Frequently Asked Questions

I have compiled a list of questions we often get asked. Scroll down to find the answers! No more wondering, when is the best time to start antenatal classes, whether you need to bring your own birthing ball to the hospital, or your own pillow or baby formula, how do you sterilise baby bottles during your hospital stay or what is the difference between free online antenatal classes and the private ones led by your local midwife.

New questions and answers are being added regularly, so watch this space!

When should I start antenatal classes?

We recommend starting the antenatal course when you are between 26 and 33 weeks pregnant. Although it is a good idea to book onto the course in advance in order to guarantee your place.

I’m going to be less than 26 weeks pregnant at the beginning of one course but more than 33 weeks at the beginning of the next course. Which one should I book onto?

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.

Do you encourage the course participants to stay in touch after the course finishes?

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 at similar times (joining the group is of course voluntary, we will ask whether you wish to be added into the group before the course starts and you can change your mind at any time).

Is it worth paying for an antenatal course if there are some free courses available online?

You might have found some free (or cheap) antenatal courses online. While it definitely 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 led by a knowledgeable professional are much more superior to the free or pre-recorded ones available online. They 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 antenatal classes led by your local midwife who knows the local hospital and its guidelines and procedures, you will get the most up to date information which is relevant to the area where you live and where you will be having your baby.

Where in Norfolk can I attend your antenatal classes?

Our antenatal classes currently take place at the Fairland Hall in Wymondham, Norfolk.

Should my birthing partner attend the course with me?

We strongly recommend that your partner or birthing partner attends the course with you if possible. This will help them to understand what you will be going through during labour and birth and how to best support you. Also, during our infant feeding and baby care sessions they will learn how to support you in whichever way you choose to feed your baby, as well as learn how to look after your new baby, change nappies, bath and dress your baby and even use a sling!

Can I attend your antenatal courses alone?

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.

Should I bring a birthing ball to the hospital?

There is no need to bring a birthing ball with you (they are not the easiest things to carry!). There are plenty of birthing balls you can use on MLBU, Delivery suite and Cley ward. If there isn’t one in your room, just ask!

Should I bring some formula milk with me to the hospital if I’m planning to breastfeed, just in case?

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.

Do I need to bring formula milk with me to the hospital if I’m planning to bottle feed?

How will I sterilise baby bottles in the hospital?

Yes, if you are planning to bottle feed your baby you will need to bring formula milk with you. Pre-made formula is easier to use whilst you are at hospital than powdered formula. It is also a good idea to bring a couple of your own bottles and a bottle brush. Newborns usually only take small volumes of milk 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).

Should I bring my own pillow to the hospital?

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.

Do I need to take my own towels to the hospital?

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

Is there anything I can do to prepare for breastfeeding?

Absolutely!

Although breastfeeding is natural, it’s also a skill that takes practice. Did you know that the best time to learn to breastfeed is before your baby is born? You have a much better chance of learning the principles of effective breastfeeding when you haven’t just given birth, are sleep deprived or staying on a postnatal ward full of crying babies and visitors!

Before your baby arrives, try to learn everything you can about breastfeeding by reading good quality information, watching breastfeeding videos, attending an antenatal course that covers breastfeeding or booking onto a breastfeeding course. There are many out there, some are free and some involve a cost. Make sure the course covers the reality of breastfeeding and doesn’t just tell you the bare minimum (which you might already know). Make sure it includes detailed information about effective positioning and how to actually attach the baby onto the breast. 

The infant feeding session of my antenatal course ticks all of these boxes! And you will also have a chance to practice the essential skills by using my weighted baby dolls. You will learn how to recognise your baby’s feeding cues, how to position and attach the baby to the breast effectively and how to recognise that your baby is feeding well and taking in enough milk. You will be able to practise holding a newborn baby, different feeding positions and learn how to harvest colostrum, as well as feeding expressed breast milk or formula from a bottle. You will be able to ask as many questions as you like.

Should breastfeeding hurt in the early days?

Although many women report pain (sometimes severe ‘toe curling’) and/ or cracked and bleeding nipples, these are usually a sign that something is not quite right. If you have not been able to get help from your midwife or an MCA, please seek out help privately! Sore nipples are one of the most common reasons why so many women stop breastfeeding before they want to and the solution can often be quite simple, with the right support.

My partner has been struggling with breastfeeding. How can I help?

