Maternity Services Quick Look Book a guide for parents The Royal Berkshire NHS Foundation Trust Maternity Services

Welcome to the Royal Berkshire NHS Foundation Trust Maternity Services. Many congratulations on your pregnancy! This booklet has been designed as a quick reference guide. More detailed information about some of the topics covered is available to download from the hospital website www.royalberkshire.nhs.uk/maternity Below are some useful telephone numbers for your reference: GP surgery Community Midwife Day Assessment Unit 0118 322 8741 (Hours: Mon-Fri 8.00am to 6.00pm, Sat 8.00am to 2.00pm) Labour triage number 0118 322 7304 Ultrasound Scan 0118 322 7279 Your contact number Antenatal Parent Education Classes 0118 322 8964 (Mon - Friday 9am 5pm) Please specify who should be contacted in the case of an emergency: Contacts name Contacts number

We look forward to supporting you during and after your pregnancy.

1

Contents Your care during and after your pregnancy ...................................................................................2 Antenatal Attending antenatal appointments .................................................................................................4 Your health during pregnancy........................................................................................................4 Other factors affecting your health.................................................................................................6 Travel .............................................................................................................................................7 Common symptoms of pregnancy .................................................................................................8 Possible complications in pregnancy .............................................................................................9 Antenatal screening and diagnostic tests ....................................................................................10 Blood tests ...................................................................................................................................10 Infectious diseases ......................................................................................................................11 Downs screening.........................................................................................................................12 Ultrasound scan ...........................................................................................................................12 Domestic abuse ...........................................................................................................................13 Emotional well-being....................................................................................................................13 Antenatal Parent Education Classes ...........................................................................................14 Choosing where to have your baby .............................................................................................14 Labour Induction of labour .......................................................................................................................15 Vaginal birth after Caesarean section (VBAC).............................................................................15 Breech presentation (bottom first)................................................................................................16 Multiple pregnancy.......................................................................................................................16 Labour recognising the signs ....................................................................................................16 The stages of labour ....................................................................................................................17 Pain relief in labour ......................................................................................................................17 Monitoring your baby during labour .............................................................................................18 Postnatal After the birth ...............................................................................................................................18 Stitches and after care .................................................................................................................18 Postnatal period ...........................................................................................................................20 Postnatal exercises......................................................................................................................21 Emotional well-being....................................................................................................................21 The baby ......................................................................................................................................22 Apgar score..................................................................................................................................22 Skin-to-Skin..................................................................................................................................22 Feeding your baby .......................................................................................................................22 Vitamin K......................................................................................................................................25 BCG vaccination ..........................................................................................................................26 Physical examination ...................................................................................................................26 Weighing your baby .....................................................................................................................26 Jaundice.......................................................................................................................................26 Sudden Infant Death Syndrome (Cot Death) ...............................................................................27 How to recognize your baby is healthy ........................................................................................27 How to recognize signs of serious illness ....................................................................................28 Newborn blood spot screening (NBBS) .......................................................................................28

2

Your care during and after your pregnancy This is an exciting time when not only will you be experiencing physical changes to your body, but also planning for a new lifestyle with new responsibilities. You will also be meeting health care professionals on a more regular basis. You may only have visited your GP surgery occasionally and may find it quite different to be keeping regular appointments. It is important that you do so for your health and your growing baby. Usually you will be looked after by your registered GP practice and your locally based midwifery team. You will be seen at regular intervals to check that your pregnancy is progressing normally and to ensure you are offered appropriate screening of you and your baby. Your appointments will normally be at your GP surgery or local Childrens Centre. If necessary you may be referred to the hospital to see an obstetrician. This is a doctor who specialises in the care of pregnant women. All those involved in providing you with care during your pregnancy can give you information, advice and support. Please dont hesitate to ask questions or seek advice.

The team The team who may be involved in your care are: General practitioner Your general practitioner (GP) is responsible for your general health but has also undertaken training in maternity care. He or she will share responsibility for your care with the community midwifery team. Midwives Midwives are trained specialists in the care of women during pregnancy and childbirth. They work both in the community and in the hospital. Their role is to provide you with lots of information, support and advice as well as checking on you and your babys physical health from the booking appointment until up to 10 days following the birth. She/he will help you understand the physical, emotional and social changes you may experience throughout this time. She/he will talk to other health professionals to ensure you receive the best possible care for you and your baby. You will be given a named midwife when you attend your booking appointment. However, it cannot be guaranteed that you will always be seen by the same midwife antenatally or postnatally although every effort will be made to do so. Contact details for your midwifery team in the community can be found on the front cover of your hand held notes. Student midwives We provide training to student midwives who work alongside and are supervised by a trained midwife. They may be involved in providing you with care at times during your journey through childbirth. If for any reason you do not wish to be cared for by a student you should mention this to your midwife.

3

Maternity support worker Maternity support workers are trained to provide support to midwives in caring for women throughout childbirth. They work in the community and in hospital. Nursery nurses Nursery nurses are trained in the care of babies. They work exclusively on the postnatal ward and are responsible for caring for babies with special care needs such as low birth weight and pre-term babies. Obstetricians Obstetricians are doctors who specialize in caring for women who have complications in their pregnancy or who have medical conditions which can be affected by pregnancy. They are based in hospital. If you are referred to an obstetrician during your pregnancy you should be made aware of the name of the consultant obstetrician who is responsible for your care although you may be seen by other obstetricians working within that consultants team. Anaesthetists Anaesthetists are doctors who specialise in providing anaesthetics. They are responsible for administering epidurals if requested in labour and anaesthetics for Caesareans and other operative procedures. They may also be involved in your care if you need high dependency or intensive care. There is 24 hour anaesthetic cover on the Delivery Suite at the Royal Berkshire Hospital. You may be referred to an anaesthetist during your pregnancy to discuss anaesthetic risks for example if you are overweight or if you have a medical condition which affects the type of anaesthetic you can have, should you need one. The anaesthetist will develop a plan which will be filed in your hospital notes for use if necessary when you are admitted in labour. If you are referred to an anaesthetist you will be sent an appointment to attend the Royal Berkshire Hospital. For more information about why it might be necessary to see an anaesthetist please see our patient information leaflet 'Why I need to see an anaesthetist' on our hospital website available at www.royalberkshirehospital.nhs.uk Neonatologists or paediatricians Neonatologists are paediatric (childrens) doctors who specialise in caring for babies. You may be seen by a neonatologist during your pregnancy if complications are diagnosed so that a care plan can be developed for your baby at birth and beyond. A neonatologist or specially trained nurse may attend your babys birth if there are concerns about his/her wellbeing in labour. In some cases your baby may need specialist neonatal care which is usually provided on our neonatal unit called Buscot which is located on the top floor of the maternity unit at the Royal Berkshire Hospital. Very premature babies (under 28 weeks) will need to be transferred to specialist neonatal units for example Oxford or Southampton. We will make every effort to transfer you to the receiving hospital at the same time or as soon as possible after the baby.

