Maternity Care Plan Templates

My High Blood Pressure in Pregnancy Care Plan


Key objectives

Provide a tool for the remote management of high blood pressure in pregnancy. Reducing the amount of times expecting mothers have to come into the hospital for routine Blood Pressure readings and urinalysis, preventing patients waiting a long time to be seen.


Outcome measures

Equip expecting mothers with the medical devices they need to self-manage their high blood pressure, as well as providing the tools they need to interact digitally rather than relying on face to face consultations. Women to check BP at home and have a care plan (including an escalation plan)


Current Baselines

All activity is face to face - expecting mothers are travelling into the hospital at least weekly to have their BP and urine checked, normally waiting at least an hour in clinical to be seen.


Workflow

Example HTML code for My High Blood Pressure in Pregnancy Care Plan

<div class="form-inline">

<style media="screen">

.form-group {width: 100%; !important}

.cp_whiteBox {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

</style>

<div class="cp_whiteBox">

<p>Your blood pressure has recently been high in the pregnancy. Raised blood pressure can be the first sign of developing a condition called pre-eclampsia in pregnancy. This is when there is raised blood pressure either with or without protein in the urine. In addition, some women also experience symptoms such as headaches, visual disturbance or pain in the epigastric area.</p>

<p>Alternatively you may have had a pre-eclampsia/pregnancy induced hypertension in your previous pregnancy or suffer from chronic hypertension, which means you have 1 in 5 risk of redeveloping hypertensive disorder and therefore closer monitoring in the subsequent pregnancy is recommended.</p>

<p>This care plan is to help you and your family self-manage your high blood pressure while you are pregnant. Your healthcare providers will be able to observe your health records effectively and provide you with an individualised care plan for your pregnancy. You can use this plan as your online resource folder. You can access online links and track symptoms.</p>

</div>

<div class="cp_whiteBox">

<h2>What is pre-eclampsia:</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-eclampsia is a condition that affects up to 6% of pregnancies</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">The cause isn't fully understood but is thought to be caused by placenta not developing properly due to a problem with the blood vessels supplying it. Typically occurring after 20 weeks of pregnancy or soon after the baby is born.</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Early signs of pre-eclampsia include high blood pressure (hypertension) and protein in the urine (proteinuria)</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Further symptoms can develop, including:

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">sudden increase in oedema - swelling of the feet, ankles, face and hands</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">severe, persistent headache</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">vision problems (blurred vision or seeing flashing lights)</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">epigastric pain (pain just below the ribs)</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">severe heartburn</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">nausea and vomiting</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">excessive weight gain caused by fluid retention</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">feeling very unwell with shortness of breath or chest pain</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">reduced movements of your baby</li>

</ul>

</li>


<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Number of things can increase your chances of developing pre-eclampsia. These risk factors are:

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-existing medical conditions: diabetes, chronic hypertension, kidney disease or auto-immune condition such as lupus or antiphospholipid syndrome</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">first pregnancy</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">age 40 years or older</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">pregnancy interval of more than 10 years</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Body Mass Index (BMI) of 35 or more at first visit</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">family history of pre- eclampsia</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">multi-fetal pregnancy</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Hypertensive disorder in the previous pregnancy</li>

</ul>

</li>

</ul>

</div>

<div class="cp_whiteBox">

<h2>Monitoring recommendations:</h2>

<ul>

<p>We recommend you take your blood pressure daily, ideally at the same time. Take two readings - let us know the second reading.</p>

<p>You can use the Medopad app to enter your blood pressure and this will automatically update your record.</p>

<p>Please test your urine for protein as often as directed by your doctor at your first appointment to start home monitoring. This will be either daily or alternate days. You can update your symptoms at the same time.</p>

<p>To enter the BP, urine and symptoms, please use the 'Edit Plan' button at the top right hand corner of this page.</p>

<div class="row">

<div class="col-sm-12">

<label for="cp_urineProtein"><h3>Please test your urine for protein as directed by your team and record the result in the box below.</h3></label>

<input type="text" name="cp_urineProtein" id="cp_urineProtein" class="form-control" style="width: 100%;"></input>

<select class="form-control" name="cp_urineProteinResult" id="cp_urineProteinResult" style="width: 100%;">

<option value="--">Select</option>

<option value="Negative">Negative</option>

<option value="Trace">Trace</option>

<option value="1+">1+</option>

<option value="2+">2+</option>

<option value="3+">3+</option>

</select>

</div>

</div>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> If you have been started on medication for your blood pressure, take as prescribed</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> Monitor the movements of your baby</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> If you notice your blood pressure is rising, detect proteinuria or you develop any symptoms or concerns please contact our maternity specialist for advice on 0203 315 6000, option 1. Blood tests and a heart rate tracing called cardiotocography (CTG) of your baby may be recommended. An additional ultrasound to monitor the growth of your baby and an admission to the hospital may be considered.</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> If &#62; 1+ proteinuria to contact your healthcare provider on 0203 315 6000 (option 1) so that that they can send a sample for measurement.</li>

</ul>

</div>

<div class="cp_whiteBox">

<h2>Lab tests:</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Blood tests for pre-eclampsia include full blood count, liver function test (ALT), renal (kidney) function, urates, urea and electrolytes.</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">If liver function test (ALT) is abnormal or if the platelets are abnormal, clotting screen (APTT, PT, fibrinogen) tests are required.</li>

</ul>

</div>

<div class="cp_whiteBox">

<h2>Online resources:</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-eclampsia - causes: <a href="https://www.nhs.uk/conditions/pre-eclampsia/causes/" target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/causes/</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Diagnosis: <a href="https://www.nhs.uk/conditions/pre-eclampsia/diagnosis/" target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/diagnosis/</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Symptoms: <a href="https://www.nhs.uk/conditions/pre-eclampsia/symptoms/" target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/symptoms/</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Treatment: <a href="https://www.nhs.uk/conditions/pre-eclampsia/treatment/" target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/treatment/</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Complications: <a href="https://www.nhs.uk/conditions/pre-eclampsia/complications/" target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/complications/</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Recommendations: <a href="https://www.nice.org.uk/guidance/ng133/chapter/Recommendations" target="_blank">https://www.nice.org.uk/guidance/ng133/chapter/Recommendations</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Hypertension in pregnancy: <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/hypertension-blood-pressure-pregnant/" target="_blank">https://www.nhs.uk/conditions/pregnancy-and-baby/hypertension-blood-pressure-pregnant/</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">RCOG 'Information for you' leaflet: <a href="https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pre-eclampsia.pdf" target="_blank">https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pre-eclampsia.pdf</a></li>


</ul>

<h2>Other useful links</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Your routine Antenatal appointment schedule: <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-appointment-schedule/" target="_blank">https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-appointment-schedule/</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">How to take blood pressure <a href="https://www.youtube.com/watch?v=gTNmNUrh9Kk" target="_blank">https://www.youtube.com/watch?v=gTNmNUrh9Kk</a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-eclampsia foundation: <a href="http://www.preeclampsia.org/" target="_blank">http://www.preeclampsia.org/</a></li>

</ul>

</div>

<div class="cp_whiteBox">

<h2>Routine Antenatal appointments during your pregnancy:</h2>

<p>In addition to your home monitoring you will be routinely seen in the Antenatal Clinic by a midwife and an Obstetric Consultant. As well as having these routine appointments, monitoring your blood pressure, proteinuria and symptoms through the personalised health portal will save you time by minimising the attendances to the Reuben's Maternity Assessment Suite.</p>

</div>

<div id="symptoms"></div>

</div>

My Choices for Pregnancy, Birth and Beyond Care Plan

Key objectives

Provide women with a digital care plan to support them throughout their pregnancy, birth and beyond. To help aid communication and support women to feel in control and have a voice in their care.


Outcome measures

Equip women with a digital care plan that can be shared and edited by the patient and midwife and accessed by anyone attached to the woman's care. Allow women a place to document their birth plan and wishes to feel more in control when giving birth. The ability to access and edit their care plan when anything in their plan changes.


