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This care checklist covers the level of care you should be offered from the time of your first hospital scan, in addition to the routine care that is offered to all women during pregnancy. It aims to reduce risks and improve outcomes for you and your babies.

You should be seen in a dedicated twins/multiples clinic by a specialist team, who have more knowledge about multiple pregnancies, all the time. This would include a midwife, sonographer and doctor. This pathway is based on national best practice and hospitals receive extra funding to look after multiple pregnancies.

If you arrive at the hospital in labour you should be seen by a senior obstetrician with an expertise in twins/multiples who should produce a clear plan for your babies birth, including monitoring the babies and how they will be born.

If you are not receiving the care you would expect please raise it with the PALS team (patient liaison) at your hospital and let us know - [email protected] . We can then liaise with the hospital regarding the correct level of care that should be offered.

Feel free to share this with your midwifery team and use it as a checklist for each appointment.

Different Types of Multiple Pregnancy

There are different types of multiple pregnancy so each care pathway is slightly different.

Twins can be dichorionic (they have separate placentas) or monochorionic (they share a placenta).

Triplets have a few possible combinations:

Trichorionic - each baby has a separate placenta

Dichorionic - two of the babies share a placenta and the third baby is separate

Monochorionic - all three babies share a placenta

It is possible for twins and triplets to share an amniotic sac as well as a placenta, Monochorionic/Monoamniotic. Although rare, these pregnancies need extra care, closer monitoring by a specialist and an individual care pathway which will include scanning every 2 weeks after 16 weeks gestation. For twins, an earlier birth is recommended between 32-34 weeks. For triplets, the timing of birth will be decided and discussed with you individually and you may also be referred to a different hospital that has more experience of triplet pregnancies

Click the buttons below to see what care you should be receiving for your type of pregnancy.

Twin Pregnancy

Triplet Pregnancy

More information can be found here:
https://www.nice.org.uk/guidance/ng137/informationforpublic https://www.twinstrust.org/pregnancy/antenatal-care

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This care checklist covers the level of care you should be offered from the time of your first hospital scan, in addition to the routine care that is offered to all women during pregnancy. It aims to reduce risks and improve outcomes for you and your babies.

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1.3.8 Offer women with an uncomplicated monochorionic diamniotic twin pregnancy at least 11 antenatal appointments with a healthcare professional from the core team. At least 2 of these appointments should be with the specialist obstetrician.

Combine appointments with scans when crown-rump length measures from 45.0 mm to 84.0 mm (at approximately 11⁺² weeks to 14⁺¹ weeks) and then at estimated gestations of 16, 18, 20, 22, 24, 26, 28, 30, 32 and 34 weeks. [2011, amended 2019]

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This guideline covers the care that should be offered to women with a twin or triplet pregnancy in addition to the routine care that is offered to all women during pregnancy. It aims to reduce the risk of complications and improve outcomes for women and their babies

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This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

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This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

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Breastfeeding Twins and Triplets UK | Facebook

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PLEASE ANSWER THE QUESTIONS REQUESTED. IF YOUR ACCOUNT IS VERY PRIVATE, YOU WILL ALSO BE MESSSAGED. This is a group to support UK based breastfeeding parents nursing twins or triplets. This is a...

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What are steroid injections?

Steroids are human-made versions of hormones. Humans make their own steroid-like hormones, for example cortisol, when we are stressed. You might hear steroid injections called Corticosteroids. If they are given during pregnancy, they are called Antenatal Corticosteroids, or ACS.

Steroids are used in medicine very frequently - you might know someone who has had steroid inhalers for asthma, steroid injections for arthritis, or even steroid cream for skin conditions like eczema. These are just a few examples of the many medical uses of steroids.

Within obstetrics (the field of medicine focused on pregnancy), steroid injections are often recommended if we think that a baby (or babies) are going to be born early. This might be because we have concerns about the mother or gestational parents' health, or concerns about the baby/babies' health and are planning the birth of the baby/babies early. Or it might be that we think someone is in preterm labour or likely to go into preterm labour. This is very difficult to predict!

Why are steriod injections offered during pregnancy?

