although there are no NIPE heart screening standards, it is recommended that the national clinical pathway above is followed. Practitioners should be familiar with, understand and follow any existing local policies, guidelines and referral pathways.

10. Screening examination of the hips

The guidance below relates to both NIPE newborn and infant screening examinations unless otherwise stated. Note that the hip screening standards and pathways changed in April 2021. National hip risk factors and suspected abnormality on clinical hip examination all now follow the same pathway.

The primary purposes of screening are:

early identification of a dislocated or a dislocatable hip(s)

the identification of sonographic pathological hip dysplasia through selective ultrasound scan (USS)

minimising the risk of long-term complications through:

timely hip ultrasound scan

further expert assessment

early intervention

10.1 Incidence

The incidence of babies requiring treatment is:

3 to 5 per 1,000 live births that may require a Pavlik Harness

1 to 2 per 1,000 live births that may require surgery

Undetected unstable hip(s) with delayed treatment may result in the need for complex surgery and, or long-term complications such as impaired mobility and pain osteoarthritis of the hip and back.

Early diagnosis and intervention should improve health outcomes and reduce the need for surgical intervention.

10.2 NIPE hip risk factors

NIPE national hip risk factors include:

first-degree family history of hip problems in early life - this includes baby's parents or siblings who have had a hip problem that started as a baby or young child that needed treatment with a splint, harness or operation

breech presentation at or after 36 completed weeks of pregnancy, irrespective of presentation at birth or mode of delivery - this includes babies who have had a successful external cephalic version (ECV)

breech presentation at the time of birth between 28 weeks gestation and term

10.3 Multiple pregnancy

All babies from a multiple pregnancy where any of the NIPE hip risk factors listed above are present should have a hip ultrasound. This is because if one of the babies meets the criteria of breech presentation described above during pregnancy, it may be difficult to accurately identify which baby was affected.

10.4 Undertaking the hip screening examination

Before the examination, practitioners should establish:

a mother's recent obstetric history

a baby's family history

the presence of any NIPE hip risk factors

The examination should take place in a warm environment and on a firm, flat surface with the baby undressed and settled.

10.5 Observation and manipulation

Observation covers:

Please note that observation of skin creases for symmetry is no longer part of the NIPE screen. This is no longer regarded as a screen positive finding.

You should undertake both the Barlow and Ortolani test manoeuvres on each hip separately to assess hip stability. The Barlow manoeuvre is used to screen for a dislocatable hip (a dislocatable hip will be displayed out of the joint by this manoeuvre). The Ortolani manoeuvre is used to screen for a dislocated hip (a dislocated hip will be felt clunking into place).

10.6 Screen negative

Babies with screen negative hip results on NIPE newborn clinical examination and no national hip risk factors present should have the NIPE infant screening examination at 6 to 8 weeks.

Infants with screen negative hip results on NIPE infant examination (and no national hip risk factors - unless they have not been previously referred), should follow the Healthy Child Programme.

10.7 Parental concern

Parents should be advised to contact their healthcare professional at any time if they have any concerns about their baby's hip(s). They should observe if:

10.8 Screen positive

A screen positive hip result is an abnormal clinical hip examination (with or without risk factors) and, or presence of NIPE hip risk factors.

A suspected abnormality on clinical examination is defined by:

difference in leg length

knees at different levels when hips and knees are bilaterally flexed

restricted unilateral limitation of hip abduction (with a difference of 20 degrees or more between hips)

gross bilateral limitation of hip abduction (loss of 30 degrees abduction or more)

palpable 'clunk' when undertaking the Ortolani or Barlow manoeuvre

Babies with screen positive hip results following NIPE newborn screening examination should be managed as outlined below.

10.9 Referral and outcome decision

The standards S03 (NP2) and S04 are effective from 1 April 2021 and replace all previous versions.

Standard 3 (NIPE S03 - NP3)

For babies with screen positive hip results, NIPE standard 3 requires the hip USS to be undertaken within the target timescale.

For babies who are born at <34⁺⁰ weeks gestation, hip USS should be undertaken between 38⁺⁰ and 40⁺⁰ weeks corrected age.

Referral to orthopaedic services after hip USS will then depend on the scan result and local management policy in place.

Please see the Good practice guidance section below for further guidance.

Standard 4 (NIPE S04)

For babies who attend for ultrasound scan of the hips after screen positive newborn hip referral, standard 4 requires an outcome decision to be made within the target timescale. This is to ensure that babies who require treatment enter the treatment pathway by 6 weeks of age.

For babies who are born ≥34⁺⁰ gestation, an outcome decision should be made by 6 weeks of age.

For babies who are born <34⁺⁰ weeks gestation, an outcome decision should be made by 40⁺⁰ weeks corrected age.

An outcome decision is either:

discharge from the hip screening pathway after review of normal hip USS results

attendance for clinical assessment by orthopaedic specialist (it is required that hip USS has been undertaken in advance of the decision)

Infants with screen positive results following NIPE infant 6 to 8-week screening examination should be referred directly to paediatric orthopaedic surgeon for urgent expert opinion and be seen by 10 weeks of age.

10.10 Good practice guidance and additional information

A 'one stop shop' model can be provided, in which ultrasound and review by orthopaedic specialist or specialist practitioner is undertaken on the same day, during the same care episode. In order to meet the national standards associated with the pathway, this joint care episode should be between 4 and 6 weeks of age (or between 38⁺⁰ and 40⁺⁰ weeks corrected age for babies born <34⁺⁰ weeks gestation).

If hip USS and orthopaedic specialist assessment are undertaken separately, the scan will need to be routinely done soon after 4 weeks of age (or equivalent corrected age) to give time for orthopaedic appointment to be arranged, outcome decision to be made and, if required, treatment to be started by 6 weeks of age (or equivalent corrected age).