Firstly, well done for looking for ways to help, that is amazing! So many people will suggest giving up and switching to bottle feeding (which is fine, if that’s what your partner wants to do) but not many will try to find an actual way to help. The best way you can help your partner who is struggling with breastfeeding is to find someone with the right knowledge and skills, who can offer support. If you are still at the hospital, ask if there is a specialist infant feeding team who could come and see your partner. If your are at home, speak to your community midwife and ask for a referral to the specialist infant feeding team. Bear in mind that there might be a waiting list. If you don’t want to wait, seek our private support. An IBCLC Lactation consultant (like myself) can visit you at home. I often manage to see my clients within 24 hours of enquiry (and sometimes I can come straight away!). I can even come and see your partner while her and the baby are still in the hospital. Please don’t hesitate to contact me, it might just be the best thing you can do for your partner (and your baby)!

Do you offer tongue tie services?

I offer tongue tie assessments and referrals if necessary. I don’t offer frenulotomy (procedure to divide tongue tie). I can make a referral to the NHS tongue tie clinic or you might choose to have the tongue tie division done privately.

Should I use pain relief in labour?

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).

What are good coping strategies for labor?

• Distraction techniques in early labour (watching favourite programmes on TV, going for a walk, baking etc.)
• Warm water – shower or bath
• Hot water bottle
• Slow deep breathing – practice during pregnancy
• Creating a calming birthing environment (think closed curtains, soft lighting or candles, aromatherapy, music)
• Hypnobirthing
• Massage by your birthing partners (back, or hand /foot massage)
• Squeezing a birth comb in your hand – this is an acupressure tool for pain management which works by distracting the brain away from the sensations of birth as they build, by focusing on a powerful acupressure point in the palm of your hand, a minor chakra called the Lao Gong (Pericardium 8) or ‘Palace of Labour’. Simply clutch the comb in your hand tightly to activate pressure points and redirect the energy of contractions and release in between. I recommend looking at www.yuula.co.uk – you can get your Yuula birth comb from there, as well as Positive affirmation cards for pregnancy and birth and a lot of interesting posts on @yuulaofficial Instagram page.
• Hire a TENS machine (see info below) – don’t rely on being able to borrow one from the hospital as they work best in early labour (most low-risk women are advised to stay at home during this time). It is a good idea to hire a TENS machine even if you are being induced as there are only limited numbers of TENS machines available to hire from the hospital – and they might all be in use when you need one! (make sure you take it off before having a shower or a bath!)

What pain relief options are available during childbirth at the Norfolk and Norwich University Hospital (NNUH)?

• Oramorph
• Warm water (birthing pools)
• Entonox (Gas & air)
• Pethidine
• Remifentanyl
• Epidural
• Spinal

What is a TENS machine?

TENS (Transcutaneous Electrical Nerve Stimulation) is a small battery powered handheld device. It connects via 4 leads to 4 pads that stick to your back. It is a drug-free hand device that stimulates the nerves which run to the spinal cord and block the transmission of pain and help to 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 weeks of gestation
• You suffer with epilepsy
• You have any metal implants

What is Oramorph?

Oramorph is a liquid morphine which is taken orally. Oramorph can be administered to women who are not yet in established labour when they require pain relief. Oramorph might help you get some rest, especially if you are sleep deprived due to a long latent phase of labour.

Does waterbirth help with pain in labour?

Warm water is a popular choice for managing labour pains in low risk women. Evidence shows that submerging in warm water during labour can reduce the level of pain experienced. Warm water can aid relaxation which then encourages the production of endorphins (your natural painkillers). 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 why 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)
• To go to the toilet
• If you need pain relief other than gas & air

If you choose to birth your baby in the pool, you will be able to lift your baby out of the water yourself or your midwife will help you if needed. 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 might be calm and not cry straight away – this is quite normal for babies born in water. You can either stay in the water to deliver your placenta (providing all is well and your midwife is happy for you to do so), 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.

What is gas & air?

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 help you 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 a 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)

How does Pethidine work in labour?

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

Advantages:

• Can be prescribed and given by a midwife, so there is no need to wait for an anaesthetist 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 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 will need to wait for the effects of Pethidine (drowsiness) to wear off first
• 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 a 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 (similar to a ‘recovery position’). Your 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 required
• Baby might be slightly more sleepy after birth (although it’s not unusual for babies to be sleepy in the first few hours after birth even if mother did not have Pethidine in labour)

What is Epidural?

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 still require 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 IV fluids, as well as having regular 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 your 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 1 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 you 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

What is Remifentanil?

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 (this is called 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. Your baby’s heart rate will need to be continuously monitored.

What is the difference between Epidural and Spinal?

An 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).

What pain relief can I use if I have a home birth (in Norfolk)?

• Paracetamol (2 tablets every 4-6 hours, max. 4 doses in 24 hours)
• Hot water bottle
• Warm water (bath, shower, birthing pool)
• TENS (you can hire these online from when you are 36 weeks pregnant (for around £25) and you get to keep them until after you have had your baby
• Aromatherapy (plan to 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)