Posts Tagged ‘pregnancy and birth’

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

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

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

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

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

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

What will happen at my postnatal checkup?  q2whn78ivz
Around six weeks after the birth of your baby, you will need to see your doctor for your postnatal checkup. During this appointment, the doctor will ensure that your body is returning to normal after the pregnancy and birth.

How long do I have to wait after my Caesarean before I can drive again?
It is generally thought best to wait for around four to six weeks before driving again following a Caesarean section. although there are no specific guidelines based on research on the subject. We would suggest that you wait until you feel that you have totally recovered from the operation and that you would be able to perform driving manoeuvres such as reversing and parking, as well as an emergency stop, without experiencing pain or discomfort. You would also need to feel comfortable with the car seat belt around you, as this will be directly over the area of your wound.
You should contact your insurance company as well to check their criteria, as some do not insure women to drive within a certain period following a major operation such as a Caesarean.

Postnatal exercise
You can exercise as soon as you warm to after your baby’s birth. The amount you do and how strenuous the exercise will depend on the type of birth you had and how much you exercised before you had your baby. Other considerations are whether you are breastfeeding and the amount of discomfort you feel. Always listen to your body as you will become uncomfortable if you do too much. Your body has just undergone an enormous change throughout the course of pregnancy and childbirth, particularly if you had a Caesarean section. There are also high levels of hormones still in your body, which can make you more supple and prone to injury If you are breastfeeding, you may just want to do gentle exercising until feeding is established. It’s a good idea to wear a supportive bra while exercising, and exercise following a feed rather than before one, which may make it more comfortable for you.
Exercises for 0-6 weeks
Always yarn up, wear” dthe correct footwear, and drink plenty of fluids while you are exercising. Stop and seek medical advice if you feel unwell or experience any severe pain or your bleeding increases. Although getting back to your pre-pregnancy shape is important for your wellbeing, do be patient with yourself as it will take time.
Which exercises can I do? Pelvic floor exercises can be commenced straight after the birth (see p.57). These important exercises help prevent you from leaking urine when you laugh, cough, or sneeze. The exercises involve drawing up and holding the pelvic floor muscles, tightening around the back and front passages, and then letting go. Make sure that you are tightening the pelvic floor (not your buttocks, thighs, or tummy muscles). Keep breathing and relax your other muscles.

Pelvicexercises can also be done lying on your side or ack with the knees bent and slightly apart.
Othe gentle exercises. like lying on your back with your kn.~es bent and doing pelvic tilts (pulling your belly-b !ton in and upwards towards your spine), are reco    ended in the first few days after the birth (not if you h. d a Caesarean).Your abdominal muscles may have separated in pregnancy, so doing these gentle exercises will help them to reunite. The exercises
below will help strengthen abdominal muscles (avoid after a Caesarean and follow the exercise advice given by the hospital). Buildup exercises gradually, starting with one cycle and then repeating this as many times as you feel comfortable. Always breathe normally. Walking and swimming are excellent ways to build up your fitness levels once you have stopped bleeding.
What should I avoid in the first six weeks? Full impact and resistance exercising should only be done about six weeks after the birth, to prevent any strain on the pelvic floor area. Ask your fitness instructor for advice and gradually increase your exercise. Always let your instructor know that you have just had a baby, so exercises can be tailored to your needs. If you had
a Caesarean, your hospital will have given you a leaflet describing the sort of exercises you can do safely, and before you carry out abdominal exercises, such as situps, check with your doctor first: these are usually safe to do around 6-8 weeks after the birth.You can gently introduce single leg-raises while lying on your back once you feel ready probably after about a month.

