Caring for you and your baby during your pregnancythe period from conception to birth“It is my aim to provide the guidance, information and reassurance that each woman needs to enable her to feel completely comfortable in making the pregnancy choices and decisions that are right for her. Of course I want to ensure the safest possible birthing experience for all of my patients, this goes without saying, and I am unbelievably proud of each and every one of the 4000 babies that I have helped into the world. I believe most of all, however, that all pregnant women should be empowered to be able to choose the type of care that is best for them.”
Congratulations, you are pregnant and it is quite understandable that you now want to ensure that you will receive the best possible care throughout your pregnancy and birth of your baby. It is very important that you should be actively involved in all of the decisions relating to your pregnancy and the delivery of your baby and that your needs and wishes are listened to and respected. You will therefore want to do as much research as possible to help you when you come to make those crucial decisions. However, as there is so much information and advice available these days I know that this can sometimes be a confusing or even overwhelming exercise.
Vast Majority of Pregnancies proceed perfectly Normally
If you are feeling this way please remember that the vast majority of pregnancies proceed perfectly normally, without any complications at all for either mother or baby. Furthermore, you will attend regular antenatal check-ups during your pregnancy, which will be an ideal opportunity to ask questions and to chat through any concerns that you might have. You will be monitored closely to ensure that your pregnancy is proceeding properly and you will be carefully assessed so that if there are any underlying risk factors these can be identified and acted upon. In other words there will be plenty of assistance and guidance on offer to you over the next weeks and months.
Nevertheless, I would like to make a number of general points here that I hope will be helpful to you as your pregnancy progresses.
Eating and keeping well during pregnancy
Making sure that you eat healthily during your pregnancy is extremely important, both for you and your baby. If you eat a balanced, healthy diet including plenty of fruit and vegetables you will get the majority of the vitamins and minerals that you need to stay well and to provide for the needs of your growing baby from your food alone. However, in addition, it is sensible to take vitamin D supplements throughout the whole of your pregnancy together with folic acidA vitamin in the group of vitamin Bs. for the first 12 weeks.
Sensible Pregnancy Precautions and Folate
Folic acid is important as it can help to prevent certain birth defects called neural tube defects. A neural tube defect is a serious congenitalAny condition present since birth. defect of the central nervous systemThe network of nerves, which are bundles of nerve fibres carrying information in the form of electrical impulses., including the spinal cord, skull and brain, which results when the neural tube fails to close normally during the first 30 days of foetal development. The three main types of neural tube deficit areanencephaly, encephalocele, and spina bifida. Folate, which is the naturally occurring form of folic acid, is one of the B-group vitamins and it is present in such things as green vegetables such as spinach and peas, as well as in brown rice, chickpeas and fortified breakfast cereals. There are also certain foods that it is sensible to avoid when you are pregnant, either because they can make you ill or because they could pose a risk for your baby. These include mould-ripened soft cheese such as brie and camembert and soft blue-veined cheeses like gorgonzola. The reason for this is that it is quite possible for soft cheese to become contaminated during the production process with bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. including listeria, which could harm your baby. You should also avoid eating paté, raw or under-cooked meat, liver products and raw shellfish. It is also advisable to avoid drinking alcohol while you are pregnant.
Risks associated with being overweight during pregnancy
Being a healthy weight when you are pregnant protects your health and the wellbeing of your baby. This is because being overweight during pregnancy, carries a number of potential risks for both you and your baby. As a result, if you are overweight, whichis usually defined as having a Body Mass Index (BMI) of over 25,you will need to be monitored very carefully so that if problems do occur they can be handled properly. The complications associated with being overweight can occur during the pregnancy, at labour and after birth and include the following:
After the birth
Routine tests carried out during your pregnancy
During the course of your pregnancy you will attend regular antenatal appointments when tests will be carried out to ensure that everything is proceeding properly. At each appointment your blood pressure will be checked and a urine test will be performed to check for the presence of protein, which may indicate pre-eclampsia, glucoseA simple sugar that is an important source of energy in the body. (sugar), which may indicate diabetes or bacteria that could indicate an infection requiring antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria.. At the beginning of your pregnancy you will have a sample of blood taken that will establish your blood group and check for anaemiaA reduced level of haemoglobin, which carries oxygen in the blood. Anaemia causes tiredness, breathlessness and abnormally pale skin., usually caused by a lack of ironAn element present in haemoglobin in the red cells., any haemoglobinThe oxygen carrying pigment that is present in red blood cells. disorders (such as sickle cell anaemiaThe anaemia resulting from sickle cell disease.), your rubellaA viral infection also known as German measles. status and any rarer infections (such as Hepatitis). This will be repeated usually around 28 weeks.
You will also normally be offered two ultrasound scans, one between 10 and 14 weeks, which is a dating scan to work out when your baby is due; and the second one between 18 and 20 weeks to check the development of your baby.
Common pregnancy problems
Most pregnancies, of course, proceed without any difficulties, however sometimes complications do occur. The most common pregnancy complications are miscarriageThe spontaneous loss of pregnancy., ectopic pregnancyA pregnancy that develops outside the uterus, most often in the fallopian tube., pre-eclampsia, gestationalRelating to pregnancy. diabetes, and placentaThe organ that nourishes the embryo during pregnancy and also eliminates waste. praevia.
