Birthing Topic

INDUCED LABOUR

Induced labour is one that is started artificially. It's fairly common. Every year in the UK, one in five labours are induced. There are a number of reasons labour may need to be started. The baby is overdue or if there is any sort of risk to you or your baby's health. This risk could be if you have a health condition such as high blood pressure, for example, or if your baby is failing to grow. It's normally planned in advance and you're able to discuss it with your midwife and doctor. Every woman has the right to refuse an induction though. Most women go into labour spontaneously by the time they are 42 weeks pregnant. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing. It is usually more painful than if you go into labour naturally.

Membrane sweep 

Your midwife may offer you a sweep if you are full-term and waiting for labour to start. She'll suggest a sweep at your 40-week appointment if this is your first baby, or at your 41-week appointment if you've had 2 or more babies before. 

During a sweep, your midwife carefully separates the membranes that surround your baby from your cervix to stimulate the production of prostaglandin. If your cervix is not dilated enough to do a sweep, she may stretch or massage your cervix instead. You may be offered two or three membrane sweeps.

It can be uncomfortable if your cervix is difficult to reach, and you may need to have several membrane sweeps before labour starts. If you are unclear about anything, ask your midwife to explain.

If you're being induced, you'll go into the hospital maternity unit.

Contractions can be started by inserting a pessary or gel into the vagina. A pessary looks a bit like a tampon. Induction of labour may take a while, particularly if the cervix needs to be softened. Walking around usually helps.

If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work. You should contact your midwife or obstetrician if:

   your contractions begin

   you have had no contractions after six hours

If you've had no contractions after six hours, you may be offered another tablet or gel.

If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you aren't having contractions after 24 hours, you may be offered another dose.

Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24-48 hours to get you into labour.

INDUCED LABOUR

Induced labour is one that is started artificially. It's fairly common. Every year in the UK, one in five labours are induced. There are a number of reasons labour may need to be started. The baby is overdue or if there is any sort of risk to you or your baby's health. This risk could be if you have a health condition such as high blood pressure, for example, or if your baby is failing to grow. It's normally planned in advance and you're able to discuss it with your midwife and doctor. Every woman has the right to refuse an induction though. Most women go into labour spontaneously by the time they are 42 weeks pregnant. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing. It is usually more painful than if you go into labour naturally.

Membrane sweep 

Your midwife may offer you a sweep if you are full-term and waiting for labour to start. She'll suggest a sweep at your 40-week appointment if this is your first baby, or at your 41-week appointment if you've had 2 or more babies before. 

During a sweep, your midwife carefully separates the membranes that surround your baby from your cervix to stimulate the production of prostaglandin. If your cervix is not dilated enough to do a sweep, she may stretch or massage your cervix instead. You may be offered two or three membrane sweeps.

It can be uncomfortable if your cervix is difficult to reach, and you may need to have several membrane sweeps before labour starts. If you are unclear about anything, ask your midwife to explain.

If you're being induced, you'll go into the hospital maternity unit.

Contractions can be started by inserting a pessary or gel into the vagina. A pessary looks a bit like a tampon. Induction of labour may take a while, particularly if the cervix needs to be softened. Walking around usually helps.

If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work. You should contact your midwife or obstetrician if:

   your contractions begin

   you have had no contractions after six hours

If you've had no contractions after six hours, you may be offered another tablet or gel.

If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you aren't having contractions after 24 hours, you may be offered another dose.

Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24-48 hours to get you into labour.

FORCEPS 

About one in eight women have an assisted birth. This can be because 

   There are concerns about the babies heart rate

   The baby is in an awkward position

   The mother is just too exhausted

Forceps are safe and are only used when necessary. If the baby's head is in an awkward position, it will need turning (rotating) to allow the birth. A paediatrician may be present to check your baby's condition after the birth. A local anaesthetic is usually given to numb the vagina and perineum (the skin between the vagina and anus) if you haven't already had an epidural.

Forceps are smooth metal instruments that look like large spoons or tongs. They're curved to fit around the baby's head. The forceps are carefully positioned around your baby's head and joined together at the handles. With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.

There are many different types of forceps. Some forceps are specifically designed to turn the baby to the right position to be born, for example, if your baby is lying facing upwards (occipito-posterior position) or to one side (occipito-lateral position).

Forceps can leave small marks on your baby's face but these will disappear quite quickly.

You will sometimes need a catheter for up to 24 hours. You're more likely to need this if you have had an epidural because you may not have fully regained sensation in your bladder and therefore don't know when it's full.

CAESAREAN 

A caesarean section is an operation to deliver a baby. It involves making a cut in the front wall of a woman’s abdomen and womb.

