Minimising the risk of cot death 

Sadly, we don’t know why some babies die suddenly and for no apparent reason from cot death, known as Sudden Infant Death Syndrome (SIDS). But there are steps you can take to reduce the risk of it happening to your baby. 

The safest place for your baby to sleep in the first six months is in a clear cot or Moses’ basket in the same room as you. This means you can hear your baby easier and respond to their needs before they start crying. 

  • Always put your baby down to sleep on its back 
  • Place your baby in the ‘feet to foot’ position, which means that the baby’s feet are right at the end of the cot to prevent the infant from wriggling under the covers and overheating
  • Always make sure your baby’s head is exposed and uncovered. We advise that you choose blankets rather than a duvet to limit the risk of suffocation. Tuck the blanket under your baby’s arms. 
  • Maintain a constant temperature in the baby’s room of around 16-20 degrees C. Although it’s important to prevent a baby becoming too cold, stuffy and overheated environments can also pose a risk. 
  • Make sure your baby sleeps in a smoke-free room and avoid smoking around your baby Or anywhere in the house
  • You should not share a bed with your baby if you or your partner are under the influence of alcohol or any drugs (including prescribed medication), are overweight or excessively tired. Don’t fall asleep with them on a sofa or Chair.
  • Stay vigilant. If your baby develops breathing problems, is overly drowsy or running a temperature then seek prompt medical advice. It could save your baby’s life. 

You can find more information about safe sleeping on Basis Online or Lullaby Trust.

It is easy to get confused about what you really need for your baby in those early days and weeks, but here are some of the essentials you will need: 

  • Disposable or cloth nappies. For non-disposable you will also need nappy pins, nappy liners, a bucket with a lid and appropriate washing solution for the nappies, as well as four pairs of plastic pants that are either tie-on or elasticated. 
  • For nappy changing: cotton wool, a plastic changing mat, , barrier cream to prevent nappy rash and a bag to carry everything in when you are out and about 
  • For bathing: a baby bath or large clean bowl, unperfumed soap and two soft towels 
  • For sleeping: a crib, carry cot or Moses’ basket, a firm mattress, sheets, and light blankets or a sleeping bag (check the manufacturer’s guidance regarding minimum weight limits for the sleeping bag). Pillows and duvets are unsuitable for babies under the age of one because of the risk of suffocation
  • For breastfeeding or bottle-feeding expressed breastmilk: nursing bras and breast pads
  • For bottle feeding: six bottles, sterilising equipment, a bottle brush, first infant formula milk (if formula feeding), breast pump (if bottle feeding expressed breastmilk)
  • Baby clothes: six sleep suits, two cardigans, four vests, a shawl or blanket to wrap your baby in, a woollen hat, mittens, socks or bootees and a sunhat. 
  • Out and about: a pushchair or baby carrier and a car seat.

Following discussion with you in hospital, your midwife will arrange transfer of your care to the community midwifery team and you will go home. The midwives will discuss with you when you can go home. For some women this could be within 12 hours after the baby is born.

Before you are discharged (go home from hospital) we will run through the discharge procedure and give you information about how you can access support and sources of help. If you are travelling home in a car, you will need to bring a baby car seat or have carry-cot restraints fitted to your vehicle. 

Home visits 

Your community midwife will see you at home the day after you are discharged from the hospital. 

More visits will be offered depending on your individual need and you can also access one of our many ‘postnatal drop-in clinics’ which are run in a variety of settings. Ask you community midwife about the ones nearest to you. 

If you live outside our area, it will be a midwife from another hospital. The purpose of home visits is to monitor your recovery from childbirth, assess the wellbeing of your baby and offer screening tests. 

If a midwife has not contacted you the day after going home, please call the community midwife team you were discharged to. 

Postnatal checks 

  • The day after your discharge. This may be a phone call 
  • Day fie to eight to weigh baby and carry out baby’s blood spot screening test 
  • Day 10-14 to transfer your care to the health visitor.

If needed, the midwife can provide care for up to 28 days following your baby’s birth. 

