Women need to plan for pregnancy like they are planning their wedding!

Women need to plan for pregnancy like they are planning their wedding!

Why should you prepare for pregnancy?

Many couples have contacted me with issues around conceiving and fertility – none of whom have considered their diet and lifestyle and how this is a major factor in optimising conception, and something I will soon be offering advice and treatment on.

But for now, as a community midwife I meet women who have come to my clinic to let me know they are pregnant. Some of these women have tried for months to get pregnant, others have just started trying to conceive. However, it always strikes me that very few women prepare their body to enhance their pregnancy and reduce their risks and anxieties around growing a human being. This process is very intricate and complex.

Much like planning a major event in your life, much time and attention to detail will be required. If you think of a wedding or a holiday – we don’t just find ourselves suddenly in these situations, we carefully consider venue, transport, clothing, pre-preparation, diet etc etc. So why do women not apply the same consideration to pregnancy?

Initially planning should include folic acid which is a type of B Vitamin. This helps with the production and maintenance of cells in your body and supporting a pregnancy. I rarely find a woman who has commenced the minimum recommended dose of folic acid pre-pregnancy. The majority of women, I would estimate to be around 95% or more think about it or commence it once they have a positive diagnosis of pregnancy through a pregnancy test. For those requiring a higher dose of 5mg, which requires a prescription from your GP and is recommended if you have any of the following:

• BMI above 35
• had a previous pregnancy and the baby has had a neural tube defect
• are taking anti-epileptic medication
• are diabetic
• you or the biological father have a neural tube condition or a family history of neural tube condition

Many women meet their midwife at around 6-10 weeks of pregnancy. Folic acid is only required for the first 12 weeks, therefore it is possible that the benefits of taking folic acid have been missed!

Research shows taking the correct dose of folic acid can significantly reduce neural tube defects (NTD) which are defects of the brain, spine, or spinal cord. These are formed in the first month of pregnancy, often before women are aware they are pregnant, hence the importance of preparing for pregnancy.

Spina bifida and anencephaly are the two most common NTDs, although there are others. With Spina bifida, the baby’s spinal column doesn’t close completely usually resulting in nerve damage causing some paralysis of the legs. In anencephaly, most of the brain and skull do not develop. These are usually permanent and non-curable.

Your diet can contribute to folic acid intake, however, it is unlikely you will be able to consume the recommended minimum daily requirement, let alone the higher dose. But preparing well for pregnancy and increasing foods which contain folic acid will help to reduce the chance of your baby having a NTD. These foods include:

• The legumes
• whole grains
• fruits (particularly citrus)
• vegetables (especially asparagus, brussels sprouts, and dark leafy greens)
• breakfast cereals fortified with folic acid.

So please, please ladies, plan to take your folic acid 🙂

Pregnancy & Infections Series – Chlamydia Trachomatis (Chlamydia)

Pregnancy & Infections Series – Chlamydia Trachomatis (Chlamydia)

In the UK routine infection screening is offered through blood tests which check for HIV, Hepatitis B and Syphilis. However, there are more infections which occur and which are not screened for. So what are these, how do they impact your health and pregnancy and what should you do to reduce any harmful effects?

What is Chlamydia Trachomatis (Chlamydia)?

Chlamydia is a very small parasitic bacterium which is spread through sexual contact. This infection infects the urethra in men. However, it infects the urethra, the cervix and can spread to the reproductive organs in women.

Sex without a condom and unprotected oral sex are the main ways a chlamydia infection can spread and so it is one of the named sexually transmitted infections (STI) which affects those having unprotected sex.
In 2016, Chlamydia was stated as the most common STI in Wales, United Kingdom. Young people in the 15-24 age range were more likely to be affected and females had higher reported infection rates than males.

Why does this matter?

This bacterial infection has no symptoms and can cause women to suffer with:
• pelvic inflammatory disease (PID)
• tubal factor infertility
• ectopic pregnancies (Hoenderboom et al, 2019).

In pregnancy, Chlamydia can contribute to complications including:
• miscarriage
• premature rupture of the membranes
• pre-term labour
• low birthrates
• postpartum endometritis

If the infection is present and left untreated in pregnancy (due to a woman not being aware of having the infection as there are no symptoms), the infection may lead to complications for the baby following mother to child transmission during delivery NICE (2008). These complications include:

• Chlamydial conjunctivitis – bacterial
• Chlamydia trachomatis pneumonia
• Possible long-term complications if not treated

All of these factors should be considered by health professions when you present in pregnancy for your booking appointment. Additional features which may indicate infection during pregnancy include:
• post coital (after sex) or intermenstrual bleeding
• lower abdominal pain (endometritis),
• vaginal discharge suggestive of infection
• dyspareunia, dysuria (urethritis),
• bartholinitis

What Can you do if you think you may have Chlamydia or other STI?

