Archive for May, 2009

THE SIDE EFFECTS OF PREGNANCY

Why does pregnancy make you feel so sick?
Although no one is really clear about the cause of sickness in pregnancy it is thought to be due partly to the hormone human chorionic gonadotrophin (hCG), released early in pregnancy. For most women, symptoms are mild and begin to ease at 12 weeks. For some, the sickness may last throughout the day and continue beyond this time. A small percentage of women experience severe nausea and vomiting, known as hyperemesis gravidarum (see p 92).
There are practical measures you can take to relieve nausea and sickness (see p 82).
I’m two months’ pregnant and feel incredibly tired all the time. Is this normal?
Yes tiredness is a common complaint in pregnancy with most women feeling a sudden loss of energy in the early stages as their body gets used to the changes caused by pregnancy. This often lasts throughout the first trimester, but after about week 13 you should start to feel a bit more energized When you’re not resting, try to stay active and take some gentle exercise.
Another cause of tiredness is anaemia, a common condition in pregnancy that needs to be monitored. Although it’s more likely that your tiredness is due to the pregnancy itself, when you see your midwife you will be offered a blood test to check your iron levels, and if these are found to be low you will be offered supplements. To avoid anaemia, eat iron-rich foods, such as dark green leafy vegetables, red meat, wholegrain cereals, pulses, and prune juice. Vitamin C helps your body to absorb more iron from your diet, so try drinking fresh orange juice with meals, and limit your tea and coffee intake, as caffeine inhibits iron absorption.
I often feel faint - what could be causing this?
Feeling faint or having a dizzy spell is quite common in pregnancy as pregnancy hormones cause your blood vessels to relax and widen Although this improves the blood flow to the baby it also has the effect of slowing down the flow of blood around your body which can lead to low blood pressure, known as hypotension. Although this is unlikely to be a risk in itself, it can cause feelings of faintness, most commonly when you stand up too fast from a sitting or lying position.
Other causes of faintness include lying on your back (as this can put pressure on several large blood vessels involved in returning blood back to your heart, which can cause low blood pressure and in turn make you feel dizzy and faint); a lack of food or drink: getting overheated; and fast breathing (hyperventilating).
Sometimes, feeling faint can be more serious. If the feeling does not pass by eating, drinking water, cooling down, or taking things slowly as you stand up, it may need investigating further and you should seek the advice of your midwife or doctor as this could be due to anaemia (see above) and you may need treatment in the form of iron tablets.
Is it normal to have pelvic pain in early pregnancy?
Pelvic pain is associated with the soft area supporting your pelvis, the symphysis pubic joint. This can swell or separate causing considerable pain, termed symphysis pubis dysfunction, or SPD This is thought to be caused by pregnancy hormones and is quite common in late pregnancy, but can occur earlier. Many women feel most pain when walking or lying Wear comfortable shoes; use pillows to support the hips and legs in bed; keep your legs together when getting out of bed; avoid breast stroke; and get lots of rest. Some women find sitting on a birthing ball helps You may be referred to an obstetric physiotherapist and advised to wear a support belt. In severe cases, crutches may be needed. Most cases resolve after the birth.
I’m embarrassed because I think I’ve got piles. I don’t want to go to the doctor - what can I do?
Haemorrhoids (piles) are swollen veins at or near the anus that can be very uncomfortable, especially during pregnancy. Piles area common feature in
pregnancy, with many women experiencing them at some stage, so your doctor will not be at all surprised You could also speak to your midwife about the problem if this is easier Your doctor or midwife will be able to recommend a treatment, such as a cream or a cooling maternity gel pad.
As piles often develop as a result of straining due to constipation, increasing your fibre and fluid intake may help you to have regular bowel motions, which in turn may help to relieve the problem Eat fresh fruit and vegetables and drink lots of water If you are very constipated, you could ask your doctor to prescribe suppositories I know you may feel embarrassed, but it is best to approach someone rather than to suffer alone.
I’ve been getting regular headaches since becoming pregnant - should I be worried?
Headaches in the early stages of pregnancy are quite normal and are thought to be related to the effects of pregnancy hormones. Headaches can also be caused by other factors such as dehydration, low
blood sugar, a stuffy environment, tiredness, and lack of sleep. Try increasing your intake of water, aiming to drink at least eight glasses of water a day, and have small regular meals to maintain your blood sugar. If you feel a headache coming on, drink two glasses of water and have a rest for 30 minutes. Taking a lose dose of paracetamol is considered safe, although it is best to avoid this if possible
If you are suffering with headaches at around
28 weeks or more, you should inform your doctor or midwife of these, especially if your headaches are accompanied by blurred vision, an inability to focus, or flashing lights, as this may be a sign of pregnancy-induced hypertension (high blood pressure), which could indicate pre-eclampsia (see p.89). Try not to worry, as even though many women complain of headaches and some will have high blood pressure in pregnancy, few go on to develop pre-eclampsia. It is thought that the incidence is somewhere between two and five per cent of all pregnancies.
My gums have started bleeding since I’ve been pregnant -why is this?
It is very common for gums to bleed in pregnancy The pregnancy hormone progesterone causes areas of tissue that connect muscles and ligaments to soften and become stretchier so that your body can make room for the growing baby However, this can affect tissue in other parts of the body, such as in the gums, making them softer and more prone to bleed.
Also, some women crave sweet foods in pregnancy, an excess of which can affect the gums, causing them to become tender, swollen, and more likely to bleed, and increasing the chances of developing gingivitis, a gum infection. Pregnant woman are encouraged to see a dentist early in pregnancy for a checkup (dental care is free up until the baby’s first birthday)
It is important to brush your teeth more than usual and floss regularly when pregnant to minimize the risk of an infection Unlikely as it may sound, it has been suggested that there is a link between premature birth and gum disease
Whenever I sneeze, I leak - is that going to last for ever?
Many women suffer from stress incontinence during pregnancy, which means a leakage of urine when you cough or sneeze The leaks are caused by the loosening of muscles in the pelvic floor - a group of muscles and ligaments that support the pelvic organs - due to pregnancy hormones. Also, as the growing baby puts more pressure on the bladder stress incontinence becomes more likely,
It is recommended that you carry out pelvic floor exercises (see p.57) to reduce the likelihood of leakage. These can be started at any stage of pregnancy, but the earlier you begin the better; once you get the technique right they are simple. As these are such discreet exercises it is easy to practise without anyone else realizing what you are doing
Stress incontinence should improve following the birth, although it can take up to six weeks There is some suggestion that the problem can persist longer depending on the type of birth you have, with a natural vaginal birth more likely to cause ongoing problems than a Caesarean delivery.
I’ve been getting nosebleeds for the first time in my life. Why is this?
It’s not unusual for nosebleeds to occur in pregnancy due to the increased blood supply in the body Nosebleeds are not serious, but if the bleeds are severe, you can ask your doctor for a spray to help the blood to clot. If your nosebleeds are frequent, a simple surgical procedure can cauterize the vessel
When you have a nosebleed, sit for a few minutes with your head upright and apply pressure to the bridge of the nose. To avoid further nosebleeds, make sure you blow your nose gently, drink plenty of fluids to avoid dehydration, use vaseline on dry nostrils, avoid smoky environments, and open your mouth when you sneeze to relieve nasal pressure
I’m 30 weeks’ pregnant and have persistent backache - is there anything that can help?
The weight of your baby and the fact that joints and ligaments soften in pregnancy can cause backache Sometimes sciatica occurs, a sharp pain that travels down the back and leg when the sciatic nerve is
trapped in a joint in the lower back
For lower backache warm baths and a warm compress can help, and gentle massage done by an experienced practitioner Exercise, such as yoga, pilates, or aquanatal classes (see p.55), strengthens back muscles, but check with your doctor before embarking on a new exercise regime. Watch your posture, making sure that you sit upright - you could try using a birthing ball - and wear flat shoes.
If you have sciatica, ask your doctor or midwife to refer you to a physiotherapist to assess your condition and teach you exercises to help relieve the pain and minimize a reoccurrence. Some women have a maternity girdle or back brace fitted.
Little moles are appearing on my skin. Why is this happening?
Skin changes occur frequently in pregnancy due to the effect of pregnancy hormones However, some changes, such as new moles and freckles appearing,
although not usually serious, should be discussed with your midwife or doctor, particularly if new or existing moles seem to change shape, are red or tender or start to bleed
In general, skin either becomes quite oily in pregnancy due to an increase in the production of the skin’s natural oil, sebum or, if skin is prone to dryness, it may become even drier and more sensitive. Many women experience a darkening of the skin, while others notice a pattern on their face that looks like a patchy sun tan, called chloasma (see p. 105). If your skin is sensitive, avoid scented creams and oils, and perfume. Regular cleansing of the skin and avoiding oil-based products may also help
My mum had varicose veins -am I likely to get them in pregnancy?
Around a third of women suffer from varicose veins in pregnancy to some degree (see p.86). These occur because increased levels of the hormone progesterone cause the walls of the veins to become more relaxed; there is also increased pressure within the veins as a result of the enlarged uterus pressing on major veins in the pelvis A family history of varicose veins does increase the possibility of them occurring, but there are several things that you can do to reduce the risk or severity of varicose veins.
If varicose veins do appear during pregnancy, they usually improve within three months of giving birth although unfortunately in subsequent pregnancies they are likely to recur.
My feet are swollen and tight; can I do anything about it?
Swollen feet and ankles, known as oedema, are due to excessive fluid seeping into the tissues because of the increased volume of blood By late pregnancy as blood volume continues to rise, this is a common problem. The swelling is usually worse later in the day and when the weather is warmer There are steps you can to take to help reduce the swelling, such as elevating your legs when sitting, rotating your feet, and lying on the floor with your feet up the wall. Wearing support tights or stockings also improves circulation in the legs. Make sure that you drink plenty of fluids, particularly water, as this improves the kidney function and reduces water retention. Gentle exercise, such as swimming or aquanatal exercises, also increases the efficiency of the circulatory system. There is evidence that reflexology from a registered practitioner may help.
If you also have swelling in your hands or face it is worth having a blood pressure check to rule out pre-eclampsia (see p,89) Most women find that the swelling gradually disappears after they give birth
My fingers are tingling and my midwife said it might be carpal tunnel syndrome - what is this?
Carpal tunnel syndrome occurs when swollen tissues in the wrist compress the nerves and cause pins and needles and numbness. Other symptoms include difficulty grasping with fingers and thumb and a general weakness in the hands. This is common in pregnancy due to the increased volume of blood, which can cause fluid retention
There are ways to reduce the symptoms, such as circling and stretching exercises to improve circulation and increase wrist mobility Wearing wrist splints and elevating your hands on a pillow at night can also help. There is some inconclusive evidence that ultrasound treatment may help in mild cases
I’m 35 weeks and get terrible leg cramp. What can I do?
Leg cramp, where the leg muscles go into a painful spasm, is common in pregnancy, particularly at night, which may be due to the pressure of the uterus on pelvic nerves This usually resolves itself once you are out of bed and using the muscle. However, if the pain doesn’t recede and there is any reddening or swelling in one leg, you should seek medical advice urgently to eliminate the possibility of a clot.
To reduce the incidence of cramp or its severity; drink lots of water to prevent dehydration and try leg stretches and ankle exercises, circling your heel first and then wiggling your toes, before going to bed. Gentle exercise, such as walking or swimming, can also help and getting your partner, friend, or relative to massage your legs, particularly the calf muscle, can improve circulation Some research suggests that taking magnesium supplements reduces the incidence of cramps but further studies are needed.
I’m itching to the point where I’m bleeding. What can I do?
Most itching in pregnancy, especially on your tummy, is due to stretching of the skin, hormonal changes, and heat. However, if you have significant itching, see your midwife or doctor to determine whether you have a condition called obstetric cholestasis, a serious but rare condition that affects the liver and occurs in about one per cent of pregnancies (see p 90) - a blood test can rule out this condition
Using a non-perfumed moisturizing lotion or emoillient cream daily after washing may help, and avoid bathing in very hot water Try not to scratch, as broken skin is vulnerable to infection; wearing cotton gloves at night may stop you scratching in your sleep After 28 weeks, five drops of essential lavender oil in a bath helps to soothe the skin. Antihistamine creams or tablets may be prescribed by your doctor if the itching is severe and other measures aren’t working.
My breasts keep “leaking”. Should this be happening now?
In pregnancy, your body prepares for breastfeeding and some women find that they leak colostrum, the first watery, yellowish milk. as early as 16 weeks Some leak large amounts, some small amounts, and some not at all. The amount you leak has no bearing on the amount of milk produced after the birth or your ability to breastfeed. If you are self-conscious,wear breast pads to protect clothing You may leak more when sexually aroused as oxytocin, one of the hormones responsible for the “let-down” reflex in the breasts, is released at this time.
I’ve got terrible indigestion -why is this?
Progesterone, the hormone that relaxes smooth muscle (muscle that controls unconscious actions) in pregnancy, has the unfortunate side effect of relaxing all smooth muscle in the body, including the whole of the digestive tract. This slows digestion and the ring of muscles called a sphincter at each end of the stomach become less effective, which can cause heartburn and indigestion as acidic juices from the stomach leak back into the oesophagus. In addition, your growing baby is squashing your stomach so that you have a smaller space to digest food.
To relieve indigestion, eat little and often, eat slowly, don’t eat late at night, and cut down on fatty or spicy foods. Rather than lie flat, prop yourself up with pillows Talk to your midwife, doctor, or pharmacist about remedies that are safe to use in pregnancy.

