The ‘baby blues’ and postnatal depression by mrsumairsheikh


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									      THE EARLY WEEKS:
      Partners                                  132        Your relationships                        134
      Help and support                          133        The ‘baby blues’ and postnatal depression 136
      Looking after yourself                    133        Your postnatal check                      136

      Your first few weeks at home can be an exciting but anxious time for parents as you get
      used to caring for your new baby.
      If you have been in hospital or a midwifery unit, you may feel apprehensive about
      being on your own without staff on call to help you. The more you handle your baby,
      the more your confidence will increase. And your community midwife, health visitor and
          GP are there to support you if you have any worries or problems. Ask your midwife
                           or health visitor for a copy of the book Birth to Five, which has advice
                               on looking after your child up to the age of five.

                                   PARTNERS                          – getting specialist help and information
                                                                       on breastfeeding if the mother has
                                    As the mother’s partner, you       any concerns
                                    can get involved in caring     • provide emotional support and
                                    for your baby from day one.      encouragement
                                    In the first weeks, you can:
                                                                   • make nutritious meals and snacks for
                                   • help your baby’s mother to      your baby’s mother
                                    breastfeed by:                 • change your baby’s nappies
                                    – spending time with her       • bathe and dress
                                      while the baby is feeding      your baby
                                       – bringing your baby        • cuddle and play
                                         to their mother when        with your baby
                                         they need feeding in
                                         the night                 • clean the house,
                                                                     go shopping
                                           – helping to wind         and do other
                                             your baby               household chores.

                                                    You may feel quite nervous about handling the baby at first
                                                    but you will get more confident. Don’t be embarrassed to
                                                   ask for help or encouragement.

HELP AND                                                                          It’s tempting to use your baby’s
                                                                                  sleep times to catch up on
SUPPORT                                                                           chores, but try to have a sleep
You will probably need a lot of                                                   or a proper rest at least once
practical help, as well as emotional                                              during the day.

                                                                                                                        THE EARLY WEEKS: YOU
support. You are bound to feel up                                                 Exercise
and down and to get tired easily in
                                                                                  Continue with any postnatal
the first few weeks. Many women
                                                                                  exercises you have been shown
want to have their partner around
                                                                                  by your midwife. You can also do
so that you get to know the baby
                                          Too many visitors in a short time       this deep stomach exercise when
together and have help with the
                                          can be very tiring. If visitors do      you feel well enough.
work. Being together at this time
                                          come, don’t feel you have to tidy
helps you to start to adjust to the
                                          up or lay on a meal. Let them do
changes in your life. If you are on                                                 1 Lie on your side with your
                                          things for you, like the washing
your own, or your partner cannot                                                      knees slightly bent.
                                          up, making a meal or bringing
be with you, ask your mother or a                                                   2 Let your tummy relax and
                                          some groceries.
close friend to be there.                                                             breathe in gently.
                                         • If you need extra help, ask. Friends
Even with help, you will probably          or neighbours will probably be           3 As you breathe out, gently
feel tired. Here are some things you       very willing to help you by doing          draw in the lower part of
could try:                                 things like shopping.                      your stomach like a corset,
                                                                                      narrowing your waistline.
• Cut down on cleaning – a bit of
  dust will not hurt.                    LOOKING AFTER                              4 Squeeze your pelvic floor.
• Keep meals simple but healthy.         YOURSELF                                   5 Hold for a count of 10
  You need to eat well but this                                                       then gently release.
  need not involve a great deal of       Although you may feel like your
                                                                                    6 Repeat 10 times.
  preparation and cooking.               every waking hour is spent caring
                                         for your baby, it’s important to look
• Try to space visitors out and say no   after yourself as well.                  You should not move your back
  to visitors if you feel too tired or                                            at any time. After six weeks,
  need some time with your baby.         Rest                                     progress to the box position
                                         While you are feeding your baby at       (see page 34).
                                         night and your body is recovering
                                         from childbirth, it is essential to      Besides these exercises, try to
                                         catch up on rest.                        fit in a walk with your baby
                                                                                                  every day. This
                                                                                                    can help you lose
                                                                                                    weight and feel

                                             After you have had a baby, the
                                             relationships around you can
                                             change. Many women find that
                                             they turn to their own mother for
                                             help and support. But your mother
                                             may not be sure about how much            Your relationship with your baby
                                             to get involved. You may find that        may not be easy either, particularly
                                             she is trying to take over or that she    if you are not getting much sleep.
                                             is so anxious not to interfere that       Don’t feel guilty if you sometimes
                                             she doesn’t help at all. Try to let her   feel resentful at the demands your
                                             and others know what help and             baby makes, or if your feelings are
                                             support you want from them.               not what you expected them to be.
                                                                                       Talk to your midwife or health
                                             Your relationship with your partner       visitor if you are upset or worried.
                                             will also change. It is very easy in      But remember, many mothers find
      Eating properly
                                             those exhausting early weeks just         their babies difficult at first and
      It’s very important to eat properly    to leave things to sort themselves        come to love them gradually over
      (see Chapter 3). If you want to lose   out. You may wake up six months           some weeks.
      weight, don’t rush it. A varied diet   later to find that you have not spent
      without too many fatty foods will      an hour alone together and have           If you are on your own and
      help you lose weight gradually. Try    lost the knack of easily talking your     don’t have family to support you,
      to make time to sit down, relax and    problems through. You both need           ask a friend to help you in the
      enjoy your food so that you digest     time alone, without the baby, to          early weeks.
      it properly. It doesn’t have to be     recharge your own batteries. You
      complicated. Try food like baked                                                 Sex and contraception
                                             also need time together, without
      potatoes with baked beans and                                                    There are no rules about when to
                                             the baby, to keep in touch with
      cheese, salads, pasta, French bread                                              start having sex again. Don’t rush
                                             each other.
      pizza, scrambled eggs or sardines on                                             into it – if it hurts, it will not
      toast, followed by fruit mixed with                                              be pleasurable. You may want
      yoghurt or fromage frais.                                                        to use a lubricating jelly the first
                                                                                       time because hormone changes
      A healthy diet is especially                                                     may make your vagina feel drier
      important if you are breastfeeding.                                              than usual.
      Breastfeeding can help mothers to
      lose weight. Some of the fat you
      put on in pregnancy will be used to
      help produce milk, but the rest of
      the nutrients will come from your
      diet. This means that you may be
      hungrier than usual. If you do need
      a snack, try having beans on toast,
      sandwiches, bowls of cereal or fruit
      (see page 29).
      Sure Start Children’s Centres give
      advice about healthy eating plans
      for mothers, as well as support for
      breastfeeding. You can find out
      more about the services offered in
      Children’s Centres in your area by

