Bump, Birth and Baby Translations

To listen and read the translation in your preferred language, please click on the "easy read and translation" button at the top of the screen.

You can also find more information about using our translation service by clicking here.

Back to Antenatal classes

Expand all

Bump, Birth and Baby Video Translations

Introduction

Hi there, my name is Karen and I work for Bedfordshire Community Health Services in the baby friendly team, which is part of the Health Visiting Service.

Health Visitors are all nurses who have gone onto do extra training for their role, and that involves supporting your on your journey for the first five years of your child’s life, ensuring that they get the best possible start to life.

Our Helth Visitors in Bedfordshire have key contacts with you, and that includes getting to know you when you are pregnant, and also a new birth contact when your baby is 10 – 21 days old. If you haven’t heard from us by the time you are 32 weeks pregnant please make contact with us on our Single Point of Access number or as we call it our SPA number on 0300 555 0606. This is also the number that you would ring at any point if you needed support or information about your parenting journey, or to get in contact with your named health visitor.

During these video’s our Bump, Birth and Baby stuff sessions we are going to be talking about a range of things, so with me you will be talking about your baby’s brain development, we will be talking about skin to skin, about feeding your baby, and we will talk about both breast feeding and formula feeding, and we will be talking a little bit about your well-being as well.

Later on you will have a midwife talking about labour and delivery, and then our children’s centre team will be talking about all that really useful practical stuff like changing nappies, bathing your baby, about car-seat safety, about safe sleep, and also about the importance of play for your child’s development.

So, it is a bit of jam packed session, and we do call it a bit of a basic session, but if it sparks any questions or concerns please do get in touch with us.

Enjoy the sessions.
Brain Development

In this section we’re going to be talking about your baby’s brain development. People often think about the brain as just one thing, the brain, but what we know from science is that it’s made up of three distinct parts. When your baby is born the brain isn’t fully developed.

The part of the brain that is most developed is called the Reptilian Brain and this is about the most automatic functions. Things like heart rate, breathing, circulation, digestion, they’re all set up and ready to go in a term baby.

The next part of the brain is called the Mammalian Brain and this is not fully developed at birth, and it’s about love and play and bonding and emotion regulation. So when your baby cries, they’re not doing it to be naughty or to manipulate you, they’re doing it to convey a need, that they’re feeling all of this but they’re not able to manage it, and what we know is that if babies are responded to, picked up, cuddled, that does really positive things for their brain development. So we won’t ever say to you that you’re spoiling your baby or that you’re making a rod for your own back, actually responding to your baby is a really positive thing.

The next part of the brain that’s least developed at birth is the frontal cortex and this is about language, so while your baby is born wanting to communicate with you, it’s not born speaking sentences. It’s about reasoning, so that cause and effect behaviour, if I do this then this will happen. And this really takes some time to develop, if you’ve ever seen a toddler having a meltdown, again they’re not necessarily being naughty, they are overwhelmed by their feelings and their experiences and they need an adult care-giver to help them to manage that.

A baby is born with around 200 billion brain cells but what they don’t have is the connections between them. About 90% of growth happens in the first five years of life. So it’s really important that these early experiences are positive and that babies and children feel supported in all of their emotions that they’re going through.

There’s a really good video by the NSPCC about how early experiences shape a child’s brain development, so that’s well worth a watch. Many parents can feel stressed when they realise that they’re responsible for not only growing their baby while they are inside of them, they also have to help develop their brain while they’re outside. But you are probably already doing stuff instinctively that is helping you to connect with your baby.

Think about what you do on a day to day basis – you might talk to your bump, you might get your partner involved with that or if you’ve got other children then they can get involved, and that’s a really good thing. Your baby can hear you and having those conversations with your baby tells them there’s something out there. They have no idea they’re going to be born, they have no idea that there is a post-birth world. So building those connections in pregnancy is really important.

You might stroke your bump, or do massage, and that touch releases really positive hormones called oxytocin which is the hormone of love, and that floods through your body and through your baby’s body.

You might respond to movement, such as when you get an elbow or a kick you might say “you’re a bit feisty today” and respond to that, and again that’s teaching your baby that there is a connection there.

You might read to your baby – it sounds a bit strange but there was some research done quite a few years ago where they had fathers read a children’s story to the bump. They read the same story every day just in the last trimester and when the babies were born they read that story again, and the babies showed by their behaviour that they not only recognised that father’s voice, but they also had become familiar with the story and were waiting for the pauses and the exciting bits, so again this is a really positive thing that you can do with your baby.

When you’re pregnant it’s often a time where you think about your lifestyle and if you’re as healthy as you can be. So it might be a time where you take up some gentle exercise, it might be a time where you cut down or stop drinking, or you stop smoking, and these are all things that we can support you with.

Some parents sign up to apps – we like an app called Baby Buddy. We like this because it’s endorsed by The Royal College of Midwives, The Institute of Health Visitors, The Royal College of Obstetricians and Gynaecologists and The Royal College of Paediatrics and Child Health, a whole host of organisations that have looked at the information on here and said “yes, that’s evidence-based and it’s good information”. You can sign up when you’re pregnant and it will go through to when your baby is 6 months old. It will send you little reminders of what stage your baby’s development is at, so you might want to look into that or other apps just to help you track your baby’s development. We know that if you start to see your baby as a real little person inside when you’re pregnant then when they’re born it’s like you’re not meeting a stranger, you’re meeting this little person that you got to know through all of these months, and that makes your relationship with them much easier to develop and you tend to be much more responsive to your baby.

We know that life can be stressful sometimes and mothers can feel under pressure about all of these things that they need to do, but even just taking 5 minutes at the beginning and the end of the day to say “hi baby how are you?” and just try to connect with your baby that way will make a difference. So even when you’re busy with work and life just taking those 5 minutes will make a difference.

In this section we’re going to talk about how to cope when your baby is crying. All babies cry, some cry more than others, and it can feel really stressful when your baby is crying, and that’s nature’s way of making sure that you’re going to respond. Your baby crying is them trying to communicate with you to say “I need something please help me,” and if it was this lovely melodic tune that we could just ignore then that baby’s needs wouldn’t be met. So it’s meant to make us feel like we want to take action and we want to do something about it.

When we do these sessions face to face with parents we play an audio clip of a baby crying and ask how that makes them feel and they will all acknowledge that makes them feel stressed and they want to do something about it. The first thing that they’ll suggest we do about it is go to their babies if they hear them crying, and they go to their babies and we act out a scenario when they go to the baby and say “it’s alright, I’m here, don’t worry,” and this is building a positive brain connection, this is telling your baby that someone is here for them when they need them and that helps your baby to cope later on when they feel stressed because they feel that pathway that enables them to cope with stressful situations.

If your baby doesn’t settle then the next thing that you would do is pick them up and just give them a little cuddle, however you want to. Babies generally like being in an upright position, they like to feel calm and you can just gently pat or rub them and you can calm them down this way, so that might work.

But what if your baby carries on crying? The next suggestion parents have is to check the nappy. Babies will tell you if they’re feeling uncomfortable because of a wet or dirty nappy, so you can check their nappy – we’ll be talking about how to change a dirty nappy later on in the sessions – and make them all clean and fresh so that they’re all happy again.

They might still be crying and the next thing parents suggest in sessions is to feed the baby. You might breastfeed them or if you’re formula feeding you might get the formula feed ready and bottle feed them. For that moment of feeding it’s quiet, it’s calm and you think “ah relief,” but then your baby might still be crying. You might wind them – when you’re winding your baby the easiest way to do it is actually over the shoulder, because gravity then stretches the legs down and stretches their tummy out and you can do some very gentle pats and rubs to bring the wind out. Babies don’t always bring wind out and they can always bring it out of the other end if they need to.

Your baby might still be crying and so it’s about thinking if they are too hot, or too cold. Sometimes when babies cry it can be a sign of illness, if that crying is persistent, so you might check your baby’s temperature and if you’re concerned about your baby contact your GP for advice about what to do next.

Sometimes babies cry because there’s no particular reason, and you’ve done all of those things on the list, and you don’t really know what else to do. Sometimes you can start to feel a little bit overwhelmed or stressed, and some parents can start to feel cross with their baby. If you’re feeling strong emotions emerge, the best thing for you to do is to put your baby down in a nice safe sleep space and then walk away. Take the time that you need to feel calm, take a few deep breaths, perhaps phone a loved one and say “can you come and help me I’m having a bad day?” But take the time you need so that you’re calm enough to go back to your baby and start that process all over again.

They won’t cry forever but it’s really important that you make them feel safe and you keep your baby safe.

In this section we’re going to talk about your wellbeing after you’ve had a baby. Having a baby is a massive transition, becoming a parent is a huge thing, and it’s very common for us to feel emotional during this process. In the first few days after birth mothers can feel The Baby Blues and that often really kicks in when you’re about 3 days post-natal, that’s when your milk is coming in and your hormones are all over the place and you can feel a little bit tearful and vulnerable and need a lot of tender loving care from your loved ones just to help get you through that.

If those feelings don’t settle down it’s possible that you could be developing post-natal depression or anxiety, and it’s really important that we get the knowledge out that post-natal depression can also affect partners, it’s not just affecting mums that have given birth. Signs and symptoms of post-natal depression can be that you’re feeling very anxious, that you’re worrying about things that you wouldn’t usually worry about. You might feel absolutely exhausted but when you try to sleep your mind is racing and you can’t get to sleep. You might find that your appetite is affected, that you don’t really want to eat and you might also find quite commonly that you feel very tearful a lot of the time. Or you might find that you feel quite cross towards your partner, or your baby, or even just indifferent – that you don’t really care and feel a bit numb.

These are all signs that you might be needing a little bit of support with your transition to parenthood. Please talk to us – we’re so much more open about mental health now and that can only be a good thing. Speak to your midwife, speak to your health visitor or you can ring your GP. In Bedfordshire we also have the Bedfordshire Wellbeing Service and you can self-refer via their website. There’s lots of help and support out there. It’s often your loved ones and your partner that might spot when things are not quite right and so keeping those lines of communication open is really important. Say to your partner “Are you ok? You’re not your usual self, what’s wrong?” so that you can help them to get support if they need it.

But please do ring us, ring our spa number on 0300 555 0606 and speak to our health visiting team so we can get you support. There’s also good support from websites such as Cry-sis which was set up by parents of babies that cried a lot and you can see that on their website and also Family Lives which is a parenting charity, and there’s lots of useful information on there, and of course Mind so you can look on there for further information.
Womb to World

We’re going to talk about the transition that your baby makes from womb to world, from inside to outside. We often think about our transition to becoming parents but we don’t think about how it is from the baby’s perspective. If we take a little bit of time now to think about that in terms of the baby’s senses – think about what your baby can see when they’re inside. What’s vision like for them? Most parents will say it’s a bit dark in there, the light is muted because it’s going through mum’s clothing and mum’s skin. But babies can respond to light – from about 29 weeks gestation their irises are developed enough to contract and dilate in response to light. What they’re seeing inside is all pretty much the same, they’ve got a very constant experience of their vision when they’re inside.

Contrast that to when they’re born, and they come out into the world, and everything is probably a bit bright for them, there’s all of these different visual stimuli and things to see – people, objects, and it can feel a little bit overwhelming and scary for your baby. Your baby’s vision is not fully developed when they’re born, like many of their systems, so vision is a little bit blurry for them, and they can’t really focus on you. But nature is very clever, and nature has it set up so that the distance at which your baby sees best is around 20-25 centimetres and that’s roughly the distance from a mother’s breast to a mother’s face. Your baby doesn’t know that there’s any other alternatives to feeding, they are hardwired to breastfeed, so nature has set it up so that your baby will see you best at the distance where they’re going to be spending a lot of time. So whatever your thoughts about how you’re going to feed your baby, remember that 20-25 centimetre gap so that they’ll be able to focus on you best. As time goes on their vision will develop further and they’ll be able to follow you moving across the room, they’ll be able to focus on your face better, and that’s one of the things that we check to make sure that your baby is developing as we would expect.

So we can see that there’s a big contrast between inside and outside and your baby might feel a bit overwhelmed about what they’re experiencing in terms of their vision.

