Post natal booklet

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Congratulations on your birth

Having a baby and becoming a parent is a major event in the lives of women and their families. Becoming a parent is usually accompanied by changes to your home life, social life and relationships. Discovering you are pregnant and giving birth is an emotional journey and parents of a new baby experience a variety of feelings after the birth. You may feel happy and proud of yourself, or just relieved the birth is over. It is impossible to prepare for the changes that pregnancy and becoming a parent brings. It can be difficult to find time for yourself, your partner or your family when you have the 24 hour demands of a new baby to deal with.

We hope that the following information will help you in adjusting to your new life together and if you have any worries about yourself or your baby. During this period you may have some concerns about your health or that of your baby. It is important that you speak to a member of your healthcare team (such as your midwife, health visitor, GP or maternity support worker (MSW) if you have any concerns or questions.

You and your family are encouraged to ask for help whenever you need it.

Care and communication

You will be provided with a link to your personal Badgernotes App. This will be completed
by the health professionals providing your care and will be filled in during every contact you
have with a member of your healthcare team.

Your care should take into account your personal needs and preferences. You have the right to be fully informed and to make decision in partnership with your healthcare team. To help with this, your healthcare team should give you information you can understand and that is relevant to your circumstances.

This information and any discussion you have with your healthcare team should include explanations about the care you receive. You can ask any questions you want and can always change your mind. Your own preference is important and your healthcare team should support your choice of care wherever possible.

All healthcare professionals should treat you and your baby with respect, dignity, kindness and understanding and explain your care simply and clearly.

A member of your healthcare team should be able to arrange for you to have an interpreter or an advocate (someone who supports you in asking for what you want) if that is what you need. Your interpreter or advocate will keep anything you tell them private.

NICE (National Institute for Health and Clinical Excellence) has recommended that all health services caring for women and their babies ensure they put into practice a programme that encourages breastfeeding.

Postnatal care in the community

When should I expect to be visited by a midwife?

We strive to accommodate your individual and family needs following the birth of your baby. You will receive a visit from a community midwife the first day following your discharge from hospital. This is to plan your individual post-natal care needs. We will not be able to give you a specific time for this first visit, it will be between 9am and 5pm.

If you and your baby are well and are happy with everything a midwife or a MSW will come again five to seven days after the birth of your baby. At this appointment, with your permission the New Born Blood Spot Test (also known as the PKU) will be performed.

From day 10 after the birth of your baby, if you and your baby are fit and well, we will discharge you from midwifery care and hand you over to the Health Visitors. Most discharge visits take place in a community clinic, where you have a timed appointment and do not have to wait at home all day for a visit from the midwife.

Owing to the unpredictable nature of our work, our workloads and schedules can vary greatly from day to day. Sometimes at short notice we may have to ring you to rearrange your visit for another time. If the midwife has not arrived by 4.00pm, please phone the labour ward on:

Advice can be gained at any time during this period by phone.

What happens if I need any extra support at home?

If at any point you need more support for any reason, a midwife or MSW will come and see you more often. The main reason for extra visits is usually for breastfeeding support. If this is the case you are more likely to be visited by an MSW.

The role of the MSW is to support you in establishing good breastfeeding techniques and help you gain confidence when feeding your new baby. The MSWs are trained in breastfeeding support and will also weight your baby when they visit to ensure the feeding is successful. If necessary, the MSW may refer back to the midwife for any concerns which are not related
to feeding or they may discuss the feeding with one of our breastfeeding specialists in order that you can continue successful feeding.

If you have any medical concerns during your visit from the MSW please feel free to mention these. It will, however, be necessary for them to refer back to the midwife.

You may also be referred to one of the local breastfeeding support groups for additional help.

Please see the list of these groups below. If you have any concerns or queries with regards to your postnatal visit please contact:

Out of hours service

If you have any concerns or questions about yourself or your baby overnight then please call the Labour Ward (RSCH: 01273 664793 / PRH: 01444 441881) where staff will be able to advise you about any issues with regards to your health, care of your baby or breastfeeding support.

Postnatal care for mum

Tiredness

Many women report being excessively tired after the baby’s birth as a result of the demands of a new baby. It is important not to fight the feeling; follow your instincts and let your body be your guide. Do not overexert yourself and take short periods of rest throughout the day. Do not be afraid to ask for help in your household chores if it is available. Just concentrate on resting and eating a healthy diet. In this way you will ease smoothly into your role of happy new mum!

Breast changes

When the milk comes in, usually around three to four days, you may find that your breasts become hard, swollen and uncomfortable. You may also feel weepy and feverish. Be reassured that these changes are only temporary and will pass quickly. If you are breastfeeding, feeding your baby may ease the discomfort. Some women find it helps to take mild painkillers such as paracetamol and / or ibuprofen. Putting a cool flannel on the breasts for several minutes,
may be helpful.

If bottle feeding, it may take a couple of days for the breasts to soften. If breastfeeding you will receive breastfeeding support from the midwife or maternity care assistant.

