Antenatal Education Session (Bumps Birth and Beyond)

Hello, hi I’m Jenny and I’m a health visitor with the Lancashire Health, Young People and Family Service. I’m working with my colleagues Zoe, Debbie and Wendy to deliver this week two version the health visitors section of Bumps, Birth and Beyond which is an antenatal class which we normally deliver face to face but unfortunately because of the current restrictions on face to face delivery with the coronavirus pandemic we thought we could make a few changes and try and deliver the sessions online.

So one of the many benefits of being online is that you can rewind, fast forward, replay all those bits that you want to hear again and you’ve got access to lots and lots of really good high quality information which we’ve provided the links to for this session.

These will be in the information accompanying the slides on the website that you came to us from.

We really do hope that you find this presentation useful and if you have any questions following the presentation the contact telephone numbers for your health visiting team will all be listed on that website where you’ve come to us from. Normally we offer a section where you can ask any questions and have answers. Obviously we can’t do that when we’re doing it like this but please make a note of any questions and we can always help you at your antenatal visit or on the phone.

In week two we’re looking beyond the bump in the birth. The aim of this session is to give you an introduction really to what the health is and service is, give you some information to support you understand about the health visiting service, what we do, why we do what we do, what our service might look like for your family, when you might see a health visitor and how you can access our services. These online sessions have been added right across Lancashire so we haven’t included any phone numbers and that’s just because of the different services we provide, health visiting services. But, I’ll remind again that those contact numbers based on where you live are provided on the websites that you’ve come to us from.

We have a section about emotional health in the perinatal period and that’s been given by my colleague Zoe. So she talks about emotional health for mums and dads, parents, co parents because the transition to becoming parents can come with some feelings you might not have felt before. So we want to help you understand how you might be feeling, what can be normal, what might not be normal and who you can ask for for help with this in pregnancy and after birth.

Debbie will then go on to talk through how, you and these really important early days and months with your baby can help support their understanding of their world and how you and your baby can communicate to improve the development of your relationship and the development of their brain. So Debbie will talk about some of the myths that we commonly hear and help you to recognise and respond to your baby’s cues.

That’s where session one of week two will end and we’ll link to session two with Wendy for infant feeding and how you can get your feeding off to the best start and finish the session with information about contraception. And this always gets a bit of a giggle or a groan in the face to face sessions but soon enough these feelings return and we would always encourage you to have had a think discussion about contraception options as soon as you can. Your midwife will likely talk to you about it before you leave the hospital with your newborn baby and your health visitor will also ask you again to, remember that it’s important to take care of your sexual health as well as preventing unplanned pregnancies.

Lots of people and skill sets make up the health visiting and public health nursing teams. Health visitors provide what’s called a universal health service so that’s a service which is offered to everybody and anybody who’s got a preschool aged child will have a health visitor. Every newborn baby will be offered a health visitor and when your child goes off to school the school nursing service then becomes this contact between public health nursing and schools and families.

We work as a big team really to provide the right care at the right time, the right place and this team includes staff nurses and nursery nurses and they can help with the more common problems that can arise with children and they’ll visit to help put support strategies in place for families where needs have been identified by either the parent or the health visitor or the school or the nursery. We also work with, child health support workers who do a lot of work around healthy eating and healthy weight. We have some bilingual support workers so, in some areas across Lancashire where there’s different language needs we have people employed directly who can do some interpreting as well which makes it familiar for people.

We have some clerical staff and we also as nurses have a professional duty to educate that next generation of nurses. So we do sometimes supervise student nurses. Now these student nurses can be what we call pre registration nurses. So these are nurses who are doing their initial nurse training.

We sometimes have some post registration health visit and school nursing students. So we know that it’s important to train the next generation of nurses, but we also know it’s important that you’ve got the right to decline having a student during your visit. So if you don’t want to have that student in with you for the visit, please will you let your healthiest to know and the student will quite happily understand and wait in the car part, wait in the car because they’ll have plenty of other work they can be getting on with.

When I deliver this session face to face, I always ask the people who have come along whether they can tell me or what they can tell me about the health visitors. What do we do? What’s our job? How are we there to help them?

And very rarely do I get much of a response at that stage. So it’s important to really have a bit more information about health visitors. They come to your house and ask you lots of very personal questions. Why are we asking those things?

Health visitors, we are all registered nurses or midwives or nurses and midwives. And then we’ve gone on to do an additional year of training in community public health nursing. So we continue to work as nurses and because we’re nurses we provide an evidence based public health service based on what we know works for families, individuals, groups and communities.