The operation can be:

a planned procedure, when a medical need for the operation becomes apparent during pregnancy

an emergency procedure, when circumstances before or during labour call for delivery of the baby by unplanned caesarean

A caesarean section is usually carried out under epidural or spinal anaesthetic, where the lower part of your body is numbed. It usually takes 40-50 minutes, but can be performed quicker in an emergency. Some caesarean sections are performed under general anaesthetic.

A caesarean section is usually carried out when a normal vaginal birth could put you or your unborn baby at risk – for example, because:

your labour doesn't progress naturally

you have placenta praevia (where the placenta is low lying in the womb and covering part of the womb's entrance)

you have had two or more previous caesarean sections

your baby is in the breech (bottom first) position

It takes longer to recover from a Caesarean section. You will usually need to spend three to four days in hospital after surgery, compared to one or two days after a vaginal birth.

Epidurals

Will numbs the nerves that carry the pain impulses from the birth canal to the brain. For most women, an epidural gives complete pain relief. It can be very helpful for women who are having a long or particularly painful labour, or who are becoming distressed. An anaesthetist is the only person who can give an epidural, so it won't be available if you give birth at home. Some hospitals offer 'mobile' epidurals, which means you can walk around. However, this also requires the baby's heart rate to be monitored remotely (by telemetry) and many places don't have the equipment to do this. Epidurals are good but it has been found out that one in eight women who have an epidural during labour, need to use other methods of pain relief.

What are the side effects?

An epidural may make your legs feel heavy, depending on the local anaesthetic used.

Your blood pressure can drop (hypotension) however, this is rare because the fluid given through the drip in your arm helps maintain good blood pressure.

Epidurals may prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This might mean that forceps or a ventouse may be needed to help deliver your baby's head. 

Sometimes, less anaesthetic is given towards the end so that the effect wears off and you can push the baby out naturally.

You may also find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you. 

Some women get a headache after an epidural. If this happens, it can be treated with painkillers. 

Your back might be a bit sore for a day or two but epidurals don't cause long-term backache.

TENS machines

TENS stands for transcutaneous electrical nerve stimulation. Some hospitals may have TENS machines. If not, you can hire your own machine, from your local chemist. TENS has not been shown to be effective during the active phase of labour (when contractions get longer, stronger and more frequent). TENS may also be useful while you're at home in the early stages of labour or if you plan to have a home birth.

How it works? 

Electrodes are taped onto your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS. It will also reduces the number of pain signals that are sent to the brain by the spinal cord.

What are the side effects?

There are no known side effects for either you or your baby.

HypnoBirthing

HypnoBirthing is a complete birth education programme, that teaches simple but specific self hypnosis, relaxation and breathing techniques for a better birth.

You can discover that severe pain does not have to be an accompaniment of labour. And learn how to release the fears and anxieties you may currently have about giving birth, and how to overcome previous traumatic births. 

With HypnoBirthing doesn't mean you'll be in a trance or a sleep. Rather, you'll be able to chat, and be and in good spirits - totally relaxed, but fully in control. You'll always be aware of what is happening to you, and around you.

You don't need any particular belief system, or prior experience. Some of our mums (and especially their husbands!) have been very sceptical at first, until they experience it for themselves.

Ventouse assisted delivery

A ventouse is an instrument that is attached to the baby's head by suction. A soft or hard plastic or metal cup is attached by a tube to a suction device. The cup fits firmly onto your baby's head. During a contraction and with the help of your pushing, the obstetrician or midwife gently pulls to help deliver your baby.  

The suction cup leaves a small swelling on your baby's head, called a chignon. This disappears quickly. The cup may also leave a bruise on your baby's head, called a cephalhaematoma. 

A ventouse is not used if you're giving birth at less than 34 weeks pregnant, because your baby's head is too soft. A ventouse is less likely to cause vaginal tearing than forceps.

Your midwife and doctor might recommend an assisted birth if:

*your baby has become distressed during the pushing stage of labour 

*you are very tired and can't push any more 

*your baby isn't making any progress through your pelvis

*there's a medical reason why you shouldn't push for too long (for example, you have heart disease or raised blood pressure, called pre-eclampsia.

You will be given pain relief, which may be a local injection inside the vagina (called a pudendal block) or epidural or spinal anaesthetic. 

A paediatrician (a doctor specialising in the care of babies and children) may be called to the delivery room. This is usual for instrumental births, so try not to worry.

Home birth

You and your birth partner should talk about your hopes for a home birth with your consultant, midwife, or the supervisor of midwives. They'll help you to weigh up the risks before you make a decision. If the advice given is to come into hospital, but you're certain you want a home birth, your choice should be respected. 