The next sense we’re going to think about is sound. Think about what your baby can hear now when they’re inside. They can hear loud noises – if you’ve dropped a stack on plates on the floor and your baby has shuddered inside, you’ll know that they can hear that. They can hear differences between voices, so those deeper voices or higher voices, they will hear that and they will learn to recognise those voices of people that talk to them lots. They can also hear the sounds of a mum’s body, they can hear your heartbeat, so this sound has been with them since they came into existence. They think it’s part of them. They can also hear your tummy rumble, they can hear the “woosh” of your blood going through your blood vessels. Thinking about it, is that why as adults when we’re cuddling a baby and trying to soothe them we instinctively make a “shhh” sound, because we know that that’s a calming, soothing thing? Who knows. But your baby gets used to constant sounds that are going on when they’re inside.

When they’re born, think about how that might be for your baby. Everybody’s very excited saying “you’re here, happy birthday, it’s a boy, it’s a girl,” but for your baby that sound is very sharp, very distinct, whereas before it was muffled because they were in this bag of waters and it’s like if you imagine swimming underwater, you can’t quite hear those sounds distinctively. So when they’re born they’ve got all of these noises around them and it can feel a little bit overwhelming and a bit scary for them.

The next sense that we’re going to think about is your baby’s sense of touch. What’s it like for them in there? As you get towards the end of the third trimester they haven’t got a lot of room, they are all squashed up and there’s not a lot of space. They’re also feeling supported in that bag of waters, they’re in a feeling of constant motion, so when you go for a walk your baby is getting a nice little rock, but even when your baby is sitting still because your heartbeat and your circulation and those tummy rumbles are sending ripples through that bag of waters your baby gets this feeling of constant motion. All their walls inside are nice and smooth so there’s no rough surfaces or sharp edges. Then they’re born. When babies are born they’re born wet, they’ve been in that nice warm bag of waters and then they’re born and their body is still wet and so they can get cold quite quickly, so we will dry them off to make sure that they don’t lose heat. But they’ve never known cloth against skin so that must feel very strange for them. They’ve suddenly got much more room, they’ve got much more space, but if you’ve never known that freedom it might feel a little bit scary. They can feel those changes in temperature, like a breeze coming through a window is a whole new thing for them. For your baby experiencing the outside world, like if someone is cuddling them and they’ve got a scratchy jumper on, all of these things are new to them, so it’s a big change and it might feel overwhelming.

The next sense that we’re going to talk about is your baby’s sense of smell. We don’t completely know if babies can smell inside, but we do know that the amniotic fluid changes according to mum’s diet and if we think about our sense of taste being connected to our sense of smell like when you have a cold and your nose is blocked so you can’t taste anything, it’s quite possible that when your baby is inside they have got some sort of sensation of smell. When they’re born all of a sudden there is all these different smells, so there might be somebody who ate a load of garlic the night before, or somebody who is wearing very strong perfume, there might be somebody who has just had a cigarette, not in the hospital room but when you go back home! So all of these smells are completely new to your baby and can feel quite overwhelming. We recommend that if you do wear perfume or aftershave that in the first few weeks you do limit that so that your baby can get used to your smell rather than some artificial smell. But again, nature is very clever and set it up so that the baby can use its sense of smell to help it find its way to food. The areola, which is the dark bit around the nipple, secretes a substance that smells very similar to amniotic fluid so the baby moves up towards the breast because it recognises that smell, so nature is really clever.

The final sense we’re going to talk about is your baby’s sense of taste and when your baby is in the final trimester it’s already starting to drink the amniotic fluid. It will swallow that amniotic fluid and it will go through its system and then it will wee it out and then it will drink it again and it will wee it out, and it’s kind of the best form of recycling, but your baby is practising what it’s like to feed. So they do get a sense of taste because your amniotic fluid changes according to your diet, so they’re already getting ready to be outside and to experience those tastes.

But think about right now, has your baby ever known hunger? They haven’t. 24/7 they are having their needs met via mum and the umbilical cord so baby gets everything it needs and has never known hunger. And then they’re born. If we could wish into the universe for our babies to feed This many times, probably a lot of us would say “breakfast, lunch and dinner would be perfect,” but we know that babies need to feed more often than that. On average babies need to feed between 8 and 12 times in a 24 hour period, whether they’re breast-fed or formula-fed, and that’s normal. Babies have evolved to feed frequently because by feeding frequently they keep you close. By keeping you close you keep them safe and you have that interaction with them that is helping to develop those amazing brains. Those amazing brains need a regular supply of fuel, so by feeding them frequently they get that and that enables them to grow and to develop. That frequent feeding is very normal and they will feed at night too, and again that’s very normal. By the age of 6 months only around 30% of babies are actually sleeping through the night, so 70% of babies are still waking up at least once, and we maybe need to adjust our expectations about what’s normal with baby behaviour, and waking up is a normal part of your baby in those early months and they will still need to feed at night.

When we thought about this transition from Womb to World for your baby in terms of all of those senses, you can see that it’s a big change for your baby from inside to outside, and there’s something that you can do to help with that transition, to help your baby feel calmer and safer. That’s skin to skin.

In this section we’re going to talk about skin to skin, and it’s a really lovely way to meet your baby for the first time, but it’s not just for after birth, it’s also in the days and weeks and months to follow, it’s a lovely way to connect with your baby. Mum’s can do skin to skin but partners can do skin to skin too, it’s a lovely way to build that relationship.
When your baby’s born they go through nine distinct stages that all babies across the world go through, and this is often referred to as “the magical hour” and you can look this up online for more details.

Of these nine stages, the first one of these stages the first stage is the birth cry. When babies are born they let out this cry that expels the fluid from their lungs and enables them to start breathing air.

The next stage is the relaxation stage and this is where your baby goes: “ah, give me a minute, that was intense, I just need to take a moment.”

Then they will start to awaken. They will start to look around a bit and think “this is new, what’s going on here?”

Then they will start to get a little bit more active. They might put their hands in their mouth, they might bob their heads up and down when you’re doing skin to skin and lying back with them, and they might start to become a little bit more active like kicking their legs and moving around.

The next stage is often referred to as the rest stage, and it doesn’t necessarily come in order. It might happen after that first activity stage, but it might happen at any point in between these 9 stages. Sometimes this rest stage is misinterpreted as “well this isn’t working, we’re going to put the baby down and have a shower,” but actually we think that the rest stage is really important for consolidation of memories. Just like us when we go to sleep, our brain is consolidating what’s gone on the day before. The rest stage is important in this process for babies to work out what they’ve just done and add that to their learning.

So once you baby has had that little rest they will then pick up from where they left off, and the next stage is the crawling stage. Did you know that your babies can crawl when they’re first born? Not like a 9 month old would crawl, but they do a very primitive arm-circling motion, and they do little kicks with their legs, so they do almost a commando crawl up mum’s body to reach the breast.

The next stage they’ll do is the familiarization stage. This sounds a bit complicated, but we just call it hanging out and getting to know you. This when they reach the breast and they do head bobbing, they may lick and nuzzle against the breast and just work out what they need to do. This stage can take around 20 minutes so it’s important not to interrupt your baby during this stage, not to help it onto the breast, but just to allow your baby to take its time.

The next stage your baby will attach to the breast and start to feed, and suckle. So once your baby has fed, they’ll then go into a sleep, and we know that the first two hours after birth are a really good time to let your baby have their first feed because they are alert and awake and responsive to trying to feed. After two hours they tend to get a little bit sleepy and they’re not as receptive to feeding, so it’s really important that you do try to feed your baby.

Now if you don’t want to breastfeed your baby it’s still really important that you do skin to skin with your baby for relationship building, but also it’s really good for your baby in general. It helps to regulate their heart rate and their breathing, it helps to release endorphins in you and your baby to help you recover from the birth. It releases oxytocin, that feel-good hormone or hormone of love, and helps you to bond with your baby.

The other thing that’s happening when your baby goes skin to skin and is licking and nuzzling against your skin is it’s taking on the friendly skin bacteria that mum’s body is colonised with, and the baby takes that into its system and colonised its gut and helps to set up its own immune system and get that started. So it’s really important that you do skin to skin even if you’re not going to breastfeed, just to help support your baby’s immune system.

So we’ve already talked about some of the benefits of skin to skin, the other thing it does is help to regulate your baby’s temperature. We know that mum’s body is a really warm place to be, the breasts have got a very good blood supply because they’re getting ready to make milk for your baby, and so placing a baby skin to skin can be a really good way to keep the baby warm. Because your baby is nice and warm and that skin to skin is helping to regulate their heart rate and breathing and they’re not stressed, it also helps to stabilise their blood sugars. So again it’s a really positive thing for your baby.

The other thing that skin to skin impacts on is hormones in breastfeeding. One of these is oxytocin, and we’ve already talked about oxytocin as the hormone of love, that hormone that helps you to connect with your baby, and oxytocin is really high when you’re doing skin to skin. But in breastfeeding it’s involved because when a baby goes to the breast it sends a message to mum’s brain to release oxytocin, and that then travels back to the breast to the milk making cells, and around those milk making cells there’s a little layer of muscle cells that the oxytocin acts on and it contracts those muscle cells and squeezes the milk out into the milk ducts down to the nipples so that the baby gets the milk. Oxytocin is raised when you’re doing skin to skin so it’s really beneficial for breastfeeding.

The other hormone that’s involved in breastfeeding is called prolactin, and prolactin is all about milk supply, so it helps to drive that milk supply in the early days and weeks of breastfeeding. What happens when a baby feeds at the breast is as they remove milk from the breast, a message is sent to make more, so it’s supply and demand, and prolactin is involved in that. But when you do skin to skin your prolactin levels are raised so it can be a really good way, in addition to feeding your baby, to boost your milk supply.
Feeding Your Baby

In this section we’re going to talk about your baby’s feeding cues. Often when we talk to parents about what their baby might do to let them know that they’re ready for a feed, the thing that parents suggest is crying. Crying is a feeding cue but babies will do other things too.

If we think about early feeding cues, that’s things like your baby stirring, so they might still be asleep but they’re just starting to come to. They might be starting to open their mouth, and they might turn their head as if they’re looking for food. They’ll do that especially if something touches their cheek, this is called “rooting” and it’s an instinctive behaviour. So they’ll do that if mum is holding them at the breast and they’ll turn down towards the breast, but they’ll also do it on your shoulder or your arm, or even if your fingers are on their cheek they might turn to that rather than whatever you’re trying to put in their mouth, so make sure that when you’re holding your baby to feed them, your hands aren’t actually on their cheeks but further back, and you’re holding them across the top of the shoulders.

These early cues have no sound attached to them, so in order for you to be able to spot them you need to keep your baby close so you can see what’s going on. Keeping your baby close is one of the first principles of Responsive Feeding which we’ll be talking about later.

As time goes on your baby moves into the mid cues, so your baby is starting to stretch and increase their physical movement, they might start to circle their arms. Do you remember when we talked about babies during those nine stages or skin to skin when they’ll move up mum’s body and do that commando crawl, that’s the arm circling working, but they may also do that on their back. They’ll put their hands in their mouth and they’ll just to get a little bit more active and start to make little noises, and that’s them saying “hello, I’m a little bit peckish now, can you feed me please?”

These early to mid cues are a really good time to start to feed your baby, because the next thing that’s going to happen is they’re going to move into the late cues. Crying is on this list. Crying is a late sign of hunger, we often talk about it like crying is your baby saying “I’m starving, feed me now,” and if you’ve ever gone a few hours without food and then you’ve got home and gone to the cupboard, you’re probably not making logical food choices and you’re just grabbing whatever you can. If you think about your state of mind when you feel like that, that’s what babies feel like too, and they can get a bit frantic when they get to that crying stage. You can be trying to feed them and saying “food is here,” and then can be saying “where is it, I can’t see it?” So it can feel very stressful for you and very stressful for your baby, and we want to avoid that stress because we know that when babies are calm their brain development is at its absolute best.

The other thing that happens when a baby cries is that its tongue lifts up towards the roof of the mouth. We think that’s a protective mechanism that prevents anything getting sucked down their airways. If you think about it, the baby’s tongue is up when its crying, but it needs to be down when it’s feeding. The tongue needs to come out of the mouth, over the lower gum and scoop in the breast or the bottle, so if a baby is crying you’re going to find it very difficult to feed them. What you need to do is calm them down and then try to feed them to avoid that difficulty.

Hopefully you can see from this that those late cues are things to avoid if possible. We know it’s the real world – sometimes you might have seen your baby sleeping and gone for a shower and by the time you get back your baby has gone through those early cues, gone through the mid cues, and you’re at the late cues. We know that every now and then that might happen, but the vast majority of the time you can look for those early cues and the mid cues and start the feeding process then. It’s going to be a lot calmer for you and for your baby.

