After your birth (postnatal care)

Breastfeeding is the healthiest way to feed a baby, it is the only food designed to meet all baby’s needs, both nutritionally and emotionally. We encourage women to breastfeed their babies and aim to support you to achieve this. 

North Middlesex hospital is committed to promoting breastfeeding has achieved level 3 Unicef Baby Friendly status. Find more information from the Unicef Baby Friendly web pages, and about breastfeeding in general.

Supporting close and loving relationships

Babies need warm and loving relationships with their primary carers to develop their brains and emotions. Babies need to be kept close and thrive when carers respond to their cues for food, love and comfort. This is essential for babies’ health, wellbeing and brain development. It can also help new parents to also cope with the changes in their lifestyles during the postnatal period.

Infant Feeding Team support

Email: northmid.breastfeedingtogether@nhs.net

Breastfeeding drop-in support groups

Haringey

Haringey Council Public Health commission The Breastfeeding Network charity to provide free, non-judgemental, evidence-based baby feeding information to all Haringey families. We will support you in your feeding choices. 

Please visit our website for more information on the free face-to-face, email, phone and virtual support that we offer: https://www.breastfeedingnetwork.org.uk/project/haringey/ 

Contact: haringeysupport@breastfeedingnetwork.org.uk 

Enfield

Wednesday 13:00-15:00

Dugdale Arts Centre Café, 39 London Rd

Enfield, EN2 6DS

Out of hours support

• National Breastfeeding Helpline 0300 100 0212 (9.30am- 9.30pm)
• La Leche Helpline 0345 120 2918 (8am-11pm)

Latching the baby

C – Close
Baby should face the breast and be as close as possible to gain a deep latch

H – Head free
Supporting the baby around the neck and shoulders rather than by the head will allow them to tilt their head back and open wide to take in your breast tissue

I – In line
Have you tried swallowing with your head twisted over your shoulder? You will soon get tired. Babies also need to have their head in line with their bodies to help them swallow.

N – Nose to nipple
The chin should lead and the mouth should be wide open when the baby latches with the nipple pointing up toward the baby’s nose so that when you latch it reaches far back into the baby’s mouth.

S – Sustainably
Will you be able to sit in this position for a whole feed? Do you have water nearby?

Reference: acronym developed by Dr Lynette Shotton, Northumbria University

How do I know if my baby is latching on properly?

• They take a large mouthful of breast tissue and you can see more of the darker area of your breast (areola) at the top of the baby’s mouth.
• Baby should have rounded cheeks
• the chin should be the first thing to touch the breast and should indent the breast and massage the tissue during the feed
• Baby’s lips (top and bottom) should be turned outward
• you should hear a 2:1 suck and swallow pattern after the initial let down.

While breastfeeding can be uncomfortable, especially for first-time mothers, it shouldn’t be painful. If you experience pinched, sore or bleeding nipples, or your baby still seems hungry after a feed, these could be signs that your baby isn’t attaching well. Seek help from your midwife.

Breastfeed responsively

You cannot over feed a baby who is only having breast milk. Often babies will feed for comfort as well as for nutrition and responsive feeding means breastfeeding whenever your baby shows feeding cues that it wants to be fed. It also means you can offer a breastfeed if your breasts feel full or for your own needs. Feeding regularly will ensure that you have a good milk supply and that the baby feels loved and supported. However, it is not usual for babies to have large gaps between feeds so if your baby is going for a long time (more than 3 hours) without showing feeding cues try to wake them and offer the breast - a baby should feed at minimum eight to ten times in 24 hours, with feeds lasting between 10 and 45 minutes. If your baby comes off the breast, this can mean the breast is nearly empty, so you can offer the other side.

Additional Resources for mothers

• Global Health Media breastfeeding and expressing videos available in multiple languages. 
• Unicef breastfeeding and expressing videos and information leaflets
• Association of Breastfeeding Mothers free online breastfeeding preparation course
• NHS start4life 
• First Steps Nutrition Trust 

If your baby is born in the birth centre

Immediately after your birth, you and your baby will be made comfortable in the Birth Centre.

Soon after that, your baby will be examined by your midwife, who will then leave you to enjoy your first moments together, during which time you can have breastfeeding guidance from the midwives to ensure you are comfortable.

