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Maternity Leaflets

Each of the Maternity leaflets are detailed below, select the heading of the one you would like to view and the content will expand with an option for you to download the PDF version.

Leaflets can be made available in difference formats on request, to view in a different language select the language change in the bottom left of the screen.

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If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at

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Please note that Google Translate is the tool that is used to translate information on our website to other languages. Google Translate is a global tool that is not under Liverpool Women’s control. Therefore whilst you may use Google Translate for useful simple translations, it should not be relied upon as a substitute for official translation services that are provided by the Trust. Please take particular notice of this when you are using the translation feature for patient information that contains detailed clinical information. Speak to a member of staff when you visit the Trust if you require any translation support.

  • What is Toxoplasmosis?

    The leaflet is detailed below, or you can download 'What is Toxoplasmosis?' leaflet in PDF. 

    What Is Toxoplasmosis?

    Toxoplasmosis is an infection caused by a parasite called Toxoplasma Gondii.

    This is a microscopic single cell organism that can be found in meat and cat faeces (poo). It is also found in the soil where cats defecate (where they go to poo), and unpasteurised goats’ milk. The parasite can infect most birds and warm-blooded animals, including humans.

    Cats are the only animals that can have infected faeces.

    A cat can shed infectious faeces for about 14 days when it has been in contact with the parasite.

    A healthy cat will not normally be a source of infection. You cannot become infected from stroking a cat, only by coming into contact with cat faeces.

    How Could I Get It?

    Toxoplasmosis can be caught by eating or having contact with anything infected or contaminated by the parasite. They include:

    • Raw or undercooked meat, also including raw cured meat. e.g. Parma ham, salami
    • Unwashed vegetables and fruit
    • Cat faeces/ litter box
    • Soil contamination with cat faeces
    • Unpasteurised goats’ milk and dairy products made from it e.g. cheese
    • Soil or water that has been infected
    • Working in the farming industry- Lambing is a particular risk to pregnant women
    • Working in the garden without using gloves
    • Working in catering without using gloves
    • Working with animals

    Person-to-person infection is not possible, except from mother to unborn baby. It is possible for transmission of the organism across the placenta if the mother becomes infected. Once you’ve been infected once, you will not catch it again.

    How Can Toxoplasmosis Affect Me?

    This infection doesn’t always cause symptoms and in most cases you may not realise that you have had it.

    In some people it can cause ‘flu-like’ symptoms or symptoms similar to glandular fever. Once you have had Toxoplasmosis you are generally thought to have life-long protection, unless you have problems with your immune system.

    It can seriously affect an unborn baby, which is why we urge pregnant women to protect themselves and reduce the risk of becoming infected.

    How Can Toxoplasmosis Affect My Baby?

    Toxoplasmosis can be passed on to the unborn baby if the infection is caught for the first time in pregnancy or just prior to conception. This is called Congenital Toxoplasmosis.

    The risk to the developing baby depends on when in the pregnancy the infection was acquired. If you catch it earlier on in your pregnancy, the effects can be more severe than catching it later on. If you catch Toxoplasmosis in pregnancy, it does not mean that the baby will be infected. Around 4 out of 10 babies of affected pregnant mums may also become infected.

    Although rare, Toxoplasmosis caught in pregnancy can cause the following problems with an unborn baby:

    • Miscarriage
    • Stillbirth
    • Learning difficulties as a result of damage to the baby’s brain
    • Problems with the eyes and hearing
    • Infection of the eyes
    • Enlarged liver & spleen
    • Jaundice (yellowing of the skin)
    • Pneumonia

    It’s thought that somewhere between 1 in 10,000 to 30,000 babies are affected by Congenital Toxoplasmosis. Most babies will have minor symptoms, or symptoms which do not become apparent until the baby grows up.

    How Can I Protect Myself And My Unborn Baby?

    You can reduce your risk of infection by following the advice below:

    • Avoid raw, undercooked and cured meats
    • Wear protective clothing such as gloves and a face shield if you work in high risk industries such as farming (in particular lambing), catering, gardening or working on the land or with animals.
    • Wear gloves when gardening at home
    • Avoid cleaning cat litter trays (ask a family member to do this instead), or at least wear gloves
    • Wash your hands before & after handling food, touching animals or doing any of the above
    • Clean food preparation surfaces and kitchen utensils thoroughly
    • Wash all fruit and veg including pre-prepared salads
    • Avoid unpasteurised dairy products (including products made from goats milk)

    The NHS does not routinely screen pregnant women for Toxoplasmosis as it is rare. However, if you feel you may have come into contact with it, ask your midwife or doctor about having a blood test. The infection may not show in your test results until 3 weeks after you became infected.

    Treatment is in antibiotic form, however this may only help reduce the effects of transmission to the baby.

    Scans and other tests can help determine any damage that may have resulted from Toxoplasmosis infection.

    If in doubt, always ask your midwife or doctor.

  • Sterilisation (Tubal Ligation) at Caesarean Section

    The leaflet is detailed below, or you can download 'Sterilisation (Tubal Ligation) at Caesarean Section' leaflet in PDF. 


    This information is for women who may have a Caesarean Section birth and have considered having a sterilisation at the same time. Sterilisation can prevent future pregnancies. The fallopian tubes link the ovaries to the womb (uterus). When they are tied off, the egg does not reach the womb and therefore a pregnancy does not occur. This procedure is known as sterilisation or tubal ligation.

    Why Do A Sterilisation Procedure?

    • If you are sure you do not want to get pregnant again.
    • If future pregnancies may be dangerous to your health.
    • If you cannot, or do not want to use any other form of contraception.
    • It is more than 99% effective at preventing pregnancy.

    How Is The Sterilisation Done?

    • Once the baby is born and placenta (afterbirth) is removed, the uterus (womb) is sewn back together. The surgeon will then locate the fallopian tubes, which are attached to each side of the uterus. Each of these two tubes needs to be operated on to stop a pregnancy occurring. This usually means removing a piece from the middle of the tube and tying each end.
    • The surgeon then makes sure there is no bleeding and finishes the operation like any other caesarean.

    Why Do A Sterilisation at a Caesarean Section?

    • You will have already been given an anaesthetic for the caesarean, which will work for the sterilisation as well.
    • It is usually easy to see the tubes when doing a caesarean and so the sterilisation operation should not be difficult.
    • A separate operation can be avoided in the future and for some women this is a much safer option than having two procedures.

    Does It Make The Caesarean Any Longer Or More Dangerous?

    • Usually it takes about ten minutes extra to do the sterilisation as part of the operation.
    • If there is a lot of unexpected internal scarring from previous surgery it may take longer. Very rarely it may be impossible to do the sterilisation because of such scarring.
    • There is a possibility that the tubes can bleed when they are cut. Dealing with this bleeding can make the whole operation longer. (There is the risk of heavy bleeding with all caesarean sections and the very small chance that further steps including a hysterectomy can be necessary. Please read the information sheet about caesarean sections.)

    What Risks Are There If I Have The Sterilisation Done During My Caesarean Section?

    • You may regret having the operation in the future.
    • The risk of heavy bleeding as above. This is not greatly different than for a Caesarean section alone. Occasionally the procedure has to be abandoned as it is more important to control the bleeding.
    • The risk of infection and blood clots occurring after the operation. These are also similar to a caesarean section alone.
    • The risk of the sterilisation failing. For all sterilisation operations there is a chance that the woman may become pregnant in the future. This is thought to happen in about 2-5 in 1000 operations but may be more common if the sterilisation is done during a caesarean.
    • The risk of an ectopic (tubal) pregnancy occurring in the future. An ectopic pregnancy is when the egg is fertilised but the pregnancy is not in the womb. This is less likely than a normal pregnancy occurring but can be a life threatening condition.

    Can The Sterilisation Be Reversed?

    This cannot be guaranteed and a reversal operation may not be available on the NHS. Therefore you must be sure that you want to be sterilised before requesting this procedure.

    Will My Periods Be Different?

    Many women find that their periods are different after giving birth.

    The sterilisation itself will not change your periods.

    What Other Options Are There?

    As well as many other forms of contraception there may be the option of having sterilisation done during the first few months after your baby is born. You should discuss this possibility with your doctor. 

    As with all operations, you need to understand the risks and benefits of having a sterilisation carried out during your caesarean section. It is important that you ask the doctors and midwives who are looking after you to explain anything that you do not understand.

    This information is not intended to replace discussion with either medical or midwifery staff. If you have any questions regarding the contents of this leaflet please discuss this with a midwife or obstetrician. The hospital is heavily involved in research and you might be asked to consider taking part in a research study. A midwife or doctor will discuss this with you and answer any questions that you may have.


  • Pelvic Floor Exercises for Pregnant Women

    The leaflet is detailed below, or you can download 'Pelvic Floor Exercises for Pregnant Women' leaflet in PDF. 

    Where Are My Pelvic Floor Muscles?

    The pelvic floor muscles are attached between the bottom of your spine (coccyx) and the pubic bone at the front.

    What Do They Do?

    Pelvic floor muscles support your bladder, the uterus (womb) and the bowel. These muscles help your bladder and bowel control so the muscles need to be strong and firm. If they are weak they cannot provide the support and control that you need, which means that urine leakage can happen.

    Why Do I Need To Do Pelvic Floor Exercises?

    Doing pelvic floor exercises helps to keep the muscles strong and reduce the risk of developing the following problems:

    If your pelvic floor is weak you may leak urine when you cough, sneeze, laugh, exercise, bend, stretch or pick things up. (This is called urinary stress incontinence).

    If your pelvic floor is weak you may not be able to stop yourself passing ‘Wind’ (Flatus).

    The pelvic floor muscles may start to fall down and push against the walls of the vagina. This is called a prolapse. It can sometimes protrude from the opening of the vagina. 

    Why Do The Pelvic Floor Muscles Become Weak?

    The pelvic floor muscles can be weakened or damaged in many ways.

    • During pregnancy
    • A chronic or ‘smoker’s’ cough
    • After childbirth (with all types of birth)
    • Lack of general fitness
    • Changes due to the menopause and age
    • Too much lifting of heavy things
    • A history of chronic constipation
    • Being overweight

    How Should I Do Pelvic Floor Exercises?

    Choose any comfortable position, with your knees slightly apart.

    Tighten up your back passage as though you are trying to stop passing wind. Then tighten up as if you are trying to stop yourself from passing urine. Do these two things together and you will be exercising your pelvic floor muscles. The feeling is one of ‘squeeze and lift’, closing and drawing up the back and front passages.

    It Is Easy To Use The Wrong Muscles Instead Of The Pelvic Floor Muscles.

    • Don’t clench your buttocks or your tummy muscles.
    • Don’t hold your breath.
    • Don’t squeeze your legs together.

    You can check that you are using the correct muscles when you pass urine. Stop the flow of urine in the middle (as if doing a mid-stream specimen of urine). This is not an exercise. You should only do it once to find the correct muscles. Make sure that you empty your bladder completely after trying this.

    It is important that you use the right muscles otherwise the exercises will not help.

    You can do the exercises sitting, lying or standing. Try to do the exercises both slow and fast.

    Slow Exercises

    • Gradually tighten the muscles and hold while you count to 10.
    • Try to do 10 of these holding exercises with 10-20 seconds rest in between each hold.
    • They help muscles support your bladder and bowel.

    Fast Exercises

    • Tighten and relax the muscles quickly. Try to do 10 of these exercises. This helps muscles stop urine leaking when you sneeze or laugh.

    Your Pelvic Floor Workout

    • Build up to doing 10 slow exercises and 10 fast exercises
    • Do the exercises three times every day
    • Tighten up muscles before coughing, sneezing, laughing and lifting.

    As your pregnancy advances and the baby grows inside you, you may find it hard to do the exercises. If this happens, don’t worry – just try and do your exercises when you can.

    It may be harder to do the exercises at the end of a busy day, as you may be more tired generally.

    The exercises should not make you sore but if you get any discomfort then stop doing them for a few days and begin again gently.

    The exercises are safe to do in pregnancy but if you are not sure, your midwife will be able to advise you.

    When you have had your baby, you should start trying to do your pelvic floor exercises when you are comfortable. Your midwife will give information on postnatal exercises while you are in hospital.

    For Further Information

    Bladder & Bowel UK                                                

    Bladder health UK                                 

    Continence foundation                          

  • Women with Group B Streptococci (GBS) In Pregnancy

    The leaflet is detailed below, or you can download 'Women with Group B Streptococci (GBS) In Pregnancy' leaflet in PDF.

    Information for Women with Group B Streptococci (GBS) In Pregnancy

    Some women (approximately 20-25%) are found to be carriers of bacteria known as Group B Streptococci (GBS) in the UK. This bacterium is often identified during routine screening of urine or swabs from the vagina during pregnancy. However, this does not mean that you have an infection and treatment is not required. There is no need for special monitoring during the pregnancy.

    About 1% of babies whose mothers are carriers will be affected by GBS. However, to prevent your baby from becoming infected during labour and birth it is important that antibiotics are given during labour. This is referred to as “prophylactic treatment”, which means prevention or to take precaution. Ideally, the antibiotics should be given at least four hours prior to the birth of your baby.

    The doctor or midwife in the antenatal clinic will explain and answer any questions you may have. He/ she will write instructions for your treatment in your hand held notes.

    It is normal for these antibiotics to be given by injection into a vein in your arm (this is referred to as an intravenous injection). Depending on the length of labour, the antibiotics will be given every six hours.

    Although this information will be written in your records, it is important that you remind the doctor and midwife when you are in labour so they are aware and the necessary treatment can be given.

    It is very important that you bring your case notes with you when you are admitted to the delivery suite or midwifery-led unit.

    Your Baby

    After the birth, the paediatrician or midwife will examine your baby. This is routine practice and in addition to this, the staff will check baby’s temperature every two hours for a period of 12 hours. This means that baby will need to stay in hospital for at least 12 hours after birth to ensure your baby is fit and well for discharge home.

    Key Points

    • Antibiotics are required during labour.
    • Information and plan of action is clearly written in hand-held notes.
    • Always bring your hand-held notes with you when you attend hospital.
    • When labour commences or your waters break, it is important that the midwife on the labour ward is informed that antibiotics are required. This information should be given first when you telephone and again on arrival at delivery suite or midwifery-led unit.
    • Hospital stay will be for a minimum of 12hrs after the birth of baby.

    This information is not intended to replace discussion with either medical or midwifery staff. If you have any questions regarding the contents of this leaflet please discuss this with a midwife or obstetrician. The hospital is heavily involved in research and you might be asked to consider taking part in a research study.

    A midwife or doctor will discuss this with you and answer any questions that you may have.

    Support Group

    The Group B Strep Support Group can be contacted at:

    Group B Strep Support

    West Sussex

    RH16 1GF

    Tel 01444 416176

    Fax 0870 1615540


    Or visit the web site at

  • When a Scan Shows a Nuchal Translucency (NT) Measurement of 3.5 Millimetres or More

    The leaflet is detailed below, or you can download 'When a Scan Shows a Nuchal Translucency (NT) Measurement of 3.5 Millimetres or More' leaflet in PDF.

    We have given you this leaflet because your baby’s nuchal translucency (NT) is 3.5mm or more. We hope that this leaflet will answer some of your questions. We will offer you an appointment to see a Consultant in the Fetal Medicine Unit at Liverpool Women's Hospital so they can assess your pregnancy and offer further tests if necessary.

    What Is Nuchal Translucency (NT)?

    Every unborn baby has some fluid under the skin at the back of their neck. This fluid is called nuchal translucency (NT). You can see this fluid on the ultrasound scan early in pregnancy. It is part of a baby’s normal development in the womb. If your baby has more fluid than usual, it can sometimes be a sign they have a health problem. This may be a physical problem (for example, a heart problem) or chromosome condition (for example, Down’s syndrome).

    It is important to remember that many babies who have more fluid than usual at the back of their neck at an early scan are born healthy and well.

    Why Do You Measure NT?

    All pregnant women in England are offered a screening test to give them information on the chance of their baby having one of three chromosomal conditions; Down’s, Edwards or Patau’s. We measure NT as part of the ‘combined’ screen test for these syndromes. This test combines the results of a blood test taken from the mother with the measurement of the NT from the baby seen on the scan and clinical information written on the form.

    You may have chosen not to have your baby screened for Down’s, Edwards or Patau’s syndromes. However, because an increased NT can also be linked with other physical problems and other chromosomal conditions in your baby, the person doing the scan will tell you if they see more than 3.5mm of fluid at the back of your baby’s neck.

    What Is A Normal NT Measurement?

    We cannot give you a normal figure, because the NT usually grows in proportion with your baby. This means that the measurement depends on how many weeks pregnant you are when you have your scan. However, we do know that if early in your pregnancy your NT is 3.5mm or more, there is more chance that your baby will have a physical problem or chromosome condition.

    What Happens Now I Know My Baby Has An Increased NT Measurement?

    You will be offered an appointment to see a Consultant in the Fetal Medicine Unit at Liverpool Women's Hospital so they can assess your pregnancy via specialist scan(s). Depending on the findings, you may be offered further tests. We aim to offer you an appointment within 3-5 working days from your ultrasound scan. 

    You will be contacted by a Fetal Medicine Midwife by telephone or post to inform you of the date of your appointment as soon as possible.

    Although this can be worrying, it is important to remember that many babies with a raised NT measurement are healthy. An increased NT does not mean there is definitely a problem.

    Please do not forget to bring your hand held notes to your appointment

    Who Can I Contact For Further Information & Support?

    Fetal Medicine Unit 0151 702 4072 9-5pm Monday to Friday

    Screening Midwife 0151 708 9988 ext 1083 9-5pm Monday to Friday

    Maternity Assist – online information and support for women booked into maternity care at Liverpool women’s Hospital - please type Maternity Assist into your search engine or use this web address:  

    Antenatal Results & Choices (ARC) – a national charity helping parents and healthcare professionals through antenatal screening and its consequences - 020 7713 7356 or use this web address:

  • Why Have I Been Referred To The Fetal Medicine Unit?