Bleeding

After your baby is born you will have some vaginal bleeding, called lochia. To start with, the bleeding may be slightly heavier than the first day of a period. It may also be heavier when you breastfeed your baby as breastfeeding causes the womb to contract and empty its contents. You must only use sanitary towels to catch the flow as tampons can introduce infection.

Over the next few days, the bleeding will gradually reduce in volume, becoming more like the end of a period in colour as the days pass, changing from bright red to pink or brown and then a clear discharge. This takes anything from two to six weeks after the delivery and it is normal. You should change sanitary pads at least every four hours.

If your lochia becomes heavier, you start passing clots or your loss becomes foul smelling, you should contact your community midwife for advice.

Bowel care

You may worry about your stitches when you have your bowels open for the first time after birth. You can safely open your bowels without any damage. Normally, your bowels would be opened within three days of birth. Try to avoid getting constipated as it causes strain on the pelvic floor muscles and stitches. A healthy diet, including plenty of fruit, vegetables, brown bread, cereals and plenty of fluids will help you to return to a regular bowel habit.

After pains

After the birth of your baby your womb will continue to contract back to its normal size. As a result you may feel pain or cramps in your lower abdomen. These can be particularly troublesome after a second or subsequent childbirth. A mild painkiller like paracetamol or ibuprofen may help. These are safe to take even if you are breastfeeding.

Haemorrhoids (piles)

Haemorrhoids are swollen veins around the rectum, which may itch, feel sore or bleed. If this is the case the midwife or GP will recommend some creams and ointments. This is due to hormonal changes in your body. It is very important to avoid being constipated as haemorrhoids are aggravated by constipation.

Your health

A small number of women may develop serious health conditions. You should be encouraged to contact a member of your healthcare team straight away or call for emergency help if you have any of the symptoms below. Common health concerns experienced by women who have recently given birth are shown later, with the recommended actions from your healthcare professional. If you are worried about any of these health issues speak to your healthcare professional, who should support and advise you.

Potentially serious health conditions in women

Symptoms to watch out for

Common heath concerns for women who have recently given birth

Symptoms to watch out for

Pain relief

Please discuss taking paracetamol or ibuprofen (if you normally take these and have no allergies) with your GP if needed.

Taking care of your perineum after birth

The perineum is the area of skin between your vaginal opening and your back passage (anus). Some women give birth without injury to the perineum, however, injuries or tears can occur at the time of vaginal delivery.

There are four types of perineal tear:

• First degree tears involve injury to skin only
• Second degree tears involve injury to the perineal muscles
• Third degree tears involve injury to the perineal muscles and anal sphincter
• Fourth degree tears involve injury to the perineal muscles, anal sphincter and the lining of the rectum

Third and Fourth degree tears

What’s the best way to care for my tear?

The first thing to do is look after yourself. In the first 48 hours rest as much a possible. Try lying on your back with your knees bent up, or lie on your side with a pillow between your legs.

Wrap ice cubes in a wet cloth (this protects the skin) and hold it next to the wound for up to ten minutes. This is often easiest lying on your side. Cold shallow baths can also help reduce swelling and this in turn will promote healing. However, do not soak for longer than ten minutes.

It is important to keep the area clean, paying particular attention to washing with mild soap and warm water after a bowel action. Avoid using a sponge or flannel to wash around your stitches.

Dry the area carefully by patting dry with toilet paper or a soft clean cloth. Do not dry using the cold setting on a hairdryer. This dries up natural oils produced by the body.

When sitting for any length of time, especially when feeding, try to get really comfortable and reduce the pressure on the area. You can try positioning cushions to support you or choose a firm chair and arrange a rolled up towel to support under the thighs. This reduces the pressure on the area of injury: You could try some feeds when lying on your side with your baby next to you.

Will it hurt when I go to the toilet?

Avoid constipation by eating a healthy balanced diet and drinking plenty of water. Try to keep an intake of 1.5 to 2 litres of fluid daily. With a balanced diet and painkillers a bowel motion shouldn’t be painful but don’t rush things. It can be helpful for someone to care for the baby when you have your bowels open for the first time. Things that can help include:

• A relaxed position on the toilet can help make bowel movements easier. Sit comfortably on the toilet seat
• Check that your knees are higher than your hips. A footstool or ‘toddler training stool’ may help
• Rest your forearms onto your knees and lean forwards
• Relax the pelvic floor muscles and stomach wall
• Relax your jaw and try not to hold your breath. Grunt!
• Holding a sanitary pad over the perineum can provide support for this area and help you to feel more confident and comfortable when opening your bowels.

What should I do about sexual intercourse?

Once the bleeding has stopped and the tissues have healed, you can of course resume sex whenever you feel ready. The timing of this is unique to every individual couple and a tear doesn’t necessarily delay this. It is perfectly understandable that with the demands of feeding and broken nights, even without the added complication of stitches, that many couples do not rush back to intimacy.

For some new mothers even with the best reassurance it can take many months to feel confident about sexual intercourse. You could consider gently examining yourself first to see how comfortable the tissues feel. Sensitive tissues will become less tender over time when they are touched and gently stretched or massaged.

