You must decide whether you are going to have your baby in a nursing home or a hospital or at home. A well-equipped hospital or nursing home is the better choice, especially if you do not have the right kind of help or facilities at home.

Things to keep ready for hospital or nursing home.

If you are registered at a good nursing home, they will advise you what things to keep ready. Keep everything packed by the end of the eighth month, just in case the baby decides to arrive a little early. The following list is not exhaustive, but may be found useful:

For the mother: Nightwear and other personal toilet requirements, four to five dozen sanitary towels and a sanitary belt.

For the baby: Three or four dozen diapers, six cotton shirts (long or shortsleeved, depending on the weather), one or two warm pullovers, one warm bonnet, four large safety pins, one blanket.

Much more preparation is necessary if the delivery is at home. Arrange in advance with a doctor, nurse or midwife to help you. The confinement room must be as near a bathroom or other sources of water as possible, and well-lit. The bed must be placed in such a way that it can be approached from all sides. When confinement is near, clear the room of all unnecessary furniture. Low beds are inadvisable; helpers will find it easier if the bed is at least 76.3 cm. (30 inches) high. Things to keep ready are:

For the mother: Rubber or plastic sheets to be put on the bed, two bed-sheets and plenty of linen, 453 gm. (1 lb) cotton wool, a few dozen sanitary towels, enamel bowls, pan, enamel can for waste, soap, some milk antiseptic like Listerine or Dettol, nail brush, night dress which can be opened in front, 6 safety pins, 2 abdominal binders, plenty of boiled water, gauze, hot water bottle.

For the baby: Receiving basket or cot, sterilised gauze for navel dressing, crepe bandage for baby's tummy, 6 vests, 12 napkins, petticoats, bootees, 2 safety pins, baby soap, baby powder, olive oil, bath tub and 1 hair brush, pail for dirty clothes, baby coat, baby shawl and baby blankets.

Most of these can be kept ready by the end of the eighth month of pregnancy.

Labour

The process by which the baby is born is known as labour, delivery or confinement. It occurs in three stages:

1. `State of dilatation': The mouth of the womb dilates and opens. When this state is completed, the bag of waters breaks and the water in it escapes.
2. `Stage of expulsion': The baby passes from the womb into the vagina, through which he is gradually expelled into the open world.
3. `Placenta': After the baby is born the placenta or after-birth is expelled, which marks the end of labour.

Sign of labour

An early sign of labour is a slight bloodstained discharge called 'the show' accompanied by contractions of the womb. These contractions give rise to pain or a sensation of tightening or pressure in the abdomen. The pain starts in the back and comes round to the front. Most women describe these pains as a pinching sensation in the back. These pains may occur at first at intervals of an hour or half an hour-but they gradually get more frequent and severe. If the hand is placed on the abdomen the hardening of the womb during each contraction can be felt.

`False pains' sometimes occur a fortnight or so before the beginning of labour. They are due to colic and are recognized by their irregular character and by the absence of `show'.

Sometimes the first sign of labour is the breaking of the bag of waters. The clear fluid in it comes out. There is no need to be alarmed at this and it does not necessarily mean that there is any thing wrong. Send for your doctor and stay in bed till he comes. Or go to the hospital if you are to be confined there.

Pain

Fear causes tenseness and tenseness causes pain; then pain causes more tenseness and thus a vicious cycle is established. This is one of the causes of difficult confinements. An enlightened mother is unafraid because she has confidence in herself and knows what to expect. The knowledge of what to expect allows her to relax and thus eliminate tension. Thus one major cause of pain is removed.

Birth & birth weight

Your baby is usually born between 38 and 42 weeks of pregnancy i.e. full term baby, and weighs more than 2.5 kg. However, if he is born earlier than 38 weeks, he is called a preterm baby (premature) and usually he weighs less than 2.5 kg. (5.1/2 lb.) and requires gentle handling and specialised care.

1. If he is born after 42 weeks of pregnancy - i.e. 'post term baby', he also requires specialised care.
2. If your baby is born full term, but weighs less than 2.5kg. he is described as small for period of gestation - and you should consult your doctor for his management.
3. Birth of the baby without medical attendance

If a baby is born before a doctor arrives or before the mother can get to a hospital, there are some points her helpers should remember. They are:

