Antenatal

There is no known safe level of alcohol consumption during pregnancy.

Alcohol and pregnancy: what you might not know (HE2523) PDF

Blood tests are offered during your pregnancy (typically at booking, 24 weeks & 36 weeks) to protect the health of yourself and your baby by identifying conditions or diseases as soon as possible so that treatment can be offered.

Urine Test:

Urine is formed by the kidneys and can tell us a lot about our health. During pregnancy urine is tested with a ‘dipstick’ which is ‘dipped’ into the mid-stream flow of urine. Most women are able to conduct this test themselves. Commonly we test for glucose and protein as these should not be present in your urine in large quantities. Glucose may be an indication of a recent high sugar intake or gestational diabetes. Protein may be due to blood in the urine, a urinary tract infection or pre-eclampsia. Dipstick style tests are only screening tests so if the test is positive having a urine or blood sample tested will be recommended to confirm the result.

Blood Pressure (BP):

Regular monitoring of BP is important as high BP puts an unnecessary strain on your heart and blood vessels. BP is a measurement of the pressure of blood against the walls of the blood vessels. The highest ‘systolic’ number measures the pressure created by the heart when it contracts to pump blood into the arteries, and the lower ‘diastolic’ number measures the pressure when the heart relaxes between beats. A pregnant woman may have a normal BP as low as 90/50 or as high as 135/80, with an average of about 110/70. The pressure itself is not as much of an issue, but how much it rises over the course of the pregnancy. A reading of 140/90 or more is called ‘hypertension’and the effects of this during pregnancy vary from mild to severe but can result in harm damage to the mother’s kidneys and other organs, and can also cause low birth weight and premature birth. Hypertension can also be a sign that the mother is developing ‘pre-eclampsia’ which can have serious consequences for both mother and baby if untreated. It’s important to remember that a single high reading can be caused by stress, emotion, anxiety and exercise so your midwife will probably take a second recording later to confirm it.

Abdominal Palpation:

This is the technical term used to describe your midwife feeling your tummy during pregnancy to assess the growth and position of the baby. It can be undertaken from around 12 weeks when the uterus rises above the bones of the pelvis. It starts with a quick visual inspection, which often gives clues to the position of the baby and the amount of fluid around it. The top of uterus (the’fundus’) is then found and measured, as any significant differences found may alert to considering possibilities such as a multiple pregnancy, inaccurate dates or slow growth etc. Next the position of the baby is found, particularly the location of the head and the position / direction of the baby’s back. The final step (only done in the last few weeks) is checking to see if the baby’s head has ‘engaged’ (descended into the pelvis). This usually begins to happen from around 36 weeks (sometimes later if it’s not your first baby). After palpation the final step is to listen to the baby’s heartbeat to ensure it’s within the normal range of 110 – 160 beats per minute.

Antenatal screening can provide some information about the chance of your baby having Down syndrome or other conditions such as trisomy 18 (Edwards syndrome), trisomy 13 (Patau syndrome) and some other rare genetic disorders. This screening is optional. There are three screening options available for women in New Zealand, who are less than 20 weeks pregnant.

First trimester combined screening: (if you are less than 14 weeks pregnant) combines the results of a blood test from you (MSS1) and a nuchal translucency (NT) ultrasound scan (usually 12 weeks), with other information, such as your age and weight.

Second trimester maternal serum screening (if you are 14-20 weeks pregnant ) combines the results of a blood test from you, with other information, such as your age and weight. This is usually done if you have not met the timeframes for the first trimester screening.

Illumiscreen: a blood test that screens for the most common chromosomal abnormalities, as above. This test is around 98% accurate, but does come with a cost as the sample is sent to Australia. (approx fee $600) Results usually take 7-10 days.

Antenatal Screening and Testing for Down Syndrome and Other Conditions (HE2382) PDF

Typically you will first start to feel your baby move when you are between 16 – 22 weeks pregnant. We suggest that from 28 weeks you spend some time each day getting to know your baby and focusing on your baby’s movements. Your baby should remain active during your entire pregnancy and when a healthy baby is awake they will usually move at least 10 times in 2 hours. If you feel a decrease in the normal daily activity of your baby this may be cause for concern. If you have concerns you should first sit in a quiet place and focus on feeling your baby’s movements.

You should contact your midwife immediately if:

• baby does not move at all one day.
• baby kicks less and less in the course of the day and you feel that there is too little activity from your baby.

Folic Acid and Iodine: Taking Folic acid (until end 12th week) and Iodine (during pregnancy & breastfeeding) supplements is recommended.

Here are some useful websites:

Gestational (“pregnancy”) diabetes occurs when a pregnant woman has high levels of glucose in her blood because she is not producing enough insulin (a natural hormone produced by the body to take the sugar from your blood and move it into your cells as an energy source for the various things that cells have to do). It affects 2 to 5% of women and if not controlled is associated with increased pregnancy complications for the woman and her baby.

