Posts Tagged ‘difference’

NAIL FUNGUS
Over the last several years, nail fungus has garnered public attention completely out of proportion with its seriousness. The medical term, onychomycosis (oh-nick-o-my-CO-sis), is long and scary, but it just means fungal infection of the nail. Perhaps so many people are curious about this topic because nail fungus is very common. In addition, the development of
•    Soak your nails in a solution of one-third vinegar to two-thirds water
•    Prepare a cornmeal suspension and soak nails for an hour a week
•    Apply Listerine to infected nails daily
•    Coat the nails with Vicks VapoRub
•    Soak the nails in tea tree or vitamin E oil
•    Try Pau d’Arco tea soaks
•    Ask your MD about a prescription for urea paste 40 percent to remove the infected nail
•    Apply prescription Penlac (ciclopirox)
•    Consider the pros and cons of Lamisil (terbinafine) and Sporanox (itraconazole)
new antifungal drugs that can treat (dare we say cure?) nail fungus has encouraged the pharmaceutical industry to advertise in magazines, in newspapers, and on television.fbe popularity of sexy sandals as footwear may also have contributed to the interest in treating nail fungus.
For diabetics, nail fungus is a medical issue.fbey need to be extremely vigilant about foot care and attend promptly even to things that may seem minor. For the rest of us, though, thick, yellow toenails that are crumbly or hard to cut are more of a nuisance than a serious health concern. They look ugly, and if they get very thick, they may be uncomfortable as well. Sometimes they split, which can be quite painful.
In our opinion, though, it would be a mistake to put your life on the line to clear up your funny-looking nails. Mat’s why we have collected so many home remedies for this problem. They probably won’t work for everyone, but they shouldn’t be very risky, either.
Q. My husband took Lamisil to treat toenail fungus, The drug worked but was ultimately responsible for his death.
The fine print for this prescription drug noted that it might cause neutropenia. For my husband, it did. This led to MDS (myelodysplastic syndrome), which was followed thereafter by AML (acute myeloid leukemia) and his subsequent death.
He had suffered with periodic flare-ups of toenail fungus and athlete’s foot for most of his life. Neither condition was life threatening. The Lamisil was!
Even though serious side effects mentioned in prescription drug labels may affect only 1 percent of users, anyone could be in that I percent. People should ask themselves if it is worth taking that chancel
A. We are so sorry to hear of your husband’s tragic death. In rare cases, Lamisil may trigger serious blood disorders such as neutropenia, a lack of white blood cells. This drug can also damage the liver; there have been deaths associated with this problem. This is a high price to pay to cure toenail fungus.
Patients must always take into account not only common side effects but also the possibility of rare but deadly adverse reactions.
Home Remedies
It’s hard to say just where nail fungus comes from and why some people appear to be more susceptible than other-, Occasionally readers report that they first noticed nail fungus after going for a manicure or a pedicure. Presumably, it is possible to pass the organism that causes nail fungus from one person to another, and surely from one nail to another.To minimize that likelihood, we suggest that any tools such as scissors or clippers that have been used on a nail that might be infected be soaked in rubbing alcohol for 15 minutes before being used on an uninfected nail.
We think home remedies are the place to start for treating nail fungus, whether it affects the toenails or fingernails. (”This does not apply to people with diabetes, who should seek medical care for this problem.) Needless to say, some doctors are not fond of the idea of using home remedies for nail fungus.
Some time ago, we heard from a podiatrist who was very unhappy with our recommendations. “Home remedies hardly ever work,” he wrote. “The unproven treatments you mentioned are little more than urban legends. In 23 years of practice, I have never seen even one patient who responded favorably to Vicks VapoRub, dilute vinegar soaks, or vitamin E oil. Don’t make me waste time dispelling these myths.” He recommended that people take FDA-approved prescription drugs like Lamisil, Penlac, or Sporanox instead.
We certainly heard from readers who disagreed with him. One person who had success treating nail fungus with vinegar soaks expressed this opinion: “If a treatment is relatively harmless, as this is, and there’s even a chance it can work, I believe doctors should encourage alternative methods instead of high-priced medicines laden with potential side effects.”
A pharmacist also weighed in with some information on the effectiveness of the prescription medications:
I would like to point out some facts about the FDA-approved drugs the podiatrist prefers (Lamisil, Penlac, Sporanox). Does this doctor know that Penlac’s success rate for a complete cure, accord-ing to the manufacturer’s prescribing information, is only 5.5 to 8.5 percent after 48 weeks? When using Sporanox, the percentage of overall success rises to a dizzying 35 percent.
Also, does he know the costs of these medications? A bottle of Penlac costs $72.99. To reach 48 weeks of treatment once a day to a single affected nail, I conservatively estimate that the patient will need six bottles of the lacquer (one bottle approximately every other month), So Penlac will cost the patient, without insurance, 5437.94 to reach an outstanding 8.5 percent cure rate.
