Author: development

Regular antenatal care is a key component of a healthy pregnancy and provides an opportunity to receive advice, information and support, while engaging in shared decision making about your  pregnancy that is designed to suit your individual pregnancy needs.

KEY POINTS

Antenatal care should be woman centred acknowledging pregnancy is a normal life event for most.

Antenatal care improves pregnancy outcomes for both mother and baby by recognising potential problems in pregnancy early.

The range of routine antenatal care visits range from 7 – 12 throughout the course of pregnancy with the average being around 10 visits.

During each visit your midwife or doctor will discuss screening test and arrange these as required.

It’s good if your partner, a friend or a family member can go with you to antenatal appointments.

Antenatal appointments keep track of your health and your baby’s health and are a great time to ask questions, discuss concerns and get health and lifestyle support throughout your pregnancy.  All antenatal visits require a directed clinical assessment at each visit, with a focus on general wellbeing and early diagnosis of pregnancy complications.

The clinical assessment should include a –

• blood pressure check
• urine dip stick, usually you do this yourself
• weight and how you can achieve a healthy weight gain
• measure your tummy, otherwise called a symphysis-fundal height (SFH) measurement
• listen to your baby’s heartbeat using a handheld doppler, this is always lovely to hear
• and ask about your baby’s movements from approximately 20 weeks of pregnancy onwards.

The midwife or doctor may also

• recommend blood tests, screening tests and other tests when appropriate and talk about test results.
• discuss healthy eating options and foods that aren’t recommended in pregnancy.
• ask about your lifestyle and help you get support for lifestyle changes like quitting smoking, or giving up alcohol or other drugs
• ask about your work and home environment and your family situation and support throughout your pregnancy.

Many women attend antenatal visits every 4-6 weeks until 28 weeks of pregnancy, then every 2-3 weeks until 36 weeks of pregnancy. After this, you’ll probably have weekly or fortnightly visits until birth.  The number and timing of pregnancy appointments could be more or less than this, depending on your health and your baby’s health. For example, if you have a high-risk pregnancy you might have more pregnancy appointments. Your midwife or doctor will talk with you about the appointments you need and why.

Having access to maternity care that is culturally appropriate and personally acceptable is important throughout antenatal care. Your midwife or doctor will ideally provide informed choice, and where possible include you in both the planning and monitoring of your pregnancy care.

Choice in pregnancy care is important and your midwife or doctor will provide access to appropriate information about the benefits and potential risks of each and every option of your pregnancy care as it applies to yours and your baby’s individual needs at each antenatal visit appointment. Be sure to ask questions at each visit too.

 

***Key Points***

You may be offered CTG monitoring during the latter part of pregnancy if there is a concern about your baby. Continuous CTG monitoring is often done in labour where there are risks to your baby such as induction of labour or you have an epidural [there are many other reasons when CTG monitoring might be recommended]. Many studies that explored the use of CTG during labour were done a long time ago, they showed benefits and problems with its use. Make sure you understand why it is being recommended to you.

***Key Points***

***CTG Monitoring***

If you are pregnant your midwife or doctor may suggest you have some CTG monitoring if they are concerned about your baby’s heart rate, or if you have reported a change in your baby’s movement pattern. This will usually be done only when you are more than 28 weeks pregnant. Often you will attend a pregnancy day stay or fetal monitoring unit where you will have the CTG monitor on for a period of time until it shows that the baby is well. That may be 30 minutes or it may be longer depending on the trace and how busy the unit is. Make sure you understand why they are recommending the monitoring.

***CTG Monitoring***

***Continuous CTG Monitoring***

Having continuous CTG monitoring during labour can restrict your ability to move around and you will not be able to use water immersion for pain relief. This may affect some women’s ability to cope with the challenges of labour. Studies showed that CTG monitoring increased the chances of interventions such as instrumental birth and caesarean section. It is known that CTGs are relatively reliable in showing a baby is well but they are not so reliable when it comes to showing a baby is unwell.

There are a number of reasons why you might need continuous CTG monitoring including but not limited to: having an induction of labour; having an epidural; an abnormal heart rate heard using a hand held Doppler; meconium [baby poo] or blood in the amniotic fluid; pre-term labour; a long first stage or long second stage of labour; or you have a high temperature.

***Continuous CTG Monitoring***

***CTG monitoring – the experience for you***

The process of having a CTG involves: you giving informed consent to the monitoring [this means you understand why you are having it]; you are on the bed in a semi-recumbent position not lying flat [you should empty your bladder first]; the midwife will complete an abdominal palpation to confirm the position of the baby [the heart sounds are picked up over the shoulder of the baby]; the ultrasound is placed in a position on your lower abdomen and held in place by a thick elastic belt; the device that monitors your uterine contractions is placed higher up on your abdomen at the top of your uterus.