Improving your recovery after birth 

Sleep deprivation is not unusual when you have a new baby. Rest when you can. If your baby has a nap during the day you may wish to catch up on sleep too. 

Talk to your midwife about when to restart regular exercise. The type of birth you had may affect how soon you can. 

Perineal Care 

The perineum is the area between the vagina and the anus (back passage). If you have had stitches, these may feel tight, tender, or uncomfortable for a few days, but this should improve with time. The stitches usually dissolve naturally when the wound has healed. This may take several weeks. 

The following may help you to remain comfortable: 

  • Pouring a cup of warm tap water over the area whilst passing urine, to reduce stinging
  • Pain relief: Paracetamol and an anti-inflammatory medication such as ibuprofen are safe to use when breastfeeding. Dihydrocodeine is safe to use in pregnancy but can cause constipation so should be used with caution. 
  • Pelvic floor exercises should be started straight away if possible as this helps aid the healing process by encouraging blood flow, along with improving sensation and strength to help with control of both the bladder and bowel
  • Keep your stitches clean and dry, to prevent infection
  • Changing your sanitary pads four to six hourly, or sooner if full
  • Clean the area with plain water only. Try to avoid applying anything soapy, perfumed, or oily to the area and avoid long baths until the stitches feel fully healed. 

If you have had a third or fourth degree tear you will be referred to the perineal clinic for follow up. You will be seen at around 6 weeks post birth and again at around 6 months. At this appointment you will be assessed by a urogynaecology midwife, and a referral made to a pelvic health physiotherapist if required. 

Going to the toilet 

Constipation 

It can take three to five days to open your bowels (do a poo) after giving birth. 

  • Try to eat foods high in fibre, such as fresh fruit, vegetables, wholegrain cereals and bread. 
  • Aim for five plus portions fruit/veg per day
  • Drink when you’re thirsty, ideally aiming for at least 1.5ltrs of water - if you are breastfeeding aim for about three litres of drinks every day
  • If you are still having difficulty doing a poo, your GP/pharmacy can give you medicine to soften your poo.

Piles (haemorrhoids) 

Piles are swollen lumps inside and around your bottom (anus). They are painful and uncomfortable when going to the toilet. These are common after giving birth and usually disappear within a few days. 

Piles can be managed by avoiding constipation, using good hygiene, creams, stool (poo) softeners and pain relief medication if needed. These can be bought over the counter at a pharmacy. 

Passing Urine (peeing) 

The first few times it might sting. If you find yourself leaking urine unintentionally, ‘pelvic floor exercises’ will help strengthen your muscles and stop accidents, and you can start gently after birth. 

Sometimes your urge to pass urine is temporarily reduced post birth, so make sure you go to the toilet regularly, even if you do not feel as though you need to. A normal pattern is to go between 2 - 4 hours depending on how much you are drinking, so bear this in mind. 

Talk to your midwife if you have difficulty/pain when peeing, your pee smells unpleasant; or if pelvic floor exercises are not helping. 

Thrombosis (blood clots in the legs) 

You are slightly more likely to develop blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolus) during pregnancy and in the first six weeks after birth. These types of blood clot are called venous thromboembolism (VTE). Your risk of developing a VTE is increased if you are: over 35 years, have a BMI over 35, had a ventouse, forceps or caesarean birth, are a smoker or you or a close family member has had a VTE in the past. You may have noticed the staff caring for you are using these risk factors to calculate a VTE score, which helps to guide the management for individual people during pregnancy and after birth. 

Your legs may be sore if you have been sitting or lying down for a long time. Try to move around as much as possible, standing up and walking will help with both recovery and constipation. To help blood flow, you can do regular ankle exercises. If given compression stockings (socks) to help with circulation, continue wearing them until you are active again. Some women are sent home with daily injections to thin the blood. It is important to complete the course of these injections. 

Attend your local accident and emergency unit if you notice: 

  • Pain, redness, swelling or lumps in your legs 
  • Pain in your chest, or in the back or shoulders. 

In rare situations, blood clots can move from the legs and into the lungs. You should seek immediate medical help if breathing is difficult, or you are coughing up blood. These can be signs of pulmonary embolism (blood clot in the lung). 

