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Working as a team

Life with a newborn is an exciting and challenging time for all new parents. Coping with the early days (and nights) can be extra tough if you're struggling to balance who does what.

Research has described the phenomenon of maternal gatekeeping (The conversation. 2015), which can cause dads or non-birth mothers to be discouraged from sharing equal responsibility for the baby. Some non-birth mothers describe feeling left out of the special bond, particularly if their partner is breastfeeding. Solidarity can make all the difference on a sleepless night so put the kettle on, fire up a box-set, and snuggle up together.

All hands on deck

Catching up on the physical bond can be especially important for a mum who hasn't given birth. Tiny babies enjoy being held skin-to-skin and are soothed by the heartbeats of both mums.

If you've gone back to work, bath time can be a lovely evening ritual. It allows you to spend some special time with your baby and give your partner time to rest at the end of the day.

Date night

While you're trying to support your partner in the physical recovery from birth, don't forget that you're both emotionally adapting to your new roles. Becoming parents can put huge pressure on a relationship. Take offers of help from friends and family that allow you to spend some time together or to catch up on sleep.

Time alone might be closer to a takeaway in front of the TV and baby monitor rather than a wild night out for a while. But it all counts in finding time to be a couple.

Value of shared parental leave

When our twin daughters were six months old, my partner went back to work and I started a period of shared parental leave. Many same-sex couples find that they are freed up from 'traditional' roles and are able to shape family life around a more equal division of labour.

For me, starting six months of parental leave presented some unique challenges. Should I simply slot into my partner's place at the baby yoga class and try to fit in with her new friends? Or should I find my own activities and networks? Everyone will make their own decisions on this.

An important part of shared parental leave for me was also that it marked the start of weaning. It gave me an opportunity to really share in a major stage of our babies' development.

Shared parental leave isn't a practical option for all couples but do consider ways in which you can both spend time with your new baby. For us, splitting the leave meant we both experienced the highs and lows of the first year.

We both survived the challenging days when leaving the house seemed impossible. We both enjoyed joyful moments of first smiles or first steps. By the end of the first year, we both felt that we had really learnt how to be parents and could hardly even remember what life was like before we were a family.
Claire Lynch is a writer and academic. She lives near Windsor with her wife Bethan and their three daughters. This article is part of series she has written about her experiences as a same-sex parent for NCT. Her book Small: On motherhoods, telling the story of her motherhood journey, is out on 24 June 2021, published by Brazen_Octopus books. If you'd like to share your story, please do get in touch: nctmatterseditor@nct.org.uk Photography by And then she clicked
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

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

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

Read the free guide from Stonewall 'Pregnant Pause: A guide for lesbians on how to get pregnant' covering all aspects of pregnancy and childbirth from conception to starting school.

Read more about the parenting issues facing same-sex parents on the website, Pink Parents

Visit We Are Family Magazine, a community resource and platform for social change, representing lesbian, gay, bisexual and trans people in a family context through positive representation, advice and support.

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Two-mum families: becoming mummy and mama

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Life with a newborn is an exciting and challenging time for all new parents. Coping with the early days (and nights) can be extra tough if you're struggling to balance who does what. Research has described the phenomenon of maternal gatekeeping (The conversation.

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How can Dads/Non Pregnant Mums connect with their baby during pregnancy

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How can Dads/Non Pregnant Mums connect with their baby during pregnancy

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Few mums-to-be believe their partner really understands what pregnancy is like. And the fact is, most men don't. We talk about it. We show interest. We'll even read up about it. But our experience of having a baby is fairly removed from the real thing until we're face-to-face with nappy changing and sleep deprivation.

No dad can possibly relate to the minute-by-minute, close-to-the-heart reality of carrying a baby to term. But we can participate. We can be there to listen to the first heartbeat. We can cut back on the beer or wine, we can pore over the baby-naming books together, and more. Here are 10 ways you can get involved.

Face your fear

If you didn't feel anxious at some point during your partner's pregnancy, you wouldn't be normal. After all, how do you know you'll make a good dad? Will your baby be born with 10 fingers and 10 toes? Will labour go smoothly? Will you love your baby? Worries like these are perfectly natural. The best solution is to talk to your partner, your dad, or friends who are old hands at parenting. You can also find other dads-to-be in the same boat as you in our community.

Pay attention

You can't be pregnant, but you can be an active observer. Here's how:

Be there

Try to make it to some of your partner's many antenatal appointments. You have a legal right to take unpaid time off work to accompany her at up to two of them. And don't miss the chance to get a glimpse of your baby during an ultrasound.

If your partner has an amniocentesis or other procedure to test for genetic conditions, make sure you're there. And, of course, attend antenatal classes, and work through the breathing and relaxation exercises together.

Get healthier, too

Your partner is probably trying to improve her diet, give up alcohol, and drink more fluids. You can support her by sharing these lifestyle changes too.

Love her changing body

As your partner's pregnancy progresses, it's understandable that she may start to feel unattractive. If you happen to agree she's not looking her best, whatever you do, don't let on!

However you feel about your partner's changing body, you'll probably find that sex takes a back seat during pregnancy. What with hormone changes, back pain and morning sickness, your love life may be a bit less exciting for a while. Read our feature on sex during pregnancy so you know what's safe, and what to expect.

Indulge her

Your partner may be pretty demanding. Go with it. She's doing most of the hard work. The least you can do is organise the grocery shopping, buy her flowers and fulfil her late-night requests for cheese-and-jam sandwiches.

Memorise the route to the hospital

This may seem obvious, but unless you're working away when your partner's waters break, you'll be the one making that drive to the hospital. With your other half in the throes of labour, you may not be in a fit state to navigate your way there. Do a dry run, so you can be confident you know the route.

Check that there's always enough petrol in the car. And make sure, too, that your partner can contact you no matter where you are when she has to make that "drop everything" call.

Be a partner in labour

Find out what your partner wants you to do when she's in labour. Does she want you to:
If you're up for it, ask your midwife if you can cut the umbilical cord.

Shop, talk, and make lots of decisions

By the time your baby arrives, you and your partner will have:
And there you were, thinking you had nothing to do...

Prepare to be unprepared

The nine months of pregnancy rush by so fast, believe it or not, that the experience can be overwhelming. Enjoy it, savour it, and don't worry if you don't have everything ready by the time baby shows up. You have his whole life ahead of you.

Strange as it may sound, some men start to feel pregnant while their partner's expecting; they even display similar symptoms. The phenomenon is called Couvade Syndrome or "sympathetic pregnancy".

You may not go to those lengths, but trying to empathise when your partner's feeling moody or uncomfortable will help you feel involved in the pregnancy. Plus you'll be storing up plenty of brownie points, too.

Get monthly tips on what to expect and how to support your partner in our month-by-month dads' guide to pregnancy.

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Dads: how to share in your partner's pregnancy

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Few mums-to-be believe their partner really understands what pregnancy is like. And the fact is, most men don't. We talk about it. We show interest. We'll even read up about it. But our experience of having a baby is fairly removed from the real thing until we're face-to-face with nappy changing and sleep deprivation.

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What will the baby call you?

When my partner was pregnant, we were often asked if we would both be called mummy once the baby could talk. Some people can find it difficult to imagine a family without traditionally gendered roles. So to them, asking about names is really a way of expressing that.

If you or your partner speak another language you might already be planning to use another word for mother in your family. Some parents simply use their names, for example mummy Jo and mummy Emma.

In our case, our children decided for us. As soon as they could talk, they named us mummy and mama and they've been quick to correct anyone who gets us muddled up ever since.

