Maternity Centre

Our Maternity Centre

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ANTENATAL CARE

Pregnancy is measured in weeks so we have referred to your pregnancy in weeks (and days where appropriate).

About antenatal care

Antenatal care is the care that you receive from healthcare professionals during your pregnancy. It includes information on services that are available and support to help you make choices. Your antenatal services should be readily and easily accessible and sensitive to your needs.

Routine antenatal care for healthy pregnant women

During your pregnancy you should be offered a series of antenatal appointments to check on your health and the health of your baby. During these appointments you should be given information and clear explanations about your care. You should be given the opportunity to discuss any issues and to ask questions. You should also be offered antenatal classes, including breastfeeding workshops.

While you are pregnant you should normally see a small number of healthcare professionals, led by your doctor, on a regular basis. They should be people with whom you feel comfortable. Your maternity notes should record the care you receive. You should be asked to keep your maternity notes at home with you and to bring them along to all your antenatal appointments.

ULTRASOUND

ANTENATAL APPOINTMENTS

The exact number of antenatal appointments and how often you have them will depend on your individual situation. If you are expecting your first child, you are likely to have atleast 10 appointments or more. If you have had a baby before, you should have around minimum 7 appointments. Your antenatal appointments should take place in a setting where you feel able to discuss sensitive problems that may affect you (such as domestic violence, sexual abuse, mental illness or recreational drug use).

Early in your pregnancy your doctor should give you information about the likely number, timing and purpose of your appointments, according to the options that are available to you. You should have a chance to discuss the schedule with them. A brief guide to what usually happens at each antenatal appointment and What should happen at the appointments is given here.

What should happen at the appointments:

The aim is to check on you and your baby's progress and to provide clear information and explanations, in discussion with you, about your care. At each appointment you should have the chance to ask questions and discuss any concerns or issues with or doctor. Each appointment should have a specific purpose. You will need longer appointments early in pregnancy to allow plenty of time for your doctor to assess you, discuss your care and give you information. Wherever possible the appointments should include any routine tests.

Appointments in early pregnancy

YOUR FIRST CONTACT WITH DOCTOR

Your first appointment should be as early in your pregnancy as possible. At this appointment you should be given information about taking folic acid supplements, food hygiene and aspects of your life that may affect your health or the health of your baby (such as smoking, recreational drug use and alcohol consumption). You should also receive information about antenatal screening options and the conditions being screened for. Before any test is done, you should be given information about the reason for the test. Your doctor should explain to you that decisions on whether to have these tests rest with you, and they should make sure that you understand what those decisions will mean for you and your baby.

Appointments in later pregnancy

The rest of your antenatal appointments should be tailored according to your individual health needs. They should include some routine tests that are used to check for certain conditions or infections. Most women are not affected by these conditions, but the tests are offered so that the small number of women who are affected can be identified and offered treatment. Your doctor should explain to you in advance the reason for offering you a particular test.

During your later antenatal appointments, you should be given information about breastfeeding, how to prepare for labour and birth, your birth plan, how to know if you are in active labour, looking after yourself and your new baby, screening tests for newborn babies and being aware of signs of 'baby blues' and postnatal depression. You should also receive information on induction of labour in case your baby is late

Checking on your baby's development

At each antenatal appointment from 24 weeks, your doctor should check on your baby's growth. To do this, they should measure the distance from the top of your womb to your pubic bone. You will be offered an ultrasound scan if your midwife or doctor has any concerns about your baby's growth. The rest of this information describes what you can expect from your midwife or doctor during your pregnancy and about the tests that you should be offered.

