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An induced labour is one that's started artificially. Every year, 1 in 5 labours are induced in the UK.

An induction will usually be planned in advance and is offered for a multitude of reasons, such as:

Maternal Health

Pregnancy Complications

Babies health

Post dates (after your due date)

A discussion will have taken place between you, your midwife and the obstetrician to ensure you are fully informed and happy with the decision for IOL.

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To book onto your virtual antenatal sessions please email:

NewBeginingsAntenatal@uhcw.nhs.uk or visit our Linktree page https://linktr.ee.com/uhcwantenataleducation

Use the QR codes to access booking information or contact the email address for more information.

You will need to tell us what sessions you would like to attend with your preferred date of attendance.

The email is monitored Monday - Friday excluding bank holidays.

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A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.

The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it's usually only done if it's the safest option for you and your baby.

Around 1 in 4 pregnant women in the UK has a caesarean birth.

There are a multitude of reasons why a caesarean section may be offered to you, and you should discuss this with your midwife and obstetrician to ensure you are fully informed.

You can have 1 birth partner with you in theatre and a midwife will stay with you throughout.

Delayed cord clamping is routinely done within our trust. In prevent your baby from becoming cold, we will adhere to at least 1 minute of delayed cord clamping in theatre. This is so your baby will receive their own blood from their cord which can help reduce the risk of becoming cold (hypothermia), reduce the risk of neonatal jaundice and helps to boost your baby's' iron levels for the first 6 months of life!

You can still have skin to skin with your baby and we will always try to facilitate whatever we can to make your birth as enjoyable as possible - whether that be choosing what song you would like your baby to be born to, to having skin to skin whilst in theatre, please speak to you midwife about your birth preferences.

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Have you thought about completing a birth plan, but just weren't sure about what to write or where to start? NHS Choices have a birth plan template (attached).

A birth plan is a chance for you and your partner to discuss important elements from the labour room.

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This video covers the preparation  from and antenatal perspective.

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It's a great idea for partners who will be accompanying you in labour to either pack the hospital bag themselves or to pack the bag with you.

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Braxton Hicks contractions are the body's way of preparing you for labour, but if you have them it doesn’t mean your labour has started.

Here, we explain more about Braxton Hicks:

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What are Braxton Hicks?

Braxton Hicks are when the womb contracts and relaxes. Sometimes they are known as false labour pains.

Not all women will have Braxton Hicks contractions. If you do, you'll usually feel them during the second or third trimester.

Braxton Hicks are completely normal and many women experience them during pregnancy. Your midwife will probably talk to you about them at some point, and you can ask questions at any time. You may also learn more about them during antenatal classes.

What do Braxton Hicks feel like?

They may be uncomfortable, but they are not painful. Women often describe Braxton Hicks contractions as feeling like mild menstrual cramps or a tightening in a specific area of the stomach that comes and goes.

"I find them like a mild stitch that goes almost as quickly as it comes. Not painful but you're definitely aware it's there. You will soon realise when you do go into labour that Braxton Hicks cannot be mistaken for labour pains."

Claire

"I have had Braxton Hicks, but I didn't know I was experiencing it - it was only because I was at the day assessment unit because I was concerned with the movements of baby that the midwife told me I was experiencing them. I asked the midwife that saw me if they were 'practice contractions' and she said they weren't contractions."

Kim

"For me the Braxton Hicks make my bump feel really tight as if my skin is being stretched, my bump also goes solid! Although not painful they can feel intense when I am out on a long walk with my family!"

Sarah

Why will I get Braxton Hicks?

We don't really know why women get Braxton Hicks contractions. But we do know some of the things that trigger them, such as:

being very active

having a full bladder

having sex

being dehydrated.

What's the difference between Braxton Hicks and labour contractions?

Unlike labour contractions, Braxton Hicks contractions:

vary in length and strength

happen infrequently, are unpredictable and non-rhythmic

are more uncomfortable than painful

do not increase in frequency, duration or intensity

lessen and then disappear, only to reappear at some time in the future.

Compared with Braxton Hicks, labour contractions:

are noticeably, and increasingly, longer

are more regular

are more frequent

are painful

increase in intensity.

Nearer the end of your pregnancy, Braxton Hicks contractions may form more of a pattern and increase in frequency and intensity. Lots of women often mistake Braxton Hicks contractions for the start of labour. But, unlike labour contractions, Braxton Hicks contractions do not cause the cervix (the entrance to the womb) to open (dilate).

How are Braxton Hicks contractions treated?

There is no treatment for Braxton Hicks contractions. But there are things you can do to ease them, such as:

changing position

lying down if you've been very active - find out more about exercise in pregnancy

going for a walk if you've been sitting down for a long time

relaxing, such as taking a warm bath, having a massage, or having a nap

drinking some water to rehydrate.

When should I contact my midwife?

It's always best to contact your midwife or maternity unit for advice if you are not sure whether you are having Braxton Hicks or labour contractions.

It's also a good idea to call them if the tightenings continue, especially if you are less than 37 weeks pregnant.

Call your midwife or maternity unit straight away if:

you have any vaginal bleeding

your waters break

you have strong contractions every five minutes that last 30-60 seconds)

these twinges become very painful

you have any concerns about your baby's movements.

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Braxton Hicks are when the womb contracts and relaxes. Sometimes they are known as false labour pains. Not all women will have Braxton Hicks contractions. If you do, you'll usually feel them during the second or third trimester. Braxton Hicks are completely normal and many women experience them during pregnancy.

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The start of labour is called the latent phase. This is the very first part of your labour, the early part of the first stage. Before labour starts, the cervix is long, situated towards the back of your pelvis, firm and closed. During the latent phase, the muscles of the uterus (womb) contract and make the cervix become thinner and softer. This is called effacement or thinning. During the latent phase the cervix thins out and opens up to 3- 4cm.

The latent phase of labour is classified until the cervix has reached 4cm dilated. For this to happen, you’ll start having contractions, which may be irregular and vary in frequency, strength and length. The latent phase can also stop and start frequently and can continue over a period of time spanning a couple of days to weeks.

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The active stage of labour is also known as established labour. This is when your cervix continues to dilate from 4cm to 10cm. The difference between the latent phase and the active phase is that the contractions will become more stronger, longer and more regular.  You will continue to contract until your baby has been delivered.

Your midwife will offer you assessment tools during labour to assess you and baby.

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This stage is when your body has reached 10cm dilated and your baby has now assed through the cervix and is travelling down through the birth canal.

This stage is also known as the pushing stage. Pushing a baby is hard work and can take (on average) around 1 hour to deliver your baby.

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The third stage of labour is the delivery of your placenta.

The placenta is delivered after the birth of your baby and can take up to 1 hour depending on your preference.

After delivery the midwife will offer you an injection of a small dose of synthetic concentration of the hormone oxytocin.  This injection will encourage your uterus to contract up small and separate your placenta from the uterine wall. This option is called an ACTIVE third stage of labour and usually takes around 15 - 20 minutes to deliver your placenta.