4

The Supervisors of Midwives The Supervisors of Midwives are a group of experienced midwives who have undertaken additional training and are appointed to provide women and midwives with support and advice. They are responsible for ensuring women receive the highest standards of care in a safe environment. If you would like to meet with a Supervisor of Midwives to discuss any issues of concern, they can be contacted at any time via the Royal Berkshire Hospitals main switchboard, 0118 322 5111 or via email supervisors.ofmidwives@royalberkshire.nhs.uk for non-urgent information/advice. All the midwives, doctors and staff working in the maternity services respect differences in the cultural, religious and ethnic backgrounds of the women and families booking to have their babies in Reading. If you have any concerns or queries please speak to your midwife. NOTE: in order to comply with Equal Opportunities & Diversity legislation, we are not able to provide a member of staff with any particular attribute (e.g. gender, race, religious beliefs etc) at your request.

Attending antenatal appointments It is important that you attend all scheduled antenatal appointments so that you do not miss the opportunity to book any screening tests and examinations that you decide you wish to have. We also want to ensure your pregnancy is progressing normally and that you are referred to an obstetrician or other specialist services if necessary. NOTE: Please remember to bring your hand held notes to all appointments so we can ensure they remain up to date with the progress of your pregnancy. If you are unable to attend your appointment for any reason please contact your surgery, midwife or hospital to let them know and book another appointment as soon as possible. The contact details can be found on the front page of your hand held maternity notes. Your community midwife will inform you of the schedule for your antenatal care, who and where your care will be provided.

Your health during pregnancy It is important that you look after yourself during your pregnancy. The following information is to help you to make healthy choices and to make you aware of some of the minor and more serious conditions so that you can seek advice at an early stage. Healthy eating Eating a healthy diet during your pregnancy is vitally important for you and your babys development. We recommend that you follow the advice below: Eating plenty of: Fruit and vegetables (fresh, frozen, tinned, dried or juiced). Aim for 5 portions daily Starchy foods, such as bread, pasta, rice and potatoes try wholegrain options

5

Foods rich in protein, such as lean meat and chicken, fish, eggs and pulses Fibre. This helps prevent constipation and can be found in wholegrain bread, pasta, rice,

pulses and fruit and vegetables Dairy foods that contain calcium, such as milk, hard cheese and yoghurt Foods to avoid: Foods bought in the chiller cabinet, such as pate, raw or undercooked meats of any type,

unpasteurized and mould-ripened cheeses such as Brie, Camembert, goats or sheeps cheese

Liver and liver products Marlin, swordfish and shark. Limit the amount of tuna you eat to no more than 2 fresh tuna

steaks/4 medium cans tuna a week Undercooked eggs or products containing raw egg, such as homemade mayonnaise and

ice cream Peanuts. Your baby may be at higher risk of developing a nut allergy if you, the babys

father, brothers or sisters have certain allergic conditions such as hay fever, asthma or eczema, so you may wish to avoid eating peanuts and peanut products while you are pregnant and breastfeeding.

Nutritional supplements The majority of women eating a balanced diet with food from all the major groups do not need to buy vitamin supplements from the pharmacy (chemist). Folic acid supplements are advised before becoming pregnant and for the first 12 weeks of pregnancy as it has been shown to reduce the risk of having birth defects such as spina bifida and other neural tube defects. The recommended dose is 400 micrograms per day. Folic acid can be obtained from the chemist. However, some women will be advised, by their midwife or doctor, to take specific supplements: Iron should only be taken if advised by your midwife or doctor. Vitamin D supplements, (10 micrograms daily, as found in the Healthy Start multivitamins)

are particularly important if you: o are from South Asian, African, Caribbean or Middle Eastern family origin; o have limited exposure to sunlight, for example if you are predominantly housebound, or

usually remain covered when outdoors; o eat a diet particularly low in vitamin D, which is a diet with no oily fish, eggs, meat,

vitamin D-fortified margarine or breakfast cereal; o have a body mass index (BMI) above 30 kg/m2 (ask you midwife to help you work this

out).

6

For more detailed information about healthy eating and drinking visit www.eatwell.gov.uk or see our patient information leaflet Healthy Eating and Drinking on the hospital website at: www.royalberkshire.nhs.uk/maternity

Other factors affecting your health Smoking Women who smoke during pregnancy are more likely to have problems such as the baby being born prematurely or being underweight, having health problems or even being stillborn. There are considerable health benefits to giving up smoking. We suggest that you try to give up or at the very least reduce smoking whilst pregnant. Your midwife or GP can refer you to smoking cessation services. For advice on giving up, speak to your midwife or your GP or telephone the NHS Pregnancy Helpline on 0800 169 9 169. Working There is no reason why you should not continue to work during pregnancy although you should avoid physically demanding roles and prolonged standing. Exposure to harmful or toxic substances should be avoided. More information on possible occupational hazards is available from the Health and Safety Executive at www.hse.org.uk/mothers/index.htm Pregnant women are entitled to special employment rights and benefits. More information on working whilst pregnant is available at www.workingfamilies.org.uk Exercise Regular exercise is important to keep you fit and supple. However, there are some sports that should be avoided such as scuba diving and vigorous racquet and contact sports which are more likely to cause trauma, falling or joint stress. Alcohol Drinking alcohol during pregnancy should be avoided especially during the first three months. If you choose to drink alcohol it is recommended that you do not drink more than 1-2 units once or twice per week (1 unit = 1/2 pt of normal strength lager, 25mls spirit or small glass of wine 125mls). Excessive or binge drinking should be avoided as this can be harmful to your baby. For more detailed information about alcohol and pregnancy visit www.alcoholconcern.org.uk or www.fasaware.co.uk (Fetal Alcohol Syndrome Aware UK) You can also find more detailed information about health factors on the hospital website www.royalberkshire.nhs.uk/maternity Medicines and other drugs Some over the counter medicines and pills (including painkillers) can be harmful to your developing baby so it is best to check with your GP or pharmacist before taking anything. Do not take non-medicinal drugs (street drugs) during pregnancy as these may seriously harm you and your baby.

7

Drug and alcohol misuse Dont be afraid to tell your midwife or doctor that you have a drug or alcohol problem as we have a specialist team of health professionals who can provide you with extra support during your pregnancy and after the birth. This will be dealt with confidentially. Complementary and alternative therapies Some women report that they find complementary therapies helpful in pregnancy and birth. They seem to be useful in aiding relaxation in some people. Please let your midwife know if you are using any complementary therapies. At Royal Berkshire NHS Foundation Trust we have a number of midwives who are trained in the use of massage techniques to aid relaxation in labour. The scent of aromatherapy oils can also aid relaxation (we keep a stock of oils if you do not provide your own). Sexual intercourse Sexual intercourse during pregnancy is not associated with adverse outcomes. However, you may notice that your sex drive changes and some positions may become more difficult as your bump grows.