                                                                                 have to use some other form of
                                                                                 contraceptive (like a condom)         12
                                                                                 as well. There is no evidence
                                                                                 to suggest that this pill affects
                                                                                 your baby in any way. Even so,
                                                                                 some women prefer not to take

                                                                                                                       THE EARLY WEEKS: YOU
                                                                                 it while they are breastfeeding

                                                                                                                           EARLY WEEKS: YOU
                                                                                 and use another form of
                                                                                 contraception instead.
                                                                               • The cap or diaphragm. These
                                                                                 can be used six weeks after
                                                                                 you give birth. If you had a cap
                                                                                 before, it probably will not be
It might be some time before you       Contraceptives                            the right size any longer. You
want to have sex. Until then, you                                                can have a new one fitted at
both may feel happier finding other                                              your postnatal check-up.
                                       contraceptive methods
ways of being loving and close.
                                       Short-acting contraceptive              Long-acting
If you or your partner have any
                                       methods rely on you taking them         contraceptive methods
worries, discuss them with your GP
                                       every day or when you have sex.         Long-acting contraceptive
or health visitor.
                                                                               methods last between three
                                       • The condom. This may be
It is possible to get pregnant even                                            months and ten years. They
                                         the easiest choice for the
if you have not started your periods                                           may be suitable if you think
                                         early weeks after childbirth.
again or if you are breastfeeding.                                             you will forget to take or use
                                         Condoms offer the best
It is therefore important to use                                               a short-acting contraceptive.
                                         protection against sexually
                  contraceptives as
                                         transmitted infections (STIs) so      • The IUD (intra-uterine device)
                      soon as you
                                         if you think you or your partner        or IUS (intra-uterine system).
                      start having
                                         may have been exposed to an             These can be fitted from the
                      sex again.
                                         STI you should use a condom in          fourth week after you give
                    Your midwife or      addition to your other choice           birth. They can be fitted at your
                    doctor should        of contraception.                       postnatal check-up when your
talk to you about contraception        • The combined pill. If you are           uterus is back to its normal size.
before you leave hospital and again      not breastfeeding, you can start      • The contraceptive injection.
when you go for your six-week            taking this pill 21 days after you      It is recommended that you wait
postnatal check. Alternatively, you      give birth. If you start it later       until six weeks after you give
could talk to your midwife or health     than the 21st day, it will not be       birth before you are given this.
visitor when they visit you at home      reliable for the first seven days.      It can be given earlier in some
or go to your GP or community            So for this time you will have to       circumstances. The contraceptive
contraceptive clinic (sometimes          use another contraceptive (like a       injection will not affect your milk
called family planning or CASH           condom) as well. Don’t take this        supply if you are breastfeeding.
clinic).                                 pill if you are breastfeeding as it   • The contraceptive implant
The FPA (Family Planning                 reduces milk flow.                      (Implanon). This contains a
Association – see page 184)            • The progestogen-only pill.              long-lasting progestogen and
publishes free leaflets about            If you are breastfeeding, you           is effective for three years.
all methods of contraception.            can take a progestogen-only             It can be fitted 21 days after
                                         pill, which will not affect your        you give birth or earlier in some
                                         milk supply. This can also be           circumstances. If it’s fitted after
                                         started 21 days after you give          21 days, you will have to use
                                         birth. It has to be taken at the        another contraceptive for seven
                                         same time every day. If you             days. The contraceptive implant
                                         start it later than the 21st day,       will not affect your milk supply
                                         it will not be reliable for two         if you are breastfeeding.
                                         days. So for this time you will
      THE ‘BABY BLUES’                                                            Tell the doctor if the examination
                                                                                  is uncomfortable.
                                                                                  • Your breasts are unlikely to be
      DEPRESSION                                                                    examined unless you have a
      As many as 8 out of 10 mothers get                                            particular concern.
      the ‘baby blues’, often about three                                         • A cervical smear test may be
      to five days after the birth. You                                             discussed if you have not had one
      might feel upset, mildly depressed,                                           in the past three years (see page
      or just keep bursting into tears for   YOUR POSTNATAL                         48). This is usually delayed until
      no apparent reason. It usually only                                           three months after delivery.
      lasts for a few days.                  CHECK
                                                                                  • If you are not immune to rubella
      Around 1 in 10 mothers become          You should have your postnatal         (German measles) and were not
      depressed. This is usually mild but    check about six weeks after your       given an immunisation before you
      sometimes can be quite severe.         baby’s birth to make sure that you     left hospital, you will be offered
      You must get help if you are taken     feel well and are recovering from      one now. You should not become
      over by a feeling of sadness and       the birth. You may be offered an       pregnant for one month after this
      hopelessness, you feel irritable       appointment to go back to the          immunisation.
      and anxious, or you have difficulty    hospital or midwifery unit where     • You will be asked if you still have
      sleeping and coping with even the      you gave birth, but otherwise          any vaginal discharge and whether
      smallest task. See page 82 for         you should see your GP. It’s time      you have had a period yet.
      more information.                      to introduce your baby to your
                                             GP as the new member of              • Tell your doctor if:
      Help and support                       your family!                           - you are having trouble holding
                                                                                      in urine or wind, or you are
                                             It’s a good opportunity to ask
      If you think you are depressed,                                                 soiling yourself
                                             any questions and sort out any
      contact your GP or health                                                     - intercourse is painful
                                             problems that are troubling you.
      visitor and explain how you are
                                             You may like to make a list of         - you are feeling very tired,
      feeling. Your partner or a friend
                                             questions to take along with you         low or depressed, or
      could contact them for you if
                                             so that you don’t forget what          - you are worried about anything.
      you want. You can also contact
                                             you want to ask.
      the Association for Post-Natal                                              You can also ask your doctor about
      Illness (see page 186) for more        What usually happens                 contraception. You may wish to
      information.                           • You will be weighed and can        choose a different method to
      If you have twins or triplets,           get weight loss advice if you      the one you had previously used
      you are more likely to experience        need it.                           (especially if your pregnancy
      postnatal and longer-term                                                   was not planned). The doctor or
                                             • Your urine will be tested to
      depression. This is mainly because                                          nurse can help you decide which
                                               make sure your kidneys are
      of the additional stress of caring                                          method is right for you now.
                                               working properly and that
      for more than one baby. Just                                                See the box on page 135 for
                                               there is no infection.
      getting out of the house can be                                             some of the different options.
                                             • Your blood pressure will be
      difficult when you have more
      than one baby, and this can make
      you feel isolated. Tamba (see page     • You may be offered an
                                                                                     Your baby’s check
      188) can help you make contact           examination to see if:
      with other mothers of multiples          - your stitches (if you had any)      Your GP’s surgery or health
      via local twins clubs and through          have healed                         clinic will probably arrange
      their helpline – Tamba Twinline on                                             for your baby’s six-week
                                               - your uterus is back to its          check to be done at your
      0880 138 0509 – where you can              normal size, and
      talk to other mothers of multiples.                                            postnatal check. If you go
      You may also find it helpful             - all the muscles used during         to the hospital, the baby’s
      to contact the Multiple Births             labour and delivery are             check will usually need to
      Foundation (see page 183).                 returning to normal.                be arranged separately.

