Handbook for Bereaved Parents

What you need to bring to hospital

Information on what you need to bring with you can be found in the ‘What should I bring with me to Hospital?’ section of this page.

Introduction

We are deeply sorry that your baby has died.

We know that no words can take away the pain of what has happened. During this time, you may feel overwhelmed, frightened, numb, angry, exhausted, or experience many emotions at once. Whatever you are feeling, please know that there is no right or wrong way to grieve. Whatever emotions you are experiencing are valid.

You may notice physical as well as emotional reactions to your loss. Some parents find it difficult to concentrate, understand information, or remember what people have said. Others may feel exhausted, restless, or disconnected from what is happening around them. These are all common and normal responses to grief.

The staff caring for you will explain what is happening and answer any questions you may have throughout your stay. However, we know that it can be difficult to take in information when you are grieving. This handbook has been created to support you during your time in hospital and after you return home.

Please remember that you do not have to face this alone. Support is available for you and your family, both now and in the weeks and months ahead.

What happens next?

Following the diagnosis of your baby’s death, you will be offered time to discuss your options with a doctor and midwife.

Unless there is a medical reason to deliver your baby urgently, many parents decide to go home for a short period before returning to hospital. Others prefer to stay in hospital. We will support whichever option feels right for you.

You will be given information about birth, investigations, spending time with your baby, and the support available to you.

Please ask questions at any time. There is no expectation that you will remember everything you are told . It is normal for information to take time to sink in and need repeating, so please ask questions as often as you need. We can also write things down or text information to you if that would help.

With your permission, we will inform your GP, Community Midwife and Specialist Public Health Nurse (formally known as a Health Visitor) so they are aware of your circumstances and we will also cancel any future antenatal appointments you may have planned.

What should I bring with me to Hospital?

Preparing to come into hospital can feel overwhelming, and you may find it difficult to think about what to pack. The following list is intended as a guide to help you prepare for your stay.

Please do not worry if you do not have everything on this list, or if there are items you had hoped to bring for your baby but feel unable to. We have a selection of baby clothing, blankets and other items available in the hospital should you wish to use them.

You may also find comfort in bringing personal items that are meaningful to you and your family.

For you

• Your maternity notes
• Any prescribed medication
• Dressing gown, nightwear and slippers
• Toiletries and hair ties/bobbles
• Maternity or sanitary pads
• Breast pads
• Mobile phone and charger, and/or a camera
• Books, magazines, music, or a tablet with pre-downloaded films or programmes
• Any personal items you may wish to include in photographs or memory-making activities (we recommend leaving valuables at home where possible)
• Some cash or loose change for vending machines, cafés or the hospital canteen

For your birth partner(s)

• A change of clothes
• Toiletries
• Snacks and drinks
• A mobile phone and charger
• Any items that may help them stay comfortable during their time with you

For your baby

If you would like to bring items for your baby, you may wish to consider:

• Clothing or a special outfit
• A blanket or shawl
• A teddy bear, cuddle toy or comfort item
• Any other items that feel meaningful to you and your family

There is no expectation that you bring anything for your baby. If you would like support with clothing, blankets, memory-making items or keepsakes, our staff will be able to help and guide you during your stay.

Coming into Hospital to deliver your baby

We understand that coming into hospital at this time may feel incredibly difficult. Our aim is to support you and your family with compassion and sensitivity throughout your stay.

Your care has been arranged at at either:

• Snowdrop Suite, St James’s University Hospital

• Rosemary Suite, Leeds General Infirmary

What happens on the morning of admission to hospital?

On the morning of your admission, please call the Delivery Suite at 9:00am and ask to speak to the Co-ordinator. They will confirm arrangements for your arrival and answer any questions you may have.

Leeds General Infirmary (LGI): 0113 392 7445

St James’s University Hospital (SJUH): 0113 206 9103

Where should I park?

Free on-site parking is available at both Leeds General Infirmary and St James’s University Hospital.

St James’s University Hospital

If you are attending St James’s, please park in the multi-storey car park. Your healthcare team can arrange free parking before your arrival – just let them know if this would help you.

Leeds General Infirmary

If you are attending the LGI, staff can apply for a temporary visitor family parking permit for use in the hospital car parks.

If you have any concerns about your journey to hospital or need additional support with arrangements, please let a member of the team know. We are here to help in any way we can.

Who should I call when I arrive at the hospital?

