Posts Tagged ‘placenta’

Your body after the birth
I’ve heard about “afterpains”, but what exactly are they?
The term “afterpains” refers to the discomfort felt after the birth as the uterus starts to contract back down  to its normal, pre-pregnancy size. These pains are often described as feeling similar to period pains. So times, women having their first baby may not notice any afterpains, or they are fairly mild; they are more commonly felt by women having their second or subsequent baby. due to the fact that the uterus has to work harder to regain its usual size after being stretched on more than one occasion. who are    also tend to be felt more in women
are breastfeeding their babies, as breastfeeding stim ates the release of the hormone oxytoch which in turn triggers the uterine contractions that are I elt as afterpains.
Getting enough rest
helping  your body to X recover
0    Whether you had a vaginal or
Caesarean birth, you are likely to feel exhausted in the first few weeks. It’s important that you don’t take on too much and give yourself time to recover. * Rather than try and catch up on chores while your baby sleeps, have a nap to catch up on sleep lost through interrupted nights.
•    Avoid heavy lifting as much as possible.
•    It’s fine to stay indoors at first and take things at your own pace while you get used to life with your new baby.
* Don’t feel you have to entertain visitors — 13k them to make you a cup of tea!
If you experience particularly uncomfortable afterpains, it is perfectly safe to take a mild analgesic or a painkiller such as paracetamol. You should find that the discomfort disappears after a few days. Taking warm baths can also be soothing.
I’m still bleeding heavily. How long will this last?
The bleeding you experience after birth is known
as lochia, which is a heavy, bloody vaginal discharge made up of blood and tissues from the uterus and from the site where the placenta was attached to the wall of the uterus. This is how your body gets rid of I he lining of the uterus that supported your baby. Most women find that the bleeding looks initially
like a “period” type of blood loss, and then gradually turns to a brownish or pinkish, watery discharge. The final colour may be yellowish and the discharge quite scanty This bleeding can last for anything from two to six weeks after giving birth. If you are breastfeeding it may finish sooner as the let-down reflex stimulates oxytocin, which in turn triggers uterine contractions.
Is it safe to use tampons while I’m bleeding?
It is not advised to use tampons for around six weeks after giving birth. This is because you are more vulnerable to contracting an infection during this period, so it is important to pay close attention to personal hygiene at this time to keep your vaginal area free from any bacteria, which can be introduced through the use of a tampon. So you should avoid using tampons while you have the post-pregnancy bleed known as lochia.
You can start to use tampons again for your first period after the birth, as long as this occurs at least six weeks after the birth.

LABOUR AND BIRTH
A NEW LIFE
Ouch! My stitches are really uncomfortable. What’s the best way to ease the pain?
Stitches do cause discomfort fora few days after giving birth, so keep the area as clean as possible as this will help prevent infection and minimize your discomfort. You should wash the area with warm water several times a day and make sue you change your pad frequently. Many women find the following techniques for reducing discomfort helpful: * Using a cold pad. You can use a cooling gel pad that has been specially designed for the purpose of soothing the discomfort caused by stitches in the perine area. These have been demonstrated to effectively reduce swelling, briusing, and pain. Or make y:)ur own cool pad by placing crushed ice in a pla tic bag and wrapping this in a dry flannel. * Taking the homeopathic remedy arnica, which is thou ht to help reduce bruising.
* Having a warm bath with a few drops of lavender or camomile essential oil.
* Taking painkillers such as paracetamol or ibuprof n. Ask your doctor or midwife for advice.
take a f w months or more. whichever category you fall to, it is important not to adopt a strict diet during e early weeks and months of parenthood, especi y if you are breastfeeding. However, it is sensib14 to eat a healthy, balanced diet and take some e ercise.You should aim to lose your “baby weight” ,gradually as this will ensure that you are receiv’ g enough nutrition in the postnatal period, and wi give your tummy more time to adjust its shape. eome women do attend professional sessions such as Weight %Vatchers, but it is important that you inform , e trainer or person in charge that you have recentl had a baby.
Coping with constipation Helping your bowels ‘Lo work after the birth
It’s common for bowel movements to be fairly sluggish after giving birth as your abdominal muscles have been stretched during the pregnancy and so exert less pressure, which slows down the movement of faeces through the bowels causing constipation.
You may also feel uncomfortable after the birth and be anxious that opening your bowels, and possibly straining, could damage stitches if you had any However, this is extremely unlikely. The best way to avoid constipation is to drink plenty of fluids each day, preferably water (also important if you are breastfeeding), and to eat tots of fibre-rich foods, such as fresh and dried fruits, cereals, and other wholegrain foods. Once you have recovered from the birth, gentle exercise that tones the abdominal muscles may also help your bowels to become more efficient (see pp.268-269).
How can I get rid of my stretchmarks?
Unfortunately, there is no magic way to get rid of stretchmarks, which affect a large number of pregnant women and seem to be influenced by genes as they often run in families. You will find that the marks fade over time from bright red to a paler pink, and then to a silvery colour that blends in with your skin tone. Massaging a natural oil into your skin may help them to fade.
If, after time, your stretchmarks are still troubling you, you could discuss treatment options with your doctor, which include Laser treatments to reduce the redness of stretchmarks. However, you should be warned that treatments for getting rid of
stretchmarks are often not completely effective and simply speed up the natural fading process rather than eradicate the stretchmarks altogether. Also you would have to pay for these treatments privately
varies widely.
How quickly will I lose the weight I put on during pregnancy?

I’m losing weight fast, but my tummy is really flabby - how can I tighten it up?
This i . a common problem after giving birth. The flabb i ess you are experiencing is caused by the muse :-s and skin having stretched to accommodate your bregnancy and baby After the birth, these muse  es relax and have lost their tone. However, you shoule find that the muscle tone gradually returns, altho gh it may never be quite the same as it was befor’ your pregnancy.
Yo u can try some gentle toning exercises (see pp.2t8-269) as soon as you feel able to after the birth,although you should wait for at least six weeks if yo ‘have had a Caesarean. Your midwife will be able io give you more information about what is safe to do land what is not. If you do go to a professional exert se class or gym, make sure you inform the train4 that you have recently given birth and what type of birth you had so he or she can give you appropriate advice and guidance.
I’ve still got a huge appetite - is this because I’m breastfeeding? Ho much should I be eating now?
This ould be because you are breastfeeding, which requi es an extra 500 calories each day However. this iay not equate to as much food as you think -it wo s out at about two slices of toast with baked bean ! Your big appetite therefore isn’t a problem
in itself, but how you satisfy it can be! As long as you are eating a healthy, balanced diet. you shouldn’t find that ou gain weight (and you definitely shouldn’t be tryinsi to diet while you are breastfeeding). Ensure
that our diet is providing sufficient quantities of prole and carbohydrates and plenty of fresh fruit and –getables. Also avoid filling up on “empty calor es” such as sweets, biscuits, and crisps, and insle.: d try to snack on foods such as fruit, nuts, and seed.. This will ensure that you receive the best nutri on during such an important time, which will bene it you and your baby, and will also help you to lose ..ny extra weight you have gained during the co -e of your pregnancy.
I’ve heard that breastfeeding helps you to lose the weight quicker. Is this true?
Breastfeeding can help you to lose weight moi e quickly after the birth as your body is using up energy to provide an adequate milk supply for
your baby. Some of the 500 extra calories a day you need may be taken from fat supplies deposited in pregnancy Often, extra fat laid down on the hips and thighs in pregnancy is lost first, providing the “fuel” required to make milk and breastfeed your baby. Gentle exercise such as walking and swimming will also help to shift the pregnancy pounds.
I’m not breastfeeding my baby at all - when will my periods start again?
If you are not breastfeeding, you can expect your first period to arrive any time from four weeks after the birth. Most women find that the first period is a little different from normal. It may be heavier or Lighter and it may last for longer or shorter than usual. A more regular pattern should establish itself over the next few months.

First Hours After Birth. FAQ.

Will they clean up my baby first?
This is something to discuss with your midwife before the birth. She will ask your preferences
for whether to deliver your baby straight on to your tummy or, as some women prefer, on to the bed to be cleaned and dried before being handed to you.
When will my baby be weighed?
Your baby will have a head-to-toe check, be weighed, and have his head circumference and body length measured This may be done very quickly after the birth, but more usually it is done once you have had the opportunity to cuddle your baby.
What is vernix?
Most babies born before 40 weeks have some vernix, a white waxy substance, on their skin that protects them while they are in the amniotic fluid. After 40 weeks this begins to disappear. If it is present after birth, it doesn’t need to be wiped off as it will gradually be absorbed into the skin.
How will the cord be cut?
Once your baby is born, the usual practice is to place a plastic cord clamp on the cord about lcm (i3 in) away from the baby’s tummy, and then to clamp another about 3cm (I in) away from the
first cord clamp using artery forceps; the cord in between the clamps is then cut using cord scissors. Recently there has been some debate about the best timing for clamping and cutting the cord. The most recent research suggests that delaying the clamping of the cord for 2-3 minutes is most beneficial for the baby. This is because the cord continues to pulsate for several minutes after the birth and so delaying cutting it allows more blood to pass from the placenta to the baby This boosts the baby’s oxygen supply and blood volume, which in turn raises iron levels and reduces the risk of anaemia developing.
Although some maternity units are changing their policies in line with this research, most are continuing with the practice of clamping and cutting immediately If you have a preference as to the timing of clamping and cutting the cord, you can include this in your birth plan If your birth partner would like to be involved in cutting the cord with the midwife, discuss this prior to the birth; this should be possible, providing all is well at the delivery.
Do all newborn babies look the same?
Babies vary in appearance at birth and a variety of factors play a part. Sometimes parents are surprised that instead of a soft-skinned baby they are faced with a red-faced,  wet, screaming individual. Some aspects of your baby’s appearance may be temporary and related to the birth or your baby adapting to life in the outside world, such as the shape of his head, which may have been affected by the birth, or the colour of his skin (see p.219). If your baby is born late, at around 42 weeks, he may have drier, flakier skin than babies born around 40 weeks if he is born prematurely, he may still be covered in the fine downy hair called lanugo, which will gradually disappear. Also the type of delivery can affect the way your baby looks after birth. If you have a Caesarean, your baby is less likely to have a distorted or ‘’squashed” appearance to his head as he has not had to squeeze through the birth canal.
I’ve heard that sometimes the genitals are quite swollen. Why is this?
The hormones produced by your body in pregnancy namely oestrogen and progesterone, cross the placenta and so are present in the baby during pregnancy and immediately after the birth. One of the side effects of these hormones can be swollen genitals in both newborn boys and girls In girls, the swelling can be accompanied by a reddening of the skin and some baby girls may have a vaginal discharge. As the hormone levels drop, the discharge may include a small amount of blood, all of which is normal. Hormone levels can also cause swelling of the breasts in both boys and girls. After the birth, any swelling and discharge settles quite quickly as the baby does not produce hormones and levels drop to zero in the first week
Will he be wrinkly?
A newborn baby’s appearance changes over the first hours and days of life Immediately
after birth, babies tend to have a wrinkly appearance because they have been in a bag of fluid for the last nine months, much the same as we get if we stay in the bath for too long As their skin adapts to being in the outside world, the wrinkles disappear If a baby is very overdue, the skin can appear quite dry and in most cases will flake off In this situation, it will also appear wrinkly due to a lack of moisture Once a newborn baby’s skin starts to flake, there is nothing that can be done to stop it, and you should not use
any moisturizing products to try to prevent it. Rest assured that the layer of skin underneath will be fine.
My baby’s face is covered in spots. Will they go?
Newborn babies have very sensitive skin. They have been protected in a safe environment in pregnancy and following the birth their skin needs to adjust to the outside world That is why rashes and spots may occur. The most common rash in newborns is called erythema toxicum neonatorum, which occurs in around 50 per cent of newborn babies and is usually noticeable around 1-5 days after the birth This consists of small red spots that appear and disappear all over the skin apart from on the palms continuing with the practice of
clamping and cutting immediately If you have a preference as to the timing of clamping and cutting the cord, you can include this in your birth plan If your birth partner would like to be involved in cutting the cord with the midwife, discuss this prior to the birth; this should be possible, providing all is well at the delivery
Do all newborn babies look the same?
Babies vary in appearance at birth and a variety of factors play a part. Sometimes parents are surprised that instead of a soft-skinned baby they are faced with a red-faced, wet, screaming individual. Some aspects of your baby’s appearance may be temporary and related to the birth or your baby adapting to life in the outside world, such as the shape of his head, which may have been affected by the birth, or the colour of his skin (see p.219). If your baby is born late, at around 42 weeks, he may have drier, flakier skin than babies born around 40 weeks, if he is born prematurely, he may still be covered in the fine downy hair called lanugo, which will gradually disappear. Also the type of delivery can affect the way your baby looks after birth. If you have a Caesarean, your baby is less likely to have a distorted or ‘’squashed” appearance to his head as he has
not had to squeeze through the birth canal.
I’ve heard that sometimes the genitals are quite swollen. Why is this?
The hormones produced by your body in pregnancy namely oestrogen and progesterone, cross the placenta and so are present in the baby during pregnancy and immediately after the birth. One of the side effects of these hormones can be swollen genitals in both newborn boys and girls In girls, the swelling can be accompanied by a reddening of the skin and some baby girls may have a vaginal discharge. As the hormone levels drop, the discharge may include a small amount of blood, all of which is normal. Hormone levels can also cause swelling of the breasts in both boys and girls After the birth, and swelling and discharge settles quite quickly as the baby does not produce hormones and levels drop to zero in the first week.
Will he be wrinkly?
A newborn baby’s appearance changes over the first hours and days of life. Immediately
after birth, babies tend to have a wrinkly appearance because they have been in a bag of fluid for the last nine months, much the same as we get if we stay in the bath for too
long As their skin adapts to being in the outside world, the wrinkles disappear If a baby is very overdue, the skin can appear quite dry and in most cases will flake off In this
situation, it will also appear wrinkly due to a lack of moisture. Once a newborn baby’s skin starts to flake, there is nothing that can be done to stop it, and you should not
use any moisturizing products to try to prevent it. Rest assured that the layer of skin underneath will be fine.
My baby’s face is covered in spots. Will they go?
Newborn babies have very sensitive skin. They have been protected in a safe environment in pregnancy and following the birth their skin needs to adjust to the outside world.
That is why rashes and spots may occur. The most common rash in newborns is called erythema toxicum neonatofurn, which occurs in around 50 per cent of newborn babies and is
usually noticeable around 1-5 days after the birth This consists of small red spots that appear and disappear all over the skin apart from on the palms.