THE EARLY WEEKS:                                                                                                          12

                                                                                                                          THE EARLY WEEKS: YOUR
                                                                                                                          THE EARLY WEEKS: YOU BABY
Enjoying your baby                137    Changing your baby                      142
Registering the birth             138    Washing and bathing                     144
Crying                            138    Illness                                 145
SleepContents                     140    Getting support                         146

In the first few weeks, you will be learning how to look after your baby. You will start to
understand them and will learn what is normal and what may be a sign that something
is wrong. But the most important thing to do in the first few weeks is to enjoy your
baby. Spending time with them is the best way to help them feel safe and loved.

Keeping your baby warm, fed and         They are learning about what the               Talking to your baby
safe may seem to take up all of your    world is like and, above all, what it
                                                                                       It is very important to talk to
time in the first weeks. But they are   feels like to love and be loved. It is
                                                                                       your baby. If you or your family
only a tiny part of what it means to    important to talk to your baby.
                                                                                       speak another language, use
be a parent. Every second that your
                                                                                       it to speak to your baby. It can
baby is awake, they are learning
                                                                                       help your baby to learn other
from you. Learning about what it
                                                                                       languages, and enjoy another

feels like to be touched gently, the
                                                                                       culture. You can talk to them
sound of your voice and your very

                                           to your
                                                                                       about anything and everything.
special smell.
                                                                                       Talking to young children, even
                                                                                       very young babies helps them

                                                                                       become good communicators
                                                                                       later in life. It will also help
                                                                                       your baby build their early
                                                                                       bond with you.

