Author: Louise Mannion

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Bringing Your Baby Home: What to Expect

Many new parents arrive back home with their newborn baby and ask themselves, “What do we do now?”. These first days and weeks at home will be filled with exciting new experiences that may also be a bit overwhelming.

Managing your time back home

First things first: attend to any immediate needs you or your baby might have, and then take some time to relax and breathe. You need time to get used to your role as a mother and learn what motherhood means! Ask your partner, family and close friends for help with household tasks such as cooking, cleaning, running errands and caring for your other children.

Managing your time back home with your baby can be a challenge. Staying connected via mobile phone, e-mail or social media can be a convenient way to share birth information and pictures. You should also let people know when you are ready for visitors and phone calls – and when you are not. It is perfectly OK to unplug, take a nap and savour your little one’s first days in the world.

Babies tend to be a bit sleepy in the first two to three days after birth, but you can expect your baby to become more alert, active and vocal after these first days. This means your baby will start telling you when they are hungry and this may not follow any schedule you expected.

Breastfeed when your baby is showing hunger cues such as mouthing movements, rooting or sucking. Look out for signs that your baby is getting enough milk, such as six or more wet nappies, three or more dirty nappies and 8 to 12 or more feeds every 24 hours. Also make sure you have an appointment with your baby’s healthcare provider for a weight check within a couple of days after your baby is discharged from hospital. Your baby should gain about 20g a day, or 140g or more per week.

During the early days at home you will be taking all of the information and advice you have read or heard and slowly developing a parenting style that works for you and your family. Each day will be different. Enjoy your baby and celebrate your growth as a mother.

How Dad can help

In these first days your partner’s role is different to yours – it is also very special and unique. The best thing your partner can do is to help create a cocoon of sorts in your home: a comfortable, quiet place where you and your baby can practise breastfeeding without interruption. He may need to deal with any phone calls or people ringing on the doorbell so that you can relax and focus on getting to know your baby.

Although you will be very deeply involved in your baby’s care and feeding in the early days, there are lots of ways for your partner to bond with the baby too: calming the baby by holding them skin to skin against his chest, having fun at bath time or even just sitting with you to enjoy those special moments that breastfeeding creates. Your partner can also support you by changing nappies, spending time with your other children and helping with the housework. Eventually, he can feed your expressed breast milk to the baby after breastfeeding is well established (usually after three to four weeks).

Every baby is different and it will take time to get used to your life together. If you have any questions or concerns, contact your healthcare professional or lactation consultant.

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Epidural: The Pros and Cons

Some mums-to-be pledge to have an epidural upon arrival at the hospital, while others hope to experience labour and birth without using this method of pain relief. It is worth knowing that while an epidural can be a relief, it does have a downside too. Learning all the facts will help you make an informed decision.

 

How does an epidural work?

The anaesthesiologist inserts a needle between two vertebrae in the lower back, stopping just short of the sac enclosing the thick cable of nerves (spinal canal) inside the spine. A fine catheter is threaded through the needle, which is then removed. Next, a mixture of local freezing agent and morphine-like medication is piped in through the tube, causing numbness below the waist.

The pros of an epidural

In most cases, an epidural provides very effective pain relief. And if you are having a difficult labour, this could make the difference between a positive birth experience and a negative one. An epidural can also be very useful in the following situations:

  • Sunny-side-up baby: If your baby will not move, facing your belly button instead of your backbone, an epidural may relax the muscles of the vagina and perineum, giving the baby just enough wiggle room to rotate and descend.
  • Exhaustion: If contractions have kept you awake for a long time, a nap made possible by pain relief can give you a second wind.
  • Hypertension: During labour high blood pressure, which can soar further during pushing, poses dangers including a small risk of stroke. One of the side effects of an epidural – a decrease in blood pressure – can reduce these risks.
  • Need for forceps or vacuum: An epidural prevents discomfort.
  • Non-emergency caesarean section: An epidural allows you to remain awake during the birth. General anaesthesia is only needed in very urgent situations, which account for a small minority of C-sections.

