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Archive for the ‘Pregnancy’ Category

Miscarriages are when the pregnancy terminates before the sixth month and are estimated to occur in about 10 to 20 per cent of pregnancies. It is hard to find an exact figure because many women miscarry before they even realise they are pregnant, and pass it off as a very heavy period.

The majority of miscarriages happen in the first three months of pregnancy and affect about one in five pregnancies. At least half of all miscarriages in the first trimester are caused by chromosomal abnormalities, which prevent the foetus from developing normally. Later miscarriage, usually in the second trimester, is more likely to be a result of the placenta not functioning properly.

The symptoms of miscarriage are vaginal bleeding accompanied by lower backache and severe stomach cramps, a bit like period pain.
Lots of women experience vaginal bleeding in early pregnancy and go on to have a normal pregnancy and healthy baby. Experts are not sure why this happens, but it affects roughly one in four women.

Once the uterus starts to expel the pregnancy there is little that can be done to save it. An ultrasound will probably be required to establish what stage you are at, or if you are miscarrying at all. You will either have an external ultrasound where a transducer (looks a bit like a microphone) is placed on your lower abdomen. If the pregnancy is very early you may have to have an internal ultrasound where a probe is inserted into your vagina. Neither procedure hurts or is harmful to your baby.

There are three types of miscarriage:

• A complete miscarriage, where the uterus expels the foetus and placenta entirely, and an ultrasound scan shows that the uterus is completely empty.
• A missed miscarriage, where the foetus and placenta die but remain in the mother’s womb for some time before being expelled. There might be very minor symptoms such as a brownish discharge. An ultrasound can check whether the foetus’ heart has stopped beating, or for an empty sac inside the uterus.
• An incomplete miscarriage, where a miscarriage happens but some of the products of conception are left inside the mother.

What treatment will I receive if I miscarry?

If you start to bleed at any time during the second or third trimester, call your maternity unit and go there as soon as possible. If you are bleeding in your first trimester, call your doctor and stop any sexual activities and exercise. Your doctor will probably refer you to an early pregnancy unit at the hospital, or gynaecological department, and you will be given an ultrasound to see whether a miscarriage is imminent.

If a miscarriage is inevitable, there is little doctors can do to stop it. You may be given the option to see if the pregnancy is expelled from your body naturally over the next few days. Most women are offered a procedure known as ERPC (evacuation of retained products of conception) which is a minor operation offered under anaesthetic, to clean out the uterus. It involves dilating the cervix and scraping tissue away from the lining of the uterus. You will probably need a short stay in hospital with this procedure.

Late miscarriage

Experts believe that an incompetent cervix is the cause of 20-25 per cent of miscarriages in the second trimester. It is a condition where the cervix opens under the pressure of the growing baby and can cause miscarriage or premature delivery.
It can be caused by a genetically weak cervix, damage during a previously difficult birth, previous surgery on the cervix, and a cone biopsy for surgical cancer or laser therapy.

How will I know if I have an incompetent cervix?

It is usually diagnosed if a woman has previously had a miscarriage in her second trimester, or through internal examinations and ultrasound.

What is the treatment?

The treatment for an incompetent cervix is a procedure that sews the cervix closed to reinforce it. It is usually performed between 12-16 weeks of pregnancy to prevent any problems when you go into labour. The stitches are removed before the estimated delivery date, or as labour starts. The chances of carrying a baby to term with this procedure have proven to be very successful.

If we could choose our ideal birth it would probably be something like this: Water’s breaking on due date at 9am (not all over the bed), labour pains for two hours, comfortable painless journey to the hospital where our partners stay calm, helpful midwife on arrival, get put into the biggest room in the maternity ward with en suite bathroom and birthing pool facility, 20 mins of pushing and your baby emerges with no help from forceps, ventouse, drugs or episiotomies. In reality, birth is very different.

Babies go overdue all the time especially for first time mums. Current research shows that first time mothers gave birth on average five days after their due dates and second time mothers gave birth on average two days after their due dates. The reason that inductions happen is that there is an increase in problems for babies that go beyond 42 weeks. This is because there is a very small percentage of babies who die or who are stillborn when the pregnancy exceeds 42 weeks. Doctors don’t know why this happens but feel that it is safer for the mother and the baby to induce labour before 42 weeks. In most pregnancies labour will start somewhere between 37 and 42 weeks and if you go over your due date you will be monitored very closely and will probably need to have weekly antenatal check-ups.

When and why might I need an induction?
An induction is usually recommended when it is felt your baby is better off outside of the womb than in. This may occur if your pregnancy is over 41 weeks, your waters break but labour does not start (your baby is at risk of infection once the waters break), or if you are suffering from a pregnancy related problem such as Pre-Eclampsia where the only cure for mum and baby is immediate delivery. Other reasons include poor growth of your baby or unexplained bleeding at term.

