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Survival Guide
Pregnancy
Helpful information from pregnancy to parenting.

This section is broken down into the following sub-categories:

Pregnancy

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ANTENATAL CHECK

(ante=before, natal=birth)

Visits are usually monthly until 28 weeks, fortnightly until 36 weeks then weekly.

At the booking visit bloods are taken to check rubella immunity, find out your blood group and if you have any antibodies, your hepatitis and HIV status, full blood count (FBC) and a VDRL test for syphilis. You can request a test to be taken if you think you could be at risk of having HIV. Bloods are repeated at 28 weeks and you may have diabetes screening at this stage to. If your blood group is Rh Negative then a blood test will be done at 36 weeks, and a FBC repeated if your iron levels are low.

Discuss with your LMC if you want to have a scan and for what reason you would want or need one. Nuchal Translucency scans are done to look at the risk ratio for Downs Syndrome, and Morphology scans look at the structure or formation of the baby.

Also discuss with your LMC if they do Group B Strep Infection Screening and what guidelines do they follow for this.

If your baby is still breech (bottom down) after 34 weeks you may want to discuss options of trying to turn the baby, this may include an ECV external version (an Obstetrician manually turning the baby to a head down position)


CHECKING BABIES HEALTH

See the video on pregnancy showing a 3D animation in the 3rd trimester http://www.babycenter.com.au/video/pregnancy/weeks-28-to-37-pregnancy/

  • FUNDAL HEIGHT fundus is the top of the uterus (womb) each cm above pubic bone= 1wk gestation
  • PALPATION is feeling the pregnant tummy to work out:
  • PRESENTATION part of baby nearest pelvic opening ie head (cephalic/vertex) breech (bottom) shoulder
  • POSITION OF BABY inside the uterus, anterior towards front, posterior towards back
  • DESCENT of baby into pelvis, usually engages (head in the pelvis) for primigravida 36wks, for a multigravida it is later or during labour
  • FETAL HEART RATE normal is 110-160 beats/min
  • FETAL MOVEMENTS usually first movements (quickening) felt by the 18-20th week in a primigravida, 16-18th week in a multigravida. Should feel >10 movements in 12hrs

CHECKING MOTHERS HEALTH:

  • BLOOD PRESSURE pressure which blood exerts against the walls of the blood vessels in the body.
  • OEDEMA fluid causing swelling
  • URINE (URINALYSIS)
  • PROTEIN indicator of pre-eclampsia or a urine infection
  • SUGAR indicator of diabetes
  • KETONES causes are diabetes, and starvation

CHILDBIRTH CLASSES

Childbirth classes usually start at 26+ wks pregnant. For more information on pregnancy classes see our Baby Friendly page on BabyWebNZ and www.birthresources.org

BirthResources Childbirth Education

See www.birthresources.org for classes in Wellington. These are 6 evening classes and weekend intensives run by Helen and Denise both of which are Midwives and Childbirth Educators.

We also provide online education and a DVD if you are unable to attend our classes.
DISCOMFORTS

There is an expected average weight gain of around 12 kg, with 2 kg in the first 20 weeks, then 0.5 kg per week until the birth. This weight is from the growth of the baby, uterus, breasts, placenta and from an increase in fat storage (for breastfeeding), fluid around baby (amniotic fluid), and body fluid (blood etc). The increase in weight and hormones are responsible for most pregnancy discomforts.

Pregnancy Discomforts

Bleeding gums and increased salivation (saliva): Use a soft toothbrush and maintain good care of your teeth and gums. There has been research linking gum disease and other infections to premature births.

