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If you feel you would benefit from going over your birth experience with one of our senior midwives please follow this link to find out how to book an appointment

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Birth afterthoughts service

Are you left with unanswered questions after your birth experience?

Diamond Jubilee maternity unit - Birth After Occasionally women need help to answer questions regarding their pregnancy or experience of giving birth. If you have any unanswered questions and have tried discussing any pregnancy or birth issues with your community midwife, health visitor or GP and are still unable to resolve them, you can contact our birth afterthoughts team.

The Birth Afterthoughts service is a listening and information service for women who have unresolved issues about their pregnancy or birth experience and provides you with an opportunity, following your birth experience, to have any questions answered. It is available to women who have given birth in the East and North Hertfordshire Trust within the last 12 months, or who are currently pregnant. Please ring and leave a message on 07879 694725 and one of the team will call you back to arrange a convenient time to meet and discuss those aspects of your experience you would like to review. We look forward to your call.

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Birthing afterthoughts - East and North Hertfordshire NHS Trust

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Birth afterthoughts service Are you left with unanswered questions after your birth experience? Diamond Jubilee maternity unit - Birth After Occasionally women need help to answer questions regarding their pregnancy or experience of giving birth. If you have any unanswered questions and have tried discussing any pregnancy or birth issues with your community midwife, health [...]

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If you are not in immediate danger and would like to talk to us about your options, call our helpline on 03301 025811. We will provide you with the support and information you need to consider your options and decide what to do to improve your safety and that of your children.

You are not responsible for the abuse that you are experiencing and you can't stop the abuse - only the abuser can do this. Domestic abuse may not end when you no longer live with the abuser and/or the relationship has ended. There are things that you can do that may improve your safety and the safety of others, including children, but this is not guaranteed. Remember, you will have the best understanding of the abuser's behaviour, so only do what you think will help.
In order to increase your safety you can:

Call 999 in the event of an emergency.

Plan what you will do and where you and you dependents, including children can go in an emergency and it is unsafe to remain in your home.

If there is anyone else that you are worried about see our [other services]

Plan an escape route from every room in your home.

Think of a safe area in your home to go if an argument happens. Stay away from rooms with no exits, hard surfaces, or where there are objects which can be used as weapons e.g. the kitchen or bathroom.

If possible, try to get any potential weapons out of the house.

Arrange where you might go if you need to leave your home suddenly, is there a neighbour or do you have friends or family close by? Let your children and any other dependents know where to go if they need to leave the home.

Make a list of safe people to contact. If possible memorise all important phone numbers, including your local domestic abuse services so that if the abuser takes your phone you still have numbers to call for help and support.

If you feel able to, speak to a trusted neighbour about your situation - give them permission to call the Police if they see or hear something that concerns them e.g. a disturbance

Create a 'code word' or 'sign' to use with friends, family, neighbours, professionals you are working with to let them know you are in danger and to ask for help without the abuser finding out.

Try to keep some money with you at all times so you can use public transport / get a taxi if you need too.

Find out where the nearest phone is that you can use.

If you have a mobile phone, keep it charged on with you at all times.

If you suffer injuries, try to access a GP / hospital as soon as possible, if you are unable to leave your home you can call 111.

You may also be able to do some of the following:

Keep a record of the abusive behaviour to support any future action you may choose to take; this could be a diary, a list or photos of injuries / criminal damage etc.

If you want to, you can log incidents with the police, even if you do not want to press charges at present.

Consider getting some legal advice to discuss what options are available to you [link to other services]

If you want to stay in your home

If the abuser does not live with you / no longer lives with you, you should consider:

Changing locks on doors and windows.

Having additional security installed e.g. sensor security lighting/alarms.

Changing your phone number, and ask for your calls to be screened when at work.

Inform ing trusted friends, relatives, neighbours that you no longer live / are in a relationship and they should call the police if they see the abuser near or trying to gain access to your home.

Inform ing people who look after your children e.g. teachers, which people have permission to collect them. If you have an injunction, give a copy to the school.

If you want to leave your home

Making the decision to leave your home is not easy - it can often be a dangerous time so planning how and when you leave can help increase your safety. You may not feel able to leave immediately, but you can be prepared and plan for what you would do if an emergency arises and you need to leave your home.

Have a bag packed with some essentials so you can leave in a hurry (things for you, your children and any other dependents - clothes, nappies, baby milk etc.)

Keep important documents (e.g. marriage/ birth certificates, passport, driving licence, legal documents e.g. injunctions, divorce papers, immigration papers, housing documents e.g. mortgage/tenancy paperwork, financial records e.g. bank statements), money and bank cards, keys, medication and medical records and items of sentimental value to you and your children in a safe place so that they can be quickly and easily accessed.

Consider leaving a bag with a trusted friend or relative containing the items you would need if you had to leave urgently.

Only tell people you trust where you will be and if you need to lie to protect yourself and others then do so.

Always try to take your children and any other dependents with you or make arrangements to leave them with somewhere safe and in the care of someone you trust.

Try not to use a phone the abuser has access to (e.g. landline) but if you do and the last number you called was a domestic abuse service, refuge, taxi or the place you are going to stay, dial another number, for example, the Speaking Clock (dial 123).

Your safety and emotional well being

If you have to communicate with the abuser e.g. due to child contact, think about the safest way to do so. If you have to meet with them you could do this in a public space and let some-one know where you are going, when you arrive and when you have left.

Have positive thoughts about yourself and be assertive about your needs.

Get support from a domestic abuse support service.

Talk to your children and let them know it is not their fault .

Be kind to yourself.

Do things that promote you emotional wellbeing - meeting up with or talking on the phone to friends and families, hobbies, exercise, mindfulness.

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If you or your children are in immediate danger, call the police on 999. If you are not in immediate danger and would like to talk to us about your options, call our helpline on 03301 025811.

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Practical help if you are struggling after having your baby and need a helping hand

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Home Visiting Support

A fully trained family mentor is matched with the family and visits them in their home for a couple of hours each week. The mentor provides practical and emotional support to help the family work through the challenges they are facing, for example, they:

Help them get out of the house to visit groups and meet people

Accompany them to medical appointments to occupy the children whilst the parent is in the appointment

Sign post the family to other support services, help with paperwork and attend meetings with them if necessary

Provide strategies and support to assist parents with issues such as routines, healthy eating or managing challenging behaviours

We will always gratefully remember the help and support we received from Home-Start when our twins came along (they have just turned 6!). It was a difficult time as we already had a 2 year old. The hands-on help and the emotional support made a huge difference to all our lives.
Group Support

Some families don't want or need one-to-one support from a family mentor but still need a bit of support. If this is the case, we are able to offer families support at one of our Family Groups.

There are groups currently running in Cheshunt, Hemel Hempstead, Letchworth, Hertford, Stevenage and Welwyn Garden City

The groups are run by Home-Start group leaders and trained volunteers. They run weekly all year round.

The group activities and topics are based on principles from our 'Big Hopes Big Future' school readiness program. Through play and interaction, children develop social, emotional and practical skills, experience routine and learn basic independence skills, ready for nursery.

Out of the Blue - peri-natal depression and anxiety support project

Having a baby is a big life event, and it's natural to experience a range of emotions and reactions during and after your pregnancy. Sometimes these emotions can start impacting on how you live your life.

Around one in five women will experience a mental health problem during pregnancy or in the year after giving birth. These are known as perinatal, meaning around birth, mental health problems.

Some parents are more at risk of developing depression and anxiety during pregnancy due to previous experiences such as:

Previous mental health conditions

Traumatic childbirth, still birth or infant mortality

Domestic abuse

Poor social support

The Out of the Blue project provides specialist trained family mentors for parents who have been identified as at risk of developing perinatal anxiety and depression. Support can be offered towards the end of the pregnancy and beyond birth.

Through weekly home-visiting support, the mentors help the parents to become less isolated, they support them to attend health appointments, help them increase their use of community support and provide advice and suggestions around parenting.

Families can refer themselves or can (with the parent's permission) be referred by health, or other relevant professionals, who have concerns.

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1 to 1 and Group Support - Home Start Hertfordshire

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Home Visiting Support A fully trained family mentor is matched with the family and visits them in their home for a couple of hours each week. The mentor provides practical and emotional support to help the family work through the challenges they are facing, for example, they: Help them get out of the house to [...]Read More...

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If you're pregnant, it's important to get vaccinated to protect you and your baby. The antibodies your body produces in response to the vaccine can also give your baby protection against COVID-19.

You're at higher risk of getting seriously ill from COVID-19 if you're pregnant. If you get COVID-19 late in your pregnancy, your baby could also be at risk.

Evidence shows that most pregnant women with COVID-19 who need hospital treatment or intensive care in the UK have not been vaccinated.

If you're pregnant and have not had your first 2 doses and booster dose yet, it's important to get your vaccinations as soon as possible.

If you're pregnant and have been vaccinated, you should have a seasonal booster dose this autumn.

It's safe to have the vaccine during any stage of pregnancy, from the first few weeks up to your expected due date. You do not need to delay vaccination until after you have given birth.

Getting vaccinated against COVID-19 reduces the risk of having a stillbirth.

There's no evidence COVID-19 vaccination increases the risk of having a miscarriage, pre-term birth or other complications in your pregnancy.

The COVID-19 vaccines do not contain any live viruses and cannot give you or your baby COVID-19.

They have been widely used during pregnancy in other countries and there have been no safety concerns. In the UK, over 100,000 pregnant women have been vaccinated.
Find out how to get a COVID-19 vaccine

You'll be able to discuss having a COVID-19 vaccine during pregnancy at your vaccination appointment.

You can also speak to a GP or your maternity team for advice.

You may find the COVID-19 vaccination in pregnancy decision aid from the Royal College of Obstetricians and Gynaecologists (PDF, 405KB) helpful.

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If you're pregnant, it's important to get vaccinated to protect you and your baby. The antibodies your body produces in response to the vaccine can also give your baby protection against COVID-19. You're at higher risk of getting seriously ill from COVID-19 if you're pregnant.

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Emergency mental health support

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Leaflets about the covid vaccine for pregnant and breastfeeding people in the following languages (scroll to the middle of the page for the links) Albanian, Arabic, Bengali, Bulgarian, Chinese, Estonian, Farsi, Greek, Gujarati, Hindi, Latvian, Lithuanian, Panjabi, Polish, Portuguese Brazilian, Romanian, Russian, Somali, Spanish, Turkish, Twi, Ukrainian and Urdu.

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Information for all women of childbearing age, those currently pregnant or breastfeeding on coronavirus (COVID-19) vaccination.

Applies to England

Documents

Ref: UKHSA gateway number 2021937 PDF, 340 KB, 2 pages

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Ref: PHE gateway number 2021425 PDF, 557 KB, 1 page

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Details

COVID-19 vaccination is strongly recommended for pregnant and breastfeeding women.

Leaflet

This leaflet for all women of childbearing age, those currently pregnant or breastfeeding on coronavirus (COVID-19) vaccination. Paper copies and translated versions will be available soon.

All women of childbearing age must read this leaflet before they go for vaccination

Paper copies of the previous version are available to order for free or download in the following languages and formats:

English, English large print, Albanian, Arabic, Bengali, Bulgarian, Chinese, Estonian, Farsi, French, Greek, Gujarati, Hindi, Latvian, Lithuanian, Panjabi, Pashto, Polish, Portuguese, Romanian, Romany, Russian, Somali, Spanish Tagalog, Turkish, Twi, Ukrainian, Urdu and Yiddish.

An easy-read version of this leaflet is available for people with a learning disability and their carers.

British Sign Language videos are available to view and download.

A Braille version of this leaflet is available to order.

An audio version is available to download.

Posters

This is a set of 4 posters aimed at pregnant women encouraging them to have both of their COVID-19 vaccinations. These posters are available for download only.

English, Albanian, Arabic, Bengali, Brazilian Portuguese, Bulgarian, Chinese, Estonian, Farsi, Greek, Gujarati, Hindi, Latvian, Lithuanian, Panjabi, Pashto, Polish, Romanian, Romany, Russian, Somali, Spanish, Tagalog, Turkish, Twi, Ukrainian, Urdu and Yiddish.

There is a set of social media cards to go with these posters and they can be downloaded and shared on social media and websites.

Thank you for your feedback

Report a problem with this page

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COVID-19 vaccination: women of childbearing age, currently pregnant or breastfeeding

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COVID-19 vaccination: a guide for all women of childbearing age, pregnant or breastfeeding

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COVID-19 vaccination is strongly recommended for pregnant and breastfeeding women.

The coronavirus (COVID-19) vaccines available in the UK have been shown to be effective and to have a good safety profile. It is important to have your COVID-19 vaccinations to protect you and your baby.

COVID-19 vaccination in pregnancy

The Joint Committee on Vaccination and Immunisation ( JCVI) has now advised that pregnant women are more at risk of severe COVID-19 disease. They are reminding pregnant women to have their COVID-19 vaccines as soon as possible. They should not delay vaccination until after they have given birth. This is to protect them and their babies. In the UK, over 100,000 pregnant women have been vaccinated mainly with Pfizer and Moderna vaccines and they have a good safety profile.

These vaccines do not contain live coronavirus and cannot infect a pregnant woman or her unborn baby in the womb.

Evidence on COVID-19 vaccines is being continuously reviewed by the World Health Organization and the regulatory bodies in the UK, US, Canada and Europe.

Pfizer and Moderna vaccines are the preferred vaccines for pregnant women of any age who are coming for their first dose.

Anyone who has already started vaccination and is offered a second dose whilst pregnant, should have a second dose with the same vaccine unless they had a serious side effect after the first dose.

Why you need the vaccine if you are pregnant

If you have COVID-19 disease in later pregnancy, both you and your unborn baby are at increased risk of serious disease needing hospital treatment, and intensive care support. UK data has shown that almost every pregnant woman with COVID-19 disease who needed hospital treatment or intensive care, had not been vaccinated. The overall risk from COVID-19 disease for you and your new baby is low but has increased since the first waves of COVID-19.

COVID-19 vaccines in pregnancy give you high levels of protection against disease. There is reassuring information on the safety of COVID-19 vaccines given to pregnant women in the UK, as well as other countries.

It is important that you are protected with all your vaccine doses to keep you and your baby safe. Don't wait until after you have given birth.

Pregnant women with underlying clinical conditions are at higher risk of suffering serious complications from COVID-19.

Risk factors for pregnant women

If you have underlying medical conditions such as:

Or if you are:

overweight

over the age 35

in your third trimester of pregnancy (over 28 weeks)

of black and Asian minority ethnic background

remain unvaccinated or partially vaccinated

You are at more risk from COVID-19 than women of the same age who are not pregnant.

Getting pregnant

There is no need to avoid getting pregnant after COVID-19 vaccination. There is no evidence that COVID-19 vaccines have any effect on fertility or your chances of becoming pregnant.

If you are pregnant

COVID-19 vaccines offer pregnant women the best protection against COVID-19 disease which can be serious in later pregnancy for some women.

The first dose of COVID-19 vaccine will give you good protection. You need to get each of your doses on time to get the best possible protection. You should have your second dose 8 to 12 weeks after your first dose. You do not need to delay this second dose. If you have delayed your vaccination for any reason, have your vaccinations as soon as possible.

If you have already had a first dose of COVID-19 vaccine without suffering any serious side effects, you can have your second dose with the same vaccine when this is offered.

If your first dose was the AstraZeneca ( AZ) vaccine you should also consider the information in the COVID-19 vaccination and blood clotting leaflet.

