Maternity Annual 2017 / 2018

2017/2018

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

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EDITORIAL DIRECTOR Mary Connaughton CREATIVE DIRECTOR Jane Matthews LAYOUT Antoinette Sinclair PRODUCTION MANAGER Mary Connaughton SALES DIRECTOR Paul Clemenson CHAIRMAN Diarmaid Lennon SINCERE THANKS AND APPRECIATION TO EVERYONE WHO CONTRIBUTED TO THIS ISSUE. ILLUSTRATIONS & PHOTOGRAPHY: istockphoto.com maternity is published by Ashville Media Group, 55 Park West Road, Cherry Orchard, Dublin 12.

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, 2017. 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

F

irstly, let me congratulate you on your pregnancy – whether it’s your first or your sixth, this is an exciting time that should be celebrated and enjoyed, as much as possible. Nine months might feel like forever at times, but in reality, it flies by so very quickly.

When you think about it, pregnancy is a real miracle.

Often before you even know you’re pregnant, your body has managed to grow and nurture a little being, with many of the major organs developed in just a few short weeks.

Even before you feel comfortable sharing your news with everyone, it can be hugely reassuring and fascinating to keep up to date on how your baby is growing in those first few weeks.

But while pregnancy is an exhilarating and exciting time, it’s also nerve-wracking. How do you know if everything is okay? What does that niggle mean? Even when your pregnancy progresses and you can feel those gorgeously reassuring kicks, those worries never fully leave you until you’re holding your precious bundle in your arms. We won’t even go into the new set of worries that come into play then!

Our aim with maternity is to guide you through every aspect of pregnancy and those early months with a newborn. This year we’ve dedicated a chapter to fertility, to offer some advice if you’re only just starting out on thinking about a family. We’ve also divided our pregnancy chapters into trimesters; each chapter is designed to guide you through those three months, both in practical terms with our guide to what to expect from your hospital appointments and scans, and in terms of preparing for your new baby. Remember to fill in the appointment cards and the notes sections, to turn this annual into a precious keepsake of your journey to motherhood.

A major focus of this year’s annual is the first few weeks with a new baby. Whether you’re breastfeeding or bottlefeeding, we have the latest and best advice on getting started, while our tips on recovering from the birth will get you back to feeling like your old self before you know it.

Our best advice is to relax and enjoy your pregnancy – before you know it, your baby will be here.

Wishing you all the very best with your pregnancy!

Penny Gray EDITOR

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CONTENTS

EDITOR Penny Gray

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CONTENTS 2017/2018 CHAPTER 1:

CHAPTER 2:

CHAPTER 3:

8 9 10 12 14

18 20 21 22 23 24 27

42 43 46 48 50 52 54

Fertility & Conception Your Cycle and Ovulation Fertility Lifestyle Advice Men’s Health Fertility Risk Factors Early Pregnancy Signs

The First Trimester

The Second Trimester Week By Week Guide Pregnancy Niggles & Symptoms The Anomaly Scan Looking & Feeling Good Work & Travel Budgeting For Baby Pregnant With Multiples

CONTENTS

28 30 34 36 38

Week By Week Guide First GP Visit Choosing Your Medical Care Home Births Your First Hospital Appointment Healthy Eating Prenatal Vitamins & Supplements Morning Sickness Fitness in Pregnancy Mental & Practical Care Illness & Vaccinations Coping With Miscarriage

2

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CONTENTS 2017/2018 CHAPTER 4:

CHAPTER 5:

CHAPTER 6:

58 62 64 65 66

76 78 79 80 83 84 85 86 88

92 94 96 99 101 104 105 107 110 113 115

The Third Trimester

67 68 70 72 74

Week By Week Guide Buying for Baby Safe Sleeping Designing a Nursery Pregnancy Niggles & Common Worries Warning Signs Gestational Diabetes Getting Ready to Give Birth Your Hospital Bag Writing a Birth Plan

CHAPTER 7:

Life as a New Parent

CONTENTS

118 122 124 126 128 129 131 134 137

Labour & Birth

90

Signs of Labour Stages of Labour Birth Story: Home Birth Pain Relief Birth Story: Epidural Breathing Techniques Birth Story: Drug-Free Labour Types of Birth Birth Stories: Caesarian Sections After the Birth

The First Few Weeks Beginning to Breastfeed Breastfeeding Basics Bottlefeeding Feeding Issues Caring For Your Baby Vitamin D Nappies Vaccinating Your Baby Your Recovery Postnatal Depression Babies in Special Care

DIRECTORY

142 Directory

The First Six Months Your Baby’s Health Meningitis Establishing a Sleeping Routine Early Teething Weaning Car Safety Work & Childcare Capturing Memories

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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FERTILITY & CONCEPTION

CHAPTER

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1 FERTILITY & CONCEPTION If you and your partner are thinking of trying for a baby, there are a number of things you can do to give yourself the best possible chance of success. This chapter covers all you need to know about your monthly cycle, boosting natural fertility, risk factors that could make conception a little more difficult, when/ where to get help, and what to do if you think you might be pregnant.

YOUR CYCLE & ovulation

B

efore you start trying for a baby, it’s a good idea to get to know your cycle.

The average menstrual cycle is 28 days long, but can range anywhere from 21 to 35 days in adults, and 21 to 45 days in teenagers. A cycle is counted from the first day of a period to the first day of your next period.

During the first half of your cycle, levels of the female hormone, estrogen, begin to rise, and the lining of the uterus grows and thickens so it can nourish an embryo if conception happens. At the same time, an egg matures in one of the ovaries before it is released (ovulation). Upon release, the egg travels along the fallopian tube to the uterus. If the egg is fertilised by the man’s sperm cell, it attached to the uterine wall; if not, it will break apart. Hormone levls fall and the thickened lining of the uterus is shed, resulting in your monthly menstrual period.

and creamy to clear, stretchy and slippery, a little like raw egg white. Other signs of ovulation include: ● breast tenderness ● bloating ● mild abdominal pain ● slightly increased body temperature ● increased sex drive Ovulation tests can be useful tools in predicting when ovulation occurs, as can sensitive thermometers meant to test for ovulation. However, according to the experts, couples who have sex every one or two days, especially during your fertile period (about five days before ovulation to two days afterwards) conceive more quickly than those who have sex only twice a week.

FERTILITY & CONCEPTION

ALL ABOUT OVULATION Ovulation occurs when an egg is released from one of your ovaries. In an average 28-day cycle, ovulation usually occurs 10 to 16 days before the start of your next period. Counting from the first day of your last period, your most fertile time is likely to be between Day 12 and Day 17. However, many women ovulate early or late some months, and some might not ovulate at all some months.

The most obvious sign of ovulation is an increase in vaginal discharge, which changes from white

WHAT ARE MY

CHANCES OF getting pregnant

There is a 20-25 per cent of geting pregnant in each cycle if no fertility issues are present.

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Fit for conception

Eat fruit & veg Fruits and vegetables are essential for good health, but in particular, the variety of vitamins and minerals in fruit and veg is useful during conception. Vegetables like broccoli, spinach and asparagus are rich in folate, a B vitamin that can help prevent neural tube defects like spina bifida (see more about folic acid in the box about prenatal vitamins). Eating citrus fruit provides your body with vitamin C, which is needed to help your body absorb iron. The advice generally is to eat a rainbow of fruit and veg, to ensure you get as many different vitamins and minerals, all of which are essential in keeping your body healthy.

Watch the caffeine There is some evidence that very high levels of caffeine (over 500mg a day, or four cups of coffee) may interfere with fertility, but the experts generally agree that moderate amounts (below 300mg a day, about two cups) shouldn’t affect your chances of getting pregnant. As no study has concluded definitively that caffeine affects fertility, to err on the safe side, some experts recommend cutting down or giving up caffeine if you are trying for a baby, especially if you are having difficulties or going through fertility treatment.

Go for fish Research suggests that a diet rich in omega-3 fatty acids may help regulate ovulation and improve egg quality; oily fish like salmon is the best source of omega-3 fatty acids.

Some types of fish contain mercury, so if you’re trying for a baby, experts suggest that you stick to just two servings of fish like canned tuna, salmon and cod, and avoiding swordfish, tilefish, king mackerel, and shark because these have the highest mercury levels.

Get some iron Iron is essential when you are pregnant, as your increased blood

volume and a growing baby quickly deplete your levels of iron, but too little iron at conception can not only affect your baby’s early development but also put you at risk of iron-deficiency anemia during pregnancy and after birth.

Make sure you eat iron-rich foods like lean red meat and dark leafy green veg regularly if you are trying for a baby, especially if you tend to have heavy periods.

Eat clean Avoiding processed carbohydrates and refined sugar is the cornerstone to any healthy diet, and is especially important when you are trying to conceive. If you suffer from polycystic ovary syndrome (PCOS), make sure you eating wholegrains rather than refined carbohydrates like white bread, as refined carbs can cause insulin spikes, which can worsen your condition.

Limit alcohol The odd alcoholic drink is fine when trying for a baby, but remember that moderate drinking (two or more drinks a day) can increase your risk of miscarriage. Alcohol is a definite no-no when pregnant, and as you mightn’t realise immediately when you do conceive, many prefer to give alcohol a miss completely.

FERTILITY & CONCEPTION

Keeping yourself fit and healthy through good nutrition and exercise is vital to help your chances of conception and to help you have a healthy pregnancy once you’ve conceived. Good nutrition is essential not only when you’re pregnant, but also when you’re trying to conceive, as what you eat affects how your body works, especially your hormones.

Here is some nutritional advice that may be useful if you’re trying to boost your chances of success when trying for a baby.

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MEN’S health

DO I NEED A

FERTILITY & CONCEPTION

vitamin supplement?

It’s essential to take a folic acid supplement for three months before conceiving to protect against neural tube defects like spina bifida, and to continue to take this supplement for the first few months of your pregnancy. If your diet is less than balanced, a general vitamin and mineral supplement may be useful; talk to your pharmacist for a suitable supplement for conceiving, and remember that some standard supplements are unsuitable for pregnancy so avoid these when trying for a baby as you will probably not know you are pregnant for a few weeks after conception.

Men also have a role to play in boosting fertility when trying for a baby. The average sperm count is about or above 120 million per cubic centimetre, and a low count is diagnosed at under 40 million per cubic centimetre. A low sperm count or poor sperm motility may be due to environmental toxins like chemicals, radiation, drugs, heavy metal exposure, cigarette smoking, excessive alcohol use, street drug use and pollution. Here’s five easy ways to ensure your swimmers are as healthy as possible.

Get your folic acid Folic acid is not just for women who are trying to conceive. According to a study at the University of California in Berkeley, men with lower levels of folic acid in their diet had a higher rate of abnormal chromosomes in their sperm. Take a good multivitamin or eat foods high in folate, like beans, leafy green vegetables, wholegrains, citrus fruits, and folate-enriched cereals, breads, and pastas.

Cut out the cigarettes Smoking cigarettes is linked with low sperm counts and slow-

moving sperm. To make sure his sperm is as healthy as possible, men should give up smoking as soon as possible, preferably at least three months before trying to conceive.

Watch the alcohol High levels of alcohol have been shown through various studies to reduce sperm production and cause sperm abnormalities. Drinking in moderation is fine, but limit to one or two drinks a day.

Keep your cool Men’s testicles hang outside the body as sperm production needs to take place at a cooler temperature than even our own bodies. So for good sperm production, avoid spending too much time in artificial heated atmospheres like hot tubs, saunas and steam rooms. Tip: use your laptop on a desk rather than on your lap, as your computer may overheat your genital area.

Limit caffeine A Danish study has linked high caffeine intake with a reduced sperm count and concentration. Limit caffeinecontaining drinks (such as coffee, tea and energy drinks) to two or three a day.

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FERTILITY

risk factors

T

here are a number of factors that could make it more difficult for you to conceive. Some are preventable or treatable, but some are not. It’s well worth reading up on these and seeking medical help if you think you may have one or more of the following risk factors.

Remember that these affect different women in different ways – one might have no impact at all on your chances while for another woman, the same risk factor could have a serious effect. The key is to do everything you can to help those factors you can control, and keep yourself fit and healthy regardless to put yourself in the best position possible. If you are worried at all, talk to your doctor.

FERTILITY & CONCEPTION

AGE According to data released to mark the International Day of Families last year, 52.7 per cent of firsttime Irish mums were aged 30-39 in 2013, making Irish women some of the oldest mothers in Europe. The fact is that more and more of us are waiting to become mothers for a number of reasons: career, financial and even social.

However, fertility starts to decline for women from about the age of 30, dropping down more steeply from the age of 35. The chances of infertility and miscarriages rise sharply after the age of 35, even more so after the age of 40.

ENDOMETRIOSIS Endometriosis refers to a condition in which the tissue that normally lines the uterus grows outside it.

Cysts or scar tissue develop and cause the surrounding area to thicken. Classic symptoms include pain before and during your period, or when having sex. It affects up to 10 per cent of women, and it’s estimated that about a quarter of sufferers can have fertility issues.

PCOS PCOS (Polycystic Ovary Syndrome) is a common problem among women. It occurs when a woman’s hormones are out of balance and can result in irregular periods, reduced fertility, excess hair growth and weight gain.

Treatments include weight loss, contraceptive pill or medicines such as clomifene or metformin if you are trying to conceive.

UTERINE FIBROIDS Fibroids are benign tumours that grow from muscle cells in the uterus.

They’re most common in women ages 30 to 40, and symptoms can include heavy or painful periods, discomfort in the lower abdomen, constipation or more frequent urination. Generally, fibroids don’t require treatment (they tend to go after the menopause due to changing hormone levels), but if they are interfering with fertility or impacting on your life, your doctor may recommend treatment through surgery or medication.

CHRONIC ILLNESS If you suffer from a chronic illness like diabetes, thyroid issues or asthma, always talk to your doctor about getting your symptoms under control before trying for a baby. While some chronic illnesses don’t cause infertility themselves, any illness puts the body under stress and could interfere with ovulation. Drugs to treat illnesses can also affect fertility, or might not be safe to take when pregnant, so always talk to your doctor about switching to a fertility- and pregnancy-safe medication.

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LIFESTYLE FACTORS Many lifestyle factors like being overweight or underweight, drinking too much alcohol, smoking and taking drugs can interfere with your fertility and affect your chances of conceiving and having a successful pregnancy. Try to give up or limit these before trying, and seeking help if you need it.

OTHER FACTORS There are a number of other fertility risk factors, such as sexually transmitted diseases like gonorrhea or chlamydia, pelvic inflammatory disease, pelvic or abdominal surgery, or blocked fallopian tubes from an infection, ectopic pregnancy, or previous surgery.

WHEN TO SEEK HELP The general advice is to have sex regularly throughout the month, especially around the time of ovulation. If you are aged under

35 and have not succeeded in conceiving within a year, talk to your doctor; if you are aged 35-plus, talk to your doctor if you haven’t succeeded within six months. If you decide after talking to your GP to seek help from a fertility clinic, follow these tips to find the right clinic for you: ● Ask your GP for recommendations ● Do research on the internet, looking for reviews from people who have used the clinic ● Get a personal recommendation ● Call the clinic and ask any questions you may have (if a clinic doesn’t answer your answers satisfactorily, then maybe it’s not the right clinic for you) ● Look for a clinic that suits you in terms of location, success rate for your particular treatment, price and general ethics and procedure.

WHAT’S THE DIFFERENCE?

IUI vs IVF: IUI is much less invasive; the sperm sample is “washed”, with the more mobile sperm inserted into the woman’s cervix. Often the woman is given a low dose of fertility drugs to enhance ovulation as well.

IVF is when the egg is extracted from the woman and fertilised with sperm from the man. The embryo is then inserted into the woman.

COPING WITH

fertility issues

Struggling to conceive is tough for any couple. Try these coping strategies: ● Approach it together

● Talk to professionals and other couples having similar issues ● Get a mix of optimism and realism when going through treatment ● Educate yourself about the medical side of fertility treatment and conception

FERTILITY & CONCEPTION

● Spend time on other interests and hobbies to give yourself head space

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Y

ou’ve started trying for a baby and you’re excited! So much so that you’re reading into every symptom and twinge – could you be pregnant? While the best way to find out for sure is to take a home pregnancy test, there are a number of early symptoms that could appear within days or weeks of conception and could point towards conception. Remember, however, that many of these symptoms are also common with a looming period.

FERTILITY & CONCEPTION

MISSED PERIOD This is the obvious early symptoms and indicates you should do a pregnancy test. Before you start trying, you should track your periods and if they are regular, you should know pretty much the exact day your period is due. Some women’s cycles differ from month to month, so allow yourself an extra day or two.

Remember that stress and lifestyle factors could delay your period.

TENDER, SWOLLEN BREASTS Early hormone changes might make your breasts fuller and heavier, or tender and sensitive. Your areoles may deepen in colour too.

NAUSEA/VOMITING

OTHER SYMPTOMS

Morning sickness occurs with a surge of the “pregnancy hormone” and could occur as early as three weeks after conception.

There are a number of other early symptoms that are common, including bloating, mood swings, dizziness, constipation and a rise in basal body temperature (your temperature when you first wake up in the morning).

INCREASED URINATION Some women find they need to pee more often shortly after conception, and throughout early pregnancy, due to hormone changes and the need for your kidneys to operate more efficiently than usual.

FATIGUE Many women report fatigue as the earliest pregnancy symptoms, and this can continue right up to the second trimester. The cause is believed to be the soaring levels of progesterone in early pregnancy.

SMELL SENSITIVITY A heightened sense of smell is another early symptom, and can cause nausea.

