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Early Days Transcript

Early Days
Information for mothers during the postnatal period

Congratulations on the birth of your baby. We hope that you have enjoyed the time you spent in
our maternity unit.
You are now ready to leave hospital and go home where your community midwife and family
doctor will now look after you and your baby. The following advice has been compiled to help
you and your baby settle in at home.

Important points to remember before leaving
Please tell us of any change in your home address – if you are not going to be staying at
your usual address or you have moved during your pregnancy, please can you tell the person
who is discharging you home.
Your notes to take home – please collect your postnatal notes and the baby’s Red Book from
the staff before going home.
You need a car seat for baby – for the safety of your baby, you should always use a correctly
fitted and approved car seat for your baby’s first journey home.
Update your family doctor – please let your family doctor/GP know that you have had your
baby and are now at home. Your baby will need to be registered at your GP surgery. You will
also need to make an appointment to see your GP for your postnatal check when your baby is
six to eight weeks old. It is recommended that you make this appointment as soon as possible.
You will find information on the maternity pages of the Trust website: www.mtw.nhs.uk/maternity
If you have any problems at home, you can contact a midwife for advice at any time, day or
night. Please call:
Tunbridge Wells Maternity Triage – 01892 633500
Maidstone Birth Centre – 01622 220161
Crowborough Birth Centre – 01892 654080

Midwife visits when you are home
Your Community Midwife will contact or visit you, the day after you are discharged from hospital
(including weekends).
If she has not contacted you by 3.30 pm please telephone:
Midwifery Liaison Office (weekdays only)
Tunbridge Wells Area – 01892 633500
Maidstone Area – 01622 220161
Crowborough Area – 01892 654080
Weekends
Maternity Triage – 01892 633500

General information
Healthy eating
With a new baby it can sometimes be difficult to find the time to cook or eat properly; however, a
balanced diet should give you all the nutrients you need to recover from your pregnancy and
delivery.
A balanced diet should include a variation of fruit, vegetables, proteins such as lean meat,
chicken, fish, eggs and pulses and carbohydrates (e.g. bread, breakfast cereals, potatoes,
pasta and rice). Dairy foods (e.g. milk, cheese, and yoghurt) are also a good source of calcium.
When breastfeeding, it is recommended that you take a supplement of Vitamin D
10micrograms.

Medication and breastfeeding
Your medication will be prescribed to cater for your specific needs. Any risks regarding
breastfeeding and your medication will be discussed with you. If you were anaemic after the
birth, you will have been given iron supplements or been advised about taking natural iron
supplements.
If you are unsure of the advice you have been given by the team caring for you or have any
concerns or questions, please speak to your midwife, pharmacist or a doctor.

Faecal or urinary incontinence
You may experience this temporary problem following childbirth. If you do, please look at the
postnatal exercise leaflet you were given on discharge from hospital. You will need to do the
pelvic floor exercises described in the leaflet.
If after ten days there is no improvement, you should see your GP who can refer you to a
physiotherapist for more intensive exercises.

Your birth experience
After the birth of your baby or at another appropriate opportunity, you may wish to discuss your
birth experience with a midwife or doctor. Please let your midwife know so that she can arrange
this for you.
On transfer to the community and at discharge from midwifery care, your midwife will give you
further opportunities to discuss your birth experience and to ask questions. Following these
discussions, if you feel you need more information, your midwife, health visitor or GP can offer
additional support.

Emotional wellbeing
After you have had your baby, you may find yourself fluctuating emotionally and experiencing
symptoms such as feeling tearful, irritable, unhappy and fatigued. These are normal responses
following delivery that affect up to 80% of new mothers.
Contributing factors are: hormonal changes, sleep deprivation and adapting to your new role.
This period usually peaks on day 3 and resolves without any need for treatment after 10-14
days.
Your midwife, health visitor and GP are there to support your emotional as well as physical
health and can provide help and access to additional support.

Domestic abuse
One in four women experience domestic abuse at some point in their lives and many cases
start, or worsen, during pregnancy or after the birth. It may take the form of physical, sexual,
emotional or psychological abuse. Domestic abuse risks both your health and that of your baby.
You can speak in confidence to any member of your health team or you may prefer to phone
the Domestic Violence 24 hour crisis line  0808 2000 247. You will be offered help and
support.