The reason steroid injections (ACS) will be offered to a pregnant woman (or pregnant person) if we think a baby is going to be born preterm is because steroids cross the placenta and help to mature babies' lungs which may reduce breathing difficulties and the need for high levels of respiratory (breathing) support in the neonatal unit. They are routinely used in singleton pregnancies which deliver very early (before 35 weeks of pregnancy), because there is clear evidence that they reduce the chance of the baby dying or having serious breathing problems.

The evidence about the use of ACS between 35-39 weeks of pregnancy when babies are still early, is less clear. We know that babies born before full term (i.e. 37 weeks) are still more likely to have breathing problems after birth and therefore have a higher chance of needing support from the neonatal unit, especially if born by Caesarean section. However, there is some evidence to suggest that ACS are still helpful and reduce the occurrence of breathing problems in babies born at these gestations too. For this reason, doctors have often offered or recommended ACS before delivery up to 37 weeks, and in the case of Caesarean section up to 39 weeks of pregnancy.

Similarly, twin births have been less well studied and we have less information on the risks and benefits of ACS for twin babies at all gestations. This really matters because people pregnant with twins are actually more likely than people carrying single babies to need to think about having steroids! There is a greater chance of twin babies being born before 37 weeks of pregnancy. Being born slightly early means that twins are at higher risk of admission to neonatal units for support with their breathing, which separates mothers and babies at a crucial time.

Recent evidence has shown that ACS may also have some unwanted side effects such as lowering babies' blood sugars and affecting babies' growth. We don't know how common these side effects are, and if they outweigh the potential benefits of antenatal steroids. Population studies have also suggested that babies who had a course of steroids before birth and were delivered at full term are slightly more likely to have additional needs including ADHD, learning difficulties and autism. These conditions are common, and it is unclear how much steroids are directly associated or whether steroids are more likely to be given in pregnancies at higher risk of complications and differences in brain development later in life. There is very little information in these studies specific to twins.

Because of the lack of evidence, there is currently no guidance on giving ACS in twin pregnancies, so whether or not women pregnant with twins receive steroids as part of routine care varies depending on their hospital. The Royal College of Obstetricians and Gynaecologists advise that doctors should discuss the potential benefits of steroids (reduction in breathing trouble and neonatal unit admission) and the possible drawbacks (higher rates of low blood sugars after birth, differences in growth and brain development) before giving after 34 weeks. This is so that you can make an informed choice. It can be difficult to make a decision when the evidence is unclear! But it's also important that you are aware of the current understanding and the knowledge gaps.

The STOPPIT-3 research study

To understand how we can best treat twins before birth, the STOPPIT-3 research study is currently recruiting across the UK. This trial aims to find out if ACS given to women with a twin pregnancy prior to a planned birth (i.e., an elective caesarean birth or induction of labour) of twins after 35 weeks of pregnancy reduces breathing difficulties in the twin babies. Pregnant women and pregnant people who agree to take part in the trial will be treated with either ACS or a placebo (dummy drug).

The STOPPIT-3 research study will compare the two groups to see if there are differences in the need for extra support after birth. If we find that the use of ACS improves health in twin babies, it could be used across the NHS straight away. If you are interested you can find out more on the study website or ask your hospital team if they are part of the study.
Dr Rosemary Townsend, Consultant Obstetrician, NHS Lothian and Senior Research Fellow, University of Edinburgh Indira Kemp, Research Midwife, Edinburgh Pregnancy Research Team

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Information on steroid injections (Antenatal Corticosteroids, or ACS) given to women expecting twins, triplets or more in pregnancy.

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Why express while pregnant? Being familiar with your breasts and…

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Considering a caesarean birth patient information leaflet | RCOG

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This information is for you if you are considering a planned (elective) caesarean birth for your baby. It may also be helpful if you are a partner, relative or friend of someone who is considering a caesarean birth.

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Top tips for using a dummy

Some research suggests that it is possible that using a dummy during sleep periods could reduce the risk of sudden infant death.

If you choose to use a dummy:

Wait until breastfeeding is well established (usually around 4 weeks old)

Use an orthodontic dummy - it adapts to your baby's mouth shape

Make sure it is part of your baby's regular sleep routine

Stop giving it for sleeps between 6 and 12 months

And here are the things to avoid:

Don't force your baby to take a dummy or put it back in if your baby spits it out

Don't use a neck cord and dummy attachments

Don't put anything sweet on the dummy

Don't offer the dummy during awake time

Dummies and SIDS: FAQs

Why does using a dummy reduce the chance SIDS?

