Pregnancy

Most women will know they are pregnant before the physical signs appear. Once you miss a period the tests will show whether this is “the month” or not.

Of course everyone talks about ‘morning sickness’ which may be anything from mild nausea to full blown vomiting, and not just in the morning!

Here are some of the other signs that you may or may not notice:

• Breast tenderness
  Some mums to be notice that their breasts feel a little sore or tender and may seem a little larger. Depending on your complexion you may even notice that your veins become more prominent and that your nipples seem more sensitive during cold weather. Making sure that you wear a comfortable bra can help you to cope with this.
• More visits to the bathroom
  In early pregnancy the hormonal changes that occur mean that you will find that you need to urinate more frequently. Even though you may feel like you never leave the bathroom it’s still very important to stay hydrated and drink lots of water. The good news is that this does settle down.
• Vomiting and nausea
  Most nausea and vomiting, also known as morning sickness, is resolved for mums to be by the end of the first trimester. Some women will notice that they may still have these symptoms up to 20 weeks gestation and some women will have nausea and vomiting throughout pregnancy. This is not the norm and if this happens to you, there will be help from your midwife or GP.
  Eating a good mixed diet with sufficient protein can help with this symptom.
• Tiredness
  Even though you cannot see a bump yet your body is already working hard to grow your baby in this early stage. There are some major internal and hormonal changes going on so at times you may notice that you feel quite tired. Try going to bed a little earlier in the evening or finding somewhere at work where you can have a power nap during your lunch break. Some mothers find the tiredness difficult to deal with as this the time of the pregnancy where most people do not know that you are expecting. Again, looking at your diet can help as too much carbohydrate and not enough protein will make the tiredness worse.
• Missed Period
  Although your periods cease during pregnancy, some women will notice something called an implantation bleed. This light spotting can occur around when you may have normally seen your period. This sometimes happens after the fertilised egg has travelled down from the fallopian tubes and then nestled into the wall of your womb, which is where your baby will continue to grow throughout your pregnancy. If you bleed heavily at any point, contact your health professional or GP.
• Constipation
  The pregnancy hormones slow down the regularity of your bowels and you may notice that you open your bowels less or that you have difficulty opening your bowels. In most cases you will find if that a fibre rich and balanced diet will help you to manage the constipation without any medication. Some mothers find that eating a few prunes or half a glass of prune juice daily can also help. Linseed on your cereal or yogurt is helpful too. Make sure that you drink at least two litres of water daily which can also help. If you find that your diet alone has not solved the problem, then speak to your midwife or GP who can also give you some advice.

Initially you will find that your baby’s due date will be calculated against the first day of your last menstrual period.  However, when you have your first scan your baby’s due date may change.  Full term pregnancy gestation is considered to last between 37-42 weeks gestation.

During pregnancy your body is naturally very efficient at growing your baby but there are some foods or substances that can be harmful to this process.  It is important to take care and you can do that by:

• Making sure that any meat or eggs that you eat have been cooked well and cooked through. This is to avoid food poisoning and the risk of toxoplasmosis which is an infection caused by a bug in undercooked food.
• Avoiding liver, pate’s and food supplements that contain vitamin A as too much vitamin A can be harmful for baby.
• Avoiding unpasteurised soft cheeses and blue veined cheeses as they can cause an infection called listeriosis which can cause miscarriage or stillbirth
• Avoiding Swordfish, Marlin and Shark.
• Having no more than two tuna steaks or four cans of tuna each week because of the mercury content.
• Only eating fish that is fully cooked.
• Washing all fruits and vegetables even when the packet says washed
• Lowering your caffeine intake, stick to decaf; large amounts of caffeine may lead to baby having a low birth weight.
• Avoiding alcohol helps your baby to grow and develop well during your pregnancy
• Making sure that any milk products such as yoghurt and ice-cream have been pasteurised.
• Not smoking. This helps not only your own health, but your baby’s health. There is a lot of support for mothers who choose not to smoke or reduce their smoking habit during pregnancy. If anyone smokes in your home, ask that they smoke outside as second-hand or passive smoking can also be harmful.

Maintaining a healthy and balanced diet is still the best way to give your body and your baby everything you need for a healthy pregnancy but finding a good pregnancy supplement, containing all of the helpful vitamins and supplements, can offer good nutritional support.

Folic acid is one of the key supplements to take during pregnancy and is known to prevent spinal defects. Ideally it should be taken whilst yuo are trying to get pregnant and for at least the first twelve weeks. Vitamin D is now also recommended for pregnant women and whilst breast feeding.

Remember that when it comes to supplements, more is not better so only take the dosage recommended.

Eating nutritious food during pregnancy not only helps you to feel great during pregnancy, it also helps you to provide your unborn baby with optimum nutrition which enables you to give your baby the best start in life.  You may be surprised to learn that a variety of small changes can make all the difference.  So, here are our top tips:

1. Vitamins

   The best way to gain micro nutrients and minerals is through food. However, for many women this can be a challenge. Find yourself a good supplement that is recommended for women that are pregnant so that you can ensure that you and your baby do not miss out on all the essential nutrients. Plenty of vitamin B and C have been found to be especially helpful during pregnancy and these vitamins can be found in whole grains, meats and nuts and fresh vegetables and fruit. Remember that a healthy eating plan helps your body to absorb more of the nutrients from the vitamins and supplements that you take.