Current Baselines

Women do not currently have any where digital to document important information and wishes around their pregnancy and birth, all documentation in done on paper and relies on the women bringing it to the midwife appointment.


Workflow

Patient: self refers to Midwife

Midwife: book first appointment

PKB: receives appointment

Patient: views appointment

Patient: attends appointment

Midwife: adds and completes My Choices for Pregnancy, Birth and Beyond care plan

Patient: views, updates and shares My choice for pregnancy, birth and beyond care plan

Midwife: reviews and edits care plan at each appointment with the patient

Example HTML code for My Choices for Pregnancy, Birth and Beyond Care Plan

<div class="form-inline">

<style media="screen">

a {word-wrap: break-word;}

.form-group {width: 100%; !important}

.cp_label {font-size: 18px;font-weight: 900;}

.cp_whiteBox {margin-bottom: 15px; padding: 20px; border: 3px solid #0c475e; background-color: #ffffff; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

h2 {color: #00A8D7;}

.purpleText {color: #BF0078;}

</style>

<div class="cp_whiteBox">

<ul id="top">

<li style="list-style:inherit; margin-left: 15px;"><a href="#1"><b>Personalising your care</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#2"><b>Health and wellbeing in pregnancy</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#3"><b>Personalised birth preferences</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#4"><b>After your baby is born</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#5"><b>Reflections on your birth experience</b></a></li>

</ul>

</div>

<div class="cp_whiteBox" id="1">

<h2>Personalising your care</h2>

<p><b>This information resource is for everyone who is pregnant in Sussex and their partners/support person. It accompanies the information provided by your local maternity service. This is not part of your official maternity record, but should help to spark conversations with your healthcare professional to aid informed decision making around the care and support you may need. </b></p>

<p>This is your own personal journal of your thoughts and choices throughout this pregnancy. Recording your thoughts and preferences can help you to explore, understand and document your individual choices for pregnancy, birth and early parenthood. Your individual needs and wishes will help you plan your care and are likely to change and develop as your pregnancy progresses. You do not have to do this alone; your midwife, health visitor and obstetrician, should you need one, will support you. You can also involve partners, family and friends, the choice is yours. This is for you, whether this is your first baby or you are adding to your family. If in completing this section you identify areas where you are not sure or would like to find out more, please raise this the next time you speak to or see your midwife, health visitor or obstetrician. </p>

<p>You will always have access to this plan as a reminder of the journey you have been on and to help inform your next pregnancy (if you decide to do this all over again!). Your baby will go on to have their own personal health record, otherwise known as the Red Book, which your midwife or health visitor will give you.</p>

<p>We have divided your plan into four sections with suggested times to complete each section, but feel free to skip ahead - this is your plan, reflecting your choices.</p>

<ul>

<li style="list-style:inherit; margin-left: 15px;">Health and wellbeing in pregnancy <br /><i>Complete at the beginning of (or anytime during) your pregnancy </i></li>

<li style="list-style:inherit; margin-left: 15px;">Your birth preferences <br /><i>Complete from 32-34 weeks of pregnancy</i></li>

<li style="list-style:inherit; margin-left: 15px;">After your baby is born <br /><i>Complete from 34 weeks of pregnancy</i></li>

<li style="list-style:inherit; margin-left: 15px;">Reflections on our birth experience <br /><i>Complete after your baby's birth</i></li>

</ul>

<p>Your midwife, health visitor and/or doctor can help you to complete or adapt your personal care plan at any point, and you are encouraged to discuss your plans and preferences with them throughout pregnancy.</p>

<p><b>It is important to remember that a plan is just that - and that things may need to be reviewed and changed around your needs and the needs of your baby, to ensure care is always of high quality and safe.</b></p>

<p style="font-style: italic;">This plan was initially developed by the North West London Collaboration of Clinical Commissioning Groups as part of the maternity early adopters project. It has been further developed by the Sussex Local Maternity System, with thanks.</p>

<h3 class="purpleText">How do I use this plan?</h3>

<p>Simply click on the the pencil icon located in the top right of the screen to put your plan into 'Edit' mode, you can now start to enter your thoughts and preferences. You can fill in as little or as much as you want and then save your changes. Revisit the plan whenever you like as you progress through your pregnancy.</p>

<p><a href="https://manual.patientsknowbest.com/patient/plans" target="_blank"><b>Follow the link to view a full user guide for this digital plan >></b></a></p>

<h3 class="purpleText">About me</h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_dueDate">My due date is:</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<input type="date" name="cp_dueDate" id="cp_dueDate" class="form-control" placeholder="dd/mm/yyyy"></input>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_supportPerson">My Support Person is:</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<input type="text" name="cp_supportPerson" id="cp_supportPerson" class="form-control" style="width: 100%;"></input>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_haveBabyAt">I intend to have my baby at:</label>

<textarea class="form-control" name="cp_haveBabyAt" id="cp_haveBabyAt" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_maternityUnit">My Maternity unit is:</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<input type="text" name="cp_maternityUnit" id="cp_maternityUnit" class="form-control" style="width: 100%;"></input>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_midwifeDetails">My midwife's name and contact details are:</label>

<textarea class="form-control" name="cp_midwifeDetails" id="cp_midwifeDetails" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_healthVisitorDetails">My health visitor's name and contact details are:</label>

<textarea class="form-control" name="cp_healthVisitorDetails" id="cp_healthVisitorDetails" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_obstetricConsultant">My named obstetric/midwife consultant is:</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<input type="text" name="cp_obstetricConsultant" id="cp_obstetricConsultant" class="form-control" style="width: 100%;"></input>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_mentalHealthLead">My mental health lead's name and contact details are:</label>

<textarea class="form-control" name="cp_mentalHealthLead" id="cp_mentalHealthLead" rows="3" style="width: 100%;"></textarea>

</div>

</div>

</div>

<div class="row">

<div class="col-sm-6">

<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents" style="margin-top:15px; margin-bottom:15px;">Back to Top</a>

</div>

<div class="col-sm-6">

<a href="#fileUploadForm_save" class="btn arrow btn-primary" title="Back to Top" alt="Click here to save the Care Plan" style="margin-top:15px; margin-bottom:15px;">Go to Save Care Plan</a>

</div>

</div>

<div class="cp_whiteBox" id="2">

<h2>Health and wellbeing in pregnancy</h2>

<p>For further information about health and wellbeing in pregnancy please follow the link to <a href="https://www.nhs.uk/conditions/pregnancy-and-baby" target="_blank"> www.nhs.uk/conditions/pregnancy-and-baby</a> and <a href="https://www.nhs.uk/start4life/pregnancy" target="_blank">www.nhs.uk/start4life/pregnancy</a>. You may also like to look at the Baby Buddy app available at <a href="https://www.nhs.uk/apps-library/baby-buddy" target="_blank">www.nhs.uk/apps-library/baby-buddy</a>.</p>

<p>Please read the content and explore the links prior to completing this section. Work your way through the questions at your own pace. You can show this plan to your midwife at any time during your pregnancy. Your midwife may also provide you with locally tailored information and resources.</p>

<h3 class="purpleText">Physical health and wellbeing</h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_longTermHealth">1. I have a long term health condition that may affect my pregnancy</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_longTermHealth1" id="cp_longTermHealth1" value="diabetes"> diabetes</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_longTermHealth2" id="cp_longTermHealth2" value=" epilepsy"> epilepsy</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_longTermHealth3" id="cp_longTermHealth3" value="high blood pressure"> high blood pressure</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_longTermHealth4" id="cp_longTermHealth4" value="asthma"> asthma</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_longTermHealth5" id="cp_longTermHealth5" value="hypo/hyperthyroidism"> hypo/hyperthyroidism</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_longTermHealth6" id="cp_longTermHealth6" value="other"> other</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_longTermHealth7" id="cp_longTermHealth7" value="none"> none</input>

</div>

</div>

</div>

<p>There are many conditions that may or may not have an impact on your pregnancy. Ask your GP, doctor or midwife about any conditions you have, or may have had in the past.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_thoughtsFeeling"><i>My thoughts, feelings and questions:</i></label>

