Pregnancy care

Antenatal care is the care and help you receive from health professionals during the course of your pregnancy. It is important you take good care of your own health and that of your unborn baby during pregnancy and making the most of the antenatal care available to you is a big part of that.

As soon as you find out you are pregnant, you should get in touch with your GP or midwife to get information on the services and support that are available and to organise antenatal care. This will include:

  • antenatal appointments - regular health appointments with your midwife or doctor to check your health and the development of your baby
  • antenatal screening - tests that assess whether your unborn baby is at risk of certain conditions or abnormalities
  • antenatal classes - classes and workshops that prepare you and your partner for the birth of your baby

As part of your antenatal care, your midwife will offer you a dating scan that will give you a date for the birth of your baby. For a rough idea, you can use the pregnancy due date calculator to work out when your baby is due.

Antenatal appointments are check-ups to assess the health of you and your baby. They give the opportunity for you to find out more about the care on offer, and also to discuss any issues and questions you have.

This topic gives an overview of some of the issues that women face during pregnancy. This includes changes to lifestyle, including diet, common health problems, coping with work and antenatal classes.

These issues can also be discussed with your midwife at antenatal appointments.

Your antenatal notes

At your booking appointment, usually the second meeting you have with your midwife, all your details will be entered into a record book. These are your antenatal notes which will be added to at each appointment you have. You will be asked to look after your notes. If you go away from home you should take your notes with you, so if you need medical attention you will have the information that is needed.

There are a number of things you can do to stay healthy during your pregnancy.

Exercise

It is good to keep active during your pregnancy. It will help you to adapt to your changing shape and weight gain and also help you to get back into shape after birth.

You can continue your normal daily physical exercise for as long as you feel comfortable. However, you should not exhaust yourself and you may need to slow down as your pregnancy progresses. If you were not active before your pregnancy, you should not suddenly take up a strenuous exercise programme.

If you start an aerobic exercise programme, begin with no more than 15 minutes' continuous exercise, three times a week. Increase this gradually to a maximum of 30-minute sessions, four times a week. Inform the instructor that you are pregnant.

Some activities are not suitable when you are pregnant because they carry extra risks, such as falling, or they put too much strain on your joints, including:

  • contact sports where there is a risk of being hit, such as kickboxing or judo,
  • racquet games such as badminton or tennis,
  • horse riding, downhill skiing, cycling and any other sport with a risk of falling,
  • scuba diving, because the baby is not protected against decompression sickness and gas embolism, and
  • exercising at heights over 2,500 metres if you are not acclimatised, because of the risk of mountain sickness.

You should also avoid lying on your back, especially after 16 weeks, because your bump can press on big blood vessels and make you feel faint.

Alcohol

When you drink, alcohol passes from your blood, through the placenta, to your baby. A baby's liver is one of the last organs to develop fully and does not mature until the latter half of pregnancy. Your baby cannot process alcohol as well as you can and too much alcohol can seriously affect your baby's development.

If you are pregnant, or planning to become pregnant, you should try to avoid alcohol completely for the first three months of your pregnancy because there may be an increased risk of miscarriage.

You should never get drunk or binge drink while you are pregnant as this can harm your unborn baby. Binge drinking is usually classed as six or more standard drinks of alcohol on a single occasion.

Smoking

Smoking during your pregnancy restricts the essential oxygen supply to your baby and increases the risk of it being born underweight or too early. These risks will be reduced if you stop smoking during your pregnancy.

As soon as you stop smoking the carbon monoxide and chemicals clear from your body and your oxygen levels return to normal. You and your baby benefit immediately.

If you decide to stop smoking, your GP will be able to refer you to a local smoking cessation service which will provide you with dedicated help and advice about the best ways for you to give up smoking. You can also call the National Smokers Quitline at 1850201203, or log on to www.quit.ie, or join our facebook page at www.facebook.com/hsequit for further support.

Caffeine

Consuming high levels of caffeine can cause your baby to have a low birth weight, which can increase the risk of health problems later in life. It can also increase the risk of miscarriage.

You do not need to cut out caffeine completely but you should try not to have more than 200mg a day. This is the equivalent of two cups of instant coffee or four small (50g) bars of dark chocolate.

Cannabis and other illegal drugs

Cannabis and other illegal drugs, such as ecstasy, cocaine and heroin, can harm your baby. If you use any of these drugs then you should talk to your midwife or GP to get advice to help you stop. If you are a dependent drug user, extra support and treatment is available to help you to come off drugs and keep your baby safe.