                                                At the moment, if you are not              CRYING
                                                married, you can decide whether
                                                you want the father’s name to              All babies cry. It’s their way of
                                                appear on the birth certificate.           saying that something is not right.
                                                If you do not want his name to             Sometimes you will be able to find
                                                appear, you can register the birth         the reason for your baby’s distress
                                                by yourself. However, the                  and deal with it. At other times
                                                government plans to change the             all you can do is try to comfort or
                                                law so that joint registration, by both    distract your baby. If it’s not obvious
                                                mother and father, becomes the             why your baby is crying, think of
                                                normal arrangement for unmarried           possible reasons.
                                                parents. Your local register office
                                                                                           Are they:
      REGISTERING                               will be able to provide detailed
                                                                                           • hungry?
                                                information about these changes
      THE BIRTH                                 when they come into effect.                • hot, cold or uncomfortable?
      Your baby’s birth must be registered      If you live in a different district from   • feeling tired and unable to sleep?
      within six weeks from when they           the one where your baby was born,          • lonely and wanting company?
      were born. This will take place at        you can go to your nearest register
      the register office in the district       office. The registrar will take details    • bored and wanting to play?
      where they were born. The contact         from you and then send them to             Do they have:
      details will be in the telephone          the district where your baby was
      book under the name of your local                                                    • a wet or dirty nappy?
                                                born. You will then be sent the
      authority or you can find it online       birth certificate. You cannot claim        • wind?
      at                      benefits, such as Child Benefit,           • colic?
                                                until you have a birth certificate.
                                                                                           It could be none of these things.
                                                All babies born in England and             Perhaps your baby simply feels
                                                Wales are now given a unique                            overwhelmed and a
                                                NHS number at birth. Midwives                              bit frightened by all
                                                request and receive a newborn                                 the new sights,
                                                baby’s NHS number. They send                                    sounds and
                                                this NHS number to the                                             sensations.
                                                Registrar of Births,
                                                Deaths and
                                                Marriages via
      If you are married, you or the father     your local
      can register the birth. If you are not    child health
      married, you may register together        department.
      with your baby’s father and his name
      will appear on the birth certificate.
      In most circumstances, children
      benefit from being acknowledged
      by both parents and by knowing the
      identity of both their mother and
      father. To register jointly, you must
      either go together to register the
      birth or one of you can go with an
      appropriate document. Including
      the father’s name in the birth
      register will usually give him parental
      responsibility. Your local register
      office will explain this process.

                                     When crying gets                         Getting help
                                     too much                                 If you feel you are having difficulties
                                     Some babies do cry more than             coping with your baby’s crying, talk
                                     others and it’s not really clear why.    to your midwife or health visitor. Or
                                     Don’t blame yourself, your partner       contact Cry-sis on 08451 228669 –

                                                                                                                        THE EARLY WEEKS: YOUR BABY
                                     or your baby if they cry a lot. It can   they will put you in touch with other
                                     be very exhausting so try to get         parents who have been in the same
                                     rest when you can. Share soothing        situation. If you have twins or more,
                                     your baby with your partner. You         the crying can seem relentless –
                                     could ask a friend or relative to take   Twinline, Tamba’s helpline (see page
                                     over for an hour from time to time,      188), can offer support.
                                     just to give you a break. If there
                                                                              If your baby’s crying sounds
                                     is no one to turn to and you feel
                                                                              different or unusual, it may be the
                                     your patience is running out, leave
                                                                              first sign of illness, particularly if
                                     your baby in the cot and go into
                                                                              they are not feeding well or will
                                     another room for a few minutes.
                                                                              not be comforted. If you think
                                     Put on some music to drown the
                                                                              your baby is ill, contact your doctor
                                     noise, take some deep breaths,
                                                                              immediately. If you cannot contact
                                     make yourself a cup of tea or find
                                                                              your doctor and it’s an emergency,
Comforting                           some other way to unwind. You will
                                                                              take your baby to the nearest
                                     cope better if you do. If you are very
your baby                            angry or upset, telephone someone
                                                                              hospital accident and emergency
Holding your baby close and                                                   department.
                                     who will make you feel better.
talking in a soothing voice or
singing softly will reassure them.   Never shake your baby. Shaking
                                     makes a baby’s head move violently.
Movement often helps to calm         It can cause bleeding and damage
down crying. Gently sway or rock     the brain.
your baby or take them for a walk
or for a ride in a car.
Sucking can also be comforting.
You can put your baby to your
breast or give them a dummy,
as long as breastfeeding
is well established
(see page
106). Make
sure the
dummy is                               Colic
sterilised and don’t
                                       If your baby has repeated episodes of excessive and inconsolable
dip it in honey or
                                       crying but they otherwise appear to be thriving and healthy,
sugar to make your baby suck.
                                       they may have colic.
They will suck anyway. Using
sugar will only encourage a            Although it may appear that your baby is in distress, colic is not
craving for sweet things, which        harmful. Your baby will continue to feed and gain weight normally.
are bad for their teeth.               There is no evidence that colic has any long-term effects.
                                       Colic can be very upsetting for parents. You may feel like you are letting
                                       your baby down or that you are doing something wrong. Although
                                       colic can be distressing at the time, it is a common phase that should
                                       last only a few weeks at the most. It may help to remind yourself that
                                       you are not causing the crying and it is not under your control. If you
                                       are concerned, talk to your health visitor or GP.

