Life Skills Programme – During Pregnancy
These days many parents have not had a lot of experience with babies until their first baby comes along. If you are one of these parents you will probably find you have many questions about this new person who has come into your life and who is so small and helpless. It can be overwhelming and scary when you realise your baby is so dependent on you for everything, especially if you feel you don’t know a lot about babies.
Understanding what babies are like may help to make it easier to care for your baby.
What are babies like?
Every baby is different:
• Babies do some things ‘automatically’ without knowing they are doing them. These are called reflexes. For example, if something is put in their mouths, they suck on it (sucking reflex), and if something is put in their hands they, hold on tight (grasp reflex). If they are startled or upset they fling their arms out and throw their heads back (startle reflex).
• Babies’ heads can sometimes be uneven in shape after the birth or because of the way they sleep. This is nothing to worry about and goes away as they grow.
• The ‘soft spot’ (fontanelle) on top of a baby’s head is there so the baby can more easily fit through the birth passage when he is being born. This spot will close over in the baby’s first year or so. The skin over the soft spot is strong and you cannot hurt babies by gently washing or brushing their heads. Sometimes the fontanelle swells when the baby is crying and goes flat when the crying stops.
• Cradle cap is crusty scales on the head. You can rub it with olive oil or petroleum jelly to soften it one evening and wash it off the next day. Gently lift off the scales with a fine-toothed comb or fingernail. If it is really bad and does not improve see your doctor.
• Some babies have sticky eyes due to a blocked tear duct. Ask your doctor how to manage this. It is not serious.
• Some babies have little white lumps like tiny pearls in their mouth, especially on the gums. These are normal and go away when the baby grows.
• Babies are often born with puffy genitals and breasts (sometimes even ‘milk’ comes from the breasts). This is from the mother’s hormones, is not a problem and it does not last long.
• Babies sometimes get a lump (hernia) underneath their belly button (umbilicus). It may swell if the
baby is crying. This is a small gap in the ‘tummy’ muscle and will nearly always go away in time. It does not need treatment and does not cause health problems.
• Most babies have spots on their faces and often on parts of the body in the first few weeks. These can look like acne – red spots with white centres. They are not acne and they do not need any treatment.
They seem to be a reaction to the skin being exposed to air rather than to fluid in the womb (uterus) before birth. Sometimes the spots come when the baby gets hot or has been lying on that side. If they go away within an hour or so they are probably this kind of spot.
• Lots of babies have hiccups after feeds. This is normal.
• Some babies spill a little milk after feeds. If they are growing well and happy this is nothing to worry about. If your baby often is bringing up milk in big spurts, you need to see your doctor. If your baby is not putting on weight or is miserable a lot of the time, talk to your doctor or child health nurse.
• Very young breastfed babies do several ‘poos’ a day. Even if baby seems to be pushing hard, the poo is usually very soft. After a few weeks baby may only have a poo every few days and it will still be soft. All this is normal.
• Bottle fed babies might have firmer poos. If the poos seem very hard, try a teaspoon of brown sugar in a little boiled water before a feed (once or twice). Don’t keep doing this after the poos are soft again.
• Babies usually start to get their teeth at about six months and usually have all their baby teeth by the time they are three years old. These teeth need to be looked after and brushed. Avoid giving bottles of juice or milk at bedtime. The sugars in these drinks stay in the mouth and can cause decay.
• Some babies don’t have any teeth until they are one year old. Occasionally a baby is born with a tooth.
What your baby can do
Remember that every baby is different. While babies usually follow similar patterns with their development, your baby might do things faster or slower or differently from other babies and this is usually fine. If your baby is doing things much more slowly or not doing some things at all, it is a good idea to check with your doctor to make sure that all is going well. Here are some of the things your baby will probably be able to do.
• By six or seven weeks he can smile at you when you smile at him. Babies can actually smile when they are just a few days old.
• By two months he can hold up his head when you are holding him upright and lift his head up if he is lying on his tummy.
• By three months he will enjoy hitting toys that make a noise and he can hold a rattle for a short time.
• By four months he may be able to roll from his front to his back, but it may be another couple of months,
or more, before he can roll from his back to his front.
• By seven months he will be sitting up and might be starting to crawl.
• By nine months many babies can pull themselves up to stand. Some babies take longer. It takes another two or three months or so before he can stand without holding onto something and then a few more weeks before he can actually walk.