***CTG monitoring – the experience for you***

The normal rate for a baby’s heart is between 110 and 160 beats per minute. The heart rate will vary with movement, or if there is pressure on the cord either by uterine contractions or your position. Most often the monitors are connected to the machine via cords that are a couple of metres long. Occasionally, the hospital may have cordless ones available called telemetry. Sometimes telemetry can improve your mobility, as long as they can still monitor the baby’s heart rate.

If you are having continuous CTG monitoring in labour and there are problems with obtaining a good heart rate reading, the medical team may want to use a fetal scalp electrode. That involves a placement of a small metal clip into the skin of your baby’s scalp via your vagina. That clip is then attached to the CTG monitor and shows the baby’s heart rate. You may be able to move around more freely if you have this type of monitoring. The clip is removed after the baby is born.

***CTG monitoring – the experience for you***

***CTG in Labour – The research***

Research has shown that there was low quality evidence showing no better outcome for babies using continuous CTG compared to using a hand held Doppler to listen to the baby’s heart rate intermittently. However, rates of instrumental birth and birth by caesarean section increased where continuous CTG was used. There has been no new research since 2016.

For women and babies considered low risk, listening to the baby’s heart rate intermittently with a hand held Doppler is as effective as continuous CTG monitoring during labour.

***CTG in Labour – The research***

References

Cochrane – continuous cardiotocography [CTG] as a form of electronic fetal monitoring [EFM] for fetal assessment during labour

RANZCOG – monitoring the baby’s heart rate in labour

Queensland Health – fetal monitoring in labour

The Women’s – CTG interpretation and response

Regular antenatal care is a key component of a healthy pregnancy and provides an opportunity to receive advice, information and support, while engaging in shared decision making about your  pregnancy that is designed to suit your individual pregnancy needs.

KEY POINTS

Antenatal care should be woman centred acknowledging pregnancy is a normal life event for most.

Antenatal care improves pregnancy outcomes for both mother and baby by recognising potential problems in pregnancy early.

The range of routine antenatal care visits range from 7 – 12 throughout the course of pregnancy with the average being around 10 visits.

During each visit your midwife or doctor will discuss screening test and arrange these as required.

It’s good if your partner, a friend or a family member can go with you to antenatal appointments.

Antenatal appointments keep track of your health and your baby’s health and are a great time to ask questions, discuss concerns and get health and lifestyle support throughout your pregnancy.  All antenatal visits require a directed clinical assessment at each visit, with a focus on general wellbeing and early diagnosis of pregnancy complications.

The clinical assessment should include a –

• blood pressure check
• urine dip stick, usually you do this yourself
• weight and how you can achieve a healthy weight gain
• measure your tummy, otherwise called a symphysis-fundal height (SFH) measurement
• listen to your baby’s heartbeat using a handheld doppler, this is always lovely to hear
• and ask about your baby’s movements from approximately 20 weeks of pregnancy onwards.

The midwife or doctor may also

• recommend blood tests, screening tests and other tests when appropriate and talk about test results.
• discuss healthy eating options and foods that aren’t recommended in pregnancy.
• ask about your lifestyle and help you get support for lifestyle changes like quitting smoking, or giving up alcohol or other drugs
• ask about your work and home environment and your family situation and support throughout your pregnancy.

Many women attend antenatal visits every 4-6 weeks until 28 weeks of pregnancy, then every 2-3 weeks until 36 weeks of pregnancy. After this, you’ll probably have weekly or fortnightly visits until birth.  The number and timing of pregnancy appointments could be more or less than this, depending on your health and your baby’s health. For example, if you have a high-risk pregnancy you might have more pregnancy appointments. Your midwife or doctor will talk with you about the appointments you need and why.

Having access to maternity care that is culturally appropriate and personally acceptable is important throughout antenatal care. Your midwife or doctor will ideally provide informed choice, and where possible include you in both the planning and monitoring of your pregnancy care.

Choice in pregnancy care is important and your midwife or doctor will provide access to appropriate information about the benefits and potential risks of each and every option of your pregnancy care as it applies to yours and your baby’s individual needs at each antenatal visit appointment. Be sure to ask questions at each visit too.

 

Regular antenatal care is a key component of a healthy pregnancy and provides an opportunity to receive advice, information and support, while engaging in shared decision making about your  pregnancy that is designed to suit your individual pregnancy needs.

KEY POINTS

Antenatal care should be woman centred acknowledging pregnancy is a normal life event for most.

Antenatal care improves pregnancy outcomes for both mother and baby by recognising potential problems in pregnancy early.

The range of routine antenatal care visits range from 7 – 12 throughout the course of pregnancy with the average being around 10 visits.

During each visit your midwife or doctor will discuss screening test and arrange these as required.

It’s good if your partner, a friend or a family member can go with you to antenatal appointments.

