Socialization for Toddlers

Learning social skills is certainly very important for young children. The more experience they have interacting with peers, the more they learn about how to get along with others, and the richer their world becomes as they develop new relationships.

Interactions with other children can happen in many different ways. It is not necessary to send a child to child care solely to provide peer experiences.  Other options are: joining parent-child classes, meeting other families with young children in your neighborhood and inviting them over to play, or going to the playground and other places where you would find families with young children.

Developing social skills is a process that takes time and experience. For example, learning to take turns and share are skills that evolve over several years, as children practice over and over how to handle these challenging situations. It is very helpful to young children when parents and caregivers coach them in this process, act as good role models for self-control and other social skills, and keep their expectations for children in line with their developmental age and stage.   

Childcare tips for working parents!!!!!!!

As part of our commitment to our young parents, Get Ahead presents a guide to childcare for working couples. This is the first in an ongoing series.

You are a working couple. You decided to work perhaps because you need to work or because you want to work.

Your motive is simple: you want the best for your child.

Slowly, your ambitions, work pressures and circumstances prevail.

This affects your family life in little ways -- you have no time for your child, no time to cook, no time for your husband.

But here is something you must know: your child's real needs will not be fulfilled by money alone.

Spend time with your child. Watch him/her grow. Be an active part of that growing process!

• Are you spending enough time with your child?

Get started!

The first question you both must ask is: do both of us really, really need to work? Are we putting our personal priorities ahead of our children?

If not, decide on the following: 

i. Who among the two should work. Traditionally, it would be the male. But, of course, it depends on both of you. 

ii. Check if one of you can get a part-time job.

iii. Try and get a job that can be managed from home.

iv. Can you go on long leave from your present job? You need to check about that.

If both of you decide to work, here are certain measures you will need to take:

• Alternate childcare
• Preparing your child psychologically to accept your absence and to be self-dependent 
• Spending quality time with children whenever possible.

Note: Compensating with gifts and overindulgence on weekends will not help.

Making your child believe this is the way life is. It will make things easier for all of you.

• Has your child drunk milk today?

Alternate childcare

~ When grandparents are at home

Having grandparent/s at home with the help of a maid may be the best solution for your child.

Children tend to feel safer and more secure in their own homes. They find it easier to move along and their psychological needs are satisfied since they are the centre of attention.

i. Keep a part-time maid to take care of the physical tasks. They are too taxing for your elderly parents.

ii. Make charts of rules/ schedules/ medicine timings (if applicable), so that nobody forgets things.

iii. Keep a list of emergency telephone numbers, in bold, near the phone. Also keep a list of first-aid instructions, if your child is small.

iv. Make sure your home is child safe -- close all balconies; no sharp tools and dangerous liquids/ tablets, or small objects like marbles lying around; ensure your door has a safety lock.

v. Keep healthy snacks, good food, activity materials, daily stationery, clean and neat clothes available and within reach. This way, your child will find it easier to do things independently.

vi. If things go wrong once in a while, do not blame or criticise your parent/s. Work out a solution to avoid it in future

vii. Work out a positive relationship by ignoring certain things, especially if the carer is your mother-in-law.

viii. Avoid asking your child or the maid what went wrong during the day in your absence and who was responsible for them. It does not help things, and has an adverse effect in the long run.

ix. Use smart methods to judge and correct the situation.

x. As far as possible, give advance notice of your changed schedules, travel plans or latecoming. Unpredictable acts may harm your child's psyche.

• Too much television can make your child a bully!

~ Crèche or babysitter care

i. Select the right place, even if it is at a distance away from your home/ workplace.

The crèche next door, though convenient, may not be really suitable for your darling child.

ii. Select a person or crèche with a reputation; consider others' experiences with them.

iii. Study the carer's body language and viewpoints on various matters. Ascertain whether they will handle your child with care or not.

iv. Check whether the place is child-friendly, clean and maintains general hygiene.

v. Check whether child safety measures of all kinds are in place.

If the carer is simple, kind and loving, but unaware of child safety, please educate the carer.