Work

If you work during your pregnancy, make sure you know your rights to antenatal care, maternity leave and benefits.

It is also important that you make sure your job is not putting the health of you and your baby at risk. Jobs that involve working with chemicals, X-rays or heavy lifting may not be suitable during pregnancy. If you have any worries you can talk to your maternity team, occupational health nurse, union representative or someone in personnel.

If you do carry on working during your pregnancy, you may get very tired, especially in the first and last weeks of your pregnancy. Make sure you try to rest in your lunch break and when you get home in the evening.

Sex

There is no evidence that sexual activity is harmful while you are pregnant. However, it is normal for your sex drive to change through your pregnancy and you may want to talk to your partner about this.

Although it is safe, it may not be easy to have sex and you and your partner may have to find different positions that are more comfortable for you both.

Travel

Flying is not harmful for you or your baby, but some airlines will not let you fly towards the end of your pregnancy. You should check the terms and conditions of an airline before flying with them.

Long-distance travel (longer than five hours) carries a small risk of thrombosis (blood clots) in pregnant women. If you fly, drink plenty of water to stay hydrated and do the recommended calf exercises.
You can buy a pair of support stockings in the pharmacy over the counter, which will reduce leg swelling.

Before you travel, think about your destination. Could you get medical help if you needed it? Are any vaccinations needed which might be harmful to the pregnancy?

Road accidents are among the most common causes of injury in pregnant women. To protect yourself and your baby, always wear your seatbelt with the diagonal strap across your body between your breasts and with the lap belt over your upper thighs. The straps should lie above and below your bump, not over it.

In most cases, if you are well and healthy and take necessary precautions, there should be no reason not to travel.

Vaccinations

Two vaccines are recommended if you are pregnant

Whooping cough vaccine

Women should get whooping cough vaccine during each pregnancy. The mother’s immunity to whooping cough decreases during pregnancy and is unlikely to protect the baby. Vaccination is recommended between 27 and 36 weeks of pregnancy. This is considered the best time in pregnancy to provide protection for the baby during the first few months of life, when the baby is too young to be vaccinated.

Influenza (flu vaccine)

The flu vaccine is inactive and can be given safely at any time during pregnancy. A pregnant woman who gets the flu is at risk for serious respiratory illness and complications. Getting flu in pregnancy can also so lead to premature birth and smaller babies. Flu vaccination during pregnancy provides immunity against influenza infection to babies in the first 6 months of life.

Both vaccines are available from your GP.

 

Medicines

Some medicines can harm your baby's health but some are safe, for example medication to treat long-term conditions such as asthma, thyroid disease, diabetes and epilepsy. Always check with your GP, midwife or pharmacist before taking any kind of medication.

Use as few over-the-counter medicines as possible during your pregnancy. Your GP should only prescribe you medication where the benefits of taking the medication outweigh the possible risks of not.

Complementary medicines

Few complementary and alternative therapies have been established as safe during pregnancy. You should make sure a practitioner knows you are pregnant before having any treatment. Tell your midwife or doctor if you are using or plan to use any herbal, homeopathic or aromatherapy remedies.

 

A healthy diet during pregnancy is very important for the development of your baby, and may have long-term beneficial effects for both you and your child.

It is advisable to follow a balanced diet based around the four main food groups:

  • carbohydrates, such as bread, rice, pasta and potatoes
  • fruit and vegetables, at least five portions a day
  • protein, such as meat, poultry, fish, pulses and eggs, and
  • dairy, such as milk, cheese and yoghurt

You should also try to drink plenty of fluids, such as water and fruit juice, as this can help to prevent constipation and nausea.

In addition to a healthy balanced diet, there are a few additions and restrictions to your diet that are recommended during pregnancy:

Folic acid

During pregnancy you should increase your intake of folic acid.  Folic acid can help to reduce the risk of problems developing with your baby's spine and brain (neural tube defects), such as spina bifida.

The Department of Health recommends that all women who are trying to get pregnant should take a daily folic acid supplement of 400 micrograms a day. This should continue for the first 12 weeks of pregnancy, while your baby's spine is developing.

You can get folic acid tablets from pharmacies, supermarkets, health food stores and on prescription. Natural sources include green leafy vegetables, breakfast cereals and bread.

If you have a family history of neural tube defects, or are taking medication for a condition such as epilepsy, check with your GP if you are planning a pregnancy and before starting to take folic acid because you may need a higher dose.

Vitamin D

It is important to get enough vitamin D during your pregnancy, and while you are breastfeeding, to keep your bones healthy and to help with the development of your baby's bones.

