Thinking of having a baby what you need to know? Dr. Nusrat
Fazal Consultant Obstetrician GWH
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Thinking of having a baby- what do you need to know?
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Are You Ready?? Physically Psychologically/emotionally Socially
Financially
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Aims of discussion Pre pregnancy Care 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
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What is Pre-pregnancy Care Why is planning important? How to
prepare well for the journey?
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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
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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
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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
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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
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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
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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
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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
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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
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Which Food and supplements Folic acid When to start How much
(400microgram/5mg) Vitamin D Healthy Diet
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Foods to avoid Raw eggs, Meat Coffee ( 200g) Soft Cheese
Unpasteurised milk Certain fishes Food rich in vitamin A.
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Stop/ cut down smoking/ Alcohol and avoid drugs Smoking 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.
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Is your work environment safer Chemicals, fumes Radiations
Animals/gardening Meat Long flight Healthcare worker- increase
exposure to infection. Support/information links
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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.
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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
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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.
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Consider Your Social Circumstances Housing Support/family
Flexibility of work
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Consider Your Finances Cost of raising a child (from diapers to
Uni) Childcare cost Maternity/paternity leave Your right/benefits
Save for long term
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When to stop contraception Depending on type Waiting till next
cycle Birth spacing after normal delivery after C/S
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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
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Common physiological symptoms During pregnancy Frequent
Urination Nausea Vomiting Heartburn Constipation Leg cramps Back
pain Fatigue Sleep disturbances Mood Swings
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Common symptoms Swelling of the Hands and Feet - Varicose Veins
Gum Disease Anaemia Darkening of the Skin
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What to expect each trimester 1 st Trimester - see your
doctor/midwife What GWH offers Early Pregnancy Unit Screening
Dating Scan Specialist Care and Support
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What to expect each trimester 2 nd Trimester - see your
doctor/midwife What GWH offers Anomaly Scan Specialist Clinics Day
assessment Unit Specialist Care and Support
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What to expect each trimester 3 rd 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
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Birth choices Birth Centre Water Birth Delivery Suite
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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.
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With all preparations in place Enjoy a smooth journey through
pregnancy Look forward to your bundle of joy
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Thank You
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References Further reading & references Antenatal care:
routine care for the healthy pregnant woman; NICE Clinical
Guideline (March 2008) Antenatal care: routine care for the healthy
pregnant woman Bille C, Andersen AM; Preconception care. BMJ. 2009
Feb 12;338:b22. doi: 10.1136/bmj.b22. Bille C, Andersen AM
Pre-conception - advice and management; NICE CKS, June 2012
Pre-conception - advice and management Smoking Cessation Services;
NICE Public Health Guidance (Feb 2008) Smoking Cessation Services
Dietary interventions and physical activity interventions for
weight management before, during and after pregnancy; NICE Public
Health Guidance (July 2010) Dietary interventions and physical
activity interventions for weight management before, during and
after pregnancy Health and Safety Executive; source of advice
regarding specific occupational hazards Health and Safety Executive
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. No
authors listed Exercise and Pregnancy; Royal College of
Obstetricians and Gynaecologists (2006) Exercise and Pregnancy
Varicella: the green book, chapter 34 (immunisation against
infectious disease); Public Health England Varicella: the green
book, chapter 34 (immunisation against infectious disease)
Depression - antenatal and postnatal; NICE CKS, revised January
2013 Depression - antenatal and postnatal Sickle Cell &
Thalassaemia screening across the UK; National Screening Portal
Sickle Cell & Thalassaemia screening across the UK
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. Bujold
EGauthier RJ