<textarea class="form-control" name="cp_thoughtsFeeling" id="cp_thoughtsFeeling" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q2">2. I am aware of the need to discuss pre-existing medical conditions and/or special requirements with my GP, midwife or doctor prior to becoming pregnant or in early pregnancy...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<select style="width: 100%;" class="form-control" name="cp_q2" id="cp_q2">

<option value="--">Select</option>

<option value="I have discussed my pre-existing medical condition/s with my maternity team">I have discussed my pre-existing medical condition/s with my maternity team</option>

<option value="I require further support with my medical condition/s or special needs">I require further support with my medical condition/s or special needs</option>

<option value="I am not sure/I would like to find out more">I am not sure/I would like to find out more</option>

<option value="information provided">information provided</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q2a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q2a" id="cp_q2a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q3">3. I am taking the following medication and/or supplements</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<select style="width: 100%;" class="form-control" name="cp_q3" id="cp_q3">

<option value="--">Select</option>

<option value="I am aware of the recommendations and I have discussed this with my GP, doctor or midwife ">I am aware of the recommendations and I have discussed this with my GP, doctor or midwife </option>

<option value="I am not sure/I would like to find out more">I am not sure/I would like to find out more</option>

<option value="information provided">information provided</option>

</select>

</div>

</div>

<p>It is recommended that you take folic acid supplements before conception and up until 12 weeks of pregnancy. It is also recommended that you take Vitamin D supplements throughout pregnancy. Any other medications should be discussed and reviewed with your team.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q3a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q3a" id="cp_q3a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q4">4. I have additional requirements</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q41" id="cp_q41" value="I will need help at appointments to translate into my language"> I will need help at appointments to translate into my language</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q42" id="cp_q42" value="I have allergies and/or special dietary requirements"> I have allergies and/or special dietary requirements</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q43" id="cp_q43" value="I have religious beliefs and customs that I would like to be observed"> I have religious beliefs and customs that I would like to be observed</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q44" id="cp_q44" value="I/my partner have additional needs"> I/my partner have additional needs</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q45" id="cp_q45" value="I/my partner have previous birth experiences we would like to discuss"> I/my partner have previous birth experiences we would like to discuss</input>

</div>

</div>

</div>

<p>If you have any special requirements, please tell your maternity team as early as possible. Use of interpreting services vary depending on local policy and availability, please discuss with your midwife.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q4a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q4a" id="cp_q4a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q5">5. I am aware that it is recommended to have both the flu vaccine and whooping cough vaccine during pregnancy...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q51" id="cp_q51" value="I am aware of the reasons for having a flu vaccine during pregnancy - further information is available at www.nhs.uk/pregnancy/keeping-well/ flu-jab "> I am aware of the reasons for having a flu vaccine during pregnancy - further information is available at </input><a href="https://www.nhs.uk/pregnancy/keeping-well/flu-jab" target="_blank">www.nhs.uk/pregnancy/keeping-well/flu-jab</a>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q52" id="cp_q52" value="I am aware of the reasons for having a whooping cough vaccine during pregnancy - further information is available at www.nhs.uk/pregnancy/ keeping-well/whooping-cough-vaccination "> I am aware of the reasons for having a whooping cough vaccine during pregnancy - further information is available at </input><a href="https://www.nhs.uk/pregnancy/keeping-well/whooping-cough-vaccination" target="_blank">www.nhs.uk/pregnancy/keeping-well/whooping-cough-vaccination</a>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q53" id="cp_q53" value="I am not sure/I would like to find out more "> I am not sure/I would like to find out more </input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q5a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q5a" id="cp_q5a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3 class="purpleText">Lifestyle and wellbeing </h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q6">6. I am aware that I should avoid some foods whilst pregnant, as they can cause harm to me and my unborn baby...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q61" id="cp_q61" value="I am aware of what foods to avoid in pregnancy "> I am aware of what foods to avoid in pregnancy </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q62" id="cp_q62" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q63" id="cp_q63" value="information provided "> information provided </input>

</div>

</div>

</div>

<p>Recommendations change about which foods to avoid, please refer to the NHS website to get the latest information <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/foods-to-avoid-pregnant" target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/foods-to-avoid-pregnant</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q6a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q6a" id="cp_q6a" rows="3" style="width: 100%;"></textarea>

</div>

</div>


<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q7">7. I am aware that I should try to maintain a healthy and balanced diet in pregnancy...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q71" id="cp_q71" value="I am aware of my nutritional needs in pregnancy"> I am aware of my nutritional needs in pregnancy</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q72" id="cp_q72" value="I have specific circumstances that affect my dietary requirements and I would like guidance from my maternity team"> I have specific circumstances that affect my dietary requirements and I would like guidance from my maternity team</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q73" id="cp_q73" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q74" id="cp_q74" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>You may be eligible for Healthy Start vouchers - follow the link to find out more <a href="http://www.healthystart.nhs.uk" target="_blank">www.healthystart.nhs.uk</a></p>


<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q8">8. I am aware of the benefits of light to moderate exercise in pregnancy...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q81" id="cp_q81" value="I am aware of the recommendations about exercise "> I am aware of the recommendations about exercise </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q82" id="cp_q82" value="I have a condition that affects my ability to exercise and I would like guidance from my maternity team "> I have a condition that affects my ability to exercise and I would like guidance from my maternity team </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q83" id="cp_q83" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

</div>

</div>

<p>Follow the link to find out more about exercise in pregnancy - <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise" target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q8a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q8a" id="cp_q8a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q9">9. I am aware that, for the health and wellbeing of me and my baby, I am advised not to smoke, drink alcohol or use recreational drugs in pregnancy...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q91" id="cp_q91" value="I am currently smoking and would like to hear about the help and support I can get to stop for pregnancy. Follow the link for more information - www.nhs.uk/conditions/ pregnancy-and-baby/smoking-pregnant "> I am currently smoking and would like to hear about the help and support I can get to stop for pregnancy. Follow the link for more information </input>

<a href="https://www.nhs.uk/conditions/pregnancy-and-baby/smoking-pregnant" target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/smoking-pregnant</a>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q92" id="cp_q92" value="my partner is smoking and I would like them to have help and support to stop "> my partner is smoking and I would like them to have help and support to stop </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q93" id="cp_q93" value="I am aware of advice around the consumption of alcohol and recreational/illegal drugs "> I am aware of advice around the consumption of alcohol and recreational/illegal drugs </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q94" id="cp_q94" value="I am not sure/I would like to find out more information provided "> I am not sure/I would like to find out more information provided </input>

</div>

</div>

</div>

<p>You can talk to your midwife or doctor for support with quitting smoking, drinking alcohol or taking recreational/illegal drugs. </p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q9a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q9a" id="cp_q9a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3 class="purpleText">Emotional health and wellbeing</h3>

<p style="margin-top: 15px;">Expecting a baby can be a joyful and exciting time, however it is also common to experience anxiety, depression or emotional distress. This tool may be helpful <a href="http://www.tommys.org/pregnancy-information/im-pregnant/mental-health-during-and-after-pregnancy/wellbeing-plan" target="_blank">www.tommys.org/pregnancy-information/im-pregnant/mental-health-during-and-after-pregnancy/wellbeing-plan</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_10">10. I have/had a mental health condition that may affect my pregnancy...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_1" id="cp_10_1" value="anxiety"> anxiety</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_2" id="cp_10_2" value="depression"> depression</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_3" id="cp_10_3" value="obsessive compulsive disorder (OCD)"> obsessive compulsive disorder (OCD)</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_4" id="cp_10_4" value="eating disorder"> eating disorder</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_5" id="cp_10_5" value="post-traumatic stress disorder"> post-traumatic stress disorder</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_6" id="cp_10_6" value="personality disorder"> personality disorder</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_7" id="cp_10_7" value="bipolar affective disorder (also known as manic depression or mania)"> bipolar affective disorder (also known as manic depression or mania)</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_8" id="cp_10_8" value="schizoaffective disorder "> schizoaffective disorder</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_9" id="cp_10_9" value="schizophrenia or any other psychotic illness "> schizophrenia or any other psychotic illness </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_10" id="cp_10_10" value="postpartum psychosis "> postpartum psychosis </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_11" id="cp_10_11" value="history of trauma - childhood or adult"> history of trauma - childhood or adult</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_10_12" id="cp_10_12" value="any other mental health condition for which you have seen a psychiatrist or other mental health professional"> any other mental health condition for which you have seen a psychiatrist or other mental health professional</input>