    The leaflet is detailed below, or you can download 'Why Have I Been Referred To The Fetal Medicine Unit?' leaflet in PDF.

    Your sonographer suspects or has found a problem with your baby, the exact nature of this may not be clear at this stage. The sonographer will explain to you the reasons for her/his concerns. You will be offered an appointment to see a Consultant in the Fetal Medicine Unit at Liverpool Women's Hospital so they can assess your pregnancy via specialist scan(s).

    What is the Fetal Medicine Unit?

    Most pregnancies progress without any complications. However, sometimes a mother or her unborn baby needs extra care from our highly experienced Fetal Medicine team - made up of specialists including fetal consultants, midwives and healthcare assistants. As a specialist unit within Liverpool Women’s, we receive many referrals from health professionals throughout the North West and further afield.

    When Will I Be Seen?

    We aim to offer you an appointment within 3-5 working days from your ultrasound scan in our Fetal Medicine Unit. However if your baby is suspected as having a problem needing specific multidisciplinary input you may wait a little longer in order to see the appropriate professionals.

    What Happens Next?

    We know this is a worrying time for you and your family. We are aware that it is very stressful waiting for a follow up scan to clarify the findings. You will be contacted by a Fetal Medicine Midwife by telephone or post to inform you of the date of your appointment as soon as possible.

    Please do not forget to bring your hand held notes to your appointment.

    Who Can I Contact For Further Information & Support?

    • Fetal Medicine Unit 0151 702 4072 9-5pm Monday to Friday
    • Maternity Assist – online information and support for women booked into maternity care at Liverpool women’s Hospital - please type Maternity Assist into your search engine or use this web address:

    Antenatal Results & Choices (ARC) – a national charity helping parents and healthcare professionals through antenatal screening and its consequences - 020 7713 7356 or use this web address:

  • Congenital Diaphragmatic Hernia

    The leaflet is detailed below, or you can download 'Congenital Diaphragmatic Hernia' leaflet in PDF.

    What Is It?

    The diaphragm is a sheet of muscle which separates the chest from the abdomen. A congenital diaphragmatic hernia (CDH) is a hole in the diaphragm which the abdominal organs (bowel, stomach and liver) can slide through. This squashes the lungs and pushes the heart over to one side of the chest.

    What Causes It?

    The diaphragm muscle does not develop properly in early pregnancy. We do not know why this happens. This is something which cannot be prevented.

    How Often Does This Happen?

    CDH occurs in about 1 in every 2,500 babies.

    How Does It Affect The Baby?

    Unfortunately this is a serious problem. Half (50%) of the babies who have this problem do not survive.

    Reasons Why These Babies Sometimes Die

    Many babies with CDH have problems with the lungs. The lungs are small and squashed. This is because the hernia sits in the space where the lung should be and prevents the lung from growing. The baby’s heart is pushed to one side and then the other lung also gets squashed. This means that the lungs do not work properly after the birth and sometimes the baby dies very quickly. In about ¼ of babies with CDH there are other abnormalities as well. These abnormalities are divided into 3 groups:

    • Chromosomal abnormality. Chromosomes are passed on from our parents. They carry the genetic instructions for our bodies to develop. Normally we have 46 chromosomes in all the cells in our bodies. Sometimes an extra chromosome is passed on. The most well-known chromosomal abnormality is Downs’s syndrome when the baby has 47 chromosomes instead of 46.
    • Sometimes the baby will have a rare genetic syndrome
    • Babies with CDH can also have serious heart problems.

    What Can We Do To Help You?

    It is very important to find out if there are other problems as well as the CDH. We would like to do 2 other tests which will give us more information.


    A very fine needle is passed into the womb in order to test the fluid around the baby. This test will check that the baby has the right number of chromosomes. There is a very small risk of miscarriage with this test (1/2 to 1%). Results may take up to 3 weeks. The results of this test are very reliable (99.9%)



    This is a special scan of the baby’s heart. It will tell us if there are any problems with the heart or the blood vessels around the heart. If either of these tests shows that there is a serious abnormality you will be given as much information as possible about the chances of the baby surviving and any special problems the baby may have. You will also have the option of continuing or ending the pregnancy.

    What Happens Next?

    During the pregnancy you will be offered scans every month to check on the baby’s progress. The doctor will be looking closely at the baby’s lungs to see how they are growing. It is very important that you keep your usual antenatal appointments with your midwife or GP. You might like to visit the special care baby unit to see where your baby will be looked after when he/she is born. You may find it helpful to talk to the staff there. It is also helpful for you to meet to the specialist doctor who may be looking after your baby in Alder Hey Hospital. Advances in fetal medicine have meant that some conditions can be operated on while the baby is still in the womb. However, this is an area which is still very new and is currently being evaluated in the United States. The baby will be delivered around the time when he or she is due. The delivery will be timed so that the paediatricians are prepared for the arrival of your baby.

    Usually these babies are delivered normally unless there are any special reasons for a caesarean section.

    After the delivery the baby is nursed on the special care baby unit. A ventilator will help the baby to breathe and the baby will need intensive nursing care. A small percentage of babies may have oxygen given directly into their bloodstream by a process known as ECMO (Extra Corporeal Membrane Oxygenation). When the baby is well enough he/she will be transferred to Alder Hey children’s hospital. However, about 10% of all babies born with CDH are too ill to have surgery.

    How Can Surgery Help?

    The surgeon will make an opening just under the ribs and push the bowel back down into the abdomen. The hole in the diaphragm is then repaired. If there are enough diaphragms then the two edges of the hole are stitched together. If not, then a patch is put in. The skin is then stitched as well. The baby will remain on a ventilator until the lungs are strong enough to work on their own. This may take days or weeks. Extra oxygen may be required for a little while after the ventilator has been discontinued. Some babies with very small lungs can have long term lung problems (including wheezing) and may need extra oxygen for some time due to underlying chronic lung disease. Most babies who do well after surgery are weaned off the ventilator quickly and do extremely well. These children do go on to lead normal lives after surgery.

    Can This Problem Happen Again In A Future Pregnancy? 

    The chance of your next baby having a congenital diaphragmatic hernia is very small. The risk is approximately 2 %.

    Support Groups


    16 Hillson Drive, Fareham, PO15 6EX

    Tel. 01329 841436

    Contact a Family

    170 Tottenham Court Rd. London W1T 7HA

    Tel. 020 7383 3555

    Fax. 020 7383 0259



    Birth Defects Foundation

    Martindale, Cannock, Staffordshire, WS11 2XN

    Tel. 01543 468888

    Fax. 0543 468999

    Family Helpline. 08700 70 70 20





    The Association of Congenital Diaphragmatic Hernia Research, Advocacy and Support, P.O. Box 1150, Creedmoor, NC 27522, USA

    Tel. 919 693 8158

    1. 834.8158.(toll free)

    Fax. 707 924 1114



  • Skin to Skin Contact with your Baby

    The leaflet is detailed below, or you can download 'Skin to Skin Contact with your Baby' leaflet in PDF.

    Skin to skin contact is beneficial for both you and your baby. Your midwife will offer skin to skin contact to you at delivery.

    Why Skin Contact Is Important

    • Keeps baby warm
    • Calms you and your baby
    • Your baby’s heart rate and breathing will be better controlled
    • Encourages bonding between you and your baby
    • Regular periods of skin contact in the early month increases a baby’s brain development
    • Skin contact and early feeding promotes successful breastfeeding

    Weighing Your Baby

    Your midwife will either weigh your baby soon after delivery and then you can have skin contact or you can have skin contact first and then have the baby weighed later.

    How to Do Skin Contact

    After birth your baby will be gently dried and placed on your chest in an upright position, with their chest to your chest. A blanket will be placed over your baby but not covering the baby’s head.

    Whilst baby is in skin contact make sure you can see your baby’s face and can hold your baby safely. It is advisable that your birth partner stays with you in the room after delivery while you are having skin contact with your baby.

    Skin to skin contact should continue uninterrupted for as long as possible immediately after delivery and continue long enough for the baby to show signs of being ready to feed (this can take up to an hour or more). You can of course choose to end this contact whenever you wish.

    Make the most of this special time immediately after the birth of your new baby. At no other time will you or your baby have such high levels of hormones to encourage bonding. Your baby will, if left uninterrupted in a quiet and unhurried environment go through a pattern of behaviour to show that he/she is ready to feed. At this point you will be offered help to feed your baby.

    If you require a caesarean section to deliver your baby, we will ensure that you will receive skin to skin contact as soon as possible after your operation.

    All mums regardless of type of birth can be transferred to the postnatal ward in skin contact if they wish.

    Points to Remember

    In the early days skin to skin contact will be of great benefit in encouraging your baby to feed and for you to get to know your baby. Skin to skin contact will help to keep your baby warm so do not worry about your baby getting cold.

    Skin to skin contact is useful at any time in a baby’s first year of life e.g. if your baby is very unsettled. The close contact and warmth from your body along with your regular heart rate and breathing will comfort and calm your baby. Partners can also have skin contact to help settle and get to know their baby.

    Babies Admitted To Neonatal Unit

    Sometimes it may not be possible to have skin to skin contact with your baby straight away, for example if your baby is unwell or very premature. However, skin to skin contact can be introduced gradually as your baby gets better. There are huge benefits of skin to skin contact for premature babies and we actively encourage this.

    For more information ask your midwife

  • Food Information

    The leaflet is detailed below, or you can download 'Food Informationleaflet in PDF.





    To avoid risk of Listeriosis:

    Avoid ripened soft cheeses – Brie, Camembert and blue veined cheese – like Stilton and Danish Blue 

    You can eat hard cheese like – Cheddar, parmesan and cheese made from pasteurised milk such as cottage cheese, cheese spread and mozzarella


    Avoid shark, swordfish and marlin

    Limit tinned tuna to 4 medium sized cans (140g) per week

    Limit oily fish to two portions per week

    Fresh salmon and tuna steaks are oily fish, therefore follow advice for oily fish


    Liver products may contain high levels of Vitamin A (too much vitamin A could harm your baby)

    Avoid all liver and liver products such as liver pate and liver sausage

    Avoid cod liver supplements, multivitamin supplements and supplements containing Vitamin A


    Drink only pasteurised or UHT milk

    If only unpasteurised milk is available, boil it first

    Don’t drink unpasteurised goat’s or sheep’s milk or eat their milk products


    Avoid eating peanuts and foods containing peanut products if you or your partner or any previous children have a history of hay fever, asthma, eczema or other allergies


    Shop bought mayonnaise is generally made from pasteurised egg and is safe to eat

    Avoid homemade mayonnaise, always follow instruction on jar and avoid mayonnaise in shops where ‘you can make your own sandwich’ if the mayonnaise is not stored correctly


    Avoid all pate



    You do not need to cut out caffeine altogether but it is advisable to limit the total intake in a day.

    The recommended intake is not more that 300mg of caffeine per day.

    Caffeine can be found in a range of food and drink. Use the table below to calculate your allowance a day.



    Caffeine Content

    One mug of instant coffee


    One cup of tea


    One can of cola


    Can of energy drink

    Up to 80mg

    50g bar of plain chocolate

    Up to 50mg

    50g of milk chocolate

    Up to 25mg

    Cold and Flu remedies

    Check with your GP/Pharmacist/other health professional before taking any of these

  • Sickness & Vomiting in Pregnancy

    The leaflet is detailed below, or you can download 'Sickness & Vomiting in Pregnancyleaflet in PDF.

    Sickness & Vomiting In Pregnancy

    Around half of all pregnant women feel sick and vomit during early pregnancy. Symptoms are mild in most cases but in more severe cases an anti-sickness medicine may be recommended by your doctor or midwife.

    If your nausea and vomiting is severe you should visit your GP.

    Why do you have pregnancy sickness?

    Your body goes through some big changes in early pregnancy. The hormones that keep your pregnancy going may also affect your:

    • Energy levels (you can feel very tired)
    • Emotions (you can easily feel close to tears)
    • Gut

    You may have a different taste in your mouth. Your saliva can be more acidic. This may be mild, with just some foods tasting different (for example, red meat may taste metallic), or severe with most foods and fluids tasting strange.

    The contents of your stomach are more acidic and this can lead to a constant queasiness. Your gut is slower throughout pregnancy.

    The muscle at the top of your stomach is more relaxed and you may get reflux of acid into your oesophagus, a feeling of nausea and heartburn.

    An empty stomach can make all of these feelings worse, and hunger can actually be felt as nausea.

    If your blood sugar drops low, this can also make you feel nauseous and weak. So it is important to try and eat during this time.

    You often feel most nauseous first thing in the morning, which is why this condition is often referred to as ‘morning sickness’. This is because your stomach is empty after not eating all night.

    Golden Rules for Pregnancy Sickness


    This stops your stomach from becoming empty and your blood sugar becoming low.

    The move severe the nausea and vomiting, the more frequently you should snack. Eat at least 6 times a day, and as frequently as every 15-20 minutes. The amount you eat will depend on how frequently you snack.

    You might try just one mouthful of food or fluid every 15-20 minutes, or a small plateful every 2-3 hours.

    Don’t skip meals and snacks. It is important that you keep trying to eat, even if you are still vomiting.

    Keep some crackers, dry breakfast cereal, or other dry starchy food near the bed, and try a mouthful to settle your stomach before getting up in the morning. 


    Being very dry will make you feel sick and give you a headache. Dehydration is worse for your health at this time than is the weight lost from nausea and vomiting.

    Sometimes sickness in pregnancy causes lots of saliva production and you find yourself constantly spitting or swallowing this. You can become quite dry from spitting and should try to sip fluids frequently.

    If you are passing little or dark urine, this can be due to dehydration. You need between 1.5 and 2.5 litres (8-10 glasses) of fluid each day. The high amounts are for summer months, or if you are losing a lot of fluid through sweating/spitting.

    Try to sip 25ml or ¼ glass of fluid every 15- 20 minutes when vomiting is severe. Some people feel they are less nauseous when they don’t take food and fluid together.

    Avoid having your fluid as drinks containing caffeine (like tea, coffee, cola drinks) as these not only make your nausea worse, but will make you pass more urine.

    Get fluids from:

    • Chilled or hot water with or without lemon or lime slices, mint leave (boil the water then cool it or let water stand in a jug for a few hours to reduce the chlorine smell and taste)
    • Ice pops or ice cubes
    • Sports drinks

    Try drinking through a straw or with a sealed cup.

    USE CARBOHYDRATES (starchy foods)

    Use these foods to settle your stomach and to provide energy for you and the baby.

    The best carbohydrate foods to try are plain starchy foods such as:

    • Bread/rolls
    • Breakfast cereals
    • Potatoes
    • Pasta/rice
    • Plain biscuits
    • Crackers
    • Toast
    • Crumpet/muffin

    Try them dry when vomiting is severe.

    What to Do On Bad Days

    Try 2 or 3 days without iron supplements (and if this reduces your nausea ask your doctor or midwife if you need to keep taking iron).

    Eat mainly carbohydrates. Try them dry when vomiting is severe. Eat very small amounts, very frequently throughout the day. Use only small amounts of proteins (like egg, meat) or fats (butter, margarine, oils) as these take longer to digest.

    Suck on ice, ice cubes, crushed ice, ice pops.

    • Freeze orange, melon pieces or grapes in cling film
    • Freeze fruit juice or cordial in ice cube trays etc, frozen fruit products, like sorbets
    • Simple drinks
    • Dilute fruit juice
    • Weak cordials
    • Mineral or soda water
    • Ginger beer, lemonade
    • Lucozade
    • Sports drinks

    Good days

    You need to catch up a bit! Widen your choices. Make sure you include foods from all food groups. Keep using carbohydrates as the basis for meals.


    • Topped with kebabs
    • Your favourite curry (perhaps ‘not so spicy’)
    • Stir-fry with meat, chicken, tofu and/ or vegetables
    • Part of a hot dish (e.g. risotto)
    • Accompaniment to a meal (e.g. rice pilaff)
    • Salad


    • A side dish (e.g. potato au gratin)
    • Stuffed jacket potato


    • Topped with a sauce of your choice (go easy with fat or oil)
    • A salad (e.g. pasta and tuna salad)


    • Bruschetta/focaccia, grilled with cheese on top
    • Try making pizza our of flat breads
    • Pitta bread filled with e.g. hot chicken stir fry or grated cheese, salad and mayonnaise
    • Egg or beans on toast

    Starting To Feel Better

    Try adding some variety; also see if you can tolerate some low fat, protein rich foods:

    • Jelly, custard, Angel Delight
    • Steamed or boiled vegetables
    • Soups made with milk (e.g. cream of chicken)
    • Marmite/Vegemite on toast, crackers, crumpets
    • Thinly sliced chicken or meat, no skin, no fat
    • Pasta with a light sauce
    • A sandwich

    Try some different drinks

    • Milk
    • Other fruit juices, nectars or vegetable juices
    • Milkshakes
    • Marmite, Bovril
    • Complan/Build-up

    ‘Make hay while the sun shines’ or have you thought ahead, making meals and freezing them for not-so-good days. Continue to eat a minimum of 6 small meals over the day. Gradually increase the amount and variety of food you eat over the day. Practice relaxation every day and try to take some walks in the fresh air and when you can, sit outside to eat and drink.

    Some Extra Remedies


    There is some evidence that ginger settles the nausea associated with pregnancy. Ginger has been used in many cultures to relieve indigestion as well as other ailments. Ginger can be taken in the following ways:

    • Sip a drink made from half a teaspoon powdered ginger dissolved in herbal tea or weak tea or coffee
    • Sip a warm drink made from grated ginger root in a cup of hot water
    • Sip on ginger beer
    • Chew crystallised or glace ginger
    • Eat a ginger flavoured biscuit, like ginger snaps / ginger nuts
    • Simmer a large crushed ginger root with 2 cups of water for 20 minutes, strain, add 1 tablespoon of honey, refrigerate and use this as a cordial with mineral water

    Ginger is reported to take effect after about 25 minutes and lasts 4 or more hours. Ginger is available at most supermarkets in the herb section or the dried fruit section. Fresh ginger is sold by fruit and vegetable shops.