Don't put off vaccination until after you give birth, make time to get the best protection we have against COVID-19 disease for you and your baby.

Booster vaccines

Pregnant women are eligible for a booster, 12 weeks after their second dose. The booster dose that is offered may be a Pfizer or Moderna vaccine.

Breastfeeding

The benefits of breastfeeding are well-known.

The JCVI has recommended that the vaccines can be received whilst breastfeeding. This is in line with recommendations from the US and the World Health Organization.

Side effects

Like all medicines, vaccines can cause common side effects. It may be helpful to make sure you know what to expect after you have the vaccine, especially if you have had your baby or have other children to look after.

Please read the What to expect after your COVID vaccination leaflet.

Continue to follow current national guidance

No vaccines are 100% effective so it is important to continue to follow current national guidance.

To protect yourself and your family, friends and colleagues, you MUST still:

where advised wear a face mask

wash your hands carefully and frequently

open windows to let fresh air in

follow the current guidance

Further information

The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives (RCM) have a decision guide and other information you may find helpful on COVID-19 vaccines and pregnancy.

Pregnancy, breastfeeding, fertility and COVID-19 vaccine information on NHS.UK.

If you would like to discuss COVID-19 vaccination please contact your midwife, doctor, or nurse.

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COVID-19 vaccination: a guide on pregnancy and breastfeeding

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COVID-19 vaccination is strongly recommended for pregnant and breastfeeding women. The coronavirus (COVID-19) vaccines available in the UK have been shown to be effective and to have a good safety profile. It is important to have your COVID-19 vaccinations to protect you and your baby.

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Community Postnatal Friends & Family Questionnaire 

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Community Postnatal Friends & Family Questionnaire 

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We are keen to collect the views of women about our community midwifery service and welcome any suggestions for improvements.

Your responses to this maternity survey are totally anonymous and cannot be linked back to you.

Thank you for completing this survey.

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We are keen to collect the views of women about our community midwifery service and welcome any suggestions for improvements. Your responses to this maternity survey are totally anonymous and cannot be linked back to you. Thank you for completing this survey.

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In order to have fun, meet new people and learn together at our family centres, you need to sign up first.

Sign up online Register using this form to access all of the events and activities available at our centres.

Refer to us If you need more targeted support from us, make a referral. Your family will need to be registered first, though.

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Sign up with Hertfordshire Family Centre Service

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In order to have fun, meet new people and learn together at our family centres, you need to sign up first. Sign up online Register using this form to access all of the events and activities available at our centres. Refer to us If you need more targeted support from us, make a referral.

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talking baby and parenthood -  postnatal social group online

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talking baby and parenthood -  postnatal social group online tickets

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Talking Baby and Parenthood - Postnatal Social Group Online

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Eventbrite - Herts Family Centre Service - Stevenage District presents Talking Baby and Parenthood - Postnatal Social Group Online - Tuesday, 4 May 2021 - Find event and ticket information.

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We’re currently building a new website

The UK’s leading membership group for IMH practitioners

If you are looking to become a member, please contact us here.
Already a member? Contact us here for support.
Follow us on LinkedIn, Facebook or Twitter for updates.
AiMH UK Events book here.

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AiMH - The Association for Infant Mental Health professionals in the UK

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If you are looking to become a member, please contact us here. Already a member?Contact us here for support. Follow us on , or for updates. AiMH UK Events .

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Everything from bathing baby to reducing the risk of cot death

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As a new parent, you're bound to have questions on everything from getting started with breastfeeding to washing and bathing your baby and changing their nappy.
Here's a quick guide to everything you need to know about caring for your new baby during those exhausting but wonderful early weeks.

Getting to know your new baby

How do we look after our baby's umbilical cord? How much can our baby see? Why are their genitals swollen?

Newborn babies do not come with an instruction manual, and you're bound to have lots of questions about their behaviour and appearance to begin with.

You'll find some of the answers you need in getting to know your newborn.

Breastfeeding your new baby

In the beginning it can seem like you're baby is constantly feeding, but gradually you and your baby will get into a pattern and the amount of milk you produce will settle.

Feed your baby as often as they want. This is called baby-led feeding. Let your baby decide when they have had enough.

Find out more about:
Breastfeeding: the first few days Soothing sore or cracked nipples How to tell if your baby is getting enough milk

Washing and bathing your new baby

You do not need to bathe your baby in the first few days. You may prefer to wash their face, neck, hands and bottom carefully instead. This is sometimes called topping and tailing.

Choose a time when your baby is awake and content. Make sure the room is warm and get everything ready beforehand.

You'll need a bowl of warm water, a towel, cotton wool, a fresh nappy and, if necessary, clean clothes.
Find out how to top and tail or bathe your new baby

How to change your baby's nappy

Babies need frequent nappy changes. Do not leave them in a wet or dirty nappy for too long because their wee and the bacteria in their poo may make their skin sore and lead to nappy rash.

Find out more about:

Changing your baby's nappy
How to treat nappy rash

Soothing a crying baby

Crying is your baby's way of telling you they need comfort and care. But it's not always easy to work out what they want.
Find out why your baby may be crying and how to soothe them

Helping your baby sleep

It's normal for new babies to only sleep for 2 to 3 hours at a time through the night, as well as during the day.

One reason is that newborn babies are not tuned into day and night yet.

Babies also grow quickly in the early months and they have very small stomachs. This means they need to feed little and often.

As your baby grows, they'll gradually start to need fewer night feeds and will sleep for longer at night.
Find out how to get your baby into healthy sleep habits

How to tell if your baby is seriously ill

It can be difficult to tell when a baby is seriously ill. Above all, it's important to trust your instincts.

You know your baby better than anyone else, so you'll know if their appearance or behaviour is worrying.

See is your baby or toddler seriously ill? for a checklist of "red alert" symptoms that should always be treated as serious.

Reducing the risk of sudden infant death syndrome (SIDS)

SIDS is rare, so do not let worrying about it stop you enjoying your baby's first few months.

Putting your baby on their back to sleep, in a cot in the same room as you, for the first 6 months is one way to reduce your baby's risk even further.

Not smoking during pregnancy or breastfeeding, and not letting anyone else smoke in the same room as your baby, will also help protect them.
Get some more tips on reducing the risk of SIDS

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Tips for new parents, including how to get breastfeeding off to a good start, washing and bathing your newborn, soothing a crying baby, how to change your baby's nappy, and helping your baby sleep.

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NOVEMBER CANCELLED
Come and meet the Nightingale team on the 1st Monday of every month from 7pm-8pm, join us on the 6th of December will be our next Microsoft Teams virtual meeting. Looking forward to meeting you all!
Click the link below to enter...

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It is important to seek help if you feel you are struggling with your mental health, you can speak to your midwife or GP, or you can complete a self referral using the link below

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pick up a self referral form from your GP surgery or ask your GP to make a referral for you

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Below are a selection of other Padlet's in use by the trust for specific audiences. Please have a look and see if any are relevant to you.

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The baby blues

During the first week after childbirth, many women get what's often called the "baby blues".

Women can experience a low mood and feel mildly depressed at a time when they expect they should feel happy after having a baby.

"Baby blues" are probably due to the sudden hormonal and chemical changes that take place in your body after childbirth.

Symptoms can include:

feeling emotional and bursting into tears for no apparent reason

feeling irritable or touchy

low mood

anxiety and restlessness

All these symptoms are normal and usually only last for a few days.

Is it postnatal depression?

Depression after a baby is born can be extremely distressing. Postnatal depression is thought to affect around 1 in 10 women.

Postnatal depression can start at any point in the first year after giving birth and may develop suddenly or gradually.

Symptoms such as tiredness, irritability or poor appetite are normal if you've just had a baby. But these are usually mild and do not stop you leading a normal life.

When you have postnatal depression, you may feel increasingly depressed and low. Looking after yourself or your baby may become too much.

Emotional signs of postnatal depression may include:

loss of interest in the world around you and no longer enjoying things that used to give you pleasure (like you "cannot be bothered")

feelings of hopelessness

not being able to stop crying

feelings of not being able to cope

not being able to enjoy anything

memory loss or being unable to concentrate

excessive anxiety about your baby

Other signs of postnatal depression may also include:

sleeplessness

extreme tiredness

feeling generally unwell

loss of appetite

Getting help for postnatal depression

It's important to seek help as soon as possible if you think you might be depressed, as your symptoms could last months or get worse and have a significant impact on you, your baby and your family.

With the right support most people make a full recovery.

If you think you may be depressed, talk to a GP, midwife or health visitor as soon as possible so you can access the support you need.

Treatment for postnatal depression

The 3 main types of treatments for postnatal depression are:

self-help - for example, talking to your family and friends about your feelings, making time to do things you enjoy, getting as much sleep as you can at night, exercising regularly, and eating a healthy diet

psychological therapy - a GP may be able to recommend a self-help course or refer you for a course of therapy, such as cognitive behavioural therapy (CBT)

antidepressants - these may be recommended if your depression is more severe or other treatments have not helped; your doctor can prescribe a medicine that's safe to take while breastfeeding

Talk to a GP about the pros and cons of different treatments so you can decide together what's best for you.

You may also find it helpful to contact the Association for Post Natal Illness or the National Childbirth Trust.

The mental health charity Mind provides useful resources for people affected by postnatal depression.

Your local children's centre can put you in touch with your nearest postnatal group.

These groups provide contact with other new mothers and encourage mums to support each other. They also offer social activities and help with parenting skills.

Avoiding alcohol

Alcohol may appear to help you relax and unwind. In fact, it's a depressant that affects your mood, judgement, self-control and co-ordination.

It has even more of an effect if you're tired and run-down.

Be careful about when and how much you drink, and do not drink alcohol if you're taking antidepressants or tranquillisers.

Postpartum psychosis

Postpartum psychosis, which is also called puerperal psychosis, is rare. Only 1 or 2 mothers in 1,000 develop a severe psychiatric illness that requires medical or hospital treatment after the birth of a baby.

This illness can develop within hours of childbirth and is very serious, needing urgent attention.

Other people usually notice it first as the mother often acts strangely.

It is more likely to happen if you have a severe mental illness, a past history of severe mental illness or a family history of perinatal mental illness.

Specialist mother and baby units can provide expert treatment without separating you from your baby.

Most women make a complete recovery, although this may take a few weeks or months.

Postnatal post-traumatic stress disorder (PTSD)

Postnatal post-traumatic stress disorder (PTSD) is often the result of a traumatic birth, such as a long or painful labour, or an emergency or problematic delivery.

It can also develop after other types of trauma, such as:

a fear of dying or your baby dying

life-threatening situations

The symptoms of postnatal PTSD, such as re-experiencing aspects of the traumatic event, can occur alone or in addition to the symptoms of postnatal depression.

The symptoms can develop straight after the birth or months afterwards.

It's extremely important to talk to someone about how you're feeling. Your midwife, GP or health visitor will be able help you.

If you're worried about talking to a health professional, consider asking a close friend or family member to come with you for support.

There are effective treatments available, such as cognitive behavioural therapy (CBT) and medicines.
Read more about treatments for PTSD

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Find out about feeling down after giving birth, including how to tell the difference between the "baby blues" and postnatal depression.

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Due to coronavirus (COVID-19), visiting in-patients at our hospitals is suspended until further notice.

The only exceptional circumstances where one visitor - an immediate family member or carer - will be permitted to visit are listed below:

* The patient you wish to visit is receiving end-of-life care.
* You are the birthing partner accompanying a woman in labour (for more detailed information, see our maternity section below).
* You are a parent or appropriate adult visiting your child.
* You are supporting someone with a mental health issue, dementia, a learning disability or autism, where not being present would cause the patient to be distressed.

Please contact the ward or department in advance to discuss appropriate arrangements.
Maternity

At the Diamond Jubilee Maternity Unit at Lister, one named birthing partner is allowed to attend throughout the birthing process, including labour.

The named birthing partner can also attend all other assessments which are undertaken in an individual room on the consultant-led unit (CLU) or midwifery-led unit (MLU). This person cannot be swapped.

From 5 October 2020, women can be accompanied by a partner or chosen supporter for their 20-week anomaly scan.

On Dacre and Gloucester wards there is no visiting.

If you are attending triage, the day assessment unit (DAU), antenatal clinic or the scan department for a scan other than the anomaly scan, please attend alone.

No other visitors will be allowed at any time, including children, until further notice.

To find out more about our maternity visiting policy please read this statement from our chief nurse and our frequently asked questions page.

If you have read the statement and our FAQs, but have further questions which haven't been answered - please call our maternity advice line (running from 7am to 9pm every day) on 07789 935620.

Outpatients are asked to attend appointments alone wherever possible, and children should be accompanied by one adult only.

These restrictions continue to be reviewed, but your health, safety and wellbeing, that of our patients, communities and individuals and teams across the organisation, remain our absolute priority.

We appreciate not being able to see loved ones is difficult, so the trust provides 'keep in touch' services so you can stay connected. As well as the use of tablets to make video calls, you can have messages and photos hand-delivered - click here to find out more.

Thank you for your continued support and understanding at this challenging time.

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Coronavirus (COVID-19): Visitor guidance - East and North Hertfordshire NHS Trust

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Due to coronavirus (COVID-19), visiting in-patients at our hospitals is suspended until further notice. The only exceptional circumstances where one visitor - an immediate family member or carer - will be permitted to visit are listed below: * The patient you wish to visit is receiving end-of-life care.

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Read about the scans, tests and antenatal care you can have.

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Our midwife-led information covers everything you need to know about having a safe and healthy pregnancy, from conception to birth.

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From the start of pregnancy to early parenthood, this app has been developed with the NHS to navigate your choices for maternity care in England.

You can:

* set your due date

* explore maternity units near you

* self-refer for care at your chosen maternity unit

* access information for all stages of your maternity journey

* make personalised plans for your care during pregnancy, birth and beyond

* keep track of your appointments and make notes

* access local contacts and information in specific NHS areas

* use the content without specifying an NHS area.

Mum & Baby has been developed in partnership between women, their partners, families and maternity staff from NHS trusts in North West London.

Independent rating
ORCHA, the Organisation for the Review of Care & Health Applications, has awarded its prestigious kitemark to the Mum & Baby app. When reviewed against 180 different criteria the app achieved 86%, the highest rating of any pregnancy and birth app tested by ORCHA.

Reviews and updates

The contents of the Mum & Baby app will be reviewed quarterly and updated accordingly by the North West London Local Maternity System - an approved panel of clinicians and service users to ensure that information given remains accurate, up-to-date and relevant for user.

Credit

The first version of Mum & Baby was launched in 2014 and was built through the initiative of Dr Sunita Sharma, Lead Consultant of Postnatal Services at Chelsea and Westminster Hospital NHS Foundation Trust, supported CW+, the charity of Chelsea and Westminster Hospital NHS Foundation Trust (CWPLUS Registered Charity No.1169897). The app was subsequently expanded and updated, led by midwife project managers in the North West London 'early adopters' team in 2018 and 2019. This project would not have been successful without the ongoing support of CW+ and Imagineear and the North West London Local Maternity System.

Glitchy still

Was recommended this by my community midwife as just launched in area. App is still glitchy with problems. Can't enter any of my many appointment dates in as won't allow to save with empty fields, even when all the fields are completed. I think once bugs are fixed it will be a useful app.

