Download For You

HELPING YOU THROUGH PREGNANCY
& CHILDBIRTH
Useful tips and helpful advice!
Welcome to Cavan Maternity Unit and Congratulations on
your Pregnancy.
Parentcraft Department
Maternity Unit
Cavan General Hospital
049 4376541
Table of Contents
Introduction ………………………………………………………….3
What to bring to hospital……………………………………………..6
Achieving a healthy pregnancy………………………………………8
Lets get physical……………………………………………….8
Healthy eating…………………………………………………13
Common pregnancy complaints ……………………………...18
Stay safe in pregnancy ……………………………………………....20
Smoking in pregnancy ………………………………………..20
Seat belt use …………………………………………………..22
Pregnancy symptoms never to ignore ………………………...23
Perineal Massage
Making space for no 2, 3, 4 ………………………………………….25
Labour………………………………………………………………..26
What is labour? ……………………………………………….26
Signs and symptoms…………………………………………..27
How long is labour?...................................................................30
Pain relief options…………………………………………………….32
Active birth positions………………………………………….33
TENs machine…………………………………………………39
Entonox………………………………………………………..40
Pethidine………………………………………………………40
Epidural……………………………………………………….41
Alternative pain relief options……………………………………….47
Birth………………………………………………………………….49
Induction of labour …………………………………………...49
Assisted delivery ……………………………………………..52
Caesarean section …………………………………………….53
1
Special Care baby unit ……………………………………………...56
Feeding your baby ………………………………………………….57
Breastfeeding ………………………………………………...57
Artificial feeding …………………………………………….63
Postnatal Care ………………………………………………………67
Body changes ………………………………………………..67
Healthy living ………………………………………………..70
Baby blues and postnatal depression ………………………..72
Baby basics …………………………………………………………75
Baby massage ………………………………………………..78
Sleep safely …………………………………………………..81
Safety in the home and car …………………………………...82
What birthing partners can expect? …………………………………85
2
Introduction to Cavan/Monaghan Hospital Group
Welcome to Cavan/Monaghan General Hospital. This hospital is under the
management of the HSE, Dublin North East and is part of the Cavan/Monaghan
Hospital Group.
The Maternity Department in Cavan/Monaghan General Hospital currently provides
Maternity Services for approximately 2000 pregnant women per year.
The options of care are;
1. Midwifery led care.
2. Consultant led public care.
3. Consultant led private care.
We also provide neonatal care for newborn babies caring for up to 300 babies per
year.
We aim to ensure that the best quality maternity service is available in partnership
with women and their families and we strive:
•
To meet the holistic needs of woman and their families and encourage joint
decision making relating to care.
•
To build an accessible cost effective service of excellence, where practice is of
highest standard and is based on proven research and governed by audit and
multidisciplinary team work.
•
To foster an environment where individuality is respected, where safety is of
paramount importance.
•
To promote and enhance the midwives role within the service, working as
autonomous practitioners in provision of care alongside their obstetric
colleagues.
We welcome you to the maternity unit and hope you will find your pregnancy and
delivery an enjoyable experience. We realise you may be apprehensive, and we
wish to assure you that our philosophy of care is designed to help you. We try to
ensure that all mothers and babies receive individualised care from competent
professionals in a kind, caring and safe manner. We respect your individual
wishes and rights within the confines of safe practice.
‘It is our aim at Cavan General Hospital to support, educate and inform women
regarding pregnancy, birth and baby care practices. Therefore we encourage you to
attend antenatal classes, and value your input and communication. All our staff strive
to make your pregnancy, birth and postnatal care a positive experience.’
Strict Visiting Hours;
Monday to Sunday, including Bank Holidays; 6.30pm – 8.30pm.
Partners are permitted all day between 9am – 9pm.
Siblings can come to visit between 6.30pm – 8.30pm.
3
You have just booked to have your baby in the
Cavan/Monaghan Hospital.
What happens next?
•
The Midwife met you and took your medical history, organized your bloods
and discussed with you what clinic you wish to attend, either with the
Midwifery Led Unit (MLU) or with one of our 4 consultants in the Consultant
Led Unit (CLU).
•
Subsequent visits to the hospital will be with your relevant caregiver and care
given specific to your needs. At a minimum this will include urine testing,
blood pressure monitoring and evaluation of the growth of your baby. At each
visit, please bring a sample of urine with you.
•
More routine blood tests may be required in your pregnancy and if so, the
midwife will organize this for you.
•
A date for your parentcraft class will be given to you while you attend for your
initial pre-assessment/booking visit. We also run Polish classes. If you do not
get an appointment for classes at your first visit please inform your midwife
on your return visit.
•
Breastfeeding classes are held once a month on the last Tuesday. To book a
place please contact the breastfeeding specialist Midwife on 049 4376864.
•
Antenatal care is shared with your GP whom you will visit alternately with the
hospital.
Models of Care Available to You
•
•
MLU Care
In the MLU you will be seen by a
team of midwives and a
midwifery manager throughout
your antenatal period, birth and
postnatal period.
Following your pre assessment
appointment you will be given an
appointment to return for your
next visit in the midwifery led
unit.
•
•
CLU care
In the CLU you will be seen by
the Consultant Obstetrician at
least once in the antenatal period
or more frequently if required.
Subsequent visits will be with a
member of his team.
Following your pre assessment
appointment you will be given an
appointment to return for your
next visit in the out patients
department.
4
•
The Midwife in the MLU will
organise all your follow up
appointments with you before you
leave. Mlu care provides flexible
appointment dates and times to
suit your needs.