As screening is not routine in the UK (unlike NewZealand and Australia), you can visit your local family planning clinic (FPA) and they will support you by giving you support to obtain a self-taken swab test.
This test is performed by you by using a specific cotton bud like swab which is passed into the entrance of the vagina, you circle the swab for 1 minute and then put the swab in the specific container – also given to you by the practitioner. This swab is then sent away for testing. If the test is positive you will be treated with antibiotics which will reduce and minimize any harm to you, your pregnancy and your baby.

What is the treatment for Chlamydia?

Best practice after a positive test for Chlamydia is antibiotic treatment with sexual abstinence for the entire time of treatment and use of condoms until a positive test that the treatment has worked and is confirmed (Public Health England, 2019).

This should be followed up at 36 weeks to ensure treatment has been successful or that no re-infection has occurred.

Other infections in this series include:
Bacterial Vaginosis (BV)
Cytomegalovirus (CMV),
Hepatitis C
Group B Streptococcus (GBS)
Toxoplasmosis
HSV (1)

Typical Chlamydial Swab –

Bacterial Conjuctivitis can be caused by Chlamydial infection

Your Birth Your Way – GIRLS ‘ALLOWED – ALOUD!’

Your Birth Your Way – GIRLS ‘ALLOWED – ALOUD!’

A recent Facebook post suggested women were choosing to ‘free birth’ because they feel midwives and doctors are ignoring their needs. This was a very upsetting and concerning article as I strive to give care that is tailored to the needs of the women I care for and work alongside. However, it very quickly hit home that the reason behind such actions being taken by women was due to the medical interventions imposed by health professionals not respecting women and their choices over their own bodies!

I was then contacted by a lady looking for a vaginal birth after caesarean section (VBAC). Her opening line stated ‘I am allowed to try a normal birth’. My heart sank. This single sentence destroys all that I have entered my profession for. Following this I received another request by a lady who stated ‘They want to induce me at 40 weeks exactly because I am over 40’. I asked the lady what it was SHE WANTED. Her reply was simply, ‘I don’t want to be induced’. I asked if she had been given any information about the risks and benefits around induction, to which she said no. I then asked if she had been informed of any other options such as sweeping the membranes, or complementary therapies. Again, she answered ‘no’. Time and time again I am contact by women who feel the reasoning behind the doctors wanting to initiate labour is questioned, examples I hear often are:

*   I am considered large for dates, so they want to induce me at 38 weeks. I have had ultra sound scans with estimated weights but I    have read that these can be wrong.

*   I saw in my notes the doctor had written ‘induction discussed’, but he just said he would sort a date at 39+2 weeks. I have no idea what it is or if I wanted, he seemed in a rush.

*   My baby was conceived through IVF so I know when my baby is due; however, they are going with the scan date. In other parts of the UK induction is not offered until 40 weeks. This is my first baby and they want to induce at 39, but I feel very strongly I want to wait because although my circumstances MAKE me higher risk, but I don’t have any of the other underlying issues to increase what I feel is a minimal risk to let me choose?

As a midwife, it is within my professional code of conduct to ensure I advocate the wishes of women, especially when women feel they cannot. I cannot help but feel that we are failing women through:
• not giving them choices in their care; and
• informing them of the risks with balanced information of any benefits
Only then can we ensure women have true informed choice and as such are able to reach THEIR OWN informed DECISION – NOT being coerced into a medical procedure because a healthcare professional feels it is their expertise in which women’s choice does not matter.

WOMEN’s AUTONOMY must be RESPECTED.

As such Complementary Therapies have a huge role to play in maternity care, both to nurture the midwife to mother relationship and offer enhanced care which supports women-centred choices. It is here I feel the fractured relationship between myself as a midwife and health professional can be restored.  I am shattered and floored by the fact that I am one professional that women feel are ignoring their needs. In my consultations relating to birthing options I discuss with the woman what she wants, consider the requests of health professional’s interventions and provide information as to the procedures involved.

Additionally we talk about guidelines and why medical professionals may feel they must intervene. I nurture women who nurture their baby’s and arm them with the evidence based information they require to make informed choices about THEIR birth. If a woman’s labour doesn’t start in line with the health professional’s timescales, I know I have given my wonderful ladies all the information, methods that can help at home and treatments that may assist spontaneous labour to commence in a safe and natural manner for which they have control.

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