I developed piles at the end of my pregnancy - will they go now the baby has been born?
haemorrhoids, are swollen veins in or around the anus. They are fairly common in pregnancy and after childbirth due to the weight and pressure of the baby s head pressing down. Most women find that haemorrhoids disappear within a month of giving birth, although a very small minority of women are not so fortunate and will need to discuss treatment optio-is with their doctor. In the meantime, if you are finding the haemorrhoids uncomfortable or itchy, there area few things you can try Applying a mate-nity cool pad to the area can be soothing (you can make your own by freezing a folded wet flannel), or you- doctor or pharmacist may be able to recommend a cream that can ease the discomfort. You should also try to avoid becoming constipated as straining to go to the toilet will make the piles
After an episiotomy
How to ease the discomfort of stitches
If you had an episiotomy, you may find that your perineum is quite uncomfortable after the birth, as the surrounding skin can swell, causing the stitches to become tighter, and sitting down becomes increasingly difficult. Here are some ways to relieve this discomfort. * Sit on a rubber ring to take the pressure off your sti hes and enable you to relax.
pply a cooling gel pack to the area, or ask your midwife or doctor to recommend an anaesthetic worse. so drink plenty of water and eat lots of fresh fruit and vegetables as well as wholegrains.
I had an episiotomy and am terrified of going to the loo. Do you have any advice?
Many women who have had a cut or tear to the perineal area experience discomfort for a while after the birth. There may also be some pain or “stinging” when passing urine or opening the bowels, but this should last only for a few days. You may find it helpful to tip a jug of warm water over the area when you pass urine, as this helps to dilute the urine and reduce the stinging sensation acidic urine can cause. If your loo is near the shower, you may be able to use the shower head over the toilet. A bidet, of course, is ideal, though not many people have these. Drinking plenty of fluids will also help to dilute your urine.
It is normal not to open your bowels for a day or two after the birth. Many women feel anxious the first time they pass a bowel motion, but it is very unlikely that this will damage your stitches. However, if you become constipated, this could cause discomfort. Make sure you drink plenty of water, and eat fresh fruit and vegetables to help prevent this. If you find that you are still feeling constipated, your midwife can give you a mild stool softener if necessary.
I had a long delivery and I’m
worried that my vagina has
stretched. Will it get back to normal?
‘I!ry not to worry. Although at first you may notice changes to your body as a result of the pregnancy and birth, a woman’s body is designed to give birth and return to normal afterwards. To help the muscles around your vagina to tighten after the birth, do some pelvic floor exercises as you did in pregnancy (see p.57). These involve identifying which muscles you need to exercise by tightening the muscles around your vagina and back passage and lifting up just as if you were trying to stop yourself passing urine and wind at the same time. You should practise 5-6 at a time, ideally several times a day If at first you are not able to hold the muscles tight for 5 seconds.

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.

Who will handle my care?
a guide to antenatal care

What types of antenatal care are available to me?
The options for antenatal care in the UK vary from one region to another, and sometimes according to the hospital you choose. so it’s worth asking your doctor or midwife early on about your choices. There are four main types of care (see p.76) The most common is shared care, where you are cared for by your doctor and community midwife with visits to the hospital limited to scans or investigations. In some areas, midwifery care is offered where you are looked after by a midwife or a team of midwives, sometimes called one-to-one care or team midwifery care. Women with pre-existing medical problems, or a more complicated pregnancy, such as a multiple pregnancy, may have consultant-led care with visits to a hospital-based consultant If you opt for private care, you will be cared for by an independent midwife Appointments will be timed to suit you and scans may be with a private obstetrician. The midwife will be on call for the birth, which may be at home, in a birth centre, or at the local hospital.
How many antenatal appointments will I need?
The exact number of appointments and how often you have them depends on your individual situation Usually, if this is your first pregnancy, you will have up to 10 appointments, whereas if you have had a baby before, you should have around 7 appointments.

When will I have my first antenatal appointment?
Your first ”booking’ appointment should be between 8 and 12 weeks, depending on the midwives’ preferences in your area. This is often the first time you will meet the midwife who will be organizing, and in most cases providing most of, your care.

I’m going for my first appointment next week - what will happen there?
The purpose of your first appointment with your local midwife is for her to obtain your medical history and exchange information so that your future care during the pregnancy and birth can be planned. This is also an opportunity for you and your midwife to get to
know each other and for you to ask any questions you may have and discuss the schedule for appointments, blood tests, scans, and antenatal classes. You will also be given booklets, information leaflets, and important contact telephone numbers
Your midwife will ask you about your medical history; your family’s medical history; your partner and your partner’s family’s medical history; about any previous pregnancies you have had; and how this pregnancy has been so far Your answers to these questions will help your midwife to build up a picture of your current state of health, and will also help identify any factors that may affect your pregnancy, for example if there is a family history of pre-eclampsia (see p.89).
Your midwife will also take your blood pressure, weigh you, test your urine (see below), and listen to the baby’s heartbeat if you are 12 or more weeks pregnant. She may also take some blood tests (see opposite). These observations provide a useful baseline for future antenatal checks

Why do I have to bring a urine sample to the clinic each time?
Your midwife is looking for the presence of protein in your urine. If protein is present, this could indicate that you have a urine infection that may need a course of antibiotics After around 24 weeks of pregnancy, protein in the urine is an indication of pre-eclampsia (see p 89), a potentially serious condition that needs close monitoring.
If you have a body mass index (BMI) (see p 18) over 35, you will be offered a glucose tolerance test, also done by testing -your urine. Glucose in the urine is a sign of gestational diabetes (see p.87) If glucose is present, you may be referred for blood tests to analyse your sugar levels. If diabetes is diagnosed, you would receive care and advice accordingly.