•
Please make your return
appointment at the reception desk
in the out patient department
‘BEFORE’ leaving the hospital.
•
On your return visit you may
come directly up to the MLU and
take a seat in the waiting room on
the unit. If you have changed any
personal details please inform the
midwife.
•
On your return visit check in at
the reception desk in the out
patient department and take a seat.
If you have changed any personal
details please inform the
receptionist at this point.
•
MLU care provides minimal
waiting times and the opportunity
to familiarise yourself with the
midwives who will look after you
in labour.
On subsequent visits the midwife
will check your blood pressure
and urine and will assess the well
being of both you and your baby.
•
A midwife will call you and will
confirm your personal details.
Your blood pressure will checked
and your urine tested.
•
You will then go to the waiting
area to see one of the doctors
from your chosen doctor’s team.
•
On average you will have at least
2 ultrasound scans during your
pregnancy. A repeat ultrasound
scan may be performed later in
your pregnancy at the doctor’s
discretion
•
•
•
On average you will have at least
2 ultrasound scans during your
pregnancy. Further ultrasounds
may be required on clinical
grounds.
PLEASE NOTE;
The clinics are often very busy and
your doctor may also be covering the
labour ward and theatre. This may
cause some delays.
‘As for Cavan MLU, what can I say, anyone having a normal pregnancy would be
mad not to use these wonderful facilities. It is your right to request it, if you are
having a healthy pregnancy with no history of pregnancy issues. Where else can you
get a big private en-suite birthing room, with a warm pool to relax in, a quiet bed, and
even a telly and couch! The couch folds out to allow your birthing partner to get some
overnight rest also. And all for free!’ Sharon
5
Are you packed and ready to go?
Its getting close now and you will soon be meeting your baby! Here are a few
suggestions from other mums and midwives on what to bring to hospital?
For You
Nightdress (front opening), Pyjamas, Dressing
gown
Slippers, Flip Flops
Toiletries
Dark Coloured Towels
Nursing Bra
Breast Pads
(Disposable or washable)
Maternity Sanitary Pads
Sanitary Pads
E.g.; Green sanitary pads in clear packaging
(Initially after delivery)
E.g.; ‘always with wings’
(2-3 days after delivery)
Disposable Underwear
Phone Charger, Camera
Hairdryer
For Labour
Front opening night dress/ t-shirt
Face cloth/sponge
Lip Balm
Hair band
Books/Magazines
Socks
Glucose Sweets/Drinks
Your Own Music
Dark Coloured Towels
6
For Baby
Washed Towels x 2
Baby Gros x 7
Vests
Hat & Mittens
Nappies
Burping Cloths
(Newborn size 1 or 2)
Cot Sheets & Cellular Blankets
Cotton Wool Balls
Olive Oil
Vaseline/Sudocrem
Going Home
Loose easy to wear clothes for you
Car Seat
Warm Baby Clothes
Warm Cellular Blanket & Hat for Baby
Postnatal Classes;
All mums are expected to attend this class to receive all the relevant information for
discharge. Classes are held on the Maternity Unit on Mondays, Wednesdays and
Fridays from 10.30am – 12.00pm.
Don’t forget PPS numbers for the birth registration.
Phone number for Maternity; 049 4376613
7
ACHIEVING A HEALTHY PREGNANCY
‘Let’s Get Physical’
Whether you spent your evenings on a treadmill or in front of the television before
you were expecting, now is the time to get active and stay active! Exercising while
pregnant can help you to cope better during your pregnancy and your labour, as well
as being a proven stress-reliever. Chartered physiotherapist LESLEY-ANN ROSS
outlines the benefits to keeping yourself fighting-fit during these nine months. During
pregnancy your body is developing so it’s important to adapt or begin a fitness regime
that accommodates these changes. This might mean tweaking your existing
programme or swapping it for an activity that’s more appropriate during pregnancy.
Before deciding on a form of exercise, take account of how your body will change
during pregnancy: issues to be aware of include your changing body shape, weight
gain, hormonal changes, increased joint laxity, tiredness, a decrease in balance or
even a propensity for clumsiness.
THE BENEFITS
Exercise, in general, can help to maintain cardiovascular fitness, posture, flexibility,
muscle strength, balance, body awareness and co-ordination. As a result, stress and
the occurrence of back/pelvic or other pains may be reduced and relaxation and
breathing control promoted. Exercise can improve physical wellbeing and can offer
the means to meet other mums-to-be at the same stage of pregnancy. Exercising
during the antenatal period may also play a role in managing gestational diabetes
(accompanied by medication and a healthy diet) and in assisting postnatal recovery.
8
WHEN TO START
Listen to your body and trust your instincts. If you are tired or suffering from morning
sickness then wait until a time you feel like exercising. If you are feeling fine in the
first trimester and have been exercising pre pregnancy, then in accordance with your
midwife or doctor’s advice, you can follow a similar exercise regime during
pregnancy, while bearing in mind the guidelines below. Many pregnancy exercise
classes encourage women to join from 16 to 20 weeks of pregnancy.
THINGS TO CONSIDER
Remember that whatever is affecting you during pregnancy is also affecting your
baby.
With all forms of exercise, you need to be aware that:
• Your heart rate should not exceed 60–70 per cent of maximum heart rate
levels –i.e., approximately 140 beats per minute (being able to exercise and
talk at same time).
• Your body temperature will change – make sure that you have enough
ventilation and fluid intake when exercising and do not overheat.
