Midwives work within the hospital and community and will care for you throughout your pregnancy, labour and postnatal period. Through team midwifery we aim to give continuity of care both before and after the birth of your baby. Each surgery has a named midwife who is primarily responsible for your care during your pregnancy. You are welcome to contact her should you have any specific worries or concerns.
For a printable summery of the guide to routine appointments please click here: Guide to Routine Appointments
Common Pregnancy Symptoms You may experience a number of symptoms during pregnancy. Most of these are normal and will not harm you or your baby, but if they are severe or you are worried about them, speak to your midwife or doctor. You may feel some tiredness, sickness, headaches or other mild aches and pains, or have heartburn, constipation or haemorrhoids. There may also be some mild swelling of the face, hands or ankles, or varicose veins in the latter stages of pregnancy.
Healthy Living Make sure you eat a variety of different foods to ensure your diet provides enough energy and nutrients for your baby to grow and develop and for you to cope with the changes taking place.
In line with the ‘Surrey Healthy Living' policy and ‘NICE' guidelines, the maternity team is there to help and advise in a sensitive and practical way on such questions as how to avoid excessive weight gain and combat obesity, in pregnancy and beyond, for your wellbeing and that of your baby.
Obesity increases risk to you and your baby during pregnancy, at birth and after the baby is born.
More information can be obtained from http://www.foodstandards.gov.uk/
and http://www.direct.gov.uk/en/Parents/HavingABaby/HealthInPregnancy/DG_171519
Healthy Eating Drop In Sessions are held at the Royal Surrey County Hospital for Mums to Be who have an increased BMI (Body Mass Index).
Caffeine is a stimulant that is contained in tea, coffee and cola drinks. Too much caffeine should be avoided as it is passed through the placenta and may affect your baby.
Alcohol Too much alcohol increases the risk of miscarriage or may lead to Fetal Alcohol Syndrome, possibly resulting in severe abnormalities. The Department of Health advises pregnant women to give up alcohol altogether or to consume no more than 1 - 2 units of alcohol per week and to avoid getting drunk.
Medication and Supplements Taking non-medicinal drugs during pregnancy is not recommended as it may seriously harm you and your baby. Over-the-counter medicines should also be avoided unless advised by a medical practitioner.
Folic acid helps to prevent abnormalities in the baby, e.g. spina bifida. The recommended dose is 0.4mg per day for at least 8 weeks before pregnancy and for up to 12 weeks into the pregnancy. If you are taking anti-epileptic drugs have a family history of fetal anomalies or you have diabetes the recommended dose is 5mg per day. Other vitamin supplements should only be taken after checking with your midwife. However, vitamin A should NOT be taken in pregnancy.
Smoking When you smoke cigarettes, carbon monoxide, nicotine and other toxic chemicals cross the placenta directly into the baby's blood stream - so the baby smokes with you! This will reduce its oxygen and nourishment and put it at risk of low birth weight, premature birth and other problems. The sooner you stop smoking the better, to give your baby a healthier start in life. Your midwife can arrange referral to your local Smoking Cessation coordinator or group (see also NHS Pregnancy Smoking Helpline). Cannabis smoking can have similar effects on the lungs, and the safety of using cannabis during pregnancy has not been established. http://www.givingupsmoking.co.uk/
Travel If you are planning to travel abroad, you should discuss flying, vaccinations and travel insurance with your midwife or doctor. Long-haul flights can increase the risk of deep vein thrombosis. We would advise women to take Aspirin 75mg half an hour prior to a flight, to wear support stockings, drink plenty of water and walk about as much as possible during the flight.
Car safety To protect you and your unborn baby, always wear a seatbelt with the diagonal strap across your body between your breasts and the lap belt over your upper thighs. The straps then lie above and below your bump, not over it. Also, make sure all baby/child seats are fitted correctly according to British Safety Standards.
Relationships Some women find pregnancy to be a time of increased stress and physical discomfort. It can greatly affect your emotional state, your body image and relationships with others. If you feel anxious or worried about anything, you can discuss your problems in confidence with your midwife or doctor. Changes in mood and sex drive are also common. Sex is safe unless you are advised otherwise by your midwife or doctor.
