Posts Tagged ‘miscarriages’

The Baby Clinic
When a mother is expecting a child, this is the beginning of an exciting period; a time of ‘expectation,’ followed by the birth and the baby’s first year. It is a special event every time, but particularly with a first child. Parenthood is `born’ along with the child, bringing all sorts of new tasks and experiences with it.
Baby clinics are located at health centres in virtually every town, and have the important task of monitoring the children and helping parents to look after their young children. In addition to ordinary baby clinics, there are also some clinics based on the approach used in anthroposophical medicine. In general, these are linked to anthroposophical medical practices.
All the work of these clinics is concerned with providing preventative care for children from birth to the age of four or five years. In general, this means providing help and support for parents to promote their child’s health.
The doctor and nursing staff at the clinic devote their attention to the physical and psychological development of your child. They ask questions and examine the child to check for certain disorders: for example, growth or psychomotor disorders; disorders or malfunctions of the cardiovascular system, lungs, kidneys and reproductive organs; ear, nose and throat disorders-, disorders of the abdomen, arms and legs; disorders of the teeth, and visual and hearing disorders.
At anthroposophical baby clinics, the constitutional characteristics of the child are also examined, and the personal characteristics and features, which might indicate a particular approach for medical and/or educational measures, are considered. After all, no child develops in accordance with the statistical norm. It is only by examining the individual developmental opportunities and problems of a child that it is possible to give appropriate advice. This is not so much a matter of preventing disorders, but of helping to ensure that the various developmental stages of the child follow each other in an appropriate way.
In addition, the baby clinic is an important place for parents to ask questions, as advice is offered on different subjects, including feeding and growth, upbringing and looking after the baby, physical and psychological development and the issue of inoculations.

The advice on children from birth to one year which you will find in this book is in line with the care provided by anthroposophical baby clinics, and may differ from the advice given by ordinary clinics, and is related to the views held by the doctor and nursing staff regarding the developing child. In Chapter 2 of this book you will find the viewpoints which form the background for the practical advice. This may be helpful when you want to make your own decision in a particular situation. However, this book serves to supplement rather than replace the supervision of the baby clinic. Whichever clinic you choose, it is important that you discuss any concerns you have, and express what you want, at the clinic.
We hope that the various subjects discussed will encourage a conscious approach to parenting and be helpful with regard to understanding, and living with, a developing child.

Pregnancy
Dufing pregnancy, the mother-tobe is in a very special condition, both physically and psychologically. There are all sorts of indications of a reduction in her level of consciousness, which may be manifested by drowsiness, diminished powers of concentration, dizziness, light-headedness and a floating sensation. At a physical level, there is a loss of muscular strength and a loss of tension in all the involuntary muscles. For example, the intestines work less effectively, which can result in constipation. There may also be changes in the action of the kidneys, blood pressure and pulse.
In a way, this whole condition resembles sleep. You could say that a pregnant woman floats between a waking and sleeping state and feels dreamier than she did before. Nevertheless, many women feel very well and active at the same time.
Pregnancy can be divided into three terms, each of roughly three months’ duration.
In the first three months, the woman’s organism has to be ‘transformed’ into a pregnant condition, or, as described above, the organism has to achieve a state between waking and sleeping. The fact that this is an intensive change is clear from the fact that the first three months of pregnancy are usually accompanied by nausea, vomiting and tiredness. It is during these months that the egg is fertilized, becomes embedded in the womb and the foetus starts to develop. It is a relatively vulnerable period of pregnancy in which miscarriages are fairly common (10%). See p.102 folic acid.
The second three-month term is usually the easiest. The pregnant woman becomes used to her condition, can do all sorts of things and does not experience much physical discomfort from the foetus. The foetus has become ‘firmly established,’ as is shown by the small number of problems during this period.
During the third stage, the physical manifestation of the child becomes increasingly clear, with a large stomach being the first sign of this. The discomfort which a pregnant woman experiences when bending down, urinating, feeling full after a meal, being unable to move, run, laugh and sit, reveals that the child has a clear physical presence. The foetus now becomes more vulnerable again. There may be bleeding or even a premature birth. At the end of this period, birth is often experienced as a real release.
When the woman has given birth, all the symptoms of the condition between waking and sleeping gradually disappear again. Only if she breastfeeds will this process be slightly postponed.
An overview of pregnancy reveals that the pregnant woman achieves a condition where she ‘makes way’ for the child to come; in which the child establishes a place on the way to birth. In a way, the expectant mother becomes less ‘earthly,’ while the child becomes increasingly ‘earthbound.’ From this perspective it is, therefore, not surprising that expectant mothers experience moments of contact with their unborn child. After all, both are in an ‘interim state;’ a state between the earthly world and the world that the child is coming from.
If we try to approach the woman’s pregnancy in this manner — taking the idea of ‘making way’ seriously — it is clearly understandable that during pregnancy a woman often finds it difficult to tolerate direct
confrontation with the world around her, and even tries to avoid it altogether. ‘Listening’ to her inner self is the best guideline.
It obviously goes without saying that alcohol and smoking should be avoided because they are known to affect the development and growth of the unborn child, and medicines should only be taken after consultation with the doctor. In addition, a natural, healthy and varied diet is clearly important for both mother and child.
To prepare for breastfeeding, it is a good idea to apply Weleda iris jelly to the nipples every day to prevent the skin cracking during breastfeeding. Stretch marks are largely dependant on genetic factors. However, it makes sense to keep the skin, particularly around the stomach and thighs, supple during pregnancy, by rubbing the skin twice daily with Weleda arnica massage oil. If there is a sensitivity to arnica, it is possible to use Weleda calendula massage oil.
The birth
Experiencing the birth of a child is one of the most intimate experiences in life. Feelings of astonishment, joy, anxiety, fear and fulfilment are experienced to extremes during the birth. Obviously these are most intense for the woman who is having the baby, but the family members and obstetric staff attending her fully share in the intensity of feeling.