If there are no complications, most women tend to stay for between 6 - 8 hours after the birth before going home. If you have had a more complicated birth you may be moved to a postnatal ward, where you will be with other mothers and babies, and stay with us between 24 and 48 hours.

If your baby is born in the Labour Ward

As soon as your baby is delivered, both you and the baby will be made comfortable in the Delivery Suite.

In hospital the safety of you and your baby is of paramount importance to us. To help us with this, your baby will have two labels and a security tag, (on admission to the Maternity Ward). It is very important for your baby’s security and safety that they are present. Please inform a member of staff if these become loose. Security  is extremely important and these must be replaced if they fall off.

If you notice any other security problems or suspicious behaviour from anyone please inform a member of staff.

If you have a straightforward birth you may be able to go home shortly after from the Delivery Suite/Labour Ward .

If you are on the Maternity Ward you will stay with us for a period of about six to 24 hours, depending on your individual need.

If you have an instrumental birth, (ventouse or forceps) it is anticipated that you will stay for approximately 24 hours, although you may choose to go home before this if both you and your baby are well.

If you have an emergency caesarean section, it is anticipated that you would stay in hospital for about 24 to 48 hours - again depending on the condition of you and your baby.

If you have a planned caesarean, there is an enhanced recovery, it is anticipated that you will stay for approximately 24 hrs

There may also be occasions when a mother and/or her baby may require a longer stay in hospital, and this will be explained to you as soon as possible if this applies to you.

This is the advice provided by the National Institute for Health and Care Excellence (NICE).

While you are in hospital, and also once you go home, help and support is available 24-hours a day from midwives and the wider maternity care team. On the Maternity Ward staff are made up of a team of doctors, midwives, maternity care assistants, nursery nurses and student midwives.

Once home you will be visited by midwives together with student midwives and maternity care assistants. They are all there to assist you and your family adapt and enjoy your new life together and to help you become confident in caring for your new baby.

Following the birth of your baby, you will both have health checks performed to ensure that you are recovering well from the birth and your baby is adjusting well to being a newborn.

Your temperature, pulse and blood pressure will be checked at least once during your stay and possibly more depending on the type of birth you have had, and how long you are required to stay.

The midwife will talk to you during the postnatal check to ensure you are happy with feeding your baby. Please ask your midwife about anything you may not be sure of.

The midwife will feel your abdomen daily to ensure your uterus (womb) is contracted and is returning back to the normal position. The blood loss you experience following delivery is often described as a very heavy period. During the first 24 hours you may have to use two maternity pads at a time. If you have sudden profuse blood loss, feel faint, dizzy or have palpitations please tell a member of staff immediately. If you pass any blood clots please save these and inform your midwife.

Once you go home you will notice that your blood loss reduces over time and goes a darker colour. If this loss changes and becomes heavy or bright red in colour or develops an offensive smell please inform your midwife, as this could be a sign of an infection.

During the birth you may have needed a cut (episiotomy) or sustained a tear which required stitches. Even if you have not had stitches, pain and discomfort around your birth canal is common, (this is due to the bruising and swelling).

There are things that you can do to help the discomfort. Firstly you must tell your midwife or doctor, so that they can check that everything is alright and you do not have an infection or a haematoma “an abnormal collection of blood outside a blood vessel” (this is rare).

You must try to keep this area as clean and dry as possible; you can do this by changing your maternity pads regularly and after going to the toilet pat your stitches dry with a clean piece of soft tissue paper. Do not use powder or ointments on your stitches.

The midwife will give you regular pain relief; paracetamol is a good form of pain relief in the post natal period. However remember not to take more than eight tablets in 24 hours. Do not worry if you are breastfeeding as this will not affect your baby or your milk supply.

To avoid constipation try to make sure that you drink plenty of water (at least eight glasses) and fruit juice. Also try to eat a normal diet that includes fresh fruit, vegetables, salads, wholegrain bread and cereals and food with plenty of fibre.).

You may find that you have piles (haemorrhoids). These often occur during the second stage of labour; pushing stage of labour. You need to avoid straining when you go to the toilet as they will become worse. Should these occur ask your midwife for advice. The first time you pass urine, you may find this difficult or it stings. This is normal and you should not worry. Drink plenty of fluids, this will make the urine less concentrated and easier to pass.