  • Morning sickness: Pregnancy often causes changes in taste, food cravings and also nausea. It is called 'morning sickness' but nausea can happen at any time of the day and is due to raised hormone levels, usually in the first 12 weeks. Small frequent meals, and dry crackers, ginger, or acupuncture/pressure may help.
  • Tiredness and insomnia: Try catnaps during the day. Insomnia is common, normal and largely 'untreatable' so stop being anxious about being awake - say things like 'well at least I'm resting'.
  • Constipation and haemorrhoids: Your gut slows down to allow more nutrients to be absorbed for the baby but this can lead to constipation. Exercise and increasing the fibre in your diet often helps. Kiwicrush found at most supermarkets in the frozen section is a natural laxative.
  • Leg cramps: Stop feet flexing at night with a pillow at the bottom of your feet. Some people say drinking a banana smoothie (contains calcium and potassium) helps reduce this.
  • Backache: The weight of the baby can cause you to lean backwards, to try to balance but this can put strain on your back in the area of your lumbar curve. Relaxin hormone can cause ligaments to be more relaxed. This is why it is important to concentrate on good posture and not to do heavy lifting. Gentle exercise, eg yoga, swimming, walking and heat packs, can help. If your backache is pregnancy related you can see a physiotherapist for free in New Zealand with a referral from your LMC.
  • Emotional changes: It is common to be more emotional and have memory loss.
  • Varicose veins and swollen feet: Avoid constriction such as crossing your legs and rest with feet up.
  • Heartburn: This is related to relaxation of the opening at the top of your stomach, letting the acid come back up. Try a bland diet and sleep with an extra pillow to keep your head above your stomach, thus using gravity to stop gastric juices coming back up. Take antacids only if prescribed by a health professional.
  • Stretch marks: Some woman will get stretch marks over the breasts, abdomen and legs. These red marks will go silvery white around 6 months after the birth but never fully go away. There is a lot of lotions that claim to reduce stretch marks but often whether you get them or not is more due to your skin type.
  • Sweating: You will often hear people tell pregnant woman they will have an inbuilt heater and some days it will feel like that. Helpful during winter but not in summer. The hormone progesterone can raise body temperature and the extra blood supply to the skin leads to more sweating.

See information on the following links http://www.babywebnz.org.nz/directory_Health.php

the pregnancy section on www.everybody.co.nz and www.babycentre.com.au

Always consult your midwife or doctor about any health problems. Ministry of Health provides access to health information such as pamphlets, fact sheets, booklets and posters.

FLYING

  • Most airlines will let you fly with them on domestic flights up to 38 weeks gestation, and up to 36 weeks on international flights.
  • Please check this with the airline and ask your LMC if you are fit to fly.
  • There may be reasons it is unsafe to fly, for example if you have any risks of bleeding (placenta previa) or premature labour.
  • During flights drink plenty of water and get up and walk or exercise your legs when able.
  • Also remember to take your pregnancy record with you.
HEALTH

Things that should be avoided in pregnancy include:

  •  Alcohol effects babies' brain development and it is not known what is a safe level of alcohol consumption in pregnancy. The Alcohol Advisory Council's website is www.alcohol.org.nz, ph 0800 787 797 (NZ)
  • Smoking affects the placenta and the baby will get a reduced oxygen and food supply thus often being smaller when born. Babies exposed to cigarette smoke have a higher risk of cot death/sudden infant death syndrome (SIDS) If you cannot stop smoking, even reducing the number of cigarettes per day you smoke will help.
  • Avoid any drugs unless they have been prescribed, and always let your doctor or chemist know you are pregnant. Even avoid vitamin supplements and homeopathic remedies until you have consulted with a health professional. It is recommended to take folic acid supplements in early pregnancy, as what you can get via your diet is often not enough.
  • Avoid x-rays during pregnancy unless they are medically needed.
  • High intake of caffeine has been linked to small babies and miscarriages.
  • Do not try to diet when pregnant, your baby will need good iron and calcium supplies. If you are on a special diet your LMC can refer you to see a dietician.
See the video about what to eat in pregnancy http://www.babycenter.com.au/video/pregnancy/what-to-eat/
LEAD MATERNITY CARE

Book your LMC (Midwife, Dr) early, often between 4-12 weeks pregnant. In some areas Independent Midwives are booked up earlier than in other areas due to availability and popularity.
For more information on finding a Midwife see our Find a Midwife page on BabyWebNZ.

