Posts Tagged ‘consultant obstetrician’

They said I need a Caesarean
all about Caesarean births
What’s the difference between an emergency and elective Caesarean?
Caesareans are classified as elective or emergency An elective Caesarean indicates that a pre-planned decision was made during pregnancy to deliver the baby by Caesarean before the onset of labour. An emergency Caesarean is when a situation arises, usually in labour, that means the safest route for delivery is by Caesarean section.
Is it fair to say that most doctors prefer Caesarean deliveries these days?
Although the Caesarean rate has risen over the years, it would be unfair to say that this is due to doctors’ personal preferences; it is more likely to be due to over-caution on the part of the medical staff. NICE guidelines on Caesareans are quite specific on the reasons why a Caesarean should be considered and offered as an alternative to a vaginal delivery However, they also recommend that as currently one in five women will have a Caesarean section, all women should be offered some information about the procedure in antenatal classes If a Caesarean section is considered to be the most appropriate mode of delivery for you, then you should also be made aware of the benefits and the risks to you and your baby and of the possible implications on future pregnancies before you give your consent
Are there any factors that might reduce the likelihood of having a Caesarean?
Research shows there are certain factors that decrease the likelihood of having a Caesarean section and these include!
* Having one-to-one support from another woman
during labour; whether a midwife, a doula, or a supportive friend or relative. This is thought to reduce your chances of having a Caesarean.
* Waiting until after 41 weeks to have an induction of labour, if your pregnancy has been uncomplicated. * Having a home birth reduces the likelihood of a Caesarean if you have had an uncomplicated pregnancy. * Having appropriate tests during labour, such as a fetal blood sample and fetal electronic monitoring, will confirm any indications that your baby is distressed before going ahead with a Caesarean
I’ve got a small pelvis; I’m not too posh to push, but they said I may need a Caesarean. Is this right?
Cephalopelvic disproportion (CPD) is the term used to describe a labour that is not progressing due to the size or shape of the mother’s pelvis in relation to the size and position of the baby entering it. Problems may occur if a baby is unusually large or a mother unusually small. True CPD is rare and even if it is a concern in pregnancy, it is often thought best to give labour a try, although you may be cautioned that a Caesarean is a possibility. Certain signs signify CPD in labour; for example if the baby does not descend through the pelvis, or the cervix does not dilate; in these situations, a Caesarean would be necessary.
The midwife wrote LSCS in my notes - what does that mean?
The most common type of Caesarean section is a lower segment one (LSCS). This refers to the 12-15cm (5—bin) cut made along the bikini line The other type of incision is a “classical” or vertical cut, although this is extremely rare nowadays and would only be used if, for example, there was a vertical scar from a previous Caesarean, or in an emergency situation, such as a haemorrhage, although even then it is rare.

I want to be asleep during the Caesarean section. Will I have that option?
It is preferable that you are awake in the operation as most surgeons and anaesthetists agree that it is safer for mothers and babies to have an epidural or spinal anaesthetic. Also, you will be able to have your
partner with you, and will see and hold your baby straight away. In addition some women even manage to breastfeed while the operation continues or straight after the operation in the recovery room There are also greater post-operative risks for the mother and baby with general anaesthesia, including respiratory problems. If you are afraid of the operation talk to your midwife or doctor You may be able to visit an operating theatre and discuss the procedures.
I haven’t had problems, but I just don’t want to go through birth. Can I opt for a Caesarean?
If there are no medical grounds for a Caesarean and this is purely down to your fear of labour pains, then to opt to have a Caesarean is a drastic decision A Caesarean is major abdominal surgery, and although it is sometimes preferable, it is not a favoured method for many reasons, such as the risk of post-operative problems occurring as a result of surgery; a higher risk of secondary fertility problems, or the second baby being born by Caesarean; and an increased risk of postnatal depression It would be better to talk to your midwife about the pain-relief options available and ensure you receive the most effective type for
you. Having somebody you know and trust with you in labour can reduce your anxiety levels greatly. If you still feel that you cannot go through with labour, you may need to talk to your consultant obstetrician as the final decision will probably be his or hers.
I’ve had two Caesareans and now have been advised to have an elective one. Is this necessary?
It is common practice to advise women who have had more than one Caesarean section or operation involving cutting the womb to have an elective Caesarean This is because the risk of the womb rupturing during labour is slightly higher with each of these procedures. Usually, women who have had one previous Caesarean can have a ”trial of labour’ (see p. 182), but this will depend on the reason for the last Caesarean and how your current pregnancy is going If you do have a trial of labour, this will be carefully monitored and any indications that may suggest a rupture beginning would result in a Caesarean without question It is usual to prepare the mother for a Caesarean in case an urgent one is required by having an epidural anaesthetic in place, as this will reduce the time delay if intervention is needed. Ultimately, whether you opt for an elective Caesarean or for a trial of labour is your decision and the consultant will be able to advise on the risks and benefits of each method.
I heard that Caesarean babies are brighter because they don’t have a traumatic birth. Is this true?
No. this is not the case at ail Full term, healthy babies are designed to cope with the stresses of a natural labour and birth and should not be affected in any way by this experience The type of birth on its own does not affect a baby’s abilities, although if a baby becomes” distressed” during the delivery, on rare occasions this can cause problems that persist into later life (although usually the baby is born fit and well) It is the case that you can help your baby by staying healthy in pregnancy, for example by eating well and not smoking or binge drinking.

