Hypnobirthing Courses - Commencing December 2021
We are thrilled to be able to bring back our popular hypnobirthing course at Maidstone Birth Centre.
Hypnobirthing is an antenatal training program using relaxation, breathing and mindfulness . It allows women and their partners to be calm, confident and feel in control during childbirth. Learning how to be free of fear and tension can enable couples to embrace the birthing process and place trust in their bodies to birth easily and effectively.
Hypnobirthing is suitable for all. For those who may require a caesarean, assisted vaginal birth or an induction of labour it can help couples remain in control at a time when they can be at their most anxious and tense.
The ideal time to attend a hypnobirthing course is between 24 – 36 weeks of pregnancy. Each course comprises four classes of two hours – 7pm – 9pm on Wednesdays at Maidstone Birth Centre. The cost is £140 per four-week course. In order to allow for safe social distancing, only 4 couples per course can be booked, and these places will be allocated on a first come first serve basis.
For further details and to book, please email Shona and Jennie on email@example.com
Please note that hypnobirthing classes will be restarting at Crowborough Birth Centre in 2022.
Unfortunately, our Parent Education classes are currently suspended.
Here you will find some helpful education videos for people in the antenatal stage of pregnancy:
Your Care On Delivery Suite
This is our Delivery Suite, you will find us on Level 2, in the green zone at Tunbridge Wells Hospital, right at the end of the corridor. One of the main differences between our Delivery Suite and our birth centres is that here we have 24 hour doctor cover, which means we would generally recommend you have your baby here if your pregnancy is complex, you go into labour before 37 weeks’ or if you would like to have an epidural for pain relief in your labour. But don’t forget we can accommodate you if your pregnancy has been uncomplicated.
We are a big team here, with many people with many different roles; all dedicated to making sure you have the best experience possible – here are some of the team.
Hello my name is Tracy Thresher and I’m one of the matrons here and Tunbridge Wells Hospital. My job is to oversee everything, all the processes that happen in those units.
Hi there, my name’s Olivia and I’m one of the Registrars. I work closely with the team here on Delivery Suite and I might be involved if your birth is complex or you might just see me around.
Hi, my name’s Anna. I’m one of the midwives who will be happy to look after you when you’re having your baby.
Hi, my name’s Hayley Webster. I’m one of the midwives here; I currently work on Delivery Suite. We are very welcoming!
Hello, my name’s Victoria. I’m one of the anaesthetists on labour ward and if you need any help during your labour with an epidural or going to theatre, I’ll be here to help you.
Hello, my name’s Jamie. I’m another anaesthetist. There’s normally more than one of us on the labour ward.
Hi, I’m Sarah, I’m a maternity support worker. I work alongside the midwives to help look after you and your baby.
Hello, my name’s Mia, I’m a student midwife. I’ll be here to care for you alongside a midwife when you’re having your baby.
Hello, this is Rafiq Sangay, I’m one of the consultant obstetricians and gynaecologists at Tunbridge Wells Hospital. We spend our time looking after you before, during and after your labour.
Hello, my name’s Deniece Hardy, I’m Delivery Suite ward manager. My job is to make sure that our team give you the best birthing experience possible.
Here on Delivery suite we have 15 rooms, all arranged in a long line. When you first come in, you will see the main reception desk, which is staffed during the day by one of our ward clerks.
When you take your the corridor to the right when you first come in, this is where we have our low risk rooms. These are designed to promote mobility and active in labour. We have two pool rooms for anyone that you can you for your labour or birth. These rooms also come equipped with other active birth equipment all designed to keep you mobile and upright during your labour. These include mats, beanbags, birthing balls and a sling.
Our beds can also be adapted into different positions to help keep you upright, mobile and comfortable in labour. We have tried to make these rooms as homely as possible, but please feel free to bring anything with you that’s going to make you feel comfortable, like your own pillow or a speaker to play music.
If you come left when you come into Delivery suite, you’ll find the rest of our labour rooms.
So, here we are in one of our lovely delivery rooms. This is the kind of room you may come to if you need a little bit more surveillance during your labour, for instance, you need to be on one of our monitors here so we can check in on baby. We still have lovely things like birthing balls in the room, you don’t need to stay on the bed, we encourage you to move about, feel a little bit of freedom, we don’t want you to feel restricted. So things are a little hidden in here, things we may need during the labour. For instance, after you’ve had your baby and they need a little bit of stimulation, maybe a little bit of oxygen, we’ve got this lovely resuscitaire unit here that we can just pull down and we have everything we need. Every room has its own toilet and shower. We have an emergency buzzer on the wall here and in the toilet. For you whilst you’re in the room, you have a call button if you need any assistance, but your midwife will be with you a lot of the time.
At the end of the corridor and around the corner, we have our theatres. We have our own dedicated theatres and theatre teams to prevent any delays in receiving treatment should you need it during your labour or after you labour. This is one of our theatres here. It really isn’t as scary as it looks. If you do have to come to theatre for any reason, your midwife will come with you and we have a really friendly theatre team who will do their best to look after you.
We are really keen that birth partners get involved in all aspects of labour and birth, When you come to delivery suite we will show you where you can help yourselves to hot drinks. We will seek to understand your views as a birth partner as well as taking on your wishes and preferences. So if you would like to be involved in any aspect of decision-making then please feel free. Please feel free to ask us any questions- no question is ever silly!
Once you have had your baby, we keep your antenatal notes and you get issued with a new set of postnatal notes. If you have anything valuable in your notes, like scan photos for example, then please take them out before you go home from hospital. If you would like to request copies of your labour and birth notes, then you can do so by visiting this link on our website http://www.mtw.nhs.uk/wp-content/uploads/2020/02/SAR-Application-form-v5.pdf.
We really appreciate any feedback you have about the care you receive from us. A midwife or support worker will ask you to complete a short survey before you leave Delivery Suite, and we would appreciate any comments you have, big or small, good or bad. We regularly review all feedback and implement any changes that we can to ensure that everyone has the best experience possible.
Tour of Maidstone Birth Centre
Welcome to Maidstone Birth Centre. We are a midwifery-led, home-from-home unit caring for low-risk women. When you come to the Birth Centre, you will see midwives, maternity support workers and midwives.
During the Coronavirus pandemic, we are unable to offer tours of the Birth Centre, so we have put together this short video so you can visualise the rooms before you attend for your Birth Place Assessment.
The Birth Centre has two spacious birthing rooms and four postnatal bedrooms. The birthing rooms have large pools, comfortable home-like furnishings and equipment to help you in labour. There is active birth equipment that includes birth balls, birth stools, a sling and beanbags to help and support you to achieve a physiological birth. The birth rooms also have air conditioning, dimmable lighting and flat screen televisions. Our four postnatal bedrooms all have en-suite facilities and beds so partners can stay. Three of our four rooms have double beds. A fully equipped kitchen-diner means you are able to help yourself to drinks and snacks whenever you want.
Like the hospital, we will be wearing PPE to protect you, your families and our staff. For all face to face contacts/ appointments we will look like this, and when your baby is about to be born, like this!
We are here for you at the Birth Centre, so if you have any questions, please don’t hesitate to contact one of the midwives who will be very happy to answer your questions.
