Posts Tagged ‘pilates classes’

The end of pregnancy

When will I start my antenatal classes and what types are there?
Antenatal, or parent education, classes start around 32 weeks and, if you are attending classes run by your local NHS trust, are free. The classes may run for 4-6 weeks, or some trusts have a monthly afternoon session. Some hospitals provide women-only classes evening or weekend classes and yoga and pilates classes (see p 60). There are also private or independent, midwives in most areas who may offer antenatal classes on a one-to-one or small group basis.
Antenatal classes are also available from the National Childbirth Trust (NCT), run by trained NCT teachers Classes are usually held in the evenings, making them more accessible to partners and friends, and they often provide ongoing postnatal support for up to six months after the birth. There is a fee, although in some cases a reduced fee or assisted places may be offered
Aquanatal classes are also popular These are gentle exercises in the swimming pool along with other pregnant women and often the teacher is a midwife who also provides antenatal information. Also many obstetric physiotherapists run relaxation and breathing technique sessions; your hospital antenatal clinic may have information on these.
What will I learn in my hospital antenatal classes?
Antenatal classes usually cover a different topic each week, including the physical changes that occur in pregnancy, the three stages of labour; hospital, home, and water births; pain relief, which should include breathing and relaxation techniques; breastfeeding; postnatal care of the baby; and changes in your relationships The most popular topics tend to be the stages of labour and pain relief, along with a tour of the maternity unit
Is it useful to learn and practise breathing and relaxation exercises before the birth?
Preparation before labour and delivery is
for most women and their partners, and breathing relaxation techniques in particular help you to focus on your breathing. which in turn can help you to fee- less tense and increase your confidence for dealing with the contractions Antenatal classes teach you
specific techniques and antenatal yoga (see p 60) also helps you to gain control through breathing
Should I practise positions for labour and birth beforehand?
Practising for labour is a good idea as you may find some positions suit you and others don’t (see below). This information can be documented in a birth plan (see p.149) so that it is available for your midwife to discuss with you. It’s also good for your partner to know your preferred positions during labour
Do you have any suggestions for labour positions?
Some popular positions for labour area
* Leaning on a work surface or the back of
a chair. Putting your arms round your partner’s neck or waist to lean against.
•    Leaning on to the bed in the delivery room
•    Kneeling on a large cushion or pillow on the floor and leaning forwards on to the seat of a chair * Sitting astride a chair and resting on a pillow placed across the top
* Sitting on the toilet; leaning forwards, or sitting astride. leaning on to the cistern.
•    Kneeling on all fours.
•    Kneeling on one leg with the other bent
•    Rocking your hips backwards and forwards or in a circled this can also be done using a birthing ball Ally of these positions can make your contractions Breech presentation
Breech position is when your baby is bottom first instead of head first. Breech babies lie in one of three positions: a flexed, or ”complete’ , breech, when the hips are bent, the thighs against the chest, and the knees bent with the calves against the back of the thighs and feet above the bottom; an extended. or
‘frank”, breech when the hips are flexed or bent the thighs against the chest, and the feet by the ears; and a ”footling” breech, like a flexed breech, but the hips aren’t so bent and the feet are below the bottom If your baby is breech at term, your doctor may recommend delivery by Caesarean section
more efficient and help you feel in control When you are in strong labour, you may find that you don’t want to move around much and will find a position that suits you If possible, keep rocking, leaning forwards during contractions, and straightening up in between. If you get tired, lie down on your left-hand side, rather than propped up on your back, which stops the pelvis being able to open effectively. Lying on your left side is much better for your baby than lying on your back because he receives more oxygen, and the contractions are still effective in this position. If you feel rested after a while, push yourself up with your hands into a sitting position and get up again
I’m 36 weeks and my baby is breech. Is this a concern?
Breech position is when your baby is bottom first instead of head first (see above) Quite a lot of
babies sit in the breech position in pregnancy and there is still a chance your baby will turn. It’s not until about 37 weeks that your midwife or doctor will focus on your baby’s position.
Is there anything I can do to help my baby turn?