Your newborn’s appearance
Your baby’s appearance straight after the birth may not be what you expected. Straight after the birth, the skin can look dark red or purple, but quickly changes to a lighter
colour as he begins to breathe air through his lungs for the first time His hands and feet may look a little blue for the first 24-48 hours; this is normal, but blue-tinged skin
elsewhere at this time is0 normal and should be assessed. A baby’s head shape sometimes concerns parents; as the baby passes through the birth canal, the bones of the skull are
designed to overlap, which means that after the birth the head can looked quite pointed However, this resolves within 24 hours. Sometimes there is bruising on the scalp due to
the baby’s position in labour that tends to disappear in the first week
of the hands and soles of the feet. It isn’t harmful and it doesn’t indicate an infection. It can’t be passed on to others and it usually disappears within two weeks without any
treatment Milla is another noticeable skin change occurring in about 40 per cent of newborn babies. These are pin-head-sized white spots, which usually appear over the nose and
cheeks, but can also occur on other parts of the face. These are blocked-off pores containing some sebum (an oily substance produced by the skin) and, again, they disappear
without treatment.
My baby has a big red strawberry mark on his head. Will it be there for ever?
Birth marks are fairly common and most disappear in the first few years of life Strawberry birth marks start as a red dot and tend to grow in size for about a year, but usually  disappear by five years. Other
marks include pink patches of skin, called stork patches, and Mongolian blue spots, which are patches of skin with a bluish tinge that occur on babies of Afro-Caribbean or Asian descent. They
usually occur at the bottom of the back but
may extend over the bottom and are due to the concentration of pigment cells in the slsjn; they often disappear by three to four years of age. Port-wine stains are larger red
marks that tend to occur on the face and neck. These birth marks are permanent, so you may want to talk to a skin specialist about whether there are treatments to reduce them.
Should I be careful about using products on my baby’s skin?
Yes, you do need to exercise caution. As a baby’s skin is very sensitive, it can react to any chemicals that it comes into contact with, including some baby bath products The
very best option is to use nothing other than plain water on a baby’s skin until he is at least a month old. and to continue to take care over which products you use in the following months
You can use oils to massage your baby Pure vegetable oil or olive oil is best; avoid aromatherapy or mineral oils, which may be harmful to a baby’s skin, and nut-based oils, as
there is a possible link between these and the development of nut allergies.

Newborn tests and checks
Between 6 and 72 hours after the birth, your baby will receive a detailed examination from a doctor or midwife The aim of this is to detect any abnormalities in a baby that may
not have been picked up by the antenatal scans during pregnancy If you need to see a specialist as a result of these tests, an appointment will be made at a later date Other
tests are carried out in the couple of weeks following the birth, usually in your home by the midwife or health visitor,
The first examination During this initial examination your baby will be weighed and measured and his heart and lungs will be listened to using a stethoscope The roof of his
mouth will be checked to make sure that there is no cleft, or split, in his palate and his eyes will also be examined His limbs will be checked to ensure that they match in
How your baby is checked
length, and that his feet are properly aligned with no sign of clubfoot Your baby’s tummy will
be felt to check that the internal organs are the right size and in the right place. and the pulses in the groin will also be checked The genitals will be examined, and the
spine will be checked to make sure that all of the vertebrae are in place His hip joints will also be looked at to ensure that these are not dislocated and not ”clicky”, which
could lead to instability later on. Your baby’s reflexes will also be checked (see p.223).
The newborn blood spot test This is most commonly referred to as the Guthrie or heel-prick test. It is usually the next check that your baby will have, and it takes place
between days 5 and 7 after the birth. This newborn blood spot screening test is carried out to identify babies who may have
rare, but potentially serious, conditions and may consequently need treatment at some stage
Conditions that are identified Blood spot tests screen babies for phenylketonuria (PKU), a rare metabolic condition: congenital hypothyroidism; cystic fibrosis; sickle cell
disorders, which can lead to severe anaemia and other serious health problems.
PKU is an inherited condition in which babies are unable to process a substance in their food called phenylalanine. Early treatment involves a special diet, which can prevent
severe disability If screening has shown that your baby suffers from congenital hypothyroidism, early treatment will involve thyroxine tablets, which can prevent permanent
physical and mental disability In some areas of the UK, babies are also screened for cystic fibrosis.
How the blood test is done The blood test involves the side of your baby’s heel being pricked and four drops of blood being carefully placed on a special card. The test is often
done while your baby is feeding, as this makes it less painful or alarming for your baby You can
get the results from your doctor, although you will be contacted if anything is detected. Sometimes further testing is needed. Most babies screened will not have any of these
conditions, but, for those who do, early treatment can be vital to ensure long-term health
Your baby’s hearing test A hearing test will be carried out when your baby is around 2-3 days old Around 1 or 2 babies in every 1,000 will have some degree of hearing loss, and
90 per cent of these are born to parents without hearing problems themselves. The hearing test involves one of two checks. For the first, the specialist will put a small
earpiece with a microphone next to your baby’s ears, and, for the second test, headphones are placed over your baby’s head. Clicking sounds are then made and the brain’s
responses are recorded and a readout is given on a computer screen A very small number of babies will need further testing (around 3 per cent). It is important that any hearing
loss is picked up within the first six months of life so that special support can be given to the parents to ensure normal language development later on.

Will my baby have any blood tests before we leave the hospital?
Apart from the newborn blood spot tests (see p.220), other occasions when a blood test may be required include
* If a baby is ill and his general health needs to be assessed which is most commonly done by checking blood sugars
* If a baby shows significant signs of jaundice, to check the bilirubin levels and rule out a more serious underlying condition in the baby, such as anaemia or an infection.
* If the mother is Rhesus negative (see p 79), although blood is usually taken from the umbilical cord at birth to determine the baby’s blood group and Rhesus factor
If the hospital does suggest taking blood from your baby, then a midwife, doctor, or other health professional should clearly explain to you the reasons why they recommend this
course of action and ask for your consent prior to blood being taken from your baby

Vitamin K

After the birth, you will be asked if you would like your baby to receive a vitamin K supplement. This is an essential vitamin for helping the blood to clot, and as babies
receive very little of it from their milk diet there is a small risk that they could suffer internal bleeding. There are two ways to give babies this supplement:
* By an injection, Only one dose is needed to prevent vitamin-K deficiency.
* By mouth Two doses are given in the first week and breastfed babies may have a further dose after a month.
I’ve heard that they check babies’ hips. Why is this?
All babies have two hip checks (see p.221) as part of the recommended child health screening programme. The checks are done in the first couple of days when the baby has a
physical assessment, and at 6-8 weeks of age when the physical assessment is repeated
The two conditions that are being screened for are congenital dislocated hip and developmental dysplasia of the hip, also known as ‘clicl y hips”. The screening may be carried
out by a doctor or a midwife, or later by a health visitor. If a problem is found. a splint may be recommended to align the hip correctly and ensure the socket develops normally.
Why do they measure the baby’s head?
Measuring a baby’s head is done to assess wellbeing, development, and brain growth Many babies have their head measured straight after the birth, but this probably isn’t the
most accurate measurement as the head may have changed shape as it passed through the birth canal It is not until a few days later that it settles into its normal shape. Your
health visitor usually takes a measurement at one of her visits in the first few weeks after the birth and this is generally used as the baseline measurement on your baby’s
growth chart. Measurements taken throughout the first year are plotted on this in a personal child health record that you will be given by your health visitor
Why do some newborns have jaundice?
Just over half of all newborns suffer from jaundice Usually it isn’t noticeable until 2-3 days after the birth and clears by 14 days The most common cause is high levels of
haemoglobin (the oxygen-carrying part of the blood) before birth Once babies are born and breathe for themselves, their haemoglobin count doesn’t need to be so high; these blood
cells die off and are processed as waste by the liver. In small babies, the liver is immature and takes a while to cope with the workload. The result is that instead of this
waste product, known as bilirubin, being passed in the urine and stools, it stays in the body for a while and gives the skin a yellow/orange colour In a healthy full-term baby
who is feeding well, jaundice will resolve on its own without any treatment. Sometimes, if there has been bruising, the baby is slow to feed, or is premature, the bilirubin
levels continue to increase, and in these cases phototherapy (ultraviolet light treatment) is needed to reduce the bilirubin levels in the baby.
Any jaundice that occurs within 24 hours of birth and any that continues after 14 days is investigated to rule out and treat any medical problems.
How much will he cry, or will he be asleep all the time?
Many factors influence your baby’s sleep pattern. such as the type of delivery you had: the gestation of your baby; his health at birth; and the method of feeding your baby,
with bottlefed babies tending to sleep for longer stretches. However, all babies need a lot of sleep approximately 16 hours each day, which consists of short intervals of sleep
intermingled with shorter periods of wakefulness through the day.
My baby’s foot is turned in and we’ve been told he may need a splint. What is wrong with him?
This is known as talipes and affects 1 in 1,000 babies. It’s more common in boys and affects one or both feet. Talipes may be positional or structural. Positional talipes is
caused by pressure compressing the foot while it’s developing, as a result of its position in the womb This may be resolved with exercises to help the foot regain its natural
position. Structural talipes is more complex and is caused by several factors, including a genetic predisposition. This needs prompt treatment while the tissues are soft to
manipulate the foot Splints, strapping, or casts may be used to hold the foot in place In some cases, if this is not effective, an operation to straighten the foot may be
suggested. Both surgical and manipulation methods have a good success rate. Your child will have regular reviews in childhood and adolescence. particularly during growth spurts,
and more surgery may be needed in adolescence. There are organizations to contact for support and advice (see p 310).

Newborn reflexes
Babies have several reflexes that are present from the moment of birth and are part of their survival skills.
* Startle, or morn, reflex. If a baby’s head is not supported, this produces a falling sensation and she will fling out her limbs. It’s important that you always support your
baby’s head. * Rooting reflex. If you touch your baby’s cheek, she will turn her head in search of food
* Grasp reflex. If you put a finger in your baby’s palm, she will grip it tightly with her fingers.
* Stepping reflex. If you hold your baby upright on a surface, she will make stepping actions.

It’s hard to imagine how you will feel at the start of your life with a new baby What is more certain is that you will most likely be shattered after the birth, and will probably experience a whole range of emotions, from euphoria at meeting your new baby and relief that the labour and birth are behind you, to tearfulness brought on by sheer exhaustion and anxiety at the prospect of caring for this tiny human being You may feel incredibly protective towards your baby and overwhelmed by the immense responsibility of looking after him All of these feelings are normal and part of the huge adjustment you make after having a baby. Here is what to expect in the first 12 hours.
1-3 hours Once your baby has been delivered and providing you both are well, you should be able to hold him straight away and enjoy your first cuddle. The cord will be cut by
the midwife, or possibly by your partner. After the birth, you will need to push again to deliver the placenta (see p.188). If you had an episiotomy or tore during the birth,
you will be given an anaesthetic before being stitched Minutes after the birth, your baby’s condition will be assessed using the Apgar score (see p 2 1 Y). Within the first
hour, he will be weighed, measured, cleaned, and wrapped in a blanket
If you are planning to breastfeed, you should be able to put your baby to the breast as soon as possible, he may root for your nipple straight away, or may simply enjoy being
held close to you and having skin-to-skin contact If you had a Caesarean, you will be moved to a recovery room once the operation is completed; once in the recovery room, the
midwife will help to position you comfortably for the first breastfeed. Also, in the first few hours after the birth, you and your partner will be offered some tea and toast, which is usually extremely welcome
4-5 hours By this stage, you may be recovering on the postnatal ward. If you haven’t already done so, you may want to shower and freshen up after the birth. You may need to have
someone with you at first in case you are feeling unsteady, If you had a Caesarean, you won’t be able to shower yet, but the midwife will be able to give you a bed bath. During
this time, you are likely to have your blood pressure, temperature, and pulse rate checked by the midwives, and any stitches you have will be checked intermittently to ensure
that they are not bleeding excessively or loose, and there are no signs of infection. You will also be offered medication to help you cope with any pain. Although you may be
sore after the birth, it’s a good idea to start moving around as soon as possible as this will help your recovery by building up your strength and helping your circulation
Movement will also encourage your bladder and bowel to start working sooner, Passing urine after having stitches can sting, so you may want to try pouring a jug of warm water
over your genitals when you go to the loo If you had a Caesarean birth, moving around will be more difficult, but it is still important to start to be active to avoid the risk
of blood clots developing.
6-12 hours Your abdomen will be palpated to check that the uterus is returning to its normal pre-pregnancy size and your bleeding, known as lochia (see p.264) will be checked to
ensure that it is not excessive and there are no signs of clotting Your baby may want to
feed and you can practise positioning him at the breast so that he latches on correctly (see p 228) The midwives or maternity support staff will help you to get started with
breastfeeding.You may find you experience fairly strong afterpains while feeding as your uterus contracts down (see p.264).You should also receive practical advice on how to
change your baby’s nappy and top and tail him (see pp.250-1). Don’t worry if you feel apprehensive about the practical care of your baby and try not to feel intimidated if there
are more experienced mums on the ward; you will find that your confidence grows quickly as you become practised at handling your baby The midwives have a supportive role to play
on the postnatal ward, so don’t be afraid to ask for help
Often, a sense of camaraderie builds up on the ward, and your stay in hospital can be a good opportunity to talk to other mums and share information and experiences You may feel
well enough to start receiving visitors and, if all is well with you and your baby and you feel ready, you may be able to return home!