When you arrive at the hospital, please telephone the Delivery Suite. A member of staff will meet you at the entrance to the Clarendon Wing (LGI) or Gledhow Wing (SJUH) and accompany you to the Delivery Suite. We hope this will make your arrival as straightforward and supportive as possible.

Leeds General Infirmary (LGI): 0113 392 7445

St James’s University Hospital (SJUH): 0113 206 9103

Preparing for your baby’s birth

When will my baby be born?

Being told that your baby has died is devastating, and making decisions about what happens next can feel overwhelming. If there is no immediate medical reason for your baby to be born straight away, you will usually be given time to consider your options and decide what feels right for you and your family.

Some parents wish to go home for a period of time after receiving this news, while others feel more comfortable remaining in hospital. There is no right or wrong decision. Our priority is to ensure that you feel informed, supported and involved in decisions about your care.

Waiting to give birth can be an incredibly difficult time. Whilst you are waiting you may have a huge range of thoughts and feelings racing through your head, you may feel completely numb, or anything in between. Even after your baby has died, as you change position, you might still feel the baby move in your womb and this could feel very unsettling for you. You will be offered a private space to give birth away from other mothers and families. As it can be very hard to focus at this time, you may be encouraged to have a partner or someone else with you who can provide support and help you make difficult decisions.

A doctor and midwife will talk with you about your options, including the timing and method of your baby’s birth. These discussions will take into account your individual circumstances, medical history and personal wishes. We will ensure you have privacy, time to reflect, and opportunities to ask questions at every stage.

For most parents in this situation, labour is induced and a vaginal birth is recommended, as this is usually the safest option and often allows for a quicker physical recovery. We understand that this may feel very difficult to think about. If you would like to discuss the induction process, a caesarean birth, or the other options, your doctor is here to explain the benefits and risks and help you make an informed decision.

Starting labour

Labour is usually started using a medication called Mifepristone, which helps prepare the womb for labour.

This medication is normally given while you are at the hospital. As it can take some time to work, many parents decide to return home afterwards and come back to hospital 36–48 hours later for the next stage of the induction process.

We recognise that the thought of going home may feel upsetting or impossible for some parents. If you would prefer to stay in hospital, we will do our best to accommodate you and support you in the most appropriate setting.

You may also decide that you would like more time before beginning this process. If so, we will discuss this with you and explain any implications for your care.

Before receiving Mifepristone, we will ask some questions about your health to ensure it is safe for you. We will also ask you to remain in hospital for a short period afterwards. If, after returning home, you experience pain, bleeding, or have any concerns at all, please contact the Delivery Suite using the numbers provided. We would always rather hear from you than have you worry at home.

Returning to Hospital

When you return to hospital, nothing will happen without your knowledge and consent.

You will be introduced to a named midwife who will care for you during their shift and support you throughout your labour and birth. Some routine blood tests may be needed, and you may be offered a cannula (a small plastic tube placed in a vein) so that medications can be given if required.

If labour has not already begun, the induction process is usually continued using a medication called Misoprostol, which encourages the womb to contract and labour to begin. The way this medication is given will depend on your stage of pregnancy and your individual medical circumstances. Your midwife and doctor will explain everything sensitively and answer any questions you may have.

Induction of labour can sometimes take longer than parents expect. Some babies are born within a few hours, while for others labour may take one or two days. Waiting can be emotionally exhausting and distressing.

Your midwife will keep you informed throughout and support you during this time.

During labour, you may decide whichever birth position feels most comfortable for you. Your midwife will support your preferences wherever possible and guide you through your baby’s birth with compassion, sensitivity and care.

After your baby is born, and with your consent, you will usually be offered an injection to help deliver the placenta and reduce the risk of heavy bleeding. Your midwife will explain everything that is happening and answer any questions you may have.

You or your birth partner may wish to cut your baby’s umbilical cord. Some families find this to be a meaningful part of their baby’s birth, while others prefer not to. There is no expectation either way, and we will support whatever feels right for you.

Pain relief options

Labour can be physically demanding as well as emotionally overwhelming. We will do everything we can to ensure you are as comfortable as possible and that you feel supported throughout your labour and birth.

Some parents find that simple comfort measures help during the early stages of labour. These may include relaxation and breathing techniques, massage, changing position regularly, using a TENS machine (if you have one), taking a shower, or spending time in a bath.

If you need additional pain relief, a range of options are available. Your midwife will discuss these with you and help you decide what feels right for you.