We know that families from all walks of life might need support at specific issues that might affect their children’s health and development, so the actual service provided for each particular family will vary according to a personalised assessment for each family’s needs.

And as I said in the previous slide, we work in teams and as we all come from nursing and midwife backgrounds, there’s a very diverse range of nursing backgrounds. So some children’s nurses, some adult nurses, some mental health nurses, some neonatal nurses, there’s midwives. And we all work together for the best outcomes of the families and our caseloads. And I feel really lucky to have such a wide variety of experience within the team that I’m in.

And I know that if I need to, I can always ask for support from one of my colleagues who’ve got more knowledge about an area. So that means that we share information about clients and while we can often do this just with general information that doesn’t identify you, sometimes we might need to share more information about you with, for example a health visitor colleague or a GP and it’s important for you to know that we only do this with your expressed consent so your information is your information and it’s not mine to share without your permission.

However, as nurses we have a duty of care to your baby and your family and this means safeguarding and child protection are key elements of a health visitor’s role and that’s really to allow all children to have the best possible start in life.

Health visitors do work together with parents and other agencies through a variety of different service levels, which include Universal, Universal Plus, so families that might need a little bit of extra support, and Universal Partnership Plus, and that’s where we work with other agencies. So your health visitor will talk to you about any concerns they might have. And through being supported to access early help, families can help to improve the child’s health and development.

Now, this slide, just to really sort of demonstrate the types of conversations your health visitor might want to have with you.

It’s in order to get to know you and your family individually and it’s important that we ask you these questions and that you of course have got the chance to ask us any questions that you might have and this slide gives some examples but it doesn’t cover everything.

Some of the things we talk about are really just getting to know you and understanding how you and your family work, how you feel about your baby, what your parenting ambitions are, what your experiences of being parented yourself were.

Now I explained earlier in the presentation that the health visiting service is an evidence based service and understanding whether there’s any important or relevant childhood experiences that might potentially impact on your parenting decisions, with knowing that we can help families put appropriate support in place.

Health visitors offer comprehensive feeding support and that’s for breast, formula or combination feeding families. We have great feeding assessment skills and that can help us to identify any changes that might help you and your baby to thrive or we can refer you to the relevant services if that’s needed and identified.

Lots of new parents find that they want help with feeding the baby and sometimes even just a listening ear just to hear that you’re doing really well and just for you to know that you’re doing really well can be enough to encourage you to keep on doing what you’re doing and knowing that your baby is safe whilst you’re doing it.

We offer information about The UK vaccination programme which is carrying on during the current COVID pandemic because we know immunisation greatly reduces the risks of preventable diseases and it will help to protect your baby.

GP surgeries are reducing the risks of transmission of COVID V. By limiting who can enter the practice.

They are using appropriate personal protective equipment and they’re screening patients before anybody can attend in person so the risks are being reduced as much as possible.

Immunisation for your baby starts at eight weeks and there’s a scheduled visit at eight weeks, 12 and 16.

Some babies are recommended to have a BCG vaccination as well, but your midwife or health visitor will speak to you individually about that if it applies to you and your baby.

Your health visitor can help you with what to expect and when, how it might impact on your baby and any recommendations following those immunisations.

We will ask you if there’s any health conditions within your family. They can be an indication that your baby might need further referral or closer monitoring of their development. We’ll ask you about any problems that you might have had during your pregnancy or labour and then we can support you with any care needed following discharge from the midwife.

We also ask you about your social circumstances and helping to ensure for example that you’re claiming the relevant benefits so that when you become a parent worries about money are reduced and we know that social circumstances can have a huge impact on the physical and emotional health for all family members and that includes you and your baby.

Clinical assessment of your baby through top to toes examinations.

Another aspect of health visitors would be for us to undertake clinical assessment of your baby. So for example when you come home with your baby and we meet you at the first visit we offer a top to toe examination. We can help to show you how your amazing newborn baby is already communicating with you and how you can communicate back with them. That’s covered later on in this session as well in full Debbie. Also as your baby grows and we do developmental, assessments, so we’re looking at milestones for your baby. Again helping you with ways that you can help your baby to do these things through simple things of playing and talking, cuddling, relaxing and responding to your baby’s needs.

Safer sleep is a huge aspect of the health visitors role and we talk to parents about it at each of our visits with you and this is helping to reduce the risks of your baby dying in their sleep. This is covered in week three and four but Sudden Infant Death Syndrome that risk can be reduced through actions that you as your baby’s parents take can significantly reduce any risks through understanding the risks, making some simple lifestyle changes and following some steps to safer sleep.

