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Decision Aid

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Getting it right from the start - Chapter 1

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Session 1 from Stockport Midwives

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Introduction

Transcript:

Kim: Hi! Welcome to our Baby and You class. We want to provide you with lots of information about birth and early parenthood and of course the importance of the bond between a parent and their baby. We usually do this in a group situation but of course we're thinking outside of the box and that's why we're doing this YouTube video for you.

Kim: My name is Kim. I'm one of the Community Midwives in Stockport and I have been a midwife for almost 10 years.

Sam: My name is Sam and I'm a Community Midwife in Stockport. Kim and I work on the same team and I have been a midwife for nearly 2 years.

Kim: Just make sure that for this video you are sitting really comfortably, particularly for the relaxation we'll be doing at the end. Make sure you have a pen and paper as I'm sure you will want to note down bits of information as we go along. You might have seen questions that relate to this video. Questions that relate to the baby in the uterus. Sam is just going to run through the answers to those questions with you now.

Sam: The first question is my unborn baby is completely formed at how many weeks in pregnancy? You might be surprised at the answer, but it is actually 11 weeks. By 11 weeks pregnant, your baby is completely formed.

The second question was my unborn baby is sensitive to touch by how many weeks in pregnancy? Your baby is sensitive to touch by 20 weeks. We are going to talk a little bit later on about the importance of touch in pregnancy and how that helps babies brain development.

Question 3 my unborn baby can see, hear, taste, experience, feel, remember, and learn, at how many weeks of pregnancy? That is 26 weeks of pregnancy. By 26 weeks your baby is already experiencing a huge amount which is making its brain development better and reinforcing some of those neuronal pathways in your baby's brain. So an awful lot is going on by 26 weeks pregnant, but we'll talk about the importance of that in a few minutes.

How many weeks old is your unborn baby when they react differently to voices of the mother, father, and other familiar people compared to unknown people? That is 29 to 32 weeks. It's really important that you talk to your baby and that people in the family talk to your baby because it is able to respond to voices of people it knows and people it doesn't know by 29 to 32 weeks.

Question 5 my unborn baby will start practising small breathing movements which can often cause hiccups at how many weeks of pregnancy? Around 25 to 26 weeks. An awful lot is going on at around 25-26 weeks pregnant. You may have already felt your baby hiccupping and sometimes it's nice for partners and brothers and sisters to feel those hiccups as well and notice at what stages the baby is moving along.

At what distance will my baby be able to focus on a face or abject when it is born? That is 22 centimetres which conveniently is around the distance from your breast to your eyes. When you are breastfeeding your baby, you will be looking and making eye contact and that again is very important for brain development.

Kim: So, the next exercise we want to do is ways that you might settle and sooth your baby once your baby is born. That will represent your baby's brain development once it is born as well. So, imagine you've got a baby and Sam will go through some ways you would settle or sooth a new born baby.

Sam: So, the first thing I might do is pick the baby up and then maybe talk to the baby a little bit. 'Come on baby it's okay. No need to cry', and then I'm going to cuddle the baby. I might try and feed the baby. After the baby has been fed, if she's still a little unsettled, I might change her nappy. Now I'm going to sing to the baby and try to settle her down whilst also cuddling her. Now I think I will try a little skin to skin contact so I'm going to strip her down to her nappy, take my top off and place the baby in skin to skin contact. Now I will cuddle the baby again and reassure her.

Kim: I'm sure there are many ways you can think of settling and soothing a baby, but if you can see from this diagram and all the crossing over, it represents the baby's brain connections. Every time you do one of these techniques to sooth and settle your baby, it's reinforcing your behaviour and your voice to your new-born and making those positive brain connections. Sam will talk to you a little bit more about that. We know that a baby's brain development and all the neurons or little brain cells are developing from very early on in pregnancy. There's something called 1001 critical days which is from conception to age 2. This is where all these brain connections are being made and the neuronal pathways are being reinforced. The things that really help with baby's brain development are stroking your stomach whilst pregnant, positive touch, talking to your baby when you're pregnant, getting partners and other family members to talk to your baby. You will probably notice when you go to antenatal appointments that midwives will often talk to your baby because we are aware of just how much that really encourages brain development. Play music to your baby, they will be familiar with sounds in the environment in early pregnancy and that does help with brain development. You can sometimes feel a little self-conscious of stroking your stomach or of your partner stroking your stomach and talking to your baby but the more you do it the more it will feel really natural and straightforward. When your baby is born, it's really important that you respond to your baby's needs. Human babies can't do a great deal when they're born unlike other mammals which can do quite a lot of other things when they are born. Other mammals can go and find food from birth, they can get up and walk or swim or whatever, but human babies can't. All they can rely on is their cry to get your attention. You can't spoil a new born baby. Every time your baby cries, it's trying to tell you something so pick your baby up and you do all the things we talked about and your baby will develop those brain connections to make them feel secure and they know that their needs are responded to from very early on and that improves attachment. It may feel a bit stressful at first, particularly if you have never heard a new born baby crying or it's in the middle of the night and you are the only parent, but what you will find is that using these techniques will probably settle and sooth your baby. What we have found is that parents can tell from the different sounds of cries what their baby needs and the way you can respond to your baby will change. Support can be really important for you, especially in those early weeks when things are going to be difficult if we are self-isolating, but you've got to think about how people can support you. If it's bringing shopping or preparing food for you. There are lots of ways that people can support you.

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Introduction Transcript: Kim: Hi! Welcome to our Baby and You class. We want to provide you with lots of information about birth and early parenthood and of course the importance of the bond between a parent and their baby.

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Session 2 from Stockport Midwives

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An accessible transcript is being produced for this video. We apologise for any inconvenience in the meantime.

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Session 3 from Stockport Midwives

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Baby and You - Session 3 - Skin-to-Skin Contact

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An accessible transcript is being produced for this video. We apologise for any inconvenience in the meantime.

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Session 3 from Stockport Midwives

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Baby and You Session 3 - Caesarean Sections

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An accessible transcript is being produced for this video. We apologise for any inconvenience in the meantime.

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Session 3 from Stockport Midwives

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Baby and You - Session 3 - Perineal Care

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An accessible transcript is being produced for this video. We apologise for any inconvenience in the meantime.

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Coronavirus - Looking after yourself and your baby in pregnancy

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Coronavirus - Looking after yourself and your baby in pregnancy

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Perinatal Mental Health

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This information was last updated on 6 April 2022. The links were checked at that time but webpages are sometimes moved. If a link appears to be broken please let us know by emailing enquiries@aims.org.uk. If it hasn't been removed, you should still be able to find the page by entering the title in your browser.

For information about what AIMS has been campaigning for during the pandemic please see here.

Although most Government restrictions introduced to control the spread of Covid-19 have now been lifted, it is possible that maternity services will continue to take a more cautious approach. We hope this information helps you to navigate your care at this time.

We try to answer some common questions about the current guidance below, but different Trusts and Boards may be taking different approaches, so you will need to check with your midwife about what is happening locally. There should also be information on your NHS Trust or Boards's website or Facebook page.

If there is any other general information that you would like to see on this page please let us know by emailing enquiries@aims.org.uk .

Latest Guidance

Here is the latest information about the implications of coronavirus during pregnancy, and the guidance that has been given to the maternity services.

Who can I speak to if I am concerned about my health?

You should have a contact number to contact your midwife, but you can also contact one of the following depending where you live.

AIMS Helpline

The AIMS Helpline volunteers have experienced an increased workload during the pandemic but continue to offer information and support to maternity service users. Please contact us by email helpline@aims.org.uk. We will respond to all enquiries as soon as we can.

The AIMS Helpline does not offer medical advice, but we can provide information and support to help you navigate the maternity system, to know your rights and to listen to your concerns. We will be regularly reviewing the issues brought to us on the Helpline, so we offer the best information and most effective support that we can.

What are the risks for me if I am pregnant?

According to the latest RCM/RCOG guidance pregnant women do not appear to be more likely to contract the infection than the rest of the population unless they are unvaccinated and also have pre-existing diabetes, gestational diabetes requiring insulin, or are overweight or obese. However, as the Omicron variant is spreading very rapidly it is likely that your chances of catching it during pregnancy will be higher than with the previous variants.

Of women who became infected with the earlier variants during pregnancy, the majority had no symptoms and most of the others experienced only mild or moderate cold or flu-like symptoms. A review summarising 70 studies from 25 countries (the PregCOV-19 Living Systematic Review) reported that 73% (almost three quarters) of pregnant women who were admitted to hospital for any reason and tested positive for COVID-19 had no symptoms, but much of this data comes from before the emergence of the later variants.

There is evidence that pregnant women infected with the wild-type, Alpha and Delta variants of COVID-19 were more at risk of severe illness and of being admitted to intensive care than those who were not pregnant (though it's possble that part of the difference in admissions may be because doctors are more cautious if someone is pregnant). We do not yet have the data to tell, but the Omicron variant may be associated with less severe disease. Severe illness appears to be more common with infections that occur in the third trimester.

This infographic shows the findings from the UK Obstetric Surveillance Survey (UKOSS), covering the period from 16th May 2021 to 31st October 2021 when the Delta variant accounted for most infections. Of the 1436 pregnant women admitted to hospital with symptoms during this time, 474 (33%) needed support to breathe, a similar number (32%) developed pneumonia, and 230 (16%) were admitted to intensive care.

It remains very rare for pregnant or postnatal women to die from COVID-19 though sadly it can happen. According to the RCOG/RCM guidance the UK maternal mortality rate from COVID-19 is 2.4/100 000 maternities.

COVID-19 infection is associated with a higher chance of giving birth prematurely (see also 'What are the risks for my baby?) with 19% of hospitalised mothers In the latest UKOSS study experiencing this. There is also a higher chance of having a caesarean (49% of those who had COVID-19 symptoms compared with 29% of a pre-COVID group). Both of these effects are, in the majority of cases, due to a decision to have the baby born early because of COVID-related concerns over the mother or baby's wellbeing.

The UKOSS study found that the main risk factors for being hospitalised with Covid-19 were being unvaccinated, being of a Black, Asian or minority ethnic background, having a body-mass index above 25 kg/m2 , having a pre-existing health condition such as diabeted or high blood pressure, being aged 35 years or older, living in increased socioeconomic deprivation, and working in healthcare or other public-facing occupations.

What are the risks for my baby?

The majority of babies born to mothers diagnosed with COVID-19 have been born healthy. So far the evidence is that a COVID-19 infection in early pregnancy does not seem to increase the risk of a birth defect or miscarriage.

Although it is possible for the virus to be transmitted to babies in the womb, the RCM/RCOG guidelines say evidence now suggests that it is uncommon. The risk of infection in the baby after birth appears to not be affected by whether the birth was vaginal or by caesarean, or by factors such as the timing of cord clamping, skin-to-skin contact, method of feeding or whether the mother and baby stay together. According to the Royal College of Paediatrics and Child Health "COVID-19 seems generally to be a fairly minor illness in young infants." However in the most recent period of the UKOSS study (16th May 2021 to 31st October 2021) sadly four babies in the UK died as a result of a COVID-19 infection after birth.

There is some evidence that COVID-19 infection is associated with an increased chance of a stillbirth, though the findings from different studies vary a lot and the actual numbers are small. Overall it looks as though the rate may be between 0.7% and 0.9% (seven to nine out of every 1000 births) for those with an infection compared to between 0.3% and 0.5% (three to five out of every 1000 births). However, the latest UKOSS survey found that of UK mothers who were ill enough to be hospitalised with a COVID-19 infection in the period when the Delta variant was dominant, 2% suffered a stillbirth. Having a severe COVID -19 infection may be associated with a slightly higher chance of having a very small baby, but the evidence on this is still unclear.

The greatest impact of COVID-19 on babies seems to arise not from any direct effect of the virus itself but because of births being deliberately brought forward due to concerns over mother or baby's well-being. This is leading to around two to three times more premature births in women with severe COVID-19 symptoms compared to the normal rate and therefore to more babies being admitted to a neonatal uit and more experiencing the complications that can result from prematurity, such as breathing difficulties. Being born prematurely can also have long-term health consequences.

What about vaccinations?

Pregnant women have been classed as a 'vulnerable group' for whom vaccination is recommended. Guidance in the UK is for all pregnant women to be offered vaccination with the Pfizer-BioNTech or Moderna vaccines unless they have already had one dose of the Oxford-AstraZeneca vaccine, in which case their second dose should be the same. This is because most of the information on the safety of vaccines in pregnancy is from the USA, where these were the main vaccines used.

As with any medical treatment it is up to you whether you wish to accept the offer of vaccination. The previous sections 'What are the risks for me if I am pregnant?' and 'What are the risks for my baby?' explain what the latest research evidence shows about the risks of catching COVID-19 during pregnancy. For more about making decisions about vaccination see out webage Vaccination During Pregnancy

The original clinical trials of the available vaccines did not include pregnant women, but there is now extensive real-world data . The RCM/RCOG guidance says that more than 347 150 women in the UK and USA have had a COVID-19 vaccine in pregnancy with "no concerning safety signals". A number of studies are now in progress to look at the safety and effectiveness of COVID-19 vaccines in pregnancy.

The real-world data has so far shown no signs of an increase in miscarriages, birth defects or any other pregnancy-related concerns after vaccination, and it appears that the level of minor side-effects is similar to that in the general population . The most common side-effects are soreness at the injection site, headache and fatigue, and studies so far have found that rates of these are similar for pregnant women, with perhaps fewer experiencing fever but more reporting nausea and vomiting after a second dose of the Pfizer-BioNTech or Moderna vaccines compared to non-pregnant women. The very rare risk of blood clots found with the Oxford-AstraZeneca vaccine has not been observed with the Pfizer-BioNTech or Moderna vaccines.

In the UK, data published by the UK Health Security Agency (UKHSA) shows that for the 355 thousand women who gave birth between January and August 2021 there was "a similar very low risk of still birth, prematurity and low birth weight in vaccinated and unvaccinated women."

In the USA the Centers for Disease Control (CDC) has safety monitoring systems which have gathered information on over 212,000 pregnant women and people who have received vaccinations (mainly with the Pfizer-BioNTech and Moderna vaccines). Their website says that the preliminary analyses "did not identify any safety concerns for pregnant people who were vaccinated or for their babies. Additional follow-up is needed, particularly among those vaccinated in the first or second trimesters of pregnancy; however, these preliminary findings are reassuring."

If you are fully vaccinated and catch COVID-19 during your pregnancy, your chances of being hospitalised or admitted to intensive care appear to be greatly reduced. According to the RCM/RCOG guidance those who have had two doses and a booster (or three doses) of vaccine (combined data on Pfizer-BioNTech, Oxford-AstraZeneca and Moderna) are 88% less likely to be admitted to hospital with the Omicron variant than those who have not been vaccinated. 96% of pregnant women admitted to hospital with symptomatic COVID-19, and 98% of those admitted to intensive care, were unvaccinated.

Will I be able to have someone to support me during my maternity care?

The guidance on partners/supporters attending in-person antenatal appointments and scans, during labour and any postnatal stay is now different in the four nations of the UK. Please follow the links below to check details of the guidance for your country, but be aware that this may change at short notice. Trusts/Boards still have discretion about how far to implement the national guidance based on local risk assessments, and the position could change if there is a rise in cases either locally or nationally. Please check the current local rules, which should be available in your hospital's website.

AIMS hopes that all Trusts and Boards will at the very least to consider on a case-by-case basis requests for support beyond these minimum levels, which may be critical to some people's mental well-being or other needs e.g. due to disability or being non-English speakers. We know that some Trusts/Boards are being flexible about allowing a second birth partner at least for people with a particular need for extra support. If yours is limiting you to one birth partner you may want to challenge this, especially if there are exceptional circumstances which mean that you need more than one person for support. You may want to ask them to give you their justification for the decision.

AIMS has drafted a set of template letters which you can adapt to your own situation if you feel that your Trust/Board is not meeting your support needs.

In England the latest guidance from NHS England Supporting-pregnant-women-maternity-services-access-for-parents-of-babies-in-neonatal-units asks "all trusts to continue enabling women to have a support person of their choice at every point throughout their maternity journey." The guidance makes clear that "Within maternity and neonatal services, support people and parents of babies on neonatal units are not considered to be visitors and should not be treated as such." Therefore any visiting restrictions in force elsewhere in the hospital should not apply.

In line with changes to Government policy on testing, the guidance says that maternity settings should no longer expect evidence of a negative test before allowing supporters in. However, if a support person has received a positive test, or has symptoms of COVID-19, they should be advised not to attend. You may therefore want to identify an alternative support person in case your chosen supporter is affected.

The guidance also makes clear that if you personally have symptoms of Covid or have tested positive you should still be able to have a supporter with you.

There is no mention of second birth supporters, but it is worth noting that the guidance on Infection prevention and control for seasonal respiratory infections in health and care settings now recommends "that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care settings" unless someone has a "suspected or confirmed respiratory infection." Since restrictions on second birth supporters were often explained by the need to maintain 2 metres' distancing this is something which those Trusts should be reviewing.

In Scotland the guidance sets out minimum standards for both for the situation in which there is "no current active outbreak on ward" or if there is "an active outbreak management scenario". However, "A birth partner supporting a women during hospital visits continues to be categorised as an essential visitor." This means that even during an active outbreak one birth supporter should be allowed to accompany you to the booking scan, 20 week scan and any emergency appointments "subject to local risk assessments and physical distancing." They should also be able to stay with you throughout induction, labour and birth (except during a general anaesthetic), and during any stay on the antenatal or postnatal ward, again "subject to risk assessments and physical distancing."

If there is no current active outbreak then an additional visitor/second birth partner should be allowed "subject to local risk assessments and physical distancing" and plans should also be in place "for return to person-centred visiting" during labour and in inpatient wards.

All visitors are asked to take a lateral flow test before attending, but staff won't be asked to check these.

In Wales the guidance makes recommendations for the support that should be available at four different "Risk Ratings": Very High, High, Medium and Low. It appears that these will be determined by a local risk assessment, so AIMS hopes that Boards and hospital managements will be transparent about both what their current Risk Rating is, and the basis on which the judgement has been made, as well as providing detailed information about any current restrictions.

We have attempted to summarise the guidance, but suggest you check the relevant document for the full details.

Health Boards are encouraged "be innovative in the way that visiting access is enabled." In addition, they are told to give consideration to reasonable adjustments for those with specific needs leading them to require extra support, such as mental health issues, learning disabilities, communication needs and "Where the treatment/procedure is likely to cause the woman distress and the partner/nominated other can provide support." It may therefore be possible to negotiate for additional support if you can demonstrate a specific need.

If the Risk Rating is Very High the recommendation is for women to attend all appointments and scans alone and for no visiting in antenatal or postnatal in-patient settings. However they can be accompanied by"essential support assistants" (defined as someone required "for specific additional support eg a support worker, BSL or foreign language interpreter", but who could be a partner or family member in some circumstances.) In addition "One nominated adult may accompany the woman attending where she requires familiar support for consultations which may cause her distress." In active labour only either a birth partner or an 'essental support assistant' is allowed.

The rules are the same if the rating is High, except that a supporter can attend an early pregnancy assessment unit scan, early pregnancy dating scan and the 18-20 week anomaly scan, or visits to the Fetal Medicine Department.

If the Risk Rating is Medium, essential support assistants and/or up to one support partner are allowed for all antenatal appointments, and one supporter is allowed at the above list of scans, all subject to social distancing rules being possible. The limitation that a supporter is allowed in 'active' labour is not mentioned, so it seems they can be present from the time of admission "if national guidance on social distancingcan be achieved in the local setting."

If the Risk Rating is Low, there should be a "phased reintroduction of usual visiting policies" if different to the medium risk level.

In Northern Ireland while in the Gradual Easing phase the maternity services should allow for a birth partner to "be facilitated to accompany the pregnant woman to any pregnancy related appointments and ultrasound scans with particular effort made to keep the environment COVID secure." A COVID-19 secure envirment is defined as: a social distance of 2 metres wherever possible, optimal hand hygiene and personal hygiene measures, good ventilation, use of PPE when required and all visitors to wear appropriate face coverings.

A chosen birth partner should also "be facilitated to accompany the pregnant woman for induction of labour, duration of labour and birth and, for up to three hours after the birth." Postnatally "One daily visit from one of two nominated individuals (from up to two households) can be permitted, with particular effort made to keep the environment COVID secure."

Will I be able to birth my baby at home?

The evidence about the safety of homebirth can be found in the "Your Choice - where to have your baby" leaflets for first time mothers and for those having a subsequent baby which your midwife should already have given you at antenatal appointment early in your pregnancy. You will also need to take into account any specific issues that might affect your birth, as well as the chance of catching Covid-19.

Article 8 of the Human Rights Act protects your right to birth where you choose. In normal circumstances if you made the decision to birth at home, you should be able to expect NHS care for the birth. However in the current circumstances there may be situations where this in not possible. This does not mean that you can be legally required to birth in hospital, but that you may not be guaranteed medical support if you decide to birth at home.

RCM/RCOG's Guidance for provision of midwife-led settings and home-birth in the evolving coronavirus pandemic recognises that "Continuation of as near normal care for women should be supported, as it is recognised to prevent poor outcomes." It also says that "The positive impact of midwife-led birth settings is well documented, including reductions in the need for a range of medical interventions. These positive impacts remain of significant importance to prevent avoidable harm, and availability of midwife-led care settings for birth should therefore be continued as far as is possible during the pandemic." The guidance notes that "Emerging evidence from European settings supports continuing to strengthen community services in order to enable social distancing and minimise spread in healthcare settings."

Although many NHS Trusts/Boards have reinstated support for home births, there may still be restrictions in some areas, often justified as being due to local staffing shortages.

This article Homebirthing in the United Kingdom during COVID-19 includes a discussion of the legal position and states that "we argue that it is illogical to assert that the blanket removal of homebirthing service meets the test of 'necessity' when two-thirds of Trusts have continued to offer some form of homebirth service throughout the pandemic. The blanket removal of homebirthing services is neither necessary nor proportionate, therefore these policies amount to a violation of the Article 8 rights of birthing people."

In fact, the RCM/RCOG guidance recommends that Trusts take a phased approach based on levels of midwifery shortage and how the ambulance service is running. They indicate that if the midwifery shortage is under 20% and the ambulance service is running as usual, all places of birth should continue to be available. The calculation of available midwifery resources should include " additional midwives from the NMC emergency register, independent midwives, those previously in non-clinical roles or year-3 student midwives."

Before moving to restrict homebirths this guidance says that Trusts should consider adapting the usual policy of having two midwives at a homebirth "to include senior student midwives, returning registered non-clinical midwives, returning recently retired midwives or appropriately prepared maternity support workers to attend as the second member of the team for low-risk home births." They should also consider a combined rota for community midwives and those at freestanding birth centres "so as to maximise the spread of resources and maintain the full range of maternity settings for as long as sustainable staffing allows."

Even with a midwifery shortage of over 30% and/or ambulance service experiencing severe delays either an alongside midwife-led unit or allocated midwife-led rooms on obstetric units should still be available, if Trusts feel unable to offer support for homebirths.

Trusts should review the constraints on a daily basis and follow a corresponding 'de-escalation plan', reinstating services as midwifery shortages reduce.

If you are planning a homebirth, you will need to check the situation in your local area, and be aware that this can change at short notice. You may want to check whether your Trust has followed the escalation/de-escalation plan which RCM/RCOG recommend, and the current state of midwifery staffing levels and ambulance services.

If your local Trust is one of those that has said that they will not support homebirths, you could try writing to your local Head/Director of Midwifery asking them to consider the solutions adopted elsewhere to enable support to be provided for homebirths. AIMS has drafted a template letter which you may like to adapt to your own situation. You can find it here www.aims.org.uk/information/item/booking-a-home-birth .

In some areas, Trusts/Boards are asking people to sign a "Homebirth Contract" before they will agree to provide midwifery support. The article by Romanis and Nelson states "These documents do not carry any legal weight when it comes to decisions during birth - the fact that a pregnant person preparing to birth has signed cannot compel them to have any intervention during their birth, such as transfer to hospital, to which they do not consent."

You may also want to find out whether you could go to a birth centre or a midwife-led room in the hospital instead, as in line with the RCM/RCOG guidance at least one of these should be an option. Another option forsome families could be to hire an independent midwife. Independent midwives work separately to the NHS and so can offer support for a homebirth even when the NHS will not, or there is a threat of withdrawal. Some Independent Midwives can be found on the IMUK website but not all midwives are part of IMUK so try social media, word of mouth and search online.

If neither of these is an option for you, and your Trust continues to decline support for a homebirth, you will need to decide whether to go to hospital or birth at home without medical support. If you are considering remaining at home for the birth even if a midwife may not be available please see the section "Can I birth at home without a midwife?" below.

Will I be able to go to a birth centre?

See "What are my birth choices if I have tested positive or have symptoms of coronavirus?" for how this might affect your ability to access a birth centre.

You should have already been given information about birth outside an obstetric unit, but you can also find it here: "Your Choice - where to have your baby" leaflet for first time mothers and for those having a subsequent baby. Your midwives should be able to answer any questions that you have. You will also need to take into account any specific issues that might affect your birth, as well as the chance of catching Covid-19.

Please see the section "Will I be able to have my baby at home?" for details of guidance from RCM/RCOG on maintaining midwife-led care settings for birth, depending on the levels of midwifery shortage and how the ambulance service is running. If there are problems with these, the guidelines say that Alongside Midwifery units (AMUs) may be prioritised over Freestanding Midwifery units (FMUs) where a Trust has both. If a Trust decides that it needs to close an FMU, then an AMU should still be available. If there is no AMU then they should arrange for "allocated midwife-led rooms on obstetric units".

Can I birth at home without a midwife?

We are receiving increasing numbers of contacts from women who tell us that they are now considering remaining at home to give birth even though a midwife may not be available to come out to them. A planned birth without the presence of a health professional is known as a freebirth. It is your right to birth without a midwife or doctor present.

We would hope that if you are planning a homebirth and want a midwife present you will not be forced into a choice between leaving home to birth elsewhere or having to birth without that support, but in the current situation we know this is happening. If you are in this position you will need to weigh up the risks and benefits of remaining at home without medical support compared to going into hospital.

Guidance from the RCM suggests that maternity services should seek to build a dialogue with women considering a freebirth. This should include a chance to "share what is important to her in relation to her psychological and physical safety", time to "explore why she wants to have an unassisted birth" and the offer of support for previous birth trauma. AIMS hopes that this means that midwives will listen to such women with empathy.

It is important for midwives to give objective, factual evidence about the risks of all of a mother's birthplace options in order to enable her to make an informed decision. However, mothers have the right to decline further discussion for any reason, including if they feel that they are being subjected to unwanted repetition of the risks of freebirth.

The RCM guidance suggests asking the woman "what plan for the birth would feel safe and acceptable to her" and that "The senior midwifery management team should then assess what individualised, flexibility of service provision might be possible to avoid an unassisted birth as far as possible." AIMS hopes that this would include the option of providing support for a homebirth if this is the only way in which a woman can feel safe and/or able to protect her mental well-being.

It is not acceptable, and could be illegal, for anyone to coerce you, or threaten to refer you to Child Services if you decide to remain at home to birth your baby unattended by a midwife. Anyone who tries to do so should be reminded that this is not a valid reason for referral and that it goes against the code of practice for both doctors and midwives, and could lead to a complaint not only to their employer, but to the General Medical Council ( GMC) or Nursing and Midwifery Council ( NMC). The RCM guidance reminds midwives that "It is not illegal for a woman to give birth unattended by a midwife or healthcare professional" and that "It is not appropriate for healthcare professionals to refer a woman to social services with concerns about the unborn baby, solely on the basis that she has declined medical support, as she is legally entitled to do."

If you are considering a freebirth we would suggest gathering as much information and emotional and practical support as possible in order to prepare for a birth without a doctor or midwife present. There is more information about Freebirth on the following AIMS Birth information page Freebirth, Unassisted Childbirth and Unassisted Pregnancy which addresses rights and other things you need to know and where you can find support.

What are my birth choices if I tested positive or have symptoms of COVID-19?

The RCM/RCOG guidelines say that i f you have tested positive at the time or within 10 days before going into labour, but have no symptoms and wish to give birth at home or in a birth centre it is recommended that you "should have an informed discussion around place of birth with {your} clinician." Note, however, that the decision whether to birth at home is yours - you do not need 'permission' to do this.

Offering continuous monitoring of your baby's heartrate "is not recommended" just because of a positive test though you should be offered a discussion of monitoring options (see our Birth Information page "Monitoring your baby's heartbeat during labour".) This is because there is no evidence that an infection without symptoms puts your baby at any increased risk of problems during labour. Consequently, you should not be denied access to a birth centre on the grounds that you need continuous monitoring if you would decline this anyway.

After the birth you should as normal be offered delayed cord clamping (waiting for the blood from the cord to finish passing to your baby before it is clamped and cut) and immediate skin-to-skin contact with your baby. There is no evidence that these practices increase the risk of a baby becoming infected.

If you have mild COVID-19 symptoms the guidelines say you should be encouraged to remain at home (self-isolating) in early labour, and if you do go to the maternity unit in early labour but all is well with you and your baby you should be encouraged to go home again until your labour is more established (assuming you have your own transport to do so). The guidelines recommend that if you have symptoms you should give birth in a hospital obstetric unit rather than at home or in a birth centre because "there may be an increased risk" of a baby becoming distressed in active labour (though they don't say how great the risk is) and because women with COVID symptoms are more likely to have a caesarean. You still have the right to birth at home if you choose.

The guidelines also say you should be offered continuous monitoring of your baby's heartrate, because "While further data is required in women with symptomatic confirmed or suspected COVID-19, it appears prudent to use" it. In other words, there isn't any evidence to say whether continuous monitoring helps in this situation, but the guideline authors feel it's better to be on the safe side. You have the right to decline continuous monitoring if you do not want it.

There is no evidence to favour either a caesarean or a vaginal birth for people with COVID-19, unless their condition is worsening and they need urgent treatment and you should be free to choose which you want to plan for. You might be recommended to have an epidural put in during early labour, so that if you were to need a caesarean very urgently you would not need to be put under a general anaesthetic. However this is just being recommended as a precaution. So far there is no evidence to show whether women with suspected/confirmed COVID-19 are significantly more likely to need a very urgent caesarean where there would not be enough time to set up an epidural or spinal block. It is up to you whether you want to have an epidural for this reason, if you were not otherwise intending to use it to manage your labour, and your doctor or midwife should discuss the benefits and risks so that you can make an informed decision.

The guideline admits that there is no evidence on which to base recommendations about your care if you have recovered from COVID-19, so the following are "based on expert consensus" - which means what those writing the guideline thought made sense.

If you have recovered from COVID-19 but did not need to be admitted to hospital with it, "there should be no change to planned care during labour and birth."

If you were admitted to hospital with severe COVID-19 and have recovered "healthcare professionals should discuss and plan place of birth with the woman" taking into consideration your baby's growth and your choices. This does not affect your right to choose a homebirth, and if all is now well with you and your baby there would appear to be no reason for you not to go to a birth centre.

Will I be able to have a waterbirth?

The availability of birth-pools varies. In some NHS Trusts there are one or more pool rooms within the main hospital obstetric unit, but in others they are only available in midwife-led units (birth centres). In that case, if the midwife-led units have been suspended, then there probably won't be a birth-pool available unless the Trust has, for example, installed a portable birth-pool in the obstetric unit. Unfortunately, you do not have a right to insist on a water-birth so you may need to negotiate for this. If homebirth is an option for you then you can hire your own birth-pool.

The RCM/RCOG guidance guidance recognises that labour and birth in water "may confer benefits" and makes it clear that those who have no symptoms or who have tested negative for COVID-19 should be able to use a birth-pool "providing adequate PPE can be worn by those providing care."

The guidelines note that for those who have tested positive but have no symptoms there is a lack of evidence to show whether the virus can be transmitted in water, so they make no recommendation for or against the use of birthpools in this case. In fact, while there is evidence that coronavirus may be present in faeces (poo) there is no direct evidence that it can be caught from a birthpool, so there seems no good reason to prevent someone without symptoms from using one, even if they have tested positive. However, hospitals may decide against it in order to protect staff.

The guidelines note that it is not usually recommended for those with fever to labour in water, and that those with symptoms such as coughing or breathing difficulties, or who feel unwell, need careful monitoring so their care is better managed on land.

This briefing from the Royal College of Midwives (RCM) concludes that "The current evidence does not suggest that there should be a blanket cessation on the use of water in labour or waterbirth for all women." It does go on to say that "Individualised risk assessment about the appropriateness of providing labour or birth care in the pool room should be undertaken for each woman by the midwifery team providing care, based on the woman's individual presentation and the pool environment within the labour setting." This would still allow a Trust to say that their pool room is not suitable.

A paper from Oxford Brookes University water immersion during labour and waterbirth - COVID-19 context makes the case for waterbirth being a potentially safer option for women who do not have suspected or confirmed symptoms of COVID-19 "because it promotes the use of social distancing without interrupting normal midwifery care" and that the water should dilute any potential contamination from respiratory droplets or faeces.

Will I still be offered an induction or planned caesarean?

The RCM/RCOG guidelines suggest having a discussion with your doctor about the timing and mode of birth but it is (as always) up to you whether to accept an offer of induction or a caesarean, and you should also be able to request a caesarean if that is what you want and it is not being offered.

If you are self-isolating because you or someone in your household has suspected COVID-19 they suggest a"personalised assessment should take place" to decide whether it is better overall to delay a planned caesarean or induction. This should include consideration of how urgent it is for your baby to be born, and the risks of infection to others and to your baby after birth. You can ask for a second opinion if you are unhappy with the decision.

Can my baby stay with me after birth if I have suspected or confirmed COVID-19?