When you do resume intercourse, extra lubrication can be helpful and some positions will be more comfortable than others. Start gently and try to keep the pelvic floor muscles relaxed for initial penetration.

Get fit for motherhood

This section offers guidance on safe and effective exercise for the pelvic floor and abdominal muscles. Try to fit in a few exercises each day to help you get back into shape. The exercises should be easy to do, need little effort but remember it takes several weeks to begin to see results. If you’ve had a caesarean section, these exercises are still ideal. Just remember to start gently and progress slowly.

Do I need to make time to exercise?

After you have given birth, you will understandably want to give your baby lots of attention. Even so, it is important to make a little time for yourself. By regaining your fitness you’ll feel good, have more energy and you could well avoid health problems in the future.

Do I need to exercise my pelvic floor muscles?

In these early days, gentle exercises for the pelvic floor muscles help to reduce the pain and swelling in the tissues after a vaginal birth. In the long term, keeping these muscles strong will improve bladder and bowel control, safeguard against prolapse and contribute to a healthy sex life. Good reason for all new mothers to exercise a little every day, now and for life!

Where are the pelvic floor muscles?

The pelvic floor muscles form a broad muscular sling across the base of the pelvis. These muscles support the position of the pelvic organs and help the closure and control mechanisms of the bladder and bowel.

How do I exercise my pelvic floor muscles?

Start in any comfortable position: sitting or lying is easier than standing. Try to tighten the muscles around the back passage and work this feeling forwards into the vagina. You could try to imagine you are stopping yourself from passing wind or try to imagine you are ‘tucking in your tail bone’.

The feeling of ‘squeezing and lifting ‘internally is the basic pelvic floor contraction. Start gently and always work with easy effort. Try not to tighten your buttocks, clench your jaw or hold your breath as you work these muscles. Work towards tightening the muscles and holding for a few seconds. Don’t worry if it is difficult to feel these muscles in the early days after the birth. The exercises will become easier as you practise and as your body recovers.

How can I exercise my stomach muscles?

We recommend that your start exercising your stomach muscles gently in either side lying or lying on your back.

The ‘deep’ stomach exercise

• Lie on your side as shown above.
• Let your tummy sag! Breath in gently
• As you breath out, gently draw in the lower part of your stomach and hold for a few seconds while breathing normally
• Let go and rest for a few seconds before repeating
• Try to keep your back still while drawing in your stomach. Progress to working your pelvic floor muscles at the same time

Different starting positions to try:

• Lying face down with a pillow under your stomach
• Lying on your back, with a pillow underneath your knees
• After 6 weeks you can progress to trying this exercise on all fours

The ‘pelvic tilt’ exercise

• Lie with your knees bent up
• Gently draw in your lower abdomen, squeeze your pelvic floor muscles and gently tilt your pelvis. You should feel your back flattening into the bed
• Hold this for a few seconds before releasing gently
• Rest for a few seconds before repeating this exercise

The ‘head lift’ exercise

• Draw in your lower abdomen and pelvic floor muscles tilt your pelvis as before, and tuck your chin to your chest
• Lift your head a little way, hold for a few seconds and lower gently
• Rest before repeating this exercise
• Progress to lifting your head and shoulders, but only when you can keep your stomach braced and flat

Why do I need to take extra care of my back?

It is vital that you take care of your back after you have had your baby. This part of your body will be vulnerable for five to six months after the birth because:

• Your stomach muscles are week
• Your joints are more flexible due to the altered hormonal levels in your body and are at risk of damage
• Caring for your baby will involve lifting, carrying, feeding and changing: all activities that will put extra strain on your back

What can I do to protect my back when I am lifting?

Remember, whenever you are lifting, tighten your pelvic floor and ‘deep’ stomach muscles to protect your back and reduce the strain onto the pelvic floor. Use your legs, bend your knees and get close to whatever you are picking up. Whenever possible, minimise the load.

What is a good position for feeding?

Look after your back by always finding a comfortable, well supported position for feeding. A pillow under your baby may be helpful and a footstool may make you more comfortable.

How can I protect my back when changing my baby?

Whether you stand, sit or kneel to change your baby, remember to try to keep your spine straight.

When can I increase my general exercise?

Exercise should always be undertaken gradually after childbirth. It is important to regain fitness levels and it certainly helps to strengthen both the abdominal muscles and pelvic floor muscles before returning to fitness activities. However, never be tempted to do ‘double leg raises’ or ‘sit ups’ with straight legs as part of a workout.
Many women choose to go back to the gym or resume a sport three months after childbirth, but everyone is different. Remember, progress at a pace that suits you.

When might I need to seek further advice?

You should ask your Midwife, Health visitor or GP for advice if you have any of the problems below:

• Persistent pain in back, pelvis, pubic bone, groin or stomach
• Any problems with loss of bladder or bowel control such as wetting, soiling or having to rush to the toilet

Your GP may then refer you for physiotherapy treatment.