Benefits to a home birth include;

*A less painful labour due to being more relaxed

*Knowing the midwives who will be at your birth

*One to one midwifery care

*More privacy and control in labour and afterwards

*Greatly reduced need for medical intervention

*Healthier mum and baby

*Baby is more likely to breastfeed

*Lower rates of postnatal infections for mum and baby

*Dad is never sent away or reduced to visitor status: you can start family life from day one.

*If you have other children they can be as involved as you want them to be.

You can opt to give birth in a birth centre or labour ward instead at any time during your pregnancy. And once you're in labour your midwife can transfer you. Your decision may change as you get nearer the birth of your baby, and your midwife understands this. 

Community midwives usually provide the care for home births. A midwife will come out to you when you are in labour to see how you are getting along. She'll talk to you and your birth partner, and watch you having a few contractions. She may carry out an internal examination to see how far dilated your cervix is, if that is what you want. 

She may stay with you, or she may come back later. It all depends on how far along in your labour you are, and how you're coping with it.

Your midwife will organise a second midwife to join her for your baby's arrival. Ideally, two midwives should be with you when your baby is born. Then, if there's an emergency, one midwife can look after you, while the other one looks after your baby.

After the birth Your midwife will stay until she is happy that you are comfortable and well. She'll see you into bed, and clear up any mess.

Water birth

The relaxing effect of water, with its support and warmth, can help you through your labour. Your contractions may lose their rhythm if you become tense. This means that your labour may stop and start without moving on. Being bathed in water is likely to help you go with your contractions in active labour, so that they are less stressful for you and your baby.

The water buoys you up and makes you feel lighter. It's easy for you to move about, so you can make yourself comfortable. The best position for you is likely to be one that helps your baby move most easily through your pelvis. 

Being in warm water can make it easier for you to cope with the pain of contractions. It's just the same as having a bath to soothe a tummy ache or back ache. Hospital guidelines state that you should not be left alone while you are in a birth pool. This means that either your midwife or your birth partner should be with you at all times.

You may be worried that your baby will inhale water with his first breath if he is born in a birth pool. However, healthy babies don't take their first breath until nerves in their face, mouth and nose have been stimulated by contact with air and a change in temperature. 

You will be asked to leave the pool if:

 *Monitoring your baby's heartbeat shows that there is a problem.

*Your labour is progressing very slowly. Your midwife may suggest getting out and mobilising for a while until your contractions get going again.

*You start bleeding during labour.

*Your blood pressure goes up.

*Your baby's first poo (meconium) is detected in your waters. If you are in the second stage of labour and meconium is detected, you may be able to stay in the pool. Your midwife will check how much meconium is in your waters and your baby's heart rate.

*You feel faint or drowsy.

Sun Safey

Heat Exhaustion 

Heat exhaustion is where a person experiences fatigue as a result of a decrease in blood pressure and blood volume. It's caused by a loss of body fluids and salts after being exposed to heat for a prolonged period of time. Someone with heat exhaustion may feel sick, faint and sweat heavily. 

If a person with heat exhaustion is quickly taken to a cool place and is given water to drink, and if excess clothing is removed, they should start to feel better within half an hour and have no long-term complications. However, without treatment, they could develop heatstroke

Symptoms 

Heat exhaustion 

The symptoms of heat exhaustion can develop rapidly. They are: 

very hot skin that feels ‘flushed’

heavy sweating 

dizziness 

extreme tiredness 

nausea 

vomiting

a rapid heartbeat 

confusion

urinating less often and much darker urine than usual 

A person with heat exhaustion should be moved quickly to somewhere cool and given fluids, preferably water, to drink. They should start to feel better within half an hour.

However, certain groups of people are more at risk of getting heatstroke, or developing complications from dehydration, and should be taken to hospital. These include:

children under two years of age 

elderly people

people with kidney, heart or circulation problems

people with diabetes who use insulin

Treatment 

If you suspect someone has heat exhaustion, follow these steps. 

Get them to rest in a cool place – ideally a room with air conditioning or, if this is not possible, somewhere in the shade.

Get them to drink fluids – this should be water or a rehydration drink, such as a sports drink; they should stop taking fluid on board once their symptoms have significantly decreased usually within 2-3 hours. 

Avoid alcohol or caffeine because they can increase levels of dehydration.

Use cool water (not cold) on their skin – if available, use a cool shower or bath to cool them down, otherwise apply a cool, wet flannel or facecloth to their skin.

Loosen clothing and make sure the person gets plenty of ventilation.