A Caesarean birth is when your baby is born during an operation in which the surgeon lifts out your baby through a short incision made through your abdomen (generally below the bikini line) and through the wall of your womb. This operation is carried out under anaesthetic, which could be spinal anaesthesia, epidural, or occasionally by general anaesthetic. There are many different reasons why a Caesarean birth happens. Sometimes the decision can be made during the pregnancy, which is called an elective Caesarean, and sometimes the decision is made during labour, which is known as an emergency Caesarean.
Today the Caesarean birth rate is 25 per cent
in the UK and rising. Look at the statistics from your local hospitals to see what their Caesarean rates are to help you decide where to have your baby. If you are considering an elective Caesarean, you should bear in mind that this is not without risks to you or your baby, or even to your next pregnancy, The decision to have a Caesarean section should be made by weighing up all the risks and then making a decision that is right for you
Can I avoid a Caesarean? There area few things you can do to help prevent a Caesarean section, for instance having someone with you throughout your labour, especially a midwife; having a homebirth (if you have no risk factors like high blood pressure); having an external cephalic version (turning your baby while you are about 37 weeks pregnant) if your baby is in a breech position (their bottom coming first); having a senior obstetrician involved in the decision not to have a Caesarean; and, if it is thought your baby is distressed, taking a fetal blood sample before deciding to carry out an emergency Caesarean.
What type of anaesthesia will I have? There are different types of anaesthesia for Caesareans all of which prevent you from feeling the operation General anaesthetics (which make you go to sleep) are only used if your baby needs to be born quickly or you have a rare blood disorder with low levels cf platelets (these help your blood to clot) Vlore offer_, an injection is put into your back, which is either a spinal block, when the drug is injected into the spinal fluid, an epidural, or a combined spinal epidural; you are awake to experience your baby being born and there are fewer complications this way

Caesarean, and these will stay in place for about 24 hours. If you wish to breastfeed, you can feed as soon as the baby is born, while the operation is still happening It is important that you are pain-free after your Caesarean, so ask the midwives for more pain relief if you need it, ideally before the pain builds up. To prevent blood clots forming in your legs, you will be given an injection and after 24 hours or preferably sooner, you will be encouraged to get up and walk around
How much can I do after a Caesarean? Once you get home, take it easy and let the pain guide you as to how much you do. You can start gently exercising as soon as you want and most hospitals give you information as to which exercises you can do safely. Using your vacuum cleaner, driving, and strenuous exercise are definitely not recommended You can drive again after six weeks, depending on your insurance company.
Will I have to have a Caesarean next time? The reason you had a Caesarean this time will determine the advice from your doctor as to whether you have a VBAC (vaginal birth after Caesarean) or have further Caesareans for subsequent babies. If you feel negative about the birth of your baby, you should try talking to your doctor or hospital and get expert help, as it is common to feel unhappy if you had an emergency Caesarean when you were expecting a vaginal birth.