These may include:

• Paracetamol or Codeine – tablet pain relief that may help in the early stages of labour.
• Entonox (Gas and Air) – breathed through a mouthpiece and can help take the edge off contractions.
• Diamorphine – given as an injection or through a drip. This can help reduce pain and may help you feel more relaxed.
• Epidural – a local anaesthetic administered by an anaesthetist into your lower back. This provides very effective pain relief and may remove most or all sensation of labour pain.
• Patient Controlled Analgesia (PCA) – a method of pain management that allows you to self-administer doses of pain medication when you need it, intravenously (IV).

Whatever your decisions, we will support you throughout and regularly review your comfort and wellbeing.

Meeting and spending time with your baby

Many parents tell us that deciding whether to see, hold or spend time with their baby feels overwhelming. This is a deeply personal decision, and there is no right or wrong decision.

Some parents wish to see and hold their baby straight away. Others prefer to wait, and some decide not to spend time with their baby at all. Whatever you decide, your decisions will be respected and supported.

If you are unsure, your midwife can talk through the options with you and help you make the decision that feels right for you. If you would like, they can describe your baby to you first, or show you a photograph before you decide whether you would like to see or hold them.

It is important to know that you do not have to make a decision immediately. Some parents decide not to see their baby at first and later change their mind. If this happens, please let your midwife know. We will do everything we can to support your wishes.

Partners and family members may also make different decisions about spending time with the baby. One parent may wish to hold their baby, while the other may not feel ready. Each person’s relationship with their baby and experience of grief is unique, and no one should feel pressured to make a particular decision.

Many parents who spend time with their baby describe these moments as precious and important memories. Others feel differently. Whatever feels right for you and your family is the right decision.

What to expect when your baby is born

Knowing that your baby has died before birth will not necessarily prepare you for the silence that follows once they are born. The silence can be “loud” and this can be very distressing.

Once your baby is born and your physical condition is stable, you can begin to think about the decisions you want to make. For example, you can think about whether you want to see and hold your baby and to have photographs taken. You may also want to create other memories such as hand and foot prints, or save a lock of your baby’s hair. You might have already started thinking about these decisions in the time before you gave birth.

What your baby may look like

Depending on when your baby died and how much time has passed before birth, there may be changes to your baby’s appearance.

Some babies look very much as parents expect. Others may have fragile skin, changes in colour, bruising, peeling skin or swelling. These changes happen naturally after death and are not caused by anything you have done.

If your labour is prolonged, these changes may become more noticeable over time.

Your baby will feel cold when you hold them, which can be difficult for many parents.

Some families have shared that they have found comfort in choosing to:

• Dress their baby in special clothing
• Wrap them in blankets
• Place a hat on their baby’s head
• Use a dummy, which some parents find helps disguise changes in lip colour
• Bathe or care for their baby
• Read stories, sing songs or spend quiet time together

These small acts of parenting can feel meaningful and may help you create memories with your baby in a way that feels right for you. Every family’s experience is unique, and there is no right or wrong decision. We will support you in whatever decisions feel most comfortable and meaningful for you.

Cuddle Cots

You may hear staff talk about a “Cuddle Cot”.

A Cuddle Cot is a special cooling mattress that is placed inside a Moses basket or crib. It helps keep your baby cool and slows the natural changes that happen after death.

Using a Cuddle Cot can allow you to spend more time with your baby in hospital and at home, if you wish to take your baby home.

Naming your baby

Many parents decide to give their baby a name. For some families, this can help acknowledge their baby’s place within the family and make it easier to talk about them with others. If you have named your baby and would like staff to refer to your baby by their name, just let your midwife know the name you have chosen.

For other parents, naming their baby does not feel right. Both decisions are equally valid.

Depending on your baby’s gestation and circumstances, it may not always be possible to determine whether your baby was a boy or a girl. In these situations, some families decide a gender-neutral name.

Memory making

You will be offered opportunities to create memories and keepsakes with your baby.

Many parents treasure these memories in the months and years that follow, but it is entirely your decision whether you wish to participate.

Examples may include:

• Photographs
• Handprints and footprints
• Hand and foot casts
• Naming certificates
• Locks of hair (when possible)
• Special clothing or blankets
• Memory boxes

You may wish to bring clothing, blankets or special items from home. If you do not have these items, please do not worry. We have clothing, blankets and memory-making resources available.