• Your nutritional intake increases – if you are exercising regularly, make sure
you are eating regularly and enough. From 13 weeks, 300 extra kcal a day are
required, even if you are not exercising. It is advisable to consult a dietician if
you are uncertain about your intake.
• Any positions or movements that cause pain. Some movements may cause
discomfort or pain, depending on where the baby is lying or your body’s
flexibility. Avoid overstretching and any movements that are painful. Consult
a physiotherapist if necessary.
• Keep breathing during exercise and avoid holding your breath.
• Exercising flat on your back for longer than about five minutes is not
recommended after 16 weeks gestation due to circulatory adaptations.
• Contact sports should be avoided after 16 weeks.
• Scuba diving should be avoided at all stages of pregnancy.
SAFE EXERCISE
Approximately 30 minutes or more of moderate exercise a day on most, if not all,
days of the week is recommended for pregnant women in the absence of medical or
obstetric complications. Moderate exercise intensity can be defined as being able to
exercise and talk at the same time, for example, walk and hold a conversation (ACOG
Guidelines 2002).
Cardiovascular exercise
Walking, swimming or cycling are good cardiovascular exercises during pregnancy.
Guidelines suggest 20 minutes, three times a week progressing to 20–30 minutes
daily. Make sure to start off slowly and increase time gradually, particularly if you
have not been doing any exercise prior to becoming pregnant. You will most likely
need to slow down again in the latter weeks of pregnancy. Follow the guidelines
above for heart rate, nutritional intake and body heat.
Gym work
This is not necessarily the time to decide to join a gym. However, if you are already a
member, you could continue with some cardiovascular work such as on the treadmill
9
or bike. Gentle arm weights can also be used. Consult a fitness instructor on the
suitability of equipment for pregnant women. Lower weights with an increased
number of repetitions are advised. Higher impact exercise such as aerobics or step
classes are not advised due to the increase in joint laxity. Stop exercising if you are
feeling unwell, in pain or are very short of breath.
Exercise classes
Pilates, yoga or aqua classes are great for meeting other mums-to-be. Pick a class with
a particular focus on pregnancy, as they will have been modified to particular stages
of pregnancy and appropriate positions. Pregnancy classes will also focus on
breathing control, relaxation techniques and posture, all of which are important at this
time. For further details of local classes, contact your antenatal department and always
check that your instructor is qualified to take pregnancy classes.
“It is important to be aware of the signals from your body and your baby while
exercising and stop immediately if you are in any way uncomfortable”
Don’t exercise if:
• you are feeling unwell, tired, faint or dizzy, if your doctor or midwife has
advised against it, if you have pain or if you have any bleeding. Exercising
during pregnancy is not always suitable for everyone so consult your
doctor/midwife before engaging in any activity.
MAKING EXERCISE WORK FOR YOU
If you are already a very active person and enjoy a regular exercise routine, you may
continue with this as long as you listen to your body and follow the guidelines above.
Other forms of exercise such as golf, gentle tennis, hill walking or dancing can be
continued well into your second trimester as long as you are feeling good. Any
queries should be discussed with your doctor or midwife. Competitive exercise that
can involve risk of impact or falling, such as basketball, horse riding or skiing, should
be discontinued to avoid risk to both mum and baby. Pregnancy is a time to maintain
fitness levels, not necessarily to try to increase them. Enjoy your exercise and use it as
time for you and your growing baby.
Making time
Try to fit exercise sessions or classes into your weekly schedule, however, if classes
or the gym are not for you, there are other ways to exercise as part of your daily
routine. If possible, a daily walk to work or at lunch would help with your
cardiovascular fitness and taking the stairs instead of the lift can strengthen the leg
muscles. Gentle housework can also keep the body flexible and moving. Do be aware
of your posture when doing housework – bend from the knees and keep your feet and
your face in the same direction, so avoid twisting or turning. An active way to work
the pelvic muscles and relieve lower back strain is to sit on a large exercise ball.
These are often called ‘Swiss’, ‘physio’ or ‘birthing’ balls. Sitting on the ball while
relaxing, watching television or working at a desk can help movement and strength in
the back and pelvis. A suitably sized ball should allow your hips and knees to rest at
approximately 90 degrees (too high or too low may irritate your back or pelvis). Ask
your physiotherapist for advice on size or suitability for you.
Postnatal Exercise
Exercising after the birth of your baby will depend on your antenatal exercise levels,
your type of delivery, and how you and your baby are feeding and sleeping. Try to
10
attend a postnatal advice class in the maternity hospital if you can. As a general rule,
after six weeks is a good time to start gentle exercise. Up until this time, you can walk
as much as you feel up to, progressing your distance or pace gradually. After six
weeks, you may be able to join yoga, Pilates, low level class or start some gym work.
Higher-level exercise or contact sports should be progressed into gradually over three
to five months, as it takes this time for the hormone levels to reduce and joints to
stabilise. Each woman, body, baby and exercise is different. It is important to be
aware of the signals from your body and your baby while exercising and stop
immediately if you are uncomfortable or a movement does not feel right. Discuss
modifications with your instructor, if necessary.
CHOOSING THE RIGHT EXERCISE FOR YOU:
Swimming
• Cardiovascular, non-weightbearing exercise.
• Good for relieving postural strains and ‘taking the weight of the baby off the
spine’.
• Take care not to overstrain the pelvic joints – particularly in breast stroke
action.
Walking
• Cardiovascular, weightbearing exercise.
• Pace, distance and stride length may need to be modified as pregnancy
progresses.
