Tip 1: Planning, planning, planning!
Surprise pregnancies are sometimes unavoidable, but if possible it is recommended that you plan your pregnancy. This will allow you to make lifestyle changes such as stopping smoking, eating healthily and exercising regularly, all of which can aid conception. You will also be able to start taking folic acid prior to conception (see below for more information).
Any illnesses or health issues that you have are also worth checking with your specialist or obstetrician prior to pregnancy. It is important to optimise things like diabetes, inflammatory bowel diseases, epilepsy, thyroid abnormalities and many other illnesses prior to pregnancy so that complications are less likely. This also allows changes to be made to medications which may not be safe to take during pregnancy.
An antenatal screening set of blood tests can also be organised by your GP or obstetrician to check for current immunity to diseases such as rubella (German measles) and varicella (chicken pox). It may be recommended that you have a booster vaccination prior to pregnancy if your results show that you are not immune.
Tip 2: Folic acid
Taking folic acid for at least one month prior and during the first trimester (three months) of pregnancy helps the formation of a normal spinal column, preventing neural tube defects including problems such as spina bifida. Folic acid is found in green leafy vegetables and other foods fortified with folic acic (such as bread), however it is still recommended that women planning a pregnancy take a supplement containing 400 mcg of folic acid each day. Certain groups of women such as those with a family history of neural tube defects or type 1 diabetes need to take a higher dose, so check with your obstetrician that you are having the correct amount for your pregnancy.
Tip 3: Vaccinations
As well as making sure you are up to date with rubella and varicella prior to pregnancy, there are some other vaccinations recommended during the pregnancy. The flu vaccination is one of these as lower immunity during pregnancy can result in particularly severe attacks of influenza which at times can require hospitalisation or even be life threatening.
Vaccination against pertussis (whooping cough) is also recommended for all pregnant women. Having this vaccination at about 28 weeks of pregnancy means that some of the immunity will be passed on to your baby, helping to protect him or her in the first few months of their life before they can be fully vaccinated. Equally, it is important to ensure that other caregivers close to the baby such as your partner, family and friends are up to date with their vaccinations prior to having contact with the new baby to avoid the risk of passing whooping cough on. Whooping cough is a life threatening illness for new babies and it is not worth the risk!
Tip 4: Food, glorious food!
It is recommended that women maintain a healthy diet during pregnancy which includes foods from all of the major food groups (protein, dairy, carbohydrates, fruits and vegetables), with plenty of fresh produce. It is unfortunately not a licence to “eat for two”!
Certain foods do need to be avoided due to the risk of infection, including sushi, soft cheeses, deli foods (meats/salads) and meat that is not fully cooked. It is also recommended to avoid alcohol during pregnancy as there is an association with alcohol intake and fetal alcohol syndrome.
Tip 5: I like to move it, move it!
Keeping active during pregnancy is very important for the health of both you and your baby. Exercise has many beneficial effects such as controlling the amount of weight gain in pregnancy, improving blood sugar levels (this and a healthy diet are two of the most important ways to reduce the likelihood of gestational diabetes), and reducing the likelihood of medical interventions during the labour and birth. Babies benefit directly too with improved oxygen delivery via the placenta to allow normal growth and development.
Exercise needs to be tailored during pregnancy due to musculoskeletal changes of the spine, joints and ligaments. Regular aerobic exercise need not be stopped, and if you were doing nothing prior to pregnancy then commencing a gentle exercise routine is recommended.
Studies have shown no link to exercise and adverse outcomes such as miscarriage, premature deliveries, or reduced fetal growth.
Tip 6: Squeeze and lift…
Pelvic floor muscle exercises (otherwise known as Kegel’s) help to strengthen the levator ani muscles which help to maintain continence and prevent against prolapse. At Alana we recommend all of our pregnant women see the pelvic floor physiotherapist both during and after the pregnancy to tailor an exercise regime that is individualised.
As well as strengthening this muscle, towards the end of the pregnancy it needs to be flexible to allow a vaginal delivery. In fact, the levator ani muscle has been shown in studies to stretch to five times its normal length to allow the birth of a baby. As a result preparation of this muscle can help to reduce the likelihood of tearing. Perineal massage or the use of commercial balloon devices that gradually stretch the tissues may help to reduce this risk. Your obstetrician or physiotherapist will let you know what is the best approach for your situation.
Tip 7: Tests during the pregnancy
Your obstetrician will direct you to have a number of investigations during the pregnancy to make sure things are progressing well. These include the antenatal blood tests which are performed prior to the pregnancy (see tip 1).
First trimester tests may include a dating ultrasound to confirm the location and the heartbeat of the embryo and screening tests which are performed to identify chromosomal abnormalities such as Down syndrome (trisomy 21), other trisomies or sex chromosome abnormalities. These screening tests are optional and include either NIPT (non-invasive prenatal testing) or the nuchal translucency screening test.
NIPT is a blood test which identifies the baby’s genetic material in your blood. Testing reveals the baby’s chromosomes and can identify abnormalities such as an extra chromosome (eg. Trisomy 21 where there are three copies of the 21 chromosome rather than the usual 2). The sex of the baby can also be identified at this test if you wish. NIPT is usually performed at around 10 weeks gestation.