    Some women have found peppermint to be helpful. Peppermint can be taken in the following way:

    • Peppermint tea
    • Cordial
    • Peppermint sweets

    Travel Bands

    These are available from chemist shops and are worn on the wrist to prevent travel sickness. They work on the principle of acupressure (similar to acupuncture). Some people find that they help to relieve pregnancy sickness. Follow the directions on the packet.

    Pregnancy Vitamins

    The Department of Health recommends that all low risk pregnant women take 10 micrograms of vitamin D and 400 micrograms of folic acid as a supplement (healthy start or pregnancy vitamins contain this).

    It is recommended that folic acid is taken until the end of the 12th week of pregnancy. However, all women in Liverpool should receive healthy start vitamins throughout pregnancy. You should also try to eat plenty of foods containing folate – the natural form of folic acid. Good food sources include broccoli, brussels sprouts, spinach, spring greens, peas, chick peas and granary and wholemeal breads. Folic acid is also added to some foods such breakfast cereals.

    Healthy start vitamins are also recommended for women who are breastfeeding.

    All women in Liverpool should receive Healthy Start vitamins

    Further Information

    NHS –

    British Nutrition Foundation –

    Healthy Start –

    Patient Information –

    Also, you will find more information in your hand held Liverpool Women’s Hospital patient notes.

  • Food First

    The leaflet is detailed below, or you can download 'Food First' leaflet in PDF. 

    Make sure that you have plenty to drink. Drink at least 6-8 glasses/ mugs of fluid every day

    Food First

    This leaflet will help you to eat well during pregnancy. As well as keeping you healthy, it will help your baby to grow and develop.

    You don’t need a special diet, but you do need to have a well-balanced diet and eat regularly.

    Include foods from each of the four food groups at every meal:

    Bread, rice potatoes, pasta and other starchy foods including yam and chapatti are packed with energy and provide fibre and carbohydrate. They should make up the main part of every meal. Choose wholegrain versions.

    Fruit and vegetables provide vitamins, minerals and fibre. Try to have 5 a day. Fresh, frozen, tinned, dried or juice all count.

    Meat, fish, eggs, beans and other non-dairy sources of protein such as nuts, pulses, dhal, quorn, and tofu provide protein, which is important for the growth and development of your baby. Many of these foods also provide iron. Try to eat these twice a day. Also try to have oily fish once a week (e.g. salmon, mackerel, herring and fresh tuna).

    Milk and dairy foods provide calcium and vitamin D which are needed for strong bones and teeth. Try to have 3 portions a day. A portion is 200 ml (a glass) milk, 150g yoghurt and 30g cheese. Choose low fat versions unless you are underweight. If you use soya alternatives, check that they have added calcium.

    Also, make sure that you have plenty to drink. Try to drink at least 6-8 glasses/mugs of fluid every day.

    Pregnancy Vitamins

    The Department of Health recommends that all low risk pregnant women take 10 micrograms of vitamin D and 400 micrograms of folic acid as a supplement (healthy start or pregnancy vitamins contain this).

    It is recommended that folic acid is taken until the end of the 12th week of pregnancy. However, all women in Liverpool should receive healthy start vitamins throughout pregnancy. You should also try to eat plenty of foods containing folate – the natural form of folic acid. Good food sources include broccoli, brussels sprouts, spinach, spring greens, peas, chick peas and granary and wholemeal breads. Folic acid is also added to some foods such breakfast cereals.

    Healthy start vitamins are also recommended for women who are breastfeeding.

    Pregnancy Sickness

    Nausea and sickness are common symptoms in early pregnancy which nearly half of all pregnant women will experience. For most women, the first 12 weeks are the worst and after that you should gradually start to feel better. You will be provided with a pregnancy sickness advice leaflet before discharge from hospital.

    If You Are Underweight or Have Lost Weight

    Try to eat little and often through the day. (This will also help with nausea and vomiting). If the problems continue after discharge and you are not gaining weight, then please discuss this with your midwife or G.P.

    Further Information

    NHS –

    British Nutrition Foundation –

    Healthy Start –

    Patient Information –

    You will find more information in your hand held Liverpool Women’s Hospital patient notes.

    Produced by the Department of Nutrition and Dietetics.

  • Information for Pregnant Women with a raised BMI

    The leaflet is detailed below, or you can download 'Information for Pregnant Women with a raised BMI' leaflet in PDF. 

    Women who are overweight are known to be at increased risk of developing problems during pregnancy, delivery and after giving birth.

    Rather than just using weight to assess who is at risk, we use BMI (Body Mass Index), which is takes into account people’s weight and height. It is a nationally recommended way of assessing health issues associated with weight. Internationally, a figure of 19-25 is classified as normal; 25-30 is overweight,

    30-40 is obese and over 40 is very obese.

    Pregnant women with a BMI of 30 or more are more likely to have:

    • Diabetes in pregnancy
    • High blood pressure problems
    • Difficulties with assessing the growth and wellbeing of the baby
    • Caesarean sections
    • Complications associated with caesareans or forceps deliveries
    • A higher risk of developing clots in the legs or lungs
    • Anaesthetic complications

    Antenatal Care

    Women with a BMI of 35 or over will be referred for consultant-led care and will be offered a glucose tolerance test (GTT) around 28 weeks of pregnancy to assess their body’s ability to handle sugars and detect any tendency towards diabetes during pregnancy.

    Women with a BMI of 40 or more will also be offered this test and will be referred to consultant led care and an antenatal clinic with a specialist midwife. Ideally women with a BMI of 30 or more should have taken folic acid 5mg up until 12 weeks. Some women may also be prescribed a vitamin D supplement and aspirin during pregnancy.


    Scanning the unborn baby of a woman with a high BMI is technically more difficult as much of the power of the ultrasound waves is absorbed by the mother’s tissues. Therefore the images obtained may not be as accurate as those normally obtained. This may mean a reduced ability to detect problems, for instance at the 20 week anomaly scan. Further scans for growth may be arranged by the consultant or midwife, if they are concerned about the growth of the baby as pregnancy progresses. A scan may also be performed at

    36 weeks of pregnancy to confirm which way the baby is lying and make a plan for the birth.

    Labour and Birth

    If you have a raised BMI 35 and above, you may not be suitable for the midwifery led unit and may be advised to give birth on the delivery suite, but this can be discussed with your midwife or doctor. If your BMI is greater than 40, you will be advised to give birth in the delivery suite.

    Pain Relief in Labour

    There are a number of options available to you for pain relief during labour. These include Entonox (‘gas and air’), water (if you are on the Midwife led unit), diamorphine and an epidural. Being overweight can mean there is an increased risk of complications if you have an anaesthetic during labour and birth (epidural or spinal). Therefore, if your BMI is 40 or more, an appointment will be made for you to see an anaesthetist during your pregnancy, who will discuss this with you and make a plan for when you are in labour, should you wish to have an epidural.

    Postnatal Care

    If you have a caesarean section, recovery following the operation may be slower. You will be given antibiotics when you are in theatre to help prevent any infections. You are also encouraged to get out of bed as soon as possible to help reduce the risk of blood clots developing in your legs or lungs and you may also need to have a daily injection to ‘thin’ your blood to help prevent this. These injections will be for at least seven days after you have had your baby.

    Feeding Your Baby

    Breastfeeding gives your baby all the nutrients it need for the first 6 months. Breastfeeding is recommended as the best way to feed your baby. Support to start and continue breastfeeding is available when you are in the hospital after having your baby and when you go home.

    Weight Loss after Having Your Baby

    After having your baby it is important that you try to lose weight, in order to reduce your BMI. There are a number of weight management services available in your local area that can assist with weight loss. Make an appointment to see your GP, who will be able to advise you on weight management and refer you to services in your local area.


    Liverpool Women’s Hospital is at the forefront of research into the way that a woman’s weight affects her pregnancy. If you attend the specialist antenatal clinic, you may be invited to take part in some research studies that have been set up to develop our understanding of this common problem.  Please do not hesitate to ask if you have any particular concerns or for any further explanations with regards to your care.

    For more information ring: 0151 702 1126

  • Iron Sources

    The leaflet is detailed below, or you can download 'Iron Sources' leaflet in PDF. 

    Teenage girls and women under 50 years old should have 14.8mg of iron per day

    Iron Sources

    An average serving is roughly the size of a pack of cards.

    Roast Beef contains


    Per average serving

    Bran Flakes contains


    Per bowl

    Baked Beans contains


    Per half tin

    Boiled eggs contain


    Per small egg

    Sardines contain


    Per 50g serving

    Figs contain


    Per 4 figs

    Green Veg contains


    Per average serving

    Avoid drinking tea and coffee with meals. Both drinks contain chemicals that reduce the amount of iron you absorb from your food.

    Drink them an hour before you eat or two hours afterwards. So, it’s better to have a glass of orange juice with your bowl of cereal in the morning than a cup of tea.

  • Promoting Breastfeeding within Liverpool Women’s

    The leaflet is detailed below, or you can download 'Promoting Breastfeeding within Liverpool Women’s' leaflet in PDF. 

    Breast milk gives babies all the nutrients they need for the first six months of life, helping to protect them from infection and diseases, and reduce the rate of asthma and obesity.

    For mothers, it reduces the chances of getting certain diseases, such as ovarian and breast cancer, and also protects against developing weaker bones in later life.

    How you feed your baby is a very personal decision and midwives will support women and families in their choices. If the decision is not to breastfeed, a supply of milk will need to be brought in to the hospital. This should be the ready prepared variety in cartons and not the powdered formula which needs preparation. Bottles and teats will still be provided.

    Therefore we do not supply formula milk for mothers who choose to artificially feed their babies.

    We will also provide information and a demonstration on how to prepare formula feeds and sterilise bottles, if this is the chosen method of feeding.

    If there are any questions or concerns, then women should not hesitate to contact their midwife for advice or the ward manger on the maternity ward on: 0151 708 9988 extension 1331.

  • Birth and Beyond Classes

    The leaflet is detailed below, or you can download 'Birth and Beyond Classes' leaflet in PDF. 

    Preparing For Parenthood

    In order for you to prepare for the birth of your new baby, Birth and Beyond parent craft classes will take place in various venues within your local community.

    When you visit your community midwife she will give you details of how to book in.

    Classes can be started once you are 28-30 weeks gestation.

    The Classes Will Be Facilitated By Midwives And Will Cover The Following Topics

    • Am I in labour? When should I come into hospital?
    • Stages of labour, how to cope with labour and management of pain.
    • Breathing and relaxation techniques for labour.
    • Feeding your baby.
    • Coping with your new baby.
    • Dad’s role and much more.
    • Breathing and relaxation classes are also available at Liverpool Women’s Hospital.

    Speak to your community midwife for details. Classes are informal and very popular and must be booked in advance.

  • Safety in Pregnancy

    The leaflet is detailed below, or you can download 'Safety in Pregnancy' leaflet in PDF. 

    These infections are rare and you are unlikely to be affected, however, you should take the following precautions to reduce risks to yourself and your baby.


    • Cook all meat thoroughly; do not eat raw or undercooked meat. Make sure ready-to eat poultry and cooked chilled meals are reheated thoroughly.
    • Wash hands, knives and cutting boards after handling uncooked foods.
    • Wash fruit, vegetables and salads to remove all traces of soil.
    • Avoid emptying cat litter trays; if you need to empty the tray wear rubber gloves (cats’ faeces may contain an organism which causes toxoplasmosis).
    • Wear rubber gloves when gardening – (even if you don’t have cats).


    • Avoid all types of pates.
    • Avoid mould-ripened soft cheeses e.g. Brie, Camembert and blue veined cheeses like Stilton and Danish Blue.
    • Avoid unpasteurised milk or foods made from unpasteurised milk.


    • Make sure eggs are thoroughly cooked until whites and yolks are solid.
    • Avoid eating raw eggs or food made with raw eggs.
    • Cook all meat and poultry thoroughly.
    • Keep cooked and uncooked foods separate, both in storage and preparation.


    • Avoid contact with sheep at lambing season and with newborn lambs.
    • Wash hands thoroughly after handling pets.

    If possible avoid emptying cat litter trays or wear rubber gloves when doing so and then wash hands thoroughly afterwards.

  • Pre-eclampsia - Things You Should Know About Pre-Eclampsia

    The leaflet is detailed below, or you can download 'Pre-eclampsia' leaflet in PDF. 

    What Is It?

    An illness which occurs only in pregnancy and can affect both a mother and her unborn baby. Most cases are mild, but there is a severe form which can be dangerous. Among the most serious complications are convulsions known as ‘eclampsia’ – hence the term pre-eclampsia.

    Who Gets It?

    About one pregnant woman in every 10. Most at risk women are first-time mothers; the over 40s; those with a BMI over 35; women with a family history of preeclampsia: where it is ten years or more since a last baby; those suffering from high blood pressure, diabetes or kidney disease; those carrying more than one baby and those who have had it before.

    What Causes It?

    A problem in the placenta which restricts the flow of blood to the baby. This problem develops in early pregnancy but doesn’t cause illness until much later – usually the last few weeks.

    What Are The Signs?

    High blood pressure, protein in the urine in the mother, and sometimes, poor growth in the baby – all of which should be detected by routine ante-natal checks.

    How Is It Treated?

    Women with pre-eclampsia are monitored carefully – usually hospital or a day ward – and may be given drugs to control blood pressure.

  • Inducing Labour at Home

    The leaflet is detailed below, or you can download 'Inducing Labour at Home' leaflet in PDF. 

    Why have Outpatient Induction of Labour?

    An outpatient induction of labour:

    • Reduces the amount of time you will need to stay in hospital before your labour begins
    • Can involve fewer vaginal examinations
    • Allows you to stay at home and wait for labour to start • Makes the process of induction more normal
    • May mean you can receive care on the Midwife-Led Unit and/or use the birth pool

    Who can have Outpatient Induction of Labour?

    You may be offered an outpatient Induction of labour if:

    • Your pregnancy is ‘low risk’
    • You have no medical or obstetric problems
    • You have previously had a caesarean section and no other complications
    • Your ‘waters’ have broken and labour has not started
    • You are between 37-42 weeks of pregnancy You have a relative who will stay with you at home on that day
    • You have transport to bring you to the hospital

    There Are Two Methods of Induction That Can Be Used At Home

    Hormone pessary

    This is small, flat rectangular shaped pessary which looks a little like a tampon. It is inserted into the vagina and slowly releases a medication called prostaglandin, which helps to ripen the cervix, ready for labour. The pessary can stay in your vagina for 24 hours, and can sometimes make labour start on its own. If this happens, you can receive low-risk care and use the birthing pool. If labour does not begin with the pessary alone, you will then come back to delivery suite for the next steps of the induction process.

    Points to consider

    • Less vaginal examinations
    • May go into labour without any further intervention
    • Must be aged 40 or less
    • Can be used if your ‘waters’ break and labour does not start.

    Image Source:

    Cervical balloon

    This is a thin tube that is placed in your cervix and a balloon on the end is inflated. The pressure from the balloon helps your cervix to ripen and dilate. It requires no medications and is a safer option for those who have previously had a caesarean section. The balloon can stay in your cervix for 24 hours, after which you will come back into hospital for the next steps of the induction process.

    Points to consider

    • Safer option when you have had a previous caesarean section
    • Medication-free
    • Can take a little longer to work
    • Less chance of hyperstimulation (having too many contractions)

    Around 20% of women will go into labour from this method alone.

    Image Source:

    Your midwife will discuss with you about the outpatient induction of labour process and if you meet all the criteria you will be offered one of the methods of induction discussed above.

    What Happens On The Day?

    Your midwife or doctor will book an appointment for you to attend the Induction Clinic.

    Please remember to bring your hand-held notes with you and an overnight bag just in case you need to stay in hospital.

    Step 1

    When you arrive you will have your pulse, blood pressure, temperature and urine checked. The midwife will also read your notes and make sure that the outpatient induction of labour checklist is completed, and which method you require.

    The midwife will discuss the process of induction of labour with you and answer any questions you may have. The midwife will check that your baby is OK by monitoring the baby’s heart beat for about 30 minutes.

    Step 2

    When the midwife is happy with the observations made she will ask if it is OK to perform an internal examination (vaginal examination) to check the neck of your womb (cervix).

    If the neck of the womb is closed, then either the pessary or balloon will be inserted. If the pessary is used you will be asked to lie down for 20 – 30 minutes afterwards. The pessary will absorb the moisture from your vagina which makes it swell (like a tampon) and settle into place. This reduces the chance of it falling out. After insertion of the balloon you can get up straight away as the balloon should only fall out when you are in labour. You will need to take care with both the balloon and pessary when:

    • Wiping yourself after going to the toilet
    • After washing

    Step 3

    When the midwife is happy with your observations, you can go home to wait for signs that labour has started.

    If you have any concerns, you should telephone 0151 708 9988 ask for Midwifery-Led Unit or phone directly on 0151 702 4270.

    Step 4

    You can continue with your day to day activities and eat and drink as normal. You should contact the helpline immediately 0151 708 9988 and ask for ‘Midwifery-Led Unit’ if you experience any of the following:

    • You have any vaginal bleeding
    • You think your waters have broken or notice vaginal loss that in not straw coloured or clear
    • The pessary or balloon falls out
    • You have pain/tenderness on or around a previous caesarean section scar
    • You feel generally unwell, shivery, hot and cold or think you may have a temperature
    • You are worried.

    What Happens When I Go Home?

    Both the pessary and the balloon catheter work by ‘ripening’ your cervix – this means the cervix softens, shortens and begins to open up. You will commonly feel a period-like ache while this happens, but sometimes stronger contractions occur and labour may start. In the very early stages of labour contractions can vary in length and how often they come. They may continue for several hours but not become much longer and stronger. This is normal. It is OK to stay at home during this time until you are in strong labour.

