Posts Tagged ‘hormonal’

Black Cohosh
One of the most popular herbal supplements used to alleviate hot flashes is black cohosh. This plant is native to North America and was used by Native Americans for a range of medicinal purposes. The botanical name has been changed in recent years, so some references refer to this plant as Cimicifuga racemosa whereas others use the current term, Actaea racemosa. The famous 19th-century patent medicine promoted for “women’s problems,” Lydia E. Pinkham’s Vegetable Compound, contained black cohosh as a prominent ingredient.
A standardized extract of black cohosh called Remifemin has been studied in Europe and found to effectively reduce Remifemin
This standardized extract of black cohosh is consistent and widely available. The recommended dose is 40 to 80 milligrams per day.
Side effects: Digestive upset
Downside: Not to be taken during pregnancy; monitor for liver toxicity
Cost: Approximately $15 to $30 per month
hot flashes.739 Physicians who scoff at herbal remedies appreciate that this research was published in a highly respected peer-reviewed journal, Obstetrics and Gynecology (May 2005). In one trial, Remifemin was compared to a low-dose transdermal estrogen preparation.”O The treatments were equally effective in reducing hot flashes, and neither one was associated with serious side effeCtS.141
Most reviews suggest that the side effects of black cohosh are infrequent and generally mild—mostly digestive upset with some headache or dizziness reported. 42 Just the same, we think that women should discuss this supplement with their doctor. Although recent studies of black cohosh have monitored liver enzymes and found no changes, there are reports of liver toxicity among women taking black cohosh.741 Women who have had hepatitis or other liver problems might want to consider a different approach. For most healthy women, 6 months or so of black cohosh may be worth trying, and it seems fairly safe.744 Unfortunately, black cohosh does not relieve hot flashes that result from breast cancer treatment with tamoxifen.
The Soy Solution
One of the other popular approaches to managing hot flashes is soy. Isoflavones such as genistein and daidzein are phytoestrogens, estrogen-like compounds derived from plants. Even though they are far weaker than the estrogen a woman’s own ovaries make before menopause, it seems logical to use these compounds to ease hot flashes. Studies from cultures like Japan, where women consume soy products such as tofu and ** Soy
The results of studies on soy have been inconsistent. Soy may be consumed as shakes, bars, or more traditional soy foods such as tofu or tempeh. Women who have more hot flashes may derive more benefit.
Side effects: Unpalatable taste, digestive distress Downside: Not advised for women being treated for breast cancer; excess soy may interfere with the production of thyroid hormone
Cost: Approximately $15 to $50 per month
tempeh as part of their normal diet, suggest that hot flashes and other menopausal symptoms may be less common there. 745
Despite the epidemiological promise, research on soy against hot flashes has been disappointing overall.746.747 One review of many trials, however, found that women who began the studies with frequent hot flashes got more relief from soy foods or isoflavone supplementation than did women who rarely had hot flashes.’ 48 A different systematic review delivered a lessthan-ringing endorsement of the effectiveness of soy preparations against hot flashes, but the authors did conclude that the risks appear to be low. 74″ As the authors of one pilot study concluded, a soy extract (they were testing Phytosoya) appears to reduce hot flashes and night sweats and is probably worth a try if women don’t want to take standard HRT.750
Red Clover
Another source of isoflavones that is marketed for perimenopausal women is red clover (Trifolium pratense). Although this plant is native to North America, its extracts are sold by an Australian firm as Promensit and Rimostil. Most of the research on red clover isoflavones has been funded by the manufacturer Novogen. Nonetheless, the results vary. One small Dutch study found a significant effect, with Promensil reducing hot flashes by 44 percent more than placebo.”‘ But a larger, multicenter trial in the United States found no clinically significant effect on hot flashes with either Promensil or out of the study, and no side effects were significantly more common among those taking red clover extracts than among those on placebo. Analyzing the data for subgroups uncovered a trend toward heavier women getting more benefit from Promensil.153 Overall, however, red clover does not seem very impressive.
Vitamin E
-the North American Menopause Society suggests taking vitamin E along with keeping cool, exercising, not smoking, eating soy isoflavones, and taking black cohosh as inexpensive,.probably helpful nonprescription measures to alleviate hot flashes. Quite a few women have heard that vitamin E can be helpful for this symptom, and some have passed the advice along to their friends.    9
A. I’m 53 and haven’t had a period for a year. I have no problems other than hot sweats.
I recently started taking 400 IU of vitamin E each day and, much to my amazement, it really works. Is there anything I should know about this vitamin?
A. Many women tell us that vitamin E can be helpful for hot flashes. Don’t count on it to protect you against cancer, though. Smokers should probably not take vitamin E supplements, because there is some fear it may actually increase their risk of lung cancer. For others, moderate doses of vitamin E seem safe for short periods of time.
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Unfortunately, there appears to be very little research on the effectiveness of vitamin E. Some of the buzz may have come from a study done more than 50 years ago.7-14 Usually we would like to see more recent research to back up a recommendation, but little seems to have been done.— Nonetheless, the North American Menopause Society considers vitamin E, like black cohosh and isoflavones, safe enough to be worth a try.
Vitamin E has performed poorly in several recent studies of cancer prevention, and women who are at particularly high risk of lung cancer—smokers, for example—should probably avoid taking large doses of vitamin E without other antioxidant nutrients. But healthy women planning to take vitamin E for a year or two to ease hot flashes probably will not notice any unpleasant effects. The best product is a combination of natural tocopherols. As with other products, start with the lowest dose available and gradually increase it to find the lowest dose that helps with your symptoms.
It is disappointing that vitamin E has received so little scientific attention over the years. That hasn’t stopped women from trying it, though. Of course, we frequently hear about other interesting nutritional supplements that have worked for a few women but have no scientific evidence to support or refute their effectiveness. If they are otherwise safe, we see no harm in experimenting.
/ can’t help but wonder why most doctors do not treat hot flashes and night sweats with bioflavonoids. As a retired registered nurse, I have found that daily use of bioflavonoids will relieve both the hot flashes and the night sweats. It saves the worry of cancer threats from hormones and is much less expensive. I use Citrus Bioflavonoid Complex, 1,9W milligrams, providing 35 percent hesperidin, 350 milligrams. [Hesperidin is a compound found in citrus fruits that has anti-inflammatory activity.]
At one time, I was hesitant to suggest this to my daughter-in-law because she had been successfully treated for breast cancer When we were visiting and she was showing the lack of sleep front hot flashes and night sweats, I finally bought bioflavonoids for her She often thanks me for the relief that it has given.
Nonhormonal Therapies
For years, women have worried about the possibility that estrogen and progesterone could increase their risk of breast cancer. Women who have already been treated for breast cancer can’t take these hormones safely. As a result, and in light of the negative results from the WHI research, physicians have been looking for other ways to alleviate hot flashes. One approach that seems to help is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) family.
PAXII.
Some doctors now prescribe antidepressants like Paxil (paroxetine) to help women deal with hot flashes. A recent study found that Paxil was significantly better than placebo in reducing the number of hot flashes and easing their intensity. 755 Low-dose Paxil (10 milligrams per day) was also better than placebo in preventing nighttime awakening, presumably due to night sweats. Women in this study did not have to be depressed to get benefit. That also seems to be the case for drugs such as Effexor (venlafaxine).71
Such medications are not without their own drawbacks, though. They can cause sweating, nausea, dry mouth, constipation, insomnia, jitteriness, and sexual problems such as difficulty achieving orgasm. Both Paxil and Effexor also can be difficult to discontinue. Stopping suddenly can lead to odd and distressing symptoms such as dizziness, sensations similar to electric shock, and a peculiar feeling that has been described as “brain sloshing” or “head in a blender.” If antidepressants are taken for hot flashes, they should be taken at the lowest dose that works for the shortest time needed, just like hor-
** Paxil (paroxetine)
Paroxetine eases hot flashes due to menopause or associated with breast cancer drugs such as tamoxifen. The effect on hot flashes is independent of its antidepressant activity. Women found a lower dose easier to tolerate.
Side effects: Nausea, digestive problems, weakness, sleep disturbances, dizziness, nervousness, sexual difficulties, hyqe.m )siio% we*ig1ht gain
Downside: Paxil can be hard to stop taking. You may need your doctor to switch you to a longer-acting drug such as Prozac and then decrease the dose gradually over several weeks or months.
Cost: Approximately $75 to $90 per month move replacement therapy. And, also like HRT, they may need to be tapered off gradually.
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Q. 1 have been having hot flashes, night sweats, mood swings, and other change-of-life problems for more than a year. I had hoped these problems would eventually go away, but so far they haven’t.
My doctor wants me to consider Premarin, but I worry about side effects, especially breast cancer. It runs in my family.
The other drug my doctor has suggested is Zoloft. But I am not depressed and don’t want to deal with side effects from that drug either. Do you have information on natural alternatives that might help me withstand hot flashes, night sweats, and interrupted sleep?
A. Black cohosh extract has been recommended for hot flashes. A double-blind study published in Obstetrics and Gynecology (May 2005) showed that the standardized product Remifemin was significantly more effective than placebo.
Another reader shared her experience with a different herb: “I have been using St. John’s wort since discontinuing hormone replacement therapy. It has relieved many symptoms, including sleeplessness, stress, and fits of temper.”
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NEURONTI N
Anoffier approach that may help some women who are suffering with hot flashes is an anticonvulsant drug called Neuron-tin (gabapentin). Pilot studies show that 900 milligrams daily of Neurontin reduces both the frequency and intensity of hot
flashes, and that it works better than placebo.757 Because Neurontin, like the SSRI antidepressants, does not have any estrogenic activity, it may be especially helpful for women who have had breast cancer and must avoid HRT. This medicine * Neurontin (gabapentin)
Gabapentin eases hot flashes due to menopause or associated with breast cancer drugs such as tamoxifen. The effect on hot flashes is not related to its anticonvulsant effects.
Side effects: Drowsiness, dizziness, problems with balance, fatigue, swelling of the feet, nausea or vomiting, depression, reduction in white blood cells
Downside: Neurontin should not be discontinued suddenly. You should ask your doctor for help in reducing the dose gradually over several weeks or months.
Cost: Approximately $60 to $150 per month, depending on whether you get a brand-name or generic product
has been associated with some potentially serious adverse reactions, such as a reduction in white blood cells that could leave a woman susceptible to infection. We recommend having a thorough discussion of its likely benefits and risks with the prescribing doctor. This is good advice for any medication, of course, but especially for one being used for an “off-label” condition like this.
Relieving Vaginal Dryness
Hot flashes may be the most obvious symptom of menopause, but for many women, vaginal dryness is just as troublesome. And despite our culture’s greater acceptance of public discussion of sexual issues such as erectile dysfunction, for example, vaginal dryness is often too personal and too embarrassing to bring up. When the WHI highlighted the potential dangers of long-term use of oral estrogen, millions of women stopped their HRT and then searched high and tow lot a personal lubricant that would be safe and effective.
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Q. 1 know this is a sensitive issue, but it affects a lot of women. Vaginal dryness is ruining our sex lives. I had breast cancer, so hormones are out. I’m embarrassed to ask my doctor about this.
My husband works long hours, and our opportunities for intimacy are unpredictable. Is there any natural lubricant I could use just at that time?
A. Readers have suggested olive, almond, and vitamin E oils. Some people are allergic to topical vitamin E, though, and it can cause a nasty rash. In addition, using any oil in combination with latex condoms may weaken them. One woman breaks a leaf off her aloe vera plant and uses the slippery gel that oozes out.
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For some women, this problem is an issue only for sexual relations, but others find that dryness is uncomfortable throughout the day. Oral HRT generally relieves this symptom along with hot flashes, but just as sudden sweats may return when HRT is stopped, so can vaginal dryness.