Dial 999 to request an ambulance if the person doesn't respond to the treatment within 30 minutes.

Heatstroke

Heatstroke is a more serious condition than heat exhaustion. It occurs when the body's temperature becomes dangerously high due to excessive heat exposure. The body is no longer able to cool itself and starts to overheat.

Suspected heatstroke should always be regarded as a medical emergency, and you should dial 999 to request an ambulance.

While waiting for the ambulance to arrive you should:

immediately move the person to a cool area

increase ventilation by opening windows or using a fan

give water to drink (if the person is conscious), but don't give them medication, such as aspirin or paracetamol

shower their skin with cool, but not cold, water, alternatively, cover their body with cool, damp towels or sheets, or immerse them in cool water (not cold)

Read more about how to treat heatstroke.

Left untreated, heatstroke can lead to complications, such as brain damage and organ failure. It's also possible to die from heatstroke.

Symptoms 

The symptoms of heatstroke can develop over several days in vulnerable people, such as the elderly and those with long-term health problems. These groups are particularly at risk during spells of hot weather. Symptoms develop more quickly when associated with physical activity. This type of heatstroke, known as exertional heatstroke, usually affects young, active people.  

Symptoms of heatstroke include:

high temperature – a temperature of 40°C (104°F) or above is one of the main signs of heatstroke 

heavy sweating that suddenly stops – if the body can't produce any more sweat, the skin will become dry which is a major warning sign that the body has become over-heated and dehydrated

a rapid heartbeat

rapid breathing 

muscle cramps 

The extreme heat that causes heatstroke also affects the nervous system, which can cause other symptoms such as:

confusion

lack of co-ordination

fits 

headache

vertigo 

restlessness or anxiety

problems understanding or speaking to others

seeing or hearing things that aren't real 

loss of consciousness

Heatstroke is a medical emergency. Dial 999 immediately to request an ambulance if you think that you or someone you know has heatstroke.

Treatment 

Always call an ambulance in cases of suspected heatstroke. While you are waiting for the ambulance to arrive, you should:

move the person to a cool area as quickly as possible

increase ventilation by opening windows or using a fan

give them water to drink (if they are conscious), but do not give them medication, such as aspirin or paracetamol

shower their skin with cool, but not cold, water (15-18°C); alternatively, cover their body with cool, damp towels or sheets or immerse them in cool water (not cold)

wait for medical supervision to arrive before fully immersing the person in water because the body’s response could cause them harm

gently massage their skin to encourage circulation

if they have a seizure, move nearby objects out of the way to prevent injury 

if they are unconscious and vomiting, move them into the recovery position by turning them on their side and ensuring their airways are clear

Tips to protect your child from sunburn

Encourage your child to play in the shade – for example, under trees – especially between 11am and 3pm, when the sun is at its strongest.

Keep babies under the age of six months out of direct sunlight, especially around midday.

Cover exposed parts of your child's skin with sunscreen, even on cloudy or overcast days. 

Use one that has a sun protection factor (SPF) of 15 or above and is effective against UVA and UVB. Don't forget to apply it to their shoulders, nose, ears, cheeks and the tops of their feet. Reapply often throughout the day.

Be especially careful to protect your child's shoulders and the back of their neck when they're playing, as these are the most common areas for sunburn.

Cover your child up in loose, baggy cotton clothes, such as an oversized T-shirt with sleeves.

Get your child to wear a floppy hat with a wide brim that shades their face and neck.

If your child is swimming, use a waterproof sunblock of factor 15 or above. Reapply after towelling.

Sunburn

Sunburn is skin damage caused by ultraviolet (UV) rays. Too much exposure to UV light can make your skin red and painful, which can later lead to peeling or blistering.

The severity of sunburn can vary depending on your skin type and how long you are exposed to UV rays.

However, the main symptoms of sunburn are red, sore and blistering skin. The symptoms may not occur immediately and can take up to five hours to appear.

Symptoms 

The symptoms of sunburn vary from person to person, and depend on your skin type and the length of time you are exposed to UV rays. The paler your skin, the more likely you are to burn compared with someone with darker skin.

The symptoms of sunburn include:

red, sore skin 

skin that is warm and tender to the touch

flaking and peeling skin after a number of days (usually four to seven days after exposure)

Dark skin can also burn and become damaged if exposed to enough UV light. However, as dark skin contains more pigments it can tolerate sunlight without burning for longer than paler skin.

The symptoms of sunburn are not always immediately obvious. They usually begin three to five hours after exposure to the sun's rays, and are usually at their worst 12 to 24 hours after being in the sun.