Why are some of my appointments with my doctor and others with the midwife?
The type of antenatal care you receive can vary slightly between different areas. If your pregnancy is straightforward, your care is usually shared between your doctor and midwife, or in some areas all your appointments are with your midwife. If you feel more comfortable with your midwife, you should be able to arrange to have the majority of your appointments with her, and the same applies if you feel happier seeing your doctor. Whichever way, it is important that -you feel able to ask any questions or discuss any issues, which may be personal or sensitive

Will I have to have an internal examination at my first antenatal appointment?
It is unlikely that you will have an internal examination at your first antenatal appointment. Twenty years or so ago, when home pregnancy tests weren’t as reliable and ultrasound scans were not so accurate or widely available, an internal examination was the
best way to confirm and ‘date” a pregnancy The midwife or doctor placed two fingers into the vagina, and pressed on the lower abdomen with the other hand to judge the size of the uterus
Nowadays, there are a few instances when an internal examination may be recommended during early pregnancy. If you have an infection, such as thrush, an internal examination enables the vagina to be visualized to check for any signs of infection and for a tissue sample to be taken with a swab (like a long cotton wool bud). The swab is sent to the hospital for testing so that the appropriate treatment can be offered
If -you have vaginal bleeding, you may have an internal examination with a speculum (an instrument shaped like a duck’s bill, used for smear tests) to allow the cervix to be seen: a small erosion on the surface is a common cause of bleeding in pregnancy Although internal examinations are not enjoyable, it is important to try and relax to help the muscles of the vagina to relax and loosen, which may prevent discomfort. Many women find it helpful to breathe slowly and steadily during the examination.

I’m very small and have tiny feet - will that be a problem when I give birth?
In the past, doctors used to measure a pregnant woman’s feet to assess her likelihood of needing a Caesarean section, as small feet were thought
to indicate a narrow pelvis Although there is some truth in the fact that small feet generally indicate that a woman is small-framed and therefore likely to have a small pelvis, small women also tend to grow small babies in proportion to their pelvic size. True cephalo-pelvic disproportion (CPD), where the baby’s head is too large to fit through the pelvis and be born vaginally is relatively rare
During labour there are other factors that help you to deliver your baby. The pelvis is not a fixed structure and the hormone relaxin helps to soften the ligaments that hold the pelvic bones together to help the pelvis to stretch and accommodate the baby
Also, your baby’s head is designed to mould into shape. The skull is made up from separate bones that are able to overlap each other slightly in order to reduce the overall size of the head as it travels through the pelvis during labour This is a normal part of the birth process. Labour positions also affect the dimensions of the pelvis. For example, squatting can increase the internal measurements of the pelvis by around 30 per cent. Sitting, or lying on your back can actually reduce these measurements by restricting the natural backwards movement of the tailbone (coccyx) during birth.

My midwife is lovely but she’s always in a hurry - how can I get her to answer my questions?
This is a common problem. Antenatal clinics are often very busy, with lots of women for the midwife to see. Asa  result, most clinics allow only a 10- to 15-minute appointment for each woman – barely enough time to go through the basic physical checks However, it is important that -your questions are addressed and it may be helpful to write them down so that you remember what you want to ask. If your midwife doesn’t have time to discuss the issues during your appointment, ask her to arrange to talk to you at a mutually convenient time This could be in the form of a phone call, or another appointment at the clinic Or she may be able to direct -you to other sources of information such as books, leaflets, websites, or other healthcare professionals.
It is a crucial part of your antenatal care that you feel comfortable with your caregivers and are given the opportunity to discuss any questions you have or issues that arise, and this is recognized by the National Institute for Clinical Excellence (NICE) in their guidelines for antenatal care (see p.310).

I’m four months’ pregnant and haven’t had many appointments. Will they get more frequent?
Yes, you will find that your antenatal appointments become more frequent as the pregnancy progresses. With your first pregnancy, you can expect a total of about 10 appointments but if you have had a baby before, you may only have 7. If you develop any complications, additional appointments would be arranged according to your needs. The schedule of antenatal appointments differs slightly from area to area, but as a general rule you can expect an appointment at the following stages of pregnancy: one to two appointments by 12 weeks of pregnancy, and then appointments at 16 weeks, 25 weeks, 28 weeks, 31 weeks, 34 weeks, 36 weeks, 38 weeks, 40 weeks, and if, your baby is overdue, 41 weeks If you are expecting your second or subsequent baby and the pregnancy is straightforward, you may miss out appointments at 25 weeks, 31 weeks, and 40 weeks.