It starts with the excitement and anticipation of what will happen when the waters break or the first contractions start. Getting everything ready, the support and help of the midwife during contractions, the constant question of how far the process has advanced — these are all part of the active and busy atmosphere of birth. However, sometimes there are also moments of near serenity and tranquillity; an atmosphere of relaxation, trust and complete surrender to what is to come.
The birth takes place in these recurrent and alternating periods of intense activity and intense tranquillity. Everyone attending the birth finds that a unique atmosphere develops as a result of these alternate emotions, which can go on for many hours. It is an incomparable atmosphere, evoking feelings of deep wonder and awe.
The focal point of everything that is going on is the mother-to-be. She is in touch with the deepest natural forces in her body, and is in danger of being overwhelmed by these natural forces, with an intensity which rarely occurs in life. She may also feel that she does not have the strength to give birth on her own, and may be very grateful to accept the instructions of the obstetric staff, so that the sense of impotence can make way for a sense of trust in the successful end of the birth.
When the cervix is fully dilated, the moment arrives when she can
THE BIRTH    15
use all her strength to help the child to be born by pushing it out. Just before this moment, it is quite common for the woman’s consciousness to be almost overwhelmed, and then return quite vivdly with the first push. This stage of pushing the baby out is extremely hard work, even though sometimes it only requires one big contraction.
From the moment that the baby’s head emerges, the atmosphere changes immediately. All attention is focused on the delivery of the rest of the baby, who eventually experiences light, air and gravity for the first time, is placed on its mother’s stomach and swaddled in warm nappies (diapers). If not giving birth at home, you should check with your midwife or consultant to see if it is possible to have a warm cloth to swaddle the baby in. All eyes are on the baby; the noises, movements, eyes and hair. Everyone feels an urge to touch the baby and stroke it.
Then the obstetrician focuses on the last part of the delivery: cutting the umbilical cord and delivering the placenta.
The whole birth is only really complete when the mother has been washed and cleaned up, and is holding the pink, warm, swaddled baby in her arms, and is surrounded by everyone who was present at the birth. The whole spectrum of emotions is experienced, together with a sense of satisfaction, gratitude and respect for the forces that play a role in the birth process.

The birth described above is probably the birth every parent dreams of. And yet, no two births are the same. The life of every person starts with a unique event; the delivery. Some children have a difficult start, for example, if the birth was induced too early, the baby was born prematurely, or if the delivery involved a great deal of medical intervention. In the UK most babies are now born in hospital, but it is possible to discuss your birth plan beforehand with your midwife or consultant.
For parents, the fear about the baby’s health or being overwhelmed by a premature birth can obstruct the feelings of wonder and gratitude described above. Sometimes it may be a while before you can start to love your child in a relaxed way and feel an obvious connection with it, particularly if you feel unsure or anxious. This takes time, so you must try and take the time that is needed. If you were admitted to hospital, you can organize a sort of second birth experience, so that when the baby comes home, you can get used to each other, feel each other, and build up a new life together. Many parents have described that this helped them to recognise the healthy aspects of the child and his lust for life.
Parenthood
The birth of a child is an intense experience for the parents, particularly
the birth of their first child. In fact, it brings about many changes. Before the birth the parents had a relationship with each other, and after the birth they have suddenly become parents and formed a family. Obviously, they still have a relationship, but the partners no longer relate exclusively to each other. In particular, the mother focuses body and soul on her child. After the birth it may be a very long time, sometimes as long as a year, before she feels her old self. Consequently, owing to the new situation in which they find themselves, parents have to redefine the way in which they relate to each other.
This process is extremely demanding because the father and mother are involved with the child in very different ways during pregnancy and birth, and during the initial period after birth. The father may have a tendency to continue his old life with some modifications, while the mother has a deep sense that everything has changed. It may be a while before the partners find a new way of relating to each other on the basis of these two different worlds of experience. It is important to take time for this process and talk about it together from time to time.
What was described above applies particularly for the situation in which mother, father and child(ren) form the family. Where there is a one-parent family from birth, this process will particularly concern the mother.