Exercise Regular exercise is important to keep you fit and supple. Make sure any instructor knows you are pregnant. Provided you are healthy and have discussed this with your midwife, exercise such as swimming or aqua-natal classes are safe. However scuba diving, any vigorous exercise or contact sports should be avoided.
Domestic Abuse Domestic Abuse is a form of physical, emotional, psychological or sexual abuse within the context of a close relationship, usually between partners or ex-partners. During pregnancy the rise of Domestic Abuse is increased.
It may happen anywhere, at any time in a relationship and across all social classes, age groups and ethnic or racial backgrounds.
Suffering abuse can seriously affect your health, your unborn baby, your confidence and belief in yourself. The midwife will discuss this with all women during pregnancy. She will inform your of where and how help can be found. See ‘Useful Links' for contact numbers.
Mental Health Pregnancy can be one of the most exciting times for all parents-to-be, but for people with mental illness it can also bring added concerns.
There is an increased risk for new mothers of developing depression, or having a new psychiatric episode within 3 months of birth - 10% of pregnant women will go on to develop a depressive illness. This risk is highest for women with bipolar disorder.
If you are worried you are at risk of this you must discuss this with your midwife, health visitor or doctor so that the right support can be put in place.
During the first half of pregnancy various tests are offered to check for potential problems, using blood tests and ultrasound scans. The tests listed here are the ones usually recommended in the NHS. Further information can be found at http://www.preg.info/ or from your midwife or doctor. Do not hesitate to ask what each test means. The choice is yours and you should have received relevant information to help in your decision.
There is an antenatal screening coordinator and a team of antenatal and ultrasound midwives and maternity support workers to provide a sensitive range of screening in the Antenatal Clinic, Level B.
Anaemia This is caused by too little haemoglobin (Hb) in the red blood cells. The Hb is usually determined as part of the full blood count. Hb carries oxygen and nutrients around the body and to the baby.
Anaemia can make you feel very tired and you will be less able to cope with losing blood at the time of delivery. If you are anaemic, you will be offered iron supplements and advice on diet.
Blood Group & Antibodies This test tells us whether you belong to Group A, B, 0 or AB; whether your blood is Rhesus Positive (Rh +ve) or Rhesus Negative (Rh-ve)); and whether you have any antibodies (foreign blood proteins).
If you are Rhesus Negative, you will be offered blood tests to check for antibodies. If your baby has inherited the Rhesus Positive gene from its father, antibodies to the baby's blood cells can develop in your blood. To prevent this happening, new guidelines now recommend that Anti-D be given, by injection, routinely to all Rhesus Negative mothers at 28 and 34 weeks of pregnancy. Anti-D should also be given to Rhesus Negative mothers whenever there is a chance of blood cells from the baby spilling into the mother's blood stream (e.g. due to miscarriage, amniocentesis or CVS, vaginal bleeding, a blow to the abdomen and after the birth of the baby).
Rubella (German Measles) Rubella infection early in pregnancy can affect your baby. A test is offered to check your immunity (ability to fight infection). Most women are protected by routine rubella vaccinations given in childhood, but if you are not immune, you will be advised to have a vaccination after the birth.
Hepatitis B This is a virus which infects the liver. If you are a carrier of the virus or have become infected during pregnancy, you will be advised to have your baby vaccinated at birth to avoid infection.
Syphilis This is a sexually transmitted disease which is now relatively rare, but on the increase. If left untreated it can affect your baby. Should it be detected, you will be offered treatment with antibiotics to control the infection and to help protect your baby.
HIV The Human Immunodeficiency Virus affects the body's ability to fight infection. This test is important because any woman can be at risk. It can be passed on to your baby during pregnancy, at birth or through breastfeeding.
Treatment given in pregnancy can greatly reduce the risk of infection being passed from mother to child. A negative test does not affect past or future life insurance claims.
Sickle Cell and Thalassaemia These are blood disorders that can be passed from parent to child. You will be offered a blood test if you or your family are originally from an area with high occurrence of the disorder, or if there is an increased chance of you being a healthy, silent carrier. This is the case if you or your family comes from Africa, the Caribbean, India, Pakistan, Bangladesh, South East Asia, China, the Middle East, or Mediterranean countries (e.g. Greece, Italy, Turkey, Cyprus). The results may require the baby's father to be tested.