What type of pain relief will I be given before the operation?
There are two main types of anaesthesia, or pain relief, prior to a Caesarean section! general and regional. A general anaesthetic is the procedure whereby the mother is put to sleep before the
Caesarean. Although this is a relatively quick
and safe method for the mother and baby, it is not common practice as it is thought preferable for the mother to be awake during the operation so that she is able to expereince the birth of her baby, rather than having to wait until she recovers from the anaesthetic and is possibly too groggy to respond to her baby. There is also a slight risk of the mother inhaling vomit during the operation and the possibility that the anaesthetic will affect the baby’s responses after the birth (see p.207).
A regional anaesthetic is given either as an epidural (see p 176), a spinal block, where the anaesthetic drug is injected into the fluid surrounding the spinal cord, or a combined spinal epidural. In both cases, a needle is inserted into the back and medication is given through a narrow tube to numb the abdomen downwards Although this takes longer to perform than a general anaesthetic, the anaesthetist will be very skilled at inserting the needle He or she will use a cold spray to ensure that you are totally numbed and the procedure will not start until the anaesthetist is completely happy that this is the case. On very rare occasions when the procedure can be felt, a general anaesthetic will be given straight away. The regional option is safer and
the birth experience is not missed The choice will ultimately be yours, unless certain conditions dictate the safest option
Who will be in the operating theatre?
Although it may seem like a crowd, all of the people in the operating theatre have a role. An anaesthetist will be present to make sure you do not feel the procedure and he or she will be helped by an operating department assistant. The main surgeon and his or her assistant will be performing the Caesarean section A midwife and sometimes a paediatrician will receive the baby A scrub nurse will pass the instruments to the surgeon and a runner’ will be there to fetch things and count the instruments with the nurse Your permission must be gained for students to be present You may wish to have your husband partner friend, or a family member present with you, which is usually agreed with the team leader in advance (although it is very common for your partner to be there).
How will I be stitched and how long will my scar be?
If you have the most common type of Caesarean, a ”lower segment Caesarean section”, a 12-1 Scm cut is made along the bikini line. The other, less common, type is a ‘classical” or vertical incision. During a Caesarean, the surgeon needs to cut through several layers of fat and tissues before making an incision in the uterus These internal layers will then be restitched after the operation using soluble stitches and then the layer of skin will be stitched or clipped at the end. Clips, or staples, are usually removed about three days after the operation whereas stitches are left in for about five days. The removal of clips or stitches is usually a fairly painless procedure.
Can my partner still cut the cord?
It is important during a Caesarean section that the procedure is carried out under sterile conditions. This means that all of the staff around the operating table, and the instruments, will be sterile (the highest level of cleanliness). The staff have to undergo a specialized washing technique called ‘’scrubbing” and then use a gown that has been washed and packed to certain standards This is to reduce the risk of infection to the mother and baby. If your partner was allowed to cut the cord, this would mean that the same principles would apply. It would therefore not be practical or possible to ensure that every partner was trained in this technique However, it may be possible for your partner to “trim’ the cord away from the table as an alternative. This is sometimes necessary when the midwife has cut the cord and applied the cord clamp; but there is still too much cord length, and it is often a good opportunity to involve dads
Will I be able to watch my Caesarean section operation if I want to?
Usually the mother is fully awake for her Caesarean section, with the exception of some emergency situations when it might take too long for the anaesthetist to insert the spinal anaesthetic, in which case a general anaesthetic will be given However, whether the mother would literally be able to watch the Caesarean section is a different matter. During
•    Caesarean when the mother is awake, it is usual for
•    screen to be erected to stop her and her partner from seeing anything. To see the operation, the screen would have to be taken down. You would also need to have your head raised, which would present difficulties for the surgeon, as the operation requires that the mother lies fairly flat so that the surgeon can get to the baby and the abdomen. Although the operation itself may sound thrilling, you may not be thinking this when it is actually happening to you On occasion, even a planned Caesarean section can run into difficulties, and in the worst case scenario, the mother will have to be given a general anaesthetic.
Many obstetricians, however, do drop the screen, if you wish, at the point of your baby being delivered from the abdomen, and the parents are shown the baby so that they can see what the baby looks like.
Is a baby born by Caesarean section any different to a baby born vaginally?
The condition of a baby following a Caesarean section depends greatly on the reason for the operation. If the Caesarean section is being performed as an emergency situation because the baby’s wellbeing is in question, there will be differences between this baby and one born by
a planned Caesarean section or vaginal birth. For example if the baby is distressed, its skin colour, activity levels, and breathing rate may all be affected Each baby is assessed, initially by the midwife and/ or a paediatrician, and is then given a score out of 10, known as the Apgar score (see p.217).This looks at the baby’s colour, heart rate, stimulation response, how the baby is breathing and the muscle tone, and the midwife will perform a detailed examination of the baby a little later to examine the baby’s skin, fontanelles, ears, eyes, mouth, nose, body, genitals, spine, anus, and heart and breathing. A baby born by a planned Caesarean will have a nice rounded head as it hasn’t been pushed through the birth canal, and about and this will. in itself, speed up recovery and reduce the risks resulting from immobility such as deep vein thrombosis.
Will I still be able to hold my baby straight after the birth?
In most units, the midwife or paediatrician will show you your baby quickly before reviewing your baby’s condition (see p.217) Once the paediatrician and the midwife caring for you are happy that your baby is well, she will be well wrapped and placed across your chest while you are on the operating table. Although it might be hard for you to hold your baby at this point due to your position, this will be the first opportunity for you to feel and see your baby.
Once you have been transferred to the recovery area after the operation, the midwife will first make sure that you are well by checking your pulse, breathing, and blood pressure, and by looking for any signs of heavy bleeding She will then attempt
to get you into a comfortable position, probably lying on your side, to enable you to enjoy some skin-toskin contact with your baby and to breastfeed your baby should you so wish.
How soon will I be able to go home after a Caesarean section?
Only a relatively few years ago, women who had had a Caesarean were kept in hospital for around five to seven days, and a few years before that, 10 to 14 days was the average amount of time spent in hospital Nowadays, mainly due to the recognition that women do recover much better in the comfort of their own homes — where they are likely to get more sleep and rest as they are not being disturbed by other babies — and also sometimes due to economics, lack of space, and reduced maternity staffing levels, women are usually discharged from hospital at around two or three days after their Caesarean operation.
There are individual circumstances when this might not be the case, for example if the mother is not coping well after the birth, if she is on her own at home, or if she is having problems breastfeeding her baby, then her discharge home may be delayed. If a baby has been admitted to the special care unit in the hospital, many maternity units will allow the mother to stay for up to 10 days.