I’m over my due date

What is happening to my baby after 40 weeks?
In many pregnancies, there are no changes to your baby’s activities after 40 weeks and his movement patterns will be the same, although your baby’s head will probably move lower into your pelvis as he gets ready for labour, resulting in a lighter feeling under your ribs and a heavier feeling down in the pelvic area. In other pregnancies, mothers may notice a slowing down of movements as the pregnancy progresses. The placenta, which feeds the baby, operates on a lower efficiency after about 38 weeks, and certainly after 41 weeks This means that your baby’s growth tends to slow down the further your pregnancy goes. As it is not possible to accurately predict whether or not the placenta will continue to function well, most hospitals have an induction policy to avoid the risk of distress to the baby, which increases the longer the pregnancy continues.
What happens if you go over your due date?
This varies slightly from area to area, however you would normally be offered an induction of labour between 41 and 42 weeks of pregnancy, which means that your labour will be started off artificially (see opposite). Different hospitals have their own criteria for how long past your due date they will wait before suggesting an induction of labour, but this is usually between 10 and 14 days after your expected date of delivery (EDD).
If an induction is considered, your doctor or midwife should discuss all your options with you before any decision is reached. Although you are within your rights to decline induction, you should make sure that you are fully aware of the reasons why it has been suggested so that you can make an informed decision.
I have a long menstrual cycle. I don’t think I’m as overdue as they say. Can nature take its course?
The ”due date” is calculated from the first day of your last period, and assumes you have an average 28-day menstrual cycle. However, if you have, for example a 35-day cycle, your due date would be a week later If this is the case, an ultrasound scan during the first 20 weeks of pregnancy would have measured the growth of the fetus and this would have given you a due date that reflected your menstrual cycle more accurately.
Current guidelines recommend inducing labour between 41 and 42 weeks of pregnancy if it has not begun on its own. If you choose not to be induced, you will be monitored regularly.
What is a “membrane sweep” and could I have this instead of being induced?
Prior to an induction of labour, at 41-plus weeks of pregnancy, it is recommended that all women are offered a membrane stretch and sweep to assess the readiness of the cervix for labour. A membrane sweep involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. The aim of this is to stimulate the release of hormones that may start labour contractions. Although this is likely to be an uncomfortable procedure, it should not cause you actual pain; you may also experience a mucus/bloodstained ‘’show” -like a discharge - following this, which is quite normal (see p.167).
Membrane sweeps have been shown to increase the chance of labour starting naturally within the next 48 hours and therefore reduce the need for other methods of induction.
I don’t like the sound of the amniotic hook. What exactly is this?
An amniotic hook is a long thin piece of plastic with a hook shape at one end. This is used to make a hole in the membranes surrounding your baby to release the amniotic fluid in an attempt to kickstart labour. The procedure, known as ”breaking the waters”, amniotomy, or ARM (artificial rupture of the membranes), is as uncomfortable as an internal examination, and isn’t usually painful, although some women do need some form of pain relief, such as gas and air, during the procedure. An amniotomy is carried out by the midwife or doctor, who will carefully guide the hooked end of the instrument into the vaginal canal with his or her fingers He or she will then press the end against the membranes to pierce them, which can help to stimulate contractions and in turn start labour.
In some cases, contractions become established quite quickly after this procedure. If this is not the case, then you will need to remain in hospital and be induced with an oxytocin drip (see p. 191)
Fetal monitoring in labour
During labour in hospital, you may spend some time attached to a cardiotocograph (CTG) machine This monitors your contractions and your baby’s heartbeat to check whether your baby is showing any signs of distress in labour Two straps are placed around your waist. One records the movement of your uterine muscle and the other measures your baby’s heart rate. The machine you are attached to produces a printout of the two readings so that the midwife or doctor can review the progress of you and your baby. If your labour is straightforward and the CTG readings show no problems, then you can be unstrapped and disconnected from the machine so that you are free to move around. Your midwife may then want to monitor you and the baby again at regular intervals throughout labour.
Can an amniotic hook harm my baby?
An amniotic hook, which is rather like a long crochet hook used to tear a little hole in the amniotic membrane surrounding the baby and the amniotic fluid, is actually fairly blunt and shouldn’t come into contact with your baby at all, so there isn’t really any risk that he could be harmed
Why do I need to be induced?
The main reason for induction of labour is when your pregnancy continues past your EDD, or estimated delivery date, as after this stage the efficiency of your placenta can decline, which can put the baby at risk.
Can I refuse an induction of labour?
You have a right to say no to any intervention
and when induction is considered, your doctor or midwife should discuss all your options before any decision is reached. However, if you wish to delay induction beyond 42 weeks, then it may be suggested that you attend the maternity unit for regular monitoring to check on your baby’s and your own health which may include a Doppler ultrasound to check the blood flow in the placenta You will also be offered an ultrasound scan to check on the amount of water surrounding your baby, as this can be a good indicator of how efficiently the placenta is working and the overall wellbeing of your baby
I’m scared about sudden full-on contractions after induction. Will it be more painful?
Some women do report that an induced labour is more painful than a spontaneous labour. This may be because induced labours can be longer, although this is not always the case. In a spontaneous labour, the body responds to the gradual onset of contractions with the release of natural painkillers called endorphins. In the case of induction, where the onset may be more sudden the body has less of a chance to do this However, some women do still get a gradual build-up of contractions after induction.
It is quite natural to be scared of pain, but -you may find it a help to be prepared mentally and physically by planning which pain relief options you are going to consider and ensuring that your birthing partner knows your plans so that he or she can give you plenty of support Many women opt for ”low-tech” forms of pain relief, such as TENS, massage, being active and changing position, and aromatherapy, in early labour, and these are all options with an induced labour. If you find these
are not enough, you can try gas and air, drugs such as pethidine, and even consider an epidural. If you know in advance how you are going to cope then you will be better able to deal with the pain
Will I need to be monitored continuously throughout labour if I’m induced?
If a syntocinon (hormone) drip is used to stimulate the contractions then, yes, continuous monitoring
of your baby’s heart rate is normally recommended. This is so the midwife and doctor can ensure that the
contractions are not too close together and that your baby is coping with the contractions and not becoming distressed. During the early stages of induction you will be monitored before, during, and following induction procedures Then intermittent monitoring of your baby’s heart rate will take place If you do need continuous monitoring, many units now have “wireless” monitors, which means that you are not physically attached to the machine and can still move around during labour.
Can my partner be present throughout?
Yes, -your partner can be with you throughout your induction and labour, and his continued support is likely to have a positive impact on your wellbeing and help your ability to cope with the pain and stress of labour. Ensure that your partner is aware of your birth plan too (see p.149) so he can support you in any decisions you need to make A lot of units allow up to two birthing partners, which can be a good idea if things are going to be long and drawn out.
What if I don’t go into labour after the induction?
Very rarely, women will experience an unsuccessful induction. especially if their cervix is unfavourable, meaning that it has failed to soften and dilate. This may ultimately result in a Caesarean section being performed As always, discuss the options with your midwife or doctor so that you are fully informed about the procedures being offered.

Types of induction
When your baby is overdue
Induction, when labour is started artificially, may be necessary for health reasons (your health or your baby’s) or if you are over your due date. If the baby’s health is at risk, your obstetrician may consider it better for your baby to be born rather than stay m your womb. For instance, a scan may show that your placenta is not working properly and your baby not growing - in this case it would be better for your baby to be born and fed orally
How will I be induced? There are several methods that can be used to induce labour. To start with, your cervix needs to ripen (soften) and begin to dilate (see p.181) You can be given gel or pessaries of prostaglandin for this to happen These are placed at the top of your vagina so that the drug can work on your cervix. Most units keep you in hospital after this, as the midwives will be regularly recording the baby’s heartbeat on
the cardictocograph machine (CTC) to ensure that you and your baby are coping with the induction drugs Occasionally the cervix does not ripen; if this happens, you may be given a second gel or pessary in six hours.
What happens next? If the gel still does not work, the midwife or doctor will break the bag of waters around the baby (artificial rupture of membranes, or ARM), which may cause discomfort. If you still don’t have contractions, a drip will be inserted into your arm and a synthetic hormone, syntocinon, is given to start contractions. Your baby’s heartbeat will be monitored while you are on the drip, as there is a risk that you may contract too much and the heartbeat be affected. Some women find this type of labour more painful and may need more analgesia, such as an epidural. If none of these works, you will be offered a Caesarean.

How long will it last?
all about labour
How long will my labour last?
This is hard to determine as every woman is different and every labour is different. Also, how long your labour lasts depends on when you start timing it as the start of labour can be a gradual build-up that occurs over a fairly long period of time. Usually, labour is classed as being established when the contractions are regular and getting stronger and do not stop until the baby is born. This, coupled with the cervix opening, are indicators that labour has commenced. During the gradual build-up of contractions, labour is sometimes described as being in the ”latent” phase until it becomes more established. This latent phase may last for a period of around 6-8 hours in first-time mothers.
As a general rule, if this is your first baby -you should expect to labour for around 12-24 hours in total. If you have had a baby before, your labour may be a lot quicker, providing there are no other complications, particularly if you have had a vaginal delivery in the last 2-3 years. In some cases, usually with second or subsequent babies, labours can last for only a few hours, or even minutes, and in these situations the mother may not to make it into hospital. The best advice in all cases is to speak to your midwife or hospital if you think labour has started
I like to know what to expect. What will happen when I first arrive at the hospital?
Hospital routines vary, but generally you will be shown to a room on the labour ward, and one of the midwives on duty will come to see you. As
well as asking you about your labour so far, she will probably ask to check your temperature, pulse, and blood pressure, and listen to the baby’s heartbeat. She will also feel your tummy to assess the baby’s position and how far the head has engaged or
moved down in the pelvis (see p. 148) If -your contractions are regular, an internal examination may sometimes be done to reveal how far your cervix has dilated and therefore what stage your labour is at. This information will give the midwife an insight into the wellbeing of both you and your baby. and will help you both to decide on the next course of action. If your labour is in the very early stages, your midwife may suggest that you return home for a while or spend some time on an antenatal ward If your labour is well established, a delivery room will be found for you
How will the hospital check my progress?
An experienced midwife can tell a lot about your labour just by looking at you and observing your behaviour. For example, a woman who is chatting happily during each contraction is unlikely to be in well-established labour. A woman who is in established labour and starts to be restless and nauseous may be in the ”transition” phase; approaching the second stage of labour (see p.183)
Another way in which your midwife will assess your progress is by feeling your tummy to check the strength of the contractions, and also by feeling the position of the baby’s head in your pelvis
Internal examinations also reveal a lot about how your labour is progressing. By placing two fingers gently into the vagina, the midwife or doctor can feel how far the cervix is thinning out (effacing) and opening (dilating), how the baby’s head is moving downwards, and what position the baby’s head is in.
What is ARM, and is it routine?
ARM stands for”Artificial Rupture of the Membranes”. This means that a doctor or midwife, using a plastic ”crochet hook” with a long handle, control while taking gas and air and therefore you may find that you want to stop taking it while you are pushing if it is distracting you too much and stopping you focusing on the contractions Some women manage their entire labour on gas and air alone, while others find that they need another form of pain relief in the later stages of labour.
How will I use the gas and air and is it likely to make me feel sick?
Gas and air is breathed in through a mouthpiece or mask that is connected to a cylinder or pipes in the wall that lead to larger cylinders elsewhere. You administer it yourself, so are more in control of how much you take and when.
Gas and air can make your lips and mouth feel tingly and dry, and in some cases women report feeling nauseous while taking it. Using a mouthpiece rather than a mask may help to reduce feelings of nausea brought on by the smell of the gas and the sensation of having a mask over your face, and taking sips of water may help As the effect of gas and air is short-lived, you only need to use it during contractions; taking gas and air between contractions will not help with the pain of the next contraction and is likely to increase the sensation of nausea.
I want to have a great birth but you hear such awful stories -how can I stay positive?
For every awful birth story there is an equally positive one — it does tend to be the case that you are less likely to hear about the positive birth stories as these aren’t such good topics of discussion! However your labour and birth proceeds, the birth of your baby will be amazing because you will finally meet the little person who has dominated your life for the past nine months.
It is sensible to remain open minded about labour and birth, because it’s impossible to foresee exactly how things will go on the day However, there is a lot that you and your partner can do to help prepare yourselves for labour and birth so that -you
Gas and air
A form of self-controlled pain relief in labour
A mixture of oxygen and nitrous oxide that is self-administered in labour.
Gas and air, also known as Entonox, is taken through a mask or a mouthpiece during labour. This dulls the pain centres in the brain and produce a sense of euphoria This needs to be timed with your contractions as the effects are short-lasting, with the gas being breathed in just prior to and during a contraction. You will feel normal once you stop using it.
Gas and air tends to be the preferred choice for managing pain in women who want to labour as naturally as possible The reason for this is that gas and air has several advantages, including the fact that you can remain mobile and active while using it; it can he used during a water birth; it doesn’t affect the baby in any way; and it doesn’t make you feel drowsy during labour, which allows you to feel more in control throughout and to remain as focused as possible on your contractions. However, although it is a widely available and a popular choice of pain relief in the UK, it doesn’t tend to be used in the United States
have the best chance of having a positive overall birth experience. For example, you can both learn as much as possible about the process of labour and birth so that you can make informed decisions in labour. You can chat with your midwife, read books, find information on the internet, and attend antenatal classes. Also, knowing how labour progresses helps to demystify the experience and therefore removes some of the fear that accompanies labour and birth. Learning basic relaxation and breathing exercises also helps (see p.173), as being able to relax as much as possible during labour helps you to feel less anxious, which in turn can help the labour to proceed as quickly and smoothly as possible tears a small hole in the amniotic membrane that surrounds the baby and contains the amniotic fluid and the fluid then passes out through the vagina. This procedure is also referred to as ”breaking the waters” and may be uncomfortable. ARM can be used to try to induce, or speed up, labour (see p,191). The idea is that the layer of membrane between the baby’s head and the cervix is removed. This enables the head to press directly on the cervix, which in turn releases the hormones that stimulate contractions and start, or help to speed up, labour.
ARM should not be performed routinely. In a spontaneous labour that is progressing normally, there is no need, and the membranes will usually rupture on their own.
I’m worried about being strapped to a bed and monitored. Is that essential?
If there are no complications or reasons for concern, your baby’s heartbeat will usually be monitored using a hand-held device much like the one used during your antenatal appointments to listen to your
10cm dilated
baby’s heartbeat Once your labour is well under way, your midwife will listen to your baby’s heartbeat for about 30 seconds to one minute every 15 minutes or so, which means that you can move around as much as you like in between.
If you have had complications in pregnancy, or problems develop during your labour, the midwife may recommend that your baby’s heartbeat is monitored continuously using a ‘ CTO”, which stands for ”cardiotocograph” (see p.192). This means that you will have two monitors strapped to your tummy using thick elastic belts. One measures the baby’s heartbeat and the other measures the frequency of the contractions. The monitors are attached to a machine that prints out information in the form of a graph This allows the doctors and midwives to keep a close eye on your baby’s wellbeing and how she is responding to the contractions.
A CTO does make keeping active a little more difficult but by no means impossible. Leads can be moved out of the way and adjusted, and some maternity units have a wireless CTG You can talk to your midwife about how this will be managed.