Just doesn't work

Every appointment I go to, my midwife wants to check I am using this app.
But it just doesn't work. It's crashed every single time I've opened it. First I see the 'enter your due date' screen, I tap to enter the due date and it crashes.
Every time.
I've uninstalled and reinstalled, tried installing on a different phone, nothing works.
I have an iPhone SE 2020, my husband has the newest Samsung phone, between the two of us we have two of the most common phones. There's no excuse for this app not to work at all on either of them.

If the NHS are putting as much weight on this app as it seems like they are from my appointments, it's obviously very important that it actually work.
Our local midwife unit was shut down during covid, there are barely any midwives or nurses available at the local hospital. I'm pregnant and scared, there's no one to talk to and all I have is this useless, broken app.

Brilliant app!

This app has been really reassuring throughout my pregnancy - it has so much information available, I've used it as a source of information when I have questions between my midwife appointments. Would thoroughly recommend!

The developer, imagineear, indicated that the app's privacy practices may include handling of data as described below. For more information, see the developer's privacy policy.

Data Not Linked to You

The following data may be collected but it is not linked to your identity:

Privacy practices may vary based on, for example, the features you use or your age. Learn More

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‎From the start of pregnancy to early parenthood, this app has been developed with the NHS to navigate your choices for maternity care in England. You can: * set your due date * explore maternity units near you * self-refer for care at your chosen maternity unit * access information fo...

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

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These are to be done forever and ever!

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Pelvic floor exercises strengthen the muscles around your bladder, bottom, and vagina or penis.

Strengthening your pelvic floor muscles can help urinary incontinence, treat pelvic organ prolapse, and make sex better too.

Everyone can benefit from doing pelvic floor exercises.

Find your pelvic floor muscles

You can feel your pelvic floor muscles if you try to stop the flow of urine when you go to the toilet.

It's not recommended that you regularly stop the flow of urine midstream as it can be harmful to your bladder.

Pelvic floor exercises

To strengthen your pelvic floor muscles, sit comfortably and squeeze the muscles 10 to 15 times.

Do not hold your breath or tighten your stomach, bottom or thigh muscles at the same time.

When you get used to doing pelvic floor exercises, you can try holding each squeeze for a few seconds.

Every week, you can add more squeezes, but be careful not to overdo it, and always have a rest between sets of squeezes.

After a few months, you should start to notice results. You should keep doing the exercises, even when you notice they're starting to work.

Pregnancy and pelvic floor exercises

If you're pregnant or planning to get pregnant, you can start doing pelvic floor exercises immediately.

The exercises will lower your chance of experiencing incontinence after having your baby.

Find out more about exercise in pregnancy, including pelvic floor exercises.

How pelvic floor exercises can help with sex

Strong pelvic floor muscles can also mean increased sensitivity during sex and stronger orgasms.

Strengthening and training the pelvic floor muscles can help also reduce the symptoms of erectile dysfunction.

Further information

Page last reviewed: 14 April 2020
Next review due: 14 April 2023

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Find out about exercises to strengthen your pelvic floor muscles, which are the muscles around your bladder, bottom, and vagina or penis.

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Our Patient Advice and Liaison Service (PALS) staff will come to wards/clinics to talk to patients/relatives/carers regarding concerns that you may have.

The PALS team aims to help patients, carers, staff and the public by:

Listening to your concerns about your care and providing support and help to resolve them

Answering questions about your care in our hospitals

Providing 'on the spot help' by giving advice, information and support

Helping disabled patients who experience any difficulty in accessing our services

Passing on your compliments to our staff

Referring patients to the complaints department

Contacting PALS

Our PALS team, which covers the Lister, New QEII and Hertford County hospitals and the Mount Vernon Cancer Centre, is based at the Lister. The team can be contacted on 01438 285811 or pals.enh-tr@nhs.net.

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Patient Advice and Liaison Service (PALS) - East and North Hertfordshire NHS Trust

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Our Patient Advice and Liaison Service (PALS) staff will come to wards/clinics to talk to patients/relatives/carers regarding concerns that you may have. The PALS team aims to help patients, carers, staff and the public by: Listening to your concerns about your care and providing support and help to resolve them Answering questions about your care [...]

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It can take a while to feel confident with breastfeeding, but there is lots of help and support available. Find out more

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Do you need breastfeeding support & advice? There is a lot of help available - including the Breastfeeding Friend from Start4Life on Amazon Alexa, Facebook Messenger & Google Home. Click to find out more.

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Informative videos on everything from birth to breastfeeding in your own language

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Global Health Media Project videos for mothers and families in 20+ languages

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The Pfizer-BioNTech COVID-19 vaccine is a new type of vaccine that has been shown to be effective and to have a good safety profile. It has not yet been assessed in pregnancy, so it has been advised that until more information is available, those who are pregnant should not have this vaccine.

Many vaccines can be given safely in pregnancy, so why are you being advised against this vaccine?

Evidence so far reviewed by the MHRA raises no concerns for safety in pregnancy.

Because of the new formulation of this particular vaccine the MHRA wants to see more non-clinical data before finalising the advice in pregnancy.

It is standard practice when waiting for such data on any medicine, to avoid its use in those who may become pregnant or who are breastfeeding. This will be kept under review as more evidence becomes available.

What this mean for you

Here are the key points you should consider until we have more evidence:

if you are pregnant you should not be vaccinated - you can be vaccinated after your pregnancy is over

if you think you may be pregnant you should delay vaccination until you are sure you are not

if you are planning to get pregnant in the next 3 months, you should delay your vaccination

if you know you are not pregnant you can start the two-dose course now and you should avoid getting pregnant until at least 2 months after the second dose

if you have had the first dose and then become pregnant you should delay the second dose until after the pregnancy is over

If you are breastfeeding you should wait until you have finished breastfeeding and then have the vaccine. If you were breastfeeding when you had the first dose you are advised not to have the second dose until you have finished breastfeeding.

This advice is precautionary until additional evidence is available to support the use of this vaccine in pregnancy and breastfeeding. It may then be possible to have the Pfizer-BioNTech vaccine. Until that advice is changed you may be able to have one of the other COVID-19 vaccines that are expected.

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COVID-19 vaccination: a guide for women of childbearing age, pregnant, planning a pregnancy or breastfeeding

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The Pfizer-BioNTech COVID-19 vaccine is a new type of vaccine that has been shown to be effective and to have a good safety profile. It has not yet been assessed in pregnancy, so it has been advised that until more information is available, those who are pregnant should not have this vaccine.

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Information about a variety of mental health conditions and medications to help you make an informed choice about your care

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Your named midwife will be able to see you at a time and place that is convenient for you both, this could be at home, a family centre, or even the hospital.

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Leaflets available in a variety of languages

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Maternity leaflets: Planning your birth - translated versions

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Health and high quality care for all, now and for future generations

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The updated version of the Breast Start App will help you breastfeed your baby

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Information on monitoring fetal movements in many different languages

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Kicks Count is the UK's leading baby movement resource and awareness campaign. By empowering pregnant women with knowledge and confidence, babies' lives can be saved.

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The on call midwife for Nightingale today 29th January  (7.30am-7.30pm) is:

The on call midwife for Nightingale tonight 29th January (19.30-07.30) is:

If you can't reach the on call midwife she might be at a birth, in this instance please ring the unit, for MLU 01438 286197 and for CLU 01438 286168
Please call (please don't text, we may not see it immediately and this may delay your care, don't worry about waking us up) if you have any feeding issues, you feel like your waters have broken, or you feel you are in labour. Any urgent concerns regarding pain, bleeding, or fetal (baby) movements, please contact Lister triage on 01438 286168

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Follow the link to find leaflets about baby's movements in a variety of languages

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Before you're 20 weeks pregnant you can contact the early pregnancy unit or attend A&E outside of their opening hours if you have any concerns

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Early pregnancy includes the time from conception to 14 weeks of pregnancy. Remember that your pregnancy is dated from the first day of your last period so you will already be around two weeks pregnant when you miss your period.

Once you have had your pregnancy confirmed you will have your first appointment with your midwife. A detailed medical history will be taken and questions will be asked about you and your partner's health and lifestyle. This is so that the right level of care is given to you throughout your pregnancy.

At your booking appointment you will be given an information pack that is useful for both parents to read. It includes information on early pregnancy ailments, advice on general health and well-being and vouchers and coupons for use when baby arrives.

Things to consider in the first trimester

You may or may not experience pregnancy symptoms from very early on - there is no set rule where pregnancy is concerned and some women experience a range of ailments, whereas others don't have any. Don't be alarmed either way - you can talk to a midwife if you feel worried in between appointments by calling 01438 284533.

Problems in early pregnancy

Occasionally you may experience problems in early pregnancy such as excessive sickness, pain or bleeding and you may need to be assessed in our Early Pregnancy Unit (EPU). You can telephone this service for advice and information on 01438 286190. Your GP is able to refer you to this service if required.

The unit is led by:

Miss Sawant
Consultant Obstetrician and Gynaecologist, supported by:

Fay Clark
Nurse Practitioner

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Early pregnancy - East and North Hertfordshire NHS Trust

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Early pregnancy includes the time from conception to 14 weeks of pregnancy. Remember that your pregnancy is dated from the first day of your last period so you will already be around two weeks pregnant when you miss your period. Once you have had your pregnancy confirmed you will have your first appointment with your midwife.

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We provide information on pain relief in labour in over 40 different languages. Read online to find information about labour pain relief in a language you understand.

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Download our leaflets in your language - Action on Pre-eclampsia

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Pre-eclampsia can kill in hours and requires immediate medical attention. Information contained on the website is for guidance only and is not intended to replace advice given by a health professional. The charity cannot be liable for any action taken or not taken as a result of information contained on this website.

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Safe sleep guidance can be found in various different languages, around half way down the page

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Order copies

Single copies of our publications can be downloaded below.

To order multiple copies, visit our shop or call us on 0203 150 3638 or email lullabytrust-orders@partridgesuk.com

PDF versions of publications

We regularly review research and data, and consequently update the information and advice we provide in line with current evidence.

It is therefore important that organisations do not directly host Lullaby Trust PDF publications on their websites (this represents a breach of copyright), but instead only use links to publications on The Lullaby Trust website. This ensures that the most up-to-date version of a publication is shared by professionals with families and minimises the likelihood of a governance risk.

Thank you for your understanding and your continued support of our work at The Lullaby Trust.

Free downloads

Antenatal publications

Click here to view our antenatal publications

Safer sleep for babies

Click here to view our 'safer sleep for babies' publications

Safer Sleep for babies: a Guide for Parents and Carers
This leaflet provides parents with all the advice on safer sleep and reducing the risk of sudden infant death.

Safer Sleep: Saving Babies Lives a Guide for Professionals
Leaflet written for all professionals working with families with young babies, giving the most up to date advice on safe infant care advice to reduce the risk of sudden infant death.

Safer Sleep for Babies quick reference card
A quick reference guide to the ABCs of safer sleep and tips for safer bedsharing

Safer sleep product guide
A guide for parents on the products they need and those to avoid and what the marketing means

Easy read card
A 2-side card giving key advice for reducing the risk of sudden infant death.

This leaflet is also available to download in the following languages:

If you require the artwork of any of these translations (to supply to a printer), please email communications@lullabytrust.org.uk

Posters

Click here to view our posters

Poster: Safer Sleep
Our newly designed safer sleep poster details the ABCs of Safer Sleep.

Poster: Sofa sharing
A3 poster which provides information on sofa sharing

Poster: Baby Check App advert
An A4 printable poster advertising the free Baby Check smartphone app. Available in portrait and landscape.
Portrait version Landscape version
Infection prevention

Click here to view our infection prevention resources

These resources have been created in consultation with British Paediatric Allergy, Immunity and Infection Group (BPAIIG), an affiliated speciality group of the Royal College of Paediatrics and Child Health (RCPCH).

Baby check app

Click here to view publications related to our Baby Check app

Baby Check Health Visitor Card
A two-sided card card explaining the use of the Baby Check App

Baby Check poster
An A4 printable poster advertising the free Baby Check smartphone app. Available in portrait and landscape.
Portrait version Landscape version
Premature babies

Click here to view our publications about premature babies

Safer Sleep Advice for Premature Babies booklet
A booklet written in collaboration with Bliss and Twins Trust featuring safer sleep advice for parents of babies born prematurely or of a low birth weight. Includes additional information for parents of twins, multiples or more.

Safer sleep advice for Emergency Situations

Click here to view our 'safer sleep advice for Emergency Situations' resources

Little Lullaby / Young parents

Click here to view our Little Lullaby publications

About Little Lullaby Booklet
Top Ten Tips for Health Professionals
A4 Poster for Health Professionals

A Young Parent Guide to Loneliness
Produced in collaboration with the Mental Health Foundation.

Safer sleep advice for emergency situations: A Guide for Young Parents and Carers (Little Lullaby version)
Produced in collaboration with Shared Health Foundation.

Games

Click here to view our games

Make a room game
A visual toolkit demonstrating the ideal sleeping environment for a baby

Spot the risk game
A visual toolkit to facilitate discussions on reducing the risks of SIDS

Fact sheets

Click here to view our list of fact sheets

Bereavement publications

Click here to view our bereavement publications

When a baby or young child dies suddenly and unexpectedly
A booklet for parents who have lost a baby or young child, covering what you might experience now and in the future (practically and in terms of thoughts and feelings).

Bereavement support leaflet
Advice and information for bereaved families, including The Lullaby Trust services and other sources of support.

Unicef Baby Friendly Publications

Click here to view the Unicef Baby Friendly publications

The Lullaby Trust has worked with Unicef in the wording on two publications to support families and professionals with the challenge of addressing co-sleeping given the association with SIDS. You might be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust

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Order copies Single copies of our publications can be downloaded below. To order multiple copies, visit our shop or call us on 0203 150 3638 or email lullabytrust-orders@partridgesuk.com PDF versions of publications We regularly review research and data, and consequently update the information and advice we provide in line with current evidence.

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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

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

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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

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Monitoring your baby's movements

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Kicks Count is the UK's leading baby movement resource and awareness campaign. By empowering pregnant women with knowledge and confidence, babies' lives can be saved.

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This link takes you to the app developers website where you can download the app for android or iOS

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If you are concerned about domestic abuse, we know it can be hard to find support. That's why Bright Sky was developed.

Download Bright Sky today because you never know when you might need it to save someone's life.

Bright Sky is a safe, easy to use app and website that provides practical support and information on how to respond to domestic abuse. It is for anyone experiencing domestic abuse, or who is worried about someone else.

Bright Sky helps you to spot the signs of abuse, know how to respond, and help someone find a safe route to support.
The app can be downloaded for free via the app stores. Please only download the app if it is safe for you to do so and if you are sure that your phone isn't being monitored.
Launched in partnership with Vodafone Foundation and Thames Valley Partnership, the app hosts a UK-wide directory of specialist support service and offers users assessment tools to help you spot the signs for someone experiencing domestic abuse. It has had over 80,000 downloads since its launch in 2018. The website is focused on how to spot the signs of domestic abuse, advice on how to support someone you have concerns for, and ways to find help.
Features

The app is available in 5 languages: English, Urdu, Punjabi, Polish and Welsh.

A unique UK-wide directory of specialist domestic abuse support services with contact details.

Content to help you understand if you or someone else is at risk .

Links to further resources and information on domestic abuse.

Information to help you to stay safe online.

Please only download the Bright Sky app if it is safe to do so. If you are in immediate danger, always call the police on 999. Visit Bright Sky Online
Contact

To add or amend the details of a specialist service on the Bright Sky app, please complete the form below.
Update service details on Bright Sky
If you have any other enquiries about Bright Sky, you can email [email protected] .

