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Survival Guide
Mothers Diary

This section is broken down into the following sub-categories:

Mothers Diary

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1st Entry: 12 WEEKS PREGNANT

The first 12 weeks

LMC: refers to 'lead maternity carer', which is the health professional (midwife or doctor) looking after you during your pregnancy.


I found the following book a great resource for my work as a midwife.
Joan Donley's Compendium for a Healthy Pregnancy and a Normal Birth
By Joan Donley

This book was written as a resource book about health for pregnancy, birth and the baby. It is written mainly looking at these areas but it could be used as a natural health reference for everyday life. The book provides a lot of references to other people's wisdom, so this is not just a book on Joan's thoughts but a collection of like-minded people.

The first section looks at environmental hazards and the reasons why we should avoid certain drugs and chemicals. She uses a quote re fetal and brain development: 'the brain and neuronal pathways have only one chance'. This made me think (use my neurons) re the importance of health of pregnant women more, as they are caring for the next generation. The survival of intelligence depends on it. Pregnant women need to look after themselves and see themselves as mothers even before the baby is born, and mother their unborn baby. Joan's references to statistics include that 360 NZ babies are born each year with impairments caused by maternal consumption of alcohol and that cigarette smoke contains an estimated 3800 chemicals.

The next section goes on to review nutrition. Quote Joan used: 'The area in which a woman can exert the most influence over the outcome of her pregnancy is nutrition' (Plotkin 1994). We often forget the food we eat is the fuel for our body; cells need certain minerals and vitamins to function properly.

I have been taking a folic acid supplement. It is recommended to increase your Folic Acid intake before getting pregnant, and in early pregnancy as deficiency can cause possible congenital neural tube defects eg spina bifida.
The present recommendation is to take folic acid daily for 4 weeks before conception until 3 months post conception. Please speak to your LMC (Doctor, Midwife) re this.

Before getting pregnant I also checked my rubella immunity. If not immune you may wish to consider having the vaccine and then you will have to wait approximately 3 months before trying to get pregnant. You usually have to avoid pregnancy after immunisations until advised otherwise.
After you realise you are pregnant then you will need to have antenatal (pregnancy) blood tests done. At the booking visit, bloods are taken to check rubella immunity, find out your blood group and if you have any antibodies, your hepatitis and HIV status, full blood count (FBC) and a VDRL test for syphilis.

Having scans is a personal decision

What is Nuchal Translucency (NT) scanning?
Nuchal Translucency scan measures a skin thickness on the back of the baby's neck between 11-14 weeks. Measurements may determine risk for foetal and chromosomal abnormalities. Eighty per cent of Downs abnormalities (Trisomy 21) are identified using this method. If after the NT it is determined you have an increased risk of Downs, your Doctor or Obstetrician may suggest you have further tests such as Amniocentesis or Chorion Villus Sampling (CVS) and will discuss the risks of having these tests.
You must think though what you would do with the information they provide you with.
If the NT scan shows a high risk of Down's syndrome would you want to terminate the pregnancy, if not then think about the reason you are having the scan in the first place.

Finding a Lead Maternity Carer (LMC)
Being a midwife myself it wasn?t hard finding a midwife. I do advise to book your LMC (midwife, Dr) early, often between 4-12 weeks pregnant. In some areas independent midwives are booked up earlier than in other areas due to availability and popularity.
0800 MUM 2 BE (0800 686 223) NZ
The 0800 MUM 2 BE Maternity Consumer phone line is run by the Ministry of Health.
The 0800 line has a person answering the phone between 9am and 2pm Monday to Friday. Voicemail is available to leave a message after hours and all messages will be responded to accordingly.
The 0800 line supplies lists of Lead Maternity Carers (LMCs) for requested areas. For maternity consumers requiring information regarding pregnancy care and other information contacts; 'Your Pregnancy' booklet is available.
LMCs and Medical Centres can obtain the Your Pregnancy booklet through their local Public Health Provider or order online at www.healthed.govt.nz
The phone line does not give counseling, midwifery or medical advice.