Severe cases of sunburn can cause:

blistering

swelling of the skin 

chills

a high temperature of 38ºC (100.4ºF) or above

a general feeling of discomfort 

You may also have symptoms of heat exhaustion, such as:

dizziness

headache

nausea 

You should contact your GP surgery if you have severe symptoms of sunburn, if you are burnt over a large area, or if a young child or baby has sunburn.

Treatment 

If you have sunburn, you should avoid direct sunlight by covering up the affected areas of skin and staying in the shade until your sunburn has healed. However, protecting your skin from the sun using sunscreen is better than treating it. Most cases of sunburn can be treated at home by following the advice below.

Water

Cool the skin by sponging it with lukewarm water or by having a cool shower or bath. Applying a cold compress such as a cold flannel to the affected area will also cool your skin.

Drinking plenty of fluids will help to cool you down and will replace water lost through sweating. It will also help prevent dehydration. You should avoid drinking alcohol as it will dehydrate you even more.

Moisturiser

For mild sunburn, apply a moisturising lotion or aftersun cream, available at pharmacies. Aftersun cream will cool your skin and moisturise it, helping to relieve the feeling of tightness.

Moisturisers that contain aloe vera will also help soothe your skin. Calamine lotion can relieve any itching or soreness.

Painkillers

Painkillers can help relieve the pain and reduce the inflammation caused by sunburn.

Paracetamol can be used to treat pain and control fever.

 Ibuprofen is a type of non-steroidal anti-inflammatory drug that can help relieve pain, reduce inflammation and lower a high temperature.

Aspirin should not be given to children who are under the age of 16. 

Severe sunburn

Severe cases of sunburn may require special burn cream and burn dressings. Ask your pharmacist for advice. You may need to have your burns dressed by a nurse at your GP surgery.

Very severe sunburn cases may require treatment at your local A&E department.

Postnatal Depression

WHAT IS POSTNATAL DEPRESSION?

Postnatal depression is a type of depression some women experience after having a baby. It can develop within the first six weeks of giving birth, but isn't always apparent until around six months. Postnatal depression is more common then people realise, affecting around 1 in 10 women after giving birth. Any woman can be affected from any walk of life and teenage mothers are particularly at risk. It can sometimes go unnoticed and many are totally unaware they have it, eve if they don't feel quite right.

SIGNS & SYMPTOMS 

There are many symptoms of postnatal depression. They're wide-ranging and can include low mood, poor appetite, difficulty sleeping, loss of libido, irritability and episodes of tearfulness. These are all common after having a baby and are often known as the "baby blues" and usually clear up after a few weeks but if they persist, it could be postnatal depression. Some women don't realise they have it, or choose to ignore their symptoms. They're afraid to be seen as a bad mother but it doesn't mean you don't love or care for your baby. If you think somebody you know is showing any of the symptoms, be supportive and encourage them to see their GP. It's important to understand that postnatal depression is an illness.

The cause of post natal depression is not completely known. Experts think post natal depression is the result of a combination of things.

These may be:

depression during your pregnancy

a difficult deliver of your baby

lack of support at home

relationship worries

money problems

having no close family or friends around you

physical health problems following the birth, such as urinary incontinence, or persistent pain from an episiotomy scar or a forceps delivery

Even if you have none of these problems and you had a straightforward pregnancy or labour, just having a baby can be a stressful and life-changing event that could trigger depression.

People often assume that you will naturally adapt to parenthood overnight. But in fact it can take months before people begin to cope with the pressures of being a new parent. 

Even if this is your 2nd, 3rd or 4th baby, doesn't mean you won't get post natal depression. Some babies are more difficult and more demanding than others, and don't settle so easily. This could lead to exhaustion and stress.

What increases your chance of post natal depression include;a family history of depression or postnatal depression

having experienced depression or postnatal depression previously 

mood disorders such as bipolar disorder.

The most important first step in managing postnatal depression is recognising the problem and taking action to deal with it. The support and understanding of your partner, family and friends plays a big part in your recovery.

Guided self-help

Guided self-help is based on the principle that your GP can "help you to help yourself".

Talking therapies

Talking therapies are where you are encouraged to talk through problems either one-to-one with a counsellor or with a group. You can then discuss ways to approach problems in a more positive manner.

Antidepressants

The use of antidepressants may be recommended if:

You have moderate postnatal depression and a previous history of depression.

You have severe postnatal depression.

You have not responded to counselling or CBT, or would prefer to try tablets first.

A combination of talking therapies and an antidepressant may be recommended.