                                                Reducing the risk                    Place your baby on their
                                                of cot death                         back to sleep
                                                Sadly, we don’t know why some        Place your baby on their back to
                                                babies die suddenly and for no       sleep from the very beginning for
                                                apparent reason from what is         both day and night sleeps. This will
                                                called ‘cot death’ or ‘Sudden        reduce the risk of cot death. Side
                                                Infant Death Syndrome’ (SIDS).       sleeping is not as safe as sleeping
                                                But we do know that placing          on the back. Healthy babies placed
                                                a baby to sleep on their back        on their backs are not more likely
                                                reduces the risk, and that           to choke. When your baby is old
                                                exposing a baby to cigarette         enough to roll over, they should not
                                                smoke or overheating a baby          be prevented from doing so.
      SLEEP                                     increases the risk.                  Babies may get flattening of
      The amount that babies sleep, even        All the advice that we now           the part of the head they lie on
      when they are very small, varies a        have for reducing the risk of cot    (plagiocephaly). This will become
      lot. During the early weeks some          death and other dangers, such        rounder again as they grow,
      babies sleep for most of the time         as suffocation, is listed on this    particularly if they are encouraged
      between feeds. Others will be             page and opposite. Remember          to lie on their tummies to play
      wide awake. As they grow older,           that cot death is rare, so don’t     when they are awake and being
      they begin to develop a pattern of        let worrying about it stop you       supervised. Experiencing a range of
      waking and sleeping. Some babies          enjoying your baby’s first few       different positions and a variety of
      need more sleep than others and at        months. But do follow the advice     movement while awake is also good
      different times. Try not to compare       given here to reduce the risks as    for a baby’s development.
      what your baby does with other            much as possible.                    The risks of bed sharing
      people’s babies. All babies are                                                The safest place for your baby to
                                                To reduce the risk of cot death:
      different, and their routines will                                             sleep is in a cot in a room with you
      change as they grow.                      • Place your baby on their back      for the first six months. Do not
                                                  to sleep, in a cot in a room       share a bed with your baby if you or
      You will gradually begin to
                                                  with you.                          your partner:
      recognise when your baby is ready
      for sleep and is likely to settle. Some   • Do not smoke in pregnancy or
                                                                                     • are smokers (no matter where or
      babies settle better after a warm           let anyone smoke in the same
                                                  room as your baby.                   when you smoke and even if you
      bath. Most sleep after a good feed.                                              never smoke in bed)
      A baby who wants to sleep is not          • Do not share a bed with your
      likely to be disturbed by ordinary          baby if you have been drinking     • have recently drunk alcohol
      household noises, so there is no            alcohol, if you take drugs or if   • have taken medication or drugs
      need to keep your whole home                you are a smoker.                    that make you sleep more heavily
      quiet while your baby sleeps. It will                                          • feel very tired.
                                                • Never sleep with your baby on
      help you if your baby gets used to
                                                  a sofa or armchair.
      sleeping through a certain amount of                                           The risks of bed sharing are also
      noise. See the column on the right        • Do not let your baby get too       increased if your baby:
      for advice on sleeping positions.           hot – keep your baby’s head
                                                  uncovered.                         • was premature (born before
      Twins, triplets or more can have                                                 37 weeks), or
      specific sleeping issues and it may       • Place your baby in the ‘feet to
                                                                                     • was of low birth weight
      be difficult for you to get them            foot’ position.
                                                                                       (less than 2.5kg or 5.5lb).
      into a routine. The Multiple Births
      Foundation and Tamba (see pages            The safest place for your           There is also a risk that you might
      183 and 188) have information              baby to sleep is on their           roll over in your sleep and suffocate
      that you may find useful. They can                                             your baby, or that your baby could
                                                 back in a cot in a room
      sleep in the same cot – there is                                               get caught between the wall and
                                                 with you for the first
      information from Tamba on                                                      the bed, or could roll out of an adult
                                                 six months.
      how you can do this safely.                                                    bed and be injured.

Never sleep with a baby on
a sofa or armchair
                                         Remember, a folded blanket
                                         counts as two blankets.
                                                                                covers, place your baby feet to foot
                                                                                in the crib, cot or pram.                13
It’s lovely to have your baby with      • Babies do not need hot rooms;         Make the covers up so that they
you for a cuddle or a feed but it’s       all-night heating is rarely           reach no higher than the shoulders.
safest to put your baby back in their     necessary. Keep the room at a         Covers should be securely tucked

                                                                                                                         THE EARLY WEEKS: YOUR BABY
cot before you go to sleep.               temperature that is comfortable       in so they cannot slip over your
                                          for you at night. About 18°C          baby’s head. Use one or more
Cut out smoking during
                                          (65°F) is comfortable.                layers of lightweight blankets.
pregnancy – partners too!
Smoking in pregnancy greatly            • If it is very warm, your baby may
                                                                                Sleep your baby on a mattress that
increases the risk of cot death.          not need any bedclothes other
                                                                                is firm, flat, well fitting and clean.
It is best not to smoke at all.           than a sheet.
                                                                                The outside of the mattress should
                                        • Even in winter, most babies who       be waterproof. Cover the mattress
If you are pregnant and want
                                          are unwell or feverish do not         with a single sheet.
to give up, call the NHS
                                          need extra clothes.
Pregnancy Smoking Helpline                                                      Remember, do not use duvets,
on 0800 169 9 169.                      • Babies should never sleep with        quilts, baby nests, wedges,
                                          a hot-water bottle or electric        bedding rolls or pillows.
                                          blanket, next to a radiator, heater
   Don’t smoke near                       or fire, or in direct sunshine.
   your baby.                                                                      Put your baby feet to foot
                                        • Babies lose excess heat from their
                                          heads, so make sure their heads          in the crib.
Don’t let anyone smoke in                 cannot be covered by bedclothes
the same room as your baby                during sleep periods.
Babies exposed to cigarette smoke                                               Breastfeeding your baby reduces the
after birth are also at an increased                                            risk of cot death. See Chapter 9 for
risk of cot death. Nobody should           Don’t let your baby
                                                                                everything you need to know about
smoke in the house, including              overheat.
visitors. Anyone who needs to              Remove hats and extra
smoke should go outside. Do not            clothing as soon as you
take your baby into smoky places.
                                           come indoors or enter
If you are a smoker, sharing a bed
                                           a warm car, bus or train,
with your baby increases the risk
                                           even if it means waking
of cot death.
                                           your baby.
Don’t let your baby get too
hot (or too cold)
Overheating can increase the risk
of cot death. Babies can overheat
because of too much bedding or
clothing, or because the room is too                                            It is possible that using a dummy at
hot. Remember, a folded blanket                                                 the start of any sleep period reduces
counts as two blankets. When you                                                the risk of cot death. Do not begin
check your baby, make sure they                                                 to give a dummy until breastfeeding
are not too hot. If your baby is                                                is well established, usually when
sweating or their tummy feels hot                                               your baby is around one month
to the touch, take off some of the                                              old. Stop giving the dummy when
bedding. Don’t worry if your baby’s                                             your baby is between six and
                                        Don’t let your baby’s head
hands or feet feel cool – this                                                  12 months old.
                                        become covered
is normal.
                                        Babies whose heads are covered
• It is easier to adjust the            with bedding are at an increased
  temperature with changes              risk of cot death. To prevent your
  of lightweight blankets.              baby wriggling down under the

