THE WILSON PRACTICE

March 2007

PREGNANCY ADVICE SHEET

Pregnancy

Congratulations on your pregnancy. Pregnancy is to be enjoyed.

 

Midwives

Sister Jane Day is the Lead Practice Community Midwife.

She is a State Registered Nurse and Midwife.  She holds booking and antenatal clinics various days during the week.  She liaises very closely with the maternity units at North Hampshire Hospital in Basingstoke and Royal Hampshire County Hospital in Winchester. They provide facilities to perform routine blood screening tests such as Rubella, HIV and Hepatitis B. They can also organise for private “Triple Tests” and Nuchal Fold Scans in the region.

Antenatal Classes are held on a regular basis and partners are encouraged to attend and are made very welcome.

Jane also provides regular breathing and relaxation classes to complement the antenatal classes. A reunion and support group also follows on postnatally.

Jane will discuss the various options for delivery with you at the first booking appointment, so that you can create a plan that is right for you.

The midwives are keen to offer the Domino Delivery Scheme, although lack of time makes this impossible for everyone.

GENERAL PREGNANCY ADVICE


It has been well shown that some lifestyle changes are associated with a better outcome for both baby and mother.

Exercise: should be continued as before pregnancy.  Unaccustomed exercise is probably best delayed until after the birth, but gentle exercise is to be encouraged.  The only sports that are to be avoided are scuba-diving and water-skiing.

Smoking: there is clear evidence that mothers who smoke through their pregnancies are much more likely to miscarry, have high blood pressure or even pre-eclampsia than mothers who don’t smoke.  Smoking can also harm your baby.  This pregnancy is your best reason you ever had to give up.

Alcohol: there are no clear guidelines as to what amount of alcohol is safe in pregnancy.  Binge drinking is thought to be more harmful than regular drinking.  It is probably best to drink no alcohol, or to limit your alcohol intake to about 2 units per week (i.e. 2 glasses of wine per week).

Diet: it is important to eat plenty of fresh vegetables and fruit throughout the pregnancy.  This will ward off constipation and anaemia.  Some foods are best avoided.  These include unpasteurised cheese (e.g. brie or camembert), pate, raw eggs, and liver. Also, eating nuts, particularly peanuts, during pregnancy is thought to increase the risk of nut allergy in children so best avoided.

Supplements: Folic acid has been clearly shown to reduce the incidence of spinal cord problems in your baby.  Ideally, Folic acid should be started before pregnancy (400 micrograms daily) and continued up to the first 12 weeks of pregnancy. 

Drugs: generally all drugs should be avoided throughout pregnancy, but this is particularly true for the first three months of pregnancy, when the baby is developing rapidly.  However, paracetamol has been used in pregnancy for many years and has been shown to be entirely safe, even in the full adult dose.  If you have any queries or concerns, please contact your midwife or doctor.

SCREENING IN YOUR PREGNANCY

In the early part of your pregnancy, you may wish to consider which screening tests are appropriate for you.  We advise that you should have all of the following, although, you may of course decline any of them.  Screening tests often do not give a definite answer but quantify a risk of a particular event occurring.  Most screening tests are available to everybody; others have special reasons to request specific tests.

Haemoglobin: to detect whether you are anaemic.

Blood Group: to identify your blood group.  Some blood groups are more at risk of problems than others.

Blood Sugar: only done if there is sugar present in your urine.  However, some hospitals do a ‘glucose loading test’ to assess how your body copes with a predetermined amount of sugar.

TPHA: the test for syphilis, rare but important.

Rubella (German Measles): this test, done at 12 weeks, checks that you are immune to rubella.  If you are not immune, you should be vaccinated after the birth of your baby.

Urine Culture: at 12 weeks, checks for infection.  Treatment will prevent the development of a kidney infection, which occasionally can cause a premature birth.

HIV: is the virus that causes AIDS.  It can be passed from mother to baby during pregnancy, at delivery, or through the breast milk.  The HIV test involves taking blood.  The test will only become positive three months after exposure to the virus.  If a mother is infected, she can be given special care that can improve the condition, and reduce the risk of her baby becoming infected by about two thirds.

Knowing if you are HIV positive allows you to make choices: whether or not to carry on with the pregnancy, whether to have the baby delivered by Caesarean section, whether or not to breast feed, how to protect your partner and to help make plans for the future.  A negative HIV test does not affect past or future life insurance.  A positive result means the person is infected, not that they have AIDS.  Please ask if you have particular questions about your own situation.

Hepatitis B: This virus is more common in the Far East, Africa and parts of Asia.  It is spread sexually or through the injection of drugs.  If the mother is a carrier of Hepatitis B, her baby will probably become infected during delivery.  90% who are infected go on to have medical problems associated with the infection, many of them serious.  If we know you have the virus, your baby can be immunised soon after the birth, and protected from the long-term consequences of the infection.

Ultrasound Scans: are done at 20 weeks. It checks that your baby has no major structural or anatomical abnormalities, checks the number of babies and confirms your dates. (Basingstoke will offer a dating scan if appropriate at 12 weeks). 

ADDITIONAL/OPTIONAL TESTS

Electrophoresis: to check for sickle cell disease or thalassaemia found in Afro-Caribbean and Mediterranean mothers.

