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Pregnancy Clinic - The Final Countdown

Wednesday, 31 March 2010

It's predicted that this year that over 75000 women will give birth, a one percent rise in childbirth from last year, and the rate has been increasing since the fifties and doesn't look set to stop. Today we'll be looking at the last trimester, and getting you ready for the brand new chapter in your life.

Dr. Peter Boylan:- Consultant Obstetrician/Gynaecologist from Holles Street Maternity Hospital, where he was master from 1991 until 1998. He is also the author of 'The Irish Pregnancy Book', which is a guide for expectant mothers.

Based on his 30 years experience of helping mother in his clinics, Dr Peter Boylan explains clearly what happens in pregnancy, how mother and baby's health develops and what to expect in labour and delivery.

Grainne Ryan - Public Health Nurse:-

Presenter of Baby on Board Series 2. Grainne is a public health nurse and midwife and mother of three children. Areas of interest child development, parenting issues, adolescent development and post natal depression. Grainne works and lives in Ennis Co. Clare.

Claudine Donohue

Blood Pressure & Pre Eclampsia

These two are normally linked. About ten percent of women will have high blood pressure and protein in their urine in the last trimester. It is quite common in first time mums because the body's immune system isn't used to dealing with pregnancy. By subsequent pregnancies the immune system is much better equipped. There is no known reason as to why a woman has it and there is nothing she can do to prevent it. However it the reason that it is very important at this stage for women to attened their ante natal appointments, and why they are so frequent in the later stages.

What can they do?

If they are diagnosed with a combination of protein and high blood pressure they are sometimes admitted to a ward for one or two days to be monitored. In some cases near the end of the pregnancy women will be admitted weeks before due date and induced. The only cure for it is to give birth.

Pre-eclampsia is a condition usually associated with hypertension and proteinuria, and occurring in the second half of pregnancy.

Hypertension is defined as a single diastolic blood pressure of 110mm HG or any consecutive reading of 90mm Hg on more than one occasion at least 4 hours apart.

Proteinuria - two urine specimens at least 4 hours apart with 2+proteinuria by dipstick.
Major cause of maternal mortality in the UK - complex disorder with widespread endothelial damage which can involve every organ of the body.

Age 40 and over
Family history of pre-eclampsia (mother or sister)
Prior history of pre-eclampsia
BMI> 35kg/m2 at first contact
Multiple pregnancy or pre-existing vascular disease (high blood pressure or diabetes)
First pregnancy
Pre-existing renal disease

Signs and Symptoms

. Headaches
. Problems with vision such as blurring or flashing before eyes
. Severe pain below ribs, vomiting
. Sudden swelling of face, hands or feet
. Epigastric pain and vomiting

To test for it:-

. Further blood and urine tests carried out.
. Assess renal and liver function
. Assess coagulation complications.
. Tracing of baby's heart beat.
. Kick chart to record baby's movements
. U/Scan
. Severe pre-eclampsia - admitted to ante-natal ward.

Management

Aim of management is to deliver the baby before life-threatening complications occur
Ongoing monitoring of blood pressure and urine
Blood pressure lowering medication


Planning the Birth

I'm always very wary about women who have birth plans. You can download these from the internet or get them from books and they generally set you up for a fall. The best thing to do is go with the flow.

If you want to have a natural birth no one will force you to take an epidural, we are there to make the birth process as safe as possible. The staff in the hospitals are not going to force an epidural, or give you an episiotomy if they don't think it's necessary.

Always discuss it with the midwife before the due date if you have any questions about what is going to happen.

Grainne, if you have loads of questions or are anxious about the birth, what should you do?

. Ask your midwife/obstrician/GP
. Attend ante-natal classes
. Read a good book
. Talk to close family and friends (beware of horror stories)
. Be prepared -bag packed.

You will need:- Disposable knickers, breastfeeding bra, Vaseline for lips, facecloth to keep you cool, nightdress, and maybe an ipod for some music.
Birth plan

Pelvic Pain

The pelvis is made up of a series of bones, which are held together by ligaments. The pregnancy hormone relaxin relaxes the joints and the ligaments become loose. If the ligaments get too loose, then the joints are unable to hold the pelvis and some women can even end up on crutches. How this effects women is completely individual and there is nothing they can do to stop it.

Pubic Pain:-

One problem that many pregnant women complain about is pubic pain. The pelvis is a type of bone that goes all around and almost meets in the middle in the front. There is a small gap between them connected by fibrocartilaginous tissue reinforced by several ligaments. This area is called the Symphysis Pubis. This is important for helping your pubic bone to move freely stabilizing the pelvis while allowing a good range of motion.

The Symphysisi and the Sacro-iliac joints are important during pregnancy as their flexibility allows the bones tomove freely and to expand to help the baby, The Pubic Symphysis and the Sacro-Iliac joints (in the back of the pelvis) are especially important during pregnancy, as their flexibility allows the bones to move freely and to expand to help a baby fit through more easily during birth.