• By twelve months babies will ‘talk’ to you in their own language and may say one or two clear words
– probably one of them will be “No!”. Your baby will be able to hold something with his thumb and forefinger and play little games like wave goodbye and ‘pat-a-cake’.
What your baby can see, hear, taste and feel
Newborn babies may seem very helpless and vulnerable, and in many ways they are, but they can see, hear, taste, smell and feel. They can move their arms and legs (though they cannot control the movements) and they can suck. They communicate their feelings and needs (such as their need for comfort and feeds) by crying.
Your baby can see quite well at birth, especially things that are close.
• She will be able to see your face and will soon learn to recognise you.
• She will be able to see objects that are further away, but they will be blurry. Her distance vision will develop over the next few months.
• Babies can see the different colours, but as they do not understand colours they may like simple shapes, each in one colour.
• In the first few weeks, a baby’s eyes often cross, or wander in different directions some of the time.
• By the age of 3 months the eyes should be lined up so that they both look at the same object.
• If a young baby’s eyes are turned in or out most of the time, or if a baby over 3 months old has turned eyes, the baby needs to have his eyes checked.
• Some babies and young children have turned eyes some of the time (more often when they are tired or unwell). These babies should also have their eyes checked.
• Babies’ eyes may change colour and you may not know what colour their eyes will be for several months.
• Your baby has been hearing since well before birth. He is familiar with your voice and the sounds of your household.
• You may notice that he tends to calm down if you make soft noises, and that he startles if there is a sudden loud noise.
• Babies seem to like high voices and animated faces (this might be why people often talk to babies in a higher voice).
• Your baby can hear voices, but he cannot understand any words yet. By talking to your baby from the time that he is born, you can help him start to understand that sounds make words and have meaning.
• Listen to your baby’s noises and sounds and copy them. When you copy your baby it is like saying “I can hear you” and this is the start of teaching your baby to talk.
Smell and taste
• Babies are born with senses of smell and taste. They are said to be able to recognise the smell and taste of their mother’s milk, and they may refuse to drink if the milk tastes different.
• Babies can recognise different tastes such as salty, sweet, sour and bitter.
• They certainly react to unpleasant tastes such as some medicines.
• They do not need salt or sugar on their foods when they start eating solids and they learn to like the tastes they are given.
• Babies are sensitive to touch from the time they are born and they can feel pain.
• Gentle, caring touch is very important so babies feel loved and cared for. Some parents enjoy learning how to give baby a massage.
• Nappy rash is very painful for babies, and they will be quite unsettled.
• Most of a baby’s movements are random and the baby is not able to control them at first. These are called reflexes.
• There are several reflexes, such as the startle reflex (the baby’s arms stretch out and her back arches and her head goes back), and the grasp reflex (she will grip something that is put onto the palm of her hand – such as your finger). These reflexes will decrease over the next few months as your baby gets more conscious control of her movements.
• When something touches his face he will turn towards it (the rooting reflex) and he will suck on it.
Sucking is a reflex too; your baby will suck on things that are put into his mouth. Some babies will even be sucking their thumbs when they are newborns. Babies need to suck so that they can survive.
• Babies also have a ‘tongue thrust’ reflex. When something is placed into their mouth, they will, in the early months, tend to push it out using their tongue. This often happens when they are started on solids. It does not mean that they do not like the taste of the food; it is because they need to learn how to control their tongue.
Many parents have not (until recently) thought about reading books to babies. We now know that a few minutes each day, will make a difference to a baby’s development.
Reading with babies brings together many of the things they need most to grow and develop – closeness, safety, touch, seeing, hearing and learning about sounds, as well as gradually learning about what they mean. Sharing a book, or a magazine, looking at pictures and hearing your words is a very special time. Babies learn that reading is a “feeling good” time.
• Every baby is different even in the same family. The best way to get to know what babies are like is to watch and learn from your own baby.
• Babies grow and learn faster than they will at any other stage of life, so what they do will be continually changing.
• Take time to enjoy the new things your baby is learning and doing.
• If you have questions, ask for information. Most other parents have exactly the same question.
• Ask for help if you have any worries about your baby.
Bleeding during pregnancy
Vaginal bleeding, or spotting, is fairly common in early pregnancy and while it can be worrying, it doesn’t necessarily mean there is anything wrong. In some cases, though, bleeding can be a sign of complications – so it’s best to speak to your doctor or midwife about it immediately.