Alternatively you can have a PHYSIOLOGICAL third stage of labour. This means that your body will use its own oxytocin hormone and contact the uterus up small and encourage the placenta to separate from the uterine wall to allow for delivery. This method usually takes around 1 hour

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What pain relief is available to me during labour?

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What pain relief is available to me during labour?

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During labour you can use the following as pain management:

Water - This can either be a warm bath at home during the latent phase or a pool birth in the active phase of labour. The water works by immersing your abdomen and can help diminish stress hormones (catecholamines) and reduce the pain felt by increasing the body's production of pain relievers (endorphins). It can also ease muscular tension and encourage you to relax between contractions.

TENS Machine - A TENS machine works by sending mild electrical impulses to sticky pads on your lower back. TENS is thought to work as the electrical pulses stimulate nerves that run to the spinal cord and block the transmission of pain. The electrical pulses can also act as a distraction tool and restoring a sense of control.

Its important to note that UHCW does not provide TENS machines and these will need to be hired or purchased privately.

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

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

Side effects:

There are no harmful side effects for you or the baby

It can make you feel lightheaded

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

Pethidine/Diamorphine - 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.

It can make you feel sick therefore you may be given an anti-sickness medication at the same time to help alleviate this possible side effect.

Side effects

There are some side effects to be aware of:

It can make some women feel woozy, sick and forgetful

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

These medicines can interfere with the baby's first feed.

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

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

An anesthetist is the only person who can give an epidural, so it will not be available at home.

Please see the epidural pin below for side effects and other useful information.

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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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Find out about the different methods of pain relief in labour, including self-help, gas and air, birth pools, pethidine and epidurals.

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Epidural information Card

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This is a summary. There is fuller information in the Pain Relief in Labour section. Please discuss anything that is not clear with your anaesthetist.

Setting up your epidural

You will need to have an intravenous cannula and maybe a drip.

While the epidural injection is being put in, it is important that you keep still and let the anaesthetist know if you are having a contraction.

Usually takes 20 minutes to set up and 20 minutes to work.

Some epidurals do not work fully and need to be adjusted or replaced.

Advantages of an epidural

Usually provides excellent pain relief.

Sometimes a spinal is given first for a quicker effect.

The dose or type of local anaesthetic can sometimes be altered to allow you to move around the bed. This is a low-dose (or mobile) epidural.

In general epidurals do not affect your baby.

Can be topped up for caesarean section if required.

Possible problems with your epidural

Repeated top-ups with stronger local anaesthetic may cause temporary leg weakness and increase the risk of forceps or ventouse delivery.

The epidural may slow down the second stage of labour slightly.

You may develop low blood pressure, itching or a fever during the epidural.

The epidural site may be tender but usually only for a few days. Backache is NOT caused by epidurals but is common after any pregnancy.

Type of risk

How often does this happen?

How common is it?

Severe headache

One in every 100 women (epidural)
One in every 100-200 women (spinal)*

Uncommon

*Subject to individual unit variation

The information available from the published documents does not give accurate figures for all of these risks. The figures shown above are estimates and may be different in different hospitals.

March 2021 Edition

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This is a summary. There is fuller information in the Pain Relief in Labour section. Please discuss anything that is not clear with your anaesthetist. Setting up your epidural You will need to have an intravenous cannula and maybe a drip.

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Its very difficult to decide on a position before you are in labour as you do not know how you will feel. Therefore, Its important to familierise yourself with various positions that may aid your coping mechanisms in labour.

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During labour we monitor a number of observations for you and baby to ensure that you both are coping with the process of labour. We will always ask your consent to complete these observations, and if you have any concerns please discuss with your midwife.

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These are the observations a midwife will ask your consent for during labour...

Blood pressure, pulse, temperature - to ensure it's with normal range
Urine output - This can delay the second stage of labour if the bladder is full
Vaginal examination - This is an internal examination where the midwife or doctor will assess the position of baby and the dilatation of your cervix.

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During labour your midwife will check on how your baby is coping during your labour. There are different ways to do this.

Intermittent Monitoring - If your pregnancy has been considered low risk with no risk factors present at the time of delivery your midwife will listen to your baby's heartbeat using a Sonicaid. This is the small, hand-held machine like the one the midwife will have used at your antenatal appointments. Your midwife will listen to your babies heart rate every 15 minutes in the first stage of labour and every 5 minutes in the second stage of labour until your baby has been delivered.

CTG Monitoring -Normally used if you are considered to have a high risk pregnancy or other risk factors present at the time of delivery. Electronic monitoring involves strapping two plastic pads to your bump. These are attached to a monitor that shows your baby's heartbeat and your contractions. We will monitor continuously until your baby has been delivered.

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Please be aware that this video was created pre-COVID-19 - and some slight changes have been made to the visiting times.

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The first part of labour is divided into two phases - Latent phase & Active phase.

Follow the link to read more about signs that labour may be starting.

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Know the signs

There are several signs that labour might be starting, including:

contractions or tightenings

a "show", when the plug of mucus from your cervix (entrance to your womb, or uterus) comes away

backache

an urge to go to the toilet, which is caused by your baby's head pressing on your bowel

your waters breaking

The early (latent) stage of labour can take some time.

Coronavirus update

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 pregnant women to go to appointments.

If you get symptoms of coronavirus, or you're unwell with something other than coronavirus, speak to your midwife or maternity team. They will advise you what to do.
Find out more about pregnancy and coronavirus

Latent phase of labour

The start of labour is called the latent phase. This is when your cervix becomes soft and thin, and starts opening for your baby to be born. This can take hours or sometimes days.

You'll probably be advised to stay at home during this time. If you go to the hospital or maternity unit, they may suggest you go back home.

Find out more about the stages of labour and what you can do at home during the latent phase.

Call your midwife if you're unsure or worried about anything.

What do contractions feel like

When you have a contraction, your womb tightens and then relaxes. For some people, contractions may feel like extreme period pains.

You may have had contractions during your pregnancy, particularly towards the end. These tightenings are called Braxton Hicks contractions and are usually painless.

Your contractions tend to become longer, stronger and more frequent as your labour progresses. During a contraction, the muscles tighten and the pain increases. If you put your hand on your abdomen, you'll feel it getting harder; when the muscles relax, the pain fades and you will feel the hardness ease.

The contractions are pushing your baby down and opening the entrance to your womb (the cervix), ready for your baby to go through.

Your midwife will probably advise you to stay at home until your contractions become frequent.

Call your midwife or maternity unit for guidance when your contractions are in a regular pattern and:

last at least 60 seconds

come every 5 minutes or

you think you are in labour

Read more information on when to go to hospital

Backache often comes on in labour

You may get backache or a heavy, aching feeling.

A "show" can signal the start of labour

During pregnancy, there's a plug of mucus in your cervix. This mucus comes away just before labour starts, or when in early labour, and it may pass out of your vagina. This sticky, jelly-like pink mucus is called a show.

It may come away in 1 blob or in several pieces. It's pink because it contains a small amount of blood.

If you're losing more blood, it may be a sign something is wrong, so phone your hospital or midwife straight away.

A show indicates that the cervix is starting to open. Labour may quickly follow or may take a few days. Sometimes there is no show.