For Sporanox, one pulse-pak costs ME99. This is a 14-day supply. The manufacturer recommends 12 weeks of treatment, bringing the patient cost, without insurance, to $1,535.94! No wonder people are looking for alternatives to these medications.
Oral medicines such as Sporanox can occasionally trigger serious reactions as well. No wonder some people are willing to spend time and effort—but not much nioney—trying a low-risk home remedy.
I assumed toenail fungus was a fact of life forme. khad spread to five or six toenails when I finally saw a dermatologist The prescribed treatment was costly, and after it began, the dermatologist told me the odds of reinfection after treatment were about 50 percent
I had a nightmare reaction to the pills a week later I was in remote Finland, of all unlikely places, when I developed hives and severe itching. After 24 hours of nonstop, nonsleep itching, I got through to my doctor and was told to stop taking the pills.
When I got home, / decided to try the vinegar treatment I applied a drop of distilled white vinegar to my toenails with a cotton swab each time I got out of the shower As the nails grew out the fungus was completely gone, along with slight traces of athlete’s foot
Cost: under $ZOO over 9 months.
Side effects: none.
Effectiveness: 1019 percent (or 200 percent it you include the athlete’s foot).
Vinegar
One of our favorite home remedies is a vinegar soak. It is surely, one of the cheapest remedies for nail fungus. People who sit still to read, use the computer, or watch television could soak the foot with the affected toenails or hand with the affected  Vinegar
Use two parts of water to one part vinegar for a soaking solution. It does not seem to matter whether you use white vinegar or apple cider vinegar, so we suggest the cheaper
white vinegar.
Downside: Your toes may smell of vinegar.
Cost: $1.60 to $2 for 64 fluid ounces—enough for at least four treatments, and possibly eight
fingernails in a solution of one part white vinegar to two parts water. Vinegar is acidic, and acid makes the environment inhospitable to nail fungus. Because it is a home remedy, there is no “prescribed” method. Some people have had success soaking for an hour each week, all at one go; others soak once a day; and still others use the technique of daubing undiluted vinegar on the affected nail with a cotton swab every day. Persistence is needed with any home remedy. Nails grow slowly, especially toenails, and you need to give them time to grow out healthy and fungus free.
Cornmeal
Another natural fungus fighter may be cornmeal. We first learned of this approach from a public radio listener: “Put about an inch of cornmeal in a plastic dishpan. Pour in hot water, stir it so the cornmeal gets dissolved, and when it is cool enough not to hurt, soak your feet for an hour. If you do this regularly, it will get rid of the fungus.”
When examining me my doctor noticed that I had nail fungus affecting toes on each foot He recommended that) make a batter by mixing cornmeal and water in a shallow pan, let it sit for an hour, and then soak my feet for an hour He told me to do this once a week for a month. I did the cornmeal therapy for 3 weeks and the fungus was gone. I don’t know why it works, but it’s cheap, harmless, and it worked for me.
We haven’t found any scientific support for cornmeal as a nail fungus treatment, and fewer people have written us regard-Cornmeal
A footbath of cornmeal mush is neither expensive nor dangerous, and it takes just 1 hour a week. Put about an inch of cornmeal in a shallow pan and add enough hot water to dissolve it. Let it cool to a comfortable temperature and soak your tootsies for an hour.
Downside: This treatment could be somewhat messy. Don’t spill it on the carped
Cost: $2 to $4 for 5 pounds of cornmeal—enough for at least five treatments, and probably more
ing their success with cornmeal than with vinegar, but some have used it to eliminate their nail fungus.
Cornmeal does seem to be a popular home remedy in the garden, though. Gardeners claim that working some cornmeal into the soil around a rose bush will discourage black spot disease, a fungus that affects roses.
Vitamin E
We are always impressed by our readers’ ingenuity. We would never have thought of putting vitamin E oil on fungus-infected toenails, for example. We can’t think of a good reason why vitamin E in particular would be useful against fungus, and yet a number of people have tried this approach with some success.
I keep reading about treatments for toenail fungus so I thought I would pass on my solution. When I had this problem several years ago, I used a simple approach. I kept my toenail soaked with vitamin E oil and the fungus disappeared completely. I can’t recall exactly how long it took but it wasn’t too long.
As we understand the vitamin E tactic, a capsule that you would take as a vitamin—any dose will do—is pierced with a needle or a pin.’Iben the contents are squirted out all around the edge of the nail and particularly under the nail, between it and the skin. The key here, as with most nail fungus treatments, is patience and persistence.
Listerine
The old-fashioned mouthwash Listerine is one of America’s favorite all-purpose home remedies. (The other is Vicks VapoRub; more about it in just a bit.) Amber-colored original flavor Listerine contains a mixture of herbal extracts that can fight fungal pasties from dandruff to jock itch. Some people have also reported having good success with soaking infected nails in Listerine.
0. 1 cured my toenail fungus using a fifty-fifty mixture of vinegar and Listerine. I kept the mixture in a quart jar with a screw-on lid and used a clean paintbrush to apply the liquid to the affected toes morning and night. I wore socks to protect the bedsheets at night.
