- August 2010
- May 2010
- March 2010
- December 2009
- October 2009
- August 2009
- June 2009
- April 2009
- December 2008
- October 2008
December 2009
Bi-monthly Edition
Smoking and Pregnancy
Whether you're struggling with quitting, or not even thinking about it, countless scientific studies show that smoking is not only bad for your health but also that of your baby. Not only does the habit cause low birth weight babies to be born, who may have an increased risk of asthma, and respiratory diseases, but smoking also increases your baby's risk of sudden infant death syndrome (SIDS). Statistics suggest that the risk for SIDS is four times higher if you smoke between one and nine cigarettes a day when pregnant, and eight times higher if you smoke 20 cigarettes a day or more.
Smoking during pregnancy has also been linked to poor health for you, with an increased chance of:
- miscarriage
- bleeding
- nausea and morning sickness
and poor health for your baby:
- slow growth
- premature birth
- stillbirth.
The problem is that when you smoke you inhale over 4000 chemicals. Two of the main components are tar and carbon monoxide, which then get into your bloodstream and cut down the amount of oxygen reaching your baby. Babies who don't get enough oxygen grow at a slower rate, so tend to be born smaller and weaker. What's more, new studies show that babies who are exposed to smoking prenatally or in the early years of life are much more likely to be chronic smokers themselves by the age of 22.
Stopping smoking will benefit your baby's health immediately, as well as in the longer-term, because when your lungs become smoke free, the carbon monoxide and chemicals clear from your body and your oxygen levels return to normal. This means there's more oxygen in your blood, making you and your baby much healthier and lowering the risk of premature birth, miscarriage and SIDS.
If you are desperate to give up but worried about being judged for smoking, you're not alone. More than 25% of pregnant smokers admit they are so worried about being criticised for smoking while pregnant that they either hide their habit, or don't seek help to give up. The good news is that there is plenty of non-judgmental help out there, especially from your midwife and/or GP.
In fact, since 1999, NHS Stop Smoking services have helped over 111,000 pregnant women to stop smoking, with a total of 18,928 setting a quit date last year. Plus, research shows you're up to four times more likely to quit smoking successfully with NHS support than on your own. The NHS Pregnancy Smoking Helpline (0800 169 9 169) is a specialised confidential support service, where a trained adviser will answer your call, listen to your needs, and then suggest different ways you can give up.
Your midwife and GP can also put you in touch with your local NHS Stop Smoking service. Most services involve working one-to-one with a trained Stop Smoking adviser, who will help you to quit. One in two people who use the NHS Stop Smoking service quit smoking in a month, and if you also use nicotine patches or gum to manage your cravings (though speak to your midwife/GP before going for this option), you are up to four times more likely to successfully become smoke free for life!
As hard as it is to quit, keep reminding yourself that research shows that smokers who successfully quit are very clear about their reasons for giving up. As a pregnant woman, you have one of the best incentives in the world - to ensure the health and well-being of your developing baby, so use this to motivate yourself and you'll do it!
For help on giving up smoking while pregnant go to www.smokefree.nhs.uk. For more information on how to stay healthy during your pregnancy, speak to your midwife, and see the Informed Choice leaflet - Health for parenthood - practical advice on how to maintain a healthy lifestyle for you and your baby at: www.choicesforbirth.org
MIDIRS 2009
Latest News
New national statistics for home birth
Recently released figures demonstrate that the number of UK women having their babies at home has remained unchanged. Statistics show that in 2008, 21,211 (2.7%) of births from 787,032 UK births took place at home; this compares to 20,548 (2.68%) in 2007.
Home birth rates across the UK are as follows: in England, from 665,779 births, 2.8% of women achieved a home birth, whereas in Wales, the proportion was higher with 3.7% of women giving birth at home from 35,256 births. In Scotland, 881 women from 60,366 births (1.5%) had a home birth and in Northern Ireland, 83 women from 25,631 (0.3%) gave birth at home.
These figures are incredibly disappointing given the government's drive to guarantee women the choice of place of birth, whether this takes place at home, in a birth centre, or maternity hospital. Research undertaken by the NCT has shown that women's access to a home birth service varies markedly across different areas of the UK. Reasons for this include: insufficient information with which to make informed choices and NHS resource constraints, including low midwifery staffing levels which are unable to support and maintain home birth services.