Birth preparation – The Start Of Labour
Here at Maidstone and Tunbridge Wells Trust, we have four options for where you can have your baby. You could have your baby at home, or at one of our three sites- Crowborough Birth Centre, Maidstone Birth Centre, or Delivery Suite at Tunbridge Wells. Please speak to your community midwife about your options, and visit our website for more details about all of your options.
The “getting ready phase”- can also be called the “latent phase of labour”
Labour is a very unique experience and it will start differently for everybody. One of our community midwives, Grainne Rose, will now tell you a little bit about what happens as your body is preparing itself to go into labour.
The latent phase is the getting ready phase, and it can take time. It can take a day, two days, maybe even three days. It’s a process by which your cervix, or the neck of the womb, has got to get ready before it can open.
In this diagram you can see a term uterus. Baby is head down. This is the cervix, or the neck of the womb, and in the cervix is a plug of mucus called the show.
So this is a knitted uterus, and this is the cervix. Before the labour process, the cervix is about 3cm long, hard, closed and way at the back. During the getting ready phase, the cervix has got to come forward, soften and be taken up. It’s very similar to the process of putting on a polo-neck jumper. To start with, as you’re putting the jumper on, the neck of the jumper is up here. As you pull the jumper on, the neck of the jumper is taken up into the jumper, so eventually you’re left with no neck and a hole of 3-4cm. And that’s exactly what your cervix has got to do in the getting ready phase. As I say, this process can take 12, 24 or 48 hours.
In order for this process to work, your body needs to be having tightenings and warm-ups, and later, contractions. These can stop and they can start, they can stop and they can start. Because this process can take such a long time, it’s really important that you stay at home, you get some food, you get as much rest as you can and you allow your body to just do its thing.
As these contractions warm up and get more powerful, then they are doing more. Each and every one is worthwhile- it’s working on your uterus and on your cervix. It’s gradually and very slowly taking up the cervix until eventually all that neck has gone and there is a hole of 3-4cm. It’s only at this point that you’re at the beginning of labour- all of that is the getting ready phase.
Signs that labour is starting
There are several signs that labour might be starting. Firstly, you may experience contractions, or tightenings, or surges. These are like period pains in your abdomen. Some people feel them in the very front, low down, or sometimes in the back. With this backache, you may also feel an urge to go to the toilet, and this is often where baby is coming quite low down and pressing on your bowel.
Your waters may also break, and we’ll go into a bit more detail about this later on.
You may also experience a show. Grainne is going to explain exactly what that is.
The show is the plug of mucus that is in the cervix, or the neck of the womb. It can come away at any time. The show can either be clear or pink or brown, but the most significant part of the show is the consistency of it- it’s sticky or tacky, it’s like wallpaper paste or snot. If you have a show, it means that your baby will probably arrive sometime in the next two weeks. You don’t need to ring anyone about your show.
When to call your midwife?
There’s always a midwife available to talk to at any time day or night if you have any queries or concerns about your labour.
Firstly we would recommend calling us if your baby’s movements are reduced, or if their normal pattern of movement has changed.
We would also recommend calling us if you experience any heavy vaginal bleeding- so not like a show, but more like a period.
Also please give us a call if you are experiencing intense contractions that are coming more regularly and frequently.
Finally, please call us if you think your waters break. This experience is different for everybody- some experience a big gush of waters, some get more of a slow trickle. The important thing to remember is that your waters will continue to leak right up until your baby is born. We’re going to go back to Grainne, who is going to explain a little bit more about what to look out for when your waters break.
We expect the fluid to be clear, however it may well be green. Sometimes the waters are green because the baby has passed meconium inside you- meconium is the baby’s first poo. Babies pass meconium for two reasons- one is that they’re overdue and they think they’re out so they have a poo; the other reason is that the baby has experienced some element of stress at some point during the pregnancy. So if your waters go, whether they’re clear or green, ring up the Birth Centre or Triage and talk to the midwife and she’ll ask you to come in.
Please remember that the points that we’ve mentioned are by no means exhaustive- please call us at any time if you have any questions or worries or concerns- we’re always here to help you and talk to you.
Between you and your midwife on the phone, you’ll decide when will be the best time for you to have a face-to-face assessment with a midwife to see how your labour’s progressing.
Seeing the midwife for the first time in labour
So we’re now going to talk a little bit about how that first assessment with the midwife looks when you’re in labour. If you’re planning a home birth, this will be in your own home with the community midwife. If you’re planning on having your baby at one of our birth centres, you’ll be greeted at the door by one of our midwives and bought into one of our labour rooms. If you’re planning on having your baby at Tunbridge Wells, this will be in Maternity Triage, which is on the second floor of the Green Zone.
When you’re settled into a room with your midwife, they will have a chat with you about what’s been happening so far- they’ll ask you about the length and strength of your contractions; they’ll ask you about any vaginal loss you’ve had either a show, or bleeding, or if your waters have broken; they’ll ask you how your baby’s movements have been, particularly over the last 24 hours. They will talk to you a little bit about your birth plan and birth preferences; they’ll do some basic observations like your blood pressure, your pulse and your temperature; they’ll have a feel of your tummy to see which position baby is in and have a listen to their heartbeat- this will either be with a sonicaid or with one of our CTG monitors; and they’ll just generally ask how you are and how you’re doing. The midwife at this point may also offer you a vaginal examination to see if there have been any changes to your cervix. The midwife will explain the reasons behind all of the checks that they’re offering, and if at any point you don’t feel comfortable with it, or you don’t want to have the check, then please just say.
If your labour is still in the early stages, then the midwife may suggest going home for a little bit just to await events and let things progress naturally by themselves. Evidence suggests that labour will progress better in an environment where you feel comfortable, and for most people this will be your home. However, if you do not feel comfortable returning home and would much rather stay on one of our birth centres or in the hospital, then please do say- it’s absolutely fine, we’ll accommodate you where we can.
What to bring in
When you feel like your labour has established, and your midwife has invited you in to see us at one of our birth centres or at Tunbridge Wells hospital, please remember to bring with you your hospital notes, a car seat to take baby home in, and your hospital bag. If you have harvested some colostrum during your pregnancy, then please bring that in with you and we can keep it safe until you need it. We have an award-winning video about how to harvest colostrum which can be found on our website. We also have a handy section on our website that gives you some advice about what to pack in your hospital bag. If you have written down some ideas and preferences for your birth, then please bring them along with you too so we can discuss them with you.
It would be a good idea to plan your journey and mode of transport well in advance before the big day so you feel comfortable and confident in your route. Unless it is an emergency and your midwife has recommended it, please do not call an ambulance to bring you into hospital.
If there’s anything in this video that you would like to discuss, then please contact your midwife.
Birth preparation – The Mechanics Of Birth
As I’m sure you’ve already noticed, pregnancy is a really incredible thing. Your body has created and grown this human being for all these months. Birth is just as amazing, and the body goes through so many different phases during the course of your labour in order to bring your baby out into the world. Grainne is going to talk to you a little bit about exactly what’s going on inside your body.
Once you are in active labour, so once your cervix is thin and open to about 4cm, your cervix continues to open about 1cm about every 1-2 hours for your first baby until the cervix is nearly all gone and you’re at the transition stage between the opening phase of labour and the giving birth phase of labour.