You may think that there is little a
partner can do during a Caesarean, but this is not the case as your birth partner still has the important job of supporting you during the operation.
* If the Caesarean is an emergency procedure, partners can make sure that the reasons why this is necessary are clear. * If you are awake for the procedure, your partner can remain in the theatre, sitting by your head and offering you reassurance throughout the operation.
* Once your baby is born, you and your partner can welcome her together,
and its gender Then the screen is put back up to deliver the placenta and stitch up the incision. If you do wish to watch more of the operation, you should discuss this with the surgeon and the anaesthetist prior to the operation Likewise, if you don’t want the screen to be lowered at all, make this clear to the operating team beforehand.
What are the reasons for Caesarean sections?
There are various reasons why a Caesarean section might be carried out. You may be advised to have a Caesarean if the baby cannot enter the pelvis due to the baby’s size or position or the shape and size of the pelvis; if you have a low-lying placenta; for a multiple pregnancy or breech baby, if your labour is not progressing; if you had a previous Caesarean section or traumatic birth: if you have severe pre-eclampsia; if the baby’s growth is severely reduced; if you have had heavy bleeding in pregnancy; and for certain other medical conditions The doctor will advise you of the reasons why a Caesarean section may be the safest option.

Recovering from a Caesarean
Although you should remain mobile after a Caesarean operation,
it is also important that you get plenty of rest A Caesarean is major surgery so you will need to avoid lifting and carrying heavy loads for the first few weeks. As this may be difficult if you have other small children or are at home alone, you should try and recruit as much help as possible after the operation You should avoid doing any shopping, which usually involves lifting, or driving for a few weeks Check with your insurance company when they are happy for you to drive again and make sure that you feel comfortable wearing a seatbelt and doing manoeuvres, including emergency stops. It is generally thought to take up to six weeks to fully recover.