Varicose veins
how can I avoid them
Self-help measures to avoid the risk of varicose veins include:
* Wearing support hosiery - this is one of the best ways to avoid varicose veins All pregnant women are entitled to two free pairs of compression tights
* Doing regular ankle and foot exercises to reduce swelling and cramp
• Avoiding standing for long periods.
• Raising your legs when sitting down
• Getting up to take regular walks if you have to sit for long periods.
* Avoiding high-heeled shoes, which reduce the work done by the calf muscles, to maintain blood flow in the legs.
Sleeplessness
You are often very sleepy at the beginning and end of pregnancy, and towards the end of pregnancy you may find it increasingly difficult to sleep restfully in the night as your bump makes it hard to find a comfortable position, pressure on your bladder causes you to get up frequently to use the toilet and your baby may not share the same sleeping pattern as you and wakes you frequently with his kicking. Coupled with the fact that your body is working extremely hard, a poor night’s sleep adds to your general levels of fatigue. If possible. try to compensate for broken night-time sleep by catnapping in the day, or find time to sit down and put your feet up

Coping with morning sickness
To alleviate feelings of nausea and sickness in pregnancy, try eating little and often, and sip water continually during the day Some women find ginger helps, so you could try nibbling ginger biscuits, perhaps before you get out of bed. Acupressure bands worn on the wrists and available from most chemists are also thought to relieve the symptoms.
Fatigue

One of the most cited complaints in pregnancy, particularly in the first trimester, is extreme tiredness as your body deals with its extra workload. Accepting this and adapting your routine accordingly can help you cope. * Slow down and take a break, or even a catnap, whenever possible.
* Eat small, healthy snacks throughout the day and drink plenty of fluids to maintain energy levels
• Whenever possible go to bed earlier.
• Take regular, gentle exercise to relieve stress and improve your fitness and stamina.

Who will handle my care?
a guide to antenatal care

What types of antenatal care are available to me?
The options for antenatal care in the UK vary from one region to another, and sometimes according to the hospital you choose. so it’s worth asking your doctor or midwife early on about your choices. There are four main types of care (see p.76) The most common is shared care, where you are cared for by your doctor and community midwife with visits to the hospital limited to scans or investigations. In some areas, midwifery care is offered where you are looked after by a midwife or a team of midwives, sometimes called one-to-one care or team midwifery care. Women with pre-existing medical problems, or a more complicated pregnancy, such as a multiple pregnancy, may have consultant-led care with visits to a hospital-based consultant If you opt for private care, you will be cared for by an independent midwife Appointments will be timed to suit you and scans may be with a private obstetrician. The midwife will be on call for the birth, which may be at home, in a birth centre, or at the local hospital.
How many antenatal appointments will I need?
The exact number of appointments and how often you have them depends on your individual situation Usually, if this is your first pregnancy, you will have up to 10 appointments, whereas if you have had a baby before, you should have around 7 appointments.

When will I have my first antenatal appointment?
Your first ”booking’ appointment should be between 8 and 12 weeks, depending on the midwives’ preferences in your area. This is often the first time you will meet the midwife who will be organizing, and in most cases providing most of, your care.

I’m going for my first appointment next week - what will happen there?
The purpose of your first appointment with your local midwife is for her to obtain your medical history and exchange information so that your future care during the pregnancy and birth can be planned. This is also an opportunity for you and your midwife to get to
know each other and for you to ask any questions you may have and discuss the schedule for appointments, blood tests, scans, and antenatal classes. You will also be given booklets, information leaflets, and important contact telephone numbers
Your midwife will ask you about your medical history; your family’s medical history; your partner and your partner’s family’s medical history; about any previous pregnancies you have had; and how this pregnancy has been so far Your answers to these questions will help your midwife to build up a picture of your current state of health, and will also help identify any factors that may affect your pregnancy, for example if there is a family history of pre-eclampsia (see p.89).
Your midwife will also take your blood pressure, weigh you, test your urine (see below), and listen to the baby’s heartbeat if you are 12 or more weeks pregnant. She may also take some blood tests (see opposite). These observations provide a useful baseline for future antenatal checks

Why do I have to bring a urine sample to the clinic each time?
Your midwife is looking for the presence of protein in your urine. If protein is present, this could indicate that you have a urine infection that may need a course of antibiotics After around 24 weeks of pregnancy, protein in the urine is an indication of pre-eclampsia (see p 89), a potentially serious condition that needs close monitoring.
If you have a body mass index (BMI) (see p 18) over 35, you will be offered a glucose tolerance test, also done by testing -your urine. Glucose in the urine is a sign of gestational diabetes (see p.87) If glucose is present, you may be referred for blood tests to analyse your sugar levels. If diabetes is diagnosed, you would receive care and advice accordingly.

Why are some of my appointments with my doctor and others with the midwife?
The type of antenatal care you receive can vary slightly between different areas. If your pregnancy is straightforward, your care is usually shared between your doctor and midwife, or in some areas all your appointments are with your midwife. If you feel more comfortable with your midwife, you should be able to arrange to have the majority of your appointments with her, and the same applies if you feel happier seeing your doctor. Whichever way, it is important that -you feel able to ask any questions or discuss any issues, which may be personal or sensitive

Will I have to have an internal examination at my first antenatal appointment?
It is unlikely that you will have an internal examination at your first antenatal appointment. Twenty years or so ago, when home pregnancy tests weren’t as reliable and ultrasound scans were not so accurate or widely available, an internal examination was the
best way to confirm and ‘date” a pregnancy The midwife or doctor placed two fingers into the vagina, and pressed on the lower abdomen with the other hand to judge the size of the uterus
Nowadays, there are a few instances when an internal examination may be recommended during early pregnancy. If you have an infection, such as thrush, an internal examination enables the vagina to be visualized to check for any signs of infection and for a tissue sample to be taken with a swab (like a long cotton wool bud). The swab is sent to the hospital for testing so that the appropriate treatment can be offered
If -you have vaginal bleeding, you may have an internal examination with a speculum (an instrument shaped like a duck’s bill, used for smear tests) to allow the cervix to be seen: a small erosion on the surface is a common cause of bleeding in pregnancy Although internal examinations are not enjoyable, it is important to try and relax to help the muscles of the vagina to relax and loosen, which may prevent discomfort. Many women find it helpful to breathe slowly and steadily during the examination.

I’m very small and have tiny feet - will that be a problem when I give birth?
In the past, doctors used to measure a pregnant woman’s feet to assess her likelihood of needing a Caesarean section, as small feet were thought
to indicate a narrow pelvis Although there is some truth in the fact that small feet generally indicate that a woman is small-framed and therefore likely to have a small pelvis, small women also tend to grow small babies in proportion to their pelvic size. True cephalo-pelvic disproportion (CPD), where the baby’s head is too large to fit through the pelvis and be born vaginally is relatively rare
During labour there are other factors that help you to deliver your baby. The pelvis is not a fixed structure and the hormone relaxin helps to soften the ligaments that hold the pelvic bones together to help the pelvis to stretch and accommodate the baby
Also, your baby’s head is designed to mould into shape. The skull is made up from separate bones that are able to overlap each other slightly in order to reduce the overall size of the head as it travels through the pelvis during labour This is a normal part of the birth process. Labour positions also affect the dimensions of the pelvis. For example, squatting can increase the internal measurements of the pelvis by around 30 per cent. Sitting, or lying on your back can actually reduce these measurements by restricting the natural backwards movement of the tailbone (coccyx) during birth.

My midwife is lovely but she’s always in a hurry - how can I get her to answer my questions?
This is a common problem. Antenatal clinics are often very busy, with lots of women for the midwife to see. Asa  result, most clinics allow only a 10- to 15-minute appointment for each woman – barely enough time to go through the basic physical checks However, it is important that -your questions are addressed and it may be helpful to write them down so that you remember what you want to ask. If your midwife doesn’t have time to discuss the issues during your appointment, ask her to arrange to talk to you at a mutually convenient time This could be in the form of a phone call, or another appointment at the clinic Or she may be able to direct -you to other sources of information such as books, leaflets, websites, or other healthcare professionals.
It is a crucial part of your antenatal care that you feel comfortable with your caregivers and are given the opportunity to discuss any questions you have or issues that arise, and this is recognized by the National Institute for Clinical Excellence (NICE) in their guidelines for antenatal care (see p.310).

I’m four months’ pregnant and haven’t had many appointments. Will they get more frequent?
Yes, you will find that your antenatal appointments become more frequent as the pregnancy progresses. With your first pregnancy, you can expect a total of about 10 appointments but if you have had a baby before, you may only have 7. If you develop any complications, additional appointments would be arranged according to your needs. The schedule of antenatal appointments differs slightly from area to area, but as a general rule you can expect an appointment at the following stages of pregnancy: one to two appointments by 12 weeks of pregnancy, and then appointments at 16 weeks, 25 weeks, 28 weeks, 31 weeks, 34 weeks, 36 weeks, 38 weeks, 40 weeks, and if, your baby is overdue, 41 weeks If you are expecting your second or subsequent baby and the pregnancy is straightforward, you may miss out appointments at 25 weeks, 31 weeks, and 40 weeks.

I want a home birth. Will this make a difference to my antenatal appointments?
Usually women planning a home birth will have the same type of antenatal care as any another healthy pregnant woman in regards to frequency and location of antenatal appointments Midwives in some areas may provide a home visit towards the end of
the pregnancy if a woman is planning a home birth This is helpful as it offers an opportunity to discuss the preparations for labour and birth, such as what equipment to have ready and the intended place for the actual delivery. If your midwife cannot offer a home visit to discuss the arrangements for your home birth, you should be given an opportunity to talk about it together during one of your usual antenatal appointments.

Is it OK to bring my partner with me to the antenatal appointments?
It is absolutely fine to bring your partner with you to some or all of your antenatal appointments It is a good way for him to feel involved in the pregnancy, and also gives him an opportunity to ask questions that he may have. It is a legal requirement that you are allowed paid time off work to attend antenatal appointments, but your partner does not have this right, which may pose a problem as most antenatal clinics are during the day. Another way to involve your partner in the pregnancy is to attend birth preparation classes together Classes are often held at the weekends or in the evenings to make it easier for partners to attend This gives you both a chance to find out more about labour and birth and about babycare after the birth.

When will I hear my baby’s heart beat?
Your baby’s heart starts beating around 20 days after conception, and can be seen on an ultrasound scan at about six weeks of pregnancy It is usually not until around 12 weeks of pregnancy that it is possible to hear the heartbeat with a hand-held monitor, known as a sonicaid, as it is around this time that the uterus starts to grow upwards out of the pelvis, making it easier to detect the heartbeat When the heartbeat can be heard also depends a bit on your build; if you are very slim, it is usually easier to find the baby’s heartbeat than if you are overweight

Will I have my own midwife?
Midwives realize that it is important for a woman to develop a relationship with them so that they feel supported and able to ask questions, and continuity of care is provided if possible However, how many midwives you meet in pregnancy, labour, and birth and the postnatal period depends on how services are arranged in your area Generally, the midwife linked to -your doctor’s surgery provides the majority of care. Depending on your situation and common practice in your area, you may also meet other midwives if some of your appointments are at the hospital. When -you go into labour, you are usually cared for by hospital-based midwives who you may not have met In some areas, community midwives look after women in hospital. If this is the case, you may be familiar with the midwife caring for you in labour Midwives working on a labour ward work shifts, so it is likely that you will meet more than one midwife during your labour and birth. Your postnatal care is usually carried out by community-based midwives. This may include the midwife you saw for antenatal appointments at the surgery
I’ve only just found out I’m pregnant and I must be at least four months. What should I do?
One of the first things you need to do is to contact your local maternity unit and inform them of your pregnancy Women can refer themselves, although many still approach their doctor first. If you inform your doctor, he or she will send a referral to the hospital or to a midwife to arrange a booking appointment as soon as possible. You should also review your diet (see p.50) Depending on the number of weeks of your pregnancy, you may be due a scan, which may need to be done before the booking appointment Most units offer a scan around 10-14 weeks, and a second one around 20 weeks. You will be offered a range of blood tests (see p. 117) and should be aware of their purpose before consenting Each unit may have a slightly different schedule for care. The earlier you book in the better, so that you do not miss out on any aspects of antenatal care.