Parenting is a series of challenges. Frankly, what you call yourselves should be the least of them. Choose the words that work for your family and feel confident in asking others to use them too.

I do understand that when people say, 'I can't remember who's who, I'll just call you both Mummy'; it's probably to cover their own embarrassment. I also know that when people don't try to get this right it confuses, or even upsets, our children. It goes without saying that we are distinct people to them and the names they call us are as meaningful as those used in a family with a mummy and a daddy.

How did you get pregnant?

It still surprises me that anyone would ask such a personal question but believe me, they do. Most people wouldn't consider approaching a pregnant woman and asking her for details of the conception, but curiosity seems to overtake manners when it comes to quizzing same-sex couples. Remember that you're not obliged to satisfy the interest of even the most persistent stranger in the supermarket.

There might be legitimate (rather than nosey) versions of this question. For example, when registering the baby's birth or during antenatal appointments if the birth mother is not also the biological mother. Even so, you should expect the same respect and privacy as any other parents get.

Who's the daddy?

There are many different ways to build a family. But you might find people struggle at first if your family structure is not familiar to them.

There might be a dad in your family set up, a male co-parent, a known donor, or the father of children from a previous relationship. Alternatively, women who conceive by anonymous donor may prefer the term 'donor' to 'dad'. This term might clarify the line between the genetic origin of a child and their parents, neither of whom identify as a father.

Families of donor-conceived children understandably feel immense gratitude to the person who has provided the opportunity to start their family. They may also feel strongly about preserving parental 'names' for the people who will parent the child throughout their life. Try to use the language you would like others to use and they will follow suit.

How did you decide who would carry the baby?

Variations on this include: 'Aren't you lucky she's doing all the hard work?' 'Did you toss a coin?' and 'you can have the next one'. For many same-sex couples the question of who carries the pregnancy can be hugely emotive.

The decision might be one of necessity, a matter of illness or infertility. It might have been the source of great heartache for one partner to 'sacrifice' this role. Non-pregnant mothers can often feel relegated to the role of observer during pregnancy and the assumption that they have 'opted-out' can be hurtful.

For others, this might have been a straightforward decision. This too can be surprising to heterosexual couples who do not have the choice to make. Not wanting to be pregnant does not mean you are not maternal. You are not less of a parent because you didn't give birth.

That said, for most women there's some adjusting to do between the images of motherhood they see around them and the mother they want to be. You don't have to be like the woman on the nappy adverts to be a great mum.

When my partner was pregnant, it was important for me to shape a role around what I could do for our babies rather than focusing on what I couldn't. So during your partner's pregnancy, this might include cooking healthy food, decorating the nursery, and taking time off work to attend scans or hospital appointments.

You might also like to sign up to a weekly email service to keep up-to-date with the baby's developments. It also helps you keep track of the symptoms your partner is likely to experience so you know how best to support her.

There's plenty of work to go around with a new baby so take some duties on as your own. Set aside time each day for skin-to-skin cuddles or take responsibility for bath time. This will help you to build your confidence as a new mum and allow your partner time to rest and recover from birth.
Claire Lynch is a writer and academic. She lives near Windsor with her wife Bethan and their three daughters. This article is part of series she has written about her experiences as a same-sex parent for NCT. If you'd like to share your story, please do get in touch: nctmatterseditor@nct.org.uk
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

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

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

Read the free guide from Stonewall 'Pregnant Pause: A guide for lesbians on how to get pregnant' covering all aspects of pregnancy and childbirth from conception to starting school

Read more about the parenting issues facing same-sex parents on the website, Pink Parents

Visit We Are Family Magazine, a community resource and platform for social change, representing lesbian, gay, bisexual and trans people in a family context through positive representation, advice and support.

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Two-mum families: how to tackle questions like 'what will they call you?'

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When my partner was pregnant, we were often asked if we would both be called mummy once the baby could talk. Some people can find it difficult to imagine a family without traditionally gendered roles. So to them, asking about names is really a way of expressing that.

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Preparing Your Dog For A New Baby

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Pelvic Floor Exercises

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Maternity and Paternity Rights at Work

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Legal rights for pregnant employees - including paid time off for antenatal appointments, maternity leave and pay, protection against discrimination and telling the employer about the pregnancy

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Baby Centre

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Join now to receive free weekly newsletters tracking your baby's development and yours throughout your pregnancy.

With your permission, we'll send you information about our products and services based on what you're looking for via email, our apps, and our site. You can change your mind and withdraw your permission at any time. Different countries may have different data-protection rules than your own. By clicking the "TRACK MY BABY" button, you agree to transferring your information to countries outside of the one you live in, including the United States. You may withdraw your permission at any time. When you register on our site, we will use your information to make sure we are sending you the content that's most helpful to you. Registering also lets you be a part of our Community and other member-to-member parts of our site. Because the content you submit in the interactive parts of our site will be available to all our users and may be available to the general public, please do not provide personal or confidential information. For more details read our Privacy Policy.

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Join now to receive free weekly newsletters tracking your baby's development and yours throughout your pregnancy. With your permission, we'll send you information about our products and services based on what you're looking for via email, our apps, and our site. You can change your mind and withdraw your permission at any time.

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If you've been wondering why pregnancy has sent you into daily crying fits or rages, then we have one word for you: hormones. Yet as well as affecting your mood, these super-powerful hormones can also affect:

growth and development

metabolism

sexual function

reproduction.

(MedlinePlus, 2016)

Yep, when you're pregnant, hormones play a massive role (Kumar and Magon, 2012). They can influence things like the way you now sob at an episode of EastEnders. They also explain why everyone says you are 'glowing' and why your nails have grown properly for the first time since you were eleven.

They also help your growing baby develop and make a difference physically, with certain hormones relaxing your ligaments ready for labour. That might mean you find yourself getting more injuries or niggles in the body when you exercise while you're pregnant too (Healthline, 2017).

Hormones may also have you leaping on your partner at certain points in your pregnancy, and horrified by the idea of sex at others.

Progesterone, oestrogen and other hormones in pregnancy

The most important hormones at play when you're pregnant are as follows.

Oestrogen

Oestrogen is produced in early pregnancy to support your baby until the placenta takes over. Oestrogen helps the development of your baby's organs and the correct function of the placenta. Yet it may also cause nausea and make ligaments softer, putting pressure on your lower back and pelvis (NHS, 2018).

Later in pregnancy, oestrogen helps to prepare your body for breastfeeding (if you choose to do so). It also enables your uterus to respond to oxytocin in labour (Society for Endocrinology, 2018).

Progesterone

Progesterone is produced in early pregnancy to support your baby until the placenta takes over. Progesterone causes an increase in blood flow to the womb. It might also be the one responsible for that pesky heartburn as well as vomiting, reflux, gas and constipation (Society for Endocrinology, 2018).

Later on it can help with your baby's development. It'll prevent you from producing milk until your baby's born and will strengthen your pelvic floor muscles ready for labour (Society for Endocrinology, 2018).

Oxytocin

Oxytocin eases the pain during labour, and encourages the cervix to open as well as helping with your lochia (bleeding after birth). Oxytocin also plays a major role in milk production and bonding (Society for Endocrinology, 2018).

Prolactin

Similar to oxytocin, prolactin helps with bonding (Society for Endocrinology, 2018).

Relaxin

This is the hormone that makes your ligaments softer and means you need to adjust certain types of exercise so you don't get an injury. Relaxin helps in labour, as it softens and lengthens the cervix as well as your pelvic area (Society for Endocrinology, 2018).

Human chorionic gonadotropin (HCG)

HCG is released into your bloodstream when you get pregnant to support you and your baby. It's often an indicator of pregnancy in over-the-counter tests as well (Society for Endocrinology, 2018).

