Posts Tagged ‘pregnant women’

Hamstring Stretch (back of thigh): Sit on a chair with a footstool in front of you omnicef price . Place your left foot flat on the floor and your right heel on the footstool so that the right leg is fully extended and your toes point to the ceiling tranexamic acid in gi bleed . Flex your right
foot, drawing the toes back towardyour body clomid making period late . With your backstraight
hips and reach toward your right toes lovegra . Take a full second to reach toward your toes and a full second to return to the starting point discount pet rx medicine clindamycin . Repeat about 15 times zoloft sponsor nascar . Repeat with your left hamstring buy viagra online netscape com . For a static stretch, reach toward your toes as far as is comfortable and without pain implant birth control norplant . Hold for 15 seconds, repeat three more times on each leg vitamin b12 and metformin .
Active Quadriceps and Shin Stretch (front of thigh and shin): Hold on to a chair or table for support counsel on salmeterol . Stand erect without leaning forward no prescription advair diskus . Bending one leg at the knee, curl your heel behind you toward your buttocks ciprofloxacin uses . Take 1 second to curl your leg behind and 1 second to return your leg to the straight position metformin advantages . Repeat about 15 times on each leg side effects topamax permenant .
Static Quadriceps and Shin Stretch: Stand close behind a sturdy chair that allows you to stand tall without leaning forward better than zoloft . Place a second chair with a seat that is no higher than your knee about a foot behind you swine omeprazole . Bend your right leg at the knee and place the top of your right foot on the seat of the chair behind you viagra free sites results . Your right knee should be directly under or slightly behind your hip steroids prednisone . Gently press the top of your right foot down against the chair to stretch the entire front of the leg antiemetic metoclopramide . The knee of the supporting leg should have a slight bend in it mechanism of caffeine on inducing lipolysis . Hold for four sets of 15 seconds, or a total of 1 minute antidepressant lamotrigine . Repeat with left leg procyclidine onset peak duration .
Other exercises may also be useful in helping to stretch muscles that tend to cramp testosterone replacement therapy patch women . Some people use a stair step to stretch the back of the leg zoloft side effects dry skin . Stand close to the edge of the step with the ball of one of your feet and drop your heel below the level of the step to stretch out the leg plantronics blue tooth 340 lithium battery .
I am often bothered with foot cramps that are annoying and uncomfortable at night and during dance class what lithium looks like . A physical therapist friend suggested a small rubber ball, about the size of a tennis ball paroxetine cod . I put it on the floor and roll each foot on it firmly, especially the arch and ball of the foot, to prevent the cramps amoxicillin dosage kittens .
Minerals
Over the years our readers have offered us dozens of suggestions for preventing nighttime leg cramps marlin prilosec sterling . Many of them involve minerals what does robaxin feel like . Some people swear by potassium cymbalta phentermine . Others are mhusiamie about calcium cats itchy skin prednisone dosage . Another contingent insists that magnesium is the magic mineral medic alert bracelet and coumadin . There’s no way to predict which mineral (or combination) will work best for you, so experiment until you find the right approach class of drug is primidone .
Before you start popping pills, though, why not start with food? Eight ounces of low-sodium V8 vegetable juice provide 840 milligrams of potassium at only 50 calories gen ranitidine ranitidine hcl .
For many years I was plagued with severe muscle cramps, usually in the middle of the night Several months ago one of your readers suggested low-sodium V8 juice, noting that it has more potassium and fewer calories than bananas withdrawal symptoms from verapamil .
I decided to try it and began drinking 8 ounces daily, In 4 months I have not had a single muscle cramp piroxicam for dogs to treat cancer . Quite a relief, to say the least! I heartily recommend it to anyone who has nighttime leg cramps lithium ion data sheet samsung .
Other foods that are rich in potassium include vegetables such as artichokes, asparagus, beets, bell peppers, broccoli, cabbage, cauliflower, chard, mushrooms, spinach, squash, and tomatoes pay pal buy nexium . A banana has about 400 milligrams of potassium, and so does a medium-size sweet potato claritin and blood pressure . Other fruits packed with potassium include apricots, blackberries, cantaloupe and other melons, nectarines, oranges, peaches, plums, pomegranates raspberries, and strawberries is celebrex a teratogen . Fish is generally rich in potassium, and many flavorings, such as ginger, onions, paprika, parsley, and red pepper, also contribute potassium to the diet scleroderma clindamycin . So do chicken and pork fosamax and gerd . Don’t forget molasses, especially blackstrap molasses, which has about 500 milligrams in a tablespoon does prozac cause selfishness . The Food and Nutrition Board of the Institute of Medicine has determined that for adults, 4,700 milligrams of potassium a day is adequate diflucan mexico .712
A word of warning patents loratadine .- Potassium can interact with many prescription drugs, particularly blood pressure medications wellbutrin verses paxil . Quite a few of these medications could boost the potassium level dangerously if a person on one of these drugs also took a potassium pill or used a potassium chloride salt substitute xyzal compare to zyrtec . Older people and those with reduced kidney function might be especially vul-
**** Magnesium
This essential mineral may help with cramps and main other 1pti3bti8M-t what invented the soma cubes . ag well the uses for paxil medication . Usual dose: 300 to 500 milligrams at bedtime—some people report it is gently sedating diovan yeast .
Downside: May cause diarrhea discount pet medication amitriptyline hci . Not for those with kidney failure rimonabant vietnam .
Cost: Approximately $4 for 100 pills, or about a 3-month sup-
ply tacrolimus ointment over counter .
nerable vantin and esbl . Too much potassium can lead to cardiac arrest, so be wary if you are taking any of the following: benazepril
moexipril
(Univasc), quinapril (Accupril), spironolactone
Maxzide), trandolapril (Mavik), or valsartan (Diovan) diflucan duration .
Magnesium is another mineral that is frequently overlooked and in short supply in the diet buspar and substance abuse . People on diuretics may be especially low in this crucial nutrient health net viagra non-formulary cost . Not only is magnesium essential for normal muscular contraction, it also plays a crucial role in heart health, blood pressure control, and hundreds of enzymatic reactions in the body captopril time to lower hypertension . It also helps reduce the risk of kidney stone formation enzyme immunoassay celecoxib .
