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

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

4. Are You Ready?? Physically Psychologically/emotionally Socially
Financially

5. 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

6. What is Pre-pregnancy Care
Why is planning important?
How to prepare well for the journey?

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Which Food and supplements
Folic acid
When to start
How much (400microgram/5mg)
Vitamin D
Healthy Diet

16. Foods to avoid Raw eggs, Meat Coffee ( ↓200g) Soft Cheese
Unpasteurised milk
Certain fishes
Food rich in vitamin A.

17. 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.

18. Is your work environment safer
Chemicals, fumes
Radiations
Animals/gardening
Meat
Long flight
Healthcare worker-increase exposure to infection.
Support/information links

19. 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.

20. 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

21. 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.

22. Consider Your Social Circumstances
Housing
Support/family
Flexibility of work

23. Consider Your Finances
Cost of raising a child
(from diapers to Uni)
Childcare cost
Maternity/paternity leave
Your right/benefits
Save for long term

24. When to stop contraception
Depending on type
Waiting till next cycle
Birth spacing
after normal delivery
after C/S

25. Journey through pregnancy
Normal changes through your body
Development of the baby

26. Common physiological symptoms During pregnancy
Frequent Urination
Nausea Vomiting
Heartburn
Constipation
Leg cramps
Back pain
Fatigue
Sleep disturbances
Mood Swings

27. Common symptoms Swelling of the Hands and Feet - Varicose Veins
Gum Disease
Anaemia
Darkening of the Skin  

28. What to expect each trimester
1st Trimester
- see your doctor/midwife
What GWH offers
Early Pregnancy Unit
Screening
Dating Scan
Specialist Care and Support

29. 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

30. 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

31. Birth choices
Birth Centre
Water Birth
Delivery Suite

32. 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.

33. With all preparations in place
Enjoy a smooth journey through pregnancy
Look forward to your bundle of joy

34. Thank You

35. 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 Feb 12;338:b22. doi: /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 Nov 3;337:a2332. doi: /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
Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months.
Bujold E1, Gauthier RJ May;115(5): doi: /AOG.