We’re going to talk about responsive feeding and what that means. The first thing is following the feeding cues like we’ve just talked about, and this goes for whether you’re breastfeeding or formula feeding. The only thing that your baby needs for the first six months is milk, whether that’s breast milk or a first stage infant milk. Then at six months of age you start to introduce solids. Then by a year of life they will predominantly be solid-fed, with some milk feeds continuing. If you’re breastfeeding you continue to do so through introducing those solids, and if you’re formula feeding you use the first stage infant milk through that process.

What does responsive feeding mean? If you’re breastfeeding, as well as following the feeding cues, it’s about knowing that you can feed your baby at any point. Babies get a lot from breastfeeding, not just nutrition. It’s about comfort for babies too, and that’s not a bad thing. It can be a really useful parenting tool that if your baby is upset, or in pain, or tired and they need a little bit of help to go to sleep, then actually you can breastfeed your baby and it will help them with that process. If your breasts feel full and uncomfortable then you can feed your baby to help you to feel a bit more comfortable. If you know that you’re going out for lunch then giving your baby a little feed before they were ready to feed might help you to get through to pudding before you need to feed your baby again. Responsive feeding works both ways, for mums to fit it in for them (perhaps before the school run for the older children) but also for babies, knowing that babies will breastfeed for reasons other than hunger and breastfeeding for comfort is fine. It’s always ok to offer the breast and you cannot overfeed a breastfed baby.

We’ll talk about what responsive bottle-feeding means in a little while, but we’re going to focus now on why you might breastfeed. As a health service we recommend and encourage you to breastfeed your baby, and the reason for this is that we know from the evidence that there are lots of benefits for you and your baby if you breastfeed.

If you don’t breastfeed, and decide that you don’t want to do it or you’re unable to breastfeed (we know that there’s a small proportion of women who because of medical conditions are not able to breastfeed) and of course there are babies with medical issues that stop them from breastfeeding too. We will make sure that you are supported and we will make sure that you get really good information about how to care for your baby. But if we think about the value of breastfeeding and the reasons why you might breastfeed, we know that if babies are breastfed they’re less likely to get gastroenteritis which is a stomach bug that can require hospitalisation. They’re less likely to get ear infections, they’re less likely to get upper respiratory tract infections, they’re less likely to get diabetes, they’re less likely to be overweight or obese in childhood, and breastfeeding also protects against Sudden Infant Death Syndrome. There’s a whole host of other benefits and you can see these on the Unicef Baby Friendly website. For mothers it also reduces your risk of breast cancer and ovarian cancer.

If we think about the practicalities, breastfeeding is free, it’s set up and ready to go, and there are estimates that say it can cost around £1000 a year to formula feed your baby, so that can be a big consideration for some families.

The other thing about breast milk is it’s there, on tap and is immediate. You don’t have to make up a feed or buy formula milk, you don’t have to sterilize bottles, it’s there and ready to feed your baby as soon as they’re ready.

In the first few weeks of breastfeeding it’s definitely a steep learning curve and you might feel that you’re spending more time feeding your baby than a friend who is formula feeding. But actually as time goes on breastfeeding can become really quick and convenient that you can just lift up your top, put the baby on, they feed and you’re done, with no need for any extra equipment. So there’s lots of reasons to breastfeed and even if you’re not sure about it, you don’t have to make a decision until your baby is born. You might find than when you do skin to skin you think: “well I might just let them do this first feed,” and what your baby will get from those first feeds is colostrum which is this amazing first milk that’s power-packed with antibodies.

Antibodies are disease-fighting substances, so when you’re poorly you produce antibodies to help you get better and to protect you in the future. Breast milk passes those antibodies out to your baby so your baby will get antibodies you already have, so if you’ve had chickenpox you’ll pass those chickenpox antibodies on to your baby, so they either won’t get chickenpox at all or they’ll get a much milder dose.

Breast milk is also really responsive to the environment you’re in, so if you pick up an illness your body will make antibodies against that illness and very quickly it will pass out through your breast milk to your baby to help to protect them. It’s really important for your baby, when their immune system isn’t fully developed, that breast feeding can actually support this. So even if you do the first feed or the first few feeds before moving onto formula feeding, that has value. It’s worth you doing it. Sometimes mums aren’t sure about it but do end up enjoying it and end up feeding when they didn’t think that they would do that. We work on the premise that any breast milk is better than no breast milk, so if you’re doing one breast feed a day, if you’re giving your baby one bottle of express breast milk a day, or you are exclusively breastfeeding, it’s all worth it. So whatever you can do, we’re here to support you so that you can do that.

In this section we’re going to talk about how to position your baby at the breast, and we follow the acronym CHINS. What this means is it spells out the key factors that you need to consider when you’re going to position your baby.

The first one of those is Close. So the “C” of “CHINS” is “holding your baby Close”. It’s really important that your baby can get close enough to the breast so it can get a deep mouthful of the breast. Things that can get in the way of this are your baby’s arms – remember those arm circling feeding cues that your baby does? Well they make it really difficult to feed your baby when you’re trying to bring them to the breast, so the temptation is to wedge the baby’s lower arm in and hold the baby against them so they only have to deal with one arm waving about. But if I turn sideways, can you see how much distance there is between the breast and the baby? This can make it very difficult for a baby to actually attach to the breast. Look what happens when I slip that arm out of the way, how instantly that baby can get closer to the breast. That’s really important because what your baby needs to do is to get a nice big mouthful of breast.

If I demonstrate with my knitted breast, when a baby attaches to the breast what it should do is take a wide mouthful of breast and go onto the breast like this. Imagine my thumb is the baby’s tongue and it does this kind of wave-like motion to draw milk out of the breast while oxytocin is contracting the milk cells and pushing the milk out of the breast. Imagine my fingers are the top of the baby’s mouth, so their hard palette and then going into their soft palette. You can see that if a baby is well attached it actually isn’t touching the nipple at all, the nipple is right in the back of the mouth right up against the hard palette and milk is just going down the baby’s throat.

But if a baby is poorly attached and it can’t get close enough to the breast then what happens is it will still attach but it will just go onto the end of the nipple. Look what happens to the nipple now when the baby is drawing the milk out of the breast using its tongue. You can see that that nipple is being pinched against the roof of the mouth, it’s being rubbed so there’s lots of friction going on, and this is how women end up with cracked nipples which shouldn’t ever happen when you’re breastfeeding. But that skin can get rubbed away and you can see that that nipple is really being compressed and that can be very uncomfortable for mums. You can also probably see that the nipple looks a bit squashed, and sometimes mums will report to us when they’re having pains during feeds that their nipple looks pinched, almost like the end of a new lipstick, after a feed. What your nipple should look like after a feed is a little bit longer but it should be a nice rounded shape, it shouldn’t be squashed or pinched in any way, and breastfeeding should be comfortable. You shouldn’t be sitting there crying, you shouldn’t be dreading every single feed because it hurts so much. If you’re in that situation please get help, please ring us on our SPA number.

It can be quite common in the first couple of weeks of breastfeeding for it to feel like a really strong sensation when a baby first attaches to the breast, because what a baby does when it attaches to the breast is it does these quick sucks when it first goes to the breast, and that sends a message up to the brain to release the oxytocin to release the milk out to the breast to the baby. But those quick sucks are also stretching the breast tissue into a teat for the baby. So those first 20 or so seconds of a feed can feel like a really strong sensation while that stretching is happening. After a couple of weeks generally your breast tissue gets used to it and you don’t feel that strong sensation anymore.

But what should happen regardless even in those early weeks is after those first few quick sucks the baby’s sucking changes to long deep sucks and swallows, you’ll see your baby’s chin bounce down and pause as it swallows and when your baby is doing that it should feel comfortable for you. It’s not sensation-free because there’s a baby at your breast, but it should feel completely comfortable. As the feed goes on your baby’s sucking might change, they might have another surge of milk letting down and so they might do these quick sucks to stimulate that and then they might go back to these long deep sucks and then as the feed ends they might go do some little fluttery sucks, not always but sometimes they do, so it’s important to let your baby finish that first side and not cut off a feed after a certain amount of time. This means that they’re going to be accessing all of the milk that they need and they’re able to regulate exactly what they need.

When your baby’s finished on that first side it will either come off the breast, or they might fall asleep at the breast, in which case if you need to take them off you can get your little finger and slip it into the corner of your baby’s mouth to break the seal and then lift your baby off the breast. At which point they might go: “ooh I wasn’t quite finished yet,” so then you can offer the second side. We call this “main course” and “pudding”. Some babies will always want pudding, some will never want pudding, and some will just see how they go, so it’s about finishing the first breast and then offering the second breast. If your baby does have a bit of a feed on the second breast, the next feed you would start on the side that they just had their pudding, just to even out the supply. Remember your milk supply works on supply and demand, the more you feed your baby the more milk they’re removing from the breast, or if they’re not able to feed then the more that you express your milk, the more milk that you’re going to make. In the early weeks of breastfeeding this is really important because you’re setting up those messages of how much milk you need to make for your baby. Try to avoid introducing bottles, avoid stretching out that time between feeds, and being responsive to your baby’s feeding cues is the best way to make sure that you make a full milk supply for your baby.

After Close the next thing we need to think about is that our baby’s head is free to tilt back. Often we’re told when we’re holding babies to support the head, but what’s going to happen if you hold your baby’s head is that you push your baby down towards the breast, and if you put your chin on your chest now and try to swallow you can see that that’s actually really difficult. So we want your baby’s head to be free to tilt back. The way that you hold your baby is you put your hand across the top of their shoulders and the bottom of their neck, not even on the neck, because if I put my hand behind my neck that restricts my movement and I can’t tip my head back as much as I need to, whereas if I take it away I can move my head much more freely.

Hold your baby across the top of the shoulders and then make sure that their head, spine and legs, are all facing in the same direction. What we don’t want is for your baby to be turned towards the breast like this, because that’s like us trying to put our chin over our shoulder and trying to swallow, which is really difficult and we can’t do it. So we need to make sure that our baby is nicely in line, and that’s our next element.

We’ve got our baby nice and close with their arms out of the way, we’ve got the head free to tilt back, we’re holding our baby across the top of the shoulders, we’ve got our baby nice and in line. If your breasts are larger your baby might be a bit flat on its back but it’s still in line.

Then what we’re going to do is line our baby up “nose to nipple”. That’s the “n” in our “CHINS” acronym. You’re going to make sure that your nipple is pointing up towards the baby’s nose, so it’s not on the nose but just pointing up. What this means is that as your baby tilts its head back then it can end up in the right position.

If you started your baby off mouth to nipple, which would make logical sense, but what happens when a baby tilts its head back, you can see that that nipple ends up too low. It will go into the baby’s mouth but it will end up where the hard gums are and where the tongue is, all that hard friction and compression. So if we start a baby off with their nose opposite the nipple, then actually once that baby tilts its head back you can see that the nipple just slips under the lip. As the baby’s chin bounces against the breast it will trigger your baby to open their mouth wide and at that stage you need to hug your baby on and bring them to the breast.

Remember in this upright feeding position your baby is not being supported by gravity, gravity wants to take your baby away, so you do need to hug your baby in to bring them to the breast. When a baby is well attached you’ll see something like this where their nose is clear of the breast, their chin is indenting the breast so it’s really dug in, and their cheeks are so close to the breast they’re making contact, so there’s no gaps there. You can see much more of the areola which is the dark bit around the nipple on the nose side of the baby rather than on the chin side. These are signs of good attachment.

What that looks like when you’re holding your baby, is you’re making sure they’re nice and close, tucking them under the opposite breast so they’re almost in a diagonal position, their head is free to tilt back so you’re ensuring that you’re not holding them on the head, that they’re nicely in line. Then you’re going to line them up nose to nipple and bring them nice and close to the breast, and as their chin bounces against the breast they will open their mouth and you go: “on you go baby,” and you hug your baby in.

Once your baby is on in this position, you won’t be able to hold them for the average feed of 5-40 minutes, so you can bring your other arm round, slip the other one out of the way so that you can have your drink or your phone, and then you can snuggle back and be nice and comfortable. If you want to put a cushion under your arm to support its weight then you can. We don’t recommend feeding pillows generally because they tend to make babies either too low and mum’s bending down to get to their baby, or they make them too high and mum’s are feeling like they need to lift their breast to get to the baby’s mouth. The problem with lifting your breast into your baby’s mouth is that as soon as you let go the weight of your breast will put out of your breast and they won’t be able to stay on the breast.