</div>

</div>

</div>

<p style="margin-top: 15px;">If you have any of these conditions, please speak to your midwife or doctor as soon as possible as you may benefit from the support of a specialist perinatal mental health practitioner.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q10a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q10a" id="cp_q10a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>11. This is how I'm feeling at the moment...</h3>

<p>Write down any concerns or worries you have, and talk to your friends, family, midwife, health visitor, GP or doctor. </p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q11a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q11a" id="cp_q11a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>12. I am aware that getting to know my baby during my pregnancy will help to build strong parental relationships, as well as helping with my emotional wellbeing. I might try...</h3>

<ul>

<li style="list-style:inherit; margin-left: 15px;">talking, singing or playing music to my unborn baby </li>

<li style="list-style:inherit; margin-left: 15px;">gently massaging my bump </li>

<li style="list-style:inherit; margin-left: 15px;">pregnancy yoga and/or hypnobirthing </li>

<li style="list-style:inherit; margin-left: 15px;">using an app to track my baby's growth and development </li>

<li style="list-style:inherit; margin-left: 15px;">reading UNICEF's 'building a happy baby guide' <a href="http://www.unicef.org.uk/babyfriendly/baby-friendly-resources/relationship-building-resources/building-a-happy-baby" target="_blank">www.unicef.org.uk/babyfriendly/baby-friendly-resources/relationship-building-resources/building-a-happy-baby</a></li>

<li style="list-style:inherit; margin-left: 15px;">doing these simple things regularly is known to release a hormone called oxytocin, a hormone which can help your baby's brain to develop and makes you feel good. </li>

</ul>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q12a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q12a" id="cp_q12a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>13. I am aware of things I can do to enhance my emotional wellbeing...</h3>

<ul>

<li style="list-style:inherit; margin-left: 15px;">taking regular gentle exercise, such as pregnancy yoga, walking or swimming </li>

<li style="list-style:inherit; margin-left: 15px;">ensuring I eat well </li>

<li style="list-style:inherit; margin-left: 15px;">trying relaxation techniques, listening to music, meditation or breathing exercises </li>

<li style="list-style:inherit; margin-left: 15px;">taking time for myself, somewhere I can relax </li>

<li style="list-style:inherit; margin-left: 15px;">talking to someone I trust - friend, family, midwife, health visitor, GP or doctor </li>

<li style="list-style:inherit; margin-left: 15px;">asking for practical help with household chores or other children </li>

</ul>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q13a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q13a" id="cp_q13a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_14">14. Specialist support for anxiety and depression or any other mental health condition is available...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_14_1" id="cp_14_1" value="I am aware of how to access mental health support if I need it whilst pregnant"> I am aware of how to access mental health support if I need it whilst pregnant </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_14_2" id="cp_14_2" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_14_3" id="cp_14_3" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>If you feel that you need some emotional support, you can speak to your midwife or health visitor, or you can refer yourself to your local talking therapies. They are free and pregnancy is prioritised. Follow the link to find out more - <a href="http://www.nhs.uk/Service-Search/Psychological-therapies(IAPT)/LocationSearch/10008" target="_blank">www.nhs.uk/Service-Search/Psychological-therapies(IAPT)/LocationSearch/10008</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q14a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q14a" id="cp_q14a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_15">15. Emotions my partner or support person and I should look out for in each other include...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_1" id="cp_15_1" value="tearfulness"> tearfulness</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_2" id="cp_15_2" value="feeling overwhelmed"> feeling overwhelmed</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_3" id="cp_15_3" value="feeling irritable or arguing more often"> feeling irritable or arguing more often</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_4" id="cp_15_4" value="difficulty concentrating"> difficulty concentrating</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_5" id="cp_15_5" value="change in appetite"> change in appetite</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_6" id="cp_15_6" value="problems sleeping or extreme energy"> problems sleeping or extreme energy</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_7" id="cp_15_7" value="racing thoughts"> racing thoughts</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_8" id="cp_15_8" value="feeling very anxious"> feeling very anxious</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_9" id="cp_15_9" value="loss of interest in things I normally like"> loss of interest in things I normally like</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_10" id="cp_15_10" value="being so afraid of birth that I don't want to go through with it"> being so afraid of birth that I don't want to go through with it</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_11" id="cp_15_11" value="having unpleasant thoughts that I can't control or keep coming back"> having unpleasant thoughts that I can't control or keep coming back</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_12" id="cp_15_12" value="suicidal feelings or thoughts of self harm"> suicidal feelings or thoughts of self harm</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_13" id="cp_15_13" value="repeating actions or developing strict rituals"> repeating actions or developing strict rituals</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_15_14" id="cp_15_14" value="lack of feeling towards my unborn baby"> lack of feeling towards my unborn baby</input>

</div>

</div>

</div>

<p>If you are worried by any of these feelings, talk to your midwife or doctor.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q15a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q15a" id="cp_q15a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3 class="purpleText">Baby's health and wellbeing</h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_q16">16. I am aware that if I notice a change in my baby's movements, I should contact my midwife immediately...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q16_1" id="cp_q16_1" value="I have an idea of when to expect to start feeling my baby moving "> I have an idea of when to expect to start feeling my baby moving </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q16_2" id="cp_q16_2" value="I understand why movement matters "> I understand why movement matters </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q16_3" id="cp_q16_3" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_q16_4" id="cp_q16_4" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>Further information is available at <a href="http://www.kickscount.org.uk" target="_blank">www.kickscount.org.uk</a> and <a href="http://www.tommys.org/pregnancy-information/pregnancy-symptom-checker/baby-fetal-movements" target="_blank">www.tommys.org/pregnancy-information/pregnancy-symptom-checker/baby-fetal-movements</a> </p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_q16a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_q16a" id="cp_q16a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

</div>

<div class="row">

<div class="col-sm-6">

<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents" style="margin-top:15px; margin-bottom:15px;">Back to Top</a>

</div>

<div class="col-sm-6">

<a href="#fileUploadForm_save" class="btn arrow btn-primary" title="Back to Top" alt="Click here to save the Care Plan" style="margin-top:15px; margin-bottom:15px;">Go to Save Care Plan</a>

</div>

</div>

<div class="cp_whiteBox" id="3">

<h2>Personalised birth preferences</h2>

<p>Your birth preferences support you (and your birth partner/s or support person) to make informed decisions about your care in labour. Sharing your preferences with your care providers enables them to personalise the care they give you. One of the most important emotional preparations is flexibility and preparing for multiple scenarios, rather than one fixed plan. Follow the link for more information about choice of place of birth .<a href="http://www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth" target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth</a></p>

<p>It is important to remember that your birth plan is personal to you. It depends on multiple factors, including what you would like, your medical history, your personal circumstances and what is available at your maternity service. What may be safe and practical for one person may not be safe and practical for another.</p>

<p>Please read the content and explore the links prior to completing this section. Work your way through the questions at your own pace. You can show this plan to your midwife from 34 weeks onwards.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q1">1. I would prefer to give birth...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q1_1" id="cp_sc3_q1_1" value="at home"> at home</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q1_2" id="cp_sc3_q1_2" value=" in a birth centre "> in a birth centre </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q1_3" id="cp_sc3_q1_3" value="in a labour ward"> in a labour ward</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q1_4" id="cp_sc3_q1_4" value="I prefer to wait and see"> I prefer to wait and see</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q1_5" id="cp_sc3_q1_5" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q1_6" id="cp_sc3_q1_6" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>Certain option(s) might be recommended for you based on your personal health and pregnancy.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q1a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q1a" id="cp_sc3_q1a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>2. My birth partner(s) or support person(s) will be...</h3>