Click here to open this question

We do not know exactly what it is about a dummy that may help reduce the chance of a baby dying of SIDS. As with most of the safer sleep information, we only know that there is good evidence to show:

what you can do to reduce the chance of SIDS

what increases the chance of SIDS

what should be avoided

Does my baby need to use a dummy every day?

Click here to open this question

Regular dummy use is the best way to use a dummy. This means offering your baby a dummy for every sleep, day or night. You and your baby will also find it easier to have a regular sleep routine.

If the dummy falls out of your baby's mouth during sleep, there is no need to put it back in.

Will a dummy make breastfeeding more difficult?

Click here to open this question

If you choose to use a dummy, only introduce it once you have established breastfeeding. The time this takes differs for each person, but it could be a few weeks.

Make sure you get help if you need it. Once breastfeeding is established, introducing a dummy should not have a negative effect.

What if my paediatrician recommends a dummy, but I have not properly established breastfeeding with my baby?

Click here to open this question

There are some situations in which babies are given dummies by medical professionals when breastfeeding has not been established.

Here are some examples:

As a general comforter for babies when they are receiving procedures or on ventilators

To help develop facial muscles in premature babies as they learn to suck

For babies receiving a certain kind of ventilation called CPAP (a dummy helps keep their mouths closed and maintains pressure in their airways)

We recommend that parents follow their health professional's advice in these situations.
What if my baby won't take a dummy?

Click here to open this question

Not all babies like dummies. If your baby repeatedly refuses a dummy, do not force them to take it.

Following other safer sleep advice such as not smoking and placing your baby to sleep on their back will still significantly lower their chance of SIDS.

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Some research suggests that using a dummy while your baby sleeps could reduce the risk of sudden infant death syndrome (SIDS).

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

Your baby may not be ready to breastfeed as soon as they are born. They may not be well enough or strong enough to breastfeed. Some babies who are born at term and sick may find it more difficult to breastfeed because of surgery or difficulties swallowing. Some babies with breathing or heart problems may also have difficulties coordinating breathing and feeding.

If your baby is very premature or sick, they may have to be fed using parenteral nutrition (PN) and/or tube feeding before they are well enough to breastfeed. We have more information about the signs a baby being tube fed may show if they are ready for breast or bottle feeding.

You can still provide breast milk for your baby if they are unable to breastfeed by using a technique called expressing. We have more information about expressing.

Sometimes premature babies need more nutrients than you can provide in your breast milk. If this is the case, your baby's doctor may prescribe a breast milk fortifier (which is usually a powder made from cow's milk) which can be added to breast milk. This can help with growth and bone development.

Some parents may feed their baby through a combination of breastfeeding and bottle feeding. This is often known as mixed or combination feeding. It is recommended that your baby, if possible, establishes breastfeeding before introducing another type of feeding. Combination feeding may be used if there are problems with breastfeeding, such as there not being enough breastmilk, or for other reasons. If you are thinking about mixed or combination feeding, talk to your neonatal team, feeding specialist, midwife, health visitor or GP.

Staff on the neonatal unit may recommend that your baby is fed your breast milk using cup feeding. They might suggest this if your baby is looking to feed but cannot latch onto the breast or is separated from the mother for any reason. If you are unsure, speak to the staff on the neonatal unit.

If you decide not to breastfeed your baby, it is very important that you are given information about the other options that are available. Your baby can still get many benefits of breastmilk if you express. Talk to your midwife, neonatal nurse or health visitor about how you are feeling and how they can support you.

The let-down reflex

Each time you breastfeed your baby, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. At first, this takes a few minutes to be released, but later it will happen within a few seconds.

The let-down reflex feels different to different women. Some women describe a slight pain and some have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage. It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can also help.

How do I start to breastfeed my baby?

You may not know where to start with breastfeeding your baby, especially if your baby has previously been tube fed. A nurse, midwife or feeding specialist (such as an infant feeding coordinator) on the neonatal unit will be able to support you.