Travel Driving Wearing a seatbelt may not always be comfortable but the law requires you to wear one, even while pregnant. The belts should be placed above and below the bump. Travelling abroad There is no reason why you should not travel abroad during the earlier months of your pregnancy. However, you should seek advice regarding vaccinations and insurance from your GP or midwife. You should also check with your airline/tour operator before booking your flight/holiday. Air travel Long haul flights are associated with a greater risk of venous thrombosis (clotting of the blood). Wearing correctly fitted compression stockings is effective in reducing the risk. They are available to purchase from the chemist. Vaccinations If you are planning to travel abroad whilst pregnant, it would be wise to check with your GP or the website hosted by NHS Scotland http://www.fitfortravel.scot.nhs.uk/home.aspx before confirming your trip. As a simple rule, vaccinations where 'live' virus particles are used, such as yellow fever, should not be given to pregnant women, but travelling without vaccinations to some parts of the world can be very dangerous. Malaria prevention is another tricky area, and again should be discussed with your GP.

8

Common symptoms of pregnancy During pregnancy, you will experience physical changes and you may experience symptoms causing discomfort or concern. The following information may help you to decide whether you need to seek advice or whether you can manage the situation yourself. Fatigue In the early months of pregnancy, you may feel tired or even exhausted. Try to rest as much as possible. Make time to sit with your feet up during the day if you can and accept any offers of help from colleagues, family and friends. This lack of energy early in the pregnancy may well improve as your pregnancy progresses. Towards the end of pregnancy, you may feel tired because of the extra weight you are carrying. Make sure you get plenty of rest. Backache During pregnancy your ligaments become softer and stretch. This can put extra strain on your lower back and pelvis causing backache. Exercising in water or massage therapy may help to relieve the symptoms. Headaches Some women find they get more headaches in pregnancy. A brisk walk may be all that you need, as well as more rest and relaxation. NOTE: in some cases headaches and/or visual disturbances can be associated with the condition known as pre-eclampsia. It is wise to report any headache that is not settled with simple pain relief such as paracetamol to your GP or midwife to exclude this condition. Feeling faint Pregnant women often feel faint. This happens when not enough blood is getting to your brain. There are some simple measures to help: Get up slowly after sitting or lying down. If feeling faint whilst standing find a seat or lie down on your side. Dont lie on your back later on in your pregnancy. Lie on you side. Indigestion and heartburn This is caused partly due to hormonal changes. If you suffer from this try the following suggestions: Try eating smaller meals more often. Sit up straight when eating. Avoid fatty and spicy foods. Sleep well propped up with extra pillows. Try drinking a glass of milk. Avoid eating or drinking a few hours before bed. If your symptoms persist discuss with your GP or midwife who may recommend an antacid preparation.

9

Swollen ankles and hands Ankles, feet and fingers often swell a little in pregnancy because the body retains more water than usual. To help reduce the swelling try: Avoid standing for long periods; Wear comfortable shoes; Put your feet up as much as you can; Remove tight fitting jewellery NOTE: in some cases swelling can be associated with the condition known as pre-eclampsia. It is wise to report any swelling to your GP or midwife to exclude this condition.

Possible complications in pregnancy Most women experience a normal pregnancy. Some women have health problems before they get pregnant and other women may develop health problems during their pregnancy. Attending antenatal appointments will ensure you receive the most appropriate advice on managing these conditions. Haemorrhoids (piles) Haemorrhoids are small swellings around the anus which can be painful when opening your bowels. To avoid discomfort, try eating high fibre foods and increase your fluid intake. If your symptoms persist your doctor or midwife can recommend a haemorrhoid cream. Vaginal discharge You may notice an increase in vaginal discharge. This is normal unless it is associated with soreness, itching, offensive smell or pain when passing urine. If you have these symptoms you should inform your GP or midwife. You may be prescribed medication to treat an infection. Vaginal bleeding Bleeding from the vagina during pregnancy is not normal. If bleeding occurs contact your GP, midwife or hospital for immediate advice. Varicose veins Varicose veins are common but do not cause any harm. Wearing correctly fitted compression stockings can help improve the symptoms but will not prevent varicose veins developing. Itching Itching can be common in pregnancy especially over the stretch marks on your tummy. However, if the itching occurs on the palms of your hands and soles of your feet or is generalised over your body without a rash this may be a sign of an underlying condition called obstetric cholestasis. You need to report these symptoms to your GP or midwife so that blood tests can be done to eliminate this condition.

10

Pre-eclampsia Pre-eclampsia is a condition specific to pregnancy and is fairly common, particularly in the first pregnancy. It usually develops in the last few weeks of pregnancy although it can develop earlier when it is usually more severe. The condition is characterised by having raised blood pressure, protein in your urine and swelling of your feet and hands which is sometimes noticeable in your face. You may develop a headache or visual disturbances. If you develop these symptoms see your GP/midwife or call the hospital for advice. If necessary you will be referred to the hospital for further tests. Diabetes Diabetes can be affected by pregnancy or may even develop for first time in pregnancy. If you have diabetes you should be referred to the Diabetes team based at the Royal Berkshire Hospital Antenatal Clinic as soon as you know you are pregnant. Diabetes that develops in pregnancy is known as gestational diabetes. This may present by experiencing excessive thirst or having sugar present in your urine when tested. You are at higher risk if you have a family history of diabetes; you are over 35, overweight or have previously given birth to a baby over 4.5kgs. You may not experience all or any of the above and that most symptoms are not putting you or your baby in danger. But it is important to know how to recognise the more serious symptoms and for you to seek advice if you have any concerns. For further information on these conditions visit our hospital website at www.royalberkshire.nhs.uk under the maternity wards and departments section where you will find a number of useful patient information leaflets and clinical guidelines.

Antenatal screening and diagnostic tests During your pregnancy you will be offered a number of different tests. These may be blood tests or ultrasound scans. You may wish to accept these tests so that you have additional information about whether your baby is developing normally. Blood tests At your first antenatal appointment you will offered a number of tests done on your blood. At your next antenatal clinic appointment your midwife or doctor should go through your results with you and record them in your hand held records. You will be asked for consent to test your blood for the following: Blood group and Rhesus factor It is very important that we know your blood group and whether you are rhesus negative or positive. If you are rhesus negative you will be offered an injection of Anti D in pregnancy to prevent you developing antibodies if your partner is rhesus positive. You will be tested again later in the pregnancy and following the birth for the same reason.

11

Full blood count (FBC) This test looks at your haemoglobin or iron level and whether or not you are anaemic. It is performed, at booking, 28 weeks and at 34-36 weeks. If your iron level is low you may need to take iron tablets and it may be advisable to do this test more often. Haemoglobinopathies (sickle cell disease and thalassaemia) All women have their haemoglobin checked for the two most common haemoglobin disorders; sickle cell and thalassaemia. Sickle cell This is an inherited disorder which mainly affects women of afro-Caribbean origin. If you are found to be a carrier of the disorder the babys father may be asked to have a blood test to check whether he is also a carrier. All babies are routinely checked after the birth for this disorder. Thalassaemia This is an inherited disorder that mainly affects women of Cypriot, Indian, Pakistani, Bangladeshi and Chinese origin. Thalassaemia can cause anaemia in the baby if both parents pass on the gene. For more detailed information about sickle cell and thalassaemia visit www.kcl-phs.org.uk/haemscreening/documents/anteleaflet.pdf