    When strong labour contractions change, they become longer, stronger and closer together and usually continue to become stronger until the baby is born. If you experience signs of labour and are not sure please don’t hesitate to call the hospital for advice.

    If your waters have broken before your labour was induced you will need to do some additional checks while you are waiting. Your midwife will give you an additional leaflet entitled ‘what happens if my waters break before I go into labour: Checks you need to carry out while you are waiting’.

    What Happens If Labour Starts?

    If labour begins after the first stage of induction, you may be suitable to have your baby on the low risk Midwifery-Led Unit (MLU). If you have had a previous caesarean birth or if there are other concerns, you and your baby require closer monitoring and care will be provided on the Delivery Suite.

    If you have signs of labour please discuss this with one of our midwives by telephoning 0151 708 9988

    (Press option 5 and enter extension number 1162 or ask for Delivery Suite or call MLU directly on 0151 702 4270) and she will advise you where your care will be provided.

    Is There Anything I Can Do To Help?

    You can help to increase the natural oxytocin levels in your body by hand massaging and expressing colostrum from your breasts, which will help support and enhance your induction and may help your labour to progress quicker.

    Oxytocin also helps stimulate breastmilk production – the first milk you make is called colostrum. This is essential for your baby’s immune system and protects against infection from birth.

    If no colostrum is produced – don’t worry, this is often the case – massage and hand expression will increase your oxytocin levels. This helps contract your uterus to contract, which then helps to stimulate your milk supply – ready to give your baby straight after birth. Ask your midwife to show you how to hand massage and express. She will show you where to store any colostrum you have collected.

    Try to have at least one membrane sweep before coming in for your induction appointment, this can help labour start naturally – ask your midwife.

    Remember – induction of labour is usually a long process – often taking more than 24 hours. This is normal – try to stay calm and do something that will help the time pass more quickly.

    It is very important you have a supportive birthing partner with you. Choose someone who has a positive attitude about birth and who you feel totally relaxed, confident and comfortable with.

    What to Do While You Are Waiting For Regular Contractions To Start

    • Potter around the house
    • Take a leisurely walk
    • Watching a DVD / video (one that makes you laugh is best)
    • Take a warm bath or shower
    • If contractions are irregular, slow down or stop, have a short nap or a lie down
    • Do some relaxation techniques
    • Keep your breathing quiet and sigh out slowly during contractions
    • Ask your birth partner to give you a massage
    • Use your TENS machine if you plan to use one
    • Put a heat source, wrapped in a small towel on areas that ache
    • Keep upright and mobile • Change your position frequently
    • Try a birthing ball – do circular movements whilst sitting on the ball
    • Drink plenty of fluids
    • Eat little and often – carbohydrates like bread or pasta and sugary foods are best.

    It is best to try and stay as relaxed as you can. It is a good idea to be at home while waiting for labour to start if you arrive in hospital in established (strong contractions) labour you are more likely to have a straight-forward birth.

    24 Hours Have Passed What Should I Do Now?

    With either method of induction, you will have an appointment made to return to hospital to continue the induction process.

    On admission you will have a vaginal examination to assess whether the neck of your womb has begun to open.

    If it is possible for your waters to be broken, you will be transferred to the Delivery Suite when appropriate. If the neck of your womb has not opened you will need further treatment to induce labour and will receive this as an inpatient.

    When You Come Back To The Hospital…

    If labour has not started with the pessary or balloon alone, you will come to the delivery suite at the arranged time (around 24 hours after).

    Breaking the waters and using a hormone drip

    Hopefully, the neck of the womb is ready for labour and your midwife may ask your permission to break your ‘waters’. The ‘waters’ are the fluids that surround your baby when he/she is in the bag (amniotic sack) in your womb. Your midwife will use a small plastic hook to break your waters during a vaginal examination.

    Following this, your midwife will place a drip into a vein, usually in your arm. This drip contains a hormone called Oxytocin, which will cause you to have contractions. The amount of Oxytocin is carefully measured and monitored by an electric pump. Throughout your labour your baby’s heartbeat will be monitored using a CTG machine. If a drip is required to induce labour you will not be able to use the birthing pool for safety reasons and your mobility may be limited. You will still be able to move and walk around the bed and use a birthing ball.

    Are There Any Side Effects?

    The hormone pessary can occasionally produce some side effects which are usually mild and include: nausea, vomiting, dizziness, palpitations and fever. If any of these occur to a distressing level you should phone up and come in to hospital (see contact numbers). There is a rare chance you may be very sensitive to the pessary and start contracting very frequently and strongly. If you experience,

    • Contractions that last for more than 30 seconds that come every two minutes
    • Contractions that last more than two minutes or
    • Severe abdominal pain.

    You must contact the Delivery Suite (0151 708 9988, press option 5 and enter extension 1162) and make your way to hospital (the midwife you speak to on the telephone may advise you to remove the pessary using the tape).

    The cervical balloon does not contain medications so there is less chance of experiencing side effects. If you have any concerns you should however speak to a midwife at the hospital.

    Helpful Telephone Numbers

    Help & information number: 0151 708 9988 – Select option 0 and ask for ‘Induction Suite’ or:

    • Press option 5 and enter extension number 1162 for Delivery Suite
    • Direct number for the Midwife-Led Unit is 0151 702 4270.

    Liverpool Women’s is a smoke free site. Smoking is not allowed inside the hospital building, grounds, car parks or gardens. If you would like advice about stopping smoking please ask a member of staff about this.


  • Advice for Women Who Inject Illicit Substances

    The leaflet is detailed below, or you can download 'Advice for Women Who Inject Illicit Substances' leaflet in PDF. 

    Whilst the Liverpool Women’s NHS Foundation Trust does not endorse the practice of self-injecting illicit substances if you decide to continue this practice this leaflet is designed to provide appropriate advice and information for you.

    Risks of Injecting

    • Injury to veins and the blood circulation system.
    • Bleeding (haemorrhage)
    • Infection either locally, to injecting sites or generalised blood infection called septicaemia
    • Blood clotting disorders such as deep vein thrombosis
    • Transmission of hepatitis B, hepatitis C and HIV
    • High risk of overdose and death
    • Carrying, dealing and using illegal substances are against the law, you risk prosecution and imprisonment


    • Stop injecting
    • Contact local specialist drug services for advice and support (contact numbers for local drug services on back of this leaflet) or see your own GP. Alternatively contact the National Drugs Helpline (contact number on the back of this leaflet.)

    If You Decide To Continue To Inject


    • Always use clean needles and syringes every time you inject
    • Never share any part of the “works” e.g. spoons, tin foil, cotton wool etc.
    • Seek advice from local drug services regarding safer injecting techniques
    • If any injecting sites become red, swollen or concerning in any way seek medical advice as soon as possible
    • Never inject alone

    Your Responsibilities

    • Dispose of injecting equipment immediately and safely. Preferably in a specially designed sharps disposal box. You can obtain a supply from some local pharmacies (chemists). You have a responsibility to the general public to ensure the safe efficient disposal of used injecting equipment
    • Do not encourage non-injecting users to begin injecting. You have a responsibility not to influence people to begin this dangerous behaviour
    • You have a responsibility to ensure your drugs and injecting equipment is stored safely, particularly when children are in the environment.
    • You have a responsibility not to use drugs in the presence of or when you are caring for children as this may impact on your ability to care for the child

    For further advice and support please discuss with your GP / midwife.

    More Information

    Liverpool Drug Dependency Unit

    Hope House

    26 Rodney Street


    L1 2TQ

    Tel: 0151 709 0516

    North Liverpool Community Drug Team

    85 Stanley Road



    L20 7DA

    Tel: 0151 933 1119

    Lighthouse Project

    South Sefton Community Drugs Team

    22 Oriel Road

    L20 7AD

    0151 955 6200

    Kirkby Drug Services

    Knowsley Drug Dependency Unit

    149 Cherryfield Drive



    L32 8SE

    Tel: 0151 546 7111

    National Drug Helpline

    Tel: 0800 776600

  • Having Anorectal Tests

    The leaflet is detailed below, or you can download the 'Having Anorectal Tests' leaflet in PDF.

    What Are These Tests For?

    Anorectal tests are offered here at LWH as part of the routine follow up for Obstetric Anal Sphincter Injury (OASI).  This is due to the fact that women that have had these types of tears are more likely to experience difficulty controlling the muscles around the back passage. This may be because the anal sphincter muscles have become weak or damaged.  This may cause you to have urgency or leakage of stools (faecal incontinence), or you may have trouble with controlling wind (flatal incontinence). Anorectal studies enable us to gain a better understanding about how your tear has healed and how your back passage is functioning.

    What Are Anorectal Tests?

    There are two different tests that provide information about the sphincter muscles and how they are working. These are:-

    • Endo-anal ultrasound

    This uses ultrasound to provide an image of the anal sphincter muscles to see if there are any defects present. An ultrasound probe is passed into the back passage and gently withdrawn to allow different views of the anal sphincter to be seen.

    • Anorectal manometry

    This provides information on the strength of the anal sphincter muscles and its ability to relax and contract. A small flexible tube is passed through the back passage into the rectum. On the end of this tube is a transducer that records the pressure inside. During this test the tube is slowly pulled outwards from the back passage to the edge of the anal sphincter. You will be asked to squeeze the muscles in your back passage several times during this test, in the same way you do your pelvic floor exercises.

    The appointment for these tests is 45 minutes; however the actual testing takes no more than 10 minutes to perform.

    Where Will These Tests Take Place And Who Does Them?

    These tests take place in the Urogynaecology Department and are done by a Doctor or the Urogynaecology Link Midwife. Sometimes there may be a member of staff who is training observing the tests, however you will be informed of this and you can decline to have them present.

    Will I Need Any Special Medication And Will I Be Able To Take My Usual Medication?

    The tests will be more comfortable for you if you have been able to empty your bowel prior to the test. No specific medications to empty the bowel, such as laxatives, are required for the tests. You should continue with any other medication that your doctor has prescribed for you.


    You will be asked to complete an online questionnaire (ePAQ) as part of your care. This is a self-assessment questionnaire which gives us more information about your symptoms.  It is confidential.

    What Will Happen When I Arrive At The Urogynaecology Department?

    You will need to use the self-check-in machines located in the main reception of the hospital or the gynaecology outpatient main reception. This then informs you of the waiting area you should head to and lets the staff know you are in attendance. You will then be called through by the Midwife when she is ready.

    What Will Happen During The Tests?

    • The Midwife will take you into the room where you will be asked questions similar to those you were asked when you attended for your 6-8 week follow up, regarding any bladder or bowel symptoms you may have experienced.
    • Each test will be explained to you and you will have the opportunity to ask any questions.
    • You will then be asked to change into a hospital gown and taken to the treatment room for the examination to be performed.
    • You will then lie on your left side on an examination couch.
    • You will have a sheet to put over you.
    • When all the tests are complete you will be able to get dressed.
    • Occasionally patients feel the need to go to the toilet immediately following the test. This is due to the stimulation of the rectum and is quite normal so no need to worry.

    Are The Tests Painful?

    You may have a feeling of pressure during the tests but they should not cause any pain. You can ask the person performing the tests to stop at any point if you are not comfortable.

    Should I Attend If I Am On A Period?

    Yes. Being on a period does not affect the results of the tests.

    When Will I Get The Results Of My Test?

    The Urogynaecology Consultant will see you after the examination and discuss the results with you. You will also be advised regarding the mode of delivery we would recommend for future pregnancies, depending on the results of the tests and taking into consideration any symptoms you may have.

    If you have any questions about these tests you can contact the Urogynaecology Link Midwife on 0151 702 4321 for advice.

    If you need to rearrange your appointment please telephone the Patient Appointment Centre on 0151 702 4328 (option 2) as early as possible.

    Some useful resources:

  • Intramuscular progesterone for women attending the preterm birth prevention clinic

    The leaflet is detailed below, or you can download 'Intramuscular progesterone for women attending the preterm birth prevention clinic' leaflet in PDF. 

    What is Progesterone?

    Progesterone is a natural hormone. It is produced by your body in pregnancy.

    What is preterm birth?

    This refers to birth less than 37 weeks of pregnancy. Babies that are born preterm have an increased risk of health problems. The team in the preterm birth prevention clinic aim to work with families to reduce their risk of preterm birth.

    Why is it important for women attending the preterm birth prevention clinic?

    Research has shown that extra progesterone can help you have a full length pregnancy.

    You have been identified as someone who has a higher risk of preterm birth. This is because in a previous pregnancy your baby was born early, or your waters broke early. A medication to prevent preterm birth could be especially helpful in your pregnancy.

    What does the research say I should do?

    If you are pregnant with one baby-

    • Use progesterone from 16 to 36 weeks of pregnancy
    • Progesterone is given as an injection into a muscle. This is normally a muscle in your bottom.
    • The injection is given weekly

    How much will this help?

    Your doctor will be able to discuss this more fully with you. Importantly progesterone will not prevent all preterm births.

    Is there any other way to get progesterone?

    Progesterone can also be given vaginally. This would be taken as a pessary placed into the vagina by yourself every night from 16 to 37 weeks of pregnancy.

    Your doctor will discuss the best way of taking the medicine with you.

    Are there any risks of taking progesterone in pregnancy?

    Progesterone medications are thought to be safe for the baby when taken after 12 weeks of pregnancy.

    Are there any side effects of taking progesterone during pregnancy?

    The injection will be sore.

    Your symptoms of pregnancy might become more pronounced with progesterone, such as breast tenderness and nausea.

    The use of progesterone injections in pregnancy is quite rare in the UK and so uncommon complications are not as well understood as for common medications. Potential rare complications are: hair loss, breast changes, cervical abnormalities, depression, drowsiness, fever, increased body hair, difficulty sleeping, jaundice (liver problems), nausea, swelling, skin reactions, weight increase.

    If you are concerned about a side effect you should seek medical advice from a health professional.

    Is progesterone licenced for pregnancy?

    Most medications used in pregnancy do not have a licence. There are currently no injections of progesterone with licences for preventing preterm birth in the UK.

    To get a licence, the drug company must prove that the medicine works and that it is safe to use, by testing it during clinical trials. The research showing a benefit of progesterone injections in pregnancy is mostly from America. Progesterone injections in pregnancy are licenced for use in America.

    As a preterm birth prevention team we feel that the progesterone medication that we are recommending will be of benefit to your pregnancy.

    Where can I find out more?

    On the March of Dimes website:

  • Omega 3 for women attending the preterm birth prevention clinic

    The leaflet is detailed below, or you can download 'Omega 3 for women attending the preterm birth prevention clinic' leaflet in PDF. 

    What is Omega 3?

    Omega 3 is a fatty acid that occurs naturally in foods including fish, eggs and nuts

    Why is it important for women attending the preterm birth prevention clinic?

    Research published in November 2018 found that Omega 3 supplements can help you have a full length pregnancy. The supplements also help babies to growth to a healthy weight in the womb.

    You have been identified as someone who has a higher risk of preterm birth, and so a supplement to prevent preterm birth could be especially helpful in your pregnancy.

    What does the research say I should do?

    If you are pregnant with one baby, take omega-3 supplements each day starting from around 12 weeks of pregnancy onwards.

    • Take at least 500mg of DHA per day.
      • This is two tablets of ‘Omacor’ supplements prescribed by the hospital
    • You do not need to take more than 1000mg of DHA plus EPA per day. Taking more will not give you or your baby any extra benefit.
    • Once you have had your baby you can stop taking omega-3s.
    • Continue with your normal pregnancy vitamins too, so long as they do not contain omega 3

    *DHA stands for docosahexaenoic acid and EPA stands for eicosapentaenoic acid

    How much will this help?

    Your doctor will be able to discuss this more fully with you. Omega 3 will not prevent all preterm births.

    Can I get the recommended amount of omega-3 fats from foods?

    It is difficult to get the recommended amount of the omega-3s docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) from food alone, unless you regularly eat fatty fish e.g. salmon, sardines or mackerel.

    To get the recommended amount of DHA from salmon, you would need to eat at least 2 large servings (150g) of salmon every week or 3 smaller servings (100g) of salmon every week.

    Are there any side effects of taking omega-3 supplements during pregnancy?  

    Some women may experience fishy burps as a result of taking fish oil supplements. Taking your fish oil supplements with food may help prevent fishy burps.

    If you encounter any other side effects, you should seek medical advice from a health professional.

    Omega 3 supplements probably increase the risk of needing an induction for a prolonged pregnancy (over 42 weeks of pregnancy). This is much less of a problem for yourself and your baby than a very preterm birth.

    What if I’m already taking a pregnancy multivitamin?

    If you are already taking a multivitamin supplement, you should check the label to find out how much DHA and EPA the supplement contains. If your pregnancy supplement does contain omega 3 it is normally as a separate tablet.

    Most multivitamin supplements do not contain enough omega-3s to reach the amounts recommended to prevent premature birth and you will need to take an omega-3 supplement in addition, to get the 500mg of DHA per day.

    Importantly Healthy Start vitamins do not contain Omega 3 at the moment.

    We recommend continuing with a pregnancy multivitamin that does not contain omega 3, and taking the prescribed omega 3 supplement as well.

    Is omega 3 licenced for pregnancy?

    Most medicines used in the UK have a licence that says exactly how the medicine should be used. There are currently no omega 3 supplements with licences for use in pregnancy.

    To get a licence, the drug company must prove that the medicine works and that it is safe to use, by testing it during clinical trials. Trials are almost always done with non-pregnant adults first. These trails have shown the omega 3 supplements are safe in non-pregnant adults. The drug companies have not tested whether or not omega 3 is safe in pregnancy.

    The research showing a benefit of omega 3 in pregnancy is new (November 2018). The omega 3 medications currently available in the UK are not exactly the same formulations as those used in the research studies. However, they do have the same active ingredients.

    Over 5200 pregnant women took part in the research studies showing a benefit in reducing the risk of preterm birth. A large analysis of these studies showed the only negative effect to be an increase in prolonged pregnancy (more than 42 weeks of pregnancy).