The fungus took about 3 months to clear up. It is slow growing but is also slow to cure. I hope this helps someone else.
A. You combined a couple of favorite remedies. Many people have reported success with soaking infected - nails in one part vinegar to two parts water. Others got good results soaking their toes in Listerine. Such remedies won’t work for everyone and take several months to produce results.
*** Listerine
This amber-colored mouthwash contains a fair amount of alcohol along with a mix of herbal oils including thymol, eucalyptol, methyl salicylate, and menthol. The thymol and the eucalyptol, at least, seem to have antifungal activity, and the other two may fight fungus as well. Soaking the nail in Listerine (original flavor) or daubing on a bit of Listerine after the daily bath has worked for some people.
Side effects: None known
Downside: Your nails may smell like Listerine. Cost: Approximately $5 for a liter  Vicks VapoRub
This ointment contains herbal oils such as camphor, menthol, thymol, eucalyptol, cedarleaf, nutmeg, and turpentine. Some of these have antifungal activity, and they may work synergistically. Apply Vicks VapoRub all around and under the affected nail or nails once or twice a day. Putting it on right after a shower or bath seems to help. If you apply it at night, wear socks to bed to protect the sheets. It may take 6 months to see results.
Side effects: Allergic rash is possible. In addition, we heard from a few people whose fungus-infected nails came off with this treatment. This might increase the effectiveness of the remedy, but it could be painful.
Downside: Inconvenience
Cost: Approximately $12 for 6 ounces. You could probably treat several toenails twice daily for 6 months with this much Vicks.
People have conjectured why Vicks seems to be beneficial against nail fungus. There is a compound in Vicks—thymol—that is now listed as an inactive ingredient.
When I was a premed student at UCLA in 1951, 1 met a mycologist (an expert on fungus). During World War It he devised a preparation to treat fungal infections that were common among the troops in the North African campaign. ft was an ointment that relied heavily on thymol as the most effective antifungal agent and reeked of thyme.
Vicks contains three active ingredients and 22 considered inactive. One or more of these might help thymol penetrate the tissues. I suspect that a pure preparation of diluted thymol, without other ingredients except a solvent, would be a good antifungal nail treatment
Vicks VapoRub certainly does not work for everyone. But we have heard from a great many people who have tried it and gotten a positive response. Some could see the results within a few weeks; others needed to keep applying it for month-s. Even prescription drugs take quite a while to clear toenail fungus, however, because the toenails grow so slowly. The infected nail must grow out completely and be replaced by uninvolved nail.
I had nail fungus fora long time. Medicines recommended by my doctor didn’t work. Then I read about using Vicks VapoRub. I applied it to the nail every day for about 5 months and now the fungus has disappeared. I’ve been cured.
Tea Tree Oil
Tea tree oil comes from an Australian tree, melaleuca. It has long been used to treat skin problems, particularly fungal infections. You don’t need to go to Australia to get it, though. It is marketed widely in stores and on the Internet in the United States. Applying tea tree oil to the infected nails daily can overcome some cases of nail fungus. Some people do develop allergic rashes in response to tea tree oil, however, so be alert for any itching or redness.
Q. Some years ago I was diagnosed with a fungal infection on one toenail. The intense throbbing pain made it difficult to wear a shoe.
My podiatrist said the only way to treat the toenail was to remove it. I had several more months of pain while the toe healed.
After the surgery I was alarmed when another toe showed signs of fungus. I asked about a natural treatment at the health-food store and was told to try tea tree oil.
I applied it liberally several times that day. Within 10 hours, the pain had diminished. I continued using tea tree oil on the nail daily for a few months. The base of the nail grew in pink and healthy.
I am angry that my podiatrist chose to operate on my toenail rather tha” recommend a natural, pain-free tMMYnent.
A. Tea tree oil (derived from the Australian melaleuca tree) has antifungal activity. It has long been used to combat skin and nail problems. Your podiatrist may not know about this herbal product, however.
Pau d’Arco Tea
The lure of the exotic can be seen not only in tea tree oil but also in Pau d’Arco, also called taheebo. This product is the inner bark of a South American tree that has been used medicinally by the natives of Brazil. Argentina, and Paraguay. It contains at least one compound with antifungal activity. Some readers report that using an infusion of Pau d’Arco to soak toenails, much as one would use vinegar or Listerine, can help clear the infection.
Oregano Oil
Oregano oil doesn’t come from a tropical rain forest, but it is hardly a common household staple. Nonetheless, some people have used it topically for fighting athlete’s foot, and others have reported success in using it against nail fungus. Like Listerine and Vicks VapoRub, oregano oil contains thymol. It also contains carvacrol. These two herbal oils together seem to have some antifungal action. Some people are allergic to oregano oil. Anyone who has experienced a reaction to basil, sage, lavender, marjoram, or mint probably should steer clear of oregano oil.