In addition, some women report food aversions or cravings as early as a few weeks after conception.

CRAMPS/SPOTTING Just to confuse you even further, cramps and spotting are common around implantation, when the fertilised egg attaches to the lining of the uterus — about 10 to 14 days after conception.

HOW DO home pregnancy tests work?

A home pregnancy test measures the amount of hCG, the pregnancy hormone, in your urine. Some tests are more sensitive than others, but to minimise the trauma of a false negative result, try to wait until the day your period is due to test (usually two weeks after you ovulate).

If you get a negative result, wait three days and if you still don’t have your period, test again, as you may have ovulated later than thought.

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HAVING A BABY IS

A BIG CHANGE AND ANOTHER AND ANOTHER, AND ANOTHER

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THE FIRST TRIMESTER

CHAPTER

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2 THE FIRST TRIMESTER Congratulations! You’re pregnant and looking forward to nine happy and healthy months! If this is your first pregnancy, you might be wondering what to expect and anxiously waiting for that magical 12-week mark when the chance of miscarriage goes down substantially. In this chapter, we cover all you need to know about the first three months of pregnancy, from making your first hospital appointment to navigating your way through morning sickness.

What’s happening to you and your baby?

T

he first trimester covers the period 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. It’s incredible to realise that even though you mightn’t look at all pregnant (many women don’t report even a tiny bump until the second trimester), there is lots of important work going on within your uterus. Here we take you through the first few months of your baby’s development.

THE FIRST TRIMESTER

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.

WEEK 6 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.

WEEK 8 Your baby is now about the size of a grape. She will probably make her first movements this week, though

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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 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.

WEEK 10 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.

WEEK 12

an early 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. If this is too long to wait, there are a number of private clinics around the country that offer early pregnancy scans from as early as seven or eight weeks’ pregnant.

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.

THE FIRST TRIMESTER

Your baby’s head is now fully formed. Eyes and eyelids are complete. Fingers and toes are

DO I NEED AN

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WHAT

should I ask?

APPOINTMENT

THE FIRST TRIMESTER

card

● Your due date: your GP will ask you the date of your last period and will estimate your due date from then. Remember the date of your last period; you’ll be asked this again and again and again! ● Any worries or concerns health-wise: If you have any long-term health issue, your GP will advise you on how best to proceed, eg if there is a special clinic to attend or an obstetrician recommended for your condition. ● What to expect: if this is your first pregnancy, you may be concerned about what to expect over the next few months. If you are worried, discuss this with your GP. In addition, if you have suffered problem pregnancies or miscarriages, your GP can advise you on the best course of action if you have any concerns between now and your first hospital appointment. ● When you should have your vaccinations: There are a number of vaccinations recommended during pregnancy, including Whooping Cough and Seasonal Flu – see pxx for more information on these. Talk to your doctor about if and when you should get these.

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TESTS CONDUCTED . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................. ............................................. ............................................. .............................................

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MAKING

decisions

N

ow your pregnancy is confirmed it’s time to make some decisions. What care do I want? More importantly, what can I afford and do I have insurance to cover any of my care?

PUBLIC OR PRIVATE? WHAT IS

combined care?

Combined Care is when you share the appointments between the hospital and your GP. As your GP knows your history and will be caring for you and your baby after the birth, many women prefer to build up this relationship now during pregnancy. A general schedule of appointments is as follows, although this can be changed as needed by your midwife/ obstetrician/GP. In addition, if you have added health issues, such as gestational diabetes or high blood pressure, you can have an additional five GP visits. ● Before 12 weeks GP ● Before 20 weeks Hospital (booking-in visit) ● 24 weeks GP ● 28 weeks GP or Hospital ● 30 weeks GP ● 32 weeks Hospital ● 34 weeks GP ● 36 weeks Hospital ● 37 weeks GP ● 38 weeks Hospital ● 39 weeks GP ● 40 weeks Hospital See www.hse.ie for more.

You will also have a baby check with your GP at two weeks post-birth, and a check-up for both you and your baby at six weeks post-birth.

THE FIRST TRIMESTER

The vast majority of women opt for a hospital birth. Depending on your hospital, you may have a choice between public and private care.

Some hospitals also offer a semi-private option.

Every woman is entitled to pregnancy care in the public health system, and our hospitals do an admirable job of dealing with the high numbers of pregnancies every year. Some women prefer a more personalised system of care, as offered under private or semi-private care. Under these schemes, it may be possible to choose your obstetrician or to opt for a ward with a smaller number of beds or even a private room (note: most hospitals don’t guarantee a specific ward or private room, but it’s done instead on a first-come, first-served basis for semi-private or private patients. Here’s what to consider: ● Do you have health insurance that will cover semi-private or private care? If not, can you afford to pay for everything privately (your hospital will be able to advise of fees)? ● If you do have health insurance, it’s up to you to check that your policy covers what you want in the hospital of your choice – so make that call before you book into the hospital. ● Remember that you will probably have to pay a deposit (for semi-private) or a private consultancy fee up-front for the obstetrician of your choice – talk to your hospital about this.

Some health insurance policies will pay for some of this, but if not, you can claim for 20 per cent of this on your medical expenses tax return at the end of the year. ● Most importantly, make your decision quickly and ring up to book your first appointment.

There are increasing numbers of pregnancies in Ireland every year, and first appointments and popular obstetricians can book up very quickly.

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HOME

births

It is possible to have a home birth if you are healthy and low risk.

According to the HSE, research shows that a planned home birth is a safe alternative to a planned hospital birth for some pregnant women. If you are interested in a home birth, your first port of call is your GP who will be able to advise you if it’s a viable option for you.

Some of the reasons for having a home birth include: ● Wanting to feel more in control ● A previous bad experience and feeling safer at home ● Desire to avoid intervention ● Freedom to move around and to choose your own method of pain relief, eg water births, acupuncture or massage

● Wanting to be surrounded by family and your other children (especially after giving birth, therefore avoiding any separation anxiety with older children) Currently in Ireland there is a National Domiciliary Midwifery service available to eligible expectant mothers who wish to avail of a home birth service under the care of a self-employed community midwife (SECM). This service is provided by the SECM on behalf of the HSE who signs the Agreement with the Health Services Executive (HSE).

An approved home birth with a registered SECM is free of charge for the mother, as the HSE pays the SECM directly. The

service extends from the date the application form has been approved by the HSE until the baby is 14 days old; the SECM’s indemnity insurance covers the same period.

Your midwife will advise you to also register with a GP for your prenatal care and with your chosen maternity hospital – some hospitals have a home birth liaison consultant. Any risks to you or your baby are constantly assessed throughout your pregnancy, and if any concerns arise that may contraindicate with a home birth, you may be advised to transfer to hospital-based care. All risk factors, both pre- and during pregnancy, are outlined on the HSE’s website, and will be advised to you by your midwife. See more at www.hse.ie

THE FIRST TRIMESTER

WHAT ABOUT A

private arrangement?

If you and your chosen SECM opt for a home birth outside the terms of the agreement or without applying to the HSE for the service, then the midwife (even if she is a registered midwife) will not be covered by the HSE’s Clinical Indemnity Scheme for any subsequent medical malpractice claims or inquests. It is up to the expectant mother to make sure the midwife has adequate alternative insurance cover in place.

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hospital appointment

I

f you’ve opted for a hospital birth, once you’ve booked, it’s a waiting game now – your booking-in visit is generally made for between 12 and 15 weeks gestation, although this can vary from hospital to hospital, and from woman to woman. This can be a long wait, especially if it’s your first pregnancy, but there are a few things to bear in mind while you are waiting.

Generally, your first hospital appointment takes up to two hours (your hospital will advise you of the time needed). Policies differ between hospitals, but generally you may have the following: ● Midwife consultation ● Dating scan ● Doctor consultation During your consultation with the midwife, your details and family history will be taken, and any areas of concern will be

5

discussed. Your midwife will also discuss with you any information you need for a healthy pregnancy, such as nutrition, pre-natal care, breastfeeding and ante-natal classes. Depending on what’s available in your hospital, you may be able to opt now for midwife care or other specific methods of care.

The midwife will also check things like your blood pressure, weight and urine sample.

Depending on hospital policy, you may have your first scan at this visit. This is just a dating scan, to check that your dates are accurate and to give you a definite due date.

Remember – you must have a full bladder for this scan.

Finally, you may have a consultation with a doctor, in which he/she will discuss any areas of concern raised by the midwife.

This is also a chance for you to raise any issues or worries you may have, either with your or the baby.

QUESTIONS TO ASK AT YOUR FIRST VISIT

1 When is my due date?

2 Can I keep taking my medications/supplements?

3 What dietary or exercise advice should I follow?

4 What is my schedule of hospital, doctor and scan visits?

5 Is there a number I can call if I am worried or if there is an emergency?

CAN I GET AN

early scan?

Depending on hospital policy, you may be offered a scan during your booking-in visit to date your pregnancy. But if you can’t wait until this time, it is possible to get a private scan for a cost at a number of scanning clinics around the country. Generally this is not recommended before eight or nine weeks of gestation. For some women, however, it can be hugely reassuring to see that tiny heartbeat on the screen.

WHAT IF SOMETHING

goes wrong?

If you experience bleeding, discomfort or are worried in any way, your first port of call is your GP. He/she may refer you on to your maternity hospital’s Early Pregnancy Unit (EPU) or emergency department. Bleeding can be common in early pregnancy so the important thing is not to panic. Always get any worries or niggles checked out.

THE FIRST TRIMESTER

YOUR FIRST

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HEALTHY eating

H

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 advice from a qualified dietitian.

Essential nutrients

THE FIRST TRIMESTER

FOLIC ACID

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.

AM I eating for two

?

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

60

12

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

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

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 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

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.

THE FIRST TRIMESTER

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

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Healthy snacks in pregnancy SUITABLE SNACK FOOD

SERVING SIZE (G)

CALORIES (KCAL)

Soda bread 1 slice (with honey)

43 (10)

100 (29)

1 cup* of bran type cereal

30

134

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

70 (30 of cheese & 50 of tomato)

160 (208 with cheese & 0 tomato)

1 small can of baked beans

140

111

Scrambled eggs (2 eggs, no milk)

120

192

1 pot low fat plain yogurt

125

71

1 cup* fortified low fat milk

200

84

1 cup* fortified full fat milk

200

120

1 small tin of tuna (in brine, drained)

70

80.5

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

100

95

A WORD ABOUT allergies

Unless you are allergic to a particular food or ingredient, eg eggs, fish, milk or milk products, there is no evidence to suggest that avoiding certain foods during 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*

THE FIRST TRIMESTER

Food safety during pregnancy ● Eat only freshly cooked food and well-washed freshly prepared fruit and 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 and 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 contribute to 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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PRENATAL supplements & vitamins ● Do I need a general prenatal supplement?

As discussed on the last few pages, this is one instance in your life when it’s essential that you take a supplement – at the very minimum, one containing 400 micrograms of folic acid.

As these defects develop in the first 28 days after conception, before many women know they are pregnant, it’s recommended that women should take a folic acid supplement for three months before conception and the first three months of pregnancy. Plus, as many pregnancies are unplanned, it’s recommended that all women of child-bearing age should take folic acid to guard against such defects. ● Do I need a full prenatal vitamin?

● What should I look for in a general prenatal vitamin?

As well as 400 micrograms of folic acid, a prenatal vitamin should contain 10 micrograms of Vitamin D, which helps to regulate the levels of calcium and phosphate in your body.

The best source of Vitamin D is from the sun, but unfortunately the Irish climate doesn’t produce enough sun to keep

our levels of Vitamin D up. If you are lacking in Vitamin D, your baby will be born with low levels of Vitamin D too, which he/she needs to build strong bones. Specific prenatal vitamins also contain iron and calcium, as well as general vitamins such as B and C. ● Is there anything I should avoid?

If you are going to take a supplement, go for a specific prenatal one, as you should avoid retinol, the animal form of Vitamin A, which is toxic to your unborn baby in large doses. Vitamin A in the plant form (beta-carotene) is okay, although many prenatal vitamins don’t contain Vitamin A at all. Don’t ever be tempted to take a multivitamin not intended for prenatal use unless cleared by your doctor in case it contains retinol, and never take more than the recommended dose.

THE FIRST TRIMESTER

Strictly speaking, apart from folic acid, if you have a healthy and balanced diet, you don’t need a vitamin. However, it is

true that when pregnant you and your baby need more of certain nutrients (as detailed in the last three pages of this handbook), so if your diet is lacking in any way, or if your doctor indicates that your vitamin or mineral levels are low, a supplement may be recommended. If you are suffering from bad morning sickness and not eating much as a result, a general pregnancy vitamin can be a handy way to make sure you are getting all your nutrients.

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DEALING WITH

morning sickness

M

orning sickness typically begins four to eight weeks into the pregnancy and continues for up to 16 weeks. The nausea you experience at some point of the day is caused by reaction to human chorionic gonadotrophin (HCG), a chemical essential for the survival of the fertilized egg. From mild nausea to morning, noon and night vomiting, morning sickness affects as many as eight out of ten pregnant women.

It may be a good sign but it’s still bloody miserable.

THE FIRST TRIMESTER

WATCH YOUR DIET Standard advice is to look at what, when and how you are eating. An empty stomach is likely to cause more nausea (hence why most women suffer in the morning), so eating little and often can help.

Keep to simple, bland food like toast and crackers, and make sure to keep hydrated by sipping water throughout the day. Some women find it beneficial to eat something little before getting out of bed in the morning so keep some crackers by the bed. Avoid caffeine, spicy food and fatty foods.

GO GINGER Some women find that ginger can help their symptoms, but try not to

rely on ginger biscuits (although in an emergency, these can help).

Instead, try making a tea from grated root ginger, by steeping two teaspoons in boiled water, leaving it to cool and sipping it during the day. Don’t take more than three teaspoons of raw ginger a day.

Alternatively, try ginger teabags or ginger capsules.

PEPPERMINT REMEDY According to Chinese medicine, ginger is suitable if you crave warmth, but if you feel constantly hot and irritable and crave coolness, peppermint might be for you. Peppermint tea is great for relieving nausea, and having sugar-free peppermint sweets and chewing gum in your bag is essential for those early weeks.

Experiment with this one, as peppermint that is too strong might make the nausea worse.

UNDER PRESSURE Some women report relief from wristbands (often marketed for travel sickness) that apply pressure on an acupuncture point (pericardium point six). To locate the right spot, measure three finger widths down from the wrist joint.

Lift your third finger off gently and feel for a slight dip. This spot

is tender and you’ll think you’re bruising yourself by pressing on it. The button on the wristbands should be pressing on this spot.

Press on these spots about 20-30 times about one second apart if you feel nausea.

VITAMIN B Some studies have indicated that taking extra vitamin B6 may help nausea. The good news is that this is easily achieved through your diet; good sources include bananas, nuts, green beans, carrots, cauliflower, potatoes, lean meats and fish. Your prenatal multivitamin will contain B6 too.

If you feel you don’t get enough B6, talk to your doctor or midwife, who may suggest you take 25mg, three times a day. However, never take supplements without seeking medical advice first.

GET HELP If your morning sickness is taking over your life and you can’t function for days or weeks at a time, or if you feel you’re getting dehydrated, talk to your GP, obstetrician or midwife. You may need rehydrating or safe prescribed medication. As always, though, if you are worried, get medical advice.

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HYPEREMESIS gravidarum

There is no doubting that HG is exhausting, worrying and miserable, but the good news is that it’s unlikely to affect your baby. If left untreated, your baby may have a low birth weight but in general, your baby is fine even if you feel awful. That said, it’s imperative that you do seek help, as you run the risk of dehydration if you can’t keep anything down. It’s also hard to take care of yourself and those around you with HG – but there’s no need to suffer in silence.

If you can’t keep water down, contact your GP or midwife as soon as you can as you could be at risk of dehydration. Signs of dehydration include dark or little urine, or not needing to go to the toilet for seven to eight hours or more. You may be admitted if you are dehydrated so your body can be rehydrated through a drip.

Symptoms you shouldn’t ignore There are a number of symptoms that could be related to HG or could be a sign of something else that you need to report to your medical team. These include: ● Tummy pain ● Fever ● Severe weakness ● Pain when peeing ● Dizziness or confusion ● Blood in your vomit ● Headache It’s important to get your HG treated, or any other worrying symptoms. Dehydration and staying in bed can increase your chances of deep vein thrombosis, so if you are admitted to hospital you may be given compression stockings to wear.

THE FIRST TRIMESTER

Kate Middleton famously suffered from Hyperemesis gravidarum (HG), but what is it? In essence, HG is excessive vomiting in pregnancy. It is relatively rare, and is thought to affect around one in every 100 mums to be. HG generally begins sometime between four and seven weeks and continues until 15 weeks-plus. In most cases, it will have cleared up by week 20, but for some unfortunate women, it can continue right up to the birth.

It’s not known what causes HG, apart from the same reason for morning sickness in general: hormones. It is believed that some women may be more at risk than others. These include: ● You’re pregnant for the first time ● You’re expecting twins or more ● Your mother or sister had HG ● You had HG in a previous pregnancy ● You were overweight at the start of your pregnancy

Treating HG First and foremost, don’t feel guilty for feeling awful and perhaps even resenting the pregnancy for making you feel bad. This is perfectly normal. HG is extremely hard to endure. If you suspect you may have HG, try taking these steps: ● Talk to your doctor or midwife as soon as you can.

