Maternity Annual 2015/2016 by Ashville Media Group

CORK 2015/2016 UNIVERSITY MATERNITY HOSPITAL 2015/2016

Maternity T H E ULT I M AT E P R E G N A NCY GUI DE

IN ASSOCIATION WITH

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DESIGNER: Jennifer Reid PRODUCTION MANAGER: Mary Connaughton SALES DIRECTOR: Paul Clemenson SINCERE THANKS AND APPRECIATION TO EVERYONE WHO CONTRIBUTED TO THIS ISSUE. PARTICULAR THANKS GO TO THE FOLLOWING FOR THEIR HELP AND SUPPORT: Siobhan Canny, Norma Deasy, Juliana Henry, Oonagh McDermott, Concepta McDonagh, Helen McLoughlin, Maria Moore, Caitriona Moriarty, Margaret Mulvanny, Edel Nagle, Deirdre Powell, Ailish Purcell, May Quirke, Rita Spellman, and Jane Whiriskey ILLUSTRATIONS & PHOTOGRAPHY: ISTOCKPHOTO.COM, thinkstockPHOTOS.COM

maternity is published by Ashville Media Group, Old Stone Building, Blackhall Green, Dublin 7. Tel: (01) 432 2200; Fax: (01) 672 7100 Email: info@ashvillemediagroup.com Web: www.ashville.com All rights reserved. Every care has been taken to ensure accuracy in the completion of this guide. The publishers cannot, however, accept responsibility for errors or omissions. Reproduction by any means in whole or in part without the permission of the publisher is prohibited. ©Ashville Media Group, 2012 All discounts, promotions and competitions contained in this magazine are run independently of maternity. The promoter/advertiser is responsible for honouring the prize. The information contained in this book is not a substitution for the examination, diagnosis and treatment by a qualified healthcare professional.

EDITOR’S welcome

very pregnancy is different, whether you’re expecting for the very first time or adding to your expanding brood. As mum to a four year old and a two year old, I can certainly testify from my own experiences that every pregnancy brings with it a unique set of both fearful and joyful moments. The key, really, is to listen to your body, relax, and seek advice if you’re unsure about anything. The Maternity Annual has been guiding mums-to-be for the best part of two decades now, and we’re proud to bring you our very latest edition, updated for today’s expectant mothers. As always, it contains the most up-to-date information on every aspect of pregnancy, from dealing with morning sickness to eating right for you and your baby to identifying all those little aches and pains associated with pregnancy. We’ve also included a comprehensive guide to the birth process itself, including information on Caesarian sections and hynobirthing, as well as what to expect immediately following the birth for both you and baby. The first week with a new baby can be an exhilarating but exhausting time. You will be recovering from the birth, while getting to know your precious new bundle and trying to get to grips with feeding and fiddly issues like nappies! Our section on the first few days offers lots of advice on what to expect and do – and most importantly, where to get help if you need it. We can’t emphasise this enough – there are people and places out there to help you in your first few days of parenthood, so don’t hesitate to ask. Need a contact in a hurry? Turn to our Directory on p126 for a list of resources available to you. We’ve also added to our section on the first six months with your baby, to include more information on such important topics as teething, weaning and health issues like meningitis. Finally, we’ve included once again our popular Pregnancy Diary, an interactive section that gives you tips and tricks at different stages of your pregnancy, as well as giving you space to note down information about your appointments and the various steps along your nine-month journey. Keep it as a souvenir of your pregnancy, because believe us, before too long this will be a dim and distant memory as you grapple with a growing toddler! Wishing you all the very best with your pregnancy!

Penny Gray EDITOR

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EDITOR’S LETTER

EDITOR: Penny Gray

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CONTENTS

2016

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INTRODUCTION YOUR 40-WEEK COUNTDOWN

CHAPTER 1:

CHAPTER 2:

CHAPTER 3:

18 21 22 24 26 30 34 36

38 39 41 46 48 50

54 56 58 60 61 63

Healthy Eating Gestational Diabetes Exercise Pregnancy Wellbeing Pregnancy Style & Beauty Difficulties & Warning Signs Coping with Miscarriage Travel & Pregnancy

Preparing for Baby Maternity Leave Budgeting for Baby Buying for Baby Designing a Nursery Hospital Bag Preparing for Birth

Labour & Birth Labour Signs Stages of Labour Pain Relief Breathing Techniques Assisted Birth After the Birth

CHAPTER 4:

CHAPTER 5:

66 68 72 74 76

Your Body Postbirth Breastfeeding Babies in Special Care Tests for Baby Going Home

78 80 82 84 88 89 92

96 100 102 104 106 108 110 111 113 116 120 122 125

126

DIRECTORY

129

YOUR PREGNANCY DIARY

After the Birth

First Days

Caring for Your Baby Vitamin D Guide to Nappies Vaccinations Registering your Baby Postnatal Depression Contraception

Life with Baby The First Six Months Babies & Sleeping Teething Feeding Issues Weaning First Aid & Infants Meningitis: The Facts Cranial Osteopathy Fun with Baby Photography Work & Childcare Car Safety Family Cars

Disclaimer: This brochure and contributions made herein have been carefully researched and are intended to act only as a guide for new parents. Independent medical advice should always be sought should you have concerns during, or after, your pregnancy. Whilst every effort has been made to ensure that the information contained in this brochure is accurate at the time of going to press, the publisher, maternity hospital, and the editor cannot take responsibility for inaccuracies or errors. The opinions expressed in the various contributions are the personal opinions of the contributors and are not necessarily the views or opinions of the publishers, the hospital nor the editor. The material contained in this brochure is not intended to constitute medical advice and all problems of a medical nature must be referred to medical staff at the hospital or other qualified medical practitioners. Advertisements within the publication are not endorsed by the hospital or the publisher. Any claims made within the advertisements are not endorsed by the hospital or the publisher.

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CONTENTS

Healthy Pregnancy

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40 40 WEEK COUNTDOWN

W EEK C O U N T D OW N

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STEP-BY-STEP Follow you and your baby’s progress with our step-by-step guide to the 40 weeks of pregnancy

T R I M E S T ER

ys a

regnancy is divided into three phases, or trimesters. The first covers the time from conception to week 12 and is a vital stage in your baby’s development when all of the major organs begin to form. It is also a period when your baby is most vulnerable to harm, so it is important to look after your health, eat well and avoid alcohol and drugs.

40 WEEK COUNTDOWN

Weeks 3-6

Once the egg has been fertilised by the sperm, it travels along the fallopian tube towards the uterus where it implants itself. This process triggers the release of hormones, which in turn spark changes in your body to prepare for pregnancy. By week four, the fertilised egg, which is now a cluster of living cells, will separate into two. One part will form the embryo and amniotic sac and the other part will form the placenta, which will supply your growing baby with nutrients and oxygen via the umbilical cord.

While some women are aware that they’re pregnant almost from the moment of conception, most don’t suspect pregnancy until they miss a period in week five. By then, your baby’s nervous system is already beginning to develop and, to minimise the risk of spina bifida and neural tube defects, it is recommended that you take folic acid supplements from 14 weeks before conception until week 12 of pregnancy. If you haven’t begun taking folic acid, start to take it as soon as your pregnancy is confirmed. The development of blood and blood vessels, bones, muscles and major internal organs has also begun. Some blood vessels will form the umbilical cord and connect to the placenta, providing a vital link between you and your baby. As well as food and nutrients, drugs and nicotine can also be passed through to your baby. Avoiding cigarettes, alcohol and other drugs is vital during this crucial time in your baby’s development.

Week 6

BABY: Although only the size of a coffee bean, your baby is recognisable as a human being even at this early stage. The cluster of living cells has now developed into an embryo. Your baby has a neck and head, a brain and a heart that is already beating, although it has only two chambers rather than the four that will soon develop. An ultrasound scan may even be able

to pick up a heartbeat at this early stage. Tiny buds that will become arms and legs are already in place. The beginnings of a digestive system, kidneys and a liver have all started. MUM: Your period is two weeks’ late. You may have had a test at this stage or made a visit to your GP. You may be feeling nauseous and your breasts might feel tender. You may be feeling tired and might need to pass urine more often, especially at night.

Week 8

BABY: Your baby is now about the size of a grape. She will probably make her first movements this week, though you won’t feel them. Her features, especially her eyes and mouth, are becoming more distinct. The eyes are covered by an intact skin, which will eventually

WHEN DO I

need a scan? Most women will be offered an ultrasound scan anytime between 12 and 22 weeks, depending on their hospital’s policy. This scan helps to check your baby is growing and developing normally. The baby’s growth is calculated by measuring her head, abdomen and legs.

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Week 10

BABY: Your baby is now about the size of an apricot. Development is now well underway with fingers and toes becoming more distinct and the facial features developing more. Your baby will be moving around and is about 4.5cm long and weighs about 5g. MUM: Although not yet visibly pregnant, your uterus is by now the size of an orange. Now is a good time to invest in a wellfitting support bra, as your breasts will have already started to increase in size. Some women experience headaches that may be caused by dehydration and not eating enough due to morning sickness. Try eating small amounts often and drinking plenty of water at regular intervals.

T R IM E S T ER

he second trimester (weeks 13 to 28) is often the most enjoyable phase, with many of the discomforts of early pregnancy having now passed. During the latter part of this phase you will first feel your baby move – one of the most exciting moments of your pregnancy.

Week 12

BABY: Your baby’s head is now fully formed. Eyes and eyelids are complete. Fingers and toes are fully formed; arms have grown and nails have started to grow. Your child’s ovaries or testicles are distinguishable but not fully developed so a scan at this stage cannot determine the sex of the baby. The ribs and spine are beginning to harden into bone. Baby’s length is now about 6.5cm, but she weighs only 18g. MUM: By now you will start to feel a bulge above your pelvis and your uterus is the size of a grapefruit. At your first antenatal visit your doctor or midwife will be able to feel the uterus by external examination. On this visit your medical history will be taken, blood and urine tests are carried out, blood pressure is checked and you will be given some nutritional advice.

Week 14

BABY: Eyebrows and a little hair have grown. All of your baby’s organs, limbs, muscles, genitalia and bones have formed and the

heartbeat is strong. She is now drinking some of the amniotic fluid and receiving all her nourishment through the placenta. She is now about 8cm long. MUM: Many women who suffer from morning sickness begin to feel better by now. You may also feel less tired. A dark line of pigment, the linea nigra, may form down the centre of your abdomen. This will fade after your baby is born.

Week 16

BABY: Your baby is now fully formed and is growing rapidly. The rest of her time in the uterus will be spent growing and maturing until she is able to survive independently. MUM: For many, this is a time of increased energy. Your bump may be becoming more noticeable. You are likely to have more of an appetite, but don’t worry too much if you don’t feel like eating a lot – it is the quality and not the quantity of food that is important.

Week 18

BABY: By week 18, your baby now has a firm grip and even has fingerprints. She will be increasingly energetic at this time; as well as kicking she is also sucking, with some babies

MAKE

communication Your baby can hear sounds from the outside. Talk to your baby and feel how he or she reacts when you play different types of music. Try singing to your baby and get your partner to sing or talk too.

40 WEEK COUNTDOWN

split to become eyelids. The limbs elongate and elbows and knees begin to appear. The internal organs are continuing their development and the heart has started its vigorous pumping. Your baby will now be about 2.5cm long. MUM: You may find you have lost a taste for some foods while you are craving others. You may also be suffering from nausea. Having some toast or crackers before you get out of bed to raise blood sugar levels and eating small frequent meals can help, as nausea is often worse when your stomach is empty. Extreme tiredness can also occur, so early nights are advised. If you are having difficulty sleeping at night, take naps during the day whenever possible. Tiredness will subside as your pregnancy progresses. You may also feel faint due to a hormone imbalance that will settle after a little while. Try to avoid hot, stuffy areas.

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beginning to suck their thumbs before they are even born. She will now be about 20cm long. Until now, your baby’s bones had been developing but were still soft. This week, they begin to harden, or ossify. Some of the first bones to ossify are those in the clavicles and the legs. MUM: By week 18, many women feel their baby move around for the first time. Some women also find that they feel flushed and perspire more than usual. This is due to the increased levels of blood circulating around your body, which is necessary to meet your baby’s demands.

prematurely at this stage. However, she would need special care, as her lungs are not developed fully enough to cope with life outside the womb without help. This is a period of very rapid growth and your baby is now about 32cm long and weighs over 1lb (2.2lbs = 1kg). MUM: You will be gaining weight rapidly at this stage. You may also be feeling practice contractions for labour called Braxton Hicks. Week 24 usually marks another visit to your doctor or midwife. At this point your baby’s heart can be heard with a stethoscope. Your own heart is now doing 40 per cent more work than usual.

Week 20

Week 26

BABY: Buds for permanent teeth are forming behind those for baby’s milk teeth, which have already formed, and hair continues to grow on her head. A thick, greasy substance, called vernix, will cling to the downy hair on your baby’s skin, forming a protective barrier around her. Baby is now about 25cm long and you could still hold her in the palm of your hand. Your baby’s sex may be determined at this stage. MUM: This is often one of the most exciting weeks in your pregnancy, when you may start to feel your baby’s movements. Some mothers describe them as ‘butterflies fluttering’.

40 WEEK COUNTDOWN

Week 22

BABY: Your baby is still moving around a great deal and has probably settled into a fairly regular pattern of sleep and activity. Her fingernails are now almost fully formed. MUM: You may find you have some swelling of your gums caused by the increased levels of hormones in your system.

Week 24

BABY: Your baby would have a chance of survival if born

BABY: Your baby’s eyes now open for the first time. Her body is covered with fine, downy hair and the skin is starting to change. Until now it has been thin and translucent but it is now becoming more opaque. MUM: You may begin to notice stretch marks on your skin and most will fade after the birth. Your baby is now pressing on your bladder, which means frequent trips to the bathroom.

Week 28

BABY: Your baby has now filled nearly all the space in your womb. Most babies turn upside down at this point and seem to fit more comfortably. Your baby’s heartbeat speeds up when you speak and she will recognise your voice at birth. Your baby’s length is now 38cm. MUM: A small amount of colostrum (thin, yellow breast milk) may leak from your breasts at this time. If your blood group is Rhesus negative, an antibody check will be taken. You may feel that you are putting on weight quite fast at this point. Swollen feet, legs, and fingers at the end of the day is common. It is usually harmless, as long as your blood pressure is normal and you do not have protein in your urine. Put your feet up when you are resting and wear shoes that are comfortable.

COUNTING

the kicks Your baby will be moving from about seven to eight weeks, but you won’t be able to feel them until your second trimester, often around Week 19/20. Early movements can feel like fluttering or bubbles popping. As the movements get stronger, start tuning into them and get used to your baby’s pattern of waking and sleeping. If you are concerned, try lying down on your left side with support under your bump. Have a snack, or a cold drink, or play some music – this will wake up your baby if he has been sleeping. Aim for 10 movements within two hours, and do this count regularly. If you feel any difference in your baby’s movements, either suddenly or gradually, talk to your midwife or doctor. As you get close to your due date, you may feel less movement due to decreased space in the uterus and your baby sleeping for longer periods of time. However, you should still feel regular movement; at least 10 over a 12-hour period. If you are worried at any stage about your baby’s movements, consult your medical team.

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Scientifically shown to help prevent iron deficiency during 1 pregnancy  Spatone is iron-rich spa water from Snowdonia, Wales  Gentle on the stomach, Spatone is a form that is readily available2  Up to 40% of the iron in Spatone 3is available for the body to absorb  Packed into individual sachets, Spatone is ideal to use on-the-go  Available from all leading health food pharmacies f od stores and phar fo rmacies

Spatone® Apple Spatone is also available with a delicious apple taste and added Vitamin C to aid in the absorption of iron. All the goodness of Spatone now even more convenient!

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Clinical and Laboratory Haematology, 2003, 25 227-231. D. McKenna (Royal Victoria Hospital) et al. ‘a randomised trial investigating and iron-rich natural mineral water as a prophylaxis

Haematology, 2003, 25 99-103. M. Worwood (University of Wales College of Medicine) et al. ‘iron absorption from a natural mineral water’ in Clinical and Laboratory Haematology, 1996, 18 23-27.

Please note that the above sources refer to Spatone, 100% natural iron supplement.

Food supplements must not be used as a substitute for a balanced diet and healthy lifestyle.

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T R I ME S T ER

y the third trimester, weeks 29 to 40, your baby’s development is virtually complete. This phase can sometimes be the most uncomfortable as your body begins to feel the strain and by its end most women are eagerly awaiting the birth of their baby.

Week 30

BABY: You may not be aware of Braxton Hicks contractions, which are now happening at regular intervals, but your baby is probably very aware of these. MUM: Your body is now beginning to feel the strain and you may find yourself getting tired and out of breath when climbing stairs. Try to maintain good posture when you are standing or sitting.

40 WEEK COUNTDOWN

Week 32

BABY: Your baby is now fully formed. She is gradually putting on weight and both the vernix and the downy hair have started to disappear. She is now about 42cm long. MUM: At each visit with your midwife or doctor, they will check your baby’s position as well as checking the baby’s heartbeat and rate of growth.

Week 34

BABY: You may now be able to distinguish your baby’s bottom from a foot or knee and will feel her movements more as she kicks or moves around. This is the period when your baby moves into the head-down position with her face towards your back. She will stay in this position until the birth. You may feel more pressure on your bladder and your pubic bone. Fluid is passing through your baby’s kidneys and this contributes to the amniotic fluid. Your baby’s mental processes are speeding up. She can now differentiate between dark and light and is bathed in a red glow when sunlight is on your tummy. MUM: You may now be feeling a bit uncomfortable due to your baby’s bottom sticking up under your ribs or by her head bumping into your bladder. You may also be feeling quite breathless as your lungs are squashed by your expanding uterus. This is a period of rapid growth, so eat small, frequent meals to keep energy levels high. Backache is a common symptom of this stage of pregnancy. Ensure that you don’t lift anything heavy, get plenty of rest and wear good support underwear.

Week 36

BABY: You will usually visit your midwife or doctor every week from now until the birth (please note that some hospitals encourage you to visit at weeks 37, 39 and 40). If this is your first pregnancy, the baby’s head will probably descend into your pelvis. This is known as ‘engaging’ and will be measured by your midwife. With subsequent births, the baby’s head will not usually engage until week 40. Your breathing will become easier, although you may find that you need to pass urine more often, and your sleep will be interrupted. This is a time of major growth and your baby’s weight may be increasing by as much as 28g a day. After the baby has engaged, its larger body movements tend to be more limited, but you will still feel movement – at least ten movements in a 12-hour period. MUM: All the rapid growth of this stage could result in you feeling quite hungry.Because of the weight of your uterus pushing against your stomach, it is better to eat small snacks at regular short intervals instead of large meals. This will help with indigestion and heartburn. Your body will be working extremely hard now, so you may feel hot and flushed as you have more blood circulating and you are burning more calories.

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Week 38

Week 40

BABY: Your baby is ready to be born. She is about 55cm long and weighs an average of 8lbs (3.6kg). Your baby’s bowels are filled with greenish black meconium that will be her first bowel movement after birth. MUM: Finally, the day you have been waiting for has almost arrived. By this time you are probably feeling fed up with being pregnant and are eager for the birth. You will feel sharp kicks under your ribs at either side and the presenting part presses through the softened, partially opened cervix. Your baby is ready to be born; but remember, some babies come sooner, and more arrive later, than the due date. Be patient, you’re almost there!

HOW I INVOLVED MY

partner in my pregnancy “At the end of every week or fortnight, we sat down together and read the corresponding update in the pregnancy guide. It made the baby more real for both of us, and gave my partner an idea of how the baby was developing in my body.” Susan, mum to Alex and Ruairi “If you can afford it, a babymoon is a brilliant idea for you to bond as a couple, before the new baby comes along. Even if this isn’t your first, a new baby can change your relationship, and making sure this change is for the better is all down to keeping your personal relationship a priority. A babymoon allows you to reconnect and get excited together about the change coming in your life.” Edel, mum of three “It’s very easy and tempting to do the baby shopping by yourself, but make sure to involve your partner as much as possible, even if it’s just the big things. Doing something practical, like building a cot, can make your partner feel as though he/she is doing something.” Sinead, mum to Sive

“I found my wife’s first pregnancy rather surreal at times, simply because I didn’t know what to expect. Second time around, I knew better and got involved as much as possible. I read the updates, went to the appointments and scans, and helped with the planning. But what really made it special was putting my hand on my wife’s tummy in the mornings when we were still in bed and feeling the little kicks. I felt like my new son was saying hello to me, and me alone. It was a really special moment and I wish I did it more on her first pregnancy.” David, dad of two “We pinned up the scan pictures on the fridge as a constant reminder of the baby who was about to come into our lives. Whether you have one scan or five, try and make sure your partner comes along too. There is nothing more real than seeing your baby flash up on that screen – even better when they are doing something like sucking their thumb!” Louise, mum of three

40 WEEK COUNTDOWN

BABY: Your baby’s movements may begin to feel different now. Instead of whole body movements, you may feel lots of jabs from the feet and knees. However, you should continue to have at least ten baby movements in a 12-hour period. If you have any lessening of movement, consult your doctor or midwife immediately. Your baby continues to put on weight and, although there is no air present in the lungs, she may be making shallow breathing movements in preparation for life outside the womb. In this way, amniotic fluid actually passes into the baby’s windpipe, giving her hiccups. MUM: If your baby does have hiccups, you will feel them. Although you will experience less movement as your baby becomes more cramped in the uterus, you will feel a strange buzzing sensation inside your vagina as the baby’s head moves against your pelvic floor muscles. Emotionally, you may begin to feel both excited and apprehensive as your due date approaches. The last weeks can sometimes be tedious and tiring as you are eager for the birth. Your baby will be three times as heavy at birth as it was at 28 weeks and will weigh anything from 5.5lb to 11lb (2.5-5kg).

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SECOND-TIME strategies

New research from Persil Non-Bio and Comfort Pure reveals that parenthood is just as hard the second time round – but there are lots of strategies to help you cope.

ADVERTISING FEATURE

espite pregnant mums feeling naturally excited about having another baby, they still feel apprehension about having another child. Persil Non-Bio and Comfort Pure have asked 500 pregnant mums what they are most looking forward to, and what worries them most, about their upcoming arrival. ● TIME: Nearly two thirds (63%) of second time mums-to-be worry about having enough to spend with their partners, while 52% think about how they will split time fairly between their expanding brood. ● ROUTINE: 53% of mums feel concerned about adding a new baby’s routine. In particular 42% feel that managing an effective sleep routine would be the most difficult stage to overcome and 20% of mums also wonder if they will have enough time to bond with their new baby. ● CHORES: 65% worry about coping with increased chores and 45% are concerned about their utility bills rising. In response to these worries, Persil Non-Bio and Comfort Pure have teamed up with Suzie Hayman from expert charity Family Lives to provide a set of top tips and practical advice to address these concerns.

PARENTS TOGETHER What children need most of all is for their parents to have a strong bond, and to be secure and content. This means it’s not selfish to spend time on each other or take time for you. Use family, friends and paid childcare to give you nights off or even weekends away. Share childcare so both of you have time to relax.

LOVE & ATTENTION Kids play up if they are ignored. If the only time they get noticed is when you tell them off, they’ll repeat that behaviour to get your attention. Set times when the children know, for instance, they are expected to tidy up and prepare for bed. Make it a golden rule that a parent plays with and bathes them, puts them to bed and reads a story every night.

DOUBLE THE ROUTINE Routines are really important to children – they make them feel secure and loved. You will find that while some activities seem to clash, others dovetail, which allows you to give special attention to each child in turn – or share out the chores such as when you’ll cook, clean, do laundry and when you’ll catch 10 precious minutes for yourself! Clare Logan, Brand Manager for

Persil Non-Bio and Comfort Pure, said: “There is a misconception that as second-time mums have been through pregnancy before they do not have any worries the next time. Persil Non-Bio and Comfort Pure know that this is a special and wonderful time for mums and are working with Family Lives help alleviate any concerns, such as managing another little one in the house, so mums can focus on the joy that a second baby brings.” Persil Non-Bio and Comfort Pure support mums by helping make sure clothes are soft, clean and comforting. Whilst they can’t help do the chores or juggle challenging routines, they can reassure mums – as both brands are skin kind, dermatologically tested, and have skincare research recognised by the British Skin Foundation. Used together they give fresh, pure results gentle enough for even delicate skins. FOR FURTHER DETAILS VISIT WWW.PERSILANDCOMFORT.CO.UK.

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*Based on AC Nielsen, MAT, 25th April 2015

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HEALTHY PREGNANCY

CH A P T ER

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1 HEALTHY PREGNANCY Keeping yourself and your baby healthy during pregnancy is vital for your own wellbeing and the baby’s development, as well as setting you up for a good birth experience and recovery. In this chapter you’ll find everything from healthy eating to pregnancy niggles and worries to keeping yourself feeling happy and relaxed.

HEALTHY eating

ealthy eating is important at all stages of life, especially during pregnancy. Your baby gets all of its nutrients from what you eat so your diet can affect the health of your baby for its entire life. The best place to start is with a healthy balanced diet. If you have special nutritional needs, such as following a vegan diet, allergies, being underweight at the start of your pregnancy or if you are a teenager who is still growing yourself, you may need specialist.

Essential nutrients FOLIC ACID

HEALTHY PREGNANCY

Folic acid reduces the risk of neural tube defects (NTDs) affecting the baby’s spinal cord. Women who are of childbearing age and who are pregnant should take a folic acid supplement of 400ug per day, continuing it into the first 12 weeks of pregnancy. If a mother has previously had an infant with a NTD, a supplement containing 4,000ug of folic acid is required per day to help prevent recurrence. As well as taking a folic acid supplement during pregnancy, women should also try to eat foods that are high in folate, such as green leafy vegetables, fortified breakfast cereals & fortified milk.

IRON & VITAMIN C Iron is important to make extra blood for you and your baby throughout the pregnancy and prevent you becoming anaemic. You need 15mg of iron from your meals every day and vitamin C helps absorb iron from the food you eat so try to include a source of vitamin C with your meal, such as a glass of orange juice, strawberries and veggies like broccoli and peppers. Limit

tannins from tea or coffee with meals or phytates from high-fibre foods like bran and high-fibre cereals, as these may inhibit the absorption of iron. If you are vegetarian or vegan, talk to your dietitian to make sure you are getting enough iron. If your diet is low in iron, you may need to take an iron supplement for pregnancy.

CALCIUM Calcium is important for healthy teeth and bones. Your baby’s teeth will start to form as early as the sixth week of pregnancy. If you are not getting enough calcium, it is taken from your bones for the baby. Pregnant women need 1000mg of calcium every day and pregnant teenage girls need 1300mg calcium daily. Include at least three portions every day of calcium such as milk or milk-based products. There are some foods that contain less calcium

AM I EATING FOR

The big pregnancy myth is that you need to eat enough for two. The reality is that only 300-500kcal extra a day is needed in the second and third trimesters. This equates to an extra snack or two a day in the later stages of pregnancy.

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FOODS RICH IN MORE EASILY ABSORBED HAEM IRON (MG)

RED MEAT Average portion* of lean beef Average portion* of lean lamb cutlets Average portion* of lean pork chops

SERVING SIZE (G)

IRON CONTENT

120 120 120

3.2 2.5 1.6

POULTRY Average* chicken breast

120

1.3

FISH 1 small tin of sardines (canned in brine) 1 small tin of salmon Average portion* of cod

70 70 120

1.6 0.4 0.5

OTHER 2 small slices of black pudding

FOODS RICH IN LESS EASILY ABSORBED NON-HAEM IRON (MG)

SERVING SIZE (G)

IRON CONTENT

1 cup** of fortified breakfast cereal 1 small can of baked beans 1 cup** of boiled spinach 1 boiled egg 1 slice of wholemeal bread 1 cup** of boiled broccoli ¼ cup of dried fruit

30 140 90 50 36 85 25

2.4-4.2 1.9 1.4 1 0.9 0.9 0.6

Average portion guide – palm of hand* and 200ml disposable cup**

WHAT ABOUT A

multivitamin supplement? A multivitamin is not necessary unless you do not have a balanced diet. If you choose to take a vitamin or mineral supplement, choose one specifically for pregnancy. Excessive intakes of supplements can be harmful and reduce the absorption of other nutrients.

like spinach, sweet potatoes, rhubarb, beans, seeds and nuts, but you shouldn’t rely on these to supply all the calcium you need. If you are lactose intolerant then soy-based products fortified with calcium are a good source. If you have a low calcium intake, a calcium supplement may be needed.

VITAMIN D Vitamin D helps you use the calcium you eat and so is an essential component for bone health. Vitamin D is made from the sun’s rays and because of the poor UV light in Ireland from October to March, Vitamin D3 cannot be made in the skin then. Pregnant women need 10ug (400IU) of vitamin D every day. It is only found naturally in a few foods such as oily fish, some fortified cereals and fortified milks. If you don’t have these foods in your diet, it is advised to take a low dose supplement containing 5ug of vitamin D3. If you are taking a pregnancy multivitamin supplement you are already getting enough vitamin D and should not “double up” by taking additional Vitamin D supplements.

OMEGA-3 FATTY ACIDS Oily fish are high in Docosahexaenoic acid (DHA), important for developing your baby’s brain, nervous system and eyes. You can include them in the diet by eating one portion of oily fish per week while you are pregnant. If you are vegetarian or vegan, you are advised to take a pregnancy specific omega-3 supplement

Pregnancy Weight Gain

You should not attempt to lose weight during pregnancy. Gaining at least 7kg (15lb) is necessary to cover the growth of your baby. Average weight gain during pregnancy is 11-12.5kg (25-28lbs), mostly gained in the second half of your pregnancy. If you are overweight before pregnancy you should aim to gain a little less weight than normally expected, and if you are underweight before pregnancy aim to gain a little more weight during pregnancy. Your doctor, midwife or dietitian will be able to advise you.

