Category: 26 – 28 Weeks

KEY POINTS:

Due to hormonal changes of pregnancy, the increasing weight of your growing baby and pressure on your hips and skeleton, you might experience some pain or discomfort in your bones or joints.

Commonly in the lower back, pelvic girdle, in joints and muscles and in the hands and wrists

Symptoms can present in a number of ways, you might experience weakness or numbness in your back, pelvis, hips, shoulders or even your wrists, hands or fingers. Your muscles may feel tight, tired or weak causing pain in the area. Symptoms can vary in severity from mild to severe and having an impact on how easily you can move around and sometimes how you walk.

Your core strength may be weakened by the pregnancy and this might make otherwise simple movements more difficult, such as getting out of bed, out of a chair or getting out of the car.

You might feel pain around your pelvic, lower back or hip area – this can be called ‘pelvic girdle pain’. If you can feel pain right in the middle at the front of your pelvis that may be made worse by movements that separate your legs such as getting out of bed or the car.

Your pelvic floor muscles may be affected by the weight of the baby causing you to feel pain or incontinence problems [both urinary and/or faecal]. This might happen before or after the pregnancy.

Try to avoid lots of walking, lying flat, getting in and out of bed without care, doing too much exercise or heavy lifting, deep squats or going up and down stairs.

For some relief, don’t overdo things, try not to ignore the pain, walk less, do less things such as heavy lifting or over exerting yourself, keep your knees together in bed and sleep on your side.

Talk to your midwife or doctor if your symptoms are bothering you.

About 10-15% of people will develop diabetes during pregnancy, known as Gestational Diabetes, around 24-28 weeks, if you are at higher risk , such as having diabetes in the family, having a high BMI, having had diabetes before and so on, you may develop diabetes earlier.

***Key Points***

The oral glucose tolerance test (OGTT or GTT) is offered to everyone during pregnancy to diagnose GDM.

If you are at higher risk of developing diabetes you might be offered the GTT earlier in pregnancy, around 14-16 weeks and then again at 28 weeks, when everyone else is offered the test.

Diabetes occurs when the hormones in your body are not able to manage the levels of sugar [or glucose] in your blood. During pregnancy some people are more likely to develop diabetes than others.

***Key Points***

***How will this impact my pregnancy and my baby?***

Usually the type of diabetes you develop during pregnancy goes away after the birth but it may increase your chances and your baby’s chances of developing diabetes later in life.

If you have diabetes during pregnancy and it is not diagnosed or managed well, your placenta may pass too much sugar and fat to your baby causing your baby to grow more than the average sized baby. If you manage your diabetes well during pregnancy the risks to you and the risk to your baby will be reduced.

***How will this impact my pregnancy and my baby?***

***Testing for GDM***

Allow about 3 hours to complete the test on the day you are having it. The GTT involves: eating your normal diet for at least 3 days before the test; fasting [no food and only sips of water if thirsty] from the night before about 8-10 hours before the test; a blood test is taken then within 5 minutes you are given a very sweet drink; you return for another blood test after one hour and again after two hours.

If your blood sugar levels are higher than normal you will be told that you have gestational diabetes [GDM] and it will be recommended that you see a specialist team who can provide advice to manage your diabetes. The team might involve a doctor, diabetes educator and/or dietician. Sometimes diabetes can be managed with diet and exercise and monitoring your sugar levels. Your baby may also be born with low blood sugar levels, so they will be checked after the birth.

***Testing for GDM***

References

Health Direct – Blood Glucose Test

Safer Care Victoria – Gestational Diabetes

The Women’s – Gestational Diabetes

Understanding what is a negative blood group and why your Midwife or Doctor is suggesting Anti-D is given at regular times during pregnancy.

***Key Points***

It is important to know your blood group and type during pregnancy.

When the mother is one blood type (negative) and the baby is another (positive) – if some of the baby’s blood mixes with the mother’s blood during pregnancy or birth, the mother’s blood can produce antibodies against the Rhesus positive blood cells that belong to the baby.

These are called anti-D antibodies, this doesn’t usually affect the first pregnancy but in other pregnancies the mother’s bodies will produce more antibodies that will destroy the baby’s blood cells, the baby can become very unwell.

To prevent this from happening, an injection of anti-D immunoglobulin (known as anti-D) is offered to women with negative blood group.

***Key Points***

***Rh Negative explained***

You may have one of four blood groups – A, B, AB, or O, and either be negative or positive. You get your blood type from your parents. If you have a negative blood group it is known as RhD (Rhesus factor) negative.

The Rhesus shows that on the surface of your blood cells you have a protein known as ‘D antigen’. Negative blood types are not as common as those who are positive and only during pregnancy is it relevant to the health outcomes of your baby.