Can you stand another toenail fungus cure? I have found one that works for me, and I have tried them all, including prescription Lamisil pills.
I read somewhere that oil of oregano will kill anything, so tried putting a drop down between the nail and the skin every day. Slowly but surely the toenail is growing out normally! I hope someone else can benefit from this as well.
Lemon
Some years ago, we heard from a reader who maintained that sleeping with a lemon attached to the toe for 3 nights running would clear up toenail fungus. Only a few others have tried this -and reported back to us. It did not work for at least one person, though it seemed to help another.
0 0 *
0. Many people write to you about toenail fungus, but you have never mentioned a remedy I learned from an elderly lady in South Carolina. This remedy requires three fresh lemons. At night cut a hole in the top of one and scoop out a hollow just large enough for the toe.
My mother had a great toenail so thick and hard that she could hardly wear a shoe on that foot. I used duct tape to hold the lemon on Mother’s foot, and put a sandwich bag over it to protect the bed. Do this for 3 nights in a row. The toenail becomes so soft that it can be peeled right off, and the new nail that grows in is normal. It worked for my mother!
A. We have been collecting nail fungus remedies for years, but this is the most unusual. Fungus doesn’t thrive in an acidic environment, which may be why dilute vinegar soaks are so effective. The citric acid in the lemon may work in a similar manner.
Prolonged exposure to pure lemon might be irritating for some people, so we suggest that anyone who wants to try such an approach test it first. Removing a
toenail should be done only with medical supervision,
because there is a risk of infection.
* 0 0
Prescription Treatments
Unlike home remedies, prescription medications for nail fungus have been scientifically tested and have performed better than placebo. That is the criterion applied by the FDA before approving any prescription product. Don’t expect too much from these medicines, though: They don’t work for everyone, even though they might be more effective than home remedies. Before beginning a prescription medicine for nail fungus, make sure you understand the risks.
Urea Passe
One treatment for toenail fungus is to remove the nail surgically and then treat the underlying skin with an antifungal cream while the nail grows back without fungus. Many people are understandably reluctant to undergo surgery for nail fungus. Infection is always a risk. We hate it when the cure is worse than the condition it’s intended for.
Dermatologists have studied a different approach that is Urea Paste
The high-strength 40 percent urea paste that dissolves infected nails is available only by prescription. Its use should be supervised by a physician who is familiar with the treatment.
Side effects: Irritation, itching, or burning
Downside: Many doctors are not familiar with this approach. Cost: Approximately $75 for an 85-gram tube
far less traumatic. Urea paste at a 40 percent concentration will dissolve infected nail and leave healthy nail alone. It is essential to work together with the prescribing physician, however, as removing a nail is not a trivial issue. Please do not do this at home by yourself.
0. 1 have ugly, thick, yellow toenails that are hard to clip. My doctor says they are infected with fungus but he doesn’t want to prescribe Sporanox because it could interact with other medicine.
I have tried home remedies, including Vicks VapoRub, and none has worked. The podiatrist wants to remove the nails surgically. I know you have written about urea paste to dissolve away the infected nail. Where do I get it and how do I use it?
A. Surgical removal of nails can be painful and there is a risk of infection. Stanford dermatologist Eugene Farber, MD, discovered the urea treatment many years ago while traveling in Russia. 761 Urea (40 percent) is available only by prescription (Ureacin-40, Carmol 40, Gordon’s Urea 40). Your doctor should supervise the treatment.
Penlac
A lot of people are reluctant to take an oral antifungal drug. Some worry about side effects, others are concerned about potential interactions with other drugs they take. Both are valid concerns.
One manufacturer came up with a topical prescription antifungal medicine that is applied like nail polish. Penlac (ciclopirox) was approved by the FDA for the treatment of mild to moderate nail fungus. Like most of the home remedies we’ve already discussed, Penlac requires a lot of persistence. It needs to be applied to the affected nail, including between the nail and the skin, every day. It can cause redness or irritation, and it may take up to 6 months to produce results.
When people use Penlac, they need to see a health-care professional on a regular basis to have any unattached, infected nail removed so it won’t continue to spread the infection. We have no way of comparing Penlac’s effectiveness to that of other treatments. Presumably it is as good as most of the untested home remedies, but it is not really too astonishing. About 12 percent of the patients treated with Penlac in clinical trials were able to clear their toenails of fungus. One of the biggest differences between Penlac and a home remedy is the cost. A little bottle (6.6 milliliters) costs $130 or more.
Sporanox or Lamisil
The heavy artillery for treating nail fungus is an oral antifungal medication. If it is crucial to eliminate the infection, the physician will prescribe a drug such as itraconazole (Sporanox) or terbinafine (Lamisi)). (You may have seen magazine or television ads for Lamisil that feature a cartoon character, Digger the Dermatophyte.)