HEALTHY PREGNANCY

The table below is a guide on the amount of iron in commonly eaten foods:

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Healthy Snacks in Pregnancy SUITABLE SNACK FOOD

SERVING SIZE (G)

CALORIES (KCAL)

(with honey)

43 (10)

100 (29)

1 cup* of bran type cereal

134

2 slices of wholemeal toast (with cheddar cheese & tomato)

70 (80)

160 (208)

1 small can of baked beans

140

111

Scrambled eggs (2 eggs, no milk)

120

192

1 pot low fat plain yogurt

125

1 cup* fortified low fat milk

200

there is no evidence to suggest

1 cup* fortified full fat milk

200

120

that avoiding certain foods during

1 small tin of tuna (in brine, drained)

80.5

1 small tin of salmon (in brine, drained)

105

1 fruit e.g. banana, apple or 2 mandarin oranges

100

Soda bread 1 slice

A WORD ABOUT

allergies

Unless you are allergic to a particular food or ingredient, eg eggs, fish, milk or milk products,

pregnancy protects the infant from developing food allergies in later life. If there is a strong history of nut allergy in the family, it is advisable to avoid peanuts.

200ml disposable cup*

HEALTHY PREGNANCY

Food safety during pregnancy ● Eat only freshly cooked food and well-washed freshly prepared fruit & vegetables. If eating out, it is safer to order hot dishes.

● Avoid refrigerated meat, vegetable or fish patés or meat spreads – for the same reason of listeria contamination. It is safe to eat the canned or shelfstable versions.

● All uncooked and rare meats and seafood should be avoided due to the high risk of listeria & salmonella poisoning.

● Liver and liver products contain a high level of vitamin A, which can be harmful to your developing baby

● Deli meats and hotdogs may be contaminated with listeria bacteria, which might result in miscarriage or stillbirth.

● Avoid high mercury-containing fish such as swordfish, marlin, shark and ray. Limit fresh tuna to one serving a week (150g) or two 240g cans of tinned tuna per week.

● Raw eggs may contain salmonella. Some homemade salad dressings, ice-cream and custards may be made with raw eggs. It is best to check with your server in a restaurant; if in doubt, avoid it.

● Consuming more than 200mg of caffeine a day has shown to have a negative effect on the infant’s birth weight. Generally two cups of coffee or up to four cups of tea a day is ok.

● Avoid soft cheeses like Feta, Brie, Camembert and goats’ cheese and blue-veined cheeses. They are safe to eat if they are labelled pasteurised.

● Alcohol crosses the placenta and can increase the risk of miscarriage and pre-term delivery or lead to physical, growth and mental problems in your developing baby. The safest option is not to drink during pregnancy.

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Gestational Diabetes Gestational Diabetes Mellitus (GDM) is diabetes that starts or is first diagnosed in pregnancy. Diabetes means that blood sugar levels in the form of glucose are too high. The causes of diabetes are not yet known but some people have a higher risk of developing diabetes. To keep your blood glucose levels normal during a pregnancy, your body has to make at least three times its normal amount of insulin to overcome the hormones made by the placenta. For most women, this extra insulin is enough to keep their blood glucose level in the normal range. For some pregnant women, however, even the extra insulin is not enough to keep their blood glucose level normal. In the midpart of pregnancy, these women end up with high blood glucose levels or gestational diabetes without knowing.

HOW IS GDM DIAGNOSED? Gestational diabetes can be picked up in pregnancy by a simple Glucose Tolerance Test between weeks 24 and 28. This is not a standard test everywhere so women need to ask for it if they feel they may be at risk. Women who are overweight or obese or who have a family history of diabetes are at risk. Those with previous GDM or those who have had fertility treatment are also at risk. Most women who have gestational diabetes give birth to healthy babies, especially when they keep their blood glucose level under control, eat a healthy diet, get regular moderate physical activity and maintain a healthy weight. However, Professor Fidelma Dunne, consultant endocrinologist at Galway University Hospital, points out that the condition can have serious implications for the mother and her baby during pregnancy, particularly where blood glucose control is not

good. “In addition it can affect the future health of mother and infant and therefore, it is very important that it is picked up at an appropriate time in the pregnancy and treated. After pregnancy, mothers should be rescreened and a programme put in place to reduce the risk of developing diabetes in the future,” she advises.

WHO IS MOST AT RISK OF DEVELOPING GDM? ● A family history of diabetes ● Body Mass Index (BMI) of over 25 ● Previous poor pregnancy outcome ● Women on steroids ● Previous baby over 4.5kg ● Polycystic Ovary Syndrome ● Unexplained infertility ● Polyhydramnios in current pregnancy ● Large baby in current pregnancy ● Non-Caucasian ethnicity ● Lifestyle factors like poor diet, infection, stress and smoking

WHAT ARE THE POTENTIAL COMPLICATIONS? Mothers with GDM have an increased chance of developing blood pressure problems in pregnancy and of preeclampsia (a dangerous complication of pregnancy with high blood pressure and fluid retention) as well as a higher chance of delivery by Caesarean section. They are at an increased risk of having excess fluid around the baby, which often leads to early delivery and babies born before full-term. Babies of mothers with gestational diabetes are at risk of being born very large (over 4.5 kilograms). This increases the chances of a difficult delivery and the need for neonatal unit care for the baby. Where the labour is difficult, a baby may develop problems with their shoulders or breastbone, which often get broken during delivery. There is also an increased risk of babies of mothers with GDM being born with low blood sugar levels (hypoglycaemic).

HOW IS IT TREATED? In approximately 70 per cent of women, gestational diabetes can be managed by 30 minutes of exercise per day and diet changes. All foods containing sugar need to be excluded and the carbohydrate portion in each meal needs to be reduced as carbohydrates get converted to sugar too. Carbohydrate foods are bread, cereals, pasta, rice and potato. In those who do not maintain normal blood sugar measurements on diet and exercise (approximately 30 per cent), insulin treatment is given. Insulin is discontinued once the baby is born. WILL IT GO AWAY AFTER THE BABY IS BORN? While 82 per cent of cases go away after the pregnancy, a large study of mothers in the West of Ireland found that one year later, 18 per cent of these cases had either pre-diabetes or diabetes and three years later, the number with pre-diabetes or diabetes had risen to 30 per cent. The international literature quotes a 50 per cent diabetes rate within five years of the GDM index pregnancy.

WHAT ABOUT FOLLOW-UP CARE? Women with GDM need to be followed up post-delivery at about 12 weeks .This is to establish whether the diabetes has gone away or not. Each year thereafter women should have an assessment with their GP as they have a sevenfold increased chance of developing diabetes.

FOR MORE INFORMATION For more information on gestational diabetes, the Diabetes Federation of Ireland have published an information leaflet, which is available to download at www.diabetes.ie

HEALTHY PREGNANCY

WHAT IS GESTATIONAL DIABETES?

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FITNESS

in pregnancy

HEALTHY PREGNANCY

omen react to the news of pregnancy in different ways. Some wonder should they be trying to stay in shape as much as possible, while others see it as a ticket to get off the treadmill for nine months and put their feet up! Once pregnancy is confirmed, one of the common questions women have is whether they should exercise and what is safe to do. Before any exercise plan is implemented, it is important to consider your current exercise levels, how active you were before pregnancy, how you are feeling now that you are pregnant, what your fitness goals are, and if you have a history of any injuries. Discuss this with your GP, obstetrician and Chartered Physiotherapist as soon as you find out that you are pregnant. A healthy, low-risk pregnancy should enable you to continue your exercise routine. If you are very sick or have any medical conditions,

such as poorly controlled diabetes or high blood pressure, seek advice on exercising from your obstetrician or GP during your first antenatal visit. For previously active women, there is no evidence to suggest that your exercise regime should be discontinued. But your fitness goals during pregnancy should be aimed at maintenance rather than any dramatic gains. Be sensible when choosing the activities you continue to do; snow sports are not advisable because of the risk of falling. Contact sports are also discouraged while pregnant. For those who are not so active usually, a gradual build-up of exercise is vital. Aim for lowimpact exercise such as walking or swimming, just three times per week, for 15-20 minutes per session. As you get fitter and your energy increases, progress to five days per week for 30 minutes per session. The right intensity for this exercise is still being able to talk to a friend

BENEFITS OF

exercise in pregnancy ● Promotes increased energy levels ● Relieves stress ● Improves sleep patterns ● Helps avoid excessive weight gain ● Strengthens your abdominal and back muscles ● Improves posture ● Prepares you for the physical exertion of labour

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while exercising, if you are too out of breath to talk, you are probably pushing yourself too much. Exercising with tender, swollen breasts is uncomfortable and can affect your posture. Get measured and invest in a good supportive bra or a sports bra. If you notice any pubic pain when swimming, or taking part in a class, stop exercising immediately and contact your Chartered Physiotherapist as soon as possible for a Pelvic Girdle Pain (PGP) assessment.

As your bump continues to grow, you may need to slow down, decrease your mileage, or consider alternative, more gentle ways to exercise. Your walking and running gait will change as your pregnancy progresses (your stride will shorten and your feet won’t lift as high) so be aware of the surface you are training on. Stop running and walk if you become aware of pain or Braxton Hicks contractions (rhythmic tightening of the lower abdomen – practice contractions).

Pelvic Floor Exercises Pelvic floor strengthening exercises should be started as soon as your pregnancy is confirmed. These muscles have to support the weight of your growing uterus, and need to be gradually built up. Give yourself time everyday to practice. Your pelvic floor muscles are mostly deep muscles and connecting with them takes concentration.

3 4

your body

If you are feeling very tired, schedule the session for the time of day when you feel at your best. Don’t be afraid to substitute a run with a lower impact brisk walk if you do not feel up to it. If you notice chest or abdominal pain, fluid leakage or bleeding, dizziness, headaches, shortness of breath, or just the feeling that something isn’t right, stop immediately and contact your obstetrician or GP.

WHAT EXERCISE SHOULD I DO

Lie on your back with your knees bent up. Breathe out to start. Now squeeze your back passage up towards your pubic bone, as if trying to stop yourself pass wind. Hold for 3-5 seconds without breathing. Now release your pelvic floor completely and let it drop back towards your tailbone. Practice this daily until it happens easily. The hardest part of this exercise is relaxing the pelvic floor back again at the end of the contraction.

Jenny Branigan is a Chartered Physiotherapist at Total Physio in Sandyford. For more information, see www.totalphysio.ie

● Walking is the gentlest form of exercise. It helps keep your lower back and abdominal muscles strong, as well as working the buttock and leg muscles. Many women can keep walking right up until they are due to give birth. Aim for at least 30 minutes per day. Try walking at lunchtime, to break up the day and prevent stiffness from too much desk-based sitting. ● Workouts in the pool are very beneficial as the buoyancy of the water supports your bump while working your abdominal muscles. Even if you can’t swim, pool walking can be a good workout. This is particularly helpful in the later stages when the bump can feel very heavy.

● Pregnancy pilates or yoga classes can be very beneficial but ensure that your instructor is specifically trained, as the antenatal exercises differ from those for the normal population. It is recommended not to start a class until approximately 15-16 weeks, but you can continue right up until your due date. If you have any history of injury, tell your instructor before you start the class, so your progress can be monitored and kept within your painfree limits. Don’t be shy; if something feels uncomfortable, let them know as there are many modifications that can be made as your bump grows.

HEALTHY PREGNANCY

1 2

LISTEN TO

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PREGNANCY wellbeing

t’s so important when you’re pregnant to look after yourself, both physically and mentally. Getting enough exercise and eating healthily will ensure that you and baby stay physically strong, but there is more to your wellbeing during pregnancy than just this. Dealing with your emotions can be difficult when hormones are swirling around, even when you are glad to be pregnant. But if pregnancy has come as a surprise, or you’re dealing with other issues that are challenging you mentally at the same time, you may find you are struggling with your emotions. The key is to get help, and the faster, the better.

HEALTHY PREGNANCY

PRENATAL DEPRESSION Prenatal depression is estimated to affect 10,000 women in Ireland every year – in reality, this figure is far higher as lots of women don’t seek help. Women who have suffered from depression in the past are thought to be more prone to the condition, as are women who suffer some sort of trauma just before or during their pregnancy, such as the death of a relative or friend, or financial worries. Symptoms of prenatal depression can vary from woman to woman, and it’s important to differentiate between the usual emotional feelings of pregnancy and

actual symptoms of depression. Common symptoms include loss of appetite, difficulty in sleeping, feelings of isolation, and unusual feelings of numbness or sadness. If you are worried about how you are feeling, this could be a sign that you need to talk to someone. Your GP can help you figure out if you are suffering from prenatal depression or not, and your midwife may be able to put you in contact with a support or counseling service for pregnant women showing signs of prenatal depression. For more severe cases, medication may be needed, but again, talk to your GP or medical team about this. A good support group is Postnatal Depression Ireland, which provides support for women suffering from both pre- and postnatal depression. See their website at www. pnd.ie, or call them on 021 4922083.

SMEAR TESTS AND PREGNANCY If you are planning on getting pregnant, it’s always a good idea to get a smear test done if you are due one. However, if your letter arrives and you are pregnant, call the CervicalCheck freephone service on 1800 45 45 55 and delay the test until three months after you give birth. Unless you are due one, it’s not necessary to have a smear test after having a baby. If you have recently suffered a miscarriage and your letter arrives for your

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DENTAL CARE Ideally, you should have a dental check-up and any work done before you are pregnant, but this isn’t always possible. However, try to book a trip to the dentist during your first trimester, or as early in your pregnancy as possible, as it’s very important that your teeth are looked after during pregnancy. For most women, routine dental visits are perfectly safe, but if you are high-risk or worried, consult your dentist for advice. Your gums are more likely to bleed during pregnancy thanks to increased hormone levels, and there is a greater chance of them becoming infected. A gum infection can lead to tooth damage. To help prevent pregnancy gingivitis, wash and floss your teeth regularly and talk to your dentist about having a deep clean early in your pregnancy. Gum disease will not affect your baby’s health, but it can be indicative that your overall health is not as good as it should be, and therefore there could be a connection with premature birth or complications. The key is to look after your teeth and consult your dentist if you encounter any issues, as well as keeping yourself as well as possible through good lifestyle habits, nutrition and exercise.

TEEN

mums Discovering a positive pregnancy test is a massive event in anyone’s life, no matter who you are or what age you are. But when you’re young and single, questions like telling your parents or wondering how you will cope with a tiny baby may spring immediately to mind. ● The first step is to tell the father, your parents and a close friend or two. They may surprise you with their reaction. Even if they are shocked at first, they will nearly always come around. Give them time and a chance to help and support you. ● Both secondary schools and third-level colleges have staff whose job it is to support students. Some secondary schools have a Home School Liaison Co-ordinator or a School Completion Coordinator. Your class teacher and the career guidance teacher may also be able to help. Third level colleges have welfare officers and access officers whose role is to support students who are having difficulties in getting to college or staying in college. ● Check to see if you live in any of the areas in which the Teen Parents Support Programme provides a service, or call Treoir at LoCall: 1890 252 084. ● If you think you will need a crèche put your baby’s name on the waiting list as soon as he or she is born. Community crèches are less expensive than private crèches so check out if there is one in your area. Ask the manager if you can avail of the Community Childcare Subvention Scheme. ● Some third level colleges also have crèches that are subsidised and you should contact them as soon as you make your decision to go to college. Ask your college about Student Access Funds and ask if there are any special funds to help you with childcare. ● The Society of St. Vincent de Paul has an Education Grant, which is a fund to help people to get into education, and that includes funding for childcare. Contact them through their National Office on 01 838 6990 or info@svp.ie. Information is adapted from Treoir’s Young Parent Survival Guide. Log on to www.treoir.ie for your own copy for the Young Parent Survival Guide and for support and advice on parenting. Locall 1890 252 084. Check out their Facebook page at www.facebook.com/treoir Treoir coordinates the Teen Parents’ Support Programme’s 11 projects around the country – see www.tpsp.ie for a project in your area.

HEALTHY PREGNANCY

smear test, wait three months before having your smear test. If your last smear test result was not normal and you are now pregnant, discuss with your GP or medical team about the best way for you to proceed. If you have been recommended to attend colposcopy, you should keep your appointment, but discuss you pregnancy with the doctor first. If you have a smear test before you find out you’re pregnant, it will not increase the risk of miscarriage; similarly a result that is not normal will not affect your pregnancy. Talk to your GP if you have any concerns. For more on smear tests, log on to www.cervicalcheck.ie

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LOOKING &

feeling good

ust because you’re pregnant doesn’t mean you have to abandon your love of fashion and beauty. Maternity wear has come on in leaps and bounds since the days of tents and overalls, with even highfashion stores like Penneys and H&M stocking decent ranges of maternity wear. The introduction of maternity ranges in high street stores means that you can dress your bump on a budget too – but try these tips to make sure you get the most out of your maternity wardrobe.

HEALTHY PREGNANCY

SPEND ON GOOD UNDERWEAR Good underwear is especially vital when you’re pregnant, especially as your breasts swell. Many women find a softer bra without an underwire more comfortable as their pregnancy progresses – but this is up to you as there is no concrete evidence that wearing an underwire bra inhibits milk production (as was previously suspected). Get yourself fitted regularly during the pregnancy and for a nursing bra towards the end of your pregnancy.

GET THE BASICS RIGHT Think about what you wear the most and buy accordingly. For instance, if you are having a baby in October or November, you’ll be spending most of your pregnancy during the summer months so t-shirts are essential. If you work in an office, then formal trousers or shirts might be needed more than jeans. Or if you spend a lot of time outside, a maternity jacket or coat is a good buy.

BORROW FROM FRIENDS Secondhand maternity clothes are often nearly new, so consider borrowing items like a dress or jeans from a friend.

THINK FOOTWEAR There’s no need to ditch the high heels just yet, but you may find them more uncomfortable as your pregnancy progresses as your feet swell and your centre of gravity changes. Make sure you have suitable shoes for both leisure and work that are comfortable – these will be needed after the birth too!

ON THE

high street Check out your local high street stores While there are some specialist maternity boutiques and baby shops out there such as Mothercare and Jojo Maman Bébé, lots of high street stores stock maternity ranges too, including Penneys, Dorothy Perkins, New Look, H&M, Debenhams (Red Herring), Topshop and Next. Go online too; Style Mama, Elora Maternity, Seraphine, Isabella Oliver, Babes with Babies, asos, Queen Bee and Bumps ‘n’ Babies all have great ranges.

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Kelo-Kote_195x275_FA.pdf

21/07/2015

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CMY

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TAKE

BEAUTY

in pregnancy

MATERNITY ESSENTIALS

Maternity oversized chambray shirt, €38.43, Topshop

Morning sickness, stretchmarks, swollen ankles... there’s a lot about pregnancy that isn’t too glamorous. But with a little bit of pampering, every woman can feel special right the way through the nine months. ● Keep things simple. If your skincare products are suitable for use during pregnancy, stick with them unless you encounter an issue ● Switch to sensitive products. If you are suffering from sensitivity, simplify your routine and use natural, non-irritant products. ● Opt for mineral makeup. Mineral makeup “sits” on the skin and is suitable for sensitive skin and for women who are wary of skin reactions with products that could be absorbed into the the skin.

Alana maternity layering tank top, €55, Isabella Oliver

● Fake tan is safe during pregnancy, but some expectant mothers like to avoid tanning booths as the chemicals used in fake tan can be inhaled. It’s always best to opt for a tan containing natural ingredients, such as Tan Organic, €19.99 ● Hair loss slows down during pregnancy, which means that your hair may look thicker than ever. However, unfortunately that applies to unwanted body hair too! Tweezing, waxing and shaving are all safe during pregnancy, but avoid hair removal creams. Belly Bands (pack of two), €13, Mothercare

MAMA shortsleeved Henley top, €14.99, H&M

● To dye or not to dye? Studies have shown that very little of the chemicals used in hair dye are absorbed into the scalp, but if you’re cautious, wait until the second trimester. Highlights minimise contact with the scalp as well. If in doubt, talk to your doctor or hair stylist.

TAKE

HEALTHY PREGNANCY

STRETCH MARK TREATS

Blue over-thebump skinny jeans, €29.99, New Look

The jury is still out on the question of stretch marks. Do creams and oils really work or are some women just destined to get stretch marks? Experts say that if you want to know if you will get stretch marks, then simply ask your mother if she has any. But fans of creams and lotions say it is possible to prevent them with the right products. One thing is for sure: the better condition your skin is in before pregnancy, the better chance you will have of your skin recovering quickly after giving birth. A good diet and keeping yourself well-hydrated will help keep your

skin healthy both in and after pregnancy. Use a good body moisturiser regularly, or a specific product for pregnancy Remember to moisturise your whole body, concentrating on your abdomen, back (you stretch from the back) and breasts. Take the opportunity to give your legs and feet a massage at the same time. OUR PICKS : (from left) Trilogy Rosehip Oil, €19.95; Bio-Oil, €9.99; Clarins Tonic Oil, €45; Burt’s Bees Mama Bee Belly Butter, €16.95; Kelo-Cote silicone gel, €POA from pharmacies nationwide (note: Kelo-Cote is great for scars too)

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PREGNANCY NIGGLES & warning signs

regnancy can bring with it all sorts of strange feelings and symptoms. But what is normal and what should you get checked out? The first rule of thumb is to get anything that you are worrying about checked out with your GP – even if it’s just to prevent any undue stress, which could be bad for you and for the baby.

HEALTHY PREGNANCY

MORNING SICKNESS Morning sickness is often the first symptom felt by newly pregnant women, and while it’s a sign that usually all is well, it’s not particularly pleasant! Morning sickness can happen at any time of the day, and eases for most women at the start of the second trimester. Occasionally, women can suffer from morning sickness throughout the pregnancy or towards the end. If it is excessive; for instance, if you can’t keep anything down, you may be suffering from hyperemesis and could be at risk of dehydration. Always consult your doctor or midwife if you are worried.

TRY THESE MORNING SICKNESS REMEDIES: ● Eat little and often. ● Have some plain biscuits or crackers at the side of the bed to nibble before you get up in the morning. ● Avoid strong smells that could make you nauseous. ● Avoid heavy meals and fatty foods. ● Some people find that ginger helps. Try nibbling on a few ginger biscuits if you are suffering from nausea. ● Keep hydrated by sipping water throughout the day. If you are prone to sickness, carry a survival kit with you for ease of mind, to include a strong bag, some mouthwash, a couple of ginger biscuits and some mints.

PELVIC PAIN Your body produces a hormone called relaxin during pregnancy, which softens your ligaments to help the baby move more easily through your pelvis during the birth process. Your pelvic joints

DEALING WITH

tiredness Check out your local high street stores While there are some specialist maternity boutiques and baby shops out there such as Mothercare and Jojo Maman Bébé, lots of high street stores stock maternity ranges too, including Penneys, Dorothy Perkins, New Look, H&M, Debenhams (Red Herring), Topshop and Next. Go online too; Style Mama, Elora Maternity, Seraphine, Isabella Oliver, Babes with Babies, asos, Queen Bee and Bumps ‘n’ Babies all have great ranges.

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may also move around more during pregnancy and just after birth, and this can cause inflammation and pain. This can cause a condition called Symphosis Pubis Dysfunction, or SPD, which is characterised by pain in the pubic area and groin. If you are suffering from SPD, your midwife or doctor will refer you on to a physiotherapist for treatment. There is also a condition called Pelvic Girdle Pain (PGP), which affects the back of the pelvis. Pain can be concentrated on the buttocks or on the back. Again, a physiotherapist will help you deal with this pain.

TRY THESE STRATEGIES FOR MINIMISING PAIN AT HOME: ● Move slowly and carefully when doing everyday activities. However, don’t stop moving altogether, as the pain is often worse when you are lying down. ● Ask your physiotherapist for tummy and pelvic floor exercises that will improve the stability of your back and pelvis. ● A pelvic support belt can give immediate relief. ● Acupuncture can help, but ensure that your practitioner is experienced in dealing with pregnant women.

HEARTBURN A form of indigestion, heartburn is common among pregnant women, especially during the latter months when the sheer size of the baby and the uterus can create pressure in the abdomen area.

TRY THESE HEARTBURN REMEDIES: ● ● ● ●

Avoid spicy or rich foods. Eat little and often. Chew your food slowly and thoroughly. If heartburn is worse at night, try sleeping propped up on pillows.

● Take regular, safe exercise, such as a walk. ● Some women find a glass of milk helps. If you are really suffering, talk to your doctor about remedies that are safe during pregnancy, both over the counter and prescribed.

HAEMORRHOIDS Women who have suffered from haemorrhoids, or piles, during pregnancy often report that this was one of the worst symptoms of all! They are caused by a combination of pressure from the baby, hormone changes and constipation. To help, eat a well-balanced diet with plenty of fruit and veg to avoid constipation; take regular safe exercise; and drink eight glasses of water a day. Talk to your doctor if you feel you need a mild laxative. Your pharmacist or doctor can recommend a cream for use on painful haemorrhoids. LEG CRAMPS Leg cramps are common towards the end of pregnancy, and although the exact cause is unknown, it’s thought that they can be due to tired muscles and increased pressure on the blood vessels and nerves in the legs.

TIPS TO AVOID LEG CRAMPS: ● Calcium and potassium are thought to help, so include milk-based products, green leafy vegetables and bananas in your diet. ● Gently stretch your legs before going to bed. ● A warm bath and a gentle leg massage in the evening could help. ● Slowly rotate your foot in both directions to improve circulation.

The effects of relaxin and the pressure from the extra weight on your abdomen can cause back pain. In addition, your breasts feel heavier, and your posture can change, which also puts pressure on your back. AVOID BACK PAIN WITH THIS ADVICE:

● Learn good posture. Stand tall (as if your head is being pulled from above), relax your shoulders and hold your weight evenly on both your feet. ● Wear good, low-heeled footwear. ● Support your lower back with pillows when sitting. ● Swimming or prenatal yoga are both great for strengthening your back. ● Avoid lifting heavy objects or over- exercising. ● Talk to your doctor if the pain is bad or persists.

HEALTHY PREGNANCY

BACK PAIN IN PREGNANCY

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JOINT PAIN AND SWELLING

PREGNANCY

warning signs While you should always report any discomfort or worries to your doctor or your midwife during your visits, if you experience any of the following, you must get go and get checked out as quickly as you can. Often they can be nothing, but if you are worried, you should always consult a professional. ● Bleeding Any cases of bleeding should be reported to your doctor or midwife. Even when it’s accompanied by abdominal pain, bleeding doesn’t necessarily mean a miscarriage, but if needed, your doctor will monitor your baby’s heartbeat. Later in pregnancy, bleeding could indicate an issue with the placenta called placenta praevia, where the placenta is lying on the bottom of the uterus. Always consult your doctor or midwife if bleeding occurs in the third trimester. ● Excessive thirst While it is perfectly normal to need more water and liquids during pregnancy – and in fact, it’s healthy to keep yourself well hydrated – if you are constantly thirsty, you may have developed gestational diabetes. This is treated easily with lifestyle changes and diet in many cases, but you need to see your doctor to make sure you don’t require medication. ● Sudden and severe swelling Swelling is perfectly common in pregnancy, but sudden swelling, accompanied by severe headache, could be a sign of pre-eclampsia. Your doctor will test your urine for protein and check for high blood pressure. Although relatively rare, preeclampsia is a serious condition that could require bed rest, medication or even early delivery. ● Itchy skin Itchy skin due to stretching is common enough during pregnancy, but if you develop severe itching towards the end of your pregnancy, especially in your hands or feet, consult your doctor. This could indicate a liver complaint called cholestasis in pregnancy, which affects about 1 per cent of expectant mothers. If you are diagnosed with this disorder, both you and your baby will be closely monitored for the remainder of your pregnancy, as premature labour is a possibility.

HEALTHY PREGNANCY

● Breathlessness It can be difficult to catch your breath towards the end of pregnancy as your baby is pushing up against your lungs, and space is at a premium in your abdomen. But severe breathlessness or pain in the chest should always be checked out, especially if you have a history of breathing difficulties such as asthma or repeated chest infections. ● Reduction in movement One of the nicest moments during pregnancy is when you feel your baby move. It’s important to monitor your baby’s movements, especially during the last trimester. Talk to your midwife about counting and recording kicks. If you haven’t felt your baby move in a while, try drinking something cold and resting for a few minutes. ● Visual disturbances Blurring, double vision, dimming, flashing lights or “floaters” could be a sign of high blood pressure and should be checked out immediately.

Swelling in the joints, especially in the ankles and fingers, is a common complaint towards the end of your pregnancy. They can sometimes be painful, so try these tips to help alleviate swelling: ● Elevate your feet when sitting down. ● Avoid tight-fitting clothes. ● Consider wearing support stockings if you spend a lot of time on your feet. ● Drink plenty of water. ● Avoid standing or sitting for long periods of time. ● Continue gentle exercise like walking or swimming. ● If your fingers swell, remove any rings. If excessive swelling occurs, consult your doctor immediately.

BRAXTON HICKS Braxton Hicks are sporadic uterine contractions than begin early in your pregnancy but women generally don’t notice until the later months. They are generally irregular and painless, although some women report that they can be uncomfortable at times. If they do become uncomfortable, try the following tips: ● Change your activity or position. ● Take a warm bath to help your body relax ● Braxton Hicks can sometimes be brought on by dehydration so try drinking some water. ● Practice your controlled deep breathing. If you get more than four contractions an hour, and are less than 37 weeks’ pregnant, consult your doctor or midwife.

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safe sleep for baby...