      If your baby is unwell, seek           CHANGING
      MEDICAL advice promptly
      Babies often have minor illnesses
                                             YOUR BABY
      that you do not need to worry          Babies need their
      about.                                 nappies changed fairly
      Make sure your baby drinks plenty      often, otherwise they
      of fluids and is not too hot. If       become sore. Unless
      your baby sleeps a lot, wake them      your baby is sleeping
      regularly for a drink.                 peacefully, always
                                             change a wet or dirty
      It can be difficult to judge whether   nappy and change
      an illness is more serious and         your baby before
      requires prompt medical attention.     or after each feed.
      See the section on illnesses on        Organise the place where
      page 145 for guidance on when          you change your baby so that
      you should get help.                   everything you need is handy (see             Clean under the penis and the
                                             page 128). The best place to change           scrotum. Water is fine for cleaning
                                             a nappy is on a changing mat or               your baby’s bottom but you may
      Normal healthy babies do not need      towel on the floor, particularly if you       want to use wipes or lotion for
      a breathing monitor. Some parents      have more than one baby. That way,            convenience when you are away
      find that using a breathing monitor    if you take your eye off your baby            from home.
      reassures them. However, there is      for a moment to look after another
      no evidence that monitors prevent                                                  • You may want to use a cream, such
                                             child, your baby cannot fall and              as zinc and castor oil cream, which
      cot death. If you have any worries     hurt themselves.
      about your baby, ask your doctor                                                     forms a waterproof coating to help
      about the best steps to take.          Try to sit down, so you don’t                 protect the skin. Or you can just leave
                                             hurt your back. If you are using a            the skin clean and dry, especially
                                             changing table, keep an eye on your           with disposable nappies, since cream
                                             baby at all times.                            may prevent them absorbing urine
      Immunisation reduces
                                                                                           so well. Don’t use baby powder
      the risk of cot death.                 See the next page for the different           as it can cause choking.
      For more information                   kinds of nappies that are available.
      about immunisation, visit                How to change a nappy
                                             You need to clean your baby’s
                                             bottom carefully each time you
                                             change a nappy to help prevent
      More information                       soreness and nappy rash.
                                             STEP 1
         For more information on
                                             • Take off the nappy. If it’s dirty, wipe
         reducing the risk of cot
                                               away the mess from your baby’s            • If you are using a cloth nappy,
         death, or to buy a simple
                                               bottom with tissues or cotton wool.         place it in a waterproof cover (if
         room thermometer for
         your baby, contact the              • Wash your baby’s bottom and                 needed) and put a nappy liner
         Foundation for the Study              genitals with cotton wool and warm          inside. Lay your baby carefully on
         of Infant Deaths (FSID):              water and dry thoroughly. For girls,        the nappy, bring the centre of the
                                                          wipe the bottom from             nappy between your baby’s legs
         Telephone: 020 7802 3200                          front to back, away             and then fasten the poppers or
         Email:                          from the vagina, so that       Velcro. Check that it fits snugly
         Website:                            germs will not infect         around the waist and legs.
                                                             the vagina or bladder.      STEP 2
                                                             For boys, gently clean      • If you are using a disposable
                                                             the foreskin of the           nappy, put the side with the sticky
                                                             penis (it can be pulled       tapes under your baby’s bottom.
                                                             back very gently).
• Fasten the tapes at the front.
                                           nappy less absorbent. Make sure
                                           you use the correct amount of
                                                                                                      stools. Formula-fed
                                                                                                      babies’ stools        13
  Be very careful not to get cream         detergent and rinse thoroughly.                            are firmer and
  on the tabs or they will not stick.                                                                 smell more.
                                          Nappy rash
• Wash your hands.                                                                                    Babies vary a lot
                                          Most babies get a sore bottom