In a long-term head-to-head study, patients with toenail fungus were given either terbinafine or itraconazole according to the recommended dosing procedure for 3 to 4 months. 762 At the end of that time, 46 percent of the people who had taken Lamisil and 13 percent of those who had taken Sporanox had no detectable fungus in their nails. The follow-up extended for another 4 years or so. The investigators (some of whom worked for the maker of Lamisfl) found that relapse rates were significantly higher among those who had taken Sporanox.
An analysis of cost-effectiveness found that terbinafine is the most cost-effective treatment a doctor can prescribe. 761 Penlac was judged to be at least three times more expensive than the others, considering cost per cure. This analysis did not take any of the home remedies into account. If there were scientific data on them, they might well demonstrate low effec-tiveness, but because they are cheap, their cost-effectiveness might compare well to some of the standard treatments.
Another advantage of home remedies is the low likelihood of serious side effects. Lamisil is considered fairly safe, even for children and the elderly.764 Nonetheless some people taking Lamisil have developed liver failure.’W~ People who already have liver problems should not be given this drug. Other people taking Lamisil have come down with a very serious skin reaction, so anyone who develops a rash should get in touch with the doctor promptly. People who have lupus could get worse while taking Lamisil, so it’s generally not recommended for them.
As we mentioned at the beginning of this discussion, Lamisil occasionally can lower white blood cell counts to dangerous levels. Usually, the count comes back up once the person stops the drug. This drug may interact with other prescription medicines, including antidepressants. beta-blockers, and certain other medications that regulate the heart’s rhythm. By now, we hope we have convinced you to stay in very close touch with the doctor who prescribes Lamisil for your toenail fungus. It’ll probably run you more than $800 for the 12 weeks of treatment, but because it works so well, it is quite cost-effective.
Conclusions
Nail fungus, particularly toenail fungus, is usually more of a nuisance than a serious medical problem. (For diabetics, however, nail fungus or any other foot problem qualifies as serious and requires medical care.) As a result, we feel comfortable in recommending that most people try home remedies first. We don’t have any data on how well they work, but the testimonials we have received indicate that they do work for some people. In addition, they are inexpensive and don’t cause dangerous interactions or reactions.
A palm) who needs a higher likelihood of cure may need a prescription for Lamisil. It is the most cost-effective of the prescription nail fungus drugs. Even so, it does not work for everyone, and it is not always appropriate. Some people may be taking other medicines that could interact with Lamisil. Others may be at risk of liver problems or complications such as lupus. Most of the time, nail fungus is a problem you can live with; some of the rare side effects could be deadly.
•Toenails grow slowly. It takes a year to a year and a half for them to grow out completely, so be very patient and persistent.
•    After cutting fungus-infected nails, soak the clippers or scissors you used in alcohol for 15 to 20 minutes so you don’t spread the infection.
•    Soak your feet in a footbath of one part vinegar to two parts water for 20 minutes a day.
•    Mix cornmeal with hot water, allow it to cool to a comfortable temperature, and soak the affected nails for 1 hour once a week for at least a month.
•    Squeeze vitamin E oil or tea tree oil around the cuticle and under the nail once or twice a day.
•    Soak the feet in original Listerine or apply it daily to the affected nails.
•    Smear Vicks VapoRub around and under the nail every day.
•    Brew an infusion of Pau d’Arco for soaking the affected nails every day.
•    Stick your toe in a lemon overnight to soften the infected nail for removal.
•    If the nail needs to come off, ask your doctor about prescribing urea paste (40 percent).
•    Lamisil is the most effective prescription pill for fighting nail fungus.

Care
Boundaries
Birth is an immense change for the baby. Her whole physiology changes fundamentally and she experiences a completely new environment. The boundaries of the womb are left behind and she enters a ‘boundless’ world. In the womb, the child was able to grow harmoniously, protected from the world.
This reveals that everything that is developing requires a protective environment. With a newborn baby, and actually throughout childhood, this protective environment is constantly provided to establish firm foundations for later life. Unconsciously, the child is constantly reminded of the situation in the womb, which is related to an experience of security, safety, protection and fundamental confidence.
Warmth
The womb not only protects the embryo from the world; it also surrounds it with an even temperature of 37°C (98.6°F). A ‘warm environment’ is provided in the best possible way.
After birth, a child has to learn to maintain her own body temperature at a constant level, at first with the help of adults. She must interrelate the warm and cold parts of the body. This is achieved by means of a sensitive metabolic process which generates heat.
Normal growth and the development of the normal physical processes are also dependent on this metabolism. All the heat which the baby does not have to produce herself in order to maintain her temperature at the right level will benefit growth.
It takes the child a long time to regulate her own temperature; the normal difference of PC (2°F). between the body temperature during the night and the day is achieved by most children between their fifth and ninth months. Up to that time they are extremely dependent on the extra warmth provided in the form of good physical care, clothes, and hot water bottles used to warm the cradle before they are placed in it.
The ability to distinguish whether something is hot or cold is learnt during the initial period. The better this ability has been developed by providing sufficient warmth in childhood, the better the child can use it at a later age.