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COPING WITH miscarriage

HEALTHY PREGNANCY

adly, miscarriage is common. According to the Miscarriage Association of Ireland, around one in five pregnancies end in miscarriage, with approximately 14,000 Irish women losing a baby each year. A miscarriage is most likely to happen in the early stages of pregnancy and the further along you are, the less chance there is of losing your baby. A miscarriage occurs when a pregnancy is spontaneously lost before 24 weeks. After 24 weeks, a baby may be mature enough to survive outside the womb, although special care will be needed. Lots of women count the 12-week mark as a milestone in their pregnancy, but the odds of miscarrying actually reduce at an earlier stage. Using data from early ultrasound scans, the UK Miscarriage Association says that if your baby has a heartbeat at eight weeks, the chance of your pregnancy continuing normally is 98 per cent. At ten weeks it increases further to 99.4 per cent. Although miscarriage is common, the majority of women go on to have healthy pregnancies – a miscarriage does not necessarily mean there’s anything wrong with your fertility. But when it does happen, miscarriage can be an unhappy and frightening experience, particularly after you’ve started to enjoy your pregnancy and preparing for your new role as a mum.

WHY DOES IT HAPPEN? It’s really important to remember that a miscarriage is not your fault and you shouldn’t blame yourself if it happens. About 50 per cent of miscarriages in the first 12 weeks are thought to happen because of a chromosomal abnormality – and this is usually down to bad luck. It is unlikely to signify any underlying problems with either you or your partner. Other causes of miscarriage in the early stages of pregnancy can be imbalances in pregnancy hormones or immune system problems, and twin or multiple pregnancies also increase the chances of miscarriage. Miscarriage is more likely as you get older because your egg quality decreases with age. If you’re eating well, getting lots of rest and following your GP’s advice, there’s not much else you can do to decrease the chance of miscarriage. Drinking alcohol and smoking while you are pregnant does put you at a higher risk – but doing moderate exercise and having sex during pregnancy won’t. Once you start to miscarry, there is little that can be done to prevent it and you may never find out exactly what caused it to happen. Although your pregnancy may appear to be progressing normally, the 12-week scan can sometimes reveal a missed miscarriage, which means that your baby died at some point in the first trimester but your body has not yet rejected the pregnancy.

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WILL IT HAPPEN TO ME?

WHAT HAPPENS AFTER A MISCARRIAGE? You may feel tired and weepy following a miscarriage due to your hormones getting back to normal and the emotional toll. Try to rest when you can and take some time off work if possible. If your miscarriage is after 12 weeks it can take longer to adjust, physically and emotionally, but time is a great healer and most women go on to have another healthy pregnancy. It can be hard for some women to think about trying again, while others want to get pregnant as soon as possible. Most doctors advise women to wait until they have had at least one period; this is to make it easier to calculate dates in the next pregnancy, not because you are more likely to miscarry again. It’s really down to you and your partner to decide in your own time and try when you both feel ready. Whatever you decide, it’s helpful to know that the vast majority of women who have experienced a miscarriage go on to have a healthy baby; only one in 100 couples will experience recurrent miscarriages and be offered further investigations. Miscarriage, whilst a traumatic experience, is a very common one. Talking to other people who have been through it and contacting support groups for advice and information will help you recover and enjoy a happy, healthy pregnancy in the future.

SUPPORTING

your partner ● If your partner has a miscarriage you may feel helpless, but you can provide a vital role in loving and caring for her as you both recover. ● Don’t expect her to bounce back; even an early miscarriage takes time to recover from. ● Talking about what has happened helps you both heal – but don’t push her to discuss it if she’s not ready. ● Ask her if she wants to remember the baby in some way; planting a tree or making a donation in memory of your loss may help. ● Eating healthily and getting some fresh air is beneficial – try cooking a nutritious meal and taking her out for a walk or to see a film when she feels up to it. ● Friends and family may try and avoid the subject, particularly with you, because they feel uncomfortable. If you want to talk, tell them so. ● If she had a miscarriage previously and is pregnant again, try to be understanding if she has any fears or is particularly protective over her pregnancy. Although the chances are she’ll give birth to a healthy baby, it’s completely normal for her to feel nervous.

FOR MORE

advice MISCARRIAGE ASSOCIATION OF IRELAND: www.miscarriage.ie A LITTLE LIFETIME FOUNDATION: www.alittlelifetime.ie NATIONAL INFERTILITY AND SUPPORT & INFORMATION GROUP (NISIG): www.miscarriage.ie UK MISCARRIAGE ASSOCIATION: www.miscarriageassociation.org.uk MISCARRIAGE ASSOCIATION OF NORTHERN IRELAND: www.miscarriageassociationni.org.uk

HEALTHY PREGNANCY

Miscarriage after 12 weeks is much less common and happens in approximately one in 100 pregnancies. The later a miscarriage is, the more likely your healthcare team will be able to determine what went wrong and offer you the right help and treatment for future pregnancies. Late pregnancy loss can be very hard to bear and you should be offered lots of support and counselling to help you recover. It can also help to mark your baby’s passing, whatever stage of pregnancy you were at. The Miscarriage Association of Ireland has memorial stones in various locations, dedicated to babies lost through miscarriage.

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TRAVEL &

pregnancy

elieve it or not, travelling while you are pregnant is probably the easiest holiday you’ll ever have with your new baby! Once he or she is born, the amount of baby paraphernalia that will be essential for a simple holiday will be astounding. For now, your baby is safely tucked away in your abdomen, and requires little attention other than a gentle pat and some soothing words.

WHEN IS THE BEST TIME TO TRAVEL? You may find that the best time is during your second trimester, between 14 and 27 weeks. If you have had an uncomplicated pregnancy and expecting just one baby, it is generally safe to fly up until about 36 weeks. However, some airlines request written permission from your doctor anytime from 28 weeks, so it’s important to check your airline’s policy before booking. Staff can refuse you permission to fly at the gate, so if in doubt, it’s a good idea to have a letter from your midwife or doctor with you once you hit the third trimester.

HEALTHY PREGNANCY

IS FLYING SAFE? People who fly hundreds of times a year, such as flight attendants and business travellers, may be at a slightly higher risk of miscarriage or fetal abnormalities due to exposure to natural atmospheric radiation. However, if you only fly a few times a year, the risk is negligible. It’s also important to consult your doctor before travelling if you have had any complications during your pregnancy, such as high blood pressure or bleeding, or have a history of premature labour.

WHAT ABOUT DEEP VEIN THROMBOSIS? Flying during pregnancy can slightly increase your risk of blood clots (thrombosis) and varicose veins. Wearing support stockings when you fly can minimize your risk. Also, moving around the plane regularly and doing simple exercises like flexing your ankles can help keep your circulation flowing.

WHAT ABOUT TRAVEL VACCINATIONS? The general rule is, don’t travel anywhere that requires vaccinations while you are pregnant. If you know you need to travel but are trying for a baby, get vaccinated at least four weeks before getting pregnant. Finally, if you really have to go somewhere that requires vaccinations, talk to your doctor who can advise you on what vaccinations are safe and what aren’t.

HOW CAN I STAY COMFORTABLE? Be sure to wear comfortable clothes and shoes. If you can, request a seat in the middle of the plane over the wing, which tends to be the most stable part of the plane. An aisle seat will let you go to the toilet or stretch your legs easily. Sitting anywhere for a long period of time can make your feet and ankles swell, so be sure to get up and walk around as often as you can. In addition, take off your shoes and rest your feet on your carry-on luggage in front of you. Bring a pair of comfy socks to change into for long flights. Drink plenty of fluids during the flight, especially water, to counteract the dehydrating effects of flying. Avoid fizzy drinks or a heavy meal before flying, especially if you are suffering from heartburn.

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PREPARING FOR BABY

CH A P T E R

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2 PREPARING FOR BABY Pregnancy is a time to prepare yourself for your baby, both practically in terms of work and your home, and emotionally. This chapter will guide you through all the steps in making sure you’re as prepared for your baby as possible.

MATERNITY leave

PREPARING FOR BABY

nder current legislation, you have to give your employer at least four weeks’ written notice of your intention to take maternity leave along with a medical certificate confirming the pregnancy. Most women tell their employer after the 12-week mark has passed, but if you work in a job that may pose risk to your pregnancy or you have health worries, it’s a good idea to tell your employer in confidence as soon as you can. Your employer is legally obliged to conduct a pregnancy risk assessment and this can only be organised once you have formally notified them of your pregnancy.

TO APPLY FOR MATERNITY BENEFIT contact the Maternity Benefit section of the Department of Social Protection. Tel: (01) 471 5898; Lo call: 1890 690 690; Email: maternityben@welfare.ie; Web: www.welfare.ie.

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What am i entitled to? You are entitled to 26 weeks’ maternity leave, commencing no later than two weeks prior to your due date. If you find work too difficult or your baby is born prematurely, you can commence your maternity leave up to 16 weeks prior to the end of the week the baby is due. Once your pregnancy is confirmed, you can take paid time off for medical visits and antenatal classes, giving two weeks’ notice to your employer. ● ANNUAL LEAVE You are entitled to any public holidays that occur during your leave, so check your diary and add them up. You are also entitled to accumulate annual leave while on maternity leave, as time spent on maternity leave is treated as though you have been in fulltime employment.

of employment. In the event that your employer can’t allow you to return to your job, they must provide you with suitable alternative work.

● PATERNITY LEAVE There is still no legal entitlement to paternity leave for fathers, leaving it entirely up to the discretion of employers, so it’s a good idea to notify your employer in advance and book a couple of weeks’ annual leave around the due date. Many employers are willing to be flexible with this leave too.

● MONEY TALK There is no legal obligation upon employers to pay you during maternity leave. It depends on the terms of your contract and, these days, more and more employers are scrutinising their outgoings in order to cut costs. Whether you have a contractual agreement or not, you may qualify for Maternity Benefit, which is issued by the Department of Social Protection and has now been standardised at €230 for all new applicants. This benefit is also taxed.

● RETURN TO WORK Make sure to give your employer at least four weeks’ written notice of your intention to return to work. Upon your return, you should be back in the same job with the same contract

● ADDITIONAL ADVICE For more information on your rights and entitlements visit www. citizensinformation.ie, www.equality. ie and www.welfare.ie, where you will find a wealth of information.

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BUDGETING for baby

STATE

help CHILD BENEFIT Child benefit is paid to all parents of children under the age of 16. If your child has a disability or is in fulltime education, this benefit is extended to the age of 18. The payment is €135 per child, and you are automatically registered for this when you register the child’s birth. FAMILY INCOME SUPPLEMENT (FIS) FIS is a weekly tax-free payment awarded to employees with children who earn below a certain threshold. Selfemployed people are not eligible. To qualify, you most have at least one child who normally lives with you or is

financially supported by you; thechild must be under the age of 18 or between 18 and 22 and in full-time education. FIS amounts are 60 per cent of the difference between your income and the threshold for your particular family size. ONE-PARENT FAMILY PAYMENT (OPFP) The OPFP is given to a single parent earning less than €425 a week. The amount depends on your earnings and number of eligible children. The age limit has been reduced to the age of seven. For more on State benefits, log on to www. citizensinformation.ie or www.welfare.ie

PREPARING FOR BABY

aving a baby is a major financial commitment for any couple, and it’s important to acknowledge this and put plans in place. The initial cost of having a baby (eg care costs if applicable and buying what your baby needs) can be high, but children cost money throughout their lives, and this cost only gets bigger as they get older. Studies have indicated that the cost of raising a child to the age of 21 can cost between h250,000 and h300,000. Without getting bogged down in these high figures, it’s well worth putting into place some sort of budget system to make sure your baby is provided for in your monthly outgoings, by readjusting your current spending. Follow these steps to work out your budget: ● Add up your total monthly income in the household, allowing for maternity leave deductions. ● Make out a list of all your bills and expenses, using the previous month as a guide. Include discretionary spending and variables like food and petrol. ● Add to your list of expenses your baby’s most pressing needs, eg formula if you are not breastfeeding, nappies, wipes, clothes etc. Add in a set amount for possible medical costs too. ● If you are planning on returning to work, add childcare to the list of expenses, or if you are giving up work, adjust your income accordingly. ● Finally, add up your total expenses and deduct it from your income. If you don’t have a surplus, look at where you can cut down. Can you reduce discretionary spending? Budget more carefully with the weekly grocery shop? Get rid of a car? Look at switching service providers to save money on your gas, electricity, phone, TV and broadband. ● If you have to make savings, start while pregnant so you are in a budgeting frame of mind before your baby arrives.

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BUYING

for baby

INFANT CARSEAT A carseat is an essential first purchase if you are planning on driving your baby home from hospital. Choose one that’s rear facing, complies with safety standards and that’s suitable for a newborn baby. Practice strapping in and taking out the carseat before the baby is born.

TRAVEL SYSTEM A travel system grows with your baby, generally converting from a pram into a pushchair and might even accommodate your early carseat for ultimate portability. However, these can be expensive. A cheaper option is a pushchair that can recline completely for a new baby (babies

under six months old should be reclined completely). Consider your needs when it comes to choosing a travel system. Will you use the pram function? Is size and weight an issue when it comes to opening and folding your choice? Would you like a system that allows you to attach baby’s carseat? Once you have worked out your needs, shop around for the best deal.

BABY BATH A baby bath isn’t an essential purchase but is useful if you are nervous about bathing a slippery newborn. Alternatively, there are inserts suitable for a standard bath that can help. A top and tail bowl is also not an essential purchase but useful when it comes to giving the baby a wash in the early days without going to the trouble of a full bath.

BABY SEAT It might not look like an essential buy, but a baby rocker or seat can be invaluable – not just because it gives you somewhere to put the baby. A chair with an inbuilt vibration unit can be useful for fussy babies as well. Shop around for a chair, as they can range from as little as €20 up to €100+.

CHANGING STATION/MAT Some parents like to invest in a whole changing unit, but if you don’t have the space, this is not at all necessary. A baby can be changed anywhere, but for comfort and ease of use, a simple changing mat is a good investment. These can cost as little as €10-€15 and will be used almost constantly!

BABY’S CLOTHING Although it’s tempting to buy lots of little outfits, bear in mind that your baby will grow very fast, and for convenience’ sake, he or she will probably spend most of their early days in babygros. Look for 100 per cent cotton items if possible. A basic wardrobe is 8-10 vests; 8-10 babygros, 2 hats, 2 scratch mittens, 2-3 cardigans, a snowsuit or jacket and 2-3 blankets for walks. Babies can grow out of the “newborn” size very quickly so it’s best to only have a couple of items in this size, and concentrate your budget on the 0-3 months age group.

BEDDING Whatever bed you decide upon for your baby, you will need sheets and blankets as well. Opt for cellular, cotton-rich blankets, which are less likely to overheat your baby. Four

PREPARING FOR BABY

ith baby comes a heck of a lot of luggage – who knew that such a tiny being would need so much “stuff ”? But while there are certain items that you really can’t do without, there are others that you mightn’t need for a while or you might even be able to go without. Ultimately it’s not necessary to have the very latest high chair or most expensive travel system – the important thing is that you have the right items for your baby and your budget.

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SAFE

Sleeping Mothercare sleep safety expert Elaine Madden gives us her top advice on a safe and comfy bed for baby. ● Moses basket, crib or cot? The safest place for your baby to sleep when they’re born is in your room for the first six months, whether that’s in a Moses’ basket, crib, cot or cotbed. From a practical point of view, a Moses’ basket or crib is probably best in terms of space. A cot or a cotbed can be used from birth if they are dressed in the right way, eg no duvets or pillows. ● What is the current safety advice regarding mattresses for babies? The most important advice is to get a new one for every new baby. You can be sure that a new mattress offers the

sheets and about four blankets should be plenty.Remember you can swaddle with an ordinary blanket, so there’s no need for a separate swaddle blanket unless you want one. As your baby gets older, ageappropriate sleeping bags are a great option.

PREPARING FOR BABY

PLAYMAT Babies really don’t need any toys for at least six months – simply staring at you or listening to you talk and sing is all they need. But a good piece to invest in is a padded playmat for tummy time. As your baby grows, he or she will enjoy reaching up for the toys and the features on the mat will encourage movement while on the tummy. Mats vary in price from about €20 upwards so there is no need to spend lots of money on one.

best support and is the most hygienic option for your baby. That advice applies to whatever bed option you go for – basket, crib or cot. ● What is recommended in terms of covers for a very new baby? It all depends on the temperature of the room. The ideal room temperature is 16-20 degrees. At 16 degrees a baby would need a sheet and two blankets, whereas if the room temperature is 24, he needs only a sheet. Remember, too, that the temperature can change during the night. This is why we’d recommend using layers, as it’s easier to add or remove a layer as needed. ● How can you tell if a baby is overheating? The best way to tell if a baby is too hot or too cold is to feel the back of their neck or their tummy. Babies’ hands can often feel cold to the touch, but that’s not necessarily a sign that they are actually cold. ● What about bumpers? Bumpers can be used, but only until the

“

baby starts moving around and sitting up, because then there’s a danger that they might use them to pull themselves up, or pull them over their face or get tangled up in the ties. ● How can the risk of SIDS be minimised? Place your baby on their back, not on their front or side. This is the most important advice of all, and it’s important to note that it’s changed from a few years ago. Place them “feet to foot” so there’s no chance of them wriggling under the covers. It’s also important that they are in the same room as you, but in their own bed. ● Is co-sleeping safe? Cosleeping is not recommended if you smoke or sleep heavily or have been drinking alcohol. We have a clever system available in Mothercare, the Chicco Next2Me cot, which can be brought right up, the side opened and attached to your bed – so it’s like co-sleeping but without the risks of your baby sleeping in your bed.

My best buy

“I INVESTED IN A CRIB rather than a Moses basket, and it was brilliant. Both my babies lasted in it until they were six months’ old and as it was small enough to fit in our bedroom, it meant I could stay with the baby all that time (as recommended) without having to move rooms – as I would have had to if the baby had to go into a cot before six months. Well worth the extra money.” Penny, mum to Danny (4) and Ellie (2)

It seems like an

“

”

BUT I FOUND A BABY ROCKER INVALUABLE. My little boy had colic and the movement of the chair really helped, plus it gave me somewhere to put him when he wasn’t asleep or feeding. I only bought a cheap one for less than €20 but it lasted him until he was crawling.” Lisa, mum to Sam (1)

didn’t have room for a changing table, but I INVESTED IN A ‘BABY BOX’ that I kept downstairs. Each morning, I’d fill it with nappies, cream, cotton wool and any other bits I needed, so I was ready to change at a moment’s notice. It doesn’t have to be fancy, but sturdy and big enough to hold supplies for a full day (and night!) Ailish, mum to Caoimhe (six months)

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“You ge so rathe

BUYING

on a budget

Looking to save money? TRY THESE HANDY TIPS TO ENSURE YOU GET MORE BANG FOR YOUR BUCK .

Invest in other items. Think of how much use you will get out of certain items, eg a car seat is vitally important and will be used virtually every day. Another good item to invest in is a safe mattress for the cot.

Plan ahead. Are you planning on having another baby in the near future? Consider items that can be used again or converted, eg a travel system with an option for a second seat or carrycot.

4 5

Sell on. Remember that some items might have a good resale value, such as a travel system.

Go secondhand. Check online and in your local paper for secondhand baby items, particularly goods that might not be used for long, such as a double buggy if you have children close in age. Remember that some things should be bought new, eg a car seat unless you know for certain that it hasnâ&#x20AC;&#x2122;t been in a car crash.

Ask for useful gifts. Remember that family and friends might want to buy your new baby a gift. Ask for something useful instead of clothes that might not be worn. For instance, could some club together to buy a baby chair or play mat?

Try before you buy. If you want to try your baby in a sling, Babywearing Ireland offers a countrywide sling library, which allows you identify the best sling for your baby before you invest. For more, log on to www.babywearingireland.ie.

Look for sales. Special offers and shop sales are great opportunities to get all you need for your baby. Look out for specials on nappies, wipes and creams in supermarkets too, so you can stock up for less.

Borrow some items. Ask around to borrow items that will only be used for a short time, eg a Moses basket.

PREPARING FOR BABY

Prioritise. Make a list and be strict in identifying what you really need. A baby swing, mobile and wardrobe of tiny outfits might be desirable but theyâ&#x20AC;&#x2122;re not vital purchases. Ask yourself with every purchase, is this really essential?

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CREATE YOUR CHILD’S HAVEN at IKEA

ADVERTISING FEATURE

hildren are at the heart of everything that we do at IKEA. Children’s products from IKEA are designed with safety, development and fun in focus. Quality time can be spent having fun with your children while helping them grow, safe in the knowledge that your home is prepared with IKEA’s great products that are all tested against the highest safety standards. Children can be busy little bees developing their personalities, discovering the world and then starting their journey to independence so having the right products at home can make this a little easier. From the day you bring them home until they’re almost all grown up, children’s furniture from IKEA will help you turn your home into a haven which enables them to grow to their full potential.

POP TO IKEA DUBLIN to pick up these great products and make it a day out for the whole family! Customers can enjoy the family-friendly atmosphere which has many convenient facilities such as a baby nursing area with nappies; baby feeding station with bottle warmer and microwave; kid’s cutlery and bibs; family tables with baby chairs. Visitors to the store can also avail of exciting offers such as free kid’s cereal with an adult breakfast, complimentary baby food with an adult meal, a free piece of fruit and healthy kid’s meals. Children will also be happily occupied during weekends and midterm with kid’s entertainment and of course the supervised play area Småland. TO FIND OUT MORE PLEASE VISIT WWW.IKEA.IE/DUBLIN.

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Other pieces included in this SUNDVIK range are the wardrobe, €150 and changing table with a chest of drawers, €150. This beautiful and traditional style furniture is timeless and can remain in your baby’s room as the staple pieces even as they get older. They provide ample storage space, enabling you to conquer all the kid’s clutter.

The SUNDVIK cot, €100 is the perfect sleeping nest as it adjusts to fit your fast growing little one. This cot has a removable side, transforming it into a bed once your baby is old enough to climb in and out by themselves. Your baby will sleep comfortably and safely in this durable and breathable cot so you can sleep like a baby, too.

The CHARMTROLL collection also includes the ALSKAD bedlinen set, €15, ALSKAD blanket, €13 and ALSKAD baby towel, €7. This stylish and affordable range is designed with attention to details like ribbons and embroideries which also features the friendly elephant motif which runs throughout these textiles.

ADVERTISING FEATURE

The new CHARMTROLL textile collection features everything needed to care for your little one from bathtime to bedtime. Elephants are some of the most caring mothers in the animal kingdom, and it’s with this inspiration that these beautiful pieces were created. These nature led pieces such as the CHARMTROLL sleeping bag, €15 and quilt €14 comes in a gentle beige tone and is made of natural cotton and lyocell, which is soft and cosy against your babies skin.

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DESIGNING a nursery

PREPARING FOR BABY

s soon as the nesting stage begins, your mind goes into nursery-planning overload. Thoughts of a beautiful, cosy room to which you can bring your baby home fill your mind, but as soon as you hit the shops the sheer choice can be overwhelming. Remember that a baby will sleep in with you for at least the first six months, so there is no need to go mad on a nursery just yet, unless, of course you have the time and money. Nurseries also don’t need to cost a fortune; a simple colour scheme and some small touches can turn an ordinary room into a cosy nursery.

PLANNING “First: de-clutter. Find a place for everything and donate the rest. You will not believe how quickly your home will be re-cluttered once baby arrives,” explains interior designer Pamela McDonald. “Plan

to decorate at least six to eight weeks before your due date as all odours must be eliminated before you bring baby home, and have the room filled with fresh air.” Pamela advises that you start by choosing a theme or colour scheme of three colours, max. It’s easier to achieve a consistent look if you decide to go for a themed nursery, but be careful not to go over the top. Remember to keep the balance between rest and stimulation. The easiest way to avoid theme overload is by creating a single point of focus and keeping the rest simple. Keep the walls and floors neutral and add easily replaced accessories like wall stickers. If you have your heart set on themed wallpaper, keep it to just one wall. Be creative; everything you buy doesn’t have to be themed. For instance, sheer drapes will create a princess theme or use a toy hammock to create a jungle look.

FUTURE-PROOFING Pick a theme that will last from baby to toddler. Flexibility is key. Think about how your baby will use the bedroom in later years. Save money by investing in a good cot-bed, dresser and curtains that will grow with baby through to the toddler years. A top tip for getting baby to develop good sleeping habits is to invest in some blackout blinds, but remember to keep cords well out of reach. Clevamama’s ClevaSafe Blind Cord Safety Winders (€6.99) ensure blind cords are secured and out of harm’s way. “Buy a dresser with a changing mat space on top that can be used as a chest of drawers in a toddler’s room,” says Pamela, adding, “Wooden floors work best in a nursery. They are easy to clean, stain-proof and dust allergies are quickly eliminated. If you feel wooden floors are too dull for a nursery, add a rug for a pop of

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colour. Rugs are multi-purposeful as they can be used as a playmat too.”

STORAGE Storage can be one of the biggest issues in a nursery. A new baby comes with so much baggage, it’s hard to find a place for everything and keep the nursery neat and tidy at the same time. In fact, gifts for a new baby can sometimes be enough to fill a nursery. “Think of how much storage you’ll need and multiply by two!” says Pamela. “A fully functional nursery means nappies, creams, wipes, baby gros and vests are kept within arm’s reach of your changing mat. Babies’ clothes are tiny, so maximise your wardrobe space by installing an extra rail.” Babies’ shoes are a bit like matching socks: easily lost, so invest in a shoe wallhanger for easy access.

SAFETY

Twitterlings mobile, €40.50, Little Dreamers Pirate-ship light, €115, Little Dreamers

Kids Scandinavia wardrobe, €167.99, Argos

Night Time Hugs pictures x 2, €39, Mamas and Papas

Forest Friends wall sticker, €49, Peanut & Pip Baby Elegance Holly Cot & Mattress, €129.99, Smyths

Austin 2-in-1 Cot Bed Frame in white, €199, Harvey Norman

“Safety is paramount,” cautions Pamela. “Keep lamps out of reach. Lamps get hot quickly and could cause a painful accident. Lamp and blind cords must be short and secured tightly. Cover all electric sockets – babies are drawn to sticking their fingers into any hole they can.” Spoka night light, €15.50, Ikea

DESIGN

Cream Star Ted Moses Basket, €80, Baby Elegance Deluxe Gliding Crib, €139.99, Mothercare

Ladybird Gliding Nursing Chair with Footstool, €229, Littlewoods Ireland

Jamporee bunting, €30, Mamas and Papas

PREPARING FOR BABY

The design and adding a personal touch is the fun part. If you already know the sex of your baby you can go ahead and add accessories that personalise your nursery. If not, you can choose to keep all accessories completely neutral or wait until baby is born and then add little decorative pieces that are special to your little one. “These could be framed images of siblings, a special outfit (like the cominghome outfit) or keep-sake cards for wall art,” suggests Pamela. “Create baby’s name using fabric lettering or bunting. Put up a bookshelf to store favourite books, old and new.”

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YOUR

hospital bag

n your first appointment at the hospital, you would have been handed a long list – what you should pack in your hospital bag for B-Day. This list is packed away until you reach the latter stages of your pregnancy and you suddenly realise that you really need to get your bag ready. Then, when you start looking at the various bits you need, the reality of giving birth really hits home! It’s exciting and nerve-wracking in equal measure! To help make the job a little easier, we’ve answered some of the most common questions about packing your hospital bag, and supplied you with a definitive list for you and baby.

PREPARING FOR BABY

WHEN SHOULD I PACK MY BAG? It’s never too soon to be prepared, and it’s recommended that you have some sort of basic bag packed by the time you’re 32 weeks’ pregnant, or earlier if you’re expecting twins or are considered high-risk. Mums who end up in hospital earlier than expected stress the importance of being prepared – lists given to partners or family only go so far!

HOW MUCH SHOULD I BRING? This is a bit of a balancing act. Make sure you have everything you need, but don’t over-pack, as maternity hospitals are usually fairly crowded places and there’s little storage space. Many mums recommend bringing the minimum of clothes for you and for baby, and then making sure that extras are in a convenient place at home, so your partner or a relation can bring them in as needed.

WHAT ABOUT A LABOUR BAG? It’s a really good idea to pack a separate bag for the labour ward. This should contain one to two button-down nighties (be prepared to throw these away, as they may get destroyed!), a light dressing gown, slippers, socks, big knickers in a dark colour, maternity pads, a dark towel, a bottle of water, snacks, a hair bobbin and a camera. Include a see-through plastic bag for the baby, containing a vest, sleepsuit, hat, scratch mittens and nappy.

WHAT ABOUT THE MAIN BAG? Bring a carry-all or case the same size as hand luggage for a flight. This can

contain the basics for you and for baby. Handy things to include are a few packs of newborn vests and sleepsuits for your baby. It’s quite common for new babies to spit up a lot, so you might find that you go through a lot of these in the early days! A couple of newborn hats and scratch mittens are also essential. Bring one pack of nappies and have a couple of packets stored at home to be brought in as needed. The big essentials for you is disposable knickers – or, even better, get a couple of packets of cheap knickers in as large a size as you can find – and maternity pads. Loose pyjamas or nightdresses that open at the front are also essential for breastfeeding. A spare plastic bag for sending home washing is also a good addition.

GOING HOME Remember that you and baby will need clothes to wear when going home. Pack a bag with your clothes and your baby’s first outfit and put it with the car seat (another essential!) for your partner to bring into the hospital when it’s time to go home.