I want a home birth. Will this make a difference to my antenatal appointments?
Usually women planning a home birth will have the same type of antenatal care as any another healthy pregnant woman in regards to frequency and location of antenatal appointments Midwives in some areas may provide a home visit towards the end of
the pregnancy if a woman is planning a home birth This is helpful as it offers an opportunity to discuss the preparations for labour and birth, such as what equipment to have ready and the intended place for the actual delivery. If your midwife cannot offer a home visit to discuss the arrangements for your home birth, you should be given an opportunity to talk about it together during one of your usual antenatal appointments.

Is it OK to bring my partner with me to the antenatal appointments?
It is absolutely fine to bring your partner with you to some or all of your antenatal appointments It is a good way for him to feel involved in the pregnancy, and also gives him an opportunity to ask questions that he may have. It is a legal requirement that you are allowed paid time off work to attend antenatal appointments, but your partner does not have this right, which may pose a problem as most antenatal clinics are during the day. Another way to involve your partner in the pregnancy is to attend birth preparation classes together Classes are often held at the weekends or in the evenings to make it easier for partners to attend This gives you both a chance to find out more about labour and birth and about babycare after the birth.

When will I hear my baby’s heart beat?
Your baby’s heart starts beating around 20 days after conception, and can be seen on an ultrasound scan at about six weeks of pregnancy It is usually not until around 12 weeks of pregnancy that it is possible to hear the heartbeat with a hand-held monitor, known as a sonicaid, as it is around this time that the uterus starts to grow upwards out of the pelvis, making it easier to detect the heartbeat When the heartbeat can be heard also depends a bit on your build; if you are very slim, it is usually easier to find the baby’s heartbeat than if you are overweight

Will I have my own midwife?
Midwives realize that it is important for a woman to develop a relationship with them so that they feel supported and able to ask questions, and continuity of care is provided if possible However, how many midwives you meet in pregnancy, labour, and birth and the postnatal period depends on how services are arranged in your area Generally, the midwife linked to -your doctor’s surgery provides the majority of care. Depending on your situation and common practice in your area, you may also meet other midwives if some of your appointments are at the hospital. When -you go into labour, you are usually cared for by hospital-based midwives who you may not have met In some areas, community midwives look after women in hospital. If this is the case, you may be familiar with the midwife caring for you in labour Midwives working on a labour ward work shifts, so it is likely that you will meet more than one midwife during your labour and birth. Your postnatal care is usually carried out by community-based midwives. This may include the midwife you saw for antenatal appointments at the surgery
I’ve only just found out I’m pregnant and I must be at least four months. What should I do?
One of the first things you need to do is to contact your local maternity unit and inform them of your pregnancy Women can refer themselves, although many still approach their doctor first. If you inform your doctor, he or she will send a referral to the hospital or to a midwife to arrange a booking appointment as soon as possible. You should also review your diet (see p.50) Depending on the number of weeks of your pregnancy, you may be due a scan, which may need to be done before the booking appointment Most units offer a scan around 10-14 weeks, and a second one around 20 weeks. You will be offered a range of blood tests (see p. 117) and should be aware of their purpose before consenting Each unit may have a slightly different schedule for care. The earlier you book in the better, so that you do not miss out on any aspects of antenatal care.

Antenatal jargon
Understanding your notes
Once your midwife has compiled your notes, you will be in charge of these and will need to take them to appointments. Abbreviations will be used for much of the medical information.
• BP Blood pressure.
• Hb Haemoglobin levels.
• Primagravida A first pregnancy
• Multigravida A subsequent pregnancy
• NAD Nothing abnormal detected (usually referring to urine sample).
FHHR Fetal heart heard and regular.
FHNH Fetal heart not heard.
FMF Fetal movements felt.
EDD Estimated date of delivery
iIc Ceph or Vx Baby head down
Br Baby is breech - feet down.
Eng/E Baby’s head is engaged for delivery * NE Baby’s head is not engaged.
* SFH Symphysis fundal height, size of the womb