People have been using magnesium for decades (as milk of magnesia) to counteract constipation amoxicillin causes liver . The normal dose ranges between 300 and 500 milligrams daily dosage for lexapro . One study demonstrated moderate effectiveness in battling nighttime leg cramps at 300 milligrams” Pregnant women are especially vulnerable to leg cramps adderall aciphex zoloft heartburn . Another study concluded that “magnesium supplementation seems to be a valuable therapeutic tool in the treatment of pregnancy-related leg cramps maxolon side effects .”"‘ Be aware that too much can cause diarrhea, and people with kidney problems should take magnesium only under medical supervision hair loss and cymbalta .
Some people are equally enthusiastic about calcium for preventing leg cramps panasonic br2330 lithium cell . The research that has been done on this remedy has been equivocal lithium manganese oxide . In one study, pregnant women with nighttime leg cramps were given calcium supplements or vitamin C as a “control paroxetine brain zapps .” Since there is no evidence that vitamin C can reduce leg cramps, it seemed that the difference between the two groups would be readily apparent if calcium worked well nasal decongestant risperdal . Both groups did equally well, however, suggesting that
715
calcium really didn’t make much difference ipratropium bromide long acting . A systematic review of the research on calcium for nocturnal leg cramps concluded that the evidence for its effectiveness is weak, at least in pregnant women how amoxicillin is produced . The reviewers found more support for supplemental magnesium tofranil pm for fibromyalgia . 716
One way to get extra minerals is with a special pediatric formulation called Pedialyte avandia problems . It was developed to “quickly replace fluids and electrolytes lost during diarrhea and vomiting to help prevent dehydration in infants and children quitting effexor weight .” Pe-Pedialyte
This rehydration solution for babies and children provides a balance of electrolytes that may help adults avoid muscle cramps trazodone and lung problems . Drinking about 4 ounces after exercising should help,
Downside: Somewhat expensive
Cost: Approximately $8 for a liter, or about $1 per “dose”
diatricians frequently recommend this ready-to-use liquid for sick children instead of juice or other beverages effect of clomid on progesterone . Ingredients include water, dextrose, potassium citrate, sodium chloride, sodium citrate, and citric acid zyprexa anorexia . Pedialyte is sold in drugstores and supermarkets in the baby section cyclosporine lipid emulsion . One athlete offered an amazing testimonial for its benefits against leg cramps coumadin interaction with foods and vitamins .
I have experienced a fair amount of cramping in my legs at night after I play tennis man dies from viagra overdose . The cramps occur more during the hot summer months when I perspire more melatonin while on zoloft .
I tried a lot of the sports drinks, but they didn’t seem to help with the cramping methotrexate ectopic . Someone suggested that I either eat bananas or drink tomato juice doxazosin mesylate msds . Unfortunately for me, I don’t like either food blood cozaar pressure .
I was told that the cramping was due to a loss of potassium in the body hsv i treating with valtrex . An assistant tennis pro suggested I try drinking the infant solution called Pedialyte rimonabant indication confusion . I thought that was a crazy idea, but I tried it because I didn’t like waking at midnight with a leg cramp depot provera pregnancy . To my surprise, the Pedialyte has worked like a charm and has eliminated my cramping micronase diabeta .
Pedialyte has one other unexpected benefit I usually play singles tennis, and I am usually pretty worn out after / play order viagra without prescription . Like a lot of people my age, my middle-aged body is usually pretty darn sore after playing, particularly the next day national geographic caffeine . Like everyone else, I take Morin for sore muscles phenergan injection adverse reaction . The Pedia(yte has substantially reduced The Soreness that I experience, and I don’t need to take Motrin the next day n1 3 lithium battery tester 3v .
B Vitamins
B vitamins have become the superheroes of nutrients cefuroxime axetil and symptom relief . Not only do compounds like folic acid, B6, and B12 have cardiovascular benefits, folic acid and niacin may help reduce the risk A combination of B vitamins may reduce nighttime leg cramps relicore zantac dieting combo . Keep the dose of vitamin B trileptal withdrawal how to .,below 100 milligrams per day to avoid nerve damage from long-term use cocaine and lexapro .
Downside: The B-complex formulas available are not specifically designed to prevent leg cramps generic viagra available .
Cost: Approximately $11 for 100 tablets, or a 3-month supply
of Alzheimer’s disease paroxetine and 5ht . One study from Taipei offers evidence that a B-complex vitamin formulation can reduce nighttime leg cramps tranny taking viagra . “After 3 months caffeine drinks . 86 percent of the patients taking vitamin B had prominent remission of leg cramps, whereas those taking placebo had no significant difference from baseline,”71 reported the study’s authors lipitor zocor news . This study used a formulation that is not available in the United States fosamax d generic . It contained vitamins B, (50 milligrams), B, ~5 milligrams), B6 (30 milligrams), and BIZ (250 micrograms) fda topamax warning .7 8
My husband has suffered horrible leg cramps at night all his life kidney infection and ibuprofen . He would writhe in pain amiodarone blood levels .
/ read that 8 vitamins might help uk imitrex . He now takes multiple B-100s every day and has no leg cramps naproxen and nursing babies .
We found a “dose-response curve caffeine makes me panic now .” With B-50s, he’d still have cramps, but they were less severe toradol and orange urine . With B-75s, he wouldn’t have cramps, just twinges in his legs ultram the medicine . At the 100 level, he has not even a twinge how to make prednisone .
A B-complex with 100 milligrams of vitamin B6 may be too much zetia buyback . We worry that regular consumption of th, s nutrient may lead to nerve damage lamisil side effects for women . Anyone who contemplates taking, more than 50 milligrams of vitamin B, should be under medical supervision synthroid phentramine .
Quinine
If you tell your physician that you suffer from frequent leg cramps at night, you may be offered a prescription for quinine depakote with tramadol . This botanical medicine (derived from the bark of a South American tree) has been used against malaria since a monk
B Vitamins sent a sample to Spain in 1633 avapro with dieuretic . (At that time, the diagnosis was probably “fever” or “the ague” rather than malaria gi lithium batteries .)
Doctors began using quinine against leg cramps in 1940 experience with lexapro . Despite this long history, there is still some controversy over whether its effectiveness outweighs the risks of side effects 19 In the 1990s, the FDA determined that the possibility of a susceptible individual experiencing a life-threatening blood reaction (idiopathic thrombocytopenic purpura, or ITP) was just too great cheapest diflucan online w o prescription . OTC sale was banned home coumadin testing . Now the FDA has forbidden doctors to prescribe quinine for leg cramps rifampicin isoniazid pyrazinamide ethambutol . One reader reported that a single glass of tonic water (which contains quinine) put her in the hospital with an almost fatal anemia flomax dosages .