Antenatal jargon
Understanding your notes
Once your midwife has compiled your notes, you will be in charge of these and will need to take them to appointments. Abbreviations will be used for much of the medical information.
• BP Blood pressure.
• Hb Haemoglobin levels.
• Primagravida A first pregnancy
• Multigravida A subsequent pregnancy
• NAD Nothing abnormal detected (usually referring to urine sample).
FHHR Fetal heart heard and regular.
FHNH Fetal heart not heard.
FMF Fetal movements felt.
EDD Estimated date of delivery
iIc Ceph or Vx Baby head down
Br Baby is breech - feet down.
Eng/E Baby’s head is engaged for delivery * NE Baby’s head is not engaged.
* SFH Symphysis fundal height, size of the womb

Rhesus negative
Each person’s blood carries a Rhesus factor (Rh-factor), which is positive or negative Problems arise if a Rh-negative woman carries a Rh-positive baby who has inherited the status from the father. If the mother’s blood comes into contact with the baby’s blood during delivery, she may produce antibodies against the baby This does not usually affect a first baby. but may cause problems in subsequent pregnancies when a mother’s antibodies attack the cells of another Rh-positive baby
Preparing for visits
Getting ready for your antenatal appointments
Knowing what to expect at your antenatal appointments and having the necessary information to hand for the midwife will mean the allotted time is used efficiently.
At your first antenatal appointment, your midwife is gathering as much information about you as possible to build up a picture of your health and consider the most appropriate type of care for you. Make sure you have the date of your last menstrual period, as well as the dates of any previous pregnancies, including ones that ended in miscarriage You will also need to be clued up on your family’s medical history and your partner’s medical history, including any inherited abnormalities, so check before the appointment if you are unsure about anything Read any information sent by the hospital and make a list of any questions so that you don’t forget them.
Antenatal care options
Wno provides your care
The options for antenatal care in the UK vary from area to area, so this section will provide a general overview You will find out more when you go for your booking-in appointment, usually around 8-12 weeks Midwives are specialists in providing maternity care where there are no complications and they provide the majority of antenatal care to women. As they are specially trained to look after normal births, women should only have to see a doctor if a problem arises, or if they are at a higher risk of complications. Within the NHS there are three main types of care: shared care, midwifery care and consultant-led care. The Association for Improvements in Maternity Services (AIMS), has a useful website that provides plenty of support, advice, and information on maternity choices in the UK (see p. 310)
What is shared care? Most women have their antenatal appointments with their doctor or community midwife during pregnancy, with visits to the hospital only for routine scans or for investigating problems. Care is then transferred to the hospital midwives and obstetrician, if required, for the birth and postnatal stay
How does midwifery care work? In some areas, teams of community midwives provide continuous care throughout pregnancy, birth, and the postnatal period, and when this type of care
is available it tends to be a popular choice in low-risk pregnancies as it enables women to build up a relationship with their midwives The community midwives are responsible for your antenatal care, your care in hospital during the labour and birth, and then for home visits after the delivery. It is not guaranteed that you will have the same midwife all the way through your pregnancy and birth. For this reason, it’s a good idea to request antenatal appointments with different midwives within the team, so that you meet as many members of the team as possible during your pregnancy, and it will therefore be more likely that you will know the midwife who is with you for the actual labour and delivery of your baby,
When might you have consultant-led care? Women with pre-existing medical conditions, such as hypertension, or those with more complex pregnancy issues, such as twins or multiple births, may have the majority of antenatal care with an obstetrician. Most of their appointments may be carried out in hospital There are other conditions, such as diabetes or epilepsy, which may require the care of two specialists: an expert in the medical condition as well as an obstetrician. A hospital midwife will usually participate in this care too.
What about independent midwives? Outside the NHS, there is also the option of independent midwives Independent midwives are midwives who have chosen to work in the private healthcare sector. They charge a fee to provide antenatal care, care during labour and the delivery, and postnatal care Because they only look after small numbers of women, independent midwives can provide a continuity of care that is not always available on the NHS and they will also tailor care to suit your individual needs, for example timing antenatal appointments when most convenient for you You can find out more details by visiting the wesbite of the Independent Midwives Association (see p.310)
Does my care change if I’m having a home birth? As well as hospital delivery in a birthing or delivery unit, there is also the option of having a home birth within the NHS framework (see p 153). When a pregnancy is straightforward, research hasn’t found any difference in the safety of having a baby at home or in
hospital If you are having a home birth, your antenatal care will be provided by community midwives who are attached to a maternity unit. Once in labour, your midwife will stay with you until your baby is born, and she will visit regularly for between 10 and 28 days after your baby has been born, or you can attend a postnatal drop-in centre in your local area.
How will I choose my antenatal care? This may be partly dictated by the type of care that is available in your area. It’s worth talking to other local mothers with young children to see if they have any advice or recommendations. The type of care you receive may also depend on where you choose to give birth. If you have a low-risk pregnancy and decide to have a homebirth or to deliver in a birthing unit, then you will probably just see midwives and your doctor in your own home or the doctor’s surgery If there are complications, your care may be shared between your midwives and doctor and a hospital obstetrician.
Blood tests
How these contribute to your antenatal care
You will be offered quite a few blood tests during pregnancy and the results provide vital information that may affect your pregnancy and help your caregivers to plan your care. At your hooking appointment, you will be offered blood tests to check for the following:
• Anaemia (low iron levels).
• Your blood group
• Your Rhesus status (see p 79).
• Hepatitis B.
• Your rubella (German measles) immunity.
• HIV and syphilis
These are usually taken at the same time, so you won’t need a separate test for each!

Will life ever be the same?
special situations
I don’t have a partner, but I want this baby - will I be OK if I go it alone?
This may be a worrying time for you, but you might find it reassuring to know that many women do have babies on their own Although it would be wrong to pretend that this is as easy as it is with two parents, with additional support it is possible. You may also have very strong reasons why you want a baby, for example, increasing age, and this determination will give you strength and focus
It will be a great help too if you can find someone to talk to and confide in. This could be your mother, a close friend or relative, or perhaps a tutor. As you are making far-reaching decisions about your future, it’s important that you have support, accurate information, and time to think things through without
fear, panic, or pressure from others. Finding somebody you really trust and who you know can give you support when you need it, especially in labour, may help to relieve a lot of the pressure you are under and enable you to think more calmly and clearly about your situation and make plans as to how to proceed. A confidential service known as Care Confidential (see p 310) offers support, advice, and information for women during pregnancy
It’s worth bearing in mind too that your birthing partner doesn’t have to be the baby’s father; they can be anyone you choose
I’m pregnant and still at school, will I have to leave school?
No, you will not have to leave school, and in fact you are expected to complete your schooling to
the normal school-leaving age at the end of year 11. You should tell a senior teacher about your situation as soon as possible so that you can plan your education during your pregnancy, It may be possible to alter your timetable as you get further into your pregnancy, and you will probably get some home tuition for the few weeks just before and after the baby is born. You are allowed to take time off school for antenatal appointments, but if you are not well enough to attend school for more than a few days because of the pregnancy you will need a note from your doctor or midwife.
In some parts of the country there are education units set up specifically to assist pregnant teenagers where midwives provide antenatal care and help girls to continue their education during and after their pregnancy. Ask -your midwife or doctor for more information on these. You could also contact the government-run organization Connexions, which offers advice and support to all 13-19-year-olds in their education decisions (see p.310).
I’ve just started university and now I’m pregnant - my parents will be furious. What can I do?
Most young women feel a strong mixture of emotions when they find out they are pregnant, with many feeling terrified of telling their parents and worrying that they are somehow letting them down. However, it’s important to talk to someone, and probably the best people to talk to are your parents. When you feel able, sit down and explain the situation to them. It may help to have someone else with you to help break the news. Although your parents’ initial reaction may be one of disappointment and shock they may feel guilty too, thinking that they have failed you in some way. Try to remind yourself that ultimately your parents love you and will most likely support you, although you may need to give them some time to adjust to the pregnancy,
If you feel you really cannot talk to your parents and discuss your options, try to find a trusted and supportive adult friend to talk to Alternatively, talk to a midwife or doctor, or a tutor from university whom you trust. Any of these people will have had previous experience of situations like yours and be able to offer impartial advice
You should be able to continue with your studies and many educational institutions have childcare facilities, such as a nursery or creche - pregnancy need not mean an end to your education plans. Being able to reassure your parents on this point will help them come to terms with your pregnancy.
My boyfriend said it was safe, but now I think I’m pregnant -who can I talk to?
Although there are times during your menstrual cycle when you are less likely to conceive, it’s important to understand that there are no guarantees and, if you are not planning a pregnancy, then it is always wise to use a form of contraception
It is frightening to find out that you are unexpectedly pregnant, but confiding in someone can help enormously. First, it is important to establish that you definitely are pregnant. Home pregnancy tests, purchased across the counter in any chemist or supermarket. are very accurate (see p.34), or you can get one free from a family planning clinic.
If you are pregnant talking to a close friend or trusted relative who you believe would give you support at this emotional time may be extremely reassuring. You could also talk to your doctor or, if you are not registered with one there are ”drop-in” health centres where you can talk to a health professional in confidence Although telling your parents may seem like a frightening prospect, you may find their support invaluable, and of course you need to talk to your boyfriend, who actually may be a great source of support too.
I know my mum cares but she wants to come everywhere with me - how can I tell her to back off?
Pick the right time, over a coffee perhaps, and try to explain sensitively to your mother that you need and want to do some things on your own Let her know that although you value her support, you also need your own space and time to reflect and bond with your baby, even during the pregnancy If you state how you feel now, this will also help to set some boundaries for after the birth
Although your mother may be upset at first and possibly feel excluded, with time she will most likely come to appreciate your point of view Ask her how her own mother reacted to her pregnancy when she was carrying you You may well discover that she was overprotective too.
I thought I was menopausal, but I’m pregnant. Our youngest child is 10. How will we adapt?
It is a shock to discover that you are pregnant when you thought your childbearing years were finished. Although fertility does decline fairly rapidly in your 40s, a pregnancy is still possible, and it is not unusual for women in this age group to believe they are entering the menopause when in fact they are pregnant, as symptoms for both are fairly similar Couples may also become more relaxed about contraception, believing that a pregnancy is unlikely So a late pregnancy is not uncommon.
The pregnancy affects not only you and your partner, but the whole family: it will take a while for all of you to adjust to the news, and many different emotions may be felt during this time. The most important thing is to keep talking so that any concerns can be ironed out rather than left unresolved Involve the whole family in your pregnancy plans to reduce jealousy and make everyone feel involved and needed.
It is important too that you give your children time to adapt to the news. Some children are delighted with a new pregnancy, while others are embarrassed and may need time to adjust. Your partner may experience a mixture of emotions
too, ranging from full-on excitement at being a new dad again to shock and disbelief, and maybe even disappointment Take heart, these will be temporary feelings, and no doubt as time goes on, and as your family adjusts, you will feel more supported.
You are probably aware that there may be some additional risks associated with your pregnancy, such as an increased risk of Down’s syndrome (see p.116). When planning your care, your midwife or doctor will take into account your age and explain the appropriate tests and care available.
It’s 12 years since my last pregnancy. Have benefits and care changed much in this time?
A lot has changed since your last pregnancy. You should take time to find out about current pregnancy
Preparing older siblings
helping your older children to adapt
If you become pregnant when your other children are grown up, you may need to take more time preparing them for the arrival of their sibling.
* Don’t be cross or impatient if they seem less than enthusiastic about the baby; they may be worried about the impact a baby will have on family life
* Reassure teenage children that you will still have time for them and that you won’t just expect them to be an unpaid babysitter. * Allow older children to express their concerns and take time to reassure them.
care as there may be tests and scans available
now that you were not offered in your last pregnancy (see p 116) Also, childcare provisions and maternity benefits have improved considerably over the last few years so, even if this baby was unexpected, it may not be such a bombshell after all.
My daughter is eight years old. Will she get on with the new baby or is it too big an age gap?
There is no right or wrong age gap between siblings and, often, how siblings get on together is more to do with their personalities rather than the age difference. Although they are likely to have independent interests, she is probably very excited at the prospect of a new baby
Our first baby is only 10 months old - how can I be pregnant again?
Usually, periods begin again between two and four months after the birth, but if you are breastfeeding, your periods may not return until your baby starts on solids, or even later. Some women use breastfeeding as a form of contraception and although it reduces the likelihood of pregnancy, it is not reliable. If you are breastfeeding, the time it takes for the return of ovulation depends on the frequency, intensity, and duration of feeding, the maintenance of night feeds, and the introduction of supplementary feeding The absence of periods does not guarantee that you are not ovulating, so there is a risk of pregnancy.
It is quite possible to ovulate within a month or two of giving birth, and not unknown to ovulate as early as two or three weeks following the birth. This is why midwives always discuss contraception in the days following the birth, even though some new mothers find this an inappropriate time to discuss family planning. Although you may feel daunted at the prospect of having two very young children, there are advantages to having a close age gap. Your children are likely to grow up as playmates and the period of sleepless nights, nappy changes, and of having very dependent young children can be dealt with altogether in a shorter space of time
I’ve left it too late for an abortion - is it wicked to let my baby be adopted?
Adoption is often dismissed as an option, but sometimes it is the best choice for you and your baby The nine months of pregnancy provide you with time to explore all options available to you, including temporary voluntary foster care During this time you will be able to talk to adoption agencies and social workers who can inform you of the process and support you. View this as a positive process, in that you care enough about your baby to find the best care at a time when you feel unable to be the one to provide this.
When it comes to making a final decision, bear in mind that it should not be made during pregnancy, since you are subject to a range of emotions and feelings and you have not yet met your baby or know how you will feel in the longer term. Talk to your doctor to find out more about the process, your rights, and your right to change your mind.
My boyfriend doesn’t want to know about my pregnancy -will he have rights after the birth?
Your boyfriend is quite possibly shocked by the news that you are pregnant but, given time, he may come round to the idea and be more supportive. Although it is a difficult and hurtful time for you, try not to overreact by denying access to the father after the birth, unless you are certain this is what you want. Once your boyfriend sees your baby, his attitude and feelings may change, so it could be worth giving him time to adjust It can help to seek support from trusted family members and friends.
A biological father does not have automatic rights to be involved in the upbringing of his baby if he is not legally married to the mother and he is not named on the birth registration forms. (If the parents aren’t married, the father has to accompany the mother to register the birth if he wants to be named on the birth certificate.) If he is named on the birth certificate, he has some basic rights in terms of access and has some financial responsibility for his child If you do not wish your boyfriend to have access then you do not need to name him on the birth forms. If he has been named on the forms and you decide later that you don’t want him to have access, you will need to go to court to seek a formal injunction and be able to justify why you require this. You should bear in mind the financial implications of your decision if you do not include him on the forms and whether this means that he would not be obliged to provide financial support for you and the baby.