2. Plenty of protein

   Protein during pregnancy is particularly important because the amino acids found in protein is the necessary foundation needed to help our cells grow. You and your baby will benefit from this because the extra protein will help to nourish your growing body as well as your baby’s. You can find your extra portion of protein in meat, fish, dairy, beans, pulses and eggs. Try to aim for at least five helpings if you are a meat eater, seven if you are vegetarian and nine if you are vegan.

3. Complex carbohydrates

   Where possible try to eat foods that are close to their natural form. Whole foods are much less processed so your body and your growing baby will be more able to obtain all the necessary nutrients. Beans, pulses and high fibre whole grain foods (wholemeal bread, brown rice and pasta etc.) are also full of fibre – try to eat complex carbohydrates with a protein rather than on their own and only one portion of wholemeal bread each day (two slices). Reduce the amount of simple carbohydrates e.g. white bread, rice, pasta, cakes, crisps and fizzy drinks.

4. Drink plenty of water

   Whether you are pregnant or not, to stay healthy your body needs water to function at its best. Hydration is essential for all of your vital organs and staying hydrated helps many mothers to cope with many discomforts during pregnancy such as; headaches, nausea and swelling. Aim for at least 10-12 tall glasses a day, if you do any exercise include another glass and if it’s a warmer time of year you may feel that you need an additional glass.

5. Exercise regularly

   Many mothers find that physical exercise during pregnancy helps them to feel calmer, improves their mood, as well increase their strength and flexibility. It is important to listen to your body and not to overdo it. The exercise does not have to be strenuous and as long as you do not have certain risk factors which you would be aware of during pregnancy, most gentle exercise is safe. Try to exercise for at least 30 minutes, five times a week. Many mothers find walking, yoga, pilates, swimming and gentle aerobics helpful during pregnancy.

6. Have fun!

   Have fun experimenting with new foods and flavours try using herbs and spices to be bold with new flavours, salt to taste with a good sea or mineral salt. Remind yourself of the great job you are doing to grow a healthy baby!

During pregnancy you will be offered a wide range of tests to help you have a healthier pregnancy for you and your baby. Your blood type and Rhesus status will be checked. Your blood will be screened (tested) for sickle cell and thalassemia, syphilis, hepatitis B, HIV and your midwife will also check whether you have a immunity against rubella. At your first scan around 11 weeks, you will be offered a Nuchal Translucency test to determine your personal risk of having a baby with chromosomal abnormalities, e.g Down’s Syndrome. Your blood will also be tested and the result will be combined with the scan result to get a more accurate result. You can also now access screening through non-invasive prenatal testing (NIPT) from 10 weeks known as the Harmony Test which is claimed to be 99% accurate. This test is currently only available privately. All tests during pregnancy are optional, however the evidence shows that having these tests may help you to have a healthy pregnancy.

Once you know you are pregnant you will be faced with a series of choices about your care:

• You may have a choice of hospitals, depending where you live. You can access information about different units here: http://www.which.co.uk/birth-choice
• Does the hospital have a midwife-led unit or birth centre in the same building as the obstetric unit (OU)? There is now very good evidence ( NICE guidelines 2014) that for women with a low risk pregnancy,it is just as safe for the baby to them to give birth in a midwife led unit or at home and leads to better outcomes and fewer interventions for the mother.
• Is there a freestanding midwife-led unit near you?
• Have you thought about a home birth?
• Who do you want to care for you? You can choose a private midwife or obstetrician to look after you alongside the maternity care provided by the NHS
• Are you looking for continuity? Many women are disappointed by the lack of continuity offered within the standard NHS maternity care model. If you choose Neighbourhood Midwives, we offer a dedicated midwife available to you 24/7 who can provide your care in your own home at a time convenient for you. This does not preclude you from continuing your NHS care or from having your baby in hospital if you choose to.

The “booking-in” appointment with a midwife normally happens before you are 12 weeks pregnant. It used to refer to the process of booking your bed for the birth but now usually means you are being booked into the hospital system.
At this first appointment the midwife will review the health of you and your partner. She will discuss any previous births with you to ensure that you get the best care for this pregnancy. At this appointment the midwife will check your blood pressure, check a sample of your urine and discuss with you how you are feeling.

Your midwife should also discuss with you how you can help yourself to make the right lifestyle choices to have a healthy pregnancy. Your height and weight may be checked and your BMI calculated from this. A healthy weight gain during pregnancy for most women ranges between 20-30lbs. Regular daily exercise is also recommended. Exercise helps you to remain fit and to adjust to the growing weight of your baby.