What happens in an induction?
When labour starts naturally your body makes a hormone called oxytocin which is released into the bloodstream and hormonal changes in the body start the process of labour. Nobody knows what the trigger is that starts labour spontaneously (or doesn’t start in some women) although lots of research has been dedicated to the subject. Inductions are when labour has to be started artificially and a synthetic form of oxytocin is administered to bring on labour.

Membrane Sweep
Once it has been established that you need an induction, you will probably be offered a membrane sweep. A membrane sweep sounds worse than it actually is and involves a midwife inserting two fingers through the cervix and sweeping them around the inside. This releases prostaglandins from the cervix and can help to start contractions. Some women report that it is a little uncomfortable but no more so than a smear test. It is perfectly safe and can be an effective way to start contractions.

Prostaglandin
Your body naturally produces prostaglandin, which stimulates the uterus into contracting, but some women may need prosthetic prostaglandin to help get labour started. Synthetic prostaglandin can be administered by inserting a pessary or gel into the vagina, which softens the cervix. You may need more than one dose of prostaglandin to start contractions at somewhere like six hours later. Lots of prostaglandin doses are given at night so that you can have the second dose when you wake up (and you’ll have had a good night’s sleep before labour starts). The gel or pessary will have to be administered on the antenatal ward because you and your baby will need to be closely monitored.

Artificial rupture of membranes
Often known as AROM. One way of speeding up contractions is to artificially break the bag of membranes which surround your baby and this is known as your waters breaking. Once the bag bursts, the amniotic fluid leaks out and the amount of prostaglandin increases, which speeds labour up. It is done using a long plastic instrument with a hook at one end, during a vaginal examination. It should not be painful, just a little uncomfortable.

Syntocinon
Syntocinon is a synthetic form of the hormone oxytocin, which makes the uterus contract and can be used once the cervix has softened. It is usually administered using an IV (intravenous line) so you won’t be able to move around as much. You may have to be attached to a foetal monitor, as Syntocinon can over-stimulate the uterus and result in your baby becoming distressed. You and your baby will need close monitoring. You are always given a small dose to start with and the dose will then be increased depending on your contractions and how effective they are. Because you are effectively forcing labour to start, contractions can come very quickly and can be much stronger. You probably won’t have had time to get used to contractions building up over time and this can make contractions feel more painful. Some women will decide to have an epidural with a Syntocinon drip as it can help with the pain.

Emergency caesarean
Sometimes none of these methods will work and an emergency caesarean is required. Read our article about what happens in a caesarean so you are prepared if this has to happen.

One of the first things you’ll be told when you find out that you’re pregnant is that you need to quit the habit if you smoke. All the evidence points to the fact that continuing to smoke while you are pregnant is very harmful to your pregnancy and your unborn baby. Unfortunately it isn’t easy to stop, even if you know it’s bad for your baby.

Smoking and your pregnancy
Many of the complications that can occur during pregnancy – for example, miscarriage, placental abruption, premature rupture of the membranes, miscarriage, stillbirth, premature birth, and low birthweight – are much more likely to happen to pregnant women who smoke. This is because cigarette smoke contains more than 4,000 chemicals many of which are highly toxic (carbon monoxide, nicotine, cyanide, and lead).

These chemicals pass into your unborn baby’s body via the placenta, and reduce his supply of oxygen. This can slow his growth and development, and increase the risk of preterm labour. Pregnant women who smoke have almost double the risk of going into labour early and having a low-birthweight baby. If your baby is very early his lungs won’t yet have matured sufficiently for him to breathe unaided and he may have to spend many weeks in a neonatal intensive care unit. Preterm birth puts your baby at higher risk of health problems including cerebral palsy and heart problems, as well as behavioural problems and learning difficulties.

By smoking you also risk your baby being born addicted to the same chemicals in cigarette smoke that you crave, and he will have to go through withdrawal. This can make him fretful and hard to settle in his first few weeks, making your job as a new mum much more stressful.

How to quit smoking in pregnancy
There’s no doubt that if it was easy to quit smoking few of us would indulge in the habit. The reality is that no matter how much you tell yourself that you’re quitting for the sake of your health and your baby’s, giving up will be difficult if you smoke a lot, and you’ll likely find yourself craving a cigarette for many weeks after you stub out that final butt.

Think very carefully about your unborn baby’s wellbeing – it can be a powerful incentive to stick to your guns when it comes to not smoking. Remember that the minute you stop smoking, you stop exposing your baby to the toxic chemicals that harm his health.

Do be prepared for nicotine withdrawal, which will make you cranky, anxious and jittery for several weeks, especially if you were a heavy smoker. This can be hard to cope with at a time when pregnancy hormones will also be making you feel more emotional than usual.