For media enquiries, please contact: [email protected]

Download Bright Sky posters, social media graphics and other marketing materials to help promote the app:
Download Bright Sky asset pack Read the Bright Sky Privacy Policy

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The Bright Sky app provides support for those experiencing domestic abuse as well as those concerned about friends and family members

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What you'll need for labour and birth

Get a few things ready at least 3 weeks before your due date.

For yourself, you'll probably want to pack:

your birth plan and hospital notes

something loose and comfortable to wear during labour that does not restrict you from moving around or make you too hot

3 changes of loose, comfortable clothes

2 or 3 comfortable and supportive bras, including nursing bras if you're planning to breastfeed - remember, your breasts will be much larger than usual

breast pads

2 packets of super-absorbent sanitary or maternity pads

5 or 6 pairs of knickers - you may want to bring some disposable ones

your washbag with a toothbrush, hairbrush, flannel, soap, lip balm, deodorant, hair ties and other toiletries

towels

things to help you pass the time and relax - for example, books, magazines, music or podcasts

a fan or water spray to cool you down

front-opening or loose-fitting nighties or tops if you're going to breastfeed

dressing gown and slippers

healthy snacks and drinks

extra pillows

a TENS machine if you intend to use one

any medicines you're taking

For the baby, you might want to pack:

bodysuits, vests and sleepsuits

an outfit for going home in

a hat, scratch mittens and socks or booties

plenty of nappies

a shawl or blanket

muslin squares or bibs

a car seat for the trip home

Home births

If you're planning to give birth at home, discuss your plans and what you need to prepare with your midwife. Think about where in your home you want to give birth.

You're likely to need:

clean bed clothes and towels

clothes (including a hat) and nappies for the baby

2 packets of super-absorbent sanitary or maternity pads

Even if you're planning to have your baby at home, you should pack some things in case you need to go into hospital at any point.

Get prepared

When you come home, you will not want to do much more than rest and care for your baby, so do as much planning as you can in advance.

If you can, buy lots of basic items such as toilet paper, sanitary towels and nappies in advance.

If you have a freezer, you could cook some meals in advance and freeze them.

Transport

You should plan how you'll get to the hospital or midwifery unit because you might need to go there at any time of the day or night.

If you're planning to go by car, make sure it's running well and that there's always enough petrol in the tank.

If someone else has said they'll take you, make an alternative arrangement just in case they're not available.

Video: What should I pack in my hospital bag?

In this video, a midwife goes through the essentials you should pack in your hospital bag.

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Get a few things ready at least 3 weeks before your due date.

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Don't panic, the early stages of labour can take a while, if it's not quite time for us to come to you try some massage, a warm bath, and paracetamol. When you feel you are having strong, regular contractions, or you feel like you need extra pain relief or support then the midwife on call and we will come and assess you. If you are having your baby in hospital we can either meet you there or support you at home until you decide you want to go in. However, if you are having constant pain, your haven't felt your baby move normally, you're bleeding, or your waters are red or green, then please contact triage ASAP - 01438 286168

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Welcome to your new bundle of joy, we are here to support you through the first few weeks of parenthood, please contact your named midwife if you need any support, or the on call midwife if she is not available.

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Every baby is offered newborn blood spot screening, also known as the heel prick test, ideally when they're 5 days old.

What is the blood spot test?

Newborn blood spot screening involves taking a blood sample to find out if your baby has 1 of 9 rare but serious health conditions.

Most babies won't have any of these conditions but, for the few who do, the benefits of screening are enormous.

Early treatment can improve their health, and prevent severe disability or even death.

What does the blood spot test involve?

When your baby is 5 days old, a healthcare professional will prick their heel and collect 4 drops of blood on a special card.

You can ease any distress for your baby by cuddling and feeding them, and making sure they're warm and comfortable.

Occasionally, the sample may need to be taken when your baby is 6, 7 or 8 days old.

Sometimes a second blood spot sample is needed. The reason for this will be explained to you. It doesn't necessarily mean there's something wrong with your baby.

The test doesn't carry any known risks for your baby.

Which conditions is the blood spot test for?

The blood spot test screens for the following 9 rare but serious conditions.

If you, your partner or a family member already has one of these conditions (or a family history of it), tell your healthcare professional straight away.

Sickle cell disease

About 270 babies are born with sickle cell disease in the UK each year. This is a serious inherited blood disease.

Sickle cell disease affects haemoglobin, the iron-rich protein in red blood cells that carries oxygen around the body.

Babies who have this condition will need specialist care throughout their lives.

People with sickle cell disease can have attacks of severe pain and get serious, life-threatening infections. They're usually anaemic because their blood cells have difficulty carrying oxygen.

The blood spot screening test means that babies with sickle cell disease can receive early treatment to help them live healthier lives. This may include vaccinations and antibiotics to prevent serious illnesses.

Pregnant women are also routinely tested for sickle cell disease early in pregnancy.

Read more about sickle cell disease.
GOV.UK also has a factsheet about sickle cell disease
Cystic fibrosis

About 1 in 2,500 babies born in the UK has cystic fibrosis. This inherited condition affects the digestion and lungs.

Babies with cystic fibrosis may not gain weight well and are prone to chest infections.

Babies with the condition can be treated early with a high-energy diet, medicines and physiotherapy.

Although children with cystic fibrosis may still become very ill, early treatment can help them live longer, healthier lives.

Read more about cystic fibrosis.
GOV.UK also has a leaflet for parents whose baby has suspected cystic fibrosis
Congenital hypothyroidism

About 1 in every 2,000 to 3,000 babies born in the UK has congenital hypothyroidism. Babies with congenital hypothyroidism don't have enough of the hormone thyroxine.

Without thyroxine, babies don't grow properly and can develop learning disabilities.

Babies who have the condition can be treated early with thyroxine tablets, and this allows them to develop normally.
The British Thyroid Foundation has more information about congenital hypothyroidism
Inherited metabolic diseases

It's important to let your healthcare professional know if you have a family history of a metabolic disease (a disease that affects your metabolism).

Babies are screened for 6 inherited metabolic diseases. These are:

About 1 in 10,000 babies born in the UK has PKU or MCADD. The other conditions are rarer, occurring in 1 in 100,000 to 150,000 babies.

Without treatment, babies with inherited metabolic diseases can become suddenly and seriously ill. The diseases all have different symptoms.

Depending on which one affects your baby, the condition may be life threatening or cause severe developmental problems.

They can all be treated with a carefully managed diet and, in some cases, medicines as well.

Severe combined immunodeficiency (SCID)

In some areas of England, screening for a condition called severe combined immunodeficiency (SCID) is also being offered as part of the newborn blood spot test. This is to help the NHS decide if screening for SCID should be offered to all babies in England.

SCID causes problems with the immune system. It makes it very hard for a baby to fight off infections like meningitis and pneumonia, which can be life-threatening. About 14 babies born each year in England have SCID.

Ask your midwife if screening for SCID is being offered in your area.
Great Ormond Street Hospital for Children has more information on severe combined immunodeficiency

Does my baby have to have the blood spot test?

The blood spot test is not compulsory, but it's recommended because it could save your baby's life.

You can choose to have screening for sickle cell disease, cystic fibrosis or congenital hypothyroidism individually, but you can only choose to have screening for all 6 inherited metabolic diseases or none at all.

If you don't want your baby to be screened for any of these conditions, discuss it with your midwife.

You should be given information about the blood spot test and the diseases it screens for in advance so you can make an informed decision for your baby.

If you change your mind, babies can be screened up to the age of 12 months for all the conditions except cystic fibrosis. Cystic fibrosis can only be screened for up to 8 weeks of age.

If you have any concerns about the tests, speak to your midwife, health visitor or GP.

When will we get the results?

You should receive the results either by letter or from a healthcare professional by the time your baby is 6 to 8 weeks old.

The results should be recorded in your baby's personal child health record (red book). It's important to keep this safe and take it with you to all your baby's appointments.

If you haven't received your baby's results, speak to your health visitor or GP.

You'll be contacted sooner if your baby screens positive. This means they're more likely to have one of the conditions tested for.

You'll be contacted:

the day the result is available, or the next working day, if your baby is thought to have congenital hypothyroidism (CHT) - you'll be given an appointment to see a specialist

before your baby's 4 weeks old if they're thought to have cystic fibrosis

before your baby's 6 weeks old if they're thought to have sickle cell disease

Screening for cystic fibrosis finds some babies who may be genetic carriers of the condition. These babies may need further testing.

Screening for sickle cell disease also finds babies who are carriers of this or other red blood cell diseases.

Carriers are healthy, although they can experience problems in situations where their bodies aren't getting much oxygen - for example, if they're having an anaesthetic.

Parents of babies who are found to be carriers should be told by the time they're 6 to 8 weeks old.

What do the results mean?

Most babies will have a normal result, which means it's unlikely that they have any of the conditions.

A small number of babies will screen positive for one of the conditions. This doesn't mean they have the condition, but they're more likely to have it. They'll be referred to a specialist for more tests.

It's important to know that screening isn't 100% certain. A baby with a negative screening result may later turn out to have the disease screened for. This is known as a false negative.

Babies with a positive result sometimes turn out not to have the disease - what's known as a false positive.

Occasionally, other medical conditions are picked up by blood spot test screening. For example, babies with beta thalassaemia major, a serious blood disease, will usually be detected. These babies also need to be referred for early treatment.

More information

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Your guide to the newborn blood spot (heel prick) test, including which diseases it screens for and when to expect the results

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SCID screening: helping you decide if you want this for your baby

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The weather is getting warmer, which can make following safer sleep advice more complicated. It is harder to keep baby cool and holidays and travel can disrupt routines. We have put together some tips on baby summer safety so you can enjoy the summer and keep baby safe when the weather gets hot.

Baby summer safety tips

Travelling by car

If your trip involves driving for long periods of time, you should stop for regular breaks. This will allow you to check on your baby, take them out of the car seat and let them stretch and move around. Ideally, a second adult should travel in the back of the car with your baby, or if travelling alone use a mirror to keep an eye on your baby.

If your baby changes their position and slumps forward, then you should immediately stop (when safe to do so), take them out of the car seat and sit them upright before continuing on your journey.

Car seats are designed to keep babies safe while travelling, not as a main sleeping place. Car seats should only be used for transport and not as an alternative for cots or high chairs. It's OK for your baby to fall asleep in a car seat when travelling, but they should be taken out as soon as you get to your destination, and placed onto a firm, flat surface to sleep.

Following a safer sleep routine on holiday

To reduce the risk of sudden infant death syndrome (SIDS) babies should be slept on their back on a firm, flat, mattress for every sleep day and night. It is important that this routine is followed on holiday. If your baby is sleeping in a travel cot the mattresses are often thinner and feel harder but don't be tempted to place folded blankets or a quilt under the baby to make them 'more comfortable'. Ensure that the travel cot isn't against a radiator, in direct sunlight, and is out of reach of blind cords and hazards.

Room temperature

Babies that get too hot have a greater chance of SIDS. We recommend keeping the room where your baby sleeps at a fairly cool temperature of 16-20°C. This can be more difficult in summer months or when away somewhere warm. If the room where the baby sleeps is difficult to cool use lighter bedding and clothing and open the bedroom door and a window, if it is safe to do so. Baby sleep bags will have guidance on what tog to use for each season. You might also like to use a fan to cool the room, but don't aim it directly on the baby. A thermometer can help you to make sure the room is at the right temperature.
We recommend using a room thermometer for accuracy. You can buy a Lullaby Trust thermometer in the shop.
Keeping baby cool when out and about

Babies' prams, travel systems and buggies should not be covered with blankets, cloths or any cover that prevents the air circulating. Covering a pram or buggy with a blanket could lead to overheating, which increases the chance of SIDS. Using a cover also creates a barrier between parent and baby, which is risky as parents won't be able to see if their baby is having difficulties or monitor their temperature easily. We recommend attaching a clip-on sunshade or parasol to a pram or buggy and checking if baby is getting too hot by feeling their chest or the back of their neck. Keep babies out of direct sunlight as much as possible.

Making sure baby has enough fluids

When the weather is hot it is important to make sure that your baby has plenty of fluids. Fully breastfed babies don't need any extra water until they start eating solid food. During hot weather they may want to breastfeed more than usual. If you're bottle feeding, as well as their usual milk feeds, you can give your baby a little cooled boiled water. If your baby wakes at night, they'll probably want milk. If they have had their usual milk feeds, try cooled boiled water as well.

Co-sleeping more safely

If you or your partner are having an alcoholic drink, smoking or taking medication that could make you drowsy on holiday (or at home) co-sleeping with your baby can be very dangerous and increases the risk of SIDS. In these circumstances your baby should be slept in a cot or Moses basket in the same room as you.

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The weather is getting warmer, which can make following safer sleep advice more complicated. It is harder to keep baby cool and holidays and travel can disrupt routines. We have put together some tips on baby summer safety so you can enjoy the summer and keep baby safe when the weather gets hot.

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Lots of useful information around feeding your baby

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Hertfordshire Community NHS Trust, HCT, Hertfordshire, HCT NHS Trust

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Includes videos on attachment, the first breastfeed, and breastfeeding problems

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Below is a selection of videos from the Best Beginnings 'From Bump to Breastfeeding' series. Find out more on the Best Beginnings website.

If you have any problems viewing the videos, please contact us.

Baby-led feeding

This clip shows how baby-led feeding happens in practice.

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Best Beginnings videos - Baby Friendly Initiative

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Selection of videos from Best Beginnings' 'From Bump to Breastfeeding' series. Find out more on the Best Beginnings website.

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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An easy guide to practicing safer sleep for your baby and reducing the risk of sudden infant death syndrome (SIDS, or cot death).

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Safer Sleep  Advice for Premature  & Low Birth Weight Babies

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Safer Sleep  Advice for Premature  & Low Birth Weight Babies

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Advice on jaundice and when to seek help

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Find out more about jaundice, a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes.

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It's recommended to buy a baby car seat before your baby is born if possible. It's important to buy a seat that fits your car and is suitable for a newborn.
If you have your baby in hospital or a birth centre, you will need the car seat to drive your newborn home safely. It's a good idea to practise fitting the seat before your baby is born.

Tips for buying a baby car seat

When buying a car seat, it's best to try a few in your car before making a decision. Try to find a retailer who is willing to help you with this. Ask whether staff have been trained in fitting car seats.

Check whether your car has Isofix connectors built into it. These are designed to make fitting baby and child car seats simpler. Most modern family cars have them. They may be hidden in the cracks between the padding of your car seats.

Some car seat manufacturers have online guides showing which cars their seats will fit in. If your baby is likely to travel in another car regularly - for example, with other family members - check the car seat fits their car, too.

Always choose a baby or child car seat that's right for your child's current height and weight - see What size car seat? for more.

Do not buy a secondhand car seat. It could have been damaged in an accident, and may not have all its parts, including the instructions. It may also not be the safest and most user-friendly model, plus it may not fit your car properly.

Only accept a car seat from friends or family if you know its history, it's not too old and it comes with instructions.

Think about how you will be using the car seat. If you'll be lifting your baby in and out of the car a lot, for example, you may be better off getting a lightweight seat with a base that stays in the car.

All car seats in this country should be EU approved. Look for the "E" mark label on the seat.

What are i-Size car seats?

i-Size is an European safety standard for baby and child car seats. It's part of regulation ECE R129, which will eventually replace the old safety regulation R44/04. The idea is that all car seats will eventually meet the tighter i-Size safety standards.