What causes bleeding in early pregnancy?
Vaginal bleeding can be triggered by the changes in your hormones during your menstrual cycle, which can cause breakthrough bleeding around the time you would usually have your period. This may occur a few times throughout pregnancy, particularly in the first weeks, and is likely to be accompanied by common period symptoms such as cramps and feeling bloated.
During very early pregnancy, implantation bleeding can also occur – this is when the fertilised egg is being implanted into the lining of the uterus, and you may experience mild cramps alongside light bleeding or spotting.
Other things which may cause bleeding or spotting in early pregnancy include:
- An internal examination/smear – any irritation to the cervix can cause some light bleeding so it’s best to avoid having a smear or internal examination in early pregnancy.
- Sex can also irritate the cervix, leading to bleeding – this is usually nothing to worry about but it’s worth telling your doctor or midwife about any bleeding you experience. Don’t worry though, sex isn’t off the table during pregnancy.
- Infections of the cervix or vagina or sexually transmitted infections can also all cause bleeding.
What is spotting?
Spotting is usually very light vaginal bleeding – it’s fairly common in early pregnancy. Blood can be red or brown, and occasionally it’s heavier, like having your period. The amount of blood you pass is important – spotting will be lighter, but more serious bleeding will be like a very heavy period, and could include passing clots.
Spotting often turns out to be nothing to worry about, but during the first 12 weeks of pregnancy vaginal bleeding can be a sign of miscarriage or ectopic pregnancy. This certainly isn’t always the case, and plenty of women who experience bleeding in early pregnancy go on to have healthy babies, but put your mind at ease by getting it checked by your doctor or midwife as soon as possible.
When bleeding indicates a problem
Sadly, sometimes the baby doesn’t develop properly in early pregnancy. These are some of the complications that can arise during a pregnancy and may be indicated by bleeding.
Threatened or actual miscarriage
Research indicates that around one quarter of pregnancies end in miscarriage, but these figures include very early miscarriages that many women won’t be aware of. Of women who are aware that they are pregnant, 1 in 6 pregnancies end in miscarriage.
Symptoms of miscarriage include mild to severe stomach cramps, back pain, nausea and passing tissue or clots alongside bleeding from your vagina.
A threatened miscarriage occurs when a pregnant woman experiences bleeding and/or abdominal pain, but the pregnancy continues.
Less common than a miscarriage, 1 in every 80-90 pregnancies in the UK is ectopic. This occurs when the fertilised egg implants outside of the uterus, usually in the fallopian tube, where it is unable to develop.
Bleeding is a common symptom, and may be accompanied by severe pain in one side of the abdomen, feeling faint, and nausea. Ectopic pregnancies are serious and need to be treated as soon as possible, so if you are concerned, do not hesitate to contact a medical professional.
Rarer still is this complication, in which the fertilisation process goes wrong and causes abnormal cell growth in the placenta. About 1-3 in 1000 pregnancies are molar, and if this happens it is likely you will experience normal pregnancy symptoms early on, but spotting or bleeding will begin between 6 and 12 weeks.
Bleeding in later pregnancy
Light bleeding in the second or third trimester is also common, and can be harmless, but it’s still important to get yourself checked out.
These are some of the causes of bleeding in later pregnancy:
An uncommon but potentially serious condition, placenta praevia (or low-lying placenta) occurs when the placenta is situated low down on the uterine wall, occasionally over the cervix. It’s likely you’ll be informed if you have this condition at your 20-week scan so you can be monitored. Bleeding from a low-lying placenta can be heavy and endanger your baby, so it’s possible you will be advised to go to hospital for treatment or to have a caesarean.
Another fairly uncommon condition, placental abruption occurs when the placenta partially or completely separates from the uterine wall, and symptoms may include severe abdominal pain and heavy bleeding. You are at more of a risk of placental abruption if you smoke, have high blood pressure, kidney problems or pre-eclampsia. You will be admitted to hospital for treatment.
In cases of Vasa praevia, the baby’s blood vessels run through the membranes covering the cervix – normally these would be protected within the umbilical cord and placenta. When your waters break, these vessels may be torn and cause bleeding, and the baby may lose a lot of blood. This is a difficult condition to diagnose as often it isn’t discovered until you are in labour, but it can be diagnosed before birth with an ultrasound scan.