Olive Oil
No studies have identified diets, exercises, or other lifestyle approaches that work for vaginal dryness. We. have heard from many women who have found remedies that work for them, however. One of the simplest is olive oil. Other women have found that almond oil has a more pleasant aroma and that it still helps with everyday moisturizing.
*** Olive Oil
If it’s safe to eat, it’s safe enough for vaginal lubrication, too. The oil is applied to the vagina with a fingertip. At first, daily application may provide the best results. Later, lessfreqxiem applications may be eileefive.
Side effects: Some women notice oily spots on their underwear. If this happens, apply less.
Downside: Some women are squeamish about fingertip application. In addition, using any oil in combination with latex condoms can weaken them.
Cost: A few dollars, or less, per month I would like to suggest a natural lubricant that is not greasy but is good for your body. It is pure olive oil. (it can be edible, too.) I have been using olive oil for this purpose for a couple of years. When my doctor did a pelvic exam, he thought I was taking hormones although I am not. I think olive oil has natural compounds to keep women youthful.
There is, unfortunately, no research to show whether any kind of oil applied topically will moisturize vaginal tissues. Our reader got a lot of other people interested in using olive oil for this purpose, though, and some of them contacted us to tell us that it helped. We really don’t know of any hazard to this one except for people who are allergic to olive oil. It doesn’t take very much, so use the best-quality extra-virgin olive oil you can find, or substitute almond oil or another vegetable oil if you
prefer.
Vitamin E
The underground popularity of vitamin E capsules taken orally for hot flashes has apparently inspired some women to try this dietary supplement “off-label.” We don’t think any vitamin manufacturer envisioned women using the contents of a vitamin E capsule for personal lubrication, but some are enthusiastic about it. They prick the capsule and squeeze out the oil for application by hand. Others use the capsule as a vaginal suppository. We caution, though, that some people are sensitive to vitamin E and might develop a rash. In addition,
** Vitamin E
Squeeze the vitamin E oil out of the capsule and apply it to either partner for lubrication “at the moment.” A capsuke may be used as avdiffinal suppository for lasting lubrication.
Side effects: Rash. Test the oil on your inner arm first, to make sure you aren’t sensitive to it.
Downside: Effectiveness has not been scientifically tested. Also, using oil in combination with latex condoms may weaken them so that they aren’t effective.
Cost: Approximately $2 to $5 per month using any oil in combination with latex condoms may weaken them.
Improbable Lubricants
Whoever said “necessity is the mother of invention” must be smiling at the ingenuity of women who have taken common, inexpensive cleansers or moisturizers and tried them to combat vaginal dryness. But some household products have been especially popular. Some years ago, we heard from a couple in their seventies who were using Corn Huskers Lotion, an old-fashioned hand lotion, as a sexual lubricant. Other readers were interested in their experience and tried the product out.
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A. 1 suffered for years from vaginal dryness and tried a lot of treatments for it. Then I read about using Corn Huskers Lotion. The results have been incredible! The lotion is inexpensive and works better than a progesterone cream my doctor prescribed. .
A. We’ve heard from others who have found that this old-fashioned hand moisturizer can be helpful for vaginal dryness. Some of the ingredients are identical to those in pricier personal lubricants.
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Corn Huskers Lotion contains glycerin, guar gum, and methylparaben, as well as a few other ingredients. It is not dissimilar to K-Y Jelly (glycerin, hyd roxymethylcel I u lose, methylparaben), Astroglide (glycerin, propylene glycol, parabens), or Replens (glycerin, mineral oil, methylparaben). All of these drugstore products are designed specifically as vaginal lubricants. Although they are a bit pricier, such products are certainly worth a try. Corn Huskers is promoted as an oil-free hand treatment lotion. The manufacturer makes no claims regarding this “off-label” use. Do keep in mind that mineral oil, as found in Replens, could compromise latex condoms.
We have also heard from many readers who sing the praises of an old-time facial cleanser for this purpose.
Q. My husband and I have used Albolene as a sexual lubricant since the early 1970s. I’m not sure how we heard about it, but it’s great: odorless, tasteless, slick, but not messy.
It comes in a white tub you can keep by the bed without embarrassment. A 12-ounce jar costs about $11, but a little goes a long way. We’ve purchased five jars in 27 years of marriage. I haven’t seen this anywhere else and wanted to share our secret.
A. Thanks for the tip. Finding a sexual lubricant that suits both partners can be challenging.
Albolene is a moisturizing cleanser that contains mineral oil, petrolatum, paraffin, ceresin, and beta-carotene. It should not be used with condoms or a diaphragm since petroleum jelly degrades latex.
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Albolene is certainly cost-effective. Although it is solid in its container, a small amount applied to the skin soon liquefies and becomes slippery. One drawback, though, is the mineral oil and petrolatum base. These petroleum products will destroy latex, so they must not be used with barrier contraceptives such as condoms or a diaphragm. (The postmenopausal woman may not need to worry about contraception, but many perimenopausal women still need to be vigilant.) Alboleneis available in pharmacies and online: for more information, you can contact the manufacturer, Numark Laboratories, at 800-338-8079.
I’ve been using a product from New Zealand named Sylk for over a year ear now and find it does a great job in lubricating and relieving pain associated with vaginal dryness during relations.
Quite a few people these days are reluctant to introduce petroleum-based products into their bodies, and they also worry about the effect of such products on latex condoms. Many of them have been pleased to learn about Sylk, a natural lubricant from New Zealand. It contains kiwifruit vine extract and, more importantly, does not contain petroleum products. As a result,  Sylk
This natural personal lubricant contains kiwifruit vine extract, citrus seed extract as a preservative, and vegetable glycerine. It is water-based, so it can be used with condoms. It is not sticky.
Side effects: None known
Downside: Effectiveness has not been scientifically tested. Cost: One bottle costs $22 to $23 and lasts 3 to 4 months.
it is safe to use with barrier contraceptives. Sylk is not available in most drugstores, but it can be ordered by telephone at 602957-7955 or on the Web at www.sylkusa.com.
People have devised a number of other clever ways to use natural products as lubricants. Some people have found that the gel from an aloe plant is ideal. It certainly is inexpensive! A few drugstore lubricants contain aloe as one of the ingredients, so presumably this is usually well tolerated.
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O. My husband and / can’t use K-Y Jelly or any other brand of lubricant we have tried. They make me itch and burn.
We have found, though, that the slimy gel that oozes from an aloe leaf when you break off a piece is a very good lubricant. I hope this will add to your uses of aloe vera and help another couple.
A. This is a most unusual sexual lubricant. Aloe vera get has been used for centuries to help burns heal and ease skin irritation.
Others who would like to try this should test the gel on the inside of the elbow first. If there is no allergic reaction, the slippery texture should make it a surprisingly effective sexual lubricant.
Hormonal Approaches
For decades, when women complained of vaginal dryness as a symptom of menopause, doctors prescribed estrogen, often as a vaginal cream. Most of the time when a vaginal cream or tablet was prescribed, the doctor would point out that it would have local effects and would not be absorbed into the bloodstream. Although vaginal estrogen creams can often help alleviate dryness, the dogma that the estrogen in the cream stays put and doesn’t get into the rest of the body is bogus. The delicate tissue of the vagina is quite efficient at absorbing estrogen and passing it into the bloodstream.758
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Q. I have been reluctant to take estrogen because I worry about possible side effects, in particular breast cancer. The worst thing about menopause has been the lack of vaginal lubrication, which makes sex very uncomfortable.
My doctor prescribed a vaginal estrogen cream for this problem. He has assured me that it is locally acting with negligible absorption.
It certainly has helped the vaginal dryness, but my hot flashes have also dropped off considerably. Is this cream getting from the vagina to the rest of my body to control the hot flashes? And if so, what about the risk of breast cancer?
A. Estrogen is easily absorbed from the vaginal lining. In fact, one study of Premarin and Estrace creams published in the Journal of the American Medical Association (December 14, 1979) found that “estrogen vaginal cream preparations, as widely used in clinical practice for their local effects on the vagina(mucosa, actually result in sus126ned high estrogen levels in the systemic circulation.”
We suggest that you discuss your risk factors for breast cancer with your physician. If oral estrogen is inappropriate for you, a cream formulation is not likely to be much safer.
There are certainly times when a vaginal cream or tablet is :appropriate. When other approaches aren’t effective, an estrogen cream often will help. As with oral estrogen, the idea is to use the lowest effective dose for the shortest possible period of time. Frequently the prescription cream will be dispensed with an applicator. Ask the doctor if you should fill the applicator or use less cream than that. It may be possible to apply just a small dab on the tip of your finger and get adequate relief with less overall exposure to estrogen. Topically applied estradiol (a form of estrogen) is available as Estrace cream and Vagifem vaginal tablets.
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Q. A couple of years ago vaginal dryness was causing me a lot of discomfort. I am prone to blood clots, so I can’t take oral estrogen.
My doctor prescribed Estring, an estradiol vaginal ring that is inserted every 3 months. It has only 2 milligrams of estrogen and has solved my problem. Please tell others about this approach.
A. Estring has been available in Sweden since 1993 and in the United States since 1996. The 2-milligram dose of estrogen is very low, especially since it is released gradually over 3 months. This approach may solve the problem of vaginal dryness with fewer side effects than oral estrogens.
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*** Estring
Estring is a vaginal silicone ring that contains estradiol that is released at a steady, low rate over 3 months, which minimizes fussing. It is placed in the vagina, usually so that it is comfortable or almost unnoticeable.
Side effects: Stomachache, nausea, vaginal discharge, headache, insomnia
Downside: Must pay for 3 months’ treatment up front Cost: $100 to $150 for a 3-month ring There is one more way to apply estrogen topically to the vaginal tissues—with a vaginal ring. This silicone ring is inserted into the vagina, where it releases estradiol at a low but steady rate for 3 months. Like other forms of estrogen, it’s not appropriate for women who have or have had breast cancer. Because the dose at any given time is lower than if a woman were taking estrogen orally, it might be used even by women who are nervous about using estrogen.
Conclusions
Although menopause is a natural process, hot flashes and night sweats can be bothersome. Vaginal dryness also may be uncomfortable. The ideal treatment for these symptoms should be used at the lowest effective dose for the shortest possible period of time, since most symptoms will eventually fade away on their own.
Here is an overview of our recommendations.
•    Keep cool by turning down the thermostat and wearing layers that can be easily removed if you start to sweat. A tall, cool (nonalcoholic) drink is less likely to trigger a hot flash than a steaming cup of coffee.
•    Keep exercising to minimize your hot flashes and help you sleep. Then follow up with relaxation and deep breathing.
O    Try Remifemin. Black cohosh can help with hot flashes if they are not too extreme.
•    Eat moderate amounts of soy products with isoflavones. They may help reduce hot flashes.
•Take vitamin E capsules. Up to 400 IU daily should be safe and might help.
•    If nothing else helps with the hot flashes, try hormone replacement therapy at the lowest effective dose for the shortest possible time. Transdermal estrogen might be worth considering.
•    An antidepressant such as Paxil (paroxetine), Effexor (venlafaxine), or Prozac (fluoxetine) may calm hot flashes even if you are not depressed. Don’t take any of these drugs for longer than you need them; you may need help getting off them.
•7be antiseizure drug Neurontin (gabapentin) may ease hot flashes and does not have the same risks as hormone re-placement therapy. Do not stop this drug suddenly, though, since that could trigger withdrawal symptoms.
•    Vaginal dryness may respond to olive oil, almond oil, or the oil from inside a vitamin E capsule.
•    Corn Huskers Lotion or Albolene offers slippery lubrication for sexual relations.
•    For more natural lubricants, try the gel from a broken aloe vera leaf or Sylk, which has kiwifruit extract. •Estring is the most convenient form of vaginal estrogen. The need for Estring should be reevaluated every 3 or 6 months so you won’t use it for longer than necessary.