Young mums and older mums
Adapting to pregnancy
Pregnant women who are older or younger than average are likely to have additional concerns about how they will cope with pregnancy and impending motherhood.
How will I cope as a younger mum? There are pros and cons to being a younger mum. On the downside. you may have more concerns about how you will cope financially and how this may affect your education or career, and you may be in a less stable relationship and be concerned about the possibility of separating from your partner, On the practical and physical side, you are likely to have far greater reserves of energy to cope with childbirth and babycare, and some younger mums have good support in the form of relatively young grandparents
What can I expect as an older mum? There are advantages and disadvantages to giving birth later in life. If you are over 35, your pregnancy will be higher maintenance and you will be offered a greater range of screening and diagnostic tests as there is a higher risk of complications for you and the baby (see p 116). As a result, you are likely to be more anxious during pregnancy Once the baby is born: sleepless nights and constant childcare may be more taxing than it would be for a younger mum with greater energy reserves On the plus side, women today are fitter than ever and plenty of older women have trouble-free pregnancies You are less likely to have financial worries, are more likely to be in a stable relationship, and be more self assured and confident in your abilities.

Avoiding isolation
building up a support network
It is important for all pregnant women
to have emotional and practical support, and this is especially important if you are in a vulnerable situation.
* Attend all your antenatal appointments and build a relationship with your midwife; she is an invaluable source of information. * Book yourself in for antenatal classes. If you are single, daytime courses may be less populated by ”couples this gives you a chance to build up a network of women, which will be invaluable after the birth * Don’t be too proud to accept offers of help from friends and family

What do I tell my boss?
your rights and benefits
My manager said I can’t have time off for my antenatal clinic, is this true?
All pregnant women are entitled to paid time off to attend antenatal appointments as required by a registered medical practitioner, midwife, or health visitor. The employee must show a certificate issued by one of the above professionals to confirm they are pregnant, together with proof of the appointment. You are not expected to do this for the first appointment as this will be when you ask for the documentation Antenatal appointments include childbirth preparation or relaxation classes, as these are an important part of your care. If your employer is refusing to allow you time off, start by talking it through with him or her. If this doesn’t help, seek advice from your human resources department or another senior member of staff You can also contact trade union representatives, the Advisory, Conciliation, and Arbitration Service (ACAS), or the Citizens’ Advice Bureau (see p 310).
When is the best time to tell my employer that I’m pregnant?
As soon as your employer knows that you are pregnant, the employment laws that protect you will apply, so it’s a good idea to tell him or her straight away. It is recommended that you inform your employer in writing with details of your expected due date. Your employer should then conduct a risk assessment for you in your working environment. Any risks identified should be removed or, if this is not possible, alternative arrangements should be made for you. You can also discuss when your maternity leave will start, when you can take any outstanding holidays, and if there are any other entitlements If your baby is born early or your maternity leave starts earlier than planned due to illness, the arrangements can be altered at short notice. Your employer should respect
your right to confidentiality, so by telling them, this should not mean that everyone else at work will know. If you wish the issue to remain confidential until a certain date, you could add this to your letter.
Can you tell me about the new baby funding from the government?
The government introduced the Child Trust Fund for children born after the 1st September 2002. This is a voucher of E250 that is to be used to set up a tax-free savings account. The account will be for the child
alone and can only be accessed by them when they reach the age of 18, although they can start to plan what to do with the money from the age of 16. Once the account has been set up, family and friends can add to the savings to a maximum of £1,200 each year. When your child is 7 years old, a second payment of £250 is made and children of low-income families will receive an additional E250 around the same time that will be paid directly into their bank account. There are three types of account that you can choose to set up for your baby a savings account, an investment account, or a stakeholder account. Talk to a bank or building society about which account they would recommend.

Since I told my boss I’m pregnant he has been really dismissive - what should I do?
The law protects you from being unfairly treated as a result of you being pregnant. This includes dismissal on the grounds of being pregnant or a reason that is connected to pregnancy, If you feel that your boss is treating you unfairly, try to resolve this with him first.
To protect yourself, it is advisable that you keep your manager informed of your maternity leave, return date, and antenatal appointments. Always confirm appointments in writing or provide official documents that show appointment times You should also ask your manager about any additional benefits the company may have and when you will have your risk assessment. If your manager does not respond satisfactorily to these requests, seek advice from your human resources department, a senior member of staff trade union representative, ACAS or the Citizens’ Advice Bureau.
Am I sure to get my job back after having my baby?
The law states that all employees on ordinary maternity leave (52 weeks) are entitled to return to their original job. This is regardless of how long they have worked there or what hours they work. Exactly the same terms and conditions should also apply. If a member of staff returns after parental leave (see right), then they should return to the same job where possible, if not a suitable alternative should be given. You have to notify your employer, usually in writing, when your maternity leave is planned to start. When they receive this letter, they have 28 days to write and confirm your return date. You do not need to give notice if this is the date you plan to return, but if the planned date is different or changes, eight weeks’ notice is required. You cannot work for the first two weeks (or four weeks if in a factory) following the birth of your baby.
How long can I stay at home after I’ve had my baby?
The law changed in April 2007. All pregnant women. can now take up to 52 weeks as maternity leave, regardless of their length of continuous service at their place of work. Notification to your employer must be given before the 15th week before the baby is due (25 weeks’ pregnant).
Statutory maternity pay is paid for 39 weeks to pregnant women earning at least £87 per week with 26 weeks continuous service into the 15th week before the baby is due You need to give written notice to your employer 28 days before the start of statutory maternity pay. If you do not qualify for this benefit, you may receive maternity allowance for 39 weeks (see p.62).
Am I allowed to take additional time off unpaid after my paid maternity leave ends?
You can take parental leave after maternity leave and will be entitled to the same terms and conditions as if you were taking ”additional” maternity leave of 52 weeks (see above). This means you can return to the same job, where possible, or a suitable alternative should be found. Parental leave is a separate entitlement for employees who have worked for the company for one year and must be used to care for the child or to find suitable childcare arrangements. Each parent can take 13 weeks for each child and it is unpaid If you have twins, this means you will get 13 weeks for each twin. If you do not qualify for parental leave, you could take paid holiday or ask your employer for unpaid leave. It may be worth discussing flexible working options with them, too.

Can I refuse to do tasks during pregnancy if they might put my health or the baby’s health at risk?
An employer has a duty to comply with health and safety laws, and when you are pregnant your employer must carry out a risk assessment for you within the workplace. The sooner you tell your employer in writing that you are pregnant, the sooner this check will be conducted Your employer has an obligation by law to tell you of any risks known to the company that may affect your pregnancy, Common risks to you or your unborn child are exposure to toxic or harmful substances; lifting heavy loads; standing, sitting, or twisting for long periods of time; long working hours; or certain shift patterns Your employer has a duty to either remove the risk or, if this is not possible, remove you from exposure to the risk. This may involve a suitable alternative job or suspension on full pay.
The company is talking about redundancy - can they get rid of me when I’m on maternity leave?
Your employer is breaking the law if they make you redundant because you are pregnant or taking maternity leave This is an example of sexual discrimination, as they could not treat a man in the same way, However, if the reason is a legitimate one unconnected with your pregnancy, and they have not treated you any less favourably because you are pregnant, then this is allowed.
Apart from unfair redundancy, how else can I be discriminated against during pregnancy?
Other discriminatory issues during pregnancy include giving you unsuitable work (you should have had a risk assessment carried out, see above), changing your hours of work without your agreement, using pregnancy-related illness as a disciplinary issue, and giving you poor staff reports because you are pregnant
My friend came back to work and was demoted - are they allowed to do that?
Under the Sex Discrimination Act (1975) it is against the law for an employer to discriminate against an employee on the grounds of gender, marriage, pregnancy, or maternity leave This can be classified as direct or indirect discrimination. An example of indirect sex discrimination may be less favourable treatment of part-time workers, which may affect women in particular as more women tend to work part time than men. All employees on ordinary maternity leave (52 weeks) are entitled to return to their original job, however long they have worked at the company. If an employee returns after additional parental leave, they should return to the same job where possible, or if not to a suitable alternative. If it is felt that an employee has been demoted due to maternity leave, advice should be sought by the human resources department, a trade union representative, ACAS, or the Citizens Advice Bureau.

I want to work part time after my baby is born - do I have that right?
Currently the law states that parents of children under the age of 6, or disabled children under the age of 18, have the right to apply for flexible working, which can include different shift patterns, when -you work, how long you work, and where. You must make your request in writing. Your employer is duty bound to consider your request and must be able to demonstrate why this is not possible if it is refused. You are entitled to take a colleague with you to any meetings regarding this issue, which may be your trade union representative if you have one.
If at any point you feel that your employer has not reasonably demonstrated why the company cannot accommodate your request, you can seek the advice of a trade union representative, the human resources department, or another senior member of staff. Also, as previously mentioned, organizations such as ACAS and the Citizens’ Advice Bureau may be able to offer advice and information.
What is maternity allowance and will I be eligible for it?
Maternity allowance is a benefit for women who have changed jobs during pregnancy, are self-employed, or who have had low earnings or unemployment during their pregnancy (see p 63). Your midwife should be able to advise you on what you are entitled to and can give you a certificate to confirm your pregnancy, which is known as a maternity certificate or Mat B1. which you will need to claim your maternity allowance.
What happens if I decide to be a stay-at-home mum - do I have to give my maternity pay back?
If you decide that you don’t want to go back to
work after the birth, you must give your employer at least the amount of notice your contract requires for leaving your job, and more notice if possible. You are still entitled to receive your maternity pay for up to
39 weeks even if your employment ends, and as long
as you do not begin another job, and you do not have to pay any of this back. However, if you had additional maternity pay or benefits, you may be required to pay some or all of these back.
I want to work right up to the birth - is that allowed?
Yes, you can do this, but you may need a doctor’s medical certificate to confirm that -you are fit to do so, and you should tell your employer at least 15 weeks before your baby is due when you want to start your maternity leave. Think carefully before making this decision Late pregnancy is extremely tiring and, if your job is mentally and/or physically taxing, it may be better to begin your leave a few weeks before your due date. You will also need time to prepare for the arrival of your baby
I want to go back to work very quickly - how soon can I start?
Legally, you can return to work anytime from two weeks after the birth, or four weeks if you work in a factory However, on a practical and emotional level returning so soon may not be a good solution Most women find that it takes around six weeks to recover after the birth Breastfeeding takes around six weeks to become established too Even if you bottlefeed, it is probable that your hormones, together with the natural exhaustion that follows having a baby, prevent you from concentrating. You may find that it is hard to be apart from your baby for long periods and -you need to think about your baby’s needs too.