Other causes of bleeding later in pregnancy
- Cervical changes or irritation, particularly after sex
- Vaginal infections
- A “show” – this is where the plug of mucus that had been in the cervix during pregnancy comes away, indicating that the cervix is ready to begin labour. It can be a bit alarming, and may occur a few days before contractions start or during labour.
What to do if you experience bleeding during pregnancy
Don’t be afraid to seek medical advice – call your midwife, GP or nearest antenatal unit. There’s a chance they will want to perform an examination or ultrasound to rule out any possible problems, and they may take a blood test to check your hormone levels and rhesus status if this hasn’t been done yet. If the bleeding is heavy or getting heavier, do call NHS Direct – you might be referred straight to the hospital to check everything is OK.
You should be given an emergency scan if you are experiencing bleeding after previously having had an ectopic pregnancy, or if you have sharp one-sided abdominal pain and/or pain in your shoulders.
Whilst you definitely should tell a doctor if you experience bleeding, you may be told to ‘wait and see’ if it’s quite light, or if it’s very early in your pregnancy (making it hard to see anything on a scan). This can be distressing, but take some comfort in the fact that your baby is likely to develop perfectly well.
If the bleeding gets worse, contains clots, or you also start to experience cramps, backache or period type pains, contact someone immediately and explain the situation.
Is there anything I can do?
Not really – although it’s likely that you’ll want to take it easy if you’re bleeding. Sadly, if the bleeding is due to a miscarriage, it is very unlikely anything can be done (the exception is if you are very close to full term).
Make sure you get plenty of rest, do what feels right for you and be kind to yourself – and don’t be afraid to ask for advice from your healthcare provider if you need it.
Cures for morning sickness
There are many things to enjoy about being pregnant – but vomiting definitely isn’t one of them. While there’s no miracle cure for sickness during pregnancy, there are a number of remedies that can help you deal with nausea and discomfort, and there’s medication that’s safe to take if you’re really struggling.
How to stop morning sickness
Unfortunately, there’s no fix-all cure for nausea in pregnancy. Everyone’s different – a remedy or medication that works for someone else might have no impact on you. Try not to worry if some of the suggested solutions don’t do the trick – but anything that could relieve some has got to be worth a go, at least once.
What helps morning sickness?
Although no one thing can stop morning sickness outright, there are a number of popular treatments that can help alleviate some of the discomfort you may be experiencing.
Popular remedies for morning sickness
- Lots of rest
- Plenty of fluids – sip drinks slowly and frequently
- Eating little and often – choose foods that are plain and high in carbohydrate but low in fat (see below)
- Travel sickness wristbands
- Ginger – the biscuit variety, or ginger tea works well
- Sucking on ice or ice lollies
- Vitamin B supplements
- Fresh air – take a walk or sit outside
- Distract yourself (easier said than done, we know)
What to eat for morning sickness
- Opt for bland, non-greasy foods that are easy to prepare
- Plain carbs like pasta, rice, bread and potatoes
- Snack on crackers, oatcakes or digestive biscuits
- Foods high in zinc: seeds, wholemeal bread, small amounts of eggs and red meat
- Avoid smelly and spicy foods
- Eat cold meals rather than hot ones – hot foods have stronger smells and flavours which may make you feel more sick
- Avoid drinks that are very cold, sour or sweet
- Try flat fizzy drinks to settle your stomach
- Fruit or herbal teas like peppermint tea
- Sorbet or ice lollies will help to keep you hydrated
Is medication for morning sickness safe?
- If you’ve tried natural remedies, including diet and lifestyle changes, and your nausea and vomiting is severe, a doctor may recommend a course of medication that is safe for use in pregnancy – probably anti-sickness medication (antiemetics) or an antihistamine.
- Antihistamines, which are often used to treat allergies, can also work as antiemtics and your GP may prescribe a short-course of these to help with the nausea. Commonly prescribed antiemetics can have side effects, such as muscle twitching, but these are rare.
How to deal with morning sickness
Nobody enjoys feeling or being sick but unfortunately for many, it’s part and parcel of being pregnant. Particularly in the early days when you may be trying to keep your pregnancy to yourself, finding ways to cope without giving the game away isn’t always easy.
Mumsnetters who’ve been there, done that, offer some tips for coping with nausea when you’ve just got to get through the day.
Coping with morning sickness
Just try and eat as much as you can (don’t gorge, I mean little and often) and if you fancy something then have it. Anything to make you feel a bit more human.
