Posts Tagged ‘vaginal bleeding’

What can I do to help?
partners at the birth
Should I be with my partner as soon as she goes into labour? I’ve heard that first babies take ages.
It’s true that first labours often take quite a few hours, although this is certainly not the case with everyone! When your partner notices signs that labour is beginning, such as a mucousy ’show”, the waters breaking, or irregular period-type pains, she may wish you to be with her. On the other hand, she may be happy to be alone, or with a friend or relative,
and keep you updated by phone Whether or not -you are there really depends on how she feels so good communication between the two of you is the key.
Once your partner is having regular, painful contractions about every five minutes, it would probably be best to be with her, if you aren’t already It is usually around this time that you should be making your way to hospital, if that is where you are planning to have the baby, or contacting the midwife if you are planning a home birth.
I feel very panicky about getting my partner to hospital on time. How can I calm down?
Your anxiety is understandable. However, not many babies are born on roadsides or in hospital car parks — that’s why these stories make their way into newspapers and magazines! It is hard to advise on a definite time to go into hospital as every labour is different and follows a slightly different pattern. However, as a general rule, you should think about going in to hospital if:
•    Your partner has had any vaginal bleeding.
•    Your partner’s waters break (see p.167), She may notice this as a gush of fluid from the vagina, or a more gradual leaking.
* Your partner’s contractions (which are often described as strong period-type pains that are
accompanied by a hardening of the bump) are lasting around 45 seconds each and coming regularly, at least every five minutes.
If you or your partner are unsure about how to proceed, don’t hesitate to give the labour ward a call. An experienced midwife can tell a lot about how far into her labour a woman is likely to be just from talking to her about what is happening.
I’ve heard lots of stories about blokes in the labour ward - I want to be helpful, but I am nervous.
Many men are very anxious about being with their partners during labour and birth. This is often due to the fact that they will be watching their partner experience one of the most intense things a woman can ever do and they may be unsure of how to help
Probably the best way to help overcome your fears is to talk to your partner about how you feel and try to discuss ways in which you could help. You will probably find that there are plenty of ways in which you can support her, such as being aware of her wishes and speaking for her if she is unable to because of the pain, repeating what midwives and doctors have said if she didn’t hear or process the information, passing her a drink, rubbing her back, holding a flannel to her face, switching music on or off, and generally encouraging and reassuring her.
Attending birth preparation classes together can be very useful You will be able to learn more about the process of labour and birth, which can be helpful, and you will learn about how to support -your partner both physically and emotionally. Some classes teach birth partners massage techniques that can be an effective form of pain relief during tabour You will also be shown how you can support your partner in certain birth positions. Your partner’s midwife will be able to advise you on classes available in your area.
I really don’t want to be there - how will I tell her and who should go in my place?
Honesty is the best policy, so you need to talk to your partner about your concerns well in advance of the big day. Although she may feel disappointed at first that you don’t want to be there, she should appreciate your reasons if they are valid ones. Perhaps you could try to reach some sort of compromise whereby you will be with her during the earlier stages of labour, go out for the actual birth (if you are worried about this), and then come back in again straight afterwards to support your partner and meet your new baby
It is up to your partner who else she has with her during labour Women often choose their mum, sister, another female relative, or a close friend to be with them However, if she can’t think of anyone suitable, you may want to consider hiring a doula, who support women in labour (see p. 196); there are websites that can help you with this (see p.310). Your partner may also wish to have more than one birth partner, which most hospitals are happy to accommodate.
What should we do when my partner goes into labour?
Although it is often hard to define when labour has started, if the signs are that your partner is in the early first stages of labour (see p.167), you can both continue with normal activities as long as she feels comfortable. Being aware of how labour progresses and how contractions build up can help you to plan your course of action. For example, if your partner’s waters have broken, established labour usually follows within a few hours (although not always) and it is best to inform the hospital
While you wait for the contractions to become stronger and more regular, try to relax as much as possible between contractions You could make a healthy snack for you both to provide fuel for the hours ahead, practise breathing and relaxation techniques together, or run a warm bath to help your partner relax Once the contractions are around every five minutes and last about 45 seconds, you may wish to consider going into hospital, if that is where you are planning to have your baby. Ring the labour ward first to let them know what is happening
Is massage useful, or will my partner find it irritating when she’s trying to cope with the pain?