Encourage and make her do the necessary modifications in the house and demonstrate certain measures.

vi. Make random checks to ensure your child is engaged in meaningful activity and is eating food properly

vii. Make sure that they are not sent out for a shopping trip or elsewhere through the day.

viii. Make sure you give a schedule to follow -- rest/ reading/ study/ play time.

ix. If your child has to attend hobby or study classes, make proper arrangements. Do not deprive your children from attending such classes because they are at the babysitter's.

x. Get to know parents of the other children who are attending. You can build a positive group together and children will feel more comfortable with each other.

xi. Keep a watchful eye. Demand for supervision of the right kind. Teach you child to take care of himself/ herself and to keep a safe distance from others.

Aaruna Jain has 22 years of experience in counselling. She holds an MA in Family and Child Welfare from the Tata Tata Institute of Social Sciences, Mumbai. She now consults as a counsellor at the Indian School, Muscat.

Decision-making during labour

Giving birth is exciting, but not always straightforward. Your partner needs you there to help if decisions have to be made. Read on for some tips on how to make the right ones.

Will we be able to stick to our birth plan?

Labour and birth often don't go as expected. Try not to worry if you can't follow your birth plan exactly.

Perhaps the birth pool your partner has set her heart on is in use. Or maybe she ends up having an epidural when she thought she could manage with gas and air. Ultimately, what counts is that she and the new baby are happy and healthy.

Sometimes complications do arise and your medical team will have suggestions about how to proceed. It can be difficult to keep a level head when the pressure is on, especially when the wellbeing of your partner and baby are at stake.

Some people worry about being assertive or involving themselves in decision making. It's fine to make your views known, and helpful for your medical team.

Different healthcare professionals have different approaches. You and your partner have knowledge that they lack. After all, you know your partner best, and she knows better than anyone how she feels!

Usually, everyone wants the same result, but may have different ways of getting there. There are rarely absolute rights and wrongs.

What say do I have if there is an emergency?

When making a decision it is important that you have been given the information you need. You'll need time to take in the information and be sure that you understand it. Your medical team should involve and support you in making decisions, but sometimes it seems as if there is no time for discussion.

In this situation it can be helpful to ask: "Is this an emergency or do we have time to talk?" Another way to find out if the situation is urgent is to ask: "Is my partner OK? Is the baby OK?"

This will help you find out if the concerns are directly about your partner and baby or about something else, such as hospital policy or guidelines.

Decision making should be a team effort, although you and your partner have the final say. If this feels like a lot of responsibility, do tell your medical team. It is fine to acknowledge that you are upset or frightened. Being honest will help them support you and your partner.

How do I get the information I need?

There is a simple, easy-to-remember tool to help you make sound, informed decisions in even the most complicated situations. It is called Brain, which stands for:

• benefits
• risks
• alternatives
• instinct
• nothing

Following the five Brain steps will help you get the right information, weigh up the pros and cons, and, finally, lead you to a decision you can be satisfied with.

Benefits: what are the benefits of this procedure?

First, make sure you understand what your medical team is proposing and why. Perhaps your partner is a week overdue and they are considering artificially starting labour?

Your midwife should explain that inducing labour reduces the tiny but slightly increased risk that you may lose your baby as the days tick by. Your partner may also be fed up with pregnancy and welcome the chance to get on with having her baby.

Risks: what are the risks of this procedure?

Most medical procedures have risks as well as benefits and you need to know what they are. For example, some methods of inducing labour (such as a membrane sweep) are uncomfortable. Other methods, such as using synthetic hormones, may make contractions more severe and painful.

There is also no guarantee these methods will work first time. They may have to be repeated. Also, despite being induced, your partner may still give birth to your baby by caesarean section.

You may also need to weigh up the pros and cons of an assisted birth. If your partner is becoming exhausted, your medical team may suggest using instruments such as forceps or ventouse to help your baby be born.

Both increase the likelihood of your partner suffering soreness and bruising afterwards. Your baby too may also have slight bruising on his face. However, bruises fade and serious injury to babies from forceps or ventouse is rare.

Alternatives: is there a choice of obstetric procedures?

Like everyone, midwives have their favourite ways of doing things, but these are rarely the only ways. If your baby is overdue, ask about the various methods of inducing labour, from a membrane sweep to synthetic hormones.

You may want to try an old-fashioned spicy curry followed by some gentle sex. But be warned. There's not much evidence of either of these working.

Similarly, when considering a caesarean section your partner may be offered the chance to try an assisted birth with a ventouse and an episiotomy first. If the assisted delivery doesn't work you have the back-up of a caesarean section. Although going through both could leave your partner feeling battered and bruised.