This is especially important for women at risk of vitamin D deficiency; this includes anyone with a South Asian, African, Caribbean or Middle Eastern family origin, those who stay indoors a lot, those who usually cover up their skin when they go outdoors, or those with a diet particularly low in vitamin-D-rich foods.

Foods that contain vitamin D include oily fish, eggs, meat, vitamin-D-fortified margarine and breakfast cereals.

Only a small amount of our vitamin D comes from diet; the best source is sunlight. To ensure you get enough vitamin D it is advised that pregnant women take a daily supplement of 10 micrograms a day. Ask your midwife or doctor about suitable vitamin supplements.

Vitamin A

Too much vitamin A during pregnancy can harm your unborn baby. Avoid supplements containing vitamin A and eating liver and liver products, as these are high in vitamin A.

Mercury

It is recommended that you do not eat shark, marlin or swordfish, and that you limit the amount of tuna you eat while you are pregnant or breastfeeding. These types of fish contain high levels of mercury, which can damage your baby's developing nervous system. You should not eat more than two tuna steaks or four cans (each 140g drained) of tuna a week.

Peanuts

Peanuts, or food containing peanuts such as peanut butter, are safe to eat during your pregnancy unless you have a peanut allergy or a health professional advises you not to.

Previously, pregnant women were advised to avoid peanuts if there was a history of allergy - such as asthma, eczema or a food allergy - in their immediate family. However, the latest research shows that there is no evidence to prove that eating peanuts during pregnancy increases the risk of your baby developing a peanut allergy.

Ask your doctor or midwife if you are worried about allergies and food intolerances.

Listeria and salmonella

Some bacterial infections such as listeriosis and salmonella can be picked up from food you eat and can harm your baby. To avoid these infections it is best to follow this advice:

  • If you drink milk, only drink pasteurised or UHT milk.
  • Avoid mould-ripened soft cheese, such as camembert or brie, and blue-veined cheese such as stilton. Other hard cheeses, such as cheddar, are safe.
  • Avoid eating pâté, even vegetarian pâté.
  • Avoid eating raw or partially cooked eggs or food that may contain them, such as mayonnaise.
  • Avoid raw shellfish.
  • Avoid eating raw or partially cooked meat.
  • Avoid eating uncooked or undercooked ready meals.

Toxoplasmosis

Toxoplasmosis is a disease caused by a common parasite. It does not usually cause any symptoms in healthy people but can cause problems for an unborn baby if an expectant mother becomes infected.

It can be passed on from undercooked or uncooked meats and from the faeces of infected cats, or soil and water contaminated with faeces. To minimise the risk of infection:

  • Wash your hands before and after handling food.
  • Wash all fruit and vegetables before you eat them - even ready-prepared salads.
  • Make sure any meat you eat is thoroughly cooked.
  • Wash all surfaces and utensils after preparing raw meat.
  • Wear gloves and wash your hands well after gardening or handling soil.
  • Avoid any contact with cat faeces.
Allergic
An allergen is a substance that reacts with the body's immune system and causes an allergic reaction.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Faeces
Faeces (or stools) are the solid waste matter that is passed from the body as a bowel movement.

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Vegetarian, vegan and special diets

A varied and balanced vegetarian diet should give you all the nutrients that you and your baby need during pregnancy. However you might find it hard to get enough iron and vitamin B12. You should talk to your midwife or doctor about how to make sure you are getting enough of these nutrients.

If you have a restricted diet, due to a food intolerance such as coeliac disease, or for religious reasons, you may wish to talk to a dietitian who can give you advice on what nutrients you need for you and your baby. Your midwife or doctor can refer you for an appointment.

Pregnancy can cause many physical and emotional changes. Most of the time these are normal and do not pose any risk to you and your baby, but they may cause you some discomfort. Your GP and midwife can provide more information and support.

Nausea and sickness

Nausea and sickness in the early weeks of pregnancy are normal but usually stop at weeks 12-14 of your pregnancy. Pregnant women experience varying degrees of sickness and nausea and at different times of the day. The reasons for this are not fully understood but it is probably caused by the hormonal changes that happen in the first three months of pregnancy. There are things you can do to help with nausea:

  • If you feel sick first thing in the morning, give yourself time to get up slowly. If possible, eat something like dry toast or a plain biscuit before you get up.
  • Get plenty of rest and sleep whenever you can. Feeling tired can make the sickness worse.
  • Eat small amounts of food often rather than several large meals, but do not stop eating.
  • Drink plenty of fluids.
  • Ask those close to you for extra help and support.
  • Distract yourself as much as you can. Often the nausea gets worse the more you think about it.
  • Avoid foods and smells that make you feel worse. It helps if someone else can cook. If not, go for bland, non-greasy foods, such as baked potatoes, pasta and milk puddings, which are simple to prepare.
  • Wear comfortable clothes. Tight waistbands can make you feel worse.