0800 MUM 2 BE (0800 686 223) NZ The 0800 MUM 2 BE Maternity Consumer phone line is run by the Ministry of Health. Voicemail is available to leave a message after hours and all messages will be responded to accordingly. The 0800 line supplies lists of Lead Maternity Carers (LMCs) for requested areas.

For maternity consumers requiring information regarding pregnancy care and other information contacts the 'Your Pregnancy' booklet is available. LMCs and Medical Centres can obtain the Your Pregnancy booklet through their local Public Health Provider or order online at www.healthed.govt.nz The phone line does not give counseling, midwifery or medical advice.

You will have the choice of a LMC who will be responsible for your maternity services. This may be a midwife, GP or private obstetric consultant. Some LMC's will provide all of your care during pregnancy, labour and birth, and postnatally, some may provide shared-care working with other maternity service providers.

The options of a place to give birth include:

  • Home birth
  • Birthing units
  • Maternity hospital
  • Private maternity hospitals.

It is important to have a LMC who understands and supports your wishes for your birth.

PREGNANT HEALTH PRACTICES (WELLINGTON)
In the childbirth education classes we cover some of the different health practices that are available. Instead of having me tell people about these I decided to put together a pregnancy health day in Wellington and invite different health practices to come and talk. There are other health practices that are available but we were only able to accommodate seven speakers, which included the following:

Kate O'Connor (Acupuncture)
Mukti Legerska (Yoga in Daily Life Centre)
Joanna Clouden (Pilates)
Jennifer Cox (Lactation Consultant)
Kath Sinclair (Pregnancy massage and shiatsu)
Catherine Falconer (Naturopath/Herbalist)
Pip Heard (Physiotherapy)

The following is a summary from the speakers of the information, which was provided.

Kate O'Connor (Acupuncture)
Acupuncture treats illness, prevents disease and promotes health and well-being. It is safe, effective and drug-free and compatible with conventional medicine. It can successfully treat many of the ailments relating to pregnancy and is effective in preparing the body to work at its optimum functioning for birth.
Treatment with acupuncture is achieved by the use of very fine needles inserted into particular points in the body and thereby altering the flow of Qi, or energy, which flows through channels along the limbs to the internal organs.
Mukti Legerska (Yoga in Daily Life Centre)
Yoga will improve your fitness and facilitate labour. It balances the
body, emotions, mind and soothes the spirit. It will help you to access
deep resources of energy, through relaxation, postures and breathing.

Joanna Clouden (Pilates)
During pregnancy our bodies adapt to changes in spinal curves and hormonal effects. Today, we recognise that pregnancy makes physical and emotional demands on you, and exercise is one way to help you stay as healthy as possible. A well-balanced exercise programme can minimize the discomforts typically associated with pregnancy and may allow for an easier delivery of the baby with a faster post-natal recovery.
There is a growing body of research that demonstrates that moderate physical exercise during pregnancy is not only safe but also beneficial for both the baby and the mother-to-be.

One option for improving your well being during pregnancy is a ?core?, ?stability? or ?pilates? programme. With an emphasis on good core control, muscle balance and postural alignment.

Jennifer Cox (Lactation Consultant)
An International board certified Lactation Consultant (IBCLC) is a breastfeeding specialist qualified to prevent, recognize and resolve breastfeeding problems. For a private consultation there will be a charge otherwise there are often Lactation Consultants who you can see for free at Plunket Family Centres.

