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150 Department Of Health New Zealand

Acknowledgement The Department of Health would like, to thank the many
Te Whakatau organisations and individuals who have helped in the preparation of
this book.
It was adapted with permission, from THE BOOK OF THE
CHILD published by the Scottish Health Education Unit.

Department of Health
New Zealand
1985

Telegraphic Address:
TATAU" Wellington
AO
MAORI WOMEN'S WELFARE LEAGUE (INC.)
Telephone 736-451 24 BURNELL AVENUE
WELLINGTON 1
P.O. BOX 12-072 WELLINGTON NORTH

Foreword
Te KOrero Whakataki
It is with pleasure that I respond to your request to write a
foreword for the content and presentation of the booklet Your
Pregnancy.
Members of the Maori Women's Welfare League found it most
informative with good Maori sections and very appropriate illustrations.
Above all we have appreciated that it was presented in a way
which young Maori/all parents would readily understand and respond
to.
It's the kind of book that we can use in the home to prepare our
daughters for motherhood - to convince them that it is a natural
progression in marriage.
The book portrays the beautiful meaning to pregnancy. It would
be a valuable resource in schools to inform pupils, to encourage healthy
interest and discussion and to ensure an acceptance by both boys and
girls that pregnancy is a joint responsibility, from beginning to end, for
both husband and wife.
As we have advocated for years the acceptance of Maori as an
official language of New Zealand, we applaud your use of "TE REO" -
the Maori language.
You have done a national service with the preparation and
publication of this book, and are to be congratulated.
I wish the book every success.

Arohanui

June Mariu (Q.S.M., J.P.)

National President
Maori Women's Welfare League

085885

LIBRARY
DEPARTMENT OF HEALTtc
—WELLINGTON
 Your Pregnancy
TO HapUtanga
What's in this book If you are pregnant, this book is for you. It takes you right through
and who is it for? pregnancy and the first few weeks after your baby is born.
He aba nga körero It gives plenty of information and ideas and suggestions for you to
o te pukapuka nd, pick and choose from.
a, ma wal nga Throughout the book we have given examples of what will
körer& probably happen to you. But you should remember that practices and
opinions may differ from place to place and between one cultural group
and another. So don't worry if your own experiences aren't exactly like
those in the book.
We often refer to "partners" in this book, though we realise that
not every woman will have the support of a partner during her
pregnancy. We hope the advice offered will be useful to everyone.
Try to keep this book by you and come back to it when you are
expecting another baby.
We would like your ideas on how this book can be improved.
Please write with these to:

Department of Health
P0 Box 5013
WELLINGTON

3
 Contents

Page
Am I pregnant?
Kei te hapu ano ahau?
How can you tell?
7 Some words you'll hear a lot now that you're pregnant
8 Action plan for pregnancy.
Nga mahi mo nga wahine hapu
How can I help myself?
11 Feelings and relationships
17 What to avoid
19 Any problems?
21 Benefits, leave and help in pregnancy
23 Start collecting things for your baby
24 A new life
He oranga hou
26 Growing in the womb
29 How should I feed my baby?
Me pehea au e whangai i taku pepi
Breastfeeding
33 Health care in pregnancy
Nga ahutu mo te wa hapu
Antenatal checks
35 Special tests
37 What other decisions are there to make?
40 When labour starts
Te timata o te whakamamae
Plan ahead
41 How will you know?
42 What should you do?
43 Giving birth
Te whakawhanau
Going to hospital
44 The stages of labour
47 Coping with pain
49 Other things that can happen
52 Love at first sight?
Te aroha i te kitenga tuatahi?
54 Taking care of yourself
Me atawhai koe Ia koe
57 How do you feel?
58 Fitting everything in
61 Family planning
63 You have access to many services during pregnancy
He maha nga kaiawhina mo te wahine hapu.
64 Booklist
65 Index

5
 Am I Pregnant?
Kel te HapU AnO Ahau?
Some women say that they "just know" when they are pregnant.
Their bodies suddenly "feel" different to them and their feelings are
strengthened when they miss a period. Other women may be several
months pregnant before they know it. This is often the case with
women who have irregular periods.

Signs of Pregnancy Watch out for the fairly common signs listed below,
Ngã Tohu o te remembering that every pregnancy is slightly different. You are
HapUtanga unlikely to notice all the signs in one pregnancy. Put a tick in the
box next to the signs you've noticed.

Missing a period. El
Having a very short period, with little loss of blood.
Noticing changes in your breasts.
Swelling, tingling, throbbing, even hurting. El
Veins showing up more. El
Nipples and surrounding area darkening and
seeming larger. El
4 Needing to pass water more often; perhaps having to get up
in the night. El
5 Being constipated. El
6 Having an increased vaginal discharge. El
7 Feeling, or even being, sick. El
8 Changing tastes.
Having a strong taste in your mouth, often described as
metallic.
Going off some foods, e.g., coffee, alcohol, spicy
things.
9 Being more tired than usual.

How Can You Tell? Start by filling in the chart above. If you tick numbers 1 or 2, plus
Me Pëhea Au I 2 or more of the others, then you are probably pregnant.
Möhio Al? By the time you have missed 2 periods, the doctor should be able to
check whether you are pregnant by an internal examination.
(Refer page 34).
Many women want to know as soon as possible. You can be sure
by having a pregnancy test done when your period is just overdue. The
test is best done on a sample of the first urine you pass in the morning.
Your doctor can arrange the test for you or you may go to your local
Family Planning Clinic.
You are almost certainly pregnant if the result of the test is
"positive". Positive tests are nearly always right
But a "negative" result does not rule out pregnancy completely.
You are probably not pregnant, but you may need another test to make
sure. Talk it over with your doctor.
If you think you are pregnant, it's best to make an early visit to
your doctor. The proper care can start right away.
Remember, it's important to tell your doctor at your first visit
about any medicines you are taking.

6
 Some Words You'll Hear a Lot
Now That You're Pregnant
Itahi Kupu ka Rangona Nuitia e
Koe na te mea kua HapU Koe
Inaianei

'
-4 I

Fallopian tube

Fj,I[*3
0n
Ovary

11

Cervix

Rectum

Vagina

Fallopi
Ovary
Uterus Y
Cervix
Vagina
&

7
 Action Plan For Pregnancy
Nga Maul mO nga Whine Hapü
How Can I Help Once you know for sure you are pregnant, you may be excited or
Myself? even apprehensive about what lies ahead. But there are many steps you
Me Pëhea Ahau? can take to help yourself through pregnancy and gain confidence for
childbirth.

Eat Well This means eating a variety of foods. Pregnancy is normal and a
Me Tika te Kai special diet is not necessary.
What do we mean by a variety of foods?
To make sure you have an adequate diet, eat some foods from each
of these four groups every day.
1 fruits and vegetables
2 bread and cereals, some wholegrain
3 milk products - milk, cheese, yoghurt, ice cream
4 meat, poultry, fish, eggs, peas, beans and lentils; including some
dried varieties.

These foods supply all the nutrients you need. Some people believe
that pregnancy means eating for two, eating twice as much as usual.
This is not true. Energy requirements during pregnancy are greater than
usual but not nearly double. Your appetite, which tells you how much


food you need, will increase. Women who eat in response to their
appetite gain about 12.5 kg (281b) during pregnancy. During the first
three months, there is little change in weight. Later, weight gain will
average about 1 kg per fortnight. Total weight gain would be made up
of approximately:
Foetus (baby) and placenta (afterbirth) 4.0 kg
Extra tissue (e.g., breast and uterus) and fluids 5.0 kg
Fat 3.5 kg
The fat you store is used to provide extra energy for breastfeeding
the baby.
Cutting down on the amount of food you eat in pregnancy to
control your weight is not a good idea. Your baby's birth weight may be
less than it should be. That means that the baby may have trouble
coping with labour and birth. Your milk supply can be reduced, too.
As a general rule, vitamin and mineral supplements are not needed.
Avoid taking them, particularly in the early months of pregnancy as
they may affect the developing baby. However, your doctor may
prescribe iron and folic acid pills, particularly if you are anaemic or if
you have had frequent pregnancies.
• (You should avoid drinking alcohol, or limit yourself to a very
occasional glass of beer, wine or spirits while you are pregnant, as the
alcohol may affect the developing baby: You should also give up
smoking as soon as possible.)
Two more points worth remembering are:
1 Don't forget to drink plenty of water each day. It helps prevent
urinary infections, and may help if constipation is a problem.
2 Take special care with toothbrushing to keep your gums healthy...

Keep Active Keeping fit during pregnancy, helps you cope with the work of
Me Mátãtoa labour, and speeds your recovery after the birth.
Carry on with normal daily activities, doing what is comfOrtable
for you at a slower speed, and for a shorter length of time.
Rest as necessary.
Walk, cycle or swim 20 minutes daily at a comfortable speed.
Lift only objects that you can comfortably manage.
For good bladder control, practise pelvic floor muscle tightening
every day.
How to do it.
Tighten around the bowel opening as if you are stopping yourself
passing wind.
Tighten around the vagina as if you are holding a tampon in place.
Tighten around the bladder opening as if you are stopping yourself
from passing water. -
Tighten all openings and pull up.
Hold to the count of four. Then relax.
Gently exercise the pelvic floor For more information on:
muscles to help strengthen
them. - back care - turn to page 10.
- varicose veins - turn to page 21.

Clitoris
Urethra
Vagina

Anus

Pelvic muscles

9
Visit Your Doctor This is an important part of looking after yourself. Regular check-
Haere ki tOu Tãkuta ups for pregnant women are provided by some family doctors, by
antenatal teams at public hospitals, and by private obstetricians. The
health care for your pregnancy, the baby's birth, and your postnatal
check, is free if you see your family doctor, or your domiciliary
midwife, or if you go to a public hospital. You will be charged a fee if
you see a private obstetrician.
These services all have their own advantages and disadvantages.
Check Out what choices of doctor, domiciliary midwife and hospital
you have in your area.
Your family, friends and/or family doctor can help you decide
which would be best for you; ask local organisations. Your family
doctor can make all the arrangements. Even if you don't see your family
doctor for your regular checks you can still consult them about any
worries you have.
Antenatal checks are usually carried out about every four weeks UJ)
to the 28th week of pregnancy, every two weeks up to the 36th week,
then weekly until labour begins at about 40 weeks.
There's more about what happens at the checks on page 33.

Look After Your

Back
Tiakina to Tuarã
3 Squat to do chores that make
you bend.

2 When you lift, bend your

knees and keep your back
straight.
4 When sitting and looking
1 Sit, stand and walk tall. When down, tuck your chin in to keep
standing, push the top of your your neck as straight as
head upwards. Notice how your possible. You can use a book to
bottom and tummy are tucked raise the height of a bench or
in. table, or choose a lower chair.

5 Try this exercise (the pelvic

tilt) to ease backache and tone
up your tummy muscles. Lying
as shown, press your back
towards the floor, tightening
the muscles of your tummy and
bottom. Do this several times,
slowly and gently, breathing
naturally.

10
Feelings and From the minute you know you're pregnant, things begin to
Relationships change. Your feelings may change about yourself, the baby, and your
Te Hmengaro me te future. And your relationships - with your partner, with parents and
Whanaungatanga friends may also change.
Adjusting to the changes that pregnancy brings isn't always easy.
This section is about some of the worries that often crop up in
pregnancy. There are some suggestions about how to cope, and some
factual information that you may find helpful.

Feelings When you are pregnant it can sometimes seem as though you are
Te Hinengaro not allowed to be anything but happy. People expect you to be looking
forward to the baby, to be excited, and to 'bloom'.
In fact, just like any other nine months of your life, you're quite
likely to have times when you feel low.
To begin with, nausea and tiredness can make you feel low in the
early months. You may find you cry more, lose your temper more, and
so on. It is thought that the hormonal changes going on in your body
contribute to this as well.

It's important to keep on top of your feelings as much as you can.

But recognise that you probably won't be able to keep on top all the
time. Talking, either with your partner or with someone who is close to
you, can help. And it certainly helps if you can avoid getting overtired,
and keep yourself well. Anyone who is tired and run down is likely to
feel emotional and a bit depressed, whether they are pregnant or not.
Although it is natural to have some worries in pregnancy and to
feel a bit down from time to time, it's a real cause for concern if you're
feeling depressed for much of the time. Whatever the reason for the
unhappiness, or even if there doesn't seem to be any reason at all,
explain how you're feeling to your doctor, midwife or nurse. Make sure
they understand that you're talking about something a bit more than just
feeling low.