After the birth, another process starts as well in that all parents discover themselves in a new way. They experience new positive feelings, although they can also have a negative character. A child brings happiness and joy, but there are also moments when irritation reaches unimagined heights.
In the whole range of emotions evoked by a child, feelings of anxiety have a special place, giving rise to questions such as: Am I doing it right’? Will anything happen to my child or me? Will everything be okay?
Every step in the child’s development is another step out into the world. From the age of three, the child even ventures beyond the horizons of the parents; he walks around the block or goes to school for the first time.
Some people are more sensitive to these anxieties than others, but since this anxiety is fruitless — and can really make life difficult for a child — something should be found to counterbalance it. Sometimes gaining an insight into the situation helps to diminish the anxiety, but often this is not enough. In order to tackle the anxiety in a structured way, it may be necessary to work on strengthening the parents’ confidence. Obviously this does not mean blind faith that ‘everything will probably be alright.’ It is not as simple as that. It means that it is possible to work on the confidence about the direction in which the
PARENTHOOD    17
child is moving, even though unexpected and undesired events may play a role. White anxiety is often ,our own problem,’ confidence can become a strength, which allows the child to flourish; having confidence in someone gives them the strength to grow.
In addition, a child often gives us a new sense of self-awareness: with his behaviour and imitations, he holds up a mirror to his parents. From the age of a few months you will see that a child assimilates the world by imitating it. The child copies everything he encounters, both internally and externally. For parents, this means that what they do and how they do things is important. Whether we do things hastily or with care, whether we do things unwillingly or with joy; all these aspects permeate the actions we perform and are unconsciously assimilated and imitated by the child. This also applies to what we say. Long before the child can understand our words, he will be aware of our intentions. Experiencing this, and occasionally having the things which we do and say, and how we do and say them, reflected by a child will lead to self-awareness, and possibly to a change in our way of being and doing things.
In positive terms, a child stimulates us to develop ourselves as well. There is also a third process. By experiencing the development of a small child and feeling co-responsible for him, it is possible to focus on your own childhood. Some things from your own childhood can lead to the feeling that ‘I want to do things for my children like that as well,’ while at other moments, you feel that ‘I want to spare my children this or that.’ Sometimes this encounter with your own past can be quite intense. It’s good to know that it is not unusual.
Just as we re-examine our own past, we also start to have a different
view of the future; in a sense looking to the future through the child. The future shines through the small child and urges us to determine the structure for that future.
Above, we have highlighted a number of the issues which will confront every parent; the redefinition of the relationship with their partner and other members of the family, a redefinition of themselves, and a new view of the past and the future.

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

Miscarriage FAQs. I’ve had a miscarriage why did it happen to me?

What is a miscarriage?
A miscarriage is the spontaneous loss of a baby at any time up until the 24th week of pregnancy After 24 weeks the loss is referred to as a stillbirth. The signs of a miscarriage are vaginal bleeding and period-like cramps. As not all miscarriages follow the same pattern, there are various terms to describe what occurs:
* A threatened miscarriage occurs when there is bleeding and possibly pain, but the fetus survives. * An inevitable miscarriage occurs when there is bleeding and pain due to contractions in the uterus, the cervix opens, and the fetus is expelled.
* A missed miscarriage occurs when the fetus dies but remains in the womb and either is expelled naturally later or removed in an operation

I’ve recently miscarried - why did this happen?
Miscarriage occurs in 10-20 per cent of pregnancies In the vast majority of these the cause is never identified, but it’s unlikely to be related to anything you did or didn’t do. There are thought to be several reasons why miscarriages occur (see p 25) There may be a genetic problem, in which the baby or placenta doesn’t develop normally, levels of the pregnancy hormone progesterone may be low; there may be an immune disorder m which the mother 3 immune system reacts against the pregnancy; an infection may be present; or there may be problems with the uterus or cervix. Miscarriages tend to be more common in older women.
The Miscarriage Association (see p.310) offers support and up-to-date advice and information about miscarriage. You may feel comforted to know that, statistically, any future pregnancy you have is likely to progress normally.
My period was late and now I’m bleeding really heavily -could I be having a miscarriage?
In the absence of a positive pregnancy test or a pregnancy confirmed by an ultrasound scan, it is difficult to know whether or not you were pregnant If you have had unprotected intercourse in the time since your last period, it is possible that you could have been pregnant and this is a miscarriage The lateness of your period may give a clue, but won’t confirm one way or another. If you have any other symptoms of pregnancy it might be worth doing a pregnancy test as sometimes, even when there has been bleeding, a viable pregnancy is discovered
However, it could also be a late period for no other reason than that this happens on occasion to everyone. A delayed period can be caused by  weight loss or gain, stress, or if you have been taking the oral contraceptive Pill but missed a dose.
Talk to your doctor if the bleeding continues:
you feel faint or experience palpitations; your period lasts for longer than seven days; you have more than six well-soaked pads a day; or if you have any severe abdominal pain Your doctor can carry out a blood
test to check your iron levels and possibly determine if you have been pregnant, in which case an incomplete miscarriage or ectopic pregnancy will need to be ruled out (see p.25)

I’m 10 weeks pregnant and getting cramping pains. Do I need to rest to avoid a miscarriage?
Cramping pains on their own without vaginal bleeding or spotting can occur at this stage of pregnancy. Sometimes pain can be felt as the ligaments stretch when the baby and -your uterus grows. There are also other possible causes for the pain aside from miscarriage, such as constipation or a urinary tract infection
Many doctors advise rest to avoid a ”threatened” miscarriage, but there is no strong evidence that this makes any difference to the outcome of a pregnancy If you feel like resting because you are in discomfort from the cramping pains then do rest, but if you feel happy continuing as normal then that may be the best option for you Soaking in a warm bath and practising relaxation techniques may ease the intensity of the pain If the pain increases or you get any bleeding or spotting, contact your doctor.
Does bleeding in pregnancy mean that miscarriage is inevitable?
No, many women experience bleeding in early pregnancy and then proceed to have a healthy pregnancy and baby. Indeed, some women have intermittent bleeding throughout pregnancy, Despite this, any bleeding should be investigated. This is usually done with a scan to determine if the pregnancy is viable (going to continue) and to identify if there is any indication of where the
bleeding is coming from. In very early pregnancy, it can be hard to see the pregnancy on a scan and a blood test to measure levels of the pregnancy hormone human chorionic gonadotrophin (hCG) may be done, mainly to rule out the possibility of an ectopic pregnancy (see p.25) Unfortunately for you this is a time of waiting; the timing of any further scans is usually determined by the findings of the initial scan and blood tests and the symptoms you are experiencing.

