Latest news, Pregnancy, Pregnancy Problems

Morning Sickness – what you can do

Often the first sign of pregnancy, morning sickness can turn the most joyful news into an unpleasant experience. Don’t be surprised if you feel sick at any and every time of the day either. The hormones causing the sickness are a great sign but how do you handle them when some of those around you don’t even know you’re pregnant? Read on to find out what your options are.

Why you feel sick

As I’ve already said, morning sickness should more accurately be called pregnancy sickness because it can happen at any time of day. For some, it is the morning when they feel the worst, for others it might be the evening, and for some it can even last all day!

Some people just feel really really sick, while other will actually vomit. Neither is pleasant and both can really impede your ability to get on with your day. Unfortunately, sometimes if you tell your midwife about this she smiles! I’m not denying that midwives can be scary and unfeeling at times (mostly in labour when she tells you that you can have a baby but you think you can’t). However, let me explain why I am pleased when a woman tells me how sick she feels or how often she vomits during the day.

The physiology behind morning sickness

In the early days and weeks of pregnancy, the fertilised egg floats down into your uterus and finds a comfy spot to settle in. Once in that spot it wiggles itself in to the lining of the uterus. This lining is called the endometrium and is on average about 8mm thick. It is filled with gorgeous juicy tiny blood vessels.

The egg’s next job is to get itself linked in with you and your blood system. This means you can start feeding it all the oxygen and nutrients it needs to grow and develop into the baby. It does this by developing some of its cells into the placenta, the baby’s life support system. The placenta provides a link between your blood vessels and the baby’s circulation. To do this, the cells of the placenta have to alter the cells and blood vessels in your endometrium. This creates a large surface area for oxygen and nutrients to cross from you to the baby. Waste products like carbon dioxide can cross from the baby to you, so that you can get rid of them for the baby. This is the beginning of the rest of your life where you are tidying up after your child!

Where the hormones come in

The way the cells of the placenta alter your endometrium to make this essential interchange between you and your baby is by releasing hormones. Hormones like prostaglandins help to change the structure and purpose of cells so that they can do new things. As the placenta changes more of these cells and grows larger, it produces more hormones which again change more cells and increase growth. The speed of this growth phase of pregnancy is incredible! The placenta can be larger than the baby at this stage.

The presence of hormones is therefore an important sign that the pregnancy is healthy. The placenta is growing strong to support the developing baby. For many women, these hormones also make them feel sick or vomit. That is why your midwife might pleased to hear that you have morning sickness.

Levels or degrees of sickness

Every woman will experience sickness in a different way and even different pregnancies can create different levels of nausea in the same woman.

Feeling sick without being sick is one way that women can be affected. I’m definitely not saying this is the least or easiest way to experience pregnancy sickness though. Feeling sick without being able to be sick can mean the feeling stays all day, reducing your ability to eat and drink.

Feeling sick at certain points during the day and then vomiting is another way that those pesky hormones make your life horrid. Now, I am certain that none of us enjoy throwing up. Often though, you start to feel a little better once you have vomited and can get on with your day a little easier. You can sometimes manage to eat a little snack or meal and drink enough to stay hydrated.

For some women, sickness and vomiting is an all day experience. No matter what time of day it is, you feel dreadful and the slightest thing can have you retching. I’ve even known women who have to walk around with a bowl in their hand as the need to vomit can hit them at any time. If you can’t keep any food or drink down, you may have the most extreme form of pregnancy sickness, called hyperemesis gravidarum. For those of you in the UK, it’s what the Duchess of Cambridge suffered with at the beginning of her pregnancies. If this is what you are experiencing, please contact your midwife or hospital care provider, as you may need extra help that you can’t get at home.

For the rest of you, read on to find out what strategies and solutions might be available to you.

Managing morning sickness

Being pleased that your pregnancy is growing well does not mean I think that you should feel horrid for weeks! There are plenty of options for managing pregnancy sickness no matter how intense or debilitating it becomes.

Natural remedies

The most important thing you must do is try to drink. Water may be best if the smell of tea or coffee makes you gag. Don’t drink a whole glass of water at once. Instead, drink little sips as often as you can. If you can’t manage sips of water, buy some ice pops. These are long sticks of frozen coloured water with some flavourings. If you can lick them they will help you keep hydrated. It might seem strange licking ice pops in winter, but sometimes that’s what you have to do!