It can be easy for your partner to feel a bit neglected when you’re pregnant as the focus is very much on the mum-to-be.

It’s important, however, to involve him as much as possible so that he doesn’t feel excluded. Here are gurgle’s top ten tips on how to achieve this:

1. Attend antenatal classes together whenever you can. These are a great way for you both to prepare for birth; you’ll learn about all aspects of pregnancy, labour and useful tips on caring for your baby. Your partner will also learn how he can help you during labour.
2. Wherever possible, go to check-ups together so that you can both understand the developments in your pregnancy. You can also discuss any queries or concerns you may have with your doctor and hopefully alleviate any fears. One of the most exciting parts of pregnancy is the ultrasound scans, so try to attend these together; nothing beats that first sight of your little one.
3. Read baby books together; your partner may not be the one carrying the baby, but the more he learns about your pregnancy, the more involved he will feel. Why not have a look at gurgle feature Bonding before birth? You could also watch our great videos on Positions for delivery and Breathing techniques to prepare you both for the big event.
4. Practice relaxation techniques with each other, such as Pregnancy massage. This is a great way for the two of you to bond and share a bit of intimacy. While your partner is massaging you he could gently place his hands on your bump to see if he can feel any baby movements!
5. Take some gentle exercise together, such as swimming, walks in the park or yoga. Read our feature on Exercises recommended in pregnancy and watch our video on Safe exercising for mums-to-be for more information.
6. Having a baby is a life-changing experience and you’re both likely to go through a range of emotional highs and lows. Don’t bottle up your feelings, but talk to each other openly and honestly. Communication is key to keeping your relationship healthy.
7. Make room for romance in your relationship. Some women find that they go off sex during pregnancy, but there are other ways to be intimate, like cuddling or enjoying a nice meal.
8. Prepare for the arrival of your baby together; decorate the nursery, buy baby clothes that you both like and make sure that you’re each happy with the name you choose.
9. It might sound cheesy, but some people sing to their baby! If your partner hasn’t got the best voice (not that this matters!) or feels self-conscious, he could read a favorite story or even chat about his favorite football team…
10. Make time for each other. When your little one makes his arrival you will have your hands full, so use the time you have now for outings such as going to the cinema or theatre and, above all, enjoying each other’s company. You could even plan a romantic mini-break!

There’s so much advice out there on what to do – and what you most definitely shouldn’t do – when you’re pregnant. But follow the ten simple steps below and you won’t go far wrong.

1. Take folic acid

Although folic acid is found naturally in foods such as liver, leafy green vegetables and wholewheat bread, the government still recommends that all women thinking about having a baby should start taking folic acid supplements three months before trying to conceive, and for three months after falling pregnant. Folic acid, a B vitamin, helps prevent birth defects of the brain and spinal cord. Your doctor can prescribe them to you, or they are sold at most pharmacies. They usually come in 400 microgram capsules which should be taken once a day, or if you don’t like taking tablets, a folic acid milk drink is also available.

2. Eat well

While you are pregnant your immune system functions at a slightly lower level than normal, so you can be at risk from infections passed on through food.

Cheese – some cheese carries the risk of listeria, a bacteria that can cause serious problems for the mother and baby.

Avoid: Ripened soft cheeses like brie or camembert and blue-veined cheeses such as stilton. They can be eaten if they’ve been thoroughly cooked. Also avoid cheese from unpasturised sheep or goat’s milk.
You can eat
Hard cheeses like cheddar, parmesan, mozzarella, gruyere and soft processed cheeses like cottage cheese, cream cheese and cheese spreads.

Fish can contain high levels of mercury, which can affect the development  of a baby’s nervous system.
Avoid: shark, swordfish and marlin. Limit your consumption of tuna to one fresh steak, or two cans a week, and avoid raw fish like sushi.
You can eat: cod, plaice, haddock and oily fish like mackerel

Shellfish carries a risk of bacteria that can cause food poisoning – which can put you and your baby at risk.
Avoid: raw or undercooked shellfish like oysters, mussels, cold prawns and crab.
You can eat: cooked shellfish

Milk can carry the risk of listeria, or toxoplasmosis
Avoid: green top milk and unpasteurized sheep and goat’s milk unless it has been boiled for two minutes.
You can drink: pasteurized, sterilized and UHT milk.

Eggs can carry the risk of salmonella
Avoid: raw or runny eggs, mayonnaise made with raw egg (shop bought mayonnaise is fine but restaurants often make homemade mayonnaise with raw egg, so always ask first) and mousses made with raw egg.
You can eat: well-cooked eggs (so that the egg-white and yolk are solid), commercially-prepared mayonnaise and salad cream.

Ice-cream can carry the risk of listeria.
Avoid: homemade ice-cream or soft-whipped ice-cream from machines.
You can eat: ice-cream from cartons.

