We're having a baby

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					We’re having a baby

   A guidebook for expectant parents
                                     Dear Reader,
                                     Babies are born in many different situations, into
                                     different kinds of families: The baby can be the first
                                     born or be born into a group of siblings. Some ba-
                                     bies have one parent while others have two. Some
                                     are born into traditional nuclear families, others in-
                                     to stepfamilies. Some pregnancies have been care-
                                     fully planned while others come as quite a sur-
                                         This booklet contains information on pregnan-
                                     cy, birth and parenting. It also gives advice on how
                                     to take care of the baby and where to find help and
                                     support. We hope that this booklet will provide you
                                     with good advice and useful information.
                                         The prenatal and child health clinics are there to
                                     offer support and advice on good parenting.You can
                                     also contact the maternity hospital and organisa-
                                     tions dedicated to issues concerning children and
                                     families for further support. u

We’re having a baby
27. edition

National Research and Development
Centre for Welfare and Health

Illustrations by Taru Castrén

Layout by Hanna Tennilä, Textop Oy

ISBN 978-951-33-2176-5
Erikoispaino Oy
Helsinki 2008

Content                                                                                                                                                                              From conception to birth
Pregnancy                                                                                                                                                                            Conception takes place during ovulation,
                                                                                                                                                                                     which is approximately two weeks after
                                                                                                                                                                                                                                  your last menstruation. A normal pregnan-
                                                                                                                                                                                                                                  cy lasts between 32 and 42 weeks. To cal-
From conception to birth  .  .  .  .  .  .  .  .  .  .  .  . 5                                                                                                                       the first day of menstruation. The ovum      culate the expected date of delivery, add 40
Signs of pregnancy  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 10                                                                                                                can be fertilised by male sperm for 24       weeks (= 9 months and 7 days) to the date
                                                                                                                                                                                     hours. Fertilisation happens when the        when your periods last began. Most babies
Nutrition and pregnancy  .  .  .  .  .  .  .  .  .  .  . 13                                                                                                                          male sperm cell penetrates the female        are born during week 39 or 40. If your
Risk factors  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .17                                                                                                  ovum. The sperm can survive in the wom-      menstruation cycle is longer than 28 days,
                                                                                                                                                                                     an’s body for 2-4 days. The male sperm de-   then conception took place more than two
Exercise and fitness  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 19                                                                                                                 termines the sex of your baby.               weeks after the first day of your latest peri-
Preparing for parenthood  .  .  .  .  .  .  .  .  .  .  .20                                                                                                                                                                       od. Most pregnant women have an ultra-
You and your partner  .  .  .  .  .  .  .  .  .  .  .  .  .  . 23                                                                                                                    The expected date of delivery                sound scan in week 20. The EDD is
                                                                                                                                                                                     The due date, or expected date of delivery   checked against the size of the baby. In lat-
Antenatal care in                                                                          Growth and development  .  .  .  .  .  .  .  .  .  . 70                                   (EDD), is calculated from the first day of   er scans, the EDD will not be revised.
the prenatal clinics  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 26                    Daily routines  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 76
Pregnancy at work and at home  .  .  .  .  . 30                                            Safety  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 79                                                Placenta
                                                                                                                                                                                                                                  The placenta begins to develop when the
What does a baby need?  .  .  .  .  .  .  .  .  .  .  . 32                                 Starting supplementary food .  .  .  .  .  .  .  . 81                                                                                  fertilised ovum is embedded in the lining
                                                                                           When the baby is ill  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .84                                                                    of the uterus a few days after conception. A
The birth                                                                                  Organizing childcare  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .88                                                                    well-functioning placenta provides the ba-
                                                                                                                                                                                                                                  sis for the healthy development of the foe-
Preparing for birth  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 34                                                                                                                                                            tus. The placenta acts as the lungs, liver, in-
C-section  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 35       Services for families                                                                                                                  testines, kidneys and source of nutrition
Onset of labour  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 38                with children                                                                                                                          for the foetus. Nutrients and oxygen travel
                                                                                                                                                                                                                                  from the placenta to the foetus via the um-
The stages of labour  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 39                       Prenatal and child health clinics  .  .  .  .  .90                                                                                     bilical cord. The veins in the umbilical cord
Labour pains and pain relief  .  .  .  .  .  .  .  . 42                                    Social services centre  .  .  .  .  .  .  .  .  .  .  .  .  .  . 91                                                                    carry the baby’s blood to be oxidised in the
                                                                                                                                                                                                                                  placenta and transfer the waste to the
The newborn  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 44              Municipal day care  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 92                                                                  mother’s circulation. The metabolism takes
Recovering from the delivery .  .  .  .  .  .  .  .48                                      Organisations  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 94                                                           place through a thin membrane: the blood
                                                                                           Special situations  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .96                                                                circulations of the mother and the baby, al-
Baby care                                                                                                                                                                                                                         though very close to each other, remain
                                                                                                                                                                                                                                  separate. A fully developed placenta
First month  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 54           Social protection for families                                                                                                         weighs about 500 to 800 grams, and is
Breastfeeding  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .60                with children                                                                                                                          shaped like a flat disc.
                                                                                                                                                                                                                                       Many substances harmful to the foe-
Hygiene  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .64       Social protection for families                                                                                                         tus, such as nicotine and alcohol, can pass
Sleep  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .68   with children  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .99                                                            through the placenta. (See page 17.)

4                                                                                                                                                                                                                                                                  Pregnancy   5
                                                                                                                              Pregnancy Calendar
The uterus of a woman who is not preg-          may dilate a little, more if the pregnancy is   Weeks         Pregnancy development                             Todo list!
nant weighs 50 to 70 grams and is 7 to 9        not the first. Experiencing painful contrac-
cm long. At the end of pregnancy, it weighs     tions during the second trimester may be a      conception    Takes place roughly two weeks                     Stop smoking and give up
nearly 1 kg and has a volume of about 5 li-     sign of an infection, and you should con-                     from the start of your period.                    alcohol! If you need support,
tres. During pregnancy, the uterus grows        tact your prenatal clinic immediately.                                                                          contact your prenatal clinic.
with the baby. During the fourth month of
pregnancy, the uterus rises from the pelvis,    Pregnancy and well-being                        weeks 0-4     At two weeks, the embryo is                       Do not take any medications
which results in visible changes in the         Although pregnancy is a natural condition,                    the size of a pinhead.                            during pregnancy without
mother’s body: in week 16 the fundus of         it is nevertheless a strain on the mother.                                                                      first consulting a doctor or
uterus is halfway between the pelvis and        The entire body must adapt to the new sit-                                                                      nurse! Check that your
the navel, by week 24 it is up to the navel,    uation. Metabolism is enhanced, breathing                                                                       medications can be safely
and by week 36 it is up to the diaphragm.       and circulation become more efficient, and                                                                      used during pregnancy.
Accelerated growth of the uterus may indi-      the uterus grows. During pregnancy the
cate a multiple pregnancy. The fundus of        placenta secretes enzymes and hormones          weeks 5-8     The foetus is now 1.5 cm long and has the         The baby is well if the
uterus usually drops a couple of weeks be-      which, together with the corpus luteum                        beginnings of arms and legs. The heart,           mother is well:
fore delivery and becomes round in shape.       and pituitary gland, regulate these chang-                    nose, ears and eyelids, the nervous system,       healthy food, sufficient rest
At the same time the baby usually turns         es. Changes in the body also affect the                       spine and umbilical cord start developing.        and plenty of outdoor
head down ready for delivery.                   mental state, or moods, of the pregnant                                                                         activities are good for both.
                                                woman. (See ”Preparing for parenthood”
Movements                                       on page 20.)                                    weeks 9-12    When the foetus is 10 weeks old, it is approx-    The early pregnancy
Women who are having their first baby                Pregnancy affects women in different                     imately 3 cm long and weighs 20 grams. The        ultrasound scan is done
usually feel its movements by week 20 or        ways: some suffer from several signs and                      baby’s heartbeats can be heard. The foetus        between the weeks 10 and
21. Mothers who have had previous preg-         symptoms while others experience very                         floats in amniotic fluidprotected by the foetal   14, and is usually an internal
nancies can already feel the movements          little discomfort. Some symptoms are                          membrane and gets its food through the            scan done through the vagina.
around week 18. At first, the movements         common at the beginning, while others                         umbilical cord. The foetus now has an upper
may feel like ”bubbling” or ”fluttering”,       are typically experienced at later stages.                    and lower jaw and the beginning of a tongue.
before they develop into gentle kicks and       Although the symptoms may cause serious                       Teeth are beginning to develop in the gums.
bumps.                                          discomfort to the mother, they seldom
                                                pose any threat to the baby.                    weeks 13-16   When the foetus is 14 weeks old, it is ap-        To qualify for the maternity
Contractions                                         During pregnancy, it is recommended                      proximately 9 cm long, and weighs about           benefit the mother must
The uterus prepares gradually for the deliv-    not to take any medications or natural                        100 grams. The uterus is now about the size       have a medical examination
ery. During the last weeks the uterus tight-    health products, not even cough drops,                        of a fist. The head is big, almost half the       either at the prenatal clinic
ens in ”practice contractions”. In the be-      without first consulting a doctor or a nurse,                 length of the foetus, and the facial features     or by a doctor before the end
ginning, the contractions only last for a few   because some drugs will be harmful for the                    start developing. The ears and genitals de-       of week 16.
seconds, but towards the end of pregnancy       baby. When at the doctor’s or dentist’s, al-                  velop. The foetus practices swallowing and
they can last for up to 30 seconds. Contrac-    ways remember to tell them that you are                       breathing. It kicks, wiggles its toes and
tions prepare the cervix for delivery. During   pregnant so that they can adjust the treat-                   thumbs, and turns its head, but the mother is
the final weeks of pregnancy, the cervix        ment accordingly. Avoid x-rays. u                             not yet able to feel these tiny movements.

                                                                                                weeks 17-20   When the foetus is 18 weeks old, it is 25 - 27    Talk to the nurse about
                                                                                                              cm long andweighs 250 - 300 grams. The            antenatal classes.
                                                                                                              foetus has its own circulatory system, and its

6   Pregnancy                                                                                                                                                                     Pregnancy     7
Weeks           Raskauden kehitys                                Todo list!                    Weeks         Raskauden kehitys                                   Todo list!
                heart beats twice as fast as that of an adult.   Most women have an                          ner. A baby born before 28 weeks is consid-
                A very fine down, known as lanugo, is now        external scan some time                     ered extremely premature. The lungs and
                covering the baby’s entire body. Most of this    during weeks 18 - 21.                       other organs are not yet fully developed.
                will disappear before birth. The baby has        The external scan is done                   With intensive care the baby often survives,
                eyebrows. The placenta is almost as big as       by rolling a transducer                     and the prognosis is better due to improved
                the foetus. It protects the foetus from some     across your tummy.                          treatment methods.
                but not all harmful substances. If this is not
                her first pregnancy, the mother will now be                                    weeks 29-32   When the foetus is 30 weeks old, it is ap-          Avoid standing work,
                able to feel the movements of the baby.                                                      proximately 40 cm long and weighs about             lifting heavy objects and
                                                                                                             1.5 kg. Most children born during weeks             other strenuous tasks.
weeks 21-24     When the foetus is 22 weeks old, it is ap-       In week 22, you can                         29 - 32 survive with intensive care, and their
                proximately 30 cm long and weighs 400 -          apply for maternity,                        risk of handicap is small.
                600 grams. At his time even women who are        paternity and parental
                having their first baby can feel the move-       allowance as well as for      weeks 33-36   When the foetus is 34 weeks old, it is ap-          Now is the perfect time
                ments. The heartbeat is clearly audible. By      the maternity benefit                       proximately 47 cm long and weighs about             to get everything ready
                week 24, the fundus of uterus is up to the       (See “Benefits for families                 2.7 kg. It gains weight rapidly. The baby has       for the baby.
                navel. Accelerated growth of the uterus may      with children”.)                            less room in the uterus and moves around
                indicate a multiple pregnancy. The foetus                                                    less than before. At this stage, most babies        In many municipalities,
                practices sucking, and its thumb often finds     Avoid excessive strain.                     turn head down ready for delivery. The ba-          you can visit the maternity
                its way into its mouth. The hair and nails are   Do not take the                             by’s skin is covered with a creamy film             hospital in advance.
                growing, and the protective membrane is          contractions lightly.                       called vernix. The uterus reaches its highest
                starting to develop into skin. Most of the                                                   point and is up to your ribs. If there is risk of
                time the baby is asleep, but it can be awak-                                                 premature birth, the delivery will take place
                ened by noise or vibration. A pregnancy ter-                                                 close to the neonatal intensive care unit. Ba-
                minating before week 22 is called a sponta-                                                  bies born in week 35 seldom need intensive
                neous abortion, or miscarriage. If born dur-                                                 care. Babies born before week 37 are con-
                ing weeks 23 or 24, the baby may survive in                                                  sidered premature, and the mother and
                intensive care, although it is very premature.                                               child may need to stay at the postnatal ward
                Developmental risks are great, and the se-                                                   for an extended period of time.
                lection of a treatment regime must often be
                given due consideration.                                                       weeks 37-40   The uterus drops and the baby’s head will           Go to the hospital if your
                                                                                                             become engaged into your pelvis. Contrac-           water breaks, you have
weeks 25-28     When the foetus is 26 weeks old, it is ap-       Be alert to the reactions                   tions will become more frequent. The baby           contractions at regular
                proximately 35 cm long and weighs about a        of your body. Remember                      is kicking so hard that he or she can push          intervals, you are experienc-
                kilogram. The foetus moves a lot. It turns       to get enough rest!                         away a book resting on your tummy. At               ing pains, or if you are
                and kicks so hard that the movements are                                                     birth, most babies are 49 - 52 cm long and          bleeding. (See “Birth”.)
                visible. The baby can open and close its eyes    Avoid any unnecessary                       weigh 3000 - 4000 grams. The average preg-
                and has a firm grip. The fundus is up to the     strain, especially if you                   nancy lasts for 40 weeks, but deviating from        When the baby is ten days
                navel now. You may be experiencing your          have contractions.                          the average by one week is very common.             over the expected date of
                first contractions: your belly tightens for a                                                                                                    delivery, the mother will go
                few seconds and then relaxes. The foetus                                                                                                         to the hospital for a post-term
                now looks like a real baby, but is a lot thin-                                                                                                   follow-up check.

8   Pregnancy                                                                                                                                                                     Pregnancy   9
Signs of pregnancy
                                                                                                turising lotion available from the chemists    Sweating
                                                                                                to prepare the skin for breastfeeding. If      Sweating increases during pregnancy as
                                                                                                your nipples are small or turned inwards,      metabolic activity increases. Pay special at-
                                                                                                stretch them daily starting a few months       tention to your personal hygiene.
                                                                                                before the expected date of delivery so that
                                                                                                the baby will be able to get a good grip.      Heartburn
Feeling tired                                                                                                                                  Heartburn is a common ailment towards
Some expectant mothers are vital and en-                                                        Vaginal discharge                              the end of pregnancy. It is caused by regur-
ergetic, while others feel very tired during                                                    The normal amount of vaginal discharge         gitation of gastric acid. Heartburn is a
the first and last months of pregnancy. If                                                      tends to increase during pregnancy. If the     painful burning feeling in your throat,
possible, rest during the working day. If                                                       discharge smells bad or itches, consult        chest or upper abdomen. It can be alleviat-
you feel extremely tired for more than two                                                      your doctor as it may be a sign of an infec-   ed by avoiding spicy and fried foods, coffee
weeks, discuss it with your prenatal clinic’s                                                   tion. When washing, use only water as          and strong tea. The prenatal clinic will be
nurse or doctor. (See ”Anaemia”.)                                                               soap may irritate the mucous membrane.         able to suggest safe medications to treat
                                                                                                                                               heartburn. It will discontinue as soon as
Body temperature                                                                                Vaginal bleeding                               the baby is born.
During the early stages of pregnancy, the                                                       Periods will stop during pregnancy be-
body temperature may rise slightly. This is                                                     cause the lining of the womb that is dis-      Anaemia
quite normal and does not need medical                                                          charged during menstruation is vital for       Anaemia may be the reason for feeling ex-
attention. However, if you have a fever                                                         pregnancy. Slight vaginal bleeding is ex-      tremely tired. Other symptoms include
during pregnancy, contact the prenatal                                                          perienced by approximately 25% of wom-         paleness, palpitations, shortness of breath
clinic or your doctor.                                                                          en around the time of normal menstrua-         during exercise and dizziness. Anaemia
                                                                                                tion. The bleeding is explained by the fer-    occurs when there is not enough haemo-
Nausea and vomiting                                                                             tilised ovum being embedded in the lining      globin in your blood. Haemoglobin levels
Almost one in every two expectant moth-         your stomach becomes empty. This can be         of the uterus. If the bleeding is heavy and    often decrease during pregnancy because
ers suffer from nausea or ”morning sick-        prevented by having snacks during the           similar to regular menstruation, it may be     there is more blood in your circulation. In
ness” during the first trimester (the first     day. Violent vomiting is not a normal sign      a sign of miscarriage and you should con-      a sense, your blood is ”diluted”. If neces-
three months of pregnancy), especially in       of pregnancy and should always be treated       tact the nurse or doctor at the prenatal       sary, your doctor or nurse will prescribe
the morning when the stomach is empty.          by a doctor.                                    clinic.                                        iron supplements. Vegetables and fruit rich
It may be accompanied by dizziness and                                                                                                         in vitamin C as well as meat and fish en-
fainting when getting up. Nausea may be         Breasts                                         Urinating                                      hance iron absorption.
triggered by certain smells or tastes, be-      Your breasts will grow and they might feel      In the early stages of pregnancy, and espe-
cause the sense of taste and smell is           tender and tight. Beginning from the sec-       cially before the time of the normal men-      Varicose veins
heightened during pregnancy. The morn-          ond month, it is possible for your breasts      struation period, you may experience a         Varicose veins are enlarged veins that are
ing sickness and vomiting usually stop af-      to leak milk. At this stage your breasts will   vague feeling of heaviness in the lower ab-    swollen and raised above the surface of the
ter the first three months. It might help to    be very sensitive to cold and should be         domen. This is caused by the expanding         skin. The condition tends to get worse dur-
drink a glass of water or juice before get-     kept warm at all times. You should buy a        veins and enhanced circulation. Toward         ing pregnancy when the expanding uterus
ting out of bed and eat something small         supportive maternity bra by the middle of       the end of pregnancy, the need to urinate      puts pressure on the veins. Wearing spe-
such as a biscuit or slice of bread as soon     your pregnancy. During the winter, wear a       is more frequent as the uterus is pressing     cialised compression stockings, which you
as possible after getting up. Get out of bed    warm woollen scarf around your breasts. It      against the bladder. A swift kick from the     put on before getting out of bed, help to
slowly, taking your time. You may be over-      might be wise to avoid swimming in cold         baby may cause the mother to have an           alleviate the problem. It also helps if you
come by nausea during the day as well, if       water. Massage your nipples with a mois-        ”accident”.                                    can put your feet up during the day and

10   Pregnancy                                                                                                                                                                 Pregnancy   11
                                                                                              Nutrition and pregnancy
place a pillow under your feet at night.        that supports your back without being too
Avoid wearing high-heeled shoes or shoes        hard. Gentle massaging and rest will relax
that are too tight. Wear different shoes        tense back muscles. Light exercise to
during the day to give your feet a rest.        strengthen the abdominal muscles is rec-
                                                ommended. Ask the prenatal clinic for ex-
Cramps                                          ercise instructions.                          Eating a well-balanced and varied diet
During pregnancy women tend to have leg                                                       keeps the expectant mother healthy, con-
cramps. Painful leg cramps often occur at       Swelling                                      tributes to the healthy development of the
night. The best way to relieve a cramp is to    Some degree of swelling is normal unless      baby, and prevents nutritional problems. It
stretch the cramping muscles: straighten        it is accompanied with rising blood pres-     also accelerates recovery from the birth
your leg, take hold of your big toe and pull    sure and protein discharges in urine. A       and supports breastfeeding. A healthy
your leg up, or press it against the bed. You   sudden increase in weight (over 500 g per     woman who has been eating a balanced
can try to relax the cramp by massaging         week in a woman of normal weight) or          and varied diet does not need to make any
the muscle lightly. Use a cold pack (e.g. a     swelling accompanied by severe itching        major adjustments during pregnancy.
bag of frozen vegetables) for first aid. Keep   may be symptoms of a liver condition              Some women will need iron, folic acid
your feet warm during the night.                (hepatosis gravidarum). Contact the pre-      and calcium supplements to meet the add-
                                                natal clinic or your doctor.                  ed demand during pregnancy. Multivita-
Constipation and piles                                                                        min-mineral supplements are necessary
As the uterus grows, it presses against the     Skin blemishes                                only if the diet is not balanced. It is recom-
rectum and thus increases the tendency to       The skin can get darker during pregnancy,     mended that all pregnant women take               recommended that pregnant women eat
develop piles. As piles are aggravated by       especially the tips of the breasts and        supplemental vitamin D during the winter          several times a day: breakfast, lunch, din-
constipation, pay special attention to what     around the genitals. A brown line often       months. It is advisable to avoid supple-          ner, and 2 to 4 snacks in between.
you eat and make sure that you exercise         appears stretching from the lower abdo-       ments containing vitamin A.
sufficiently. Fibre-rich foods and sufficient   men to the naval, and brown spots (ch-                                                          Weight gain
liquid intake help prevent constipation.        loasma) appear on the face. These marks       Energy requirements                               The average total weight gain during preg-
Wholemeal bread and porridge, vegeta-           will fade after delivery.                     During the first three months of pregnan-         nancy is 12.5 kg. Weight gain is caused by
bles, berries and fruit are all good sources                                                  cy (the first trimester), there is virtually no   the growth of the uterus, foetus, placenta
of fibre. If necessary, add bran or wheat       Stretch marks                                 need for extra food. During the second and        and breasts, and the increased amount of
germ and dried fruit to your diet to en-        Pregnant women may develop stretch            third trimester the need for extra energy         blood and amniotic fluid. However, during
courage regular bowel movements. Exer-          marks on their breasts, abdomen and           can be met with a slice of bread with             the first trimester it is common to lose so-
cise and other physical activities will also    thighs, caused by tearing of the dermis.      spread, a glass of milk, and one piece of         me weight. Women gain different amounts
help.                                           Massaging stretch marks with a moisturis-     fruit. Often the physical activity of the         of weight, and recommendations are based
                                                ing lotion may help during the early stages   pregnant women decreases towards the              on the weight prior to pregnancy.
Backache                                        of pregnancy. The red lines will usually      end of pregnancy, which further decreases             Weight gain should be monitored for
As the tummy grows, the back muscles            fade after delivery. u                        the need for additional energy. Thus, there       several reasons: Insufficient weight gain
have to take a lot of strain, which may re-                                                   is no need to ”eat for two”, but to eat a         may be an indication that the foetus is de-
sult in back pain. Good posture and sup-                                                      well-balanced and varied diet, and eat at         veloping too slowly. A steady excessive in-
port by the abdominal muscles (hold your                                                      regular intervals.                                crease in weight is a strain on the expect-
navel in as much as possible) will alleviate                                                      It is very important to maintain regular      ant mother. A sudden increase may be a
the pain. Wearing a supportive maternity                                                      meal times. Feeling tired or nauseous may         sign of too much fluid collecting in the
bra and comfortable shoes with flat heels                                                     indicate that the expectant mother should         body (see ”Swelling”). Excessive weight
will ease the backache. Find a mattress                                                       get more rest and eat more regularly. It is       gain during pregnancy may predispose the

12   Pregnancy                                                                                                                                                                 Pregnancy   13
woman to gestational diabetes, which is a        Wholemeal products are also rich in fibre,      um-packed raw-cured and cold-smoked            sulfame, taumatine and sucralose, are not
disorder of carbohydrate metabolism that         which helps digestion and prevents consti-      fish products as well as unripened chees-      forbidden during pregnancy and breast-
can result in the excessive growth of the        pation.                                         es, blue cheese and camembert made from        feeding. The only exceptions to this rule
baby and low blood sugar levels at birth.             Vegetables, fruit and berries are rich     unpasteurised milk.                            are cyclamate and saccharin, which are not
(See ”Weight control” on page 50.)               in vitamins, minerals and fibre. Because                                                       recommended during pregnancy and
     Putting on a lot of weight during preg-     they contain little energy, they are not fat-   Salt                                           breastfeeding. Enjoy only moderate
nancy predisposes the woman to being             tening. Vegetables, fruit and berries should    Use as little salt as possible, because it     amounts of liquorice, because it contains
overweight after delivery as well. Obesity       be eaten in large quantities, preferably at     causes swelling, burdens the kidneys and       high levels of glycyrrhizin, which may
is a risk factor for many chronic diseases,      every meal, and at least 5 portions a day.      raises your blood pressure. Food cravings      cause swelling and raise blood pressure.
such as Type 2 diabetes. Healthy eating          Prefer uncooked vegetables and try differ-      during pregnancy may considerably in-
habits and sufficient exercise help in con-      ent colours. Use vegetables and fruit to        crease the amount of salt intake, if the       Fat
trolling weight, and a positive mood will        add taste and to cut down the amount of         craving is for salted snacks or other foods    Use low fat spreads on bread and toast.
support these efforts.                           calories. Beans, lentils, seeds, peas and       with high levels of salt, such as salted       Prefer low fat spreads, vegetable oils and
                                                 nuts all contain a lot of protein. Remember     gherkins, pickles or dried sausages. Most      vegetable oil blends in cooking.
A well-balanced diet during pregnancy            to rinse salads and other vegetables care-      seasoned salts and stock cubes contain
Every family has its own eating habits.          fully in order to avoid listeria.               50% salt. In addition to salt, soup mixtures   Liquids
Pregnant women should, however, pay at-               Meats and fish are rich in protein,        and marinated poultry and meats also           Drink sufficient liquids during pregnancy
tention to their eating habits and be pre-       which is important for the healthy devel-       contain soy or sodium glutamate. Improve       and while breastfeeding. Fresh water and
pared to make some adjustments to im-            opment of the baby. Choose products             taste and use less salt by using plenty of     diluted juice are the best alternatives for
prove the well-being of the developing ba-       which are low in fat and salt. Avoid eating     vegetables and fruit.                          quenching thirst. Current recommenda-
by and herself. It will benefit the whole        liver and liver products during pregnancy                                                      tions suggest that pregnant women should
family to pay attention to the type and          because they contain high levels of vita-       Sugar                                          limit their coffee consumption to 3 cups a
amount of fats they eat and their sugar and      min A. It is advisable not to eat more than     Reduced consumption of sugar helps to          day. For many, coffee is a cause of heart-
salt intake.                                     200 g of liver pâté or sausage per week         prevent putting on a lot of weight and pro-    burn.
      Milk, cheese and other dairy prod-         and to eat a maximum of 100 g at a time.        tects teeth. Soft drinks have high levels of
ucts are important sources of protein, cal-      The recommendation is to eat fish 2 to 3        sugar but contain none of the necessary        Vitamins and minerals
cium and other nutrients. There is an in-        times a week. Avoid pike during pregnan-        nutrients, and this is why soft drinks are     The developing baby takes all the nutrients
creased need for these during pregnancy,         cy and while you are breastfeeding be-          not part of a balanced diet. According to      it needs from the mother’s body, and rare-
and it is recommended that pregnant              cause it contains high levels of mercury.       current recommendations, drinks with ar-       ly suffers from any deficiencies. The preg-
women eat dairy products even if they are        Because of the risk of listeria, avoid vacu-    tificial sweeteners, such as aspartame, ace-   nant women needs a rich supply of vita-
not normally part of the usual eating hab-
its. To ensure a sufficient supply of calcium,
pregnant women should drink
4 glasses (8 dl) of milk or other
liquid dairy products daily.
Select the non-fat or low-
fat alternatives.
      Bread and por-
ridge, especially those
made from whole-
meal, contain lots of
minerals and vitamins.