The NCT's recently launched Location, Location, Location campaign calls on governments across the UK to deliver on policy commitments for choice in maternity services. Further information about the NCT campaign and how you can become involved and influence change is available from the campaign web page at: www.nct.org.uk/choice
When your baby is overdue
While every pregnant woman is given a ‘due' date for the estimated birth of her baby, it is perfectly normal for some pregnancies to go beyond this date.
When a pregnancy continues beyond 42 weeks (294 days), this is then referred to as a ‘post-term' or ‘prolonged' pregnancy. It is recognised that only four out of every 100 babies are born on their due date and that anything between 38 weeks and 42 weeks is considered to be a normal length/duration for a woman's pregnancy. The estimated date for your baby's birth (EDD) is calculated from the first day of your last menstrual period, but some women will have their babies earlier than this and others will continue beyond their due date. It is not known why some pregnancies last longer than others, but research available has suggested that the length of a woman's pregnancy may be affected by hereditary (genetic) and racial factors, and that seasonal variations and shift work may also have an effect. There is also some evidence that prolonged pregnancy is more common if you are expecting a boy. In addition to these, some rare birth (congenital) abnormalities have been associated with prolonged pregnancy, because they interfere with the body's natural mechanisms that encourage labour to start.
Should you go overdue it is understandable to start feeling impatient about when your baby is finally going to arrive. The latter weeks of pregnancy can seem to ‘drag' and you may be uncomfortable because of your enlarged uterus (womb), which often leads to backache, disturbed nights and fatigue. At this time, however, you may also find yourself faced with a choice between waiting and continuing to let nature take its course, or making plans to have your labour started (induced). In making this choice, your EDD will have additional significance for your midwife and doctor, who use this to estimate key stages in your baby's (fetal) development and to assess their well-being.
Once you're 41 weeks pregnant, your midwife or doctor will see you more often (usually twice a week) and will monitor you and your baby's well-being carefully to check that all is well. Currently, NHS guidance suggests that women with uncomplicated pregnancies (low-risk women) should be offered induction of labour at 41 weeks of pregnancy, with the proviso that, if you decide against this, you will be offered regular monitoring of your own health and your baby's health. This is called ‘watchful waiting' or ‘expectant management'.
The great majority of babies are born healthy, whether they arrive at term (when they are due), or later. What matters most is how well your baby is growing, that your baby remains healthy and is well positioned for labour. If your pregnancy continues beyond the EDD there is an increased risk that this will mean you have a larger baby. This might result in a birth that is less straightforward and it might cause your baby some health problems during and after the birth. This is also one of the most common reasons for a caesarean section. Similarly, babies born after 42 weeks are more likely to have their bowels open during the labour and they can pass some sticky dark green/black stools (poo) while they are still in the womb (uterus), and at the point of their birth. This substance is called ‘meconium' and while it is rarely a problem, if your baby breathes this into their lungs it can cause quite serious breathing problems (this is called ‘meconium aspiration').
The risk of severe complications, even death, is also very slightly increased in prolonged pregnancies, although the overall risk remains low. As these risks are considered to be avoidable, your midwife and doctor will talk to you about using medical interventions to initiate labour and to help to speed up the birth, should this become appropriate. However, in order to be able to make an informed choice, you need accurate information about the possible risks to your own health and that of your baby about the various approaches to inducing your labour, as well as the risks associated with each method of induction. These then need to be balanced with the risks associated with continuing with the pregnancy beyond the EDD in the hope that labour will start on its own.
MIDIRS Informed Choice leaflet, ‘When your baby is overdue' explores what happens in terms of your and your baby's health and well-being, and the various options for induction of labour if your pregnancy goes beyond 42 weeks. Detailed information on a whole range of aspects is available to help you make the right choices for you and your baby; further information is available at: www.choicesforbirth.org
How will your baby be born?