    Therefore, as a preterm birth prevention team we feel that the omega 3 supplements that we are recommending will be of benefit to your pregnancy.

    Where can I find out more?

    On the Cochrane website:

    On the SAHMRI website:

  • Obstetric Anal Sphincter Injury (OASI)

    The leaflet is detailed below, or you can download 'Obstetric Anal Sphincter Injury (OASI)' leaflet in PDF.

    What is Obstetric Anal Sphincter Injury?

    Obstetric Anal Sphincter Injury (OASI) can extend down from the vaginal wall and backwards through the perineum to the muscle that controls the back passage (anal sphincter).

    Image Source: The Newcastle Upon Tyne Hospitals NHS Foundation Trust

    Why does Obstetric Anal Sphincter Injury occur?

    Obstetric Anal Sphincter Injury (OASI) occurs due to the tearing of the tissues during childbirth.  It is impossible to predict who will have OASI.  However, certain factors increase the chances of a perineal tear happening.  These can include:

    • First baby
    • Ethnicity (Asian and Black)
    • Shoulder Dystocia (when one of your baby’s shoulders becomes stuck behind the pubic bone during delivery)
    • Large baby
    • The direction the baby is facing at birth
    • Induction of Labour
    • Epidural
    • Pushing for a long time
    • Assisted delivery

    The reported rate of OASI has tripled from 1.8% to 5.9% from 2000 to 2012 in England.  The overall incidence in the UK is 2.9%, with a rate of 6.1% in first time mothers compared with 1.7% in those who have had babies before.

    How is Obstetric Anal Sphincter Injury repaired?

    You will have been examined by a doctor to confirm the extent of your injury. The repair normally takes place in theatre with an anaesthetic.  The muscles are stitched back together using dissolvable sutures (stitches).

    Care after Obstetric Anal Sphincter Injury?

    • To speed up healing and prevent infection keep the area clean.
    • Have a tepid bath or shower at least once a day and pat the area dry to keep it free of moisture.
    • Change your sanitary pad regularly washing your hands before and after you do so.
    • Skin sensation is likely to be altered so do not have too hot a bath.
    • Do not put additives such as bubble bath in the water as this may delay healing. You may have heard that salt added to bathwater can help, but salt can make the stitches break down too quickly.
    • To avoid pressure on the wound in the first few days it is best to avoid sitting for long periods and to lie on your side. If you are breastfeeding your midwife will show you comfortable positions for you and your baby.
    • Signs of infection are an increase in pain, or an offensive discharge. If you experience any of these problems please contact your midwife or GP.
    • Constipation causes straining and pressure on the recovering tissues. To help prevent this, please eat plenty of foods containing fibre such as brown rice, cereals and fruit.
    • Try to drink about two litres of water each day (if you are breastfeeding increase this to three litres). This helps stools to be softer and therefore easier to pass.

    What happens after the repair?

    You will be sore but the midwife will be able to give you pain relief, when required. You will be prescribed a set of medication which comprises of:

    • A course of antibiotics to prevent infection in your stitches.
    • Medicine to prevent constipation (Laxatives) so you are not straining when having your bowels opened.

    It may be uncomfortable when you first open your bowels but it will get easier. Don’t be frightened to push down gently so that you can open your bowels - the stitches won’t give way.

    Some women have noticed that they have difficulty controlling their bowels at first and some have even leaked, or had problems controlling wind (flatus). If this happens to you, don’t be too worried. This should settle after 2 or 3 weeks when the swelling has gone and the muscles of the back passage start to function properly

    Sit on the toilet in the correct position to make sure you empty your bowel properly.

    Image Source: Reproduced by the kind permission of Ray Addison, Nurse Consultant in Bladder and Bowel Dysfunction. Wendy Ness, Colorectal Nurse Specialist

    Produced as a service to the medical profession by Norgine Ltd.

    Is there anything I can do to strengthen the damaged muscles?

    YES - Any woman who has had a baby should exercise the pelvic floor muscles.  These strengthen the pelvic floor muscles, which have been affected by the tear. 

    The pelvic floor muscles are the firm supportive muscles that stretch from your pubic bone at the front of your pelvis to the base of your spine at the back.  They help to hold your bladder, womb and bowel in place, and to close your bladder outlet and back passage.

    When your pelvic floor muscles are well toned they stop leakage of urine from your bladder and wind or stools from the bowel.  When you pass urine or stools the pelvic floor muscles relax and afterwards they tighten to restore control.  They actively squeeze when you laugh or cough to avoid leaking.

    During the first five days the area will feel numb and sore and it will be difficult to exercise during this period, but keep practicing. 

    Image Source: National Institute of Diabetes and Digestive and Kidney Diseases

    How do I do pelvic floor exercises?

    It is not always easy to find your pelvic floor muscles. However, it is important to focus on the right group of muscles when exercising your pelvic floor. You shouldn’t be working the

    muscles in your legs, buttocks or above your tummy button and you mustn’t hold your breath.  Exercising them should not show at all ‘on the outside’.  However, feeling some slight tension in your lower abdominal muscles is normal.

    To start exercising lie down with your knees bent and feet on the bed. As you improve you can sit comfortably upright with your feet touching the floor.

    Slowly tighten and pull up the muscle around your anus and vagina. This squeezes the muscle upwards and inwards.  Imagine that you are trying to stop yourself from passing wind, and at the same time stopping your flow of urine mid-stream.  Once you’ve identified the right muscles, try and see what they can do. See how long you can squeeze the muscles for? How many times can you repeat this? Then try and work towards the following routine:

    • Squeeze and lift your pelvic floor muscles as hard as you can. Hold for a count of 10 seconds. If your muscles feel too weak to hold for 10 seconds. Aim to build up the time slowly. Repeat this exercise up to 10 times.
    • Tighten and lift your pelvic floor muscles as quickly and as strongly as you can, then relax. Do this up to 10 times
    • Aim to do the exercises three times a day, every day.
    • Squeeze and lift your pelvic floor every time you pick up anything heavyg. baby/ car seat, before coughing/sneezing. This helps your pelvic floor muscles to support the increasing downward pressure on your body.
    • Remember to make time for your exercise. Find a time that works for you e.g. when feeding your baby / cuddling baby, resting in bed.
    • Persevere with it. Don’t expect it to work instantly. It takes weeks of regular exercise to improve pelvic floor muscles and several months to regain its strength. However, if you stick to the program you should notice a difference after 6 weeks.

    If you find the exercises described difficult or not working after six week please speak to your midwife or GP so that they can refer you to a women’s health physiotherapist for further help.

    When can I have sex?

    When you feel ready and comfortable enough, however, we advise you not to have sex until approximately six weeks, once the vagina has healed and the area feels comfortable.  Sexual intercourse may be a little uncomfortable at first, therefore we would advise you to use lubricants which you can buy from most pharmacies. This discomfort should improve with time. If you feel apprehensive about sex or experience pain it is important to speak to the urogynaecology link midwife when you attend the hospital.

    DO remember to use effective contraception - as it is possible to conceive a few weeks after your baby is born - See your GP or Family Planning Clinic for contraceptive advice.

    What are the long term effects of OASI?

    • You may find that you need to rush urgently to the toilet. Some women will experience symptoms such as leakage of urine from the bladder or wind or stools from the back passage. This is often temporary and can improve over time with doing regular pelvic floor muscle exercises.  For some women symptoms may appear several months after the repair, in this case seek advice from your urogynaecology link midwife.
    • Stitches have usually dissolved by ten days after the birth of your baby. Sometimes a knot of stitch material can persist and cause discomfort.  All stitch material used in the repair should eventually dissolve.  Often the stitches around the back passage remain in place for up to twelve weeks and can make passing bowel motions uncomfortable.  Ensure you do not become constipated and if the pain is intense or you lose blood with the stool seek advice from your doctor.
    • Very rarely a connection can form between the vagina and the rectum (rectovaginal fistula). It is important to report any unexpected leakage of faecal material from the vagina to your GP or urogynaecology link midwife.  This is not common and can usually be repaired if it does not heal by itself.

    Follow up and the Perineal Clinic

    An appointment will be sent to you to attend the Perineal Clinic for approximately 6-8 weeks after your delivery. This clinic is held in the Urogynaecology Department, which is located on the ground floor of the hospital.

    The Perineal clinic is a specialist clinic for women who have had OASI or who have developed chronic perineal problems post-delivery.

    The first appointment will be with the Urogynaecology Link Midwife. The midwife will ask you some questions regarding any bladder or bowel symptoms you may have experienced and examine the perineum and pelvic floor muscles. This is to assess that your bowels, bladder and pelvic floor muscles are functioning normally and that your perineum has healed. You can decline this examination if you wish.

    Prior to the appointment you will be sent a special on-line questionnaire (ePAQ) to complete as part of you medical care. This is confidential. Please try and complete it before attending for the appointment.

    As part of your follow-up we will arrange for you to re-attend the clinic at approximately 6-9 months after your delivery for some Anorectal studies. These are useful to check how well the muscle in the back passage has healed and how well it is working. You will be asked to complete another ePAQ prior to this appointment. You will be seen by one of the Consultants following the tests to discuss the results.

    It is very important that you attend for both these appointments.

    What if I do not want to have the tests?

    The tests do give us useful information about how well you have recovered from the tear and can help us in providing you with a clearer picture of the future with regards to your continence. They are also very useful, as the consultant can help advise you on how she would recommend you deliver any future pregnancies based on the test result. However, if you do not want to have the tests done, please tell the midwife.

    What about future deliveries?

    It is not known what happens to the anal sphincter muscles in the long-term, after this type of damage. After the Anorectal studies, we will have a better idea of how successful the repair has been. If there are no symptoms and no damage evident, it may be possible for you to consider future vaginal delivery. This causes a 25 in 100 risk of worsening the previous damage. If there are symptoms or evidence of persistent damage then your obstetrician may recommend elective (planned) caesarean section in a future pregnancy.

    If you have any questions, please contact the Urogynaecology Specialist Midwife on 0151 708 9988 Ext. 4321

    Some useful websites are:-


  • What If I Need A Planned Caesarean Section?

    The leaflet is detailed below, or you can download the 'What If I Need A Planned Caesarean Section?' leaflet in PDF.

    What If I Need A Planned Caesarean Section?

    A Caesarean Section is an operation to deliver the baby through the abdomen. Approximately 22% of all babies are born by caesarean section each year in England and Wales. In 2014 the rate was approximately

    23% here at Liverpool Women’s NHS Foundation Trust.

    There are two types of caesarean section: Planned and Emergency. A planned caesarean section is sometimes called an Elective caesarean section. A decision to perform an elective caesarean section is made by a senior doctor, usually during your pregnancy.

    An Emergency caesarean section is performed if any complications occur. This can be before or during labour.

    Common Reasons for a Planned Caesarean Section

    Medical History / Conditions

    Occasionally there may be a medical reason or condition that would cause the doctor to advise you to have a caesarean section. This would be discussed with you during your pregnancy.


    Your baby needs to be in a position that will ensure that he/she will pass safely through the pelvis and birth canal. If the baby is lying in an awkward position e.g. bottom, feet, shoulder, brow or limbs coming first, he/she will not be able to come through the pelvis.

    Placenta Praevia

    Occasionally the placenta may be low down inside the uterus and may cover the neck of the womb: this can often cause bleeding during pregnancy. Placenta Praevia is measured by a scan:

    • If your placenta is less than 2 cm from the opening of your womb you will be advised to have a caesarean section.
    • If the edge of your placenta is more than 2 and less than 3 cm from the opening of your womb, the way you give birth will need to be discussed with your consultant.
    • If the edge of your placenta is more than 2 cm from the opening of your womb, you have more chance of having a vaginal birth. This will be discussed with your consultant.

    Previous Caesarean Section

    If you have already had a Caesarean Section it does not necessarily mean you would be advised to have another, however, if you had any problems at all, then you may be advised to have another section. This depends on your previous birthing experiences.

    Risks of a Caesarean Section

    A Caesarean Section is only performed when absolutely necessary. This is because it is a major operation, which carries possible risks to both mother and baby. Any alternatives to this surgery will be discussed with you by senior medical staff in the antenatal clinic. This discussion will include the risks and benefits for you and your baby of both Caesarean Section and aiming for a vaginal birth.

    If you do not want to have an Elective Caesarean Section, you may choose to wait for labour to occur naturally. If you go more than 10 days overdue or there are other reasons to consider inducing labour further discussion will take place about the risks and benefits of induction of labour or caesarean section as these will put you or your baby at risk of complications.

    There are more risks attached to having a caesarean section than if you have a vaginal birth. There are also more risks if you have an emergency caesarean section rather than a planned caesarean section. These risks may depend on whether you have a medical condition or complications and the reasons why you are having your caesarean section. Listed are some of the possible risks:

    • There is an increased chance that you will take longer to recover, physically and emotionally, after you have had a caesarean section.
    • As with any major abdominal operation you will have an increased chance of bleeding afterwards and due to this you may have an increased chance of a blood transfusion.
    • In very rare circumstances you may bleed so much you need to have a hysterectomy. This means that your womb may be removed.
    • If you have your caesarean section under general anaesthetic (GA), there are risks of complications occurring due to the general anaesthetic.
    • As with any operation, there is a risk of a blood clot forming. However, this risk has fallen dramatically because we use heparin (a small injection under the skin). This helps to prevent any blood clots from forming. There are other ways of preventing clots developing this includes advising you get up and about soon after surgery.
    • There is a small risk that your baby may experience a small cut to his/ her skin during the operation, especially if your waters have broken.
    • Again, as with any operation, there is the risk of possible infection following your caesarean section. We have reduced this risk by giving you antibiotics through your drip during your operation.
    • There have been isolated cases of accidental injury to babies caused by the urgency to deliver babies as quickly and safely as possible.
    • In any future pregnancies you may have, there may be a small risk of rupture (tear) of your uterus (womb) during your labour, but again this is very rare.
    • Occasionally you may experience some difficulty passing urine once your catheter has been removed. A catheter is a soft tube placed into your bladder, whilst you are in theatre, to allow urine to drain out more easily. In this case, the midwives will take the advice of medical staff about how to resolve this.

    Side Effects

    • You will not be able to drive a car for 6 weeks (always check with your car insurer about this).
    • You need to take care when lifting heavy objects such as baby baths, prams or car seats.

    Preparation for a Planned Caesarean Section 

    • You will be asked to attend a “Pre Op” This will help us to assess you and your baby before your operation. At this clinic we will:
      • Measure your blood pressure.
      • You will be seen by a midwife or doctor, who will ask you some questions regarding your general health and your pregnancy and you will have an opportunity to ask your own questions if you have any.
      • You will be given the time and date to return to the hospital. This will usually be the morning that your operation is planned for.
    • You will have not be able to eat or drink after midnight the night before you come back into hospital if your caesarean is planned for the morning and after 6am on the day of operation if planned for the afternoon. This is in case you need a general anaesthetic.
    • The anaesthetists will discuss which type of anaesthetic is best for you.
    • It is recommended that you stay awake during the operation by having a spinal anaesthetic. This is similar to an epidural, which is an injection into your back making your tummy, legs and feet feel numb. A spinal anaesthetic is a lot stronger than an epidural and makes you completely numb from the top of your tummy to your feet.
    • You may be aware of some movement but you will not feel any pain. If you do feel pain, please let your anaesthetist know and he/she will be able to give you a general anaesthetic.
    • If you have a general anaesthetic you will be asleep during the operation.
    • If you decide to have a spinal anaesthetic, you will be able to have your birthing partner with you in the operating theatre during the operation. If you have a general anaesthetic your birthing partner will be able to wait in the waiting room.
    • Your birthing partner will be allowed to sit by the head of the operating table. They will be given green theatre clothes to wear: this is to minimise the risk of infection. A screen will be put up covering your body so that neither of you can see anything. As soon as your baby is born she/he will be lifted up so that you can see him/her. If all is well, you will be allowed to hold you baby within minutes.
    • You will have had a drip put in your arm to enable you to be given fluids until you are eating and drinking. You are able to eat and drink usually as soon as you feel hungry. The drip will then be removed.

    Care Following Your Caesarean Section

    • The operation usually takes between 40-45 minutes and afterwards you will be in the recovery room for at least ½ hour before transferring to the postnatal ward.
    • Once you are on the ward, you will be expected to observe the visiting hours. It may be useful to inform your visitors that the policy on visiting is there to help with your recovery following a major abdominal operation.
    • Following your operation you will usually be in hospital for 1 – 2 days dependent on yours and your baby’s condition. You will be up and about as soon as possible. This is because it is better for your blood circulation that you are up and moving about. There are usually fewer complications if you are active.
    • You will also have a catheter put into your bladder (whilst you are in theatre). This is to allow urine to drain out easily whilst you are unable to move or get out of bed.
    • The midwives will offer you analgesia once back on the Post-natal ward. Please take this on a regular basis to help you to move around.
    • Your drips and catheter will be removed as soon as you are able to eat and drink and you are mobile. The midwife will check your wound daily. The stitches may be dissolvable: otherwise, you will have clips or stitches, which will be removed after 5 days by the midwife.
    • Your midwife will give you advice on caring for yourself when you get discharged from hospital.
    • You will be able to ask any questions you may have at any time throughout your stay.
    • For further information please ask your midwife who may refer you to the appropriate person.

    Vaginal Births Following a Previous Caesarean Section

    It is possible for women to have a vaginal birth following a previous caesarean section. Approximately 70% of women who try a vaginal birth after one caesarean section succeed. This can increase to around 90% for women who have had a vaginal birth before.

    Opportunity will be available for you to discuss this with our maternity team.

    For more information, please go to

    Retained Tissue

    Any tissue taken at the time of your operation will be sent for examination and your Consultant will be informed of the result. Following investigation the tissue will be disposed of in accordance with health and safety.

    This information is not intended to replace discussion with either medical or midwifery staff. If you have any questions regarding the contents of this leaflet please discuss this with a midwife or obstetrician.