If your baby is breech towards the end of pregnancy there are some exercises you can try in an attempt to turn your baby A ‘knee-chest” position can help To do this, kneel on your bed with your bottom in the air and your hios bent at just over 90 degrees Try to keep your head, shoulders and upper chest flat on the mattress Adopt this position for 15 minutes every two waking hours for five days If you feel nauseous or light-headed, do not continue. Positions in which the buttocks are elevated can also help, and sleeping with a pillow under your buttocks or kneeling on all fours so the weight of your pregnancy is unsupported may help You can combine ”all fours’ positions with household chores, such as cleaning the floor. If these are not successful, there are other ways to try to turn your baby (see below).
I’ve heard about doctors “turning” breech babies. How does this work?
Some obstetricians may try to turn a breech baby in late pregnancy, known as external cephalic version (ECV), which has a success rate of around 50 per cent. During an ECV, an obstetrician gently moves your baby by pressing his hands on your abdomen, using an ultrasound as a guide You may be given a drug to relax the uterine muscles You will be scanned first and if the baby is in an awkward position the procedure may not continue. Also, if your baby is large this can affect the procedure, as can the amount of fluid around the baby, as a low amount of fluid offers less protection to the baby, If you are Rhesus negative, you will have an injection of anti-D after the ECV (see p.79) because of a small risk of a bleed around the placenta An ECV is not recommended if you have a multiple pregnancy, have had bleeding in pregnancy, your placenta is low-lying, your membranes have ruptured, or there is a known problem with the baby
The procedure is not without risk and some think it only works with babies who would have turned anyway. If your baby remains breech, a Caesarean may be advised, although some obstetricians are willing to try a vaginal delivery You are not obliged to have an ECV and should discuss your options.
Finally, a form of acupuncture called
I f moxibustion”is sometimes used, whereby a fragrant herb is held over an acupuncture point, the aim being to relax the uterine muscles to help the baby turn Talk to your doctor or midwife before trying this and seek advice from a qualified acupuncturist.
What triggers labour?
While there are many theories, no one really knows what triggers labour One is that the mother’s pituitary gland secretes oxytocin, the hormone that
stimulates contractions, when the baby is ready to be born Others now believe that the baby starts labour by sending a signal to the mother’s body One theory is that a baby’s lungs secrete an enzyme when they are developed that causes a substance called prostaglandin, which triggers contractions, to be released into the mother’s body. Another theory is that, when the baby is ready to be born, its adrenal glands produce hormones; these cause hormonal changes in the mother that start labour
I don’t want to go overdue. How can I help labour to start?
Various methods have been tried, although none is proven. Popular methods include having sex, as the prostaglandins in semen are similar to the ones used to induce labour; stimulating your breasts to trigger the release of the hormone oxytocin, which stimulates the uterus; eating spicy food to bring on a loose bowel movement, thought to stimulate labour (see p 48) ; and taking long walks to help the baby move down in the pelvis and put pressure on the cervix Homeopathic remedies are also available; consult a registered practitioner for advice.
I’ve heard that raspberry leaf tea can start labour. Is this true?
Unfortunately this is a misconception as raspberry leaf tea doesn’t actually help to bring on labour, but it may help to reduce the length of labour In a study m Sydney, 192 first-time mums were given either a 1.2g raspberry leaf tablet or a placebo twice a day from 32 weeks. The tablet had no harmful effects. and the women who had taken the supplement had a shorter second stage of labour and a lower rate of assisted delivery (19.3 per cent to 30.4 per cent).
Raspberry leaf tea contains an alkaloid, ”fragine”, said to strengthen and tone uterine muscles, helping them to contract more efficiently. You should start taking raspberry leaf tea during the last eight weeks of pregnancy At 32 weeks, you could have one cup of raspberry leaf tea a day, gradually increasing to four cups or tablets a day (depending on the strength of the blend). The tea can be sipped in labour, too.