When your cervix has reached the transition stage, this is the stage where the cervix has nearly finished opening, the baby has come down a little bit further in your pelvis and you feel a lot of pressure in your back passage, similar to when you want to have a poo. It’s important for you to just breathe with these sensations and that way your body can just nudge your baby down into the pelvis. So you’re breathing through each and every one of these sensations, and that last little bit of cervix nudges away until all the cervix has gone and the baby is deeper in the pelvis.
It’s also important at this stage to remember about the significance of your bony pelvis- it’s not going to get any bigger, so you’ve got to make the most of the space that you’ve got. At the base of your spine you’ve got the coccyx, some people know that as the tailbone. The coccyx, or your tailbone, create a curve in your pelvis and when you’re giving birth this can be significant also. If you’re upright and you give birth, you’re working with gravity and working with the curve of your pelvis. If you’re on all fours when you give birth, again you’re working with gravity and working with the curve of your pelvis. If you’re sitting down, you’re sitting on your tailbone, and that can encroach into the pelvic space. It also means that you’re working against gravity and you’re giving birth uphill, so your midwife will assist you to get into a position that you can adopt to help the baby’s progress during this stage.
The birthing process is a “two steps forward, one step back” process- two steps forward, one step back. Each and every time you have a contraction or a surge, your body’s contractions will nudge the baby down, and then at the end of the contraction, the baby goes back. And it’s two steps forward, one step back, two steps forward, one step back- nudging all the way with each and every one of the contractions or surges. Until the widest points of the head are coming through- and this can be quite a stinging/burning sensation, and the midwife may well say to you “breathe” or “pant” or “blow”- she basically just wants to ease that last little bit of the baby’s head out, so you just blow and the baby’s head is out, and you breathe and you relax and you’re waiting for the next contraction. The baby rotates, and then with the next contraction or surge, you will get an urge again, and you go with that urge and the rest of the baby will come out- and then the baby is born!
If there’s anything in this video that you would like to discuss, then please contact your midwife.
Birth Preparation – Pain Relief Options In Labour part 1
Labour can be an intense experience and as well as being different for everybody. Each labour that each individual has will be different so it’s important to keep an open mind. Here at MTW we have a vast array of ways that we can help you deal with the pain of labour. In this video we will tell you about all the options that we have and the risks and benefits of each one. For the purpose of this video we will use the words pain and contraction, we are aware that those who are using hypnobirthing techniques prefer to use the word surge and wish to avoid all reference to the word pain. If you’re using hypnobirthing techniques in your labour please put this into your birth plan so we can ensure that we are using your preferred terminology.
Hypnobirthing combines breathing techniques, mindfulness, relaxation and visualization to help you concentrate on your body and the birth of your baby. You and your birth partner can learn practical techniques to help you feel confident to make decisions together about your labour. Hypnobirthing can be used with all forms of pain relief at any stage of your labour and wherever it is that you are having your baby. Now some expectant parents will attend private hypnobirthing classes but you don’t have to, you can teach yourself a lot of the techniques like from books or CD’s, audio tracks podcasts or by looking at websites. Please speak to your midwife or check our website for details about our private hypnobirthing classes that we run at Crowborough and Maidstone birth centres.
One of our community midwives Grainne Rose is now going to talk to you a little bit about breathing techniques that can help reduce feelings of anxiety and labour.
A lot of people enter labour and they’re fearful and if you’re fearful about anything at all your body produces a huge surge of the hormone adrenaline, which is the fight flight response hormone. When adrenaline is high your muscles are tense, your blood pressure is up, your pulse is high and all your blood goes to your legs and your arms so that your body is ready to run from whatever it’s frightened of or fight it and consequently you’ve got no blood flow around your middle which is where you need it for labour. When you’re relaxed and the oxytocin hormone, which is the labour hormone that is necessary, is high your heart rate is steady, your blood pressure is low, your breathing is deep and steady and your muscles are loose and relaxed so the crux of this is for you to get your breathing right and it sounds terribly simple. Practice in the pregnancy breathing exercises and this is just about breathing in through your nose for a count of three or maybe four and out through your mouth for a count of five six or maybe seven but whatever is comfortable for you. So it’s just a……. I want you doing that five or six times each and every day so that you get into the habit of it and when labour starts and your tightening’s arrive and then your contractions arrive and the surges then you just naturally click into that breathing technique.
Another great method of pain relief that you can use in labour is water. We know from just general life if you’re feeling quite stressed or you’re uncomfortable getting in a nice warm bath is a really nice way to relax this is because water creates weightlessness it increases your ability to move around and be more upright and mobile to help baby descend into the pelvis. We also know that heat is really good for pain, think about things like deep heat cream or if we hit ourselves we rub it to create heat because that really helps relieve pain. We recommend the pools be around 37 degrees, so around body temperature which is just right to help you relax in labour. You can use water wherever you plan to have your baby, if you’re coming to one of our birth centres or to Tunbridge wells hospital we have some lovely birth pools for you to use. If you’re planning on having your baby at home you can talk to your midwife about where you can hire an inflatable birth pool to use in your house or you can use your bath if you have one.
There is some evidence to suggest that being in water for your labour can help increase your chance of having a vaginal birth can help increase feelings of relaxation and control over your experience and can also sometimes decrease the length of your labour. As well as there being plenty of benefits to being in water for your labour there are also benefits to being in water for the birth of your baby as well so if you’d like to stay for the whole thing then that’s absolutely fine. There’s no evidence to suggest of any negative outcomes for babies that are born water compared to babies born on dry land and if you would like to then your birth partner can be in the pool with you as well during the birth but that’s completely up to you. When you’re in labour we listen regularly to your baby’s heart rate and if you’re in water then that can still be achieved. If we’re listening into your baby intermittently then our sonic aids are waterproof so this can come in the water with you, your midwife may just ask you to move ever so slightly or possibly even stand up briefly from the pool just so they can have a listen to baby’s heart rate. If we have recommended that we listen into your baby continuously throughout labour with one of our CTG monitors and Tunbridge Wells Hospital does have wireless telemetry monitors that are waterproof so that can also come in the pool with you. When you’re calling either the birth centre or Tunbridge Wells Hospital to say that you’re in labour please let the midwife know that you are intending to use a pool so they can start preparing it and filling it for you ready for when you arrive.
Grainne is now going to talk a little bit about TENS.
TENS is trans electrical nerve stimulation, it’s a unit that you hire or you can hire them from the Maidstone Birth Centre or Crowborough Birth Centre. It comes as a unit all of them look slightly different but they do the same thing so long as you’ve hired an obstetric TENS. There are two pairs of pads and yours will be impregnated with a gel, they are single person pads not single use so when you put the pads on you may well want to take them off and then get in the bath and then put them on a little bit later, so long as you put the pads back on the perspex sheet that they came with then they’re reusable for you. So you put one pair of pads either side of your spine below your bra line and one pair of pads either side of your spine above your knicker line. It doesn’t matter which pair go where. You then switch one of the dials, you switch it on and switch it up until you start feeling a pins and needle sensation, you switch it up a little bit further and then you personally think, oh I don’t like that put it back to where it was comfortable. That’s now set you go to the second dial. You switch it on, you switch it up until you feel the pulse, that pins a needle sensation. Switch it up a little bit more when you don’t like the sensation put it back to where it’s comfortable. Your TENS is now set and you are in charge of your TENS and you’re the only person that changes the dials. The pins and needles sensation continues all the way through labour, when you have a contraction you press the boost button and the pins and needle sensation becomes constant. At the end of the contraction you release the boost button and it goes back to a pulse. Put the tens machine on as early as you like it will help your body it builds up natural endorphins over time. Your tens machine can then stay on throughout the process of labour, until after your baby’s born.