  • Renal Pelvic Dilation (RPD)

    The leaflet is detailed below, or you can download 'Renal Pelvic Dilation (RPD)' leaflet in PDF. 

    Your baby has been found to have more fluid in its kidneys than normal. This leaflet will explain what this means for your baby.

    First of all, we think it is important for you to understand how kidneys work.

    How Kidneys Work

    The kidneys work to filter water and waste products from the body and dispose of it as urine.


    Image Source: Mid Cheshire Hospitals

    The outer part of the kidney (Renal Cortex) creates the urine, whilst the inner part (Renal Pelvis) collects it and drains it into the ureter.

    The ureter drains the urine into the bladder, where it is stored and then passes through the urethra when we pas urine.

    This urine makes up the amniotic fluid that surrounds and protects baby, whilst baby is in the womb.

    There are valves at the entrance to (ureter) and the exit from the bladder (urethra), to stop it flooding up to the kidney.

    What Have We Seen In Your Baby?

    We have seen that there is more urine in the pelvis part of your baby’s kidney. We call this renal pelvis dilation (RPD). It is very common to see this in babies in the womb.

    We expect the bay’s kidney pelvis to be less than 7mm at 20 weeks and less than 10mm at any other time in pregnancy. When we find RPD at the 20 week scan, we need to do checks before and after birth on baby. This will be explained below.

    Why Has This Happened?

    RPD is one of the commonest problems we see on antenatal scans. It is rarely a significant problem and often no cause if found.

    The most common cause of RPD is pelvic-ureteric junction (PUJ) obstruction or blockage (see picture). This usually only affects one side and if mild has no long term effects.

    An obstruction can also occur where the ureter narrows as it joins the bladder. We call this vesico-ureteric junction (VUJ) obstruction. This is responsible for 1% (1 in 100) of RPD (see picture). In most cases it is difficult to tell the difference between PUJ and VUJ blockage before birth.

    Other rarer causes will be discussed with you at the Fetal Medicine Unit scan.

    What Happens Now?

    Fetal Medicine Unit Scan

    Once RPD has been seen, another ultrasound scan will be performed by a consultant obstetrician within 7-14 days in the Fetal Medicine Unit at the Crown Street or Aintree site. You will be given an appointment for this.

    The purpose of this scan is to confirm that the RPD is still present and to take a close look at the rest of the urinary system and the baby’s other organs. Many cases of RPD will have gone away by this scan and are called transient. If this has happened, then the RPD will not recur and no further scans are  required.

    If the RPD is still present, then further checks will be required (See below).

    Of all babies with confirmed RPD, approximately 80% will have mild RPD which will almost always return to normal before birth.

    Of those with more severe RPD a third will get better on their own, half will stay the same and a few will get worse during the pregnancy. Even if it gets worse, all we usually need to do is keep an eye on the baby by ultrasound.

    Will I Have Any Further Scans?

    If RPD is confirmed on the Fetal Medicine Unit scan, you will have a second ultrasound scan at about 30 weeks to check if here is any improvement or worsening of the RPD.

    Your baby will also have a scan after birth to see whether the RPD is still present.

    Your baby will also have a scan after birth to see whether the RPD is still present.

    What Does This Mean For My Pregnancy?

    • Your baby will not have to be born early.
    • There is no increased rate of miscarriage or preterm delivery.
    • Your baby will grow at the normal rate.
    • Your baby will need to be seen by the neonatal (baby) doctor and have passed urine before you go home.
    • Your baby may need another detailed ultrasound scan within a few weeks of birth and possibly before going home (see below).

    What Will Happen Once My Baby Is Born?

    Once your baby is born, he/she will be examined by a neonatal (baby) doctor who will arrange any follow-up that is needed.

    Your baby will have an ultrasound scan 3-14 days after birth to assess the RPD. Your baby can go home with you and come back to LWH for this scan. If this scan is normal then your baby will be rescanned a final time when he/she is about 6 weeks old. This scan will also be performed at LWH. If this later scan is normal, then your baby will be discharged.

    If the RPD is more than 10mm on the 3-14 day ultrasound scan, then your baby will be seen by a paediatric urologist (baby doctor specialising in kidneys) and they will organise further investigations. These investigations will be organised by Alder Hey Children’s Hospital.

    They may feel it is necessary to put your baby on antibiotics to prevent any urinary tract infections (UTI’s), and in a small number of cases (3%) they may need to perform an operation at some time in childhood. You will have an opportunity to discuss this at the time.

    Please note: An ultrasound scan will not exclude all abnormalities.

    If you have any questions about any of the information in this leaflet, please contact the Specialist Midwife at the Fetal Medicine Unit on 0151 702 4072.

  • Postnatal Urinary Retention

    The leaflet is detailed below, or you can download 'Postnatal Urinary Retention' leaflet in PDF.

    What is postnatal urine retention? 

    We want you to be able to pass urine spontaneously within 4 hours of your baby being born or 4 hours after you have had your catheter removed. If you are unable to do this it may mean you have gone into postnatal urinary retention. Sometimes you may not be able to pass urine at all but sometimes you may be able to pass small volumes of urine with difficulty, but larger volumes still remain in your bladder. If this happens it is important to tell your midwife.

    Why does urine retention happen?

    1. This can happen because you feel sore underneath, especially if you have had stitches
    2.  There is usually some swelling in and around the vagina after having your baby, which can take time to settle and can make it harder for you to pass urine
    3. An epidural or spinal anaesthetic can cause altered sensation in your lower body, which can affect your bladder temporarily
    4. There may be injury to the pelvic nerves, which may have happened during the birth

    You are more likely to have problems if:

    • This is your first baby
    • You have had an epidural or spinal anaesthesia
    • You have had a prolonged labour
    • You have had an instrumental delivery (forceps or ventouse)
    • You have had a tear or stitches
    • You have a urine infection
    • You have had problems previously

    What can I do to help me try to pass urine?

    1. Analgesia – ask your midwife to give you painkillers if you feel sore
    2. Getting up and walking about – movement really helps to reduce any swelling there may be
    3. Privacy – If you feel nervous about using the toilet in the bay, use one of the toilets on the main corridor of the ward
    4. Taking a warm bath or shower – this will help relax you and make you more comfortable

    What happens if I can’t pass urine?

    If you are unable to pass urine 4 hours after having your baby or your catheter removed then a midwife or doctor will scan your bladder to check how much urine is there. It may be likely that the midwife will then need to empty your bladder using a catheter.

    If you are in discomfort from a full bladder before this time or the midwife can feel a very full bladder, then you may have to have your bladder emptied earlier.

    What is a catheter?

    This is a thin, sterile tube, which is usually made of plastic. The catheter is passed into your urethra (the small opening through which urine is passed) and into your bladder. This allows the urine to drain out. Your midwife or doctor will ask for your consent to put a catheter in your bladder. If you decide you do not want this, then you will be encouraged to try to pass urine again yourself. You could be at risk of harming your bladder in the long term if you still cannot pass urine, especially if there is a large volume of urine there.

    Having a catheter inserted can be a little uncomfortable but it is a quick, safe procedure .You should feel much more comfortable when your bladder is emptied. It may be necessary to leave the catheter in place for at least 24 hours, to let the bladder “rest”. If this happens, a leg drainage bag will be attached to the catheter to collect the urine. This will be strapped to your leg to allow you to continue to mobilise. Staff will show you how to empty your bag when it is getting full. Overnight, another larger catheter bag will be attached to the leg bag and kept on a stand at the side of the bed. This will allow more urine to drain without having to be emptied as frequently and therefore allow you to rest for longer periods.

    You can still have showers and it is important to keep the perineal area (the area between the vagina and back passage) clean, especially after opening your bowels.

    It is really important to stay hydrated. Aim to drink 2 litres of water or dilute juice per day, 3 litres if breast-feeding.

    What happens when the catheter is removed?

    You will be asked for permission to take your catheter out. A midwife or maternity assistant will remove it. This is a quick procedure and you may experience some very slight discomfort.

    It is important that when the catheter is removed we monitor what you drink and how much urine you pass. This can tell us whether your bladder is working normally again. This is easy to do: you will be given a fluid chart and shown how to write down what you drink and how much urine you pass. To measure the urine you pass, your midwife or maternity assistant will provide you with a jug.

    You may find that initially you are unable to tell when your bladder is full. This is usually a temporary problem. If this is happening then it is recommended that you try to go to the toilet every 3-4 hours. This will prevent your bladder getting too full.

    What happens if I cannot pass urine after the catheter is removed?

    It may be necessary to put the catheter back in. This would be for around a week and you would then be referred to the link Midwives in the Urogynaecology Department. This is situated on the ground floor of the hospital. The staff there are trained to provide specialist investigation, advice and support for women with bladder problems. They will discuss the best form of management for your bladder problem.

    In most cases, urine retention is a temporary problem, which may take a few weeks to resolve. If you have any ongoing voiding issues we may teach you how to perform self catheterisation (Clean Intermittent Self Catheterisation) as an interim measure until the issues resolves. The staff in the Urogynaecology department will provide support and advice during this time and will arrange any follow-up you may need.

    Will bladder problems happen again in another pregnancy?

    This is hard to say – there is a chance you may have a recurrence of these problems however we cannot predict if this would be the case for you. If you fall pregnant again, make sure you tell the midwife who is ‘booking’ you in that you have had previous bladder problems with your last pregnancy, so that the staff caring for you are aware.

    Many women have temporary bladder problems in pregnancy and after childbirth, please do not feel embarrassed to discuss any problems with your midwife or doctor who can offer advice and support.

    If you have any questions, please contact the Urogynaecology Link Midwives on 0151 702 4321

    For more information:-

    Please note that Liverpool Women’s NHS Foundation Trust is a smoke free site. Smoking is not allowed inside the hospital building or within the hospital grounds, car parks and gardens.

    Staff are available to give advice about stopping smoking, please ask your Nurse or Midwife about this.


  • Twin to Twin Transfusion Syndrome

    The leaflet is detailed below, or you can download the 'Twin to Twin Transfusion Syndrome' leaflet in PDF.

    Twin to Twin Transfusion Syndrome 

    A diagnosis of Twin to Twin Transfusion Syndrome (TTTS) can be an upsetting and emotional time for you and your family. TTTS is a complication that occurs in around 10-15% of pregnancies to twins that share a placenta (monochorionic). It can occur at any time during your pregnancy but is most likely to occur in the early to middle stages of your pregnancy before 26 weeks.

    This leaflet has been produced to give you a bit more information about TTTS and can be used alongside the advice and support you will receive from the Liverpool Multiple Pregnancy Team

    What is TTTS?

    TTTS occurs when there are abnormal connections between the babies’ blood vessels on the surface of the placenta. This then causes blood to be transferred (shunted) from one twin (called the donor) to the other (the recipient).

    By donating some of its blood supply to its sibling, the donor has less oxygen in its blood. As the donor has less oxygen it prioritises the flow of blood to the brain. This may mean that other organs such as the kidneys do not receive as much blood which will reduce urine production and lead to a small bladder and less fluid around the baby. We can see this on ultrasound.

    The recipient twin has an increase in blood volume from the donor which can sometimes put strain on the baby’s heart as it must pump harder. The recipient will compensate for the extra blood by producing more urine, increasing the amount of fluid around the baby.

    How is TTTs diagnosed?

    TTTS is diagnosed by ultrasound scan and divided into stages. Early ultrasound scanning is important to determine the type of twin pregnancy and whether the babies share a placenta.

    You will have regular ultrasound scans in pregnancy to screen for TTTS. The diagnosis is made by measuring the amount of fluid around each baby, the size of their bladders, the baby’s weight and the baby’s blood flows (Dopplers).

    There are a few warning symptoms to keep an eye out during your pregnancy but often you will have no symptoms at all:

    • Sudden weight gain
    • Feeling of increased pressure in your tummy
    • Feeling like your tummy is tight


    Quintero Stage

    Key Features

    Treatment indicated


    Low liquor around the donor and high around the recipient



    No urine in the donor baby’s bladder



    Abnormal blood flow (Doppler) in either baby



    Heart failure or hydrops (fluid inside the baby’s tummy) in the recipient baby



    How is TTTs managed?

    If you are diagnosed with TTTS, you and your babies will be monitored very closely. Every pregnancy is different, and a specialised plan will be made with you and the Liverpool Multiple Pregnancy Team.

    If the TTTS is mild (stage 1) and the babies are stable, you may not need any treatment. You will be regularly monitored and if the situation gets worse, doctors may intervene.

    If the TTTS is more advanced you will be advised about treatment options. If no treatment is performed the outcome for the pregnancy can be poor with an 80% chance of losing at least one baby. The most effective treatment is Laser Ablation of the blood vessels of the placenta which connect the babies. It involves a needle being inserted into your uterus (womb). The laser will burn the connecting blood vessels stopping the shunting which causes the TTTS. Both babies will still be connected to the placenta by their umbilical cords so will still receive nutrients and blood.

    Laser for TTTS is our most effective treatment with a 75% chance of taking home one or both babies, 50% chance of taking home both. However, there are complications associated with laser, such as; preterm labour, rupture of membranes and have learning difficulties after birth.

    How and when will my babies be delivered?

    TTTS is associated with premature labour and therefore your babies may need to spend some time on the neonatal unit. If the TTTS is fully resolved the pregnancy may carry on as normal with delivery planned as for any other monochorionic twin pregnancy and a vaginal delivery may be possible.

    Key websites to visit

    Twins Trust (formerly TAMBA)

    YouTube Video 

    Multiple Births Foundation

    This leaflet can be made available in difference formats on request. If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at


    Liverpool Women’s NHS Foundation Trust

    Crown Street


    L8 7SS

    Tel: 0151 708 9988

    Issue Date: 28.01.20

    Reference: Mat/2020-261-v1

    Review Date:28.01.2023        © Liverpool Women’s NHS Foundation Trust



  • Stopping Smoking in Pregnancy

    The leaflet is detailed below, or you can download the Stopping Smoking in Pregnancy leaflet in PDF.


    This information is for you if you smoke and are either already pregnant or thinking about having a baby. It is also for you if you are exposed to tobacco smoke at home. You may also find it helpful if you are the partner or a relative of a woman who smokes.

    Many women find it difficult to stop smoking but it is one of the most important things you can do to improve your baby’s health, growth and development. It is also the single most important thing that you can do to improve your own long-term health.

    This leaflet tells you about the effect of smoking on you and your baby. It also tells you about the help and support that you will be offered to stop smoking. It’s never too late to stop smoking and your healthcare team will be supportive throughout your pregnancy.

    When you stop smoking, you and your baby will feel the benefits immediately.

    Why is smoking in pregnancy harmful to me and my baby?

    Just as smoking is bad for you, babies in the womb can be harmed by tobacco smoke because it reduces the amount of oxygen and nutrients that pass through the placenta from you to your baby.

    Smoking when you are pregnant increases your risk of:

    • Miscarriage
    • ectopic pregnancy (a pregnancy growing outside the womb)
    • Your baby dying in the womb (stillbirth) or shortly after birth – one-third of all deaths in the womb or shortly after birth are thought to be caused by smoking
    • Your baby being born with abnormalities – face defects, such as cleft lip and palate, are more common because smoking affects the way your baby develops
    • Your baby’s growth and health being affected – the more you smoke, the less healthy your baby will be, and a baby that is small due to smoking is more likely to have health problems when young and also later in life
    • Bleeding during the last months of pregnancy, which is known as an abruption (when the placenta comes away from the wall of the womb) – this could be life threatening for you and your baby
    • Premature birth, when you have your baby before 37 weeks of pregnancy.

     Babies and children whose mothers smoke during pregnancy are also at greater risk of:

    • Sudden and unexplained death, known as sudden infant death syndrome (SIDS) – as well as happening to new born babies, this can also happen to infants over 12 months: the risk is greater if you or your partner continue to smoke after she or he is born, particularly if you share a bed with your baby at night
    • Asthma, chest and ear infections, and pneumonia
    • Behaviour problems such as ADHD (attention deficit hyperactivity disorder) performing poorly at school.


    Will I be asked about smoking when I am pregnant?

    Yes. From your first antenatal appointment, your midwife will ask whether you or any other member of the household smokes. This is important so that you and your family can be given support and help to stop smoking as early as possible. You will be asked how often you smoke and how much tobacco you smoke per day. You will be given information about how smoking and passive smoking harms you and your baby (see next section).

    In an effort to support you and reduce smoking in pregnancy, to give you and your baby the added benefits of a smoke free pregnancy – all women who smoke, e-cig and vape are referred to our local stop smoking service. The Stop Smoking Advisor will contact you and offer further support and advice.

    Second-hand (passive) smoke harms your baby.

    If your partner or anyone else who lives with you smokes, their smoke can affect you and your baby before and after their birth. You may also find it more difficult to stop if someone around you smokes.

    Second-hand smoke can also reduce your baby's birthweight and increase the risk of sudden infant death syndrome (SIDS), also known as "cot death". Babies whose parents smoke are more likely to be admitted to hospital for bronchitis and pneumonia during their first year.

    To find out more about quitting and to get support, your partner can call NHS Smoke free helpline on 0300 123 1044 from 9am to 8pm Monday to Friday, and 11am to 4pm Saturday and Sunday

    I’m a smoker, so what should I do?

    There is no safe level of smoking, either for you or your baby. The earlier you stop smoking, the greater the benefit to you and your baby, but it is important to know that stopping at any time during pregnancy is beneficial to some extent.

    Reducing the number of cigarettes you smoke is a positive step, although there is no evidence that this is better for your baby. Therefore, both you and your partner will be advised to stop completely – not just cut down. To help you with this, you should be referred to services that will help you both to stop smoking (see information at the end of the leaflet).

    What is the carbon monoxide (CO) test?

    Carbon monoxide (CO) levels are higher in women who smoke and in passive smokers than in women who don’t. CO is a poisonous gas that restricts the amount of oxygen getting to your baby.

