Antenatal (before birth)

The role of the Health Visitor will be discussed in relation to how they can support you and your baby from the antenatal period until baby reaches the age of 5 years.

Some of the topics that may be discussed are:

• Infant feeding choices
• How you can develop a relationship between you and your baby, and why this is important
• Support for your mental health if needed
• Safe sleep practices for your baby
• Other support services that could be available to you

During this contact the Health Visitor will ask you lots of questions. They may also bring some different things with them for you to look at such as a baby brain box and a lullaby trust visual.

The Health visitor will ask you about how your pregnancy has been, who will be living with you and the baby, and how your own childhood was; as this may impact on you as a parent. 

It is likely will be asked if you have thought about how you want to feed your baby.

You will also have the opportunity to share any worries you may have. 

This information is gathered to help support you if needed in the antenatal period.

If you don’t need any extra support the same HV will come and see you when the baby is born between 10-14 days of age. Seeing you in the antenatal period should make the birth visit quicker, as all the important information has been gathered already. It also gives you continuity and you know who will be coming to see you and your new baby.

Derby City Health Visitor Preparation for Parenthood sessions: come and meet the Health Visiting and the Family Hub teams at our preparation for parenthood sessions.

We are running a rolling programme of three weekly sessions to share important information and skills to help expectant parents on their journey in to parenthood. All expectant parents are welcome!

What will the sessions cover?

• Week 1 - Introduction to the HV service and the family hub service. Baby brain development during pregnancy and bonding. Information about the red book, immunisations, and health checks that are needed in the first months of life.
• Week 2 - Information and practical demonstration on safe sleep, safety, safe handling of babies, dressing and bathing. How to support your baby’s brain development.
• Week 3 - 'Feeding your baby' session, led by the Infant Feeding Team.

Each session will be approximately two hours long.

Where will the sessions be held?

The sessions will take place in a local family hub.

These details are also available in the Derby City Family Hub guide - see page 5.

You can also enquire about dates and venues via our Chat Health number below. 

How do I book a place?

Please text our Chat Health service to book on to a session: 07507 327754.

Alternatively you can just turn up. You can attend all three sessions or just the ones you are interested in.

During your pregnancy you will start to think about how you want to feed your baby when they are born. As a service we will support you in any decision you make, whether that be exclusively breastfeeding, offering breast milk and formula milk in combination or formula feeding. Responsively feeding your baby will support you to build a loving and close relationship with them. 

It is important that you have all the information to make an informed choice. 

Breast feeding your baby gives them the best start in life, and the service will support you to meet your feeding goals. For further information on breastfeeding your baby and the benefits this can have for both you and the baby please click Breastfeeding support - Derby :: Derbyshire Healthcare NHS Foundation Trust (derbyshirehealthcareft.nhs.uk)

For further information on Responsive and safe formula feeding, making up of feeds and sterilisation of bottles please visit Feeding your baby - Start for Life - NHS (www.nhs.uk) 

We offer antenatal sessions on feeding your baby. If you would like to attend one of these please call us on 0300 1234586 option 3.  
 

Forming an attachment with your baby is so important and this can start even before your baby arrives. This can still be achieved even if you are not physically carrying your baby, and will make you more likely to develop a strong bond with your baby when they do arrive. Building a bond with your baby applies to both parents in the antenatal period. 

Ways in which you can help build an attachment:

• Responding to babys movements with touch
• Talking, singing and reading to the baby
• Using massage and touching your/ your partners bump
• Some parents to be find it useful to keep a diary of their thoughts and feelings through this time to look back on

This video from Solihull Approach provides more information on antenatal bonding before birth.

The baby’s brain needs the right conditions in pregnancy to start healthy development i.e.- nutrition, vitamins, oxygen and a happy place to live. 

Babies can cope with some stress in pregnancy but lots of stress can affect development of healthy brain cells and healthy connections. By reducing stress in pregnancy, a mother is helping with her baby’s healthy brain development.  

A baby is born with more than a 100 billion brain cells. Much of the wiring happens after birth. In the first few months and years of a baby’s life the brain cells form connections that shape our thinking, feelings and behaviours. Here is a video that shows the benefits of singing and talking to your bump - Singing to baby: When can babies hear in the womb? - BBC Tiny Happy People

From birth every experience taken in by the five senses helps build connections and guides brain development. 