Information compiled by:
The Women’s Health Team
Physiotherapy Department
Brighton and Sussex University Hospitals NHS Trust

Your baby’s health

Most babies are born healthy and stay healthy in the postnatal period. A small number of babies have problems with their health. Babies who develop jaundice (a condition that causes yellowish colouring of the eyes and skin) in the first 24 hours should be checked straight away. Babies who haven’t passed the thick greenish brown meconium (the first stool of newborn babies) in the first 24 hours should also be checked straight away.

At every contact you should be offered information to help you care for your baby’s health and recognise potential concerns (see table below). This information should help you to identify if your baby is unwell and when you need to contact your health professional. If you are worried about your baby’s health or have any questions you should be encouraged to talk to your healthcare professional or ring the advice line number.

Colour

Your baby’s lips should be pink and his / her skin warm; the baby’s hands and feet might feel cooler and slightly pale but this will improve within 24 hours. There may be some bruising on the baby’s head. If the baby appears slightly yellow (jaundiced) within the first 24 hours you should contact the midwife.

Umbilical cord

Your baby’s umbilical cord will be securely clamped. The cord should be kept clean and dry, and outside the nappy area. There is no need to use wipes or put powder on it. The cord stump will dry and fall off between five and twelve days. As part of normal skin care we recommend that you clean around the stump with tap water only and dry the cord. Powders or other lotions are not recommended.

Nappies

For the first 24 hours after birth, your baby’s stool will look dark and sticky. This is normal and it is called ‘meconium’. Babies also pass very little urine in the first 24 hours. The baby’s skin is very sensitive and delicate and we would recommend using cotton wool and water to clean the nappy area. Small amounts of orange / red discolouration are common in the urine and may appear in the nappy in the first 24 hours.

Crying

All babies cry and some babies cry a lot. Sometimes you will know the reason; perhaps your baby needs a nappy change, a feed or a cuddle, or is not feeling well. However, sometimes parents can try everything to stop their baby crying and nothing seems to work. This can be very distressing for parents. There are many things you can do to comfort a crying baby: skin-to-skin, letting your baby suckle at your breast, holding the baby close to you, rocking, swaying, singing and stroking them. Rocking your baby to and fro in the pram or taking your baby for a drive in the car may be of help. Massaging your baby or giving him / her a warm bath may also be of benefit. If your baby’s crying is upsetting you, talk to your midwife, health visitor or GP about it.

Contact a midwife if:

• Your baby is jaundiced and is sleepy, not feeding or the yellow colour is getting worse
• Your baby is sleepy and feeding less than six times in 24 hours
• Your baby’s stool has turned from yellow to green
• Your baby’s cord looks red and inflamed
• Your baby is disinterested in feeding and seems lethargic

Weight

Your baby will be weighed regularly by the midwife or health visitor. It is usual for a baby to lose weight during the first week. After this time, if your baby is gaining weight steadily this is a good indicator that they are feeding well. Most babies will have regained their birth weight by 10 to 14 days.

Safe Sleeping

Please see:

• Unicef
• Lullaby Trust
• Lullaby Trust on Youtube

Common health concerns in newborn babies

Feeding

You baby will have a variable feeding pattern, this should be responsively between 8 to 12 feeds in 24 hours. Initially they will take small amounts of colostrum, then increasing amounts as the milk comes in around day 3 to 4. A feed is successful if you can hear the baby swallowing and sucking rhythmically with pauses. Ask your midwife or care assistant for information on attachment, positioning, feeding patterns and breastfeeding support networks.

All babies should be fed responsively, ask to be shown how to sterilise equipment and make up feeds safely if bottle feeding.

If your baby is breastfeeding

Your healthcare professional should ask you about breastfeeding at every contact. You should be offered advice and support if you have any concerns (see below).

You should be encouraged to breastfeed your baby as often and for as long as he or she wants. This will help you body produce enough milk. Your baby will stop feeding when he or she is satisfied, this may be after feeding on both breasts or just one breast. You should not be advised to give your baby a top-up of formula milk if you are breastfeeding.

During the first week

If your baby is breastfeeding your healthcare professional should review your breastfeeding experience each time they talk to you. If you or your healthcare professional has any concerns, for example that your baby is not getting enough milk or you are experiencing pain, these should be discussed.

If you think that your baby is not getting enough milk you may be advised to increase your milk supply by feeding more regularly or to use expressed breast milk in a cup or bottle.

You should be encouraged to discuss any concerns you may have about breastfeeding with your healthcare professional or support worker (some common concerns are listed below). Your healthcare professional should work with you to help you breastfeed successfully.

Speak to a midwife if your baby does not poo at least twice every day or if the poo hasn’t turned yellow by day 5. This can be a sign that your baby isn’t getting enough milk.

Bottle feeding

If you are bottle feeding, you will be shown how to sterilise equipment and make up a formula feed. Guidance about making up feeds has recently been changed, so please make sure you speak to a midwife or maternity care assistant about making up feeds and that you receive written information on how to do this safely.

Please see guide to bottle feeding for further information.