For more information on finding a midwife see our Find a Midwife page on BabyWebNZ

You will have the choice of a LMC who will be responsible for your maternity services. This may be a midwife, GP or private obstetric consultant. Some LMC's will provide all of your care during pregnancy, labour and birth, and postnatally, some may provide shared-care working with other maternity service providers.
The options of a place to give birth include:
Home birth, birthing units, maternity hospital, and private maternity hospitals.
It is important to have a LMC who understands and supports your wishes for your birth.

Helen 21-9-2006
The information in this article is not a substitute for professional medical or midwifery care.
You should always seek the advice of your midwife, doctor or health professional for any concerns you may have regarding your health.
2nd Entry: 18 WEEKS PREGNANT
18 weeks and counting

By Helen@babywebnz.org
www.babywebnz.org
A Mother, Midwife and Childbirth Educator.

The time seems to be going faster with my second pregnancy than with the first. I'm busy with my three year old son, then a little person gives me a kick to remind me that yes they are in there and busy growing. I am excited about this pregnancy, I know how much I love my son and know I will love this child just as much. But I do have a realisation of what I'm are in for! With Jack I thought how hard can looking after one baby be, I was a Midwife I had a lot of experience with babies. The reality is different, when it is your baby and you have to look after them 24 hours a day, 7 days a week. Even when you are not looking after them for that time you are thinking about them.
Mothering...to take on one of the most emotionally and intellectually demanding, exasperating, strenuous, anxiety-arousing and deeply satisfying tasks that any human being can undertake...quote Sheila Kitzinger. From Ourselves as Mothers.

Antenatal Check (ante=before, natal=birth)

Visits are usually monthly until 28 weeks, fortnightly until 36 weeks then weekly. A diabetes screen blood test may be done at 28 weeks. A blood test at 36 weeks may be done if you are Rh negative and a Full Blood Count (FBC) if your iron levels are low.  Discuss Group B Strep Infection Screening and find out what guidelines your LMC follows for this. If your baby is still breech (bottom down) after 34 weeks you may want to discuss options of trying to turn the baby, this may include an ECV external version (an obstetrician manually turning the baby to a head down position)

Checking baby's health:

  • FUNDAL HEIGHT fundus is the top of the uterus (womb) each cm above pubic bone= 1wk gestation
  • PALPATION is feeling the pregnant tummy to work out:
  • PRESENTATION part of baby nearest pelvic opening, ie head (cephalic/vertex) breech (bottom) shoulder
  • POSITION OF BABY inside the uterus, anterior towards front, posterior towards back
  • DESCENT of baby into pelvis, usually engages (head in the pelvis) for primigravida 36wks, for a multigravida it is later or during labour
  • FETAL HEART RATE normal is 110-160 beats/min
  • FETAL MOVEMENTS usually first movements (quickening) felt by the 18-20th week in a primigravida, 16-18th week in a multigravida.
  • Should feel >10 movements in 12hrs

Checking mother's health:

  • BLOOD PRESSURE pressure which blood exerts against the walls of the blood vessels in the body.
  • OEDEMA fluid causing swelling
  • URINE (URINALYSIS)
  • PROTEIN indicator of pre-eclampsia or a urine infection
  • SUGAR indicator of diabetes
  • KETONES causes are diabetes, and starvation

During your visits to your LMC (Lead Maternity Carer) they will be asking you to make decisions. It should be a partnership model that you have with your LMC: working together. With parenting, which I believe begins at conception, you will have to make a lot of decisions.

To make a decision you have to have information to base that decision on. The Concise Oxford Dictionary defines decision as quote 'settlement (of question etc), conclusion, formal judgment, making up one's mind, resolve, (come to, make, take, a decision): resoluteness, decided character.'
Being an adult is seen by society as a time when you have to make a lot of decisions. There are many decisions that need to be made involving pregnancy, childbirth and the postnatal period eg when to tell people you are pregnant, if to have a scan or not, choice of LMC (Lead Maternity Carer), where to deliver your baby, name for your baby, the list goes on.

To make these decisions we need information. The information can come from different sources and it is up to the person to decide what information they believe, as not all information is helpful or factual. People often love to give advice especially when it comes to babies. This sometimes is helpful but often confusing. When you get told different things it becomes conflicting and you don't know whom to believe, so sometimes you just don't listen to anyone. But I do believe it is important to listen and come to your own your own conclusions. This may mean you need to do your own research, as in reading books, looking up the internet and going to childbirth education classes.