During your pregnancy you will see a midwife regularly at your antenatal appointments. These appointments provide an opportunity for your midwife to review the health of you and your baby.  At each appointment your midwife will:

• Enquire how you are feeling
• Check your Blood pressure
• Test your urine
• Have a feel of your tummy to check baby’s growth
• Listen to the baby’s heartbeat
• Answer any questions you have

Your partner is always welcome to attend your antenatal appointments with you.

If you book with Neighbourhood Midwives, these visits will all be carried out at home and will be very relaxed, lasting around an hour and providing an opportunity to discuss any anxieties or concerns you may have.

Antenatal classes are a great way to help you and your partner prepare for this new adventure of birth and parenthood. There is a wide range of choices for you to choose from now, for example, in London there is the NCT (National Child Birth Trust), the Daisy foundation, Lulubaby, the Bump Class, the Blooming Bunch, as well as yoga for pregnancy and hypnobirthing.  Even though meeting your baby is many months away, many classes get booked up quite early. Hypnobirthing classes or Natal Hypnotherapy classes suggest that you attend during your second trimester so that you can start to practice your preparations for birth.

Pregnancy situations that require extra care

In most cases being pregnant is a normal part of a woman’s life and for many women maintaining a healthy lifestyle during their pregnancy is a very straightforward process. However on some occasions there can be health challenges that require extra care from midwives and doctors (usually obstetricians):

• Severe vomiting (Hyperemesis Gravidarum)
• Raised blood pressure and Pre-eclampsia
• Gestational diabetes
• Low-lying placenta

Nausea and vomiting for most women is a part of early pregnancy. However very severe vomiting and nausea in pregnancy is known as hyperemesis gravidarum (HG) and the woman will need extra care to help her cope with it.

Suffering with HG can mean that a pregnant woman vomits frequently and cannot even keep fluids down. This can lead to dehydration, weight loss and low blood pressure (as well as feeling very unwell). In such cases, the woman may need medical intervention and/or hospitalisation.
Some mothers can feel quite exhausted and may find it impossible to get on with their normal activities and could find themselves totally unable to work when the sickness is at its worse.

It’s important to speak to you midwife or your GP if you feel this affects you as the sooner you get help, the easier it is to treat. Some women will be prescribed anti-sickness medication and in severe cases, women can find that having an intravenous drip to replace lost fluids can help them feel much better.

Your midwife will check your blood pressure and test your urine for protein at every visit so that she can pick up early signs of raised blood pressure or pre eclampsia (raised blood pressure and protein in the urine) if they occur.

Pre-eclampsia is a condition that can occur during pregnancy and/or the early postnatal period. The exact cause is still not completely understood but there are a few theories as to why it affects the mother and sometimes the growth of the baby. It is thought there are problems with the placenta and its blood vessels that can affect the oxygen and nutrient supply to the baby. Pre-eclampsia affects up to 5% of pregnancies, and severe cases develop in about 1-2% of pregnancies. There are a number of things that can increase your chances of developing pre-eclampsia, such as:

• If it is your first pregnancy
• If you developed the condition during a previous pregnancy
• If you have a family history of the condition
• If you are over 40 years old
• If you are expecting multiple babies (twins or triplets)

It not only causes high blood pressure but it can also have effects on other parts of your body, such as kidneys, liver, clotting system and brain. Pre-eclampsia causes the kidneys to leak protein into the urine, which is why the midwife tests your urine for this. Other symptoms include:

• swelling of the feet, ankles, face and hands caused by fluid retention (oedema)
• severe headache
• vision problems
• pain just below the ribs

It affects 1 in 200 pregnancies and very rarely can cause the woman to be very ill and have a fit (eclampsia). This is why it is important that it is detected before it becomes serious. Pre-eclampsia is most likely to occur after 20 weeks of pregnancy or shortly after birth Once you have had your baby your blood pressure will also be checked to make sure that it’s normal.

Many women do not have any symptoms and that is why the midwife will check your blood pressure at each antenatal appointment but if you develop any of the following you should contact your midwife, GP or the labour ward urgently:

• A severe headache that does not go away with paracetamol.
• More (or sudden) swelling than usual in the face, feet and hands. It might be your partner who notices the facial swelling.
• Problems with your vision, flashing lights, blurred vision or spots.
• A pain under your ribs or in your upper abdomen.
• Vomiting in later pregnancy with no particular cause.

During pregnancy if there are signs of pre-eclampsia then your midwife will recommend that you have further testing and you will be referred to a hospital. This may involve checking your urine output over a longer period, having your blood screened, electronic fetal monitoring and having an ultrasound scan to ensure that baby is growing and developing well. You are likely to see an obstetrician.
In pregnancy, pre-eclampsia can be “cured” by delivering the baby. However, it will depend at what stage you are in your pregnancy and how severe the pre-eclampsia is. The health professionals caring for you will either monitor the pregnancy closely and may give you medication to help manage your blood pressure or they will recommend that you give birth earlier by induction or caesarean birth.
In most cases, pre-eclampsia is mild and with the right treatment both mother and baby are well.