What happens when my waters break

It's likely your waters will break during labour, but it can also happen before labour starts.

Your baby develops and grows inside a bag of fluid called the amniotic sac. When it's time for your baby to be born, the sac usually breaks and the amniotic fluid drains out through your vagina. This is your waters breaking. Sometimes when you're in labour, a midwife or doctor may offer to break your waters.

If your waters break naturally, you may feel a slow trickle or a sudden gush of water you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you're going out, and put a protective sheet on your bed.

Amniotic fluid is clear and pale. Sometimes it's difficult to tell amniotic fluid from urine. When your waters break, the water may be a little bloodstained to begin with.

Tell your midwife immediately if:

the waters are smelly or coloured

you're losing blood

This could mean you and your baby need urgent attention.

If your waters break before labour starts, call your midwife. Use a sanitary pad (not a tampon) so your midwife can check the colour of the waters.

If labour does not start after your waters break

It's usual to go into labour within 24 hours of the waters breaking. You'll be offered an induction if you do not because, without amniotic fluid, there's an increased risk of infection for your baby.

Until your induction, or if you choose to wait for labour to start naturally, tell your midwife immediately if:

your baby moves less than usual

there's any change in the colour or smell of any fluid coming from your vagina

You should take your temperature every 4 hours when you're awake, and tell your midwife if it's raised. A raised temperature is usually above 37.5C, but you may need to call before this - check with your midwife.

There's no evidence that having a bath or shower after your waters have broken increases your risk of infection, but having sex might.

How to cope when labour begins

At the beginning of labour, you can:

walk or move about, if you feel like it

drink fluids - you may find sports (isotonic) drinks help keep your energy levels up

have a snack, if you feel like it

try any relaxation and breathing exercises you've learned to deal with contractions as they get stronger and more painful - your birth partner can help by doing these with you

have your birth partner rub your back - this can help relieve pain

take paracetamol according to the instructions on the packet - paracetamol is safe to take in labour

have a warm bath

Find out what happens during labour and birth, and what you can do for pain relief in the early stages of labour.

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There are several signs that labour might be starting, including: contractions or tightenings a "show", when the plug of mucus from your cervix (entrance to your womb, or uterus) comes away backache an urge to go to the toilet, which is caused by your baby's head pressing on your bowel your waters breaking The early (latent) stage of labour can take some time.

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Find out more here:

https://www.nct.org.uk/pregnancy/worries-and-discomforts/common-discomforts/how-do-perineal-massage-step-step-guide

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Research shows perineal massage in the third trimester is likely to reduce your chances of perineal trauma (Abdelhakim et al, 2020). What's more, most mums-to-be who tried perineal massage felt comfortable and positive about their experience. They said they'd do it again in another pregnancy and would recommend it to others (Labrecque et al, 2001).

The perineum is the skin and muscle between vagina and anus. You can massage your perineum by yourself, or with your partner if you'd prefer.

Perineal massage aims to stretch, usually using two fingers, the perineal tissues ready for birth.

You can start practising perineal massage whenever you like, and many women will start during the third trimester. Avoid perineal massage if you have vaginal herpes, thrush or a vaginal infection (Oxford University NHS Trust, 2014). Here's what you'll need:

Clean hands and short nails to protect the delicate tissues in your vagina and perineum (RCOG, no date).

Unscented lubricant or oils - eg. vitamin E oil, almond or olive (RCOG, no date). Unscented personal lubricant would be fine.

One or two pillows might be handy for your comfort - if you'd prefer to sit or lie back. Some people find it pleasant to relax in a bath first. Other people prefer to do the massage standing.

Some people find it helps to use a mirror so they can see what they're doing.

1. Be prepared

Wash your hands thoroughly and make sure your or your partner's (if they're helping) fingernails are short.

Find somewhere you can relax, uninterrupted and in privacy with your legs open wide and your knees bent.

Make sure you have your chosen oil and your mirror handy if you need it.

2. Find a comfy position for you

You could try:

being propped up with pillows on a bed or sofa so you or your partner can reach your perineum more easily

reclining in the bath with one leg up on the side at a time

standing in a warm shower with one leg up on a stool before you change legs

sitting on the toilet.

3. Lubricate your perineum

Put some oil on your perineum and the lower part of your vaginal opening. This helps to make the massage more comfortable.

4. Relax and start the massage

Taking some deep breaths might help you relax.

1. Put your thumbs about 2.5cm to 4cm just inside the back wall of your vagina. You might find it easier to use a mirror the first few times.

2. Press down towards your anus and to the sides. You should feel a bit of a stretching feeling.

3. Hold this stretch for about one to two minutes.

4. Then gently massage the lower bit of your vagina for around two to three minutes, focusing on relaxing your perineum. Massage using your thumbs upwards and outwards then back again in a U-shaped movement. You could practice your slow, deep breathing techniques while you do this. (RCOG, no date) Repeat this two to three times (RCOG, no date).

5. Some people will focus the massage on any previous scar tissue.

Perineal massage shouldn't hurt, though you may feel pressure in the first few weeks of starting, which should ease.

5. Partner involvement

It can be difficult to massage your perineum by yourself in the later stages of pregnancy.

You might want to start off doing the perineal massage yourself. Then as you get nearer to the due date, if you feel comfortable doing so you could ask your partner to do it.

Simply follow the same method as before. The only difference is that your partner will use their index fingers rather than thumbs to perform side-to-side and U-shaped downward pressure.

6. Keep up the routine

Repeat daily or when possible.

Fit it into your daily or weekly routine, for example during or after a bath or shower. This is a good time because blood vessels in the area are already dilated, making the perineum softer and more comfortable to massage. You will also be more relaxed.

7. Support is available

Perineal massage shouldn't be painful although there might be some discomfort to begin with. If you're concerned about any pain, or you need further information or support with perineal massage, talk to your midwife or GP.

Abdelhakim, A.M., Eldesouky, E., Elmagd, I.A. et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J 31, 1735-1745 (2020). https://doi.org/10.1007/s00192-020-04302-8&nbsp;

Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005123.pub3/abstract;jsessionid=CF32264FB13246A8540B877017B34E8C.f02t04 [Accessed 1st September 2018]

Labrecque M, Eason E, Marcoux S. (2001) Women's views on the practice of prenatal perineal massage. BJOG. 108(5):499-504. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2001.00111.x [Accessed 1st September 2018]

Oxford University Hospitals NHS Trust (2017) Antenatal perineal massage. Available from:

https://www.ouh.nhs.uk/patient-guide/leaflets/files/10938Pmassage.pdf [Accessed 1st September 2018]

RCOG (no date) Reducing your risk of perineal tears. Available at : https://www.rcog.org.uk/en/patients/tears/reducing-risk/&nbsp;

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How to do perineal massage: a step-by-step guide | Pregnancy, Worries and discomforts articles & support | NCT

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So you know perineal massage might help you to avoid perineal tears and you're keen to try it out. Read on for our guide to how to massage your perineum.