The LMC and childbirth educator has the responsibility to provide information and should try and do this in a non-biased way, basing their information on research, experience, education and health guidelines. Having knowledge on the different options available relating to pregnancy, childbirth and the postnatal period and providing sufficient information about the benefits and the risks of these options.

We may not always make what others believe to be the right decision. This is part of being human, but it is important that we are allowed to make decisions and that they are informed decisions based on facts. Informed decisions give us control and responsibility over our lives, this is why our brain will always be our most treasured asset as it enables us to think.

Childbirth Classes

Childbirth classes usually start at 26+ wks pregnant. For more information on pregnancy classes see our Baby Friendly page on BabyWebNZ


Helen 31-10-2006
The information in this article is not a substitute for professional medical or midwifery care.
You should always seek the advice of your midwife, doctor or health professional for any concerns you may have regarding your health.


3rd Entry: 24 WEEKS PREGNANT
Twenty-four weeks and growing

By Helen@babywebnz.org
www.babywebnz.org
A Mother, Midwife and Childbirth Educator


Pregnancy is the biggest natural body change. The female body is designed for pregnancy, but even so, having another little person grow inside can cause some discomforts. It is a time to look after your health. You have to look after yourself to be able to look after your baby; this does not just relate to pregnancy but also after the baby is born.

With my first pregnancy I was working a lot of nights and got run down and ended up in hospital with bronchitis at 38 weeks. Looking back I should have rested more and finished working earlier. This pregnancy my midwifery job is more clinic work, which I am finding easier. Some women will sail through their pregnancy and others will find 40 weeks feels like a very long time.

I have listed some of the common pregnancy discomforts and some things I have found or heard are of help. Hormones and the increase in weight cause most of these discomforts. Everyone will put on a different amount of weight in pregnancy and a lot of LMC's do not weigh pregnant women any more. How much weight you put on doesn't always relate to the weight of your baby - sometimes it is more to do with how many chocolate biscuits you have been eating.
I always feel hungry when pregnant. I put on 22 kgs in my first pregnancy and it all came off again after 6 months, fingers crossed that it will be easy to loose the weight this time around. I feel like I'm walking like a penguin already. Our fridge broke down and as it was going to take a week to get a replacement part we got a hire fridge. When I told my husband that people who visited thought it was funny that we had two fridges he said, tell them it is to store all the extra food you eat when pregnant. There is an expected average weight gain of around 12 kg, with 2 kg in the first 20 weeks, then 0.5 kg per week until the birth.
This weight is from the growth of the baby, uterus, breasts, placenta and from an increase in fat storage (for breastfeeding), fluid around baby (amniotic fluid), and body fluid (blood etc).

Pregnancy Discomforts
  • Bleeding gums and increased salivation (saliva): Use a soft toothbrush and maintain good care of your teeth and gums. There has been research linking gum disease and other infections to premature births.
  • Morning sickness: Pregnancy often causes changes in taste, food cravings and also nausea. It is called 'morning sickness' but nausea can happen at any time of the day and is due to raised hormone levels, usually in the first 12 weeks. Small frequent meals, and dry crackers, ginger, or acupuncture/pressure may help.
  • Tiredness and insomnia: Try catnaps during the day. Insomnia is common, normal and largely 'untreatable' so stop being anxious about being awake - say things like 'well at least I'm resting'.
  • Constipation and haemorrhoids: Your gut slows down to allow more nutrients to be absorbed for the baby but this can lead to constipation. Exercise and increasing the fibre in your diet often helps. Kiwicrush found at most supermarkets in the frozen section is a natural laxative.                                                         
  • Leg cramps: Stop feet flexing at night with a pillow at the bottom of your feet. Some people say drinking a banana smoothie (contains calcium and potassium) helps reduce this.
  • Backache: The weight of the baby can cause you to lean backwards, to try to balance but this can put strain on your back in the area of your lumbar curve. Relaxin hormone can cause ligaments to be more relaxed. This is why it is important to concentrate on good posture and not to do heavy lifting. Gentle exercise, eg yoga, swimming, walking and heat packs, can help. If your backache is pregnancy related you can see a physiotherapist for free in New Zealand with a referral from your LMC.
  • Emotional changes: It is common to be more emotional and have memory loss.                                                                                           
  • Varicose veins and swollen feet: Avoid constriction such as crossing your legs and rest with feet up.
  • Heartburn: This is related to relaxation of the opening at the top of your stomach, letting the acid come back up. Try a bland diet and sleep with an extra pillow to keep your head above your stomach, thus using gravity to stop gastric juices coming back up. Take antacids only if prescribed by a health professional.
  • Stretch marks: Some woman will get stretch marks over the breasts, abdomen and legs. These red marks will go silvery white around 6 months after the birth but never fully go away. There is a lot of lotions that claim to reduce stretch marks but often whether you get them or not is more due to your skin type.
  • Sweating: You will often hear people tell pregnant woman they will have an inbuilt heater and some days it will feel like that. Helpful during winter but not in summer. The hormone progesterone can raise body temperature and the extra blood supply to the skin leads to more sweating.