Normally, the amount of glucose in the blood is controlled by a hormone called insulin.
However, during pregnancy, some women develop higher than normal levels of glucose in their blood, which insulin can't control. This may be due to diet and is called gestational diabetes (GD). GD usually develops in the third trimester (after 28 weeks) and usually disappears after the baby is born. However, women who develop GD are more likely to develop Type 2 diabetes later in life. Whether this is due to poor diet control or other factors is unclear.

GD is diagnosed in 1 in 20 to 1 in 50 of women. Having a healthy balanced diet during pregnancy full of good quality proteins and low in sugary processed foods can help your body with managing all the extra work of growing your baby. Exercise and activity can also help.

GD only occurs during pregnancy and normally develops during the third trimester of pregnancy (the last part of your pregnancy). However you may be screened for gestational diabetes at your first antenatal appointment with your midwife or GP, which takes place around weeks 8-12 of your pregnancy.
During this appointment, your GP or midwife will find out if you are at increased risk of GD. They will ask about your own history and your family history. If any of the risk factors apply to you, you'll be offered a blood test to check your glucose levels. This may also include a glucose tolerance test (GTT).

• Feeling thirsty with a dry mouth
• Needing to urinate a lot (which can be hard to notice during pregnancy)
• Suffering with regular thrush or infections
• A change in your vision or feeling your vision is more blurred

Once a woman has been diagnosed with GD, it means that she will have to monitor her blood sugar levels and her diet. Women with GD will get support from the clinic to teach them how to do this. They will also be advised about healthy eating and eating a low glycaemic index diet. If it is difficult to control the blood sugar with just diet alone medication will be considered.
Although GD only occurs during pregnancy and in most cases disappears once you have had your baby, some women find that postnatally their diabetes does not go away and becomes Type 2 diabetes (women who have had GD are more likely to develop diabetes in later life even if it goes away after the birth of their baby). On most occasions, women find that by six weeks after they have had their baby, their GD has gone and they feel well.

Unstable blood sugars can make you feel unwell and may cause your baby to weigh more and be larger than expected. This may result in the birth being premature and/or less likely to be straightforward and more likely to need intervention (e.g. a caesarean or early induction). It is important for you to discuss the options open to you and feel comfortable about your plan of care.
It may also take your baby a while to stabilise his/her own blood sugars after the birth making it important that the baby is closely observed and feeds well. Good care, exercise and a healthy diet throughout pregnancy can minimise the impact on both of you. At Neighbourhood Midwives, we take extreme care to help women to avoid these problems, through awareness of the importance of diet and lifestyle.

When you become pregnant, the placenta that nourishes your baby nestles into the wall of your womb. In a very few cases, the placenta will lie close to the neck of the womb (cervix) or in some cases, the placenta can cover the opening of the cervix. This is known as a low-lying placenta or, in medical terms, placenta praevia. A low lying placenta may be detected in early pregnancy but by the end of pregnancy will usually be in a better position as the lower segment of the placenta grows in later pregnancy.

About 1 in 200 women have some degree of low-lying placenta.

Normally at the 20 week ultrasound scan, the sonographer would let you know if it appeared that your placenta was low-lying. In most cases as the womb grows during pregnancy it will cause the placenta to move up and away from the cervix which is the opening of your womb and your baby’s exit route. The sonographer will advise you to come back for another ultrasound scan which is normally around 34 weeks gestation to make sure that the placenta is out of the way in time for your baby’s birth.

As the baby grows and your womb stretches, there may be some bleeding from behind the placenta. Always contact your midwife if you experience any vaginal bleeding at any stage of your pregnancy. If the placenta does not move out of the way of the neck of the womb by the time the baby is due to be born, then the safest birth for you and your baby would be by caesarean.

The second trimester is defined as week 13 to week 27 and is sometimes referred to as the “blooming phase”. Typically nausea reduces, your energy picks up, your emotions feel less volatile and if you are lucky your sex drive returns - good news all round! Women also often report glowing skin and shiny hair. You will also feel the baby’s movements for the first time and will definitely start to look pregnant rather than bloated.

This is the time to consider whether you want to know the sex of your baby at the next scan, where you might want to have your baby and who you want with you, what classes you might want to go to and when you will organise your maternity leave. Yes you are really pregnant now! At Neighbourhood Midwives your midwife will take some time to talk about these issues and of course she will be with you and your birth partner at the birth.

You can choose to have your baby in the comfort of your own home, a standalone birthing centre, a midwifery led unit or in hospital on a labour ward. No matter where you have your baby, the main health professional that will look after you during your labour is the midwife. Although you have a choice about where to have your baby this choice might be affected by your general health, the health of your baby, any complications in this pregnancy or any previous pregnancy. It might be helpful to discuss your thoughts with your midwife so that she can talk over the options which are specific to you so that you can make an informed decision. Your Neighbourhood Midwife will be happy to take the time to help you to explore these issues and wherever you give birth she will be by your side.