Maternity benefits
Your rights in pregnancy
There is a range of benefits available to pregnant women and what you are entitled to depends upon your individual circumstances and your employment status These benefits have improved considerably over the years Check your company’s policy, as individual companies may also offer their own, more generous, maternity package.
Ordinary maternity leave All pregnant employees are entitled to take 52 weeks of maternity leave, regardless of the amount of time they have worked for an employer and their salary You can start your leave up to 11 weeks before the baby is due You can choose to work up to your due date, although if you take any time off sick in the four weeks before your due date, your employer can start your leave from that date
You are obliged to give your employer a minimum of four weeks’ notice of when you intend to start your leave and a minimum of four weeks’ notice of when you plan to return. You are also legally obliged to take a minimum of two weeks’ leave after the birth of your baby You may need to inform your employer in writing of your intention to take leave Tell them the date when the baby is due and the date you want to start your maternity leave. If you meet certain criteria (see right), you may be entitled to statutory maternity pay for 39 weeks of your maternity leave, after which time you will be taking unpaid maternity leave.
What are my rights while I’m on leave?
You have the same employment rights and benefits (with the exception of your wages) while you are on maternity leave However, while on additional maternity leave, some of your rights, such as contributions to a pension, may be temporarily
suspended. While on leave, you are also entitled to build up your minimum holiday entitlement, which you can add on to your leave either at the beginning or the end
Statutory maternity pay If you have been in full-time employment, or work part-time or on a fixed contract for over six months, you are entitled to receive statutory maternity pay (SMP).You are eligible for this benefit if you have worked for the same company for 26 weeks, by the end of the 15th week before the expected week of the birth. This is paid at 90 per cent of your weekly earnings for the first six weeks and then at the lesser of £112,75 or 90 per cent of your weekly average for the next 33 weeks. This is not dependent on whether or not you plan to return to work, and you do not have to return the money if you change your mind about returning to work. Your employer will deduct your tax and National Insurance contributions, and then your employer reclaims around 90 per cent of your pay from the Inland Revenue.
Maternity allowance If you are self-employed have changed your job, or have had periods of unemployment during pregnancy, you are entitled to maternity allowance, which is a tax-free benefit from the government that is also dependent on your National Insurance contributions
Maternity allowance is paid for 39 weeks at a rate of £112.7 5, or 90 per cent of your average weekly earnings if your earnings are below this figure To be eligible for maternity allowance, you will need to have been working for at least 26 weeks out of the 66 weeks before your baby’s estimated due date, and have average weekly earnings of around £30. You can begin to claim your maternity allowance up to 11 weeks
before your baby is due, and the latest you can claim this allowance is the day after your baby is born.
Time off for antenatal care Your employer is legally obliged to allow you to take a reasonable amount of time off to attend any antenatal appointments, which can include time off to attend antenatal relaxation classes or hospital antenatal classes.
Additional benefits There is a range of other benefits that are not linked to employment, which pregnant women are entitled to claim. All pregnant women are entitled to free NHS dental care during pregnancy They are also entitled to free eye treatment and free prescriptions. You continue to be entitled to free dental care and prescriptions for you and your baby for a year after the birth.You will need to obtain your exemption certificate from your health authority and your midwife or doctor will give you the application form when you have your booking in appointment.

Paternity leave
Rights for fathers
Paternity leave can be granted for an employee who is the biological father or the partner or person who will be responsible for the child’s upbringing.
To qualify for paternity leave, an employee must have had 26 weeks’ continuous service at the end of the 15th week before the baby is due and the employer should be notified, in writing, by the end of the 15th week before the baby is due. The amount of leave granted is usually around one or two weeks, which can be taken together, but not as separate days This time off must be taken within 56 days after the birth Statutory paternity pay will be paid if an employee earns at least 87 pounds per week It will be worked out as the lesser of £112.75 a week or 90 per cent of the average weekly earnings. This is the standard paternity leave package, but individual companies may offer more generous terms and conditions.

Keeping active in pregnancy
I regularly go to the gym. I’ve just found out I’m pregnant -can I still go?
Many forms of exercise are safe during pregnancy Regular exercise keeps you fit and healthy, so if you currently exercise then it’s fine to carry on as before Although you can continue to take part in most activities during the first trimester of your pregnancy, you may need to stop more vigorous exercise as your pregnancy continues Do tell your fitness instructor that you are pregnant, so they can tailor your programme accordingly — pregnancy is not the time to break records or go for personal best! Ideal exercise gets your heart pumping, keeps you supple, manages weight gain, and prepares your muscles for the hard work of labour and delivery without causing undue physical stress for you or your baby.
Benefits of exercise
why you should aim to stay fit in pregnancy
There is no doubt that exercising during pregnancy offers numerous benefits to both mother and baby.
* Regular exercise increases flexibility and suppleness, which will benefit you in labour, * Aerobic exercise, such as swimming, increases stamina, improving blood circulation and preparing you for labour. * Exercise releases endorphins, the body’s natural painkillers, helping you to relax and lifting your mood
•    Exercise keeps backache at bay.
•    An exercise regime will help you to recover more quickly after the birth
Being active during your pregnancy can also reduce the physical discomforts of backache, constipation, fatigue, and swelling, as well as improve your mood and even help you to sleep more soundly. The Royal College of Obstetricians and Gynaecologists (RCOG) states that weight-bearing exercise in pregnancy can reduce the length of labour and may decrease delivery complications. So continue if you can.
Other forms of exercise recommended in pregnancy include swimming, walking, aquanatal classes, yoga, and pilates, as these are not high impact so are less likely to injure your joints.
What’s the best type of exercise during the third trimester?
Swimming is an excellent form of exercise and can be maintained safely throughout pregnancy
It improves circulation, increases muscle tone and strength, builds endurance, and is favoured in late pregnancy as it makes you feel almost weightless. Many women find aquanatal classes enjoyable
exercising while standing in water is gentle on the joints and helps reduce swelling in the legs, common in late pregnancy Aquanatal classes may be run either by a local midwife or by an exercise teacher trained to teach pregnant women.
Walking is a good form of exercise for this later stage of pregnancy as it keeps you fit without jarring your knees and ankles. Take some water to drink to avoid dehydration Yoga and pilates are good if you can find a registered practitioner experienced in dealing with pregnant women. Yoga teaches breathing and relaxation techniques that can help with the demands of labour and birth. Many pilates exercises are done in a ”hands and knees” position, which is ideal for pregnancy as it takes stress off the back and pelvis and, towards the end of pregnancy, can help to position your baby ready for delivery.

I’ve had a previous miscarriage - should I avoid all kinds of exercise?
Many doctors feel that it is best to avoid all but the gentlest forms of exercise in the first 12-16 weeks of pregnancy if you have had two or more miscarriages, or have had vaginal bleeding during this pregnancy
I’m not terribly fit, but would like to start an exercise regime - any advice?
If you are unused to exercise, then moderate activities, such as walking and swimming, would probably be best for you and beneficial for your baby, whereas starting a new competitive sport or vigorous exercise programme would not be ideal Your body is already undergoing huge changes with your heart, lungs, kidneys, and virtually every other major body organ beginning to work much harder. Also, the pregnancy hormones progesterone and relaxin are softening the muscles and ligaments, so soft tissue injuries, back injuries, and abdominal strain become more likely, especially if you haven’t exercised much before. Contact sports, vigorous team sports, and activities like diving and gymnastics carry the further risk of direct injury to your abdomen and uterus - especially as your uterus grows and rises out of your pelvis.
Is it safe to go jogging when you’re pregnant?
Exercise is recommended in pregnancy to improve your circulation and energy levels, boost the immune system, and increase your stamina for labour. Although low-impact activities, such as walking, swimming, and gentle toning and stretching, are ideal, if you are used to jogging and your pregnancy is straightforward, it is fine to continue in pregnancy. However, it is not advisable to take up jogging for the first time now, particularly as there is a risk of falling and hurting your abdomen, and you should avoid jogging if you have a high-risk or multiple pregnancy Other sports and exercises to avoid include gymnastics, horse riding, skiing, and squash.

When should I start doing pelvic floor exercises?
Pelvic floor exercises (see above) can be started at any stage of your pregnancy, but the earlier you start them the better These exercises strengthen the pelvic floor, which is the network of muscles that support the bladder, womb, and bowel. Strengthening these muscles helps to reduce the risk of leaking urine while coughing or sneezing, known as stress incontinence It is important that you know how to do these exercises and practise them regularly throughout your pregnancy
As well as practising the exercises shown above, another way to exercise your pelvic floor muscles is by inserting a finger into your vagina and tightening the muscles around it.

I’m very desk-bound in my job - is it dangerous to sit for long periods of time?
During pregnancy, your circulation slows down and if you sit for long periods of time with the lower leg vertical, it can make it hard for blood to travel upwards. Although this may increase the risk of a blood clot, known as deep vein thrombosis (DVT), sitting for long periods in itself is unlikely to cause a clot Your degree of risk also depends on your level of activity at other times. Exercise is the best way to minimize the risk of a blood clot and taking a brisk daily walk is ideal as it exercises your legs. There are also simple measures you can take while at work to reduce the risk of developing a clot. Try ankle movements every hour, get up and walk around every 3-4 hours, take the stairs rather than the lift, and walk over to see a colleague rather than email.
If you are especially concerned, talk to your midwife or doctor about wearing special stockings that are designed to improve circulation However, it is important that you get the right size, as stockings that are too tight can add to the problem.

I’ve been getting lower back pain - could it be due to bad posture? I’m eight months pregnant.
In a recent review of current research, more than two thirds of pregnant women reported back pain. This pain increased with advancing pregnancy interfering with work, daily activities, and sleep. Lower back pain is caused by the forward pull of the growing abdomen, so as your baby increases in size and gestation, the strain on your back is greater So although bad posture may not be the sole cause adopting a good posture is important to reduce the strain Gentle exercise also helps to reduce the pain, and water aerobics is particularly beneficial.
Some women use a Transcutaneous Electrical Nerve Stimulation (TENS) machine in late pregnancy (see p.175), which helps to block the pain nerve impulses to the brain and stimulates the release of natural painkillers called endorphins. Other tips for lower back pain include a warm hand massage using a base oil a warm deep bath, and using cushions to support you when relaxing and in bed
I’m seven months’ pregnant now and quite big. Should I adapt my swimming style?
You may find that as you get very large towards the end of pregnancy, you need to alternate your swimming style to find the one that is most comfortable for you. Apart from this, a low-impact activity like swimming is ideal as the water provides resistance, there is a low risk of injury and the mass of water relieves pressure on the abdomen and helps to ease lower back pain.
My midwife is running aquanatal classes at our local pool - are they safe?
Yes, low-impact activities such as aquanatal classes are fine in pregnancy. You are fortunate to have this facility as not all areas are able to provide classes. The trainer or midwife conducting the sessions
should be able to advise you about the range of movement recommended to minimize any risk.

We love going clubbing; will the loud music be OK for my baby?
There is evidence to suggest that babies can hear
in the womb from about 16-20 weeks. However, your baby is protected by the amniotic fluid surrounding him, so most noises do not affect him. The ears of a fetus are often full of a protective greasy coating produced by the skin, known as vernix, so external loud noises would be muffled by the time they reach your baby. Your baby is most likely to respond to your reaction to loud music rather than the music itself
There is a study that suggests that constant or regular exposure to noise can increase the risk of a small-for-dates baby, meaning your baby’s growth is smaller than expected for his gestation. However, it is more likely that it is the environment and its effect on the mother that contributes to the baby’s weight rather than the actual noise. Too much clubbing may mean you are getting too little rest and you may be drinking more alcohol than you should. You should
probably consider whether you are getting enough quality rest and ensure that you are reducing or stopping your alcohol intake, as this is more harmful to your baby than loud music.
We like walking, but should I cut down on the number of miles now that I’m pregnant?
Walking is ideal in pregnancy as it is low-impact exercise and can be maintained throughout your pregnancy If you plan to continue lengthy walks and like to walk briskly, try combining this with a slower, more leisurely pace. It’s important to control your body temperature so that you don’t overheat and feel uncomfortable To do this, drink plenty of water to avoid dehydration and wear layers that you can take on and off as required. As your tummy grows, you may find hill climbing causes physical instability, as may trekking over uneven terrain, so stick to more level paths. If you find yourself getting breathless, take frequent breaks.

