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Up to 30 Weeks Pregnancy

Healthy babies start with healthy pregnancies.

 

OFFICIALLY "LOOKING" PREGNANT!

You are almost into your final quarter of pregnancy! Its getting a bit real now & we are starting to look towards your birth and baby arriving. In the meantime its still really important to keep taking care of yourself, eating well, drinking plenty of water & getting some light exercise each day.

We will have your results back now from your second antenatal blood tests and gestational diabetes screening. Baby's movements should be regular each day. We have now start plotting your "fundal height" on your customised growth chart. This is getting exciting!

Whooping cough vaccine

Whooping cough can be very serious for babies and children – especially those under 1 year old. If babies catch whooping cough, they:

  • may not be able to feed or breathe properly.

  • may become so ill they need to go to hospital.

  • could end up with serious complications such as pneumonia and brain damage.

 

The best protection for infants is for their mother to be vaccinated during pregnancy and then on-time vaccinations for the infant at 6 weeks, 3 months and 5 months. A booster dose of a pertussis vaccine is recommended for every pregnancy and is free for women between 28 to 38 weeks of pregnancy.
When a pregnant woman is vaccinated against whooping cough, her body develops antibodies (disease-specific protective proteins) which pass through the placenta. This helps protect the newborn from severe whooping cough for the first few months of life, until they have had their own 3 doses of vaccine and can make their own longer-term protection.
Breastfeeding does not provide direct effective protection against whooping cough.

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Premature Labour signs and symptoms

Premature or pre-term labour is labour that starts before 37 weeks of pregnancy, or more than 3 weeks early.

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The ABC of premature birth

A: Abnormal vaginal discharge. Watch for vaginal discharge of water or mucus; sometimes there will be a small amount of blood. The breaking of the bag of waters around the baby can cause a gush of fluid. This is often one of the first signs of being in premature labour. 

B: Bleeding. Vaginal bleeding is never a normal part of pregnancy. A ‘show’ is mucus and blood that occurs before labour starts, and is due to the plug in the neck of the womb (the cervix) coming away as the cervix starts to open.

C: Contractions. It can be difficult to tell if contractions are labour contractions or just practice contractions, called Braxton Hicks. Braxton Hicks contractions are not usually regular and while they can be uncomfortable, they do not become progressively stronger or more painful. They can become more noticeable if you have a full bladder. Try going to the toilet – Braxton Hicks contractions may settle down if your bladder is emptied. 

Painful contractions occurring regularly every 15 minutes over a period of more than an hour may indicate the start of premature labour. To time the contractions, use your hand to feel the uterus tighten, become hard and then relax. A contraction may last from 30 seconds to around 2 minutes. Time how long it takes from the beginning of one contraction to the start of the next one. Contact your doctor or LMC if you think you are having regular contractions and could be in premature labour.

phone your midwife anytime if:

  • You are and you think you may be going into labour (having regular contractions) or your waters break

  • You begin to bleed from your vagina, especially if it is heavy, fresh, bright red blood with or without clots and with or without pain

  • Your waters break and they are green, brown or heavily blood stained

  • You do not feel your baby move when he or she normally moves, or you feel the movements are reduced

Customised growth chart

Alright- so you've had your 20 weeks scan ages ago now. How come some women have more scans? How will your midwife keep track of baby's growth?

Ah-ha... good question! Midwives have lots of tricks up their sleeves!

Using some of the info you gave me at the start of pregnancy (height, weight, ethnicity, how many babies you've had before and their weights) my midwifery software generates a customised growth chart for you. This gives a predicted range of "normal" baby size for you individually through pregnancy. Every two weeks or when we have an appointment I will measure your "fundal height". This is basically the measurement from the top of baby or your uterus to the top of your pubic bone. This measurement is entered into your notes and plots automatically on your chart. This way we can get an idea of how baby is growing.

Its not just about measurements though- as a midwife I use my hands to feel your tummy- often this also gives me an idea of how big or small baby is and how much fluid is around baby.

If I have any concerns around either what my hands are telling me or your growth chart then we will chat about possibly getting a scan to check on baby.

I will only order a scan if I feel that we have good reason to as it is a medical screening tool and comes with its own shortcomings. However, they can also be really useful when we use them at the right time for the right reasons.

Secondary care/transfer of clinical responsibility

During labour & birth there are occasionally situations where your care changes from “primary” (normal care which LMC midwives are paid by the Ministry of Health to provide care for) to “secondary” (complex care requiring a higher level of care input). This will be discussed with you at the time and often entails a 3-way conversation between you, your LMC midwife and specialist maternity staff or Obstetric Dr’s (O&G’s). This can be a confusing time for women but we will make it as smooth for you as possible and please ask questions if you do not understand anything at any stage.

Your LMC midwife may choose to continue to provide care or support for you during this time but there is no expectation or payment from the MOH to do so. Alternatively, your primary midwife may choose to “hand over care” to the hospital staff for secondary care. If this happens it will be explained to you but please understand it is done with your best interests at heart.