I’ve had three miscarriages before and I’m scared of trying again - is there anything I can do?
It is understandable given your experiences that trying to get pregnant again is a scary proposition. Following a third miscarriage, it is usual for your doctor to offer you a number of investigative tests
to see if a reason for the miscarriages can be found. In some cases, a cause is identified and treatment can be offered to help improve the outcome for subsequent pregnancies.
You are likely to be given a number of blood tests. These are to look for antibodies (proteins in the blood that fight any substance they recognize as foreign to your body), chromosomal abnormalities, and infection. You may also have a vaginal examination and swab and an ultrasound scan to check your womb and tubes. If a chromosomal abnormality is found, genetic counselling should be offered to discuss the implications for future pregnancies. The levels of the hormones progesterone and prolactin may also be checked as these can play a role in miscarriage. Sometimes, the cervix is found to be weakened and likely to open early If this is the case, you may be offered a cervical stitch that acts like a drawstring on the cervix and hopefully prevents future miscarriage or premature delivery
If you haven’t already been offered these tests, talk to your doctor about them before trying to get pregnant again so that you can begin any recommended treatment as soon as possible
My mum had two miscarriages -does that mean I am more likely to miscarry?
Ask your mum if she was given any particular reason for her miscarriages If for example, she knows that they were due to a chromosomal abnormality, such as sickle-cell disease, or if she had a medical condition such as heart disease, then there is a possibility that the condition is hereditary and the risk of miscarriage may be the same for you too.
However, it’s most likely that your mother’s miscarriages were unfortunate chance occurrences for which no reason was found If this is the case, then you are at no more risk of experiencing a miscarriage than any other woman your age. However, if you do become pregnant, it would be worth mentioning your mother’s pregnancy history at your initial antenatal appointment, as your family medical history is an important part of your medical notes during pregnancy.

I’ve had several miscarriages and my doctor has referred me to a genetic counsellor - why?
A genetic counsellor is a highly trained professional who supports families before and after conception. Quite often a miscarriage is caused by a genetic abnormality in the fertilized egg or embryo. This is usually a one-off and can affect any woman. However, if a woman has recurrent miscarriages, it may be that she is carrying a genetic condition
Women and their partners are referred to a genetic counsellor if either partner has a condition that can affect future children or the chances of becoming pregnant or continuing with a pregnancy (as they may be more likely to miscarry or be offered a termination) For example if there is a history of sickle-cell disease, a blood disorder that causes chronic anaemia and increases the risk of a preterm birth and health problems in the baby, it may be that either or both couples are carrying a gene that can affect a baby.
A genetic counsellor helps you understand how your genes could affect conception and pregnancy and about the tests available to determine if a fetus is affected. The counsellor will discuss a range of
issues, including the moral and ethical issues related to genetic testing, as it is common for couples to feel stress, guilt, and confusion in this type of situation.

I lost my baby, but I want to get on and try again - is this OK?
Although there are no hard rules about when to try for another baby, it is important that you allow yourself time to grieve and your body to recover before trying to conceive again. Some women feel able to try again within a month, while others may not feel ready for at least a year. Whatever you feel, it’s wise to let your hormones and body settle down after a miscarriage before considering another pregnancy. The usual advice is to wait for at least three months before trying to conceive again so that you feel both emotionally and physically prepared for another pregnancy. Your partner also needs to feel that the time is right for you both to try again.

We had a miscarriage at 20 weeks. Will the doctors find the cause so that we can move on?
Coping with the loss of a baby well into pregnancy is difficult and upsetting. Many women ask themselves why a miscarriage happened and feel unable to move on until that important question is answered. Unfortunately, unless this was a recurrent
miscarriage of three or more, there may not be an investigation, although it may be suggested that you have a cervical stitch in future pregnancies to stop the cervix dilating too early (see p 24)
It may be worth talking to a counsellor who
is trained to support women and families through such difficult times, your doctor or midwife may be able to refer you. You may find that discussing your miscarriage directly with a health professional helps to answer any concerns you or your partner have, and by communicating in this way you will have started to move forward and may begin to feel able to consider planning another pregnancy

My partner had a miscarriage. I’m being supportive, but I’m devastated too. What should I do?
Dealing with a miscarriage is very difficult for both women and men, but often far more attention is given to a woman, and a man’s feelings are simply ignored However, it’s important that you don’t internalize your loss and do acknowledge your feelings, which may range from feeling scared, disappointed, and out of control, to blaming yourself for not being supportive enough and mourning the loss of your identity as a father. Although you want to support your partner, you also need to recognize your own need to grieve, as working through your emotions can help you to come to terms with your loss more quickly
A good support network is important for both of you and it can help to find a sympathetic listener outside of your relationship. Initially, you may find discussing your feelings with another male easier than talking to your partner. You could also talk to your doctor, the midwife, or a counsellor, or contact the Miscarraige Association helpline.

What is a “D and C”?
D and C stands for dilation and curettage, a surgical procedure in which the opening to the uterus, called the cervix, is stretched (dilatation) and the tissue that lines the uterus is scraped away or removed (curettage). This procedure is sometimes carried out after a miscarriage to ensure that any of the remaining products of the conception and pregnancy have been removed
There are advantages and disadvantages to consider before having a D and C. The procedure is usually completed within two hours and most women resume their usual activities within a week. However, the need for routine surgical evacuation, or a D and C, following a miscarriage has been questioned because of potential complications, such as bleeding and infection. Ask your doctor for advice There are less invasive options than a D and C for dealing with a miscarriage. One method is simply to watch and wait to see if the uterus will spontaneously expel any remaining products of conception. Another option is a drug treatment that works by stimulating the uterus to contract and naturally expel pregnancy tissues.