So in order to help you with this your health visitor will ask to see where your baby sleeps day and night at most of our home visits so please don’t be surprised if we ask you to show us to where your baby sleeps in your bedroom.

We do talk about the benefits of vitamin D for you and your baby and your midwife will have recommended a vitamin D supplement throughout your pregnancy and we know that it’s likely in The UK for all of us to be at some risk of vitamin D deficiency. So as a precaution all adults and children over one year of age are recommended to have a daily vitamin D supplement of ten micrograms. But again as a precaution preventing vitamin D deficiency breastfeeding babies should also be offered a daily dose of eight point five and ten micrograms of vitamin D drops from birth. Your health visitor can help you with how to give these your baby safely and whether you can apply for the Healthy Start scheme and get these vitamins for free as part of that scheme or whether you can buy appropriate vitamins for your baby.

We also have a really good local knowledge so one of our aspects of our role is community and we’re specialist community public health nurses. Local groups and services are really important source of peer support helping to widen your social circle and that can help you and your baby with their emotional well-being as well as improve confidence and your baby’s development. Currently face to face sessions have had to stop but there’s some really creative innovative services being started up and you can access these through technologies such as smartphones and laptops. There’s lots of phone support available as well, not just from health services but charitable and third sector support and agencies. And your health visitor can help with suggestions specific and relevant to your family’s needs.

Now as we’ll be discussing further in the next set of slides, emotional health and support for your emotional needs is part of our assessment and support offered. So your health visitor will ask you each time we see you in that perinatal period about your emotional well-being. We ask about any mental health history and identify potential risks. We offer to support or refer.

We have really good ears for those that just need somebody to hear you in your time of need.

Please don’t feel any stigma attached to mental health or emotional well-being. Having a baby, this transition to parenthood, responding to your baby twenty four hours a day, the tiredness and changes to your lifestyle can have a dramatic impact on how you feel and this can be absolutely normal. So please just ask us for some help. Answer the screening questions and the tools we use as accurately and honestly as you can and don’t worry if it sounds negative because with the right support you can start to feel much better.

The next session hosted by Zoe who is a specialist health visitor for mental health. We’ll go into this in more details.

Finally any questions you have please please ask them. We’re there for you and your family and if we don’t know the answer immediately because I said earlier we work in teams there’s loads of experience and we will liaise and coordinate care between multiple services so if we don’t know the answer we will help you to find out.

This slide tries to demonstrate the Healthy Child Programme’s five core contacts for each family. So remembering that health visitors are the lead of the Healthy Child Programme for preschool aged children and these five core contacts are universal contacts offered to everybody with a baby.

Partners are encouraged to attend all contacts as they can but it’s not always feasible with working patterns and responsibilities. But any opportunity we can, we love seeing partners, and we can help with their mood and their transition to parenthood as well.

Now visits are normally undertaken in the home however NHS England guidance at the moment for community nursing staff has changed following the current Covid restrictions so some visits are being offered at home with health visitors wearing PPE, undertaking a telephone screen assessment prior the visit. Some contacts are being undertaken by telephone or video consultation.

It’s all about reducing the risk of transmission of coronavirus so in order to do that home visits are currently being prioritised for those with a compelling clinical or priority need for a home visit to be made.

Now our antenatal contacts, normally completed between weeks thirty to thirty eight of pregnancy and they are normally offered at home. These are being offered by telephone or video with the guidance. The antenatal contact really is their getting to know your visit and we have lots and lots of questions and we ask you to complete a baseline maternal mood assessment.

When I do face to face sessions of BBB, I always ask the pregnant people to let me know if they’ve had or not had contact from their health visitors yet so that way I can check to ensure that the details are on our system accurately.

So I’d really urge you to do the same, if you’re watching this presentation and you haven’t heard from a health visitor and you’re sort of thirty four or thirty six weeks pregnant, I would just ask you to phone the telephone number for your health visiting service which is a company in the slides on the website you’ve come to us from.

Now when you have your baby and you come home from the hospital you remain under the care of a midwife. Now midwives are continuing visit at home at the moment and some home visits and some clinic visits. But again we’re having to consider reducing the risks of what’s being called non essential contacts. And again it’s all about reducing transmission of coronavirus. So this guidance changes quite regularly. There’s information provided on the slides and the attached enclosed information but ask your midwife what will happen locally for you, because that guidance changes when we get new evidence.

Your health visitor will visit you at home between days ten and fourteen following your baby’s birth. Now again because of the coronavirus guidance we will ask you to wash our hands when we come to your house with soap and hot water. We’ll ask you to dispose of all items we’ve used in providing care for your baby in a double waste bag which we also ask to put in your refuse bin. And at the new birth visit we will assess you and your baby’s well-being, ask to see where your baby sleeps day and night and give you the opportunity to talk to us about your birthing experiences.