14   Pregnancy                                                                                                                                                                Pregnancy   15
                                                                                                Risk factors
                                                                                                During pregnancy, it is especially impor-       Note! For the sake of the child’s health
                                                                                                tant to avoid infections that could be          as well as for the sake of their own
                                                                                                harmful to the foetus. The risk of infection    health, both parents should give up
mins and minerals for the safe develop-          grains. The iron from meat and fish is eas-    can be considerably reduced by carefully        smoking at the early stages of pregnan-
ment of the baby and for her own health.         ily absorbed. Foods rich in vitamin C en-      following the protective instructions. Tox-     cy, if not before.
     The need for vitamin D increases dur-       hance iron absorption from wholemeal           oplasmosis is a parasite that causes infec-
ing pregnancy. The best sources of vitamin       grains and vegetables. Sometimes even a        tions. It is found in cats, guinea pigs and    They also impair the normal functioning of
D include fortified dairy products, marga-       well-balanced diet cannot supply a suffi-      laboratory animals. To prevent infection,      the placenta.
rines and fish. Using dairy products and         cient amount of iron during pregnancy.         avoid contact with cat litter trays or soil        Nicotine levels are higher in the foetus
margarines fortified with vitamin D is safe      Usually, half of the needed iron is from       that may have been fouled by cats or other     than in the mother. Babies born to smok-
and there is no danger of overdose. It is        food and the other half from the mother’s      animals. Do not let the cat sleep in your      ers have low birth weight and are restless
recommended that all pregnant and                iron reserves or from iron supplements.        bed.                                           and irritable more often than those born to
breastfeeding women take supplemental            The need for iron supplements is individu-         For pregnant women, listeria is a dan-     non-smokers. Smoking during pregnancy
vitamin D during the winter months (Oc-          ally assessed at the prenatal clinic.          gerous bacteria found in food products.        may have harmful effects on the develop-
tober through March).                                 Calcium is necessary for the develop-     The best way to avoid listeriosis is by        ment of the brain and lungs, and also in-
     Folic acid or folate is a form of vita-     ment of the baby’s bones. The calcium in-      washing your hands thoroughly after han-       creases the risk of infection after birth.
min B. The need for folic acid increases         take of most women is sufficient. If your      dling meat, and storing raw meat away              Support for giving up smoking is avail-
during pregnancy. Wholemeal and whole-           diet does not include any dairy products,      from cooked food. Follow the instructions      able from the prenatal clinic and through
grain products and uncooked vegetables,          you need to take calcium supplements. If       when heating processed foods and frozen        the Internet (www.stumppi.fi). Nicotine
fruit and berries are rich in folic acid. Sup-   the need for calcium is satisfied by supple-   vegetables. Fresh vegetables should be         replacement products other than the patch
plemental folic acid is not needed if the        ments only, the daily dose is 1000 mg. Cal-    carefully rinsed. Avoid vacuum-packed          can be used, if necessary.
mother is eating a well-balanced and var-        cium and iron supplements should be tak-       cold-smoked and raw-cured fish products,
ied diet including wholemeal products and        en at different times.                         blue cheese and camembert, and cheeses         Alcohol
5 to 6 portions of fruit and vegetables eve-                                                    made from unpasteurised milk.                  Alcohol causes foetal damage. When a
ry day. To secure the sufficient supply of       Dental care and fluoride                           Sexually transmitted diseases and in-      pregnant woman drinks alcohol, so does
folic acid, it is recommended to choose a        Pregnant women should take good care of        fections can be prevented by using a con-      her foetus, because alcohol passes through
multivitamin product containing 0.4 mg           their teeth. This is important for both the    dom.                                           the placenta and travels via the umbilical
folic acid.                                      mother and the baby; tooth development                                                        cord into the foetus. The blood alcohol lev-
     The need for iron multiplies during         starts while the foetus is in the womb. For    Smoking                                        el can be higher in the foetus than in the
pregnancy. Iron is necessary for making          teeth, the most important mineral is fluo-     Smoking is harmful for both the mother         mother.
red blood cells and oxygen transport and         rine. Fluorinated toothpaste strengthens       and the baby. Cigarette smoke often caus-
for the development and proper function-         the teeth when used daily. When neces-         es nausea in expectant mothers. The nico-       Note! Pregnant and breastfeeding wo-
ing of the placenta. These are also very im-     sary, the dentist might recommend fluo-        tine and carbon monoxide in the smoke           men should avoid alcohol completely to
portant for the baby. The main sources of        ride tablets. Health care centres arrange      are absorbed into the mother’s blood and        prevent its harmful effects.
iron include meat, fish and wholemeal            dental care for pregnant women. u              transfer via the placenta into the foetus.

16   Pregnancy                                                                                                                                                                Pregnancy    17
     Binge drinking (consuming large quan-       ment of the placenta and premature birth.       freephone helpline aimed at preventing          travelling long distances by car, be pre-
tities of alcoholic beverages) is particularly   Drug abusers often neglect their own well-      foetal defects. The helpline also provides      pared to stop every few hours to walk
dangerous for the foetus. The body parts         being, are in bad physical condition, and       information on infections, radiation and        around a bit.
and organs develop during the first trimes-      suffer from malnutrition and infections. All    other external risk factors during pregnan-         Motorcycling is not recommended for
ter (the first three months of pregnancy),       of these pose particular risk during preg-      cy and breastfeeding.                           pregnant women. Travelling by planes that
and a dangerous drinking pattern during          nancy. The newborn may suffer from with-                                                        are not pressurised may cause the foetus to
the first trimester can result in foetal mal-    drawal symptoms and later defects. When         Travelling                                      suffer from oxygen deficiency. Airlines
formations, e.g. a congenital heart defect.      the expectant mother is a substance abus-       Wearing a seatbelt is compulsory in the         have rules regarding travelling and preg-
Excessive alcohol use should be avoided          er (drugs or alcohol), she should seek help     back seat of the car as well. Towards the       nancy. Most airlines have an upper limit
whenever there is a possibility of pregnan-      as soon as possible. The prenatal clinic will   end of pregnancy, wearing a seatbelt might      beyond which they refuse to carry a preg-
cy. Pregnant women should avoid alcohol          be able to assist in finding appropriate        feel uncomfortable, but it is important for     nant woman. It is advisable to check with
completely.                                      support.                                        the safety of the mother and the baby in        your airline what they use as the upper
     Alcohol slows down foetal growth                Huumeambulanssi ry (www.huume-              case there is an accident. If you will be       limit on long-haul flights. u
throughout the pregnancy and may result          ambulanssi.fi) is an organisation providing
in low birth weight. The foetal central          support and advice on substance abuse
nervous system (CNS) is very vulnerable,         and assists people in finding help. Thehel-
and at worst the baby may suffer from            pline service at (09) 278 7727 is available
mental retardation. Alcohol-related foetal       from Monday to Thursday 5 pm to 12 am,
defects may cause problems associated            and at weekends from Friday 6 pm to Sun-

                                                                                                 Exercise and fitness
with attention span, learning, and linguis-      day 12 am.
tic development.                                     Irti Huumeista ry (www.irtihuumeista.
     There is no safe amount of alcohol that     fi) is a non-governmental organisation
a woman can drink while pregnant. Exces-         that provides information on drugs and
sive alcohol consumption during pregnan-         drug addictions and their effects on the
cy increases the risk of miscarriage. Other      substance abuser and his or her family. The     Get as much exercise and fresh air as pos-
risks include malfunctions of the placenta,      organisation provides advice, support and       sible during pregnancy. When the mother
bleeding and the resulting infections, and       information by phone and email. The Na-         is in good physical condition, it will con-
the premature detachment of the placenta.        tional Drug Service line (0203 22388)           tribute to the healthy development of the
Caesarean sections, or C-sections, are           maintained by the organisation is available     baby. It should be possible to enjoy your
more common in heavy drinkers than in            Mon-Fri from 9 am to 3 pm and 6 pm to 9         sport throughout most of your pregnancy.
other women.                                     pm.                                             During pregnancy your ligaments will
     There are several sources of support                                                        loosen and the centre of gravity will move
                                                                                                                                                   MOTHER’S GOOD CONDITION WILL CONTRIBUTE
and advice to help in giving up alcohol: for     Medication                                      forward, which may cause backache. Be             TO THE BABY’S HEALTH AND DEVELOPMENT.
example, the prenatal clinic, the A-Clinic       Do not take any medications or natural          sensitive to your body’s reactions and
Foundation (www.a-klinikka.fi, tel. [09]         health products during pregnancy without        modify your exercise accordingly. It is ad-
6220 290) and Alcoholics Anonymous               first consulting a doctor or nurse. Further     visable to avoid activities involving leaps,    chores, such as washing rugs and moving
(www.suomenaa.fi).                               information on the effects of drugs on the      stretching and other sudden movements.          furniture, increase contractions and in-
                                                 foetus is provided by the Teratology Infor-     It might be wise to avoid swimming in           crease the risk of miscarriage. Ask the pre-
Illegal drugs                                    mation Service of the Hospital District of      cold water, because of the risk of infections   natal clinic for exercise instructions. The
All drugs pass through the placenta into         Helsinki and Uusimaa, available Mon-Fri 9       and contractions. Walking is an ideal daily     training programmes of pregnant athletes
the foetus. Drugs restrict the growth of the     am - 12 pm (tel. [09] 471 76500). The Tera-     activity during pregnancy. Light house-         should always be prepared in close co-op-
baby, and may cause premature detach-            tology Information Service is a national        work is excellent exercise, but strenuous       eration with a doctor. u

18   Pregnancy                                                                                                                                                                  Pregnancy    19
                                                                                                                                            Becoming a mother
Preparing for parenthood
                                                                                             change of life. However, it is not possible
                                                                                             to be prepared for everything – some           For many women, pregnancy is the time of
                                                                                             things will always come as a surprise! Be-     their life and everything is just wonderful.
                                                                                             coming a parent brings a lasting responsi-     The baby grows in the safety of the womb
                                                                                             bility for caring for the baby. Worries and    and the mother can continue with her nor-
                                                                                             even fears concerning the baby and how         mal activities. However, women will need
Having a baby will affect family life                                                        you are going to cope are quite common-        to review some of their choices and habits
Having a baby is an enormous change for           Usually, first time parents cannot fully   place. Nevertheless, having a baby is an in-   concerning food, drink, exercise and rest.
all members of the family. Pregnancy is the   appreciate how completely a baby changes       finitely rich experience, one of the most      You will start seeing things from a new
time to prepare: hormonal and physical        their life. At the beginning, the baby will    precious and natural in your life. Having      perspective now that you are also respon-
changes help the mother adjust to the         require the parents’ full attention. All       an open mind will help in solving many         sible for the well-being and healthy devel-
coming change. For the dads, who are not      thoughts, talk and actions revolve around      questions and problems during pregnancy        opment of your unborn baby (see ”Preg-
pregnant, one way of preparing is to sup-     the baby. Prepare everything ready for the     and after the baby is born.                    nancy and well-being” on page 6).
port the mum and focus on her experienc-      baby during pregnancy. Make room for the
es and feelings. It is recommended that       baby in your home and buy or borrow the        Fears and concerns                             Mood swings
women share their feelings and experienc-     items that the baby needs, such as clothes     During pregnancy the parents may be            Hormonal changes may cause severe
es with their partners and encourage the      and a cot or crib. Think about how you         worried about many different things: Will      mood swings in the mother. She might be
dad-to-be to put his hand on her tummy        want to arrange day care. Pregnancy is al-     the child be healthy? How will I know how      extremely weepy and be deeply hurt by
to feel the movements of the baby.            so the time to prepare mentally for the        to take care of a baby? What to do when        offhand remarks. The first pregnancy is es-
                                                                                             the baby cries? Will I make a good mum/        pecially testing. A pregnant woman needs
                                                                                             dad? Will I love my child? How will we         to be assured and reassured that her part-
                                                                                             manage financially? A single parent might      ner still loves and supports her. The devel-
                                                                                             also worry about being ”shorthanded” and       oping baby exhausts the mother’s energy
                                                                                             how she will manage alone with the baby.       resources, and she will need a lot of rest.
                                                                                                  Even when the pregnancy has been          However, pregnancy is a natural condition,
                                                                                             planned, it is quite common that the par-      not an illness. Sharing your thoughts and
                                                                                             ents have second thoughts at some point.       feelings with your partner and other close
                                                                                             You may be overwhelmed by the thought          friends will help.
                                                                                             of being responsible for the life of another
                                                                                             human being and wish you could just can-       Physical changes
                                                                                             cel the whole thing. These feelings are very   The female body goes through tremen-
                                                                                             common and they will pass in time. It will     dous changes during pregnancy. Skin and
                                                                                                       help if you can share these fears    other tissues are stretched to their limits.
                                                                                                              and concerns with some-       Breasts usually grow during pregnancy by
                                                                                                                  one. Remember that        at least one cup size, and the pelvis
                                                                                                                    there is no need to     spreads. Pregnant woman acquire femi-
                                                                                                                      feel guilty about     nine softness and sensuality. The centre of
                                                                                                                       such thoughts and    gravity changes as pregnancy progresses
                                                                                                                       feelings; process-   and this will affect balance. The changes
                                                                                                                      ing your thoughts     are great, but they happen slowly as preg-
                                                                                                                     and feelings is part   nancy progresses. Your general mood de-
                                                                                                                   of becoming a parent.    pends greatly on how well you will be able

20   Pregnancy                                                                                                                                                             Pregnancy   21
                                                      The father may also have questions          tives, the prenatal clinic’s nurse, a social
                                                 and doubts about the life ahead of him.          worker and health care centre psychologist           MOTHERS NEED SPECIAL ATTENTION
                                                 Men often wonder if they will be good fa-        are available to provide support. You can
                                                                                                                                                       AND SUPPORT DURING PREGNANCY.
                                                 thers and a good example to their children,      also contact helplines, the child guidance
                                                 and how the family will cope financially in      and family counselling centre, or the
                                                 the new situation. The responsibility may        church’s family guidance centres (see
                                                 feel overwhelming. Some men try to es-           ”Services for families with children” on         support person) to attend the birth. For
                                                 cape: they might work late hours or spend        page 90). Single parents will find peer sup-     more information, please visit the Federa-
                                                 all of their spare time ”with the lads”trying    port from the association for single parents     tion of Mother and Child Homes and
                                                 to savour freedom as long as possible. It is     (visit ”Yksin- ja yhteishuoltajien liitto” at    Shelters’ site at www.ensijaturvakotienliit-
                                                 recommended that the dads-to-be share            www.yyl.fi). If you are pregnant without a       to.fi. (Find contact details by typing ”dou-
                                                 their feelings with other prospective fa-        partner, you can invite a doula (a trained       la” in the search field.) u
                                                 thers or experienced dads.

                                                 Support networks
                                                 For the mother, late pregnancy, childbirth

                                                                                                  The relationship with
                                                 and maternity leave constitute a time
                                                 when socialising with colleagues and
                                                 friends decreases. Nursing and caring for

                                                                                                  your partner
                                                 the baby at home might make the mother
                                                 feel isolated, especially if there are no oth-
                                                 er mothers with babies in the neighbour-
                                                 hood or among her friends. Since there is
to accept these inevitable changes. Often        less contact with other adults than before,
pregnant women expect their partners to          great expectations fall on the partner to lis-
admire the growing tummy and altered             ten and keep company.                            Cherish the love you have
appearance.                                          Start building your social network al-       Your relationship with your partner is one       if they have not been talked through and
                                                 ready during pregnancy and actively seek         of the most important relationships in           forgiven.
Pregnancy and the father                         to make friends with people in the same          your life.
Pregnancy and having a baby are demand-          situation, e.g. with the parents in your an-          A source of joy and mutual satisfac-        Housework
ing for the father as well. He is expected to    tenatal class. Maternity and parental leave      tion, it does not flourish if left unattended.   Couples without children generally split
be supportive and understanding. Espe-           provide a chance to make new friends.            Firstly, to be able to love another, you need    housework evenly without argument, but
cially during early pregnancy, it might be       Find peer support in parenting clubs, par-       to accept and love yourself. Secondly, a         in families with young children housework
difficult to understand why the mother is        ent nights and family cafeterias organised       good relationship must be nurtured: be           is a major source of disagreement. House-
so tired and emotional. If the dad-to-be is      by the municipalities, church and the            caring and attentive, show affection, listen     work is the responsibility of each and eve-
aware of the hormonal changes and other          Mannerheim League for Child Welfare              and interact. At best, pregnancy can be a        ry family member; it should not be consid-
pregnancy-related changes, it will be easi-      (MLL). You can meet other parents with           shared experience that strengthens the re-       ered as ”helping mum”. If not before, dur-
er to understand the pregnant mother. At-        young children in parks, playgrounds and         lationship and enhances the feminine and         ing pregnancy all family members should
tending an ultrasound scan is just as im-        open day care centres.                           masculine traits of the parents. On the          participate in housework – not just the
portant for the father as it is to the mother:       Mothers, particularly single mothers,        other hand, unpleasant experiences, in-          parents but the older children as well.
they will both see their baby for the first      need special attention and support during        sults and unfair behaviour experienced                Dad’s share of housework increases
time.                                            pregnancy. In addition to friends and rela-      during pregnancy are forever remembered          during pregnancy, especially if the mother

22   Pregnancy                                                                                                                                                                   Pregnancy   23
is suffering from contractions. Dur-                                                           fatigue and breast tenderness during early      especially important when your means of
ing late pregnancy, the mother                                                                 pregnancy may cause your desires to de-         expressing your sexuality are limited and
should avoid physical strain, such                                                             cline. However, you might find that the lit-    you are feeling unusually emotional. Hav-
as lifting heavy objects.                                                                      tle secret you are carrying makes sex during    ing a satisfactory sex life in your relation-
     During the first week after                                                               early pregnancy thrilling in a new way.         ship is a shared responsibility – it takes
birth, the baby needs round-                                                                        For many expectant mothers, the sec-       two to tango!
the-clock attention. If all house-                                                             ond trimester is a sexually fulfilling time.
work is left to the mother, she                                                                The increased blood flow to the vagina          Abuse is unacceptable
will become over-exhausted.                                                                    causes a feeling of fullness and heightened     It is good to be an understanding partner,
                                                                                               sensitivity. During this time, it is not un-    but there are limits as to what should be
Sharing your feelings                                                                          common for women to masturbate more             tolerated. Physical and mental abuse are
In a good relationship, you                                                                    than ever before. For many women, this is       crimes against another person and should
can openly share every-                                                                        a peak erotic time in their life.               not be tolerated. Heavy blows to the area
thing that is on your mind:                                                                         Many men enjoy their sexually more         of the abdomen may damage the womb
joys, sorrows, concerns,                                                                       active partner. However, the new situation      and the foetus. At worst, this may cause
fears, hopes and dreams.                                                                       is likely to be confusing for the man as        the pregnancy to terminate. If you are be-
Sharing your feelings and                                                                      well. He might worry about harming the          ing abused, turn to your neighbours or
thoughts is not always easy                                                                    unborn child and avoid situations that will     friends for help, or call the police, social
and requires practice.                                                                         lead to sex. A normal pregnancy does not        services or a mother and child shelter.
                                                                                               prevent the couple from having sex.             Sometimes the first priority is to remove
The following advice
                                                                                                    During late pregnancy, many women          yourself from the abusive partner into a
might be helpful:
                                                                                               feel awkward and sexually unattractive          safe environment.
1) Listen to what your partner is saying.                                                      while others enjoy sex right up to birth.            The emergency phone number is 112.
   What is he/she feeling? What is his/her          IF ALL HOUSEWORK IS LEFT TO THE            Remember that sexual intercourse is just        The Emergency Response Centre staff will
   intention? Could it be just bad phras-                                                      one aspect of sexuality. In this phase when     tell you what you need to do and will alert
                                                    MOTHER, SHE BECOMES OVER-EXHAUSTED.
   ing and that he/she is not trying to of-                                                    your sex life takes on new forms, maintain      the necessary authorities. For the Police,
   fend intentionally?                                                                         intimacy and affection by saying and doing      dial 10022. Girls and women who have ex-
2) The individual is the best judge of his/        ”You are always so careless”. If you        things you know will give pleasure to your      perienced violence or the threat of vio-
   her own feelings. If your partner says          want something, state it clearly. For ex-   partner.                                        lence can receive help from the National
   he/she is afraid or troubled, don’t tell        ample, ”Could you vacuum the house?”             After the child is born, there will be a   Women’s Line in Finland (www.naisten-
   him/her that there is nothing to be             (instead of ”You never do anything”).       period when your sex life will have to be       linja.com) by calling the national tele-
   afraid of. Rather, ask what it is specifi-   4) Do not injure the other person’s self re-   on hold. The parents can decide the length      phone helpline (tel. 0800 02400). Help for
   cally he/she is afraid of. Allow you part-      spect. Even when you are terribly angry,    of that period, but it is recommended to        men in finding an alternative to intimate
   ner to have the feelings he/she is expe-        don’t say the things you know will hurt     put off sex for a couple of weeks, until the    partner violence is provided by the
   riencing and say, for example, ”You             the most.                                   vaginal discharge ends. However, there is       ”Lyömätön Linja”organisation. If you need
   must have felt terrible when you were        5) Bringing up past arguments is human,        no need to refrain from showing affection!      help, call tel. (09) 612 66 212, or email lyo-
   being reproached by your boss” etc.             but it is detrimental to your own life.     Hugs, caresses, kisses and nice words are       maton.linja@miessakit.fi. u
3) Tell your partner how you feel. If you          Can you forgive and forget?
   are angry, say ”Having to clean up after
   you makes me angry”, for example. Try        Pregnancy and sexuality
   not to blame your partner, and avoid         Pregnancy may change the way you feel
   the word ”always” in phrases such as         about sex in one way or another. Nausea,

24   Pregnancy                                                                                                                                                                 Pregnancy   25
Antenatal care in theprenatal
                                                                                                clinic through examinations and a person-        It is recommended that the expectant
                                                                                                al interview. A blood sample is taken at         mother pays attention to the baby’s
                                                                                                the first appointment to determine your          movements, especially in late pregnan-

                                                                                                blood group, Rhesus factor and blood             cy. If you are concerned about the well-
                                                                                                haemoglobin concentration. The sample            being of you or your baby, share it with
                                                                                                will also be tested to rule out syphilis. A      your nurse or doctor. You can discuss, in
                                                                                                urine sample is tested for sugar levels,         complete confidence, issues concerning
                                                                                                protein and bacteria. The expectant moth-        pregnancy, including depression, famil-
                                                                                                er will be weighed, her height measured          ial problems and fears with the doctors
Antenatal care is provided by the                                                               and her blood pressure checked. With the         and nurses at the prenatal clinic. If nec-
prenatal clinics to maintain the                                                                mother’s permission, the blood sample            essary, further support is available
good health of the expectant moth-                                                              can also be tested for HIV antibodies and        through social workers, psychologists
er and the unborn child, to promote                                                             hepatitis. Visits to the prenatal clinic al-     and specialists.
a healthy lifestyle for the whole                                                               ways include personal discussions and ad-
family and to help the family pre-                                                              vice.
pare for the new baby. The aims of                                                                  Your doctor will perform an internal        Intensive antenatal care
antenatal care include promoting                                                                examination at the first appointment to         Some expectant mothers receive intensive
the well-being and good health of the                                                           determine the position of the womb and          antenatal care in, for example, the follow-
prospective parents, supporting the                                                             check that the size of the uterus corre-        ing situations:
parents in their growth towards par-                                                            sponds to the pregnancy weeks.                  u when the mother suffers from
enthood and family life, and provid-                                                                                                               prolonged or chronic diseases,
ing tools for preventing and solving                                                            Follow-up visits                                u multiple pregnancy,
possible problems in their relationship. In     close collaboration between the prenatal        Follow-up appointments at the prenatal          u a very young or a relatively old women
particular, support is needed in families       clinics and the hospital maternity unit.        clinic are at early pregnancy every four           having her first baby,
expecting their first baby. The prenatal             A nurse or midwife and a doctor work       weeks, every two weeks from week 28, and        u raised blood pressure and protein
clinics are organised around the whole          at the prenatal clinic. Antenatal care in-      once a week from week 35.                         found in urine (signs of pre-eclampsia,
family, not just the mother. Dads receive       cludes physical examinations, screening             During every visit, the mother is             which is a condition that requires a
support in their personal growth towards        tests, personal guidance and antenatal          weighed, her blood pressure is taken and          doctor’s attention),
becoming fathers and advice on a healthy        classes. Your nurse or midwife may also         her urine is tested for sugar. Blood haemo-     u itching or yellow skin
lifestyle and how to best support the           visit you at home. During the course of a       globin is determined at least three times         (signs of hepatosis gravidarum),
mother. Additional support and advice is        normal pregnancy, the expectant mother          during pregnancy. An average weekly             u certain inflammatory diseases at
provided by online clinics.                     makes 12 to 15 visits to the prenatal clinic.   weight gain is determined to ensure the           the beginning of pregnancy,
     Antenatal care monitors possible prob-     Of these, 2 to 3 are doctor’s appointments.     pregnancy is progressing normally. Swell-       u birth canal infections.
lems during pregnancy, takes action to pre-     Most health care centres offer ultrasound       ing is monitored, if present. Foetal heart-
vent them and refers the mother for further     scans at 12 to 16 weeks. The services of a      beat will be monitored at each visit and the
                                                                                                                                                 The majority of babies born in Finland
examinations and treatment in a hospital,       psychologist, a nutritional therapist, a        baby’s position will determined by external
                                                                                                                                                 are healthy. This is mostly due to the
if necessary. The prenatal clinics and hospi-   physiotherapist and a social worker are al-     examination. If the need arises, the exam-
                                                                                                                                                 good health of Finnish women and the
tal maternity units also support the family     so available for families.                      ining doctor or nurse refers the mother to
                                                                                                                                                 regular visits to the prenatal clinic and
if and when the mother has fears relating                                                       the hospital maternity unit for further test-
                                                                                                                                                 maternity unit where the health and
to childbirth, suffers from depression, or is   First visit                                     ing. Topics concerning pregnancy, child-
                                                                                                                                                 well-being of the mother and baby are
having a multiple pregnancy. Care during        The mother’s overall health and possible        birth and parenting will be discussed with
                                                                                                                                                 closely monitored.
pregnancy and childbirth is realised in         risk factors are assessed at the prenatal       both the mother and father.

26   Pregnancy                                                                                                                                                                 Pregnancy   27
Screening programmes                           with your partner about the possibility of       is a more detailed scan called a structural    for families with children. Antenatal class-
(to be harmonised across the nation by 2010)   increased risks and how you feel about           scan. The number of foetuses and their         es often include a visit to the hospital ma-
Screening tests performed at prenatal          terminating the pregnancy or having a            status is checked, the age of the foetus       ternity unit.
clinics vary greatly between different mu-     handicapped child.                               and the amount of amniotic fluid are de-
nicipalities. According to the recently            The early pregnancy ultrasound scan          termined, and the position and condition       Prenatal clinics and dads
passed Screenings Decree, municipalities       is performed at 10 to 14 weeks, either in-       of the placenta are verified. The baby’s       Dads are welcome to attend every ap-
are obliged to arrange screenings to deter-    ternally or externally. The primary purpose      major organs and skeleton are checked for      pointment as well as the antenatal classes.
mine foetal chromosome abnormalities           of the scan is to confirm the weeks and to       structural abnormalities. The mother may       Dads bring the male perspective into the
and severe structural abnormalities by the     check the number of foetuses. Structural         be accompanied to each scan by the father      pregnancy discussion. The child will be-
beginning of 2010. (A guide on screening       abnormalities may be revealed by the             or some other person.                          come attached to both the mother and the
programmes can be found in Finnish at          scan. The risk of chromosome abnormali-              Pregnancy can be terminated until the      father, so it is only natural that parenting
http://www.stm.fi/Resource.phx/publish-        ties can be assessed by performing an ul-        end of week 23 (24+0), if the foetus has       is shared. A child needs the support and
ing/store/2007/05/pr1178537602112/pass-        trasound scan at 10 to 12 weeks. At this         been reliably tested to have a severe dis-     assurance of both mum and dad for his/
thru.pdf).                                     time, the nuchal fold at the back of the ba-     ease or handicap.                              her development. Shared parenting re-
    Ultrasound scans and tests on mater-       by’s neck is also measured. Blood samples                                                       sponsibility gives dad a chance to realise
nal serum, amniotic fluid and the placenta     for chromosome screening tests are taken                                                        himself in new ways, while mum can have
are all voluntary. Screening tests are per-    at 8 to 11 weeks. If the first prenatal clinic       DADS ARE WELCOME TO ATTEND EVERY           some private time on her own. When both
formed to detect increased risk of certain     appointment is after week 11, a blood test           APPOINTMENT IN PRENATAL CLINICS.           parents participate in caring for the chil-
conditions so that the birth and aftercare     called the triple test is offered at weeks 14                                                   dren, the relationship tends to be happier.
of the newborn can be planned well in ad-      or 15. However, the triple test is not as re-                                                   However, as much as the dad might wish
vance. The majority of babies develop nor-     liable in the assessment of the risk of          Antenatal classes                              to be a caring and actively participating
mally without severe injuries or diseases.     chromosomal abnormalities as the earlier         Every prenatal clinic organises antenatal      father, it is not always easy; changing your
    An increased risk does not necessarily     screening test. Women at increased risk          classes to prepare the prospective parents     lifestyle and starting to live on the baby’s
mean that the baby will be born with a         are offered placental tests and an amnio-        for labour, childbirth and parenthood. It is   terms may be difficult.
handicap or disease. Furthermore, not all      centesis (amniocentesis is a diagnostic test     recommended that you attend your first              Prenatal clinics help mums and dads
conditions show up in screenings, and no       where a fine needle sample of amniotic           antenatal class during weeks 20 to 30.         form a positive yet realistic picture of life
test can guarantee that the child will be      fluid is taken). Examinations are voluntary      Usually there are 4 to 5 meetings, some of     with a new baby. The clinics strive to pro-
healthy. Before going to a screening, talk     and carry a slight risk of causing a miscar-     them preferably after the baby is born. The    mote the mother’s and father’s commit-
                                               riage (at most 1 out of every 100 pregnan-       antenatal classes are usually held by a        ment to caring for the baby. Prenatal clin-
                                               cies).                                           nurse or some other health care profes-        ics also accommodate the men’s views
                                                   Several municipalities offer amniocen-       sional, and the topics covered include         and needs as parents. Dads are advised on
                                                     tesis or placental tests to women over     what happens during labour and how to          how they can best support their partners
                                                          40 without the preliminary            prepare for it, breastfeeding and caring for   during labour and how they can partici-
                                                            screenings, because the risk of     the newborn. Antenatal classes provide a       pate in caring for the baby. Many prenatal
                                                              chromosomal abnormalities         chance to learn how to care for the baby,      clinics organise meetings for just the dads
                                                                     increases with age.        to discuss changes in daily routines when      where they can share their experiences
                                                                             The second ul-     there is a new baby in the house, to talk      with other men in the same situation.
                                                                           trasound scan at     about parenthood and relationships with        When the nurse comes to meet you at
                                                                            18 to 23 weeks      other prospective parents, and to learn        home, schedule it so that the father will be
                                                                             or after week 24   about the services and benefits available      present as well. u