In fact, the pregnancy hormones relaxin and progesterone help the ligaments of your body to loosen and be even MORE flexible than before, so that there is plenty of 'give' and lots of room for the baby to slip right through.

Pelvic pain can vary from person to person, but almost all women who have it experience substantial pelvic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it is inside. The pubic are is generally very tender to the touch. Women may have difficulty walking, getting out of a car, bending over sitting down or getting up and turning in bed can be very painful.

Use pillows to support bump or between legs when sleeping.

Swimming may help relieve pressure on the joint.

When standing, stand symmetrically, with weight evenly distributed through both legs:

. Sit down to get dressed.
. Ice pack may feel soothing and help reduce inflammation in the pubic area.
. Back pain can often be helped by resting backwards over a 'birth ball'
. Some women find 'pelvic girdles' are helpful

Swelling around body (feet, hands, legs)

This is fluid retention and women can completely change the shape of their body. Feet and ankles are usually the worse hit due to gravity. It will gradually go down after the birth, especially through urine so women will find themselves going to the toilet a lot.

Is it true that if your feet swell that they don't go back to the same size due to ligament change?


No it is just fluid and the ligaments will stay the same.

Oedema (swelling)

Around half of all expectant mums suffer swelling due to water retention. It happens when tiny blood vessels leak from the pressure of carrying extra blood around your body. Also the uterus compressing the pelvis makes the blood pool rather than flow freely, which in turn causes the fluid normally contained in other body tissues to be forced into the tissue in the hands and feet.


What to do:-

Avoid standing for long period.

Rest with your feet elevated. This will help fluid drain away from ankles.


Remove any rings that are becoming tight


Myths to bring on childbirth?

. Spicy foods
. Castor oil
. Sex
. Laughing (makes the contractions come on quicker?)
. Pilates Ball

None of these will bring on childbirth. A lot of people do believe it in due to someone they know having the experience, but it is only a coincidence. If there was a genuine way of bringing on childbirth it would be known and proven. The sex myth was probably made up by men.

Over due babies:- Less than 5% of babies actually arrive on the day they are expected

Sex:-

Though it can be difficult to get into the mood during the later stages of pregnancy, sex is perfectly safe and commonly suggested method of natural induction. Medical science suggests that the prostaglandins contained in semen help to ripen (soften and thin) the cervix. Also when a woman experiences orgasm, oxytocin is released stimulating labour.

Acupuncture:-

Acupuncture has been used for thousands of years to induce women in late stages of pregnancy and is considered for both mother and baby. Women must ensure that they attenda qualified registered acupuncturist with experience of working with pregnancy.


Curries and spicy foods:-

Spicy foods have often been suggested as an effective way to naturally induce labour. It is thought that stimulating the mother's digestive system may also stimulate contractions. This suggestion may be borne around a misunderstanding. One of the less frequently acknowledged signs of labour is a loose bowel motion or diarrhoea. As the cervix and bowel share a common nerve, the softening cervix can stimulate the bowel. However the reverse is not the case. You may just end up with an upset tummy and a case of diarrhoea. (theory same for castor oil).

Any tell tale signs that the baby is coming early?

Yes if the women is getting a heavy discharge, Braxton hicks, or if the head is in position, then they are likely to go early.

There are ways that you can be induced by the doctor, but only under medical supervision if it is necessary, by breaking waters or a drip of oxytocin.

Will I know if they are false labour pains?

No, if you get contractions (pain, unable to walk, talk, eat, sleep) go into the hospital because there's no way of knowing otherwise.

Prices/Stockists/Relevant Information

2As1 Antinatal is run by registered nurse, midwife & mum of three, Susan Mac Nicholas. Susan conducts One-Day Intensive Antenatal Classes in both Dublin & Meath for expectant couples covering the later stages of pregnancy, labour, birth and the early stages of parenthood. Please see www.2as1.ie for further information-

. Hospital bag €65

Contains everything mum & baby need for hospital

For mum:

Stylish and practical bag - black

. 100ml Mothercare soothing nipple cream
. 12 Mothercare maternity towels
. 40 Mothercare breast pads
. 1 travel toothbrush and travel toothpaste
. 24pk little softie wipes
. For baby:
. 2 pairs of scratch mitts
. 1 hat
. 6 newborn disposable nappies
. 100 cotton wool balls
. 2 bodysuits (size 0-3mths)
. 1 sleepsuit (size 0-3mths)

2 pack deco floral nursing bra €31

. Black and White
. A convenient and easy 2 pack of super soft cotton bras. In summer's key bold black and white print with lace and satin trim detail. With drop down clip for easy breast feeding. These bras are available with matching items.
. 100% cotton, excluding trims
. Sizes: 34B-40E
. Mothercare disposable maternity briefs - 5pk. €2.99
. Specially designed for use during and after pregnancy
. Made from 100% non-woven polypropylene
. White
. Sizes: 10-12, 14-16, 18-20

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