Infectious diseases Rubella: (German measles) this test checks the mother for immunity to Rubella virus. If you are found not to be immune to Rubella you will be offered a vaccination after the birth before you leave the hospital. You should avoid contact with anyone who is suspected or known to have Rubella during your pregnancy. Hepatitis B virus: Hepatitis B is a virus that infects the liver and can be passed on to the baby. If you are found to be positive to the hepatitis virus your baby will be vaccinated after birth to protect him/her from the virus. Syphilis: Although this is a rare disease in the UK it can be passed on to the baby. If you are found to be positive to syphilis you will be contacted by the antenatal screening coordinator to discuss your results and advise on the treatment. Human Immuno-deficiency virus (HIV): Most women are negative for HIV as it rare in our population. However, if you are found to be positive for the virus you will be contacted by the antenatal screening coordinator and invited to meet with our specialist team at the Royal Berks who will monitor you carefully and advise you on the treatment which will greatly reduce the risk of passing the virus on to your baby. If you think you may have been at risk of contracting the virus you should ask to be tested again later in the pregnancy as the virus can take up to three months to be detected following contact with the virus. MRSA (methicillin resistant staphylococcus aureus): MRSA is a bacterium (germ) that can be found on the skin or in the nose of healthy people. However, the bacterium can sometimes

12

enter the skin and cause infection which can be difficult to treat due the increasing resistance to antibiotics. All women are tested for MRSA at 34 weeks of pregnancy. This involves having swabs taken from your nose and throat. If you are found to be MRSA positive you may be prescribed a special skin wash to remove the bacteria.

Other infectious diseases The following infections may present in pregnancy but are not routinely screened for: Group B Streptococcus or Herpes Simplex virus: If you know that you have been infected in the past with either of the above you should inform the midwife or doctor as these organisms can be harmful to your baby. Chicken pox: Chicken pox is a relatively common disease especially among young children. We do not test for chicken pox but if you have had chicken pox you are likely to be protected. However, if you are unsure you should avoid contact with anyone suspected or who have chickenpox. If you develop chicken pox in pregnancy you should contact your doctor for advice. Parvo virus: Parvo virus, otherwise known as slapped cheek syndrome, is common amongst pre-school children and is highly infectious. If you think you have been infected with the virus you should contact your GP in the first instance. For further information please see our patient information leaflet at www.royalberkshire.nhs.uk Seasonal influenza (flu): All pregnant women are advised to have a flu vaccination from September through the winter period. This can be obtained from your GP surgery. Please ask you midwife, GP or practice nurse.

Downs screening All women are offered screening tests for Downs syndrome. This involves having a blood test combined with an ultrasound scan before 12 weeks of pregnancy. This test does not give a definite diagnosis but gives you a predictor of the risk of your baby having Downs syndrome or spina bifida. If you are found to be at an increased risk you will be offered a diagnostic test either chorionic villus sampling (CVS) or amniocentesis. NOTE: If you miss the test before 12 weeks you will be offered a blood test only.

Ultrasound scan Most women will have an ultrasound scan offered before 12 weeks to date the pregnancy and again at 20-22 weeks for a thorough check on the babys development and for abnormalities. Further scans will only be done at the request of an obstetrician. It is worth noting that not all abnormalities can be picked up on ultrasound. This test offers parents the opportunity to see their babys image on an ultrasound screen and to buy the images taken by the ultrasonographer. However, the test is primarily performed to determine the expected date of delivery and to detect abnormalities.

13

You can also find more detailed information about screening tests on the Hospital website www.royalberkshire.nhs.uk/maternity and in National Screening Committee booklet which you will be given by your midwife in your booking pack.

Domestic abuse One in four women experience domestic abuse at some point in their lives. Domestic abuse can take many forms, including physical, sexual, mental or emotional abuse and any woman can experience domestic abuse regardless of race, ethnic or religious group, class, disability or lifestyle. Domestic abuse can often begin or worsen during pregnancy. We advise taking action, as abuse can increase the risk of miscarriage, infection, premature birth, low birth weight, injury or death of the baby. If you, or someone you know, has experienced or is experiencing domestic abuse there are a number of support agencies who can help you. Berkshire Womens Aid is a support agency that can provide help and somewhere safe to stay for women and children available 24 hours a day on 0118 950 4003. Newbury area A2 Dominion Call the Domestic Abuse Helpline on: 0800 731 0055 10am-4pm Monday to Saturday or for 24 hour advice 0808 2000 247 Thames Valley Police Berkshire West Domestic Violence Unit is able to advise and provide a wide range of support and action to those who are experiencing domestic abuse telephone 0845 850 5505. In an emergency dial 999.

Other useful contact numbers Sahara Asian Women's Project contact via the Berkshire Womens Aid (BWA) helpline.

The project provides emergency accommodation, practical advice and counselling for Asian women.

Samaritans 0118 926 6333. Available at all times on the above number, or ring their national link 0345 909090. The Samaritans can put you in touch with people who can help, and can provide emotional support to anyone in distress.

Crossing Bridges 0118 959 7333 (10am until 4pm, Monday to Friday). 5 Queens Walk, Reading. Crossing Bridges is a safe and friendly place where you can get professional help on a range of issues, from legal advice and police support, to health and benefits advice. Please phone for an appointment.

Emotional well-being During your pregnancy you may experience many different feelings and emotions. Some of your emotions may be caused by the realization that you are going to become a parent which can be an overwhelming thought. Your emotional well-being is very important during your pregnancy and emotions such as stress and anxiety can increase.

14

Your midwife and GP will ask you how you are feeling during your antenatal checks. Please let them know if you are feeling low or you are worried that you may be experiencing signs of stress or anxiety.

Antenatal Parent Education Classes Becoming a new parent can be exciting and challenging in equal measure. Mothers and fathers frequently say that they sometimes feel overwhelmed. To help prepare you for the birth and parenthood to ensure it is a fulfilling experience we provide a course where you will discover how to help yourself to achieve the best labour and birth possible and how to care for yourself and your newborn baby. Classes are held at the Royal Berkshire Hospital, West Berkshire Community Hospital, Brambles Childrens Centre and in Henley on Thames. These classes are very popular so you are advised to book them as soon as possible after your 20 week scan. To book the classes ring 0118 322 8964 Monday to Friday 9am 5pm. This is a busy line and is best contacted later in the day. For women who have a multiple pregnancy or who are booked for an elective (planned) Caesarean section additional classes are held at the Royal Berkshire Hospital. To find out more about the classes please ask your midwife at the 16 week appointment. Needless to say you will be supported by our team of midwives and doctors throughout your pregnancy who will be happy to answer any questions you may have. It may be helpful to make notes of the questions you want to ask before your appointment.