Human placental lactogen (hPL)

The hormone hPL helps your baby to get the nutrients they need while you're pregnant (Society for Endocrinology, 2018).

Prostaglandins

Prostaglandins help to get the cervix ready for labour (Society for Endocrinology, 2018).

Hormones and emotions during pregnancy

While it can be a happy time in many ways, you're likely to feel emotionally vulnerable and down at times during your pregnancy. No matter how excited you are that you're having a baby.

If you think you're feeling down or anxious a lot, speak to your GP, midwife and someone close to you (Northamptonshire Healthcare NHS Foundation Trust 2015). Feeling this way during pregnancy can also increase the chances of postnatal depression later down the line, so it's good to flag it now.

Further information

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

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

Healthline. (2017) What bodily changes can you expect during pregnancy? Available from: https://www.healthline.com/health/pregnancy/bodily-changes-during [Accessed 11th July 2018]

Kumar P, Magon N. (2012) Hormones in pregnancy. Niger Med J. 53(4):179-183. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23661874 [Accessed 11th July 2018]

MedlinePlus. (2016) Hormones. Available from: https://medlineplus.gov/hormones.html [Accessed 11th July 2018]

NHS Choices. (2018) Back pain in pregnancy. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/backache-pregnant/ [Accessed 11th July 2018]

NHS Inform. (2017) Exercises during pregnancy. Available from: https://www.nhsinform.scot/healthy-living/keeping-active/getting-started/exercise-during-pregnancy [Accessed 11th July 2018]

Northamptonshire Healthcare NHS Foundation Trust. (2015) Emotional changes during pregnancy and following childbirth. Available from: https://www.nhft.nhs.uk/download.cfm?doc=docm93jijm4n1351.pdf&ver=2068 [Accessed 11th July 2018]

Society for Endocrinology. (2018) You and your hormones. Hormones of pregnancy and labour. Available from: http://www.yourhormones.info/topical-issues/hormones-of-pregnancy-and-labour/ [Accessed 11th July 2018]

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Pregnancy hormones: progesterone, oestrogen and the mood swings

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If you've been wondering why pregnancy has sent you into daily crying fits or rages, then we have one word for you: hormones. Yet as well as affecting your mood, these super-powerful hormones can also affect: growth and development metabolism sexual function reproduction.

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Oxytocin

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Baby's Movements in Pregnancy

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Helping Your Baby into a Good Position

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Parenthood Starts with Pregnancy

You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth.

Proactive Preparation for Easier Birth

Join others who are enthusiastic for your life-giving year! Find a Spinning Babies ® Certified Parent Educator to start using techniques for comfort in pregnancy and smoother progress in labor through our unique approach to physiological birth.

Help Change Birth on Earth

Find Spinning Babies ® Workshops and events near you to start helping parents experience a more confident and comfortable birthing process for both themselves and their baby.

For additional education to even further enhance your pregnancy and labor preparation, shop our extensive collection of digital downloads, videos, DVDs, workbooks, and more.

Daily Essentials can be practiced daily throughout pregnancy to help bring balance and comfort - and an easier, shorter birth.

Spinning Babies® Parent Class

Spinning Babies® Parent Class provides clear instructions on how to use Spinning Babies® for a more comfortable and confident pregnancy and labor.

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Spinning Babies - Comfort in Pregnancy and Easier Birth

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Parenthood Starts with Pregnancy You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth. Proactive Preparation for Easier Birth Join others who are enthusiastic for your life-giving year!

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Pelvic Girdle Pain

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The Pelvic Partnership provides women and healthcare professionals with information about best practice for the treatment and management of pregnancy-related PGP, and to enable and empower women to access the right treatment. We have packed our website with information about PGP, so please do have a read, and use and share this resource.

Free PGP leaflets

With support from the National Lottery and Dreamgenii, we have developed leaflets explaining PGP and how it can be treated with manual therapy. To find out more please click here to request a FREE leaflet about PGP or to click here to buy a pack of leaflets to share with friends, family or your clients.

"PGP is treatable" ebook

In our new ebook we share practical suggestions and realistic solutions to help you manage your pregnancy-related PGP throughout pregnancy and after your baby is born. This ebook was produced as part of our COVID-19 Response Project, funded by the National Lottery's Coronavirus Community Support Fund.

The ebook is available on AmazonKindle or FOR FREE as a PDF here.

Talking about pelvic girdle pain with your GP or midwife: a toolkit for women with PGP

We have developed a free resource for women with PGP to help them at healthcare appointments.

We have heard from many women with PGP that it is challenging to describe their PGP to GPs or midwifes with little knowledge about the condition and how it can affect women physically and emotionally.

This FREE resource helps women find the words describe their symptoms, how PGP affects them and how to ask for the right referrals for further treatment, pain relief and support services.

Download Talking about pelvic girdle pain with your GP or midwife here.

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The Pelvic Partnership provides women and healthcare professionals with information about best practice for the treatment and management of pregnancy-related PGP, and to enable and empower women to access the right treatment. We have packed our website with information about PGP, so please do have a read, and use and share this resource.

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Tips to move a back-to-back baby

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While there's definitely no right or wrong position for your baby to hang out in in your womb, labour's definitely easier if they're facing a certain way. That's head down, with their tummy facing your back.

Some babies though will lie with their back against your back, known as being in the 'occiput posterior' (OP) position.

"If they're in that position, giving birth tends to take longer - words no-one wants to hear. It's because your baby can't tuck their chin in so easily and that makes getting through the pelvis more awkward."

Giving birth to a back-to-back baby can also give you backache while you're in labour (Simpkin, 2010; RCM, 2012).

Here are some tips to help during pregnancy.

1. Lean forward

Forward-leaning positions, like getting on all fours, have often been recommended. There's no evidence that this can help turn your baby but it can reduce any backache that you're suffering because of the baby's position (Hunter et al, 2007). So it's definitely worth a go.

It can also be helpful in the first stages of labour to ease backache (Guittier et al, 2016).

2. Don't panic

In the end, your baby is very likely to end up in the occiput anterior position - one of the best positions. Only five to eight of every 100 babies end up back-to-back with you anyway (Tommy's, 2016). So try not to worry too much.

3. Get into positions where your pelvis and belly tilt forwards

Some ways to do that are:

Sit upright on a chair making sure your knees are lower than your pelvis and your torso is slightly tilted forwards.

Sit on a swiss ball.

Watch your favourite Netflix show while kneeling on the floor, over a beanbag or cushion or sit on a dining chair.

Use yoga positions, like sitting with your back upright and the soles of the feet together, knees out to the sides.

Sit on a wedge cushion in the car, so your pelvis is tilted forwards.

Sleep on your side, not on your back.

Swim with your belly downwards.

Any exercises that you do on all fours can be helpful too.

(Sutton and Scott, 1996; Andrew, 2010)

4. Avoid certain positions:

Sometimes you won't be able to but if you can, ditch:

deep squats

crossing your legs

sitting with feet raised

leaning back into a sofa or armchair.

