Sunday, 23 October 2011

Pregnant? Now what?

So you’re pregnant?

Here are some things you should know straightaway...

How do you know you’re pregnant?
·         the most obvious is that you have missed your period
·         feel extremely tired
·         Breast changes: areola (dark area around your nipple) darkens, breasts swell, breasts are tender, glands (like spots) around the edge of your areola enlarge (they are called Montgomery tubercles)
·         Feel hormonal, like the start of your period; some women even feel period like aches.
·         Metallic taste in mouth
·         A positive pregnancy test: these are extremely accurate and if you have used one your gp/midwife will not do another.

What now?

Well – you could do nothing.  There is no need to see anyone or do anything.  If you don’t see anyone or have any checks your baby will grow and one day you will go into labour and your baby will be born – it’s nature, it’s what humans and cats and dogs and pigs and all other mammals have been doing for millenia.  However, antenatal screening has been shown to be beneficial – but it is up to you to choose which parts of it you want for you and your baby.  No test can guarantee a healthy baby, and you can’t jinx your pregnancy by not doing a test.  There are reasons for doing each test and check up, and you should weigh each up and decide.

Most people in the UK tootle off to see their GP or contact a midwife.  It has become more common in recent years to contact a midwife directly – you can get the details from your local surgery or contact the maternity unit at your local hospital.  There is a poster up in my local surgery and children’s centre with the number.  They will just want your name and contact details and the date of the first day of your last period – pregnancies are measured from this date which is often abbreviated as LMP (last menstrual period).
If you do go to a GP: they will want to know your LMP and will calculate your estimated due date (EDD, also known as estimated date of delivery).  (See next blog post for how this is done.)  They may check your blood pressure and listen to your heart.  Mostly they will just fill in a form to send off to the midwife.  They may ask you where you want to have the baby.  This is only so they know who to send the paperwork to.  You could ask what the options are in the area – choice of hospitals, any birth centres?  Most GPs have very little firsthand experience of birth so you may find the midwife is the best person to ask anyway.  It is perfectly reasonable to say ‘we haven’t decided yet’.  You can make a decision about place of birth, or change your mind, at anytime – even during labour!  Bear in mind, home birth is an option for first timers – in fact the first is often the best to have at home (see my blog post, first baby at home).  Sometimes GPs try to put women off homebirth or say it isn’t an option, but, again, they have little experience of birth, beyond a short time during their training.  It always strikes me as bizarre to be asked where you’re having the baby at a time when the main worry is whether you’ll miscarry, and you know so little about what birth is like and how your pregnancy is going to progress.

If you contact a midwife directly then you will not need this first appointment and will go straight to a booking visit.

Booking visit

Your midwife will contact you to arrange a booking visit.  These are usually done in a woman’s own home by a community midwife, at about 8-10 weeks, and last about an hour.  There is a lot of form filling and some discussions.  They will go through
  • Your contact details and your partners’
  • How and when to contact a midwife
  • Your medical history
  • Options for place of birth
  • Programme of antenatal checks, inc scans
  • Information about the benefits of breastfeeding especially straight after birth
  • Healthy pregnancy – diet, exercise, what to avoid, smoking, drinking, domestic violence

They will probably test your urine (they may give you a pot with a lid to keep so you can bring a sample of urine to each check up).  Urine is tested for levels of protein and sugar which can indicate potential problems.  They may take your blood pressure to give an early reading to compare later measurements to.  They may ask to weigh you, or ask you for your weight and your height, and thereby work out your bmi.  As with all tests you choose to accept or decline each.  Even though they are routine, there is no obligation to accept.

The midwife will be taking your details down twice – one in a set of notes you will be given to keep with you and bring to appointments and one kept by the midwife at the hospital.  You will be given a date for the first scan if you decide to have it, or the midwife will make an appointment for you and contact you later.  You will also be given an appointment for a blood test (or you’ll be asked to make one at your surgery). 

Further antenatal check ups will take place either at your gp surgery, children’s centre, hospital, birth centre or at home.  For more details of what is done at each check and how many to expect you can look at the national guidelines by NICE (National Institute of Health and Clinical Excellence – also see their guidelines on caesareans, anti d, care in labour and more).  Here is the link for the antenatal care guidelines.  They will send you a free copy of their patient copy or the professional’s version or you can view on line.

I hope this helps.  Early accessing of maternity care (contacting a midwife and starting antenatal checks before 12 weeks) is associated with improved outcomes.  If you are a first time parent then you are probably excited about the whole process – as I was.  By the time I was pregnant with number 3, 4 and then 5 I was much more laid back and didn’t contact the midwife till later.  With baby number 4 I was 17 weeks and with baby number 5 I was 16 weeks at my booking visit – but then I didn’t want any scans and knew that my previous pregnancies had been uneventful.

Early pregnancy units

Just a quick note before the end of this post.  Most hospitals have early pregnancy units.  If you think you are miscarrying you can just let nature happen.  However if you are bleeding and there is no sac, or if bleeding and pain continues, or you would like to know more you can ring up and make an appointment to go there.  If the pregnancy is at least 14 weeks they may be able to hear a heart beat.  They also offer scans. More pregnancies than you’d think have episodes of unexplained bleeding with no miscarriage.  (See previous post for more information about miscarriage and sources of support and information.)

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