The risk of miscarriage
There are several factors that can increase your risk of miscarriage.
Older women have an increased risk of having a miscarriage. It is thought that this is largely due to the fact that older women are more likely to have babies with chromosomal abnormalities, which may have problems developing and miscarry Some underlying medical conditions can also increase your chances of miscarriage, such as polycystic ovary syndrome or fibroids. Other factors that can increase your risk are if you are particularly underweight or overweight, smoke drink heavily, or take recreational drugs.
Miscarriages are also more likely the more pregnancies you have had.

Talking to others
Losing a baby during pregnancy can be devastating, leading to feelings of grief such as anger, depression, guilt, and anxiety. Talking to others can help you to work through your feelings.
* Ask your midwife or doctor to put you in touch with a counsellor who specializes in pregnancy loss
* Let close friends and family members know how you are feeling
* The Miscarriage Association is a great source of support and advice (see p.310). * Talk to your doctor or midwife about why the miscarriage may have happened.

Possible causes of miscarriage

About 1 in 4 first pregnancies ends in miscarriage, generally within the first 12 weeks. Often no cause is identified and it may not be investigated unless a woman has had three or more miscarriages in a row, known as ‘recurrent miscarriages”
Why has it happened? Some miscarriages occur because of a one-off genetic problem (caused by a faulty chromosome) when the baby does not develop properly. Genetic problems account for 60 per cent of early miscarriages If you think this may have been the cause, you can request tissue tests from the baby. Based on these results, you may be able to receive specialist counselling to discuss the risk of it happening again (see p.24). After 12 weeks, the chances of you losing your baby because of a chromosomal disorder reduce to about 10 per cent: however, if
Ectopic pregnancy
you are over 35, this risk is higher. Other less common causes of miscarriage include fibroids (non-cancerous growths), infection, problems with the uterus, hormonal imbalances, and immune system disorders. An ectopic pregnancy. below, occurs when the embryo implants in a Fallopian tube and needs to be removed
What can cause late pregnancy loss? A late pregnancy loss (referred to as a stillbirth after 24 weeks) can be due to the cervix being weak (or ‘incompetent’), causing the cervix to dilate too early. This accounts for 15 per cent of repeated miscarriages. In future pregnancies, a stitch around the cervix can strengthen this muscle and prevent it opening early Another cause of a late miscarriage can be if the placenta does not function properly and affects the baby’s growth.
fertilized egg implants in tube

Glossary
Abruption The detachment of part of the placenta from the wall of the uterus during late pregnancy, which may result in bleeding. Accelerated labour The artificial augmentation of contractions, after the cervix has started to dilate, by the injection of oxytocin through an intravenous drip Often used to speed up a long labour. Active birth An approach to childbirth that involves upright positions and movements during labour.
Active management of labour The constant monitoring and technical control of labour to monitor its duration
Alphafetoprotein (AFP) A substance produced by the embryonic yolk sac, and later by the fetal liver, which enters the mother’s bloodstream during pregnancy Alveoli Milk glands in the breasts, which produce a flow of milk when they are stimulated by prolactin and the baby’s sucking.
Amniocentesis The surgical extraction of a small amount of amniotic fluid through the pregnant woman’s abdomen. This procedure is usually carried out as a test for fetal abnormalities.
Amniotic fluid The fluid that surrounds the fetus in the uterus. Ultrasound scans may be done in late pregnancy to ensure that enough is present
Ammotomy The surgical rupture of the amniotic sac, often done to speed up labour This is referred to as ARM (artificial rupture of the membranes).
Anaemia A condition in which there is an abnormally low percentage of haemoglobin in the red blood cells, it is treated by iron supplements
Anaesthetic Medication that produces partial or complete insensibility to pain Anaesthetic, general Anaesthetic that affects the whole body, with temporary loss of consciousness.
Anaesthetic, local Anaesthetic that affects a limited part of the body
Analgesics Painkilling agents not inducing unconsciousness
Antenatal Before the birth
Anterior position See Occipital anterior Antibiotics Substances capable of
destroying or limiting the growth of micro-organisms, especially bacteria Antibodies Protein produced naturally
by the body to combat any foreign bodies, germs or bacteria
Anti-D An injection of antibodies given to women who have a Rhesus negative blood group if it is thought they may have been exposed to Rhesus positive fetal blood cells
Antihistamines Tranquillizers that are used in the treatment of nausea vomiting and certain allergies.
Apgar scale A general test of the baby’s wellbeing given shortly after the birth to assess the heart rate and tone respiration blood circulation, and nerve responses. Areola The pigmented circle of skin surrounding the nipple.
ARM See Ammotorny
Bile pigment See Bilirubin.
Bilirubin Broken-down haemoglobin, normally converted to nontoxic substances by the liver. Some newborn babies have levels of bilirubin too high for their livers to cope with See also Jaundice, neonatal. Birth canal See Vagina
Blastocyst An early stage of the developing egg when it has divided into a group of cells. Braxton Hicks contractions Practise contractions of the uterus that occur throughout pregnancy, but which may not be noticed until towards the end. Breast pump A device for drawing milk from the breasts.
Breech presentation When the position of the baby in the uterus is bottom down rather than head down
Caesarean section The delivery of the baby through an incision in the abdominal and uterine walls
Candida See Thrush,
Cardiotocograph (CTG) An electronic monitor that is used to measure the progress of the mother’s contractions and the baby’s heartbeat during labour.
Carpal tunnel syndrome Numbness and tingling of the hands arising from pressure on the nerves of the wrist In pregnancy it is caused by the body’s accumulation of fluids
Catheter A thin plastic tube that is inserted into the body through a natural channel to withdraw fluid from, or introduce fluid into, a particular part of the body This can be used to draw off urine from the bladder after an operation, or to maintain a constant input of fluids into a vein, or to introduce anaesthetic into the epidural space.
Cephalic presentation (Vertex presentation) The position of a baby who is head down in the uterus The most common presentation. Cephalopelvic disproportion A state in which the head of the fetus is larger than the cavity of the mother’s pelvis Delivery must therefore be by Caesarean section
Cervical dilatation See Dilatation.
Cervical incompetence A disorder of the cervix, usually arising after a previous mid-pregnancy termination or damage to the cervix during a previous labour, in which the cervix opens up too soon, resulting in repeated mid-pregnancy miscarriages. It is sometimes treated by suturing to hold the cervix closed. Cervix The lower entrance to the uterus, or neck of the womb
Chloasma Skin discolouration during pregnancy, often facial.
Chorion The outer membranous tissue that envelops the fetus and placenta
Chorionic gonadotrophin See Human chorionic gonadotrophin (HCG).
Chorionic villus sampling A method of screening for genetic handicap by analysis of tissue from the small protrusions on the outer membrane enveloping the embryo that later form the placenta.
Chromosomes Rod-like structures containing genes occurring in pairs within the nucleus of every cell. Human cells each contain 23 pairs. See also Gene
Cleft palate A congenital abnormality of the roof of the mouth
Club foot A congenital abnormality in which the foot is painlessly twisted out of shape. Colostrum A kind of milk, rich in proteins, formed and secreted by the breasts in late pregnancy and gradually changing to mature milk some days after delivery
Conception The fertilization of the ripened egg by the sperm and its implantation in the uterine wall.