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PACKING

checklist IN YOUR HOSPITAL BAG: Three cotton nightdresses or loose pyjamas

IN YOUR LABOUR BAG: Copy of birth plan

IN BABY’S BAG: Six long-sleeved babygros or sleepsuits

Two maternity bras

Details of any medication/ hospital notes

Breast pads

An old nightgown

Nipple cream

Bibs

Light dressing gown and socks

Two packets of maternity pads

Clean nightwear for after the birth

One pack of disposable newborn nappies

Dark-coloured towel and face cloth

Hair bobbin

Two cardigans

Light dressing gown and slippers or flip-flops

Lip balm

Two hats

Bottle of water and snacks Facial mist spray

Two pairs of scratch mittens

TENS machine

One blanket

Camera

Two soft baby towels

MP3 player

One baby sponge

Toiletries and towel

Nappy cream

Nappy, vest, babygro, hat and scratch mittens for baby

Cotton wool

Six pairs of old or disposable underwear Shower gel Shampoo and conditioner Toothbrush and toothpaste Deodorant Cleanser and moisturiser Make-up

Six vests

Hairbrush and bobbin Phone and charger Magazine or book Notepad and pen Coins for parking, snacks etc Witch hazel to soothe stitches

“

I HAD

packed

“FOOD! And lots of bottled water. Some people breeze through labour in a few hours, but if it’s your first, pack for a long wait. You mightn’t need it, but there’s nothing worse than being in the early stages of labour, in a sweltering hospital in the middle of the night with no water or snacks to keep you going!” Sinead, mum to Ben (1)

“I wish I had packed a separate labour bag and gone through it with my partner. Just having the first nappy and baby clothes in a handy compartment even would have saved a lot of stress (and a little bickering) when our baby was born.” Tara, mum to Luke (four months) “One tip that I got after I had my baby that I wish I knew beforehand was to pack a nice shower gel and some travel toiletries. That first shower after you give birth is wonderful and a really nice shower gel would have helped me feel a bit more human and special.” Olivia, mum to Genevieve (2) and Isabella (1)

PREPARING FOR BABY

WHAT

I wish

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PREPARING

for birth

PREPARING FOR BABY

s your due date approaches, you will be starting to think about labour and birth, and how you would like your baby to be born. It’s essential to arm yourself with as much information as possible, from this guide, your antenatal classes and other books and magazines. This information will help you think about what sort of birth you ideally would like, and once you have this formulated in your head, it’s a very good idea to write it down in the form of a birth plan. This can then be given to your midwife and/or consultant. However, remember that your and your baby’s safety are the main priority during labour and birth, so sometimes your ideal birth is not achievable. Try not to be too upset if this happens.

Some points to consider when writing your birth plan:

or a friend, or even a professional doula. This is your choice.

LABOUR MANAGEMENT

PAIN RELIEF

Think about whether you would like to stay at home for as long as possible or be in the hospital from early on in your labour. Some mums like to help the labour process by having a bath, using a birthing ball or walking around – if these appeal to you, talk to your midwife about whether this is possible. If you don’t want to be confined to the bed, you can ask for foetal monitoring only to be used if medically necessary.

There are several methods of pain relief used in labour, eg epidural, pethidine, TENs – these are explained more fully in the next chapter. Some women would like to attempt a natural birth through hypnobirthing or a TENs machine. Whether you would like to have an epidural or want a natural birth, it’s a very good idea to state this from the start.

BIRTH PARTNER Think about who you would like with you while you are in labour – this needn’t be your partner. Some women prefer a relative

AFTER THE BIRTH Think about your preferences for you and for baby after the birth. Would you or your partner like skin-to-skin contact after birth? Would you like to breastfeed immediately after birth? Would you like your partner cut the cord?

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BIRTH PLAN

advice

“My birth plan was a great opportunity to get my thoughts about childbirth and what I wanted down on paper. Things didn’t exactly go according to plan, but at least I had thought about what would happen and when.” Aine, Mullingar “Make sure your partner or birth partner gets a copy of your birth plan. Once you’re in the throes of labour, there’s no way you’ll remember what safe compartment in your bag you put it in!” Mary, Co Kerry “I wanted a natural birth - or at least, as natural as possible - and giving my birth plan to the midwife about four weeks before my due date gave me the opportunity to discuss the options with her so she was aware of my preferences.” Angela, Letterkenny “While your birth plan might be your ideal scenario, don’t get too upset if things don’t go according to plan. Your doctors and midwives want what’s best for you and for baby, so put your trust in them.” Sophie, Dublin “It’s a really good idea to think about labour and birth from as early on as possible in your pregnancy. It can be a daunting subject, but the earlier you start, the more information you can gather, and the better placed you will be to write a birth plan and hopefully get the birth experience you want.” Penny, Dublin

If you are planning on breastfeeding your new baby, it’s a very good idea to do some preparation before the baby is born. Cliodna Gilroy, mum-of-two and NUK Ireland breastfeeding advisor, has this advice to give: “One of the first things I advise women to do is find their local breastfeeding support network. Ask your Public Health Nurse if there is a group in the area or contact La Leche Legue or Cidue for local support groups. Try your best to go and call in to the group before you

have your baby and get to know some of the mothers in the group. I have been lucky enough to make lifelong friends from the breastfeeding support network I met every Wednesday in Balbriggan. Like many women, my breastfeeding journey had a rocky start but this support network ensured I stuck with it.” For more details on breastfeeding support, go to the section on Breastfeeding in Chapter 4, and to the directory towards the end of this book.

Antenatal Classes Antenatal classes are designed to give you information about pregnancy, labour and birth, and babycare. They’re also a great opportunity to meet other pregnant women and to discuss any worries you might have. It’s strongly advised to do a dull course of antenatal classes on your first pregnancy, and some mums like to do a few classes as a “refresher” on subsequent pregnancies. Maternity hospitals host antenatal classes that should be booked as early as possible (generally you book them in from about 30 weeks). Classes are held for pregnant women by themselves or with partners. There are also several private antenatal

classes around the country, which vary in length from one day up to a course of classes. Topics covered in the course may include: ● Looking after your health during pregnancy ● Growth and development of the baby during pregnancy ● Options for labour and delivery ● Pain relief during labour ● When to go into hospital ● What to expect during labour ● Breastfeeding support and advice ● Emotional aspects of becoming a parent ● Physical care of your baby ● Returning to work/childcare arrangements

PREPARING FOR BABY

Preparing for breastfeeding

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MERRION FETAL HEALTH Ultrasound for Women Consultant led centre of excellence in prenatal ultrasound conveniently located at 60 Lower Mount Street, adjacent to theNational Maternity Hospital. With our team of 5 consultant obstetricians obstetricians, all experts in fetal medicine and their carefully selected team of extremely experienced sonographers and clinic administrators administrators, we ensure the highest standard of patient care. The newly renovated Georgian property offers a haven of comfort, privacy and medical excellence for its patients patients.

The clinic offers ultrasound scans for all stages of pregnancy • Early reassurance • Nuchal translucency • Anatomy • Growth We also offer gynaecological ultrasound • Pelvic ultrasound • Follicle tracking

We are delighted to announce our Early Pregnancy Clinic which provides dedicated ultrasound services for: • Confirmation and dating of pregnancy • Previous miscarriage • Reassurance • First trimester screening – Nuchal Translucency and HARMONY NIPT (Non Invasive Prenatal Test) (by appointment only) This clinic is available on a ‘walk-in’ basis or by appointment

“State-of-the-art equipment combined with highly qualified and experienced fetal ultrasound specialists allows Merrion Fetal Health to provide a fetal diagnostic service that is second to none.” Opening hours: Monday, Tuesday, Thursday, Friday 08.00am to 4.00pm Wednesday 8.00am to 8.00pm

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21/08/2015 14:52

LABOUR & BIRTH

CHAPTER

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3 LABOUR & BIRTH So that’s it – your 40 weeks are just about up and it’s time to think about labour and birth. In this chapter we look at alternative births, how to know when you’re in labour, what happens during labour and some things to note immediately after the birth.

SIGNS

of labour PRE-LABOUR WARNING SIGNS Although the following may indicate that labour is not far off, they are not actually part of the process itself: ● Braxton Hicks contractions are random ‘practice’ contractions that occur at various times throughout pregnancy. They are typically not painful and do not dilate the cervix as real contractions do. Prelabour Braxton Hicks contractions can be quite strong and while everyone feels them differently, they are seldom accompanied by pain. If this is your first baby it may be hard to believe that they are not the real thing, but Braxton Hicks seldom continue regularly for more than 60 minutes. ● You may be aware of your baby’s head pressing down. ● You may have a bout of diarrhoea, and some women also feel nauseous. ● Some women may experience a burst of energy a day or two before they go into labour.

SIGNS OF LABOUR

LABOUR & BIRTH

When you see one of the following signs, you know that you’re going into labour: ● Contractions associated with the onset of labour may start off as cramp-type pains (similar to period pains) and you may notice them in your stomach, back or thighs. Some women have irregular pains for a whole day before they are in labour, while other women get regular pains from the start. When you are in labour, the contractions will increase steadily, reach a peak,

and then decrease again. In between, there should be a phase without any pain. Labour is usually established when your contractions last for more than 40 seconds, occur every five to seven minutes over an hour and are beginning to become painful. ● A ‘show’ is the release of the mucous plug that seals the cervix or opening to your womb. As the cervix starts to soften and open a little, the show comes away. It is usually sticky and jellylike and may be streaked or tinged with blood. It is not, however, usual to lose a lot of blood with a show. If you find that you have lost quite a lot of blood, call your midwife or hospital immediately. The time between the show and the start of labour proper can be several days or just an hour or so, or anything in between. ● For about ten per cent of women, the breaking of the waters is the first sign that labour is imminent. When this happens some women feel a distinct ‘pop’ or ‘ping’ and then a gush of warm, clear fluid called ‘liquor’. Others just notice a gentle trickle. At this stage you should contact your midwife. For most women, though, the waters do not break until they are well into labour. If you are not sure if your waters have broken, it is advisable to wear a sanitary towel or pad and contact your midwife for advice. Occasionally, the water may be a brown/ yellow/ greenish colour, indicating that the baby has passed its first bowel motion. This means that your labour will need careful monitoring and therefore you should make your way to the hospital.

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WHEN WILL I CALL THE MIDWIFE OR GO TO THE HOSPITAL?

WHAT CAN

I do?

● Eat and drink as you want; small portions and light snacks are the easiest to digest. Once admitted into hospital, however, you may not be allowed to eat. ● Try taking a warm bath or shower to ease any aches or pains. ● Try to relax and concentrate on your breathing, which should be slow and steady – in through the nose and out through the mouth. Listen

to some relaxing music or try to visualize holding your baby at the end of this process. Remember that your body is designed to cope with labour and birth. ● Alternate between walking and resting. If you can, try to get some rest to prepare you for labour. ● Keep in contact with your birthing partner for support and reassurance.

LABOUR & BIRTH

The right time to call your midwife and go to the hospital is when you feel you would be more relaxed if she was close by. For some people, this is when contractions are still infrequent and for others it is not until they have strong contractions at five-minute intervals. Always contact the hospital if you experience any of the following: ● Excessive or abnormal vaginal bleeding aside from the standard “show” ● Concerns about the baby’s movements ● Severe abdominal pain ● Headaches or vision disorders ● Any other worries or concerns about yourself or the baby

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STAGES

of labour

veryone is different and every labour is different. At the end of the day, you won’t know how labour will affect you and you will just have to wait and see. It is important to note that all labours and births are different and the following is merely a guide.

LABOUR & BIRTH

FIRST STAGE Some women experience mild, short, regular contractions that have a long interval between them, eg 20 minutes. As labour establishes, the contractions become shorter and more painful, last longer and have a shorter interval. Some women start labour with contractions that are of long duration, feel painful and occur frequently. Massage, TENS machines, walking around and warm baths can help. As labour progresses, your contractions will be more frequent, occurring every two to four minutes and lasting up to 60 seconds. Start your breathing exercises and relaxation techniques. Find a position that is comfortable. You may request pain relief, if you need it, such as an epidural, injection or ‘gas and air’.

SECOND STAGE Contractions will be more frequent and last up to 60 seconds. Once your cervix is dilated to 10cm, you will feel the urge to push. If you’ve had an epidural, your midwife will tell you when to push and when to hold back. This stage can last from a few minutes to an hour. You may feel a burning sensation as the baby’s head becomes visible or ‘crowns’, stretching the birth canal. You will be asked to pant and stop pushing so the midwife can check everything is okay and to allow controlled delivery to avoid undue trauma to the perineum. The baby’s head will turn toward your leg, the baby will be delivered and placed on your tummy and the umbilical cord will be cut by the midwife.

THIRD STAGE After a short pause, contractions come again around every five minutes so that you can deliver the placenta and membranes. This stage can last up to an hour.

AFTER BIRTH Some women may experience slight tearing of the perineum area during

childbirth. Your midwife or doctor will stitch any tears directly after you give birth, as well as giving you a general examination, including your blood pressure and to check your blood loss. You may also feel some ‘after-pain’ – this is your uterus contracting back to its normal size and is nothing to worry about. Ask your doctor for some pain relief if it is particularly painful. If circumstances allow and you request it, your baby can have skin-on-skin contact with you immediately after birth. If you are breastfeeding, you will give your baby a feed as soon as possible. Your baby will also be examined and weighed, and then wrapped up to keep warm. Occasionally, babies might need a little help to take their first breath. If so, most recover within minutes and can then be placed skin-onskin. However, if needed, the midwife can keep your baby under observation in the birth room. If your baby needs to be admitted to the neonatal ward, your caregiver will explain the reasons. See the “Babies in Special Care” section on p72 for more information.

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PAIN

relief

LABOUR & BIRTH

THE FIRST THING TO DO IS TO THINK ABOUT THE METHODS AVAILABLE TO HELP YOU COPE WITH LABOUR, AS THERE ARE MANY DIFFERENT CHOICES OF PAIN RELIEF AND OTHER REMEDIES AVAILABLE. IT IS IMPORTANT TO BE WELL INFORMED OF ALL OF YOUR OPTIONS AS YOU MAY CHANGE YOUR MIND ON THE DAY.

TENS MACHINE

ENTONOX

Transcutaneous electrical nerve stimulation (TENS), a popular form of pain relief during labour, is an application of painless electrical impulses through surface electrodes placed on the skin. The TENS machine consists of a small, battery-powered, hand-held unit and two or four pads that are placed on your back. TENS works by stopping pain impulses from reaching your brain and by stimulating the body to produce its own natural painkillers called endorphins. To get the most benefit, it is recommended that you begin to use the TENS machine once you feel labour has started. TENS units are available for hire or purchase from Medicare Rental and Sales – call (01) 201 4900 or book online at www.medicare.ie.

Entonox is an equal mixture of two gases (nitrous oxide and oxygen) and is commonly referred to as ‘gas and air’. It is the most widely used drug for helping women cope with labour. While Entonox won’t remove all the pain, it will give sufficient relief for most women. It is usually given through a mask that covers your nose and mouth or you can use a mouthpiece instead if you prefer.

ADVANTAGES:

DISADVANTAGES:

● Most women find TENS provides good pain relief. ● TENS has no known side effects for you or your baby. ● Some hospitals have TENS machines available for use in the hospital.

● Can make your lips feel dry. A lip cream is helpful in preventing this. ● Can make you feel light-headed and voices can sound like echoes. ● Can make you feel nauseous – if this happens to you, stop using it and nausea should disappear quickly.

ADVANTAGES: ● Effective within 15 to 20 seconds. ● It has no smell or taste. ● There are no known harmful side effects for you or your baby. ● You can remain mobile for as long as possible where portable cylinders are available.

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ADVANTAGES:

The most effective form of drug pain relief, an epidural is only given after the onset of labour has been confirmed (usually by your midwife) and after a vaginal examination. It involves injecting a small amount of anaesthetic (and, commonly, a pain-relieving agent) outside the spinal cord. A small plastic catheter is placed through the needle. Top-up drugs can be given through this as you need them, or a small amount may be given continuously (like a drip). An epidural is given by an anaesthetist, takes about 15 minutes to insert and 15 to 20 minutes to become effective. Although an anaesthetist is available at all times, the epidural may be held up if your anaesthetist is delayed. You don’t have to decide whether or not you would like an epidural until you are in labour. Very occasionally the midwife or doctor will recommend you have an epidural if you have high blood pressure or there are other pregnancy complications that the doctor or midwife will discuss with you.

● Epidurals give the most effective pain relief.

PETHIDINE Pethidine is a painrelieving drug (from the opiates group), which is given by intra-muscular injection.

ADVANTAGES: ● It takes about 15 to 20 minutes to take effect and lasts for two to four hours. ● It helps most women to relax and reduces pain.

DISADVANTAGES: ● Most women experience mobility loss due to the anaesthetic drugs used. ● You will not be able to get out of bed during labour or for three to six hours after the birth of your baby. ● You will need to have a drip inserted in your arm to minimise the drop in blood pressure that an epidural can cause. ● It is more likely you will need a forceps or vacuum (ventouse) delivery but not necessarily a Caesarean section. ● A small tube may have to be passed into your bladder to drain urine as you may find it difficult to pass urine yourself, but this is usually not painful. ● Occasionally, some women (one per cent) get a severe headache as a result of the epidural, but this can usually be treated effectively.

DISADVANTAGES: ● Pethidine can make some women feel rather ‘drunk’, ‘distant’ and/or sleepy. * It may cause nausea and vomiting but an injection is usually given at the same time to counteract this effect. ● It can affect your baby by slowing down his/her breathing at delivery, especially if given within two hours of your baby’s birth. If this happens, your baby may need an injection that works rapidly to reverse the effects and stimulate normal breathing. ● Pethidine may cause drowsiness in the baby, which can affect baby’s interest in feeding.

AROMATHERAPY Essential oils are fast becoming a complementary means of coping with labour. The result is an overall satisfaction, with the aroma removing the ‘hospital smell’ and decreasing anxiety. Preparing to give birth begins in the mind and the earlier that positive associations and imagery are started, the more relaxed you will become. There is a vast array of oils available on the market, such as Clary sage, which relieves tension and anxiety, and assists the uterus in effective contractions without artificially strengthening them. It has been suggested that it can ‘bring on’ your labour and, consequently, should be avoided during pregnancy. Lavender, neroli and rose are used to assist relaxation during labour. Suspend your chosen essential oil in a base oil, such as grapeseed, if they are to be applied to the skin. This blend can also be added to your bath water. It is essential that you seek advice from a certified aromatherapist, as some oils are not suitable for use during pregnancy and labour or the dose may alter.

“

“If you are nervous about labour, possibly the most positive thing you can do is to arm yourself with knowledge about pain relief. Talk to your care team about what’s available. Know the stages of labour and when you should ask for an epidural (if you want one). And relax – the pain is not as bad as you think and there is relief available.” Chloe, Co Galway

LABOUR & BIRTH

EPIDURAL

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WHAT IS

hypnobirthing?

BREATHING techniques

ossibly the most powerful pain relief tool you have at your disposal is your own mind, and learning how to breathe your way through labour and to relax and trust your body to do what’s right for you and your baby is something that should be practiced throughout pregnancy. Your prenatal class should teach you some breathing techniques, but if you want to go further with this, there are some private hypnobirthing services available, as well as a range of books and guided relaxation CDs.

LABOUR & BIRTH

AS A START, TRY THESE TIPS TO MAKE THE MOST OF YOUR BREATHING: ● Keeping your breathing slow and steady during labour will maximise the oxygen available to you and your baby. Learning how to concentrate and control your breathing can also help you handle contractions more easily. ● Breathing becomes shallow and fast when you are panicking, and your upper body becomes tight and rigid. This type of breathing reduces the amount of oxygen in your body and you can feel light-headed and out

of control. You will also become exhausted within a short period of time – not ideal when you’re in labour. ● Focus on your breathing when you’re relaxed. Your in-breath matches your out-breath in length, and your breathing pattern is rhythmic. When going through a contraction, it’s natural for your breathing to become faster, but try to keep it in a steady rhythm without becoming faster and faster. ● Try this exercise to regulate your breathing. As you breathe in, count slowly to three, and count again when breathing out. Choose whatever number is more comfortable for you. Some people find it easier to breathe in for a count of three and breathe out for a count of four. Make sure you breathe in through your nose and out through your mouth. Simply focusing on your breathing will help regulate it. ● During labour, get your birth partner to breathe with you and help keep your breathing regular. Practise this technique while you are pregnant and ask your birth partner to practise with you.

● Hypnobirthing is based on the theory that negative stories and ideas about the birth process has led to many women associating labour with excruciating pain – and so we develop an acute fear of giving birth. The physical tension resulting from this fear prevents the body from doing what it is made to do, and the result can be long and painful labours, or unnecessary intervention. ● Hypnobirthing is a type of training that a woman can do during pregnancy to prepare their body and mind for labour. Using a combination of education and self-hypnosis (through guided meditations), women can learn to ignore the negative information and instead trust their body to see birth as a normal and positive process. ● Don’t be fooled by the hypnosis label, however – women performing hypnobirthing are not in a trance when giving birth. Instead they are awake and fully in control. A good Hypnobirthing programme teaches the expectant mother about why labour doesn’t have to hurt, and about the science of fear – what happens to your body when you get scared. They then learn how to transform this fear into feelgood endorphins, allowing your body to open naturally instead of constricting. For more on hypnobirthing or to find a practitioner in your area, log on to www. hypnobirthingireland.co.uk

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TYPES

of birth

VAGINAL BIRTH AFTER CAESARIAN (VBAC) If you have previously had a Caesarean, it may be possible to have a vaginal birth this time. Some women feel they missed out on the experience of feeling their baby move out of their body, while others may want the faster recovery time of a vaginal birth, and to avoid surgery and its complications. If you are interested in having a VBAC, firstly find out why you had a Caesarean birth last time. Most reasons for a Caesarean donâ&#x20AC;&#x2122;t necessarily repeat themselves, but it is essential to discuss your

individual experience with your consultant or midwife. The most common reason for repeated Caesareans in the past was the belief that the uterine scar may rupture during a vaginal birth. Medical findings now show that this is extremely rare. If you are aiming for a VBAC, learn as much as you can during the pregnancy. Consider going to antenatal classes designed for VBAC, which can prepare you both for the reality of labour and for a spontaneous labour. Classes can also give you more confidence in yourself and the birth process. The chances of having a VBAC depend on several factors, the most important of which is spontaneous labour. In some cases you can plan and work for a VBAC and still end up having another Caesarean birth, which may be disappointing. However, you will have worked for the best possible birth experience for you and your baby. Women who have experienced another

Caesarean birth after planning a VBAC often say they are glad that they tried.

ELECTIVE CAESARIAN SECTION While the majority of women deliver their baby without any complications, some women with complications, such as a low-lying placenta or who have a breech presentation, pre-eclampsia or very high blood pressure, may need to have a Caesarean section. This will be decided in advance with your caregiver, and a date will be set for an elective section, usually as close to 39/40 weeks as possible. Usually in the case of an elective section, you are expected to come into the hospital early that morning; the necessary checks and paperwork will be completed and you will be brought down to the theatre according to the schedule. See the box on the right for more on Caesarian sections, and tips on aiding your recovery.

LABOUR & BIRTH

aginal delivery in a hospital is by far the most common type of delivery. However, there are other methods of delivery that may be suitable according to your individual circumstances. Talk to your consultant and/or midwife for more information.

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HOME

birth If you want a home birth, you will need to contact your hospital very early on to ask if they operate the service. If they don’t, you can contact an independent source for more information. Get in touch with the Homebirth Association of Ireland at www.homebirth.ie.

INDUCTION OF LABOUR If you are between ten days and two weeks over your due date, your doctor may discuss the option of inducing your labour using: ● Prostaglandin gel or pessaries inserted into the vagina to ripen your cervix. ● Artificial rupture of membrane (ARM), where a small hook is used to break your waters and start contractions. ● Oxytocin given by a drip to start contractions.

LABOUR & BIRTH

ASSISTED DELIVERY While complications are not common, some women do require some form of assistance during labour and birth. If you have been pushing for a long time or the baby is in distress, your doctor may discuss using one of the following methods to deliver your baby safely: ● Forceps: This involves lying on your back with your feet elevated. You may be given a local anaesthetic if an episiotomy is performed to widen the vaginal opening. As you push, the obstetrician will assist the baby out by using forceps. ● Ventouse: A silicone cup (connected to a vacuum pump) is attached to the baby’s head. During contractions, while you are pushing, the obstetrician gently guides the baby out and assists with the delivery.

BIRTH BY

Caesarian section Whether elective or emergency, it’s important to remember that a Caesarian section is surgery and therefore carries with it all the risks of surgery. The anaesthetic used depends on the circumstances and whether the mother is in labour or not. The procedure itself takes about 35-40 minutes, most of which is spent on stitching up after the baby is born. The mother is then monitored closely for a period of time after the birth before taken to the ward, depending on the circumstances. As a c-section is surgery, recovery is slower than after a vaginal birth. The mother usually stays in hospital for up to five days but could go home sooner, depending on her recovery. Before going home, the mother is generally mobile, eating and drinking normally and has had at least one bowel movement. Recovery continues at home, with the general guidelines being to avoid lifting anything but your baby, no driving for six weeks, and no exercise until you’ve been given the all-clear from your GP. There can be complications with repeated sections, which is another reason why the decision to have a c-section should not be taken lightly. Remember that a vaginal birth is possible on a second baby after having a section on your first, so always discuss the available options to you with your medical team.

“

I had to have an emergency section with my daughter because of preeclampsia and a failed induction. I was so disappointed. But my baby was born healthy and well, and if I hadn’t had the skilled care of my doctors and midwives, the outcome could have been so different. Eva, mum to Jessie, 2

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FEELINGS

about the birth already left the hospital, talk to your GP about post-birth counsellors, or contact your hospital in case there is a postbirth counsellor on staff

REQUESTING YOUR NOTES You have a right to a copy of your notes, which may give you more insight into what happened during the birth. If you are thinking of making a complaint, itâ&#x20AC;&#x2122;s a good idea to get your notes first. You can apply for your birth notes through the Freedom of Information Officer or Patient Liaison Officer at your maternity unit. The notes are usually free of charge. You will need to provide the officer with enough information and identification to prove that you are the patient, as notes cannot be requested by a third party.

MAKING A

complaint Every hospital has a complaints procedure, and complaints should be made in accordance with the official guidelines. All hospitals will appreciate any feedback you have, good or bad. Refer to your hospital handbook for details of the complaints process.

LABOUR & BIRTH

hen you were pregnant you probably had a vision in your head of how you would like your labour and birth to progress. Unfortunately, sometimes the reality is different from the plan, for a whole variety of reasons. Due to safety reasons, your birth preferences sometimes may not be possible, and your caregivers could change your plan suddenly during labour. They should always discuss this with you and your partner, but in certain circumstances it may not be possible. If you feel angry, confused, scared or bewildered by your birth experience, talk to the midwives, who can put you in touch with someone who can help. If you have

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Another little helping hand for mums • 6 9% of pregnant women and new mums experience light bladder weakness* • Absorb faster than ordinary liners • L ock in moisture and control odour with FeelFresh Technology™

™ ! ts n e om m s p o for those Ooo

*Source: lights by TENA Myriad Survey 2014

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AFTER THE BIRTH

CHAPTER

08/09/2015 11:08

4 AFTER THE BIRTH Congratulations – you made it! So what now? You are likely to stay in hospital for a few days, depending on the type of birth you had; this is an opportunity to get to know your little one, recover from the birth and get some valuable advice from the midwives. In this chapter you’ll learn about breastfeeding, what happens if your baby needs special care and some special tests for baby.

WHAT

happens next?

nce the midwife is satisfied that everything is okay, you will be transferred to the ward. There, the midwives and care assistants will help you get to know and care for your baby, as well as recover from the birth. If you are a first-time mum and have had a normal, uncomplicated birth, you will most likely remain in hospital for three to five days. If you are a secondtime mum having had a normal, uncomplicated birth, the hospital stay generally lasts from two to three days. Some hospitals offer an Early Transfer Home Programme (ETHP). This is where you return home between six and 24 hours after delivery (as long as you and your baby are well) and a community midwife comes to your home for up to the following five days.

EXERCISE AFTER BIRTH Some women are dismayed to see they still look pregnant after giving birth. Don’t fear – your uterus is still shrinking and once it’s back to normal, a lot of this bloating will be gone. However, your tummy muscles will have been stretched and weakened, and it’s recommended that you start moving around as soon as possible. Remember if you have had any complications, interventions or a section, you may have to wait for six weeks or more before starting an exercise regime. In any case, always build up any exercise slowly and wait for the all-clear from your doctor. In the meantime, you can continue to perform pelvic floor exercises (see p23).

AFTER THE BIRTH

YOUR BODY No matter what type of birth experience you had, it’s important to give yourself time to recover from labour. Now is the time to get to know your new baby with plenty of skin-on-skin contact and establishing breastfeeding. You may be experiencing some pain from any stitches or tears during birth, but these should heal within a few days. Talk to your midwife if you need pain relief or are worried about pain. You may also experience some “afterpains”, which is your uterus shrinking back to its normal size. While you recover, your body will gently expel the extra fluids it retained to help your baby develop. You may find that you are peeing more than usual – this is perfectly normal, but again, if you are worried, talk to your midwife. The inner layer of cells in your uterus will also be expelled, which will look like a light period. This bleeding will slow down and stop after a few weeks.

TEMPORARY

incontinence You may find that you leak pee occasionally after giving birth, especially when you cough, sneeze, laugh or exercise. This is very common but in the majority of cases, it’s temporary. Your pelvic muscles were put under immense strain during late pregnancy and need strengthening after you give birth. If you have been performing pelvic floor exercises regularly during pregnancy, this will help speed your recovery, and it’s important to continue these exercises – aim for three times a day. Ask your midwife if you are unsure about how to perform pelvic floor exercises. If you still have the problem a few weeks after birth, or you find you are having problems with passing urine, talk to your GP or a midwife, as you may need to see a physiotherapist specialising in women’s issues.

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The Natural Way To Go! Whether you’re expecting a new baby or have recently given birth, it can be hard to maintain a consistently healthy diet with the right amounts of fibre and fluids. Reduced or irregular bowel movements are one warning sign that your diet needs attention. Hormonal changes during pregnancy and iron supplements can make you more susceptible to constipation, so extra care is needed to eat well at this time. Many women are introduced to prune juice during pregnancy and nursing. There are a lot of good reasons why: • Fluids are important. Water and milk are the primary liquids, and nutritious juices are important fluids too.

