Antenatal Care

This is the care you receive from healthcare professionals DURING your pregnancy. The aim of antenatal care is to maximise the chance of a positive outcome from a pregnancy: a healthy mother and a healthy baby or babies.

What to expect …

In the UK, the great majority of antenatal care is led by registered midwives.  These are care-givers who specialise in pregnancy and birth. They look after you throughout your pregnancy and in the first week or two after your birth. Antenatal care can also be GP-led or shared between the GP and midwife.  Whoever your care giver is, it is important that you feel comfortable, safe, and able to discuss any concerns you have, however sensitive they may be.

Once you know you are pregnant, you need to register your pregnancy with a GP or with a midwife as soon as possible so that you get the appropriate antenatal care.

During your antenatal care, you will have blood tests (to check your blood group, blood disorders and infections, and genetic disorders), an ultrasound scan at 11-14 which offers further screening, an ultrasound scan at 18-20 weeks to check your baby’s growth and any anomalies, vaccinations (for whooping cough and influenza), as well as education in the form of antenatal classes that will help prepare you for birth and the post-delivery period.

It is important that carry your antenatal notes or ‘case notes’ with you as these records communicate your ongoing antenatal care with other care-givers.

If you have been identified as having any factors that may potentially complicate your pregnancy, you are likely to receive additional support from a specialist or a team of specialists which will include an Obstetrician.

Postnatal Care

This is the care you receive from healthcare professionals AFTER your pregnancy.

Adjusting to a new family is one of the most significant life events that many women will face due to the emotional, physical and psychological changes that take place during this time.

For some, these changes occur without much disruption, however, for some women, it can be a very challenging and destabilising time, particularly where mother or baby or both, have additional or complex care needs.  We are here to support you.

What to expect …

After delivery, when your care has been transferred to the community, you should be visited by a midwife within the first 3 days.  The midwife will then hand over care to a health visitor whose main role is to support you and your baby, and to ensure that your baby’s development is on track.  They are usually involved up until your baby is 2yrs of age (although there may be some exceptions).

At 6-8 weeks, a postnatal assessment is carried out by a GP during which they discuss any concerns relating to the delivery and any necessary follow-up, breastfeeding, contraception, your mental health, support networks including family support, as well as reviewing your general medical health.

Health and wellbeing

“I wish I had gotten myself in better shape before my pregnancy” 

Women reported that they wished they would have ‘gotten healthier’ before their pregnancy.  It’s easier to maintain the exercise that you are already accustomed to when you are pregnant, than trying to motivate yourself to start something new.   

But it’s never too late to start!  Try doing some form of daily exercise and stick with it!  Start with something gentle, like walking, yoga, Pilates, swimming, and even trying relaxation techniques.  Avoid contact or high impact sports.  Scuba diving should be avoided.  Take time out for yourself to discover the things that you enjoy.  Several women regret not having made the most of the time before delivery.

Other things to consider (1) Avoid alcohol altogether (2) Stop smoking.  Speak to your GP or midwife, or visit your local pharmacy for support with smoking cessation (3) Eat a healthy, balanced diet.  There is a misconception that if you are pregnant you need to ‘eat for two’ or ‘three’.  This is not the case!  You still need to have a healthy diet and maintain a healthy weight.  Being overweight can be harmful to a pregnancy.

Please speak to our 2Me Clinic Nutritionist or Personal Trainer who can provide more tailored information regarding diet and exercise.  Follow the links below: 

When do I take folic acid?

In fact, if you’re thinking of trying for a baby, then you should start taking folic acid! It’s a vital B vitamin that helps with the development of the baby’s brain and spine. The recommended dose of folic acid is 400 micrograms (mcg) a day taken before you are pregnant and continued until you are 12 weeks pregnant.   