11
Worrying About the Every first-time mother probably worries about the birth, whether
Birth it will be painful and if they will be able to cope.
Te Awangawanga mö te When you're expecting your first baby, you can't know what
Whakawhãnau labour is going to feel like. Nobody can describe a contraction to you -
though some will probably try. . If you're expecting a second baby, you
may feel you know too much.
Talk to your doctor or midwife and ask questions about labour and
delivery. Getting the facts straight does help. It also helps if you go to
antenatal classes, either at your hospital or elsewhere (see page 15), and
meet other parents-to-be.
Talk to your partner, too, especially if he is going to be with.you
during labour. He may also be worried, and it can help to share your
feelings and work Out together what you can do.

Worrying About Everybody worries at some time that there may be something
Abnormality wrong with their baby. It's best to talk about it openly with your
Nga Awangawanga mö partner-and others around you.
te Piari It's important to remember that while you can increase your baby's
chances of being normal and healthy, you can't make absolutely certain
of it. Some things cannot be prevented. Either the causes are not
known, or they are beyond anybody's control. So while it is important
to do whatever you can to cut down on any risks to your baby (by not
smoking, by eating healthily, and so on), remember that you can't cut
out the risk entirely.
It may help to know some facts. About 98 percent of babies born
in New Zealand have no major abnormality. Amongst the small
proportion of babies that are disabled in some way, some have inherited
problems; some, for one reason or another, haven't developed properly
in the womb; and a very few are damaged because of difficulties during
birth. The risk of your baby suffering any of these problems is lessened
by good health care in pregnancy. For example, antenatal tests can
show whether a birth may be difficult and the difficulty can then be
avoided by, say, a Caesarean delivery. Antenatal tests can also show up
some abnormalities like spina bifida or Down's syndrome so that,
provided it is early enough, the parents can decide whether or not they
want to go on with the pregnancy.

Talk to Your Family Partners and relatives, and friends, can often give valuable support
Me Körero ki Töu during pregnancy.
Whãnau How will your partner and children feel about the arrival of the
new baby? It helps to be prepared.

Couples A first baby is bound to bring about some quite big changes in a
Ngã Tokorua couple's relationship. For some these changes happen very easily,
almost without being noticed. For others it is more difficult.
Perhaps the important thing is to recognise that during pregnancy
there are understandable reasons for the odd difficulty between you,
just as there are also good reasons for feeling closer and more loving.
If you do have an argument, perhaps with lots of tears and
shouting, don't start to worry afterwards that you may have harmed the
baby in some way. There's no good evidence for this idea.

12
 One practical question that all couples need to talk and decide
about during pregnancy is how they will cope with labour and in
particular, whether the father will be there. Very many fathers do want
to be present at their baby's birth. Look at the section on Labour and
Birth (pages 40 and 43) to find Out about the sort of things a partner can
do to help during labour and to get some idea of the kind of experience
- and task - that you will be sharing. And if you are having your baby
in hospital, find out about the hospital's views on fathers being present
at the birth. For example, are they ever asked to leave? Are they allowed
to be present at a Caesarean delivery? And so on.

Sex in Pregnancy People usually want to know if they can continue sex during
Te Ai i te Wa pregnancy.
HapUtanga There's no physical reason why you shouldn't go on with sexual
intercourse right through a normal pregnancy. It doesn't harm the baby
because the penis can't penetrate beyond the vagina. The muscles of the
cervix, and a plug of mucous specially formed in pregnancy seal off the
womb completely.
Later in pregnancy an orgasm can set off the kind of contractions
that usually happen later in pregnancy, called Braxton Hicks
Contractions. You will feel the muscles of your womb go hard. If this is
uncomfortable after intercourse, just lie quietly until the contractions
pass. There is no need to be worried about these contractions.
If you have had a previous miscarrriage, ask your doctor for
advice. Many doctors feel that it is safest not to have intercourse in the
early months of pregnancy if you have had a previous miscarriage.
While sex is safe for most couples in pregnancy, it may not be all
that easy. You will probably need to find different positions. The man
on top can become very uncomfortable for the woman quite early in
pregnancy, not just because of the baby, but because of tender breasts as
well. It can also be uncomfortable for the woman if the man's penis
penetrates too deeply. So it may be better to lie on your sides, either
facing, or with the man behind.

-E^

Some couples simply feel that they don't want to have intercourse
during pregnancy and they find other ways of making love and being
loving.

13
Fathers - Fathers share much of the excitement and worries of pregnancy.
Nga Mãtua Táne Adjusting to the pregnancy and the idea of being a father can be
difficult for some men.
For men just as for women there are no rules about how to feel or
behave in pregnancy. But both partners do need to understand that
pregnancy can be a stressful time, for men as well as for women, and
that there's a need to support each other. How you do it is up to you.

Coping Alone If you are coping with pregnancy on your own, it is even more
Ko Koe Anake important to make sure you get whatever support you feel you need,
from family or friends and from people like your doctor, midwife,
nurse, social worker, and so on. Sorting out problems, whether medical
or personal, is often difficult when you're on your own and it is better
to find someone to talk to than let the problem get on top of you.
For a lot of people on their own in pregnancy, money and housing
are particular problems. For more advice on the financial benefits that
are available to you, go to your local Department of Social Welfare
office or your Citizens Advice Bureau (CAB). Or ask your hospital or
doctor to put you in touch with a social worker. Social workers can
help with non-medical problems of all kinds, including housing.
You may be thinking of having your baby adopted. If so, your first
step is to ask to be put in touch with your social worker.
Look ahead to your labour and the baby's birth. You may feel you
would like to have someone with you during labour to give you
support - perhaps one of your family or a close friend. If so, tell the
hospital that this is what you want. Talk with your 'labour partner'
about the birth and about the sort of support you feel will help. This
person can attend classes with you.
You also need to plan for after the baby's birth. If you are hoping
to work, look at page 60 for information about childcare. Good
childcare arrangements are vital for all working mothers but they are
particularly important if you are on your own. You need to start making
the arrangements early. Think too about how you will cope after your
baby is born. Who will be around to help you? Will you be able to get
out for a break from time to time? Plan ahead as much as you can.

14
Children Need to Know Your other children should be told that there is going to be a new
WhakamOhiotia nga baby in the family so then they can get used to the idea gradually before
Tamariki the baby is born. When you tell them may depend on your children's
ages. Remember nine months is a very long time to a toddler.

1:•.

Helping your older child cope. An older child may be anxious

there is going to be a change in his or her life.
Involve him or her in your pregnancy. Let them put their hands on
your stomach to feel the baby moving around, and think of ways they
can help in preparations for the baby.
Make as many changes as you can in the house well before the
baby is born. You may need to change bedrooms around. Many parents
prefer to have the baby sleep in a cot or bassinet in their own bedroom
for at least the first six months. Keep your bedroom warm but not too
hot, so that you don't have to dress the baby heavily at night.
If your toddler is about to start daycare or playcentre, make sure
that it doesn't happen when the baby is due to arrive.

Prepare for Childbirth There are several ways you and your partner can prepare for the
Te TakatU mO te baby's birth. Preparation helps you understand your body, the birth
Whakawhãnau process and helps you cope with labour.
Going to antenatal classes. Antenatal classes are offered by
maternity hospitals or private organisations such as the Parents Centre,
and by some domiciliary midwives. Some also offer Early Pregnancy
evenings for mothers and couples in the first 16 weeks of pregnancy.
There are often 'refresher' classes as well for those who have already
been through at least one pregnancy.

15


For parents unable to attend a class, a postal course on pregnancy

and childbirth is available.
Write to : The Registrar, Correspondence School, Private Bag,
Wellington.
Antenatal classes -
I provide information to help you keep fit through pregnancy;
2 teach coping skills for labour;
3 promote healthy living habits for the whole family;
4 introduce you to other parents-to-be.
Find out about classes in your area and choose the one that suits you
best.

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Preparing at home. Antenatal classes form the basis of

preparation, but a lot can be done at home as well, for example:
reading books (like this one) and magazine articles;
making lists of questions to ask at the classes or next time you see the
doctor;
V

practising positioning, breathing, relaxation exercises and other coping

skills with your partner;
talking with other expectant mothers about how they feel;
talking with other mothers about their labour and childbirth;
sharing your feelings and concerns with your family.
Preparation at home and in classes can help you gain confidence,
especially if you adapt what you learn to suit yourself.

16
What to Avoid So far we've listed the positive things you can do in pregnancy, but
Ngã 'Whakatupato there are also some things you should avoid.

Taking Care With If you are pregnant, or want to be, you must be very careful with
Medicines medicines. This means all kinds of medicines from pills, tablets and
Kia Tüpato i ngã ointments to cough mixtures and headache remedies. The wrong
Rongoã medicines can harm the developing baby.
To be on the safe side, women should not take any medicines
during pregnancy, except on the advice of their doctor.
Make sure your doctor knows you are pregnant when he or she
prescribes any medicines for you.
Make sure your dentist also knows that you are pregnant. The X-
rays and some of the local and general anaesthetics that dentists use
should be avoided during pregnancy.

You Can't Sleep, Feel Without medicines, sleeplessness can be helped by gradually
Tired, Your Head's slowing down before bedtime, by having the bedroom warm, having a
Aching? hot milky drink last thing, or just having someone to talk to.
Kãore koe e Moe, kei te Worrying about not sleeping does far more harm than lack of
Ngenge, kei te Anini sleep. So do something quiet that you enjoy rather than just lying there.
Tôu Mãhunga? Relaxation is often taught at antenatal classes; it can be a help to
you before and after pregnancy. Relaxation exercises can be better than
tablets for headaches, backaches and loss of sleep.

Should I Give up . V

Smoking and Drinking?

Me Mutu taku Momi -
Paipa me taku mu
Waipiro?
- .. V
VVV V. -

/
-

I
If

YES. You may ask yourself if you should try to give up, especially
now you are pregnant.
Smoking can affect the growth of the baby, reducing their weight.
This could be dangerous if baby is small anyway, or born prematurely.
Some people believe that smoking will help keep the baby's weight
down and that they will have an easier birth. This is not true. A lower
birth weight baby is more likely to have health problems.
After birth, your baby is more likely to get chesty illnesses if they
continually breathe in cigarette smoke, from you or from other
members of the household. Try and discourage visitors from smoking
around the baby and where the baby normally sleeps.

17
Are You a Heavy Giving up smoking during pregnancy reduces the risk to the baby,
Smoker? but it can be very difficult. There's no painless way to stop smoking, no
He Kaha koe ki te wonder cure. However, thousands of people do manage to stop, so
Momi Paipa? there's a chance for you.
During pregnancy a lot of women lose the urge to smoke quite
naturally. So you might find it easier now than ever before. And it
might help to think of the baby.
Even if you are not able to stop smoking, you can at least try to cut
down. Now is the time to plan a smokefree zone for your baby. To stay
healthy babies need clean air to breathe.

Try These Hints to Stop
Smoking
Anei Etahi Tohutohu
hei Whakamutu Momi
Paipa
1 Cut down gradually over two or three weeks. And then stop for
good. To begin with, try cutting out the first cigarette of the day.
Then the second. Then the third. Each day try to go a little longer
without cigarettes.
2 Many smokers find it easier to give up if they change their day-
to-day habits or routine. Sit in a different chair. Read another
newspaper.
3 Get your partner and family, if they smoke, to join in too. You
can give each other moral support in your weak moments.

Alcohol Pregnant women should avoid alcohol altogether if possible,

Te Waipiro or drink as little as possible. There is some evidence that even a
low intake of alcohol may have some effect on the baby's
development.

