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Pregnancy or Antenatal

Pregnancy can be daunting time for some incumbent mothers, especially if it is their first pregnancy.

We have developed some advice to assist you in the transition to motherhood:

1.       Remember this is a natural process of reproduction that has occurred since as far we and other mammals have been here!

2.       You should not see the GP to confirm you are pregnant. We have no special urinalysis strips. They are all very similar. We do not do blood testing to confirm that someone is pregnant. If your urine strip shows an unclear result, it is likely that it is too early, please leave up to a week and repeat the test.

3.       You do not need to see the GP to be referred to a midwife/hospital. All the local hospitals operate a self-referral mechanism to access their antenatal services. Think about which hospital you would like to have your care. Most women tend to go to either the local Royal Free or University College London Hospitals, some prefer going St Mary’s or the Whittington Hospital and few go even farther afield to Chelsea and Westminster or Queen Charlotte’s. The latter three are accessible only via self-referral.

Royal Free Hospital:

https://www.royalfree.nhs.uk/services/services-a-z/maternity-services/maternity-self-referral-form/

University College London Hospital:

https://www.uclh.nhs.uk/OurServices/ServiceA-Z/WH/MAT2/Documents/UCLH%20Maternity%20Services%20-%20Referral%20Form.pdf

St Mary’s Hospital:

https://www.imperial.nhs.uk/antenatal-referral-form

Whittington Hospital:

https://www.whittington.nhs.uk/mini-apps/default.asp?page=Maternity/Self_referral.aspx

Some like the Royal Free Hospital operate a tour of their labour ward (https://www.royalfree.nhs.uk/services/services-a-z/maternity-services/parent-education-classes/labour-ward-tour/).

All hospitals operate classes, known as antenatal classes which cover various aspects of pregnancy and labour. We encourage all newly incumbent parents to attend.

Try and refer yourself to a hospital by 6 weeks gestation, which is calculated as 6 weeks after the first day of your last menstruation, to allow for plenty of time for your first appointment, which should ideally occur from weeks 8-11. This is your booking appointment where the midwife will talk you through the process and what to expect as well as some blood tests (see the schedule below).

You will receive your first scan a few weeks after your booking appointment. This is mainly a dating scan to check how far the pregnancy has progressed. The second development scan takes place around week 18.

You will be monitored by the midwives and if necessary a consultant and they will assist you with issues relating to your pregnancy.You can access services such as physiotherapy and psychology through the antenatal clinic. If, as we hope you have an uneventful pregnancy without any complications. It will be mainly your midwife taking care of you.

Towards the middle to end of your pregnancy you may be offered to have some of the antenatal appointments with your GP. This is different to the Royal Free Midwives who also do a weekly clinic at our surgery. We do not encourage you have your antenatal care with anyone other than your antenatal clinic (midwife/hospital). The reason for this is that we will not have your full history or all your results, but more importantly we do not have the same experience and skill set as they do nor the rapid direct access to additional services, if required.

Vitamins Supplements:

We recommend that all women take folic acid and vitamin D supplements 3 months prior to trying to conceive, which is available in pre-pregnancy multivitamins.

Once you become pregnant, we encourage all women to switch to the slightly different pregnancy multivitamins.

There is a healthy start programme available in many supermarkets and various pharmacies and community centres intended for those in receipt of certain benefits so they can obtain from week 10 these multivitamins for free. Please refer to the following link to see if you qualify and you can also put your post code to find where your local centre is: https://www.healthystart.nhs.uk/healthy-start-vouchers/do-i-qualify/

The don’ts during pregnancy:

Avoid smoking, drinking and drugs prior and during pregnancy.

·       For the first 12 weeks (called first trimester) avoid prolonged exposure to heat ie sauna’s/steam rooms. You can continue exercising, just do not push yourself too hard!

·       Do not consume more than 2 portions of fish a week – this is due to the mercury in seawater.

·       Avoid any uncooked meats or unpasteurised cheeses ie mouldy cheeses.

·       Limit your caffeine intake to less than 200mg ie no more than 2 cups of tea/coffee or use decaffeinated drinks. Remember chocolate and fizzy drinks also have caffeine.

·       Take care handling cats (especially their litter) and undomesticated animals – due to the risk of toxoplasmosis.

·       If you are feeling nauseous nausea try to have smaller meals, less fatty, not so late, with less spice. Ginger and peppermint can help.

·       Please try to avoid travelling to any Zika or Malaria regions-check the advice posted on the foreign office website.

·       Avoid contact with children with infectious rashes such as chickenpox and see a doctor straightway if you think you may have developed chickenpox.

When to see a GP:

We are here to help and support you during your pregnancy, so if you have any concerns or issues you wish to discuss then we invite you to book an appointment to see us. 

If you are experiencing any problems such as infections, reflux, indigestion, vomiting more than a few times a day then please book to see a doctor.

It is normal to sometimes experience light spotting and mild period cramping in the first 10 weeks. We encourage women with slight bleeding or non-severe abdominal pain to see a doctor. If this on the weekday you can book an urgent appointment to see us and we can arrange for a scan at the hospital usually by the next day. If this occurs on the weekend then please go to your local emergency department and they will book this scan for you.