Your car must have Isofix connectors for you to be able to use an i-Size car seat. At the moment there are only a few i-Size seats on the market in the UK and not all cars have Isofix connectors.

Visit the Royal Society for the Prevention of Accidents (RoSPA) child car seats website for more on i-Size car seats.

What size car seat?

Car seats are divided into 3 main groups, depending on your baby or child's age and weight:

group 0+ - rear-facing car seats suitable for babies aged up to about 15 months or who weigh up to 13 kg (29lb); some can be clipped on to a pushchair frame and are known as travel systems

group 1 - forward-facing seats suitable for children who weigh 9-18kg (20-40lb) or who are aged from about 9 months to 4 years

group 2/3 - high-backed booster seats suitable for children who weigh 15-36kg (33lb-5st 9lb) or are aged from about 4 to 11 years

You can also buy combination seats that cross over these groups, such as group 0+/1 seats, which are suitable from birth until your child weighs about 18kg (40lb) or is aged about 4. These can be more economical, but may not offer the same level of protection.

Baby or child car seat fitting

It is dangerous and illegal to carry a baby in a rear-facing baby seat in a front passenger seat that has an active airbag. Forward-facing seats in the same position, while not illegal, are not ideal. It's always safer for children to travel in the back of the car.

Make sure the seat is fitted properly in the car, following the manufacturer's instructions.

Look out for safety days where experts demonstrate how to fit baby and child car seats safely. These often take place in supermarket or shopping mall car parks.

Using a baby or child car seat

Make sure you always put your baby into their car seat from the pavement side of the car.

Make sure your baby is securely strapped in according to the manufacturer's instructions. When you buy your car seat, ask the retail staff to demonstrate how to strap your baby into it.

Use a rear-facing car seat for as long as your baby fits into it, as these offer better protection in the event of a car accident.

Credit:

Janine Wiedel Photolibrary / Alamy Stock Photo

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More help and advice on car seats

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It's recommended to buy a baby car seat before your baby is born if possible. It's important to buy a seat that fits your car and is suitable for a newborn. If you have your baby in hospital or a birth centre, you will need the car seat to drive your newborn home safely.

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Royal College of Obstetricians & Gynaecologists

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The Royal College of Obstetricians and Gynaecologists (RCOG) provides this advice and guidance for your information purposes only. This information is not intended to meet your specific individual healthcare requirements and this information is not a clinical diagnostic service. If you are concerned about your health or healthcare requirements we strongly recommend that you speak to your clinician or other healthcare professional, as appropriate.

Coronavirus and pregnancy

Q. What is the main advice for pregnant women?

There is no evidence that pregnant women are more likely to get seriously ill from coronavirus but pregnant women have been included in the list of people at moderate risk ( clinically vulnerable) as a precaution. The government guidance for the clinically vulnerable remains in place and you should ensure you continue to follow the latest government guidance.

Pregnant women should follow the latest government guidance on staying alert and safe ( social distancing) and avoid anyone who has symptoms suggestive of coronavirus. If you are in your third trimester (more than 28 weeks' pregnant) you should be particularly attentive to social distancing.
Key advice for pregnant women during the pandemic:
More information on pregnancy and coronavirus is available on the NHS website.
What should I do if I develop symptoms of coronavirus?

The main symptoms of coronavirus are a high temperature, a new, continuous cough or a loss or change to your normal sense of smell or taste (anosmia). Most people with coronavirus have at least 1 of these symptoms.

If you think you may have symptoms, use the NHS 111 online service/NHS 24 in Scotland for information and advice, and follow the guidance for households with possible or confirmed coronavirus infection.

You should tell your midwife or maternity team that you have symptoms of coronavirus.

If you feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more severe infection that requires specialised care. You should contact your maternity team, GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.

Seek medical advice as early as possible if you have any questions or concerns about you or your baby.

Q. What effect does coronavirus have on pregnant women?

All available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus. The large majority of pregnant women experience only mild or moderate symptoms.

In the UK, information about all pregnant women requiring admission to hospital with coronavirus is recorded in a registry called the UK Obstetric Surveillance System ( UKOSS).

The first report from this study included information about the outcomes of 427 pregnant women admitted to hospital with coronavirus and their babies during the pandemic, and was published on 11 May 2020. While most women in the study required only ward treatment and were discharged home well, around one in ten women required intensive care, and sadly five women with coronavirus died, although it is currently unclear if coronavirus was the cause of their death. The study found that the majority of women who did become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing and regular hand washing from 28 weeks of pregnancy.

The study also found that pregnant women from Black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for coronavirus. Pregnant women over the age of 35, those who were overweight or obese, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness and requiring admission to hospital.

Q. What effect will coronavirus have on my baby if I am diagnosed with the infection?

As this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage if you become infected with coronavirus and are pregnant.

Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) might be possible. It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the babies were well.

Given current evidence, it is considered unlikely that if you have the virus it would cause problems with your baby's development, and none have been observed currently.

Across the world, emerging reports suggest some babies have been born prematurely to women who were very unwell with coronavirus. It is unclear whether coronavirus caused these premature births, or whether it was recommended that their babies were born early for the benefit of the women's health and to enable them to recover.

In the recent UK study of 427 pregnant women with coronavirus published on 11 May 2020, the data reported outcomes for babies who were born to women with coronavirus severe enough that the woman required hospital admission. Although almost one in five were born prematurely and were admitted to a neonatal unit, fewer than 20 babies were born very prematurely (when the women were less than 32 weeks' pregnant). One in 20 babies born (12 babies in total) had a positive test for coronavirus, but only half of these babies - 6 babies - had a positive test immediately after birth, suggesting that transmission of the coronavirus infection from a woman to her baby is low. The number of babies born at term (37 weeks or later) to women who had tested positive for coronavirus that required neonatal care was similar to the number of babies born to women without the virus - about 1 in 10.

Q. What research is being done to monitor the effect of coronavirus on pregnant women and their babies?

The UK is conducting near-real-time surveillance (observation) of women who are hospitalised and test positive for coronavirus during pregnancy, through well-established systems already used by all maternity units - this is the UK Obstetric Surveillance System ( UKOSS).

Imperial College London are also running a surveillance programme ( PAN-COVID) to monitor pregnancy and neonatal outcomes for women with coronavirus. Other maternity surveillance programmes are being funded by the National Institute of Health Research (NIHR). You can also ask your maternity team about any local research that is taking place in your area.

The COVID-19 Symptom Study app has been developed by King's College London and health science company ZOE. Members of the public, including pregnant women, can use this app to report on their health during the coronavirus pandemic.

Q. Why are pregnant women in a vulnerable group?

Pregnant women have been included in the list of people at moderate risk ( clinically vulnerable) as a precaution. This is because pregnancy in a small proportion of women can alter how your body handles severe viral infections and some viral infections, such as flu, are worse in pregnant women. This is a particular concern for women who are 28 weeks pregnant and beyond, for whom there is an increased risk that you could become severely unwell should you contract the virus at this stage in your pregnancy. This is something that midwives and obstetricians have known for many years in relation to other similar infections (such as flu) and are used to caring for pregnant women in this situation.

However, all available evidence continues to suggest that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus.

Q. What impact will coronavirus have on my pregnancy?

The NHS has made arrangements to ensure that women are supported and cared for safely through pregnancy, birth and the period afterwards during this pandemic when there will be extra pressures on healthcare services.

Maternity services are absolutely essential and the RCOG is supporting units to coordinate staff in maternity services, to ensure safe and personalised care is provided. This includes reducing staff commitments outside maternity units, reducing any non-essential work within Trusts and re-organising staffing.

Maternity units are increasingly providing consultations on the phone or by video link, when this is appropriate, so you do not have to travel unnecessarily to the hospital. However, some visits in person with a midwife or doctor are essential and it is important for the wellbeing of you and your baby that you attend these to have routine checks. You will be required to follow guidance about face coverings during visits to healthcare settings.

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies - please check with your maternity unit for their policy on visitors to the antenatal and postnatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland (13 July), Wales and Northern Ireland (6 July) has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable a pregnant woman to invite another person to accompany her to antenatal and postnatal appointments, including pregnancy scans. Some Trusts in England are permitting partners or other supportive people to attend these appointments but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures enabling partners and other supportive people to attend antenatal and postnatal appointments, including scans, with women.

This is an important step not only for the health and wellbeing of pregnant women, but also their partners and families whose mental health has been affected by missing out on these appointments and bonding time with their babies.

If visitor restrictions remain in place on your antenatal/postnatal ward, midwives obstetricians, and other members of the maternity team will be able to support the needs of all women and the practical challenges of caring for newborns after birth.

Q. Should I take Vitamin D supplementation?

Vitamin D supplementation is recommended to all women during pregnancy as it can help reduce the risk of respiratory infections.

There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop coronavirus.

However, there is not enough evidence to show that taking vitamin D prevents coronavirus infection or is an effective treatment.

Most people living in northern hemispheres will have low levels of vitamin D and as such, we advise all pregnant women to consider taking 10 micrograms of vitamin D a day to keep their bones and muscles healthy. Vitamin D supplements are available from most pharmacies and supermarkets and for eligible families, through the NHS Healthy Start scheme.

Women from Black, Asian and minority ethnic backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D and are advised to take a higher dose of vitamin D. Speak to your midwife or maternity team if you have any questions about vitamin D supplementation.

Visit the NHS UK website for more information on vitamins in pregnancy and where and how you can access these.

Q. What should I do if I develop a temperature, a new cough, or both, when I am pregnant?

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

Q. What is the international travel advice if I am pregnant?

If you are in the UK, you should follow the advice given by the Foreign and Commonwealth Office, which is being regularly updated in line with the evolving situation.

All individuals, including pregnant women, should ensure they have adequate insurance arrangements prior to travel. You should also check that your travel insurance will provide cover for birth and care of your newborn baby if you give birth while abroad.

Q. What is the advice for pregnant women with older children attending school/nursery/external childcare?

Pregnant women were placed in the vulnerable category as a precaution during the coronavirus pandemic. The government's guidance on schools and early years settings advises that: children and young people who live with someone who is pregnant (vulnerable) can attend school and early years settings. See the next question for information about pregnant women who are classed as extremely vulnerable.

All pregnant women are advised to follow government guidance on staying alert and safe ( social distancing). Pregnant women are at no greater risk of contracting coronavirus or becoming seriously unwell than other healthy adults. However, there are additional concerns for pregnant women in the third trimester. This is based on the challenges in caring for women who are heavily pregnant, and the risk of the baby needing to be born early for the woman's wellbeing.

A recent report from a UK study showed that so far the majority of pregnant women who became seriously unwell with coronavirus were in the third trimester. This emphasises the importance of stringently adhering to social distancing from 28 weeks of pregnancy.

When you take your children to school/nursery/external childcare, you should ensure you practice social distancing - stay two metres away from teachers/carers and other parents and do not go inside the building. If this is difficult, then consider staggering your child's drop off and pick up times. Remember to wash your hands when you return home and ensure that your children wash their hands when they leave the childcare setting. Alcohol gel can be used if they cannot wash their hands with soap and water.

If you are concerned about the choice of returning to school or other childcare settings based on the risk to children attending, helpful information is available from the RCPCH.

Q. What is the advice for pregnant women who are classed as extremely vulnerable or who are shielding on older children attending school/nursery/external childcare?

Some pregnant women with pre-existing severe medical illnesses have been classed as extremely vulnerable and were previously advised to shield. You will have been advised of this by your medical team.

The advice to shield is now paused in all four nations of the UK. However, this is happening differently in the four nations of the UK with specific advice in England, in Scotland, in Wales, and in Northern Ireland. Practical advice for measures that may be helpful to adopt within a family are now available within this guidance.

In areas with local lockdowns, the advice to shield may be re-introduced. Even in this situation, if schools and childcare settings remain open, the UK government advice is that children and young people who live in a household where another member is shielding should attend school/nursery/external childcare if stringent social distancing, and hand hygiene, can be adhered to.

Q. Should I plan a pregnancy during the coronavirus pandemic?

Becoming pregnant during the coronavirus pandemic is a matter of personal choice.

The Faculty of Sexual and Reproductive Healthcare (FSRH) recommend that when considering a pregnancy, women and their partners consider the risks of coronavirus transmission associated with routine contact with healthcare professionals during pregnancy, particularly if pregnancy complications may necessitate frequent hospital attendance.

For more information, see the FSRH clinical statement: Information to support management of individuals requesting to discontinue contraception to plan a pregnancy during the Covid-19 outbreak.

Advice for women at higher risk of serious illness, including women who are Black, Asian or from other ethnic minorities

Q. What are the shielding measures for pregnant women at high risk of severe illness?

Pregnant women with significant heart disease (congenital or acquired) are classed as clinically extremely vulnerable and were previously advised to shield, because they are at very high risk of developing severe illness from coronavirus. Shielding guidance is now paused but this is happening differently in the four nations of the UK - advice in England, in Scotland, in Wales, and in Northern Ireland. In areas with local lockdowns, the advice to shield may be re-introduced. Further information on local restrictions is available from each of the national webpages linked to above.

If you are pregnant and have significant heart disease, you should continue to take the precautions outlined in this updated guidance relevant to your area, and speak to your midwife or doctor (obstetrician) with any questions you may have.

Q. Are some pregnant women more at risk of becoming seriously unwell from coronavirus than others?

Data from the UKOSS study of 427 pregnant women in May 2020 found the majority of women who have become severely ill from coronavirus were in their third trimester of pregnancy, emphasising the importance of social distancing and regular hand washing from 28 weeks of pregnancy.

The study also found pregnant women from Black, Asian and minority ethnic (BAME) backgrounds are more likely than other pregnant women to be admitted to hospital for coronavirus. Pregnant women over the age of 35, those who are overweight or obese, and those women who have pre-existing medical problems, such as high blood pressure and diabetes, also appear to be at higher risk of developing severe illness.

All pregnant women are advised to follow government guidance on staying alert and safe ( social distancing). If you develop coronavirus you are still most likely to have no symptoms or a mild illness from which you will make a full recovery.

It is important that if you feel your symptoms are worsening or if you are not getting better, you should seek medical help, particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. You should contact your maternity team, your GP, or use the NHS 111 online service/ NHS 24 in Scotland online service for further information and advice. In an emergency, call 999.

The increased risk to pregnant women from a BAME background, those who are over the age of 35, those who are overweight or obese, and those women who have pre-existing medical problems, such as high blood pressure and diabetes, will mean that your maternity team may offer you additional appointments, or refer you to a doctor or specialist clinic should there be any concerns about your or your baby's health.

This will be discussed and planned with you by your community midwife or maternity team through a risk assessment, and personalised antenatal and postnatal care plan.

The recommendation to all pregnant women remains that you should seek medical advice as early as possible if you have any questions or concerns about your or your baby's health. Your maternity team is there for you and you will receive safe, personalised and respectful care.

Q. What is the advice for women from a Black, Asian or minority ethnic background?

Women from Black, Asian and minority ethnic (BAME) backgrounds are at higher risk of becoming seriously unwell and being admitted to hospital so it's important that if you feel your symptoms are worsening or if you are not getting better, you should seek medical help.

Your maternity team may offer you additional appointments, or refer you to a doctor or specialist clinic if there are any concerns about your or your baby's health.

If you aren't already, you should consider taking a vitamin D supplementation, which is recommended to all women during pregnancy. There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop coronavirus. However, there is not enough evidence to show that taking vitamin D prevents coronavirus infection or is an effective treatment.