It is hard to predict ahead of time whether a person might react to quinine by developing severe anemia erythromycin resistance peptide . Pregnant women should stay completely clear of quinine (even though they may suffer leg cramps) because it could cause birth defects and induce premature labor about penicillin capsules . Other side effects from quinine include ringing in the ears, rash, changes in color vision, headache, nausea, diarrhea, liver damage, low blood sugar, life-threatening anemia (ITP), vomiting, and trouble breathing prescribed premarin . Anyone experiencing such symptoms should get medical attention promptly meloxicam tab .
The amount of quinine in tonic water may vary from one brand to another discount digoxin . Some brands contain as much as 80 milligrams in a quart of tonic pseudoephedrine hydrochloride tablets canada . The dose that proved effective in preventing muscle cramps in one placebo-controlled study was 400 milligrams cialis tadalafil cialis tadafil tal .720 That suggests that a person would have to drink more than a gallon to get an effect, but many readers report that they notice a benefit from one or two glasses of tonic why hairloss with zetia . The
* Quinine
This traditional prescription for leg cramps is probably effective zocor causes ed . One or two glasses of tonic water may contain enough gui(xi(
Downside: Tinnitus (ringing in ears), rash, changes in color vision, headache, nausea, diarrhea, liver damage, low blood sugar, life-threatening anemia (ITP), vomiting, and trouble breathing are possible reactions atomic model of lithium .
Cost: Approximately $65 in the United States for 100 pills or $33 from a Canadian pharmacy prescription dose used to be 260 to 300 milligrams-, older people should generally start with a’lower dose warfarin graph .
I used to take quinine, but then it became unavailable over the counter My doctor recommended that I drink a glass of Schweppes Tonic Water lasix diabetes . It has enough quinine that it might help long terra omeprazole .
I tried it and it works methanphetamine ephedrine or pseudoephedrine . I have recommended this to others bothered with cramps after exercising, and they have been pleased procardia sr .
One word of caution is probably unnecessary triamcinolone .1 . Even though some people are accustomed to putting gin in their tonic water, the alcohol does nothing to prevent leg cramps resonance caffeine . If it is taken shortly before bedtime, alcohol can disrupt sleep—the last thing a sufferer wants swelling that is helped by prednisone .
Conclusions
Health care professionals generally consider leg cramps more of a nuisance than a serious health problem free live online zoloft help . Nonetheless, anyone who suffers from nighttime leg cramps knows that they can disrupt sleep, and that can eventually have consequences for health as well as mood is prazosin compatable with prozac . Finding the remedy that suits you best may require some trial and error increase free testosterone females . Don’t be afraid of the home remedies: They may seem silly, but since the only prescription treatment, quinine, can have such serious adverse effects, we think they are worth considering teva pantoprazole december .
I had terrible leg cramps, and nothing helped prozac action . Then my husband got some liquid calcium, and that worked immediately olympus li 10b lithium batteries . I have not had another leg cramp women’s international testosterone .
He decided to try mustard for leg cramps, but he still had leg cramps and really did not savor the mustard cat soma . He decided to try turmeric, an ingredient in mustard lithium batteries for electric automobiles . He took’/, teaspoon at bedtime and ‘/;, teaspoon at breakfast xenical side efftects . BINGO! This worked great price of prevacid . Not only did it cure his leg cramps, but it also eased the pain in his hip and feet
He recommended I try it for my awful loot problems valtrex capl . It felt like an ice pick was stuck in the ball of my foot As soon as I started taking the turmeric, I had no more pain ephedrine caffeine stack . I can now wear my lovely high-heeled shoes on Sunday without suffering celebrex qoclick .
e Ibck a bar of ordinary soap under the bottom sheet when you make the bed tricor side . It should be near your legs, and may need to be replaced every 6 weeks or so buying generic zoloft . We don’t know why it would prevent leg cramps, but many readers report success—and we know of no side effects naproxen and methylprednisolone .
• Swallow a teaspoonful of yellow mustard—the inexpensive kind sometimes dispensed in individual packets cyclosporine ointment . We think it may be the turmeric in the mustard that helps lexapro peak . This remedy can work very quickly, though some readers have reported heartburn as a result wellbutrin xl prozac weight loss .
• Sip about an ounce of pickle juice medroxyprogesterone acetate anorexia . Some pickles may contain turmeric, so perhaps that explains why this helps some people fight off muscle cramps so quickly procardia sr . Or, it may provide some missing minerals salbutamol inhaler medication information . Pickle juice is high in sodium, so this home remedy is not for anyone on a low-sodium diet buy viagra on line .
• Baking soda, ‘44 teaspoon in 8 ounces of water, is reputed to fight painful leg cramps quickly prozac video for dogs . Baking soda contains sodium, so it is not for anyone on a low-salt regimen viagra sports .
• Pinch your upper lip firmly between your thumb and forefinger until the cramp eases veterinary ranitidine pricing . This may have the effect of providing a distracting pain that is under your control testosterone injections chronic fatigue . Many readers claim it is helpful, although we have not been impressed information lipitor prescribing .
• Stretch leg muscles for several minutes before bedtime toprol xl 50 mg .
• Consume plenty of potassium-rich vegetables, especially low-sodium V8 juice doctors give shots of penicillin . Increasing potassium intake seems to help prevent leg cramps hydrid technologies lithium power .
• Take a supplement of 300 to 500 milligrams of magnesium a day atacand picture . Reduce the dose if this gives’you diarrhea viagra gif . Avoid magnesium if you have kidney disease can i take accutane and bactrim .
• Try 4 ounces of Pedialyte after vigorous exercise to replenish minerals and prevent muscle cramps decadron vs prednisone .
• Consider B-complex vitamins to prevent cramps oxycoton compared to tramadol . Keep the dose of vitamin B,, under 100 milligrams per day to avoid nerve damage cialis patent expiration wikipedia .
• Ask your doctor about quinine beers effect on levitra . it is available by prescription (or at low doses in some brands of tonic water) how long before wellbutrin kicks in . Severe side effects are uncommon but may be life-threatening, especially a blood disorder called ITP carafate suspension pets .