Health http://www.babywebnz.org.nz/directory_Health.php
Please always consult your Midwife or Doctor re health problems.
Ministry of Health provides access to health information such as pamphlets, fact sheets, booklets and posters. There is a lot of information and pamphlets covering health in pregnancy some topics they cover are:

  • Alcohol effects babies' brain development and it is not known what is a safe level of alcohol consumption in pregnancy. The Alcohol Advisory Council's website is www.alcohol.org.nz, ph 0800 787 797 (NZ)
  • Smoking affects the placenta and the baby will get a reduced oxygen and food supply thus often being smaller when born. Babies exposed to cigarette smoke have a higher risk of cot death/sudden infant death syndrome (SIDS) If you cannot stop smoking, even reducing the number of cigarettes per day you smoke will help.
  • Avoid any drugs unless they have been prescribed, and always let your doctor or chemist know you are pregnant. Even avoid vitamin supplements and homeopathic remedies until you have consulted with a health professional. It is recommended to take folic acid supplements in early pregnancy, as what you can get via your diet is often not enough.
  • Avoid x-rays during pregnancy unless they are medically needed.
  • High intake of caffeine has been linked to small babies and miscarriages.
  • Do not try to diet when pregnant, your baby will need good iron and calcium supplies. If you are on a special diet your LMC can refer you to see a dietician.



Helen 14-12-2006
The information in this article is not a substitute for professional medical or midwifery care. You should always seek the advice of your midwife, doctor or health professional for any concerns you may have regarding your health.
4th Entry: 30 WEEKS PREGNANT
Thirty weeks

By Helen@babywebnz.org
www.babywebnz.org
A Mother, Midwife and Childbirth Educator.


Baby Names

I was looking at the website http:/babycenter.com and noticed it listed the top 100 names for USA in 2006. For girls it was Emma and for boys it was Aiden. For NZ 2006 girls it was Olivia and boys Jack. I have been thinking about names of late. One of my friends who is a teacher said it was hard to find names for her children because she didn't want to give them the same name of any children who she had looked after that she had bad memories of. A lot of babies get called by a nickname or just 'baby' for a long time.

You need to send in a birth registration form for your baby before 2 months of age. It states the name must not be offensive, or more than 100 letters, or resemble an official title or rank. So I guess Queen or King are not allowed. If you need help with this after the birth you can ring The Department of Internal Affairs on Free phone 0800 225252 NZ.


Birth Plans
I see birth plans as 'preferences and options you are considering for your birth, and your baby'. I'm not too sure of the word 'plans' as birth can be unpredictable, and when in labour you may have different thoughts on what you want. Birth plans do mean that you sit down and think about the options. Then you can discuss these options with your LMC so you can work in partnership and make informed choices. Know that you can change your mind at any time. Some of the things you may include in a birth plan are:

Birth
  • Planned place and type of birth eg home, birth centre, hospital, water birth, caesarean section
  • Support people and other people present eg would you be happy to have students?
  • Labour aids (things to make you feel comfortable eg wheat heat packs)
  • Positioning for labour
  • Pain relief
  • Who will deliver the baby?
  • Who will cut the cord?
  • Do you want to video or take photos?
  • Do you want a mirror to watch the birth of the baby?
  • Delivery of the placenta; do you want to push it out yourself or have ecbolic injection?
  • Do you wish to keep the placenta?
  • Do you want to keep cord blood?