28     Pregnancy                                                                                                                                                              Pregnancy   29
Pregnancy at work and at home
The elder siblings and jealousy                   They might have thought that ”my mum           poses risks such as chemical substances,
If the baby is not the first child in the fam-    and dad don’t have sex”. The older chil-       radiation or infectious diseases. If this is
ily, it is a good idea to start preparing the     dren might also be uneasy about their sta-     not possible, the mother can apply for spe-
other children for the new baby in ad-            tus and fear losing their parents to the ba-   cial maternity allowance from the Social
vance. The age of the child dictates when         by. In such a situation, some children         Insurance Institution (KELA) to begin ma-
to tell about the baby: immediately when          freeze completely while others begin to        ternity leave at an earlier date.
the pregnancy has been confirmed, or lat-         exhibit problem behaviour. Talk with your           Pregnant women should not do jobs         active virus. Pregnancy should be taken in-
er when the pregnancy clearly begins to           children about their feelings, expectations    involving exposure to radiation (e.g. X-       to account when dividing the daily tasks
show in the mother’s body, for example.           and fears. Sometimes, talking with a friend    rays). They should also avoid physical         in, for example, infectious disease depart-
Regardless of the moment, pregnancy will          of the family or a health care professional    strain, such as lifting or moving heavy ob-    ments in hospitals.
last for a long time from the child’s per-        or social worker can help both the child       jects. According to current knowledge,              If you work in the health care sector,
spective. However, the child should first         and the parents.                               working by a computer monitor and using        you might become infected with hepatitis
hear about the pregnancy from his/her                                                            physical therapy equipment do not pose a       B or HIV via the blood or excretions of in-
own parents, not from other people.               Sort your priorities                           radiation risk. If your job involves coming    fected patients. In the cleaning business,
      For the first born, a new baby is a tre-    The new baby drains energy from the            into contact with anaesthetic gases, lead,     syringes and needles in waste bags may
mendous experience which causes envy              whole family during pregnancy, especially      mercury, cytostatic agents, carbon monox-      present a risk. Usually, a biohazard does
and jealousy. These feelings will pass soon-      in the first weeks after birth. Think in ad-   ide or carcinogens (cancer-causing sub-        not exist unless the patient’s blood comes
er if the elder sibling is invited to partici-    vance what is important and what can wait      stances), consult your occupational health     into contact with the worker’s circulation
pate in caring for the baby. If the cot or oth-   until later. The well-being of the mother is   care representative to ensure the safety of    via a wound or a needle prick. Reduce the
er things are handed down to the baby, this       a prerequisite for the well-being and          your working environment.                      risk by wearing protective gloves, using
should be done well in advance before the         healthy development of the baby. Work,              Pregnant women should also carefully      disposable instruments and avoiding
baby moves in. When the child asks you a          cleaning, guests and travel can wait – the     investigate any social risks relating to pa-   mouth pipetting in the laboratory. There is
question, try to give a simple and straight-      baby cannot. When the parents get enough       rental leaves, discuss the statutory rights    a risk of cytomegalovirus infection if you
forward answer. If the first child is very        rest, they will be able to better enjoy and    and benefits with their superiors and have     are working in an institution where you
young, you can say, for example, that ”Dad        care for the baby. It is recommended that      a preliminary discussion about returning to    come into contact with infant excreta.
gave mum a baby seed and now there is a           you begin your maternity leave at least a      work from maternity leave (see ”Benefits       Pregnant women should be removed from
little baby growing in mum’s tummy. When          month before the expected date of deliv-       for families with children” on page 99).       these environments. However, for most in-
the baby is ready, he or she will come out        ery. Remember, giving birth demands                                                           fections, it is sufficient to be aware of the
through a special opening (different from         more than running a marathon!                  Infectious diseases and vaccinations           risks and to protect yourself adequately. u
the ones for pee-pee and poo-poo) and the                                                        If a pregnant woman has never had the
baby will be our baby, and mum and dad            Risks at work                                  common pox diseases or been vaccinated
                                                                                                                                                 Learn the policies and procedures in
will love you and the baby just as much.”         The superiors of expectant mothers are re-     against them, she might become infected
                                                                                                                                                 use at your workplace. Discuss risks
                                                  sponsible for ensuring safe working condi-     when working with children. If you have
                                                                                                                                                 and biohazards with your superior,
Older children                                    tions and methods. A pregnant woman is         never had chicken pox, you should be vac-
                                                                                                                                                 occupational health care services, or oc-
For children over 10 years, the idea of a         entitled to request being transferred to       cinated against it before becoming preg-
                                                                                                                                                 cupational safety personnel.
new baby may be very difficult to accept.         other jobs if the working environment          nant. Avoid contact with people with an

30   Pregnancy                                                                                                                                                                 Pregnancy   31
What does a baby need?                                                                       Somewhere to sleep
                                                                                             The maternity package comes in a carton
                                                                                             that is designed to double as a baby basket
                                                                                                                                             three pieces of everyday clothing, such as
                                                                                                                                             jumpsuits, pants and body suits: one to
                                                                                             when it is lined with cloth (e.g. a sheet).     wear, one in the wash, and one drying. As
                                                                                             Dark red is a soothing colour that reminds      for other clothes, such as hats and over-
Maternity package                                                                            the baby of the womb. At first, the baby        clothes, three is often too many. However,
The Finnish maternity package delivered                                                      can also sleep in a crib, carrycot, basket or   if washing clothes is not easily accom-
free of charge to expecting mothers is the                                                   other baby bed. A cot with bars will be         plished, it is wise to have several pieces of
only one of its kind in the world. The ma-                                                   necessary by the time the baby starts turn-     clothing, since babies tend to use up at
ternity package is a complete baby gear                                                      ing and moving around and the previous          least one outfit per day. The first year is a
”starter pack”. The pack includes useful,                                                    sleeping arrangement is no longer safe.         time of rapid growth, and your child will
high-quality clothes and other necessary                                                     When the child is 1.5 to 2 years old, he/she    quickly grow into and out of clothes. A
items. Pregnant women must apply for the                                                     will be able to climb out from the cot. At      1-year-old child is 73 to 80 cm and weighs
maternity package from the Social Insur-                                                     this time, the child can start sleeping in a    10 to 12 kg.
ance Institution (KELA). The application                                                     children’s bed.                                     The essential bigger purchases for the
can be sent together with the application         The contents of the maternity package                                                      baby include a tub, a pram and a car safety
for maternity allowance. Another alterna-     and the fabrics for clothes and bed linen      Acquiring and storing baby gear                 seat, if the family travels by car. Use the
tive is to fill in an online application at   change from time to time, but there are no     Despite the maternity package, it is advis-     carrycot that fits inside the pram to trans-
www.kela.fi/asiointi. You can log yourself    major changes.                                 able to acquire more clothes and linens, if     port the baby when the pram does not fit
in with Finnish banks’ net bank user IDs,         The clothes come in different sizes (60    possible, since babies tend to use up           inside the house or cannot be pushed all
but please note that the service is only      to 70 cm). A newborn is about 50 cm. If the    clothes quickly. It is not necessary to buy     the way to the front door. When buying
available in Finnish and Swedish. You can     sleeves or pant legs are too long, shorten     all items new; there are charity and sec-       prams, pay attention to safety, durability
claim your maternity package from Kela or     them temporarily by sowing folds on the        ond-hand shops selling baby wear and            and size (will it fit into the elevator?). Most
retrieve it from the post office a few        outside or tying a knot at the end of very     gear at reduced prices, and you can also        modern additional features, such as air
months before the estimated date of deliv-    long legs. You can also shorten pant legs by   look for baby gear for sale in local news-      conditioning, have little effect on the well-
ery (see ”Maternity grant” on page 99).       using socks or booties.                        papers, market notice boards and online         being of the baby. If it is possible to sleep
                                                                                             shops. There is a variety of online auc-        the baby on a balcony, you can get a used
                                                                                             tions and second-hand shops. It is also         pram in good condition at a very reasona-
The package contains:                                                                        relatively simple to make bed linen your-       ble price to keep on the balcony.
(For photos of the contents, please visit www.kela.fi).                                      self. Friends, relatives and neighbours             A couple of shelves or drawers is
                                                                                             may be willing to lend you some items.          enough space for storing the baby’s clothes.
u Baby wear: wrap-tops, body suits,           u Baby care: a mattress, a mattress            There are also national organisations that      It is possible to change nappies whilst
pants, jumpsuits, a top and pants set,        protector, a hairbrush, disposable             lend baby gear, such as the Mannerheim          holding the baby in your lap, but in many
baby hats, socks, mittens, overalls, warm     nappies, a tooth brush, nail clippers,         League for Child Welfare (MLL) and              cases a proper changing mat or changing
booties, padded mittens, a pramsuit           bath water thermometer, basic lotion,          Folkhälsan. Recycling is beneficial, since      top can be very useful (see ”A place for
                                              a bib, a book, a toy                           most clothes and items can be used by           changing”on page 57). A baby carrier, sling
u Linens, towels, nappies: terry
nappies, a cloth nappy set, a bath towel,     u Other: sanitary pads, condoms,               several babies.                                 and baby sitter allow you to keep your
a sheet, a blanket cover, a blanket,          bra pads, lubricant lotion, and pamphlets           Remember that the baby does not            hands free. Baby carriers and slings are er-
a sleeping bag (turns into a padded           on relationships, breastfeeding, nutrition,    need massive amounts of toys, equipment         gonomically designed for the comfort of
blanket)                                      cloth nappies and safety while travelling      and clothing. As a rule of thumb, have          both the mother and the baby. u

32   Pregnancy                                                                                                                                                               Pregnancy   33
Preparing for birth
                                                                                                mother can decide which of the available        assessed prior to birth, but cannot be abso-
                                                                                                options she is willing to use, while the care   lutely determined as some situations may
                                                                                                personnel will assist and give advice on        change quickly. It may become necessary
                                                                                                suitable alternatives. The mother is free to    to induce labour, or there might be com-
                                                                                                move around during labour and has the           plications requiring specific procedures
Antenatal classes                                                                               right to decide on the position most suita-     during labour. Intervention is required in
Preparing for birth is one of the topics cov-                                                   ble for delivery. Alternative forms of pain     approximately 15% of births. Intervention
ered in antenatal classes, with the aim of                                                      relief are also discussed with the mother.      methods include Caesarean section (C-
providing both the mother and the father                                                                                                        section), vacuum extraction, forceps and
with information and guidance on birth                                                          Father’s role                                   assisted breech birth.
and delivery so that when the time comes                                                        It is the role of the father (or some other
they will be able to make informed deci-                                                        companion) to support, encourage and
sions. Being prepared both physically and                                                       rally the mother during labour. Giving              THE PRESENCE OF A CLOSE COMPANION
mentally will help the mother stay in con-                                                      birth usually takes several hours, and sup-         IS A COMFORT TO THE MOTHER .
trol of the situation during delivery. It is                                                    port and encouragement is much needed.
important that the mother feels in control,                                                     Some very concrete supportive measures
and that the baby’s birth is as positive an                                                     include, for example, massaging the moth-            In approximately 3 percent of deliver-
experience as possible.                                                                         er’s aching back, fetching something to         ies, the baby is in the breech position (the
    To act purposefully during birth, both                                                      drink, wiping away sweat and helping the        baby is head up instead of head down). A
parents must be familiar with the three                                                         mother to relax. The presence of a close        breech position (or any other abnormal
stages of labour, know about operations                                                         companion is a comfort to the mother and        presentation) is usually detected at the
and standard procedures, and have infor-                                                        helps her keep her spirits up.                  prenatal clinic. You may be referred to the
mation on controlling one’s own body. La-        event. Hospital maternity unit staff aim to         Furthermore, this shared experience        hospital, where a doctor will try to turn the
bour, as the name implies, is hard work and      create a calm and comfortable atmosphere       often strengthens the relationship.             baby from the breech position to a head-
requires a great deal of mental and physical     for the family, and provide the mother              When the father has witnessed the          down position. This procedure is also
energy. Being able to relax in between and       with sufficient space to focus on the deliv-   birth of his own child, the relationship be-    called external cephalic version. However,
during contractions preserves the mother’s       ery. In many units, a member of staff will     tween the father and the child forms im-        if this is not successful and the baby re-
strength. Preparing for birth in advance         hold a discussion with the parents before-     mediately when the baby is lying on its         mains in the breech position, the final de-
usually eases the delivery process.              hand on their thoughts and wishes related      mother’s breast, seeking contact with its       cision on the delivery method is made af-
    It is not always possible for the father     to the oncoming birth. This discussion is      parents. A strong bond is created when the      ter a thorough check at the hospital mater-
to attend the birth and, when this is possi-     then continued during labour when con-         baby first opens its eyes and makes eye         nity unit, where the baby’s size and moth-
ble, it is ultimately the father’s own choice.   sidering the available options and proce-      contact with the faces close by. Some fa-       er’s pelvic dimensions are carefully meas-
Alternatively, the mother can also have          dures that might assist in the delivery. Be-   thers find they feel a stronger sense of        ured. A baby in the breech position is often
some other person as a companion, a close        ing prepared is important, but it should be    closeness - as if the baby was more their       born by caesarean section (C-section), es-
friend, a relative or a doula (a person          borne in mind that giving birth is always a    ”own”- when they have been present dur-         pecially when it is the mother’s first deliv-
trained in labour support), for example.         unique experience and that the parents         ing the birth. Fathers who have seen their      ery, the mother has had previous caesar-
Whatever the decision, it should be made         will be facing issues that cannot be consid-   baby being born describe it as one of the       ean sections or when the baby is prema-
as early as possible.                            ered in advance, but must be decided upon      finest moments of their lives.                  ture.
                                                 as the situation arises.
How to plan in advance                               Maternity units are equipped with dif-     Anticipating the delivery method                An elective caesarean section
In recent years, the emphasis has been           ferent kinds of birth stools and rocking       Most babies (85%) are vaginally delivered       In Finland, approximately every sixth child
placed on the fact that birth is a natural       chairs, birth pools and deep baths. The        in a head down position. Presentation is        is born by caesarean section and of those

34   The birth                                                                                                                                                                  The birth   35
                                                 been no complications. As in all deliveries,       Overdue pregnancy                              What to take to hospital
                                                 the mother and baby are the centre of at-          If your pregnancy lasts over 10 days beyond    Pack your hospital bag ready with the
                                                 tention and their well-being takes prece-          the estimated delivery date based on meas-     items you will need well in advance. You
                                                 dence over everything else.                        urements taken from an early pregnancy         can pack your own robe and nightgown to
                                                                                                    ultrasound scan, it is considered overdue.     wear at the hospital.
                                                 Giving birth before reaching the hospital          You or your health nurse should make an
approximately 50% are elective caesarean         Sometimes the baby is born so fast that the        appointment at the hospital maternity unit
                                                                                                                                                   u your current and any previous
sections. Typical reasons for a caesarean in-    mother cannot make it in time to the hos-          where a doctor will examine the mother
                                                                                                                                                      maternity cards
clude breech presentation, abnormal pla-         pital. Each year, some 50 women deliver            and the baby and, based on the well-being
                                                                                                                                                   u pre-filled personal data form
cental position, the large size of the baby, a   their baby on the way to the hospital and          of them both, decide how to proceed.
                                                                                                                                                      (received from the prenatal clinic)
decelerated growth rate and previous cae-        another 50 have an unplanned home birth.                Overdue pregnancies are closely mon-
                                                                                                                                                   u your Social Security Card (Kelakortti)
sareans. Sometimes the mother experienc-         In these cases, the first stage of labour pro-     itored to detect any signs of possible risks
                                                                                                                                                   u toiletries and other personal items,
es such fear of giving birth that vaginal de-    ceeds quickly to the second stage and the          as early as possible. The most common
                                                                                                                                                      such as a toothbrush and toothpaste,
livery is not possible.                          mother feels the need to push suddenly,            complication in overdue pregnancies is
                                                                                                                                                      deodorant, body lotion, hairbrush
     A caesarean section is scheduled for a      while still at home or on her way to the           placental insufficiency, other problems in-
                                                                                                                                                      (shampoo and soap are usually
time when the baby is most likely to be          hospital. Hence, the father or other com-          clude foetal oxygen deficiency, a decreas-
                                                                                                                                                      available at the unit)
best prepared for life outside the womb,         panion has to play the midwife’s role. The         ing amount of amniotic fluid, and changes
                                                                                                                                                   u nursing bras.
i.e. when the lungs have matured and oth-        first priority is to stay calm. If possible, the   in the foetal heart rate. It is recommended
er risks remain as small as possible. How-       father should contact the hospital where           that the expectant mother pay attention to     Unless the hospital accepts payment in ar-
ever, a child born by elective caesarean         they will be able to give advice over the          the baby’s movements, following the in-        rears, you are expected to pay for your stay
section is at a higher risk of being slow to     phone. Once the baby is born, he or she is         structions given at the hospital or prenatal   upon leaving the hospital. Other than that,
adapt and to develop wet lung syndrome,          bathed and then placed on the mother’s             clinic.                                        you will not need large amounts of cash. It
because the complicated mechanisms that          breast. Remember to ensure that the baby                                                          is also advisable to leave any valuables,
mature the lungs and are naturally activat-      is kept warm. It is advisable to prepare for                                                      such as expensive watches and jewellery,
ed during vaginal delivery do not have           such a delivery, especially when the hospi-                                                       at home.
enough time to function adequately dur-          tal is far away or when previous births                                                               The father can bring any gear and
ing a caesarean. Further, both the mother        have been quick.                                                                                  items you need for the journey home on
and the baby need more time to recover.                                                                                                            the day before you leave the hospital.
     In the case of an elective caesarean, the   Home birth                                                                                        The baby will need:
hospital maternity unit staff provide advice     Home birth is very rare in Finland, al-
                                                                                                                                                   u undergarments (e.g. a body suit),
well in advance. Fathers are welcome to          though it is also an option. Each year,
                                                                                                                                                   u a shirt and pants or a jumpsuit,
participate in elective caesarean sections.      about 10 mothers decide to give birth at
                                                                                                                                                   u a hat and a sleeping bag and, if the
(For more information on Caesarean sec-          home. Home births require somewhat
                                                                                                                                                     weather is cold, the baby will also need
tions, see page 40.)                             more initiative and activeness from the
                                                                                                                                                     a cardigan and a pram suit or padded
                                                 mother. She will need to book a midwife
A policlinic delivery                            and acquire the necessary equipment.
                                                                                                                                                   u a car safety seat, if the family
The inpatient period following delivery has      Mothers choosing home birth are also re-
                                                                                                                                                     travels by car.
become shorter, and so called ”polyclinic        sponsible for all of the related expenses
deliveries”have become possible, although        and any unexpected consequences. If you                                                           Before the baby is born, make sure you have
they are still quite rare. In a polyclinic de-   are interested in home birth, be sure to in-                                                      small nappies for the newborn and sanitary
livery, the family can take the baby home 6      vestigate the option thoroughly before                                                            pads for yourself, for heavy bleeding after
hours after birth, provided that there have      making your final decision.                                                                       the birth, kept in readiness at home. u

36   The birth                                                                                                                                                                    The birth   37
Onset of labour                                                                               The stages of labour
Onset of labour                                    As the estimated delivery date ap-         There are three stages of labour: the first           With mothers
Labour usually begins at 38 to 42 weeks,       proaches, the father or other companion        stage is the dilation of the cervix, the sec-    who have had previ-
with contractions or with your water           should never be more than a phone call         ond is the delivery of the baby, and the         ous pregnancies, the
breaking. However, it is not yet fully un-     away. If the maternity unit is far away or     third is the delivery of the placenta. For       cervix begins dilating even before the cervi-
derstood what triggers the onset of labour.    the journey is otherwise demanding, re-        first-time mothers, labour often takes be-       cal canal has fully effaced. Labour often
The loss of the pink mucus, ”the plug”,        member to plan accordingly.                    tween 6 and 20 hours. For women who              starts to progress faster when the cervix is 4
that keeps the cervix closed, is a sign that       If your water starts to leak during the    have already given birth, labour may only        to 5 cm dilated.
labour is approaching. Labour usually be-      night, the amniotic fluid is colourless and    take 3 to 12 hours. For some women,                   At the beginning of the first stage,
gins with irregular contractions which         you are not having contractions, you can       though, labour may last much longer,             contractions are experienced approximate-
gradually become stronger and more fre-        wait until morning to go to the hospital. If   while for others it’s over much sooner.          ly every five minutes, lasting for 30 sec-
quent. Labour can also begin with your         the amniotic fluid is green, it means that          Midwives are skilled professionals and      onds at a time, but as the labour progress-
water breaking either suddenly or in a         the baby has emptied his or her bowels         you can talk with your midwife about your        es, contractions become more frequent
gradual trickle. It can also be induced us-    and you should go to the hospital without      views, hopes, wishes and feelings during         and last longer.
ing medication.                                delay. Although your waters have broken,       labour. She is there to support, encourage            During the first stage, the midwife will
                                               you do not need an ambulance to go to          and give advice to both the mother and           check the cervix’s status, the baby’s posi-
When to go to the hospital                     hospital. If an elective caesarean section     her companion. Together with the mother,         tion in the birth canal and the mother’s
Women who are having their first               has been scheduled for you and your water      the midwife will try to find comfortable         blood pressure every one or two hours.
baby should go to the hospital when            breaks or you are having regular contrac-      positions and suitable forms of pain relief,     Technical devices are usually applied to
                                               tions, go to the hospital in order to reas-    and will place all of her skill at the dispos-   monitor the well-being of the baby (CTG,
u contractions come regularly
                                               sess the urgency of the operation.             al of the mother during the course of the        cardiotocography) and to listen to the ba-
     after every 5 to 10 minutes,
                                                                                              labour.                                          by’s heartbeat through the mother’s abdo-
u contractions last at least
                                               Admission process                                                                               men. An electrode may be attached to the
  45 seconds at a time,
                                               When you arrive at the hospital, a midwife     The first stage of labour:                       baby’s head which records the trend in the
u you have had contractions for
  two hours.
                                               will welcome you and request your mater-       the dilation of the cervix                       mother’s contractions and the foetal heart-
                                               nity card. Any patient data on the mother      The uterus is a very strong organ and its        beat. The colour, odour and amount of am-
Mothers who have had previous                  will be retrieved from the hospital records.   muscular activity will push the baby             niotic fluid are also monitored. If neces-
pregnancies should leave earlier, when         The mother’s blood pressure is taken and       through the birth canal and into the world.      sary, the baby may be further monitored
u contractions are regular, and                her urine tested for protein and sugar. The    During the first stage of labour the cervix      via ultrasound scans, taking blood samples
u last at least 30 seconds.                    midwife will then perform an external and      dilates to 10 cm. For a first-time mother,       or using a STAN device which records the
                                               internal examination. The external exami-      the cervix only begins to dilate after the       baby’s ECG in addition to its heartbeat.
                                               nation is performed to determine the sta-      cervical canal has gradually effaced                  During this stage, the mother can as-
 Note! Go to the hospital immediately, if
                                               tus, position, size and presentation of the    (thinned out) due to contractions. This          sist the uterus by staying relaxed. Moving
 you have vaginal bleeding or experi-
                                               baby. An internal examination is per-          might take 8 to 9 hours. Once the cervical       around and staying in an upright position
 ence severe pain.
                                               formed to determine the stage of labour,       canal has effaced, the cervix dilates about 1    will further accelerate the dilation. The
    If your waters have broken or your
                                               the extent to which the cervix has dilated     to 2 cm per hour. If the contractions are        mother should remember to empty her
 baby is in the breech position, it is ad-
                                               and the placement of the presenting part       not sufficiently effective, they can be stim-    bladder sufficiently often so that a full
 visable to travel lying down.
                                               (usually the baby’s head). u                   ulated with a hormone drip (oxytocin).           bladder does not hinder the delivery.

38     The birth                                                                                                                                                                The birth   39
    Many mothers find that the presence               At some point, the midwife asks the          the baby’s well-being is believed to be de-          Having a caesarean section does not
of the baby’s father or other companion is        mother to stop pushing altogether for a          teriorating or when the delivery stops pro-      prevent the mother from having a vaginal
especially important during this stage, as        while so that she can help the baby’s head       gressing as it should. A swift deterioration     birth in the future. However, it is recom-
he will be there to encourage and support         emerge from the birth canal. Next, the ba-       in the baby’s condition will require an          mended that there is an interval of at least
the mother, offer something to drink, mas-        by’s shoulders will emerge one at a time         emergency caesarean so that the baby will        one full year before the next pregnancy, in
sage her aching back and create a general         and the mother will be encouraged to             be delivered as fast as possible. If a caesar-   order to ensure the uterus has sufficient
sense of security. In many cases, this will       push yet again, until the baby is fully born.    ean section has been scheduled in ad-            time to heal properly. If the mother has
ease the pain as well.                            For a first-time mother, the second stage        vance, it’s called an elective caesarean (see    had two caesarean sections, vaginal birth is
                                                  takes 20 to 30 minutes, for others only          ”Anticipating the delivery method” on            most likely no longer an option.
The second stage of labour:                       about 10 minutes.                                page 35).
the delivery of the baby                                                                                A caesarean section is performed under
The second stage begins when the cervix is        The third stage of labour:                       general anaesthesia or using an epidural or          MIDWIFES ARE SKILLED PROFESSIONALS
fully dilated and the baby’s head is turned       the delivery of the placenta                     spinal anaesthetic. Usually the method saf-          WHO ARE THERE TO SUPPORT YOU.
into the correct position. The mother will        As soon as the baby is born, the mother is       est for the mother and baby is selected, but
feel a very strong urge to push downwards.        given an oxytocin injection that stimulates      in an emergency the fastest method is ap-
Some mothers may feel the urge to push at         the uterus to contract. The contractions will    plied. The surgeon makes an incision in the      Vacuum extraction and forceps delivery
an earlier stage, but the personnel will ad-      cause the placenta to be expelled from the       mother’s abdominal wall and cuts through         Vacuum extraction is performed using a
vise her to refrain from pushing too early        uterus, usually in about 5 to 10 minutes.        the uterus. The baby is then helped out. The     ventouse which is often the best way to ac-
to prevent prolonged delivery due to a            The midwife helps the placenta to be deliv-      placenta and the membranes are removed           celerate delivery when the baby is showing
swollen cervix. Many women find this the          ered by pressing the uterus lightly with one     in the same way. The whole operation takes       signs of distress or when contractions slow
most painful and unpleasant stage of de-          hand and pulling lightly on the umbilical        30 to 45 minutes. If the mother is con-          down during the second stage of labour.
livery, but luckily it is usually quickly over.   cord. The foetal membranes will also come        scious, she will be able to experience the       The doctor fixes a silicone or metal cup
The atmosphere in the delivery room is            out at this time. The placenta and mem-          birth of her baby.                               over the baby’s head which remains in
kept peaceful and calm, avoiding unneces-         branes are then examined, weighed and                 Recovery after a caesarean section          place through suction.
sary fuss and bright lights.                      measured. If the placenta does not come          takes somewhat longer than after a vaginal            In this way, the doctor has a firm grip
     When a contraction comes, the moth-          out by itself, the midwife will assist the de-   birth, because having a C-section is a seri-     on the baby. By pulling the ventouse as the
er will have a strong urge to push. She will      livery by pressing the uterus and tugging        ous surgical operation compared to vaginal       mother pushes, the doctor can help the
have time to push 3 to 5 times during one         the umbilical cord. Sometimes the placenta       delivery. The mother will usually be able to     mother deliver the baby. Vacuum extraction
contraction, taking a quick breath in be-         needs to be removed manually. This will be       get up within one day of the caesarean,          is used in about 5% to 7% of all deliveries.
tween each push. When to push depends             done under a general anaesthetic, or very        and is allowed to go home with the baby          Vacuum extraction causes swelling of the
on the mother, but when the baby’s head           effective local anaesthesia.                     when she is feeling well enough. The             baby’s head, which disappears within a
starts to press against the perineum and              The episiotomy cut and any tears will        stitches are removed after one week.             week, but can be painful during the first
stretches it, pushing may be guided by the        be stitched under local anaesthesia. Before           During the weeks following the C-sec-       few days.
midwife, who can see what’s happening.            being transferred to the postnatal ward,         tion, the mother will need extra help                 Forceps used to be a commonly used
The midwife monitors the stretching of the        the mother and baby will remain under            around the house as she is not allowed to        aid in deliveries, but today they are seldom
perineum and the pressure caused by the           surveillance at the delivery room for ap-        lift anything heavier than the baby. To en-      used. Forceps are used in similar situations
baby’s head and assesses the need for an          proximately two hours.                           sure proper healing of the incision, exer-       to vacuum extraction, but especially in cases
episiotomy to prevent the perineum from                                                            cise and the heavier household chores            where, towards the end of the delivery, the
tearing. An episiotomy - an operation in          C section                                        must be entered into with care. The moth-        baby’s heartbeat suddenly slows down and
which the perineum is cut to widen the            Approximately every sixth baby is born by        er may find many movements painful or            there is a sudden danger of oxygen deficien-
opening - is performed on only on one out         caesarean section (C-section). A caesarean       difficult. However, staying up and mobile        cy. In such circumstances forceps provide a
of every three mothers.                           section might be needed if, during labour,       will enhance recovery.                           faster method than vacuum extraction. u