Further information

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

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

Andrew CG. (2010) Considering non-optimal fetal positioning and pelvic girdle dysfunction in pregnancy: increasing the available space. Journal of Clinical Chiropractic Pediatrics. 11(2):783-788. Available from: http://jccponline.com/jccp_v11_n2.pdf [Accessed 13th August 2018]

Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. (2016) Maternal positioning to correct occiput posterior position during the first stage of labour: a randomised controlled trial. BJOG. 123;2199-2207. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132127/ [Accessed 13th August 2018]

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev.(4):CD001063. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001063.pub3/full [Accessed 13th August 2018]

RCM. (2012) Evidence based guidelines for midwifery-led care in labour: persistent lateral and posterior fetal positions at the onset of labour. Available from: https://www.rcm.org.uk/sites/default/files/Persistent Lateral and Posterior Fetal Positions at the Onset of Labour.pdf [Accessed 13th August 2018]

Simkin P. (2010) The fetal occiput position: state of the science and a new perspective. Birth. 37(1):61-71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20402724 [Accessed 13th August 2018]

Sutton J, Scott P. (1996) Understanding and teaching optimal foetal positioning. Tauranga: New Zealand.

Tommy's (2016) Getting your baby into the best birth position. Available from: https://www.tommys.org/pregnancy/labour-birth/baby-best-position-birth [Accessed 13th August 2018]
Further reading
Andrews CM, Andrews EC. (1983) Nursing, maternal postures and fetal positions. Nursing Research. 32:336-341. Available from: https://www.ncbi.nlm.nih.gov/pubmed/6567853 [Accessed 13th August 2018]

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Tips: how to get your back-to-back baby into position for birth | Labour & birth articles & support | NCT

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If your midwife's said your baby is back-to-back, there's still a big chance that they'll move. In the meantime, here are some ideas to help them shift...

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A Mother's Body During Pregnancy

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The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour and get back into shape after the birth.

Keep up your normal daily physical activity or exercise (sport, running, yoga, dancing, or even walking to the shops and back) for as long as you feel comfortable.

Exercise is not dangerous for your baby. There is some evidence that active women are less likely to experience problems in later pregnancy and labour.

Exercise tips for pregnancy

Do not exhaust yourself. You may need to slow down as your pregnancy progresses or if your maternity team advises you to. If in doubt, consult your maternity team.

As a general rule, you should be able to hold a conversation as you exercise when pregnant. If you become breathless as you talk, then you're probably exercising too strenuously.

If you were not active before you got pregnant, do not suddenly take up strenuous exercise. If you start an aerobic exercise programme (such as running, swimming, cycling or aerobics classes), tell the instructor that you're pregnant and begin with no more than 15 minutes of continuous exercise, 3 times a week. Increase this gradually to daily 30-minute sessions.

Remember that exercise does not have to be strenuous to be beneficial.

Exercise tips when you're pregnant:

always warm up before exercising, and cool down afterwards

try to keep active on a daily basis - 30 minutes of walking each day can be enough, but if you cannot manage that, any amount is better than nothing

avoid any strenuous exercise in hot weather

drink plenty of water and other fluids

if you go to exercise classes, make sure your teacher is properly qualified and knows that you're pregnant, as well as how many weeks pregnant you are

you might like to try swimming because the water will support your increased weight. Some local swimming pools provide aqua-natal classes with qualified instructors. Find your local swimming pool

exercises that have a risk of falling, such as horse riding, downhill skiing, ice hockey, gymnastics and cycling, should only be done with caution. Falls carry a risk of damage to your baby

Exercises to avoid in pregnancy

do not lie flat on your back for long periods, particularly after 16 weeks, because the weight of your bump presses on the main blood vessel bringing blood back to your heart and this can make you feel faint

do not take part in contact sports where there's a risk of being hit, such as kickboxing, judo or squash

do not go scuba diving, because the baby has no protection against decompression sickness and gas embolism (gas bubbles in the bloodstream)

do not exercise at heights over 2,500m above sea level - this is because you and your baby are at risk of altitude sickness

Exercises for a fitter pregnancy

If you are pregnant, try to fit the exercises listed in this section into your daily routine. These types of exercise will strengthen your muscles to help you carry the extra weight of pregnancy. They'll also make your joints stronger, improve circulation, ease backache, and generally help you feel well.

Stomach-strengthening exercises

As your baby gets bigger, you may find that the hollow in your lower back increases and this can give you backache. These exercises strengthen stomach (abdominal) muscles and may ease backache, which can be a problem in pregnancy:

start in a box position (on all 4s) with knees under hips, hands under shoulders, with fingers facing forward and abdominals lifted to keep your back straight

pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward. Do not let your elbows lock

hold for a few seconds then slowly return to the box position

take care not to hollow your back: it should always return to a straight/neutral position

do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully

only move your back as far as you can comfortably

Pelvic tilt exercises

stand with your shoulders and bottom against a wall

keep your knees soft

pull your tummy button towards your spine, so that your back flattens against the wall: hold for 4 seconds then release

repeat up to 10 times

Pelvic floor exercises

Pelvic floor exercises help to strengthen the muscles of the pelvic floor, which come under great strain in pregnancy and childbirth. The pelvic floor consists of layers of muscles that stretch like a supportive hammock from the pubic bone (in front) to the end of the backbone (spine).

If your pelvic floor muscles are weak, you may find that you leak urine when you cough, sneeze or strain. This is quite common, and there is no reason to feel embarrassed. It's known as stress incontinence and it can continue after pregnancy.

You can strengthen these muscles by doing pelvic floor exercises. This helps to reduce or avoid stress incontinence after pregnancy. All pregnant women should do pelvic floor exercises, even if you're young and not suffering from stress incontinence now.

How to do pelvic floor exercises:

close up your bottom, as if you're trying to stop yourself going to the toilet

at the same time, draw in your vagina as if you're gripping a tampon, and your urethra as if to stop the flow of urine

at first, do this exercise quickly, tightening and releasing the muscles immediately

then do it slowly, holding the contractions for as long as you can before you relax: try to count to 10

try to do 3 sets of 8 squeezes every day: to help you remember, you could do a set at each meal

As well as these exercises, practice tightening the pelvic floor muscles before and during coughing and sneezing.

Find out more about incontinence.

Find out more about keeping fit and healthy after you've had your baby.

Need activity ideas for the rest of the family?

Get activity ideas from Change4Life to help get your family more active. Please bear in mind that the activity plans are not designed for use during pregnancy, but can be useful for your partner, children and other family members.

Get Start4Life pregnancy and baby emails

Sign up for Start4Life's weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

Community content from HealthUnlocked

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The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour and get back into shape after the birth.

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From The Huffington Post
We might not have a money tree, but we can have a happiness tree. Dopamine, serotonin, oxytocin and endorphins are the quartet responsible for our happiness. Many events can trigger these neurotransmitters, but rather than being in the passenger seat, there are ways we can intentionally cause them to flow.

Being in a positive state has significant impact on our motivation, productivity, and wellbeing. No sane person would be opposed to having higher levels in those areas.

Here are some simple ways to hack into our positive neurochemicals:

Dopamine motivates us to take action toward goals, desires, and needs, and gives a surge of reinforcing pleasure when achieving them. Procrastination, self-doubt, and lack of enthusiasm are linked with low levels of dopamine. Studies on rats showed those with low levels of dopamine always opted for an easy option and less food; those with higher levels exerted the effort needed to receive twice the amount of food.

Break big goals down into little pieces - rather than only allowing our brains to celebrate when we've hit the finish line, we can create a series of little finish lines which releases dopamine. And it's crucial to actually celebrate - buy a bottle of wine, or head to your favorite restaurant whenever you meet a small goal.

Instead of being left with a dopamine hangover, create new goals before achieving your current one. That ensures a continual flow for experiencing dopamine. As an employer and leader, recognizing the accomplishments of your team, e.g. sending them an email, or giving a bonus, will allow them to have a dopamine hit and increase future motivation and productivity.