In line with national standard S04 and after local agreement, babies can be discharged by ultrasound services after normal hip scan. However, please note that some areas may wish review of all hip scan results by an orthopaedic specialist.

The term 'orthopaedic specialist' (standard S04) encompasses anyone with delegated responsibilities to initiate treatment decisions based on local policy or practice arrangements. These may include roles such as specialist paediatric physiotherapists, specialist orthopaedic nurse specialists and experienced radiographers.

If a hip rescan is required for technical reasons, it should, wherever possible, take place before 6 weeks of age (or equivalent corrected age). This will ensure that the final outcome decision is known and, if necessary, treatment can start within the optimum timescales (within 6 weeks of age or equivalent corrected age).

If a hip rescan is required for findings of immature hips (Graf 2a), it is acknowledged that this will be required at a timescale exceeding 6 weeks of age (or 40⁺⁰ weeks corrected age).

In both instances, the need for rescan should be recorded on S4N with the specific reason added in the comments box. Comments should include the keywords 'technical' or 'immature'.

The national programme will be reviewing the hip screening pathway. It is vital that S4N data is accurate and complete to enable full analysis when the hip screening pathway is reviewed. A performance threshold will be set for standard 4 (outcome decision) in due course. A hip rescan undertaken after 6 weeks of age (or equivalent corrected age) will not count as an outcome decision as the screening pathway is not complete and an outcome decision is still required.

A local agreement should be in place to ensure that the results of the hip ultrasound scan and orthopaedic specialist or specialist practitioner appointment are recorded on S4N. This can be supported by enabling ultrasound and orthopaedic services access to S4N so that outcomes can be added.

10.11 Confirmation of breech presentation

Note that it may not always be feasible to arrange for a same day USS.

If the practitioner is sure of the findings on abdominal palpation (at or after 36 weeks gestation) and has recorded breech presentation in the woman's records, this would count as a national NIPE hip risk factor.

If the practitioner is unsure of the findings on abdominal palpation (at or after 36 weeks gestation) and has recorded them as '? breech' in the woman's records, this initial finding of '? breech' would not count as a national NIPE hip risk factor. Ultrasound at the earliest opportunity or senior practitioner assessment would be required.

In both these scenarios, if the woman gives birth before confirmation ultrasound and the presentation at birth is cephalic, the NIPE examiner should seek local senior practitioner advice to assess whether the risk factor would apply (this would be a local decision).

10.12 Management of 'clicky hips'

Hip screening aims to identify hip instability. The significance of isolated 'clicks' is debated. On balance and after review of evidence, isolated clicks are not considered clinically significant by the NHS NIPE screening programme.

Isolated clicks without any other relevant clinical findings should therefore not be classified as screen positive and do not require referral for ultrasound.

If the examiner is unsure of their findings, confirmation of the screening outcome should be sought by an experienced clinician. After a second opinion, and if the screening outcome is still unclear, an ultrasound scan may be considered. This would be a local clinical referral and not part of the national NIPE hip screening pathway and should be recorded as an 'other' hip finding on S4N.

Local audits may be carried out to assess clinical competency and feedback to practitioners about 'clicky hip' findings.

Relevant studies related to 'clicky hips' include Kamath and others, 2005, Nie and others, 2017 and Marson and others.

Please contact the PHE screening helpdesk if further references regarding hip pathway changes are required.

11. Screening examination of the testes

The primary purpose of screening is to identify bilateral undescended testes or unilateral undescended testis.

Note that the NIPE testes screening pathway will be reviewed in the tax year 2021 to 2022.

11.1 Incidence

Undescended testes affect approximately 2 to 6% of male babies born at term. One in 100 of these babies will have testes that stay undescended unless treated.

Undescended testes are associated with:

Bilateral undescended testes in the newborn may be associated with ambiguous genitalia or an underlying endocrine disorder. Congenital adrenal hyperplasia must be excluded in a baby with bilateral impalpable gonads.

Early diagnosis and treatment at an early age can reduce the risk of fertility problems and reduce the risk of testicular cancer.

11.2 Clinical risk factors

Clinical risk factors include:

Although practitioners should be aware of these risk factors, they do not alter the NIPE national testes screening pathway.

11.3 Undertaking the examination

Before the examination, practitioners should review the mother's recent obstetric history and baby's family history.

11.4 Observation

Observe the scrotum for symmetry, size and colour.

11.5 Palpation

Carry out palpation of scrotal sac to determine location of testes bilaterally. Undertake palpation of the inguinal canal and perineum if testes are not located in the scrotal sac. Where testes are felt bilaterally but high in the inguinal canal, this should be managed as screen positive.

The term 'undescended' applies for clinical findings of either 'absence' and 'incorrect position'.

11.6 Screen negative

Babies with screen negative results following the NIPE newborn screening examination should have the NIPE infant screening examination at 6 to 8 weeks of age.

Infants with screen negative results following the NIPE infant screening examination should then follow the Healthy Child Programme. Parents should be advised to contact their healthcare professional or emergency services if they have any concerns about their baby.

11.7 Screen positive

A screen positive result is the absence or incorrect position of one or both testes.

Babies with screen positive findings of bilateral undescended testes following NIPE newborn examination should be seen for assessment by a senior paediatrician within 24 hours of the examination to rule out metabolic and disorders of sex development conditions.

Infants with screen positive findings of bilateral undescended testes following NIPE infant screening 6 to 8-week examination should be referred and seen by a senior paediatrician within 2 weeks of the examination.

Infants with screen positive findings of persistent unilateral undescended testis following NIPE infant screening 6 to 8-week examination should be reviewed by a GP between 4 and 5 months of age, then be referred to a surgeon if testis still absent or not descended (to be seen no later than 6 months of age).

12. Training and maintenance of competency

All healthcare professionals have a personal and professional responsibility to maintain their clinical competency. There is also an organisational responsibility to ensure a safe and competent workforce.

