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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 Pals@lwh.nhs.uk.

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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. 

    Introduction

    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                                                          http://www.bladderandboweluk.co.uk/

    Bladder health UK                                           https://bladderhealthuk.org/

    Continence foundation                                    www.continence-foundation.org.uk

  • 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

    Email info@adss.org.uk

    Or visit the web site at www.gbss.org.uk

  • 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: https://liverpool-womens.custhelp.com/  

    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: https://www.arc-uk.org/

  • 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: https://liverpool-womens.custhelp.com/

    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: https://www.arc-uk.org/

  • 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.

    Amniocentesis

    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%)

     

    Echocardiogram

    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

    Patches

    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

    Email;info@cafamily.org.uk

    Web; www.cafamily.org.uk

    Birth Defects Foundation

    Martindale, Cannock, Staffordshire, WS11 2XN

    Tel. 01543 468888

    Fax. 0543 468999

    Family Helpline. 08700 70 70 20

    Email; enquiries@birthdefects.co.uk

    Web; www.birthdefects.co.uk

     

    Cherubs

    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

    Web;www.cherubs-cdh.org

     

  • 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.

     

    Food

    Comment/Information

    Cheese

    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

    Fish

    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

    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

    Milk

    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

    Peanuts

    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

    Mayonaise

    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

    Pate

    Avoid all pate

     

    Caffeine

    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.

     

    Food

    Caffeine Content

    One mug of instant coffee

    100mg

    One cup of tea

    100mg

    One can of cola

    50mg

    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

    EAT OFTEN

    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. 

    DON’T GET DEHYDRATED

    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.

    Rice:

    • 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

    Potato:

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

    Pasta:

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

    Bread:

    • 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

    Ginger

    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.

    Peppermint

    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 – www.nhs.uk

    British Nutrition Foundation – www.nutrition4baby.co.uk

    Healthy Start – www.healthystart.nhs.uk

    Patient Information – www.patient.co.uk

    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 – www.nhs.uk

    British Nutrition Foundation – www.nutrition4baby.co.uk

    Healthy Start – www.healthystart.nhs.uk

    Patient Information – www.patient.co.uk

    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.

    Scans

    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.

    Finally……

    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

    www.nhs.uk/start4life/Pages/Welcome-to-Start4Life

    www.eatwell.gov.uk

  • 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

    2.3mg

    Per average serving

    Bran Flakes contains

    6mg

    Per bowl

    Baked Beans contains

    2.8mg

    Per half tin

    Boiled eggs contain

    1mg

    Per small egg

    Sardines contain

    1.5mg

    Per 50g serving

    Figs contain

    3.4mg

    Per 4 figs

    Green Veg contains

    1.96mg

    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.

    Toxoplasmosis

    • 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).

    Listeriosis

    • 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.

    Salmonella

    • 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.

    Pets

    • 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: www.medicines.org.uk

    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: www.health.qld.gov.au

    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

    Advice

    • 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

    Liverpool

    L1 2TQ

    Tel: 0151 709 0516

    North Liverpool Community Drug Team

    85 Stanley Road

    Bootle

    Liverpool

    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

    Kirkby

    Liverpool

    L32 8SE

    Tel: 0151 546 7111

    National Drug Helpline

    Tel: 0800 776600

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.

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