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breastfeeding latching, positions and cues

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breastfeeding latching, positions and cues

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Attaching Your Baby at the Breast – Breastfeeding Series

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You've made it through your first 24 hours as a new mom. Maybe you have other children, but you are a new mom all over again... and now it's your baby's second night.

All of a sudden, your little one discovers that he's no longer back in the warmth and comfort - though a bit crowded - womb where he has spent the last 9 months - and it is SCARY out here! He isn't hearing your familiar heartbeat, the swooshing of the placental arteries, the soothing sound of your lungs or the comforting gurgling of your intestines. Instead, he's in a crib, swaddled, in a diaper, a tee-shirt, a hat and a blanket. All sorts of people have been handling him, and he's not yet become accustomed to the new noises, lights, sounds and smells. He has found one thing though, and that's his voice... and you find that each time you take him off the breast where he comfortably drifted off to sleep, and put him in the bassinet - he protests, loudly!

In fact, each time you put him back on the breast he nurses for a little bit and then goes to sleep. As you take him off and put him back to bed - he cries again... and starts rooting around, looking for you. This goes on - seemingly for hours. A lot of moms are convinced it is because their milk isn't "in" yet, and the baby is starving. However, it isn't that, but the baby's sudden awakening to the fact that the most comforting and comfortable place for him to be is at the breast. It's the closest to "home" he can get. It seems that this is pretty universal among babies - lactation consultants all over the world have noticed the same thing.

So, what do you do? When he drifts off to sleep at the breast after a good feed, break the suction and take your nipple gently out of his mouth. Don't move him except to gently slide him into an upright neutral position with his head to the side. Don't try and burp him - just snuggle with him until he falls into a deep sleep where he won't be disturbed by being moved. Babies go into a light sleep state (REM) first, and then cycle in and out of REM and deep sleep about every ½ hour or so. If he starts to root and act as though he wants to go back to breast, that's fine... this is his way of settling and comforting. During deep sleep, the baby's breathing is very quiet and regular, and there is no movement beneath his eyelids.

Another helpful hint... his hands were his best friends in utero... he could suck on his thumb or his fingers anytime he was the slightest bit disturbed or uncomfortable. And all of a sudden he's had them taken away from him and someone has put mittens on him! He has no way of soothing himself with those mittens on. Babies need to touch - to feel - and even his touch on your breast will increase your oxytocin levels which will help boost your milk supply! So take the mittens off and loosen his blanket so he can get to his hands. He might scratch himself, but it will heal very rapidly - after all, he had fingernails when he was inside you, and no one put mittens on him then!

By the way - this might happen every once in a while at home too, particularly if you've changed his environment such as going to the doctor's, to church, to the mall, or to the grandparents! Don't let it throw you - sometimes babies just need some extra snuggling at the breast, because for the baby, the breast is "home."

Copyright © by Jan Barger, RN, MA, IBCLC, FILCA
Lactation Education Consultants

No portion of this text may be copied or reproduced in any manner, electronically or otherwise, without the express written permission of the author (IBCLC@aol.com).

Jan Barger is a mom of three, and proud Grammie of three and one due in 2017. She has been in private practice as a lactation consultant, worked for many years for a pediatric practice in the Chicago 'burbs as their lactation consultant, has a background in all aspects of maternal-child health nursing, and currently teaches with Lactation Education Consultants - an organization that provides education for those aspiring to become IBCLCs. Jan is a past president of ILCA, was on the IBLCE board and exam committee, and is a co-author of Clinical Experience in Lactation: A Blueprint for Internship, and Clinical Instruction in Lactation: Teaching the Next Generation. She lives in Wheaton IL with husband Bob and loves to travel and read.

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You've made it through your first 24 hours as a new mom. Maybe you have other children, but you are a new mom all over again... and now it's your baby's second night.

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Place to ask breastfeeding questions and find support

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A support group to compliment our information page. We are Breastfeeding Counsellors in the UK. If you are offering support, please state if you are a breastfeeding counsellor, IBCLC, peer...

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Expressing colostrum - everything you need to know

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Expressing colostrum - everything you need to know

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Breasts change a lot during pregnancy. Tender boobs can be one of the first signs that you're growing a little human. Then they get larger and look a little different. The colour of the nipples and areola gets darker. Nipples may stand a little more to attention than usual. And from the 16th week of pregnancy, breasts begin to make colostrum.

Colostrum is the first milk produced by breasts, and it's pretty powerful stuff. It's packed with antibodies and immunoglobulins - all aimed at protecting teeny babes as they enter a germy world. Interestingly, it also helps newborns get rid of their first bowel movement, the meconium.

Expressing colostrum before giving birth is becoming increasingly popular, so here's everything you need to know about collecting to storing breastmilk before the baby is born.

Why express colostrum before birth?

Colostrum is designed to be bub's first feed, but sometimes births don't quite go to plan. Which is why so many mums are now hedging their bets and storing their colostrum while still pregnant.

Lactation consultant Susan Shaw says babies born to mums with diabetes are at risk of having low blood sugar levels after birth. So having expressed colostrum on hand can avoid the use of formula, and help stabilise a baby's blood sugars.

"Also, some babies have a strong family history of dairy intolerance or inflammatory bowel disease, so having extra colostrum to use will be beneficial.

"Some babies are diagnosed antenatally with various conditions (cleft lip and/or palate, congenital conditions e.g. Downs Syndrome, cardiac conditions) which may make it hard for them to breastfeed, so they may be needing to have extra colostrum 0n hand to use if needed."
Benefits of antenatal colostrum expressing:

Raises a baby's blood sugars

Acts as a laxative to help pass meconium quickly

Keeps bub hydrated

Helps baby's immune system develop

When to start expressing colostrum?

While nipple stimulation can cause uterine contractions, there's no relationship between nipple stimulation and inducing labour, says Susan Shaw. With that in mind, she says daily expressing can start at 36 weeks.
Do not express if:
You have a history of, or are currently experiencing, threatened or actual preterm labour, cervical incompetence or you have a suture put in your cervix to prevent preterm labour.

How to express colostrum

Use your hand to express a few small drops at a time

Start with three to five minutes on each breast

Build up to five to 10 minutes on each breast

You can use each breast twice during each session

Use a sterile syringe to catch the colostrum drops

Colostrum can be collected two to three times every day, and you can use the same syringe

Stop expressing if having uterine contractions associated with expressing

Tips for expressing colostrum

Relax - if nothing is coming out, take a break and try again another time

Try expressing after you've had a warm bath or shower

Put a warm compress on your breasts before starting to help increase circulation

Massage breasts before expressing

It shouldn't hurt so make sure you're not trying to express by putting your fingers too close to the nipple

Drink lots of water

Try thinking of your bub, or looking at ultrasound pictures

What colostrum looks like

Colostrum can look very different, both in colour and consistency. The colour can be, pale, clear, yellow, cream, brown or orange.

It can be sticky and thick or thin and watery.

Storing expressed colostrum:

For storage of colostrum at home you will need 1ml-5ml syringes, zip-lock bags and labels

Colostrum can be stored in syringes in the fridge between expressing sessions

Colostrum can be frozen, make sure you pop the syringe in a labelled, zip-lock bag first

Frozen colostrum can be stored for three months, or 12 months in the deep freeze.

How to take it to the hospital

If you're headed off to have your baby, put fresh or frozen syringes in a cooler pack with frozen ice bricks. Once you get to hospital ask for it to be placed in a fridge. Once it defrosts it must be used within four hours and it cannot be refrozen.

Won't my colostrum 'run out' before baby is born?

The short answer is no. Your body will keep producing colostrum until your milk comes in, so it won't run out or be used up by the time bub comes along.

A real mum's story

Catherine Leask decided to express her colostrum before birth, sharing her story with other mums-to-be in one of Mum's Grapevine's Due Date and Baby Groups.

"I'd actually stumbled on an article about expressing colostrum antenatally by accident! It wasn't a 'thing' with my previous bubs (it's been a long time between bubs!) but I did know that expressing colostrum post birth was recommended in some hospitals.

"Being older, having a traumatic birth resulting in emergency caesarean last time, and booked for an elective this time, I thought what a great idea - not that you want anything to go wrong but you certainly want to be prepared. Better to have it and not need it than need it and not have it!"

Catherine admits it was daunting at first, but after chatting with lactation consultants she felt more at ease.

"They prepared me well by showing me the technique on a crochet boobie! The kit supplied by them had everything I needed including a very easy to follow instruction sheet. Initially, I managed to get half a ml, but by day three, I was filling the syringe in a few minutes. I could have easily filled two or three in the recommended 10 minutes!"

She says having the colostrum on hand helped her newborn settle and gave her a breastfeeding kickstart.

"We used the colostrum the following morning after bub was born. She slept for hours! I think expressing must have helped with bringing in my milk. The midwife mentioned that the process of labour triggers the milk coming in, however, being a caesarean, milk can be delayed a little. I definitely recommend the process but most importantly - get in touch with the lactation consultants at your hospital as they are the experts and a treasure trove of information and support!"

Like with anything during pregnancy, every woman is different and some won't be able to express colostrum. That doesn't mean there's anything wrong, or that you won't be able to breastfeed.

Want to be prepared for your breastfeeding journey? Here are 16 breastfeeding essentials to help.

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Everything you need to know about expressing colostrum

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Breasts change a lot during pregnancy. Tender boobs can be one of the first signs that you're growing a little human. Then they get larger and look a little different. The colour of the nipples and areola gets darker. Nipples may stand a little more to attention than usual.

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c-section — Positive Birth Stories — The Positive Birth Company

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Monthly group Hypnobirthing classes in London, Devon and Birmingham. Home of The Positive Birth Company DIGITAL PACK - the world’s most affordable and accessible online hypnobirthing program. Committed to empowering women and their birth partners to create positive birth experiences and changing…

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During pregnancy your body is preparing to give birth and your breasts are getting ready to feed your baby. If you are told you need to have a caesarean birth you may wonder if you will still be able to breastfeed as you planned. Mothers successfully breastfeed after a caesarean birth and you can expect your healthcare professionals to support you with getting breastfeeding established straight away.

Whichever way we give birth, our bodies need time to recover and to adjust to feeding a new baby. Birth by caesarean usually means a longer hospital stay, and a longer recovery time because this is major abdominal surgery so practical support from friends and family can make a big difference to you.

Before the birth
Common concerns
A good start for breastfeeding
Practical help and support

Before the birth

Whichever way you will be giving birth, find out as much as you can beforehand about labour and breastfeeding. Whilst some aspects will be out of your control, choosing your place of birth and your caregiver can reduce your chance of a caesarean.

An induced birth can lead to more interventions, increasing the chance you'll need a caesarean.

Continuous support during labour from a woman you feel comfortable with and trust can reduce the risk of a caesarean birth.

Simple things like eating and drinking, moving around and relaxation can improve your experience of labour.

Tell hospital staff beforehand that you plan to breastfeed and to emphasise:

You want to keep your baby with you, provided neither of you needs special care.

You don't want your baby to be given bottles or dummies without your permission, because this will interfere with breastfeeding.

An unplanned caesarean
A caesarean after a long or difficult labour can leave you feeling extremely tired and frustrated. However the hormones released during labour have already prepared you and your baby for breastfeeding.

A planned caesarean
Knowing in advance that you will be having your baby by caesarean can let you prepare, both emotionally and practically. When possible, going into labour first can help get breastfeeding off to an easier start. If you have had a previous caesarean, it is not always necessary to have one the next time. Discuss your options with your health professionals.

After an caesarean
Whether or not your caesarean was planned, you may still feel upset or sad about what happened and mourn the loss of the birth experience you were hoping for. It is quite understandable to feel this way and these feelings may affect the way you feel about your baby and breastfeeding at first.

Breastfeeding can give you confidence in your body's abilities. When you breastfeed, your baby needs you. The close physical contact can also help you to feel better emotionally. Breastfeeding helps your womb to contract, which will help you heal more quickly. And it's nature's way of ensuring you spend time sitting or lying down, resting and recovering.

Common concerns

IVs or drips
To make holding and feeding your baby easier, ask that your IV drip be inserted into your forearm, rather than in the back of your hand (and without the supporting board if one is used). You can request that your catheter be inserted after your spinal anaesthetic has taken effect, to make the procedure more comfortable.

The extra fluid from an IV can increase engorgement. Before breastfeeding, you can easy any swelling back by pressing your fingers around the nipple area (reverse pressure softening) and see Engorged Breasts-Avoiding and Treating for suggestions.

IV fluid will also transfer to your baby. This can lead to an artificially high brith weight which may result in a higher percentage weight loss in the early days. Weighing your baby at 24 hours old may give a more accurate baseline weight.

Anaesthetic
Any anaesthetic in your system will not be harmful to your baby. However the anaesthetic may make your baby very sleepy during the first few days-you may have to wake them up and encourage them to nurse. Keep them close and offer the breast whenever they stir.

Antibiotics and pain relief
Pain relief and antibiotics are routinely given after a caesarean. Pain relief will be essential to help you through the early days. Over the counter pain medications, such as paracetamol and ibuprofen, are considered safe for breastfeeding. If you need something stronger, then discuss this with your health care team, who can check which drugs are compatible with breastfeeding. You may need further antibiotics, but be aware that these increase the risk of a thrush infection for you and your baby.

A good start for breastfeeding

Express your milk
Separation or feeding problems are more likely if your baby is born early, if you have an induced birth, or if you have a health problem such as diabetes. It can be very helpful to express and store colostrum before the birth so that your milk will be available for your baby if separation occurs. See Antenatal Expression of Colostrum.

If your baby is a bit sleepy at first you can hand express drops of colostrum and give it on a spoon. You partner could help with this.

It can sometimes take a little longer to have a plentiful milk supply after a caesarean birth. Hand expressing frequently will encourage this process. If you baby needs a supplement offer it with a spoon, syringe, feeding cup or supplementer.

Breastfeed as soon as possible
You can breastfeed as soon as you are alert enough to hold your baby, in the recovery room or even on the delivery table. At this stage you will be free from pain as the anaesthetic will not have worn off. Although you may be lying flat on your back and may need some help positioning your baby, you don't need to be sitting up to breastfeed. Simply lying there, skin-to-skin is enough to prompt a baby to nuzzle onto your breast themself. If you are drowsy your partner can help by holding your baby close to you.

Skin-to-skin contact with your baby
It's important and never too late, to enjoy skin-to-skin contact with your baby. Tuck a blanket over both of you to keep warm. Skin-to-skin

Encourages your baby to latch on and feed frequently.

Helps colonise your baby's skin with your own individual 'good' bacteria.

Calms your baby and regulates their temperature.

Encourages bonding.

If your need for medical care prevents this happening straight away, your birth partner can step in. Babies still benefit from sking-to-skin contact even when they can't be with you.

Get comfortable for breastfeeds
Getting your baby attached well at the breast helps them to feed effectively and helps prevent nipple damage. Lying down, laid back or using the underarm position may be easiest at first. Use extra pillows for support and comfort-behind your back, under your arms or between your knees. A rolled up towel or small pillow can cover and protect your incision. . See Positioning & Attachment for tips. Be aware that pain relief can mask pain during breastfeeding. If your nipples are squashed or flattened after feeds, or look sore or damaged, seek help without delay.

Baby feeding cues
Mothers often find they need help responding to their babies' early feeding cues. If you feel groggy after birth, it helps if the people supporting you are aware of the signs your baby needs to feed. These include, in increasing urgency:

Opening their mouth, making sucking motions and turning their head (rooting) looking for the nipple.

Moving their tongue.

Furrowing their eyebrows-perhaps showing tension in their face.

Clenching and unclenching their fists.

Flexing their arms.

Moving their hands to their mouth.

Followed by restless movement.

Then crying-the last resort.

Practical help and support

It is useful to check hospital policies on visitors, so you can arrange as much help as possible. Even in hospital, it will be much easier with your partner, family member or friend to help you care for your baby. If you are on your own, ring for help from hospital staff when you need it.

Once at home, extra help will be essential. You will be recovering from major abdominal surgery and need to rest, recover and concentrate on nursing your baby. You may be advised not to drive for about six weeks. Organise as much help as possible with meals, laundry and essential housework, and with caring for any older children. Drink enough fluids to keep your urine pale, and eat a balanced diet. Simple meals will be easier to prepare.

See Supporting a Breastfeeding Mother and Adjusting to Motherhood include practical tips on making life easier after birth.

Support for breastfeeding
Try to contact an LLL Leader, attend an LLL meeting or join an LLL Facebook group before your baby arrives to establish your support network. The LLL Leaders and other mothers will be able to give you ongoing support and enouragement, along with useful practical ideas. You can find your local LLL group here.

Written by Sara Walters, Karen Butler, Sue Upstone, Bronwyn Davies and mothers of LLLGB.

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
NICE Clinical Guidance: Caesarean Section. www.nice.org.uk/guidance/ng192

Antenatal Expression of Colostrum
Birth and Breastfeeding
Beginning Breastfeeding
Comfortable Breastfeeding
Engorged Breasts - Avoiding and Treating
Hand Expression of Breastmilk
My Baby Won't Breastfeed
Positioning and Attachment
Sleepy Baby - Why and What to do
Supporting a Breastfeeding Mother
Treating Thrush

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
Impacts of Birthing Practices on Breastfeeding 2nd edition, Smith, LJ. Jones and Bartlett Publishers, 2010.

You can buy this information in a printed leaflet from the LLLGB Shop here

Updated March 2022

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Caesarean Birth and Breastfeeding - La Leche League GB

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Caesarean birth: c-section recovery tips

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Caesarean birth: c-section recovery tips

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1. Taking care of yourself

With a newborn baby in your life it can be easy to prioritise their needs above your own, but you also need to focus on yourself and get enough rest and support so your body can heal.

Take it easy and ask for help if you need it. Making time to look after yourself is important - having a bath, taking a nap, or going for a short walk can all support emotional wellbeing and physical recovery.

Physical wellbeing - get plenty of rest, don't lift anything heavier than your baby, eat healthily and keep hydrated (NHS, 2019a).

Emotional wellbeing - the postnatal period can trigger lots of different thoughts and emotions, as you reflect on and process your birth experience. If you need emotional support, you could contact a peer support service, or many hospitals offer a birth reflections service. Some independent midwives will also review maternity notes with you to help you understand what happened and why.

2. Organise help (and accept it)

Sometimes it feels difficult to ask for and accept help, but now is the time to draw on the support of your friends and family to help out however you need it.

We are not all fortunate enough to have family or friends living close by, but think about who you could ask for help, so you can focus on resting and recovering from surgery, and bonding with your baby.

If you don't have anyone nearby, you might want to consider hiring a postnatal doula. They're trained to support you after birth and can often provide support with breastfeeding or bottle feeding, if you want it. They can help you with your recovery and answer any questions you might have about your baby. They often have lots of local information and are happy to provide whatever support you need in the home too. A few hours of doula support could be a great gift to a new family!

If planning a caesarean birth, you could consider the tasks your support network could do ahead of time, like freezing meals, and decide who could help with which tasks.

If you don't have a local support network, ask your health visitor or contact your local children's centre to find out if any support is available locally. For example, a charity like Homestart  might be able to offer practical help.

It's also a good idea to contact  your local NCT branch  to see what NCT support and social groups are nearby.

3. Get moving

It's important to be mobile after having a caesarean to help prevent the risk of blood clots or deep vein thrombosis, and aid healthy recovery (NHS 2019a, NHS 2019b; Sheedy et al 2022). You'll be encouraged to get out of bed in hospital as soon as you regain feeling in your legs and feel able to walk (NHS 2019a).

At first it might be painful or uncomfortable getting out of bed. You may find it easier to get out of bed by rolling on your side. You can then put your feet over the edge of the bed and push yourself up to a sitting position. It may be helpful to have a midwife or birth partner close by the first few times you stand up, in case you feel lightheaded and/or wobbly.

When you get home, it's a good idea to get up and start going for gentle walks when you feel up to it. Over time, you'll start to feel better.

Gentle exercise, such as walking, can start as soon as possible, moving on to gentle swimming or yoga from six weeks, depending on how recovery is going (NHS 2019b). Stronger exercise may need to wait longer for internal healing and you can discuss this with your midwife or GP.

4. Attend postnatal check ups

Your midwife or health visitor should give you information about recovering from a caesarean. This may include practical information about how to clean your wound, when to return to your usual activities and when to seek medical advice.

Each hospital trust is different, but most offer contact with a midwife every day for the first few days after a baby has been born. These are good opportunities to discuss recovery, and check the wound is healing well.

You will be offered an appointment after around five days to a week to remove any stitches or staples, if they are not the dissolving kind.

You will be offered midwifery support for at least the first 10 days, before being discharged. Every recovery is different, and the length of time support is offered should be personal to your birth and recovery.

You will also be offered a postnatal check with your GP at six to eight weeks after birth, which is another opportunity to seek guidance and support with recovery.

5. Don't rush back behind the wheel

Wait to get back to driving until you feel up to it. You might have to wait six weeks or longer to get back behind the wheel (NHS 2019a).

It's worth checking with your insurance company if they have a policy on driving after a caesarean.

The DVLA suggests that a doctor should be able to say when a driver is likely to be able to drive again, but in practice, a midwife or GP would say that you can begin driving again when you feel you have recovered from the surgery.  It would be a good idea to wait until you feel physically able and comfortable to perform an emergency stop.

6. Know when to seek medical advice

Although rare, it's important to know the signs of possible infection or deep vein thrombosis following a caesarean birth.

Contact your local maternity assessment centre or your GP immediately if you experience any of the following:

severe pain

pain when weeing

a cough or shortness of breath

pain or swelling in your lower leg

discharge, pus or bad-smelling fluid from the caesarean wound

heavy vaginal bleeding, or large clots

the wound becomes red, swollen and painful

fever, high temperature, or you feel very unwell (NHS 2019a)

If you can't get through to your doctor, call 111 for advice or an emergency appointment.
This page was last reviewed in April 2022
Further information

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

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

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

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

Find out more about HomeStart - a family support charity that offers practical support to parents.

NICE provides evidence-based recommendations about caesarean.

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Top tips for recovery after a caesarean birth | Labour & birth, Different types of birth articles & support | NCT

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

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Planned Caesareans: What are they like and what are your options?

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Planned Caesareans: What are they like and what are your options?

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April is 'National Caesarean Month', so when better a time for a post on c-sections! We are extraordinarily lucky to live in a country where c-sections are safely available, and available for free! For this post I'll be looking at elective caesareans, where you choose to have one in advance, for whatever reason and the options that may be available to you. Some choices may vary from hospital to hospital, or have different risks attached due to your personal medical background, so do discuss any preferences with your healthcare team in advance.

So, what actually happens in a caesarean? An operation where you're awake? That's got to be scary right?! It doesn't have to be, if you know what to expect.

Usually, you'll come the hospital first thing in the morning, having not eaten or drunk since the previous evening. You'll wait on the ward or delivery suite, where you'll meet an obstetrician and midwife in advance, and they will chat you through everything you need to know about the procedure and ask you to sign a consent form. This would be a good point to reiterate any 'special requests' for your birth.

You will then essentially, be made to wait your turn, whilst the team prioritise the safest order for the babies to be born! (Taking into account what is going on throughout the unit.) Take something to entertain you and keep you relaxed- a funny series on Netflix or a comedy podcast should do the job!

You will need to wear a hospital gown for the birth, you can put this on backwards if you are keen to have skin to skin immediately following the birth. Your birth partner will change into 'scrubs', which are like comfy blue pyjamas and be asked to wear a stylish fabric hat, this helps keep the theatre sterile, to keep you safe from infection. Mum will have a cannula fitted into her hand, for fluids and other medicines as required.

In you go! Now, the next bit might seem strange! But everyone in the room will go around introducing themselves- this is part of a checklist for safe surgery, they haven't all just met for the first time!

Who's in there? It might seem like there's a lot of people in the room, but they all have a role in keeping you and baby safe.

Anaesthetist and Anaesthetic Nurse- in my experience, Anaesthetists are all LOVELY! They are responsible for making you numb before surgery, and monitoring you throughout surgery, they will stand by your head during the birth.

Two Obstetricians- One doing the surgery and facilitating the birth, the other assisting. The lead surgeon is 'in charge' of the procedure, and both will be seated, usually behind a screen by your bump!

Midwife, at least two- one is 'scrubbed' (sterile, and will stand with the obstetricians to check, count and provide instruments, stitches etc.) The other will be there to support you, keep you informed of what is going on, and to support you with your baby after the birth.

Midwifery Assistant- to 'scribe' (write down) what is happening during the birth, double count instruments, swabs etc with the midwife, and pop in and out of theatre to fetch things/people.

Student Midwife/Medical Student- with your permission, they will shadow their assigned mentor and be there as addition support to you during the birth.

Paediatrician- in some instances a paediatrician may be present, depending on your medical circumstances or any concerns that arise during or following the birth.

So, after all those intros, you will receive a spinal anaesthetic, which goes into your back and makes you numb from the nipples down. The anaesthetist will use a cold spray to check it is working. You will have a blood pressure cuff on one arm, and some stickers, which can be put on your chest or back to monitor your heart.

With consent, your midwife will insert a catheter, to drain your urine during and following the birth.

Once you are comfortable and the anaesthetic has taken effect, the operation will begin. The atmosphere during the birth can be quiet and calm, or upbeat and relaxed, it's totally up to you!

After baby is born, if all is well, they can be placed straight on mums chest, or taken and wrapped up by the midwife before being brought back over for a cuddle.

The process of safely birthing the placenta and stitching the uterus and skin back up can take much longer the 'birth' part! Usually around 30-40 minutes. Plenty of time for cuddles with your new baby!

After this you will be transferred to a 'recovery' room, where you will be closely monitored for the few hours after birth, whilst the anaesthetic wears off. If you are planning to breastfeed, you will be supported to do so at this point.

OK Let's chat birth preferences!
Atmosphere of the room

Most hospitals will have the facility to play your choice of music throughout the birth. You can also bring earphones and an mp3 player if you prefer. You can play your hypnobirthing scripts, or any music that makes you feel calm and relaxed.

It is becoming more common for hospitals to be able to 'dim' the lighting of the theatre- with full lights on the operation area. This can help you feel relaxed and calm, and welcome your baby into a comforting area.

Photos, pictures or affirmations. You can bring in something to look at during the birth, to help maintain a sense of calm and make you feel confident and at ease.

The Birth

A 'gentle' caesarean. You can ask for the baby to be born more slowly, mimicking the process of a vaginal birth, squeezing fluid from the lungs, and allowing moulding of the head.

'Delayed Cord Clamping' can still occur during a c-section birth.

The screen can be lowered during the birth or straight after, so you can see your baby being born.

If you don't know the sex of your baby, you can ask for your birth partner to see, or find out for yourself.

Baby can be put straight onto your chest for skin to skin cuddles, getting all of the benefits of this as with any other type of birth.

More coming up on the risks and benefits, research, recovery and 'emergency' c-sections on the blog soon!

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Planned Caesareans: What are they like and what are your options? - birth-ed

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So, what actually happens in a caesarean? An operation where you're awake? That's got to be scary right?! It doesn't have to be, if you know what to expect. Usually, you'll come the hospital first thing in the morning, having not eaten or drunk since the previous evening.

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What to pack in your caesarean hospital bag

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What to pack in your caesarean hospital bag

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You'll want to make sure you have everything you need to make your stay in hospital as easy and stress-free as possible. You can then focus on what's most important - getting to know your newborn.

You probably won't have room to store everything in the small cabinet by your bed on the postnatal ward. So keep some things in a bag in the car, or at home for your partner to bring in when you need them.

Even if you're planning a vaginal birth, it may be worth throwing a few extra items in another bag, just in case you need an unplanned caesarean.