Choosing where to have your baby You have plenty of time to make your decision where you would like to give birth and you can change your mind anytime during your pregnancy. It is your decision where you wish to give birth and you should discuss your preferences with your midwife. There are many factors to be considered when making your decision, but one of the main factors is safety for both you and your baby. There are some circumstances when you will be advised to have your baby in hospital either in the Rushey Birth Centre or in the main Delivery Suite. You should discuss the risks and benefits with your midwife or obstetrician. Your birth options at the Royal Berkshire Hospital are: Home birth Rushey Birth Centre Delivery Suite NOTE: There are rare occasions when our Delivery Suite may be full and it is necessary to divert women in labour to other hospitals for the birth. We will do all we can to avoid this but if necessary we will try to locate you a bed in another maternity unit as near as possible. We will

15

make all the arrangements for you and provide you with details on how to get to the accepting unit. For more information about choosing where to have your baby visit www.infochoice.org. You can also find more detailed information about your birthing options at our Hospital website at www.royalberkshire.nhs.uk/maternity

Induction of labour For most women the birth occurs around the expected date of delivery. However, for those whose labour does not start spontaneously we offer induction of labour when you have reached 12 days past your due date. If there is a medical reason for doing so earlier an obstetrician will discuss this with you. If you decide that you do not want to be induced, you will be given an appointment to see an obstetrician to discuss the risks of continuing the pregnancy as there is a small increase in the risk of stillbirth after 42 weeks of pregnancy. You will be offered regular monitoring of your baby up until the birth or you decide to have an induction of labour. NOTE: please be aware that Induction of labour cannot be done upon your request as doing so before 42 weeks, unless there is a medical reason, increases the risk of Caesarean section. You can discuss this further with the consultant in the antenatal clinic. You can find more detailed information about managing prolonged pregnancy on the hospital website www.royalberkshire.nhs.uk/maternity

Vaginal birth after Caesarean section (VBAC) If your previous baby was born by Caesarean section you may not need a repeat Caesarean delivery unless there are medical grounds to do so. It is important that you have an opportunity to discuss this with your obstetrician. It may be helpful to know that an attempt at vaginal birth after a previous Caesarean section is safe, and about 2/3 of mothers who go into labour will achieve a vaginal birth. About 1/3 will have a Caesarean during their labour, but often for a different reason to that which led to their first Caesarean. If after seeing the obstetrician you wish to discuss this matter further you may like to make an appointment with our consultant midwife to go through the choices available to you. For more detailed information see our patient information leaflet Caesarean section information for women considering vaginal birth after Caesarean section on the hospital website: www.royalberkshire.nhs.uk NOTE: There is a small risk of rupture of the scar in your next labour we therefore recommend that you give birth in the maternity unit so that your baby can be monitored to detect this at an early stage and where you can be transferred immediately to the operating theatre.

16

Breech presentation (bottom first) In approximately 3-4% of pregnancies the baby is found to be in the breech position from 37 weeks. This may have been picked up during pregnancy or during labour. If we know the baby is in the breech position before labour you will be offered what is known as an external cephalic version (ECV). In other words we turn the baby round into the head down position. This is done by one of our consultants in the Day Assessment Unit. If it is not possible to turn the baby or you are found to have a breech position in labour you will be advised to have a Caesarean section. NOTE: all babies who have been in the breech position are referred for an ultrasound of his/her hips after the birth to ensure that the hip joint is correctly formed. An appointment will be made by the hospital which will be posted to you. This will usually be done at around 6-8 weeks following the birth. For more information on breech presentation and ECV see our hospital website www.royalberkshire.nhs.uk

Multiple pregnancy If you are having two or more babies you will need to be cared for by the hospital team. You will have regular ultrasound scans to ensure the babies are growing and developing normally. Special parenthood classes are held at the Royal Berkshire Hospital which includes a tour of the Delivery Suite and a visit to the operating theatre where most twins will be born. More information on multiple pregnancy and your care during the pregnancy and birth can be found on our hospital website: www.royalberkshire.nhs.uk

Labour recognising the signs It is impossible to pinpoint exactly when labour begins as labour is different for every woman: You may notice a show (a brownish or blood-tinged mucus discharge). However, the

show may appear up to a week before the baby is born so it is not a definite sign unless you are experiencing regular contractions.

You may have persistent lower back pain, often accompanied by a crampy period like pain.

You will experience contractions at regular intervals which will increase in their frequency and become longer and stronger in intensity.

Your waters break. You may either notice a steady trickle or a sudden gush of water that you can not control. Even if it is not accompanied by contractions, you should contact the hospital for advice. It is particularly important for you to ring the hospital if your waters are brown or green in colour as this can be a sign that your baby is distressed.

17

Early labour With first babies, you may be aware of an increase in the number and strength of contractions over several days before they become truly regular. This is entirely normal and there is no need to be worried, but you may want to speak to a midwife Make sure that you have the telephone numbers of the hospital where you are booked handy. Most women cope well with this stage by continuing with their normal routines, but with some extra rest and support from their partner, friends or family. When you think your labour has started, or your waters break, you should ring the labour triage line for advice before you leave home. The triage line is manned by midwives who will ask questions and help you to decide whether you should stay at home or come into hospital. If you are advised to come into hospital you will need to bring your hand held notes and your packed case with your and your baby items You can also find more detailed information about getting ready for the birth, early labour, prolonged pregnancy and pre-labour rupture of membranes on the hospital website www.royalberkshire.nhs.uk/maternity

The stages of labour There are four stages to labour: Early labour (sometimes called latent phase). The cervix (neck of the womb) has to soften and reduce in length in readiness for the next stage. This stage can last for several days. First stage (or active labour) dilation of the cervix. The contractions open your cervix (neck of the womb) to allow your baby to move down the vagina (birth canal) ready for the birth. Second stage your babys birth. This stage begins when your cervix is fully dilated and lasts until your baby is born Third stage delivering the placenta (afterbirth). This starts after your baby is born and finishes when the placenta is delivered. In a small number of cases the placenta does not deliver and will need to be removed under spinal/epidural or general anaesthesia. This is known as manual removal of placenta. For more information on manual removal of placenta see our patient information leaflet at www.royalberkshire.nhs.uk. For more information on choices for labour and birth are available at www.royalberkshire.nhs.uk

Pain relief in labour You will probably have thought about how you will cope with labour pains, what the options are, and discussed them either with your midwife, or in antenatal classes. You might be interested in: Breathing and relaxation exercises, aromatherapy, using a bath or pool TENS Gas and air (Entonox) Epidurals

18

Pain relieving injections such as Pethidine or Diamorphine You can also find useful information on Exercises in labour, Having your baby and Pain relief on the hospital website www.royalberkshire.nhs.uk/maternity. More detailed information about pain relief in labour can be obtained from the hospital website www.royalberkshire.nhs.uk/maternity

Monitoring your baby during labour The majority of babies cope well with labour and are born in a healthy condition. However, the contractions can cause stress to some babies and the guidance from National Institute for Health and Clinical Excellence (NICE) about care in labour is that your midwife should listen to the babys heart beat at regular intervals throughout your labour. This is usually done by placing a pinnard (trumpet) or an ultrasound device called a sonicaid gently onto your abdomen (belly). This is done at 15 minute intervals in the first stage of labour and after every contraction in the second stage of labour (pushing stage). If changes are picked up you may be advised that it would be best to change to continuous electronic monitoring using a CTG machine. If you are at home or on the Rushey Birth Centre it may be suggested that you are transferred to the main Delivery Suite. A CTG monitors your babys heartbeat and your contractions continuously. This is done by strapping two monitors around your abdomen (belly); one to listen to the babys heart beat and the other to monitor how often your contractions occur and how long they last. This will help the midwife to decide how to care for you and your baby. If for any reason the monitor is not picking up the babys heart rate continuously you may be advised to have a small electrode attached to the babys scalp through your vagina. If there is any concern about your babys heart beat it is sometimes suggested that a very small sample of the babys blood is taken from his/her scalp to be analysed. If the baby is found to be distressed (not getting enough oxygen) he/she may need to be born by immediate emergency Caesarean section.

