Thinking of having a baby – what you need to know? Dr. Nusrat Fazal Consultant Obstetrician GWH

Thinking of having a baby- what do you need to know?

Are You Ready?? Physically Psychologically/emotionally Socially Financially

Aims of discussion Pre pregnancy Care Journey through Pregnancy 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 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? 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

Are you up to date with your immunisation? Dental hygiene Are you up to date with your immunisation? 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 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 Chemicals, fumes Radiations Animals/gardening Meat Long flight Healthcare worker-increase 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) 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 (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 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 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-releases-2011/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.