During your second trimester, your appointments with the midwife will increase. You will be offered a second ultrasound scan which normally happens between 18-21 weeks of pregnancy. This ultrasound scan is called an anomaly scan. At this scan, the sonographer will be looking at your baby in some detail to ensure that s/he is developing normally and that the placenta is functioning well. It’s at this scan you can also find out the sex of your baby unless you want to keep it as a surprise. So be prepared.

It is currently recommended that you have both the whooping cough and flu vaccine during pregnancy. Babies can get vaccinated against these two illnesses but not until they are around eight weeks old. For the first eight weeks of their life, babies may be at risk of coming into contact with whooping cough or flu which is why pregnant women are now being offered the vaccines. If you choose to have these vaccines, you would ideally have the whooping cough vaccine between 28-32 weeks of pregnancy (third trimester) and you can have the flu vaccine at any stage during your second and third trimesters. You can normally get these vaccines at your GP.

During pregnancy as your bump grows it’s normal to find it difficult to sleep especially if you loved sleeping on your back. It is recommended that you sleep on your side during pregnancy as sleeping on your back can put pressure on your blood vessels from the weight of your uterus and cause circulation problems. Generally, sleeping on your left may be more comfortable as internally in your body all of your vital organs have more room if you sleep on your left. However do not worry if you find you have moved onto your back or are more comfortable on your right. Some mothers find it useful to prop a pillow or two behind their back to help them “feel” as if they are sleeping on their back. Try propping a pillow between your legs too as that often helps you to feel more comfortable.

During the second trimester, the body is growing a lot of new tissue - the uterus, placenta, baby, blood volume etc. This requires protein as building blocks and it is suggested that 75 g of protein a day, broken down into five smaller portions, is ideal. In addition, you should be eating a variety of fresh vegetables, fruit and complex carbohydrates. Try to avoid fruit juices, sugars and simple carbohydrates as these convert straight into sugars and are not helpful in pregnancy. Always ensure your food is fresh and properly cooked.

Gentle exercise is very positive for both you and your baby in pregnancy. Being active during pregnancy helps your body to deal with all the changes in your body whilst you grow your baby. If you are normally quite active, it is ideal to keep up your usual activity for as long as you feel comfortable - the key is to listen to your body. Of course, contact sports would not be recommended and unless you were very active prior to pregnancy, it’s important not to suddenly take up vigorous exercise. Many mothers find attending pregnancy yoga or pilates helps to improve their core strength, which in turn reduces their back pain. Daily walks or swimming regularly can also help you to prepare for childbirth. Exercise helps to improve your mood and can help you to regulate your blood sugars, which is especially important for diabetic mothers and mothers with gestational diabetes. Being active may also help your baby to move in the ideal position for the birth.

Pregnancy supplements are useful throughout pregnancy and the postnatal period. However, you get the best nutrients from having a healthy and balanced diet. Supplements should mainly be used to enhance your diet, not replace vital nutrients.

Hypnobirthing is a childbirth technique that seeks to empower women to approach birth without fear using self hypnosis, breathing and relaxation techniques. Using hypnobirthing techniques helps mothers to allow their minds and their bodies to connect with each other to work in harmony. The techniques used help to reduce fear and anxiety which have a negative effect on labour and birth. Mother’s using hypnobirthing techniques are more likely to:

• Experience a natural and calm birth
• Have shorter labours
• Feel more in control
• Have less or no medication for pain relief
• Feel more energised
• Have a normal birth
• Partner’s feel actively involved
• Women are less likely to be disappointed if they deviate from their birth plan

Unlike regular antenatal classes which can be typically attended late in pregnancy. It’s recommended that Hypnobirthing classes are attended from around 25 weeks of pregnancy. This is to allow time to practice the techniques. Your Neighbourhood Midwife will help you to choose the best approach for you and support you in your preparation.

During your second trimester your baby will go through many changes. Your baby will be able to respond to your voice and your touch. The flutters that you felt during the first trimester become more like little kicks and wiggles. The baby’s fingerprints and footprints form. Your baby more than doubles in length, growing from around 15cm to around 35cm long! Your baby can now open and close their eyes and will have more defined sleeping and waking phases.

From the moment that you choose where to have your baby and you book in with your midwife you have started to put in place plans for your birth. The aim of actively researching and writing a birth plan is that it encourages you to really think about what is important to you. You may not realise it but you probably already have an instinctive and individual philosophy about birth. It may be that you feel that it should be as natural as possible with minimal intervention at home or that you already know you would like to have an epidural and are happy to have your baby in a labour ward or, you may be somewhere in between. Whatever your initial birth preferences it is important to remain open minded and continue to explore different options. It is useful to think about your birthing plan in the second trimester as there may be antenatal classes that you want to arrange and have time to attend. Revisit your birthing preferences again in your third trimester to see if there are any changes that you want to add. The main items to think about initially are:

• Where you are planning to have your baby?
• Who will be there to support you during birth?
• How active do you want to be during labour?
• Do you have any pain relief preferences?
• How do you feel about any complications or interventions?