Postnatal exercises
These simple exercises will make you feel more comfortable after the birth of your baby. Start
the day after delivery and continue for at least 3 months. These exercises are suitable following
any type of delivery.
Practice these exercises often during the day e.g. when feeding your baby, when standing at
the kitchen sink and after you have passed urine.
You may feel sore at first, but gently moving these muscles will help to reduce any swelling and
help healing.

Pelvic floor exercises
The pelvic floor muscles will have been stretched during pregnancy and delivery. If allowed to
remain weak, then stress incontinence (leaking urine when you laugh, cough or sneeze) or
prolapse may occur. Your pelvic floor muscles are also important for your sex life.
In a standing, sitting, or lying position, pull up or close around your back passage; then close
your front passages and draw up inside, hold for the count of 4, then let go slowly. Repeat this
exercise 3 more times.
Then start working the muscle gently by lifting around the front and back passages:
Do not hold your breath, or tighten your tummy, legs or buttocks while doing this exercise
Once you can do this exercise, try and hold for longer, gradually increasing up to a count of 10. Rest for a few seconds between each tightening exercise .Repeat this exercise as many times as you can
For more information please visit The Pelvic, Obstetric and Gynaecological Physiotherapy
website: pogp.csp.org.uk/information-patients

Your health and possible complications
It’s normal to have some bleeding, discomfort and tiredness after you have your baby.
However, sometimes new mothers experience real medical emergencies in the days and weeks
following birth and getting help quickly can help prevent severe illness and improve your recovery.

1. Post-partum Haemorrhage. Sudden or very heavy bleeding and signs of shock including faintness, dizziness, palpitation or tachycardia (when you become aware of your heart beating very fast) You should get emergency medical attention. Please phone Tunbridge Wells Hospital Maternity Triage – 01892 633500 immediately for advice. You may need to come back to the hospital for review.
2. Infection. Fever and chills, lower abdominal pain or tenderness, smelly/offensive vaginal discharge. You should get emergency medical attention. Please phone Tunbridge Wells Hospital Maternity Triage – 01892 633500 immediately for advice. You may need to come back to the hospital for review.
3. Pulmonary Embolism Phone Shortness of breath or chest pain. Phone Tunbridge Wells Hospital Maternity
Triage – 01892 633500 immediately.
4. Deep Vein Thrombosis Phone. Calf pain, redness or swelling. Phone Tunbridge Wells Hospital Maternity
Triage – 01892 633500 immediately.
5. Pre-eclampsia. Headache, neck stiffness, visual disturbances. Many women suffer from tension headache
and/or migraine; these usually resolve with rest and mild painkillers. If, however, your headache persists you should contact your GP. If you get a severe headache within three days of the birth, which is accompanied by heartburn type pain, flashing lights, nausea or vomiting, you should phone Tunbridge Wells Hospital Maternity Triage – 01892 633500 immediately for advice. You may need further investigations and treatment.
6. Mastitis. Red painful area on the breast. Non-infective mastitis can be relieved by correct positioning of the baby on the breast and by wearing a correctly fitting bra. If uncomfortable, we suggest using paracetamol and ibuprofen (if tolerated). Infective mastitis is a bacterial infection, usually caused by a cracked nipple, and will need to be seen by your GP. You may need antibiotics. Neither is a reason to cease breastfeeding. Please contact your midwife, GP or feeding clinic for advice.

Babies’ illnesses can become serious very quickly. You know your baby best. If you are
worried do not wait – ask for help sooner rather than later. If your baby has any of these
symptoms call Tunbridge Wells Hospital Maternity Triage 01892 633500 for immediate advice
– Passes much less urine than usual
– Is pale
– Grunts with each breath
– Vomits green fluid
– Has blood in stools/faeces
– Poor feeding
– A high pitched or weak cry
– Is much less responsive or floppy
– A high fever or sweating

If your baby has any of these symptoms seek immediate urgent help by dialling 999
– Stops breathing or goes blue
– Cannot be woken
– Is unresponsive
– Has a fit
– Has glazed eyes and does not focus on anything