BOOKING APPOINTMENT

At your booking appointment your midwife or doctor should weigh you and measure your height. If you are significantly overweight or underweight, you may need extra care.
Your doctor should give you information about:
  • how the baby develops during pregnancy
  • nutrition and diet, including vitaminD supplements
  • exercise, including pelvic floor exercises
  • antenatal screening tests
  • your pregnancy care pathway,where to have your baby
  • breastfeeding and workshops
  • antenatal classes
  • Your doctor should: see if you may need additional care or support andplan the care you will get throughout your pregnancy
  • ask about your job to identify any potential risks
  • measure your height and weight and calculate your body mass index
  • measure your blood pressure and test your urine for protein
  • find out whether you are at increased risk of gestational diabetes or pre-eclampsia
  • ask about mental illness and ask about any signs of depression
  • offer you screening tests and make sure you understand what is involved before you decide to have any of them
  • offer you an ultrasound scan to estimate when the baby is due
  • offer you an ultrasound scan at 18to20weeks to check the physical development of the baby.
16 weeks
  • Your doctor should give you information about the ultrasound scan you will be offered at 18to20weeks and help with any concerns or questions you have. Your midwife or doctor should: review, discuss and record the results of any screening tests
  • measure your blood pressure and test your urine for protein
  • consider an iron supplement if you are anaemic.
18 to 20 weeks (anomaly scan)
  • Ultrasound scan to check the physical development of the baby if you wish it.
  • As 40% of cardiac anomalies can be missed byUSG due to positional variations of fetus-its best advised to do a fetal echocardiogram at this sitting—USUALLY PERFORMED AT 20 -21WEEKS
25 weeks
  • Your midwife or doctor should: check the size of your abdomen
  • measure your blood pressure and test your urine for protein.
28 WEEKS- Your doctor should:
  • check the size of your abdomen
  • measure your blood pressure and test your urine for protein
  • offer more blood screening tests
  • offer first anti-D treatment if you are rhesus D-negative.
31 weeks
  • Your doctor should: review, discuss and record the results of any screening tests from the last appointment
  • check the size of your abdomen
  • measure your blood pressure and test your urine for protein.
34 weeks
  • Your doctor should give you information about preparing for labour and birth, including how to recognise active labour, ways of coping with pain in labour and your birth plan. Your doctor should: review, discuss and record the results of any screening tests from the last appointment
  • check the size of your abdomen
  • measure your blood pressure and test your urine for protein
  • offer second anti-D treatment if you are rhesus D-negative.
36 weeks
  • Your doctor should give you information about: breastfeeding, including hints and tips for success
  • caring for your newborn baby
  • vitamin K and screening tests for your newborn baby
  • your own health after the baby is born
  • Your doctor should: check the size of your abdomen
  • check the position of the baby and discuss options to turn the baby if he or she is bottom first (breech position)
  • measure your blood pressure and test your urine for protein.
38 weeks
  • Your midwife or doctor should give you information about what happens if your pregnancy lasts longer than 41 weeks. Your midwife or doctor should: check the size of your abdomen
  • measure your blood pressure and test your urine for protein.
40 weeks
  • Your midwife or doctor should give you more information about what happens if your pregnancy lasts longer than 41 weeks. Your midwife or doctor should: check the size of your abdomen
  • measure your blood pressure and test your urine for protein.
41 weeks
  • Your midwife or doctor should: check the size of your abdomen
  • measure your blood pressure and test your urine for protein
  • offer a membrane sweep
  • offer induction of labour.
  • Extra appointment if this is your first baby.

LIFESTYLE ADVICE

There are a number of things you can do to stay healthy while you are pregnant. Your midwife or doctor can tell you more about them.

Work

You should be able to carry on working during your pregnancy, but your midwife or doctor will ask about your job to see whether the work you do could be putting you or your baby in danger.

Exercise

You can continue or start moderate exercise before or during your pregnancy. Some vigorous activities, however, such as contact sports or racquet games, may carry extra risks such as falling or putting too much strain on your joints. You should avoid scuba diving while you are pregnant because this can cause problems in the developing baby.

Alcohol

If you are pregnant or planning to become pregnant, you should try to avoid alcohol completely in the first 3months of pregnancy because there may be an increased risk of miscarriage. If you choose to drink while you are pregnant, you should drink no more than 1 or 2 UK units of alcohol once or twice a week. There is uncertainty about how much alcohol is safe to drink in pregnancy, but at this low level there is no evidence of any harm to the unborn baby. You should not get drunk or binge drink (drinking more than 7.5 UK units of alcohol on a single occasion) while you are pregnant because this can harm your unborn baby.

Smoking

Smoking increases the risk of your baby being underweight or being born too early – in both instances, your baby's health may be affected. You will reduce these risks if you can give up smoking, or at least smoke less, while you are pregnant. You and your baby will benefit if you can give up, no matter how late in your pregnancy.

Cannabis

The effects of cannabis on the unborn baby are uncertain; however, if you use cannabis, it may be harmful to your baby.

Sexual activity

There is no evidence that sexual activity is harmful while you are pregnant.

Travel

When you travel by car you should always wear a 3-point seatbelt above and below your bump, not over it. If you are planning to travel abroad you should talk to your doctor, who should tell you more about flying, vaccinations and travel insurance. The risk of deep vein thrombosis from travelling by air may be higher when you are pregnant. Your doctor can tell you more about how you can reduce your risk by wearing correctly fitted compression stockings.

Prescription and over-the-counter medicines

Only a few prescription and over-the-counter medicines have been shown to be safe for pregnant women by good-quality studies. While you are pregnant, your doctor should only prescribe medicines where the benefits are greater than the risks. You should use as few over-the-counter medicines as possible.