These are our principles: we’ve got the baby close, with their head free to tilt back, we’ve got them in line so their head, their spine and their legs are all in the right position and then we’re lining the baby up nose to nipple, we bring the baby on, and then we make sure it’s sustainable, that we’re comfortable and can sit there and enjoy that feed for as long as it needs to take.

You might find during your breastfeeding journey that you might want to express some milk for your baby, and in this section I’m going to talk about how to hand express milk for your baby. You may also want to do this if you decide not to breastfeed, your body doesn’t realise in the early days that you’re not going to breastfeed and what happens is that your breasts become very full at the end of day 3 and beginning of day 4, and that’s called your milk “coming in.” If you’re not breastfeeding and you are very uncomfortable then you could hand express a tiny bit off just for your comfort, but remember the more milk you remove the more milk you’re going to make, so you really want to minimize that if you can if you’re not going to breastfeed. If you decide not to breastfeed, by the end of the first week generally you’re body’s got the idea that you’re not going to breastfeed the baby and you’ll stop making milk.

If you do need to hand express your milk this is how you do it. The first thing that you want to do is do a little bit of breast massage, and what this does is skin to skin so it helps to raise those oxytocin levels, and remember oxytocin helps to move that milk through the breast. So we’re just waking up the breast and telling it that there’s work to be done. Any of the ways that I’ve demonstrated here will work, just for 30 seconds to a minute just to wake up the breast.

The next thing you’re going to do is make a C shape with your thumb and your index finger. What we often suggest mums do is that they start at the nipple. This may feel a bit tough and fibrous, and then if you move back a bit further it will feel a little bit empty like a bit of cushion that’s lost its padding. Move back a little bit further and you’ll notice a change of texture. It might feel a bit more solid or lumpy or bumpy, but it’s the change of texture that you’re looking for and that’s usually around 2-3 centimetres back from the nipple. Once you’re on that spot you’re just going to compress and release repeatedly. You’re going to avoid dragging your fingers along the breast because that can cause trauma and make you sore, so keep on this spot and after 30 seconds or so you should start to get some drops of milk. If it’s colostrum that’s all you’ll get, little drops, but if your milk is already in you may well get sprays of milk and you’ll need to collect that in a sterilized container.

Once that milk is flowing then you stay on that spot compressing and then you get that flow of milk so holding it on while the milk is flowing and then compressing and releasing repeatedly. Once it’s stopped flowing or slowed down you rotate your fingers around the breast to access another lot of milk-making cells. Then you repeat that process. If milk’s not flowing at all you might need to move your fingers forward or back a bit. Once you’ve finished expressing from one breast you can then move on to the other breast if you’re doing it to collect lots of milk. If you’re just doing it to soften the areola around the nipple, which makes it easier for the baby to attach, you might do this in the early days if you’re really full, or if you’re doing it to clear a blocked duct, then you can just stay on that one side. That’s how you hand express.

In this next section we’re going to talk about how to hold your baby when you’re bottle feeding your baby. You might have expressed breastmilk in this bottle or you might have a First Stage Infant Formula in this bottle. What you’ve probably seen when a baby is being bottle fed is they’re being held nice and close and the person that’s feeding them is making lots of eye contact with their baby and that’s a really good thing, that’s really important for their brain development. Probably the bottle is being held like I’m demonstrating and actually this can be quite difficult for a baby, because you can see from this that this bottle is quite upright and if this was full of milk gravity would be acting on the flow of that milk and making it come out quite quickly. Where the baby’s head is wedged against my arm, it can’t move its head back to say “I’ve had enough, it’s coming too quickly,” so babies can feel quite overwhelmed and they have to just keep on sucking and swallowing because that milk is flowing out.

What we encourage you to do if you’re bottle feeding your baby is to sit them more upright. Have them more upright and still hold them close and make eye contact, it’s such an important part of your relationship with your baby. Before you put the bottle in, you’re going to stroke the teat to the top lip. Just like when you’re breastfeeding and line up nipple to nose. Then your baby will open its mouth making sure it’s ready rather than that bottle coming in from nowhere. Once the baby opens its mouth you’re going to gently put that bottle into the baby’s mouth. You can see the position of this bottle is much more horizontal. There will still be milk in the end of the teat so the baby’s not taking in air, but this baby now has much more control. It’s much easier because their head isn’t wedged back by gravity for them to turn away if they’ve had enough.

So you hold your baby like this and let them feed, but what we want to do is to pace the feed every few minutes. What that means is actually taking the bottle away or tilting the bottle down so your baby can work out if they’ve had enough or if they want more. They will let you know if they want more, and then you repeat that process, so stroke the teat to the top lip, baby opens their mouth wide and you put the bottle in. As the bottle of milk gets emptier you may need to tilt your baby down a little bit so that they can get all of the milk that’s in that bottle, but because gravity won’t be acting on the larger volume of milk it won’t be as overwhelming for your baby.

When we think about how much milk your baby should take, use the instructions on the tins of formula milk as a guide but they are a guide. There are 700,000 babies born in the UK every year and the instructions and volumes on those tins don’t match all babies. Use it as a guide of how much milk you should make up but never force your baby to finish a bottle. Their appetites vary throughout the day just like yours does, so sometimes they might want the whole bottle but sometimes they might only want half of it. Please don’t make them finish their bottle and force those final bits in when your baby is showing signs that they’ve had enough.

So what might they do? Feeding cues at the beginning of a feed are just like we discussed in another video, when they’re telling you that they’re ready for a feed and you follow those, but you also need to think about cues for if they’ve had enough, and what a baby will do is turn their head to the side, stop sucking, spit the teat out, or they may even push away with their hands. Milk might start to spill out of their mouth because they’re no longer swallowing it. Look for those signs that your baby is telling you they don’t want to feed anymore and then stop that feed.

What else is really important is to limit who feeds your baby. Often bottle feeding is thought of as a time where anyone can feed the baby, but actually for your baby that’s quite stressful. People hold the bottle different, they move the bottle around, they smell different, or they might wind them differently, so for your baby it’s not necessarily a pleasant experience. They just want you. So we encourage you to limit the feeds to mum and then partner. If you had someone in your family that was going to have a strong close relationship with your baby and see them frequently then that’s ok but really it should be mum doing the majority of the feeds. We want your baby’s brain to be in a nice calm state and for them to feel safe and secure because that’s the best environment for their brain to develop. Please limit who feeds your baby so they can get the most out of that feed.

In this section we’re going to talk about how to make up feeds safely and also a bit about sterilising feeding equipment. I direct you to the Guide To Bottle Feeding leaflet which you can access on the Unicef Baby Friendly UK website, and you can also get information about how to make up feeds safely on the NHS Choices website. We’ll just go over a summary here.

It’s really important that you know that the only milk your baby needs for the first 12 months if you are formula feeding is a First Stage Infant Formula. There is no need for your baby to move on to follow-on milk when they hit 6 months old, First Stage Infant Formula is fine for 12 months and then you go on to full fat cow’s milk. Again there’s no need for these growing up milks or toddler milks, cow’s milk is fine once they reach 12 months. In terms of brands of formula milk we don’t recommend any special brand. By EU law they have to comply with a certain level of nutrients, fat, carbs, protein, vitamins and minerals in them, so all formula milks will have those in them whether you choose a budget brand or the most expensive brand.

Think about what you can manage in your budget, think about what’s available in your local shop, and if you need to change brands because the one you usually use isn’t available that’s ok because they’re all within the same range of ingredients and made up the same way.

When you are bottle feeding you need to sterilise all feeding equipment. What you do when your baby has finished its bottle is tip away any milk they haven’t drunk, you can’t save that, and then you’re going to take the bottle apart. Then you’re going to wash all of those in hot soapy water and rinse the bubbles off. You need to make sure that you use a bottle brush to get into all of those nooks and crannies where milk residue can gather, because that’s a really good breeding ground for bacteria. Once you have washed it thoroughly and rinsed it, it then goes in your steriliser. There are different sorts of sterilisers, you can use cold water sterilisation methods with chemical tablets, or you can use steam sterilisers, you can use microwave sterilisers, just follow the manufacturer’s instructions according to how you would do that.

When you’re ready to make up a feed it’s really important that you know that you need to make up each feed as you go along. The reason for this is because it’s been discovered that there could be harmful bacteria in powdered formula milk and so by making up each feed as you go along you are minimising the risk of that bacteria being able to grow and multiply within that bottle of milk.

The way you make up each feed is that the first thing you need to do is boil the kettle. You need to put about a litre of water fresh from the tap, not bottled water as the mineral content is too high, so just cold water from the tap. Once it’s boiled you have about 30 minutes to make up that feed because what’s really important is that the water is above 70 degrees Celsius in order to kill the majority of the bacteria that might be in the formula milk so you have to add the formula to the water while that water is still hot.

Put the water into the bottle according to how big a feed you want to make up. Always put the water in first, if you put the powder in first you can make the feed too thick and concentrated and that’s not good for your baby’s tummy. So you put the water in first and then add the scoops of milk from your tin of formula milk. Scoop up the formula, level it off with a flat knife so you’re not packing it down or giving an extra heaped scoop, you’re going to make sure that that’s level. Always use the scoop that came with that tin of formula milk because there’s a possibility that it might change sizes so use what’s come with that tin. However many scoops it says in accordance with the size of the feed that you’re making.

Then you’re going to put all of the bottle components back together. Obviously you will have washed your hands before this and you can also get tongs to pull the teat through, but fingers are fine. Screw the lid back on and gently mix that bottle so the powdered milk dissolves. You have a bottle of made up formula milk but it’s 70 degrees Celsius, it’s way too hot to give to your baby. What you need to do now is cool down the bottle of milk. Run the bottle under the cold tap making sure the lid is still on or put it in a jug of cold water to cool it down. Test the temperature by dotting some milk onto your wrist – if it feels hot then it’s still too hot and you need to cool it down a bit more. If it feels your body temperature then it’s perfect to give to the baby. If it feels a bit cold and you’ve gone a bit too far with the cooling process it’s still safe to give to your baby, never reheat milk in a microwave as it’s very unsafe, it can develop hot spots that can scald your baby. If it’s a little bit cold then don’t worry, it is safe, you can go ahead with that feeding process.

The guide to bottle feeding leaflet that you can get from the Baby Friendly UK website has also got information about how to cope with feeding your baby when you’re out and about and what the best thing to do is in those situations so please do look at that for a written guide and for further information.

How are you going to tell if your baby is getting enough milk? This is true whether you’re breastfeeding or formula feeding. We look at how our baby’s behaving – are they happy after a feed? Are they contented? Are they growing and putting on weight, filling out their baby-grows? The other really good sign of how much milk your baby’s getting in those early weeks is your baby’s nappies. This knitted nappy shows the colours of poo that your baby will go through when it’s born.

When they’re born it will pass this lovely black tarry poo called meconium. That lines their gut in the third trimester so it’s there and ready to come out. As food and milk gets into their system the poo goes through these different colour changes, so by the time your baby gets to day 4 or 5 it’s changed to this lovely mustard-coloured poo. We expect by day 4 or 5 for your baby to be doing at least 2 £2 coin sized poos a day and at least 6 heavy wet nappies a day and that reassures us that they’re getting enough milk. If they’re doing more than 2 poos a day then the more poo the better, we like that very much.

You can find more information about this if you look on the Unicef Baby Friendly website and look for the “off to the best start” leaflet which will have lots of information about nappies and what they should look like and this information is also on the NHS Choices website.
Bathing your baby and changing nappies

My name’s Alison, I’m a family support worker with the Children’s Centre team here in central Bedfordshire. I’m going to talk about nappies, how to change a baby, caring for your baby, we’re going to go on to do some safe sleep and some car seat safety (please see other videos for these).

First of all we’re going to talk about nappies and the contents of your baby’s nappies. You will get asked quite a lot from your midwife and health visitor how many wet and dirty nappies your baby is having every day. You should be expecting to change your baby up to around 10 times a day in the first few weeks. The contents will vary greatly, for the first 2 or 3 days your baby will produce a black sticky substance called meconium which will look a bit like this, it can be a bit oily, thick and dark. Then after the first few days when all the meconium has passed through it will start to look a bit like this. It will be more green, there might be a few bits of black strain in, it might look a bit like spinach. Then once all of that’s out the way eventually it will start to look a nice bright yellow colour a bit like mustard or korma. It shouldn’t smell until about day 10 once the colour of the nappy has changed, and then depending on how you feed will determine what the colour of the poo is.