What is miscarriage?
A miscarriage is when the pregnancy is lost within the first 20 weeks. They occur more often than people think as up to 20% of all confirmed pregnancies end in miscarriage, with 80% occurring in the first 12 weeks. They can happen for many reasons but we believe that most occur as a result of some form of chromosomal abnormality in the developing embryo.
What is ectopicDisplaced from its normal position in the body. Also used to refer to ectopic heartbeats. pregnancy?
Sometimes the fertilised egg will implant itself somewhere outside the uterusThe womb, where embryo implantation occurs and the growing foetus is nourished. and when this happens it is called an ectopic pregnancy. The vast majority of ectopic pregnancies occur in one of the fallopian tubesTwo tubes that transport the egg from the ovary to the uterus. although occasionally an egg implants in an ovary, in the cervixAny neck-like structure; most commonly refers to the neck of the uterus. or in the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs.. If the embryo continued to develop in the fallopian tubeOne of two tubes in the female body that connect the ovaries to the uterus. it could cause a rupture resulting in damage to the tube and in internal bleeding that could be fatal. Unfortunately, there is no way of transplanting the embryo into the uterus and therefore ending the pregnancy is the only option.
What is pre-eclampsia?
Pre-eclampsia is a complicated condition that affects up to 10% of pregnancies and it usually occurs in the second half of the pregnancy. In most cases it develops near to the due date and is relatively mild but severepre-eclampsia can result in serious problems for both mother and baby. This is because pre-eclampsia makes blood vessels constrict and this results in high blood pressure and a reduced blood flow, which can affect the organs in the body including the liver, kidneys, and brain. This change to the blood vessels can in turn cause the capillariesThe tiniest blood vessels, linking the arterial and venous circulations. to release fluid into surrounding tissueA group of cells with a similar structure and a specialised function. causing oedemaThe accumulation of excess fluid in the tissues of the body. or swelling. A reduced blood flow to the uterus can also present problems for the developing baby.
Sometimes women with pre-eclampsia go on to develop a disorder called HELLP syndrome, which stands for Haemolysis, Elevated Liver enzymeA protein that speeds up chemical reactions in the body without being used up itself. and Low Platelets. This puts both mother and baby at a higher risk of the same kind of problems that are caused by severe pre-eclampsia.
Occasionally, pre-eclampsia can lead to eclampsia, which causes seizures. Women suffering from severe pre-eclampsia will usually be given medication to prevent this.
What is gestational diabetes?
Diabetes occurring during pregnancy is one of the most common complications. Diabetes is a complex condition but in essence it means that there is too much glucose (sugar) in the blood and if during pregnancy it is not detected and treated it can increase the risk of harm to the baby. It usually develops after the 26 to 28 week mark and disappears once the baby is born. It can be controlled with diet and exercise alone but some women will require medication.
Gestational diabetes normally has no actual symptoms and for this reason it is usual to have a glucose-screeningA way to identify people who may have a certain condition, among a group of people who may or may not seem to test at around the 28 week mark.
What is placenta praevia?
With placenta praevia the placenta is lying unusually low in the uterus, next to or covering the cervix. This is not a problem in the early stages of pregnancy but if the placenta remains low it can cause bleeding as the pregnancy progresses, which can lead to complications. However, only a small number of women who have placenta praevia in the middle of their pregnancy will still have it when they come to give birth as frequently the placenta will move up and away from the cervix. By the end of pregnancy around one in 200 women will have placenta praevia to some degree but this is usually partial and presents no problem. Women who have complete placenta praevia will need a caesarean section delivery.
Birthing plans and the delivery of your baby
It is very sensible for each pregnant woman to devise a birth plan that feels right for her. I am personally very flexible with birth plans and I will always try to accommodate them providing that it is safe to do so. I would encourage women to chat through their birth plans with their obstetrician well in advance of the actual birth so that if any problems are foreseen these can be properly discussed and resolved. The issue of pain relief is also one that should be based entirely upon the wishes of each individual woman. However, I would advise epiduralOn or over the dura mater, the outermost of the three membranes covering the brain and spinal cord. The epidural space is used for anaesthetising spinal nerve roots, for example during pregnancy. analgesia if there are particular medical conditions like high blood pressure. In certain situations Caesarean section delivery will be necessary. This is a surgical procedure that involves making a cut in the abdomen and wombThe uterus. to enable the baby to be removed. It is carried out under local anaestheticA medication that reduces sensation in a part of the body. so that the lower part of the body is numbed. Sometimes this can be an unplanned procedure that becomes necessary due to complications during the labour or it can be planned (elective). I recommend a planned Caesarean delivery if the mother has had two or more Caesarean sections previously, if there is placenta praevia, with a breech baby or when the baby is very large (4.25 to 4.5kg). Not infrequently the pregnancy will go beyond the due date and this is not a problem providing there are no maternal or foetal concerns. However, ideally the baby should be delivered before 42 weeks and labour would normally be induced at this point if it has not commenced by this stage.
In conclusion then, please always try to remember that pregnancy and birth are natural processes and wherever possible you should feel able to relax and enjoy this special time. Most of all have the confidence to make the choices that are right for you.