Sex in pregnancy

Can having sex in pregnancy harm the baby in any way?
Unless you have been told by your midwife or doctor to avoid intercourse because of specific problems, such as a history of miscarriage or unexplained bleeding, then sex is perfectly safe as your baby is cushioned in fluid in the amniotic sac inside your womb and protected by a cervical plug, and even deep penetration isn’t harmful. Enjoying intimacy with your partner will also be beneficial for your relationship.
I’m either uncomfortable when we make love or not in the mood. Should I fake it?
Levels of sexual desire in pregnancy vary greatly, with some women finding their sex drive is heightened, while others feel too ill, anxious, hormonal, or just too uncomfortable to attempt sex at all. If you really don’t want sex, be as honest and open as you can about your lack of sex drive. Don’t be pressurized into doing something you really don’t want to do, as this could complicate your relationship. Communication is very important at this time, so talk to your partner about how you are feeling — you may find that he is completely unaware of your feelings, anxieties, and worries.
You could use the presence of your ”bump” as an ideal excuse to experiment with different positions, as most couples find the missionary position very uncomfortable in late pregnancy Some couples prefer it if the woman is on top as this allows her more control over the amount of penetration and there is less weight on her bump. A ‘’spooning” position, with your partner behind you, also allows for shallower penetration and removes pressure on your bump totally Having a baby is all about adapting to new experiences, and most couples find they need to adapt their sex life too
Since we hit the second trimester I’ve wanted sex more than ever - why is this?
Often, in the second trimester, women find that once early pregnancy symptoms wear off they feel far more energetic and sexier than ever! However, this may not be the case for everyone as each woman is affected differently by the physical and psychological changes that occur in pregnancy, and women have different views about their changing bodies, which can affect their libido.
From a physiological point of view, an increased blood flow to the pelvic area combined with an increased lubrication of the vagina means that, in theory, having sex can be better than ever So if you and your partner are quite happy with your increased sex drive, this is not a problem.
My placenta is low and I’ve been told to avoid sex. Why is this? I’m only 30 weeks’ pregnant.
As the baby develops and grows so does the womb, with the result that the placenta is carried upwards away from the opening of the womb. However, in
10 per cent of women, the placenta remains low-lying during late pregnancy and then poses a risk because of potential bleeding (see p 92). A low-lying placenta is often first detected at an early scan and, if this is the case, it is usual for a repeat scan to be carried out at around 34 weeks of pregnancy to determine if the placenta is still low and exactly where it is situated in respect of the opening of the cervix (neck of the womb).
The biggest risk from a low-lying placenta is bleeding and if you have already experienced any bleeding, it is usual to recommend that you avoid sexual intercourse, as agitation of the cervix, which happens during sex, can encourage more bleeding If in doubt, it’s probably best to discuss your particular circumstances with your midwife or consultant obstetrician
My partner hasn’t wanted sex at all since I’ve become pregnant. Will he ever fancy me again?
It isn’t uncommon for either partner to experience a reduced sexual desire in pregnancy for a variety of reasons. It is important that you talk to your partner and ask about his feelings while also explaining your own thoughts and feelings.
Some partners find pregnancy a little scary, and some of these fears centre around sex and concerns about harming the baby or you. Sometimes, these worries may be based on real concerns, for example if there have been any problems in early pregnancy such as threatened miscarriage, bleeding, pain, or excessive morning sickness. Equally they can be based on misunderstanding, and this is where discussion between the two of you will help.
Although you may feel more attractive and sexy, perhaps your partner is feeling clumsy and
Talking to each other
Maintaining a healthy relationship
It is essential that you and your partner keep the lines of communication open during this time of change and some uncertainties.
* If you have gone off sex completely, reassure your partner that this is a
temporary situation and explain how the pregnancy is making you feel mentally and physically.
* Likewise, if your partner seems reluctant to initiate lovemaking, don’t take it
personally. Try to find out how he is feeling. * Don’t allow a quieter sex life to stop you being affectionate at other times.
uncomfortable. Each couple is different and you will need to talk to each other to find your way through this. You may also feel that you want to talk to someone who isn’t so closely involved, such as your midwife, doctor, a trusted friend, or a relative
Is it best to stick to oral sex during pregnancy?
Research on the benefits and risks associated with oral sex in pregnancy is limited and the findings are very often contradictory There is nothing that indicates that oral sex is recommended in place of penetrative vaginal sex unless you have been advised to avoid sexual intercourse because of the risk of bleeding, threatened miscarriage, or premature labour, when avoiding orgasm is also advisable and so complete abstinence is the better option for a while. Apart from this, it is important to remember that some infections can still be passed on easily by oral sex.
Will having an orgasm cause me to go into labour?
In a pregnancy without problems, an orgasm alone will not cause premature labour, and at full term orgasm will only cause the onset of labour if your body is ready for labour anyway. If you have had any signs of premature labour, or if you have had premature rupture of your membranes (see p.167) you will be advised to avoid sexual intercourse. This is because the hormone oxytocin increases during sexual arousal and the effect from the oxytocin is to cause the muscles of the uterus to contract.
During pregnancy the muscles of the uterus experience practice contractions, known as Braxton Hicks (see p 168), which are not harmful, and orgasm may increase these practice contractions
If you have gone past your due date and are at a point when your body is ready to go into labour, then sexual intercourse may help things to start for two reasons the prostaglandins in semen will help the cervix to soften at this stage of pregnancy, and the contractions stimulated by orgasm have more chance of developing into early labour contractions.
I’ve got problems with my pelvis - is there a comfortable way for us to have sex?
Problems with the pelvis, particularly symphysis pubis dysfunction or SPD (see p.82), tend to be made worse by moving your legs too far apart, so it is a matter of finding a position that you feel comfortable in that doesn’t involve too much stress on the pubic area. Many women find the “missionary position” the most difficult as it involves significant parting of the legs, plus there is the weight of a partner to consider Some, although not all, women find an all-fours position for intercourse more comfortable, both for sexual intercourse and for giving birth. If intercourse is really proving difficult, then it could be that while you are experiencing significant problems you will need to find alternative ways for you and your partner to be intimate that don’t involve penetrative sex.
Many women find that pelvic discomfort improves significantly once they have had the baby. A very useful organization that has a lot
of information and advice on pelvic pain during
pregnancy is the Pelvic Partnership (see p 310). You can also talk to your midwife or doctor for a referral to a physiotherapist, which may be beneficial and help you to achieve a greater degree of comfort during pregnancy
I’m 36 weeks. My boyfriend insists on regular sex and has been a bit abusive. Is this normal?
It is not normal for someone to be abusive to another person or to force them to have sexual intercourse when they don’t want to You should never be forced to do something that is against your will. In almost 30 per cent of all domestic abuse cases, the first incidence occurs in pregnancy. It is very important that you talk to someone about how your boyfriend is treating you, perhaps to a close friend or relative There are also organizations that offer confidential advice and help you if you really feel there is no one you can talk to or trust (see p.3 10). You could also try talking to your midwife, who will treat everything you say in the strictest confidence and will have details of local organizations that can help and advise you.

Comfortable lovemaking
You and your partner may need to experiment more during pregnancy to find lovemaking positions that are comfortable for you and your rapidly growing bump As pregnancy progresses, most women find that lying on their back in the missionary position becomes increasingly uncomfortable as your partner presses on your bump. You may find being on top an enjoyable position, which allows you to control penetration and does not put pressure on your tummy. Lying in the spoons position, with your partner behind you, can be pleasurable and puts no pressure on your abdomen. Other positions that don’t restrict your pleasure and are comfortable include sitting together, kneeling while your partner enters from behind, and lying side by side with your legs bent over your partner’s legs.