No two brains develop the same for example a child who learns to play football will make certain connections compared to a child that has never kicked a ball. 

The type of care your baby receives plays a big part in how the brain chooses to wire itself. Parents who read and talk to their babies are helping their baby to develop important language connections in their brain, this can start from pregnancy so lots of talking to your bump will assist this. 

Parents who respond sensitively to their babys cries are building the emotional connections that lead to healthier relationships.

When thinking about getting prepared for your baby it is important to consider safe sleep practices for when your baby is born. 

There will be lots of things that people will recommend you buy for when the baby is here to help them sleep, but these are not all needed, and some of the items are not always safe for a baby to sleep on/with. You should always avoid products that claim to make your baby sleep longer or more deeply. By encouraging a baby to sleep for longer than they developmentally need to can affect their ability to wake when there is something not quite right. 

Some of the items the Lullaby trust do not recommend you buying are:

• Pods or nests
• Pillows/ duvets/ thick heavy bedding
• Cot bumpers
• Hammocks
• Sleep positioners

Items that are recommended for your new baby:

• Moses basket or cot
• Firm, flat mattress
• Baby sleeping bag (ensure this is the correct size for baby based on their weight
• Sheets and blankets
• Room thermometer
• Car seat

For further information on product information visit The-Lullaby-Trust-Product-Guide-Web.pdf (lullabytrust.org.uk)

Health professionals may refer to something called Sudden Infant Death Syndrome, or SIDS for short. This is where a baby has died suddenly and in an unexplained circumstance. Other families may refer to this as 'cot death'. 

We don't know why babies die from SIDS, but we can identify risk factors that can contribute to increasing the chances of SIDS.

You can find out more information about SIDs and how to prevent it on the NHS website.
 

When you are pregnant there may be times that you feel a little low or anxious. 

This is totally normal and many mums to be go through this period. The feelings shouldn’t last long, however if they do it may be time to speak to someone and get some help.

Is it depression?

Depression can be extremely distressing. Many women suffer in silence. Their friends, relatives and health professionals don't know how they're feeling.

Some of the symptoms, such as tiredness, irritability or poor appetite, are normal when you are pregnant. But these are usually mild and don't stop you leading a normal life. The time to get help is when these feelings have an impact on your day-to-day life.

When you have depression, you may feel increasingly depressed and withdrawn. Looking after yourself may become too much.

Emotional signs of postnatal depression

• feelings of hopelessness
• not being able to stop crying
• feelings of not being able to cope 
• not being able to enjoy anything
• memory loss or being unable to concentrate
• excessive anxiety about the baby

Other signs of depression may also include:

• panic attacks
• sleeplessness
• extreme tiredness
• aches and pains
• feeling generally unwell
• anxiety
• loss of appetite 

Getting help for depression

If you think you have depression, don't struggle alone. Your midwife/ Health Visitor will assess your emotional wellbeing at your antenatal check. She may ask you to fill in an assessment called a HADS. This will assess your feeling and identify any anxiety or depression you may be experiencing.

It's not a sign that you're going to be a bad mother or will be unable to cope. Depression is an illness and you need to get help, just as you would if you had an illness like flu.

Talk to someone you trust, such as your partner or a friend. You can ask your health visitor to call in and visit you. Many health visitors have been trained to recognise depression and have techniques that can help. If they can't help, they'll know someone in your area who can.

It's also important to see your GP. If you don't feel up to making an appointment, ask someone to do it for you. 

Treatment for depression

Milder cases of depression can be treated with counselling. More severe cases often require antidepressants and you may need to see a specialist.

Within Derby there is a service called 'Talking Mental Health' that service users can self-refer into for support with mental health illness.

They also offer relationship support through their service 'Relate'.

You may also find it helpful to contact the Association for Post-Natal Illness or the National Childbirth Trust.

The mental health charity Mind provides useful resources for people affected by postnatal depression

Your local Children's Centre can put you in touch with your nearest support group. These groups provide contact with other new mothers and encourage mums to support each other. They offer social activities and help with parenting skills.