Cold feet are an important sign that extra attention should be devoted to regulating the child’s temperature. A baby should have warm feet, warm legs, a warm body and warm arms.
Special attention to warmth also has another significance. A warm environment helps the child to ‘warm up’ for life on earth. However, our motto is not ‘the warmer, the better,’ because always being dressed in too many clothes or being covered up can actually make a child either drowsy or very restless, and overheating can be very dangerous. Detailed research has revealed that there is a relationship between overheating and cot death. Duvets and synthetic materials can especially cause overheating. Therefore we certainly advise against using these.
In our view, the important thing is to learn to observe the needs of the child with regard to warmth, and to read the signs when more or less warmth needs to be provided in the form of clothes, bedding or ambient heating. The body temperature of the child is the most important thermometer, and in a healthy baby, this fluctuates around 37°C (98.6°F). You can learn to take the baby’s temperature with your hands so that you can literally feel how the child is regulating its own temperature. In the first week or two after birth, take the baby’s temperature every day, as well as feeling how warm she is. Then start testing yourself: feel how warm the baby is, then predict her temperature and check with the thermometer for a few days. If your predictions are correct, you will only have to take the baby’s temperature when you are doubtful or if she is sick.
Impressions
Everything we do, feel and think around the child is assimilated by the child. She is still completely open and has a boundless trust in the environment. The buffer which
we have between ourselves and the world as adults is formed by recognising and understanding that world. A small child is not yet able to do this. Up to about the third year, the child identifies with the environment in which she is living in a very natural way. This is followed by a stage in which thinking gradually assumes set patterns, and the child leans to distinguish herself from the outside world. For the first time, she makes a distinction between her own individuality and the world which is perceived. In this light it is understandable that first memories only go back to the third year, and there are no, or very few, memories before this.
The child is one big sensory organ. Up to the third year, all impressions are assimilated in an uninhibited way and disappear into the subconscious. There they are combined with other physical processes, and a sort of print is made; it is as though the child models the influences of the environment in its own `clay.’ Therefore, it is important that we are aware of what ‘goes into’ the child — also for later on.
Example. A child in a boat on the water, experiences the swell, feels the sunlight on her skin and the wind in her hair, smells the odour of water and fish, is taking in healthy impressions which build up the whole organism. The situation is quite different for a child at a department store who is placed in a rotating ship, which goes round and round when a coin is placed in the machine. The child will enjoy both these experiences, but they affect the organism in significantly different ways. The ‘boat on the water’ situation sounds idyllic; this is usually a vacation experience. However, there are also impressions closer to home, which can be constructive and have the above-mentioned character
Positive, constructive impressions are those impressions in which the natural origin of materials, sounds etc, can be perceived by the child. For hearing, these are the sounds of people and animals, and natural sounds such as the rustling of the wind. For sight, they are natural colours. For the sense of touch, they are materials such as wool, cotton, silk, wood, sand and water.
Many domestic appliances such as vacuum cleaners, washing machines, radio, television and plastic toys were created as a result of human technical ingenuity. For children, these are actually an abstraction, lacking in natural connection.
Radio, television and plastic toys are things you can consciously choose to have or not to have in a small child’s immediate environment. With household appliances, you can take care to minimize the sound in the baby’s immediate environment. So-called ‘white noise’
from household appliances is not a good idea for the young child as it blocks out normal impressions. Autistic children can also become obsessed by white noise. Playing a lyre, humming or singing are better background sounds for the child.
Simple actions such as washing hands, or sweeping up with a dustpan and brush in the child’s presence show how things are done. These actions are enjoyable and you can invite children to imitate them.
The feelings of people around the child also have an effect. It is obvious that a child will thrive best in a genuine atmosphere of joy and warmth. This has a positive effect. But there is not a parent in the world that is always cheerful and relaxed at every moment of the day (and night). It is worth aiming to achieve these qualities, but at times when you do not succeed, you must take them for what they are — also real human emotions. In every family there are days when everything goes pear-shaped and the ideal image of a happy family seems a long way off. Humour is always a good remedy. It can be a relief if you can laugh about yourself and the situation.
The needs which were mentioned above — that is, the need for boundaries, warmth and positive impressions — make great demands on the environment. It means that parents must have clear insight and a good level of empathy to get things right: too cold or too warm, too many im-pressions or too quiet, well-protected or not enough room to breathe?
From this point of view, we would like to discuss a number of practical aspects of childcare.
Clothes
Clothes are like a second skin, which support the functions of the skin. The skin helps to regulate body temperature and protects us from infections. In addition, the skin is a sensory organ with which we perceive the environment. These three functions are most effectively supported with clothes made of wool, silk, cotton or hemp. These fibres are preferable as they provide sense impressions from a natural source via the skin, which help the child to build up its body. Other fibres are more alien, and even viscose, which is made from cotton or wood, is processed quite strongly, in a way which is now known to be quite polluting.