There is little evidence about the risk of a baby catching COVID-19 from an infected mother but according to Advice from the British Association of Perinatal Medicine (BAPM) "it now appears unlikely" that a baby will become infected around the time of birth "if correct hygiene precautions are undertaken." The recommended approach differs according to whether the baby is well at birth, or needs to spend time in a neonatal unit.

The RCM/RCOG guidance says that, as long as your baby is healthy they should remain with you and you should be supported to breastfeed and to practice skin-to-skin/kangaroo care if you wish, even if you have a suspected or confirmed COVID-19 infection. However, if your baby needs to be cared for in a neonatal unit then you will probably not be admitted to the unit, in order to protect the other babies and adults in there, except in some specific circumstances. The guidance confirms that parents should still be involved in decisions about their baby's care and that those who wish to breastfeed should be supported to do so. (See " Will I be able to be with my baby if s/he is being cared for in a neonatal unit (NNU)?" for more about this situation.)

Will I be able to be with my baby if s/he is being cared for in a neonatal unit (NNU)?

Advice from the British Association of Perinatal Medicine (BAPM) makes it clear that there should be no restriction on parents being with their baby in a neonatal unit unless they have tested positive or are required to self-isolate. They state that "it is essential that the mother and her partner are never considered to be visitors within the neonatal unit - they are partners in their baby's care, and their presence should be encouraged." NNUs are advised to identify how to admit parents safely at all times of day, including during ward rounds, so that they can be properly involved in discussions of their baby's care. It notes that "The benefits of extended parental contact, including skin to skin care and active involvement in their baby's care are well documented, as are the long established advantages of breast feeding. At such a stressful time it is important for both parents to be able to be present together, at least for part of the day, unless such practice would be clearly detrimental to other babies and/or staff in the NNU or TCU." BAPM also encourages hospitals to offer testing to parents on the same basis as to staff, in order to minimise unnecessary separation from their baby.

Most Trusts/Boards appear to be allowing both parents to visit together, for all or a large part of the day, but some still have restrictions e.g. only allowing one parent to visit at a time, or limiting visiting to daytime. AIMS has a template letter which parents can use to request access to a baby in a neonatal unit, if this is being restricted without good reason.

BAPM recognises that "It would generally not be appropriate" for parents who have tested positive or are self-isolating to visit a neonatal unit but every effort should be made to facilitate remote contact by use of video technology and/or social media. If a baby is critically ill or receiving palliative or end-of-life care then "everything possible should be done to achieve parental presence and participation in cares" even if the parents have tested positive.

If parents are not able to visit their baby, it remains their right to receive information and be supported to make decisions about their baby's care, and mothers should be supported to express breastmilk if they wish (see " Can I breastfeed my baby if I have suspected or confirmed COVID-19?")

All four nations of the UK have issued their own , which in most cases is in line with the BAPM advice.

In England the latest guidance from NHS England Supporting-pregnant-women-maternity-services-access-for-parents-of-babies-in-neonatal-units asks "all trusts to continue enabling parents of babies on neonatal units having access to their babies." The guidance makes clear that "Within maternity and neonatal services, support people and parents of babies on neonatal units are not considered to be visitors and should not be treated as such." Therefore any visiting restrictions in force elsewhere in the hospital should not apply.

The guidance advises that parents should not attend neonatal units if they are symptomatic of COVID-19, but should be offered video access to their baby.

Welsh Government guidance is for "Up to two parents, guardians, or carers at the bedside at a time for paediatric inpatients and neonates subject to local determination, and following a risk assessment including the ability to maintain social distancing."

In Scotland the guidance sets out minimum standards for both for the situation in which there is "no current active outbreak on ward" or if there is "an active outbreak management scenario". In all cases "Parents/primary care givers are partners in neonatal care, and as such should never be considered as visitors to neonatal units and are also considered essential." If there is a current outbreak, both parents should still be able to visit "Both parents subject to local risk assessments and physical distancing." If there is no current outbreak then an additional visitor may be allowed "subject to local risk assessments and physical distancing" and for long-stay patients, siblings are permitted to visit, subject to local risk assessment.

In Northern Ireland the guidance states that in the current 'Gradual Easing' phase any child admitted to a neonatal unit "can be accompanied by two persons (either/both parents or two nominated caregivers from up to two households) at all times for the duration of the stay."

Can I breastfeed my baby if I have suspected or confirmed COVID-19?

The best way to protect your baby from infection is to breastfeed and maintain close contact/skin to skin contact with your baby even if you are ill. You may choose to wear a mask when you are in close contact with your baby, or when you are feeding them.

The latest Advice from the British Association of Perinatal Medicine (BAPM) confirms that even a woman with a suspected or confirmed COVID-19 infection should be enabled to have skin-to-skin contact and breastfeed her baby if that is her choice and the baby is well. They say " To date viral RNA has been reported only very rarely in fresh breast milk of COVID-19 confirmed mothers" and so, though the sample is small, the current advice for "well babies of COVID-19 suspected or confirmed mothers is that the benefits of breast feeding outweigh any theoretical risks."

For a baby being cared for in a neonatal unit (NNU) it suggests that carers and parents should discuss the pros and cons of a mother with a suspected or confirmed infection expressing breastmilk for her baby, taking into account the baby's age and state of health, and whether donor breastmilk is available as an alternative. However, it would be the mother's right to provide expressed breastmilk if she wishes, and the RCM/RCOG guidance says that if you are unwell or otherwise unable to breastfeed your baby directly, you should be supported to express your breastmilk, or be offered donor milk for your baby.

If your baby is receiving donor breastmilk, you may wish to continue expressing and discarding your own milk until you are no longer infectious, in order to maintain your supply.

The following breastfeeding helplines offer information and support:

National Breastfeeding Helpline: 0300 100 0212
www.nationalbreastfeedinghelpline.org.uk

NCT Helpline: 0300 330 0700 (Choose option 1 for NCT infant feeding line)

La Leche League GB Helpline: 0345 120 2918

Association of Breastfeeding Mothers: 0300 330 5453

Breastfeeding Support organisations
What if you are giving your baby formula?

If you are formula feeding your baby it is even more important than usual to make sure you are carefully sterilising all the equipment you use and minimising the number of people who hold and feed the baby.

Many parents worry about their baby not taking the recommended amount of milk, and during this time where they may be a lack of support you may be concerned about this. In which case you may find the 'Paced Bottle-Feeding' method may be useful and information can be found here https://feedsleepbond.com/lactation-consultants-guide-bottle-feeding.

Written by: Nadia Higson
Reviewed by: AIMS Helpline Team
Reviewed on: 06/04/2022
Next review needed: 01/04/2023

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.

Published on 29th July 2020

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This information was last updated on 6 April 2022. The links were checked at that time but webpages are sometimes moved. If a link appears to be broken please let us know by emailing enquiries@aims.org.uk. If it hasn't been removed, you should still be able to find the page by entering the title in your browser.

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Glossop

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Good information about vitamin K is key for every parent.

In most countries, one of the first decisions that parents need to make for their baby is whether or not they want their baby to have vitamin K. If they do, it's usually given within the first hour of birth.

It's your decision whether or not your baby has vitamin K. It's also up to you to decide which kind of vitamin K (oral or injection) you want your baby to have. So you'll want to weigh up the pros and cons, as with every decision you'll make for your child.

I have been researching vitamin K for more than twenty years, and I have written several books and information leaflets on this subject. Here's the most recent.

I have written this summary of information about vitamin K that you might want to consider when making your decision. It's based on the information in my book, and you might also want to visit my vitamin K information hub, which offers a few more articles on vitamin K.

1. Vitamin K is offered in order to prevent a rare but serious blood clotting problem.

Vitamin K is needed in the human body for several key processes.

One of the most important is that it helps blood to clot.

This is why it is offered to newborn babies. Without it, a small number of babies will develop a rare but serious blood clotting problem.

We used to call this problem haemorrhagic disease of the newborn (HDN). It is now more commonly known as vitamin K deficiency bleeding (VKDB).

2. The likelihood of the problem is low, but it can be serious.

Exact figures vary, but the chance of a baby experiencing VKDB if they don't have vitamin K is about 1 in 11,000.

Most babies who have VKDB will recover, especially if they receive treatment quickly. This is why it is important to be vigilant if you decide to decline vitamin K.

A small number of the babies who experience VKDB will experience long-term damage and, sometimes, a baby will die. The actual chance of death from VKDB is very low, but if we give vitamin K to all babies, it's even less likely.

3. Vitamin K can be given by mouth or by injection.

Vitamin K can be given by injection, or your baby can have oral drops.

The drops may be given in several doses over the first few weeks of your baby's life.

Oral drops are not as effective as the injection, but some parents prefer to give vitamin K that way.

The timing and amount of vitamin K that is given orally can vary between areas of the world.

Vitamin K is also added to formula milk.

4. Vitamin K is very effective, especially when given by injection.

We do not have a randomised controlled trial into vitamin K.

However, other studies, audits and long experience suggest that vitamin K is very effective at preventing VKDB when given by injection.

Oral vitamin K is less effective than vitamin K given by injection. But oral vitamin K is more effective than no vitamin K. We don't have good data on exactly how effective oral vitamin K is.

5. Vitamin K is very safe, but there are a few downsides.

Compared to some drugs, vitamin K is considered very safe.

The injection of vitamin K will occasionally result in infection (at the injection site), bruising or bleeding (as with any injection). It can cause pain to the baby when it is being given.

There have been cases of the wrong drug being injected, but these are rare.

Some people are concerned about other possible downsides to vitamin K, because it hasn't been well researched.

We have given vitamin K to millions of babies for many years because we know that it prevents almost all cases of VKDB.

But we don't know why babies have a relatively low level of vitamin K (compared to adults). It may be that this is beneficial to them in some way.

No research has been done into this, and not enough research has been carried out into possible side effects.

The fact that so much is unknown makes the decision difficult for some parents.

6. There are alternatives; it's not always 'all or nothing'.

As with many birth and parenting decisions, it's not always an 'all or nothing' decision.

For instance:
You may decide to have oral vitamin K rather than the injection.
In this situation, be aware that Vitamin K is fat soluble. So in order to be properly absorbed by the baby's body, it should be given with or just after a feed. Also be aware that it tastes bitter. Many babies will try to spit it out again and you might want to have your finger ready to scoot it back in!
You may decide to wait and see and make a decision according to your situation.
There are a few key vitamin K information issues to consider. If your baby is breastfed and is slow to feed or has feeding problems, the chance of VKDB is higher and you may want to reconsider. If you or your baby have antibiotics, this can increase the chance of VKDB. Again, you may want to take that into account. Likewise if your baby has a procedure such as a tongue tie division or circumcision.

It is good to look into all aspects of this decision to make sure that you are fully informed.

7. It's up to you

As I said at the beginning of this blog post, this is your decision.

You have the right to have good information and make the decision that is right for you and your baby.

I hear from midwives and others in some areas of the world (notably the USA) that parents are sometimes told that it is illegal to decline vitamin K.

This may not be true, so please check what your rights are.

It is also the case that, unfortunately, some parents are put under pressure to accept vitamin K. In some situations, senior professionals are brought in to try to persuade parents to accept it.

If you are thinking of declining vitamin K, I really would recommend that you look further into this area. Here's a link to my book if you'd like to get more depth.

We have an entire information hub on this topic, with links to several more articles and blog posts.

And if you are thinking of declining vitamin K, please take a look at this information in particular.

Books to help you become informed and make the decisions that are right for you...

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Seven things every parent needs to know about vitamin K - Dr Sara Wickham

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Dr Sara Wickham, author of Vitamin K and the Newborn, shares information about vitamin K. Seven things every parent needs to know before making a decision.

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Hypnobirthing Courses Approach birth with confidence, calmness and excitement Find a course My name is Katie, I am the founder of Birthcare. I am a practising midwife, KG Hypnobirthing teacher, NCT antenatal practitioner, and a mother of my two daughters Holly and Chloe.

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COVID-19 UPDATE: All courses will now be delivered online via video conference to support you and allow you to still benefit while you are observing social distancing or self-isolation.

GOV.UK ALERT CORONAVIRUS.
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Coronavirus infection and pregnancy www.rcog.org.uk Information about coronavirus for pregnant women and their families

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Your pain relief options

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

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

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

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

Self-help in labour

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

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

learn how to relax, stay calm and breathe deeply

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

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

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

have a bath

take paracetamol, which can help relieve some of the pain in the early stages of labour

Gas and air (Entonox) for labour

This is a mixture of oxygen and nitrous oxide gas. Gas and air will not remove all the pain, but it can help reduce it and make it more bearable. It's easy to use and you control it yourself.

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

Side effects

there are no harmful side effects for you or the baby

it can make you feel lightheaded, sick, sleepy or unable to concentrate, but if this happens you can stop using it

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

Pethidine injections in labour

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

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

Side effects

There are some side effects of pethidine and diamorphine to be aware of:

it can make you feel woozy, sick and forgetful

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

these medicines can interfere with the baby's first feed

Epidural

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

In most cases, an epidural gives complete pain relief. It can be helpful if you are having a long or particularly painful labour.

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

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

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

An epidural can provide very good pain relief, but it's not always completely effective in labour.

How does an epidural work?

To have an epidural:

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

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

a very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the womb (uterus). Medicines (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10 to15 minutes for it to work. It does not always work perfectly at first and may need adjusting

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

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

Side effects of epidurals in labour

There are some side effects of epidurals to be aware of.

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

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

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

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

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

You may get a headache after an epidural. This happens in about 1 in 100 cases and can be treated.

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

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

Remifentanil

Remifentanil goes into a vein in your arm. You control it yourself by pushing a button.

It works quickly and wears off after a few minutes. You can use it up until your baby is born.

You'll need a small clip on your finger to measure your oxygen levels, as remifentanil can make you feel breathless or need oxygen.

Side effects

Remifentanil can make you feel sleepy, sick, dizzy or itchy. These stop once you stop taking the medicine.

Like pethidine, remifentanil can affect the baby's breathing but this usually wears off quickly.

Using water in labour (water birth)

Being in water can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water will be kept at a comfortable temperature, but not above 37.5C, and your temperature will be monitored.
Find out more about using water during labour and birth on the National Childbirth Trust website

TENS machines

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

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

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

How TENS machines work

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

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

Side effects of TENS machines

There are no known side effects of TENS for either you or the baby.
Read more about TENS

Alternative methods of labour pain relief

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

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

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

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

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Pain relief in labour

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When it comes to giving birth, most women want to know: how much is it going to hurt and will I be able to cope with the pain? Unfortunately, you can't answer either of these questions with certainty. But what you can do is improve your ability to cope with pain during labour, as well as understand your options for pain relief and their impact on you, your labour and baby.

Your birth partner(s) will make a huge difference to how you feel during labour. Emotional support, such as encouragement and reassurance from somebody you trust, can really boost your confidence and ability to cope with pain when you need it most.

Here we look at the different pain relief options that are available during labour.

Overcoming fear during labour

Labour is complex but, unfortunately, fear can affect this amazing process.

Fear makes you release adrenaline, which slows down the production of oxytocin and prepares your body to fight or run away (not helpful when you're trying to give birth). This makes your contractions less efficient and you focus on the pain and feel worse. So staying calm is the key to coping with pain.

To help you feel relaxed, it's good to read up on what happens during labour and choose a place to give birth where you feel safe.

It'll help to choose the right person to be your birth partner to help you cope with the pain and discomfort of labour more easily. It should be a person you trust, and who can give you encouragement, reassurance, listen to you and just be there. Research has shown that emotional support is important for women in labour.

Attending antenatal classes is also a really useful way of preparing for labour and gaining an understanding of what will happen on the day.

If it feels really tough, ask your midwife how you are getting on. Positive encouragement - knowing you are coping really well and making good progress - can make all the difference.

Position and movement in labour

Labour can last a long time so, at the beginning, try movement, upright positions, massage and water to help you cope. If you head straight for maximum pain relief, you'll never know how other things can help - plus your labour may end up being even longer.

Lying on your back can make your contractions slower and more painful. Different positions and movement, such as rocking, swaying and leaning forwards, maximises your body's ability to give birth as it helps ease your baby along the birth canal.

Pros

Maximises your body's ability to give birth.

No lasting side-effects for you or your baby

Cons

Try not to overdo it; saving energy is also important. Lying on your side for a while or sitting up supported by lots of pillows can help your body to work really well while you conserve energy.

Water and birthing pools in labour

Water soothes pain and, in a large birthing pool, supports you, enabling you to glide into any position. For more about water births and using water during labour, see here.

TENS (Transcutaneous Electrical Nerve Stimulation) machine in labour

A TENS machine transmits mild electrical impulses to pads on your back. These block pain signals and help your body to produce endorphins. For more about the pros and cons of TENS, see here.

Complementary therapies

Various complementary therapies are available, such as acupuncture, aromatherapy, reflexology, yoga, self-hypnosis and massage.

Pros

Some studies show acupuncture is helpful.

Massage or pressure on the lower part of your back can help reduce levels of stress and ease discomfort, too.

You can learn self-hypnosis techniques for labour by attending a course or using CDs; you don't have to have a hypnotherapist with you in labour.

Cons

There is little research proving the effectiveness of these treatments though lots of women say that they found these techniques useful.

Apart from massage and self-hypnosis, you will need a registered practitioner to perform the therapies.

Sterile water injections

Sterile water injections involve injecting a tiny bit of water into the skin of your lower back to help with back pain during labour. For more about sterile water injections, see here.

Gas and air (Entonox) in labour

Entonox is a colourless, odourless gas made up of half nitrous oxide and half oxygen. You'll probably be given gas and air through a mouthpiece and told how to breathe it in. Read more about Entonox here.

Painkilling drugs in labour (opioids such as pethidine, diamorphine, meptid and remifentanil)

Pethidine, diamorphine and meptid are pain relieving drugs given by injection into the thigh. Some hospitals offer remifentanil, which is a very strong, short-acting painkiller given via a drip that you can control yourself using a machine. For more details, see our articles about intramuscular opioids and remifentanil.

Epidural

Epidural analgesia is a local anaesthetic injected into the space between two vertebra in your back. It usually removes all pain and most feeling from the waist down.

The combined spinal epidural (CSE) injection contains a low dose of pain-relieving drugs and works more quickly than an epidural alone. Read more about their pros and cons in our articles about epidurals and CSEs.

Top tips for labour

The following tips have been found to be useful by women in labour:

1. Before labour, spend some time imagining having your new baby in your arms after the birth and that all is well. Imagining that you did it, and that you did it as you wanted, creates a positive picture to focus on.

2. Moving about helps labour to progress and women have said they were better able to work with the pain while rocking and leaning forwards (the pressure of the baby's head on the cervix will promote the release of oxytocin as well as endorphins - the body's natural pain relievers). Focus on letting go and relaxing any muscles that aren't needed to hold you in a position.

3. Focus on the out breath during a contraction. Keep the breathing calm and rhythmic.

4. Make a noise if you want to - be somewhere with people that are happy for you to moan, grunt, sigh or even swear if that helps.

5. Belly-dancing, hip-wriggling and stepping movements all help your baby settle into a good position to be born.

6. Massage or pressure on the lower part of your back just above the top of your bottom can help.

7. Water helps women relax and move more easily; being in a pool can give women a feeling of safety and security.

8. Positive, affirmative thoughts and supportive comments from birth partners help to promote confidence in the process. 'You are doing well - your body is made for this - feel the power of your body - your body knows how to do this - each pain is progress' are all positive and encouraging statements.

9. During labour, think about welcoming each contraction. As your contractions become stronger, longer and closer together your body is getting ready to give birth.

10. Rest, relax and conserve energy between contractions as labour progresses.

11. Have confidence in your own self-help resources.

12. Acknowledge that labour is unpredictable and that uncertainty is difficult to go along with. Try to go with the flow.

Recognising the point at which labour feels worst - when you have had enough - is often the point just before you are ready to start pushing your baby out. Having people with you who help you feel strong and capable can make all the difference.

Do what feels best for you

Every labour is different and each woman should choose whatever she needs to help her work with the pain of labour. Most importantly, have confidence that you can do it.
This page was last reviewed in August 2019.
Further information

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

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

NHS Choices guide to pain relief.

Research from the Royal College of Obstetricians and Gynaecologists (RCOG) about the use of water as pain relief in labour.

Information from NHS Choices about complementary therapies during pregnancy and before birth.

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Pain relief in labour | Labour & birth articles & support | NCT

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Find out about the different options available for pain relief in labour and childbirth, including epidural, pethidine, TENS and other ways to reduce pain.

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Position & Attachment

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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College of Human and Health Sciences, Swansea University

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The Lullaby Trust raises awareness of sudden infant death syndrome (SIDS), provides expert advice on safer sleep for babies and offers emotional support for bereaved families

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Product Guide

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There may be a need to reduce the number of face-to-face antenatal visits you have. This will be communicated with you, and will be done as safely as possible, taking into account available evidence on the safe number of visits required. Please do not reduce your number of visits without agreeing so first with your maternity team. It is very important you still attend for antenatal care and the maternity teams are all still working to provide this care for you and your baby.

The visits will depend on how your pregnancy is progressing. For many women, the number of routine visits will change and some of them will be 'virtual' or telephone contacts. Others will be face to face with your midwife or obstetrician - this will vary by person and by maternity service. Your maternity team will be in touch to discuss your visits with you and may request that you attend on your own.

Please make sure to contact your midwife for advice regarding issues such as reduced fetal movements, bleeding, back pain, urinary tract infection (UTI) etc. It is important to communicate with your midwife if you feel worried.

If you are worried about a virtual appointment, please do tell your midwife when she contacts you.

The number of scans required is being reviewed in each maternity service, in line with national guidance. Certain scans will still need to take place, for example your anomaly scan at around 20 weeks of pregnancy. Your midwife will be able to advise you of which scan appointments you will need to keep and whether you should attend on your own. Please do not miss a booked scan appointment without contacting your midwife.

In order to support social distancing unfortunately, partners are not able to attend scans at present but please speak to your midwife or sonographer about how you can use technology like smart phones to support this important moment in your pregnancy. You might want your partner to be in close communication with you via phone in case you need to speak to them.

Scans and face to face appointments will be undertaken only when necessary. In terms of safety when attending your scan, the national guidance around safe distancing whilst waiting and protective equipment will be observed by staff. Some procedures require the health practitioner to be closer than 2 metres, but protective equipment and infection control measures will be in place as advised by Public Health England. The health practitioner will introduce themselves to you so you will know their name and what they are going to do.

If you develop a temperature or a cough, or both, in pregnancy, you can use the NHS 111 or NHS 24 website to obtain advice about isolation, which you should follow in line with current regulations. However, please also be alert to the other possible causes of fever in pregnancy. In particular, these include urine infections (cystitis) and your waters breaking. If you have any burning or discomfort when passing urine, or any unusual vaginal discharge contact your maternity provider, who will be able to provide further advice.

It is also important if you have any concerns about your baby's movements that you contact your maternity provider immediately and make them aware.

Before any face to face appointment, you will be contacted by your maternity team or you will be asked a few questions on arrival at clinic reception. You will be asked a few questions to determine whether you or anyone in your household are self-isolating or displaying signs of having contracted COVID-19 and they will advise you accordingly, including rearranging appointments where possible. Appointments will be rearranged safely for you and your baby as ongoing antenatal care is very important.

The Royal College of Obstetricians recommends that if you develop more severe symptoms or your recovery is delayed, this may be a sign that you are developing a more significant chest infection that requires enhanced care, and our advice remains that if you feel your symptoms are worsening or if you are not getting better you are recommended to contact the NHS on 111 (or a local alternative), or your maternity unit (using numbers given to you) straight away for further information and advice.

All pregnant women, regardless of gestation, should observe the social distancing guidance available on the Government website. Advice includes the avoidance of contact with people who are known to have COVID-19 or those who exhibit possible symptoms including high temperature and/or new and continuous cough.

Women above 28 weeks' gestation are recommended to be particularly attentive to social distancing and minimising contact with others.

Major new measures have been announced for people at highest risk from COVID-19. This includes pregnant women with significant heart disease (congenital or acquired) see the RCOG website:
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/
If you are having difficulty understanding the advice and information, please talk to your midwife or maternity team, using the contact numbers given to you. If you have underlying conditions, or conditions of pregnancy that increase your level of risk, these will have been considered and arrangements put in place. For some conditions, such as gestational diabetes, you might find that some monitoring appointments can be done via the telephone or video conferencing, rather than a face to face appointment.

Your midwife can also refer you to the NHS Volunteering service if you need help with shopping, picking up prescriptions etc.

We recognise that this is a very anxious time for many people and whilst you are pregnant the situation can be very unsettling, especially when the usual sources of reassurance are not there.

Your midwife will be able to talk to you about some of your fears and your maternity service will also have a specialist midwife who supports women with mental health conditions including anxiety. If you are currently receiving care from specialist services, they will be contacting you to check if you are well or need additional support.

If you are not receiving any specialist care but wish to access some additional means of support in these difficult times, you will be able to use online resources that might help such as the Tommy's mental wellbeing page for advice on taking care of yourself. The links to these and other resources are at the bottom of this page and may also be on your maternity unit internet page and it is worth going online to look at what is available. Please remember to talk with your family and friends too about how you are feeling.

Currently antenatal classes are suspended. A number of maternity units are looking to put classes online and therefore you will need to contact your midwife to see what is available in your area.

If you cannot access local parent education, the NCT (National Childbirth Trust), the UK charity for parents, provides information for parents and parent education classes. It has already changed its way of offering antenatal preparation courses, so provision is now online via live, interactive courses. The website is regularly updated and aligns with the advice from the Royal Colleges of Midwives, Obstetricians & Gynaecologists. For more information on virtual antenatal courses and to sign up for one, visit https://www.nct.org.uk/courses-workshops/nct-virtual-antenatal-course

It is reassuring to speak to other women in your position and there are several online resources that you might want to use, such as https://www.nct.org.uk/local-activities-meet-ups, with many local volunteer groups currently switching their support to a virtual offer in order to comply with social distancing advice.

In addition, some maternity services have established social media groups for women receiving care from their unit and you can ask your midwife if such as service if available in your area.

You may also find other local groups for new mothers on Facebook and in your community. Facemums is also an option, so please ask your midwife if this is available as part of your local maternity service.

Our Maternity Voice Partnership (MVP) Network have two Facebook groups:

https://www.facebook.com/groups/AntenatalSupportGMEC

https://www.facebook.com/groups/PostnatalSupportGMEC

Your individual circumstances will be considered by your midwife and maternity team, especially where you are receiving specialist mental health support. Please contact your midwife and discuss what is permitted before your appointment, so that you can be supported whilst ensuring safety for you, your family and the wider population.

If you are having difficulty understanding the advice and information, please talk to your midwife or maternity team, using the contact numbers given to you. You can also go to the Bounty website for advice here or the Start for Life website for advice for pregnant women updated website (6th April).

We do not recommend that children are taken to antenatal appointments. We understand that this may be really hard for you, as schools are shut at the moment. If you are unable to attend alone, please speak to your midwife who will try to arrange alternatives that fit your circumstances.
Please be aware that the household isolation instruction as a result of COVID-19 does not apply if you need to leave your home to escape domestic abuse.
The National Domestic Abuse Helpline is run by Refuge and offers free, confidential support 24 hours a day to victims and those who are worried about friends and loved ones.

Telephone: 0808 2000 247

For immediate support, call 999. If calling from a mobile, press 55 and the call will be connected to the police. If calling from a landline and only background noise can be heard and operators cannot decide whether an emergency service is needed, then you will be connected to a police call handler.

Yes, you can still take items into hospital that will help you to relax and feel comfortable. Please keep the items with you at all times and when finished using them ask your partner to take them home.

This will vary according to your maternity unit. Some units are still providing the option of using the pool in labour and/or for the birth if women are well and have no symptoms of COVID-19 (asymptomatic) and are able to use the pool.

Some units are not offering this option, so you will need to contact your midwife to ask if this is available.

Where COVID-19 infection is suspected or confirmed, the use of birthing pools in hospital should be avoided given the inability for healthcare staff to use adequate waterproof Personal Protective Equipment (PPE) and the risk of infection via faeces.

If you are well but have been self-isolating for 14 days due to a member of the household having symptoms, you will need to be treated as a suspected COVID-19 patient and advised to labour and birth on the obstetric-led unit.

The Royal College of Obstetricians and Gynaecologists advise that there is no evidence that the use of gas and air (Entonox) causes an increased risk of spreading the virus and it can, therefore, be used. When Entonox is used for pain relief, it comes with a single-use mouthpiece with a filter that is standard issue in all maternity units.

If you have symptoms or are infected with COVID-19, you will be advised to labour and birth on the obstetric unit and have continuous electronic monitoring of your baby's heart pattern.

If you are well but have been self-isolating for 14 days due to a member of the household having symptoms, you will need to be treated as a suspected COVID-19 patient and advised to labour and birth on the obstetric-led unit.

If you are well, with no member of the household with symptoms (symptomatic) of COVID-19 and have planned to give birth in a birth centre, as long as your pregnancy remains straightforward, you can birth as planned in the birth centre. If you wish to change your current plan to birth in a birth centre, please discuss this with your maternity team.

As with home births, free-standing birth centres that are situated away from an obstetric unit rely on the availability of ambulance services to allow for rapid transfer to hospital, and the right number of staff to keep you safe. Unfortunately, we have had to take the decision to temporarily suspend births at our stand-alone birth center at Ingleside.

Most maternity units have a co-located birth centre close to the Obstetric-led unit, which may be an option for you to use.

Please contact your maternity team to confirm if this option is available.

Your planned caesarean will go ahead. Occasionally things might change, if for example, you become ill, or your individual circumstances/clinical needs change. In certain circumstances, the date or scheduling of your caesarean may be deferred if it is safe to do so, in order to minimise the risk to you, your baby and others. Your maternity team will discuss this with you.

Your discharge will always depend on how you are (your clinical condition) and that of your baby. If it is safe for both of you, it will be preferable for you to return home as soon as possible.

Your induction will go ahead as planned. In certain circumstances, for example if you are ill, the date of your induction may be deferred or rescheduled if it is safe to do so, in order to minimise risk to you, the baby and others. Your maternity team will discuss this with you. Please be aware that there might also be delays in your induction process due to the current situation, but your maternity team will discuss this with you at the time.

In most maternity units one birth partner without symptoms is be able to attend for parts of your induction of labour. Ideally this will be in a single room on the ward or on the Labour Ward. If the induction has to take place in a bay on a main ward, it might not be possible to achieve the necessary social distancing measures. The staff can advise you at the time of your induction what arrangements are in place.

This guidance is in place to protect other pregnant women and babies, and birth partners themselves. Please be assured that if your partner is unable to be with you on a ward during your induction, this will not impact on your birth partner's presence during labour and the birth, unless they are unwell. At the point you go into active labour, you will be moved to your own room and your birth partner will be able to join you.

Local restrictions by maternity services on visiting may mean that one partner/person is only able to be present during labour, birth and the immediate period after birth when you are on the labour ward.

In some maternity units, partners may be able to stay on the antenatal ward during the induction process and for a limited amount of time on the postnatal ward, dependent on the environment and infection control measures. Please check with your local maternity unit for their arrangements.

Where local restrictions exist, the decisions to employ them are not taken lightly, and we hope that you understand they are designed to keep as many people as safe as possible.

Only your planned birth partner - as long as they remain symptom free of COVID-19 - can attend during the labour and for limited periods on the wards in certain maternity units. Please check with your maternity team for local arrangements.

Some maternity units are allowing partners to be present for a limited amount of time on postnatal wards, others are unable to permit partners to be present if not able to observe social distancing and other infection control measures. Please check with your maternity team for local arrangements.

You and your baby will be best off at home and we will do our best to discharge you both as soon as possible, based on your clinical need.

There is no access for birth partners who have or are suspected of having COVID-19. This is unfortunate but something that we have to do to keep as many people as safe as possible. You might want to think of an alternative person who can accompany you for the labour, birth and immediate period after the birth on the labour ward. We will try very hard to get you and your baby back home to your family as soon as we can.

Your maternity team will continue to care for you as planned during labour and the birth.

Due to the COVID-19 pandemic, and depending on what procedures are being undertaken, the staff will be wearing enhanced personal protective equipment (PPE) to prevent the spread of infection. This can make it more difficult for them to communicate.

Staff wearing PPE will introduce themselves to you and you will know what their role is. Everyone will be doing their best to provide the highest level of care as we always do.

By working together with you and your partner we hope to achieve a safe and happy experience for you and your family.

Occasionally, a general anaesthetic (where you're put to sleep) may be used, particularly if your baby needs to be born urgently. During this type of caesarean birth, even under more routine circumstances, for safety reasons it is not recommended for the birth partner to be present during the birth.

While the maternity team will do all they can to ensure that your partner is present for the birth, there will be some occasions when there is a need for an urgent emergency procedure and it may not be possible for your partner to be present. This is because during an emergency, operating theatres are more high-risk environments in terms of potential spread of COVID-19 to everyone who is present.

If it is the case that your partner will not be able to be present during the birth, your maternity team will explain this to you and will do everything they can to ensure that your partner can see you and your baby as soon as possible after the birth.

You should have been contacted by a midwife from either Macclesfield or the unit where your care in labour will take place. Your elective caesarean section will still go ahead, but there might be some changes to the scheduling. Each of the maternity units receiving women who have booked at Macclesfield have made arrangements to care for you and you will have been given contact numbers for those units. Your antenatal and postnatal care will continue to be given by the maternity team at Macclesfield and you can contact them with the numbers given to you at booking.

There is no evidence that women who have recently had a baby and are otherwise well are at increased risk of contracting COVID-19 or of becoming seriously unwell. Children, including newborns, do not appear to be at high risk of becoming seriously unwell with the virus.