How Soon Can I Go Home with My Baby? FAQ
I just want to go home
I hate the thought of being in hospital for long - how soon can I go home with my baby?
In most maternity units, there is a degree of flexibility as to how long you remain in hospital after
the birth If you wish to stay for as brief a period as possible, talk to your midwife about this. In
the past, postnatal stays tended to be longer - in 1997-98, the average stay in England was 2.2 days,
and was 5.5 days in 1981 Nowadays, the minimum length of time in hospital is about six hours and many
mothers just stay overnight to rest and gain some confidence. In some areas, you can move to a doctor’s
unit or birthing centre. To help make the transition home as smooth as possible plan your return,
making sure you have plenty of support in place.
How long you stay in hospital will largely depend on your type of delivery If you have a vaginal
delivery, you should be able to return home fairly soon, but a Caesarean may mean you need to stay in
for about three days Also, if your baby is born early, or is unwell, or struggling to feed or maintain
his temperature, then you will be advised to stay in hospital until your baby is ready When babies are
premature, mothers may have to leave them in the special care unit and visit regularly
Will I have any privacy in hospital? I don’t want to be on a ward.
There is usually an attempt to make maternity wards as cheerful as possible, although the reality is
they are often busy and lacking privacy. Your delivery room is likely to be a single room and may have
ensuite facilities. Postnatal ward facilities vary tremendously in different locations: there may be
single rooms, small rooms, or traditional Nightingale wards with a corridor of beds Each bed will have
curtains to pull around it for extra privacy, and bathroom facilities can vary.
Where will my baby sleep when we’re in the hospital?
Mothers and babies usually remain together for 24 hours a day You should only be separated from your
baby if there is a medical reason for this, for example your baby needs special care, and you should be
fully informed before agreeing to this. Your baby will usually sleep in a cot attached to the bed or
next to it This is recommended by the World Health Organization (WHO) and UNICEF who run a programme
called The Baby Friendly Initiative This works with healthcare systems to ensure a high standard of
care for mothers and babies, and many maternity units are guided by their advice.
My friend’s baby slept almost continuously for the first day or so. Is this normal?
The birth process is tiring for the baby as well as the mother and so it is not unusual for the first
24 hours to be fairly quiet, as your baby rests after the birth Babies are often very alert and ready
for a feed immediately after the birth, but then have a long sleep. Also, if you had drugs such as
pethidine or diamorphine, during labour: these can linger in the baby’s system and contribute to the
drowsiness. If your baby does sleep a lot at first, make the most of the opportunity to rest while
still offering regular feeds — your midwife will advise you. After the first 24 hours, you may still
find that your baby is feeding erratically, maybe every hour for five hours, and then having a
four-hour sleep. Rest assured there is no set pattern in the early days; your baby should feed when she
wants to and you shouldn’t expect any routine to emerge at this stage.
Will the hospital help me with the everyday care of my baby if I’m having problems?
While -you are in hospital there will be midwives and maternity support workers to help you They have
plenty of advice and information to offer so don’t be afraid to ask about anything that is worrying
you, such as specific questions about your baby, or any aspects of baby care (see below). However do
bear in mind that maternity units tend to be extremely
busy and this, coupled with the fact that presently there is a shortage of midwives nationwide, means
you may have to be patient and prepared to wait a while at times before someone is free to help you
Before you go home you will also be given contact numbers in case you need help or advice in between
your postnatal checks.
Once you are home, your community midwife and your health visitor will be available to offer advice and
support They will also be able to give you details of local mother and baby groups, and postnatal
drop-in clinics, all of which offer support and information for new mums and their families and give
you the chance to meet other mums.
Do we need a car seat straight away or can I hold my baby in the car?
If you intend to take your baby home in the car, it is a legal requirement for them to travel in a car
seat appropriate for their age. Indeed, it is illegal for children to travel in a car without a
correctly fitting and fitted car or booster seat until they are over
Getting advice in hospital
Although the arrival of your baby is a time of incredible excitement, it can also seem overwhelming and
you may feel daunted by the enormous task of looking after and meeting the needs of this tiny new baby.
One of the benefits of your stay in hospital, as well as recovering from the birth, is to help you feel
confident in the care of your baby, There are several aspects of baby care and feeding that the
hospital midwives can help with.
* Staff can help you to establish breastfeeding by
guiding you on technique. Some hospitals have a    BATHING HELP: dedicated breastfeeding counsellor on
site.
* The midwives can help you with everyday care by
demonstrating topping and tailing, bathing techniques,
changing a nappy, and dressing and undressing.
Small babies and children need the protection that baby seats and child seats are designed to provide.
So, yes, you do need to get your car seat ready before the birth to take your baby home from the
hospital.
I’m going to be on my own when I go home and I’m worried I won’t manage.
It’s only natural to feel anxious about your new responsibilities when you arrive home with your baby
Being a single parent is increasingly common so don’t be afraid to ask for help. Your midwife and
health visitor will visit you to help with any baby-care problems and you will be given contact
telephone numbers before your discharge from hospital in case you experience problems or need advice in
between postnatal visits and checks
When you are on your own, it’s a good idea to arrange for a group of reliable friends or family members
who are willing to assist you with babysitting, morale boosting, and provide general all-round back-up
in the early days. Over time you
can establish a network of other single parents in your area with whom you can share your problems and
solutions. Also, ask your midwife or health visitor for contact details of local postnatal groups and
organizations that support single parents.
My mum is coming to stay with me but I don’t want her to take over. How should I approach this?
Overbearing mothers and mothers-in-law can be a problem, however well-intentioned they are. You will
find it’s not just mothers who insist on issuing lots of advice and information, but friends and other
relatives can be just as vocal Although this advice is often useful, some of it may be old-fashioned or
simply conflict with -your own ideas on how to care for your baby
Even though -you may be feeling vulnerable after the birth, practise being clear and assertive about
the way in which you want to do things and make sure that people understand and respect your views and
that your partner supports you in this too. It may help to pass on leaflets or books that you have read
so your mother can see how things have changed since she brought up her children, and what advice you
are following. You could suggest other ways in which she could help, such as shopping, cooking, and
cleaning, so that you are left with the care of your baby Most mums just want to help in some way, so
it’s up to you to channel her enthusiasm
Will I get any sleep at all in the early days?
You will get sleep but whether it is of the same quantity and quality that you are used to is
questionable. Although young babies need a lot more sleep than adults, approximately 16 hours each day,
they do not take all of this sleep in one long stretch as they need to wake up for frequent small feeds
Up to the age of three months, babies have ‘’sleep—wake” cycles throughout the day with longer spells
of sleep at night
The length of these cycles varies from baby to
baby, but on average your baby will sleep about two hours at a time in the day, and four to six hours
at night. All babies wake up a number of times throughout the night. The length of time your baby
sleeps for during the night may also be affected by how she is fed. Several studies suggest that
breastfed babies take longer than formula-fed babies to develop a pattern of sleeping through the
night. This is because breast milk is easier to digest than formula milk, so babies get hungry more
quickly and wake more often in the night Most babies are physically capable of sleeping through the
night from the age of six months.
Should my baby be in her own room or in with us and, if so, for how long?
In the early days, when your baby is fed frequently, often every two to three hours, you may find it
more convenient to have her closer to you. UNICEF recommends that babies share their mother’s room for
the first six months of life as this helps to sustain breastfeeding and is also thought to help protect
babies against cot death (see p.276).
As -your baby grows and develops, her needs and sleeping patterns will change One of the main changes
is that your baby will start to sleep longer between feeds at night and often this is the stage that
many parents decide is a good time to move their baby into their own room. You may also find that, if
your baby is a light sleeper, she may sleep better in her own room as she is less likely to be
disturbed by you and your partner
I’m a really deep sleeper and I’m worried that I won’t hear my baby crying. Is this likely?
This is a common worry for many new parents,
but you should rest assured that it is highly unlikely you will sleep through your baby crying Many new
parents find that they do not sleep as deeply following the birth of their baby, which may be partly an
unconscious worry about sleeping too deeply and not attending to their baby’s needs Having your baby
sleep in the same room as you to begin with and using a baby monitor later if your baby moves into her
own room will help you to feel confident about hearing your baby at night It’s a good idea to try to
catch up on some sleep during the day-time and take a nap while your baby is sleeping, as this will
mean that you are not totally exhausted when you go to bed at night. You should also learn to trust the
greatest prompt of all, your natural inbuilt maternal instincts!
Who can I turn to if I have problems with breastfeeding?
Although breastfeeding comes naturally to some mums, for many others it can prove surprisingly
difficult. Initially you will have midwives and maternity care assistants on hand in the hospital to
assist you with breastfeeding. Once you return home, your community midwife and health visitor can
continue to advise you, but obviously they will not be available 24 hours a day If you continue to have
problems with breastfeeding, there are many helplines and local support groups available for which your
hospital, doctor’s surgery, and health centre should have contact details. Also, there are plenty of
Internet sites that have forums, which are useful for discussing problems and comparing experiences.
Some midwives and health visitors run local drop-in breastfeeding sessions, and some breastfeeding
groups meet informally in cafes, so enquire whether there are any of these groups locally The National
Childbirth Trust (NCT) (see p 310) also has a national network of trained breastfeeding counsellors and
a helpline for you to call.