- “Try to eat before you start feeling nauseous – having a snack next to your bed for when you wake up can help”
- “Eat a small bowl of porridge before you go to bed at night”
- “Snack regularly, if you feel you can keep it down, on crisps/biscuits/toast/sweets”
- “Try to think about other things while eating, and make the experience as pleasurable as possible”
- “If certain smells trigger your nausea, avoid them if you can”
- “Wear loose clothes so nothing digs into your waistline”
- “Carry mints everywhere (helpful as a breath freshener, too, if you’re sick when you’re out somewhere)”
- “Online food shopping, if going round the supermarket makes you want to retch”
- A little self-pity – “My aunt recommended sitting on the bathroom floor wailing ‘Oh please, just let me die’. I felt more comforted by her telling me that than by all those who offered more conventional advice”
Morning sickness at work and taking time off:
- As with any illness, if you are experiencing morning sickness to a degree that would impact your ability to work, you may want to – and are entitled to – take time off work. Your employer should respect this and be supportive.
- The 2010 Equality Act states that it is unlawful discrimination for an employer to treat a woman unfavourably due to pregnancy or illness relating to pregnancy. Discriminatory treatment includes withholding sick pay and unfair dismissal. If you think you have been subject to discrimination, you may wish to claim for compensation through an employment tribunal.
- If other words – if you’re too sick to work, you’re too sick to work. It’s as simple as that. Visit your doctor and explain the situation, and ask for a sick note if you need it.
- If an illness is pregnancy-related, it should be recorded as such – it won’t count towards your sickness record and you cannot be dismissed for it.
- If you are able to continue working, you might want to tell your employer so they can make adjustments, which they are legally required to do to protect your health. For example, it may be that you need easier access to a toilet, or a desk not so close to the kitchen and the smell of someone heating up last night’s curry for lunch.
Coping with morning sickness at work
Recommendations from women who have been there, done that and have the sick bag in their desk drawer to show for it:
- “Take things one hour at a time. It might sound silly, but I found that worrying how I was going to get through a whole working week only made things worse.”
- “Keep nibbling throughout the day – make sure there are plenty of snacks in your desk or your coat pocket.”
- “I’m a teacher and found that walking around the classroom all day really helped – but I also made sure I properly rested during my lunch break.”
- “I used to wear travel bands under my shirt. It might not work for everyone, but it certainly helped me.”
- “Speak to your manager and see if you can work from home – it won’t help the nausea, but you’ll be more comfortable and relaxed.”
- “Know your limits – if it gets really bad, go to your doctor and get signed off.”
What to put in your hospital bag
Getting your labour bag ready is a tricky task. You’re packing for several eventualities as labour and birth can go many ways, including the way you’re least expecting. You also have to pack clothes and other items for a human being you haven’t yet met – it’s like the most complicated surprise holiday ever. As if preparing for life with a newborn weren’t a terrifying enough prospect in itself…
When should I pack my hospital bag?
You should pack your bag four to six weeks before your due date and use the checklists below to help you get the essentials together and ensure nothing is forgotten on the day. Your birth partner should also pack a bag.
Hospital bag checklist
It helps to break down your packing list in three categories:
Delivery suites are often short on space so you can always leave your bag of stuff to take to the postnatal ward in the car and send your birth partner out for it after you’ve given birth.
The essentials for you and your newborn baby
- Your birth plan
- Your maternity notes
- An old nightie/T-shirt to give birth in
- Bottle of water with a ‘sports’ lid
- Snacks (you could be there a while)
- Hair clips/band to keep your hair out of your face
- Dressing gown
- Breastpads and nursing bras
- Maternity pads and ‘old’ knickers
- Clean sleepwear if you’re staying in overnight
- Baby clothes
- Nappies and wipes
- Phone and charger
- Clothes to go home in
- Car seat
What to pack in your hospital bag for labour and birth
As well as your birth plan, don’t forget anything you might want to help you during labour, eg:
- Birth ball
- Music or hypnobirthing CDs
- Essential oils, massage lotion
- Spray bottle to spritz your face during sweaty moments – and a flannel to cool your face
- TENS machine, if you’re using one
- Lip balm for dry lips if you’re using gas and air
To make things more comfortable:
- Bottle of water with a ‘sports bottle’ type lid, or straws, so you can sip while lying down
- Cereal bars and other individually wrapped snacks are good. Dextrose tablets and isotonic drinks are also good for a short, sharp burst of energy. Take something for afterwards, too, in case you give birth in the wee small hours, hospital catering is closed and the vending machine is on the blink.