Both parents can be involved in breastfeeding, and other people close to you can also provide encouragement and support, such as grandparents. Having as much support as possible can help ensure that you continue to breastfeed when you go home from the neonatal unit. It might be helpful to talk about how you are going to approach breastfeeding with your partner, and how they can best support you. The NHS website has more information about how dads and partners can support breastfeeding, and signposts to more support that is available.

It is important to recognise the signs that your baby is hungry (feeding cues) before breastfeeding. Early feeding cues might include putting their fingers into their mouth, making sucking motions (rooting) and becoming restless.

What breastfeeding positions should I try?

When you are on the neonatal unit, a healthcare professional such as a neonatal nurse or midwife should support you to try to breastfeed your baby. They will help you to find feeding positions that are most comfortable for you. There are positions that may be more suitable for mothers who have had surgery, or whose baby was born premature or sick. Unit staff may recommend that you use pillows to support your arms or back.

If you have twins or multiples, you may also need more support with pillows when feeding, so that you are more comfortable and your babies are supported. Some mothers benefit from a hard pillow that ties at the back or a sling. It can be daunting at first to hold multiple babies at once, but staff in the neonatal unit will help with this. Twins Trust have some more information about breastfeeding multiples that you may find useful.

I am having difficulties getting my baby to breastfeed and latch on. Why is this?

As with all newborn babies, some find breastfeeding easier than others. This can depend on factors such as your baby's age, maturity and any medical conditions they have. It is normal for babies who are born premature or sick to take slightly longer to establish breastfeeding than babies born at term. Every baby is different, and it is important to ask for help and support, especially when you start.

There are some common problems that parents experience when starting breastfeeding. Some babies born premature can be too sleepy to feed effectively, and it can be difficult to get the right position for feeding when your baby is so small. We have a page that lists common problems you may have when breastfeeding or expressing milk for your baby and what can help.

For some mothers, it can take a while to gain confidence in breastfeeding. This is normal, even if you have breastfed before. Having a baby born premature or sick is a unique experience and it is okay to find things difficult at times. Having plenty of support around you can help you build up confidence. We have more information about support you can get with breastfeeding below.

Where can I get help and support with breastfeeding?

Many parents find breastfeeding a rewarding, empowering experience. But establishing breastfeeding can be challenging at times. It can be tiring, especially when you are travelling to and from the unit, and some mothers experience discomfort when they are starting to breastfeed. There are many places where you can get help and support.

Most parents find that having lots of support helps them to get started and to continue to breastfeed. Support can come from your partner, family and friends, and from medical professionals on the unit and at home.

Support on the unit could come from your unit's feeding specialist, a neonatal nurse, or your midwife. Some neonatal units also have a lactation consultant or feeding specialist, who are trained to help parents who are having problems with breastfeeding and expressing.

If you are at home, support with breastfeeding could come from your health visitor, a community neonatal nurse, if you have one, or your GP. You can talk to your health visitor for more information about any breastfeeding support groups in your area. It is always important to speak up and ask if you need more help and support, or if you have questions.

There are also helplines and organisations that can help:

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Find more information about breastfeeding your premature or sick baby here, including how to get started and how to find support.

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Baby product information - The Lullaby Trust

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

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Twins Trust has a team of NCT accredited breastfeeding peer supporters who have all breastfed their multiples.

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A key issue concerning the sleeping arrangements of twins is the question of co-bedding. Little research has addressed the potential benefits and risks of this practice. Past research has tended to focus on twins with special health needs, rather than home sleeping arrangements for healthy, term twins. Nevertheless the practice of co-bedding twin infants is common:

A study carried out in New Zealand, based on postal surveys, investigated the prevalence of co-bedding and SIDS-related child care practices in twins (Hutchinson et al 2010). The researchers stated that despite a lack of evidence of the risks or benefits of co-bedding this practice was very popular, especially among younger twins (52% of 109 twin pairs co-bedded at 6 weeks of age, 31% at 4 months, and 10% at 8 months of age). The authors neither advocate nor warn against the practice of co-bedding due to the lack of sufficient data, and conclude that more research is needed.

Damato et al (2012) based their research on home interviews with parents of 104 pairs of twins in the US. Their study found that more than 65% of twins were co-bedded at 4 weeks of age while 42% of twins were co-bedded by 13 weeks of age. Room sharing was practiced among 64% of families at 4 weeks of age and by 40% by 13 weeks of age.