Health problems with your baby
Newborn baby health problems are often a source of concern for new parents. It is normal for
babies to do lots of things that might be new to you and it is quite natural for you to be
concerned that these are health problems when they are probably just normal behaviour.
You will soon learn what is normal for your baby, but we offer the following information and
advice to help you recognize potential health problems and decide what action to take:
Jaundice
Jaundice can be recognised in your baby if his/her skin becomes yellow. It is a common and
usually a temporary and harmless condition. However, jaundice at any time must be assessed.
This is particularly important if you think your baby is jaundiced in the first 24-36 hours.
Your community midwife will visit within the first 24 hours of your transfer home and are often
the first to recognise jaundice in your baby. They will make a plan to monitor your baby’s
jaundice.
If you notice possible jaundice in your baby outside of the community midwife visiting, please
phone the Maternity Triage – 01892 633500 straightaway for advice. You may be asked to
bring your baby into the hospital for assessment and advice about ongoing care and treatment.
If jaundice is prolonged, lasting more than 14 days, you should see your GP who may arrange
for you to see a paediatrician at the hospital.
Umbilical cord
During the process of separation the cord may become sticky and slightly smelly – this is
normal. However, should the area around the cord on the baby’s tummy become red and inflamed or
offensively smelly, advice should be sought from your community midwife, GP or Maternity
Triage – 01892 633500, as further treatment may be needed.
Baby hats in hospital but NOT when indoors at home
After your baby is born; he/she may be given a little hat to wear in hospital to avoid hypothermia
(low temperature) and hypoglycaemia (low blood sugar).
However, it is NOT usually appropriate for your baby to wear a hat indoors once at home. Skin
to skin contact is the best method for preventing hypothermia.

Health visitor service
The local health visitor team will be automatically informed of the birth of your baby and will
contact you to arrange a home visit at around 10-12 days after the birth.
Health visitors are specialist community nurses who work with new parents offering support and
informed advice around child and family health and child development. They offer a minimum
of five home visits from birth to age two and can link you into Child Health Clinics and Children’s
Centres.

Welcome to the Transitional Care Ward Transcript

Welcome to the Transitional Care Ward
Information for parents
This leaflet has been designed to help you understand transitional care and how you and your baby will be looked after during your stay.
What is Transitional Care (TC)?
Transitional Care (TC) is given to babies born between 34 and 36+6 weeks and those born after 37 weeks who need additional care. This includes low birth weight babies and those with other medical needs that do not require the Neonatal Unit. All babies use blood sugar (glucose) for energy to keep warm, feed and cry. TC babies can use up their blood sugar stores more rapidly and therefore are more at risk of developing hypoglycaemia or low blood sugars. Specialist feeding programmes will help your baby get the energy required for healthy growth and development.
The Transitional Care (TC) ward
The TC ward is an eight single room area within the Postnatal Ward of the Tunbridge Wells Hospital. You and your baby will stay together and we will help you meet the needs of your baby with support and guidance. During your stay you will be supported by midwives who specialise in caring for TC babies. These midwives are part of a neonatal and midwifery team, which includes:
– Transitional Care Manager
– Infant Feeding Specialists
– Paediatric Doctors
– Advanced Neonatal Nurse Practitioner
– Nursery Nurses
– Support Workers
What will happen when you and your baby are admitted to
the Transitional Care ward?
The TC midwife will discuss care with you and develop a personal plan specifically for your baby. These plans are reviewed daily by the midwife supporting you and will be adjusted to suit the ongoing needs of your baby. You will be involved in all discussions regarding your baby’s care needs so that you are able to make an informed choice. Please feel free to ask any questions that you may have.