You should continue to follow government advice about social distancing; stay away from public places and avoid anyone who has symptoms suggestive of COVID-19. If a member of your household has symptoms, they should try to remain isolated from you and your baby according to national guidance. Only leave the house for food and health reasons and do not meet others including family and friends which is understandably disappointing at this special time. Keep in touch using remote technology such as phone, internet, and social media. It will help to eat a healthy, balanced diet, do some mild exercise and follow the current government guidelines.

Remember that hygiene is, as always, important for anyone who lives in your home. Remember to wash hands thoroughly for 20 seconds minimum with hot water and soap as recommended.

Evidence is limited, however we know premature babies are more susceptible to infections and therefore strict precautions will be in place on the neonatal unit to reduce the possibility of contracting COVID-19.

Do not put off seeking medical advice if you have concerns about your baby's health during the pandemic.

Seek medical advice if your baby has any symptoms you may have concerns about. The Royal College of Paediatricians and Child Health (RCPCH) and Healthier Together have produced a guide with advice for parents during coronavirus, which shows symptoms to look out for and who to contact.

There is currently no evidence that the virus can be carried in breast milk. The current advice is that the benefits of breastfeeding outweigh potential risks of transmitting the virus. However, there is concern about the close contact between you and your baby, as you may share airborne droplets infected with the virus.

Many support groups have moved online in accordance with the new Government restrictions on movement but continue to support with telephone advice and online group meetings. All maternity units will have a breast feeding support team and they will have made arrangements to offer both virtual and telephone support. When you or anyone else feeds your baby, the following precautions are recommended:

Wash your hands before touching your baby, breast pump or bottles

Try to avoid coughing or sneezing on your baby while feeding at the breast

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.

If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.

There are further links for information at the end of the page.

It is reassuring to speak to other parents in your position and there are several online resources that you might want to use, such as www.netmums.com ;

National Childbirth Trust ; www.nctpregnancyandbabycare.com( Helpline: 0300 330 0772) and https://dadmatters.org.uk

In addition, some maternity services have established social media groups for women receiving care from their unit and you can ask your midwife if such as service if available in your area. You must, however, continue to follow government advice about social distancing; stay away from public places and avoid anyone who has symptoms suggestive of COVID-19. Only leave the house for food and health reasons and do not meet others including family and friends which is understandably disappointing at this special time. Keep in touch using remote technology such as phone, internet, and social media

Our Maternity Voice Partnership (MVP) Network have a Postnatal support group:

https://www.facebook.com/groups/PostnatalSupportGMEC

Advice and information on how to look after your mental health and wellbeing during the coronavirus (COVID-19) outbreak is available https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing and there are several other links that you can use (See links at the end of this document).

Additionally, your midwife will be able to sign post you to local mental health support services that are available.

Speak to your midwife, health visitor or GP if you are feeling worried/anxious/concerned about your mental wellbeing.

During pregnancy and after your baby is born, your midwife or health visitor should also ask if you have ever had problems with your mental health in the past, and whether you have been bothered by feeling down, hopeless or unable to enjoy things lately. Don't be afraid to tell your midwife, health visitor or GP how you're feeling. They can help you to consider what support you may need with your emotional and mental health.

There are further links at the end of this page that you might find useful.

You will be informed by your midwife of the local arrangements in place and face to face visits will be limited to protect you and your family from the spread of COVID-19. However you will continue to receive support and advice from both your midwife and Health Visitor via telephone/video calls.

It is important that you continue to recover from the birth and that you and your baby are well. Even though the midwife might not be visiting as often as usual, you can still speak to a midwife using the numbers given to you. We want to make sure that the baby is feeding well and gaining weight too, so if you have any concerns please contact your midwife and there is further advice on the link below.

Do not put off seeking medical advice if you have concerns about your baby's health during the pandemic. Seek medical advice if your baby has any symptoms you may have concerns about. The Royal College of Paediatricians and Child Health (RCPCH) and Healthier Together have produced a guide with advice for parents during coronavirus, which shows symptoms to look out for and who to contact.

The NHS have produced post-natal leaflets on this subject:

Illness in new-born babies
https://www.england.nhs.uk/coronavirus/publication/illness-in-newborn-babies
Coronavirus - Parent information for new-born babies
https://www.england.nhs.uk/coronavirus/publication/coronavirus-parent-information-for-newborn-babies
Neonatal units are limiting who can visit the neonatal unit. At the moment most units are allowing one parent at a time to have access to their baby on the unit as long as they do not have, or are not suspected to have, COVID-19. Parents who have had a positive test for COVID-19 will not be allowed access to their baby on the neonatal unit. Parents who are self-isolating, because a family member has symptoms will not be allowed access to their baby until a negative test has been confirmed.

Your neonatal unit may be able to arrange video contact for you. They will still be able to give you updates on how your baby is and involve you in decisions. Talk to your neonatal unit about how they can support you if you are not able to be with your baby on the unit.

Policies for allowing parents onto neonatal units may vary between different units, and units might change their policies at short notice as the situation develops. Check with your neonatal unit for the most up to date information.

A discussion about the risks and benefits should take place between you, your family and the doctors caring for you (obstetricians) and your baby (neonatologists) to individualise care for your baby.

Bolton NHS Foundation Trust

Maternity Triage: (01204) 390 612

COVID-19 Helpline (Mon-Fri, 9am-4pm): Tel (01204) 487 497
Tameside and Glossop Integrated Care
Maternity Triage: 0161 922 6175

COVID Helpline: 07585 124 955
St Mary's at Wythenshawe/ St Mary's at Oxford Road
COVID-19 & pregnancy helpline (Monday to Friday 8am-9pm): 0161 701 5572

St Mary's at Oxford Road Maternity Triage: (0161) 276 6567

St Mary's at Wythenshawe Maternity Triage: 0161 291 2724

East Cheshire (Macclesfield District General)

Midwives are contacting women under their care. You can still speak to a midwife at Macclesfield antenatal clinic or day unit. Call 01625 661140.

You will be given details of the hospital where you will give birth to your baby and you will contact them if you think that you might be in labour.

For Stepping Hill Hospital Labour Ward: 0161 419 5551

For Royal Stoke Hospital Labour Ward: 01782 672333

For Leighton Hospital Labour Ward: 01270 612144

For Wythenshawe Hospital Labour Ward: 0161 291 2762

Oldham, Rochdale, North Manchester

Contact numbers list:
https://www.pat.nhs.uk/patients-and-visitors/ward-contact-numbers.htm
Oldham Maternity Assessment Unit: 0161 627 8855

North Manchester Maternity Care Hotline: 0161 656 1757

Stockport - Stepping Hill Hospital

Maternity Triage: 0161 419 5551

Covid advice line (Mon-Fri, 8:30-4:30pm): 0161 419 5514
Wigan, Wrightington & Leigh
Maternity Triage: 01942 7878628
Links and further information Mental Health & Wellbeing support
Twitter: @MatVoicesGMEC

Facebook: @MatVoicesGMEC

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Coronavirus & Pregnancy - My Birth My Choice

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Information about Maternity Services and care during the Covid-19 pandemic Please make sure that you continue to attend your scheduled routine antenatal care when you are well. Do not reduce your number of visits without agreeing first with your maternity team. Maternity care is essential and has been developed over many years to reduce ...

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This page contains information that you or parents you know may find useful. Please feel free to share, download and use the content on this page.

Infant crying is normal and it will stop! Babies start to cry more frequently from around 2 weeks of age. Click on this LINK to read more about infant crying.

Comfort methods can sometimes soothe the baby and the crying will stop. Is the baby hungry, tired or in need of a nappy change? Click on this LINK to download some comfort techniques.

It's okay to walk away if you have checked the baby is safe and the crying is getting to you. After a few minutes when you are feeling calm, go back and check on the baby.

Never, ever shake or hurt a baby. It can cause lasting brain damage and death.

Looking for more advice? Download our infographics.

Please note that some may find this video distressing. Viewer discretion is advised

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This page contains information that you or parents you know may find useful. Please feel free to share, download and use the content on this page. Infant crying is normal and it will stop! Babies start to cry more frequently from around 2 weeks of age.

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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.

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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Every mind matters

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Working from home, remotely or splitting time between home and the office (hybrid working) has become more common than ever.

Many of us have had to adjust to these new ways of working following the coronavirus (COVID-19) outbreak in 2020. Some of us have even entered the workforce for the first time, starting working life in a remote role, without having experienced an office-based job.

Working from home can have benefits and perks that some of us enjoy (bye bye commute!), but a change like this can be challenging too and can have a big impact on our mental health.

It can cause stress, a lack of motivation, anxiety and uncertainty. Alongside this, we might worry about future job prospects or the best way to juggle work with our personal and family life.

These simple tips can help you feel more productive, motivated and take care of your mental health while working from home.

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6 simple tips to tackle working from home - Every Mind Matters

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Read our 6 simple tips to help you manage working from home and look after your mental wellbeing.

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Recycle for Greater Manchester - Cloth nappies

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NHS

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Tameside NCT Nappy Library. 454 likes. Ever thought about trying cloth nappies? Better for the environment, better for your budget, better for your bin & better for baby! Fortnight trials.

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Home birth with Independent Midwives working for your NHS Trust

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Home birth with Independent Midwives working for your NHS Trust

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IMUK 18 Mar 20

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Web hosting and free web hosting from Bravenet.com. Build your website with our easy webpage builder, web tools, web services, and free website content.

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28 Mar 20.  The requirement to register the birth within 42 days at a Registry Office has been set aside.  For more local information, go to https://www.gov.uk/register-offices and put in your postcode.

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Everything you need to know about how babies sleep

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Everything you need to know about how babies sleep

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AIMS

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This information was last updated on 6 April 2022. The links were checked at that time but webpages are sometimes moved. If a link appears to be broken please let us know by emailing enquiries@aims.org.uk. If it hasn't been removed, you should still be able to find the page by entering the title in your browser.

For information about what AIMS has been campaigning for during the pandemic please see here.

Although most Government restrictions introduced to control the spread of Covid-19 have now been lifted, it is possible that maternity services will continue to take a more cautious approach. We hope this information helps you to navigate your care at this time.

We try to answer some common questions about the current guidance below, but different Trusts and Boards may be taking different approaches, so you will need to check with your midwife about what is happening locally. There should also be information on your NHS Trust or Boards's website or Facebook page.

If there is any other general information that you would like to see on this page please let us know by emailing enquiries@aims.org.uk .

Latest Guidance

Here is the latest information about the implications of coronavirus during pregnancy, and the guidance that has been given to the maternity services.

Who can I speak to if I am concerned about my health?

You should have a contact number to contact your midwife, but you can also contact one of the following depending where you live.

AIMS Helpline

The AIMS Helpline volunteers have experienced an increased workload during the pandemic but continue to offer information and support to maternity service users. Please contact us by email helpline@aims.org.uk. We will respond to all enquiries as soon as we can.

The AIMS Helpline does not offer medical advice, but we can provide information and support to help you navigate the maternity system, to know your rights and to listen to your concerns. We will be regularly reviewing the issues brought to us on the Helpline, so we offer the best information and most effective support that we can.

What are the risks for me if I am pregnant?

According to the latest RCM/RCOG guidance pregnant women do not appear to be more likely to contract the infection than the rest of the population unless they are unvaccinated and also have pre-existing diabetes, gestational diabetes requiring insulin, or are overweight or obese. However, as the Omicron variant is spreading very rapidly it is likely that your chances of catching it during pregnancy will be higher than with the previous variants.

Of women who became infected with the earlier variants during pregnancy, the majority had no symptoms and most of the others experienced only mild or moderate cold or flu-like symptoms. A review summarising 70 studies from 25 countries (the PregCOV-19 Living Systematic Review) reported that 73% (almost three quarters) of pregnant women who were admitted to hospital for any reason and tested positive for COVID-19 had no symptoms, but much of this data comes from before the emergence of the later variants.

There is evidence that pregnant women infected with the wild-type, Alpha and Delta variants of COVID-19 were more at risk of severe illness and of being admitted to intensive care than those who were not pregnant (though it's possble that part of the difference in admissions may be because doctors are more cautious if someone is pregnant). We do not yet have the data to tell, but the Omicron variant may be associated with less severe disease. Severe illness appears to be more common with infections that occur in the third trimester.

This infographic shows the findings from the UK Obstetric Surveillance Survey (UKOSS), covering the period from 16th May 2021 to 31st October 2021 when the Delta variant accounted for most infections. Of the 1436 pregnant women admitted to hospital with symptoms during this time, 474 (33%) needed support to breathe, a similar number (32%) developed pneumonia, and 230 (16%) were admitted to intensive care.

It remains very rare for pregnant or postnatal women to die from COVID-19 though sadly it can happen. According to the RCOG/RCM guidance the UK maternal mortality rate from COVID-19 is 2.4/100 000 maternities.

COVID-19 infection is associated with a higher chance of giving birth prematurely (see also 'What are the risks for my baby?) with 19% of hospitalised mothers In the latest UKOSS study experiencing this. There is also a higher chance of having a caesarean (49% of those who had COVID-19 symptoms compared with 29% of a pre-COVID group). Both of these effects are, in the majority of cases, due to a decision to have the baby born early because of COVID-related concerns over the mother or baby's wellbeing.

The UKOSS study found that the main risk factors for being hospitalised with Covid-19 were being unvaccinated, being of a Black, Asian or minority ethnic background, having a body-mass index above 25 kg/m2 , having a pre-existing health condition such as diabeted or high blood pressure, being aged 35 years or older, living in increased socioeconomic deprivation, and working in healthcare or other public-facing occupations.

What are the risks for my baby?

The majority of babies born to mothers diagnosed with COVID-19 have been born healthy. So far the evidence is that a COVID-19 infection in early pregnancy does not seem to increase the risk of a birth defect or miscarriage.

Although it is possible for the virus to be transmitted to babies in the womb, the RCM/RCOG guidelines say evidence now suggests that it is uncommon. The risk of infection in the baby after birth appears to not be affected by whether the birth was vaginal or by caesarean, or by factors such as the timing of cord clamping, skin-to-skin contact, method of feeding or whether the mother and baby stay together. According to the Royal College of Paediatrics and Child Health "COVID-19 seems generally to be a fairly minor illness in young infants." However in the most recent period of the UKOSS study (16th May 2021 to 31st October 2021) sadly four babies in the UK died as a result of a COVID-19 infection after birth.

There is some evidence that COVID-19 infection is associated with an increased chance of a stillbirth, though the findings from different studies vary a lot and the actual numbers are small. Overall it looks as though the rate may be between 0.7% and 0.9% (seven to nine out of every 1000 births) for those with an infection compared to between 0.3% and 0.5% (three to five out of every 1000 births). However, the latest UKOSS survey found that of UK mothers who were ill enough to be hospitalised with a COVID-19 infection in the period when the Delta variant was dominant, 2% suffered a stillbirth. Having a severe COVID -19 infection may be associated with a slightly higher chance of having a very small baby, but the evidence on this is still unclear.

The greatest impact of COVID-19 on babies seems to arise not from any direct effect of the virus itself but because of births being deliberately brought forward due to concerns over mother or baby's well-being. This is leading to around two to three times more premature births in women with severe COVID-19 symptoms compared to the normal rate and therefore to more babies being admitted to a neonatal uit and more experiencing the complications that can result from prematurity, such as breathing difficulties. Being born prematurely can also have long-term health consequences.

What about vaccinations?

Pregnant women have been classed as a 'vulnerable group' for whom vaccination is recommended. Guidance in the UK is for all pregnant women to be offered vaccination with the Pfizer-BioNTech or Moderna vaccines unless they have already had one dose of the Oxford-AstraZeneca vaccine, in which case their second dose should be the same. This is because most of the information on the safety of vaccines in pregnancy is from the USA, where these were the main vaccines used.

As with any medical treatment it is up to you whether you wish to accept the offer of vaccination. The previous sections 'What are the risks for me if I am pregnant?' and 'What are the risks for my baby?' explain what the latest research evidence shows about the risks of catching COVID-19 during pregnancy. For more about making decisions about vaccination see out webage Vaccination During Pregnancy

The original clinical trials of the available vaccines did not include pregnant women, but there is now extensive real-world data . The RCM/RCOG guidance says that more than 347 150 women in the UK and USA have had a COVID-19 vaccine in pregnancy with "no concerning safety signals". A number of studies are now in progress to look at the safety and effectiveness of COVID-19 vaccines in pregnancy.

The real-world data has so far shown no signs of an increase in miscarriages, birth defects or any other pregnancy-related concerns after vaccination, and it appears that the level of minor side-effects is similar to that in the general population . The most common side-effects are soreness at the injection site, headache and fatigue, and studies so far have found that rates of these are similar for pregnant women, with perhaps fewer experiencing fever but more reporting nausea and vomiting after a second dose of the Pfizer-BioNTech or Moderna vaccines compared to non-pregnant women. The very rare risk of blood clots found with the Oxford-AstraZeneca vaccine has not been observed with the Pfizer-BioNTech or Moderna vaccines.

In the UK, data published by the UK Health Security Agency (UKHSA) shows that for the 355 thousand women who gave birth between January and August 2021 there was "a similar very low risk of still birth, prematurity and low birth weight in vaccinated and unvaccinated women."

In the USA the Centers for Disease Control (CDC) has safety monitoring systems which have gathered information on over 212,000 pregnant women and people who have received vaccinations (mainly with the Pfizer-BioNTech and Moderna vaccines). Their website says that the preliminary analyses "did not identify any safety concerns for pregnant people who were vaccinated or for their babies. Additional follow-up is needed, particularly among those vaccinated in the first or second trimesters of pregnancy; however, these preliminary findings are reassuring."

If you are fully vaccinated and catch COVID-19 during your pregnancy, your chances of being hospitalised or admitted to intensive care appear to be greatly reduced. According to the RCM/RCOG guidance those who have had two doses and a booster (or three doses) of vaccine (combined data on Pfizer-BioNTech, Oxford-AstraZeneca and Moderna) are 88% less likely to be admitted to hospital with the Omicron variant than those who have not been vaccinated. 96% of pregnant women admitted to hospital with symptomatic COVID-19, and 98% of those admitted to intensive care, were unvaccinated.

Will I be able to have someone to support me during my maternity care?

The guidance on partners/supporters attending in-person antenatal appointments and scans, during labour and any postnatal stay is now different in the four nations of the UK. Please follow the links below to check details of the guidance for your country, but be aware that this may change at short notice. Trusts/Boards still have discretion about how far to implement the national guidance based on local risk assessments, and the position could change if there is a rise in cases either locally or nationally. Please check the current local rules, which should be available in your hospital's website.

AIMS hopes that all Trusts and Boards will at the very least to consider on a case-by-case basis requests for support beyond these minimum levels, which may be critical to some people's mental well-being or other needs e.g. due to disability or being non-English speakers. We know that some Trusts/Boards are being flexible about allowing a second birth partner at least for people with a particular need for extra support. If yours is limiting you to one birth partner you may want to challenge this, especially if there are exceptional circumstances which mean that you need more than one person for support. You may want to ask them to give you their justification for the decision.

AIMS has drafted a set of template letters which you can adapt to your own situation if you feel that your Trust/Board is not meeting your support needs.

In England the latest guidance from NHS England Supporting-pregnant-women-maternity-services-access-for-parents-of-babies-in-neonatal-units asks "all trusts to continue enabling women to have a support person of their choice at every point throughout their maternity journey." The guidance makes clear that "Within maternity and neonatal services, support people and parents of babies on neonatal units are not considered to be visitors and should not be treated as such." Therefore any visiting restrictions in force elsewhere in the hospital should not apply.

In line with changes to Government policy on testing, the guidance says that maternity settings should no longer expect evidence of a negative test before allowing supporters in. However, if a support person has received a positive test, or has symptoms of COVID-19, they should be advised not to attend. You may therefore want to identify an alternative support person in case your chosen supporter is affected.

The guidance also makes clear that if you personally have symptoms of Covid or have tested positive you should still be able to have a supporter with you.

There is no mention of second birth supporters, but it is worth noting that the guidance on Infection prevention and control for seasonal respiratory infections in health and care settings now recommends "that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care settings" unless someone has a "suspected or confirmed respiratory infection." Since restrictions on second birth supporters were often explained by the need to maintain 2 metres' distancing this is something which those Trusts should be reviewing.

In Scotland the guidance sets out minimum standards for both for the situation in which there is "no current active outbreak on ward" or if there is "an active outbreak management scenario". However, "A birth partner supporting a women during hospital visits continues to be categorised as an essential visitor." This means that even during an active outbreak one birth supporter should be allowed to accompany you to the booking scan, 20 week scan and any emergency appointments "subject to local risk assessments and physical distancing." They should also be able to stay with you throughout induction, labour and birth (except during a general anaesthetic), and during any stay on the antenatal or postnatal ward, again "subject to risk assessments and physical distancing."

If there is no current active outbreak then an additional visitor/second birth partner should be allowed "subject to local risk assessments and physical distancing" and plans should also be in place "for return to person-centred visiting" during labour and in inpatient wards.

All visitors are asked to take a lateral flow test before attending, but staff won't be asked to check these.

In Wales the guidance makes recommendations for the support that should be available at four different "Risk Ratings": Very High, High, Medium and Low. It appears that these will be determined by a local risk assessment, so AIMS hopes that Boards and hospital managements will be transparent about both what their current Risk Rating is, and the basis on which the judgement has been made, as well as providing detailed information about any current restrictions.

We have attempted to summarise the guidance, but suggest you check the relevant document for the full details.

Health Boards are encouraged "be innovative in the way that visiting access is enabled." In addition, they are told to give consideration to reasonable adjustments for those with specific needs leading them to require extra support, such as mental health issues, learning disabilities, communication needs and "Where the treatment/procedure is likely to cause the woman distress and the partner/nominated other can provide support." It may therefore be possible to negotiate for additional support if you can demonstrate a specific need.

If the Risk Rating is Very High the recommendation is for women to attend all appointments and scans alone and for no visiting in antenatal or postnatal in-patient settings. However they can be accompanied by"essential support assistants" (defined as someone required "for specific additional support eg a support worker, BSL or foreign language interpreter", but who could be a partner or family member in some circumstances.) In addition "One nominated adult may accompany the woman attending where she requires familiar support for consultations which may cause her distress." In active labour only either a birth partner or an 'essental support assistant' is allowed.

The rules are the same if the rating is High, except that a supporter can attend an early pregnancy assessment unit scan, early pregnancy dating scan and the 18-20 week anomaly scan, or visits to the Fetal Medicine Department.

If the Risk Rating is Medium, essential support assistants and/or up to one support partner are allowed for all antenatal appointments, and one supporter is allowed at the above list of scans, all subject to social distancing rules being possible. The limitation that a supporter is allowed in 'active' labour is not mentioned, so it seems they can be present from the time of admission "if national guidance on social distancingcan be achieved in the local setting."

If the Risk Rating is Low, there should be a "phased reintroduction of usual visiting policies" if different to the medium risk level.

In Northern Ireland while in the Gradual Easing phase the maternity services should allow for a birth partner to "be facilitated to accompany the pregnant woman to any pregnancy related appointments and ultrasound scans with particular effort made to keep the environment COVID secure." A COVID-19 secure envirment is defined as: a social distance of 2 metres wherever possible, optimal hand hygiene and personal hygiene measures, good ventilation, use of PPE when required and all visitors to wear appropriate face coverings.

A chosen birth partner should also "be facilitated to accompany the pregnant woman for induction of labour, duration of labour and birth and, for up to three hours after the birth." Postnatally "One daily visit from one of two nominated individuals (from up to two households) can be permitted, with particular effort made to keep the environment COVID secure."

Will I be able to birth my baby at home?

The evidence about the safety of homebirth can be found in the "Your Choice - where to have your baby" leaflets for first time mothers and for those having a subsequent baby which your midwife should already have given you at antenatal appointment early in your pregnancy. You will also need to take into account any specific issues that might affect your birth, as well as the chance of catching Covid-19.

Article 8 of the Human Rights Act protects your right to birth where you choose. In normal circumstances if you made the decision to birth at home, you should be able to expect NHS care for the birth. However in the current circumstances there may be situations where this in not possible. This does not mean that you can be legally required to birth in hospital, but that you may not be guaranteed medical support if you decide to birth at home.

RCM/RCOG's Guidance for provision of midwife-led settings and home-birth in the evolving coronavirus pandemic recognises that "Continuation of as near normal care for women should be supported, as it is recognised to prevent poor outcomes." It also says that "The positive impact of midwife-led birth settings is well documented, including reductions in the need for a range of medical interventions. These positive impacts remain of significant importance to prevent avoidable harm, and availability of midwife-led care settings for birth should therefore be continued as far as is possible during the pandemic." The guidance notes that "Emerging evidence from European settings supports continuing to strengthen community services in order to enable social distancing and minimise spread in healthcare settings."

Although many NHS Trusts/Boards have reinstated support for home births, there may still be restrictions in some areas, often justified as being due to local staffing shortages.

This article Homebirthing in the United Kingdom during COVID-19 includes a discussion of the legal position and states that "we argue that it is illogical to assert that the blanket removal of homebirthing service meets the test of 'necessity' when two-thirds of Trusts have continued to offer some form of homebirth service throughout the pandemic. The blanket removal of homebirthing services is neither necessary nor proportionate, therefore these policies amount to a violation of the Article 8 rights of birthing people."

In fact, the RCM/RCOG guidance recommends that Trusts take a phased approach based on levels of midwifery shortage and how the ambulance service is running. They indicate that if the midwifery shortage is under 20% and the ambulance service is running as usual, all places of birth should continue to be available. The calculation of available midwifery resources should include " additional midwives from the NMC emergency register, independent midwives, those previously in non-clinical roles or year-3 student midwives."

Before moving to restrict homebirths this guidance says that Trusts should consider adapting the usual policy of having two midwives at a homebirth "to include senior student midwives, returning registered non-clinical midwives, returning recently retired midwives or appropriately prepared maternity support workers to attend as the second member of the team for low-risk home births." They should also consider a combined rota for community midwives and those at freestanding birth centres "so as to maximise the spread of resources and maintain the full range of maternity settings for as long as sustainable staffing allows."

Even with a midwifery shortage of over 30% and/or ambulance service experiencing severe delays either an alongside midwife-led unit or allocated midwife-led rooms on obstetric units should still be available, if Trusts feel unable to offer support for homebirths.

Trusts should review the constraints on a daily basis and follow a corresponding 'de-escalation plan', reinstating services as midwifery shortages reduce.

If you are planning a homebirth, you will need to check the situation in your local area, and be aware that this can change at short notice. You may want to check whether your Trust has followed the escalation/de-escalation plan which RCM/RCOG recommend, and the current state of midwifery staffing levels and ambulance services.

If your local Trust is one of those that has said that they will not support homebirths, you could try writing to your local Head/Director of Midwifery asking them to consider the solutions adopted elsewhere to enable support to be provided for homebirths. AIMS has drafted a template letter which you may like to adapt to your own situation. You can find it here www.aims.org.uk/information/item/booking-a-home-birth .

In some areas, Trusts/Boards are asking people to sign a "Homebirth Contract" before they will agree to provide midwifery support. The article by Romanis and Nelson states "These documents do not carry any legal weight when it comes to decisions during birth - the fact that a pregnant person preparing to birth has signed cannot compel them to have any intervention during their birth, such as transfer to hospital, to which they do not consent."

You may also want to find out whether you could go to a birth centre or a midwife-led room in the hospital instead, as in line with the RCM/RCOG guidance at least one of these should be an option. Another option forsome families could be to hire an independent midwife. Independent midwives work separately to the NHS and so can offer support for a homebirth even when the NHS will not, or there is a threat of withdrawal. Some Independent Midwives can be found on the IMUK website but not all midwives are part of IMUK so try social media, word of mouth and search online.

If neither of these is an option for you, and your Trust continues to decline support for a homebirth, you will need to decide whether to go to hospital or birth at home without medical support. If you are considering remaining at home for the birth even if a midwife may not be available please see the section "Can I birth at home without a midwife?" below.

Will I be able to go to a birth centre?

See "What are my birth choices if I have tested positive or have symptoms of coronavirus?" for how this might affect your ability to access a birth centre.

You should have already been given information about birth outside an obstetric unit, but you can also find it here: "Your Choice - where to have your baby" leaflet for first time mothers and for those having a subsequent baby. Your midwives should be able to answer any questions that you have. You will also need to take into account any specific issues that might affect your birth, as well as the chance of catching Covid-19.

Please see the section "Will I be able to have my baby at home?" for details of guidance from RCM/RCOG on maintaining midwife-led care settings for birth, depending on the levels of midwifery shortage and how the ambulance service is running. If there are problems with these, the guidelines say that Alongside Midwifery units (AMUs) may be prioritised over Freestanding Midwifery units (FMUs) where a Trust has both. If a Trust decides that it needs to close an FMU, then an AMU should still be available. If there is no AMU then they should arrange for "allocated midwife-led rooms on obstetric units".

Can I birth at home without a midwife?

We are receiving increasing numbers of contacts from women who tell us that they are now considering remaining at home to give birth even though a midwife may not be available to come out to them. A planned birth without the presence of a health professional is known as a freebirth. It is your right to birth without a midwife or doctor present.

We would hope that if you are planning a homebirth and want a midwife present you will not be forced into a choice between leaving home to birth elsewhere or having to birth without that support, but in the current situation we know this is happening. If you are in this position you will need to weigh up the risks and benefits of remaining at home without medical support compared to going into hospital.

Guidance from the RCM suggests that maternity services should seek to build a dialogue with women considering a freebirth. This should include a chance to "share what is important to her in relation to her psychological and physical safety", time to "explore why she wants to have an unassisted birth" and the offer of support for previous birth trauma. AIMS hopes that this means that midwives will listen to such women with empathy.

It is important for midwives to give objective, factual evidence about the risks of all of a mother's birthplace options in order to enable her to make an informed decision. However, mothers have the right to decline further discussion for any reason, including if they feel that they are being subjected to unwanted repetition of the risks of freebirth.

The RCM guidance suggests asking the woman "what plan for the birth would feel safe and acceptable to her" and that "The senior midwifery management team should then assess what individualised, flexibility of service provision might be possible to avoid an unassisted birth as far as possible." AIMS hopes that this would include the option of providing support for a homebirth if this is the only way in which a woman can feel safe and/or able to protect her mental well-being.

It is not acceptable, and could be illegal, for anyone to coerce you, or threaten to refer you to Child Services if you decide to remain at home to birth your baby unattended by a midwife. Anyone who tries to do so should be reminded that this is not a valid reason for referral and that it goes against the code of practice for both doctors and midwives, and could lead to a complaint not only to their employer, but to the General Medical Council ( GMC) or Nursing and Midwifery Council ( NMC). The RCM guidance reminds midwives that "It is not illegal for a woman to give birth unattended by a midwife or healthcare professional" and that "It is not appropriate for healthcare professionals to refer a woman to social services with concerns about the unborn baby, solely on the basis that she has declined medical support, as she is legally entitled to do."

If you are considering a freebirth we would suggest gathering as much information and emotional and practical support as possible in order to prepare for a birth without a doctor or midwife present. There is more information about Freebirth on the following AIMS Birth information page Freebirth, Unassisted Childbirth and Unassisted Pregnancy which addresses rights and other things you need to know and where you can find support.

What are my birth choices if I tested positive or have symptoms of COVID-19?

The RCM/RCOG guidelines say that i f you have tested positive at the time or within 10 days before going into labour, but have no symptoms and wish to give birth at home or in a birth centre it is recommended that you "should have an informed discussion around place of birth with {your} clinician." Note, however, that the decision whether to birth at home is yours - you do not need 'permission' to do this.

Offering continuous monitoring of your baby's heartrate "is not recommended" just because of a positive test though you should be offered a discussion of monitoring options (see our Birth Information page "Monitoring your baby's heartbeat during labour".) This is because there is no evidence that an infection without symptoms puts your baby at any increased risk of problems during labour. Consequently, you should not be denied access to a birth centre on the grounds that you need continuous monitoring if you would decline this anyway.

After the birth you should as normal be offered delayed cord clamping (waiting for the blood from the cord to finish passing to your baby before it is clamped and cut) and immediate skin-to-skin contact with your baby. There is no evidence that these practices increase the risk of a baby becoming infected.

If you have mild COVID-19 symptoms the guidelines say you should be encouraged to remain at home (self-isolating) in early labour, and if you do go to the maternity unit in early labour but all is well with you and your baby you should be encouraged to go home again until your labour is more established (assuming you have your own transport to do so). The guidelines recommend that if you have symptoms you should give birth in a hospital obstetric unit rather than at home or in a birth centre because "there may be an increased risk" of a baby becoming distressed in active labour (though they don't say how great the risk is) and because women with COVID symptoms are more likely to have a caesarean. You still have the right to birth at home if you choose.

The guidelines also say you should be offered continuous monitoring of your baby's heartrate, because "While further data is required in women with symptomatic confirmed or suspected COVID-19, it appears prudent to use" it. In other words, there isn't any evidence to say whether continuous monitoring helps in this situation, but the guideline authors feel it's better to be on the safe side. You have the right to decline continuous monitoring if you do not want it.

There is no evidence to favour either a caesarean or a vaginal birth for people with COVID-19, unless their condition is worsening and they need urgent treatment and you should be free to choose which you want to plan for. You might be recommended to have an epidural put in during early labour, so that if you were to need a caesarean very urgently you would not need to be put under a general anaesthetic. However this is just being recommended as a precaution. So far there is no evidence to show whether women with suspected/confirmed COVID-19 are significantly more likely to need a very urgent caesarean where there would not be enough time to set up an epidural or spinal block. It is up to you whether you want to have an epidural for this reason, if you were not otherwise intending to use it to manage your labour, and your doctor or midwife should discuss the benefits and risks so that you can make an informed decision.