                                                                                                                            THE EARLY WEEKS: YOUR BABY
                                                                                                in how often they
Nappy hygiene                             or have nappy rash at some time,
                                          but some have extra-sensitive skins.            pass stools. Some have a
Disposable nappies                                                                 bowel movement at or around each
                                          Nappy rashes are caused by contact
If the nappy is dirty, flush the                                                   feed; some can go for several days
                                          between sensitive skin and soiled
contents down the toilet. Roll up                                                  without having a movement. Either
                                          nappies. If you notice redness or
the nappy and re-tape it securely.                                                 can be normal, but most breastfed
                                          spots, clean your baby very carefully
Put it into a plastic bag. Don’t put                                               babies produce at least one stool
                                          and change their nappies more
anything but nappies in this bag.                                                  a day for the first six weeks.
                                          frequently. Better still, give your
Fasten the bag and put it outside
                                          baby time without a nappy and            When to get help
in your bin each day.
                                          let the air get to their skin. Keep a
                                                                                   Most small babies strain and go
Cloth nappies                             spare nappy handy to mop up any
                                                                                   red in the face, or even cry, when
• If the nappy is dirty, flush the        accidents. You will soon see the rash
                                                                                   passing a stool. This is normal and
  contents down the toilet.               start to get better.
                                                                                   doesn’t mean they are constipated
  Biodegradable, flushable nappy          If your baby does have a rash, ask       as long as the stools are soft. If you
  liners are available to make it easy.   your midwife or health visitor about     are worried that your baby may be
• Have a lidded bucket ready to store     it. They may advise you to use a         constipated, mention this to your
  the dirty nappies. You can soak         protective cream. If the rash seems      midwife or health visitor.
  them in a nappy cleanser (follow        to be painful and will not go away,
                                                                                   What you find in your baby’s
  the instructions on the packet) or      see your health visitor or GP.
                                                                                   nappies will probably vary from day
  just store them here until you have
  a load ready for washing.
                                          Babies’ poo (stools)                     to day, and usually there is no need
                                                                                   to worry. For example, it is normal
                                          Immediately after birth and for the
• Wash nappies every two to three                                                  for some babies to have very runny
                                          first few days, your baby is likely
  days. Follow the care instructions                                               stools. But ask your doctor, midwife
                                          to pass a sticky, greenish-black
  on your nappies, but a 60ºC                                                      or health visitor if you notice any
                                          substance. This is called meconium
  wash is usually OK. If you did not                                               big changes, such as stools:
                                          and it is the waste that has collected
  soak the nappies before, add an
                                          in your baby’s bowels while they         • becoming very frequent and
  antibacterial nappy cleanser to your
                                          were in your uterus.                       watery
  normal washing detergent (follow
  the instructions on the packet).        As your baby begins to digest milk,      • being very smelly
  Don’t use enzyme (bio) washing          the stools will change. They will        • changing colour to become
  powders or fabric conditioner as        become more yellow or orange               green, white or creamy.
  these may irritate your baby’s skin –   and can be quite bright in colour.
  and the conditioner may make the        Breastfed babies have quite runny        See ‘Babies with jaundice after
                                                                                   two weeks’ on page 149.

Putting on a disposable nappy

  STEP 1                                    STEP 2                                   STEP 3

      WASHING AND                              See page 124 on keeping your
                                               baby’s umbilical cord clean and dry.
      Washing                                  Bath your baby two or three times
      You don’t need to bath your baby         a week, or more often if they enjoy
      every day, but you should wash           it. Don’t bath them straight after
      their face, neck, hands and bottom       a feed or when they are hungry or
      carefully each day. You can do this      sleepy. Make sure the room is warm
      on your lap or on a changing mat.        and that you have everything you
      Choose a time when your baby             need ready in advance.
      is awake and contented, and
      make sure the room is warm.              1 Check that the water is not
      You will need a bowl of warm                too hot. Test it with your wrist
      water, some cotton wool, a towel            or elbow. It should be just
      and a fresh nappy. If you want to           comfortably warm.
      use soap, make sure that it is mild      2 Undress your baby except for         6 Lift your baby out and pat them
      and unperfumed.                             their nappy, and wrap them             dry with the towel. Dry carefully
                                                  snugly in a towel. Wash your           in all the creases. If your baby’s
                                                  baby’s face with cotton wool and       skin is dry, gently massage in
                                                  water as described above. There        some baby oil or cream (not
                                                  is no need to use any soap.            aqueous cream). Your baby may
                                               3 Wash your baby’s hair with baby         enjoy this.
                                                  soap or liquid, supporting their    If your baby seems frightened of
                                                  head over the baby bath or          the bath and cries, it may help to
                                                  basin. Rinse carefully. You don’t   try bathing together. You may like
                                                  need to use soap every time.        to do this anyway. Make sure the
                                               4 If you want to use soap              water is only warm, not hot, and
                                                  occasionally, use a mild,           don’t add anything to the water.
                                                  unperfumed soap. Unwrap your        You should also think about how
      1 Take off your baby’s clothes              baby and soap them all over, but    you are going to get out of the bath
         except for the vest and nappy.           keep them on your lap so you        with your baby. You might need
         Wrap your baby in a towel.               have a firm grip. Take the nappy    someone around who you can pass
      2 Gently wipe round each eye,               off at the last minute.             them to.
         from the nose side outwards.          5 Put your baby gently into the
         Use a fresh piece of cotton              water. Using one hand for
         wool for each eye, so you                support, gently swish the water
         don’t transfer any stickiness            to wash your baby without
         or infection.                            splashing their face. You should
      3 Using fresh, moist cotton wool,           never leave your baby alone
         wipe out each ear – but don’t            in the water even for a few
         clean inside their ears. Never use       seconds. For boys, gently clean
         cotton buds inside the ear canal.        the top of the foreskin of the
                                                  penis. The foreskin can be pulled
      4 Wash the rest of your baby’s face
                                                  back very gently to clean.
         and neck with moist cotton wool
         and dry gently. Wash and dry your
         baby’s hands in the same way.
      5 Take off the nappy and wash
         your baby’s bottom (genitals),
         with fresh cotton wool and
         warm water. Dry your baby very
         carefully, including in skin folds,
         and put on a clean nappy.
ILLNESS                                                                                                                 13
                                                                                   If you are worried
It’s sometimes difficult to tell at first                                          about your baby
when a baby is ill, but you may have
                                                                                   • Phone your midwife or health
a funny feeling that things are not
                                                                                     visitor for advice. Keep their
quite right. If you are at all worried,