If it is felt your postnatal depression is so severe you are at risk of harming yourself or your baby, you may be admitted to hospital or referred to a mental health clinic. If you have support available from your partner or family, it may be recommended they care for your baby until you are well enough to return home.

Diagnosis

Your GP should be able to diagnose postnatal depression by asking two questions:

*During the past month, have you often been bothered by feeling down, depressed or hopeless?

*During the past month, have you often been bothered by taking little or no pleasure in doing things that normally make you happy?

If the answer to either of these is yes, then it is possible you have postnatal depression. If the answer is yes to both, postnatal depression is probable.

Some mothers, especially those without a partner or relative to help care for their baby, can be reluctant to provide honest answers to these questions. This is because some worry that a diagnosis of postnatal depression will mean they are seen as a bad mother and that there is a chance their baby will be taken into care. It should be stressed that a baby will only be taken into care in the most exceptional of circumstances. One of the prime goals of treatment of postnatal depression is to help you care for and bond with your baby.

Symphysis Pubis Dysfunction (SPD)

SPD

The symphysis pubis is a stiff joint that connects the two halves of your pelvis. This joint is strengthened by a dense network of tough, flexible tissues. Your body produces a hormone called relaxin, which softens your ligaments in order to help your baby pass through your pelvis. Your pelvic joints move more during and just after pregnancy. This can cause inflammation and pain. 

Symptoms 

Pain in the pubic area and groin are the most common symptoms, though you may also have the following signs: 

Back pain, pelvic girdle pain or hip pain.

A grinding or clicking sensation in your pubic area.

Pain down the inside of your thighs or between your legs. It can be made worse by parting your legs, walking, going up or down stairs or moving around in bed.

Worse pain at night. SPD can prevent you from sleeping well. 

Causes of SPD

SPD is thought to be caused by a combination of hormones that you produce during pregnancy, as well as the way your body moves. If one side of your pelvis moves more than the other when you walk or move around, the area around the symphysis pubis becomes tender. 

The size of the gap in your joint doesn't bear any relation to the amount of pain you may feel. Many women with a normal-sized gap feel a lot of pain. You may be more likely to develop SPD if you started your periods before you were 11, or are overweight.

When does SPD happen?

SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time during the middle of your pregnancy. 

If you have SPD in one pregnancy, it is more likely that you'll have it next time you get pregnant. The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to get pregnant again.

How is SPD diagnosed?

SPD is becoming more widely understood by doctors, physiotherapists and midwives. Your doctor or midwife should refer you to a women's health physiotherapist. Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles.

How is SPD treated?

Exercises, especially focused on your tummy and pelvic floor muscles. These will improve the stability of your pelvis and back. You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes help.

You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan which takes into account your SPD symptoms.

A pelvic support belt will give quick relief.

Pre-Eclampsia

Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.

Symptoms 

swelling of the feet, ankles, face and hands caused by fluid retention 

severe headache

vision problems

pain just below the ribs

Although many cases are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated. 

Who is affected?

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)

What causes pre-eclampsia?

Although the exact cause of pre-eclampsia is not known, it is thought to occur when there is a problem with the placenta 

Treating pre-eclampsia

If you are diagnosed with pre-eclampsia, you should be referred for an assessment by a specialist. This will usually be in a hospital. While in hospital you will be monitored closely to determine how severe the condition is and whether a hospital stay is needed.

The only way to cure pre-eclampsia is to deliver the baby, so you will usually be monitored regularly until it is possible for your baby to be delivered. This will normally be at around 37-38 weeks of pregnancy, but it may be earlier in more severe cases. At this point, labour may be started or you may have a caesarean section 

Medication may be recommended to lower your blood pressure while you wait for your baby to be delivered.

Prenatal Depression

What is it?

Antenatal depression, also known as Prenatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% percent of pregnant women are affected by this condition.

SIGNS AND SYMPTOMS

Antenatal depression is classified based on a woman's symptoms. During pregnancy, a lot of changes to mood, memory, eating habits, and sleep is common. When these common traits become severe, and begin to alter one's day-to-day life, that is when it is considered to be antenatal depression. Symptoms of Antenatal depression are:

Inability to concentrate.

Difficulty remembering.

Feeling emotionally numb.

Extreme irritability.

Sleep problems that aren't related to pregnancy.

Extreme or unending fatigue

Desire to over eat, or not eat at all.

Weight loss/gain unrelated to pregnancy.

Loss of interest in sex.

A sense of dread about everything, including the pregnancy.

Feelings of failure, or guilt.

Persistent sadness.

Thoughts of suicide, or death.