Leaving hospital

Each hospital varies, but generally, before being discharged from the hospital, several checks take
place. *You will be examined by a midwife or doctor to check that your uterus is starting to return to
its pre-pregnancy size.
* If you had stitches, these will be checked to see if they are healing properly.
*Your baby will undergo various newborn checks (see p.220) and will need to be signed off by a
paediatrician.
* If you need to take any medication home, this will be dispensed and you will be told how to arrange
your postnatal check.

First days at home
Regardless of whether or not this is your first baby, on your return home you are likely to be both
physically and mentally exhausted. If this is your first baby, although the transition to motherhood is
exciting, it can be daunting and, once home, you may be surprised at how big an adjustment this is.
While some families want to share their joy with family and friends as soon as possible, others decide
to have some quiet time together at first to get to know the new arrival and get used to their new
roles Try to put worries about housework and clearing up to the back of your mind – these will keep
Hormonal changes may mean that you feel quite low and weepy about three days after the birth, known as
the ”baby blues” (see p.281). Getting as much rest as possible will help you to recuperate and begin
to feel normal once more.
I don’t want to go home too soon - can I stay in hospital if I want to?
When you leave hospital is something that you will agree with the hospital midwives and doctors, and it
will be dependent on your particular needs and circumstances. Although you obviously can’t remain in
hospital indefinitely, generally you won’t be transferred home until you feel ready to return The
midwife will ensure that you are confident feeding -your baby, whether this be breastfeeding or
bottlefeeding and that you are confident providing everyday care for your baby, which is good
preparation for returning home.
When you go home, your care will be transferred back to the community midwife, so you will continue to
receive support, information, and advice as necessary Also, planning in advance support for when you
return home may help you to feel more confident about leaving the hospital As well as support from your
partner, try to enlist the help of family, friends, and close neighbours to help you cope in the first
few weeks after the birth.

BEING TOGETHER:
We had so many visitors in hospital last time it was exhausting. Can I stop this?
Many people seem to believe that if you are in hospital then they can visit whenever they want to,
whereas most people, even close family. wouldn’t just turn up on your doorstep unannounced if you were
at home with your baby If you know in advance how you will feel then you really need to be assertive
this time and let people know your wishes It is possible to do this in a diplomatic way without
offending people by simply telling friends and maybe family too that you would prefer to have some
quiet time with your partner and children during the first few days to recuperate and get to know your
new baby. Most people will understand this sentiment and will be more than happy to wait for a few days
until you are feeling ready to see them.
If you are discharged fairly early from hospital
it may be easier to control the flow of visitors as you will be able to dictate visiting on your own
terms. You can then take the time that you need to settle down to a new family life.