When can I start pushing?
Ideally you can start pushing as soon as you feel the urge to, assuming that your cervix is fully open. The urge to push is usually stimulated by the baby moving down the birth canal, which happens at some stage once the cervix is fully open. You may experience a sensation of needing to open your bowels and may actually pass some stools or urine, as the baby is pushing on the back passage. This is a very common occurence in labour (see p 188)
If both you and the baby are well, you will be encouraged to follow the natural urge to push. Sometimes, you can feel an urge to push before the cervix is fully open If this is the case, it is important to resist this feeling as much as possible, as pushing at this stage can cause the cervix to swell, which makes it more difficult for it to dilate. Some women find that kneeling on all fours with their head and shoulders lower than their hips is a good position for this stage of labour.
What is “crowning” and should I continue to push during this part of the labour?
This term refers to the part of birth when the widest part of the baby’s head – known as the crown –eases out of the opening of your vagina. Your midwife will encourage you not to push at this stage so that the baby’s head can be born in a slow and controlled way, which can help to prevent serious tears to your vagina and perineum (the muscle and tissue around the outside area of your vagina and anus). Although stopping pushing can be hard, -you could try short panting breaths or slow steady breaths to help you achieve this.
Although many women are worried about the possibility of tearing during the delivery of their baby it can be reassuring to remind yourself that midwives are very experienced and practised at guiding women and helping them to avoid tears whenever possible.
Positions for the second stage of labour
Although by this point in your labour you may be extremely tired and the contractions are lasting longer, it is best to resist any urge to lie down as this will not help the progress of the baby through the birth canal.Your partner can help support you while you hold certain positions and help you to remain upright if possible so that gravity can assist your baby. Many women find squatting or kneeling on all fours the most comfortable, or if you really need to lie down, get your partner to support one leg so that the pelvis can remain as open as possible.

How long will the first stage of labour last?
The first stage of labour lasts until the cervix is fully open, or ”dilated” (see p.181). Women tend to time their labour from the first contractions, but midwives and other healthcare professionals don’t start to time a labour until it is ”established” once contractions are coming regularly, roughly once every three or four minutes, and lasting for about 45 seconds to one minute, and the cervix is around 3cm dilated Due to the difference in how labours are timed, you may hear about labours that lasted 50 hours and others that lasted two! On average, for first-time mothers labour lasts around 12-14 hours. If it continues after this time, the doctor may want to investigate why labour is not progressing
Once labour is established, healthcare professionals usually expect the cervix to open at an average rate of half a centimetre an hour. However, there are huge variations in this average,
and a labour can still be progressing normally with a slower or faster rate of dilation Your midwife will keep you informed about how things are going during your labour, and don’t be afraid to ask how things are progressing.
Is it best to stay upright in early labour?
It is thought that keeping upright and mobile can help labour to progress and make the pain easier
to manage. This is because in an upright position the baby’s head can press down onto the cervix and in turn stimulate it to dilate, and also gravity helps the baby to move down through the pelvis.
I’m having a trial of labour-how long will I be allowed to be in labour for?
A trial of labour is something that is done if, for example, a woman has had problems in pregnancy.
I’m scared in case I poo in labour, how will I feel?
You are not alone — lots of women are very nervous at the idea of pooing while they are in labour. It may not be what you want to hear, but in fact a large number of women do poo, usually during the second, or pushing, stage of labour. This is totally natural and happens as the baby’s head comes down the vagina and pushes against the rectum, where faeces are stored. The faeces are then forced out of the anus and this is totally beyond your control. It is unlikely that you will be aware of pooing at this stage — the overwhelming sensations of birth will be more powerful! Midwives and doctors are very used to women pooing, and will simply wipe it away without a second thought. Also, sterile cloths will be placed around so it will be easily cleared away.
Will I tear when the baby comes out?
Some women do sustain some degree of tearing during the birth of their baby Unfortunately, it is impossible to tell whether you will tear or not until the actual delivery Some tears only involve the skin and may not require any stitches However, others can involve the skin as well as the muscle underneath and the vaginal canal, and this will require stitches Stitching will be performed by an experienced midwife or doctor after you have had a local anaesthetic injection. There is some evidence to suggest that regularly massaging the perineum, which is the area between the vagina and anus, during late pregnancy may help avoid tearing (see p.111) Allowing the baby’s head to be born slowly can also help to prevent tears (see p 186).
What does a “skin-to-skin” birth mean?
”Skin-to-skin” is a phrase that means cuddling your naked baby against your bare skin. Many women wish to have skin-to-skin contact with their baby straight after the birth. This can help with bonding, the baby’s temperature control, and the initiation of breastfeeding. As long as you and your baby are well, there should be no reason why this cannot be done — having your baby cleaned, weighed, and dressed can wait a moment. Most health professionals now recognize the importance of this early skin-toskin contact, and will help you achieve this if that is what you wish. Communicate your thoughts and desires to your midwife as early as you can following admission to the labour ward, so that the midwife can plan your birth to try and meet your wishes.
What is the third stage of labour?
The third stage of labour lasts from after the birth of the baby until the placenta, or afterbirth, and membranes (the amniotic sac your baby has been growing inside) have been delivered. This stage can last for around 10-15 minutes to an hour, depending on whether you have drugs to speed it up (see below).
How does the placenta come out?
After the birth of your baby, the uterus starts to contract again and the placenta shears away from the wall of the uterus and passes out through the vagina. This will not feel the same as giving birth to the baby as the placenta is soft and squashy and much smaller! You may have had an injection to speed up this part of labour, and this is referred to as a “managed” third stage (see below). If this is the case, your midwife will apply gentle traction to the umbilical cord to guide the placenta and membranes out. If you are having a natural third stage, you won’t need an injection, which may mean that this part of labour lasts a little longer, and the midwife will encourage you to deliver the placenta and membranes by pushing, and perhaps squatting over a bedpan Your midwife will advise you as to whether a natural or managed third stage, or a choice between the two, is most suitable for you
What happens when you have an injection for the third stage of labour?
Women are usually offered an injection of syntometrine during the baby’s birth. This is a mixture of two drugs, syntocinon and ergometrine, both of which help the uterus to contract and so speed up the delivery of the placenta and membranes This is also thought to help prevent the risk of heavy bleeding. Having this injection means that the third stage of labour lasts about 10
to 15 minutes. If you have raised blood pressure you will be offered a slightly different injection - just the syntocinon - as ergometrine is known to stimulate a rise in blood pressure.
What happens to the placenta?
checking the afterbirth
The placenta has sustained your baby during her nine months in the womb, and what happens to it after its delivery is a common question.
* The placenta will be checked to ensure it is complete and has been delivered successfully If it looks healthy, it will be disposed of in the hospital
* It may be taken away for analysis in a laboratory if there is anything untoward in its appearance.
* Some cultures perform ceremonies with the placenta; and in some parts of the world there is even a tradition of eating the placenta
However, if your pregnancy, labour, and birth have been straightforward, there is no reason why you should not have a ”physiological”, or natural, third stage of labour.
What will happen once my baby has been delivered?
Once your baby has been born, if all is well, you will be encouraged to hold him and get to know him. The placenta and membranes will be delivered and the midwife will examine your vagina and perineum to see if you need stitches, which will be done under a local anaesthetic When you are ready, your baby will be checked over (see p.217), labelled with your name and her date of birth, weighed, and dressed. If she hasn’t fed already, the midwife will help you with the first feed You and your partner may also be offered tea and toast, which is usually most welcome! Before going onto a postnatal ward, you will be helped to wash and go to the toilet. If you and the baby are fit and well, you may be able to go home within a few hours, sometimes straight from the labour ward, providing you have all the help you both need.
If you have a Caesarean, you will be moved to a ‘recovery” room near to the theatre for up to two hours to observe your breathing rate, pulse, and blood pressure. Your incision and vaginal blood loss will be checked as will your fluid levels, and the midwife will help you to breastfeed your baby. You will then be moved to a postnatal ward.
It all sounds very “busy”. Will we be left alone at all once the baby is born?
Many couples look forward to having some time alone together after the baby’s birth in order to start to get to know, and bond with, their baby in private. There shouldn’t be a problem with this, as long as neither mum nor baby has any medical problems The midwife will make sure you know how to call for assistance if you need it. You would usually be taken to a postnatal ward about two hours after your baby’s birth, if all is well Or an early discharge home may be an option.

The three stages of labour
How your labour -progresses
Your labour is divided into three stages. The first stage begins when you have regular contractions that widen your cervix: the second stage starts when your cervix is fully dilated and ends with the birth of your baby; and the third stage is the delivery of the placenta and membranes
What is the first stage of labour? The first stage of labour describes the process in which your cervix dilates (progressively opens because of the womb contracting) from being tightly closed to being around I Ocm - wide enough to get the baby out, or ”fully dilated”. During this first stage
of labour, contractions generally start off gently and don’t last very long - about 30-45 seconds. It is now recognized that you are in established labour only if you are 4cm dilated. Prior to this stage, the contractions you have been feeling have been
The birth of your baby
ripening (effacing) your cervix During the early stages of labour, it is a good idea to rest and eat carbohydrates such as toast or pasta, so that you will have some energy when the contractions really kick in. This is called the latent stage of labour. Once the contractions do start coming regularly, staying active is beneficial in that it can help labour become established, as gravity will help press your baby against your cervix Going to bed could result in labour ceasing altogether. In a first labour, the time from the start of established labour to full dilation is between 6 and 12 hours, although it is often quicker for subsequent labours.
What is “transition”? Towards the end of the first stage of labour, you may feel a great urge to push with each contraction. This period, when you are between 8-1 Ocm dilated, is called transition. It may
be brief, or could last up to an hour, and is often seen as the most challenging part of labour. You will need to resist the urge to push if you are not fully dilated, and may need to use breathing techniques - such as blowing out in little puffs - to help you.
What is the second stage of labour? Once your cervix is fully opened (fully dilated), this is known as the second s-age of labour At the beginning of the second stage, you may experience a pause in contractions, but they will resume and you will be ready to push your baby out with each contraction. Your contractions will now be very close together and very strong, lasting 60-90 seconds, for which you will probably need pain relief (see p. 174). Most hospitals will limit the length of the pushing stage to less than three hours You will soon see your baby
What is the third stage of labour? The third stage of labour is the delivery of your placenta. This is the afterbirth that has been feeding your baby during pregnancy You will be offered an injection
of syntometrine to speed this process up and reduce the risk of heavy bleeding, or you can to wait until the placenta comes away naturally If you choose a natural, or physiological, delivery of the placenta, this can take from 30 minutes to one hour, and you tend to bleed a bit more than if you have an injection.

A natural breech birth
If you are having a natural vaginal delivery with a breech birth, this will be carefully handled by an obstetrician. A vaginal breech birth can be slower than a head-first, cephalic, delivery as the bottom doesn’t push down as much The obstetrician will
guide the baby out. Usually, the buttocks are delivered first and then the legs will be carefully guided out The baby may then be rotated to deliver the shoulders as smoothly as possible Lastly, the weight of the baby helps to draw the head down for delivery
or has had a previous Caesarean. This allows a woman to be in labour long enough to determine if a vaginal birth may be possible. It is hard to say how long you will be allowed to labour for, as the length of time depends on how your labour is progressing and the opinion of the medical staff caring for you.
Your labour will be closely monitored, with your midwife regularly assessing its progress to check that the cervix is dilating as expected and that the baby is moving down through the pelvis. You may be offered continuous monitoring of the baby’s heartbeat (see p.192) and would be close to medical assistance in the event of a Caesarean being needed.
When will I be fully dilated?
”Fully dilated” means that your cervix is fully open so that your baby can move down the vagina and be born. When your labour begins, your cervix is either closed, or only one or two centimetres open The contractions of the uterus gradually open it further until it is completely open. Once this happens, you are in the second stage of labour, which lasts until the birth. The point at which your cervix is fully
dilated can occur quite quickly after the onset of strong, regular contractions, or can take many hours.
What is meant by “transition” and why do people say it’s the worst bit?
Transition describes the.period of time between the end of the first stage of labour and the onset of the second, or pushing, stage. Contractions are usually at their strongest and most frequent at this point It can last from a few minutes to over an hour, and in some cases may not happen at all. The transition period is often characterized by a woman feeling exhausted, fed up, unable to cope, shaky, or nauseous. In films and books, this is often the time when a woman swears and gets a bit mad with her partner! It is usually around this time that the first feelings that you need to push begin.
If you experience any of the unpleasant symptoms of transition, it helps to focus on the fact that your baby will soon be born. Try to keep your breathing slow and regular, and focus on your partner and midwife for additional support.