If you’re breastfeeding your nappies will still stay a nice yellow colour, if you’re formula feeding it will start to take on and resemble poo as we know it to look like and it will be more brown and it will certainly be smellier. Breastfed babies’ poo tends to smell quite sweet, I think it smells like toffee yoghurt, but it will still be a nice bright yellow colour. You might get seeds like a seeded mustard in the yellow poo but that’s just the bits of fat that haven’t broken down and is all perfectly normal.

If you see blood, you may see a few spots of blood, that’s when you need to speak to your health visitor or your midwife. Keep the nappy and take a picture of it and just show them if you’re not sure, and they can tell you whether that’s normal or not.

If you have had a baby girl you might also see a bit of vaginal discharge or bleeding, if it’s only a few spots this is absolutely normal, but if it’s more than a few spots you do need to raise that with your health professional.

When we change our babies what we want to do is keep them as safe as possible. The safest place to change a baby is on the floor with a changing mat and a towel. The reason we say that is because the baby can’t fall off. However if you can’t get on the floor and do it on a table that’s waist height, this is the perfect height for you to not bend over too much, but do make sure that you keep an eye on your baby at all times. If you turn your back or walk away babies can still move their feet and wiggle and this can cause the mat to slide off. So if you need to do it on the table please make sure that you watch your baby at all times.

We want to start off by undressing the baby. We want to change baby as soon as they have a dirty or wet nappy. They have very sensitive skin and it gets sore very easily. It doesn’t matter what type of nappy you buy, they’re all very similar these days, whether you buy the premium brand or the supermarket brand, they’re all made up of the same thing. The reason this line is down right around the nappy that indicates when they have a wet nappy. They have a gel lining with crystals down the middle of the nappy to absorb the urine, so as soon as the baby’s had a wee the indicator line will change colour but the gel crystals draw the urine away from the baby’s skin and it stops them being wet. If we then add any type of barrier cream or nappy cream it will stop the nappy from working so we would suggest that babies don’t need nappy cream unless they’ve got nappy rash. All it will do is prevent the crystals from doing their job and therefore not draw the urine away from baby’s skin. It will sit on their skin and cause nappy rash. You will know when your baby has nappy rash – it’s very red and sore and the best thing for that is fresh air. When you’re changing baby, take their nappy off and clean them up, if you let them have a bit of a wriggle around then that way their nappy rash will clear up. You can add a little nappy cream if you want but a very thin layer and only when they’ve got nappy rash.

When changing a baby, what you should do is hold their toes or ankles, lift up most of the waist and then get rid of the dirty nappy. This is a top and tail dish for two sets of water – one side is for the face and the other is for the bottom. We also suggest using cotton wool rather than baby wipes, wipes can be quite harsh on baby’s skin and if you use them frequently throughout the day it will dry the baby’s skin out and cause irritation. Plain water and any type of cotton wool balls or pads will be more than adequate for cleaning your baby and a lot gentler on the skin.

When cleaning your baby, take a little bit of water and always wipe front to back so that you don’t spread any type of infection, making sure that you get in the creases here, and at the back babies have a little dimple above their bottom and waste can collect in there, so make sure that you clear out that dimple. With boys you need to lift the testicles up and clean around them, but don’t pull back the foreskin on the penis because that can cause infection, and with girls don’t wipe inside the vagina just wipe from front to back so that you don’t cause any infections.

Once they’re all clean you can put on a new nappy. A lot of the nappies will have a little dip, they’re made like that, some don’t, but that’s to sit under the cord. If there isn’t a dip on the nappy just turn the nappy down so it’s not pushing the cord into the nappy, it’s just sat outside of the nappy. That’s also the same with little boys, make sure that the penis is not upwards and that it is down otherwise it will be uncomfortable.

Once the nappy is on and you lift baby up it should be tight enough so that the nappy doesn’t fall down, but not so tight that you can’t fit your fingers down the waistband meaning that babies can move and aren’t restricted.

When they’ve got the nappy on you can dress them again. Baby grows are the easiest type of clothing when you have a young baby, with the poppers, that way you can lay it down onto your changing mat and you can lift your baby onto it and dress them. Or if you have these little vests you can see at the top they have what we call “envelope” sleeves – these are designed so that you can pull them down over the baby. If they’ve had an explosion out of the nappy we don’t want to be lifting up over baby’s head in case they get mess into their mouth or on their face. Always bring their clothes downwards or open with the poppers.

When buying clothes, if you take them out of the packaging to wash them, turn them inside-out and just check to make sure there’s no loose threads in the seams. Sometimes you can get a long hanging thread, especially on things that have little toes just in case it gets wrapped around a finger or toe and cuts off the circulation. Just make sure that you do that with all of your clothing before you put them on your baby.

Normally if you’re just changing a nappy then you would be all done here, but if you’re doing top and tail, which you only need to do this a couple of times a day, we suggest that you do it first thing in the morning when baby wakes up and you take them out of their nightclothes and put them into their day clothes, and then again at the end of the day when you do the reverse.

Same thing again, we’re going to change which side of the water we’re using, one side for face and one side for bottom. Take some clean cotton wool, clean their eyes from inside to outside and then get rid of that piece of cotton wool. Then do the same on the other side from inside to outside, and get rid of that piece of cotton wool. So if they do have something in their eye we’re not transferring the infection from eye to eye. With another fresh piece of cotton wool we’re going to wash baby’s face all around. Take care that you clean behind the ears, because babies feed lying down the milk can dribble and collect behind the ear and go crusty, so make sure that you get behind the ear and do the same underneath their chin. Babies tend to have lots of layers beneath the chin and their milk can dribble, so just make sure to get right underneath the chin.

Once their face is nice and clean you can lay them down on the towel and pat them dry. Do the same with their hands; just make sure that you wash in between their fingers and toes. That’s all they need a couple of times a day.

When you’re bathing baby, we only suggest you bath them a couple of times a week, wait until the nappy cord has come off. It’s usually off by about day 10. If you bath while they’ve still got their cord on chances are that you might cause an infection, so what you want to do is wait until the cord has gone completely, then you can start bathing them.

It might be a little bit scary for the first time that you do it. It doesn’t need to be a proper baby bath like I have here, it can be anything that holds water, but you want the water to be around body temperature. You don’t need it completely full, it can be around half full, just enough for the baby to be able to splash about. Again, make sure that your baby isn’t tired or hungry or feeling grouchy, you want them to be nice and relaxed, and you need to be relaxed. If you’re nervous about bathing then make sure someone else is in the house with you so you have someone who can help you. You want to pick a time where you’re free so that you’re not rushing and we’re going to do the exact same as when you’re top and tailing.

Do the face first, leave the nappy on while you wrap baby up in the towel. Have a good hold on them underneath your arm so that you have a really good position and wash their hair. Use either a sponge or some cotton wool in the water. The water needs to be around body temperature and the best way to test this is to dip your elbow. If it’s too hot and you can feel it on your elbow then it’s too hot for the baby. You can get a thermometer as well but it needs to be around 37 degrees.

Just put a little bit of water on their head – you don’t need to use shampoo and don’t need baby bath soaps. Just put their hood up, you don’t want to rub their head because it will just cause friction, just pat them dry. If they have lots of hair and they’ve not been bathed since birth, and they have a lot of blood and matter in there, you can put a little drop of shampoo on just to get that out. But generally speaking don’t use any shampoo. If they have lots of hair then just use a soft baby brush to brush them over. Some babies will also have something called “cradle cap” which is a thickening of the scalp. Don’t be tempted to pick it, don’t try and brush it out, you can buy cradle cap oil that you can add to it and rub a little bit on the top of the scalp just to soften it, but it’s best just to leave it alone.

Once baby has had their hair washed and they’re all dry then you can take off their nappy. Be prepared, especially if you have a boy, that this is where they will wee. If you hold either the towel or the nappy in front for them to wee into, they won’t get you. If they’re dirty just give them a quick clean with some cotton wool before you put them in the bath.

If you’re moving downstairs with baby and holding them in the crook of your arm, make sure to have a hold on their limb, with one hand holding on to the rail as you come downstairs, that way if you do drop baby then at least you’ve got a good hold on them if you stumble or feel feint or anything like that. It’s a safer way of carrying them.

As you put them into the bath just gently pop them in, smile, relax, and give them a splash. You can you a sponge or your hand or some cotton wool to splash them. You don’t want them in there very long in case they get too cold. If you’re confident, you can turn your baby over and wash their back as well. Make sure that all the time you’re talking to them, you tell them what you’re doing, and you’re relaxed and smiling. The first couple of times you just need to get them nice and clean and then get them out onto the towel, cover their head in the towel, and the best way to dry them is to pick them up and give them a cuddle.

Just pat them dry, don’t rub their skin, as they can be very sensitive, and give them a nice pat all over. Make sure that you dry in between their knees and elbows and in all their little creases so that they don’t get sore. Once they’re nice and dry you might be tempted to give them some moisturiser or body lotion or talcum powder – we would suggest not to. At this point babies don’t need it. If you squeeze a talcum powder bottle you can get a cloud of dust that can go into the baby’s lungs, and all it does is clog their pores up. If they have really dry skin and the midwife says it’s healthy then they might need a bit of moisturiser, just apply it very thinly. Generally speaking babies don’t need anything on their skin.

You might be given lots of products when you’re in hospital like free gifts or tester pots, and that’s fine, just take them home and use them on yourself, or keep them until your baby’s a little bit older. At this point as a new-born they don’t need anything.

Then what you want to do is put a clean nappy onto your baby, and then you can get them dressed into their night or day clothes.

When buying nappies don’t be tempted to go out and buy lots and lots of nappies. This is a new born nappy and this is the next size up, they go from new born to the next one very quickly. Just buy as you need them, one pack at a time. If you don’t want to use disposables, disposable nappies can take around 500 years to break down, you may want to go down the real nappy route and this is what a real nappy looks like. You can get them in different colours and patterns. They can be disposable liners or washable liners. There’s lots of information on our central Bedfordshire website – central Bedfordshire will give you a £25 grant as a start up to get you your first pack. If that’s the route you want to go down have a look into it and do your research, there’s plenty of real nappy libraries around and if you do need more information there’s advice on our website.

Unless baby has a bit of nappy rash, in which case this is when you would let them have an air and a kick about, they’re now nice and clean and ready for their day.
Safe sleep

So now we’re going to talk about safe sleep and something called Sudden Infant Death Syndrome. We will refer to it as SIDS. It used to be called Cot Death but it was renamed a few years ago simply because a lot of deaths of babies don’t occur in the cot, they can be on sofas or chairs, so it’s now referred to as SIDS. We’re going to talk about the risks, but what I’d like to say first is that SIDS is very very rare and doesn’t happen often, and if you practise safe sleep then hopefully you can avoid it. If you research the stats on SIDS they can be very hit and miss, some websites will tell you different things, but it’s a very low percentage.

We have a picture here, and there are 8 risks on this picture that would increase the chances of SIDS. Ignore the carpet and wires which are trip hazards, as we’re looking only at safe sleep in this video.

As baby is asleep, the safest space for them to sleep is in their own space with a flat, firm mattress. Whatever you’re using, whether it’s a Moses basket or a baby box or anything that a baby can sleep in, make sure the mattress is firm and flat and that it has a nice fitted sheet rather than loose sheets.

The 8 things on this picture – the first thing to notice is that baby is sleeping next to a radiator. This can cause baby to get too hot and if the cot is pushed up against a radiator the baby can lean against the radiator and therefore burn their skin, so we want them away from the radiator. We also want them away from a window, they can cause drafts in the winter but more so in the summer when you get direct sunlight coming in – if you’ve ever been in a car on a hot sunny day you’ll realise how hot that can get. The best place for the cot in the room is on a wall away from direct sunlight. If the hot room gets too hot, especially in the summer, you can put a fan in the room to keep the temperature down. The temperature should be around 18 degrees, so to cool it down you can put a fan in there, but we do suggest it’s not aimed directly at the baby and circulates the air rather than making baby cold.