- Flip flops and a dressing gown in case you don’t have an ensuite loo in the labour room and need to pop out
- Some spare socks – lots of women get very cold feet during transition
- A couple of things to pass the time (in the early stages of labour there may be a few hours when you’re thankful for a magazine and iPad)
- Your own pillow (for home comforts) if you want it and the hospital are ok with it
- Towels: “There were none where I gave birth. And, as I hadn’t expected to have my baby at 35 weeks, I hadn’t packed very well. I had to dry myself on the blue paper stuff in the labour suite.”
- A small stock of maternity pads, basic toiletries, a nursing bra and a clean nightie (just so you can get cleaned up, have a shower and get comfy after the birth until your birth partner can grab your postnatal bag)
What to pack in your hospital bag for after the baby’s born
- Another nightie to wear if you stay in – front opening is best if you are intending to breastfeed (just try to remember to do it up again before you pop to the hospital shop)
- Maternity pads, breast pads, and nursing bras. Some people opt for disposable paper knickers, but take it from us, unless you like rustling when you sit down, do yourself a favour and sacrifice a few trusty pairs of ‘big’ pants for your first post-birth days
A hairbrush for the regulation happy mum and baby photos. I forgot mine and I was gutted. I have long hair and it looked a mess in the photos.
- Two bras, in case of leaks if you’re breastfeeding
- Slippers in a size up, in case your feet swell
- Phone and charger, maybe a portable charger in case you can’t reach a plug
- A camera if you don’t have one on your phone
- Plastic bag to put dirty clothes in
- Headphones so you can block out the noise of the postnatal ward with some music, and an eye mask and ear plugs to help you sleep.
- Clothes to go home in. If you don’t think you’ll have enough room for these, you can always leave them behind to be brought in later. But if your other half’s not exactly Gok Wan you’d be wise to get together an outfit you’ve chosen and leave it somewhere obvious
What to pack in your hospital bag for your baby
- Nappies and nappy sacks
- Baby wipes
- Muslin squares
- Bodysuits and baby vests (three of each – just in case)
- A baby hat to keep them warm
- Scratch mitts
- Socks or booties
- Bottles, milk and anything else you need if you know you will be bottlefeeding
- Baby car seat – remember you won’t be able to drive home from the hospital without one
While you’re shopping for your newborn essentials, buy the baby an outfit for the trip home (an all-in one is best) and don’t forget a jacket if it’s likely to be cold.
What does my birth partner need to pack for labour?
- A comfortable outfit and shoes (there might be a lot of pacing and waiting around and your birth partner’s comfort won’t be the first thing on anyone else’s mind)
- A change of clothes
- Swimwear if they want to get in a birth pool with you if you are having a water birth
- Plenty of snacks and drinks
- Camera, phone and charger
What sort of bag should I use as a labour bag?
Something compact that makes it easy to find everything is best – a small holdall or a rucksack is useful. One with a pocket for your phone and charger so you can find that and other essentials easily is a good choice. A similar-sized one for ‘post’ birth can stay in the car boot until you need it. Your baby won’t need too much so you can always leave a pack of nappies, the jacket and car seat in the car and pack the rest into your changing bag.
What do I pack in my hospital bag for a planned caesarean?
If you know you’re having a caesarean, that does take some of the guesswork out of things, and you’ll also know exactly when you’re going into hospital so you can get prepared in plenty of time. It’s still worth packing a few weeks ahead, however, just in case you should go into labour early and need to get to the hospital fast.
Your birth plan will obviously look a little different, but you can still ask for things like your choice of music to be playing during the caesarean, for them to dim the lights as soon as possible, and to be helped in having skin-to-skin contact straight after the baby is born.
The packing lists for your baby and after birth remain pretty much the same, but exchange the ‘for labour and birth list’ above with the following items you’ll want during birth and while recovering from a caesarean:
- Hospital notes
- Loose-fitting clothes to go home in – a tunic and leggings with a high waist are good
- High-waisted knickers to wear after birth that won’t rub on your caesarean scar
- A bottle of water with a sports lid as you won’t be able to sit up in bed to drink easily
- Flip flops or slippers you can put on easily – you won’t be bending down to put shoes on for a while, either
- Extra pillows, and possibly a breastfeeding pillow to make sitting up to feed easier
- Don’t forget that you will still experience some bleeding after birth so you’ll still need maternity pads.