What’s happening to my body?
how your body changes
I’m feeling like a beached whale and I’m only 16 weeks, what can I do?
Weight gain during pregnancy is not only due
to the baby, placenta, and amniotic fluid, but to a number of factors. Changes in your metabolism, the development of certain organs such as the uterus and breasts, and an increase in your blood supply causing more fluid retention and swelling,
all contribute to your weight. In addition, extra stores of fat are laid down as pregnancy requires more energy for the work involved in developing the fetus and coping with the demands of labour. Although most of this fat is stored in the first 30 weeks, weight gain is usually slower at the beginning of pregnancy and suddenly increases in the second half.
The average weight gain is 12 5kg (271b), 4.5kg (101b) of which is gained in the first 20 weeks, and the remainder thereafter. If you feel you have put on more than this, my advice is to eat healthy, smaller, more regular meals and take some gentle exercise.
People keep telling me I’m too small, but the midwife says everything is fine. Can you explain?
Tell them to mind their own business! If your midwife says she is not worried, then I would feel reassured -some women just hide a pregnancy very well! Your midwife starts to measure your tummy at around 26-28 weeks, as by then the major organs are more or less developed and your baby is concerned with growing and laying down fat supplies. Most units use personalized growth charts that are designed to take into account your individual traits such as your race and height, which influence how big your baby is likely to be By taking these factors into account, your midwife can predict more accurately the expected weight and measurements of your baby.
I’m 17 weeks and my breasts have changed - they’re painful and look different. Is that normal?
It’s perfectly normal and very common to
experience breast changes in pregnancy. These are caused by both an increased blood supply and a rise in pregnancy hormones, particularly in the
first 12 weeks. Before your pregnancy was confirmed you may have felt tingling sensations (especially in the nipple area) as the blood supply increased. As early as 6-8 weeks, breasts can get larger and more tender and may begin to look different on the surface, with threadlike veins starting to appear. At around 8-12 weeks, the nipples darken and can become more erect, and as early as 16 weeks, colostrum, the first milk, may be expressed.
Why am I getting more vaginal discharge since becoming pregnant?
In pregnancy, the layer of muscle in the vagina thickens and this, combined with an increase in the pregnancy hormone oestrogen, causes the cells in the vagina to multiply in preparation for childbirth. As a side effect, the extra cells mean that there is an increase in vaginal discharge, known as leucorrhoea.
If you feel sore or itchy and the discharge is anything other than cream or white, or smells, see your midwife or doctor so that a swab can be taken to rule out infection Some infections: such as thrush, cause an abnormal discharge They are common in pregnancy and are easily treated.
Dark patches have appeared on my face. What could they be?
The dark patches on your face are called “chloasma’ or `pregnancy mask” and these patches affect around half of pregnant women. Nearly all pregnant women notice some changes in skin colouring, with skin usually darkening from 12 weeks. This is due to an increase in the hormones that stimulate skin pigmentation, with darker-skinned women affected more. This darkening may be more apparent on certain areas, such as the nipples, perineum (skin between the vagina and anus), and naval, or areas that experience ”friction rubbing”, such as the inner thighs and armpits. You can reduce or prevent dark patches on your face by minimizing your exposure to the sun and using high-factor sun creams.
I’m a model and I’m worried I’ll get stretch marks. Is there anything I can do to avoid them?
I appreciate your concern, especially as looking good affects your work. Stretch marks, also called striae gravidarum, are thought to be connected to the collagen and elastin content of your skin rather than to how much your stomach expands They occur as the collagen layer of the skin stretches over areas of fat deposits on the breasts, abdomen, and thighs. Unfortunately, there are no pills, creams, or magic lotions that can influence whether or not you will get stretch marks or, if you do, how badly you will get them, although taking regular exercise can help you to maintain an ideal weight during pregnancy and so minimize your chances of developing stretch marks.
Take comfort from the fact that although the marks may be red and livid in pregnancy, in the months following the delivery they lose their colour, usually becoming silvery-white and less obvious.
My tummy is really itchy. Is it safe to use moisturizers on my skin in pregnancy?
As your abdomen grows it can become itchy as the skin stretches You can use moisturizers on your body in pregnancy, and these may relieve the discomfort. Choose non-perfumed lotions oils, or creams to avoid further irritation Rubbing almond oil, vitamin E, or wheatgerm oil over the abdomen may also help.
Eating a healthy diet with fruit and vegetables and drinking plenty of clear fluids to keep you well hydrated will also help the condition of your skin.
I can’t look in the mirror as I’m feeling so depressed about my size. Will things get better?
You are not alone in battling with your self-image in pregnancy For many women, their changing body shape can create very negative feelings Eating a healthy diet and taking some exercise helps to keep weight gain to a minimum, and exercise will help to lift your spirits and improve your sense of wellbeing. There is no set emotional response to pregnancy, but as well as coming to terms with a momentous life and body change, you are also under the influence of fluctuating hormones, all of which affect your moods and add to feelings of negativity.
Mild depression in pregnancy is often helped by reassurance and support from your partner, family, or friends. Talking over your fears and concerns with your partner, or with other pregnant women at antenatal classes, may help to relieve your anxieties -you will probably find that other pregnant women are experiencing the same feelings.
If your depression is very severe and you
feel desperate, consult your midwife or doctor as antenatal depression is now recognized as having an effect on pregnancy and birth outcomes, with studies showing a possible link between medication given to treat depression in pregnancy and a lower birth weight and increased risk of premature birth. Your doctor or midwife may refer you for counselling, and some areas hold group classes for pregnant women suffering from antenatal depression.
Why do people talk about the second trimester as the time when pregnant women “bloom”?
For many women, the second trimester is the most enjoyable part of pregnancy. As women find themselves released from the draining symptoms of early pregnancy, this can lead to an upsurge of energy and many find it easier to eat, sleep, and work. Many women also notice that their skin is glowing and their hair is glossier than usual. It is also around this time when you first feel your baby move and, as your baby grows, you start to notice a definite bump and begin to look pregnant - changes that can help you feel more positive and excited
However, not all women feel this way A sizeable minority of women don’t feel any better as the second trimester progresses, with nausea, tiredness, and other symptoms continuing unabated Some may find it hard to come to terms with physical changes such as weight gain, or skin and hair changes. If this is the case, it’s important to remind yourself that almost all of pregnancy’s downsides clear up as soon as the baby is born. If you’re feeling particularly down or low on energy it may be a sign of other problems, such as anaemia (see p 81) Speak to your midwife or doctor for further advice.
I’m worried that my husband doesn’t find me attractive any more. Am I being paranoid?
Self-image can be a big problem with pregnant women and many worry that they are unattractive to their partners in the latter stages of pregnancy This worry is usually unfounded and more to do with their own feelings about their increased size. Keeping anxieties bottled up can make them seem bigger than they actually are, so talk to your husband about your worries and explain how you are feeling. He may be completely unaware of what you are thinking
As your husband isn’t carrying the baby he cannot truly understand the physical demands of pregnancy. Informing him about the changes your body is going through can help him to understand the process of pregnancy and be better equipped to
provide support when you need it most Some men actually find their partners more attractive during pregnancy but you won’t know this unless you talk to each other about your changing shape.
If you are worried about gaining too much weight in pregnancy, focus on eating a healthy, balanced diet (see p 50) and take some light, daily exercise. Even if this is only a short walk or swim, it will help to keep you toned and supple, which will help your confidence as well as prepare you for childbirth
Can I wear high heels?
Although lots of pregnant women continue to wear the same footwear during pregnancy, it is advisable to avoid heels and opt for a flatter shoe, particularly as your pregnancy progresses.
Later in pregnancy, your posture and centre of balance changes, as your increased weight is now mainly at the front of your body. In addition to this, increased levels of hormones secreted during
pregnancy, such as relaxin, make the joints and muscles of the body more lax So wearing high heels can increase the strain on the lower back and pelvic
Looking good
Making the most of the pregiiar..cy “bloom”
Whether you are ecstatic about your body shape, or feeling like a beached whale, spending time pampering yourself will help you enjoy the new you. *Your hair may feel thicker and glossier o:- become more unmanageable. TYeat yourself to a new haircut to make the most of your pregnancy hair.
* Book yourself in for a massage to relax and chill out. Find a masseur experienced in dealing with pregnant women.
* If you’re feeling low about your size, splash out on some new maternity clothes, nowadays available in fabulous styles.
joints, oints, giving rise to aches and pains in those areas However, it’s alright once in a while to wear high heels, for example at a party, but it might be wise to take flat shoes to change into for walking home.