40    The birth                                                                                                                                                                     The birth   41
Labour pains and pain relief
                                                                                               access the baby’s circulation through the       tion, the mother may experience back pain
                                                                                               placenta. If the baby is born 2 to 3 hours      around the injection area, and sometimes
                                                                                               after the last dosage, the pain killer may      have a severe headache. The pain is be-
                                                                                               paralyse the breathing of the newborn.          lieved to be caused by spinal fluid leaking
                                                                                               Hence, these drugs are generally not ad-        from the needle hole in the dura mater.
Labour pains                                                                                   ministered during the later stages of la-       First aid for headaches involves drinking
Labour is a massive strain on the mother       and singing, pillows, a bean bag, a rocking     bour.                                           large amounts of fluids, taking painkillers
and baby, both physically and mentally.        chair or gymnastic ball can be used as re-                                                      and resting in a darkened room. If the
When discussing pain relief with the par-      laxation aides. Many mothers find relief in     Nitrous oxide                                   headache persists, an anaesthesiologist
ents, the doctor and midwife consider the      warm water or a warm wrap that relaxes          A mixture of oxygen and nitrous oxide can       may need to asses the situation. If neces-
benefits and disadvantages to the mother       the muscles. During the first stage of la-      be safely administered throughout the first     sary, a special procedure called a ”blood
as well as the baby.                           bour the mother can shower her back and         stage of labour because it is quickly ex-
    At the beginning, pain occurs as a sign    abdomen or relax in a delivery pool or          pelled from the circulation. The mixture is
of the onset of labour. It is caused by the    deep bath. The mother is not allowed to go      inhaled through a mask in periods timed             RHYTHMIC BREATHING HELPS TO RELAX
muscles and tissue stretching as the baby’s    into the water if her water has broken over     with the contractions. It takes effect slowly       AND CONSERVES MOTHER’S ENERGY.
head descends in the birth canal. During       24 hours beforehand or if labour is not         and must therefore be inhaled before the
the second stage of labour, the urge to        progressing as expected.                        contraction begins.
push usually surpasses the pain caused by          Aqua acupuncture is a form of natural                                                       patch”, an injection of the patient’s own
contractions. During the third stage of la-    pain relief where water blisters are injected   Anaesthesia                                     blood into the epidural space where it
bour, when the placenta is delivered, the      under the skin to enhance the mother’s          An epidural is the safest and most effec-       forms a ”patch” over the hole, can be per-
pain has usually subsided.                     endorphin secretion. Endorphins are the         tive form of nerve block anaesthesia. It        formed to relieve the headache.
    Women experience labour pains differ-      body’s own painkiller and their effect lasts    eliminates the first stage labour pains al-          Anaesthetics travel through the pla-
ently. It will depend on her pain threshold    from 1 to 2 hours.                              most completely, if not completely. The an-     centa and may slow down the baby’s heart
and overall tiredness, but also on fear and        During labour it is recommended that        aesthetic drug is injected into the epidural    rate. Further, anaesthetics may temporari-
uncertainty. Fear of the unknown and not       you move around and try different posi-         space to the side of the spinal cord and a      ly affect blood circulation in the womb and
knowing what’s happening or what to ex-        tions to find the ones that are most com-       catheter is left in place so that additional    placenta, leaving the baby at risk of oxygen
pect is common for all of us, and when we      fortable. Swaying your hips removes some        medication can be given throughout the          deficiency. Because of these risks, the doc-
are frightened our sense of pain is height-    of the pressure against your lower back         delivery. An epidural may only be given by      tor needs to check from the baby’s ECG
ened.                                          and helps to control the pain caused by         an anaesthesiologist, and is therefore not      that he or she is in excellent condition pri-
                                               contractions.                                   available in every hospital.                    or to the administration of any anaesthetic
Natural pain relief                                The father or other companion may               Spinal anaesthesia is a very effective      agents. Furthermore, the mother and baby
Knowledge is the basis for all pain relief.    further help by massaging the painful are-      form of pain relief and commonly used in        must be closely monitored while the an-
Being familiar with the stages of labour al-   as during contractions.                         quickly progressing, fierce deliveries to in-   aesthetic is effective.
so assists the mother in coping with labour        Drugs injected into muscle tissue or        duce adequate pain relief with just one
pains. The correct breathing and being able    administered intravenously                      dose. Spinal anaesthesia may also be given      Hypnosis
to relax during each stage of labour are           Labour pains have a purpose: they           only by an anaesthesiologist.                   In Finland, hypnosis and the power of sug-
helpful to the mother and optimal for the      keep the mother informed of the labour              Your doctor may introduce a local cer-      gestion are rarely used for pain relief.
baby, as these forms of pain relief have no    process. However, one in five mothers ex-       vical anaesthetic during an internal ex-        However, both methods are safe for the
adverse effects on the baby.                   periences such pain that she will need          amination. Its effect will last for about an    baby. Hypnosis is best achieved if the hyp-
    Rhythmic breathing decreases muscu-        some form of effective pain relief. Each        hour.                                           notherapist will participate in the birth. If
lar strain, conserves the mother’s energy      mother is entitled to receive effective drugs       It is very rare for anaesthetics to cause   you wish to use hypnosis, arrange this
and helps the mother stay focused. Music       for pain relief, but drugs will also quickly    complications. As a side effect of the injec-   with the hospital in advance. u

42   The birth                                                                                                                                                                 The birth   43
The newborn
                                                                                                   frequent, which will require closer surveil-      its condition is stabilised. The units en-
                                                                                                   lance and be assessed by a paediatrician.         courage ”kangaroo care”where the baby is
                                                                                                   Infections passed on from the mother dur-         placed on the mother’s or father’s bare
                                                                                                   ing birth, gestational diabetes, pre-ec-          chest, under the shirt. This will help the
                                                                                                   lampsia and other diseases or medication          premature baby adapt to life outside the
Birth is a miraculous event touching the                                                           all have an impact on how the newborn is          womb. Skin-to-skin contact is soothing to
hearts of everyone present. Months of ex-                                                          monitored after birth. The breathing and          the baby and will help the baby maintain
pectation climax in pushing the baby out                                                           general well-being of premature (born be-         its body temperature.
and into the world. Love is in the air, but                                                        fore week 37) and low-weight (under
there is also a mixture of relief, exhaustion,                                                     2,500 g) babies are monitored particularly        Postnatal ward
anxiety and joy.                                                                                   closely. The more preterm the baby is, the        The staff at the postnatal care monitor the
      Immediately after birth the baby is lift-                                                    more likely it is to be transferred to the        well-being of the newborn baby and en-
ed onto the mother’s chest to provide skin-                                                        paediatric ward.                                  sure that the mother recuperates well from
to-skin-contact. The baby is then dried and       need reviving, others’ noses and mouths                                                            the delivery. They will also guide the par-
the umbilical cord is cut and tied. The           have been suctioned (if the amniotic fluid       Premature birth                                   ents on how to take care of their baby. The
mother and baby are allowed to rest under         was green) before being lifted onto the          When a preterm birth between 24 and 34            objective is to give as positive an experi-
a warm blanket. After a little while, curios-     mother’s chest.                                  weeks is expected, corticosteroids are given      ence as possible of the birth, and breast-
ity surpasses fatigue and the parents start            Soon after the birth, before the umbil-     to the mother to speed up the foetus’s lung       feeding and caring for the baby.
caressing the baby, peeking under the             ical cord is cut, a name tag is placed around    development. Preterm deliveries (baby
blanket to wonder at the tiny fingers and         the baby’ wrist or a necklace with an ID         born before 35 weeks) are located near the         Successful breastfeeding is important to
toes. This is the beginning of parent-child       plate is put on the baby bearing the moth-       neonatal intensive care unit (NICU). Today,        the well-being of both the mother and
interaction.                                      er’s name and social security ID. This pro-      very premature and low weight babies can           the baby. Breastfeeding provides suffi-
      After a moment of rest the baby will        cedure ensures that there can be no mix-         survive with the help of intensive care.           cient nutrition for the baby and also
open its eyes and seek eye contact with the       ups. The newborn receives a vitamin K                 The more premature the baby is, the           gives the mother a sense of security in
people close by. Slowly the little fists relax,   shot in the leg in order to prevent bleed-       longer he or she will need intensive care          her ability to feed her baby.
the mouth opens and a tiny tongue peeks           ing. After birth the baby’s health is as-        and incubator treatment. With each week,
out. The baby is now ready to start feeding.      sessed using the so-called APGAR score. A        the risks associated with premature birth              In the postnatal ward, the mother stays
      He or she will nudge towards the            numerical value (max. 10) is awarded for         decrease and the need for supplemental            in the same room as the baby. Milk pro-
breasts and start feeding within 30 minutes       skin colour, heart rate, breathing, reflex ir-   oxygen decreases. A premature baby usu-           duction begins in the delivery room where
to one hour after birth. The baby will ob-        ritability and muscle tone. The APGAR            ally spends the first days or weeks of its life   the baby’s sucking has stimulated the re-
serve the world around him or her with            scores are a tool used by health care pro-       in an incubator, where the temperature            lease of hormones (oxytocin). This close
bright eyes, stimulating the parents’ nursing     fessionals to assess the well-being of the       and humidity is controlled and the baby           interaction between mother and child con-
instincts. At this point, the midwife will        newborn and to forward this information          can be better monitored. If the baby is un-       tinues in the postnatal ward. The mother
monitor the well-being of the baby with as        to others. APGAR scores cannot be com-           able to feed, it is fed through a feeding         will care for her baby according to her own
little disturbance as possible. The baby is       pared between babies.                            tube. Premature babies born after 35              strength and following the rhythm of the
kept warm, bathed, dried, weighed and                  Provided that everything is alright, the    weeks usually survive in the postnatal            child. Other family members are welcome
measured. The father will be given the op-        mother and baby are transferred to the           ward, although feeding may take longer to         to visit the mother and newborn baby.
portunity to be the first to care for his baby.   postnatal ward two hours after birth. Fol-       accomplish than with full-term babies.                 The first breast milk is called colostrum.
      Each birth has a different story. Some      lowing a caesarean section, the father is the         The parents are welcome staying with         It is a rich milk providing all the required
births need to be assisted using vacuum           first to witness his baby’s first minutes.       their premature baby in hospital as much          nutrition for full-term babies. Milk produc-
extraction, while others may have ended in             Sometimes the baby’s breathing may          as possible. Parents may hold the baby as         tion is enhanced by frequent feedings. Pre-
an emergency caesarean. Some babies               have a wheezing quality or become overly         soon as its vital signs have developed and        mature, low-weight babies and high birth

44   The birth                                                                                                                                                                        The birth   45
weight babies (over 4,500 g) need large         ceuticals) can prevent breastfeeding, and in       baby can maintain a normal body temper-          formation. Some hospitals may provide
amounts of milk from the beginning, and         such a case the proper treatment of the            ature, normal breathing and normal heart         the parents with eye drops, a saline solu-
supplemental milk is often required to          mother takes priority. Sometimes, the baby         rate, express hunger, and suck, urinate and      tion for the stuffy nose and solution for
maintain the baby’s blood glucose at the        has an injury or defect (e.g. cleft palate) that   defecate normally. Also, by this time stuff-     cleaning the navel. Parents receive infor-
normal level. Glucose levels are also moni-     makes sucking difficult. The nurses will as-       iness of the nose, swelling around the eyes      mation on possible follow-up appoint-
tored when the baby is at a higher risk due     sist the parents in bottle-feeding expressed       and burping amniotic fluid will have clear-      ments and the postnatal ward’s contact in-
                                                breast milk or formula milk to the baby.           ly diminished. The baby will burp less milk      formation if the mother or baby encounter
                                                     Many hospitals have family suites de-         and gain weight following the dip after          problems during the first weeks.
     IN THE POSTNATAL WARD, THE MOTHER          signed to accommodate both parents.                birth. The paediatrician will have examined
     STAYS IN THE SAME ROOM AS THE BABY.        Family suites enable both parents to share         the baby earlier, if any problems were de-
                                                                                                                                                     When leaving the hospital, the parents
                                                the first days with the new baby, practice         tected. Both parents usually attend the
                                                baby care under the guidance of profes-            paediatrician’s examination.                      should feel secure and content and
to the mother’s diabetes or gestational dia-    sional midwives, and become familiar with               This examination usually includes as-        have confidence in their ability to take
betes, for example, since low glucose levels    the baby’s communication. When the fam-            sessing the baby’s skin colour, muscle tone,      care of the baby.
will have a negative effect on the baby’s       ily goes home, both parents know the baby          reflex irritability and sucking reflex. The
central nervous system. Supplemental milk       well, which will facilitate settling in. There     doctor will listen for sounds made by the             It should be remembered that families
is not a dairy product and is used only tem-    are several ways in which the father can           heart and lungs, press the baby’s abdomen        and their situations in life vary greatly.
porarily. Donated breast milk is given first    contribute to successful breastfeeding. By         and feel the baby’s pulse. The baby’s hips,      Some parents are experienced in caring for
to premature or low birth weight babies.        remaining calm and having complete faith           skull (fontanel), clavicles, eye fundus, pal-    babies, while for others this may be their
    Some babies have a strong sucking re-       in milk production, by caressing and pam-          ate, testicles (if the baby is a boy) and ex-    first contact with a baby. If the baby is in-
flex immediately after birth. However, it is    pering the mother and the baby, and by             ternal genital organs (if it’s a girl) are ex-   jured or suffers from a disease, it is impor-
not uncommon for the mother and baby to         changing nappies and offering a helping            amined. If the doctor needs a blood sam-         tant that both parents discuss the issue
need some help in learning the correct          hand the father can help the mother relax          ple from the baby, a mixture rich in sugar       with the doctor. This discussion can also
feeding technique. It is very important that    and not lose faith in breastfeeding. Staying       will be given to the baby for pain relief.       be scheduled to take place after the exam-
the mother and baby practice the correct        in a family suite is never compulsory and               Based on information provided by the        ination. The staff of the neonatal ward of-
breastfeeding technique while still at the      does not necessarily meet the needs of all         nurse, the doctor will consider the baby’s       ten includes a social worker who will
hospital. Mothers are entitled to receive all   families. Issues to be considered when             milk consumption, weight and skin colour         provide support and guidance when the
of the support and guidance they need for       making arrangements for baby care include          (yellow tint). Some of these symptoms are        family needs special attention (single par-
successful breastfeeding. Once breastfeed-      a possible operation or illness affecting the      merely signs of slow adaptation and will         ent families, a very young mother, the
ing begins to roll, the mother and baby can     mother, or the mother feeling very faint or        pass in the course of the first week. Howev-     family has considerable financial or other
be discharged. Milk production will con-        weak, or if the baby needs to be monitored.        er, they may necessitate keeping the baby in     problems etc.). The social worker will in-
tinue to increase during the following          Whatever the situation, the parent-child           hospital under surveillance for a few days       vestigate the social benefits and support
weeks. At this stage, the main considera-       relationship is encouraged early on.               longer than originally planned. A jaundiced      available to the family and become in-
tion is to ensure that the baby receives ad-         On the third day of birth, the baby will      baby’s skin will appear yellow and can be        volved in child welfare situations when
equate nutrition. The key to successful,        be examined by a paediatrician. At this            assessed by a simple fingertip test or by tak-   the family has problems involving drug
long-term breastfeeding lies in keeping         time it will be apparent how well the baby         ing a blood sample to measure the bilirubin      abuse, violence or mental health, for ex-
the baby alert while feeding.                   has adapted to living outside the womb,            level. Treatment includes phototherapy with      ample. In situations governed by the Child
    Breastfeeding soon after birth will cause   how breastfeeding is going, whether the            blue light and feeding the baby well.            Welfare Act, the social worker is often re-
the uterus to contract. This decreases bleed-   mother’s milk production is sufficient, and                                                         garded as a threat. However, the main ob-
ing and aids the recuperation from preg-        how well the parents can interpret the sig-        Leaving the hospital                             jective of social work is to support the
nancy and birth. Some medications (e.g.         nals the baby gives them. Already, at the          When the family is leaving the hospital          family in establishing safe routines guar-
drugs for hypertension and psychopharma-        age of three days, it is evident whether the       they will receive feeding and baby care in-      anteeing good care of the children. u

46    The birth                                                                                                                                                                     The birth   47
Recovering from delivery
                                                                                                       It is recommended that you defer sex         taining only progesterone and sterilisa-
                                                                                                   until the vaginal discharge ends and both        tion are safe while breastfeeding, because
                                                                                                   parents feel ready for it. However, there is     they have no effect on milk production or
                                                                                                   no need to refrain from showing affection!       the baby. If you opt for sterilisation, bear
                                                                                                   Both parents need love and attention, ca-        in mind that this is an irreversible opera-
                                                                                                   resses and cuddling; now maybe more              tion.
Puerperium - the first weeks after birth                                                           than ever as there is an extra person shar-           If you are not breastfeeding, you may
The period of time after delivery, during       weeks after delivery in the prenatal clinic.       ing the ”cuddling resources”. Having a           ovulate as soon as 30 days after delivery.
which your body recovers from the chang-        You will receive a certificate to this effect to   satisfactory sex life in your relationship is    In this case, you can start using contra-
es caused by pregnancy and childbirth and       be included in your parental allowance ap-         a shared responsibility – it takes two to        ceptive pills three weeks after the deliv-
returns to its normal pre-pregnancy condi-      plication.                                         tango!                                           ery or when you have your first period. It
tion, is called the puerperium. This usually                                                                                                        is not advisable to start using contracep-
takes 6 to 12 weeks. The uterus will return     Sex life and showing affection                      Note! Remember to use contraception             tive pills any earlier due to the elevated
to its normal size and may contract during      Once the baby is born, the parents will             when you start having sex. Even if you          risk of thrombosis.
feeding, particularly if the baby is not your   find that they have little time to spend            are breastfeeding it doesn’t mean you                The condom is a highly suitable meth-
first. Lochia is the bloody discharge after     alone with each other, especially if there          can’t immediately become pregnant               od of contraception after birth, protecting
birth. It is more abundant than your usual      are other children in the family. There will        again.                                          the uterus from infection. Using a lubricant
period and turns pale after two weeks. If       be a period when their sex life will have to                                                        during the first few months may help if the
the discharge smells bad, continues to be       be put on hold. The length of this period is                                                        vagina is tender and irritable. Polyurethane
bloody and doesn’t seem to diminish, you        for the parents to decide. The mother may          Contraception                                    condoms are sold at the chemist’s for peo-
may have an infection.                          have scars which make sexual intercourse           Think about contraception before having          ple allergic to natural rubber.
     Getting up soon after the delivery will    painful, and witnessing the birth of his ba-       sex for the first time after delivery, as ovu-        The copper IUD is an intrauterine de-
improve the circulation and promote bow-        by might have affected the father’s libido.        lation is possible before your first period.     vice that can be placed in the uterus im-
el movements and bladder activity. Sitting          The hormonal surge following delivery          Breastfeeding will normally postpone your        mediately after birth (10 to 30 minutes af-
down may be painful, if you have had an         may cause a decline in the mother’s libido,        periods, but is not in itself a reliable con-    ter the placenta is expelled). It is, however,
episiotomy. Showering the area with warm        but not in her need for love and affection.        traceptive.                                      recommended that the copper IUD be
water will help the stitches dissolve and       How soon you can expect to return to your               Breastfeeding will protect you against      placed during the postnatal medical exam-
the cut to heal. Wash and dry your intimate     usual sex life will depend on you and your         conception if less than six months have          ination to ensure it stays in place properly.
areas with special care. Take showers but       partner, and it is recommended that you            passed since the birth, your periods have        It can also be placed at a later stage, even if
avoid bathing. If you enjoy going to the        both share your thoughts with each other.          not yet started and your baby feeds at least     your periods have not yet started due to
sauna, you can go when you are feeling          There is, however, no reason why you               eight times a day at regular intervals and       breastfeeding. A pregnancy test will be
well enough.                                    should not have sex if you both want to.           does not receive supplementary nutrition.        performed before placing a copper IUD at
                                                After birth the woman may suffer from              The contraceptive effect of breastfeeding        a later stage. A copper IUD can be used for
Postnatal medical examination                   vaginal dryness for a long period. Dryness         diminishes rapidly if you feed your baby         five years.
Mothers remain clients of the prenatal          will make the vagina irritable and tender,         less than seven times a day. If you do not            Hormonal contraceptives containing
clinic until the postnatal medical examina-     especially when using a condom. Using              want to become pregnant, remember to             only progesterone include mini-pills, hor-
tion. During this examination, the doctor       the lubricant lotion delivered in the mater-       use contraception whenever you have sex.         mone implants placed under your skin,
checks that there are no ulcers in the cervix   nity package or some other lubricant               By the time the baby starts having supple-       hormone IUDs and progesterone injec-
and no signs of infection, since problems       (cooking oil, body lotion without a fra-           mental food, contraception is necessary to       tions. The advantage of a hormonal IUD
tend to be minor and almost without             grance or Vaseline) may prove helpful. Lu-         avoid becoming pregnant.                         is that its hormonal effect is local and only
symptoms at the beginning. A postnatal          bricants are also sold at the chemist’s and             Condoms, copper IUDs, pills and oth-        a small amount of hormone is released in-
medical examination is performed 5 to 12        in department stores.                              er types of hormonal contraceptive con-          to the circulation. The conventional com-

48   The birth                                                                                                                                                                       The birth   49
bined oral contraceptive pills (COCP) are a    milk production dwindles you will notice          mothers of young children, and many need        training and long walks are examples of
combination of oestrogen and progester-        how your breasts have lost some of their          support either from a professional or a         activities not recommended prior to the
one, which decreases milk production.          previous pertness. Stretch marks may be           peer group. If you are having weight prob-      postnatal examination.
     Chemical contraceptives, such as          visible on the abdomen, thighs and                lems, identify the options available in your        You will find a balanced exercise re-
foams, gels and sticks, may irritate the mu-   breasts.                                          community.                                      gime in this leaflet. Start by doing each ex-
cous membranes. If you have been using a           Women often tend to be overly critical                                                        ercise once or twice a day (following vagi-
pessary, you may need to refit it and use it   of the changes in their appearance and            Exercise helps in getting back into shape       nal delivery). Remember to breathe evenly
in combination with contraceptive gel.         might consider themselves far from the            It is best to rest and relax on the day after   and pause between exercises, if you feel
     Emergency contraception is also           current notion of beauty. Changes result-         delivery, but start getting back into shape     like doing so.
called post-coital contraception or the        ing from pregnancy and birth are visible          on the next day. Some health care centres           Abdomen: Contract your abdominal
morning-after pill. It stops you from be-      signs of being a mother and should be car-        and maternity units organise postnatal ex-      muscles and press the small of your back
coming pregnant if contraception failed or     ried with pride. When you are a mother,           ercise for groups, but you can also exercise    against the floor. Hold this position for a
wasn’t used. You can buy these pills from      you have the right to look as if you have         daily at home. Ask for exercise instructions    while, and relax.
the chemist’s without a prescription. The      given birth.                                      from the hospital or from your prenatal             Buttocks and sides: Lay on your side.
pills are taken as a single dose, preferably       Some women are able to return to              clinic. Exercise will make your muscles         Lift your topmost leg up, heel first. Keep
within 12 hours, but no later than 72          their pre-pregnancy shape quickly, and not        firm, improve your posture and lift your        your body straight.
hours, from having unprotected sex. When       all women carry the signs of pregnancy            spirits. It also eases back and shoulder
taken within the recommended time              and delivery. But most importantly, be easy       pains and improves continence.
frame, this method is 98 percent effective.    on your body shape. The well-being of the              If you have had a caesarean section, be
You can continue breastfeeding after tak-      mother and child is far more important            sure to begin exercising slowly while pay-
ing the emergency contraceptive. Emer-         than your physical appearance. On the             ing close attention to your body. Fitness
gency contraceptives contain progesterone      other hand, spending a little time pamper-
which has no known effect on the baby.         ing and caring for yourself will be a wel-
However, if you want to be on the safe         come change and help you cope with your
side, express milk from your breasts and       baby with renewed energy.
throw it away for 1 to 2 days before breast-
feeding again. As the name ”emergency          Weight control
contraceptive” implies, these pills are in-    About 50% of women gain excessive
tended for occasional use, not as a regular    weight during pregnancy. This excessive
form of contraception.                         weight gain is not easily lost after the birth,
     A copper IUD can also be used as          demanding persistence and hard work. Di-
post-coital contraception, if it is placed     eting during pregnancy, immediately after
within five days of unprotected sex. A cop-    birth or while breastfeeding is not recom-        Pakara- ja                                                                     Vatsalihakset
per IUD is more effective than pills and       mended.
provides optimum contraception when left            Instead, it is advisable for everyone to
in place.                                      maintain a healthy diet and exercise regu-
                                               larly. These are also the cornerstones of
Changes in shape                               lasting weight control. Results are seen
Pregnancy and birth will inevitably change     only gradually, but are the more rewarding
the shape of the mother’s body. After birth    for this. In addition, breastfeeding pro-
the skin around the abdomen is stretched       motes weight control. Finding time,
and the breasts are bursting with milk. As     strength and motivation are a challenge to

50   The birth                                                                                                                                                                   The birth   51
    Abdomen and thighs: Press the small       have had a multiple pregnancy, or your        every now and then is worthwhile be-                  Strength exercises: Imagine a white
of your back against a wall and contract      second stage of labour was lengthy. Being     cause strong muscles are always an ad-            ball at the entrance to the vagina. Haul the
your abdominal muscles. Bend your knees       overweight and smoking additionally bur-      vantage.                                          imaginary ball as fast and as far as possi-
and stay in this position for a while.        den the pelvic floor muscles. If you suffer        If you did not feel a squeeze, suffer        ble inside the vagina and hold it there
Straighten your knees and relax.              from varicose veins or piles, your muscles    from incontinence (you have difficulties          while counting to five. Slowly release the
    Pelvic floor muscles: Press your an-      may be predisposed to slackening. And if      controlling your bladder) or if your sensa-       ball. Relax, counting to ten. Repeat three
kles, knees, thighs and buttocks firmly to-   you engage in a form of sport involving       tions seem weak during sexual inter-              times. Gradually increase the number of
gether. Hold this position for a while, and   jumping, the slackened pelvic floor mus-      course, make an appointment to see your           repetitions.
relax.                                        cles may give in and cause incontinence.      gynaecologist.
                                                  You can begin exercising your pelvic           If you are having difficulties identifying   Endurance exercises
Pelvic floor muscles                          floor muscles on the day following the        the correct muscles, tighten and relax your       Imagine a white ball at the entrance to the
Your pelvic floor muscles will be severely    birth.                                        tummy, thigh and buttock muscles a few            vagina. Pull the ball as slowly and as far as
strained if you have given birth to several       First perform a finger test: wash your    times and then try again. It will help if you     possible inside the vagina. Contract your
children, your babies have been large, you    hands and rub your index and middle fin-      insert a couple of fingers into your vagina       muscles and hold the ball inside. Hold
                                              gers with a non-irritating lubricant (e.g.    while you are trying to identify the correct
                                              cooking oil). Press your fingers together     muscles. Try different positions; sitting, ly-
                                              and gently push them 3 to 5 cm into your      ing on your side, tummy and back, and                 SPENDING A LITTLE TIME CARING FOR
                                              vagina. Relax for a moment, and then          squatting. After you have found the mus-              YOURSELF WILL BE A WELCOME CHANGE..
                                              squeeze your fingers with your vagina.        cles and can do the exercise without using
                                              Relax. Remove and wash your fingers. If       your fingers, you can perform these exer-
                                              you felt an upward and inward contrac-        cises without anyone noticing.                    your urine and clench your anus while
                                              tion, your pelvic floor muscles are strong.        Identification exercises: Clench your        counting to five. Slowly release the ball
                                              Nevertheless, exercising your muscles         anus, while gently squeezing your mus-            and relax, counting to ten. Repeat three
                                                                                            cles and counting to five. Then slowly re-        times. Gradually increase the number of
                                                                                            lax the muscles, while counting to ten. Re-       repetitions.
                   Vatsa- ja                                                                peat three times. Clench your anus and at              Perform these exercises five times a day
                   reisilihakset                                                            the same time clench your vagina and              as part of your daily routine, on your way to
                                                                                            hold your urine while counting to five (the       work, during coffee breaks, while cleaning
                                                                                            contraction will proceed like a wave from         or queuing in a shop. Remember to take
                                                                                            back to middle to front) and relax while          one day of rest each week. Perform one
                                                                                            counting to ten (front-middle-back). Re-          type of exercise at a time, otherwise you
                                                                                            peat three times.                                 will tire. If you feel you are not making
                                                                                                 Speed exercises: You need quick pelvic       progress, consult an expert. Many health
                                                                                            muscle reflexes when you cough or sneeze          care centres and private medical centres
                                                                                            and to hold your urine. Exercise your re-         have equipment and medical staff trained
                                                                                            flexes by making brisk contractions in a se-      to diagnose and treat dysfunctions of the
                                                                                            ries. Start by doing this ten times. Gradual-     pelvic muscles. You can also buy exercise
                                                                                            ly increase the number of repetitions.            kits with instructions. u
                                                                 Lantionpohjan lihakset

52   The birth                                                                                                                                                                The birth   53
First month
                                                                                                 parents; their methods may be different         symptoms can last for several months. If
                                                                                                 but equally correct - there is no need for      the depression is not severe, the symptoms
                                                                                                 the mother to act as an interpreter be-         may go unnoticed or the mother may be
                                                                                                 tween the baby and the father. This will al-    ashamed and try to hide them. However,
                                                                                                 so be beneficial to the future father-child     you should seize the opportunity to talk
The most important person for the baby is                                                        relationship.                                   about your feelings with the clinic’s nurse
the person caring for him. Without that                                                              The baby demands around-the-clock           or your doctor. If untreated, postnatal de-
person, the baby cannot survive. The baby                                                        attention which can leave both parents ex-      pression can develop into long-term severe
makes eye contact with its carer, simulta-                                                       hausted. When either of the parents is at       depression. In addition to caring for the
neously pleading and demanding care and                                                          the end of his or her tether, the other         mother, treatment is also vitally important
attention. This gives the carer a sense of                                                       should take over. Going outside for a walk,     to securing the well-being of the baby.
self-esteem and confidence, yet the re-                                                          taking a long shower or reading the paper           Some health care centres organise
sponsibility may at the same time feel                                                           while enjoying a cup of coffee can work         meetings where mothers receive peer sup-
overwhelming, even frightening.                                                                  miracles. Another tip is to swap roles so       port and encouragement from mothers in
                                                                                                 that the parent usually in control plays the    the same situation (See also ”ÄIMÄ - the
Motherly and fatherly love                                                                       part of assistant. Caring for the baby to-      Association for mothers suffering from de-
For most parents, their baby is the most        pointment and jealousy. Learn to accept all      gether strengthens the relationship be-         pression” on page 96).
wonderful thing in the world. However, it       of the feelings you and your partner may         tween the parents as they share the love            When the mother is depressed, the fa-
is not always a case of love at first sight.    experience. Give yourself time to adjust.You     and joy the baby brings.                        ther’s role becomes even more important.
Giving birth to a baby is exhausting and        have an entire lifetime to love your child.                                                      On the other hand, fathers may also have
looking after the baby takes all of your                                                         Maternal depression                             problems after the birth. Prenatal and
spare energy. Since the mother is absorbed      Both parents participate                         Postnatal hormonal activity may cause           child health clinics offer support for both
in breastfeeding, the father may feel reject-   In our culture, both the mother and the fa-      emotional instability and mood swings.          parents.
ed and left out. Having a baby may also be      ther are responsible for taking care of their    The mother may feel depressed and weepy,
totally different to what the parents had       children. Looking after the newborn is a         although everything seems to be going           Being a single parent
anticipated. A little individual enters the     rich, fulfilling experience for both parents.    well. This is quite natural. Four out of five   Divorce, the death of a partner or being
parents’ life, changing everything, making      The baby may evoke powerful emotions             mothers suffer from ”baby blues”, a mild        left alone in some other way can make
its demands known with loud authority.          that can take the parents by surprise. Being     case of postnatal depression which starts 3     parenting a heavy burden. If you are the
This noisy little person may be a source of     indispensable to another human being             to 5 days after birth and lasts for a few       sole parent, do not make unreasonable de-
confusion and even irritation, one’s feel-      makes the parent view his or her life from       weeks. Symptoms include being tearful           mands on yourself - don’t expect to make
ings towards the demanding little bundle        a new perspective and often inspires him         and irritable, mood swings, and sometimes       up for two parents. Accept help from your
may not always be entirely warm.                or her to see the world differently. This        also loss of appetite and sleeping prob-        family, relatives and friends, and take ad-
    Becoming acquainted with your new           provides a new source of energy for coping       lems. This condition does not require med-      vantage of family workers and the profes-
family member may be a slow process, but        with daily demands.                              ical treatment. Support and compassion          sionals at the child health clinic.
eventually you will become attached to              Apart from breastfeeding, there is           from family and friends is enough. Talking           Sometimes a baby is born into a single
your child. Love develops gradually while       nothing the father cannot learn to do just       about the situation with your partner or a      parent family. In single parent families, it is
caring for your baby.                           as well as the mother. At first, parents take    trusted friend usually helps, and the baby      advisable that a close friend, or the baby’s
    Parents vary in the way they take to        care of the baby together. Later on, it is im-   blues pass as the mother’s general condi-       grandmother or godparent, be invited as a
new things. Experiencing extreme emo-           portant that they take turns. This will give     tion improves due to sufficient sleep and       ”trusted adult” who will learn to know the
tional fluctuations is quite normal. Sudden-    one parent the opportunity to relax while        healthy nutrition.                              child from infancy. A good relationship be-
ly amidst love, affection and joy, you may      the other is having some private time with           Approximately one in 5 women suffer         tween the baby and the trusted adult will
be stuck by exhaustion, concern, disap-         the baby. The baby will get used to both         from postnatal depression (PND). The            lower the threshold for getting help, if the