Secondary care is best provided by well rested staff. The hospital midwives work 8-12 hour shifts so will be well-rested, fresh, and alert. Hospital midwives also provide secondary care much more often than LMC midwives so may be better placed to provide care.  Whereas, your LMC midwife may go many long hours without a break or sleep and still be pushing herself and expected to be working to the highest standards, even when fatigued. Higher risk and sometimes complicated obstetric care needs someone managing them that is not already exhausted.

A couple of examples of common secondary care are inductions of labour, diabetics on insulin pumps, or epidurals.

“Labour” overview

Remember that you may experience pre-labour for several days before the real thing. The contractions/tightening’s might be painful and regular but they won’t be debilitating, and they won’t get closer than five minutes apart. These contractions are working on ripening your cervix, toning up your uterus and helping the baby get into a good birth position. It is best to eat, drink, rest and ignore these pains for as long as possible. Consider pre-labour as like going for a walk on the flat. You get tired and breathless but it’s not that hard. Real labour is like walking up a steep hill – it gets harder, stronger and takes more work.

Contractions:

These usually start out irregular and mildly painful. Over the hours they will get stronger, longer and closer together. Until they are 4-5 minutes apart and 90 seconds long it is not real labour, but “pre labour” and you must rest while you can. Once they get to 4-5 minutes apart, and 90 seconds long, we consider it “established” labour – but we still like you to labour at home for a few hours before going to hospital (unless you are planning a homebirth!). Let your midwife know they are now close and strong. Start using your “active labour” techniques – breathing, rocking, squatting and walking. It is almost time for your baby to be born.

Every labour pattern varies so it is hard to say black and white “rules” of when to call but we will discuss this in our appointments.

Everyone deals with pain differently but the best way to approach labour pain is to welcome it, breath through it and surrender to it. It will pass and the sooner you relax into it and go with it, the soon it will do its work.

Pain is a funny thing- if we fight it, become scared, fearful, or stressed, our perception and experience of pain increases. You have the power within you to decrease your perception of labour pain by relaxing and going to semi-sleep state between contractions to allow the hormones to flow. Your support people can help you with this by keeping your environment relaxed with low stimulus, calm, happy, and to offer you things such as gentle back rubs, drinks, snacks or a warm shower.

It is important to remember to keep going to the toilet regularly throughout labour to empty your bladder.

phone your midwife anytime if:

  • You are and you think you may be going into labour (having regular contractions) or your waters break

  • You begin to bleed from your vagina, especially if it is heavy, fresh, bright red blood with or without clots and with or without pain

  • Your waters break and they are green, brown or heavily blood stained

  • You do not feel your baby move when he or she normally moves, or you feel the movements are reduced

Mucous or bloody show

After 37 weeks you might get some bloody mucous or slimy blood stained mucous as a blob or a smear. It might be when you wipe after going to the toilet, it might plop into the toilet, or it might just be on your pad/pants. A few women get clear mucous that is like milky water, rather than blood.

This is a sign your cervix is getting ready to open/dilate. It usually means labour will start within the next 3-4 days, but sometimes it can still be 2-3 weeks. Relax and be happy that your labour will start soon.

If you have a LOT of blood, running down your leg, or more than half a cup, please phone your midwife and let her know.

Waters breaking

Amniotic fluid is clear and a pale straw colour. Sometimes it's difficult to tell amniotic fluid from urine. When your waters break, the water may be a little blood-stained to begin with. If the water is clear or pink, this is great. If the waters are smelly or coloured, or if you are losing blood, please phone your midwife straight away as this could mean you and your baby require urgent attention.

There is about a litre of water around your baby, and when they break it is usually a BIG gush, of at least a cupful, and it will keep on running so pop a pad in your underwear. Your body continually makes water until the baby is born, so you will not run out or have a “dry birth”.

Mostly your waters break when you are in strong labour, after several hours. Sometimes, (around 10% of women) waters break before labour starts. For most of these women, labour will start on its own within 12 hours, but some may need to be induced to get labour going. Don’t panic. Put on a pad, take some panadol and go to bed to SLEEP! Unless it is green water you don’t need to call your midwife till 8am. Sleep and be delighted that your labour is going to start very soon! You can have a shower if you want but please do not have a bath or have sex or anything else that may introduce outside bacteria into the vagina.

If you don’t go into labour by 18-24 hours after your waters break, you and your midwife will need to have a discussion about options which may include monitoring baby’s wellbeing, waiting for labour or inducing, and IV antibiotics in labour. The obstetrician may be included in these discussions to ensure the best plan for you and your baby is agreed on. Remember this only happens to around 5% of women, and we will have a full discussion with you so you can choose what plan best suits you as an individual.

phone your midwife anytime if:

  • You are and you think you may be going into labour (having regular contractions) or your waters break

  • You begin to bleed from your vagina, especially if it is heavy, fresh, bright red blood with or without clots and with or without pain

  • Your waters break and they are green, brown or heavily blood stained

  • You do not feel your baby move when he or she normally moves, or you feel the movements are reduced

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