Infections Some infections in the early months of pregnancy can cause

Ngã Kainga a te Mate abnormalities. For example, if a woman at this stage catches rubella
(German measles) the baby may be born damaged. If possible avoid
anyone with rubella, but if you think you have been near someone with
it, tell your doctor immediately. A routine antenatal blood test can
show if you are immune to rubella. If possible have this done before
you get pregnant. You can't be immunised while you are pregnant, but
once the baby is born you can be immunised to protect later babies.
Some infections which you may have caught before pregnancy can
affect the baby. For example, if you or your partner have ever had
herpes, let your doctor or midwife know. This is important because
herpes can cause meningitis (an infection of the lining membrane
around the brain) in a baby. To avoid this, women with a proven active
infection in the last three weeks of pregnancy usually have a Caesarean
delivery.
It is also important that the few women who have the sexually
transmitted disease syphilis are detected and treated as the infection
may be passed on to the baby.
The routine antenatal blood test can check for syphilis, and may
also show whether you are carrying the hepatitis B virus which you
may have had for a long time. Your baby may catch hepatitis B from
you during birth, and may become a carrier.
Other people can catch it from YOU too. Hepatitis B is a virus
which is common in New Zealand. Your baby and other children need
to be protected from hepatitis B by being immuriised.
If you want to know more:
I Ask your doctor;
2 Ask your nearest area health board or Health Development Unit for a
leaflet about hepatitis or any of the other infections mentioned here.

18
Any Problems? You may. never feel sick, you may just feel slightly ill, or you may
He Raruraru Ano? actually vomit. Luckily sickness usually stops by about 14 weeks.
Pregnancy Sickness During this time it often helps if you try:
Nga Momo Mãuiui o te biscuits or dry toast or tea in bed before getting up;
Haputanga small frequent meals rather than two or three large meals a day;
avoiding greasy and spicy foods.

Going to the Toilet Constipation may be cured by taking extra dietary fibre (whole
Te Haere ki te "are cereals, fresh fruit and vegetables) and drinking plenty of fluids. Don't
Paku strain or sit on the toilet for ages because this might encourage piles
(haemorrhoids) to form.
Frequent visits to the toilet. These are caused by the enlarged
womb pressing on the bladder. This is more of a nuisance than anything
else, especially at night. Unfortunately, there is little you can do to help.
If you get burning as you pass urine, you may have an infection so see
your doctor.

Heartburn or This is common towards the end of pregnancy. Small meals with
Indigestion snacks in between may help. Again avoiding spicy and fatty foods may
Te Pohongawha, Te help.
Pokopa rand

19


Tiredness You may feel more tired than usual, especially during the first three
Te Mãuiui and last three months. This is because of the gain in weight, and various
other changes in your body.
Many chores usually done standing up can be done just as easily
sitting down. Ironing and preparing vegetables are two.
Putting your legs up on a foot stool with full pillow support,
relieves discomfort in the legs. Exercising the feet by "pedalling" them
in this position helps relieve pressure in the veins in your legs.
With other children in the house it is difficult to rest completely
but you should try sitting with your feet up for short periods when the
children are playing quietly.

Bleeding Let your doctor know immediately if you start to bleed at any time
Te Rere o te Toto in pregnancy. Rest in bed may help stop the bleeding and the pregnancy
may well go on normally.

Miscarriage However, bleeding sometimes leads to a miscarriage, which can be

Mate-roto a bitter shock to both parents and to the family.
It may help a bit to realise that miscarriages are fairly common,
and they are not in any way the fault of the parents. Some are due to
the failure of the embryo to develop properly.
After a miscarriage many people are left with mixed feelings -
sorrow and anger, guilt and fear. It is most important for partners to
talk about their feelings together and to feel able to talk to their family
and others about them.
Don't feel that other people will be embarrassed or not want to
hear. Talking about your sorrows is not being morbid. It's a way of
learning to accept the loss and go through the necessary mourning for
the baby.

Starting Again Just because you have had one miscarriage, it doesn't necessarily
Te Timata Anö mean you are more likely to have a second.
Don't lose hope and give up trying. After two or more miscarriages
a woman may need careful supervision from the very first days of
pregnancy.
However, with medical help almost every woman who has had a
miscarriage can go on to have a healthy baby.

20
Benefits, Leave and
Help in Pregnancy
Ngã Awhinatanga
mO ngã Wãhine
Social Welfare Benefits. During your pregnancy, and once the
baby is born, you may qualify for some welfare benefits. You should
check with your local Department of Social Welfare office to make
sure you get all you are entitled to.
Maternity Leave. If you have been working for your present
employer at least 12 months before the baby's expected birth date,
you and your partner may be entitled to a total period of 52 weeks
unpaid parental leave, under the Parental Leave and Employment
Protection Act 1987. Some industrial awards may be more
generous. You can take parental leave under the Act or under your
award, whichever suits your own circumstances best. If you have
difficulty deciding, you can contact your union.
Pregnancy Help. This organisation exists to help women who
are, or whO have recently been, pregnant. It offers'practical help
with such things as child-minding, transport and acc6mmodation,
and assistance in getting maternity clothes, baby clothes and
equipment. There are branches in many parts of New Zealand. You
can find out how to contact the branch nearest you from your.
phone book, or phone the nearest area health board or Health
Development Unit.

Some Physical Almost all women have more vaginal discharge in pregnancy. As
Problems long as you are not sore or itching, it's quite normal. It can help to
Etahi Mate wear cotton pants. And use a mini-pad if you need to.
ã-Tinana Soreness or irritation, or a coloured or smelly discharge,
Vaginal Discharge probably means you have some sort of vaginal infection such as
Te Ero mail te Tene thrush. Tell your doctor or midwife. Thrush is quite common in
pregnancy but it is easily treated with pessaries. If left untreated, it
can cause a mild infection of the baby's mouth after birth. This is
nothing to worry about but it will need treatment.

Varicose Veins Varicose (enlarged) veins in the legs may be caused by the effects
Ngã Iaia Tetere of the pregnancy hormones or, later in pregnancy, by the enlarged
womb pressing down and obstructing the flow of blood from the legs
to the heart. Varicose veins usually get better after delivery.
Try to avoid standing for long periods of time and sitting with
your legs crossed. Also try to make sure you don't put on more
weight than you should. It can ease discomfort to Sit with your legs
up as often as you can, and to wear support tights; You can even try
putting the end of your bed up on bricks, to raise your legs higher
than the rest of your body.

Twins . Identical twins are the result of one fertilised egg splitting into
Nga Mahanga two separate cells. Each cell grows into a baby. Because they
originally came from the same egg, the babies have the same genes.
They are the same sex and look very like each other.
Non-identical twins are more common. They are the result
of two eggs being fertilised by two sperm at the same time. The
babies may not be the same sex and will probably look no more alike
than brothers and sisters.

21
 Twins are quite common. They happen about once in every
hundred pregnancies. A couple is more likely to have twins if there
are twins in the woman's family.
Triplets are much more rare and quads rarer still, although
nowadays the use of drugs in the treatment of infertility has made
multiple births a bit more common.
It is usually possible to find Out if you are expecting twins by
about the end of the fourth, month of your pregnancy. An ultrasound
scan is needed (see page 35).

Twins in the uterus.

Identical twins. Non-identical twins are more

common.

Ectopic Pregnancy Sometimes a pregnancy goes wrong at the Very beginning. After
Te Takoto He o te Pepi i conception, the fertilised egg, instead of moving down into the womb,
te Wa HapU gets stuck in the fallopian tube and begins to grow there. This is called
an 'ectopic' or 'tubal' pregnancy. It cannot develop properly and has to
be removed in an operation. A common cause of an ectopic pregnancy
is a blockage in the fallopian tube, for example, if the tube has been
damaged by an infection.
Signs of an ectopic pregnancy usually occur after a missed period.
If you get a strong one-sided pain and vaginal bleeding and it is possible
that you may be pregnant, contact your doctor immediately. After an
ectopic pregnancy, talk to your doctor and find out exactly why it
happened and whether your chances of conceiving a baby may be
affected.

22
 Start Collecting Things For
The Baby
Me Timata te Kohikohi I nga
Hiahiatanga mO te Pepi
Here are some suggestions. You don't have to get everything
you need all at once. You can collect one or two items each week
and have them ready in plenty of time. Friends and relatives will
probably buy some presents for the baby or pass on things from
their own children. i

1 For the bassinet and cot

you'll need a firm mattress
(not plastic covered). You can
fold larger sheets and
blankets in half. Babies don't
need pillows.
2 It's good to give your baby
interesting things to look at .,.
when he or she is
lying in their cot.
3 For bath time you'll need a
tub or basin, soft cloth, towel
and soap.
4 Make sure you choose a
pram or pushchair that gives
plenty of support for
your baby's back. Baby
buggies are not suitable until -
your baby is able to support
his or her head and back
fully. Make sure you always
use the safety clips.
5 You'll need a supply of
nappies for the baby, nappy
pins with safety caps, and
a nappy bucket, with a
tightly-fitting lid.
6 You will need baby clothes COW
--Irl-I
0
for everyday wear. Make
sure that stretchy clothes
don't get too tight. If you can
keep your bedroom
reasonably warm, you
shouldn't need to dress your
baby heavily at night.
Woollen clothes are best for
- * -,--.- --- winter, cooler clothes for
$,. summer. Check that
nightwear has the NZ
Standards Association mark
for safety.
7 Don't forget cardigans,
bonnet, mittens and bootees
for cold weather, and
a sunhat for protection
against strong sunshine.
Watch Out for loose threads
on bootees which can trap
your baby's toes.
8 When travelling with a
young baby an infant safety
.. seat is recommended for
every car. Talk to Plunket
about renting one well
before the baby is born.

23


A New Life
Te Ira Tangata Hou
You can see yourself change from week to week but what's
happening to the baby during this time? What does the baby look like
and what can he or she do?

Growing in the Womb Pregnancy is measured in weeks. It starts on the first day of the last
Te Whakatipu Haere I period and goes on for about 40 weeks.
roto I te Whare Tangata ' The most dramatic changes happen in the first three months in the
womb, when all the organs and tissues of the body are formed.
For example, by the time you are 14 weeks pregnant, the baby's
heart, lungs, liver, eyes and ears are formed and development of the
limbs, hands and feet has taken place.
From now on the baby's general appearance doesn't change much.
For the rest of the time in the womb the baby slowly grows until he or
she reaches a stage at which there is a chance of surviving outside the
womb.

By 11 weeks all your baby's

organs and systems have
formed.

There's more about the developing baby over the page.

24

What Can the Baby Do Until a few years ago it was believed that, apart from kicking a bit,

Now? the baby lay quiet inside the womb. But we know that the baby is able

Me Pëhea te Pepi I to do lots of things before the birth.
tënei Wi?

Movements The baby starts to move at about 14 weeks.

Nga Koiri Even before this, we know that she can twist and squirm a little.
But now she can stretch and bend her limbs and turn her head. By
about 18-20 weeks the mother notices gentle flutterings. The movements
of the baby become stronger as the weeks go by. The baby is floating in
a roomy, liquid-filled bag and her slightest kick sends her zooming
around. She can even somersault. She doesn't have so much room in
the last few weeks. She usually becomes fixed in a head down position
ready for birth. So her movements are now confined to kicking
upwards towards her mother's ribs.

Seeing At birth the baby's eyes react to light. She sees things held close to
Te Kitenga her face.
The womb is dark, but in late pregnancy the baby can probably
make Out light.
Many women have reported their babies moving around more
when they have been sunbathing. You might like to check this if you are
pregnant at the right time of the year.

Hearing The baby can hear before birth. It seems that babies become used
Te Rangona to the sound of the mother's heartbeat and intestinal rumbles and
gurgles.
Newborn babies can be soothed by being held close to the
mother's heart.

25
 Growing In The Womb
• Te Whakatipu Haere I Roto I te
Whare Tangata

6 Weeks 16 Weeks

Your baby has just under 40 weeks to change from a tiny ball
of cells to a bouncing baby. During that time you will notice many
changes in yourself. It can be exciting to follow the baby's progress
and know what is going on.
6 Weeks Pregnant The baby is only about 6 mm (1/4 inch) long but already has a
head and a "tail end" to his body and tiny swellings which will
become arms and legs. It's in the first 12 weeks or so that all parts
of the body are developing and the baby begins to take on human
shape. After that he spends his time growing and maturing. You
won't see any change in your own shape yet.
16 Weeks Pregnant The baby is now about 18 cm (7 inches) long and weighs
about 115 g (4 oz). Arms, legs, fingers and toes can be seen: All the
main organs such as heart, lungs, kidneys and liver have developed
and the sex of the baby is obvious. From 14 weeks the baby can
move about. But you won't notice his moving until around 18
weeks. At first you will feel gentle flutterings which soon grow
into proper kicks. You still don't look pregnant, though your waist
may start to get thicker about this time.