1. Do not be frightened. Quick births are usually normal births.
2. See that the mother is comfortably lying down on a mattress that does not sag.
3. Wash your hands thoroughly. Sterilise all materials by boiling.
4. Do not touch the area around the vagina.
5. Place a clean towel under the mother's hips for the baby
6. If the bag of waters comes out intact, with the baby inside, puncture the sac with a pin or scissors-tip. Wipe the baby's mouth, nose, face and head with a clean handkerchief. Do not use cotton or tissue paper.
7. Move the baby to a clean spot between the mother's legs. The head must be slightly elevated and the face must be away from the secretions. Let the umbilical cord remain slack.
8. Cover his body with a blanket or towel but do not cover the head, lest he should have difficulty in breathing
9. If the doctor has not arrived even after the baby is delivered, tie the cord. First of all tie the cord in two places about 5 cm. (2 inches) apart with tape or twine which has been previously boiled. The knot nearest the baby must be about 12 cm. (6 inches) from the navel. Cut the cord between the two knots with scissors. Wrap the baby and lay him on his side in a warm place.
10. Do not pull the cord to bring out the placenta. It will come out by itself.
11. After the placenta comes out, place your hands over the mother's womb - a lump below her navel - and message, to keep it firm. Keep your hand there until the uterus gets firm.
12. Clean the mother's buttocks and lower thighs, but do not touch the vaginal area
13. Make the mother comfortable. Give her a hot drink if she wants. Do not leave her till the doctor comes.

Everything must be clean. While binding the cord remember to use a sterilised piece of gauze. If a dirty piece of cloth is used, infection may result.

Post natal care

After the birth of the baby the mother is tired and goes to sleep. But after she has rested from her exertions she feels cheerful and is ready to face the world again. But she is not physically ready yet. She needs special care and attention during the post-natal period.

Food

She will have a light diet of soup and soft foods the first day, but can return to a regular diet as soon as she feels like it. Much the same foods as in pregnancy are recommended. But she must take more milk and fruits and protein-rich foods, especially if she is breast-feeding the baby.

Exercise

The following exercises are recommended, but should be done only on doctor's advice. Discard your pillows which doing the exercises:

A. Lying on your back with knees bent:

1. Rest your hands lightly on the stomach. Draw the stomach in, away from the hands. Relax (May be done from the second day after confinement).
2. Squeeze knees and thighs together and tighten buttock muscles. Relax. (From the third day onwards)
3. Breathe deeply, using the stomach instead of the upper chest (from the fifth day).
4. Bend from the waist stretching right hand down alongside as far as the ankle. Straighten. Repeat with left hand. (from the sixth day).
5. Raise hips from the bed. Twist until right hip is higher than left. Straighten and twist to the other side. Relax (from the sixth day).
6. Bend right knee upon chest, grasping knee with both hands. Bend head so that forehead touches knee. Stretch leg out quite straight and repeat with left knee. (From the seventh day).

B. Lying on your back with legs straight:

Cross one foot over the other. Squeeze ankles, knees and thighs together and tighten stomach and buttocks. Relax. Repeat with the other foot crossed (From fourth day).

C. Sitting with your legs over side of bed:

• Cross right knee over left. Squeeze knees, thighs and buttocks together; draw the stomach in. Relax. Repeat with the other leg crossed. (From the tenth day).

D. Standing:

Cross one foot over the other. Squeeze knees and thighs together and draw the stomach in. Relax. Repeat with the other foot crossed (From the tenth day).

• Choose the exercises that suit your condition and do them six times at a stretch, three times a day. Stop the moment you feel tired. It is important that you consult the doctor before you start on these exercises. Continue them for three months, by which time your figure will have returned to normal.

Evacuation

Don't let the bladder get too full. Urination once in six hours is absolutely essential. If you have trouble passing urine consult the doctor.

Constipation is common. The doctor may suggest a mild laxative or changes in your diet. Do not take strong laxatives. They may effect the baby if you are breast-feeding him.

After-pains

'After-pains' are occasional cramp-like contractions in the abdomen. They will probably stop in a few days. They are commoner among those who breast-feed their babies, but not serious.

In six weeks the uterus shrinks back to its original size. The remains of the thick lining of the uterus are passed out through the vagina after the baby is born. At first it is a free flow, and bloody. Later it decreases in quantity and is colourless. If bleeding continues after the second week, consult the doctor.

The breasts are a little painful after the third day when they are tense and firm, with milk forming inside. A good nursing brassiere will relieve the discomfort. Sagging breasts are not the result of breast-feeding, but of poor support during pregnancy and the nursing period.

Visitors

Discourage visitors in the first few days, especially if the baby is with you.

Return to normal life

Some women are able to move about freely about five days after the birth of the baby. Most women take ten days or more. Have someone to do the house-work for a few weeks. Avoid bending down, especially if you have back-ache.

The period when menstruation returns varies from five weeks to six months. But a second pregnancy is possible even before menstruation returns. During menstruation there is less breast milk and so a breast-fed baby is likely to be a little restive then. The first menstrual period may be a little abnormal.

It is better not to have sexual intercourse at least for six weeks.