Antenatal appointments keep track of your health and your baby’s health and are a great time to ask questions, discuss concerns and get health and lifestyle support throughout your pregnancy.  All antenatal visits require a directed clinical assessment at each visit, with a focus on general wellbeing and early diagnosis of pregnancy complications.

The clinical assessment should include a –

• blood pressure check
• urine dip stick, usually you do this yourself
• weight and how you can achieve a healthy weight gain
• measure your tummy, otherwise called a symphysis-fundal height (SFH) measurement
• listen to your baby’s heartbeat using a handheld doppler, this is always lovely to hear
• and ask about your baby’s movements from approximately 20 weeks of pregnancy onwards.

The midwife or doctor may also

• recommend blood tests, screening tests and other tests when appropriate and talk about test results.
• discuss healthy eating options and foods that aren’t recommended in pregnancy.
• ask about your lifestyle and help you get support for lifestyle changes like quitting smoking, or giving up alcohol or other drugs
• ask about your work and home environment and your family situation and support throughout your pregnancy.

Many women attend antenatal visits every 4-6 weeks until 28 weeks of pregnancy, then every 2-3 weeks until 36 weeks of pregnancy. After this, you’ll probably have weekly or fortnightly visits until birth.  The number and timing of pregnancy appointments could be more or less than this, depending on your health and your baby’s health. For example, if you have a high-risk pregnancy you might have more pregnancy appointments. Your midwife or doctor will talk with you about the appointments you need and why.

Having access to maternity care that is culturally appropriate and personally acceptable is important throughout antenatal care. Your midwife or doctor will ideally provide informed choice, and where possible include you in both the planning and monitoring of your pregnancy care.

Choice in pregnancy care is important and your midwife or doctor will provide access to appropriate information about the benefits and potential risks of each and every option of your pregnancy care as it applies to yours and your baby’s individual needs at each antenatal visit appointment. Be sure to ask questions at each visit too.

 

What investigations are available to assess the wellbeing of you and your baby

Care providers might suggest methods you can try yourself at home or you could explore alternative or complementary practices that have been thought to start labour. There is limited evidence to support any of these practices

***Key Points***

Physiological onset of labour is different to a labour that is started using methods of induction.

Some midwives or doctors might say there are ‘natural methods of induction’ however there is limited evidence to support any of these methods.

***Key Points***

***Natural methods of induction***

In the weeks before you go into labour your body is producing hormones in preparation for labour. Spontaneous labour means that your baby has sent signals to your body and brain that you are ready to go into labour. Your brain then produces oxytocin to begin and continue the labour process.

An induced labour involves medical interventions to start and keep the labour going, when your body or baby are not ready to go into labour.

On or around the due date some women may try some things to try and go into labour, or some care providers may suggest some things to try. Women will usually try these methods to avoid a medical induction of labour.

You may have heard of eating spicy food or certain fruits to help go into labour, there is no evidence to support this. However, maintaining a nutritious diet is beneficial to you and your baby. There is limited evidence to support the consumption of raspberry leaf either in tea or capsule form but research has found no harm in having it.

Having sex, and especially having an orgasm releases oxytocin and semen has prostaglandins in it which are present naturally when the cervix is softening. It is not known whether having sex has any influence on the start of labour. However avoid having sex if your waters have released.

Sometimes gentle nipple or breast stimulation is recommended to try to start labour. Limited research shows that an increased number of women might go into labour within three days as this method stimulates the body’s release of oxytocin.

Walking or gentle exercise can be good for maintaining fitness near the end of your pregnancy but there have been no studies to explore whether or not it can influence the start of labour.

Complementary therapies such as acupuncture, aromatherapy, reflexology and massage are often suggested as ways to ‘naturally’ influence the start of labour, limited studies have not demonstrated the effectiveness in starting labour. However, if you see a therapist trained in pregnancy you may find it a relaxing thing to do as you get closer to the time of birth.

***Natural methods of induction***

Sara Wickham – let’s be clear labour onset is spontaneous or induced

Pregnancy, birth & beyond – interview Rachel Reed

Induction of labour – what are the risks of being induced?

Cochrane – acupuncture or acupressure for induction of labour

Regular antenatal care is a key component of a healthy pregnancy and provides an opportunity to receive advice, information and support, while engaging in shared decision making about your  pregnancy that is designed to suit your individual pregnancy needs.

KEY POINTS

Antenatal care should be woman centred acknowledging pregnancy is a normal life event for most.

Antenatal care improves pregnancy outcomes for both mother and baby by recognising potential problems in pregnancy early.

The range of routine antenatal care visits range from 7 – 12 throughout the course of pregnancy with the average being around 10 visits.

During each visit your midwife or doctor will discuss screening test and arrange these as required.

It’s good if your partner, a friend or a family member can go with you to antenatal appointments.