If you can eat, stick to small carbohydrate based meals like pasta or potatoes. High fat food will make you feel worse. Plain toast or crackers are helpful. Having said that, don’t worry too much about your choice of diet at this point. Whatever calories you can get into you are good calories in my opinion!

If your sickness occurs in the morning, have a small snack before you venture out of bed to settle your nausea a little.

Some research studies find that eating ginger in various forms can help, so experiment with what makes you feel better. There are tablets, tea and biscuits forms of ginger available so you should find something that works for you.

Some people find that drinking fizzy or slightly flat previously fizzy drinks help when they are feeling sick. It may help to release gases and make you burp, making you feel less sick. If this doesn’t help you, don’t worry. Just try something different.

More recently, acupressure and acupuncture have been found to reduce nausea. Why not check for local trained practitioners near you? Some people find that wristbands sold as sea or travel sickness bands can be effective too.

Medication options

Firstly, let me say that you should only take medication under the guidance of a doctor. My recommendations below are only here as suggestions. You must check with your own doctor to make sure you get the right medication for you.

You should start with tablet forms of anti-sickness medications. There are lots of different options, and I’m not going to list them here. I don’t know all the brand names for every country and don’t want to give incorrect information. If you need tablets, speak to your doctor.

Thankfully, there are lots of anti-sickness tablets that you can use. You can be on one, swap to another or have a combination of several of them. Always return to your doctor if they aren’t helping and try another option or additional type. We have now got many years of experience of using these tablets in pregnancy so we will only give you ones that are safe for you and baby.

If you are unable to take tablets or you vomit them up as soon as you take them, try taking them at a different time of day. Some women find they can’t eat anything first thing in the morning, but the afternoon is better. Take your anti-sickness tablets in the afternoon with whatever you manage to eat.

If there is nothing you can eat or drink and no time of day that you can take tablets and not throw up straight away, you need more help. Contact your doctor or hospital immediately. They will need to give you anti-sickness medication via a drip into your arm to settle things down enough so that you can start taking tablets. They will also probably have to give you some fluids this way too as you will probably be very dehydrated.

Where to go from here

Please remember that for most women, pregnancy sickness will ease off by about 10-12 weeks. You may need to confide in your boss and friends about your pregnancy before this. They will then be able to help you with time off work or childcare of older children.

Have a look at the resources page for some other helpful websites. One I really like is Pregnancy Sickness Support. This has great articles and even an online forum for those struggling with this issue. You can also look at the UK’s national guidance for health professionals treating pregnancy sickness here . Alternatively, you can view a patient information leaflet from the Royal College of Obstetricians and Gynaecologists here.

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Infant feeding, Labour and Birth, Latest news, Newborn Care

Feeding tips for slow or sleepy feeders

Feeding your baby is a fierce biological drive which rises in a mother often as soon as the baby is born. It can be extremely worrying when a baby is not making much effort to try and feed or seems more interested in sleeping than feeding.

mother feeding

Let me state at the very beginning that if you have any concerns regarding your baby’s health including feeding you MUST CONSULT A HEALTH PROFESSIONAL IMMEDIATELY! The following suggestions are only suitable for healthy babies born after 37 weeks of pregnancy, who weigh 2.8kg or above (6lbs 3oz). You can use them while you wait for your health professional to see you but do not delay seeking medical advice.

Why does baby seem reluctant to feed?

It can be helpful to consider any possible reasons for the baby being slow to start feeding.

Some mums may have had diamorphine or pethidine during labour to reduce labour pain. These pain-relieving drugs can make labour easier to bear, but they also pass across to the baby. It is not uncommon for babies whose mum had these medications to be more interested in sleeping them off than in feeding for the first 24 hours or so.

Babies can get tired after a long labour. They may also still have quite a lot of mucus and other gunk in their stomach. This is very normal, but it fools the baby into thinking they are full so they don’t look for milk. It’s similar to how you feel after a large Sunday lunch with all the trimmings. You are often keen for an afternoon nap so you can digest everything! The baby thinks the mucus in its stomach is a large meal, so decides to sleep while it digests. Unfortunately, mucus can take time to be digested or coughed up, so babies can delay feeding while they do this.