Congenital abnormality An abnormality or deformity existing from birth, usually arising from a damaged gene, the adverse effect of certain drugs or the effect of some diseases during pregnancy
Contractions The regular tightening of the uterine muscles as they work to dilate the cervix in labour and press the baby down e birth canal
Cordocentesis A fine needle is passed trough the mother’s abdomen into the fetal –vein in the umbilical cord. The technique allows fetal blood to be tested, facilitates intra-urine blood transfusions, and enables drugs to be injected directly into the baby Corpus lutuem A glandular mass that forms n- the ovary after fertilization It produces progesterone. which helps to form the placenta, and is active for the first 14 weeks of pregnancy
Crowning The moment when the baby’s head appears in the vagina and does not slip back again.
CVS See Chorionic villus sampling.
D and C The surgical dilatation (opening) of the cervix, and curettage (removal of the contents) of the uterus
Dehydration A physical condition caused by the loss of an excessive amount of water from the body, often resulting from severe vomiting or diarrohea
Depression, respiratory Breathing difficulties in the newborn baby
Diabetes Failure of the system to metabolize glucose, traced by excess sugar in the blood and urine.
Diamorphine A narcotic opium derivative used as an analgesic.
Dilatation The progressive opening of the cervix caused by uterine contractions during labour.
Distress See Fetal distress
Dizygotic See Twins
Domino scheme A scheme operated by some hospitals in which community midwives provide antenatal care and are present at hospital for the delivery.
Doppler A method of using ultrasound vibrations to listen to the fetal heart
Doula A supportive woman helper who provides physical and emotional support during childbirth
Down’s syndrome A severe congenital abnormality caused by an incorrect number
of chromosomes that produces physical abnormalities and reduced intelligence. Drip See Intravenous drip.
Eclampsia The severe form of pre-eclampsia, which is characterized by extremely high blood pressure, headaches, visual distortion, flashes, convulsions and, in the worst cases. coma and death The condition is now rare since the symptoms of pre-eclampsia are treated immediately See also Pre-eclampsia.
Ectopic (Tubal pregnancy) A pregnancy that develops outside the uterus, usually in one of the Fallopian tubes. The mother has severe pain low down on one side in her
abdomen at any time from the 6th to 12th week of pregnancy. The pregnancy must be surgically terminated.
EDD The estimated date of delivery Electrode A small electrical conductor used obstetrically for monitoring the fetal heartbeat during labour.
Electronic fetal monitoring The continuous monitoring of the fetal heart by a transducer placed on the mother’s abdomen over the area of the fetal heart, or by an electrode inserted through the cervix and clipped to the baby’s scalp
Embryo The developing organism in pregnancy from about the 10th day after fertilization until about the 12th week of pregnancy, when it is termed a fetus Endometrium The inner lining of the uterus. Engaged (Eng/E) The baby is engaged when it has settled with its presenting part deep in the pelvic cavity. This often happens in the last month of pregnancy
Engorgement The over congestion of the breasts with milk. If long periods are left between feeds, or the baby is not well latched on painful engorgement can occur. This can be relieved by putting the baby to the breast or expressing the excess milk Entonox A mixture of 50 per cent oxygen and 50 per cent nitrous oxygen, breathed in through a mask during tabour, that gives pain relief as contractions peak
Epidural (Lumbar epidural block) Regional anaesthesia used during labour and for Caesarean sections, in which an anaesthetic is injected through a catheter into the epidural space in the lower spine. Episiotomy A surgical cut in the perineum to enlarge the entrance to the vagina.
External version (External cephalic
version, or ECV) The manipulation by gentle pressure of the fetus into the cephalic position This may be done by an obstetrician at the end of pregnancy if the baby is breech or transverse
Fallopian tube The tube into which a ripe egg (ovum) is wafted along after its expulsion from the ovary along which it travels on its way to the uterus
False labour Braxton Hicks (rehearsal) contractions, which are so strong and regular that they are mistaken for the contractions of the first stage of labour,
Fertilization The meeting of the sperm with the ovum or egg to form a new life See also
Conception.
Fetal distress A shortage in the flow of oxygen to the fetus, which can arise from numerous causes
Fetus The developing child in the uterus, from the end of the embryonic stage at about the 12th week of pregnancy until birth FH Fetal heart.
Fibroid A benign (non-cancerous) muscle growth in the uterus.
Forceps Metal tong-like instruments placed either side of the baby’s head during labour to help deliver the baby
Hormone A chemical messenger in
the blood that stimulates various organs to action.
Human chorionic gonadotrophin (HCC) A hormone released into the woman’s bloodstream by the developing placenta from about six days after the last period was due. Its presence in the urine means that she is pregnant
Hyperemesis gravidarum Almost continuous vomiting during pregnancy Hypertension (High blood pressure) During pregnancy this can reduce the fetal blood supply.
Hypnosis A state of mental passivity with a special susceptibility to suggestion. This can be used as an anaesthetic, and can be self-induced.
Hypotension Low blood pressure.
Identical twins See Twins
Implantation The embedding of the fertilized ovum or egg within the wall of the uterus
Induction The process of artificially starting off labour and keeping it going.