Those who undertake NIPE examinations must work in a framework of professional accountability and code of conduct. Each practitioner is responsible for maintaining their own competence to carry out the examination to the highest standard and to identify gaps in their knowledge and any training needs.

To provide duty of care, an appropriately trained health professional must carry out NIPE examinations.

12.1 NIPE newborn screening examination

This must be completed by a trained practitioner who is competent to undertake all elements of the newborn screening examination and who has undergone relevant training and a locally agreed competency assessment by a practising NIPE examiner. This can be a midwife, nurse or health visitor who has successfully completed a university accredited 'examination of the newborn' programme of study or a doctor.

Any newly qualified midwife who has undertaken the module as part of their pre-registration midwifery training must have completed both the theoretical and clinical components of the module before they can be deemed competent to undertake the examination. When employing newly qualified midwives (who are trained in examination of the newborn), providers need to be diligent to ensure all required elements of the course have been successfully completed as pre-registration course content varies across the country.

Nursing associates

The national programme considers that nursing associates would not be eligible to undertake examination of the newborn training or the newborn examination (as agreed by the NIPE Education and Training working group January 2020).

12.2 NIPE infant (6 to 8-week) screening examination

Doctors

It is suggested that any GPs who have not undertaken the 6 to 8-week exam for some time or for whom it is a new activity should firstly refresh by working through the NIPE e-learning module. In addition, a number of universities undertake one-off updates and clinical study days. These could be accessed by contacting the NIPE course leader at local university for details.

If the GP or practice feels it necessary, they may wish to consider the GP working with a colleague who is confident and competent to undertake NIPE practitioner in the practice to offer some mentorship or observed practice.

Physician's associates

The ability to undertake the NIPE newborn or infant screening examination will depend on the training and qualification achieved. Physicians associates who require training should contact the relevant university provider to discuss enrolment for the examination of the newborn course.

Health visitors or nurses

The examination can also be carried out by a health visitor or nurse with suitable competency. To be considered competent, a health visitor or nurse is expected to:

successfully complete a university-accredited examination of the newborn course, as elements of this would also be relevant for the infant examination

undergo a locally agreed competency assessment by a practising NIPE examiner

Currently there are no courses that specifically focus on training for the 6 to 8-week NIPE infant examination. Current national guidance is that health visitors or nurses should undertake an examination of the newborn training, as some elements of the course are transferrable and relevant to undertake the infant screening examination.

12.3 Maintenance of competency

A local competency assessment process should be in place. The focus should not be on a minimum number of examinations, but on the quality of the examination performed. Local providers may choose to determine and set minimum numbers of examinations, but this is not a programme requirement.

The NIPE e-learning module should be completed annually. Registration and a password are required to access the resource on the e-Learning for Healthcare platform.

12.4 Non-university accredited training courses

If practitioners undertook a 'short unaccredited examination of the newborn course' (prior to 2016) then in line with national guidance at the time, practitioners need not undertake another course. In such cases, trust(s) would need to ensure they have a process to assess the practitioner competence and CPD and manage any risk associated with this approach ( NIPE Education and Training working group January 2020).

Trusts should seek university accreditation or a formal university quality assurance process for any in-house NIPE practitioner training courses. In order to ensure appropriate expertise of assessors, any assessment should be undertaken by a university which provides an accredited examination of the newborn practitioner course. A quality assurance process should assess course content in line with required competencies, documentation (including teaching materials and lesson plans) and assessment processes. An annual review should include evaluation strategies, including feedback from students and inform future course planning.

Trusts are responsible for managing any risk associated with the approach where they enable practitioners to undertake the NIPE screening elements of the newborn examination by:

offering, commissioning or accessing a locally delivered examination of:

the newborn practitioner training course

an unaccredited course

Note that short courses or in-house training may not be recognised by all providers, so this may pose a problem if practitioners were to transfer from one trust to another.

13. Quality assurance

The NIPE screening programme has a defined set of standards that providers must meet to ensure local services are safe and effective. Quality assurance ( QA) is the process of checking these standards are met and encouraging continuous improvement.

It includes:

Formal QA visits provide the forum for a peer review of the whole multidisciplinary screening pathway.

Screening quality assurance service ( SQAS) teams make recommendations to providers and commissioners about what is needed to make sure the service meets the national service specifications and standards. They monitor and provide expert advice on the management of screening incidents and promote shared learning and examples of good practice at national, regional and local levels.

Participation in a formal process of QA is the responsibility of each local screening provider. The performance of local services is monitored in a variety of ways including the national data reports, at local trust meetings and within screening programme boards.

13.1 Key performance indicators (KPIs)

KPIs provide a way of measuring screening programme performance in specific areas. They contribute to the overall quality assurance of screening programmes but are not sufficient to fully quality assure, or performance manage, screening services. KPIs help local screening services identify potential or actual problems so remedial actions can be taken.

The 2 for the NIPE screening programme are NP1 and NP3 (S03).

13.2 Coverage data and failsafe

For babies screened by non-NHS services (independent or private), there is no obligation to complete S4N. However, it is good practice to record that screening has taken place by a private provider if this information is known.

The NIPE programme produces quarterly reports that are available on S4N.

Trusts should regularly review S4N failsafe reports and follow up babies identified as 'not screened' or who have not attended for post screen positive referral appointments. These reports should also be reviewed and discussed at local screening programme boards.

13.4 Screening safety incidents

Health professionals should use the managing incidents guidance if there are any problems during screening.

NIPE screening programme standards provide a defined set of measures that providers must meet to ensure local programmes are safe and effective.

The NIPE national standards are available.

Trusts should make sure there are local systems for entering all relevant coverage and outcome data on to S4N including date of post screen positive referral appointment or review.