Wool
Sheep’s wool protects the sheep from heat and cold, rain and toxic waste. The curls trap the warm air around the sheep’s skin. The wool keeps out the rain, and waste products are absorbed and emitted through the wool via perspiration.
All these qualities are found in woollen clothes. The warmth of the wool protects the child from cooling down too quickly and supports her unstable heat regulation system which cannot yet retain body heat.
Its absorbent capacity (30 to 40%) ensures that the child remains comfortably dry. The quality of the wool depends on the age of the sheep, the animal’s diet and health, as well as the way in which the wool was turned into clothing.
Finely knitted woollen vests are available, which forma soft, flexible outer skin. Woollen jumpers and cardigans should be loose fitting so that they are easy to put on and take off. Woollen pants are wonderful to use over cotton nappies. They can be knitted easily, preferably from slightly greasy sheep’s wool, and are ideal for absorbing moisture and neutralizing the waste products in urine.
A woollen shawl will keep the baby warm when there are fluctuations in temperature. Woollen socks will also keep the feet nice and warm. Furthermore, wool does not attract dirt, and therefore woollen clothes do not have to washed as often as cotton clothes, though they do have to be aired regularly.
Silk
The silkworm spins its cocoon of silk thread, in which the worm is sealed off from any negative external influences. The silk is made under the influence of sunlight — at sunset, the silkworm stops spinning, and at sunrise, it starts work again.
If you use silk in clothes, you will feel its enclosing qualities. Furthermore, silk can absorb 30% of its weight in moisture without feeling damp. In addition, silk retains heat when it is cold and releases heat when it is warm. That is why silk is worn especially in summer. Silk and, in particular, knitted silk is an excellent basic material for vests, but it is advisable to put a woollen vest over the silk vest as well.
Children who are sensitive to wool against the skin, and children who are very sensitive to impressions and consequently become restless, will benefit from wearing a silk vest.
Cotton
Cotton is widely used nowadays for children’s clothes, especially as this material can be washed so easily in the washing machine. At the same time, it should be said that it actually has to be washed often because it attracts dirt easily. Cotton can absorb 20% of its own weight in moisture.
As cotton cannot absorb heat, this passes easily through the material to the outside air. Consequently, this material is not the best choice for a child’s underclothes throughout the year. Furthermore, the way in which cotton is grown is not particularly environmentally friendly, and chemical products are often used in the treatment of the material. Fortunately, there are several eco-cotton projects which now promote its environmentally-friendly cultivation and processing, and eco-cotton is becoming increasingly available in shops and over the internet.
We suggest dressing the baby in at least two layers of clothing, covering the whole body, including the arms, legs and feet. This produces a layer of air between the two layers which retains heat. In a temperate climate, a long-sleeved woollen vest — or a vest of wool and silk — can be worn for most of the year.
In practice, we regularly find that babies are not dressed warmly enough, and they are often restless and troubled by stomach cramps, or they are constantly crying. The simple remedy of dressing the child more warmly, in better fitting clothes, will do wonders for this.
Bonnets
Unfortunately, bonnets are no longer in fashion. In comparison with the rest of their bodies, little babies often have an enormous — and sometimes rather bald — head. The head is constantly losing heat, which should really be retained for the development of the brain and organs. On the one hand, a silk bonnet will retain the baby’s heat, and oil the other hand, it protects the head and the open fontanel from a restless environment. It is important for the forehead to be free, because this part of the body acts as a sort of thermostat for regulating body heat. Where it is often windy, it may also be necessary for the baby to wear a second bonnet made of wool. There are wonderful bonnets on sale, or they can be knitted in material which is so soft that it is like a second skin.

Bonnets can be removed when the child is in the cot as long as the baby is well protected.
Wraps and swaddling
Because of the need for boundaries, it is understandable why many babies, as well as older children, calm down and fall asleep easily when they are firmly tucked in, or if they are wrapped up or swaddled.
Usually, babies have a flannel sheet wrapped around them, during the postnatal period, but this often disappears, to be replaced by a babygro/sleepsuit. We recommend continning to use a swaddling cloth and wrapping it firmly around the babygro/sleepsuit before putting the baby to bed (see illustration). As the baby still lies with its arms and legs bent, it should be swaddled in this position, to increase the sense of security. The baby can now relax and will fall asleep warm and snug. However, you must make sure that the baby is not wrapped up too warmly (see p.25).
The woollen wrap can serve as a blanket outside the cot for when the baby is fed. When the woollen cloth is no longer sufficient, use a (woollen) baby sleeping bag for in bed.

Children who remain restless and have difficulty falling asleep despite being wrapped up, as well as babies who do not establish a good rhythm of drinking/sleeping, may benefit from the old-fashioned method of swaddling in which the arms are also wrapped up so that the child cannot flail about. Flailing is often a response to crying, cramps or fright, but because it is involuntary, it can cause new restlessness. Swaddling can help to break this vicious circle.
