Antenatal

What Your Lead Maternity Carer (LMC) Is Responsible For :

Under the  New Zealand College of Midwives Standards for Practice we are duty bound to practice in a manner that does not place women at risk. It is therefore vital that we recognise our limitations in terms of working for long periods of time and often unsociable hours which may result in our not getting enough sleep or time off to recover, we need this time to enable us to practice safely.

 

Within our practice we work closely together to allow a structure of adequate time off call.  What this means for you is that you will always have access to an experienced midwife in an emergency situation.  It may not be your  LMC – it may be her backup.  Kathy and Lynda usually cover each others’ clients when one of them is unavailable.

 

Each midwife takes approximately 2 weekends off each month and her backup midwife will cover all emergencies and births. If a midwife has been working all night she will need to sleep during the following day and her back up will cover any call outs.

 

  •  * contact numbers for both myself and my backup midwife

 

  • *  regular appointments at our clinic to monitor both you and your baby’s wellbeing – this will include blood pressure, urine testing and listening to baby’s heartbeat

 

  • *  referrals for scans and specialist appointments as required – including obstetrician if and when required

 

  • * all your care during your labour and birth

 

  • *  postnatal care for you and your baby including referral to a Well Child Provider – ie Plunket or Te Korowai Trust

 

  • *  the opportunity for meeting with my backup midwife before your labour

Throughout your pregnancy, labour and birth there will be choices to be made. It is important these choices are based on correct information. For that to happen I will endeavour to give you the knowledge you will need to make these choices. This is known as informed consent.

Individual Care: If there is anything you need me to know about any special needs you may have please let me know. These needs may include cultural, religious, medical or family/relationship issues.

This is a guide and will change if your individual needs warrant it.

Tests

You will need to have a blood test at the beginning of your pregnancy which can either be ordered by your GP or your LMC. This will provide information on your blood type, iron levels, glucose levels, rubella immunity, hepatitis B, syphilis, red cell antibodies, HIV and hepatitis C.

Bloods are repeated at 28 weeks and, in some cases, at 36 weeks. At your 28 week bloods we recommend a test which checks for gestational diabetes.

Testing is available between 9 and 13 weeks to screen for an increased risk of congenital abnormalities including Down Syndrome, cardiac defects and genetic syndromes. This involves a scan and blood test at around 12 weeks. The tests are then combined to give a more accurate result.

It is important to know that these are screening tests (assesses whether your baby is at high or low risk of having a particular condition) rather than a diagnostic test which identifies babies who actually have a particular condition. Screening tests can have a high ‘false positive’ or ‘false negative’ result which means a test may indicate your baby has a condition when it doesn’t or conversely says your baby doesn’t have a condition when it does.

If you are interested in having any of these tests please discuss the implications with me before making a final decision. Inaccurate information provided by a scan can lead to unnecessary increased anxiety for parents.

A scan at 19 – 20 weeks will tell us whether your baby is growing according to what we think is within a ‘normal’ range for that age. It provides information about growth, position of the placenta and, if parents want to know, the sex of baby (providing baby is co-operating and does not have his/her legs crossed!)

Medical

If you have any problems unrelated to your pregnancy you need to see your GP. Anything pregnancy related you should call me first because your GP will charge you. A good rule of thumb is to think whether the problem could be happening even if you weren’t pregnant. If the answer is yes it’s probably your GP you need to see. I can prescribe medications for pregnancy related problems.

Antenatal Classes

I strongly encourage you to do these if this is your first baby, I will discuss your birth options with you as we go along. There are some very good books in the library and the internet can be invaluable but be aware there are also some shockers out there so choose wisely.

Care Plan

This tends to be a dynamic procedure which we add to each week. You may have some preferences already or may be entirely flexible and take a ‘wait and see’ approach. The main thing is that this is your experience and my job is to support that within safe parameters for you and your baby, not to impose my beliefs and preferences on you.

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And finally

WARNING SIGNS in pregnancy :

  • * Vaginal bleeding
  • Waters leaking from the vagina
  •  *Severe abdominal cramps, pain or contractions
  • Severe headache or visual disturbances
  • Baby moves less than 10 times during a day
  • * Burning or stinging when passing urine
  •  * Severe vomiting

You should phone your midwife immediately if any of the above occur.

 

Some Extra “Bits and Pieces”

 

Certificate for Work : available from me if required, just ask at our next antenatal appointment.

Constipation : increase fluids, check diet – need good fibre intake (not too much chocolate!). A daily walk will work wonders with the previous advice. Iron tablets can exacerbate constipation so discuss this with me.

Coughs/Colds : viral – not much we can do for this. Increase fluids, stay warm, rest, panadol if needed. If ill go to GP.

Dizzy spells : some women are more prone to dizziness and fainting in pregnancy, particularly if their blood pressure is low. Eat frequent meals, stay well hydrated, avoid standing still for prolonged periods of time and when you get up from sitting or lying do so slowly. Try and avoid hot, crowded and cramped spaces.

Ear-ache : see pharmacist, take panadol if needed, if worsening see GP.

Groin pain : may be felt as a dragging type pain low down. Most likely caused by ligaments stretching and straining. Also felt in a line from the hip bone toward the pubis or around the sides of the uterus. If this pain becomes severe let me know as the physio (available free through the hospital) may give you a support belt which takes a lot of the weight of the pregnancy giving you some relief.

Pins and needles in hands/wrists : known as carpal tunnel syndrome and very common in pregnancy . Tell me about it at our next visit.

‘Pulse’ or ticking in uterus: likely to be that baby has hiccups – normal, it will settle eventually.

Stuffy nose : not a cold but just a stuffed up feeling in nose and/or sinuses. Mucous membranes can become quite ‘leaky’ as they thicken and soften. This forms extra secretions in the nose. (Worthwhile noting that those mucous membranes go clear through to the vagina so some women experience a lot of extra secretions/discharge vaginally also!) May also experience nose bleeds and/or bleeding gums when brushing teeth.

Haemorrhoids (piles) : don’t fiddle with them! Make sure your diet contains fruit and vegetables and plenty of water. Can use natural remedies – see Bodywise or Health 2000 or prescription for medication available from me.

Headache : increase fluids, rest, use regular panadol as directed on box. If no improvement call me.

Heartburn : avoid greasy/spicy foods and large meals. Try not to eat too close to bedtime. Milk may help or Gaviscon liquid available from the supermarket.

Leg cramps : most frequent at night when you are asleep! Do not point your toe but extend your heel out to stretch the calf. Increase your water intake, adding an electrolyte replacement drink such as powerade or similar may help. Sometimes a magnesium supplement can be of use if neither of the above help.

Nausea : small, frequent meals may help. Try and keep your blood sugar on an even level rather than 3 large meals a day. Graze throughout the day. Ginger may help, increase water if you can keep it down.  For constant vomiting please contact me  as dehydration may mean needing intravenous fluids at hospital.

Swollen hands and/or feet : again very common in later pregnancy as by 35/36 weeks the body has approximately 40% more blood volume circulating. Gravity and hot weather will cause pooling in the extremeties. If your face is swollen then tell me.

Thrush : very common in pregnancy. Applying live, natural yoghurt may clear it up. Avoid bubble baths, synthetic or tight underwear. Antifungal cream can be obtained over the counter from the pharmacy or I can prescribe the same for you.