Trusts should make sure all NIPE screening and outcome data is inputted onto S4N to:

Where NIPE newborn screening examinations have taken place in primary care, local feedback mechanisms should be developed and agreed so screening results can be entered on S4N in a timely fashion.

Summary S4N data reports are produced quarterly and sent to screening and immunisation teams and SQAS to provide a useful overview and quarter by quarter comparison. PHE Screening publishes KPI data reports quarterly and shares an extended KPI data set with NHS England.

We gratefully acknowledge professionals involved (including members of the NIPE expert working groups) for their contribution to the content of this handbook. If you would like further information, please contact the PHE screening helpdesk.

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Newborn and infant physical examination (NIPE) screening programme handbook

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This handbook informs and supports best clinical practice and should be used in conjunction with the NIPE programme standards and the NIPE screening pathways. It relates to the screening elements of the top-to-toe physical examination of the baby.

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We screen you for carbon monoxide at every antenatal appointment, here's why.

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The Edgware Birth Centre is standalone centre located within Edgware Community Hospital. There are no obstetricians on site and should complications arise during labour you would be transferred to our nearest hospital by ambulance.

All women planning to give birth at Edgware Birth Centre will be cared for by a dedicated team of midwives who will care for you throughout your pregnancy, labour and after your baby is born. Please call the midwife on the number provided by the Edgware Birth Centre Team when you are in labour.

If you are unable to contact the midwife or for any other concerns about yourself or your baby please call Barnet Hospital Maternity Triage on 0208 216 4408.

Facilities

At the Edgware Birth Centre we have:

four ensuite birthing rooms

three birthing pools for you to labour/birth in

birth stools to help you with an upright birth as well as bean bags and birth balls.

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Maternity Voice Partnership (MVP)

The MVP is a group of parents, parents to be and maternity staff all working together to make the maternity care at RFL the best it can be.

If you would like to be more involved in the maternity care provided by the Royal Free, you can join the Royal Free Maternity Voices. Please email: royalfreematernityvoices@gmail.com

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Having a baby is an important event for women and their families. We aim to ensure that the whole childbirth experience is comfortable and relaxed.

At Royal Free Trust, we have a few birth place options available to you and encourage you to have a conversation with your midwife regarding which one is best for you.

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Due to the COVID-19 pandemic, we've had to make some important changes to our maternity services to help keep you and our staff safe.
Please read our dedicated COVID-19 advice page which provides the latest information about our maternity services.
Having a baby is an important event for women and their families. We aim to ensure that the whole childbirth experience is comfortable and relaxed.

If you are healthy and your pregnancy is straightforward the evidence says you should give birth at home or in a birth centre. Giving birth at home or in a birth centre is as safe for your baby as giving birth in hospital. Giving birth at home or in a birth centre also has many benefits for you.

You're significantly less likely to have:

an emergency Caesarean section

ventouse or forceps delivery

an episiotomy

blood transfusion.

You're significantly more likely to have:

a normal birth

to be able to use water for labour and birth

have a better birth experience.

To find out more talk to our midwives or visit the Which? Birth Choice website.

Where can I have my baby?

Evidence says that if you are healthy and your pregnancy has been uncomplicated, you should plan to give birth at home or in a birth centre.

At the Royal Free London we have three birth centres, the Barnet Birth Centre, the Edgware Birth Centre and the Heath Birth Centre. If you are planning to give birth in a birth centre, you can discuss which birth centre is most appropriate with your midwife.

For further information, read our patient information leafet: Choosing where to have your baby.

Women or babies experiencing complications during pregnancy or labour, or women who have medical problems requiring specialist care, are advised to give birth in a consultant-led delivery suite. At the Royal Free London we have two consultant-led delivery suites, one at Barnet Hospital and one at the Royal Free Hospital. You can discuss which suite is most appropriate with your midwife.

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Please read our dedicated COVID-19 advice page which provides the latest information about our maternity services. Having a baby is an important event for women and their families. We aim to ensure that the whole childbirth experience is comfortable and relaxed.

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Royal Free and Barnet Maternity Services Website

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Royal Free and Barnet Maternity Services Website

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The trust website has an incredible amount of information for you. From antenatal screening, to birth and where to give birth, to postnatal care.

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Overview

If you are planning a homebirth around this time, your midwife will speak to you about what this means for your care.

We are proud to provide supportive, personalised and high-quality maternity care to more than 10,000 women living in and around Barnet, Camden, Enfield, Haringey, Hertfordshire, Islington, and Middlesex.

If you would like to have your baby with us, please fill out our online self-referral form.

We offer maternity care from several hospitals and community hubs. Our two main maternity hospitals are Barnet Hospital and the Royal Free Hospital. We also provide maternity services at Chase Farm Hospital, Edgware Community Hospital, Cheshunt Community Hospital, Finchley Memorial Hospital and a range of health centres, GP practices, children's centres and other community locations.

Watch a video about our maternity services.

This film highlights the maternity services available at our hospitals. If you are pregnant and deciding which hospital to have your baby at, watch this film to see our maternity team explain the services we offer and the different sorts of births available.

National maternity safety strategy

The Government asked all organisations with maternity services to make a commitment to contribute towards achieving the national ambition and improve maternity outcomes. The Royal Free London NHS Foundation Trust maternity services are part of this National Maternity Safety Strategy and has implemented a Maternity Safety Improvement Plan to support the national Maternity Safety Ambition.

Your feedback matters: compliments, comments, and complaints

If you would like to speak with us about your maternity visit or stay, please contact PALS.

Please debrief about your birth experience or aspects of your maternity journey please inform your community midwife who should be able to facilitate this for you or will liaise with the maternity team on your behalf.

To send us feedback about our website or if you have spotted an error, please contact our website team.

Referrals

Referral details
If you are a GP and would like to refer to our service, please use our online GP referral form.

If you are pregnant and would like to have your baby with us, please fill out our online self-referral form.