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• With a low Glycemic Index, Prune Juice contains only naturally occurring sugars, with no added sugar . • Our prune juice comes from the best quality Californian Prunes, you know that you and your baby are getting the best from nature.

• Made from 100% Sunsweet Californian Prunes

A perfect daily contribution to your healthy and balanced diet, Sunsweet Prune juice is: • 100% natural • A source of fibre • A source of potassium which supports normal blood pressure • Is fat and and salt-free • Sugar-free and preservative free • Contains sorbitol (Sorbitol is a type of carbohydrate. Not all sorbitol is digested, which is why it is so useful!)

Download our free pregnancy guide at: www.sunsweet.ie/DuringPregnancy.asp All nutrition claims comply with the EU food information to consumers regulation (2011) http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:20 11:304:0018:0063:EN:PDF

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STARTING

to breastfeed

AFTER THE BIRTH

he decision of how to feed your baby is an important one that needs careful consideration. More and more women are choosing to breastfeed in Ireland, but almost two thirds have stopped by the time their babies are three months old and many of these would have liked to breastfeed for longer. However, there are advantages to breastfeeding for even a short time and research shows that the longer you breastfeed the greater these advantages are for you, your baby, the environment and Irish society. Breastfeeding has many advantages for babies, their mothers, for society and for the environment. Babies who are breastfed are less at risk of stomach upsets, coughs and colds, ear infections, diabetes, asthma and eczema, obesity and high blood pressure later in life. The health benefits of breastfeeding for mothers include less risk of breast and ovarian cancer and osteoporosis in later life and a faster return to pre-pregnancy figure.

Breastfeeding also creates a special bond between mother and baby, is cheaper because less equipment is needed, and saves you time because you do not have to prepare bottles. The first milk your breasts produce is called colostrum. This is usually produced in small amounts to meet the needs of your baby in the first few days of life. Colostrum is very high in antibodies so is very important in helping your baby fight infections. As your milk supply develops the amount of milk increases and your breasts may feel fuller. This later milk also contains lots of antibodies and other ingredients to ward off illnesses as well as providing all the food and drink your baby needs to grow and develop.

GETTING STARTED Immediately after your baby is born he will be placed on your chest in skin-to- skin contact with you for his first cuddle. Most babies are very alert and anxious to suck soon after they are born. Holding him in skin-

to-skin contact will give him time to find your breast and start to suckle. Your midwife will help you with this first breastfeed if you need it. Having your baby with you at all times while you are in the hospital (and when you go home) will help you learn your baby’s way of ‘asking’ for a feed or a cuddle etc. You will know he is looking for a feed when he starts making sucking noises and when he moves his head from side to side while opening and closing his mouth. Crying is a late indication of hunger.

“I think it’s rare when a new mum and baby take to breastfeeding immediately. It’s important to be patient and to seek help if you need it. The midwives in hospital can offer great support in the first few days. Make sure you also know where to get help once you get home – your public health nurse will be able to advise you.” Caoimhe, Cork City

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How to attach Some tips to help your baby attach:

and your baby Correct positioning and attachment of your baby for breastfeeding will ensure that he gets plenty of breast milk and you will avoid getting sore nipples. Most of the problems experienced by breastfeeding mothers in the first few weeks (for example, sore nipples, engorgement, mastitis) occur either because the baby is not attached to the breast in the right way or because he is not being put to the breast often enough. Ask for help if you are unsure. ● If you are sitting down to feed, try to make sure that: - Your back is straight and supported - Y our lap is almost flat - Your feet are flat on the floor (you may need a footstool or a thick book) - You have extra pillows, if needed, to support your back and arms or to help raise your baby to the level of your breast. ● Breastfeeding lying down is especially good for night feeds as you can rest while your baby feeds. - Try to lie fairly flat with a pillow under

your head and your shoulder on the bed. - Lie well over on your side. A pillow supporting your back and another between your legs can help with this.

Once your baby is feeding well, you will be able to feed him comfortably anywhere without needing pilalows. There are various ways that you can hold your baby for breastfeeding. Whichever way you choose here are a few guidelines to help make sure that your baby is able to feed well: ● Make sure your baby is held close to you and across your chest. ● He should be facing the breast, with his head, shoulders and body in a straight line. His nose or top lip should be opposite the nipple. ● He should be able to reach the breast easily, without having to stretch or twist Remember always move your baby towards your breast rather than your breast to the baby.

● The baby’s whole body should be in contact with your upper body and facing your breast (his head and body should be in a straight line) with his nose at the level of your nipple. ● Support his back and shoulders with your arm but leave his head free to tilt back when he starts feeding. ● When he opens his mouth wide bring him onto the breast with his chin pointing forward and touching the breast below the nipple while allowing him to take in most or all of the areola (the dark area around the nipple) into his mouth (more below the nipple than above). ● You can encourage him to open his mouth wide by gently brushing his upper lip with your nipple. When your baby is correctly attached to your breast you will notice that: ● His mouth is wide open and he has a big mouthful of breast ● His chin is touching your breast ● His bottom lip is curled back (you may not be able to see this) ● If you can see any of the areola (the brown skin around the nipple), more is visible above his top lip than below his bottom lip. ● His cheeks stay full and rounded during sucking. ● His sucking pattern changes from short sucks at the beginning to long deep sucks with pauses.

AFTER THE BIRTH

POSITIONING YOU

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EXPRESSING MILK Why you may need or want to express your milk:

HOW DO I KNOW IF MY

baby is drinking enough?

Many new mothers worry that their baby is not getting enough food while breastfeeding. But there are a number of signs that your baby is thriving: ● Your baby is producing wet and dirty nappies. ● Your baby is putting on weight. ● Your breasts feel softer and lighter after feeding. ● You can hear your baby swallowing frequently and sucking steadily. ● Your baby is calm and satisfied

AFTER THE BIRTH

WHEN FEEDING HURTS Feeding should not be painful. While you and your baby are learning to breastfeed you may feel some discomfort when the baby first attaches to the breast. This sensation should fade quickly after starting to feed and from then on it should feel comfortable. If it continues to hurt, this probably means that your baby is not attached properly. In this case, take him off by gently pressing your breast away from the corner of his mouth so that the suction is broken and then help him to re-attach. If the pain continues, ask for help from your midwife, public health nurse, lactation consultant or La Leche League or Cuidiu volunteer.

● If you need to help your baby attach to a very full breast. ● If your breasts feel full and uncomfortable. ● If your baby is too small or sick to breastfeed. ● If you need to be away from your baby for more than an hour or two. ● If you are going back to work. Whether you choose to handexpress or to express by hand/ electric pump, the milk may take a minute or two to flow after you start expressing. Express from one breast until the flow slows or stops. Change to the second breast and when the milk stops flowing from that breast return to the first breast and start again. Repeat this several times until you can no longer get any milk from either breast. To encourage your milk to flow while expressing, try the following: ● Try to be as comfortable and relaxed as possible. Sitting in a quiet room with a warm drink may help. Have your baby close by. If this is not possible, have a photograph of your baby to look at instead. ● If you can, have a warm bath or shower before expressing, or apply warm flannels to your breast (especially when you are learning to express). ● Gently massage your breast. This can be done with your fingertips or by rolling your closed fist over your breast towards the nipple. Work around the whole breast, including underneath. Do not slide your fingers along your breast as it can damage the skin. ● After massaging your breast,

gently roll your nipple between your first finger and thumb. This encourages the release of hormones, which stimulate your breast to produce and release the milk. ● As you get used to expressing your milk you will find that you do not need to prepare so carefully. Just like breastfeeding, it gets easier with practice.

BREASTFEEDING WHEN OUT AND ABOUT Breastfeeding is the normal and natural way to feed your baby and you should feel proud and confident in your decision to breastfeed. Your baby can look for food or comfort anywhere and at anytime. Feel free to offer your baby a breastfeed whenever and wherever he or she needs it. Breastfeeding makes it easy to go anywhere with your baby, particularly when you are travelling by car, bus, train or air. You don’t have to carry feeding equipment or worry about keeping bottles fresh and germ free. Remember: ● You don’t have to ask to breastfeed. You can breastfeed anywhere you and your baby want or need to. ● Make it easier for yourself by wearing trousers or a skirt with a jumper, sweatshirt or T-shirt that can be pulled up from the waist. If possible wear a maternity bra that can be opened from the front with one hand. ● Feed early. Don’t wait until your baby gets too hungry or distressed, that way you’ll both be more relaxed and feeding will go more smoothly.

All information courtesy of the HSE. See www.breastfeeding.ie for more, or pick up a leaflet from your public health nurse, GP or maternity hospital.

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Getting help HOW LONG SHOUD

I breastfeed for?

Trust. In a few areas there are also non-affiliated voluntary motherto- mother breastfeeding support group meetings that you can attend. All La Leche League leaders and Cuidiu counsellors are mothers who have breastfed their own babies and who have completed an accredited training programme. Even if you are not having problems, this is an excellent way to meet other mums and share your experiences. Make contact with a private lactation consultant. There are an increasing number of International Board Certified Lactation Consultants (IBCLC) providing private breastfeeding information and support. Consult your local telephone directory or the Association of Lactation Consultants in Ireland, www. alcireland.ie, to find out if there is an IBCLC-qualified lactation consultant in practice in your area – there is a cost for this service.

AFTER THE BIRTH

There are advantages to breastfeeding for even short periods. But to maximize the health, social, emotional, environmental advantages of breastfeeding, aim to continue for as long as you can. The way to ensure you and you baby get the most out of breastfeeding is to exclusively breastfeed for the first six months and then continue breastfeeding while also giving your baby nourishing solid foods until the baby is two years old or older.

If you feel you need it, it’s important to seek help. Many hospitals offer breastfeeding support after the birth. Talk to your midwife or your GP about what’s available in your area. Or you can contact your public health nurse (based in the local HSE Health Centre – see local telephone directory for number). Public health nurses hold drop-in (no appointment necessary) well baby clinics and provide home consultation visits to mothers and babies. Contact your local breastfeeding support group to receive information and support over the telephone or arrange to attend one of the local support group meetings. Motherto-mother breastfeeding support group meetings are organised and facilitated by HSE public health nurses and voluntary breastfeeding counsellors, mainly by La Leche League and Cuidiú-Irish Childbirth

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experience ALLISON MOLLOY, founder of the Irish Premature Babies charity, shares her experience of having her two boys, Cillian (6) and Oisin (3), pre-term.

BABIES

in special care

AFTER THE BIRTH

t’s estimated that over 4,500 babies are born prematurely in Ireland every year. Thankfully, medical care has improved so much that even after only 24 weeks of gestation, babies have a chance of survival. When your baby makes an earlier than expected appearance, it may come as a shock for parents who weren’t prepared to meet their child so soon. Quite often parents feel helpless, scared or guilty, in case it resulted from something that they did wrong – when of course it had nothing to do with that walk or the hot curry you ate that night. This feeling can be immediate, or may hit them once later, one they are home and settled. Premature babies are classed as babies born before 37 weeks. They are usually cared for in a Special Care Unit or the Neonatal Intensive Care Unit (generally for more critical cases). Babies needing the intensive care

of a Neonatal Unit may be transferred to a major maternity hospital, which can be even more scary and disruptive for the parents. However, the staff on special care and neonatal unit are more than willing t talk to you about your baby and to facilitate bonding at every opportunity. If you need to know anything or want time with your baby, talk to the staff and ask them for help.

GET HELP If your baby has been born early and is in need of special care, Irish Premature Babies offers parents both practical support (invaluable if you have to travel to see your baby in a neonatal unit) and emotional support, as well as advice and information. The charity also runs a buddy system so that parents of premature babies who are experiencing the same things can be put in touch with each other. For more information, visit www.irishpremature babies.com.

At 30 weeks, Allison Molloy went into labour with her first child, Cillian. “When the doctors lifted the baby out [he was born by c-section], I caught a fleeting glimpse of him. The doctors congratulated my husband and I on our little boy and he was taken off to the Neonatal Intensive Care Unit (NICU). My husband went with the baby.” After recovery, Allison was given a picture of her son, and a few hours later was allowed to see him. “I burst out crying. He was so tiny, nothing like the picture I had upstairs in the ward.” Without anywhere for mothers to stay in the NICU after being discharged, Allison returned every day to be with Cillian and she says she found great support from other mums in the same situation. “I was really lucky when I had my first baby that I met a group of wonderful mums and we are all still friends now.” Allison’s second child, Oisin, was also born prematurely. “It was difficult having a two-year-old at home wanting to be with mammy when I needed to be with the new baby when he was in the NICU. “Even though you know your baby is doing well and gaining weight, it can be so scary bringing them home for the first time as you still remember the frightening times,” says Allison on bringing her children from hospital. “You have to learn to be a mother and trust your instincts.” Allison’s advice: ● Take each day as it comes, some days will be better than others. ● Accept any help from family and friends. ● Premature birth can happen to any woman and it’s not your fault. ● Look after yourself as well, it is very easy to neglect yourself. during those difficult weeks and months. ● Accept any help from family and friends.

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experience

RUTH KENNEDY gave birth to Sophie at 23 weeks and six days in June 2013 “I’d had a normal pregnancy and was feeling good, so we arranged a holiday in Orlando during my second trimester to do some shopping and relax. I’d just had a check and all was looking fine. But when I was in Orlando about three days, I started having back pains and went into labour. Two days later, I gave birth to Sophie at 23 weeks and 6 days. We were very lucky to be where we were, as we were admitted to the Winnie Palmer neo-natal intensive care unit, which is one of the best in the world. Sophie was one pound, ten ounces, which is a good weight for that time, but she was very, very small, and she was on a ventilator for eight weeks. At the beginning

she’d stop breathing about every hour, and as time went on, it would be every two hours. The staff were great, they explained everything to us – that her lungs were not ready for the outside world yet, so this was why she’d stop breathing. I actually had the What to Expect app and it was spot on with the development – Sophie’s eyes were shut when she was born and about three weeks later the app told me that the baby’s eyes were opening and sure enough, two days later, Sophie opened her eyes! On the down days, the nurse would say to us that all we were doing was watching her grow. “We had some problems along the way. We were just about to get Sophie to the next level, where she’d be in a cot and we’d get to go home and she developed a highly dangerous lung infection, RSV, and had to be re-ventilated and put into isolation for two weeks – the longest two weeks of our life. We then were back to square one, moving her oxygen down slowly. “We were in Orlando until we were brought home on October 3rd; we then spent 28 days in the Rotunda. Again the staff couldn’t have been better – Irish staff are under a lot more pressure than the staff we had in America but they really give their

“

all to the babies and the parents. “Looking back, we did go into a type of survival mode over the time spent in hospital. We had great support from people at home – some friends did fundraisers to pay bills and mortgages so we didn’t have to worry about anything like that while we were in Orlando, and we used Skype to talk to family and show them the baby. “I got involved with Irish Premature Babies because I found the support of other people who had gone through the same thing invaluable. During low moments I liked seeing the pictures of babies who had been born very early and who were now celebrating their birthdays years later. It was reassuring. I had great support while I was going through it, and I’d like to pay that back to other mums. “Sophie is now 14 months and thriving. She’s beginning to crawl and is even starting to catch up on her birth age. We do have to have her eyes checked every six months because of the prematurity and the amount of oxygen used, and she has RSV injections too, as it’s so serious and I never want to see her like that again.”

“We were in Orlando until we were brought home on October 3rd; we then spent 28 days in the Rotunda. Again the staff couldn’t have been better – Irish staff are under a lot more pressure than the staff we had in America but they really give their all to the babies and the parents. Ruth Kennedy

AFTER THE BIRTH

Staff were excellent

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BABY’S

screening tests

here are a number of screening tests for your baby that may be carried out during your stay in the hospital. If not, they may be done by your public health nurse.

AFTER THE BIRTH

HEARING SCREENING Some hospitals have introduced a hearing screening test shortly after birth. If your hospital does not offer this yet, your public health nurse will conduct a hearing test at a development check when your baby is older. If applicable, the hearing screen is usually done before you leave the hospital. The trained screener places a small soft tipped earpiece in the outer part of your baby’s ear, which sends clicking sounds down the ear. When an ear receives sound, the inner part, known as the cochlea, usually produces an echo. The screening test only takes a few minutes and does not hurt your baby. The hearing screening test will usually be done while your baby is asleep or settled in your arms. The results can be discussed with the screener immediately after the birth.

BLOODSPOT SCREENING The National Newborn Bloodspot Screening Programme identifies babies who may have rare but serious inherited conditions, which are treatable if detected early in life. The screening test is offered to all parents when the baby is about four days old. All babies born in Ireland are offered screening for Phenylketonuria (PKU), Maple Syrup Urine Disease, Homocystinuria, Classical Galactosaemia, Cystic Fibrosis and Congenital hypothyroidism. Screening your baby for all these conditions is strongly recommended. If you are considering opting-out please discuss your reasons with the public health nurse. Your decisions will be recorded and you will be asked to sign an opt-out form. The public health nurse or midwife will prick your baby’s heel using a special device to collect some drops of blood onto a special card. When the sample is collected, the newborn screening card is sent to the Children’s University Hospital in Temple Street for testing. Most babies will have normal test

results. However, if the test results suggest that your baby might have one of the conditions, you will be contacted by a nurse or doctor; the time interval will range within five to seven days of the test or possibly up to four weeks depending on the condition. The test is not 100 per cent accurate, and your baby will need to have more tests to confirm the result. If the test results show that your baby does not have any of the conditions, you will not be contacted directly. However, you can ask the public health nurse for the results at your baby’s three-month health check. The HSE is currently carrying out a review of storage and disposal policy for archived screening cards, in consultation with the Department of Health, the Data Protection Commissioner, and patient and clinical representative groups. For current policy, consult the HSE website at www.hse.ie or talk to your public health nurse. Information on newborn tests courtesy of the HSE. For more information, log on to www.hse.ie

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The Women’s Health Group The Women’s Health Group provides a wide variety of treatments for women during pregnancy and other times during their lives. From early pregnancy scans to reassurance scans and 3d/4d bonding scans we can help you avoid long waiting lists and give you an appointment that accommodates your schedule. The faster you get your results the faster your doctor can get on with your care.

No waiting for appointments • Nuchal Translucency Pregnancy Scan 11-24 weeks Screen for Down’s Syndrome and other abnormalities • Non invasive Pre Natal testing (NIPT) from 10 weeks For Down Syndrome and other chromosomal an • Early dating scan 7-10 weeks • 20 week Anatomy Survey 20-23 weeks • Growth and Well Being Pregnancy Scan 22 weeks onwards • 3D/4D Ultrasound scanning • Gynaecology and Antenatal care • • • •

High diagnostic accuracy Rapid response to clinical findings Comfortable and convenient location Safe - No Radiation

Call us today to make an appointment on 056-7795302 The Women’s Health Group, Ayrfield Medical Park, Granges Rd, Kilkenny Tel: 056 7795302 | Fax: 056 779 5303 | Email: reception@womenshealth.ie | Web: www.womenshealth.ie 235229_2L_Womans Health Group_Maternity2015.indd 1

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Each year in Ireland over 4,500 babies are born prematurely. It is the beginning of an often difficult and stressful journey for themselves and their families. Irish Premature Babies is 100% voluntary so all funds raised go directly to where they are needed most - supporting the families of Ireland’s smallest and sickest babies, and buying essential equipment for the Neonatal Intensive Care Units around the country.

How can YOU help?

l By making a donation to IPB l l

Through sponsorship for marathons or mini-marathons Support our fundraising events l By purchasing IPB merchandise from our online shop

IPB offers families:

Support networks l Emergency help Discount Card Scheme l Buddy system l Workshops l Meet ‘n’ Greet sessions l Lactational help Information leaflets l l

Newsletters

www.irishprematurebabies.com Tel:

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Carmichael Centre, North Brunswick Street, Dublin 7 Facebook: irish premature babies Email: info@irishprematurebabies.com 13/04/2015 11:36

21/08/2015 14:59

GOING home

AFTER THE BIRTH

fter a couple of days (up to five if you’ve had a Caesarian section), your doctor or midwife will talk to you about going home. On the day of discharge, you will be examined by a doctor and given any prescriptions, letters or advice, while your baby will also be examined and discharged with any instructions needed. Your baby should be seen by the GP (or the consultant if requested) at two weeks and six weeks. You are also due a checkup at six weeks with the GP.

YOUR PUBLIC HEALTH NURSE Once home, you are in the public health care system, and your public health nurse will be in touch within a few days, usually 48 hours, to arrange a

first visit. The first visit often takes place at your home, and will include a chat about any worries of concerns you may have, a weigh in, the newborn screening blood test if it wasn’t done in the hospital and some information on facilities in your area and vaccination schedule. The public health nurse usually gives you a contact number if you have any questions or concerns as your child develops. As your child grows, your public health nurse is there to help with development questions and issues. Following the first visit, the developmental checking appointments can be offered at three months, nine months, 18-24 months, and aged three to three and a half. Parents can ask questions at these visits and request any follow-ups if they are needed.

GETTING

help

Those first few days at home can be scary for new parents, especially if this is your first child. Don’t be afraid to ask for help - your public health nurse is there to guide you and help you with any issues you might have. The nurse can also refer you on if there are any problems that she/he cannot deal with. Your baby is due a check-up at two weeks and at six weeks, and you will have a check at six weeks, but if you have any health concerns before that, contact your public health nurse or GP.

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EARLY DAYS

CH A P T ER

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EARLY DAYS

5 EARLY DAYS Arriving home with your newborn baby is a hugely exciting time – but it’s also a potentially scary time. How will you cope with such a tiny being to care for? What about registering your baby? And your own post-birth health? In this chapter you will learn about caring for your new baby as well as some of the practical issues like vaccinations and birth registration. We also take a look at the very real problem of post-natal depression – the signs to look out for and some of the ways in which you can help your mental health. Remember that your public health nurse is there to help and guide you during the early days.

CARING FOR your baby

he joy of arriving home with your baby, after being surrounded by professionals for the first days of your child’s life, can be overshadowed by nerves, particularly with your first child. Rest assured, you will gain confidence over time through learning to look after your baby’s individual needs and responding to his cues.

BATHING YOUR BABY Newborn babies do not need bathing in the first few days of life. Topping and tailing your baby is sufficient for the first few times until you get used to bathing your baby. When your baby is ready for a bath, set aside plenty of time, especially for the first few times. It may take a few days to gain confidence, but try to relax and enjoy the activity. Talk and sing to him and try to make it a special time to bond with your child.

EARLY DAYS

NAILS Baby nails do not require cutting in the first few weeks. Put loose-fitting mittens on baby’s hands to stop him scratching his face. When trimming baby’s nails, place his hand on a flat

BATHING

your baby ● Remember, babies don’t regulate their temperatures very well, so undress baby in stages, starting with the top part of the body. ● Pour a small amount of cold water first into the bath and then add warm water until the bath reaches a warm temperature. Test the temperature with your elbow or the inside of your wrist. ● Start with the top part of the body. Wrap baby in a towel and wash his face, eyes and hair. ● Remove his nappy and clean the area with baby lotion. ● Remove the towel and, supporting baby’s shoulder with your left forearm, hook your hand under the armpit. ● Gently cradle baby’s legs with

your right arm holding on to one thigh. Gently place baby in the bath so that you are facing him. ● Keep him in the semi-upright position with lower body immersed in the water and his head and shoulders out of the water. ● Holding him firmly with your left hand, wash baby with your right hand. Talk or sing to your baby all the time. ● When the washing is finished, lift your baby out of the water, placing your right hand under his bottom. Place baby in a towel and give him a cuddle. ● Dry him well. ● Never, ever, leave your baby alone in the bathroom at any stage. Ignore the doorbell and turn off your phone.

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surface and cut the nails using a blunt-edged scissors.

HAIR

EYES If baby’s eyes need cleaning (ie if there is a crust or discharge): ● Wash your hands. ● Dip a cotton-wool ball in boiled, cooled water. ● Squeeze out the excess. ● Start in the inside aspect of the baby’s closed eye, wiping towards the outer. ● Discard the cotton ball. ● Repeat for the other eye.

SKIN A newborn baby’s skin contains natural oils; there is no need to use soap products to wash your baby in the early weeks. Using only water, clean and dry all the skin creases, otherwise moisture in the creases may lead to irritation of the skin. At a later stage, you can add unperfumed products to the bath. The newborn baby may have a variety of spots, blotches or rashes on the skin. If you are concerned about any aspect of your baby’s skin, ask your public health nurse for advice.

THE UMBILICAL CORD The umbilical cord is cut and clamped following the birth of

advice. A baby may be given a bath during this time. In general, a baby’s bowel motion may change in colour and consistency without giving rise to any problem. If you are concerned, discuss it with your public health nurse. In a small number of cases it may be advisable to contact your doctor if there is a sudden change in consistency, colour and smell of the stools, accompanied by a feeling that your baby is sick and unwell.

the baby. The remaining cord stump heals naturally; it dries, shrivels and falls off during the first two weeks of life. Leave the area around the cord stump uncovered as much as possible to encourage healing. Gently clean the cord at each change and fold baby’s nappy down below the stump until it heals. If you are concerned about redness or signs of infection at the site, contact your public health nurse for

SIGNS

of illness Consult your doctor immediately if: ● Your baby has a fever – temperature above 38°C (100°F) – if accompanied by a rash, especially red or purple spots that don’t disappear when pressed by a glass. ● Your baby has a high-pitched cry. ● Baby’s skin feels cold and he appears drowsy or is unusually quiet and limp. ● Your baby’s neck is rigid or stiff. ● Your baby has prolonged vomiting. ● Your baby has diarrhoea. Always contact your doctor if you are concerned in any way. If your baby stops breathing, contact your hospital immediately for advice, or call 999 for emergency services.

EARLY DAYS

Some babies are prone to cradle cap, a dry, scaly condition of the scalp. Health professionals advise daily washing to prevent its occurrence. To wash baby’s hair: ● Wrap the baby’s trunk in a towel and hold underneath your armpit. ● Place head over the bath and wash hair using a little amount of nonstinging shampoo. ● Rinse well and dry with a soft towel. ● If cradle cap does occur, apply a little baby oil in the evening and wash off the following day. Do not try to remove the scales with your fingernails, as this may give rise to a breakdown of the skin and result in infection.

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Look out for the following: ● Watery stools ● Change in colour ● Increased frequency ● Very smelly ● Baby seems unwell For more information on your baby’s bowel movements, turn to p82

BOWEL MOVEMENTS Baby’s first stool is called meconium and this is a dark green, sticky substance. The colour and consistency changes over the next few days depending on whether the baby is breast or bottle-fed. In general, a baby’s bowel motion may change in colour and consistency without giving rise to any problem. If you are concerned, discuss it with your public health nurse. In a small number of cases it may be advisable to contact your doctor if there is a sudden change in consistency, colour and smell of the stools, accompanied by a feeling that your baby is unwell. Look out for the following: * Watery stools * Change in colour * Increased frequency * Very smelly * Baby seems unwell For more on your baby’s bowel movements, turn to p82

EARLY DAYS

MALE CIRCUMCISION Circumcision is an operation to remove the foreskin, which covers the penis, leaving the top of the penis exposed. Some parents circumcise their male babies for religious reasons. It is recommended that babies should not have this procedure within the first year of life unless medically indicated. Select a reputable surgeon for the procedure. After the operation, follow instructions given by the surgeon. In general, a baby recovers from the shock of surgery within 24 hours. The baby’s penis is nearly always swollen and inflamed for a few days. During this time, observe for signs of bleeding. Change baby’s nappy frequently to reduce the chance of infection. Expose to the air as much as possible. Refer back to the surgeon if you are concerned in any way. Remember that female circumcision is illegal in this country. Sylvia McShane is a public health nurse, barrister at law (Gray’s Inn) and freelance writer.

VITAMIN

It is now a public health policy that all infants born in Ireland must receive Vitamin D3 drops from birth, whether babies are breast- or bottle-fed. ● What is Vitamin D? Vitamin D is a fat-soluble vitamin that is needed for every cell in the body to function properly. When the sun shines on our skin, the body makes vitamin D. We need to top up our supply as often as possible. Sitting in the sunshine for more than 15 or 20 minutes per day is not recommended, as there is a direct connection between skin cancers and sun exposure. Furthermore, from October to March we see very little sunshine in Ireland. ● Infants and Vitamin D Infant skin is very sensitive and burns easily and should not be directly exposed to the sun. The Irish Cancer Society recommends that baby’s skin is not exposed to direct sunlight, and should be protected by clothing, shade and sunscreen. Therefore, infants do not have the capacity to safely get Vitamin D from the sun. Infants with African, Afro-Caribbean, Middle-Eastern or Indian ethnic backgrounds are at even higher risk of vitamin D deficiency. Their stores of vitamin D may be particularly low when born, as their mother’s skin is not as efficient at making vitamin D from the amount and type of sunlight in Ireland. Exclusively breastfed infants are more at risk of Vitamin D deficiency than bottle-fed; however, all infants are at risk of deficiency since their Vitamin D stores at birth are dependent on their mother’s vitamin D status during pregnancy. Babies are also born with only 50 to 60 per cent of mum’s stores. Research carried out at the National Maternity Hospital showed that no pregnant woman in the study met the recommended daily allowance for vitamin D. ● Why is Vitamin D important? Rickets, a condition that affects bone formation, has re-emerged in Ireland thanks to Vitamin D deficiency. Furthermore, it is now widely accepted that insufficient calcium and vitamin D in early childhood can lead to osteoporosis in later life. In Ireland we have very high rates of osteoporosis, with one in three Irish women over the age of 65 developing the disorder. This very important vitamin is also gaining lots of positive attention from the research community. It is now being investigated for its role in autoimmune disease, Type 1 diabetes, and cancers. ● What about supplements? The recommended form of vitamin D supplement for infants is actually vitamin D3 (cholecalciferol). It should be given as an oral supplement in a liquid or drop form and should contain only vitamin D3 – it should not contain any other vitamins. It should provide five micrograms (5ug) of D3 daily. Supplementing your baby is a very simple preventative health care strategy. Remember to give the drops daily.