Do I still need a hospital bag if I’m having a home birth?
Yes. Firstly because there’s always a chance with a home birth that you might end up transferring to hospital and the last thing you want is to be rooting around in your knicker drawer in that scenario. Secondly, it’s just a good idea to have everything in one place where the midwives can find it easily.
How much am I allowed to pack in my hospital bag?
Given that it’s all a bit of a guessing game (and you’re likely to get some raised eyebrows from the midwives if you turn up with ‘excess baggage’), you don’t want to go overladen.
Firstly, remember you are going to hospital, not the Gobi desert – there will be some things already there that you are perfectly entitled (and probably expected) to use. Some hospitals will give you nappies, for example, while others don’t. These are the sort of things you need to check in advance.
Secondly, and this is something many mums-to-be forget: the shops do not shut forever on the day you give birth. If you find you wish you had brought more vest tops or an extra hat for your baby, your partner, mother or some other reliable soul can simply go out and buy it for you. People love to feel useful, so make the most of this.
In short, try to keep it to a minimum.
What every pregnant woman should know about group B strep
Group B strep (GBS) is the most common cause of life-threatening infection in newborn babies, causing meningitis, sepsis and pneumonia. Make sure you know what it is, as well as how you can get tested for it before giving birth. Be sure to spread the word to fellow mums-to-be, too.
Every so often, the topic of group B strep (GBS) makes the headlines, largely thanks to a lady called Jane Plumb, MBE, who’s chief executive of the charity Group B Strep Support, and whose son Theo died from a GBS infection in 1996. She’s campaigning tirelessly for the NHS to implement a simple, safe and effective test that will detect GBS bacteria and save lives.
Although things are heading in the right direction (read more about GBS clinical trials taking place below), it’s still not routinely tested as part of NHS antenatal care. So, until it is, make sure you know what GBS is and how you can get tested in our comprehensive guide below…
What is GBS?
GBS (group B strep) is a very common bacteria, which around 20–30% of adults carry (usually in the gut, bowel or vagina). Contrary to belief, GBS is not a sexually transmitted disease. GBS usually does no harm and rarely shows any symptoms, so you won’t feel unwell or even know you are GBS positive. However, if you’re pregnant and are GBS positive, this can mean your baby comes into contact with the bacteria around labour. In some cases, this can cause your baby to become unwell. This is why it’s vital to get tested for GBS when you are pregnant, so you can be treated with antibiotics during labour, and your baby can be monitored.
How often does GBS affect newborn babies?
Approximately one in every 1,000 babies born in the UK develops group B strep infection. That’s according to Group B Strep Support, the only UK charity dedicated to wiping out group B strep infections in babies.
On average in the UK, at least:
- two babies a day develop a group B Strep infection
- one baby a week dies from their GBS infection
- one baby a week survives with long-term disabilities – physical, mental or both.
How serious is GBS in babies?
Although a group B strep infection can make a baby very unwell, most babies make a full recovery with prompt treatment.
However, the infection can sometimes cause life-threatening complications, such as:
- blood poisoning (septicaemia)
- infection of the lung (pneumonia)
- infection of the lining of the brain (meningitis)
‘GBS is the most common cause of severe infection in newborn babies, and the most common cause of meningitis in babies under three months of age,’ says Jane Plumb, MBE, chief executive of the charity Group B Strep Support, and whose son Theo died from a GBS infection in 1996.
What are the signs of GBS in babies?
In most cases, babies whose mothers have been treated with antibiotics during labour will be protected from early-onset GBS infection. The baby will be closely monitored for signs of GBS in the first 24 hours of being born. If he appears healthy, he won’t be given any antibiotics.
However, if a baby develops GBS infection less than seven days after birth, it’s known as early-onset GBS infection. Most babies who become infected develop symptoms within 12 hours of birth.
- being floppy and unresponsive
- not feeding well
- high or low temperature
- fast or slow heart rates
- fast or slow breathing rates
Late-onset GBS infection develops seven or more days after a baby is born. This usually means the baby probably became infected after the birth – for example, they may have caught the infection from someone else. GBS infections after three months of age are extremely rare.
Typical signs of late-onset group B strep infection are similar to those associated with early onset infection and also include signs associated with meningitis, such as:
- being irritable with high-pitched or whimpering cry, or moaning
- blank, staring or trance-like expression
- floppy, may dislike being handled, be fretful
- tense or bulging fontanelle (soft spot on babies’ heads)
- turns away from bright light
- involuntary stiff body or jerking movements
- pale, blotchy skin.