Being actively involved and supportive during your partner’s pregnancy will also positively impact on not only on your developing relationship with your baby, but also your relationship with your partner.  
Your mental health:

Looking after yourself for a healthy happy baby, family health and happiness is key. You may feel side-lined as the attention is on mum and baby, but your role is crucial. A strong male role model is important for a child.

Having a new baby is stressful. We put a lot of pressure on ourselves. Lack of sleep, adjusting to a new experience and supporting your partner’s recovery add to stress.

It’s possible that you feel your partner has less time for you as she is focusing on baby.
Feelings of having to step quietly around the house and perform well at work to provide for the family are common. All this whilst having less sleep!

However much you wanted to be a dad this can still be hard. So it’s important to reach out if you’re struggling, and chat to family and friends.
Just like new mums, new dads can have feelings of anxiety or depression.
Look out for:

• Feelings of inadequacy, overwhelming feelings of stress
• Feelings of loss of appetite, difficulty sleeping, loss of pleasure in things you normally enjoy
• Feeling tired all the time
• Unexplained anger.

If you’re feeling any of these things it's important to get help professionally, as well as speaking to family and friends. Speak to your GP or Health Visitor.

It’s important for your baby for you to seek help, to enable you to be the best dad you can be. Your bond with your little one will make them feel safe and secure and enable them to tackle life's challenges well.

Your baby will learn from your attitude to life and is likely to imitate this in their own future relationships.

For more information on how dads can be affected by and supported through post-natal depression, please visit:
www.nct.org.uk/life-parent/emotions/postnatal-depression-dads
www.reachingoutpmh.co.uk
www.thedadsnet.com

Supporting each other 

To be able to provide a baby with the loving, emotionally warm and responsive parenting, parents need to look after themselves. A happy mum and dad make a happy baby.

Mums are particularly vulnerable after the birth and will need strong emotional support from family, friends and especially their partner.
It's ok to feel a sense of loss for your pre-baby life.

You and your partner are adjusting to a novel experience.

The tiredness can be immense and affect your coping abilities. Your partner will be healing from the physical and emotional aspects of pregnancy and labour and needs time.

Midwives, Health Visitors and your GP will all want to make sure that mum and baby are thriving, and at this time extra care and reassurance are needed. It is easy for mums to feel they are constantly being judged.

There are lots of things dads can do and fathers play a vital role in bringing up baby. Babies need dads to be healthy and happy to help mum and baby to feel healthy and happy too.

If anyone in the family is struggling to cope – you, mum or baby – then it is really important that you get support from family or friends. And your GP or Health Visitor, who are experienced professionals, are uniquely placed to help you.
It is ok to ask for help - many people find parenting hard and there is nothing to feel ashamed of.

For further information, visit the NHS Information Service for Parents: www.nhs.uk/start4life/signups/new 30

Feeling low, anxious or depressed

It is important to remember that mum may be having low feelings. Many women suffer from low feelings after the excitement of a pregnancy and birth and following hormonal changes.
Mood swings and tears -  ‘baby blues’ - are pretty normal. Most people feel down and tearful some of the time, but if mum is feeling this all the time help may be needed.
Admitting you are feeling depressed and anxious can be hard. Your partner may need your help to feel strong enough to do this.
Some things to ask yourself are:

• Does mum feel that she is having difficulty establishing a bond with baby?
• Is she feeling tearful and low?
• Does mum feel tired all the time?
• Where there any difficulties or complications in pregnancy?
• Does mum feel a lack of support/unsafe?
• Is mum behaving in an odd or bizarre way, or in a way that is out of normal for her?
• Insomnia? Not able to sit still? Is she getting mixed up or worrying excessively?

If any of these behaviours become apparent and go on for a few days, get some help from your GP, Midwife or Health Visitor.

You may find that you are having arguments with your partner while you’re pregnant.
Some arguments may have nothing to do with the pregnancy, but others may be caused by feeling worried about the future and how you're going to cope.

It's important to talk with your partner about how you’re feeling. If you are worried about your relationship, talk to a friend, family member or your midwife/ Health visitor.

If you are having a baby and you are going to raise it alone

You could think about attending some antenatal classes in your local area to meet other parents.