For the majority of women, when their labour is allowed to take its natural course, where it starts and continues without any interference, this will usually be followed by a vaginal birth - also known as a ‘normal delivery'. It is common to refer to this ‘interference' as an intervention: this is a better word as it explains that an action is considered necessary to help resolve what is already, or might become, a problem. The increasing use of medical interventions and rising caesarean section rates has meant that fewer women are able to achieve the normal birth they had hoped for, and there has been quite a lot of publicity about the positive and negative issues around these ‘interventions'. In recognising this, MIDIRS has developed its Informed Choice leaflet, ‘How will your baby be born?'. This offers you and your partner accurate information about the potential benefits and disadvantages that are associated with the various delivery options available to you.
Normal childbirth is defined as a problem free pregnancy where labour starts on its own (spontaneously) between the 37th and 42nd week of pregnancy. Once you are in labour, a normal labour means that you do not have any interventions or complications, the birth takes places spontaneously and the baby is born in good condition, and neither you nor your baby have any health problems in the first few hours afterwards. The following factors all indicate a normal labour:
- labour starts on its own (even where this is before 37 weeks)
- regular contractions begin on their own
- the membranes (your waters) break naturally
- your cervix opens up (dilates) without the need for stimulating drugs
- your baby's head can be felt to move slowly through the pelvic bones until a small part of the head can be seen which does not disappear again without a contraction (this is called ‘crowning')
- the baby is born vaginally without using forceps or ventouse.
It is usual for a woman's first labour to last approximately 18 hours and for subsequent labours to be around 12 hours long, but if your labour lasts for longer than this, without any signs of complications, this can still be normal for you. However, it is also widely recognised that labour is a very individual process and it is not always possible to know in advance exactly how your baby will be born, but it will be by one of the following methods:
- a spontaneous vaginal birth (also called a ‘normal birth' or ‘normal delivery')
- assisted vaginal birth: using vacuum extraction (‘ventouse') or forceps
- caesarean section.
Research shows that, where there are no existing complications for the mother or the baby, it is better for both if the labour is normal, as this is more likely to mean that you give birth to your baby spontaneously without the need for instrumental assistance, using forceps or ventouse. A natural labour and birth that does not involve clinical or medical interventions, such as having your waters broken, drugs that speed-up your contractions or assistance to deliver your baby using forceps or ventouse, shows large benefits for both mother and baby that include: less pain following the birth and a quicker postnatal recovery; improved relationship with your baby (also called ‘mother/baby attachment' or ‘bonding'); lower rates of postnatal depression; a better breastfeeding experience and lower rates of postnatal infection and bleeding. Babies have also been found to be calmer and more settled, with a reduced risk of developing breathing problems.
However, while you and your baby are more likely to benefit when the birth is normal and uncomplicated, the use of interventions does not automatically mean your labour has become ‘complicated', as many of these interventions are designed to avoid more severe problems arising. Your midwife will give you care and support in labour which will increase your chances of having a normal vaginal birth. However, situations can arise where your midwife may need to refer any concerns they have to a doctor and medical interventions may be advised which may affect the choices you had planned for labour and birth, including not being able to have a normal vaginal birth. This might be the case where, despite having an uncomplicated pregnancy and normal progress in labour, help may be needed to give birth vaginally. The most common reasons why forceps or the ventouse may be recommended include: concern about your baby's heart rate and their well-being in the final stages of labour, when you have been pushing for a long time and have become exhausted or distressed yourself, or because there is a medical reason why you should avoid any muscular exertion or physical strain.
Your midwife will support you in labour, but they will also help and support the obstetrician, where needed. One of the most important things they can do is to help the communication between you and the doctor at a time when you are likely to be very tired and stressed. They can help you to make your wishes known and they can help explain to you what the doctor is doing and why. Further more detailed information around this subject is available from MIDIRS Informed Choice leaflet ‘How will your baby be born?' at: www.choicesforbirth.org
Looking after your baby
Alongside the joyous feelings associated with being a new mum, the demands of caring for your newborn baby 24 hours a day can be a real shock, not to mention totally exhausting. However, as you get to know your newborn and become more adept at recognising their needs, you will also feel a lot more confident about being competent to care for them. While the newborn baby is really much tougher than you might think, one important point to remember is that your baby is vulnerable to the effects of substances in the environment around them and with which they come into contact. As parents, you are likely to be in the most contact with your baby and maintaining good hand hygiene is crucial. You should always wash your hands before and after carrying out any baby care, and you should ask anyone else who comes into close contact with them to do this as well. This article offers some practical tips and guidance in caring for your baby.