Positions for the first stage of labour
In the early stages, many women prefer to walk around, and being active helps labour progress. If you get tired, sitting on a chair leaning forwards can be comfortable, as can kneeling over a birthing ball or pillows Some women find sitting on the toilet comfy! If you want to lie down, lying on your left side is best as the pelvis isn’t restricted and can open as the baby moves down, and the blood flow to the baby is not affected

Dilatation
In the early stages of labour, the cervix begins to soften, known as effacement, and then starts to widen, or dilate, so that the baby can pass through it and out of the vagina The baby’s head cannot pass through
the cervix until it is I Ocm wide and fully dilated The time this takes varies with each labour, Some women are several centimetres dilated at the start of labour while others take several hours to reach this stage.
2CM DILATED:
6CM DILATED:
10CM DILATED:

Twins and multiple births

We are expecting twins following IVF treatment. How will we cope?
Although finding out that you will be the parent of two babies rather than one can be a shock, the initial surprise will settle and you will soon start to get used to the idea There are many associations that offer information and support to parents of twins, as well as companies that make products for parents of two or more children (see p.310) Your midwife and obstetrician will offer information and support and may put you in touch with local multiple birth support groups You will also be invited for more regular antenatal appointments and scans than if you were having just one baby to keep an eye on the growth of your babies.
As with all multiple births, there are no additional financial benefits if you are having twins, although you may receive more of certain benefits that are dependent on income (see below).
We’re having triplets. Help! My wife is over the moon, but I feel numb. Where can we get advice?
As having triplets is relatively rare - only 149 sets
of triplets were born in the UK in 2006 - the majority of information and support for couples does relate to having twins. However, more and more research is being carried out into how to help and support parents having more than two children
Your midwife and obstetrician will be great sources of information and will be able to put -you in touch with other parents of multiple-birth children. There are also several organizations that offer support and information for parents having a multiple birth (see p.310). As you and your wife learn more about having triplets, your anxiety will hopefully start to ease
Will we receive any additional financial or practical support
as we’re having more than one baby?
Unfortunately, there are no financial benefits available to all parents having twins or multiple births. However, there are some benefits that are dependent on your income, some of which you may be able to claim per baby One of these is the Child Tax Credit, made up of three elements: a family element: an amount payable per child dependent on your joint income; and a baby element of £545 if you have cne or more children under a year old This credit is the focus of the Twins and Multiple Birth Association’s current campaign, as they feel strongly that the baby element should be paid per baby, so that a family with newborn triplets would be entitled to £1635. The Sure Start Maternity Grant, a payment of £500, is payable per baby so if you are entitled you would be able to claim £ 1500 for triplets. This must be claimed within three months of the birth so it is important to apply as soon as possible For practical support, it is worth finding out about Home Start schemes in your area. Home Start is a charity that provides trained volunteers to lend support at home. Each scheme is locally based, managed, and run by individual communities, supporting families in that community.
IDENTICAL TWINS: NON-IDENTICAL TWINS:
Does taking folic acid increase the incidence of twins?
There has been some debate and conflicting studies about whether taking folic acid pre-conceptually could increase the chance of having twins. A study in Sweden in the 1990s found a higher incidence of multiple births among women taking folic acid. However, this could be attributed to other factors, such as a greater number of women undergoing fertility treatment, which carries an increased probability of twins. Also, subsequent studies have refuted these findings; in 2003, the medical journal The Lancet reported on a large-scale study in China that found there was no significant difference in the number of women who had taken folic acid carrying twins.
Are all same-sex twins identical?
No. Whether or not twins are identical depends on how they were conceived, not on what sex they are (see above). While identical twins are obviously the same sex, non-identical same-sex twins are as similar or different as any other non-twin siblings.
How likely is it that our twins will be identical?
One in 80 pregnant women carries twins and one-third of twins are identical Although there are factors that make you more likely to have non-identical twins, such as a family history of twins or being over 35, having identical twins is not an inherited trait and there are no other factors that make this more likely.
Will I know before the birth if they are identical?
The term “zygosity determination” means finding out whether twins, triplets, or more are identical (monozygotic) or non-identical (dizygotic or fraternal). It is natural for parents to want to learn all about their babies, and with twins this includes their zygosity As well as for reasons of natural curiosity, knowing whether twins are identical can help parents to determine the chance of having a multiple pregnancy again, and also has implications on care during pregnancy, as identical twins, especially if they share a placenta, are higher risk, and so the pregnancy may be more closely monitored.
In two-thirds of cases, the placenta provides the answer as to whether twins are identical. If the babies have a single amniotic sac surrounded by one outer protective membrane, known as the chorion, they are monozygotic However, one-third of identical twins whose egg split early, before the placenta started to form, have two chorions with either a fused placenta, where two placentas grow together, or two separate placentas. These placentas are hard to distinguish from those of dizygotic twins
We don’t know if our twins are identical. Will it be obvious after the birth?
In a third of cases, twins are different sexes and therefore obviously non-identical In same-sex twins by the time the children are around two
years old their’ zygosity” is usually quite clear from their physical features Before this, there are many indications as to whether twins are identical such as the colour of their hair and eyes, the shape of their ears, the eruption and formation of teeth, the shape of the hands and feet, and the pattern of growth
If there is doubt as to whether twins are identical, the most accurate way to determine zygosity is by the DNA probe method when tiny amounts of DNA are collected with a swab from inside each twin’s mouth. A laboratory examines specific markers present in the DNA and 12 diagnostic targets are compared. Although non-identical twins may share five marker patterns by chance, monozygotic or identical, twins will have the same pattern for all 12 markers
Will I love one twin more than the other?
Although this can be a concern, it is more likely to be the case that rather than favour one child over the other, a parent gives more love and attention to the baby who needs it most at that particular time
It is also possible that the strain of having two new babies in the house may increase the likelihood of delayed bonding, although this can also happen_ the birth has been traumatic if the mother or indeed the father is exhausted: or if one baby has taken time to establish feeding, or is more fractious than the other This does not mean that bonding will not take
Am I likely to have a normal birth?
Although many women having twins have normal deliveries, the rate of Caesareans is increased with twin births With one baby the Caesarean rate is around 25 per cent in the UK; with twins, the rate is closer to 50-60 per cent which also means that 40-50 per cent of twins are delivered vaginally. Triplets and above are generally delivered by Caesarean in the UK and Europe Whether or riot twins are born vaginally depends on their position in the womb ~ whether one or both twins is head down (see p 133).
There may be an indication as to the type of birth in pregnancy as women with twins are usually scanned to check the position of the babies near to term, at around 27-34 weeks.
place over time, but if this is worrying you, you should mention it to your midwife or health visitor, as they may well be able to offer some helpful advice
In every family, there are bound to be ebbs and flows of love between parents and children, which is normal and not a cause for concern When a parent has two children born at different times, that parent may love one child differently to the other, but this does not mean that the love a parent has for one child is to the detriment of the other.
Will the side effects of pregnancy be much worse with a multiple pregnancy?
Although in some cases the side effects of pregnancy may be the same when you are expecting two or more babies, the likelihood is that many pregnancy symptoms will be exaggerated Symptoms such as morning sickness, fatigue or exhaustion, disturbed sleep and swollen hands and feet are often worse with a multiple pregnancy Unfortunately, women with multiple pregnancies also tend to suffer more from varicose veins (see p.86) In addition to these increased side effects, weight gain is greater and more rapid for mothers carrying more than one baby and the uterus measurement is often increased for the gestational age This extra weight and size caused by carrying two or more babies may also cause more constipation haemorrhoids (piles), urinary tract infections, and vaginal thrush infections.
Although there may be more exaggerated symptoms with a multiple pregnancy the majority of these problems can be monitored by your midwife or doctor, and they may be able to offer advice and treatment to ease these symptoms.
Will my weight gain be much greater than for someone who is having just one baby?
Mothers of twins or triplet pregnancies are likely to gain more weight than women having one baby. Indeed, in the first trimester, rapid weight gain may be an indicator of a multiple pregnancy The increased blood volume and size of the uterus, as
well as each baby’s weight, possibly two placentas, and the amniotic fluid for each baby, will continue this pattern of greater weight gain during pregnancy
Although on average a woman having a multiple pregnancy is likely to put on around I Okg (221b) or more than a woman having one baby, this is not double the weight gain If you are having twins, you should raise your calorie intake by only 500 calories per day in the last trimester, compared to 200 calories more for a single pregnancy
I’m only 24 weeks, expecting twins, and already I’ve got high blood pressure. What can I do?
Unfortunately high blood pressure is more likely to start, or worsen if you already have the condition, in a twin pregnancy as the rates of pregnancy-induced hypertension (PIH) and pre-eclampsia (see p 89) are increased in multiple pregnancies
There is little that can be done to prevent PIH General lifestyle changes, such as reducing your salt intake, avoiding alcohol and tobacco, taking gentle, regular exercise, and getting enough rest, are thought to help. You should also ensure that you attend all your antenatal appointments and contact your midwife or doctor if you experience headaches or visual disturbances such as flashing lights or there is reduced movement from your baby
What can go wrong if I have a vaginal delivery?
If both twins are head down, a vaginal birth is usually possible. Sometimes, the first twin may be head down and born vaginally, but the second twin may be breech Sometimes, the second twin will turn and be head down after the birth of the first twin, and you are then more likely to deliver both twins vaginally Studies suggest that there has been a significant increase in combined vaginal-Caesarean births of twins and a decrease in vaginal only births, which may be due to the fact that there is a greater willingness nowadays to allow women carrying twins to try for a vaginal delivery, which also increases the likelihood of this scenario. If you have a vaginal delivery, there is a greater chance of one or both twins having an assisted delivery by vacuum extraction or forceps (see p.202), either because one or both twins is positioned in a tricky -way, for example facing the mother’s back, or because the labour may be longer and weaker because of the amount of work involved in pushing two babies out, which means that the mother is therefore likely to be more tired and needing help at the end of labour.
Why might the doctors decide to deliver my twins by Caesarean section?
An elective Caesarean (see p.206) might be recommended for a twin delivery for several reasons, but ultimately it is your decision The optimum time for delivering any baby is at term (37-40 weeks’ gestation) and this remains the case for delivering twins as they may well be smaller than a singleton baby, having had to share your supply of nutrients However, if one or both of the babies are compromised, possibly due to twin-totwin transfusion syndrome (see p 134) or raised
blood pressure in pregnancy there may be a need to deliver the babies preterm.
Many units recommend a Caesarean for a breech baby where the baby is bottom down inside the womb, because there are more risks associated with a breech vaginal delivery In a twin pregnancy if the first baby is breech, this puts the second twin at risk too Also. if the first twin is breech and the second is head first (cephalic), a Caesarean is recommended due to the rare complication of ”locked” twins, when the babies’ chins get locked together
If both babies are head down and appear to be thriving, many maternity units will encourage a normal delivery Your doctor and midwife will discuss this with you nearer the delivery time.
Will my triplets need to be delivered before 40 weeks?
Yes, it is very likely that your triplets will be delivered before 40 weeks. Although most twins are born at around 37 weeks, which is considered to be a term pregnancy it is rare for triplets to reach term, and most are delivered at around 32-36 weeks’ gestation
As a woman’s body is designed to carry one infant at a time, carrying more than one increases the risks for both mother and babies, and the decision to deliver your triplets will be taken when one or more of the babies is not coping well. To improve the chances of a good outcome, get plenty of rest and eat a healthy diet (see p.50) Although premature deliveries do carry a risk to the infant, if the baby’s wellbeing is compromised an early delivery is necessary. If you go into premature labour, you may be given medication (see p.162) to try to stop labour for long enough to administer steroids, which will help to mature the babies’ lungs before delivery -as long as this does not put the babies at risk
How likely is it that my twins will have a lower than average birth weight?
Over 40 per cent of twins are born with a lower than average birth weight, which is mainly due to the fact that they are born earlier than singleton babies.
Do twins run out of room to turn in the womb?
It does tend to be the case that, in the third trimester, twins find a position and settle there at an earlier stage of pregnancy than if there was just one baby. Generally, with twin pregnancies there seems to be a lot less movement in presentation from about 32-34 weeks. However, how your twins are likely to be delivered depends largely on the direction that the twin who is lowest in the pelvis is facing. If this twin is head down, then a vaginal delivery should be possible and the second twin may be able to be gently coaxed into a favourable position, or may need to have an assisted delivery (see p 202)
I’ve been told that one baby isn’t developing as well as the other.What will the doctors do?
Although it is common for twins to grow at a different rate in the womb, if there is a significant difference in size, it may be that one baby is getting a greater proportion of the nutrients than the other. It is important to check that your babies are developing in line with their gestational age. It is not unusual for some babies to grow slowly and then accelerate later on, which is not a concern if it’s within the accepted range of growth for their gestational age. However, if your midwife or doctor is concerned about the development of one baby, they will probably refer you to a fetal medicine specialist: an obstetrician with additional training in caring for the unborn baby He or she may do blood tests and perform an ultrasound to assess the growth of each baby and investigate why there is a difference.
You may continue to have additional scans, known as growth scans, which will help the doctor to assess if one baby is small or growing slowly These usually start around 26-28 weeks and continue every 2-4
weeks until your babies are due to be delivered They look at a number of areas including the head, abdomen, and thigh bone measurements; the amount of amniotic fluid around the babies; the babies’ levels of activity; the blood flow in the umbilical cord; and the position of the placentas. Your doctor should
explain the findings of the scans and if there is a concern you will be closely monitored.
What is twin-to-twin transfusion syndrome?
This is a rare but serious condition that occurs only in identical twins who share a placenta. It is caused when there is an abnormal blood supply and a blood vessel directly connects the twins. One twin pumps blood around his own body and that of his twin and, as a result, he does not grow properly An early delivery is usually needed to save the smaller twin.
Am I likely to lose one or more of my babies?
There are increased risks for both mother and babies associated with multiple pregnancies and sadly there are occasions when one or more of the babies dies in the womb This occurs in around 2 5-5 per cent of twin pregnancies. In some circumstances, for example if there is a fetal abnormality in one twin such as a heart defect, the doctor may suggest that one or more of the babies is terminated in the very early weeks to allow the normal healthy development of the other baby or babies. However, many doctors believe that this is unnecessary as the procedure itself carries the risk of losing all the babies.
Although incredibly hard, this is ultimately your decision so you should spend time discussing the options with your doctor.
Unfortunately the death of a baby in a twin pregnancy can sometimes cause problems for the surviving twin, although the degree and type of problem depends on whether the twins were identical or non-identical. If the twins were identical, the doctors will want to assess whether it was a monochorionic pregnancy (in which the twins share the same placenta) or a dichorionic pregnancy (in which they have a different placenta). This is because, when the placenta is shared, there is a 30 per cent risk of death or a neurological problem to the surviving twin if the other dies, whereas if there are two placentas, there is a lower risk of 5-10 per cent, of death or disability occurring in the surviving twin.

The position of twins
Twins can lie in a variety of positions in the uterus and these positions can determine how your baby will be born One baby will always be lower than the other one, and this baby will be known as the first baby - it is closer to the birth canal and will
generally be born first.
What are the possible positions? Babies can be in the head down position (cephalic) or buttocks or feet first (breech). Occasionally a baby may be lying across you diagonally or horizontally (transverse) Twins can lie in any combination including: cephalic-cephalic, cephalic-breech, breech-breech, breech-cephalic These positions can change throughout the pregnancy, As with a singleton pregnancy (one baby), once the presenting baby nearer to the cervix goes down into the pelvis, it will stay in that position ready for birth.
Can I have a vaginal birth? When both babies are in a cephalic position you may be offered the chance to try for a normal labour and vaginal birth Sometimes, the first baby is cephalic and the second twin is in a breech position. If this is the case, your obstetrician may suggest that you have a Caesarean from the outset, or may suggest that you have a vaginal birth with the doctor assisting the birth of the second twin with forceps or ventouse (see p 202) if necessary You can certainly be party to these discussions and it’s important to share your feelings about the birth and birth choices. If the first baby is breech and the second baby is cephalic, then it is highly likely that your doctor will recommend that you have a Caesarean delivery. If both your babies are in the breech position you will almost certainly need a Caesarean, as is the case if both babies are lying across you in the transverse position

How are twins conceived?
Identical ”monozygotic” twins are produced when a single egg is fertilized by a single sperm, and the egg then splits into two. The babies may share the membranous, or amniotic, sac that surrounds them in the uterus Depending on when the egg splits, they may also share a placenta. Identical twins, therefore, are the same sex and look almost completely alike as they share the same genetic makeup. Non-identical, or ”dizygotic”, twins result when two eggs are fertilized by separate sperm at the same time and each therefore has its own individual genetic makeup Each fetus also has its own amniotic sac and placenta.