High-Risk Pregnancy FAQ

The midwife says I’m “high risk” because of my blood pressure. What does this mean?
Blood pressure is monitored in pregnancy as raised blood pressure can be a sign of pre-eclampsia (see p39) At your first antenatal visit, your midwife will record your blood pressure and assess your risk of pre-eclampsia based on the blood pressure reading, your medical history and family medical history Certain factors increase your risk These include: * High blood pressure.
* Pre-eclampsia or raised blood pressure in previous pregnancies, or having a mother or sister who had pre-eclampsia.
* Being aged over 40 years and this being your first pregnancy.
• Being significantly over- or underweight
• Having a multiple pregnancy.
If your midwife thinks you are ”high risk”, she will refer you to a consultant obstetrician and discuss a plan of care for your pregnancy Many women who are assessed as high risk have pregnancies that progress without complications, but they are monitored a little more closely
I’ve been told that because of my diabetes I have to go to the hospital clinic - why is this?
Whether you develop diabetes in pregnancy (known as gestational diabetes), or have pre-existing diabetes, you will require special care with support from a diabetic health care team and a consultant obstetrician. This is because diabetes poses risks in pregnancy if there is poor control of blood glucose levels In the mother, these include hypertension (high blood pressure), thrombosis (blood clots), pre-eclampsia, diabetic kidney disease, and diabetic retinopathy a condition that affects the retina in the
eye. For the baby, there is an increased risk of congenital abnormalities and growth may be too fast or too slow. It is important that your care is tailored to you, taking into account any other complications you may already have from diabetes.
The key to a healthy pregnancy and baby when you have diabetes is good blood glucose control as your insulin requirements will change throughout pregnancy Controlling blood glucose levels reduces the risk of birth defects and stillbirth, or a larger than expected baby, which can present problems during birth. If you have gestational diabetes, you will need to adapt your diet to include carbohydrates and fibre and reduce fats and sugar: you may also need insulin injections to help control blood sugar levels
I have epilepsy - will I need special care in pregnancy?
Ideally, women with epilepsy should discuss their situation with their doctor prior to conception. Epilepsy and the medication used to control it do carry some risks in pregnancy but there are ways to minimize these. Some anti-epileptic drugs (AEDs) are thought to be more harmful to a developing baby than others, so your doctor may wish to change your medication before you become pregnant. Although
most women taking AEDs have healthy babies, taking any type of AED increases the risk of birth defects, so you will probably be offered extra scans. The aim is to control your seizures on the minimum dose AEDs also restrict your body’s absorption of folic acid, which reduces the risk of an unborn baby developing neural tube defects such as spina bifida, so your doctor will probably discuss taking a higher dose of folic acid. Once your baby is born, you will generally be advised to breastfeed if at all possible, as any risk to the baby from AEDs is outweighed by the many health benefits of breast milk
I’m 28 weeks and have been having contractions. Is my baby going to come early?
From early pregnancy, the uterus ‘practises` contracting in preparation for labour. A mother is usually unaware of these practice contractions, known as ”Braxton Hicks”, until later in pregnancy, when they can be felt as a hardening of the ”bump’ Each contraction lasts from a few seconds to a few minutes before the uterus relaxes and becomes soft
again. These contractions are painless (although
they can feel quite uncomfortable!), follow no regular pattern, and having them does not necessarily mean that your baby is going to be born early
However, if you experience painful contractions -described as being like strong ”period-type” pains -and they seem to increase in strength and frequency, you should contact your hospital as you could be
going into labour. You should also seek medical advice if you leak any fluid or blood from the vagina
My last baby was premature -is this likely to happen again?
Having one premature baby, born before 37 weeks of pregnancy, means that you have about a 15 per cent chance of having a second preterm birth, although this also depends on why you had a premature birth originally, Reasons why babies are born prematurely include
Infection in the mother
Early rupture of the membranes (’waters breaking”)
• Multiple pregnancy.
• Weak, shortened cervix (neck of the womb).
• Unusual shaped womb, for example, a bicornuate uterus (heart-shaped womb).
* A medical condition in the baby, for example if the baby is not growing as expected, which means that labour has to be induced early.
* A medical condition in the mother, such as pre-eclampsia (see opposite). which also means that labour has to be induced early.
Although most of the causes of premature
birth cannot be prevented, there are steps you can take to reduce the risk of premature labour. These include not smoking, avoiding being under- or overweight. and avoiding extreme stress In addition, it is essential that you attend all your antenatal appointments so that the wellbeing of both you and your baby is constantly assessed You should discuss whether there was an obvious reason for your last baby being premature. and if there are any specific preventative measures you can take to help avoid a reoccurrence this time round.
I’m expecting triplets. Will I be treated as “high risk”?
Yes, you will be classed as having a high-risk pregnancy as all the usual risks are increased for women with twins and multiple pregnancies This is partly because hormone levels are higher when there is more than one baby and partly because it is hard work for your body to carry and nourish three little lives! There will be an increased risk of miscarriage; severe pregnancy sickness (hyperemesis gravidarum); raised blood pressure/ pre-eclampsia: anaemia (iron deficiency), diabetes: and premature and/or low birth weight babies There is also an increased, although small, risk that one or more of the babies will die during the pregnancy With triplets, you will almost certainly need to give birth by Caesarean section Although considered a very safe operation, this is still major surgery and carries the associated risks.
You can expect to be referred to an obstetrician, who will plan your antenatal care with you and you will probably have more frequent checkups and scans. If you attend all your appointments and look after your health, it is likely that you will have three healthy babies at the end of your pregnancy. For more information about multiple pregnancy and details of local support groups, contact the Twins and Multiple Births Association (TAMBA) (see p.310).