The next core contact offered is between six and eight weeks. Now again the current guidance for these visits is that we’re to undertake them remotely unless there’s a compelling need for a face to face visit.

The focus of this visit really is for maternal emotional mood so it’s assessment and support. See how you’re all feeling about baby and how you’ve adapted to your new life.

Trying to understand what your baby can do now, and just making sure that your baby’s GP check and the first immunizations have been arranged, starting remember at eight weeks of age for that first immunization.

Between eight and 12 of age one of the health visiting teams so this will be very much dependent on your family’s needs. So it could be a community nursery nurse or it could be a health visitor. We’ll visit you at home and we’ll complete a health and development review. Now there’s an accompanying questionnaire for this assessment, we normally send that out to you in the post and we ask to you complete that before we visit. And again we’ll ask to see where your baby sleeps overnight because the needs of a baby at this age, they change and the sleeping space and environment are likely to have changed since they’re a newborn baby and there can be safety implications.

So we ask if we can help you to keep your baby safe by considering their sleeping environment.

And the last core contact we offer is between two and two and a half years and this is with another health and development review. Now these are normally undertaken by one of our community nursery nurses and they’re specifically trained in child development.

The focus of this visit is thinking ahead to your child’s school readiness, putting in any supports in place early to help children achieve their developmental milestones ready for school. So the nursery nurses will keep in touch with their health visitor about what they’ve found when they’ve been to do the visit and the health visitor and nursery nurse work together to plan appropriate interventions and referrals if needed.

It’s important to remember though each family’s needs are assessed individually and support plans in place reflect your family’s needs so you might be offered more contact than this.

It’s also remembering that once the coronavirus restrictions have been lifted we have regular healthy child drop ins. They run differently in each area of Lancashire and your health visitor will give information about these and once they restart.

I added this slide just for a bit of confidence really. During the current restrictions, parents rightly are treating the children’s minor ailments at home but there’s some evidence emerging that children and families aren’t accessing medical advice and review as soon as would normally be indicated.

So as we know, there’s better outcomes when we access the right care at the right time in the right place. The Royal College of Paediatrics and Child Health have created this information for parents and carers.

The link’s available in the important links section at the end of the slideshow, and your healthcare Hi everyone, I’m Zoe and I’m one of the specialist health visitors for Perinatal and Infant Mental Health.

The following part of the presentation we’ll discuss emotional health with an aim to provide an overview of mental health illnesses with some of the symptoms of what these look like and the support available in both the antenatal and postnatal period.

So it’s vital to recognise the importance of looking after our emotional health. This is important at any time but especially during pregnancy and after the birth. It’s understandable that the current situation and developments around coronavirus may have sparked and raised anxiety in most of us. This is understandably also a stressful time for most of us. It’s therefore even more important at this time when we are expecting a baby or perhaps looking after a young child, when we may not have the same access to our usual support networks that we would ordinarily. This is important that we should take care of ourselves and our loved ones. This is a time when I would urge you to consider what support you do have around you, in order to think about who you can talk to for further support and advice, or to discuss any worries you might have no matter how big or small.

If you or someone you are concerned about are experiencing any worries or mental health issues please contact a health professional such as your GP, midwife, health visitor or mental health worker if you have one.

Both the transition into parenthood and becoming a parent can be both a joyous and anxiety provoking time. These are normal emotions, however if left untreated they can impact upon your mental health and the relationship with others, including your baby. It’s important that we recognise and look after our emotional health for everyone including fathers. Support for the affected parent and for the rest of the family can make a really positive difference to the outcome for everybody in the family.

Whilst we bear this in mind, it’s important to recognise what the terminology refers to.

What is perinatal mental health?

Perinatal mental health refers to women who experience mental health issues. This is from the period of conception when we first become pregnant, right up until the first year following the birth of a child. Perinatal mental illness affects up to twenty percent of new and expectant mums and covers a wide range of conditions.

Perinatal mental health includes a variety of many different illnesses and conditions. We know that these conditions can affect everyone differently and may have different degrees and severities. So thinking about these on a spectrum ranging from mild to moderate and severe and may include depression, anxiety or worsening of any pre existing conditions such as bipolar affective disorder, eating disorders and postpartum psychosis amongst many others. Before we go on to discuss some of these in more detail, here are some interesting facts.

One in five women develop mental health problems in pregnancy or within the first year after childbirth.