<p>It is recommended that no more than two people act as your birth partner in labour at any one time.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q2a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q2a" id="cp_sc3_q2a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q3">3. Student midwives/doctors may be working with the team when I have my baby... </label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q3_1" id="cp_sc3_q3_1" value="I am happy for a student to be present during my labour/birth "> I am happy for a student to be present during my labour/birth </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q3_2" id="cp_sc3_q3_2" value="I prefer that no students are present during my labour/birth "> I prefer that no students are present during my labour/birth </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q3_3" id="cp_sc3_q3_3" value="I prefer to wait and see "> I prefer to wait and see </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q3_4" id="cp_sc3_q3_4" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q3_5" id="cp_sc3_q3_5" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>Students learn by working closely alongside their named midwife mentor and will provide you with care and support with your consent under direct supervision at all times.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q3a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q3a" id="cp_sc3_q3a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q4">4. I have additional requirements...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q4_1" id="cp_sc3_q4_1" value="I will need help at appointments to translate into my language "> I will need help at appointments to translate into my language </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q4_2" id="cp_sc3_q4_2" value="I have allergies and/or special dietary requirements "> I have allergies and/or special dietary requirements </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q4_3" id="cp_sc3_q4_3" value="I have religious beliefs and customs that I would like to be observed "> I have religious beliefs and customs that I would like to be observed </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q4_4" id="cp_sc3_q4_4" value="I/my partner have additional needs "> I/my partner have additional needs </input>

</div>

</div>

</div>

<p>If you have any special requirements, please tell your maternity team as early as possible. Use of interpreting services vary depending on local policy and availability, please discuss with your midwife.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q4a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q4a" id="cp_sc3_q4a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q5">5. I have had a discussion with my midwife/obstetrician about how I would like to give birth, my thoughts and feelings are... </label>

<p>The majority of pregnancies end in a vaginal birth, however for some a caesarean birth may be recommended.</p>

<textarea class="form-control" name="cp_sc3_q5" id="cp_sc3_q5" rows="3" style="width: 100%;"></textarea>

</div>

<a href="#anchor_q15">Follow this link if you are having a planned caesarean birth</a>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q6">6. I am aware that, in some circumstances, my midwife or obstetrician may offer to help my labour get started (this is known as induction of labour)...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q6_1" id="cp_sc3_q6_1" value="I am aware of why an induction might be recommended "> I am aware of why an induction might be recommended </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q6_2" id="cp_sc3_q6_2" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q6_3" id="cp_sc3_q6_3" value="information provided "> information provided </input>

</div>

</div>

</div>

<p>There are a number of reasons for offering induction of labour and if this is something that may be required, this will be planned carefully with you and your midwife/doctor. Follow the link for further information about inducing labour. <a href="http://www.nice.org.uk/guidance/CG70" target="_blank">www.nice.org.uk/guidance/CG70</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q6a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q6a" id="cp_sc3_q6a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q7">7. During labour and birth I would consider the following coping strategies/pain relief...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_1" id="cp_sc3_q7_1" value="I prefer to avoid all pain relief"> I prefer to avoid all pain relief</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_2" id="cp_sc3_q7_2" value="self-hypnosis/hypnobirthing"> self-hypnosis/hypnobirthing</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_3" id="cp_sc3_q7_3" value="aromatherapy/homeopathy/ reflexology"> aromatherapy/homeopathy/ reflexology</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_4" id="cp_sc3_q7_4" value="water (bath or birthing pool)"> water (bath or birthing pool)</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_5" id="cp_sc3_q7_5" value="TENS machine (transcutaneous electrical nerve stimulation)"> TENS machine (transcutaneous electrical nerve stimulation)</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_6" id="cp_sc3_q7_6" value="gas and air (entonox) "> gas and air (entonox) </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_7" id="cp_sc3_q7_7" value="paracetamol/codeine"> paracetamol/codeine</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_8" id="cp_sc3_q7_8" value="oral morphine"> oral morphine</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_9" id="cp_sc3_q7_9" value="pethidine/diamorphine/ meptid (opioid injection)"> pethidine/diamorphine/ meptid (opioid injection)</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_10" id="cp_sc3_q7_10" value="epidural"> epidural</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_11" id="cp_sc3_q7_11" value="I prefer to wait and see"> I prefer to wait and see</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q7_12" id="cp_sc3_q7_12" value="I am not sure/would like to find out more"> I am not sure/would like to find out more</input>

</div>

</div>

</div>

<p>Your options for pain relief will depend on where you plan to give birth. Follow the link for more information about pain relief <a href="http://www.labourpains.com/home " target="_blank">www.labourpains.com/home </a>. Discuss with your midwife and ask what options are available to you at your local maternity unit.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q7a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q7a" id="cp_sc3_q7a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q8">8. During labour and birth I would consider...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_1" id="cp_sc3_q8_1" value="massage"> massage</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_2" id="cp_sc3_q8_2" value="walking/standing "> walking/standing </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_3" id="cp_sc3_q8_3" value="different upright positions such as all fours/squatting/ kneeling"> different upright positions such as all fours/squatting/ kneeling</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_4" id="cp_sc3_q8_4" value="a birthing ball"> a birthing ball</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_5" id="cp_sc3_q8_5" value="bean bags, birth stools and birth couches if available"> bean bags, birth stools and birth couches if available</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_6" id="cp_sc3_q8_6" value="a birthing pool"> a birthing pool</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_7" id="cp_sc3_q8_7" value="a bed, for rest - propped up with pillows or whilst lying on my side "> a bed, for rest - propped up with pillows or whilst lying on my side </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_8" id="cp_sc3_q8_8" value="music to be played (which I will provide) "> music to be played (which I will provide) </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_9" id="cp_sc3_q8_9" value="the lights dimmed "> the lights dimmed </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_10" id="cp_sc3_q8_10" value="my birth partner or support person taking photographs/filming "> my birth partner or support person taking photographs/filming </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_11" id="cp_sc3_q8_11" value="I prefer to wait and see"> I prefer to wait and see</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q8_12" id="cp_sc3_q8_12" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

</div>

</div>

<p>Your circumstances in labour may influence what choices are available to you. Please discuss this with your midwife at 34-40 weeks. </p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q8a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q8a" id="cp_sc3_q8a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q9">9. During labour and birth, I am aware that it is recommended that my baby's heartbeat is monitored...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q9_1" id="cp_sc3_q9_1" value="If needed, I prefer to have intermittent fetal heart rate monitoring with a handheld device"> If needed, I prefer to have intermittent fetal heart rate monitoring with a handheld device</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q9_2" id="cp_sc3_q9_2" value="If needed, I prefer to have continuous fetal heart rate monitoring using a CTG machine"> If needed, I prefer to have continuous fetal heart rate monitoring using a CTG machine</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q9_3" id="cp_sc3_q9_3" value="If I need continuous monitoring I would like to be mobile and use wireless monitoring if available"> If I need continuous monitoring I would like to be mobile and use wireless monitoring if available</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q9_4" id="cp_sc3_q9_4" value="I do not wish to have monitoring"> I do not wish to have monitoring</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q9_5" id="cp_sc3_q9_5" value="I prefer to wait and see"> I prefer to wait and see</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q9_6" id="cp_sc3_q9_6" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

</div>

</div>

<p>Follow the link to learn more about the stages of birth. <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/what-happens-during-labour-and-birth" target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/what-happens-during-labour-and-birth</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q9a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_q9a" id="cp_sc3_q9a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q10">10. I am aware that, during labour, my midwife and/or obstetrician are likely to recommend vaginal examinations to assess the progress of my labour...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q10_1" id="cp_sc3_q10_1" value="I am aware of why vaginal examinations are part of routine care "> I am aware of why vaginal examinations are part of routine care </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q10_2" id="cp_sc3_q10_2" value="I am very worried about having vaginal examinations "> I am very worried about having vaginal examinations </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q10_3" id="cp_sc3_q10_3" value="I prefer to wait and see "> I prefer to wait and see </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q10_4" id="cp_sc3_q10_4" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q10_5" id="cp_sc3_q10_5" value="information provided "> information provided </input>

