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Knowledge

Knowledge is a human need and is essential for first time mothers.

We at HerPregnancy are aware that one naturally becomes more anxious upon embarking on a new experience with uncertain outcomes.

We feel being educated and informed is essential to banish any fear and to ensure a happy, healthy pregnancy.

Antenatal Care

The purpose of antenatal care is to ensure your wellbeing, the wellbeing of your baby and to prepare and plan for safe delivery. There are several milestones in pregnancy and certain medical tests that should be done around these. Throughout the pregnancy, you will have many appointments with health professionals. Your blood pressure will be checked regularly and your baby's heartbeat will be heard or visualised. A regular assessment size will also be made.

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Blood Tests

In early pregnancy you will have blood tests. These will fall broadly into three groups: tests to identify the levels of blood sugar, check for anaemia, etc, tests to screen for previous exposure to viral infections and tests to identify your blood pattern (this includes blood group, Rhesus status and exclusion of Haemoglobinopathies such as Mediterranean Anaemia).

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Scan testing

The NHS provides two routine scans to all pregnant women. The first is performed between 11 and 14 weeks and is known as the Nuchal scan. This scan will ascertain viability, expected delivery dates, identify twins and can comment on foetal anatomy and normality as expected at this stage. The result of the scan, along with a blood test, are called the combined test. This combined test is the screen tool for Down's Syndrome and similar conditions.

The second scan is at 20 weeks. Humans can have normal chromosomes but have structural problems or have babies with structural problems. This scan is known as 'structural anomaly scan'. At this time we can check the structure of the baby and its organs. Special attention is focused on the developing foetal brain and heart.

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Amniocentesis

If the diagnosis of the combined test is unacceptable to your or you are above the age of 37, you may wish to consider amniocentesis. During an amniocentesis test, some of the baby's cells are obtained by inserting a needle through the uterine wall and extracting some of the amniotic fluid. This fluid surrounds the baby and contains some cells from the baby. This test will ascertain chromosomes and the sex of the baby. However, you should be aware that this type of test is associated with a 1% pregnancy loss rate.

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Pain Relief

Pain relief in labour is an important subject and at the forefront of any pregnant woman's mind. Many things help: hot bath, using tens machines, sitting on the ball etc. A contraction usually lasts 45 seconds to a minute. It has a rising phase, peak and a descending phase. This will be followed by a quiet phase. Knowledge is helpful. If you time your breathing exercises to coincide with these you will be able to bypass one third to one half of labour before requesting pain relief.

Gas and air, morphine and other agents are all helpful but they interfere with your awareness and ability to co-operate with your attendants.

Epidural is the most potent method of pain relief we have today. It is effective and at least half the women in the British Isles use it. It is, however, recognised that it has a negative impact on the progression of labour and is associated with longer labour and an increase in the rate of instrumental delivery. It is useful therefore to use it when you are in advanced labour. Although, some might find this unrealistic or unacceptable.

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Labour

Labour declares itself or starts in three ways. These are either by breaking your water (spontaneous rupture of membranes), or by having a show, (which is expulsion of the mucous plug), or the onset of uterine contractions. One of these three events usually starts followed by the others.

It is advisable that you inform your carer as soon as possible when one of these events occurs so that we can plan. You will normally have the telephone numbers of your labour ward or midwifery team. Slow labour is associated with unfavourable outcome. Active attention and management of labour maintains normality and minimises intervention. Normal birth can be achieved in a higher proportion of women who adopt this path.

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Caesarean Section

No conversation about labour and childbirth is complete without discussion about Caesarean Section. Today's CS rate is around 20% and this reflects the increasing safety profile of the procedure. CS is a highly emotive subject and associated with strongly held views and debates among different health professionals. A decade ago, women used to see CS less favourably than today. It was not unusual for women to feel upset and disappointed when they were told that they needed a CS. Today the situation is different and many women request CS for no clear biological reason. The introduction of epidural analgesia is the main reason for the substantial migration towards CS.

Twenty years ago most CS was performed under general anaesthesia. This would have meant that the mother would have missed the moment of birth. This emotive time that gathers the mother, the partner and the baby is for many the climax of the event. When CS is performed under epidural analgesia, this social aspect of childbirth is maintained. The rate of complications after CS is higher than after normal birth, but in general, these are very low. There is however one rare complication of CS which only occurs in subsequent deliveries. Its incidence is very very low but it can be deadly, this is placenta accreta or morbid adherence of the afterbirth. The morbidity (medical problems) of emergency CS is higher than that of elective CS.

We are in the middle of substantial epidemiological phenomena around the way this alternative method of delivery is evolving and being seen as attractive by many women.

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Nutrition

Supplementation with folic acid in the prior to pregnancy phase and the in the early weeks of pregnancy is proven to be beneficial. It is believed that conditions like Spina bifida are totally preventable by folic acid. Other than Folic acid there is very little information to support routine supplementation. A healthy balanced diet is all that you need.

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After Delivery

Breast-feeding is associated with a variety of beneficial effects to babies after delivery. This correct message is highlighted everywhere. Breast-feeding however can be difficult despite the best efforts. The propaganda around breast-feeding can cause concerns and guilt feelings among those who cannot do it. This is unnecessary and it is important to realise that you are not alone since there is a substantial number of women around the world today and throughout history who had similar problems. Pain, fever and a hungry baby can create an unbearable situation. Wet nurses have existed throughout history for this reason.

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Location: Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH email: info@herpregnancy.co.uk Tel: +44 (0) 207 352 6412 / +44 (0) 207 362 5600