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

Will life ever be the same?
special situations
I don’t have a partner, but I want this baby - will I be OK if I go it alone?
This may be a worrying time for you, but you might find it reassuring to know that many women do have babies on their own Although it would be wrong to pretend that this is as easy as it is with two parents, with additional support it is possible. You may also have very strong reasons why you want a baby, for example, increasing age, and this determination will give you strength and focus
It will be a great help too if you can find someone to talk to and confide in. This could be your mother, a close friend or relative, or perhaps a tutor. As you are making far-reaching decisions about your future, it’s important that you have support, accurate information, and time to think things through without
fear, panic, or pressure from others. Finding somebody you really trust and who you know can give you support when you need it, especially in labour, may help to relieve a lot of the pressure you are under and enable you to think more calmly and clearly about your situation and make plans as to how to proceed. A confidential service known as Care Confidential (see p 310) offers support, advice, and information for women during pregnancy
It’s worth bearing in mind too that your birthing partner doesn’t have to be the baby’s father; they can be anyone you choose
I’m pregnant and still at school, will I have to leave school?
No, you will not have to leave school, and in fact you are expected to complete your schooling to
the normal school-leaving age at the end of year 11. You should tell a senior teacher about your situation as soon as possible so that you can plan your education during your pregnancy, It may be possible to alter your timetable as you get further into your pregnancy, and you will probably get some home tuition for the few weeks just before and after the baby is born. You are allowed to take time off school for antenatal appointments, but if you are not well enough to attend school for more than a few days because of the pregnancy you will need a note from your doctor or midwife.
In some parts of the country there are education units set up specifically to assist pregnant teenagers where midwives provide antenatal care and help girls to continue their education during and after their pregnancy. Ask -your midwife or doctor for more information on these. You could also contact the government-run organization Connexions, which offers advice and support to all 13-19-year-olds in their education decisions (see p.310).
I’ve just started university and now I’m pregnant - my parents will be furious. What can I do?
Most young women feel a strong mixture of emotions when they find out they are pregnant, with many feeling terrified of telling their parents and worrying that they are somehow letting them down. However, it’s important to talk to someone, and probably the best people to talk to are your parents. When you feel able, sit down and explain the situation to them. It may help to have someone else with you to help break the news. Although your parents’ initial reaction may be one of disappointment and shock they may feel guilty too, thinking that they have failed you in some way. Try to remind yourself that ultimately your parents love you and will most likely support you, although you may need to give them some time to adjust to the pregnancy,
If you feel you really cannot talk to your parents and discuss your options, try to find a trusted and supportive adult friend to talk to Alternatively, talk to a midwife or doctor, or a tutor from university whom you trust. Any of these people will have had previous experience of situations like yours and be able to offer impartial advice
You should be able to continue with your studies and many educational institutions have childcare facilities, such as a nursery or creche - pregnancy need not mean an end to your education plans. Being able to reassure your parents on this point will help them come to terms with your pregnancy.
My boyfriend said it was safe, but now I think I’m pregnant -who can I talk to?
Although there are times during your menstrual cycle when you are less likely to conceive, it’s important to understand that there are no guarantees and, if you are not planning a pregnancy, then it is always wise to use a form of contraception
It is frightening to find out that you are unexpectedly pregnant, but confiding in someone can help enormously. First, it is important to establish that you definitely are pregnant. Home pregnancy tests, purchased across the counter in any chemist or supermarket. are very accurate (see p.34), or you can get one free from a family planning clinic.
If you are pregnant talking to a close friend or trusted relative who you believe would give you support at this emotional time may be extremely reassuring. You could also talk to your doctor or, if you are not registered with one there are ”drop-in” health centres where you can talk to a health professional in confidence Although telling your parents may seem like a frightening prospect, you may find their support invaluable, and of course you need to talk to your boyfriend, who actually may be a great source of support too.
I know my mum cares but she wants to come everywhere with me - how can I tell her to back off?
Pick the right time, over a coffee perhaps, and try to explain sensitively to your mother that you need and want to do some things on your own Let her know that although you value her support, you also need your own space and time to reflect and bond with your baby, even during the pregnancy If you state how you feel now, this will also help to set some boundaries for after the birth
Although your mother may be upset at first and possibly feel excluded, with time she will most likely come to appreciate your point of view Ask her how her own mother reacted to her pregnancy when she was carrying you You may well discover that she was overprotective too.
I thought I was menopausal, but I’m pregnant. Our youngest child is 10. How will we adapt?
It is a shock to discover that you are pregnant when you thought your childbearing years were finished. Although fertility does decline fairly rapidly in your 40s, a pregnancy is still possible, and it is not unusual for women in this age group to believe they are entering the menopause when in fact they are pregnant, as symptoms for both are fairly similar Couples may also become more relaxed about contraception, believing that a pregnancy is unlikely So a late pregnancy is not uncommon.
The pregnancy affects not only you and your partner, but the whole family: it will take a while for all of you to adjust to the news, and many different emotions may be felt during this time. The most important thing is to keep talking so that any concerns can be ironed out rather than left unresolved Involve the whole family in your pregnancy plans to reduce jealousy and make everyone feel involved and needed.
It is important too that you give your children time to adapt to the news. Some children are delighted with a new pregnancy, while others are embarrassed and may need time to adjust. Your partner may experience a mixture of emotions
too, ranging from full-on excitement at being a new dad again to shock and disbelief, and maybe even disappointment Take heart, these will be temporary feelings, and no doubt as time goes on, and as your family adjusts, you will feel more supported.
You are probably aware that there may be some additional risks associated with your pregnancy, such as an increased risk of Down’s syndrome (see p.116). When planning your care, your midwife or doctor will take into account your age and explain the appropriate tests and care available.
It’s 12 years since my last pregnancy. Have benefits and care changed much in this time?
A lot has changed since your last pregnancy. You should take time to find out about current pregnancy
Preparing older siblings
helping your older children to adapt
If you become pregnant when your other children are grown up, you may need to take more time preparing them for the arrival of their sibling.
* Don’t be cross or impatient if they seem less than enthusiastic about the baby; they may be worried about the impact a baby will have on family life
* Reassure teenage children that you will still have time for them and that you won’t just expect them to be an unpaid babysitter. * Allow older children to express their concerns and take time to reassure them.
care as there may be tests and scans available
now that you were not offered in your last pregnancy (see p 116) Also, childcare provisions and maternity benefits have improved considerably over the last few years so, even if this baby was unexpected, it may not be such a bombshell after all.
My daughter is eight years old. Will she get on with the new baby or is it too big an age gap?
There is no right or wrong age gap between siblings and, often, how siblings get on together is more to do with their personalities rather than the age difference. Although they are likely to have independent interests, she is probably very excited at the prospect of a new baby
Our first baby is only 10 months old - how can I be pregnant again?
Usually, periods begin again between two and four months after the birth, but if you are breastfeeding, your periods may not return until your baby starts on solids, or even later. Some women use breastfeeding as a form of contraception and although it reduces the likelihood of pregnancy, it is not reliable. If you are breastfeeding, the time it takes for the return of ovulation depends on the frequency, intensity, and duration of feeding, the maintenance of night feeds, and the introduction of supplementary feeding The absence of periods does not guarantee that you are not ovulating, so there is a risk of pregnancy.
It is quite possible to ovulate within a month or two of giving birth, and not unknown to ovulate as early as two or three weeks following the birth. This is why midwives always discuss contraception in the days following the birth, even though some new mothers find this an inappropriate time to discuss family planning. Although you may feel daunted at the prospect of having two very young children, there are advantages to having a close age gap. Your children are likely to grow up as playmates and the period of sleepless nights, nappy changes, and of having very dependent young children can be dealt with altogether in a shorter space of time
I’ve left it too late for an abortion - is it wicked to let my baby be adopted?
Adoption is often dismissed as an option, but sometimes it is the best choice for you and your baby The nine months of pregnancy provide you with time to explore all options available to you, including temporary voluntary foster care During this time you will be able to talk to adoption agencies and social workers who can inform you of the process and support you. View this as a positive process, in that you care enough about your baby to find the best care at a time when you feel unable to be the one to provide this.
When it comes to making a final decision, bear in mind that it should not be made during pregnancy, since you are subject to a range of emotions and feelings and you have not yet met your baby or know how you will feel in the longer term. Talk to your doctor to find out more about the process, your rights, and your right to change your mind.
My boyfriend doesn’t want to know about my pregnancy -will he have rights after the birth?
Your boyfriend is quite possibly shocked by the news that you are pregnant but, given time, he may come round to the idea and be more supportive. Although it is a difficult and hurtful time for you, try not to overreact by denying access to the father after the birth, unless you are certain this is what you want. Once your boyfriend sees your baby, his attitude and feelings may change, so it could be worth giving him time to adjust It can help to seek support from trusted family members and friends.
A biological father does not have automatic rights to be involved in the upbringing of his baby if he is not legally married to the mother and he is not named on the birth registration forms. (If the parents aren’t married, the father has to accompany the mother to register the birth if he wants to be named on the birth certificate.) If he is named on the birth certificate, he has some basic rights in terms of access and has some financial responsibility for his child If you do not wish your boyfriend to have access then you do not need to name him on the birth forms. If he has been named on the forms and you decide later that you don’t want him to have access, you will need to go to court to seek a formal injunction and be able to justify why you require this. You should bear in mind the financial implications of your decision if you do not include him on the forms and whether this means that he would not be obliged to provide financial support for you and the baby.

Young mums and older mums
Adapting to pregnancy
Pregnant women who are older or younger than average are likely to have additional concerns about how they will cope with pregnancy and impending motherhood.
How will I cope as a younger mum? There are pros and cons to being a younger mum. On the downside. you may have more concerns about how you will cope financially and how this may affect your education or career, and you may be in a less stable relationship and be concerned about the possibility of separating from your partner, On the practical and physical side, you are likely to have far greater reserves of energy to cope with childbirth and babycare, and some younger mums have good support in the form of relatively young grandparents
What can I expect as an older mum? There are advantages and disadvantages to giving birth later in life. If you are over 35, your pregnancy will be higher maintenance and you will be offered a greater range of screening and diagnostic tests as there is a higher risk of complications for you and the baby (see p 116). As a result, you are likely to be more anxious during pregnancy Once the baby is born: sleepless nights and constant childcare may be more taxing than it would be for a younger mum with greater energy reserves On the plus side, women today are fitter than ever and plenty of older women have trouble-free pregnancies You are less likely to have financial worries, are more likely to be in a stable relationship, and be more self assured and confident in your abilities.