The guideline admits that there is no evidence on which to base recommendations about your care if you have recovered from COVID-19, so the following are "based on expert consensus" - which means what those writing the guideline thought made sense.

If you have recovered from COVID-19 but did not need to be admitted to hospital with it, "there should be no change to planned care during labour and birth."

If you were admitted to hospital with severe COVID-19 and have recovered "healthcare professionals should discuss and plan place of birth with the woman" taking into consideration your baby's growth and your choices. This does not affect your right to choose a homebirth, and if all is now well with you and your baby there would appear to be no reason for you not to go to a birth centre.

Will I be able to have a waterbirth?

The availability of birth-pools varies. In some NHS Trusts there are one or more pool rooms within the main hospital obstetric unit, but in others they are only available in midwife-led units (birth centres). In that case, if the midwife-led units have been suspended, then there probably won't be a birth-pool available unless the Trust has, for example, installed a portable birth-pool in the obstetric unit. Unfortunately, you do not have a right to insist on a water-birth so you may need to negotiate for this. If homebirth is an option for you then you can hire your own birth-pool.

The RCM/RCOG guidance guidance recognises that labour and birth in water "may confer benefits" and makes it clear that those who have no symptoms or who have tested negative for COVID-19 should be able to use a birth-pool "providing adequate PPE can be worn by those providing care."

The guidelines note that for those who have tested positive but have no symptoms there is a lack of evidence to show whether the virus can be transmitted in water, so they make no recommendation for or against the use of birthpools in this case. In fact, while there is evidence that coronavirus may be present in faeces (poo) there is no direct evidence that it can be caught from a birthpool, so there seems no good reason to prevent someone without symptoms from using one, even if they have tested positive. However, hospitals may decide against it in order to protect staff.

The guidelines note that it is not usually recommended for those with fever to labour in water, and that those with symptoms such as coughing or breathing difficulties, or who feel unwell, need careful monitoring so their care is better managed on land.

This briefing from the Royal College of Midwives (RCM) concludes that "The current evidence does not suggest that there should be a blanket cessation on the use of water in labour or waterbirth for all women." It does go on to say that "Individualised risk assessment about the appropriateness of providing labour or birth care in the pool room should be undertaken for each woman by the midwifery team providing care, based on the woman's individual presentation and the pool environment within the labour setting." This would still allow a Trust to say that their pool room is not suitable.

A paper from Oxford Brookes University water immersion during labour and waterbirth - COVID-19 context makes the case for waterbirth being a potentially safer option for women who do not have suspected or confirmed symptoms of COVID-19 "because it promotes the use of social distancing without interrupting normal midwifery care" and that the water should dilute any potential contamination from respiratory droplets or faeces.

Will I still be offered an induction or planned caesarean?

The RCM/RCOG guidelines suggest having a discussion with your doctor about the timing and mode of birth but it is (as always) up to you whether to accept an offer of induction or a caesarean, and you should also be able to request a caesarean if that is what you want and it is not being offered.

If you are self-isolating because you or someone in your household has suspected COVID-19 they suggest a"personalised assessment should take place" to decide whether it is better overall to delay a planned caesarean or induction. This should include consideration of how urgent it is for your baby to be born, and the risks of infection to others and to your baby after birth. You can ask for a second opinion if you are unhappy with the decision.

Can my baby stay with me after birth if I have suspected or confirmed COVID-19?

There is little evidence about the risk of a baby catching COVID-19 from an infected mother but according to Advice from the British Association of Perinatal Medicine (BAPM) "it now appears unlikely" that a baby will become infected around the time of birth "if correct hygiene precautions are undertaken." The recommended approach differs according to whether the baby is well at birth, or needs to spend time in a neonatal unit.

The RCM/RCOG guidance says that, as long as your baby is healthy they should remain with you and you should be supported to breastfeed and to practice skin-to-skin/kangaroo care if you wish, even if you have a suspected or confirmed COVID-19 infection. However, if your baby needs to be cared for in a neonatal unit then you will probably not be admitted to the unit, in order to protect the other babies and adults in there, except in some specific circumstances. The guidance confirms that parents should still be involved in decisions about their baby's care and that those who wish to breastfeed should be supported to do so. (See " Will I be able to be with my baby if s/he is being cared for in a neonatal unit (NNU)?" for more about this situation.)

Will I be able to be with my baby if s/he is being cared for in a neonatal unit (NNU)?

Advice from the British Association of Perinatal Medicine (BAPM) makes it clear that there should be no restriction on parents being with their baby in a neonatal unit unless they have tested positive or are required to self-isolate. They state that "it is essential that the mother and her partner are never considered to be visitors within the neonatal unit - they are partners in their baby's care, and their presence should be encouraged." NNUs are advised to identify how to admit parents safely at all times of day, including during ward rounds, so that they can be properly involved in discussions of their baby's care. It notes that "The benefits of extended parental contact, including skin to skin care and active involvement in their baby's care are well documented, as are the long established advantages of breast feeding. At such a stressful time it is important for both parents to be able to be present together, at least for part of the day, unless such practice would be clearly detrimental to other babies and/or staff in the NNU or TCU." BAPM also encourages hospitals to offer testing to parents on the same basis as to staff, in order to minimise unnecessary separation from their baby.

Most Trusts/Boards appear to be allowing both parents to visit together, for all or a large part of the day, but some still have restrictions e.g. only allowing one parent to visit at a time, or limiting visiting to daytime. AIMS has a template letter which parents can use to request access to a baby in a neonatal unit, if this is being restricted without good reason.

BAPM recognises that "It would generally not be appropriate" for parents who have tested positive or are self-isolating to visit a neonatal unit but every effort should be made to facilitate remote contact by use of video technology and/or social media. If a baby is critically ill or receiving palliative or end-of-life care then "everything possible should be done to achieve parental presence and participation in cares" even if the parents have tested positive.

If parents are not able to visit their baby, it remains their right to receive information and be supported to make decisions about their baby's care, and mothers should be supported to express breastmilk if they wish (see " Can I breastfeed my baby if I have suspected or confirmed COVID-19?")

All four nations of the UK have issued their own , which in most cases is in line with the BAPM advice.

In England the latest guidance from NHS England Supporting-pregnant-women-maternity-services-access-for-parents-of-babies-in-neonatal-units asks "all trusts to continue enabling parents of babies on neonatal units having access to their babies." The guidance makes clear that "Within maternity and neonatal services, support people and parents of babies on neonatal units are not considered to be visitors and should not be treated as such." Therefore any visiting restrictions in force elsewhere in the hospital should not apply.

The guidance advises that parents should not attend neonatal units if they are symptomatic of COVID-19, but should be offered video access to their baby.

Welsh Government guidance is for "Up to two parents, guardians, or carers at the bedside at a time for paediatric inpatients and neonates subject to local determination, and following a risk assessment including the ability to maintain social distancing."

In Scotland the guidance sets out minimum standards for both for the situation in which there is "no current active outbreak on ward" or if there is "an active outbreak management scenario". In all cases "Parents/primary care givers are partners in neonatal care, and as such should never be considered as visitors to neonatal units and are also considered essential." If there is a current outbreak, both parents should still be able to visit "Both parents subject to local risk assessments and physical distancing." If there is no current outbreak then an additional visitor may be allowed "subject to local risk assessments and physical distancing" and for long-stay patients, siblings are permitted to visit, subject to local risk assessment.

In Northern Ireland the guidance states that in the current 'Gradual Easing' phase any child admitted to a neonatal unit "can be accompanied by two persons (either/both parents or two nominated caregivers from up to two households) at all times for the duration of the stay."

Can I breastfeed my baby if I have suspected or confirmed COVID-19?

The best way to protect your baby from infection is to breastfeed and maintain close contact/skin to skin contact with your baby even if you are ill. You may choose to wear a mask when you are in close contact with your baby, or when you are feeding them.

The latest Advice from the British Association of Perinatal Medicine (BAPM) confirms that even a woman with a suspected or confirmed COVID-19 infection should be enabled to have skin-to-skin contact and breastfeed her baby if that is her choice and the baby is well. They say " To date viral RNA has been reported only very rarely in fresh breast milk of COVID-19 confirmed mothers" and so, though the sample is small, the current advice for "well babies of COVID-19 suspected or confirmed mothers is that the benefits of breast feeding outweigh any theoretical risks."

For a baby being cared for in a neonatal unit (NNU) it suggests that carers and parents should discuss the pros and cons of a mother with a suspected or confirmed infection expressing breastmilk for her baby, taking into account the baby's age and state of health, and whether donor breastmilk is available as an alternative. However, it would be the mother's right to provide expressed breastmilk if she wishes, and the RCM/RCOG guidance says that if you are unwell or otherwise unable to breastfeed your baby directly, you should be supported to express your breastmilk, or be offered donor milk for your baby.

If your baby is receiving donor breastmilk, you may wish to continue expressing and discarding your own milk until you are no longer infectious, in order to maintain your supply.

The following breastfeeding helplines offer information and support:

National Breastfeeding Helpline: 0300 100 0212
www.nationalbreastfeedinghelpline.org.uk

NCT Helpline: 0300 330 0700 (Choose option 1 for NCT infant feeding line)

La Leche League GB Helpline: 0345 120 2918

Association of Breastfeeding Mothers: 0300 330 5453

Breastfeeding Support organisations
What if you are giving your baby formula?

If you are formula feeding your baby it is even more important than usual to make sure you are carefully sterilising all the equipment you use and minimising the number of people who hold and feed the baby.

Many parents worry about their baby not taking the recommended amount of milk, and during this time where they may be a lack of support you may be concerned about this. In which case you may find the 'Paced Bottle-Feeding' method may be useful and information can be found here https://feedsleepbond.com/lactation-consultants-guide-bottle-feeding.

Written by: Nadia Higson
Reviewed by: AIMS Helpline Team
Reviewed on: 06/04/2022
Next review needed: 01/04/2023

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.

Published on 29th July 2020

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This information was last updated on 6 April 2022. The links were checked at that time but webpages are sometimes moved. If a link appears to be broken please let us know by emailing enquiries@aims.org.uk. If it hasn't been removed, you should still be able to find the page by entering the title in your browser.

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What is the Period of PURPLE Crying? | PURPLECrying.info

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What is the Period of PURPLE Crying? | PURPLECrying.info

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The is a new way to help parents understand this time in their baby's life, which is a normal part of every infant's development. It is confusing and concerning to be told your baby "has colic" because it sounds like it is an illness or a condition that is abnormal. When the baby is given medication to treat symptoms of colic, it reinforces the idea that there is something wrong with the baby, when in fact, the baby is going through a very normal developmental phase. That is why we prefer to refer to this time as the Period of PURPLE Crying. This is not because the baby turns purple while crying. The acronym is a meaningful and memorable way to describe what parents and their babies are going through.

The Period of PURPLE Crying begins at about 2 weeks of age and continues until about 3-4 months of age. There are other common characteristics of this phase, or period, which are better described by the acronym PURPLE. All babies go through this period. It is during this time that some babies can cry a lot and some far less, but they all go through it.

Scientists decided to look at different animal species to see if they go through this developmental stage.
So far, all breast feeding animals tested do have a similar developmental stage of crying more
in the first months of life as human babies do.

When these babies are going through this period they seem to resist soothing. Nothing helps. Even though certain soothing methods may help when they are simply fussy or crying, bouts of inconsolable crying are different. Nothing seems to soothe them.

During this phase of a baby's life they can cry for hours and still be healthy and normal. Parents often think there must be something wrong or they would not be crying like this. However, even after a check-up from the doctor which shows the baby is healthy they still go home and cry for hours, night after night. "It was so discouraging," said one dad. "Our baby giggles and seems fine during the day and almost like clockwork, he starts crying around 6 pm. He is growing and healthy, so why does he cry like this?"

Often parents say their baby looks like he or she is in pain. They think they must be, or why would they cry so much. Babies who are going through this period can act like they are in pain even when they are not.

In my own case, I know my son was not sick. He was in the top percentile for growth, he giggled and was happy other times Then he would start to cry, and cry, and cry. The doctor kept telling me he is just fine.

After learning all of this, we decided we needed to share this information with other parents. We had to take this information and put it into a statement that told the story about this phase in a baby's life. Dr. Ronald Barr, a developmental pediatrician who has likely done more studies on infant crying than anyone in the world, came up with the phrase the Period of PURPLE Crying. His idea was to explain this phase to parents of new babies so they would know it was normal and they would be encouraged that it would come to an end.

The acronym PURPLE is used to describe specific characteristics of an infant's crying during this phase and let parents and caregivers know that what they are experiencing is indeed normal and, although frustrating, is simply a phase in their child's development that will pass. The word Period is important because it tells parents that it is only temporary and will come to an end.

Parents, after learning about Period of PURPLE Crying have said, "Finally they have called it something that describes what we are going through. This word colic was hard to get a handle on."

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Adam Miconi, Ryan Steinbeigle, National Center on Shaken Baby syndrome, Period of PURPLE Crying

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The is a new way to help parents understand this time in their baby's life, which is a normal part of every infant's development. It is confusing and concerning to be told your baby "has colic" because it sounds like it is an illness or a condition that is abnormal.

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When to take your child to emergency department

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When to take your child to emergency department

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6 Apr 20

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While you might be one of the lucky ones who's totally relaxed about their post-baby bod, never feel bad if it's not that easy. A lot of women struggle with the changes that happen to them after they go through labour.

Knowing what will happen in advance can make it easier to prepare. Here's what you can expect...

Why do I still look pregnant?

You may feel that way because your muscles have stretched during pregnancy so your tummy won't ping back straight away to how it was before. (NHS Choices, 2015) For a while, it'll be a bit looser.

How can I recover?

You might not know this but breastfeeding can help as it causes contractions that shrink the womb (NHS Choices, 2015). And it burns calories. Postnatal exercise can tone your pelvic floor and tummy muscles and of course resisting that cake and eating healthily will help (NHS Choices, 2015).

Issues to look out for

While you're pregnant, your stomach muscles may become separated. They should return to normal by the time your baby is eight weeks old. If they are still separated, speak to your GP about getting a referral to a physiotherapist. (NHS Choices, 2016a)

To tell whether your stomach muscles are still separated, put one hand on your tummy with your fingers on the midline of your naval. Press your finger down gently and bring your head up (shoulders on the ground) like you're doing a mini-crunch. Feel for the sides of your muscles and see if they are still separated.

Will my pregnancy stretch marks fade?

During pregnancy you might have noticed stretch marks developing on your stomach, breasts and inner thighs. They look like narrow pink or purple lines. After birth these should fade.

How can I recover?

Stretch marks will become less noticeable although they're unlikely to completely disappear. You can buy products aimed at removing stretch marks, but there is little evidence that these work. (Liu et al, 2014; NHS Choices, 2016b) If you are particularly self-conscious about your stretch marks, you can have laser therapy but be warned, it can be pricey.

Is back pain after giving birth normal?

Yes, a lot of women experience back pain after giving birth.

How can I recover?

You should:

Keep your back well supported when breastfeeding.

Kneel or squat (do not bend your back) to do low-level jobs like bathing your baby.

Change nappies on a raised surface.

Keep your back straight and bend your knees when lifting.

Keep your back straight when pushing your pram or buggy, or carry your baby in a well-fitting sling. (NHS Choices, 2016a)

If back pain persists, speak to your GP.

Is fatigue normal?

Yes. It's common to feel incredibly tired after you have given birth. Your body has been through a lot and your baby is likely to wake several times during the night. But it will get better.

How can I recover?

Try early nights and the old but true cliché of resting when your baby's asleep. If you're formula or combi feeding, share the night feeds with your partner. (NHS Choices, 2016c) Find out more about tiredness after birth here.

Issues to look out for

If you are particularly irritable, stressed or down, speak to your health visitor. They might look at other underlying causes like postnatal depression. (NICE, 2006)

Are headaches common after labour?

An estimated 39% of women will experience a headache in the first week after giving birth. (Goldszmidt et al, 2005)

How can I recover?

Drink plenty of water and take paracetamol or ibuprofen.

Issues to look out for

Tell your GP if you have a severe or persistent headache, especially if you had an epidural. It could be a sign of eclampsia (high blood pressure), which might require further treatment. (NICE, 2006)

And lastly, a couple of other post-birth worries...

Caesarean section scar

Keep your wound clean, wear loose comfortable clothing and take painkillers if you need to. See a doctor if you have any sign of infection, such as discharge or an unpleasant smell. Your caesarean section wound will scar, but it will become less noticeable over time and often your pubic hair will hide it. (NHS Choices, 2016d)

Deep vein thrombosis

Pregnant women and women who have had a baby in the past six weeks are at an increased risk of deep vein thrombosis. The symptoms are a swollen, painful leg and/or difficulty breathing.

Deep vein thromboses are caused by a clot developing in the deep veins of your leg. It can be fatal if the clot travels from your legs to your lungs. If you develop a swollen, painful leg or have breathing difficulties after a trip, see your GP urgently or go to the nearest A&E department. (NHS Choices, 2015)
This page was last reviewed in February 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.

To prepare yourself more for what happens during and after labour, we 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.

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Your post-pregnancy body questions answered | Life as a parent articles & support | NCT

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While you might be one of the lucky ones who's totally relaxed about their post-baby bod, never feel bad if it's not that easy. A lot of women struggle with the changes that happen to them after they go through labour. Knowing what will happen in advance can make it easier to prepare.

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Excessive Crying – What’s The Right Response? – Maternity Experience

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Excessive Crying – What’s The Right Response? – Maternity Experience

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Our thanks to Sally Hogg for this blog post. Sally is a mother who works in children's policy, research and practice, and has done extensive work on the subject of excessive crying in infants.
All babies cry and some babies cry a lot; between 10 and 20 per cent of babies will cry excessively during the first three months of life. As professionals, we know that this crying is normal and will pass. But for parents it is tough. Really tough.
"There were times when I resented him for screaming, and then hated myself for feeling like that, and also for not being able to make it better. I just felt a huge sense of failure."
While most families survive a period of excessive crying relatively unscathed, it does increase the risk of a range of poor outcomes including maternal mental illness, relationship breakdown, child abuse and childhood behavioural problems.

Parents of babies who cry a lot will often try to identify a cause of this crying, and, with it, a solution. This isn't helped by the fact that excessive crying is generally known as 'colic', leading to the common misconception that it is caused by stomach problems. In fact, excessive crying has been shown to be associated with digestive problems in only a small subgroup (around 5-10 per cent) of babies who cry excessively. For other babies, the causes of excessive crying might include temperament, early sensitivity, feeding problems, or a poor fit between parenting expectations and behaviours and babies' needs. For many babies, we will never really know why they cry a lot.

Crying is one of the most common reasons that parents seek support in the postnatal period. In these situations, it can be tempting to suggest a 'cure' for the crying, or to reassure the parent that crying is normal. Both the academic evidence, and the experience of parents, tell us that neither response is appropriate.

It is not appropriate to simply suggest a cure for the crying - whether that be winding, infancol, changes to feeding, or actions like walking the baby in a pram or carrying him. These actions might work for some babies, but not for all. There is no 'one size fits all' solution to crying - all babies are different and can cry for a huge number of different reasons, requiring different responses.

It is also not appropriate simply to reassure parents that crying will pass. Even if the crying is normal and the baby fine, excessive crying is hugely difficult for parents and can damage their self-esteem, self-efficacy, mental health and wider wellbeing. So some form of response is required.

So what might an appropriate response to excessive crying be?

Based on a review of the evidence, and in particular a useful article by Ian St James Roberts I would suggest that a good response to excessive crying has six parts. These are set out below. I've also highlighted where we might take action in the antenatal period to prepare parents to cope with a crying baby.

Building awareness of babies' development.

The first three months of a child's life (sometimes called the 'fourth trimester) is a distinct phase of babies' development, in which they are not yet able to regulate themselves, and in which their crying has particular characteristics. Ronald Barr refers to the 'period of purple crying', where the acronym 'purple' describes different features of babies' early crying.

Supporting all parents - both antenatally and postnatally - to understand this developmental stage, and to know that it will pass, can be really helpful. (Although there isn't a magic transition point at three months and each stage of children's development brings new and different challenges, so it's important to manage parent's expectations!)

Help parents to understand the stress that they feel and how to cope with this.

It is normal for parents to find their baby's crying stressful, but hard to admit this. We can help parents by normalising this experience, making it acceptable to talk about how one feels when a baby cries, and helping parents to think about ways to deal with this. Evidence shows that giving parents coping strategies to deal with the stress they feel when their baby cries, together with educating them about the importance of not shaking baby, can help parents and reduce the risk of abuse to babies. The NSPCC's Coping with Crying Programme has shown the value of sharing these messages with parents in the antenatal and postnatal period.

Provide a menu of options

There are many reasons why a baby might cry and many ways to help babies to keep calm, or to soothe them when they cry. These could be shared with parents antenatally, to help provide them with a 'toolkit' to draw from when their baby cries.

When a baby is crying excessively, it is useful to help parents to consider their own baby's experiences and needs, and to identify what actions might help them. Evidence from successful interventions suggests that the most effective responses to excessive crying involve reassuring and supporting parents, and helping them to formulate hypotheses about why the baby is crying and identify and test actions to reduce their babies' crying or to make it feel more manageable. One intervention, Possums, uses five domains - infant health, mother health, feeding, sensations and sleep - to consider the families' needs and identify actions.

Help parents to enjoy their baby.

When a baby cries excessively, this understandably becomes the focus of parents' attention. But the perinatal period is a formative time when parents develop beliefs about their child's personality which can influence how they interpret and respond to the child's behaviour and the quality of their interactions. It is therefore important to highlight a babies' wider characteristics, and help parents to enjoy the positive interactions that they have with their baby so that they don't develop too negative an image of their child based on their crying.

Frame crying as an experience and not a symptom.

It is helpful to address the idea that crying is a sign that there is something 'wrong' with the baby, either physiologically or emotionally. Helping parents to see excessive crying as a part of their baby's experience of early life, rather than a symptom of a medical problem or a sign of poor behaviour, can help them to focus on how best to soothe their baby and cope with crying during this stage.

Finally, let's not forget that excessive crying is really hard, and parents can feel feelings of isolation, helplessness and failure. These mums and dads need a kind, compassionate response and ongoing support.
"More helpful still were the very few people at health clinics who bothered to learn my or my babies' name, who offered to hold him for a little bit, and who were interested in how I was doing. These people were few and far between."
Sally Hogg

2016
Our thanks to Sally Hogg for this blog post. Sally is a mother who works in children's policy, research and practice, and has done extensive work on the subject of excessive crying in infants.
All babies cry and some babies cry a lot; between 10 and 20 per cent of babies will cry excessively during the first three months of life. As professionals, we know that this crying is normal and will pass. But for parents it is tough. Really tough.
"There were times when I resented him for screaming, and then hated myself for feeling like that, and also for not being able to make it better. I just felt a huge sense of failure."
While most families survive a period of excessive crying relatively unscathed, it does increase the risk of a range of poor outcomes including maternal mental illness, relationship breakdown, child abuse and childhood behavioural problems.

Parents of babies who cry a lot will often try to identify a cause of this crying, and, with it, a solution. This isn't helped by the fact that excessive crying is generally known as 'colic', leading to the common misconception that it is caused by stomach problems. In fact, excessive crying has been shown to be associated with digestive problems in only a small subgroup (around 5-10 per cent) of babies who cry excessively. For other babies, the causes of excessive crying might include temperament, early sensitivity, feeding problems, or a poor fit between parenting expectations and behaviours and babies' needs. For many babies, we will never really know why they cry a lot.

Crying is one of the most common reasons that parents seek support in the postnatal period. In these situations, it can be tempting to suggest a 'cure' for the crying, or to reassure the parent that crying is normal. Both the academic evidence, and the experience of parents, tell us that neither response is appropriate.

It is not appropriate to simply suggest a cure for the crying - whether that be winding, infancol, changes to feeding, or actions like walking the baby in a pram or carrying him. These actions might work for some babies, but not for all. There is no 'one size fits all' solution to crying - all babies are different and can cry for a huge number of different reasons, requiring different responses.

It is also not appropriate simply to reassure parents that crying will pass. Even if the crying is normal and the baby fine, excessive crying is hugely difficult for parents and can damage their self-esteem, self-efficacy, mental health and wider wellbeing. So some form of response is required.

So what might an appropriate response to excessive crying be?

Based on a review of the evidence, and in particular a useful article by Ian St James Roberts I would suggest that a good response to excessive crying has six parts. These are set out below. I've also highlighted where we might take action in the antenatal period to prepare parents to cope with a crying baby.

Building awareness of babies' development.

The first three months of a child's life (sometimes called the 'fourth trimester) is a distinct phase of babies' development, in which they are not yet able to regulate themselves, and in which their crying has particular characteristics. Ronald Barr refers to the 'period of purple crying', where the acronym 'purple' describes different features of babies' early crying.

Supporting all parents - both antenatally and postnatally - to understand this developmental stage, and to know that it will pass, can be really helpful. (Although there isn't a magic transition point at three months and each stage of children's development brings new and different challenges, so it's important to manage parent's expectations!)

Help parents to understand the stress that they feel and how to cope with this.

It is normal for parents to find their baby's crying stressful, but hard to admit this. We can help parents by normalising this experience, making it acceptable to talk about how one feels when a baby cries, and helping parents to think about ways to deal with this. Evidence shows that giving parents coping strategies to deal with the stress they feel when their baby cries, together with educating them about the importance of not shaking baby, can help parents and reduce the risk of abuse to babies. The NSPCC's Coping with Crying Programme has shown the value of sharing these messages with parents in the antenatal and postnatal period.

Provide a menu of options

There are many reasons why a baby might cry and many ways to help babies to keep calm, or to soothe them when they cry. These could be shared with parents antenatally, to help provide them with a 'toolkit' to draw from when their baby cries.

When a baby is crying excessively, it is useful to help parents to consider their own baby's experiences and needs, and to identify what actions might help them. Evidence from successful interventions suggests that the most effective responses to excessive crying involve reassuring and supporting parents, and helping them to formulate hypotheses about why the baby is crying and identify and test actions to reduce their babies' crying or to make it feel more manageable. One intervention, Possums, uses five domains - infant health, mother health, feeding, sensations and sleep - to consider the families' needs and identify actions.

Help parents to enjoy their baby.

When a baby cries excessively, this understandably becomes the focus of parents' attention. But the perinatal period is a formative time when parents develop beliefs about their child's personality which can influence how they interpret and respond to the child's behaviour and the quality of their interactions. It is therefore important to highlight a babies' wider characteristics, and help parents to enjoy the positive interactions that they have with their baby so that they don't develop too negative an image of their child based on their crying.

Frame crying as an experience and not a symptom.

It is helpful to address the idea that crying is a sign that there is something 'wrong' with the baby, either physiologically or emotionally. Helping parents to see excessive crying as a part of their baby's experience of early life, rather than a symptom of a medical problem or a sign of poor behaviour, can help them to focus on how best to soothe their baby and cope with crying during this stage.

Finally, let's not forget that excessive crying is really hard, and parents can feel feelings of isolation, helplessness and failure. These mums and dads need a kind, compassionate response and ongoing support.
"More helpful still were the very few people at health clinics who bothered to learn my or my babies' name, who offered to hold him for a little bit, and who were interested in how I was doing. These people were few and far between."
Sally Hogg

2016

Twitter - Join the@MatExpBazaar!

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Excessive Crying - What's The Right Response?

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Our thanks to Sally Hogg for this blog post. Sally is a mother who works in children's policy, research and practice, and has done extensive work on the subject of excessive crying in infants. All babies cry and some babies cry a lot; between 10 and 20 per cent of babies will cry excessively during the first three months of life.

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University of Birmingham/NHS, 2 Apr 20

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Why you need to write a postnatal recovery plan - Sophie Messager

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Why you need to write a postnatal recovery plan - Sophie Messager

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If you're pregnant or have ever had a baby, you're heard of birth plans, I'm sure, but have you heard of writing a postnatal plan? I doubt it.

As a doula , antenatal teacher and babywearing educator, I've been working with expectant and new parents since 2010, so I have met quite a few pregnant and new families and their babies (I think it's something like close to a thousand now).

So you see I thought I kind of knew quite a bit about postnatal recovery. Expect I had missed something crucial in the mix.

When I attended the doula UK conference a few weeks ago, Mia Scotland (she is a clinical psychologist and doula, and author of the awesome "why perinatal depression matters"-the best book I have read about depression and perinatal mental health) gave a talk about postpartum practises from around the world and the dire lack of them in the West. I kind of knew all of this-I bang on about it in my antenatal classes-my friends from China, Africa, India or South America tell me stories of spending a month in bed with their babies whilst family members rally round to take care of chores, or people fighting over who is going to cook them delicious, nourishing food, or daily full body massages etc. Heck I even teach a postpartum massage from Ecuador called closing the bones.

What do we get in the UK? Two weeks leave for the partner, and we get told to "leave the chores" and "sleep when the baby sleep". But chores need doing eventually (you need to eat, at least, and some clothes to wear for you and your baby!), and what if your baby only power naps in 40 min batches? When do you rest then? Also most mums have no family nearby, and the majority of them find themselves alone at home all day with their new baby-with no social network because their friends are at work. So you get an exhausted and lonely new mother, with no support. Feeling guilty because she isn't feeling serene and fulfilled by new motherhood. Ah! This isn't what we were supposed to get as a species. This isn't right, and deep down, we know it.

So yeah I've been rabitting on about all this to pregnant couples. But that wasn't enough.

What Mia suggested if that we encourage expectant couples was to write a postnatal plan. This was new to me. I think this is a genius idea!

It's quite revolutionary when you think about it.

A postnatal recovery plan.

Just like a birth plan-I guess we could call it a postnatal recovery preferences plans.

It's a lot more focused than just talking about what's missing in our culture. It is encouraging parents to think about what is missing and what they can do about it. BEFORE they have their baby.

So what would it look like? I asked my birthworkers friends on Facebook over the week-end to come up with an acronym. They came up with several brilliant ideas! The one that appealed to me most was the RECOVER acronym by author and breath coach Catherine Holland. I then adapted her idea and added the words describing what each letter prompts for. It's a great starting point for parents to think about and put support in place for after the birth.

R est-you need to recover from growing and birthing this baby. Adult help, daytime naps (Sleep when baby sleep ), early nights, taking it in turns, or other sleep deprivation strategies that work for you.

E at-nutritious food- fill your freezer, ask friends and family to cook and deliver food, take away menus...

C hores-can you get another adult to help? A cleaner, family members, friends, a postnatal doula, mother's help?

O ptional-refers to the visitors below but also to the fact that the plan will only work if it is tailored to your needs-some new mums prefer to stay at home, some prefer to go out and see people for example

V isitors-This can be a good or a bad thing, depending on yourself and the visitors. Visitors who come and expect to be waited upon, and insist on holding your baby, can leave you feeling exhausted with a cranky baby. Can you discuss this with friends and family ahead of time? If you don't want visitors but don't want to confront them, note on the door with "new mother and baby asleep" might do it.

E motional Take it easy, this is a big change and the first few weeks are usually very chaotic. New parents need solid emotional support, Think "mothering the mother". Yet most are bombarded with well meaning "advice" which can undermine their confidence. Find someone to talk to who can listen unconditionally.

R eceive- this isn't a time for you to give to other people-you are supposed to receive support. Demand nurturing present for yourself, like a postnatal massage. It is much more useful to have nurtured parents who feel strong enough to look after their baby than lots of flowers, babygros and cuddly toys.

Of course a postnatal doula can help you design such a plan, signpost you to the right people and provide all the support highlighted above 🙂

Let's start the postnatal plan revolution!

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Why you need to write a postnatal recovery plan | Sophie Messager

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If you're pregnant or have ever had a baby, you're heard of birth plans, I'm sure, but have you heard of writing a postnatal plan? I doubt it. As a doula , antenatal teacher and babywearing educator, I've been working with expectant and new parents since 2010, so I have met quite a few pregnant and new families and their babies (I think it's something like close to a thousand now).

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Common Sense and Well Tried Soothing Methods | PURPLECrying.info

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Common Sense and Well Tried Soothing Methods | PURPLECrying.info

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Now that you have become familiar with the common features and two important principles of soothing that are often used in all countries and all cultures, let's consider a number of common soothing methods that parents and caregivers have used to calm their infants.

As you may imagine, there are hundreds of options. As an example, cultures around the world have developed many methods for carrying their infants. Some of these include different ways of swaddling their infants, some of these include different kinds of baby carriers or slings, and some of these just include carrying your baby around in your arms. When you think about the carrying methods that you or others have used, you will probably notice that your carrying technique incorporates many of the common features of soothing, for example:

1. Carrying often includes changes of position;

2. Carrying often (but not always) includes looking at your baby and him/her looking at you, increasing eye-to-eye contact as well as human stimulation;

3. Carrying includes many sensations including touches, smells, sights and, if you talk while carrying your baby, sounds;

4. Carrying includes closeness with the baby's mother or parent;

5. If you are walking around with your baby, the walking introduces rhythm into the baby's calming experience.

And, of course, the two principles of soothing will be part of it: carrying works some of the time, but it doesn't work all of the time; and carrying is something that you can do all of the time, not just in response to the baby's crying.

Common soothing methods in the Period of PURPLE Crying.
In another section of this website, there is a description of the Period of PURPLE Crying program. The program materials describe in a very straightforward way what a parent or a caregiver can expect a new baby's crying to be like in the first weeks and months of life. This is important because, as anyone who reads the booklet or watches the video will learn, the crying of new babies will increase in the first weeks and months of life before it decreases.

So, as a starting point, let's talk about soothing methods from the Period of PURPLE Crying materials. The booklet contains a section about what is appropriate to do if a baby is crying a lot. It suggests three action steps, and the First Action Step is about soothing. The first action step says that caregivers should:

"Increase the comfort, carry, walk and talk responses with their infants."