    At your first antenatal appointment your midwife will ask you to do a breath test, which will measure your level of exposure to CO. This will help your midwife measure your exposure to tobacco smoke. This will also be repeated when you are 36 weeks pregnant and some other times it may be required in pregnancy.

    All pregnant women are advised to have the test whether they smoke or not as levels may also be high if you have faulty gas appliances at home. CO poisoning can be fatal. If you don’t smoke and you are not exposed to tobacco smoke but your levels are high, you should contact the free Health and Safety Executive Gas Safety Advice Line on 0800 300 363. CO levels may also be raised if you are exposed to high levels of pollution or if you have a medical condition called lactose intolerance.

    Nicotine replacement therapy

    You can use nicotine replacement therapy (NRT) during pregnancy if it will help you stop smoking and you're unable to stop without it. It's not recommended that you take stop smoking tablets such as Champix or Zyban during pregnancy.

    NRT contains only nicotine and none of the damaging chemicals found in cigarettes, so it is a much better option than continuing to smoke. It helps you by giving you the nicotine you would have had from a cigarette.

    You can be prescribed NRT during pregnancy by a GP or an NHS stop smoking adviser. You can also buy it over the counter without a prescription from a pharmacy.

    NRT is available as patches, gum, inhalator nasal spray, mouth spray, oral strips, lozenges and microtabs.

    If you have pregnancy-related nausea and vomiting, patches may be a better solution.

    NRT patches should be used for no more than 16 hours in any 24-hour period. The best way to remember this is to remove the patch at bedtime.

    Before using any of these products, speak to a midwife, GP, a pharmacist or a specialist stop smoking adviser.

    By getting this specialist advice you can be sure that you're doing the best for your baby and for you.

    Call the NHS Smokefree helpline on 0300 123 1044 from 9am to 8pm Monday to Friday, and 11am to 4pm Saturday and Sunday.

    Remember, you are twice as likely to be successful at quitting if you get some support from a trained adviser.

    E-cigarettes and Vaping in Pregnancy.  

    E-cigarettes are fairly new and there are still some things we do not know. However, current evidence on e-cigarettes indicates they are much less risky than smoking.

    Cigarettes deliver nicotine along with thousands of harmful chemicals. E-cigarettes allow you to inhale nicotine through a vapour rather than smoke. By itself, nicotine is relatively harmless.

    E-cigarettes do not produce tar or carbon monoxide, the 2 main toxins in cigarette smoke. Carbon monoxide is particularly harmful to developing babies. The vapour from an e-cigarette does contain some of the potentially harmful chemicals found in cigarette smoke, but at much lower levels.

    If using an e-cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke.

    Unlike nicotine replacement therapy (NRT), such as patches or gum, e-cigarettes are not available on an NHS prescription. If you want to use an e-cigarette, you can still get free expert help from a stop smoking adviser.

    Call NHS Smokefree helpline on 0300 123 1044 for more information, or ask a midwife to refer you.

    Find out more about using e-cigarettes to stop smoking.

    NHS Smokefree Helpline.

    The NHS Smokefree helpline offers free help, support and advice on stopping smoking and can give you details of local support services.

    You can also sign up to receive ongoing advice and support at a time that suits you.


    NHS Smokefree helpline: 0300 123 1044

    9am to 8pm Monday to Friday

    11am to 4pm Saturday and Sunday.

    To find your nearest NHS Stop Smoking service talk to:

    • a midwife
    • a health visitor
    • a nurse at your GP surgery
    • a pharmacist

    NHS Stop Smoking services can offer 1-to-1 or group sessions with trained stop smoking advisers and may have a pregnancy stop smoking specialist.

    They can also offer advice about dealing with stress, weight gain and support the use of NRT (such as patches or gum), if appropriate, to help you manage your cravings.

    Further Support and Advice.

    Smokefree Liverpool

    Life Bank 23 Quorn Street


    0800 061 4212

    0151 374 2535

    Text QUIT to 66777

    Please speak to your Midwife or G.P about the benefits to stopping smoking in pregnancy and for further information on accessing stop smoking services.

    The information found in this leaflet is taken from  

    and Smoking and Pregnancy Leaflet, produced Dec 2015. Accessed 16.01.2019

    This leaflet can be made available in different formats on request. If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at 


    Liverpool Women’s NHS Foundation Trust

    Crown Street


    L8 7SS

    Tel: 0151 708 9988

    Issue Date: 18.06.2020

    Review Date: 18.06.2023

    Ref: mat/2020-282-v1                                                        

    © Liverpool Women’s NHS Foundation Trust

  • Ondansetron in pregnancy

    The leaflet is detailed below, or you can download 'Ondansetron in pregnancy' leaflet in PDF.

    What is Ondansetron?

    Ondansetron is a medication that we use to treat nausea and vomiting. In pregnancy it is used as third line medication. This means that it is used if two other medications have not helped with the woman’s symptoms.

    Is Ondansetron safe in pregnancy?

    A large study of over 1.8million pregnancies in 2018 has shown that there is no increased association with heart problems in babies of mum’s who take Ondansetron in pregnancy. There was an increased association of 3 per 10,000 of cleft palate. This means that the number of babies born with cleft palate increased from 11 per 10,000 to 14 per 10,000).

    What are the benefits of taking Ondansetron in Pregnancy?

    There is a significant risk to women in early pregnancy with severe nausea and vomiting, including and not limited to malnutrition, dehydration, hospital admission, loss of work, blood clots, reduced quality of life, small babies and some women opt to terminate the pregnancy as the sickness is so severe.

    Because we use Ondansetron as a third line this means that only women with severe nausea and vomiting are taking the medication.

    What does the Pregnancy Sickness Community say?

    The pregnancy sickness community has challenged this view that Ondansetron should not be used in the first trimester based upon the trial. The European Medicines Agency (EMA) responded to say that their statement is not referring to women with severe nausea and vomiting in pregnancy. They said that it is up to local units to decide whether to continue to prescribe for women with severe nausea and vomiting in pregnancy.

    The advice from the pregnancy sickness community is that we should inform women of the small increased association with cleft lips and palates . If women understand and are willing to accept the risk we should continue to prescribe Ondansetron.

    More information

    Talk to your doctor for more information or visit the Pregnancy Sickness Support website

    i Huybrechts K F, Hernandez-Diaz S, Straub L, Gray K J, Zhu Y, Patrono E, Desai R J, Mogun H, Bateman B T. Association of maternal first trimester Ondansetron use with cardiac malformations and oral cleft palates in offspring. JAMA 2018:320(23);2429-2437
    ii Ondansetron update. Pregnancy Sickens Support. Available at Accessed 28th November 2019

    This leaflet can be made available in different formats on request. If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at

  • Latent Phase of Labour - How will I know my labour has started?

    The leaflet is detailed below, or you can download the 'latent phase of labour' leaflet in PDF

    Labour is a journey and every woman’s journey is different.  This leaflet has been produced by midwives to try to help you help yourself during the early stages of labour.

    We hope that using some of the tips in this leaflet will help.

    Coping with the Latent Phase of Labour

    The three stages of labour

    The first stage

    Is the longest stage and ends when the neck of your womb opens fully (10 centimetres dilated)

    The second stage

    Is when your baby moves down through the birth canal and is born.

    The third stage

    Is when your afterbirth is delivered.

    What is the Latent Phase of Labour?

    The latent phase of labour is the very first part of your labour.  During pregnancy the neck of the womb (cervix) is long, firm and closed.

    During the latent phase the neck of the womb shortens (effaces) and opens (dilates) to about 4 centimetres.

    The next part of labour is called active labour and we say labour has become established or properly started.

    What happens during the latent phase?

    During the latent phase the muscles of the womb (uterus) contract and this causes the neck of the womb to shorten and open by 4 centimetres.  The latent phase can last several days.  Some women feel backache or cramps during this time.  Some women will have bouts of contractions lasting a few hours.  The contractions may start and stop several times.  This is normal.

    Many women pass a “show”, which is a plug of mucous from the neck of the womb, usually stained with blood.  Some women pass a large plug of mucous all at once; others have several “shows” over several days.

    In the latent phase of labour contractions can vary in length and how often they come.  They may continue for several hours but not become much longer and stronger.  This is also normal.

    If your contractions do slow down or stop, this is a good time to rest and make sure you have something to eat.  When your body has built up some energy supplies your contractions will start again.  Many women find that coming into the hospital or having a vaginal examination during the latent phase slows down the contractions; this is why your midwife may encourage you to remain at home in early labour or avoid too many internal examinations.


    In the active phase of labour contractions change, they become


    and usually continue to become stronger until the baby is born

    It is very important you have a supportive birthing partner with you.  This should be someone who is happy to be with you throughout your labour.  Choose someone who has a positive attitude about birth and who you feel totally relaxed, confident and comfortable with.

    We welcome two birthing partners (occasionally there may be times when this is not possible- please check hospital website or speak to your midwife for more information)

    What can I do in the Latent Phase of Labour?

    It is best to try and stay as relaxed as you can, distract yourself from focusing on the contractions.  It is a good idea to stay at home for as long as possible.  This is because there is evidence that if you arrive in hospital in established (strong) labour you are more likely to have a straight forward birth.

    You may also feel more relaxed and comfortable in your own home.

    There are many things you can do to help your labour go well

    Things to try:

    • Potter around the house
    • Take a walk
    • Watching a DVD/video (one that makes you laugh is best)
    • Take a warm bath or shower
    • If the contractions slow down or stop, have a short nap or lie down
    • Do some relaxation
    • Keep your breathing quiet and sigh out slowly during contractions
    • Ask your birth partner to give you a massage
    • Kiss and cuddle or make love
    • Use your TENS machine if you plan to use one
    • Put a heat source, wrapped in a small towel on areas that ache
    • Keep upright and mobile
    • Change your position frequently
    • Try a birthing ball
    • Drink plenty of fluids
    • Eat little and often – carbohydrates like bread or pasta and sugary foods


    You should inform a midwife if you experience

    • Constant or rapidly increasing pain
    • You know or suspect your waters have broken
    • You have a green or yellow vaginal discharge
    • Vaginal bleeding that is not mucousy (jelly-like)
    • Any change in your baby’s movement pattern – Your baby’s movements should continue throughout labour
    • Persistent vomiting
    • Feeling generally unwell or feverish
    • You need further advice or reassurance

    If you think you may be in early labour, call the Triage Midwife at the hospital for advice.

    If you have any pregnancy complications please inform the midwife you speak to.

    If you are not in established (strong) labour when you are assessed by a midwife you may be advised to stay at home.

    Research tells us that women who spend the early part of their labour at home are less likely to experience medical interventions such as caesarean section, a drip to speed up labour, or develop an infection.

    If you have signs of labour or are concerned please speak with a midwife:

    Call our Triage Midwife on 0151 702 4413


    The Midwife Led Unit on 0151 708 9900



  • Obstetric Cholestasis

    The leaflet is detailed below, or you can download the 'Obstetric Cholestasis' leaflet in PDF.

    What is Obstetric Cholestasis?

    Obstetric cholestasis also known as ICP (Intrahepatic Cholestasis of Pregnancy) is the commonest liver condition specific to pregnancy

    It affects more than 5,000 women a year in the UK

    Its cause is unknown, but is thought to be a combination of:-

    • Genetics – it can run in families
    • Hormones – it is more common in twins/multiple pregnancies
    • Environment

    Cholestasis causes itching. Itching more commonly affects the hands and feet, but can occur anywhere on the body. It can vary from mild to severe. Most women notice itching is worse at night.

    Why is ICP important?

     ICP is associated with increased risk of

    • Baby passing meconium (poo) prior to birth
    • Spontaneous preterm (early) labour
    • Admission to neonatal units
    • Stillbirth (small risk applies to women with severe ICP with bile acids more than 100)

    Most recent research has suggested that 90% women can be reassured that risk of stillbirth for their baby is not increased due to the condition.

    Careful monitoring and management of the 10%, who are at risk, can mean babies can be born safely.

    Diagnosis and management of obstetric cholestasis

    20% of women will experience itching during pregnancy, but only a small number will have ICP.

    The most important test is a blood test for Bile Acids. This is done alongside liver function tests (LFTs).

    If this test is normal and itching persists it should be re-checked, as the itch can be present for weeks before it becomes raised.

      Treatment of cholestasis involves

    • Medicines to help with itching (antihistamines and topical treatments such as creams)
    • Regular blood tests. Frequency will depend on how pregnant you are and blood levels.
    • Early delivery of baby (between 35 and 39 weeks) dependent on bile acid levels.

    After birth

    After birth blood tests should go back to normal after 6 weeks. It is important that your GP checks this as if they remain abnormal you might need to be referred to a liver specialist

    Having cholestasis means you have a higher chance of developing liver problems such as gallstones in the future

    Up to 80% women will have cholestasis in a following pregnancy


    Further information and support available from



  • My Pregnancy Notes Information Leaflet

    The leaflet is detailed below, or you can download 'My Pregnancy Notes' leaflet in PDF. 

    The new way to view and interact with your maternity notes online

    Registering for My Pregnancy Notes

    You will only ever need to register for My Pregnancy Notes once. If you ever get pregnant again and wish to have your care with us, you will be able to create a new pregnancy linked to your account. 

    • Click Register
    • Click I am a pregnant woman
    • Complete registration Details
      • Your email will become your username
    • Click Verify Email
    • Navigate to your email
    • Open email
    • Click Verify Email

    • Create Password
    • Click Complete Registration
    • You will be asked to complete a registration form for this pregnancy
    • Click Complete Registration
    • Complete form
    • Select Liverpool Women’s Hospital
    • Complete data sharing consent (if you do not wish to share data please discuss this with your midwife. What your data is used for will be discussed with you).
    • Click Submit

    What can I do on My Pregnancy Notes?

    My Notes:

    • Welcome page with advice on when to call your midwife courtesy of MAMA Academy.
    • Add information to your notes including questions or maternity certificates.

    My Health:

    • Record a private diary and
    • Add observations if you have been asked to by your clinician.

    My Preferences/information and Settings:

    • Add in preferences for your pregnancy and birth.
    • Access information leaflets and links.
    • Take control of some of the things you see in your notes.

    Why should I use My Pregnancy Notes?

    We have been working very with hard other hospitals to produce a tool which you can use to access your notes wherever and whenever you wish and communicate better with your clinicians.

    My Pregnancy Notes will allow you to be more involved in your care and provide your clinicians with more information than ever about you preferences. It will enable you access to up to date information about your care and the leaflets and information you need, whenever you need it.

    Your clinician may also discuss the need to monitor a part of your care (Blood pressure, Temperature etc.). If this is the case, they will discuss this with you, and you will be able to enter these observations straight into your notes, which can be seen in real time by your clinician.

    What if I need help?

    If you need help, the first person to contact should always be your midwife or doctor giving your care. However below there are links to help guides to help you with the use of My Pregnancy Notes.

    User Guides

    Patient Information

    Add My Pregnancy Notes to your phone home screen

    iOS (Safari)

    Select the action button highlighted in green below

    • Scroll down and select add to home screen

    • Click add

    Android (Chrome)

    • select the action button highlighted in green below

    • Click add

    Contact Us

    Liverpool Women's NHS Foundation Trust
    Crown Street
    L8 7SS

    0151 708 9988

  • Asprin in Pregnancy to prevent Pre-Eclampsia

    The leaflet is detailed below, or you can download 'Asprin in Pregnancy to prevent Pre-Eclampsia' leaflet in PDF.

    You have been asked to take 150mg of Aspirin during your pregnancy to reduce the risk of Pre-Eclampsia.

    This leaflet explains why we have asked you to take Aspirin during your pregnancy.

    What is Pre-Eclampsia?

    Pre-Eclampsia is a condition found only in pregnancy that causes:

    • Raised blood pressure (Hypertension)
    • Protein in the urine (Proteinuria)

    It affects around 2 to 10 of every 100 pregnant women.  Most women will have a mild form, with some having more severe cases.

    Women will often have no symptoms and it is diagnosed at routine antenatal appointments with your midwife.  Some women will experience headaches, blurred vision and swelling of the hands, feet and face.

    These symptoms can be managed with medications that bring your blood pressure down, however the only cure for pre-eclampsia is when your baby is delivered.

    What is the risk of Pre-Eclampsia?

    If pre-eclampsia is not treated then there is a risk that it may affect the growth of the baby inside the womb, as well as a risk to the health of the mother.  In these cases, the baby may need to be delivered (induced) earlier.

    Who gets Pre-Eclampsia?

    Any woman can develop pre-eclampsia during pregnancy.  However, some women are at increased risk for a variety of reasons.  The risk factors are divided into Moderate Risk Factors and High Risk Factors.

    Moderate Risk Factors:

    • First pregnancy
    • BMI >35
    • Age >40 years
    • Multiple pregnancy (twins/triplets etc)
    • Family history of pre-eclampsia (Sister/Mother)
    • >10 years since previous pregnancy
    • If you have a British and Minority Ethnic Origin (BAME)

    High Risk Factors:

    • Previous pre-eclampsia before 37 weeks
    • Pre-existing chronic or essential hypertension
    • Chronic kidney disease
    • Systemic Lupus Erythematosus or Antiphospholipid antibody syndrome (Autoimmune disease)
    • Diabetes
    • Previous fetal growth restriction (birthweight less than the 3rd centile) at any gestation

    Why have I been asked to take Aspirin?

    You have been asked to take Aspirin because your doctor feels that you are at risk of developing pre-eclampsia based on the previously mentioned risk factors. Research suggests that taking Aspirin during pregnancy reduces your risk of developing pre-eclampsia before 37 weeks by two thirds.

    Is Aspirin safe to take during pregnancy?

    Yes it is!

    Research has shown that Aspirin does not cause harm to the development of the baby during pregnancy.  There is also no increased risk of bleeding when taking Aspirin during pregnancy, either to you or the baby.

    Although it is advised for you to take Aspirin, it is an unlicensed use of the medication.

    What happens next?