Getting in the mood for a feed

breastfeeding baby

One of the simplest ways to remind baby that feeding is a good option is to put them close to the breast! Your breasts start producing colostrum or milk as soon as the baby is born, although the amounts may be small to start with. When you cuddle your baby close to your chest they can smell the milk and that may be enough to persuade them to try feeding.

Try some skin to skin contact. Skin to skin contact is brilliant for mums and babies. It helps babies regulate their temperature and breathing. It also calms them down and helps their stress hormones to return to normal levels after rising during labour.

Skin to skin contact is pretty easy to do. Just take off your top and any maternity or nursing bra you might have, and strip your baby down to his or her nappy. Put baby on your chest between your breasts and cover both of you with a blanket or sheet or two to keep warm.

This will often be enough to enable the baby to smell your milk and move across to the breast by themselves! This amazing reflex they have of moving towards the breast can be seen in lots of youtube videos if you are interested. Just try searching for ‘Biological nurturing’.

Secret Midwife’s Tip for Faster Skin to Skin

Skin to skin can be brilliant for getting baby to feed. However, it isn’t always easy or practical when you have guests visiting or have to look after other children. It can also be frustrating to undress a baby every 2-3 hours to get them to feed.

One great tip handed down by generations of midwives working on postnatal wards is to dress baby in a centre fastening babygro without a vest. You might need another layer such as a cardigan or an extra blanket to keep them warm when they are sleeping. When it comes to feeding time, you can just unbutton the cardigan and unfasten the babygro. Keep baby’s arms and legs in the babygro but open the front of the babygro wide. This means there will be a large enough area of the baby’s chest to enable you to do mini skin to skin! It also means baby doesn’t get cold arms and legs and redressing them after the feed is much easier.

Hand Expressing

sleeping baby

One of the most effective techniques for getting a sleepy baby to feed is to remind them what they’re missing. If a baby gets a little milk into their system, they often wake up enough to want to feed. So how do you get milk into a sleeping baby? It’s really very simple.

Hand expression is a key skill for mothers of sleepy babies. I imagine I’ll do a longer blog post with more in-depth technical explanations at some point. At present though, let’s keep it short and simple. After all, there’s a baby to feed!

Make sure you are somewhere that you can relax and not be disturbed. Oxytocin is a key hormone in producing milk and it isn’t going to flow so easily in a room full of friends, family, a screaming toddler and the postie dropping off baby gifts! You need to feel safe and comfortable.

Make a C shape with your thumb and forefinger. It’s a bit like miming a crab’s claw! Using that C shape, put your fingers around the edge of your areola. That’s the pigmented part of the skin that surrounds the nipple. Don’t put your fingers directly on the nipple, as there is no breast tissue there for you to stimulate. Placing your fingers further back towards the area where your areola meets the normal skin tissue will help you find more milk ducts to compress.

With your fingers touching your skin, gently press your fingers towards each other, squeezing your breast in the process. Don’t slide your fingers forwards towards your nipple or backwards towards your chest wall. Just keep them pinching directly towards each other.

Getting Milk into a Closed Mouth

It may take a few seconds or more but you should start to see little droplets of colostrum at your nipple within a minute or two. This is the good stuff! Now, all we need to do is give that to the baby and let its sugary goodness wake them up enough to want to try feeding.

You may be shouting at the screen that it’s no good having the milk if the baby is asleep and won’t open their mouth. Don’t worry, I’ve got a midwife’s tip for that too!

It is true that if a baby doesn’t want to open their mouth, it’s pretty difficult to force them. Parents who give milk via a bottle will have experienced the frustration of a baby crying for milk but refusing to open their gums to allow the teat in! Thankfully, we don’t need to get the milk past their gums.

Have you ever heard the term ‘pet lip’? It’s used to describe a baby or child who has rolled their bottom lip out and down as a sign of unhappiness. It’s actually really useful to practice it yourself so you understand what I mean. Go on. No one is watching! Without opening your teeth, just roll your bottom lip forward and down, almost like it’s inside out. You’ll notice that the lovely pinkish area of tissue that sits between your lips and your teeth is exposed. This is a mucous membrane and it’s all we need to get some calories into a sleeping baby.