Kangaroo care and skin to skin contact
TC babies need a little extra support to adjust to their new environment and keeping warm is the most important factor. We are proud to offer Kangaroo Care to all TC babies and we do encourage you to get involved. Kangaroo care involves keeping your baby in skin to skin contact with the help of a specially designed KangaWrap. Kangaroo care research at Tunbridge Wells Hospital has shown that this level of skin to skin contact reduces the length of hospital stay for babies requiring additional care.
Research shows that Kangaroo Care helps all babies regardless of feeding method:
– To keep warm and maintain blood sugar levels
– To create a bond between baby and parent
– Helps with brain development
– Helps babies’ digestion
– If you are breastfeeding, it can help make this more successful
We have a leaflet we can give you about Kangaroo Care, which explains the benefits for you and your baby.
Daily routine
All TC babies are weighed daily in the morning before a feed. The amount of milk feeds for your baby will then be recalculated for that day and you will be fully informed of the plan and any changes. For breastfed babies, length of breastfeeds will be discussed so that we can ensure your baby is getting enough milk.
Feeding your baby
However you choose to feed your baby we are here to support you. Breastfeeding has many benefits for both you and your baby. Breastmilk is full of antibodies to help your baby fight infection, it helps ‘line the gut’ with good bacteria and helps promote bonding. This is particularly important in premature babies and those that are small for gestational age (SGA).
Responsive breastfeeding
Responsive breastfeeding involves responding to your baby’s cues and recognising that feeds are not just for nutrition but also for love, comfort and reassurance. Responsive breastfeeding is also characterised by the need for physical comfort, i.e. relieving of heavy uncomfortable breasts. You can do this by encouraging your baby to feed even when they are not displaying feeding cues; there are no concerns that you will ‘overfeed’ the baby; it is impossible to overfeed a breastfed baby
Responsive bottle feeding
Responsive bottle feeding is characterised by:
– Feeding the baby when they show feeding ‘cues’ e.g. head bobbing, hand to mouth movements.
– Holding baby close in a semi-upright position, looking into their eyes, changing the sides they are held, talking to baby when feeding.
– Inviting baby to take the teat by stroking the top lip with the teat, gently inserting the teat and holding the bottle in an almost horizontal position to prevent a fast flow of milk, which the baby will not be able to control.
– For the parent to be alert to the baby’s cues and act accordingly i.e. if baby splays their fingers or toes it is a sign that they want to stop drinking.
Nasogastric tubes
Sometimes TC babies do not manage to take enough breastmilk or formula milk per feed. This means that we may need to help your baby get their required amount through a nasogastric tube, with your consent. This is a small tube that is put down the nose and into the tummy so that milk, either expressed breastmilk or formula, can be given to your baby through the tube by a syringe. If we feel your baby needs a nasogastric tube we can discuss this with you further and answer any questions you may have.
Facilities
We have breast pumps available to use during your stay if required and we provide cold water sterilisers. If you wish to formula feed you will need to bring in your own formula, bottles and teats.
Length of stay
Your length of stay on the TC ward can be anywhere between 3- 14 days and depends on your baby and the care they need. Our aim is to get you home as soon as possible once your baby has established feeding and is gaining weight as expected. Family-centred care is encouraged on the TC ward. Partners are welcome to stay and we support them to be as involved as they would like in the care of your baby. We have some fold out single sofa chairs but your partner will need to bring their own bedding and pillow. If your baby is being cared for by the Neonatal Unit, we are unable to accommodate parents on the postnatal ward as we need the rooms for other families. Therefore, unless it is thought your baby will be coming back to the ward within 24 hours we will need to ask you to go home. You will be able to visit your baby following the Neonatal Unit visiting plans.
Infection Control
All staff are vigilant to prevent and control cross infection. We do ask you to please observe the hand hygiene signs and to regularly wash your hands. We also request no flowers please.
Visitors
– Visiting times are restricted to allow time for you to rest and for midwifery/nursing care
– Please do not let your visitors sit on the beds; chairs are available
– Visitors are asked not to visit if they have a cold, diarrhoea or sickness
– Visiting times for partners and your own children are 8.00am– 8.30pm
– Visiting times for other visitors (adults only) are 3.30pm – 7.30pm. No children under 16 will be allowed on the ward, except your own children.
– Please limit the number of additional visitors to two at a time
– Visitors’ toilets are located in the hospital’s main reception area. Please do not let your visitors use the toilets in your room
– No flowers please; this is to assist with keeping rooms clean and tidy and an infection control requirement

Further information and advice can be obtained from:
NHS 111
NHS Choices online www.nhs.uk
The Transitional Care Ward: 01892 631216
Maternity Triage 01892 633500
Crowborough Birthing Centre 01892 654080
Maidstone Birthing Centre  01892 220161
BLISS 0500 618140 www.bliss.org.uk
TAMBA  0800 138 0509 www.tamba.org.uk
UNICEF
Responsive Feeding Infosheet – Baby Friendly Initiative (unicef.org.uk)

 

 

 


 

Useful links:

After you baby is born

Screening Tests For You and Your Baby 

Unicef UK – Infant Feeding Foreign Language Resources 

COVID-19 vaccination when breastfeeding

Coronavirus: Parent Information for Newborn Babies

Unicef UK – Statement on Infant Feeding During the Covid-19 Outbreak

Baby Umbrella Charity – Free Breastfeeding and Early Parenting Support (available in-person or via Zoom)

Coping with Crying (ICON)

Pelvic Floor Exercises 

Kent Community Health

Start 4 Life – Information about pregnancy, birth and parenthood

Baby Buddy app

Dadpad app