There is treatment available that can help relieve your symptoms, and if you are treated early for HG, hopefully it won’t get too bad. ● Accept all the help you’re offered and don’t be afraid to ask your partner, family or friends for help with practical things. ● Forget about healthy eating for now; listen to your body and eat what you want. If that’s just toast or biscuits, so be it. It won’t last forever. ● Avoid sights and smells that make you nauseous.

Don’t cook if the smell makes you feel sick. ● If food is an issue, try keeping hydrated by sucking ice cubes or taking tiny sips of water. ● Get as much rest as you can, as tiredness can make your symptoms worse.

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FITNESS

in pregnancy

THE FIRST TRIMESTER

W

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 low-impact 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 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).

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● 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.

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 GP or obstetrician.

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. ● 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.

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

LISTEN TO YOUR

body

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

THE FIRST TRIMESTER

WHAT EXERCISE SHOULD I DO?

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THE FIRST TRIMESTER

ZUMBA AND DANCE: Are they suitable for pregnancy?

Dr Joanna Helcké, author of The Little Book Of Making Your Exercise Safe For Pregnancy, says that Zumba and dance classes can be adapted to suit pregnancy.

Remember to say it to your instructor so s/he can advise you further.

“There is no doubt that Zumba and dancing in general have the feel-good factor about them. I always say to people that dancing is good for the soul. I am a great believer in exercising for emotional wellbeing and if you enjoy dancing then it will definitely make you happy. So from this perspective, dance is a great way of keeping fit, including in pregnancy, but there are definitely certain considerations to be taken into account when you are expecting.”

Dr Helcké outlines a few pointers for pregnant dance fans: ● Latin-type dance includes a

good deal of twisting of the pelvic area and with the load of pregnancy being carried by the pelvis, this is a vulnerable area prone to complications such as pelvic girdle pain and lower backache. Given this, I would recommend that if you do decide to arry on with Zumba in pregnancy that you adapt the class by missing out the twisting rotational movements of the pelvis. ● Ideally it would be best to attend a Zumba class that is led by an instructor who has a qualification in ante- and postnatal exercise as s/he will know exactly how to adapt things for your safety. ● When you are having fun it is easy to become a little careless with your movements and to even overdo things. In pregnancy it is important to exercise with excellent form and also not to

get too hot, so if you decide to carry on dancing in pregnancy, be sure not to work at too intense a level. ● Certain dance forms are very focused on taking your limbs beyond their normal range of movement, ballet being a case in point. In pregnancy this should be avoided so as not to overstretch or strain the ligaments, a possibility due to the high relaxin levels in the body. So keep dance moves smaller and more restrained in pregnancy. ● If you really love dancing but find it hard to do so within the constraints mentioned above, you might find it better to opt for a more standard exercise to music class. This will give you the music side of things without the twisting, turning and pelvic movements associated with dance.

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MENTAL &

practical care

THE FIRST TRIMESTER

I

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.

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

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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

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.

THE FIRST TRIMESTER

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 smear test, wait three months before having your 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

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ILLNESS &

vaccinations

M

ost women will get sick at some point during their pregnancy. Any health issues should be brought up with your GP or medical team, but there are some strategies that you can try for more minor illnesses.

THE FIRST TRIMESTER

TREATING A VOMITING BUG In the early months of pregnancy, it cane be difficult to differentiate between a stomach bug, food poisoning and morning sickness.

One possible indication is if your nausea and vomiting is accompanied by cramps, fever or diarrhoea. In any case, the treatment is roughly the same: get plenty of rest and guard against dehydration. Signs of dehydration include not urinating often enough and passing darkcoloured urine. Keep sipping liquids – water, weak decaffeinated tea, clear broth or hot water with lemon – and if you can’t

keep down liquids, try sucking on ice cubes. If you suspect dehydration, always consult your GP. In terms of solids, follow your body’s lead and keep it plain and bland – unbuttered toast or plain crackers are a good start, or follow the BRAT diet (bananas, rice, applesauce, toast).

If you are suffering from wind or cramps, there may be some over-the-counter remedies suitable for use during pregnancy.

Rehydration powder sachets may also be recommended but always follow medical advice from your pharmacist or GP when taking any medication, whether it’s on prescription or over the counter.

TREATING COLDS AND FLUS During pregnancy, your immune system is compromised, which means you’re more at risk of colds and flus. Colds are caused

by viruses, and sufferers generally choose to treat symptoms with over-the-counter medications.

Many of these are unsuitable for use during pregnancy, so it’s always a good idea to talk to your pharmacist about what you can take. Rest up and keep hydrated, and make sure you’re eating well and healthily. Steam and Vicks are safe for helping unblock your nose, while a spoon of honey in water with lemon can help relieve a sore throat (remember that honey is okay for pregnant women in moderation but is unsuitable for babies under the age of one). Try elevating your head when sleeping.

Talk to your doctor is you’re running a high fever, if you can’t eat or sleep, if you’re coughing up green or yellow mucus, if you have chest pain or wheezing, if your sinuses are sore and if your cold last for more than a week or so.

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TREATING HAY FEVER

PREGNANCY

vaccinations It’s not just your newborn baby who needs vaccinations – the HSE now recommends that expectant mothers have vaccinations against seasonal flu and pertussis (whooping cough).

WHOOPING COUGH The whooping cough (pertussis) vaccine is essential during pregnancy as the mother’s immunity to whooping cough diminishes as the nine months progress. Babies under the age of six months are too young to be vaccinated against whooping cough, yet the disease tends to be most serious in this age group. The answer is for the mother to be vaccinated during pregnancy, therefore passing on the immunity to the baby who is protected then for the first few months of life.

What vaccine do I need?

The vaccine given during pregnancy is called a Tdap vaccine, which is a low dose tetanus (T), diphtheria (d) and acellular pertussis (ap) booster vaccine, protecting against tetanus, diphtheria and whooping cough (pertussis).

Vaccination is recommended between 27 and 36 weeks of pregnancy. This is considered the best time in pregnancy to provide protection for the baby during the first few months of life.

so it’s essential that your child gets the routine childhood vaccines at two, four and six months to stay protected.

SEASONAL FLU The flu season runs from October through to April, so if you’re pregnant during this time (even if it’s just for a month or two either end), you should get the seasonal flu vaccine.

How serious is flu?

For most people, flu is self-limiting, and recovery generally occurs within two to seven days. But in some cases it can be severe and can result in serious respiratory complications, including pneumonia and bronchitis. Pregnant women have also been found to be at increased risk of the complications of flu, thanks to their compromised immune systems.

Why should pregnant women get the vaccine?

According to the HSE, pregnant women are more likely to get complications from flu due to changes in their heart and lung function.

Getting flu in pregnancy may also lead to premature birth and smaller birth weight. The seasonal flu vaccine can be given at any stage of pregnancy.

Do I need it every pregnancy?

Yes – as your immunity wanes during pregnancy, you need a new vaccine each pregnancy so the antibodies can be passed on to each unborn child.

Will the vaccine protect my baby?

Yes. Vaccination during pregnancy can protect your baby for up to the first six months and also prevent you getting flu and passing it on to your baby.

How long is my baby protected from whooping cough?

If you get the vaccine during pregnancy, your baby is protected for the first few months of life. However, the levels of antibodies rapidly decline,

Your maternity hospital or GP can organise vaccines for you and answer any questions you have.

The HSE’s website also has an excellent information section; log on to www.hse.ie for more.

THE FIRST TRIMESTER

Symptoms of hay fever include streaming eyes, sneezing, blocked nose and stuffed sinuses. Many of the usual over-the-counter remedies like antihistamines are unsuitable for use during pregnancy, but there are some drug-free alternatives like a sinus rinse or saline spray that are very effective for keeping the pollen from going into your sinuses.

Alternatively, a smear of Vaseline around your nostrils can stop the pollen from entering your nose in the first place. Try, too, the following strategies for avoiding hay fever symptoms – if your symptoms become too hard to manage, consult your GP who can prescribe you a safe remedy. ● Keep a diary of symptoms.

Knowing your triggers is the best way to avoid bad bursts of hay fever. ● Keep track of the pollen forecast each day so you know if you have to take precautions in advance. ● When inside, keep your windows closed. ● Don’t hang your clothes outside to dry, as the pollen will stick to them.

Keep your house dustfree and change your bed clothes frequently. ● Wear sunglasses outside to protect your eyes from pollen, and shower and change your clothes immediately when you go back inside. ● Avoid triggers. If grass pollen sets your hay fever off, get someone else to mow the lawn. Similarly, if dust acts as a trigger, get someone else to vacuum and leave the house while they are doing it.

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COPING WITH

miscarriage

U

nfortunately, sometimes things don’t go according to plan. In this section, we take a look at miscarriage and ectopic pregnancy and answer some common questions that may be raised by these sad events.

THE FIRST TRIMESTER

Coping with miscarriage

Sadly, 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 increase risk.

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.

WILL IT HAPPEN TO ME? 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

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& Information Group (NISIG): www.miscarriage.ie UK Miscarriage Association: www.miscarriageassociation.org.uk Miscarriage Association of Northern Ireland: www.miscarriageassociationni.org.uk

WHAT HAPPENS AFTER A MISCARRIAGE?

Ectopic pregnancy

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.

FOR MORE ADVICE CONTACT: Miscarriage Association of Ireland: www.miscarriage.ie A Little Lifetime Foundation: www.alittlelifetime.ie National Infertility and Support

Ectopic pregnancy is a lifethreatening condition affecting 1 in 80 pregnancies. An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus. About 95 per cent of ectopic pregnancies occur in the fallopian tube (also known as tubal pregnancies) but it is possible to have an ectopic pregnancy in the ovaries, cervix or abdomen. An ectopic pregnancy occurs when the fertilized egg implants outside the uterus. If not treated, the ectopic pregnancy can rupture and cause severe bleeding, which may lead to collapse and maternal death.

WHAT ARE THE SYMPTOMS OF AN ECTOPIC PREGNANCY? ● Abdominal pain. This pain can either be constant and severe, or can come and go.

Generally this pain is on the side of the ectopic pregnancy but this is not always the case ● Shoulder-tip pain ● Vaginal bleeding – this bleeding is usually light and might also be constant or come and go ● A late or missed menstrual period ● Pain or diarrhoea during a bowel movement ● Pain when passing urine ● Nausea ● A positive urine pregnancy test. However, in some cases of ectopic pregnancy a urine pregnancy test is negative ● Feeling light headed or faint or actual collapse. The symptoms vary from woman to woman and this can make the diagnosis difficult

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.

THE FIRST TRIMESTER

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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HOW IS AN ECTOPIC PREGNANCY DIAGNOSED?

WHAT ARE MY CHANCES OF ANOTHER ECTOPIC PREGNANCY?

The main methods of diagnosis are: ● The measurement of the pregnancy hormone beta hCG in the blood (it is usually lower and rises more slowly in an ectopic pregnancy) ● A vaginal ultrasound scan ● Laparoscopy

Your chance of another ectopic is higher than normal (approximately 10 per cent). However, that means that 90 per cent of subsequent pregnancies will be in the normal place, ie the womb. It is important that when you next find out you are pregnant that you present yourself for an early scan to ensure that the pregnancy is intrauterine (this can be confirmed at around six weeks).

HOW ABOUT RECOVERY? An ectopic pregnancy can be an overwhelming experience. It involves the loss of a pregnancy, often the physical recovery following surgery and blood loss, but also the uncertainty of your future fertility. It can be a very confusing time. Your physical recovery will differ depending on the treatment you may have had. Recovery from surgery will obviously take longer.

It can take up to six weeks for the pregnancy hormones to dissipate and this can also be confusing to your recovering body. Your emotional recovery, however, is not so easy to put a time frame on.

THE FIRST TRIMESTER

WHAT ABOUT MY FERTILITY? This is a common question following removal of a fallopian tube and / or ovary. Your fertility has been affected but not to the degree you may fear. Even if your tube was removed, you should have been told if your remaining tube appeared normal. If it is, the majority of women are pregnant again within 18 months of trying. However, if you have not conceived after six to nine months of trying, you should consult your GP or consultant.

This is particularly important if it took a while to get pregnant with the original ectopic pregnancy.

Some women may be very unlucky and have damage to both fallopian tubes or even two consecutive ectopic pregnancies resulting in the loss of both tubes. This is thankfully rare and IVF can be an excellent treatment in such cases.

THANKS TO ECTOPIC PREGNANCY IRELAND. For help and support after ectopic pregnancy, contact Ectopic Pregnancy Ireland www.ectopicireland.ie Tel: 089 436 5742 Email: info@ectopicireland.ie Ectopic Pregnancy Ireland, Carmichael Centre for Voluntary Groups, North Brunswick Street, Dublin 7

HOW IS AN

ectopic pregnancy treated?

Unfortunately an ectopic pregnancy cannot be saved. In some cases the ectopic pregnancy does not progress and it may be possible to manage the pregnancy without surgery, ie by monitoring the hCG levels until they fall and by using ultrasound scans throughout.

Other treatment options include: ● Keyhole surgery (laparoscopy) This is performed under general anaesthetic to examine the inside of the abdominal cavity and to remove the ectopic pregnancy. In some cases, it might be possible to remove the ectopic leaving the tube intact but if the ectopic is large, if the tube is badly damaged or if there is significant bleeding the tube and pregnancy will be removed together. ● Abdominal surgery (laparotomy) If the ectopic pregnancy has not been diagnosed soon enough or the woman presents with severe symptoms, then she may need open abdominal surgery to remove the ectopic. In this case, it is unlikely that the tube will be saved. ● Treatment with Methotrexate Methotrexate is a drug that is given in injection form to treat ectopic pregnancy, although it is not a suitable treatment in all cases. Regular monitoring with blood tests is required until the beta hCG levels fall to non-pregnant levels.

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THE SECOND TRIMESTER

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3 THE SECOND TRIMESTER Many couples feel relieved once the 12-week mark has passed, as the risk of miscarriage reduces significantly. You may have also had a scan and seen that all-important heart beating away, which is always hugely reassuring. Your second trimester is often the most exciting part of pregnancy, as morning sickness passes and you start feeling more energetic. In this chapter we looking at what to expect during your second trimester, and how you can start preparing practically for your baby, in terms of budgeting and work.

What’s happening to you and your baby?

T

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 14 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.

WEEK 16 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.

THE SECOND TRIMESTER

WEEK 18 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 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.

WEEK 20 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.

WEEK 24 Your baby would have a chance of survival if born 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).

WEEK 26 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.

WEEK 28 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.

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PREGNANCY

Niggles & Symptoms

BACKACHE You may start feeling the extra weight of your baby and bump.

Make sure you sit in a chair with good support, and wear shoes with low heels and plenty of arch support.

Sleeping with a pillow between your legs can help too. Pregnancy yoga or Pilates can help strengthen your lower back; most courses recommend you begin during your second trimester. If the pain is severe, seek medical attention, as a physio might be able to help.

HOW DO I

count 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.

BREAST ENLARGEMENT It’s not just your tummy that is growing – your breasts are too.

During the first trimester you may have experienced some breast tenderness; this hopefully is easing off now, but your breasts

are growing and preparing to feed your baby. Make sure you are wearing a good supporting bra. It’s not unusual to go up a full cup size during the second trimester, so be prepared to invest in some new underwear!

THE SECOND TRIMESTER

T

he second trimester is when you start to feel – and show – the physical signs of pregnancy. Many women find that they start showing a small bump during the early part of the second trimester, often “popping” sometime from the fifth month onwards. Every woman is different, however, so don’t worry if your bump is bigger or smaller than another woman’s – as long as your doctor is confident that your baby is developing and growing at a good rate, everything is progressing as normal.

As your bump grows, you may start feeling some physical effects of pregnancy. These could include the following:

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Look forward to a happy pregnancy

on healthy legs!

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CONGESTION If you suffer from hayfever or dust allergies, you may find that these worsen during pregnancy (see pxx for more). However, even if you don’t, you may experience nasal congestion or nose bleeds during the second trimester. Hormonal changes can cause your mucus membranes to swell, which can result in a stuffy nose and snoring. It’s also common to get nose bleeds at this stage too. Again, seek attention if this is worrying you, otherwise natural methods such as saline sprays can help relieve congestion.

Many women “glow” during their second trimester – but many suffer skin issues during pregnancy, including acne or newly dry or oily skin. Some experience what is called “the mask of pregnancy”, this is due to an increase in melanin leading to brown patches on the face. You may find that you’re more sensitive to the sun during this time too; wear a high SPF and limit exposure between 11am and 2pm.

You may also start seeing the first signs of stretch marks – see p48 for more on dealing with these.

never to ignore As always, contact your doctor if you have any worries at all. Call your doctor immediately if you experience any of the following: ● Severe cramping or pain ● Bad dizziness ● Bleeding ● Rapid or too little weight gain

HAIR GROWTH A lot of press is given to the fact that your hair is thicker and more luscious than ever during pregnancy. But the truth is that hair growth is boosted elsewhere on your body; shaving and tweezing are the best options while pregnant; laser hair removal and electrolysis are not recommended during pregnancy. There’s no evidence that waxing is unsafe; however, your skin is more sensitive when pregnant so you may not find this as comfortable

APPOINTMENT

card

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...............................................................

as usual. Talk to your therapist first, as some have specific policies for pregnant clients.

VAGINAL DISCHARGE It’s normal to experience thin, milky-white vaginal discharge early in your pregnancy. Use a panty liner if you feel more comfortable with one, but don’t use a tampon as this can introduce bacteria into the vagina. If you experience a lot of discharge or if it’s bad smelling, green or yellow, or bloody, talk to your doctor.

