Transcript Are You Ready?? - Great Western Hospital

Thinking of having a baby –
what you need to know?
Dr. Nusrat Fazal
Consultant Obstetrician GWH
Thinking of having a babywhat do you need to know?
Are You Ready??
 Physically
 Psychologically/emotionally
 Socially
 Financially
Aims of discussion
 Pre pregnancy Care
 what planning and lifestyle changes ?
 Journey through Pregnancy
 what changes your body go through during pregnancy?
 Child Birth
 what birth choices and how to prepare for the big day?
 After delivery care and support
What is Pre-pregnancy Care
 Why is planning important?
 How to prepare well for the journey?
Are you ready to make some life
style changes
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Quit/cut down smoking/alcohol
Stop taking street drugs
Eat Healthy
maintain healthy weight
Keep fit and Exercise regularly
Avoid certain foods and exposure to infection
Add certain supplements to your diet
You need to know about your
Physical well being
Do you have any chronic Medical Condition/ Psychiatric
condition?
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Diabetes (High blood sugar)
High blood pressure
Kidney problem
Heart problems
Epilepsy (seizures/fits)
Other
Are you taking any Medications
 How is it going to affect your baby
 Is it important to continue
 Is there any alternative
 Can I modify or reduce the dose
 What are the options
Your Previous Obstetric/Surgical
history
 Miscarriages
 Premature birth
 Previous Pregnancy Loss
 Previous surgery
 Cervical smear/ any procedure on the neck of the
womb
 Previous Caesarean Section
Do you know your family history
 Any chronic health conditions running in the family
 Any genetic problems in the family or have a previous
child with genetic condition
 See your doctor
 Genetic counselling
Dental hygiene
 Rubella
 Effects on baby (early pregnancy – eyes, ears, heart,
growth and intellect)
 Avoid pregnancy for at least 4 weeks after vaccination.
 Chicken pox
 Hepatitis
 Other infection
Dental Hygiene
New research is showing that poor dental health may be
linked to premature birth, so keeping your teeth and
gums healthy is important during pregnancy.
 Peridontal Disease in Pregnancy
 Have dental x-ray before pregnancy
 Dental treatment is free during pregnancy
Do You have a healthy weight
BMI (19-25)
 Under weight
• Small Baby and early labour
 Over weight
• Structural defect
• Preterm labour
• Diabetes
• High Blood Pressure
• Clots
• Operative delivery
Which Food and supplements
 Folic acid
 When to start
 How much (400microgram/5mg)
 Vitamin D
 Healthy Diet
Foods to avoid
 Raw eggs,
 Meat
 Coffee ( ↓200g)
 Soft Cheese
 Unpasteurised milk
 Certain fishes
 Food rich in vitamin A.
Stop/ cut down smoking/ Alcohol and avoid
drugs
 Smoking
 Low birth weight, preterm labour,
antepartum haemorrhage , still birth
and cot deaths
 Alcohol
 low birth weight, brain damage and
facial malformation
 Street drugs:
 miscarriage, Low birth weight, birth
defects, life threatening bleeding
from placenta, pre mature birth, still
birth ,neonatal withdrawal, etc.
Is your work environment safer
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Chemicals, fumes
Radiations
Animals/gardening
Meat
Long flight
Healthcare workerincrease exposure to
infection.
 Support/information
links
Emotional/Psychological well being
Pregnancy is the scariest roller coaster ride not only for women but for men too as you have to deal with on daily basis.
- Discuss with your doctor if you have any pre existing condition and are already taking medication then its not a good idea to
stop your medication abruptly. Your doctor will assess and modify according to severity of your problem. There are alternative
available that has lesser effects on the baby.
- We have to weigh the benefits of medicine for you against risks to the baby.
-Important thing is to be aware ,acknowledge , listen to your body and seek help when needed.