Kath Sinclair (Pregnancy massage and shiatsu)
Massage and Shiatsu are both great ways to help reduce stress, alleviate some of the discomforts of pregnancy and promote general well-being. They are very relaxing which is important when many pregnant women work for most of their pregnancy or have other children to care for. It helps prepare both the expectant mother and baby for birth and the postnatal period.
Benefits of Massage during Pregnancy
� Relieves many normal discomforts of pregnancy, such as back pain, leg cramps, headaches, nausea and sore swollen ankles and feet.
� Aids circulation which eases the load on the heart, helps to check blood pressure, and brings more oxygen and nutrients to body cells (yours and your baby).
� Relaxes tense muscles, especially in the back, shoulders and legs.
� Helps relieve depression or anxiety caused by normal hormonal changes.
� Soothes and relaxes nervous tension, letting you sleep more easily and deeply.
� Maintains the body in good condition, enabling a faster return to normal after birth of your baby (or babies).
� Helps relieve the tension that often occurs when coping with the major changes and adjustments of parenthood.
Shiatsu - Works by balancing the energy in the body. It is done fully clothed and is deeply relaxing
Catherine Falconer (Naturopath/Herbalist)
Keeping well energised and in good health during pregnancy will have a profound effect on your stamina for birth, nutrients for breastfeeding and your recovery after birth.
As a Naturopath and Herbalist I will be able to advise you about diet. During a consultation health issues are addressed and a maintenance plan is formulated. My focus is on optimum health for you and your baby and preventing any foreseeable problems.
I treat:
� Complete preconception care
� Anxiety/depression
� Constipation/Haemorrhoids
� Nausea/Fatigue /Insomnia
� Poor immunity
� Recovery after birth

Pip Heard (Physiotherapy)

Physiotherapy services are available both privately and publicly in New Zealand
and cover a wide range of musculoskeletal complaints that occur during and immediately after pregnancy. Common pregnancy conditions helped by physiotherapists can include Carpal Tunnel Syndrome, Low Back Pain, Pelvic Pain, Incontinence issues, and TENS machine use to name a few. The hospitals also provide loans of specialised braces and provide some hydrotherapy and stretch class services. Pre or Postnatal women are encouraged to seek assessment from a physiotherapist with a referral from their LMC.


For more information from these Wellington Health practices:
Kate O?Connor (NZCompN, Reg Midwife, NZDip Acup., MNZRA) City Osteopaths, Level 4, 166 Featherston St, Wellington Ph (04) 499 1439 www.cityosteopaths.com
Mukti Legerska www.yogaindailylife.org.nz or call us at 801 7012.Yoga in Daily Life, 21 Jessie St, Wellington
Joanna Clouden is a musculoskeletal physiotherapist.
Kath Sinclair Phone: (04) 499-0334
e-mail: reception@revitalize.net.nz
Level 4, Hallenstein House
276 Lambton Quay, Wellington.
Kath Sinclair and Allison Bell also hold Active Birth Workshops. Kath teaches Baby Massage
Catherine Falconer. ND, DipHerbMed, BHSc, MNZAMH
Registered Naturopath & Medical Herbalist
Ph: 977-9435
arborvitae2004@yahoo.com.au

Daytime service providing contact details of an IBCLC Lactation Consultant ring
0800 4 lactation. Websites www.lactcon.org.nz and www.ilca.org
Plunket Family Centres in Wellington:
Johnsonville Mon- Tue 478 4900
Rongotai Wed- Thu 387 7594

Article by Helen (copy write www.babywebnz.org)
REARCH STUDY
Women’s use of the Internet in pregnancy

I am seeking your help. My name is Briege Lagan: I am a Clinical Midwife Specialist currently undertaking research at the University of Ulster, Northern Ireland.

Part of my study is focused on women’s use of the Internet in pregnancy. I am keen to invite women that are pregnant or have had a baby in the last year and have used the Internet to seek information in relation to their pregnancy to complete an online questionnaire to determine: Why women seek information from the Internet; How useful they found the information and how they used the information.

Briege Lagan
PhD Student/Clinical Midwife Specialist
University of Ulster
lagan-b@ulster.ac.uk
http://www.science.ulster.ac.uk/survey/blagan_p2.html

Women's and LMC's experiences of having a Doula.

Also explore those who may have considered the idea but did not end up choosing to have a Doula or "specialised" birth support. I would like to talk to women, midwives, GP's and OB's. I am especially keen to hear the perspective from both sides of the question - so if you are passionate about the role of Doula's - whichever way -, then I would love to hear from you!!