Other symptoms can include the inability to get excited about the pregnancy, and/or baby, a feeling of disconnection with the baby, and an inability to form/feel a bond with the developing baby.This can drastically effect the relationship between the mother and the baby, and can drastically effect the mother's capacity for self care

CAUSES

Antenatal depression affects about one in every eight women.It's becoming more prevalent as more medical studies are being done. Antenatal depression was once thought to simply be the normal stress associated with any pregnancy, and was waved off as a common aliment. It can be caused by many factors, usually though involving aspects of the mothers personal life such as, family, economic standing, relationship status, etc. It can also be caused be hormonal and physical changes that are associated with pregnancy.

TREATMENT

Treatment for Antenatal depression poses many challenges because the baby is also affected by any treatments given to the mother. It is suggested that the emotional aspects are handled first which includes;

Taking it easy by relaxing when possible.

Spending time with your partner.

Talk about your fears & anxieties involving the pregnancy.

Manage your stress.

Counseling is highly recommended to any woman suffering from antenatal depression. It is a very effective way for the mother to express her feelings and explain in her own words what she is feeling. This is very effective in that it gives the doctors a better insight into the symptoms and their severity. In severe cases Medication can be prescribed. This is usually only done if the symptoms have proven so severe that they interfere with day-to-day life, self care, and ability to sleep.

Gestational Diabetes

What Is It?

Gestational Diabetes means you have a high blood sugar level that happens during pregnancy. The condition usually resolves itself after your baby is born.

Gestational Diabetes begins in your second trimester. If you develop diabets in pregancy it means that either your body isnt releasing enough insulin or your cells arnt responding to it. The result is that your blood sugar remains high, this can have a number of effects on you and your baby.

SIGNS AND SYMPTOMS

Symptoms of Gestational Diabetes are uncommon. This is because the condition is usually diagnosed from screening tests before symptoms develop. However, if diabetes isnt detected or treated you may have the following symptoms :

feeling thirsty more often than usual

needing to urinate more often

having infections which affect your urinary tract

 

These symptoms aren’t always caused by gestational diabetes. If you notice any of these symptoms, see your doctor.

CAUSES

There are a number of factors that can increase your risk of getting Gestational Diabetes. You are more at risk if you:

Are overweight or obese

Have given birth to a baby that wieghed 4.5KG or more

Had Gestational Diabetes in a previous pregnancy

Have a close relative with Diabetes

Have Polycystic overies syndriome

Your ethnic group may also increase your risk of it. The condition is more common in people with a South Asian, Black Carrabian, or a Middle Eastern background.

TREATMENT

If you’re diagnosed with diabetes, you should be offered an appointment with a joint diabetes and antenatal clinic. The doctors and nurses here will be experienced in looking after pregnant women with diabetes. You will have more frequent antenatal appointments than women who don't have gestational diabetes.

Your treatment will be aimed at keeping your blood sugar lowered enough to help prevent complications. You will need to regularly test your blood sugar

Placenta Previa

What Is Placenta Previa?

The placenta is the organ created during pregnancy to nourish the fetus, remove its waste, and produce hormones for your pregnancy. The placenta is attached to the wall of the uterus by blood vessels that supply the fetus with oxygen and nutrition and remove waste from the fetus and transfer it to the mother.

The fetus is attached to the placenta by the umbilical cord. Through the cord, the fetus receives nourishment and oxygen and removes waste. On one side of the placenta, the mother's blood circulates, and on the other side, fetal blood circulates. The mother's blood and fetal blood usually don't mix in the placenta.

The placenta is usually attached to the upper part of the uterus, away from the cervix, the opening which the baby passes through during delivery. On rare occasions, the placenta lies low in the uterus, partly or completely blocking the cervix, a condition called placenta previa.

Placenta previa is frequently seen in pregnancies before the 20th week but usually resolves in most cases, leaving only 10% that persist into later pregnancy. As the uterus grows, the placenta usually moves higher in the uterus, away from the cervix. But if it remains near the cervix as your due date nears, which happens in about 1 in 200 pregnancies, you're at risk for bleeding, especially during labor as the cervix thins and opens. This can cause major blood loss in the mother. For this reason, women with a placenta previa usually deliver their babies before their due date by cesarean delivery.

There are several types of placenta previa:

A low-lying placenta is near the cervical opening but not covering it. It will often move upward in the uterus as your due date approaches.

A partial placenta previa covers part of the cervical opening.

A total placenta previa covers and blocks the cervical opening.

What Causes Placenta Previa?

The cause of placenta previa is usually unknown, although it occurs more commonly among women who are older, smoke, have had children before, are pregnant with more than one baby (twins, triplets, or more) or have had a cesarean section or other surgery on the uterus.