If there is something meaningful you would like to do for your baby, please tell your midwife. We will do our best to support your wishes.

Photographs

Photographs can be an important part of creating memories, although deciding whether to have photographs taken can feel difficult.

The midwife caring for you will usually offer to take photos of your baby. You can also take your own photos. If you are unsure whether you would like photographs, they can still be taken and a memory card can be provided to you if you decide. Some parents find comfort in having this option available in the future.

You could also have photos taken and ask that these are put in a sealed envelope for you to take home to open if and when you feel ready. Although it may feel uncomfortable, you may like to take photographs of just your baby or of all of you as a family. Some parents like to have photographs of their baby’s hands or feet. If your baby was a twin or a multiple and their siblings are alive, you might like to take pictures of them together. It is important that what you decide to do feels right for you.

Memorial books and services

The hospital holds an annual memorial service to remember babies and children who have died. Families are welcome to attend if they feel this would be meaningful for them.

Further information can be obtained from the Chaplaincy Team or Leeds Teaching Hospitals Website.

Taking your baby home

Some parents choose to take their baby home for a period of time. Unless there are legal restrictions, such as a Coroner’s investigation. Alternatively, you can choose to take your baby to spend some time with them at a hospice. Hospice support may be available and the following services support Leeds families:

• Martin House Hospice
• Forget Me Not Hospice

If this is something you are considering, your midwife will explain the practical arrangements and support you through the process.

If a post-mortem examination has been requested, the timing of when your baby can be taken home will be discussed with you.

Caring for your baby at home

If you decide to take your baby home, your maternity bereavement team will explain how to care for your baby safely and respectfully.

To help preserve your baby’s appearance:

• Rest them away from direct sunlight.
• Rest them away from radiators and heat sources.
• Use cooling equipment if provided such as a ‘cuddle cot’
• Handle them gently as their skin may become increasingly delicate.

You may notice natural changes in your baby’s appearance over time- even when cooling measures are used. Your bereavement team will explain what changes you may notice and who to contact if you have concerns.

Seeing your baby again

After you leave hospital, your baby will be cared for respectfully within the hospital mortuary.

If you would like to spend more time with your baby after going home, visits can be arranged through the Chapel of Rest. If you would like to arrange this, please speak to your delivery suite midwife, who would be happy to do this on your behalf or alternatively you can contact the teams directly within normal working hours (8am-4pm Monday-Friday):

LGI Mortuary 0113 392 3313 or

SJUH Mortuary 0113 206 4312

Many parents find comfort in knowing this option remains available, even if they do not wish to make arrangements immediately.

Your baby will be cared for with dignity, respect and compassion at all times.

Lactation decisions

Following the birth of your baby, your body may begin producing breast milk. This can be a painful and unexpected reminder of your loss.

Your midwife will discuss the options available and support whichever decision feels right for you.

You may decide:

• To allow your milk supply to reduce naturally.
• To take a medication called Cabergoline, which helps stop milk production.
• To explore the possibility of donating your breast milk.

Natural suppression

Milk production varies from person to person. If you decide not to suppress lactation with medication, your milk supply will usually reduce naturally over several days.

You may experience breast fullness or discomfort, particularly two to five days after birth.

The following may help:

• Taking regular pain relief such as paracetamol or ibuprofen.
• Wearing a supportive bra.
• Applying cold compresses or gel packs.

Cabergoline

Cabergoline is a medication that can help prevent or reduce milk production and is most effective when taken within the first 12 hours after birth.

The medical team will discuss whether this medication is suitable for you and answer any questions you may have.

Milk donation

Some parents decide to continue expressing breast milk and donate it to help premature or sick babies. Others may find meaning in donating milk for research purposes.

If this is something you would like to explore, your midwife can provide further information and support . Remember, this decision is purely about what feels right for you and your family.

Post-mortem, investigations and review of care

Understanding why your baby died

Many parents want to understand what happened to their baby and why their baby died. This might include the medical circumstances, possible causes and what is known about the death. For some, this information can help answer questions and support future pregnancy planning.

Because many baby deaths are unexpected, it may not immediately be known what caused your baby to die. We will offer investigations that may help provide more information. These may include tests for you, examination of the placenta, and, if you decide, a post-mortem examination for your baby.

We will offer investigations that may help provide more information. The tests we will do fall into two main groups, investigations for you and investigations for your baby.

Sometimes a cause is identified. Sometimes, despite extensive investigations, no clear explanation is found.