All pregnant women are offered a HbA1c blood test test at booking to identify women with probable undiagnosed diabetes or prediabetes. At approximately 28 weeks’ gestation women who are at high risk of gestational diabetes are offered the diagnostic two-hour, 75 g oral glucose tolerance test (OGTT).

All other women should be offered screening using the one-hour, 50 g, oral glucose challenge test known as the polycose test. It is the woman’s decision whether she wishes to be screened or not.

Immunisations for Whooping Cough (from 16 weeks) and Flu (1st April – 31st Dec) are offered to women during pregnancy. These are available via your GP (& some pharmacies).

Link to and download this PDF to read: Immunise during Pregnancy (HE2503)

Breastfeeding is the best way to feed your baby. Breastmilk is the biologically normal way of providing infants with the nutrients they need for healthy growth and development. It recommended you breast feed until around six months and your baby is ready for foods. As midwives we will support you in beginning your breastfeeding relationship. However, if for some reason breastfeeding is not the right choice for you or your baby then we can discuss your options and support you with alternatives.

We encourage you to attend an antenatal breastfeeding classes in the last trimester of your pregnancy, you can find information in these places:

During your pregnancy you will need to make many choices about your maternity care. Informed choice & consent means you must be given unbiased information about the proposed treatment/procedure; unbiased information about other options if you ask for this; be given time to consider this information; and you must have freely decided to give your consent.

Maternity Services Consumer Council – Your right to informed choice

These resources provide information about your options for maternity care:

Optimal Foetal Positioning (OFP) describes ways women can in late pregnancy encourage their baby to move in positions which are the simplest and safest for labour and birth. This “optimum” position is head down with baby’s chin tucked down towards its chest and the back of babys head facing towards the front of your body. As the baby’s back is on the heaviest side of its body it will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower than your back (e.g. if you are sitting on a chair leaning forward) then the baby’s back will tend to swing towards your tummy.

However if your back is lower than your tummy (e.g. if you are lying on your back or slouching on a sofa) then the baby’s back may swing towards your back. So avoid positions which encourage your baby to face your tummy. The main culprits are slouching in armchairs, reclining on a car seat, or anything where your knees are higher than your pelvis. The best way to do this is to spend lots of time kneeling upright, sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your torso tilts slightly forwards.

A very helpful website is Spinning Babies

Research has shown that going to sleep on your side from 28 weeks of pregnancy halves your risk of stillbirth compared with sleeping on your back.

Sleep on side when baby’s inside – from 28 weeks (HE2550): https://www.healthed.govt.nz/system/files/resource-files/HE2550_Sleep%20on%20Side%20when%20baby%27s%20inside.pdf

Smoke free pregnancies have better outcomes. Remaining smoke free or stopping smoking is one of the most important things you can do to improve your baby’s health, growth and development and your own long-term health. Your midwife can provide help and support, including Nicotine Replacement Therapy (patches, gum, lozenge).

Depending on your situation you may be eligible for parental leave or other financial assistance. Your midwife can provide you with a letter confirming your pregnancy.

Some links to help:

Smart Start

IRD Working for Families

If you are working when you are pregnant you can get up to 10 days unpaid special leave to attend medical appointments, antenatal classes etc. Your rights as a pregnant worker.

It’s normal to feel a little worried and stressed when you’re pregnant, but for some people anxiety can become a real problem and they will need professional help. Postnatal depression affects up to 15 % of women after they have given birth (and up to 9 percent of women during pregnancy).

The ultrasound scans you will be offered during your pregnancy are optional. Ultrasound scans during pregnancy are painless and non-invasive with no known risks to the baby or the mother. They have clear benefits when performed for medically necessary reasons however should only be performed by appropriately trained healthcare providers for medical purposes. Routine scanning of women whose pregnancies are progressing normally does not lead to healthier babies or fewer problems during labour and birth. Additional keepsake scans solely for the purpose of producing an image or video are not recommended. Not all problems can be seen with a scan as sometimes the problems are very difficult to see, especially if there are twins, the baby is in a difficult position or the mum has a high BMI. Occasionally something is seen on the scan that might indicate there is a problem, but usually the baby is fine. If a potential problem is found you may need a repeat scan or maybe referred to an obstetrician for further discussion / testing.

Regular visits are a very important part of your care. Your partner, family, support people are always welcome and encouraged to be part of your visits.

The schedule of antenatal visits will be negotiated with you but is typically as follows:

Booking visit (ideally by 10 weeks), then every 4 weeks until 28 week, then 2 weekly until 36 weeks, then weekly until your baby is born. Once your baby is born our postnatal midwife will visit you in your home (or other location at your request) for 4-6 weeks (minimum of five home visits).