Thinking of having a baby – what you need to know?

1. Thinking of having a baby – what you need to know? Dr. Nusrat Fazal Consultant Obstetrician GWH

2. Thinking of having a baby- what do you need to know?

4. Are You Ready?? • Physically • Psychologically/emotionally • Socially • Financially

5. Aims of discussion • Pre pregnancy Care • what planning and lifestyle changes ? • Journey through Pregnancy • what changes your body go through during pregnancy? • Child Birth • what birth choices and how to prepare for the big day? • After delivery care and support

6. What is Pre-pregnancy Care • Why is planning important? • How to prepare well for the journey?

7. Are you ready to make some life style changes • Quit/cut down smoking/alcohol • Stop taking street drugs • Eat Healthy • maintain healthy weight • Keep fit and Exercise regularly • Avoid certain foods and exposure to infection • Add certain supplements to your diet

8. You need to know about your Physical well being Do you have any chronic Medical Condition/Psychiatric condition? • Diabetes (High blood sugar) • High blood pressure • Kidney problem • Heart problems • Epilepsy (seizures/fits) • Other

9. Are you taking any Medications • How is it going to affect your baby • Is it important to continue • Is there any alternative • Can I modify or reduce the dose • What are the options

10. Your Previous Obstetric/Surgical history • Miscarriages • Premature birth • Previous Pregnancy Loss • Previous surgery • Cervical smear/ any procedure on the neck of the womb • Previous Caesarean Section

11. Do you know your family history • Any chronic health conditions running in the family • Any genetic problems in the family or have a previous child with genetic condition • See your doctor • Genetic counselling

12. Are you up to date with your immunisation? Dental hygiene • Rubella • Effects on baby (early pregnancy – eyes, ears, heart, growth and intellect) • Avoid pregnancy for at least 4 weeks after vaccination. • Chicken pox • Hepatitis • Other infection

13. Dental Hygiene New research is showing that poor dental health may be linked to premature birth, so keeping your teeth and gums healthy is important during pregnancy. • Peridontal Disease in Pregnancy • Have dental x-ray before pregnancy • Dental treatment is free during pregnancy

14. Do You have a healthy weightBMI (19-25) • Under weight • Small Baby and early labour • Over weight • Structural defect • Preterm labour • Diabetes • High Blood Pressure • Clots • Operative delivery

15. Which Food and supplements • Folic acid • When to start • How much (400microgram/5mg) • Vitamin D • Healthy Diet

16. Foods to avoid • Raw eggs, • Meat • Coffee ( ↓200g) • Soft Cheese • Unpasteurised milk • Certain fishes • Food rich in vitamin A.

17. Stop/ cut down smoking/ Alcohol and avoid drugs • Smoking • Low birth weight, preterm labour, antepartum haemorrhage , still birth and cot deaths • Alcohol • low birth weight, brain damage and facial malformation • Street drugs: • miscarriage, Low birth weight, birth defects, life threatening bleeding from placenta, pre mature birth, still birth ,neonatal withdrawal, etc.

18. Is your work environment safer • Chemicals, fumes • Radiations • Animals/gardening • Meat • Long flight • Healthcare worker-increase exposure to infection. • Support/information links

19. Emotional/Psychological well being • Pregnancy is the scariest roller coaster ride not only for women but for men too as you have to deal with on daily basis. • Discuss with your doctor if you have any pre existing condition and are already taking medication then its not a good idea to stop your medication abruptly. Your doctor will assess and modify according to severity of your problem. There are alternative available that has lesser effects on the baby. • We have to weigh the benefits of medicine for you against risks to the baby. • Important thing is to be aware ,acknowledge , listen to your body and seek help when needed.

20. Your mental wellbeing • Are you suffering from any psychiatric disorder • Depression ( feeling low) • Look out for its other signs • changes in appetite or sleep patterns, weight gain or loss, feelings of hopelessness, lack of interest in things you once enjoyed, or loss of energy • See your Doctor • Counsellor • Support groups • Psychiatrist

21. Exercise • Keeps you fit • Stress reliever • Increase your chances of getting pregnant • Help maintain good weight • Continue into pregnancy • Pelvic floor exercise. • Avoid high impact sports( tennis), contact sport, skiing and thing like scuba diving. • Aqua aerobics, brisk walking, swimming is ok.

22. Consider Your Social Circumstances • Housing • Support/family • Flexibility of work

23. Consider Your Finances • Cost of raising a child (from diapers to Uni) • Childcare cost • Maternity/paternity leave • Your right/benefits • Save for long term

24. When to stop contraception • Depending on type • Waiting till next cycle • Birth spacing • after normal delivery • after C/S

25. Journey through pregnancy • Normal changes through your body http://www.youtube.com/watch?v=6TO1GJfKRAo • Development of the baby http://www.youtube.com/watch?v=h82ltr84_Yg

26. Common physiological symptoms During pregnancy • Frequent Urination • Nausea Vomiting • Heartburn • Constipation • Leg cramps • Back pain • Fatigue • Sleep disturbances • Mood Swings

27. Common symptoms • Swelling of the Hands and Feet -  • Varicose Veins • Gum Disease • Anaemia • Darkening of the Skin  

28. What to expect each trimester 1st Trimester - see your doctor/midwife • What GWH offers • Early Pregnancy Unit • Screening • Dating Scan • Specialist Care and Support

29. What to expect each trimester 2nd Trimester - see your doctor/midwife • What GWH offers • Anomaly Scan • Specialist Clinics • Day assessment Unit • Specialist Care and Support

30. What to expect each trimester 3rd Trimester - see your doctor/midwife • What GWH offers • 28 weeks bloods • Specialist Clinics • Additional scans if needed • Day assessment Unit (BP, reduced fetal movement) • Specialist Care and Support

31. Birth choices • Birth Centre • Water Birth • Delivery Suite

32. Aim for normal Delivery Why Vaginal Delivery? • Early recovery of mum • Less breathing problems of the new born • Early initiation of breastfeeding and bonding Caesarean section • General risks of operative delivery • Maternal hospital stay • Increased risk of respiratory problems for the infant • Greater complications in subsequent pregnancies, including uterine rupture, placental implantation problems, and the need for hysterectomy.

33. With all preparations in place • Enjoy a smooth journey through pregnancy • Look forward to your bundle of joy

34. Thank You

35. References • Further reading & references • Antenatal care: routine care for the healthy pregnant woman; NICE Clinical Guideline (March 2008) • Bille C, Andersen AM; Preconception care. BMJ. 2009 Feb 12;338:b22. doi: 10.1136/bmj.b22. • Pre-conception - advice and management; NICE CKS, June 2012 • Smoking Cessation Services; NICE Public Health Guidance (Feb 2008) • Dietary interventions and physical activity interventions for weight management before, during and after pregnancy; NICE Public Health Guidance (July 2010) • Health and Safety Executive; source of advice regarding specific occupational hazards • No authors listed; Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study. BMJ. 2008 Nov 3;337:a2332. doi: 10.1136/bmj.a2332. • Exercise and Pregnancy; Royal College of Obstetricians and Gynaecologists (2006) • Varicella: the green book, chapter 34 (immunisation against infectious disease); Public Health England • Depression - antenatal and postnatal; NICE CKS, revised January 2013 • Sickle Cell & Thalassaemia screening across the UK; National Screening Portal • http://www.eshre.eu/Annual-meeting/Archive/Stockholm-2011/For-the-media/Press-releases-2011/Hart.aspx • Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. • Bujold E1, Gauthier RJ. 2010 May;115(5):1003-6. doi: 10.1097/AOG.