Why is this important to do? Well, there are two main reasons. The first is that it is a reminder for caregivers to do all the great soothing things that they already know, but to increase the amount or number of times they soothe their baby. In other words, pick up your baby more often, carry them around more often, sing to them and gently pat and stroke them more often. This is because the more you do these things, the more likely it will be that you will be able to calm your baby. "Comforting" might involve wrapping your baby in a blanket, or just holding your baby in your arms. "Carrying" includes holding, contact and closeness. "Walking" includes all of those as well as introducing a rhythm to your movements. You may also want to move your body to the rhythm of the beats in music while carrying and comforting your baby. "Talking" includes adding a human voice, perhaps saying or singing the same things over and over to a melody.

"Pick up your baby more often, carry them around more often, sing to them and gently pat and stroke them more often. This is because the more you do these things the more likely it will be that
you will be able to calm to your baby."

The second reason comes from the soothing principle that doing these soothing methods when your infant is not crying will make them even more effective by keeping your infant calmer once it stops crying. So, if you begin using these comfort, carry, walk and talk methods when your infant is crying, it is helpful to continue to use them after the baby has become calm. This can help to prevent the crying from beginning again. Many mothers put the baby down again as soon as it stops crying, but continuing to use soothing methods for a while afterward should help your baby stay calm.

It is good to experiment with various methods and see what works at the time. It is also important to see what makes you feel good as you try them. Some parents have said that just having a list to go through gives them "something to try" or "something to do," even if it does not work all the time. Calming yourself down by trying things can be as important as calming your baby down.

"Some parents have said that just having a list to go through gives them
"something to try" or "something to do," even if it does not work all the time."

It is very important, however, not to let yourself get frustrated while trying these things. Remember, it is not your fault or your baby's fault. That is why there is a second action step. The second action step says that, IF you get frustrated because the crying does not stop, it is OK to put the baby down in a safe place and walk away for awhile, and then come back and check on your baby when you have had a chance to become calmer.

Other common methods
Now let's talk about other common methods that many parents use. Some of these methods are built on the idea of providing "white noise." White noise comes in lots of forms. We have already mentioned the sound of an airplane taking off that parents and their babies experience if they live near an airport. Other parents have found that the sound of the machine that provides air to fish tanks (an aerator) is an effective soothing technique. If you have such a fish tank, it is worth putting your baby's crib near the fish tank when the aerator is on to see if it calms your baby. Another source of white noise that almost every home has is a vacuum cleaner. Mothers often report that their infant stops crying when they vacuum around the house. Fans will sometimes do the same thing. In addition, fans provide a source of gentle "contact" from the air that moves over the infant.

"Mothers often report that their infant stops crying when they vacuum around the house."

Another technique that parents have suggested is putting a baby on a clothes dryer when it is running. This probably "works" because of the white noise and the constant jiggling motion that the clothes dryer provides. However, parents need to know that this can be very dangerous, as the motion of the dryer can result in the baby falling off the dryer and onto the floor. Another potentially dangerous situation can occur if a baby is put near a hair dryer that is running, especially if the baby can come into contact with the dryer and get burned.

Almost all parents who have a car have noticed that their baby will calm down and even go to sleep if they take their baby for a ride in the car. As you can imagine, a ride in a car includes "white noise" (car engine, street noises, and so on) as well as constant and the rhythmic movement we talked about before. Sometimes there is the background of familiar human voices from the other family members in the car. A car ride is often listed by parents as one of the most effective soothing strategies for their baby. In fact, it is so well known as a soothing strategy that, a few years ago, a major car company made a television advertisement in which dad took the baby to the car and drove around and around the block a few times. Not only did the car get many camera exposures, but the baby calmed down and went to sleep!

"A car ride is often listed by parents as one of the most effective soothing strategies for their baby"

Carrying your baby in a sling
I want to mention one more idea that can be helpful in providing soothing, and that is carrying a baby in a carrier worn close to the body of the parent, like a sling. As you might imagine, with the possible exception of feeding a baby (especially breastfeeding), there is probably nothing a parent can do that uses more of the common features of soothing. In addition, it is something that you can do when your baby is not crying that can help keep them calm.

It is only fair to say that the research studies that have been done on this technique have not always shown that increasing the amount of time you carry your baby will be effective in reducing the crying. One study of infants who came to pediatricians' offices showed that parents (both mothers and fathers) who increased carrying their baby to more than three hours a day from three weeks of age reduced the overall amount of fussing and crying that their infants did by 43%. Another study looked only at healthy but very high crying infants (infants that cried for greater than three hours a day for greater than three days in one week-what most people would consider to be "colic"). In this study, parents who increased the carrying that they were already doing by 50% were not able to reduce the crying and fussing that their infants did compared to parents who continued the amount of carrying that they were doing already. So, it remains unclear why increased carrying was so effective in one study and not in the other.

It may have been that the parents in the second study needed to do even more carrying of their already high crying infants. It may have been that the increased carrying needed to begin earlier, before the high crying became established. Whatever the reason, it is not clear that carrying will work for all infants, although it seems very effective in some. Of course, this is what is said in the section "Principles of Soothing": namely, that some soothing behaviors work some of the time, but nothing works all of the time. However, if it is convenient for you to use one of these carrier slings and it helps to calm your baby, then it is a good thing to try. It may have the extra benefit of making you feel closer to your baby and that you are doing something to help.

You may have heard that babies are more often carried and carried for longer in other societies, especially outside of North America and Europe. This is true. It is interesting that, in these societies, babies are often described as crying less. Actually, there have been some studies on carrying and crying in these societies. In general, that relationship is true: the babies in those societies do cry less than babies in North American societies. However, not all features of crying are reduced. One of the better documented studies was done with a group in Africa called the !Kung San. In this society, babies are carried pretty much all of the time in a sling called a kaross. Interestingly, the overall duration of crying and fussing was reduced by 50% relative to babies in North America and in Holland (where babies are not carried all of the time and carrying occurs more often in response to crying). However, Kung San infants still showed the increased crying pattern that is normal and common in the first few months of a baby's life-- they cried the same number of times (that is, the frequency of crying was the same, but they did not cry as long when they did cry) and they still had inconsolable crying from time to time. So the increased carrying seems to help, but it does not take all of the crying and fussing away, even when parents carry their babies all of the time, as the !Kung San do.

Author: National Center on Shaken Baby Syndrome

Many parents and caregivers ask what they can try to soothe their crying infant. The following is a list of practical things to try to calm your crying baby. It is important to remember that while many of these suggestions will work most of the time, nothing will work all of the time. When you begin to become very frustrated with a baby's crying, it is time to set the infant in a safe place and walk away. For tips to deal with frustration and anger click here.

The list above is not an all-inclusive list as there are many other things you can try to calm your baby's crying. Remember... while many of these techniques will work most of the time, nothing works all the time and that is okay. This does not mean there is anything wrong with you or your baby.

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Adam Miconi, Ryan Steinbeigle, National Center on Shaken Baby syndrome, Period of PURPLE Crying

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Common Sense and Well Tried Soothing Methods

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Now that you have become familiar with the common features and two important principles of soothing that are often used in all countries and all cultures, let's consider a number of common soothing methods that parents and caregivers have used to calm their infants.

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Maternity Action

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Οι αποδοχές μητρότητας (SMP) είναι £148,68 τη βδομάδα μέχρι τις 4 Απριλίου 2020 και από τις 5 Απριλίου 2020 αυξάνουν στις £151,20 τη βδομάδα (ή το 90% των μέσων αποδοχών σας, αν αυτό είναι λιγότερο).

Η Δράση Μητρότητας έχει γράψει στην κυβέρνηση για να ζητήσει τις αλλαγές στα προγράμματα υποστήριξης Covid-19 έτσι ώστε οι έγκυες γυναίκες και οι νέοι γονείς να μην χάσουν άμεση υποστήριξη: https://maternityaction.org.uk/2020/04/support-for-and-advice-to-pregnant-women-new-

Αν ο χώρος εργασίας μου κλείσει κατά τη διάρκεια της πανδημίας, εξακολουθώ να πληρώνομαι τις αποδοχές μητρότητας;

Ναι, εάν πληροίτε τις προϋποθέσεις για SMP ο εργοδότης σας θα πρέπει να σας πληρώσει την άδεια μητρότητας μέσω της μισθοδοσίας με τον συνήθη τρόπο.

Εάν πληροίτε τις προϋποθέσεις για SMP, ο εργοδότης σας θα πρέπει να σας το πληρώσει σύμφωνα με το νόμο, ακόμη και αν ο χώρος εργασίας έχει κλείσει κατά τη διάρκεια της πανδημίας. Ο εργοδότης σας μπορεί να ζητήσει επιστροφή χρημάτων για το SMP από το HMRC: https://www.gov.uk/recover-statutory-payments

Ο εργοδότης σας μπορεί να λάβει συμβουλές σχετικά με την πληρωμή και την ανάκτηση SMP από τη Γραμμή Βοήθειας Εργοδοτών του HMRC στο 0300 200 3200.

Εάν ο εργοδότης σας έχει τεθεί σε χρεωκοπία, μπορείτε να ζητήσετε το SMP σας απευθείας από το HMRC. Θα πρέπει να τηλεφωνήσετε στη Γραμμή Βοήθειας Εργαζομένων του HMRC στο 0300 200 3500 ή στην Ομάδα Διεκπεραίωσης Διαφωνιών Νόμιμων Αποδοχών HMRC στο 0300 0560 630.

Ο εργοδότης μου έχει θέσει το υπόλοιπο προσωπικό σε άδεια fulrough και τους καταβάλλει το 80% των κανονικών αποδοχών. Εμένα μου πληρώνουν μόνο το 80% του κανονικού SMP. Είναι σωστό;

Όχι, ο εργοδότης σας θα πρέπει να σας πληρώσει το πλήρες SMP σας. Οι πρώτες έξι εβδομάδες του SMP σας βασίζονται στις μέσες εβδομαδιαίες αποδοχές σας κατά την περίοδο υπολογισμού του SMP (περίπου από την 18η έως την 26η εβδομάδα της εγκυμοσύνης σας). Για τις επόμενες 33 εβδομάδες το SMP σας θα πρέπει να πληρωθεί με το νόμιμο ποσό των £148,68 την εβδομάδα (έως τις 4 Απριλίου 2020) και £151,20 την εβδομάδα από τις 5 Απριλίου 2020. Εάν ο μέσος όρος των εβδομαδιαίων αποδοχών σας είναι λιγότερα από 90% του νόμιμου SMP, τότε θα λάβετε το 90% των μέσων εβδομαδιαίων αποδοχών σας καθ' όλη τη διάρκεια της άδειας μητρότητάς σας.

Ο εργοδότης σας μπορεί να ζητήσει την επιστροφή χρημάτων για το SMP από την HMRC: https://www.gov.uk/recover-statutory-payments. Ο εργοδότης σας μπορεί να λάβει συμβουλές σχετικά με την πληρωμή και την ανάκτηση SMP από τη Γραμμή Βοήθειας Εργοδοτών HMRC στο 0300 200 3200.

Εάν ο εργοδότης σας δεν είναι σε θέση να σας πληρώσει το SMP σας, μπορεί να ζητήσει εκ των προτέρων χρηματοδότηση από την HMRC: https://www.gov.uk/recover-statutory-payments/if-you-cant-afford-to-make-payments

Εάν ο εργοδότης σας δεν σας πληρώσει το νόμιμο SMP σας, μπορείτε να το διεκδικήσετε από την Ομάδα Διεκπεραίωσης Διαφωνιών Νόμιμων Αποδοχών HMRC στο 0300 0560 630. Θα πρέπει να ενημερώσετε τον εργοδότη σας ότι επικοινωνείτε με την HMRC εκ των προτέρων, καθώς αυτό μπορεί να τους προτρέψει να πληρώσουν το πλήρες SMP σας.

Τι μπορώ να κάνω αν ο εργοδότης μου δεν απαντά σε τηλεφωνικές κλήσεις και μηνύματα ηλεκτρονικού ταχυδρομείου σχετικά με την αμοιβή μητρότητας μου (SMP);

Δεδομένου ότι αυτή είναι μια δύσκολη και ταχέως εξελισσόμενη κατάσταση, είναι σημαντικό να δώσετε στον εργοδότη σας όσο το δυνατόν περισσότερες πληροφορίες, συμπεριλαμβανομένων των παραπάνω πληροφοριών σχετικά με το πού μπορεί να λάβει συμβουλές ο εργοδότης σας. Βεβαιωθείτε ότι ο εργοδότης σας γνωρίζει ότι θα αποζημιωθεί για το SMP σας και ότι μπορούν να λάβουν προκαταβολή εάν αυτό είναι απαραίτητο.

Εάν ο εργοδότης σας δεν απαντά στις κλήσεις/μηνύματα ηλεκτρονικού ταχυδρομείου σας, ενημερώστε τον ότι εσείς θα χρειαστεί να επικοινωνήσετε άμεσα με το HMRC για να λάβετε το SMP σας. Αυτό μπορεί να προτρέψει τον εργοδότη σας να αναλάβει δράση, καθώς είναι πιθανό ότι το HMRC θα επικοινωνήσει με τον εργοδότη σας για να ζητήσει τις σχετικές πληροφορίες.

Εάν ο εργοδότης σας δεν ανταποκρίνεται, εάν αρνείται να σας πληρώσει το SMP σας ή εάν έχει κλείσει και δεν μπορεί πλέον να το πληρώσει, μπορείτε να επικοινωνήσετε άμεσα με τη Γραμμή Βοήθειας Εργαζομένων του HMRC στο 0300 200 3500 ή με την Ομάδα Διεκπεραίωσης Διαφωνιών Νόμιμων Αποδοχών HMRC στο 0300 0560 630. Το HMRC θα διερευνήσει την κατάσταση και θα διατάξει τον εργοδότη σας να σας πληρώσει το SMP σας. Εάν ο εργοδότης σας έχει κλείσει, το HRMC θα σας πληρώσει το SMP σας άμεσα.

Θα εξακολουθήσω να πληρώνομαι τη Νόμιμη Κρατική Αμοιβή (SMP) ή την Επιδότηση Μητρότητας εάν το δικαιούμαι, αλλά πρέπει να φύγω από τη χώρα;

Ναι, ο εργοδότης σας θα πρέπει να συνεχίσει να σας πληρώνει το SMP σας κανονικά εάν φύγετε από τη χώρα. Εάν πληροίτε τους όρους πρόκρισης για SMP έχετε το δικαίωμα να το παραλάβετε για 39 ολόκληρες εβδομάδες.

Μπορείτε να συνεχίσετε να λαμβάνετε το επίδομα μητρότητας για ολόκληρη την περίοδο των 39 εβδομάδων, εάν μεταβείτε προσωρινά στο εξωτερικό. Θα πρέπει να ειδοποιήσετε το Υπουργείο Εργασίας και Συνταξιοδότησης (DWP) πριν φύγετε.

Είμαι σε άδεια μητρότητας και παίρνω £151,20 την εβδομάδα, αλλά όλοι οι συνάδελφοί μου είναι εκτός εργασίας με άδεια furlough και πληρώνονται το 80% των κανονικών αποδοχών τους χωρίς να χρειάζεται να εργαστούν. Πρέπει να πληρωθώ το ίδιο;

Δυστυχώς, οι αποδοχές μητρότητας είναι πολύ χαμηλές, αλλά δεν δικαιούστε "κανονικές αποδοχές" κατά τη διάρκεια της άδειας μητρότητας. Κατά τη διάρκεια αυτής της περιόδου μπορείτε να λάβετε μόνο αποδοχές μητρότητας SMP. Ο μόνος τρόπος για να λάβετε πληρωμένη άδεια είναι να ειδοποίησετε τον εργοδότη εάν μπορείτε να τερματίσετε την άδεια μητρότητας νωρίς και να τεθείτε σε άδεια furlough με πληρωμή.

Πρέπει να έχετε υπ'όψιν ότι εάν τερματίσετε την άδεια μητρότητας νωρίς, μόλις λήξει το πρόγραμμα άδειας και οι επιχειρήσεις επιστρέψουν στο φυσιολογικό πρόγραμμα εργασίας, αναμένεται και εσείς να επιστρέψετε αμέσως στην εργασία σας. Δεν μπορείτε να επιστρέψετε στην άδεια μητρότητας.

Δεν είμαι σε θέση να εργαστώ από το σπίτι, και μου έχουν πει ότι θα λάβω μόνο τη νόμιμη αναρρωτική αμοιβή (SSP). Είμαι 16 εβδομάδων έγκυος, αυτό θα επηρεάσει την αμοιβή μητρότητας μου;

Εάν κατά τη διάρκεια της περιόδου του συνόλου των 8 εβδομάδων / 2 μηνών, είστε μόνο στη νόμιμη αναρρωτική αμοιβή (SSP) των £94,25 ανα εβδομάδα, δεν θα πληρείτε τις προϋποθέσεις για SMP και θα πρέπει να διεκδικήσετε επίδομα μητρότητας (MA) αντ' αυτού. Εάν βρίσκεστε σε ναποδοχές αναρρωτικής άδειας (SSP) κατά τη διάρκεια μέρους της περιόδου των 8 εβδομάδων/2 μηνών, οι μέσες αποδοχές σας θα είναι χαμηλότερες, γεγονός που μπορεί να μειώσει το ποσό των SMP που παίρνετε.

Ο εργοδότης σας θα πρέπει να σας πληρώσει SSP μόνο αν έχετε χαρτί αναρρωτικής άδειας απο τη μαία σας / GP ή είστε σε αυτό-απομόνωση για 2 εβδομάδες με συμπτώματα κορονοϊού. Εάν δεν μπορείτε να εργαστείτε κατά τη διάρκεια της πανδημίας για λόγους υγείας και ασφάλειας, ο εργοδότης σας θα πρέπει να σας αναστείλει με πλήρεις αποδοχές, εάν δεν υπάρχει κατάλληλη εναλλακτική εργασία διαθέσιμη. Βλέπε παραπάνω ενότητα σχετικά με την υγεία και την ασφάλεια κατά τη διάρκεια του Covid-19.

Ο εργοδότης σας μπορεί επίσης να σας βάλει σε πληρωμένη άδεια εάν δεν είστε ικανή να εργαστείτε λόγω της εγκυμοσύνης. Ο εργοδότης σας μπορεί να διεκδικήσει έως και το 80% των μισθών σας από την κυβέρνηση, μέχρι £ 2500 ανά μήνα, κατά τη διάρκεια της πανδημίας. Περισσότερες πληροφορίες σχετικά με τη βοήθεια για τους εργοδότες είναι διαθέσιμες εδώ: Ε άν ο εργοδότης σας δεν σας παρέχει κατάλληλη εναλλακτική εργασία, αναστολή με πλήρεις αποδοχές ή αρνείται την άδεια λόγω της εγκυμοσύνης σας, μπορεί να κάνετε αίτηση για παράνομη μείωση των μισθών ή/και διακρίσεων λόγο εγκυμοσύνης.

Εάν είμαι εκτός εργασίας με αποδοχές αναρρωτική άδεια (SSP) ή με πληρωμένη άδεια (furlough), αυτό μετράει για τις 26 εβδομάδες συνεχούς υπηρεσίας για την τήρηση των προϋποθέσεων για Νόμιμη Αμοιβή Μητρότητας (SMP);

Η Δράση Μητρότητας αγωνίζεται για να βελτιώσει τον τρόπο που η Αποδοχές Μητρότητας (SMP) υπολογίζονται έτσι ώστε οι έγκυες γυναίκες που είναι άρρωστες ή είναι ανίκανες να εργαστούν στα μέσα της εγκυμοσύνης τους να μην έχουν μειωμένο SMP.

Είμαι σε άδεια (furlough) και λαμβάνω το 80% του μισθού μου. Αυτό θα επηρεάσει την Νόμιμη Αμοιβή Μητρότητας (SMP);

Εάν ξεκινάτε την άδεια μητρότητας σας στις ή μετά τις 25 Απριλίου 2020, ο εργοδότης σας θα πρέπει να χρησιμοποιεί τις συνήθεις αποδοχές σας κατά την επεξεργασία του SMP σας και όχι την αμοιβή της άδειας furlough. Εάν ξεκινάτε τώρα την άδεια μητρότητας σας, είναι απίθανο να επηρεαστείτε επειδή η νόμιμη αμοιβή μητρότητας σας θα βασιστεί στις αποδοχές σας όταν ήσαστε περίπου 18 έως 26 εβδομάδες έγκυος.

Για παράδειγμα, εάν πληρώνεστε στο τέλος κάθε μήνα, και το μωρό σας αναμένεται την εβδομάδα που αρχίζει στις 16 Αυγούστου 2020, η 15η εβδομάδα πριν από την ημέρα του τοκετου σας είναι η εβδομάδα που αρχίζει στις 3 Μαΐου 2020. Το SMP σας θα βασίζεται στις μέσες εβδομαδιαίες αποδοχές σας τον Μάρτιο και τον Απρίλιο του 2020. Εάν λαμβάνετε πληρωμένη άδεια furlough σε αυτούς τους μήνες, ο εργοδότης σας θα πρέπει να χρησιμοποιήσει τις αποδοχές που θα είχατε λάβει αν δεν ήσασταν σε άδεια κατά τον υπολογισμό του SMP σας, οπότε η αμοιβή μητρότητας σας δεν θα επηρεαστεί από την αμοιβή άδειας.

Ο εργοδότης μου με πληρώνει Νόμιμη Αναρρωτική Αμοιβή (SSP), αλλά ανησυχώ ότι αυτό θα επηρεάσει την Νομιμη Αμοιβή Μητρότητας μου (SMP). Αυτό θεωρείται διάκριση;

Για τον υπολογισμό των μέσων εβδομαδιαίων αποδοχών σας για τη νόμιμη αμοιβή μητρότητας (SMP), ο εργοδότης σας θα πρέπει να χρησιμοποιήσει τις μέσες αποδοχές σας κατά τη διάρκεια της περιόδου μεταξύ των 8 εβδομάδων ή 2 μηνών πριν από τη 15η εβδομάδα προ της αναμενόμενης εβδομάδας τοκετού σας. Αυτό είναι όταν είστε περίπου 18 έως 26 εβδομάδες έγκυος. Μπορείτε να χρησιμοποιήσετε τον υπολογιστή αμοιβής μητρότητας εδώ: https://www.gov.uk/maternity-paternity-calculator Η περίοδος πρόκρισης για το SMP είναι πολύ αυστηρή και ο εργοδότης σας δεν μπορεί να λάβει υπόψη οποιαδήποτε άλλη περίοδο. Αυτό μπορεί να σημαίνει ότι εάν έχετε περιόδους αναρρωτικής αμοιβής ή άδειας άνευ αποδοχών κατά τη διάρκεια της παραπάνω περιόδου, αυτό θα επηρεάσει τις μέσες αποδοχές σας και μπορεί να σημαίνει ότι το SMP σας θα είναι χαμηλότερο. Ο εργοδότης σας δεν μπορεί να χρησιμοποιήσει οποιαδήποτε άλλη περίοδο για τον υπολογισμό των μέσων αποδοχών σας. Εάν είστε σε πληρωμένη άδεια (furlough) κατά τη διάρκεια αυτής της περιόδου, ο εργοδότης σας μπορεί να χρησιμοποιήσει τις συνήθεις αποδοχές σας αντ' αυτού, βλέπε ερώτηση 8. Εάν δεν μπορείτε να προκριθείτε για δικαίωμα SMP, θα μπορείτε να κάνετε αίτηση για επίδομα μητρότητας (MA). Θα είστε σε θέση να ζητήσετε επίδομα μητρότητας, αλλά θα πρέπει να στείλετε εκκαθαριστικά σημειώματα με τις υψηλότερες αποδοχές σας, και όχι από τις εβδομάδες κατά τις οποίες πληρωθήκατε αναρρωτική άδεια. Εάν ο εργοδότης σας έχει θέσει το υπόλοιπο προσωπικό σε πληρωμένη άδεια furlough με πλήρεις αποδοχές ή το 80% των αποδοχών, δικαιούστε και εσείς να είστε σε πηρωμένη άδεια μέχρι την έναρξη της άδειας μητρότητας. Εάν ο εργοδότης σας, σας πληρώνει τη νόμιμη αναρρωτική αμοιβή (SSP) κατά τη διάρκεια της εγκυμοσύνης σας όταν οι συνάδελφοί σας πληρώνονται την κανονική αμοιβή ή την αμοιβή άδειας 80% (furlough), μπορεί να κάνετε αίτηση για την παράνομη κατακράτηση των μισθών ή/και της διάκρισης λόγο εγκυμοσύνης. Αναρρωτική άδεια θα πρέπει να πληρώνεστε μόνο εάν έχετε χαρτί αναρρωτικής άδειας ή αν είστε σε απομόνωση, επειδή εσείς ή κάποιο μέλος της οικογένειας έχει συμπτώματα του Covid-19. Οι Κυβερνητικές οδηγίες για την άδεια furlough είναι διαθέσιμες εδώ: https://www.gov.uk/guidance/claim-for-wage-costs-through-the-coronavirus-job-retention-scheme

Κάνω περιστασιακή εργασία, αλλά μου είπαν ότι δεν μπορούν να μου προσφέρουν καμία εργασία επί του παρόντος. Τι δικαιούμαι;

Πρέπει να ειδοποιήσετε τον εργοδότη σας, ή το γραφείο εύρεσης εργασίας σας, πριν τη 15η εβδομάδα προ της ημερομηνίας τοκετού σας, πότε θέλετε να ξεκινήσετε την άδεια μητρότητας με απόδοχες. Θα πρέπει επίσης να τους δώσετε το πιστοποιητικό μητρότητας MATB1 σας που μπορείτε να πάρετε μόλις είστε 20 εβδομάδες έγκυος. Λαμβάνοντας υπόψη την πίεση στις υπηρεσίες NHS μπορεί να χρειαστεί να τηλεφωνήσετε στη μαία ή το GP σας και να ρωτήσετε αν μπορούν να σας στείλουν το MATB1.

Εάν δεν έχετε άλλο εισόδημα κατά τη διάρκεια αυτής της περιόδου μπορεί να έχετε δικαίωμα και για άλλες παροχές ή επιδοτήσεις. Ανατρέξτε στην ενότητα σχετικά με τις παροχές.

Δουλεύω μέσω γραφείου ευρέσεως εργασίας και ο εργοδότης μου με έστειλε σπίτι για λόγους υγείας και ασφάλειας καθώς εργάζομαι με το κοινό. Το γραφείου ευρέσεως εργασίας μου είπε να ξεκινήσω άδεια μητρότητας με αποδοχές νωρίς - αυτό είναι δίκαιο;

Όχι, εφόσον έχετε απασχοληθεί για τουλάχιστον 12 εβδομάδες στον ίδιο χώρο εργασίας ,ως εργαζόμενος από γραφείο ευρέσεως εργασίας, έχετε δικαίωμα στην προστασία της υγείας και της ασφάλειας κατά τη διάρκεια της εγκυμοσύνης. Εάν ο εργοδότης έχει λήξει τη σύμβασή σας για λόγους υγείας και ασφάλειας, το γραφείο σας θα πρέπει να σας προσφέρει κατάλληλη εναλλακτική εργασία ή να σας αναστείλει με πλήρεις αποδοχές μέχρι την ημερομηνία στην οποία θα είχε λήξει η συμβαση σας υπο κανονικές προϋποθέσεις. Η προστασία αυτή προέρχεται από τον νόμο Περί Εργασιακών Δικαιωμάτων του 1996, τμήματα 68A/B/C.

Αν δεν είστε σε θέση να εργαστείτε λόγω της κρίσης κορονοϊού, το γραφείο ευρέσεως εργασίας σας μπορεί επίσης να σας βάλει σε πληρωμένη άδεια furlough στο πλαίσιο του κυβερνητικού συστήματος, όπου το γραφείο μπορεί να διεκδικήσει το 80% των αποδοχών σας. Πληροφορίες σχετικα με πληρωμένη άδεια furlough στο πλαίσιο του κυβερνητικού συστήματος που μπορείτε να δείξετε στην υπηρεσία σας: https://www.gov.uk/guidance/claim-for-wage-costs-through-the-coronavirus-job-retention-scheme

Εάν ο εργοδότης σας δεν σας παρέχει κατάλληλη εναλλακτική εργασία, αναστολή με πλήρεις αποδοχές ή αρνείται την άδεια λόγω της εγκυμοσύνης σας, μπορεί να κάνετε αίτηση για παράνομη μείωση των αποδοχών ή/ και για διακρίσεις λόγω φύλου/εγκυμοσύνης.

Εάν η υπηρεσία (εύρεσης εργασίας) σας, σας αναστείλει με πλήρεις αποδοχές ή σας βάλει σε πληρωμένη άδεια furlough, θα παραμείνετε απασχολούμενη υπό την υπηρεσία μεχρι την ημερομηνία που η σύμβασή σας θα είχε λήξει υπο κανονικές συνθήκες. Η υπηρεσία σας μπορεί να αρχίσει το SMP σας αυτόματα όταν είστε 36 εβδομάδες έγκυος, εάν δεν είστε σε εργασία λόγω μητρότητας ή άδειας furlough ή μπορεί να το αρχίσει από την ημερομηνία που θα είχε τελειώσει η σύμβασή σας, εάν αυτή είναι νωρίτερα. Εάν είχατε απασχόληση από την υπηρεσία σας για τις πρώτες 26 εβδομάδες της εγκυμοσύνης σας και κερδίζατε τουλάχιστον £118 την εβδομάδα κατά μέσο όρο μεταξύ της 18ης έως 26ης εβδομάδας της εγκυμοσύνης σας τότε πληροίτε τις προϋποθέσεις για τη νόμιμη αμοιβή μητρότητας από την υπηρεσία σας. Όταν είστε 26 εβδομάδες έγκυος, θα πρέπει να δώσετε στο γραφείο σας το πιστοποιητικό μητρότητας MATB1 και να τους ζητήσετε να ελέγξουν εάν πληροίτε τις προϋποθέσεις για SMP. Μπορείτε να το υπολογίσετε εδώ: https://www.gov.uk/maternity-paternity-calculator

Εάν η υπηρεσία σας δεν σας πληρώνει το SMP σας, μπορείτε να επικοινωνήσετε με την Ομάδα Διαχείρησης Διαφωνιών για Νόμιμες Αποδοχες του HMRC στο 0300 0560 630 και να υποβάλετε αίτηση. Εάν δεν πληροιτε τις προϋποθέσεις για SMP αντ' αυτού μπορείτε να ζητήσετε επίδομα μητρότητας (MA): Υπάρχουν περισσότερες πληροφορίες σχετικά με τις επιδοτήσεις και τις βοήθειες που διατίθενται κατά τη διάρκεια της κρίσης στην ιστοσελίδα μας εδώ: https://maternityaction.org.uk/covidmaternityfaqs/benefits-for-rent-bills/ Επίδομα μητρότητας (MA)

Δεν θα είμαι σε θέση να πάρω αποδοχές μητρότητας (SMP), διότι θα είμαι σε νόμιμη
αναρρωτική αμοιβή (SSP) για το υπόλοιπο της εγκυμοσύνης μου - τι μπορώ να διεκδικήσω;
Εάν είστε σε νόμιμη αναρρωτική αμοιβή όταν είστε περίπου 18 - 26 εβδομάδες έγκυος ή οι αποδοχές σας είναι πολύ χαμηλές σε αυτή την περίοδο για να ζητήσετε SMP, τότε μπορείτε να ζητήσετε επίδομα μητρότητας.

Για να δικαιούστε επίδομα μητρότητας πρέπει να δείξετε ότι έχετε απασχοληθεί ή να ήσασταν αυτοαπασχολούμενη για τουλάχιστον 26 εβδομάδες από τις 66 εβδομάδες πριν από την αναμενόμενη ημερομηνία τοκετού σας. Εάν εργάζεστε, θα σας ζητηθεί επίσης να στείλετε εκκαθαριστικά σημειώματα που καλύπτουν περίοδο 13 εβδομάδων. Δεν χρειάζεται να είναι 13 εβδομάδες στη σειρά. Μπορεί να είναι οποιεσδήποτε 13 εβδομάδες στην περίοδο πρόκρυσης των 66 εβδομάδων σας. Θα πρέπει να στείλετε τα εκκαθαριστικά σημειώματα αποδοχών με τις υψηλότερες αποδοχές σας, όχι τις εβδομάδες στις οποίες πληρωνόσαστε αμοιβή αναρρωτικής άδειας (SSP).

Μπορείτε να ζητήσετε επίδομα μητρότητας εδώ: https://www.gov.uk/government/publications/maternity-allowance-claim-form. Μπορείτε να στείλετε τη αίτηση μόλις είστε 26 εβδομάδες έγκυος.

Σημείωση: εάν ο εργοδότης σας έχει στείλει όλους τους υπαλλήλους στο σπίτι επειδή δεν είναι σε θέση να εργαστούν κατά τη διάρκεια της πανδημίας, έχετε το δικαίωμα να πληρωθείτε το ίδιο με τους συναδέλφους σας. Προκειμένου να βοηθηθούν οι εργοδότες να διατηρήσουν τους εργαζομένους που είναι ανίκανοι να εργαστούν κατά τη διάρκεια της πανδημίας, η κυβέρνηση έχει χορηγήσει μια επιχορήγηση στους εργοδότες για να είναι σε θέση να συνεχίσουν να πληρώνουν σε όλους τους εργαζομένους το 80% των μισθών τους, μέχρι £2500 το μήνα.