Ball's studies (2006, 2007) investigated UK parents' perspectives and concerns about co-bedding, and also employed video data to assess potential risks and benefits of co-bedding compared to separate sleeping. In this study, parents of twins were asked to keep sleep logs and were interviewed through mail. At this point parents' reasons for sleeping their twins together or apart were given. Subsequently, the actual sleeping arrangements were recorded and observed. To collect data in the first phase of the research, cameras were installed in participants' homes for two nights. In the second phase, families visited the Sleep Lab for three nights. During both phases parents were asked to behave normally and to put children to bed as they usually do. The study found that:

Co-bedding facilitates rooming-in and thus can influence the reduction of SIDS risk

Make-shift barriers separating co-bedded infants are unnecessary and can result in harm

Hospital practices can influence parents' behaviour - co-bedding was more popular among parents who observed such sleeping arrangements while in hospital

Parents may find that co-bedding makes night-time care easier due to sleep synchronisation of twins

No evidence was found to support parents' concerns about co-bedding (i.e. concerns which led to parents deciding to sleep twins separately - twins disturbing each other, risk of overheating and suffocating). Parents' reasons for sleeping infants together were supported by the observation that co-bedded twins had synchronous sleep patterns and were subjectively easier to care for; this in turn might be connected with co-bedded infants remaining in the parents' room for longer. Neither co-bedding nor separate sleeping resulted in parents obtaining more sleep.

The US National Association of Neonatal Nurses' statement concerning co-bedding of twins and higher order multiples (2011) is non-prescriptive, with the organisation emphasising the lack of sufficient body of knowledge. At the same time the American Academy of Pediatrics (AAP) (Moon et al 2011) recommends against co-bedding twins, justifying this advice with exactly the same argument - the lack of data on the benefits of this practice. However, the AAP does not focus on healthy infants and does not mention the research conducted by Ball (2007). NHS Choices (UK), on the other hand, advises that "You may put your twins to sleep in a single cot while they're small enough, either because they slept together in hospital or because space is tight. This is called co-bedding and is perfectly safe. In fact, putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe them and their twin." (2012)

While most twins are initially co-bedded in a side-by-side position, a great variety of co-bedding configurations are used by parents. These are not all equally safe, and a general rule is that babies cobedded babied should be positioned with their feet to the foot of the cot as for singletons. Diagonal positioning is undafe if used with blankets as these are difficult to secure in this position, but with the use fo sleeping bags is less hazardous. Parents should avoid cobedding twins in a moses basket or small bassinette due to lack of space.

It is important that parents are aware that it is the presence of an adult carer that is associated with reduced SIDS risk, rather than the presence of another infant, and that general infant sleep safety recommendations apply just as with singletons.

Co-regulation and the stress response

Prior to birth the twin fetuses are in constant contact in utero, giving rise to a synchrony in movement and co-regulation in biological measures (Gallagher et al., 1992; Klaus & Klaus, 2000; Nyquist & Lutes, 1998; Touch et al., 2002; Sherer et al., 1990). Once birthed, they are uniquely adapted to develop alongside their twin counterpart. It is therefore thought that close contact is beneficial to their wellbeing in the extrauterine environment (Hayward et al., 2015; Nyquist & Lutes, 1998).

The benefits of twin co-bedding are still being investigated. Hayward et al (2015) found co-bedding preterm twins had fewer adverse health issues and longer durations of quiet sleep than non-co-bedding preterm twins. Co-regulation of infant heartbeats means that co-bedding infants have significantly lower heart rates and thus have a lower stress levels overall (Hayward et al., 2015; Byers et al., 2003; Stainton et al., 2005).

Co-bedding and co-regulation can be important in medical situations. Twins and higher order multiples are more likely to be born preterm and require some medical intervention. However it has been shown that co-bedding twins provides comfort to infants undergoing stressing procedures, comparable to the presence of a mother ( Campbell-Yeo et al, 2009).

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A key issue concerning the sleeping arrangements of twins is the question of co-bedding. Little research has addressed the potential benefits and risks of this practice. Past research has tended to focus on twins with special health needs, rather than home sleeping arrangements for healthy, term twins.