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GUIDE TO

THE SCOOP ON

nappies

ne of the first baby essentials you’ll become an expert on is the nappy – both the item itself and its varying contents! But before baby even comes, there are some considerations when choosing what nappy to use.

what suits your child. If you want to stick with most expensive brands, remember to shop around – there are always plenty of special offers on nappies if you keep an eye on supermarket ads, especially around children’s allowance days (first Tuesday of the month).

CLOTH OR DISPOSABLE?

HOW MANY NAPPIES DO I NEED?

Cloth nappies have come on in leaps and bounds in recent years, and have become a real option for busy mums now. The advantage is the lower overall cost for the baby – especially if you keep the nappies for later children or sell on afterwards (there is a buoyant second-hand market for “designer” cloth nappies). You do need to invest in cloth nappies to begin with, however – a starter pack can cost in the region of €200 upwards, but this can save you hundreds in the long run. Many mums use disposables in the early days and on the go, and then cloth nappies as they get into a routine with their little one. If you want to know more about cloth nappies and try before you invest, contact the Cloth Nappy Library (www. clothnappylibrary.ie).

ARE BRANDED DISPOSABLE NAPPIES BETTER?

EARLY DAYS

baby poop

Disposable nappies have an incredible amount of technology in them these days, and the market is so competitive that there is a huge choice of great brands out there. Most mums agree that different brands suit different kids – and what suits a baby at one stage (eg newborn) mightn’t suit them at another (eg when walking). The key is to try different bradns and choose

Generally speaking, you will be changing your baby about six to eight times a day in the early stages, less as they get older. Stages like teething and weaning can have and effect on your nappy usage, but in general, allow for six a day once the initial newborn stage is over.

WHAT ABOUT THE ENVIRONMENT? Both disposable and cloth nappies affect the environment negatively, but in different ways. Disposable nappies require more raw materials in their manufacture, and create more landfill, but cloth nappies require lots of water and electricity to clean. A 2005 study made by the UK Environmental Agency found very little difference between disposable nappies and cloth nappies when it came to environmental impact. A later study, in 2008, found that cloth nappies could be better for the environment if parents followed a more “green” way of cleaning them, eg drying them on the line instead of using a tumble dryer. There are also environmentally healthier disposable nappies on the market, such as chlorine-free choices or organic cotton nappies, which use no pesticides when growing.

For the first few days after baby arrives, they will pass something called meconium. Meconium is a mixture of mucus and amniotic fluid, along with everything your baby has ingested while in the womb. It will have a greeny-black colour and a sticky texture. Meconium may be difficult to wipe off your baby’s bottom, but its appearance is a good sign as it means that your baby’s bowels are working normally. Breastfed babies After about three days, when your milk arrives, you will notice a change in their poo. Your baby’s poo will now become lighter in colour, changing from a greenish brown to a bright or mustard yellow. The texture of their poos will also be a lot looser than the meconium. Formula-fed babies Formula-fed babies might experience more constipation than breastfed babies, and their poo may differ. Their poo will be bulkier in texture (a bit like the texture of toothpaste). This is because the formula milk is not digested as fully as breast milk. The colour of their poo will vary from a pale yellow to a yellowish-brown colour, and be stronger smelling than breastfed babies’ poo. Changing from breastmilk to formula Any change to your baby’s diet will alter their poo. Their poo may become darker, more paste-like and have a stronger smell. When making the change from breastmilk to formula, try and make the change slowly and gradually, ideally over several weeks. When to worry Consult your doctor if you notice a difference in the colour of your baby’s poo, especially if it is very pale (chalky white – this could indicate jaundice), ruby red (this could indicate a bacterial infection or a milk allergy) or green (this could be the result of a stomach bug or reaction to medication). If you suspect constipation or diarrhea, a trip to the GP or nurse, especially in younger babies, is also recommended.

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VACCINATING your baby

EARLY DAYS

mmunisation is important for your child’s health and for the health of the children and adults your child will come into contact with. Many of the diseases your child will be immunised against in the primary childhood schedule are potentially very serious, especially for a young infant, which is why your child is so young when she gets her immunisations. All the recommended immunisations listed in the primary childhood immunisation schedule are free in Ireland. Your child will need five visits to your GP to complete their course of vaccines and be fully protected against serious diseases. Please note that the vaccinations given at six months have changed slightly for babies born on or after 1st July 2015.

HOW DO VACCINES WORK? When your child is given a vaccine, their body responds by making antibodies, the same as if they had

caught the disease but without getting sick. Their body then produces antibodies to destroy the vaccine, and these stay in your child’s body and protect them against the actual disease.

WHY ARE VACCINES GIVEN AT SUCH AN EARLY AGE? Vaccines are given at an early age because young babies are most vulnerable to these diseases and need to be protected as early as possible. For example, babies younger than six months are at the highest risk for serious complications of pertussis (six out of ten need to go into hospital, and nine out of ten deaths from whooping cough are in this age group). The MMR vaccine is not usually recommended for children under 12 months because it may not work properly.

HOW SERIOUS ARE THESE DISEASES? Any of them can kill a child or an adult. It’s easy to forget how serious they are because thanks largely to vaccines – we don’t see them nearly as much as we used to. Measles used to kill thousands of people in Europe and the United States every year. In the 1940s and 1950s, tens of thousands of children were crippled or killed by polio. As recently as the mid 1980s, 100 children a year in Ireland suffered from meningitis and other serious complications as a result of Hib infection. These diseases have not changed. They can still cause pneumonia, choking, meningitis, brain damage and heart problems in children who are not protected. These diseases still kill children in many parts of the world, even in Ireland.

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Schedule of vaccination

ARE TOO MANY VACCINES GIVES?

WILL IMMUNISATIONS STILL WORK IF MY CHILD DOESN’T GET THEM AT THE RIGHT AGE? Yes. Most of these vaccines can be given at any age, and a child who misses one injection in a course of injections does not have to start again. The vaccines already given will still work and your child will still develop protection. Just ask your GP. Your child needs to get the vaccines at the right age so that they are protected from serious diseases when they are most vulnerable.

WHAT WILL HAPPEN IF MY CHILD DOESN’T GET VACCINES? Basically, one of two things could happen: ● If your child goes through life without ever being exposed to these diseases, nothing would happen.

At Birth Hospital or HSE clinic BCG (one injection) Two Months GP 6 in 1 & PCV (two injections) Four Months GP 6 in 1 & Men C (two injections) Six Months GP 6 in 1 & PCV (two injections) 12 Months GP MMR & PCV (two injections) 13 Months GP Men C & Hib (two injections) * BCG: * 6 in 1: * PCV: * Men C: * MMR: * Hib:

Bacille Calmette-Guerin (TB) vaccine Diphtheria, Haemophilus influenzae B (Hib), Hepatitis B, Pertussis (whooping cough), Polio and Tetanus vaccine Pneumococcal conjugate vaccine Meningococcal C vaccine Measles, Mumps, Rubella vaccine Haemophilus influenzae B vaccine

● If your child is exposed to any of these diseases, as a child or as an adult, there is a good chance that he or she will get the disease. Your child could get mildly ill and have to stay inside for a few days; or get very sick and have to go into hospital or at worst die. Your child could also spread those diseases to others who are not protected, such as children who are too young to be vaccinated. Many people could get very sick and some could die if not enough people in your community are protected.

DO VACCINES ALWAYS WORK? Vaccines work most of the time, but not always. Most childhood immunisations protect 90-99 per cent of the children who get them,

EARLY DAYS

Some parents worry that giving several vaccines at once will overload their child’s immune system or that the vaccines may not work properly. However, there is nothing to worry about as your child’s immune system can easily cope with vaccines. Studies have shown that vaccines are just as safe and just as effective when they are given together as when they are given separately. For example, if your child received single injections instead of the combined MMR vaccine, they would be exposed to the diseases of measles, mumps or rubella for a longer period and would have to have six injections instead of two. A number of injections are needed to give your child the fullest possible protection, so it is important to complete the course. The number of injections is reduced by the use of combination vaccines where several vaccines are combined into one injection. The ages at which vaccines are recommended are chosen to give your child the earliest and best protection against disease.

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but sometimes a child will not respond to certain vaccines. This is another reason why it’s important for all children to be immunised. A child who has not responded to immunisation depends on the immunity of others around them for protection. Your child could be infected by a child who hasn’t been immunised, but not by one who is immune.

ARE VACCINES SAFE? The vaccines used in Ireland are safe. All medicines can cause side effects, but with vaccines these are usually mild, like a sore arm or leg or a slight fever. Serious side effects to vaccines are extremely rare. Research from around the world shows that immunisation is the safest way to protect your child’s health. Your doctor or nurse can discuss the risks with you before giving your child their vaccines. All the recommended vaccines used to protect children in Ireland are licensed by the Irish Medicines Board or the European Medicines Agency. They are allowed to be used only after they have been shown to be both effective and safe.

EARLY DAYS

WHAT ABOUT THE SCARE STORIES? We know that vaccines don’t cause autism, diabetes, multiple sclerosis, allergies, asthma or attention deficit disorder (commonly known as hyperactivity). However, when things happen to our children around the same time as they are immunised we can wrongly presume that there is a link. For example, the signs of autism usually become noticeable at about the age when children are given the MMR vaccine, but one does not cause the other. Because

TREATING COMMON

side effects

COMMON SIDE EFFECTS CAN INCLUDE: ● Soreness, swelling and redness in the area where the injection was given.. Fever (over 39.5°C) Headache or irritability.

● Children do NOT usually need to take any medicine when they are given a vaccine. However, if your child gets a fever (over 39.5°C) or is sore where the injection was given, you may give them paracetamol or ibuprofen.

WHAT TO DO ● Give paracetamol or ibuprofen to relieve aches and pains. ● Make sure clothes are not too tight or rubbing against the area where the injection was given. ● Do not overdress your baby. ● Make sure their room isn’t too hot. ● Give extra fluids to drink. ● Give paracetamol or ibuprofen to lower the fever or aches and pains

● Remember, after having the MMR vaccine a fever may happen about six to 10 days later, so give paracetamol or ibuprofen then.

TIPS ● Remember, if your child is very unwell after getting a vaccine, they may be sick for some other reason. Talk to your GP about this.

most children get immunised, those who have conditions such as autism, asthma or attention deficit disorder will probably have been immunised as well. Studies to see if children who have been immunised are more likely to have these conditions have shown that there is no link between the conditions and vaccines. Extensive research into the MMR vaccine, involving thousands of children, was carried out in the UK, the USA, Sweden and Finland. This research showed that there is no link between MMR and autism. One study looked at every child born in Denmark from 1991 to 1998. During that

● The dose of paracetamol or ibuprofen recommended for your child is written on the bottle according to the child’s age. ● Please ask your pharmacist for sugar-free mixture of paracetamol or ibuprofen suitable for your child’s age. ● Using paracetamol or ibuprofen over a long period without advice from a doctor may be harmful.

time, 82 per cent of children born in Denmark received the MMR vaccine. The researchers looked at the records of over half a million children and found the risk of autism was the same in immunised children as in children who had not been immunised. Experts from around the world, including the World Health Organization, agree that there is no link between MMR and autism. Information in this section was adapted from the HSE booklet, Your Child’s Immunisation: A Guide for Parents. For your own copy, log on to www. immunisation.ie or contact your public health nurse or GP.

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REGISTERING your baby

side from running around catering for your newborn’s every whim, one of the most important tasks is to schedule an appointment with a Civil Registration Services Office of your choosing and formally register your child’s birth. Maybe you never expected your baby to come into this world attached to a string of boring paperwork, but the importance of registering comprehensive and accurate information about your child should become evident when you think about the amount of times this information will be used throughout the course of his or her life. Enrolling in school, exams, getting a job, getting a passport, submitting health and social welfare applications – these are all times when this information will be vital in the future. Another worthwhile reason is that upon registration your child will be issued with a Personal Public Service Number (PPSN), which will entitle you to receive Child Benefit Allowance for your child.

EARLY DAYS

WHAT IS THE PROCEDURE? The Civil Registration Act 2004 requires the parent or parents of a newborn child, not later than three months from the date of birth, to attend in person before any registrar of births, to provide such information as is required to register the birth and to sign the register of births in the

presence of the registrar. All you need to do is to gather all the basic facts about both baby and parents and present them in person to a registrar of your choice.

WHAT DOES THE REGISTRATION OFFICE DO? A Birth Notification Form will usually be completed with the parent(s) by hospital staff. It outlines the information to be recorded in the Register of Births and is forwarded to a registration office to inform the registrar of the birth. These details are usually registered within two weeks so it is always worthwhile for you to call ahead to the Registration Office you have chosen and check that they have received the details before you arrive in person. To register, the mother or father, or both, can attend. If the parents are unmarried the father must consent to have his details included, so it is advisable for both of you to attend. Advanced contact is recommended if the mother has previously been married, or is separated or divorced.

WHAT SHOULD I BRING? Both parents must bring photographic identification (for example, a passport or driving licence) as well as their Personal Public Service Numbers. These can be obtained

from the Department of Social Protection if unknown. After these details have been recorded, you will need to provide the following details to complete registration of your baby:

CHILD’S DETAILS ● The time, date and place of birth. ● The gender of the child. ● The forename(s) and surname of the child. Ensure the surname(s) appearing in the Register of Births is correct so as to avoid any later confusion or difficulties.

PARENTS’ DETAILS The following details must be supplied separately for both the mother and the father at the time of registration: ● The forename(s) and surname of each parent at the time of the birth. ● Each parent’s birth surname. ● Each parent’s occupation described as accurately as possible. ● Each parent’s normal address at the time of birth. ● Each parent’s date of birth. ● Each parent’s marital status at the time of birth. ● The birth surname of the mother of each parent. Having all these details ready when you are registering your baby will make it a quick and easy process and leave you with more time for figuring out the parts of parenthood that don’t require messy paperwork, but are rather just messy!

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POSTNATAL

ostnatal depression (PND) is an illness that happens as a result of having a baby. It can happen after any birth and can last anywhere from three months to a year. If unrecognised, it can continue on into the second year. The feeling of ‘baby blues’ comes on around the second or third day after giving birth. It is quite normal and very common. It usually only lasts for a day or two but in a number of women it could last up to a week. If it goes on for longer than ten days you should visit your GP as a small percentage of woman can get PND from delivery. Some of the symptoms include: ● Crying for no reason. ● Feeling tired and weary. ● Feeling cross and anxious. ● Feeling useless. ● Afraid to be left on your own with the baby. ● Trouble sleeping even though you are exhausted. The most severe form of depression

after childbirth is puerperal psychosis, where mum is very high, doing things out of the ordinary and having hallucinations. It is very rare and only affects one in 500. The majority of women with puerperal psychosis develop symptoms within the first two weeks of delivery. It is caused by a chemical imbalance brought on by childbirth. The earliest signs are restlessness, irritability, insomnia and mild confusion. Urgent medical intervention is needed if this condition is suspected.

good day, two bad days) but you will eventually notice that the bad days become fewer as you start to get back to normal. Some women prefer not to take tablets, and for this option you will need support. Most importantly, talk to your partner and extended family; their support is invaluable. It is truly essential that you realise you are not on your own going through this illness, and there are a number of things that your partner can do to help, such as:

SEEK SUPPORT

● Be patient, supportive and encouraging. ● Reassure mum that she will recover. ● Encourage mum to talk about how she is feeling. ● Ask family and friends to help around the house. ● Ensure that she gets enough food and rest. ● Organise babysitting so that you can have some time together. ● Encourage time spent between mum and baby to bond and get to know each other without feeling under stress.

It is very important to go and see your doctor and to inform your public health nurse if you suspect you are suffering from PND. You might be encouraged to go on antidepressants and, though most women dread being put on medication, new tablets have come a long way. If you are put on anti-depressants, you should see some improvement in about a week to ten days. PND is a very up and down illness (i.e. one

EARLY DAYS

depression

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SIGNS OF

PND

SIGNS ● Lack of interest in yourself or your baby. ● Unable to cope with small things, finding everything an effort. ● Feeling that you are a bad mother. ● Afraid of being left alone with your baby. ● Feeling exhausted but unable to sleep. ● Feelings of hopelessness. ● Feeling angry, rejected and/or confused. ● Inability to concentrate, forgetfulness. ● Lack of interest in your appearance. ● Marked over-activity or under-activity is common. ● Lack of interest in sex. ● Obsessed with baby, not wanting anyone else to hold or mind the baby. ● Racing negative thoughts that you can’t stop. ● No interest in food, or over-eating. ● Feelings of panic or anxiety, not being able to relax. ● More often than not, mum does not realise that anything is wrong and it is up to her partner to notice many of these signals for PND.

● Be aware that mum may not be in the mood for sex but does need love and affection.

EARLY DAYS

MEETING OTHER MUMS Nowadays many expectant mothers may be living away from home with little or no support; working almost right up until the baby is due and living in housing estates where everyone is out working all day. This can lead to feelings of isolation and loneliness, which can be worsened if mum has nobody to share these concerns with. I would encourage every new mum to join a mother and toddler or baby group where they can meet other mums. At the very least, check and see if you have any friends or neighbours that you can call on if

CAUSES ● PND affects about 20 per cent of women in Ireland every year. It can develop after any pregnancy up to six months after giving birth; the most common occurrence seems to be six to ten weeks after delivery. ● We are not sure what causes PND and why it affects some mums and not others, but we do know certain things. Firstly, if there is a history of PND or clinical depression in your family then you might be more susceptible. It is very important to let your GP and public health nurse know so they can keep an eye on you after the birth. ● If a life-changing event happens while you are pregnant (i.e. a death in the family, moving house, losing your job), this can be a trigger for PND. A bad birth experience can also be a trigger; a lot of women draw up a birth plan but sometimes an emergency might occur that prevents this plan being used. Some women can take this as a sign of failure on their behalf and become fixated. ● We have all read about the amazing rush of love to expect the first time you see your baby. This does not happen to every woman straightaway. This let-down has been the starting point of PND for lots of women as they feel a sense of failure. But, look at it this way: your baby is a stranger to you until he is born, and how many strangers do you fall in love with straightaway? ● Last but not least we come to ‘Supermum’: the woman who puts herself under pressure to be perfect. What Supermum needs to know is that no woman needs to do everything alone, and there are a number of places she can go for help.

you need help. The website, www.pnd. ie, is an Irish website dedicated to postnatal depression. Here you can read other women’s stories and their helpful suggestions. There is also a discussion section where you can communicate with other mums around the country. You can also call Postnatal Depression Ireland (based in Cork) to see if there is a support group in your area. These small groups comprise of women who are going through different stages of PND and meet monthly and offer each other support. Partners are also welcome to join these sessions. For areas without a support group, Postnatal Depression Ireland keep a file of

mothers who have recovered from PND and are willing to offer their support to others. Contact us if you need help and support. We all need someone to listen to us and counselling certainly has its place in the treatment of PND. Some women with very mild cases have found this to be a great help. However, be careful not to rush into anything before you are ready. Women with postnatal depression do get better. Professional, family and community support helps speed recovery. Finally, if things are bad in the middle of the night and you have no one to talk to, please call the Samaritans (1850 609 090); they are there to listen and to help you.

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HELPFUL

suggestions

● Take life one day at a time.

● Don’t try to be Supermum. Caring for a baby 24 hours a day is exhausting; you are allowed to drop your standards for a while.

● Try to find the positive in things – everything in your life is not always negative, even if it feels that way at the moment. It will be difficult at the start but do try. If you don’t look for the positive things in your life, you won’t see them.

● Don’t be afraid to ask for help: it is not a sign of weakness. People are only delighted to help.

● Be open about your feelings and worries with people you trust who will understand and won’t judge you.

● Find time to have fun. Accept genuine offers of help and go out with your partner or a friend, even if only for an hour. You will feel the benefit the next day.

● Try to get some exercise every day; even if it is only a walk around the block, fresh air really helps.

● Eat a balanced diet, little and often. This will give you energy. ● Involve your partner as much as possible.

● If you are having a bad day, get out of the house. Visit a friend or walk to the shop – a distraction really helps.

● We all have certain times during the day when we feel better so keep a diary of your moods, especially in an upswing. This helps you to see that your day isn’t all doom and gloom. ● Don’t be too hard on yourself or your partner. Blaming yourself or others is not helpful to anyone, least of all you. Life is tough at this time but it will get better. ● It can help to write down how you are feeling. This way you can get things off your chest – and you can always burn it afterwards. Madge Fogarty is the founder and chairperson of Postnatal Depression Ireland. For further information on Postnatal Depression Ireland, call (021) 492 3162 or visit www.pnd.ie.

EARLY DAYS

● Accept there is a problem and you need help.

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CONTRACEPTION advice

EARLY DAYS

ontraception is probably the last thing on your mind, but unless you are breastfeeding, your periods and your fertility return to normal about three weeks after giving birth, so it’s important to give it some thought. In some ways, your contraceptive choices will depend on the issues relevant prior to your pregnancy: effectiveness, convenience, any side effects and any medical conditions you have or medicines you need to take. One new factor is whether or not you are breastfeeding your baby. If so, your periods are unlikely to return for at least six months, or as long as you continue feeding. Breastfeeding significantly reduces a woman’s fertility, but unless you are very conscientious about never missing a feed, including at night, it’s not a completely reliable method of contraception, much less so after six months. Fortunately many contraceptive methods can be safely used when breastfeeding. The exceptions are contraceptives containing oestrogen, such as the combined pill and vaginal rings and patches, as oestrogen affects milk flow. What worked well before your pregnancy may be the right choice

again, but another new decision is the possible timing of another baby. Longer-acting contraceptives, such as hormonal injections, implants, or a coil (either an intra-uterine device or system), may be a better alternative if you’re pretty sure you will not want another baby for some years, or if you think your family is complete. It’s better not to make a possibly irreversible decision too soon, so wait until your baby is over a year old before opting for a sterilisation or for your partner to have a vasectomy.

EARLY CHOICES If you have decided not to breastfeed you can start the pill, or use a vaginal ring or skin patch, from three weeks after birth. These can be very reliable methods of contraception, but you have to take them regularly. You can start the progesterone-only pill (“minipill”) any time after birth, whether you’re breastfeeding or not, but remember this needs taking at the same time each day. Your doctor or nurse can usually fit an implant or coil four weeks after birth and these options can be very useful if you want long-acting, very reliable and usually well-tolerated contraception.

It is usually recommended to delay starting the contraceptive injection until at least six weeks after delivery, since used earlier this may cause more heavy or irregular bleeding. If you used a diaphragm or cap before your pregnancy, this can be used again after six weeks. You should check it’s correctly fitted first, as your cervix and vagina change shape during pregnancy and birth. This is also appropriate if you have put on more than 3kg in weight. Natural family planning is possible after you have had a baby, but you may find your cycle much less predictable, certainly for a year or so. You should discuss this option with an experienced Natural Family Planning (NFP) practitioner. Contraceptive planning after you have had your baby is as important as before you became pregnant: think through your options, get advice, and make the best choice for you. Dr Julius Parker, general practitioner with HSF Health Plan’s free 24 hr GP advice line, answers health questions relating to young families. For more information on HSF health cash plans, please visit www.hsf.ie or Lo Call 1890 473 473.

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AFTER THE BIRTH

CH A P T E R

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LIFE WITH BABY

6 LIFE WITH BABY You’re over the first few weeks and settling into parenthood – what does the next six months bring? This is your guide to making the most out of parenthood over the next few months, as well as some valuable tips on getting your baby into a good sleeping routine and how to adjust your lifestyle to suit a family.

THE FIRST 6 months

ongratulations! Your precious bundle has arrived, and you’re about to embark on the most exciting journey of your life. Over the coming months you’ll see your baby develop and grow into a sturdy little person with a personality all of his or her own – in fact, your baby may even be preparing to move around unaided! This might be hard to imagine when you’re holding a tiny, slippery newborn in a hospital! All babies develop at different rates, and it’s important to remember that development is not a race. There are certain milestones that a baby will reach over the coming months – some will reach them more quickly than others. In particular, premature babies may reach their milestones closer to their adjusted age (the age they would be if they were born on their due date), or even later. Our month-to-month guide is simply an indication of what to expect. Your public health nurse will be able to help you gauge your individual baby’s development.

AFTER THE BIRTH

MONTH ONE It’s quite normal for a newborn to sleep most of the day, waking only for feeds. As your baby grows, you may find that your baby is more likely to wake for longer during the night. Again, this is normal, but your baby will settle into a proper routine before too long. The key is to be patient and to sleep when the baby sleeps. At birth, your baby can see objects close up – especially your face – and will shortly learn to recognize your smell. A gentle touch and soothing voice will help calm your baby, and you will see your baby react to bright light and noises.

MONTH TWO By the time your baby has reached its one month birthday, you might notice that he or she is more active and alert and is sleeping a little less. Your baby’s routine might feel exhausting at the moment, but remember that this won’t last forever. Over the course of the coming weeks, your baby will grow and develop and may even start stretching sleep time during the night. At this stage, your baby will be able to lift his or her head when lying on the stomach. Short and frequent bursts of tummy time are important to encourage this development. You may even hear sounds from your baby other than crying, such as cooing. And this month you may even be rewarded for all your hard work by a smile!

YOUR BABY’S

weight

One of the biggest issues during the first few weeks is your baby’s weight. It is normal for your baby’s weight to drop up to 10 per cent over the first couple of days after birth, often while you are still in hospital. Your baby’s weight will be monitored by both your doctor and your public health nurse in your regular checkups, but you can help by noting down feeds and keep an eye on your baby’s nappies – regular wet and dirty nappies mean your baby is feeding well and thriving.

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MONTH THREE

MONTH FOUR Congratulations – you’ve made it through the first three months! Many babies start to really settle down after three months, which may even mean something resembling a full night’s sleep for you – although this might be hugely different to your definition of a full night’s sleep before baby! Parents of colicky babies will also find that the symptoms are thankfully beginning to ease. Your baby is becoming more alert and sociable, and happy to smile and coo at anyone in vision. His or her head is becoming more sturdy, and by the end of this month, your baby may be able to hold its head steady when upright. Your baby may even be able to reach for and grasp a rattle.

ESTABLISHING ROUTINE

GROWTH

spurts By the end of the first month, you may feel as though you’ve got the hang of feeding, and your baby has settled into a routine – but suddenly baby wants to be fed all day long! This is a growth spurt, and will pass within a few days to a week. Babies hit their growth spurts at different times, but generally there is one between six and eight weeks, then at three months, six months and nine months. You may find that after a growth spurt your newborn baby doesn’t feel so newborn after all, and may even be bursting out of his or her clothes!

MONTH FIVE

MONTH SIX

This is really a lovely time for you and your baby. Every day your baby is discovering more about her world, and is happy to share all the new discoveries with his or her favourite person – you. Baby’s attention span is getting better too, and something as simple as a rattle or a toy (or even hands!) can captivate. You may find that your baby is putting toys and rattles into his or her mouth, so be careful to keep small objects out of reach. Your baby is getting stronger by the day, and should be able to support his or her own head when upright. When put on the tummy, your baby should be able to start pushing up on his or her arms – this may happen later, depending on the amount of tummy time the baby gets. Watch out too – the first sign of mobility is your baby being able to roll over, and this will come any time from the end of this month onwards.

Your baby is developing his or her own personality, and is becoming even more sociable. But be aware that some babies may develop anxiety around strangers at this stage. This is nothing to be alarmed about, and will pass in time. At home, games like peekaboo or a toy that makes noise can provide endless delight, as can exploration, such as pulling your hair and taking your glasses. Your baby is also becoming more vocal – encourage this by talking to your baby and answering his or her coos and babble. By the end of this month, your baby will be able to keep his or her head level when pulled to sitting. He or she will also be able to make vowel-like sounds and gurgle. Some babies may even be able to sit without support and bear weight on his or her legs when held upright. This can be encouraged by standing your baby on your lap as a game – just remember that your baby will tire easily, so keep sessions short.

The first few weeks may feel like your baby will never settle into a routine. But following a simple routine such as eat/change/play/sleep can help in the early days, and noting down when your baby wants to eat and sleep can aid you in understanding your baby’s natural routine. Then, establishing a simple bedtime ritual will help your baby distinguish between day and night. Regular events like a walk in the afternoon, or tummy time on the playmat can help too. For more, see p138.

AFTER THE BIRTH

Your baby is getting increasingly active, and expanding his or her horizons beyond eating, sleeping and crying. Hopefully during this month your baby will show signs of staying alert for longer during the day and playing – which should eventually lead to longer sleeping times at night. You may feel that you can interact more with your baby too, as smiles, coos and eye contact become more plentiful. This month your baby is showing more signs of being able to control his or her head. When on his or her tummy, your baby will be able to lift its head a little higher, and may even be showing signs of pushing the chest off the ground. Your baby may be showing more smiles and interacting with you during playtime and changing time.

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STARTING SOLIDS BABY’S

eye colour While African, African-American, Hispanic and Asian babies are generally born with brown eyes that stay brown, Caucasian babies are born with dark blue or grey eyes that may change several times before their first birthday. The final colour depends on the amount of melanin in the baby’s irises, which is dictated by genes. The more melanin in the irises, the darker the eyes will be. When your baby is born, the natural light kickstarts the melanin process in its eyes, which leads to the colour changes – this is the same process that turns your skin brown when you go into the sun. Most babies’ eye colours are established by the time they’re a year old, but some continue changing until they are three, and a few even into adulthood!

Your baby will start to show signs that he or she needs more than milk feeds soon, such as looking for more feeds or waking up more frequently at night. Solids are not recommended before your baby is four months old, or 17 weeks, but you should start sometime before your baby turns six months old. Some mothers find it easier to start introducing solids slowly from about five months, but every baby is different. Your public health nurse can guide you on when is the right time for weaning. For more, see p106.