If you had a caesarean section, your postnatal check is the same. In addition, your wound is checked daily. However, the plastic 'opsite’ dressing is left on to prevent infection and ensure that your wound heals. Also if you had a caesarean section you will be seen the next day by the anaesthetist to discuss your anaesthetic, and check you have no problems.

If your recovery is straight forward you may not see a doctor during your stay in hospital. However, if the midwife has any concerns about you, a doctor will be asked to see you. If you would like to discuss anything with a doctor please tell the midwife who will arrange this for you.

You and your baby will be discharged home as soon as you are clinically well to do so; this will usually be within 6-48hrs after birth. Please be aware that discharges occur throughout the day and into the evening Monday to Sunday. For your discharge to be completed, the following milestones will need to be met:

• A postnatal check of the mother by the midwife (you may require a review by a doctor)
• Your newborn is examined by our specialist team
• Medication for you or your baby to go home if needed
• Hearing screening will be offered during your stay in the Maternity Ward , or you may be offered an appointment in the community
• In addition to this, midwives will provide you with the following discharge documents:
  • Transfer papers for the community midwife
  • Transfer papers for the health visitor
  • A child health record book (Red Book)
  • Information leaflets about your recovery, contraception, emotional support, safe sleep for babies, birth registration and useful contact details of support groups for parents in your community
  • List of contact details for hospitals in your area as well as North Mid in case you become unwell

What we offer

The birth reflections clinic runs on Thursday mornings and is offered to women who have had complications at or around the time of delivery. We aim to see women 4-6 weeks after birth and provide a robust clinical review, with a discussion and debrief around the events that occurred. We support women to ensure they understand what happened at their delivery and make any appropriate arrangements for ongoing support. We give advice concerning any future pregnancies and care.

We would usually see women with the following complications:

• Severe pre-eclampsia
• Massive bleeding after delivery (>2.5 litres or needing >4 units of blood transfusion)
• Admission into ITU for any reason
• Failed instrumental delivery leading to Caesarean section
• Category 1 Caesarean section (urgent emergency for low fetal heart rate, placental separation or cord prolapse)
• Baby required admission to SCBU for over 24 hours for reduced oxygen levels at birth
• Complicated Caesarean sections
• Prolonged hospital stay of more than 7 days after delivery
• Repeat operation after delivery
• If your consultant feels it is appropriate

If we see you in this clinic we aim to explain events in a way that you understand and answer all of your questions to the best of our ability. If you have any concerns to raise then we can take action as necessary

Meet the team

• Miss V Sivashanmugarajan - Consultant obstetrician
• Janet Pardo - Midwifery matron

How you get referred

Usually you would be given an appointment prior to discharge from the maternity ward. 

If you would like to be seen in the birth reflections clinic but don’t have an appointment then please speak to your midwife or GP who will refer you to the clinic. 

If you have not displayed any symptoms for Covid-19, it is likely the Covid-19 test upon admission to our maternity unit will come back as negative. Should this not be the case and your test result is positive, a Midwife will contact you with your result to discuss how you are feeling and ask you to self-isolate for the recommended time frame.   

• If you have symptoms or have tested positive for COVID-19, you must self-isolate for at least 7 days.
• If you do not have a high temperature after 7 days, you no longer need to self-isolate and can leave your home on the 8^th day after your symptoms started or from receiving the positive swab result, adhering to the government’s social distancing measure’s.
• If you still have a high temperature after 7 days, keep self-isolating until your temperature returns to normal and you feel better

Will Covid-19 affect my baby?

As this is a new virus, there is limited evidence about caring for women with coronavirus infection when they have just given birth. A small number of babies have been diagnosed with coronavirus shortly after birth, so there is a chance that infection may have occurred in the womb, but it is not certain whether transmission was before or soon after birth. Your maternity team will maintain strict infection control measures at the time of your birth and closely monitor your baby.

Can I still breastfeed if I have tested positive for Covid-19?

Yes. There is no evidence showing that the virus can be carried or passed on in breastmilk. The well-recognised benefits of breastfeeding and the protection it offers to babies outweigh any potential risks of transmission of coronavirus through breastmilk. Provided your baby is well and doesn’t require care in the neonatal unit, you will stay together after you have given birth so skin-to-skin and breastfeeding can be initiated and supported if you choose.