Something else that we can offer you to help with the pain of labour is aromatherapy. Aromatherapy oils can be used in various ways, you can either have a few drops of a tissue that you can smell during labour, you can have some oils in a diffuser or they can be used with a carrier oil and massaged into your skin. Some of these oils have very powerful properties and may not be suitable for you or your particular stage in pregnancy so it’s really important that you discuss what you’re planning on using and how with a midwife or aromatherapist before using them. One of the most common oils that we use here is lavender, lavender is a great all-rounder it’s very calming and relaxing and it smells great. It’s really nice put on a tissue or a diffuser that you can smell anytime that you’re feeling stressed or anxious. Another oil that we use here is clary sage. Now clary sage is really great for stimulating labour and can really help if your labour has slowed down a little bit or to try and get contractions going. It’s really nice again putting a carrier oil and massage into your skin. Because of this effect that it can have on your contractions it’s really important that you avoid using this in early pregnancy. We have aromatherapy oils stocked in all of our places of birth so both of our birth centres and at Tunbridge Wells Hospital. Some of our midwives are trained aromatherapists and can make up specific blends. So here we’ve got a relaxation blend and also a labour blend that have been mixed up by our midwives. Please speak to your midwife if you’re interested in using any aromatherapy oils at any point during your pregnancy or labour.
Another method we can use for pain relief in labour that doesn’t involve giving drugs are sterile water injections. These injections are given with really small needles in the base of the spine and can really help relieve lower backpain. This can be a really common place to feel discomfort during labour so these really help. Now you may think water that’s not going to help me but it really, really does. It’s quick and easy and the effect can last for up to two hours. Two midwives will identify specific points on the base of your spine and will give you injections on each side at the same time so the effect is equal. It will sting for around 20 seconds as they first go in but then the relief from the pain is almost instantaneous. Like all the other methods of pain relief we’ve spoken about in this video because they don’t involve using drugs you can use them in combination with drugs. With sterile water for injections you can continue to be mobile and move around during your labour and you can have the injections as many times as you like.
If there’s anything in this video that you would like to discuss then please contact your midwife.
Birth Preparation – Pain Relief Options In Labour part 2
All of the pain relief options that we’ve looked at so far don’t contain any kind of drug or medication, but there are some methods of pain relief in labour that do. Grainne’s going to kick us off and talk a little bit about Entonox, or gas and air.
Entonox, or gas and air, is available at the Birth Centres and at Tunbridge Wells and at home births, it’s nitrous oxide and oxygen. It has a one-person mouthpiece and a two-way valve. It takes about 15-30 seconds to get into your system, so it’s very important right at the beginning of a contraction that you start breathing Entonox. As soon as you feel the contraction starting, you put the mouthpiece in your mouth and you breathe in and out, in and out. All the way up, over the top, and down the other side. At the point where you want to stop breathing it, you take it out of your mouth and you breathe air.
Entonox can actually, because of all the mouth-breathing, make you feel quite thirsty so it’s worth having a sports bottle of water near you so you can sip water whenever you want. It may also be worth having a lip balm with you to keep your lips moist.
Grainne is now going to talk about another form of pain relief that contains medication, and this is called pethidine.
Pethidine is an opiate and it may be offered to you as a pain relief in labour. It is given as an injection either in your thigh or your bottom, and you can have two separate injections of pethidine in your labour. In many instances, it allows your body to catch up with itself, and those people who have been so internally tense that has been out of their control, their body is then allowed to relax and the cervix can often do some opening in that time.
The final method of pain relief we’re going to talk about is the epidural. The epidural is described as being the most effective form of pain relief, as it numbs you completely from the waist-down so that you can’t feel the pain of contractions.
An epidural is performed by an anaesthetist, so it is therefore only available at our Delivery Suite at Tunbridge Wells Hospital. So if you start your labour at one of our Birth Centres or at home, and you decide during your labour that you would like to have an epidural for pain relief, then we will arrange to transfer you over to Delivery Suite.
Our anaesthetists are present and available on Delivery Suite 24 hours a day, 7 days a week. As soon as you ask us for an epidural, an anaesthetist will get to you as soon as they can. When you decide that would like an epidural, your midwife will discuss the pros and cons with you, and will also give you one of these epidural information cards for you to read. This gives you all of the information about some of the common and not so common side-effects associated with an epidural.
Some of the most common side effects of an epidural are that it drops your blood pressure, which can make you feel quite dizzy or light-headed, and also that it doesn’t work quite well enough so you need other forms of pain relief in labour.
So once you’ve had a read of the epidural card and you’re happy that would like to proceed with the epidural, the midwife will start collecting all of the equipment that you see here that is needed for an epidural. One of the first things that your midwife or a doctor will do is insert a cannula, or a drip, into your hand. Once this is in your hand, we use it to give you fluids directly into your vein- this will help to stop that drop in blood pressure that we talked about and also can help just to hydrate you during labour.
The epidural medication runs through this pump, and we’ll talk a little bit about this later on.
When you’re ready to continue with the procedure, they’ll talk you through everything that’s going on and they’ll ask you to stay as still as possible, just for a few seconds. Once the procedure is finished, a thin tube is left in your back and this is where the medication is fed through.
As we mentioned earlier, the medication will run through that tube and through this pump. You will be given this button where you control how much of the medication you receive from the epidural. Every time you feel any pain or discomfort, you press the button to give yourself a top-up. The machine is programmed so you can only deliver medication every half an hour, so you can’t accidentally give yourself too much.
Our epidurals are called mobile epidurals, which means they affect your legs to a lesser degree than your classic epidural, so you can still walk around and move around the room, keep upright and mobile in labour and change your positions regularly with an epidural. The epidural and the top-ups work as a cumulative effect- every time you top-up it builds the medication up a little bit more. So if your labour’s quite long, or you’ve had a lot of top-ups, then gradually the ability that you have to move around becomes a little bit less. In the same way, the epidural can gradually reduce your sensation of needing to pass urine, and if this is the case we may offer you a catheter in your bladder to help drain it for you. Sometimes the sensation also of needing to push your baby out can be a little bit more difficult if you’re feeling quite numb, but we can help support you with this if needs be.
We have a great section about pain relief in labour on our website, so please check it out and also have a chat with your midwife about your pain relief options.
Birth Preparation – Monitoring Your Baby’s Heartbeat In Labour
In this video, we’re going to be talking about your fetal monitoring options when you’re in labour. Monitoring your baby’s heart rate is one way that we can assess their health. As you’ll be aware, when you come to your antenatal appointments we will have a listen in to your baby then, and we continue to do that during your labour. Listening into your baby’s heart rate regularly during labour gives us and you reassurance that your baby is okay.
There are two main ways that we can listen in to your baby. One is intermittently, so at short intervals, and the other is continuously. We will discuss each one of these in turn and we’ll also show you how we do it.
Listening to your baby’s heart intermittently
So the first method that we’re going to talk about is intermittent auscultation. Now as the name suggests, it means that we listen to your baby for short periods of time rather than continuously. Nationally, and here at Maidstone and Tunbridge Wells Trust, it is recommended that midwives listen in to your baby every 15 minutes for a minute during the first stage of labour, and every 5 minutes for a minute in the second, or pushing stage of labour.