BSUH Guide for Newborn feeding.

Breastfeeding in the first few days

Establishing breast feeding can be really challenging. Your baby may want to feed very frequently and this can feel really hard especially when you are very tired, during the night and if your nipples are sore. We are here to help support you during this time to establish breastfeeding, both on the post natal wards and at home. This leaflet offers some useful tips and practical advice about breastfeeding in the first few days that we hope you will find useful.

Frequency of Feeding

Babies vary in the frequency of their feeding in the first 48 hours. Many feed frequently for short periods, whilst others may not feed very much in the first 24 hours and then want to feed a lot. A baby’s stomach at birth is tiny (about the size of a hazelnut) and it does not need much to fill it. Even though you may think that you are producing only small amounts it matches the size of the baby’s stomach. After the first 24 to 48 hours your baby should be feeding between 8 to 12 times in 24 hours, including at night. If your baby is breastfeeding less than 8 times in 24 hours, you can start expressing. This will help your milk supply and provide your baby a little extra milk. Speak with a midwife about this.

Night feeds

Night time feeds are particularly valuable because the milk producing hormone Prolactin is present in larger quantities at night. Thus night feeds are really important for building up your milk supply. Surprisingly, night feeds also have a relaxing effect; the quality of sleep improves due to the breastfeeding hormones produced. It has been proven that women who breastfeed have a better quality of sleep and get back to sleep quicker than mothers who bottle feed. If it is your first baby, and the baby has fed a lot at night, have a lie in the following morning.

Sore nipples

Sore nipples are caused by the baby being incorrectly attached to the breast, rather than suckling itself. When positioning and latch are corrected, feeding will immediately become more comfortable, and even very tender nipples will heal quickly.

‘Reading’ your baby

Babies have many ways of letting you know they need food. They only begin to cry to be fed once the other signals they have given have not been recognised. Some newborn babies will not have the energy to cry and may just go back to sleep if the feeding cues are not responded to.

Infant feeding cues

• Rapid eye movements seen under closed eyelids
• Flexing of arms while still asleep
• Making sighing noises
• Lip sucking
• Mouth gaping
• Rooting and putting hand to mouth
• Following their hand with gaping mouth
• Waking and making quiet eye contact

This sequence of non verbal cues lasts for approximately fifteen minutes. If the above body language is not responded to, most babies will cry. Some, however, will simply go back to sleep to conserve energy.

It is recommended that you respond to the early cues. Babies that are learning to breastfeed, often feed better when, they are coming out of a sleep, rather than very hungry and upset. This is called responsive feeding and allows for babies to find comfort as well as food at the breast. We now know that keeping our babies close and responding to their cues for food, comfort and love is important for their brain growth and this closeness helps to foster close family relationships, which are good for long term health and wellbeing. Breastfed can be used to comfort babies and breastfed babies cannot be overfed

How an artificial feed may affect breastfeeding

• Breastfeeding works on a supply / demand basis. The more the baby feeds the more milk is produced. If a baby is given an artificial feed it will take longer to digest and she / he will not want to suckle for some time. This affects this natural balance of supply / demand and thus less milk is produced
• If the baby does not breastfeed often enough, your breasts may become full. This can be painful and may make it difficult for the baby to attach correctly
• Artificial feeds alter the bacteria in the baby’s gut. This may increase the risk of your baby developing infections
• Artificial feeds may potentially increase the risk of asthma, diabetes obesity and allergies, particularly if there is a family history
• A baby uses the tongue, jaws and mouth differently when sucking on a bottle. If a baby is given a bottle at this early stage, she / he may find it more difficult to learn to suckle at the breast as a very different technique is practised when bottle feeding

Breast milk – how much does my baby need?

Your baby’s tummy is tiny at birth, with a stomach capacity of around 5 to 7mls: about the size of a hazelnut. This increases over the first few days to 22 to 27 mls at 3 to 5 days. By 10 to 12 days the capacity expands to 60 to 85 mls (about the size of a walnut!). Don’t worry about your milk production, providing that the baby is feeding regularly at the breast or you are expressing 8 to12 times a day your milk supply will increase to match your baby’s growing appetite.

Count the number of wet nappies: baby should be producing at least two on day two, three on day three, four on day four and at least six wet nappies a day thereafter. The volume of urine in the nappy should increase along with the increase in number of wet nappies. Note the colour of dirty nappies. The stool should be changing from the sticky, dark meconium by day three, be brown by day four and become a yellow colour by the fifth day. Your baby should poo at least twice a day, many babies poo more frequently than this. It is a good sign that your baby is getting enough milk.

If your baby does not have a dirty nappy for more than 24 hours or the stools are not changing colour in the first five days, you should seek advice from a midwife. The following is a guide for mothers who need to express milk for their babies.

Breastmilk: Average amount produced

Hand expressing

You can practice the technique toward the end of your pregnancy from 36 weeks, so that you feel comfortable with it. Start again as soon as possible after your baby is born, while you are on labour ward, during skin to skin. This may stimulate your baby to feed and if not, provide valuable colostrum, you can express onto babies lips. Every drop is precious.

