We recommend starting the antenatal course when you are between *26 and 33 weeks pregnant. Although we would suggest that you book onto the course in advance in order to guarantee your place.

*Although if for whatever reason you would rather start the course earlier, that is absolutely fine with us! Just bear in mind that if you start too early, you might forget a lot of the stuff by the time you are in labour.

If this is the case, we suggest booking onto the earlier course to ensure that you manage to finish the course before your baby arrives.

Yes! We create a WhatsApp group and encourage the participants to talk to each other and stay in touch when the course ends. It can be invaluable to have a support network of other mums and dads who are going through similar experiences (joining the group is of course voluntary, we will ask whether you wish to be added before the course begins and you can change your mind at any time).

You might have found some free (or cheap) antenatal courses online. While it doesn't hurt to watch them, more often than not you will find that they are very basic. And while some people might be happy with basic information, if you want to truly prepare for labour, birth and what to expect after your baby has been born, you will find that live classes are much more superior to the pre-recorded ones. They will offer more in-depth information, you will be able to ask questions as and when you think of them, and if you sign up to classes led by local midwives, you will get the most up to date information relevant to the area where you live and where you will be having your baby.

Our antenatal classes currently take place at the Queen's Head, 2 Bridewell Street, Wymondham, Norfolk, NR18 0AR

Due to some unforeseen circumstances our Norwich and Strumpshaw classes have been put on hold.

It is strongly recommended that your partner or birthing partner attends the course with you. This will help them to understand what you will be going through during labour and how to best support you.

Also, during our baby feeding and baby care sessions they will learn how to support you in which ever way you choose to feed your baby, as well learn how to look after your new baby, change nappies, bath and dress your baby and even use a sling!

Of course you can! If you do not have a partner or your partner works away or can't make it to some of the sessions, you are welcome to attend on your own, or if you prefer, you can bring a friend, parent or anyone else with you.

No, there are plenty of birthing balls you can use at the MLBU, Delivery suite and Cley ward. If there isn't one in your room, just ask!

No, you don't need to bring any formula milk with you if you are planning to breastfeed. If for any reason your baby requires some formula during your stay, this will be provided to you.

Yes, if you are planning to bottle feed your baby you will need to bring formula milk with you. Pre-made formula is easier whilst you are at hospital. It is also a good idea to bring a couple of your own bottles and a bottle brush. Newborns usually only take small volumes in the first few days and you can avoid a lot of wastage by decanting some pre-made formula milk into your own bottle.

At NNUH you will be provided with a Milton tank for the duration of your stay. This will be changed daily by the lovely maternity care assistants (MCA's).

Whilst it is not essential to bring your own pillow when you go to the hospital, you might find that it is a good idea to bring one if you can carry it. Pillows in hospitals are like gold dust! Just make sure you remember to take it with you when you get discharged home.

No, you will be provided with towels, whether you are on Cley or Blakeney ward, MLBU or Delivery suite. If you need more, just ask!

There is no getting away from the fact that childbirth is usually a painful experience. Each woman will experience and cope with labour pains differently. Some women are keen to avoid any drugs or other medical interventions while others are happy to consider all available options. Every labour is different and therefore it is impossible to predict how you will cope. For this reason it is a good idea to be open minded and aware of the options for pain relief that are available at your hospital (or at home if you are planning a homebirth). Most pain relief methods will help you to cope with the pain of labour, but will not get rid of the pain completely (apart from Epidural and Spinal anaesthesia).

- TENS machines
- Oramorph
- Warm water (birthing pools)
- Entonox (Gas & air)
- Pethidine
- Remifentanyl
- Epidural
- Spinal

TENS (Transcutaneous Electrical Nerve Stimulation) is a small battery powered handheld device. It connects via 4 leads to 4 pads that stick to your skin. It is a drug free hand help device that stimulates the nerves that run to the spinal cord and block the transmission of pain and relax the muscles. When you press the button, tiny pulses (that feel tingly) are delivered to the electrodes (pads). In a nutshell, this process stimulates endorphins which are the body’s own natural pain relief, and reduces the number of pain signals sent to the brain - so you feel less pain. It can reduce anxiety and help you feel in control of your labour. TENS machines are mostly beneficial during the latent (early) phase of labour. They can be bought or hired online (hiring is much cheaper and you will get to keep the machine for several weeks).