Testings During Pregnancy. FAQ

Testing, testing
investigations in pregnancy
What is the difference between diagnostic and screening tests?
Screening tests identify your baby’s ”risk factor” for a particular condition, but do not confirm that your baby definitely has a condition. For example, a screening test for Down’s syndrome may give your baby a risk factor of 1:200 This means that your baby has a 1 in 200 chance of being affected by Down’s syndrome. Another way to view this result could be that the baby is most likely to be healthy. If your baby has a high risk factor, you may then decide to have a diagnostic test, such as amniocentesis or chorionic villus sampling (see pp 122-123), which gives a definite yes or no as to whether or not a condition is present. These tests are more invasive, as they require a sample of amniotic fluid or blood from the fetus or placenta, and they carry a slight risk of miscarriage.
Certain screening tests, such as first- or second-trimester screening for Down’s syndrome, are offered routinely to all women regardless of any factor other than they are pregnant. These tests, in the form of scans or blood tests, identify who would benefit from further diagnostic tests. This avoids subjecting all pregnant women to diagnostic tests, which carry some risks (see p. 125). Any benefit from a test should outweigh the potential risk.
What do these tests look for?
Screening and diagnostic tests aim to identify abnormalities in the unborn baby, which may be congenital, genetic, or chromosomal. Congenital abnormalities are often detected in the 18-22 week scan (see p.121) and these include conditions such as heart abnormalities or extra digits These abnormalities can sometimes be treated after, or sometimes even before, the birth and are not inherited. Some conditions, such as spina bifida, are thought to be due to a combination of genetic and
environmental factors; a dietary deficiency of folic acid may also contribute to this condition. Other congenital abnormalities may be caused by infections caught in pregnancy.
Diagnostic tests are usually carried out to identify genetic or chromosomal abnormalities, such as Down’s syndrome, cystic fibrosis, sickle-cell anaemia, and muscular dystrophy. (Cystic fibrosis and muscular dystrophy are screened for if there is a family history) These conditions occur either because there is a problem with the inherited genetic material, for example a gene has mutated, or because there is a chromosomal problem, for example there may be an incorrect number of chromosomes, as in Down’s.
Down’s syndrome, or ”trisomy 21”, is a chromosomal abnormality in which there is an extra copy of the chromosome 21. It is the most common ”trisomy” disorder. Babies born with this condition have physical anomalies, such as slanting eyes and
a protruding tongue, and there is a high incidence of heart, intestinal, hearing, and sight problems. Down’s is the biggest single cause of learning difficulties. The majority of Down’s syndrome conceptions are lost through spontaneous miscarriage early on in pregnancy, although over 600 babies are born with Down’s syndrome in the UK each year.
I’m 38 - will I have more tests because I’m older?
Although the risk of Down’s syndrome increases as you get older (see p 118) currently many women regardless of age are offered one of two types of screening test for Down’s. This is either a first trimester screening that involves a blood test and a scan to measure nuchal translucency (see p.118), or second trimester screening which is a blood test only, called the triple, or Bart’s. test (see below) Both tests give the result as a risk or a percentage risk. If the test indicates there is a high risk of Down’s, then all women are offered a diagnostic test such as amniocentesis (see p.123). However, if you are over 35. amniocentesis is offered routinely in the UK.
Your midwife should discuss with you in detail all the tests that are available and give you written information about them. Ideally, you should have this information several weeks before you are asked to decide if you wish to go ahead with any screening or diagnostic tests so that you have plenty of time to consider the possible outcomes and whether these tests are something -you wish to undergo
Depending on your past medical history and other factors, such as your blood pressure during your pregnancy or problems you had in previous pregnancies, you may be offered additional scans to check your baby’s growth after 26-28 weeks.
We don’t want invasive tests as we will love the baby whatever. Can we refuse diagnostic tests?
Whether or not you have a diagnostic test is your choice and you can refuse at any time to have any test offered As well as the question of whether you are prepared to have a Down’s baby, there is also the risk of miscarriage to consider (see p.125) On the other hand, you might decide you want a definite diagnosis to be able to prepare for your child.
What blood tests will I be having, and when?
There are various blood tests offered during pregnancy As well as routine blood tests taken during antenatal checks to assess your health, there are also blood tests to screen for problems with the baby. Within the first 12 weeks you will be given a routine blood test to check your levels of haemoglobin, the oxygen-carrying part of blood. Although these fall slightly in pregnancy as the blood becomes more diluted, a significantly low haemoglobin level indicates iron-deficiency anaemia (see p 8 1). You will also have tests to identify your blood group, Rhesus factor, and rubella immunity (see p 15). and to screen for infectious diseases including syphilis, HIV, and hepatitis B. You may also be tested for sickle cell and thalassaemia, inherited blood conditions more commonly found in people of African, Caribbean, Indian, or southern Mediterranean origin.
Other blood tests may be offered to screen for congenital abnormalities in the baby Between 10 and 14 weeks, a blood test that measures the levels of the substance known as pregnancy associated plasma protein (PAPP-A) may be offered that is combined with the nuchal translucency scan (see opposite) to calculate a risk of Down’s syndrome.
If first trimester Down’s syndrome screening isn’t available, then second trimester blood screening tests are offered, which also include screening for neural tube defects, such as spina bifida These tests, carried out between 16 and 18 weeks, include the triple, or Bart’s, test, which measures the levels of the hormones AFR hCG, and oestriol; and the quadruple test, which, in addition to the other three hormones, measures inhibin A and PAPP-A.
Will I have a test for HIV?
Ali screening and diagnostic tests recommended in pregnancy are optional, so it is up to you and your partner to decide whether to have them. One of these is a blood test to check if you have the human immuno-deficiency virus, or HIV, and, indeed, some women only find out about their HIV status in pregnancy It is worthwhile to test for HIV in pregnancy as, if the result is positive, anti-retroviral medication, careful monitoring of maternal blood levels, and careful, safe delivery of the baby can reduce the chance of transferring the infection to the baby from 40 per cent to 2 per cent.
For pregnant women with HrV, a blood test is taken around the time of delivery to measure the levels of the virus. Depending on the results of the blood test, the obstetrician will either recommend a planned Caesarean section or decide that the levels are low enough to have a normal delivery.
After the delivery, HIV-positive mothers are advised to bottlefeed, again to reduce the risk of transferring the virus to the baby
How do ultrasound scans work?
Ultrasound scans use high-frequency sound waves — so high we can’t hear them — that bounce off solid objects and create a picture, visible on a
computer screen, of your baby, the placenta, and your organs in the surrounding area.
How many scans will I have and when?
All women should routinely be offered two scans, a dating scan between 10 and 14 weeks and an anomaly scan between 18 and 22 weeks. Some units routinely offer a screening scan for Down’s syndrome between 11 and 14 weeks, known as the nuchal scan (see opposite), although this isn’t available nationwide. You can also arrange to have private scans that may be 3D/4D (see p, 124) and which you have to pay for
I’m quite scared about my first scan. What happens during the scan and what does it feel like?
Although not painful, early scans can cause discomfort as you need a full bladder (see p, 124). Ultrasound scans can be carried out by a doctor,
a midwife, or a sonographer. You will lie on a couch and need to wear something that makes it easy to expose your tummy. The person doing the scan puts cold gel on the lower part of your tummy, which improves contact with the skin, making it easier to view the baby. You will feel a little pressure as a transducer is pressed against your skin and moved around to look at the baby from different angles and to take measurements The image produced by the scan is viewed on a screen similar to a computer monitor. The person carrying out the scan may spend some time first studying the image and taking measurements before talking to you about what they can see Although this can be unnerving, it does not mean that anything is wrong
Some units offer a transvaginal scan in early pregnancy, which can give an improved image at this stage. This internal scan is done using a probe that is covered by a condom and gently inserted into your vagina. The image is viewed on the screen in the same way as an abdominal scan. This may be offered before 10 weeks if there is bleeding or pain.
Many units offer to print an image from the scan for you to take home Although ultrasound scans
Should I have a scan? is ultrasound safe ill pregnancy’?
Ultrasound scans in pregnancy, first introduced 40 years ago, have become a routine part of antenatal care.
* Most research indicates that they are a safe way to view the baby even when extra scans are needed for medical reasons * Suggested links between additional scans and growth problems and dyslexia are tentative as babies scanned more often are more likely to have problems linked to other factors.
* Recommendations are that scans are carried out only for clinical reasons and the number done is kept to a minimum.
How long do scans last?
The length of time an ultrasound scan takes varies depending on the reason for the scan and the experience of the ultrasonographer.
During the dating scan, performed at around 10-14 weeks, the sonographer takes some basic measurements. This includes the measurement from the top of the head to the end of the bottom, known as the ”crown-rump” measurement, used to calculate how many weeks old your baby is and
therefore your due date. This scan can take around 20-30 minutes. The nuchal fold scan (see p 118), during which the sonographer measures the fluid at the back of the baby’s neck, takes around 20 minutes. Anomaly scans, performed between 18 and 22 weeks, are detailed scans that take approximately 40 minutes (see opposite) At this scan, the sonographer measures the baby and looks at physical and structural development. The size and position of the placenta are examined and the amniotic fluid around the baby is measured
If, during your pregnancy, your midwife has any concerns about your baby’s growth or wellbeing, she may refer you to an obstetrician who may recommend another scan. As this will be to identify a specific problem, such as whether there is a concern about your baby’s growth, it may take a bit longer. This may be in the form of a Doppler scan, which measures the blood flow in the uterus, placenta, and umbilical cord and can help to identify growth problems in the baby This procedure usually takes around 30 minutes.
Do I have to have scans in pregnancy?
Official guidelines are that all women should be offered two routine scans during their pregnancy, but the choice to have one is yours. As scans are screening tests to look for anything out of the ordinary some women choose not to have any as they prefer not to know about any problems until the baby is born, or are confident that they will continue with the pregnancy regardless. You need to decide whether you fall into this category
Can my partner come along for the scans?
There is no reason why your partner should be excluded from attending these appointments if you want him to be there and, indeed, it’s very common for partners to attend ultrasound scans For many couples, the scan is a special moment as it’s the first time they get to see their baby and begin to think of themselves as parents.
primarily area clinical screening tool to determine if your baby is growing and developing as expected, they are also an opportunity to see your baby for the first time and often see your baby moving even before you feel the first flutters inside your uterus.
So scans become part of the developing relationship between you and your partner and the baby. In recognition of this, most units offer the facility of providing photos of the scan for a small charge to cover printing costs. Ask your community midwife whether the maternity unit where you are having your scan has this facility.
Do you have to drink pints of water before a scan? I’m scared I’ll have an accident.
For the 10-14 week dating scan it’s important to have a full bladder to make it possible to view the baby. This is because until 12 weeks the uterus stays in the pelvis and the bowel obscures the view. a full bladder raises the uterus and pushes the bowel out of the way. You may need a full bladder for a nuchal scan, between 11 and 14 weeks, depending on when it is done. Some units do transvaginal. scans (a small ultrasound probe placed inside your vagina) before 10 weeks if the image from an abdominal scan is poor In this case, you won’t need a full bladder and research indicates that transvaginal scans are more comfortable in early pregnancy compared to abdominal scans. You don’t need a full bladder for the 18-20-week scan, as the position of the uterus has changed
I’m pregnant through IVE Will I have more scans than normal?
It’s usual to have one extra scan in an IVF pregnancy usually carried out by the centre where you had the
3D and 4D ultrasounds
Many companies now offer special scans that reveal your baby in three dimensions or moving on film or video. These 26-32 week scans can be quite expensive and are carried out for curiosity value and not for medical reasons The quality of the pictures is usually amazing and parents are sometimes able to spot genetic similarities between themselves and
procedure This scan is usually done around two weeks after the embryo has been transferred to confirm the pregnancy and make sure that the pregnancy is within the uterus rather than in a Fallopian tube (see ectopic pregnancy, p.25) Although the main purpose is to reassure you that all is well, the centre also has to inform the Human Fertilisation and Embryology Authority (HYEA) of the outcome of the IVF treatment. Once your pregnancy is confirmed, you will continue with routine antenatal care like any other pregnancy
Can they really tell the sex
of the baby early on? I’m 18
weeks and not sure if I want to know.
It is possible to identify the sex of a baby on routine ultrasound scans from around 20 weeks, but this is dependent on a number of factors, including the expertise of the person performing the ultrasound, the quality of the equipment being used, the position the baby is lying in, and the position of his or her legs. Even if all of these factors are favourable and the genitalia can be seen, there is an error factor, so
their baby However, the scan is often lengthy which means the baby is exposed to ultrasound for longer than is normal Also, if the baby is in the wrong position, it may be difficult to get a clear picture The position of the placenta, the amount of amniotic fluid, and the size of the mother can also affect the quality of the pictures obtained  the information given about gender from a scan is never seen as 100 per cent accurate Some research has been carried out to try and determine gender at an earlier stage, but this was even less accurate. Sometimes when you are watching the scan you may be able to see the genitalia yourself and may decide you know the sex of your baby without being told. But remember you may be wrong. If you have an amniocentesis the sex of the baby can be definitely identified during the procedure.
Most units have a written policy only to reveal the baby’s sex if this information is requested Some units have a policy of not telling anyone the sex of the baby from scans alone, partly because they cannot be 100 per cent accurate and also because, in a small number of cases, the information about gender may lead to a request for termination. If you want to know the policy in your area, ask your community midwife.
I’ve seen lots of companies advertising scans and videos of scans - are these safe?
Many companies offer 3D scans (still pictures) and 4D scans (moving pictures copied onto video or DVD) (see opposite), and the detail in these can be very good. If you have a private scan, you should check the expertise of the person carrying out the scan, and check if the company has a referral policy to an appropriate consultant obstetrician if anything untoward is discovered, as not all companies employ the services of obstetricians or midwives.
There are twins in our family. When will they be able to check whether I’m having twins?
Most women find out that they are having twins
at their ultrasound dating scan between 10 and 14 weeks Very occasionally, one twin is hidden on the first scan and is seen at the second ultrasound scan, but nowadays this is less likely due to advances in scanning Family history also gives a clue to the possibility of twins, but only if they are fraternal, or non-identical (see p.129).
Is everyone offered amniocentesis?
Amniocentesis is a diagnostic test (see p 123) that is routinely offered if you are over 35 and so have a higher risk of having a baby with Down’s syndrome Alternatively, you may be offered the test if your family history suggests there may be a risk of your baby having muscular dystrophy, haemophilia, cystic fibrosis, or another genetic disorder. Also, if you have had a screening test that suggests your baby has a high risk for a congenital condition, you will be offered a diagnostic test to confirm or rule it out For example, if the nuchal scan (see p.118) showed a high risk of Down’s, amniocentesis may be offered.
I’ve heard that amniocentesis carries a risk. Is this true?
Amniocentesis does carry a small risk of miscarriage. It is thought that the risk of miscarriage is increased above the normal risk by 1 per cent immediately following an amniocentesis, but after two days the risk returns to normal. You need to balance the risk against the value of the test to you and also be aware that a normal test result is not a guarantee that there will not be any other problems, but is nonetheless reassuring
Can chorionic villus sampling cause miscarriage?
Chorionic villus sampling (CVS) is another diagnostic test used to establish whether a baby has Down’s syndrome (see p.122). Unfortunately, as with other invasive tests, this carries a risk of miscarriage, of around 1.5-2 per cent, with the risk reducing each day, Larger hospitals carrying out more than 100 CVS tests a year may have lower miscarriage rates due to the opportunity for the doctors to fine tune their ability to carry out the procedure.
When is cordocentesis used?
Cordocentesis is a diagnostic test used to diagnose Down’s syndrome and other problems
in a baby It can also detect infection from diseases such as toxoplasmosis (see p.45). Additionally,
cordocentesis is used to detect rubella infection (see p.15), as well as to perform a blood count on a baby that is suspected of having anaemia From 18 weeks, the baby’s blood is examined using a sample of
blood carefully extracted from the umbilical cord The test is carried out in a similar way to that of amniocentesis, though results are available within 72 hours. The risk of miscarriage is 1-2 per cent.
Will I get weighed at my antenatal appointments?
In 1941, routine weighing of all pregnant women at each antenatal appointment began Although it was thought that there was a connection between a mother’s weight gain and a baby’s birth weight,
it was decided more recently that this is not a good indicator of when a baby is not growing, and so over the last 10 years routine weighing at each appointment has been abandoned. Furthermore, weight gain can vary from woman to woman in normal healthy pregnancies as widely as 3-18 kg (7-401b).
Nowadays, all women are weighed once at the beginning of pregnancy and then, together with a height measurement, their BMI (body mass index) is calculated (see p.18), which helps to predict certain risk factors, for example in women who have a very high or very low BMI The only time that you might be weighed on successive visits is if there is a medical reason to do so, for example if you had significant weight gain in a short space of time that could indicate excessive fluid retention (oedema), a sign of pre-eclampsia (see p 89).
My friend is 27 and has had a Down’s baby - is that unusual?
Although the risk or chance of having a baby with Down’s syndrome increases with age, particularly over 35, the majority of Down’s babies are born to younger mothers. This is probably due to the fact that more women have their babies younger, and also because women over 35 are likely to have more tests The risk of having a baby with Down’s at the age of 20 years is 1 in 1,700. This risk increases to 1 in 1,400 by the age of 25 and by the time the mother reaches 35, the risk has increased to about 1 in 400
My partner wants to hire a Doppler so we can listen to the baby’s heartbeat. Is this a good idea?
During pregnancy your midwife listens to the baby , s heartbeat with an instrument called a Doppler sonicaid or pinard (ear trumpet). Most midwives use a sonicaid so the parents can hear the heartbeat too This passes sound waves through the abdomen. which pick up movement and bounce it back to the machine, where it is converted into sound.
Being able to hear your baby’s heartbeat during pregnancy is reassuring, especially when the earlier symptoms wear off but the baby’s movements have yet to be felt. However, your baby’s heart beats at a rate approximately double the rate of your heart. If the closest moving thing to the ”beam” is your blood pulsating through your aorta, the sonicaid will pick this up, and if you pick up your heart rate, this might cause you anxiety Also, depending on your gestation and the position of your baby the heartbeat will be found in different areas on the abdomen. If you can’t pick up a heartbeat, you may be unduly worried.
Midwives undergo specialist training to find the heartbeat and many won’t try to find the heartbeat until the baby is around 16 weeks, and even then may have difficulty Occasionally, due to the baby’s position, they may need to call another midwife or doctor to help them locate the heartbeat
It is up to you and your partner if you decide to hire a sonicaid, but it would be wise to be aware of the anxieties that may accompany this decision.

