As soon as you discover you are pregnant, questions arise. The start of a new life brings change and responsibilities. A healthy pregnancy starts with good and early pregnancy advice. Therefor we encourage you to come and see us as soon as you find yourself pregnant. Engaging early ensures continuity of care, advice and education throughout your pregnancy, birth and postnatal period, improving health outcomes for both yourself and that of your baby. During the intake appointment we get to know each other and discuss the midwifery care appropriate for you, taking your personal history into account. We provide you with information e.g. in regards to your care options, screening tests, healthy lifestyle and supplements. A personalized maternity care record book will be set up which you will bring with you to every subsequent visit. Baseline observations will be taken such as a blood sample, urinalysis, blood pressure and weight. Also your expected date of delivery will be determined and a viability and dating scan will be requested as appropriate.
During following antenatal visits your personal pregnancy care pathway will be formulated. We share our knowledge and the observations with you, taken during your pregnancy. In our small-scaled midwifery practice there is lots of space and time for listening and advising. You will be fully informed and involved. Your personal experiences, questions and feelings will be taken into account in the preparation to childbirth.
When you are pregnant it is important to eat healthy. A Healthy and varied diet will meet most nutritional requirements during pregnancy, along with folic acid and iodine supplementation. Foods that potentially contain listeria should be avoided during pregnancy, as listerioris can result in miscarriage, stillbirth or premature birth. Foods that have a higher risk of carrying listeria include cold “deli” meats, raw seafood and soft cheeses made from unpasteurized milk. We recommend the guidelines on the following website: http://www.foodsmart.govt.nz/information-for/pregnant-women/
Alcohol consumption should be avoided during pregnancy, as there are no known safe limits. High alcohol consumption during pregnancy is associated with fetal alcohol spectrum disorders (FASD) which result in growth problems of the unborn baby and post natally, among other effects.
We also recommend that women who are pregnant (and breastfeeding) limit their daily caffeine consumption. Energy drink can contain high levels of caffeine and should be avoided. High doses of caffeine during pregnancy have been associated with increased risks of congenital abnormalities, miscarriage, low birth weight and withdrawal symptoms in the newborn infant.
Folic acid reduces the risk of neural tube defects in the developing baby. It is recommended that all women intending to become pregnant should start taking folic acid, ideally at least four weeks prior to conception and continued for the first 12 weeks of pregnancy. Women who have an increased risk of conceiving a baby with neural tube defect require a higher dose of folic acid: 5 mg, daily.
Folic acid is available as an 800 mc tablet or a 5 mg tablet (each taken once daily), subsidized on prescription or purchased over-the-counter from a pharmacy. The Ministry of Health recommends that women shouldonly take folic acid tablets that are registered as medicines and not rely on dietary supplements.
Iodine supplements should be taken throughout your pregnancy and breastfeeding. Iodine is essential for normal growth and brain development in the fetus. It is recommended that pregnant and breastfeeding women take 150 mcg of supplementary iodine, daily, starting when pregnancy is confirmed and continued until breastfeeding ceases. Like folic acid, iodine supplements are fully subsidized when on script. Foods that contain iodine include cooked seafood, milk, eggs, iodised salt and bread (iodised since 2009).
Iron supplements and multivitamins are not routinely required.
If dietary iron intake and iron stores are adequate iron supplements are not routinely required. The best way to ensure this is to maintain adequate pre- conception iron stores by eating foods high in iron, e.g. lean beef and lamb. I low iron stores or iron deficiency is suspected and confirmed, we prescribe you an oral supplementation that is subsidized. Iron supplements can cause constipation, therefore we advice to include adequate amounts of fluid and fibre in your diet.
Multivitamin supplements are not routinely required in pregnancy. If you do wish to take one make sure it contains adequate amount of folic acid and iodine and does not contain excessive amounts of fat soluble vitamins (vitamin A,D,E and K), which can accumulate in your body. Vitamin A-containing supplements, in particular, are not recommended during pregnancy, as excessive intake of vitamin A has been associated with teratogenicity during the first trimester, e.g. cleft lip and palate central nervous system abnormalities.
During each antenatal visit routine observations are gathered. In addition there will also be blood samples, ultrasounds and any other screening or diagnostic tests that may be indicated.
We recommend for all pregnant women to have routine antenatal blood sampling at:
In some pregnancies observations may indicate extra blood sampling to rule out pregnancy complications. The majority of the blood sampling is done during the visit with your Central Otago Midwife in a comfortable environment.
At intake your first ultrasound for determination of your due date will be organized when you are unsure of your first date of your last period (LMP), if you have irregular periods or when you need reassurance in regards to the viability of your pregnancy.
A prenatal screening ultrasound that will take place at 13 weeks gestation in combination with a maternal serum blood sample as part of the first trimester NT-screening will be offered and explained to you at intake. This prenatal screening calculates your risk of having a baby with chromosomal abnormalities such as Down syndrome (Trisomy 21), Patau syndrome (Trisomy 13) and Edwards syndrome (Trisomy 18).
At 19 weeks of pregnancy it is standard for all pregnant women to have a ‘ foetal anatomy ultrasound’. The aim of this scan is to rule out any structural abnormalities in your baby’s tissues and organs. Besides looking at your baby’s anatomy this ultrasound will also have a look at the amount of amniotic fluid around your baby, your baby’s growth and the placenta. These parameters are recorded and may later be used again for comparison.
In some pregnancies a standard ultrasound or routine observation may indicate the need for an extra ultrasound to monitor the well being of your pregnancy and to rule out pregnancy related complications. You can be confident that your midwife will suggest this to you appropriately.
There are a few things to think about and prepare for before your baby is born. During our antenatal visits we will take time to discuss these with you. For example:
After 20 weeks of pregnancy we will start discussing and formulating a birth plan. For some women this can be helpful in the preparation of their delivery practically and emotionally. The aim is to make any healthcare provider involved in the birth of your baby aware of your wishes. At the same time it is also a useful tool to help discuss any expectations that you and your partner may have of one another or your Central Otago LMC.
We will take time to explain all the options there are available and to help you understand the mechanism and stages of labor. Our aim is to keep you fully informed in the lead up to delivery and during the delivery so that you are involved in the decision making process and to avoid any surprises as much as possible.