Can you help?? Either forwarding my email to potential people to be interviewed or even nominating yourself! I would really like to interview approximately three in each category and would like a mix of experiences and philosophies. I am keen to explore the issue of continuity amongst high risk women and would be interested in talking to some of those women about their experiences. I only have a handful of questions to ask so it will not be an onerous process. If anyone would like to see my questions before committing to the interview, then they will not be a problem either. I am able to conduct interviews by phone at a time to suit - evenings or day.

I can be contacted by email on valgrefamily@xtra.co.nz or by phone on 576-4647 or 021-1138314. My study is being completed through Aoraki Polytechnic and I am being supervised by Erin Hudson.


SEX

The females sex drive may change during pregnancy due to tiredness. The males
desire may change due to concerns for his partners health and the baby's. But to be reassured
with a normal pregnancy, it is safe to have intercourse. It will not harm your baby as there is a mucous plug at the cervix which helps protect against infection and the baby is protected within the uterus in a bag of amniotic fluid. It is always important to protect yourself from catching sexually transmitted diseases especially if you are not in a monogamous relationship
If there have been concerns during your pregnancy then you may have been advised against intercourse. This would be if you've been treated for premature labour a shortened or dilated cervix, leaking amniotic fluid, placenta previa, or bleeding, or if you have a history of recurrent miscarriages.
In the third trimester (after 28 weeks) you may have to experiment with positions that avoid the female lying on her back and putting weight on the pregnant abdomen eg: Lie side-by-side in the spoon position
TERMS USED

GRAVIDA pregnant ie primigravida pregnant for the first time, multigravida previously had more than one pregnancy
PARITY borne infants
LMP last menstrual period by which they work out your EDD estimated date of delivery from ie 40 wks (9mths+7 days) from LMP or approx 38 wks from conception
GESTATION pregnancy time
ANTENATAL time while you are pregnant
POSTNATAL time after the birth
UTERUS the womb, inside which the baby grows
FUNDUS the top of the womb, the fundal height is the measurement from the pubic bone to the fundus, which is used to look at baby’s growth
PLACENTA nourishes the baby in the uterus. Will come after the birth of the baby and is also called afterbirth
CERVIX located at the bottom of the uterus and at top of the vagina. It dilates (opens) during labour to 10cm (fully dilated) for the baby to be born
PERINEUM the skin between the vagina and anus, this stretches at the birth
SHOW vaginal mucous plug which may have some spotting of blood in it
OEDEMA swelling due to fluid retention
BRAXTON HICKS mild tightenings of the uterus also called practice contractions
CONTRACTIONS uncomfortable/painful tightenings of your uterus which help the cervix dilate and push the baby down so it can be born
INDUCTION starting the labour artificially by use of hormonal drugs
RUPTURE OF MEMBRANES the bag of fluid around the baby breaks and leaks vaginally
CTG using a machine to monitor the babies heart rate and the contractions
LOCHIA vaginal loss after the birth which may last up to six weeks. It is like a period to begin with then goes pinker then more white in colour

WARNING SIGNS

Notify your LMC (Midwife/Doctor) if you experience any of the following:

*STOMACH PAIN
*PRETERM (<37 wks) CONTRACTIONS
*VAGINAL BLEEDING
*PRETERM RUPTURED MEMBRANES (waters breaking)
*OFFENSIVE VAGINAL DISCHARGE
*CHANGE IN NORMAL PATTERN OR REDUCED FETAL MOVEMENTS
*GENERALISED SWELLING, HEADACHES OR VISUAL DISTURBANCES
*UNWELL, VOMITING OR DIARRHOEA
*HIGH TEMPERATURE
*PAINFUL OR BURNING URINATION
*CONSTANT ITCHING AND DARK URINE
*PERSISTENT SEVERE LEG CRAMP OR
CALF PAIN
*ACCIDENT INVOLVING INJURY TO ABDOMEN
*FAINTING OR PERSISTENT DIZZINESS

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