Medical appointments Most women have their initial hospital visit around 12 weeks; once this is complete, it’s pretty quiet on the appointments front until week 24, when there’s a GP check-up scheduled under the Combined Care timetable. As always, though, if you have any worries or concerns, talk to your doctor.

Also, if any concerns have been raised during your booking-in visit, for instance high blood pressure, you may have some extra appointments. Always listen to your medical team and follow their advice.

THE SECOND TRIMESTER

SKIN CHANGES

SYMPTOMS

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ANOMALY scan

THE SECOND TRIMESTER

D

epending on hospital policy, you may be offered an anomaly scan at around 18-22 weeks of pregnancy. This is a detailed scan that checks your baby’s development and your placenta.

It may also be possible to tell the baby’s gender at this scan (check your hospital’s policy, however).

This scan will check: ● The shape and structure of your baby’s head ● Your baby’s face, especially for signs of a cleft lip ● Your baby’s spine, both along its length, and in cross section ● Your baby’s abdominal wall ● The placenta, umbilical cord and the amniotic fluid ● Your baby’s heart, and to make sure the four chambers are all working normally

SHOULD I FIND OUT

the gender?

● Your baby’s stomach ● Your baby’s kidneys and bladder, which are now working ● Your baby’s arms, legs, hands and feet If this is not offered as part of your hospital care, it is possible to have this done privately in a scanning clinic.

Or, if you want to find out your baby’s gender but this wasn’t possible at your hospital scan, some private scanning clinics offer a gender scan.

WHAT IF WE GET BAD NEWS? Getting bad news at the anomaly scan is a common worry for parents to be, but it’s relatively rare. According to Babycentre. co.uk, about 15 per cent of scans

YES

“Finding out we were having a girl made everything more real for us. We were able to talk seriously about names and started to consider her as a real baby. We even called her by name and sang to her at night!”

Helena, Co Donegal

NO

”There aren’t a lot of nice surprises in life, but finding out if your baby is a girl or a boy after labour is one of the nicest! The look of awe on my partner’s face when the doctor declared that we had a baby boy was something I’ll always remember!”

Cathy, Dublin 6

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If your sonographer suspects there is a problem, you will be told straightaway and booked in for a scan with a specialist. If a heart issue is suspected, a fetal echo scan will be booked; this looks at youra baby’s heart in detail. If an issue is confirmed, you will have plenty of support from medical specialists who will tell you the best way to treat or deal with the issue. Serious concerns are relatively rare; however, the medical team will support you as best they can all the way.

APPOINTMENT

card

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WEEKS PREGNANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................................... ...............................................................

SCAN

?

HOW DID YOU

cope

“I was a bag of nerves before the anomaly scan on my second baby.

- I don’t know why! But the doctor reassured me that bad news is relatively rare - and if there is bad news, it’s better to know now, as in many cases they can prepare or treat an issue.”

Cathy, Mayo

THE SECOND TRIMESTER

have to be redone, but this doesn’t mean there’s anything wrong, but usually that the baby is lying in an awkward position. Sometimes an issue might be found that doesn’t cause any problems to you or the baby. If something is found, the condition might be treatable upon birth, in which case your medical team can prepare in advance so they’re ready to treat your baby as soon as possible.

Sonographers look for a list of conditions at the scan. Some of these are easy to spot, but some are difficult. Here, according to Babycentre, is the list of signs the sonographer looks for: ● absence of the top of the head (anencephaly) ● cleft lip ● defect of the abdominal wall, where the bowel and liver protrude (exomphalos) ● defect of the abdominal wall, where the intestines protrude (gastroschisis) ● missing or very short limbs ● spina bifida ● major kidney problems ● hole in the muscle separating chest and abdomen ● excess fluid within the brain (hydrocephalus) ● Chromosomal abnormalities, such as Edwards syndrome ● major heart problems (defects of chambers, valves or vessels)

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LOOKING

& feeling good

J

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 high-fashion 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.

THE SECOND TRIMESTER

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

STRETCH

marks 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. ● You don’t need a specific stretch mark product. A good moisturiser rich in cocoa or shea butter will do a good job too. ● 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. ● Get into the habit of moisturising every day at the same time.

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BEAUTY IN pregnancy

● Keep things simple. If your skincare products are suitable for use during pregnancy, stick with them unless you encounter an issue such as sensitivity or acne. ● Switch to sensitive products.

If you are suffering from sensitivity, simplify your routine and use natural, non-irritant products.

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

● Go natural. Knowing what you’re putting on your skin is vital when you are pregnant.

A simple product such as a skincare oil (make sure it is suitable for use during pregnancy) is ideal for dry skin. ● Opt for mineral makeup.

Mineral makeup “sits” on the skin and therefore is suitable for sensitive skin and for women who are wary of skin reactions with products that could be absorbed into the first few layers of the skin. ● 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 TanOrganic, €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.

And remember, you will return to your normal level of shedding about three to six months after giving birth. ● 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 to colour your hair. Highlights minimise contact with the scalp as well. If in doubt, talk to your doctor or hair stylist.

outside, a maternity jacket or coat is a good buy.

work that are comfortable – these will be needed after the birth too!

BORROW FROM FRIENDS

LOCAL HIGH STREET STORES

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

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.

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

THE SECOND TRIMESTER

Morning sickness, stretchmarks, swollen ankles... there’s a lot about pregnancy that isn’t too glamorous. But even women who are unfortunate enough to suffer some of more unpleasant pregnancy symptoms can get some of the nicer bits – such as glossy, full-bodied hair and glowing skin.

In fact, some women can look and feel at their most beautiful during pregnancy, especially during the second trimester. And with a little bit of pampering, every woman can feel special right the way through the nine months.

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WORK

& travel

THE SECOND TRIMESTER

U

nless there is a specific reason for not doing certain activities, it’s generally believed that you should continue on everyday tasks as normal as your pregnancy progresses, but always with an eye on your health and energy levels.

Under 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.

You are entitled to 26 weeks’ maternity leave, with the option of a further 16 weeks’ unpaid leave, commencing no later than two weeks prior to your due date. If you find it too difficult to work during the final phase of your pregnancy, 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 associated with the pregnancy 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 as you can tack an extra few days on to the end of your 26 weeks.

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 full-time employment.

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 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.

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Money

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 what they deem to be unnecessary 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.

As of September 2016, fathers are entitled for two weeks’ statutory paternity leave. This can be taken at any time within the first six months following the birth or adoption placement. Providing sufficient PRSI contributions have been made, eligible fathers will be paid 230 weekly during paternity leave.

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

To apply for Maternity or Paternity Benefit, contact the Maternity Benefit section of the Department of Social Protection on: Tel: (01) 471 5898; Lo call: 1890 690 690; E: maternityben@welfare.ie; W: www.welfare.ie.

TRAVEL what’s safe?

Believe 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.

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.

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.

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 you doctor who can advise you on what vaccinations are safe and what aren’t.

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.

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.

THE SECOND TRIMESTER

TALK

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BUDGETING for baby

THE SECOND TRIMESTER

H

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. It’s estimated that a child costs about 10,000 a year, rising to 15,000 a year by secondary school age. Studies have indicated that the cost of raising a child to the age of 21 can cost between 250,000 and 300,000.

That’s a lot of dough! 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, as well as regular savings. ● 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 have a surplus, congratulations! If you don’t, you need to look at your list of expenses and make changes. 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. ● Don’t forget to include regular savings in your budget, both for those emergencies that inevitably crop up at the end of the month and for future expenses like education or a big purchase like a car.

INITIAL COSTS It’s easy to go crazy on new items for the baby, and if you read magazines and the internet, you’d be convinced that you need an awful lot of stuff for a new little one. The fact, though, is that while there are some things you really do need, a lot of the items available are not strictly necessary. The key is to look at your budget, and decide what you really need and what you can do without.

The following few pages will take you through the essential items, how you can save some money, and tips on choosing the really big essential buys like a travel system.

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MY BEST

baby buy “It cost an awful lot, but by far my best buy was my travel system. I bought one with a roomy carrycot for the early days, and the baby took all her naps in it for the first few months. I also found the ability to just put the car seat on the chassis invaluable in the early days - my baby used to nap in the car, and this way I could take her into the shops without waking her up first.

Then, as she grew, I turned it into a pushchair and it was sturdy enough to see her right the way through to pre-school. Even better, it’s still in great condition for the next baby, or even to sell secondhand!”

Alison, Co Dublin

“I was on quite a strict budget for my first baby, and bought a lot of things secondhand or borrowed from friends and family. I also resisted the urge to buy all those gorgeous baby clothes. However, when I found out I was pregnant, I went out and bought a tiny little furry coat. We had gone through a lot to conceive this little baby and I needed something concrete to hold onto during those early days before anyone else knew I was pregnant. Every night I went and held the coat for a few minutes and imagined a little baby in it. It sounds silly, but I believe that helped keep my spirit and mind positive for my growing baby.”

Niamh, Co Wicklow

“When it comes to advising people what to invest in and what to save on, I always tell them to think of the essentials first and foremost.

Your baby needs something to travel in, somewhere to sleep, something to eat and something to wear. So it’s a bit mad to admit that my best baby buy was something completely inconsequential!

Almost as an impulse buy, I cought a baby box in Mothercare - a plastic box with a removable tray for bath items. I used this as my changing box - I kept in there a couple of nappies, a pack of wipes, cream and a change of clothes. It was invaluable in an urgent Code Brown situation!”

Jenny, Co Dublin

FAMILY INCOME SUPPLEMENT (FIS) FIS is a weekly tax-free payment awarded to employees with children who earn below a certain threshold. Self-employed people are not eligible. To qualify, you most have at least one child who normally lives with you or is financially supported by you; the child 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) Designed for mothers or fathers parenting alone, the OPFP is given to a parent earning less than 425 a week. The amount depends on your earnings and number of eligible children. The age limit is slowly being reduced to the age of seven, which means as soon as your youngest child reaches the age of seven, you will no longer be eligible for the payment.

As this is being brought in gradually, however, you may still be eligible for older children depending on when you first applied for the payment.

CHILD BENEFIT Universal child benefit is paid to all parents of children under the age of 16 regardless of income. If your child has a disability or is in full-time education, this benefit is extended to the age of 18. The payment is 140 per child, and you are automatically registered for this when you register the child’s birth.

For more on State benefits, see www.citizensinformation.ie or www.welfare.ie

THE SECOND TRIMESTER

State help

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TWINS

or more!

THE SECOND TRIMESTER

W

ith celebrities like Amal Clooney and Beyonce recently giving birth to twins, it feels like twins are everywhere right now. But you’d be right in thinking there are more women giving birth to multiples right now – the numbers of multiple births are rising every year, thanks to a number of factors, including older mums and more sophisticated reproductive technology. Through natural conception the chances of having twins is 1 in 8, but with IVF, the chance of conceiving twins is 1 in 5 – depending of course on how many embryos are implanted.

The splitting of a single zygote

or fertilised egg causes monozygotic twins, or identical twins. Identical twins may share a placenta but will normally have their own amniotic sac. Conjoined twins occur when identical twins fail to separate. Nonidentical twins, or fraternal twins, are more common and involve two fertilised eggs. Each twin will have their own placenta and amniotic sac. Triplets or any higher multiple births can be identical, non-identical or a combination of both.

Having a multiple birth will mean more frequent ante-natal check-ups and your health will be monitored carefully. There will be more emphasis on certain nutrients,

ie folic acid, calcium, iron, protein and other essential nutrients. You will need to gain more weight. If you have a healthy weight prior to your pregnancy you should aim to gain between 37 and 54 pounds (17-25 kilograms). You should also take more precautions, for example, limiting some activities such as work, travel and physical activities.

The gestation period for multiple births will also differ; if you are having twins, your pregnancy is likely to last around 37 weeks; for triplets your gestation period will be around 34 weeks; and if you are having quadruplets it will be approximately 32 weeks.

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PREGNANCY with multiples

Is pregnancy with multiples harder?

Symptoms can be heightened.

For instance, your hormone levels can be higher, which could mean you are more susceptible to morning sickness during the first trimester – and it could last for longer. You put on more weight with multiples, which could increase the impact of tiredness, insomnia, backache, heartburn, haemorrhoids and varicose veins as your pregnancy progresses.

Should I finish up work earlier?

With multiples, you will probably give birth earlier, which means you will probably have to finish work sooner too. The added weight of more than one baby means that you might feel as big as someone at full term with one baby as early as 28 weeks – and so finishing up work even earlier than expected might be needed.

There may be an opportunity

to work from home or reduce to part-time hours, so perhaps talk to work about what might be possible ahead of time.

Am I at risk of going into premature labour?

The more babies you have the less likely you are to carry your pregnancy to full term. If you start to show signs of preterm labour, a steroid injection can be given to speed up the development of your baby’s lungs. Complications of premature birth include low birth weight, breathing and digestive problems, and underdeveloped organs.

What is delayed interval delivery?

This is rare. Delayed interval delivery is when one baby is delivered premature, while the other baby/ babies are able to continue development in the uterus.

Am I at a higher risk of complications?

Again, it depends on the mother and the pregnancy. Higher blood pressure is more common with multiples; if combined with protein in the urine, it could signify pre-eclampsia.

With a multiple pregnancy, you will be monitored more closely for any complications for you or the babies.

What is twin-to-twin transfusion?

Twin-to-twin transfusion can occur in identical twins, and generally manifests between 16 and 24 weeks. A blood vessel in the placenta connects the

babies’ circulatory systems, causing one baby to receive too much blood, and the other to receive too little. Laser surgery is the most effective treatment for this, and this is carried out in the National Maternity Hospital and in the Rotunda Hospital.

The Rotunda, in particular, is a world leader in relation to twinto-twin transfusion. See www. tttsfoundation.org for more.

Do I have to have a section?

Not necessarily. Caesarean sections are more common and frequently suggested, especially in the cases of triplets or higher – but it depends on the mum and the pregnancy. With twins, if the first baby is in the head down position, vaginal delivery is often possible. Sometimes complications can arise after the first delivery and a C-section is needed for the second twin.

Is there more government support for multiples?

Yes, there is increased Child Benefit. If you have twins, you get one and a half times the normal monthly rate for each child. For triplets and other multiple births, Child Benefit is paid at double the normal monthly rate for each child, provided at least three of the children remain qualified. In terms of practical, hands-on help, talk to your public health nurse about the possibility of home help from the HSE, but you may not be eligible for this or you may have to pay a fee. There is private help available, and support too. The Irish Multiple Births Association (www.imba.ie) is a great source of information and advice.

THE SECOND TRIMESTER

Will my pregnancy care be different?

You are likely to have more scans and appointments with a multiple pregnancy. This is to check that the babies are developing and growing well, and that you are not experiencing any bad symptoms.

Depending on your hospital, you may be asked to take part in a twin study, which could mean more scans. During the last two months of your pregnancy, you will have more frequent appointments. If at any stage, your medical team is worried about the growth of your babies, you may need regular monitoring to check the babies’ hearts or scans to measure the placental blood flow.

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LET KIDS

BREATHE EASY Don’t let a stuffy nose hold your little one back.

Help them run free with the Stérimar range of nasal sprays.

IN ASSOCIATION WITH STÉRIMAR

P

lay and exploration are vital for children’s healthy development, and as parents you want to make sure you’re supporting them as best you can as they explore and learn all about the world around them. A blocked nose can be very distressing for children, causing problems with everything from feeding and sleeping to generally getting on with their all-important play.

Made from 100% natural sea water, the Stérimar children’s range harnesses nature’s power to clear stuffy tiny little noses, relieve discomfort and allow your little one to breathe naturally, so that they can get on with their busy life.

Suitable from birth, Stérimar

Baby’s effective solution is gentle enough to use as part of your baby’s daily routine to help unblock tiny little noses, with no known risk of side effects. While it can also be used to help prevent the onset of colds, this wonder spray can also improve breathing to facilitate sleep and bottle- or breastfeeding, putting parents at rest. And don’t forget; babies cannot blow their nose!

In response to tiny little blocked noses and in order to protect children from classroom and playground nasties, Stérimar Kids is specifically formulated to rapidly decongest nasal passages and helps provide relief from congestion in children.

Suitable for use from three

months plus, Stérimar Kids’ solution has a slightly higher salt concentration than cells in the human body, to help naturally drain excess, contaminated mucus from the cells in the nasal lining, allowing your little one to breathe naturally and get on with their day.

As the UK’s number 1 GPrecommended brand* Stérimar children’s range are drug-, steroid- and preservative-free, allowing your little ones to get on with exploring life to the full.

Stérimar Baby (50ml); Stérimar Kids (50ml) both available from your local pharmacy at the new lower RRP€6.99. For more information on the range of Stérimar products please visit www.sterimarnasal.co.uk

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THE THIRD TRIMESTER

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4 THE THIRD TRIMESTER Your bump is getting bigger, the kicks are getting stronger and finally you are allowing yourself to get excited about an imminent arrival, all going well! Physically, this is the toughest part of your pregnancy, as you start getting bigger and more tired. Some of the more uncomfortable symptoms start appearing too – so it’s important to know what’s normal and what’s not at this stage. We take a look at what to expect in the third trimester, plus give a little advice on preparing for the birth.

What’s happening to you and your baby?

B

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 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. By week 32, your baby is 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. 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.

THE THIRD TRIMESTER

WEEK 34 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.

30 weeks DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. .............................................

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DON’T

forget

APPOINTMENTS Now you are into your final trimester, your appointments are beginning to ramp up. Expect an appointment with either your hospital or your GP every second week until 36 weeks and then every week until you give birth.

Now is the time to...

Pack your hospital bag!