Many women find massage, particularly of the lower back to be very helpful during labour. The sensations of warmth and pressure can be soothing and give some relief from pain during labour. Massage stimulates the body to release endorphins, which are the body’s natural painkillers, and also acts as a ”distraction” from pain, providing another focus Communication is the key when it comes to massage. For example, your partner can tell you whether she wants to be massaged during contractions. or just between the contractions, or whether she wants firm or light pressure. You will probably learn simple massage techniques during birth preparation classes, or you may find some classes dedicated to massage techniques for labour. Ask the midwife what is available in your area
It can be the case that some women find that they do not want to be touched at all during labour If your partner feels this way, try not to take it personally -this is her way of dealing with the pain
Apart from massage, are there other ways I can help my partner cope with the pain?
Every woman’s experience of pain during labour is different, and they will have different ways of coping It can be difficult to know in advance if a particular coping technique will help, but many couples find
it helpful to talk before labour about how they might feel, and how the partner may be able to help. While some women find massage beneficial (see above). others will need help to focus on keeping their breathing slow and steady It’s worth practising labour positions that require the support of a partner before the actual birth (see p.182 and p 186). Having some favourite music on in the room may help your partner to relax Above all, most women appreciate encouragement and gentle loving support from their partner, and just the fact that you are there will go a long way in helping her to cope with the pain and exhaustion of labour and birth.
My friend’s husband won’t be at the birth. She wants me to be her birth partner. How can I prepare?
It’s a great privilege to be asked to be a birth partner for a friend and there are plenty of things you can do to prepare for the event. Obviously you will need to talk in advance about your friend’s expectations for labour and familiarize yourself with her birth plan if she has prepared one (see p 149). It’s important to be sensitive to your friend’s wishes, for example does she want you to remain with her throughout, or would she like you to leave the room if she has an internal examination? Talk to her about how she thinks she might react under stress and in pain - is she likely to shout or perhaps become more withdrawn? - so that you can prepare yourself mentally to deal with this. It would also be wise to find out as much as possible about what birth entails - the different stages of labour and what can help or hinder them. You could suggest attending antenatal classes with your friend so that you feel fully informed. It may also help to talk to someone else who has been a birth partner and who may have some useful tips. Bear in mind that you may need to be with your friend for a fairly lengthy amount of time. so you may want to have some provisions for yourself, such as snacks and drinks. You may also need periods of relief during the labour, and there may be times when you feel your morale is flagging. in which case it can be a good idea to have someone on standby who you can phone for encouragement and support.
How will I feel when I see a male doctor examine my partner? Will I feel jealous?
If labour and birth are straightforward, it is unlikely that your partner will need to be examined by a doctor. It is only if there is some concern over the wellbeing of either your partner or the baby, or both, that a doctor’s opinion is sought Even in this situation, an internal examination is not always necessary.
If your partner did need to be examined, you would probably find that you would be too worried to be aware of any feelings of jealousy Doctors, whether male or female, have only your partner’s and baby’s health in mind when they are performing any kind of examination.
I secretly want a boy - I haven’t told my partner - how will I cope if it’s a girl?
This is certainly not an unusual feeling to have and I think that many prospective parents have a preference, secret or otherwise, for a baby of a particular sex While it may take you a little while to become accustomed to having a baby of your less preferred” gender, you may well find that you have no problems at all bonding with the baby if it is a girl Seeing your own newborn baby for the first time is something that no-one can prepare for, and many parents feel a strong rush of emotion straight away. Others take a little longer to fall in love with their baby, and this is fine too.
Whichever sex your baby is, it takes time to get to know him or her. You will probably find that you relish watching every little movement and expression,
touching and stroking his or her little body, and will enjoy learning about all the different aspects of baby care. By being involved with your baby from the beginning, you will quickly experience the joy of parenting your son or daughter
I can be quite panicky in stressful situations. What if I pass out?
The image of the father-to-be fainting onto the floor of the delivery room is often portrayed in cartoons and on birth congratulation cards, but it is far from funny if it actually does happen! Fortunately, it is probably much less common than you may think.
It is understandable for any birth partner to
feel anxious and tense — you are watching someone you care about in pain, and you are m unfamiliar surroundings experiencing probably the most significant moments of your life! Focusing on your partner and attending to her needs may help to keep you occupied and distracted and less likely to dwell on your own anxieties. Also, developing a trusting relationship with your partner’s caregivers will help you feel able to express any worries you are having, and hopefully you will be given the reassurance and information you need
If you do find yourself feeling even the slightest bit woozy, try and leave the room as the midwife will be focused on caring for the mother and baby If you do not have time to leave the room to seek help, and you feel faint, dizzy, or light-headed, try to sit down immediately, with your head lower than your hips, or lie down with your feet raised Try to stop yourself “panic breathing” (breathing quickly and lightly), and take slow, deep breaths You should find that the feeling passes quite quickly. The midwife will probably ring the buzzer for assistance. A good tip is to ensure that you are not too hot — take shorts and a T-shirt with you as delivery rooms can be quite stuffy — and make sure you eat and drink regularly to prevent your feeling faint due to low blood sugar.