Baby
  • Skin to skin contact in which the baby is placed directly onto your chest after the birth.
  • Feeding
  • Vitamin K
  • Metabolic Screening (Guthrie Test)
  • BCG immunisation
  • Hepatitis B vaccine (if Mother has Hepatitis B)

Sleep

I am finding sleeping harder now as I can no longer lie on my back and haven't been able to lie on my stomach for ages so that limits me to being on my side. I put a pillow between my knees for added comfort but find I just get comfortable then need to get, out of bed and go to the toilet again! Due to my tossing and turning and my husbands snoring, we are now in separate bedrooms which is fine for me especially as I have gone off the idea of romance.

Sex

The females sex drive may change during pregnancy due to tiredness. The males

desire may change due to concerns for his partner?s health and the baby's. But be reassured with a normal pregnancy, it is safe to have intercourse. It will not harm your baby, as there is a mucous plug at the cervix, a bit like the cork in a bottle. The baby is protected within the uterus in a bag of amniotic fluid that is mainly water. It is always important to protect yourself from catching sexually transmitted diseases especially if you are not in a monogamous relationship

If there have been concerns during your pregnancy then you may have been advised against intercourse. This would be if you've been treated for premature labour, a shortened or dilated cervix, leaking amniotic fluid, placenta previa, or bleeding, or if you have a history of recurrent miscarriages.
In the third trimester (after 28 weeks) you may have to experiment with positions that avoid the female lying on her back and putting weight on the pregnant abdomen eg: Lie side-by-side in the spoon position.

Helen
The information in this article is not a substitute for professional medical or midwifery care.
You should always seek the advice of your midwife, doctor or health professional for any concerns you may have regarding your health
5th Entry: 36 WEEKS PREGNANT
36 Weeks

By Helen@babywebnz.org

www.babywebnz.org

A Mother, Midwife and Childbirth Educator


It is hard to think that soon this baby will be born. Around term which is 40 weeks (280 days) from your last menstrual period, is when most babies are born. I have started to semi prepare with getting out the baby clothes, putting a few things in a bag and booking a car seat capsule from Plunket. I have also been talking to my three year old son about babies so he knows what to expect. He told the baby off the other day when I told him that the baby was kicking me he said 'naughty baby'. He seems happy with the idea of being a big brother though has told me the baby isn?t allowed to play with his trains.

At the visits with my Midwife she listens to the baby and checks the position. It has its head down towards my pelvis. She also wants to know if I have any concerns.

Warning signs of pregnancy

Notify your LMC (midwife/doctor) if you experience any of the following:

  • Stomach Pain
  • Preterm (<37 wks) contractions
  • Vaginal bleeding
  • Premature rupture of membranes (waters breaking)
  • Offensive vaginal discharge
  • Change in normal pattern or reduced movements from the baby
  • Generalised swelling, headaches or visual disturbances (seeing spots)
  • Unwell, vomiting or diarrhea
  • High temperature
  • Painful or burning when pass urine
  • Constant itching and dark urine
  • Persistent severe leg pain/cramps with swelling of the leg
  • Accident involving injury to your pregnant stomach (abdomen)
  • Fainting or persistent dizziness

Exercise

Exercise helps with sleep, increases fitness and energy levels and increases muscle tone.
It is good to try to exercise 20-30mins 3-4 times a week, though even 10 minutes a day of walking can be beneficial
When pregnant, choose low impact exercises such as walking, yoga, stretching and swimming.
Remember to drink (water) and avoid over exerting, exercise which causes pain, contact sports, bouncing movements, over heating or getting short of breath
Some women may be advised not to exercise if they are unwell, if there is risk of premature labour, any bleeding, if you have high blood pressure or if your midwife or doctor advises them not to.

Also see information on the survival guide for pregnancy.