• Supportive footwear recommended.
• ‘Respect’ pelvic joints and do not walk through pain.
Pilates
• Minimal weightbearing – modified positions
• Increases postural awareness as body changes
• Focus on awareness of and strengthening of pelvic support muscles – lower
abdominal muscles and pelvic floor muscles
• Flexibility and breathing work also incorporated
• Some classes will modify Pilates exercises to use Swiss balls
Yoga
• Minimal/modified weightbearing
• Flexibility exercises
• Relaxation and breathing exercises
• Classes often incorporate useful positions for labour
The Basics
If you aren’t able to exercise during pregnancy, it is worth considering the following
points and basic exercises.
1. THINK SYMMETRY, Back and pelvic problems can often be aggravated
during pregnancy due to the ‘asymmetries of posture’. Most people will have
one side more dominant than the other but a few simple tips can help to keep
your posture more symmetrical as it changes as pregnancy progresses.
• Think about keeping the weight equal through both ‘sit bones’ if sitting or
both feet if standing.
• Try not to ‘hang off one hip’ – particularly if standing for long periods
or carrying toddlers or other objects.
• Crossing your legs can contribute to pelvic asymmetry and circulatory
problems. Try to avoid it.
11
If working at a desk or work station, try to keep your ‘tasks’ straight
ahead of
you, rather than over to one side, causing you to twist or rotate.
•
2. LOWER ABDOMINAL MUSCLES, The lower abdominal muscles are one
of the muscle groups supporting the weight of your baby. Good tone in this
muscle is needed to keep your lower back and pelvis strong. This muscle can
be activated if you gently ‘hug’ your baby in towards your spine by slowly
pulling in from your pubic bone up to your navel. This should be a gentle
contraction, hold for approximately ten seconds as you keep breathing. Ten
repetitions regularly are recommended. Incidentally, the upper abdominal
muscles often split during pregnancy. The size of this split can vary so please
ask a nurse in your maternity hospital, public health nurse or a chartered
physiotherapist to check this for you as specific exercises and advice may be
necessary.
3. PELVIC FLOOR EXERCISES, Awareness of your pelvic floor is
important during pregnancy to maintain good muscle tone as your baby
grows, to control urine and bowel, and to allow your pelvic floor to relax
sufficiently during delivery. Basic pelvic floor exercises include pulling up
your ‘water passage’ as if you are trying to stop yourself from passing urine.
Do not clench your buttock muscles. This exercise needs to be done quickly
(about ten repetitions at a time regularly during the day) and slowly (being
able to hold for ten seconds and do ten repetitions). If you have any problems
with leakage of urine during pregnancy or after delivery, please contact your
maternity hospital or a chartered physiotherapist specialising in this area for
advice. Other specific exercises will be discussed in antenatal or exercise
classes.
Lesley-Anne Ross, B.Sc, M.Sc, BCPT, is a chartered physiotherapist at the National
Maternity Hospital, Holles Street, Dublin.
12
Eating well in pregnancy
Eating a balanced diet during pregnancy can help to protect the health of you and your
baby. It’s also a good idea to eat healthily if you’re trying for a baby because a healthy
pregnancy starts well before conception.
Folic Acid
Take at least 400 micrograms of folic acid a day while you’re trying to get pregnant, and during
the first 12 weeks of pregnancy. Folic acid reduces the risk of your baby having a neural tube
defect, such as spina bifida. A neural tube defect is when the foetus’s spinal cord (part of the
body’s nervous system) doesn’t form normally.
Folic acid tablets are widely available from pharmacies, or you can talk to your GP about getting a
prescription.
Don’t worry if you get pregnant unexpectedly and weren’t taking folic acid supplements. Start
taking them as soon as you find out, until you’re past the first 12 weeks of pregnancy.
•
•
Do take your folic acid supplement every day.
Do eat plenty of food rich in folate (the natural form of folic acid), such as green leafy
vegetables, including spinach and watercress, nuts, pulses, wholegrains and fruit juice.
Iron
In normal pregnancy the recommended iron intake is 3.5mgs rising slightly in the last trimester to
6-7mgs a day. Iron supplementation is not routinely requred for all pregnant women as it does not
benefit the mother’s or babies health and may have some unpleasant side effects (NICE, 2008). A
diet rich in iron is sufficeint unless your iron level runs low. Your health care provider will
monitor your iron levels during the pregnancy and if needed iron supplements will be
recommended.
Dried fruits such as apricots are great sources of iron, and they’re easy to snack on. Other good
sources for pregnant women include spinach, pumpkin, collards, kale and turnip greens. Beans
such as green peas, lentils and chick-peas are also good sources of iron.
Fruits and vegetables have nonheme iron, which while good, is a little harder for the body absorb.
It’s very important that you take these iron-rich foods with iron helpers (see below) so your body
absorbs the iron rather than flushing it away.
13
If you’re getting your iron from meat sources, there are some things to keep in mind. Make sure
you’re cooking red meat to well done and microwaving any deli meat to steaming to prevent
listeriosis (a bacteria that can affect the baby). Poultry needs to be cooked well and you should
watch out for any contamination of raw poultry and other foods that you eat.
If you’re a vegetarian or vegan, speak to your care provider about ways to add iron to diet.
Increase Vitamin C (Helper) Intake
It’s not enough to just increase the amount of iron you eat; you also need vitamins that will help
you absorb the iron. Vitamin C is a great “helper” in iron absorption. Try drinking a glass of
orange juice as you eat foods high in iron. If you can’t stomach that, add a side of brightly colored
vegetables such tomatoes or peppers to your plate.