When will my

AFTER THE BIRTH

baby crawl Babies generally learn to crawl anytime after seven months, but usually around nine months to a year. Crawling follows shortly after your baby is able to sit up unaided. However, because babies are now encouraged to sleep on their backs to help prevent Sudden Infant Death Syndrome (SIDS), some babies skip crawling altogether, and go straight to standing and cruising (holding on to furniture as they move around). Others “bum shuffle” – move around on their bottoms. Crawling is encouraged as it helps to develop coordination between the right and the left sides of the body, but if your baby has skipped crawling and is learning to coordinate both sides of the body, there is nothing to worry about. Consult your doctor of public health nurse if you are worried. To encourage crawling, get your baby used to tummy time from as early an age as possible. This will help develop the muscles needed for crawling. As your child gets older, try putting toys and other desirable objects slightly out of his or her reach, to encourage your baby to move forward and reach out. Rolling a towel under his or her chest will allow your baby look up and explore his or her surroundings. Get down in front of your child and encourage him or her to move towards you.

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ESTABLISHING

a sleep routine

chieving and maintaining sleep for some babies is effortless and for others it may be more of a challenge. But it is possible, within the first six months of your baby’s life to attempt to lay a healthy foundation for sleep – here are some recommendations on a month by month basis:

AFTER THE BIRTH

MONTH ONE Understand that your baby’s sleep is not organised for the first three months or so. Their sleeping habits are routinely structured around their feeds, with a need to feed every 1-3 hours and a need to sleep every 1-2 hours of being awake. Learning to read your baby’s cues for food and sleep can be a very positive step towards a healthy sleep structure. Try to see if you can identify the difference between a hunger cry and a tired one. Within this, see if you can establish a getting tired cue vs an overtired

signal: getting tired will typically be represented by a brief eye rub or yawn, snuggling into you or away from others, a momentary decrease in activity-staring into space or zoning out. If you can help your baby fall asleep around this time, you will be starting to meet their sleep need at the right time for their body, which can prevent an overtired presentation.

MONTH TWO You will notice that you baby is more awake now. They are starting to produce the sleep hormone melatonin and differentiating between night and day. Help this along by exposing your baby to bright and natural light when they are awake and dimming the environment when it is time to sleep. If you are struggling to find a balance between feeds and sleeps, try to start the day with a feed no later than 7.30am. Most babies in this

age range can only stay awake for small segments of time. Observe a very small wakeful period first thing in the day of probably no more than 1.25-1.5 hours before the first nap. This wakeful period increases slightly to two hours throughout the day.

MONTH THREE Your baby is becoming more alert; they can respond to a social cue and hopefully smile back at you when prompted. Night time sleep has some potential to start getting longer. Don’t worry if your baby is still feeding frequently overnight, that is still to be expected. Bedtime may also still be quite late. This month presents a perfect opportunity to help your baby start to be less dependent on you when they are going to sleep. Many sleep issues that occur in later months, can be avoided by some adjustments now. Around 10-12 weeks of age, if you haven’t already, try to help your

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MONTH FOUR This is a good time to have a formal feeding and sleep balance to the day. Observe a regular wake time with a feed no later than 7.30am. Many young children now will be able to stay awake up to two hours from morning wake time and that may lengthen to 2.5 hours as the day unfolds. Another significant change here is that bedtime will have become much earlier, with most young children ideally in bed asleep somewhere between 6pm and 8pm. Potentially, longer stretches of night sleep are possible, especially if you have been successfully encouraging a larger percentage of wakefulness at bedtime. Establishing a formal bedtime routine for both bed and naptime is a great plan now. Factor in quiet one 20-30 minutes before bedtime and an abbreviated version for daytime sleep. Use this time to help prepare, relax and unwind your child for sleep. Do this in a dim bedroom and make sure they are doing some of the sleep work for themselves once in the cot.

FIVE MONTHS You child’s sleep is more defined at this age range. You may still have night time feeds, but you may observe longer stretches of consolidated sleep at night time. Now you may want to address day time sleep. Your baby will possibly require 3-4 day time sleeps totalling 3-4 hours. Consider phasing out motion sleep for nap 1 and nap 2 at this stage and relying on sleep on the go only for the later part of the day.

SIX MONTHS At this age, although many children will still require night feeds, the end is in sight. The possible introduction of solid food can help. Hopefully you will have a regular wake time from 6am and no later than 7.30am. Three naps, totally 3.5 hours, with two naps in the cot and the third in the car or the buggy. An age-appropriate bedtime no later than 8pm, maintaining wakefulness no more than 2.5 hours from the final nap. Stick to a comprehensive bedtime routine in the bedroom. If you feel that you are still very much involved in the getting to sleep part, then you can work on paring that intervention back further by making sure your baby’s skillset and the timetable for sleep are correct. Together, these components start to create the right combination for sleep that helps to underpin the sleep foundation that you have laid since birth Lucy Wolfe, CGSC, MAPSC, is a paediatric sleep consultant and mum of four young children. She runs a private sleep consulting practice with her 98% effective method for sleep. See www. sleepmatters.ie, t: 087 2683584 or e: lucy@sleepmatters.ie

KEY INFORMATION

for safe sleep In Ireland, Sudden Infant Death Syndrome (also known as SIDS, or cot death) is the leading cause of death in babies aged four weeks to one year. It isn’t common (less than one in every thousand babies die from SIDS every year), and there are measures you can take to minimise risk. ● For safety when sleeping:

• Place your baby on their back to sleep, with their feet to the foot of the cot. • Always keep your baby in a smokefree zone. • Keep your baby’s head uncovered when they sleep and don’t let them get too hot. • Never fall asleep with your baby on an armchair or sofa.

● Never let your baby sleep in your

bed if anyone else in the bed: • Is a smoker. • Has drunk alcohol or taken drugs. • Is excessively tired or has taken medication that makes them sleep more heavily.

● The safest place for your baby to

sleep in the first six months is in a cot in your room. If your baby is unwell, seek medical advice immediately.

“

“I found it really beneficial to keep the bedroom for night-time sleep. I used her pram for daytime naps, and kept her crib for the night, just to try and establish a difference between night and day from the start.” Lesley, Drogheda

AFTER THE BIRTH

baby finish off going to sleep by themselves. If your baby is 100% asleep in arms on a feed when you are putting them into the cot at bedtime, over a few days, help them be slightly more awake – start with 1% less asleep and work your way back so that over a few weeks your baby is maybe 70% asleep with help from you and finishing the last part for himself. Comfort and support your baby if they protest at this adjustment. If they are very upset then, forget about it for a while a try again in a few weeks’ time.

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BABY

teething

AFTER THE BIRTH

our baby’s first tooth appears anything between three and 12 months, with the seventh month being average. Some babies can produce teeth even earlier than this, and it’s not unheard of for a baby to be born with a tooth. Even before the first tooth has appeared, however, teething can begin weeks and even months before the first tooth arrives – look out for these first signs of teething: ● Drooling – Excess saliva is a classic sign of teething. Use a bib and wipe baby’s chin frequently. ● Chewing – nipping at your finger or chewing on a toy or a spoon helps to relieve the pressure on her gums. ● Crying – Your baby will cry when his or her gums are hurting. If your baby winces when you gently touch his or her gums, she may need some pain relief. Talk to your pharmacist or doctor for natural and medical forms of pain relief. ● Changes in routine – Changes such as not being interested in food or waking in the night can point to teething. However,

if these persist, talk to your doctor to rule out any illness. Teething discomfort can affect some babies more than others, and some teeth, like the back molars, can be more painful than others. Babies’ milk teeth generally arrive in a set pattern, although it’s not unusual for some teeth to appear slightly out of order. Below is the general order of the teeth, as outlined by the HSE: ● bottom front teeth (incisors) – these are the first to come through, at around 5-7 months ● top front teeth (incisors) – around 6-8 months ● top lateral incisors (either side of the top front teeth) – around 9-11 months ● bottom lateral incisors (either side of the bottom front teeth) – around 10-12 months ● canines (towards the back of the mouth) – around 16-20 months ● molars (back teeth) – around 12-16 months ● second molars – around 20-30 months

WHAT CAN

you do If your baby is showing signs of teething, there are a number of strategies and over-the-counter aids you can try. Don’t immediately reach for the pain relief; instead try the drug-free remedies first. ● Apply a little pressure to the sore gum with a clean finger – this often gives your baby a little relief. ● Something hard and cool to chew on, such as a teething ring kept in the fridge, can help. Don’t put it in the freezer, however, as extreme cold can make the pain worse. ● If your baby is eating solids, chewing on something hard and cold, such as a piece of peeled cucumber or carrot, for example, can offer some relief. Make sure to continually supervise your baby if you try this, as a piece that breaks off could be a choking hazard. ● There are a number of over-thecounter remedies, such as Teetha granules and teething gel, that can be used. Talk to your pharmacist about these and make sure your baby is old enough to try them. ● If all else fails, and your baby seems in a lot of pain, an over-the-counter pain reliever like Nurofen for Children or Calpol can be used. Always follow the instructions closely.

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FEEDING issues

hatever way you choose to feed your baby, be it bottle or breast, some complications may arise. More often than not any of these issues can be easily overcome; however, they can be distressing for both parents and the baby. Discomfort caused by gas is common and normal after feeding in the early months. Here we describe eight common concerns that parents may encounter when feeding their infant.

AFTER THE BIRTH

POSSETING Posseting and regurgitation are terms given to the milk a baby brings up after feeding. Although a little posseting is natural, if it happens regularly – more than four times a day – and your baby brings up more than just a little bit of feed, there may be a chance that your baby has reflux. If you suspect your baby is posseting too much, you should speak to your doctor or public health nurse.

VOMITING Vomiting is when your baby brings their entire feed back up. Vomiting usually happens a little longer after a feed than posseting and is a more forceful action with a larger volume and can smell unpleasant. Professor Eleanor Molloy is a consultant neonatologist at the National Maternity Hospital in Dublin. “You should contact your doctor if your baby is vomiting regularly, if it’s a large amount, if it’s green coloured or contains blood,” she says.

CONSTIPATION There is no “normal” when it comes to a baby’s bowel movements. If you’re concerned that your baby may be constipated, there are a couple of things to look for. Less frequent bowel movements than normal, obviously uncomfortable movements and hard, dry stools that are difficult to pass may be indicators of constipation. Prof. Molloy suggests giving the baby some sugar water or

even prune juice to increase intestinal movement and relieve constipation.

FAILURE TO THRIVE Most newborn babies lose a little weight straight after birth. It is considered normal for a baby to lose up to 10 per cent of their body weight, but they should soon begin to put weight on if they are feeding correctly. There’s also no ideal amount or rate at which they should gain weight due to the fact that all babies are different. However, a very low rate of weight gain may need to be investigated. If you have any worries, get your baby weighed regularly and your public health nurse will let you know if there’s any cause for concern.

BABY FEEDING CONSTANTLY A baby that wants to feed more than usual or for longer may be going through a growth spurt. Common times for growth spurts are around nine days, two-three weeks, four-

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WHEN SHOULD I TAKE

my baby to see a doctor

Bringing up milk or occasional vomiting after feeds is nothing to worry about. Immediate medical attention is required if you see: ● Green vomit ● Vomit containing blood ● Stools containing blood ● Baby is lethargic and uninterested in feeding

six weeks, three months, four months, six months and nine months. They usually last for two to three days at a time. During a growth spurt, breastfed babies nurse more often than usual, called cluster feeding. Cluster feeding usually happens in the evenings, but can occur any time during the day or in the middle of the night. Cluster feeding at night can become very tiresome but it’s perfectly normal. Cluster feedings do not mean that you have a low milk supply. Supplementing your baby with formula at this time will cause your body to produce less milk. Continuing with the cluster feeding will make sure your body is producing the right amount of milk for your baby. If your baby is formula fed, you may find he’s looking for a little more formula at the end of each feed during growth spurts. It can be tempting to start solids at an earlier age than recommended when a baby appears to be constantly hungry. However, this rarely helps and if solids are given too early it can create additional problems.

A baby’s digestive system is immature so posseting (a little spit-up) after a feed is normal, and eventually they outgrow it. Reflux occurs when the swallowed milk comes back up into the oesophagus or mouth and causes distress and irritation. Babies have a ring of muscle where the oesophagus joins the stomach. This muscular valve opens to let through milk the baby has swallowed, and closes to keep milk in the stomach. Babies usually get reflux because the ring of muscle hasn’t developed fully yet so milk and stomach acid can come back up the oesophagus, causing discomfort akin to heartburn in adults. Prof. Molloy explains that reflux is difficult to diagnose in newborns. It usually presents itself from about three weeks of age onwards. If you suspect your baby suffers from reflux she advises bringing the baby to the GP where an antacid may be suggested. Often babies with suspected reflux are treated with antacids and if their condition improves after a week the treatment is continued until they start solids or the stomach muscles strengthen.

LACTOSE INTOLERANCE Some newborns can have a mild lactose intolerance. The symptoms of this would be 5-10 episodes of diarrhoea in a day often accompanied by a nappy rash. Prof. Molloy recommends trying simeticone such as Infacol for a few days to see if this helps before trying a lactose-free formula or in the case of breastfeeding, altering the mother’s diet.

COLIC Colic is a term used to describe uncontrollable crying in an otherwise healthy baby often at the same time of day, frequently in the late afternoon or evening. It usually appears when the baby is two or three weeks old. It is defined as a baby younger than

five months old who cries for more than three hours in a row on three or more days a week for at least three weeks. Colic won’t cause your baby any long-term harm, but it’s a tough thing to go through for both babies and their parents. If your baby has colic, the abdomen may look enlarged. You may notice that they alternately extend or pull up their legs and pass gas as they cry. It is important to bring a baby with suspected colic to the GP to check for any other medical reason for the crying. Colic tends to peak around six weeks, then improves significantly between months three and four. By five months it has generally resolved itself. In the meantime, comfort your baby as best you can and ask for help when you need it, as caring for a colicky baby can be very stressful. Colic is one of the great mysteries of baby life and there is not much scientific proof on what is effective in its treatment. Some experts believe that long bouts of colicky crying are a physical release for overstimulated babies. Prof. Molloy wonders if colic might be another way of describing reflux. It is a good idea to talk with your doctor about any feeding issues that arise, if only to rule out other causes and help determine the best course of action for your baby. And remember each baby is different, so listen to your baby’s needs and feed them accordingly.

SYMPTOMS

of reflux ● Frequent posseting ● Happier when upright ● Refusing to feed or

difficulty feeding ● Apparent abdominal pain

AFTER THE BIRTH

REFLUX

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WEANING

your baby

AFTER THE BIRTH

t is recommended that you start weaning when your baby reaches six months old if breastfed, and between four and six months if formula fed. Your public health nurse will be able to advise on the best time for your baby. Don’t attempt to wean until your baby is at least 17 weeks old, as weaning too early puts the baby at risk of developing allergies. First foods should be bland and runny in consistency. Ideal first foods include baby rice (mixed with breastmilk or formula), root vegetables like carrot and non-acidic fruit like stwed pear. Your baby will only take a spoon or two at first, but you can gradually build this up as your baby begins to get used to eating from a spoon. Remember you can mix your baby’s usual milk with any puree to make it more palatable.

TRY THESE TOP TIPS TO GET YOU STARTED COURTESY OF WWW.SAFEFOOD.EU: ● A gentle start! If you can, pick a time when both you and your baby are relaxed to first introduce them to the spoon. ● One at a time. Introduce one food at a time. Allow your baby to get used to this food before starting another. ● Keep it clean. Anything you use to feed your baby needs to be kept very clean ● Test it yourself. When you’re feeding your baby a warm meal, heat it thoroughly, let it cool, stir it well and then test it yourself before giving it to them. ● Pace it. It takes time for your baby to learn how to move food around

their mouth and swallow it, so try not to rush them. Let your baby set the pace. ● Try not to force-feed. Most babies know when they’ve had enough to eat. If you spend too much time persuading your baby to eat, they may start to refuse food as a way of getting attention. ● Let your baby help! At some point, your child will show an interest in feeding him or herself. While it’s a messy business, this is something to be encouraged! Allow your baby to hold one spoon, while you try to spoon in most of their meal with another spoon. ● Be safe. Make sure that an adult is always with your baby when they’re eating. This is to give them encouragement, but more importantly to make sure they don’t choke.

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FOODS

to avoid

● Raw eggs: There is a risk to baby of food poisoning from raw or partly cooked eggs. Cook them until both the yolk and the white of the egg are solid.

● Whole or chopped nuts: Nuts carry a risk of choking for children under five. Crushed or flaked nuts are okay. ● Shark, Swordfish and Marlin: These fish contain levels of mercury that are unsuitable for babies and toddlers. ● Honey should never be given to babies under one year, as there is a risk of botulism poisoning. ● Added sugar: A baby does not need sugar added to food. It will only give baby a taste for sweet

● Cook it yourself. Give your baby food you’ve prepared yourself as often as you can. It’s cheaper than buying jars of baby food and it means your baby will get used to eating like the rest of the family. Don’t add any salt (or sauces containing salt) to food your baby will be eating. ● Ice-cube trays. Prepare a family meal that’s suitable for baby too (remember not to add any salt). Freeze small portions of the meal in an ice-cube tray for later. Tip: Silicone trays are great as the frozen cubes pop out very easily. The cubes can be then stored in a labelled freezer bag. ● Safe re-heating. If feeding baby food that has been stored frozen, it must be heated to piping hot to kill all bugs and then allowed cool to before giving to baby. ● When you feed your baby re-heated food, make sure to throw out any leftovers - it’s not safe to reheat foods more than once. ● Variety is the spice of life. Over time, offer your baby a wide range of foods that you and your family normally eat. This can help to avoid fussiness later on.

things and could damage new little teeth. ● Sugary drinks or fruit juice: The best drinks for babies are milk either breast or formula and water. ● Salt should never be added to baby’s food: Having too much salt can be bad for baby’s kidneys. ● Gluten: If baby is weaned before six months, foods containing gluten should be avoided. Gluten is found in foods such as wheat, oats. Baby rice, fruit and vegetables are gluten free.

Recipes TO

try

BAKED SWEET POTATO PURÉE

Preheat oven to 180°C. Scrub and prick your sweet potato all over with a fork. Bake for about 45 minutes until the inside is soft. Cut open and scoop out the flesh. Use a food processor to purée until smooth, adding a little baby milk or cooled boiled water if needed to make a smooth purée. This recipe is perfect for first tastes and can be frozen in individual weaning pots.

APPLE PURÉE

Choose a sweet apple like Pink Lady. Peel, core and chop two apples and place them in a small saucepan. Cover the apple with a little water. Cook on a low heat for about eight minutes until very tender. Remove any excess water and purée in a food processor or with a hand blender. This recipe can also be frozen in individual weaning pots.

AFTER THE BIRTH

● Regular cow’s milk is not suitable as a main drink for your baby until baby is one year old. Cow’s milk can, however, be added to foods to soften them (e.g. mashed potato or cereal) from six months onwards. Breastmilk or formula milk can also be added to foods to soften them.

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BABY

first aid

sick baby is always scary, and we would recommend that if ever you’re worried about your child’s health that you visit the doctor. In an emergency situation, however, you may have to perform first aid yourself before medical back-up arrives. A first-aid course is essential for every parent – in fact, everybody – as it will give you confidence that you will know what to do in case of emergency.

AFTER THE BIRTH

BURNS Again, it can happen so easily – a bad burn from boiling water or accidentally touching a hot oven. Here’s what the Red Cross recommends: ● Cool minor burns under cold running water. ● Cover with clean cling film or a loose sterile (non-fluffy) bandage. ● Seek medical assistance if you are unsure of the severity of the burn.

BLEEDING

Every child falls and cuts herself at some stage, but what if it’s severe bleeding? Recommendations from the Red Cross: ● Blood loss should be treated as quickly as possible. ● Wear disposable gloves if available. If there is NOTHING embedded in the wound: ● Press on the wound with your hand over a clean pad. ● Secure with a bandage. ● Raise the wound above the level of the heart. ● Call for ambulance. If SOMETHING is embedded ● Do not press on the object. ● Instead, press either side of the object and build up padding around it before bandaging to avoid putting pressure on the object itself. ● Get the person to hospital as quickly as possible.

FIRST AID

essentials ● Paracetamol or ibroprofen (Calpol or Nuofen) for pain relief ● Bandages, including a roll of elastic wrap and plasters in assorted sizes ● Instant cold packs ● Disposable latex or synthetic gloves ● First-aid manual ● Sterile eyewash, such as a saline solution ● Triangular bandage ● Antibacterial ointment ● Home burns spray or gel.

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Irish Red Cross First Aid courses are run around Ireland each week. Prices start at s80 depending on course length and type. For more details call 1890 502 502 or visit www. redcross.ie

PERFROMING

CPR

Cardiopulmonary Resuscitation, or CPR as it is commonly known, is a life-saving technique to be used on someone who is showing no signs of life. Chest compressions and rescue breaths help to keep oxygen-rish blood circulating and therefore prevent death or brain damage until medical help arrives. How to perform CPR: ● STEP 1: Position the infant If there is bleeding, first get it under control and then place the infant on her back on a firm and flat surface. ● STEP 2: Open the airway Tilt the infant’s head back slightly and lift the chin. Check for breathing. If she is not breathing, give two small rescue breaths through the mouth, covering the nose. If the infant

FEBRILE CONVULSIONS is a baby, these breaths should only last about a second each. If the chest doesn’t rise, there is something caught in the airway, so follow the instructions for choking.

● STEP 3: Do 30 chest compressions Place the pads of two or three fingers just below an imaginary line linking the child’s muscles. Smoothly and firmly, press down about 1.5 inches, at a rate of about 100 a minute. ● STEP 4: Give two rescue breaths After the compressions, repeat two rescue breaths. ● Continue this routine of chest compressions and rescue breaths until help arrives.

Temperatures are common enough in small babies and toddlers, but as long as they respond to paracetamol, there is usually nothing to worry about. However, some babies and children can suffer from febrile convulsions, fits that occur with a high temperature. Although they are terrifying to watch, they are rarely harmful. A febrile convulsion usually lasts for between 20 seconds and two minutes. If your baby suffers from a brief febrile convulsion, take her to a doctor or a hospital to be checked over and to confirm the cause of the fit. If the fit lasts for more than three minutes, call for an ambulance. If your baby has a brief febrile convulsion for the first time, take her to the accident and emergency department of your local hospital. A doctor can check her and help to confirm the cause of her fit. While your baby is having a febrile convulsion, loosen any tight clothing and remove anything that is in her mouth, such as a soother. Try not to restrain her in any way.

choking

It’s every parent’s nightmare – your baby is choking on a piece of food or worse, a toy that she has swallowed. Follow this advice from the Red Cross: ● If an infant is unable to breathe, cough or cry and you suspect they have a severe obstruction in their throat: Lay them face down on your forearm, with head low and supporting the body and head. ● Give up to five back blows between the shoulder blades with the heel of your hand.

● If the obstruction is still present, turn the infant around give up to five chest thrusts, with two fingers in the middle of the chest. ● Continue this cycle of five back blows and five chest thrusts and if the obstruction still doesn’t clear, call an ambulance – but don’t leave the infant unattended. ● Continue the sequence until help arrives. ● Anyone who has been treated for choking in this way should be advised to see their doctor after the incident.

AFTER THE BIRTH

INFANT

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MENINGITIS

what you need to know

eningitis is caused by an inflammation of the lining around the spinal cord and the brain that can be caused by both bacteria and viruses. Bacterial meningitis is quite uncommon, but is very serious and requires urgent medical attention and an intense course of antibiotics. Viral meningitis is a less serious version of the condition, but cannot be helped by antibiotics. The symptoms of bacterial and viral meningitis are very similar, so to determine between the two, hospital tests are required. A condition closely related to bacterial meningitis is septicaemia, which is a type of blood poisoning. The same bacteria that causes bacterial meningitis causes septicaemia, which sees the break down of blood vessels under the skin, and is characterised by rashes of purple bruises and blood spots on the skin.

AFTER THE BIRTH

WHAT ARE THE SYMPTOMS OF MENINGITIS? If a person begins to show symptoms of meningitis, they will become very ill quickly, and will require urgent medical attention. However, be aware that they may not show all of the symptoms below at once, but will still require attention. The symptoms of meningitis in children are fever, with possibly cold hands or feet, refusing feeds or vomiting, highpitched moaning, crying or whimpering, dislike of being held, neck retraction

paired with arching of the back, a blank and staring expression, the child is difficult to wake and they have a pale or blotchy appearance. A rash may also occur with some forms of meningitis. You can test whether a rash is caused by meningitis by doing the Tumbler Test. If a glass tumbler is pressed firmly against a rash and the marks will not fade, seek medical attention immediately. Time is everything when it comes to meningitis, so itâ&#x20AC;&#x2122;s important that if your child has any of these symptoms and you suspect meningitis that you seek medical help immediately.

HOW DO YOU CONTRACT MENINGITIS? At any time, a number of people in a population could be carrying the bacteria that causes bacterial meningitis or septicaemia. Many people would carry the bacteria in the back of the nose or the throat, without any adverse affects for the carrier. However, some people's immune system may not be able to ward off the bacteria and they pass through the lining of the nose and throat and into the blood stream. Viral meningitis is caused by groups of viruses, which includes the mumps virus. Babies and toddlers are at a heightened risk of developing meningitis as their immune systems are not yet fully developed.

HOW CAN YOU PREVENT IT? There is currently no vaccine that can protect you from all forms of meningitis, but vaccines exist that can protect again some strains. The pneumococcal meningiti A vaccine is available to protect against Group C Meningococcal Disease. This vaccine is included in the Primary Childhood Immunisation Programme and is offered to all infants. The vaccine is available free of charge to all up to the age of 23 years of age.

WHAT ARE THE AFTER-EFFECTS OF CONTRACTING MENINGITIS? Recovering from meningitis can be a long and arduous process. Fortunately, however, many of the after-effects improve and disappear over time. Some after-effects include memory loss, lack of concentration, clumsiness, residual headaches, deafness, learning difficulties, epilepsy, weakness, speech problems or changes in sight. Most people recover with no after-effects and the likelihood of developing permanent aftereffects depends on the type and severity of the illness. ACT for Meningitis is an Irish charity that offers a range of free support services to those affected by meningitis. For more information, log on to www. actformeningitis.ie. More information abour meningitis is also available from the Meningitis Research Foundation. Log on to www.meningitis.org or call 1800 41 33 44.

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CRANIAL

osteopathy

STRUCTURAL STRAINS In pregnancy, when the baby has been pressed against part of the mother’s anatomy for long period of time the baby can mould to the structures around it. During birth, the baby’s ribcage twists and turns under compression and the soft bones of the skull bend, overlap and mould to help it pass through the birth canal. Babies born by emergency caesarean section are vulnerable to the same pressures of the uterus in the last few weeks of pregnancy and may have been stuck in the birth canal for some time, while babies born by elective caesarean section are not exposed to the pumping action of contractions and tend to lack movement in their diaphragm and drainage from their head. Due to these influences, many babies are born with misshapen heads that gradually unmould in the first few days of life, and it may or may not be visible if this unmoulding process is complete. Treatment is tailored to each individual baby as every baby is different; below are descriptions of the most common findings for each condition.

COLIC/WIND Common osteopathic findings of babies with colic are tensions in the diaphragm, compression of the cranial nerves that supply the stomach and contraction in the muscular walls of the gut. Parents report less crying, increased ability to bring up wind and a significant improvement in hours of restful sleep after osteopathic treatment. REFLUX/SILENT REFLUX Osteopathic treatment uses gentle techniques to release any distortions in the diaphragm and ribs aiming to improve the function of this valve and help to resolve reflux. Parents report babies appear more comfortable and spit up less after osteopathic treatment. FEEDING DIFFICULTIES An insufficient latch may be due to mechanical stresses through the head, face and throat, and the nerves to the tongue may also be irritated as they exit the skull making sucking more difficult. Breastfeeding mothers have reported a change in their baby’s latch after they have received osteopathic treatment. SLEEP PROBLEMS Disruption in a baby’s sleep patterns may be caused by mechanical strains in the head or chest. Often it’s necessary to release these structural strains before parents can establish a routine. Parents often report immediate improvement to sleep quality and quantity after osteopathic treatment. STICKY EYE/BLOCKED TEAR DUCT Persistent sticky eyes may mean there is insufficient drainage from the head and face. In most cases parents report a complete recovery after just one

treatment even for babies up to three months old who have had it since birth. INFECTIONS Osteopaths work to help babies and children who have recurrent ear, eye, sinus, chest, and throat infections to improve blood supply to the affected area and drainage away from it. The lymphatic system is also worked on to boost immunity. TORTICOLLIS Torticollis can sometimes be accompanied by an asymmetrical head. It is important for babies to receive both physiotherapy and osteopathy as physiotherapy will give exercises and practical advice on how to encourage your baby to look the other way, and osteopathy uses gentle techniques to release and balance asymmetries in your baby’s head and neck in order to make these exercises more achievable.

Further Information For more information on conditions go to www. osteopathic-care.ie, for a full list of qualified osteopaths please refer to the website of the Osteopathic Council of Ireland www.osteopathy.ie Claire Padgham B.Ost.Med. DO.ND trained in the UK and she is registered with the Osteopathic Council of Ireland. She has trained in Paediatric and Obstetric Osteopathy and now practices in Bishopstown, Cork. For further information please call 021 434 5955 or visit www. osteopathic-care.ie

AFTER THE BIRTH

Cranial osteopathy is a gentle, safe and effective treatment for pregnant women, babies and children, which works by holding structural strains in a position of ease and waiting for them to release themselves. Osteopaths are highly skilled in identifying and releasing even the most subtle imbalances in the body. Despite the term cranial, cranial osteopathic techniques are applied to all parts of the body.

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ANTENATAL CLASSES

WE DON’T WANT TO SAVE CHILDREN’S LIVES

Are you a busy mummy-to-be? No time for lengthy classes at hospital? Looking for accurate and updated information?

