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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 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 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
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) beech (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
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CHILDBIRTH CLASSES
Childbirth classes usually start at 26+ wks pregnant. For more information on pregnancy classes see our Baby Friendly page on BabyWebNZ http://babywebnz.org.nz/baby_friendly.php
NZ Wide
Parent Centre Childbirth Education Classes
How are the classes run?
6-8 weekly sessions
led by qualified childbirth educators
usually held in the evenings so that partners can attend
groups are small, up to 12 couples, so joining in is easy
classes are informal, comfortable, and welcoming
information and skills to make your own choices
classes are regularly evaluated to ensure they meet your needs
chance to make friends with other new parents
Contact your local Parents Centre in the telephone directory or call the Parents Centre national office on (04) 560 1990
Wellington
Childbirth Classes at Newlands College, Tawa College and Wgth High School
Childbirth Classes Through Community Education Evening Classes at Newlands College, Tawa College and Wgth High School
Six antenatal classes followed by two postnatal classes (after babies are born). The postnatal classes become a continuing coffee group.
Wide range of topics covered, some examples are: cot making, avoiding flat head, SIDS, the labour process, types of intervention, role of the support person(s), PND, Plunket speaker, 1st Aid speaker, postnatal care for new parents and baby, pain relief (natural to medical), feeding baby and birth stories (speakers).
Tutors: Pauline Quinn 2328958, Miranda Brown and Denise Garcia
To book: Newlands 4741330, Tawa 2327163, Wgtn High 3858919
Pauline Quinn
I teach childbirth classes for 3 colleges in Wellington via community education evening classes.
Birth And Baby Education (BABE)
Ph 04 2328958
Wellington Region Parents Centre Website
http://www.wnpc.org.nz/
Wellington North
Wellington South
Lower Hutt
Mana
Kapiti
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DISCOMFORTS
Please always consult your LMC or Doctor re health problems
“pregnancy is the biggest natural body change"
Morning sickness
Small frequent meals and dry crackers, ginger or Acupunture/pressure may help
Tiredness/Insomnia: Pillow between knees at night and Cat Naps during the day. Insomnia is common, normal and largely ‘untreatable’ so allow yourself to stop being anxious about being awake – say things like “well at least I’m resting, and its nice and cosy in this bed”
Constipation/Haemorrhoids: exercise and increase the fibre in your diet.
Kiwicrush from most supermarkets in the frozen section is also a natural laxative.
Leg Cramps:
Stop feet flexing at night with a pillow at bottom of feet,
try drinking a Banana smoothie (calcium and potassium)
Backache:
Gentle exercise eg yoga, swimming, walking
No heavy lifting
See a physiotherapist
Emotional Changes:
Reassurance it is common to be closer to emotions and have memory loss
Varicose Veins or Swollen feet:
Avoid constriction: crossing your legs
Rest with feet up
Heartburn:
Bland diet
Sleep with extra pillow to keep the head above the stomach and use gravity to stop gastric juices coming back up.
Antacid only if prescribed
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EXERCISE
Why:
Helps with sleep, increases fitness and energy
levels and increases muscle tone.
How often:
20-30mins 3-4x week, though
even 10 minutes a day of walking can be beneficial
Type:
Low impact exercises eg
Walking, yoga, stretching, swimming
Remember to:
Drink (water)
Keep heart rate <140 beats/min
Avoid:
Over exerting, exercise which causes pain, contact sports
bouncing movements, over heating or getting short of breath
When not to exercise:
If unwell, if there is any risks of premature labour, any bleeding, if you have high blood pressure or
if your Midwife/Dr advises you not to.
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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. But 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.
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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 Councils web site is www.alcohol.org.nz ph 0800 787 797
-smoking effects 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 can not 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.
-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.
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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 http://babywebnz.org.nz/find_a_midwife.htm
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
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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
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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
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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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Pregnancy 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 loan 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, who currently runs Pilates for Pregnancy and Post-natal Pilates classes on Saturday mornings at Revitalize Health Practice. Contact Jo: 0210651101 or bumpnz@gmail.com
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)
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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.
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TRAINING FOR TWO – EXERCISE DURING PREGNANCY
Karina Balle BHSc(physiotherapy), MNZSP, Reg. REPs
(NZ),
Director Preggi Bellies (NZ) Ltd
You would never run a marathon without training for it, and as indicated by research, training for birth is just as essential. Pregnancy is a special time during one’s life, both for your self and for the future life of your baby. For yourself, this often entails unique bodily changes and discomforts, such as painful breasts, morning sickness and pelvic discomfort - changes which once detracted women from exercise. In fact, exercise is proven to alleviate these ongoing discomforts and reaps significant benefits during labour. Studies have concluded that regular exercise can shorten labour by approximately one third and have shown a considerable 75 percent decrease in maternal exhaustion and the need for caesarean and forceps intervention. The psychological benefits are immense. By maintaining fitness and looking great, all over well-being increases. The benefits of regular exercise are compelling, to the point where all women who maintain an uncomplicated pregnancy are recommended to exercise most days, if not every day. In 2002, The American College of Obstetrics and Gynecology (ACOG) published their latest pregnancy recommendations which promoted that a healthy, pregnant women with a uncomplicated pregnancy not only could exercise but should exercise.