26
 Ii

28 Weeks 40 Weeks

28 Weeks Pregnant The baby is growing rapidly now. He is over 38 cm (15

inches)long and about 0.9 kg (2 Ibs) in weight. The baby's skin
begins to develop a white greasy covering called vernix which you
might notice at birth. This water-proofs the skin. The baby is very
active at this stage, moving about freely in the bag of waters
around him. You feel him kicking strongly. Your womb is getting
much larger and feels hard when you touch it. Sometimes lumps
appear on the surface as the baby twists and turns.
40 Weeks Pregnant Over the past four months the baby has fully developed and is
ready to be born. The baby's cheeks are now chubby and dimpled
and his lungs have matured ready for action at birth. He has been
lying in a fixed position, usually head downwards, since about
week 32. There's not much room left for him to move around
because he is 50 cm (20 inches) long and weighs just over 3 kg (7
ibs). But you can still feel his kicking upwards towards your ribs. In
your first pregnancy, from about the 36th week the baby's head
starts to drop into your pelvis. Then the head is said to be engaged.
You might notice this because your stomach feels less crowded and
you can breathe more easily. In later pregnancies this happens
nearer the end of pregnancy.

27
Practising Breathing We know the baby makes breathing movements in the last six
Te Ako ki te Whakahä weeks or so of pregnancy. These are not true breathing movements
because the baby's mouth and lungs are full of liquid.
However, he practises for after he is born by using the muscles in
his chest to make these movements.

Swallowing A growing baby gets all his food through the placenta. From the
Te Horomi middle of the pregnancy the baby can swallow the liquid in which he
floats and anything it contains.
Babies practise sucking too. Some babies have been born with quite
swollen thumbs because of this.

Passing Urine The baby has been able to pass a very weak watery urine for
le Mimi several months before birth and it mixes with the liquid around him.
But this does not affect him in any way.

28
 How Should I Feed My Baby?
Me Pehea te Whangal I taku
PpI?
Whether to breastfeed or bottle feed your baby is an important
question. Breastfeeding a baby and knowing you are giving him the very
best possible start in life is a great pleasure. Breastfeeding not only
supplies your baby with the right food. It also forms a bond between
you both which is the very basis of good mental health.
Discuss breastfeeding early in your pregnancy with your doctor,
midwife or practice nurse. Read as much as you can about it and talk to
other mothers who have breastfed. If you do not know any, you can
meet other mothers through your antenatal classes, La Leche League
and Parents Centre.

Breastfeeding Breastfeeding is best for the health of your baby for many reasons:
Te Whãngai U • Breastfeeding is a natural progression from pregnancy and birth.
• Breastfeeding helps your uterus shrink to its normal size after birth.
• Breast milk gives your baby exactly the right food he needs.
• Breastfeeding contributes to the bond between your baby and you
which is the very basis of your future relationship, and your baby's
relationships with others.
• The first milk or colostrum contains important antibodies which help
protect your baby from infections.
• Breast milk is easily digested by your baby.
• Babies thrive on breastmilk and do not need solids until they are at
least 4-6 months old.
• Breastfed babies are less likely to get fat. They take just as much milk
as they need.
• Breastfed babies are very unlikely to get constipated because the milk
is right for them.
• There is some evidence that breastfed babies are less likely to have
allergies such as eczema and asthma.

Preparing for Changes in your breasts are often among the first signs of
Breastfeeding pregnancy.
Te TakatU mote During pregnancy your hormones signal the breasts to get ready
Whangai U for breastfeeding the new baby. The milk ducts deep in the breast start
to enlarge. Later in pregnancy a small amount of first milk or colostrum
may discharge from the nipples.
As pregnancy progresses your breasts will become larger and
sometimes more tender. A properly fitted maternity bra will provide
comfort and support now, and after the milk comes in.

Nipples Some people think that small breasts mean that a woman cannot
Ngã KOmata breastfeed. That is not true. What is more important is that your nipples
are prominent and not flat or inverted.
Have your doctor, nurse or midwife check your nipples at your
early antenatal visits so that any problems can be dealt with.
If your nipples are flat or inverted that does not mean you cannot
breastfeed successfully. They can be drawn out by using a nipple shield
during pregnancy, so that when you start to feed the baby is able to
suckle properly.

29
 You can prepare your nipples by gently rolling the nipple between
finger and thumb at bath time to make them more prominent. Your
midwife or nurse will show you how. -
Avoid using soap on your nipples as this dries them out. Exposing
your nipples to the air or sunshine for short periods will also help
harden them, but avoid burning. It is not necessary to use any special
cream on them.

. '.'
, -N

'V \ .- v_•
Normal nipple. Flat or inverted nipples Nipple shield in place. Nipple shield.
can be drawn Out during
pregnancy by using a
nipple shield.

How Breastfeeding Sometimes women wonder how they will know if they have
Works enough breast milk for their baby.
Te Ahuatanga o te The amount of milk the breasts produce is controlled by the needs
Whangai U of the baby. That is why babies can be fed entirely on breastmilk for the
first four to six months without needing any other food.
The first milk or colostrum produced by the breasts contains the
food your newborn baby needs, as well as those important antibodies
which pass on to your baby your own resistance to infection.
Colostrum looks like rich creamy milk and is sometimes quite yellow in
colour. Gradually this changes to breastmilk which looks thinner than
the cows milk we are used to seeing but contains just the right food
your baby needs.
As your baby grows she needs more breastmilk. If she is sucking
strongly and is fed as often as she wants, your breasts will produce all
that is needed. That is why mothers can feed twins. The more often
they feed, the more milk the breasts produce.
As your baby grows older and moves onto solid food at the end of
the first year she will need less from the breasts and they will gradually
produce less milk until your baby is weaned.
If you understand how the supply of breastmilk works and how to
increase it; you do not need to worry about not having enough. If your
baby is gaining weight, has plenty of wet nappies and is mostly
contented, she is probably getting enough milk.

Getting Started Your baby's first feed will probably be soon after the birth. Right
Te Timatanga from the start it is very important that he is correctly positioned at the
breast so that your nipples don't become sore. It is important that you
sit or lie comfortably while feeding, with your baby facing towards you.

30
 Short frequent feeds are best at the start, and it is most important
) that your whole nipple is covered by the baby's mouth while suckling.
It is also important to break the suction that your feeding baby creates
before taking your baby off the breast. Your midwife or nurse will teach
you this.
The letdown reflex starts the flow of milk from your breasts. Many
women feel a tingling sensation in their breasts as the milk starts to
flow. Sometimes it can even start on its own from one breast while you
Short frequent feeds are best at
the start.
are feeding from the other. This can be stopped by pressing your hand
or arm against the nipple.
As the first milk comes in your breasts may feel heavy and
uncomfortable at first, but as they adjust to the requirements of your
baby, the amount of milk you produce will settle down and your
breasts will feel more comfortable again.

Your whole nipple must be

covered by the baby's mouth
while suckling.

Request Feeding It's always best to feed your baby when she is hungry, rather than
Ngã Tanginga Matekai by the clock. This might be very often at first. Newborn babies need to
have at least six feeds every 24 hours, and may need more to start with,
until your milk supply adjusts to your baby's needs.
Some days she may need more frequent feeds than others. It is
often at a crucial time like this that some mothers think they do not
have enough milk and do not know what to do about it. If your baby
feeds more frequently at this time your milk supply will increase. It is
important to rest more and remember to eat and drink enough yourself
at these times.
Other babies may be sleepy and need waking for feeds. If this is
happening a lot have a word with your midwife or nurse.
Sometimes mothers think that because their breastmilk looks thin
that it is not strong enough for their baby. This is not true. Breastmilk is
not as yellow or creamy looking as cow's milk, but it is the right
formula for your baby. The quality is mostly consistent, although the
quantity may vary from time to time.

Difficulties For some people breastfeeding may not be easy at first. Perhaps
Ng;! Uaua your nipples may become sore or cracked. Of you may even have a
breast infection. You will still be able to continue breastfeeding
successfully if you understand how the process works and if there are
people supporting you.
The golden rule is:
The more often you feed, the more milk will be produced.
Other things to remember are:
• Make sure your baby is "fixed" to the breast properly. -
• Make sure your baby's suction is broken gently at the end of feeding
before taking him off your nipple.
• Breastfeed as soon as possible after the birth.
• Room-in with your baby in hospital so that you can breastfeed.
• Avoid the use of bottles.

31
 Breastfeeding in Public
Te Whangai U i Mua i te
Tangata
AIf

There is no need to feel embarrassed about breastfeeding in public.

It is actually quite easy to feed a baby in front of other people without
anyone even noticing, by wearing blouses or jerseys. If you feel
comfortable, then you should not worry about it. It's up to you.

Returning to Work If you return to work before your baby is six months old, it is still
Te Hokinga lii te Mahi possible for you to continue to breastfeed. If you have childcare
facilities at your work or close by, you may be able to continue to
breastfeed fully. If you can't do this, you can have expressed brcastmilk
or formula for your baby, and breastfeed the other times of the day.
Remember, just one feed a day can continue lactation.

Cultural Practices - New Zealand has many cultures who have different approaches to
Ngã Tikanga ã-Iwi breastfeeding. Share your beliefs about feeding with your midwife,
nurse or doctor so that they can support you in your desire to
breastfeed.
If breastfeeding doesn't go easily for you at the start, it is still
worth working at. Most problems can be overcome with the right
advice and support.

More Information Before your baby is born, talk to family members and friends who
Etahi atu KOrero have breastfed successfully. You can get more information from your
Whakaatu midwife at the antenatal clinic, your doctor or domiciliary midwife,
your hospital or Parents Centre antenatal classes and La Leche League.
Reading about breastfeeding can help your understanding too.
There are good books available in your local library or bookshop if you
want to read about breastfeeding.

Contacts Most new breastfeeding mothers need the support of others at

Ngã Kaiãwhina some stage. After your baby is born you will be given contact telephone
numbers to ring if you need advice, such as your hospital midwife or
domiciliary midwife. Your Plunket nurse or public health nurse are also
there for advice.
In addition, your local La Leche League counsellors are always
available for help and guidance. You should be able to get their
telephone number from your hospital, doctor, midwife, antenatal
classes, CAB or telephone book.
Many women have weaned their baby at the first sign of trouble
thinking they did not have enough milk or it was not "strong enough
for the baby", when they could have overcome their problems with the
right advice and support.

32
 Health Care In Pregnancy
Te Atawhai o te Hauora I te Wa
Haputanga

Antenatal Checks A range of health services is available to women right through

Ngã Tirotiro I te pregnancy and childbirth. These include:
Wa HapU Antenatal checks at regular intervals.
Special tests on the developing baby.
Health care to cover the delivery of the baby.

Questions at the First The first visit will probably take longer than later ones, because
Visit there are lots of questions to be asked about your health and usually an
Nga Pãtai I te Torotoro internal examination is done.
Tuatahi

The doctor or midwife will want to know about your illnesses and
pregnancies, and about any serious illnesses or history of twins in your
family. -
They will ask about your present pregnancy, for example, when
was the first day of your last period. This information is needed in
order to calculate when the baby will be born.
There might be other information required such as the length of
your cycle, the amount of blood loss and whether you have just come
off the pill. These help in deciding if the expected date of delivery is
going to be accurate.

33

Tests at the First Visit At the first visit a general health examination is carried out. Then

Nga Tirotiro i te an internal examination may be done to check the position of the
Torotoro Tuatahi womb and to judge the age of the baby.

Internal examination.

Regular checks on weight and

blood pressure help keep YOU
healthy.
Some of the tests carried Out at this visit include:
• Weight. From now on your weight will be checked regularly.
• Blood Pressure. Your blood pressure will be taken, and will also be
checked at every visit from now on. If your blood pressure goes up a
lot later in pregnancy, it can endanger the baby, but regular blood
pressure checks mean that it can be detected early and kept under
control.
• Urine Sample. This will be tested for a number of things including:
Sugar. Pregnant women may have sugar in their urine from time to
time, but if it is found repeatedly, you will be checked for diabetes.
Diabetes has to be very carefully controlled in pregnancy.
Protein. This is to check, among other things, that your kidneys are
coping with the demands of pregnancy.
Any infection which would need to be treated.
Your urine will be checked at every antenatal visit after this.
• A Blood Sample, to find your blood group, in case a transfusion
should ever be needed. It is also to find mothers whose blood group
is rhesus negative. This is not a worry for a first baby, but all rhesus
negative mothers are given an injection after the birth of their first
baby to protect their next baby from severe anaemia, which may
occur if the baby is rhesus positive.