Serotonin flows when you feel significant or important. Loneliness and depression appears when serotonin is absent. It's perhaps one reason why people fall into gang and criminal activity - the culture brings experiences that facilitate serotonin release. Unhealthy attention-seeking behavior can also be a cry for what serotonin brings. Princeton neuroscientist Barry Jacobs explains that most antidepressants focus on the production of serotonin.

Reflecting on past significant achievements allows the brain to re-live the experience. Our brain has trouble telling the difference between what's real and imagined, so it produces serotonin in both cases. It's another reason why gratitude practices are popular. They remind us that we are valued and have much to value in life. If you need a serotonin boost during a stressful day, take a few moments to reflect on a past achievements and victories.

Have lunch or coffee outside and expose yourself to the sun for 20 minutes; our skin absorbs UV rays, which promotes vitamin D and serotonin production. Although too much ultraviolet light isn't good, some daily exposure is healthy to boost serotonin levels.

Oxytocin creates intimacy, trust, and builds healthy relationships. It's released by men and women during orgasm, and by mothers during childbirth and breastfeeding. Animals will reject their offspring when the release of oxytocin is blocked. Oxytocin increases fidelity; men in monogamous relationships who were given a boost of oxytocin interacted with single women at a greater physical distance then men who weren't given any oxytocin. The cultivation of oxytocin is essential for creating strong bonds and improved social interactions.

Often referred to as the cuddle hormone, a simple way to keep oxytocin flowing is to give someone a hug. Dr. Paul Zak explains that inter-personal touch not only only raises oxytocin, but reduces cardiovascular stress and improves the immune system; rather than just a hand shake, go in for the hug. Dr. Zak recommends eight hugs each day.

When someone receives a gift, their oxytocin levels can rise. You can strengthen work and personal relationships through a simple birthday or anniversary gift.
Endorphins
Endorphins are released in response to pain and stress and help to alleviate anxiety and depression. The surging "second wind" and euphoric "runners high" during and after a vigorous run are a result of endorphins. Similar to morphine, it acts as an analgesic and sedative, diminishing our perception of pain.

Along with regular exercise, laughter is one of the easiest ways to induce endorphin release. Even the anticipation and expectation of laugher, e.g., attending a comedy show, increases levels of endorphins. Taking your sense of humor to work, forwarding that funny email, and finding several things to laugh at during the day is a great way to keep the doctor away.

Aromatherapies: The smell of vanilla and lavender has been linked with the production of endorphins. Studies have shown that dark chocolate and spicy foods can lead the brain to release endorphins. Keep some scented oils and some dark chocolate at your desk for a quick endorphin boost.

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Hacking Into Your Happy Chemicals: Dopamine, Serotonin, Endorphins and Oxytocin

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From The Huffington Post Thai Nguyen We might not have a money tree, but we can have a happiness tree. Dopamine, serotonin, oxytocin and endorphins are the quartet responsible for our happiness. Many events can trigger these neurotransmitters, but rather than being in the passenger seat, there are ways we can intentionally cause them to...

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Is it safe to have sex during pregnancy?

In most cases, yes! As long as you're having a normal pregnancy without complications, you can continue to have sex right up until your water breaks or you go into labor.

Don't worry: Your baby is protected by your uterus and a layer of muscles, and is safely cushioned by the surrounding amniotic fluid. The mucus plug inside your cervix also helps guard against infection.

Though if you're not in a mutually monogamous relationship with an uninfected partner, always use male or female condoms to protect yourself - and your baby - from sexually transmitted infections (STIs).

Are there any benefits to having sex during pregnancy?

Besides having sex during pregnancy just for the sheer fun of it, other possible benefits include:

Staying active. Having sex burns calories, which could help you and your partner stay active and keep fit.

Better orgasms. Increased blood flow to your genital area during pregnancy often means better orgasms.

A boost in happiness. Having an orgasm releases endorphins that can make you feel happy and relaxed.

Closer bond with your partner. Having a healthy sex life during pregnancy is a good way to maintain a close emotional connection with your sexual partner - especially important in a time of so many changes.

Is it ever not a good idea to have sex while pregnant?

In some circumstances, you may have to skip certain activities or positions, or stop having sex entirely for part or all of your pregnancy. Your midwife or doctor will let you know whether you have - or develop - any complications that make sex a no-go.

Your provider may tell you not to have sex if you have:

Your provider may advise you to not have sex in other situations as well - like if there are signs you might be at risk for preterm delivery.

If you're uncertain, ask your provider.

Will sex feel different now that I'm pregnant?

Most women say that sex does feel different for at least part of the pregnancy. You may find it more pleasurable at times but not really enjoy it or feel up to it at other times.

Certain physical changes can also make sex during pregnancy feel different. Increased blood flow to the pelvic area can heighten sensation that may add to your pleasure during sex. You may have more vaginal lubrication, which could also be a plus.

On the other hand, more sensitivity in certain areas may feel uncomfortable or even unpleasant. You may also have some mild abdominal cramps or contractions during or immediately after intercourse or orgasm, which can be worrisome even though they're aren't uncommon.

Your breasts may feel tingly, tender, and unusually sensitive to touch, particularly in the first trimester. The tenderness generally subsides, but your breasts may remain more sensitive. Again, you may be turned on by this, or you may find it too intense and prefer that your breasts not be touched at all.

Let your partner know if anything feels uncomfortable, even if it's something you're used to doing together.

I've had a low sex drive since I got pregnant. Is this normal?

When it comes to sex drive during pregnancy, there's a wide range of individual experiences. Some women want more sex during pregnancy; others, not so much. In general, sexuality is different for every woman and depends on how you're feeling physically and emotionally - which changes a lot during pregnancy!

You may feel too tired, moody, or nauseated for sex, especially in the first trimester. It's also not unusual to feel overwhelmed by the physical and emotional changes you're going through. But you may find that your libido returns in full force once you reach the second trimester, when morning sickness and fatigue typically ease up.

Though don't be surprised if your desire fades again in the third trimester, especially in the last month or two. At this point, you may be too big, achy, or exhausted to even think about having sex. You may also feel self-conscious about how your body has changed or be preoccupied with upcoming labor and birth.

If you feel like being less physically affectionate than usual, try to share your feelings and reassure your partner of your love. Keeping the lines of communication open will help you support each other as best you can while you go through these changes together.

Will my pregnancy affect my partner's sex drive?

Most partners find their pregnant lover as attractive as ever, or even more so. But pregnancy worries can also affect your partner's desire. For example, your partner may be anxious about the reality of parenthood, and that can affect sex drive.

Also, guys often become more tentative about sex during pregnancy because they're afraid it will hurt the baby. But rest assured - if you have a male partner, his penis doesn't go past your vagina during intercourse, so it can't harm the baby.

What if I don't feel like having sex?

Even if you can't have intercourse, or if you're turned on but not enjoying penetration, you can explore other ways of expressing your love:

Cuddle

Make out

Massage each other

Give and receive oral sex

Masturbate (on your own or with your partner)

And never underestimate the importance of simply sharing your feelings with each other as a way to feel close. Open communication can defuse a lot of tension and allow you to relax, enjoy each other, and find ways to be intimate, whether or not you're having sex.

What are the best positions for sex during pregnancy?

As your belly grows, you may have to experiment to find the positions that work best for you. For example, the missionary position gets increasingly difficult as your pregnancy progresses and is nearly impossible in late pregnancy.

Check out our slideshow for more ideas and information on the best positions for sex during pregnancy. You'll find helpful suggestions and tips for making sex positions comfortable (and enjoyable!) at every stage of pregnancy.

Is oral sex safe when I'm pregnant?

For the most part, oral sex is safe. That means licking is fine, but not blowing into your vagina. Forcing or blowing air into the vagina could form a bubble of air that gets into your blood circulation (embolism). This very rarely happens, but it can be life-threatening for you or the baby.