Instinct: what does your instinct tell you?

Pay attention to what your instincts are telling you. After all, you know your partner better than anyone else in the room. If you feel she is, for example, able to cope with the pushing stage for longer, then you should support her if she turns down an assisted birth.

But if you feel she is refusing forceps or ventouse simply because she always imagined having a totally natural birth then you should say so – tactfully!

Nothing: what happens if we do nothing?

Doing nothing can sometimes be justified. For example, if your baby is overdue, you and your partner may decide to wait a few days to see if nature will eventually take its course. The risk to your baby does rise, but only slightly. At 37 weeks of pregnancy, one in 3,000 babies is stillborn. This rises to four in 3,000 at 42 weeks

Doing nothing is rarely an option in a medical emergency. However, it is still worth asking your medical team "what happens if we do nothing?" as the answer may help to clarify your thoughts.

The role of a labour partner

Should I have a labour partner?

There are good reasons why you're encouraged to have a birth partner and why midwives and obstetricians are encouraged to involve them in your labour and birth. You'll need someone to be with you, to empathize with you, and to help and support you during your labour.

Continuous one-to-one support can help you cope better with contractions and have a more satisfying birth experience. The right sort of support can even result in a slightly shorter labour. Labour support is powerful stuff!

What will a birth partner need to do during labour?

There are four main ways in which your birth partner can support you:

Emotional support

This could mean just being there for you, or praising, reassuring or encouraging you. Just holding you and keeping eye contact with you can be hugely comforting. This kind of emotional support can help reduce your anxiety and the level of pain that you feel.

Physical support

Breathing, relaxation techniques and massage have all been shown to help women cope with the pain of labour, and your partner can help you with these.

Physical support can also mean putting the TENS machine on you or helping you into comfortable positions that can help your labour progress. If warmth relaxes you, your partner could heat up a hot water bottle, or help you to use a birth pool, bath or shower. Or you may feel hot and like to have a cool cloth on your forehead. Making sure you have enough to drink during labour and reminding you to go to the toilet regularly are other important jobs.

Information

This could be explaining to you what's happening or suggesting something you learned at prenatal classes. He can remind you to keep moving around or that transition means you're nearly there!

Advocacy

This could mean asking for help when you need it or speaking up for you. This is particularly important in strong labour when your concentration is taken by the power of the contractions and you may be unable to speak for yourself.

Your partner may be the one to inform you if a medical procedure is suggested, such as having your waters broken, or an episiotomy. He can ask for further explanations of what will happen, if you agree to it, so that you can make an informed decision. He may also ask for time for you to think about what's being suggested, unless it's an emergency.

One of the most important things you can both do is keep an open mind, because you won't really know what you want until the day. It's important that you feel comfortable about communicating with your birth partner. You may find yourself being very short and to the point about what you need!

How can my birth partner help me if I have a caesarean?

If you’re having a caesarean section, there are many ways your birth partner can support you:

• Your birth partner can be with you in the operating theatre to talk to you and reassure you. You may be feeling anxious or nervous, so having him there will be a huge source of comfort.



• If you’re having a planned caesarean your birth partner can help you prepare in the run-up to the operation. Knowing what will be involved during and after a caesarean will give both of you confidence.



• If you have an emergency caesarean you may have already gone through hours of labour so you’re likely to be very tired. You may also be worried about the sudden change of plan. You will need emotional support from your birth partner, and he may need to help in practical ways, such as speaking on your behalf to medical staff.
  
  

  How should my birth partner prepare?

  He should understand what happens in a straightforward labour and have some idea of the interventions that may be suggested. This, and rehearsing coping strategies, can give your birth partner confidence and can reduce his anxiety levels (and yours) once labour is under way.
  
  Attending prenatal classes with you is a great way to prepare. So too, is talking through with you what you're hoping for at the birth and what you'd like to happen and not to happen. If you write a birth plan, your birth partner should be aware of its contents and how strongly you feel about different parts of it. He will also need to keep an open mind. Things can change quickly in labour, and he may have to help you make a new decision about some aspect of your care.
  
  On a very practical note, your birth partner will need food and drink during your labour. In hospital, a hot drinks machine will probably be provided on the labour ward, but it may be a long walk to the hospital canteen. It's best to prepare food and drinks to take in with you.
  

  Does my labour partner have to be my baby's father?