 
The 18-22 week anomaly scan
Your baby’s physical examination
Also known as the fetal anomaly or anatomy scan, this detailed scan is offered to all women between the 18th and 22nd week of pregnancy. At this stage of gestation, your baby has well-developed limbs and facial features and all its major organs and
body systems are in place and can be checked.
How is it done? The scan involves transmitting high-frequency sound waves through the uterus that bounce off the baby and the returning sounds are converted into an image (see p.119), The biggest echoes are from hard tissues, such as bones, which appear white in the image on the screen, while soft tissues are grey-flecked. Fluid-filled spaces, such as the stomach, bladder, blood vessels, and amniotic fluid surrounding the baby, do not return sound waves so appear black. It is
the difference between echoes and colours that enables the ultrasonographer to interpret images
What will be checked? The ultrasonographer starts by checking the fetal heartbeat and then counts the babies - rarely, twins are not revealed until 20 weeks! She will measure the head circumference and diameter (biparietal diameter), and the abdominal circumference and the femur (thigh bone) to date the pregnancy and ensure your baby is growing well She will check for abnormalities in the brain, face and lips, spine, abdomen, heart, stomach, kidneys, bladder, and hands and feet. Lastly, the placenta, umbilical cord, and amniotic fluid are examined You may be able to find out the sex of your baby, although you can ask not to be given this information (see p.124).

Diagnostic tests
Identifying fetal abnormalities
Diagnostic tests give a definitive answer as to whether or not your baby has an abnormality such as Down’s syndrome These tests are not carried out routinely and you will be offered one only if a screening test indicated that your baby had a higher risk for Down’s syndrome, if you are over 35, or you have a family history that puts you at a higher risk of having a baby with an abnormality, All diagnostic tests also carry a small risk of miscarriage and you will need to weigh up the pros and cons before deciding to go ahead with one
Chorionic villus sampling (CVS) This is a
diagnostic test that involves taking a tissue sample from the placenta to identify for certain whether your baby has Down’s syndrome or a genetic
Chorionic villus sampling
needle and
syringe  ultrasound transducer
abnormality This can be done as the placenta contains the same genetic information as the baby The test is carried out between 11 and 13 weeks, The advantage of this test is that it can be performed earlier in pregnancy than amniocentesis, so if an abnormality is found and you decide to terminate, it is early enough to have a suction termination.
How is it done? There are two procedures for CVS: one method extracts a sample of the placenta via the abdomen, and the other method carries out the procedure vaginally With the abdominal method, a fine needle is inserted through your abdomen and, using an ultrasound scan for guidance, the doctor removes a very small sample of tissue from the placenta You have to wait about
ultrasound transducer
catheter 10 days for the results, which means that if your baby has an abnormality and you want to terminate your pregnancy, you can do so well before you start to feel your baby kicking.
To carry out CVS vaginally the doctor inserts a small tube through your vagina and the cervix, which then passes through the uterine wall. As with the abdominal method, the doctor then takes a small sample of tissue from the placenta, using ultrasound for guidance. The sample is sent to a laboratory where it is grown in a culture for around seven days. The sample is then studied under a microscope to check for chromosomal abnormalities or other defects.
Amniocentesis Amniocentesis is a diagnostic test used mainly to identify a chromosomal abnormality and it is the most commonly used test for identifying Down’s syndrome. During the test, a sample of amniotic fluid containing cells from the baby’s system is taken from the uterus. It is a relatively quick and painless
Amniocentesis test
ultrasound — needle and
transducer syringe
placenta uterus — amniotic  
fluid
cervix
procedure and may be offered at around 16-19 weeks of pregnancy It is offered later than CVS because there may be insufficient fetal cells in the amniotic fluid before this stage of pregnancy The results from this procedure are usually very accurate and, although there is a slight risk of miscarriage, this is lower than the risk of miscarriage with CVS, especially in units where a large number of the tests are carried out and the doctors are particularly practised at conducting the test Apart from the slight risk of miscarriage, the main disadvantage of amniocentesis is that it has to be carried out later in pregnancy, so if the result comes back as positive, then you will be half way or even further into your pregnancy should you decide to terminate and would need to be induced to undergo a vaginal delivery
How is it done? Using an ultrasound scan to guide the procedure, a long, thin needle is inserted through the mother’s abdomen into the amniotic sac and a small sample of amniotic fluid is extracted. This contains fetal cells, which are then grown in a culture in a laboratory to be analysed. As there is a small risk of miscarriage, you may be advised to rest for a day or two afterwards to minimize this risk. Depending on the maternity unit and the laboratories used, there may be a chance that the result could be back before the end of one week, but the majority of units still have to wait two or even three weeks. It usually takes 2-3 weeks for the fetal cells to grow, Very occasionally this does not happen and you may need to have another amniocentesis test
Cordocentesis This diagnostic test is also known as ”fetal blood sampling” or “umbilical vein sampling”. In this test, blood is taken from the baby’s umbilical cord to diagnose Down’s syndrome when earlier screening tests have shown a possible problem. Since this is an extremely specialized procedure, it can only be carried out at a regional specialist fetal medicine centre in certain parts of the country.

 
Nuchal fold and dating scans
Ultrasound examinations
A dating scan at 10-14 weeks measures fetal growth so that a gestational age can be given The nuchal fold scan, or nuchal translucency scan, is offered between weeks 11 and 14 and assesses the risk of Down’s syndrome. Only some hospitals offer this scan at the moment The risk of Down’s syndrome rises with age. At 20 the risk is 1:1527; at 25 it is 1:1352; at 30 it is 1:1895; at 35 it is 1: 356; and at 40 it is 1,97,
What does the dating scan look for? The distance is measured from the top of the baby’s head to its bottom (crown-rump measurement), and the diameter of the head is recorded, known as the biparietal diameter - the distance between the parietal bones either side of the head
How is the nuchal fold scan done? The sonographer will measure the width of the fold of
skin behind your baby’s neck to see if any excess fluid has collected there This measurement is calculated into a risk ratio based on your age The ratio is considered high if it is above 1:300. You will be given the results of the scan immediately If your baby has a high risk, you will be offered further tests and, depending on the results and after counselling, the choice of continuing your pregnancy with support or having a termination.
Is it reliable? The nuchal fold scan is considered to be 80 per cent accurate, which means there is a 20 per cent (1:5) chance of it being inaccurate If your hospital offers you a blood test (PAPP-A, see p.119) with the scan, it becomes 85 to 90 per cent accurate. When the nasal bone is also measured, the accuracy rises to 95 per cent. Your local maternity unit should be able to provide you with information as to how accurate their scans are.