The cons of an epidural

Did you know that epidurals do not always work? Roughly five to ten per cent of the time, an epidural only provides patchy, partial relief, for instance numbing only one side of the lower body. Adding more medication or redoing the epidural corrects the problem in about 75 per cent of those cases. If you are one of those – albeit few – cases where the epidural does not work as expected, this can be extremely disappointing.

  • Limited mobility: Most epidurals keep you more or less immobile. But even if the resulting numbing is light enough to allow you to move your legs (a type of epidural that is only available in a handful of hospitals), in most centres you will automatically be hooked up to an IV and a foetal monitor, so you will not be able to walk or move around.
  • Less effective labour and pushing ability: This side effect can not only lengthen labour, but can also substantially increase the likelihood of a forceps or vacuum delivery. Some doctors say the likelihood increases by around 38 per cent, while others estimate that epidurals double or even triple the odds. Furthermore, over half of women who have an epidural will need the hormone oxytocin (which has its own risks) to strengthen slowed or stalled contractions.
  • Drop in the mum’s blood pressure: This can cause the baby’s heart rate to slow down, which is sometimes a sign of distress. If IV fluids and drugs do not bring the mum’s blood pressure and the baby’s heart rate back to normal, a C-section is usually the next step.
  • Perineal injury: Tears and other injuries are more common because epidurals increase the risk of a vacuum or forceps delivery.
  • Fever: For reasons that are not completely understood, an epidural significantly increases the likelihood of developing a fever during labour. In one study from the year 2000, nearly 12 per cent of women who received an epidural ran a temperature of 37.8°C or higher compared with only 0.2 per cent of those who did not receive an epidural. In case the fever signals infection, typically mother and baby are both treated (often unnecessarily) with antibiotics. The baby may also be admitted to the NICU for close observation.

Considering the pros and cons of epidural anaesthesia, you should make your own decision before the onset of labour so that you have at least one less decision to make and can concentrate on the labour and birth. Talk to your healthcare provider or midwife for advice.

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Birthplace: Hospital, Birth Centre or Home?

Nowadays, most women give birth in a hospital. However, increasing numbers are choosing to give birth at home or at a birth centre instead. Here is an overview of the benefits of the different birthplaces.

Hospital birth

The vast majority of births take place in hospitals. Women who have no midwives or birth centres near their homes give birth in hospitals. So do women who want the security of knowing that help is at hand in case of an emergency and those who want the option of having pain medication such as epidurals.

If you decide to have a hospital birth, you can still plan a natural birth. Lots of hospitals have adopted more relaxed, homelike furnishings for their delivery rooms, and many hire midwives to work alongside the obstetricians. To ensure that things go as smoothly as possible, you and your partner should discuss your ideal birth experience with your healthcare provider before you go into labour. That will allow your partner to be the best advocate for your choices, if necessary. Remember that things might not go as planned. Nature is always full of surprises and some hospitals still have medical intervention policies that may not always promote a natural birth. In any case, the most important outcome is a healthy baby and mother.

Home birth

Two of the main reasons why women choose home birth are:

  • to avoid what they have previously experienced or what they anticipate might happen with a hospital birth and
  • for their baby to be delivered with care by just one or two midwives who they can get to know and trust.

Other benefits include:

  • In the familiar environment of their home, they often feel more in control of their labour and birth, and can have whoever they want present.
  • There is less risk of infection for both mother and baby.
  • There is less risk of an unnecessary episiotomy.
  • Even if a hospital transfer is needed, the risk of caesarean is very low.
  • Antenatal and postnatal visits at home or in the midwife’s home feel much more personal than visiting a clinic with many other women.