Don't rely on being able to hire one from the hospital, as there might not be any available when you need one!

Advantages:

Non invasive pain relief
No harmful effects on mother and baby
Can be used at home in early stages of labour
Does Not restrict ability to mobilise
Other pain relief can be used alongside

Disadvantages:

Cannot be used in water
It takes about 40 minutes to build up your body’s natural pain relief
Will not completely get rid of the pain

Not recommended if:

You have a heart condition
Before 37/40
You suffer with epilepsy
You have any metal implants

Liquid morphine which is taken orally. Women admitted to hospital not in established labour who require pain relief may be given a dose of Oramorph and can be discharged home after 30 minutes if it is clinically safe to do so. Oramorph might help you get some rest, especially if you are sleep deprived due to a long latent phase of labour.

Warm water is a popular choice for managing labour pains in low risk women. Evidence shows that submerging in water during labour can reduce the level of pain experienced. Warm water can aid relaxation which then encourages the production of endorphins. You can get in and out as you please and the midwife is still able to listen to the baby's heart rate without you getting out. You can use Entonox (Gas & Air) whilst in the pool.

Reasons you may be asked to get out of the birthing pool:

- If the midwife is concerned about your or your baby’s wellbeing
- Vaginal examination
- If you become unwell (for example develop a high temperature or raised blood pressure)
- Bleeding
- Changes in baby’s heart rate
- Prolonged labour
- Thick meconium
- Difficulty delivering baby (malposition)

If you choose to birth your baby in the pool, your midwife will guide you to ‘breathe your baby out’. When the baby is born the midwife will gently guide your baby to you. You will be encouraged to slowly bring your baby to the surface. Don’t worry, your baby will not breathe until their face comes out of the water (they will continue to get oxygen via the umbilical cord until then).
Your baby's body will be kept under the water, skin to skin with mum. Your baby might be calm and not cry loudly - this is quite normal for babies born in water.

Providing all is well, you can stay in the water to deliver your placenta or sit on the seat in the pool while the midwife drains the water. Some women decide to get out of the pool at this stage.

Gas & air (Entonox) is a popular type of pain relief in labour which is inhaled through a mouthpiece during contractions. Entonox can be a good distraction as you need to breathe slowly and deeply for it to work effectively. It can regulate your breathing and calm you down should you start to breathe too fast.

Advantages:

- fast-acting
- easy to use
- you control how and when you use it
- the effects wear off very quickly once you stop inhaling it
- it doesn’t take away all the pain, but it can reduce it to a more manageable level
- it's safe for the baby
- baby doesn't need any extra monitoring
- you can use it if you are labouring in a birthing pool

Disadvantages:

- It might make you feel drowsy, light-headed or nauseous, and you may be sick (although this usually
stops once you have used it for few minutes)
- It can make your lips, mouth and throat go dry if you use it for a long time (remember to drink plenty and
make sure to pack a lip balm)

Pethidine is a morphine-like opioid. It's synthetic, which means it's manufactured, rather than extracted from the opium plant (poppy). Pethidine can make you feel sick, so the injection will contain another drug to control sickness (an antiemetic). It takes around 20 minutes for Pethidine to start working and the effects usually last between two hours to four hours. You can use Entonox (gas and air) at the same time to help you manage your pain.

Advantages:

- Can be given by a midwife, so there is no need to wait for a doctor to become available
- Can be administered on MLBU (Midwife led birthing unit)
- Can help you relax and get some rest (can work really well if the woman is tired due to long latent phase)
- It won't slow down your labour
- It may help you to postpone or avoid having an Epidural if you are finding your contractions difficult to
cope with
- You can still use a birthing pool during labour, but not within two hours of having a dose of Pethidine, or
if you feel drowsy
- Pethidine is a muscle relaxant - it relaxes the muscles of the uterus. This little-known side effect of
Pethidine might assist with rotating the baby into a better position for birth (i.e. if baby is in a back to
back position) and thus might help to prevent an instrumental delivery due to malposition. To aid a
rotation of a back to back (OP) baby, you should lie down on your left or right side (depending on where
the fetal back is - check with your midwife), with your ‘top’ leg bent and propped up with a peanut ball or
a stack of pillows or cushions. Your ‘bottom leg’ should be straight and pushed back - this will rotate your
body forwards, towards your bump (baby might find it easier to turn into a more optimal position due
the gravity and the relaxed uterine muscles).