Complementary therapies

Few complementary therapies have been established as being safe and effective during pregnancy.

Diet and FOOD HYGIENE

Folic acid

Your doctor should give you information about taking folic acid tablets (400micrograms a day). If you do this when you are trying to get pregnant and for the first 12weeks of your pregnancy, it reduces the risk of having a baby with conditions that are known as neural tube defects, such as spina bifida (a condition where parts of the backbone do not form properly, leaving a gap or split that causes damage to the baby's central nervous system).

Vitamin D

Your doctor should give you information on getting enough vitaminD both during your pregnancy and while you are breastfeeding. You should be advised to take a vitamin D supplement (10micrograms of vitamin D per day) as found in the Healthy Start vitamin supplement. If you are not eligible for the Healthy Start benefit your midwife or doctor will be able to tell you where you can buy the supplement. Taking a daily vitamin D supplement is especially important if you are at risk of vitaminD deficiency (if you have darker skin, for example, your family origin is African, African–Caribbean or South Asian; if you have limited exposure to sunlight, for example you are housebond, or stay indoors for long periods, or if you usually cover your skin for cultural reasons.

Vitamin A

Excess levels of vitaminA can cause abnormalities in unborn babies. You should avoid taking vitaminA supplements (with more than 700micrograms of vitamin A) while you are pregnant. You should also avoid eating liver (which may contain high levels of vitaminA) or anything made from liver, such as pâté.

Other food supplements

You do not need to take iron supplements as a matter of routine while you are pregnant. They do not improve your health and you may experience unpleasant side effects, such as constipation.

Food hygiene

Your doctor should give you information on bacterial infections such as listeriosis and salmonella that can be picked up from food and can harm your unborn baby. In order to avoid them while you are pregnant it is best to keep to pasteurised or UHT milk, if you drink milk,avoid eating mould-ripened soft cheese, such as Camembert or Brie, and blue-veined cheese (there is no risk with hard cheese such as Cheddar, or with cottage cheese or processed cheese)avoid eating pâté (even vegetable pâté),avoid eating uncooked or undercooked ready-prepared meals,avoid eating raw or partially cooked eggs or food that may contain them (such as mayonnaise),avoid eating raw or partially cooked meat, especially poultry. Toxoplasmosis is an infection that does not usually cause symptoms in healthy women. Very occasionally it can cause problems for the unborn baby of an infected mother. You can pick it up from undercooked or uncooked meat (such as salami, which is cured) and from the faeces of infected cats or contaminated soil or water. To help avoid this infection while you are pregnant it is best to:

  • wash your hands before and after handling food
  • wash all fruit and vegetables, including ready-prepared salads, before you eat them
  • make sure you thoroughly cook raw meats and ready-prepared chilled meats
  • wear gloves and wash your hands thoroughly after gardening or handling soil
  • avoid contact with cat faeces (in cat litter or in soil).

SCREENING AND TESTS

Early in your pregnancy you should be offered a number of tests.

Your doctor should tell you more about the purpose of any test you are offered. However, the information these tests can provide may help your antenatal care team to provide the best care possible during your pregnancy and the birth. The test results may also help you to make choices during pregnancy.

QUESTIONS TO ASK UR HEALTHCARE TEAM
  • What is the test for?
  • What does the test involve?
  • Are there any risks?
  • What will the results show?
  • How and when will I get the results?
  • Who do I contact if I don't get the results?
  • What happens if I choose not to have the test?
  • What happens if the test shows that there might be a problem?
Ultrasound scans

You should be offered an ultrasound scan between 10weeks0days and 13weeks6days to estimate when your baby is due and to check whether you are expecting more than 1 baby. This scan may also be part of a screening test for Down's syndrome. You should be offered another scan, normally between 18weeks0days and 20weeks6days, to check for physical problems in your baby. This is called the anomaly scan. Your doctor will give you more information about the scan and what the results may mean for you so you can decide whether you want to have the scan or not. If the scan shows a possible problem, you will be referred to a specialist to discuss the options available to you. It is important to realise that no test is 100% accurate.

Screening tests for Down's syndrome

Down's syndrome is a condition caused by the presence of an extra chromosome in a baby's cells. It occurs by chance at conception and is irreversible.

Early in your pregnancy you should be offered information and screening tests to check whether your baby is likely to have Down's syndrome. Your doctor should tell you more about Down's syndrome, the screening tests you are being offered, what the results may mean for you and the decisions that you may need to think about

Screening tests will only indicate that a baby may have Down's syndrome. If the screening test results are positive, you should be offered further information, support and more tests to confirm whether or not your baby has Down's syndrome.