54   Baby care                                                                                                                                                                    Baby care   55
need arises later on. Being a single parent       ments of joy - it will not be the cause of       The parents nourish, nurture and protect        nappies, bathing and feeding, and it will
is not uncommon and there are peer                any disappointments tomorrow. A sick ba-         the baby. They comfort the baby with soft       feel wanted and safe. This will provide a
groups which can offer invaluable support         by needs the love and attention of the en-       touches, gentle smiles and soft voices. And     sound basis for future development.
(see ”Support Networks” on page 78 and            tire family even more than a healthy baby        the baby responds with eye contact, facial
”Organisations” on page 94).                      would. Becoming attached to your baby            expressions and movements.                      A place for changing
                                                  will not cause you to lose it; and trying             Early interaction refers to reciprocal     It is possible to change nappies whilst
Visitors                                          hard not to become attached will not save        and synchronic interaction between the          holding your baby in your lap, but in many
Friends and relatives will be eager to come       you from the consequent pain.                    parent and the child. Early interaction con-    cases a proper changing mat or changing
for a visit to meet the new baby. However, if          The hospital staff, prenatal and child      tributes to the baby’s sense of security,       top is very convenient. Make sure the
your visitors are suffering from a cold or        health clinics, social workers and organisa-     happiness and capabilities, supporting the      changing top has edges that prevent the
other illness, do not let them near the baby.     tions for the disabled and their parents offer   baby’s development in several ways. It is       baby from falling. Ideally, the top should
If you feel too tired to entertain, you can ask   information and support in coping with this      important to the baby that an adult is able     be placed at a height where there is no
the visitors to come at a later date or agree     kind of situation. Many hospitals will also      to identify, share and name the feelings of     need to bend, because the mother’s back
on a very short visit. You can also tell your     know the contact details of support families     joy, fear, anxiety and hurt the baby is expe-   in particular will be sensitive to strain dur-
visitors that you will not be offering tea or     who have been in the same situation and          riencing. Eye contact, physical contact and     ing the first weeks after delivery.
coffee. If the visitors want to have a little     will be able to comfort and encourage the        speech are all important to the baby. When          Arrange the changing corner close to
something, they can bring it themselves.          parents. (See ”Services for chronically ill or   this interaction functions well, the parent     the baby’s cot or near the bathing area. You
                                                  disabled children” on page 92.)                  will be able to enjoy his or her relationship   can place the changing mat on a regular
If there is a problem                                                                              with the child and the child will feel secure   table or on a changing top. The changing
Having a disabled or ill baby is an unex-         Early interaction                                in the knowledge that the parent under-         gear can also be in the bathroom, where
pected, painful reality parents can never be      No other human relationship is quite as          stands and accepts its feelings and needs.      you can place the changing top on top of
fully prepared for. Nevertheless, even if dif-    intimate and positive as the relationship             A baby never accuses its carer, never      the washing machine or over the bath tub.
ferent, the baby is your own and in these         between a baby and the person caring for         criticises and never makes comparisons. A       Attach pads on the underside of the top to
situations parents often discover strength        it. From the moment of birth, the baby           baby needs looking after and will always        prevent it from sliding. The bathroom is an
they never believed they possessed.               seeks to interact with those around him.         accept and become attached to the person        optimal place, since water is close to hand
     Feelings of bitterness, anger, disap-                                                         caring for it. From the very first week, the    and getting wet is not a problem.
pointment and guilt are quite common                                                               baby will want to be where the family is.           However, the most important thing is
and sometimes your anger may be direct-                                                            Do not leave the baby in its cot. Holding,      to have all the changing gear within reach,
ed at your partner or the personnel.                                                               caressing and cuddling the baby will not        because you cannot leave the baby unat-
Good days are not enjoyed for fear of                                                              spoil it. Touching the baby will help it grow   tended while fetching something from an-
disappointments. Parents may strug-                                                                accustomed to its own body and learn to         other room. The changing area does not
gle against becoming attached to                                                                   control it. Some clinics will teach you how     need to be heated, normal room tempera-
the child in the hope that                                                                         to give a gentle baby massage.                  ture is sufficient (20 - 22°C).
should the baby not survive                                                                             Start talking to your baby during the
the loss would somehow be                                                                          pregnancy. Although it will not be able to      Crying and comforting
easier to bear.                                                                                    understand you words for some months, it        Crying is the way babies express them-
Allow yourself                                                                                     will understand your tone of voice. A soft,     selves. By crying, the baby may communi-
to love your                                                                                       calm voice creates a sense of security and      cate hunger, a wish to see familiar faces, a
sick baby just                                                                                     hearing people talk will help the baby          wet diaper or some other discomfort. Par-
as you would                                                                                       learn how to speak. The way you handle          ents will gradually learn to interpret the
a healthy one.                                                                                     your baby is extremely important. Smile at      movements and sounds the baby makes.
Savour the mo-                                                                                     your baby and talk to it while changing         Healthy babies cry during the initial

56   Baby care                                                                                                                                                                     Baby care   57
months. Babies start to cry more frequent-       to the stomach). If colicky crying has been      appointment to give the baby suitable               in the house. When the moment has
ly at the age of two weeks, peaking at           interpreted as hunger, this has caused a         medication that brings the temperature              passed, talk to your baby to let her
around 1.5 months and gradually decreas-         cycle of over-feeding. Try prolonging the        down. Take your baby to the doctor, if she          know that it was only temporary and
ing after that. This period is called the col-   time between feeds using a dummy, taking         is under 2 months old and has a fever,              that now you are back to being your fa-
ic period. It is sometimes called the three      the baby outside in the pram or carrying it      even when other members of the family               miliar self. Don’t feel angry with your-
month colic as it is usually over by the time    in a baby carrier.                               also have a fever.                                  self; everybody loses their temper at
your baby is 4 months old.                                                                            Night-time crying is usually the hard-          some point. Rather concentrate on how
    When a baby cries long and hard for                                                           est to bear and often makes the parents             to cope in the future and how to secure
several hours a day, each day of the week,           BABIES CRY EVEN WHEN THEY ARE                feel helpless and worried. Babies cry even          enough sleep for yourself. Discuss this
the baby is said to be ”colicky”. Despite            BEING WELL CARED FOR.                        when they are being well cared for. Parents         with your child health clinic’s nurse.
the long and hard crying, colicky babies are                                                      of colicky babies should not accuse them-
usually healthy babies growing and devel-                                                         selves of being bad or inexperienced par-        Never shake your baby!
oping normally. Colic crying is mostly dis-           Help your baby to burp after feeding.       ents. Sometimes, the crying may seem             Never shake or manhandle your baby, no
content whining and there are pauses.            Some babies swallow a lot of air while           never-ending and nothing seems to com-           matter how upset or tired you may be.
Constant crying or screaming starts sud-         feeding, resulting in wind and regurgita-        fort the baby. Nevertheless, stay close to       Shaking the baby is life threatening, be-
denly without any apparent reason. De-           tion. The frequency of bowel movements           the baby while it is not well. It is important   cause a baby’s head is large and heavy
spite the long crying periods, colicky ba-       varies individually. However, if you do not      to identify solutions that will help every-      compared to the rest of its body and its
bies do get enough sleep. Breastfed babies       find stools in your baby’s nappies every         one cope during this trying period. Once         neck muscles are not fully developed.
are as likely to become colicky as babies        other day and it is crying a lot, contact your   the colic period is over, things will calm       When a baby is vigorously shaken, the
receiving formula milk. Although colic and       child health clinic nurse. Increased regurgi-    down and taking care of the baby will be-        head moves rapidly back and forth with
adding supplemental vitamin D to the ba-         tation requires medical attention, especially    come even more enjoyable.                        great force. This sudden motion can cause
by’s nutrition may coincide, giving your         if your baby is not gaining weight properly.                                                      bleeding inside the brain and behind the
baby vitamin D supplement is not the             It may be a case of reflux, where milk flows     Comforting a crying baby                         eyes. Immediately after being shaken, the
cause of the colic.                              back into the tube that connects the mouth       u Carrying your baby close, making hush-         baby may be sleepy, have trouble feeding
    Crying usually signals hunger or dis-        to the stomach (also called GER, Gastro Es-        ing sounds, giving a gentle massage and        and difficulty in breathing, or lose con-
comfort, but sometimes there may be rea-         ophageal Reflux) or pyloric stenosis.              soft purring sounds are comforting. Tak-       sciousness. The long term consequences of
son to investigate the matter further. Hun-           A rash may be the reason for crying,          ing your baby into a quieter room and          shaking a baby, such as total or partial
ger is a common reason for crying. Visit the     especially in allergic families. Child health      swaddling her in a blanket may also be         blindness, learning difficulties and epilep-
child health clinic to weigh your baby and       clinics provide skin care information. Milk        soothing.                                      tic seizures, can be severe and permanent.
compare your baby’s growth to the clinic’s       allergy is a rare condition that causes skin     u Try to stay calm while your baby is cry-            Never let the situation reach the point
reference charts together with the nurse. If     rash. If milk allergy is suspected, treat the      ing. If you find you can’t stand the cry-      where you feel desperate. It is not a weak-
your baby seems to be growing slowly, try        rash and feed your baby special formula            ing any more, let your partner or some         ness to admit that you are exhausted and
giving supplemental milk and see how it          milk according to your doctor’s instruc-           other trusted adult look after the baby        need help; seeking help is the mature, re-
affects your baby. The amount of breast          tions. When the rash is better, the allergy        for a while. Go out for a walk, for exam-      sponsible thing to do. If you feel at the
milk intake can be estimated at the child        can be confirmed with a challenge test. Ba-        ple, and then give your partner a chance       end of your tether, contact your child
health clinic via test weighing (weighing        bies allergic to dairy products may have ei-       to rest.                                       health clinic’s nurse or the family workers
the baby before and after feeding). If the       ther skin or bowel reactions.                    u Caring for a crying baby is very trying.       in your municipality for help. Other sourc-
weight gain is excessive in relation to the           Consult your doctor, if your baby has         Take turns and ask friends and relatives       es of help include organisations and hel-
baby’s height, the reason for crying may be      sudden or exceptional crying fits accompa-         for help.                                      plines, such as the Family Federation’s
too much feeding. Too much feeding               nied by a fever, cough or respiratory symp-      u Don’t get upset with your baby. If you         Family Network (see ”Contact details” on
causes tummy ache and reflux (milk flows         toms. If your baby is running a tempera-           feel you’re going to lose your temper          page 96). If your baby has been shaken,
back into the tube that connects the mouth       ture, you do not need to wait for a doctor’s       with your baby, take time out elsewhere        take it to the doctor immediately! u

58   Baby care                                                                                                                                                                    Baby care   59
                                                                                                milk flow. Supporting your head and                 Expressing (i.e. milking your breasts) is
                                                                                                shoulders with pillows during breastfeed-      not usually necessary but sometimes it
                                                                                                ing might help.                                helps to empty your breast if it is too ten-
                                                                                                     Start each feed with a different breast   der for feeding or is still packed tight after
                                                                                                first. You can press your breast to have a     your baby has finished. You should never
Breast milk provides the optimal nutrition                                                      few drops of milk ready. Offer your nipple     throw breast milk away. If you produce
for your baby. Except for vitamin D, breast                                                     to the baby so that it goes far back, touch-   more milk than your baby needs, you can
milk supplies all the nutrients a healthy                                                       ing the roof of its mouth. Do not force the    express and freeze your breast milk for lat-
baby with a normal birth weight needs                                                           baby against your breast by pushing it         er use or donate it to your hospital’s milk
during the first six months. Exclusive                                                          from the cheeks or head. If your baby          bank. It is also possible that your clinic’s
breastfeeding means that the infant needs                                                       seems hungry after feeding on the first        nurse knows someone needing breast
no supplemental nutrition (except for sup-                                                      breast, offer the second. However, before      milk. Make sure that the breast milk you
plemental vitamin D) and ensures that nu-                                                       changing breasts make sure the first one is    donate is clean.
trients are absorbed as well as possible and                                                    fully discharged and that the baby has re-          Sore or cracked nipples make breast-
the baby is protected against diseases. This                                                    ceived the nutritious hind-milk. At the be-    feeding very painful. Using nipple shields
feeding method has a positive long-term                                                         ginning, the baby will easily fall asleep      may ease the pain. Nipple shields are sold
impact on the baby’s health.                                                                    while feeding. You can carefully try to        at the chemist’s and in department stores.
      Nearly all mothers can produce breast                                                     awaken him or her in order to finish the       If your breasts become red and tender and
milk. In the beginning, the milk supply is                                                      feed.                                          you have a fever, you may have a breast
small but usually sufficient for the baby. In                                                        Milk may often seep from your breasts,    infection. Despite the infection, you can
most cases, the size or shape of your                                                           even when you are not breastfeeding, es-       continue breastfeeding. Contact your child
breasts does not have any impact on milk                                                        pecially during the first weeks. Seepage       health clinic or hospital maternity unit
production. Successful breastfeeding re-                                                        may also occur from the other breast while     and follow their treatment instructions.
quires some learning and practising the          duced. Oxytocin is a hormone that causes       the baby is feeding. Use breast pads in
correct technique. Information and guid-         the milk to trickle down the milk ducts.       your bras to absorb milk which has seeped      Take care of your liquid intake
ance provided in problem situations will         This is called the let-down or milk ejection   out. If you want to collect seeping milk,      While breastfeeding you need to drink
help the mother to get started. If you are       reflex. Let-down often occurs when you         place a milk collector inside your bra over    more than you are perhaps used to. Water,
unable to breastfeed for whatever reason,        think about your baby, are watching your       the nipple. Milk collected during the day      diluted juice and drinks with artificial
it is advisable to start giving your baby for-   baby or hear your baby cry. Exclusive          may be refrigerated in a separate dish and     sweeteners (aspartame and acesulfame)
mula milk and secure the baby’s nourish-         breastfeeding and letting your baby set        combined into a plastic bag to be frozen.      are suitable alternatives during breast-
ment in this way, rather than fretting and       the pace of feeding will ensure that the       Breast milk can be stored in the freezer for   feeding. Drinks sweetened with sugar are
worrying over breastfeeding.                     quantity of produced milk increases dur-       several months.                                bad for your teeth, especially if consumed
                                                 ing the first couple of days after birth to                                                   several times during a day. Such drinks are
Breast milk production                           meet your baby’s needs. Once milk pro-         Take good care of your breasts                 an unnecessary calorie supply and tend to
The breast prepares for breastfeeding dur-       duction has started, it will not stop sud-     When your baby has finished, squeeze a         raise your blood sugar levels.
ing pregnancy. Milk production is initiated      denly.                                         drop of milk over your nipple and leave it
by delivery and maintained by frequent                                                          to dry. This will protect your nipple better    Do not smoke while you are
breastfeeding. A hormone called prolac-          Technique                                      than any lotion. Keeping your breasts           breastfeeding!
tine causes milk production in the breast,       Breastfeeding can be done in several posi-     clean is important. However, it is not nec-     Both parents should give up smoking
the baby’s suckling stimulating the release      tions. Try different positions to find the     essary to wash them before and after eve-       while pregnant and breastfeeding, if
of such hormones, so that the more often         ones most comfortable for you and your         ry feed. Excessive washing will erode the       not for good.
you feed your baby the more milk is pro-         baby. Being relaxed will contribute to the     skin’s own protective agents.

60   Baby care                                                                                                                                                                 Baby care   61
     Nicotine reduces the secretion of hor-      package at room temperature until the ex-        any wind. Burping may be facilitated by         your nipples are getting sore, carefully re-
mones (prolactin) needed to produce milk,        piry date. An opened package can be              softly patting the baby’s bottom, and is        move the nipple and replace it with a
which may lead to a decrease in your milk        stored in the fridge (+2°C to 5°C); its con-     performed equally well by both parents.         dummy. Remove the dummy after the ba-
supply. Nicotine levels in breast milk are       tents must be used within 24 hours. Warm         Burping will radically decrease tummy           by falls asleep. In some special cases, such
three-fold compared to blood nicotine lev-       formula by standing the bottle (or cup) in a     trouble. If the baby has gobbled his food       as preterm babies and babies with a cleft
els. Furthermore, the presence of nicotine       bowl of warm water, running the bottle (or       down and swallowed a lot of air, it may
in breast milk causes restlessness and met-      cup) under warm tap water or carefully in        bring up some of the milk. If your baby has
abolic problems, disrupts the baby’s sleep-      a microwave oven. To distribute the heat         a tendency to regurgitate, try burping it in        NOT ALL BABIES WILL EVER NEED
ing patterns and makes the baby cry. If you      evenly, stir the formula milk after warming      the middle of feeding to expel the air from         OR WANT A DUMMY.
are unable to quit smoking completely,           it. Test a drop of heated formula on your        its tummy. Once it is started on solid foods,
avoid smoking 2 to 3 hours before and            wrist to make sure the milk is not too hot.      this will happen less frequently.
during a feed. The same safety period of 2            Powdered formulas are not sterile.                                                          palate or lip, dummies are used to encour-
to 3 hours also applies, if you are using        Therefore, it is important that you follow       Soothers, dummies, pacifiers                    age sucking and to learn the correct feed-
nicotine gum or other nicotine replace-          these instructions:                              Babies explore the world though their           ing technique.
ments. Never expose your baby to cigarette       u Run cold tap water into a clean pot and        mouths by sucking on everything they can               Foreign micro-organisms easily
smoke. Babies exposed to cigarette smoke            let it boil. (After you have started giving   reach. The mouth is the baby’s most                     cause diarrhoea so remember to
have recurring respiratory problems, a              your baby supplemental foods, there is        sensitive body part. Fingers will                            keep dummies as clean as bot-
cough and a much higher risk of develop-            no need to boil the water if your tap         slip easily into the mouth. When                                tles and bottle-feeding teats.
ing asthma.                                         water quality is good.)                       the sucking instinct is strong, it                                 Never suck a dummy
     For more information on breastfeed-                                                          is better for the baby to suck on                                   clean in your own mouth.
                                                 u Let the water cool.
ing, breast milk and weaning, see the ma-                                                         a pacifier than on a finger, be-                                    Otherwise, the micro-or-
ternity package’s breastfeeding leaflet. For     u Add powder and mix with water. Care-           cause the skin on the fingers                                        ganisms in your mouth
further help and support in breastfeeding,          fully follow the instructions on the          may become chapped due to                                            will be passed on to
contact the national Breastfeeding Support          package.                                      energetic sucking and break-                                         your baby. For the same
Line (tel. 041-528 5582) or search the In-       u Always prepare the quantity needed for         ing the habit is easier with                                         reason, take care other
ternet (visit www.imetys.fi).                       one feeding; never prepare large quan-        dummies. Not all babies                                              children do not share
                                                    tities of formula milk in advance.            will ever need or want a                                            your baby’s dummy. Ster-
Formula milk                                                                                      dummy.                                                               ilise bottles, teats and
If you stop breastfeeding before your baby       Water                                                 It may be wise to wait                                           dummies in boiling wa-
is one year old, start using industrially pre-   Run your tap on COLD for a while before          until you feel breastfeeding is                                      ter until your baby is six
pared infant formulas. There are powdered        taking water for the baby’s food or to give      well established and your ba-                                         months old. After-
and ready-to-use liquid formulas; follow         as a drink. Always use cold tap water;           by has adopted a good tech-                                            wards, washing with
the instructions on the package carefully.       warm or hot tap water may contain micro-         nique before trying a dummy.                                            warm water is suffi-
     For the safety of the child, formula        organisms and other contaminants. There          Rather than automatically                                               cient. Make sure the
milk should never be warmed and stored           is no need to give your baby juice or water      offering the dummy, wait for                                           hole of the bottle-teat
in a thermos flask or prepared in advance        sweetened with sugar; such drinks will on-       your baby to be fussy or dis-                                        is not too large or your
for night-time feeds. Warm the formula to        ly harm the budding teeth and accustom           contented and in need of                                           baby is liable to suck ex-
body temperature (approximately 37°C).           the baby to sweets.                              soothing. Once the baby has                                       cess air which in turn will
Taste the formula milk before giving it to                                                        fallen asleep, take the                                            cause tummy trouble. The
the baby. Discard any left-over formula.         Burping and regurgitating                        dummy gently away. If                                               hole size is correct when
     Ready-to-use liquid formula can be          When the baby has finished feeding, lift         your baby is sucking hard                                           the milk flows out in
stored in its original unopened and intact       him up against your shoulder to bring up         even after feeding and                                              drops. u

62   Baby care                                                                                                                                                                     Baby care   63
Baby urine and stools                                                                        Nappy changing
Babies have an active metabolism and may       absorbing insert. There are one-piece nap-    Change your baby’s nappy about as often               Bathing is recommended every 2 to 5
wet their nappies a dozen times a day. The     pies, pocket models and nappies where         as you feed him - newborn babies wet             days. More frequent bathing will dry the
frequency of bowel movements varies in-        each layer is separate. The cotton squares    their nappies frequently. Rinse your baby’s      baby’s skin. Soap is not necessary since it
dividually. Some babies have bowel move-       in the maternity package are suitable for a   bottom with warm water (soap is seldom           will only remove the baby’s natural oils
ments several times a day while others on-     newborn. Change the cloth insert fre-         needed). Carefully dry your baby’s bottom.       and cause the skin to dry. If your baby has
ly a few times per week. For the first cou-    quently, otherwise your baby might feel       Apply a barrier cream after washing. Use a       very dry skin, add a drop of oil to the bath
ple of days after the birth, your baby will    uncomfortably wet. To make the nappies        basic lotion. Do not rub it in forcefully, but   water. Do not use bathing salts. Never
pass a sticky, greeny-black substance called   leak proof, you need to fasten them prop-     pat it gently onto your baby’s skin.             bathe a sick child, a quick wash will be suf-
meconium. After a short while the stools       erly. Fibre cloth inserts transfer moisture        Washing is not required during each         ficient.
will turn brownish or yellow.                  into the absorbing portion of the nappy       nappy change. Change nappies as soon as               If the baby’s nappy was dirty, wash its
    Normal stools smell sour but not un-       and stools wash off these more easily than    you can to protect your baby’s skin from         bottom before bathing. Wash the new-
pleasant. Often the stools of breastfed ba-    from cloth. The outer part of the nappy       the irritating effect of urine and stools. If    born’s face separately with a cotton pad
bies are greenish and runny. This is not a     does not need frequent washing, only the      your baby has very sensitive skin, change        and lukewarm water. Wash the eyes from
symptom of diarrhoea. If your baby has di-     absorbent inserts must be washed after        nappies frequently and apply barrier             the outer side towards the inner corner
arrhoea, the stools will have a terrible       each use. Woollen nappies are particularly    cream upon each change. Should your              and clean the baby’s ears (from the out-
smell and be completely absorbed into the      warm and breathable. When opting to use       baby’s bottom become red or sore when            side). Do not dig into the ear canal or nos-
nappy, leaving a green stain.                  reusable nappies, you will need at least 20   you have been using reusable nappies, try        trils as they are very sensitive and are usu-
                                               inserts and a couple of nappies per size.     using disposable nappies for a while. Also,      ally cleaned naturally.
Nappies                                            For more information, please refer to     be sure to rinse the reusable nappies very            At first the bathing time will be very
Disposable nappies are very convenient to      the nappy guide in the maternity package or   carefully.                                       short, but after a couple of week babies
use, but expensive over the two or three       the Internet (www.kestovaippayhdistys.fi).         Let the baby be without a nappy every       usually start to enjoy bathing and are hap-
years that your child is in them. Slow to                                                    now and then as constant dampness only           py to take longer baths. Often babies find
decompose, disposable nappies burden                                                         irritates the skin more. Let him or her have     bathing very soothing. Bathe your baby us-
the environment. The advantages of dis-                                                      a good kick without a nappy in a warm            ing calm, confident movements. Avoid
posable nappies include very good ab-                                                        place. If your baby’s skin has spots or the      sudden movements which will alarm the
sorbance, leaving the baby’s skin dry                                                        skin is broken, sprinkle baby powder or          baby. Take care the baby does not swallow
and thus preventing the risk of nap-                                                         potato flour over the area. For further in-      any bath water. There may be times when
py rash. If your baby has sensi-                                                             structions, contact your child health clinic.    your baby will refuse to bathe. Do not force
tive skin or severe nappy rash,                                                                                                               bathing. You can take a break and wash the
disposable nappies will facili-                                                              Bathing                                          baby using other methods.
tate skin care.                                                                              Your baby will need a bath tub that is not            Make sure your hands are warm. Take
    There is a large vari-                                                                   used for any other purpose. This will help       off your watch, rings and bracelets to avoid
ety of reusable nappies.                                                                     to prevent skin complaints, for example.         scratching your baby. Place the baby’s
Inside reusable nappies                                                                      Bath water should be at body temperature         clothes somewhere warm, on a radiator,
there is usually a layer of                                                                  (37°C). Check the temperature using a            for example. Warm the bath towel either
surface-dry cloth and an                                                                     thermometer.                                     on a radiator or by tying it around your

64   Baby care                                                                                                                                                               Baby care   65
                                                                                               other creases. If your baby’s skin is smooth    child’s hand as you trim its nails. If your
                                                                                               and does not seem dry, there is no need for     baby is restless or fussy, wait for a better
                                                                                               body lotion. If the skin is dry or red and      moment.
                                                                                               chapped, apply a thin layer of baby barrier
                                                                                               cream.                                          Sauna
                                                                                                                                               Do not take a baby under six months old
                                                                                               Hair, scalp and nails                           into the sauna. Under six months old, ba-
                                                                                               Wash your baby’s hair during the bath.          bies cannot control their body temperature
                                                                                               Many babies develop cradle cap, an oily,        by sweating. If your baby enjoys a sauna
                                                                                               yellowish crust on the newborn’s scalp. To      when it is older (6 to 12 months), you can
                                                                                               remove the crust, apply basic lotion or ba-     sit with it on the lower bench if water is
                                                                                               by oil to the scalp and let it soak for a few   not thrown on the stove. Splash lukewarm
                                                                                               minutes. After washing the baby, scrape         water over the baby’s head.
                                                                                               the crust gently off using a baby brush or
                                                                                               comb. Brush the baby’s hair daily. The soft     Laundering your baby’s clothes
                                                                                               spots on the baby’s head where the skull        The best detergent for washing baby
                                                                                               has not yet fused (fontanel) do not need        clothes is fragrance-free or only mildly
                                                                                               special attention.                              scented. Wash new baby clothes before
                                                                                                    The nails of a newborn are often too       they are worn for the first time. When
                                                                                               long. However, due to the risk of cuticle       measuring the detergent, follow the in-
                                                                                               infection it is not recommended to trim         structions on the detergent carton to en-
                                                                                               your baby’s nails during the first week. If     sure clean clothes without traces of deter-
own waist. Lift the baby out of the tub and     need to turn it over for washing. Later, you   you worry about scratching, use cotton          gent. Using extra-gentle detergent will
wrap it inside the warm towel.                  can proceed as follows:                        mittens on its hands.                           leave the clothes extra soft. Nappies in
     Holding your baby: Hold the baby               Wash the tummy side first. Then turn            Trim you baby’s nails after about one      particular must be washed and thoroughly
with its back on your arm. Support the ba-      the baby onto its tummy by taking hold of      week. A good time to check if your baby’s       rinsed to remove all detergent. For more
by’s head and neck with your arm and            the baby’s upper arm with your free hand       nails need trimming is after a bath. To keep    information on washing clothes, please re-
grasp its arm, placing your hand just under     and turning it gently over. Keep your ba-      it from wriggling, keep a firm hold of your     fer to the maternity package leaflet. u
the armpit and hooking your thumb over
its shoulder. This will give you a firm hold
of the baby.                                        BATHE YOUR BABY USING CALM,
     Bathe your baby from the head down-            CONFIDENT MOVEMENTS.
wards. With your free hand, gently wash
your baby’s head taking care not to splash
water into its eyes. Wash its neck, armpits     by’s arm in a firm grip but do not use ex-
and folds in the skin with special care, as     cessive force. Wash your baby’s back side
they tend to gather lint.                       from head to toes. If you didn’t use soap,
     At first, many mothers and fathers are     separate rinsing is not necessary.
nervous about bathing their baby and es-            When you’ve finished, take your baby
pecially about turning the baby onto its        out and pat him or her dry with a towel.
tummy. However, until the baby’s muscles        Use your baby’s own towel. Pay special at-
develop and it can lift its head, there is no   tention to the elbows, knees, armpits and