If you are being sick all the time and cannot keep anything down, tell your midwife or doctor. Some pregnant women experience severe nausea and vomiting. This condition is known as hyperemesis gravidarum and needs specialist treatment.

Backache

As your baby grows, the hollow in your lower back may become more pronounced, and this can also cause backache. During pregnancy, your ligaments become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause backache.

How to avoid backache:

  • Avoid lifting heavy objects.
  • Bend your knees and keep your back straight when lifting or picking something up from the floor.
  • Move your feet when turning round to avoid twisting your spine.
  • Wear flat shoes that allow your weight to be evenly distributed.
  • Work at a surface that is high enough so that you do not stoop.
  • Try to balance the weight between two bags when carrying shopping.
  • Sit with your back straight and well supported.
  • Make sure you get enough rest - particularly later in pregnancy.

If your backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital. They will be able to give you some advice and may suggest some helpful exercises.

Pelvic joint pain

If during or after your pregnancy you have pain in your pelvic joints when walking, climbing stairs or turning in bed, you could have pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). This is a slight misalignment or stiffness of your pelvic joints, at either the back or front. It affects up to one in four pregnant women. Some women have minor discomfort, others may have much greater immobility.

Ask a member of your maternity team for a referral to a manual physiotherapist, osteopath or chiropractor who is experienced in treating pelvic joint problems.

Constipation

You may suffer from constipation during your pregnancy. This is usually caused by the hormonal changes in your body and can be relieved by eating more fibre (such as wholegrain cereals and wholemeal breads, fruit, vegetables and pulses), drinking more water and exercising regularly.

Iron supplements can cause constipation. If you are on iron supplements, ask your doctor whether you can manage without them or change to a different type.

Haemorrhoids (piles)

Haemorrhoids, also called piles, are swollen veins around the anus that can be itchy, feel sore and make it uncomfortable to go to the toilet.

In pregnancy they are caused by hormones that encourage your veins to relax, and by the increased pressure on your pelvic blood vessels.

Some ointments and creams are available but there is little evidence on how well these work. Your midwife or GP can give you advice on other ways to get rid of and avoid haemorrhoids such as changes to your diet (to prevent constipation), exercise and avoiding standing for long periods of time..

Heartburn and indigestion

Heartburn is a strong burning sensation in your chest. In pregnancy this is caused by the valve between your stomach and the tube leading to your stomach relaxing. This means stomach acid can pass into the tube, causing the burning feeling.

It is often brought on by lying flat, so sleeping propped up can help. Drinking a glass of milk before bed and avoiding eating or drinking a few hours before you go to bed can also help to relieve symptoms.

If symptoms persist you can ask your GP or midwife for advice. They may be able to prescribe an antacid remedy that is safe for you to take while pregnant.

Indigestion can also cause discomfort. It is partly caused by hormonal changes and in later pregnancy by your growing uterus pressing on your stomach. Try eating smaller meals more often. Sit up straight when you are eating, as this takes the pressure off your stomach.

Thrush

When you are pregnant, changes in levels of the female sex hormones, such as oestrogen, can mean that you are more likely to develop thrush. Thrush is a common vaginal infection, also known as candida or vaginal candidiasis. It causes itching and soreness of the vagina, as well as vaginal discharge, and can make it painful to have sex or pass urine.

Thrush can be treated by using a cream or pessary prescribed by your GP. While you are pregnant you should not treat thrush using a medicine that needs to be swallowed as there is no evidence that these are safe to use by pregnant women.

Vaginal discharge

Most women find they get more vaginal discharge than usual when they are pregnant. This is normal, but if the discharge becomes smelly, yellow or green, or if you experience any pain or soreness in the vaginal area, you may have an infection and should tell your midwife or GP.

Varicose veins

Varicose veins are veins that have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening). They usually get better after delivery.

If you have varicose veins try to:

  • avoid standing for long periods of time,
  • avoid sitting with your legs crossed,
  • not put on too much weight, as this increases the pressure on your veins,
  • sit with your legs up as often as you can to ease the discomfort,
  • wear support tights, which may also help to support the muscles
    of your legs,
  • sleep with your legs higher than the rest of your body - use pillows under your ankles or put books under the foot of your bed, and
  • do foot exercises and other antenatal exercises such as walking and swimming, which will help your circulation.