  Not necessarily. Since the 1970s, fathers have almost routinely attended births but they don't have to -- if your partner doesn't want to be there, talk it through and decide what's right for both of you. If your partner isn't going to be there, if he may not be able to be there, or if you want someone else there as well, you may want to enlist the services of a close friend, your sister, your mother, or a paid birth companion called a doula. If your labour partner is anyone other than your baby's father, do mention this to your doctor, nurse, or midwife.
  

  What should a birth partner not do?

  Flexibility is essential during labour and birth and it's essential that your partner is as aware of this as you are. It's important for your partner to remember that things can change quickly and that you may have to change your mind or make a new decision about some aspect of your care or treatment. So it's important that your partner doesn't cling to something you may have said before the event, not realizing that your views have now changed. He must be aware that you have the final word; although he might want to help you in making a decision, or in communicating that decision to your care-givers, your views are what count.

  What if my birth partner finds it hard-going on the day?

  Being a labour partner isn't for the faint-hearted: a first labour in particular may be many hours long. Providing emotional and physical support throughout is going to be exhausting, so your partner must look after himself, too. Talk beforehand about how and when he'll be able to take breaks, and make sure he remembers to take food and drink into hospital for himself. If the birth involves medical intervention, your partner may find it difficult to cope and may even feel guilty about what happened -- make sure he, as well as you, talks this through afterwards with the midwife and/or obstetrician.

Tips for labour partners

If you aren't nervous about labour and delivery, you're either in denial or not paying attention. Remember that as difficult as it may be to watch your partner or loved one in pain, most fathers find the birth of their child to be one of life's most powerful and satisfying moments. Of course, it's better if know that you've been a help rather than a hindrance. To help you be the kind of birth partner a labouring woman dreams of, William Wade, a father of one, asked people who've been there to share their feelings.

Ask questions

Doctors, midwives, and nurses don't always explain what they're doing, or whether it's mandatory. When the midwife wanted to put up a drip for Andrew's wife - just in case she needed it later - Andrew, a teacher, firmly turned the offer down. "It helped that I knew what I could ask for," he said, "and what we could refuse."

And make sure to ask for what you want: Since Andrew and his wife had looked around the hospital before the birth, they knew that some of the rooms had good views and they requested one when they registered. "I'll never forget seeing the sunrise over the city the morning my daughter was born," he recalls.

Bring a few things for yourself

The mom-to-be is the centre of attention, but you'll probably be spending the night at the hospital too, so don't forget to pack some things for yourself. A clean T-shirt and comfortable shoes are essential. "We must have walked about three miles through the hospital corridors during her contractions," says Andrew. "The next day, neither of us could figure out why our feet were sore." Though women in labour necessarily lose their modesty, partners don't. So consider bringing your swim suit, if your hospital offers a birth pool. Finally, remember to bring something to eat and drink.

Know what to expect

Many people say they never used the breathing techniques they learned at prenatal classes, but they're very glad they learned what labour and birth entails, from start to finish. Labour is not the right time to be flipping through a pregnancy and birth manual, so bone up on your reading beforehand. And go to an prenatal class with an open mind -- you'll get solid, basic information, as well as a sense of how other labour partners are planning to get through the event.

Be flexible

Labour strategies that work for some women, may not work for your partner. A birth partner's job is to discern what works, and be prepared to drop what doesn't. "Our prenatal teacher stressed the need to keep an open mind and make decisions as we went along," said Jim Ware. "It proved to be very useful in what turned out to be a long labour." Well before your baby's due date, you and your partner should take time to discuss her expectations and options; later you can take the initiative while keeping her wishes in mind.

Find a compelling distraction

Giving birth is a long, hard job. At some point during the hours of labour, you and your partner will discover something -- perhaps a breathing pattern, a spot on the ceiling, a stuffed animal from home -- that she can focus on during the contractions. Your job is to help your partner find this distraction, and then bring her back to it whenever she starts to think she won't make it.

"I ended up rubbing my wife's foot all the way through labour," says Chris Gathard. "She told me to squeeze her foot until it hurt, so she could focus on that pain instead." Other techniques focus on teaching women how to work with the pain by using relaxation techniques.

Be a one-person support team

Though there will be lots of experienced people around you to whom you can look for help, you will be your partner's most important support. How can you keep her comfortable? By doing whatever she needs, from running to the cafeteria for something sweet to getting her another drink or talking things through with your doctor, nurse, or midwife. Chris tried to pay attention to his wife's emotional and physical state. "I was her primary advocate and labour partner," he says.