Anxiety and depression are the most common, with around twelve to thirteen percent experiencing either one and up to twenty percent women experience both of these.

One to two women in every thousand will experience postpartum psychosis after birth.

Five to ten percent of fathers experience depression in the perinatal period.

So it’s important to understand and talk about the more common mental health issues in the perinatal period.

I’m sure most of us have heard the term ‘baby blues’ and it’s important to understand the difference between ‘baby blues’ and ‘perinatal depression’.

Starting with baby blues, this affects up to eighty percent of women who experience baby blues. This can be described as mild low mood, feeling down, teaful and anxious, which usually happens in the first few days after giving birth. These are normal feelings and are thought to be due to the sudden hormonal and chemical changes that happen in your body after childbirth. These should pass within a few days and not last more than two weeks following the birth. These are absolutely normal, however if you do feel that these are persisting or causing upset or concern, you should talk to your partner, family, friends, your midwife, health visitor and GP.

Thinking about perinatal depression. We may have previously heard this referred to as postnatal depression, however as we’ve heard previously, depression can happen at any time in the perinatal period and can affect anyone both in the antenatal period whilst pregnant or after birth in the postnatal period. Therefore we refer to this as the perinatal depression.

As the previous slide showed, one in five women are affected by perinatal mental illness.

Perinatal depression affects up to twelve percent of women.

It’s important to recognise that five to ten percent of fathers experience depression in the perinatal period also.

Perinatal mental illness can affect anyone and does not mean you are a poor or bad parent.

Your health visitor and GP should talk with you about how you’re feeling after the birth.

Some of the warning signs to watch out for may include: a persistent feeling of sadness and low mood, a loss of interest in the world around you, no longer enjoying the things that you may have used to, a lack of energy and feeling tired all of the time, trouble sleeping at night, Feeling you’re unable to look after your baby.

Problems concentrating and making decisions.

A loss of appetite or an increase in appetite. We know this as comfort eating.

Feeling agitated, irritable or very apathetic, as though you can’t be bothered.

Feelings of guilt, hopelessness and self blame.

Some people may experience difficulties with bonding with their baby.

Feeling of indifference or maybe no sense of enjoyment with their baby.

Some other frightening thoughts might be for example, thoughts around hurting your baby. These can be very scary, but are very rarely acted upon.

Other thoughts around thinking about harm or suicide and ending your life are extremely important that you continue to get some support from the practitioners who already were involved with, such as your midwife, health visitor, GP or mental health worker.

It’s important to talk about and understand perinatal anxiety.

We know that perinatal anxiety affects up to thirteen percent of women.

Many women, around twenty percent, experience both depression and anxiety.

Some of the more common symptoms of anxiety may include: feeling tense or nervous and on edge, having a sense of dread or feeling the worst, feeling like the world is speeding up or slowing down, feeling like other people can see that you’re anxious and are looking at you, feeling your mind is really busy with thoughts, dwelling on negative experiences or thinking over a situation again and again, feeling restless and not being able to concentrate or feeling numb.

It is important to say that this is not an exhaustive list and there are potentially lots of other experiences that different people may feel.

Other anxiety disorders such as obsessive compulsive disorders, panic and post traumatic stress disorder can occur on their own or coexist with depression.

As we said this is not an exhaustive list and there may be additional symptoms you may experience.

If you are unsure if you are affected, please speak to your midwife, health visitor, GP or mental health practitioner if you have one and get support at the earliest possible point.

There is absolutely lots of support available to you and we’re going to go on to talk about that shortly.

So whilst we’ve considered the more common aspects of perinatal mental illness on the previous slide, we’re now going to look at the more serious and severe aspects of perinatal mental illness. So we’re going to talk about postpartum psychosis.

Many people become understandably worried and anxious in relation to postpartum psychosis.

However, it is important that we have some awareness of what this is, how to spot the signs and the importance of getting help early.

Whilst we know that postpartum psychosis is serious, we also know that this is rare and affects one to two in every thousand women following birth. Symptoms usually start quite suddenly within a few weeks after giving birth, however can also present later on. Postpartum psychosis can be an overwhelming and frightening experience for you and your loved ones. It is important to seek help immediately and treat it as a medical emergency.

You may experience a mix of depression and mania, for example periods of overactive and excited behaviour that can have a significant impact on your day to day life.

Hallucinations and changes in your thinking or beliefs amongst others that you may not have ever felt or experienced before.

It is extremely important that you seek help immediately to get appropriate support.

Most women do fully recover with the right support.

Be aware that if you do have postpartum psychosis, you may not realise you are ill yourself.