Birth centres

Birth centres are a great alternative for women with uncomplicated pregnancies who want the relative comfort of giving birth in a low-tech environment and the security of being in or near a hospital. These places are typically decorated to look less like hospital rooms and more like bedrooms, right down to curtains on the windows and a rocking chair in the corner. Most are staffed by midwives working with doctors affiliated with the hospital that the birth centre is part of, or with a hospital near the birth centre.

Birth centres encourage women to manage their labour as naturally as possible. Midwives are skilled at managing pain during childbirth through controlled breathing, labour positions and relaxation techniques. Most birth centres are also equipped to provide pain relief. However, if you want an epidural, you will have to give birth in a hospital. Look for a birth centre that is accredited, which means that it has physician contacts and hospital affiliations.

Inform yourself about the different available options of birthplaces and talk to your midwife or healthcare provider, who can advise you on how to make a backup plan at a suitable hospital.

 

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The Stages of Labour

Every woman experiences labour differently. Nobody can predict what your labour will be like or how long it will last. But there are plenty of things you can do to prepare yourself. Here is what to expect when it is time to give birth.

Active labour

Contractions become stronger, longer and closer together. The cervix is dilating at a rate of about one centimetre per hour. From four centimetres onward, you are in active labour.

Transition

For many women, this is the toughest part of childbirth. Contractions come one after the other as your cervix dilates to 10 centimetres. You may feel like you can no longer cope or even start vomiting or trembling, especially in your legs. It is also common to feel flushed, overwhelmed and panicky. Thankfully, transition is usually the shortest stage of labour.

Pushing stage

When the cervix is fully dilated and your baby’s head has descended, you are ready to push. Most women feel a strong urge to push that can be almost impossible to resist, coming in several surges through each contraction. Each push moves the baby forward a little, but when the contraction ends, the baby slides back. When the baby’s head crowns at the entrance of the vagina, you will feel a burning sensation as the skin stretches. With another contraction or two, the head will emerge. Once the shoulders are out, the rest of the baby usually slips out quickly.

Final stage

Even after your baby is born, your labour is not quite over. The umbilical cord will be clamped and cut. You will experience a few more contractions as you deliver the placenta.

Every woman’s labour is different. Talk to your health professional or midwife if you have questions or concerns.

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Real Signs of Impending Birth

In films, the pregnant woman’s waters break in the middle of the night, she runs around the house in a panic, her husband forgets the bag and then they speed off to the hospital. Pregnancy and the onset of labour are usually depicted in a more dramatic way than they are in real life. Here is how you can distinguish real signs of labour from a false alarm.

Real signs that your baby is coming

Labour pains come at regular intervals and with increasing intensity over a long period of time. To help tell whether you are in real labour use the 4-1-1 rule: if contractions are four minutes apart, last for about one minute and recur for one hour or more, the chances are you are in labour. Other sure signs are that your waters break or your mucus plug comes out. Your midwife or doctor can confirm and measure changes in your cervix via a pelvic examination. If the cervix is dilating, your baby is on the way.

False alarms

Pre-labour, or Braxton Hicks contractions, are common from the 16th week of pregnancy onwards. These ‘practice contractions’ are usually painless and irregular. They do not form any sort of pattern, nor do they last very long or dilate the cervix. Among first-time mums, they often go unnoticed or are written off as cramps or muscle spasms.

How much time do I have until my baby comes?

If you think you are in labour, take a moment to assess your pain levels and the intensity of the contractions. Stay at home and take a relaxing bath. There is no need to rush to the hospital just yet. If this is your first birth, bear in mind that first-time labours tend to progress more slowly. The early labour stage can last anywhere from two hours to more than a day. However, listen to your body and do what you feel you need to do.

Every pregnancy and onset of labour is different. Contact your hospital, health professional or midwife for advice.

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Pregnancy Nutrition and Supplements

What should you know about nutrition during pregnancy, prenatal vitamins and diets for pregnant women? There is no magic formula for a healthy pregnancy diet. In fact, the basic principles of healthy eating remain the same – you should get plenty of fluids, fruits, vegetables, whole grains, lean protein and healthy fats. However, a few nutrients deserve special attention.