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Pelvic floor exercises are extremely important in pregnancy. IT is recommended you do at least 10 per day prenatally and then into the postnatal period.

https://www.nct.org.uk/pregnancy/exercise-and-fitness/pelvic-floor-and-stomach-exercises-pregnancy

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How and when should I do pelvic floor exercises? | NHS

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Your babies movements in the third trimester 

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Your babies movements in the third trimester 

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Your babies movements will not 'slow down' or reduce towards the end of pregnancy. Its is very important you are aware of your babies movements.

If you have any concerns then please contact our fetal wellbeing unit - 024 7696 7427

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Water birth is the process of giving birth in water using a deep bath or birthing pool. Being in water during labour is shown to help with pain as well as being more relaxing and soothing than being out of water. The water can help to support your weight, making it easier to move around and feel more in control during labour.

https://www.tommys.org/pregnancy-information/giving-birth/where-can-i-give-birth/how-prepare-water-birth

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TENS stands for transcutaneous electrical nerve stimulation. It’s a form of pain relief that you can control with a hand-held device.

A TENS machine works by sending mild electrical impulses to sticky pads on your lower back. TENS is thought to work as the electrical pulses stimulate nerves that run to the spinal cord and block the transmission of pain.

TENS might also work by providing a distraction and restoring a sense of control, both of which may lessen the anxiety that can delay the progress of  labour.

Find out more here:

https://www.nct.org.uk/labour-birth/your-pain-relief-options/labour-pain-relief-tens-machine

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Group B strep is a type of bacteria called streptococcal bacteria.

It's very common – up to 2 in 5 people have it living in their body, usually in the rectum or vagina.

It's normally rather common in pregnancy and is harmless the majority of the time however GBS can pose some risks in pregnancy.

Risks in pregnancy

If you have group B strep while you're pregnant:

Your baby will usually be healthy

There's a small risk it could spread to your baby during labour and make them ill – this happens in about 1 in 1,750 pregnancies

There's an extremely small risk you could miscarry or lose your baby.

UHCW policy for all women that are GBS positive is that they commence antibiotics once they are in established labour or their waters have broken.

Please speak with your midwife if you have concerns.

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Group B strep is a type of bacteria called streptococcal bacteria.

It's very common in both men and women and usually lives in the bottom (rectum) or vagina. It affects 2 to 4 women in 10.

Group B strep is normally harmless and most people will not realise they have it.

It's usually only a problem if it affects:

pregnant woman - it could spread to the baby

young babies - it can make them very ill

elderly people or those who are already very ill - it can cause repeated or serious infections

This page focuses on group B strep in pregnancy and babies.

Group B strep in pregnancy

Group B strep is common in pregnant women and rarely causes any problems.

It's not routinely tested for, but may be found during tests carried out for another reason, such as a urine test or vaginal swab.

Risks in pregnancy

If you have group B strep while you're pregnant:

your baby will usually be healthy

there's a small risk it could spread to your baby during labour and make them ill - this happens in about 1 in 1,750 pregnancies

there's an extremely small risk you could miscarry or lose your baby

What to do if you're worried

If you're worried about group B strep, speak to your midwife or GP for advice.

Talk to them about the risks to your baby and ask their advice about whether to get tested.

Routine testing is not currently recommended and tests are rarely done on the NHS, but you can pay for one privately.
Find out more about getting tested for group B strep on the Group B Strep Support website
What happens if you have group B strep

If tests find group B strep, or you've had a baby that's been affected by it before, you may need extra care and treatment.

You may be advised to:

speak to your midwife about your birth plan - they may recommend giving birth in hospital

contact your midwife as soon as you go into labour or your waters break

have antibiotics into a vein during labour - this can significantly reduce the risk of your baby getting ill

stay in hospital for at least 12 hours after giving birth so your baby can be monitored - this is not always necessary

Group B strep in babies

If you had group B strep during pregnancy, there's a small risk it could spread to your baby and make them very ill.

If this happens, it's usually soon after they're born. Your baby may be monitored in hospital for up to 12 hours to check for any problems.

They'll be given antibiotics into a vein if they develop symptoms.

What to look for after leaving hospital

Occasionally, symptoms of a group B strep infection can develop up to 3 months after birth.

Call 999 or go to A&E if your baby gets any of these symptoms:

being floppy or unresponsive

grunting when breathing, or working hard to breath when you look at their chest or stomach

very fast or slow breathing

a very fast or slow heart rate

an unusually high or low temperature

changes in their skin colour or blotchy skin

not feeding well or vomiting milk up

an unusually fast or slow heart rate

They may need treatment with antibiotics in hospital immediately.

Risks in babies

Most babies with a group B strep infection make a full recovery if treated.

Some babies may develop serious problems like sepsis or meningitis.

This can cause lasting problems like hearing loss or loss of vision. Sometimes it can be fatal.

More information

Page last reviewed: 12 March 2021
Next review due: 12 March 2024

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Group B strep is a type of bacteria called streptococcal bacteria. It's very common in both men and women and usually lives in the bottom (rectum) or vagina. It affects 2 to 4 women in 10. Group B strep is normally harmless and most people will not realise they have it.

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Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head-first position are called breech babies. Breech is very common in early pregnancy, and by 36-37 weeks of pregnancy, most babies turn naturally into the head-first position.

Towards the end of pregnancy, only 3-4 in every 100 (3-4%) babies are in the breech position.

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If you are healthy and have had a trouble-free pregnancy this is the recommended method of monitoring your baby’s heartbeat during labour. This should happen every fifteen minutes during the first stage of labour increasing to once every five minutes or after each contraction for full one minute in the second stage of labour. This is the simplest way to listen to the baby’s heartbeat and is done by the midwife using a Pinard Stethoscope, or a hand held ‘Doppler’. A Pinard trumpet shaped stethoscope helps the midwife hear your baby’s heartbeat through your abdomen (tummy). A Doppler is small hand held device, which looks like a microphone. It is placed against your abdomen and helps you, your midwife and your partner to listen to your baby’s heartbeat at the same time.

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Birth partners can help a woman feel supported in labour and make the experience more positive. Here are some top tips for being a brilliant birth partner.

Whether it’s your partner, daughter or friend due to give birth, it‘s an honour to be asked to be a birth partner. Yet this exciting role can also be daunting. Here we discuss some top tips to help you get ready.

You’ll find a whole number of ways you can help support the mum-to-be during labour. One place to start is by talking to them in advance about their expectations of you – ask them how they’d like you to support them. This will help you both feel more prepared ahead of the birth and confident in your role as birth partner.

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How do I Support my Partner During Labour?

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During July, as part of their #TalkToUs month, the Samaritans are celebrating their many volunteers, who provide emotional support 24 hours a day, 7 days a week. For those of us struggling with our mental health, the volunteer at the end of a phone line, text message or email could be just the lifeline that we need.

At DadPad, we know that maintaining our emotional wellbeing can be especially hard around the time of becoming a new parent and that's why we're always working on raising awareness of the fact that - just like mums - dads can also suffer with their mental health at any time, but especially during the perinatal period. [In case you weren't sure, in mental health terms, the perinatal period is viewed as covering pregnancy and through the first year following baby's birth.]

Mark Williams speaking at TEDx Nantymoel in early 2020 on The importance of new fathers' mental health.