I have lupus - how will this alter my care during pregnancy?
Lupus is an autoimmune disease that causes inflammation in the bone joints, blood, kidneys,
and skin and sufferers often find that symptoms flare up due to certain triggers. The condition is more common in women than men, especially women of childbearing age Some women find that pregnancy aggravates lupus, causing a flare-up, probably due to the hormonal changes that occur, while others find that pregnancy eases the symptoms. As lupus can affect an unborn baby, increasing the risk of stillbirth, miscarriage, premature labour, and slow growth, your pregnancy will be monitored very closely, especially when checking your blood pressure and
urine However the likelihood is that you will have a completely healthy pregnancy resulting in a healthy baby You can contact Lupus UK for support and information (see p.310)
I’ve had a few small bleeds during pregnancy - will my baby be OK?
Bleeding in early pregnancy is not uncommon Usually, the reason is unknown, but there is a theory that although the hormones of the menstrual cycle are suppressed, variations in the cycle continue. This could explain why some women have light “spotting” around the time a period would be due. If the bleeding is light, and not accompanied by abdominal cramping or pain, then it is unlikely that there is anything wrong
Bleeding after early pregnancy can be due to
a cervical ectropian, when the surface of the cervix becomes ‘raw’. This results from hormonal changes and is not harmful to the baby. Sexual intercourse can aggravate a cervical ectropian, stimulating bleeding.
Bleeding in late pregnancy may be more serious as it can be due to the placenta partially, or totally,
detaching from the wall of the uterus, known as placental abruption, or to a low-lying placenta, known as placenta praevia (see below and p.92).
If you have a mucus discharge tinged with blood in late pregnancy, this may be a ‘’show” when the plug of mucus sealing the cervix comes away. This is normal and can indicate that labour isn’t far away
It is important that you seek advice for any type of bleeding at any stage of pregnancy, as serious causes for bleeding must always be ruled out
We know our baby has Down’s syndrome. How can we best prepare ourselves?
On a practical level, you can prepare in much the same way as every parent, thinking about your preferences for labour, attending antenatal classes, and buying baby equipment Knowing in advance that your baby is going to be born with a condition such as Down’s gives you time to adjust and find out as much as possible about what to expect. You may wish to tell family and friends too, to give them time to prepare. Ask your health visitor for details of local support groups and contact the Down’s Syndrome Association for more information (see p.310).
I had an emergency Caesarean last time. Now the doctor says I’ll have a trial of labour, what is this?
This means labour after a Caesarean section. Another term is VBAC (Vaginal Birth After Caesarean section). Until relatively recently, most doctors
advised women who had had a Caesarean to have a planned Caesarean for the next baby to avoid uterine rupture, where the Caesarean scar tears in pregnancy or labour. Although serious this is rare, and it is now thought to be preferable for both the mother and baby to have a natural vaginal delivery if possible. Even so, if you want a vaginal delivery, it would be wise to opt for a unit that has fetal heart monitoring and that can carry out Caesareans if one turns out to be required.
Your chances of having a successful labour depend partly on why you had a Caesarean section. If it was because the baby was breech or you had a low-lying placenta, -your chances of a natural labour this time are higher If it was due to complications in labour, such as slow cervical dilatation, then the problem may recur Overall, about half of women have natural deliveries after a Caesarean You can contact the Caesarean organization for more information (see p.310).
My friend had placental abruption. Is this serious?
Placental abruption means that the placenta has started to come away from the wall of the uterus before the pregnancy has reached full term. This is a potentially serious condition that may mean the baby needs to be delivered as soon as possible by Caesarean section. If there is persistent pain in the abdomen during pregnancy which may be accompanied by fresh, bright red bleeding and/or a change in the baby’s movements, then medical help should be sought straight away
I have had three miscarriages -will my antenatal care be different because of this?
While one or even two miscarriages are relatively common, three is less so. If you have had recurrent miscarriages, you will be offered extra antenatal care. You may be advised to take low-dose aspirin if there is evidence that you have a blood-clotting condition called anti-phospholipid syndrome (aPL). A vaginal scan may also be offered to check if you have a ”weak cervix”, where the cervix is unable to support the growing baby. If a weak cervix is diagnosed, you may be given a stitch during pregnancy to hold the cervix shut. There is some evidence that taking the hormones progesterone or human chor 4 onic gonadotrophin in early pregnancy can reduce the risk of miscarriage.
My baby is very small for her dates - can anything be done about this?
From 25 weeks, your midwife will measure and palpate your tummy to estimate the fetal size If she thinks you are ‘’small for dates” she may refer you for a scan for a more accurate assessment of the baby’s size and of the efficiency of the placenta You may be offered a repeat scan in a week or so to measure growth over time. If babies do not grow as they should, this is called intra-uterine growth restriction (IUGR). This can be due to a problem with the baby or the placenta, affecting the amount of oxygen and nutrients reaching the baby, Pre-eclampsia can cause IUGR, as can smoking, drinking alcohol, and
recreational drugs. If your baby is very small and the rate of growth drops off considerably, it may be necessary to deliver the baby early
My friend had hyperemisis gravidarum in her pregnancy -can you tell me more about this?
Hyperemesis gravidarum (HG) is severe pregnancy sickness, a debilitating condition affecting around one per cent of women. The woman is unable to keep down food or fluids without vomiting and becomes clinically dehydrated. This can begin at around week 6 of pregnancy and may last until 16-20 weeks (although some women suffer
throughout pregnancy). Sufferers may need hospital treatment with intravenous fluids, and medications to control the vomiting may be given, but their success varies No-one is sure what causes the condition,
but it is thought that high levels of the hormone hCG, fluctuations in thyroid levels, and changes in liver function may all be involved Sometimes the condition runs in families. There is a support group that provides information and tips (see p.310).