Rhesus negative
Each person’s blood carries a Rhesus factor (Rh-factor), which is positive or negative Problems arise if a Rh-negative woman carries a Rh-positive baby who has inherited the status from the father. If the mother’s blood comes into contact with the baby’s blood during delivery, she may produce antibodies against the baby This does not usually affect a first baby. but may cause problems in subsequent pregnancies when a mother’s antibodies attack the cells of another Rh-positive baby
Preparing for visits
Getting ready for your antenatal appointments
Knowing what to expect at your antenatal appointments and having the necessary information to hand for the midwife will mean the allotted time is used efficiently.
At your first antenatal appointment, your midwife is gathering as much information about you as possible to build up a picture of your health and consider the most appropriate type of care for you. Make sure you have the date of your last menstrual period, as well as the dates of any previous pregnancies, including ones that ended in miscarriage You will also need to be clued up on your family’s medical history and your partner’s medical history, including any inherited abnormalities, so check before the appointment if you are unsure about anything Read any information sent by the hospital and make a list of any questions so that you don’t forget them.
Antenatal care options
Wno provides your care
The options for antenatal care in the UK vary from area to area, so this section will provide a general overview You will find out more when you go for your booking-in appointment, usually around 8-12 weeks Midwives are specialists in providing maternity care where there are no complications and they provide the majority of antenatal care to women. As they are specially trained to look after normal births, women should only have to see a doctor if a problem arises, or if they are at a higher risk of complications. Within the NHS there are three main types of care: shared care, midwifery care and consultant-led care. The Association for Improvements in Maternity Services (AIMS), has a useful website that provides plenty of support, advice, and information on maternity choices in the UK (see p. 310)
What is shared care? Most women have their antenatal appointments with their doctor or community midwife during pregnancy, with visits to the hospital only for routine scans or for investigating problems. Care is then transferred to the hospital midwives and obstetrician, if required, for the birth and postnatal stay
How does midwifery care work? In some areas, teams of community midwives provide continuous care throughout pregnancy, birth, and the postnatal period, and when this type of care
is available it tends to be a popular choice in low-risk pregnancies as it enables women to build up a relationship with their midwives The community midwives are responsible for your antenatal care, your care in hospital during the labour and birth, and then for home visits after the delivery. It is not guaranteed that you will have the same midwife all the way through your pregnancy and birth. For this reason, it’s a good idea to request antenatal appointments with different midwives within the team, so that you meet as many members of the team as possible during your pregnancy, and it will therefore be more likely that you will know the midwife who is with you for the actual labour and delivery of your baby,
When might you have consultant-led care? Women with pre-existing medical conditions, such as hypertension, or those with more complex pregnancy issues, such as twins or multiple births, may have the majority of antenatal care with an obstetrician. Most of their appointments may be carried out in hospital There are other conditions, such as diabetes or epilepsy, which may require the care of two specialists: an expert in the medical condition as well as an obstetrician. A hospital midwife will usually participate in this care too.
What about independent midwives? Outside the NHS, there is also the option of independent midwives Independent midwives are midwives who have chosen to work in the private healthcare sector. They charge a fee to provide antenatal care, care during labour and the delivery, and postnatal care Because they only look after small numbers of women, independent midwives can provide a continuity of care that is not always available on the NHS and they will also tailor care to suit your individual needs, for example timing antenatal appointments when most convenient for you You can find out more details by visiting the wesbite of the Independent Midwives Association (see p.310)
Does my care change if I’m having a home birth? As well as hospital delivery in a birthing or delivery unit, there is also the option of having a home birth within the NHS framework (see p 153). When a pregnancy is straightforward, research hasn’t found any difference in the safety of having a baby at home or in
hospital If you are having a home birth, your antenatal care will be provided by community midwives who are attached to a maternity unit. Once in labour, your midwife will stay with you until your baby is born, and she will visit regularly for between 10 and 28 days after your baby has been born, or you can attend a postnatal drop-in centre in your local area.
How will I choose my antenatal care? This may be partly dictated by the type of care that is available in your area. It’s worth talking to other local mothers with young children to see if they have any advice or recommendations. The type of care you receive may also depend on where you choose to give birth. If you have a low-risk pregnancy and decide to have a homebirth or to deliver in a birthing unit, then you will probably just see midwives and your doctor in your own home or the doctor’s surgery If there are complications, your care may be shared between your midwives and doctor and a hospital obstetrician.
Blood tests
How these contribute to your antenatal care
You will be offered quite a few blood tests during pregnancy and the results provide vital information that may affect your pregnancy and help your caregivers to plan your care. At your hooking appointment, you will be offered blood tests to check for the following:
• Anaemia (low iron levels).
• Your blood group
• Your Rhesus status (see p 79).
• Hepatitis B.
• Your rubella (German measles) immunity.
• HIV and syphilis
These are usually taken at the same time, so you won’t need a separate test for each!