Antenatal yoga
Practising yoga in pregnancy is hugely beneficial. As well as strengthening and toning muscles, which will help you in labour and birth, yoga aims to bring about a greater awareness of your breathing rhythms, providing a perfect relaxation tool in pregnancy and preparing you to breathe through the contractions. Find an accredited teacher experienced in teaching pregnant women or attend an antenatal class.

Exercise in late pregnancy
adapting your routine to suit your changing needs
Towards the end of pregnancy, you will inevitably slow down, but you may not want to stop altogether! There are sensible ways to modify your exercise regime to ensure you stay safe and fit. * In later pregnancy, avoid exercises that involve sudden movement, such as tennis, as your balance is less steady now. * Swimming is perfect in late pregnancy and aids relaxation.You may need to modify your stroke and enjoy more floating. * Reduce the intensity and length of your workout to avoid exhaustion.

Pelvic floor exercises Strengthening the muscles that support pelvic organs
Learning how to exercise your pelvic floor muscles is vital in pregnancy to help you avoid stress incontinence (leaking urine). This discreet exercise can be practised any time. Pelvic floor exercises involve squeezing your buttocks in and pulling in your tummy muscles, then holding for 5 seconds and releasing. Repeat this 5-6 times several times a day. You could imagine your pelvic floor going up like a lift, contracting your muscles a little more at each floor.

Safe exercise
Taking care in pregancy
Although exercise is highly recommended during pregnancy, this is a time when you may have to moderate your usual programme, especially as you get bigger, and avoid types of exercise or situations that may put you or your baby at risk.
What safety precautions should I take? If you are taking up exercise during pregnancy, be sensible about which type of exercise you choose. Avoid any type of exercise that is too strenuous and opt for low-impact activities, such as walking and swimming. Always do warm-up stretches before exercising and build up your stamina and fitness gradually. This is especially important as hormones in pregnancy relax joints and ligaments
in preparation for labour (see opposite), which means that you are more susceptible to injury. Avoid exercising in very hot conditions as this may be harmful to the baby; in hot months, exercise early in the morning or indoors Also, avoid exercising near traffic as you are more likely to be affected by pollution while exercising. Your centre of gravity changes in pregnancy, so avoid high-impact, fast-moving sports, such as tennis.
Should I stop exercising at any time?You should stop exercising straight away if you feel dizzy or short of breath; if you feel that you are overheating; if you are experiencing pain in your back or pelvis; or if you feel exhausted.

What to eat … What not to eat
your diet in pregnancy
I love seafood and eat it regularly. Can I continue to eat it during pregnancy?
Eating raw or undercooked shellfish is risky and should be avoided as they can contain harmful viruses and bacteria Raw oysters can carry a virus called Norovirus, which causes nausea, abdominal pain, and diarrhoea, and raw or partially cooked shellfish can contain hepatitis A, a virus that affects the liver However, eating well-cooked prawns, lobster, oysters, clams, cockles, scallops, or crab is now considered safe as cooking kills any bacteria or viruses Nutritionally, too cooked shellfish are beneficial as they are low in fat, high in proteins
and rich in minerals A well-cooked prawn or lobster turns red and its flesh opaque, while a cooked scallop is opaque, white, and firm to touch Clams, mussels, and oysters open their shells when they are well cooked – throw away any that don’t open. Make sure you buy shellfish from a reputable source.
My midwife said I should avoid pate. Why?
All pates including those made from vegetables
or fish, should be avoided during pregnancy unless they are tinned or have been heat-treated. This is due to the risk of listericsis, a rare infection caused by the bacterium Listeria monocytogenes found in pates, blue-veined and some soft cheeses, unwashed salads, and ready-to-eat foods Listeriosis resembles a mild ‘flu”, with symptoms such as aching, sore throat and a raised temperature However, even a mild infection can cause miscarriage, stillbirth, or severe illness such as meningitis or septicaemia in the newborn Another reason to avoid liver pate (and also fish liver oils, liver sausage, and liver) is that it contains high levels of vitamin A, which has been linked to birth defects.
I like to eat rare steaks - are they allowed in pregnancy?
No. You should make sure that you eat only meat that has been well cooked, as raw meat contains bacteria that can cause food poisoning. This is especially important with poultry and products made from minced meat such as sausages and burgers. Meat should be cooked until it is piping hot all the way through, there is no pink meat, and the juices run clear. Wash -your hands after handling raw meat, and keep it separate from foods that are ready to eat You should also avoid eating raw eggs and undercooked poultry because of the risk of salmonella
I eat a lot of mozzarella, but
is it counted as one of the “soft cheeses” to be avoided?
Cheese is one of the top worries for pregnant women according to a health research charity. However, soft processed cheeses, such as mozzarella, cottage cheese, and cream cheese are safe to eat throughout pregnancy. The advice is to avoid cheeses such as Camembert. Brie or Chevre (a type of soft goat’s cheese), or others that have a similar rind and blue-veined or mould-ripened cheeses, as these could contain listeria, a type of bacteria that could harm your baby (see above) According to the Food Standards Agency, cooking should kill any listeria, so it should be safe to eat food containing soft, mould-ripened, or blue-veined cheeses, provided it has been properly cooked and is piping hot all the way through.
I’ve started to crave chocolate all the time - is this likely to harm my baby?
It’s not unusual for women to experience cravings in pregnancy. Most are “normal”, while others, such as urges to eat earth, coal, chalk, or soap, are not, although they do sometimes happen!
Normal cravings can include a desire to eat anything from pickled onions and ice cream to chocolate. Do mention this craving to your midwife as she may want to check that you are not deficient in magnesium, B vitamins, or iron, all found in dark chocolate. A little indulgence is fine, but giving in to a pregnancy full of chocolate could cause nutritional deficiencies if it stops you eating a well-balanced diet, and lead to excessive weight gain.
However, eating chocolate in pregnancy has been linked to contented babies; this may be due to a high intake of phenylethylamine, a mood-enhancing chemical present in chocolate (also present in larger quantities in tomatoes and fruit), or it may be due to happy, relaxed mothers who have indulged!
I love spicy foods but have been told these may trigger an early labour - is this true?
Many people believe that eating a curry encourages the start of labour, but this is completely untrue. Although the reasoning behind this sounds logical, the theory does not work. One of the less talked about first signs of labour is a loose bowel motion or even diarrhoea This occurs because the cervix (neck of the womb) and part of the bowel have a common nerve supply. As the cervix starts to soften in readiness for labour, so the bowel is stimulated. This may cause faster movement of food and more frequent, looser bowel motions. Labour may follow in
the next few hours or it may not happen for a day or so. Some people think that if you eat an extra hot curry, for example, to bring on a bout of diarrhoea, this will stimulate the cervix and labour will start Unfortunately, the process doesn’t seem to work reliably in reverse. Labour following self-induced diarrhoea is probably coincidental, and the side effects of abdominal cramps, diarrhoea, and soreness are disagreeable.
However, if you regularly eat curries and spicy food, and have not been suffering from heartburn or indigestion, then there is no harm in treating yourself every now and then
I’m fed up with people telling me what I should and shouldn’t eat and drink - what do you say?
While no health promoter wants to be prescriptive there is plenty of research highlighting the ill effects of poor nutrition, smoking, alcohol, and drug misuse on the fetus. Members of the heath profession, and even friends and family, may have personal experience of babies born with low birth weights, birth defects, syndromes, withdrawal symptoms, or infants who go on to develop allergies in childhood, such as eczema and asthma. The reason people are offering advice is because they want what is best for you and your baby In the first three months in particular, while your baby’s organs are developing, lifestyle choices carry a risk If you can, try to take on board this advice as long as you are sure it is correct, current, and evidence-based.

I’m really overweight - could this affect my pregnancy?
The medical concensus is that women with a high body mass index prior to pregnancy (see p.18) should try to limit the amount of weight they gain, as putting on too much weight increases the risk of developing high blood pressure, gestational diabetes, and having a big baby, The recommended weight gain in pregnancy is 10-12.5 kg (22-28 lb), If you gain weight within this range, you have a lower risk of complications during labour and birth.
However, pregnancy is not the time to go on a diet. Research shows that, for a pregnant woman who is overweight, a low-calorie diet does not reduce her chances of developing high blood pressure or pre-eclampsia and doesn’t benefit the baby Instead, you should seek advice from your midwife or doctor about how to eat a healthy, well-balanced diet that will ensure you don’t pile on the pounds, but which keeps you and your baby healthy (see p.50).
I want to get back into my jeans right after the birth. How can I make sure I don’t get too fat?
These days, it is almost impossible to pass a newspaper stand without seeing the latest celebrity who has not only fitted straight back into her clothes
after having her baby, but who actually weighs less than she did before her pregnancy. However, this is concerning for health professionals, as a dramatic weight loss after the birth is not good for the mother or for her baby The average weight gain during pregnancy is 10-12.5kg (22-281b) (see p. 107). Your baby (including the placenta and the waters surrounding the baby) makes up approximately 5kg (11 lb) of this, with 6 kg (131b) gained from increased fluids, fats, and an enlarged uterus Much of this extra weight will be lost as soon as your baby is born. Also, after the birth, some of this extra weight provides nutrients for breastfeeding, which uses up to 500 calories a day.
The most sensible approach to controlling your weight during pregnancy is to eat a healthy diet and take gentle exercise to ensure that weight gain is not too dramatic You should be eating around 2,1002,500 calories a day, increasing this by 200 calories in the last trimester — the equivalent of a couple of slices of toast with low-fat spread and a glass of milk.
It is important to be realistic about postnatal weight loss. A sensible guide is “nine months on, nine months off” and most dieticians recommend losing no more than 0.9kg (21b) a week. This may not seem much, but adds up to 6kg (141b) in seven weeks — achievable with healthy eating and exercise.

Is it alright for me to have the occasional glass of wine throughout my pregnancy?
This is really a personal choice you need to make in pregnancy Although experts do not agree on the exact level of alcohol needed to cause harm to babies during pregnancy the general consensus is that drinking has to be heavy and regular to cause a dangerous condition known as fetal alcohol syndrome (see p 37).
However, you should be aware that alcohol crosses the placenta to your baby very easily and quickly, and that drinking during pregnancy could potentially damage -your baby and -your own health. The government’s official advice is not to drink alcohol when you are pregnant or trying to conceive If you do decide to drink, make sure it is no more than one or two units, just once or twice a week. Many women give up alcohol during pregnancy and you may feel that you simply no longer enjoy the taste. It’s also worth noting that although alcohol doesn’t contain fat, it’s high in calories, with a glass of dry white wine containing over 100 calories.
I have a really sweet tooth - is it OK to indulge this during pregnancy?
While occasional treats of sweets or crisps are fine, processed foods usually contain hidden fats and sugars and provide few nutrients, so it’s best to try and curb the amount of sweet foods you eat. Read food labels and look for alternative foods containing less fat and added sugars Just as you would consider carefully how you wean and feed your growing child, you should look after yourself in the same way
One of the best ways to curb your sweet tooth is to eat regular meals throughout the day This helps to steady your blood sugar level and reduce sweet-tooth cravings. Try not to go longer than three hours without eating and, if you are hungry, have a healthy snack between meals, such as malt loaf, a cottage cheese sandwich, chicken or lean ham, a low-fat yogurt, or fruit, including fresh. tinned, or dried, such as raisins or apricots. Also, try to ensure that you
drink about two litres of water a day, as perceived hunger is often really dehydration. If you can’t give up sweet drinks, you could try artificial sweeteners, such as saccharin. There is no evidence that small amounts of these are harmful during pregnancy or while breastfeeding
Should I be taking vitamin supplements during my pregnancy?
There is still uncertainty about whether women who have a well-balanced diet need dietary supplements during their pregnancy If you do decide to take a supplement, it is important to choose one that is designed specifically for pregnant and breastfeeding women and which contains the appropriate mix of vitamins and minerals A good pregnancy supplement contains more folic acid, calcium, and iron than a general multivitamin and no vitamin A.
If you do take a supplement, it’s still important to eat a varied, well-balanced diet If you are unsure at all about which medicines and supplements are safe during pregnancy, your local pharmacist will be able to advise you You can buy antenatal supplements
at almost any chemist, or your doctor may prescribe them if he or she feels that your diet is providing insufficient nutrients.
I don’t have a very balanced diet - does this matter?
Maintaining a balanced diet is important and especially so in pregnancy Now is a time when you need to make sure that your diet is providing you with enough energy and nutrients for the baby to grow and develop, and for your body to deal with the changes taking place. So yes, your diet does matter.
Your daily intake should include foods in approximately the following proportions: a third fruit and vegetables (at least five portions a day); a third carbohydrate-based foods like bread, potatoes, cereals, and pasta; a sixth of protein foods like meat, poultry, pulses, cheese, and other dairy products; a small amount of sugar and fat; and at least eight glasses of water each day It’s a good idea to cut down on foods such as cakes and biscuits, which are high in fat and sugar, to avoid putting on too much weight. If you feel you need some advice, discuss your diet with -your midwife or doctor, who may also recommend that you take vitamin supplements in addition to your food (see above)
Is it safe to eat peanuts or foods containing peanuts during my pregnancy?
Some experts feel that if a child is at a particular risk of developing a peanut allergy, the problem may have started to develop before birth, when a sensitivity to peanuts may have started due to exposure in the womb from the mother’s diet
However, some recent studies have suggested that avoiding peanuts may actually be increasing the incidence of allergies, pointing to countries where peanuts area staple food and allergies relatively rare.
Your baby may be at risk of a peanut allergy if you, or your partner, or your baby’s siblings suffer from asthma, eczema, hay fever, or other allergies. Official government advice is that if you fit into any of these groups, you should not eat peanuts, or peanut products, in pregnancy or while breastfeeding. There is no need to avoid peanuts if your baby is not at risk of peanut allergy Other nuts, such as hazelnuts, Brazil nuts, and wainuts, are safe to eat during pregnancy.
Weaning information has also changed, with ‘`at risk’ families being advised to delay the introduction of peanuts until the age of three
Does what I eat in pregnancy influence my baby’s long-term health?
There are reasons to believe that what you eat during your pregnancy can influence your baby’s health long term and possibly her tastes too. Some experts have suggested that problems that occur later in life, such as obesity diabetes, and other health problems, may be caused not so much by what a person eats during their own lifetime, as by what their mother ate while she was pregnant
Also, there have been studies that have looked at links between a pregnant mother’s protein and carbohydrate intake and a baby’s blood pressure.
Research undertaken at Tommy’s Maternal and Fetal Research Unit (see p.310) suggests that a mother’s diet in pregnancy and while breastfeeding does influence the health of her offspring throughout their lives Studies reveal that pregnancy diets rich in fat have been associated with the later development of breast cancer in children and further research is being carried out Talk to your midwife for advice on eating a varied, well-balanced diet.