Meat can carry a risk of toxoplasmosis, listeria and salmonella if it hasn’t been cooked properly.
Avoid: Raw or undercooked meat (ask for your steaks well-done for the next nine months and avoid parma ham) and ready-cooked poultry unless it has been thoroughly reheated.
You can eat: Meat and poultry that has been cooked thoroughly all the way through.

Liver can contain high-levels of the retinol form of vitamin A, which can be harmful to your developing baby.
Avoid: Liver, or liver products such as liver sausage and pate. Some fish oil supplements can contain liver of fish, so check the ingredients first.

Salads can carry the risk of listeria or toxoplasmosis if they haven’t been washed properly.
Avoid: packaged salads, unless you wash them first. Ready-prepared dressed salads like coleslaw or potato salad.
You can eat: any salad that has been properly washed.

Cooked-chilled foods can carry the risk of listeria.
Avoid: unheated cooked-chilled foods.
You can eat: cooked-chilled foods that have been thoroughly heated all the way through.

Peanuts can be dangerous if you or your partner’s family has a history of peanut or other allergies, asthma, eczema or hayfever.
Avoid: eating peanuts, or peanut products (Satay chicken for example) during pregnancy and breastfeeding.
You can eat: other types of nut, including Brazil nuts, hazelnuts, walnuts or cashew nuts, have not been identified as a potential problem.

If you find that you have accidentally eaten the wrong thing, don’t panic, the risks are small, but it is best to avoid these foods while pregnant.

3. Cut out Caffeine

Caffeine has been associated with the risk of miscarriage and hindering the development of babies in the womb. The government’s advice is to limit your caffeine consumption to 300 mg a day (roughly three mugs of coffee, six cups of tea or eight cans of cola).
Avoid: drinking too much caffeine, but a small amount is fine. Remember caffeine can also be found in energy drinks and chocolate.

4. Cut out alcohol

Alcohol can be one of the hardest things to give up in early pregnancy.  Some women find they cannot stand the smell or taste of it once they are pregnant, which makes it easier. In the past experts agreed that a small amount of alcohol in pregnancy was fine, but current information advocates women avoiding alcohol altogether during pregnancy.

There is no doubt that heavily drinking in pregnancy can cause severe abnormalities in babies, and alcoholic mothers put their babies at risk of foetal alcohol syndrome. If you are worried, it might be best to avoid alcohol altogether. At first it may seem strange to go out and not drink, because it was only a few weeks ago that you were enjoying a glass of wine. After a few months you’ll be used to not drinking, and you will probably feel better for it.

5. Don’t smoke or let anyone around you smoke

Smoking is one of the most damaging things you can do to your unborn child, and the risks are huge. Smoking has been linked to miscarriage, stillbirths, a low birth-weight, damage to the placenta and a higher risk of fetal abnormalities. If your partner smokes he is compromising your baby’s health through passive smoking. It is essential that you stop smoking even before you fall pregnant, as smoking can cause men to experience a low sperm count. If you need help quitting visit www.givingupsmoking.co.uk or phone the NHS smoking helpline on 0800 169 9169.

6.Exercise gently

Exercising during pregnancy is important for your health, your stress levels and for your growing pregnant body, but make sure you stick to safe gentle exercises that put minimum strain on your body.

7. Slow down

Although you may feel completely normal, your body is going through one of the biggest events it will ever have to deal with so make sure you take time to slow things down. Don’t try to cram extra time in at work because you feel guilty about time off for maternity leave. Accept that on days when you feel rough, tired or nauseous, it’s ok to ask for help or have a lie down. If you have a boisterous two-year-old to look after, lean on a few relatives to take care of him or her while you have some time-out.

8. Sleep

Lie-in till 2pm, have early nights and long baths… Try to get at least eight hours sleep a night, because once your baby arrives your sleep pattern will be disrupted by broken nights and early starts and sleeping through the night or having a lie-in will seem like a distant memory! If you can, take a little nap in the afternoon and remember to lie down on your left side, if it is comfortable, to relieve the major blood vessels that supply oxygen and nutrients to your growing baby.

9. Change your shoes

Stiletto lovers don’t despair – you will get into your heels again, but for the next nine months it is probably best to stick to comfortable non-restricting shoes. In pregnancy your ankles, feet and legs can swell slightly so anything restricting will make them worse. Try to put your legs up (even on a box under your desk) a few times a day. If your legs, ankles or toes excessively swell make an appointment with your GP as this could be a sign of pre-eclampsia.

10. Look after YOU

This might mean doing pregnancy yoga, going to a spa for a bit of pampering or buying a special maternity outfit, anything which helps you to nourish your mental wellbeing. Why not book a weekend away for you and your partner in a luxury hotel before the baby comes. Your partner may be feeling apprehensive about the impending birth and a weekend away will do you both good.