You will need a higher dose of 5mg taken once a day if you:  

• Have a body mass index of more than 30 
• Take medication for epilepsy 
• Have coeliac disease  
• Have type 1 or type 2 diabetes  
• Have a personal or family history of birth defects of the brain and spine  
• Have had a pregnancy affected by a birth defect of the brain and spine  
• Have certain blood disorders such as thalassaemia, thalassaemia trait, and sickle cell anaemia – with these blood disorders, 5mg of folic acid must be taken throughout pregnancy. 

You get freebies!!

You are entitled to free prescriptions and free dental care during your pregnancy which applies even up to a year after your expected date of delivery.  Speak to your GP or midwife about a maternity exemption certificate.

The Pelvic floor thing!

“We were all told about the ‘pelvic floor’ but I didn’t really take it that seriously”

Embarrassing leaks can and do happen, and they can happen quite soon after pregnancy.  There was shared agreement amongst women, we surveyed, that there needs to be more emphasis on how to do pelvic floor exercises correctly and more importantly, the embarrassing consequences of not doing them. Check out ‘Squeezy’ app by visiting www.squeezyapp.com. It’s a great resource for supporting you in strengthening your pelvic floor. Don’t wait till after your delivery to start, just start!

Tip! As a general rule, try doing 10 contractions each time you wash your hands or do a nappy change

Miscarriage

“When you have a miscarriage, all you see around you is women with healthy babies, but I was shocked to hear their stories”   

The loss of a pregnancy can be a very lonely experience, particularly when all of a sudden, all you seem to see is around you is women with healthy babies, but every one of those women has a very different story behind that successful pregnancy, and it’s that story that needs to be heard.  For some women the pregnancy journey had been a tumultuous one, with some experiencing not just one but several miscarriages.   

Miscarriage affects about 20-30% of all pregnancies and therefore is more common than we realise.  There needs to be more support to help women talk about it so it doesn’t feel like much like a taboo topic, even amongst family and friends, or trivialised by comments like, ‘don’t worry, just have another one, or you’ll get over it’.  Don’t keep it in, talk about it!  It’s ok to grieve for your loss.  

If you have suffered a pregnancy loss and need support, please contact the Miscarriage Association at: info@miscarriageassociation.org.uk: support line: 01924 200 799. Alternatively, you can contact Denise, our friendly 2MeClinic psychotherapist and counsellor.

Post-pregnancy fatigue

“No-one prepared me for this level of exhaustion” 

It is normal to feel tired after delivery. Healing from childbirth, taking care of a newborn, and breastfeeding every 2 to 3 hours requires a lot of energy. If you’re also having to negotiate the demands of a busy home and have work commitments, then it’s easy to understand why you might feel so exhausted  

Tips we were given by women we surveyed were: Get help! If you can, reach out to your partner, family, friends, midwife, health visitor, or your doctor.  It’s hard work, so don’t feel guilty about recruiting help.  It’s a journey that you don’t need to make alone.  Make sure you make time to eat regular meals or small meals regularly, and drink plenty of water (particularly if you are breastfeeding).  Family, friends or support groups can help prepare meals for you.   

Tiredness can also be caused by a low blood count, which is called ‘anaemia’. The incidence of anaemia related to pregnancy is about 25 to 30%.  Anaemia may aggravate your tiredness and alter your ability to look after your baby. Speak to your doctor.  You should also increase your intake of foods containing iron (red meat, beans, nuts, green vegetables) together with vitamin C (which also helps the body absorb iron).  

Is it ok to feel moody?

Yes it is!  Dips in hormone levels occur 48-72hours after delivery leading to changes in mood which has historically often been referred to as ‘baby blues’.  Many women feel guilty or panic about such feelings as though this should not be happening.  It’s normal, and as you’ve just read, there is in fact some science behind it!  Nevertheless, it is important to reach out and talk about the way you feel. 

Contraception

Do I still need contraception if I’ve just given birth or if I’m breast feeding? 

If you have had a baby in the last 6 months, have not started having periods and fully breastfeeding (every 2hrs during the day and night), this is about 98% effective contraception.  This is called the lactational amenorrhoea method (LAM).  The risk of pregnancy is increased if the frequency of breastfeeding decreases (e.g., through stopping night feeds, starting or increasing supplementary feeding, use of dummies/pacifiers, or expressing milk), when menstruation returns or if more than 6 months has passed since your delivery.