Watch out for These Foods
Some foods actually decrease your absorption of iron and shouldn’t be taken with iron-rich foods.
Calcium and caffeine both decrease the absorption of iron. So foods such as teas, milks and
coffees should be avoided while eating iron-rich foods. While you shouldn’t cut milk out of your
diet (pregnant women need the calcium), a better solution is to drink the milk between meals so
your body has a chance to absorb the iron from your meals.
Vitamin D
It is important to ensure that you maintain adequate Vitamin D stores during pregnancy. Vitamin
D promotes bone growth in the baby’s first year of life and decreases the risk of developing
rickets. In order to achieve this woman may choose to take 10 mcgs supplement of Vitamin D per
day, or ensure a good supply of Vitamin D as part of a well balanced diet. Foods rich in Vitamin D
include eggs, meat, Vitamin D fortified margarine, milk and breakfast cereal
And:
•
•
Don’t take supplements that contain vitamin A, because too much vitamin A can cause
foetal abnormalities.
Don’t eat liver or products that contain it, such as paté. Liver contains a lot of vitamin A.
Alcohol
When you drink, alcohol reaches your baby through the placenta. Too much exposure to alcohol
can seriously affect your baby’s development. If you’re trying to conceive, or are already
pregnant, the government advises that you should avoid drinking alcohol.
Getting pregnant may be more difficult if you drink. It’s known that drinking heavily throughout
pregnancy can result in Foetal Alcohol Syndrome (FAS). Children with this syndrome have
restricted growth, facial abnormalities and learning and behavioural disorders. When a woman
drinks while pregnant, the alcohol passes into the baby’s bloodstream.
The safest approach is to not drink at all.
Caffeine
You don’t need to cut out caffeine completely, but don’t have more than 200mg a day as high
levels can result in babies having a low birth weight, which can increase the risk of health
14
problems in later life. Too much caffeine can also cause miscarriage. There’s caffeine in
chocolate, cola and ‘energy’ drinks, as well as tea and coffee.
The amount of caffeine in foods and drinks will vary, but each of the following contains
roughly 200mg of caffeine or less:
•
•
•
•
•
•
Two mugs of tea (75mg each).
Two mugs of instant coffee (100mg each).
One mug of filter coffee (140mg each).
Five cans of cola (around 40mg each).
Two cans of ‘energy’ drink (around 80mg each).
Four 50g bars of dark chocolate (around 50g of caffeine each). Milk chocolate contains
around half as much caffeine as dark chocolate.
Try to have less than 200mg of caffeine a day during the rest of your pregnancy.
Eat safely
Bacterial infections such as listeriosis, salmonella and toxoplasmosis can be dangerous for
pregnant women and their unborn babies. The bacteria can harm the unborn baby and interfere
with its normal development. Taking the following the steps can help you to avoid harmful
bacteria:
•
•
•
•
•
Do cook eggs thoroughly until the whites and yolks are solid. Avoid any foods that contain
raw or lightly cooked eggs, such as home-made mayonnaise, sauces and puddings.
Do make sure that all meats are cooked thoroughly. This is especially important with
poultry (such as chicken and turkey) and food made from minced meat (such as burgers
and sausages). Make sure that they’re very hot all the way through, and there’s no trace of
blood or pink meat. Treat all meat at barbecues with caution.
Do wash your hands, utensils and work surfaces after handling raw meat. It may contain
bacteria, which can cause food poisoning.
Do wash fruit, vegetables and salads to remove all traces of soil.
Do heat ready meals until they’re very hot all the way through. This is especially important
for meals that contain poultry.
And:
•
•
•
•
•
•
Don’t eat mould-ripened soft cheese, such as brie and camembert, or blue cheese, such as
Stilton or Danish blue. You can eat hard cheeses (e.g. cheddar, parmesan), cottage cheese,
mozarella, and processed cheese (such as cheese spread).
Don’t eat any kind of paté, including vegetable paté, because it can contain listeria.
Don’t eat liver or liver products, such as liver paté or liver sausage, as this is a very rich
source of vitamin A (which can harm your unborn baby).
Don’t eat more than two portions of oily fish a week (for example, mackerel, trout or fresh
tuna), or more than four cans of tuna (around 140g per can). These contain high levels of
mercury, which can harm your baby’s developing nervous system.
Don’t eat marlin, shark or swordfish. These can contain high levels of mercury, which
can damage your baby’s developing nervous system.
Don’t eat raw shellfish, as they can contain bacteria and viruses that can cause food
poisoning.
15
Balanced diet
A well-balanced diet will supply all the energy and nutrients needed by you and your growing
baby.
•
•
•
•
•
•
•
•
Do eat plenty of fruit and vegetables (fresh, frozen, tinned, dried or juice); at least five
portions a day.
Do eat plenty of foods from the starchy carbohydrate group, such as breads, cereals, rice,
pasta, noodles, maize, millet, yams and potatoes. Choose wholegrain versions whenever
you can.
Do have milk and other dairy products (e.g. yoghurt, hard cheese) to ensure that you have a
good intake of calcium. Use low-fat varieties where you can. For example, semi-skimmed
or skimmed milk, low-fat yoghurt and reduced-fat hard cheese.
Do get enough vitamin D. It keeps bones healthy and provides your baby with enough
vitamin D for the first few months of life. Take a 10-microgram supplement of vitamin D
each day. Your body makes vitamin D from exposure to sunlight, but the amount of time
you need in the sun to make enough vitamin varies from person to person. If you have dark
skin or always cover your skin, you may be at particular risk of vitamin D deficiency. Talk
to your midwife or doctor if you’re worried about this.