Generally if your pregnancy has been low-risk and uncomplicated, we would recommend this form of monitoring for your baby in labour.
One way that your midwife can listen in to your baby is with a Pinard. It works by the wider end being against your abdomen, and this being against the midwife’s ear. The one downside to using a pinard is that the midwife is the only person who can hear the baby’s heart rate- you won’t be able to hear. So this is why midwives generally will use sonicaids. With the sonicaid, the midwife will use the little probe and put it against your tummy to hear your baby’s heart rate, and the sound is amplified through the monitor. You may have seen these used by your midwife at your antenatal appointments. The blue colour means that this is waterproof, so if you are having a water birth or a water labour then it can come in the water with you. The aim during this is to disrupt you as little as possible, so it can be used in whatever position you happen to be in during labour. The midwife may just ask you to move ever so slightly if she’s having trouble picking up baby’s heart rate, but generally you can still move around and do whatever it was that you were doing. The midwife will always ask your permission before listening in to the baby’s heart rate. If you have any specific preferences, such as if you want the volume turned right down or anything else, then please just let us know.
Listening to you baby’s heart beat continuously
Depending on what’s happened during your pregnancy or your labour, we may recommend listening in to your baby continuously during labour. The main way that we do this is with one of our CTG machines. How they work is they come with two probes, both of which go on your abdomen, and they’re secured in place with an elastic band each. This means that you’re then still able to move around and be mobile and keep upright during your labour. One of the probes listens in to your baby’s heartbeat, and the other one monitors your contractions. Both of these then print out on a graph, so then the doctors and midwives have a visual representation of your baby’s heart rate in relation to your contractions which we look at all the way through.
When you are being monitored continuously on one of these machines, every hour we ask another midwife or doctor to come in and do what we call a “fresh eyes” assessment. This hourly review doesn’t mean that there’s something wrong with your baby’s heart rate, it’s just something that we do routinely here.
If we have recommended that it would be beneficial for your baby to be monitored continuously throughout labour, this can only be achieved here at our Delivery Suite at Tunbridge Wells Hospital. Please ask your midwife to discuss your fetal monitoring options and how this will impact your place of birth during your pregnancy.
Another way that we can listen to your baby continuously throughout labour is with something called a ‘fetal scalp electrode’, or an FSE. We would only ever use these if we had recommended that we listen to your baby continuously and we were struggling to pick your baby’s heart rate up with one of the probes that we mentioned earlier. The FSE looks like this, and is a little clip about the size of a small fingernail that we attach to your baby’s head. It then attaches to the CTG monitor and creates the same graph that we had before. Once the fetal scalp electrode is attached, we then stick a little pad onto your leg just to keep the wire out of the way so you can still walk around and move around and be as mobile as you had been.
The fetal scalp electrode does not harm your baby, but you may notice a small mark on their head when they’re born- this should heal very quickly. Please be assured that we do not use fetal scalp electrodes routinely here, and we would discuss the risks and benefits with you and your birthing partner before putting one onto your baby.
As we mentioned previously, listening in to your baby’s heart rate can give us and you reassurance that your baby is okay. Midwives and doctors are trained to interpret and recognise the patterns of a baby’s heart rate, so it is a really useful tool in assessing your baby’s wellbeing during labour. We would recommend having a discussion with your midwife or doctor during your pregnancy to discuss the risks and benefits of all of the fetal monitoring options and what is going to be best for you and your labour.
As with every topic that we discuss in these videos, every aspect of your care is a partnership, and every decision is made together with you and your healthcare professional. So if you’re not comfortable with any of the recommendations that we make, or you have further questions, or you would like to talk about it some more, then please let us know so that we can make an individualised plan of care for you and your labour.
Birth Preparation – Induction of Labour
This video is going to explore induction of labour- why we offer it, when we offer it, how we carry it out, and how it affects you and your birth experience.
Induction of labour is the process whereby a midwife or doctor artificially starts your labour. There are many reasons why we may recommend that you have your labour induced. Here at Maidstone and Tunbridge Wells NHS Trust, and in the UK, around 1 in 4 labours are induced. The most common reasons for offering induction include, if your pregnancy has reached 42 weeks and your labour hasn’t started by itself, secondly if there are any concerns about your health or the health of your baby, and thirdly if your waters break and your labour doesn’t start itself within 24 hours.
As is the case with anything to do with your health or the health of your baby, any decision is made in partnership with you and your named healthcare professional. If we have recommended induction we will explain the reasons why, we’ll give you the pros and cons, we’ll talk to you about your alternative options, and we’ll allow you time to discuss this with your birth partner.
To help your decision making, we have produced our own birth planning infographics using local data from this Trust. If you would like to see these, please ask your midwife or obstetrician. Please feel free to ask us as many questions as you want to, and we will respect any choice or decision that you make.
The main benefit of offering induction of labour is that it’s promoting safety in a scenario where it would be safer at that point to start your labour.
There are some downsides to having your labour induced. It can be a long process, and for some it can take anything up to three days to get into fully established labour. Also having your labour induced can increase the likelihood that you may need further pain relief during your labour that you may not necessarily have planned for during your pregnancy. And thirdly, it is worth noting that around 1 in 5 to 1 in 6 inductions aren’t successful, so result in your baby having to be born by Caesarean section. Because we know of these downsides to induction of labour, we would only recommend it to you if the benefits outweigh the risk.
If we have recommended induction of labour but you have decided that you would like to wait some more time for your labour to start spontaneously, then we will support you in that decision. We will work with you and come up with a plan depending on your wishes and your personal circumstances and the reasons that we have recommended induction. We may ask you to come in for regular monitoring at our Maternal Day Unit just to make sure that you and baby are remaining well. Your midwife may also refer you to one of our obstetricians just to have a further discussion about your options and to work out what’s right for you.
If you reach 41 weeks of pregnancy and labour hasn’t started by itself, your community midwife or obstetrician can offer you something that we call a membrane sweep. A membrane sweep is a more natural way of trying to encourage labour to begin. If you would like more information about membrane sweeps, please speak to your community midwife, or you can access our induction of labour leaflet on our website.
Induction of labour- Step One
If you decide that you would like to go ahead with induction, there are various methods that we can offer you to start your labour off. The method that we choose will depend on your preferences, what’s happened with your pregnancy and how may weeks you are, and the reasons for induction.
The first part of the induction process involves helping your cervix to thin out and start to open, a process that we call effacement. Methods of starting this process off fall into two categories- either hormonal methods or non-hormonal methods. Our non-hormonal method of induction is called Dilapan, and it’s how most inductions are started here at MTW. Dilapan consists of small rods that go inside your cervix and they swell up to help your cervix open. We generally try to insert around 4 or 5 of these rods to give your cervix the best chance of opening. The rods expanding and gently pushing your cervix open can help to release natural hormones called prostaglandins which can help start off your contractions. These are generally left inside your cervix to expand for around 12-16 hours, but they can be left up to 24 hours.