Εάν ο εργοδότης σας συνεχίζει να σας καταβάλλει μόνο αποδοχές αναρρωτικής άδειας όταν οι συνάδελφοί σας πληρώνονται με πλήρεις αποδοχές ή το 80% των αποδοχών, αυτό μπορεί να θεωρηθεί παράνομη κατακράτηση μισθών ή/και διάκριση κατά της εγκυμοσύνης.

Περισσότερες πληροφορίες σχετικά με τη βοήθεια για τους εργοδότες είναι εδώ: 2. Μπορώ να παραμείνω σε αποδοχές αναρρωτικής άδειας (SSP) ή πληρωμένη άδεια furlough μέχρι να ξεκινήσω το επίδομα μητρότητας (MA);

Ναι, από εσάς εξαρτάται πότε θέλετε να ξεκινήσετε την άδεια αποδοχών μητρότητας και μπορείτε να παραμείνετε με αναρρωτική αμοιβή ή άδεια furlough μέχρι την έναρξη της άδειας μητρότητας. Το νωρίτερο που μπορείτε να ξεκινήσετε την άδεια μητρότητας είναι 11 εβδομάδες πριν από την ημερομηνία τοκετού. Το αργότερο που μπορείτε να ξεκινήσετε την άδεια μητρότητάς σας είναι η ημέρα τοκετού.

Εάν είστε σε αναρρωτική άδεια εξ ολοκλήρου ή εν μέρει λόγω της εγκυμοσύνης, ο εργοδότης σας μπορεί να ενεργοποιήσει την άδεια μητρότητάς σας κατά τις τελευταίες 4 εβδομάδες πριν από την αναμενόμενη εβδομάδα του τοκετού σας. Για παράδειγμα, μια αρρώστια που προέκυψε λόγω της εγκυμοσύνης, εάν η εργασία σας έχει ανασταλεί λόγω υγείας και ασφάλειας στον χώρο εργασίας ή αν έχετε βγεί σε άδεια furlough επειδή δεν μπορείτε να εργαστείτε κατά τη διάρκεια της εγκυμοσύνης.

Θα πρέπει να ενημερώσετε το Jobcentre Plus για την έναρξη της άδειας μητρότητας, ώστε να μπορούν να καταβάλλουν το επίδομα μητρότητας από την ημερομηνία αυτή. 3. Εάν είμαι εκτός εργασίας με αποδοχές αναρρωτικής άδειας (SSP), αυτό πληρεί τις προϋποθέσεις των 26 εβδομάδων απασχόλησης για το επίδομα μητρότητας (MA);

Ναι, κάθε εβδομάδα σε SSP μετρά ως εβδομάδα απασχόλησης. Για να δικαιούστε επίδομα μητρότητας πρέπει να εργάζεστε για τουλάχιστον 26 εβδομάδες από τις 66 εβδομάδες πριν από τη ημερομηνία τοκετού σας. Κάθε εβδομάδα κατά την οποία βρίσκεστε σε SSP θα εξακολουθεί να υπολογίζεται ως εβδομάδα απασχόλησης.

Επίσης οποιεσδήποτε εβδομάδες νόμιμης ετήσιας άδειας και άδειας furlough μετράνε ως εβδομάδες απασχόλησης καθώς επίσης και οποιεσδήποτε εβδομάδες ήσασταν σε άδεια μητρότητας απο προηγούμενη εγκυμοσύνη κατά την διάρκεια αυτών των 66 εβδομάδων.

Για να έχετε τη δυνατότητα επιδόματος μητρότητας, oι συνήθεις κανόνες ισχύουν κατά τη διάρκεια της πανδημίας. Για περισσότερες πληροφορίες σχετικά με τις αποδοχές μητρότητας βλέπε: 4. Είμαι σε άδεια furlough με αμοιβή του 80% των κανονικών αποδοχών μου. Αυτό θα επηρεάσει το επίδομα μητρότητας μου;

Εάν ξεκινάτε την άδεια μητρότητάς σας στις ή μετά τις 25 Απριλίου 2020, το Υπουργείο Εργασίας και Συντάξεων πρέπει να χρησιμοποιήσει τις συνήθεις αποδοχές σας κατά τον υπολογισμό του επιδόματος μητρότητας και όχι την αμοιβή κατα την άδεια furlough.

Εάν υποβάλλετε αίτηση για επίδομα μητρότητας, πρέπει να στείλετε τα εκκαθαριστικά σημειώματα μισθοδοσίας που καλύπτουν μια περίοδο 13 εβδομάδων από τις 66 εβδομάδες πριν από την ημερομηνία τοκετού σας. Θα πρέπει να στείλετε τα εκκαθαριστικά σημειώματα με τα υψηλότερα κέρδη σας. Εάν στείλετε εκκαθαριστικά σημειώματα που καλύπτουν την περίοδο όταν ήσασταν σε άδεια furlough θα πρέπει να ενημερώσετε το Τμήμα Αιτήσεων Επιδόματος Μητρότητας (MA), ώστε να μπορούν να χρησιμοποιήσουν τις συνήθεις αποδοχές σας στον υπολογισμό του επιδόματος μητρότητας.

Εάν έχετε ήδη ζητήσει επίδομα μητρότητας και έχετε στείλει εκκαθαριστικά σημειώματα για 13 εβδομάδες, συμπεριλαμβανομένων τυχόν εβδομάδων κατά τις οποίες λάβατε αποδοχές άδειας furlough, θα πρέπει να επικοινωνήσετε με το Τμήμα Αιτήσεων Επιδόματος Μητρότητας (MA) και να ζητήσετε τον επανυπολογισμό του επιδόματος μητρότητας για να συμπεριλάβουν τις αποδοχές που θα είχατε λάβει εάν δεν ήσασταν σε άδεια furlough.

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COVID maternity FAQs (Greek) - Maternity Action

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Οι αποδοχές μητρότητας (SMP) είναι £148,68 τη βδομάδα μέχρι τις 4 Απριλίου 2020 και από τις 5 Απριλίου 2020 αυξάνουν στις £151,20 τη βδομάδα (ή το 90% των μέσων αποδοχών σας, αν αυτό είναι λιγότερο).

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The Birth Trauma Association

Welcome to the Birth Trauma Association (BTA). We're a charity that supports women who suffer birth trauma - a shorthand term for post-traumatic stress disorder (PTSD) after birth.

In July 2022, during our Awareness Week, we are pleased to publish the results of a survey carried out jointly with Make Birth Better and the Australasian Birth Trauma Association (ABTA) into women's experience of receiving diagnosis and treatment of birth injuries, and how those injuries affected their daily lives. The results are a powerful testimony to the terrible impact birth injuries have on women, and how they are under-diagnosed or misdiagnosed by doctors. We found that 84% said that the injury had affected their confidence and self-esteem.

You can read the report in full here.

We have a team of peer supporters: women who have all experienced traumatic birth themselves and been through a process of recovery. If you'd like to talk to them over email about your experience, please contact them at This email address is being protected from spambots. You need JavaScript enabled to view it..

You can also join our Facebook group for parents with birth trauma: www.facebook.com/groups/TheBta

What is birth trauma?

About 30,000 women a year, according to the most recent research, experience birth trauma in the UK. Instead of being joyful and happy, the experience of giving birth has been frightening. Perhaps the baby's heartrate dipped, leading to an emergency caesarean section. Maybe you or your baby suffered injuries as the result of the birth. Or maybe you felt that you weren't well looked after in labour, or you weren't told what to expect.

If something like this has happened to you, you might have felt scared that you or the baby were going to die. As with any other traumatic experience - a car accident, or a sexual assault, or seeing a bomb explode - a traumatic birth can lead to symptoms of PTSD: flashbacks, a sense of heightened anxiety, constantly feeling on the alert, avoiding anything that reminds you of the trauma.

Birth trauma means that it can be difficult to bond with your baby. You may find your symptoms are triggered by reminders of the birth: pregnant women, other babies, programmes such as One Born Every Minute.

Witnessing someone else's trauma can also be traumatic, so partners can experience PTSD too.

In the video below, five women talk about their experience of birth trauma and how they found help.

Keep up to date with The Birth Trauma Association (BTA) on social media

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The Birth Trauma Association (BTA) supports all women who have had a traumatic birth experience. It is estimated that, in the UK alone, this may result in 10,000 women a year developing Post Traumatic Stress Disorder (PTSD)

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Coronavirus: 13 important facts for pregnant women

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Coronavirus: 13 important facts for pregnant women

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Which? 2 Apr 20

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Did you know, if your partner is depressed after the birth of your baby, then there's a 50% chance you will be too? [4]
When you become a dad, you undergo an incredible amount of change. There's a shift in your intimate relationship and your personal identity and you experience new emotions.

It can be demanding and overwhelming. And it can lead to paternal postpartum depression.

Below you will find a checklist which you can fill out and share with your healthcare provider. It will help you discuss your situation so you can determine if you need professional help.

Click on zoom icon below the checklist to enlarge the text, or click on the download arrow to download it and print out.

Paternal Postpartum Depression Checklist

Paternal postpartum depression is a real condition, and it's one that can be treated. If you're feeling sad, unconnected to your baby and partner or want to feel more on track with fatherhood, then read on to find out more about paternal postpartum depression, available treatment options, and how to seek help:

What is paternal postpartum depression?

Paternal postpartum depression is a form of depression that usually occurs in the first twelve months after the birth of your child.

It can happen during pregnancy too. For some fathers the pregnancy period can be more stressful than the postnatal period. [1,4]

Paternal postpartum depression is characterized by all of the usual signs of depression but takes into account the unique psychological experience of becoming a dad.

How common is paternal postpartum depression?

Depression is most likely to develop in parents during the first twelve months of the postpartum period. [3]

Approximately 10% of fathers experience postpartum depression [3,4,6], and some research has indicated that rates can be anywhere between 4-25% of new fathers. [4] That statistic jumps up to 50% of fathers experiencing depression if their partner has maternal postpartum depression. [4]

Children with two depressed parents are at a higher risk of future social, psychological and learning problems. [1,2,3]

A study of parents expecting their first child found 13.3% of fathers experienced increased depressive symptoms during the third trimester of pregnancy. These fathers were more likely to be older, unemployed, under financial strain and men who have suffered more stressful life events than fathers who were not depressed. [5]

It is important to note; the evidence does not indicate men are more likely to experience depression in the perinatal period than at other times of their lives. [8] Most fathers do not experience higher levels of psychological distress during their partner's pregnancy or the first twelve months of their child's life.

[10] According to the World Health Organization (WHO), there are 450 million people affected by mental illness globally. In the United States, 51.8% of women and 48.2% of men experience depression in their lifetime. [3]

Symptoms: How do I know if I have paternal postpartum depression? [13]

Perhaps fatherhood hasn't turned out how you'd envisioned and you find yourself feeling sad, irritable or helpless. [4]

You may feel detached from your family or excluded from the relationship your partner has with your baby.

Some dads say they feel like a bystander while the mother and baby bond. Pregnancy and early baby care can feel like 'women's business' and you may be encouraged to take a step back, making you feel like you're unimportant.

Not sure whether you're feeling depressed?

These are some of the symptoms

Low mood: crying, irritability, angry outbursts

Poor sleep (unrelated to infant sleep patterns)

Changes in appetite (overeating or undereating)

Low motivation

Thoughts of bringing harm to self, partner or baby [4]

Other warning signs

Anxiety (feeling worried) [4]

A sense of helplessness or guilt [4]

Difficulties concentrating or making decisions at work [3]

Destructive health behaviors such as increased consumption of alcohol or cigarettes [5]

Research shows that depressed fathers are more likely to:

Spend less time reading and singing to baby [3]

Engage in less physical play with child [2]

Smack/spank their child than non-depressed fathers [3]

What makes me at risk of paternal postpartum depression? [6]

The three main predictors of paternal postpartum depression are:

1. Previous experience of depression or anxiety at another time in your life [3]

2. Your partner has maternal depression [3,5]

3. You were depressed during the antenatal period [3]

Paternal postpartum depression is also associated with: [3]

Low levels of satisfaction in your relationship

Unemployment

Older age

Financial stress

Stressful life event in the past six months

Feeling like fatherhood wasn't what you expected

Lack of social support

Poor communication between parents

Not feeling a bond with baby

Feeling excluded from mother-infant bond

Unplanned/ unwanted pregnancy [8]

Labor complications [8]

Being born in a foreign country [6]

Having 3 or more children [6]

Poor sleep quality in the antenatal period [5]

What are some of the factors that protect fathers during pregnancy from developing postpartum depression? [3]

Good social support in pregnancy

Antenatal education

Sharing experiences with other expectant fathers

What causes paternal postpartum depression?

[3] Many parents believe postpartum depression in women is mostly biological.

While biology does play a role in why some women experience depression, it only reflects one area that impacts the significant emotional changes experienced by women in the perinatal period. There is a psychological and social component too.

These days many men are expected to be more hands-on in their infant's life but also to maintain the traditional role as breadwinner. Long work hours can result in less time with the baby. This can place an immense pressure on dads who feel torn between spending time with their infant, supporting their partner, meeting employer demands and paying the bills. [4]

This is why postpartum depression is not unique to women who give birth; men also undergo their own psychosocial transformation.

Biological

Some people are more prone to depression due to genetic factors (family history of mental health issues), or due to a dependence on alcohol or drugs.

Organic conditions such as thyroid problems can also affect mood.

Social factors such as financial strain, a depressed partner, unhappy relationship and poor social networks can contribute to the stress that may lead to depression.

Psychological

The general way in which you cope with stress can influence the development of depression.

If you're someone who keeps your feelings to yourself and turns away from people when you feel stressed (as opposed to turning to them for support), then you may be more likely to develop depression.

Other factors include negative thinking style, low self-esteem, and perfectionistic traits.

How can I assess if I have paternal postpartum depression? [6]

The Edinburgh Postnatal Depression Scale (EPDS) is a screening tool consisting of ten questions, primarily used to identify symptoms of anxiety and depression in women during the perinatal period. [11,12]

The screening tool has been considered useful in English-speaking fathers with a cut-off score of 10. [1,5]

If you're concerned about how you're currently feeling as a new father, I'd recommend completing the EPDS.

You can complete the EPDS and have it scored online here: https://psychology-tools.com/epds/

If you score 10 or more, it could be a sign you are currently experiencing anxiety or depression, and you should see a healthcare professional. If you score above 0 on question ten (thoughts of harming self or someone else), then you should see your General Practitioner (GP) immediately.

How does paternal depression affect my relationship with my baby?

Fathers have a unique contribution to the lives of their children. Even if you don't feel important to your child, you certainly are and here's why:

Babies as young as eight weeks old know the difference between their mothers and fathers and respond differently to each. Babies and children do appreciate differences in play, verbal communication and physical contact between their fathers and mothers. [9]
Research has shown that the more fathers participate in infant care (feeding, bathing and changing nappies), the more social their babies were, and at twelve months of age they were more resilient and coped better with stressful situations. [9]
Through fathering, babies learn about transitions, separations and love in a way that's different than maternal love. In fact, fathers play such a crucial role in these areas that often toddlers show a preference for their fathers as they develop autonomy and separation from their mother. [9]

These are just some of the reasons why your child benefits from a relationship with you. This unique relationship fosters positive emotional development in a child. However, when a father is depressed, it has the opposite effect.
Children of depressed fathers are more likely to develop problems managing their emotions and hyperactivity. This is especially the case in boys. [1,2,3]
This information isn't designed to make you feel guilty, it's simply making the point that dads count too. You are a prominent figure in your child and partner's life, and you mustn't hold back on asking for help.

How can I cope better as a father?

There are many ways you can manage depression. Here are some suggestions:

Increase your support: Talk to your partner, friends or co-workers

Spend quality time with your baby: Get more hands-on and involved. It's okay if your baby cries for their mother. If you stick it out, your baby will eventually learn to feel secure and trust you.

Talk to other fathers: Join a father's group or an online community where you can feel understood and supported during this big change in your life

Seek professional help: Speak to your General Practitioner (GP) or a psychologist.

When should I seek professional help?

Often fathers don't know where to look for resources on depression in the postpartum period. Much of the information is geared towards women and mothers. [3] Paternal depression just isn't talked about, so it can be difficult for men to reach out to social support and healthcare professionals.

If you have undertaken the EPDS and scored 10 or above, if you just don't feel 'yourself,' are concerned about your negative thought patterns, are feeling disconnected from your partner and baby, or are having suicidal thoughts, then it is highly recommended you seek professional help.

Sometimes it can be hard to seek help simply because you feel low in energy and motivation, or because you feel worried about being judged, but health professionals are trained to assess your situation and offer appropriate treatment options.

The first step in accessing professional help should be discussing how you feel with your GP.

What treatment options are available?

As with any form of depression, paternal postpartum depression is a treatable condition. If it is a severe form of depression, then medication may be recommended, however many women and men who have postpartum depression benefit from counseling and other types of help too.

Counseling

A qualified psychologist or mental health clinician provide you with a non-judgmental space to discuss how you are feeling, utilize specific interventions to address the symptoms and support you to engage in healthy behaviors.

Sometimes talking to someone outside of your family or social network can be just what you need to honestly get to the bottom of how you feel.

Medication

In some cases, anti-depressants or anti-anxiety medications are required to treat depression. You can discuss with your GP what options will be the most appropriate for you. Medication is most effective when you also engage in a psychological intervention, such as counseling.

Support groups/ parent education programs

Anxiety levels have been shown to decrease as a father's confidence in infant care increases. Try to access more information about pregnancy, birth and caring for a child through the perinatal services your partner has access to. If you're an expectant father, attend antenatal classes and meet with other dads-to-be.

There is a range of books and online therapy programs that can support you to overcome depression.

Postpartum depression in fathers is a common condition, and it is treatable.

Expectant and new fathers undergo psychological, emotional and identity change. Fatherhood can be motivating and rewarding, but it can also be demanding and overwhelming. During this time of immense transformation, some fathers develop anxiety and depression. If you are one of these dads, then remember, you are not alone. Paternal postpartum depression is common among new fathers, and there is support available.

As a father you play a significant role in your child's life and if you are depressed then it can impact their development. It's worth seeking help as soon as you can, for yourself and for your family.
References
1. Fletcher, R.J., Matthey, S., and Marley, C.G. (2006). Addressing depression and anxiety among new fathers. Medical Journal of Australia. 185(8), 461-463.

2. Fletcher, R., Feeman, E., Garfield, C., and Vimpani, G. (2011). The effects of early paternal depression on children's development. The Medical Journal of Australia. 195(11/12), 685-689).

3. Edward, K.L., Castle, D., Mills., C., Davis., and Casey, J. (2015). An integrative review of paternal depression. American Journal of Men's Health. 9(1) 26-34.

4. Kumar, S.V., Oliffe, J.L., and Kelly, M.T. (2018). Promoting postpartum mental health in fathers: Recommendations for nurse practitioners. American Journal of Men's Health. 12(2), 221-228.

5. Da Costa, D., Zelkowitz, P., Dasgupta, K., Sewitch, M., Lowensteyn, I., Cruz, R., Hennegan, K., and Khalife, S. (2017). Dads get sad too: Depressive symptoms and associated factors in expectant first-time fathers. American Journal of Men's Health. 11(5), 1376- 1384.

6. Carlberg, M., Edhborg, M., and Lindberg, L. (2018). Paternal perinatal depression assessed by the Edinburgh Postnatal Depression Scale and the Gotland Male Depression Scale: Prevalence and possible risk factors. American Journal of Men's Health.

7. Isacco, A., Hofscher, M.A., and Molloy, S. (2016). An examination of fathers' mental health help-seeking: A brief report. American Journal of Men's Health. 10(6), N33-N38. Retrieved from: https://journals.sagepub.com/doi/full/10.1177/1557988315581395

8. Leach, L., Poyser, C., Olesen, S., Mackinnon, A., & Fairweather-Schmidt, K. (2014). The impact of pregnancy and early fatherhood on Australian men's mental health. Centre for Research on Ageing, Health and Wellbeing: The Australian National University.

9. Pruett, K.D. (1997). How men and children affect each other's development. Zero to Three.

10. World Health Organization. (2011). Depression.

11. Cox, J.L., Holden, J.M., and Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry. 150,782-786.

12. K. L. Wisner, B. L. Parry, and Piontek, C.M (2002). Post-partum Depression. The New England Journal of Medicine. 347(3), 194-199.

13. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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Did you know, if your partner is depressed after the birth of your baby, then there's a 50% chance you will be too? [4] When you become a dad, you undergo an incredible amount of change. There's a shift in your intimate relationship and your personal identity and you experience new emotions.

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For all sorts of reasons, it might take a while to get back to your old sex life after having a baby. One study found that more than half of couples had started to have sex by eight weeks after birth, and more than three quarters of couples by 12 weeks (McDonald and Brown, 2013). Yet for many couples, it's closer to 12 months after their baby's birth that they're having sex as frequently as before the birth (Jawed-Wessel and Sevick, 2017).

So here are a few questions you could ask yourself to see whether you're ready to make that move...

1. Do I feel emotionally ready for sex?

This is pretty important. The timing is very much up to you. And it is common for new parents to find that tiredness and the responsibility of caring for a new baby mean they have less interest in sex.

A decline in sexual interest after the birth of a baby can be related to the drop in oestrogen that new mums experience (Hendrick et al, 1998). In fact, one study suggests this is a way of ensuring new mums do not become pregnant while caring for a new baby (Lorenz et al, 2019).

2. Am I worried that my partner wants to have sex?

If you aren't ready but your partner is, reassure them that you're not pushing them away. This is just a temporary situation while you get your head around the demands of a small human. It can take time for your body to recover from the birth.

Your partner's moves over to your side of the bed are likely because they still love and fancy you and want you to know it. But you should never feel under pressure to do anything you are not 100% ready for.

It might sound like a cliché but communication and a mutual understanding of each other's needs can help keep a loving relationship alive. You might also want to remind your partner that your focus on your baby doesn't take away from your love for them. That you're not pushing them away.

"There's no right or wrong time to start having sex again after you have had a baby. Don't rush into it. If sex hurts, it won't be pleasurable." (NHS, 2018a)

Sex is more likely if you make time to relax together. You're more likely to make love when your minds are on each other, rather than other things (NHS, 2018b).

3. Am I worried about my body?

If you gave birth, you might be thinking 'Will it feel different?' Worries around discomfort or becoming pregnant again are normal.

You might start by gently exploring your vagina to discover whether there is any pain or change (NHS, 2018b). You could then discuss the changes to your body with your partner and how you want to be touched.

Dryness might contribute to sex being painful, and lower oestrogen levels until your periods restart after childbirth are partly to blame (NHS, 2018a). But probably the most important reason for dryness is that you're exhausted and adapting to your post-birth body, so you're not sexually aroused enough to produce lubrication. You could use a lubricant and make sure you are fully aroused before sexual activity, and begin with oral or mutual masturbation (NHS, 2018b).

You could also grab a chat with your health visitor or GP to go through your questions about post-baby sex. If you experience any pain, see your GP (NHS, 2018a).

4. Am I rushing into post-baby sex because I'm worried I'll lose closeness with my partner?

If that's the case, there are plenty of other ways to maintain that bond. With everything from cuddling up in front of a film to doing anything else you fancy in bed that doesn't involve penetration.

5. How will the type of birth I had affect sex?

The type of birth you had can affect your feelings about sex (McDonald and Brown, 2013).

If you had an uncomplicated vaginal birth, you might feel tired, bruised or have some grazing that may sting, so you may want to take it gently. Your health visitor will probably check in with you about pain or difficulties around sex about two to six weeks after the birth (NICE, 2021a). If you have had stitches in your perineum after the birth, you may feel anxious about discomfort and perhaps find that sensation is different (NHS, 2020a).

If you had a caesarean section, you can resume sex whenever you feel fully recovered from the birth (NICE, 2021b). If your scar is still sensitive, you could explore positions that don't put pressure on it.

6. Will my tear or cut (episiotomy) affect sex?

Let yourself recover first. Your stitches should dissolve after 10 days and by two weeks you should feel like you're healing well. But it can take up to a month to heal (NHS, 2020a). For third and fourth degree tears, wait until you've stopped bleeding and your tear has healed before having sex again (RCOG, 2015).

With stitching, when you're ready to have sex again, you'll want to take things slowly and gently. You could try positions that limit penetration or reduce the pressure on the stitched area. If sex is painful or difficult when you do try, speak to your GP.

7. Will how I am feeding my baby affect sex?

This may seem unrelated but actually, if you're breastfeeding, hormones can cause vaginal dryness and a dip in libido (Riordan, 2005). See our Breastfeeding and sex article for more details.

Your breasts may be less of an erogenous zone than they used to be and you may find that the oxytocin released during breastfeeding means you crave affection less elsewhere. On the other hand, as our bodies are never simple, you may find that breastfeeding actually increases your arousal levels.

Some women feel 'all touched out' by the intensity of being constantly on demand as a parent. This isn't a reason to stop feeding, but might mean you just don't feel like having sex.

8. Have I thought about contraception?

Very important information: you can get pregnant soon after the birth of your baby. This can happen even if you are breastfeeding and your periods haven't reappeared. So make sure you look into your options for contraception and discuss it with your health visitor, midwife, GP or contraception clinic (NHS, 2020b).

9. Am I putting it off as I'm worrying about my baby being in the room?

Such a common one, trust us. Yet your baby won't understand what's going on. Your noises are completely familiar to them from their time in your womb and hearing them from outside will not upset them. Plus they won't care what you're up to.

Just be careful if your baby is in the bed with you or move them into their cot. You might also want to choose a time when your baby is less likely to interrupt things, like after a feed.

10. Am I ready to talk honestly with my partner?

If sex hurts, say it. If you need your partner to be gentler, say it. If you need extra foreplay, say it. If you need to nip to the chemist and buy some lube, say it. If you just want to chill out in front of the TV, say it. See a GP and say it to them if something doesn't feel right.

Further information

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

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

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

Hendrick V, Altshuler LL, Suri R. (1998) Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics. 39(2):93-101. Available at: https://www.sciencedirect.com/science/article/pii/S0033318298713556 [Accessed 9th December 2021].

Jawed-Wessel S, Sevick E. (2017) The impact of pregnancy and childbirth on sexual behaviors: A systematic review. J Sex Res. 54(4-5):411-423. http://www.tandfonline.com/doi/abs/10.1080/00224499.2016.1274715 [Accessed 9th December 2021].

Lorenz T, Ramsdell EL, Brock RL. (2019) A close and supportive interparental bond during pregnancy predicts greater decline in sexual activity from pregnancy to postpartum: applying an evolutionary perspective. Front Psychol. 10:2974. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966960/ [Accessed 9th December 2021].

McDonald EA, Brown SJ. (2013) Does method of birth make a difference to when women resume sex after childbirth? BJOG. 120(7):823-830. Available from: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12166/full [Accessed 9th December 2021].

NICE. (2021a) Postnatal care [NG194]. Available at: https://www.nice.org.uk/guidance/ng194 [Accessed 9th December 2021].

NICE. (2021b) Caesarean birth [NG192]. Available at: https://www.nice.org.uk/guidance/ng192 [Accessed 9th December 2021].

NHS. (2018a) Vaginal changes after childbirth. Available from: https://www.nhs.uk/Livewell/vagina-health/Pages/vagina-after-childbirth.aspx [Accessed 9th December 2021].

NHS. (2018b) Sex and contraception after birth. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/sex-contraception-after-birth/ [Accessed 9th December 2021].

NHS. (2020a) Episiotomy and perineal tears. Available from: https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/episiotomy-and-perineal-tears/ [Accessed 9th December 2021].

NHS. (2020b) When can I use contraception after having a baby? Available from: https://www.nhs.uk/conditions/contraception/when-contraception-after-baby/ [Accessed 9th December 2021].

Riordan J. (2005) Breastfeeding and human lactation. Sudbury, MA: Jones & Bartlett Publishing

RCOG. (2015) A third- or fourth-degree tear during birth (also known as obstetric anal sphincter injury- OASI. Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf [Accessed 9th December 2021].

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Sex after a baby: 10 questions to ask yourself | Life as a parent articles & support | NCT

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For all sorts of reasons, it might take a while to get back to your old sex life after having a baby. One study found that more than half of couples had started to have sex by eight weeks after birth, and more than three quarters of couples by 12 weeks (McDonald and Brown, 2013).

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Gay and lesbian step-parents are becoming more common in the UK and non-traditional families are no longer a taboo. However, step-parenting is very challenging, while being gay or lesbian makes it even more challenging.

Resentful Ex-Spouses

Gay and lesbian parents who have come from a heterosexual relationship often face resentful ex-spouses or partners who may use their sexual orientation against them in court and custody arrangements. It also isn't unusual for them to try to influence the extended family and family friends, and even children. Not only does this increase the tension and stress for everyone involved, especially for children but it can also seriously jeopardise the parent-child relationship and the newly attached same-sex couple.

Unfortunately, there are no guidelines to follow when ending a heterosexual relationship and entering same-sex relationship. But all who went through the process stress the importance of communication, honesty and openness with everyone involved and above all, with ex-partners and children.

Non-Accepting Children

Children react to breakups and divorces highly emotionally. Feelings of sadness, anger and fear are nearly universal to all children, especially if the ex-partners kept their differences aside in front of their kids. But for children of gay and lesbian parents, there is another reality they need to accept - their parent's sexual orientation which can make them even more confused. Again, communication, honesty and openness are crucial to help children understand what has happened, what is sexual orientation and what it isn't as well as how it can affect their lives. And yes, they should also be warned about potential negative comments from their schoolmates and even adults.

Older kids are usually expected to accept a gay or lesbian step-parent sooner and more easily but it is actually just the opposite. They often refuse to accept their gay or lesbian step-parent and may even develop negative feelings towards their biological parent. This, however, is not unusual for heterosexual relationships either. Kids often worry that the new partner will "steal" their parent away from them and in case of homosexual relationships, they may worry that they will also become homosexual. Therefore it is of key importance to be understanding and above all, patient as it is not easy for kids to accept that mum and dad are no longer together and that there is a new person in their parent's and their life.

Not Coming Out?

Given that coming out can complicate many lives, some gay and lesbian parents decide not to live together with their partners and present them to their kids as friends. Not coming out, however, often takes a toll on the relationship between the partners, while the children cannot benefit from having two parents taking care of them.

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Gay and lesbian step-parents are becoming more common in the UK and non-traditional families are no longer a taboo. However, step-parenting is very challenging, while being gay or lesbian makes it even more challenging. Gay and lesbian parents who have come from a heterosexual relationship often face resentful ex-spouses or partners who may use their sexual orientation against them in court and custody arrangements.

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Updated 15 March 2022.

Pregnant women do not seem to be at higher risk of getting SARS-CoV-2, the virus that causes COVID-19. However, studies have shown an increased risk of developing severe COVID-19 if they are infected, compared with non-pregnant women of a similar age. COVID-19 during pregnancy has also been associated with an increased likelihood of preterm birth.

Pregnant women who are older, overweight or have pre-existing medical conditions such as hypertension (high blood pressure) and diabetes are at particular risk of serious outcomes of COVID-19.

It is important that pregnant women - and those around them - take precautions to protect themselves against COVID-19. If they become unwell (including with fever, cough or difficulty breathing), they should seek urgent medical advice from a health worker.

Pregnant women should take the same precautions to avoid COVID-19 infection as other people. Measures to protect yourself - and those around you - include:

getting vaccinated;

keeping space between yourself and other people, and avoiding crowded spaces;

keeping rooms well ventilated;

wearing a mask where it is not possible to keep sufficient physical distance from others;

washing your hands frequently with an alcohol-based hand rub or soap and water; and

practicing respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

If you have fever, cough or difficulty breathing, seek medical care early. Call before going to a health facility and follow the directions of your local health authority.

Pregnant women and women who have recently delivered should attend their routine care appointments according to local policies and following adapted measures to reduce possible transmission of the virus.

Testing protocols and eligibility during pregnancy vary depending on where you live.

However, WHO recommendations are that pregnant women with symptoms of COVID-19 should be prioritized for testing. If they have COVID-19, they may need specialized care.

Transmission of the virus while your baby is in the womb or during birth is possible, but very rare. Most babies won't develop COVID-19 disease, and those who develop symptoms tend to recover quickly.

Babies can be infected after birth, so if you do get COVID-19, it is important for you and other caregivers to take all precautions to reduce the risks of passing the virus to the baby.

Babies can be placed skin-to-skin and breastfed if the mother is confirmed or suspected to have COVID-19. The numerous benefits of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.

All pregnant and postpartum women and their newborns, including those with confirmed or suspected COVID-19 infections, have the right to high quality care before, during and after childbirth, including mental health care.

A safe and positive childbirth experience includes:

being treated with respect and dignity

having a companion of choice present during delivery

clear communication by maternity staff

appropriate pain relief strategies

mobility in labour where possible, and birth position of choice.

If COVID-19 is suspected or confirmed, health workers should take all appropriate precautions to reduce risks of infection to themselves and others, including hand hygiene and appropriate use of protective clothing like gloves, gown and medical mask.

No. WHO advice is that caesarean sections should only be performed when medically justified.

The mode of birth should be individualized and based on a woman's preferences alongside obstetric indications.

Yes. Close contact and early, exclusive breastfeeding helps a baby to thrive. You should be supported to

breastfeed safely, with good respiratory hygiene

hold your newborn skin-to-skin

share a room with your baby.

Yes, pregnant women can be vaccinated against COVID-19.

COVID-19 vaccines offer strong protection against severe illness, hospitalization and death from COVID-19. Vaccination during pregnancy is important whenever there is risk of the disease, but especially for frontline health workers, people living in areas where there is high community transmission, and those with health conditions like hypertension (high blood pressure) and diabetes that add to risk of severe disease.

Some evidence also suggests that babies may receive protective benefits from the vaccine, in addition to the benefits for pregnant women.