If this form does not display properly, please access it as a standalone web page.

The Team

Consultant

Consultant Midwife

Consultant Obstetrician and Gynaecologist, Lead for Fetal Medicine/ Recurrent Miscarriage

Phone number: 020 7794 0500 ext 34939

Email address: demetrios.economides@nhs.net

Private practice phone number: 020 7435 5417 / fax: 020 7472 6154

Consultant Obstetrician and Gynaecologist, Clinical Director/ Lead for Gynae Cancer

Email address: heatherevans@nhs.net

PA/secretary phone number: 020 7830 2566

PA/secretary email address: maureen.cumberbatch@nhs.net

Fax: 020 7830 2562

Consultant Obstetrician and Gynaecologist, Lead for Urogynaecology including perineal care, Undergraduate Lead, Women's Health Module

Phone number: 020 7830 2563

Email address: Joanne.hockey@nhs.net

Consultant Obstetrician and Gynaecologist, Special interest in Benign Advanced Laparoscopic Surgery and Fibroid

PA/secretary phone number: 0207 830 2566

PA/secretary email address: maureen.cumberbatch@nhs.net

Private practice phone number: 020 7794 0500 ext 35874

Consultant Obstetrician and Gynaecologist, special interest in Preterm Birth Screening

Phone number: 020 7830 2566

Email address: hmohiudin@nhs.net

PA/secretary phone number: maureen.cumberbatch@nhs.net

Consultant Obstetrician and Gynaecologist, special interest in colposcopy and Vulva Disease

Phone number: 020 7830 2566

Email address: rf.obstetricsandgynaeadmin@nhs.net

PA/secretary email address: Maureen.Cumberbatch@nhs.net

Fax: 020 7830 2562

Management team

Divisional Director of Operations, Women and Children

Senior Operations Manager, Women's Directorate

Other key team members

Patient leaflets

Read our patient leaflets and publications

.pdf (379 KB)

.pdf (188 KB)

Approved: 26/11/2020

.pdf (310 KB)

View all patient resources

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The Royal Free is fully committed to providing the best possible antenatal care. Learn more about having a baby at the Royal Free London.

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You can refer yourself to our physiotherapy department if you need help with muscular and hip pain in pregnancy.

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A healthy diet is important for the health and growth of your baby. Click below for some helpful advice and information on foods we would recommend and those to avoid.

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Protein provides the building blocks for your baby to grow. Foods in this group include:

Fish

Have no more than 2 portions of oily fish each week. Make one of them an oily fish like salmon, sardines or mackerel.

There are some types of fish you should avoid (raw shellfish, shark, swordfish and marlin) if you're pregnant or trying to conceive.

Eggs

Hen eggs produced under the British Lion Code of Practice (stamped with the red lion) or produced under the Laid in Britain scheme, are considered very low risk for salmonella and safe to eat raw or partially cooked.

Any hen eggs that are not British Lion eggs or produced under the Laid in Britain scheme, should be well cooked. Other types of eggs, including duck, quail and goose eggs, should also be well cooked.

If you have a severely weakened immune system or are on a medically supervised diet prescribed by health professionals, you should cook all eggs thoroughly.

Read about the healthy way to eat eggs.

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Healthy eating in pregnancy - Start for Life

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Having a healthy diet is important in pregnancy, find out which foods to include in your pregnancy diet.

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Talking and bonding with your unborn baby

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Talking and bonding with your unborn baby

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Did you know that your baby can hear you from as early as 16 weeks of pregnancy? See link for information on how to ensure that you are doing all you can to build a strong bond with your unborn baby.

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The early relationship you, your partner and family have with your baby's really important. How you meet their needs and care for them, shapes how their brain develops. This is as true before they're born as when they arrive.

Attachment

The way your baby builds these close relationships is called attachment. It lays the foundations for them to feel safe and secure.

Babies are totally dependent on those who care for them to keep them safe.

When you give your baby responsive care and lots of attention, it will help them manage their feelings and have safe and healthy relationships in the future.

Babies need their carers close at all times. Staying close to your baby will help you notice when they're trying to communicate with you.

Your baby's needs are met by forming a close relationship with you. It's usual for babies to form attachment with any adult in the family group who provides consistent care.

Bonding before birth

Your baby can hear you from at least 16 weeks, and perhaps earlier.

Babies hear their mother's voices most clearly, but anyone can talk and sing to them - your baby will love to hear from anyone.

This helps your baby:

to get to know voices, which will help them feel safe and secure

tune up their hearing and get ready for when they will eventually talk

Talking and singing to your baby is also good for their development.

Talk or sing to your baby

Find a quiet time when you and your baby can focus on each other and use a tuneful, sing-song voice.

It doesn't matter what music or song - if you like it, so will your baby. Never put headphones on mum's tummy though, as it's too loud for your baby.

If you feel a bit silly talking to the bump, don't worry - lots of people do. If you can't think of anything to say, just chat about the day or share a story.
For tips about reading and singing to your baby before birth, visit the Scottish Book Trust Read more about building a relationship with your baby after they're born
Bonding takes time

Parents don't always feel a great rush of love and bonding straight away. It comes in time.

Many parents have other feelings such as fear along with love, especially if it's a first baby. It's what you do that counts.

Attachment and love aren't the same thing. Some parents love their children but can't keep them consistently cared for and safe and if that happens it can cause attachment issues. If you're worried about your safety or your baby's, tell someone you trust and ask for help.

Further information and other languages and formats

Translations and alternative formats of this information are available from Public Health Scotland.

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How your baby's development is helped by building a relationship with them early in your pregnancy

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Attached is a list that you can print to help you pack your bags for your stay in hospital. This is just an idea, to get you started! You may think of other things that will make the experience what you want it to be.

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Safe sleeping, car advice and caring for your baby at night.