Antenatal appointments keep track of your health and your baby’s health and are a great time to ask questions, discuss concerns and get health and lifestyle support throughout your pregnancy.  All antenatal visits require a directed clinical assessment at each visit, with a focus on general wellbeing and early diagnosis of pregnancy complications.

The clinical assessment should include a –

• blood pressure check
• urine dip stick, usually you do this yourself
• weight and how you can achieve a healthy weight gain
• measure your tummy, otherwise called a symphysis-fundal height (SFH) measurement
• listen to your baby’s heartbeat using a handheld doppler, this is always lovely to hear
• and ask about your baby’s movements from approximately 20 weeks of pregnancy onwards.

The midwife or doctor may also

• recommend blood tests, screening tests and other tests when appropriate and talk about test results.
• discuss healthy eating options and foods that aren’t recommended in pregnancy.
• ask about your lifestyle and help you get support for lifestyle changes like quitting smoking, or giving up alcohol or other drugs
• ask about your work and home environment and your family situation and support throughout your pregnancy.

Many women attend antenatal visits every 4-6 weeks until 28 weeks of pregnancy, then every 2-3 weeks until 36 weeks of pregnancy. After this, you’ll probably have weekly or fortnightly visits until birth.  The number and timing of pregnancy appointments could be more or less than this, depending on your health and your baby’s health. For example, if you have a high-risk pregnancy you might have more pregnancy appointments. Your midwife or doctor will talk with you about the appointments you need and why.

Having access to maternity care that is culturally appropriate and personally acceptable is important throughout antenatal care. Your midwife or doctor will ideally provide informed choice, and where possible include you in both the planning and monitoring of your pregnancy care.

Choice in pregnancy care is important and your midwife or doctor will provide access to appropriate information about the benefits and potential risks of each and every option of your pregnancy care as it applies to yours and your baby’s individual needs at each antenatal visit appointment. Be sure to ask questions at each visit too.

 

During pregnancy there are some signs or things you might experience that would mean you should call your midwife or hospital. These include:

***Key Points***

• Signs of early labour prior to 37 weeks pregnant
• If your waters break
• A change in your baby’s movements
• Any vaginal bleeding
• A headache, blurred vision or flashing lights in front of your face
• Severe swelling in your hands, face or feet, which comes on suddenly and reapidly.
• Any continual pain that you are concerned about
• If you are feeling very unwell
• Labour has started

***Key Points***

***Waters breaking***

If you waters break, call your Midwife or birth suite. Put a pad on and note the colour, odour, amount and time (COAT) and let your Midwife know.

Be mindful of your baby’s movements after your waters have broken.

***Waters breaking***

***Your baby’s movements***

If you notice a change in your baby’s normal pattern of movement you should call your hospital or midwife as soon as possible.

Trust your instinct, if you are at all concerned call and have everything checked out,

***Your baby’s movements***

***Vaginal bleeding***

If you experience any vaginal bleeding let your Midwife or birth suite know. A small amount of bleeding is mixed with mucous it is likely a show and is a sign that labour is progressing normally. Always call for advice if you are concerned.

***Vaginal bleeding***

***Premature labour***

If you notice cramping or tightenings, before 37 completed weeks of pregnancy, that comes and go in a pattern and doesn’t go away, contact your care giver.

Call your Midwife or birth suite if you experience a sudden gush of fluid from your vagina – your waters may have broken.

***Premature labour***

***Headache/blurred vision**

If you have a headache, blurred vision or seeing spots, or swelling in your feet, ankles and hands you should call the hospital as soon as possible.

***Headache/blurred vision**

***Pain***

If you have pain that worries you, you think something is wrong or you feel scared, call your care provider for advice.

If you are experiencing abdominal pain that is continual and does not come and go, please call your midwife or doctor.

***Pain***

***Labour has started***

If you contraction have become regular and in an established pattern. They are closer together than 5 minutes, lasting around 45 seconds and this pattern is established for more than 1 hour. Call your midwife or birth suite for advice.

We know labour can take many hours or days to establish. This is sometimes called the latent phase of labour or pre-labour and is often more common when having your first baby.

If you contractions are irregular this is very normal in early labour and during this time your cervix is softening and thinning out. This is a normal process and the best place to spend this phase of labour is at home.

*If you have been given any different information related to your individual circumstances, please follow those specific instructions.

Listen to your body and do what you instinctively feel is right for you. Stay active, eat small amounts often as you desire, stay hydrated and enjoy activities that you love… have a bath, watch a movie, go for a walk – whatever makes your feel nourished and cared for.

***Labour has started***

Make sure you have your phone numbers for your Midwife or birth suite at your hospital written down, or saved into your phone so you can easily make the call when you need to.

If your partner or other support person is not with you, you should call them too to let them know that you have called the hospital or your midwife.