Remember that having the time to build a relationship with your Neighbourhood Midwife will allow you to explore and revisit these – and lots of other - issues throughout your pregnancy within a safe and trusting environment but you do not need to make any final decisions until much later.

It’s the home stretch, the last 12 weeks of pregnancy. During the last trimester (28-40wks) your baby will be getting bigger, laying down fatty stores and getting ready to be born. Their eyelids open, their fingernails begin to grow and you may notice that your bumps seems to jump every now and then as your baby may get hiccoughs. After 37 weeks of pregnancy, you may feel heavy down below as your baby’s head moves further down into your pelvis.

The aim of massaging the perineum before labour is to lessen the likelihood of having a tear or needing an episiotomy during childbirth. The perineum is the area between your vagina and your rectum. Many mothers report that perineal massage helped them to get to know that part of their body which is useful for birthing and research suggests that you may be less likely to tear after practising regular perineal massage during pregnancy.
It is useful to start around 34-35 weeks of pregnancy and practice 3-5 times a week. Some women feel able to do it themselves whilst others will enlist the help of their partner. It is important to have clean warm hands so doing the massage after a bath or shower would be a good time to practice. It is essential to use a natural oil as a lubricant and to relax as much as possible. If you are doing the massage yourself you might find it useful to put one leg up on the side of the bath or lie down otherwise the bump may get in the way. http://www.wikihow.com/Do-Perineal-Massage
The Epi-no is a great alternative to doing perineal massage. It is a small inflatable latex ‘balloon’ which can be inserted inside the vagina and gradually increased in size over the last few weeks of pregnancy to help with stretching and preparing the area. It is especially useful for women having their first baby or hoping for a vaginal birth after a caesarean (VBAC). It can also be used post birth to help strengthen pelvic floor muscles. http://www.epi-no.co.uk

Pelvic floor muscles act like a hammock supporting your internal organs and during pregnancy, your womb grows from being the size of your fist to, well, you can see how large bumps can get! If you have a weak pelvic floor, you may suffer with stress incontinence and take longer to recover after birth. Practising pelvic floor exercises helps to strengthen the muscles which have to work hard during pregnancy to carry your growing baby. There are lots of ways to practice your pelvic floor exercises. Here is one suggestion: try sitting or lying on your left side and ensure that you feel well supported. Imagine that you need to stop yourself from opening your bowels and passing urine, allow yourself to draw up those muscles feeling them go tight, hold for ten seconds and then release. Once you get used to this you can practise these exercises anywhere and will get better at holding the tension for a little longer.

At around 28 weeks of pregnancy, you will be offered another blood test. This will be a full blood count and will test your haemoglobin levels. Haemoglobin carries oxygen round the body and a basic level is important for our general health and energy. It is normal for your HB or iron levels in pregnancy to drop slightly in pregnancy, which is why they are rechecked. Some mothers-to-be find that they can feel a little tired when this happens. In most cases an iron rich diet and reducing cups of tea and coffee can help to improve iron levels. Some mothers will find that their iron levels increase once they use an iron supplement such as Spatone which is a very gentle form of liquid iron, ideal for use in pregnancy.

It is currently recommended that you have both the whooping cough and flu vaccine during pregnancy. The flu vaccine is mainly to protect you as pregnant women may be more at risk of complications from flu. The whooping cough vaccine is meant to protect your baby. Babies do get vaccinated against whooping cough but not until they are around eight weeks old. For the first eight weeks of their life babies are vulnerable which is why pregnant women are now offered the vaccine which will pass across the placenta to help to protect to protect the baby during their first weeks after birth. You would ideally have the whooping cough vaccine between 28-32 weeks of pregnancy and you can have the flu vaccine throughout pregnancy. You can normally get these vaccines if you choose to have them at your GP. Always read all the information provided and ask questions if you feel unsure.

During pregnancy your body releases a hormone called relaxin which helps to relax your muscles allowing your pelvis to be more flexible for labour and birth. During pregnancy many women get some ligament or back pain while their body changes and their womb grows to accommodate their baby. Pelvic girdle pain is characterised by an ache at the front of your pelvis in the middle and also shooting pains down the leg when you stand or move your legs There are lots of things that you can do to help yourself:
Use a pregnancy belt or support knickers.
Avoid opening your legs too widely.
Avoid heavy lifting, even your toddler!
Get out of the car as if you are a 1950’s model, knees together!
Speak to your midwife and ask for a referral to see a physiotherapist
See an osteopath with experience of dealing with pregnancy clients
Practice your pelvic floor exercises
Try sitting on a birthing ball
Try homeopathic arnica.
Listen to your body and don’t overdo it

Towards the end of pregnancy, your baby starts to fill the uterus and there is less room for him/her. During this trimester, you may feel more sweeping and slow movements. Although your baby’s pattern may change, they will continue to move regularly. Try to spend some time every day with your bump and talk to your baby. Find a time during the day when you are not going to be busy and can feel more relaxed, play some soothing music and place your hands on your bump and let your baby know that you are looking forward to meeting them.