What will I need while I'm waiting for my caesarean?

You'll be admitted to hospital several hours before your caesarean is booked to go ahead. If the labour ward is particularly busy, your time slot may be put back. Having things to take your mind off the wait could help you to feel more relaxed (DH 2015a):

Your phone. So you can text friends and family, or distract yourself by playing games or listening to music (DH 2015).

Books and magazines.

Your caesarean birth plan, to remind yourself of your preferences for your baby's birth (DH 2015a). This includes things like whether you want music playing in the operating theatre, and whether you want the screen lowered so you can see your baby being born (NICE 2011).

What will my birth partner need while we're at the hospital?

These items will help your birth partner to take care of himself and to look after you:

Snacks and drinks. Although you won't be allowed to eat and drink before you have your caesarean, you don't want a dehydrated, hungry birth partner looking after you (APA 2015b).

Camera or mobile to take photos or a short film of the birth and early moments with your baby (APA 2015b). If you want your birth partner to take photos in the operating theatre, check with the hospital beforehand, as not all allow it.

Phone, for calling and texting friends and family when your baby arrives.

What will I need after my caesarean birth?

After your caesarean, you'll be offered painkillers to keep you comfortable (NHS 2015b). You'll be able to eat and drink again when you're ready (NICE 2011). Your nurse or midwife will encourage you to get out of bed and move around as soon as you feel able (NHS 2015b).

These items will help to make your stay on the postnatal ward as comfortable as possible:

Several pairs of high-waisted cotton knickers Normal knickers may rub your wound. Look for knickers without nylon or lacy fabric, as these can catch on or irritate your wound.

Maternity pads. You'll need these as you'll still experience some bleeding from your womb (uterus), or lochia, as with a vaginal birth (APA 2015a). You may need as many as 24 maternity pads , though you may want to buy more than this and keep some at home for when you leave hospital (DH 2015a).

Baby wipes or face wipes As you won't be able to get to the bathroom easily, these can help you to stay feeling clean and fresh.

Nappy sacks to make it easy to dispose of your used sanitary pads and wipes, and your baby's nappies.

A couple of comfortable, loose-fitting nightshirts. If you choose ones with short sleeves, it will help you to cope with a drip and a warm hospital ward. And nightshirts with buttons down the front will make breastfeeding easier (DH 2015a).

Dressing gown Hospitals can be very warm, so a lightweight one may be best (DH 2015a). A dark colour or a busy pattern will help to hide any stains, if you think that may be a concern for you. You'll have bleeding after the birth (lochia), and it's also perfectly normal to leak a little wee in the early days.

Bendy straws as it will be difficult to sit up to drink.

Handouts about how to get breastfeeding started that you may have received at your antenatal classes (APA 2015b). If you have a contact card for a breastfeeding counsellor or specialist, bring that with you too (DH 2015a).

Nursing bras Bring two or three, and bear in mind that your breasts are likely to grow bigger as your milk comes in (DH 2015a).

Breast pads You may need plenty if you're producing a lot of milk (DH 2015a).

Purified lanolin ointment or cream for your nipples, in case they get sore when you start breastfeeding.

Backless slip-on slippers or flip-flops that you don't need to bend down to put on, as this may be awkward at first.

Wrap or shawl, to have around your shoulders if you want to cover up or in case you get chilly. Some women feel a bit shivery after an epidural (RCOA 2009, Tidy 2015), and it can be difficult at first to twist around to get a cardigan or jumper on.

Lip balm and moisturiser. The warm air on the postnatal ward can dry out your skin.

Fibre-rich snacks to help ease constipation (GHC 2014) . Try dried prunes or apricots. If you are recovering well, you should be able to eat and drink as soon as you feel like it (NICE 2011).

Peppermint teabags Peppermint tea can help to soothe the pain of trapped wind, which you may have after surgery (GHC 2014). The smell of peppermint may also help relieve any nausea you're feeling after your caesarean (Lane et al 2012), so perhaps include a packet of mints (APA 2015b).

Arnica cream or tablets. Although there's no conclusive evidence that it works, some women say that arnica cream helps to reduce bruising and encourage healing (Fetrow and Avila 2001). Don't apply the cream directly to your wound, though.

Washbag containing towels, hairbrush, toothbrush, toothpaste, deodorant, shower gel and shampoo. You may want to choose unscented toiletries, as your newborn will love your own, natural smell. Decant them into smaller bottles or buy travel versions, to save on space.

Comfy, loose clothing for when you're up and about, such as T-shirts and jogging bottoms. Plus, clothes to wear home (DH 2015a).

Extra pillows. Some hospitals will supply these, but your own from home may be more comfortable (APA 2015b). A V-shaped pillow can give you extra support when breastfeeding your baby.

Mobile and charger. Most hospitals should allow you to use your mobile, but it's worth checking with your midwife first (DH 2015a).

Eye mask and earplugs, in case you have trouble sleeping on a brightly lit, noisy ward.

Glasses or contact lens case. There's not much room in your bedside cabinet, so this will ensure they don't get knocked or damaged (APA 2015b).

Notebook and pen. You may want to jot down your feelings, memories or experiences about your baby's birth and the first few days of being a mum. Or it could come in handy for noting down lists of other things you'd like brought in.

A small amount of cash. Some hospitals sell maternity and baby items, so have a bit of money with you in case there's anything you've forgotten. You may also want to take a credit or debit card, as some hospitals offer pay-per-view TV services. Check in advance to find out what's available.

Confidence! Don't be afraid to ask for help when you need it. Be prepared to press your buzzer to call for a midwife or doctor. They can help with everything from pain relief to nappy changing.

What will my baby need?

Your baby will probably sleep in your hospital room with you, in a cot beside your bed. Here's what he'll need while you're both on the postnatal ward:

About five sleepsuits and vests Newborn babies get through a lot of clothes. If possible, you may also want to have more on standby at home, so someone could bring them in if required.

Nappies. If you plan to use disposable nappies, you'll need as many as 12 a day for your newborn. If you're using reusable nappies, the exact amount depends on the type of nappy you choose.

Plenty of Muslin squares for mopping up milk that your baby may bring up (possetting).

Several pairs of socks or booties (DH 2015b).

A couple of hats (DH 2015b). Your baby will lose a lot of heat through his head (APA 2015b).

One outfit for the trip home (all-in-one stretchy outfits are easiest).

Jacket or snowsuit for winter babies.

Baby blanket Although hospitals are very warm, your baby may need a blanket if it's chilly outside when you leave (DH 2015b).

A few pairs of scratch mittens. Your newborn may have long nails, so this will help prevent him accidentally scratching his face or body (APA 2015b).

Disposable change mats. These cut down the need for bedding changes if you have to change your baby's nappy while he's in his cot.

A baby car seat (DH 2015b). Some hospitals won't let you leave by car without one. You may need to leave your baby's car seat in your car or at home until it's needed, though, as it can be too bulky to store in hospital.

See our guide to recovery after a caesarean birth.
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References

APA. 2015a. Caesarean birth after care. American Pregnancy Association. americanpregnancy.org [Accessed March 2016]

APA. 2015b. Packing for the hospital or birth center. American Pregnancy Association. americanpregnancy.org [Accessed March 2016]

DH. 2015a. Labour and birth. In: The pregnancy book. London: Department of Health, 85-6

DH. 2015b. What you need for your baby. In: The pregnancy book. London: Department of Health, 127-31.

Fetrow CW, Avila JR. 2001. Professional's Handbook of Complementary and Alternative Medicines. 2nd ed. Pennsylvania: Springhouse, 43-7.

GHC. 2014. Recovery after a caesarean birth. Group Health Cooperative. www.ghc.org [Accessed March 2016]

Lane B, Cannella K, Bowen C et al. 2012. Examination of the effectiveness of peppermint aromatherapy on nausea in women post C-section. J Holist Nurs. Jun; 30 (2): 90-104.

NHS. 2015a. Pack your bag for labour. NHS Choices, Health A-Z. www.nhs.uk [Accessed March 2016]

NHS. 2015b. Caesarean section. NHS Choices, Health A-Z. www.nhs.uk [Accessed March 2016]

NICE. 2011. Caesarean section. National Institute for Health and Care Excellence. NICE Guidelines, CG132. www.nice.org.uk [Accessed March 2016]

RCOA. 2009. Risks associated with your anaesthetic. Section 3: Shivering. The Royal College of Anaesthetists. www.rcoa.ac.uk [Accessed March 2016]

Tidy C. 2015. Pain relief in labour Patient UK. patient.info [Accessed March 2016]

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What to pack in your caesarean hospital bag

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You'll want to make sure you have everything you need to make your stay in hospital as easy and stress-free as possible. You can then focus on what's most important - getting to know your newborn. You probably won't have room to store everything in the small cabinet by your bed on the postnatal ward.

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Birthing partner information - Caesarean Birth

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Birthing partner information - Caesarean Birth

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Togel Hongkong - Togel Singapore - Togel Sidney - Keluaran SDY - Pengeluaran SGP - Data HK Hari Ini

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Labour Pains - Caesarean information sheet

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Labour Pains - Caesarean information sheet

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Why Caesarean Matters aims to navigate the research and put women at the centre of their own care so that their birth can be a positive experience, however it unfolds. The clear and evidence-based discussion addresses the questions that women and their care providers may have, enabling women to make positive decisions and feel supported if a caesarean is needed.

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Pinter & Martin is an independent publishing company specialising in pregnancy, birth, parenting, breastfeeding, yoga and psychology books

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Please click on the videos below to watch more about your caesarean birth. If you would like to read more about this topic, then make sure you take a look at our information leaflets or see our translations page.

The videos below cover the topic 'caesarean birth'

English

Please select your prefered language

Our videos are available in a variety of languages which is constantly being updated.

The above videos have been produced independently of the LabourPains.com working group and the Obstetric Anaesthetists' Association. As such, no formal responsibility is accepted for the included content. Local policies and practices on the provision of pain relief in labour may vary from unit to unit, but we hope that these videos may provide a useful overview on what pain relief may be available in a hospital near you.

To see our archived videos and material please click here.

We remain grateful to those individuals who have assisted with translating our videos. These videos have been translated to the best of our knowledge, however they have not been professionally verified.

Scan the QR code below to download the infographic on mobile or tablet.

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Information Videos - Your Caesarean Birth

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Please click on the videos below to watch more about your caesarean birth. If you would like to read more about this topic, then make sure you take a look at our information leaflets or see our translations page. English Our videos are available in a variety of languages which is constantly being updated.

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Most women in the UK get their maternity care for free through the NHS, but there are also private options available.
From paying for scans and doulas to private hospitals and amenity beds, this guide explains what services are available before, during and after giving birth.

We also list the pros and cons for both NHS and private maternity services and reveal what you might expect to pay if you decide to go private.
For ways to keep your family living costs down, and kids of all ages happy,
NHS vs private maternity care: pros and cons

Whether you choose private or NHS maternity care, there are benefits and disadvantages. We'll go into more detail further down the page but here's a quick overview of how they differ.

NHS maternity care: pros

It's free. This is from your first appointment through to scans, antenatal care, the birth itself and postnatal care. There may be some exceptions for non-UK residents but you'll never be turned away from NHS maternity care.

Access to a range of experts. If your birth becomes complicated, you'll have direct access to some of the world's best experts, without having to worry that your costs will rack up.

You still have choices. Whether it's at home, in a hospital or at a birth centre, having an NHS birth still gives you scope to somewhat tailor your experience. You have more options than you might realise. For example you can ask to use a different hospital rather than one that your GP may refer you to locally and you can also request to have an elective c-section .

NHS maternity care: cons

You might not get the birth you want. For example, if you've chosen a water birth but all the birthing pools at your chosen facility are occupied when you need one. The NHS will try to support your wishes but it may not always be possible.

You might not feel as supported as with private care. Staff shortages are a reality in NHS hospitals compared to private hospitals. Also, shift changes can mean you might have various midwives looking after you, even when you're labouring and this may be unsettling for you at the various stages of your pregnancy and birth.

Private maternity care: pros

A team of familiar experts. Whether it's an obstetrician or midwife-led delivery, you'll have the added reassurance of getting to know your team throughout your maternity care and birth.

Regular contact. One of the things you're paying for is their time so you may feel you can contact the facility as much as you like without feeling like you're bothering anyone. You might even have the mobile number of your obstetrician for out of hours use.

Hotel-like facilities. Luxury and privacy are standard and facilities often include 24-hour room service, satellite TV and premium toiletries in your ensuite bathroom. Unlike NHS hospitals, which tend to be strict on visiting hours, there may be more flexibility for visitors to come and see you if you've gone private, plus your partner may be able to stay.

Private maternity care: cons

It's expensive. Private care can cost many thousands of pounds and even with a package there may be lots of added extras such as epidurals, induction or instrumental delivery. The earlier in your pregnancy you start with a care package, the more you'll pay. You'll also pay more if you're expecting multiples.

You may end up with NHS treatment anyway if something goes wrong. The Portland Hospital for example has its intensive care facilities for newborns and mums, but most private delivery services are situated within or next to NHS hospitals and will use their facilities in an emergency, such as the obstetric emergency theatre on a standard labour ward.

There might not be one near you. Private maternity facilities aren't as common as NHS ones so you may have to travel to get to one. If your birth happens quickly and unexpectedly, you might not have time to get there. Most are in the London area so if you factor in antenatal care and unforeseen events such as going into labour early, it might not work for you unless you're London-based.

- our guide makes sure you have everything you need
Can I give birth in a private hospital?

Yes, you can choose to give birth in a private maternity hospital or unit or pick and choose aspects of private maternity care that suit your needs.

For example, although the NHS offers expectant mums at least two ultrasound scans during pregnancy , some people want 3D or 4D scans to see the baby's features more closely and these are only available privately.

What's it like giving birth in a private hospital?

If you're giving birth in a private hospital or on a private wing, your obstetrician will usually look after you in labour, but you can also have midwife-led care, depending on the package you've paid for.

Once you've given birth, you'll have a private ensuite room at the hospital with hotel-like facilities such as a concierge, luxury toiletries and 24-hour room service.

The cost of your room is usually included in the price although you can pay more to stay for extra nights or to upgrade to a suite.

Private midwives will then support you for your immediate postnatal care.
Taking baby home in a car? Make sure you choose one of our
How much does it cost to give birth at a private hospital?

When we looked in December 2022, the lowest cost we found for a vaginal/normal delivery with a consultant at a private hospital was £5,500 and the lowest for a c-section was £6,300 but this is a starting price. There are a number of variables and added extras to factor in when working out what the total cost might be.

Consultant-led or midwife-led delivery? A 'consultant-led' normal birth is different from a 'midwifery-led' birth, which is generally suitable for low-risk pregnancies. However, it still isn't cheap - we found one that started at £8,015 but extra charges could be added on if you stay beyond one night and have interventions such as an epidural or induction.

Your consultant's professional fees will be charged separately and it's likely the anesthetist's will too, so contact their administrative staff beforehand for an idea of what these might be.

Vaginal delivery, elective c-section or emergency c-section? Each of these incur a different cost. For example, a consultant-led 'normal' delivery at the Lindo Wing of St Mary's Hospital in Paddington has a basic price of £6,300 whereas a consultant-led c-section is £8,000 (plus consultant's fees in both cases). Not only that but you may want to check how many nights' stay you get after a c-section. Some, such as the Westminster Wing at Guy's and St Thomas' Hospital , include two nights' stay whereas many others only include one then charge anything from £750 to £1,325 for each additional night.

Unexpected extras. Unforeseen interventions such as epidurals, instrumental deliveries, inductions and delivering a baby in breech position may be charged for separately and could collectively add thousands to your final bill, not to mention if you end up having an emergency c-section. You may need to spend some time in hospital before the birth and you'll be charged for this, too. For example, per night an antenatal admission at the Kensington Wing at Chelsea and Westminster Hospital costs £1,325.

Where you live. It may be that where you live could affect not only your access to private maternity facilities, most of which are based in London, but also what you pay. Although a London private birth is expensive, one offers private delivery including up to a three-night hospital stay (plus follow up) for £17,000.

How do you pay? You may be asked to pay half of your fees as early as 20 weeks and although some private facilities offer payment plans, many will ask for BACS transfer or credit card payment. Get a breakdown of what's included before you sign up.

Why do parents choose to give birth in a private hospital?

In our 2022* survey, we asked 1,424 parents about where they had given birth - almost all had done so in an NHS hospital (90%) and around 4% gave birth in a private hospital or private wing.

There are various reasons you might choose to give birth in a private hospital or clinic, including:

A desire for additional comfort and/or privacy

Having more say in your care

The chance to develop a closer relationship with your midwife and/or consultant

Easy access to additional scans such as 3D and 4D ultrasound scans

*Baby & Child survey carried out in February 2022. - we compare the leading brands to discover whether one is better than another
What maternity care can I get on the NHS?

NHS antenatal care

With the NHS, you get seven to 10 antenatal appointments with a midwife, as well as blood tests and at least two free .

If you have more complicated needs, you'll also see a consultant (doctor) in addition to your midwife appointments.

NHS when giving birth

Most women have their baby in an NHS maternity unit. If you choose to have a home birth, two NHS midwives will come to your home to support you during the birth.

Whether you give birth in a birth centre or a labour ward, you'll always have your own room for the birth itself and be looked after by midwives. However, if you're induced you may need to spend time on a shared antenatal ward.

Similarly, if you need to stay overnight after the birth it's likely you'll be moved to a postnatal ward, where you'll be sharing a room and bathroom with a number of other women and their babies.

NHS postnatal care

Immediately after giving birth in an NHS facility, you'll go home a few hours after a straightforward birth or after a couple of days if you've had a c-section or experienced complications.

You'll have postnatal appointments with NHS midwives once you're back home. This may be at your home, or at a local clinic or children's centre.

The number of appointments varies, but most women tend to see a midwife three or four times postnatally.
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How can I enhance my NHS maternity care?

You can still choose aspects of private maternity care to suit your needs, even if you're not going completely private. In fact, our 2022 survey showed that out of just over 1,400 parents, nearly all had paid for private services during pregnancy or birth.

Private pregnancy scans and blood tests

Our 2022 research showed that almost all parents (83%) had a private scan during the pregnancy and around one in five (19%) had a private blood test.

The NHS provides you with all the diagnostic scans you need but some people pay for extras such as 3D and 4D scans at private clinics or private hospitals to enhance their experience, such as being able to see their baby's features more clearly and to get video footage of it.

For more information see our guide to NHS and private ultrasound scans during pregnancy .

Private amenity room after the birth

Women having an NHS birth sometimes choose to pay to hire a private 'amenity' room within the NHS maternity unit, which give you more privacy but where you'll still be looked after by NHS midwives.

The rooms are often just off the postnatal ward, and can cost anything from around £80 up to five times that, depending on where you are in the UK.

Our research showed that while just 6% of parents opted for a private amenity room in the NHS, almost all (97%) found it useful.

Hiring a doula

A doula is someone who has training in supporting expectant and new parents, rather than a health professional, and as such they're not there to replace midwives or other health staff.

Your doula can work with you during your pregnancy, be with you as a birth partner or advocate, or provide support in the early days postnatally - their service is tailored to your needs.
See all our
In our survey, 5% of respondents paid to have a doula and 90% said they found it useful.

Is NHS maternity care always free?

The rules say no-one should ever be denied NHS maternity care, but in some cases it isn't free.

The UK has a residence-based healthcare system so if you are 'ordinarily resident' here you're entitled to free NHS maternity care, whatever your citizenship or immigration status.

However, who is considered 'ordinarily resident' when it comes to NHS charging is complicated and the charity Maternity Action has a guide to who is considered 'ordinarily resident' in the UK to help you see where you stand.

Each NHS Trust has an Overseas Visitor Team with responsibility for reaching a decision about whether you'll be charge for your maternity care if you aren't ordinarily resident.

Can I choose to go private mid-way through my pregnancy?

Yes, and this may give you the benefit of some private care but without incurring the full cost.

To give you some idea, delivery by an obstetrician at the private facility of is £6,500 from 12 weeks of pregnancy, £5,500 from 28 weeks, £5,000 from 32 weeks and £4,500 from 36 weeks, although you'll generally pay 50% of your fees as early as 20 weeks and the remainder by 36 weeks.

Some private facilities - for example, the Sir Stanley Clayton Ward at Queen Charlotte's and Chelsea Hospital in west London - have a consultant-led late transfer elective c-section package suitable for patients from 38 weeks onwards and this starts at £6,795 (excluding extras).

However, in other situations you could find that the amount it costs is the same as if you started it early on in your pregnancy.

For example, , which represents independent midwifery, says that because an independent midwife has fixed costs to bear and will often have to work harder within a short space of time to give you the care you need, you still pay the full amount.

If you cancel - for example, to return to the NHS - you may be charged a cancellation fee (e.g. £400 at the Lindo Wing).
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You should be aware that, as per Department of Health guidelines, if you transfer from private to NHS care you're not permitted to change back to private care.

Can I pay for a private room in an NHS hospital after the birth?

The availability of private or 'amenity' rooms following delivery varies from one hospital to the next, as does the price.

Some offer single amenity rooms with shared facilities and some have private rooms with ensuite facilities. They may also have tea and coffee facilities and a television - some even allow someone to stay with you overnight.

However, even if your hospital has them, there's no guarantee you'll get one. They tend to be allocated on a first-come, first-served basis and can't be held or booked in advance.

Also, if you are occupying an amenity room that is needed by someone with a clinical need, you may have to relocate to an alternative room or a postnatal ward.

The cost varies from one hospital to the next but can start at around £80 for a single room with shared bathroom facilities, rising to, in some cases, upwards of £400 a night but whatever you pay, you are still an NHS patient and won't be given preferential treatment.

Can I hire a private midwife?

Yes, if you want more flexibility in your maternity care than the NHS can provide, you can look into hiring a private or independent midwife.

says a complete package of care throughout pregnancy, birth and the postnatal period costs anywhere between £2,000 and £5,000, although it can cost as much as almost £9,000.

Most independent midwives are happy to accept payment in instalments or flexible payment plans, and in some special circumstances they may consider caring for women for a reduced fee.

In this video, an independent midwife explains what she believes are the benefits of using a paid-for, non-NHS midwife for maternity care.

Having a home birth with a private midwife

Many women who choose to have an independent or private midwife are planning to have a home birth.

Private midwives can be a good option if you're finding it difficult to get support for a home birth from your local NHS services.

If you're having a home birth with a private midwife, there's still the possibility you may need to be transferred to hospital because you or your baby needs extra help.

In this case, the NHS midwives and doctors in the hospital will take over your care. However, your private midwife will still be there to act as a supportive birth partner.

Postnatal care with a private midwife

Women who have given birth with private midwives can pay to carry on seeing the same midwife they had throughout their pregnancy, after the baby is born.

Others may choose to supplement their NHS postnatal care by having additional private appointments as well.
See all our for information on child car seats, pushchairs, baby monitors, nursery furniture and much more.
As well as providing continuity of care, a private midwife can assist if you're having problems with breastfeeding and will also be a familiar face if you've had a challenging or difficult birth.

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NHS vs private maternity care: what are your options? - Which?

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When it comes to your pregnancy, we've got it covered. You'll find everything you need to help you feel confident and reassured over the next nine months right here.

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This video guides mothers through how to hand express, and talks about the times when hand expression might be useful.

See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk.

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Hand expression video - Baby Friendly Initiative

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Please note: The breastfeeding information on this website has been put together by La Leche League Leaders, who are accredited by La Leche League to provide breastfeeding information. Please note that Leaders have a wide knowledge and experience of breastfeeding but are not medically trained. If you have a medical query, or are concerned about your health or the health of your child please consult your doctor.

Information, references and links on this website are taken from La Leche League resources, unless stated otherwise. Please note that La Leche League GB does not endorse information from outside sources, extra information is provided for you to consider.

Information supplied is not intended as advice. You are in the best position to make a decision as to how the information offered will affect you and your baby.

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There are a range of ways LLLGB can offer you support with breastfeeding, by telephone, in writing, or using our online information and printed materials. If the blue "chat now" button is showing, then you can also use our online chat service to have an instant conversation with one of our breastfeeding counsellors.

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IS THRUSH CAUSING MY SORE NIPPLES?

Persistent nipple pain in the early weeks of breastfeeding, or nipple pain that appears after several weeks or months of pain-free nursing, may be caused by thrush, which is a yeast infection of the nipples. Thrush is caused by a yeast fungus, usually Candida albicans. Additional symptoms can include:

Itchy or burning nipples that appear fiery red, shiny, flaky, and/or have a rash with tiny blisters

Cracked nipples

Shooting pains in the breast during or after feedings

Intense nipple or breast pain that is not improved with better latch-on and positioning

When thrush occurs, the discomfort tends to be reported in the nipple region and almost always in both breasts as it is very contagious. If baby is nursing at the breast, thrush may be indicated by obvious symptoms in baby's mouth which appear as white plaques on baby's cheeks or gum tissue. You may be at higher risk for developing thrush if you or your baby has had a recent course of antibiotics, your nipples are cracked or damaged, or you are taking oral contraceptives or steroids (such as for asthma).

In the past, nipple pain was often attributed to thrush, however current research suggests that it is not as prevalent as once believed. Be sure to examine other causes of nipple and breast pain. Positioning and latching problems are the most common causes of pain. Vasospasm of the nipple or a bacterial infection are often confused with thrush symptoms. Breastfeeding isn't supposed to hurt! Check out our post on Positioning and latch for more information.

TREATMENT FOR THRUSH

Thrush can be very difficult to treat for many reasons. Yeast is so prevalent on our bodies so that some strains are not impacted by initial interventions. Many of the interventions that are suggested for thrush can be drying or irritating to the skin of the nipple, making it difficult to determine whether the pain is caused by thrush or the "cure" itself.

It is essential for both you and your baby to be treated for thrush, because it is easily spread, and thrives in warm moist environments, such as your baby's mouth. A baby may also have yeast rashes in the diaper area. Any skin that touches other skin is especially vulnerable for the breastfeeding dyad: under arms or breasts, between fingers or toes, in the groin area, and even in the creases of the eyelid. Yeast can spread to other family members as well, especially with shared bedding or eating utensils or cups.

According to the Academy of Breastfeeding Medicine (ABM), nystatin should be the first choice for treating thrush[i]. The ABM is a worldwide organization of medical doctors dedicated to the promotion, protection, and support of breastfeeding. They recommend:

Topical azole antifungal ointment or cream (miconazole and clotrimazole also inhibit the growth of Staphylococcus (bacteria) on nipples.[ii]

Nystatin suspension or miconazole oral gel for infant's mouth.[ii]

Gentian violet (less than 0.5% aqueous solution) may be used daily for no more than 7 days. Longer durations and higher concentrations may cause ulcerations and skin necrosis.

Of course, different people react better to different medicines, so you may have to try more than one. Check with your health care professional about the medications listed and other

After treatment for thrush begins, the symptoms may not disappear quickly. If the pain continues, offer your baby short, frequent feedings, beginning on the least painful breast. Some mothers use crushed ice to reduce pain before starting to nurse. Rinse your nipples with clean water and let them air dry after each feeding. If you find that applying cold to your nipples or air drying increases the pain, investigate whether the discomfort you are experiencing is related to nipple vasospasm. Taking mild over-the-counter pain medication (whatever you find effective for a headache) can also be useful. Wash your hands with soap and water very frequently during the treatment period - especially after nursing, diaper changes, and handling your breasts. Dry with a clean towel, or even paper towels during the treatment period.