If you are not exclusively breastfeeding and are sexually active, you need contraception. In this case, contraception needs to be initiated within 21 days of delivery. The progestogen-only pills (also known as ‘mini-pills’), the depo injection and the contraceptive implant can be used. These methods can still be used after day 21, but you may need additional protection for a short period, so speak to a doctor.

Combined hormonal contraception can be started after 21 days IF you are NOT breast feeding. 

Combined hormonal contraception can be started after 6 weeks IF you are breast feeding.

COILS (Hormonal and Copper coils) can be safely inserted immediately after birth (within 10 minutes of delivery of the placenta) or within the first 48 hours after uncomplicated caesarean section or vaginal birth. After 48 hours, insertion should be delayed until 28 days after childbirth.  

Breast feeding.. Is it supposed to be this hard?

Majority of the responses from our survey were in fact in relation to difficulties around breast-feeding and the pressure on mums to breast feed.  The decision to breast feed is one of personal choice.  There are many benefits of breastfeeding, and when it is going well, it is very satisfying, but we are also aware that it can be a very challenging and frustrating time if it is not as successful as we would have hoped. 

It is important to give a few facts: 

1. Did you know that the mode of delivery can affect milk production? During delivery, movement of the baby down the birth canal stretches the vaginal walls.  This stimulates the release of a hormone caused oxytocin which causes milk production from the breast.  With a caesarean section, there is no stretching of the vagina, so less oxytocin is released which can affect milk production from the breast.
2. Other factors that may affect the breast-feeding process include: maternal or infant complications around delivery, separation of mother and baby, maternal confidence, and medication.
3. Breast and nipple pain:  If breastfeeding, it’s a good idea to speak to a health visitor, midwife or breastfeeding specialist first as the problem could be easily rectified e.g. a poor latch. Pain can be caused by the breast becoming overly full, in which case expressing can help; Pain may also be caused by ‘Mastitis’ or ‘Thrush’: Head over to the section on ‘breasts’ in the 2Me Clinic health corner. 
4. It is important to recognise that there are alternatives to breast milk such as formula milk which is considered a ‘healthy’ alternative, on which your baby can thrive.

If you need support with breast feeding, you can contact a lactation consultant at www.lcgb.org.

Pregnancy red flags:

When do I need to worry?

We advise you to contact your doctor immediately in the event that you experience any of the following symptoms: 

1. Heavy menstrual bleeding with or without pain
2. Severe abdominal pain
3. Severe Headache
4. Any visual disturbance 
5. Fainting or light headedness
6. New onset sudden swelling of hands and feet 
7. Sudden onset breathlessness 
8. Shoulder tip pain  
9. Sudden onset of chest pain  
10. Generalised itching  
11.  Pain and swelling in one of the calves 
12.  Reduced foetal movements 
13.  Persistent vomiting 

Haemorrhoids and constipation

No-one mentioned the haemorrhoids! 

Haemorrhoids are lumps containing blood vessels which can develop around and inside the anus.  Things that contribute to the development of haemorrhoids: (1) Pressure in the pelvis (due to the growing baby) which puts pressure on veins in the abdomen (2) Constipation, which can result from the fear of passing stools in the presence of perineal trauma, reduced mobility, medication (such as iron and certain pain medication received in labour), and reduced fluid intake 

Did you know that constipation is reported by approximately 20% of women after delivery? 

Altered taste

Why does everything taste weird? 

Taste can be distorted during pregnancy due to changes in hormones: Some women report a sour or metallic taste in the mouth.  You may start to crave foods that are not healthy so you need to be careful. It may cause you to dislike a food that you normally love, or enjoy foods you normally dislike. 

Tips: Try sucking on an ice lolly, or a mint; eating green apples or drinking citrus juice.