Our two hormonal methods are called Propess and Prostin. These contain prostaglandins, which as we mentioned is the hormone that helps start your contractions and helps make your cervix thin and soft and stretchy. They work in very similar ways but are slightly different. So Propess is a pessary which looks a little bit like a really tiny tampon, and it goes far high up in the vagina and sits behind the cervix and stays in place for 24 hours. It slowly releases those hormones over that 24-hour period just to help soften up your cervix and get those contractions started. Prostin comes in a gel form, and comes in a little applicator tube like this so that the gel can go in the same place as the Propess, really high up in the vagina. It comes in a much lower dose than the Propess, but it releases it much quicker, so it just works in a slightly different way. The aim of all of these methods is to open your cervix up to about 2cm, because it’s at that point that we are able to comfortably break your waters for you, which is the second part of the induction process.
Induction of Labour- Step Two
As we mentioned earlier, the second stage of the induction process is breaking your waters. You’ll often see this written in your notes as ‘artificial rupture of membranes’ or ‘ARM.’
When your waters break, this can often make the contractions that you’re already having much more effective, as those waters in front of the baby’s head are now gone, and baby’s head can apply direct pressure onto your cervix, helping your cervix to dilate a little bit quicker. The waters breaking can also help release natural hormones again, which can start your contractions off if they haven’t started already.
So once your cervix is open to about 2cm, a doctor or a midwife will use something called an Amnihook to help pop your waters. This will be no less uncomfortable than a normal vaginal examination.
Once your waters have broken, we will encourage you to be as upright and active and move around as much as possible to help encourage those contractions to continue.
Like the first stage of the induction process, this may be enough to get you into established labour. If at this point your labour has established, and you don’t have any further risk factors or need any further intervention to speed up your labour, then you are more than welcome to use the pool for your labour and birth. Please speak to the team caring for you to decide whether this is a good option for you.
We will offer you a review 4 hours after your waters have broken to allow your body the best chance to get into labour by itself. However, if by that point you’re not quite in established labour, then we may offer you the third step of the induction process which is the hormone drip, or Syntocinon infusion.
Induction of Labour- Step Three
The third stage of the induction process is the hormone drip, or Syntocinon infusion. Syntocinon is the name for a synthetic form of the hormone oxytocin, which you will produce naturally in labour to help your contractions along. When labour is induced, often your uterus needs a little bit more stimulation to help increase the strength, length and frequency of your contractions. This is completely tailor-made to you, so if you find that you’re not having enough or having too many contractions, the dose can be played around with and changed until we find the right dose for you. If you reach this part of the induction process and you’re happy to have the oxytocin infusion, we would recommend listening into your baby continuously through labour with one of our CTG monitors.
Some people often find the contractions they have whilst they’re on this infusion more intense than before, so please do let your midwife know if you would like some further pain relief.
Please see our website for more information, or please do speak to your community midwife or your obstetrician if you’d like a bit more information about the induction process, or anything else that you’ve seen in this video today.
Getting Prepared for Your Induction of Labour
Some inductions are what we call ‘outpatient inductions,’ which means we start the process off here in hospital and then you go home for a certain amount of time to await events. If this is a good option for you, then your midwife will discuss it in more detail.
If you are staying in with us to have your induction then we recommend bringing in everything that you would want for your labour with you, as well as everything that you’ll need for you and baby after the birth. We have a handy section on our website with a list of what to pack in your hospital bag. If you have harvested any colostrum and you want to bring that with you, then please do and just let us know when you arrive so that we can keep it safe for you. Because the induction process can take some time, it’s also a good idea to bring stuff with you to keep you busy, like books or magazines. We also have free WiFi here for you to use. If you have written a birth plan, then please also bring that with you so we can discuss it when you’re here.
Your partner can stay with you on the Antenatal ward throughout the induction process if they wish. If they are planning on staying overnight, it might be a good idea to bring an extra pillow or some bedding to keep them comfortable.
If you’re happy to go ahead with induction, then your community midwife of doctor will book in a date for your induction. Generally, we ask everyone to call the Antenatal ward on the morning of their booked induction date, just to let us know how you are and that you’re still planning on coming in for induction. The midwife and you will arrange a time for you to come to the ward to start the process off. Our Antenatal ward is located on the second floor of the Green Zone here at Tunbridge Wells Hospital.
Please remember that at any stage of the induction, if you want to ask us questions about any aspects then please do. Any decision is made is made in partnership with you, so if you’re not happy with anything that’s been suggested, or you want to try some alternatives, then please don’t hesitate to start that conversation with us, we’d be more than happy to have that with you.
Birth Preparation – Assisted Vaginal Delivery and Caesarean Section
Hi, we’d like to talk to you about assisted vaginal birth and emergency Caesarean section. It’s quite common to need a helping hand to deliver baby if you’re a first-time parent. In terms of the numbers, we’re looking at around 14% of parents will need an assisted vaginal birth and 25% of parents will need an emergency Caesarean section. If you’ve had a baby vaginally before then your chance is even lower, so roughly around 4% of second- or subsequent-time parents will have an assisted vaginal birth, and around 2% will have an emergency Caesarean section.
Throughout your antenatal care here at Maidstone and Tunbridge Wells hospital, we encourage you to talk to your team about your birth preferences. We aim to support your decisions and preferences throughout your journey here at MTW. Please remember that you are at the centre of every decision that is made about you and your care.
In this next section, we’re going to specifically talk about assisted vaginal birth.
Assisted vaginal birth
Assisted vaginal birth is undertaken during the second stage of labour. You will be offered a vaginal examination and if you’re fully dilated and if it’s appropriate, we will aim to deliver your baby vaginally. The main reasons for undertaking this is if there are concerns about baby’s wellbeing, needing a speedier birth or if you’re feeling too tired to push after a long labour.
A ventouse Kiwi cup is a suction cup placed on baby’s head. It is a team effort to deliver baby, and we gently guide baby around the pelvic outlet. It might be necessary to do a small cut in the perineum to help deliver baby. Baby may have a small swelling on top of their head, but this usually settles in a couple of days.
The alternative is a forceps delivery. Forceps look like salad spoons that gently hug the baby’s head and help guide out of the pelvic outlet.
If between you and the team looking after you you’ve decided that an assisted vaginal birth, so either a ventouse or a forceps birth, is the safest option for you, then this can take place in one of two places. Your baby’s birth will either happen in the Delivery Suite room that you are already in, or it may happen in our specialist theatre. It’s really important to note that both a ventouse and forceps are both very safe. It’s also not uncommon for the doctor to have to change from one instrument to the other during the course of your birth. If this does happen, please don’t be alarmed. The team around you will be discussing with you every step of the way what’s happening and keeping you informed and doing everything with your consent.
Depending on what is happening during the course of your labour, it may become the safest option to birth your baby by Caesarean section, and we’ll talk about this in a little bit more detail now.
A Caesarean section is an operation which allows your baby to be born via your abdomen. The main reasons why we would offer a Caesarean section during labour are if there are any concerns about your wellbeing or your baby’s wellbeing. If the team looking after you recommend that a Caesarean section is a good option, they will discuss the pros and cons and any potential alternatives with you and your birth partner. During this conversation, the senior obstetrician involved in your case will fill out a consent form with you and document all of the pros and cons you’ve discussed together. Once you’ve agreed on a plan, they will ask you to sign this consent form. Please only sign if and when you are completely happy with and understand everything that has been discussed. We appreciate that this is likely to be a very emotional moment for you and your birth partner, so please do ask us for some time to think about and discuss your options if you think that will be helpful, and please ask us as many questions as possible.