Pumping your breasts and offering baby milk by a small cup may be another alternative, especially while you have cracked nipples. Just make sure you are sterilizing pump parts and feeding utensils after each use. (It is unclear whether the milk you pump during a thrush outbreak can be frozen and fed to your baby in the future as freezing does not kill yeast. Indicate on the bags whether they were pumped during thrush treatment and use if no alternatives are available or if you determine that you did not experience thrush in the first place. )

Yeast infections take some time to treat and heal. There is a section on treatment for other causes of sore nipples in this post.

Anything that goes into your baby's mouth (other than your breast or a finger) should be boiled for 20 minutes a day and replaced every week. Toys that go in your baby's mouth should be washed with hot, soapy water frequently

In addition to the medical treatment, there are other steps which some people report as helpful. Wash all bras, bra pads, nightgowns, etc. (anything that comes in contact with your nipples) in HOT water with bleach and dry on hot in the dryer or in the sun.

If you are using cloth diapers, wash with HOT water and bleach or a similar alternative.Consider using disposable diapers until the yeast infection is gone.

Rinsing your nipples with a vinegar and water solution (1 tablespoon apple cider vinegar preferred to 1 cup water) or baking soda in water (1 tablespoon per cup) after every feeding is helpful. Use a fresh cotton ball for each application and mix a new solution every day. Wash your hands thoroughly.

Many women report that reducing sugar, yeast, and dairy products in their diet helps.

Consider switching to a non-antibacterial hand soap during this time. Antibacterial soaps kill both good and bad bacteria, and good bacteria keeps yeast in check.

Nonetheless, experience tells us that yeast infections on other parts of the body can often be addressed without these extra steps. If you decide to try these home remedies, they should be in addition to the medication, not instead of it.

PERSISTENT THRUSH

Maybe you and your family have been dealing with suspected thrush for weeks or months. Persistent pain can be exhausting, and you are to be commended for sticking it out so long through this challenge!

Remember, in cases of thrush it is important to treat the breasts and the baby's mouth at the same time consistently. If you find that all of these treatments for your yeast infection do not improve your situation, it is possible that you are experiencing a condition other than thrush. Discomfort related to a shallow latch remains the most common cause of nipple pain. Bacterial infections may be more prevalent than thrush or occur at the same time and require a different treatment regime. Pain from vasospasm of the nipple is often confused with thrush symptoms. If the symptoms seem consistent with thrush and continue to resist treatment, you might also want to have medical tests done to rule out other conditions including anemia and diabetes. Talk to your healthcare provider and a lactation consultant (IBCLC) about these possibilities.

Attend a La Leche League Group meeting in your area for additional information and support.

RESOURCES FOR ADDITIONAL INFORMATION

The Womanly Art of Breastfeeding, published by La Leche League International, is the most complete resource available for the breastfeeding mother. It contains a section on breastfeeding while treating thrush. (Softcover, 480 pages.)

ABM clinical protocol: https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/26-persistent-pain-protocol-english.pdf

Positioning and Latch Article
Medications: A Quick Guide For Parents
General Pain Article
Nipple Pain Article

[i] Berens, P., Eglash, A., Malloy, M., et al. (2016). ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeed Med.

[ii] Barrett, M. E., Heller, M. M., Fullerton Stone, H., et al. (2013). Dermatoses of the breast in lactation. Dermatol Ther, 26(4), 331-336.

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IS THRUSH CAUSING MY SORE NIPPLES? Persistent nipple pain in the early weeks of breastfeeding, or nipple pain that appears after several weeks or months of pain-free nursing, may be caused by thrush, which is a yeast infection of the nipples. Thrush is caused by a yeast fungus, usually Candida albicans.

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Inverted or Flat Nipples

The size and shape of nipples and breasts vary from person to person and can change during the breastfeeding journey. It is common for nipples to gradually change shape, become more elastic and protrude more during pregnancy and while breastfeeding. When babies suck at the breast, they stretch the nipple and surrounding breast tissue into their mouth. The more elastic or stretchy the nipple, the easier it will be for your baby to latch. However, even if the nipples don't protrude more during pregnancy, you can still breastfeed. These variations often have very little to do with the baby's ability to breastfeed, because baby latches to the nipple and surrounding breast tissue.

If you have inverted or flat nipples, your baby may need more time and patience to breastfeed. A flat nipple is smooth next to the breast tissue. Inverted nipples withdraw below the surface of the nipple. If you think your nipple may be inverted, try placing your thumb and finger on opposite sides of the areola (the darker area of skin surrounding the nipple) and squeezing gently inwards. Sometimes nipples may be partly inverted, looking dimpled or folded. Severely inverted nipples retract deeply when compressed or stimulated. A nipple that stands out when stimulated is not inverted.

After your baby is born, your nipples may appear flatter than usual but babies often lick the nipple to stimulate it before latching on. Your nipples may also appear flatter if your breasts are very full or engorged.

A deep latch and comfortable position helps your baby latch and breastfeed effectively. In the beginning, the following techniques may help you initiate breastfeeding:

Immediately after birth, place your baby in skin-to-skin contact on your chest. Continue to use skin to skin during early breastfeeding to soothe your baby and to ease frustrations during breastfeeding. Ideally, the breastfeeding dyad is kept together until both are discharged.

Being with your baby helps you to recognize your infant's hunger cues.

Before breastfeeding, express several drops of milk, so the milk is immediately available when your baby latches.

You may massage your breast while breastfeeding to assist your baby in receiving milk.

To help evert the nipple:

Pull back on breast tissue so nipple will protrude more.

Breastfeed in a laidback or side-lying position especially if you have large breasts.

Breast engorgement can contribute to the nipple being less protruded. Massage the nipple and areolar area so milk will move back into the breast or will leak out, softening the areola and everting the nipple. Also try reverse nipple softening. Reverse pressure softening involves using gentle finger pressure around the base of the nipple to temporarily move some of the swelling slightly backward and upward into the breast.

Roll the nipple between the thumb and index finger and immediately afterwards touch the nipple with a moist cold cloth. Avoid making the nipple too cold because it can result in the nipple being numb, and inhibit let down.

Use nipple and breast support to help protrude the nipple. Use both hands on each side of breast to make a "sandwich", to squeeze nipple and areola. Use hands to press in on breast like the way you hold a big sandwich to put in the mouth.

Use a breast pump for several minutes to draw out the nipple. The suction from a pump will often cause the nipple to protrude more.

If you have had assistance with latch and tried the tips in this article and your nipples are still sore, consider trying a nipple shield. The nipple shield is a thin silicone devise that goes on top of your nipple and areola while breastfeeding. It looks like a brimmed hat. The nipple shield is a commercially made product. A nipple shield can be used temporarily to help establish breastfeeding or in some cases to help ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby's mouth where the soft and hard palate meet. This may help your baby suckle more effectively.

Commercial products that are intended to assist in drawing out inverted nipples such as breast shells or everters are best used only with the guidance of a trained lactation consultant.

If Nipple Soreness Occurs

You may experience nipple soreness for about the first two weeks of nursing while your flat or inverted nipple is gradually drawn out by baby's suckling. This discomfort is generally the result of adhesions or skin binding to underlying breast tissue. If the soreness is severe, or continues past the initial two weeks, consult your health professional.

If your nipple retracts after feedings, that skin may remain moist, leading to chapping of the skin. After feeding, pat your nipples dry and apply a moisturizer safe for breastfeeding. You may also want to wear breast shells or other devices to keep your nipple out between feedings so the skin can dry.

When Nipple Soreness is Prolonged
Rarely, sore nipples may persist for a longer period because instead of stretching, the adhesions remain tight. This can create a stress point which may lead to cracks or blisters.

If one breast is easier for your baby to grasp and he nurses well from that breast, you can continue to feed on that side. You can pump the breast with the deeply inverted nipple until the adhesions loosen and the nipple is drawn out. Your baby will get all the milk he needs from one breast if allowed unlimited and unrestricted time at the breast.

If both nipples are deeply inverted, you can pump both breasts simultaneously for 15-20 minutes 8 or more times in 24 hours. You can feed your baby with an alternative feeding device until she is able to latch on effectively and comfortably.

How long you will need to pump in order to draw out your nipples depends upon the strength of the adhesions and the degree of inversion. One pumping may be enough to completely draw out the nipple. If the nipple continues to deeply invert, you may need to continue pumping. When your nipple stays out after pumping, you can resume breastfeeding immediately.

Once your nipple can be drawn into the baby's mouth correctly and the baby can breastfeed effectively, you should be able to discontinue pumping and breastfeed without discomfort.

On rare occasions you may continue to feel some discomfort even after your nipple has been drawn out. This could be due to the correction to the nipple.

The nipple may invert again as your baby pauses during a feeding. In this case, you may need to stop breastfeeding and pump again for a few minutes before putting baby back to the breast.

As a temporary transition to exclusive breastfeeding, breast compressions or the use of a nursing supplementer might help to encourage continuous sucking and swallowing so that the nipple won't be as likely to invert during feeding.

If you do encounter challenges during your breastfeeding journey, support from a La Leche League Leader and other participants in Group meetings may help you to overcome the challenges. ( Find a Leader or meeting.)
Additional Resources
Cotterman, Jean K., Reverse Pressure Softening, http://breastfeedingmadesimple.com/wp-content/uploads/2016/02/SimplerRPSsheet2.pdf

Cotterman, Jean K., Reverse Pressure Softening, http://www.breastfeedingonline.com/rps.shtml#sthash.2MPE4KHE.T3v63FBt.dpbs

Cotterman, Jean K., Engorgement Help: Reverse Pressure Softening
... a technique to aid latching when a mother is engorged, https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/

Cotterman, Jean K. Reverse Pressure Softening, http://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm

Genna, Catherine Watson, Supporting Sucking Skills in Breastfeeding Infants, C. Burlington, MA: Jones & Bartlett, 2012.

La Leche League Great Britain, Nursing Supplementers, https://www.laleche.org.uk/nursing-supplementers/

Mohrbacher, N. Breastfeeding Answers: A guide to helping Families, 2nd edition

( Revised February 2022)

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Inverted and Flat Nipples - La Leche League International

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Inverted or Flat Nipples The size and shape of nipples and breasts vary from person to person and can change during the breastfeeding journey. It is common for nipples to gradually change shape, become more elastic and protrude more during pregnancy and while breastfeeding.

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Information and private consultations

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

The Association of Tongue-tie Practitioners (ATP) was set up in 2012 by a group of tongue-tie practitioners from the NHS and independent sectors with the aims of:

Increasing awareness about the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

Supporting parents of tongue-tied babies to access safe and effective care.

Assisting tongue-tie practitioners to provide safe and effective care through training and sharing knowledge and experience.

Providing resources and education for healthcare providers who refer babies for tongue-tie division.

The Association of Tongue-tie Practitioners (ATP) is also actively working to redress inaccuracies in the reporting and documenting of the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

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Association of Tongue-tie Practitioners | For parents & health care providers, all of the information you need about tongue-tie and the support available.

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

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Introduction

You have a sore or tender breast, a change in color in an area of the breast, or feel a hard spot or small lump. What now? Could it be mastitis?
Whatever the reason for your sore breast:

Breastfeed as often as your baby wishes

Rest

Apply ice or cold packs to the tender area

If you are engorged, consider doing lymphatic drainage-a very gentle, light yet firm touch, with fingertips flat to the skin in the armpit area and upper chest. To see a demonstration of lymphatic drainage massage, you can watch this video

In consultation with your healthcare provider, consider using ibuprofen (Advil®, Nurofen®...) alternating with acetaminophen/paracetamol (Tylenol®, Panadol®...)

What breastfeeding experts used to think of as separate problems in the breast, such as mastitis, blocked ducts, milk blister "blebs," and abscesses, are now suggested to be stages in the process of inflammation-the body's response to a threat. The Academy of Breastfeeding Medicine (ABM) has revised their protocol explaining this: ABM Protocol #36.pdf: The Mastitis Spectrum. The information in this article is based on this ABM protocol.

Blocked Ducts

Milk flows through a system of microscopic-sized tubes-ducts-in your breasts, which are easily compressed. When more milk is produced than your baby drinks (for example, if you're pumping in addition to breastfeeding), or a tight bra or strap compresses your breasts, this can produce pressure which your body responds to as a threat. Inflammatory cells and fluids rush into the area to help repair the damage and fight off bacteria. The swelling that occurs from this inflammation presses on some of the ducts, which slows or blocks the milk from flowing well. The skin in this area may appear darker, redder, or pinker than usual. In darker skin, redness may not be as easily detected or may not be visible at all. It may feel warm to the touch. If this inflammation is not treated, the area can become more inflamed or infected. This can occur any time your breasts become overly full, Possible factors include:

You and your baby are separated for longer stretches than usual between feedings

Your baby starts sleeping longer at night

Your baby is teething, has a stuffy nose, or is otherwise feeling out of sorts and nursing less.

Treatment for what we know as blocked/clogged/plugged ducts and mastitis is similar. You may want to try the following ideas:

Consider yourself sick, and rest! Focus on caring for yourself, your breast, and your baby.

Apply cold or ice packs to the affected area.

Be aware that antibiotics may not be recommended right away. This is not an infection when it starts, and antibiotics may encourage resistant strains of bacteria to thrive, and may make you more likely to have recurrent mastitis or an abscess in the future.

Make sure you are breastfeeding responsively to your baby (on cue) so that you don't unintentionally go too long between feedings. You want a good match between your baby's needs and the rate at which your breasts are producing milk. Read more about frequency of feeding in our FAQs.

Avoid excessive pumping. Extra pumping can make it difficult for your breasts to keep milk production at the level matching your baby's needs.

Check to see that your baby or child is well-positioned and has a good latch or attachment. This helps the baby to take more of your milk.

Change positions when you feed your baby to increase your comfort and help remove milk around the breast. This video showing natural breastfeeding positions can be helpful.

If you wear a bra, make sure it is well-fitting, supportive, and not tight. Avoid clothing or straps that are tight on the breast, chest, and underarm area.

If you have frequent blocked ducts that are not helped by the above recommendations, taking a lecithin supplement may help. The supplement may be sunflower lecithin or soy lecithin, if you do not have sensitivities or allergies to soy or dairy. The evidence for this supplement is not strong. You can find more information about this in the ABM protocol.

MILK BLISTERS (BLEBS)

A milk blister, or bleb, is usually a painful white dot on the nipple or areola. This is the result of inflammation or mastitis in the breast which sends inflammatory cells from the ducts down to the surface where they lodge in the nipple or areola area.

These are treated as any other condition in the mastitis spectrum. They do not always hurt and may resolve over several weeks. If you have a painful milk blister:

Apply ice or cold packs

Keep breastfeeding as your baby wishes

Follow the same recommendations as for blocked ducts

Avoid opening the blister yourself. It may bring some relief, but it also brings a risk of infection, more inflammation, and the possibility it will re-form. Avoid using soap or other cleansers on the nipple, as this can cause skin damage and pain.

If these suggestions don't help, ask your healthcare professional for help. They may prescribe a steroid cream to help the skin to thin out and open up, allowing better milk flow in that area.

MASTITIS

Mastitis can occur when an area of blocked ducts continues to be compressed, or more generally, when your breasts become overly full, causing swelling and inflammation. This does not happen as the result of one delayed feeding, but rather is part of a process.

Chronic engorgement, over pumping or trying to "empty the breasts," all increase the risk of mastitis. Areas of the breast where ducts are compressed may create opportunities for bacteria to take hold, becoming an infection.

It is important for your baby to continue breastfeeding from the affected side to help prevent the inflammation from worsening and creating an abscess. It is a myth that it is unhealthy for your baby to breastfeed while you have mastitis. Mastitis is not contagious: there is no risk to your baby in continuing to breastfeed. Breastfeeding responsively can help to reduce the inflammation in your breast.

If you have mastitis, you can try all the recommendations in the section on blocked ducts, as well as the following plan. Many symptoms of inflammation will go away without antibiotics when you follow these guidelines.

Signs, Symptoms, and Treatment

If you:

Can feel a hard, sore lump in your breast

Feel achy, tired, or run down

Have a low-grade fever of less than 101°F (38.4℃)

Notice a change in the appearance of the skin on the affected breast. An area of red, pink, brown, or gray may be noticeable depending on your skin tone and which part of the breast is inflamed. Some mothers have described a color change as triangular or "wedge" shaped on the skin. However, the absence of skin changes does not mean that mastitis is not present.

Then:

Rest as much as you can. Try resting in bed with your baby lying with you. Here are some LLL guidelines for safe bedsharing: sleep-safe-surface-checklist. Keep supplies such as nappies/diapers and wipes, toys, books, your phone, a container of water, and some snacks near you to minimize trips out of bed.

Keep applying cold packs or ice packs as often as you like to reduce inflammation and swelling.

Continue to feed your baby on cue, at least 8-12 times each 24 hours from both breasts. If you have a nursing toddler or older child, they may feed less frequently. If your baby refuses the sore side, you may need to express or pump some milk, just enough to soften the breast to the point it usually feels after a feeding.

To relieve engorgement, consider using lymphatic drainage, which is a very gentle, light yet firm touch, with fingertips flat to the skin in the armpit area and upper chest. This helps to move the fluid away from the ducts. Watch Lymphatic Massage for the Breast During Pregnancy and Lactation for a demonstration.

Ask your healthcare provider about using medications such as Ibuprofen (for example, Advil®, Nurofen®) to reduce inflammation alternating with acetaminophen/paracetamol (for example,Tylenol®, Panadol®) to help with pain.

Probiotics, taken by the mother, might help with mastitis. Two strains which were studied and found to be of possible help are Limosilactobacillus fermentum and Ligilactobacillus salivarius.
The authors state that more research is needed.

If you:

Do not feel any better, or feel worse after the first 24-48 hours

Develop a fever of 101°F (38.4℃) or more

Then:

Call your doctor or primary healthcare provider.

If antibiotic medication is prescribed, take it until the recommended course is completed, even if you feel better.

Continue to rest and drink plenty of fluids.

Continue to nurse. Hand express or (gently, try not to overdo this) if your baby is unwilling or unable to feed on the affected side.

Discuss using therapeutic ultrasound (TUS) with your healthcare provider. If TUS is available in your area, it may be helpful to relieve edema (swelling and extra fluid in the breast) and reduce inflammation. Many areas do not have this technology available, and the evidence for TUS is not very strong.

If there is no improvement after 48 hours, you might ask your healthcare provider if culturing your milk would be appropriate or available. Milk cultures are not available in all areas and there is some debate about the value of them, as interpretation of the results is difficult.

ABSCESS

An abscess is a swollen area of pus and bacteria walled off within the breast. This occurs in a small percentage of mastitis cases. It often appears as a very reddened or dusky area in a light skinned breast. In darker skin, redness may not be easily detected or may not be visible at all.

The area feels hard to the touch. This lump is usually very tender. It can seem to get better and then worsen, or your symptoms can worsen until the abscess needs to be drained.

In some cases, the abscess will open up and drain itself through the skin. If it needs to be drained, a physician (usually a radiologist or a breast surgeon) will either draw out the contents of the abscess with a needle aspiration, which may have to be performed several times, or by inserting a drain which will stay in place until the abscess has drained. A drain is typically inserted if more than two aspirations are necessary. In certain cases, surgery under anesthesia is necessary. In addition, antibiotics will most likely be prescribed if you have an abscess. No matter how your abscess is taken care of, continued breastfeeding on the affected breast is valuable in decreasing inflammation.

It can be useful to discuss the options for your individual situation with a La Leche League Leader. If you need to have a breast imaging ultrasound, here is a reference for continuing to breastfeed after testing: lumps-and-breast-imaging.

RECURRING BLOCKED DUCTS/MASTITIS

In order to prevent future inflammatory problems, it is wise to be cautious of unusually long stretches between breastfeeds. Frequently changing your baby's feeding positions, while ensuring a good latch, will help to get milk flowing from all the ducts. Maintaining good general health through your diet and getting extra rest may help keep your breast from getting sore again. Examine your breasts gently each day. If you find an area of tenderness, make sure to rest, use cold packs, and continue breastfeeding or expressing your milk to decrease the inflammation.

Mastitis can recur for different reasons. When bacteria are resistant or not sensitive to the antibiotic which was prescribed or when the antibiotics are not continued for long enough, it can recur. It can also recur when nursing is not continued on the affected side; or when the initial cause of the mastitis is not corrected.

If mastitis recurs, ask your healthcare provider if you might be able to have a culture and sensitivity test done on your milk. This can indicate what organism is causing the infection and what antibiotic will eliminate it.

Antibiotic-resistant bacteria are becoming much more common and are causing more serious infections, including in mastitis. Use of ineffective antibiotics, especially when used repeatedly, increases the risk of bacteria developing resistance to antibiotics. This can lead to an abscess.

OTHER CAUSES OF MASTITIS AND HOW TO PREVENT IT

There is some evidence that mastitis is more common in women who have recently taken antibiotics. Mothers who test positive for group B strep and those who have cesarean births are usually given antibiotics during their labor and delivery. This causes changes in the breast microbiome-the number and balance of microbes which live in healthy breast tissue. When the microbiome is changed in an adverse way, it is called "dysbiosis." Dysbiosis is one reason inflammation occurs.

Frequent pumping to build up a supply of milk in the freezer or to try to "empty the breasts" can be another cause of dysbiosis and inflammation from increased milk supply.

Exclusively pumping can also affect the microbiome, since there is no feedback from saliva in the baby's mouth to the nipple. Pump suction pressures may be higher or lower than the infant's suction when feeding at the breast. Suction pressures that are too high can lead to breast and nipple trauma and inflammation, increasing the risk of mastitis. Suction pressures that are too low can lead to breast inflammation due to insufficient milk removal. Pumps do not remove milk as efficiently as a baby feeding well directly from the breast and may contribute to a bacterial imbalance in the ductal system. Taking care in selecting your pump flange size and checking regularly around the nipple and areola after pumping can help reduce these risks.

If you are exclusively expressing, you may find the following articles helpful:
Life as an Exclusive Expresser
Exclusively Expressing Breastmilk for Your Baby

Nipple shields, pacifiers and other artificial nipples can affect how babies suck. They can affect the microbiome of the ductal system and thereby initiate an inflammatory process. Of course these tools may be important to help transition to direct feeding or to soothe a baby when breastfeeding is not feasible. As always, we encourage you to do what is best for your family. If you are trying to minimize pump, shield, and pacifier usage, get in touch with your local LLLLeader.

Some babies are reluctant to feed, have difficulties latching, or refuse the breast due to a nursing strike or other factors. Sudden changes in breastfeeding patterns may contribute to inflammation. Problems with inflammation commonly occur around the holidays or when you are entertaining company. At these times, feedings are likely to be delayed more than usual due to your being busy.

Make sure your clothing isn't too tight-fitting, particularly your bra. Some bras and bathing suits, particularly those with underwires, may put too much pressure on areas of your breast. A heavy purse or bag with a strap that crosses your breast or baby carriers can cause problems. Frequently changing which side you carry bags/purses on or how you wear your carriers, slings, and wraps may help.

Changing sleep positions throughout the night can help relieve pressure on the breasts. Wearing a stretchy sleep bra or camisole bra top may also help to take pressure off the breasts if you feel the need to wear a bra to sleep.

The shoulder strap of a seat belt can cause a sore breast, with a too tight strap applying pressure to your breast. Also, the pressure from the shoulder strap with a sudden stop may cause a sore breast. When taking long car trips, it is helpful to get out of the car to feed the baby periodically, which also removes pressure from the seat belt.

Certain injuries can result in sore breasts, such as being kicked or hit by an active toddler, or biting the breast. These may result in bruising and inflammation. Treat them with rest, cold or ice packs, and nurse per your baby/toddler's cues.

Prior breast surgery, breast lumps, or injury to the breast can also hamper milk flow and increase the risk of inflammation.

Another common cause of mastitis is reducing or attempting to stop breastfeeding (weaning) suddenly or too quickly. You might develop mastitis when you return to work outside the home, for example. See our article Working and Breastfeeding for support in expressing your milk or to work feeding around separations.

Breastfeeding challenges can sometimes make you feel anxious or sad. Anxiety may lead to over-pumping to create a stash of breastmilk, potentially causing inflammation. If you are feeling this way, please talk to a La Leche League Leader, and reach out to your healthcare provider.
At times, mastitis is the result of difficulties with positioning and/or latch that impact how efficiently your baby takes milk from your breast. A La Leche League Leader can help you explore changes you can make to help prevent these conditions from recurring.
Get local support.
Treatments which are NO LONGER recommended
Revised January 2023 by Dr. Justice Reilly, MBChB, IBCLC, and Susan Mocsny Thomas, RN

Heat to the breast, or soaking in warm water

Vigorous, deep massage, or squeezing to try to get rid of a clog

Dangling over baby for feeding to try to move a clog using gravity

Using a comb, vibrator, or electric toothbrush on the breast

Trying to "empty" the breast through extra pumping or breastfeeding which increases milk production

Using antibiotics right at the beginning of symptoms

Using Epsom salts in a Haakaa or similar silicone breast pump for nipple blebs

Using saline soaks, warm compresses, olive oil, castor oil, or other oils on the skin of the breast or nipple

Removing the skin or "popping" a bleb, which may allow infection to develop

Routine sterilization of pumps and household items is not necessary, although daily cleaning according to the manufacturer's instructions is important to avoid infection from dirty pump parts. For more general information see this.

Footnotes

1. Some points in the protocol are controversial within the lactation community. We will note and comment on them.

2. As noted in the disclosure statements in the protocol, one of the authors (Dr. Juan Miguel Rodriguez) has been the PI (primary investigator) of research projects and clinical assays funded by Puleva/Biosearch Life (Granada, Spain) or Nutricia (Utrecht, The Netherlands), involving the characterization, safety, and efficacy of probiotic strains for the mastitis target. He and his research group have never received any payment or royalty related to the commercialization of probiotic strains.

3. If you do not have access to a safe water supply, you can clean pump parts with water boiled (at 212°F, 100°C) for at least 20 minutes.

Resources

If you would like to read more about the causes of mastitis, here is a good review: Interventions for the prevention of mastitis following childbirth | Cochrane

Since much of the information in the most recent ABM mastitis protocol is new, you may find it helpful to share it with your healthcare provider: ABM Protocol #36.pdf

References

1. Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., ... & Academy of Breastfeeding Medicine, Clinical Protocol# 36: The Mastitis Spectrum, 2022, Breastfeeding Medicine, 17(5), 360-376,
https://pubmed.ncbi.nlm.nih.gov/35576513/ (accessed 7 February 2023)

2. Mitchell, K. B., & Johnson, H. M., Breast pathology that contributes to dysfunction of human lactation: a spotlight on nipple blebs, 2020, Journal of Mammary Gland Biology and Neoplasia, 25(2), 79-83,
https://pubmed.ncbi.nlm.nih.gov/32495215/ (accessed 7 February 2023)

3. Crepinsek, M. A., Taylor, E. A., Michener, K., & Stewart, F., Interventions for preventing mastitis after childbirth, 2020, Cochrane Database of Systematic Reviews, (9),
https://pubmed.ncbi.nlm.nih.gov/32987448/ (accessed 7 February 2023)

4. Baeza, C, Paricio-Talayero, J.M., Pina, M and De Alba, C. , Letter re 'Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022'' , Breastfeeding Medicine, 2022, Volume 17, Number 11,
https://pubmed.ncbi.nlm.nih.gov/36378818/ (accessed 7 February 2023)

5. Mitchell et al, Response to Baeza et al re Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022'', Breastfeeding Medicine, 2022, Volume 17, Number 11,
https://pubmed.ncbi.nlm.nih.gov/36378817/ (accessed 7 February 2023)

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You have a sore or tender breast, a change in color in an area of the breast, or feel a hard spot or small lump. Could it be mastitis?

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Why do I need to sterilise my baby's feeding equipment?

A baby's immune system is not as well developed as an adult's. So they could become very ill if they drank milk that was contaminated with bacteria.