Helen
The information in this article is not a substitute for professional medical or midwifery care. You should always seek the advice of your midwife, doctor or health professional for any concerns you may have regarding your health.
6th Entry: 40 WEEKS PREGNANT
40 weeks or 280 days

By Helen@babywebnz.org
www.babywebnz.org
A Mother, Midwife and Childbirth Educator


You may have your EDD (estimated date of delivery) circled on the calendar but it is only an estimate and less than 5% of babies are actually born on this day! Babies do come early, so be ready in advance.

If planning a hospital birth you may want to bring:

  • Snack food and drinks for the labouring woman eg Muesli bars, bottled water and food for the support people.
  • Labour causes you to get dry lips, thus a chap stick is helpful.
  • Heat packs good for back pain. With wheat bags remember to have a glass of water in microwave as they are a fire risk and do not add oil to the heat/wheat pack.
  • Massage Oil, lavender scented oil is relaxing.
  • Calming music and a player.
  • Hair tie if you have long hair.
  • Remember to have film in the camera.
  • Money/phone cards, have a list of phone numbers of who to call after the birth. Most people will ask you the sex of the baby, time of birth and weight (kgs and pounds) Bring pen and paper to write these kinds of things down.
  • Cell phones aren't allowed to be used inside some hospitals, as may interfere with equipment. Ask your LMC about your hospital guidelines re this.
  • Comfortable cool clothes eg a sarong, big T-shirt.
  • You will often still look pregnant for about a week after the birth so also have clothes which will fit after the baby is born. Bring in old knickers as you will bleed (like a heavy period) and have to wear pads. Tampons are not recommended as increase the risk of infection and your midwife will want to know what your blood loss is like. If you have a caesarean section you will want large granny knickers so that the elastic doesn't sit over your scar!
  • Sandals or slippers as feet swell. Your feet get cold during labour so bring warm socks.
  • Have your Antenatal record with you. Also remember to take this with you if you are going away when pregnant so if you need to go to another hospital they will know about your pregnancy checks.
  • Leave valuables/rings at home if going to the hospital, as they may get lost or stolen.
  • Maternity bras, at about day 3 your breasts will become large and heavy with engorgement of fluid. Some woman leak breast milk and need to use breast pads.
  • Postnatally a tri pillow is handy for breast feeding.
  • Most hospitals don't provide clothes for the baby so bring in 2-3 sets of clothes. This may include singlets, stretch and grow, woollen jersey and hat, socks, mittens and booties (ones with ribbon ties don't tend to stay on).
  • Ask your midwife if the hospital supplies nappies. Babies will need 6-8 changes per day. You will legally need an approved infant car seat to take baby home in. Know how the car seat works before putting baby in it. Have baby warmly wrapped with a blanket around them when going outside.

Homebirth

The New Zealand Home Birth Association estimates that around 75% of pregnant woman could safely give birth at home.


Homebirth is a birth service that is available to people in Aotearoa New Zealand. Other choices are birth centres and hospitals.
Homebirth is a free service as is all antenatal, pregnancy and postnatal care up to six weeks by a public lead maternity carer (LMC).
Homebirth is an option to any woman without complications in their pregnancy or labour. If complications arise then it is recommended that they go to hospital.
Not all midwives and doctors will provide the service of attending a homebirth so it is important to find out which midwives do, and to be happy with your choice of LMC as you will be working in partnership with them.
The midwives who do conduct homebirths will bring with them equipment needed to assist in the delivery, or if there are complications.

The midwife may have a TENS machine to help with pain relief, if not these can be hired from some chemists or via the physiotherapy department .
The midwife may also carry entonox gas.
The birthing woman or couple will often be asked to provide the following:
  • Washing up bowl.
  • Towels.
  • Sanitary towels.
  • Torch/spot light.
  • Container to put the placenta in.
  • Hot water bottle or heater to warm baby clothes and towels.
  • The room needs to be kept warm for when the baby is born, and running water is helpful (cold and hot).
  • A working phone, though most midwives carry a mobile phone so emergency services can be contacted if needed.
  • The couple should also have arranged care of any other children they have in the house, and prepared them for the delivery.
  • They need to decide where in the house the delivery will take place and be prepared (eg plastic sheets) and any items needed to assist in the comfort of the labouring woman (eg pillows, drinks and snacks).