The Childrens centres in the area also offer groups you could attend. 

There is a free peer support service available from connected perinatal- https://www.connectedperinatalsupport.org/

There is Gingerbread which is a self-help organisation for single-parent families. It has a network of local groups and can give you information and advice. The charity can also put you in touch with other parents in a similar situation to you.

Visit the Gingerbread online forum (registration required).
 

It is really important that you access all of your antenatal care to ensure you and your baby remain as healthy as can be. 

Things to consider when you are pregnant to stay healthy.

Smoking and your unborn baby -

Protecting your baby from tobacco smoke is one of the best things you can do to give your child a healthy start in life. It can be difficult to stop smoking, but it's never too late to quit.
Every cigarette you smoke contains over 4,000 chemicals, many of which are dangerous, so smoking when you are pregnant harms your unborn baby. Cigarettes can restrict the essential oxygen supply to your baby. As a result, their heart must beat harder every time you smoke.

Benefits of stopping smoking in pregnancy
Stopping smoking will help both you and your baby immediately. Harmful gases, such as carbon monoxide, and other damaging chemicals will clear from your body. When you stop smoking:

• you will reduce the risk of complications in pregnancy and birth
• you are more likely to have a healthier pregnancy and a healthier baby
• you will reduce the risk of stillbirth
• your baby is less likely to be born too early and have to face the breathing, feeding and health problems that often go with being premature
• your baby is less likely to be born with a low birth weight. Babies of smokers are, on average, lighter than other babies, which can cause problems during and after labour. For example, they are more likely to have problems keeping warm and are more likely to get infections
• you will reduce the risk of sudden infant death syndrome (SIDS), also known as "cot death"

Stopping smoking now will also help your baby later in life. Children whose parents smoke are more likely to suffer from asthma and other serious illnesses that may need hospital treatment.
The sooner you stop smoking, the better. But even if you stop in the last few weeks of your pregnancy this will benefit you and your baby.- Taken from NHS Choices website. 

For support on quitting smoking you can speak to your midwife/ Health visitor or you can use any of the following support services:

Find Stop smoking support services services - NHS (www.nhs.uk)
National Smokefree helpline: 0300 123 1044
https://www.nhs.uk/start4life/pregnancy/smoking/ 

Healthy lifestyle choices

By choosing to have a healthy lifestyle in pregnancy you will be giving your baby the best start in life. Having a healthy diet ensures that your baby is able to get the correct amount of nutrients to grow and develop. Aim to eat 5 portions of fruit and vegetables a day. You can also take vitamins in pregnancy to assist with this. You may be eligible to apply for Healthy Start vouchers at https://www.healthystart.nhs.uk/how-to-apply/ . Healthy start will not only give you access to vitamins but it also helps to buy 

• plain liquid cow’s milk
• fresh, frozen, and tinned fruit and vegetables
• fresh, dried, and tinned pulses

During pregnancy it's safe to eat:

• cooked fish
• sushi, but only if the fish has been cooked thoroughly
• seafood/shellfish as long as it has been thoroughly cooked until steaming hot, for example mussels, lobster, crab, oysters, scallops, clams and pre-cooked prawns
• Peanuts and other nuts (unless you're allergic) - eating nuts when pregnant will not affect whether or not your baby has a peanut allergy
• spicy food - there's no reason to avoid spicy foods
• honey - it's ok for you to eat honey, but you should not give it to your baby until they're over a year old
• All hard cheeses, such as cheddar, Parmesan or Gruyere
• Pasteurised semi-hard and soft cheeses, such as cottage cheese, mozzarella, feta, paneer, ricotta, halloumi, cream cheese, cheese spreads, or goat's cheese without a white coating on the outside (rind)
• Any cheese that has been thoroughly cooked until steaming hot
• Pasteurised milk and yoghurt
• Pasteurised cream and ice cream are safe, but are not considered 'dairy' by The Eatwell Guide and have high sugar and fat content.
• You can eat runny or even raw eggs as long as they are pasteurised, or have the British Lion Code mark on them, or are Laid in Britain (LIB) eggs.
• Foods made with these eggs are also safe to eat. This includes:
  • mayonnaise
  • ice cream
  • salad dressing
  • mousse
• Aim to have 6 to 8 200ml glasses of water or other fluids every day, and:
• try different kinds of drinks, such as sugar-free squash, decaf tea and coffee, fizzy water, fruit juice or smoothies
• limit fruit juice or smoothies to 150 ml per day with meals to help to prevent damage to your teeth
• Decaffeinated coffee and tea are safe to drink during pregnancy.
• Drink plenty of water when you’re pregnant to keep hydrated and stop you getting constipated, especially in your last 3 months.
• have no more than 4 cups of herbal or green tea a day as there isn't enough evidence about their effect on developing babies
• avoid teas that contain ginseng or echinacea as doctors aren’t sure what effects they might have when you’re pregnant or breastfeeding
  • Talk to your midwife if you’re unsure about using any herbal products.
• While you’re pregnant it’s important to have no more than 200mg of caffeine a day.