Whatever the outcome, we will discuss the results with you sensitively and answer any questions you may have.

Investigations for you

We will ask your permission to take some routine blood tests when you are admitted to hospital for delivery. The tests required will be decided on an individual basis following a discussion with a doctor.

Placental examination

Important information can often be gained by a detailed examination of your baby’s placenta. We will seek your permission to examine the placenta in detail in the laboratory to look specifically for infection and evidence of impaired blood supply. We will also take a swab from both sides of the placenta to look for any evidence of infection.

Post-mortem examination of your baby

All parents are offered the opportunity to consider a post-mortem examination for their baby. There are different types of post-mortem available to you. All post-mortems for babies are carried out at St James’s hospital by specialist paediatric Pathologists. You will be provided with an information leaflet about your options for post-mortem and it will be discussed with you in more detail during your stay in maternity services.

Reviews and investigations of care

Following the death of a baby before or shortly after birth (from 22 weeks of pregnancy onwards), a review of care is routinely carried out using the Perinatal Mortality Review Tool (PMRT). This is part of standard NHS care and is a review of the care you and your baby received- looking back at the care provided by healthcare professionals- what was done, whether the care was appropriate, whether anything could have been done differently and whether there is any learning for future care. More information regarding PMRT is available here:
www.npeu.ox.ac.uk/pmrt/information-for-bereaved-parents

Before you leave hospital, a member of staff will explain the review process and answer any questions you may have. Your thoughts, questions and concerns are important, and you will be given the opportunity to contribute to the review if you wish.

Your bereavement midwife will support you throughout this process and act as a link between you and the review team. Once you have returned home, they can help you share any questions, concerns or feedback about your or your baby’s care. You can contribute in the way that feels most comfortable for you, whether in person, by telephone, online or by email.

A multidisciplinary team of healthcare professionals will review your baby’s care and consider any questions or concerns you have raised. Where appropriate, the findings of the review will be shared with you and discussed further at your follow-up appointment.

Independent reviews

In some circumstances, your baby’s death may also be reviewed by the Maternity and Newborn Safety Investigations (MNSI) programme, an organisation independent of the NHS. This usually applies when a full-term baby who was alive at the start of labour dies during labour or shortly after birth.

If an MNSI investigation is offered, your consent will be required. As with the hospital review, you will have the opportunity to ask questions, share concerns and be involved in the process if you wish.

Information I need before leaving hospital

When your baby has died, there can be a lot of information to take in at a time when you may be feeling overwhelmed, shocked or exhausted. You may not be able to remember everything that is discussed with you.

This checklist is here to help you, and your family, think about the information and support you may need before you leave hospital. You do not have to make every decision before you go home. Please ask a member of staff if you would like something explained again, written down, or if you would like more time to think.

Key contact numbers

St James’s University Hospital (SJUH) – 0113 206 9103

Leeds General Infirmary (LGI) – 0113 392 7445

Bereavement Services – SJUH,
Monday – Friday, 8:30am – 4:30pm – 0113 206 6432 / 0113 206 4162

Bereavement Services – LGI,
Monday – Friday, 8:30am – 4:30pm – 0113 392 3560 / 0113 392 2674

LGI Mortuary – 0113 392 3313

SJUH Mortuary – 0113 206 4312

Funeral arrangements and faith and cultural support

Making decisions about what happens after your baby’s death can feel overwhelming. Many parents tell us they never imagined having to think about funeral arrangements for their baby, and it is completely understandable if this feels difficult to consider.

There is no need to make decisions immediately. We encourage you to take the time you need, ask questions, and talk through your options with the bereavement team, who are here to support you.

Whatever decisions you make, they will be respected, and we will support you throughout the process.

Hospital-arranged funerals

Some parents decide for the hospital to arrange a funeral on their behalf. This may include a burial or cremation, depending on local arrangements and your wishes.

Parents who decide a hospital-arranged funeral can usually decide whether they would like to attend the service. Some families find comfort in attending, while others prefer not to. There is no right or wrong decision.

Your maternity bereavement team, along with our bereavement services department, will explain the arrangements available, what is included, and any decisions that need to be made.

Arranging your own funeral

You may prefer to make your own arrangements through a funeral director of your decision.

Some parents find comfort in planning a personalised service that reflects their baby’s place within their family. Others may wish for a simple ceremony or gathering.