Non-alcoholic drinks
It’s important to stay well hydrated in pregnancy to combat fatigue and avoid constipation, which is a common side effect of pregnancy due to a sluggish digestion brought about by hormonal changes in your body. The advice is for you to aim to drink around two pints of fluid every day. This fluid should come mainly from water, but there are other good
sources of fluids including herbal teas (avoid raspberry leaf tea until later in pregnancy, see p, 144), fruit juices, and milk. However, try not to drink too much milk as it has a fairly high calorie content (stick to skimmed or semi-skimmed). Avoid, or limit your intake, of drinks
containing caffeine, including tea, coffee, and carbonated drinks, as caffeine interferes with your absorption of vitamins, and high levels of caffeine have even been linked to an increased risk of miscarriage

Cravings
should you give in to a food craving?
No-one is really sure what causes food cravings in pregnancy, although it may be a mixture of hormonal, physical, and psychological factors.
* The most common cravings are for sweet or salty foods; these are OK to indulge now and then, but are lacking in nutrients so try to limit your intake
* Cravings for foods such as fruit or fish may be a natural desire to eat as healthily as possible in pregnancy
* Strange cravings, known as ”pica”, for items such as chalk, may indicate an iron deficiency - and should not be indulged!

Taking Medicines in Pregnancy

What is safe to take?
The advice to pregnant women is to avoid taking any medicines in pregnancy if at all possible. If you do need to take medication, check with your midwife or doctor first, or ask your pharmacist for information on over-the-counter drugs. The list below offers some guidance
Antiemetics: For women with severe morning sickness, an antiemetic drug may be suggested Your doctor will recommend one that is safe to take in pregnancy
Antihistamines: Most of these should be avoided in pregnancy. If you have hay fever, try to avoid known triggers and allergens or talk to your doctor about safe medications in pregnancy
Painkillers: If natural remedies, such as a head massage to relieve a headache, or a warm bath to ease backache, don’t work, then paracetamol is generally considered safe for short-term use in pregnancy although it should be avoided if possible. Ibuprofen should be avoided altogether. as should aspirin (unless specifically prescribed by your doctor)
Antibiotics: There are antibiotics that are safe for use in pregnancy. Penicillin-based ones are usually prescribed, or if you are allergic to these there are other safe alternatives The following ones should be avoided in pregnancy!
* Tetracylines can affect the development of a baby’s bones and teeth and may cause discolouration of the teeth.
* Streptomycin can cause damage to the ears of the growing fetus and result in hearing loss and so should be avoided in pregnancy
* Sulphonamides: These cause jaundice in the baby and should not be given in pregnancy
Laxatives: If you are suffering with constipation, try natural dietary remedies first, such as eating lots of fibre and drinking plenty of fluids If these don’t work, then over-the-counter laxatives are
safe to take in pregnancy. Ones that contain bulking agents are the best.
Antacids: Heartburn is a common problem in late pregnancy due to the pressure of the baby on the stomach. Antacids are generally safe to take, but avoid sodium bicarbonate as the sodium is absorbed into the bloodstream.
Diuretics: These should be avoided If you experience sudden swelling in the face, hands, or feet, you should talk to your doctor or midwife, as this is one of the signs of pre-eclampsia (see p 89)
Cold and flu remedies: As these remedies often contain a variety of ingredients, which can include antihistamines and other decongestants that are best avoided in pregnancy it’s important to check the label carefully and talk to your doctor or pharmacist before taking any of these Try natural remedies, such as steam inhalations, before resorting to medicines, or simply take paracetamol for a short time.
Steroids: Anabolic steroids should not be used in pregnancy. It’s safe to use mild steroid creams short term for eczema, although avoid using these over a large surface area. Steroid asthma inhalers are safe, as are steroids prescribed for other conditions if your doctor knows you are pregnant.

Why is pregnancy so scary?
a safe pregnancy
Is it OK if I cut down on smoking, rather than give up?
Although you may be tempted just to cut down, many smokers inhale more deeply when smoking fewer cigarettes and so their intake of damaging toxins increases. The carbon monoxide, nicotine, and other substances that you inhale pass out of your lungs, into your bloodstream, and cross the placenta Nicotine makes your baby’s heart beat faster as he struggles to get oxygen, which can affect his growth rate. Smoking increases the risk of miscarriage, premature birth, and low birth weight, and exposure to tobacco chemicals makes your baby more likely to suffer from conditions such as asthma and chest infections after the birth, which may be bad enough to warrant a hospital stay. There is also a higher risk of cot death if you or your partner smokes.
Can passive smoking affect my unborn baby?
In a word, yes. If you live with a smoker, you will be inhaling thousands of toxic carcinogenic chemicals that are released into the air around you from the burning end of the cigarette and the exhaled smoke Several studies have confirmed that passive smoking can result in health problems and increase the risk of
miscarriage and premature birth. There has also been a link between passive smoking in pregnancy and an increased risk of central nervous system tumours in children and a reduced IQ.
I’ve been told that sunbeds and Jacuzzis can harm my baby. Is this true?
Although there is no evidence that sunbed or jacuzzi use cause harm to the unborn baby, it has been reported that a rise in the mother’s temperature which can happen while on a tanning bed, or in a hot tub or sauna, may in turn increase the temperature of the fetus. A temperature above 39°C (102°F) has been associated with spinal malformations in developing babies, and if a rise in temperature is maintained for long enough, it has been suggested that it can cause brain damage. The temperature of the amniotic fluid around the baby can also increase and it is thought that an extreme rise in your body temperature can cause problems with the flow of blood to the baby particularly in the first 12 weeks of pregnancy. Generally, the advice is to limit sunbed use and sunbathing because of the risk of skin damage leading to skin cancer In pregnancy it would be best to stop or limit sunbed and jacuzzi sessions, and take extra precautions when sunbathing
Is it safe to use a microwave?
Microwaves use electromagnetic radiation, which causes water molecules in food to vibrate to produce heat. The radiation levels in modern microwave ovens are low and not thought to pose
a risk to the health of either a woman or her unborn baby although there hasn’t been extensive research It is best not to use a microwave if it is very old or is not working properly, as there is a slight risk of radiation leakage. Always follow the instructions.

My friend says it’s dangerous to dye my hair while I’m pregnant. Is she right?
A concern is that chemicals in hair dye could be carried via your bloodstream to the baby. However, hair dyes are not thought to be highly toxic, and women who colour their hair are exposed only to low amounts of chemicals Any risks, if there are any, are lowered after the first 12 weeks, when the main organs and systems of the baby’s body have formed. If you are dyeing your own hair, wear gloves, don’t leave the dye on for longer than needed, rinse your scalp thoroughly with fresh water afterwards, and use the dye in a ventilated room. You could try alternatives such as henna. or opt for highlights where the dye doesn’t come into contact with skin
Is it safe to take over-the-counter painkillers while I’m pregnant?
Many women are concerned about the safety of medications in pregnancy (see p.43) Any medicine taken by a pregnant woman can cross the placenta and enter the baby’s bloodstream; the effects on the baby depend on what the medicine is and at what
stage of pregnancy it is taken. As the first 12 weeks is a critical time for the fetus when its limbs, organs, and systems are forming, many women choose to avoid all but the most essential medication at this time Most experts believe that paracetamol is safe on an occasional basis, but that aspirin and ibuprofen should be avoided. Codeine-based painkillers are thought to be safe in small amounts but should be approved by a doctor. Any persistent pain should be brought to the attention of your doctor or midwife
Since I’ve been pregnant, I’ve had terrible headaches. Could computer work be the cause?
Tension headaches and migraines are common in pregnancy, probably due to fluctuating hormones. Also, it is not uncommon to have severe headaches with prolonged computer use. This could be due to eye strain and the fact that you are immobile, which can cause tension Minimizing computer use and taking breaks may reduce the risk of headaches. If this doesn’t help, talk to your manager about moving to a different area of work at least until later in pregnancy (headaches are often worse in the first trimester) This is your right as a pregnant woman.

I’ve been told I should wear gloves when gardening. Why?
The main concern for a pregnant gardener is toxoplasmosis The parasite Toxoplasma gondii can be found in soil usually from cat faeces, and can be passed from hands to mouth or eyes Although toxoplasmosis doesn’t affect healthy adults with good immune systems, if contracted in pregnancy it can have serious consequences. There is a 40 per cent chance that the infection will be passed to the baby, causing miscarriage or stillbirth blindness, brain damage, or other health problems later However, contracting toxoplasmosis in pregnancy is rare — only about 1 in 500 pregnant women in the UK contract it.
There are simple precautions to make gardening safe in pregnancy, such as wearing gloves when touching soil or plants, washing your hands with soap and water after gardening. even if you wore gloves, and not touching your face or eyes while gardening or until you have washed your hands Wear gloves too if you have to change cat litter.
I work for a dry cleaner. Could the chemicals harm my baby?
Concerns about dry cleaning chemicals stem from research showing that women who operated dry cleaning machines had a higher risk of miscarriage If touched or inhaled, some organic solvents used in dry cleaning machines can pass through the placenta and some are thought to increase the risk of miscarriage or birth defects In pregnancy, try to limit your contact with organic solvents and industrial chemicals Your employer should carry out a detailed risk assessment and it may be necessary to change your duties for the duration of your pregnancy
Should I worry about pollution?
There have been studies on the effects of pollution on unborn babies The WHO (World Health Organization) reviewed the evidence in 2004 and concluded that pollution can negatively affect lung growth in unborn babies, leading to respiratory problems. One study found a link between pregnant women being exposed to high levels of carbon
monoxide and ozone in the second pregnancy month and an increased risk of heart defects in the baby Another study found a link between nitrogen dioxide pollution and an increased risk of premature birth. All studies stated that further research is needed in order to provide conclusive evidence.
Simple measures can reduce your exposure to pollution during pregnancy, such as avoiding busy streets, avoiding exercising near traffic, standing back from the kerb when crossing a road, and avoiding having to stand for too long on central reservations. Try not to travel during ”rush hour” and, if you live in a town, spend some time in the countryside. Keep your home ventilated, and use a doormat to trap outdoor pollutants.
I’m asthmatic. Can I use my inhalers during pregnancy?
It is essential that you keep asthma under control in pregnancy, which means continuing to use your inhalers, as the risks from uncontrolled asthma are greater than any risk from taking asthma medication If asthma is uncontrolled, it can mean that not enough oxygen gets to the baby, leading to a low birth weight and increasing your risk of pre-eclampsia (see p 89). One of the best ways to control asthma, in addition to taking medication, is to avoid ”triggers”, such as pet fur and dust mites. Use air filters, vacuum and damp dust, and use duvet and pillow protectors Sometimes, pregnancy reduces the severity of asthma However, if you feel wheezier than usual, talk to your doctor about reviewing your medication.