There are certain foods that should be avoided in pregnancy as they have the potential to harm the developing baby: 

You should avoid eating:

• unpasteurised semi-hard and soft cheeses (unless cooked until steaming hot)
• all mould-ripened soft cheeses with a white coating on the outside, such as brie, camembert and chèvre (unless cooked until steaming hot)
• blue cheeses such as Danish Blue, Gorgonzola and Roquefort (unless cooked until steaming hot)
• any unpasteurised milk or cream
• Liver and liver products such as pâté or liver sausage can have large amounts of vitamin
  • This can be harmful for your baby. All types of pâté, including vegetable versions, can have listeria in them. It’s best to avoid them.
• Do not eat swordfish, marlin, shark or raw shellfish.
• Do not eat ready-to-eat cold-smoked or cured fish products as they can present a risk of listeria. These include products like smoked salmon, smoked trout, and gravlax. You can eat these products if they're cooked until steaming hot, as this destroys any listeria that may be present.  
• Only eat cured meats (like salami, pepperoni, chorizo and prosciutto) if they've been thoroughly cooked until steaming hot.
• You should not eat game meat, such as hare, partridge or pheasant due to the presence of lead. You should also not eat raw or rare meat as this can cause food poisoning.
• Always make sure any meat you eat is well cooked and steaming hot all the way through. You should not be able to see any pink meat and the juices should run clear.
• Try not to have more than two portions of oily fish a week. Oily fish includes mackerel, sardines and trout.
• Tuna is not classed as an oily fish, but do not eat more than two tuna steaks (about 140g cooked or 170g when raw) or four medium-size cans of tuna (about 140g when drained) per week.
• Thoroughly rinse fruits, vegetables and salads as they can have soil on them, which can make you unwell. 

Alcohol intake 

• It's recommended that if you're pregnant or planning to become pregnant you should not drink alcohol. This will keep any risk to your baby to a minimum.
• Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink, the greater the risk.

Foetal Movement

• Is your baby moving normally for you? Reduced or changed movements in pregnancy around 24 weeks can be a sign that your baby is not well
• If you notice a reduction or change in your baby's movements, call the hospital where you are having your baby straight away for advice
• Do not be tempted to use a home doppler to check on the health of your baby at home. Even if you detect a heartbeat it does not mean your baby is well

• Breastfeeding support - Breastfeeding - NHS (www.nhs.uk)
• Bottle feeding support - Bottle feeding - Start for Life - NHS (www.nhs.uk)
• Links to UHDB maternity page - Maternity | University Hospitals of Derby and Burton NHS (uhdb.nhs.uk)
• UHDB maternity antenatal videos - Online antenatal education | University Hospitals of Derby and Burton NHS (uhdb.nhs.uk)
• Text messages chat health - Text messaging advice service launched for Derby’s young people and parents :: Derbyshire Healthcare NHS Foundation Trust (derbyshirehealthcareft.nhs.uk)
• Support to stop smoking - Stop smoking in pregnancy - NHS (www.nhs.uk)
• Relationships - Relationship building resources - Baby Friendly Initiative (unicef.org.uk)
• Mental health support for men - Team Talk | Derby County Community Trust
• Peer support - Home | Connected Perinatal Support Derby
• Children's centres - Children's centres - Derby City Council

• For further information, guidance and resources for the antenatal period please visit the In Our Place website.