Nappy changes
In the early days following your baby's birth, you'll notice that their nappy contents change by the day. In the first day or two, your baby passes (poos) ‘meconium' - this is a very dark green/brown/black thick and sticky substance which is present in their bowel at birth. As your baby takes more milk, whether breast milk or infant formula, the colour of their poo changes to more of a green colour until, by the time that they are five or six days old, they have soft yellow poos. You will also notice that they pass more urine (wee) and several heavy nappies of wee each day is usual. It is thought that the contact between the poo and the urine can be quite toxic; needless to say, this can make your baby's nappy area susceptible to soreness and/or nappy rash. To prevent this, at least for the first month, try to change your baby's nappy as soon as you are aware that it is soiled and clean your baby's nappy area using only plain water and cotton wool. After this time you can start to introduce baby products. By doing this, you'll ensure that your newborn's skin is not exposed to substances before it has had time to develop its own natural barrier. If nothing seems to be making a difference to the rash, you should seek advice as sometimes the skin can become infected with bacteria, and medical treatments are needed.
Handy Tip: When you decide to introduce baby products, lotions or wipes, these should not be heavily perfumed or coloured and should be free of alcohol and sulphates (referred to as SLES and SLS). These substances could harm the delicate barrier of your baby's skin. Applying a thin layer of barrier cream to the nappy area can help protect against nappy rash; however, these should be free from the additives previously mentioned, and antiseptics, and be clinically recognised as effective in treating nappy rash.
Changing your baby girl's nappy
With baby girls it is always important to clean from the front of their genitals to the back, so that you don't introduce any bacteria from their bottom (anus), into their vagina. You may notice that the area around the vagina (genitals) is swollen or red and they may also have a small amount of white, clear or slightly bloody discharge - these are all normal and are due to exposure to maternal hormones in the womb (uterus). If this discharge continues beyond the first six weeks, tell your family practitioner.
Changing your baby boy's nappy
With baby boys, it isn't necessary to retract their foreskin to clean under it and in fact, you won't be able to do so for several months, even years, as it can take this long for the foreskin to separate from the penis. However, it is important to clean under their scrotum as any urine/poo that is left on their skin will cause it to become red and sore.
Handy Tip: It is worth remembering that cloth nappies are just as efficient as disposable nappies, and are a cheaper alternative, much kinder to our environment, and do not increase the risk of your baby developing nappy rash!
Cord care
The umbilical cord dries out after your baby's birth and after a few days will separate and fall off. Until this happens, it is important to keep your baby's cord clean and dry. Your midwife will show you how to fold the baby's nappy down to help avoid the cord becoming soiled, but should this happen, it is best to use wet cotton wool to clean and dry the area around the base of the cord. There is no need to use antiseptic wipes or powders. If the area around the cord becomes reddened or develops an unpleasant/bad smell, it is important that you tell your midwife or family practitioner as soon as possible as this might be the start of an infection.
Caring for your baby's eyes, ears and nose
It is best to leave these alone to avoid introducing infection. Sometimes the baby's eyes will become sticky; if this happens, you should tell your midwife or family practitioner who can check your baby and organise treatment if required. They will also show you how to clean your baby's eyes safely. You should never use cotton wool buds to clean your baby's ears or nostrils, as these can push any debris present deeper into the ear or nasal canal.
What about trimming finger and toe nails?
Your midwife will advise you against using scissors to cut any long nails because of the risk of cutting your baby's skin, as the nail and the skin blend in together at the edges of the nail bed. As a baby's nails are often very soft and flexible they can be peeled away at the ends using your fingers. Some mums prefer to nibble off the end of their baby's nails, because their tongue is far more sensitive than any pair of scissors. Even where you might have specially designed baby nail scissors/clippers with rounded ends, it is best to wait a few weeks before using them and maybe get some help holding the baby while you are doing it. It is safer to file nails with a soft nail file.