Toxoplasmosis: this rarely causes damage in unborn babies.  Blood tests are not recommended as most people are immune and the results are often confusing.  Simple hygiene, particularly with regard to cats, is the best deterrent.

Hepatitis C: is associated with intravenous drug use and blood transfusions.  Transmission to a baby is rare and cannot be prevented.

Downs Syndrome: remains the commonest cause of mental retardation in the UK.  The risk of having a Downs Syndrome child increase with the mother’s age, but about half of Down Syndrome cases are in women under 30, as the majority of mothers are in the younger age group.  Downs Syndrome is diagnosed by amniocentesis (examination of the cells from the fluid surrounding the unborn baby), or Chorionic Villus Sampling (biopsy of the placenta}. CVS is done very infrequently now, as it was thought to be associated with foetal malformations.  Amniocentesis is offered to all women over the age of 35, but carries a small risk of miscarriage (1:200).  Certain hormone levels in the blood may be different in Down’s affected pregnancies, and tests are available to tell you the risk that you have, in your pregnancy, of having a Downs baby.  These tests are:

1.      Triple test: tests 3 hormones.  Will pick up 2 out of 3 affected pregnancies.  Is done in the 16th week.   This is currently being offered free of charge at Basingstoke and Winchester NHS.

2.      Nuchal Fold: scanning measures the thickness of skin at the back of the baby’s head.  It is done between 10-13 weeks, and will give you a risk of abnormality.  It will pick up 2 out of 3 affected pregnancies.  This is now being offered by Basingstoke and Winchester hospitals free of charge.

Please remember that the majority of mothers have uncomplicated pregnancies and deliveries.  Please ask if you have any worries or concerns.

ANTENATAL CARE

Weeks of pregnancy are counted from the first day of your last period.  Conception would usually occur in between week 2 and week 3 of the pregnancy (i.e., the pregnancy is considered to have started before conception has actually occurred).  A ‘booking appointment’ is made with the midwife at about 10 weeks of pregnancy.  Some ladies opt for shared care, where the care is provided by the surgery with two visits to the hospital.  Most opt for GP care; where all the care is provided by the midwives at the surgery.  All ladies are scanned at about 20 weeks to check for anomalies.  Women with the blood group Rhesus negative require additional care and blood tests.

8 weeks:  Blood taken for screening tests, including Hepatitis B & HIV.  Please arrange with the receptionist to have your blood taken in advance of your booking appointment.

8-10 week Booking Appointment: the midwife will discuss any concerns and dietary and lifestyle advice will be given.  Weight and blood pressure will be checked.  The antenatal care plan will be outlined, and other screening organised.  It is helpful if blood can be taken for the screening tests prior to this appointment so the results can be discussed at the appointment.  Please decide where you would like to have your baby.  Nearly all ladies go to either Winchester or Basingstoke, although some prefer the other hospitals listed below.  Some carefully selected patients opt for home delivery after discussion with the midwife 

Hospitals

1.  North Hampshire Hospital, Basingstoke.  01256 314790.   17 miles from Alton

2.  Royal Hampshire County Hospital, Winchester  01962 82232.   22 miles from Alton

3.  Andover Birthing Centre.     01962 782131.  38 miles from Alton

4.  Royal Surrey County Hospital, Guildford.  01483 464133.   24 miles from Alton

5.  St Mary’s Hospital, Portsmouth.  01705 286000.  36 miles from Alton

6.  Petersfield Maternity Ward, Petersfield,  01730 266742.   14 miles from Alton

7.  Frimley Park Hospital, Surrey.  01276 604604.   22 miles from Alton

Those choosing North Hampshire Hospital have the option of antenatal classes, domiciliary delivery and home confinement with the community midwife team.  They are also offered 1st trimester screening (nuchal fold scan with blood screening) between 11-13.6 weeks or 2nd trimester serum screening (triple test) between 15-20 weeks (ideally 16 weeks).  The anomaly scan (19-20 weeks) can be at Alton Community Hospital.

12 weeks:  Winchester patients – a dating scan can be arranged by the midwife. 

16 weeks:  Basingstoke and Winchester patients can see midwife with results of scan.  An extra blood test can be taken to screen for Down’s and spina bifida. (Second trimester bloods)

18-20 weeks:  an anomaly scan will have been organised.  For those who have opted for shared care, this will coincide with a hospital visit. For those having GP care, there will be a visit to the midwife at the surgery.

(24 weeks:  routine antenatal check. – only for first time or high risk pregnancies.)

28 weeks:  routine antenatal with midwife.  Blood tests and Anti D given if rhesus negative.

31 weeks:  routine antenatal check

34 weeks:  routine antenatal with midwife.  Blood tests and Anti D given if rhesus negative. 

36 weeks:  routine antenatal with GP

38 weeks:  routine antenatal with midwife

40 weeks:  routine antenatal with GP

41 weeks:  if you baby has not arrived, it may be necessary to organise a date for the induction of labour.

If you have any particular, individual problems, your antenatal care package will be altered to suit your pregnancy.

.Form /Pregnancy Advice Sheet March 2007