Pregnant women in many countries around the world have now received COVID-19 vaccines, and no safety concerns have been identified related to their pregnancies or the health of their babies. None of the COVID-19 vaccines authorized to date use live viruses, which are more likely to pose risks during pregnancy.

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Coronavirus disease (COVID-19): Pregnancy, childbirth and the postnatal period

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Updated 15 March 2022. Pregnant women do not seem to be at higher risk of getting SARS-CoV-2, the virus that causes COVID-19. However, studies have shown an increased risk of developing severe COVID-19 if they are infected, compared with non-pregnant women of a similar age.

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Glossop & District Branch

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Whistlestop Wednesday Changes

The time of the session had now changed and is 10am to 12pm!

Also we have added another ticket type.

You can now get a ticket for yourself, a child and juice and sandwich for the little one! Only £4!!!
NCT TV
Our Bumps and Babies groups are back! Check out our NCT Glossop Bumps and Babies Facebook page for up to date information.

Find us over on Facebook and our fun interactive group NCT TV

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Working with the community
NCT Glossop are sponsored by...
Thank you Tesco for yet again supporting us by donating refreshments for our Bumps and Babies sessions.

We rely solely on donations to pay the running costs and maintain/replace equipment at our local groups, so every little really does help!

Join our Mailing List!

If you would like to be kept up to date about all of our upcoming courses, events & news please Click here to subscribe to our newsletter.

Branch coordinators

Contact details

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Glossop and district | Local activities & meet-ups | NCT

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Whistlestop Wednesday Changes The time of the session had now changed and is 10am to 12pm! Also we have added another ticket type. You can now get a ticket for yourself, a child and juice and sandwich for the little one! Only £4!!! NCT TV Our Bumps and Babies groups are back!

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How are you Dad - raising awareness around mental ill-health in new fathers

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The experts behind MotherToBaby have created fact sheets that answer frequently asked questions about exposures during pregnancy and breastfeeding. MotherToBaby Fact Sheets are available in both English and Spanish and can be downloaded for free. Currently available fact sheets are listed below by category of exposure. All medications are listed by generic name.

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Within the UK there are a number of childcare options. Here we discuss the different options to help you make a decision on your childcare search that perfectly suits you and your family.

Childcare options

Childminders

Registered with Ofsted (in England), the Care Inspectorate (in Scotland) and Care and Social Services Inspectorate Wales (CSSIW). Childminders are self-employed and usually take care of children within their own home

Children's centres

Children's centres began as a major part of the 'Sure Start' programme targeting child poverty. Now under local authority control, children's centres aim to be a 'one-stop-shop' for families and will have facilities to support early education, childcare, health, family support and help into employment (for parents and carers). Childcare facilities vary between centres - while some may offer nursery facilities, many don't.

Day nurseries

Day nurseries offer care for children from birth to four or five years old. The number of children attending may vary from nursery to nursery. There are different types of nurseries including private, community, local authority and workplace nurseries.

Pre-school playgroups

Less formal than nurseries, these groups operate for a few hours each day only and do not provide full-time care. They tend to be run by private individuals or charities. Parents may be asked to volunteer their support for certain periods.

Crèches

Crèches will provide 'occasional care' for children and are provided on particular premises. Parents will use them on an irregular basis i.e. when they go to the gym or if they're shopping.

Nannies

A nanny is someone who is typically paid to look after a child (or children) in the home of the child. They can either live-in or live-out, depending on their arrangement with the family.

Au pair

These are generally students from outside the UK, who are here to study and improve their English. They must also be provided with a bedroom, meals and pocket money.

Informal childcare

A family member, often a grandparent, may agree to take on some of the childcare. Frequently this is part-time, for example one to two days per week, or after the hours of formal childcare.

Questions to consider

While trying to decide which method of childcare would be most suitable for your family - you may want to ask yourself a number of questions beforehand and these include:

Would you rather the childcare take place in your own home or outside it?

If outside it, how far are you able to travel each morning?

Would it be easier to arrange the childcare nearer to home or work?

If you are delayed at work, do you have a back-up plan in place?

What would happen if you are ill? If the child is ill? If a childminder is ill?

What happens during your own or a childminder's holidays?

If there was an emergency would you be able to get to your child quickly?

Will your chosen method of childcare qualify for financial help with childcare costs: working tax credit or childcare vouchers?

If you ask a family member to help out, will they have to reduce their working hours to fit in with yours? Although this may initially look like a 'cheaper' option, you will not be given any financial assistance and may be expected to pay for necessary equipment e.g. car seats, stair gates etc. Will they provide care in your home or theirs? You will need to think about illness and holidays too.

Is there a clear fee structure? Will this include meals, snacks, nappies and days out?

Do they have a notice period if you wish to change childcare?

In addition, depending on the childcare you choose, it's worth considering:

How is discipline enforced? How is positive behaviour reinforced? How is negative behaviour discouraged?

Does the carer have extensive experience of working with babies or children of a similar age to your child?

How qualified are the staff?

What is the staff turnover?

What is the ratio of carer to children? For children aged two years and under, it should be no less than one adult to three children.

Has your carer completed a course in baby first aid?

How frequently are environmental risks assessed?

What are the sleeping arrangements and how are they monitored?

How will you be kept informed on your baby's progress?

If/when a childminder takes the children outside for a walk, to the park, etc, how does she/he ensure safety of them all?

A big factor in deciding on childcare will, of course, also be costs. Why not use the cost of childcare calculator here to estimate how much you might spend on different options?

Holidays and sick days

It would also be helpful to think about holidays and whether your choice of childcare is available all year round.

Is your childcare flexible? Do you need it to be?

Will your child be taken care of if your working day overruns?

Will you be penalised if you take your child out to go on holiday?

Will the chosen method of childcare be offered all year round?

Would you be expected to co-ordinate your holidays with your childminder?

If your baby is sick, what arrangements do you have in place?

If the childminder is sick what will happen?

Choosing the right childcare for you and your children will need some time and attention. It's definitely worth thinking through all of your options to make sure you make the best choice for your family.

Further information

Our support line offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.

Make friends with other parents-to-be and new parents in your local area and see what N CT activities are happening nearby.

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.

Childcare must be registered with Ofsted (England), the Care Inspectorate Scotland and the Care and Social Services Inspectorate Wales (CSSIW).

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Childcare options | Life as a parent, Work and childcare articles & support | NCT

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Within the UK there are a number of childcare options. Here we discuss the different options to help you make a decision on your childcare search that perfectly suits you and your family. Registered with Ofsted (in England), the Care Inspectorate (in Scotland) and Care and Social Services Inspectorate Wales (CSSIW).

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Analytical Armadillo: Before You Try Infacol, Try This Blog...  Colic remedies?

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Analytical Armadillo: Before You Try Infacol, Try This Blog...  Colic remedies?

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According to their webpage Infacol is:

"Clinically proven to significantly reduce the frequency and severity of crying attacks associated with colic."

Music to the ears of any new parent with a distressed bundle right? It seems so as their site claims they are "Britain's number 1 infant colic remedy"!
I'm guessing that's pretty profitable, heck they even provide a phone app to help you identify if your baby has "colic".

Now perhaps I'm naive, but as colic is only defined as frequent persistent periods of unexplained crying (often in the evening), I'm pretty sure that parents know whether this is happening without an app to tell them?

It seems others agree as two reviewers wrote:

"Easy to use, navigate and understand but felt too engineered to get you to the end and say 'Use Infacol!'"

"It basically tells you what you already know and then says buy infacol."

Shock horror.

For those who aren't familiar the active ingredient in Infacol is Simethicone; and it's not just colic Infacol claims to work for:

"Unfortunately, wind can sometimes get trapped which can cause your baby discomfort. Infacol can gently help to bring up wind as its active ingredient- simeticone- helps the little trapped gas bubbles join into bigger bubbles which your baby can easily bring up as wind. - helping to relieve the pain. Infacol can be used from birth onwards, unlike gripe waters, which can only be given to babies 1 month old and over"

Wow wind and colic right, and suitable from birth.

Perhaps this is why so many doctors, midwives and health visitors prescribe or recommend parents try it? And given how many do, it must be pretty solid "clinically proven" evidence right?

Er no.

A BMJ paper published in 2007 reviewing treatment of colic examined the evidence :

"One poor-quality randomised controlled trial (RCT) found limited evidence that simethicone reduced the number of crying attacks on days 4-7 of treatment compared with placebo."

By poor quality the BMJ clarify that there were only 26 infants aged 1-12 weeks in the study and no reported details on how cases of colic were defined.

Oh that's disappointing. But surely GP's and all these other health professionals aren't suggesting or prescribing infacol on the basis of a "poor quality" small study of 26 babies? A study that doesn't define nor claim to ease colic, but refers to "crying attacks" which could potentially have any cause or be of any frequency?

The BMJ discuss two other trials that do define colic, perhaps these are more compelling.

First is a double-blind, crossover of 83 infants aged 2-8 weeks, comparing 0.3 mL of simethicone versus placebo for a week before feeds.

"It found no significant difference in colic (using the standard colic definition), when rated by carers, between simethicone and placebo (28% improved with simethicone v 37% with placebo v 20% with simethicone plus placebo.)"

So a study three times the size of the first, found Infacol was actually 9% LESS effective than a placebo at helping colic?

Let's try again.

The second study (double-blind, crossover trial, 27 infants aged 2-8 weeks) found no significant difference between simethicone and placebo (10 drops before meals, duration of treatment 24 hours) in improvement as rated by parental interview, 24-hour diary, or behavioural observation.

In fact the BMJ conclude:

"Further trials are not considered to be of clinical importance and are unlikely to be undertaken. According to the available evidence, there is no reason to use simethicone in the treatment of infantile colic."

"This medicine helps relieve griping pains and colic in babies and infants which may be caused by swallowing air."

Does it NHS? Says who? Infacol themselves with their "clinically proven" claims? The BMJ disagrees!

What about reasons not to?

Let's look at the other ingredients in Infacol besides Simethicone.

Purified Water

Hypromellose

Orange Flavour

Saccharin Sodium

Methyl Hydroxybenzoate (E218)

Propyl Hydroxybenzoate (E216)

Obviously these ingredients have been approved for use in this product, but when weighing up whether to use or take a medicine, we typically consider the benefits that can be obtained, versus any risks or downsides.
The literature surrounding infacol states that Simethicone is not absorbed into the body and thus is unlikely to cause harm (although some parents do report perceived side effects and some more here), but some do warn that Methyl and propyl hydroxybenzoates (E218, E216) may cause allergic reactions (possibly delayed)

Furthermore E216 and E218 are parabens considered controversial by some and even taking this out of the equation, has anyone considered the potential the impact to the baby's gut flora of putting a product containing fungicide, combined with artificial sweetener and a dollop of orange flavour in his digestive system several times per day for weeks at a time?

All for something that evidence suggests doesn't work?

What's also interesting is that there is a mounting body of evidence that probiotics may be an effective tool in reducing infant crying, including a trial that directly compared them to Simethicone:

"Eighty-three infants completed the trial: 41 in the probiotic group and 42 in the simethicone group. The infants were similar regarding gestational age, birth weight, gender, and crying time at baseline.
On day 28, 39 patients (95%) were responders in the probiotic group and 3 patients (7%) were responders in the simethicone group.

And it's not an isolated study, a second study highlights effectiveness of probiotics for colic here and a third here.

So why then aren't GP's, health visitors and midwives prescribing and recommending them instead of something seemingly no more effective than a placebo?

Like Calpol, it seems to me Infacol has just via clever marketing become recognised as a default turn to product for many parents. But as the antibiotic popping for every ailment generation age, more parents are becoming aware of the implications of what we put into our bodies, more cynical about marketing and more holistic (and thus less keen to simply medicate symptoms without looking for a cause). Perhaps gradually we will see a change.

1. Effectiveness of treatments for infantile colic: systematic review, BMJ 1998;316:1563

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Before You Try Infacol, Try This Blog...

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According to their webpage Infacol is: "Clinically proven to significantly reduce the frequency and severity of crying attacks associated with colic." Music to the ears of any new parent with a distressed bundle right? It seems so as their site claims they are "Britain's number 1 infant colic remedy"!

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Breastfeeding Twins - Association of Breastfeeding Mothers

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Breastfeeding Twins - Association of Breastfeeding Mothers

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs. With two babies, more milk is removed from the breasts, so more milk is made. The best way to make sure you establish a good supply is to feed your babies often in the early weeks and to ask someone knowledgeable to help you check that they are attached and breastfeeding correctly.

During the first few days and weeks, babies send signals to your milk supply and may sometimes feed more frequently. This frequent feeding is sometimes perceived as a sign of a lack of milk but, if feeds happen responsively, milk supply will swiftly increase, and feeding will settle into a pattern again. Your babies' weight gain and their nappies will reassure you that they are getting the milk they need.

"I found out at an antenatal scan that I was expecting twins. I asked if I could breastfeed them and was told that I would have to give bottles as well. This upset me as I'd really enjoyed breastfeeding my other two children. The twins were born at 36 weeks (though I nearly had them earlier than that). They never had bottles. I'm glad I found out in advance that it's possible to breastfeed twins."
How can I breastfeed two babies?
Confidence and the belief that it can be done are important. Attend a breastfeeding support group or workshop while you're pregnant to increase your confidence and find out where to get support locally. If you have any questions after your babies are born, you'll know who to ask. Perhaps you can be put in touch with someone who has breastfed twins (or see the Facebook group mentioned below).

"The twins were our first children and I thought I'd like to try to breastfeed. I read a little and a friend invited me to watch her breastfeed her baby. Most of the mums I met at a twins' club hadn't tried, but I decided to give it a go. Our babies were born at 37 weeks after a straightforward labour and the hospital staff were generally encouraging. I wish I'd known a bit more about growth spurts though and how to let the babies increase my milk supply at these times. I also wish I had known about antenatal hand expressing."

Twins can be fed separately or together. Many mums find that they do both in different situations and when their twins are at different stages of development. Feeding babies together can be a good way to establish a plentiful milk supply quickly and can save time. While mum and each baby are still learning about breastfeeding, it may be easier to spend some time feeding separately. As the babies grow and their head control develops, it will be easier to breastfeed them together. Later still, the babies will be able to position themselves. Decisions like when to swap breasts and which positions work best, will vary from family to family.

"Don't be afraid to ask for help positioning the second twin in the early days, so you can have a go at feeding two babies together."

Rugby hold, Parallel and Crossover holds
Breastfeeding cushions designed with twins in mind are more likely to enable a mum to tandem feed and even feed hands-free. However, some mums find they prefer to use V-shaped or normal pillows or cushions or use positions where no cushions are needed. If you have someone to assist you in the early days, they can help you position a second baby after the first one has started feeding.

"After a couple of weeks, I got the hang of feeding lying down and that made things a lot easier at night. When they were a little older, I managed to find a way of feeding both lying down. You get inventive about using different positions and doing things like answering the phone while breastfeeding."

"Our girls are now 17 months old and I'm still enjoying breastfeeding them. Now they are toddlers, I tend to feed them separately, but I used to do a mixture of breastfeeding separately and together."

What if my babies are born early?
Twins are more likely to be born early than single babies. If babies are born early, their mother's milk will be different to full-term milk and have specific advantages for pre-term babies. Breastmilk reduces a baby's chances of becoming ill and some conditions can be particularly serious in a pre-term baby. If twins are born very early, they may need to be fed by tube or special cup until they are able to breastfeed. Expressing breastmilk for premature babies will mean a mother is making a valuable contribution to her children's welfare, especially as hospital staff are responsible for other aspects of their care. Donor milk can also be an option.
Won't I be too tired to breastfeed?
Tiredness is sometimes given as a reason not to breastfeed twins, but there's no evidence that breastfeeding in itself is tiring. In fact, breastfeeding mums can make the most of opportunities to sit or lie down. It's important to eat a balanced diet and to rest when your babies sleep.

Once breastfeeding is established, it gets easier to go out or travel with twins, because breastmilk is available immediately and at the right temperature. Imagine the sheer number of bottles to be washed, sterilised, made up with hot water then cooled down for bottle-fed twins, and the cost of formula.

Breastfeeding involves the release of specific hormones that help a mother to feel relaxed. This is particularly beneficial for mums of twins who are likely to have an even busier time than other mothers. Also breastfeeding will help your uterus (particularly enlarged after having twins) to contract back to its pre-pregnancy shape and size and will help you lose weight more quickly.

If families feed their babies at the same time, they may choose to wake the other twin at night to minimise the number of night feeds. Breastfeeding at night can be done lying down and can help to establish a good supply of milk.
But my family and friends want to help
Grandparents or others might ask if they can help by giving a baby a bottle, but if bottles are introduced early on, this may make breastfeeding more difficult to establish and reduce a mother's milk supply. Dummies may also mean the demand on your milk is reduced so the supply reduces. However, some mothers of twins do find that expressing breastmilk can be useful and allows someone else to feed the babies occasionally.

There are lots of other things that family and friends can offer to do to help parents of newborn twins e.g. cuddling a baby, changing a nappy, offering mum a drink or sandwich, helping at bath time if needed, or hanging out washing. The support and encouragement of friends and family is an important aspect to breastfeeding twins successfully.
More information:

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs.

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24 Mar 20

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"Will I give birth alone?" is one of the key questions being asked by pregnant women and birthing people as hospitals adapt their policies to minimise the spread of Coronavirus.

As a doula, I'm an additional birth supporter, working with partners and midwives and medics to create a support team around the mother or birthing person. I recently supported a birth in London as the only birth partner where a family member had self-isolated, and where it was treated as a suspected Covid-19 case - the first the hospital was dealing with. (Article updated 12/5/20 to reflect new UK hospital policies and RCOG guidance)

Many hospitals in the UK are changing their guidelines and restricting the number of people coming into the building - surgery is being cancelled, visitors restricted to one or none. Doula Lauren Mishcon shared this analogy: 'remember the photos of the firemen running into the twin towers as everyone was running out? That's the medics right now'. Birthing in a pandemic wasn't in your birth plan, so what changes can you expect?

Guidelines are changing daily as more is becoming known about the spread of Coronavirus. The guidance for pregnant people in the UK is (as of 17th April) on version 8. And this is only two months since version 1 was published. People giving birth are generally being asked to bring only one supporter who must not have symptoms (this varies by Trust as each can make its own decisions) and can stay for a short time after the birth. Of course, this guidance may change again to limit the spread of Coronavirus even more. Antenatal and postnatal services are moving to online or phone consultations where possible. Staying in hospital after a birth is being reduced to the minimum safe times, for example to 24 hours after an uncomplicated caesarean and to 3-6 hours after a straightforward vaginal birth with partners not being allowed on most antenatal or postnatal wards or for scan appointments.

Apart from the small number of births each year that are so sudden that neither a midwife or paramedic can get to you, or where you can't get to a hospital, you will not birth alone. Labour support is the priority of the midwifery services even in a crisis, so even if you don't have your expected birth partner(s) with you due to their symptoms, you will be cared for by a midwife whose job it is to support you through your labour and birth. At the moment Trusts in the UK are allowing one supporter for the birth. The Royal Colleges of Midwives, The Royal College of Obstetricians and Gynecologists and the World Health Organisation have issued guidance supporting the necessity of having a birth partner of choice for labour and birth, which is some reassurance to those giving birth in the UK.

This wasn't on your birth plan, and your partner, planned birth supporter or doula will be gutted not to be there physically with you if they have symptoms or hospital policies have restricted how many people can stay. But these rules will help to keep you and your baby safe from Coronavirus, and to make it possible for the midwife to support the next birth and the next.

You can expect to be treated with respect, kindness and compassion - human rights don't disappear in a crisis.

You can expect increased levels of infection control, with staff wearing masks, gowns or other protective clothing. This can make it harder to tell who everyone is, to hear them or to see facial expressions, so staff should be working hard to overcome these barriers.

You can expect a symptom-free partner or companion to be able to accompany you in labour and for the birth.

You can expect to be together with your newborn, unless one of you needs specialist medical care after the birth.

You can expect a shorter hospital stay (if you're birthing there), no visitors and reduced face to face contacts for appointments before and after the birth (although you should still be seen a minimum of 6 times face to face during your pregnancy).

Home births may increase or decrease, dependent on your hospital trust's staffing decisions. Home births keep people out of hospitals but the benefits have to be balanced with the lack of availability of ambulances to transfer to obstetric care if needed.

Planned elective caesarean births are currently going ahead in the UK, unless the Trust does not have the capacity to honour the commitment.

The charity Birthrights has published a great blog on maternity rights within the context of Coronavirus and are a source of support if you feel you are not being treated with respect and dignity.
"What can I do to plan ahead?"

"Are there any positives right now?"

Keep up to date with your hospital trust's current policies via their social media accounts, through your midwife or the local Maternity Voices Partnership.

Minimise all contact (social distancing) for you and those living with you by following government guidelines, self-isolation if you or someone you've been in contact with has symptoms, and good hygiene at all times.

Talk through your birth preferences with your midwife and birth partner/s. Think about what things are the most important to you and how these can be best achieved. Now is the time for plans A through to Z!

Find out what local online support there is for new parents - and make connections now to ensure you are supported after your baby arrives.

Consider whether sustainable parenting choices such as cloth nappies/wipes will be right for you to reduce reliance on shops.

Look into hiring a doula for phone and skype support, or as a back up for your partner if they are self-isolating or ill. Doulas are also volunteering with online support for many vulnerable or disadvantaged people so if cost is a barrier do ask about this.

Consider who else could be your birth partner if yours has to self-isolate.

Consider planning to breastfeed. Not only will it support your baby's health, there will never be a shortage of breastmilk at the supermarket. The Team Baby online learning course from the Association of Breastfeeding Mothers is a good place to start if you want to learn more.

Hospital services such as food outlets and restaurants are closed to the public (the birthing person will get meals), so for partners bring snacks and Pot Noodle style meals which can be made with hot water.

Phones, cables and portable charges have never been more important to pack if you own or can borrow these.

Take care of your mental health. It's really normal to feel anxious, and organisations such as the Maternal Mental Health Alliance have some great resources to help you cope.

This article is written in the author's capacity as a private doula. It does not constitute medical advice, and is not representative of the views of any voluntary organisation with whom she works nor any hospital Trust.

For people who are not self-isolating due to a family member with symptoms, and who don't have symptoms themselves, the main changes are around restrictions on the number of people you can have with you in hospital settings and in moves to online/phone appointments where possible. Having supported a birth recently, the biggest changes were around minimising the risks of infection with the use of masks and protective clothing for us and for staff, and changes to where things happened (for example not moving rooms after the birth to a postnatal ward). When we got home, some postnatal visits were conducted by phone instead of in person.

With groups moving online, there is a groundswell of support for expectant and new parents, along with a feeling of all being in it together which may help tackle the isolation new parents often feel. Extended homeworking means that partners may be around and able to flexi their time well beyond the statutory 2 weeks paternity leave usually offered. Being encouraged to labour at home for as long as possible and/or birth at home is likely to lead to less intervention in birth, giving a long-lasting reminder of the benefits of birthing without interruption and showing the midwifery profession's core skills of supporting physiological birth. And with no known increased infection risks to pregnant people compared to the general population, and because in all known cases of newborns with Covid-19 the baby remained well, the biggest positive will be the birth of your baby - just don't name them Corona!

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"Will I give birth alone?" is one of the key questions being asked by pregnant women and birthing people as hospitals adapt their policies to minimise the spread of Coronavirus. As a doula, I'm an additional birth supporter, working with partners and midwives and medics to create a support team around the mother or birthing person.

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Whether it's sleep deprivation, money worries, new responsibilities, or the relationship dynamic shifting, dads also have a lot to take on board. This is a huge life change for both parents. On top of this, dads and co-parents might feel guilty about what their partner is going through, knowing they aren't the ones breastfeeding at 3am or healing from labour and birth.

Here's what you need to know about postnatal depression in partners. (Most of the research has been conducted in fathers to date, so while we often refer to dads below, we know it can apply to all types of partners.)

1. Dads and partners can experience depression in the first year after birth

The number of men who become depressed in the first year after becoming a dad is double that of the general population (Davé et al, 2010). Twenty five percent of dads experience mild depressive symptoms (Noorullah et al, 2020) and around 10% to 12% have a diagnosis of depression (Paulson et al, 2010; Philpott and Corcoran, 2018).

First time dads are appear to be more vulnerable to postnatal depression than dads welcoming subsequent children (Fatherhood Institute, 2010).

2. Postnatal depression in men and other partners often goes undiagnosed

The peak time for postnatal depression in men is three to six months after the birth (Fatherhood Institute, 2010).

As with postnatal depression in mums, it often goes undiagnosed. The symptoms can look a lot like the everyday stresses of having a newborn (Musser et al, 2013).

If you have concerns about your own or your partner's mental health, do seek help from your GP who can help you to access support services.

3. Hormonal changes may play a role

Just as with mums, changes in hormones might make postnatal depression in dads more likely (Saxbe et al, 2017).

Hormones including testosterone, oestrogen, cortisol, vasopressin, and prolactin may change in dads during the period after their babies arrive (Kim and Swain, 2007).

4. Postnatal depression in dads and partners is more likely if the mum has depression too

If one of you is experiencing emotional or mental health difficulties, it's more likely that the other is too. Of fathers with depressed partners, a quarter to half may experience depression themselves (Fatherhood Institute, 2010).

5. A range of factors can make dads and partners more likely to get postnatal depression

Dads who are under 25 are more likely to experience postnatal depression than their older counterparts (Davé et al, 2010).

Yet age isn't the only risk factor for postnatal depression in men. Other major risk factors include a history of depression and anxiety, financial pressures, and no longer being in a relationship with the child's mother (Huang and Warner, 2005; Wee et al, 2010; Nazareth, 2011).

Other factors that make postnatal depression in men more likely include: sleeping or crying issues with the baby; drug abuse or dependence; and feeling unsupported by their partners (Huang and Warner, 2005; Fatherhood Institute, 2010; Stadtlander, 2015).

However, the relationship between these factors is unclear so they might not necessarily be the direct cause of mental health difficulties.

6. Postnatal depression in dads and partners can show itself in different ways than in mums

Symptoms can include:

fear, confusion, helplessness and uncertainty about the future

withdrawal from family life, work and social situations

indecisiveness

frustration, irritability, cynicism and anger

marital conflict

partner violence

negative parenting behaviours

alcohol and drug use

physical symptoms like indigestion, changes in appetite and weight, diarrhoea, constipation, headaches, toothaches and nausea.

(Musser et al, 2013; Stadtlander, 2015)

7. Postnatal depression in dads and partners can take its toll on their relationships

Postnatal depression in dads can affect their relationship with the baby's mother (Wee et al, 2011; Demontigny et al, 2013). It can also affect the relationship they have with their child. They may play and engage less with their children and talk more negatively about and to them. They may sing and read less to their children, and may discipline them more harshly (Sethna et al, 2015).

8. Postnatal depression in dads and partners can have an impact on the development of their child

Dads' depression is associated with emotional, social and behavioural problems as well as developmental delay in their children (Fatherhood Institute, 2010).

The association is stronger when a father experiences antenatal as well as postnatal depression, and when his symptoms are particularly severe. There is also a stronger association when the mum also has mental health problems (Stadtlander, 2015).

9. Screening is available

You might associate screening with physical illness but mental health diagnoses are catching up. Men who are concerned about their mental health can use this NHS screening tool (NHS, 2020). Alternatively, if you're concerned, see your GP or call NHS 111.

10. Postnatal depression in dads and partners is treated the same as postnatal depression in mums

The treatment of paternal postnatal depression is in its early stages. Currently, the options for treatment are the same as for mothers with psychotropic medication and/or talking therapies (Nazareth, 2011; NHS, 2018).

Relationship counselling may also be useful (Musser et al, 2013).

Most, importantly share how you're feeling. You're not alone and support is available.
This page was last reviewed in February 2022.
We run Partners in Mind, a peer-to-peer support group for dads and partners in the North West. There are lots of videos and online resources to help you manage your mental health, as well as groups so you can meet and talk to other dads. Take a look at their information page here, email parentsinmindnw@nct.org.uk or follow them on Instagram @nctparentsinmindpartners and on Facebook @NCT Parents in Mind.

Our support line offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses that are a great way for both parents to find out more about birth, labour and life with a new baby.

For information and support, visit Fathers Reaching Out run by Mark Williams, campaigner, speaker and writer.

The Campaign Against Living Miserably (CALM) is leading a movement against male suicide, the single biggest killer of men under 45 in the UK.

The Hub of Hope is a national mental health database, bringing help and support together in one place, with a focus on grassroots organisation.

ANDYSMANCLUB is a non judgmental, talking group for men.

DadsNet offers support and knowledge through a community of dads on practical parenting and fatherhood.

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Postnatal depression in dads and co-parents: 10 things you should know | Life as a parent articles & support | NCT

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Whether it's sleep deprivation, money worries, new responsibilities, or the relationship dynamic shifting, dads also have a lot to take on board. This is a huge life change for both parents. On top of this, dads and co-parents might feel guilty about what their partner is going through, knowing they aren't the ones breastfeeding at 3am or healing from labour and birth.

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The childbearing experience has always been unpredictable and potentially dangerous. In response, humans have sought ways to create a sense of control and minimise danger. Practices (actions) aimed at creating a sense of control reflect the culture from which they arise. Historically, women relied on a spiritual connection to the Goddess/es, rituals (rites of passage and rites of protection); wisewomen and remedies from nature. The current approach emerges from Science and Research (the new religion?) and sustains a technocratic approach to birth. Risk and danger are considered to be located within the woman (rather than her environment or others) and practices aim to identify danger and control it from the outside. This new approach claims to be rational, effective and underpinned by research evidence.
From evidence-based-practice to research-based-practice
By the end of the 1900s 'evidence based practice' was an established concept in medicine and health care in general. However, it was never meant to be purely 'research based practice': "Evidence based medicine is not restricted to RCT and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions" (Sackett et al 1996). Whilst the emphasis was on 'external' evidence it did involve taking account of the individual 'patient' and the experience and skill of the practitioner.

Along with the shift towards research based practice came an increasing emphasis on quantitative research. If you are unsure about the different between quantitative and qualitative research - see this summary and this cartoon:

Quantitative research purports to be objective and is underpinned by Popperian philosophy and principles. Popper's (1961) philosophy of science maintains that scientific knowledge develops in an incremental and linear fashion whereby 'truths' are systematically tested. Truths or hypotheses cannot be proven, only falsified, and scientific theories can be objectively tested to measure how much truth or falsity they contain. How neat and tidy!

In keeping with this idea of being able to objectively measure humans and their experiences the Pyramid of Evidence was devised. This pyramid illustrates the hierarchy of 'quality' relating to research evidence. As you can see the more (allegedly) objective the research, the greater the quality and the greater the weight given to the findings. However, reality is a lot more complex and subjectivity and bias permeate all research:

"Research is carried out within paradigms of knowledge. Everything from the research question; the research framework; the methodology; the interpretation of findings; and the implementation of the findings into practice is influenced by the paradigm of knowledge in which the research is conducted." (Kuhn 1970)

This blog post takes a critical look at quantitative research - the purported foundation of modern maternity care. There are also issues with qualitative research, however qualitative philosophy and methodology acknowledges the element of bias as part of the research design.
Money
Researchers do not generally carry out research in their spare time funded by the goodness of their heart. Research requires money to pay for time and resources. Competitive grants are offered by a variety of organisations - government, charity and industry. Research topics are influenced by the requirements and criteria dictated by grant providing organisations. For example, government funded grants will usually focus on government health priorities such as the treatment of diabetes, heart disease, etc. Therefore, it would be much easier to obtain a grant to study the management of gestational diabetes than to study psychosocial outcomes of maternity care. Government health priorities reflect culture (and health lobby groups eg. industry). For example, the joint leading cause of maternal death in Australia is psychosocial morbidity (cardiovascular disease is the other). There is a clear link between how women are treated by care providers and mental health outcomes ( Harris & Ayers 2012). However, women's mental health is not a cultural priority in Australia.

Another source of funding for research comes from the industries that develop and sell interventions (eg. technology and medications). This has resulted in major issues in the area of pharamacology (see Ben Goldacre's book). In the maternity context there are no companies offering grants to find out about the benefits of birth without medication or intervention - there is no profit in physiological birth.
Problem focus
Research plans and grant applications require the identification of a 'problem' - there is usually a section subtitled 'describe the research problem'. This creates a focus on pathology rather than on wellness. For example, a study aiming to investigate why 'x' institution has a high rate of physiological births and great outcomes is less likely to get a grant than a study aimed at trialling a medical intervention to reduce the high PPH rates in another institution. However, former study may result in important findings that could help to improve the latter.
Research partners
Most government grants require a government health employee to be listed as a researcher on the grant application. Frequently this results in a manager from the institution becoming a named 'researcher' (although sometimes they contribute nothing to the research process). This looks great on the managers CV and allows the rest of the research team to access samples (women) and data (whatever information they are collecting/measuring). However, as a representative and employee of the institution they may have a vested interest in ensuring that the research topic and findings do not reflect badly on the institution. This can influence the research topic because some topics (the interesting ones) will be off the agenda of the institution... more on this later re. disseminating the findings.