Our little boy suffered a lack of oxygen at his birth. He is fine, but I’m anxious about this delivery.
Unborn babies are designed to cope with a moderate lack of oxygen during the birth, which is quite normal Some babies do suffer a greater lack of oxygen, and midwives are often alerted to this by observing the baby’s heart-rate pattern If there is any cause for concern, the baby can be delivered quickly either by forceps or ventouse, or by a Caesarean section In most cases, the baby is born in a healthy condition, or responds quickly to resuscitation after the birth.
Every labour is different and there is no reason why your next baby should react to labour in the same way as your first, but your baby’s heart rate will, of course, be monitored very closely, so you should feel reassured by this.
Will I be able to help the midwife cut the cord after the birth?
It is popular for the baby’s father, or another birth partner, to cut the umbilical cord after the birth. Midwives and doctors are usually happy for this to
happen, as long as there are no problems with the mother or baby that would necessitate the cord being cut very quickly
The cord is tougher than most people think, but the midwife will guide you and show you how to cut it safely. Be warned that it usually takes quite a few attempts to sever it completely!
Will I be able to video or photograph the birth and do I need to agree this in advance?
Most hospitals are happy for you to film or photograph the birth of your baby if that is what you both want However, before you embark on this, you should first check that the midwives or doctors who will be conducting the actual delivery have no objection, as some professionals do not wish to be filmed for legal reasons.
While some couples treasure having a visual record of probably the most special and momentous time of their lives, other couples prefer to start filming or photographing their baby after the actual birth. It is important to consider the impact that being filmed or photographed at such an intimate and vulnerable time could have on your partner, and she should not feel in any way pressured to be filmed Also, it might be worth thinking about how filming the event may affect your actual participation in the birth. If you are concentrating on filming or taking photographs, you may not be as involved in the birth as you could be and may not be providing your partner with all the support that she needs.
When planning how to record the birth of your baby, bear in mind that clear communication between you and your partner before the labour, and with the midwife and doctor once labour has started, is important to ensure that everyone’s wishes in this matter are respected
Can we take food into the delivery room?
Most hospitals are happy for you to bring your
own food and drink into the delivery room, although most are able to provide your partner with light refreshments should she want something It used
to be the case that women in labour weren’t allowed to eat or drink, but nowadays this is not the case. Research on the subject has concluded that it is perfectly safe for women to control their own food and drink intake during labour
However, hospitals don’t tend to provide food for birth partners, so it would be wise to pack plenty of snacks There is usually a canteen on the hospital campus somewhere but getting supplies from there may mean you are away from your partner for a time Alternatively, vending machines may be available.
What and how much your partner eats should be guided by her appetite. She should try, however, to stick to light, easy-to-digest foods that will give her plenty of energy, such as fruit juices, bread and honey, dried fruit, digestive biscuits, or bananas. Once labour is well established, it is likely that she won’t feel much like eating as her body needs to focus on delivering the baby,
I’ve heard that natural or water births are best for the baby. Should I ask my wife to have one?
Most childbirth experts would agree that a straightforward vaginal birth is the safest form of birth for both mother and baby. It is also generally considered safe to use water as a method of relieving the pain in uncomplicated labours (see p, 156) However, it is sometimes not possible to achieve a straightforward vaginal delivery due to certain situations that can arise during pregnancy, labour, and/or the actual birth If a problem with either the mother or baby occurs, the medical team will advise on the safest way of delivering the baby.
It is important that your partner thinks herself about the type of birth she would prefer and does not try something she is uncomfortable with. So it is not really your job to make decisions on behalf of your partner, and it’s also wise to be prepared to be flexible and to see how labour unfolds.
My wife doesn’t remember much about the birth. How much should I tell her?
It’s best to be honest about your memories of the labour and birth, even if this was a daunting experience for you both. You are likely to be the best person to explain to your partner about how she coped, and sharing your memories may help her to feel comfortable about expressing her own emotions about the birth, particularly if it was fairly traumatic. In this case an important part of your partner’s (and your) acceptance of what happened during the birth is to recall the sequence of events and to try to understand why things went the way they did This is especially important if you feel that your partner’s care didn’t go according to the birth plan. If this is the case, you may even want to talk to the midwife who cared for your partner during labour and birth about what happened. You can ask her to go through your partner’s notes with you both and explain exactly what happened. You can also ask for a postnatal ”briefing” to discuss the birth by contacting the head of midwifery at -your local unit.