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Babies cry, you can cope When babies cry it can be stressful and overwhelming. Help is out there and all you need to do is ask. Latest news Testimonials

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Support for mums and families | Maternal Mental Health Alliance

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© Maternal Mental Health Alliance 2023. Maternal Mental Health Alliance is a charitable Incorporated Organisation (CIO) registered in England and Wales No. 1178152. Registered address International House, 12 Constance Street, London E16 2DQ.

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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

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We offer a variety of courses for parents of twins, triplets and more including first aid and safety courses.

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Postnatal depression (PND) is a type of depression that many parents experience after having a baby. It can affect any parent, regardless of whether they've suffered from a mental health condition before. Postnatal depression is linked directly to giving birth and is a common problem, affecting 1 in 10 women within a year of giving birth.

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Baby Check App

Baby Check features 19 simple checks that parents can do if their baby is showing signs of illness. Each check tests for a different symptom and when completed, a score is calculated that tells parents or carers how ill their baby is. The app then lets parents know whether their baby needs to see a doctor or health professional.

Download for FREE from Google Play or the App Store.

Buy posters, business cards and other materials to help promote Baby Check to your clients and patients

Shop

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The Baby Check App helps parents decide if their baby needs to see a doctor or health professional

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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.

Latest

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

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Going home from the neonatal unit leaflet

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This information has been written to help parents with any questions they might have when their baby is ready to leave the neonatal unit.

This guide explains how to prepare for life at home as a new family, what support is available to parents and what to do if their baby becomes unwell.

Weaning card

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A double-sided A5 info card to give to parents with top tips on weaning your premature baby.

You could also direct parents to the weaning information on our website (or tell them to search on the Bliss site for 'weaning').

Weaning your premature baby

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Our guide to help parents introduce their premature baby to solid foods.

You could also direct parents to the weaning information on our website (or tell them to search on the Bliss site for 'weaning').

Common infectious illnesses

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Information for parents about common infectious illnesses, how you can help prevent your baby catching them, and what to do if you're worried about your baby's health.

You could also direct parents to the common infectious illnesses info on our website (or tell them to search on the Bliss site for 'common infectious illnesses').

Look at me - I'm talking to you

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An A5 information guide about watching and understanding signals and cues from a premature baby.

Translated from the French publication Je vous parle, regardez-moi! Produced by SPARADRAP.

Skin to skin with your premature baby

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An A5 information guide to help parents do skin-to skin with a baby in neonatal care.

You could also direct parents to the skin-to-skin information on our website (or tell them to search on the Bliss site for 'skin-to-skin').

Getting involved info card

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An A5 double sided info card giving parents tips on how to get involved in their baby's care on the unit.

You could also direct parents to the looking after your baby on the neonatal unit (or tell them to search on the Bliss site for 'looking after your baby' or 'family centred care').

Mental health info card

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A double sided A5 info card giving parents tips on how to look after their mental health whilst on the neonatal unit.

You could also direct parents to the information on mental health on our website (or tell them to search on the Bliss site for 'mental health').

About neonatal care leaflet

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This leaflet has been written especially to answer the questions parents might have when they first arrive on the unit.

It explains how neonatal care works, who parents might see on the unit, what the equipment does, the care their baby might get, and how they can parent their baby on the unit. It also has helpful ideas for getting more support, and places to write down questions parents might have, or notes on how they're feeling.

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Download now This information has been written to help parents with any questions they might have when their baby is ready to leave the neonatal unit. This guide explains how to prepare for life at home as a new family, what support is available to parents and what to do if their baby becomes unwell.

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Child car seat safety advice and information to keep your children safe when they travel.

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Keep your baby close and keep your baby safe. When you're wearing a sling or carrier, don't forget the T.I.C.K.S.

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Good hygiene is very important when making up a formula feed.
Your baby's immune system is not as strong as an adult's. That's why bottles, teats and any other feeding equipment need to be washed and sterilised before each feed.

This will reduce the chance of your baby getting an infection, in particular diarrhoea and vomiting.
Find out more about sterilising baby bottles

Product recall: Elecare Similac and Alimentum Similac powdered formula

Some batches of Elecare Similac and Alimentum Similac powdered formula, made by Abbott, have been recalled as a precaution because they may contain bacteria. If you have bought or been prescribed either of these types of formula, return them to where you got them from and do not give them to a baby.
Find out more from the Food Standards Agency

Step-by-step guide to preparing a formula feed

Step 1: Fill the kettle with at least 1 litre of fresh tap water (do not use water that has been boiled before).