Insulin A hormone produced by the pancreas that regulates the level of carbohydrates and amino acids in the system. It may be used as a means of controlling the effects of diabetes.
See also Diabetes.
Internal monitoring See Electronic fetal monitoring
Intravenous drip The infusion of fluids directly into the bloodstream by means of a fine catheter introduced into a vein Intravenous injection An injection into a vein
Invasive techniques Any medical technique that intrudes into the body
In vitro fertilization (IVT) A type of assisted conception where fertilization occurs outside of the womb and fertilized embryos are tranferred back into the womb.
Jaundice, neonatal A common complaint in newborn babies which is caused by the inability of the liver to break down successfully an excess of red blood cells See also Bilirubin
Lanugo The fine soft body hair of the fetus Lateral position Transverse lie or horizontal position of a fetus in the uterus (sometimes occurring if the mother has a large pelvis), where the presenting part is either a shoulder or the side of the head
Let-down reflex The flow of breast milk into the nipple.
Lie The position of the fetus within the uterus Linea nigra A line of dark skin that appears down the centre of the abdomen over the rectus muscle in some women during pregnancy
Lochia Postnatal vaginal discharge Longitudinal lie The position of the fetus in the uterus in which the spines of the fetus and the mother are parallel
Low-birthweight baby A baby who weighs below 2,5 kg (57 lb) at birth.
Meconium The first contents of the bowel, present in the fetus before birth and passed during the first few days after birth The presence of meconium in the amniotic fluid before delivery is usually taken as a sign of fetal distress
Miscarriage The spontaneous loss of a baby before 24 weeks of pregnancy
Monitoring See Electronic fetal monitoring Monozygotic See Twins.
Morula A stage in the growth of the fertilized
egg when it has developed into 32 cells. Moulding The shaping of the bones of the baby’s skull, which overlap to allow the baby to pass through the birth canal.
Mucus A sticky secretion.
Multigravida A woman in her second or subsequent pregnancy
Multiple pregnancy The development of two or more babies, See also Twins Mutation A damaged genetic cell. This can occur naturally or more commonly as an effect of outside agents, such as radiation. Neural tube defects Abnormalities of the central nervous system See also
Anencephaly, Hydrocephalus Spina bifida. Nicotine A highly poisonous substance that is present in tobacco During pregnancy this can enter the bloodstream of a woman who smokes and may affect the efficiency of the placenta, which often results in a lowbirthweight baby
Nucleus The central part or core of a cell, containing genetic information.
Occipital anterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s front (anterior)
Occipital posterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s back (posterior)
Oedema Fluid retention, which causes the body tissues to be puffed out.
Oestriol A form of oestrogen.
Oestrogen A hormone produced by the ovary
Opioids (Narcotics) Painkilling drugs that induce drowsiness and stupor,
Ovary One of the two female glands, set at the entrance of the Fallopian tubes, which regularly produce eggs until the menopause Ovulation The production of a ripe ovum or egg by the ovary
Oxytocin A hormone secreted by the pituitary gland that stimulates uterine contractions during labour and stimulates milk glands in the breasts to produce milk Palpation Feeling the parts of the baby through the mother’s abdominal wall. Pelvic floor The springy muscular
structure set within the pelvis that
supports the bladder and the uterus, and through which the baby descends during tabour,
Pelvis The pelvis is a solid ring of bone at the base of the abdomen: it shields the bladder and portions of the genital tract. Perinatal The period from the 24th week of gestation to one week following delivery Perineum The area of soft tissues surrounding the vagina and between the vagina and the rectum.
Pethidine See Analgesics
Phototherapy Treatment by exposure
to light, which may he used when a baby has jaundice
Pituitary gland A gland set just below the brain that among other functions, secretes various hormones controlling the menstrual cycle. In late pregnancy it releases a hormone, oxytocin, into the bloodstream, which stimulates uterine contractions and also the milk glands.
Placenta The organ that develops on the inner wall of the uterus and supplies the fetus with all its life-supporting requirements and carries waste products to the mother’s system.
Placental insufficiency A condition in which the placenta provides inadequate life support for the fetus, often after 40 weeks, resulting in a baby at special risk.
Placenta praevia A condition in
which the placenta lies over the cervix at the end of pregnancy. This part of the uterus stretches in the last few weeks of pregnancy, but the placenta cannot stretch, so it may separate, the result is bleeding during late pregnancy, A woman with a complete placenta praevia is delivered by Caesarean section
Posterior See Occipito posterior
Postnatal After the birth.
Postpartum After delivery.
Post-traumatic stress disorder Panic and anxiety experienced by some women after traumatic and disempowering childbirth Pre-eclampsia (Pre-eclamptic toxaemia or PET) An illness in which a woman has high blood pressure, oedema, protein in the urine, and often sudden excessive weight gain See also Eclampsia.
Premature A baby born before the 37th week of pregnancy and weighing less than 2.5 Ing (5 lb)
Presentation The position of the fetus in the uterus before and during labour,