Hand expressing is really useful when you have a sleepy baby who needs colostrum in the first 24 to 48 hours, but is not able to feed.

It is also helpful when your baby has been admitted to Special Care at the PRH or the Neonatal Unit at the RSCH. By hand expressing you can stimulate your milk supply and your colostrum will be given to your baby. When the baby is well enough to breastfeed you will have a ready supply. If your baby is born premature it is recommended that you start hand expressing within 2 hours of birth and continue to do so between 8 to 10 times every 24 hours, including at night.

What do you do?

Hair brushing and shoulder massage before and during your expressing will relax you and increase Oxytocin levels. Massage your breasts for a few minutes. Use flat of fingers, and gently move around the breast, gradually work your way towards the nipple and areola. Do not drag your fingers over your skin. About five minutes of massage will help the milk to flow. Some women make a fist and gently knead the breast, do not drag the skin, move around the breast in circular movements, gradually working down to the areola. Rolling your nipple between your finger and thumb stimulates Prolactin output.

When you are ready to start expressing, place your thumb on top of your breast approximately 2cm away from the base of the nipple, place your index finger the same distance away from the base of the nipple, underneath your breast.

Push back into breast tissue a little, and then gently compress the breast.You can move finger and thumb, around the breast so that you express all areas. Ask a member of staff to talk you through it.

Do not be concerned if you do not see anything at first, just keep trying and it will come. To establish your milk supply, if baby is not feeding in the first 24 to 48 hours try to hand express for about 100 minutes in 24 hours. This sounds a lot, but if you hand express for five minutes every hour, you will be doing fine, and if you were able to do more, so much the better.

The trick is not to be put off if you do not see anything at first, the repeated hand expression will trigger the production of colostrum as the day goes on, and in the course of a day you can go from nothing, to a few beads by lunchtime to collecting colostrum into a syringe for baby by late afternoon! Babies only need small amounts of colostrum in the first day and even tiny beads of colostrum are packed with components which reduce risk of infection; increase baby’s ability to use alternative energy stores in the first two days, and help protect against future illness.

Common breastfeeding concerns

Please also see NHS breastfeeding for the latest information and advice on breastfeeding including lots of really useful videos and tips for successful feeding.

Breastfeeding drop-ins in Brighton & Hove and West Sussex

There are daily breastfeeding drop in-clinics for Brighton and Hove and West Sussex. For the most updated information follow these links:

Brighton and Hove

West Sussex

Registration of baby’s birth

Your baby’s birth needs to be registered in the registration district where it took place within 42 days (six weeks) of the date of birth.

If your baby was born in Brighton & Hove

To make an appointment telephone 01273 292016 or go to the website

If your baby was born in Haywards Heath

Please telephone 01243 642122 to make an appointment.

Haywards Heath Register Office

Haywards Heath Library
34 Boltro Road
Haywards Heath, RH16 1BN

Who can register?

If the baby’s mother and father were married to each other at the time of the birth, either parent may register. If the mother and father were not married at the time of the birth, the mother may register alone, but the father’s details can only be entered if they attend to register together. If this is difficult the mother or father may make a statutory declaration using a prescribed form (please contact the register office for further details), or the father’s details can be added by re-registering the child at a later date. Other people may register the birth in exceptional circumstances. Please contact the register office for further information.

Same sex couples

Same sex couples can now become equal legal partners of children they conceive together or conceive through a surrogate. Lesbian couples who are civil partners or married at the time of the conception and conceive a child through artificial insemination will both automatically be treated as their child’s legal parents.

Lesbian couples who are not civil partners or married at the time of conception but who conceive together through a fertility clinic in the UK licensed by the Human Fertilisation and Embryology Authority may also be treated as legal parents.

Different options are available to gay men depending on their specific circumstances. For further information please contact the register office.

What information will the registrar ask for?

Baby

• Date and place of birth
• Whether the baby is a boy or a girl
• The full name and surname in which the baby is to be brought up
• Proof of your baby’s NHS number (infant discharge summary)

Mother

• Full names and surname
• Date and place of birth
• Address at the time of the birth
• Her occupation

Father or co-parent (if his / her details are to be entered in the register)

• Full names and surname
• Date and place of birth
• His / her occupation

You should bring at least one form of identification when you go to the register office. You can bring:

• Passport
• Birth certificate
• Deed poll
• Driving license
• Proof of address (eg. utility bill)
• Council Tax bill
• Marriage or civil partnership certificate

What certificates will I be issued with?

After the birth has been registered you will be given a short birth certificate which is issued free of charge. A full birth certificate (needed to obtain a passport) which is a complete copy of the entry in the register is also available for a fee. Further short and full birth certificates can be purchased at the time of registration of at any time afterwards.

Registering your baby with a General Practitioner

You will need to register your baby with a General Practitioner (GP) as soon as possible. To do this you will need to complete a form GMS1 which is available from all GP practices. Your baby / babies has / have been allocated an NHS number at birth and this number is printed on the Infant Discharge Summary that you will be given before you go home. The NHS number of your baby / babies must be entered on to form GMS1 to register your baby / babies with a GP.