Labour

When labour starts there are no flashing lights to say this is labour. With some people it can take awhile for them to realise they are in labour, as it can just start with a few cramping pains like period pains. For others it can start in a rush and you go straight into full on strong contractions.

Signs and stages of Labour

There are three signs of labour, which can happen in any order:
  • Contractions: These become more frequent and last longer as labour progresses, often are in a regular pattern, usually painful and do not go away with rest.
  • Show: When the cervix (the neck of the womb) opens a plug of mucous, sometimes with a small amount of blood, may be passed. A show may happen during labour or up to 2 weeks before contractions start.
  • Rupture of membranes: Usually there is a small gush if your waters break by themselves. The head then drops down to act like a plug, and you will continue to leak small amounts of sweet smelling clear fluid. In 15% of labours waters break before labour. Let your LMC know if the fluid is green in colour as this is from the baby doing a bowel motion/poo (meconium) which is a sign of being distressed.

First stage of labour (early, established and transition phases)

Early/latent Labour

How you may feel:
Unsure is this labour?
Restless

Physical changes:
Contractions begin then become more regular (10-30mins apart)
Start off feeling like period cramps then get stronger, like a tight rubber band getting pulled around your abdomen.
Some people feel it in their back also.
Cervix is thinning (effacing) and starting to open (dilatation)

Established labour

How you may feel:
Hot and sweaty
Find it hard to get comfortable
Want to move around
Need reassurance and support

Physical changes:
Contractions are stronger more painful and closer together (5 minutes apart)
Your body will be working hard, like climbing up a mountain with a heavy backpack (in this case a heavy frontpack!). Try to use visualisation eg
Think of the wonderful view you get from the top of a mountain.
Think of the contractions as waves on the ocean.
Think of your wonderful baby you will see at the end of this.
Cervix is opening more 3-4cm+

Transition

How you may feel:
You may feel you are rowing up stream and not getting anywhere.
This is time when you become fed up and annoyed.
Do not want to do this any more!!
Very verbal or quiet
Feel can not cope, as there is little time to relax between the contractions
Need reassurance and support

Physical changes:
Contractions more painful and last longer (60 seconds)
Your body may shake; legs cramp and you may have waves of nausea.

Second Stage of Labour
The pushing stage

How you may feel:
Urge to push and feeling of pressure in your bottom.
Some people find pushing feels productive.
Find it hard work, are tired and want to rest but unable to.
Realization that you will soon see your baby

Physical Changes:
Cervix is fully dilated (10cm)
Push with contractions
Lots of pressure in your bottom, like you are constipated and need to go to the toilet!
Stretching/burning feeling as the baby's head pushes on the perineum just before the head is born

Birth
How you may feel:
Amazed at this beautiful baby
Deep emotions
Relief that the baby is out
Feel happy on a natural high
Exhausted as if you have just run a marathon
Want to touch, hold and feed your baby
A Birthday party, your babies Birth Day!

Third Stage
7th Entry: BABY
Baby

By Helen@babywebnz.org
www.babywebnz.org
A Mother, Midwife and Childbirth Educator


People see babies in different ways. Some people look at them as though they are an alien from another planet, as though they are all the same, or something to be feared. I disagree with all of these ideas. Babies are just little humans. Humans need food, sleep, play and love. As for being all the same, no they all come with their own personalities.

Information about babies and their needs:

Clothes See the survival guide what you need list.
  • Nappies, blanket and warm clothes/hat.
  • Lots of bibs are handy if you have a baby that spills a lot
  • Mittens that stay on as new babies often scratch their own faces
  • Newborn babies need one more layer of clothing than you do. Check their temperature using your 2 fingers down their front or back (in-between shoulders), this gives you an idea of their core (central) temperature.

Safety See the survival guide home safety pages.
  • A baby car capsule is for birth - 6mths and is rear facing going in the back seat of your vehicle.
  • If using a heater it should have a thermostat. We careful with gas heaters as some give off toxic fumes.