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Help save babies' lives

Our work is entirely reliant on donations. Support from people like you has saved 29,000 babies' lives since 1991. Please donate today to help give little lives big futures.

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How to reduce the risk of SIDS

Our safer sleep advice gives simple steps for how you can sleep your baby to reduce the risk of sudden infant death syndrome (SIDS) which is commonly known as cot death. It can give you the peace of mind to enjoy this special time.

Our advice is based on strong scientific evidence and should be followed for all sleep periods, not just at night.

If you have any questions about SIDS or safer sleep, please call our information line on 0808 802 6869 (lines open Monday-Friday 10am-2pm).

Watch our free presentations on how to sleep your baby safely and reduce the risk of SIDS

Things you can do

Always place your baby on their back to sleep

Keep your baby smoke free during pregnancy and after birth

Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months

Breastfeed your baby

Use a firm, flat, waterproof mattress in good condition

Things to avoid

Never sleep on a sofa or in an armchair with your baby

Don't sleep in the same bed as your baby if you smoke, drink or take drugs or are extremely tired, if your baby was born prematurely or was of low birth-weight

Avoid letting your baby get too hot

Don't cover your baby's face or head while sleeping or use loose bedding

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Reduce the risk of sudden infant death syndrome (SIDS) for your baby by following our safer sleep advice. The advice is based on strong scientific evidence.

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You could get a one-off payment of £500 to help towards the costs of having a child. This is known as a Sure Start Maternity Grant.

You usually qualify for the grant if both of the following apply:

you’re expecting your first child, or you’re expecting a multiple birth (such as twins) and have children already

you or your partner already get certain benefits

You must claim the grant within 11 weeks of the baby’s due date or within 6 months after the baby’s birth.

You do not have to pay the grant back and it will not affect your other benefits or tax credits.

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There’s a lot to think about when you’re becoming a dad. The Dad Course offers a relaxed, practical and positive online introduction to fatherhood.

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The Dad Course is the practical, down-to-earth and proven online course that builts confidence, skills and knowledge in dads-to-be. Join the hundreds of other expectant fathers who have benefitted from The Dad Course over the last six years. In the words of one participant: “Quite simply the best th

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BUMPs - best use of medicine in pregnancy

This website provides reliable, evidence-based, and accurate information about use of medicines in pregnancy, in the form of freely available patient information leaflets called 'Bumps ' leaflets are produced by the UK Teratology Information Service ( UKTIS), a not-for-profit national organisation hosted by the Newcastle upon Tyne hospital NHS Foundation Trust and funded by the UK Health Security Agency (UKHSA) on behalf of the UK Health Departments.

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bumps - best use of medicine in pregnancy

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This website provides reliable, evidence-based, and accurate information about use of medicines in pregnancy, in the form of freely available patient information leaflets called 'Bumps ' leaflets are produced by the UK Teratology Information Service ( UKTIS), a not-for-profit national organisation hosted by the Newcastle upon Tyne hospital NHS Foundation Trust and funded by the UK Health Security Agency (UKHSA) on behalf of the UK Health Departments.

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Speak to your midwife if you are currently smoking and would like help to quit. Click below for information on how smoking can affect you and your baby.

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Becoming smokefree before or during pregnancy is important for your baby's health. It's also important for your health.

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Between 16 and 24 weeks of pregnancy, you should start feeling your baby move. Click here for information on the importance of getting to know these movements.

Below is the current advice from Tommy's and the NHS regarding your baby's movements in pregnancy. This leaflet is also available in other languages.

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If you’re pregnant or have a child under 4, the Healthy Start scheme can help you buy basic foods like milk or fruit.

If you qualify for the scheme you’ll be sent vouchers you can use in over 30,000 shops in the UK.

You can also get coupons to swap for:

pregnancy vitamins

breastfeeding vitamins

vitamins for children aged 6 months to 5 years old

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Applying online

If you get Universal Credit, you can apply online if:

you're more than 10 weeks pregnant or have at least one child under 4 years old

your family's monthly 'take-home pay' (also called 'earned income') is £408 or less from employment

If you get Child Tax Credit, you may be eligible for Healthy Start if:

your family's annual income is £16,190 or less

you do not get Working Tax Credit

Most people who get Child Tax Credit can apply online. You can apply online if you're either:

more than 10 weeks pregnant and have children under the age of 4

not pregnant but have children under the age of 4

If you're more than 10 weeks pregnant and have other children who are all aged 4 or older, you'll need to apply by email or phone.

To apply online, you'll need your:

name

address

date of birth

National Insurance number

baby's due date (if you're pregnant)

benefit award letter if you're over 18 - make sure you enter the exact details shown on your benefit award letter

Make sure that your details are up to date with HMRC or DWP - you may wish to contact them to check or update your details before you apply.

Applying by email or phone

You can apply by email or phone if you're more than 10 weeks pregnant, or have at least one child under 4 years old, and get either:

Income Support

Income-based Jobseeker's Allowance

Pension Credit (which includes the child addition)

You can also apply by email or phone if you're more than 10 weeks pregnant and either:

under 18 years old and not getting any benefits

getting Income-related Employment and Support Allowance (ESA)

If you get Child Tax Credit, you'll need to apply by email or phone if you're more than 10 weeks pregnant and have other children who are all aged 4 or older.

You can apply by either:

Phone lines are open 8am to 6pm Monday to Friday (except public holidays). Find out about call charges (opens in a new tab).

If you're not a British citizen but your child is

You might be eligible for Healthy Start depending on your immigration status.

You can get Healthy Start if all the following are true:

Your biometric residence permit (BRP) or your online immigration status (opens in a new tab) will say if you cannot claim public funds. You might also have a letter from the Home Office about it.