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

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

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

What’s happening to my baby?
fetal development
Is it true that much of the really important brain development happens in the first trimester?
Your baby’s brain starts to develop soon after conception when brain cells begin to form at the tip of the embryo After about three weeks, a structure called the ”neural tube” begins to change in order to form the spinal cord, and the brain and brain cells (neurons) start to develop and send messages to each other In the early weeks, brain cells multiply at a rate of about 250,000 per minute.
After about 20 weeks of pregnancy, the rate at which brain cells multiply begins to slow down and the brain starts to organize itself into over 40 systems to direct vision, language, movement, hearing, and other functions By the time you are half way through your pregnancy, almost all the brain cells your baby needs for life are present
During the third trimester, the connections between the brain cells start to mature and the baby’s nervous system becomes more developed. Brain development is not totally complete by the time the baby is born and many important brain connections that help your baby develop skills and personality are made after the birth.
So, although fetal brain development occurs throughout pregnancy, and after, crucial foundations are certainly laid during the first three months
Is there anything I can do to help the development of my baby’s brain?
You can ensure that your diet includes good sources of omega-3 fatty acids, as these are thought to play an important part in the development of the brain They can be found in oily fish such as mackerel and salmon (limit to one or two portions a week) ; omega-3 supplements designed to take in pregnancy are available.
When will my baby’s face be formed?
The development of the face starts as early as the sixth week of pregnancy, when grooves that
will form the structures of the face and neck start to grow. A week later, the eye starts to develop and a primitive mouth and nose are evident. By the end of the first trimester the face is well formed and has a definite human appearance, although the skin is still transparent By the 24th week of pregnancy, the eye is fully developed, the eyebrows and lashes have formed, and the skin becomes less transparent, but the eye remains fused shut and does not open until around the 28th week of pregnancy
During the last trimester, your baby’s hair begins to grow on the head and fatty deposits give your baby rounded cheeks
I would like to communicate and bond with my baby before the birth. Is there anything I can do?
As your pregnancy progresses, there are many ways to focus on your baby and communicate with him, and these occasions area chance for you to relax and take time out, too.
* Relax in a warm bath and concentrate on feeling your baby’s movements, imagining what he is doing inside you.
* Talk to your baby. Your baby can detect sounds from outside the womb by the second trimester and is especially likely to tune in to your voice. You can give a running commentary on your activities, or even read to your baby Get your partner to chat too! * Rub or massage your bump. You may find that your baby responds by kicking; it’s almost like having a conversation!
* Spend some time making plans for your baby’s arrival, for example, choosing colours for the nursery
or even just buying a few sleepsuits
* Sign up for birth preparation classes for you and your partner This will give you both a chance to think about labour, birth, and your baby
* Start reading through a book of baby names and make a list of those you and your partner like * Some couples enjoy taking regular photographs of their growing bump
I’ve got a full-on career and have hardly thought about the baby. Will this stop us bonding?
Even if you work full time during pregnancy, this doesn’t have to have a negative effect on your relationship with your baby. As your baby grows, you will probably find that you start to develop a relationship with your ”bump” as you anticipate your baby’s movements and perhaps talk to your baby Make sure you plan enough maternity leave before your due date as this gives you time for practical and emotional preparations, as well as time to rest There is some evidence to suggest that too much stress in a mother can affect her unborn baby’s brain development although this is not conclusive. However, it does highlight the importance of regular opportunities to relax during pregnancy
I’m trying to get my partner involved; I keep letting him feel the baby move, what else can I do?
This is a common concern Feeling the baby move inside you is a great way for your partner to begin to connect with the baby as a separate person and seeing the baby on an ultrasound scan can help too, as can hearing the heartbeat.
It is often difficult for partners to feel involved with a pregnancy since it is not physically happening to them and can feel quite an unreal experience Try to spend time together finding out about pregnancy labour, and birth as this will help your partner to feel as informed as you and discover ways to help -you during the labour and birth and care for the baby after the birth. Some of the suggestions in the box above may also help.
My husband didn’t talk about the baby before the scan. Now he is over-protective. Is this normal?
Many fathers-to-be find it difficult to come to terms with the fact that their partner is carrying their baby, and that the baby will eventually be born and bring all the joys, trials and responsibilities of parenthood. This is all even harder to envisage when they are not physically experiencing the changes that pregnancy brings - not feeling the symptoms or feeling the movements. The ultrasound scan is often a pivotal point for partners - suddenly they are ”face to face” with their baby, and it becomes more real Perhaps your partner is now realizing his responsibilities and affection for the baby and is showing these feelings by taking care of you. If you are finding that his cosseting of you is a little too much, you might want to discuss other ways he can feel involved with the pregnancy and prepare for the baby (see box, above)! Try to embrace his involvement and enthusiasm for the pregnancy - it is a great way for you to strengthen your relationship as a couple and prepare to face parenthood together.
When can a baby first suck its thumb?
Ultrasound scans have shown unborn babies sucking their thumbs from as early as 12 to 14 weeks of pregnancy However, this is likely to be a reflex at this stage as the brain does not have any conscious control over movement until the fetus is much more developed later on in pregnancy,
Some research has suggested that if an unborn baby shows a preference for sucking, for example its right thumb, then it will prefer to lie with its head turned to the right after the birth The same research also suggested that this preference in the womb could be used to predict right or left handedness in the baby as it grew older
When will the midwife be able to hear my baby’s heartbeat?
Your midwife should be able to hear your baby’s heartbeat by the time you are around 12 weeks pregnant using a hand-held device called a sonicaid”. The heartbeat sounds rather like a galloping horse, and the rate is usually somewhere between 120 and 140 beats per minute — around double the rate of your own pulse.
There are factors that can influence whether or not the baby’s heartbeat can be picked up. For example, if you are overweight, or the baby is in an awkward position, it may be harder to hear the heart. If your midwife is unable to locate the baby’s heartbeat at 12 weeks, try not to worry, At this stage, the baby is only about 5cm (2in) long, so it’s still very tiny’ Your midwife will try again in a few weeks. Certainly by 16 weeks it should be easier to pick up and listen to the heartbeat.
When will I first feel my baby move?
Although ultrasound scans have shown that babies may start to move slightly from around 6 weeks, it is not usually until the second trimester (13-26 weeks) that the fetus will make active movements. The sensation known as ”quickening” is described as a fluttering type of feeling usually felt by mums between 16 and 20 weeks, although exactly when a movement is felt can vary from woman to woman and may be affected by various factors. If it is your first baby, you may not notice any movement until later as you won’t know what to expect. Also, if you are an active person, these slight flutters may be missed. Women with an anterior placenta (lying at the front of the womb) may feel movements later, as may larger women, as there is more flesh for the movement to be felt through.
It is not until around 28 weeks that it becomes more important to monitor the pattern of movements. From this stage, the amount your baby moves, as well as the type of movement and the time it happens, are relevant as these indicate that the placenta is sustaining the pregnancy and your baby’s muscles are developing. If you are concerned about lack of movement, contact your midwife or hospital.
What sounds can my baby hear in the uterus?
The baby’s outer ear is visible at around eight weeks and the first reaction to loud noises has been recorded at nine weeks. This has been measured in studies by playing a range of sounds through the mother’s abdomen and recording any responses, such as movement, through ultrasound scans. It is thought that babies start off hearing low tones and then higher tones are heard later on as the hearing system continues to develop.
Studies also suggest that a fetus can determine
its mother’s voice and the voices of close friends and family significantly during pregnancy One study revealed that not only did the fetus hear its mother’s voice, but its heart rate decreased, indicating that her voice had a calming effect. By 16-20 weeks, hearing is considerably developed. Premature babies born at this time react to sounds, so they are living proof that babies inside the womb at that gestation can hear Research also suggests that babies respond to stories read to them or music played during pregnancy after the birth
I’m 25 weeks’ pregnant, and my baby seems to “jump” when it hears loud noises - is this likely?
Babies born prematurely react to sounds, and loud sounds will produce a ‘’startle reflex’, so this provides strong evidence that babies inside the womb at that gestation will hear and react to loud sounds too, possibly with sudden movements
As mentioned above, studies have shown that a baby can react to sounds in the womb from as early as nine weeks’ gestation. As the fetus grows, the hearing develops, with babies responding to a greater range of sounds.
My tummy measurement has been the same for three weeks. Why isn’t my baby growing?
In pregnancy, your abdomen is measured to establish the height of the top of the womb, which indicates how the baby is growing It is important
to know whether the same person is measuring you, as there is an element of subjectivity depending on techniques. In early pregnancy, it is not necessary to measure you as this doesn’t give an indication of fetal growth, but from 26-28 weeks, growth can be assessed this way. However, even with your own personalized growth chart and with the same person measuring you at the correct time, on their own these are not an accurate means of estimating your baby’s growth. If there are any concerns, you will probably be referred to a consultant to decide whether you need further investigations, for example ultrasound scans. If you are at the end of your
pregnancy, one possible explanation may be that your baby’s head is engaging into the pelvis, so although your baby is still growing, some of his head has not been measured due to its position If you are worried, talk to your midwife and, if necessary, she can refer you for a ”growth scan”,
Do babies have hiccups in the womb? I’m sure I can feel them.
Babies hiccup from early in the third trimester. This is a normal phenomenon that is usually short-lived but often recurs at similar times each day It feels like a quick, spasmodic sensation in your abdomen. Hiccups are not harmful to the baby and in fact are a sign that your baby is healthy, in the same way that your baby’s movements are a positive sign.
It is thought that the hiccups may be caused when, occasionally, babies take a deep breath in and ingest the amniotic fluid that surrounds them. The sudden change in chest cavity pressure when they take in fluid can cause the hiccups, just as when we drink something fast. These deep breaths help to exercise breathing muscles and stimulate their lungs to produce “surfactant”, which is essential for the lungs to function. The baby cannot drown, as it receives its oxygen supply from the placenta.
When will my baby grow fingernails?
Babies begin growing fingernails from the end of the first trimester and the nails reach the fingertips between 34 and 36 weeks of pregnancy It is possible for babies to scratch themselves inside.
After birth, cutting a baby’s nails can be a cause of concern for parents. Newborn nails grow rapidly and the best time to shorten them is after a bath, when they are at their softest and the baby is more relaxed. There is some controversy over whether to use scissors, clippers, or simply bite them off. Scissors and clippers may easily cut the skin, but biting carries a higher risk of infection if the skin is broken. Pressing the nail helps to distinguish nail from skin. Using emery boards or simply peeling them off can be slightly safer options, or put your baby in scratch mittens.
At what stage could my baby survive outside of the womb?
Until relatively recently, babies born under 28 weeks’ gestation often did not survive Today, with medical advances in special care baby units, babies of 22 weeks’ gestation have survived outside the womb, although this is still very rare. The guidelines for most hospitals is that 24 weeks is the earliest point at which they will resuscitate a baby, unless the baby shows signs of life at birth.
Extremely premature babies have an increased risk of disability, even with the best medical care, and often the delivery itself can put an enormous strain on the baby.
Very experienced doctors, midwives, and nurses will be involved in the care of extremely premature births If possible, the delivery should take place in a hospital with a dedicated special care baby unit (SCBU) If this is not possible, babies are often transferred to a specialist centre when they are stable enough to be moved.
As each day and week is a milestone for your baby, the nearer to your due date you deliver, the better the chances for your baby.
I like to rub my tummy and talk to my baby as even now I feel like my baby is here - is this daft?
No, this is perfectly normal and may be soothing for him as babies can determine their mother’s voice in the womb and sometimes their heart rate decreases in response. However, I wouldn’t recommend that
you rub your tummy too vigorously or too often as, in some cases, this can cause contractions and may trigger a premature labour if you are around 37 weeks’ gestation.
Many women feel that the mother-child bond
is there before the baby is born. It is good that you are having these positive thoughts during your pregnancy, as this is an excellent foundation for your future relationship with your baby
Can my baby see bright lights? I’m 32 weeks’ pregnant.
A baby’s eye structures begin to develop from as early as 4-5 weeks, with the eyelids forming at around 8 weeks and closing between 9 and 12 weeks. By 24 weeks, all of the eye structures are fully developed and at around 28 weeks, the eyelids start to open and shut Although we tend to presume the uterus is dark, this is not so Between 30 and 32 weeks, the baby experiences light and dark environments, depending on where the mother is and the time of day. It has even been reported in studies that not only do babies react to light, but have been seen on ultrasound scans trying to grasp at the light source. When a baby is born, he reacts to lights by frowning or blinking and can see to a distance of around 15-20cm (6-8m) (the same distance to mum’s face from the breast!).
Is it normal for babies to stop moving around so much towards the end of pregnancy?
Towards the end of pregnancy, your baby’s range of movements may change as there is less room for him to extend his limbs and trunk However, you should still be aware of a regular pattern of movement. Over the last 30 years, women have been actively encouraged to count how much their babies kick However, in 2003, the National Institute for Clinical Excellence (NICE) recommended that this practice of counting movements stopped, as counting how many kicks a baby makes is not an accurate indication of whether the baby is well and each baby makes a different number of kicks Nowadays, women are encouraged instead to tune in to their babies’ pattern of activity, including the type of movement they make and the periods when they are most active. Studies have shown that over 50 per
cent of women who had a stillbirth noticed a change in the pattern of movement. The general advice is, if -you are worried about your baby’s movement pattern you should speak to your midwife or hospital.
When will my baby’s head engage?
Engagement, when your baby’s head moves from higher in your abdomen down into your pelvis in preparation for the birth, can happen at any time from 36 weeks until the onset of labour (see p 148). The head tends to engage earlier in a first pregnancy
Can my baby’s position in the womb affect when his head engages?
A baby’s position can affect how it engages into the pelvis. For example, if the baby is lying in a ”back-to-back” position, with his back lying along the mother’s back; this can make it more difficult for the baby’s head to move through the pelvis. Similarly, if the baby is in a breech, feet first, position or a transverse position (see p. 145), then engagement will not be possible unless the baby moves and a Caesarean delivery may be necessary.
It is thought that the mother’s level of activity and the positions she adopts can influence the position of the baby in the womb. Nowadays, it is more common for babies to lie in a back-to-back position and it is thought that this may be due to people leading a more sedentary lifestyle. In the past, when women were possiby more active, perhaps performing tasks such as scrubbing the floor on their hands and knees, there was less incidence of this position
Will my baby develop much in the last month of pregnancy?
During the final month of pregnancy, your baby is busy preparing for birth. He will be practising breathing movements and sucking, and will start to turn towards light. You may notice that there are fewer vigorous movements now — this is natural as there is less space within the uterus. However, you should still be noticing plenty of nudges and wriggles.The downy hair that covered your baby’s body starts to disappear and the hair on the head and your baby’s nails continue to grow Meconium, the waste product that will be your baby’s first poo, starts to form in the bowels at this time. During this last month, most of your baby’s organs are fully mature and the lungs will continue to develop. ”Full term’ is considered to be from 37 weeks.
I feel very emotional at times and am scared that I won’t love my baby - is this normal?
The feelings you have are not uncommon An increase in hormones during pregnancy can cause some extreme and deep feelings, some of which are irrational Pregnancy is a major life event and, as well as the physical changes that are going on in your body, the emotional pressures are vast. There may be a range of pressures that are adding to how you are feeling, such as relationship problems, financial pressures, caring for other children, lack of space in your house, or returning to work after the birth. It is fine if these are occasional feelings, but if you find
that you are constantly snapping or crying, tired, having difficulty sleeping and eating, or sleeping and eating too much, are unable to concentrate, feel reluctant to leave the house, feel sad and anxious most of the time, or have developed obsessive compulsive disorder (OCD), then you need to speak to your midwife or doctor for help and advice as these are all symptoms of depression.
I’ve recently lost a parent and am very traumatized. Can stress affect my baby’s development?
This is a major life-changing event and with the additional fluctuation in hormone levels and the physical changes that are occurring in pregnancy you are obviously under a great deal of stress However, it may be helpful to bear in mind that your body is designed to deal with episodes of stress
There are studies that have suggested that women experiencing long-term stress may have an increased risk of pre-eclampsia (see p.89) and premature birth, although how reliable this evidence is has been questioned It has also been suggested that there may be a link between extreme stress in pregnancy and children becoming hyperactive, but again this is inconclusive The most important thing to do, now that you have recognized you may be at risk of long-term stress, is to speak to your doctor or midwife, particularly as there has been a recent increase in levels of support and treatment offered
to pregnant and new mothers in your situation, which may help to limit any adverse effects of stress.
YOUR BABY’S MOVEMENTS
First kick
The moment when you feel your baby’s first movements is a truly emotional experience, as you start to become completely aware of, and connect with, the baby growing inside
you. Usually, the first movements are felt as a fluttering sensation, or a ”quickening”, as your baby starts to stretch and turn. This can be felt from around 18 weeks, although for some women it is much later; if you have had a baby before you are likely to be aware of these movements earlier, but for a first baby, awareness of the baby’s movements is usually later, around 22 weeks It is not until about 24 weeks that you will really start to feel regular, more definite movements and you will soon become accustomed to your baby’s activities.

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

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.