Avoiding isolation
building up a support network
It is important for all pregnant women
to have emotional and practical support, and this is especially important if you are in a vulnerable situation.
* Attend all your antenatal appointments and build a relationship with your midwife; she is an invaluable source of information. * Book yourself in for antenatal classes. If you are single, daytime courses may be less populated by ”couples this gives you a chance to build up a network of women, which will be invaluable after the birth * Don’t be too proud to accept offers of help from friends and family

What do I tell my boss?
your rights and benefits
My manager said I can’t have time off for my antenatal clinic, is this true?
All pregnant women are entitled to paid time off to attend antenatal appointments as required by a registered medical practitioner, midwife, or health visitor. The employee must show a certificate issued by one of the above professionals to confirm they are pregnant, together with proof of the appointment. You are not expected to do this for the first appointment as this will be when you ask for the documentation Antenatal appointments include childbirth preparation or relaxation classes, as these are an important part of your care. If your employer is refusing to allow you time off, start by talking it through with him or her. If this doesn’t help, seek advice from your human resources department or another senior member of staff You can also contact trade union representatives, the Advisory, Conciliation, and Arbitration Service (ACAS), or the Citizens’ Advice Bureau (see p 310).
When is the best time to tell my employer that I’m pregnant?
As soon as your employer knows that you are pregnant, the employment laws that protect you will apply, so it’s a good idea to tell him or her straight away. It is recommended that you inform your employer in writing with details of your expected due date. Your employer should then conduct a risk assessment for you in your working environment. Any risks identified should be removed or, if this is not possible, alternative arrangements should be made for you. You can also discuss when your maternity leave will start, when you can take any outstanding holidays, and if there are any other entitlements If your baby is born early or your maternity leave starts earlier than planned due to illness, the arrangements can be altered at short notice. Your employer should respect
your right to confidentiality, so by telling them, this should not mean that everyone else at work will know. If you wish the issue to remain confidential until a certain date, you could add this to your letter.
Can you tell me about the new baby funding from the government?
The government introduced the Child Trust Fund for children born after the 1st September 2002. This is a voucher of E250 that is to be used to set up a tax-free savings account. The account will be for the child
alone and can only be accessed by them when they reach the age of 18, although they can start to plan what to do with the money from the age of 16. Once the account has been set up, family and friends can add to the savings to a maximum of £1,200 each year. When your child is 7 years old, a second payment of £250 is made and children of low-income families will receive an additional E250 around the same time that will be paid directly into their bank account. There are three types of account that you can choose to set up for your baby a savings account, an investment account, or a stakeholder account. Talk to a bank or building society about which account they would recommend.

Since I told my boss I’m pregnant he has been really dismissive - what should I do?
The law protects you from being unfairly treated as a result of you being pregnant. This includes dismissal on the grounds of being pregnant or a reason that is connected to pregnancy, If you feel that your boss is treating you unfairly, try to resolve this with him first.
To protect yourself, it is advisable that you keep your manager informed of your maternity leave, return date, and antenatal appointments. Always confirm appointments in writing or provide official documents that show appointment times You should also ask your manager about any additional benefits the company may have and when you will have your risk assessment. If your manager does not respond satisfactorily to these requests, seek advice from your human resources department, a senior member of staff trade union representative, ACAS or the Citizens’ Advice Bureau.
Am I sure to get my job back after having my baby?
The law states that all employees on ordinary maternity leave (52 weeks) are entitled to return to their original job. This is regardless of how long they have worked there or what hours they work. Exactly the same terms and conditions should also apply. If a member of staff returns after parental leave (see right), then they should return to the same job where possible, if not a suitable alternative should be given. You have to notify your employer, usually in writing, when your maternity leave is planned to start. When they receive this letter, they have 28 days to write and confirm your return date. You do not need to give notice if this is the date you plan to return, but if the planned date is different or changes, eight weeks’ notice is required. You cannot work for the first two weeks (or four weeks if in a factory) following the birth of your baby.
How long can I stay at home after I’ve had my baby?
The law changed in April 2007. All pregnant women. can now take up to 52 weeks as maternity leave, regardless of their length of continuous service at their place of work. Notification to your employer must be given before the 15th week before the baby is due (25 weeks’ pregnant).
Statutory maternity pay is paid for 39 weeks to pregnant women earning at least £87 per week with 26 weeks continuous service into the 15th week before the baby is due You need to give written notice to your employer 28 days before the start of statutory maternity pay. If you do not qualify for this benefit, you may receive maternity allowance for 39 weeks (see p.62).
Am I allowed to take additional time off unpaid after my paid maternity leave ends?
You can take parental leave after maternity leave and will be entitled to the same terms and conditions as if you were taking ”additional” maternity leave of 52 weeks (see above). This means you can return to the same job, where possible, or a suitable alternative should be found. Parental leave is a separate entitlement for employees who have worked for the company for one year and must be used to care for the child or to find suitable childcare arrangements. Each parent can take 13 weeks for each child and it is unpaid If you have twins, this means you will get 13 weeks for each twin. If you do not qualify for parental leave, you could take paid holiday or ask your employer for unpaid leave. It may be worth discussing flexible working options with them, too.

Can I refuse to do tasks during pregnancy if they might put my health or the baby’s health at risk?
An employer has a duty to comply with health and safety laws, and when you are pregnant your employer must carry out a risk assessment for you within the workplace. The sooner you tell your employer in writing that you are pregnant, the sooner this check will be conducted Your employer has an obligation by law to tell you of any risks known to the company that may affect your pregnancy, Common risks to you or your unborn child are exposure to toxic or harmful substances; lifting heavy loads; standing, sitting, or twisting for long periods of time; long working hours; or certain shift patterns Your employer has a duty to either remove the risk or, if this is not possible, remove you from exposure to the risk. This may involve a suitable alternative job or suspension on full pay.
The company is talking about redundancy - can they get rid of me when I’m on maternity leave?
Your employer is breaking the law if they make you redundant because you are pregnant or taking maternity leave This is an example of sexual discrimination, as they could not treat a man in the same way, However, if the reason is a legitimate one unconnected with your pregnancy, and they have not treated you any less favourably because you are pregnant, then this is allowed.
Apart from unfair redundancy, how else can I be discriminated against during pregnancy?
Other discriminatory issues during pregnancy include giving you unsuitable work (you should have had a risk assessment carried out, see above), changing your hours of work without your agreement, using pregnancy-related illness as a disciplinary issue, and giving you poor staff reports because you are pregnant
My friend came back to work and was demoted - are they allowed to do that?
Under the Sex Discrimination Act (1975) it is against the law for an employer to discriminate against an employee on the grounds of gender, marriage, pregnancy, or maternity leave This can be classified as direct or indirect discrimination. An example of indirect sex discrimination may be less favourable treatment of part-time workers, which may affect women in particular as more women tend to work part time than men. All employees on ordinary maternity leave (52 weeks) are entitled to return to their original job, however long they have worked at the company. If an employee returns after additional parental leave, they should return to the same job where possible, or if not to a suitable alternative. If it is felt that an employee has been demoted due to maternity leave, advice should be sought by the human resources department, a trade union representative, ACAS, or the Citizens Advice Bureau.