66   Baby care                                                                                                                                                                Baby care   67
During the first weeks, most babies sleep       Sleeping position
through most of the time they are not           According to current research, placing your
feeding. The safest position for a newborn      baby on its side or back to sleep until it is 6
is on its side, older babies should sleep on    months old reduces the risk of cot death,
their back. At first, your baby will wake up    or SIDS (sudden infant death syndrome).
2 to 3 times a night for feeding. At two
weeks, babies usually start staying awake       Cot toy
to socialise for longer time periods. A         At a few months old, many babies like to
three-month-old is awake for 6 to 8 hours       have a soft toy or blanket to cuddle when         attention, babies also need peace and qui-        in a cool, shady place and make sure it
a day. Try to teach the baby a sleeping                   they go to bed. Sleep is a form of      et according to their individual needs.           cannot tip over or start rolling downhill.
pattern that matches the sleep-wake                               parting and may some-                A child’s sleep is often disturbed when      Draping a mesh net over the pram will
routines of the other members of                                    times be difficult to en-     it learns to crawl and walk. Excited by new       protect your baby from insects and other
the family.                                                         dure. A soft toy or blan-     experiences and skills, the baby is slow to       animals.
                                                                   ket will soothe your baby      relax and calm down. Changing from crib                In the winter, wait until your baby is
Settling to sleep                                              to sleep. Remember the cot         to cot may also cause sleeping problems. If       about two weeks old before starting to
When you’re trying to settle your                               toy when your baby is stay-       the baby is used to sleeping in a crib, try       sleep it outdoors. Do not sleep your baby
baby to sleep (or back to sleep af-                                ing overnight at some          draping the sides of the cot to pacify it. Ba-    outdoors if the temperature is under
ter a night feed) be careful not to                                 other place or when           bies do not usually require absolute silence      -10°C. In cold weather, be careful not to
excite it. Loud voices, bright                                      someone other than a          in order to be able to sleep, but it will be      apply cream or lotion containing water to
lights and playing with the baby                                   parent puts it to bed. Dur-    prove to be difficult to sleep if the televi-     your baby’s cheeks as it will freeze and
by trying to make it laugh will                                  ing changes such as wean-        sion is blaring. Falling asleep in a very light   damage the skin. Tuck the baby tight inside
wake a baby that was already half asleep.       ing, the cot toy provides comfort and secu-       room may be difficult for older children in       its sleeping bag and check that its cheeks
Rocking the baby in your arms and hum-          rity, substituting to some extent for the         particular.                                       stay warm. The baby can sleep outdoors a
ming quietly will help your baby fall asleep.   carer’s presence.                                                                                   little longer every day until it eventually
It is not necessary to hold your baby until                                                       Night-time nappy changes                          takes all day-time naps outdoors.
it is fast asleep. Instead, you can put it to   Sleeping problems                                 If your baby needs changing during the                 In rainy and windy weather, put the
bed when it’s sleepy and relaxed, but still     Tummy troubles and wind are the most              night, be as quick as possible and then re-       hood up and pull a rain cover over the
awake.                                          common reasons for sleeping problems.             turn it to bed. Keep the lights dim and           pram. Place the pram in a sheltered place.
     Prams are the modern alternative to        Sleeping problems may also be caused by           speak softly, but do not engage in play that      Strong wind will make temperatures be-
cradles and swaying the pram or moving it       letting the baby stay for long periods of         will stimulate the baby. Otherwise, nightly       low freezing even more chilling. During
back and forth will help your baby fall         time in bed while awake. On the one hand,         entertainment will become a habit.                the spring and summer months, take care
asleep. Watch your baby for signs that it’s     not receiving sufficient attention during                                                           not to place the pram in direct sunlight in
tired. Putting your baby to bed while it is     the day may lead the baby to demand its           Sleeping outdoors                                 order to prevent the baby from suffering
wide awake and sociable will not make it        share at night. On the other, excessive           Many babies sleep best outdoors where             heat suffocation.
sleep. You can’t force sleep, but you can en-   stimulation and too much attention will           the fresh air enhances deep, sound sleep.              Discuss sleeping a preterm baby out-
tice it. A dummy, a blanket or a musical toy    prevent the baby from sleeping and it will        Summer babies can be put outdoors to              doors with your child health clinic’s nur-
may prove comforting.                           become overtired. In addition to care and         sleep during the first week. Place the pram       se. u

68   Baby care                                                                                                                                                                    Baby care   69
                                                                                                negative feelings, curiosity, courage and         When you are holding your baby, for ex-
                                                                                                being shy or reserved in new situations are       ample, it will feel his own weight against
                                                                                                also components of temperament. From              yours. Such experiences will gradually

and development
                                                                                                the parents’ viewpoint the child may have a       make it aware that it is an entity separate
                                                                                                sweet or difficult temperament depending          from its environment.
                                                                                                on how easy or demanding the baby is.
                                                                                                                                                  Height and weight
                                                                                                The baby enjoys company                           At birth, babies usually weigh 3,000 to
                                                                                                Your baby will closely observe its environ-       4,000 grams and are 49 to 52 cm tall. Dur-
Children develop in their own time                                                              ment from birth. There are many things it         ing the first few days their weight drops by
Children develop in their own time ac-                                                          will only be able to learn from others and        6 to 8%, but is regained in a couple of
cording to their genetic and environmen-                                                        your company is therefore very important.         weeks. Afterwards, the weight should in-
tal influences. The following table depict-                                                     To secure your baby’s healthy develop-            crease by 150 to 200 grams per week. By
ing child development provides a rough                                                          ment, you only need to do what comes              the age of one year, most children weigh
guide as to the order and age in which                                                          very naturally to most parents: talk to the       roughly three times their birth weight (10
children will reach a certain stage or learn                                                    child, hold it, rock it in your arms, move its    to 12 kg) and are about 1.5 times as tall
a particular new skill. However, there is                                                       arms and legs, sing, hum, show it the             (73 to 80 cm).
great variation between different chil-                                                         things in your home, introduce it to other            However, there is great variation in
dren. The same child may be fast to devel-                                                      people etc. There is no need to ”train” your      this. A newborn can weigh anything be-
op in one area and slower than average in                                                       baby or invent abundant stimuli.                  tween 400 and 6,000 grams and future
another. Or, one week may be a week of                                                                                                            growth and development expectations de-
several new skills, and then these skills are                                                   Allowing for the baby’s needs                     pend on the birth weight. Growth charts
practiced throughout the following                                                              To secure your child’s development, allow         are an important tool when monitoring
weeks.                                                                                          for its needs and show that you accept and        your baby’s growth and its relation to the
     Noticing and being happy about how           more important that the baby is develop-      love it just the way it is. Feed your baby        size of the parents.
your child grows and develops and offer-          ing and that things are not completely for-   when it is hungry and let your baby sleep
ing support and encouragement in learn-           gotten once learned.                          when it is tired. If your baby shows interest     Learning to talk
ing new skills is very important to the               Problems at birth or later infections     in some object, encourage him or her to           One of the most important things a child
healthy development of your child. When           may slow down your baby’s development.        examine it. Since your baby will mainly ex-       learns from others is how to speak. Before
your baby has just learned how to roll over,      Therefore, the so-called corrected age is     amine the object with its mouth, make             learning to talk, it will need to hear people
play with it on the floor instead of sitting it   applied when assessing the development        sure that the things you give it are safe.        talking. Therefore, it is vitally important
in the baby bouncer. Allowing the baby to         of preterm babies.                                                                              that you talk to your baby. At first, your
grasp objects that interest it is a kind of di-                                                 Babies are strangers to themselves                baby will respond with baby sounds. At
alogue with the baby. You can try to allure       Children are born unique                      During the initial months, the baby’s con-        six months, your child may know a few
a baby who is slow to warm up to new              Each baby has his own, unique features        cept of itself is very vague. It cannot distin-   words even though it cannot speak yet it-
things, but too much ambition and paren-          and habits which are permanent. These         guish itself from its environment, and            self. It may, for example, know how to
tal desire to speed up the baby’s natural         personal traits are called temperament.       thinks it is part of its mother and the sur-      point to its own mouth if asked to do so,
course of development may be harmful. If          Temperament includes characteristics such     rounding environment. The baby is not             provided the parts of its body have fre-
the baby is overweight, stabilising its           as patterns (sleeping pattern), patience,     fully aware that its hands and legs are part      quently been pointed out to it. At 7 to 8
weight curve may promote its motoric de-          calmness, activity, restlessness and the      of it, but that its mother’s breast and its       months, your baby will start to repeat syl-
velopment. Making comparisons between             ability to adapt and concentrate. Different   own blanket are not. In order to discover         lables and will be able to chatter by itself
different children is seldom fruitful. It is      moods such as being irritable or prone to     its boundaries, it will need your help.           for long stretches at a time. Children nor-

70   Baby care                                                                                                                                                                    Baby care   71
Infant development (deviation from this table is common)                                             mally utter their first word when they are      its linguistic skills may have developed in
                                                                                                     10 to 13 months old.                            many ways. By singing, playing, looking at
                                                                                                         Speech is central to the child’s devel-     picture books and reading fairy tales - just
Age           Sociability         Movements                Hand movements       Eye sight            opment. Being able to express itself in         to mention a few. There may come a time
              and speech                                                        and hearing          words and understanding speech help it          when the bilingual child refuses to use one
                                                                                                     gain a better understanding of the world.       of the languages. This may be a real trial
                                                                                                     A child who understands what is said to it      for the parent concerned. Nevertheless,
0-1           random,             moves arms               hands mostly         cannot see           is easier to guide and will learn things        continue speaking your own language
months        involuntary         and legs                 clenched in a fist   clearly, starts at   more quickly. In many instances, a child        even if your child does not answer in it.
              smiles, direct      simultaneously                                loud noise and       who can talk and has a large vocabulary              Learning two languages takes more
              eye contact                                                       bright light         will perform better than other children.        time and effort. Be patient and give the
                                                                                                         Just talking to the baby is, however, not   child time. Also, show that you are inter-
2-3           first real smile,   holds head up,           catches hold of      turns head           sufficient for teaching it to speak; you need   ested in both languages. For more infor-
months        makes baby          kicks with               things using both    towards sound,       to have a conversation adapted to the situ-     mation on bilingualism, contact your child
              sounds (ah, goo),   both legs                hands, studies       follows moving       ation and feelings at hand. In practice, this   health clinic. For more information on the
              is sociable         simultaneously           own hands            object with eyes     might be interpreting the baby’s feelings       Swedish language, contact the Swedish
                                                                                                     aloud, putting questions to the baby and        language day-care centres and the Sven-
4-6           laughs out loud,    pushes arms up           picks things up      recognises a         explaining things. Use rich, versatile and      ska Finlands Folkting (www.folktinget.fi).
months        recognises the      straight, turns,         with one hand,       picture of a face,   correct language when talking to a baby.
              person caring       sits supported           palm grip            studies colourful    Besides baby talk, your child needs to hear     Sight
              for him, first                                                    images               ordinary speech in order to learn to pro-       A newborn does not see very clearly. What
              attemps at play                                                                        nounce words correctly.                         it sees best are the eyes of a person close
                                                                                                                                                     by. Babies enjoy looking at things. Hang
7-8           distinguishes       sits without             moves toy from       no longer            Bilingual families                              colourful objects (such as pieces of cloth)
months        between familiar    support, rolls           one hand to          squints,             If you and your partner do not share the        or a mobile about 50 cm above the crib.
              and unfamiliar      over, crawls             the other,           seeks hidden         same mother tongue, you may be consid-          The baby enjoys seeing them move, but
              people, knows       (sometimes               pats table with      objects              ering having your child grow up bilingual.      remember to remove them when it is time
              2 to 3 simple       backwards)               hands                                     Children are usually able to learn two lan-     to go to sleep. The baby will first learn to
              words, repeats                                                                         guages, provided that their parents are         recognise human faces. A 3 to 4-month-
              sound s such                                                                           willing to invest some time in teaching the     old enjoys looking at a very simple, smiley
              as dadada etc.                                                                         child and know how to go about it in the        face. Most babies squint during the first
                                                                                                     right way. For the child’s linguistic devel-    months. However, their sight develops
9-10          is shy of           crawling on all          picks up objects     looks at images,     opment, it is vital it learns to distinguish    fast and the child enjoys observing its en-
months        strangers,          four, pulls up to        between thumb        notices objects      between the two languages. Both parents         vironment.
              first words         stand and walks          and forefinger       sized 1 to 2 cm      must consistently speak only their own               Babies usually find pictures of familiar
                                  with support                                                       mother tongue with the child. In their dis-     everyday items very interesting. You can
                                                                                                     cussions with each other and other people       start ”reading” picture books with a
11-12         can say 2 to        stands with              throws objects       turns towards        the parents may use the language they are       2-month-old, but if it is not interested,
months        3 words,            support,                 about,               a whisper,           accustomed to.                                  stop and try again a few weeks later. Chil-
              interested in       first steps              claps hands          recognises objects       It is usually the case that one of the      dren only learn through curiosity; forcing
              other children                                                    from images          languages develops more quickly than the        things on your child usually only serves to
                                                                                                     other. By the time your child is a toddler,     slow down this process.

72    Vauvan hoito                                                                                                                                                                   Baby care   73
     You can make your own picture books         Touch and grasping                             different textures, letting your baby touch     not to let your baby be in a baby carrier, a
by cutting simple pictures out of maga-          The mouth is the baby’s most sensitive         smooth, hairy, soft and hard surfaces, feel     baby swing or walker for extended periods
zines, gluing them onto cardboard and            body part. Babies explore the world            wood and stones etc. In this way, your ba-      at a time. Being in the same - possibly in-
covering the pages with adhesive plastic         though their mouths by sucking on every-       by will learn what the world feels like.        correct - position for a long time is a strain
film. Your baby will also be delighted with      thing they can reach. A newborn holds its                                                      on your baby’s back and hips. If you wish
its own little photo album with pictures of      hands clenched in a fist. Later, its hands     Toys                                            to promote your baby’s development, al-
mum and dad, its sisters and brothers,           will relax and the fingers splay out. At the   You can make baby toys yourself. Under          low it to be on a blanket that is spread out
grandparents and other familiar people.          age of 2 to 3 months, babies start grasping    two-year-olds like to play with rattles, soft   on the floor as much as possible.
Babies are especially interested in por-         objects with both hands, putting them in-      toys and balls. Many of your household               Babies enjoy being held, bounced and
traits.                                          to their mouths. Make sure that the things     items are suitable as toys, such as plastic     lifted, and like swinging and having their
                                                 your baby can reach are not toxic or dirty,    containers and their covers, empty plastic      hands and legs moved. However, babies
Hearing                                          and that they are big enough not to suffo-     bottles, scoops, cotton reels and so on.        do not enjoy sudden movements, loud
Newborn babies have very good hearing.           cate it (avoid string, rubber bands, buttons                                                   noises and rough handling. For more in-
Most babies can recognise their mother’s         etc.).                                                                                         formation on how to encourage your ba-
                                                                                                 Make sure they do not have:
and father’s voice before the age of two             When a little older, the baby will grasp                                                   by’s motoric development, contact your
                                                                                                 u sharp edges,
weeks. By 2 to 3 months, the baby will start     an object with one hand and move it from                                                       child health clinic. Many gymnastics asso-
                                                                                                 u little pieces that can become loose,
turning its head towards a sound, but will       one hand to the other. A further develop-                                                      ciations organise parent and baby fitness
                                                                                                 u toxic paint,
not be able to hear whispers until towards       mental stage is for the baby to pick up ob-                                                    classes. Baby swimming is also a fun form
                                                                                                 u strings or bands, or
the end of the first year. Babies are easily     jects between its thumb and forefinger.                                                        of family time. The ideal time to start is
                                                                                                 u anything that will break or crack.
startled by loud noises.                         This is called the pincer grasp. Play with                                                     when your baby is 3 to 5 months.
    Babies usually enjoy music and are an
appreciative audience for any musical per-                                                      Movements                                       Take notes and pictures
formances by other family members. Do                                                           Your baby will start lifting its head during    It is interesting for both the parents and
not hesitate to make up your own songs,                                                         the first months. It will learn how to turn     child that its development has been docu-
however silly this might feel. And your ba-                                                     onto its tummy at the age of 3 to 5 months      mented in notes and pictures and by sav-
by won’t mind even if your singing or                                                           and sit up at the age of 6 to 8 months. Af-     ing early drawings and toys, for example.
playing is somewhat off pitch. By the time                                                      ter 6 months, your baby will start crawling     Parents caring for their first baby often im-
they are a few months old, babies are                                                           on its tummy. Some babies may start by          agine they will remember until their dying
aware of rhythm and dance and jiggle in                                                         crawling backwards. A short while after         days what their child did and what it
time to music. However, do not leave a ra-                                                      this, your baby will learn to crawl on all      looked like at every age. Yet the details are
dio or television on all the time. Constant                                                     fours and will be very quick at moving          in fact soon forgotten. Therefore, it is a
noise is stupefying and makes music less                                                        around. At 7 to 9 months, your baby will        good idea to write down some of the mile-
enjoyable.                                                                                      pull itself up to stand using support, and      stones, such as when your baby had its
                                                                                                succeed without support after a few             first tooth, how it chattered, what made it
Sense of smell                                                                                  months of practice. About one in every two      laugh, which books and toys it liked, what
Newborns have a keen sense of smell. Ba-                                                        babies takes its first steps before its first   its first words were etc. If you take pictures,
bies smell breast milk which helps in find-                                                     birthday.                                       remember to mark them with a date and
ing the nipple and starting to feed. When                                                           You can sit your baby in a baby bounc-      the child’s name. When there are more
the baby is fussy at night and feeds at fre-                                                    er for short periods at a time as long as its   children in the family, it is not always easy
quent intervals, it might sleep better when                                                     position is relaxed and its head is support-    to remember later who was in the picture
its father is holding it and the smell of milk                                                  ed. A car safety seat is not a baby bouncer     and when it was taken, or which of the
doesn’t activate the feeding instinct.                                                          and should only be used in the car. Be sure     children used a funny word. u

74   Baby care                                                                                                                                                                   Baby care   75
Daily routines
New challenges
Being a new parent is a wonderful, happy        the working day you still have time and
experience, but it also means facing new        energy to enjoy your family.
challenges. Your daily routines need to be           Avoiding major changes and ”projects”
rearranged, requiring cooperation from all      during the early months with a new baby
members of the family. The baby cannot be       will make family life much less demand-
left alone anywhere and its needs must be       ing. Most things can be postponed, but
attended to. You can take your baby along       caring for your baby cannot. Of course, it is
to most places, as long as you are able to      not always possible to anticipate overlap-
accommodate its sleeping and feeding            ping changes such as moving to a new
patterns. When you have a baby, you need        home or sickness in the family. However,
to accept certain limitations. Leaving the      the fewer major distractions there are, the
house will generally take much longer           easier it will be to arrange your time and       try to divide them into tasks that can be       may be very enthusiastic and eager to par-
than before. You need to plan and then          daily routines.                                  left for later and tasks that must absolute-    ticipate in caring for the new baby, while
pack the baby gear accordingly, and just as          All in all, you will need to pay more at-   ly be done now. In addition to caring for       also being jealous. Children’s feelings of
you’re ready to step out your baby may          tention to how you are spending your             the baby, you need to save your energy for      jealousy have been compared to a situa-
need a feed or nappy change.                    time. Your friends and relatives can be of       caring for yourself and your relationship       tion where your partner would bring home
     Caring for your baby comprises repeti-     great help when you need the occasional          with your partner. Do not make unreason-        a new husband or wife.
tive routines which enhance the baby’s          helping hand, but most arrangements              able demands on yourself or on your part-            Due to such jealousy, older children
sense of security, but which are very bind-     must be negotiated within your own fami-         ner; perfection is not a requirement for        may be very angry at the baby whereas
ing for the parents. Feeding, burping,          ly. You will need to agree on ”my time”,         good parenting. Remember that your life         others may start pretending to be babies
changing, washing and sleeping the baby         ”your time ” and ”our time”.                     need not be a sequence of exhausting rou-       themselves. Such reactions include want-
often interrupt other activities. This can           Be patient. Taking care of a baby in-       tines. Little surprises and shared moments      ing to sit on your lap when you start feed-
sometimes be very frustrating. Although         volves routines and changes. On the one          with your partner will break up the routine     ing the baby. An older child may start wet-
rewarding, caring for your baby can also be     hand, it is the parent’s job to create a         nicely.                                         ting its pants again and demand to be
exhausting, especially if your baby wakes       sense of stability and security for the baby.                                                    treated like a baby. The child may become
up many times per night leaving you with        Yet on the other, parents need to adapt to       Brothers and sisters                            tearful, demand a dummy, want to sleep
insufficient sleep, cries a lot or has a de-    the constant changes as their baby grows.        When the baby arrives, your older children      beside the parents or be very quarrel-
manding temperament.                            Both parents must be flexible and adapt          may suddenly seem very competent. Do            some.
     During the baby’s first year, it is very   quickly to the big and small changes in          not expect them to suddenly be more ma-              An older child may try to hurt the baby
important that both parents have some           daily routines. It is important that neither     ture just because they seem so much big-        by hitting or pinching it. Naturally, broth-
time to themselves to rest and enjoy a          of the parents expects the other - nor           ger than the baby. A new baby in the fam-       ers and sisters cannot be allowed to tor-
hobby, sports for example. However, do          himself or herself! - to carry on with the       ily is a change for the older children as       ment the baby and you must put and end
not fool yourself into thinking that you can    same responsibilities as before the baby’s       well, not just for the parents. For some, the   to such behaviour very determinedly. The
participate in activities and go out with       birth.                                           most trying time is when the baby is born,      child may also express hopes of the baby
friends as actively as before. Also try to            If you begin to feel that your daily       while for others the difficulties begin when    dying or being given away. This may sound
balance work and family life so that after      tasks and chores are becoming a burden,          the baby starts moving around. The child        terrible to the parents, but it helps the

76   Baby care                                                                                                                                                                  Baby care   77
child to let off steam. This stage passes      the older child a baby doll which it can        they did their own children. If doting turns     they will both need to attend. However, not
more quickly, if the parents understand the    nurture while mum or dad is looking after       into spoiling, it may cause friction between     all families have close relatives living near-
older child’s pain and find the time to lis-   the baby.                                       the parents and grandparents. Tactful            by and even if they do, they may be very
ten. When your child says, ”I wish the ba-         Refer to the baby as ”our baby” to em-      grandparents will understand that the            much engaged in their work and social life.
by were dead”, you can reply by saying, for    phasise that the baby is a family member.       young parents need to make their own de-         In such cases, the availability of other forms
example, ”I know you’re angry with the         Remember to frequently tell your children       cisions, and will not interfere unless invit-    of support is particularly important. Fami-
baby and wish it had never arrived. Do you     that you love them and that they are very       ed to do so. In conflict situations, each par-   lies with young children can agree to ba-
feel like I’m not spending enough time         important to you. Praise the older children     ent should carefully broach the subject          bysit each other’s children. In many loca-
with you? I love you just as much, but I do    for the things they can already do and          with his or her own parents.                     tions, organisations such as MLL (the
need to take care of the baby as well”.        which the baby is only just learning.                                                            Mannerheim League for Child Welfare)
    Older children may be cross just be-                                                       Short-term child care                            and Väestöliitto (the Family Federation of
cause the parents no longer spend so           Support networks                                Friends and relatives can offer invaluable       Finland) offer short-term child care for a
much time with them - which is true. This      In addition to your relationship as a cou-      help when the parents have something             fee (see ”Organisations” on page 94). u
passes more quickly if they are allowed to     ple, the new baby has an impact on other
pretend being a baby for a while, although     people as well. A new baby creates grand-
this may feel like a nuisance. Make an ef-     parents, aunts, uncles, cousins and god-
fort to spend time with the new big sister     parents. Parenthood is an experience that

or big brother. Set aside a time of the day    binds different generations but also poses
to be with him or her, while the baby is       new challenges. Society as well as beliefs
sleeping or with the other parent. Also, al-   and views on child rearing and baby care
low the child to participate in taking care    have changed during the years, which may
of the baby. He or she can sort out the ba-    create conflicts between the new parents
by’s things or hold the baby while sitting     and the older generation. Despite the           Accidents often take place in the home.              If your baby is sitting on your lap at the
on the floor, a chair or on the sofa. Give     number of differences there are also many       For safety in the home, read the following       table, ensure that he or she cannot pull hot
                                               opinions that are shared.                       precautions.                                     drinks or hot food onto him or herself and
                                                    When you become a parent, you begin                                                         be scalded.
                                               to view your own parents from a new per-         Never leave a child unattended
                                               spective. At best, the relationship is one of    u on a changing top or a bed without            Always place the following out
                                               mutual respect. Becoming a parent often             sides.                                       of reach of children
                                               stirs up feelings and memories from your         u in a bath. Always make sure the wa-
                                               own childhood. Talk about them with                 ter is not too hot and that hot water        u plastic foil and plastic bags
                                               someone and, if they are very distressing,          does not drip from a leaking tap on-            (risk of suffocation).
                                               seek professional help.                             to your baby’s head.                         u sharp or fragile objects. Place knives
                                                    In many families, grandparents are                                                             and other tools out of the reach of child.
                                                                                                u in a room where a window or balco-
                                               naturally an important part of the family                                                           Use locks or guards in cabinets and
                                                                                                   ny door is open. Place guards on the
                                                   and are glad to participate in caring for                                                       drawers. If this is not possible, tie the
                                                        the baby. Often, caring for their                                                          cabinet doors and drawers with string
                                                           grandchild brings back memo-         u in the kitchen when something is
                                                                                                                                                   or remove all handles.
                                                            ries from the time their own           cooking on the stove or in the oven.
                                                                                                   Always turn pot and pan handles in-          u cigarettes, alcohol, medication, cleaning
                                                            children were small. It is often
                                                                                                   wards. Buy a cooker guard to cover              agents, paint, detergents, insect repel-
                                                           easier for grandparents to dote
                                                                                                   the stove’s burner knobs.                       lent and other toxic materials.
                                                          over their grandchildren than

78   Baby care                                                                                                                                                                    Baby care   79
                                                                                              Starting supplementary food
u nails and other thin objects the child         out and fall. Make sure no animals get in-
     might stick into electric outlets. Use      to the pram. u
     plugs in unused outlets or install safety
     sockets.                                     Safety in the car
u toys with small, loose parts and button         u The safest place for a child aged 1
     cell batteries which can block the              to 3 years old is a rear-facing baby     Exclusive breastfeeding is recommended
     child’s airways.                                seat. Just hitting the brakes can be     for the first six months, if possible. At six
                                                     enough for your child to be injured.     months you can start introducing solids
    Check that your baby gear, such as the                                                    into your baby’s diet, but it is recommend-
                                                  u Fasten baby and child seats accord-
changing top and pram, are safe and in                                                        ed that you continue breastfeeding until
                                                     ing to their instructions. Children
good condition.                                                                               your baby is 1 years old or beyond, if you
                                                     must travel with the appropriate
    Be aware of any heavy objects the child                                                   both enjoy it. However, a one-year-old will
                                                     restraints and sitting in their own
could pull on top of it from the table or                                                     receive all the necessary nutrients from
                                                     seats (travelling by car sitting on an
shelves. Make sure the child cannot over-                                                     other foods and his or her digestive system
                                                     adult’s lap is forbidden). Never use
turn the bookcase.                                                                            will be ready for other nutrition in addition
                                                     rear-facing baby seats in a seat fit-
    Keep a keen eye on your child when                                                        to breast milk or formula. Once your baby
                                                     ted with an active front airbag. An
you are visiting. If your hosts do not have                                                   has reached its first birthday, you can be-
                                                     inflating airbag can be life threat-
young children, they will most likely not                                                     gin to give it skimmed milk and milk-
                                                     ening to a baby.
be prepared for little explorers eager to                                                     based foods.
touch and taste everything.                       u Never leave your child unattended             The correct time to start introducing
    Never leave a child who can move                 in the car. On a very warm day in        solid foods into your baby’s diet depends
around alone in the pram. It could climb             particular, this could be fatal.         on its growth and overall development,
                                                                                              and breastfeeding. However, you should
                                                                                              not wait long after your baby has turned        portion. It is wise to introduce foods one at
                                                                                              six months to supplement breastfeeding          a time as this can help identify food aller-
                                                                                              with other food. Delaying solids may cause      gies or intolerances. At the age of six
                                                                                              eating problems and slow down its               months, offer your baby puréed food at
                                                                                              growth.                                         several meals.
                                                                                                  If your breast milk is scant, you can            Getting used to solid foods takes time,
                                                                                              start introducing solids at the age of four     so be patient. If your baby refuses a new
                                                                                              months. To ensure breastfeeding, it is rec-     food, try it again a few days later. There is
                                                                                              ommended that you give puréed food in-          no point in making haste when your child
                                                                                              stead of bottle-feeding formula or baby ce-     is slowly learning to eat and getting used
                                                                                              real. If you are not breastfeeding, begin       to new tastes and textures.
                                                                                              supplementing formula with solid foods at            Start by offering puréed potatoes, veg-
                                                                                              the age of 4 to 6 months.                       etables, fruit or berries. You can make a
                                                                                                                                              large amount of purée at once and freeze
                                                                                              Introducing new foods into your                 suitable portions in e.g. an ice cube tray.
                                                                                              baby’s diet                                          Meat, fish, poultry, eggs and baby cere-
                                                                                              Try adding 1 to 2 new foods every week.         als should not be introduced until your ba-
                                                                                              Start by offering your baby small quantities    by is five months old. When you start in-
                                                                                              at first and then gradually increase the        troducing solids at the age of six months,

80     Baby care                                                                                                                                                              Baby care   81
move from one food group to the next af-               Vegetables and potato                           der 12 months Chinese cabbage, swede,           Dairy products
ter trying 1 or 2 different foodstuffs: after          Mild in flavour, mashed potato is a good        turnip, beetroot or spinach because they        Towards the end of your baby’s first year,
starting with two different vegetables,                food to begin with. Introduce other vege-       are rich in nitrates.                           you can start giving it dairy products. Start
move on to meats or cereals. In this way               tables into your baby’s diet gradually. Serve                                                   with cultured dairy products such as low-
you can ensure a varied selection of foods             vegetables boiled and puréed. Wash the          Fruit and berries                               fat or non-fat curdled milk, natural yo-
that meets your baby’s growing needs.                  potato/vegetable well and cook it in water.     All fruit and berries are suitable. Serve       ghurt or buttermilk. During meals, your
When you return to fruit and vegetables,               Do not add salt. Purée or mash the potato/      them puréed, grated or as a compote. Pre-       child can drink skimmed milk.
try something new!                                     vegetable using a fork. Add boiled water or     fer domestic berries. Wash and peel foreign
     When you are cooking, set aside a                 breast milk.                                    fruit carefully before use. You can add a
small portion for your baby before adding                  Cooked vegetables can gradually be          moderate amount of sugar or fructose to
                                                                                                                                                           GETTING USED TO SOLID FOODS
spices (salt) and purée it if necessary.               supplemented with finely grated raw veg-        sweeten sharp or sour fruit and berries.
When your baby begins teething, mash the               etables and purées. Your baby will thus get     However, take care that your baby does              TAKES TIME, SO BE PATIENT.
food more coarsely to promote chewing.                 used to a wide variety of vegetables. Suita-    not get used to very sweet food. Honey
Towards the end of its first year, your baby           ble vegetables include carrots, cauliflower,    should not be given to children under one
can start eating the same food as the rest             zucchini, sweet corn, sweet potato, cucum-      year of age.                                    Fats
of the family.                                         ber and tomatoes. Do not offer babies un-                                                       Rapid growth demands a lot of energy.
                                                                                                       Meat, fish, poultry and eggs                    Breast milk and formulas are rich in fat.
                                                                                                       From five months at the earliest, add a         When the child starts eating the same
                                                                                                       small amount of finely chopped meat,            food as the rest of the family, choose soft
                                                                                                       chicken or egg (one teaspoon) to the pota-      vegetable fats. As the proportion of solid
Age and food                                                                                           to or vegetable purée. Serve fish only 2 to 3   foods in the child’s diet increases and it
                                                                                                       times a week because of the oily fat it con-    starts drinking skimmed milk, its fat in-
                                                                                                       tains. For under one-year-olds, 1 to 1.5 ta-    take decreases. Add a small amount of
0-4    over 4 months                 over 6 months        over 8 months         over 10 months
months                                                                                                 blespoons of meat or fish per meal is suffi-    cooking oil or soft vegetable fats (2 tea-
                                                                                                       cient. Liver is not recommended for under       spoons per day) to your child’s porridge,
Exclusive breastfeeding 6 months Continue breastfeeding until 12 months                                one-year-olds because of its high vitamin       for example.
                                                                                                       A content.
          Depending on               Solid foods          Coarse mash
                                                          and new foods:
                                                                                Same as rest
                                                                                of the family or
          the baby new
          foods puréed:
                                     for everyone
                                     puréed               - potatoes,           coarse mash:
                                                                                                       Baby cereal and porridge                        Do not add any salt to your baby’s food
                                                                                                       Ideally, offer your baby full grain cereals     during the first year. Avoid foods with a
          - potatoes                 - potatoes             vegetables and      - baby cereal, bread
                                                                                                       cooked in water without salt. Add puréed        high salt content such as sausages, cold
          - vegetables               - vegetables           meat/fish           - potatoes
                                                          - baby cereal         - vegetables           fruit or berries for taste. Next to home-       cuts, marinated meat/poultry, ready-pre-
          - berries                  - berries
                                                          - berries and fruit   - raw vegetables       made porridge, you can give your baby in-       pared foods and cheese as they also con-
          - fruit                    - fruit
                                                          - fine grated raw        grated              dustrial baby cereals. Breastfeed or bottle-    tain high levels of additives and preserva-
                                     - meat or fish
                                                            vegetables          - berries and fruit    feed your baby after a porridge meal.           tives.
          over 5 months              - baby cereal
                                                                                - meat and fish             From six months, part of the formula
          meat or
          baby cereal                                                           - dairy products       can be replaced with industrial baby cere-      Vitamin D
                                                                                   and milk-based      al. Industrial baby cereals are not recom-      Children need supplemental vitamin D
                                                                                   foods               mended for children under five months in        from two weeks until three years of age. In
                                                                                                       order to maintain breastfeeding.                Finland, supplemental vitamin D is also
Vitamin D supplement in all age groups, according to instructions .