Next thing is blankets. The picture is showing lots and lots of blankets and loose blankets. The best blankets to use are something like this, this is called a cellular blanket and they have lots of little holes in so that the air can circulate. The holes are also small enough that baby can’t get their fingers trapped. One blanket is fine, if you fold your blanket and use it as two layers that now becomes two blankets, so bare that in mind. If you are using blankets you want to put them underneath the mattress and not underneath the baby. This is simply because, if baby is moving around, if the blankets are loose they can creep up and go over the baby’s face and suffocate them. So we want blankets that are tucked underneath the mattress.

The next thing to notice on the picture is to notice that baby is wearing a hat. We’re going to take baby’s hat off. They don’t need a hat, we don’t wear a hat indoors so babies don’t need one, especially when they’re sleeping. Some hospitals may put a hat on your baby when they’re born, that’s just to regulate their temperature but once they’re home they don’t need a hat indoors.

The next thing on your picture that you might have noticed would be that baby is sleeping on their side and at the top of their cot. The safest place for a baby to be sleeping is on their back. As they get older and they start rolling over by themselves and positioning themselves onto their tummy that’s absolutely fine and you can leave them to do that because if they’re capable of getting onto their tummy they can then safely get back. But when they’re new born for the first few months they need to be on their back, it’s the safest place for them to be. They need to be at the bottom of the cot, so feet to footboard, that way they’ve got nowhere to go. If they’re high in the cot and they have blankets they could wiggle down and get trapped. So we want them at the bottom of the cot, and that’s whether they’re in a Moses basket or in a full sized cot, they should always be at the bottom.

Also on the picture you’ll see that baby is sleeping with a pillow. Babies don’t need a pillow – they have a natural pillow on the back of their head for when they’re sleeping flat and their head will be in the perfect position. If you put something underneath like a cushion or a pillow it pushes the baby’s chin onto their chest and can restrict their breathing. We want to have those airways open with nothing underneath the head. If you have a pillow and baby turns their head they can get caught up in the soft furnishings and that can cause suffocation.

You can also see they have some nice bumpers. Lots of companies still market bumpers – they were introduced to stop babies putting their arms through the bars in the cot and they look pretty, but they are a soft furnishing and again they can cause suffocation. Some of the ties that they have can get wrapped around the baby and cause their circulation to stop in their fingers, so again we suggest that you don’t have them in the cot. They don’t need them and even if babies get their arms through the bars of the cot, we’ve never heard of a baby being injured or getting trapped.

What’s not obvious on the picture is soft toys, we don’t recommend that these go into your cot with your baby because they can be a suffocation risk. Make sure that they are out of the cot, same thing with anything that makes a white noise. These are fine to use but make sure that they are out of the cot, on a shelf away so that they can’t fall into the cot. If you’re using nice blankets that someone has bought don’t drape them over the side of the cot so baby could pull them in. Make sure that it’s only baby in the cot.

You may want to use something called a sleep bag. These are a really good alternative to blankets and duvets. These come in different togs – there is lots of different advice on the internet so make sure that you research and find the correct tog for the time of year. If you’re having a spring or summer baby make sure that you’re using a lighter tog and not an autumn or winter tog. Make sure that you fit your baby correctly – some old stock in shops, or second hand items, go by the age of the baby but we all know that one baby could be 5 pounds at birth and another baby could be 10 pounds at birth. They have changed them now and it goes by your baby’s weight, so just make sure that if you do buy one that it is the correct weight size for your baby. Where the arms go through they should fit snugly, not tight, around the baby. If it’s a big gap and baby can get their arms into the sleep bag and move down then they can be trapped in the bottom, so make sure that they do fit correctly if you are going to use them. They are a good alternative to blankets.

A rule of thumb when you’re putting your baby to sleep is that they wear one layer more than what you do, so if you are wearing a t-shirt and a cardigan your baby would wear a vest, a t-shirt and a cardigan. If they’re in bed in their sleep bag then their arms should be covered, if it’s a bit chilly you can put a long-sleeved vest on them, but they don’t need blankets with the bags as well.

That’s it for safe sleeping. If you want to co-sleep, a lot of people used to say don’t co-sleep at all, but now we know that people do, make sure that you do it safely. There’s lots of information on The Lullaby Trust, and we have a clip. Make sure that you have a watch of that so that you do it safely and that you don’t put baby in between you and your partner, that you’ve got the correct position, and that baby has got their own blankets. Just make sure to do your research so that you do it safely!
Car Seat Safety

So now we are going to talk about car seat safety. You can buy any car seat as long as it fits your car correctly, make sure you go to an independent retailer and take some advice. Make sure that you practice before you go to the hospital to collect baby, some hospitals won’t allow you to leave until they make sure it is correctly fitted, and that you have got a safe way of taking your baby home from hospital.

The best time to practice getting your baby in and out of the car is before it is born, so make sure you do all that before baby comes along. Once baby is in the car seat recommendations are that you don’t have baby in the car seat for more than two hours absolute maximum. Bear in mind if you are going shopping that you are driving to a shopping centre, baby is in the car seat and then you would lift your car seat out to a frame if you have got a three in one buggy system, then you do your shopping, then the baby would be transported from the system back into the car, you get home, baby is still asleep, it is very very tempting to pop them out onto the floor while you put your shopping away, and then they are still sleeping so you might want to have a cup of tea as well. So just bear in mind that all of that time adds up and baby is sitting in a car seat quite thrust up with their chin down onto their chest. So what we would want you to do is suggest that baby is in the car seat as absolutely as little as possible. If you are going shopping, once you get to the shopping centre have a bit of a break, take baby out, give them a bit of a stretch, hold so that they can get their chin of their chest, give them a cuddle, lay them down on your lap, go and have a coffee, or just walk around with them for 5-10 minutes, just to give them a bit of a break before you go back in.

If you’re going off on long car journeys make sure that you drink lots and lots of water, this will force you to stop to go to the toilet, so that then baby can get out of the car seat, and give them a good 15-20 minutes out of the car seat before you pop them back in and go and do another 2 hours driving. This just allows baby to get their chin of their chest and take in some air and just stretch their back. It is really difficult, traffic is horrendous nowadays, and if you just want to go from one of the town to the next then bear that in mind as to how long they are sitting in their car seat.

So the safest space for the car seat to be in the car is behind the passenger side. This is because research shows that most accidents happen on the driver’s side of the car, so the safest place for your baby is behind the passenger seat.

Make sure that you don’t overdress your baby when you are popping them into the car seat as well, they just need their day clothes on. If you pop a big thick coat on we will adjust the straps accordingly and therefore may not hold the baby should the car crash. If baby has got a big thick coat on in the car they may overheat, they may get too hot with the sun coming through the windows, so the best thing to do is just have their day clothes on and then have a blanket, therefore the blanket can be unwrapped whether they are in the car or out shopping, going into a warm shopping centre you could then just take the blanket off them and they will be a lot more comfortable than what they would be if they had a great big thick coat or a snow suit on.

So that’s it for car seats. Just do your research and make sure your car seat fits your car and that you use the correct car seat for the age of your baby, it does go by weight. The first size seat that you need, their legs will dangle over the side, it doesn’t matter, as soon as the top of their head gets to the top of the car seat that is when you need to be thinking about buying the next size up. So – go to an independent retailer, do your research, and make sure that you have got the correct one for your baby.
Stages of labour
Welcome to this session labour and birth, my name is Jo Wiles and I’m a midwife in Bedford hospital. The plan is that we’ll be taking the bump in front of you into a cot beside you. The aims of this session are:
1. To have an understanding of the process of labour
2. To be aware of choices if further pain relief is required
3. If the “plan” changes what interventions may be necessary?
The process of labour will include what’s going to happen to you during labour, as well as how labour starts. When are you going to go into hospital? Questions like this are ones we hope to answer on the first point.

Number two is being aware of choices if further pain relief is required. We’re going to be talking about what happens in hospital, but a big part of this session is what’s going to be happening to you at home. We’re going to be talking about the things that you should be doing at home in the early stages.

The third one, if the “plan” changes what interventions may be necessary? The word “plan” is in inverted commas – this session isn’t about making a plan for labour with you, this session is about providing you with all the information you need to make choices. Also we know as midwives that you want to arrive at our hospital, to get into your corner, deliver your baby, and get home as soon as you possibly can, and that’s what we want for you. We know it doesn’t always work that way but ideally having all of the knowledge will help you make decisions along the way. Interventions is another way of saying complications. We will talk about forceps and caesarean sections.

We’re going to start with dividing the three stages of labour. Let’s refresh so that you have your knowledge. The first stage of labour is the onset of labour up to when the neck of the womb is completely open, ready for baby to be born. It’s the longest stage and as a first time mum you’re aware that it’s probably the longest labour that you may have, not always, but generally. First time mums can do this fairly quickly – this would probably be something like 4-6 hours. That would be very good. What you don’t always think about is the length of time in labour that it can take to reach the end. For a first time mum, in labour, around 24-36 hours with lower average of around 12-18 hours.

When we’re talking about the first stage of labour, we’re talking about a few things that should be happening, namely 3 major things. The first one being that you’re having regular contractions. These are occurring every 3-5 minutes, lasting at least 30 seconds or longer, and the neck of the womb begins to open up to about 4 centimetres or more. We know then that labour has started for you – anything prior to that is what we would call early labour. Sometimes when early labour stops and starts and goes on for a while we call it a “latent phase”. We’ll talk more about that later. An average time is around 12-18 hours, but everybody is different. We know that women can do this quite quickly, or can go through to taking the longest time; it varies from person to person.

Second stage – when the baby is ready to be born. This is where you will be pushing as well. As a first time mum, if you’ve completed this in around 30 minutes you will have done well. The longest time it could take would be up to about 3 hours. We wouldn’t leave you in 2^nd stage pushing for any longer than that. This time includes what we call a “passive hour”, particularly for mums that have certain types of analgesia, namely epidural. We do give a passive hour if mums haven’t wanted to start pushing. An average for this stage would be around an hour.

The third stage is the placenta, which is the attachment where the baby feeds while it’s in utero. This can be delivered two different ways. The first one is active, the second one is physiological. Active is where we help the placenta to come out by giving mum an injection of something called and oxytocic drug. Oxytocin is a requirement for labour – mums produce oxytocin in labour to help their contractions, which means it helps the uterus to contract and get the placenta out. We know that generally after an oxytocic injection, within about 10 minutes the placenta can be delivered.

Physiological is where we let the uterus contract itself and mum can deliver the placenta. That can take up to an hour. Questions around this often regard whether mums have a choice. It’s something that’s discussed with midwives when you go in. An active placenta delivery can be necessary in some situations.

Other things about your placenta that are quite interesting are that your ends down all of the oxygen and baby sends back all of the waste. The uterus itself is attached to the wall of the womb and this process continues throughout the antenatal period until the baby takes its first breath. This all changes when baby is born. When they take their first breath the flow of blood changes, their lungs begin to fill and it begins to adapt to extra-uterine life.

We also know that the placenta contains up to about a third of baby’s blood supply immediately after delivery. Within a minute, 80% of what’s in the placenta will go back through to baby; within 3 to 5 minutes almost all of it will have returned. All hospitals now practise “delayed cord clamping” – we don’t plan to clamp the cord until it needs to be done and not for the first few minutes. Generally we can leave babies until the placenta has gone all the way back through to them. The reason for this is that we know the red blood cells and stem cells, which help build babies immunity, are really important. What you want to do is a discussion to have when you go in.

Everybody has different stories about what set them into labour – even mums that have had more than one baby won’t start their labours the same way. Our commonest one is probably contractions, which are very difficult to describe. It’s a feeling that comes on, reaches a peak, and goes off. It can be felt from the front to the back, back to front, bottom to top or top down, it can be different for everybody. Contractions also can start at a different rate – it’s difficult to say that they will be 15, to 10, to 5 minutes. It never works that way. If you ask women who have had their babies they will give different stories. They can also start in this early phase and go off again. The latent phase can start contractions, build a little, and then disappear. It may not be until the contractions become stronger and closer together that you realise you are actually in labour. The one definite thing about contractions is that if you are in labour they’re not going to stop!

We would generally say being at home for as long as possible, for a low-risk healthy mum, is the most important thing. If you look at research, it shows that the longer women are in hospital the more likely there is to be interference. We also know that you are calmer and more relaxed at home. Moving into hospital too early can ramp up the anxiety levels, which affects the oxytocin that you need to help the contractions. So you’ll be at home for the early part of them – it will only be when they become much more difficult to manage that most mums come into hospital, as their contractions have gotten stronger and they are struggling. Normally you will find that contractions don’t become regular until they start to get down to around 5 minutes apart. We also know that this is when they tend to get stronger too.