To apply for Healthy Start, ask for an application form via email. Only use this email address if you think you cannot claim public funds because of your immigration status.
Healthystartclaim@dhsc.gov.uk

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If you get Universal Credit, you can apply online if: you're more than 10 weeks pregnant or have at least one child under 4 years old your family's monthly 'take-home pay' (also called 'earned income') is £408 or less from employment If you get Child Tax Credit, you may be eligible for Healthy Start if: your family's annual income is £16,190 or less you do not get Working Tax Credit Most people who get Child Tax Credit can apply online.

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Camden Dads supports fathers as equal parenting partners, please see link for details.

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All Camden Children have the best start in life and are ready for school at the age of 5.

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We recommend a number of screening tests both during your pregnancy and following your baby's birth. We will discuss them at your booking appointment and then periodically through your pregnancy. Linked below are the leaflets by Public Health England describing these tests.

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STFYAYB provides information about the screening tests offered during and after pregnancy.

Details

This information is about the screening tests you will be offered during your pregnancy and after your baby is born. It explains the different types of test and what the tests are looking for.

Easy read versions of this leaflet are available. Additional information is also available for parents of babies who are in a special care baby unit, neonatal intensive care unit or paediatric intensive care unit.

We hope this advice will help prepare you for discussions with your midwife or doctor so that you can ask the questions that are important to you.

It is your decision whether or not to have any of the tests described.

In this publication, we use the terms 'woman' and 'women' to refer to anyone able to become pregnant, including trans men. Trans men who are pregnant should be offered the same antenatal and newborn screening tests as other pregnant individuals.

The information is available in 12 other languages: Arabic, Bengali, Chinese, French, Latvian, Lithuanian, Polish, Portuguese, Punjabi, Romanian, Somali and Urdu.

See how to print digital leaflets if you want to print any sections of this guidance.

Free printed copies of this leaflet are also provided for local screening providers to give to women who cannot access the internet. Screening services can view the full PDF of the printed leaflet and order printed copies on the APS online ordering portal (requires login).

Contact the screening helpdesk with any queries about this publication, making sure you include its full title.

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Screening tests for you and your baby (STFYAYB)

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STFYAYB provides information about the screening tests offered during and after pregnancy.

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One of our community midwives will visit you the day following your discharge from hospital to check on you and your baby. The next visit will generally be on day 5, when we check your baby's weight and complete the Newborn Blood Spot Screening if you are happy for them to have it. Information on this test can be found here.

Your midwife will then set the next visit based on the needs of you and your baby. We will usually visit until day 28, after which time your care is handed over to the health visiting team.

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If you are having a planned caesarean section you will be asked to attend the maternity day assessment unit two working days before the date of your caesarean and you will be seen by a midwife, a doctor and an anaesthetist. They will assess you and your baby and complete all of the necessary procedures to ensure you are prepared.

There will be time for any of your questions to be answered so please do ask if you are not sure about something.

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iCope is a service offered through Camden Council that supports local residents struggling with a variety of mental health conditions.

If you feel you could benefit from their support, please use the self referral form on their website.

The service is comprised of:

Psychological Wellbeing Practitioners (PWPs) – who are skilled at helping people find practical ways to manage their difficulties. Methods used include guided self-help, stress management skills, computerised cognitive behavioural therapy and psycho-education groups.

CBT therapists – who are trained to deliver cognitive behavioural therapy with you alone or in a group.

Counsellors who are trained to provide you with an opportunity to talk about day to day difficulties as well as difficulties from the past.

Online Therapy – delivered by accredited therapists and counsellors, using instant chat on a secure platform, available 24/7.

You can either self refer to the service, or speak to your named midwife who will be happy to help you with the referral process.

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ICON training provides information on how to cope when your baby cries and support to help you when you need it.

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Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes.

Below is a link to the NHS website providing further information on this condition.

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Find out more about jaundice, a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes.

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Please visit the government's website for up to date information regarding birth registration.

Babies should be registered within 42 days of their birth to avoid the risk of a fine. Registering your baby is necessary in order for you to register them at your GP, obtain a passport and apply for tax credits.

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All births in England, Wales and Northern Ireland must be registered within 42 days of the child being born.

You should do this at the local register office for the area where the baby was born or at the hospital before the mother leaves. The hospital will tell you if you can register the birth there.

If you cannot register the birth in the area where the baby was born, you can go to another register office and they will send your details to the correct office.

Information you need when registering a birth

When registering the birth, you should know:

place and date of the birth

name, surname and sex of the baby

parents' names, surnames and address

places and dates of parents' birth

date of parents' marriage or civil partnership

parents' jobs

mother's maiden surname

You might not need to give all of this information, depending on who is registering the birth.

What you should take

You should take at least one form of identification when you go to the register office. You can use:

passport

birth certificate

deed poll

driving licence

proof of address (for example, a utility bill)

Council Tax bill

marriage or civil partnership certificate

You should also take your child's personal child health record or 'red book' as some registrars may ask to see it.

If you're going to the register office on your own, you may need proof of paternity from the other parent before you give their details.

After the birth is registered

Once you've registered the birth, you may be able to claim:

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Find out how to register a birth - who can register, birth certificates

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Switchboard: 020 3758 2000
Department extension numbers:
Appointment line - 0203 758 2022 - option 2 Sapphire team
Scans - 0208 216 5216
Triage - 0208 216 4408
Maternity Day Unit - 0208 261  5144
Antenatal/Postnatal Ward - 0208 216 5219
Labour Ward - 0208 216 5180

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Home births are available to all pregnant people in the UK, please look at the link to find out more.

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Homebirth can be a very fulfilling experience for you and your family. It is a great option for women and birthing people who wish to be cared for in the comfort of their own home. The Royal Free London has a dedicated homebirth team run by passionate midwives who will care for you throughout your antenatal, labour and postnatal period. The team has been established since 2018 with the purpose to increase women's and birthing people's place of birth choices.