The last trimester can be a busy time and you may find that you feel that you have physically slowed down. You may have noticed that you feel a little emotional or you may feel joyful or anxious, or all of these, as your due date draws near. If you are working, you may feel pressurised by all the deadlines before you go on maternity leave. Do try to finish work by 36 weeks at the latest. You need a buffer zone between finishing work and having your baby and you will really benefit by allowing yourself this time. At Neighbourhood Midwives, we work with women to establish the ideal time for each woman to stop working and help her to plan this very special time.
Some couples may be in the middle of moving to a new home or renovating. All of these activities can lead to stress and anxiety. During this trimester, think about what you can do to alleviate any extra stresses that you have. Book yourself a massage, go out with your partner for dates (they may have to be day/lunch dates as you may be tired), arrange to meet up with your new antenatal class friends and research what is available in your area for new mums. Your life is going to change soon and the research show that mothers who have a less stressful pregnancy are more likely to enjoy their postnatal period.

Nesting is your instinct to prepare for birth. It usually occurs in the weeks before birth. Mothers-to-be can typically wake up feeling energised and wanting to ensure that all the last minutes bits and bobs have been prepared before baby arrives. You may find yourself packing your birth bag, cleaning, tidying and sorting….some women even feel the urge to decorate. Embrace it.

Being told that you are expecting more than one baby can be a shock. Many women will worry how they will cope with two, who will help? And, what about sleep and feeding?

Part of the answer to these questions lie in the early days of pregnancy. There is so much that you can do to maximise your chances of a healthy, trouble free pregnancy and well grown twins that you carry to term. Some simple changes to your lifestyle will give you more energy and that in turn will ensure that you really do enjoy your pregnancy.

Many of the midwives here at Neighbourhood Midwives have supported women with twin pregnancies through the pregnancy, birth and postnatal period. Well grown twins who are born close to term will be healthier and easier to care for postnatally. They will be easier to feed and often sleep better.

According to the World Health Organisation any pregnant woman needs 75 g of protein each day. This is essential to grow new tissue and support the body’s needs in pregnancy. Growing twins requires even more. We all think that we eat a healthy diet, less sugar and salt, our 5 a day etc. What we have noticed however is that many women eat too much carbohydrate and not enough protein. Furthermore the protein is often consumed in one or two meals and this is a problem as the body can only absorb limited amounts of protein at a time. By eating 5/6 small servings of protein a day your desire for sugar and carbs will reduce and your energy will rise. Most importantly your body will gain what it needs to grow your babies, placenta and increase your blood volume. This in turn may help you to avoid some of the complications of twin pregnancies. Support this with vegetables, fruit and complex carbs and you will discover that you will feel so much better. An adequate intake is not just about having to eat large steaks though – there is plenty of protein in more humble food, for example one egg is 6g of protein, ¼ cup of almonds is 8g, a cup of yogurt is 8-12 g, So an example meal plan could be;

• 2 eggs for breakfast with rye toast
• yogurt and nuts for mid morning
• chicken salad for lunch
• spelt crackers and peanut butter or cheese mid afternoon
• fish, and veg for dinner with drinks and fruit to taste

These are small changes that can make a big difference to your pregnancy and postnatal period. So maybe give it a try…

We all know that keeping active and maintaining our social life helps to ensure that we enjoy life. Too often the “minor discomforts” of pregnancy, which tend to be exacerbated in twin pregnancies, can leave us with poor energy, feeling drained and unable to do the things we enjoy.

First and foremost, it all takes us back to diet since a low carbohydrate diet with plenty of fresh food and adequate protein will maintain your energy, reduce oedema and allow you to keep active throughout the pregnancy.

Swimming is a perfect exercise as the water supports your weight and keeps you flexible. It is also really helpful in calming your mind which can sometimes seem so busy with work and worry. Maybe you can organise to go with other pregnant friends or join an aqua natal class.

Pregnancy yoga combines exercise with relaxation and breathing and the right class will give you opportunities to socialise too. NCT offer Relax, Stretch and Breathe classes as well as Yoga for Pregnancy. Pilates for pregnancy is also a good option as this will improve your core strength and help you to feel stronger. Even just regular walking every day is a great help. The aim is to avoid sinking into a sea of exhaustion and inactivity, tempting as it may be!

Relaxation techniques, hypnobirthing and visualisation are all useful regardless of how you plan to give birth. Acquiring these skills will serve you well, especially during the early days of multiple motherhood - not to mention the terrible twos and up to the teen years!

Sophrology is a technique recently imported from Europe and especially popular in France. It combines mind, and body work techniques and has been very helpful to women preparing for parenthood. For more information visit: http://www.be-sophro.co.uk

Meeting lots of like minded people in pregnancy will help you to have an active social life after the babies are born. The Twins Club is often your first point of reference but you might also want to access the NCT and Match Up Mums http://matchupmums.com which is a London based organisation who match up like-minded women according to interests and location. A bit like a dating profile for mums! Many twin mums say they like to mix with non twin mums just to get a different perspective on things.