Once you’ve signed your consent form with our obstetric doctors, one of our anaesthetic doctors will come and have a chat with you about your pain relief options for the Caesarean to make sure that you are as comfortable as possible. If you already have a really good working epidural, then this is often sufficient for a Caesarean section, but you may also be offered a spinal anaesthetic which is very similar to an epidural, or a general anaesthetic in very rare circumstances.
When you arrive in theatre you will be greeted by our theatre team. Now please don’t be alarmed- it will seem like there are a lot of people there. But everyone has their own specialist job to ensure that you and baby are well cared for. Most people who are having a Caesarean birth are generally in theatre for approximately an hour, and your birth partner will be able to be with you that whole time. Please be rest assured that a lot of the aspects of your birthing plan can still be respected during a Caesarean birth, such as immediate skin to skin, delayed cord clamping or anything else that you would like.
A Caesarean section scar is generally quite small and quite low down on the abdomen. The stitches used to repair the scar are dissolvable, and when you go home from hospital you’ll have a dressing over the scar which will be removed normally by your community midwife on day 5. Your midwife will talk to you about how best to look after your stitches to prevent any infections.
If you are pregnant and you are planning on having your baby by a planned or an elective Caesarean, then we have a video on our MTW Maternity website which details the entire journey start to finish of an elective Caesarean birth, so please check it out for more information.
If you have a Caesarean section with this baby, and you are planning on expanding your family, this may have potential implications for your future pregnancies. However, when the time comes, your obstetric and midwifery teams will discuss all of your options with you so you can make the right choice for you.
We appreciate that talking about and thinking about an assisted vaginal birth or a Caesarean section birth conjures up a lot of differing feelings and emotions in all of us. However you do feel about them, we really hope that this video has helped to debunk some myths and help to reassure you that however your baby decides to enter the world, their birth will be special and it will be safe.
We are more than happy to talk to you after your birth about everything that happened if you feel that would be helpful. We appreciate any feedback that you may have about your experience so that we can improve our service for others.
If you have any questions about anything that you’ve seen in this video, then please speak to your midwife or your obstetrician.
Birth Preparation – Third Stage of Labour
Our videos so far have looked at the different stages of labour- so you have the first stage, which is from when your cervix is about 4cm dilated and you’re having regular contractions up until your cervix has completely gone and you’re ready to push. The second stage is when you are pushing your baby out, up until the birth of your baby. This video is going to be talking a bit about the third stage of labour, and that is the birth of your placenta, the membranes that surround your baby and the baby’s cord.
There are two main options for how you can birth your placenta. The first is what we call the physiological third stage, so completely unaided; your body births your placenta by itself. The second option is an actively managed third stage, where we assist you with birthing your placenta. Whichever way that you decide, or whichever way is recommended and is best at the time, the same three principles will be applied:
- Firstly, that we will allow the cord to pulsate for at least a minute after baby’s born, and we’ll talk a little bit about the benefits and why we do that a bit later on.
- The second principle is that we will try our best to minimise the amount of blood loss that happens.
- The third principle is that we will try to minimise the amount of disruption between you and your baby in those first precious minutes after their birth.
We’ll start by talking about a physiological third stage of labour.
So a physiological third stage is where we do not interfere at all in the birth of your placenta. Your body will naturally continue to have contractions after the birth of your baby, and they will help to push the placenta out in just the same way that you pushed out your baby. You may start to feel pressure in your bottom, just like you did when you were pushing your baby, as the placenta comes down into the vagina. Normally with a few pushes, your placenta will be out. Your midwife may recommend that you be more upright, you might stand or move around a little bit more; sometimes if you’re planning on breastfeeding having baby on the breast can help to stimulate more contractions; emptying your bladder and sitting on the toilet as well can just help give your placenta that little bit of extra encouragement to be born.
Generally a physiological third stage is only possible if your birth has been straightforward, has started spontaneously, and you have birthed your baby vaginally. Your placenta can take anywhere up to an hour to be born if you’re using this method.
If your midwife feels that the bleeding is getting heavier, or you’re not feeling very well, then they may recommend switching to an actively managed third stage.
An actively managed third stage involves the midwife or doctor at your birth giving you an injection of a hormone called oxytocin. Oxytocin is the same hormone that you use naturally and produce naturally to labour. We give you a synthetic version just to help your uterus contract. The injection will be given quite soon after birth. Whereas in a physiological third stage you’re required to do a little bit of pushing to deliver your placenta, no pushing is required with an actively managed third stage. After the injection has been given and has taken effect, the doctor or midwife will gently pull on the cord to help birth your placenta. An actively managed third stage generally is a lot shorter than a physiological third stage- it normally takes anywhere up to half an hour to deliver your placenta.
As we mentioned at the beginning of this video, one of the key principles that we maintain whichever way you choose to deliver your placenta is that we offer every baby delayed cord clamping. Over the last decade, more and more research is emerging telling us about the benefits of leaving the cord to pulsate for at least that minute after the baby is born. This means that the baby will receive extra blood flow, red blood cells, stem cells and iron, which will help reduce the risk of anaemia in childhood.
Once the cord has stopped pulsating, or once you’re ready for the cord to be cut, then you or your birth partner or the midwife can cut the cord, it’s completely up to you.
Although delayed cord clamping is now much more commonly accepted as standard regardless of how your birth your baby, either by Caesarean section or by vaginal birth, it’s still worth putting it in your birth plan and letting your midwives and your doctors know that you’re really keen to have delayed cord clamping.
If you have any other specific preferences about your third stage of labour, such as if you’re planning on keeping your placenta, then please let us know and we can accommodate those for you.
If your third stage lasts for longer than an hour, then we would consider this a delay in the third stage. If you’ve had a homebirth or you’re at one of our birth centres, then we would arrange transferring you to our delivery suite at Tunbridge wells hospital. Once here, we would ask one of our doctors to come and review you and make a plan. Sometimes there is a delay because the placenta just needs a bit of further assistance to be born. In this case, we would recommend transferring you to our theatre on delivery suite where we can give you further pain relief and a doctor can deliver your placenta safely.
It is really important to explore all of your options for the safe birth of your placenta during your pregnancy, and do discuss any questions that you might have with your midwife.
After Birth Preparation – Baby Care
Learning to take care of your new baby can be quite daunting especially if this is your first baby.
You’ll probably find that you have lots of questions everything from how to hold your baby, feeding, nappy changing, dressing and more. This video will cover some of the common topics that new parents ask us about.
Because of how underdeveloped we are when we’re born, human babies are completely dependent on their parents to keep them warm, feed them and keep them safe. Every time you communicate with your baby and respond to their needs you’re reassuring them that they are safe, touching them rocking them singing to them. All of these things will have a direct and positive effect on their brain development. The best thing that you can do for your newborn is to learn their cues and respond to their needs as quickly as possible. Each baby is different and spending as much time as possible with them as a family unit in those first few weeks will help you to understand what each cue means. Babies are aware that they can’t look after themselves so they will always seek assurance that their parents are nearby to help keep them safe. Babies will often not want to be put down or left alone too much in those early days and this is completely normal, you can’t spoil your baby or get your baby into bad habits by picking them up and holding them a lot in those first few weeks.
Picking up and holding your newborn baby for the first time is a big source of anxiety for new parents but the more that you hold them the more that you’ll get used to them and they’ll get used to you. In no time at all you’ll be picking up and holding your baby like it’s second nature.