In his TEDx talk, Mark Williams quotes some of the following statistics from various research studies:

1 in 10 dads suffer from PND - that's 75,000 dads each year in the UK

An average of 10.4% of fathers are depressed both pre- and post-natally, with the peak time for fathers' depression being between three and six months post-birth (Paulson & Brazemore, 2010)

24%-50% of new dads with partners suffering from depression were also affected by depression themselves (Goodman, 2004)

Up to 38% of new dads are worried about their mental health (NCT)

33% of young fathers wanted support for their mental health and there was nothing for them (NCT)

20% of new dads felt completely isolated during their first year of fatherhood (Movember)

33% of dads were stressed during the perinatal period (Movember)

Fathers with perinatal mental health problems are 47 times more likely to be rated as a suicide risk than at any other time in their lives (Quevedo et al, 2010)

And there are at least 600,000 male suicides each year (with the figure probably even higher in reality, due to the stigma surrounding suicide)

These are pretty eye-opening and worrying figures, which is why we believe it is so important to ensure that all dads-to-be and new dads are provided with the information and support that they need to not only recognise, but also seek help, for any emotional and mental health difficulties that they and/or their partner might be experiencing.

Raising awareness of these issues is only part - but still a very important part - of the battle to help dads and men who are struggling. It's not enough to simply say: "It's OK not to be OK". We need to ensure - for those dads who come forward and say, "I need help" - that there is help available.

What we're hoping to achieve in this blog post is to give you - whoever you are - some ideas on what you can do if you think that you are struggling. We've spoken with some of our key perinatal mental health contacts and experts, in order to ensure that this article contains the best information, help and advice possible.
Post-natal depression - that's just for mums, though, right?
Wrong! Post-natal depression (or PND) - as defined by the NHS - is:

A type of depression that many parents experience after having a baby. It's a common problem, affecting more than 1 in every 10 women within a year of giving birth. It can also affect fathers and partners.

A widely-held view is that PND is based on hormones, and that - as only mums experience a hormone change in pregnancy and post-birth - men can't get PND. However, this perception is wrong on both counts.

Firstly, hormonal changes affect dads as well as mums, as Kieran Anders of DadMatters UK confirms:
Just as mums experience hormonal changes around the time of birth, there's also a drop in testosterone and a rise in oestrogen in men, so they also experience hormonal change (although it is more nuanced).
If that surprises you, there's a perfectly logical reason for it. Dr Anna Machin, an evolutionary anthropologist, has explained that the drop in testosterone helps dads to become a more sensitive father, better able to meet their child's every need.

Secondly, it's now recognised that PND is caused by a combination of two things - hormonal changes and situational changes. Mental health campaigner and educator, Dr Andy Mayers, explains:
Often, the perception is that dads cannot get PND because it's hormonal. As it happens, hormones play a very small part in the risk for maternal PND. Environmental factors (such as income, housing, partner support, the mother not having her own mother close by, education, etc) and psychological ones (previous mental health, coping skills, etc) play a much larger part in maternal PND.
And therefore, as both dads and mums will be experiencing the impact of hormonal, environmental and psychological factors, as well as situational changes - including lack of sleep, added responsibility, increased worry about all sorts of things, dealing with your wider family, etc - it soon becomes clear that PND is just as likely to affect you as it is to affect your partner.

One thing Kieran tells us always to remember, though, is that: " Importantly, this depression is because [you] have a baby, and NOT because [you] are a man with depression."

(L-R) DadPad's Julian with Kieran Anders of Dad Matters, Ash Curry, and Dr Andy Mayers - 2019.

PND - what to look out for
So what are the symptoms that you need to look out, in both yourself and your partner, which might suggest that you are suffering from PND?

The first thing to be aware of is that you will probably have heard mention of the mum suffering from 'baby blues' and might wonder what this is. Over 70% of new mums experience 'baby blues', and it's not the same as PND.The Perinatal Mental Health Team at Worcestershire emphasise that it is, " important for dads to be aware of baby blues and that it is 'normal'. Women can be very tearful, emotional and upset during this time and may struggle to explain why. It will resolve itself after a couple of days. If it doesn't, then it's worth speaking to your midwife or health visitor."

In terms of actual PND, Dr Andy Mayers reminds us that, " ...PND (like 'depression') is not just about being sad. While low mood is common, another crucial symptom is losing the motivation to do those things we would normally do. It's also about the duration, frequency and timing of symptoms."

Dr Mayers also stresses that there are similarities and differences in PND for mums and dads. Firstly in your partner, there are a range of behaviours that you should be alert to and our experts each gave us some different suggestions on these; this just goes to show the many ways in which PND can present itself and/or be experienced. We'll start with Kelly Arnold, Interim Perinatal Mental Health Team Lead at the Betsi Cadwaladr University Health Board:
Your partner may become withdrawn, more tearful or feeling that she is not good enough as a mum. Sometimes [she] may find it difficult to bond with baby, but this is not always the case. Sometimes mum can feel over-protective of baby and have anxious thoughts around harm coming to baby.
Kieran Anders adds that: " Mum might still be able to do all the practical stuff - changing nappies, feeding, etc - but it's all about whether [she's] responding to baby's cues, nuanced little cues like returning a smile, responding when they [baby] lifts their hands to play."

The team at Worcestershire added that it is " worth dads being aware that irritability is often a symptom of postnatal depression, along with low mood."

Kerry Thomas, from PANDAS (the Pre and Post Natal Depression Advice and Support charity) suggested the following:
...consistent low mood and heightened anxiety, persistent sadness, frightening thoughts that won't 'go away', feelings of worthlessness and struggling to bond with your baby.
Finally, Dr Andy Mayers provided a list of symptoms that could be experienced by both mum or dad, including:

Low mood

Poor motivation

Changes in appetite

Poor sleep (over and above what normally happens with a new baby)

Poor concentration

Feelings of guilt and/or worthlessness

Thoughts of death or dying (including suicidal thoughts)

Where dads are concerned, though, as well as being alert to any of the above behaviours in yourself, you may experience PND in other ways. Kelly explains:
For men, symptoms may feel or be recognised a little differently - feeling angry/irritated more easily, increased consumption of alcohol or cigarettes, needing to exercise more or finding that you would rather be out of the family home. Dads can also feel that they are not bonded with their baby, too.
Mark Williams has also explained how PND symptoms look different in men: " There's more avoidance, overworking, drinking and substance abuse."

It's useful to hear from real-life dads who have experienced PND themselves, to get the best idea of what it feels like. We hugely appreciated hearing Michael's story, which was shared on the PANDAS Twitter page (and shared again here with theirs, and Michael's, permission), back in June.