Foods to enjoy and to avoid during pregnancy:

  • Drink regularly, up to 2 – 2.5 litres a day.
  • Eat a wide variety of foods. Try to eat less fat, but more carbohydrates and protein. Increase your intake of minerals such as folic acid, iron, calcium and magnesium. Replace white flour products and sugar with quality carbohydrates from potatoes, wholewheat pasta and wholemeal bread.
  • Do not start dieting. Pregnancy is definitely not the time to lose weight. Eat consciously and do not go for long periods with little or no food.
  • A strictly vegetarian diet can lead to a lack of protein, vitamin B12, calcium, iron and zinc.
  • Cravings make you unhappy. So every now and then, give in to temptation and have those chips or that bar of chocolate, but always in moderation.

During pregnancy avoid:

  • Raw or undercooked meats such as minced beef, steak tartare, salami and raw ham, due to the risk of toxoplasmosis.
  • Foods containing raw eggs such as mayonnaise, tiramisu and zabaglione, as they pose a risk of salmonella.
  • Unpasteurised milk and raw milk products such as soft and raw milk cheeses, due to the risk of listeria.
  • Raw fish such as sushi, smoked salmon and other types of smoked fish.
  • Offal such as liver and kidneys, which could be contaminated.
  • Smoked foods such as serrano ham, smoked salmon and eel.
  • Pre-packaged salads and delicatessen products, because they might contain bacteria.
  • Alcohol, which may harm your baby physically and mentally.
  • Drinks containing caffeine and tannin such as coffee and black or green tea do not pose a risk up to two or three normal-sized cups a day. Do not drink cola, energy drinks or quinine drinks such as bitter lemon and tonic water.

Prenatal supplements and vitamins:

Although the need for certain nutrients increases during pregnancy, many supplements may not be needed if you eat a balanced diet. They are often overdosed or contain substances such as iron, which you should only take on doctor’s orders. Pay attention to iron, omega-3 fatty acids and especially folic acid and iodine, which cannot be obtained in sufficiently high quantities from a normal diet:

  • Folic acid: Folate is a B vitamin that helps prevent neural tube defects, which are serious abnormalities of the brain and spinal cord. The synthetic form of folate found in supplements and fortified foods is known as folic acid. While you are pregnant, your daily requirement increases to 600 micrograms. Even when trying to conceive, it is recommended that you take 400 micrograms daily four weeks before a possible pregnancy. Fortified cereals are a great source of folic acid. Leafy green vegetables, citrus fruits and dried beans and peas are good sources of naturally occurring folate.
  • Iodine: Iodine plays an important role in regulating your thyroid gland and metabolism – the rate at which your body uses energy. It also helps your baby’s brain and nervous system develop. A deficiency in iodine increases the risk of miscarriage and abnormalities. During pregnancy, the requirement increases by 20 per cent and a dose of 100 to 150 micrograms daily is recommended. Iodine is found in dairy products, eggs, vegetables, seafood (especially ocean or saltwater seafood) and brewer’s yeast.
  • Iron: Although pregnant women often have an increased need for iron, you should only take special supplements prescribed by a health professional.
  • Omega–3 fatty acids: To cover your requirement for omega-3 fatty acids, an intake of 200mg per day is recommended. If you do not like fish, special supplements prescribed by a health professional are a good option. It may be more effective, however, to eat oily fish twice a week, which supplies you optimally with omega-3 fatty acids. But remember: do not eat raw fish.

If you want to know whether a dietary supplement is useful for you, ask your doctor or health professional. Dietary supplements are especially important if you eat in canteens, need to follow a special diet or suffer from indigestion. But keep this in mind: even though chemists are full of supplements, you should never self-medicate. Never take drugs of unknown origin such as from the internet.