What shall I do about my pierced belly button?
If you are pregnant and your navel is pierced, your midwife will probably recommend that you remove any metal jewellery from your navel for the duration of your pregnancy Some women are happy with this advice, but a lot of women do not want to risk letting their piercing heal up, and then having to have it re-pierced after their baby is born, so they try to wear jewellery in their navel through their pregnancy
You can use something called a”pregnancy retainer” Due to the popularity of body piercing, these have been manufactured to help pregnant women maintain their piercing as their body shape changes. They are made up of a soft, flexible substance called PTFE (polytetrafluoroethylene) in the shape of a ”banana” bar that has two acrylic screw-on end balls. There is a wide range of sizes and styles for women to choose from. As a general rule, you should choose a retainer that is at least 4mm longer than the size of the jewellery you are currently wearing, although, as you can imagine, every tummy is different and will obviously change in size as your pregnancy progresses The important factor is that your pregnancy retainer should not pinch into your skin at any time - if you feel your retainer is causing you discomfort, then buy a larger size.
I don’t have much to spend on maternity clothes, any ideas?
Lots of women are faced with this predicament when they become pregnant, but you don’t need to spend a lot of money Most women’s clothes shops now stock selections of maternity wear at very reasonable prices. Invest in a couple of pairs of trousers or skirts that you will be able to adapt as your pregnancy progresses and then mix and match colours and styles with a few tops. The tops don’t have to be maternity wear - you could just buy ones a couple of sizes up from your normal size.
You could look in charity shops too, or loan maternity clothes from friends and family, as women wear maternity clothing for such a short period that it is often in good condition. Ebay is a good place to pick up a bargain, and local NCT (National Childbirth Trust) sales have plenty of items in excellent condition. Lastly, don’t forget your partner’s tops and jeans, which may be the perfect fit!
I’m 20 weeks’ pregnant and have noticed that I get short of breath very easily. Is this normal?
When you’re pregnant, your lungs have to work much harder to meet your body’s increased oxygen needs. To help you take in more air, your ribs flare out and your lung capacity increases dramatically This can make you feel breathless, particularly from mid-pregnancy onwards. In the last three months, most women find they get breathless even during mild exertion, which happens as the expanding uterus pushes up against the lungs. However, being breathless can also be a sign of anaemia, which may need to be treated (see below). Your breathing may start to get easier when your baby engages - moves down into your pelvis ready to be born.
My midwife has told me I’m anaemic. Can I improve my iron levels through my diet?
All pregnant women should be offered screening for anaemia, which is done early in pregnancy (at the first appointment), and again at 28 weeks. Generally,an iron-rich diet is advised in pregnancy and this
is enough to prevent or improve anaemia. Eat plenty of lean red meat, beans, dried fruits, dark green vegetables, fortified cereals, and bread Try including a vitamin C-enriched food or drink in your diet, as vitamin C helps the body to absorb iron more efficiently. Vegetarians need to eat plenty of eggs, pulses, beans and nuts to boost iron supplies. Iron tablets may be recommended depending on how low your iron levels have become.
I have developed a dark vertical line down the middle of my tummy. What is this?
A brown line down the centre of your stomach is known as the linea nigra This occurs due to changes in skin pigmentation, which are extremely common in pregnancy, affecting 90 per cent of all women in some way or another, and is often more noticeable if you are darker sl6nned. As well as the line on your tummy, you may also notice a darkening of the skin around your nipples and a darkening of freckles, moles, or birthmarks. A few women may also experience brown patches on their face called chloasma or ”pregnancy mask” (see p.105), These changes are caused by the extra amounts of the hormone oestrogen in pregnancy, which affects the melanin-producing cells of the skin - the cells that produce the pigment that darkens the skin. These colour changes are normal and will usually fade once the baby is born
I’m 32 weeks and my pelvis
is really aching now - what are the reasons for this?
Mild pelvic discomfort is a common symptom in pregnancy as your ligaments loosen due to the increased levels of the hormones relaxin and progesterone in pregnancy These changes in your pelvis prepare your body for the birth. This feeling is quite normal and happens to most pregnant women. If your pelvis continues to give you discomfort, you can try to adapt your day-to-day living to relieve the symptoms Keep your legs together and swing them
round when getting in and out of a car or bed. Think about your activities for the day and plan your movements ahead so as not to exacerbate any discomfort you have Avoid wearing high-heeled shoes and take a rest whenever the discomfort becomes more noticeable
If your pelvis is more than just uncomfortable, seek medical advice More extreme discomfort that causes chronic pain is a sign that there’s a dysfunction in the pelvic area, which may require treatment and support as pregnancy progresses The most common form of pelvic dysfunction is symphysis pubis dysfunction (SPD), which is caused by the pubic joint not working as it should (see p.82)
I’ve never looked better -why is that?
Hormone levels in early pregnancy can make for a miserable time for many women as they battle against morning sickness, tiredness, and sore breasts. However, at around 12-16 weeks, when pregnancy hormones begin to settle and these symptoms start to subside, many women feel that their skin and hair are in great condition and their energy levels are at a high. This is sometimes called ”blooming” (see p 108) and you may be lucky and find that this continues throughout your pregnancy.
If you are feeling particularly well, you may feel tempted to do too much, but you should exercise some caution as there will still be times when your body needs additional rest and you need to store up energy in preparation for labour and birth.
GETTING COMFORTABLE:
I’m 36 weeks and have noticed that I’m more comfortable and breathing more easily. Why is this?
It sounds like your baby has moved down into the pelvis. The baby’s head is ”engaged” when the widest part of the head has passed down into the pelvis. This means that when the midwife feels your abdomen, less than half of the head can be felt abdominally. Engagement is normally recorded in your antenatal notes in fifths, ranging from 1/5 to 5/5, so if the midwife has written ” 1/5 palpable” your baby’s head is deeply engaged in the pelvis, as this means that 4/5 of your baby is down within the pelvis The timing and significance of engagement depends on several factors. Women expecting their first baby tend to have firmer abdominal muscles, which gently ease the baby down into the pelvis during the last four weeks of pregnancy. This appears to be what your baby has done, and that is why you suddenly feel you can breathe a little easier as your lungs and rib cage are not so squashed A second or third baby may not become engaged until labour starts, as the abdominal muscles tend to be more lax.
What is perineal massage?
Perineal massage is the practice of massaging the perineum, the stretch of skin between the vagina and anus, to make it more flexible in preparation for childbirth. The intention is to prevent tearing of the perineum during birth, and the need for an episiotomy or an assisted (forceps or vacuum extraction) delivery, as the skin in this area may become more stretchy as a result of massage. Clinical trials indicate that perineal and vaginal massage can reduce the seriousness of tears and so some consider it beneficial.
Use a lubricant such as KY jelly cocoa butter, olive oil vitamin E oil, or pure vegetable oil on your thumbs and massage around the perineum Place your thumbs about 3-4cm (1-1%zin) inside your vagina and press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling, or stinging sensation. With your thumbs, hold the pressure steady for about two minutes, or until the area becomes a little numb and you don’t feel the tingling as much. As you keep pressing with your thumbs,slowly and gently massage back and forth over the lower half of your vagina, avoiding the urinary opening, and along your perineum, working the lubricant into the tissues for three to four minutes. This helps stretch the skin in much the same way that the baby’s head will stretch it during birth. Do this massage once or twice a day, starting around the 34th week of pregnancy. After about a week, you should notice an increase in flexibility
I’m 35 weeks and feeling as tired as I did in the first trimester. Is that normal?
Tiredness can cause real problems for women in the first and last trimesters and is often worse for women who are overweight or who have a multiple pregnancy In the early stages, you may feel tired
and lethargic due to hormonal changes, while later in pregnancy tiredness is caused by the extra demands on your body Rest is the best cure, though this may be difficult if you’re working or looking after children.
Boost your energy levels with regular, balanced meals. Late pregnancy is also the time to get your
partner, family, and friends to help out with things like shopping. chores around the house, and cooking
Severe tiredness in the last trimester may indicate that your iron levels are low, so it may be worth getting your iron levels checked
I’ve gone from an A cup to a size D - my husband hopes this will last forever, but it won’t will it?
Many women notice an increase in the size of their breasts in the second trimester and some maintain a bigger size after the birth, especially if they breastfeed. This is due to the effects of oestrogen, which causes fat to be deposited in the breasts. As your breasts enlarge, the veins become noticeable under the skin, the nipples and area around the nipples (areolae) become darker and larger, and bumps may appear on the areolae. Some women get stretch marks on their breasts, but these fade in time After the birth, your breasts may get even bigger when the milk comes in! They do reduce in size once you finish breastfeeding, although the majority of women report a permanent increase of some degree.