</div>

</div>

</div>

<p>Vaginal examinations are a routine part of assessing labour progress and will not be undertaken without your consent. </p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_10a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_10a" id="cp_sc3_10a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q11">11. I am aware that, in some circumstances, my midwife or obstetrician may offer interventions to assist with my labour...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q11_1" id="cp_sc3_q11_1" value="I am aware of why assistance/intervention might be recommended "> I am aware of why assistance/intervention might be recommended </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q11_2" id="cp_sc3_q11_2" value="I do not want to have any intervention in labour and would like to discuss this before labour to ensure my wishes are respected"> I do not want to have any intervention in labour and would like to discuss this before labour to ensure my wishes are respected</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q11_3" id="cp_sc3_q11_3" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

</div>

</div>

<p>Interventions may be recommended if your labour slows down, or if there are concerns with you or your baby's health.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_11a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_11a" id="cp_sc3_11a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q12">12. I am aware that, in some circumstances, my obstetrician may recommend an assisted or caesarean birth...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q12_1" id="cp_sc3_q12_1" value="I understand why an *assisted birth might be recommended"> I understand why an *assisted birth might be recommended</input>

</div>

<p>*An assisted birth (also known as an instrumental delivery) is when forceps or a ventouse suction cup are used to help deliver the baby.</p>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q12_2" id="cp_sc3_q12_2" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

</div>

</div>

<p>An assisted or caesarean birth may be recommended if it is thought to be the safest way to deliver your baby; your obstetrician will discuss this with you and ask for your consent before any procedure is undertaken.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_12a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_12a" id="cp_sc3_12a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q13">13. I am aware that, in some circumstances, my midwife or obstetrician may recommend a cut to the perineum to facilitate birth (episiotomy)...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q13_1" id="cp_sc3_q13_1" value="I understand why an episiotomy might be recommended"> I understand why an episiotomy might be recommended</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q13_2" id="cp_sc3_q13_2" value="I prefer to avoid an episiotomy, but would give my consent at the time if it was required"> I prefer to avoid an episiotomy, but would give my consent at the time if it was required</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q13_3" id="cp_sc3_q13_3" value="I do not consent to episiotomy under any circumstances and would like to discuss this before labour to ensure my wishes are respected"> I do not consent to episiotomy under any circumstances and would like to discuss this before labour to ensure my wishes are respected</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q13_4" id="cp_sc3_q13_4" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q13_5" id="cp_sc3_q13_5" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>An episiotomy may be recommended for an instrumental birth or if your midwife/doctor is concerned that your baby needs to be born quickly. Your midwife/doctor will always ask for your consent.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_13a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_13a" id="cp_sc3_13a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_q14">14. I am aware that, after my baby is born, I will give birth to the placenta (this is known as the third stage of labour). There are two ways this can happen...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q14_1" id="cp_sc3_q14_1" value="I would like to have a natural (physiological) third stage, the cord is left intact and I push the placenta out myself"> I would like to have a natural (physiological) third stage, the cord is left intact and I push the placenta out myself</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q14_2" id="cp_sc3_q14_2" value="I would like to have an active third stage, where the cord is cut within a few minutes, I receive an injection of oxytocin, and the midwife/ doctor delivers my placenta"> I would like to have an active third stage, where the cord is cut within a few minutes, I receive an injection of oxytocin, and the midwife/ doctor delivers my placenta</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q14_3" id="cp_sc3_q14_3" value="I prefer to wait and see"> I prefer to wait and see</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q14_4" id="cp_sc3_q14_4" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q14_5" id="cp_sc3_q14_5" value="I/my birth partner or support person would like to cut the umbilical cord"> I/my birth partner or support person would like to cut the umbilical cord</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q14_6" id="cp_sc3_q14_6" value="I prefer the midwife/doctor to cut the umbilical cord"> I prefer the midwife/doctor to cut the umbilical cord</input>

</div>

</div>

</div>

<p>Your midwife or doctor may offer an active third stage due to your personal circumstances and will discuss this with you at the time of birth.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_14a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_14a" id="cp_sc3_14a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label id="anchor_q15" class="cp_label" for="cp_sc3_q15">15. I am aware that skin-to-skin contact with my baby, immediately after birth, is recommended.</label>

<p>Follow the link for more information about skin to skin contact with your baby <a href="http://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact" target="_blank">www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact</a></p>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q15_1" id="cp_sc3_q15_1" value="I understand why skin-to-skin contact is recommended "> I understand why skin-to-skin contact is recommended </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q15_2" id="cp_sc3_q15_2" value="I would like immediate skin-to-skin contact"> I would like immediate skin-to-skin contact</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q15_3" id="cp_sc3_q15_3" value="I prefer to wait and see"> I prefer to wait and see</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q15_4" id="cp_sc3_q15_4" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_q15_5" id="cp_sc3_q15_5" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>As long as you and your baby are both well, skin-to-skin can be done following any type of birth. Your partner or support person can also have skin-to-skin contact with your baby.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_15a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_15a" id="cp_sc3_15a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_q16">16. I am aware that I will be provided with support to feed my baby, my thoughts around feeding are...</label>

<textarea class="form-control" name="cp_sc3_q16" id="cp_sc3_q16" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<p>During pregnancy you will have a chance to discuss how you wish to feed your baby. A midwife will help you to get feeding off to a good start.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc3_17">17. I am aware that, after my baby is born, he or she will be offered Vitamin K...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_17_1" id="cp_sc3_17_1" value="I would like my baby to have Vitamin K by injection "> I would like my baby to have Vitamin K by injection </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_17_2" id="cp_sc3_17_2" value="I would like my baby to have Vitamin K by oral drops "> I would like my baby to have Vitamin K by oral drops </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_17_3" id="cp_sc3_17_3" value="I do not want my baby to have Vitamin K "> I do not want my baby to have Vitamin K </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc3_17_4" id="cp_sc3_17_4" value="I am not sure/I would like to find out more "> I am not sure/I would like to find out more </input>

</div>

</div>

</div>

<p>Vitamin K is a supplement that is recommended for all babies that prevents a rare condition known as Vitamin K Deficiency Bleeding (VKDB). It has no known side effects. </p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc3_17a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc3_17a" id="cp_sc3_17a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

</div>

<div class="row">

<div class="col-sm-6">

<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents" style="margin-top:15px; margin-bottom:15px;">Back to Top</a>

</div>

<div class="col-sm-6">

<a href="#fileUploadForm_save" class="btn arrow btn-primary" title="Back to Top" alt="Click here to save the Care Plan" style="margin-top:15px; margin-bottom:15px;">Go to Save Care Plan</a>

</div>

</div>

<div class="cp_whiteBox" id="4">

<h2>After your baby is born</h2>

<p>Much of the information you need will be provided by your midwife and health visitor, but you can also access information on any of the following websites:</p>

<p><a href="http://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth" target="_blank">www.nhs.uk/pregnancy/labour-and-birth/after-the-birth</a></p>

<p><a href="http://www.nhs.uk/start4life/baby" target="_blank">www.nhs.uk/start4life/baby</a></p>

<p><a href="http://www.unicef.org.uk/babyfriendly/baby-friendly-resources" target="_blank">www.unicef.org.uk/babyfriendly/baby-friendly-resources</a></p>

<p><a href="http://www.tommys.org/pregnancy-information/after-birth" target="_blank">www.tommys.org/pregnancy-information/after-birth</a></p>

<p>We recommend you revisit these pages after your baby is born and share any thoughts and questions with your postnatal maternity and health visiting teams.</p>

<h3 class="purpleText">Developing a relationship with your baby </h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_1">1. I am aware of UNICEF's 'Meeting your baby for the first time' video?</label>