***Rh Negative explained***

***Rh Negative in pregnancy***

When you have early blood tests in pregnancy your blood group will be tested, if you have a negative blood group you will be offered anti-D at around 28 weeks and 34 weeks of pregnancy when it is known that your partner has a positive blood group.

You will have anti-body screening offered during pregnancy and before the scheduled anti-D administration times. Tests will be done after pregnancy and anti-D may be offered after birth too.

Anti-D is an injection that is administered to the mother if she has negative blood group and been exposed to positive blood [from the baby], it prevents a process called sensitisation. The anti-D neutralises any RhD positive antigens that may be in the bloodstream.

Things that may be a sensitising event may include – bleeding, invasive procedure (such as amniocentesis) or trauma to the pregnant abdomen.

***Rh Negative in pregnancy***

REFERENCES

RANZCOG Anti-D in pregnancy and after the birth

Pregnancy Birth Baby – Rhesus D negative in pregnancy

NHS Rhesus disease

Queensland Health Rhesus negative blood group

Stillbirth has an enormous and devastating impact on parents and their wider families.

***Key Points***

Stillbirth is when a baby has no signs of life after 20 weeks of pregnancy.

Before 20 weeks it is known as a miscarriage.

In Australia, there are approximately 6 babies stillborn each day. This impacts around 2200 families each year.

Our rate of stillbirth in Australia is 7.4stillbirths per 1000 babies born.

There are evidence-based ways to reduce the likelihood of a stillbirth occurring. The information to follow helps you to understand these risk factors in 5 key areas.

We share this knowledge with you, so they can better understand and manage these risk factors.

***Key Points***

***5 key areas***

There are evidence-based ways to reduce the likelihood of a stillbirth occurring. The information to follow helps you to understand these risk factors in 5 key areas.

• Quit Smoking
• Monitor you baby’s growth
• Monitor your baby’s movements in pregnancy
• Sleep on your side
• Timing of birth

***5 key areas***

***Quit Smoking***

1. Quit Smoking

Smoking cigarettes in pregnancy is one of the major contributors to stillbirth. Every time you smoke a cigarette it has an immediate effect on the baby. Nicotine reduces the flow of blood through the umbilical cord to your baby and some of the oxygen in your blood stream is replaced by carbon monoxide.

Your care provider will ask you about smoking cigarettes (or anything else) at your first visit for confirmation of pregnancy and at your booking visit.

Quitting at any time during pregnancy reduces the harm to your baby. However, planning to quit as early as you can means a better start in life for your baby.

What are the risks for my baby from my smoking?

Smoking during pregnancy increases your risk of miscarriage or stillbirth. Smoking increases the likelihood your baby may be born premature (before 37 weeks’ gestation), there is also an increased risk of placental problems, increased risk of Sudden Unexplained Death of an Infant (SUDI or cot death), low birthweight and breathing problems.

What can help you quit smoking in pregnancy?

Your care provider can help if you are thinking about quitting.

It is key to understand and help address your triggers and for some women, quit smoking products may be needed. They can assist you with a quit plan and behavioural support.

The most common counselling service offered by Health services is Quitline, which is staffed by specially trained counsellors who will support you to quite without judgement.

Contact your local Quitline for free on 13 7848 or download the ‘Quit for you – quit for two’ app designed for pregnant women

***Quit Smoking***

***Monitor as your baby grows***

2. Monitor your Baby’s Growth

Big or small. Your baby’s growth matters.

Your pregnancy is unique to you and all women and babies are different. What is most important is a healthy rate of growth for your baby so your baby can reach its growth potential.

• Assessing your Risk: Early in pregnancy your risk for fetal growth restriction (FGR) will be assessed.  For women at a higher risk of FGR it may be necessary to monitor the growth of your baby with regular ultrasound.
• Measure: At each antenatal visit from 24 weeks onwards, your baby’s growth will be measured and plotted on a growth chart.

You can plot your baby’s growth on the growth chart yourself within the app.

• Monitor: If your baby is growing slower than expected, increased monitoring may be required, and any concerns will be discussed with you.

What is Fetal Growth Restriction? 

Fetal Growth Restriction (FGR) is when a baby is growing slower than expected and indicates that the baby is not reaching it’s growth potential.

How will my baby’s growth be measured? 

Starting from 24 weeks the growth of your baby will be measured at each of your antenatal visits.  Your maternity healthcare professional will use a measuring tape to measure the size of your abdomen. This is called the symphysial fundal height (SFH).  This measurement should be plotted on a growth chart and shows your babies growth over the period of your pregnancy.

For some women it may be necessary to monitor the growth of your baby by ultrasound.

Why is my baby growing at a slower rate – what is causing this? 

If a baby is growing slower than expected your maternity healthcare professional should investigate the cause.  At times this may be related to the placenta and how it  is working but sometimes a cause cannot be found.