A funeral director can help guide you through the practical arrangements and discuss the options available. If you would like support finding a funeral director or understanding the decisions available, please speak to a member of the maternity bereavement team.

Burial

Burial provides a special place where some families decide to visit, remember and feel close to their baby.

You may decide burial in a cemetery, burial ground or another location where this is permitted. Some families decide a shared baby burial area, while others prefer an individual grave.

If burial is something you are considering, your bereavement team or funeral director can explain the options available in your local area and answer any questions you may have.

Cremation

Some families decide cremation for their baby.

You may be able to decide whether you would like any ashes that are recovered to be returned to you, scattered in a dedicated remembrance garden, or cared for according to your wishes.

For very small babies, there may be little or no ashes available following cremation. If this applies, the crematorium or bereavement team will discuss this with you sensitively before any arrangements are made.

You will be given information about the options available and supported to make the decisions that feel right for your family.

Faith, spiritual and cultural practices

Many families have religious, spiritual or cultural beliefs that are important following the death of a baby.

You may wish for your baby to receive a blessing, naming ceremony, baptism, prayer, washing ritual, burial within a particular timeframe, or other important customs and traditions.

Different faiths and cultures have specific practices following the death of a baby. If this is important to you and your family, please let us know as soon as possible so that we can support your wishes and, where appropriate, arrange contact with a faith leader, chaplain, community representative or spiritual advisor.

Support is available for families of all faiths and for those who do not follow a particular religion.

Personal items and keepsakes

Many parents find comfort in placing special items with their baby.

Depending on whether you decide burial or cremation, it may be possible to include items such as letters, cards, photographs, blankets, toys, religious symbols or other meaningful keepsakes.

Your funeral director or bereavement services department will advise you about which items can be included and discuss any restrictions that may apply.

Financial considerations

Many parents worry about the cost of funeral arrangements at an already difficult time.

Leeds City Council does not charge for the burial or cremation of babies and children under 17 years of age, whether arrangements are made through the hospital or independently.

However, there may be additional costs if you decide certain options, such as flowers, memorials, orders of service, transport or particular funeral director services.

If you have concerns about costs, please speak to your bereavement midwife or bereavement services department. We can explain what support may be available and help you understand any potential expenses before decisions are made.

Registration and certificates

If your baby died before 24 weeks of pregnancy, the loss cannot be legally registered as a stillbirth. However, in England, you can apply for a free Baby Loss Certificate through the government scheme to formally recognise your loss. You may also be able to request a commemorative certificate from a bereavement charity.

If your baby was stillborn at 24 weeks of pregnancy or later, or was born alive and died after birth, their stillbirth, birth and/or death must be legally registered. The maternity bereavement team will explain the process and provide the information you need.

Further support

If you are unsure about any aspect of funeral arrangements, please speak to your bereavement midwife or the Bereavement Services Office. No question is too small, and we are here to help guide and support you through each step at a pace that feels right for you and your family.

Bereavement services office contact details:

St James’s University Hospital: 0113 206 6432 / 0113 206 4162

Leeds General Infirmary: 0113 392 3560 / 0113 392 2674

(Monday to Friday, 8:30am–4:30pm)

Looking after yourself and your family

Physical recovery

Pregnancy and birth makes many changes to your body and it may take weeks or months to physically feel the way you did prepregnancy. Your midwife will ask you about your wellbeing at each contact. Below is a list of common conditions and what you can do to relieve the symptoms and when you need to seek help from a GP or midwife.

Care of stitches and the perineum

What to expect

You may experience discomfort or stinging especially in the first few days after giving birth, even if you do not have stitches.

What you can do

• Wash your hands before and after going to the toilet and change sanitary pads regularly.
• Daily bathing or showering to keep the perineum clean,
• Cold treatments, such as crushed ice or gel pads.
• Pain relief such as paracetamol.

When to seek help

• Pain or discomfort is worsening.
• Signs of infection (feeling unwell, offensive smelling).
• Pain during intercourse.

Headache

What to expect

You may experience mild headaches that are relieved with pain relief or rest.

What you can do

• Pain relief such as paracetamol.
• Rest, hydration and relaxation

When to seek help

• Headache that worses when sitting or standing.
• Headache that is accompanied by visual disturbances.

Backache

What to expect

This could be due to due to hormones, posture or labour.

What you can do

• Make sure you have good posture and support your back when sitting.
• Be careful how you lift objects.

When to seek help

• If worsens and not relieved with simple pain relief.
• Other symptoms such as numbness or unusual sensation in your legs.