Fetal positions
Your baby in the uterus
Your baby can lie within your uterus in many different positions. Your midwife or doctor will palpate your abdomen (gently feel your tummy) to identify which way your baby is lying. There are two main positions in which your baby will lie: with his head downwards (cephalic presentation) or with his buttocks downwards (breech presentation). Occasionally your baby will lie across your uterus in a transverse position or even diagonally across you in an oblique position, particularly if there is too much fluid around the baby or you have had several babies previously. In about 17 per cent of cases, the midwives and doctors do not identify a breech presentation until the labour itself
What is LOA and ROA? Once your midwife has identified how your baby is lying, she will also try to determine whether the baby is lying on your right or left side The midwife will track where
Your baby’s position
your baby’s back is, and you will generally feel kicks on the opposite side. The midwife will describe your baby as being LOA or ROA, which stands for left or right occipital anterior -the occiput being the back of your baby’s head facing forwards, so your baby is actually facing backwards These are the best positions for your baby to lie in for labour.
What if the baby isn’t anterior? Sometimes babies lie in a posterior position, which means that their back is lying against your back and they are looking upwards This position may prolong your labour, which can be tiring If this is the case, you can try the same exercises for turning a breech baby (see p.143) to encourage your baby to turn to be in an anterior position towards the end of pregnancy Sometimes your baby will only turn with the help of strong, effective contractions when you are in fully established labour.

What is the “nesting instinct” and is this just a myth?
The nesting instinct is a well-documented natural phenomenon In the final weeks of pregnancy, many women have an uncontrollable urge to clean their house and to prepare and make the ”nest’ safe for the new arrival This is a primal instinct and females of the animal kingdom are all equipped with this need. Just as birds make their nests preparing for their young, mothers-to-be do exactly the same.
The act of nesting puts you in control and gives
•    sense of accomplishment You may also become
•    homebody and want to retreat into the comfort of your home and familiar people The nesting urge can be an indicator that labour is not too far away If you have the energy, take advantage and get on with tasks that you won’t have time for after the birth
Is it true that first babies are often late?
Birth normally occurs at a gestational age of 37 to 42 weeks and, while it certainly isn’t the case that all first babies are late, many do arrive after the predicted
due date. From the point of view of waiting if you approach the end of your pregnancy expecting your baby to be a couple of weeks late, then you may avoid feelings of frustration. It is worth considering that your body has never done this before and that your “due date” is an estimate, the majority of babies do not arrive on this date
I’m 39 weeks and my baby’s head isn’t engaged. Should I be worried?
Not all babies engage into the pelvis before
the beginning of labour It is likely, from about 36 weeks onwards of -your pregnancy, that you may experience your baby moving lower down in your abdomen, causing your baby’s head to enter the pelvis. This process is known as ”engagement’I and simply means that the leading part of the baby has ”engaged” the pelvic brim (see p.148) This is normal and helps to position your baby in preparation for the birth later on.
Engagement often happens earlier with first
babies because the uterine muscles have not been
Your hospital bag
Although hospital visits tend to be short, with many women staying around 24 hours or less after a normal delivery you will need a few essential items. Many mums have a bag for themselves and one for the baby, while others organize a labour bag and postnatal bag for mum and baby. It’s up to you. Basic requirements include:
•    Clothing for labour (including socks and/or footwear).
•    Nightwear.
Toiletries
A towel, sanitary pads disposable pants and a bra.
iIc Music, books, and magazines, as well as money, telephones, phone numbers, and cameras.
* A food bag with nutritious snacks to keep you going
For your baby you will need:
* Clothing, cleaning materials, and some clothes for returning home * Nappies (check with your midwife if the hospital provides these or whether you need to supply your own).

Engagement
Engagement is when your baby’s head starts to move down into the pelvic brim in preparation for birth, and this can occur any time from around 36 weeks until the start of labour In the last weeks of pregnancy, your midwife will palpate your abdomen to see if the head has started to engage. The degree to which a baby’s head is engaged is measured in fifths. If three- or four fifths of the head can be felt above the pubic bone, then
the baby is not engaged If only two-
fifths of the head can be felt, then the baby is said to be fully engaged, and if just one-fifth is felt, the baby is recorded as being deeply engaged.
previously stretched and so they tend to exert more pressure on the baby, moving it down into the pelvis earlier: whereas a second or third baby may not become engaged until your labour actually starts. When your baby’s head engages can also depend on other factors, such as the position in which your baby is lying within the womb (see p.145) and the shape of your pelvis
Am I likely to feel any different once my baby’s head has engaged?