Michael found his mental health suffering following the birth of his second child, who was diagnosed with a terminal heart defect. He described his symptoms:
I found myself crying a lot. I found myself feeling - yeah - very depressed about the whole situation. I just didn't know how to let people know that I was hurting, that there was those days where I couldn't function, I just didn't want to be here anymore. I wanted the thought of everything and the pain to stop, and it wasn't a really good time. There were times when I would go to bed and I would have really horrible nightmares. There were times when I just couldn't sleep because I would worry so much.
Mark Williams suffered a breakdown five years after first witnessing the traumatic birth of his son, and then supporting his wife through severe PND, which manifested soon after the family returned home from hospital. He experienced:
...worry that I wasn't going to be good enough to be a father, [concern about] how I was going to support this child, waking up with nightmares about the birth... [I was] frustrated, drinking and worried for my situation, trying to avoid myself, family and friends. During that postnatal period, my personality changed. I remember punching the sofa, I bust my hand. I was avoiding situations. I was using alcohol... I couldn't tell my wife how I was feeling because I didn't want that to impact on her mental health. And I was actually having suicidal thoughts in the postnatal period as well. But as a man I was told just to man up and get on with it. "What have you got to be depressed about? You didn't give birth to the baby." I was more concerned about my wife.
Before concluding this section, it's important to note that there are other mental health conditions to be alert to in the perinatal period, including postpartum psychosis (or PP) in mum, and post-traumatic stress disorder (or PTSD), anxiety and/or OCD in either parent. Although we aren't going to explore these topics in further depth in this article, we have included some links to further reading on these conditions at the end of this blog.

Planning ahead
One of the most important things that you and your partner can do in the run up to baby's arrival is to start reading up on potential mental health difficulties that you might face (and it's brilliant that you're here, as that means you're already doing that!), and talking together about how you might deal with them.

It's important to be open to the fact that - even if you and/or your partner have no history of mental health problems - it is something that you might need to deal with. Preparation and communication are both key.

If possible, go to as many antenatal classes with your partner as you can. Although they won't always cover aspects of mental health and wellbeing in detail, they are still a good thing to do, as Kelly Arnold explains:
Attending appointments with your partner will help you feel more involved in the arrival of your new baby and also give you the opportunity to ask questions about things that may be worrying you.
Dr Andy Mayers also encourages dads-to-be to " feel confident to ask questions". It will be a huge help for you to learn as much as you can on baby care in advance, to help you gain confidence and reduce the risk of feeling overwhelmed and/or anxious in your new role. This, in turn, may help reduce the risk of your mental health deteriorating. We'd also recommend that you get hold of a DadPad and/or DadPad app as these both contain lots of good advice on key skills for new parents as well as information on mental health for mum and dad, and the app will also have links to sources of local and national support and crisis response.

If you're lucky, there may be a specific support group for dads in your area, such as Dad Matters. Kieran Anders explains that the Dad Matters DadChat groups include antenatal discussions around mental health, with dads first asked to identify the sort of things - the 'red flags', if you like - that he will need to look out for in mum and then consider how he would approach that with her. This discussion then hopefully makes it easier for dad to appreciate that he will need to be looking out for the same things in himself.

Keep talking...
It's also important to talk to those around you - including, of course, baby's mum - about what they should be looking out for in you. Kieran encourages dads-to-be and new dads to " keep open the lines of communication with the people closest to you to recognise possible changes in [your] behaviour."

This period of your lives will be a huge test of your relationship - Kerry at PANDAS comments: "...the mental endurance test of supporting a pregnant partner through pregnancy, birth and beyond is testing" - and strategies that the two of you come up with to help deal with this will not only be beneficial to you both, in terms of building a strong, long-lasting relationship, but also for your family's future wellbeing. Be open to the fact that " having a new baby can be stressful and often adds to a lot of mixed emotions within the family unit... [and remember that], by speaking with your partner about your worries, this is the first step in reducing your risk of further mental health deterioration " (Kelly Arnold).

One thing to consider is the reminder from the perinatal mental health team at Worcestershire not to forget " how important sleep is and that sleep deprivation is a major issue in the postnatal period. Any steps which help both mum and dad get more sleep will be beneficial."

Finally, don't ever forget that you, "...as a father, are equal in terms of importance ...[and it is therefore] crucial you give yourself the time, self-care and accept any support and help that could be offered " (Kerry at PANDAS).

Help!
So, if you do find yourself struggling, what should you do?

Firstly, and probably most importantly, you need to talk to someone. The obvious candidates for this are, of course, your partner, your family and/or your friends, but this might not always be possible. You might be worried about adding to your partner's own stresses or difficulties, for example.

Another option might be to talk to one of the health professionals around you - such as your GP, or your family's Health Visitor or Midwife. Remember that those services " are all available to support dad's mental health as well as mum's " (Kelly Arnold), so don't feel that they won't be interested.

If none of this feels like something you can do, Kieran at Dad Matters also advocates for finding a peer support group (if there is one) near you, or even an online support group, " where you can let it all out anonymously." The crucial thing is that you DO take the steps to unburden yourself as: " Once you've done this, then you can take the steps that you need to fix it. Acknowledging how you're feeling before you get to the point of needing professional support means that you'll be less likely to need professional support."

Kelly Arnold supports this advice: " ...being open about how you are feeling about your new baby or any worries that you have will be the first step in making those worries a little less overwhelming."

It may well be that, once you've started to talk to someone about how you are feeling, you will be able to start sorting out your problems without any further assistance. However, if you - or your partner - feel that you might need more help (if your symptoms are getting worse, or are not improving), then it is essential that you seek additional support.

Unfortunately, at the moment, dedicated support groups for fathers are limited. The good news is that Dr Andy Mayers is trying to keep an up-to-date list on his website, so this is definitely worth a look. He and Mark Williams also recommend the online Hub of Hope as a " really good resource for searching local services."

Dad Matters provide peer support for dads, attempting to fill the gap between a man becoming a dad and when he starts to struggle. They find that most men won't accept help until late on in the cycle. They therefore support men antenatally, with resources, support, and drop-in clinics. These cover three key points: (1) attachment and bonding (which help to break cycles of poor bonding, and its effect); (2) mums' and dads' mental health (to enable dads to acknowledge their own mental health); and (3) accessing services (which includes signposting services which dad might otherwise avoid, such as midwifery, health visiting, and Children's Centres).

The PANDAS Foundation offers " free peer-to-peer support for every parent, and their network, who needs it. With experts in our field, we offer advice from trained volunteers with a wealth of lived, academic and work experience within mental health. We offer education, positive and motivational content based on lived experiences, and a wealth of knowledge, hope, empathy and signposting through our four support channels: free helpline, email support, group support (currently on hold at the time of writing, due to the pandemic) and also our inspirational social media channels."

Kerry adds, though, that whilst " social media can be useful if following motivational and positive content, ...it can also be an unwelcome distraction when used as a comparison tool."

Whichever - if any - of the above options you choose to explore, we strongly recommend that you speak to your GP or Health Visitor ASAP, if you haven't already done so; they will not judge you, or consider you to be a 'bad parent'. In fact, they will be pleased that you have felt able to talk to them about your concerns, and will also be able to help you work out the best course of action to help you start to feel better.

Don't be afraid...
We ended our chats with each of our experts by asking them to share with us one simple piece of advice for a new dad who thinks he might be struggling with his mental health since becoming a parent, and we want to draw this blog post to an end by sharing them with you - we were not surprised to see how similar their advice was!

Dr Andy Mayers: Quite simply, don't be afraid to talk about your mental health and then feel confident to seek that help. Keeping quiet and doing nothing will only make it worse.