This is where it’s important that your partner, family, friends and loved ones may spot the signs and act on your behalf.

Certain risk factors include: There is an increased risk if you have a history of previous postpartum psychosis, schizophrenia or other psychosis or bipolar disorder.

There is also an increased risk if: There is a family history of bipolar, schizophrenia or previous psychosis with your mother, sister or daughter.

It is extremely important this information is shared with your health practitioner.

Your GP, midwife or health visitor will routinely ask questions and ensure that you are in receipt of the right support.

Further supporting information can be found at the following website at the nhs.ukconditionspostpartumpsychosis.

There are other links at the end of the session in relation to action for postpartum psychosis.

Whilst we’ve heard about perinatal mental illness across the course of the perinatal period, it’s now important to understand what help and support is available.

Commonly prospective parents may feel worried about disclosing any concerns or mental health worries. This is completely understandable, however we must remember that our mental health is just as important as our physical health and your health professional will understand that you may have these concerns.

Your health visitor and midwife will routinely ask specific questions about how you are feeling emotionally. Please be assured that this is to ensure we’re having conversations about both our physical and mental health and to ensure that you are offered the right support at the right time.

There are so many services available now to provide support for mental health and well-being ranging from mild, moderate to severe. Support is available. If you are worried about your own or your partner’s mental health, please speak to someone privately after the session by contacting your health professional, your midwife, health visitor or GP.

Some of the surveys you can see on the slide may be familiar, others may not. MINDMATTER are a well-being service which offers a range of free face to face and online psychological therapies to people aged 16 years and over to support them with anxiety, depression and stress amongst others. Parents can self refer or speak to their health visitor, midwife, GP if they would like some support to do this and contacted sooner if they are in the perinatal period. For specific details in relation to what support is available in your locality, please speak to your midwife, health visitor and GP.

Adult community mental health teams are to support adults with a variety of mental health issues.

There is a specialist perinatal community mental health team which is there to offer support for severe complex mental health needs in the community for those in the prenatal period.

A home treatment team is previously known as the crisis team and offers intensive support at home to those who may be in crisis to prevent hospital admission.

There is also a mother baby unit at Troughly Hospital which offers inpatient hospital admission for those with severe and complex perinatal and mental health needs.

Mental health practitioners are also available at A and D and are known as the Mental Health Liaison.

These offer support in cases of emergency, at times where you may require urgent assessment and support.

It is absolutely essential that you are aware of what services are available and please contact your health professional for more details.

It is important that you follow the most recent advice around keeping you and your family safe and continue to make decisions that are right for you and your family. The following websites contain up to date information to help you to do this.

Please contact your health practitioner should you require any further advice. Thank you.

Hello. My name is Debbie. I’m a specialist health visitor for perinatal and infant mental health.

The following slides are going to look at building loving relationships with our babies and how we can support healthy baby brain development.

This slide is around bonding with your baby and developing healthy parent infant relationships.

The first one thousand and one days from conception to age two are really important for healthy emotional and social development.

Healthy relationships and early positive interactions will help your baby feel secure.

This lays down the foundation for lifelong physical and mental health.

By developing a positive relationship, your baby can learn to manage their emotions and learning as they get older.

So what is bonding?

Bonding is the intense emotional connection that a parent feels for their baby.

This loving relationship with a parent and their baby can feel like falling in love.

Most parents feel this straight away, however others may take some time to get to know their baby and that’s okay.

Sometimes parents can feel concerned if they don’t feel the immediate bond with baby.

So it’s really worth remembering, bonding is a relationship and this is built over time. It can be different for every parent.

Fathers have an important role also with bonding.

Studies tell us that fathers undergo a hormonal change when they are becoming a parent, such as their testosterone levels fall and their oxytocin levels change in line with their mothers, helping them to become better attuned to their infants needs and respond when they cry.

Dads can develop their bond with their baby by communicating, caring and playing with them.

If you ever feel you have any difficulties developing a bond with your baby there are lots of support available for you.

Please talk to your healthy straw midwife and on the next slide we’re going to look at ways both parents can promote a bond with their baby.

Nurturing relationships begin before birth.

During pregnancy, spend some time bonding with your unborn baby.

It’s important to ensure that you also have time to relax and do things that help you feel calm such as yoga, mindfulness, walking or listening to music. Whatever helps you to relax.

Other ways you can help talk to your baby are: touch and stroke your tummy, talk to your baby bump, respond to your baby’s movements and notice when they’re most active.

We know that babies can hear from around twenty four weeks so they will hear your voices and the music you play.

You could have a bath and spend some time watching and talking to your baby, giving yourself time to reflect and relax.