When to see the hospital:

If you experience any severe abdominal pains, cramping or bleeding then please immediately go to your hospital/emergency department. If you have not felt any movements (after movements become established and noticeable) for more than 24 hours please see contact a doctor or your antenatal clinic directly as soon as possible.

Similarly if you have any other severe symptoms including chest pain, shortness of breath, severe vomiting, feeling extremely faint or fainting, extreme headaches or sudden severe weakness in a limb, or problems with speech or swallowing or visual loss please contact 999.

Please be aware that you are at increased risks of developing clots, so please take additional precautions on long haul flights (keep moving, wear stockings, drink plenty of water). If you develop unexplained sudden calf pain in one leg which is persistent ie not short lived for few minutes or hours, with or without leg swelling please see a doctor urgently for a scan of your leg.

What to expect:

Do read Emma’s diaries which gives a week by week account of what to expect (https://www.emmasdiary.co.uk/) and has been approved by the Royal College of Obstetricians and Gynaecologists.

The following are other useful links/sites include:

·       https://www.babycentre.co.uk/pregnancy

·       https://www.tommys.org/pregnancy-information/im-pregnant

·       https://www.nhs.uk/conditions/pregnancy-and-baby/

It is normal for your body to go through some substantial changes during pregnancy to adapt to your developing baby. But if you are concerned please speak to your midwife or book to see a doctor.

Above all else enjoy your pregnancy. Remember that we are here to help!

We wish you all the best in for your pregnancy and birth!

Antenatal Schedule:

The following is the routine antenatal schedule for uncomplicated pregnancies (https://www.nice.org.uk/guidance/cg62/ifp/chapter/antenatal-appointments-schedule). 

Appointment

What should happen

Booking appointment

Your midwife should give you information about:

·       how the baby develops during pregnancy

·       nutrition and diet, including vitamin D supplements

·       exercise, including pelvic floor exercises

·       antenatal screening tests

·       your pregnancy care pathway

·       where to have your baby

·       breastfeeding and workshops

·       antenatal classes

·       maternity benefits.

Your midwife  should:

·       see if you may need additional care or support

·       plan the care you will get throughout your pregnancy

·       ask about your job to identify any potential risks

·       measure your height and weight and calculate your body mass index

·       measure your blood pressure and test your urine for protein

·       find out whether you are at increased risk of gestational diabetes or pre‑eclampsia

·       ask about mental illness and ask about any signs of depression

·       offer you screening tests and make sure you understand what is involved before you decide to have any of them

·       offer you an ultrasound scan to estimate when the baby is due

·       offer you an ultrasound scan at 18 to 20 weeks to check the physical development of the baby.

16 weeks

Your midwife should give you information about the ultrasound scan you will be offered at 18 to 20 weeks and help with any concerns or questions you have.

Your midwife or doctor should:

·       review, discuss and record the results of any screening tests

·       measure your blood pressure and test your urine for protein

·       consider an iron supplement if you are anaemic.

18- 20 weeks 

(anomaly scan)Ultrasound scan to check the physical development of the baby if you wish it.

25 weeks*

Your midwife should:

·       check the size of your abdomen

·       measure your blood pressure and test your urine for protein.

28 weeks

Your midwife should:

·       check the size of your abdomen

·       measure your blood pressure and test your urine for protein

·       offer more blood screening tests

·       offer first anti‑D treatment if you are rhesus D‑negative.

31 weeks*

Your midwife should:

·       review, discuss and record the results of any screening tests from the last appointment

·       check the size of your abdomen

·       measure your blood pressure and test your urine for protein.

34 weeks

Your midwife should give you information about preparing for labour and birth, including how to recognise active labour, ways of coping with pain in labour and your birth plan.

Your midwife should:

·       review, discuss and record the results of any screening tests from the last appointment

·       check the size of your abdomen

·       measure your blood pressure and test your urine for protein

·       offer second anti‑D treatment if you are rhesus D‑negative.

36 weeks

Your midwife should give you information about:

·       breastfeeding, including hints and tips for success

·       caring for your newborn baby

·       vitamin K and screening tests for your newborn baby

·       your own health after the baby is born

·       being aware of the 'baby blues' and postnatal depression.

Your midwife  should:

·       check the size of your abdomen

·       check the position of the baby and discuss options to turn the baby if he or she is bottom first (breech position)

·       measure your blood pressure and test your urine for protein.

38 weeks

Your midwife should give you information about what happens if your pregnancy lasts longer than 41 weeks.

Your midwife should:

·       check the size of your abdomen

·       measure your blood pressure and test your urine for protein.

40 weeks*

Your midwife or doctor should give you more information about what happens if your pregnancy lasts longer than 41 weeks.

Your midwife should:

·       check the size of your abdomen

·       measure your blood pressure and test your urine for protein.

41 weeks

Your midwife should:

·       check the size of your abdomen

·       measure your blood pressure and test your urine for protein

·       offer a membrane sweep

·       offer induction of labour.

* Extra appointment if this is your first baby.

 

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