Maternity bras
Breast changes are one of the first signs of pregnancy, as from around 3-4 weeks’ gestation there is an increased blood flow, which increases tenderness. Some women notice a change in breast size early in pregnancy. while others may not notice any change until they breastfeed Nevertheless, it’s a good idea to get advice from a shop that stocks maternity bras with staff trained to measure and advise on what size you need. If your current bra fits well, wait until later in pregnancy to get measured when changes in cup size are more likely In the early days of feeding, you may experience some engorgement of your breasts, but don’t panic and send your partner out for a bigger size as this settles in a few days.

 
Weight gain in pregnancy
Monitoring your weight
The recommended weight gain in pregnancy depends on your pre-pregnancy weight. If your BMI was less than 19.8 you should aim for a gain of between 12.5-18kg (28-401b): between 19.8 and 26 you should aim for 11 5-16kg (25-351b); above 26 you should aim for 7-1 lkg (15-251b).
What if I gain too much or too little? There is a link between not putting on enough weight in pregnancy and low birth weight babies. If you gain too much weight, you are more likely to suffer from pre-eclampsia, high blood pressure, diabetes, backache, varicose veins, tiredness, shortness of breath, and to have a large baby
How do I maintain a healthy weight?
Take moderate exercise, eat healthily (see p.50), and follow a weight-reducing diet only under supervision. You need only 200-300 calories more per day so ”eating for two” is not a healthy option.

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

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

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

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

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

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

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

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

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

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

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

Not Getting Pregnant FAQs.

We’re not getting pregnant what do we do now?
We’ve been trying to conceive for 12 months - can the doctor identify the problem?
There are many factors that can increase or decrease your chances of becoming pregnant, but if you have been trying for a year, it would be sensible to contact your doctor. After an initial assessment of your general health and lifestyle, your doctor will offer your partner a sperm test (see below) and you will be offered tests to see if you are producing eggs and check whether or not your Fallopian tubes are blocked. Blood tests will be carried out to check your iron levels, your red and white blood cell count, and to check how organs such as your liver and kidneys are functioning In addition, couples are asked to agree to a sexual health screening to check for previous or current STls, such as HIV and syphilis.

My wife has been tested and has the all clear - how can I tell if I’m causing our fertility problem?
You will be offered a semen analysis to determine your sperm quantity and quality — how sperm move (motility) and whether they are a normal form. A healthy sperm count should have a concentration of 20 million spermatozoa per millilitre of semen, with
75 per cent of these alive and 50 per cent of these ‘motile”, or moving as well as possible Differences can occur over time in both the quality and quantity of sperm, so if your first sample is poor, you will probably be tested again a couple of months later.
You are also likely to be advised to give up smoking, reduce alcohol intake to 1-2 units once or twice a week, and to wear loose-fitting underwear to avoid overheating the testes If a problem is found, you will be referred to a specialist for a consultation Try to avoid becoming stressed as this can also affect fertility Learning relaxation techniques with your partner and practising these regularly will help.

We can’t conceive naturally - what do we do now?
Assisted conception; or assisted reproduction, is the term used when women are helped to conceive without having intercourse There are five main procedures available, listed below. Your consultant will go through each one with you, and together you can make a decision about which is most suitable depending on your problem. You can also contact the National Institute for Health and Clinical Excellence (NICE) for more information (see p.310)
* Ovarian Stimulation (OS), or Super Ovulation (SO), involves injections of fertility hormones to boost egg production This is followed by intrauterine insemination (IUI) of sperm, whereby sperm are collected and sorted so that only the strongest remain and these are then artifically placed inside the uterus via a catheter. This is ideal for couples when the man’s sperm is “slow” or the woman has problems ovulating, or there is a combination of both. * Gamete Intra-Fallopian Transfer (GIFT). This is suitable for couples for whom no cause for infertility has been found. It involves stimulating the ovaries to produce eggs, which are removed, mixed withsperm and replaced directly into the Fallopian tubes, allowing conception to occur inside the body.
* In Vitro Fertilization (IVF). This is the most widely used treatment and involves a seven-step process (see below and p.30) This is ideal for most problems including blocked tubes
* Intra-Cytoplasmic Sperm Injection (ICSI). This is used if the man’s sperm count is low, the motility of the sperm is very poor, or the woman is allergic to her partner’s sperm. The treatment involves injecting just one viable sperm into an egg (see box right). * Artificial Insemination by Donor (AID). This is simply the injection of donated sperm into the cervix This is used when a man is unable to maintain an erection or is sterile Similarly, women may require an egg donation if they are unable to produce their own eggs, although this is more complicated.
Whatever treatment is provided, it is important that you and your partner are treated as a couple rather than separate patients. It is also essential that you are kept informed throughout the process and given information on any risks and benefits.

What does IVF involve?
IVF, or In Vitro Fertilization, involves the surgical removal of an egg which is then mixed with sperm in a laboratory dish to fertilize and produce an embryo outside of the womb (see p.30).
IVF treatment occurs in cycles, as there are various stages that must be completed for it to be successful. Initially, a drug is used in the form of a nasal spray or injection to switch off the woman’s natural cycle of egg production in the ovaries, known as ”clown-regulation”. Fertility drugs are then given to stimulate the ovaries to produce more than one egg (ovulation induction). Mature eggs are collected from the ovaries using a fine needle guided by ultrasound. The procedure is usually uncomfortable rather than painful. On the same day, the partner’s sperm is collected and then the eggs and sperm are mixed in a dish. Within a few days, one or sometimes two embryos are transferred into the womb. If an embryo successfully attaches to the inside of the womb and continues to grow, a pregnancy results.