Birth may feel like a long time away, but it is better to have your bag ready should you need it early for any reason. See pxx for more on what you need in your bag.

…to apply for your maternity benefit if you haven’t already. See p50 for contact details.

32 weeks DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32 & 34 WEEK APPOINTMENTS Many women feel that their bumps “pop” around about now, and they start feeling very pregnant! You will also be experiencing lots of movement – remember to take note of this movement and if you notice any reduction in movement, contact your GP or hospital as soon as possible.

........................................... ........................................... ........................................... ...........................................

Now is the time to...

Take your antenatal classes! You will have been told of these at your booking-in visit. There are several private options available around the country. It’s recommended that both you and your partner attend these classes, unless otherwise specified.

...........................................

34 weeks DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If you have been told that your baby is breech and you want to encourage him to turn, try these at-home tips (best tried after 32 weeks and before 35 weeks): ● Put something cold at the top of your bump to encourage your baby to turn away from the cold ● Put something warm or play soothing music at your pubic bone to encourage your baby to move closer to the warmth or music ● Try the breech tilt exercise, where you lift your hips higher than your head (stack pillows under your hips if it’s more comfortable) Going for a swim can also help as it keeps your pelvis and hips relaxed, encouraging turning. As always, talk to your doctor if you are worried.

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................... ........................................... ...........................................

THE THIRD TRIMESTER

TURNING A BABY

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WEEK 36

WEEK 38

WEEK 40

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.

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.

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. 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!

WHAT IS

THE THIRD TRIMESTER

false labour?

False labour is a term often used by women to describe Braxton Hicks contractions. What it really means is that the womb (uterine muscular walls) start to contact at irregular intervals. These tightenings can be a bit uncomfortable because as the muscle of the uterus tightens, it pushes the baby’s head lower into your pelvis causing pain and discomfort. These tightening start in late pregnancy and continue until you go into labour. The difference between these tightenings and the contractions of labour is firstly they are usually shorter and not as painful, and they are also more irregular and are most noticeable in the lower part of your abdomen. Labour pains are more painful, more regular and last up to a minute or so. They also cause pain across the whole of your tummy, not just low down.

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APPOINTMENTS 36 & 37 WEEK APPOINTMENTS Congratulations! Once you have reached 37 weeks, you have reached full term, according to hospitals. However, full term is considered 40 weeks unless there are complications. These are the appointments to discuss birth preferences with your caregiver. For instance if you are having a Caesarian section, you mat be asked to book a date now. Or now is a good time to give your midwife or obstetrician a copy of your birth plan.

36 weeks

37 weeks

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

38, 39 & 40 WEEK APPOINTMENTS

38 weeks

39 weeks

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40 weeks DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TESTS PERFORMED . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DOCTOR/MIDWIFE SEEN . . . . . . . . . . . . . . . . . . . . . . . .

NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

THE THIRD TRIMESTER

At this stage you may be feeling very impatient indeed to get things started! Appointments now are weekly, and the tests performed in each appointment differ from woman to woman according to your needs. Start taking notes yourself on your progress as this may help if you suddenly go into labour. You may have more than three appointments according to your needs and if you go over.

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BUYING

for baby

W

ith baby comes a lot of kit. The magazines and shops would have you believe that you need to invest a lot of money in order to have everything there for baby, but with a bit of research and some clever thinking about buying, you can save some cash along the way. Over the next few pages we look at what you really need to buy, and present out Buyers’ Guide to some of the most popular items.

WHAT DO I REALLY NEED? There is a whole list of things to get, but some bits can be borrowed, while others can be postponed until your baby is older.

THE THIRD TRIMESTER

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. For your guide

on car seats and car safety with newborn and older babies, see Chapter 7.

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).

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.

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 when he or she is not feeding or sleeping. 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

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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 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, sleeping bags are a great option.

FEEDING ITEMS If you are planning on breastfeeding, then you will need very little to begin with, apart from some breast pads and nipple cream. A breast pump can be useful, but wait until breastfeeding has been established before you start pumping. If you are planning on bottle feeding, you will need bottles and a steriliSer. More information on feeding and what you need in Chapter 6.

BUYING

on a budget Looking to save money? Try these handy tips to ensure you get more bang for your buck ● 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 they’re not vital purchases. Ask yourself with every purchase, is this really essential? ● Borrow some items. Ask around to borrow items that will only be used for a short time, eg a Moses basket. ● Invest in other items. Think of how much use you will get out of certain items, veg a car seat is vitally important and will be used virtually every day. Another good item to invest in is a 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. ● 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 hasn’t been in a carcrash. ● 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.

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.

THE THIRD TRIMESTER

PLAYMAT

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SAFE

sleeping

M

othercare 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 THIRD TRIMESTER

The most important advice is to get a new one for every new baby.

You can be sure that a new mattress offers the best support and is the most hygienic option for your baby.

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.

Top pick

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 - which is when they might pull them down.

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.

We love Clevamama’s Mum2Me Pod, a unique sleep pod that’s suitable from bump to baby. This clever product can be used in an open position during pregnancy as a support pillow for mum`s entire body.

Then, after the baby is born, it can be used in a closed position to give your baby a safe and snug sleeping environment.

It’s perfect for tummy time too! Tested and certified, the baby nest is made with 100 per cent soft breathable jersey cotton and features a machine washable cover. Available exclusively from Mothercare.

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a nursery

A

s soon as the nesting stage begins, your mind goes into nursery-planning overload.

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.

Interior designer Pamela McDonald tells us more:

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

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 completely 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 wall-hanger for easy access.

SAFETY “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.”

THE THIRD TRIMESTER

DESIGNING

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

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PREGNANCY NIGGLES and common worries

T

he third trimester can bring with it some physical aches and pains – but what’s normal and what should get checked out? Our basic rule of thumb: if you are concerned, talk to your medical team. Here are some commons niggles and warning signs – and what you can do to help them.

THE THIRD TRIMESTER

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 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.

● If you are really suffering, talk to your doctor about remedies that are safe during pregnancy, both over the counter and prescribed.

BACK PAIN

HAEMORRHOIDS

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.

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. ● Eat a well-balanced diet with plenty of fruit and veg to avoid constipation. ● Take regular safe exercise. ● 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.

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.

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.

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JOINT PAIN AND SWELLING

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.

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. For more on gestational diabetes, turn to pxx.

Sudden and Severe Swelling Swelling is perfectly common in pregnancy, especially in the latter stages, 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, pre-eclampsia 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.

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 importanxt 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.

THE THIRD TRIMESTER

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 tightfitting 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, or consult your doctor immediately.

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GESTATIONAL

diabetes

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 rick 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 pre-eclampsia (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, insulin treatment is given.

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.

What about follow-up care?

Women with GDM need to be followed up post-delivery at about 12 weeks to redo the glucose tolerance test. This is to establish whether the diabetes has gone away or not.

Each year thereafter women should have an assessment of their sugar status with their GP as they have a sevenfold increased chance of developing diabetes in the future.

Professor Dunne advises: “Post pregnancy, women with GDM need to focus on lifestyle change by sticking to a healthy diet and increasing physical exercise. We have also found a lower conversion rate to diabetes in GDM mothers who breastfeed their babies.

For more information, the Diabetes Federation of Ireland has published an information leaflet, which is available to download at www.diabetes.ie.

Words by Michelle McDonagh

THE THIRD TRIMESTER

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. 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.

However, for some pregnant women, even the extra insulin is not enough to keep their blood glucose level normal. In the mid-part of pregnancy, these women end up with high blood glucose levels or gestational diabetes without knowing.

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GETTING READY to give birth

A

s your due date nears, you will begin to think more and more about the birth and how your baby will arrive into the world.

Your medical care team will talk more about the birth as your due date nears, and it’s advisable to enrol on antenatal classes to help prepare you further.

However, there are many other things you can do to help prepare you mentally for labour, birth and the first few weeks with a new baby.

THE THIRD TRIMESTER

EDUCATE YOURSELF Probably the best way you can prepare is to find out as much as possible about labour and birth, your options, what you can do to help make your experience positive and uplifting, and what you can expect from the hours and days following the birth of your baby. Knowledge is definitely power when it comes to giving birth.

FOCUS YOUR MIND Pregnancy is an ideal time to learn how to focus your mind and dismiss any spiraling, negative thoughts. Put aside a few minutes a day to close

your eyes and concentrate on your breathing. Free your mind of any thoughts and just listen to the sound of your breath and your heart beating.

Need help with this? A big part of a prenatal yoga class is learning how to breathe and focus. Learning to focus will give you a head start on learning breathing techniques in your prenatal classes for labour. Another option is learning about hypnobirthing.

Even if you’re not planning on having a natural birth, the basics of hypnobirthing are extremely beneficial in terms of relaxing and focusing the mind.

GET POSITIVE SUPPORT

KEEP PHYSICALLY STRONG

BE WELL RESTED

Pregnancy is no time to start a new exercise regime, but it is important to continue being physically active.

Go for a walk, try a prenatal exercise class or go swimming – keeping your body fit will help improve your stamina and strengthen your body for labour and birth. See Chapter 2 for more on prenatal exercise and remember to always follow the advice of your medical team.

While keeping physically strong is important, being well rested is equally as vital as your pregnancy progresses. This can be difficult as your bump grows, so do whatever it takes to make sure you get a break.

Have a nap after lunch, head to bed early, or simply have a lie down with a book after work – all of this can help you rest and recharge as you prepare for birth.

Make sure you have a good support network around you, both before and after the birth, and during labour itself. Whoever you choose to be with you for the birth, make sure he/she is well versed in your preferences for the birth, what their role should be, and any pain relief choices, breathing techniques or labour positions you need help with. Even better, prepare practically for the birth with your partner – bring him/her to your prenatal class, do your breathing exercises together, and write your birth plan.

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KEEP YOUR EYE ON THE PRIZE

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 full 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

breastfeeding 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-three 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 into 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.

THE THIRD TRIMESTER

Remember that labour and birth passes relatively quickly and all going well, you’ll have the wonderful moment of meeting your new baby at the end of it – isn’t that worth it? Every contraction is a step closer to meeting your little one – start thinking about how happy you will be with a new baby in your arms, rather than the labour pains.

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Your hospital bag On 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 things you need, the reality of giving birth really hits home!

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.

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 containing all your essentials. This should contain one to two buttondown nighties (be prepared to throw these away, as they will probably 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 a newborn nappy.

IN YOUR HOSPITAL BAG: Three cotton nightdresses or loose pyjamas Two maternity bras

Toothbrush and toothpaste

Breast pads

Deodorant

Nipple cream

Cleanser and moisturiser

Two packets of maternity pads

THE THIRD TRIMESTER

Shampoo and conditioner

What about the main bag?

Bring a carry-all bag or a small case.

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.

A couple of newborn hats and scratch mittens are also essential. Bring one pack of nappies and have a couple of packets at home to be brought in when needed.

The one big essential for you is disposable knickers – or, even better, cheap cotton 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. Bring a plastic bag for sending home washing too.

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.

IN YOUR LABOUR BAG: Copy of birth plan Details of any medication/ hospital notes An old nightgown Light dressing gown and socks Clean nightwear for after the birth

IN BABY’S BAG: Six long-sleeved babygros or sleepsuits Six vests Bibs One pack of disposable newborn nappies

Make-up

Hair bobbin

Dark-coloured towel and face cloth

Hairbrush and bobbin

Lip balm Bottle of water and snacks

Light dressing gown and slippers or flip-flops

Phone and charger

Facial mist spray

Magazine or book

TENS machine

Two pairs of scratch mittens

Notepad and pen

Camera

One blanket

Coins for parking, snacks etc

MP3 player

Two soft baby towels

Toiletries and towel

One baby sponge

Witch hazel to soothe stitches

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

Nappy cream

Six pairs of old or disposable underwear Shower gel

Two cardigans Two hats

Cotton wool

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MY BIRTH PLAN

advice

THE THIRD TRIMESTER

As 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: ● Labour management 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. ● 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 or a friend, or even a professional doula. This is your choice. ● Pain relief 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. ● 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?

“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

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5 LABOUR & BIRTH

CHAPTER

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5 LABOUR & BIRTH Exciting stuff – you’re just about there and you’re more than ready to meet your new baby.

But first there’s the small matter of the labour and birth. Whether it’s your first time or your sixth time, preparation is everything. Knowing what to expect and being prepared for any curveballs that may come your way will give you confidence in you, your body and your care team. 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 too far off in the future, 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.

LABOUR & BIRTH

SIGNS OF LABOUR 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 jelly-like 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?

LABOUR SIGNS

what can I do? 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 LABOUR BIRTH

● 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 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 fiveminute 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

E

veryone is different and every labour is different.

There is no way of telling how labour will affect you before you give birth; the best advice really is 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 The onset of labour differs between many women. 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, eg every five minutes. Some women start labour with contractions that are of long duration, feel painful and occur frequently, eg every five minutes.

Massage, TENS machines, walking 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 now.

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 with each contraction. 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 will then 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.

Relax – the worst is over.

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 skinon-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 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-on-skin.

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 chapter on “Babies in Special Care” for more information.

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BIRTH STORY

home birth

“My first son was born in hospital.

I was induced, had an epidural and I felt the experience was quite far away from how I had pictured his birth. I also felt that my husband was very much secondary to the process. So, when I discovered I was pregnant with my second child I knew that I wanted to look at my options. I came across the Home Birth Association of Ireland and engaged the services of a selfemployed community midwife (SECM). The beauty of home birth is that you have the same midwife for all of your visits. Any initial reservations I may have had dissipated as soon as I met the wonderful Philomena Canning.

It was such a lovely pregnancy, having my antenatal care at home, having my toddler son involved throughout, measuring my tummy, listening to baby’s heartbeat. It was as though they bonded before she was born. In the end, my daughter was born very quickly, with just my husband and sister present. I never would have felt able to do that, had it not been for the support and encouragement of Philomena.

“My third birth, a water birth in my living room was a phenomenal experience. Many people don’t associate birth with positivity but as a GentleBirth instructor, I view birth as normal and natural and believe that

when women are undisturbed, then pure magic can happen.

“As I neared the end of my pregnancy, I prepared my nest.

The pool was inflated, the burco was ready to be switched on, everything I’d need were gathered in a basket, my playlist was ready, my mood board was hanging up, positive affirmations were scattered around the house. At 39+2 I went to bed with some backache but also a real sense of calm. I felt the words “I’ll be there soon Mommy’ wash over me and fell asleep with a huge smile, hugging my precious bump. I woke at 3am and couldn’t settle back to sleep and started to pay attention to surges. I made tea and a hot water bottle and pottered about and as surges got stronger, I text my midwife Brenda O’Toole. I woke my husband and knew the baby wasn’t far away. I lit the fire and some candles and oil burner and started to get into my comfort zone, while the pool filled. When Brenda arrived at 5.30am I was using a birthing ball to stretch out and listening to my relaxation tracks. She listened into baby and all was perfect.

The next hour passed quickly, I was swaying and circling my hips deeply, trying to stay loose and limp, while Brenda did some light massage on my back. Nuria, my second midwife arrived and both

herself and Brenda just stayed in the shadows. By about 6.45am I was feeling a lot of pressure. I remember the feeling of being a lioness, that raw power of your body taking over and you just have to go with it. I climbed into the pool, letting the water soothe me. My husband was holding my hands and I could feel our baby descending and reached around to feel his head emerge. One more surge brought the rest of his body and I felt my waters release.

Brenda passed our beautiful baby boy to me and I held him and my heart swelled with love and pride for the wonder that is birth. It was 7.17am. Our older children had been in and out and they were enthralled by the experience. We named our little boy Ruairí and I placed him on my tummy and watched mesmerised as he crawled to my breast and started to feed.

“The level of care with an SECM is outstanding. They come every day in the week after birth. It’s such a beautiful way to end the journey together. Not only are these women expert healthcare professionals, they truly do become a treasured part of the family. I urge anyone interested in learning more to look at the research, which consistently shows that home is as safe, if not safer than hospital in healthy, low risk pregnancies.”

LABOUR & BIRTH

Ethna Quirke gave birth to her daughter and her second son at home, and found it a very positive experience:

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PAIN

relief

T

he 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.

LABOUR & BIRTH

ENTONOX 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: ● 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.

DISADVANTAGES: ● 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.

TENS MACHINE 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, batterypowered, 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.

ADVANTAGES: ● 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.

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

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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.

EPIDURAL

ADVANTAGES: ● Epidurals give the most effective pain relief.

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.

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.

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.

LABOUR & BIRTH

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.

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Home is the place where memories are made.

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BIRTH STORY

epidural

I had my daughter in the Coombe in 2015. At 39+3, the fluid around the baby was measuring high, plus we had had a few episodes of decreased fetal movements so the consultant decided to induce me. That night I was admitted to the antenatal ward and the Di rst dose of prostin gel (2g) was administered late night/early morning. I needed a CTG before insertion then the gel was inserted and had to lie in bed for an hour to give it time to work before having another CTG to make sure baby was ok with it. There was an unpleasant burning feeling, which I had thankfully been warned about so I knew to expect it.

“Unfortunately nothing happened after the first game so I had two more doses the following day along with some internals to see if I was progressing, regular traces and lots of walking around the hospital and bouncing on a ball.

“Dr Farah said she’d try a fifth gel on Tuesday night but if she couldn’t reach my waters on Wednesday morning to break them it would be an elective section. The doctor was able to break my waters, but I was so tired that I thought a section would be better, but the doctor promised me to get an early

epidural so I could rest.

“The consultant came in a few mins to break my waters.