We count contractions in blocks of 10 minutes, such as 1 every 10 minutes, but you could even get up to 4 every 10 minutes. Between 4 and 5 every 10 minutes is usually as quick as they will get. They’re timed from the start of one to the start of the next one. If they’re occurring every 10 minutes you’ll have a full strength contraction for a minute, and then around another minute before the next one arrives. All you need to do is make sure to relax well between those contractions. You need the contractions though, as they do the work of opening up the neck of the womb. Each one you have brings you one step closer to birth.

When they get down to between 3 and 5 minutes they have usually gotten stronger, enough to make you need to lean on something or do some slow breathing. We recommend you stay at home for as long as you comfortably can, until your contractions are up to around 3 in 10 minutes. But if you’re not sure or are worried about them, don’t be afraid to ring your local hospital as well, the midwives there can give you advice.

The next common part of labour is the water breaking. This is the amniotic fluid around baby – it’s usually either colourless or a straw-like colour. Sometimes it can be slightly discoloured, to a green or brown. We would prefer not to see this but they can come in any variation of those colours. Waters breaking is not something that’s always very evident to mums, across the world. Some mums can never be completely sure, and sometimes it can also take midwives a little while to work it out as well. When your waters break it often isn’t a huge gush, it can be a very small amount, which is why some mums aren’t sure. We encourage you to do things like emptying your bladder, pop a pad on, get your feet up on a bed or couch for around 20 minutes. If small amounts are still starting to leak, when you stand up you’ll get a little stream of water. As long as you’re not in constant pain and your baby is moving around that’s fine to do. Again, if you’re not sure, ring your delivery suite.

If you are sure, then they will need to see you and help make a plan with you. With a bit of luck in the coming hours your labour will commence. But we need to keep an eye on you because the protective covering around the baby has now gone. So we need to plan what will happen next. We’ll be taking you in if your water breaks or your contractions come every 2-3 minutes and last half a minute or longer.

Show is the plug of mucus that’s found in the neck of the womb, and a second line of defence that forms during pregnancy. It can come away in small amounts, often in the last few weeks of pregnancy, or it may not come away until a mum is well into labour. It’s a good sign, and doesn’t mean you necessarily need to be in hospital. If you ring the delivery suite and tell them you have had a show they may ask you to sit tight and wait for something more to happen.

So these have been the three main areas of things to look for – the one thing that is important is fresh blood. If you see any then you must ring your delivery suite straight away, usually you can see it dripping.
Birthing options

So labour has started, and you’re at home and it may be that this length of time is going to be longer than the length of time you will spend in hospital. We strongly recommend that low risk mums remain at home in early labour. We now know that you don’t need to be in hospital when you’re in labour as a low-risk mum and that in actual fact it can increase the anxiety, so being at home is a really important bit of this labour.

So what are you going to do at home? What are the things that can help you at home? Why do we say stay at home? Again, it is this being in your own environment, of being calm and relaxed as well. We know that if you are in your own environment you will be able to access everything that you need quite easily as well. Also, if you have a latent phase of labour, which is quite a lot of stopping and starting then It can actually be quite tiring for you to be there and you don’t want to come in in labour into hospital totally tired because you have spent 2 or 3 days wondering when it is going to start. You must just go with it and stop and rest when you need to, eat and drink when you need to and move around when you need to.

So it’s unique to every women without a shadow of doubt, we know that there are things that can help you at home, things that you can do to help yourself. The common one is bath, so why do we say a bath? Is it just something to do while you are at home – run a bath – no it is because we know that there are properties that water can provide that help women. We know that water provides volume, which means that you can move around a little bit easier, helps support your gravi-uterus – for any mums that swim you will certainly notice that. We know that the warmth of the water is soothing, relaxing, calming. We know that it helps to soften areas like the perineum to stretch during the actual birth of baby. We know that warm water actually on the outside of the skin helps to stimulate nerve endings to override deep pain nerve endings, and this is how it works as pain relief as well. We also know that if you watch women in labour and you put them into a corner, or they go into their own little space, once they are in established labour, they will very often dig in and carry on. So it is a bit like taking your own space, getting into that bath as well, and into using a pool at the hospital.

So bath, and you may do this a few times – what else might you do? How about taking paracetamol? Right paracetamol - something that most mums probably haven’t taken all through pregnancy, perfectly safe to take through your antenatal period if you need it. Don’t be afraid to take your 2 tablets of 500mg each, so take 2 of them, repeat this 4-6 hours later if you need to. Pain relief is always better when it is built up, you might thing oh – paracetamol they are not going to do very much, they really do work for taking the edge of say backache that you might have, or just a little bit of low ache in your tummy where this baby is moving into the pelvis. Don’t be afraid to use your paracetamol, it also won’t have any bearing on any other drugs that you might need to use later on.

What else can you do at home? Anybody have a gym ball? We use them a lot in hospital, we use gym balls for mums in labour quite a bit. They are really very very comfy to sit on. Ok, so gym ball – you will find that gym ball at home will help you get your baby into a good position. If you look at your pelvis it isn’t just a hole that your baby goes straight through, it’s actually on a tilt, and it’s actually an S bend. Baby goes in through, round and out. Baby will get into 4 positions ready for delivery, with the head down. To the left and the right with the back towards mummy’s tummy. Sometimes they can turn around and put their head to the left and right with their back towards mum’s spine. We call this posterior position or back to back as you may well know it. Now your primary position, your ideal first choice one, would be with baby with their back towards mums tummy because they tuck their head well in. When they turn around this way they turn their heads back a little bit sometimes and take just a little bit longer to get in the pelvis. So we do see babies that go in this way round, and we do see them a bit more now that we used to. So, why is the reason for that? We believe it is due to our lifestyles a little bit more.

When you look at the pelvis, when you are busy with your, cycling maybe, walking, digging, scrubbing floors as mums used to may years ago, then you are in the squatting position, opening up the pelvis, and it’s much better for baby to rotate and go in. What we do now often is we go to work in cars, and then we sit and watch tv, so you are at s right angles where you are closing your pelvis. The gym ball enables you to get your knees below your hips and open up your pelvis to get your baby in a good position. So if you are thinking about using one, use it in that last month of pregnancy definitely, for comfort, but also to get this baby rotating into a good position. Super in labour, really comfy, you can rock your pelvis, change positions around it, as well as keeping your knees below your pelvis and keeping your pelvis open. It’s also keeping you in an upright position, really important because your new best friend here is gravity; your baby is not going to go through your pelvis with you laying down all the while. Your baby needs gravity to help it down and through. So being upright over your pelvis is another important fact.

So what else can you use? You can use anything in positions that keep you upright and moving around. It is important that you do get rest when you need to. You also need to have food and fluid. Food and fluid you tend to forget about, first time mums don’t always that that this is what they need to do as their labour progresses. We know that if you become dehydrated then it can affect things that can happen to you which can have a knock on effect to your baby. It can send things like your pulse rate a bit higher, and often then your baby’s heart rate. We might then need to start monitoring what’s going on, which means that then we are beginning to interfere. So make sure you drink, and whilst we are thinking about drink, think of things like isotonic. Isotonic drinks can be very useful in that later stage of labour, so have a couple or so that you can take in with you. Food, nibble, particularly in the early part of labour, particularly if labour is stopping and starting a little bit, make sure that you nibble in between. You are using energy and you need to eat. So take your food, take what you fancy, ideally your more complex carbohydrates will last you a little bit better than things like your neat sugars. A whole bar of galaxy will provide you with certainly a whole lot of calories, but as sugars levels go up and back down again quickly your carbohydrates will sustain you just a little bit better. Your body will tell you when not to eat, your body will say you know that’s enough, I think you just need fluids now. So do nibble in that early part, your body is working hard and using calories – very important.

Ok, what else can you do at home? Let’s put TENS in here.

Right, let’s go onto the next thing that can be used. A TENS machine. So what is a TENS machine? This is a TENS machine. It’s a little box with a battery in it and it has four pads that go onto mums back. And these actually when turned on stimulate the nerve endings below the skin on either side of the spine. So let’s just draw a mum for you. You have many nerve endings that come off of the spine, particularly in areas near your sacrum and the bottom of your rib cage if you like. These pads fit into either side of the spine over these areas. So when it is turned on it stimulates these nerve endings:

1) to produce something called endorphins, which is your body’s natural pain relief and build them, and

2) to actually block the messages that these nerve endings are sending to the brain to register as pain.

So it works two ways. The important thing to remember about the TENS machine is that it needs to be on early. It is no good waiting until you are established in labour to actually apply a TENS machine. It needs to be on very early to build up those endorphins, and also to block the messages that are going to the brain as well. So, TENS can be used or practised with from 37 weeks onwards. If you require TENS you need to hire it yourself – usually to the tune of £20 - £25 for the duration. I think they are about £30 or so to buy. If you have a friend with one, then borrow. Make sure it is an obstetric TENS, because TENS relief is used for pain relief for quite a few other problems as well, but you need specifically a TENS obstetric machine.

How does it work then, how good is it? It’s a really difficult one to answer because pain is subjective, but from the many years of working with women who have used TENS machines, I would say that one or two have said, no I wouldn’t bother it didn’t do anything for me, and one or two have said absolutely fantastic saw me all the way through. I think the majority of women come somewhere in the middle where it will get them further down the line. But it is certainly a choice that you would have to make regarding using TENS machine.

Ok so what else might you do when you are at home? Anything else in the way of games, music, anything that you would generally do that acts as a distraction as well. Don’t forget that these are very simple methods and things to use and have that planned music, or those games or things that you can do in that very early part of labour.

Also, some women attend hypnobirthing. The other one here is mindfulness.

These are practiced ways of controlling your mind a little bit at what is happening with your contractions. Have a look at hypnobirthing, there are some courses online. You can go into main courses of it and pay for one to one courses too. So hypnobirthing is a way of breathing steadily through contractions, and removing yourself from the contractions, taking yourself away from it to a place that is a special place for you. The same with the mindfulness as well, training your mind to rethink a little bit about what’s happening to your body.

So these are kind of psychological methods that you can use. The NHS doesn’t provide Hypnobirthing and mindfulness yet, they are things that you would have to look up certainly for it.

Anything else that you can do on this? I think we have got most of them on here now. Very simple things really. The whole list is to enable you to consider moving around them. You tend to find that women in labour will often manage for about 20 minutes for what they are doing and then they need to move onto the next thing. So having this written down as a list of things that you can do, or having thought about it, means that you are making a plan, particularly if this becomes a latent phase of labour, and things are stopping and starting. It is important that you stay with it.
Pain relief

As your labour is progressing and you’ve been at home for a few hours you can find you’re ready to go into hospital. Please see earlier videos to help with the signs of when this can be. You will first need to ring your maternity unit, and on your way in you will be triaged, which means that you will be put into a room and we will do a complete check of you. This is where we can find out what’s going on and make the decisions with you about where you go for the plan of delivery. We have to check you first in case there’s something happening to you that could be a problem then it may mean that we have to change the area that you go in to deliver. We’ll check mum’s temperature, blood pressure and pulse, and baby’s heart rate and position as well. We’ll find out if you’re contracting well and what the neck of the womb is doing.

If we’re going to assess how progress occurs then we need a base line to work on. If you are establishing in labour then you’ll come into the delivery suite; if you’re not it may well be that the delivery suite will be able to give you something a bit stronger in the way of pain relief, usually codeine based, and let you go home until you definitely need to be with us. This can even happen a couple of times; just remember that you have been checked over so it is safe to go home.

You’ll then be assigned a room that will stay with you for the duration of labour. No one will be able to come in without asking and we have curtains that pull all the way round. At the moment you are only allowed to bring one birth partner with you for obvious reasons of infection. We would prefer that this birth partner is someone that you live with, again to limit cross-infection. Depending on what’s happening we will do regular checks on things like your blood pressure and pulse, and we will check your baby once you’re established in labour, at least every 15 minutes.

If everything is fine you’ll be moved onto a midwife-led unit. In that unit we wouldn’t continually monitor you but would have machines as well as checking everything else. There will be a certain amount of pain relief available in that area but if you needed other forms we would have to move you into consultancy.

As you come in, already 4 centimetres, contracting every 2 to 3 minutes, you’ll be given your own room to move around in and make comfortable. It may be that after a certain length of time you decide you don’t feel quite as comfortable and need some more pain relief. If we were to ask what pain relief you would like first, the usual first answer is: “gas and air,” also called Entonox. This is something that is piped with a mouthpiece and a two-way valve, so mums put it in their mouth then breathe in and out.