Many parents find it difficult to restrict their baby in this way; in our age of boundless freedom, it is not so easily accepted. However, parents usually overcome their resistance when they see how the baby responds to swaddling. For most babies, it results in a much greater sense of peace, and consequently they sleep well and establish a pattern of sleeping and feeding every few hours. Nowadays, two methods of swaddling are recommended: either ready-made swaddling blankets or swaddling wraps, or using the method shown at the back of this book (see p.108). (See also Blom, Crying and Restlessness in Babies.)
The cradle
The cradle is an important successor of the smallest home in which the baby lived before birth. You can opt for a basket cradle (Moses basket), a wooden (rocking) cradle or
a cot. For safety considerations, the baby’s feet should always be placed at the end of a cot, with its head halfway down. Tuck in the blanket in such a way that the head is free and the shoulders are covered. A hood or canopy over the cradle or cot makes the space more intimate, so that the child is not distracted by the environment and can sleep more peacefully.
For the canopy, it is best to use plain materials in soft colours. A canopy made of light blue silk combined with a layer of pink silk gives a very subtle calming colour.
The mattress must be absolutely flat, providing good support, and it must be well-ventilated and warm. Our preference is for a mattress of kapok, cotton or another natural material. A sheep’s fleece can be placed on the mattress. The fleece is soft and gives a beneficial warmth so that the newborn baby is protected from cooling down too quickly. Make sure that the fleece is not too large and lies on the mattress without any folds. Cover the fleece with a sheet. The bedding should be made of cotton and wool. Do not use synthetic materials. The sheets and blankets should be big enough to tuck the baby in quite firmly. The fleece and the mattress should be regularly aired. If you use a woollen wrap there are likely to be patches of damp under the mattress. If necessary, use a waterproof sheet. There are cotton sheets available that are impregnated with rubber and do not feel clammy. We do not recommend the use of duvets, even those made of wool, because of the risk of suffocation.
If the cradle is next to the window, watch out for overheating in the sun. A baby can easily become too hot in a heated room when the sun shines through the window.
The playpen
Up to the age of four months, it is not really necessary to have a playpen. Nevertheless, when the baby is downstairs, it is a good idea to have a safe place to place it. A wicker basket with a soft cover, or the bed of a pram, are quite suitable.
We do not recommend the frequent use of a baby seat or recliner, as the baby is stimulated by the ac-
tion of sitting in an upright position at a stage when he is still physically immature. The baby can only lie passively in a baby seat, which does not matter for a short period, but is harmful to physical development in the long term.
This objection does not apply so much to the use of a recliner, but there are other objections; when the baby discovers that he can bounce the recliner with one leg, he often finds it difficult to stop, even when he gets tired of the mechanical movement.
When the baby starts to reach out for things and becomes more active in its motor development, it is time for a playpen. Quite apart from the fact that this provides a safe place for the child to learn to sit and stand, it is often a favourite place for being quiet and for playing undisturbed. A cloth cover, like a curtain, along three sides of the playpen will increase the sense of security, and is not to be confused with cot bumpers, which are not recommended as they pose a suffocation risk for the young child. For motor development, it is important that the floor of the playpen is sturdy and not too smooth (for example, a cloth folded double), so that the child can roll over and can put pressure on it.
Walkers and baby bouncers
We emphatically advise against the use of walkers and baby bouncers. These are ‘aids’ which speed up the child’s motor development in an unnatural way. Children certainly like to use these things — especially if they can move around in them quickly — and want to use them more and more. However, it is much better for a child to learn to stand and walk at his own pace. In this sense, walkers and baby bouncers do not help healthy development in any way, and are actually more of a deterrent to healthy development.
Prams and baby carriers (slings)
The pram can be a safe and sheltered place in which the baby can sleep outside during the first few months. For walking, a baby carrier is often a better alternative because it means
that the baby moves in time with the pace at which the adult is walking, and is not shaken about so much as in a pram, as it goes up and down the pavement. The child is carried in a natural position in a baby carrier (sling), (see the illustration on p. 106).
However, at this point a warning should be given. It has been shown that babies can become too hot and stuffy, particularly if carried under a coat. Unfortunately, there are even a few cases, which resulted in a baby’s death. We recommend that you keep a careful eye on a baby in a baby carrier, and if possible carry it on top of a coat rather than underneath, with, if necessary, a woollen cloth around the baby.
The disadvantage of a baby carrier in which the baby is in a vertical position is that the baby did not take up this position itself. In this sense, the baby carrier is not for babies until they reach the age of nine months. A sling is preferable, as the whole back and head are supported, although it might be tiring for the mother to carry.
When a baby has reached the age for a pram, the best model is one in which the baby faces the parent. In this way, the baby constantly has the comforting face of its father or mother in front of it, and can find out from that face what is happening in the big wide world. A traditional pram has the advantage that the child lies flat, as at this age the baby’s head is still relatively heavy and the neck cannot keep the head in a stable position. We recommend a buggy only from the age when the child is able to sit unassisted.

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!