Know your capabilities

There's a lot going on in the birth room. Be aware of what you are willing to do during the process, and what you want to leave to the professionals. Mathew Reece remembers the midwife asking if he wanted to catch his son when he came out. "I said no, and I'm glad I did," he says. "But I did cut the umbilical cord. That was easy."

Be prepared to take charge of the situation

Only you and your partner know what you both want, but she may not be in the best condition to make hard decisions. Be ready to step in with some decisive action if the situation calls for it.

David Sawyer, a lawyer, remembers that the doctor was going to break the waters during an internal examination. "Jenny was having a contraction and in pain and the doctor said something like, 'I'll just break the waters while I'm here shall I?'. I stepped in and said, 'Lets just wait until we can discuss it with Jenny.' The doctor was a bit suprised, but I knew Jenny didn't want anything done without the chance to discuss it and she wasn't able to talk just then."

Be ready to wait

Unlike what you see in films and on television, most women labour for hours before they even go to the hospital. Indeed, many couples find it more comfortable to spend the initial stages of labour at home. Besides, many maternity units prefer you to come when your contractions are regular and close together.

"We ended up watching a video together at home during early labour," says David. "Not only was it a good way to relax, but it was really very bonding."

Being there

A woman's birth partner is a vital support at a crucial time in her life. Although these days it is often a father who attends, many maternity units welcome whoever the mother has chosen as partner. Many women ask their mother to help them, and some choose close friends.

For all partners, this is one of those events when just showing up is the most important thing of all. Even if you want -- or have -- to leave most of the hands-on stuff to the pros, it will matter that you're there. Some expectant dads say they're worried they won't be up to the task, but most say it's worth being there. "I wanted to be very involved, and I felt honoured to be there," says new father Chris.

How do I know when I am in labour?

How do I know when I am in labour?

Every mom's labour is different, and pinpointing when it begins is not really possible. It's more of a process than a single event, when a number of changes in your body work together to help you give birth.

In early labour, also called the latent phase you may feel the following:

• Persistent lower back or abdominal pain, often accompanied by a crampy premenstrual feeling.
• A bloody show (a brownish or blood-tinged mucus discharge). If you pass the mucus plug that blocks the cervix, labour could be imminent or it could be several days away. It's a sign that things are moving along.
• Painful contractions that occur at regular and increasingly shorter intervals and become longer and stronger in intensity.
• Broken waters, but you're in labour only if it's accompanied by contractions that are dilating your cervix.

How you will feel in early labour depends on whether you've had a baby before, how you perceive and respond to pain, and how prepared you are for what labour may be like.

When should I contact my doctor or midwife?

You, your doctor and midwife have probably talked about what to do when you think you're in labour. But if you think the time has come, don't be embarrassed to call. Doctors and midwives are used to getting calls from women who are uncertain if they're in labour and who need guidance - it's part of their job.
And the truth is that your doctor or midwife can tell a lot by the tone and tenor of your voice, so verbal communication helps. Your provider will want to know how close together your contractions are, whether you can talk through a contraction, and any other symptoms you may have.
If you're planning to have your baby in hospital or a birth centre, she may ask you to come in so that she can make an assessment.

If she thinks you're still in early labour she may encourage you to go home until you're in stronger active labour. Her decision will depend on how you're coping and whether you've got a birth partner to support you.

You should contact your midwife or doctor if:

• your waters break, or if you suspect you're leaking amniotic fluid
• your baby is moving less than usual
• you have vaginal bleeding (unless it's just a small amount of blood-tinged mucus)
• you have fever, severe headaches, changes in your vision, or abdominal pain

See our list of other pregnancy symptoms you shouldn't ignore, in case anything else is worrying you.

What should I do early on in labour?

This will depend on what time of day it is, what you like doing and how you're feeling. Keeping calm and relaxed will help your labour to progress and help you cope with the contractions. Do whatever will help you to stay relaxed.

This could mean watching a favourite film, relaxing, or asking a friend or relative over to keep you company. You could alternate between walking and resting, or try taking a warm bath or shower to ease any aches and pains. If you can, try to get some rest to prepare you for the work ahead.

During early labour, you may feel hungry so eat and drink if you feel like it. This will help to comfort you and help you to rest.