82    Baby care                                                                                                                                                                       Baby care   83
                                              recommended for children over 3 years old             Some babies sound wheezy, particu-         without fever may be a sign of an ear in-
                                              during the dark months (October through          larly after feeding, until they are about one   fection or feverless pneumonia.
                                              March). Enquire about the dosage instruc-        year old. This is due to their soft windpipe
                                              tions from your prenatal clinic or chem-         cartilage. A baby may experience its first      Fever
                                              ist’s.                                           viral infection early on, if family members     On average, under three-year-olds have 5
                                                                                                                                               to 6 common colds or respiratory infec-
                                              Teething                                                                                         tions per year. Give your child antipyretics
                                              The first teeth (milk teeth) appear when             VACCINATIONS PROTECT THE CHILD              (drugs that reduce a fever), if he or she is
                                              the baby is about six months old. Children           FROM INFECTIOUS DISEASES.                   running a fever and his or her food and
                                              will usually have all their 20 milk teeth by                                                     drink intake is inadequate, or the child is
                                              the time they are three years old. It is pos-                                                    restless, irritable or in pain, or if the tem-
                                              sible to keep the child’s teeth healthy and      are suffering from colds or the baby is         perature rise is significant (38.5°C to
                                              free of cavities, if looked after properly. Do   born during an epidemic. Saline drops,          39°C). Paracetamol is available as a syrup
                                              not encourage the growth of bacteria             nose drops, an elevated position and fre-       and suppositories from the chemist’s,
                                              based on sugar. Start to brush your baby’s       quent feedings will make the baby feel          without a prescription. The usual dose of
                                              teeth as soon as they appear. You will re-       better. See your doctor, if your baby is very   paracetamol is 10 to 15mg per kg of body
                                              ceive advice on the need for fluoride from       small or your firstborn, or if the symptoms     weight every 6 to 8 hours (100 to 150 mg
                                              the prenatal clinic. u                           persist.                                        if the baby weighs over 10 kg). If a baby
                                                                                                    Smoking should be avoided in fami-         under two months old is running a fever,
                                                                                               lies with children, as cigarette smoke irri-    see your doctor even if the temperature
                                                                                               tates the mucous membranes.                     drops with medication. Contact your doc-

                                                                                               Colds are frequently accompanied by a

When the baby is ill
                                                                                               cough. When something irri-
                                                                                               tates the throat, the baby
                                                                                               will try to remove it by
                                                                                               coughing. Cough drops
                                                                                               will help the baby
                                                                                               sleep, but will not
Common colds and stuffiness                                                                    cure the symptom.
of the nose                                                                                        Contact your
Newborn babies breathe through their              Stuffiness will pass with time, but          doctor, if your ba-
nose. If the nose is stuffy, feeding be-      some children tend to get milk up their          by has a barking
comes problematic as it is difficult to       nose while feeding. Accompanying stuff-          cough accompa-
suckle and breathe at the same time. In       iness, yellow mucus can build up in the          nied by shortness of
maternity clinics, saline drops and some-     corner of the eye and the eyelids may            breath and a high fe-
times a small pump to remove mucus are        stick together as blocked tear ducts pre-        ver, as you may need
used to relieve stuffiness of the nose. Sa-   vent normal flow. If stuffiness continues,       respiratory medica-
line drops may help feeding at home – af-     contact your doctor as prolonged stuffi-         tion. A cough following
ter a good sneeze your baby’s nose will be    ness may cause ear infections, even in ba-       a common cold may last
clear.                                        bies.                                            for weeks. A prolonged cough

84   Baby care                                                                                                                                                                 Baby care   85
tor, if the temperature persists even after      Contact your doctor or health nurse
giving your baby the correct dosage of           without delay, if your baby:                  Childhood vaccination programme
antipyretic and it refuses to drink, or if its
temperature is high for several days with-       is under 2 months and                         Vaccine                                                                  Age
out a cough or cold. Hospitals and health        u has a fever,
care centres provide advice over the             u is not feeding properly,                    DTaP-IPV-Hib I             (diphtheria, tetanus, pertussis,              3 months
phone, especially during epidemics. If           u is sleepy or lethargic,                                                polio, incl. some respiratory and
your baby has feverish convulsions, ask          u cries or is sensitive to being touched,                                ear infections)
for instructions from your clinic’s nurse or     u has trouble breathing or shortness
doctor.                                             of breath, or                              DTaP-IPV-Hib II                                                          5 months
                                                 u its urine starts smelling odd.              DTaP-IPV-Hib III                                                         12 months
Baby stools tend to be rather runny and          You can also phone the maternity              MMR I                      (measles, mumps, rubella)                     14-18 months
this should not be viewed as a symptom of        unit for advice.                              DTaP-IPV                   (diphtheria, tetanus, pertussis, polio)       4 years
diarrhoea. During respiratory infections,
baby stools are often even less solid than       runs a fever over 38.5ºC and                  MMR II                     (measles, mumps, rubella)                     6 years
normally. If your baby has diarrhoea, its        u is irritable and is easily startled,
stools will have a terrible smell and be         u is sleepy and vacant,
completely absorbed into the nappy. Diar-        u has trouble breathing or shortness
rhoea is more serious the younger the              of breath,
child is and the major concern in such           u cries and cannot be soothed,              Why are vaccinations necessary?
cases is dehydration. When the child has         u refuses drinks,                           Vaccinations protect the child from infec-      stead, they have rare but severe secondary
diarrhoea, it will lose a lot of fluids that     u its skin seems bruised,                   tious diseases. Vaccines are given to protect   diseases which cause disability, infertility
will need to be replaced by giving extra         u has a severe primary disease.             the child against several dangerous diseas-     and death. Vaccines contain extremely
drinks, such as water, juice or a special                                                    es such as diphtheria, pertussis (also called   small amounts of additives, such as mer-
preparation obtainable from the chemist’s.       Contact your doctor when your baby          whooping cough), tetanus and polio. Im-         cury and aluminium, compared to the
Contact your doctor or health nurse with-        is running a fever (over 38.5ºC) if:        proved hygiene and nutrition have had a         amounts received in food, for example. The
out delay, if your baby is still very young or   u your baby is 2 to 5 months old,           considerable effect in preventing infectious    benefits of immunisation far outweigh the
if diarrhoea is accompanied by prolonged         u its temperature is very high              diseases, but vaccination has completely        very small risk of side-effects.
vomiting.                                            (over 41ºC),                            eliminated these diseases from Finland.             Vaccines are administered by the
                                                 u the baby cries when urinating,            Although these diseases are a thing of the      health nurse in the child health clinic. In
Exanthema subitum                                    the urine smells very bad,              past in Finland, some cases have been re-       addition to vaccinations, protect your child
Exanthema subitum is also called roseola,        u a fever has lasted for over 24 hours      ported in Sweden, the Baltic countries and      from diseases by avoiding contact with ill
baby measles and the three day fever. It is          without any apparent reason,            Russia. Further abroad, the risk of infection   people. Alongside the vaccination pro-
a very common infectious disease in chil-        u the baby has had fever convulsions        is even higher. If the proportion of vacci-     gramme, your child may be vaccinated
dren aged six months to 2 years. It is a vi-         previously, or                          nated children decreases, the risk of infec-    against chicken pox, hepatitis A or B and
ral disease characterised by an abrupt high      u it has a fever for three days and then    tion will also rise in Finland.                 tick-borne encephalitis, if considered nec-
fever lasting three days. As the fever sub-          begins running a temperature again.         Vaccinations are voluntary. Some par-       essary.
sides, small spots appear on the baby’s                                                      ents wonder whether vaccinations are nec-           For more information on vaccines,
skin. The rash disappears in roughly 1.5         Reduce the fever by giving your child       essary and may be suspicious about the          contact your child health clinic’s nurse or
days. Ear infections may occur as a sec-         antipyretics (paracetamol) and using        components they contain. Pox diseases do        the National Public Health Institute at
ondary illness.                                  damp wraps before seeing the doctor.        not contribute to the child’s health. In-       www.ktl.fi. u

86   Baby care                                                                                                                                                                Baby care   87
Organising childcare
Parents need to make decisions on child-        sense of security is based on the presence      is ill, location, environment etc. Finding     spite problems in the beginning. For day-
care arrangements during the first year.        of the primary carer (usually mother or         well-functioning, reliable day-care is es-     care to succeed, parents need to update
Many families decide to care for the baby       father). When separated from him or her,        sential for the well-being of all family       their information every day. Talk with the
at home for as long as possible. Some-          the child becomes distressed. For chil-         members.                                       day-care personnel to find out how your
times, the mother may have agreed with          dren, separation causes stress and pro-              But even when the parents have done       baby’s day went and what he or she has
her employer on a date upon which she           longed stress may impede healthy devel-         their best to find an optimal solution,        been up to.
will return to work. In some families, the      opment. A stressed child is tearful, clings     something unexpected may come along                In addition to preparing the child for
father stays at home to care for the chil-      to its parents and has difficulties adapting                                                   day-care, parents need to prepare them-
dren while the mother returns to work.          to day-care or accepting the new carer.                                                        selves as well.
Childcare arrangements are important to         The risk of such problems diminishes                EACH FAMILY NEEDS THE SOLUTION                 Work on your ”separation anxiety”
the parents and the child. Each family          drastically over just a couple of months.           THAT IS BEST FOR THEM.                     and observe your reactions and emotions
needs to find the solution that best suits           The child’s cognitive development                                                         when someone else is caring for your ba-
their needs; no single alternative is opti-     and other skills speak highly in favour of                                                     by while you are away. Placing your child
mal for everyone.                               waiting until the child is at least one year    causing a change of plan. The family needs     in childcare outside the home will create
                                                old before entering day-care. However,          to move, for example, or your family day-      mixed feelings, and the new situation
Considering day-care                            this is not always possible. In some fami-      care provider retires, is taken ill or moves   may be distressing for the parents as well.
When considering day-care, parents              lies, placing the child in day-care very        away, there are personnel changes in the       Discuss your feelings with the day-care
should take their child’s developmental         early is the best solution. In addition to      day-care centre, or your child for one rea-    personnel. u
stage into account. Once the child has          family finances, parental exhaustion is a       son or another does not seem to adjust to
reached its first birthday, many skills start   very sound reason for placing the child in      day-care. In such cases you will need to
to develop fast. It will learn to walk, talk    day-care.                                       reassess the situation.
(some words at least), eat and drink.
Some children will even begin dressing          Finding the right alternative                   Adjusting to the new situation
themselves. Being in day-care is very dif-      Choosing the proper day-care solution for       There is great variation in how children
ferent for a one-year-old than for a baby       your child should be a carefully thought        react to day-care, the new carers, and
which still needs continuous care and as-       out and researched process. Ask for infor-      changes in general, which makes prepar-
sistance. At the age of one, children usu-      mation on day-care options available in         ing for possible problems in advance dif-
ally become more interested in other chil-      your neighbourhood from your child              ficult. Do not expect your child to adjust
dren. Although one-year-olds tend to            health clinic, municipal officers responsi-     immediately; it is likely that problems will
play by themselves and rarely engage in         ble for day-care in the area, private day-      occur but they usually pass with time.
joint activity, they do notice and enjoy the    care organisations and directly from day-       Most children go through periods when
presence of other children.                     care centres and other day-care providers.      they are reluctant to go to day-care. How-
     When maternal and parental leave           Consider in advance the things that are         ever, if the problem persists find out why
ends, the child is about nine months old.       important to you, your family and the           your child is distressed and what it is that
This is a particularly challenging time to      child, i.e. group size, the ages of the other   frightens or perturbs it. On the other
begin day-care as at this age children are      children in care, the carers’ education and     hand, young children are masters at ad-
very selective in their affection. A child’s    attitude, backup resources when the carer       justing and will find the positive sides de-

88   Baby care                                                                                                                                                               Baby care   89
Services for families with children
                                                                                                                                                    discharged from hospital earlier, many is-
                                                                                                                                                    sues that used to be solved in the postnatal
                                                                                                                                                    ward are now the responsibility of child
                                                                                                                                                    health clinics. Supporting breastfeeding
                                                                                                                                                    and ensuring adequate milk production,
Prenatal and child health clinics                                                                                                                   monitoring skin colour (yellow tint) and
Prenatal and child health clinics operate in      16 times before school-age. Families with                                                         possible infection or cardiac symptoms, and
connection with health care centres. They         under one-year-olds visit the clinic at least                                                     addressing tearfulness caused by hormonal
offer regional health and social services         10 times. After the child has turned one, the                                                     changes, are among these new responsibil-
which are voluntary and free of charge.           family is invited to visit the clinic when the                                                    ities.
Clinics are usually located around the city       child is aged 18 months and then once a                                                                Groups for parents, mothers and fa-
or municipality. Finnish prenatal and child       year (usually around the child’s birthday).                                                       thers meet in most child health clinics.
health clinics comprise a reliable system;            Child health clinic nurses are responsi-                                                      Some clinics organise joint meetings with
nearly all expectant parents and families         ble for monitoring the growth and healthy                                                         more than one family, providing families
with children use their services. Clinics’        development of your child. During an ap-                                                          with the opportunity to meet other parents
personnel are obliged to keep their clients’      pointment, the child’s height, weight and                                                         in addition to seeing the nurse and doctor.
details confidential. According to the            head circumference are measured. Its
health care confidentiality code, no infor-       hearing and sight are controlled and psy-                                                         Social services centre
mation can be forwarded to another health         cho-social development supported and                                                              Families with children needing financial
care unit or professional without the prior       observed. Furthermore, the clinic nurse is                                                        support or home-help services (household
permission of the mother or father.               an invaluable source of information re-           clude screening for diseases and abnormal       chores, child care or help with upbringing)
     Child health clinics promote the             garding the child’s developmental stage,          development, and interpreting the devel-        should contact the social services or fami-
health and well-being of children and their       and topics covered during visits usually in-      opmental disturbances usually first detect-     ly support centre without delay for long-
families with the objective of reducing the       clude nutrition and adherence to a healthy        ed by the clinic nurse.                         term help or support over a shorter period
health differences between families. Child        diet, exercise and activities etc. Speech de-          Other professionals working at the         of time. Services include house calls and
health clinics monitor the physical, social       velopment is monitored during every visit.        child health clinic include family workers,     trained support persons for the family or
and cognitive development of children un-         Breastfeeding advice and guidance is pro-         psychologists, logopaedists, physiothera-       child. Discuss problems related to financ-
der school age. The clinics also aim to sup-      vided as long as required. The clinic’s nurse     pists, nutritional experts and dental care      es, housing or other family issues with a
port parents in implementing safe, child-         will also vaccinate your child according to       professionals. In addition to this wide array   social worker in order to identify viable
centred upbringing strategies and caring          the current Finnish vaccination programme         of professionals, child health clinics also     solutions.
for their children and their mutual rela-         and perform any screening tests required.         work in close co-operation with other in-            Family workers are municipal social
tionship. Attention is increasingly paid to           Clinic nurses offer their professional        stances involved in family care such as mu-     welfare professionals who may be availa-
the early detection of possible problems          expertise to parents, co-operating with the       nicipal home-help services, child welfare,      ble for support when the person normally
and arranging the appropriate help for            families in full confidentiality. Together with   day-care and pre-schools, child guidance        responsible for the family’s finances has
families with children.                           the family, clinic nurses assess the family’s     and family counselling centres, schools and     fallen ill, or is injured or suffers from ex-
     The point of contact is your clinic’s        need for further examinations or support.         specialised health care.                        haustion. Support is provided on the
nurse, who is a professional in promoting             In addition to clinic nurses, child health         The clinic nurse makes at least one        grounds of a social risk, such as birth, lack
health and family care. Clinic nurses are fa-     clinic doctors are the only professionals         house call when the baby is born (house         of rest or some other difficult episode in
miliar with the people and families living in     that meet every family and their children         calls are also recommended prior to birth),     life. Home-help services and child care are
the area. According to the national strategy      within their operating area. Clinic doctors       but may visit at other times as well if this    subject to fees, based on the family’s finan-
and based on the individual needs of fami-        participate in monitoring the child’s health      seems necessary or when the family so           cial standing. These services are free of
lies, clinic nurses meet with families at least   and development. Their responsibilities in-       wishes. Since mothers and newborns are          charge for poor and low-income families.

90 Services for families with children                                                                                                                          Services for families with children   91
    Family work by home-help services            health sector. If the services provided are                                                     (Ensi- ja turvakotien liitto), tel. 09 - 4542
aims to address family problems at an ear-       not adequate, they may be complemented               ALL CHILDREN UNDER THE AGE OF THREE        440, or visit www.ensijaturvakotienliitto.fi.
ly stage and also to offer preventive sup-       with special services. For more information          ARE ENTITLED TO MUNICIPAL DAY-CARE.
port services.                                   on services and benefits available for fam-                                                     Mother and child shelters
                                                 ilies with disabled children, contact your                                                      Mother and child shelters help adults and
Municipal day-care                               municipal social workers or rehabilitation       family should visit the child guidance and     children who have experienced domestic
Municipal day-care supports and comple-          counsellors. For contact details, refer to the   family counselling centre, since the prob-     violence or the threat of violence. Mother
ments child rearing at home and is availa-       municipal guidebook of your place of resi-       lems of one family member tend to have         and child shelters accept single adults and
ble for all families with children. Day-care     dence, white pages or the Internet.              an impact on the whole family.                 parents with children, and are open
applications are submitted to the social              In addition to municipal services, an           The centre’s psychologist, social work-    around-the-clock. A phone call in advance
services centre responsible for organising       array of organisations and parents’ associ-      er and doctor will schedule meetings and       is recommended, but not necessary. Shel-
the municipal day-care services. Charges         ations provide services for disabled chil-       appointments for examinations for the          ters and their helplines are available
for day-care are based on the family’s in-       dren and their families. Associations or-        family together or for each family member      around the clock.
come, family size and daily day-care hours.      ganise adaptation training and various           individually. Services provided at child            You can stay at the shelter from a few
The highest fee is €200 per month. The           forms of educational and recreational ac-        guidance and family counselling centres        days to two months. During this time, par-
family may be exempt from payment on             tivities. For detailed information, please       are confidential and free of charge. For       ents are supported by authorities across
certain grounds.                                 contact the Central Union for Child Wel-         more information, please contact the Finn-     several sectors, in identifying solutions to
    All children under the age of three are      fare (Lastensuojelun keskusliitto), tel. 09 -    ish Association for Child and Family Guid-     their problems. ”Out-patient”support is al-
entitled to municipal day-care. Day-care is      329 6011 or visit www.lskl.fi, or contact        ance, tel. 09 - 272 7470, or visit www.        so provided, and receiving support does
organised in various forms including day-        YTRY, the union’s umbrella organisation          suomenkasper.fi.                               not thereby necessitate staying at the shel-
care centres, family day-care, group family      for disabled and chronically ill children’s                                                     ter. Shelters are maintained by municipali-
day-care and supervised playgrounds. Day-        parents’ associations, or FAIDD (the Finn-       Mother and child homes                         ties and member organisations of the Fed-
care centres offer full and part-time care for   ish Association on Intellectual and Devel-       Mother and child homes provide support         eration of Mother and Child Homes and
children aged 0 to 6 years and supervised        opmental Disabilities), tel. 09 - 348 090 or     in parenting and life management. Moth-        Shelters. For more information, please con-
afternoons for school-aged children. Some        visit at www.kehitysvammaliitto.fi.              ers are welcome during pregnancy or            tact your municipal social service or family
day-care centres provide late night and                                                           when the baby is born. If necessary, fathers   support centre. For online mother and child
overnight childcare services or special needs    Child guidance and family                        may sometimes be accommodated as well.         shelters, please visit www.turvakoti.net.
day-care for children with disabilities.         counselling centres                              In mother and child homes, parents can
                                                 Child guidance and family counselling            practice baby care and daily routines in a     Family guidance centres of
Services for chronically ill or                  centres promote the favourable develop-          supervised environment. A care plan is         the Church of Finland
disabled children                                ment of children and families. Children,         drafted in co-operation with municipal         The church’s family guidance centres wel-
Municipalities are obliged by law to arrange     teens and their families receive support         child welfare according to the family’s        come everyone needing help in problems
services for intellectually disabled children    and advice on issues relating to child rear-     needs.                                         relating to family and relationships. The
whose development has been disturbed             ing, development and relationships be-               Mother and child homes also provide        focus is on family relationships and opera-
due to a congenital illness, defect or injury,   tween family members. Reasons for con-           around-the-clock advice on child care is-      tional methods include individual discus-
or one which has been detected during            tacting a child guidance and family coun-        sues, such as breastfeeding and caring for     sion therapy as well as couples and family
childhood. Support services are arranged         selling centre include conflicts between         a crying baby. Some mother and child           therapy. Help is free of charge and offered
for children with hearing, sight or motoric      family members, children’s fears, inability      homes specialise in problems related to        to members and non-members of the
disability, as laid down in the Act on Servic-   to adjust, shyness and problems at school.       substance abuse. Their operational area in-    Church. Personnel are obliged to keep
es and Assistance for the Disabled               The sooner such problems are addressed,          cludes all of Finland. For more informa-       their clients’ details confidential.
    Children with a disability or injury re-     the easier it is to find a satisfactory solu-    tion, please contact the Federation of              For contact details, please visit www.
ceive services via the social services and       tion. When there is a problem, the whole         Mother and Child Homes and Shelters            evl.fi/kkh/to/kpk/pankyhte.htm. u

92 Services for families with children                                                                                                                       Services for families with children   93
Federation of Mother and
Child Homes and Shelters
The Federation of Mother and Child              ports and protects breastfeeding and posi-      motes the wellbeing of children and of          alternative to intimate partner violence
Homes and Shelters (Ensi- ja turvakotien        tive attitudes towards breastfeeding. The       families with children, increases respect for   (”Lyömätön Linja”). If you need help, call
liitto) is a national child welfare organisa-   association organises breastfeeding cours-      childhood and seeks to make this issue          tel. 09 - 6126 6212 or email lyomaton.
tion aiming to secure a child’s right to fa-    es for support mums and those responsi-         more prominent, and ensures that chil-          linja@miessakit.fi.
vourable living conditions and safe devel-      ble for the local support groups, distributes   dren’s views are taken into account in pub-
opment, support parenting and families,         up-to-date information on breastfeeding         lic decision-making. Visit MLL’s Web pag-       Multicultural Women’s Association
and prevent domestic violence. The Feder-       and breast milk, assists mothers in organ-      es at www.mll.fi for information on the         Monika-Naiset liitto ry. is a multicultural
ation provides assistance to parents in var-    ising local peer support groups, and pub-       growth and development of children and          women’s association promoting equality,
ious problem situations. Further activities     lishes a newsletter on breastfeeding issues.    parenting. There you will also find a guide     human rights, multiculturalism and the
include ”out-patient” support and devel-        For support and more information on             to prenatal and child health clinics intend-    empowerment of women. Its objectives in-
opment projects such as baby blues and          breastfeeding, visit www.imetys.fi, or call     ed for immigrants.                              clude promoting the status of immigrant
the baby sleep solution. For more informa-      the national Breastfeeding Support Line,             MLL has 566 local associations             women in Finland, offering and develop-
tion, please visit www.ensijaturvakotienli-     tel. 041 - 5285 582. Support groups where       throughout the country providing short-         ing services for immigrant women and
itto.fi or call tel. 09 - 4542 440.             mothers assist each other are organised         term child care services when, for example,     children who have experienced intimate
     Also visit Miesten kriisikeskus (Men in    nationwide (for details, please visit www.      the child is ill or the parents need a break    partner violence, preventing social exclu-
Crisis) at www.miestenkriisikeskus.net, or      imetystukilista.net).                           to devote time to hobbies or spend some         sion among immigrant women and pro-
call tel. 09 - 6129 370.                                                                        time together.                                  moting the integration of immigrant wom-
                                                Special-interest Group of                            The parent helpline Vanhempainpuhe-        en into Finnish society.
Folkhälsan                                      Families with Children                          lin (tel. 0600 - 12277) and interactive on-         Services, legal advice and sheltered ac-
Folkhälsan is an organisation in the social     The special-interest group of families with     line help Vanhempainnetti (www.mll.fi)          commodation are available in several lan-
welfare and health care sector that carries     children (Lapsiperheiden etujärjestö) aims      provide guidance and support for parents.       guages. For clients, these services are free
out scientific research and provides social     to act as a direct channel in influencing de-   Another parent who has volunteered and          of charge. Contact Monika-Naiset liitto by
welfare and health care services as well as     cision-makers. The special-interest group       is trained for the task will answer the         phone, tel. 09 - 6943 485, email info@
information and counselling in order to         can be joined via an online mailing list at     phone or reply to your mail. Contacts are       monikanaiset.fi, or visit www.monika-
promote health and quality of life. Folkhäl-    www.lapsiperheet.net. In some locations,        confidential and anonymous. The parent          naiset.fi.
san provides child welfare and child day-       members have formed action groups or-           helpline is available on Mondays at 5 pm
care services, mainly in the Swedish speak-     ganising outings and special events for         to 8 pm, on Tuesdays and Thursdays at 10        National Women’s Line in Finland
ing regions of Finland, and organises baby      families with children, and made proposals      am to 1 pm and 5 pm to 8 pm.                    The National Women’s Line in Finland
swimming in several locations. For more         to develop local services and benefits.                                                         (Naisten Linja) (www.naistenlinja.com) is
information, please contact Folkhälsans                                                         Men’s Association                               a national freephone helpline (tel. 0800
Förbund, tel. 09 - 315 000.                     The Mannerheim League                           The Miessakit Association provides peer         02400) providing information and advice
                                                for Child Welfare                               support for men in crisis and problem sit-      for girls and women affected by violence or
The Breastfeeding Support                       The Mannerheim League for Child Welfare         uations. Visit their Web pages at www.          the threat of violence. Groups intended for
Association in Finland                          (Mannerheimin Lastensuojeluliitto, MLL)         miessakit.fi, or call tel. 09 - 6126 620. The   women and girls meet in the facilities of
The Breastfeeding Support Association in        is a non-governmental organisation and          activities of the Miessakit Association in-     the National Council of Women, in Helsin-
Finland (Imetyksen tuki) promotes, sup-         membership is open to everyone. It pro-         clude providing help for men in finding an      ki (address Mannerheimintie 40 A 17).