Bathing your baby
There's something quite irresistible about the scent of a newborn baby, but how often should you bath them? For many parents, their baby's bath time is a treasured time of the day and babies too often love bath time. However, until they are actually crawling around and exploring things, newborns don't tend to need a daily bath. It is also advisable to hold-off bathing your baby until their umbilical cord has dried, separated and fallen off. Your midwife will advise you to use plain water for bathing your baby for at least the first month. This ensures your baby's skin is not exposed to harsh substances before it has had time to develop its own natural barrier. Mums who have used a water-only regime compared with commercial baby skin care products report that their babies do not suffer from the usual spots, rashes and cradle cap.
Caring for your baby's hair
The amount of hair that your baby is born with is a very individual thing. Some babies are born with a head full of hair, while others have hair that is so fair and fine, they look almost bald. All babies tend to lose some of their hair during the first six months because it grows in two stages - the growing stage and the resting phase. After the resting phase, the hair falls out. This hair loss is also thought to be linked to the influence of mum's sex hormones during pregnancy and after the birth the levels of these hormones fall. Bald patches commonly appear on the back of the baby's head from where they're sleeping in the same position, or from rubbing their head against the cot mattress. There's nothing that you can do to prevent this hair loss. Shampooing isn't necessary in babies under 12 months of age, however, once you've started introducing baby products in their baths, you can rinse your little one's hair with the bath water. If you prefer to use baby shampoo, it's important that these don't contain the sulphates previously mentioned (SLES and SLS). You can use a specially designed baby's hair brush to comb their hair and stimulate baby's scalp. Any debris from the birth can be gently removed from their hair by using a baby comb.
Where should my baby sleep?
A Moses basket is ideal for a young baby because it is not too large and overwhelming for them, so when you get home from hospital, unless your baby is comfortably snoozing in their car seat, it is probably a good idea to place them in the basket so that they can get used to it. You will want to put the basket in the places where you are for the first few days, so this will be the living room/dining room and your bedroom. It is extremely important that you, your partner or visitors, do not smoke in the same room as your baby, as research has shown that smoking around babies increases the risk of cot death. For the same reason it is equally important that your baby doesn't get too hot or too cold.
The room temperature should be comfortable so that, for example, you are warm wearing one layer of clothing, but not so hot that you, and everyone else, feel the need to discard clothing! The ideal room temperature for your baby is between 16-20oC, the optimum being 18oC (65oF). It can be difficult for you to gauge the room temperature, so use a room thermometer in the room(s) that your baby occupies and move the thermometer whenever you move the Moses basket to a different room. If your baby has been born during the colder months of the year, you will also need to think about where to place their Moses basket, especially if this is going to be directly onto the floor. Just be aware of draughts from doorways or windows that might chill them even though the room itself might feel warm. You should never place the Moses basket next to a heater, radiator or fire, as your baby could easily become too hot.
For their bedding, it is best to use either lightweight sleeping blankets or a baby sleeping bag. You can tell if your baby is too warm, by gently touching their tummy. If it feels hot and clammy your baby is too warm, so simply take off some of the layers of bedding or use a lower tog sleeping bag. The pillow and duvet set that often come with your Moses basket can look very pretty, but should not be used. They could become a hazard if your baby's head becomes covered by them, or they become tangled in the duvet. All babies need to be able to lose any excess heat from the top of their head, so it is important that when lying in the Moses basket, your baby sleeps on their back with their feet to the foot of the basket. This way there is no danger of the baby's head becoming covered by the bedding and their becoming too hot.
As noted at the beginning, caring for a new baby can be a daunting and exhausting experience, but there are many people around you who are very willing to help, so never feel that you are bothering them, or that you should be able to manage if something is worrying you - just ask them for help and things will get easier.
For more detailed information on baby skincare, visit the website of MIDIRS Specialist Consultant, Sharon Trotter, at www.tipslimited.com, where you can access free copies of Sharon's excellent leaflet, ‘Baby care: back to basics™'
Registered office: 9 Elmdale Road, Clifton, Bristol. BS8 1SL. Email: support@choicesforbirth.org. Tel: 0800 581 009.
Terms & Conditions
The MIDIRS Informed Choice website is provided for reference information only. MIDIRS is not responsible or liable for any diagnosis made by a user based on the content of the website. Although great care is taken to ensure reference information is both suitable and accurate, MIDIRS is not liable for the contents of any external internet sites referenced, nor does it endorse any commercial product or service mentioned or advised on any of these sites.
