Thinking of having a baby – what you need to know? Dr. Nusrat Fazal Consultant Obstetrician GWH
Are You Ready?? • Physically • Psychologically/emotionally • Socially • Financially
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
What is Pre-pregnancy Care • Why is planning important? • How to prepare well for the journey?
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
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
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
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
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
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
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
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
Which Food and supplements • Folic acid • When to start • How much (400microgram/5mg) • Vitamin D • Healthy Diet
Foods to avoid • Raw eggs, • Meat • Coffee ( ↓200g) • Soft Cheese • Unpasteurised milk • Certain fishes • Food rich in vitamin A.
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.
Is your work environment safer • Chemicals, fumes • Radiations • Animals/gardening • Meat • Long flight • Healthcare worker-increase exposure to infection. • Support/information links
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.
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
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.
Consider Your Social Circumstances • Housing • Support/family • Flexibility of work
Consider Your Finances • Cost of raising a child (from diapers to Uni) • Childcare cost • Maternity/paternity leave • Your right/benefits • Save for long term
When to stop contraception • Depending on type • Waiting till next cycle • Birth spacing • after normal delivery • after C/S
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
Common physiological symptoms During pregnancy • Frequent Urination • Nausea Vomiting • Heartburn • Constipation • Leg cramps • Back pain • Fatigue • Sleep disturbances • Mood Swings
Common symptoms • Swelling of the Hands and Feet - • Varicose Veins • Gum Disease • Anaemia • Darkening of the Skin
What to expect each trimester 1st Trimester - see your doctor/midwife • What GWH offers • Early Pregnancy Unit • Screening • Dating Scan • Specialist Care and Support
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
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
Birth choices • Birth Centre • Water Birth • Delivery Suite
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.
With all preparations in place • Enjoy a smooth journey through pregnancy • Look forward to your bundle of joy
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.