Between 11weeks0days and 13weeks6days, the screening test for Down's syndrome should be the combined test (an ultrasound scan and blood test). Between 15weeks0days and 20weeks0days, the screening test should be the triple or quadruple test (both are blood tests).

Blood tests

ANAEMIA

You should be offered 2 tests for anaemia: one at your booking appointment and another at 28weeks. Anaemia is often caused by a lack of iron. If you develop anaemia while you are pregnant, it is usually because you do not have enough iron to meet your baby's need for it in addition to your own; you may be offered further blood tests. You should be offered an iron supplement, if appropriate.

BLOOD GROUP AND RHESUS STATUS
  • Early in your pregnancy you should be offered tests to find out your blood group and your rhesusD (RhD) status. Your doctor should tell you more about them and what they are for. If you are RhD-negative, you should be offered an anti-D injection to prevent future babies developing problems.
  • Early in your pregnancy, and again at 28weeks, you should be offered tests to check for red-cell antibodies. If the levels of these antibodies are significant, you should be offered further special tests and Doppler study for managing the rest of your pregnancy.
INHERITED BLOOD CONDITIONS

Inherited blood conditions, such as thalassemia and sickle cell disease, mainly affect people whose family origin is African, Caribbean, Middle Eastern, Asian or Mediterranean, but these conditions are also found in the North European population. At your first appointment, your midwife or doctor should give you information about inherited blood conditions, offer advice and support, and ask some questions about your and your partner's family origins to find out whether you are at risk of being a carrier or having a baby with an inherited blood condition. If you are a carrier of an inherited blood condition, the father of your baby should also be offered advice, support and screening without delay.

Testing for infections

Your midwife or doctor should offer you a number of tests, as a matter of routine, to check for certain infections. These infections are not common, but they can cause problems if they are not detected and treated.

ASYMPTOMATIC BACTERIURIA

Asymptomatic bacteriuria is a bladder infection that has no symptoms. Identifying and treating it can reduce the risk of developing a kidney infection. It can be detected by testing a urine sample.

CHLAMYDIA

Chlamydia is a sexually transmitted vaginal infection that is more common in women who are younger than 25 years. It may have no symptoms but, rarely, may cause problems such as eye infections and pneumonia in the baby.

HEPATITIS B

Hepatitis B virus is a potentially serious infection that can affect the liver. Many people have no symptoms. It can be passed from a mother to her baby (through blood or body fluids), but may be prevented if the baby is vaccinated at birth. The infection can be detected in the mother's blood.

HIV

HIV usually causes no symptoms at first but can lead to AIDS. HIV can be passed from a mother to her baby, but this risk can be greatly reduced if the mother is diagnosed before the birth. The infection can be detected through a blood test. If you are pregnant and are diagnosed with HIV, you should receive specialist care.

GERMAN MEASLES

Screening for German measles (rubella) is offered so that, if you are not immune, you can choose to be vaccinated after you have given birth. This should usually protect you and future pregnancies. Testing you for rubella in pregnancy does not aim to identify it in the baby you are carrying.

SYPHILIS

Syphilis is rare . It is a sexually transmitted infection that can also be passed from a mother to her baby. Mothers and babies can be successfully treated if it is detected and treated early. A person with syphilis may show no symptoms for many years. A positive test result does not always mean you have syphilis, but your healthcare team should have clear procedures for managing your care if you test positive.

Screening for medical conditions

GESTATIONAL DIABETES
Gestational diabetes is a type of diabetes that develops in the later stages of pregnancy. Some women are more likely to develop gestational diabetes. You should be given information about gestational diabetes and offered a test if:
  • you are overweight (body mass index above 30kg/m2)
  • you have given birth to a very large baby before
  • you have had gestational diabetes before
  • you have a parent, brother or sister with diabetes
  • your family origin is South Asian, black Caribbean or Middle Eastern.

Gestational diabetes usually improves with changes to diet and exercise. Tablets or insulin therapy may be needed to control diabetes if lifestyle changes do not work. Women with gestational diabetes may have more monitoring and interventions during both their pregnancy and their labour. If you are at risk of gestational diabetes and it is not detected and controlled, this may lead to a larger than normal baby which may mean a small risk of difficulties during the birth.