HAVE YOUR OWN CUSTOM MADE CLASS: • Choose what topics concern you most (pain relief, labour positions, breastfeeding, etc.) • Choose a day and time of your convenience. • Get all the information you need in the comfort of your home. • Call, text or email anytime for advice and support up to 6 weeks after baby is born.

Children’s lives shouldn’t need saving from entirely preventable causes. UNICEF wants you to help prevent needless deaths.We believe that one child dying is one too many. We believe in zero and we desperately need your help.

• Baby Massage Classes also available.

Call 01 878 3000 or visit unicef.ie today to give your support.

Services provided by Qualified Registered Midwife Anabela Almelda

Believe in zero.

www.supermummy.ie • 087 393 4195

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FUN

with baby

GET DANCING! You may have noticed that your baby is soothed when you walk

around with her in your arms. Try turning the walk into a gentle waltzstyle dance, complete with slow twirls and turns. Your baby will love the movement and the fun of the activity. Just make sure to keep your baby’s back and head well supported throughout, and avoid any jerking or shaking movements. Your baby will also enjoy watching you dance, especially exaggerated movements with your arms or body!

RHYMES AND STORIES Even though your baby might seem too young for stories, nursery rhymes and brightly coloured pictures will engage them from a very early age. Go for baby books in bright primary colours, and point out the objects in the pictures. Soft cloth books are great for baby to grab and to play with by herself.

SHOW AND TELL Your baby will find all sorts of objects fascinating, from an empty plastic bottle to a kitchen utensil. Introduce your baby to different objects and let

her touch and feel them. Just make sure the object is non-harmful for your baby.

MAKING THE MOST OF

your maternity leave Maternity leave can be a bit lonely for a new mum, but there are usually plenty of resources out there to help. Details of breastfeeding or mum and baby groups in your area are available from your public health nurse. Try to get out and about as much as you can, even if it takes you a long time to get out the door. Exercise will help both you and your baby. Look at www.activemum.ie and www.meetmums.ie for details of groups and classes in Ireland.

AFTER THE BIRTH

hen your baby first comes home, it seems like all they do is eat, sleep and cry. But your new baby is taking in all her surroundings and learning literally by the minute. As the weeks move on, she will become more and more alert, and receptive to simple games and playtime. It’s important to take time during the day to play with your baby, as it’s the best way to bond and help with her development at the same time. Your baby may be young, but her senses are developing fast. When playing with your baby, make sure to appeal to all the senses (apart from taste) – touch, sight, hearing and smell. Remember that she is familiar with your face, voice and smell, and will respond and enjoy any activities with you. Try these ideas to inject some fun into your day.

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SING LIKE YOU’RE WINNING You are your baby’s world right now and everything you do is fascinating and amazing. Even if you haven’t a note in your head, try singing to your baby. Children’s favourites like Old Macdonald and How Much Is That Doggy in the Window are always good, as are songs with actions, like Twinkle Twinkle or Head, Shoulders, Knees & Toes.

BABY

massage

TICKLE TIME Your baby loves your touch, and gently tickling her tummy will get a great reaction, especially as she gets older. Kisses and tickles are the quickest route to those beautiful first smiles.

KIDDIE GAMES Games like Itsy Bitsy Spider and This Little Piggy appeal to baby’s sense of hearing and touch. If you need reminding of the words and actions, do a search on the internet.

BATHTIME FUN Your baby’s bathtime is a great opportunity for play. Try showing her simple toys like a rubber duck or simply splashing the water gently on her tummy. Take a facecloth full of water and gently squeezing it up and down her arms and chest. Follow with a massage or a game like This Little Piggy, and plenty of tickles and kisses.

GET CREATIVE! Remember the senses when introducing your baby to new things. For instance, blowing bubbles can be the source of endless fascination for babies, as can examining something as simple as ribbon or a soft fabric. A soft squashy ball or object can provide lots of fun, especially if you show your baby everything that can be done with it – try juggling, rolling or bouncing the ball, as well as letting to touch and squeeze it.

AFTER THE BIRTH

PEEK-A-BOO! Never underestimate the enjoyment that a baby gets out of this age-old game. Hide behind a towel and peep out. Make different faces as you pop your head out. Pretend it’s baby who’s disappeared: “Where’s baby? There’s baby!” Hours of fun!

● Touch is one of the most important senses for a young baby, and offers one of the best early bonding experiences for you both. As well making your baby feel calm and secure, baby massage can have many positive health benefits for your baby, such as relieving colic and wind, enhancing sleep, relaxing baby, and building immunity. There is also evidence to suggest that baby massage may help in relieving postnatal depression in new mothers. ● To get started, choose a time when your baby is calm and relaxed. After bathtime and before her bedtime feed is ideal. Make sure the room is warm and your baby is comfortable. Have everything you need close to hand, such as a warm towel, clothes to dress your baby in afterwards, a clean nappy, a simple natural massage oil (good olive oil or grape seed oil is ideal), and some cotton wool to remove excess oil. Perform a patch test on your baby’s arm to check for any reactions first; use a lotion if there is a reaction to the oil.

● Talk to your baby throughout and ask her for permission before massaging. This is a good opportunity to raise awareness in your baby of the different parts of her body, by naming them and talking to her about them. Keep the session to about five minutes in total. Your strokes should be soft and smooth, concentrating on each area before moving into the next. Begin with your baby’s chest and tummy, moving up the chest to the shoulders in a heart shape. Gently massage the tummy with the flat of your hand in a clockwise direction. Move on to your baby’s arms and legs, gently rolling your hands down each limb, not forgetting the fingers and toes. Count your baby’s fingers and toes, or use the opportunity to play This Little Piggy. Finish by gently putting your baby on her tummy and giving her back a soft massage. ● Go to www. babymassageireland.com for a baby massage instructor in your area. There is a discount under some health insurance schemes for baby massage courses; check this with your insurer and your instructor before proceeding.

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Classes held across Ireland

Precious bonding time in a bubble of splashy fun! There’s nothing quite like the feel of your baby’s skin against your own. It’s one of the best things you can do to bond with your baby and being in cosy warm water enhances those cherished moments. Our world-class teachers could have trained as private pilots – five times over – in the time it takes to fully qualify with us. You can trust us to take the very best care of you and your little one.

To give your baby a splashing start visit

waterbabies.ie

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BABY

photography

e have never lived in a more photo-centric time. With the simple equipment and easy editing that is part and parcel of digital photography anyone can, and does, have a go! Every little thing has become the subject of day-to-day photography, and there is no ‘little thing’ more important than your child. So how best to go about photographing your bundle of joy, your toddler, your ever-growing family? We have compiled a few tips to make it easier to get that flawless family photo or that perfect picture of play:

AFTER THE BIRTH

KEEP IT SIMPLE When you’re taking a photo all you see is a perfect moment with your child. Yet, all too often, the end result is cluttered and completely misses the point. Try to use a neutral background, and a setting that gives your subject space to breathe. You want a photo of your child, right at this moment, but not necessarily the things that surround him or her. Make the photo more dynamic by positioning the main action a little off-centre.

USE LINES Use naturally occurring lines to attract attention to the main focus of your photo. A path or fence can draw the eye towards someone who otherwise might not have stood out so clearly. Look particularly for an ‘S curve’ – a winding path or wavelike shape. This is seen as a graceful line but still draws in the viewer forcefully. This can be particularly useful with smaller children.

LOOK FOR BALANCE Arrangement of colours and shapes and the play of light and dark across your photo can make all the difference between a generic shot and one you’ll want to keep forever. Try to find patterns or symmetry in the scene, and shoot that. If you want to take a picture of more than one person – maybe your whole family, or your children playing together – narrow the space between them. Too much of a gap can split attention and lead to a less warm and less loving end product.

PLAY WITH SHUTTER SPEED There are few moments more precious than watching your child

at play, but unfortunately activity often results in photos that are just one big blur. Experimenting with your camera’s shutter speed can bring definition to your pictures. Speeding up the shutter speed – from half a second to a tenth of a second, for example – will help to capture your child’s movement while still looking incredibly natural.

LIGHT! Light is perhaps the most important aspect of photography. Sometimes it’s better to take a quick shot rather than miss the moment entirely but, when you do have the time, feel free to plan the photo in advance and think about what time of day, or what position in a room, will give the best effect. The optimum time for photography is the ‘golden hour’ – right before sunset or right after sunrise. But make sure that the settings on your camera don’t take all of the warmth out of the evening rays. Tinker a little with settings before getting everyone together.

DON’T FORGET TO PRINT THEM! Jackie Farrell, Marketing Manager,

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LEAVING IT TO THE PROFESSIONALS If you’ve ever tried to take a family photograph with yourself in it you’ll know how hard it is to pose the family, press the button on the camera and try to dash back into place before the flash fires! A professional photographer has the right equipment and expertise for the job and is a qualified expert in lighting, posing and working with children. So you can relax and enjoy the experience! Pregnancy portraits capture a beautiful time in your life, the beginning of your baby’s story. The professional will help you look your absolute best by posing you in the most flattering way and using digital retouching where necessary. The latest trend in baby photography is having a portrait session within two weeks of birth. It is at this time that a qualified photographer can create beautiful portraits of your baby fast asleep, be it curled up in your arms or snug in a basket. Newborn safety is a professional’s number one priority, so be sure you select a photographer that is experienced in working with newborns. If you are not sure at which age to photograph your baby, why not look for a Baby’s First Year plan, which offers multiple sessions throughout the first year. You will be certain to capture all their gorgeous milestones. Finally, don’t let your children grow up without printed portraits! CDs are no replacement for an archival printed, mounted and framed fine art portrait. Experts are saying an entire generation will grow up with no pictures as CDs degrade and computers fail. Your professional portraits are priceless heirlooms that will be treasured for generations.

CHOOSING THE

right photographer Jules Furlong, a South Dublin photographer who specialises in maternity, newborn, child and wedding photography, gives us her top tips on finding the right photographer for you. One of the most important things when searching for your photographer is finding one whose style you absolutely love. When searching try narrow down your list to maybe five or less from those whose images you absolutely love and reflect the style you are looking for. ● Does the photographer have experience, were they referred to you, do they have great testimonials, what have their clients said? ● Don’t let your choice be dictated by the price. You want these portraits to adorn your home for a long time, make sure you love what they do! Price will always be a factor when choosing your photographer, but it should not be the most important part of your decision. You should expect to pay anything from €300 - €2000 plus depending on what type of session and product packages you decide to go for. ● If your search is for a newborn photographer, what are you looking for, lifestyle or posed, do you want your siblings or yourself and partner in the shots? Does your photographer have the experience and knowledge to safely photograph you baby? ● Think about the location for your session, for instance, if you are getting newborn portraits, would you prefer having it in your own home? This makes for a very peaceful and relaxing session for both baby and mum, remember, the sleepier the baby, the more poses and wider range of shots for the parents! ● Does the photographer take time to get to know you and your family on some level prior to your shoot? Do they listen to your likes or dislikes and understand what you are looking for? Will they go the extra mile to achieve it? ● Have a look through the photographer’s online portfolio and make sure that the style that you are seeing matches with the style that you are looking for. And is the work consistent? ● In this digital world we tend to have thousands of beautiful images saved on a disc in our top drawer, never to be seen again! Try to decide what you want from your session beforehand. Think about what kind of framed artwork you would like in your home. It’s a wonderful thing to have portraits from your newborn or child’s first years professionally framed and presented to you. You will have them to cherish for a very long time! ● Make sure you have a consultation with the photographer before the shoot, so they are clear about what you want and expect from the shoot. You should be confident that they can deliver. Last but not least, have fun, enjoy the experience, your children will too! Contact: www.julesmphotography.com

AFTER THE BIRTH

FUJIFILM Ireland, reminds you to print your photos. “Many parents spend endless moments taking photos of their newborn and then forget to print, time moves on and they lose the memory as it is locked away in a camera or worse still, the image gets lost on a computer.”

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PRINT OUT

those memories download the app from the Google Play store or the Apple Store for free. Once you have it installed, you can choose the photo product that you’d like to print or take it a step further and personalise – then simply upload the picture from your phone or tablet.” You can choose from a wide range of photo services: ● Photo Prints ● Photo Gifts (including mugs, mousemats, placemats, coasters, t-shirts, teddies and lots more!) ● Canvas Art (showcase your newborn as spectacular wall art!) ● Poster Prints

ADVERTISING FEATURE

s your phone full of photos? Print them and don’t risk losing them! Preparing for a new baby is such an exciting time in your life – perhaps it’s the start of your family or a new companion for young siblings. Either way, you will lose track of the amount of pictures you will have taken of your new bundle of joy. With so much going on it is easy to forget to print your precious memories, and some of the best and most beautiful moments in your life risk being lost. We’ve all lost phones or cameras or lost images on laptops – and with those lost items, we lose some fabulous never-to-bereplaced memories.

According to Jackie Farrell, Marketing Manager at FUJIFILM Ireland, 44% of the Irish Population surveyed have lost photos at some point, and 53% of those say they would definitely print again so as not to risk losing those precious memories. (Source Amarach Research). “FUJIFILM have the solution for the busy mum or mum to be. We can offer you lots of convenient options when it comes to your digital photos so they will remain safe with you forever. “In March 2015 we launched our new and very convenient photo printing App, FUJIFILM IMAGINE. It’s so simple to get started – all you need to do is

Payments are made through PayPal or via credit / debit card and once your order is ready you can have it sent by post to save you a trip or collect from your local FUJIFILM store. Try the FUJIFILM Imagine Mobile app today and turn those digital memories into something really special. Once you try it you will be amazed how easy it is to use!

DOWNLOAD THE FUJIFILM IMAGINE APP TODAY!

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GET YOUR SMARTPHONE BACK IN SHAPE!

INSTORE. ONLINE. MOBILE.

DOWNLOAD THE FUJIFILM IMAGINE APP TODAY! The Fujifilm Imagine App is designed to make it faster and easier to print your photos, put your photos onto gifts, canvas or posters on the go. You can choose to have them delivered or collect instore.

To use this simple, high speed app please follow these steps:

Download The FREE Fujifilm Imagine App from the App Store or Google Play.

Launch The Fujifilm Imagine Application.

Select the output you require Digital Prints, Gifts, Canvas or Posters

If you have chosen Digital Prints, select the size you require, open your album, select the photos you require, select quantities, add to cart and checkout.

If you have chosen Gifts, select the gift you require, open your album, select the photos you require, select quantities, add to cart and checkout.

If you have chosen Canvas, select what size you require, open your album, select the photos you require, select quantities, add to cart and checkout.

If you have chosen Posters, select what size you require, open your album, select the photos you require, select quantities, add to cart and checkout. Enjoy Printing! Imagine App or scan the relevant QR code .

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WORK

and children

AFTER THE BIRTH

reparing for your return to work after having a baby can be a stressful experience, but there are several ways in which you can minimise the upheaval. You need to give your employer at least four weeks’ notice of your intention to return to work. While that’s legally all you’re obliged to give, it’s a good idea to decide when you want to return and inform your employer as early as you can, as it gives both of you plenty of time to prepare. Leaving your baby with someone else is something most mothers find very difficult. It’s easy to blame yourself and feel guilty that you’re in some way letting down your baby or being a bad mother for working, either for financial or your own career reasons. If you’ve made the decision to return to work, take heart in realising that it’s the decision the mother of your baby (that’s you!) has made and that you know what’s best for your family. Plenty of women have made this decision and made it work for them. Just take it at

your own pace and if you feel you’re struggling, speak to your partner and family or chat with friends and see how they manage. If it’s possible financially, talk to your employer about the possibility of taking parental leave, cutting down your working week or even job-sharing.

CHOOSING YOUR CHILDCARE By law, pre-school childcare facilities must be notified to, and be inspected by the Health Service Executive (HSE). More detailed information about the regulation of childcare service is available from your Local Health Office. Your City/County Childcare Committee can provide a list of childcare providers in your area. They can also put you in touch with your local HSE pre-school officer.

TYPES OF CHILDCARE

FULL-DAY CARE: This is a structured care service for more than three and a half hours per day. Providers care for children from

three months to six years, depending on facilities and policies. Some may also include an after-school facility. In full-day care, sleeping arrangements and food preparation must meet standards laid down by the Health Service Executive. Providers include day nurseries and crèches. SESSIONAL SERVICES: These services offer a planned programme consisting of up to three-and-a-half hours per session (such as a morning or an afternoon). Generally, they cater for children between two and six years of age. These services may also be provided for younger children. In order to provide a sessional childcare service, a recognised childcare qualification is required. Sessional services include: Montessori groups: which focus on individualised education, teaching social skills and maximising children’s development. They cater to children up to the age of six. Parent and toddler groups: where

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CHILDMINDERS: Childminders care for children in the minder’s own home. A childminder can care for up to five children under six years of age (including the childminder’s own). The service is usually offered for the full working day or for different periods during the day. Parents and childminders arrange their own terms and conditions. For more on childminding and finding a registered childminder in your area, check out Childminding Ireland’s website at www.childminding .ie AU PAIR: An au pair is a young person who is treated as a family member in exchange for certain services, such as a limited amount of light housework or help minding children. It is a voluntary arrangement between a private household and a private individual. The objective of the arrangement is to enable the au pair to experience a different culture and improve his or her foreign language skills. There is no specific regulatory framework covering au pairs. An au pair is not a professional nanny or childminder. Au pairs are not employees and there is no contract of employment between the host family and the au pair. The au pair is usually given room and board and paid weekly pocket money. There are specialist private agencies that can assist you to source an au pair.

AFFORDABLE CHILDCARE: Affordable childcare is intended to provide childcare for families on lower incomes, and also to support parents to return to work or education. This type of service is called a community childcare (not-for-profit) facility. Funding is available through the National Childcare Investment Programme (NCIP). For more information on affordable childcare services in your area, contact your local City/ County Childcare Committee.

TIPS ON FINDING THE RIGHT CHILDCARE

START LOOKING EARLY: It’s a good idea to start thinking about your childcare as early as you can, even while you are pregnant. Talk to other working parents with children, and try to get as many personal recommendations as possible. DO YOUR RESEARCH: Once you have decided what type of childcare you want, eg childminder or crèche, look into what sort of regulations or qualifications they should be adhering to. The more information you have about the type of facility you want, the better equipped you will be when visiting and making your decision. CONSIDER YOUR BUDGET: Childcare facilities can differ in price from place to place so it’s a good idea to ring around and compare prices. VISIT AND ASK QUESTIONS: Make sure you visit the facility in question and ask lots of questions. Talk to the manager and visit the room in which your child will be minded. A lot can be learned by watching the children at play. Bring your child with you if you can. If you are choosing a childminder, spend some time with him/her and observe other children in their care. Ask about accreditation,

BREASTFEEDING

& work

Under section nine of the Maternity Protection Act 2004, if you are breastfeeding when you return to work, you are entitled to time off to breastfeed if your employer cannot provide suitable facilities on-site for you to do so. For more details on your options, the HSE have created a leaflet called ‘Breastfeeding and Work’, and it’s available from www.healthinfo.ie.

regulations, the types of facilities they have, staff qualifications and turnover, what they do with the children all day, a typical day’s menu, adult to child ratio, and any other queries you might have. The more open and transparent a facility is to prospective new parents, the better. If you can get to talk to a parent with a child in that facility, all the better. TAKE YOUR TIME: Make notes after your visit and take your time over making your decision – it’s important that you’re confident and happy with your decision. Try to visit a variety of childcare facilities and options so you know exactly what’s available. KEEP INVOLVED: After you have returned to work, make sure you stay in touch with your childcare provider. He/she should tell you at the end of each day what your child did and ate during the day. If your child is in a crèche, attend parents’ evenings or meetings. Some information taken from Citizens Information. For more, log on to www.citizensinformation.ie and www.childmindingireland.ie

AFTER THE BIRTH

a group of parents, guardians or carers and children come together for supervised play and companionship for their parents. Naíonraí: which are nursery schools or playschools operating through Irish. Playschools: which give children an opportunity to play with other children of a similar age, learn to share and take turns and to understand the rules of the classroom, such as listening.

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CAR

safety

AFTER THE BIRTH

hildren are extremely vulnerable – a child left unrestrained can be killed at speeds of just five miles an hour – which makes ensuring your little bundle is secure in a car seat that is appropriate to their weight and height extremely important. In a crash at just 50km/hr (30 mph), an unrestrained child would be thrown forward with a force 30 to 60 times their body weight. They would be thrown about inside the vehicle, injuring themselves and quite possibly seriously injuring or even killing other people inside the vehicle. They are also likely to be ejected from the car through one of the windows. It is not safe to hold a child on your lap. In a crash, the child could be crushed between your body and part of the car’s interior. Even if you are using a safety belt, the child would be torn from your

arms – you would not be able to hold onto them, no matter how hard you try. It is also dangerous to put a safety belt around yourself and a child (or around two children). The safest way for children to travel in cars is in a child seat that is suitable for their weight and height. Since August 25th, 2003, drivers face up to four penalty points and a fine of up to 800 if convicted in court for a failure to observe the legal obligations with respect to the wearing of safety belts and child restraints.

TAKE TIME TO RESEARCH As many new parents will know, buying equipment for their new baby can be an overwhelming experience, with so many different products to buy and so much choice. However, spending time to research the right child car seat for both your child and your car is

crucial, according to Brian Farrell, Communications Manager with the Road Safety Authority. “As a parent myself, I know that new parents are often bombarded with information in the weeks leading up to the birth of their child and find it difficult to know what to prioritise. We recommend that parents give themselves plenty of time to choose their child car seat so that they can shop around, make sure they know how to correctly fit it and have it in the car, ready to take the baby home from the hospital. Buying a child car seat a couple of months before the baby is born will give you plenty of time to choose the right one and to practise fitting it in the car. Remember, the golden rule for choosing a child car seat is making sure it is suitable for your child’s weight, height and age and that it conforms to the latest EU safety regulations.”

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LEGAL REQUIREMENTS

TOP TIPS

for parents ● Remember, it’s now EU law that all children must travel in an appropriate child seat, booster seat or booster cushion. ● The golden rule for choosing a child car seat is making sure it is suitable for your child’s weight, height and age and that it conforms to the latest EU safety regulations (look for the ‘E’ mark). Don’t use age as your only guide as every child is different. ● When buying a child car seat, make sure you go to a retailer who can show you how to fit it in your car. If the child car seat will be used in more than one car, make sure it’s compatible with those cars as well.

is the driver’s legal responsibility to ensure all passengers in their car aged up to 17 years of age must be in an appropriate child restraint, whether that’s a child car seat, a booster seat, booster cushion or seatbelt.”

SAFE JOURNEY, EVERY JOURNEY “According to the AA Motoring Trust, ensuring your child is properly restrained in a child car seat can reduce injuries by a factor of 90 to 95 per cent for rearward-facing seats and 60 per cent for forwardfacing seats. So it’s vitally important that parents ensure their child is adequately restrained every time they get into the car, no matter how short

● Avoid using a second-hand child car seat or restraint unless you know its history. It may have been damaged in a previous collision, and although the damage may not be visible, it won’t provide the same level of protection for your child. If your seat is in a car that has had an accident, replace the seat immediately. ● Don’t move your child from a rearward-facing child car seat to a forward-facing child car seat too soon. If you’re unsure, also consult with your retailer before you buy your next child car seat. Thanks to the Road Safety Authority for this information.

the journey,” says Farrell. The RSA has produced a range of ‘Child Safety in Cars’ material to advise parents on how to select and install a child car restraint as well as outlining their legal responsibilities to do so. This is available to download at www.rsa. ie/childsafetyincars. You can also order a free ‘Child Safety in Cars’ booklet and DVD online or by phone at LoCall 1890 50 60 80. The RSA also regularly posts information on child safety in cars on their Facebook page at www. facebook.com/RSAIreland and on Twitter at www.twitter.com/ RSAIreland

AFTER THE BIRTH

EU child safety protection law makes it compulsory for all children to travel in a child seat, booster seat or booster cushion, and where safety belts are fitted, they must be worn. The specific legal requirements are as follows: ● As a driver, it is your responsibility to ensure that passengers in your car aged 17 or younger are properly restrained in the appropriate seatbelt, booster seat, booster cushion or child car seat; ● Children under three years of age must not travel in a car or goods vehicle (other than a taxi) unless they are restrained in the correct child seat; ● Children aged three years or over who are under 150cm in height and weigh less than 36 kilograms (i.e. generally children up to 11/12 years old) must use the correct child seat, booster seat or booster cushion when travelling in cars or goods vehicles; ● Children over 3 years of age must travel in a rear seat in vehicles not fitted with safety belts; ● Rearward-facing child car seats must never be used in the front passenger seat of cars with an active airbag; ● Child car seats must be in accordance with EU or United Nations Economic Commission for Europe (UN-ECE) standards. Brian Farrell says that many parents are unsure of their legal obligations when it comes to ensuring their child is properly restrained. “The law states that children up to 150cm in height and weighing less than 36kg, which is generally a child of around 11 or 12 years of age, must be in an appropriate child restraint. This is simply because young children are too small to be properly restrained by a seatbelt so it would provide little or no protection in the event of a crash. It

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Is your Child Safe in your Car? 4 in 5 seats fitted incorrectly Research shows that as many as 4 out of 5 child car seats in Ireland are incorrectly fitted which could lead to a serious or fatal injury in the event of a collision. The ‘Check it Fits’ Service team of child car seat installation experts will be travelling all over Ireland to ensure that car seats are correctly fitted. The whole process shouldn’t take more than 10-15 minutes, is completely free of charge, and gives parents and guardians the peace of mind that their child is safe and secure in the car.

View our calendar of locations on www.rsa.ie/checkitfits

TOP TIPS FOR PARENTS: • By law, all children under 36kgs or 150cms must travel in a child seat, booster seat or booster cushion. • Make sure it is suitable for your child’s weight and height (Don’t use age only as a guide) • Make sure that it conforms to the latest EU safety regulations (look for the ‘E’ mark). • Make sure you go to a retailer who can show you how to fit it in your car. • Avoid using a second-hand child car seat or restraint unless you know its history. • Don’t move your child from a rearward-facing child car seat to a forward-facing child car seat too soon.

For more information or to order a FREE Child Safety in Cars DVD, visit www.rsa.ie

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For 125 Years The ISPCC has campaigned for the rights of Children across Ireland. We have worked tirelessly to support some of the most vulnerable Children nationwide in their time of need. Help us to make a lasting difference in 2014

Over 700,000 calls received by our Childline service in 2013

1500 Children & Families Individually Supported

670 Dedicated Part-Time Volunteers

The ISPCC has to raise between 80-90% of its income through fundraising. Irish Society for the Prevention of Cruelty to Children, 29 Lower Baggot Street, Dublin 2 T: 01 676 7960 Website: www.ispcc.ie Registered Charity Number: CHY 5102

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CHOOSING A

family car Most parents spend hours agonising over the appropriate equipment for their little one and your first family car deserves no less time and consideration. It can be a tricky decision to get right, particularly as it’s likely to be with you for quite some time. Here are some pointers on what to consider before making the big purchase: ● Functionality What do you actually need your family car for? This is key if the family car is the sole vehicle of the home and therefore has to service a number of needs. If it’s just for one parent (plus kids and baby equipment), managing rush hour traffic and ease of fitting into challenging city centre parking spaces need not be top of the list. However if it’s likely to be used on a work commute as well as school runs, take that into account.

The most important piece of kit if you’re heading out will probably be your pram or pushchair. Measure it when fully collapsed and ensure there’s space in the back for it to fit comfortably. If you’re likely to take overnight trips and will be bringing a cot or bags remember to make sure there’s plenty of space - the back seat will be taken up with a lot more precious cargo and needs to be kept clear of large bulky items.

● Safety First With a baby in a car comes a car seat, so you’ll need to make sure the car seat of your choice fits easily, ● The Extras comfortably and is accessible. Added extras can make journeys There’s typically no issue with this go that bit more smoothly. UVif you have a MPV but if you have a filtering tinted back windows smaller two-door model accessibility or integrated sun-blinds will may be an issue. Most MPVs now be welcome if you’re travelling come with Isofix mounting points during the summer. Some of the as standard. Take your car seat with more deluxe models offer seat you when viewing cars and make back DVD screens which can sure it fits comfortably and securely keep older children entertained on the mounting points or on the and cries of ‘are we there yet’ seat if it’s not an Isofix car seat. quelled. For older kids in the driving seat, some models offer ● Measure Up satnavs, in-built computers, As you may have noticed from deluxe sound systems and friends or family with children, babies parking sensors – a design that and toddlers come with a seemingly can keep the whole family happy. unending amount of paraphernalia.

AFTER THE BIRTH

● Efficiency This leads into the question of mileage – if you’re driving to work or likely to face a lengthy

daily commute to childminders, crèche or school, make sure your chosen car is fuel efficient – petrol and diesel prices aren’t pretty these days so make sure you’re getting the most from your money. For a Moving People Vehicle (MPV), you should be looking for an average of around 35-40mpg.

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SUPPORT & ADVICE directory

HELP AND ADVICE CAN BE SOUGHT FROM THE FOLLOWING SOURCES

CHILDBIRTH, BREASTFEEDING & NEW MUM SUPPORT HSE, Oak House, Millennium Park, Naas, Co. Kildare Tel: (045) 880400 LoCall: 1850 24 1850 Email: infoline1@hse.ie Web: www.hse.ie Cuidiú – Irish Childbirth Trust, Carmichael House, North Brunswick Street, Dublin 7. Tel: (01) 872 4501 Web: www.cuidiu-ict.ie Home Birth Association of Ireland, Tel: 087 164 0847, (0906) 405267 Email: enquiries@ homebirth.ie Web: www.homebirth.ie La Leche League of Ireland, Please refer to your local telephone directory. Email: leader@ lalecheleagueireland.com Web: www. lalecheleagueireland.com