Milk provides an ideal breeding ground for bacteria that could cause food poisoning, but sterilising kills the majority of these bacteria. Sterilising all your baby's feeding equipment helps to protect your baby against these illnesses, in particular diarrhoea and vomiting (First Steps Nutrition Trust, 2021).

That's why, in the UK, the NHS recommends that all equipment used for collecting, storing or feeding expressed breastmilk or formula milk for babies under 12 months is sterilised before use (NHS, 2019a).

How long do I need to sterilise bottles and other feeding equipment for?

The NHS recommends sterilising all feeding equipment each time you use it for at least the first 12 months of your baby's life (NHS, 2019a). Washing items in a dishwasher doesn't have the same effect of killing the bacteria (NHS, 2019a; 2021).

Do I still need to wash feeding equipment before sterilising it?

Yes, it's still important to wash your baby's feeding equipment thoroughly to remove any dried-on milk, because bacteria can grow on any remaining milk. As soon as possible after you've used bottles, teats, breast pumps and any other milk collection, storage or feeding equipment, thoroughly wash them in warm, soapy water. Check they are not damaged, too (NHS, 2021).

If you're using a dishwasher, make sure you place bottles and teats face down, so they don't fill with dirty water. If you're washing by hand, using clean bottle and teat brushes will help you reach every part of the bottle, teat or breast pump. Only use these brushes for cleaning your baby's bottles and teats (NHS, 2019a).

After washing, rinse all equipment in clean, cold, running water before you sterilise it (NHS, 2021).

Which method of baby bottle sterilisation is best?

We can't say for sure which method of sterilisation is more effective than another. So you might want to consider what suits you best to help you decide which method to use.

Cold water sterilising

Cold water sterilisers use chemicals, which are mixed with cold water, to sterilise feeding equipment. They can be bought in tablet or concentrated liquid form, which you add to cold water. They are also available as a ready-to-use sterilising solution.

Items you're sterilising need to be submerged in the cold water solution for at least 30 minutes before you use them (NHS, 2019a; 2021). This method can be used to sterilise a large number of items, making them ready for use as soon as you need them.

How to cold water sterilise baby-feeding equipment

Use a clean, watertight container with a well-fitting lid.

Make up the sterilising solution in accordance with the manufacturer's guidelines.

Try to make sure all items remain fully submerged in the solution and that there are no air bubbles. Items might need to be held in place by a floating cover or plate.

Leave the items in the solution for at least the length of time specified by the manufacturer and follow the guidance on how often to change the solution.

Remove items from the solution immediately before use. Shake off any excess solution or rinse with cooled boiled water from the kettle (not the tap).

Make sure you have clean, dry hands before removing items from the solution.

(NHS, 2019a; 2021; Public Health Scotland, 2021)

Boiling

The majority of bacteria are killed at a temperature of 100°C (boiling point of water) for 10 minutes. You do not need any specialised equipment, so this method is particularly useful if you're only sterilising occasionally.

Boiling might be particularly useful in the very early days. For example, if you need to hand express some colostrum to feed to your baby using a small cup or teaspoon you've sterilised (see our article about expressing and storing your milk for more information).

If you do use this method on a regular basis, some items may be damaged by the heat so might need replacing more regularly (NHS, 2021).

How to sterilise baby-feeding equipment by boiling

Check that the item is safe to boil.

Bring a saucepan of water to the boil.

Submerge the items to be sterilised in the boiling water, making sure they are completely covered and continue to boil for at least 10 minutes. You could set a timer so you don't forget to turn the heat off.

Never leave hot pans and liquids unattended.

Keep the items covered and remove them just before use.

(NHS, 2019a; 2021)

Steam sterilising

This works on the same principle as boiling. Water is added to the sterilising unit and the water boils, creating steam that kills the bacteria.

Several different types of steam sterilisers are on the market. Some steam sterilisers are used in a microwave, while others are stand-alone units that plug into the mains. Some microwave steam sterilisers can also be used as cold-water sterilisers.

It is also possible to buy reusable steriliser bags for use in the microwave, or bottles that can be sterilised alone in the microwave. These might be a more convenient option when you're away from home but have access to a microwave, or if you don't think you'll need to sterilise equipment very often.

How to steam sterilise baby-feeding equipment

Follow the steam steriliser manufacturer's instructions, which normally involves adding a specific amount of water to the unit and running it for a specific period of time. The length of time can vary from one steam steriliser to another.

Ensure the openings of bottles and teats are facing downwards in the steriliser.

Again, check the manufacturer's guidelines for information about how long you can leave items in the steriliser before using them.

(NHS, 2019a; 2021)

UV sterilising

UV light kills the majority of bacteria and viruses (including coronavirus) by destroying their genetic material and cell structure (Reed, 2010; Raeiszadeh and Adeli, 2020). UV sterilising units have UV light bulbs and reflective inner surfaces so the light bounces around and kills any microorganisms it touches.

UV sterilising units can be used to sterilise any baby equipment except latex rubber teats. As with other sterilisers, all items must be washed thoroughly first because even very small particles left on surfaces can deflect UV rays. Some units have a drying cycle so items can be put in straight after washing.

The advantages of UV sterilisation are that bottles can be used straight out of the machine without rinsing or cooling. They are also safer for the user because they don't use hot water, steam or chemicals and they are effective against a wider range of micro-organisms. They're long lasting, too - bulbs can last for over 2000 hours.

On the other hand, UV light doesn't pass through objects so everything must be completely dis-assembled and not touching. This might make UV sterilisers unsuitable for some things, e.g. the narrow tubing of some breast pumps. Also, the sterilisation cycle can take longer with these sterilisers.

What to do after sterilising

You can leave sterilised items in the steriliser or pan until you need them but the majority of manufacturers advise using or re-sterilising after 24 hours. If you do take sterilised items out, you'll need to put the teats and lids on the bottles immediately.

Clean and disinfect the area that you'll be using to prepare the feed or assemble the pump, or use the upturned lid of the steriliser.

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

Expressed breastmilk

Breastmilk contains ingredients that limit the growth of unwanted bacteria, but you'll still need to store and handle it carefully to prevent unwanted bacteria contaminating the milk. See our articles Expressing milk using a breast pump and Expressed Milk: Your questions answered.

You'll need to thoroughly wash and sterilise the cup, bottle or spoon and the washable parts of the breast pump just before you use them again (NHS, 2019b).

Formula milk

Powdered infant milks are not sterile, so it's important that they're made up in line with the instructions on the packet (NHS, 2019c). This will get rid of most of the micro-organisms that may be present (First Steps Nutrition Trust, 2021). Ready-made liquid formula milk is sterile until it is opened, but all feeding equipment will still need to be sterilised (NHS, 2021). See our articles Step-by-step guide to preparing a formula feed and What if I need to formula feed my baby away from home?

Any formula milk that's left in the cup or bottle at the end of the feed should be thrown away (NHS, 2019c). And you'll need to thoroughly wash up and sterilise the cup, bottle or spoon just before you use them again (NHS, 2019a).

Sterilising when out and about

Going out for the day or going on holiday can make the practicalities of sterilising, storing expressed breastmilk, or making up formula more challenging. So if you'd like to talk through how to do this when away from home, you can speak to one of our Breastfeeding Counsellors by calling our Infant Feeding support Line (see below).

Sterilising and microplastics

It has been reported that heating plastics frequently to the high temperatures needed for sterilisation by boiling or steaming them, then shaking when making up formula, releases microplastics from the bottles. The effect of these microplastics on humans is currently unknown (Li, 2020).

UNICEF have recommended parents follow current NHS guidelines until further research investigates the effect of these microplastics (IHV, 2020). Some parents prefer to use glass bottles to avoid microplastic contamination.

Where can I go for support?

You can speak to one of our NCT Breastfeeding Counsellors about any aspect of feeding your baby by calling the NCT Infant Feeding Line on 0300 330 070. The lines are open from 8am to midnight every day.

You might also find it useful to talk things through with your midwife or health visitor (NICE, 2015).
This page was last reviewed in February 2022.
Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our NCT Infant Feeding Line on 0300 330 0700. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

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

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

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How to sterilise baby bottles, breast pumps and other feeding equipment | Baby & toddler, Feeding articles & support | NCT

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A baby's immune system is not as well developed as an adult's. So they could become very ill if they drank milk that was contaminated with bacteria. Milk provides an ideal breeding ground for bacteria that could cause food poisoning, but sterilising kills the majority of these bacteria.

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How to cope with anxiety

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I think every parent-to-be, feels anxious at some point about whether they will be ok during their birth. With the current covid-19 pandemic, there seems to be so much more to worry about.

Your birth can sometimes feel so big that you can't even see past it, to the fact that you're actually having a baby. And when you start thinking about become a parent, it can be overwhelming.

From the thoughts of will you cope with sleep deprivation, feeding your baby, knowing what they want and how to do it, to the can it really be that bad and what if your baby is unwell?

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I think every parent-to-be, feels anxious at some point about whether they will be ok during their birth. With the current covid-19 pandemic, there seems to be so much more to worry about. Your birth can sometimes feel so big that you can't even see past it, to the fact that you're actually having a baby.

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Isabella gets dressed for her trip home from the hospital

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Everything you need to know

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Latest nappy news, help, advice & videos: The Very Best Brand Names Recommended by The Nappy Lady The Nappy Lady Recommends Free Expert Help & Advice Making cloth nappies work is all about getting the right sort of cloth nappy advice first.

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Restorative yoga nidra for going to sleep

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Yoga Nidra For Going To Sleep by Nicola Arnett

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Restorative Yoga Nidra, for going to sleep. 

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1. Urinary incontinence: what it is

Urinary incontinence is weeing or leaking urine without meaning to (NHS, 2016a). Pregnant women sometimes can't stop themselves from leaking wee when they cough, laugh, sneeze, move suddenly, do exercise or just get up from a sitting position (NHS, 2018).

2. What causes urinary urgency or incontinence in pregnancy?

The most common cause of pregnancy-related urinary incontinence or urgency is weak pelvic floor muscles (the muscles around the bladder) (CSP, 2017). This might be temporary as the pelvic floor muscles relax to prepare for labour (CSP, 2017).

Pelvic floor muscles support the uterus and help control the bladder and bowel. The weight of your baby can weaken these muscles.

3. What causes urinary urgency or incontinence after childbirth?

Another thing that weakens your pelvic floor muscles is, of course, giving birth. The pressure inside your bladder becomes greater than the strength of your urethra to stay closed and any sudden extra pressure sees wee leak out (NHS, 2016a).

Your urethra might not be able to stay closed if your pelvic floor muscles are weak or damaged. Alternatively, the muscle that keeps the urethra closed might be damaged. These problems may be caused by damage during vaginal births (NHS, 2016a).

4. Epidurals and spinal blocks may affect urinary incontinence

If you had an epidural or a spinal block, for a few days after birth you may not be able to tell when you need to wee. If you had an epidural, the catheter that was inserted into your bladder might make it harder for you to control when you wee too (NHS, 2017a). But this should get better within a few days.

5. Urinary incontinence is super common

In the three months after childbirth, a third of women suffer from incontinence (Thom and Rortveit, 2010). Yet a third of those women were embarrassed about mentioning it to their partners and almost half with friends (NCT, 2016).

Even more worrying? Almost 38% of women said they were self-conscious speaking about the problem with a healthcare professional (NCT, 2016).

"Incontinence is curable but only if you get help from a midwife, GP or health visitor (NHS, 2018)."

6. Pelvic floor exercises are key

If you're pregnant or planning to get pregnant, you should start doing pelvic floor exercises straight away (NHS, 2017c). This will lower your risk of experiencing incontinence after you have your baby (BAUS, 2017; CSP, 2017; NHS, 2017b).

Do your pelvic floor exercises even if you haven't had any leaks or dashes to the loo as they will improve your bladder control (NHS, 2017b). Find out how to do them here.

As long as the birth was straightforward, start the exercises again as soon as you feel up to it (NHS, 2016c). If you had stitches, start lying down and work your way up to doing them while sitting. Start with gentle, short, pelvic floor muscle squeezes.

If you had ventouse, forceps or a caesarean, start your pelvic floor muscle exercises once any urinary catheter has been removed and you are weeing normally.

Don't assume you don't have to do these exercises if you've had a caesarean. Being pregnant in itself can weaken your pelvic floor muscles so you're still at risk of bladder and bowel problems (sorry...).

As you feel more comfortable, squeeze a little harder and add in your long squeezes again. Gradually build up how many squeezes you do, and how long you hold. Try to do this four to five times per day. Once your baby is feeding well, put your favourite Netflix show on and you'll find this is the perfect time for your exercises.

7. There are other ways to help your bladder

As well as doing your pelvic floor exercises:

cut down on caffeine

avoid spicy and acidic foods

drink six to eight glasses of fluid a day but no more (many people with urinary incontinence avoid drinking fluids but this worsens it by reducing your bladder capacity)

be a healthy weight

quit smoking

avoid lifting.

8. There is specialist treatment available

If you have any concerns, ask your GP for a referral to a women's health physiotherapist. You should receive at least three months of supervised pelvic floor muscle training, for starters (CSP, 2017).

9. Consider the possibility of a urinary tract infection (UTI)

Sometimes, having no control over when you wee is caused by a urinary tract infection (UTI) (NHS, 2017d). UTIs can affect different parts of your urinary tract, including your bladder (cystitis), urethra (urethritis) or kidneys (kidney infection). Most UTIs can be easily treated with antibiotics (NHS, 2017d).

Symptoms of a UTI include:

needing to wee suddenly or more often than usual

blood in your wee

pain in your lower tummy

feeling tired and unwell

pain or a burning sensation when you wee

cloudy wee

unpleasant-smelling wee

fever.

Contact your doctor or midwife immediately if you have any of these symptoms because you might need antibiotics (NHS, 2017d).

10. It's crucial to break the taboo

Many women who get incontinence issues after they have a baby keep it quiet because they are embarrassed (CSP, 2017). Yet the condition is so common. It's certainly nothing to be embarrassed about.

Not seeking help can leave you feeling lonely, affect relationships and careers, and can stop you exercising or having sex. So take a deep breath and speak to friends, midwives and partners about what's happening to you. You'll feel relieved, supported and then you can start to get help and move on too.

Further information

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

The Chartered Society of Physiotherapy (CSP) has lots of useful information about pregnancy-related incontinence.

You can also use the CSP's Physio2U service to find a local practitioner or contact the Pelvic Obstetric and Gynaecological Physiotherapy group.

Read more about the evidence around incontinence.

NHS Choices has helpful information about urinary incontinence including symptoms and treatment.

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10 truths: leaking urine in pregnancy and after birth

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Urinary incontinence is weeing or leaking urine without meaning to (NHS, 2016a). Pregnant women sometimes can't stop themselves from leaking wee when they cough, laugh, sneeze, move suddenly, do exercise or just get up from a sitting position (NHS, 2018).

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Ten things you should know about induction 

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Ten things you should know about induction 

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by Sara Wickham

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In modern Western culture, most women and families know about induction of labour before they even become pregnant.

They know that it is suggested when it is felt that it would be safer for the baby to be born than to stay inside its mother. Many people also know that one of the main reasons for recommending induction of labour is because pregnancy has lasted for a certain number of weeks and the baby is perceived to be 'overdue'.

Other reasons for offering induction include that the woman is older than average, that her waters have broken early and/or that she has a health problem or condition. These days, induction is often suggested where someone has a high BMI, or has been told they have gestational diabetes.

There's a big focus on telling women when they are deemed to be 'at higher risk.'

Induction is really common now. Some people think it's oversold. Some are concerned about how a lot of the 'official' information is geared to promoting induction. For instance, women and families are often told the pros of induction, but not the downsides. There are pros and cons to everything! Some are given an induction date without even being asked whether this is what they want.

But this is not the whole story. There are many other aspects to the decision that some women need to consider about whether or not to have their labour medically induced.

That's what this blog post is about. I'm not going to tell you the things that you know or have already been told. I'm here to offer a deeper perspective and cover some of the lesser-known things you might want to consider.

Hello, I'm an induction researcher

In case this is your first visit to my website, maybe I should introduce myself. My name is Sara, hello. I'm a midwife and a researcher who has been studying induction of labour for more than twenty years. That's me in the pic, speaking about induction and risk in Australia.

I have written two bestselling books about induction of labour. talks the reader through the process and the pros and cons of induction. Inducing Labour: making informed decisions In Your Own Time: how western medicine controls the start of labour and why this needs to stop explains how we got to the current situation and looks more deeply at the evidence and issues in relation to topics such as the due date, suspected big babies, and being deemed to be 'at higher risk.'

And I'm passionate about helping women and families make the decisions that are right for them.

One quick note, though. I'm not anti-induction. I've looked after lots of women whose labours were induced. I want everyone to make the decisions that are right for them. If you're fully informed and decide you want an induction, that's brilliant. But lots of women and families aren't given all the facts, so that's why I've written this blog post. In it, I share some of the evidence, issues and implications that women have told me they were less aware of but which they wish they had been able to take into account when making their decision.

And there are, of course, far more than ten things to know! That's why I've managed to fill two whole books with information that parents may find useful when considering induction. This article is intended to serve as a starting point for discussion and offer links to more info rather than to tell you everything that you might want to take into account when making your decision.

So let's dive in!

1. Induced labour isn't like spontaneous labour.

This might be obvious to some people, but I know from experience that it isn't to others. Induced labour is very different from labour that starts spontaneously. Individual women's experiences vary, of course, but there are a number of key and interwoven areas of difference that are fairly universal. First, a woman having her labour induced is given artificial hormones. These can create more pain more quickly than would occur in spontaneous labour.

Synthetic hormones don't trigger the release of a woman's own natural pain-relieving substances as her own hormones would if she were in spontaneous labour. They also come with a range of possible side effects. That means a woman whose labour is being induced needs to be monitored more closely.

The increased monitoring can lead to the woman being less able to move around. That in turn can increase her pain and stress, and this can quickly lead to a woman feeling that things have spiralled out of her control. Not everybody finds this a problem, but it is something to be aware of. Induction can also take quite a long time. Women are often waiting (usually, but not always, in a hospital ward) for two or three days before labour really gets going. This is frustrating to some women, especially when their loved ones aren't allowed to stay.

It's also worth knowing that there are many advantages to spontaneous labour. These are lost when labour is induced, so that's the first reason why it's important to look at the pros and cons of both approaches. If you'd like more on this, I wrote a whole chapter on it in In Your Own Time: how western medicine controls the start of labour and why this needs to stop.

2. Some women find induction of labour more painful.

I started to cover this already, but there is a bit more to know about this in relation to possible sources of pain.

The contractions caused by the cervical ripening methods that are the first stage of medical induction can become really sharp really quickly, but without having any measurable effect. Some women feel that this has a negative effect on women's experiences, and it is easy to become tired and/or disillusioned more quickly than if they were in spontaneous early labour.

The contractions brought on by an oxytocin drip can also be very strong. There is often less time to get used to these than when labour starts spontaneously. With induction, your body doesn't get to make the decisions about what hormones you need and when. Those decisions are made by your caregiver and/or dictated by the hospital protocol or guidelines. They may or may not work for you and your body. Which is why induction sometimes fails, as I discuss below.

In addition, the increased number of vaginal examinations and other interventions (such as the insertion of cannulas) can create additional pain or discomfort. Again, not everyone finds this a problem, but it's worth knowing about beforehand. If you decide to have your labour induced, you might want to give some thought to your pain relief decisions. And plan ahead so that you can take things that will help you cope.

More on the process of induction in Inducing Labour: making informed decisions.

3. Induction of labour is a package deal.

I am frequently asked whether women can have a physiological placental birth or decline monitoring and/or vaginal examinations if their labour is induced. The answer is usually no.

But that's not because anyone wants to prevent a woman from making the decisions that are right for her. It's because the drugs used to induce labour are powerful substances that block a woman's own hormones. They can sometimes cause side effects in the woman or baby.

It is the effect of these drugs that needs to be measured, monitored and compensated for in induced labour. If a woman is concerned that aspects of induction are not what she wants, then it might be better for her to consider whether induction is really necessary or right for her in the first place.

I have written about this in this blog post too if you want a bit more detail.

4. Stretching and sweeping isn't benign.

Nowadays, many areas have introduced a policy of offering women a ' stretch and sweep ' at a certain point in pregnancy. They do this in the hope that this will reduce the number of women who go on to have full-blown medical induction.

Even if we ignore the assumption that all of the woman who are offered induction will consent to having it, there are downsides. A stretch and sweep can cause discomfort, bleeding and irregular contractions. And it probably won't do that much. In some of the studies the stretch and sweep intervention only brings labour forward by about 24 hours, and then only in some women.

It's also important to remember that a stretch and sweep is a form of induction. Find out more about what the research on this intervention can show us here.

5. Natural induction of labour is an oxymoron.

Some people talk about 'natural induction.' But there's no such thing. Either we are awaiting spontaneous labour, or we are trying to interfere and bring it on earlier than it would otherwise have occurred.

Sometimes there is good reason to try to bring labour on. But if a woman takes castor oil or has a stretch and sweep or picks any one of the range of things that are purported to bring on labour, then she is aiming to induce her labour with non-medical means. Some holistic therapists offer to help women 'go into labour' but try to avoid using the word induction.

I am not saying there is anything wrong with trying these things, but I think it's important to be clear. Either we are letting the body and the baby do its thing spontaneously, or we are trying to induce labour.

I'm not saying this because I want to stop anyone trying bumpy car rides or having acupuncture. You do you. And I love acupuncture. But I think it's important to be clear that all the different means of induction - which include western medicine, Traditional Chinese Medicine, home remedies, holistic therapy - are still induction. The alternative to medical induction isn't necessarily to choose another form of induction. Though it can be, for some. But the alternative to induction can also be to wait and let your body and baby do their thing. It's easy to forget this in a culture which over focuses on time and continually devalues patience and women's bodily processes. More on the over focus on time in In Your Own Time.

This is another issue that I have written about elsewhere if you'd like to know more .

6. Induction of labour is NOT the law!

I was absolutely appalled to hear, part-way through writing an earlier version of my inducing labour book, what one woman had been told.

' We have to induce you twenty four hours after rupture of membranes. It's the law'.

The woman agreed to induction when she was told this. She went on to have what she felt was a very traumatic birth experience.

In most countries, including the UK, there are no laws which state what a pregnant woman must or must not do.

And any practitioner saying such a thing should be reported to their professional body.

There's a bit more on rights in my book 'What's Right For Me?' There are also fab organisations around the world that help women to understand their rights. I recommend that anyone who is pregnant seeks out good local sources of information.

7. It's not 'just a trickle' (or a whiff)...

I am always really concerned when I hear midwives, doctors and birth workers using language which downplays the interventions that they are recommending or discussing. I particularly dislike the terms 'trickle' and 'whiff' when used in relation to intravenous oxytocin (syntocinon).

"It's just a trickle," they'll say.

That sounds very soft and innocent, doesn't it?

But that's always not how it feels to your body or baby.

Now, syntocinon is an amazing medication. As a midwife, I am grateful for it and have seen it literally save lives.

But anything that is sometimes lifesaving is, by definition, very powerful. Syntocinon is a very powerful and very overused drug which needs to be respected as such. It can cause the baby to not cope as well with labour. In fact, in some areas the practice is to keep increasing the amount of syntocinon that women receive until the baby reacts and shows that it isn't coping well any more. It is only turned down then as it is considered that the optimal level has been found. In this situation, the 'optimal level' is the maximum dose that can be given before the baby displays signs of stress. This in itself shows you what syntocinon can do to babies' wellbeing.

But even where this is not done and the syntocinon is only increased until contractions are effective at making a woman's cervix dilate, it is still a powerful drug that needs to be given respect.

If you weigh up the pros and cons of syntocinon and decide that it is right for you, then great. That's informed decision making. But its effects should not be minimised by professionals using language that downplays those effects.

More on the pros and cons of syntocinon in Inducing Labour: making informed decisions.

8. Women don't fail. Inductions and systems do.

This one pretty much speaks for itself.

Induction doesn't always work, and this is not the fault of the woman. As I discuss in Inducing Labour: making informed decisions, we now know that some women don't respond as well to the drugs used as others because of genetic factors. There are also several other reasons why induction might not work. A key one is that the woman or baby weren't ready for labour. If they were ready, labour would have begun on its own! That's a really key thing to consider when deciding whether or not induction is right for you. And it's not a black or white decision, either. Maybe it's not right today or this week, but you might want to reconsider the decision in a couple of days, in week or two, or if a genuine problem develops.

I wish I could reassure all women who have had an induction that was unsuccessful that there was nothing wrong with them or their bodies.

This is another case where some of the language used in the maternity services really needs to be reconsidered.

9. The risks are later, lower and sometimes less preventable than people think.

In both Inducing Labour and In Your Own Time, I look at a number of studies and data sets that look at the risk of stillbirth. And whether the chance of this can be reduced by inducing women's labours.

The simple answer to this is, well it's complicated.

Sorry about that.

But there is an advantage to knowing that it's complicated. When you encounter someone who tries to make it sound as if it's a simple decision, you'll know to ask some questions.

Here's an example. In some situations, like post-term pregnancy, the increase in risk doesn't happen as early as some people believe, and it is also lower than women are often told. In fact, the outcomes experienced by women who awaited spontaneous labour and by women whose labour was induced were so similar that none of the individual studies which compared induction with non-induction were able to show a benefit to induction in their findings. It is only when all of the results for all of the studies were added together that it was possible to see a small difference. And there was still a big question mark about whether induction really made a difference because the quality of the research wasn't that high.

As I will explain further in the next point, we don't always have good evidence that sad events like stillbirth are preventable by increased intervention, such as induction of labour.

Again, I have written about this in depth in Inducing Labour: making informed decisions and In Your Own Time.

10. The risks for older women, women with suspected large babies and women who conceived via IVF aren't as clear cut as is often suggested either.

My final point relates to the women who are told that they are at greater risk of having a baby with a problem, and that they should have their labour induced because of this.

This currently includes women who are older, women who are thought to have a large baby (even though we aren't very good at estimating fetal weight, even with ultrasound), women who have a higher BMI, women who have been told they have gestational diabetes, and women who conceived by IVF. Some other groups are affected too, but it depends a bit on where you are in the world.

This is complicated, too.

Let's look at older women as an example. Some studies show a correlation between increased maternal age and an increase in certain types of complications, including stillbirth.

But ... there's a big but.

That doesn't mean that induction of labour will improve outcomes. In fact, we don't have robust evidence demonstrating that it does.

It's nice to think that it would. It's nice to think that we can control things, and prevent tragedies. That's why the offer of induction is so compelling. But sadly, in many of these situations, there's no evidence that it will help.

There are also downsides to induction, so the decision needs to be weighed up carefully by the person who it will most affect.

Women who are older or deemed to be 'at higher risk' are often offered monitoring and intervention in abundance. But this can cause complications, restrict movement, and lead to more intervention.

Older women are also more likely to have other health challenges, which is sometimes called co-morbidity. That means that it is hard to tell whether these problems and/or their age are the cause of poor outcomes.

The studies that have looked at this have not always separated these issues out, and the only papers that have done so looked at women who gave birth some years ago, and who may not be comparable to women today.

So there is a real lack of good data in this area, and unfortunately the studies that are being carried out to look further at this are tending to induce even younger women even earlier in pregnancy, so their results may not be of much use to women either.

This issue is such a big one that I devoted an entire chapter of In Your Own Time to it.

What's the take home message?

Women who are offered induction of labour need to weigh up lots of things in order to determine which path is right for them.

We need to wholeheartedly support women who want their labour to be induced, and to wholeheartedly support women who don't.

Women report variable experiences of induction of labour. Some are really happy with their experience, and others much less so.