If your baby shows signs consistent with GBS infection or meningitis, go straight to your nearest paediatric A&E department. If your baby has late-onset GBS infection or meningitis, early diagnosis and treatment are vital: delay could be fatal.
How can GBS in babies be prevented?
Largely by knowing if the mum-to-be is GBS positive, something which a simple test can detect (see Getting tested for GBS, below). If midwives know that you’re GBS positive, they can prevent infection spreading to the baby (or at least be on the lookout for it) by giving intravenous antibiotics during labour. This helps to prevent the baby from picking up the bacteria around labour.
Preventative treatment for GBS in early labour
Recently (in 2017), the Royal College of Obstetricians and Gynaecologists (RCOG) updated its guidelines to recommend that all pregnant women who go into labour too soon should be given antibiotics to protect their baby from group B strep. This was a huge development as, up until this point, antibiotics used to pre-empt and prevent a baby from picking up GBS in labour wasn’t an option on the NHS, despite pressure and petitions to change this (see below).
The RCOG now says that any woman who goes into labour before 37 weeks should be offered antibiotics as a precaution, even if her waters haven’t broken and the protective amniotic sac surrounding the baby in the womb is still intact.
Getting tested for GBS:
“I’m pregnant – how do I know if I’m GBS positive?”
The NHS says that roughly one pregnant woman in five in the UK carries GBS in their digestive system or vagina.
But because of the symptom-less nature of carrying group B strep, most women will not know they are carriers. Having a test is the only way to establish whether you are a carrier or not.
However, in the UK, pregnant women are not offered testing routinely for group B Strep, unlike in many other developed countries. If your NHS trust doesn’t offer it (and most don’t) you can get one done privately (see below) for less than £40. Routine antenatal urine tests may detect group B strep though usually only when you have a urinary tract infection caused by the bacteria.
Other tests that may be carried out during pregnancy (for example a vaginal swab, if you’ve had an unusual discharge) are often not completely fail-safe – they only pick GBS up about 50% of the time from women who are carrying it.
Why does the NHS not offer GBS screening?
This is a contentious issue. Unlike in other countries, such as the US, Canada and France, there is no routine screening during pregnancy for GBS – despite the statistics and the fact that a test costs the NHS just £11.
Following numerous petitions to screen for GBS, the government says only a small minority of babies whose mothers test positive for GBS will become infected, leading to many women and babies being exposed to ‘unnecessary antibiotic use’. However, a breakthrough happened this year (2019), when a major clinical trial received funding.
Lasting two years, it’ll compare two different methods of testing for GBS:
- a lab-based test, known as ECM (Enriched Culture Method) done at 35 to 37 weeks of pregnancy
- and, a ‘bedside test’, known as PCR (Polymerase Chain Reaction) at the start of labour.
It’s hoped the outcome will inform future policy in the UK, and potentially lead to routine and accurate NHS testing for all pregnant women – something that happens in many other countries already. Group B Strep Support is encouraging women to sign a petition urging the government to provide testing to prevent any more avoidable deaths of newborn babies.
Where can I have a GBS test done?
The only reliable home test to detect GBS carriage is called the Enriched Culture Method (ECM) test, which is available privately and from a small number of NHS trusts – so do check if yours offers it. The test involves taking vaginal and rectal swabs during the third trimester of your pregnancy.
It’s important to do the test towards the end of the third trimester (between 35 and 37 weeks) to get the most accurate result. Don’t leave it too late in case your baby arrives before you’ve had chance to do the test and get the results.
Private testing costs around £35-£40. You can also find out more at the GBSS website. GBSS recommends home testing kits from The Doctors Laboratory.
Other than this, the Polymerase Chain Reaction (PCR) test, can be carried out at hospital for ‘high risk’ patients, for instance who’ve had a GBS+ pregnancy before. This test swabs the low vagina and rectum and then places it into a machine that amplifies the DNA present to test for infection. Results can be available in 30 minutes.
Can I self-test for GBS?
You can purchase a home-testing pack online, which costs less than £40 for the test, processing the swabs and sending you (and your midwife if you select that option) the results.
Or you can call 020 7307 7373 to order a group B strep test or text ‘GBS’ to 88020 to order a group B strep test.