It's also not safe for you to receive oral sex during pregnancy if:

Your partner has an active outbreak of oral herpes or feels one coming on. And during the third trimester, if your partner has ever had oral herpes, you should not receive oral sex at all, whether or not your partner has symptoms.

You don't know if your partner has HIV or an STI. In this case, use a dental dam (a sheet of latex that you place between your genitals and your partner's mouth). There's some evidence suggesting that a person may be able to transmit HIV, as well as STIs such as herpes, gonorrhea, and HPV, through microabrasions or tiny cuts in the mouth.

Editor's note: The CDC recommends that pregnant women abstain from vaginal sex and anal sex in addition to oral sex (or use condoms during these activities) with a partner who has been diagnosed with Zika virus, or who lives in or has traveled to an area where Zika is being transmitted by mosquitoes.

Is anal sex safe when I'm pregnant?

In most cases, yes, although there are exceptions. Anal sex during pregnancy may not be a good idea if you have:

Hemorrhoids. These are unfortunately common during pregnancy and tend to get larger as you get closer to your due date. Not only is anal sex probably pretty uncomfortable if you have hemorrhoids, but if they're bleeding, you could lose enough blood to cause a potentially dangerous complication.

Placenta previa. If your placenta covers all or part of your cervix, anal sex could damage the placenta. In this case, check in with your provider about whether it's safe for you to have anal sex.

A risk of preterm labor. Just as when you're not pregnant, never go from anal to vaginal penetration before your partner washes his penis (or changes condoms). Otherwise you put yourself at risk for bacterial vaginosis (an overgrowth of certain bacteria in the vagina), and there's some concern that this can make your water break early.

Can we use sex toys during pregnancy?

Sex toys during pregnancy are fair game, with a few general precautions (and as long as your provider hasn't advised against them):

Clean all toys before and after you use them, especially after anal sex.

Stop using sex toys if you have pain, cramping, or discomfort.

Don't use them if you have bleeding, are at risk for premature labor, or have a low-lying placenta.

Don't use them after your water breaks.

Is it safe to have sex in the third trimester of pregnancy?

Sex during the third trimester is safe if you're having a healthy, normal pregnancy. Though as your third trimester progresses and you get bigger, you may have to get creative about positions.

That said, sex during the third trimester may not be safe if you have:

And don't have sex once your water has broken - after that, your baby is no longer protected from infections.

Can having sex trigger labor?

No, not if you have a normal, low-risk pregnancy. Sexual stimulation or orgasm cannot start labor or cause a miscarriage. Orgasm may cause mild contractions (as can nipple stimulation), but these are generally temporary and harmless.

Some pregnant women, midwives, and doctors claim that having sex near the end of pregnancy might give you the boost you need to get labor started. One theory is that the hormones in semen (prostaglandins) and the contractions of orgasm stimulated the cervix, but studies show no such link.

But as long as your pregnancy is healthy and uncomplicated, you can have as much sex as you want, right up until your water breaks. Just don't expect it to jump-start labor!

When should I call my doctor or midwife?

Don't hesitate to contact your doctor or midwife any time you have any questions or concerns, especially if you aren't sure whether you should be having sex during pregnancy, or you're worried about your baby's health or safety.

Call your provider any time you have any unusual symptoms during or following intercourse, including:

More than mild cramping that doesn't go away after a few minutes

Pain

Bleeding

Discharge

And if your provider does tell you to stop having sex, make sure you ask whether this means you need to avoid specifically intercourse, or whether you shouldn't put anything in your vagina or do any activity that could bring you to orgasm.

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In most cases, yes! As long as you're having a normal pregnancy without complications, you can continue to have sex right up until your water breaks or you go into labor. Don't worry: Your baby is protected by your uterus and a layer of muscles, and is safely cushioned by the surrounding amniotic fluid.

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Exercise During Pregnancy

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You definitely don't need to avoid exercise for nine months, unless you have specific medical advice telling you not to do any (NICE, 2017). A few health conditions, mentioned below, do mean you should speak with your GP or midwife first.

For many people, a certain level of activity can improve you and your baby's health while you're pregnant (RCOG, 2006). It can also mean that you have a shorter labour with fewer complications (RCOG, 2006; OTIS, 2010; May, 2012; NHS Choices, 2017).

"It might seem surprising but if you don't normally exercise much, now is actually a great time to start (NICE, 2017)."

Regular exercise can do the following:

Help to reduce high blood pressure.

Help to reduce the risk of diabetes (Harding, 2017; Department of Health, 2017). For women who have gestational diabetes, exercise may help to control it (Nascimento et al, 2012).

Help you to adapt to your changing body shape and maintain a healthy weight during and after pregnancy.

Help to reduce the likelihood of varicose veins, swelling in ankles, feet and hands and back pain (Harding, 2017).

Improve your fitness levels (Kramer and McDonald, 2006).

Improve mood, and reduce depression and anxiety (RCOG, 2006; Department of Health, 2017; Harding, 2017).

Improve sleep (Nascimento, 2012; NHS Choices, 2017).

Lower the risk of pre-eclampsia, very low birth weight and caesarean birth (Dignon, 2013).

Improve your body's ability to cope by shortening the length of labour and improving the likelihood of a straightforward labour and recovery after the birth (RCOG 2006; OTIS, 2010; May, 2012; NHS Choices, 2017).

Exercise is safe for most women but speak to your GP or midwife before exercising during pregnancy if you have any of the following:

Known heart problems or lung disease.

Known weakness of the cervix or if you've had a cervical stitch.

A twin or multiple pregnancy.

History of premature labour or any signs of premature labour in your pregnancy.

Premature waters breaking.

Vaginal bleeding that continues throughout your pregnancy.

Placenta praevia, which is where the placenta is close to the cervix.

Pre-eclampsia.

Poorly controlled diabetes, seizures or thyroid disease during pregnancy.

Anaemia during pregnancy.

Bone or joint problems that affect mobility.

An eating disorder.

A body mass index higher than 40 or you are very inactive.

A smoking habit where you smoke more than 20 cigarettes a day.

(Harding, 2017)

Signs you need to stop exercising immediately are listed in our Pregnancy workouts: safety article.

Pregnancy exercise ideas

Walking

The bonus of heading through a park or woodland is that connecting with nature can reduce stress levels (Natural England, 2016). You might particularly appreciate this relaxation during pregnancy.

Yoga or pilates

This is a brilliant way to check in with your changing body, and to ease any stress (Cameron, 2014). Pilates can help strengthen the key muscles around the pelvis and spine too (Balogh, 2005).

Check that the instructor is qualified to teach pregnant women or better still, attend a pregnancy-specific class. You could try our NCT Yoga for Pregnancy class. If you prefer a gentler mind and body exercise, you might enjoy yoga breathing and relaxation or hypnobirthing exercises.

If you do yoga or pilates at home, make sure the exercises you do are safe for pregnancy. Avoid:

lying on your back after 16 weeks

exercises that include holding your breath or taking short forceful breaths

stretches that put you under strain

lying upside down or on your abdomen

back bends or strong twists.
(Cameron, 2014

Aquanatal classes and swimming

Aquanatal classes are aerobic exercise classes that you do in water. It's another great exercise during pregnancy as it can improve your cardiovascular fitness and muscle tone, and help you relax (ACPWH, 2010). The beauty of exercising in the water is that it'll support your bump, and you'll have less muscle soreness afterwards and less risk of injury (NHS Choices, 2017).