Women with placenta previa,  particularly if they have a placenta previa after having delivered a previous baby by cesarean section, are at increased risk of placenta accreta, placenta increta, or placenta percreta.

In placenta accreta, the placenta is firmly attached to the uterus. In placenta increta, the placenta has grown into the uterus; and in placenta percreta, it has grown through the uterus. These conditions can sometimes be confirmed by ultrasound, CT scan, or MRI. Women with one of these conditions usually require a hysterectomy after delivery of the baby because the placenta does not separate from the uterus.

Symptoms of Placenta Previa

Some women with placenta previa don't have any symptoms. But others may have warning signs such as:

Sudden, painless vaginal bleeding - the blood is usually bright red, and the bleeding can range from light to heavy.

Symptoms of early labor - these include regular contractions and aches or pains in your lower back or belly.

Call your doctor or go to the nearest emergency room right away if you have:

Medium to heavy vaginal bleeding during the first trimester.

Any vaginal bleeding in the second or third trimester.

Treatment of Placenta Previa

Close monitoring throughout your pregnancy - In 90% of cases the placenta moves from infront of the cervical opening before you give birth

If you aren't bleeding, you may not need to be in the hospital. But you will need to be very careful.

Avoid all strenuous activity, such as running or lifting.

Call your doctor and go to the emergency room right away if you have any vaginal bleeding.

In the 10% of cases where this doesn't happen a c section is preformed due to risks involved for Mum & baby. 

If you are bleeding, you may have to stay in the hospital. If you are close to your due date, your baby will be delivered. Doctors always do a C-section when there is a placenta previa at the time of delivery. A vaginal delivery could disturb the placenta and cause severe bleeding.

If your bleeding can be slowed or stopped, your doctor may delay delivery and monitor you and your baby closely. The doctor may do:

Fetal heart monitoring to check your baby's condition.

Amniocentesis to find out if your baby's lungs are fully formed.

You may be given:

A blood transfusion if you've lost a lot of blood.

Steroid medicines if you aren't close to your due date. These medicines help get your baby ready for birth by speeding up lung development.

Tocolytic medicine to slow or stop contractions if you are in early labor.

If your newborn is premature, your baby may be treated in a neonatal intensive care unit, or NICU. Premature babies need to stay in the hospital until they can eat, breathe, and stay warm on their own.

Hyperemesis Gravidarum

What is Hyperemesis Gravidarum?

Hyperemesis gravidarum also known as HG, is a condition that is much more severe than normal  pregnancy sickness.

It can be so severe that a woman becomes dehydrated, lose weight could have to be admitted to hospital and put on a saline drip under specialist care.

Causes of Hyperemesis Gravidarum

It is thought that a lack of vitamin B6 in the diet may be a cause of HG.

You should be able to get enough vitamin B6 through a healthy, balanced diet. It's present in foods including cereals, wholemeal bread, cod, potatoes, milk and bananas. 

Vitamin B6 supplements may ease your symptoms, but don't take them without speaking to your doctor first as it's not clear how safe it is to take vitamin B6 supplements during pregnancy.

Symptoms of Hyperemesis Gravidarum?

The symptoms of HG go far beyond the discomfort of morning sickness and require urgent medical attention. 

They include:

Continued & severe nausea and vomiting

Dehydration caused by the vomiting

Ketosis - raised levels of toxic acidic chemicals in the blood called ketones

Losing weight due to inability to keep food down

Low blood pressure, known as hypotension, especially on standing up

Risk of DVT - deep vein thrombosis (blood clots in a vein) - due to dehydration

In terms of the quality of life, HG can affect a woman’s work, home life and family life due to frequent vomiting.

It’s been described by some women as like having your stomach turned inside out. This lasts for weeks and weeks and weeks. It can last throughout the whole pregnancy for some very unfortunate women.

Treatment of Hyperemesis Gravidarum

Is there anything that pregnant women can do themselves to alleviate the symptoms?

Doctors suggest trying to move less, avoiding tasks such as cleaning the house may help, as any movement may exacerbate the feeling of nausea. 

Rest and relaxation may be recommended as well as avoiding some smells, including food or cooking odours.

In some cases HG needs specialist treatment, and you will need to be admitted to hospital so that doctors can assess your condition and give you the right treatment. This can include intravenous fluids given through a drip to treat the ketosis and treatment to stop the vomiting.

Hyperemesis gravidarum is unpleasant with dramatic symptoms, but the good news is it's unlikely to harm your baby. However, if it causes you to lose weight during pregnancy there is an increased risk that your baby may be born smaller than expected.