I want to work part time after my baby is born - do I have that right?
Currently the law states that parents of children under the age of 6, or disabled children under the age of 18, have the right to apply for flexible working, which can include different shift patterns, when -you work, how long you work, and where. You must make your request in writing. Your employer is duty bound to consider your request and must be able to demonstrate why this is not possible if it is refused. You are entitled to take a colleague with you to any meetings regarding this issue, which may be your trade union representative if you have one.
If at any point you feel that your employer has not reasonably demonstrated why the company cannot accommodate your request, you can seek the advice of a trade union representative, the human resources department, or another senior member of staff. Also, as previously mentioned, organizations such as ACAS and the Citizens’ Advice Bureau may be able to offer advice and information.
What is maternity allowance and will I be eligible for it?
Maternity allowance is a benefit for women who have changed jobs during pregnancy, are self-employed, or who have had low earnings or unemployment during their pregnancy (see p 63). Your midwife should be able to advise you on what you are entitled to and can give you a certificate to confirm your pregnancy, which is known as a maternity certificate or Mat B1. which you will need to claim your maternity allowance.
What happens if I decide to be a stay-at-home mum - do I have to give my maternity pay back?
If you decide that you don’t want to go back to
work after the birth, you must give your employer at least the amount of notice your contract requires for leaving your job, and more notice if possible. You are still entitled to receive your maternity pay for up to
39 weeks even if your employment ends, and as long
as you do not begin another job, and you do not have to pay any of this back. However, if you had additional maternity pay or benefits, you may be required to pay some or all of these back.
I want to work right up to the birth - is that allowed?
Yes, you can do this, but you may need a doctor’s medical certificate to confirm that -you are fit to do so, and you should tell your employer at least 15 weeks before your baby is due when you want to start your maternity leave. Think carefully before making this decision Late pregnancy is extremely tiring and, if your job is mentally and/or physically taxing, it may be better to begin your leave a few weeks before your due date. You will also need time to prepare for the arrival of your baby
I want to go back to work very quickly - how soon can I start?
Legally, you can return to work anytime from two weeks after the birth, or four weeks if you work in a factory However, on a practical and emotional level returning so soon may not be a good solution Most women find that it takes around six weeks to recover after the birth Breastfeeding takes around six weeks to become established too Even if you bottlefeed, it is probable that your hormones, together with the natural exhaustion that follows having a baby, prevent you from concentrating. You may find that it is hard to be apart from your baby for long periods and -you need to think about your baby’s needs too.

Maternity benefits
Your rights in pregnancy
There is a range of benefits available to pregnant women and what you are entitled to depends upon your individual circumstances and your employment status These benefits have improved considerably over the years Check your company’s policy, as individual companies may also offer their own, more generous, maternity package.
Ordinary maternity leave All pregnant employees are entitled to take 52 weeks of maternity leave, regardless of the amount of time they have worked for an employer and their salary You can start your leave up to 11 weeks before the baby is due You can choose to work up to your due date, although if you take any time off sick in the four weeks before your due date, your employer can start your leave from that date
You are obliged to give your employer a minimum of four weeks’ notice of when you intend to start your leave and a minimum of four weeks’ notice of when you plan to return. You are also legally obliged to take a minimum of two weeks’ leave after the birth of your baby You may need to inform your employer in writing of your intention to take leave Tell them the date when the baby is due and the date you want to start your maternity leave. If you meet certain criteria (see right), you may be entitled to statutory maternity pay for 39 weeks of your maternity leave, after which time you will be taking unpaid maternity leave.
What are my rights while I’m on leave?
You have the same employment rights and benefits (with the exception of your wages) while you are on maternity leave However, while on additional maternity leave, some of your rights, such as contributions to a pension, may be temporarily
suspended. While on leave, you are also entitled to build up your minimum holiday entitlement, which you can add on to your leave either at the beginning or the end
Statutory maternity pay If you have been in full-time employment, or work part-time or on a fixed contract for over six months, you are entitled to receive statutory maternity pay (SMP).You are eligible for this benefit if you have worked for the same company for 26 weeks, by the end of the 15th week before the expected week of the birth. This is paid at 90 per cent of your weekly earnings for the first six weeks and then at the lesser of £112,75 or 90 per cent of your weekly average for the next 33 weeks. This is not dependent on whether or not you plan to return to work, and you do not have to return the money if you change your mind about returning to work. Your employer will deduct your tax and National Insurance contributions, and then your employer reclaims around 90 per cent of your pay from the Inland Revenue.
Maternity allowance If you are self-employed have changed your job, or have had periods of unemployment during pregnancy, you are entitled to maternity allowance, which is a tax-free benefit from the government that is also dependent on your National Insurance contributions
Maternity allowance is paid for 39 weeks at a rate of £112.7 5, or 90 per cent of your average weekly earnings if your earnings are below this figure To be eligible for maternity allowance, you will need to have been working for at least 26 weeks out of the 66 weeks before your baby’s estimated due date, and have average weekly earnings of around £30. You can begin to claim your maternity allowance up to 11 weeks
before your baby is due, and the latest you can claim this allowance is the day after your baby is born.
Time off for antenatal care Your employer is legally obliged to allow you to take a reasonable amount of time off to attend any antenatal appointments, which can include time off to attend antenatal relaxation classes or hospital antenatal classes.
Additional benefits There is a range of other benefits that are not linked to employment, which pregnant women are entitled to claim. All pregnant women are entitled to free NHS dental care during pregnancy They are also entitled to free eye treatment and free prescriptions. You continue to be entitled to free dental care and prescriptions for you and your baby for a year after the birth.You will need to obtain your exemption certificate from your health authority and your midwife or doctor will give you the application form when you have your booking in appointment.

Paternity leave
Rights for fathers
Paternity leave can be granted for an employee who is the biological father or the partner or person who will be responsible for the child’s upbringing.
To qualify for paternity leave, an employee must have had 26 weeks’ continuous service at the end of the 15th week before the baby is due and the employer should be notified, in writing, by the end of the 15th week before the baby is due. The amount of leave granted is usually around one or two weeks, which can be taken together, but not as separate days This time off must be taken within 56 days after the birth Statutory paternity pay will be paid if an employee earns at least 87 pounds per week It will be worked out as the lesser of £112.75 a week or 90 per cent of the average weekly earnings. This is the standard paternity leave package, but individual companies may offer more generous terms and conditions.