PREECLAMPSIA(HIGH BLOOD PRESURE DURING PREGNANCY)

Pre-eclampsia is a condition that happens in the second half of pregnancy and can cause serious problems for you and your baby if it is not detected and managed. Signs of pre-eclampsia are high blood pressure, protein in the urine and/or swelling of the hands, feet, ankles and sometimes face. Your blood pressure and urine will be checked for signs of pre-eclampsia at every antenatal appointment.

Your risk of pre-eclampsia should be assessed at your booking appointment in order to plan for the rest of your appointments. You are more likely to develop pre-eclampsia when you are pregnant if you have any of these risk factors:

  • you are 40 or older
  • you have not had a baby before
  • your last pregnancy was more than 10years ago
  • you or a family member has had pre-eclampsia before
  • your body mass index is 35kg/m2 or more (very obese)
  • you already have circulation problems such as high blood pressure
  • you already have kidney disease
  • you are expecting more than 1 baby.

You may need to have your blood pressure measured more often if you have any signs of pre-eclampsia, such as protein in your urine or high blood pressure.

You should seek immediate medical help if you experience any symptoms of pre-eclampsia, which include:
  • severe headache
  • problems with vision, such as blurred vision or lights flashing before the eyes
  • severe pain just below the ribs
  • vomiting
  • sudden swelling of the face, hands or feet.

PLACENTA PRAEVIA (LOW LYING PLACENTA)

Placenta praevia is when the placenta is low lying in the womb and covers all or part of the entrance (the cervix). In most women, as the womb grows upwards, the placenta moves with it so that it is in a normal position before birth and does not cause a problem. If an earlier ultrasound scan (usually between 18weeks0days and 20weeks6days) showed that your placenta extends over the cervix, you should be offered another abdominal scan at 32weeks. If this second abdominal scan is unclear, you should be offered a vaginal scan.

MANAGING COMMON PROBLEMS

Pregnancy brings a variety of physical and emotional changes. Many of these changes are normal and pose no danger to you or your baby, even though some of them may cause you discomfort. Remember that your doctor is there to give you information and support.

Backache

Backache is common in pregnant women. You may find that massage therapy, exercising in water or going to group or individual back care classes may help you to relieve the pain.

Constipation

If you become constipated while you are pregnant, your doctor should tell you ways in which you can change your diet (such as eating more bran or wheat fibre) to help relieve the problem.

Haemorrhoids (piles)

There is no research evidence on how well treatments for haemorrhoids work. However, if you get haemorrhoids, your doctor should give you information on what you can do to change your diet. If your symptoms continue to be troublesome, they may offer you a cream to help relieve the problem.

Heartburn

Your doctor should give you information about what to do if you get heartburn during your pregnancy. If it persists, they should offer you antacids to relieve the symptoms.

Nausea and sickness

You may feel sick or experience vomiting in the early part of your pregnancy. This does not indicate that anything is wrong. It usually stops at around your 16th to 20th week. Your midwife or doctor should give you information about this. You may find that using wrist acupressure or taking ginger tablets or syrup helps to relieve these symptoms. If you have severe problems, your doctor may give you further help or prescribe antihistamine tablets for sickness.

Thrush

If you have thrush (a yeast infection – also known as candida or vaginal candidiasis) your doctor may prescribe cream and/or pessaries for you to apply to the area for 1week. While you are pregnant, it is best to avoid taking any medicine for thrush that needs to be swallowed. There is no evidence about how safe or effective these medicines are for pregnant women.

Vaginal discharge

You may get more vaginal discharge than usual while you are pregnant. This is usually nothing to worry about. However, if the discharge becomes itchy or sore, or smells unpleasant, or you have pain on passing urine, tell your doctor, because you may have an infection.

Varicose veins

Varicose veins are also common. They are not harmful during pregnancy. Compression stockings may relieve the symptoms (such as swelling of your legs), although they will not stop the veins from appearing.

IF U R PREGNANT BEYOND 41 WEEKS

If your pregnancy goes beyond 42 weeks, there is a greater risk of your baby developing health problems. Therefore at 41 weeks you should be offered a 'membrane sweep', which involves having a vaginal examination; this stimulates the neck of your womb (known as the cervix) to produce hormones that may trigger spontaneous labour. If you choose not to have a membrane sweep, or it does not cause you to go into labour, you should be offered a date to have your labour induced (started off). If you decide against having labour induced and your pregnancy continues to 42weeks or beyond, you should be offered ultrasound scans and your baby's heartbeat may be monitored regularly.

IF UR BABY IS POSITIONED BOTTOM FIRST

At around 36weeks your midwife or doctor will check your baby's position by examining your abdomen. If your baby is bottom first (known as the breech position), your doctor should offer you planned caesarean section if this is first pregnancy or with associated comorbidities .