34

A cervical smear will probably
be done.
• Anaemia. If you are anaemc, you will probably be given iron tablets
to take. Having anaemia means you are less able to cope with losing
blood at delivery, for example.
Your blood may also be tested for:
• Immunity to rubella (German measles). See pages 18 and 55.
• Syphilis. See page 18.
• Hepatitis B. See page 18.
A cervical smear will probably be done although it may be left until
your postnatal check-up.
A cervical smear is a way of checking the health of the cervix. It is
when a sample of cells is taken from the surface of the cervix.
A cervical smear will show if there have been any changes in the
cells of your cervix which could lead to cancer. If changes are found
treatment can be planned to remove these cells and prevent cervical
cancer from developing.
Once you are lying down a speculum is placed in the vagina so that
the cervix can be seen. Some cells are gently taken from the cervix with
a small wooden spatula. This may be uncomfortable but is not painful.
It only takes a few minutes.
The cells are smeared on to a glass slide and sent to a laboratory
for testing.

What Will You Ask? There may be several questions you want to ask your doctor,
He Aha ö Pátai? midwife or nurse. It's a good idea to write down any questions that
occur to you before your visit, so that you won't forget them when you
get there.
Never be afraid to ask the doctor, midwife or nurse if you don't
understand something or if you have a problem that is worrying you.

Regular Visits Later visits are usually much shorter, with just weight, blood
Nga Tini o te Torotoro pressure and urine checks, followed by an examination of. your tummy
to check the baby's growth, position and heartbeat. If you have any
problems, such as raised blood pressure or bleeding, it may be necessary
to go to hospital. This is usually only for a short period, but it can be
for several weeks.

Special Tests In the past few years, special tests have been devised to help detect
Ngã Tirotiro abnormalities in babies before birth. You may come across these at your
Motuhake antenatal checks.

Ultrasound Scans In this test a picture of the baby is built up by directing sound
Nga Tirotiro waves at the baby in the mother's womb. These scans are used quite
Whakarongo frequently to find Out the position of the baby and of the placenta
(afterbirth). They are also used to check the baby's age if there is doubt
about dates and to make sure the baby is growing normally.
Ultrasound scans also help to detect abnormalities of the head and
spine. The test only takes a few minutes to do, is painless and can be
carried out at any stage of pregnancy. It's often done at about 16-17
weeks. I The result is ready immediately. Ask to have someone with you
when you have a scan done if you want to.

35
An ultrasound scan
Scan supplied by Noralee
OIsson, Kelvin X-ray Services.

Although some doubts have been expressed about the safety of

scanning, there is no evidence that it harms the baby and it does have
obvious benefits if there are concerns about his welfare. Even so, some
women do decide not to have a scan unless there are clear ieasons for
it. If you feel doubtful about having one, you should talk it over with
your specialist or family doctor. There may be a charge for this test.
Check with your doctor or midwife.

Amniocentesis Your doctor may recommend that this test is done if there is extra
Nga Tirotiro Ngira risk of such conditions as Down's syndrome (mongolism), spina bifida
or haemophilia. -
Deciding whether to have an amniocentesis, then waiting for the
results afterwards, can be worrying and it is very important to get clear
exactly why you are having the test. Discuss the test and its possible
results with your doctor, midwife or nurse and other support people
beforehand, so you know what is involved.
Amniocentesis means putting a fine needle through the-wall. of the
mother's tummy into the fluid which surrounds the baby and taking a
sample of the fluid. This test takes only a few minutes, is usually
painless, and after about half an hour the mother can go home. This test
is carried out at about 17 weeks.
An ultrasound scan is always done before an amniocentesis to
check the position of the baby and placenta so that neither are damaged
by the needle. All the same, there is a small risk that the amniocentesis
will cause a miscarriage.
The fluid is tested for signs of head or spine defects; and
chromosome culture, if there is a special risk of Down's syndrome. This
second test, which takes about three weeks, also gives the baby's sex,
which is important to know when there is haemophilia or muscular
dystrophy in the family. Tell the doctor if you don't want to know the
baby's sex.

36
 Your doctor will see-you about 3 weeks after the test to discuss the
results. If the amniocentesis shows that your baby is likely to be
• handicapped, the doctor will offer to end your pregnancy. If you want
to keep your baby whether disabled or not, then you may prefer not to
have the test in the first place. Or you may want to have the test so
-: that, if necessary, you can prepare for having a disabled child.
If your pregnancy has to be ended for medical reasons, you will
• - have been carrying your baby for some time and feel very tied to her.
- -
- For whatever reason it is done, a medical abortion or termination is a
difficult thing to go through. Afterwards you will need to grieve over
- your lost baby. -
-. It helps if you are very clear about the reasons for ending your
- -. pregnancy. Doubts and unanswered questions can only add to your
- - unhappiness, so talk to your specialist and midwives at the hospital, or
- your family doctor and ask all the questions you want to ask.

Other Special Tests If the baby is not growing as she should or if your blood pressure is
Etahi Atu Tirotiro - -- raised, more specialised tests may be done to make sure the baby is
Motuhake - - - -. healthy. Some of these are simple, such as counting your baby's
- movements. Others may include an extra blood or urine test to measure
hormone levels. The baby's heartbeat may also be monitored
electronically, with a device held on your stomach.

What other - - We've already talked about some of the choices you have during
decisions are there your pregnancy. Who will do your antenatal checks, for instance, and
to make? - which kind of antenatal class you go to. There are also some choices to
He aha ëtahi atu - make about whether you want to have your baby at home, in hospital,
Whakaritenga? or a birthing centre. -

Where Will You Have Nearly all New Zealand babies are now born in hospital where -
Your Baby? maternity services are concentrated. Hospitals are equipped to deal with
Ka Whãnau to Pepi the unexpected for both mother and baby. First babies are often born at
kihea? - - base hospitals which may mean some travelling.
Before you go into hospital you should spend some time learning
about what is going to happen. Antenatal clinics and classes will give
you information about what choices you may want during your stay in
hospital, for example, choosing the most comfortable position during
labour, who will be with you during labour and the birth, whether you
want your baby rooming in with you, no complementary bottle for
your baby and so on. Discuss this with your doctor and midwife well
before-hand. -

37
Hospitals try to make
conditions quiet and relaxed.
'[hey encourage you to have
your partner or someone cisc
With you.
After the birth some parents and families may wish to undertake
certain religious and cultural practices. Maori families, for example, may
wish to take the whenua (placenta) home to be placed in its special
resting place. These arrangements can be made with the hospital staff
and your doctor.
Pack a suitcase 2 or 3 weeks in advance with your night clothes,
dressing gown, nursing bras and toilet articles. (While you are in
hospital, nappies and baby clothes will be supplied by the hospital.)
Whoever takes you into hospital may be asked to take your outdoor
clothes and the suitcase back, as some hospitals don't have enough
space for them.

Useful Telephone We suggest you fill out two cards like the one below. Keep one by
Numbers the telephone and the other in your handbag with change for a
Nga Nania Waea telephone call, in case labour starts when you are Out of the house.
Whaitikanga
Where can your partner be contacted:

Work:

Other Contact Numbers:

Family doctor:

Hospital where you

are booked:

Person who is going to look

after your children:

District nurse or midwife:

Others:

38
Having the Baby At Some women prefer home births because:
Home • They feel happier in the quiet, familiar surroundings of their own
Te Wh.nau I te Kinga home. They will often have a more relaxed delivery in the environment
where they feel most secure.
They don't want to leave their other children.
If you have the baby at home you will be looked after during the
birth by the doctor who does your antenatal care, and by a domiciliary
(home) midwife. Domiciliary midwives in New Zealand are licensed and
paid a fee by the Department of Health. Some also charge a fee to
mothers in their care. The midwife also checks that all is well after the
baby is born.
Your doctor will tell you if there is a special risk to you or your
baby. But even if there are no risks your doctor may not wish to deliver
the baby at home and may advise you to have the baby in hospital,
where maternity services are concentrated. If you have difficulty in
arranging a home birth contact your nearest area health board or health
development unit (the number and address are in your phone book) or
the Homebirth Association.
You still need to book into a hospital in case there is a problem
during your pregnancy, or you change your mind.
The Homebirth Association can help you to prepare for the birth
and provides antenatal classes in some areas.
If you are having the baby at home, your midwife will have given
you a list of things you should have ready several weeks in advance.

Early Discharge From Even if you feel safer having your baby in hospital, you may want
Hospital to be at home soon after you have had your baby. The district nurse or
Te Puta Wawe I te midwife from the hospital Will visit you at home for the first two
Hohipera weeks.
Start planning for an early discharge as soon as possible. The
district nurse or midwife usually visits you after you have booked into
the hospital, so that you have a chance to get to know one another.
Some hospitals are actively encouraging mothers to leave early.
If you are planning an early discharge you will need help at home
with cooking and washing from your partner or family, especially if
there are other children to care for. This needs to be organised early.

39


When Labour Starts

Te timata o te Whakamamae

Plan Ahead It's important not to wait until labour starts before you make your
Me Whakaaro plans. Here you'll find a list of things you should try and take care of
Whakamua before you go into labour. It will make things easier later on when you
might not have time. Sometimes it is necessary to stay in hospital a little
longer than usual if you or your baby are not well after the birth.

How Will You Get To If someone is going to drive you to the hospital, they might like to
Hospital? try a dummy run to be sure they know the way.
Ma te aha koe Haere ai Also, it's important that they always have enough petrol in the car.
ti te HOhipera? If you have difficulty getting to hospital when you are in labour,
ring the hospital and ask their advice.
The ambulance service is for emergencies only.

When Labour Starts

Te timata o te
Whakamamae

A /
/ ' •1 ., S

* \

- _ I L]
When labour Starts.
-?' -
How do you know that your labour has started? What do you do
about it? If this is your first baby you have probably dreamed about the
moment you tell your partner, "It's coming". Many people think that
labour will be sudden, that they'll be taken completely by surprise and
the baby will appear before they know what's going on. It's often like
that in comedy films, but almost never like that in real life.

When Will Labour

Begin? Your doctor will tell you when your baby is likely to be born.
Ahea ka timata te The estimated date of delivery (EDD) can only be a rough guide.
Whakamamae? You can be almost certain of having your baby during the two
weeks before your EDD or the two weeks after. (Less than one in ten
babies is born more than two weeks before the EDD.)
Off and on during the last few weeks of your pregnancy you'll
notice y our stomach going very hard, as the muscles practise for labour.

40
 Labour contractions themselves are stronger and more regular than
these practise ones.
If you are at all suspicious of getting labour contractions earlier in
pregnancy, you should contact your doctor or the hospital immediately.
Some women go to hospital thinking they are in labour. They may
be watched for a while and sent home again if the hospital staff think
this is a false alarm. Don't feel foolish if this happens to you. Doctors
and midwives much prefer you to go to hospital too early rather than
too late.

Who Will Be With You You will probably want to have your partner or someone else with
During the Labour and you during labour and the birth. Most hospitals now encourage this and
the Birth? make them welcome. You can discuss your plans with your doctor.
Ko wal ka Noho I to When we talk about the birth in this book, we mostly mention
taha i te Wa partners, as this is most common. But the person with you may just as
Whakamamae me te Wa well be your mother, or someone else in your family, or a friend.
Whakawhãnau?

Make Arrangements for Who will take care of your children? You will probably have a
the Rest of Your Family relative or friend lined up to look after your children for the week or
Whakahaerengia ngã so after the baby is born. Your partner may be able to get leave from
Whakarite mö TOu work. But what if you go into labour at night? Can you leave your
Whãnau children with a neighbour or relative at short notice?
If you go to hospital while your children are at school, can
someone meet them from school and look after them for a while?
If you have any difficulty arranging emergency child care, contact
your local branch of Pregnancy Help.
Who will take care of your pets? Arrange for someone to take care
of your pets ahead of time.

Things You Should Long journeys towards the end of the pregnancy.
Avoid Getting too tired.
Ng;! Ahuatanga
Whakatüpato

How Will You Know?
Me Pëhea Koe MOhio
Al?
The three most common ways for labour to begin are:
I With regular contractions.
2 With a small show of blood.
3 With a breaking of the waters.
Whichever way your labour starts, you should phone the
hospital or your doctor for advice. This is very important if your
labour is early. No one will mind if it's a false alarm, so don't
hesitate if you have any reason to worry.