Extra birth partners

Most hospitals are happy for women to have more than one birth partner, although some do set limits, depending on the amount of available space.
* It’s common for women to have their mum, sister, or close friend with them in addition to their partner.
* If labour is particularly long, having more than one birth partner can mean that they can relieve each other for breaks knowing that the mother has someone with her, * Some evidence suggests that having a female birth partner reduces the amount of pain relief and intervention needed.

Birth partners
The aim of a birth partner, whether this is your husband or life partner, a friend, family member, or hired doula, is to offer practical and emotional support to you throughout labour and birth.
How can birth partners help? As a birth partner’s role is to support you through labour and birth. it is important that they are aware of your wishes and are prepared to liaise on your behalf or keep track of events when you are not able to. It is important that they are knowledgeable about the stages of labour and have discussed with you in advance ways in which they might help, whether through practical support such as massage or helping you with labour positions, or by offering you encouragement and reassurance
What is a “doula”? Doula is a Greek word that means ”woman servant” or ”caregiver”. Nowadays, this refers to someone who gives emotional and practical support to a woman before, during, and after birth. The aim is for a woman to have a positive experience of
pregnancy, birth, and early motherhood This help and support is extended to the partner and other children Doulas can offer support in pregnancy which gives time for the family to get to know her, In labour and birth, she can help with massage, suggesting different positions, liaising with professionals, and giving emotional support. After birth, doulas can help with feeding and baby care, as well as care of the mother, Some do housework, prepare meals, and entertain older children.

Your role as go-between
One of the most important roles of a birth partner, whether you are the baby’s father or someone else chosen to be the birth partner, is to be aware of what is happening during the labour and birth and to liaise with the medical professionals on behalf of the mother if necessary There may be instances when you or your labouring partner don’t understand why a certain course of action is being taken, and your partner may be in too much pain, or too preoccupied with labour, to be able to ask.Your job is to talk to the midwife or doctor and gather information about what is happening. This means that you will both feel fully informed about what is happening in labour and will be able to participate in any decisions that have to be made about the labour or birth.

Remaining calm

Even though the birth of your baby is one of the most memorable and exciting events of your life, it can also be hard to witness your partner’s pain and to stay calm under pressure. * Being mentally prepared to see your partner experience considerable pain can mean that you are more likely to respond in a reassuring, rather than anxious, way. * Breathing and relaxation techniques can help you to stay calm and focused too. * If you do start to feel flustered, it may be wise to leave the room briefly, if there is an opportune moment, to refocus.

Who will handle my care?
a guide to antenatal care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Possible causes of miscarriage

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