Women from BAME backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D and are advised to take a higher dose of vitamin D. Speak to your community midwife or maternity team if you have any questions about vitamin D supplementation. Vitamin D supplements are available from most pharmacies and supermarkets, and for eligible families through the NHS Healthy Start scheme.

The Royal College of Midwives has developed new guidance for midwives and maternity support workers to ensure that they are aware of the increased risks for BAME women and can pass on relevant advice and support to the women in their care.

The NHS in England has written to all maternity units in the country calling on them to take four specific actions to minimise the additional risk of coronavirus on BAME women and their babies.

Early pregnancy

Q. What is the advice if I am in my first trimester/less than 12 weeks' pregnant?

Even during the pandemic, it is very important that if you have any questions or concerns about yourself or your baby at any time, you contact your GP, midwife or local early pregnancy unit straight away to discuss them. Some symptoms, such as pelvic pain, cramping and/or bleeding during early pregnancy, are linked to ectopic pregnancy and miscarriage and you should seek urgent medical advice should you experience any of these symptoms.

A telephone appointment will be arranged for you as soon as possible with your local early pregnancy unit to check your symptoms. They will be able to advise whether a visit to the hospital during the coronavirus pandemic is necessary, and ensure you receive the care that you need.

Whilst hospitals are trying to minimise the number of people entering them, in order to reduce the spread of the coronavirus and to limit the impact on services, they are organised in such a way that they are able to provide all acute services including maternity care.

Find out more in the RCOG guidance and information on the changes to early pregnancy care and what to expect during the coronavirus pandemic.

Mental health

Q. How can I protect my mental wellbeing during the pandemic?

We understand that the coronavirus pandemic will inevitably result in an increased amount of anxiety in the general population, and this is likely to be even more so for pregnant women and their families as pregnancy presents an additional period of uncertainty.

Specifically, these anxieties are likely to revolve around:

The virus itself

The impact of social isolation resulting in reduced support from wider family and friends

The potential of reduced household finances

Major changes in antenatal and other NHS care, including appointments being changed from face-to- face to virtual contact

Isolation, bereavement, financial difficulties, insecurity and inability to access support systems are all widely recognised risk factors for mental ill-health. The coronavirus pandemic also increases the risk of domestic abuse or violence.

You should be asked about your mental health at every contact with a health professional. By acknowledging these difficulties, healthcare professionals can help to contain some of these anxieties. If you require support, you should be signposted to resources which can be provided remotely, where possible. If you are experiencing domestic abuse or violence, please disclose this to a healthcare professional who can provide information and support to keep you safe.

Where necessary, women in England can self-refer to local IAPT (Improving Access to Psychological Therapies) services. In Scotland, advice is available from Parentclub and NHS Inform. More information about mental health and pregnancy, including the signs of perinatal depression, is available from the NHS website.

Symptoms of perinatal depression include:

feeling sad and hopeless

negative thoughts about yourself not sleeping well, even when your baby is, or sleeping too much

a lack of interest or pleasure in doing things or being with people

loss of appetite

Further information is also available from the following organisations:

Antenatal care

Q. How will the coronavirus pandemic affect my routine antenatal and postnatal appointments?

We understand that it could be a stressful and anxious time if you are pregnant or have recently given birth during the coronavirus pandemic. The NHS is working to ensure that you, your baby and your family are supported and cared for during these uncertain times. This means that there may be some changes to how, when and where you attend essential routine appointments and how safe, personalised care and support are given to you. Any changes implemented by your local maternity service should be discussed with you.

Antenatal and postnatal care is based on years of evidence to keep you and your baby safe through pregnancy, birth and beyond. Antenatal and postnatal care should therefore be regarded as essential and you should be encouraged to attend, while adhering to social distancing measures as far as possible.

Your local maternity team may reduce routine appointments, provide more home visits or deliver some care and support over the phone or by video to reduce the number of times you need to travel and attend hospital/clinics. Any changes to your care will be discussed with you in advance.

Q. Why are changes to antenatal and postnatal care necessary during the coronavirus pandemic?

These changes are a way of ensuring we deliver the best care without overloading our NHS services, which are crucial during the coronavirus pandemic. This helps us to:

Reduce the number of people coming into hospitals where they may come into contact with other people and spread the virus

Ensure staff are not overwhelmed and stretched too far by the additional strain on services, which could be due to staff sickness and self-isolation as well as the higher numbers of patients needing care and overnight hospital stays due to coronavirus

This allows us to care for you and protect you from coronavirus while also ensuring we protect NHS staff and services.

Q. Who should I contact about my antenatal and postnatal care appointments?
If you have been allocated a local health continuity team or a named community midwife
You should continue to contact your continuity team or community midwife by telephone to discuss any questions or concerns you might have and to check on arrangements for all scheduled and future appointments.
If you have not been allocated a local health continuity team or a named community midwife
You should contact your GP surgery or local maternity unit in order to be connected to an appropriate continuity team or named community midwife so you can discuss any questions or concerns you might have and to check on arrangements for all scheduled and future appointments. If you are unsure when your next appointment is you should make contact as above to help us care for you.

Q. Can I still attend my antenatal/postnatal care appointments?

Your antenatal and postnatal appointments remain an important part of your maternity care to provide checks and screening on your health and your baby's health. A member of the maternity team looking after you may call you before your appointment, and/or carry out an assessment at the entrance of the clinic/hospital to check whether you have any symptoms that are suggestive of coronavirus.

If you are advised to attend an appointment by your local maternity team, this is because the need for the appointment to help reduce the risk of complications for you and your baby is greater than your risk of being exposed to coronavirus.

If you are well, you should be able to attend your appointments. You may be asked to attend alone to protect your household from the risk of coronavirus. Your local maternity team will discuss this with you in advance. If you are asked to attend your antenatal appointments alone, you should be advised where possible to have a discussion with your partner, or other supportive companion, about any questions they would like you to ask your maternity team on their behalf.

If you are currently self-isolating with suspected or confirmed symptoms of coronavirus and you have an appointment scheduled in the coming days, you should telephone your continuity team, community midwife, or local maternity unit, to inform them.

Your upcoming appointment will be reviewed by the maternity team looking after you and your baby. You will then be advised whether your appointment is urgent and a home appointment is required, or whether your appointment can be safely delayed for a period of 10 to 14 days until you are well.

Q. How many antenatal appointments will I have?

You will have at least six face-to-face antenatal appointments in total. Where possible, essential scans/tests and routine antenatal care will be offered within a single appointment. This is to prevent multiple journeys and visits to clinics/hospital, and will involve contact with as few staff as possible to prevent the spread of coronavirus to you, your family and other patients/staff.

This may mean that your initial 'booking in' appointment will take place at the same time as your 12-week (dating) scan.

You should be asked about your mental health at every appointment, whether in person or via phone/video.

In the third trimester, you should be asked about your baby's movements at every appointment, whether in person or via phone/video.

All pregnant women should be provided with information about Group B streptococcus (GBS) in pregnancy and newborn babies.

Sometimes, you may need additional antenatal appointments and medical care. This will depend on your individual medical needs. These appointments may be carried out over the phone or via video, provided a physical examination or test is not required. This will enable partners and other family/household members to join you for support and allow social distancing to protect you and your baby from coronavirus.

Q. Will I need to wear a facemask when I attend hospital for antenatal appointments, or to have my baby?

To reduce transmission of coronavirus in hospitals, the government has announced that from 15 June 2020, face masks and coverings must be worn by all NHS hospital staff and visitors in England. All visitors and outpatients, including pregnant women attending antenatal appointments or scans, must wear face coverings at all times to protect other pregnant women and patients and staff from coronavirus. This should be communicated with you through your appointment letter, local Trust websites and social media outlets. At present hospital inpatients, including women giving birth, are not required to wear masks.

Pregnancy scans

Q. Will I be able to bring someone with me to scans?

In some hospitals and maternity units, there are restrictions on visitors which might mean that partners and other supportive people are not able to attend routine antenatal appointments, including scans, with you.

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies - please check with your maternity unit for their policy on visitors to the antenatal and postnatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland (13 July), Wales and Northern Ireland (6 July) has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable a pregnant woman to invite another person to accompany her to antenatal and postnatal appointments, including pregnancy scans. Some Trusts in England are permitting partners or other supportive people to attend these appointments but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures enabling partners and other supportive people to attend antenatal and postnatal appointments, including scans, with women.

This is an important step not only for the health and wellbeing of pregnant women, but also their partners and families whose mental health has been affected by missing out on these appointments and bonding time with their babies.

If you are still unable to bring someone with you to your scan, we encourage units to allow women to share the ultrasound scan experience with their partner (or other family members and friends) by saving a short 10-30-second video clip of the baby at the end of the dating scan and/or anomaly scan.

We understand it may be upsetting if you are asked to come alone to a scan, but this measure has been put in place to protect maternity staff, other women and babies, and you and your family from the risk of infection. Scans are an essential part of pregnancy care and it is important that you continue to attend them for your and your baby's wellbeing.

Childbirth choices

Q. Will my childbirth choices be affected by the coronavirus pandemic?

We understand this must be a stressful and anxious time if you are pregnant and due to give birth in the coming months. Maternity units have been working to manage additional pressures and facilitate women's choices.

Like all areas of NHS care, maternity services have been affected by the pandemic but units are working to ensure services are provided in a way that is safe, with the levels of staff that are needed and the ability to provide emergency care where necessary.

In some areas of the UK, some Trusts and Boards have had to pause their home birth service or close their midwife-led unit. Most of these services have now been reinstated.

Birth partners

Q. Will I be able to have my birth partner(s) with me during labour and birth?

Yes, you should be encouraged to have at least one well birth partner present with you during labour and birth. Your birth partner(s) must wear a mask in hospital.

Having at least one trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of women in childbirth.

If a birth partner has symptoms of coronavirus or has recently tested positive for coronavirus, we do not recommend they go into the maternity suite, to safeguard the health of you, other women and babies and the maternity staff supporting you.

In some hospitals and maternity units, restrictions on visiting remain in place which might mean that birth partners or other supportive companions are not able to attend routine antenatal appointments, or stay with women on antenatal or postnatal wards. However, this should not impact on your birth partner's presence during your labour and the birth, unless they are unwell with coronavirus symptoms or have tested positive for coronavirus.

We know that for some women, their chosen birth partner(s) may be from a different household due to their individual circumstances. You should be supported to have them with you, unless they are unwell with coronavirus symptoms or have tested positive for coronavirus.

Q. Will I be able to have my birth partner(s) with me if I am being induced?

At least one birth partner without symptoms should be able to attend your induction of labour where that is in a single room (e.g. on the maternity suite) but potentially not if the induction takes place in a bay on a main ward, as it may not be possible to maintain the necessary social distancing measures.

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies - please check with your maternity unit for their policy on visitors to the antenatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland, Wales and Northern Ireland has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable at least one birth partner to be present throughout induction of labour. Some Trusts in England are permitting birth partners to attend these appointments but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures birth partners to stay with women during their induction of labour.

We understand this must be a very worrying and anxious time if you are pregnant and your birth partner(s) cannot be with you while you are being induced. However, hospitals still need to limit the number of visitors during this time.

This guidance is in place to protect other pregnant women and babies and birth partners themselves, as well as maternity staff.

Please be assured that if your birth partner(s) is unable to be with you on a ward during your induction, this will not impact on your birth partner's presence during labour and the birth, unless they are unwell with symptoms of coronavirus or have tested positive for coronavirus. At the point you go into active labour, you will be moved to your own room and at least one well birth partner will be able to join you.

Q. Will my birth partner(s) be able to stay with me if I have a caesarean or instrumental birth that occurs in an operating theatre?

We fully support women having at least one birth partner with them during labour and birth, unless they are unwell or have tested positive for coronavirus.

Around one in four women in the UK has a caesarean birth. A caesarean birth may be recommended as a planned (elective) procedure for medical reasons or as an emergency - for example, if doctors and midwives are concerned that your baby is not coping with labour and needs to be born immediately.

Furthermore, around one in five women in the UK has an instrumental birth (ventouse or forceps). Some instrumental births may also be recommended to occur in an operating theatre in order to allow the maternity team to modify plans and undertake a caesarean birth if necessary.

Most caesarean and instrumental births in theatre are carried out under spinal or epidural anaesthetic, which means you'll be awake, but the lower part of your body is numb and you cannot feel any pain. In this situation, everything will be done by the clinical staff - midwives, doctors (obstetricians) and anaesthetists - to keep your birth partner with you.

Due to the coronavirus pandemic, staff in the operating theatre will be wearing enhanced personal protective equipment (PPE) to prevent the spread of infection, which will make it more difficult for them to communicate. To enable the clinicians to assist in the birth of your baby safely, it is very important your birth partner(s) follows the instructions from the maternity team carefully and quickly.

Occasionally, a general anaesthetic (where you are put to sleep) may be used, particularly if your baby needs to be born urgently. During this type of caesarean birth, even under usual circumstances (before the coronavirus pandemic), for safety reasons it is not possible for birth partners to be present during the birth.

While the maternity team will do all they can to ensure that your birth partner(s) is present for the birth, there will be some occasions when there is a need for an urgent emergency birth with epidural or spinal anaesthetic in which it will not be possible for your birth partner(s) to be present. This is because, during an emergency, operating theatres are more high-risk environments for the potential spread of coronavirus to anyone who is present.

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

Q. Will I be able to have a birth partner with me on the postnatal ward?

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies - please check with your maternity unit for their policy on visitors to the postnatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland, Wales and Northern Ireland has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable birth partners to remain with women on the postnatal ward. Some Trusts in England are permitting birth partners to the postnatal wards but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures birth partners to stay with women on the postnatal ward.

We understand that not having a birth partner with you on the postnatal ward after you have given birth may be upsetting for you both but these restrictions are in place to reduce the risk of transmission of coronavirus to you, your baby, the maternity staff and birth partners themselves.

Please be reassured that during this time, midwifery, obstetric and support staff will do their best to support the needs of all women and the practical challenges of caring for newborn babies after birth. If visitors are permitted, it is important that they follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Q. What is the advice for birth partners during the coronavirus pandemic?

We are asking you to follow the guidance below to keep yourself, your family, other families and NHS staff as safe as possible during the pandemic:

During the coronavirus pandemic, all hospitals have been restricting visitors, but there has always been an exception for a well birthing partner during active labour and birth.

Birth partners will be required to wear a mask or face covering when entering a hospital under new NHS guidance.

Every woman should be able to have at least one birth partner stay with her through labour and birth, unless the birth occurs under a general anaesthetic.

To help prevent spread of coronavirus to other women, their babies and key front-line healthcare staff, it is very important that you do not attend the maternity unit if you have any symptoms of coronavirus or have had any in the previous 10 days.

If you are unwell, protect your family and NHS staff, and stay at home. To prepare for this, women and their current birth partner(s) are being encouraged to think about an alternative birth partner(s), if required. This person does not need to be from the same household as you.

If you are supporting a woman during labour and birth, please be aware of the strict infection control procedures in place to prevent the spread of coronavirus to other pregnant women and their babies, as well as other people within the hospital and the maternity staff.

Please wash your hands regularly with soap and water and use hand sanitiser gel in clinical areas as available.

If you cough or sneeze, please cover your mouth with a tissue and dispose of it in a bin immediately.

If you are asked to wear any additional personal protective equipment (PPE) in addition to a mask or face covering during the labour or birth, please follow the instructions carefully and take it off before you leave the clinical area.