Many women report feeling more physically at ease following the engagement of their baby’s head as there is a release of pressure within the abdomen As a result, you may find that it feels easier to breathe, sleep, and walk around
On the other hand, sometimes when the baby’s head engages this can increase the pressure on your bladder and you may experience a sensation of fullness and pressure between your legs. Many women also report shooting vaginal pains. Engagement is also likely to affect bowel sensations.
My midwife mentioned checking the position of the placenta. Is this normal?
This is not routine, but if your 20-week scan indicated that the placenta was low-lying, known as placenta praevia (see p.92), your midwife would suggest a further scan at 34 weeks to see if the placenta had moved up and away from the cervix.
My baby isn’t moving so much now - should I be worried?
There is some natural reduction in the range of your baby’s movements towards the end of pregnancy as he has less room to stretch his limbs However, you should still be familiar with your baby’s pattern of movement in later pregnancy as this is a good indicator of your baby’s health and is just as important as the number of movements a day (see p.103) You may find at this stage that your baby is developing a pattern for waking and sleeping, often different to yours, so your baby may be awake when you go to bed and may start kicking Or your baby may get the hiccups and you will feel the jerk of each hiccup, a sign that your baby is preparing for life after delivery. If your baby’s movements have reduced or stopped, contact your maternity unit. You could also try things like having a cold or hot drink, having a bath or shower or massaging your tummy. A formal assessment may be recommended and if there are concerns, you will be asked to make a conscious effort to increase your awareness of when your baby moves. There should never be fewer than 10 individual groups of movements a day between 9am. and 9pm. Some areas have walk-in antenatal day units (ANDLJ) where you can have a cardiotograph (see p.192) to record your baby’s movements.
I’m practically incontinent. Is there anything I can do to stop this?
During pregnancy, many women find that they leak urine slightly when they cough, laugh, exercise, bend over, or lift something. This is known as stress incontinence. The pelvic floor muscles are under strain during pregnancy as they have to support the weight of your growing uterus and cope with the changes caused by pregnancy hormones. As a consequence, a sharp increase in abdominal pressure when you cough and so on may be too much for the muscles to hold back the flow of urine. Stress incontinence may happen at any time in pregnancy, but is more common towards the end.
The best treatment for incontinence is regular pelvic floor exercises to keep the muscles toned (see p.57). Taking some gentle exercise each day can also help and, although you may not make a full recovery during pregnancy, regular exercise now will minimize the problem and help you towards a full recovery after your baby is born. Stress incontinence is often worse for a few days following the birth, when the muscles of the pelvic floor and other structures are recovering If it does not get better after this time, talk to your health visitor or doctor as you should not have to suffer long term without help.
Ask your midwife to refer you to your obstetric physiotherapist, who can review the problem and offer you advice and monitoring.
Birth plan
Stating your preferences for labour and birth
The purpose of a birth plan is to communicate your wishes for labour and birth.
Your plan can be as detailed or as brief as you like Do bear in mind that circumstances may dictate that not all of your preferences are met Discuss this plan with your midwife before the birth. Here are some suggestions of what to include:
* You may want to state who your birth partner will be, whether you want more than one birth partner, and if you want them present throughout. * You could include your preferences for managing labour pain Do you want to labour naturally (maybe using a birthing pool), or do you have a preferred type of medical pain relief? *You can state which positions would you like to use in the different stages of labour? Do you want to be active in the first stage, and in which position would you prefer to deliver your baby?
* Do you have concerns about being strapped to a fetal monitor? If so, do you want to request that this be done intermittently only?
* State your preferences for after the birth. Do you want your baby delivered on to your tummy, and how soon do you want to breastfeed?