Your mental wellbeing
 Are you suffering from any psychiatric disorder
 Depression ( feeling low)
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Look out for its other signs
changes in appetite or sleep patterns, weight gain or loss,
feelings of hopelessness, lack of interest in things you once
enjoyed, or loss of energy
 See your Doctor
 Counsellor
 Support groups
 Psychiatrist
Exercise
 Keeps you fit
 Stress reliever
 Increase your chances of getting
pregnant
 Help maintain good weight
 Continue into pregnancy
 Pelvic floor exercise.
 Avoid high impact sports( tennis), contact sport,
skiing and thing like scuba diving.
 Aqua aerobics, brisk walking, swimming is ok.
Consider Your Social Circumstances
 Housing
 Support/family
 Flexibility of work
Consider
Your
Finances
 Cost of raising a child
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(from diapers to Uni)
Childcare cost
Maternity/paternity leave
Your right/benefits
Save for long term
When to stop contraception
 Depending on type
 Waiting till next cycle
 Birth spacing
 after normal delivery
 after C/S
Journey through pregnancy
 Normal changes through your body
http://www.youtube.com/watch?v=6TO1GJfKRAo
 Development of the baby
http://www.youtube.com/watch?v=h82ltr84_Yg
Common physiological symptoms
During pregnancy
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Frequent Urination
Nausea Vomiting
Heartburn
Constipation
Leg cramps
Back pain
Fatigue
Sleep disturbances
Mood Swings
Common symptoms
 Swelling of the Hands and Feet  Varicose Veins
 Gum Disease
 Anaemia
 Darkening of the Skin
What to expect each trimester
1st Trimester
- see your doctor/midwife
 What GWH offers
 Early Pregnancy Unit
 Screening
 Dating Scan
 Specialist Care and Support
What to expect each trimester
2nd Trimester
- see your doctor/midwife
 What GWH offers
 Anomaly Scan
 Specialist Clinics
 Day assessment Unit
 Specialist Care and Support
What to expect each trimester
3rd Trimester
- see your doctor/midwife
 What GWH offers
 28 weeks bloods
 Specialist Clinics
 Additional scans if needed
 Day assessment Unit (BP, reduced fetal movement)
 Specialist Care and Support
Birth choices
 Birth Centre
 Water Birth
 Delivery Suite
Aim for normal Delivery
Why Vaginal Delivery?
 Early recovery of mum
 Less breathing problems of the new born
 Early initiation of breastfeeding and bonding
Caesarean section
 General risks of operative delivery
 Maternal hospital stay
 Increased risk of respiratory problems for the infant
 Greater complications in subsequent pregnancies,
including uterine rupture, placental implantation
problems, and the need for hysterectomy.
 With all preparations in place
 Enjoy a smooth journey through pregnancy
 Look forward to your bundle of joy
Thank You
References
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Further reading & references
Antenatal care: routine care for the healthy pregnant woman; NICE Clinical Guideline (March 2008)
Bille C, Andersen AM; Preconception care. BMJ. 2009 Feb 12;338:b22. doi: 10.1136/bmj.b22.
Pre-conception - advice and management; NICE CKS, June 2012
Smoking Cessation Services; NICE Public Health Guidance (Feb 2008)
Dietary interventions and physical activity interventions for weight management before, during and
after pregnancy; NICE Public Health Guidance (July 2010)
Health and Safety Executive; source of advice regarding specific occupational hazards
No authors listed; Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a
large prospective observational study. BMJ. 2008 Nov 3;337:a2332. doi: 10.1136/bmj.a2332.
Exercise and Pregnancy; Royal College of Obstetricians and Gynaecologists (2006)
Varicella: the green book, chapter 34 (immunisation against infectious disease); Public Health
England
Depression - antenatal and postnatal; NICE CKS, revised January 2013
Sickle Cell & Thalassaemia screening across the UK; National Screening Portal
http://www.eshre.eu/Annual-meeting/Archive/Stockholm-2011/For-the-media/Press-releases2011/Hart.aspx
Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months.
Bujold E1, Gauthier RJ. 2010 May;115(5):1003-6. doi: 10.1097/AOG.