But the overarching thing that I hear from new mothers on the topic of induction is that many women wish they had had more information.

That's why I write so much about induction.

If you'd like to find out more so that you can get informed and make the decisions that are right for you, please look at my books.

Inducing Labour: making informed decisions talks the reader through the process and the pros and cons of induction.

In Your Own Time: how western medicine controls the start of labour and why this needs to stop explains how we got to the current situation and looks more deeply at the evidence and issues in relation to topics such as the due date, suspected big babies, and being deemed to be 'at higher risk.'

I wish you well in your decision making.

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Ten things I wish every woman knew about induction of labour - Dr Sara Wickham

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In modern Western culture, most women and families know about induction of labour before they even become pregnant. They know that it is suggested when it is felt that it would be safer for the baby to be born than to stay inside its mother.

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

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BRAIN - A useful tool to make decesions if offered induction

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BRAIN - A useful tool to make decesions if offered induction

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Induction of labour and balancing the risks

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Induction of labour and balancing the risks

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In Australia 33% of labours are induced ( 40.5% of first time mothers). The most common reason for induction is to prevent a 'prolonged pregnancy'. That's an awful lot of babies outstaying their welcome and requiring eviction. I am not going to get stuck into the concept of 'due dates' or rather 'guess dates' here - I discuss estimating birth dates in my book. This post will focus on induction of labour to prevent a 'prolonged' pregnancy and the complexities of risk in this situation.

A quick word about risk

I don't particularly like the concept of 'risk' in birth. There are all kinds of problems associated with providing care based on risk rather than on individual women. However, risk along with 'due dates' is here to stay, and women usually want to know about risks. Risk is a very personal concept and different women will consider different risks to be significant to them. Everything we do in life involves risk. So when considering whether to do X or Y there is no 'risk free' option. All women can do is choose the option with the risks they are most willing to take. However, in order to make a decision women need adequate information about the risks involved in each option. If a health care provider fails to provide adequate information they could be faced with legal action. Induction for prolonged pregnancy is not right or wrong if the choice is made by a woman who has an understanding of all the options and associated risks. As a midwife I am 'with woman' regardless of her choices. It is my job to share information and support decisions - not to judge.

What is a prolonged pregnancy?

Before we go any further lets get some definitions clear:

Term (as in a 'normal' and healthy gestation period): is from 37 weeks to 42 weeks.

Post-dates: the pregnancy has continued beyond the decided due (guess) date ie. is over 40 weeks.

Post-term: the pregnancy has continued beyond term ie. 42+ weeks.

The World Health Organization's definition of a 'prolonged pregnancy' is one that has continued beyond 42 weeks ie. is post-term. However, induction is usually offered when a pregnancy becomes post-dates with the aim of preventing it becoming 'prolonged'. Therefore, very few women experience a prolonged pregnancy - in Australia only 0.6% of pregnancies continue beyond 42 weeks.

The idea of a prolonged pregnancy assumes that all women naturally gestate their babies for the same length of time. However, it seems that genetic differences may influence what is a 'normal' gestation time for a particular woman. For example, Morken, Melve and Skjaerven (2011) found "a familial factor related to recurrence of prolonged pregnancy across generations and both mother and father seem to contribute." Therefore, if the women in your family gestate for 42 weeks so might you. The length of gestation may also be influenced by factors such as diet ( McAlpine et al. 2016).

The initiation of labour is likely caused by the baby who secretes surfactant protein and platelet-activating factor into the amniotic fluid as their lungs mature ( Mendelson 2009; Science Daily). This results in an inflammatory response in the mother's uterus that initiates labour.

The risks associated with waiting for spontaneous labour

Ageing placenta?

Some people believe that the placenta has a best before date and starts to deteriorate after 40 weeks resulting in reduced nutrition and oxygen for the baby. There is evidence that the structure and biochemistry of the placenta changes as pregnancy develops. Some scientists interpret these changes as the placenta growing and adapting to meet the changing needs of the baby: "There is, in fact, no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not..." Others argue that these changes are due to the ageing and deterioration of the placenta. However, tests of placental function show no changes in post-dates pregnancies ( Madruzzato et al. 2010). In practice, I have seen signs of placental shut down (ie. calcification) in placentas at 37 weeks and I have seen big juicy healthy placentas at 43 weeks. Sophie Messenger write more about 'the myth of the ageing placenta' here.

Big baby

People also have concerns that the baby will grow huge and therefore be difficult to birth. There is evidence that babies continue to grow bigger the longer they gestate, and this contradicts the above theory about the ageing placenta. If the placenta stops functioning, how does the baby continue to grow so well? Big babies are pretty good at finding their way out of their mothers expandable pelvis. The research about complications relating to big babies suggests that it is the interventions carried out when a baby is assumed to be big - rather than the actual size of the baby - that mostly contributes to complications ( Sadeh-Mestechkin et al. 2008; Blackwell et al. 2009; Peleg et al. 2015).

Meconium liquor

There is an increased chance that the baby will pass meconium as his/her bowels mature. I have written about this scenario in another post.

Perinatal death

The general rate of perinatal death (stillbirth + newborn death) increases as pregnancies advance beyond term. The rate remains small but is statistically significant. For example a systematic review and meta-analysis ( Muglu et al. 2019) reported that: "The overall gestation-week-specific prospective risk of stillbirth steadily increased with gestational age, from 0.11 per 1,000 pregnancies at 37 weeks to 3.18 per 1,000 at 42 weeks gestation... The risks of newborn death remained constant between 38 and 41 weeks, and only increased beyond 41 weeks" .

Post-dates induction of labour reduces the general rate of perinatal death. A Cochrane Review summarises the research examining induction vs waiting: "There were fewer baby deaths when a labour induction policy was implemented after 41 completed weeks or later." However, it goes on to say: "...such deaths were rare with either policy...the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks." Hands up all the women who had a discussion with their care provider about the relative and absolute risks of waiting vs induction...

Essentially, according to the available research, if you are induced at 41 weeks your baby is less likely to die during, or soon after birth. However, the chance of your baby dying is small either way - less than 1%... or 30 out of every 10,000 for those waiting vs 3:10,000 for those induced. This research article reports the relative and absolute risk of stillbirth at various gestations with waiting vs induction. The authors state that 1476 women would need to have an induction to prevent 1 stillbirth at 41 weeks gestation.

Reviews are only as good as the research they review and there are some concerns about the quality of the available research. The World Health Organization recommends induction after 41 weeks based on the Cochrane Review above but acknowledges the evidence is "low-quality evidence. Weak recommendation". Another review of the literature in the Journal of Perinatal Medicine ( Mandruzzato et al. 2010) concluded: "It is not possible to give a specific gestational age at which an otherwise uncomplicated pregnancy should be induced."

One of the main problems with quantitative research is that it rarely answers the question 'why', and rather focuses on 'what' (happens). For example, congenital abnormalities of the baby and placenta are associated with post-term pregnancy and this may account for the increased risk in some cases, rather than the length of gestation ( Mandruzzato et al. 2010). Quantitative research also takes a general perspective rather than addressing the risk for an individual woman in a particular situation. For example, is the prolonged pregnancy as sign of pathology, or does this woman come from a family of women who have a longer gestational timeframe? For a woman who has previously gestated to post-term without complications, there is no increased chance of an adverse outcome ( Kortekaas et al. 2015).

The risks associated with induction

It can be difficult to untangle and isolate the risks involved with induction because usually more than one risk factor is occurring at once (eg. syntocinon, CTG, epidural). In addition, there are differences in outcomes and risks between women who have previously laboured, and women having their first baby. It is important for women to consider their own individual factors and how they alter their individual risk profile. Care providers should also share individualised information when discussing induction options.

General risks associated with the induction procedure and medications

The induction process is a fairly invasive procedure which usually involves some or all of the following (you can read more about the process of induction here). There are a number of minor side effects associated with these medications/procedures (eg. nausea, discomfort etc.) There are also more significant risks:

The most extreme of these risks are rare, but fetal distress and c-section are fairly common. The potential effects of uterine hyperstimulation on the baby are well known ( Simpson & James 2008)- which is why continuous fetal monitoring is recommended during induction. This may also explain the association between induction and cerebral palsy ( Elkamil et al. 2010)

Induced contractions are usually more painful than a physiological contractions. Syntocinon (pitocin) produces strong contractions without the gentle build up and endorphin release of natural contractions. The National Institute of Clinical Excellence (UK) state that health care professionals should discuss this with women when offering induction "recognising that women are likely to find induced labour more painful than spontaneous labour".

Most research comparing induction with spontaneous labour combines populations of 'experienced' labourers with first timers. These studies report conflicting findings. For example, some studies report a lower chance of c-section with induction for this mixed group ( Gülmezoglu et al. 2012; Mishanina et al. 2014; Wood et al. 2014). In contrast, more recent studies have found increased rates of c-section with induction ( Zhao, Flatley, Kumar 2017; Ekéus & Lindgren 2016). A 2019 review compared the timing of induction for low risk pregnancies - 41 weeks vs 42 weeks ( Rydahl, Eriksen & Juhl 2019). The review used stricter inclusion criteria than previous reviews to "enhance the methodological quality and increase the relevance for contemporary maternity care"; and reported that: "Induction at 41+0-6 gestational weeks compared to 42+0-6 gestational weeks was found to be associated with an increased risk of overall cesarean section."

Risks for women who have had a previous labour

Women who have laboured before respond more effectively to syntocinon (pitocin) because they have more oxytocin receptors in their uterine muscle. Therefore, this group of women are more likely to experience a successful induction and avoid c-section. They are likely the reason for lower or similar rates of c-section the mixed group research discussed above. However, they are at increased risk of hyperstimulation with prostaglandin medication and/or syntocinon. So doses are usually smaller and very carefully monitored to avoid fetal distress. Women who have given birth vaginally before, are also at increased risk of perineal tearing if they have syntocinon induced contractions.

Risks for women having their first labour induced

Inducing a first labour requires higher rates of syntocinon, and the length of labour is usually longer. It is not surprising that first time mothers are more than 3 x more likely to opt for an epidural during an induction ( Selo-Ojeme et al. 2011); and epidural analgesia increases the chance of ending up with an instrumental birth - ventouse or forceps ( Anim-Somuah et al. 2018)

The majority of research comparing induction (IOL) with spontaneous (SP) labour in populations of first time labourers report increased c-section rates:

Another US study ( Ehrenthal et al. 2010) reported that after "adjusting for maternal demographic characteristics, medical risk, and pregnancy complications. The contribution of labor induction to cesarean delivery in this cohort was estimated to be approximately 20%." This brings up interesting risk comparisons relating to c-section vs the risk of post-dates perinatal death (see above). For example, induction is recommended because there is a less than 0.3% chance of perinatal death in post-dates pregnancies (see above). However, the chance of a significant complication during c-section (eg. hysterectomy) is higher than the chance of perinatal death in a post-dates pregnancy; and after a c-section the chance of stillbirth during a subsequent pregnancy increases to 0.4% - again, a higher rate than a postdates pregnancy.

A recent study causing a stir is the ARRIVE RCT trial (US) which reported lower c-section rates in the induction group (18.6% vs 22.2%). This one study is now being used to justify recommending early induction at 39 weeks - primarily because the findings align with cultural norms and preferences (see this post re. implementation of research findings into practice). Whilst I don't want to give this study unwarranted attention... it keeps popping up in conversations, workshops, and presentations. Like the perineal bundle - it is an unavoidable topic in the birth world. So here goes (briefly)... recommendations based on the trial are problematic in a number of ways. The findings and recommendations have been constructively critiqued by academics, midwives and obstetricians ( Dekker 2018; Carmichael & Snowdon 2019; Davis-Tuck et al. 2018; Scialli 2019). In summary, the main points are:

Only 27% of eligible women agreed to participate - Findings can only be applied to women who are willing to have a medically managed birth.

94% of the woman were cared for by private obstetricians in US medical settings - Findings cannot be applied to other types of care providers and settings which have much lower rates of c-section and higher rates of spontaneous vaginal birth.

Care providers were not blinded - Knowing about the trial my have altered their practice.

IOL reduced c-section rates by 4% - This cannot be used to recommend IOL to prevent c-section. Other factors have a much more significant effect on c-section rates eg. continuity of midwifery care; place of birth; intermittent auscultation in labour; etc.

The primary outcome measure for this study was perinatal outcome (ie. the baby) - IOL made no difference to the immediate outcomes for the baby, and the study did not address the long-term harm of early birth for the baby (eg. brain development).

In relation to the primary outcome measure - perinatal outcomes. Another study ( Selo-Ojeme et al 2011) found that outcomes for the baby were worse when a first labour was induced: "babies born to mothers who had an induction were significantly more likely to have an Apgar score of <5 at 5mins and an arterial cord pH of <7.0 ".

The experience of induction

Research into induction tends to focus on physical outcomes rather than women's emotional/psychological experiences of the process.

Choosing induction will totally alter the birth experience and the options open to you. Women need to know that agreeing to induction means agreeing to continuous monitoring and an IV drip, which will limit movement. Induced contractions are usually more painful than natural contractions and the inability to move and/or use warm water (shower or bath) reduces the ability to cope. The result is that an epidural may be needed. An induced birth is not a physiological birth and requires monitoring (vaginal exams) and time frames. Basically you have bought a ticket on the intervention rollercoaster. For many women this is fine and worth the risk, but I encounter too many women who are unprepared for the level of intervention required during an induction. This does not mean you have to hand over control of your decisions or your body; and in my book I include a chapter on creating a birth plan for induction of labour.

There have been some studies examining women's experience of induction. A UK study by Henderson and Redshaw (2013) found that "women who were induced were generally less satisfied with aspects of their care and significantly less likely to have a normal delivery. In the qualitative analysis the main themes that emerged concerned delay, staff short- ages, neglect, pain and anxiety in relation to getting the induction started and once it was underway; and in relation to failed induction, the main themes were plans not being followed, wasted effort and pain, and feeling let down and disappointed.". A German study ( Schwarz et al. 2016) concluded that: "women's expectations and needs regarding IOL are widely unmet in current clinical practice... and that "there is a need for evidence-based information and decisional support for pregnant women who need to decide how to proceed once term is reached."

A recent systematic review ( Coates et al. 2019) of qualitative research into women's experiences of induction of labour concluded that induction "is a challenging experience for women, which can be understood in terms of the gap between women's needs and the reality of their experience concerning information and decision-making, support, and environment. "

Alternatives to medical induction

Waiting for spontaneous labour

Around 90% of women who wait for spontaneous labour will give birth before 42 week, and only 1% will go beyond 43 weeks ( Gülmezoglu et al. 2012). Most guidelines recommend additional monitoring of the baby - however no form of monitoring reduces the chance of complications ( Gülmezoglu et al. 2012).

'Natural' induction?

There are a number of 'alternative' or 'natural' induction methods available (I have a chapter discussing the evidence for various methods in my book). However, trying to get the body/baby to do something it is not ready to do is still an intervention whether it is with medicine, herbs, therapies, techniques... or anything else. Interventions of any kind can have unwanted effects and consequences. Medical inductions take place with close monitoring of mother and baby and access to medical support if a complication arises. Alternative inductions do not have this level of monitoring or back up.

However, 'interventions' (massage, acupuncture, etc.) that are aimed at relaxing the mother and fostering trust, patience and acceptance may assist the body/baby to initiate labour if the physiological changes have already taken place.

Summary

A significant minority of babies will not be born by 41 weeks gestation. Whilst the definition of a prolonged pregnancy is 42 weeks+, induction is usually suggested during the 41st week. Women need to be given adequate information about the risks and benefits involved with either waiting or inducing in order to make the choice that is right for them. There is no risk free option. The risk of perinatal death is extremely small for both options. I know women who have lost a baby in the 41st week of pregnancy, and women who have lost a baby as a result of the induction process. For first time mothers the induction process poses particular risks for themselves and their babies. Each individual woman must decide which set of risks she is most willing to take - and be supported in her choice.
You can read more about induction in my book Why Induction Matters

Further resources

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Post-Dates Induction of Labour: balancing risks

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Updated: August 2019 In Australia 33% of labours are induced (40.5% of first time mothers). The most common reason for induction is to prevent a 'prolonged pregnancy'. That's an awful lot of babies outstaying their welcome and requiring eviction. I am not going to get stuck into the concept of 'due dates' or rather 'guess dates'...

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National Institute for Health & Care Excellance 

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National Institute for Health & Care Excellance 

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- information for parents

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This guideline has been updated and replaced by inducing labour

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Helpful Info and real stories of mums breastfeeding

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Helpful Info and real stories of mums breastfeeding

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Click below to watch the 13 short videos

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This information and videos are available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Meet four prospective mums, Melissa, Maria, Teresa and Angela. Melissa has never been through labour - she had a caesarian-section with her previous child. For medical reasons Maria has to have a c-section; Teresa wants to give birth at home; and Angela is expecting her third child. We follow them as they prepare for their births.

All our mums have different birth experiences. Find out why skin-to-skin contact is so important and about breastfeeding for the first time. "It's a great feeling to be able to provide for him without anything else, just me myself," Angela says. Melissa's partner Andy says breastfeeding is healthy, cheaper and much less effort than making up bottles.

Angela is back home with baby Cameron and breastfeeding is going well. "It's a great feeling to be able to sit there and watch him feeding away. It's a really special bond," she says. Teresa is making sure she has plenty of contact with Rufus, ensuring her body is supplying enough milk for him. Breastfeeding can protect you against ovarian cancer and give you stronger bones in later life.

How to make sure your baby is attaching well at the breast.

Meet four mums whose babies have been breastfeeding for a little while and hear their experiences. Linda was troubled by breastfeeding outside the home - until she tried it. "I thought, 'nobody breastfeeds in public,'" she says. "What I realised is, loads of women breastfeed in public, you just don't realise it's happening."

Find out about overcoming challenges like uncomfortably full breasts and mastitis, and how to position your baby so he or she feeds properly.

Linda and Heidi have fed their babies breast milk for six months. Now their babies are ready to try their first solids.

Join a class with specialist midwife Bella Dale, who explains how breastfeeding works and how mums' bodies start preparing to feed their babies before birth.

Three mums tell us how they overcame hurdles with breastfeeding. Thomasina overcame sore nipples, while Lowri encountered mastitis, both of which were caused because their babies weren't attaching properly at the breast.

We meet three mothers who express their milk for different reasons and learnt how to do it in different ways. Find out techniques for expressing, different pumps and ways to store breast milk. We also discover how mothers fit breastfeeding into their return to work.

In their first few weeks, pre-term babies may be fed using a nasogastric tube. But as they progress they will begin to take milk feeds, usually through a tube into the baby's mouth or nose. Breast milk is best for many reasons. Find out why and how as we follow four mothers and their premature babies.

Follow three mothers as they share their tips on the joys and challenges of feeding twins.

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The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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Your guide to breastfeeding and how to do it successfully.

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How to put your baby to bed safetly video

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How to put your baby to bed safetly video

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including what equipment you need

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All your baby needs for a safer night’s sleep

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What to buy (and what not to buy) for safer sleeping

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What to buy (and what not to buy) for safer sleeping

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Baby product information - The Lullaby Trust

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It can be hard to know which products are safest for your baby to sleep in. We’re here to help you find the safest baby products…

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Everything you need to know about Baby Sleep

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Everything you need to know about Baby Sleep

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The baby sleep
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Basis does not address clinical sleep problems or provide individual sleep advice and parents should contact a health practitioner with any concerns about their baby's health. For information about the organisations and funding that support Basis please see ' About Us '

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

Get it Now

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Research-based information on baby sleep for parents and practitioners, covering normal infant sleep, sleep safety, where and how babies sleep, SIDS and SUDI, parental sleep and free resources.

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

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

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

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

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

Key Features of Infant Sleep App

* Bed-sharing decision tool.

* Where will my baby sleep?

* How will my baby sleep?

* Sleep log to track baby's sleep

* Links to Basis info sheets.

* Links to Basis partner organisations

Frequently asked questions about the app

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

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

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

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and why you should hibernate for the month after your birth

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Having a baby is one of those pivotal moments in your life - all of a sudden your world spins on its axis and you see everything in a new light.

You may find that your priorities shift and that previously important things suddenly drop down your to do list, making way for the demands of motherhood and family life.

Having a baby will change your life forever; this is true whether it's your first or fifth baby.

And that monumental shift takes time to get used to, so it's important to allow yourself time to adjust.

Each new baby brings new responsibilities, fresh challenges and more demands on your time. After birth, you will need time to heal and rest. You and your baby need time to get to know one another and bond without distraction.

Many women feel a pressure to have it all and be everything to everyone, and these pressures don't simply disappear when you have a baby. Some women feel so concerned about losing their strong business reputation that they take work into the delivery room with them. Other women feel pressure to keep their homes beautiful, and so skip much-needed naps in favour of cleaning. Other women feel it is important for their bodies to shrink back as soon as possible, and so immediately start dieting and working out as soon as they can walk again, rather than resting.

Wouldn't it be great if we lived in a world where new mothers were encouraged to slow down, instead of being reminded about how quickly celebrities shift their baby weight? Where new mothers were complimented for how great they were at meeting their babies' needs, instead of the focus being on how they look?

In East Asia, a number of cultures encourage new mothers to rest for a full month. In India and Greece, this hibernation period is extended to 40 days. These cultures place great importance on this time by encouraging and supporting mothers to heal from birth and ease into new motherhood. Family members gather round to help out around the home, cook meals, clean and help with baby while mum takes necessary breaks. This hibernation period is a great way of nurturing new mothers as well as newborn babies. It may seem like an impossible feat, but you can carve out a chunk of time to spend bonding with your baby.

Why You Should Hibernate After Having A Baby

There are plenty of reasons why you should take some time after having a baby, including:

#1: You Need Rest

No matter how smooth-going your pregnancy was, how perfect your birth was, or how great your baby sleeps, you will still need rest. Even the easiest pregnancies contain their fair share of sleepless nights and aches and pains. And no matter how 'to plan' your birth went, your body still achieved something monumental and now needs the time to recover.

Giving birth and becoming a mother are not small everyday tasks, so there's no need to rush back to your everyday routine. Having a baby is a big deal and should be treated as such. Forcing yourself to carry on as normal the very next day could actually slow down how long it takes you to recover. It's not just your body that needs time to heal - having a baby is a peak emotional and psychological experience, too.

#2: You Need To Bond With Your Baby

For these few precious weeks, it really doesn't matter when you last hoovered your stairs, or how recently you washed your hair. What matters is that you and your new baby have the time to bond. This is the start of a lifelong love, so give yourself the chance to get to know your baby in the beginning. Remove distractions, slow down and spend some time soaking up your baby.

#3: You Deserve It

Growing a baby is hard work! It could be argued that giving birth is even more work. After all of that, you deserve a break. You were amazing during labour and birth, and now it's your opportunity to reap the rewards. So snuggle up on the sofa with your baby in your arms and don't move until you want to or really have to.

Being a mother isn't an easy job. It is physically demanding, can be emotionally draining and allows for very little sleep. Giving yourself this time to rest in the beginning will help you to replenish your own resources so you can be the best mother you can be.

#4: You Can

What better reason to take a break than because you can? The beauty of new motherhood is that you don't need an excuse to fob off the world. Nobody is going to judge you for spending all day every day in your pyjamas, so make the most of this period in your life.

How To Hibernate After Having A Baby

Ok, now that you're convinced about the importance of hibernation with your new baby, you just need to know how to go about it. Here are a few pointers to help you shut out the world and focus on your beautiful new family:

Fill up your freezer in advance - there's no need to eat for two during pregnancy, but you should be cooking to feed the five thousand. By the time the baby arrives, you should be struggling to close your freezer thanks to all the home-cooked meals in there. When the baby arrives, all you'll need to do is spend a couple of minutes with the microwave and you'll be able to have a nutritious and delicious meal. You won't need to slave away in the kitchen or spend hours at the supermarket, and will instead be able to spend that time with your baby.

Stock up on non-perishables - having to pop to the supermarket isn't really in-keeping with hibernation, so make sure your cupboards are stocked with all of the essentials. If you do run out of something, ask a guest to pick it up on the way over and save you a trip.

Accept help - friends and family want to help when you have a new baby, especially those who remember how exhausting those first few weeks are. Accept all offers of help, it may not feel natural but it will free up so much time for you to spend with your baby. Let people do you washing up, pick up your shopping, and take your older kids out for the day.

Get your partner on board - your partner can help you in two very important ways. Firstly, he can join you in the hibernation and enjoy spending his free time bonding with the new baby too. While he may have to return to work sooner than he might like, he can create a shorter period of hibernation for you all to enjoy as a family. And secondly, by understanding the importance of you doing nothing during this time, he can help out by not creating jobs for you to do around the home and play a role in carrying the load to support your rest and recovery.

Find company - hibernating doesn't mean you have to hide from friends and family. Invite your loved ones round to visit you and the baby. This can help you to feel connected to the outside world, whilst allowing you to enjoy your break from it.

...

Another important reason to hibernate is to minimise the chances your newborn baby will be exposed to whooping cough (currently in an outbreak year) and other germs. Babies have immature immune systems, and even if they are vaccinated, it can take time to provide any immunity. Find out more here.

PREGNANT and in MELBOURNE on April 7th? JOIN US at the BellyBelly Birth & Early Parenting Immersion. MAXIMISE your chances of getting the birth you want... MINIMISE your chances of a disappointing or traumatic birth experience. Come and hear from some of Australia's best educators.

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4 Reasons Why You Should Hibernate After Birth | BellyBelly

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Having a baby is one of those pivotal moments in your life - all of a sudden your world spins on its axis and you see everything in a new light. You may find that your priorities shift and that previously important things suddenly drop down your to do list, making way for the demands of motherhood and family life.

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About baby cues and body language

Your baby's body language can tell you how your baby is feeling and what they need from you.

Your baby's body language gives you important cues about whether your baby is:

Why it's important to respond to baby cues

When you notice your baby's body language and respond to it, your baby feels safe and secure. This helps you to build a strong relationship with your baby. And a strong relationship with you and other main caregivers is vital to your baby's development.

Recognising baby cues

All babies give cues to how they're feeling and what they need from you. But each baby develops their own mix of signs to tell you how they're feeling and what they want.

And as you and your baby get to know each other, you'll begin to recognise their cues and figure out the best way to respond to your baby's individual cues. For example, your grizzling baby might look relaxed when you smile at them, or they might seem to like it better when you sing and talk to them. This helps you know how to respond the next time your baby grizzles.

Understanding your baby's cues can take practice, and there'll be times when you don't know what your baby wants. At those times, it's good to remember that warm and gentle responses from you help your baby feel safe. Your responses also build your relationship with your baby.

Watch the video to learn more about baby cues.

If your baby is unwell, they might cry, seem listless or pale, have a fever or show other signs like a rash.

Baby cues that say 'I'm tired'

Tired signs in babies include:

staring into the distance

jerky movements

yawning

fussing

sucking fingers

losing interest in people or toys.

Watch the video to see what these cues look like in real babies.

When you recognise tired signs in your baby, it's a good idea to start settling baby for sleep.

Baby cues that say 'I'm hungry'

When your baby is hungry, they might:

make sucking noises

turn towards the breast.

Watch the video to see what hunger cues look like in real babies.

Baby cues that say 'I want to play'

Cues that your baby is ready to play with you include:

eyes wide and bright

eye contact with you

smiles

smooth movements

hands reaching out to you.

Watch the video to see more signs that your baby is ready to play and to see these baby cues in action.

When you recognise 'ready to play' signs in your baby, it's a good time to smile and talk to your baby. Baby play is simple: it's all about the interactions between you and your baby.

Baby cues that say 'I need a break'

Babies who are 4 months and older might not always be ready for a nap after their play time. Sometimes they might want a change of pace or activity instead. So what do these baby cues look like?