Do get plenty of iron because some women can develop low iron levels during pregnancy.
Iron is found in meat, green leafy vegetables (such as spinach and watercress), pulses,
bread and fortified cereals. Your midwife can advise you whether you need to take an iron
supplement.
Do eat protein foods, such as meat, fish, poultry, eggs, beans, soya, pulses and nuts (see
below for information on peanuts). Have a good variety to ensure that you get enough
protein and important nutrients, such as iron, zinc, magnesium and essential fatty acids.
Fatty acids include omega 3 fats (found in flaxseed oil, rapeseed oil, and oily fish, such as
mackerel and sardines).
Do stay active and move around.
Don’t eat for two. You don’t need extra calories until the final three months, when you
need around 200 extra calories a day (equivalent to two slices of toast with margarine or
butter). Be guided by your appetite. When you feel hungry between meals, choose a
healthy snack such as fruit, yoghurt or a bowl of cereal.
Nuts
If you want to eat peanuts or foods containing peanuts (such as peanut butter) during pregnancy,
you can do so as part of a healthy balanced diet, unless you’re allergic to them or your health
professional advises you not to.
If you have any queries, talk to your GP or midwife
References:
National Institute for Clinical Excellence. (2008) Antenatal care: routine care for healthy pregnant
woman. NICE:London
16
A Growing
Mum & A Growing Baby
17
Common Complaints of Pregnancy
The problem
• Bleeding gums
Dental problems are
common during pregnancy
because the gums soften,
allowing plaque to form
more easily.
•
Heartburn
• Leg cramps
May have something to do
with a lack of calcium,
although the growing fetus
on certain nerves and
blood vessels are
considered responsible.
Haemorrhoids and
Constipation
Haemorrhoids (piles), the
varicose veins in your
rectum, are often
aggravated by
constipation. This is
usually due to increased
hormone levels relaxing
the intestinal muscle and
slowing down bowel
movement. Pressure from
the baby’s head can also
make them appear.
•
The symptoms
Bleeding when you
brush your teeth
The solution
Brush your teeth extra
carefully and always use
dental floss.
Book a check up with
your dentist and advise
him that you are pregnant.
Remember that pregnant
women should avoid
certain dental treatments,
such as X-rays and
amalgam fillings.
. Eat little and often,
• Hormone changes
relax the valve at the upper avoiding fatty and spicy
foods
end of the stomach,
allowing acid to pass back Try sleeping in a more
into the food pipe between upright position.
Check with your
your mouth and your
midwife doctor or
stomach. Your enlarging
pharmacist – they can
uterus pushing on your
recommend the best
diaphragm doesn’t help
course of action for you
either.
A searing, burning
sensation in your chest.
Regurgitating small
amounts of very sour food
Sudden painful muscle
Stretch with your toes
contractions, usually in the flexed towards you.calves and the feet.
Massage the affected leg
Often happens at night
or foot or walk around
from stretching your legs
until the cramp subsides.
with the toes pointed
Eat more calcium-rich
downwards.
foods or see your doctor
for a special supplement.
Itching and soreness
Eat plenty of fibre and
around your anus
drink lots of liquid.
especially when you go to Don’t strain when you
the toilet.
go to the toilet – put your
Straining to pass hard
feet on a footstool.
dry stools is a sign of
Don’t stand or sit for
constipation.
long periods.
Keep your labia and
rectum clean – wipe from
front to back.
If your piles persist or
you have any rectal
bleeding – see your
midwife or doctor.
.
.
18
• Swollen joints
Some oedema (swelling) is
normal because your body
is retaining extra fluid.
Prolonged or sudden
severe swelling must
always be checked out
Slightly puffy ankles,
usually at the end of a hot
day or when you’ve been
on your feet.
Rings are tight on your
fingers, often first thing in
the morning
• Urinary problems
Your growing baby may
be pressing on your
bladder, causing you to
urinate more frequently
and possibly leak urine.
Weak pelvic floor muscles
may also be responsible
for leaking
. Going to the toilet more
often.
Leaking urine when you
cough, sneeze or exert
yourself
• Morning Sickness
Some women suffer from
morning sickness,
especially during the first
few months of pregnancy.
It can occur during the day
or night but is always
worse on an empty
stomach.
•
Nausea / vomiting
• Back pain
Back pain, especially in
the lower back, occurs
during pregnancy. The
reasons are numerous,
including ligaments
softening and stretching
and posture changing as
your baby grows.
•
Back pain
Relax with your feet up.
Rotate your ankles
gently or flex your fingers
above your head.
See your midwife or
doctor immediately if the
swelling is marked or
persistent, as it could be a
sign of pre-eclampsia and
must be treated.
Take your rings off
Always go to the toilet
when you need to –
hanging on may lead to
infection.
Do your pelvic floor
exercises. Draw up the
muscle around your anus
and vagina like a lift. Hold
for 5-10 seconds, relax and
repeat Ten times aim for
100 every day! If
concerned discuss with
you GP or midwife who
can refer you to a
continence promotion
nurse.
• Have some tea and dry
toast or a biscuit before
getting up each
morning.
• Get up slowly
• Rest on the side of the
bed for a few minutes.
• Eat small frequent
snacks.
• Avoid fatty foods that
may make the nausea
worse.
• Avoid strong smells
that are likely to make
you feel sick
• Good posture is vital.