Constipation

What to expect

It may take a few days after birth before you have opened your bowels.

Certain medications can cause constipation or loose stools.

What you can do

• Drink plenty of fluids. Eat fruit, vegetables and fibre.
• Gentle laxatives may be recommended (speak with your midwife)

When to seek help

• If you have not opened your bowels for longer than three days or experiencing incontinence (no control over your bowels).

Piles (Haemorrhoids)

What to expect

These are small lumps that can protrude outside your bottom around your anus, They may feel painful and/or itchy.

What you can do

• Drink plenty of water and eat a fibre rich diet to keep your stools soft and regular.
• Simple pain relief such as paracetamol may help, alongside a warm bath to ease itching and pain.
• Your pharmacist may recommend creams.

When to seek help

• If you are experiencing severe, swollen or prolapsed haemorrhoids or rectal bleeding.

After a Caesarean Birth

What to expect

If you have had a Caesarean birth the outside skin edges of your wound should heal after about three days but the internal healing of muscle and other tissue below the surface go on for many months.

It is normal to experience some discomfort that should gradually ease.

What you can do

• Take regular pain relief medication.
• Follow your midwife’s instructions around looking after your wound dressing and keeping the wound clean.
• Do not rub soap, shower gels, or talc directly onto the wound.
• Pat the wound dry with a clean towel.
• Wear loose-fitting clothes to prevent rubbing.

When to seek help

• You have more pain in the wound which is not relieved with pain relief medication.
• The wound is red, swollen or hot.
• Your wound has green or yellow weeping discharge.
• You have unpleasant/ offensive smelling vaginal discharge.
• You feel hot or have a high temperature.

Fatigue

What to expect

It is natural to feel more tired than usual as your body is recovering from pregnancy and birth.

What you can do

• Eat a health balanced diet.
• Return to gentle exercise when you feel ready.
• Take time to rest and relax.
• Ask friends or relatives to help.

When to seek help

• If you have other symptoms too such as feeling dizzy and/or headaches).
• Feeling low in mood and experiencing trouble sleeping.

Passing urine

What to expect

You may be afraid to pass urine after birth especially if you have stitches in case it may sting.

It is important that you do not stop yourself from passing urine.

What you can do

• Passing urine in the shower in the early days after birth.
• Drink plenty of water.
• Start your pelvic floor exercises.

When to seek help

• You have no control or are leaking urine.
• You are finding it difficult to pass urine or empty your bladder.

Important symptoms to recognise in yourself

• Stomach pain or unpleasant vaginal discharge
• A high temperature (above 38°C) or a low body temperature (less than 35°C), chills and shivering, a fast heartbeat, problems or changes to your breathing
• A headache and changes in vision, nausea or vomiting
• Pain, swelling or redness in the calf muscle of one leg
• Feeling or acting differently from normal- you do not seem your normal self

Pelvic floor health

What is the pelvic floor?

• The pelvic floor consists of layers of muscles that stretch like a supportive hammock from the pubic bone (at the front) to the tailbone (coccyx) at the back.

Why is it important to train the pelvic floor muscles?

• Pelvic floor muscles help to support your bladder, bowel and vaginal function.
• There is high quality evidence that it is important to take care of your pelvic floor muscles in pregnancy.
• If your pelvic floor muscles are weak, you may find that you leak urine when you cough, sneeze or strain.

Illustration showing where the pelvic floor muscles are

Pelvic floor muscle training

Easy steps for pelvic floor muscle training:

• Find the right muscles: To locate your pelvic floor muscles, engage your back passage imagining you are stopping yourself breaking wind, followed by engaging your front passage as if you are stopping yourself passing urine. You should feel a lift and tightening sensation in your vaginal region.
• Practice the squeeze: Tighten your pelvic floor muscles for up to 10 seconds, then relax for the same amount of time.
• Repeat: Aim to complete these long squeezes 10 times, followed by 10 quick one second hold repetitions. You can do this while sitting, standing, or lying down.
• Focus: Make sure to only tighten your pelvic floor muscles, not your stomach, thighs, or buttocks. Breathe normally during the exercises.

Visual guide

The NHS Squeezy App can show you how to do these exercises.