Once a research topic/problem has been identified, a research question is created. Again, the question that arises reflects the cultural paradigm in which the research is taking place. A study by Phipps, Charlton and Dietz (2007; 2009) provides a perfect example of this. The problem: high rates of intervention due to first time mothers being unable to push their babies out within the ( non-evidence based) hospital prescribed timeframe. The question arising from this problem became 'can women be taught how to push more effectively' and women were randomly allocated to antenatal education sessions aimed at teaching them how to push effectively. This reflects a paradigm in which women's bodies are considered the problem. An alternative paradigm would have resulted in examining the problem of using prescriptive timeframes to define individual birth processes.
Physiology as experimental
Usually in quantitative research the control group is the group that does not get an intervention. This control group is compared to the experimental group that gets the intervention. However, this is usually the opposite in maternity care, reflecting a culture in which intervention is the norm. Initially routine interventions during birth were introduced as part of the general medicalisation of childbirth, without any supporting research evidence (Donnison 1988). These interventions continue to be carried out until research is conducted to support a change in practice. Therefore, research in maternity care is often carried out to support not performing an intervention that was initially introduced without research evidence. For example, women were routinely subjected to vulval shaving, enemas and episiotomies until research demonstrated it was safe to not abuse women this way. In such studies, the control group is the group subjected to the intervention, with the experimental group not receiving the intervention.
Confounding factors in complex human experiences
Research is often conducted with the assumption of simplicity as a framework. The origin of this assumption is Descartes' concept of dualism, that the body could be studied as a separate entity to the social, psychological and spiritual aspects of a person. This approach ignores the complexity of cause and effect in individual human subjects and varying situations.

Confounding variables are factors that influence the relationship between x and y. Research design aims to reduce confounding variables. This is easier when carrying out research in laboratory conditions where you can control the environment and any interactions with the subject (eg. bacteria in a petri-dish). However, pregnancy, birth, breastfeeding, mothering, and maternity care are incredibly complex. In most cases it is impossible to limit confounding factors. For example, when designing research comparing active management of placental birth vs physiology, it is not possible to isolate the effects of administering an oxytocic medication or not. The 'management' is being carried out on a complex human, by a complex human, in a complex environment, all of which may influence the outcome. For example, a practitioner who is used to active management but now has to carry out physiological management may find this challenging... their approach and interactions are likely to be influenced by their feelings. This partly explains the different outcomes in different studies with different participants and settings ( see this post).
RCT, blind arms and ethics
It can be argued that the gold standard or research - randomised controlled trials - are often unethical in maternity care. For example, it would be unethical to randomly allocate a woman to a particular birth setting (and her feelings about her birth setting would alter her outcomes). Considering what we know about placental transfusion immediately after birth, and the importance of adequate blood volume for newborns, it would be unethical to randomly allocate newborns to have premature clamping of their cords (and many mother's would refuse consent).

It is also considered good research design for both the practitioner (person administering the intervention) and the subject (person getting the intervention - or not) to be 'blind' to this ie. not know. This works well in the case of medications ie. neither the doctor nor the patient know whether the pill is the experimental medication or a placebo. However, it is virtually impossible to 'blind' practitioners or women to interventions. Women and their care providers will know if an intervention is carried out or not eg. active management of the placenta, episiotomy, premature cord clamping.

The cultural paradigm also influences how researchers and the media interpret the results of studies. In particular, the creation of links between factors assumed by cultural understandings to be linked ie. presenting correlations as causations. The classic example of this is the relationship between ice-cream sales and shark attacks. There is an correlation between increased ice-cream sales and increased shark attacks. However, ice-cream does not cause shark attacks - both of these factors are influenced by how the weather effects human behavior (eating ice-cream and swimming in the ocean).

In relation to maternity care identifying cause and effect are even more difficult due to the complex nature of the issues. For example, there is a general consensus that obesity is associated with poor outcomes for women and babies and the solution is to reduce BMI. However, this raises further questions: is obesity the direct cause of poor outcomes? Is obesity a symptom of some other heath related disorder that is the causal factor of obesity? Is the treatment of obese women the cause of poor outcomes (increased stress/shaming, surveillance, intervention)?

RECOMMENDATIONS ARISING FROM THE FINDINGS

Once a study has been concluded the researchers offer recommendations arising from their study. Again, these recommendations are influenced by the cultural paradigm. An example of this is the recommendations resulting from research into early labour (discussed in this post). Women admitted to hospital in early labour = increased intervention and decreased normal birth. The recommendation is therefore to limit the time a woman is exposed to the hospital system... not change the hospital system to better accommodate the needs of women in early labour.

The aim of research is to publish the findings and contribute to the evidence-base for practice. However, whether, and how research findings are disseminated is influenced and controlled by a number of factors. In particular the 'interested parties' (see above 'research partners') can prevent or manipulate publication. For example, to access data held by an organisation the researcher is likely to have signed an agreement that publications relating to that data must be approved by the organisation. I know more than one researcher who has been unable to publish interesting results because they have been blocked by the organisation they had an agreement with. The Union of Concerned Scientists have published a report detailing how corporations obstruct, distort and supress research. Techniques include: terminating and suppressing research; intimidating or coercing scientists; ghost writing scientific articles; publications bias ie. only allowing certain results to be published (Ben Goldacre also discusses this in his book).

Good journals use a peer review process to ensure quality research dissemination. However, peer reviewers are humans and are also influenced by the cultural paradigm and their own emotions. An article that is not aligned with the philosophy/views of a journal or a particular reviewer will be more likely to be rejected. For example, an article reporting findings that demonstrate midwifery continuity of care resulted in poor outcomes (I am making this up) would be more likely to be published in a medical journal than a midwifery journal. And some topics are difficult to publish anywhere.

IMPLEMENTING RECOMMENDATIONS INTO PRACTICE AND DECISION MAKING
Evidence based practice?
The final step - implementing evidence into practice is perhaps the least successful step in maternity care research. The discipline of obstetrics was awarded the 'wooden spoon' by Archie Cochrane in 1979. In response Iain Chalmers et al. published the first edition of 'effective care in pregnancy and birth' in 1989. However, it seems that not much has changed.

"Despite claims of EBP, practices are underpinned by an established hierarchy of understanding and practice, rather than by research." (McCourt 2009)

It is easier to introduce and maintain culturally based practices that lack evidence, than to introduce evidence based practices that challenge the cultural norm. For example (and I have stuck to the 'gold standard' of Cochrane reviews relating to 'normal' birth here): Common practices that lack evidence include routine vaginal examinations; amniotomy to shorten labour; routine antibiotics for rupture of membranes; use of a partogram; admission CTG and CTG during labour; (I could go on).Uncommon practices supported by evidence include midwife-led continuity of care; warm compresses to reduce perineal trauma; skin-to-skin contact; optimal cord clamping (aka 'delayed'); warm water immersion; (I could go on).

Organisations and the staff working in them rely on clinical guidelines to guide practice. However, so called 'evidence based guidelines' are anything but. If you take a look at most clinical guidelines and follow the reference trail you will find that they cite another clinical guideline, which cites another clinical guideline... and you end up at a dead-end with no actual research in site. Prusova et al. (2014) published an article about this situation: RCOG 'Green-top Guidelines': 9-12% based on Grade A evidence. Whilst the article focuses on the RCOG - this is widespread across maternity care guidelines.
Evidence based decision making?
When it comes to how individual women make decisions about their maternity care - research is also fairly low on the list. Below is a quote from a previous post that is relevant here:

Many factors influence decision making, and the information a midwife provides is only one piece of the puzzle. Humans are active seekers and interpreters of information. We pick and choose, using and discarding information according to internal and external constraints and considerations. Embodied knowledge, personal experiences and other people's experiences influence the selective designation of knowledge as authoritative or not. We often start with a conclusion, then rationalise it with evidence. We surround ourselves with people who have beliefs and opinions aligned with our own. The internet has increased our access to information and people who will reinforce our beliefs and choices.
A WAY FORWARD
I am not advocating discarding research. I am a researcher myself and believe that this type of evidence can, and does shift practice. Midwives need to contribute to, and understand the evidence-base for practice from the woman's perspective. The International Confederation of Midwives position statement 'The Role of the Midwife in Research' provides guidance on this:

...all midwives have a role and a responsibility in advancing knowledge within the midwifery profession and the effectiveness of midwifery practice...

Research on the childbearing cycle maintain a holistic approach that includes the physiological, psycho-social, cultural and spiritual aspects of the health of women and babies

Midwives design/participate in studies that support and promote holistic care as well as evaluating the effects of using technology as an intervention during pregnancy and birth

We also need to be able to discuss research with women - not just quote statistics. More importantly we need to acknowledge and respect all the other forms of evidence that operate when a woman makes a decision about what is best for her - in particular her own embodied knowledge.

This post is published in French here.
References
Cochrane AL (1989). Foreword. In: Chalmers I, Enkin M, Keirse MJNC, eds. Effective care in pregnancy and childbirth. Oxford: Oxford University Press.

Donnison, J 1988, Midwives and medical men: a history of the struggle for the control of childbirth, 2nd edn, Historical Publications, London.

Kuhn, TS 1970, The structure of scientific revolutions, University of Chicago Press, Chicago.

Phipps, H, Charlton, S & Dietz, HP 2007, 'Can antenatal education influence how women push in labour? A pilot randomised control trial on maternal antenatal teaching for pushing in the second stage of labour (PUSH STUDY)', paper presented to Big Bold & Beautiful: Australian College of Midwives 15th National Conference, Canberra, Australia, 25-28 September 2007.

Phipps, H, Charlton, S & Dietz, HP 2009, 'Can antenatal education influence how women push in labour? A pilot randomised control trial on maternal antenatal teaching for pushing in the second stage of labour (PUSH STUDY)', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 49, pp. 274-278.

Popper, KR 1961, The logic of scientific discovery, Basic Books, New York.

Prusova, K, Tyler, A, Churcher, L & Lokugamage 2014, 'Royal College of Obstetricians and Gynaecologists guidelines: how evidence based are they?' Journal of Obstetrics and Gynaecology, DOI: 10.3109/01443615.2014.920794

Sackett, DL, Rosenberg, WMC, Gray, JAM, Haynes, RB & Richardson, WS 1996, 'Evidence-based medicine: what it is and what it is not', British Medical Journal, vol. 312, pp. 71-72.

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The childbearing experience has always been unpredictable and potentially dangerous. In response, humans have sought ways to create a sense of control and minimise danger. Practices (actions) aimed at creating a sense of control reflect the culture from which they arise.

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iHV is a UK-wide organisation with a web-based Centre of Excellence to strengthen the quality and consistency of health visiting services for the benefit of all children, families, and communities.

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Also call your GP or 111 if you have any other concerns about your baby.

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has vomit that's green or yellow, or has blood in it is projectile vomiting (being sick with more force than usual) has blood in their poo has a swollen or tender tummy has a very high temperature or they feel hot or shivery keeps being sick and cannot keep fluid down has diarrhoea that lasts for over a week or has signs of dehydration will not stop crying and is very distressed is refusing to feed Also call your GP or 111 if you have any other concerns about your baby.

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AIMS Journal, 2011, Vol 23 No 4 Joanne Whistler asks whether they are really a variation on normal
After a wonderful home birth with my firstborn, Oliver, in 2006 I felt confident in my body's ability to labour and give birth. Even when I discovered that I was pregnant with twins late last year I had the attitude that it was just a variation on normal.

It was only when I started reading up about multiple pregnancy and birth that my belief that I would have another good experience began to falter. Everything I read said that multiple pregnancies were higher risk, that I should expect a more medicalised experience of pregnancy and birth than a mother of a singleton, and implied that for my babies' sake I should give up any thought of what I considered to be a normal birth. Of course I wanted my babies to be safe, but I also wanted their entry into the world to be gentle and unmedicated - I was very aware of the risks and side effects of pharmacological pain relief and interventions such as induction.

In the end I had a fabulous home water birth attended by two independent midwives. My husband and a trusted friend were also there. My midwife monitored the babies intermittently and removed the caul from twin two's face but otherwise my labour and birth were completely intervention-free. In this article I will discuss the evidence base for management of multiple pregnancies and explore some aspects of planning the birth of twins or more.

A dearth of evidence

With my scientific background and working as I do in health policy, I naturally tried to read up on the evidence to help inform my choices for this pregnancy. What soon became clear was that research in many areas was sparse and often of poor quality. Multiple births are often excluded from mainstream studies, or are lumped together with singleton births. Twin-specific studies may not separate out pregnancies where the twins have separate sacs and placentas, those with one placenta and two sacs, and where the babies share both sac and placenta, despite the different risk profiles of each type of twin pregnancy. The biggest problem with the published research, however, was that in most cases it did not evaluate the options I was considering. One consultant obstetrician I saw said that from research currently underway we would soon know 'whether planned csection or vaginal birth is safer fortwin births.' No. We will know whether c-section or typical hospital management of vaginal twin birth is safer, but physiological twin birth in a place the woman feels safe with a trusted and highly skilled birth attendant will remain unevaluated. Research into other 'high risk' situations has been similarly flawed - the Hannah term breech birth trial is a case in point.

Even when there is good-quality evidence, women need to be able to consider the research in the light of their own specific circumstances. For example, having twins put me at greater risk of pre-eclampsia than a secondtime mum with a singleton pregnancy. However, my uncomplicated previous pregnancy meant I was less likely to develop pre-eclampsia than a first-time mum expecting a single baby.

With the patchy evidence base for management of multiple births, the process of making informed choices can be particularly difficult for an expectant mother of multiples. The rest of this article explores some ideas for thinking through the issues.

Avoiding complications of multiple pregnancy and birth

It can be empowering for the expectant mother to realise that she can reduce the likelihood of some of the commonly-cited complications of multiple pregnancy and birth. For example, pregnancy-related stress is associated with pre-term labour, so after panicking in my first trimester I made a conscious decision to stay away from upsetting birth stories and articles. I also ensured I ate well, as insufficient weight gain in twin pregnancy is associated with pre-term birth and low birth weight. Before accepting an intervention, especially one with unproven benefits, mothers should consider potential iatrogenic complications. For example, artificially rupturing membranes (ARM) for twin two once the first twin has been born is a very common procedure, but the rush of fluid could bring the cord with it. Given that the presenting part may not yet be engaged in the pelvis, cord prolapse could result.

Understanding the risks, their likelihood and impact

The articles and books I read in early pregnancy that frightened me with their shroud-waving were frustratingly short on detail. They often simply said that multiple pregnancies were 'high risk' without specifying what those risks were, and used the 'high risk' label to justify why mothers of multiples should submit to interventions such as frequent ultrasounds and electronic fetal monitoring (EFM) without explaining how these interventions would reduce the risks. Those that gave more detail often mentioned complications such as premature birth and pre-eclampsia, but even then it was not at all clear how the interventions would help reduce risk. Discussion of the risks of the interventions themselves was almost nonexistent. I really struggled to find information on the additional risks of a twin birth where the pregnancy was uncomplicated and term, which was information I needed in order to plan my babies' place of birth in the event of everything going smoothly. It is not acceptable for care providers to justify increased routine intervention by simply using the 'high risk' label. Women should ask what specific complications the clinician is concerned about, and how the proposed intervention will alter the likelihood or effect of these risks.

Many of the additional risks of multiple birth relate to things that can be dealt with reactively if they occur, rather than trying to pre-empt them. Attempting to do so may be counterproductive, such as repeated ultrasound scans to detect reduced growth. In addition most potential problems would be extremely unlikely to lead to death or serious injury to the mother or babies. For example, postpartum haemorrhage is more of a risk in multiple pregnancies because of the larger placental site. However, should there be excessive blood loss in a physiological third stage, the opportunity has not been lost to administer drugs to contract the uterus and control the bleeding. Should this initial intervention not be sufficiently effective, further treatment might be necessary, but life-threatening blood loss in a healthy well-nourished woman is extremely unlikely.

With the 'high risk' label comes an additional reliance on care providers for information and guidance. The content and emotional tenor of this advice will be heavily influenced by the clinicians' background and experience. I saw two consultant obstetricians at two different Trusts and they were each concerned about entirely different aspects of my twin pregnancy! Nevertheless, the experience of talking to them was positive and I felt that they respected my right to make 'unusual choices'. I know this is not the experience many women have of maternity services. If the consultant is exerting inappropriate pressure on a woman to conform to hospital guidelines, some of the following suggestions may help:

taking another clinician, such as a senior midwife, to any meetings with the consultant

approaching the midwife consultant in normality at the Trust for support (if there is one)

considering changing to a different consultant or even a different Trust

Creating favourable conditions for physiological birth

In all labours, the conditions that facilitate physiological birth are privacy, warmth, low light levels, upright and forward-leaning positions and avoiding activating the labouring woman's neocortex by, for example, asking her questions. These conditions are even more important for multiple births, but are less likely to occur. I asked a consultant obstetrician how many mothers of multiples laboured and gave birth in her hospital in predominantly upright positions. The answer : 'almost none', due to a combination of EFM and epidural use. There are often more people around during a multiple birth, and clinicians' belief that multiple births are high risk can create an atmosphere of fear. Michel Odent says of twin births:
'In general those who know about privacy as a basic need in labour are not scared by this sort of birth. It is the art of doing nothing. First you wait for the first baby. Then you wait for the second baby and finally you wait for the placenta. The point is to make sure that there is not too much excitation around after the birth of the first twin, so that the mother is not distracted and has nothing else to do than look at her baby in a sacred atmosphere. The same after the second one, while waiting for the placenta [...]. Those who don't know about the importance of privacy are so scared of twin births that they create a cascade of interventions... if they have not chosen the easy way, that is to say a caesarean section. Today many practitioners are right to prefer a caesarean section. Giving birth without any privacy among scared people can be dangerous.'
Unless the woman knows who will attend her in labour and trusts that the midwife will create and support the conditions that facilitate normal birth, having a doula or other birth supporter to protect those conditions is likely to be very helpful. The woman's partner may find it difficult to support her through labour whilst at the same time protecting her birth space.

I was privileged to have had a highly-skilled team of independent midwives looking after me during my twin pregnancy and birth. My first midwife has extensive experience of breech birth (my twins were both vertex, but over half of term twin pregnancies involve at least one twin in the breech position), water birth and physiological third stage, and also experience of twin home birth. I had complete confidence in her skills, but also knew she would only intervene if truly necessary. Can women under NHS care say the same things? Unfortunately not. Because of the very small number of women choosing (for example) vaginal breech birth and even physiological third stage, clinicians rarely get the opportunity to develop their skills and confidence in these areas. It is difficult for expectant mothers of multiples to choose physiological options if they cannot trust that the midwives and doctors are skilled in these areas. For example, inappropriate pulling on a baby during a physiological breech birth can be dangerous.

Minimising the negative impact of necessary interventions

Even when everything is in place to optimise a woman's chances of a normal, uncomplicated birth, it is important to recognise that complications can still occur and appropriate interventions can improve outcomes. Being prepared for the most common complications and interventions and planning for those eventualities can help a woman be and feel more in control if things do not go entirely to plan. For example, I was clear that if one or both of my babies were breech, I wanted to try for a hands-off vaginal breech birth. Should progress stall, however, I wanted a caesarean section rather than an attempted vaginal breech extraction, which I felt would be traumatic for both me and the babies. If I had ended up with a caesarean section in such circumstances I would have been disappointed, rather than traumatised as could have been the case if I had been bounced into a breech extraction.

Seek support

Being classified as 'high risk' can be a frightening and lonely experience. Women going through this in their pregnancy need support, but must take care where they seek it. It is very common to encounter the 'just do what the doctors tell you, what matters is a healthy mother and babies' attitude, even though it is not as simple as more medicalised = safer. The internet is particularly potent. I benefited from being able to talk to women who had experienced twin pregnancy and birth, and was very grateful to friends who sent me links to inspiring twin birth stories and film clips. On the other hand I was scared to the point of tears by some of the 'information' I found on the internet and found venturing onto the TAMBA (Twins and Multiple Births Association) message board an extremely negative experience.

The future

The biggest stumbling block to 'high risk' women wanting low-intervention, physiological births is the deskilling of clinicians that results from the vast majority of 'high risk' births being very medically managed. Independent midwives on the other hand have opportunities to develop their skills and confidence in a wider range of births. It is hoped that independent midwives will be able to contract in to the NHS in future through the arrangements IMUK is seeking to put in place. It would be a huge step forward if women wanting a low-intervention approach to the birth of twins could be offered the services of an independent midwife on the NHS.
References
Hannah ME et al (2000) Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. The Lancet, Volume 356, Issue 9239, Pages 1375 - 1383.

Hannah ME et al (2000) Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. The Lancet, Volume 356, Issue 9239, Pages 1375 - 1383.

Dole N et al (2003) Maternal Stress and Pre-term Birth. Am. J. Epidemiol. 157 (1): 14-24.

Fox NS et al (2010) Weight Gain in Twin Pregnancies and Adverse Outcomes: Examining the 2009 Institute of Medicine Guidelines. Obstetrics & Gynecology. Volume 116 - Issue 1 - pp 100-106

Beech BL (1999) Ultrasound - Weighing the Propaganda against the Facts. Midwifery Today. Autumn 1999

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.

The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: editor@aims.org.uk

Published on 1st December 2011

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AIMS Journal, 2011, Vol 23 No 4 Joanne Whistler asks whether they are really a variation on normal After a wonderful home birth with my firstborn, Oliver, in 2006 I felt confident in my body's ability to labour and give birth.

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The experts behind MotherToBaby have created fact sheets that answer frequently asked questions about exposures during pregnancy and breastfeeding. MotherToBaby Fact Sheets are available in both English and Spanish and can be downloaded for free. Currently available fact sheets are listed below by category of exposure. All medications are listed by generic name.

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The Conversation: Coronavirus while pregnant or giving birth

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The Conversation: Coronavirus while pregnant or giving birth

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16 Mar 20. Written by Professors of Midwifery and Obstetir

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Having a baby is stressful enough without a coronavirus (COVID-19) pandemic and all the associated misinformation.

If you're pregnant and/or due to give birth soon, it's best to get information from trusted sources such as the World Health Organisation, the Royal College of Obstetricians and the Australian Government Department of Health.

Here are the key take-home messages.

It's a new virus

As COVID-19 is a new virus, we are learning more about it every day. As most pregnant women are young and generally healthy, they're less likely to be severely affected (which is good news). But as there is also a baby to consider, the picture can be more complex.

A baby born recently to a mother in the UK with COVID-19 recently tested positive soon after birth but we are not sure whether it was infected in the womb (unlikely) or after birth (more likely).

As far as we know, the baby is fine and the mother is being treated. Other reports on babies with COVID-19 have also shown they had mild symptoms and a good recovery.

Read more: Coronavirus with a baby: what you need to know to prepare and respond

From China's experience to WHO advice

To date, much of our information on COVID-19 has come from China. This is where one of the first studies, involving just nine pregnant women with COVID-19, came from.

All these women had caesarean sections, none were seriously unwell and all mothers and babies recovered. The study found none of the babies appeared to get COVID-19 and there was no evidence of the virus in the baby, breastmilk or fluid surrounding the baby. It's not clear why these babies were born by caesarean section. China has a very high caesarean section rate, which is not optimal, and this may have influenced how they responded.

The World Health Organisation's new guidelines state:

there is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness. So far, there is no evidence on mother-to-child transmission when infection manifests in the third trimester ... WHO recommends that caesarean section should ideally be undertaken only when medically justified

Why pregnant women are not more susceptible to COVID-19

Pregnant women are generally more susceptible to viruses that cause breathing problems (like the flu). Their immunity is lowered, their lungs are more compressed and they need more oxygen.

However, this doesn't seem to be the case with COVID-19. In an analysis of 147 women with COVID-19, only 8% had severe disease and 1% were in critical condition. That's lower than the general population.

The lowered immune response of pregnancy, which is needed to stop a woman's body responding to her baby as a health threat, may actually provide extra protection with COVID-19. COVID-19 seems to be more severe in people with an immune system working hard dealing with other health disorders.

With COVID-19, more men than women are affected and women are less likely to get severely ill and die. To date, the death rate is 1.7% for women and 2.8% for men.

However, as the pandemic spreads this may change. Women comprise the majority of the health workforce and caregivers will be in contact with more sick people.

How can pregnant women protect themselves and others?

Pregnant women should do the same things as the general public to protect themselves, including:

covering the mouth when coughing (by coughing into the crook of your elbow)

avoiding people who are sick

asking people who are unwell to avoid visiting

washing hands often with soap and water or an alcohol-based sanitizer and

avoiding large gatherings.

It would be sensible not to travel overseas at the moment; you may have to self-isolate when you return.

Women who think they may have contracted COVID-19 can now consult their GP or other health professional with a bulk billed telehealth call (video call) rather than having to go in person.

Women who are pregnant or have new babies are given priority for telehealth services.

If you have been asked to self-isolate due to contact with someone with COVID-19, or have the illness, make sure you contact your midwife or obstetrician by phone and follow the advice of your health care provider.

What about going to hospital for antenatal visits and birth?

Keep going to appointments but don't stress if you miss a couple, and early discharge might be a good idea if you're able.

If you are booked into a birth centre or hospital, lots of precautions are in place to minimise the risk of infection. Birth will proceed as planned in the vast majority of cases and going home early would be ideal and may be encouraged if you and your baby are well.

Be aware some hospitals are restricting visitors and even support people, other than the partner, to try and reduce risk to the community.

Can the baby be infected with COVID-19 in the uterus?

The placenta is a very efficient filtering system and does an amazing job protecting babies from harm. The Zika virus was an exception to this.

There is no evidence of increased complications, though if a woman was very unwell (with high temperature or pneumonia, for instance) then the baby may be born prematurely.

This may be due to deliberate intervention by health professionals if the woman is very sick.

In general, though, a COVID-19 diagnosis should not lead to a decision for an early birth, unless ending the pregnancy is thought to be beneficial to the mother due to her overall condition.

There is not enough evidence that COVID-19 increases miscarriage and it is too early to know other longer-term impacts on the baby.

What should I do after the birth?

The benefits of breastfeeding are so significant the WHO recommends this should begin within an hour of birth. Skin-to-skin contact should be supported immediately following birth if the baby is well.

If the mother is too ill, she should be assisted to express her milk. Breastfeeding is particularly effective against infectious diseases because it transfers antibodies and other important immune factors to the baby. If the woman or the baby have an infection, the composition of breastmilk even changes to increase important components that help the baby fight infection. So, if you were thinking of giving up breastfeeding, perhaps continue until this pandemic ends.

WHO recommends women who have COVID-19 should wash their hands before and after contact with the baby, use a medical mask when near the baby if they have symptoms (such as coughing), and routinely clean and disinfect surfaces they may have touched.

What else can you do?

When the seasonal flu vaccine becomes available, get vaccinated. We know this can be protective during pregnancy. It is free for pregnant women and there are no risks to your baby from flu vaccine. You will not be protected from COVID-19 but you will get some protection from the flu (which can be very problematic for pregnant women). The last thing you want is to have the flu and COVID-19 at the same time.

Free flu vaccinations will be available from GPs mid-April but if women want them earlier, they can get them for a fee at the pharmacy from end of March.

Most of all, try and stay calm and talk to your midwife or doctor if you are getting very worried.

Read more: Coronavirus: 5 ways to manage your news consumption in times of crisis

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Coronavirus while pregnant or giving birth: here's what you need to know

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Having a baby is stressful enough without a coronavirus (COVID-19) pandemic and all the associated misinformation. If you're pregnant and/or due to give birth soon, it's best to get information from trusted sources such as the World Health Organisation, the Royal College of Obstetricians and the Australian Government Department of Health.

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Stockport Sling Library, Стокпорт. Отметки "Нравится": 2 692 · Обсуждают: 22 · Посетили: 9. Stockport Sling Library has over 200 slings and baby carriers we offer library meets, workshops, private...

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The Queen's passing has no doubt brought up questions from children, who for the first time are encountering the loss of someone they 'knew'. While it may seem unnecessary to talk about the Queen dying with kids, this may be their first experience of death and be...

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What do I do when she goes into labour? | DAD.info

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The baby's coming! What to do? Don't panic - here's our quick checklist and action plan. One. Check that it IS labour! In the final weeks of pregnancy it is not uncommon for the pregnant body to have some warm-ups, which can sometimes mean women can think labour is beginning and then find it all...

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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The Pelvic Partnership provides women and healthcare professionals with information about best practice for the treatment and management of pregnancy-related PGP, and to enable and empower women to access the right treatment. We have packed our website with information about PGP, so please do have a read, and use and share this resource.

Free PGP leaflets

With support from the National Lottery and Dreamgenii, we have developed leaflets explaining PGP and how it can be treated with manual therapy. To find out more please click here to request a FREE leaflet about PGP or to click here to buy a pack of leaflets to share with friends, family or your clients.

"PGP is treatable" ebook

In our new ebook we share practical suggestions and realistic solutions to help you manage your pregnancy-related PGP throughout pregnancy and after your baby is born. This ebook was produced as part of our COVID-19 Response Project, funded by the National Lottery's Coronavirus Community Support Fund.

The ebook is available on AmazonKindle or FOR FREE as a PDF here.

Talking about pelvic girdle pain with your GP or midwife: a toolkit for women with PGP

We have developed a free resource for women with PGP to help them at healthcare appointments.

We have heard from many women with PGP that it is challenging to describe their PGP to GPs or midwifes with little knowledge about the condition and how it can affect women physically and emotionally.

This FREE resource helps women find the words describe their symptoms, how PGP affects them and how to ask for the right referrals for further treatment, pain relief and support services.

Download Talking about pelvic girdle pain with your GP or midwife here.

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The Pelvic Partnership provides women and healthcare professionals with information about best practice for the treatment and management of pregnancy-related PGP, and to enable and empower women to access the right treatment. We have packed our website with information about PGP, so please do have a read, and use and share this resource.

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Within the UK there are a number of childcare options. Here we discuss the different options to help you make a decision on your childcare search that perfectly suits you and your family.

Childcare options

Childminders

Registered with Ofsted (in England), the Care Inspectorate (in Scotland) and Care and Social Services Inspectorate Wales (CSSIW). Childminders are self-employed and usually take care of children within their own home

Children's centres

Children's centres began as a major part of the 'Sure Start' programme targeting child poverty. Now under local authority control, children's centres aim to be a 'one-stop-shop' for families and will have facilities to support early education, childcare, health, family support and help into employment (for parents and carers). Childcare facilities vary between centres - while some may offer nursery facilities, many don't.

Day nurseries

Day nurseries offer care for children from birth to four or five years old. The number of children attending may vary from nursery to nursery. There are different types of nurseries including private, community, local authority and workplace nurseries.

Pre-school playgroups

Less formal than nurseries, these groups operate for a few hours each day only and do not provide full-time care. They tend to be run by private individuals or charities. Parents may be asked to volunteer their support for certain periods.

Crèches

Crèches will provide 'occasional care' for children and are provided on particular premises. Parents will use them on an irregular basis i.e. when they go to the gym or if they're shopping.

Nannies

A nanny is someone who is typically paid to look after a child (or children) in the home of the child. They can either live-in or live-out, depending on their arrangement with the family.

Au pair

These are generally students from outside the UK, who are here to study and improve their English. They must also be provided with a bedroom, meals and pocket money.

Informal childcare

A family member, often a grandparent, may agree to take on some of the childcare. Frequently this is part-time, for example one to two days per week, or after the hours of formal childcare.

Questions to consider

While trying to decide which method of childcare would be most suitable for your family - you may want to ask yourself a number of questions beforehand and these include:

Would you rather the childcare take place in your own home or outside it?

If outside it, how far are you able to travel each morning?

Would it be easier to arrange the childcare nearer to home or work?

If you are delayed at work, do you have a back-up plan in place?

What would happen if you are ill? If the child is ill? If a childminder is ill?

What happens during your own or a childminder's holidays?

If there was an emergency would you be able to get to your child quickly?

Will your chosen method of childcare qualify for financial help with childcare costs: working tax credit or childcare vouchers?

If you ask a family member to help out, will they have to reduce their working hours to fit in with yours? Although this may initially look like a 'cheaper' option, you will not be given any financial assistance and may be expected to pay for necessary equipment e.g. car seats, stair gates etc. Will they provide care in your home or theirs? You will need to think about illness and holidays too.

Is there a clear fee structure? Will this include meals, snacks, nappies and days out?

Do they have a notice period if you wish to change childcare?

In addition, depending on the childcare you choose, it's worth considering:

How is discipline enforced? How is positive behaviour reinforced? How is negative behaviour discouraged?

Does the carer have extensive experience of working with babies or children of a similar age to your child?

How qualified are the staff?

What is the staff turnover?

What is the ratio of carer to children? For children aged two years and under, it should be no less than one adult to three children.

Has your carer completed a course in baby first aid?

How frequently are environmental risks assessed?

What are the sleeping arrangements and how are they monitored?

How will you be kept informed on your baby's progress?

If/when a childminder takes the children outside for a walk, to the park, etc, how does she/he ensure safety of them all?

A big factor in deciding on childcare will, of course, also be costs. Why not use the cost of childcare calculator here to estimate how much you might spend on different options?

Holidays and sick days

It would also be helpful to think about holidays and whether your choice of childcare is available all year round.

Is your childcare flexible? Do you need it to be?

Will your child be taken care of if your working day overruns?

Will you be penalised if you take your child out to go on holiday?

Will the chosen method of childcare be offered all year round?

Would you be expected to co-ordinate your holidays with your childminder?

If your baby is sick, what arrangements do you have in place?

If the childminder is sick what will happen?

Choosing the right childcare for you and your children will need some time and attention. It's definitely worth thinking through all of your options to make sure you make the best choice for your family.

Further information

Our support line offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.

Make friends with other parents-to-be and new parents in your local area and see what N CT activities are happening nearby.

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.

Childcare must be registered with Ofsted (England), the Care Inspectorate Scotland and the Care and Social Services Inspectorate Wales (CSSIW).

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Childcare options | Life as a parent, Work and childcare articles & support | NCT

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Within the UK there are a number of childcare options. Here we discuss the different options to help you make a decision on your childcare search that perfectly suits you and your family. Registered with Ofsted (in England), the Care Inspectorate (in Scotland) and Care and Social Services Inspectorate Wales (CSSIW).

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Find out which vaccinations are offered on the NHS, what age you should ideally have them, and why they are safe and important.

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Best Beginnings | Watch Small Wonders online

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Best Beginnings | Watch Small Wonders online

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This information is 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:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

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This information is 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.