What to eat … What not to eat
your diet in pregnancy
I love seafood and eat it regularly. Can I continue to eat it during pregnancy?
Eating raw or undercooked shellfish is risky and should be avoided as they can contain harmful viruses and bacteria Raw oysters can carry a virus called Norovirus, which causes nausea, abdominal pain, and diarrhoea, and raw or partially cooked shellfish can contain hepatitis A, a virus that affects the liver However, eating well-cooked prawns, lobster, oysters, clams, cockles, scallops, or crab is now considered safe as cooking kills any bacteria or viruses Nutritionally, too cooked shellfish are beneficial as they are low in fat, high in proteins
and rich in minerals A well-cooked prawn or lobster turns red and its flesh opaque, while a cooked scallop is opaque, white, and firm to touch Clams, mussels, and oysters open their shells when they are well cooked – throw away any that don’t open. Make sure you buy shellfish from a reputable source.
My midwife said I should avoid pate. Why?
All pates including those made from vegetables
or fish, should be avoided during pregnancy unless they are tinned or have been heat-treated. This is due to the risk of listericsis, a rare infection caused by the bacterium Listeria monocytogenes found in pates, blue-veined and some soft cheeses, unwashed salads, and ready-to-eat foods Listeriosis resembles a mild ‘flu”, with symptoms such as aching, sore throat and a raised temperature However, even a mild infection can cause miscarriage, stillbirth, or severe illness such as meningitis or septicaemia in the newborn Another reason to avoid liver pate (and also fish liver oils, liver sausage, and liver) is that it contains high levels of vitamin A, which has been linked to birth defects.
I like to eat rare steaks - are they allowed in pregnancy?
No. You should make sure that you eat only meat that has been well cooked, as raw meat contains bacteria that can cause food poisoning. This is especially important with poultry and products made from minced meat such as sausages and burgers. Meat should be cooked until it is piping hot all the way through, there is no pink meat, and the juices run clear. Wash -your hands after handling raw meat, and keep it separate from foods that are ready to eat You should also avoid eating raw eggs and undercooked poultry because of the risk of salmonella
I eat a lot of mozzarella, but
is it counted as one of the “soft cheeses” to be avoided?
Cheese is one of the top worries for pregnant women according to a health research charity. However, soft processed cheeses, such as mozzarella, cottage cheese, and cream cheese are safe to eat throughout pregnancy. The advice is to avoid cheeses such as Camembert. Brie or Chevre (a type of soft goat’s cheese), or others that have a similar rind and blue-veined or mould-ripened cheeses, as these could contain listeria, a type of bacteria that could harm your baby (see above) According to the Food Standards Agency, cooking should kill any listeria, so it should be safe to eat food containing soft, mould-ripened, or blue-veined cheeses, provided it has been properly cooked and is piping hot all the way through.
I’ve started to crave chocolate all the time - is this likely to harm my baby?
It’s not unusual for women to experience cravings in pregnancy. Most are “normal”, while others, such as urges to eat earth, coal, chalk, or soap, are not, although they do sometimes happen!
Normal cravings can include a desire to eat anything from pickled onions and ice cream to chocolate. Do mention this craving to your midwife as she may want to check that you are not deficient in magnesium, B vitamins, or iron, all found in dark chocolate. A little indulgence is fine, but giving in to a pregnancy full of chocolate could cause nutritional deficiencies if it stops you eating a well-balanced diet, and lead to excessive weight gain.
However, eating chocolate in pregnancy has been linked to contented babies; this may be due to a high intake of phenylethylamine, a mood-enhancing chemical present in chocolate (also present in larger quantities in tomatoes and fruit), or it may be due to happy, relaxed mothers who have indulged!
I love spicy foods but have been told these may trigger an early labour - is this true?
Many people believe that eating a curry encourages the start of labour, but this is completely untrue. Although the reasoning behind this sounds logical, the theory does not work. One of the less talked about first signs of labour is a loose bowel motion or even diarrhoea This occurs because the cervix (neck of the womb) and part of the bowel have a common nerve supply. As the cervix starts to soften in readiness for labour, so the bowel is stimulated. This may cause faster movement of food and more frequent, looser bowel motions. Labour may follow in
the next few hours or it may not happen for a day or so. Some people think that if you eat an extra hot curry, for example, to bring on a bout of diarrhoea, this will stimulate the cervix and labour will start Unfortunately, the process doesn’t seem to work reliably in reverse. Labour following self-induced diarrhoea is probably coincidental, and the side effects of abdominal cramps, diarrhoea, and soreness are disagreeable.
However, if you regularly eat curries and spicy food, and have not been suffering from heartburn or indigestion, then there is no harm in treating yourself every now and then
I’m fed up with people telling me what I should and shouldn’t eat and drink - what do you say?
While no health promoter wants to be prescriptive there is plenty of research highlighting the ill effects of poor nutrition, smoking, alcohol, and drug misuse on the fetus. Members of the heath profession, and even friends and family, may have personal experience of babies born with low birth weights, birth defects, syndromes, withdrawal symptoms, or infants who go on to develop allergies in childhood, such as eczema and asthma. The reason people are offering advice is because they want what is best for you and your baby In the first three months in particular, while your baby’s organs are developing, lifestyle choices carry a risk If you can, try to take on board this advice as long as you are sure it is correct, current, and evidence-based.

I’m really overweight - could this affect my pregnancy?
The medical concensus is that women with a high body mass index prior to pregnancy (see p.18) should try to limit the amount of weight they gain, as putting on too much weight increases the risk of developing high blood pressure, gestational diabetes, and having a big baby, The recommended weight gain in pregnancy is 10-12.5 kg (22-28 lb), If you gain weight within this range, you have a lower risk of complications during labour and birth.
However, pregnancy is not the time to go on a diet. Research shows that, for a pregnant woman who is overweight, a low-calorie diet does not reduce her chances of developing high blood pressure or pre-eclampsia and doesn’t benefit the baby Instead, you should seek advice from your midwife or doctor about how to eat a healthy, well-balanced diet that will ensure you don’t pile on the pounds, but which keeps you and your baby healthy (see p.50).
I want to get back into my jeans right after the birth. How can I make sure I don’t get too fat?
These days, it is almost impossible to pass a newspaper stand without seeing the latest celebrity who has not only fitted straight back into her clothes
after having her baby, but who actually weighs less than she did before her pregnancy. However, this is concerning for health professionals, as a dramatic weight loss after the birth is not good for the mother or for her baby The average weight gain during pregnancy is 10-12.5kg (22-281b) (see p. 107). Your baby (including the placenta and the waters surrounding the baby) makes up approximately 5kg (11 lb) of this, with 6 kg (131b) gained from increased fluids, fats, and an enlarged uterus Much of this extra weight will be lost as soon as your baby is born. Also, after the birth, some of this extra weight provides nutrients for breastfeeding, which uses up to 500 calories a day.
The most sensible approach to controlling your weight during pregnancy is to eat a healthy diet and take gentle exercise to ensure that weight gain is not too dramatic You should be eating around 2,1002,500 calories a day, increasing this by 200 calories in the last trimester — the equivalent of a couple of slices of toast with low-fat spread and a glass of milk.
It is important to be realistic about postnatal weight loss. A sensible guide is “nine months on, nine months off” and most dieticians recommend losing no more than 0.9kg (21b) a week. This may not seem much, but adds up to 6kg (141b) in seven weeks — achievable with healthy eating and exercise.