                                                                                                                        THE EARLY WEEKS: YOUR BABY
                                                                                     phone numbers where they
ask for help. You are not fussing.
                                                                                     can be reached easily.
It’s far better to be on the safe side,
particularly with a very small baby.                                               • Phone your GP. Your GP may
Trust your own judgement. You                                                        be able to advise you over the
know your baby best.                                                                 phone or may suggest that you
                                                                                     bring your baby along to the
Very urgent problems                                                                 surgery. Most GPs will try to
Sometimes there are obvious signs                                                    fit a young baby in without an
that your baby is not well. Contact                                                  appointment, although it may
your doctor at once if your baby:                                                    mean a wait in the surgery.
• turns blue or very pale                                                          • If you are really worried about
                                                                                     your baby, you should always
• has quick, difficult or grunting
                                                                                     phone your GP for help
  breathing, or unusual periods of
                                                                                     immediately, whatever the
  breathing, for example breathing          • If your baby cries in an unusual       time of day or night. There will
  with pauses of over 20 seconds              way or for an unusually long time      always be a doctor on duty,
  between breaths                             or seems to be in pain.                even if it is not your own GP.
• is very hard to wake, unusually           • If you notice any bleeding from        If you cannot contact a
  drowsy or doesn’t seem to                   the stump of the umbilical cord        GP, take your baby to an
  know you                                    or from the nose, or any bruising.     appropriate paediatric
• develops a rash of red spots              • If your baby keeps refusing feeds.     emergency department. Not all
  that do not fade and lose colour                                                   A&E departments have resident
                                            • If your baby keeps vomiting            paediatricians. You need to
  (blanch) when they are pressed
                                              a substantial part of feeds or         take them to one that does.
  (see the ‘glass test’). This may be
                                              has frequent watery diarrhoea.
  the rash of meningococcal disease
                                              Vomiting and diarrhoea together
  and meningitis, which causes
                                              may mean your baby is losing too
  infection in the blood. There may
                                              much fluid, and this may need        The ‘glass test’
  not be any other symptoms.
                                              prompt treatment.
Your baby may need treatment                • If your baby develops jaundice
very quickly. If you cannot get               (looks yellow) when they are over
hold of your GP at once, dial 999             a week old, or has jaundice that
for an ambulance or take your                 continues for over two weeks
baby to the nearest accident and              after birth (see page 149).
emergency (A&E) department with
a paediatrician on site.                    If you have seen your GP and your
                                            baby is not getting better or seems
Problems that could                         to be getting worse, tell your GP
be serious                                  again the same day. If you become
• If your baby has a hoarse cough           very worried and cannot get hold of    The ‘glass test’ can help you
  with noisy breathing, is wheezing,        your GP, dial 999 for an ambulance     to tell if a rash is a symptom
  or cannot breathe through                 or take your baby to the nearest       of meningitis. Press the side or
  the nose.                                 A&E department with a                  bottom of a glass firmly against
                                            paediatrician on site.                 the rash. You will be able to see
• If your baby is unusually hot,
  cold or floppy.                                                                  if the rash fades and loses colour
                                                                                   under the pressure (see photo).
                                                                                   If it doesn’t change colour,
                                                                                   contact your GP immediately.

                                           Everyone needs advice or
                                           reassurance at some time when
                                           they are caring for a young baby,
                                           even if it’s just to make sure that
      Group B                              they are doing the right thing.
      streptococcal                        Some problems just need talking
                                           over with someone. It’s always
      infection                            better to ask for help than to
      Group B streptococcal infection      worry on your own. Do talk to
      is a life-threatening infection in                                         Your nearest Children’s Centre
                                           your midwife or health visitor.
      babies. Most babies who are                                                can be found by visiting
                                           As you grow more confident,
      infected show symptoms within                                    
                                           you will begin to trust your own
      12 hours of birth, but there         judgement more. You will be
      are some who get it later.           able to decide which advice
      The symptoms include:                makes most sense for you and
      • being floppy and unresponsive      your baby and which suggestions
                                           you can safely ignore.
      • not feeding well
      • grunting                           You will also want to talk to
                                           friends, relations or other mothers
      • high or low temperature            in a similar situation. You will
      • fast or slow heart rate            meet other mothers when you           Your health visitor can tell you
                                           start taking your baby to the         about any mother and baby
      • fast or slow breathing rate
                                           child health clinic or Sure Start     groups in the area. Or your local
      • irritability.                      Children’s Centre. Your health        branch of the NCT (see page
      Your baby may need treatment         visitor will explain where            183) or MAMA (Meet A Mum
      very quickly. If you cannot get      these are and when you                Association) (see page 184) may
      hold of your GP at once, dial        should go.                            be able to put you in touch with
      999 for an ambulance or                                                    other mothers nearby.
      take your baby to the
      nearest accident
      and emergency
      department with
      a paediatrician
      on site. For more
      information, see


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