After the birth After the birth of your baby your midwife or doctor will examine your vagina and advise whether you need stitches. If you need stitches, you will be given a local anaesthetic injection to make it less uncomfortable.

Stitches and aftercare Tearing of the tissues around your vagina after birth is common. This can be a minor tear that does not need stitching to a more extensive tear that needs stitching to ensure the tissues are put back together correctly and to prevent bleeding. There are four different types of tear: 1st degree tear is superficial and may involve the skin and/or a graze inside your vagina or

anywhere in that area. This grade of tear may not need stitching.

19

2nd degree tear is the more common and is deeper, involving the skin and the underlying muscles. These tears usually extend towards your anus and will need stitching.

Episiotomy this is when the midwife or doctor who is delivering your baby cuts the skin to allow the babys head to delivery and to prevent severe tearing. This will be discussed with you beforehand and if necessary you will be given local anaesthesia. 1st and 2nd degree tears and episiotomies are usually repaired by midwives unless you needed a forceps or ventouse delivery when the repair will be done by the doctor who delivered your baby.

About one woman in 30 will have a more extensive tear, known as: 3rd degree tear involves tearing of the skin, muscle and also damage to the muscle around

the anus known as the anal sphincter. 4th degree tear is a more extensive than a 3rd degree tear which involves tearing into the

rectum (back passage). These tears will need to be stitched under epidural/spinal or general anaesthetic in the operating theatre and are always repaired by a senior doctor

NOTE: if you had a 3rd or 4th degree tear you will be offered an appointment to attend a postnatal follow up clinic at the hospital to make sure you are healing properly. This is usually around 6-8 weeks following the birth. TIP: If you are expecting your first baby, massaging your perineum during late pregnancy with natural oil may help in preventing tears see our leaflet Tears and stitches for more information at: www.royalberkshire.nhs.uk/maternity Caring for your stitches It is important to look after your stitches to prevent infection Generally, tears heal very well - usually within two weeks. To aid healing it is advised that you: Wash your hands before and after changing your pad to prevent infection Change your pad every few hours. Keep the area clean through bathing or showering. Pat the area dry with a clean towel. Take painkillers, such as Paracetamol 1gram four times a day. Start pelvic floor exercises as soon as possible after the birth. Eat a diet containing vitamin C, protein and zinc. If you smoke, stopping smoking will help. For further information refer to the Tears and stitches information leaflet which is available at www.royalberkshire.nhs.uk NOTE: your stitches should be visually checked at each postnatal visit until you are discharged by the midwife on around 10th postnatal day. This is important to ensure healing and early recognition of infection. If the wound is unusually tender or you notice an offensive smell please inform your midwife or GP.

20

Postnatal period Pain relief Most women feel some discomfort after the birth whether you have stitches or not. It is safe to take the following pain relief whilst breastfeeding which are available over the counter: Paracetamol tablets 500mg: these are the simplest and safest painkillers. Up to eight tablets

(a total of 4000 mg) can be taken each day. Be aware that other medicines may contain Paracetamol so check carefully before taking any medication.

Ibuprofen tablets 200mg otherwise known as Brufen or Nurofen. You should not take these while you are pregnant or if you have asthma.

Ensure you have a stock of these medicines before the birth for when you get home. Whilst in hospital you will be offered regular pain relief. Other medicines are only available on prescription. You can also find more detailed information about pain relief after the birth on the hospital website www.royalberkshire.nhs.uk/maternity. Bleeding It is usual to lose blood after the birth which can be quite heavy for the first 24 hours and may contain small clots. This will eventually lessen and change from fresh red blood to dark blood then a pinky colour. If you are passing clots larger than a 10p piece or it remains or becomes heavier than the heaviest part of your period you should inform your midwife or your GP. If you notice that there is an offensive smell to your loss you should inform the midwife or your GP as this may be a sign of infection. NOTE: You will need to provide high absorbancy sanitary pads that for use in the first week. You need to buy these before the birth as we do not supply sanitary wear. Breasts Whether or not you are breastfeeding your breasts will become tender and larger on around the third postnatal day. If you are not breastfeeding the milk will dry up and your breasts will become less tender. During this time wearing a well fitting bra will help. For advice on breastfeeding please see section below. Passing urine It is not uncommon to leak small amounts of urine after the birth when you laugh, cough or move suddenly as your muscles in the pelvic area have become stretched. This will lesson with time. Pelvic floor exercises will help restore your muscle tone. Inform your midwife or GP if you have any concerns. NOTE: if you are still leaking urine at 3 months you should seek advice from your GP Bowels You may be afraid to open your bowels after the birth because you think it might be painful or that your stitches will come undone. To help make your stools easier to pass eat fresh fruit, vegetables, salad, bran and wholemeal bread, and drink plenty of water. Try not to let yourself become constipated or to strain.

21

NOTE: In very rare cases you may experience incontinence of faeces. This is more common with 3rd or 4th degree tears. Please consult your doctor if this is the case.

Postnatal exercises It is important that you get your body back in shape following the birth. Doing postnatal exercises helps to regain your muscle tone in your tummy and pelvic floor. This will also help with bladder and bowel function. You will be given a leaflet on how to do the exercises or you can find further information on the hospital website www.royalbershire.nhs.uk

Emotional well-being Being a parent is a constant and demanding role that will involve a variety of emotional and physical changes for both you and your partner. It is important to remember that learning how to be a parent takes time and patience. The baby blues Up to 80% of women will experience the baby blues. These feelings can vary between extreme happiness to anxiety, exhaustion and tearfulness. This normally occurs within the first ten days of birth and is usually short-lived with most women feeling back to normal within a few days or even hours. Postnatal depression Depression that begins after the birth of a baby is referred to as postnatal depression. While symptoms can occur at any time during the first year, they mostly present within the first three months after birth. One in eight women is affected. The symptoms include: Feeling low. Lack of interest or pleasure in usual activities. Loss of appetite. Difficulty in sleeping. Loss of energy. Tearfulness. Irritability. Anxiety or excessive worry, often about how to care for their baby. Difficulty concentrating. Feelings of worthlessness or guilt about being a bad mother. Thoughts of suicide or harming the baby (although these are rarely acted upon). If you think you may have postnatal depression dont delay, speak to your midwife, health visitor or GP. You may need treatment for to relieve your symptoms.