Early labour is a good time to try out different positions and breathing techniques to see if they help you cope with the contractions, now that you're having them for real! If you've rented a TENS machine, early labour is the time to use it.

Can I have contractions and not be in labour?

Yes. When you are in labour your cervix becomes gradually thinner (called effacement) and dilated. Some women are sensitive to the pain of contractions before the cervix has started to dilate. A labour and delivery nurse or a midwife can confirm whether cervical changes have started during an examination.

If your baby is in a posterior position (with his head down but his back to your back) it can take longer for your baby's head to engage and for labour to get started properly. Your contractions may be erratic and low in intensity, and you may have a lot of backache.

Your doctor or midwife will advise you on ways to cope at home until labour becomes stronger. You could try a warm bath or massage to relieve the pain.

Can I tell if labour is about to happen soon?

Maybe. Signs of the approach of labour include:

• Lightening (when the baby's head begins to drop into position in your pelvis). You may notice that you can breathe more deeply and eat more, but you'll also need to pee more frequently.



• Your vaginal discharge becomes heavier and more mucous.



• You'll have more frequent and noticeably more intense Braxton Hicks contractions.



• You may have loose bowels.

The stages of childbirth

No one can tell you what your experience of labour will be like or how long it will last. There's plenty you can do to prepare yourself, though. It helps if you know what to expect. We take you through the stages of labour, from the first hints that things are on the move to the birth of your baby.

What are the stages of labour?

Labour moves forward in three clear stages:

• First stage: when contractions gradually open up the neck of your uterus (cervix). The first stage of labour consists of early labour, active labour and the transitional phase.



• Second stage: when you push your baby out into the world.



• Third stage: when you deliver the placenta.

What happens in the first stage of labour?

During pregnancy your cervix is closed and plugged with mucus, to keep out infection. Your cervix is long from top to bottom and firm, giving a strong base to your uterus (womb).

In the first stage of labour your cervix has to open so that your baby can be born. By the end of this stage your cervix will be fully dilated, or open to about 10cm in diameter.

First, your cervix has to shorten and soften. Feel your nose: it's firm and resists your touch. Now feel your lips: they're soft and stretchy. Your cervix starts out firm like your nose, and has to become soft and stretchy like your lips.

These changes may start in late pregnancy, before labour has begun, particularly if this is your first baby. Days or hours before labour starts your cervix may start to open a little, and the mucus plug may come out. This is called a show. It looks a bit like jelly and can be stained with blood.

If you've had a baby before, a show could be a sign that labour has started.

Early labour?

During early labour, your cervix starts to open and widen. It'll go from being closed to about 3cm or 4cm dilated. You may not notice this starting, as your uterus may be contracting very gently. It may feel like the mild cramps you get with your period, or a dull ache or backache. You may even be several centimetres dilated before you realize you're in labour.

Many women, however, notice that they're getting increasingly painful contractions and that they're coming regularly. These are different to Braxton Hicks contractions, which are irregular and painless.

You'll have your own rhythm and pace of labour. As a rough guide, early contractions are more than five minutes apart and short, perhaps only 30 or 40 seconds long. You'll be able to talk through them and carry on with your normal routine, if you want to.

For some women, early labour starts and stops. For others, it progresses smoothly into active labour.

Active phase of labour

As labour progresses your contractions usually become longer and more frequent. You've moved into the active phase of labour. This is when your cervix opens from 3cm or 4cm to 10cm.

Contractions are more powerful now. A contraction usually starts gradually, building up to a peak of intensity before fading away. You probably won’t be able to talk through these contractions. You may have to stop and breathe through them. Relaxation techniques will help you to keep calm and control your breathing.

Contractions may come as often as every three to four minutes and last 60 to 90 seconds. They'll feel very intense. Between contractions, you'll be able to talk, move around, have a drink or something to eat, and prepare yourself for the next one. Contractions in the active phase open your cervix more rapidly, but it may still be many hours before your cervix is fully dilated.

Transitional phase of labour

The transitional phase happens when you move from the first stage of labour to the second, pushing stage. It often starts when your cervix is about 8cm dilated. It ends when your cervix is fully dilated, or when you get the urge to push.

You may have less frequent, but much stronger and longer lasting contractions. Sometimes they come in a double wave. Each one may peak, start to fade but then increase in intensity again before fading away completely. It's common for your waters to break just before or during transition.

Women feel this stage in different ways. It can be intense and overwhelming. You may feel zoned in to your labour and only able to make abrupt demands. You may shout and feel impatient with everyone. You might feel shaky, shivery and sick. Or you may feel none of these things!

If you're planning to give birth without pain relief, this might be the most intense part of labour for you and your birth partner. You may want to tear up your birth plan. You may demand an epidural, when you'd hoped to avoid one. Or if you'd planned a home birth, you may want to go to hospital.

Transition means that you're nearly there. With support you can get through this stage. Thankfully, there's often a lull at the end of transition when the contractions pause and you and your baby can rest.

Tips for the first stage of labour

• Listen to your body and try different positions.



• Empty your bladder often.



• Take a warm shower or bath or use a birth pool to ease the pain.



• Use Entonox (gas and air) to take the edge off the contractions.



• If you need something stronger, ask your midwife for Demerol or an epidural.



• If your labour slows, follow our tips for speeding up labour yourself.

What happens in the second stage of labour?

This is the stage of labour when you push your baby down your vagina (the birth canal) and, at long last, you meet him or her for the first time.

You'll feel the pressure of your baby's head between your legs. With each contraction you may get two or three strong urges to push. Listen to your body and push when you get a strong urge. With every push, your baby will move through your pelvis a little, but at the end of the contraction, he'll probably slip back again!

Don't despair. As long as your baby keeps on moving a little further each time, you're doing fine. When your baby's head is far down in your pelvis, you'll probably feel a hot, stinging sensation. This will happen as the opening of your vagina starts to stretch around your baby's head.

Your midwife or Obstetrician will tell you when she can see your baby's head, and he is no longer slipping back between contractions. Your midwife may ask you to stop pushing and take short, panting breaths for the next two or three contractions. This helps make sure that your baby is born gently and slowly, and helps you avoid tearing or needing an episiotomy.

If you've had a baby before, the second stage may only take five or 10 minutes. If this is your first baby, it may take several hours.

Tips for the second stage of labour

• Empty your bladder, if you haven't done so recently.



• Don't hold your breath when you're pushing.



• Try an upright position, if possible, so gravity can help your baby be born.



• If you're very tired or have had an epidural and have to lie down, lie on your left hand side. Ask your birth partner to support your upper leg. This will take the pressure off your lower back and open up your pelvis.



• If you've had an epidural and can't feel the urge to push, listen to your midwife or doctor. She'll tell you what to do.

What happens in the third stage of labour?

Once your baby is born, the third stage begins. Contractions, weaker this time, will start up again. These will make the placenta gradually peel away from the wall of your uterus. You may get the urge to push again. The placenta, with the membranes of the empty bag of waters attached, will drop to the bottom of your uterus and out through your vagina.

Many hospitals routinely give you an injection which makes the placenta come out. This is called a managed third stage. This speeds up the third stage and you won't have to do any pushing.

Your midwife ordoctor will examine the placenta and membranes to make sure that nothing has been left behind. She will also feel your tummy to check that your uterus is contracting hard to stop the bleeding from the place where the placenta was attached.

You may want to have a look at the placenta. After all, it has been your baby's lifeline through your pregnancy.

Tips for the third stage

• Hold your new baby next to your skin and, if you're going to breastfeed, offer your breast as soon as possible. This will stimulate hormones to make the placenta separate.



• Have a snack, or lie back and rest as your partner cracks open the champagne!

You may feel elated about your new arrival, or you may feel nothing but exhaustion.

Nuchal translucency (NT) ultrasound

What is a nuchal translucency ultrasound measuring?

Nuchal translucency is a collection of fluid under the skin at the back of a baby's neck. Nuchal translucency (NT) can be measured using ultrasound when your baby is between 11 weeks and 13 weeks plus six days old. All babies have some fluid, but many babies with Down's syndrome have an increased amount.

A nuchal translucency (NT) ultrasound is a screening test which assesses whether your baby is likely to have Down's syndrome. A screening test can only estimate the risk of your baby having Down's, whereas a diagnostic test, such as CVS or amniocentesis will give you a definite diagnosis (but also carries a small risk of miscarriage).

Combining an NT ultrasound with a blood test, often called a triple test or a combined test, gives a more accurate result. The blood test measures the levels of the hormone free beta-hCG and a the protein PAPP-A. Babies with Down's syndrome tend to have high levels of hCG and low levels of PAPP-A.

When the NT ultrasound is combined with this blood test, the detection rate improves to about 90 per cent. This test is called the combined test. Read our article on screening for Down's syndrome to find out more about this and other screening tests.

The NT ultrasound can't tell for certain whether your baby is affected. However, it can help you decide whether or not to have a diagnostic test.

How is the NT ultrasound performed?

A NT ultrasound must be performed between 11 weeks and 13 weeks plus six days of pregnancy. Before 11 weeks the ultrasound is technically difficult because the baby is so tiny and, after 14 weeks, any excess fluid may be absorbed by the baby's developing lymphatic system.

The ultrasound is usually done through your tummy, but occasionally it's necessary to have a vaginal ultrasound, which will give better views. There is no risk to you or your baby and it should not be too uncomfortable. Read about vaginal ultrasound in our overview of ultrasounds .

To accurately date your pregnancy, the person performing the ultrasound, called a sonographer, will measure your baby from the top of his head to the bottom of his spine. She will then measure the width of the NT. The skin will appear as a white line, and the fluid under the skin will look black.

You will be able to see your baby's head and spine, limbs, hands and feet on the screen. Some major abnormalities may be excluded at this ultrasound, but it's recommended you also have a mid-pregnancy ultrasound between 18 and 22 weeks.

It's a good idea to take your partner or a friend with you, to share the experience. You will not likely get any results until your next prenatal appointment. Most sonographers are not allowed to share results with you. The ultrasound must first be interpreted by a radiologist who will then send your results to your doctor or midwife.

What is a normal measurement?

An NT measurement of up to 2mm is normal at about 11 weeks, and up to about 2.8mm by 13 weeks and six days. The NT normally grows in proportion with your baby. The image, left, shows a baby with a normal NT of 1.3mm; this baby will be low-risk. An increased NT does not mean there is definitely a problem. Some babies without Down's have increased fluid, too. The image, right, shows a baby with an NT of 2.9mm, which is at the upper limit of normal range. Nine out of 10 babies with a measurement between 2.5mm and 3.5mm will be completely normal.

As the NT increases, so does the risk of Down's and other chromosomal abnormalities. The baby in the image, left, has an NT of 6mm and has a high risk of Down's, as well as other chromosomal abnormalities and heart problems. Fortunately, not many babies have as much fluid as this.

How is the risk of Down's calculated?

Every woman has a risk of giving birth to a baby with Down's syndrome, and this risk increases with age.

To calculate your risk, the sonographer will enter your age and the measurements from your NT ultrasound into a database. It shows the risk that applies to all women of your age, known as the background risk.

Your ultrasound measurements will be combined with your age to generate your own individual risk for this pregnancy. This may be higher or lower than your background risk.

What should I do if I am high risk?

Most women given a high risk (one in 150 or less) will go on to have a baby without Down's. Even with a risk as high as one in five, your baby has four out of five chances that he does not have Down's. Nevertheless, once your pregnancy has been labelled high-risk, you might feel anxious and perhaps unsure of what to do.

The only way to know for certain if your baby has Down's or another chromosomal abnormality is to have a diagnostic test, such as CVS or amniocentesis. This decision can be very difficult, but you do not have to decide in a hurry.

One advantage of the NT ultrasound is that it is done early in your pregnancy, and it is possible to have a CVS and get the result while you are still in the first trimester. If you are unsure what to do, you can wait until 16 weeks and have an amniocentesis then if you wish. Your midwife or doctor will provide more information if you need it.

Will I be given a risk for any other abnormalities?

You may also be given a risk for two other chromosomal abnormalities, Edwards' syndrome and Patau's syndrome. These conditions are much rarer than Down's, and most affected pregnancies miscarry. Babies with these conditions usually also have abnormalities that can be seen on the ultrasound.

How reliable is a nuchal translucency ultrasound?

A large research study involving over 100,000 pregnancies found that about 75 per cent of babies with Down's syndrome were correctly identified using this method. When combined with a blood test, the detection rate improves to about 90 per cent. However, to achieve these detection rates, it is important that the NT is measured accurately. For this reason, strict standards have been devised so that every sonographer measures in exactly the same way. To use the database to calculate the risk, sonographers must first undergo training by Fetal Medicine International and, once they are considered competent, their technique and results are reviewed every year.