Click the link for more info!

https://squeezyapp.com

Emotional wellbeing

You do not have to face this alone. Everyone experiences grief differently. For some, expressions of grief will be overwhelming and public. For others it may be very private, but no less deeply felt. Feelings of shock, grief, depression, guilt, loss and anger are common. Grief may produce physical symptoms, as well as emotional ones, such as disturbed sleep, lack of appetite and nausea. These are normal and may be eased by discussing them with your partner, friends, with a doctor or midwife, or with someone who can listen and understand. There is no time limit to the grieving process.

Many parents find comfort in speaking with others who have experienced the death of a baby, or in accessing specialist bereavement support.

A range of organisations, charities and support groups are available to support you, your partner, your children and your wider family and are detailed at the end of this page. Your bereavement team can help you find services that meet your individual needs and preferences.

Dads and partners

More information is available on the DadPad app that can be downloaded for free from Google Play or Apple App Store. The Tommy’s website also has lots of information for fathers and partners and can be accessed at:

www.tommys.org/baby-loss-support/ dads-and-partners

Support and information for same sex couples can be found at Legacy of Leo thelegacyofleo.com/lgbt-baby-loss/

Support and advice can be sought from many bereavement sources, both online and via local groups. SANDS, 4Louis and JOEL all offer online forums where you can make contact with other bereaved families.

Sands United Football Club are a group of men that have experienced baby loss (whether they be fathers, grandfathers, brothers or uncles who have experienced loss through either miscarriage, stillbirth, neonatal death or termination for medical reasons). They have a Facebook page that can be accessed by searching Sands Utd South Yorkshire

Supporting children

Explaining the death of a baby to children can be incredibly difficult.

Children often benefit from simple, honest explanations that are appropriate to their age and level of understanding.

Using clear language can help avoid confusion. It is usually best to avoid phrases such as “the baby has gone to sleep” or “we lost the baby”, as children may interpret these literally.

Children may not fully understand what has happened, but they often sense that something is wrong. Reassuring them and answering their questions honestly can help them feel safe and supported.

Returning to work

Returning to work can bring up a range of different emotions- there is no set timeline for grief.

Some people feel ready to return to work after a few weeks, while others need much longer. Grief can affect concentration, memory, energy levels and emotional wellbeing for many months.

Returning to work is often a gradual process, and you may find it helpful to speak with your employer beforehand about any support you may need.

Follow-up care

You will usually be offered a follow-up appointment with a consultant several months after your baby’s birth . The hospital will arrange this with you directly.

This appointment provides an opportunity to:

• Discuss investigation results.
• Ask questions.
• Talk about your physical recovery.
• Discuss future pregnancies if and when you feel ready.

Many parents find it helpful to write down questions beforehand or bring someone with them for support

Support groups and information for bereaved parents

There are a number of organisations which understand and can support you and your family who find themselves trying to cope after such a devastating event. We have listed several for you, but this is not an exhaustive list, there may be other support groups more relevant to your individual needs.

If you cannot find the support you are looking for please contact your Bereavement midwife team who may be able to help you further.

Other useful information

For any further support, help or advice please contact:

Useful contact numbers:

Your feedback

Your views are very important to us and we welcome your thoughts and feelings regarding your care.

Maternity Bereavement Experience Measure (MBEM) Feedback

We have previously worked with other bereaved parents to develop a questionnaire called the Maternity Bereavement Experience Measure (MBEM). This questionnaire will be sent to you via post or email and your answers will remain anonymous unless you with to waive anonymity. You can opt-out of receiving the questionnaire if you wish, please just let your healthcare team know.

https://docs.google.com/forms/d/e/1FAIpQLSezAZN-WHq-sQuYWn0GRxr15o1WySYHVLpz-PV1SL2cng1KGg/viewform?pli=1

We appreciate how difficult it may be to provide us with feedback. Feedback is optional and there is no timescale in which you need to do this. We will use your answers and comments to continually improve care for other bereaved parents.

PALS service

If you would like to raise a concern or complaint about your maternity care, please contact the Patient Advice and Liaison Service (PALS) team:

Email: [email protected]

Telephone: 0113 206 6261

Textphone: 07468 753 025 (if you are D/deaf or speech impaired)

Maternity and Neonatal Voices Partnership Feedback

The Maternity and Neonatal Voices Partnership listens to the experiences of Leeds service users, and ensures their voices are heard by LTHT staff, to shape services for the better.

You can share any feedback about your experience with us, whether by email, phone call or in person.

Please do get in touch – nothing you have to share is too small.

Instagram: @leedsmnvp_chair

Email: [email protected]