22

Alternatively you may like to contact Talking Therapies which is an NHS helpline which is easily accessible that offers a variety of different types of help and support. The options will be discussed with you to make sure you find the right treatment. Sometimes, this may mean that you may be referred to another service. If you live in Reading, Newbury or Wokingham: Tel: 0118 976 9121 or e-mail: talkingtherapies@berkshire.nhs.uk For further information on postnatal depression visit www.infochoice.org or on the hospital website www.royalberkshire.nhs.uk/maternity

The baby After the birth your baby will remain with you at all times unless you or your baby become unwell. Apgar score When your baby is one and five minutes of age the midwife or doctor will assess your babys condition and give him/her what is called an Apgar score. This assessment is based upon his/her colour, tone heart rate, breathing and whether or not he/she is crying. If you wish to know your babys Apgar score please ask your midwife. Skin-to-Skin Soon after the birth you will be offered an opportunity to give your baby skin-to-skin contact. This is where your baby is held close, either naked or in a nappy, on your bare chest and covered with a blanket. This is beneficial to you and your baby, regardless of your chosen method of feeding. It enhances emotional closeness and bonding, keeps your baby calm, stabilises your babys temperature and breathing and helps with the first feed. Skin-to-skin contact is beneficial at any time, it will help comfort you and your baby over the first few days and weeks after childbirth. Fur further information on skin-to-skin; download our leaflet on our website, www.royalberkshire.nhs.uk

Feeding your baby You may have already decided how you wish to feed your baby, but if it is your first baby or you wish to learn more about your choices, an infant feeding class is available when you are 34 weeks pregnant. Your midwife will remind you to book this class at your 28 week antenatal appointment. Most babies will look for a feed quite soon after birth. Your midwife will assist you to position the baby if necessary. After that you will soon learn to recognize when your baby is hungry. When your baby is hungry he/she will demonstrate the following cues: Will move about and move their head. Will make murmuring sounds. Will root around, suck their fists or blanket. May make eye movements.

23

Crying is a later sign of hunger. A normal healthy baby who is feeding well will produce five or six wet nappies a day after the first few days. This means that you baby is getting enough milk. The urine should appear clear or pale yellow. A normal healthy baby will pass meconium (first stools) in the first few days which is very dark brown/black and will change to a more formed yellow stool by day 5. Breastfeeding If you choose to breastfeed it is recommend that your baby should be exclusively breastfed for the first six months of life to achieve optimal growth, health and development. If you choose to breastfeed, the first feed will be soon after birth, ideally within the first half an hour, when your baby is most receptive; a member of staff will help you if you wish. You will be offered support for the next feed which is usually within six hours. For future feeds as is necessary, please ask for help if you are concerned about anything. Signs of good attachment are: Mouth wide open. Chin touching the breast. Cheeks full and rounded. More areola visible above the nipple than below. Rhythmic sucks and swallows. Feeding is pain free. Signs of good positioning are: Babys head and body in line (head free to tilt back). Baby held close to mother. Nose to nipple. You are comfortable and can sustain the position. If you are unable to latch your baby, you will be encouraged to hand express breast milk which can be given to your baby by syringe, spoon or cup. All mothers are shown how to hand-express their breast milk prior to going home, to help you manage if you experience blockages and engorgement. Here is some additional information which you may find helpful: For the first six months your baby will not need extra water or formula feed except in cases

of medical indication or through your own choice. Baby led feeding (demand) is encouraged for your baby unless otherwise indicated for

medical reasons. Breastfed babies usually feed 8-12 times in 24 hours. Night feeding is important for milk production as the prolactin (milk making -hormone)

levels are higher at night. It is sensible to wake your baby for feeding if your breasts become overfull.

24

Before leaving hospital you will be provided with information and support contact details for local and national breastfeeding support groups.

NOTE: some medications cross from the mother to the baby in breast milk. Before taking any medications you should consult your pharmacist or GP. For more breastfeeding information, tips, mothers real-life stories go to: www.nhs.uk/breastfeeding Formula feeding Most infant formula is derived from cows milk which has been modified to make it suitable for human babies. The content of formula milk is laid down by statute which means that there is a minimum and maximum level of each ingredient. There are several brands of baby formula and there is no evidence to suggest that any are better than another so you do not need to stick to one brand. Price is as good a reason as any for choosing a particular brand. There are also different types of formula milk. First milk, second, hungrier baby and follow on milk. Talk to your midwife or health visitor about using any milk other than the first milk, before you start. How to give a formula feed Bottle feeding, like breastfeeding, is a time for interaction between you and your baby and you should hold him/her close to you and make eye contact during the feed. It is advised that you keep the number of people feeding your newborn to a minimum. Your baby should be positioned fairly upright, with his/her head supported in the neutral

position so he/she can breathe and swallow easily. You should ensure that milk fills the teat whilst your baby is feeding. The bottle should be

held horizontal, just tilted enough to prevent the intake of air. Before inserting the teat brush it against your babys lips. The babys mouth should then

open wide and your baby will draw the teat in over the tongue. Air bubbles should be seen as your baby feeds. If this is not the case, the baby may have

created a vacuum so move the teat to the side of the mouth which should cause bubbles to rush back into the milk.

Babys feed in spurts resting before starting again. Your baby may need short breaks during the feed to rest or burp. To burp your baby

gently rub or pat his/her back either in the sitting or over the shoulder position. Short breaks will also give your baby time to register whether he/she is full or not. Dont worry if there is no wind within one or two minutes or the baby falls asleep, just settle him/her down in the crib.

You should feed baby on demand. The instructions of amounts on the tin are only a guide. Newborn babies may take small amounts to start with but by one week will have increased

25

to 150-200 millilitres (ml) per kg of babys weight per day until they are six months old. This will vary from baby to baby. The feeding pattern may vary from little and often to longer feeds depending on how much your baby wants at any particular time. Your baby may not always finish the bottle. It is better to work on a 24 hour cycle rather than feed to feed.

Dont be tempted to give larger feeds in the hope that your baby will go longer as he/she may put on too much weight or be sick.

We do not advise offering extra water to a well hydrated the baby. It is important that you make the feeds up correctly; ensuring the scoops are loosely packed and always use the correct scoop for the packet as they may vary in size. Otherwise you could change brands to see if it makes a difference as stool hardness is related to the concentration of calcium soaps of unsaturated fatty acids in the stools which as said previously can vary within a normal range from brand to brand. Before leaving hospital you will show you how to make up a formula feed and how to sterilize the equipment. You will also be given written information to help you. NOTE: You should never leave your baby alone with a bottle or feed the baby lying flat as both can be dangerous as your baby may choke or inhale milk into the lungs. Also if your baby falls asleep and milk pools in the mouth, the sugary content can cause future dental problems. If you give birth in hospital, before you are transferred to the postnatal ward or home the midwife will check the baby to ensure there are no obvious abnormalities. He/she will give you the babys health record otherwise known as the Red Book. NOTE: The Red Book is used to record your babys health up to the age of five. It is important that you keep the Red Book safe and take it to all appointments for your babys checks and immunisations. The midwife will discuss the following with you:

Vitamin K Vitamin K is needed to help the blood to clot. Babies are born with low levels of Vitamin K. Formula milk contains vitamin K supplements. However, breast milk has low levels of vitamin K which may not be sufficient for the newborn babys needs. Rarely, lack of Vitamin K can lead to bleeding in the babys gut or brain. This is known as Vitamin K-Deficiency Bleeding (VKDB). Although the risk is very small, we cannot predict which babies will be affected. There are two methods of giving Vitamin K to your baby:

By injection - This is probably the most effective method as it ensures a good dose of Vitamin K and provides good protection for your baby. It is given into your babys thigh soon after birth.