The internal that morning had been particularly painful so she recommended I use gas & air while she did it. At first I found it great and it really helped to distract me from the pain but as time went on it started to make me feel really nauseous so I had to stop using it.

“An hour or so passed where I was in increasingly bad pain, all in my back so I asked for epidural.

The midwives said it was very early but I said that was Dr Farah’s intention to let me get some rest so they called the anaesthetist.

It took two attempts to site the epidural and having to stay still with the terrible pains in my back was so difficult however once it started to work it was magic.

“I fell asleep for a good two hours off and on while on the syntocin drip. The midwife would ask me to switch sides or do my blood pressure then cover me back with blanket and I’d go back to sleep. It was the first time in days I’d had no back pain and the first time in months I’d had no pelvic pain!

“Suddenly I went from 5cm to 10cm in an hour around 6pm, they did another fetal blood measurement and still ok so left

me another while to see would head drop. Unfortunately it didn’t! They got me to do a few test pushes to see did baby’s head move down with a push and while it did she would shoot straight back up again as soon as I stopped. She was also too high for any instruments to be used to help. The epi had worn off for me in one part of my back too so I was in a good bit of pain in that one localised area so consultant asked would we switch to section or wait longer... It had already been an hour and a half of increasing discomfort and no progress on head dropping so I agreed section would be preferred.

“Both me and the baby were fine but still full emergency section protocol swing into play - room suddenly full of people all with specific jobs, some stripping me, asking questions, topping up epidural, taking notes, wheeling me up to theatre where there was more monitoring, setting up lines etc. all very scary but in a controlled manner. “From checking my notes it was knife to skin at 7.56pm and Olivia was born at 7.58pm, weighing 9lb.

They gave Olivia to me skin to skin under my gown so I could hold her for a few minutes while they sewed me up.”

LABOUR & BIRTH

Stella Greene gave birth to her daughter via induction, epidural and section.

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BREATHING techniques

P

LABOUR & BIRTH

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 (see box on opposite page), as well as a range of books and guided relaxation CDs.

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.

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BIRTH STORY

drug-free birth Aine Murphy gave birth to her second son with just gas and air.

“Emmet Karl Murphy was our little surprise. I already had a nine year old so was quite surprised and delighted when I found out we were going to have another baby.

My waters broke about 10pm at night. The hospital was about an hour’s drive away, but I wasn’t in any pain and so I pottered around gathering myself and my few bits.

“We got to the hospital about midnight. The contractions started around 3am, and by 4am the pains started getting more intense, so the nurse recommended some gas. We all thought it would be a while yet so I told my husband to go and get some sleep.

“About an hour later I really needed to pee. So I got out of the bed and went to the loo. When I

was on the loo I felt like I needed to push. The nurse examined me and realised the baby was coming now. They rang my husband but he was sound asleep in the car in the car park! They kept trying him and it turned out he was trying to ring them as he got locked outside the labour ward! But he managed to get in just before Emmet’s head was crowning. Out he popped about 15 minutes later. I was in the delivery room at 5.40am and Emmet was born at 6.22am. By 6.45 the midwife was stitching the small few tears and I was having a cup of tea. No drugs. Just gas and air. 8lbs of cuteness tucked under my shirt sucking his thumb.

“The hospital was very busy and there were people everywhere.

I was on the postnatal ward, but they had to put a lady who was to be induced beside me. My heart went out to the poor girl as she was having a tough time. I don’t sleep that well in hospitals and I was tired and sore and cranky.

“When my husband rang me the following morning I said to him, right I am going to get checked over and get Emmet checked over and if everyone is happy I am out of here.

We both got examined and got to go home when Alan visited us that day. Emmet’s big brother Sean was delighted to see us. It also gave us a little bit of time at home on our own before all the visitors arrived.

“So that’s my story, my lil surprise baby was fast and furious and he is still holding true to that.”

WHAT IS

● 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 information or to find a practitioner in your area, log on to www.hypnobirthingireland.co.uk

LABOUR & BIRTH

hypnobirthing?

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TYPES

of birth

V

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.for more information.

LABOUR & 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 don’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.

HAVING A

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.

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Women who have experienced another Caesarean birth after planning a VBAC often say they are glad that they tried.

INDUCTION OF LABOUR

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.

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.

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 pre-eclampsia 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

LABOUR & BIRTH

If you are between ten days and two weeks over your due date, your doctor may discuss the option of inducing your labour with the use of: ● 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.

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BIRTH STORY

emergency C section

LABOUR & BIRTH

Penny Gray gave birth to her first baby, Danny, via emergency section after complications and a failed induction

“I had a fairly standard pregnancy apart from slightly high blood pressure up until 30 weeks, when on a routine appointment, I was diagnosed with possible HELLP syndrome, which is a variant of pre-eclampsia but with liver complications. I received steroids in case the baby had to be delivered suddenly and then spent the next few weeks going in and out of the Rotunda as they monitored my condition. From 34 weeks, I was in a bed. The aim was to get me to the 37 weeks if possible.

Just before the 37 weeks, I was brought down to the induction suite where a doctor administered the gel at about 7pm. The first symptoms were like period pains and a heavy feeling in the pelvis.

The next morning, a doctor tried to break my waters but I wasn’t ready so a second dose of gel was given. Again I spent the morning pacing the corridors hoping that gravity would give me a helping hand, and once again, I had what could only be described as bad period pains. At lunchtime, the doctor examined me and said that the head was right at the entrance (hence the heavy feeling), but she couldn’t quite get in to break the waters – but a third dose of gel should do it, and she even predicted that my waters would break by themselves in the meantime.

We were getting excited at this point, and even more so when I started having mild contractions mid afternoon. But unfortunately I wasn’t progressing, and as my liver function was bad by then, they decided to put me in for an emergency section.

“All of a sudden I was in the theatre and my husband was being chased out (he had just followed me in, instead of going off to dress up in his scrubs!). It was all a bit scary then. I was given the spinal, my blood pressure was monitored and my husband was then eventually brought in to talk me through it. The screen went up, and they tested to see I was numb. It all kicked off then and the doctor talked me through it all. Sections feel uncomfortable but that’s about it. I was panicking though, and my blood pressure went a bit mental, going up and down and I began feeling really sick. But my husband kept on talking to me and calming me down, telling me that my little baby would be here soon and everything would be okay when we were finally complete as a happy little family. Suddenly I heard a cry and my baby was born. He was taken and weighed and proclaimed perfect. I was then stitched up – which took FOREVER – while I tried not to pass out again. I was then taken down to recovery to be monitored

while my husband bonded with Danny. After about an hour, I was brought up to the ward and met my little man – and my big man – once again. I tried breastfeeding, and gave him a huge cuddle.

“My emergency section didn’t feel like an emergency because

“All of a sudden I was in the theatre and my husband was being chased out (he had just followed me in, instead of going off to dress up in his scrubs!).

It was all a bit scary then. I was given the spinal, my blood pressure was monitored and hubs was then eventually brought in to talk me through it. The screen went up, and they tested to see I was numb. It all kicked off then and the lovely doctor talked me through it all.”

all the staff are so calm and they know what they’re doing. The experience made me realise that you really don’t know what will happen, but you need to put yourself in the capable hands of the people looking after you, while arming yourself with knowledge, of course.”

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BIRTH STORY

planned C section Ann Scully gave birth to her second daughter, Lucy, via a planned Caesarian section.

by the surgical team. They were all so nice and informative and open to any questions we had. I signed my consent forms and was taken into the theatre. My husband put on his scrubs, wine ones this time and we joked about him looking like a real doctor, a la George Clooney. Wishful thinking on my part!

“That will tell you how relaxed I was, but of course I was still very nervous at what was ahead. I sat up on the table and they gave me my epidural and I lay down. Everyone so nice and still so reassuring.

They knew that this time around it was important to me that I had skin to skin and they advised that once all is well I would be able to so. My husband beside me and we waited patiently to get going. I felt so relieved that there was no panic and that I was getting ready to meet our baby, Ava’s little sister.

“About 10 minutes later our second daughter Lucy was born. I

was blown out of the water when I was told she weighed 10.15lbs. She was perfect and she was handed to me on my chest. I was very shaky again but the nurses advised me all was well. I will never forget that moment; after missing out with Ava, having skin to skin with Lucy was just bliss.

“This time around I was camera ready and beamed as my husband took photos of me with Lucy. I was still beaming later when Ava got to meet her baby sister for the first time. I felt so relaxed and so happy; at times of course I felt uncomfortable but it didn’t matter as I was so content. I had a much better recovery this time around and if I had to do it all again, I would opt for a planned section again. For me, it was the right decision. Both my experiences were very different, yet I feel privileged to have gone through them both in order to bring my girls safely into the world.”

“About 10 minutes later our second daughter Lucy was born. I was blown out of the water when I was told she weighed 10.15lbs. She was perfect and she was handed to me on my chest. I was very shaky again but the nurses advised me all was well. I will never forget that moment; after missing out with Ava, having skin to skin with Lucy was just bliss.”

LABOUR & BIRTH: AFTER THE BIRTH

“I have two beautiful daughters, Ava and Lucy. My girls were both born by C section – one emergency and one planned.

I had a difficult delivery on Ava, which ended in an emergency section. My second pregnancy was uneventful until 34 weeks when I was diagnosed with gestational diabetes and had to start insulin injections. At 37 weeks, my consultant suggested a planned section, seeing as I had such a tough time on Ava. A part of me panicked but despite this, I felt more prepared this time around.

So at 39 weeks I set off for the Rotunda once again. I had to be admitted the night before, as I had to get connected to an insulin drip at 4am to keep levels steady for delivery for me and baby.

At 7am, I got gowned up for the occasion. I was nervous but excited that the time was near. My husband arrived and we were both taken down to theatre and greeted

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AFTER

the birth

LABOUR & BIRTH: AFTER THE BIRTH

N

o matter what type of birth experience you had, it’s important to give yourself time to rest and 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. These generally feel like period pains but can occasionally be more painful. Your uterus will take a few weeks to get 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.

FEELINGS ABOUT THE BIRTH When 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 already left the hospital, talk to your GP about post-birth counsellors, or contact your hospital in case there is a post-birth 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, it’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. Refer to your hospital handbook for details of the complaints process.

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THE FIRST FEW WEEKS

CHAPTER

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6 THE FIRST FEW WEEKS Your little one is finally here – congratulations! You are about to embark on the adventure of your life! Over the next few weeks, you will learn how to care for your new baby – it’s an exciting time but can also be nervewracking too. Let us guide you through those important first few weeks.

BEGINNING

to breastfeed

THE FIRST FEW WEEKS

T

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.

POSITIONING YOU 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

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way or because he is not being put to the breast often enough. Ask for help if you are unsure.

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 pillows.

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.

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 Cuidiú volunteer.

HOW

to attach Some tips to help your baby attach: ● 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.

THE FIRST FEW WEEKS

If you are sitting down to feed, try to make sure that: ● Your back is straight and supported ● Your 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.

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BREAST-

feeding basics

BREASTFEEDING WHEN OUT AND ABOUT

HOW LONG

THE FIRST FEW WEEKS

should i breastfeed for?

There are advantages to breastfeeding for even short periods. But to maximise 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.

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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EXPRESSING MILK

Why you may need or want to express your milk: ● 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 hand-express 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.

GETTING

help 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 Trust. In a few areas there are also non-affiliated voluntary mother-to-mother breastfeeding support group meetings that you can attend. ● All La Leche League leaders and Cuidiú 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.

THREE OF THE BEST:

Innosense Electric Breastpump, €79.95, Mothercare

Medela Freestyle Double Electrical Pump, €329.99

NUK Jolie Manual Breastpump, €39.99

THE FIRST FEW WEEKS

breast pumps

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BOTTLE-

feeding basics

W

THE FIRST FEW WEEKS

hile breast is always best if at all possible, there are often reasons why a mum might not be able to breastfeed or choose not to.

Thankfully we live in an age where this is not a problem. However, like any food, powdered infant formula is not sterile. It may contain bacteria like E.sakazakii and Salmonella, which could make your baby sick, causing vomiting, diarrhoea and, in rare cases, meningitis. Make sure you follow these guidelines to prepare your baby’s bottle feeds safely.

To feed your baby formula milk, you need ● a clean work surface ● facilities to wash your hands and equipment ● a supply of bottles and teats ● a bottle brush and a small teat brush ● sterilising equipment and tongs ● suitable water and a way to boil it ● formula powder Make sure your bottles, teats and lids are completely clean and dry. A

dishwasher can be used to clean your bottles, but remember that you must also sterilise them. A microwave or plug-in steam steriliser is the best option, although you can also sterilise equipment by boiling in water for at least three minutes or with a chemical steriliser like Milton.

Follow these steps for making up bottle feeds: ● Use equipment that has been thoroughly cleaned and sterilised first ● Boil 1 litre of tap water and leave to cool for 30 minutes (no longer) ● Follow the guidelines on the formula tin to measure out the ratio of powder to water. Remember that too much or too little formula could make your baby sick. ● Cool prepared feeds quickly by running sealed bottle under the cold tap. Test temperature of the milk on the back of your hand (it should be lukewarm) ● Either use the feed immediately and throw away anything left over within two hours or store

made-up bottles are the back of the fridge (the temperature should be 5°C or lower) and use within 24 hours. Throw out any that has not been used within that time.

Important When preparing a bottle feed, it is important that the water is boiled and left to cool for 30 minutes. By boiling the water you make it sterile.

By allowing it to cool for 30 minutes, the water reaches a temperature of 70°C. At this temperature it is hot enough to kill harmful bacteria that may be in the formula powder and cool enough not to damage a lot of the nutrients in the formula.

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AGE

AV FEEDS PER 24 HOURS

DAILY INTAKE PER BABY’S WEIGHT

Birth to 3 mths

6-8 (feeding every 3-4 hours)

150ml per kg

4-6 mths

4-6 (feeding every 4-6 hours)

150ml per kg

7-6 mths

4 (with solids)

120ml per kg

10-12 mths

3 (with solids)

120ml per kg

If you have any concerns about how much milk your baby is having or how often they are feeding, speak to your public health nurse or doctor. Your baby will develop his own pattern of feeding, which can vary a little from day to day.

Babies generally feed according to their appetite. It is good to allow your baby to recognise hunger cues and feeling of fullness.

Do not force your baby to take

more than they want or to finish the amount prepared. Babies may not always want to feed at regular intervals. Young babies tend to need feeds more regularly, including during the night. However, this varies from baby to baby. Babies tend to gradually increase the amount they drink at each feed.

Once you start introducing food, the amount of milk they drink will reduce. The chart above shows how much a baby usually drinks.

HOW CAN I FEED WHEN TRAVELLING? You can travel with made-up bottles if the journey will be less than two hours and you can keep the feeds cold while travelling.

1. Before your journey, prepare feeds as normal, cool quickly and place in a fridge at 5°C or below.

2. Just before you leave, place the cold feeds in an insulated cool bag with ice packs.

3. When you arrive, place the feeds in a fridge as soon as you can. Re-warm a feed when you need one.

If the journey will be longer than two hours, or if you have no way of keeping the feeds cold, it is not safe to bring made-up bottles.

The safest option is to bring the powder with you and prepare a feed as normal using water that is hotter than 70°C. Cool it quickly and feed your baby right away. If you will not be able to boil water when you are out, you could fill a thermos flask with boiling water to bring with you. If you fill the flask and seal it, the water will stay above 70°C for several hours. You can use it to make up a feed when you need to. Wash flasks well and rinse with boiling water before you fill them with the boiling water that will be used to make up the feed.

Another very safe option is to use cartons of liquid formula available in chemists or supermarkets.

You do not need to keep them in a fridge or heat them up before feeding your baby.

THE FIRST FEW WEEKS

FEEDING PATTERNS & SIZES

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FEEDING issues

W

hatever way you choose to feed your baby, be it bottle or breast, some complications may arise.

More often than not, 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.

THE FIRST FEW WEEKS

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 his 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 who 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-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 tiring but it’s perfectly normal.

Cluster feedings do not

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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.

WHEN SHOULD I TAKE

baby

a doctor?

TO SEE

Bringing up milk or occasional vomiting after feeds is nothing to worry about. Immediate medical attention is required if you see:

REFLUX 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.

If you suspect your baby might have reflux, visit your doctor, who may prescribe antacids. If the antacids help, treatment may be continued until it’s time to wean.

LACTOSE INTOLERANCE SYMPTOMS OF

reflux

● Frequent posseting ● Happier when upright ● Refusing to feed or difficulty feeding ● Apparent abdominal pain If you suspect that your baby is suffering from reflux, consult your GP who may prescribe an antacid.

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.

THE FIRST FEW WEEKS

● Green vomit ● Vomit containing blood ● Stools containing blood ● Baby is lethargic and uninterested in feeding

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CARING FOR your baby

T

he first few days can be nerve-wracking – your baby looks so tiny and delicate; how can you be sure you’re caring for him/her properly? Don’t panic – you’ll be amazed at how quickly your baby grows and becomes more sturdy. Plus, you’ll grow in confidence as the days pass.

THE FIRST FEW WEEKS

BATHING YOUR BABY Newborn babies do not need bathing in the first few days of life. Topping and tailing your baby is sufficient 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.

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

HAIR 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 non-stinging shampoo. ● Rinse well and gently 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.

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 at first. 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, such as a paediatrician-approved range like Aveeno Baby, which is specially formulated for baby’s sensitive skin.

The newborn baby may have a variety of spots, blotches or rashes on the

skin. If you are concerned, ask your public health nurse for advice.

THE UMBILICAL CORD The umbilical cord is cut and clamped following the birth of 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 advice. A baby may be given a bath during this time.