It is all about the preparation and the training, not just for you, but for two.
Preggi Bellies is a tailored fitness programme catering for three special markets: pre-pregnant, pregnant and postnatal women. The program is a Physiotherapy based workout utilises the most recent research and classes are now available in New Zealand.
The ‘Training for 2’ program incorporates cardiovascular, strengthening and stretching components in its one-hour long aerobics style workout on the Duraball. All components of the program are adapted from research and allows even for those who have never taken part in
gym classes or engaged in regular exercise. Women at all levels of fitness and stages of pregnancy including postnatal will benefit.
Visit www.preggibellies.co.nz or phone (09) 300 7152
POTENTIAL BENEFITS OF EXERCISE DURING PREGNANCY
Preparation for the physical demands of labour
Increased ability to cope with physical demands of motherhood
Increase in energy level
Maintain a healthy weight gain
Improve your mood
Improve your postural awareness
Improve your sleep patterns
Reduce stress and anxiety
Relieve back pain
Prevent constipation
Prevent varicose veins
Prevent gestational diabetes
Increase coping with labour and delivery
Faster postnatal recovery
Improve and maintain your fitness level, strength and flexibility
EXERCISE GUIDELINES
The following is a summary of the American College of Obstetricians and Gynecologists' revised guidelines for exercising while pregnant from Obstetrics & Gynecology 2002; 99: 171-173.
In the absence of contraindications (see below), pregnant women are encouraged to engage in 30 minutes or more of moderate exercise a day on most, if not all, days of the week.
As always, check with your doctor before beginning an exercise program.
After the first trimester, pregnant women should avoid supine (on your back) positions during exercise. Motionless standing should be avoided as well.
Participation in a wide range of recreational activities appears to be safe. However, activities with a high risk for falling or abdominal trauma should be avoided during pregnancy, such as ice hockey, soccer, basketball, gymnastics, horseback riding, downhill skiing and vigorous racquet sports.
Scuba diving should be avoided throughout pregnancy.
Exertion at altitudes of up to 6,000 feet appears to be safe; however, engaging in physical activities at higher altitudes carries various risks.
SAFETY CONSIDERATIONS
Avoid exercise in warm/humid environments, especially during your first trimester
Avoid isometric exercise or straining while holding your breath
Maintain adequate hydration and nutrition – drink liquids before, during and after exercise
Avoid exercise while lying on your back past the 4th month of pregnancy
Avoid activities which involve physical contact or danger of falling
Know your limits – listen to your body
Know the reasons to stop exercise and consult a qualified health care provider if they occur
New exercisers are encouraged to seek physician approval
REASONS TO STOP EXERCISE AND CONSULT YOUR HEATH CARE PROVIDER
Excessive shortness of breath/breathlessness prior to exertion
Chest pain
Headache – severe, persistent and/or visual disturbances
Painful uterine contractions (more than 6-8 per hour)
Vaginal bleeding
Muscle weakness
Sudden calf pain/swelling (rule out DVT)
Dizziness or faintness
Decreased fetal movement
Palpitations
Pain
Pre-term labour
Amniotic fluid leakage
Any “gush” of fluid from your vagina
(suggesting premature rupture of the membranes)
I recommend all newly pregnant women should have a discussion with their doctors or midwives about their exercise routine.
ABSOLUTE CONTRAINDICATIONS TO AEROBIC EXERCISE DURING PREGNANCY
Hemodynamically (pertaining to the movements involved in circulation of the blood) significant heart disease
Restrictive lung disease
Incompetent cervix/cerclage
Multiple gestation at risk for premature labor
Persistent second- or third-trimester bleeding
Placenta previa after 26 weeks of gestation
Premature labor during the current pregnancy
Ruptured membranes
Preeclampsia/pregnancy-induced hypertension
RELATIVE CONTRAINDICATIONS TO AEROBIC EXERCIUSE DURING PREGNANCY
Severe anaemia
Unevaluated maternal cardiac arrhythmia
Chronic bronchitis
Poorly controlled type 1 diabetes
Extreme morbid obesity
Extreme underweight (BMI <12)
History of extremely sedentary lifestyle
Intrauterine growth restriction in current pregnancy
Poorly controlled hypertension
Orthopedic limitations
Poorly controlled seizure disorder
Poorly controlled hyperthyroidism
Heavy smoker
Disclaimer
The information is not a substitute for medical advice. You are responsible for protecting yourself from injury to yourself and your baby. We strongly recommend that you discuss this with your doctor before implementing it as part of your exercise routine.
The contents of this article are for informational purposes only and do not render medical advice or professional services. The information provided in this article should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care.
Preggi Bellies (NZ) Ltd disclaims any liability whatsoever for any information, which is or may become a part of this Website. If you think you may have a medical emergency, call your doctor, LMC or 111 immediately.
Copyright
© 2005 Preggi Bellies (NZ) Ltd This document is protected by copyright under the Copyright Act 1968, no part of this article supplied by Preggi Bellies (NZ) Ltd may be reproduced or reused for any commercial purposes without prior approval from the directors of Preggi Bellies (NZ) Ltd. Contact us www.preggibellies.co.nz
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