If you are accompanying a woman to her birth in an operating theatre, please be aware that operating theatre staff will be wearing PPE and it may be more difficult for them to communicate with you:

A staff member will be allocated to support you; please carefully follow their instructions and approach them if you have any questions.

To enable the clinical staff to do their job, it is very important that you do not move around the operating theatre as you risk de-sterilising sterile areas.

The maternity team will do everything they can to enable you to be present for the birth. However, if there is a particular safety concern, they may ask that you are not present in the operating theatre. If this is the case, the team should discuss this with you and explain their reasons unless it is an emergency.

We understand this is a stressful and anxious time for pregnant women, birth partners and their families and we thank you for your cooperation during this time.

Please be assured that the maternity team will do all they can to provide information, guidance and support to you and the woman giving birth.

Coronavirus testing

Q. Will I be tested for coronavirus?

The process for diagnosing coronavirus infection is changing rapidly. The offer of testing is now open to anyone in the UK (including pregnant women) with coronavirus symptoms. You should visit the NHS website or call 119 to arrange testing. The list of symptoms has also been expanded to include loss of or change in someone's normal sense of smell or taste.

To minimise the spread of coronavirus in hospitals, the offer of testing is available to all patients admitted to hospital, regardless of whether they have coronavirus symptoms or not. This includes offering tests to all women who attend hospitals for urgent or emergency maternity care, including attendance for spontaneous labour and birth.

New national guidance from the National Institute for Health and Care Excellence (NICE)recommends that individuals admitted for elective (planned) procedures should be offered testing prior to admission, following a period of self-isolation. The pre-existing NHS England guidance for both urgent and planned care which supports this recommendation is also still available. For maternity units, there are particular practical concerns and therefore, the RCOG has developed more detailed information about this.

If you have an elective caesarean birth or induction of labour planned, you may be asked to follow a period of self-isolation and offered a test for coronavirus prior to admission. You may also be asked to self-isolate and offered a test prior to a home birth. Your maternity team will discuss this with you.

The ability for widespread testing in a hospital trust will depend upon the availability of testing kits, testing capacity in the local laboratory and availability of staff to administer the tests. This is likely to vary across the UK and local adaptations will be required according to local capacity and infection prevalence.

Q. How does the coronavirus test work?

Pregnant women are tested in the same way as anyone else. Currently, the test involves swabs being taken from your mouth and nose. You may also be asked to cough up sputum, which is a mixture of saliva and mucus.

The most effective tests currently take 24-48 hours for the result to be available. This means that if you have symptoms suggestive of coronavirus and you are awaiting test results whilst in hospital, you may be treated as potentially infectious until the result is returned.

If you have symptoms of coronavirus but have recently received a negative test result, your maternity team may still use caution when caring for you. Sometimes, the virus doesn't show on the test results if you have been tested not long after you have become infected. You may be offered another test in a few days.

Q. What is an antibody test - will I have this?

You may also have heard about antibody testing for coronavirus. This is a blood test that can show whether you have previously come into contact with the virus or not. It does this by detecting antibodies, which your body produces if you have had coronavirus. This is called an immune response.

At present, this type of test is only being offered to NHS staff and some individuals across the UK. It is hoped the results of these tests will help us to understand how immunity to coronavirus works as we do not yet know how the antibodies develop and how long immunity lasts. Therefore, we do not currently recommend that results from antibody tests are offered when caring for pregnant women.

Q. Will my birth partner(s) be tested for coronavirus?

It is possible that your birth partner(s) may also be offered testing for coronavirus when you are admitted to hospital. Your maternity team will be able to advise you further.

Q. What if I decline testing for coronavirus?

If you decline testing for coronavirus prior to attending hospital for urgent or planned maternity care (including labour and birth), your care will be the same as any woman who is admitted to hospital and who does not yet have a test result.

If you have symptoms suggestive of coronavirus your care will be the same as for any woman who potentially has coronavirus.

If you do not have symptoms you will be treated as other asymptomatic women who do not yet have a test result. For most units, this will mean that you are presumed to not have coronavirus.

Postnatal care

Q. After my baby's birth, is there any increased risk to me or my baby?

There is no evidence that women who have recently had a baby and are otherwise well are at increased risk of contracting coronavirus or of becoming seriously unwell.

A recently pregnant woman's immune system is regarded as normal unless she has other forms of infection or underlying illness. You should however remain well-nourished with a balanced diet, take mild exercise and ensure social distancing guidance is followed.

Children, including newborn babies, do not appear to be at high risk of becoming seriously unwell with the virus.

However, close observation of hygiene, including washing hands regularly, is important amongst all members of your household and they should be careful when holding your baby if they have symptoms suggestive of any illness.

Anyone from outside your household who enters your home should pay stringent attention to hygiene precautions and follow social distancing guidance.

The government has also published guidance on meeting people outside your household.

It is important that your baby is feeding well and gaining weight and if you have any concerns, please contact your midwife. Once restrictions are lifted, we would caution against large family gatherings to celebrate your baby's arrival until more is known about the spread of the virus in the community.

Do not put off seeking medical advice if you have concerns about your baby's health during the pandemic. Seek medical advice if your baby has a fever, lethargy, irritability, poor feeding or any other symptoms you may have concerns about.

The NHS has produced a leaflet on coronavirus and information for newborn babies.

Q. How many postnatal appointments will I have?

Your postnatal care will be individualised to meet your needs and those of your baby. You should have at least three postnatal appointments with your local continuity team or community midwife. These will take place once you have been discharged from the maternity unit or the day of your homebirth: on your first full day at home, then on day 5 and day 10.

These appointments may be a mixture of face-to-face care at home or in a clinic, and telephone consultations where this is appropriate. After your postnatal appointment on day 10, your care will be transferred to your local health visiting team. You will be given information about this.

In early June 2020, the NHS provided guidance to all maternity teams that your first postnatal appointment should be a face-to-face visit at home following birth. This will be day 1 (if you gave birth to your baby at home) or the first day following discharge from the maternity unit (if you gave birth to your baby away from home in hospital or a midwifery led unit). This is an important visit to check that you and your baby are well and support you in these first few days. The Royal College of Midwives has produced a useful infographic on preparing for a home visit from your midwife.

Advice for pregnant women with suspected or confirmed coronavirus infection

Q. What should I do if I think I may have coronavirus or have been exposed to it?

If you are pregnant and you have a high temperature or a new, continuous cough or a loss or change to your sense of smell or taste, you should stay at home for 10 days.

The offer of testing is now open to anyone in the UK (including pregnant women), with coronavirus symptoms. You should visit the NHS 111 online service/ NHS 24 in Scotland or call 119 to arrange testing. Do not go to a GP surgery, pharmacy or hospital without contacting them on the telephone first.

You should contact your maternity unit to inform them that you have symptoms suggestive of coronavirus, particularly if you have any appointments in the next 10 days.

Please also be alert to the other possible causes of fever in pregnancy. In particular, these include urine infections (cystitis) and waters breaking. If you have any burning or discomfort when passing urine, or any unusual vaginal discharge, or have any concerns about your baby's movements, contact your maternity care provider as early as possible, who will be able to provide further advice.

If you are infected with coronavirus you are still most likely to have no symptoms or a mild illness from which you will make a full recovery.

If you feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more severe infection that requires specialised care.

You should contact your maternity care team, your GP, or use the NHS 111 online service/ NHS 24 in Scotland for further information and advice. In an emergency, call 999.

This advice is important for all pregnant women, but particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. This includes women who are in their third trimester, from a Black, Asian or minority ethnic background, over the age of 35, overweight or obese, or have a pre-existing medical problem, such as high blood pressure or diabetes.

If you have concerns about the wellbeing of yourself or your unborn baby during your illness, contact your midwife or, if out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.

Q. What should I do if I test positive for coronavirus?

If you test positive for coronavirus outside of a hospital setting, you should contact your midwife or maternity team to make them aware of your diagnosis. If you have no symptoms or mild symptoms, you will be advised to recover at home. If you have more severe symptoms, you might be treated in hospital.

Q. Why would I be asked to self-isolate (as opposed to reducing social contact)?

You may be advised to self-isolate because:

You have symptoms of coronavirus, such as a high temperature or new, continuous cough, or loss or change in your sense of smell or taste

You have tested positive for coronavirus and you've been advised to recover at home

You have an elective caesarean birth or induction of labour planned and you have been asked to self-isolate prior to your admission to hospital

You have a home birth planned and have been asked to self-isolate prior to your due date

Q. What should I do if I'm asked to self-isolate because I have symptoms or confirmed coronavirus?

Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for 10 days. If you live with other people, they should all stay at home for at least 14 days, to avoid spreading the infection.

Follow the NHS guidance on when and how to self-isolate.

You may wish to consider online fitness routines to keep active, such as pregnancy yoga or Pilates. Keeping mobile and hydrated, even if you are self-isolating, is important to reduce the risk of blood clots in pregnancy. Find out more about exercise in pregnancy.

All pregnant women are recommended to take 10 micrograms of vitamin D supplementation daily. This is especially important if you are self-isolating as you may not be getting enough vitamin D from sunlight. Vitamin D supplements are available from most pharmacies and supermarkets, and for eligible families through the NHS Healthy Start scheme.

Q. Can I still attend my antenatal appointments if I am in self-isolation?

You should contact your midwife or antenatal clinic to inform them that you are currently in self-isolation for suspected/confirmed coronavirus and ask for advice on going to any antenatal appointments.

It is likely that routine antenatal appointments will be delayed until isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. For example, you may be asked to attend at a different time, or in a different clinic, to protect others.

Q. What do I do if I feel unwell or I am worried about my baby during self-isolation?

If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact your midwife or, if out-of-hours, your maternity unit. They will provide further advice, including whether you need to attend hospital.

If you are advised to go to the maternity unit or hospital, you will be asked to travel by private transport, or arranged hospital transport and to alert the maternity unit reception once on site before going into the hospital. You will be required to wear a mask or face covering.

Q. Will being in self-isolation for suspected or confirmed coronavirus affect where I give birth?

As a precautionary approach, when pregnant women with suspected or confirmed coronavirus go into labour, they are being advised to go to an obstetric unit for birth where the baby can be monitored using continuous electronic fetal monitoring and their oxygen levels can be monitored hourly.

The continuous fetal monitoring is to check how your baby is coping with labour. As continuous fetal monitoring can only take place in an obstetric unit, where doctors and midwives are present, it is not currently recommended that you give birth at home or in a midwife-led unit, where there would not be a doctor present and where this monitoring would not be possible.

We will keep this advice continually updated as new evidence emerges. Maternity units everywhere are working around the clock to manage additional pressures and facilitate women's choices to the best of their abilities.

There is currently no evidence to suggest that you cannot give birth vaginally or that you would be safer having a caesarean birth if you have suspected or confirmed coronavirus, so your birth choices should be respected and followed as closely as possible.

However, if you are unwell and your team feel that this suggests that your baby needs to be born urgently, a caesarean birth may be recommended.

If you have confirmed coronavirus or are experiencing symptoms of coronavirus (a cough, fever, or feeling unwell), labour and birth in a birthing pool is not recommended as the monitoring of vital signs and administration of therapy is more challenging in water.

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. In an early version of the guidance it was suggested that the use of Entonox (gas and air) may increase aerosolisation and spread of the virus, but a review of the evidence suggests there is no evidence that Entonox is an aerosol-prone procedure, so there is no reason you cannot use this in labour.

Q. What happens if I go into labour during my self-isolation period?

If you go into labour during self-isolation, you should call your maternity unit for advice, and inform them that you have suspected or confirmed coronavirus infection.

If you have mild symptoms, you will be encouraged to remain at home (self-isolating) in early labour, as usual practice.

Your maternity team have been advised on ways to ensure that you and your baby receive safe and high quality care, facilitating and respecting your birth choices as closely as possible.

When you and your maternity team decide that you need to attend the maternity unit, general recommendations about hospital attendance will apply:

You will be advised to attend hospital via private transport where possible, or call 111/999 for advice, as appropriate

You will be met at the maternity unit entrance and may be provided with a face mask, which you will need to wear until you are isolated in a suitable room

Q. Could I pass coronavirus to my baby?

As this is a new virus, there is limited evidence about caring for women with coronavirus infection when they have just given birth. A small number of babies have been diagnosed with coronavirus shortly after birth but it is not certain whether transmission was before or soon after birth. Your maternity team will maintain strict infection control measures at the time of your birth and closely monitor your baby.

Q. Will my baby be tested for coronavirus?

If you have confirmed or suspected coronavirus when the baby is born, doctors who specialise in the care of newborn babies (neonatologists) will examine your baby and advise you about their care, including whether your baby needs to be tested.

Q. Will I be able to stay with my baby/give skin-to-skin contact if I have suspected or confirmed coronavirus?

Yes, if that is your choice. Provided your baby is well and doesn't require care in the neonatal unit, you will stay together after you have given birth.

In some other countries, women with confirmed coronavirus have been advised to separate from their baby for 14 days. However, this may have potential negative effects on feeding and bonding.

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

Q. How can I feed my baby if I have suspected or confirmed coronavirus?

There is no evidence showing that the virus can be carried or passed on in breastmilk. The well-recognised benefits of breastfeeding and the protection it offers to babies outweigh any potential risks of the transmission of coronavirus through breastmilk. Provided your baby is well and does not require care in the neonatal unit, you will stay together after you have given birth, so skin-to-skin contact and breastfeeding can be initiated and supported if you choose.

The main risk of breastfeeding is close contact between you and your baby, as if you cough or sneeze, this could contain droplets which are infected with the virus, leading to infection of the baby after birth.

A discussion about the risks and benefits of breastfeeding should take place between you and your family and your maternity team if you have suspected or confirmed coronavirus.

If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines.

However you feed your baby, the following precautions are recommended:

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

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

Consider wearing a mask or face covering while feeding

Follow recommendations for pump/bottle cleaning after each use

Consider asking someone who is well to feed your expressed breast milk or formula milk to your baby

If you are expressing breast milk in hospital, a dedicated breast pump should be used. Further information on infant feeding during the coronavirus pandemic is available from Unicef.

Occupational health guidance for pregnant women who work in a public-facing role

Q. Can I still go to work? What if I work in a public-facing role?

We understand that it must be an anxious time if you are pregnant and you work in a public-facing role.

National policy on social distancing measures has shifted considerably since the peak of the pandemic and now varies regionally. However, the UK Government has maintained the precautionary measure of classing pregnant women as clinically vulnerable. Therefore, despite the easing of restrictions from 4 July 2020, the advice remains that pregnant women who can work from home should continue to do so.

If you cannot work from home, you can work in a public-facing role if your employer can make appropriate arrangements to minimise your exposure to the virus. This should be considered and discussed with your occupational health team and/or employer in line with the RCOG, RCM and FOM clinical guidance and the UK government guidance linked to below. If you are advised that it is safe to go to work, you should be especially diligent about social distancing and hand hygiene.

The RCOG, RCM and FOM joint guidance version 3.4, updated on 10 August 2020 is still available to provide you and your employer with clinical advice on the risk and potential implications of being severely affected by COVID-19, particularly if you are 28 weeks' pregnant or more. This clinical advice still stands and remains important (please see the statement included at the beginning of this document about why we have kept this guidance available).

How and where you can safely work should be advised by your employer, after they conduct a risk assessment of your workplace and your individual situation in line with the UK Government guidance on Working Safely during the Coronavirus (COVID-19) pandemic.