Kieran Anders - Dad Matters: Talk to someone. Whoever it is is irrelevant - just talk.

Kelly Arnold: Talk to someone! It doesn't matter who that someone is... Dad's mental health is as important as mums and the services around a family within the perinatal period are there to support both mum and dad.

Kerry Thomas - PANDAS: You are significant and your feelings are valid. Do not undermine your own thoughts struggling with your mental health, but equally do not underestimate the strength you have and the support available through PANDAS and the NHS for parents who are able to recover from perinatal mental illness.

Mark Williams: If you are struggling in silence, make sure you speak to somebody today. There's no shame - speak to your family members, doctors, health visitors, any health professionals. If you're not getting the support off them, make sure you try somebody else until you get that support.

Worcestershire Perinatal Mental Health Team: If in doubt, speak to a professional. This could be your Health Visitor, Midwife or GP, for advice.

And we'll end with a little advice from us, at DadPad:

Remember that, your baby needs a dad who will read with her, play with her and interact with her. A dad who is depressed is less likely to want to do this. The close emotional relationship that babies, infants and children have with their carers will influence them for the whole of their lives. Staying positive and emotionally well will help you influence your child's future for the better, and give them the best start. Don't be ashamed if you're struggling - seek help, because YOU matter!

Sources of support: PANDAS Foundation UK

FREE helpline: 0808 1961 776. Available on all landlines from Monday - Sunday 11.00 am-10.00 pm, the helpline is manned by a team of trained volunteers who will be happy to chat to you and direct you to the right support.

Email Support: info@pandasfoundation.org.uk, available 365 days a year. They'll respond within 72 hours, and you are invited to get in touch if you'd like any more information regarding perinatal mental illness or are looking for support for yourself or your partner, friend or colleague.

PANDAS also have two Facebook groups that you might like to follow: (1) their main PANDAS Foundation page, on which their social media team updates on current perinatal mental health news and reports; and (2) their PANDAS Dads private group, where the PANDAS Dads volunteers are on hand, seven days a week, to offer support and information for dads and carers affected by perinatal mental illness.

Samaritans

FREE helpline: 116 123. Available 24 hours a day, 365 days a year, Samaritans' volunteers will listen to you, with no judgement or pressure, to help you work through what's on your mind.

If you find it easier to write things down, you can also email them on jo@samaritans.org (with a 24-hour response time) or write them a letter.

Mind's website also includes a list of mental health crisis helplines and listening services, which you may find useful.
Further reading and references:
NHS webpages:

Mind (mental health charity) webpages:

Hub of Hope website - mental health support network

Mark Williams' TEDx talk: The importance of new fathers' mental health

Dr Anna Machin's TEDx talk: We need to change the conversation about fathers

Dr Andy Mayers' fathers' mental health webpage, including information on support groups for dads
Dad Matters UK website
Mark Williams' Fathers Reaching Out website

NCT PND in Dads webpage

The Guardian online article: Men get postnatal depression too - Tue 04 Sep 2018

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Mental health and new dads | Ask DadPad | Support for new dads

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During July, as part of their #TalkToUs month, the Samaritans are celebrating their many volunteers, who provide emotional support 24 hours a day, 7 days a week. For those of us struggling with our mental health, the volunteer at the end of a phone line, text message or email could be just the lifeline that we need.

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The list of podcasts below will celebrate fatherhood and give you real advice on parenting, financials and even a few health tips to be the best dad you can be!

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We Edit Podcasts | The fastest podcast editing service online, all within 48 hours

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In honor of Father's Day, we've decided to create a list of the best podcasts especially for all those incredible dad's out there! Being the "fun" parent and listening to a ton of kids stories and songs can become a bit draining at times, so when the little ones are finally asleep in the backseat or you're on your way to work, perhaps instead of hoping for something nice to be on the radio just tune in to your new favorite dad podcast.

The list of podcasts below will celebrate fatherhood and give you real advice on parenting, financials and even a few health tips to be the best dad you can be!

Beardy Dads

Beardy Dads isn't a podcast hosted by experts, it's hosted by dads just like you. Roo and Nick are two dads from the United Kingdom, and they've been there and done that and are ready to share their experiences with you. So, if you're like the Beardy Dads then you probably have very little experience with kids, babies and especially changing those nasty diapers. Tune in to their weekly podcast and enjoy episodes such as "Holidays are coming" and "Postman Pat".

Listen here: Beardy Dads

The Modern Dads Podcast

The name says it all! The Modern Podcast Dads is a show for dads in the modern age published every two weeks. You can't raise your children the way your parents raised you since times have changed and your parenting skills have to change with it. The role of a father has changed and has become more of an active role in their children's lives. This podcast helps you navigate the new challenges of fatherhood as they stand today.

Listen here: The Modern Dads Podcast

The Dadcast

The Dadcast discusses topics such as "Top 5 Reasons Why Your Baby is an Asshole", "Top 5 Reasons Why Dad Needs a Gun", and "Top 5 Ways to Embarras Your Kids". As you can see this podcast is unlike most dad podcasts! It is hosted by self-proclaimed "Super Dads" Nick Nieblas and Shawn Warner. It's a mix of the best dad humor, insights and comedians.

Listen here: The Dadcast

The Fatherly Podcast

This podcast joins in on the conversation of famous and notable fathers. Listeners come for the celebrities but they stay for the stories. Get monthly advice from imperfect parents and find yourself fully amused and educated with episodes such as "Shooting Blanks: Are We Becoming a Nation of Vasectomized Men?" and "Ken Burns on War and Sons, Plus Jokes from a Six-Year-Old."

Listen here: The Fatherly Podcast

The Life of Dad Show

The Life of Dad is an excellent podcast and blog specifically for dads. The podcast isn't necessarily just about parenting; they have a lot of sports talk, interviews and even a bit of movie talk such as the latest animations. Listening to The Life of Dad is like having a discussion with other dads next to the soccer field or over a barbeque, it's funny and engaging.

Listen here: The Life of Dad Show

Dad so Hard

Being a dad is completely different from being a mom, and sometimes people tend to forget that fact. Dad So Hard shares stories, advice on how to juggle having a life of your own, while also giving your kids everything they might need, such as time and love. Whether you're a brand new father or have been one for many years, you will feel included and will be able to relate to this podcast topics.

Listen here: Dad so Hard

The Dad Podcast

The Dad Podcast is one of the most popular podcasts out there for dads to listen to. The show is hosted by comedian, husband, and father Justin Worsham, who brings a fun and hilarious spin to the world of fatherhood while being quite informative at the same time. He is a husband and father and he gets down and dirty on what parenting means and the challenges you might face as a parent.

Listen here: The Dad Podcast

The Dad Edge Podcast

Host and founder, Larry Hagner, breaks down all the challenges you might face during fatherhood, while also making it easier for you to understand and overcome. The Good Dad Project's mission is to help you become the best version of yourself you can be and in turn guide your kids to become the best they can be.