Stand tall, shoulders
relaxed, buttocks
tucked in and weight
spread evenly on both
feet.
• Footwear should be
low-heeled.
• Sit with your lower
19
•
•
back well supported by
pillows.
Avoid lifting heavy
objects.
Do some exercises –
swimming may ease
back pain
20
Smoking & Pregnancy
WHY STOP?
• Stopping Smoking is the single most important
thing you can do to protect your own and your
baby’s health.
• When you smoke you breathe in 4000 chemicals
many of them poisonous such as arsenic and
ammonia.
• The tar and chemicals build up inside your lungs
and may eventually cause cancer.
• Nicotine, carbon monoxide and other chemicals
reduce the amount of oxygen in your blood.
If you Smoke…………
I Smoke Too………...
For help and advice to quit smoking contact National Smokers Quit line 1850 201 203
Or locally
Smoking Cessation Nurse Mary Gaffney
049 4361399 bleep 200 or leave a message on 049 4376388.
RISKS OF SMOKING WHEN PREGNANT
•
•
•
•
•
•
•
Women who smoke while pregnant are more
likely to suffer from sickness, bleeding, miscarriage and other
pregnancy complications
They are 1.5% to 2.5% more likely to have an ectopic
pregnancy than non-smokers
Smokers are twice as likely to develop problems with their
placenta which supplies oxygen and nourishes the
developing fetus. There is a 1.4 to 2.4 fold increased risk of
placental abruption if you smoke. Potential complications
can lead to illness and/or death of mother and baby.
1:10 stillbirths are linked to smoking
Pregnant women who smoke are likely to have lighter babies
on average 200gms/8ozs.
Smaller babies are more at risk of infection and other health problems
A SMALLER BABY WON’T MEAN AN EASIER DELIVERY AS THE
SIZE OF THE BABY’S HEAD IS NOT REDUCED!
RISKS AFTER DELIVERY
•
•
•
•
•
Smoking increases the risks of cot death
by up to 3 times
Studies have shown that a quarter of all
cot deaths are connected to parental smoking
Babies are twice as likely to develop asthma
and at increased risk of other lung problems
such as wheezing and chest infections
Increased risk of colic and ear infections
Risk of Meningitis is increased by three and
a half times
STOPPING AT ANY STAGE OF YOUR
PREGNANCY IS BENEFICAL.
AND STOPPING SMOKING BEFORE
PREGNANCY AVOIDS ALL RISKS –
DAD’S TOO.
21
PLANNING TO QUIT
Some other reasons for quitting are…………
• Hair and Clothes will smell better
• Teeth whiter
• House and car will not smell or smoke
• And FINANCIAL –
The extra money you would have for yourself
and your baby for example 20 cigarettes cost approx.
• 9.18 Euro a day
• 64.26 Euro each week
• 257.04 Euro each month and
• 3,350.70 Euro each year
REMEMBER
• Don’t stop trying to quit you can succeed
• No two smokers will have the same reasons for quitting or encounter exactly
the same problems
PREPARATION
Ask yourself
• What changes do I need to make?
• When or where am I most likely to think of a cigarette?
STOPPING
• set a date and stick to it
STAYING STOPPED
• keep reminding yourself of your reasons for quitting. It is a great achievement
with huge benefits for you and your baby
Addiction to nicotine has now been shown to be as addictive as heroin.
Nicotine replacement therapy, which contains low level of nicotine without the other
poisonous chemicals, reduces withdrawal symptoms and has been found to double
MOTIVATED quitters chances of success. When you are pregnant you should discuss
its use with your midwife or doctor.
22
Seat Belts & Pregnancy
‘Above and below the bump, not over it’
The shoulder belt should go over the shoulder, collar
bone and down across the chest – between the breasts.
Wear the lap belt as low as possible under the abdomen
and the unborn child.
CEMD 1997-1999
23
Pregnancy Symptoms Never to Ignore
Some symptoms during pregnancy should immediately lead you to consult your
doctor or midwife. In many cases you will contact your caregiver, have your
symptoms checked out, your baby’s heartbeat monitored and be reassured that your
baby is fine and your pregnancy is progressing in a healthy manner. You should
contact the hospital if you experience or are concerned regarding any of the
following;
Baby Movements;
• It is important to have regular movements from your baby throughout
your pregnancy
• If you notice that your baby has become quiet, sit down, relax, have a
sugary cold drink and some food and concentrate on your baby’s
movements. This will often help to get your baby moving.
• If you have reduced movements you should contact the hospital and
come in to be monitored.
Vaginal Bleeding;
• If at any time you have fresh bleeding, you must contact the
maternity unit and come in to be checked out and monitored.
Abnormal Swelling, Severe Headache with Heartburn;
• Some swelling or oedema in pregnancy is normal, particularly
towards the last few weeks and often at the end of the day
• However, abnormal swelling where your feet and hands don’t reduce
after lying down or is worse in the mornings, or your face gets more
puffy – when combined with an associated headache, sudden weight
gain, stomach pain, high blood pressure and protein in your urine,
could indicate a condition called pre-eclampsia.
• If you experience any of these symptoms, contact the hospital or
your GP.
Extremely Itchy Skin;
• While it is normal to have itchy skin during pregnancy, intense itching
on the arms, legs, hands and feet is not normal.
• If it gets worse at night and you cannot sleep or eat and feel sick, see
your doctor straight away as it could indicate a liver condition called
obstetric cholestasis, which is more common in the second and third
trimester of pregnancy.