Homebirth is one of the safest options for place of birth for uncomplicated pregnancies. Planning a homebirth means you're more likely to see the same midwife throughout your care, you'll be in a familiar environment and feel more comfortable to labour. People planning a homebirth are more likely to have a straightforward vaginal birth compared people planning to birth in an alongside midwife birthing unit.

You can choose to have a homebirth at any point in your pregnancy, our team will provide home antenatal care from 36 weeks onwards. Receiving care from the homebirth team doesn't mean you have to give birth at home, you are able to change your mind at any time, even during your birth.

After you have given birth to your baby, the midwives will support you in the immediate postnatal period with infant feeding and caring for your baby. All babies are offered the New-born Infant Physical Examination (NIPE) regardless of where you give birth. This can be facilitated at home or at the Edgware birth centre and the hearing test will be made as an outpatient appointment.

If any complications arise during your birth or postnatal period we would transfer via ambulance to the local obstetric unit, your midwife caring for you will transfer with you.

If you live within the Royal Free Hospital catchment area and have a straight-forward pregnancy, with no medical or obstetric problems, and go into labour between 37-42 weeks we would be happy to provide homebirth services for you.

What do people say about our homebirth service?

"Outstanding care & support from the home birth team."

"The team where completely faultless, I felt safe & secure the while time & I had the best possible experience."

"Thank you team for giving me the best birth I could have ever imagined!!"

"It was a hugely positive & empowering experience for me and I am very grateful for the work you do."

Birth story

My first birth, with my daughter, was quick. I called triage in the morning as I was having contractions, but they didn't recognise that I was in established labour. Separately, I had a sweep booked, for that day, at a hospital without delivery facilities. The midwife at Triage told me to go anyway...so I ended up having my baby in an antenatal hospital appointment room. After that, for my second birth the midwives suggested I look into home birth!

After experiencing the power of Hypnobirthing I then trained and qualified as a practitioner as I wanted to help support people to have more positive birth experiences, which is now my passion! I didn't entertain, initially, the idea of home birth because my husband worried about possible transfer to hospital, if it was needed. I did a lot of research around it and then, came to the conclusion to transfer to Edgware Birth Centre.

We were so supported by the wonderful midwives. Everything felt very relaxed and focused towards you as a mother and your individual wants and needs for your birth. It was refreshingly different to being part of a hospitalised system.

I got to 41 +4 and then after several frustrating nights of intense, but inconsistent, braxton hicks (or perhaps even slow labour), the contractions starting ramping up. I didn't wake my husband as I wanted to be sure it was the real deal this time. I measured contractions for about 45 mins and as they were getting close together I messaged my doula, called the midwife about 1am and asked my husband set up the birth pool to get ready for the arrival of our baby, it was finally happening!

Compared to being in a hospital setting, the first time around, being at home felt calm, safe and the environment was in our control. We had fairy lights, candles, clary sage in the diffuser, Hypnobirthing audio playing, and even a little shrine with crystals and photographs of my mum who had passed away. In Hypnobirthing, we stress how important the environment is, home comforts to help encourage and keep the flow of oxytocin and endorphins (your body's birthing hormones).

When my doula arrived, I got in the water as the tens machine wasn't doing much for me this time around. The water was soothing, warm, and so supportive and I loved being in there. My doula held me and gave me Reiki, which was wonderful. My husband rubbed my back and splashed water over my sacrum. The midwives arrived shortly after and, were hands off but very supportive and kept checking on the baby and myself. Following an intense active labour with few breaks between contractions, my son was born in the water. His head was born en caul (in the amniotic sac) then once his shoulders came out it burst and my husband caught him in the water. It was beautiful, emotional and truly magical. All the while our daughter was asleep in her room, so that when she awoke in the morning we could introduce her to her baby brother.

I am so pleased that we decided to have a home birth and my husband was a raving fan afterwards. It was one of the most special experiences of our lives and something we will never forget. I hope sharing this story supports or helps someone in some way!

Contact us

If you would like further information about a home birth, please contact:

020 3758 2434 or email the team at rf.ebc@nhs.net

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The Royal Free London is fully committed to providing the best possible range of birth options when you are having a baby. Learn more here.

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You may be at increased risk from COVID-19 if you have a health condition, such as:

a long-term lung condition, such as chronic obstructive pulmonary disease (COPD), asthma (if you need steroid tablets) or cystic fibrosis

a long-term heart condition, such as congenital heart disease, chronic heart failure or atrial fibrillation

long term kidney disease (CKD) stage 3, 4 or 5

a severe liver disease, such as cirrhosis

a long-term problem with the brain or nerves, such as epilepsy, cerebral palsy, multiple sclerosis, motor neurone disease, Huntington's disease, myasthenia gravis, or a stroke or transient ischaemic attack (TIA)

severe or multiple learning disabilities (or being on the learning disability register), such as Down's syndrome

diabetes or another hormone disorder, such as Addison's disease

a weakened immune system, due to a medical treatment (such as steroid medicine, biological therapy, chemotherapy or radiotherapy), a condition (such as leukaemia), or from having an organ or bone marrow transplant

problems with the spleen, having no spleen or having a condition that can affect the spleen (such as sickle cell disease)

living with severe obesity (having a body mass index (BMI) of 40 or above)

a severe mental health condition, such as schizophrenia or bipolar disorder

being pregnant (all stages)

living in a long-stay nursing and residential care home as a younger adult.

This list is a summary and does not cover everything. There are other health conditions and treatments that may mean you're at increased risk from COVID-19.

You should be told if you have an increased risk from COVID-19. If you're unsure, speak to a pharmacist, GP or your specialist for advice.

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Find out if you're eligible to get a seasonal COVID-19 vaccination and how to get it.

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We measure your baby's growth from 28 weeks of pregnancy, please follow the leaflet above to see how you can access the records for your baby's growth.