Disadvantages:

- Does not get rid of pain completely but women often report that the contractions are much easier to
manage
- Might make you feel woozy (therefore it’s better if given when you are tired as it’s more likely to make
you sleepy and allow you to get some rest)
- It crosses the placenta and might affect your baby's breathing, therefore you wouldn’t be given the
injection if the midwife thought your baby was going to be born soon. Your doctor or midwife can give
your baby an injection to help reverse this side-effect of pethidine if needed.
- Baby might be slightly more sleepy after birth (however, babies are often sleepy after birth even if mother
did not have Pethidine in labour)

Epidural in labour aims to provide pain relief, rather than a total lack of feeling. It blocks the nerve signals from both motor and sensory nerves to reach your brain. Epidural can provide very good pain relief, but it's not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that 1 in 10 women who have an epidural during labour need to use other methods of pain relief. To have Epidural as pain relief, you will need to be on delivery suite as you will need to be more closely monitored. The drug is delivered via a very thin plastic tube (catheter) which is inserted into your back and held securely by tape and connected to a pump. You will have a button which you press twice every hour to give yourself a ‘top up’ (or your midwife can do this for you). You will need to have a cannula in your hand and have fluids as well as having frequent blood pressure checks. A CTG monitor will be put on to enable the midwife to keep a close eye on your baby’s heart rate.

Advantages:

- Can be a very effective pain relief (for 9 in 10 women)
- Does not cause drowsiness
- Will allow you to get some sleep if you are tired

Disadvantages:

- Might cause itching
- Might cause a drop in blood pressure and raised temperature (midwife will be checking your blood
pressure and temperature regularly)
- Numbness or tingling sensation in the legs, legs might feel heavy
- You may develop a severe headache after having an epidural, although this can be treated. This occurs in
approximately one in 100 women
- It might make the second stage of labour slightly longer and reduce your urge to bear down and push
your baby out - in which case your midwife will guide when it comes to this stage
- Increased risk of assisted birth with suction or forceps (but not Caesarean section)
- It might make it difficult for you to pass urine and you are more likely to need a catheter (small tube) put
into your bladder to help with this
- Other serious complications can occur, but are very rare. The Anaesthetist will tell you about all of the
risks prior to the procedure

Remifentanil is a strong, short acting opioid drug. It is given via a drip, through a cannula in your hand or arm, which is connected to a pump that you control yourself by pressing a button to administer the drug (PCA - patient controlled analgesia). Remifentanil starts working very quickly (within about 30 seconds) and the effects of it wear off within a few minutes. It might make you feel relaxed and sleepy, but because the effects wear off quickly, women usually don’t manage to go to sleep due to needing to press the button with every contraction. Unlike an Epidural, Remifentanil will not provide total pain relief. As with Pethidine, Remifentanil crosses the placenta so may cause your baby to breath slowly or be drowsy. It needs to be set up by an anaesthetist and therefore can only be given on Delivery Suite.

Epidural can be quite slow to act. If the pain-killing drugs are put directly into the bag of fluid surrounding the nerves in your back, they work much faster - this is called a spinal. The drug is delivered directly via a needle, which is then removed from your back. Unlike with Epidural there is no catheter left in your back afterwards and you don’t have a button to press to give yourself any further ‘top ups’. This is why spinal anaesthesia is most commonly used for forceps births and caesarean sections (both elective and emergency).

- Paracetamol (2 tablets every 4-6 hours, max. 4 doses in 24 hours)
- warm water (bath, shower, birthing pool)
- TENS (you can hire these online from when you are 36 weeks pregnant, for around £25 and get to keep
them for 6-7 weeks)
- Aromatherapy (do some reading about which essential oils are suitable and how to use them)
- Hypnobirthing and visualisation
- Entonox (gas & air) - each midwife will carry 1 bottle of gas and air with her, home births are usually
attended by two midwives (although occasionally there might only be one midwife, especially if you
labour quickly)
- Pethidine - if you know you would like to use Pethidine in labour, or if you would like to have some at
home just in case you need it, you will need to get it prescribed by your GP and collect from a pharmacy.
Community and home birth team midwives DO NOT carry Pethidine with them! If your GP is reluctant to
prescribe Pethidine, discuss this with your midwife (ideally before you are 37 weeks pregnant).