<a href="https://youtu.be/0vzW9qPz3So" target="_blank">https://youtu.be/0vzW9qPz3So</a>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_1_1" id="cp_sc4_1_1" value="I have watched UNICEF's video"> I have watched UNICEF's video</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_1_2" id="cp_sc4_1_2" value="I have not watched UNICEF's video"> I have not watched UNICEF's video</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_1_3" id="cp_sc4_1_3" value="I am not sure/would like to know more"> I am not sure/would like to know more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_1_4" id="cp_sc4_1_4" value="information provided"> information provided</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_1a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_1a" id="cp_sc4_1a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_2">2. I am aware that skin-to-skin contact with my baby after birth and beyond is recommended.</label>

<p>Follow the link to find out more about skin to skin contact with your baby <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/" target="_blank">https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/</a></p>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_2_1" id="cp_sc4_2_1" value="I am aware of the benefits of skin-to-skin contact"> I am aware of the benefits of skin-to-skin contact</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_2_2" id="cp_sc4_2_2" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_2_3" id="cp_sc4_2_3" value="information provided"> information provided</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_2a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_2a" id="cp_sc4_2a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_3">3. I am aware that I will be given information about infant feeding and how to get it off to a good start...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_3_1" id="cp_sc4_3_1" value="I am aware of the benefits of breastfeeding "> I am aware of the benefits of breastfeeding </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_3_2" id="cp_sc4_3_2" value="I am aware of how to get feeding off to a good start"> I am aware of how to get feeding off to a good start</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_3_3" id="cp_sc4_3_3" value="I am not sure/I would like to find out more "> I am not sure/I would like to find out more </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_3_4" id="cp_sc4_3_4" value="I am aware of how to use formula safely"> I am aware of how to use formula safely</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_3_5" id="cp_sc4_3_5" value="information provided"> information provided</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_3a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_3a" id="cp_sc4_3a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_4">4. I am aware that my baby may show early signs that he or she might be ready to feed...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_4_1" id="cp_sc4_4_1" value="I am aware of the signs to look out for that my baby might be ready to feed"> I am aware of the signs to look out for that my baby might be ready to feed</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_4_2" id="cp_sc4_4_2" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_4_3" id="cp_sc4_4_3" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>Follow the link of further information about feeding your baby. <a href="http://www.unicef.org.uk/babyfriendly" target="_blank">www.unicef.org.uk/babyfriendly</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_4a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_4a" id="cp_sc4_4a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3 class="purpleText">Preparing for the first few hours and days after birth </h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_q5">5. I am aware that my maternity unit may or may not be able to facilitate my birth partner(s) or support person to stay with me in all areas, 24 hours a day...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q5_1" id="cp_sc4_q5_1" value="I am aware of my maternity unit's local policy on birth partner(s) or support person staying with me "> I am aware of my maternity unit's local policy on birth partner(s) or support person staying with me </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q5_2" id="cp_sc4_q5_2" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q5_3" id="cp_sc4_q5_3" value="information provided"> information provided</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q5_4" id="cp_sc4_q5_4" value="ask your midwife for information on your local maternity unit."> ask your midwife for information on your local maternity unit.</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_5a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_5a" id="cp_sc4_5a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_q6">6. I am aware that visiting hours at my maternity unit can vary...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q6_1" id="cp_sc4_q6_1" value="I have checked times visiting and I am aware of when and who can visit me after giving birth"> I have checked times visiting and I am aware of when and who can visit me after giving birth</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q6_2" id="cp_sc4_q6_2" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q6_3" id="cp_sc4_q6_3" value="information provided"> information provided</input>

</div>

</div>

</div>

<p>It's useful to find out visiting times, particularly if you might have visitors travelling from a long distance.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_6a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_6a" id="cp_sc4_6a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>7. I am aware that my length of stay could vary depending on my recovery from the birth.</h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_7a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_7a" id="cp_sc4_7a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>8. I am aware that my baby may need to stay longer in hospital if they need additional support on the neonatal unit. </h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_8a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_8a" id="cp_sc4_8a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>9. I am beginning to think about having things ready at home...</h3>

<p>Think about what things you could do now to make caring for yourself and your baby easier at home.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_9a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_9a" id="cp_sc4_9a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3>10. I am beginning to think about who will be able to support me after giving birth when at home...</h3>

<p>Your partner, friends or family, it's worth considering who will be able to help you at home.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_10a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_10a" id="cp_sc4_10a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3 class="purpleText">Your physical and emotional wellbeing after birth</h3>

<p><b>Follow the link for further information and advice about your body after the birth of your baby <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/you-after-birth " target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/you-after-birth </a></b></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_11">11. I can be prepared for my physical recovery after giving birth in order to help to get me and my new family off to the best start. I am aware of...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_1" id="cp_sc4_11_1" value="physical changes to expect"> physical changes to expect</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_2" id="cp_sc4_11_2" value="postnatal pain relief options"> postnatal pain relief options</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_3" id="cp_sc4_11_3" value="the importance of hand hygiene"> the importance of hand hygiene</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_4" id="cp_sc4_11_4" value="signs of infection and what to do"> signs of infection and what to do</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_5" id="cp_sc4_11_5" value="pelvic floor exercises"> pelvic floor exercises</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_6" id="cp_sc4_11_6" value="physical recovery after a caesarean birth"> physical recovery after a caesarean birth</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_7" id="cp_sc4_11_7" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_11_8" id="cp_sc4_11_8" value="information provided"> information provided</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_q12">12. I am aware that giving birth and becoming a parent is known to be a time of great emotional change, and that I can prepare for how I might feel after birth...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q12_1" id="cp_sc4_q12_1" value="I am aware of the emotional changes to be expected"> I am aware of the emotional changes to be expected</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q12_2" id="cp_sc4_q12_2" value="I have considered what my family/friends can do to support me "> I have considered what my family/friends can do to support me </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q12_3" id="cp_sc4_q12_3" value="I know how to access support with my emotional and mental health after giving birth"> I know how to access support with my emotional and mental health after giving birth</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q12_4" id="cp_sc4_q12_4" value="I am not sure/I would like to find out more"> I am not sure/I would like to find out more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q12_5" id="cp_sc4_q12_5" value="information provided"> information provided</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_13">13. Changes in thoughts, feelings and/or behaviours I and my partner/support person should look out for in each other...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_1" id="cp_sc4_13_1" value="persistent sadness/low mood"> persistent sadness/low mood</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_2" id="cp_sc4_13_2" value="lack of energy/feeling overly tired"> lack of energy/feeling overly tired</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_3" id="cp_sc4_13_3" value="feeling unable to look after my baby"> feeling unable to look after my baby</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_4" id="cp_sc4_13_4" value="problems concentrating or making decisions"> problems concentrating or making decisions</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_5" id="cp_sc4_13_5" value="changes in appetite"> changes in appetite</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_6" id="cp_sc4_13_6" value="feelings of guilt, hopelessness or self-blame"> feelings of guilt, hopelessness or self-blame</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_7" id="cp_sc4_13_7" value="difficulty bonding with my baby"> difficulty bonding with my baby</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_8" id="cp_sc4_13_8" value="problems sleeping or extreme energy loss of interest in things I normally like"> problems sleeping or extreme energy loss of interest in things I normally like</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_9" id="cp_sc4_13_9" value="having unpleasant thoughts that I can't control or keep coming back"> having unpleasant thoughts that I can't control or keep coming back</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_10" id="cp_sc4_13_10" value="suicidal feelings or thoughts of self-harm"> suicidal feelings or thoughts of self-harm</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_13_11" id="cp_sc4_13_11" value="repeating actions or developing strict rituals"> repeating actions or developing strict rituals</input>

</div>

</div>

</div>

<p>Please take the time to share this list with your birth partner or support person and close family as they are often the first to spot that you are becoming unwell. Both you and your partner can access support from your local talking therapies services, follow the link for further details <a href="http://www.nhs.uk/service-search/find-a-psychological-therapies-service" target="_blank">www.nhs.uk/service-search/find-a-psychological-therapies-service</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_13a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_13a" id="cp_sc4_13a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<h3 class="purpleText">Caring for your baby</h3>

