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)
HSV (1)

Typical Chlamydial Swab –

Bacterial Conjuctivitis can be caused by Chlamydial infection

Approaching your due date or Overdue?

Approaching your due date or Overdue?

The National Institute for Health and Care Excellence (NICE) (2008) guidelines state that information should be conveyed to women informing them that the most women will go into spontaneous labour by 42 weeks. It is possible for your midwife to offer you a membrane sweep . This is a vaginal examination in which the midwife attempts to separate the membranes of the amniotic sac from the cervix. It is thought that this then will release hormones to aide the cervix to open and initiate labour. If you have not spontaneously commenced labour by 40 weeks plus 12 days you will be offered a medical induction of labour. This method uses a medication which is referred to as a pessary which is inserted into the vagina and placed behind your cervix. This pessary contains hormones and it is expected that these hormones work to soften and dilate (open) the cervix. This then creates an opening in your cervix to enable your waters to be broken, called an amniotic rupture of the membranes (ARM). According to NICE (2008), this medical induction occurs in up to 20% of pregnancies

However, it is possible to use complementary therapies in an attempt to initiate labour from 40 weeks. Using a tailored package of care based on your individual circumstances. Therapies you may be able to use include aromatherapy, massage, acupressure and/or acupuncture. Some recent research using aromatherapy, acupressure and reflexology by Grabowska & Weston support complementary therapies alongside a membrane sweep with results showing 65% of first time labour and 74.5% of second or subsequent labour initiating spontaneous labour following treatment. Furthermore, in their most recent audit 16 women declined a sweep but all proceeded to spontaneous labour with the complementary therapies alone.

It is essential if you decide to try the complementary therapy route for any treatment during pregnancy, childbirth or during the post-natal period that you seek out a practitioner who is trained specifically in maternity care.

How can Complementary Therapies contribute?
By Christine Grabowska and Michelle Weston. Complementary Therapies for IOL. See here: https://www.researchgate.net/profile/Christine_Grabowska/publication/258114438_Complementary_therapy_for_induction_of_labour/links/54dd0e7c0cf282895a3b40d5.pdf

Cochrane Systematic Review – Acupuncture for Induction of labour.
By Helen Hall, Lisa McKenna and Debra Griffiths.
See here: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002962.pub2/full

Complementary and alternative medicine for induction of labour
See here: http://www.sciencedirect.com/science/article/pii/S187151921100028X

Help with Morning Sickness

Help with Morning Sickness

Feeling sick (nausea) or being sick (vomiting) may be the first signs that you are pregnant and tends to start at about 6 weeks of pregnancy.  This is because your hormone levels of hCG (human chorionic gonadotropin) is increasing to support your pregnancy.

Therefore, nausea and vomiting is a very common indication of pregnancy with up to 90% of women suffering with symptoms.  These may be triggered, or aggravated, by odours, tiredness, anxiety or stress, a multiple pregnancy or the time of day. Additionally, a family history of the condition or motion sickness may intensify the symptoms.  If vomiting is excessive it can lead to dehydration and weight loss which may be a condition called Hyperemesis Gravidarum which should be reported to your midwife immediately.

Regardless of the cause, the condition is often misunderstood and misinterpreted by health professionals as a minor complaint without acknowledging the debilitating and disruptive effects it has on women and their family.  It can lead to women feeling isolated, depressed and physically and emotionally exhausted.

How can Complementary Therapies contribute?

Complementary therapies offer a holistic assessment of you and your symptoms to understand and appreciate the impact of the condition on your day to day life.  Using stand alone or combinations of therapies such as acupressure, acupuncture, aromatherapy, massage, reflex zone therapy, homeopathy and herbal remedies can help to reduce and improve symptoms.  Ginger may contribute to reducing symptoms but this is not through eating ginger biscuits!

However, these therapies, whist considered natural, must only be used under the instruction of a trained professional, such as myself.  This ensures you have been assessed to have no physiological issues pertaining to the treatment which may cause harm to you or your baby.  It also will provide correct dosages to make sure you don’t take too much and cause the symptoms to return or become worse (known as reverse proving).

Interesting articles for further reading:

By.  Sheba Jarvis and  Catherine Nelson-Piercy.  Management of nausea and vomiting in pregnancy
See here: http://www.bmj.com/bmj/section-pdf/187262?path=/bmj/342/7812/Clinical_Review.full.pdf

Denise Tiran.  Ginger to reduce nausea and vomiting during pregnancy: Evidence of effectiveness is not the same as proof of safety
See here:  http://www.sciencedirect.com/science/article/pii/S1744388111000739

Cochrane Library.   Interventions for nausea and vomiting in early pregnancy
See here: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007575.pub3/full

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