The main principle you need to remember when handling your newborn is that it’s really important to protect their heads. Babies are born with quite weak neck muscles which means they can’t hold their heads up by themselves so whenever you are moving or handling your baby do make sure to keep their head protected at all times.
You will notice a couple of areas on the front and the back of your baby’s head these are called fontanelles or soft spots and they’ll feel like a gap. These are a natural gap that occurs in your baby’s skull which allows your baby’s brain to grow. Try to be gentle with these areas when you’re handling your baby and try not to apply too much pressure to them.
Babies can’t see much when they’re first born but they can make out face shapes, when you’re holding your baby this is about the perfect distance for them to just about make out your facial features. Over time they will start to recognize your facial features and they’ll also recognize your voice which is why talking to your bump in pregnancy is really important.
It’s completely natural for baby to want to sleep close to you and to not want to be put down too much in those first few days. As we mentioned this is completely normal and is baby’s survival instinct kicking in to make sure there’s always someone there to protect them. The safest place for your baby to sleep in the first six months is in a cot or moses basket in the same room as you. When you’re putting your baby down to sleep it’s important that you put them on their backs with their feet to the foot of the cot so they can’t wriggle down under any blankets that you put on top of them and when you are putting blankets making sure it’s tucked underneath baby’s arms so again the blanket can’t wriggle up in front of their face and stop them from breathing. If you have teddies or anything else in the cot please take them out when baby goes to sleep, it’s also best to keep baby lying flat when they go to sleep so pillows or anything under their head aren’t necessary. A lot of new parents often ask, but what if baby is sick in the night and they’re on their back? Because of the shape of babies heads they naturally put their head to one side when they’re lying on their back so they can breathe so if baby is a little bit sick in the night before you get to them it will naturally fall down the side and onto the side of the cot. Try to also ensure that baby doesn’t get too hot while they’re asleep keep their head uncovered don’t put any hats on baby during the night because if they do get hot this is where they’ll lose heat from.
Try to keep babies at sleep environment free from cigarette smoke including their bedding, exposing babies to cigarette smoke is a risk for sudden infant death syndrome or sids. If you your partner or any other members of your family are smokers please remember that everyone should wash their hands after every cigarette and again before handling a newborn baby. It’s also good to not hold baby against the same top you’ve just been wearing to smoke.
If you choose to share your bed with your baby there are ways that you can do this safely. Firstly, avoid covering them with your duvet. They should have their own blanket or sleeping bag to avoid suffocation. Do not share the bed with your baby if you or anyone else in the bed has smoked, had any alcohol or taken any drugs or medication that make you feel excessively tired. Make sure your baby has enough space where you’ve put them in the bed try to make sure that it wouldn’t be easy for them to roll onto the floor. Try to avoid any pets getting into your bed your baby is there and please also avoid falling asleep with your baby on a sofa or an armchair where it is much easier for them to roll off and fall onto the floor or into a position where they could become trapped. You can talk to your midwife or health visitor about all aspects of safe sleeping or access the lullaby trust for more information and support.
it is recommended that you organize your car seat during your pregnancy and bring it with you to the hospital or birth centre when you are in labour. Each car seat is different so do make sure that you read the manufacturer’s instructions on how to fix it into your car and how to fit baby in there safely. Some retailers can give you a demonstration of how to do this when you buy your car seat. Make sure the measurements of the car seat are correct and that is the appropriate size for your newborn. When fitting your car seat it’s important to note that the car seat must be rear-facing. It is currently illegal for your baby to be in the front passenger seat of your car if that seat has an air bag. When putting your baby into their car seat only have them in close fitting clothes rather than in a thick coat. A coat or a blanket will make the harnesses less effective in an accident and can cause overheating. If it is cold in your car then fix the harnesses first and then cover your baby with a blanket for the journey.
Your baby’s nappies will be a big source of interest for you and your healthcare professionals in the first few weeks of life. Your baby’s poo will start out very thick and sticky and black, this is what we call meconium and this is the very first poo that baby will do. As the week goes on it will change into a more green colour and then by the end of the week it will be bright yellow. The nct have a really good resource to have a look at what is normal and what isn’t normal. When you’re changing your baby’s nappy, whether you’re at home or out and about, it’s a really good idea to have them on a flat surface which isn’t too high off the ground just so they can’t roll off onto the floor. It’s also a really good idea to have a bag with all your essentials to hand wherever you may be. When you come to change your baby’s nappy start by washing your hands and then get your baby comfortable. Undo the bottom half of your baby’s clothing and tuck it out of the way. Undo baby’s dirty nappy but don’t take it away just yet. Gently holding their ankles lift their bottom up and start to wipe the whole area with your cotton wool or wipes. For girls it’s really important that you always wipe from front to back to help prevent infection. Once you’ve cleaned the whole area pat baby dry with cotton wool and remove the dirty nappy. Lifting baby again by the ankles, slide a clean nappy underneath them. The side with the adhesive tags attached is usually the back of the nappy, some nappies will also have a design on the front but do double check your nappy pack for more information. Fasten the nappy by unfolding the adhesive tags and sticking them to the front of the nappy around your baby’s hips. Attach it so that it is snug but not too tight. Where possible fold down the top edge so that the cord is not in the nappy. Then you can wash your hands and redress your baby.
Once your baby is born their umbilical cord will be clamped and cut, separating them from your placenta. A small stump of cord will be left attached to your baby’s belly button with a clamp attached to the end of it. It takes about a week but this will slowly dry up and then fall off. There’s no need to put any creams or powders or anything on the cord, it will dry up and fall off of its own accord. If you notice that the area around the cord has got dirty then you can wipe it with a little bit of plain water and then pat it dry afterwards. In the first couple of days you may notice that the stump of cord weeps a little bit of dry old brown blood but this is completely normal. Do let your midwife know however if you notice any fresh red bleeding from the cord or if there’s any pus or any sticky smelly discharge coming from it or if the area around the cord looks red or inflamed. Try to avoid where possible anything that might rub against or irritate the cord such as tight clothes or the nappy.
We usually recommend to avoid bathing your baby in the first few days after they’re born to help prevent them from getting cold and to also protect their skin. If you want to keep your baby clean before you start bathing or you want to keep them clean in between baths we recommend cleaning their face and neck and also their bottom in a process that we call top and tailing. When you are cleaning or bathing your baby it’s important that you keep the room you’re in warm and close any windows or doors it’s also good to have everything that you’ll need to hand before you start just so they don’t get cold and also so that you don’t have to leave them unsupervised. When you do top and tail or bath your baby we recommend just using plain water rather than adding soaps or oils. the water that you use in your baby’s bath should be warm and not hot, the best way you can check the temperature is by using an elbow or a wrist. When you are putting your baby in the bath you can support their head and neck using your arm and using your other hand you can gently swish water over them. It’s really important to not leave your baby unsupervised for any length of time while they’re in the bath. When you’ve finished get them out and put them straight into a warm towel so they don’t get cold.
If you notice that your baby’s eyes are sticky or they need cleaning it’s best to clean them using cooled down boiled water. Use a piece of cotton wool and wipe from the inside of the eye out and then discard that cotton wool. Use a fresh one to wipe again, this will stop you from passing germs from one eye to the other.
If there’s anything in this video that you would like to discuss then please contact your midwife.