Incontinence

Incontinence is a common problem during and after pregnancy. Some pregnant women find that they can not prevent small leaks of urine when they cough, sneeze or laugh, or when they move suddenly. Others have more severe incontinence and find they cannot help wetting themselves.

It is usually a temporary problem caused by your pelvic floor muscles relaxing slightly to prepare for your baby's delivery. Your midwife, doctor or health visitor can give you advice on how to deal with incontinence.

Stretch marks

Stretch marks are pink or purplish lines that occur on your abdomen, or sometimes on your thighs and breasts. Not all women get them - it depends on your skin type and how elastic it is. You are more likely to get stretch marks if you gain a lot of weight during your pregnancy.

It is unlikely any creams or oils will help to prevent you from getting stretch marks. After your baby is born, the marks will gradually fade and become less noticeable.

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You may see a number of different professionals during the course of your pregnancy. Below are the people you are most likely to meet:

Midwife

A midwife is specially trained to look after mothers and their babies throughout pregnancy, labour and after birth. They work in hospitals and in the community.

You will see a midwife each time you have an antenatal appointment and you and your baby will be cared for by midwives on the postnatal ward after you give birth.

You will probably get to know your community midwife before your baby is born and they will visit you at home after you have given birth to help you through the early weeks of motherhood.

GP

Many women choose to go to their GP as soon as they know they are pregnant. Your GP will refer you to a midwife or hospital.

You may need to see your GP while you are pregnant if you get a non-pregnancy-related illness. If your baby is born in hospital, your GP will be notified and you will be invited in for an appointment soon after you return home. You will need to register your new baby with your GP.

You will also need to see your GP to get the vaccines that recommended in pregnancy. These are:

Whooping cough vaccine

Women should get whooping cough vaccine during each pregnancy. The mother’s immunity to whooping cough decreases during pregnancy and is unlikely to protect the baby. Vaccination is recommended between 27 and 36 weeks of pregnancy. This is considered the best time in pregnancy to provide protection for the baby during the first few months of life, when the baby is too young to be vaccinated.

Influenza (flu vaccine)

The flu vaccine is inactive and can be given safely at any time during pregnancy. A pregnant woman who gets the flu is at risk for serious respiratory illness and complications. Getting flu in pregnancy can also so lead to premature birth and smaller babies. Flu vaccination during pregnancy provides immunity against influenza infection to babies in the first 6 months of life.

Obstetrician

An obstetrician is a doctor that specialises in the care of women during pregnancy, labour and straight after birth. If you have a hospital birth you may be under the care of a consultant obstetrician and their team of doctors and other specialists, including midwives.

In some hospital settings you will see a obstetrician regularly, in others you will only see an obstetrician if you are referred for an appointment because of a concern or complication. If everything is straightforward with your birth then a midwife will usually deliver your baby without the help of an obstetrician.

Paediatrician

A paediatrician is a doctor that specialises in the care of babies and children. They may check your newborn baby after birth to make sure everything is ok and, if you have a complicated labour, they may be present during the birth. If your baby has any problems, you can talk about these with a paediatrician. If your birth is straightforward you may leave the hospital without seeing a paediatrician at all.

Obstetric physiotherapist

An obstetric physiotherapist is trained to help you cope with the physical changes that pregnancy and childbirth brings to your body. Sometimes they attend antenatal classes to teach exercises, relaxation and breathing techniques and other ways you can help yourself through pregnancy. After you give birth they can recommend postnatal exercises to strengthen your muscles.

Public Health Nurse

Public health nurses sare pecially trained to look after the health of you and your family. After birth they will contact you to arrange a home visit to offer help and support with your newborn baby. After this you may continue to see your public health nurse at home, or when you go to your child health clinic, health centre or GP surgery.

Dietitians

You may see a dietitian if you want advice on healthy eating during pregnancy or if you need to follow a special diet, for example if you have gestational diabetes.

Students

Health professionals sometimes have students helping and observing them. Students can be at different stages of their training but will always be supervised.

You can choose not to be seen by a student, but agreeing to be seen helps with their education and may add to your experience of pregnancy.

Glossary

Ultrasound scans
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Womb
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
Urine sample
Urinalysis / UA is when a urine sample is tested, commonly to check for any signs of infection, or protein or sugar levels.
Heart
The heart is a muscular organ that pumps blood around the body.
Caesarean
A caesarean section is an operation to deliver a baby by cutting through the mother's abdomen to open the womb.

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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