Food See the survival guide breastfeeding pages.
  • Breast milk is all babies need in the first 6 months
  • Weight may go down (up to 10% loss) in first 3 days, and then they regain their Birth Weight in approx 10 days. All babies are different so talk to someone if worried.
  • Rough guide re weight is by 6 months the baby's weight would have doubled, by 1 year baby will be 3 times birth weight.
  • Growth indicators for newborn babies: Baby Feeds around 6-8 times a day. Urine clear colour and have 6-8 wet nappies/24hrs. Alert when awake. Increasing weight and length
  • Relate babies to yourself, eg you sometimes take a short or long time to eat your meals.
  • Wind can cause abdominal discomfort in babies and it is important to try winding them after feeding. It could be due to the baby feeding fast and also sometimes diet related if breastfeeding. Cabbage, leeks and onions can sometimes cause wind. Try positions that put some gentle pressure on their stomach eg over your shoulder or across your knee, and rub their back at the same time. If after trying for several minutes and they won't bring up wind or they are asleep put them down. If they wake again 15 minutes later try winding again then.

Sleep See the sleep article.
Research says newborns normally cry a total of 1-4hrs/day usually pre feed and pre nap (for 10mins) and often have personal fussy time often late pm. Babies may take up to 10 minutes to settle off to sleep, may grizzle and cry before hand
  • If baby is crying consider - are they hungry, have wind, wet/dirty nappy, too hot/cold, uncomfortable or lonely and wanting a cuddle. Listen to the cry if very distressed? the cause and if worried seek advice from a health professional. If it is Colic, this usually appears at the second week, often worse early evening and babies draw up their legs with the discomfort
  • Newborns sleep approx total of 16-18hrs/24hrs. Note this is in total. Each separate sleep may between 1-8hrs. Sleep needs decrease over the first year of life to a point that they are awake most of the day having 1 or 2 day time naps and sleeping 12hrs at night.
  • Signs of being tired: jerky movements, grimaces, grizzling, making fists, yawning, rubbing eyes, staring vacantly into space or crying
  • Signs of wanting a feed: hand to mouth movements, fussiness, sucking action or sounds, cooing or sighing and nuzzling at breast
  • A bath in evenings tires them out and may help them go off to sleep more easily. If you don't have time to bath them every day still give their face then bottom a wash.

Nappies
  • Leave the cord out of nappy to allow to dry
  • Motions to start with are called meconium which is green/black colour and last for the first 1-2 days then it changes to a mustard colour, formula feed babies have light brown/clay coloured motions
  • Expect about 6-8 wet nappies/24hrs. Until toilet trained (around 2-3yrs old) you have approx 7000 nappies that will need changed!

Health See the infant and child health article.
See the back page of your Well Child Health book for child sickness danger signals. Remember to ring 111 for an ambulance. The phone number for the National Poisons Centre is 0800 764 766 NZ
  • Thermometer to check babies temp if you think they are unwell, (digital ones go under babies arm-pit)
  • Jaundice is yellowing of the skin and eyes caused by a build up of waste products (bilirubin). It can make babies sleepy and at high levels is dangerous. Your Midwife or Doctor will monitor this and the baby may need to go under phototherapy lights if the levels get too high.
  • Common minor health problems include:
  • Infection around the fingernails called paronychia. Try cleaning with alcohol wipes from the chemist and let your midwife or doctor know about this, if it doesn't get better your baby may need antibiotics.
  • Sticky eyes can be due to a blocked eye duct. Try gentle massage of the duct with your finger. Clean the eye with normal saline solution from the chemist and drops of breastmilk into the eye can help also as this has a natural antibiotic in it. Again see your Midwife or Doctor if doesn't improve or if the discharge is yellow or green in colour or the eye is inflamed.
  • Thrush may be present in the mouth or the bottom of babies. If breastfeeding it can be passed from the babies mouth onto your nipples. Thrush is a fungal infection that will cause discomfort.
  • If wanting immunisations these usually start at 6 weeks of age. Hepatitis B and BCG vaccines are given earlier than 6 weeks to newborns who are at risk of catching these diseases.

Helen
The information in this article is not a substitute for professional medical or midwifery care. You should always seek the advice of your midwife, doctor or health professional for any concerns you may have regarding your health
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