Additional Blood Tests These are offered as required during pregnancy. The majority of women carry immunity to common infections which also protects the developing baby but as infections can have an effect on a baby of a non immune mother, you should inform your midwife or doctor if you develop a rash or come into contact with any infectious disease.
Most babies develop normally. Screening tests can show if there is an increased chance that your baby has a problem, such as a neural tube defect, Down's syndrome or other, rarer abnormalities. Agreeing to a screening test does not mean you have decided what to do if a problem is found. You will be offered additional support and counselling to be aware of all your options.
Neural Tube Defects e.g. Spina Bifida An opening anywhere along the baby's spine can result in paralysis of the lower limbs or a collection of fluid on the brain (hydrocephalus). These problems are detected by ultrasound scans which are offered to all women.
Down's syndrome Babies born with this condition have an extra chromosome 21 and are at increased risk of heart and bowel problems and learning difficulties. The overall risk increases for older mothers. The risk is best assessed by one or a combination of screening tests which are available on the NHS or privately.
Nuchal Translucency (NT) Is the fluid filled space at the back of the baby's neck which can be measured by ultrasound scan between 11 weeks + 4 days and 13 weeks + 6 days of pregnancy. Presence of extra fluid increases the chance that there may be a chromosomal or heart problem.
Serum Biochemistry or Blood Test Maternal blood contains markers which can be indicators of Down's syndrome. These markers are measured between 10 weeks and 13 weeks + 6 days of pregnancy.
The Combined Test The analysed blood test is combined together with your age, the size and gestation (age) of the baby and the NT measurement to estimate the risk of Down's syndrome. This is the screening test of choice which will be offered to you.
There are two occasions when this test cannot be used: Non-Identical Twins Multiple Pregnancy
In this situation we would use the NT measurement together with your age, the size and gestation (age) of the baby to calculate the risk of Down's syndrome.
If you are more than 14 weeks pregnant at your first visit In this situation we would offer you a blood test at around 16 weeks of pregnancy. This is known as the Quadruple Test. This blood test is analysed to calculate the risk of Down's syndrome.
More information can be obtained from the booklet ‘Screening Tests for you and your baby' which your Community Midwife will give you at your booking appointment.'
If the calculated risk from the screening test is 1:250 or less (e.g. 1:500) it is considered low risk that the baby will have Down's syndrome. In other words if the risk was exactly 1:250 it would mean that only one baby out of 250 would be affected. Similarly, if the risk was 1:1000 it would mean that amongst 1000 babies there would be just one baby with Down's syndrome.
However if the calculated risk is greater than 1:250 (eg 1:150) it is considered high risk that the baby may have Down's syndrome.
If you receive a high risk result you will be offered an additional test to make an accurate diagnosis such as a chorionic villus sampling (CVS) or an amniocentesis. You will have the opportunity to discuss this with your midwife.
The screening tests for Down's syndrome do not detect all babies with Down's syndrome. This is because the tests can only calculate the risk of a baby having an extra chromosome; they cannot count the chromosomes which is the only way of knowing for sure.
A further ultrasound scan is offered between 21 and 23 weeks of pregnancy. This is to check and assess your baby's physical development.
It is important to be aware that not all abnormalities are detectable before birth.
http://www.direct.gov.uk/en/Parents/HavingABaby/index.htm?cids=Google_PPC&cre=Parents
Ultrasound Scans An ultrasound scan involves having a hand-held scanning device rolled over your stomach. This allows images from inside your womb to be shown on a screen. These may be used to:
You may purchase ultrasound pictures when you attend your ultrasound appointment. The revenue from this goes back into the Maternity Funds.
For more information see: http://www.direct.gov.uk/en/Parents/HavingABaby/HealthInPregnancy/DG_4018289
Anaesthetic Pre-Assessment There is a clinic is for expectant mothers who may have anaesthetic related questions or worries as well as for those with medical conditions that may have some bearing on local anaesthetic techniques, including epidurals and/or general anaesthetic techniques.
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