Is it safe to sleep on my back?
This is more of a problem in late pregnancy when lying on your back can cause the baby to press on the large blood vessels that carry blood to and from the heart, making you dizzy However, in a healthy pregnancy, you are unlikely to harm yourself or the baby by sleeping on your back for brief periods. If you stayed on your back for long, you would wake feeling uncomfortable and change position anyway,
Often, the best sleeping position is on your side, preferably on the left to make it easier for the heart to pump blood around. A pillow under your tummy and one between your knees can increase comfort (see p 111) If you want to sleep on your back, put a pillow under one side to tilt your body and take the pressure off the large veins and lower back.
We’re renovating an old house. Could dust from old lead paint harm my baby?
You are right to be concerned about exposure to lead Lead was a common ingredient in paint before the mid-1970s It’s unclear exactly what the risks are,
partly because it’s difficult to measure how much the body absorbs substances, and partly because of the lack of research on the effects of lead in pregnancy. However, lead has been linked with a higher risk of miscarriage, prematurity, low birth weight, and early infant death. You’re exposed to lead if you scrape or sand lead paint causing you to inhale lead dust Get professionals to remove lead-based paint while you are out, and air rooms thoroughly afterwards
My partner works with pesticides - is this a problem?
A pesticide is a substance or organism used to control or destroy a pest and is generally toxic to the human body It is possible that exposure to harmful substances could affect a man’s fertility, but there is no evidence that substances in the semen interfere with the normal development of a baby, or that substances on a father’s clothes or shoes can affect the mother prior to or during pregnancy If your partner’s workplace is properly regulated, he should be wearing protective clothing and practising good hygiene to reduce his exposure to toxins.

Travelling abroad
Enjoy hassle-free travel in pregnancy by planning ahead and taking sensible precautions If you need to fly check the airline’s guideliness, many require a doctor’s note after about 28 weeks to say that you are fit and most won’t take pregnant women from around 34 weeks. * Check whether immunizations or other precautions, such as anti-malaria treatment, are needed
* When flying, take frequent sips of bottled water. move your legs and ankles to lessen the risk of a blood clot, and wear support stockings.
*’VVhen abroad, drink only bottled water and wash your hands before eating.

NOW YOU’RE PREGNANT
My test is positive
-what happens next

We’ve confirmed the pregnancy - when should we tell everyone?
This is down to personal preference. Many women wait until after their first scan at around 12 weeks before announcing their pregnancy This is mainly because the chances of miscarriage are at their highest during the first trimester. This avoids having to break the news if you do miscarry On the other hand, you may value others’ support Circumstances may dictate that you tell people earlier for example, if pregnancy symptoms are pronounced. Some couples find that waiting to share the news allows them to adapt to the idea of parenthood without constant ”advice” from others.

It’s what we wanted, but now I feel unsure - am I just scared?
Finding out you are pregnant, even if it was planned, can feel overwhelming and what you are feeling is perfectly normal. The hormonal changes you are experiencing can also give you highs and lows, which you have to handle along with the physical changes of pregnancy. Talking to your partner, a trusted family member or a friend, or confidentially to your midwife, about how you are feeling may help relieve your anxiety It’s important to acknowledge that pregnancy is a period of enormous change —physically, emotionally, socially, and financially — and it takes time to adjust to these changes.
I want the baby but my partner doesn’t - can he force me to have an abortion?
No, whether or not you proceed with the pregnancy is your decision. Your partner may simply need more time to adjust, but if he remains adamant that he doesn’t want the baby you need to decide about the future of your relationship.

My mum has strong opinions about pregnancy - how can I tell her I want to do it my way?
You could take your mother to an antenatal appointment so she can see how things have changed and your midwife can explain the reasoning behind your care. If she still interferes, have a frank talk Tell her that although you love her and know she wants to help, you want to make your own decisions. Hopefully she will come round to your point of view

We don’t feel ready financially -how will we cope?
There are ways to cut costs when preparing for your baby, Although some items should be new, such as mattresses and car seats, many things can be bought second-hand or passed on from friends and relatives, who may also wish to buy an ”item’ There is a range of monetary and health benefits that you may be entitled to (see pp.62-3). Also some families are eligible for a Sure Start Maternity Grant, a one-off payment that doesn’t have to be paid back, and child benefit is paid to all people bringing up children A child trust of E250 is also available for each baby born in the UK (see p 6 1). Your midwife can give you contact details for any benefits you are entitled to

I’m pregnant by IVF - is there anything different I should do?
Some experts believe that once pregnant, providing there are no other risk factors. you should be treated the same as unassisted low-risk pregnancies. Others believe that you are already a higher risk because
you needed help to conceive. Recent research suggests a link between IVF and growth problems, so regular scans may be sensible. Your hospital may have a policy for IVF pregnancies and you could speak to your midwife about consultant care.

wnen will I have my first antenatal appointment and how many can I expect?

Your first appointment with the midwife, known as the “booking appointment”, usually takes place between 8 and 12 weeks. This tends to be the longest one as its purpose is to obtain your medical history and carry out a series of checks (see p.74) so that your care during pregnancy and birth can be planned.For a first pregnancy with no complications, 10 appointments are usual, and for subsequent pregnancies, 7 visits are adequate. You can contact your midwife between appointments if you have any concerns or questions.

I got pregnant straight away - are we super-fertile?If you have intercourse around ovulation time and neither of you has fertility problems, you have a 25 per cent chance of conceiving. So I’m afraid this just indicates that intercourse was well timed!

My partner treats me as if I’m made of glass. How can I show him that this isn’t necessary?
Discuss your feelings and allow him to voice his concerns. Ask him to come to an appointment, as the more he understands, the better equipped he will be to provide more appropriate support when needed.

How will I know I’m pregnant? FAQs.

I think I might be pregnant -what is the best way for me to confirm this?

By far the most accurate way to confirm a pregnancy is to perform a home pregnancy test. If used correctly, these are extremely accurate. Your doctor can offer a pregnancy testing service if confirmation is required This may be the case if, for example, you test too early and get a false negative result (see below) and then lose faith in the home test Apart from a home pregnancy test, pregnancy can also be confirmed with a blood test, although this is usually only done if there are possible problems such as irregular bleeding. Occasionally, ultrasound scans are used to confirm a pregnancy particularly if there is a question mark about the dates, although an embryo cannot be seen on a scan until at least four weeks after conception.

I feel pregnant - how early can I do a test?

Pregnancy tests determine if you are pregnant by detecting a hormone called human chorionic gonadotrophin (hCC) in your urine. This pregnancy hormone is released when the fertilized egg is implanted in the lining of the womb and it rises significantly in the early stages of pregnancy.Most pregnancy tests can now detect hCG as early as the day you are due to have your period. If you have irregular cycles, use your longest recent cycle to determine when you should test

My period is late but the pregnancy test was negative. Could I be pregnant?

If your test was negative and you still think you may be pregnant, wait for three days and perform another test! there may not have been enough hCG in your urine when the first test was carried out. If you have had two or three negative tests and still feel you may be pregnant, or your period has not arrived, ask your doctor for advice as there may be a number of medical reasons apart from pregnancy why your period has not arrived.

Are home pregnancy tests reliable?

If you follow the instructions carefully, home pregnancy tests are around 97-99 per cent accurate. When you are carrying out a home pregnancy test, it is advisable to use the first urine sample of the day and to not drink too much fluid the night before This is to prevent the sample becoming too diluted, which could make it difficult to measure the levels of hCG. Certain fertility medications can interfere with the results of a pregnancy test, so if you have been undergoing any fertility treatment and think this may apply to you, you should ask your doctor or fertility clinic for more information and advice. Doing a pregnancy test too early in pregnancy can produce a false negative result, which means that the test reads negative but you are really pregnant. If you think this may be the case, repeat the test in three days’ time.

I’m on the Pill but my doctor has confirmed I’m pregnant.
How can this have happened?
The oral contraceptive Pill is around 92-99.7 per cent effective, depending on the brand and how reliably it is taken. Although figures indicate that approximately 8 out of 100 women do become pregnant during the first -year of using the Pill, other studies indicate that
when the Pill is taken properly as instructed this figure falls to less than I out of 100
Ideally, the Pill should be taken at the same time each day although some types can be taken up to 12 hours late. If you forget to take even one Pill, you increase your chances of getting pregnant. If two or more Pills from the same packet are missed, this can dramatically increase the risk of pregnancy if no other contraception is being used.
Certain drugs, such as antibiotics, some herbal remedies, and other medicines can interfere with the reliability of the Pill Also, sickness and diarrhoea can reduce the Pill’s effectiveness. Talk to your doctor, who will be able to help and advise you about what your options are next.
My girlfriend has told me she’s pregnant - how can I be sure it’s mine?
Unfortunately, the only way to be sure that you are the father of her baby is to take a DNA test, which can be carried out several weeks after the baby is born. To do this, you will need the consent of the
mother, as samples of DNA will need to be obtained from the child (and possibly from the mother too). DNA (deoxyribonucleic acid) is found in our body cells and is responsible for our genetic makeup and hence our characteristics. DNA is identified in a blood sample or from a scraping of cells inside the cheek. Samples from the child and partner need to be obtained in the same way,
I drank and smoked quite a lot before I realized I was pregnant. Will this affect the baby?
As you are probably aware, it is not advisable to drink and smoke during pregnancy. There are, however many women in your position who did not realize they were pregnant and continued to smoke and drink The important thing is to stop drinking and smoking now and take the best possible care of yourself and your baby As many young women ”binge drinks’, it is important for women of child-
bearing age to be aware that alcohol does cross the placenta and is a toxic substance to the baby. Most women, once they realize they are pregnant, stop drinking immediately and this is the best course of action for you to take.
If a mother continues to drink heavily, the alcohol can adversely affect the developing fetus, especially between weeks 4 and 10 of pregnancy, and serious complications, such as fetal alcohol syndrome and fetal alcohol spectrum disorder can develop. If one of these conditions develops, it can result in physical, behavioural, and learning disabilities that can have lifelong implications for the baby Drinking in pregnancy also increases the risk of miscarriage and premature labour.
The harmful chemicals in smoke can restrict the baby’s growth and cause dependency on nicotine even within the womb (see p 42) so give up now
I haven’t got any pregnancy symptoms yet - when are they likely to start?
Not everybody feels the full range of pregnancy symptoms as soon as they become pregnant, and it is not uncommon for some women to experience none at all. There are many factors that influence the range and intensity of pregnancy symptoms, such as your age, working environment, your state of health, diet, previous pregnancies, smoking, and how your body reacts to pregnancy hormones.
Nausea and vomiting are among the most common symptoms that women report, usually in the first three months and starting at around six weeks. These tend to improve by 12 weeks, but for some women can continue throughout the pregnancy.
Another early pregnancy symptom is breast tenderness, which is caused by changes in the levels of hormones that help to get your breasts ready for breastfeeding. The breasts may enlarge and become tender and heavier.

My partner doesn’t seem as enthusiastic as me about the pregnancy - should I be worried?
Men and women can react to the news of a pregnancy in different ways and for many men, coming to terms with a pregnancy can take far longer. It’s worth bearing in mind that during the early stages of pregnancy, men can find it hard to relate to the pregnancy as they have yet to see their baby on a scan or the changes in your body On the other hand, you may be very aware that your body is undergoing many physical and emotional changes.
It’s likely that your partner simply needs more time to adjust to the news. He may be concerned about the changes to your lifestyle and the financial implications of having a baby Talking openly to each other can help to ease anxieties for you both.

First signs of pregnancy
The most obvious initial sign that you are pregnant is a missed period. Other common early pregnancy symptoms include feeling extremely tired and bloated, having increasingly tender breasts, experiencing an increased need to pass urine, and finding that you have a greater or lesser sex drive, although all of these symptoms can occur premenstrually Some women also experience a small bleed around the time their period was due: which may be confused with a lighter period, that occurs when a fertilized egg implants in the wall of the uterus. There may also be a metallic taste in the mouth, nausea or vomiting - described as morning sickness, although this can occur at any time of day Some women don’t experience any symptoms.

A surprise pregnancy
dealing with unexpected
If your pregnancy was unplanned, you may have to work through feelings of shock and anxiety before coming to terms with this life-changing event.
* Be open with your partner about your feelings and reassure him that this is as much of a shock for you
* Rather than feel anxious about your lifestyle, make positive changes straight away! adopt a healthy diet, stop smoking and drinking, and take folic acid (see p.15). *You may feel overwhelmed, but rather than despair, just allow yourself time to adjust physically, mentally. and emotionally
These early symptoms may settle around the middle of the pregnancy A lack of symptoms is not indicative of how healthy your pregnancy is - you may just be one of the lucky few who sail through with no annoying side effects’.