Listen here: The Dad Edge Podcast

PediaCast

Fathers are always known for being the roughhouse, the one who will teach you how to throw a ball or build a treehouse. Whether you're this type of dad or not, it's guaranteed that you will worry about your kids when they get sick. PediaCast is hosted by a pediatric expert, Dr. Mike, answers questions and ensures that Dads and Moms are prepared for anything that might happen to your kid's bodies.

Listen here: PediaCast

Dad's Guide to Twins

Dad's Guide to Twins Podcast is based on the book written by Joe Rawlinson. Each episode is around 8 minutes and is filled with unique tips and tricks on how to deal with having twins. Joe reviews children's products and helps you find ways to deal with the daily challenges such as how to fit multiple car seats and how to potty train twins.

Listen here: Dad's Guide to Twins

Featured Image: Caleb Jones

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Top 10 Podcasts for Dads | We Edit Podcasts

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In honor of Father's Day, we've decided to create a list of the best podcasts especially for all those incredible dad's out there! Being the "fun" parent and listening to a ton of kids stories and songs can become a bit draining at times, so when the little ones are finally asleep in the backseat [...]

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Hand Expressing Colostrum after 37 weeks 

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Hand Expressing Colostrum after 37 weeks 

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Did you know yo can hand express colostrum after 37 weeks gestation?

Colostrum is the milk produced by mothers in the first few hours & days after birth. It is extremely rich in growth & protective factors. These help to develop babies immature systems and protect them from infection and complications of premature birth.

Benefits of hand expressing from 37 weeks?

Builds confidence

Increases oxytocin hormone

Builds a small supply for you to bring in to hospital with you when you are in labour

See the leaflet attached for the 'How to guide' and storage information.

You can request some purple syringes from your community midwife or Katie the perinatal development midwife by emailing NewBeginnings@hotmail.com

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When a mother holds her baby in skin to skin contact after birth it initiates strong instinctive behaviors in both. The mother will experience a surge of maternal hormones and begin to smell, stroke and engage with her baby. Babies’ instincts after birth will drive them to follow a unique process, which if left uninterrupted will result in them having a first breastfeed. If they are enabled to familiarise themselves with their mother’s breast and achieve self attachment it is very likely that they will recall this at subsequent feeds, resulting in fewer breastfeeding problems.

Why is skin-to-skin contact important?

There is a evidence that skin to skin benefits mother and baby in many ways.

Calms and relaxes both mother and baby

Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb

Stimulates digestion and an interest in feeding

Regulates temperature

Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection

Stimulates the release of hormones to support breastfeeding and mothering.

Additional benefits for babies in the neonatal unit

Improves oxygen saturation

Reduces cortisol (stress) levels particularly following painful procedures

Encourages pre-feeding behavior

Assists with growth

May reduce hospital stay

If the mother expresses following a period of skin-to-skin contact, her milk volume will improve and the milk expressed will contain the most up-to-date antibodies

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Unicef UK Baby Friendly Initiative | Meeting baby for the first time

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Skin to skin contact is time spent with your baby lying upright on your chest in direct contact with each other’s skin.  Dads can enjoy skin to skin contact with their babies, which has huge benefits for your baby’s development and wellbeing, in the same way mums can.  It also promotes healthy attachment.  Skin to skin contact with your baby can rewire your brain ready for your role as a father.  Feelings of protectiveness and connection which begin to develop during your baby’s gestation help form new neural pathways when you hold your baby close.  Both dad and baby will have high levels of the hormone oxytocin during skin to skin contact which relaxes them both and reduces stress levels.

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Skin to skin contact is time spent with your baby lying upright on your chest in direct contact with each other's skin. Dads can enjoy skin to skin contact with their babies, which has huge benefits for your baby's development and wellbeing, in the same way mums can. It also promotes healthy attachment. Skin to skin contact with your baby can rewire your brain ready for your role as a father. Feelings of protectiveness and connection which begin to develop during your baby's gestation help form new neural pathways when you hold your baby close. Both dad and baby will have high levels of the hormone oxytocin during skin to skin contact which relaxes them both and reduces stress levels.

Skin to skin contact after birth

When your baby is born, assuming all is well, they will be placed directly onto the mum's chest. When left in undisturbed skin to skin contact babies will initiate breastfeeding during the first hour after birth. So when is the right time for dad to have skin to skin contact?

When your baby has had their first feed mum may wish to rest and baby will be feeling sleepy too. This is a great time for dads to have skin to skin contact with their new baby. Dad's can provide warmth and comfort during skin to skin contact which soothes babies and helps regulate their temperature, heart rate and breathing.

Dad and baby can also have skin to skin contact immediately after baby is born if mum is unwell or has had an anaesthetic. If your baby is born prematurely skin to skin contact is an important way to support their development. Dads can have skin to skin contact with their premature babies as soon as the baby is well enough and sharing this time with them can help them thrive, it is often called Kangaroo Care.

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Skin to skin contact with your newborn baby - From Dads To Dads

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Skin to skin contact is time spent with your baby lying upright on your chest in direct contact with each other's skin. Dads can enjoy skin to skin contact with their babies, which has huge benefits for your baby's development and wellbeing, in the same way mums can.

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A growing body of research has shown that when dads spend time with their newborns and begin developing a strong relationship with them from the very beginning, they reap a number of benefits:

A child’s physical and mental development is significantly boosted when his dad has played with him from the start, compared to children whose fathers took a more hands-off approach.

Fathers experience less stress and increased confidence when they have their own special time with their newborns.

Strong father-child bonds can help counter issues such as depression later on in life.

Men who report that they had a good relationship with their fathers during childhood were found to be better equipped to handle stress.

Children who experienced close interactions with their fathers from an early age tend to be more successful academically, have better relationships with their peers and be less likely to get involved with crime or abuse drugs and alcohol.

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UHCW Caesarean Section patient information leaflet 

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UHCW Caesarean Section patient information leaflet 

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UHCW planned Caesarean Section Anesthetist patient information leaflet  

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UHCW planned Caesarean Section Anesthetist patient information leaflet  

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Information from your anaesthetist about planned caesarean section

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Can I still have skin to skin in theatre?

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Can I still have skin to skin in theatre?

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Yes! Skin to skin has many mazing benefits and staff will facilitate skin to skin irrespective of the mode of delivery.

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During your pregnancy you may visit either of our maternity units either at University Hospitals Coventry & Warwickshire Hospitals or Rugby St Cross for various reasons.

You may have up to 2 birth partners with you on Labour Ward the whole time

Ward 24 & 25

1 Birth partner the whole time + 1 other visitor allowed for an hour between 7pm-8pm

You are allowed 1 other person to accompany yourself to scans and clinic appointments

Siblings may visit the wards but cannot attend scans. No other children are allowed on the wards.

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Take a look at our Maternity Departments 

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Take a look at our Maternity Departments 

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Virtual Tour of the Maternity Departments at UHCW NHS Trust

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This is a method of observing the baby’s heartbeat by using a machine called a Cardiotocograph (CTG). The machine allows us to hear your baby’s heart beat and record it on graph paper, which we will interpret. This recording is obtained by placing two plastic pads onto your abdomen, one will record the heartbeat and one will record the contractions. Continuous monitoring keeps track of your baby’s heartbeat for the whole of your labour.