Thinking of having a baby – what you need to know?

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??PhysicallyPsychologically/emotionallySociallyFinancially

Aims of discussionPre pregnancy Carewhat planning and lifestyle changes ?Journey through Pregnancy what changes your body go through during pregnancy?Child Birthwhat birth choices and how to prepare for the big day?After delivery care and support

What is Pre-pregnancy CareWhy is planning important?How to prepare well for the journey?

Are you ready to make some life style changesQuit/cut down smoking/alcoholStop taking street drugsEat Healthy maintain healthy weightKeep fit and Exercise regularlyAvoid certain foods and exposure to infectionAdd certain supplements to your diet

You need to know about your Physical well beingDo you have any chronic Medical Condition/ Psychiatric condition?

Diabetes (High blood sugar)High blood pressureKidney problemHeart problemsEpilepsy (seizures/fits)Other

Are you taking any MedicationsHow is it going to affect your babyIs it important to continueIs there any alternativeCan I modify or reduce the doseWhat are the options

Your Previous Obstetric/Surgical history MiscarriagesPremature birthPrevious Pregnancy LossPrevious surgery Cervical smear/ any procedure on the neck of the wombPrevious Caesarean Section

Do you know your family historyAny chronic health conditions running in the familyAny genetic problems in the family or have a previous child with genetic conditionSee your doctor Genetic counselling

Are you up to date with your immunisation?

RubellaEffects 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

Dental HygieneNew 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

Which Food and supplementsFolic acidWhen to startHow much (400microgram/5mg)Vitamin DHealthy Diet

Foods to avoidRaw eggs,MeatCoffee ( 200g)Soft CheeseUnpasteurised milkCertain fishesFood rich in vitamin A.

Stop/ cut down smoking/ Alcohol and avoid drugsSmoking Low birth weight, preterm labour, antepartum haemorrhage , still birth and cot deathsAlcohol low birth weight, brain damage and facial malformationStreet drugs: miscarriage, Low birth weight, birth defects, life threatening bleeding from placenta, pre mature birth, still birth ,neonatal withdrawal, etc.

Is your work environment saferChemicals, fumesRadiationsAnimals/gardeningMeatLong flightHealthcare 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 wellbeingAre you suffering from any psychiatric disorderDepression ( 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 energySee your DoctorCounsellor Support groupsPsychiatrist

ExerciseKeeps you fitStress relieverIncrease your chances of getting pregnantHelp maintain good weightContinue into pregnancyPelvic 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 CircumstancesHousingSupport/familyFlexibility of work

Consider Your FinancesCost of raising a child (from diapers to Uni)Childcare costMaternity/paternity leaveYour right/benefitsSave for long term

When to stop contraceptionDepending on typeWaiting till next cycleBirth spacingafter normal deliveryafter C/S

Journey through pregnancyNormal changes through your bodyhttp://www.youtube.com/watch?v=6TO1GJfKRAo

Development of the babyhttp://www.youtube.com/watch?v=h82ltr84_Yg

Common symptoms Swelling of the Hands and Feet -Varicose Veins Gum DiseaseAnaemia Darkening of the Skin

What to expect each trimester 1st Trimester - see your doctor/midwifeWhat GWH offersEarly Pregnancy UnitScreeningDating ScanSpecialist Care and Support

What to expect each trimester2nd Trimester - see your doctor/midwifeWhat GWH offersAnomaly ScanSpecialist ClinicsDay assessment UnitSpecialist Care and Support

What to expect each trimester 3rd Trimester - see your doctor/midwifeWhat GWH offers28 weeks bloodsSpecialist ClinicsAdditional scans if neededDay assessment Unit (BP, reduced fetal movement)Specialist Care and Support

Birth choicesBirth CentreWater BirthDelivery Suite

Aim for normal DeliveryWhy Vaginal Delivery? Early recovery of mum Less breathing problems of the new born Early initiation of breastfeeding and bondingCaesarean 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 placeEnjoy a smooth journey through pregnancy Look forward to your bundle of joy

Thank You

ReferencesFurther reading & referencesAntenatal 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 2012Smoking 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 hazardsNo 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 EnglandDepression - antenatal and postnatal; NICE CKS, revised January 2013Sickle Cell & Thalassaemia screening across the UK; National Screening Portalhttp://www.eshre.eu/Annual-meeting/Archive/Stockholm-2011/For-the-media/Press-releases-2011/Hart.aspxRisk 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.