41
1 With Regular How will you know?
Contractions To begin with they'll be mild, and may happen 10 or more
minutes apart. At first the contractions may feel like a low back
pain, but later you'll feel them across your tummy as well. They
may feel like period pains. If you are asleep or very busy you may
not notice the first ones. When labour is really under way they'll
come every 3-5 minutes and be much stronger.
What should you do?
There will probably be time while the contractions are still
weak for your partner to come home and take you to hospital. Try
to get some sleep or carry on with your ordinary activities while
you are waiting for him. Don't take public transport to hospital.
If your contractions become stronger and more frequent while
you are still waiting for your partner, get to hospital as quickly as
possible. If you can't find someone to take you, phone the hospital
and tell them what's happening. If necessary they will get an
ambulance for you. Ask someone to tell your partner to go straight
to the hospital.
2 With a small show ol How will you know?
blood When the neck of the womb begins to open the small amount
of blood, mixed with sticky mucous, that has been plugging the
neck of the womb comes away and is noticed as a show from the
vagina.
What should you do?
It is important to distinguish between a normal show, which is
a sign that labour is about to begin, and real bleeding, which could
mean a complication.
Generally, a show should do no more than stain a pad. A loss
as heavy as a period is not a show and you should telephone your
doctor or the hospital at once.
When you notice the show, you've got time to get in touch
with your partner and wait for him to come home.
3 With a breaking of How will you know?
the waters The bag of water in which the baby has been lying has to
break at some time in labour. Usually it happens when the
contractions are regular, but it may happen much earlier as the first
sign of labour. The waters may flow from the vagina in a slight
trickle, causing just a dampness in your pants or it may gush out,
all at once, soaking your clothes or the bed. (You can protect your
bed by putting a plastic sheet under the bottom sheet, or by
sleeping on a towel in the last few weeks.)
What should you do?
If you think your waters have broken but there are no
contractions, don't delay. Your doctor may want you to go into
hospital now as the baby is no longer protected from infection and
labour will begin soon.

For Partners: it makes it easier if you plan ahead too.

Can you get from work to home in time to take your partner to
hospital? If not, be sure you have worked out the quickest way to the
hospital from your work, as well as from home.
Plan to be able to leave work quickly at any time during the last
two weeks of pregnancy.
Try to have a quick snack before you go and take something to eat
with you. You might have a long wait ahead of you.
If you have time, change into something comfortable.

42
 Giving Birth
Te Whakawhãnau
In this section we explain what happens in hospital to a woman
who is having a normal delivery.

Going to Hospital When you think you are in labour, you should telephone the
Te Haere ki te hospital. They will ask your name, address and date of birth. Once they
Höhipera have these they can get your case notes.
The first thing the midwife will do when you arrive at the hospital
will be to check these details. Then you can change into more
comfortable clothes if you want to.

Midwife's Examination The midwife will check the baby's position and listen to her
Nga Tirotiro a heartbeat. She will note how strong and how frequent your
te Wahine- contractions are.
whakawhãnau Next your midwife may give you an internal examination. This is
important because it tells her how far the neck of the womb has
opened. It also shows if the waters have broken. You can ask her how
you are getting on.
She may ask you if you need to go to the toilet. An empty bowel
makes it easier for the baby's head to come down the vagina. If you
need help, she may offer you suppositories which she puts into your
rectum (back passage).
A sample of your urine will be taken for examination and your
blood pressure will be recorded.

Not Long to Go? A nurse will keep a check on the baby's heartbeat and other things such
Kua Tata te Wa Whãnau? as your contractions and blood pressure.
The nurse may not be able to stay with you and your partner all
the time if the ward is busy.
However, you will have a buzzer to call for help or advice at any
time.

Partners and Labour Partners provide the vital company needed, particularly during the
Nga Hoa me te first stage of labour which can last for many hours.
Whakamamae

Your partner can play a vital

role in the time before and
when you are giving birth. He
can massage your back, help
you change position, and
sponge your face. He can also
explain your needs to busy
staff.

43
 A partner can give you support and love during this time. For
example, they can make you' comfortable by massaging your back,
helping you change position, giving you sips of water and sponging
your face. They can explain your needs to busy staff. If your partner has
practised relaxation and breathing with you at antenatal class they can
help you through the most difficult contractions.
.. Your partner may feel uncomfortable during some of the
procedures that are done during labour and delivery, such as an internal
examination. They should feel free to leave while this is happening. You
may both like to discuss these sorts of things before labour begins.

The Stages of There are three main stages in labour. In the first stage the neck of
Labour the womb opens, in the second stage the baby is pushed out of the
Ngã Wãhanga o te womb and through the vagina, and in the third the placenta comes
Whakamamae away from the womb and comes out of the vagina.

The First Stage This is the longest part of labour, when the contractions open the
Te Wahanga Tuatahi neck of the womb to a width of 8 to 10 cm (3 to 4 inches).
Anything from 1 to 24 hours is normal for a first stage. In early
labour you may like to walk around if your contractions are not
bothering you. Use your breathing rhythm to help you as you have been
shown at .antenatal classes.

When you get a contraction,

stop moving, prop your body in
a supported position, stop and
relax.

Once the contractions are lasting for a minute or so you will

probably want to start relaxation and breathing exercises. It is a good
idea to pass urine every hour or so during the first stage; a full bladder
makes the contractions more painful. You can lie on your side, or
propped up with pillows, whichever is more comfortable. If they
haven't broken already, your waters will probably break towards the
end of the first stage of labour.
Sometimes the waters are broken deliberately to check the
condition of the baby. It may be necessary to watch the baby's
heartbeat closely with an electronic heart monitor.

By the end of this stage the neck

of the womb is fully open.

44
The Second Stage In the second stage the contractions now push the baby Out
Te Wahanga Tuarua through the vagina.
This is the active, hardworking stage of labour and seldom lasts
longer than an hour.
You can usually tell that the second stage has begun, because with
each contraction you really feel you want to push. Let the midwife
know immediately you feel this urge so that she can get you into the
best position and guide you with your pushing. Antenatal classes should
help you do this.

Between contractions you can rest a little and wet your lips with
sips of water.
You feel pressure against your bowel opening. It feels as if the baby
is coming out of the wrong hole! The top of the baby's head can be
seen in the vagina. With each contraction it moves forward a little
further then slips back a little.

Panting, and relaxation of the pelvic floor muscles to allow as

much stretch as possible are important at this time. An episiotomy is
sometimes necessary when the tissues are unable to stretch enough.
This is a cut made, under a local anaesthetic, to enlarge the opening of
the vagina. It is stitched up again when the placenta has been delivered.
Soon the baby's head crowns - that is, it remains visible after the
end of the contraction. You-will now be asked to pant rather than push
so that the baby's delicate head may be delivered gently. When the
baby's head is born her nose and mouth may be cleared of mucous. She
may start to breathe before the rest of her body comes out. Another
push and the baby is born.
In most cases, at this moment the midwife will give you an
injection to make your womb contract and reduce the risk of bleeding.
Within seconds the baby breathes, then cries and moves.
Her skin quickly turns from blue to pink. The baby can usually be
held close by the mother and father as soon as she is breathing well,
within seconds of delivery. If you want, she can he put to your breast at
once.
45
 /H
/

14;

[q
The long first stage of labour is r
over and the neck of the womb
is fully open. Now you are

'
ready for the delivery of the
baby. This only takes a short

I
time, about half an hour to an

h
hour. At the delivery stage you
want to push. Then you know
it won't be long. The midwife
will help you into the best )r-
position for pushing. The
contractions will start to force
the baby out of the womb and
down the vagina head first. You
will feel pressure against your
back passage. It feels as though
the baby is coming out of the
wrong hole! The head appears Al
and the midwife helps to ease /

it out gently. Then the baby's

body comes out sOOfl after. And
there's the baby, still attached I
to you by the cord. /• (

•.

1L I
Parents can be together when
their baby is born.

46
The Third Stage
Te Whanga Tuatoru

In the final stage the placenta comes out. The strong contractions
of the second stage stop when the baby is born, then start again within
a few minutes. The womb becomes smaller as it contracts and the
placenta separates from it. Careful pressure on the womb or gentle
pulling on the cord helps the placenta out of the body. This may be
accompanied by a final contraction and you may have to push again. In
a small number of cases the placenta does not come out on its own and
has to be removed under an anaesthetic.

After the Birth The process of birth is now complete. You may require stitches if
A Muri I Te Whãnau you have had an episiotomy or if there has been a small tear in the
vaginal opening. All that remains is for the placenta to be examined. At
this time the baby is weighed and his cord is clipped with a special
plastic clamp and then cut short.

Coping with Pain As you get further into your labour, you are likely to find that the
Te WhakakiriUka 1 contractions become painful. Very few people have a completely
te Mamae painfree birth. During your pregnancy you need to think and talk about
how you will cope. Find out what kinds of pain relief are available and
what you find acceptable. Remember that whatever decisions you make
in advance, circumstances may change your plans. Don't feel guilty or
disappointed if you need more pain relief than you had hoped for.
Everyone is different.

What You Can Do For If you understand what's happening in labour, you'll be able to
Yourself cope better. Fear makes pain worse, so learning about labour and how
Me Pehea TO Awhina i a to relax and breathe properly at antenatal classes can help a lot.
Koe So you can feel in control of what is happening to you throughout
your labour, don't hesitate to ask questions and to ask for whatever you
want. You are working with the midwife or doctor, and they with you.
As well as relaxation and breathing, your position in labour can
also make a difference. Kneeling helps some women, for example.
Walking around, or moving in other ways such as rocking backward
and forwards, can also help. So can massage.
Most women manage better in labour if their partner, or someone
else, is with them. If you've no-one with you, then your midwife will
certainly help and support you.

Combined Relaxation Combined relaxation and breathing exercises will help you cope
and Breathing with pain with or without the use of medicines. For some women the
Exercises coping techniques taught in classes work very well, allowing them to
Te Whakatãpiri i te remain in control throughout.
Mahi Whakatã me te Others find them useful, but still need a little help from pain
Mahi Whakahã relieving medicines. No woman should feel she must try and do
without. Whatever happens, your labour can be made as comfortable as
possible.
If you are finding it difficult to cope the midwife may offer you an
injection for pain-relief.
47
Injections The drug most widely used is pethidine. The injection is easily and
Nga Werowero quickly given. It takes about 20 minutes to work, and then the effects
last for about two to four hours. For most women, pethidine or similar
drugs do lessen pain but don't do away with it altogether.
The disadvantages of injected drugs are that they can make you
feel 'woozy' or sick - or sometimes be sick. Or you may feel drowsy
so that you can't push so well when you need to. Although there are no
serious side effects, if you have a drug like pethidine within an hour or
so of delivery, your baby may be sleepy and slow to breathe. But babies
can be helped to breathe properly very quickly.

Gas The midwife may not give the injection if she thinks the baby will
Te Hau Whakakore be born soon. Instead you will be able to make use of gas which reduces
Mamae pain and which you can control yourself. You'll probably have been
shown how to use it at antenatal classes, or by the midwife in the
delivery room. Gas is a mixture of oxygen and another gas called
nitrous oxide. You breathe it in through a mask which you hold for
yourself. You start just as the contraction begins because the gas takes
fifteen to twenty seconds to work. It's easy to use but if you breathe in
too much, it can make you feel sick or sleepy.

Epidurals An important advance in easing pain over the past few years has
Te Ngira Whakakore been the use of epidurals. An epidural is a special type of local
Mamae anaesthetic which numbs the nerves which carry the feelings of pain
from the birth canal to the brain. For most women an epidural gives
complete pain relief.
An epidural has to be given by an anaesthetist, and may therefore
be only available in base hospitals. You he curled up on one side and a
needle is injected between the bones of your spine. A plastic tube is
threaded down the needle into a place outside the nerves of the spinal
cord. Then the needle is taken out. The tube is held in place on your
back by a piece of sticking plaster. All this takes about twenty minutes.
The anaesthetic is then injected down the tube and, starts to work in
about 15 to 20 minutes. As the first injection wears off, further 'top-up'
injections can be given in the same way.
An epidural can be very helpful for some women who are having a
long labour or who are becoming very distressed. But there are
disadvantages. Your legs feel heavy, you may find it difficult to pass
water on your own, and it is difficult to move yourself about to get
comfortable. Since you can no longer feel your contractions, the
midwife has to tell you when to push, rather than you doing it
naturally. This means that it can take longer to push the baby out, and
forceps are needed more frequently to help the delivery.