Your early pregnancy is when you will want to research your choices about caregivers and the birth. It is all too easy to get caught up in the label of high risk and to think that you have no choices. In fact 40% of twins are born vaginally http://www.nhs.uk/conditions/pregnancy-and-baby/pages/giving-birth-to-twins.aspx#close and Nice Guidelines state that women should always be a central person in the decision making process.

Some women feel that the support of a known midwife who provides continuity is very helpful because, as pregnancy progresses, she can ensure that you are aware of all the evidence available while making decisions. An ongoing discussion about a balance of potential risks enables you to feel in control of your choices and can open up different options. As an example, we recently cared for a women who wanted a less interventionist approach and we were able to help her negotiate a planned midwife-led birth in an AMU (alongside midwifery unit) as she was fit and healthy, had no complicating factors and the babies were well grown and head down.

Equally, you may want to choose a planned caesarean and would like to draw up a plan about the things that will be important to you -who will be there, what will be said to you, organising skin to skin in theatre and early breastfeeding.

Whatever your choices, it is important that you are listened to and that you feel that your care is woman centred.

What about afterwards? With twins the answer is usually help, help and more help!

At Neighbourhood Midwives we are passionate about providing proper midwifery and breastfeeding support during this important time - our midwives visit daily at home for the first few days and help you to get feeding established, reassure you and be available by phone 24/7.

Products that help. Tried and tested by women like you. First a good breastfeeding pillow is essential:

• Jo Jo Maman Bebe http://www.jojomamanbebe.co.uk do a good one
• as do www.thrupennybits.co.uk and
• Mybreastfriend. https://www.mybrestfriend.com.

Another vital is the Sleepyhead - Available from John Lewis it will transform your life in terms of getting babies to sleep and stay asleep. Get someone to buy these for you - a gift from work perhaps? http://www.enfant-terrible.se/products/sleepyhead®-deluxe-9707003 Finally the Snugglebundl will help you to lift baby easily after a caesarean and allow you to transfer the sleeping baby from car seat or pram to cot without him waking! http://snugglebundl.co.uk The majority of the women we have cared for have carried their babies to term (or near) and then have found that their own recovery is quicker and the babies feed better. This allows women to feel more normal which is so important. They then go on to enjoy their postnatal period and parenting. All of this makes having twins a much more enjoyable experience which is what we all want. Remember, twins are not twice the trouble but two is twice as nice!

Aromatherapy is a complementary therapy using essential oils (concentrated extracts) from a wide range of plants. In aromatherapy, highly concentrated essential oils specially derived from medicinal plants are carefully selected and blended then administered by inhalation, massage, compresses or baths, for specific therapeutic effects. Why use aromatherapy in pregnancy, for labour or the postnatal period? In recent studies aromatherapy during pregnancy, birth or the postnatal period has been found to:

• Reduce anxiety and stress
• Aid relaxation
• Help with aches and pains
• Improves your circulation
• Enhance your immunity
• Help to further connect a mother to her unborn baby

In recent studies aromatherapy during pregnancy, birth or the postnatal period has been found to:

• Reduce anxiety and stress
• Aid relaxation
• Help with aches and pains
• Improves your circulation
• Enhance your immunity
• Help to further connect a mother to her unborn baby

Almost all essential oils are antibacterial, antiseptic, antimicrobial, anti-fungal, antibiotic, and antiviral. Individualised aromatherapy blends can help with the following:

• Nausea and vomiting in pregnancy
• Other digestive symptoms such as constipation, wind, gastric reflux (indigestion)
• Anxiety and stress
• Insomnia
• Nasal congestion, minor coughs and colds
• Minor aches and pains
• Carpal tunnel syndrome (tingling in hands and fingers)
• Promotion of the onset of natural labour at full term (40+ wks)
• Pain relief in labour
• Stimulation of effective labour contractions
• Natural delivery of the placenta (afterbirth)
• Afterpains and natural involution of the uterus (womb) after birth
• Breast care during breast feeding

Lavender is a highly adaptable oil used for inhalation, massage and compresses and also in baths. Lavender oil has a sedating, relaxing and pain-relieving effect. It also helps to ease the sensations of contractions, although it should not be used before the 36th week of pregnancy. Not always suitable if you are a hay fever or asthma sufferer.

Rose assists the circulation and encourages deep and calm breathing. It is renowned for its anti-depressant benefits. Rose has a lovely, uplifting aroma which helps to calm nervous feelings and severe anxiety.

Lemon and Mandarin are both refreshing and emotionally uplifting. They are often used with other oils to enhance their effects.
Peppermint is useful for relieving sickness and nausea. Peppermint is not recommended for use in combination with homeopathic remedies.

Frankincense and Neroli can be used as a labour inhaler to relieve anxiety and help with deeper breathing.

BE AWARE:
Do remember that essential oils not only smell lovely but at times can be just as strong as drugs so should be used with caution. Do let your midwife know if you are using essential oils. If you would like a bespoke aromatherapy blend contact your local Neighbourhood midwife or an aromatherapist trained to look after pregnant and postnatal women