The transition to parenthood, mood changes, postnatal depression and post traumatic stress disorder

Childbirth can be one of the most challenging and rewarding experiences in any woman’s life. The creation of a new life is a very personal experience which brings enormous pride, pleasure and responsibility. While it is a very exciting time, new mums can and do feel tired, stressed and sometime overwhelmed by their new circumstances; these feels are natural and a period of adjustment is to be expected. Post natal depression affects about 10 percent of women who have just had a baby. It is a reaction to a life event which can be split up into three categories. Baby blues a few days after delivery, post natal depression which can continue for months, and postnatal psychosis.

The information below has been written to try to explain the changes that can occur in the early months after you have given birth to your baby, and to help women who are suffering from these very common problems to talk about them and seek the help they need.

Baby blues

Around the third or fourth day after giving birth, 50 to 80% of women go through what is known as the ‘baby blues’. It is not known why it happens but it is quite normal and very common and may last up to a week.

You may be feeling:

• Upset and cry for no reason
• Tired and weary
• Feeling useless
• Anxious (stressed out)
• Unable to sleep
• Cross and cranky
• Not eating properly

What can you do to help yourself?

• Rest, rest and more rest. Take naps when you can and as often as you can
• Do not be too hard on yourself. You do not have to be super woman. Accept help around the house from family and friends
• Eat a healthy diet, little and often if your appetite is poor. Take plenty of drinks especially if breastfeeding
• Talk about your feelings to your partner and friends and allow yourself to have a good cry if you feel upset
• Treat yourself and try to organise time for yourself and your partner
• Remember: please do not be afraid to talk to your midwife, health visitor or GP. They are there to help you

What can partners / family / friends do to help?

• Be aware that most new mothers go through the ‘baby blues’. Be patient and willing to help with the baby and the housework
• Give the new mother time out to rest and relax

What is postnatal depression?

Postnatal depression is a term used to cover feelings of depression after having a baby and affects about 10% of new mothers. It usually begins between one month and three months after giving birth.

At first many women are tired, feel unsure and are not able to cope when they come home from hospital. This normally passes within a couple of weeks. However, for some mothers with postnatal depression, things do not improve.

Any new mother can get postnatal depression, but some women seem to be at higher risk than others. If you have the following ‘risk factors’ then you might be more at risk of postnatal depression than other women, but the chance of this is still low and it does not automatically mean that you will get depressed.

Risk factors for postnatal depression

• Being depressed before, particularly previous postnatal depression
• Having a psychiatric illness (disorder) already
• Being alone or isolated with few friends and poor social support
• A poor relationship with your partner
• A recent stressful event, e.g. bereavement, moving house
• Severe / unresolved postnatal blues

You may not know what is wrong with you and do not want anybody else to know your feelings about yourself and your baby. This makes it difficult to look for help, but by doing so, you can get the support and help you need to make a speedy recovery and prevent the possibly consequences of untreated postnatal depression. Delay may affect your ability to bond with and stimulate your new baby which will have a detrimental effect on the baby’s development.

What are the main symptoms to look for?

• A lack of interest in yourself or the baby
• Unable to cope, finding everything is an effort
• Feeling that you are a bad mother, guilty and ashamed
• Fear of being left alone with your baby
• Feeling angry, confused and unable to concentrate
• Feelings of panic, anxiety, dizziness, fast heart beat, sick in your stomach and sweating
• Feeling exhausted yet unable to sleep properly (finding it hard to get to sleep and/or waking up very early in the morning)
• Overeating or no interest in food
• No interest in sexual relations
• Feelings of hopelessness

Postnatal depression usually lasts up to six months, but some symptoms may remain a year after the baby was born. Some women may not feel depressed but suffer from an anxiety disorder or panic disorder instead. You may have symptoms of intense anxiety, rapid breathing and heart rate, shaking and dizziness.

Some women also suffer from obsessive compulsive disorder following birth. Symptoms include repetitive thoughts (possibly about harming the baby), avoiding the baby and anxiety.

What can be done to help?

Postnatal depression is treatable and is treated in much the same way as ordinary depression. Talking about the problem with somebody, such as a midwife, health visitor or GP is very important and you should not delay in seeking professional help.

Getting extra support and help from family and friends with looking after the baby is also important. Often simple measures like more rest and time out will be very beneficial. Joining a support group for women suffering from postnatal depression may also be helpful. Prescribed treatment may involve a combination of drug treatment and psychotherapy. The initial treatment can be counselling and may be carried out by health professional visiting the mother at home.

Where some women have more severe postnatal depression sometimes antidepressants are necessary. Although this can cause problems with breastfeeding, since some drugs get into the breast milk, there are drugs that are safe. You should remember that the most important thing both from the baby’s and your point of view is to get better as quickly as possible.

In rare cases, women can become very severely depressed and may then need admission to hospital for their own safety and to receive specialist help.