TENS Is a drug-free form of pain relief. It uses electrical stimulation to

Te Hilo Arai Mamae dull the pain sensation.
The TENS stimulation is supplied by a small box-like machine, the
size of a mini walkman, which can be clipped to the nightgown.
Electrical stimulation is applied by electrodes which are usually attached
to your back. Moving around and changing positions is fully possible
when using TENS. TENS has no effects on the baby, and TENS machines
are available in some, but not all, hospitals.
If you still don't want any of these kinds of pain relief, you are free
to say so. And if you decide you do want something, you should ask for
it without waiting to be offered.

48
Other things that Your labour may be very similar to the one we've described, or it
Can Happen might vary a little. There are other common practices you might come
Etahi atu across.
Ahuatanga o te
Whakamamae

Starting Labour Off This can be done in several ways.

Artificially - Induction Hormone tablets may be placed in the vagina to prepare the womb
Te Whakatimata I te and the neck of the womb for labour. Induction can also be done by
Whakamamae breaking the waters. A hormone drip into the arm may be used as well
to improve contractions.
After induction the labour progresses in the normal way, though it
may be quicker with more severe contractions.
A doctor suggests induction if there would be a risk to the mother
or her baby if the pregnancy went on any longer, for instance:
1 If the placenta is not working properly. This may happen if the
mother's blood pressure is raised or if the baby is too long overdue.
2 If the mother is becoming ill. In this case induction may be planned in
advance. You have time to ask your doctor to explain fully what is
involved. They can answer any queries.

Helping the Delivery - About 10 percent of women need the help of forceps, and another
Forceps and Caesarean 10 percent, a Caesarian section for a safe delivery.
Section Forceps are usually needed because the contractions aren't strong
Te Awhina I te enough, or because the baby has got into an awkward position and is
Whakawhãnau - ngá becoming distressed.
Taonga Huhuti me te Usually a local anaesthetic is given so the mother can still be
Whãnau Poka conscious when the baby is born. The forceps are placed round the
baby's head and by gentle, firm pulling the baby can be born. You can
help by pushing at the same time.
Afterwards you may see red marks on your baby's head where the
forceps have been. These marks fade quite quickly.
An episiotomy (cutting the perineum to make the vaginal opening
bigger) is always needed for a forceps delivery, so stitches are needed
afterwards.
Your partner should be able to stay with you.

About 10 percent of women

need the help of forceps because
the contractions aren't strong
enough or because the baby is
becoming distressed.

49

A baby born by Caesarian often
has a beautiful, unmoulded
bead.
With a Caesarean section a general anaesthetic may be given,
making the mother unconscious, or an epidural may be used. This
numbs the operation area but allows the mother to stay awake. The
surgeon delivers the baby by cutting through the abdominal muscles to
the muscular wall of the womb. The cut is usually done crossways and
low down, just below the bikini line. It is hidden when your pubic hair
grows again.
A Caesarean section is done when there is a high risk of damage to
the baby or the mother from an ordinary delivery - perhaps because a
woman has a small pelvis so that delivery would be difficult, or if either
the baby or the mother is at risk in some way and delivery must be
quick. Medical staff prefer normal deliveries but where this is likely to
be dangerous, the well-being of the mother and baby come first. In fact,
babies born by Caesarian section often look particularly beautiful at
birth because the head does not get misshapen during delivery.
After the operation the mother has stitches to seal up the wound.
These are taken out 5-8 days after the operation. Deep breathing and
exercises started soon after the delivery of your baby are important for
your circulation and return to fitness. A graduated exercise programme
over the next 12 weeks will assist you back to physical fitness.
Guidance and assistance will be given by a physiotherapist.
Breastfeeding may be a little more difficult after a Caesarean
section but the midwife will be able to help you find a comfortable
position in which to nurse your baby.
Your stay in hospital will be longer after the operation and you
won't be fit to run a home or look after other children right away.
You'll find that you tire easily and need plenty of extra rest, as you
would expect after any major surgery.

Breech Birth A breech birth is when a baby is born bottom first. It is possible for
Te Whánau Koaro a baby to be born this way quite normally but labour is usually longer
and forceps are quite often used. A breech position may be a reason for
a Caesarean delivery.

'-/

head first, or cephalic. Breech, or bottom first.

50
Transfer to Another Special arrangements have to be made for some babies whose birth
Hospital weight is less than 2500 gm (5 1/2 ibs). Some babies are too small
Te Haere lii tetahi atu because they have been born too soon, before the 36th week of
Höhipera pregnancy. Others have grown rather slowly in the womb.
Every mother wants to see and hold her baby at once, but tiny
babies need immediate expert care. The baby will be taken to a special
trolley to help him breathe. He will then be transferred to an incubator
which helps keep him warm, moist and free from infection. Very small
babies have difficulty sucking so they may have to be tube-fed. If the
mother wants to breastfeed, she can express the milk from her breasts
so that it can be given to the baby. Parents can still see their baby as
often as they want to.

A premature baby. Physical

contact is important for this tiny
baby.

Hospitals encourage parents to take part in nursing their tiny baby

so they can get to know him in the earlydays.

51
Love at First Sight? Your newborn baby may well be the first you have ever seen.
Te Aroha I te Young babies can often look very odd - a wrinkly skin, lumps or
Kitenga Tuatahi? bumps on the head, and maybe even blood-shot eyes.
Have a Good Look There is no such thing as a "perfect" baby. Perfectly healthy babies
Me Ata Titiro may differ widely and it doesn't matter. However, some "oddities" are
so common that they're worth listing:
The navel. The baby's umbilical cord is cut at birth and clamped
or tied near the body. It soon dries up and falls off.
Jaundice. This gives a yellow, "sun-tanned" appearance including
the whites of the eyes. Many babies have some jaundice, which is
usually harmless and goes away by the 7th or 8th day. Jaundiced babies
may be treated by phototherapy. The baby is undressed and put under a
very bright light. Usually a soft mask is put over the baby's eyes.
Sometimes this treatment is needed for several days, before the jaundice
clears up. If the jaundice gets worse, an exchange transfusion of blood
may be needed to cure it.

Birthmarks. A great variety of small red, blue or black marks may

be visible on close inspection. Some babies have a greyish-blue area on
their bottom, which gradually fades.
These marks should be left as they are, unless they get bigger at any
time. Then you should tell your doctor.
Breasts. The breasts of both boy and girl babies are often swollen
and sometimes ooze milk in the first month. Girls may also lose a few
drops of blood from the vagina, like a tiny period.
Both effects are caused by hormones from the mother crossing the
placenta to the baby before its birth.
Miia. These are yellow or white pinhead spots on the baby's face.
They are due to a build-up of secretions in the tiny glands in the baby's
skin. They go by themselves within a few months.

52
 The fontanelle. On top of your baby's head, near the front, is a
diamond shaped patch where the skull bones haven't yet fused
together. This is called the fontanelle. It will probably be a year or more
before the bones close over it. You may notice it moving as your baby
breathes. You needn't worry about touching it. There is a tough layer of
membrane under the skin.
Baby's stools. Immediately after birth and for the first few days
your baby is likely to pass a sticky black-green substance. This is called
meconium and it is the waste that has collected in the bowels during
the time in the womb. Then, as your baby begins to digest your milk,
the stools will change, probably becoming more yellow or orange.
The colours can be quite bright.
Babies vary a lot in how often they pass stools. Some have a bowel
movement at or around each feed, some can go for a day or even
several days without having a movement at all. Either is normal.
In any case, the baby will be examined by a doctor in detail soon
after the birth and again before you go home. Ask if you are worried
about any of these "oddities".

Safe and Warm Don't be afraid to hold and cuddle your baby as much as you
Te Mahana want.
o te Awhi It's very important to be close to your baby as soon as possible
after birth. Love at first sight won't necessarily follow. It takes time to
fall in love. But being close and cuddling gives you and your baby the
best chance to get "in touch" with each other right from the start.
Soon after your baby's birth, you will be given her Health and
Development Record book.
You should take this with you every time you see your child health
nurse or doctor. It also gives you a lot of advice on caring for your
child.

Circumcision Doctors do not recommend circumcision of new-born babies any

Te Tapahi longer. The operation is distressing for the baby and there is an
o te Kiri Mata increased risk of infection when babies are in nappies. If you are very
keen to have your baby circumcised, then you should talk this over
with your doctor.

Registering Your The hospital (or domiciliary midwife, if you had your baby at
Baby's Birth home) within 48 hours of your baby's birth notifies the nearest Registrar
Te Rëhita i te of Births that you have had a baby. The Registrar then sends you a birth
Whãnau oTö Pepi registration guide form to complete, so that your baby's birth can be
registered. This should be returned to your nearest district registry
office within two months of the birth.
If you are not married when you register the birth, but would like
the father's details recorded on the registration, both mother and father
need to attend the district registry office together. If the mother and
father were living together as man and wife at the time of birth then
consent to having the father's details recorded may be given in a letter
to the Registrar.

53
 Taking care of yourself
TO Atawhai I a Koe
After the birth, you will find that if you take good care of yourself,
you are more able to care for and enjoy your baby.
For the first few days you may well feel quite shaky. If you've had
stitches, they'll be sore. Going to the toilet may be difficult. Even just
walking and moving about can be hard work. And your breasts will fill
with milk and may become quite painful for a day or so.
After the excitement of the birth some women can feel low. Give
yourself time. You've been through an exhausting and emotional
experience.
You may even need some time before you are able to love your
baby. As with any relationship, it's not always a case of love at first
sight.

Being in Hospital Hospital life can be restful and easy, or tiring and difficult. if you
Te Noho I te HOhipera find you have a problem, talk to the staff on the ward and see whether
anything can be done.
For example, in some hospitals babies are with their mothers all
day but are taken to a nursery at night so that the mothers can sleep.
The staff then see to the night feeds. This Suits some mothers but not
others who are breastfeeding or who particularly want to be close to
their babies all the time. If you can't arrange for your baby to stay with
you all the time, ask the midwife to wake you up when your baby cries
so that you can go to the nursery or your baby can come to you.
Getting enough rest and sleep can also be a problem in hospital.
There is always so much going on. But there will probably be a rest
period each day when there is no visiting, so make the most of it.

Bleeding After the birth you will lose blood from the vagina for a few days.
Te Rere o te Toto The blood may come in quite large clots from time to time. You will
then continue to have a brownish discharge, probably for some weeks.
The discharge will gradually get less and less. Use ordinary sanitary
towels, not tampons. There is a risk of infection if you use tampons in
the early weeks after the birth.
If you are breastfeeding, you may not have another period until
you stop feeding. Even then it may be some weeks or even months
before you bleed again. If you don't breastfeed, you may have your first
period as early as a month after delivery or not until much later.
During breastfeeds you may notice you tend to lose more blood
or get a rather heavier discharge. This is normal.

Stitches Sore stitches can be soothed by sitting on a rubber ring or perhaps

Ngã Tuituinga by using an ice pack if the hospital recommends it. You will help the
stitches to heal if you bath often. Or just bathe the stitches with cotton
wool and warm water. After bathing, dry around the vagina carefully. A
good way of doing this is to use a hair dryer. The hospital will also give
you pain-kiffing tablets if you need them.
Going to the toilet can be difficult and a bit frightening at first
because of the soreness and because you can't seem to feel or control
what you are doing. If you really find it impossible to pass water, tell
the midwife;

54
 You probably won't open your bowels for a few days after the
birth, but it's important not to let yourself become constipated. Try to
include some fresh fruit, vegetables or salad and brown bread in the
food you choose from the hospital menu. This should mean that when
you do open your bowels you will pass a stool more easily.
Whatever it may feel like, it's very unlikely that you will break the
stitches and open up the cut or tear again. Still, it can make you feel
better if you hold a pad of clean tissue over the stitches when you try to
pass a stool. And avoid straining for the first few days. Usually stitches
don't have to be taken out. They just dissolve after a week or so, by
which time the cut or tear will have closed.