 

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Types of Nipples

There are different variations of nipples, such as normal, flat and inverted. Before your baby is born, it is helpful to know what type of nipples you have.

 If your baby is able to take in a good mouthful of breast, it is likely that there will not be any complications due to the type of nipples you have. However, flat or inverted nipples are less easy for your baby to latch on to.

To determine whether you have flat or inverted nipples, gently compress your areola three centimetres behind your nipple. The nipple will evert or protrude; an inverted nipple will invert or retract.

If your nipples are flat or inverted, you can use Medela Nipple Formers. They draw out the nipple and can be used during pregnancy or after birth. Formers are worn inside the bra, which may need to be one size larger than normal to accommodate them.

If you have any questions relating to the shape of your nipples, ask your health professional or lactation consultant.

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Changes to a Woman’s Breasts From Pregnancy to Weaning

Your breasts undergo changes during pregnancy and breastfeeding to accommodate your body’s natural ability to provide milk for your baby. During pregnancy, hormonal changes prepare your breasts to produce milk. After birth, additional hormone responses trigger milk production in larger volumes.

Changes of the breasts during pregnancy

During pregnancy, hormones cause the growth of glandular tissue in your breasts and they get larger. Your nipples become more sensitive, the skin around the nipple and areola darkens and the Montgomery glands (the bumps on the areola) enlarge and secrete a liquid that treats and protects the nipple area.

In the second trimester of pregnancy, your breasts begin to produce early milk, which is usually absorbed by the body. Some women may notice this early milk leaking and others may not. In any case, you will produce the amount of breast milk your baby will need and your body is able to.

You may be concerned about the size of your breasts – are they too small or could they possibly be too big? Most women experience some breast enlargement in pregnancy but ultimately, breast size does not matter when it comes to breastfeeding success – women with large and small breasts can breastfeed successfully.

Changes after delivery

Three to five days after delivery, for around one day or less, your breasts may become hard, red and warm as a physiological reaction to decreasing levels of placenta hormones. The blood circulation in your breasts increases and there is more lymphatic fluid in your breast region. The small amounts of colostrum produced in the first days postpartum will give way to mature milk within approximately 10 to 14 days.

If your breasts become uncomfortable and excessively firm, please tell your nurse or doctor. This physiological breast engorgement is not uncommon at this time but there are ways to relieve it.

Changes during lactation phase

In the first three months (approximately) the hormone prolactin is responsible for milk production. During this time your breasts may feel full before a feed. After the first three months or so, your baby’s sucking triggers milk production and you will no longer feel this fullness of the breasts, but you will still produce enough milk for the baby.

Changes after weaning

After weaning, many of the breast changes noted during pregnancy and the lactation phase will reverse. The extra glandular tissue that produced milk is no longer needed and will revert to almost the same state it was in before pregnancy.

Every woman’s breasts are different. Check with your health professional or lactation consultant if you have questions or concerns.

 

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Pregnancy Symptoms and Body Changes

A missed period is usually the first sign of pregnancy. You may feel tired or sick more than usual and you may notice changes in your breasts. During pregnancy your body is constantly adapting to the situation and preparing for childbirth.

The first trimester

At the onset of pregnancy you may experience some mild cramping and a little bleeding when the fertilised egg implants itself in your uterus. If you have missed your period and think you may be pregnant, you can try a home pregnancy test. These tests are very accurate if you take them a few days after you expected to get your period. Your doctor can confirm your pregnancy and talk to you about prenatal care.

Feeling very tired is one of the most common symptoms of early pregnancy. Your body is working hard to adjust to being pregnant. This can cause extreme fatigue. You may need to sleep longer than usual at night and take short naps during the day.

Morning sickness is a feeling of nausea during the first few months of pregnancy. Some but not all pregnant women experience this. It is caused by pregnancy hormones and can occur at any time, not just in the morning. Certain foods, odours or even an empty stomach can cause you to feel sick and sometimes vomit. Morning sickness usually starts a few days after you miss your period or have a positive pregnancy test. It usually goes away by the second trimester.