Entonox is made up of two substances: 50% oxygen and 50% nitrous oxide. Both of these go in and out via the lungs, so it doesn’t have any lasting effect once you’ve breathed it out. What it can do is make you feel a bit dizzy, but if you stop using it for a few breaths it will level out quickly. This makes it very safe to use.

Think of your contraction as a wave – you need to start breathing at the very start of the wave. You need 3 or 4 good breaths of it before it starts working and most mums find that if they keep breathing it through the peak of the contraction, they can put it down and breathe out the Entonox as the contraction goes down. It’s almost instantaneous and quite effective.

When we talk about pain relief some people imagine something that is going to take it all away, but most of the forms of pain relief that we use take the top of the contractions off and don’t make the pain go away completely. But they do make it very manageable.

However, Entonox is something that is hard work to administer; you have to do it yourself, because if you take too much and become sleepy you’re going to drop it so you can’t overdose. Not only can this dry your mouth out but it can be hard work to use – a few hours of usage is ok but not 12-18. We’ll sometimes change it out for something else and may go back to it later.

Injections come in the form of two main drugs: pethidine and morphine. Different units may use different things. This is an intra-muscular injection that we give and starts to work within about 20 minutes. It will have a similar effect of taking the top off of the contractions and also relaxes you quite nicely. These injections get a lot of bad press, and people can be very anxious to use this kind of pain relief, but we know that it’s very effective. There has been a lot of research into using strong pain relief in labour – they believe that trace elements can go through to babies and this can, in large amounts, cause the baby to be a bit slower with their feeding. But every day we see mums who didn’t have an injection and their baby still won’t feed because that’s what babies do sometimes without a doubt. Don’t be afraid to use these things – they are very effective. They work by calming and relaxing to allow your oxytocin to still flow. We use pethidine in doses that won’t make you fall asleep or not know what you’re doing. We know that if we gave it to you very early on then labour could stop, so it needs to be there once you are already established in labour.

Sometimes if you need it you can have more than one dose. We would try not to give it to you just prior to delivery because we know that this isn’t the best time to use it. We need you to be as “with us” as possible at that end part to deliver your baby, so we wouldn’t be giving it if you’re just going to second stage. Having said that, midwives do often give pethidine and later find that a baby still arrives – mums just do this sometimes.

We have at Bedford pools that we use in our low-risk labour area, but do have a high-risk pool as well. The high-risk pool is generally one for women to labour in and not on that you would deliver in. We use it for mums that have had caesarean sections previously or have other problems going on or may have an intravenous line in for previous problems. This also needs to be discussed with your consultant beforehand. The pool that you can use on our midwife-led unit is something that you can go in and out of, as you don’t want to be sat in a pool for 12-18 hours. If you are considering using the pool take in bra tops or spaghetti strap tops, not t-shirts with sleeves as if they become wet you can get very cold. We provide everything else that you need and can still monitor babies in pools as well. This is a very relaxing way of helping you in labour. Mums that may not have considered it before will often use it for just being in labour. You don’t have to use it but it is an option.

Epidural is the injection into your spine that passes through some anaesthetic, which freezes your uterus so that you can’t feel it contracting. Everything is carrying on but you can’t feel the contractions. We use something now called light epidurals which mean that you can sometimes move your legs around a little bit and we can help you change positions. You’re not going to get up and skip across the floor but you will be able to move around a little bit better. These are attached to a pump system that delivers the regular amount of anaesthetic that you need to keep the contractions under control.

Epidural isn’t just about having that epidural spine, there are other things too. First of all the topography machine checks that baby is ok and fine and that mum is contracting well before we start. The intravenous line supplies fluid going in because sometimes the epidural can unbalance your blood pressure a little bit so fluid needs to be there. It may also mean that your bladder doesn’t work quite as well as it did before, so sometimes we have to pass a catheter too. Considerations are generally that we would like to get you as established as possible before we give you an epidural. Mums can sometimes be started sooner if they are having it induced because we know that labour will be progressing.

Spinal is the name for a one-off complete block, usually for a procedure. A spinal injection goes in, the anaesthetic goes in, the needle comes out and mum is ready for the procedure. This is usually done for things like caesarean sections and sometimes for assisted deliveries. It can also be for suturing afterwards if anything needs to be looked at carefully, or if a placenta doesn’t choose to deliver and needs removing.

If a mum in labour chooses an epidural and then finds that she’s going to have a caesarean section then this can be topped up to act the same way as a spinal block.

So how do you choose? It depends where you’ve started – if you’ve woken up at 3am and your waters go at 5am, arrive at the hospital at 6am and you’re 6 centimetres dilated you are doing fabulously. We would say to consider using the pool and ask if we need to give you gas and air. You can use the gas and air when you’re in the pool. Whereas if you have been in and out 2 or 3 times in that early latent phase of labour it may be that you struggle to get to 3 centimetres, in which case you might need a bit more rest or to consider something else to give you more rest such as pethidine or epidural.

You may already have decided what to do once you’re in established labour. We’re not saying that any one of these should absolutely be done first or have second – it’s your choice as well. Your midwives will also be there with you and discussing this with you.

If you have an epidural you won’t need anything else. If you have pethidine we won’t put you in the pool for the next few hours because we need to be able to get you out sometimes in a hurry so it wouldn’t make sense. It depends on your stage of labour for your choices that you make on these.

As you reach second stage and are fully dilated then you’re ready to move on to deliver. You will see that there are positions that are the comfiest to adopt. We know that in second stage the neck of the womb has completely moved out of the way and it is also important to know which position the baby is laying in. When babies come down through the birth canal the head touches the pelvic floor and rotates into place. We can feel along the skull these little lines that we call suture lines, and they tell us which position baby is in. When the baby moves down onto the perineum and rotates to face forward it stretches the muscle bit by bit. In second stage it may be that all you see is a tiny bit of the baby’s head before it disappears. As the baby moves down eventually there will be a point where their head doesn’t disappear.

Then as their head moves up, they crown and are born, over the perineum facing down. Then as the contraction goes off baby will turn to one side or the other depending on which side it’s laying. There can be a gap for a minute or so before the next contraction comes along, and with that next one the top shoulder is delivered and then the bottom one. So second stage is a gradual process.

Sometimes mum’s contractions can go off because they’re exhausted and there is no movement of the baby through the pelvis. We call this “delay”. Sometimes babies need a bit more help to deliver. That decision is make alongside mum and with obstetricians as well. There’s often a good idea that things are slowing down and you are prepared for it by the time it arrives. Very occasionally there is an emergency, but the more likely chance is that we have already picked up on things that aren’t going quite the right way and we prepare for it.

There are two ways of helping your baby to deliver. The first one is a ventouse, which is a suction cap that goes onto baby’s head. Usually it’s just a bit of extra pull by the user and push by mum, which helps to create a better push overall. Within around 3 pulls this baby’s head will be born and the rest of the baby soon after.

Forceps are open spoons around the size of my hand with a long arm on them, they slide around baby’s head either side and lock together, and then babies can be lifted out. If these procedures need to be done then adequate pain relief needs to be had by mum, and that can be in the form of either topping up an epidural or creating a block in your perineum so that you don’t feel any pain. Usually we talk you through the reasons why beforehand as well.

The last thing that’s done for assisted or normal deliveries is something called an episiotomy. This is a surgical incision that’s made into the perineum to widen the opening, usually for things like ventouse or forceps. It sometimes needs to be done for normal deliveries. The area can be infiltrated so that you don’t feel it, and it will be sutured up afterwards fairly soon. It’s an area with a good bloody supply so it heals quickly. Don’t forget, a lot of midwives and obstetricians are parents themselves and this isn’t going to be done unless there is a clinical reason to do it for you or your baby. These aren’t routine but they sometimes need to happen.

Baby is delivered onto you so that we can see what’s going on. We can watch baby in that first minute afterwards, dry them, and start seeing how they’re coming around. 9 times out of 10 we don’t have to do anything else, baby and mum stay together and they can get to know each other.

Once your third stage is delivered, that’s the placenta, you’re normally in a delivery suite for 2 or 3 hours, possibly a bit longer for caesarean, before you’re transferred to the post-natal ward. We do have mums that deliver and go home quite quickly, but we don’t plan on keeping you any longer than is necessary. If we’re not doing anything medically for you or the baby then you need to be at home, with your family, being cared for and looked after by them.

Who is there to help you in your delivery suite and what are their roles? You as the mum are the most important, and you can bring in a birthing partner with you. You’ll be met by a midwife – they will stay with you for the duration of her shift. She may have a student midwife with her. Our student midwives work 1 to 1 with the midwives and are very well trained. They are a font of knowledge and a great deal of help and are keen to help couples. As long as everything is going fine your midwife and their student will look after you, but it may be that your midwife needs some help, so she will go for the senior midwife. She needs to know everything that’s going on, what their midwives are like, their experience, and where her doctors are as well. She may need to get the SHO, senior house officer, down. This is a qualified doctor learning obstetrics but that can do a lot of the basic things especially if there is no rush. Once he does some tests and has the results he can go back to the registrar which is the one that can make important decisions and give information. The registrar will come down and may need to have a discussion with the consultant. In an emergency the registrar and senior house officer will carry on with a caesarean section on their own. With complicated cases the consultant may be around. If the consultant comes in the next thing they will have to do is call the anaesthetist. We cannot do anything without them giving us the ok. It might be to top up the epidural to create a complete spinal, or giving a full spinal. We use these kind of pain relief every day on delivery suites so it’s well practised. The anaesthetist is there to get mum ready for any kind of surgery. The operating department practitioner may well come with them to sort out drugs, IV fluids or to support the anaesthetist. The midwife in charge will get hold of a scrub nurse to get into theatre. The last person that goes in is the maternity care assistant. This is the one that is the runner in theatre and does all of the sorting and clearing. The last call in an emergency is the paediatrician. For all emergency deliveries, and even normal deliveries that have some concerns, we would call our paediatrician to be there with us. Although midwives are well trained, we need the paediatrician when things aren’t quite as good as they should be.

Hopefully you won’t meet them all! Sometimes if things happen suddenly then members of those teams can arrive suddenly, but that’s how many people are there to look after you. We know that you expect us to be competent and kind, and that’s what we plan.

So good luck, take away with you the fact that you are made to do this and you can do it. This journey that you are undertaking is physical and psychological as well.

Thanks for taking part!

25.55 https://vimeo.com/408591582
Help and Support

So where can you get support? Don’t forget you can ring us on our Single Point of Access number, and that is 0300 555 0606 to speak to the health visiting service about any aspect of your parenting journey. We also have Parentline, which is a text number that you can see (07507 331456), and if you have just got a quick query and you want to ask something, just text that number, and it is covered by our staff and they will respond to you by text. So you can get support there as well.

We have already talked about Bedfordshire Well-Being service and you can self-refer via their website, and crisis is a charity that was set up by parents who experienced babies that cried a lot, so they know what it can feel like, and you can access their support via their website.

Family lives is a really good parenting charity, with lots of good information on their about all aspects of parenting, so you can look at that too.

With have a wonderful partnership with the Breastfeeding Hub app, and there is lots of information on here about breastfeeding, video’s about positioning and attachment, hand expressing, all sorts of information and it’s free to download either on Apple or android, so please do have a look at that. It also has got a review system where you can go to a café, and if you have had really good support whilst you were breastfeeding there, the staff were nice, you can rate that place, and so it is a bit like trip adviser for breastfeeding. So please do have a look at the Breastfeeding Hub app.

We also support mums to feel confident to breast feed when they are out and about, and that’s our FreeToFeed campaign, so if you look up FreeToFeed Bedfordshire then you will see all our details on our website and also on our facebook page. Our facebook page is @bedscyp, so please do follow our facebook page because we put all sorts of information on there.

If you have got any health concerns you can contact your GP, you can contact 111 if you are not sure if you should be going to your GP or should you be going to the hospital, and that is also available out of hours, and obviously you have got the NHS Choices website as well, and if there is an emergency with you or your baby you can also ring 999.

All of our Bump, Birth and Baby sessions are done in conjunction with the children’s centres, so in Beds Borough that is the Early Childhood partnership, and in Central Bedfordshire that is managed directly by Central Bedfordshire Council, so we are all here to support you, and please do get in touch with us if you need any help or information.

Thanks for watching.