Swimming

A miracle all-rounder. It's is one of the safest exercises you can do during pregnancy. Benefits include easing swelling, feeling of weightlessness and relief from sciatic pain as it encourages circulation.

Swimming can also ease leg and foot swelling, relieve stress and help your baby into a good position for birth (Swim England, 2015). Just avoid backstroke late on in your pregnancy as it can press on the main blood vessels in the abdomen (Swim England, 2015).

Weight lifting

Again, don't start weight lifting if you haven't done it before but if you were a regular weight lifter pre-pregnancy, feel free to continue. Weight training can actually prepare you for the physical demands of labour (Evenson, 2004; O'Connor, 2011; Nascimento et al, 2012).

A few things to watch out for are that you might have to use lighter weights than before (Van Hook 1993; ACPWH 2010). You must also avoid certain positions, like those where you forcefully push or lift heavy weights while holding your breath as they can affect blood pressure (Nascimento et al, 2012). If you do classes, let your instructor know you are pregnant.

Housework

Sorry not to get you out of that one.

Dancing, working out at the gym, cycling or running

If you're used to cardiovascular exercise, it can be great to continue it during pregnancy. Continuing to run during pregnancy is fine. Evidence suggests it does not affect gestational age or birth weight centile (Kurht et al, 2018).

Just don't start running when pregnant if you didn't run before - try walking or swimming. Running can affect your knees and pelvic floor even if you're not pregnant (Davies, 2013) but pregnancy hormone relaxin makes you more injury prone than before.

Aerobic classes

Again, if you did aerobics before, you can carry on. Do make sure you tell the teacher so they can amend movements if needed.

Pregnancy exercise to avoid

While exercise during pregnancy is a great habit, some sports aren't advisable while you have a baby on board. If you're in any doubt, speak to your midwife or GP but make sure you avoid the following.

High-impact sport or vigorous racquet sports

Can lead to abdominal trauma, falls or excessive joint stress (NICE, 2017).

Scuba diving

Can cause birth defects or fetal compression disease (NICE, 2017).

Exercise over 2500m above sea level

This might be an unusual one, we know, but it can lead to altitude sickness. If you are in those conditions and want to exercise, wait until you have acclimatised (NICE, 2017).

Further information

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

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

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

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You definitely don't need to avoid exercise for nine months, unless you have specific medical advice telling you not to do any (NICE, 2017). A few health conditions, mentioned below, do mean you should speak with your GP or midwife first.

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How to do perineal massage: a step-by-step guide

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Perineal Massage

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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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People may tell you that pregnancy is a good time to put your feet up. If your pregnancy is uncomplicated it is actually much healthier for you and your baby to exercise while pregnant.

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Now that you are pregnant your body has two jobs to do - manage a full or part-time job and grow a baby (or babies). Both are tiring for different reasons, but it is possible to enjoy your pregnancy and your job at the same time.

Tips for working safely during pregnancy:

Take frequent breaks.

Stretch your legs every couple of hours.

It will depend on your job but try to put your feet up if they're swollen and uncomfortable. You could use a foot rest or a box - anything that feels comfortable.

Wear loose clothing and comfortable shoes.

Take a healthy packed lunch and snacks. This will stop you eating unhealthy snacks at work.

Ask for help when lifting heavy things at work.

Your rights at work

Most of the information below relates to employees who are on their employer's payroll and covers the minimum legal maternity rights (the things that every employer has to do). Check your employment contract to see if your company offers better maternity benefits.

Self-employed and agency workers

There are different rules if you are self-employed or an agency worker. Please visit Gov.UK for more detailed information.

When do I have to tell my manager that I'm pregnant?

Legally you don't have to tell your manager that you're pregnant until 15 weeks before your ' Expected Week of Childbirth ' (the week of your baby's due date).

It is usually a good idea to tell them sooner though, especially if you have a physical job or need extra check-ups in your pregnancy for any reason. By law you are entitled to paid time off for all antenatal appointments. It will also help them plan for your maternity leave. Many women tell employers after 12 weeks when the risk of miscarriage goes right down. This is also around the time of your first pregnancy appointment, the booking appointment.

Once you have talked to your manager, you will need to put your pregnancy in writing. The letter should state your due date and the date you plan to start your maternity leave. You should also include any details about holiday you want to take before that time. As well as your letter, they will need your MAT B1 form, which you will get from your midwife at around 20 weeks of pregnancy

Your manager should reply to you to confirm the latest date that your maternity leave can end. This will be the date when you will return to work, unless you choose to come back sooner. Read more about the length of your maternity leave.

Telling your manager about your pregnancy early

You can tell your manager[ about your pregnancy as early as you like. However, if you do decide to tell them early and don't want anyone else at work to know, make it clear that your news should not be shared until you're ready.

What is my Expected Week of Childbirth (EWC)?

Your EWC is the week when your baby is due. It will be stated on the MAT B1 form, which will be given to you by your midwife around 20 weeks into your pregnancy.

To find the 15th week before your EWC, find the Sunday before your due date (unless your baby is due on a Sunday, in which case use that date), and count back 15 weeks.

Examples

1. Alison's baby is due Friday 29 March 2019.
Alison's EWC starts the Sunday before, Sunday 24 March 2019.
Therefore, legally, Alison would need to let her employer know about her pregnancy on the week starting 9 December 2018.

2. Amina's baby is due Sunday 31 March 2019.
Because Amina's baby is due on a Sunday that is when her EWC starts.
Therefore, legally, Amina would need to let her employer know about her pregnancy on the week starting 16 December 2018.

MAT B1 forms and why they're important

The MAT B1 form, or maternity certificate, proves to an employer that you are pregnant and confirms your EWC.

You must give your MAT B1 to your employer because without it you cannot claim Statutory Maternity Pay (SMP) or any other maternity benefits.

Health and safety at work

When you formally tell your employer that you're pregnant (that is, in writing) they may think about doing a risk assessment of your job. They'll need to find out if any changes are needed to make you more comfortable at work.

If there are any risks to your health, or your baby's health, these must be addressed.

Health and safety covers obvious problems like loose cables, but also things like posture, noise, and tiredness. Your job might involve a lot of bending and stretching, being on your feet all day, or travelling long distances - things that might be more difficult to do now that you're pregnant. It also includes things like lifting heavy items.

Your employer may need to offer you different types of work or a change to your working hours. If your employer can't get rid of the risks (for example by finding other suitable work without any reduction in pay for you), they should offer you suspension on full pay.

Working long hours during pregnancy

It is unclear whether working very long hours during pregnancy increases a woman's risk of miscarriage or preterm birth. Evidence shows there may be a small increase in risk. However, it is not enough to make it compulsory for employers to reduce working hours to below 40 hours per week.

If you feel that working long hours is causing you physical or mental harm during your pregnancy, talk to your midwife or GP. They can advise you on whether you're doing too much, and if you are how you can approach it with your employer.

Pregnancy and sick leave

If you are ill because of your pregnancy (morning sickness for example) and need to take time off work, it cannot be counted on your sickness record. However, taking time off for an illness that is not because of your pregnancy, such as a bad cold, will count towards your sickness record.

If your company usually provides company sick pay (such as full basic pay for a certain number of days of sickness) then you are still eligible for company sick pay in the same way as your colleagues. However, your pregnancy does not mean you are entitled to any more company sick pay than your colleagues are. If your company doesn't offer company sick pay you can apply for Statutory Sick Pay (SSP).

If, before you start your maternity leave, you are off work with a pregnancy-related illness from 36 weeks your manager can make you start your maternity leave early.

Find out more about getting sick pay when you're pregnant.
If your job is making you ill, or if it is not safe to do while you are pregnant, then this is seen as a health and safety issue and you will need a risk assessment.
Time off for antenatal appointments

By law your employer must allow you paid time off for antenatal appointments.