    We recommend you take 150mg of Aspirin every night from the 12th week of pregnancy until delivery of your baby.  We will ask your GP to provide a prescription for Aspirin and we will continue to monitor your blood pressure and urine protein throughout your pregnancy.

    Further information

    If you have any further questions about taking Aspirin during pregnancy, or about pre-eclampsia, then please speak to your community midwife, GP or contact the Antenatal Clinic at Liverpool Women’s Hospital.






  • High Blood Pressure and Pre-eclampsia

    The leaflet is detailed below, or you can download 'High Blood Pressure and Pre-eclampsia' leaflet in PDF.

    This leaflet is for women who had high blood pressure (hypertension) in pregnancy or shortly after delivery.

    Women who had raised blood pressure during pregnancy, have a greater risk of health problems in future pregnancies and in later life. This risk can be reduced by making healthy lifestyle choices and having regular check-ups with your GP (family doctor). Most women will have their follow up appointments with their midwife and GP.

    If you are discharged home on medication your GP will review the need to continue these medications over next few weeks or months.

    If you are concerned about your blood pressure or you feel unwell, and your baby is less than four weeks old, please contact your community midwife (using the contact details provided by the hospital).

    If your baby is four weeks old or more, please contact your GP.

    Why worry about pre-eclampsia and high blood pressure after birth?

    Although pre-eclampsia is usually considered a disease of the second half of pregnancy, it can show itself for the first time after delivery. Pre-eclampsia at any time can cause headaches, visual disturbances, nausea and vomiting and other unpleasant symptoms.

    High blood pressure can cause cerebral haemorrhage (a stroke) if not treated.

    Eclamptic fits can occur up to 23 days postnatally, and long term untreated high blood pressure can lead to heart and blood vessel problems.

    Although serious problems are rare, they are all avoidable and treatable.

    Facts about pre-eclampsia after the baby is born

    • Pre-eclampsia always goes away eventually after the baby is born because it is a disease of the placenta (afterbirth).
    • It may disappear within hours, or any time up to six months after the birth.
    • Occasionally pre-eclampsia presents for the first time up to four weeks after birth.
    • Pre-eclampsia may necessitate a longer postnatal stay in hospital until the blood pressure has been controlled for 24-48 hours, depending on the severity of symptoms and blood pressure readings.
    • Anti-hypertensive drugs (drugs to lower the blood pressure) should not be stopped without close medical supervision, and this should usually be done gradually.
    • If the high blood pressure does not eventually disappear after the birth, the condition will be diagnosed as non-pregnancy hypertension, which will require treatment to control cardiovascular problems in later life.

    How should pre-eclampsia be managed after delivery?

    All women should have their blood pressure checked soon after the birth.

    The condition of some women with pre-eclampsia will deteriorate soon after delivery and midwives and doctors monitor affected women very carefully.

    Approximately a third of women with pre-eclampsia and pregnancy induced hypertension will continue to have high blood pressure after the birth or have a recurrence of high blood pressure within a week of birth, and 5-6% of women who develop pre-eclampsia will develop it in the postnatal period for the first time.

    You may be asked to stay in hospital until your blood pressure can be maintained below 150/100mmHg, and this could take a few days.

    Will I get high blood pressure in my next pregnancy?

    If you had high blood pressure before you became pregnant or had blood pressure problems in this pregnancy, you have a greater risk of similar complications in future pregnancies.

    This risk depends on how severe your problem was and how many weeks pregnant you were when the high blood pressure started.

    • If you developed pre-eclampsia after 37 weeks, there is about a one in ten to one in twenty (5-10%) chance that it will happen again.
    • If you developed pre-eclampsia between 34 and 37 weeks, there is about a 1 in 5 (20%) chance that it will happen again.
    • If you developed pre-eclampsia between 28 and 34 weeks, there is about a 1 in 4 to 1 in 3 (25-33%) chance that it will happen again.
    • If you developed pre-eclampsia before 28 weeks, there is about a 1 in 3 to 1 in 2 (33-50%) chance that it will happen again.

    Pre-eclampsia may occur at a similar time or later in your next pregnancy, but it is likely to be less severe than the first time.

    If you get pregnant again, please make sure you see your GP as soon as possible. Starting low-dose aspirin (150mg daily) from 12 weeks’ gestation in your next pregnancy can significantly reduce the risk of high blood pressure and pre-eclampsia happening again.

    Will I have high blood pressure when I am older?

    If you have had high blood pressure in pregnancy you have an increased risk of having certain health problems later in life, especially if your baby was delivered before 37 weeks. You may be able to reduce the risk of these conditions if you have regular check-ups and make healthy lifestyle choices.

    The problems related to long-term high blood pressure (Chronic Hypertension) include:

    • Venous thromboembolism – blood clots that can move to the lungs.
    • Cardiovascular disease – problems with your heart and your blood vessels like palpitations, heart attacks or angina.
    • Cerebrovascular disease – problems with the blood vessels in your brain such as stroke or mini-stroke and dementia.
    • Renal disease – problems with your kidneys that could lead to needing dialysis.
    • Retinal disease – problems with your eyes that can lead to poor vision or blindness.

    Staying Healthy

    What can I do now?

    Make sure your blood pressure is well controlled. This will reduce your chances of complications now and in the future.

    Make sure you:

    • Follow the plan for blood pressure checks with your midwife, health visitor and GP.
    • Take your medications as advised.
    • If you have any questions or you run out of medicines, speak to your GP.

    What can I do long-term?

    There are lots of things you can do to try and stay healthy. Talk to your GP if you need help with any of these:

    • Regular exercise - for example, 20 minutes fast walking a day.
    • Eat a healthy, balanced diet - your GP can give you advice.
    • Do not drink too much alcohol (less than 14 units a week is advised).
    • Keep to a healthy weight for your height - your GP or health visitor can give advice.
    • Do not smoke cigarettes or take recreational drugs – for help on quitting see your GP for a local programme.
    • If you are diabetic, make sure you keep your blood sugars within your targets.
    • Have your blood pressure and cholesterol checked at least once a year by your GP.

    More information

    Action on Pre-eclampsia:  Helpline: 01386 761 848

    NHS Choices for information on healthy eating and exercise following childbirth:

    NICE Guideline Hypertension in Pregnancy, available from










  • Corticosteroid treatment in Hyperemesis Gravidarum

    The leaflet is detailed below, or you can download the 'Corticosteroid treatment in Hyperemesis Gravidarum' leaflet in PDF.

    What is Hyperemesis Gravidarum?

    Nausea and vomiting in pregnancy are very common, affecting up to 80% of pregnant women.

    Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy; this is less common, affecting 1-3 in every 100 pregnant women.  This type of nausea and vomiting in pregnancy is diagnosed by your healthcare practitioner when you have significant dehydration (feeling dry mouthed, very thirsty, drowsy or you have dark urine) and weight loss.

    Some women with this condition need to be admitted to hospital for support.  This can include fluids through a drip or medications as injections or through a drip as well as nutritional support.

    Why does Hyperemesis Gravidarum happen?

    Nausea and vomiting in pregnancy and hyperemesis gravidarum are thought to be due to the pregnancy hormone, human chorionic gonadotrophin (hCG).  There is no clear reason why some women get it worse than others.  It is more likely to occur if you have had it before, you are having twins or triplets or rarely, if you have been diagnosed with a molar pregnancy (where the placenta overgrows and the pregnancy does not form correctly). 

    Where can I find out more about Hyperemesis Gravidarum?

    The team at the women’s are always happy to discuss HG or any concerns you have.  We have a leaflet about sickness and vomiting in pregnancy on our website that can be found here.

    There is also an excellent online support network through the charity Pregnancy Sickness Support.  This can be accessed on the web address below

    We would encourage anyone affected by nausea and vomiting in pregnancy and their families to visit this site as it has a lot of information, advice and support.

    What are corticosteroids?

    Corticosteroids are strong anti-inflammatory, immunosuppressive and anti-sickness medications. There is increasing evidence that steroids are an effective treatment for hyperemesis gravidarum.

    The way they help with anti-sickness is unclear.

    Corticosteroids have been used for a long time in pregnancy for other conditions such as acute asthma, inflammatory bowel disease and to speed up lung development in babies at risk of premature birth.

    At what point should I be treated with corticosteroids for hyperemesis gravidarum?

    Your doctor will consider prescribing you a course of corticosteroid treatment after you have tried other anti-sickness medications, and they have not been effective at reducing or stopping your vomiting symptoms.  This is a medication that is only started in hospital by the specialist early pregnancy team.  Corticosteroids are termed a “third-line” medication which means that you will be prescribed both first- and second-line treatment prior to consideration of this therapy.  See example below:

    Table 1.  Recommended anti-sickness therapies (RCOG GTG 69)

    Benefits of corticosteroid use in hyperemesis gravidarum

    There is good evidence that corticosteroids can dramatically improve the symptoms of severe hyperemesis gravidarum that have not responded to other anti-sickness therapies.   

    How will I take corticosteroids?

    Corticosteroids are usually started while you are in hospital.  They will be commenced intravenously (through the vein) at a high dose.  When you feel better, they will be given as oral tablets and gradually reduced over several weeks (Table 1) until they are stopped altogether or continued at a low dose.

    Are there any side effects?

    Side effects of corticosteroids are uncommon - your doctor should prescribe the lowest effective dose for the shortest time possible.

    Examples of side effects include some disturbance of mood, developing ulceration of the gastric tract (your stomach and bowel) and muscle breakdown.  Less commonly, changes in your blood pressure, swelling and electrolyte disturbances (the salts in your blood) can occur.  With prolonged use they are associated with diabetes, gestational diabetes, and osteoporosis (bone thinning).

    Seek medical attention if you experience visual disturbances for example, blurring of your vision.

    Are there any reasons I should not be taking corticosteroids?

    This medication should not be used if you have a widespread serious infection.

    Are corticosteroids safe for me to take during pregnancy?

    Corticosteroids are generally safe to take in pregnancy.  Only a small amount of corticosteroids used for hyperemesis gravidarum pass through to your baby.

    There is some association between taking corticosteroids in pregnancy and cleft lip/palate.  Since 2003 no study has proven a significant risk but the rate for cleft lip/palate is believed to be increased from 1.7 to 2.7 per 1,000 babies born to mums who have taken corticosteroids in pregnancy.

    It is important to stress that the effects of hyperemesis gravidarum itself on pregnancy can be significant.  HG is associated with low birth weights, preterm birth, dehydration and malnutrition for mum, increased risk of blood clots and in some circumstances families having to make the very difficult and heart-breaking decision to end a pregnancy because they cannot continue with the sickness.

    Your obstetrician may recommend that you have a test for gestational diabetes during your pregnancy if corticosteroids are taken long-term.

    When will I stop taking corticosteroids in my pregnancy?

    Most women will stop corticosteroid treatment by 18-20 weeks of pregnancy.  1 in 5 women may require a low dose for the rest of the pregnancy to control nausea and vomiting, sometimes until delivery.

    The most important thing when you stop your steroids is that you do it gradually.  This is usually done by reducing the dose by 5mg (1 tablet) each week.  For some women this causes the nausea and vomiting to return.  If this is the case we would advise you to go back to the dose level that stopped your sickness symptoms.

    Who will look after me as my pregnancy progresses?

    You will be followed up by a consultant in the antenatal clinic.  They will advise you further on managing your medications and will arrange growth scans for your baby from 30 weeks.

    Further information

    Liverpool Women’s Hospital website

    There are information leaflets on the website for early pregnancy.  Look for the tab for patients, then patient information leaflets.  Select gynaecology and you will see and area for early pregnancy.  Here are all our specific early pregnancy leaflets.  Below is the direct link to the sickness and vomiting in pregnancy leaflet

    Pregnancy sickness support

    An online charity for women and their families who suffer sickness and vomiting in pregnancy

    Royal college of Obstetricians and Gynaecologists (RCOG)

    This is our medical body that produces guidance and support for doctors, nurses and midwives caring for women and their families in pregnancy.   They also write information leaflets for women and their families.  They have information on pregnancy Sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum) accessible at









  • Post-Natal Pain Relief

    The leaflet is detailed below, or you can download the 'Post-Natal Pain Relief' leaflet in PDF.

    Why have I been asked to read this leaflet?

    You have been given this leaflet to read alongside the pain relief you will take home after the birth of your baby.  This leaflet is to help you understand the pain relief options that are available to you, how to take them and the common side effects.  If you have any further questions or concerns, please do not hesitate to ask you midwife or doctor.

    What tablets will I be given?

    We aim to give you a range of medications to help with your pain.  Each of these medications are safe to take together and work in different ways so they complement each other to give you the best pain relief. 

    • Paracetamol

    This is the same medication that you can buy over the counter.  You can take two tablets up to four times a day.  Each tablet is 500mg so this means you are taking 1g each dose.  You should not take more than 4g (8 tablets) in 24 hours. Make sure you do not take any other medication that contains Paracetamol, such as cold and flu medications alongside your Paracetamol.  If you do take more than 4g in 24 hours you should seek medical help via 111.

    It is considered safe for breastfeeding

    More information below in the section: Are these tablets safe for breastfeeding?

    •  Naproxen

    This is similar to Ibuprofen and is known as a Non-Steroidal Anti-inflammatory or NSAID for short.  You can take 500mg twice a day.  We advise you to take Naproxen with food as it can cause stomach upset.  It is considered safe for breastfeeding. 

    More information below in the section:  Are these tablets safe for breastfeeding?

    There are some occasions when we would not advise NSAIDs.  These include

    • Blood pressure problems such as pre-eclampsia
    • Very heavy bleeding
    • Kidney problems
    • Low platelets
    • Asthma
    • Stomach ulcers


    • Dihydrocodeine

    This is a Codeine-like pain killer (a bit like Morphine) which is commonly effective for moderate to severe pain. You can take one (30mg tablet) every six hours. This means a maximum of 4 tablets in 24 hours.  It is best taken as and when pain is most severe, for example in the early days after giving birth or after surgery. It can work best when taken before performing tasks which result in excess pain. It is considered safe for breastfeeding.  More information below in the section:  Are these tablets safe for breastfeeding?

    It is strongly advised that this drug is not given to anyone else other than who it has been prescribed for.  Any excess tablets left over when you have recovered should be returned to a local pharmacy/ hospital pharmacy or GP surgery for safe disposal.

    A reliance on taking Dihydrocodeine can become a problem with prolonged use, which is why limiting it for severe pain episodes will give you better control of your pain. We would not expect you to need strong pain relief like Dihydrocodeine for longer than 2 weeks.  If you are still struggling please contact us at the Maternity Assessment Unit or through your GP.

    It is rare, but people can develop an addiction to pain killers such as Dihydrocodeine with prolonged use is even though the pain killer action is no longer offering them pain relief qualities.  Continued use of pain killers after 90 days is called chronic pain.  If you have any worries about this please speak to us here at the women’s or speak to your GP.

    How can I get the best out of my pain relief?

    Take Paracetamol and/ or Naproxen at REGULAR intervals in the first two or three days after leaving hospital (they can be administered safely together or with time gaps).  Taking pain medication regularly like this helps you to keep on top of the pain as it gives you a constant background level of pain relief.

    In combination with these regular doses, you can take Dihydrocodiene AS AND WHEN the pain is at its worst or when you know you are going to be particularly active such as before a shower, or a walk.  You can take one 30mg tablet every six hours. This means a maximum of 4 tablets in 24 hours.

    At the end of this leaflet is a table that may help you to keep track of what you have taken and when.  Having a newborn baby can make it difficult to keep track of your medications.

    You will become good at balancing the need for pain relief medication, soon not needing any. You'd probably expect this to be within a week or two.

    What are the common side effects of these tablets?   

    Most women will not have any side effects with Paracetamol when it is taken in the correct dosage.  Naproxen can cause acid reflux and stomach ulcers.  This is why we always advise you take it with food.  If you develop problems with stomach pain we advise you to stop taking this medication.

    Dihydrocodeine can case constipation.  This can be avoided by making sure you drink plenty of fluids and have a high fibre diet.  It may be that you need laxatives to help avoid this.  Over the counter medicines are safe to take but if you are breastfeeding please check with your doctor or pharmacist what is the best option.

    Dihydrocodeine when taken at rest may make you drowsy, and not make the best use of this strong drug. It affects some people more than others in this way.

    Special attention must be given to taking Dihydrocodeine if planning on driving as it may lead to an increase in chances of drug-related road accidents and invalidate your vehicle insurance.

    Are these tablets safe for breastfeeding?

    We have chosen these medicines so that they are safe for mums no matter how they choose to feed their baby.  Some manufacturers advise to avoid Naproxen with breastfeeding.  It is common for manufacturers to advise caution for their medications in pregnancy and breastfeeding due to licensing of the product rather than the effects on mum or baby.  We are happy to recommend Naproxen for breastfeeding mums as the amount found in breast milk is very small. 

    More information can be found on the breastfeeding and medication website.  Accessible at or via their information leaflet which can be found at    

    Will I be given tablets to take home?

    Yes.  We will be giving you a week long supply of your tablets to take home.  We would advise you to take the tablets regularly at first and then reduce them as you feel you need less.  It is best to taken the pain relief regularly when you first need it as it works better this way.  You may find that as you start to do more activity when you are at home compared to being in hospital you have an increase in your pain.  This can be normal and we would suggest taking your medications more regularly if you find this happening.

    What should I do if I am still in pain?

    As we all have different birth experiences there may be some women who need more pain relief.  If you are still in hospital please alert your midwife or doctor and the will assess you and make a plan with you for more pain relief.

    If you are at home your community midwife will be visiting you so please let them know you need more pain relief.  If the midwife is not visiting you that day or you cannot wait please call the Maternity assessment unit to speak to a midwife for advice.

    Maternity Assessment Unit 0151 702 4164





The links below are relating to national leaflets which are deemed appropriate for services that we at LWH provide.

Please note: The formatting of these leaflets are mandated nationally and LWH does not have the authority to amend these.

Screening Leaflets