Your baby is listening to the sounds of your family and getting to know your voices.

Ask your partner or children to be involved too.

This is helping your baby to become familiar with your voices for after they’re born.

After your baby is born there are lots of ways that can help parents develop a close and loving bond with their baby such as: letting babies see your face, having regular eye contact.

This triggers pleasure chemicals which help your baby’s brain to grow.

Babies can imitate their parents’ facial expressions from birth.

Sing and talk to your baby.

Babies have already tuned into your voice during pregnancy and will be comforted by your soft, gentle, soothing voice.

Babies are sensitive to their parents emotions and also their tone of voice.

Have plenty of skin to skin contact with your baby and keep holding them close.

Gently touch baby using gentle strokes or baby massage.

Take time to notice your baby’s cues, responses or behaviours and begin to wonder what they’re doing and how they’re feeling.

Okay, we have a quick quiz now. The quiz is around building loving relationships with our baby and baby brain development.

Over the next couple of slides there’ll be a few questions. They’ll come onto the screen. Just take a few moments to think about the question and then we’ll go through the answers together.

Okay we’ve got our quiz questions now. Just click on the mouse when you’re ready for the next question and then consider is this true or false?

From birth, babies will recognise familiar faces, voices and smells and prefer them to unfamiliar ones.

This is true. Your baby will recognise familiar faces, voices and smells.

It’s important to get your baby into a routine. It will make your life easier.

This is false. Newborn babies are not capable of learning a routine. However, by responding to your new baby’s cues for feeding and comfort, this will help them feel secure.

They will gradually cry less and feel more content.

When babies’ needs for love and comfort are met, they will grow up to be calmer and more confident.

This is true. When babies’ needs for love and comfort are met they will grow up to be calmer and more confident young people.

A rattle is the most interesting sound for a baby to listen to.

This is false. Your voice as well as your faces, playing and interactions are the most interesting things for your newborn baby. So keep playing, talking, singing and reading to your baby and start this during pregnancy and continue for the first years of life.

Okay we have a few more questions now.

By twenty four weeks of pregnancy babies cannot feel, hear, see or taste. Is this true or false?

This is false. By twenty four weeks of pregnancy babies can already feel, hear, respond to light and taste.

Looking at your face is the best way for babies to learn.

Talking, listening and smiling helps your baby’s brain grow.

Is this true or false?

This is true. Looking at your face and hearing your voice is the best way for your baby to learn.

Newborn babies can see objects most clearly when positioned about a foot away from their face.

Is this true or false?

This is also true, babies can see most clearly when they are positioned about 30 centimetres away.

It’s no coincidence babies can see this distance. When they’re breastfeeding or close to your chest it’s the perfect opportunity for them to get to know you.

Last question: Newborn babies will imitate the facial expressions of an adult. Is this true or false?

This is also true, babies are born ready to find their parents faces and have eye contact.

They are able to copy mouth movements and facial expressions.

Try this with your newborn baby by sticking your tongue out, waiting a few seconds and watch how your young baby tries to copy you.

Reward this effort by giving them a big smile.

This is the beginning of turn taking interactions.

Here are some myths you may have heard before.

Babies become spoilt and demanding if they are given too much attention.

However, we know now you cannot spoil a baby by holding, cuddling or responding to their needs.

Your baby benefits each and every time you or your partner interact with them during pregnancy and following the birth.

Another one is you should leave babies to settle alone so that they learn to be independent.

We do know now that babies do not learn to settle themselves and become independent.

When babies are routinely left alone they think they’ve been abandoned by their caregivers and they may demonstrate this through crying and unsettled behaviours.

Babies are totally reliant on their parents to help them to feel calm and secure.

They need support from their parents to help them gradually learn to regulate their emotions during the first few years of life.

Click on the links at the end of this presentation to download this UNICEF leaflet called Building a Happy Baby and also watch the video clip My Baby’s Brain.

This slide shows how communicating and interacting with your baby not only helps physical brain development but also helps their emotional health, sense of security and that they learn you understand their needs.

Babies are amazing they’re born sociable, ready to relate and interact with others around them.

Babies’ brains are built through everyday interactions such as eye contact, smiling, singing, talking and playing gently.

All these help towards healthy relationships and positive emotional health.

Babies are making millions of brain connections every day and their brains double in size during the first year of life.

Their brains are built through sensitive interactions with their parents.

Brains are also built through back and forth interactions, turn taking, much like a game of tennis.

Healthy interaction looks like when a baby is babbling or making a sound and the parent notices and responds, they’re sharing the interaction, each taking turns.