The nuchal translucency test is a combination of an ultrasound which measures the thickness of the skin at the back of the baby’s neck and a set of blood tests taken from you. These are performed between 11+5 weeks and 13 weeks gestation. The two results are put into a computer algorithm and a numerical risk is generated for certain abnormalities including Down syndrome. The result will be in the format 1 in 10, 1 in 100, 1 in 1000, 1 in 10000 likelihood of your baby having the abnormality. On the basis of this result your obstetrician will discuss with you the need for further definitive testing such as amniocentesis or chorionic villus sampling which take a sample of either the amniotic fluid or the placenta to confirm the baby’s chromosomes.
Second trimester tests include a morphology ultrasound at 18-20 weeks gestation which is a thorough assessment of the baby’s anatomy. This ultrasound can take quite a while especially if the baby is not co-operating! Other information from this ultrasound include the length of your cervix and the location of the placenta (expect to have a transvaginal ultrasound to assess these). Blood tests are performed between 26 and 28 weeks gestation and include a blood count, iron levels, antibodies in your blood group and a glucose tolerance test to assess for gestational diabetes. This is one of the worst tests during pregnancy as you have to fast and then drink a very sugary liquid before sitting down and having three blood tests over 2 hours – yuck! It is very important though, as identifying gestational diabetes at this stage of the pregnancy can help to avoid many complications later on.
Third trimester tests may depend on what else is happening with your pregnancy. If there are any concerns about the growth of the baby or you have a high risk pregnancy such as twins, diabetes or high blood pressure, you will be having regular ultrasounds to assess the baby. Blood tests may be performed at 36 weeks to look at your iron levels again if these were low early on. A vaginal swab test is also performed at this time to look for a bacteria called group B streptococcus. This is found as a colonising bacteria in about 1/3 of pregnant women and can cause an infection for baby if it picks it up during labour. If you are one of the women where this is identified, it will be recommended you have antibiotics through a drip during the labour to help to prevent infection.
Although this may all look daunting, these are just some of the ways we can ensure that your pregnancy is as healthy as possible, and identify any issues early on.
Tip 8: Regular antenatal visits
Speaking of identifying issues early, regular visits to the obstetrician or midwife are the mainstay of a happy, healthy pregnancy. As well as getting to know your obstetrician before the delivery (we know how nice it is to see a familiar face walk into the room when your baby is about to be born!), it is also vital that we check a few other parameters on a regular basis. These will include your blood pressure and your baby’s heartbeat (we use an ultrasound for this and can also get an idea of the fluid around the baby and the baby’s position at the same time. We might also get a sneak peek at your baby’s cute little chubby cheeks and lips too!). We will feel the baby within your abdomen, measure the growth and may also test your urine. Women who have a negative blood group will be receiving anti-D at regular intervals in the pregnancy to make sure that you don’t develop antibodies to the baby’s blood group.
Tip 9: Just kicking around…
The kicks and movements of a baby can be one of the loveliest parts of the pregnancy or one of the most uncomfortable (depending on where those little feet are resting – sore ribs anyone?!). “Quickening” is the term that was used to describe the time when a woman starts to feel fetal movements and occurs between 16-24 weeks for most women. Of course the baby has been moving long before that time (as you may have seen on early ultrasounds). Factors such as an anterior placenta may mean that movements are felt later or are not felt to be as strong.
Babies establish a pattern of movements that each women will recognise for their own baby. Sometimes eating or drinking will encourage a baby to move, or lying on your side in a quiet room so you notice the movements. It is very important that if your baby doesn’t move as much as it usually does, or has been quiet for a long period of time to seek help. Call your obstetrician or midwife and get an assessment. We will check the baby’s heartbeat with a cardiotocogram (CTG) and may organise an ultrasound to check the fluid around the baby and the blood flow to the baby. Sometimes on the basis of these investigations the baby will need to be born early. It is always better to get reduced movements checked out – we would rather check many times than miss a baby who was in distress!
Tip 10: Support network
It is vital for a healthy mother and baby to have a good support network around you. Pregnancy can be a stressful time with many changes both physically and mentally. This is a time when anxiety and depression can appear or worsen, either antenatally or after the baby is born. Sometimes it can feel that your hormones are making you go haywire but if you have symptoms of being more worried or anxious than you usually are, crying more easily or without provocation, blaming yourself unnecessarily for things that have happened or feeling like you would harm yourself or someone else then it is important to seek help. Speak to your partner, GP and obstetrician. There are many resources for pregnant women and new mothers who are dealing with antenatal and post-natal depression. Sometimes just talking to a psychologist can help to identify what’s happening and direct you to treatment.
It is also important to recognise that you may need help when the baby is born and to be able to accept when things are less than perfect. Get as much sleep as you can, especially in those first weeks after the baby is born, even if it means the house looks like a train wreck!!
Following these tips through the nine months of pregnancy will help to make sure you and your baby start off in the best way.