What is postnatal psychosis?

This is a rare complication of childbirth occurring in 1 in every 500 women or so. It is most likely to occur in mothers who have previously had an episode of serious mental illness or in those who had a strong family history of serious mental illness.

Symptoms of the disorder can be varied but usually include:

• A disturbance of mood, though this can be either an elevation of mood (mania) or depression
• Having muddled thoughts
• Loss of contact with reality
• False ideas (delusions)
• Hearing voices or seeing things that are not there
• Abnormal behaviour

Symptoms appear from a couple of days to a couple of weeks after the birth and it is important for mothers with postnatal psychosis to receive treatment as soon as possible.

Postnatal psychosis requires treatment that will depend on the exact symptoms that you are suffering. The use of drug treatments may vary if you are breastfeeding. This will usually involve a psychiatrist.

The effects of a mother’s postnatal depression on other family members and their subsequent needs should be considered and support offered as appropriate.

What is post-traumatic stress disorder?

A small percentage of women may find their birth experience traumatic and may suffer from anxiety or distress. Some may even find they have symptoms of post-traumatic stress disorder. If you are feeling traumatised by your birth experience and are experiencing any of the following symptoms:

• Nightmares
• Flashbacks
• Panic attacks
• Numbed emotions
• Sleeping difficulties
• Problems with concentration
• Irritability or anger

Please speak to your GP, Midwife, a close friend or your family and tell them. You can also contact the Birth Trauma Association.

What does this mean for me?

If you think you are at risk of developing postnatal depression, it is very important that you seek advice for your own particular situation.

It may be easier to contact someone you already know, this could be your midwife, GP or health visitor, or you may prefer to contact a self-help organisation.

We all expect to feel a gush of love for our new baby. This may not happen straight away for every mother. Skills will come with time and experience. Do not be afraid to look for help.

Are there any support groups?

For details on local support groups you will need to ask your midwife, health visitor, GP or ask at your children’s centre or local health centre.

Contraception

There is no ‘right time’ to start having sex again after you have given birth. It is important to listen to your body and start having sex when you feel you are ready. You can get pregnant again as little as three weeks after having a baby even if you are breastfeeding and your periods haven’t started again. Make an appointment to see your family planning nurse or GP to discuss your contraception options.

Contraception Choices

Long acting contraception

Further information

Maternity rights and benefits

For an up to date guide on help with managing your money before, during and after the birth of your baby please check the Money Advice Services website.

For further up to date information on maternity right and benefits, check the Department for Work and Pensions website.

Domestic Violence

One in four women is affected by domestic violence in their lifetime. It often increases in pregnancy. If you are concerned, talk to your midwife or call the 24 hour national helpline 0808 200 0247.

East Sussex Domestic Violence Advice

RISE is a domestic abuse charity working in Brighton and Hove and throughout West Sussex. Our services include refuge accommodation, resettlement, crisis appointments, helpline, counselling, housing, legal and financial advice, solicitors appointments, support groups, play therapy, one to one support and training and preventative education.

West Sussex Domestic Violence Advice

WORTH Services is an Independent Domestic (IDVA) Service here to support people affected by domestic abuse in West Sussex. We are available seven days a week 9.00am to 5.00pm.

Maternity services liaison committee

The Brighton and Hove Maternity Services Liaison Committee or MSLC is a group run by parents for parents and parents to be. They can answer your questions and help you get the best from local maternity and postnatal services.
They can put you in touch with specialist health professionals or pass your feedback to them. This may even help change the way NHS services are run! For further information please see their websites:

Brighton
Mid Sussex

Access to health records

Your medical records are confidential and are only shared with people who have a clinical reason for seeing them, including your GP.

Whilst in hospital you can ask to look at your medical notes and for 40 days after you have left hospital. There is a charge after this time. You can request a copy of your medical records at a maximum cost of £50.

Please put your request in writing to:

Data Protection Office
Room 153, Downsmere
Princess Royal Hospital
Lewes Road
Haywards Heath, RH16 4EX

Subject Access Office
1st Floor, Barry Building
The Royal Sussex County Hospital
Eastern Road, Brighton BN2 5BE

Equality and diversity

If you have any special requirements for example religion or related to an allergy or disability please contact the Maternity service for further discussion. If you have vision, mobility or access issues please contact Linda Woods (Maternity Administrator) on 01273 696955 extension 4603.

She will be able to direct your call for further advice and information.

Your Patient Advice and Liaison Service (PALS)

PALS provide confidential advice, information and support for patients, relatives and carers. PALS are available to assist with concerns and liaise with staff on your behalf, ensuring you receive a timely and appropriate response.

The PALS team will:

• Actively listen and respond to concerns, suggestions or queries to help make your experience as easy as possible
• Provide information on NHS services
• Support you through an anxious time as a patient, relative, friend or visitor
• Feedback your views to the Chief Executive and Trust Board
• Offer advice on the complaints service and provide information on how to seek independent advice if you wish to make a complaint

Contact us

You can contact the PALS team by telephone between 10.00am and 4.00pm on: