Next Steps - Choosing a Nanny

Several of my clients have decided that they would like ongoing help with their childcare. There are several options to consider:

Nanny - lives in or out of your house, can often work long hours including evenings, nights or weekends. Is employed by you so you are responsible for their contract, pay and tax.

Childminder - cares for your child in their own home. Generally offers working-day care. You are a client so pay them a set fee.

Nurseries - care for your child on their specially adapted premises, in a large group of children. Generally open 8-6 or similar. You are a client so pay them a set fee.

Au Pair - sole charge of children over 2 (before/after school) and/or support with a parent for under 2s, and light housework, for around 25h a week including any babysitting evenings. You pay them pocket money and give them bed, board and treat them like a family member. I regularly hear of au pairs being expected to do the job of a nanny on the cheap. Here's a link to sensible expectations https://eastmidlandsnanniesandaupairs.co.uk/find-an-au-pair/roles-and-expectations/ 

Here I'll share a list of things to think about when choosing a nanny, though many of the questions are applicable to any childcare provider you might be talking to. In this scenario, the family are looking for a nanny who will also do some household chores. Some nannies will only do child-related chores (baby washing, child meals), others will apply for mixed roles like the nanny/housekeeper one discussed below. It's really important to be clear about your needs from the outset, so applicants know what they are expected to do and can choose to apply for roles that fit with their own needs and preferences.

Documents to be seen:

Enhanced DBS check (either less than 3 months old or registered to the online update service which you can then check)

ID check to ensure able to work in UK (passport, visa)

Original qualification certificates (Level 3 or 4 (or higher) in childcare and / or ‘common core’ nanny training)

Nanny insurance certificate or public liability (some families will pay for this (£70ish/year) but it is the nanny who registers for it

12 h pediatric first aid certificate

CV (looking for lengthy stays with families and families with babies of a similar age to yours. If you have multiples, look for experience with those.)

Checkable references from her current/last job and 2 more. Suggest phoning refs with a question to validate them (how was x when your baby was teething or similar)

If going to drive, business insurance and licence/MOT etc

Describe post:

Hours, duties (childcare, meal prep, household tasks, expectations whilst baby sleeps), salary (gross, not net), your level of involvement/whether you’ll be at home during the day,  meal arrangments during the day, holidays booked, expected length of the contract.

Possible Questions:

Why did they choose nannying?

What attracted them to your post?

What did they most enjoy about their last post? Why did they/are they leaving?

How would they plan a typical day with baby at eg x months old?

What activities do they enjoy doing with babies? Do they attend baby groups /nanny meetups with their current / last charge?

What strategies would they try if e.g. baby was unsettled and not sleepy?

How do you feel about leaving babies to cry?

How would they use the garden/park to support baby’s development?

What would they do if they were out and baby was sick and burning up? (looking for immediate care/first aid, assessment of illness/seriousness and contact with you to discuss)

What recent training/reading about child development have they been on?

Can they give an example of where an issue arose with a family and how they worked it through?

How do they feel about routines for babies of babies of X’s age (no ‘right answer’, looking to be in tune with your parenting philosophy)

(If looking for meal prep) What are some of your favourite dishes to prepare for a family?

What are they looking for in an employer/family?

How do they feel about caring for a sick child?

Can you tell me about a moment recently that made you happy to be a nanny?

Expect a good nanny to be interviewing you back with a list of questions to check that they would fit in well to your family.

If it’s going well, tell them a little more about your parenting style/beliefs.

Things to consider:

Nannies are generally considered employees rather than self employed by HMRC, so you will be liable for their workplace pension (unless they opt out – new legal requirement), employer’s liability insurance (about £100/year)  NI and taxes. 

https://www.nannytax.co.uk/salary-considerations/gross-vs-net is a good article on why advertising a gross not a net salary is the best.

https://s3-eu-west-2.amazonaws.com/nanny-network-wp/wp-content/uploads/2018/02/28142753/MODEL-CONTRACT-2.pdf has a sample contract

Some salary indications https://nanny.network/2018/02/12/go-gross-how-much-should-i-pay-my-nanny/

www.childcare.co.uk a good place to advertise 

https://ginghamkids.co.uk/  a nanny agency that I signpost when asked for a recommendation, ask for Dee.

Previous clients can also send me their ad text and I’ll also advertise it in my facebook nanny groups for the relevant geographical area.

What does a birth doula do?

*disclaimer - this is an amalgam of births I have supported, to give the feel of what I do rather than telling the story of one particular birth and to protect client confidentiality.*

There have been texts to and fro for a few days, signalling that changes are happening that might  mean that birth is imminent, so I've made sure I head to bed early and am not surprised when at 2am the phone rings.

"We think that I'm in labour and we'd like you to come over please." As their birth doula, I will support this family from whenever they feel that they would like the one to one support, rather than from a particular point in the labour. There's no need to wait for established or active labour to be in full flow - if the family feel like they would like my presence then I head straight to them, whatever time of day or night.

When I arrive the mother is in the living room, using her birth ball, and I check when she last ate, drank and used the bathroom. I observe her having a contraction, and when it is over ask if there is anything that might make her more comfortable - a warm compress, a lower back massage or some music. Her partner shows me the record they have been making of the contractions and I agree that it seems to point in the direction of increasing intensity and decreasing gaps, which is great. I suggest that her partner has something substantial to eat and ask the mother to be if she fancies some cut up fresh fruit to nibble on, which she does so I prepare a little for her to snack on and refill her water with fresh.

We talk through how the last couple of days and the changes that they've both been noticing. Whilst I've been here I've noticed definite changes in how the mother is managing each contraction - she now has to stop talking and really think and breath through what is happening. Her partner looks a little anxious, but I reassure them that this all looks normal and just shows that things are all heading in the right direction. By now I'm giving a lower back massage through each contraction, which seems to be helping, and her partner is on the other side of her, holding her hands to balance her on the ball. It's fabulous that she is surrounded by love and support.

The family have chosen to birth at the local midwife-led birth centre, and the partner asks me if we should call them and head over. I remind them that it's their decision and that they can always call in to the midwives for a chat to help them make their choice.  Having spoken to a midwife they decide it's the right time to go in, so I travel in the back of the car with the mum as her partner drives (slowly) to the birth centre.

As they get checked in, the midwife asks about when the mother last used the toilet - as she can't remember I remind them that it was half an hour ago, as I've been making sure that I suggest a visit at least every hour. I pop out to let the midwife know that the wee sample is ready for her to test. I also make sure that the special things the mother wanted on display are taken out of the bags and are placed so that she can see them, and connect up her ipod to the room's sound system so that she can listen to her chosen music whilst she labours. The midwife asks the mum if she wants a vaginal (internal) examination, and as she's not sure, I remind her of the pros and cons and what she'd put in her birth plan, then suggest she asks the midwife more about why she's recommending it to help her make the right decision for her.

As the labour progresses I suggest changes of position to help the mother to remain active, which is great for the baby's descent, and use my doula bag of bits and bobs to help her to be comfortable - straws so that she doesn't have to tip her head back to drink, honey sachets when she needs energy but doesn't want to eat, and a cold flannel on her forehead when she's getting too warm in the birth pool. I remind her of the awesome job she is doing, and how well her body is working.

Because contractions have slowed a little, the midwife and I work to support the mother in some 'Spinning Babies' positions. It's great when everyone's on the same page with what might help, and it turns out that the midwife and I were at the same training session last year!

Things are getting more intense, and I'm reminding the mother of the breathing techniques she wanted to use by mirroring them to her, as her partner has taken over massage duties. I reiterate the midwife's suggestions, making sure that the mother has heard and taken them in, and that her partner also understands what is being suggested and why. I also keep smiling at her partner, so that they know all is well and going just as expected - it can be pretty daunting if you've not witnessed a birth before!

As the birth gets closer, the partner and I work together to physically support the mum in the positions she wants to be in and as the baby is born I'm able to take a few photos which was a special request from this family. I then help the mum move her leg back over the cord, so that she can welcome her baby onto her chest as she had planned. I help the midwife to put some fresh pads and bedding underneath the mother so that she is more comfortable, and congratulate the new family. When they are ready, I fetch both parents some tea and toast which they devour with gusto.

After a couple of hours of getting to know their newborn, mum decides that she'd like some help with showering, so we head off to the en suite together with fresh clothes and I help her to get cleaned up. Back with the baby, I point out some of the features that help the parents to see if the baby is latched and positioned well for breastfeeding. The family are staying in the birth centre for a few more hours to get some sleep, and decide that it is time for them to be alone as a new family, so I hug them all and head home to enjoy a sleep too. We'll meet up again in a week or two when they are ready to talk through their birth.

What does a postnatal doula do?

What do I do as a postnatal doula to support families with newborn babies? Here's a taste of 24 hours in the life of a postnatal doula.

I head off at 8.30pm ready to support a family overnight. They know I'm on call for a birth so my phone has to stay on at all times, just in case I'm called away, but tonight turns out not to be the night. When I arrive the parents update me on how their day has been and how the last two nights have been with the baby, since I was last there. We talk through the occurrence of colic in new babies and how this generally resolves by around 3 months - there is light at the end of the tunnel. They have some questions about what to expect at their six week check and we chat through how it's about the wellbeing of the baby and of the mother, and I warn them to expect a contraception chat with their GP. They resolve to tell the doctor that having a doula sleep in the room with mum and the baby is pretty effective contraception! On a more serious note, I explain how breastfeeding can be a method of contraception, but only when specific criteria are met, to do with fully breastfeeding on demand, and I What's App over a link for more information. The mum then has a bath whilst I look after their baby and dad heads to the spare room for a well deserved early night. I sleep on a mattress on the floor in the same room as the mum, next to the baby who is in a moses basket. This way I can ensure that mum gets the maximum amount of sleep possible, whilst still breastfeeding responsively to the baby's needs. During the night, this means winding and changing the baby, and settling her back to sleep after each feed. Over one dimly lit nighttime feed, we discuss postnatal depression and some of the ways the mother can take care of herself to lessen the chances of suffering from this most common of parental illnesses. I reassure her about how well they are doing as a new family and remind her of some of the recent successes and steps forward they have made as parents.

In the morning, with both parents refreshed, I head to my morning client. I make the family breakfast - porridge and tea - and then hold the baby so that the mum can get her eldest child ready for school. As dad heads off for the school run and to work, mum heads up for a sleep as she's been up feeding frequently throughout the night. Whilst she's upstairs, I pop the babies (twins) in a wrap sling and start to clear the kitchen. Whilst not a cleaner, I do give everything a once over, unload and reload the dishwasher and change the laundry over. The twins snooze happily on my chest as I prepare some vegetables that will keep for the family's dinner later this evening. As one then the other twin stirs, I feed them using expressed milk, and we have some tummy time on the playmat. As mum emerges from her sleep, I heat up some soup for her and then make sure that she has everything around her that she needs in order to relax whilst breastfeeding the twins.

I head on over to my afternoon client after lunch. She's been reading about baby massage and would like to talk about the benefits of it. I give her the details of a local baby massage specialist and after supporting her to bathe her baby (she's quite nervous as it's the first full bath for him), we use some oil and simple strokes to relax him before he has a snooze. Whilst the baby is asleep, I run the vacuum cleaner round and make a simple salmon dinner for the couple, leaving it ready to pop in the oven later on. I run the baby's bottles through the steriliser ready for the evening. Mum asks about the best way to make up formula whilst out and about, so we look together at the Unicef Babyfriendly guidelines on this and she decides that a flask of hot, boiled water is going to be the safest way to make up a feed when out of the house. We have a chat about something that has been niggling her since the birth, and I remind her about the birth afterthoughts service run by the local hospital which might be a way to explore her feelings further. Baby then has a poonami and as we change his nappy we talk about what is normal infant poo, and how often to expect a poo at this age. I pull out my knitted poo chart and we go through the colours and stages, and how it changes as he gets older. As a doula, baby poo is one of my main topics of conversation, and occasionally the subject of picture messages from anxious parents! I remind the mum that she can always talk to her health visitor if she is concerned.

I head off home for the day, where my dogs inspect me for baby-sick stains and any scents of other people's furry animals. They are rarely disappointed!

Developing Doulas

So, how did I get to be a doula?

Well, I was a primary school headteacher so a large amount of my working life has been spent supporting families, most often mothers, in varying circumstances. Looking for a change, I investigated breastfeeding support as it was something I felt passionately about and this googling led me to look at doula training websites. Reading them I realised that I had 'doula'd' for various friends both through birth and postnatally and it sowed the seed that this could be something I wanted to do more of.

I'm the sort of person for whom 'accredited' is important when looking at training, so I found myself on Doula UK looking at the courses which would lead to DUK membership. I quickly decided that I wanted one covering both birth and postnatal support, and locality was important too (though I was the only Cambridge person on my course of 12 in the end, so people travel quite far for the right training - Newcastle was my group's furthest flung participant). I was very lucky to find that an accredited DUK course was being held right on my doorstep - Developing Doulas in Cambridge, so I called the course leader Maddie for more information.

Maddie and I had a long chat about breastfeeding counsellor training (which I was also committing to), doula training and me and my journey. I really felt valued and embraced in that call, as if I could be part of the team of doulas that were Developing Doulas. Maddie went on to 'doula' and mentor me even before the course started, offering infinite support and suggestions  as I made my first forays into offering voluntary postnatal support for some local women.

I was a little apprehensive about the training as I am not a 'woo' or at all hippy person - I like facts, evidence and preferably a randomised control trial for efficacy where my maternal health is concerned! Fortunately as the course progressed I was treated to a session on evidence-based practice, and although there were aspects which appealed to people more at ease with group sharing and alternative practice than I, it was a really good mix which I felt appealed to the broad range of people in the group I was fortunate enough to be in.

The group itself was one of the most important aspects of the course for me, alongside being educated and exploring my own knowledge and potential. The group of 12 quickly bonded and shared deep truths and stories about ourselves, knowing that our feelings and emotions would be 'held' and respected by the group. The group was diverse culturally, geographically and in their past experiences and future plans. My group contained hypnobirthing practitioners, ex children's and healthcare professionals, new mothers and grandmothers, community leaders and scientists. As someone who generally has more male than female friendships, I found a solidarity I wasn't expecting and a group of women (though men can and do train) who I could solidly rely on and trust. We have continued our support through a private facebook group where I continue to learn and be supported by them and I genuinely feel that if I turned up on any of their doorsteps in a crisis I would be taken in without question.

Having completed the course I think I turned around the fastest assignment in DD history, so keen was I to start my mentoring process with DUK. As a mentored doula I feel like there are layers of support radiating around me: there is my local group of Cambs Doulas who via facebook, phone, and in person offer both support, challenge and crucially, the majority of my current workload which comes from internal referrals from other doulas and the Cambs Doula web presence. Then there is the DD layer, comprising a facebook group for all DDs and my cohort's personal group page. This really extends out the experience I can access whilst being secure that the doulas posting have had similar training experiences to me and thus are likely to hold similar core values. On top of that there is the DUK layer, which via facebook and my excellent mentor offers a mix of professional and personal support and a wealth of experience and back up through policies and professional structure.

As I now grow my business I feel that being part of the Developing Doulas community gives me a solid base of support to draw upon in new or tricky situations and it is great to be able to be part of its community.

Birth Manifesto

Birth Manifesto

A 14 point plan to improve maternity, labour and postnatal care  

1. 1.               Provide continuity and consistency of care and carer for pregnant women.
   2.              Enable all women to have the choice of home, birth centre and hospital births, ending the postcode lottery.
   3.              Normalise physiological birth by working to lower the emergency caesarean rates in the UK.
   4.              Fund doula support for vulnerable women, such as those at risk of domestic violence, refugees or women with perinatal depression.
   5.              Support independent midwives to practice, replace or reinstate the abolished Supervisor of Midwives tole and ensure regulation of midwives is fit for purpose.
   6.              Offer specialist perinatal mental healthcare across the country.
   7.             Ensure health professionals receive appropriate training and annual statutory updates on facilitating informed decision making, including an understanding of maternity care in a human rights context.
   8.              Reinstate grant funding of midwifery training.
   9.              Ensure optimal cord clamping is offered for babies, including those needing resuscitation.
   10.           Include the importance of an oxytocin-rich environment in the training of all birth professionals.
   11.           Fund community support for breastfeeding and infant feeding specialists and specialist midwives in hospitals.
   12.           Provide comprehensive antenatal and postnatal education for new parents.
   13.           Work to end the ethnic inequality in maternal and neonatal birth outcomes.
   14.           Celebrate birth as a positive experience to be honoured and respected.

1. National Maternity Survey, recommendation 2.1: 'Every woman should have a midwife, who is part of a small team of 4 to 6 midwives based in the community who know the women and family, and can provide continuity throughout the pregnancy, birth and postnatally.' 
NICE CG190 1.1.19: 'Maternity services should: provide a model of care that supports one‑to‑one care in labour for all women.'

2. National Maternity Survey, recommendation 1.3:  'Women should be able to choose the provider of their antenatal, intrapartum and postnatal care and be in control of exercising those choices through their own NHS Personal Maternity Care Budget.'
NICE Guideline CG190 1.1.2: 'Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth.'

3. Quality watch: 'Apart from Italy, UK has high and increasing C-section rates relative to the Nordic countries. OCED statistics 2013' ASPH re NICE CG190:
  'Irrespective of population a commitment and belief underpinned by sound understanding of the physiological process of childbirth improves women's' ability to labour and birth normally.' 

4. Cochrane report: 'We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial.' Also current project with Social Care in North Cambridge, findings not yet released.

5. IMUK: 'There is legislation in place to require all health professionals to have professional indemnity insurance. Our regulator, the Nursing and Midwifery Council (NMC), ruled in December 2016 that IMUK’s indemnity scheme was no longer sufficient, despite it having been deemed suitable by two independent actuaries. This decision is not based on evidence nor on our previous safety record. We have never received a complaint regarding our indemnity cover from either a client or another midwife. IMUK had chosen to use an indemnity product that mirrors the scheme used by the NHS.'

6.  National Maternity Survey, recommendation 4.1: 'There should be significant investment in perinatal mental health services in the community and in specialist care. '

7. NICE CG 138, 1.5.22: 'openly discuss and provide information about the risks, benefits and consequences of the investigation or treatment options (taking into account factors such as coexisting conditions and the patient's preferences)'

8. NHS:  If your course starts on or after 1 August 2017

You must be accepted for a place on a full or part-time NHS-funded course which will lead to you registering as a:

9. NICE CG190 1.14.14: 'Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster. If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice.'
BASICS: Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support trolley: 'The-state-of-the-art BASICS trolley can be manoeuvred alongside the bed for a normal delivery, as well as next to a caesarean section or assisted forceps delivery. This means that the baby can remain close to the mum at a time when she most wants to keep her newborn within sight. In addition, it means that the baby’s umbilical cord can be left intact, enabling doctors who believe delayed cord clamping offers benefits to babies, especially those who are weak or premature, to employ this technique while resuscitation takes place.'

10. BUCKLEY, S, AIMS JOURNAL 'The full expression of these labouring hormones requires specific conditions: that the labouring mother feels private, safe and unobserved. This basic need is recognised by traditional systems of maternity care, which prioritise the emotional well-being of the labouring woman and ensure that she is cared for in a familiar place with known and trusted helpers. These factors will keep her as calm and relaxed as possible, and her adrenaline levels low.'

11. Infant Feeding Survey, 2.5.6: 'These findings illustrate the fact that the main reason why so few mothers follow the recommendation of feeding exclusively until six months is due to the introduction of formula, either to replace or supplement breastmilk. Given that this is also associated with breastfeeding exclusively for a relatively short period, information and support for mothers in the early weeks to help them to breastfeed exclusively for longer is likely to have an impact.' 
NICE CG 37, 1.3.1: 'Breastfeeding support should be made available regardless of the location of care.' 1.3.3: 'All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.'
1.3.15: 'From the first feed, women should be offered skilled breastfeeding support (from a healthcare professional, mother‑to‑mother or peer support) to enable comfortable positioning of the mother and baby and to ensure that the baby attaches correctly to the breast to establish effective feeding and prevent concerns such as sore nipples.'
UNICEF Babyfriendly Initiative, Step 3: 'Implement evidence-based initiatives that support breastfeeding, including the Unicef UK Baby Friendly Initiative, across all maternity, health visiting, neonatal and children’s centre services.'

12. National Maternity Survey, recommendation 2.3: 'Community hubs should enable them to access care in the community from their midwife and from a range of others services, particularly for antenatal and postnatal care.' 
NICE CG 37, 1.1.5: Women should be offered relevant and timely information to enable them to promote their own and their babies' health and wellbeing and to recognise and respond to problems.

13. ONS: 'Babies born in 2013 had an infant mortality rate of 3.8 deaths per 1,000 live births, compared to 3.9 deaths per 1,000 live births for babies born in 2012. Pakistani, Black Caribbean and Black African babies (6.7, 6.6 and 6.3 deaths per 1,000 live births respectively) had the highest infant mortality rates.'

14. NICE CG190 1.1.12: Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion, and that appropriate informed consent is sought.
1.2.1: 'Treat all women in labour with respect. Ensure that the woman is in control of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To facilitate this, establish a rapport with the woman, ask her about her wants and expectations for labour, and be aware of the importance of tone and demeanour, and of the actual words used.' 

REFERENCES:

BUCKLEY, S, IN AIMS JOURNAL 23, n4: www.aims.org.uk/?Journal/Vol23No4/undisturbedBirth.htm
COCHRANE REPORT: http://www.cochrane.org/CD003766/PREG_continuous-support-for-women-during-childbirth
INDEPENDENT MIDWIVES UK: http://www.imuk.org.uk/news/judicial-review-to-protect-independent-midwifery-begins/
INFANT FEEDING SURVEY 2010: http://content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf
NATIONAL MATERNITY SURVEY 2015 : https://www.england.nhs.uk/mat-transformation/mat-review/
NHS: https://www.gov.uk/nhs-bursaries/eligibility
NICE: https://www.nice.org.uk/sharedlearning/providing-a-choice-of-a-midwifery-led-unit-birth-centre-for-women-with-low-risk-pregnancies 
https://www.nice.org.uk/guidance/cg37
https://www.nice.org.uk/guidance/cg138/
https://www.nice.org.uk/guidance/cg190
ONS: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/pregnancyandethnicfactorsinfluencingbirthsandinfantmortality/2015-10-14
QUALITY WATCH: http://www.qualitywatch.org.uk/indicator/international-comparisons-surgical-procedures 
UNICEF: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/call-to-action/

Labour and birth bead line

On our Doula training course we were introduced to the idea of a beaded birth line, where beads are used to represent the different stages and phases of labour.

Katherine Woodbury offers workshops on how to make a beaded birth line and bead lines for sale, see her site for details: http://www.beyondbirthing.co.uk/beyond-birthing-workshops-for-collegues.html

Here is my birth line and the story for each bead.

The silver balls represent changes in stages so we start off with the latent phase of the first stage, with amber representing the rests and ruby representing the contractions. See how the rest periods gradually become shorter as the contractions or surges start to come closer together. We then move through the silver bead into active labour, where the contractions, now represented by the oval pink beads are more intense, and the rests, the pink spheres, are shorter and more predictable. This continues until the mother is around ten centimetres dilated, represented by the round pink bead showing the open cervix. We then may see the transitional stage - a starfish representing the spiky nature of transition experienced by some women, before passing into the second stage of labour.

At the start of the second phase, there may be a 'rest and be thankful' pause, illustrated by the oval teal bead, before involuntary pushing starts which is shown by the regular silver and lilac beads. At crowning, shown by the red bead representing the sensation of crowning, the baby starts to pass through the last stage of his or her journey and is born - the little blue baby bead.

After the birth of the baby, the placenta will be born, shown by a large red bead and the golden hour occurs, represented by the large gold bead. After that are four pearly days of colostrum as the mother and baby move into their fourth trimester, shown by the large golden heart at the end.

Dealing with toddlers hitting and biting

Sometimes when a newborn comes along, older toddlers can react by changing their own behaviours to try and help them deal with the new situation. Biting and hitting are very common behaviours amongst 1-3 year olds, whether they are in a house with a new baby, or just growing up and challenging the boundaries set for them.

First try to consider why your child might be biting or hitting. Reasons can include:

* not being able to communicate their needs verbally
* feeling their space is being invaded by another person
* experimenting with new sensations or a feeling of control over someone else
* sensory overload - too much noise/light/stimulation
* are teething/needing oral stimulation
* wanting to show love or affection (yes, really, they may not realise how much it hurts)

Then look to see if there is a trigger for the behaviour - is it the same child, when your child is tired or bored, is it at a certain place like nursery or home or around a certain toy or activity? Try to remove or reduce the triggers if possible or if not, be even more vigilant when around the triggers to try and catch you child before they bite or hit - this is the most effective strategy.

When you child does bite or hit someone else, you can try to:

* respond with a firm 'no - biting/hitting hurts'. Use the same phrase consistently and share it with all your child's carers.
*tell your child what you do want them to do, 'use gentle hands' or 'smiling mouths', again being consistent with the phrase used.
* check on the other child's wellbeing and pay them attention. Ensure your child is not receiving all the attention (positive or negative) as this can reinforce the behaviours.
* explain very simply to your child the effect on the other person's feelings, 'Jenny is crying because biting hurts'. Avoid blaming your child or labelling them as 'naughty', instead talk (very briefly) about the behaviour.
* re-engage the child who has bitten/hit out in another activity.
* ensure that you are praising them when they are showing appropriate behaviours - be specific, 'I like it when you hug me', 'good gentle hands with the cat'.

Remember that all new behaviours take time to learn - there are no magic bullets. Often these behaviours reduce as your child becomes more verbally able, so if you are concerned that your child is having trouble communicating in an age-appropriate way, seek the advice of a speech and language therapist via your doctor or health visitor.

Books can be a great way of learning new behaviours, try sharing Teeth are Not for Biting, Hands are Not for Hitting, or No Biting regularly to reinforce the behaviours you do want to see.

There is little research on toddler biting, but the Early Years Childhood and Parenting Collaborative have brought together what research there is here. Interestingly, they note one study showing toddlers in a large nursery initiated an average of around 3 bites per 100 days in the nursery falling to about 0.5 bites per pre-schooler per 100 days, showing that this phase does usually pass!