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 baby’s bowel movements, see the next page.

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. Female circumcision is illegal in this country.

RECOGNISING

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 highpitched 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.

Sylvia McShane is a public health nurse, barrister at law (Gray’s Inn) and freelance writer.

THE FIRST FEW WEEKS

Grooming

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VITAMIN D

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.

THE FIRST FEW WEEKS

It is now a public health policy that all infants born in Ireland must receive Vitamin D3 drops from birth, whether babies are breastor bottle-fed.

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YOUR GUIDE to nappies

O

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.

choose 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).

THE FIRST FEW WEEKS

ARE BRANDED DISPOSABLE NAPPIES BETTER? 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 brands and

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 chlorinefree choices or organic cotton nappies, which use no pesticides when the cotton is growing.

THE SCOOP ON

baby poop For the first few days after baby arrives, they will pass something called meconium. This 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 that 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

October 2016, with two new vaccines added to the schedule to protect against Meningococcal B disease and rotavirus disease.

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.

WHO 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.

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. ● If your child is exposed to any

THE FIRST FEW WEEKS

I

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 schedule has changed for babies born on or after 1st

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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.

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 and reactions 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.

Schedule of vaccination At Birth

Hospital or HSE clinic BCG

Two Months

GP

6 in 1, PCV , MenB, Rotavirus

Four Months

GP

6 in 1, MenB, Rotavirus

Six Months

GP

6 in 1, PCV, MenC

12 Months

GP

MMR, MenB

13 Months

GP

MenC/Hib, PCV

* BCG: * 6 in 1:

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 Rotavirus oral vaccine Meningococcal B vaccine

* PCV: * Men C: * MMR: * Hib: * Rotavirus: * MenB:

THE FIRST FEW WEEKS

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

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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.

CHANGES TO

schedule

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

There is an ongoing supply issue with the BCG vaccine but as TB is rare these days, it has been stated that the BCG vaccine does not now need to be given routinely to all babies in Ireland.

The primary immunisation schedule is constantly being monitored and updated to ensure that children are given the best protection possible from potentially deadly diseases. The HSE has an excellent website at www.immunisation.ie where you can find out the latest information. Alternatively, your public health nurse or GP will be able to advise you on what vaccines your baby needs.

THE FIRST FEW WEEKS

given the MMR vaccine, but one does not cause the other. Because 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 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.

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242748_SCA_SM_MaternityAnnual.indd Ad Template_Maternity_2017_2018.indd 1142

09/05/2017 11/10/2017 10:53 14:11

RECOVERY

I

t’s important to remember that it will take time for you to feel “normal” after giving birth. Even after the first few days have passed, when your uterus shrinks down and the bleeding stops, you may still feel tender and sore.

Fatigue is also common after birth – especially when you throw a new baby into the mix. Try our tips for helping your recovery after birth.

ACCEPT ALL OFFERS OF HELP You will naturally be physically tired after a long pregnancy, labour and birth, and your body will need some time to recover. Make sure you give your body that time it needs. Rather than trying to prove to others (and yourself ) that you

can do it all – no one is doubting that you can cope – accept offers of help from your friends and family. There’s a lot that you can’t delegate, so focus on the things you can – let your partner change the baby while you feed him, for instance.

GET ADVICE Having a baby is a steep learning curve and you are not expected to know it all straightaway. In fact, many seasoned mums will admit they still are a long way from knowing it all! Every baby is different, and there is always a time of getting to know your new bundle, whether it’s your first or your tenth. The public nurse system is set up to support

new mums, and is an excellent resource if you have any worries about your new baby, from feeding to sleeping. For more serious health issues, there’s your GP too, and the under-sixes doctors’ card means that you can visit for free. Just don’t rely on the internet for your medical advice – always talk to the professionals.

CONCENTRATE ON THE BABY With a new baby comes a lot of visitors – it’s time, now, to prioritise tasks in your mind. In the first few weeks, your focus is the baby, not the hoovering.

Get friends or family to help out in this regard, so budget for

THE FIRST FEW WEEKS: RECOVERY

after the birth

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a cleaner. Even better, realise that no one is expecting a perfect house with a new baby in it! Concentrate on looking after your baby and yourself – and forget about the dishes for a bit.

LEARN TO SAY NO On the same note, remember that it’s your prerogative to say no if you don’t want visitors for a week or two. Only take on what you can handle and just say ‘not today’ to the others. Trust us, no one will mind waiting a week or two before meeting a new baby. Don’t feel like you’re being selfish or unfriendly – good friends and family will always understand and would rather you to be honest with them.

GET OUT AND ABOUT Obviously you should judge yourself when you’re able to get out and about, especially if you’re recovering from a long labour or a C section. Driving might be out if you have stitches or recovering from a section, but when you feel up to it, getting out in the fresh air for a walk or even a sit in the garden will do your spirits no end of good. And you’ll get a lot of attention with a new baby!

SLEEP WHEN YOU CAN

THE FIRST FEW WEEKS: RECOVERY

You’ve probably heard the phrase ‘sleep when the baby sleeps’ – and the hollow laughs of new mums

when asked if this is possible.

But the fact remains that new babies take anything from a few weeks to a few months to get into a decent sleeping routine, which means you’re going to have to get used to broken nights of sleep. In the early days, your baby will be feeding every few hours

(sometimes more frequently if you’re breastfeeding on demand), so you have got to grab your rest when you can. We’re not saying you should be in a deep sleep every time your baby is sleeping but you should at least be resting.

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.

Incontinence falls into two categories: stress and urge. If you leak when you laugh, sneeze or cough, you have stress incontinence. This is caused by pressure on the bladder by the uterus, worsened by the hormone relaxin, which reduces bladder support. Urge incontinence is caused by an overactive bladder. This is when you get sudden urges to go to the toilet, even though your bladder is nearly empty, and leak before you get there. 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 or consult our guide on p24. 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 and childbirth.

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SRC Activate Leggings were designed with the needs of women in mind and perfect for supporting and protecting during exercise. Unlike other compression leggings, SRC Activate has Anatomical Support Panels (ASP) for the pelvic floor, lower back and legs, whilst True Cross Compression Technology offers unrivalled stretch performance.

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POSTNATAL depression

THE FIRST FEW WEEKS

P

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 and untreated, 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.

SIGNS

of PND ● 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.

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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

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.

SEEK SUPPORT 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 anti-depressants 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 good day, two bad days) but you will eventually notice that the bad days become fewer as you start to get better.

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.

Helpful SUGGESTIONS ● Accept there is a problem and you need help. ● Take life one day at a time. ● 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. ● Be open about your feelings and worries with people you trust who will understand and won’t judge you. ● Try to get some exercise every day; even if it is only a walk around the block, fresh air really helps. ● 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. ● Don’t be afraid to ask for help: it is not a sign of weakness. People are only delighted to help. ● Eat a balanced diet, little and often. This will give you energy. ● Involve your partner as much as possible. ● 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. ● 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. Accept that 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.

THE FIRST FEW WEEKS

MEETING OTHER MUMS

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 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. 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.

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.

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MY

experience

BABIES

in special care

THE FIRST FEW WEEKS

I

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 to 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 Irish Premature Babies at irishprematurebabies.com

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

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; remember that 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 that your baby arrived early. ● Look after yourself as well, it is very easy to neglect yourself during those difficult first weeks and months.

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LIFE AS A NEW PARENT

CHAPTER

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7 LIFE AS A NEW PARENT Life is beginning to settle down and you’re getting into the swing of life with a newborn. Your tiny baby is going to grow quickly over the next few months – here’s what to expect over the first six months of parenthood, including some handy tips on how to get your little one into a routine.

LIFE

stages

Y

our precious bundle is finally here, 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 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.

LIFE AS A NEW PARENT

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

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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?

STARTING SOLIDS

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 p130.

MONTH THREE 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.

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.

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!

LIFE AS A NEW PARENT

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!

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a

ESTABLISHING ROUTINE

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.

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 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.

BABY’S

LIFE AS A NEW PARENT

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!

When will my

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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YOUR BABY’S health

LIFE AS A NEW PARENT

A

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.

fingers in the middle of the chest.

4. 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.

5. Continue the sequence until help arrives.

6. Anyone who has been treated for choking in this way should be advised to see their doctor after the incident.

A CHOKING INFANT

BURNS

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: 1. 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.

2. Give up to five back blows between the shoulder blades with the heel of your hand.

3. If the obstruction is still present, turn the infant around give up to five chest thrusts, with two

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: 1. Cool minor burns under cold running water.

2. Cover with clean cling film or a loose sterile (non-fluffy) bandage.

3. Seek medical assistance if you are unsure of the severity of the burn.

FALLS 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: 1. Press on the wound with your hand over a clean pad.

2. Secure with a bandage.

3. Raise the wound above the level of the heart.

4. Call for ambulance.

If SOMETHING is embedded 1. Do not press on the object.

2. Instead, press either side of the object and build up padding around it before bandaging to avoid putting pressure on the object itself.

3. Get the person to hospital as quickly as possible.

Irish Red Cross First Aid courses are run around Ireland each week. Prices start at €80 depending on course length and type. For more details call 1890 502 502 or visit www. redcross.ie

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PERFORMING 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-rich 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 breaths through the mouth, covering the nose with your fingers and ensuring the mouth is sealed (rescue breaths). If the infant 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 4: Give two rescue breaths ● After the compressions, repeat two rescue breaths.

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.

Continue this routine of chest compressions and rescue breaths until help arrives.

FEBRILE CONVULSIONS 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.

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

LIFE AS A NEW PARENT

STEP 3: Do 30 chest compressions ● Place the pads of two or three fingers just above where the lowest

ribs link in the middle. Smoothly and firmly, press down about 4cm, at a rate of about 100 a minute.

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MENINGITIS:

When your life can change in a heartbeat

LIFE AS A NEW PARENT

S

ome days are easier than others for Siobhan Carroll, but there is never an easy day.

Sometimes she can roll out of bed without too much thought, other times it takes a couple of deep breaths before that first step of the day can be taken, and that is often how she and her husband Noel get through the day – one step at a time.

The date of April 2, 2008, saw Siobhan and Noel’s lives turned completely upside down when the ultimate horror for a parent visited them – the death of a child.

Their eldest child, Aoibhe, who had turned four in January, woke up in the middle of the night of April 1 with vomiting and diarrhoea. Noel was at home alone with Aoibhe and her brother Eimhin (2), as Siobhan, who was pregnant with their third child, was experiencing some difficulties related to her pregnancy and so was in hospital for overnight observation. Noel comforted Aoibhe, changed her and when she fell asleep again, tucked her back into bed, and rang Siobhan in the hospital to let her know Aoibhe had been sick.

“I didn’t expect a thing, sure how could you? Yes, I was worried that one of the kids was sick, but the kids get sick all the time. I had spoken to her on the phone earlier in the evening before she went to bed and she was in great form, so I wasn’t overly worried,” Siobhan recalls.

However, Aoibhe got sick again later in the night, setting off alarm bells with Noel, and he called the doctor, who told him it sounded like Aoibhe had a vomiting bug. As her condition deteriorated during

the night, he rang the doctor a couple of times and followed the advice given. Around 5am, Noel was sitting on the couch cradling Aoibhe watching cartoons when Aoibhe’s eyes closed. Noel thought she was drifting off to sleep, but he then noticed her lips had started to turn blue. He immediately rang an ambulance, and phoned Siobhan to tell her Aoibhe was not well and there was an ambulance coming out.

“I was obviously very worried then, and I spoke to Noel when the ambulance arrived and he told me ‘They’re working on her’ and I didn’t know what he meant, ‘working on her,’ sure she only had a vomiting bug.”

What Siobhan didn’t know was by the time the ambulance had arrived to the house, Aoibhe had stopped breathing. The ambulance crew worked furiously on the little girl, and managed to revive her, and she was rushed into hospital.

“I was being kept in for the night for observation, so when Noel told me she was on the way in to the hospital in an ambulance, I made my way over to the A&E to wait for them. The ambulance pulled up, the doors opened and someone just ran out, straight past me, and into A&E, followed by the ambulance crew and Noel with Aoibhe. Aoibhe was gone, an aggressive strain of meningitis taking her life.

“I never got to hold her, I never got to say goodbye to her, and that’s very hard to take, she was gone, just like that. She was a great little character – we’d go shopping together, and when we’d be on the way home we’d

hatch a plan that I would go in and distract Daddy so she could run upstairs and hide the bags of things we had bought in the wardrobe.

“She was born at 12.06am on New Year’s Day in 2004, the second baby born in Ireland that year.

That’s the thing, we start every year on her birthday, every year without her, which is unbelievably hard. You have this huge pain in your heart, and it never, ever goes away. You have to learn to deal with it, you just understand that it will be there forever, and you work out how you can live from day to day with that pain.

Siobhan and Noel were naturally devastated, as was their second child, Eimhin, who shared a room with Aoibhe. Four weeks after Aoibhe died, Siobhan gave birth to their son, Noah, and their youngest child, Sophie, was born in December 2009. Both have been told about Aoibhe, and they, like Eimhin, regularly ask about her. Siobhan thought she knew all she needed to know about meningitis – but realising she didn’t, she and Noel decided to do something to try and stop another family going through their heartache – and so ACT For Meningitis was born.

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MENIN ITIS & M SEPTICG AEMIA S E TRUST Y E OUR IN DO STINCTS T

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ALL ABOUT

ACT for Meningitis

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which eases the isolation.

ACT for Meningitis future plan is to build “Aoibhe’s House”, a meningitis centre of excellence based in Galway, providing essential support, vital training and life-saving awareness at a national level and most importantly a community, for children and adults affected by meningitis either through bereavement or living with the long term effects of the disease.

[PIC OF AOIBHE’S HOUSE] What is meningitis?

Meningitis is the inflammation of the lining around the spinal cord and the brain, caused by a viral or bacterial infection. Meningococcal bacteria can cause meningitis, septicaemia or both. There are several types/strains of meningococcal meningitis with the main groups A, B, C, W123 and Y. Meningococcal group B is the cause of most cases of meningitis in Ireland. It is extremely important for people to be aware that while there are vaccines available to protest against some strains of the disease, not all strains are protected by vaccination.

It is easily misdiagnosed, as the symptoms can be flu-like, appear in any order and some may not appear at all, therefore we urge people to trust your instincts.

Babies and children up to age five are most at-risk age group of contracting meningitis, while 16-24 year olds are the second highest at risk age group but anyone of any age

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can get meningitis. It is easily misdiagnosed, as the symptoms can be flu-like, appear in any order and some may not appear at all, therefore we urge people to trust your instincts.

Symptoms of meningitis can develop rapidly. While early symptoms including headache, fever, vomiting and muscle pain are flu-like, someone with meningitis or septicemia can get a lot worse very quickly so keep checking them. Further specific symptoms of meningitis include fever with cold hands and feet, stiff neck, dislike to bright lights, drowsiness, confusion and a rash that doesn’t fade under pressure.

Although a rash is often the most well-known symptom, it may not always appear. If it does it is often a sign that the disease is advancing rapidly and it is therefore crucial not to wait for it to appear before seeking medical attention.

For more information about meningitis or to download ACT for meningitis free awareness card, visit www.actformeningitis.ie.

Our free life saving APP is available for download on both Android: goo.gl/RL9fPT iOS: goo.gl/K6ULcw

LIFE AS A NEW PARENT

ACT for Meningitis was set up in 2011 by Siobhan and Noel Carroll following the tragic loss of their daughter Aoibhe, aged just four, to meningitis, with the purpose of raising life-saving awareness of this disease and providing life-changing support services to children, families and individuals who have been affected by meningitis.

ACT for Meningitis have become the only organisation to offer a vast range of free support services to anyone in Ireland affected by meningitis, either through bereavement of living with the severe after affects of this life-changing disease. Our support services are tailored to the needs of the individual/family to find the most appropriate and beneficial service for them. Meningitis has a wide range of severe side effects coupled with the trauma of the experience and in 1 in 10 cases it tragically results in bereavement. Our trained family support officer assesses where the charity will be most beneficial in providing support.

Our services include creative therapies – including play and art therapy which helps children deal with the impact of the disease – free counselling services for families or individuals who have been affected by meningitis, Cranial Sacral Therapy, physiotherapy, psychologist assessment, oneto-one support, and free family support days aimed at bringing families together to share their experiences of meningitis,

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ESTABLISHING

a sleeping routine

A

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:

LIFE AS A NEW PARENT

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 activitystaring 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.

bright and natural light when they are awake and dimming the environment when it is time to sleep at night.

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 TWO

MONTH THREE

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 by exposing your baby to

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

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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 Your 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 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

SUCCESSFUL

sleeping “My top tip is really to go with the flow. Accept that your baby is not going to sleep for any length of time during the first few months. Once you get passed Month Three, you can start looking at time and routines; anything before that is a bonus!”

Clare, Co Wicklow “Even though I felt like an eejit, I started a bedtime routine very early on. Daytime naps were kept downstairs, and then we did a bath, change and cuddle before the nighttime sleep. Mia was still having night feeds at that stage, but I think having a clear distinction between night and day helped get her into a routine sooner rather than later.”

Caitriona, Cork City “I kept the night feed very quiet and in as dim a light as I possibly could. It eventually became a “dream feed” so when it was time to phase it out, Sam barely noticed it gone. Bonus: I was able to drift back to sleep much more easily afterwards too.”

Geraldine, Dublin 9 “Remember - this too will pass! On my first baby I really felt the stress of the first few months of no sleep; on my second, I almost enjoyed those quiet nighttime feeds - because I knew they would end so soon. I made sure to savour every newborn baby snuggle and gurgle.”