Placenta praevia
Placenta praevia means a low-lying placenta, which occurs when the placenta is either partially covering (minor), or completely covering (major), the cervix. In major placenta praevia, the baby cannot be born vaginally Major placenta praevia poses a high risk of heavy bleeding, either in the later stages of pregnancy or during the actual labour, which is treated as an emergency If a low-lying placenta is detected at your 20-week scan, you may be offered
a scan in late pregnancy; this is because the placenta may ”move up” as the uterus grows, and by about 34 weeks may no longer be low. If you have placenta praevia, particularly major placenta praevia, most hospitals admit you for bedrest in the last weeks of pregnancy until the birth so that if you bleed heavily, you can be treated immediately

Cholestasis is a condition in which bile does not flow freely down the bile ducts in the liver, causing bile to leak into the bloodstream. This condition poses serious risks for both the mother and the baby, and so it is important that it is diagnosed with a blood test and managed as soon as possible. Medication will be given to relieve the itching and improve the liver function. The aim of the medication is to stabilize the condition until it is safe for the baby to be delivered. Usually labour is induced between 35 and 38 weeks of pregnancy.

Pre-eclampsia is a condition that affects around 10 per cent of women during their pregnancy (or, rarely, in the first 72 hours after the delivery) The cause is still unknown. although it is thought that it may be caused by a malfunction of the placenta.
What are the symptoms? There are varying degrees of pre-eclampsia, from your blood pressure rising a little bit towards the end of your pregnancy and a small amount of protein detected in your urine (which affects about 1 in 10 pregnant women), to a large rise in your blood pressure and a considerable amount of protein found in your urine (affecting about 1 in 50 pregnant women) Your blood pressure and urine will be checked (and the size of your baby measured) at your antenatal appointments to look for signs of pre-eclampsia and you will be referred to the hospital if necessary. Sudden swelling, headaches, pain =der your ribs, and visual disturbances also indicate pre-eclampsia and you should contact your midwife or doctor straight away if you experience any of these.
What can be done? If you have the milder form of pre-eclampsia, this will only require your blood pressure and urine being tested a little more frequently – perhaps weekly However, the more serious form will require you to go into hospital where you and your baby will be monitored and given medication to lower your blood pressure This is because if you are left untreated it could develop into eclampsia, which is a very serious condition in which you may suffer convulsions, and your and your baby’s lives could be in danger. However, with both types of pre-eclampsia, you will generally need
to be induced early (see p 190) as once your baby is born and the pregnancy is over, this will end the pre-eclampsia.
Who is at risk? Women are at a greater risk of pre-eclampsia if they have had the condition before; are over 40 years old have a body mass index (BMI) over 35; have a family history of pre-eclampsia (mother or sister); had high blood pressure, diabetes, or kidney disease before the pregnancy; or are carrying more than one baby.

Prescribed bedrest

Towards the end of pregnancy, there are some circumstances when you may need to be admitted into hospital for bedrest and monitoring.
* If you have contractions, but your waters haven’t broken; you may also be given a drug to slow contractions.
* If you develop pre-eclampsia in
pregnancy you may have to stay in hospital and measures will be taken to reduce your blood pressure.
* If you have placental abruption (see p 91), you will be monitored in hospital and early delivery may be needed