Fighting for Breath;
• Feeling slightly short of breath is common in pregnancy, especially
during the last trimester when your baby pushes against vital organs
including your lungs.
• Extreme shortness of breath while doing very little, painful or difficult
breathing, or chest pain should always be checked out.
24
Fever/Temperature;
• It is not good for you or your baby to develop a temperature of 39
degrees Celsius (102 degrees F) or more during pregnancy, so, if you
get a fever that you think is more than a head cold, take medical
advice.
• From the second trimester of pregnancy it is safe for you to take two
paracetamol, but if this doesn’t bring your temperature down its
important to see your midwife or doctor.
Group A Streptococcus;
• Group A streptococcus (GAS) is often found in the throat and
on the skin. People may carry it in their throat or on their skin
and not be ill. Most GAS infections are fairly mild illnesses
such as a ‘strep throat’ and impetigo (skin infection). It is
unusual for GAS to cause more severe illness but it can happen.
• It is easily spread by person-to-person contact or by droplet
spread from a person with the infection.
• Most people who come in contact with GAS remain well and
symptom free, or may develop mild illness such as a sore throat
or skin infection.
• If you develop any of the symptoms below, you should contact
your GP or maternity unit for advice;
High fever greater than 39 degrees Celsius
Muscle aches, pain or swelling
Redness at the site of a cut or wound
Dizziness and confusion
A flat red rash over large areas of the body
• If you have symptoms of GAS you will be prescribed antibiotic
treatment. It is important that you complete the course of
antibiotics that is prescribed.
• To prevent GAS infection or any other infection, hand washing,
especially after coughing or sneezing and before preparing
foods or eating is the single most important factor to remember.
• All pregnant and recently delivered women need to be aware of
the importance of good basic hygiene.
25
PERINEAL MASSAGE
Your perineum will stretch a remarkable extent during the birth of your baby, but in
spite of this elasticity it is frequently torn. In extreme cases of either failure of your
perineum to stretch or sign that a bad tear will develop, your midwife may need to
perform an episiotomy.
RESEARCH HAS SHOWN THAT MASSAGING YOUR PERINEUM DAILY FOR 5 10 MINUTES IN THE LAST 6 WEEKS OF PREGNANCY WILL HELP PREVENT
TEARING OR THE NEED FOR EPISIOTOMY.
Before you begin;
o Make sure your bladder is empty
o Wash your hands
o Ensure you are propped up comfortably.
o When first starting you may find that a warm bath will help stretch the tissues.
o Select a natural oil – olive oil or almond oil, adding a little wheat germ oil if
you have scar tissue from previous tears or episiotomy as this oil will nourish
damaged tissue and encourage elasticity.
o Massage the carrier oil into your perineum and lower vaginal wall.
o Pay special attention to any scar tissue.
o Then place both your thumbs inside your vagina and press down towards your
rectum, maintaining a steady pressure move your thumbs along in a “T” type
movement, hold this stretch for 30 -60 seconds then release.
o Massage with more oil, stretch again to the maximum, hold, then release.
During your massage try to stretch you’re vaginal opening until you feel a
burning or tingling inside your muscles. This sensation is similar to what you
experience when your baby’s head begins to crown. At this point draw up your
pelvic floor muscles, the muscles you would tighten when you try to stop
urinating midstream, and feel how much more painful this sensation becomes.
o It is by consciously relaxing your pelvic floor muscles during the moment of
birth that you will help prevent further tissue damage.
o At first you may find it difficult to relax your pelvic floor muscles
consciously, but the moment you experience this tingling or burning sensation
during your perineal massage try to relax your muscles.
o Really concentrate and remember not to hold your breath, but continue to take
regular breaths in and out.
o When you first begin practicing perineal massage your tissues will feel tight,
but in time and practice they will relax and stretch.
o Perineal massage should not be painful, if you experience problems do not
hesitate to seek further advice.
26
Your Growing Family
Making space for number 2,3,4,etc…………
You have gone through the amazing experience
of having a baby. You have survived the birth,
the early weeks, the adjustment to your life and
all the problems that no one warned you about.
So now you are going to do the whole thing again.
Right?
Having a second and subsequent baby is a whole new experience. Rarely is
anything the same as the first time around so why should producing another child be
any different? The birth experience is different, the pregnancy is often different and
the child you produce may be totally different.
Bringing another child into your life is every bit as challenging as bringing the
first, in many ways even more so. You start making space in your life before their
born. Perhaps your other child/children are old enough to understand there is a new
baby coming. You can let them feel the baby moving. Most children are loving and
protective of you and their new sibling. But it can be a time of great change for your
child/children; you need to be careful they don’t feel they are being replaced. Your
children may amaze you with their generosity of spirit and at this stage there are
rarely any problems – make sure you get enough rest!
The real test starts when you get home and the exhausting job of looking after
yourself, your child and a new baby begins. This can be a difficult time for many
mothers. Rest, support and avoidance of housework are essential.
If you feel you need more help – Ask for it! Let someone do the cooking, cleaning
and shopping, giving you time to enjoy your baby and other children.
Involve your child/children in the care of the baby so they feel valued and not
excluded. My daughter ‘breast-fed’ her doll while I breast-fed the baby – it was very
sweet to watch her. But if they are not interested in helping – don’t force the issue,
they will adjust in their own time.
The rewards of having another child are wonderful. To see the special bond that
develops between your children is a wonderful experience. They support each other in
school and in their social world in a way the best mother in the world can never do.
And that’s what makes the effort worthwhile.
27