Step 2: Boil the water. Then leave the water to cool for no more than 30 minutes, so that it remains at a temperature of at least 70C.

Step 3: Clean and disinfect the surface you are going to use.

Step 4: It's important that you wash your hands.

Step 5: If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse them with cooled boiled water from the kettle (not tap water).

Step 6: Stand the bottle on the cleaned, disinfected surface.

Step 7: Follow the manufacturer's instructions and pour the amount of water you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first, while it is still hot, before adding the powdered formula.

Step 8: Loosely fill the scoop with formula powder, according to the manufacturer's instructions, then level it using either the flat edge of a clean, dry knife or the leveller provided. Different formulas come with different scoops. Make sure you only use the scoop that comes with the formula.

Step 9: Holding the edge of the teat, put it into the retaining ring, check it is secure, then screw the ring tightly onto the bottle. Make sure the ring is attached firmly.

Step 10: Cover the teat with the cap and shake the bottle until the powder is dissolved.

Step 11: It's important to cool the formula so it's not too hot to drink. Do this by holding the bottle (with the lid on) under cold running water.

Step 12: Test the temperature of the formula on the inside of your wrist before giving it to your baby. It should be body temperature, which means it should feel warm or cool, but not hot.

Step 13: If there is any made-up formula left in the bottle after a feed, throw it away.

Dos and don'ts of making up formula feeds

Do follow the manufacturer's instructions very carefully, as they vary as to how much water and powder to use.

Do not add extra formula powder when making up a feed. This can make your baby constipated or dehydrated.

Do not add extra water when making up a feed. Too little powder may not give your baby enough nourishment.

Do not add sugar or cereals to your baby's formula.

Never warm up formula in a microwave, as it may heat the feed unevenly and burn your baby's mouth.

Reducing the risk of infection

Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria.

Bacteria multiply very fast at room temperature. Even when a feed is kept in a fridge, bacteria can still survive and multiply, although more slowly.

To reduce the risk of infection, it's best to make up feeds 1 at a time, as your baby needs them.

Use freshly boiled drinking water from the tap to make up a feed. Do not use artificially softened water or water that has been boiled before.

Leave the water to cool in the kettle for no more than 30 minutes. Then it will stay at a temperature of at least 70C. Water at this temperature will kill any harmful bacteria.

Remember to let the feed cool before you give it to your baby. Or you can hold the bottle (with the lid on) under cold water from the tap.

Do not use bottled water to make up formula feeds

Bottled water is not recommended for making up feeds, as it's not sterile and may contain too much salt (sodium) or sulphate.

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How to make up formula milk feeds for your baby correctly and safely.

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This technique involves expressing colostrum in the final few weeks of pregnancy. It can also be referred to as 'colostrum harvesting' and is advocated by some NHS Trusts.

Mothers are normally advised to wait until around 36 weeks before starting antenatal expression. Mums who are having multiple births may sometimes start sooner as giving birth earlier is more likely.
Why do it?
For some mothers, it can be a useful tool that helps ensure their baby will start life without the need for formula supplementation. The importance of exclusive breastfeeding for all babies has been well-established by scientific research.

Colostrum contains vital immunological properties and helps to colonise the baby's gut with healthy bacteria that protect against allergy and disease.

It also contains the perfect balance of proteins, fats and micronutrients needed for human babies as well as acting as a laxative to help the passing of the first tarry meconium stools.

Some babies may experience difficulties with feeding or maintaining their blood sugar levels during the first few days after birth and therefore may require supplementary feeds.

These include babies:

whose mother had diabetes in pregnancy or who has a history of diabetes.

with a cleft lip or palate identified during pregnancy.

with congenital conditions e.g. Down syndrome or cardiac complications.

diagnosed with intrauterine growth restriction.

whose mother is taking beta blockers to control high blood pressure.

who are twins or triplets.

Where there is a family history of cow's milk protein sensitivity or type 1 diabetes, families may be particularly keen to avoid the use of early formula supplementation.