Some health visitors in your area may have had extra training with the neonatal behaviour observation tool. This is also known as Enbo.

This can show you how amazing your baby is at communicating what they are feeling, their likes, preferences or dislikes.

During turn taking and talking to your baby you may notice your baby look away or stops interacting for a short time.

This is completely normal.

In the early weeks your baby will look at you briefly but this can be overwhelming so they will look away for a short time.

Just give your baby time and they will engage with you again when they are ready to interact.

At the end of this presentation there are two short video clips which show the serve and return interaction between parents and babies and there’s an animation about how babies brains are built.

Babies move through six different states: three awake states and three sleep states.

The awake states are: quiet alert, unsettled and crying.

The sleep states are drowsy, light sleep and deep sleep.

Babies don’t have moods, they have needs, so getting to know a baby’s sleep and wake states helps us to know what they need support with and can also help us improve the bond and relationships you have with your baby.

Very small babies move through these states quickly, so by recognising which state their baby is in, this can help parents adapt and provide the right support for their baby at the right time.

Watch your baby and gradually become familiar with what your baby is like.

Getting to know your baby’s sleep and wake states can help you respond to your baby’s needs.

An example of this is, if a baby is in the quiet alert state, their eyes are wide open, their body is relaxed, they are focused and ready to engage.

This is the state that babies are ready to play in and interact with you.

However, if babies are in the unsettled or crying state, it’s important to remember your babies cry letting you know that something needs to change and they need your help to feel calm and soothed.

Getting to know your baby takes time.

By watching their cues and signals you can begin to work out what they like and don’t like.

Each baby is different and will develop their own pattern and move through the different sleep and wake states.

Positive responses to your baby’s needs and cues helps them feel safe and secure and gives them the very best start in life.

Please click on the link at the end of this presentation and look at the videos and read the handout called Baby Watching.

Parents find this is a really useful handout. It goes through all the different baby states and helps us to notice if this is too much, too little or just right interaction with my baby.

Hello, I’m Wendy. I’m one of the health visitors. Intraception. It’s been a while since you’ve talked about that, hasn’t it? But obviously, following delivery and everything, and the fact that you’re really tired, intimacy might feel a million miles away. However, it’s probably a lot closer in your partner’s mind being realistic. So bear in mind you’re really fertile after you’ve had a baby, and I’ve done many eight month reviews where mums actually advise me that they’re expecting again, so it’s really important that you use protection, even if you’ve a few condoms to hand when that magical moment happens.

So I’ll just run through some forms of contraception with you now. Obviously, no form of contraception is 100% reliable, And you can get more information from local family planning clinics, I’ve got the website on the next slide for you. So running through the different options, contraceptive injections, there’s a couple of percentages. So we’ve got perfect use, which a society as a whole, probably not many of us do use anything perfectly. And so the perfect use and a typical use. So the injection perfect use is 99% reliable, but typical use is only 94%. The contraceptive implants 99% effective, as is a contraceptive coil, the Mirena coil and the copper coil are both overall 99% protective.

The progesterone only pill that’s perfect use is 99% but typical use ninety two.

The combined contraceptive pill perfect use is over 99% but typical use is only 91%. Now with the combined pill that’s only recommended from six weeks if you’re breastfeeding because if it’s introduced before your breastfeeding is established, can reduce your milk supply. So if anything was to happen before the six month period, I’d recommend using condoms. Moving on to condoms and if used correctly 98% reliable, but typical use which I was surprised at actually was an 82%.

Contraceptive patch perfect use 99%, typical use 91 The diaphragm, don’t know if many people use the diaphragm actually, but perfect use is only between ninety two and ninety six percent. But typical use is 71 to eighty eight. I suppose that’s expected if got other things on your mind while trying to fit it. Natural family planning is 99% effective, but typical is only 76% again, which is massively reduced.

But I suppose if you’re going to be going for that method, you need to be doing absolutely perfecto, don’t you? And then breastfeeding is 98% reliable, providing that you’re fully or nearly fully breastfeeding, your baby’s less than six months old, and you’ve not had your first period.

So a few things there for you to be thinking about, but you can discuss it when you go to your postnatal with your GP or like I said, you can mention it to family drop in clinics as well.

That’s the first section of week two completed. We’d recommend now you have a bit of a break, maybe have a cup of tea and some fresh air if you can. Feel free to come back another day if it suits you better Don’t forget those links to the video clips and information that we keep discussing are all listed on the accompanying information on the website you accessed this presentation from. They’re really easy to watch and read and we think you’ll find them informative and enjoyable and they’ll help you to respond to your baby’s needs.