If your baby wants a break from what they're doing right now, they might:

turn their head away from you

squirm or kick.

Watch the video to see more signs that your baby wants to change activity and to see these baby cues in action.

When you recognise 'ready for a break' signs in your baby, it's a good idea to give your baby some quiet time or a different activity. For example, if your baby turns their head away from the rattle you're showing them, you could lie your baby on their back to look at a mobile for a while.

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Baby cues and baby body language: video guide

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Baby body language gives cues to whether babies are tired or hungry, want to play or need a break. Our guide has videos so you can see baby cues in action.

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Newborn Cues narrated - What is Your Baby Trying to Tell You?

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Step-by-step guide to massaging your baby

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Carry My Baby - Your Ergonomic Baby Carrier Specialist

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Go directly to our Youtube channel , or click to watch below

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We know this may still be a worrying time for everyone and that you may have particular concerns if you are pregnant or have a baby. We have put together the following advice on coronavirus (COVID-19) and caring for your baby that is currently available and will keep updating this.

Coronavirus (COVID-19) and caring for your baby

If you have a young baby, continue to follow public health advice:

Continue to breastfeed your baby if you are doing so

It is important that you continue to follow safer sleep advice to lower the risk of sudden infant death syndrome (SIDS). We understand that isolating at home and/or working from home can put additional pressures on families, however it is really important that your baby has a safe space to sleep. The safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket.

If you show symptoms of coronavirus (COVID-19) try not to cough or sneeze on your baby. Make sure they are in their own separate sleep space such as a cot or Moses basket in the same room as you for all day and night sleeps

If your baby is unwell with a cold or fever don't be tempted to wrap them up more than usual. Babies need fewer layers to lower their body temperature. Click here for more advice on temperature and here for more information about our Baby Check app. Please note the Baby Check app does not diagnose/test for COVID-19

Always seek medical advice if you are worried about your baby - either linked to coronavirus (COVID-19) or any other health issue click here for more information about our Baby Check app. Please note the Baby Check app does not diagnose/test for COVID-19

If you have questions about safer sleep contact our information line on 0808 802 6869 or email info@lullabytrust.org.uk.

Taking your baby to a clinic during the Covid crisis

During this time you may be worried about taking your baby for their routine appointments at your GP surgery or clinic. You may be anxious about what to expect when you get there, which is understandable. We have worked with some of the people who might help to look after you and your baby to help you understand what it might be like. It is really important that you take your baby to any appointments they have, or to get help if you are worried about their health.

Things will be a bit different and you may find that:

Reception staff and nurses will be wearing PPE; Reception staff wear masks, nurses are in a gown, apron, paper mask and visor. Some staff are drawing animal faces on the masks to make it a bit easier for babies and children to look at

There may be fewer people at the clinic as most are having telephone conversations with doctors. Anyone with Covid symptoms is asked to stay at home, so there are very few people attending clinics at the moment. Babies are a top priority.

You will be asked to wait in the waiting room as usual, however as it is quiet you should be able to stay 2 metres apart from others.

Clinics have a regular cleaning rota, and you might see people cleaning around you

You may have a few appointments combined into one - for example a six week check and first vaccinations.

The staff will get you and your baby checked as quickly as they can so you probably won't have to wait for long. This doesn't mean you won't have a chance to ask questions though, so make sure you write down what you might want to ask or say before you go.

Some tips for you:

It's important to go to your appointment unless you or you baby or someone you live with has symptoms of coronavirus or you are having to self-isolate.

You can book an appointment by calling your GP surgery or speak to your Health Visitor for further advice.

Always seek medical advice if you are worried about your baby - either linked to coronavirus (COVID-19) or any other health issue click here for more information about our Baby Check app. Please note the Baby Check app does not diagnose/test for COVID-19.

Try and take your baby with just one adult, and keep other adults and children at home if you can.

If your baby has not had their 6-8 week check the Institute of Health Visiting have produced some guidance on what you should do

Coronavirus (COVID-19) advice in pregnancy

As soon as you find out you're pregnant speak to a GP or midwife.

They'll support you and give you all the information you need. They'll also make sure you receive safe and personal maternity care.

If you're pregnant, it's important to follow advice about how to avoid catching and spreading COVID-19, such as washing your hands regularly. If you're more than 28 weeks pregnant it's especially important to follow this advice.

According to the (RCOG) Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms. However, a small number of pregnant women can become unwell with COVID-19. Pregnant women who catch COVID-19 are at slightly increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester. Pregnant women have been included in the list of people at moderate risk ( clinically vulnerable) as a precaution.

Although it's very rare for pregnant women to become seriously ill if they get COVID-19, it may be more likely later in pregnancy. If this happens, there's a small chance your baby may be born early or you may be advised to give birth earlier than your due date.

While the chances of having a stillbirth are low, there is some emerging evidence that the risk may be higher if you have COVID-19 at the time of birth.

It may be possible for you to pass coronavirus to your baby before they are born but when this has happened, the babies have got better.

There is also no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage or affects how your baby develops in pregnancy.

Advice from the Royal College of Obstetricians and Gynaecologists

Vaccination is recommended in pregnancy. You can get vaccinated against COVID-19 if you're pregnant and aged 18 or over. Receiving two doses of the vaccine is the safest and most effective way of protecting you and your baby from COVID-19 infection (read our Q&As about COVID-19 vaccines and pregnancy for more information).

As COVID-19 restrictions ease across the UK, pregnant women who are unvaccinated or not fully vaccinated, may choose to limit the close contact they have with those they do not usually meet with in order to reduce the risk of catching or spreading COVID-19, particularly if they are in the third trimester and when COVID-19 disease levels in the general community are high.

Keep mobile and hydrated to reduce the risk of blood clots in pregnancy.

Stay active with regular exercise, a healthy balanced diet, and folic acid and vitamin D supplementation to help support a healthy pregnancy.

Contact your maternity team if you have concerns about the wellbeing of yourself or your unborn baby.More information on pregnancy and COVID-19 is available on the NHS website.

Appointments and scans

You'll still have regular appointments and scans while you're pregnant. But there may be some changes.

You may find that:

some midwife appointments are online, by phone or by video call.

you may be asked to wear a mask or gown when you're in a hospital or clinic.

you may be asked to show proof of a recent negative COVID-19 test.

some appointments may be cancelled or rescheduled - your appointment will be rescheduled or you'll be able to rebook.

This is to help keep everyone safe and stop the spread of COVID-19.

If you're unsure if you can bring your partner to your appointment, ask your midwife or maternity team.

Important

If you're well, it's really important you go to all your appointments and scans for the health of you and your baby.

Hospitals and clinics are making sure it's safe for you to go.

Other things to consider

When you are visiting family or friends with your baby remember it is still important to continue to follow the government guidelines to prevent the spread of the virus.

If things are feeling overwhelming and you are increasingly anxious it is important to talk about this with your Health Visitor.

If you are feeling anxious now that lockdown has lifted this the NHS has some useful tips https://www.nhs.uk/every-mind-matters/coronavirus/tips-to-cope-with-anxiety-lockdown-lifting/

It is important to try to look after your mental health as well as your physical health - this website has some useful tips. The Institute of Health Visiting has some useful contacts to support your mental health during pregnancy and after having a baby https://ihv.org.uk/families/parenting-through-coronavirus-covid-19/

Check in your local area if local fitness classes have resumed or you may wish to consider online fitness workouts to keep active, postnatal Yoga or Pilates for example. There are lots of mindfulness and mediation websites and apps that might also help.

If you have questions about safer sleep contact our information line on 0808 802 6869 or email info@lullabytrust.org.uk.
We will update this page as more advice is available. Click here for more advice on safer sleep
Coronavirus (COVID-19) and caring for your baby FAQs

Although there is no research evidence on COVID-19 and infants yet, we have put together some advice to try to answer some questions you may have around caring for your baby during this time.

Advice for if you smoke from the Smoking in Pregnancy Challenge Group

How do I self- isolate and keep my baby safe?

By following our safer sleep advice, you are doing all you can to reduce the risk of SIDS. Follow the NHS guidance on self-isolation: https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-and-treatment/when-to-self-isolate-and-what-to-do/

Do not leave home for any reason and you must not leave home is you are self-isolating- if you need food or medicine, order it online or by phone, or ask someone to deliver it to your home.

Do not have visitors in your home - including family or friends expect for people providing essential care.

Do any exercise at home - you can use your garden, if you have one.

What do I do if I/my partner show signs of the virus?

If you have any of the main symptoms of coronavirus (COVID 19) get a test as soon as possible. Stay at home until you get the result.

The main symptoms of coronavirus (COVID-19) are:
What to do if you have symptoms

a high temperature- this means you feel hot to touch on your chest or back (you do not need to measure your temperature)

a new, continuous cough- this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)

a loss or change to your sense of smell or taste- this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal.

If you have any of the main symptoms of COVID-19, even if they're mild:

1. Get a PCR test (test that is sent to a lab) to check if you have COVID-19 as soon as possible.

2. Stay at home and self-isolate and do not have visitors until you get your test result - only leave your home to have a test. Check if people you live with need to self-isolate.

Get a PCR test to check if you have COVID-19 on GOV.UK https://www.gov.uk/get-coronavirus-test

How long do I/my partner self-isolate if one or both of has symptoms or tests positive?
https://www.nhs.uk/conditions/covid-19/covid-19-symptoms-and-what-to-do/
The self-isolation advice for people with coronavirus (COVID-19) has changed. It is now possible to end self-isolation after 5 full days if you have 2 negative LFD tests taken on consecutive days. The first LFD test should not be taken before the fifth day after your symptoms started (or the day your test was taken if you did not have symptoms). The self-isolation period remains 10 full days for those without negative results from 2 LFD tests taken a day apart.

Help and support whilst you are self-isolating/staying at home

Contact family and friends to ask them to help with medical or shopping supplies

You can also get help from an NHS volunteer, where healthcare teams can refer people for 'Check In and Chat' and volunteer responder can provide a friendly phone call and a listening ear.

Most local councils offer help for those who are unable to go out for supplies. Check the website of your local council for details or call your local councillor.

Contact family and friends online to talk to so you don't feel so alone.

The NHS website has more information on how to look after yourself during covid-19.

Plan ahead: It's a good idea to have a plan if one or more of you become infected; where will you both sleep for example? How will you manage childcare? How will you ensure you are still able to follow safer sleep advice?

Can I still breastfeed if I have coronavirus (COVID-19)?

Yes. There is no evidence showing that the virus can be carried in breastmilk.

If you breastfeed your baby, the following precautions are recommended by Royal College of Gynaecology:

Wash your hands following the recommended guidelines before touching your baby, breast pump or bottles

Try to avoid coughing or sneezing on your baby while breastfeeding. Have a drink of water and box of tissues within reach. Catching coughs and sneezes in tissues helps prevent the spread of infection.

Consider wearing a face mask while breastfeeding, if available

Follow recommendations for pump cleaning after each use

Consider asking someone who is well to feed your expressed breast milk to your baby. It is essential that you closely follow sterilisation guidelines if you are feeding your baby with formula or expressed milk. You must also follow these guidelines for any soothers or teethers that you may give to your baby.

If you have any worries or concerns speak to your Midwife or Health visitor, support is available.

Can I still use a breast pump?

Yes, and the same advice should be followed as above. If you are expressing breast milk in hospital, a dedicated breast pump should be used.

If you are feeding with formula or expressed milk, sterilise the equipment carefully before each use. You should not share bottles or a breast pump with someone else.

UNICEF recommends that if you are too ill to breastfeed you can express milk and give it to the child via a clean cup and/or spoon - all while following the same infection prevention methods as above.

Can I breastfeed if I have had the vaccination?

The JCVI has recommended that the vaccines can be received whilst breastfeeding. This is in line with recommendations from the USA and the World Health Organization.

For further information on breastfeeding and vaccinations see the NHS advice here:

Can I still have skin to skin contact?

Yes. It is recommended to continue with skin-to-skin contact with your baby.

Can I still attend antenatal/postnatal appointments?

Yes, making sure that you access antenatal and postnatal care when you are pregnant and have a new baby is really important to ensure the wellbeing of you and your baby. Many appointments will now be over the phone or online such as through Skype or Zoom.

To attend any appointments in person, you must not be self-isolating because you or your partner has had contact with the COVID-19 virus, it is important that you advise your midwife of any concerns rather than miss an appointment or attend if you think you may be infected.

Should I bedshare with my baby if I am unwell?

If you are unwell we would advise that your baby sleeps in their own separate sleep place, such as a cot or Moses basket in the same room as you. When your body is fighting an infection, you may sleep more deeply and not be as responsive as when you are well. You may also be taking medication that could make you drowsy.

Even if you are well it is important for you to know that there are some circumstances in which co-sleeping with your baby can be very dangerous:

Either you or your partner smokes (even if you do not smoke in the bedroom)

Either you or your partner has drunk alcohol or taken drugs (including medications that may make you drowsy)

You are extremely tired

Your baby was born premature (37 weeks or less)

Your baby was born at a low weight (2.5kg or 5½ lbs or less)

Never sleep on a sofa or armchair with your baby, this can increase the risk of SIDS by 50 times

If my partner is unwell can we bedshare?

We would advise that your partner sleeps somewhere else or you put your baby in their own separate sleep space such as a cot or Moses basket. If either of you switch to the sofa to sleep, don't be tempted to take your baby to sleep with you, sleeping on a sofa with your baby increases the risk of SIDS.

What do I do if I bedshare but I have a slight temperature?

If you have a temperature we would advise you to sleep your baby in a separate sleep space. Your increased body temperature may make your baby overheat. Research shows that babies that get too hot have an increased risk of SIDS.

What do I do if my baby has a temperature?

If your baby is unwell with a cold or fever don't be tempted to wrap them up more than usual. Babies need fewer layers to lower their body temperature. Click here for more advice on temperature and here for more information about our Baby Check app.

Always seek medical advice if you are worried about your baby - either linked to coronavirus (COVID-19) or any other health issue
How do I know if my baby is getting really ill, or if they are just 'a bit' unwell?
This NHS link has advice on looking after a sick child https://www.nhs.uk/conditions/pregnancy-and-baby/looking-after-sick-child/
The Baby Check app does not diagnose COVID-19
If your baby is unwell the Baby Check app has 19 simple checks that parents can do if their baby is showing signs of illness and will give a score. If the check gives a low score but you are still worried, you should seek advice from a doctor or NHS 111.

I am really worried about my baby as they have scored high on baby check app but is it a risk taking them to a doctor or hospital because of COVID -19?

If your baby is unwell it is important to seek medical attention. If you are unwell or self-isolating you need to make the health professionals aware. Call your doctor or NHS 111.

I am worried about taking my baby for their routine checks and appointments because of COVID-19 should I delay or avoid going?

We know it can be worrying to think about taking your baby to a clinic at the moment, but appointments for you and your baby are really important. See 'Taking your baby to a clinic during the Covid crisis' for key information and tips for you on what to expect and how to prepare for a visit.

We would advise you to keep all medical appointments, and make sure your baby receives medical attention if you have any concerns about their health. The clinic and staff are going to look different but surgeries are very quiet at the moment so it is easy to stay far apart from others. The staff will look after you and your baby as quickly as they can. Be prepared by having just one person go with your baby if you can, and write down any questions or concerns you have in advance.

Advice for if you smoke from the Smoking in Pregnancy Challenge Group

How does smoking during pregnancy impact my baby?

Smoking or being exposed to secondhand smoke during pregnancy significantly increases your risk of miscarriage, stillbirth or having a premature or unwell baby. Quitting smoking is the most effective way to protect your child from the harms of tobacco smoke.

Does smoking increase my risk from coronavirus?

As a precautionary measure, the government has classed pregnant women as a group at risk of severe illness from coronavirus. Evidence suggests smokers who contract coronavirus are more likely to need intensive care than non-smokers. Smoking damages your lungs and weakens your immune system. This makes it more likely that you will have complications if you get sick and take longer to recover.

Can I get help to quit from my midwife?

Yes. Your midwife should: 1. Provide you with information about the risks of smoking and benefits of quitting for you and your baby. 2. Refer you to a specialist stop smoking service. This service can provide you with support and advice via telephone/Skype/Facetime and may be able send you stop smoking medications and vouchers in the post. They should also be able to give you advice about using an e-cigarette to quit smoking.

How can I keep my home smokefree?

You can use nicotine replacement products (e.g. patches or gum) or e-cigarettes to protect yourself and your family from harmful cigarette smoke. Ensure your home is a smoke-free zone and always go outside to smoke. If you are on your own, never leave your baby alone - take them outside in a pram but keep a safe distance between you.

Other useful links

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Coronavirus (COVID-19) and caring for your baby - The Lullaby Trust

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We know this may still be a worrying time for everyone and that you may have particular concerns if you are pregnant or have a baby. We have put together the following advice on coronavirus (COVID-19) and caring for your baby that is currently available and will keep updating this.

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Help and advice on dog training, behaviour, care and our Dog School from our experts.

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How to test and what you can do.

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Diastasis Recti Word Origin:
Diastasis, from Greek, meaning separation
Recti: refers to the rectus abdominis muscle (see illustration below)
Definition: Diastasis recti is a fairly common condition of pregnancy and postpartum in which the right and left halves of Rectus Abdominis muscle spread apart at the body's mid line fascia, the linea alba.
Looking for Diastasis Recti Rehab Workouts? Download one of our award-winning rehab packages:
Post Natal SuperSaver Package - Diastasis Post Natal Core Rehab Package - Diastasis
About Diastasis Recti or Abdominal Separation

Widening and thinning of the mid line tissue occurs in response the force of the u terus pushing against the abdominal wall, in conjunction with pregnancy hormones that soften connective tissue. A mid line of more than 2 to 2.5 finger-widths, or 2 centimeters, is considered problematic. Diastasis recti can occur anytime in the last half of pregnancy but is most commonly seen after pregnancy when the abdominal wall is lax and the thinner mid line tissue no longer provides adequate support for the torso and internal organs.

A small amount of widening of the mid line happens in all pregnancies and is normal. Diastasis recti occurs in about 30% of all pregnancies. Some postpartum women's mid lines close to less than 2 finger-widths spontaneously, but for many, the tissue remains too wide, causing problems.

Diastasis recti can also be seen in infants, and adults with excessive abdominal visceral fat.

Diastatsis recti reduces the integrity and functional strength of the abdominal wall and can aggravate lower back pain and pelvic instability. Separation in a previous pregnancy significantly increases the probability, and severity, of the condition in subsequent pregnancies. Women expecting more than one baby, petite women, those with a pronounced sway back, or with poor abdominal muscle tone are at greatest risk. Genetics also plays a big role. For some women, it simply how their bodies respond to pregnancy.

Unfortunately, flurries of misconception swirl around diastasis recti and abdominal exercise during and after pregnancy in general. You're likely to encounter a broad range of contradictory opinions and advice about how to recondition your abdominal wall and how to restore the midline after childbirth. Some of these assertions can cause unnecessary alarm, while another common piece of advice-do a lot of "crunches"-can actually worsen diastasis recti/abdominal separation.

COMMON MYTHS about Diastasis Recti During and After Pregnancy:

Diastasis recti/abdominal separation causes permanent damage to your abdomen.

Diastasis recti/abdominal separation requires surgical repair.

Diastasis recti/abdominal separation causes permanent bulging of the abdomen, i.e., "mummy-tummy."

Diastasis recti causes pain.

60% of pregnant women develop diastasis recti.

The abdominal muscles will always be weaker after childbirth.

All women should wait for at least six weeks after delivery before beginning any abdominal exercises or postnatal reconditioning program.

None of these statements are true!

Diastasis Recti Facts:

The vast majority of women can close their mid lines and flatten their abdominal walls with the proper rehabilitation exercises.

The abdominal wall can get as strong, or even stronger, after diastasis recti rehab.

Basic diastasis rehab moves such as abdominal compressions (Belly Lacing), abdominal compressions with pelvic tilt (Belly Scooping) and others can, and should be started directly after delivery.

About 30% of women will have some degree of diastasis recti past 6 weeks

Rarely, an umbilical hernia can result as a complication of diastasis recti. Umbilical hernias may require surgical repair.

Diastasis Recti/Abdominal Separation Test:

This simple self-test will help you determine if you have diastasis recti.

Lie on your back with your knees bent, and the soles of your feet on the floor.

Place one hand behind your head, and the other hand on your abdomen, with your fingertips across your midline, parallel with your waistline, at the level of your belly button.

With your abdominal wall relaxed, gently press your fingertips into your abdomen.

Roll your upper body off the floor into a "crunch," making sure that your ribcage moves closer to your pelvis.

Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle. Test for separation at, above, and below your belly button.

Use Correct Form for an Accurate Assessment

Make sure that you don't simply pull your head off the mat-a common mistake. To effectively contract your abs, you need to move your ribcage closer to you pelvis. If you don't adequately activate your abdominal wall, you might assume that you have abdominal separation. But for most, as the ribcage moves closer to the pelvis and the contraction deepens, the width of the gap at your midline will decrease.

Don't panic if you feel a "hole" in your belly in the first few postpartum weeks. Everyone's connective tissue at the midline is lax after childbirth. As you recover, your midline will slowly regain its former density and elasticity, and the "hole" will become shallower, and if you do the right exercises, more narrow too.

Signs of Diastasis Recti/Abdominal Separation

A gap of more than 2 1/2 finger-widths when the rectus abdominis is fully contracted.

The gap does not shrink as you contract your abdominal wall.

You can see a small mound protruding along the length of you midline.

NOTE:
If at any time you see a round, hard, or painful bulge protruding from your belly button area, or along your mid line, this may indicate a possible hernia. If so, consult with your OBGYN.

Special Precautions for Women with Diastasis Recti/Abdominal Separation

Avoid all activities that place stress on the midline, that stretch or overly expand the abdominal wall through everyday activities, exercise, or breathing techniques.

Diastasis Recti: Movements to Avoid

Movements where the upper body twists and the arm on that side extends away from the body, such as "triangle pose."

Exercises that require lying backward over a large exercise ball.

Yoga postures that stretch the abs, such as "cow pose," "up-dog," all backbends, and "belly breathing."

Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, Oblique curls, "bicycles," roll ups/roll downs, etc.

Pilates mat and reformer exercises that utilize the "head float" position, upper body flexion, or double leg extension.

Any exercise that causes your abdominal wall to bulge out upon exertion.

Lifting and carrying very heavy objects.

Quadruped exercises without adequate abdominal support.

Intense coughing without abdominal support.

During pregnancy or after childbirth, if you develop a cough from allergies or a respiratory illness, such as a cold or flu, place your hands across your belly and manually splint your abdomen together during coughing episodes. This will provide needed additional support, and help to prevent separation of your midline.

To protect your mid line during pregnancy, always use the "log roll" maneuver when rising from the floor or out of bed. Log roll: with your torso and head aligned and in one piece, roll over onto your side, then use your arms to help push yourself up to a sitting position.

Exercises to Prevent or Lessen the Severity of Diastasis Recti/Abdominal Separation

You can do a lot to help prevent or lessen the severity of diastasis recti by strengthening your deepest abdominal muscle, your Transverse Abdominis, or TvA. The TvA is the body's internal "girdle" and when contracted, compresses the abdominal wall.

All pregnant women should perform basic TvA exercises throughout their pregnancies to help prevent diastasis recti as well as back pain and Pelvic instability . As an added bonus, because the TvA is our body's major expulsion muscle, building and maintaining strength here greatly aids in the pushing phase of labor.

Safe Prenatal TvA Exercises to Prevent or Lessen the Severity of Diastasis Recti/Abdominal Separation:

Two safe TvA exercises to prevent diastasis recti, watch and learn here:

Diastasis Recti Exercise One - Baby Hugs

Diastasis Recti Exercise Two - Baby Lifts

Prenatal Abdominal Splinting Technique to Close the Mid Line:

Pregnant and postpartum women with diastasis recti, should perform TvA exercises with manual splinting of the rectus abdominis. Watch and learn here:

While the model in these videos is pregnant, these exercises are safe and beneficial to perform throughout your postpartum rehabilitation.

Diastasis Recti/Abdominal Separation Recovery and Rehabilitation

Most postnatal fitness programs feature standard abdominal exercises like crunches and curls, and advise women with diastasis recti to manually splint their midlines together with either the hands or a towel wrapped around the belly while performing these exercises. However, reliance on external forces only will not adequately close the gap in your midline.

Additionally, prenatal and postpartum exercises that use lower spine flexion rather than upper spine flexion provide many more benefits and should be used whenever possible. Exercises that flex the upper spine should be done sparingly, if at all during and after pregnancy.

External splinting (either with the hands, a towel, or belly binder) of the rectus abdominis without first having established adequate strength and functional control in your TvA will not repair diastasis recti. External splinting performs the function that your TvA should be doing, therefore the muscle does not engage and stays weak with poor functioning. When the TvA lacks adequate strength and functional control, then the abdominal wall bulges out upon exertion, which stretches the midline and can make abdominal separation worse. (Please see Abdominal Reconditioning After Pregnancy for more information on this topic.)

Another Common but Ineffective Postpartum Exercise: "Mini-Crunches"

Other postpartum exercise programs suggest that women with diastasis recti start abdominal reconditioning with "mini-crunches," or lifting only the head, while applying manual compression with the hands across the abdomen. Isolation of the head exerts a small amount of work on the external abdominal muscles, but only in some individuals. Women with good neuromuscular coordination will, for the most part, engage the muscles that flex the neck in this movement, not their abs.

In addition, lifting the head off the floor as a preamble to exercises like crunches teaches poor technique. Ideally, in all abdominal exercises that flex the upper spine, movement should be initiated in the Thorax, which will pull the ribcage closer to the pelvis. The head and shoulders should stay fairly relaxed, and basically "go along for the ride." In Pilate's exercises, this is aptly called the "head-float position." (For more information see Abdominal Reconditioning After Pregnancy)

Signs of Midline Recovery

Abdominal separation resolves when either your muscles have pulled back together to less than two finger widths, or when you can feel that your midline has become strong and elastic, at about six to nine months postpartum. At this point, you will no longer feel a hole in your abdomen. Once your connective tissue has regained its former density and elasticity, you are no longer at risk for hernia or other associated problems.

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Diastasis Recti (Abdominal Separation) During and After Pregnancy

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Diastasis Recti Word Origin: Diastasis, from Greek, meaning separation Recti: refers to the rectus abdominis muscle (see illustration below) Definition: Diastasis recti is a fairly common condition of pregnancy and postpartum in which the right and left halves of Rectus Abdominis muscle spread apart at the body's mid line fascia, the linea alba.

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What it is and how to help

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If you're feeling totally clueless about what you need to pack in your bag for labour, try not to worry.

Your midwife can steer you in the right direction. The Which? Birth Choice guide can let you know what will already be available at the hospital you'll be giving birth in.

You might also be able to book a tour of the hospital where you'll be having your baby. That way you can ask more about what you need to bring from home and what's available at the hospital.

Here are your other questions answered on all things hospital kit related.

When should I pack my hospital bag for birth?

You can start packing whenever you want to. But it's a good idea to have your bag ready at least two weeks ahead of your due date (NHS, 2018).

What type of hospital bag do I need?

You can use whichever of your bags that'll do the job. You definitely don't have to spend money on a special bag to take into hospital. Why not save the cash for an extra cute babygrow or three instead.

Packing two bags might also work for you - one for during labour and one for afterwards. Or you could go for a small suitcase; it might sound crazy but the stuff you will need adds up. And, after all, you are packing for a possible overnight stay (for at least two people).

When your bag is packed, leave it by the front door so you don't forget it. Then let your birth partner or whoever is driving you to the hospital know where it is and what's in it. That way they can be ready to help as soon as you need them to.