<p>Follow the link for further information about caring for your baby during the first few weeks <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/being-a-parent http://iconcope.org/parentsadvice" target="_blank" >www.nhs.uk/conditions/pregnancy-and-baby/being-a-parent http://iconcope.org/parentsadvice</a></p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_14">14. I am aware of things to consider before going home, including...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_14_1" id="cp_sc4_14_1" value="BCG vaccination (if you have been told that your baby needs it)"> BCG vaccination (if you have been told that your baby needs it)</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_14_2" id="cp_sc4_14_2" value="how to tell if your baby is feeding well"> how to tell if your baby is feeding well</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_14_3" id="cp_sc4_14_3" value="signs of an unwell baby and what to do if you're worried"> signs of an unwell baby and what to do if you're worried</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_14_4" id="cp_sc4_14_4" value="changes to expect in your baby's nappy"> changes to expect in your baby's nappy</input>

</div>

</div>

</div>

<p>The team in your maternity unit will be on hand to provide support and can arrange access to additional treatment if needed.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_14a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_14a" id="cp_sc4_14a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_q15">15. I am aware of things to consider for when I am at home, including...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q15_1" id="cp_sc4_q15_1" value="safe sleeping practices (sudden infant death syndrome prevention)"> safe sleeping practices (sudden infant death syndrome prevention)</input><a href="https://www.lullabytrust.org.uk/safer-sleep-advice" target="_blank"> www.lullabytrust.org.uk/safer-sleep-advice</a>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q15_2" id="cp_sc4_q15_2" value="newborn jaundice - what's normal, and what might need review "> newborn jaundice - what's normal, and what might need review </input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q15_3" id="cp_sc4_q15_3" value="newborn blood spot screening test"> newborn blood spot screening test</input><a href="https://www.nhs.uk/conditions/baby/newborn-screening/blood-spot-test" target="_blank"> www.nhs.uk/conditions/baby/newborn-screening/blood-spot-test</a>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q15_4" id="cp_sc4_q15_4" value="newborn hearing screen test"> newborn hearing screen test</input><a href="https://www.nhs.uk/conditions/baby/newborn-screening/hearing-test" target="_blank"> www.nhs.uk/conditions/baby/newborn-screening/hearing-test</a>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q15_5" id="cp_sc4_q15_5" value="umbilical cord care and skin care "> umbilical cord care and skin care</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_q15_6" id="cp_sc4_q15_6" value="bathing your baby"> bathing your baby</input>

</div>

</div>

</div>

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_15a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_15a" id="cp_sc4_15a" rows="3" style="width: 100%;"></textarea>

</div>

<h3 class="purpleText">Community care and next steps </h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_16">16. Community postnatal care is delivered in a variety of settings and by a multidisciplinary team of healthcare professionals. I am aware of...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_16_1" id="cp_sc4_16_1" value="community postnatal care"> community postnatal care</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_16_2" id="cp_sc4_16_2" value="how to contact my local community midwives"> how to contact my local community midwives</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_16_3" id="cp_sc4_16_3" value="how to contact my health visitor who will offer to visit me at home within a couple of weeks of the birth"> how to contact my health visitor who will offer to visit me at home within a couple of weeks of the birth</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_16_4" id="cp_sc4_16_4" value="how to access additional infant feeding support"> how to access additional infant feeding support</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_16_5" id="cp_sc4_16_5" value="how to access services in my local Children's Centres"> how to access services in my local Children's Centres</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_16_6" id="cp_sc4_16_6" value="I am not sure/I would like to know more"> I am not sure/I would like to know more</input>

</div>

</div>

</div>

<p>Follow the link to find out more about the role of your health visitor <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/baby-reviews" target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/baby-reviews</a>.</p>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_16a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_16a" id="cp_sc4_16a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_17">17. After the birth, I will need to...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_17_1" id="cp_sc4_17_1" value="register my baby's birth within six weeks"> register my baby's birth within six weeks</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_17_2" id="cp_sc4_17_2" value="register my baby with my GP"> register my baby with my GP</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_17_3" id="cp_sc4_17_3" value="book a postnatal check with my GP at six to eight weeks after the birth for both me and my baby"> book a postnatal check with my GP at six to eight weeks after the birth for both me and my baby</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_17_4" id="cp_sc4_17_4" value="arrange for further tests at my GP surgery (if recommended by my midwife or doctor)"> arrange for further tests at my GP surgery (if recommended by my midwife or doctor)</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_17a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_17a" id="cp_sc4_17a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_18">18. I am aware that, if I have a pre-existing medical condition or if I was unwell around the time of the birth, I may have specific medical recommendations made by my doctor...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_18_1" id="cp_sc4_18_1" value="I have a pre-existing medical condition and I have discussed my specific postnatal care requirements with my doctor and midwife"> I have a pre-existing medical condition and I have discussed my specific postnatal care requirements with my doctor and midwife</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_18_2" id="cp_sc4_18_2" value="I experienced complications/was unwell around the birth, I am aware of the implications this may have on my postnatal care"> I experienced complications/was unwell around the birth, I am aware of the implications this may have on my postnatal care</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_18_3" id="cp_sc4_18_3" value="I am not sure/I would like to know more"> I am not sure/I would like to know more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_18_4" id="cp_sc4_18_4" value="information provided"> information provided</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_18a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_18a" id="cp_sc4_18a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-6">

<label class="cp_label" for="cp_sc4_19">19. I am aware that if I have any concerns about my own health and recovery, I can speak to my midwife, health visitor or GP...</label>

</div>

<div class="col-sm-6" style="margin-top: 15px;">

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_19_1" id="cp_sc4_19_1" value="I know how to support my own recovery from vaginal birth or caesarean section"> I know how to support my own recovery from vaginal birth or caesarean section</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_19_2" id="cp_sc4_19_2" value="I have an idea of signs that may indicate any problems with recovery, e.g. raised temperature"> I have an idea of signs that may indicate any problems with recovery, e.g. raised temperature</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_19_3" id="cp_sc4_19_3" value="I am not sure/I would like to know more"> I am not sure/I would like to know more</input>

</div>

<div class="form-check">

<input class="form-check-input form-control" type="checkbox" name="cp_sc4_19_4" id="cp_sc4_19_4" value="information provided"> information provided</input>

</div>

</div>

</div>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc4_19a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc4_19a" id="cp_sc4_19a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

</div>

<div class="row">

<div class="col-sm-6">

<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents" style="margin-top:15px; margin-bottom:15px;">Back to Top</a>

</div>

<div class="col-sm-6">

<a href="#fileUploadForm_save" class="btn arrow btn-primary" title="Back to Top" alt="Click here to save the Care Plan" style="margin-top:15px; margin-bottom:15px;">Go to Save Care Plan</a>

</div>

</div>

<div class="cp_whiteBox" id="5">

<h2>My reflections </h2>

<h3 class="purpleText">Thoughts about your pregnancy and birth to discuss with your midwife or doctor </h3>

<p>Use this section to reflect on your experience of pregnancy, labour, birth and immediately after birth. This can include emotional and physical experiences. If you have specific concerns, share them with your midwife, health visitor or doctor.</p>

<p>Follow the link for further information about you after the birth <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/you-after-birth" target="_blank">www.nhs.uk/conditions/pregnancy-and-baby/you-after-birth</a>. And information about talking therapies and specialist perinatal mental health services <a href="http://www.sussexpartnership.nhs.uk/perinatal" target="_blank">www.sussexpartnership.nhs.uk/perinatal</a>.</p>

<h3>1. In pregnancy...</h3>

<div class="row" style="margin-top: 15px;">

<div class="col-sm-12">

<label class="cp_label" for="cp_sc5_1a">My thoughts, feelings and questions:</label>

<textarea class="form-control" name="cp_sc5_1a" id="cp_sc5_1a" rows="3" style="width: 100%;"></textarea>

</div>

</div>

<