Finger Feeding

So, the next step is to transfer those lovely drops of colostrum to the baby. The simplest way to do this is to run your little finger over the droplet so it transfers to the finger. Take this milk covered finger and run it along the inside of the baby’s bottom or top lip. You don’t need to force the finger in between their gums. Simply coating the mucous membrane will be enough.

Once you’ve done it, go back and hand express another drop and repeat the process. Yes, it’s time-consuming but it works miracles! If you do this for 5 – 10 minutes, the baby will have a crusty milky mouth. More importantly, they will have absorbed the milky goodness and their body will normally wake them up as they decide they want more! That is the time to put your baby to the breast so that they can actively feed themselves.

Making Baby Less Comfortable

Crying baby

Okay, this section shows that I’ve got my midwife hat on, rather than that cuddly mummy hat that keeps babies cozy at all times. The truth is that sometimes babies are just too comfortable sleeping to rouse themselves to feed. A few weeks down the line, I would never encourage you to wake a sleeping baby. During the first couple of days, though, it is helpful in stimulating milk production and establishing breastfeeding to wake babies if they sleep too long.

How long is too long? That depends on many factors and you should be guided by your midwife or health professional. I tend to err on the side of caution and encourage waking to feed if they haven’t done so themselves by 4 hours after the end of the last feed. That’s just until we know that baby has figured out feeding and is putting weight back on after their initial weight loss.

For a baby who hasn’t yet started attaching to the breast, who seems full of mucous or very sleepy, I would encourage you to hand express and finger feed every 2 – 3 hours. Although this is a lot of work, it ensures that even if baby only decides to wake and feed at every other finger feed session, they are still getting enough milk to maintain their health. It also ensures that you are stimulating your milk production in those essential first few days whilst the baby is a little too sleepy to do so.

Waking Techniques

My ‘Pick them up and let them hang’ technique is often very effective at waking babies, although it does tug at the heartstrings. Holding the baby securely with both hands under their armpits, lift them up into the air so that their legs are no longer supported by the bed or your lap. Although the baby is perfectly safe, they don’t like the sensation of having their bottom half unsupported, so it usually wakes them up and sometimes even makes them a little upset. I don’t recommend doing it for long periods! Just use it as a 2-second thing to wake them up enough to put them on the breast.

The other surefire way to wake a baby is to change their nappy! You’ll probably have noticed that babies do not like getting naked and having their bottom wiped. This makes it an excellent tool for waking them up if you need to. You may just need to open their babygro to wake them. You may need to go all the way to changing the nappy (or opening it then closing it again if it is clean).

Another good way to wake a baby is to have a bath with them. This ticks lots of boxes for waking baby – they get naked and they get skin to skin! Of course, it only works if your house has a bath and if you don’t have lots of other children, pets and partners needing your attention!

A Suggested Feeding Schedule for Sleepy or Reluctant Babies

Every two hours start off by doing skin to skin for at least 30 minutes. Follow this by hand expressing for 5 to 10 minutes. Use your finger to transfer the drops of milk to the baby’s rolled down lips as described above. After finger feeding like this for 10 minutes, you can settle baby back to sleep. Hopefully, they won’t settle and will insist on having a proper active feed.

If the baby has a good feed of 10-15 minutes of active sucking and swallowing with rhythmic pauses, you can let them sleep for another 3 – 3.5 hours before waking them again.

If the baby decides they don’t want to feed after you’ve hand expressed, or if they only actively feed for less than 10 minutes, repeat the process in another 2 hours.

When to Seek Immediate Assistance

Always, always ask for professional advice if you are at all worried about your baby’s feeding or lack of it. Whilst most babies will wake up and start feeding themselves, a slow or reluctant feeder can be a sign that the baby is unwell. If you notice any of the following symptoms, please take your baby to the nearest Emergency Care Centre immediately.

  • Jitteriness – this is a repetitive unprovoked movement in one or more limbs
  • Excessive sleepiness
  • Floppy limbs
  • Poor sucking or refusal of the breast or bottle
  • Any breathing problems or colour changes
  • High pitched crying
  • Problems maintaining body temperature
  • Unresponsive and/or seizures

Sleepy feeders

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