What essentials shall I pack in my hospital bag for labour?

Here's a starting point for what you'll need in labour:

Maternity notes.

Birth plan, if you've made one.

A comfy, loose outfit for labour that you can move around in and that won't make you too hot. A cosy nighty or a big t-shirt is perfect.

Chill-out kit including books, magazines, music or podcasts (more for the early stages).

A fan or water spray to cool you down.

A phone and charger - with good storage.

Healthy snacks and drinks.

Your own pillow, possibly a giant pregnancy one.

A TENS machine and batteries if you want to use one and if your hospital doesn't provide one.

Any medication you're taking.

Your wash bag with your toothbrush, toothpaste, hairbrush, soap, hair ties and other toiletries (NHS, 2018).

Aromatherapy oils, especially if you have been using them during pregnancy, e.g. for hypnobirthing.

You might also want to bring your birth ball but check on your tour or with your midwife whether the hospital has its own.

What essentials shall I pack in my hospital bag for after the birth?

When you're chilling out with your new arrival, you'll need a whole host of other things.

Bring these in your bag:

large sanitary or maternity pads

large comfy knickers (or disposable ones)

towels

dressing gown

slippers or flip-flops

comfy, maternity-sized outfit to wear home

cash - you might need it for parking or to grab a magazine or emergency chocolate bar

iPad or tablet.

And if you're planning to breastfeed, add:

nursing bras

breast pads

front-opening nighties or pyjama tops.

What should I pack in my hospital bag for my new baby?

Yep, it's not just you you're packing for. For the baby, add in:

bodysuits or vests

sleep suits (including one you want them to go home in)

a hat

scratch mittens

socks or booties

nappies

cotton wool balls or pads

blankets

muslin squares

a snowsuit if it's cold.

You'll also need to make sure you have a car seat that's correctly fitted. If you're getting a taxi home, check you know how to fit the car seat yourself (NHS, 2018).

What should my birth partner pack in their hospital bag?

Your birth partner may be at hospital with you for a long time, and even overnight, so they will definitely need to have a bag packed too.

They should think about packing:

snacks

cash

a change of clothes

a wash bag

a camping mattress if there is room for them to stay over

a book or something to distract the mum to be if you're relaxing in the early stages.

Important numbers

Wherever you're planning to give birth, keep a list of important numbers in your purse or in your phone. You'll need to include:

the hospital, midwife or doula's phone number

your partner or birth partner's phone number

your hospital reference number (on your card or notes).

This page was last reviewed in September 2018.
Further information

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

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

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

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Hospital bag checklist: what do I need to take? | Labour & birth, Deciding where to give birth articles & support | NCT

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Snuggly PJs, babygrows and a whole buffet of snacks. Here's what you should think about adding to your bag when you go into labour.

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Is your baby in the best position for birth? Do you have aches and pains in your pelvis area. Then this website has all the answers I highly recommend watching the spinning babies parenting class

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Parenthood Starts with Pregnancy

You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth.

Proactive Preparation for Easier Birth

Join others who are enthusiastic for your life-giving year! Find a Spinning Babies ® Certified Parent Educator to start using techniques for comfort in pregnancy and smoother progress in labor through our unique approach to physiological birth.

Help Change Birth on Earth

Find Spinning Babies ® Workshops and events near you to start helping parents experience a more confident and comfortable birthing process for both themselves and their baby.

For additional education to even further enhance your pregnancy and labor preparation, shop our extensive collection of digital downloads, videos, DVDs, workbooks, and more.

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

Spinning Babies® Parent Class

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

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Spinning Babies - Comfort in Pregnancy and Easier Birth

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Parenthood Starts with Pregnancy You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth. Proactive Preparation for Easier Birth Join others who are enthusiastic for your life-giving year!

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Find out about your local hospitals and facilities availble

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Most women in the UK get their maternity care for free through the NHS, but there are also private options available.
From paying for scans and doulas to private hospitals and amenity beds, this guide explains what services are available before, during and after giving birth.

We also list the pros and cons for both NHS and private maternity services and reveal what you might expect to pay if you decide to go private.
For ways to keep your family living costs down, and kids of all ages happy,
NHS vs private maternity care: pros and cons

Whether you choose private or NHS maternity care, there are benefits and disadvantages. We'll go into more detail further down the page but here's a quick overview of how they differ.

NHS maternity care: pros

It's free. This is from your first appointment through to scans, antenatal care, the birth itself and postnatal care. There may be some exceptions for non-UK residents but you'll never be turned away from NHS maternity care.

Access to a range of experts. If your birth becomes complicated, you'll have direct access to some of the world's best experts, without having to worry that your costs will rack up.

You still have choices. Whether it's at home, in a hospital or at a birth centre, having an NHS birth still gives you scope to somewhat tailor your experience. You have more options than you might realise. For example you can ask to use a different hospital rather than one that your GP may refer you to locally and you can also request to have an elective c-section .

NHS maternity care: cons

You might not get the birth you want. For example, if you've chosen a water birth but all the birthing pools at your chosen facility are occupied when you need one. The NHS will try to support your wishes but it may not always be possible.

You might not feel as supported as with private care. Staff shortages are a reality in NHS hospitals compared to private hospitals. Also, shift changes can mean you might have various midwives looking after you, even when you're labouring and this may be unsettling for you at the various stages of your pregnancy and birth.

Private maternity care: pros

A team of familiar experts. Whether it's an obstetrician or midwife-led delivery, you'll have the added reassurance of getting to know your team throughout your maternity care and birth.

Regular contact. One of the things you're paying for is their time so you may feel you can contact the facility as much as you like without feeling like you're bothering anyone. You might even have the mobile number of your obstetrician for out of hours use.

Hotel-like facilities. Luxury and privacy are standard and facilities often include 24-hour room service, satellite TV and premium toiletries in your ensuite bathroom. Unlike NHS hospitals, which tend to be strict on visiting hours, there may be more flexibility for visitors to come and see you if you've gone private, plus your partner may be able to stay.

Private maternity care: cons

It's expensive. Private care can cost many thousands of pounds and even with a package there may be lots of added extras such as epidurals, induction or instrumental delivery. The earlier in your pregnancy you start with a care package, the more you'll pay. You'll also pay more if you're expecting multiples.

You may end up with NHS treatment anyway if something goes wrong. The Portland Hospital for example has its intensive care facilities for newborns and mums, but most private delivery services are situated within or next to NHS hospitals and will use their facilities in an emergency, such as the obstetric emergency theatre on a standard labour ward.

There might not be one near you. Private maternity facilities aren't as common as NHS ones so you may have to travel to get to one. If your birth happens quickly and unexpectedly, you might not have time to get there. Most are in the London area so if you factor in antenatal care and unforeseen events such as going into labour early, it might not work for you unless you're London-based.

- our guide makes sure you have everything you need
Can I give birth in a private hospital?

Yes, you can choose to give birth in a private maternity hospital or unit or pick and choose aspects of private maternity care that suit your needs.

For example, although the NHS offers expectant mums at least two ultrasound scans during pregnancy , some people want 3D or 4D scans to see the baby's features more closely and these are only available privately.

What's it like giving birth in a private hospital?

If you're giving birth in a private hospital or on a private wing, your obstetrician will usually look after you in labour, but you can also have midwife-led care, depending on the package you've paid for.

Once you've given birth, you'll have a private ensuite room at the hospital with hotel-like facilities such as a concierge, luxury toiletries and 24-hour room service.

The cost of your room is usually included in the price although you can pay more to stay for extra nights or to upgrade to a suite.

Private midwives will then support you for your immediate postnatal care.
Taking baby home in a car? Make sure you choose one of our
How much does it cost to give birth at a private hospital?

When we looked in December 2022, the lowest cost we found for a vaginal/normal delivery with a consultant at a private hospital was £5,500 and the lowest for a c-section was £6,300 but this is a starting price. There are a number of variables and added extras to factor in when working out what the total cost might be.

Consultant-led or midwife-led delivery? A 'consultant-led' normal birth is different from a 'midwifery-led' birth, which is generally suitable for low-risk pregnancies. However, it still isn't cheap - we found one that started at £8,015 but extra charges could be added on if you stay beyond one night and have interventions such as an epidural or induction.

Your consultant's professional fees will be charged separately and it's likely the anesthetist's will too, so contact their administrative staff beforehand for an idea of what these might be.

Vaginal delivery, elective c-section or emergency c-section? Each of these incur a different cost. For example, a consultant-led 'normal' delivery at the Lindo Wing of St Mary's Hospital in Paddington has a basic price of £6,300 whereas a consultant-led c-section is £8,000 (plus consultant's fees in both cases). Not only that but you may want to check how many nights' stay you get after a c-section. Some, such as the Westminster Wing at Guy's and St Thomas' Hospital , include two nights' stay whereas many others only include one then charge anything from £750 to £1,325 for each additional night.

Unexpected extras. Unforeseen interventions such as epidurals, instrumental deliveries, inductions and delivering a baby in breech position may be charged for separately and could collectively add thousands to your final bill, not to mention if you end up having an emergency c-section. You may need to spend some time in hospital before the birth and you'll be charged for this, too. For example, per night an antenatal admission at the Kensington Wing at Chelsea and Westminster Hospital costs £1,325.

Where you live. It may be that where you live could affect not only your access to private maternity facilities, most of which are based in London, but also what you pay. Although a London private birth is expensive, one offers private delivery including up to a three-night hospital stay (plus follow up) for £17,000.

How do you pay? You may be asked to pay half of your fees as early as 20 weeks and although some private facilities offer payment plans, many will ask for BACS transfer or credit card payment. Get a breakdown of what's included before you sign up.

Why do parents choose to give birth in a private hospital?

In our 2022* survey, we asked 1,424 parents about where they had given birth - almost all had done so in an NHS hospital (90%) and around 4% gave birth in a private hospital or private wing.

There are various reasons you might choose to give birth in a private hospital or clinic, including:

A desire for additional comfort and/or privacy

Having more say in your care

The chance to develop a closer relationship with your midwife and/or consultant

Easy access to additional scans such as 3D and 4D ultrasound scans

*Baby & Child survey carried out in February 2022. - we compare the leading brands to discover whether one is better than another
What maternity care can I get on the NHS?

NHS antenatal care

With the NHS, you get seven to 10 antenatal appointments with a midwife, as well as blood tests and at least two free .

If you have more complicated needs, you'll also see a consultant (doctor) in addition to your midwife appointments.

NHS when giving birth

Most women have their baby in an NHS maternity unit. If you choose to have a home birth, two NHS midwives will come to your home to support you during the birth.

Whether you give birth in a birth centre or a labour ward, you'll always have your own room for the birth itself and be looked after by midwives. However, if you're induced you may need to spend time on a shared antenatal ward.

Similarly, if you need to stay overnight after the birth it's likely you'll be moved to a postnatal ward, where you'll be sharing a room and bathroom with a number of other women and their babies.

NHS postnatal care

Immediately after giving birth in an NHS facility, you'll go home a few hours after a straightforward birth or after a couple of days if you've had a c-section or experienced complications.

You'll have postnatal appointments with NHS midwives once you're back home. This may be at your home, or at a local clinic or children's centre.

The number of appointments varies, but most women tend to see a midwife three or four times postnatally.
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How can I enhance my NHS maternity care?

You can still choose aspects of private maternity care to suit your needs, even if you're not going completely private. In fact, our 2022 survey showed that out of just over 1,400 parents, nearly all had paid for private services during pregnancy or birth.

Private pregnancy scans and blood tests

Our 2022 research showed that almost all parents (83%) had a private scan during the pregnancy and around one in five (19%) had a private blood test.

The NHS provides you with all the diagnostic scans you need but some people pay for extras such as 3D and 4D scans at private clinics or private hospitals to enhance their experience, such as being able to see their baby's features more clearly and to get video footage of it.

For more information see our guide to NHS and private ultrasound scans during pregnancy .

Private amenity room after the birth

Women having an NHS birth sometimes choose to pay to hire a private 'amenity' room within the NHS maternity unit, which give you more privacy but where you'll still be looked after by NHS midwives.

The rooms are often just off the postnatal ward, and can cost anything from around £80 up to five times that, depending on where you are in the UK.

Our research showed that while just 6% of parents opted for a private amenity room in the NHS, almost all (97%) found it useful.

Hiring a doula

A doula is someone who has training in supporting expectant and new parents, rather than a health professional, and as such they're not there to replace midwives or other health staff.

Your doula can work with you during your pregnancy, be with you as a birth partner or advocate, or provide support in the early days postnatally - their service is tailored to your needs.
See all our
In our survey, 5% of respondents paid to have a doula and 90% said they found it useful.

Is NHS maternity care always free?

The rules say no-one should ever be denied NHS maternity care, but in some cases it isn't free.

The UK has a residence-based healthcare system so if you are 'ordinarily resident' here you're entitled to free NHS maternity care, whatever your citizenship or immigration status.

However, who is considered 'ordinarily resident' when it comes to NHS charging is complicated and the charity Maternity Action has a guide to who is considered 'ordinarily resident' in the UK to help you see where you stand.

Each NHS Trust has an Overseas Visitor Team with responsibility for reaching a decision about whether you'll be charge for your maternity care if you aren't ordinarily resident.

Can I choose to go private mid-way through my pregnancy?

Yes, and this may give you the benefit of some private care but without incurring the full cost.

To give you some idea, delivery by an obstetrician at the private facility of is £6,500 from 12 weeks of pregnancy, £5,500 from 28 weeks, £5,000 from 32 weeks and £4,500 from 36 weeks, although you'll generally pay 50% of your fees as early as 20 weeks and the remainder by 36 weeks.

Some private facilities - for example, the Sir Stanley Clayton Ward at Queen Charlotte's and Chelsea Hospital in west London - have a consultant-led late transfer elective c-section package suitable for patients from 38 weeks onwards and this starts at £6,795 (excluding extras).

However, in other situations you could find that the amount it costs is the same as if you started it early on in your pregnancy.

For example, , which represents independent midwifery, says that because an independent midwife has fixed costs to bear and will often have to work harder within a short space of time to give you the care you need, you still pay the full amount.

If you cancel - for example, to return to the NHS - you may be charged a cancellation fee (e.g. £400 at the Lindo Wing).
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You should be aware that, as per Department of Health guidelines, if you transfer from private to NHS care you're not permitted to change back to private care.

Can I pay for a private room in an NHS hospital after the birth?

The availability of private or 'amenity' rooms following delivery varies from one hospital to the next, as does the price.

Some offer single amenity rooms with shared facilities and some have private rooms with ensuite facilities. They may also have tea and coffee facilities and a television - some even allow someone to stay with you overnight.

However, even if your hospital has them, there's no guarantee you'll get one. They tend to be allocated on a first-come, first-served basis and can't be held or booked in advance.

Also, if you are occupying an amenity room that is needed by someone with a clinical need, you may have to relocate to an alternative room or a postnatal ward.

The cost varies from one hospital to the next but can start at around £80 for a single room with shared bathroom facilities, rising to, in some cases, upwards of £400 a night but whatever you pay, you are still an NHS patient and won't be given preferential treatment.

Can I hire a private midwife?

Yes, if you want more flexibility in your maternity care than the NHS can provide, you can look into hiring a private or independent midwife.

says a complete package of care throughout pregnancy, birth and the postnatal period costs anywhere between £2,000 and £5,000, although it can cost as much as almost £9,000.

Most independent midwives are happy to accept payment in instalments or flexible payment plans, and in some special circumstances they may consider caring for women for a reduced fee.

In this video, an independent midwife explains what she believes are the benefits of using a paid-for, non-NHS midwife for maternity care.

Having a home birth with a private midwife

Many women who choose to have an independent or private midwife are planning to have a home birth.

Private midwives can be a good option if you're finding it difficult to get support for a home birth from your local NHS services.

If you're having a home birth with a private midwife, there's still the possibility you may need to be transferred to hospital because you or your baby needs extra help.

In this case, the NHS midwives and doctors in the hospital will take over your care. However, your private midwife will still be there to act as a supportive birth partner.

Postnatal care with a private midwife

Women who have given birth with private midwives can pay to carry on seeing the same midwife they had throughout their pregnancy, after the baby is born.

Others may choose to supplement their NHS postnatal care by having additional private appointments as well.
See all our for information on child car seats, pushchairs, baby monitors, nursery furniture and much more.
As well as providing continuity of care, a private midwife can assist if you're having problems with breastfeeding and will also be a familiar face if you've had a challenging or difficult birth.

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NHS vs private maternity care: what are your options? - Which?

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We compare the pros and cons of NHS and private maternity care. Learn about the antenatal care and birth options available for free through the NHS, and what private midwives and hospitals can offer, how much it costs and what you can access

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Vitamin K and newborns: what you need to know | Labour & birth articles & support | NCT

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

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Cochrane review on position during labour

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Cochrane review on position during labour

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There is little doubt that women should be encouraged to utilise positions which give them the greatest comfort, control and benefit during first stage labour. As women in most western societies now lie in bed for the entire duration of their labour, it is important that they understand the risks and benefits of the positions they choose.

This review included 25 studies (involving 5218 women). Although many studies were not of high quality, and most of the women were low risk, they did show that the first stage of labour may be approximately one hour and twenty minutes shorter for women who are upright or walk around. As every contraction is potentially painful, and prolonged labour can be an overwhelming and exhausting process resulting in an increased need for medical intervention, this is a meaningful outcome for women. Indeed other important outcomes for women who were upright and mobile compared with lying down in bed included a reduction in the risk of caesarean birth, less use of epidural as a method of pain relief, and less chance of their babies being admitted to the neonatal unit. More research of better quality is still needed to validate these results for all women in labour. However, based on the results of this review we recommend that wherever possible, women should be encouraged and supported to use upright and mobile positions of their choice during first stage labour, as this may enhance the progress of their labour and may lead to better outcomes for themselves and their babies.

If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.

There is clear and important evidence that walking and upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers' and babies' well being. Given the great heterogeneity and high performance bias of study situations, better quality trials are still required to confirm with any confidence the true risks and benefits of upright and mobile positions compared with recumbent positions for all women. Based on the current findings, we recommend that women in low-risk labour should be informed of the benefits of upright positions, and encouraged and assisted to assume whatever positions they choose.

Read the full abstract...

It is more common for women in both high- and low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour, and in some women reduce placental blood flow.

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

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013).

Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour.

Data collection and analysis:

We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently evaluated methodological quality and extracted data for each study. We sought additional information from trial authors as required. We used random-effects analysis for comparisons in which high heterogeneity was present. We reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data.

Results should be interpreted with caution as the methodological quality of the 25 included trials (5218 women) was variable.

For Comparison 1: Upright and ambulant positions versus recumbent positions and bed care, the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as opposed to recumbent positions (average MD -1.36, 95% confidence interval (CI) -2.22 to -0.51; 15 studies, 2503 women; random-effects, T ² = 2.39, Chi ² = 203.55, df = 14, (P < 0.00001), I ² = 93%). Women who were upright were also less likely to have caesarean section (RR 0.71, 95% CI 0.54 to 0.94; 14 studies, 2682 women) and less likely to have an epidural (RR 0.81, 95% CI 0.66 to 0.99, nine studies, 2107 women; random-effects, T ² = 0.02, I ² = 61%). Babies of mothers who were upright were less likely to be admitted to the neonatal intensive care unit, however this was based on one trial (RR 0.20, 95% CI 0.04 to 0.89, one study, 200 women). There were no significant differences between groups for other outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies.

For Comparison 2: Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), there were no significant differences between groups for outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies.

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Mothers' position during the first stage of labour

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There is little doubt that women should be encouraged to utilise positions which give them the greatest comfort, control and benefit during first stage labour. As women in most western societies now lie in bed for the entire duration of their labour, it is important that they understand the risks and benefits of the positions they choose.

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Home Birth with the Leicester home birth team

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What can you do to support your partner during labour.

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Suggestions for your Birth Plan

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In this article

What is TENS?

TENS is a drug-free kind of pain relief often used by women in the early stages of labour. TENS stands for Transcutaneous Electrical Nerve Stimulation.

A maternity TENS machine consists of a battery-powered, hand-held controller connected by fine leads to four flat pads. The pads are covered in a firm gel that helps them stick to your back.

The machine sends small, safe pulses of electrical current via the leads to the pads on your skin. The pulses pass through your skin and into your muscles and tissues. This gives you a gentle tingling or buzzing sensation OAA 2012), which may be stronger or weaker, depending on the setting level.

The controller part of the TENS machine is easy to hold in your hand while you're in labour. But if you don't want to hold it, you can clip it to your clothing or attach a strap and hang it around your neck.

A TENS machine has buttons that you can use to control the frequency and strength of the pulses. There's also a boost button for you to press with your thumb when you want maximum output from the machine. This may help you to get through each contraction.

Cranial TENS is an alternative to maternity TENS that may help with pain relief once you're in active labour (Dowswell et al 2009). Instead of pads, you wear a band around your head. The band delivers electrical impulses to your forehead, just above your nose.

How does a TENS machine work?

We don't know exactly how TENS works to help you cope in labour. It's probably due to a combination of factors. These could include:

the electrical pulses prevent pain signals from reaching your brain

the pulses stimulate your body to release natural, feel-good substances called endorphins (Bedwell 2011, Dowswell et al 2009, NHS 2015a)

it helps you to feel in control of your labour and be less anxious

it offers a distraction from your contractions (Dowswell et al 2009)

There's not a lot of evidence to show how effective using a TENS machine is as a form of pain relief but most midwives are supportive of the idea of using one (McMunn et al 2009). About one woman in five plans to use TENS at some point in labour (CQC 2013) and most mums who've tried it say that they'd be willing to use it again in their next labour (Dowswell et al 2009).
When should I use TENS?

You can use TENS from the very beginning of your labour (Blincoe 2007, NHS 2015a).

You could start using it when you're getting regular contractions or backache. You may find that the machine works better at relieving your backache than other types of pain (Francis 2012, OAA 2012). This is probably because the pads are on your back.

TENS is most likely to be effective in early labour but it may also help you during the first stage of labour (Dowswell et al 2009, Shahoei et al 2017). You may need other forms of pain relief as your labour gets stronger (OAA 2012).

Your midwife will not recommend starting TENS if you're already in established labour (NICE 2014). However, if you started using TENS earlier and want to carry on using it, that's fine. You may need to take off the TENS pads if your baby's heart has to be monitored electronically (NCT nd), because the pads could affect the signals to the monitoring machine.

How should I use TENS?

Your birth partner can place the pads on your back for you. Follow the instructions that come with your maternity TENS machine, though they're likely to be as follows:

Check the machine is turned off before placing the pads on your back (NHS 2015b)

Place two of the pads on either side of your spine, with the tops of the pads at about bra-strap level.

Place the other two lower down, at about the level of the dimples on your lower back, just above your bottom.

Switch the machine on, starting with the controls at the lowest setting. Turn them up gradually as your contractions get stronger, or when the pain in your back gets worse.

Use the boost button at the peak of each contraction. The boost function results in more intense, wave-like tingling or buzzing sensations.

Remember to turn off the boost button again when the contraction has ended. This is so you feel the benefit of the boost next time you have a contraction.

Keep mobile. Moving around during labour helps you to feel in control and will make TENS more effective.

Don't give up straight away if you think TENS isn't doing anything. You may need to keep using it for at least an hour before it starts to work for you (Blincoe 2007).

If the pads start to lose their stickiness, rub a few drops of water into the gel side of the pads before putting them back on. The more firmly the pads are stuck on, the better they'll work.

If you don't think the pads are helping you after a while, take them off. You are in control of your labour and what is working for you. All other forms of pain relief, both medical and non-medical, are still open to you.

When shouldn't I use TENS?

Never use a TENS machine under the following circumstances, without talking to a midwife or doctor first:

Before you go into labour (NHS 2015b).

When you're in a shower, bath, or birth pool (NCT nd).

If you have epilepsy (NHS 2015b).

If you have broken skin or a healing scar where you want to place the pads (NHS 2015b).

If you have a cardiac pacemaker or a heart rhythm problem (NHS 2015b).

If you have pain that you don't think is labour pain. See your doctor or midwife if this is the case.

What are the advantages of TENS?

You can keep moving around while using it (NHS 2015a, NCT nd).

It won't directly interfere with your labour.

You can use it for as long as you want to (NHS 2015b, NCT nd) and take it off if you want or need to.

There are no lasting side-effects (NHS 2015a, NCT nd).

It's safe for you and your baby (Dowswell et al 2009, OAA 2012, NHS 2015a).

You don't need an anaesthetist, doctor or midwife to help you use it (NCT nd).

It can be used for a home birth (NCT nd).

It's portable and non-invasive.

You control it.

It's easy to use.

What are the disadvantages of TENS?

You probably won't be able to put the pads in place without help (NCT nd).

You may find it only gives you relief in the early stages of labour (Blincoe 2007: 519; NHS 2015a, NCT nd).

You'll probably need to pay to hire or buy a TENS machine, as not all hospitals have them (NHS 2015a).

TENS can't be used in water, though you can still use it before you get in a bath or birth pool (NCT nd).

If you want your birth partner to massage your back, he'll have to work around the pads (NCT nd).

How do I get a TENS machine?

You'll probably need to hire, buy or borrow a TENS machine for use at home, while you're in early labour.

Not many hospital maternity units provide TENS machines. If you're having your baby in a hospital, you probably won't be admitted until you're in active labour. By then, TENS won't work as well for you (NHS 2015a). That's why hospitals invest in other methods of pain relief.

Birth centres or midwife-led units are more likely to have TENS machines, but most will rely on you bringing your own (McMunn et al 2009).

There are many types of maternity TENS machines available to hire. It costs between £25 and £35 to hire one for a month to six weeks. Shop around online for the best deal. If you have sensitive skin, it's worth finding out if your chosen machine comes with hypoallergenic pads (NHS 2015b).

It may be cheaper in the long run to buy rather than hire. You could share the cost with a pregnant friend or relative, or use it again yourself in the future to get the best value. TENS can also be used for other types of pain, such as arthritis, back pain and period pain (NHS 2015b). Bear in mind that cranial TENS machines are more expensive and less readily available than normal maternity machines.

Other types of pain relief for labour

Explore some of your other pain relief options:

References

Bedwell C. 2011. Why do women use TENS equipment and how effective is it? British Journal of Midwifery. 19(6): 348-51

Blincoe AJ. 2007. TENS machines and their use in managing labour pain. British Journal of Midwifery. 15(8): 516-19

CQC. 2013. National findings from the 2013 survey of women's experiences of maternity care. Care Quality Commission. London: CQC. www.cqc.org.uk [Accessed March 2016]

Dowswell T, Bedwell C, Lavender T, et al. 2009. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour. Cochrane Database of Systematic Reviews. onlinelibrary.wiley.com [pdf file, accessed December 2015]

Francis R. 2012. TENS (transcutaneous electrical nerve stimulation) for labour pain. Practising Midwife. 15(5): 20-3.

Jones L, Othman M, Dowswell T, et al. 2012. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews. 3: CD009234. onlinelibrary.wiley.com [Accessed December 2015]

McMunn V, Bedwell C, Neilson J, et al. 2009. A national survey of the use of TENS in labour. British Journal of Midwifery. 17(8): 492-5

NCT. nd. Pain relief in labour. National Childbirth Trust. www.nct.org.uk [Accessed March 2016]

NHS. 2015a. Pain relief in labour. NHS Choices, Health A-Z. www.nhs.uk [Accessed March 2016]

NHS. 2015b. TENS (transcutaneous electrical nerve stimulation). NHS Choices, Health A-Z. www.nhs.uk [Accessed March 2016]

NICE. 2014. Intrapartum care: care of healthy women and their babies during childbirth. National Institute for Health and Care Excellence, Clinical guideline, 190. www.nice.org.uk [Accessed March 2016]

OAA. 2012. Pain relief for labour. Obstetric Anaesthetists Association. www.oaa-anaes.ac.uk [Accessed March 2016]

Shahoei R, Shahghebi S, Rezaei M, et al. 2017. The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: A clinical trial. Complement Ther Clin Pract 28:176-80

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In this article TENS is a drug-free kind of pain relief often used by women in the early stages of labour. TENS stands for Transcutaneous Electrical Nerve Stimulation. A maternity TENS machine consists of a battery-powered, hand-held controller connected by fine leads to four flat pads.