ICSI

This procedure may be used when it is thought that the quality of the partner’s sperm may be responsible for fertility problems. If the sperm count is low or movement is poor, sperm may be ”assisted” in fertilizing the egg. An individual sperm is injected directly into the egg and, if fertilization takes place, the resulting embryo is placed in the uterus.
What are the success rates of fertility treatments?
Success rates for treatments vary, depending on the treatments used and the health of the couple If you want to know the success rates of individual clinics, you can ask for their ratio of “live-births-per-cyclestarted”. This information is available from each clinic, but there are currently no nationally held data
Overall, couples have a better success rate if the woman is aged 23-39 years, has been pregnant or has had a baby, and has a normal body weight (a body mass index between 19 and 24). The older a woman is, the less likely she is to get pregnant
Figures show that for every 100 women who are 23 to 35 years, more than 20 will get pregnant after one PVT cycle; from 36 to 38 years around 15 will get pregnant at 39, around 10 will get pregnant; and in women over 40, around 6 will get pregnant

IVF is so expensive - can we get help with funding?
Since April 2005, women between the ages of 23 and 39 are entitled to one free IVF cycle on the NHS. However, you must meet the eligibility criteria set by your local Primary Care Trust (PCT), which varies across the country and depends on factors such as your marital status, weight, and whether you or your partner smoke Couples who can afford to, or who may have had one unsuccessful cycle already, often opt for a private clinic Although these are regulated by the Human Fertilisation and Embryology Authority (HFEA), this cannot set costs, and a private course of IVF can cost from E4,000 to £10,000
My partner is worried about producing his sperm sample. How can I reassure him?
As fertility problems affect 1 in 7 couples in the UK reassuring your partner that this is not an unusual situation is always a good start. You could try leaving out a leaflet on fertility problems for him to read for more information Try to empathize with him as much as possible by sharing your experiences and the tests you have undergone.
Your partner may be worried about ejaculating at the required time when he is already feeling anxious and is in a clinical environment Some men require a sex toy, magazines, or video clips to help. For others, restraining from sexual intercourse for a few days can make ejaculation easier If you live fairly close to the clinic, your partner may be able to produce the sample at home and deliver it.
Sometimes a medical condition such as diabetes prevents a man ejaculating If this is the case, sperm can be obtained through ‘’sperm recovery”, whereby a small needle is passed through the skin of the scrotum into the testes and sperm is withdrawn.

The drugs I’m taking for IVF are giving me terrible mood swings. Is this normal?
The drugs used in IVF treatment are female hormones (see p.30) to stimulate your ovaries to mature more than one egg at a time, and progesterone, which helps to sustain a pregnancy. Different levels of hormones can result in mood swings, as any woman who suffers with premenstrual tension (PMT) can testify, and this is also a common side effect of IVF treatment It’s worth considering too that couples undergoing IVF are under incredible stress, which has been linked to an increased risk of developing depression, so it’s important to decide whether you are feeling ”hormonal” or are in fact depressed. Your doctor can advise you and refer you if necessary.
My partner has a low sperm count - can you tell us what help is available for us?
Usually, two or three semen samples are taken to work out the average sperm count and to see if there are abnormal sperm present. A healthy semen sample of 2-5ml contains more than 20 million sperm per ml; a count below this is considered low If your partner has abnormal sperm, further testing may be necessary Lifestyle changes can boost sperm (see below). There are also hormonal treatments to improve sperm count and surgery to remove blockages You may be reassured to know that even poor-quality semen can be used to fertilize an egg with IVF or with ICSI (see p.29).
Can lifestyle changes really improve sperm?
Poor quality sperm has been linked to excessive drinking (more than three or four units of alcohol per day), smoking, and to wearing tight-fitting underwear,
which overheats the testicles and can affect their efficiency Excessive stress and a poor diet are also thought to affect sperm So yes, it is worth reviewing your lifestyle to see if improvements can be made Jobs that may expose you to harmful agents, such as pesticides, may also affect sperm, so if you think your partner’s job may pose a risk, it’s worth investigating.
I’m pregnant using a donor -what happens if my child wants to trace her biological dad?
From April 2005, children who were conceived using donor sperm have had a right when they reach 18 years of age to find out their parent’s identity. This also applies to children conceived using donor eggs and embryos. This right applies only to children conceived after this date and not retrospectively. Prior to this date, children had the right to know at 18 years of age if they were conceived using donor sperm, eggs, or embryos and to find out if they were related to someone they wanted to marry. The reason for this change in the law is that children conceived in this way are being given the same rights as adopted children regarding information on their genetic parents. However, some fertility experts fear that this will deter potential donors.
Is surrogacy allowed in the UK?
Currently, surrogacy is legal in the UK, although it is illegal to advertise it as a service However, the law does not recognize surrogacy
as a fixed agreement, which means that a surrogate can change her mind about the arrangement during the pregnancy and up to six weeks after the birth. It is usual for a surrogate to receive ”reasonable expenses”, although there is no definition of what is deemed as reasonable. Usually, this includes costs incurred by the surrogate relating to her pregnancy, If the father of the child is named on the birth certificate, this gives him equal rights to the child. If this is not the case, then six weeks after the birth the new parents can apply for a parental order that gives them full parental status At this point, the surrogate gives up any parental rights to the child.

Conception problems

There are a range of reasons why a couple may have difficulty in conceiving. Investigations and tests may uncover specific conditions, which may be treatable, or you may be offered help to conceive.
What can affect a man’s fertility? A semen analysis may reveal various reasons why sperm have difficulty in fertilizing an egg The sperm count may be low (less than 20 million sperm per ml); the motility of the sperm (how they move) may be poor, and there may be a high percentage of abnormally formed sperm Some men experience a failure to ejaculate at orgasm There may also be damage to the tubes that connect the testicles to the seminal vesicles where sperm are produced, and this may have been present from birth or caused by a later infection
What can affect a woman’s fertility? Conditions such as polycystic ovary syndrome
(a hormonal imbalance that causes ovarian cysts) and endometriosis (see p 19) can disrupt fertility. Other hormonal imbalances, such as low levels of FSH and LH, can affect ovulation; or levels of progesterone may be too low to sustain a fertilized egg. Damaged Fallopian tubes, caused by an ectopic pregnancy (see p 25), surgery endometriosis, or pelvic inflammatory disease, which may be caused by an infection such as chlamydia, can prevent conception. Damage to the ovaries can occur from scarring as a result of surgery or infection, or the supply of eggs may be low Some women have an abnormally shaped uterus, or have uterine scarring, that can prevent the successful implantation of an egg.

IVF treatment

In vitro fertilization or IVF, is a complex procedure with several stages, from the stimulation and harvesting of your eggs to the successful fertilization of the eggs, development of embryos and transfer of the embryos into the womb for implantation. Undergoing IVF can be a stressful and time-consuming undertaking, but knowing in advance how the procedure works and what you can expect at each stage can reduce anxiety and help you and your partner to cope.
What happens first? To optimize the chances of success with IVF more than one egg at a time is removed for fertilization Normally, your body produces one egg each month. In rVF, you will inject yourself with drugs, such as clomiphene and hMG (human menopausal gonadotrophin) to stimulate your ovaries to produce several eggs. While you are undergoing this treatment, you will need to visit your clinic every one to two days over one or two weeks to monitor the development of the eggs. Once it is thought that the eggs are mature, you will be given a blood test to measure your levels of oestrogen, which is released around ovulation.

What happens next? Once your follicles are ripe and ready for ovulation, your eggs will be collected at the clinic using ultrasound or laparoscopy to guide a probe. Once the eggs have been collected, they will be mixed with your partner’s sperm in a Petri dish in a laboratory ready for fertilization Your partner needs to produce the sperm on the same day as the egg collection. He can either do this at home, or come into the clinic with you and produce the sperm while you are undergoing the egg collection procedure.What happens in the laboratory? Once the egg and the sperm have been mixed, they are placed in the laboratory and monitored closely for the next few days. They will first be inspected around 18 hours later to see how many of the eggs have been fertilized and the clinic will usually pass this information on to you the day after the procedure It’s quite common for not all of the eggs to be fertilized and for only two or three to develop into embryos. The fertilized eggs are incubated in the laboratory over the next couple of days and their progress measured. The laboratory technician watches cell division under a microscope, waiting for the eggs to divide into two or more cells on their journey to becoming a blastocyst (see p.21).
If one or more fertilized eggs develop in the laboratory, you will be called back in for the embryo transfer, This is done by injecting eggs through a catheter into the uterus. No more than two eggs will be transferred and you will have the option to freeze any remaining embryos.

Surrogacy
A surrogate mother is a woman who reaches an agreement to carry a baby on behalf of another woman. She can either conceive the baby with the partner’s sperm, in which case she is the maternal mother, or the infertile couple may fertilize their own egg through fertility treatment, which is then transferred into the uterus of the surrogate mother for her to carry the baby through pregnancy and deliver at birth. This process can be beset with problems: such as the conflicting emotions of both the surrogate mother and the receiving couple, or legal issues if, for example, the surrogate mother has a change of heart after the birth and wishes to keep the baby, For this reason, it is important that all parties entering into the agreement have carefully considered the implications and are confident and happy in their roles.