Some women may need to consider supplementing feeds from an early stage if there are concerns over their ability to make and/or secrete milk.

These include women:

who have a breast hypoplasia (limited breast development).

who have had previous breast surgery.

It is important for a mother to discuss her plans to express antenatally with her healthcare provider. It may not be recommended if you've been at risk of preterm labour in previous pregnancies, or have a surgical stitch, for example.

It is recommended to express antenatally by hand rather than use an electric or manual breast pump. Colostrum will be produced in quite small quantities and can easily stick to the bottles or pump parts and be harder to collect. A pump at this stage is likely to be more uncomfortable than gentle hands. Try hand expressing for a few minutes, 2 or 3 times a day.

If you hand express and use a syringe to draw up the individual drips of colostrum, you can use these syringes for storage prior to birth. Your health care provider may be able to supply you with sterile syringes.
How to hand express:

Always wash your hands before expressing.

Applying a warm compress to your breast or expressing after a warm bath or shower can help the flow of colostrum.

Get yourself comfortable. Perhaps seated and leaning slightly forward but find what works best for you.

Start with a gentle breast massage, stroking from the back of your breast towards the nipple to encourage the let-down reflex.

Put your thumb above the nipple and your first few fingers below the nipple. You will be cupping the breast in a 'C' shape.

With your thumb and fingers, feel a few centimetres back from the nipple.

Press back towards your chest, then compress (press your fingers together), and release.

Repeat this process, building up a rhythm. Press, compress, release.

It may be useful to look online for videos of hand expression techniques.

Colostrum should start to arrive drop by drop. Initially it may just be a glisten on the end of your nipple, and it may take a few days of practice before drops appear.

Collect the colostrum into a clean container, like a syringe (1ml or 2ml syringe). If nothing happens, adjust your finger position slightly to find the spot that works for you. Try not to pinch your nipple or slide your fingers uncomfortably over the skin.

Rotate the position of your fingers and thumb around the areola (imagine a clock face) and repeat the expressing process to stimulate and remove colostrum from different parts of your breast.

Express each breast twice during each session.

Colostrum can vary in appearance. Sometimes it may appear quite thick and yellow or orange and at other times paler and thinner. Expressing colostrum antenatally will not decrease or increase your milk supply after baby is born.
Storage of human breast milk
Colostrum can be collected two to three times each day in the same syringe. You will need to store the syringe in the fridge between uses.

At the end of the collecting day, the colostrum can be frozen - place the syringe into a zip-lock bag before putting into the freezer. Label the syringe and bag (separately) with the date and time of when you expressed.

The frozen colostrum can be stored for up to six months in the freezer. Once thawed, it should be used within 24 hours.
Is it safe?
The oxytocin hormone released when expressing, stimulates the uterus. Opinions differ on whether expressing colostrum antenatally is likely to induce labour. Those who advocate it do not believe that expressing would constitute sufficient stimulation to start labour. Sex while pregnant and breastfeeding through pregnancy both release oxytocin and both are generally considered safe while pregnant. If you experience any cramping in your uterus however, you should stop expressing and discuss your choice with your healthcare provider.
Transporting your frozen colostrum
You can take syringes of frozen colostrum into hospital using a freezer block and insulated bag. The colostrum can be defrosted under a running warm tap or at room temperature.

It's a good idea to mention your colostrum stores on your birth plan and make sure staff are aware in advance of your wishes in certain situations. The hospital may have access to a freezer for storage once you arrive.

After the birth, breastfeeding should usually be unrestricted. Ideally, a baby should feed successfully at the breast and the antenatally expressed colostrum would remain unused.

If your baby is experiencing difficulties with breastfeeding at this time, you may be encouraged to express some fresh colostrum to give to your baby. You may also use any colostrum you have brought into hospital with you in preference to using any formula.

If harvested colostrum ends up being 'wasted' because you are able to establish early exclusive breastfeeding, this is a cause for celebration rather than commiseration!

The process of antenatal expressing however, gives you a back-up if things don't go to plan which many families find reassuring. You'll also start your breastfeeding with a good sense of how to hand express and confidence about how your breasts work.

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Expressing your milk before your baby arrives - ABM

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Antenatal expressing is expressing colostrum in the final few weeks of pregnancy. Find out if it could be a useful tool for you.