26

By mouth - The Vitamin K can be given by mouth (orally) in the form of a liquid. Two or three doses will need to be given to achieve the same protection as one injection. These will be given at birth, 5 days and one month.

Whether or not your baby receives Vitamin K and how it is given is your decision. You can also find more detailed information about vitamin K on the hospital website www.royalberkshire.nhs.uk/maternity or www.dh.gov.uk

BCG vaccination It may be advisable to give your baby a BCG vaccination to protect him/her against TB. This will depend on your country of origin or your current postcode. If it is advised it should be done before you leave hospital unless there is a reason why it cannot be given e.g. your baby is having antibiotics.

Physical examination The baby will have a second examination within 72 hours of the birth. This may be done by a specially trained nurse, midwife or doctor. If there are any concerns your baby will be referred to a neonatologist. The result of the examination will be recorded in your babys Health Care Record or the Red Book. NOTE: You will need to make an appointment to see your GP six to eight weeks after the birth so that your baby can be checked again for conditions such as heart defects which may only become apparent as the baby grows.

Weighing your baby Your baby will be weighed at birth and again at 3 days and before you and you baby are discharged by the midwife when the baby is around 10 days of age. If your baby is found to have lost 12.5% or more of his/her birth weight since birth your midwife will refer you to the GP who may advise that the baby should be readmitted to the hospital for assessment of his/her feeding.

Jaundice Jaundice or yellowing of the babys skin is common in the first week of life. For most babies jaundice is mild, harmless and clears up by itself. If you think your baby is jaundiced it is always best to tell your midwife or doctor. It is important that you tell your midwife or doctor on the same day if you notice that the whites of your babys eyes are yellow or the inside of your babys mouth or gums have a yellow colour. You should also tell your midwife or doctor if your babys stools (poo) are pale and chalky or the urine is dark and stains the nappy. The midwife or doctor will perform a blood test to check the levels of a substance called bilirubin. If the level is high the baby may need to be placed under special lights called

27

phototherapy. Less commonly the baby may need more specialist treatment on a neonatal or paediatric ward. NOTE: It is important to report to your midwife or doctor urgently if jaundice occurs within 24 hours of birth as this could be a sign of another medical condition. For more information on jaundice please see our hospital website at www.royalberkshire.nhs.uk or NHS Choices at www.nhs/conditions/jaundice-newborn NICE website at www.nice.org.uk/guidance/CG98

Sudden Infant Death Syndrome (Cot Death) Sudden infant death syndrome is rare and the risk of your baby dying from it is low. It occurs mainly in the first three months. Although it usually occurs at night it can happen during the day. The cause is not fully understood but we know there are things you can do to reduce the risk. Place your baby on their back to sleep. The safest place for them to sleep is in a cot in a

room with you for the first six months. Do not smoke while you are pregnant or after your baby is born, and do not let anyone

else smoke in the same room as your baby. Do not share a bed with your baby, particularly if you have been drinking alcohol or taking

drugs. Never sleep with your baby on a sofa or an armchair. Do not let your baby get too hot. Keep your babys head uncovered. Their blanket should be tucked in no higher than their

shoulders.

How to recognize your baby is healthy It is important that parents know how to recognize when the baby may not be well and when you need to get help. Here are some characteristics of a healthy baby: He/she should have normal colour for his/her ethnicity. He/she should feel warm (to assess this feel your babys tummy and/or on the back of

his/her shoulders). The inside of your babys mouth should be reddish/pink. After the first few hours of life, your baby should have good muscle tone (on picking the

baby up, the baby is not floppy). After 12-18 hours your baby will start to wake regularly for feeds, suck and cry when

hungry or uncomfortable. Nearly all babies will have passed urine within 24 hours. Most babies pass a black tarry stool called meconium within 24 hours.

28

How to recognize signs of serious illness Here are some signs that could indicate that your baby is ill. If you think that your baby has any of the following signs or you are concerned about your baby, do not hesitate to ring your GP. A GP is available 24 hours a day for emergencies, or alternatively call 999 in an emergency situation and ask for an ambulance: Call for help if your baby: Looks pale. Is floppy when you pick him/her up. Does not feed regularly (at least 5-6 times a day) after 12-18 hours. Vomits large amounts of feed regularly and/or the vomit is green in colour. Has not passed urine within 48 hours. Has not passed meconium within 24 hours. Feels hot and his/her temperature is 38 degrees or above or babys temperature is low i.e.

36 degrees or less. Has difficulty breathing, fast breathing, grunting while breathing, or if your baby is working

hard to breathe, for example, sucking their stomach in under their ribs. Has a high pitched or feeble cry. Further information is available at www.royalberkshire.nhs.uk/maternity Find the postnatal advice booklet by clicking on Maternity information leaflets J-P and at http://www.nhs.uk/Planners/birthtofive/Pages/Recognisingsigns.aspx

Newborn blood spot screening (NBBS) After five days your midwife or maternity care assistant will take a blood sample from your babys heel to test for five conditions that can affect your babys health and development. More information about these conditions is available in the booklet Screening tests for you and your baby which you will be given by your midwife. If any of the tests are positive you will be contacted by the hospital otherwise your results can be obtained from your GP or health visitor at 6 weeks. Your midwife will usually stop visiting at 10 days although there may be situations where his/her visits will extend beyond this time. Your care will then be handed over to a health visitor and your GP. We hope this information has been useful. There is a wealth of information on our hospital website to assist you in making decisions about care for both you and your baby. In addition there is a Postnatal Information booklet which provides greater detail on caring for your baby at www.royalberkshire.nhs.uk. Additionally, our maternity team are there to help and to answer your questions. Your views on your experience of our maternity services are important to us. If you have any comments about the care you received then following the birth you will find touch screen

29

kiosks placed in the maternity unit and in the hospital corridors. Alternatively, you may be asked to complete a questionnaire prior to leaving the maternity unit. If your baby is born at home, please look up the maternity survey form on our website. The local Maternity Services Liaison Committee (parents, midwives and doctors working together to improve services) would also like to hear your views. See their page on the hospital website, or the MSLC Parent Group blog at http://westberksmslc.wordpress.com/ (also on Facebook) We are always pleased to hear positive feedback but understand that there are times when your experience may not have gone as planned. We would like to know at an early stage if things arent going well Please speak to a member of staff or if you prefer you can contact our Patient Advisory and Liaison Service (PALS) on 0118 322 8338 or by email talktous@royalberkshire.nhs.uk For further details on how to make a complaint please contact our Patient Relations Department by letter, telephone 0118 322 8338 or email at talktous@royalberkshire.nhs.uk. See our hospital website for further information www.royalberkshire.nhs.uk

Royal Berkshire NHS Foundation Trust London Road Reading RG1 5AN 0118 322 5111 www.royalberkshire.nhs.uk MAT_0061 Author/s: Linda Rough (Matron for Hospital Services), Annette Weavers (Consultant Midwife) Written : January 2009 Revised: May 2010, Sept 2010, June 2013, Jan 2014 (Nicky Benns, Clinical Risk Manager) Review: June 2015