94 Services for families with children                                                                                                                      Services for families with children   95
Save the Children Finland                        Sexual Health Clinic                              and is based on volunteer work. Mothers        and needs to give his consent. Counselling
                                                 appointments tel. 09 - 6162 2267,
Save the Children Finland (www.pela.fi) is                                                         who have suffered and recovered from           is provided free of charge to the parents.
                                                 helpline tel. 09 - 644 066
a non-profit, non-governmental Finnish                                                             postnatal depression form a peer group
organisation which fights for children’s         Medical Genetics Clinic                           supporting mothers with PND and their          Miscarriage
rights and aims to improve children’s lives.     tel. 09 - 6162 2246,                              friends and family. ÄIMÄ offers an addi-       Miscarriage or spontaneous abortion is the
Activities include volunteer work; chil-         email med.genet@vaestoliitto.fi                   tional service that complements profes-        spontaneous end of a pregnancy prior to
dren’s holiday housing, support families,                                                          sional aid.                                    22 weeks. In addition to early stage mis-
foster care and group homes in several lo-       The Single Parents’ Association                        For more information on postnatal de-     carriages (when the mother doesn’t even
cations, domestic and international adop-        The single parents’ association Yksin- ja         pression, please visit the association’s       know she has been pregnant), every tenth
tions, sponsor activities, children emer-        yhteishuoltajien liitto provides information      website at www.aima.fi. In addition to peer    pregnancy ends spontaneously in a mis-
gency help, and local and regional devel-        and useful tips for pregnant single mums          support, the association organises meet-       carriage. Most miscarriages occur prior to
opment projects.                                 and parents facing a divorce, via the asso-       ings and training sessions and publishes       12 weeks.
                                                 ciation’s Web pages at www.yyl.fi. Advice         its own magazine. Helpline 040-7467 424,           Miscarriage usually begins with bleed-
The Family Federation of Finland                 and support is also available by phone.           email toimisto@aima.fi.                        ing accompanied by pain in the lower ab-
(Väestöliitto) is an organisation in the so-     Southern Finland tel. 09 - 8777 884, East-                                                       domen and lower back. In most cases, the
cial welfare and health care sector provid-      ern Finland tel. 017 - 2622 644, Northern                                                        cause of the miscarriage cannot be deter-
ing versatile services for families. Visit the   Finland tel. 08 - 334 912.                                                                       mined. Sometimes the foetus never began
Väestöliitto at www.vaestoliitto.fi.                  The Single Parents’ Association aims to                                                     developing (this is called empty sac), while
Central Office                                   improve the quality of life of single parent                                                     in other instances the miscarriage may have
is located in Helsinki, tel. 09 - 228 050
Child Care
                                                 families. The association comprises about
                                                 50 local associations, clubs and meeting
                                                 places. Member families organise free-
                                                                                                   Special situations                             been caused by a severe developmental dis-
                                                                                                                                                  order. The mother’s age, chronic diseases
                                                                                                                                                  and structural weaknesses of the uterus in-
– short-term child care, tel. 09 - 6126 130
                                                 form activities for single parents, meeting                                                      crease the risk of miscarriage. Also, some
Family Network
− services for families with young
                                                 parents, biological parents, widows and           Giving your baby up for adoption               external factors (e.g. strong medications, ra-
                                                 widowers.                                         If you decide to give your baby up for         diation, solvents) may increase the risk.
children, tel. 09 - 6127 102,
                                                      Member associations organise divorce         adoption, you will receive counselling pro-        A miscarriage is confirmed by an ultra-
email perheverkko@vaestoliitto.fi
                                                 seminars for adults and children, meeting         vided either by the Save the Children or-      sound scan performed in a hospital. After a
A Functioning Couple Relationship
                                                 places for single parents, field trips, theatre   ganisation (for more information, please       miscarriage, a D&C (dilatation and curet-
– relationship support and advice,
                                                 visits, supported holidays, training, shared      visit www.pela.fi) or your local Social Wel-   tage) or evacuation is carried out to reduce
tel. 010 - 3093 900
                                                 mother’s/father’s days, Christmas parties         fare office. If necessary, the baby will be    the chance of infection and to ensure that
Family Clinic                                    etc. One in every two associations organis-       placed in a children’s home or a private       you do not continue bleeding. If you expe-
– expertise counselling (psychologist) for       es peer support, meetings for the divorced,       child care home. It is possible to transfer    rience heavy bleeding or if your tempera-
families, appointments tel. 050 - 4403 977       child care networks and supervised kid’s          the baby directly from the hospital, which     ture rises after having a miscarriage, con-
Kotipuu                                          corners.                                          will give the mother time to consider her      tact the hospital as soon as possible.
– multicultural family work, tel. 09 -                                                             decision.                                          Miscarriage is a devastating experience
2280 525, email kotipuu@vaestoliitto.fi          ÄIMÄ - the Association for Mothers                     If the mother decides to give her baby    and stirs up an array of emotions ranging
Men’s Moment                                     Suffering from Depression                         up for adoption, formal consent to adop-       from sadness and guilt to anger and de-
– service for men,                               The ÄIMÄ Association offers support to            tion cannot take place until at least eight    pression. Sometimes it may be advisable to
email miehenaika@vaestoliitto.fi                 mothers suffering from postnatal depres-          weeks after the baby is born. If paternity     go over the experience with a trained pro-
Open-Door Youth Service                          sion and to their friends and family. ÄIMÄ        has been confirmed or the baby is born to      fessional or with someone else who has al-
– services for young people free of charge,      is a member organisation of the Federation        parents who are married to one another,        so had a miscarriage (visit www.enkelisi-
tel. 09- 6162 2267                               of Mother and Child Homes and Shelters            the father is also entitled to counselling     vut.net). Ask your nurse if there is a mis-

96 Services for families with children                                                                                                                         Services for families with children   97
carriage support group in your neighbour-
hood. Väestöliitto, the Family Federation of
Finland, has a support group within its fer-
                                                drome (SIDS). KÄPY ry, the Association for
                                                SIDS and child death families in Finland,
                                                was established to support families who         Social protection for
                                                                                                families with children
tility clinic in Helsinki for couples who       have lost their child. Visit KÄPY ry. at www.
have lost one or more babies to miscar-         kapy.fi. The association’s helpline (0800-
riage (for more information, please visit       95959) is available on Mondays and Thurs-
www.vaestoliitto.fi).                           days from 8:30 am to 11:30 am.
                                                     KÄPY ry. publishes material intended       (Dated 1 January 2008)
The death of a child                            for families who have lost a child and for
The death of a child must be one of the         the people supporting those families. Ac-
most painful experiences in life. It can hap-   tivities include providing trained peer sup-    Up-to-date information on benefits for                       Information on family benefits can al-
pen quite unexpectedly or you may have          port (individuals or families) for parents      families with children is provided by the                so be found online at www.kela.fi/asiointi.
some time to prepare. The sudden and un-        who have lost their child. The association      local offices of the Social Insurance Institu-           You can log in using net bank user IDs
explained death of an apparently healthy        also organises regional get-togethers and       tion of Finland (KELA) and the municipal                 provided by Finnish banks, but please note
infant is called sudden infant death syn-       family weekends. u                              social services department. The informa-                 that the service is only available in Finnish
                                                                                                tion presented herein was correct on 1 Jan-              and Swedish. The online service also pro-
                                                                                                uary 2008.                                               vides the chance to monitor the applica-
                                                                                                     For further information, please see                 tion’s progress and the related fees.
                                                                                                Families with children at www.kela.fi. For
                                                                                                details on parental leave and parental al-               Maternity grant in goods or cash
                                                                                                lowance periods and employment, please                   The maternity grant is intended to be used
                                                                                                visit www.mol.fi and www.tyosuojelu.fi,                  for the baby.You can choose between a cash
                                                                                                respectively.                                            benefit (EUR 140) and a maternity package

                                                                                                BENEFITS APPLIED FOR THROUGH KELA
                                                                                                  ToDo list during pregnancy:
                                                                                                                                      Make an appointment with your doctor or the prenatal clinic before
                                                                                                  Pregnancy diagnosed                 the end of the fourth month of pregnancy .
                                                                                                  Is your work dangerous?                    Grounds for special maternity allowance?
                                                                                                                                                 Pregnancy certificate for maternity allowance, maternity
                                                                                                  Pregnancy has lasted 154 days                  grant and family allowance
                                                                                                                                    2 months in advance
                                                                                                  Notify your employer              (if the intended leave is no more than 12 days, 1 month in advance is sufficient)
                                                                                                  At least 2 months before                     Apply for maternity allowance, maternity grant and family
                                                                                                  the estimated date of delive                 allowance from kela
                                                                                                  50 to 31 weekdays before the estimated date of delivery                     Early maternity allowance period
                                                                                                  30 weekdays before the estimated date of delivery                     Maternity allowance period

98 Services for families with children                                                                                                                              Social protection for families with children 99
containing clothes and child care items.                child’s country of origin (Estonia EUR        titled to take leave from work for this peri-
Mothers who have undergone a medical                    1,900; China and Columbia EUR 4,500;          od. Maternity leave can begin a maximum
examination through a doctor’s appoint-                 other countries EUR 3,000). In internation-   of 50 weekdays and no later than 30 week-
ment or have visited the antenatal clinic               al adoptions, the permission of the Council   days before the estimated date of delivery.
before the end of the fourth month of                   on International Adoption (lapseksiot-
pregnancy are entitled to a maternity                   tamisasioiden lautakunta) is required.        Special maternity allowance
grant.                                                                                                If a pregnant woman needs to be absent
    In cases of multiple birth (twins, tri-             Family allowance                              from work, because her duties or working
plets, quadruplets...), the number of ma-               Family allowance (lapsilisä) is sometimes     conditions present a danger to her own or
ternity grants increases. This increase also            also called ”Child allowance” or ”Child       to the baby’s health and if suitable alterna-
applies to families which adopt several                 Benefit”. It is paid for children under 17    tive work cannot be found nor the risk fac-
children at the same time. You can choose               years of age who are living in Finland.       tors eliminated, she may be entitled to a
to receive cash, packages or a combination              Family allowance is paid once a month in-     special maternity allowance (erityisäitiys-
of both.                                                to the bank account of the child’s legal      raha) paid until the maternity allowance
    Adoptive parents are also entitled to a             guardian. Payments begin in the month         period begins. The special maternity allow-
maternity grant. Furthermore, parents                   following birth and continue until the end    ance can be backdated by up to 4 months.        leave (äitiysvapaa) during the period that
adopting a child from abroad can claim an               of the month in which the child reaches       If the expectant mother is employed, she is     they receive maternity allowance.
adoption grant (adoptiotuki) from KELA.                 the age of 17. Family allowance is untaxed    entitled to take leave from work for the pe-
This adoption grant is a tax-free, one-time             and the amount per child increases with       riod during which she received a special        Parental allowance
payment. Its amount depends on the                      each child:                                   maternity allowance.                            Parents are entitled to 158 weekdays of pa-
                                                                                                           The first maternity allowance instal-      rental allowance (vanhempainraha) and
                                                                                                      ment is paid for a 30-day period and sub-       parental leave (vanhempainvapaa) after
 Child                   First                 Second     Third           Fourth         Fifth        sequent instalments after each 25-day pe-       the maternity allowance period and ma-
                                                                                                      riod. Employees are entitled to maternity       ternity leave have ended.
 EUR/month               100,00                110,50     131,00          151,50         172,00
  Single parents receive an increase of EUR 46.60 for each child.
  Applications for family allowance and raised family allowance should                                                  Maternity, paternity and parental allowance payments
  be submitted to the Social Insurance Institution’s (KELA) local office.

                                                                                                                                                            Father’s month
                                                                                                                                                            = the last 12 weekdays of parental
                                                                                                                                                            leave + 1 to 12 weekdays
                                                                                                         Maternity allowance   Parental allowance
Maternity allowance                                                                                      105 weekdays          158 weekdays

Expectant mothers are entitled to mater-                (EDD), and is entitled to receive Finnish
nity allowance (äitiysraha) when the preg-              benefits.
nancy has lasted 154 days and providing                     Apply for maternity allowance at least
that the mother has been resident either                two months before the estimated date of
in Finland or in another member state of                delivery, from your local KELA office or                               Paternity allowance          Extended parental allowance perio
                                                                                                                               18 weekdays in total         + 60 weekdays for each
the European Economic Area (EEA) or the                 employer’s benefit fund (työpaikkakassa).        EDD
                                                                                                                               during maternity and         additional child
European Union (EU) for 180 days pre-                   Maternity allowance is paid for 105 week-                              parental allowance periods
ceding the estimated date of delivery                   days. If the mother is employed, she is en-

100      Social protection for families with children                                                                                                         Social protection for families with children 101
    For the parents of twins, the parental               allowance to begin. The father’s month                work is made with the employer, for a                If the parents wish to combine the last
allowance period is extended by 60 week-                 (isäkuukausi) is exceptional in that appli-           minimum period of two months.                   12 days of parental allowance with a sub-
days, and for the parents of triplets by 120             cations must be submitted 2 months be-                                                                sequent father’s month, they must notify
weekdays. It is possible for the father to               fore the desired start date. Employees                Benefits for fathers                            KELA of this at least 2 months before the
take these extra days at the same time as                must inform their employers about the                 Fathers participating in the care of the        end of the parental allowance period.
the mother is on maternity or parental                   planned leave of absence at least 2 months            child are entitled to paternity allowance            Paternity allowance is paid retrospec-
leave.                                                   in advance.                                           (isyysraha) and parental allowance (van-        tively for one or more periods, as request-
    Adoptive parents receive parental al-                    Parental allowance is paid retrospec-             hempainraha). These allowances can be           ed. The application period lasts for 2
lowance for at least 200 weekdays for an                 tively for 25 weekdays at a time. Payments            paid to the father if he is married to the      months after the parental allowance peri-
adopted child under 7 years of age when                  begin only after the mother has undergone             child’s mother and they are not separat-        od has ended. For a father’s month that
the adoptive parent leaves his or her work               a post-natal medical examination within 5             ed. They can also be paid to a spouse co-       has been flexibly moved, paternity and pa-
to take care of the child. Adoptive parents              to 12 weeks after childbirth and has pre-             habiting with the mother.                       rental allowances must be applied for 2
must apply for parental allowance within 2               sented a certificate to this effect from a                Adoptive parents can apply for pa-          months in advance from your local KELA
months of receiving the child. Parents liv-              doctor or nurse.                                      rental and paternity allowances from the        office or employer’s benefit fund. Fathers
ing in a registered partnership (rekisteröi-                                                                   Social Insurance Institution KELA. Adop-        must inform their employers about pater-
ty parisuhde) must decide on how to di-                  Partial parental allowance                            tive fathers have the same rights regard-       nity leave at least 2 months in advance. If
vide the parental allowance period among                 Partial parental allowance (osittainen van-           ing paternity allowance and the father’s        the period is no more than 12 days, em-
themselves, when a child is born or adopt-               hempainraha) is half of the full allowance.           month as other fathers.                         ployers must be informed 1 month in ad-
ed after the partnership has been regis-                 The amount is calculated separately for                   Fathers are entitled to paternity al-       vance.
tered.                                                   each parent. Partial parental allowance is            lowance for a total of up to 18 weekdays
    The parents must decide whether pa-                  paid for a maximum of 158 weekdays for                in up to 4 segments during the maternity        Maternity, paternity and parental
rental allowance is paid to the mother or                the birth of one child. It is possible for the        allowance or mother’s parental allowance        allowances are subject to tax
father taking leave from work to care for                parents to share responsibility for taking            period. Fathers are entitled to paternity       Maternity, paternity and parental allow-
the baby. If both parents take parental                  care of the baby by agreeing part-time                leave during the time they receive pater-       ances are subject to tax, which is usually
leave and apply for parental allowance,                  working arrangements with their employ-               nity allowance.                                 withheld by KELA. As a rule, the amount
they both receive a raised allowance pay-                ers for the same period of time and taking                                                            of the allowance is calculated based on the
ment for up to 30 weekdays (60 weekdays                  turns in caring for the child. Work is con-           Father’s month                                  earned income confirmed in the tax re-
in total).                                               sidered part-time work when the total                 Paternity leave now provides more possi-        turn. To calculate an estimate, please visit
    Apply for parental allowance no later                working hours and salary are reduced by               bilities due to additional flexibility in the   www.kela.fi/laskennat where you can
than 1 month before the date you wish the                40% to 60%. The agreement on part-time                dates of the father’s month (isäkuukausi),      find online calculation tools. Please note
                                                                                                               provided that either the father or mother       that, so far, these tools are available only
                                                                                                               cares for the baby at home during the in-       in Finnish.
  Fathers month                                                                                                termittent period.                                  The amount of maternity allowance is
                                                                                                                    Fathers can use the last 12 or more        raised during the first 56 days (over 9
                                                                      Timing chosen by family                  days at the end of the parental allowance       weeks). Normal maternity allowance is
                                                                                                               period instead of the mother, and com-          paid for the subsequent 49 days. However,
                                                                                                               bine them with an extension of 1 to 12          the increase is only added to allowances
      Maternity                                                                   Parental
      allowance             Parental allowance            Home care               allowance          Bonus     weekdays. This father’s month must be           based on confirmed income. The paternity
      105 days              158-12=146 days               allowance               12 days            12 days   taken within 180 days of the last day of        allowance paid for the father’s month can
                                                                                                               the parental allowance period immedi-           be raised if the father did not use up all of
                                                                                                               ately following the maternity allowance         the 30 days during the parental allowance
      Mother                Mother or father           Mother or father                         Father         period.                                         period.

102     Social protection for families with children                                                                                                                 Social protection for families with children 103
    The maternity, paternity and parental            the requirements of a normal child of the
allowances are paid to the employer if the           same age, for a period of over 6 months.                                                       Supplement criteria (EURO/month)
employee receives normal wages during
his or her maternity/paternity and parental          Child care leave and reduced                                    Family members         Income limit        Decrease            Income exceeding         Income exceeding
leave. Should the allowance be greater               working hours                                                      (number)               for full        persentage      the limit for chil home care the limit for private
than his or her salary, the difference be-           After the parental allowance period has                                                   amount                            allowance supplement       day care supplement
longs to the employee.                               ended, parents can take child care leave
    If the mother is at work during her              (hoitovapaa) with full employment securi-
maternity or parental allowance period,              ty to look after a child under 3 years old.                            2           1 160 EURO/month           11,5          2 622,48 EURO/month         2 329,96 EURO/month
her allowance is EUR 15.20 per day during            Both parents cannot be on full-time leave                              3           1 430 EURO/month           9,4           3 219,21 EURO/month         2 861,33 EURO/monthk
working days. If the father is on paternity          at the same time. The minimum length of                            4 or more       1 700 EURO/month           7,9           3 828,93 EURO/month          3 403,11 EURO/month
leave during his military or civilian service,
his allowance is EUR 15.20 per weekday.                                                                                If the family’s income exceeds the limit entitling to a full supplement, the full amount of the supplement
                                                          Care benefits for young children                             is reduced by the cited percentage calculated based on the part exceeding the limit . Only 2 parents and 2
An ill or disabled child                                                                                               children under school age are included in the calculations .
Should your child be ill, you can apply for           Child home care allowance
compensation from KELA. Benefits to se-               One family member must be a child under 3 years              The private day care allowance and an earnings-related supplement
cure the family’s income include special                                                                           are paid for each eligible child.
care allowance (erityishoitoraha) and child           Basic allowance                         EURO/month
home care allowance (lapsen kotihoidon-               - for one child under 3 years           294.28
tuki). For more information, please visit             - for each subsequent child                                  child care leave is 1 month. Parents must                   care at the same time. They may, for exam-
the ”Sickness and disability” section at                     under 3 years old                84.09                inform their employers of the intended                      ple, share the responsibility so that one
www.kela.fi. Disabled children and chil-                     under school age                 50.46                child care leave and its duration a mini-                   parent looks after the child in the morning
dren suffering from a severe illness may be                                                                        mum of 2 months before it begins. Em-                       and the other in the afternoon. Parents
entitled to rehabilitation. Detailed infor-           Supplement (income dependent)                                ployers are not required to compensate                      may also agree on caring for the child on
mation has been published in Finnish in               - paid for one child only, max.         168.19               employees who are on child care leave.                      alternate days or weeks.
the brochure Kuntoutukseen.                                                                                        Credits for paid annual leave do not accrue                      Request partial child care leave from
    Special care allowance (erityishoito-             Parents are not required to care for the child themselves.   during child care leave.                                    your employer no later than 2 months be-
raha) can be paid to the parents of under                                                                              Parents are entitled to an unpaid re-                   fore starting to work reduced hours. For
16-year-old children resident in Finland              Private day care allowance                                   duction in working hours (also called part-                 more information on reduced working
who, on account of participating in the               One family member must be a child under school age           time or partial child care leave (osittainen                hours and partial child care leave, please
treatment of the child, can not carry out                                                                          hoitovapaa) up to the end of the second                     contact your occupational health and safe-
their regular work and are not paid during            Basic allowance                          EURO/month          school year (third school year when the                     ty inspector (työsuojelutarkastaja).
the leave of absence. Special care allow-             - for each child                                             child is in the extended compulsory educa-
ance is paid for care given at home only in             under school age                       137.33              tion system). The related arrangements are                  Child home care allowance and private
the case of a severe illness.                                                                                      agreed between the parent and the em-                       day care allowance
    Disability allowance (vammaistuki)                Supplement                                                   ployer. In practice, reduced working hours                  After the parental allowance period ends,
for persons under the age of 16 is paid to            - for each child under                                       often translate into 6 hours per day or 30                  parents can choose between municipal day
children aged 16 or under and living in                 school age, max.                       134.55              hours per week.                                             care, home care allowance (lasten koti-
Finland, whose disability or illness requires                                                                          Both parents can be on partial child                    hoidon tuki) if the child is under 3 years
care, attention and rehabilitation causing
                                                      The benefit is paid to a private child care provider         care leave during the same calendar peri-                   old, and private day care allowance (yk-
                                                      designated by the parents.
the family stress and limitations exceeding                                                                        od, but they may not both provide child                     sityisen hoidon tuki) if day care for chil-

104   Social protection for families with children                                                                                                                                      Social protection for families with children 105
dren under school age is provided by a pri-          Students                                        subsidies are available to all those who           If either of the parents is performing
vate child care provider approved by the             Full-time study is considered full-time em-     have a low income, provided that interest is   military or civilian service, the family may
local authorities.                                   ployment. When the parent is a student, he      not being capitalised for market-rated stu-    apply for conscript’s allowance (sotilasa-
     The adoptive parents of a child over 3          or she can receive both the study grant         dent loans or provided that the claimant       vustus) for housing and living costs from
years old may receive child home care al-            (opintoraha) as specified in the Act on Stu-    has not received financial aid during the      KELA. For more information, please visit
lowance until 2 years have passed from the           dent Financial Aid, and maternity and pa-       five months preceding the due month for        www.kela.fi.
date on which parental allowance was first           rental allowance of EUR 15.20 per week-         interest-subsidised loans. For more infor-         A parent receiving unemployment
paid. However, this right ends when the              day. If the parent decides not to draw his or   mation on eligibility criteria and applica-    benefit is entitled to a child supplement
child begins school.                                 her study grant, parental allowance can be      tion instructions, please visit KELA at        (lapsikorotus) from the date of birth on-
     It is possible for a family to receive          calculated on the basis of earned income.       www.kela.fi or read the related brochure.      wards. To receive the supplement, the
child home care allowance and private day            Your local KELA office will assist in com-                                                     child’s birth is indicated on unemployment
care allowance at the same time, but for             paring available alternatives and determine     Other forms of benefits                        notification form TT2, which needs to be
different children.                                  how they will affect other income, such as      Families whose income is insufficient to       delivered to the local KELA office or un-
     The child home care allowance consists          the housing supplement (asumistuki).            pay the rent or other fees for an owner-oc-    employment fund (työttömyyskassa).
of a basic allowance (hoitoraha) and a                   If both parents are employed and they       cupied home can apply for housing al-              A retired parent can receive a child
supplement (lisäosa) paid for one child              have agreed that the parental allowance is      lowance (asumistuki) from KELA. For            supplement for his or her pension, begin-
only. Eligibility for the supplement and the         to be paid to the father, he will receive a     more information, please visit KELA at         ning on the month following the baby’s
amount paid depend on the family’s in-               parental allowance of EUR 15.20 per             www.kela.fi or read the brochure on            birth. A child supplement is applied for
come.                                                weekday.                                        housing benefits.                              through your local KELA office.
     As a rule, the allowance is not paid for            In addition to income subject to tax
children permanently or temporarily resid-           and other forms of income benefits, ma-
ing abroad. However, a child residing in a           ternity and parental allowances, together
member state of the European Economic                with the child home care allowance, are
Area (EEA) or the European Union (EU)                considered when awarding a study grant.
may be eligible for home care allowance. A           Students have personal limits for annual
family receiving maternity and parental al-          income based on the number of months
lowances may receive home care or private            they have drawn a study grant or housing
day care allowance for its other children un-        allowance. Any income exceeding the an-
der school age. Child home care basic allow-         nual limit affects the amount of study
ance is adjusted to the parental allowance.          grant and housing allowance. For more in-
     Partial care allowance (osittainen hoito-       formation on the annual income limits,
raha) is available for parents who are work-         please read the KELA brochure on study
ing reduced hours (max. 30 hours/week) to            grants or use the online calculation tool to
look after the child. When parents share             determine your annual income limit at
the care of the child, they are both entitled        www.kela.fi/opintotuki. Please note that
to partial care allowance.                           these online tools are so far only available
     Applications for child home care al-            in Finnish.
lowance, private day care allowance and
partial care allowance are submitted to the          Student loan interest subsidies
Social Insurance Institution’s (KELA) of-            KELA pays the interest in full on student
fice. These allowances can be backdated              loans guaranteed by the State. Students are
up to 6 months.                                      not obliged to repay the subsidies. Interest

106   Social protection for families with children                                                                                                        Social protection for families with children 107
Municipal benefits                                   cases. Maintenance allowance (elatusapu)
                                                     may be provided when one or both of the
                                                     parents do not take care of the child’s main-
                                                     tenance. The amount of maintenance al-
Children born outside marriage                       lowance is determined through a contract
The mother is always the legal guardian of           or a court order. Maintenance allowance is
the child, if the parents are not married.           paid monthly in advance or as an one-time
However, the father may choose to be-                payment and is revised according to the
come established as the child’s guardian             cost of living index. It is recommended that
either together with the mother or alone.            you contact your social services department
In such a case, paternity must be con-               at the beginning of each year to find out the
firmed and the parents need to enter into            revised amount.
a written agreement endorsed by the social                If the liable parent cannot pay the
welfare body in question or a court of law           maintenance allowance agreed upon or ne-
must decide on joint custody.                        glects the payments, the child is entitled to
    Paternity is confirmed either by ac-             maintenance support (elatustuki). Main-
knowledging paternity before a magistrate            tenance support is also paid to children
or through a court action. This also applies         whose father has not been established and
to co-habiting parents. The municipal child          when the amount of maintenance allow-
welfare officer is responsible for proceed-          ance is smaller than maintenance support.
ings confirming paternity. Paternity must be         Maintenance support is EUR 118.15 per
established before it can be confirmed. To           month per child. It is paid from municipal
establish biological paternity, the necessary        funds and applied for through the social
evidence is obtained through tests. If neces-        service board.
sary, paternity testing through forensic ge-
netics is applied to establish or refute pater-      Income support
nity. Blood or buccal swap samples are test-         Families with insurmountable financial
ed at the National Public Health Institute or        problems may apply for income support
in the University of Helsinki Department of          (toimeentulotuki). All income and assets
Forensic Medicine. The mother has the right          available are considered when the need for
to refuse to establish the identity of the fa-       support is assessed. Applications for in-
ther. The child welfare officer does not have        come support are submitted to the social
permission to continue establishing pater-           services department.
nity against the mother’s wishes, except
when a man has acknowledged paternity.               Support for informal care
                                                     Support for informal care (omaishoidontu-
Child maintenance and support                        ki) is intended for supporting the home
Children have the right to sufficient main-          care of chronically ill patients, disabled
tenance from their parents. Children born            people and the elderly. The parents of a
to unmarried parents are also entitled to            disabled or ill child can apply for informal
maintenance from their fathers, due to               care support from the local social services
which paternity must be established in such          department. u

108   Social protection for families with children                                                           109

110     111

112     113

                               “We’re having a baby”
       is a guidebook for expectant parents. Prenatal clinics issue all expectant
             mothers a copy free of charge. This guidebook is also available
           in Finnish (”Meille tulee vauva”) and Swedish (”Vi väntar barn”).
 The original guidebook text was edited by Ms. Sirpa Taskinen. This revised version is
   based on the original and edited by Anna Kokko (Sociologist in Family Studies,
  University of Helsinki) and Johanna Lammi-Taskula (Senior Researcher, STAKES).
   Other people who have contributed to this guidebook include Arja Haapakorva
    (the Development and Research Centre for Maternity and Child Health Care),
Merja Kumpula (Finland’s Midwives Association), Suvi Mieskonen (Helsinki University
  Hospital, Jorvi Hospital), Minna Oulasmaa (the Family Federation of Finland) and
    Maire Kolimaa and Marjaana Pelkonen (Ministry of Social Affairs and Health).
            We would like to extend our warmest thanks to the experts and
                  parents who have shared their knowledge with us!
                Feedback? Please contact Johanna Lammi-Taskula,
     address STAKES, PL 220, 00531 Helsinki, or email johanna.lammi@stakes.fi.
                  For copies of ”We’re having a baby” please contact
  the National Research and Development Centre for Welfare and Health, STAKES,
                       Raija Rantamäki, PL 220, 00531 Helsinki
                (fax 09 - 3967 2170), email raija.rantamaki@stakes.fi.
        These guidebooks are provided free of charge for health care centres;
                       in other instances a fee will be charged.

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