What are the changes to the body in the first trimester (weeks 1 – 12)?

  • Breast changes: Many women notice changes in their breasts early in pregnancy. The hormones in your body are changing to prepare for breastfeeding. Your breasts may feel tender and swollen. Small bumps may form in the area around your nipples, the so-called Montgomery Glands. The glands’ secretions lubricate your nipples and areolae and protect your breasts from infection. Your breasts will continue to change throughout your pregnancy.
  • A growing belly: Your waistline will begin to expand as your baby and your uterus grow larger. Depending on your size before pregnancy, you may not notice this change until the second trimester.
  • Skin changes: Pregnancy hormones can cause some extra oil on your skin, which might spark a temporary flare-up of acne.
  • Frequent urination: Towards the end of the first trimester, you will feel like urinating more frequently as your growing uterus pushes on your bladder. Because of this extra pressure, you may leak a little urine when you cough or sneeze.
  • Emotional symptoms: You might feel moody, forgetful or unable to concentrate. These symptoms can be caused by fatigue, pregnancy hormones and the emotions that can come with being pregnant.

The second trimester

Most women who did not feel so great in the first trimester usually start to feel much better in the second. The morning sickness should taper off, mood swings may lessen and you will probably have more energy. You will gain weight more rapidly, adding as much as two kilograms a month for the rest of your pregnancy. So, you may need to start wearing maternity clothes.

Changes to the body in the second trimester (weeks 13 – 26)

  • Breast changes: Your breasts may not be as tender as they were in the first trimester, but they will continue to grow and prepare for breastfeeding. Enlarging milk glands cause the growth. You may also notice that the skin on and around your nipples will darken. The bumps may still secrete an oily substance to keep the nipples from drying out. A yellowish fluid called colostrum might begin to leak from your nipples.
  • Skin changes: As your body grows, some areas of skin may become stretched tight. Elastic fibres right below the skin may tear, creating streaks of indented skin called stretch marks. Not every pregnant woman gets stretch marks, but they are very common. Stretch marks should fade and become less noticeable after pregnancy.
  • Aching back, pelvis and hips: The job of supporting your growing belly may strain your back. Your hips and pelvic area may begin to ache as pregnancy hormones relax the ligaments (tough, rope-like bands of tissue) that hold bones together. The bones will begin moving in preparation for childbirth.
  • Teeth: Pregnancy hormones also affect the ligaments and bones in your mouth, so teeth may loosen. This symptom will go away after pregnancy. However, if you have periodontitis, inflammation or low-grade infection of the gums and tissue around the teeth, seek treatment.

The third trimester

As your baby grows, your body will feel even more awkward and heavy. Everyday things like getting out of bed or rising from a chair will require extra effort. The tiredness you felt early in pregnancy may return. You might also start to feel more emotional as you prepare for labour, delivery and parenthood.

Changes to the body during the third trimester (weeks 27 – end of pregnancy)

  • More breast growth: Your nipples may leak colostrum. If you breastfeed, this fluid will be your baby’s first food.
  • Sleeping: As you get bigger, you might struggle to find a comfortable sleeping position. Side sleeping will be best. Sleeping on your left side helps blood circulation.
  • Tingling and numbness: The swelling in your body may press on nerves, resulting in tingling and numbness in the legs, arms and hands. The skin on your belly may feel numb, too, because it is so stretched out. Fortunately, the problem usually goes away after pregnancy.
  • Abdominal pain: The muscles and ligaments that support the uterus will continue to stretch as your baby grows, and they may hurt.
  • Shortness of breath: As your uterus grows upward, your lungs will have less room to expand. You may find yourself huffing and puffing more.

 

Every woman’s pregnancy is different. Check with your doctor or health professional if you have any questions or concerns.