What can I do to monitor my baby’s health? 

It’s important to come to each antenatal visit to have your baby’s growth checked.  Additionally, every baby has its own unique pattern of movements, which you will get to know.  If your baby’s movements pattern changes, you should always let you maternity healthcare professional know.

***Monitor as your baby grows***

***Monitor movements***

3.Monitor your Baby’s Movements in pregnancy

Your baby’s movements really do matter

Being aware of your baby’s movements during pregnancy is one of the simplest things you can do to know your baby safe and healthy. Regular and healthy movements are a good indication of your baby’s wellbeing.

You will start to feel your baby move between weeks 16 and 24 of pregnancy, regardless of where your placenta lies, and you should feel your baby’s movements right up until they are born,

There is no set number of normal movements. You should get to know your baby’s movements and what is normal for them.

A baby’s movements can be described as anything from a flutter or kick, to swish and roll. These are signs that your little one is well! When babies become unwell, they may slow down their movements in order conserve energy- this could be an early indication of something being wrong with them so contact your care provider immediately if you have any concerns about changes in activity levels.

It’s important that this information be shared with partners, family and friends so that they too can understand the importance of your babies’ movements.

Common myths about baby movements

It is not true that babies move less towards the end of pregnancy. You should continue to feel your baby move right up to the time you go into labour and whilst you are in labour too.

If you are concerned about your baby’s movements, having something to eat or drink to stimulate your baby does not work. This is outdated advice. You should always phone your care provider

Guide to help you to get to know your baby’s movements:

Sit or lie down in a quiet place, try to relax, and focus on feeling your baby’s movements

Some babies are more active than others. Its important to get to know your baby. The easiest way to learn your baby’s normal pattern of movement is to choose a time when baby is usually active and focus on their movements. You may wish to record each movement you feel but be mindful of any changes in strength of the movements as well as the number.

If you are still concerned about your baby’s movements after doing this, contact your doctor of midwife that very day or night. Your doctor of midwife might suggest that you take some time to focus on movements, so let your doctor of midwife know that you have already done this. You do not have to wait until the end of the suggested recording period of 2 hours to contact them.

What if I am concerned about my baby’s movements? 

If at any point you are concerned about your baby’s movements, please contact your doctor or midwife. It is very common for pregnant women to have concerns about their baby at some point in their pregnancy. It is part of the natural role of a mother or mother-to-be to do things to look after your baby and your midwife or doctor is there to help you, no matter what time of night or day.

Please don’t feel silly about contacting your doctor of midwife if you want to. And remember that no one knows your baby better than you do. It’s your body and your baby, so trust your instincts.

What happens at hospital? 

If you have contacted your doctor or midwife and your doctor or midwife suggests that you come in to hospital, there are a few things that you can expect to happen.

First, your doctor or midwife will likely ask you questions about any known risk factors or issues you might have had during pregnancy. Then he or she may do a CTG (cardiotocograph)1. This will involve placing an elastic belt around your belly to measure your baby’s heart rate. Your doctor or midwife will also feel your belly to see where your baby is positioned and to check his or her growth.

After this, your doctor or midwife might do an ultrasound of your baby if this has not been done recently (1). You may have had an ultrasound scan in early pregnancy to work out your gestation. Ultrasound scans can also be used to measure your baby’s heart rate and blood flow, and to check on growth.

Your doctor or midwife may also do a blood test.

***Monitor movements***

***Sleep on your side***

4. Sleep on your Side

Research shows that going-to-sleep on your side from 28 weeks of pregnancy can halve your risk of stillbirth, compared to going-to-sleep on your back.

After 28 weeks of pregnancy, lying on your back presses on major blood vessels which can reduce blood flow to your uterus and the oxygen supply to your baby.

You can go to sleep on either the left or the right side – either side is fine. It’s normal to change position during sleep and many pregnant women wake up on their back. That’s OK!  The important thing is to start every sleep lying on your side (both for daytime naps and at night). If you wake up on your back, just roll over on your side

***Sleep on your side***

***Timing of birth***

5. Timing of Birth

If there are health concerns that might increase your risk of stillbirth, your health care professional will discuss with you how the timing of birth might reduce risks, with your pregnancy continuing as long as it is safe for you and your baby.

We talk a lot about shared decision making in pregnancy and this is one of the key times where it is important decisions about whether you wait for labour to begin on its own is the best option for your baby.

For all pregnancies, there’s an optimal time for a baby to be born. If your pregnancy is healthy and progressing without any issues, then waiting for labour to begin on its own is the ideal plan.

Through research we’re discovering that every week your baby continues to grow inside you makes a difference to their short- and long-term health and developmental outcomes

***Timing of birth***

Resources

Stillbirth Centre of Research Excellence

The Safer Baby Bundle

Safer Baby Bundle flyer

 

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.