Penny, Co Dublin

LIFE AS A NEW PARENT

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 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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EARLY

teething

LIFE AS A NEW PARENT

Y

our baby’s first tooth appears any time 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 the 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) – these come through at around 6-8 months ● top lateral incisors (either side of the top front teeth) – these come through at around 9-11 months ● bottom lateral incisors (either side of the bottom front teeth) – these come through at around 10-12 months ● canines (towards the back of the mouth) – these come through at around 16-20 months ● molars (back teeth) – these come through at around 12-16 months ● second molars – these come through at around 20-30 months

WHAT YOU CAN DO If your baby is showing signs of teething, there are a number of strategies and aids you can try. Don’t reach for the medicine straightaway, 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, 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 can be used. Always follow the instructions closely.

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WEANING

your baby

LIFE AS A NEW PARENT

I

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 nonacidic 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.

Ready to give it a go? First, read our top tips on how to introduce this wonderful new world to your baby!

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

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

KEEP IT CLEAN

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.

Anything you use to feed your baby needs to be kept very clean.

LET YOUR BABY HELP!

Introduce one food at a time.

Allow your baby to get used to this food before starting another.

TEST IT YOURSELF When you’re feeding your baby a warm meal, heat it thoroughly, let

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

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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.

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.

TRY 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.

FOODS

to avoid ● 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. ● 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 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.

SAFE RE-HEATING

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 in toddlerhood.

Top tips courtesy of www.safefood.eu

DO I NEED

follow on

MILK?

Follow-on milk is designed for babies aged over six months who have been weaned to ensure they get enough vitamins and minerals (especially iron) as they grow. It is not a substitute for breastmilk or infant formula. Strictly speaking, if your baby is eating and drinking well, there should be no need for follow-on milk. However, just like with supplements for children and adults alike, if you feel your baby needs extra levels of certain nutrients, like iron, then follow-on milk can be a good addition to the diet. Ideally, your baby should be eating a variety of fruit and veg after initial weaning, and continuing to drink breastmilk for as long as you both want, albeit in smaller quantities than in the first six months. Remember that cow’s milk is not suitable until your baby is one year old.

LIFE AS A NEW PARENT

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 reheated food, make sure to throw out any leftovers - it’s not safe to reheat foods more than once.

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CAR

safety

LIFE AS A NEW PARENT

C

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 December 2014, the penalty for drivers who fail to observe the legal obligations in respect of the wearing of seatbelts and child restraints increased from two penalty points to three and a fine of 60 (increasing to 90 if not paid within 28 days) and five penalty points-plus being incurred if contested in court.

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 fitted into the car by a child car seat expert, 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 and height, and that it conforms to the latest EU safety regulations and it can be fitted safely in your car. Drop in to your nearest RSA Check it Fits Service for expert advice specific to your child, their car seat and your car.”

LEGAL REQUIREMENTS EU child safety protection law makes it compulsory for all children to travel in a child seat, booster

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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 whose 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.

● 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.

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 90-95 per cent for rearward-facing seats and 60 per cent for forward-facing 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 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 532 532. The RSA also has a child seat checking service, ‘Check It Fits’,

WHERE TO FIND MORE INFORMATION

HOW TO FIT CAR SEAT INTO YOUR CAR

Be aware of these points when choosing a car seat for your child.

Log onto www.rsa.ie/checkitfits to see when Check it Fits is in your area.

YOUR CHILD’S HEIGHT AND WEIGHT

CAR SEAT'S COMPATIBILITY WITH YOUR CAR

YOUR RETAILER'S ACCREDITED TRAINING

that travels around the country checking child car seats everywhere it goes so parents are invited to have their children’s car seats checked or simply talk to the experts for advice in this area: www.rsa.ie/checkitfits The RSA also regularly posts information on child safety in cars at www.facebook.com/RSAIreland and on Twitter at www.twitter.com/RSAIreland Thanks to the Road Safety Authority for this information.

LIFE AS A NEW PARENT

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 three 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 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.”

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FOUR OF THE BEST

safe family cars FORD KUGA The 2017 version of the Ford Kuga is one of the most connected, comfortable, safe and stylish family cars available in Ireland. The Kuga has received the highest five-star rating in the stringent safety tests that are organised by Euro NACP (European New Car Assessment Programme). The Kuga is also jam-packed with cuttingedge technologies like Active City Stop, an automated braking system that prevents slow speed accidents if the car detects that the driver does not engage the brakes when a collision appears imminent. Boasting a range of fuel-efficient diesel and petrol powertrains, the car was recently restyled and is now one of the most stylishlooking SUVs on the road.

VOLVO XC60 The new version of Volvo’s XC60 premium SUV, launched in the first half of 2017, is fully loaded with new technology such as a new safety system called Oncoming Lane Mitigation, which uses Steer Assist to help mitigate headon collisions. The brand’s Blind Spot Indication System also now uses Steer Assist functionality to reduce the risk of lane-changing collisions. Pilot Assist, Volvo’s advanced semi-autonomous driver assistance system, which takes care of steering, acceleration and braking on well-marked roads up to 130 km/h, is available in the new XC60 as an option. Plus, the new CleanZone four-zone climate system removes harmful pollutants and particles from outside the cabin to deliver fresh air on the inside.

1

2

LIFE AS A NEW PARENT

VOLVO S90 AND V90 Volvo has built upon its reputation as a producer of some of the dafest family cars on the road today by becoming the first car maker to score a full six points in the Autonomous Emergency Braking for Pedestrians (AEB Pedestrian) test procedure and an overall five-star rating for both its new S90 sedan and V90 wagon. The brand’s success in the Autonomous Emergency Braking tests is a result of the advanced City Safety system, which is standard in all new Volvo cars. City Safety works by identifying potential hazards on the road ahead, such as vehicles, pedestrians and cyclists in certain situations, day and night. The results are a further step in Volvo’s aim that no one should be killed or seriously injured in a new Volvo car by the year 2020.

4

ŠKODA KAROQ Hot on the heels of the Kodiaq, ŠKODA has unveiled a smaller compact SUV called Karoq. The emotive and dynamic design with numerous crystalline elements is a feature of ŠKODA’s design language that is evident across its entire range. New technologies including driver assistance systems and full LED headlights are featured and – for the first time in a ŠKODA – a digital instrument panel. New comfort systems include Park Assist, Lane Assist and Traffic Jam Assist. Blind Spot Detect, Front Assist with predictive pedestrian protection and Emergency Assist serve to increase safety. Plus, the second generation Modular Infotainment Matrix offers state-of-the-art functions and interfaces and is equipped with capacitive touch displays.

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WE DON’T WANT TO SAVE CHILDREN’S LIVES Children’s lives shouldn’t need saving from entirely preventable causes. Every day tens of thousands of children worldwide die needlessly from illnesses such as measles, tetanus and diarrhoea. UNICEF wants you to help prevent these deaths. We believe that one child dying is one too many. We believe in zero and we desperately need your help.

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

Believe in zero.

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CHOOSING A

family car

LIFE AS A NEW PARENT

Most parents spend hours agonising on 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. ● 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. ● 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, comfortably and is accessible. There’s typically no issue with this if you have a MPV but if you have a smaller two-door model accessibility may be an issue. Most MPVs now come with Isofix mounting points as standard.

Take your car seat with you when viewing cars and make sure it fits comfortably and securely on the mounting points or on the seat if it’s not an Isofix car seat.

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.

● The extras Added extras can make journeys go that bit more smoothly. UVfiltering tinted back windows or integrated sun-blinds will be welcome if you’re travelling during the summer. Some of the more deluxe models offer seat back DVD screens which can keep older children entertained and cries of ‘are we there yet’ quelled.

For older kids in the driving seat, some models offer satnavs, ● Measure up in-built computers, deluxe sound As you may have noticed from systems and parking sensors – a friends or family with children, babies design that can keep the whole and toddlers come with a seemingly family happy. unending amount of paraphernalia.

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WORK &

childcare 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.

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.

LIFE AS A NEW PARENT

P

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

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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

LIFE AS A NEW PARENT

● 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 afterschool facility. In full-day care, sleeping arrangements and food preparation must meet standards laid down by the Health Service Executive. ● 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 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. ● 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 help you 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.

SHOULD I STAY

or should I go?

If you’re thinking you should stay at home rather than return to work, it’s important to look at your finances closely. ● What is your actual income from your job including salary, bonuses and perks (i.e. car, mobile phone, health insurance etc)? ● Now consider how much being in work costs you through transport, lunches, etc. ● Take one amount from the other. ● Do the same for your partner. ● Consider the cost of childcare. Does it make financial sense for you to work? For your partner?

If you are a single parent, unfortunately your choices are more limited. If you cannot work, there is help available.

Visit citizensinformation.ie for details of your entitlements.

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CHOOSING

your childcare

● 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, 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. Or try to talk to a parent with a child in that facility. ● 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. ● 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.

LIFE AS A NEW PARENT

● 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 lots of personal recommendations.

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CAPTURING memories

W

LIFE AS A NEW PARENT

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: ● 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.

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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? ● 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.

Contact: www.julesmphotography.com

LIFE AS A NEW PARENT

● Don’t forget to print them!

Jackie Farrell, Marketing Manager, 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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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

DIRECTORY

CHILDCARE SERVICES, The Childcare Directory Ltd, Media Cube, Kill Avenue, Dun Laoghaire Co Dublin.

Tel: (01) 201 6000 Email: info@childcare.ie Web: www.childcare.ie

Childminding Ireland, 9 Bullford Business Campus, Kilcoole, Co. Wicklow.

Tel: (01) 287 8466 Email: info@childminding.ie Web: www.childminding.ie Early Childhood Ireland, Hainault House, Belgard Square, Tallaght, Dublin 24.

Tel: (01) 405 7100 Email: info@earlychildhood. ie Web: www.earlychildhood. ie

DEPRESSION AND MENTAL HEALTH Aware 72 Lower Leeson Street, Dublin 2.

Tel: (01) 661 7211 LoCall Helpline: 1890 303 302 Email: info@aware.ie Web: www.aware.ie Aware conducts support group meetings across the country. Manned by trained volunteers, their Depression Helpline is a listening service that operates Monday to Friday, 10am to 10pm.

Aware also provide an email support service. Please visit their website for more information.

Post Natal Depression Ireland, Administration Building, Cork University Hospital, Wilton, Co. Cork.

Support Line: (021) 492 2083 (Tuesdays and Thursdays, 10am to 2pm) Email: support@pnd.ie Web: www.pnd.ie Monthly support meetings are held on the last Tuesday of every month at Cork Maternity Hospital, Wilton, Cork.

LONE PARENTS Doras Buí – A Parents Alone Resource Centre Bunratty Drive, Coolock, Dublin 17.

Tel: (01) 848 4811 Email: info@dorasbui.ie Web: www.dorasbui.ie One Family, Cherish House, 2 Lower Pembroke Street, Dublin 2.

Tel: 01 662 9212 LoCall Info Line: 1890 662 212 Email: info@onefamily.ie Web: www.onefamily.ie OPEN – One Parent Exchange and Network, National Centre, 7 Red Cow Lane, Smithfield, Dublin 7.

Tel: (01) 814 8860 Email: enquiries@oneparent. ie Web: www.oneparent.ie

Services Centre IFSC, Dublin 1.

Tel: (01) 670 0120 LoCall Info Line: 1890 252 084 Email: info@treoir.ie Web: www.treoir.ie Information and advice resource for unmarried parents

MISCARRIAGE AND CHILD LOSS SUPPORT A Little Lifetime Foundation, 18 Orion Business Campus, Rosemount Business Park, Ballycoolin, Blanchardstown, Dublin 15.

Tel: (01) 882 9030 Email: info@alittlelifetime.ie Web: www.alittlelifetime.ie First Light - Irish Sudden Death Syndrome Association, Carmichael House, North Brunswick Street, Dublin 7.

Tel: (01) 873 2711 LoCall Helpline: 1850 391 391 Email: support@firstlight.ie Web: www.firstlight.ie Miscarriage Association of Ireland, Carmichael Centre, North Brunswick Street, Dublin 7.

Tel: (01) 873 5702 Email: info@miscarriage.ie Web: www.miscarriage.ie

Treoir 14 Gandon House, Custom House Square, International Financial

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MULTIPLE BIRTHS Irish Multiple Births Association, Carmichael Centre, North Brunswick Street, Dublin 7.

Tel: (01) 874 9056 Email: info@imba.ie Web: www.imba.ie

SUPPORT AND ADVICE FOR AN UNEXPECTED PREGNANCY Cura, LoCall Helpline: 1850 622 626 Email: curacares@cura.ie Web: www.cura.ie PACT, Arabella House, 18D Nutgrove Office Park, Rathfarnham, Dublin 14.

Tel: (01) 296 2200 Crisis Pregnancy Line: 1850 673 333 Email: info@pact.ie Web: www.pact.ie

SUPPORT FOR NON-NATIONALS (INCLUDING ASYLUM SEEKERS) Cáirde, 19 Belvedere Place, Dublin 1.

Tel: (01) 855 2111 Email: info@cairde.ie Web: www.cairde.ie The Lantern, 17 Synge Street, Dublin 8.

Tel: (01) 405 3868 Email: info@lanterncentre. org Web: www.lanterncentre.org

DIRECTORY

Tallaght Intercultural Action, West Tallaght Resource Centre, 16 Glenshane Lawns, Tallaght, Dublin 24 Tel: (01) 452 2533 Email: tia@ireland.com

SUPPORT FOR ASYLUM SEEKERS The Integration Centre, 20 Mountjoy Square East, Dublin 1

Tel: (01) 645 3070 Email: info@ integrationcentre.ie Web: www.integrationcentre.ie Spirasi, 213 North Circular Road, Dublin 7.

Tel: (01) 838 9664 Email: info@spirasi.ie Web: www.spirasi.ie

SUPPORT FOR CHILDREN AND PARENTS UNDER STRESS Barnardos, Christchurch Square, Dublin 8.

Callsave: 1850 222 300 Tel: (01) 453 0355 Email: info@barnardos.ie Web: www.barnardos.ie Childline, 24-hour Freephone Helpline: 1800 666 666 Text: ‘TALK’ to 50101 (2pm-10pm daily) Web: www.childline.ie Parentline, Carmichael House, North Brunswick Street, Dublin 7.

Tel: (01) 873 3500 LoCall: 1890 927 277 Email: info@parentline.ie Web: www.parentline.ie

SUPPORT FOR FAMILIES WITH SPECIAL NEEDS Asthma Society of Ireland, 42-43 Amiens Street, Dublin 1.

Helpline: 1850 445 464 (10am-1pm, Monday-Friday) Tel: (01) 817 8886 Email: office@asthma society.ie Web: www.asthmasociety.ie Cleft Lip and Palate Association of Ireland, Tel: 087 131 9803 Email: info@cleft.ie Web: www.cleft.ie

Down Syndrome Ireland, Unit 3, Park Way House, Western Parkway Business Park, Dublin 12.

Tel: (01) 426 6500 LoCall: 1890 374 374 Email: info@down syndrome.ie Web: www.downsyndrome.ie Enable Ireland, 32F Rosemount Park Drive, Rosemount Business Park, Ballycoolin Road, Dublin 11.

Tel: (01) 872 7155 Email: communications@ enableireland.ie Web: www.enableireland.ie The Hope Project – Inclusion Ireland (Disability/ Autism), St Joseph, Ballinabearna, Ballinhassig, Co. Cork.

Tel: (021) 488 8503 Email: hope.project@esatclear.ie Web: www.inclusionireland.ie Irish Deaf Society, Deaf Village Ireland, Ratoath Road, Cabra, Dublin 7.

Tel: (01) 860 1878 Email: info@irishdeafsociety.ie Web: www.irishdeafsociety.ie The Irish Society for Autism, Unity Buildings, 16/17 Lower O’Connell Street, Dublin 1.

Tel: (01) 874 4684 Email: admin@autism.ie Web: www.autism.ie Irish Wheelchair Association, Áras Chúchulainn, Blackheath Drive, Clontarf, Dublin 3.

Tel: (01) 818 6400 Email: admin.roc@iwa.ie

National Council for the Blind, Whitworth Road, Drumcondra, Dublin 9.

Tel: (01) 830 7033 LoCall: 1850 92 3060 Email: info@ncbi.ie Web: www.ncbi.ie

WOMEN’S NEEDS Women’s Aid, 5 Wilton Place, Dublin 2.

Helpline: 1800 341 900 (10am-10pm daily) Tel: (01) 678 8858 Email: info@womensaid.ie Advice and support for women and children experiencing domestic violence.

OTHER USEFUL INFORMATION AND ADVICE Department of Justice and Equality, 94 St Stephen’s Green, Dublin 2.

Tel: (01) 602 8202 Lo-Call: 1890 221 227 Email: info@justice.ie Web: www.justice.ie Maternity Benefit Section, Department of Social Protection, McCarter’s Road, Ardarvan, Buncrana, Co. Donegal.

LoCall: 1890 690 690 Tel: (074) 916 4491 Email: maternityben@welfare.ie Web: www.welfare.ie Irish Human Rights & Equality Commission 16-22 Green Street Dublin 7.

LoCall: 1890 245 545 Tel: (01) 858 9601 Email: info@ihrec.ie Web: www.ihrec.ie

Meningitis Research Foundation, Gardiner House, 64-66 Lower Gardiner Street, Dublin 1 Helpline: 1800 413 344 Tel: (01) 819 6931 Web: www.meningitis.org

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