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Part 1. Practice Contraction and Breathing technique 

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Part 1. Practice Contraction and Breathing technique 

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Part 2. Practice Contraction and Breathing Technique

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Part 2. Practice Contraction and Breathing Technique

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This is a 20 min deep relaxation to reduce fears and anxiety about your birth.

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Good birth stories are powerful. Hearing a mother's experience - how she felt, what helped her feel strong, the way they were loved and listened to - it's more than comfort. It's a model to copy.

Learning from first-hand experience gifts you confidence for your birth. And when you also have a story to share, you can pay that forward in turn.

For nine years, tell me a good birth story has been building a big chain of beautiful birth stories. The link gets longer all the time, so if you'd like to add to it, please get in touch. Whether waterbirth or caesarean, induction or a breech birth at home, if you want to contribute your experience as a way to support new parents, contact us using the SHARE YOUR STORY page.

As for how to use this site.....head over to our library and dive in. A scroll's ok. But better still, get yourself a cup of tea and have a proper 'meeting' with the people sharing their stories there. In amongst the tales you'll find some tips from me - pearls and pointers about what all women need, wherever their birth journey takes them.

For further encouragement, my book is packed with practical guidance, and will help provide a clear path to you having a positive birth experience yourself.

Buy a copy, for yourself or a friend, and you'll be supporting our site and helping our community to grow.

'Absolutely loved this book. Very informative and full of no-nonsense, real and realistic advice about giving birth. A fantastic resource for preparing for a positive birth experience, whatever kind of birth you have. On top of that, it is a beautiful book with gorgeous imagery. A joy to read.' Noobug, Amazon Customer

'Natalie is all your mothers, your sisters, your aunties and your friends arriving bearing the gifts of their experience and wisdom. Nothing this book shares with us is useless; every page holds a nugget that could make birth or parenting easier or more beautiful. Reading the section on labour I felt I could hear Natalie's warm, kind voice, holding my hand as she passed on the deep, intuitive knowledge that can only come from years spent accompanying parents through labour and birth.' AIMS ( Association for the Improvement of Maternity Services )

'I adored this book and can't stop recommending it to people. I read it when pregnant with my second child and learnt so much, despite having giving birth before. It made so much sense! I learnt about all the stages of labour and was so much better prepared for my second birth. I loved the suggestions of lavender and hot water bottles, and other tips. It made me feel nurtured and excited about the birth. A very special book!' Jo

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Good birth stories are powerful. Hearing a mother's experience - how she felt, what helped her feel strong, the way they were loved and listened to - it's more than comfort. It's a model to copy. Learning from first-hand experience gifts you confidence for your birth.

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how to test and what you can do

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Diastasis Recti Word Origin:
Diastasis, from Greek, meaning separation
Recti: refers to the rectus abdominis muscle (see illustration below)
Definition: Diastasis recti is a fairly common condition of pregnancy and postpartum in which the right and left halves of Rectus Abdominis muscle spread apart at the body's mid line fascia, the linea alba.
Looking for Diastasis Recti Rehab Workouts? Download one of our award-winning rehab packages:
Post Natal SuperSaver Package - Diastasis Post Natal Core Rehab Package - Diastasis
About Diastasis Recti or Abdominal Separation

Widening and thinning of the mid line tissue occurs in response the force of the u terus pushing against the abdominal wall, in conjunction with pregnancy hormones that soften connective tissue. A mid line of more than 2 to 2.5 finger-widths, or 2 centimeters, is considered problematic. Diastasis recti can occur anytime in the last half of pregnancy but is most commonly seen after pregnancy when the abdominal wall is lax and the thinner mid line tissue no longer provides adequate support for the torso and internal organs.

A small amount of widening of the mid line happens in all pregnancies and is normal. Diastasis recti occurs in about 30% of all pregnancies. Some postpartum women's mid lines close to less than 2 finger-widths spontaneously, but for many, the tissue remains too wide, causing problems.

Diastasis recti can also be seen in infants, and adults with excessive abdominal visceral fat.

Diastatsis recti reduces the integrity and functional strength of the abdominal wall and can aggravate lower back pain and pelvic instability. Separation in a previous pregnancy significantly increases the probability, and severity, of the condition in subsequent pregnancies. Women expecting more than one baby, petite women, those with a pronounced sway back, or with poor abdominal muscle tone are at greatest risk. Genetics also plays a big role. For some women, it simply how their bodies respond to pregnancy.

Unfortunately, flurries of misconception swirl around diastasis recti and abdominal exercise during and after pregnancy in general. You're likely to encounter a broad range of contradictory opinions and advice about how to recondition your abdominal wall and how to restore the midline after childbirth. Some of these assertions can cause unnecessary alarm, while another common piece of advice-do a lot of "crunches"-can actually worsen diastasis recti/abdominal separation.

COMMON MYTHS about Diastasis Recti During and After Pregnancy:

Diastasis recti/abdominal separation causes permanent damage to your abdomen.

Diastasis recti/abdominal separation requires surgical repair.

Diastasis recti/abdominal separation causes permanent bulging of the abdomen, i.e., "mummy-tummy."

Diastasis recti causes pain.

60% of pregnant women develop diastasis recti.

The abdominal muscles will always be weaker after childbirth.

All women should wait for at least six weeks after delivery before beginning any abdominal exercises or postnatal reconditioning program.

None of these statements are true!

Diastasis Recti Facts:

The vast majority of women can close their mid lines and flatten their abdominal walls with the proper rehabilitation exercises.

The abdominal wall can get as strong, or even stronger, after diastasis recti rehab.

Basic diastasis rehab moves such as abdominal compressions (Belly Lacing), abdominal compressions with pelvic tilt (Belly Scooping) and others can, and should be started directly after delivery.

About 30% of women will have some degree of diastasis recti past 6 weeks

Rarely, an umbilical hernia can result as a complication of diastasis recti. Umbilical hernias may require surgical repair.

Diastasis Recti/Abdominal Separation Test:

This simple self-test will help you determine if you have diastasis recti.

Lie on your back with your knees bent, and the soles of your feet on the floor.

Place one hand behind your head, and the other hand on your abdomen, with your fingertips across your midline, parallel with your waistline, at the level of your belly button.

With your abdominal wall relaxed, gently press your fingertips into your abdomen.

Roll your upper body off the floor into a "crunch," making sure that your ribcage moves closer to your pelvis.

Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle. Test for separation at, above, and below your belly button.

Use Correct Form for an Accurate Assessment

Make sure that you don't simply pull your head off the mat-a common mistake. To effectively contract your abs, you need to move your ribcage closer to you pelvis. If you don't adequately activate your abdominal wall, you might assume that you have abdominal separation. But for most, as the ribcage moves closer to the pelvis and the contraction deepens, the width of the gap at your midline will decrease.

Don't panic if you feel a "hole" in your belly in the first few postpartum weeks. Everyone's connective tissue at the midline is lax after childbirth. As you recover, your midline will slowly regain its former density and elasticity, and the "hole" will become shallower, and if you do the right exercises, more narrow too.

Signs of Diastasis Recti/Abdominal Separation

A gap of more than 2 1/2 finger-widths when the rectus abdominis is fully contracted.

The gap does not shrink as you contract your abdominal wall.

You can see a small mound protruding along the length of you midline.

NOTE:
If at any time you see a round, hard, or painful bulge protruding from your belly button area, or along your mid line, this may indicate a possible hernia. If so, consult with your OBGYN.

Special Precautions for Women with Diastasis Recti/Abdominal Separation

Avoid all activities that place stress on the midline, that stretch or overly expand the abdominal wall through everyday activities, exercise, or breathing techniques.

Diastasis Recti: Movements to Avoid

Movements where the upper body twists and the arm on that side extends away from the body, such as "triangle pose."

Exercises that require lying backward over a large exercise ball.

Yoga postures that stretch the abs, such as "cow pose," "up-dog," all backbends, and "belly breathing."

Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, Oblique curls, "bicycles," roll ups/roll downs, etc.

Pilates mat and reformer exercises that utilize the "head float" position, upper body flexion, or double leg extension.

Any exercise that causes your abdominal wall to bulge out upon exertion.

Lifting and carrying very heavy objects.

Quadruped exercises without adequate abdominal support.

Intense coughing without abdominal support.

During pregnancy or after childbirth, if you develop a cough from allergies or a respiratory illness, such as a cold or flu, place your hands across your belly and manually splint your abdomen together during coughing episodes. This will provide needed additional support, and help to prevent separation of your midline.

To protect your mid line during pregnancy, always use the "log roll" maneuver when rising from the floor or out of bed. Log roll: with your torso and head aligned and in one piece, roll over onto your side, then use your arms to help push yourself up to a sitting position.

Exercises to Prevent or Lessen the Severity of Diastasis Recti/Abdominal Separation

You can do a lot to help prevent or lessen the severity of diastasis recti by strengthening your deepest abdominal muscle, your Transverse Abdominis, or TvA. The TvA is the body's internal "girdle" and when contracted, compresses the abdominal wall.

All pregnant women should perform basic TvA exercises throughout their pregnancies to help prevent diastasis recti as well as back pain and Pelvic instability . As an added bonus, because the TvA is our body's major expulsion muscle, building and maintaining strength here greatly aids in the pushing phase of labor.

Safe Prenatal TvA Exercises to Prevent or Lessen the Severity of Diastasis Recti/Abdominal Separation:

Two safe TvA exercises to prevent diastasis recti, watch and learn here:

Diastasis Recti Exercise One - Baby Hugs

Diastasis Recti Exercise Two - Baby Lifts

Prenatal Abdominal Splinting Technique to Close the Mid Line:

Pregnant and postpartum women with diastasis recti, should perform TvA exercises with manual splinting of the rectus abdominis. Watch and learn here:

While the model in these videos is pregnant, these exercises are safe and beneficial to perform throughout your postpartum rehabilitation.

Diastasis Recti/Abdominal Separation Recovery and Rehabilitation

Most postnatal fitness programs feature standard abdominal exercises like crunches and curls, and advise women with diastasis recti to manually splint their midlines together with either the hands or a towel wrapped around the belly while performing these exercises. However, reliance on external forces only will not adequately close the gap in your midline.

Additionally, prenatal and postpartum exercises that use lower spine flexion rather than upper spine flexion provide many more benefits and should be used whenever possible. Exercises that flex the upper spine should be done sparingly, if at all during and after pregnancy.

External splinting (either with the hands, a towel, or belly binder) of the rectus abdominis without first having established adequate strength and functional control in your TvA will not repair diastasis recti. External splinting performs the function that your TvA should be doing, therefore the muscle does not engage and stays weak with poor functioning. When the TvA lacks adequate strength and functional control, then the abdominal wall bulges out upon exertion, which stretches the midline and can make abdominal separation worse. (Please see Abdominal Reconditioning After Pregnancy for more information on this topic.)

Another Common but Ineffective Postpartum Exercise: "Mini-Crunches"

Other postpartum exercise programs suggest that women with diastasis recti start abdominal reconditioning with "mini-crunches," or lifting only the head, while applying manual compression with the hands across the abdomen. Isolation of the head exerts a small amount of work on the external abdominal muscles, but only in some individuals. Women with good neuromuscular coordination will, for the most part, engage the muscles that flex the neck in this movement, not their abs.

In addition, lifting the head off the floor as a preamble to exercises like crunches teaches poor technique. Ideally, in all abdominal exercises that flex the upper spine, movement should be initiated in the Thorax, which will pull the ribcage closer to the pelvis. The head and shoulders should stay fairly relaxed, and basically "go along for the ride." In Pilate's exercises, this is aptly called the "head-float position." (For more information see Abdominal Reconditioning After Pregnancy)

Signs of Midline Recovery

Abdominal separation resolves when either your muscles have pulled back together to less than two finger widths, or when you can feel that your midline has become strong and elastic, at about six to nine months postpartum. At this point, you will no longer feel a hole in your abdomen. Once your connective tissue has regained its former density and elasticity, you are no longer at risk for hernia or other associated problems.

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Diastasis Recti (Abdominal Separation) During and After Pregnancy

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Diastasis Recti Word Origin: Diastasis, from Greek, meaning separation Recti: refers to the rectus abdominis muscle (see illustration below) Definition: Diastasis recti is a fairly common condition of pregnancy and postpartum in which the right and left halves of Rectus Abdominis muscle spread apart at the body's mid line fascia, the linea alba.

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Collecting your colostrum NHS leaflet

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This can help reduce/prevent perineal tears.

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Statutory Maternity Pay

The normal rules on qualifying for Statutory Maternity Pay (SMP) still apply during the pandemic. For more information on maternity pay see: https://maternityaction.org.uk/advice/maternity-pay-questions/

The flat rate of SMP is £148.68 pw up to 4 th April 2020 and £151.20 pw from 5 th April 2020 (or 90% of your average earnings if they are less).

Maternity Action has written to the Government to ask for changes to the Covid-19 support schemes so that pregnant women and new parents do not lose out: https://maternityaction.org.uk/2020/04/support-for-and-advice-to-pregnant-women-new-parents-during-covid-19/

Yes, if you meet the qualifying conditions for SMP your employer must pay it through the payroll in the normal way.

Firstly, you need to check whether you meet the qualifying conditions for Statutory Maternity Pay (SMP). If you have been employed up to the 15 th week before your baby is due and meet the other qualifying conditions, you are still entitled to be paid your full SMP. This is our information sheet on maternity pay: https://maternityaction.org.uk/advice/maternity-pay-questions/

To work out the 15 th week before your baby is due, find the Sunday before your baby is due (or your due date if it's a Sunday) and count back 15 weeks. That is the start of the 15 th week before your baby is due. There is an online calculator here: https://www.gov.uk/maternity-paternity-calculator

If you meet the qualifying conditions for SMP, your employer must pay it by law even if the workplace is closing during the pandemic. Your employer can claim reimbursement for the SMP from HMRC: https://www.gov.uk/recover-statutory-payments. Your employer can get advice on paying and reclaiming SMP from the HMRC Employers Helpline on 0300 200 3200.

If your employer is unable to pay your SMP, they can request advance funding from HMRC: https://www.gov.uk/recover-statutory-payments/if-you-cant-afford-to-make-payments

If your employer has gone into liquidation, you can claim your SMP directly from HMRC. You should telephone the HMRC Employees Helpline on 0300 200 3500 or the HMRC Statutory Payments Disputes team on 0300 0560 630.

If you do not meet the qualifying conditions for SMP, you can claim Maternity Allowance instead. You can find the claim form here: https://www.gov.uk/government/publications/maternity-allowance-claim-form.

No, your employer must pay your SMP in full. The first six weeks of your SMP is based on your average weekly earnings in the calculation period for SMP (approx. weeks 18 to 26 of your pregnancy). For the next 33 weeks your SMP must be paid at the statutory (legal) rate of £148.68 per week (up to 4 th April 2020) and £151.20 per week from 5 th April 2020. If your average weekly earnings are less than the statutory rate you will get 90% of your average weekly earnings throughout your SMP period.

Your employer can claim reimbursement for the SMP from HMRC: https://www.gov.uk/recover-statutory-payments. Your employer can get advice on paying and reclaiming SMP from the HMRC Employers Helpline on 0300 200 3200.

If your employer is unable to pay your SMP, they can request advance funding from HMRC: https://www.gov.uk/recover-statutory-payments/if-you-cant-afford-to-make-payments

If your employer does not pay your SMP in full you can claim it from the HMRC Statutory Payments Disputes Team on 0300 0560 630. You should tell your employer you are contacting HMRC in advance as this may prompt them to pay your SMP correctly.

As this is a difficult and fast-moving situation, it's important to give your employer as much information as possible, including the information above on where your employer can get advice. Make sure your employer knows that they will be reimbursed for your SMP and that they can get advance payment if necessary.

If your employer is not replying to your calls/emails, let them know that you will now need to contact HMRC to get your SMP. This may prompt your employer to take action as it is likely that HMRC will contact your employer to ask for relevant information.

If your employer is not responding, you can contact the HMRC Employees Helpline on 0300 200 3500 or the HMRC Statutory Payments Disputes team on 0300 0560 630 if your employer is refusing to pay your SMP or has gone out of business and can no longer pay it. HMRC will investigate and will order your employer to pay your SMP. If your employer has gone out of business, HRMC will pay your SMP directly.

Yes, your employer must continue to pay your SMP as normal if you leave the country. Once you have met the qualifying conditions for SMP you are entitled to receive it for the full 39 weeks.

You can continue to receive your Maternity Allowance for the full 39 week period if you go abroad temporarily. You should notify the DWP before you go away.

Unfortunately maternity pay is very low but you are not entitled to 'remuneration' (normal salary) during maternity leave as you can only get maternity pay during this period. The only way you can receive furlough pay is to give notice to end your maternity leave early and ask your employer if you can be put on furlough.

You need to bear in mind that if you end your maternity leave early, once the furlough scheme ends and businesses return to normal you will be expected to return to work immediately. You cannot go back onto maternity leave.

If you did not use up all your maternity leave and pay you may be able to take any untaken leave/pay as shared parental leave but you need to check eligibility carefully as it is very complex. You can only take shared parental leave/pay up to a year from your baby's birth: https://maternityaction.org.uk/advice/shared-parental-leave-and-pay/

In order to qualify for Statutory Maternity Pay (SMP) you need to have average weekly earnings of at least £118 pw (£120 pw from 5 th April 2020) in the 8 weeks before the 15 th week before your baby is due. If you are paid monthly, you need to look at your average weekly earnings in the 2 months before the 15 th week before your baby is due. This period is when you are approximately 18 to 26 weeks pregnant. You can find more information on maternity pay here: https://maternityaction.org.uk/advice/maternity-pay-questions/

If you are on Statutory Sick Pay (SSP) of £94.25 pw during the whole of your 8 week/2 month period, you will not be able to qualify for SMP and you will need to claim Maternity Allowance instead. If you are on SSP during part of the 8 week/2 month period, your average earnings will be lower which may reduce the amount of SMP you get.

Your employer should only pay you SSP if you are signed off sick by your midwife/GP or you are self-isolating for 2 weeks with coronavirus symptoms. If you are unable to work during the pandemic for health and safety reasons, your employer should suspend you on full pay if there is no suitable alternative work available. See section above on health and safety during Covid-19.

Your employer can also put you on furlough if you are unable to work because of pregnancy. Your employer can claim up to 80% of your wages from the Government, up to £2500 per month, during the pandemic. More information on help for employers is available here: https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/covid-19-support-for-businesses

You may have a claim for unlawful deduction of wages and/or pregnancy discrimination if your employer does not provide suitable alternative work, suspension on full pay or refuses furlough because of your pregnancy.

Yes, any weeks on SSP or on furlough count as continuous employment. In order to qualify for SMP you must be employed by the same employer for at least 26 weeks by the 15 th week before your baby is due. If you are on SSP or on furlough during part of that period it will still count towards your continuous employment. But bear in mind that SSP is below the earnings threshold for SMP, so it may affect your average earnings, see question above.

If you are on furlough and receiving 80% of your normal pay this will also affect how much SMP you will get.

Maternity Action is campaigning to improve the way that SMP is calculated so that pregnant women who are off sick or are unable to work in the middle of their pregnancy do not lose out on SMP.

Unfortunately the normal regulations still apply in relation to calculation of your average weekly earnings for Statutory Maternity Pay. Your employer will use your average earnings during the 8 week or 2 month qualifying period before the 15th week before your expected week of childbirth. You can use the maternity pay calculator here: https://www.gov.uk/maternity-paternity-calculator

The qualifying period for SMP is very strict and your employer cannot take into account any other earnings. This can mean that if you have periods of sick pay or unpaid leave during your qualifying period it will affect your average earnings and this can mean that your SMP will be lower. Your employer cannot use any other period for calculating your average earnings.

If you are unable to qualify for SMP, you will need to claim Maternity Allowance. You will be able to claim Maternity Allowance but you must send in payslips with your highest earnings, not weeks in which you were paid Statutory Sick Pay.

If your employer has put other staff onto furlough and started paying full pay or 80% of pay, you are entitled to be put on furlough as well up to the start of your maternity leave. You may have a claim for unlawful deduction of wages and/or pregnancy discrimination if your employer pays you Statutory Sick Pay during your pregnancy when your colleagues are being paid normal pay or 80% furlough pay. You should only be paid sick pay if you are off sick or in isolation because you or a family member have Covid-19 symptoms. Government guidance on furlough is available here: https://www.gov.uk/guidance/claim-for-wage-costs-through-the-coronavirus-job-retention-scheme

All workers and employees who are paid through PAYE, with tax and National Insurance deducted at source, are entitled to Statutory Maternity Pay if you meet the normal qualifying conditions. This means that agency workers, zero hours' workers and casual workers, as well as employees can claim SMP. If you don't meet the qualifying conditions for SMP you can claim Maternity Allowance: https://www.gov.uk/government/publications/maternity-allowance-claim-form

You can use the online calculator here to see if you qualify for SMP: https://www.gov.uk/maternity-paternity-calculator

You must give your employer, or agency, notice of when you want to start your maternity leave and pay by the 15 th week before your baby is due. You will also need to give them your MATB1 maternity certificate which you can get once you're 20 weeks pregnant. In view of the pressure on NHS services you may need to telephone your midwife or GP and ask if they can send your MATB1.

Workers and agency workers are treated as employees for Statutory Sick Pay purposes so you may be eligible if you are off sick or in isolation because you or a family member have coronavirus symptoms and you meet the normal qualifying conditions. For more on sick pay, see: https://www.gov.uk/statutory-sick-pay

You may also be eligible for other means-tested benefits if you have no other income during this period. See the section on benefits.

The furlough scheme also applies to agency workers, casual workers and those on zero hours contracts who are paid through PAYE and were employed on the 28 th Feb 2020. This is designed to enable employers and agencies to continue to pay your wages up to £2500 per month if they are not able to provide you with work. More information on help for employers is here: https://www.gov.uk/guidance/claim-for-wage-costs-through-the-coronavirus-job-retention-scheme

No, as an agency worker you are entitled to health and safety protection during pregnancy as long as you have been employed for at least 12 weeks in the same placement. If the employer (hirer) has ended your contract because of health and safety reasons, your agency must offer you suitable alternative work or suspend you on full pay until the date that your placement would have ended. This protection comes from the Employment Rights Act 1996, sections 68A/B/C.

Your agency can also put you on furlough if you are unable to work because of the coronavirus crisis under the government scheme where the agency can claim 80% of your pay. This is the Government information about furlough to show to your agency: https://www.gov.uk/guidance/claim-for-wage-costs-through-the-coronavirus-job-retention-scheme

You may have a claim for unlawful deduction of wages and/or sex/pregnancy discrimination if your employer fails to provide suitable alternative work, suspension on full pay or refuses furlough because of your pregnancy.

If your agency suspends you on full pay or puts you on furlough you remain employed by the agency up to the point when your placement would have ended. Your agency can start your SMP automatically when you are 36 weeks pregnant if you are off work on maternity suspension or furlough or they can start it from the date that your placement would have ended if that is earlier.

If you have been employed by your agency for the first 26 weeks of your pregnancy and earn at least £118 per week on average in approx. weeks 18 to 26 of your pregnancy you may be eligible for Statutory Maternity Pay from your agency. You should give your agency your MATB1 maternity certificate when you are 26 weeks' pregnant and ask them to check whether you qualify for SMP. There is an online calculator to help you work it out here: https://www.gov.uk/maternity-paternity-calculator If your agency does not pay your SMP you can contact HMRC Statutory Payments Disputes Team on 0300 0560 630 to make a claim.

If you're not able to qualify for SMP you can claim Maternity Allowance (MA) instead: https://www.gov.uk/government/publications/maternity-allowance-claim-form

There is more information on benefits and help available during the crisis on our website here: https://maternityaction.org.uk/covidmaternityfaqs/benefits-for-rent-bills/
Maternity Allowance I won't be able to get Statutory Maternity Pay (SMP) because I will be on Statutory Sick Pay for the rest of my pregnancy - what can I claim?
If you are on Statutory Sick Pay when you are approximately 18 - 26 weeks pregnant or your earnings are too low in this period for you to claim SMP, you can claim Maternity Allowance instead.

To qualify for Maternity Allowance you need to show that you have been employed or self-employed for at least 26 weeks out of the 66 weeks before your baby is due. If you are employed, you will also be asked to send in payslips covering a 13 week period. It doesn't need to be 13 weeks in a row. It can be any 13 weeks in your 66 week test period. You should send in payslips with your highest earnings, not weeks in which you were paid Statutory Sick Pay.

You can claim Maternity Allowance here: https://www.gov.uk/government/publications/maternity-allowance-claim-form. You can send the claim form in once you are 26 weeks pregnant.

Note: if your employer has sent all employees home because they are unable to work during the pandemic, you are entitled to be paid the same as your colleagues. The Government has provided a grant for employers to be able to continue to pay all workers 80% of their wages up to £2500 per month in order to help employers to retain workers who are unable to work during the pandemic. It may be an unlawful deduction of wages and/or pregnancy discrimination if your employer continues to pay you Statutory Sick Pay when your colleagues are being paid full pay or 80% of pay. More information on help for employers is here: https://www.gov.uk/guidance/claim-for-wage-costs-through-the-coronavirus-job-retention-scheme
Can I stay on sick pay or furlough until my Maternity Allowance starts?
Yes, it is up to you to decide when you want to start your maternity leave and pay and you can remain on sick pay or furlough up to the start of your maternity leave. The earliest you can start maternity leave and pay is 11 weeks before your baby is due. The latest you can start your maternity leave is the day of the birth.

Your employer can trigger your maternity leave in the last 4 weeks before your expected week of childbirth if you are off sick wholly or partly because of pregnancy, for example, a pregnancy-related illness, health and safety suspension or you have been furloughed because you cannot work during pregnancy.

You will need to notify Jobcentre Plus of the start of your maternity leave so that they can pay your Maternity Allowance from that date.
If I'm off work on Statutory Sick Pay (SSP), does that count towards the 26 weeks of employment for qualifying for Maternity Allowance?
Yes, any weeks on SSP count as weeks of employment. In order to qualify for Maternity Allowance you must be employed for at least 26 weeks in the 66 weeks before your baby is due. Any weeks in which you are on SSP will still count as weeks of employment.

You can also count any weeks of annual leave and weeks of furlough as weeks of employment as well as any weeks in your 66 week test period in which you took a period of maternity leave for a previous pregnancy.

The normal rules on qualifying for Maternity Allowance still apply during the pandemic. For more information on maternity pay see: https://maternityaction.org.uk/advice/maternity-pay-questions/
[This page was last updated on 08 April 2020.]

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FAQs: Covid-19 - rights and benefits during pregnancy and maternity leave

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FAQs: Covid-19 - rights and benefits during pregnancy and maternity leave [This page was last updated on 22 April 2020.] Maternity Action is experiencing exceptional demand for our advice line at present so we have put together some frequently asked questions on rights at work and benefits during pregnancy and maternity leave during the Covid-19 ...

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Everything you need to know to formula feed your baby.

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Information for if you are offered an induction

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Top tips to reduce perineal tears in labour 

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Top tips to reduce perineal tears in labour 