We recommend that employers use the clinical advice in our occupational health document (in particular, section 3 'Recommendations for pregnant healthcare workers') along with the sector-specific advice on Working Safely during the Coronavirus (COVID-19) pandemic and on the NHS Employer website. We can assure you that the RCOG, RCM and Faculty of Occupational Medicine continue to act as clinical advisors on these documents published by government agencies.

Maternity Action has published FAQs around rights and benefits during pregnancy and maternity leave which you may find helpful.

Q. What is the advice if I am pregnant and my partner is a key worker working in a public-facing role?

The government has maintained guidance for people living with a clinically vulnerable person (which includes pregnant women as a precaution) and for people living with an extremely clinically vulnerable person (which includes pregnant women with pre-existing serious underlying health conditions identified within the government guidance).

Particular sensible advice includes frequent hand-washing, showering when you re-enter the house and washing the clothes you travelled in. Some useful advice for healthcare workers on general precautions to prevent infection is available in the Nursing Standard article, COVID-19: the steps to take when your shift ends to stay safe at home. While this hygiene article is aimed at healthcare workers, it may also be useful to anyone in a public-facing role. Because every work environment will have different requirements, your employer should advise you on best practice for hygiene within your specific role and in line with any sector-specific guidance on working safely provided by the UK government.

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The Royal College of Obstetricians and Gynaecologists (RCOG) provides this advice and guidance for your information purposes only. This information is not intended to meet your specific individual healthcare requirements and this information is not a clinical diagnostic service.

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If you’re pregnant, read about how coronavirus (COVID-19) could affect you, your baby and your pregnancy care.

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A short video on how to position yourself for safe sleep in the third trimester

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How to sleep safely during pregnancy - Tommy's

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Learn how to keep babies and toddlers active to help them grow up fit and healthy, including tummy time, active play, and swimming.

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UK's maternity rights charity, free legal advice about maternity rights at work and NHS care entitlement for vulnerable women.

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challenging inequality : promoting wellbeing

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Follow the link to find out how to apply for healthy start vouchers. These entitle you to free vitamins, milk, fruit, and vegetables
(if you struggle to fill this out or need assistance with printing please speak to your midwife)

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1. Get an application leaflet - see below where you can get it from. You need to fill in Part A of the application form carefully in black ink using CAPITAL letters.

2. Due to changes in the law, you no longer need to get a health professional to sign your Healthy Start application form. This means you can leave Part B blank. However if you are pregnant you need to complete your estimated due date in Part B. Don't forget that you/the applicant still needs to sign the application in Part A, Section 7.

3. Make sure all the information on the form is correct and that you have signed and dated it.

4. Send the form to us at the address below - either write the address on a plain envelope (you don't need a stamp) or use the freepost envelope at the back of the application leaflet if you have one.

Applying for Healthy Start FAQs:

Do I still need a midwife/health visitor to sign my application form?

Since 6 April, a health professional signature is no longer required.

I've completed my application (apart from the healthcare professional signature). Can I just send it in now?

Since 6 April, you no longer need a health professional to sign your Healthy Start application form. This means you can leave Part B blank. However if you are pregnant you need to complete your estimated due date in Part B. Don't forget that you or the applicant still needs to sign the application in Part A, Section 7.

Why can't you just issue vouchers automatically to everyone on benefits? Why do I still need to apply?

Not everyone who is on benefits or tax credits is eligible for Healthy Start vouchers and by law Healthy Start vouchers can only be issued after a completed application is received. If you are eligible for Healthy Start vouchers, you will be invited to apply - all eligible families are sent a partly filled in form for them to complete and send back.

How to get the application leaflet

You can get an application leaflet by:

asking your midwife or health visitor for one

calling the Healthy Start helpline on 0345 607 6823 and asking them to send one to you by post

filling in the form online and then printing it off to check and sign

emailing a blank form (PDF) to yourself

or downloading it directly from this website. If you are emailing a blank application form to yourself or downloading it from this website, you will need to have the free Adobe Acrobat Reader to view and print it.

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Get an application leaflet - see below where you can get it from. You need to fill in Part A of the application form carefully in black ink using CAPITAL letters. Due to changes in the law, you no longer need to get a health professional to sign your Healthy Start application form.

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Best Use of Medicines in Pregnancy (BUMPS)

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Best Use of Medicines in Pregnancy (BUMPS)

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bumps - best use of medicine in pregnancy

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This website provides reliable, evidence-based, and accurate information about use of medicines in pregnancy, in the form of freely available patient information leaflets called 'Bumps ' leaflets are produced by the UK Teratology Information Service ( UKTIS), a not-for-profit national organisation hosted by the Newcastle upon Tyne hospital NHS Foundation Trust and funded by the UK Health Security Agency (UKHSA) on behalf of the UK Health Departments.

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How to not need a holiday after the holidays

The holidays can be a stressful time for single parents, Natalie is a volunteer in our Wellbeing Digital Group and recently held an online workshop where she shared her 'go to' tools for managing the...

Read more

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We are Gingerbread, the charity for single parent families. We provide expert advice and practical support for single mums and dads in England and Wales.

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If you or someone you know is experiencing domestic abuse, verbal, physical, sexual, emotional, or financial, then please seek help from the police, or Herts Sunflower

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Herts Sunflower is a service supporting people who have been abused or people who know someone who has been abused. Get help and advice if you're suffering from domestic violence, rape and sexual abuse, forced marriage, Female Genital Mutilation, honour based abuse or you're an abuser and need help.

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Your waters can break before labour starts, if this happens we still want to see you so we can check on your baby and make a plan in case labour doesn't start on its own. Call your midwife, or the midwife on call and we can come and assess you at home (keep the pads you have been wearing!). However, if the fluid coming away is red or green then please contact triage - 01438 286168

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1st stage of labour

During the 1st stage of labour, contractions make your cervix gradually open (dilate). This is usually the longest stage of labour.

At the start of labour, your cervix starts to soften so it can open. This is called the latent phase and you may feel irregular contractions. It can take many hours, or even days, before you're in established labour.

Established labour is when your cervix has dilated to about 4cm and regular contractions are opening your cervix.

During the latent phase, it's a good idea to have something to eat and drink because you'll need energy for when labour is established.

If your labour starts at night, try to stay comfortable and relaxed. Sleep if you can.

If your labour starts during the day, stay upright and gently active. This helps your baby move down into your pelvis and helps your cervix to dilate.

Breathing exercises, massage and having a warm bath or shower may help ease pain during this early stage of labour.

When to contact a midwife

Contact your midwifery team if:

your contractions are regular and you're having about 3 in every 10-minute period

your waters break

your contractions are very strong and you feel you need pain relief

you're worried about anything

If you go into hospital or your midwifery unit before your labour has become established, they may suggest you go home again for a while.

Once labour is established, your midwife will check on you from time to time to see how you're progressing and offer you support, including pain relief if you need it.

You can either walk around or get into a position that feels comfortable to labour in.

Your midwife will offer you regular vaginal examinations to see how your labour is progressing. If you do not want to have these, you do not have to - your midwife can discuss with you why she's offering them.

Your cervix needs to open about 10cm for your baby to pass through it. This is what's called being fully dilated.

In a 1st labour, the time from the start of established labour to being fully dilated is usually 8 to 12 hours. It's often quicker (around 5 hours), in a 2nd or 3rd pregnancy.

When you reach the end of the 1st stage of labour, you may feel an urge to push.

Monitoring your baby in labour

Your midwife will monitor you and your baby during labour to make sure you're both coping well.

This will include using a small handheld device to listen to your baby's heart every 15 minutes. You'll be free to move around as much as you want.

Your midwife may suggest electronic monitoring if there are any concerns about you or your baby, or if you choose to have an epidural.

Electronic monitoring involves strapping 2 pads to your bump. One pad is used to monitor your contractions and the other is used to monitor your baby's heartbeat. These pads are attached to a monitor that shows your baby's heartbeat and your contractions

Sometimes a clip called a foetal heart monitor can be attached to the baby's head instead. This can give a more accurate measurement of your baby's heartbeat.

You can ask to be monitored electronically even if there are no concerns. Having electronic monitoring can sometimes restrict how much you can move around.

If you have electronic monitoring with pads on your bump because there are concerns about your baby's heartbeat, you can take the monitor off if your baby's heartbeat is shown to be normal.

A foetal scalp monitor will usually only be removed just as your baby is born, not before.

Speeding up labour

Labour can sometimes be slower than expected. This can happen if your contractions are not coming often enough, are not strong enough, or if your baby is in an awkward position.

If this is the case, your doctor or midwife may talk to you about 2 ways to speed up your labour: breaking your waters or an oxytocin drip.

Breaking your waters

Breaking the membrane that contains the fluid around your baby (your waters) is often enough to make contractions stronger and more regular. This is also known as artificial rupture of the membranes (ARM).

Your midwife or doctor can do this by making a small break in the membrane during a vaginal examination. This may make your contractions feel stronger and more painful, so your midwife will talk to you about pain relief.

Oxytocin drip

If breaking your waters does not work, your doctor or midwife may suggest using a drug called oxytocin (also known as syntocinon) to make your contractions stronger. This is given through a drip that goes into a vein, usually in your wrist or arm.

Oxytocin can make your contractions stronger and more regular and can start to work quite quickly, so your midwife will talk to you about your options for pain relief.

You will also need electronic monitoring to check your baby is coping with the contractions, as well as regular vaginal examinations to check the drip is working.

2nd stage of labour

The 2nd stage of labour lasts from when your cervix is fully dilated until the birth of your baby.

Finding a position to give birth in

Your midwife will help you find a comfortable position to give birth in. You may want to sit, lie on your side, stand, kneel, or squat, although squatting may be difficult if you're not used to it.

If you've had lots of backache while in labour, kneeling on all fours may help. It's a good idea to try some of these positions before you go into labour. Talk to your birth partner so they know how they can help you.

Find out what your birth partner can do.

Pushing your baby out

When your cervix is fully dilated, your baby will move further down the birth canal towards the entrance to your vagina. You may get an urge to push that feels a bit like you need to poo.

You can push during contractions whenever you feel the urge. You may not feel the urge to push immediately. If you have had an epidural, you may not feel an urge to push at all.

If you're having your 1st baby, this pushing stage should last no longer than 3 hours. If you've had a baby before, it should take no more than 2 hours.

This stage of labour is hard work, but your midwife will help and encourage you. Your birth partner can also support you.

What happens when your baby is born

When your baby's head is almost ready to come out, your midwife will ask you to stop pushing and take some short breaths, blowing them out through your mouth.

This is so your baby's head can be born slowly and gently, giving the skin and muscles in the area between your vagina and anus (the perineum) time to stretch.

Sometimes your midwife or doctor will suggest an episiotomy to avoid a tear or to speed up delivery. This is a small cut made in your perineum.

You'll be given a local anaesthetic injection to numb the area before the cut is made. Once your baby is born, an episiotomy, or any large tears, will be stitched closed.

Find out about your body after the birth, including how to deal with stitches.

Once your baby's head is born, most of the hard work is over. The rest of their body is usually born during the next 1 or 2 contractions.

You'll usually be able to hold your baby immediately and enjoy some skin-to-skin time together.

You can breastfeed your baby as soon as you like. Ideally, your baby will have their 1st feed within 1 hour of birth.

Read more about skin-to-skin contact and breastfeeding in the first few days.

3rd stage of labour

The 3rd stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina.

There are 2 ways to manage this stage of labour:

active - when you have treatment to make it happen faster

physiological - when you have no treatment and this stage happens naturally

Your midwife will explain both ways to you while you're still pregnant or during early labour, so you can decide which you would prefer.

There are some situations where physiological management is not advisable. Your midwife or doctor can explain if this is the case for you.

What is active management?

Your midwife will give you an injection of oxytocin into your thigh as you give birth, or soon after. This makes your womb contract.

Evidence suggests it's better not to cut the umbilical cord immediately, so your midwife will wait to do this between 1 and 5 minutes after birth. This may be done sooner if there are concerns about you or your baby - for example, if the cord is wound tightly around your baby's neck.

Once the placenta has come away from your womb, your midwife pulls the cord - which is attached to the placenta - and pulls the placenta out through your vagina. This usually happens within 30 minutes of your baby being born.

Active management speeds up the delivery of the placenta and lowers your risk of having heavy bleeding after the birth (postpartum haemorrhage), but it increases the chance of you feeling and being sick. It can also make afterpains (contraction-like pains after birth) worse.

Read about preventing heavy bleeding on our page What happens straight after the birth.

What is physiological management?

No oxytocin injection is given, and the 3rd stage of labour happens naturally.

The cord is not cut until it has stopped pulsing. This means blood is still passing from the placenta to your baby. This usually takes around 2 to 4 minutes.

Once the placenta has come away from your womb, you should feel some pressure in your bottom and you'll need to push the placenta out. It can take up to an hour for the placenta to come away, but it usually only takes a few minutes to push it out.

If the placenta does not come away naturally or you begin to bleed heavily, you'll be advised by your midwife or doctor to switch to active management. You can do this at any time during the 3rd stage of labour.

Read more about what happens straight after you give birth.

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During the 1st stage of labour, contractions make your cervix gradually open (dilate). This is usually the longest stage of labour. At the start of labour, your cervix starts to soften so it can open. This is called the latent phase and you may feel irregular contractions.

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If you're starting to think about the kind of birth experience you'd like and how you might approach labour and delivery, hypnobirthing may be something you'd like to find out more about.

What is hypnobirthing?

Hypnobirthing is a birthing technique that combines deep breathing, relaxation, visualisation, self-hypnosis and education for both you and your birth partner. You can use the techniques in labour and delivery to help you cope with pain.

How does hypnobirthing work?

Hypnobirthing uses techniques to shift focus away from awareness of feelings of fear, anxiety and pain that are often associated with childbirth-who hasn't heard multiple negative birth stories?! These techniques prepare you for birth, help you feel calm and confident and empower you to feel in control for the birth of your baby.

What are the methods and techniques used in hypnobirthing?

Controlled breathing exercises

Deep breathing in through your nose and out through your mouth helps you stay calm and keeps your mind focussed.

Visualisation

Visualisation techniques help you to imagine or 'daydream' about the birth of your baby and how it will feel and happen so that you can create a positive moment in your mind that you can revisit and rehearse over and over before you go into labour.

Deep relaxation and meditation

You'll practice techniques to help you tune out external noise so that you can focus solely on your body and your baby.

Positive language

Hypnobirthing takes a different approach to talking and thinking about birth to reduce fear and negativity-for example, contractions are referred to as 'waves' or 'sensations' that have purpose.

Hypnobirthing techniques can be used in the early stages and when labour is established. You can use the techniques in combination with other things through your birth journey and with other types of pain relief. Hypnobirthing isn't just for natural labour-the techniques can be used successfully if things don't go to plan by helping you keep calm and focussed.

Does hypnobirthing work?

There isn't an easy answer here as there are only a small number of studies which have assessed its use. While some women believe it allowed them to have a positive birth experience and reduced their need for pain killing drugs others do not feel it helped.

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Hypnobirthing explained - the benefits | Emma's Diary

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If you're starting to think about the kind of birth experience you'd like and how you might approach labour and delivery, hypnobirthing may be something you'd like to find out more about. Hypnobirthing is a birthing technique that combines deep breathing, relaxation, visualisation, self-hypnosis and education for both you and your birth partner.

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If you bring your own aromatherapy to MLU, or to use at home, please inform anyone looking after you, aromatherapy must also not be added to a birthing pool