lying directly over the cervix
Preterm See Premature
Primigravida A woman having her first pregnancy.
Progesterone A hormone produced by the corpus luteum and then by the placenta Progestogen A synthetic variety of the hormone progesterone used in oral contraceptives.
Prolactin A hormone that stimulates milk production for breastfeeding Prostaglandins Natural substances that stimulate the onset of labour contractions. Prostaglandin gel may be used to soften the cervix and induce labour
Proteinuria The presence of protein in the urine, which may be a sign of pre-eclampsia. See also Pre-eclampsia
PTSD See Post-traumatic stress disorder Pubis The bones forming the front of the lower pelvis.
Quickening The first noticeable movements of the fetus felt by the mother.
Respiratory depression See Depression, respiratory.
Rhesus factor A distinguishing characteristic of the red blood corpuscles. All human beings have either Rhesus positive or Rhesus negative blood If the mother is Rhesus negative and the fetus Rhesus positive, severe complications and Rhesus disease (the destruction of the red corpuscles by antibodies) may occur, unless prevented by anti-D gamma globulin.
Rooting The baby’s instinctive searching for the breast
Rubella (German measles) A mild virus that may cause congenital abnormalities in the fetus if it is contracted by a woman during the first 12 weeks of pregnancy
Scan (Screen) A way of building up a picture of an object by bouncing high-frequency soundwaves off it. The sonar or ultrasound scan is used during pregnancy to show the development of the fetus in the uterus. See also Transducer.
Show A vaginal discharge of bloodstained mucus occurring before labour, resulting from the onset of cervical dilatation. A sign that labour is starting
Small-for-dates Babies who are born at the right time but who for a range of reasons have not flourished in the uterus. See also
Placental insufficiency
Sperm (Spermatozoon) The male reproductive cell that fertilizes the female ovum or egg.
Spina bifida A congenital neural tube defect in which the fetal spinal cord forms incorrectly, outside the spinal column Spinal anaesthesia An injection of local anaesthetic around the spinal cord.
Steroids Drugs used in the treatment of skin disorders, asthma, hay fever, rheumatism, and arthritis. Because they alter the chemical balance of the metabolism they may very rarely cause fetal abnormalities if used extensively during pregnancy
Stillbirth The delivery of a dead baby after the 24th week of pregnancy
Streptomycin A broad-spectrum antibiotic that should not be taken in pregnancy See also Antibiotics
Stretch marks Silvery lines that sometimes appear on the skin after it has been stretched during pregnancy
Supplementary feeding Additional bottles given to a breastfed baby.
Surfactant A creamy fluid that reduces the surface tension of the lungs so that they do not stick together when deflated. Preterm babies may have breathing difficulties if surfactant has not developed sufficiently Suture The stitching together of a tear or a surgical incision.
Syntocinon A synthetic form of
oxytocin, which is used to induce or accelerate labour.
TENS machine See Transcutaneous electronic nerve stimulation
Term The end of pregnancy this is measured at 38-42 weeks from the first day of the last menstrual period. Tetracycline A wide-spectrum class of antibiotic that should be avoided during pregnancy. because it can affect the development of the fetal teeth and hones See also Antibiotics.
Thrombosis A blood clot in the heart or blood vessels.
Thrush A yeast infection that can form in the mucous membranes of the month, genitals, or nipples.
Toxoplasmosis, congenital A parasitic disease that is spread by cat faeces. If it crosses the placenta during pregnancy, it can cause eye or central nervous system damage in the baby
Transcutaneous electronic nerve stimulation A method of pain relief that uses electrical impulses to block pain messages to the brain.
Transducer An instrument that translates echoes of very high-frequency soundwaves bounced off the developing fetus in the uterus to build up an ultrasound image on a monitor. See also Scan.
Transition A phase between the first and second stages of labour when the cervix is dilating to between 7 and 10 cm
Trial of labour A situation in which, although a Caesarean section may be necessary, the mother labours in order to see if a vaginal delivery is possible
Twins The simultaneous development of two babies in the uterus, either after two eggs are fertilized independently by two sperm - dizygotic or fraternal twins - or, more rarely, after one fertilized egg divides to produce monozygotic or identical twins.
Ultrasound See Scan, Transducer.
Umbilical cord The cord connecting the fetus to the placenta
Uterus (Womb) The hollow muscular organ in which the fertilized egg becomes embedded, where it develops into the embryo and then the fetus
Vacuum extractor An instrument, used as an alternative to forceps which adheres to the baby’s scalp by suction and with the help of the mother’s bearing down, can be used to guide the baby out of the vagina
Vagina The canal between the uterus and the external genitals It receives the penis during intercourse and is the passage through which the baby is delivered
VE Vaginal examination.
Vernix A creamy substance that often covers the fetus in the uterus
Vertex presentation (VX) See Cephalic presentation.
Vulva The external part of the female reproductive organs, that includes the labia and the clitoris
Water birth Birth of a baby under water.