All pregnant women are also entitled to 'reasonable' paid time off work to go to any relaxation, parenting or smoking cessation classes. However, these should be recommended by your midwife or GP as part of your care. You may be asked for a letter from a healthcare professional to prove it.

Travelling and waiting times are included too, so don't worry about rushing or if your appointment is late.

Read more about your right to go to appointments.

Maternity leave and pay

Maternity leave

Employees are entitled to 52 weeks' maternity leave, regardless of length of service or the number of hours you work. This leave is divided into 26 weeks' Ordinary Maternity Leave (OML), and 26 weeks' Additional Maternity Leave (AML). OML and AML offer slightly different rights about your return to work.

Your employer will assume that you will return at the end of your Additional Maternity Leave (after 52 weeks). If you plan to come back earlier, you will need to give them 8 weeks' notice in writing.

Maternity pay

You may be entitled to Statutory Maternity Pay (SMP). If so, this is paid to you by your employer in your usual pay packet.

If you don't qualify for SMP you may be able to claim Maternity Allowance (MA), for example if you are self-employed or have not been working for your employer for enough weeks to qualify.

Both are payable for up to 39 weeks.

For detailed information about maternity leave and pay, visit www.worksmart.org.uk or www.gov.uk/maternity-pay-leave.

If you don't go back to work after maternity leave

If you decide not to return to work at all, then you need to resign in the normal way and hand in your notice according to your contract of employment with your company. For example, your work may ask for 4 weeks' notice or more. Make sure you check your contract.

Find out more about resigning during maternity leave.

Fair and unfair dismissal during pregnancy

While you can be fired or made redundant during pregnancy the dismissal MUST NOT in any way relate to your pregnancy, a pregnancy-related illness or your maternity leave plans.

If you are fired or made redundant because of your pregnancy or maternity leave it is classed as unfair dismissal.

See Maternity Action for more about problems at work and unfair dismissal.

Tommy's Pregnancy at Work Accreditation Programme

At Tommy's we run a highly respected Pregnancy Accreditation Programme that aims to ensure all pregnant employees stay healthy. The Programme recognises that a healthy pregnancy in the workplace is a team effort, so both employee and manager need to work together.

Tell your employer about Tommy's Pregnancy at Work scheme.

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Now that you are pregnant your body has two jobs to do - manage a full or part-time job and grow a baby (or babies). Both are tiring for different reasons, but it is possible to enjoy your pregnancy and your job at the same time. Take frequent breaks.

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Baby Positions

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What is the best position for my baby to be in?

"The best position for your baby to be in ready for their birth, is head down, facing your back, with their back against your belly."

In this position, your baby's head and neck are flexed and their chin is tucked into their chest. This means the narrowest part of their head (the back) presses on your cervix, helping it to open.

The flexible joints in your baby's skull allow your baby's head to change shape and make its way more easily down the birth canal during labour. This helps them fit through your pelvis more easily (Simpkin, 2010; RCM, 2012).

What is the 'occiput anterior' position?

If your baby is lying head down in your womb and facing your back, like described above, they're in what medics call the occiput anterior (OA) position. This means that the back of their head (occiput) is at the front (anterior). Most babies lay this way and it's the best position for birth (RCM, 2012).

Which other positions might my baby be lying in?

If your baby is lying in your womb to your left, you'll see LOA (left occiput anterior) written in your maternity notes.

If they are lying in your womb to your right, you'll see ROA (right occiput anterior) written in your notes.

If your baby is bottom down in your womb, you'll see B or BR (breech) written in your notes - see our article on breech babies.

Back-to-back - see below.

See our article about maternity notes to find out the other abbreviations for baby positions that your midwife might note.

My baby is 'back-to-back', what does it mean?

Some babies lie with their back against their mother's back. This is known as an occiput posterior (OP) position or back-to-back position in the womb.

Labour tends to take longer, be more painful and you're more likely to have a caesarean or assisted (instrumental) birth if your baby is in a posterior position. This is because they can't tuck their chin in very easily, which makes getting through the pelvis more awkward. This position often causes backache during labour too (Simpkin, 2010; RCM, 2012; Tommy's, 2016).

What can I do to help my baby to turn?

Some people think that women with babies in the back-to-back position can use certain positions during the end of pregnancy to turn their babies. Forward-leaning positions like going on all fours have in the past been said to help babies into the best position for birth. Unfortunately, there is no evidence that this works (Guitier et al, 2016).

On the plus side, forward-leaning positions could ease your backache when you're in the first stage of labour (Hunter, 2007; Guitier et al, 2016).

What position in the womb is my baby in? How to tell whether they're front or back facing

Your midwife should be able to tell you during an ultrasound which way round your baby is lying. Saying that, babies will move position during pregnancy and birth. So it's good to know there are some giveaways to how your baby's lying.

Here are the tell-tale signs you can look out for:

You might be able to visualise how your baby is lying from their movements. Tickles might be their little hands waving around, while harder movements could be their elbows, knees or feet.

Your baby's bum will feel squashier than their head, which will be firm and round.

If your baby is lying back-to-back (OP position), your bump might feel squashy and you may feel (and see) kicks in the middle of your belly. Another sign of the OP position is a dip around your belly button instead of it poking out.

If your baby is head down and facing your back (OA position), you'll probably feel kicks under your ribs. You'll also be able to feel the hard, rounded surface of your baby's back, which will be on one side of your belly.

(Tommy's, 2016)

My baby is not in the ideal position for labour, should I worry?

No, as there isn't much chance it will be a problem. Most babies turn during labour to the anterior position. Here are the stats:

Between 15% to 32% of women have a baby in an OP (back-to-back) or occipito-lateral position when they go into labour. This happens more often among women who haven't given birth before (Simkin, 2010).

Only five to eight babies out of every 100 will stay in the OP position (Tommy's, 2016).

Taking an antenatal course could help to prepare you for labour and birth. It could also help to ease any worries you might have about labour and give you the chance to meet other parents in your local area.
This page was last reviewed in July 2018.
Further information

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

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

Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. (2016) Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG. 123(13):2199-2207. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132127/ [Accessed 1st July 2018].

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. (4):CD001063. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001063.pub3/full [Accessed 1st July 2018].

RCM (Royal College of Midwives). (2012) Persistent lateral and posterior fetal positions at the onset of labour. Evidence based guidelines for midwifery-led care in labour. Available at: https://www.rcm.org.uk/sites/default/files/Persistent%20Lateral%20and%20Posterior%20Fetal%20Positions%20%20at%20the%20Onset%20of%20Labour.pdf [Accessed 1st July 2018].

Simkin P. (2010) The fetal occiput posterior position: state of the science and a new perspective. Birth. 37(1):61-71. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20402724 [Accessed 1st July 2018].

Tommy's (2016) Getting your baby into the best birth position. Available at: https://www.tommys.org/pregnancy/labour-birth/baby-best-position-birth [Accessed 9th September 2018].

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"The best position for your baby to be in ready for their birth, is head down, facing your back, with their back against your belly." In this position, your baby's head and neck are flexed and their chin is tucked into their chest.

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Whatever you want to know about being pregnant, from early pregnancy signs to which prenatal vitamins you should take, you should find it here. We're here to give you the essential guide and lots of free tools for having a healthy, happy baby..

# data[].attributes.attachment_link.description
Whatever you want to know about being pregnant, from early pregnancy signs to which prenatal vitamins you should take, you should find it here. We're here to give you the essential guide and lots of free tools for having a healthy, happy baby..