Exercises for recovery 

Back care 

  • During pregnancy, the ligaments of your body soften and stretch to make room for your baby. These ligaments remain soft for up to five months after the baby is born. It is therefore important to protect your back in your day-to-day life. 
  • Getting out of bed: Bend your knees, roll on to your side and use your arms to push yourself into a sitting position. 
  • Sitting: Sit with your bottom back in the chair to support your lower back. When feeding your baby, you may wish to put the baby on a pillow, so you are in a comfortable position. 
  • Standing: Stand upright and tuck your bottom in. Always stand and walk tall with your tummy drawn in. When changing your baby, make sure your back is straight. If you are changing your baby on a low table or bed, kneel on the floor, keeping your back straight. 
  • Lifting: When you lift your baby (or anything else), make sure you bend your knees and keep your back straight. Do not twist when lifting. 

Pelvic floor exercises 

The pelvic floor consists of layers of muscles supporting the pelvis. The muscles attach to the pubic bone at the front and to the base of the spine at the back, forming a supportive ‘bowl’ between your legs. Pelvic floor exercises should be started straight away if possible as this helps aid the healing process by encouraging blood flow, along with improving sensation and strength to help with control of both the bladder and bowel. 

What do the pelvic floor muscles do? 

The pelvic floor muscles support the bladder, uterus (womb) and bowel. They prevent the leakage of urine when you cough, sneeze, laugh or run. They control the three openings – the anus (back passage), vagina (birth canal) and urethra (bladder opening). They increase pleasure during sex. 

How to do pelvic floor exercises

Pelvic floor exercises can be performed in any position, and no-one will know you are doing them: 

  • Tighten the muscles around your back passage, as if trying to stop the passing of wind
  • At the same time, tighten around your front passages (vagina and bladder), as if trying to stop the flow of water
  • Your buttocks, legs and tummy should not move
  • Do these exercises every day. 

Work towards two to three sets per day of 10 x fast squeezes and 10 x squeeze and holds, aiming to hold for 10 seconds eventually, but focus on the quality of the squeeze rather than the quantity at first and increase as you get stronger. It can take three to five months of regular exercises to notice an improvement in strength and then when you feel strong and can complete those sets easily, maintain that strength by doing just one set per day for the rest of your life. 

Associating these exercises with a regular activity like brushing your teeth, when feeding your baby may help you to remember to do the exercises regularly. 

Abdominal muscles 

During pregnancy, the abdominal (tummy) muscles are stretched and elongated, which weakens them. In the later stages of pregnancy, the muscles separate to allow the baby to grow, creating a gap. When your baby is born, this gap may still be present. 

Deep abdominal exercise

It is important to help support and close the gap: 

  • Lay on your side or on your back, and let your tummy relax
  • As you breathe out, gently draw in the lowest part of your tummy towards your spine (back) 
  • Hold this for a few seconds and then let go
  • Repeat four to five times, resting between each one
  • Aim to hold for 10 seconds and to repeat 10 times
  • Once confident, try tightening the pelvic floor at the same time. 
Pelvic tilt 

Once you can do the deep abdominal exercise, move onto this: 

  • Lay on your back with knees bent 
  • As you breathe out, draw in your tummy as before and tilt your pelvis backwards by gently squeezing your buttocks. You should feel your back flatten onto the floor or mattress. 
  • Hold this position for five seconds, and then relax
  • Repeat these four to five times (increase the hold to a 10 second hold, repeating 10 times)
  • You may also like to try this lying on your side. 

When can I start exercising? 

When you feel ready! Start gently by walking with ten minutes a day and increase the time and distance as you feel able. 

After your six-week check, exercises such as swimming or classes can slowly be resumed. 

Switchboard Liverpool Women’s University Hospital

Tel: 0151 708 9988 

Community Midwifery

Tel: 0151 702 4175 

Monitored Monday to Friday, 9am-4pm.

Maternity Assessment Unit (MAU)

Tel: 0151 702 4413 

Baby unwell             

Urgent: 999 

Less Urgent: 111 

Out of area Community Midwives Office