Is it alright for me to have the occasional glass of wine throughout my pregnancy?
This is really a personal choice you need to make in pregnancy Although experts do not agree on the exact level of alcohol needed to cause harm to babies during pregnancy the general consensus is that drinking has to be heavy and regular to cause a dangerous condition known as fetal alcohol syndrome (see p 37).
However, you should be aware that alcohol crosses the placenta to your baby very easily and quickly, and that drinking during pregnancy could potentially damage -your baby and -your own health. The government’s official advice is not to drink alcohol when you are pregnant or trying to conceive If you do decide to drink, make sure it is no more than one or two units, just once or twice a week. Many women give up alcohol during pregnancy and you may feel that you simply no longer enjoy the taste. It’s also worth noting that although alcohol doesn’t contain fat, it’s high in calories, with a glass of dry white wine containing over 100 calories.
I have a really sweet tooth - is it OK to indulge this during pregnancy?
While occasional treats of sweets or crisps are fine, processed foods usually contain hidden fats and sugars and provide few nutrients, so it’s best to try and curb the amount of sweet foods you eat. Read food labels and look for alternative foods containing less fat and added sugars Just as you would consider carefully how you wean and feed your growing child, you should look after yourself in the same way
One of the best ways to curb your sweet tooth is to eat regular meals throughout the day This helps to steady your blood sugar level and reduce sweet-tooth cravings. Try not to go longer than three hours without eating and, if you are hungry, have a healthy snack between meals, such as malt loaf, a cottage cheese sandwich, chicken or lean ham, a low-fat yogurt, or fruit, including fresh. tinned, or dried, such as raisins or apricots. Also, try to ensure that you
drink about two litres of water a day, as perceived hunger is often really dehydration. If you can’t give up sweet drinks, you could try artificial sweeteners, such as saccharin. There is no evidence that small amounts of these are harmful during pregnancy or while breastfeeding
Should I be taking vitamin supplements during my pregnancy?
There is still uncertainty about whether women who have a well-balanced diet need dietary supplements during their pregnancy If you do decide to take a supplement, it is important to choose one that is designed specifically for pregnant and breastfeeding women and which contains the appropriate mix of vitamins and minerals A good pregnancy supplement contains more folic acid, calcium, and iron than a general multivitamin and no vitamin A.
If you do take a supplement, it’s still important to eat a varied, well-balanced diet If you are unsure at all about which medicines and supplements are safe during pregnancy, your local pharmacist will be able to advise you You can buy antenatal supplements
at almost any chemist, or your doctor may prescribe them if he or she feels that your diet is providing insufficient nutrients.
I don’t have a very balanced diet - does this matter?
Maintaining a balanced diet is important and especially so in pregnancy Now is a time when you need to make sure that your diet is providing you with enough energy and nutrients for the baby to grow and develop, and for your body to deal with the changes taking place. So yes, your diet does matter.
Your daily intake should include foods in approximately the following proportions: a third fruit and vegetables (at least five portions a day); a third carbohydrate-based foods like bread, potatoes, cereals, and pasta; a sixth of protein foods like meat, poultry, pulses, cheese, and other dairy products; a small amount of sugar and fat; and at least eight glasses of water each day It’s a good idea to cut down on foods such as cakes and biscuits, which are high in fat and sugar, to avoid putting on too much weight. If you feel you need some advice, discuss your diet with -your midwife or doctor, who may also recommend that you take vitamin supplements in addition to your food (see above)
Is it safe to eat peanuts or foods containing peanuts during my pregnancy?
Some experts feel that if a child is at a particular risk of developing a peanut allergy, the problem may have started to develop before birth, when a sensitivity to peanuts may have started due to exposure in the womb from the mother’s diet
However, some recent studies have suggested that avoiding peanuts may actually be increasing the incidence of allergies, pointing to countries where peanuts area staple food and allergies relatively rare.
Your baby may be at risk of a peanut allergy if you, or your partner, or your baby’s siblings suffer from asthma, eczema, hay fever, or other allergies. Official government advice is that if you fit into any of these groups, you should not eat peanuts, or peanut products, in pregnancy or while breastfeeding. There is no need to avoid peanuts if your baby is not at risk of peanut allergy Other nuts, such as hazelnuts, Brazil nuts, and wainuts, are safe to eat during pregnancy.
Weaning information has also changed, with ‘`at risk’ families being advised to delay the introduction of peanuts until the age of three
Does what I eat in pregnancy influence my baby’s long-term health?
There are reasons to believe that what you eat during your pregnancy can influence your baby’s health long term and possibly her tastes too. Some experts have suggested that problems that occur later in life, such as obesity diabetes, and other health problems, may be caused not so much by what a person eats during their own lifetime, as by what their mother ate while she was pregnant
Also, there have been studies that have looked at links between a pregnant mother’s protein and carbohydrate intake and a baby’s blood pressure.
Research undertaken at Tommy’s Maternal and Fetal Research Unit (see p.310) suggests that a mother’s diet in pregnancy and while breastfeeding does influence the health of her offspring throughout their lives Studies reveal that pregnancy diets rich in fat have been associated with the later development of breast cancer in children and further research is being carried out Talk to your midwife for advice on eating a varied, well-balanced diet.

Non-alcoholic drinks
It’s important to stay well hydrated in pregnancy to combat fatigue and avoid constipation, which is a common side effect of pregnancy due to a sluggish digestion brought about by hormonal changes in your body. The advice is for you to aim to drink around two pints of fluid every day. This fluid should come mainly from water, but there are other good
sources of fluids including herbal teas (avoid raspberry leaf tea until later in pregnancy, see p, 144), fruit juices, and milk. However, try not to drink too much milk as it has a fairly high calorie content (stick to skimmed or semi-skimmed). Avoid, or limit your intake, of drinks
containing caffeine, including tea, coffee, and carbonated drinks, as caffeine interferes with your absorption of vitamins, and high levels of caffeine have even been linked to an increased risk of miscarriage

Cravings
should you give in to a food craving?
No-one is really sure what causes food cravings in pregnancy, although it may be a mixture of hormonal, physical, and psychological factors.
* The most common cravings are for sweet or salty foods; these are OK to indulge now and then, but are lacking in nutrients so try to limit your intake
* Cravings for foods such as fruit or fish may be a natural desire to eat as healthily as possible in pregnancy
* Strange cravings, known as ”pica”, for items such as chalk, may indicate an iron deficiency - and should not be indulged!

Taking Medicines in Pregnancy

What is safe to take?
The advice to pregnant women is to avoid taking any medicines in pregnancy if at all possible. If you do need to take medication, check with your midwife or doctor first, or ask your pharmacist for information on over-the-counter drugs. The list below offers some guidance
Antiemetics: For women with severe morning sickness, an antiemetic drug may be suggested Your doctor will recommend one that is safe to take in pregnancy
Antihistamines: Most of these should be avoided in pregnancy. If you have hay fever, try to avoid known triggers and allergens or talk to your doctor about safe medications in pregnancy
Painkillers: If natural remedies, such as a head massage to relieve a headache, or a warm bath to ease backache, don’t work, then paracetamol is generally considered safe for short-term use in pregnancy although it should be avoided if possible. Ibuprofen should be avoided altogether. as should aspirin (unless specifically prescribed by your doctor)
Antibiotics: There are antibiotics that are safe for use in pregnancy. Penicillin-based ones are usually prescribed, or if you are allergic to these there are other safe alternatives The following ones should be avoided in pregnancy!
* Tetracylines can affect the development of a baby’s bones and teeth and may cause discolouration of the teeth.
* Streptomycin can cause damage to the ears of the growing fetus and result in hearing loss and so should be avoided in pregnancy
* Sulphonamides: These cause jaundice in the baby and should not be given in pregnancy
Laxatives: If you are suffering with constipation, try natural dietary remedies first, such as eating lots of fibre and drinking plenty of fluids If these don’t work, then over-the-counter laxatives are
safe to take in pregnancy. Ones that contain bulking agents are the best.
Antacids: Heartburn is a common problem in late pregnancy due to the pressure of the baby on the stomach. Antacids are generally safe to take, but avoid sodium bicarbonate as the sodium is absorbed into the bloodstream.
Diuretics: These should be avoided If you experience sudden swelling in the face, hands, or feet, you should talk to your doctor or midwife, as this is one of the signs of pre-eclampsia (see p 89)
Cold and flu remedies: As these remedies often contain a variety of ingredients, which can include antihistamines and other decongestants that are best avoided in pregnancy it’s important to check the label carefully and talk to your doctor or pharmacist before taking any of these Try natural remedies, such as steam inhalations, before resorting to medicines, or simply take paracetamol for a short time.
Steroids: Anabolic steroids should not be used in pregnancy. It’s safe to use mild steroid creams short term for eczema, although avoid using these over a large surface area. Steroid asthma inhalers are safe, as are steroids prescribed for other conditions if your doctor knows you are pregnant.