Piles It is common to have piles after delivery. They are the result of all
Nga Tero Puta the pushing you did in labour. They are uncomfortable for a while but
soon go. A rubber ring makes sitting easier. Also try to include plenty of
fibre in what you eat - fresh fruit, vegetables, salad and brown bread.
Try not to push or strain when you go to the toilet as this will make the
piles worse.
Let the midwife know if the piles are very uncomfortable. She may
be able to give you something to soothe them.

Rhesus Negative If your blood group is rhesus negative and your partner is rhesus
Mothers positive you will be given an injection within seventy-two hours of
Nga Whãea Toto delivery in order to protect your next baby against anaemia. If you are
Rhesus Negative not given this injection, check with your doctor or midwife.

Rubella (German If you were not immune to rubella (German measles) during your
Measles) pregnancy, you will probably be offered the immunisation before you
Te Köpukupuku leave hospital. If this doesn't happen, ask. It is a good opportunity to
get it done and you can then be confident that any future babies will be
protected.
L The immunisation is safe even if you are breastfeeding. But it is

vital not to become pregnant again for three months after having it.

Regaining Your Figure You can start right away after the birth to get yourself fit again.
Te Whakaãthahua ano i The muscles around the vagina may feel very slack. If you had stitches
tO Tinana you may be feeling sore and uncomfortable as well. Apart from that you
probably feel quite slim after losing your "bump". it is only when you
get home that you realise your tummy and waist are also rather lax and
flabby.
It is important to start gently exercising these pelvic floor muscles
soon after birth. Regular muscle tightenings help the healing process and
restrengthen the muscles which give good bladder control.
Exercising the abdominal (tummy) muscles helps firm your
waistline and helps good posture which is important for care of your
back.
The exercises over the page should be done often through the day
until your six-week post-natal check. After six weeks a gradual increase
in activity can be undertaken. Avoid vigorous exercise and heavy lifting
for at least 12 weeks after delivery, as it takes this long for the ligaments
(supports for your joints) to firm up. Some women find strenuous
activity while breastfeeding can diminish the milk supply.

55
 Exercises are much better for losing weight than skipping meals.
If you don't eat regularly you'll find you get very tired.
You may be shown exercises at antenatal classes, or by a
physiotherapist at the hospital. If not, ask your midwife where you can
be shown some.
If you have had stitches, bathing the area and exercising the
muscles round the vagina can help the healing process.

Rest and Relaxation Previous sleeping patterns are often changed when baby arrives. It
Te Whakatã me is important to get sleep when the opportunity arises, both during the
te Whakanga day and night.
Practise relaxing by using the methods you learnt at antenatal
classes, especially during feeding times.

Take Five About 12 hours after birth, start very gently strengthening your
Minutes to Lose muscles.
Five Inches Practice the pelvic floor exercises from page 10. Remember to
Ma te Korikori protect your back by bending your knees before lifting. Four or 5 days
Tinant ka heke after a normal birth add these exercises:

U -

I. Pull tummy in. Keep

breathing regularly.
2. Curl your chin on to
your chest and lift
head and shoulders.

3. STOP before your

tummy bulges.
4. Arch your spine like an
angry cat and then
relax. Don't let your
tummy muscles sag.
Twist your head,
shoulders and hips
from side to side so
that you bend at the
waist. Your shoulders
and hips should almost
meet, then repeat on
the opposite side.

If you have trouble with incontinence now or later consult a

physiotherapist.
Do not expect to return to vigorous activity until your ligaments
(which loosened for the birth) have had time to tighten up, about 6
weeks after the birth.

56
Tiredness: Fitting Even with extra rest, tiredness is often a problem because most
Everything In new mothers do far too much. They don't stop to sort out what really
Te Mauiuitanga: must get done from what can be left. It's up to you to work out what
Te Whakauru i ngã the most important jobs are and which you can happily leave. Accept
Mahi Katoa offers of help people make. It lets them contribute to you and your
baby's wellbeing.
On the next page there's a list of activities. Tick those that suit you.

Postnatal Checks Six weeks or so after the birth your doctor should give you and
Ngã Tirotiro i muri your baby a complete check-up to make sure everything is normal. The
i te Whãnau visit is free. It's a good time to ask for advice on any problem you have,
like tiredness or depression.
If you are still having:
1 Discomfort in the pelvic floor muscles, where the episiotomy (cut in
the muscles) was made.
2 Are still unable to hold water when you cough, sneeze, laugh, lift etc.
3 Have pain in your back or neck and shoulders.
4 Still have a large gap between your tummy muscles.
Mention these problems to your doctor, who can then refer you to
a physiotherapist for specialist treatment. Your baby should also be
checked at this time. Ask advice on any problems, like sleeping or
feeding, your baby may have. This is also the time for his hepatitis B,
and triple immunisation.
Remember to take your baby's Health and Development Record
book with you.

How Do You Feel? It can take a long time to get used to having a baby in the house.
Kei te péhea. töu Big changes take place all at once. You are instantly faced with
Ahua? being a parent responsible for a baby 24 hours a day. Your relationship
with your partner changes too. And you have probably given up your
work (at least for a while). You find yourself at home all day, often
alone except for the baby.
It's not surprising that there are problems in getting used to these
sudden changes. But there are ways of making life easier for yourself.

Parents Are People Many parents have very romantic ideas about what it will be like to
He Tangata ngã Mãtua have children. They think that when the baby arrives all the right
feelings will come naturally and they'll know just what to do.
Then they feel helpless and guilty when faced with a real-life baby
who seems to be all work, cries when visitors come, and tires them Out
day after day.
They may get even more guilty if they feel bad-tempered towards
the baby from time to time.
It is important to realise that almost all parents have mixed
feelings about their babies at some time or other, though not all
will admit it.
Nearly everyone feels angry sometimes, but very few ever do
anything about it. In other words, no-one is perfect, no-one can do
• everything they'd like to do for their baby. So don't get worried or
guilty if you don't live up to that dream. It is often difficult to think
• things through when baby is crying.
Talk with someone about your feelings towards your baby. On
page 60 there are some ideas to help you.

57
 Fitting Everything In
Te Whakauru I ngã Mahi Katoa

Tick the column that suits you Essential I

Important I Could Be Left

1 Basic cooking for self and partner

2 Special cooking
3 Washing day-to-day clothes for the family
4 Washing curtains, blankets etc

5 Housework: barest essentials-washing up,

vacuuming, etc
6 Housework: dusting, polishing, cleaning
windows etc
7 Your own interests
8 Writing letters
9 Watching TV, reading
10 Shopping
11 Shopping: non-essentials
12 Telephoning friends
13 • Seeing friends and family
14 An hour's rest or sleep
15 Getting to know your baby
16 Sharing feelings with your partner

If you had difficulty putting any ticks in the third column, go

through it again. Think hard about each item. Aim to tick about five.
It makes good sense to tick some relaxing activities as important or
essential.
Now stick to the essentials, using any spare time to relax or even
sleep. As you regain your energy, you can include the important
activities, making sure that you still relax. If not, drop them again -
you deserve to put your feet up.

58
Problems With Your A couple may have problems with their relationship after the baby
Partner is born. The woman may easily be so busy with the baby that she
Ngi Raruraru d doesn't take any notice of her partner. The man may feel jealous of the
Körua ko To Hoa baby for taking all the attention and love. Their sex-life may also be
affected by tiredness and worry. Women often say things like:
"He doesn't seem to want me physically anymore. I think all this
motherhood and breastfeeding is turning him off."
Or "We don't seem to be getting on very well. He just doesn't
seem to understand that I can't spend so much time with him as I'd like
to because the baby is so demanding and time consuming."
What can you do about these problems? First of all, talk over your
feelings together, trying to understand the other's point of view.
Many couples find their problems are solved by the man helping
look after the baby. He can then take some pressure off his partner and
hopefully feel less jealous.
It is not unusual to have difficulty with lovemaking at first,
especially if the woman has had stitches at the birth. It might take some
time for the area to heal fully.
You can help yourself by doing exercises, going to the postnatal
check-up and giving the area a chance to heal. You may have to try
different positions to see which is the most comfortable, and use extra
lubrication for a time in the form of special creams, e.g., K-Y Jelly
available from the pharmacist. Talk it over with your partner. Then you
can relax and take your time.

Depression You may feel low or "have the blues" for a few days after having a
Te Pouritanga baby. This is normal and goes away quite quickly with support and
understanding from those around you.
But later on depression can develop if things get on top of you and
you feel out of control.

Let family and friends help with

the baby sometimes and give
you a break.
Here's how two mothers felt soon after they had their babies:
"I wanted my baby so much, and of course I love him, but it does
worry me. I have had bad thoughts about him sometimes. He cries and
sometimes I wish I'd never had him."
"Some days I feel so depressed, I just burst into tears for no reason
and I feel I just can't cope. Everything seems to go wrong and I feel I'm
a failure as a mother."
If you feel like this, remember these reactions are very common.
You are not a freak or a failure.
They are caused by things like tiredness and getting used to being a
mother for the first time.
These causes can be overcome.
59
Helping Yourself with
Depression
Te Awhina i a Koe
i roto I te Pouritanga
2 Keep a check list of the good feelings you have in any one day.
4 Have a good sleep. Extra rest is essential because you will feel
ro Some centres are now running sessions for mothers and babies as a
It is important not to let worry or anxiety blot out your good
feelings about the baby. Make the most of the times when she's
feeding well and you're feeling relaxed. Don't let thoughts of
cooking or washing the nappies crowd out the pleasure.
Even if they last only a moment jot them down. When your
partner comes in make him listen to them. As you tell him, you can
relive the good moments.
Let people help you. For instance, ask your neighbour to do a bit
of shopping for you. It makes people feel good to think they are
helping someone else, but they may only offer once for fear of
interfering. Help with the routine chores lets you get more rest,
relax with your baby and get out of the house for short breaks.
exhausted. Try to get at least half an hour's rest during the day.
Talk about your feelings of depression with someone; don't be
afraid to say how you feel. Your partner is closest to you but he
may not be very good at listening. He may even get impatient if
you are still depressed after all his efforts.
Other mothers are probably the most sympathetic listeners,
and they will be able to come up with practical suggestions. You
may be able to share your feelings at your local Te Kohanga Reo.
You can also discuss depression with your doctor or child health
nurse.
continuation of their antenatal classes. Some areas have Parents
Centre postnatal groups or New Mothers Support Groups. Your
child health nurse, practice nurse or doctor will be able to tell you
what is available in your area. You could start a group of your own
with friends.

Child Care You may need good child care while you take a break, do
Te Atawhai Tamaiti something for yourself, or add to the family income. If you are going
back to work, you should begin to make plans well in advance. It is not
always easy to find satisfactory childcare and it may take you some
time. It is essential to feel happy and confident about whatever
arrangements you make. Once you are working again, it is difficult to
make new arrangements.
Childcare centres charge parents fees but a subsidy may be
available for some families. Visit and choose the type of care that suits
you. Pregnancy is often a good time to do this. There is a range of early
childhood services in New Zealand. For further information about these
and about childcare you can contact your District Manager, Early
Childhood Development Unit, whose telephone number is in the phone
1)00k.
Some people choose home-based care such as a nanny, relative or
friend, or family day care. Others prefer centre-based care.
Te Kohanga Reo. The language nest. The family (whanau) is the
basis of all Maori life and in these whanau centres (kohanga) child care
is offered in an environment of Maoritanga and kinship values. The
Maori language (reo) is used to benefit children from birth to five years.
Childcare Centres. These provide mainly for families who need
regular, booked child care. They are usually open all day, every day to
suit employed parents. Most offer both full-time and part-time child
care. Only some cater for children from birth. They offer both care and

60
 education for children. Very occasionally, a centre may be provided at
your place of work. This allows you to see your baby, even breastfeed if
you wish, in your lunch break. If there are enough mothers where you
work who would use a centre, it is certainly worth discussing the idea
with your employer.
Creches. These provide for families needing child care on a casual
basis for a few hours at a time. Creches are sometimes associated with
an adult activity, such as at a sports stadium, with a craft group, at
shopping centres, etc.
Family Day Care. This is full or part-time care arranged in a
private home by an agency which selects carers, and puts families
needing child care in touch with them. The agency sets up the
arrangement, supports the caregivers, keeps in touch with parents
whose children are in care, and supervises the childcare. Children are
usually cared for in ones or twos in private homes and arrangements
may be made for them to attend other early childhood groups. This is
an alternative to group care.

Family Planning Discuss family planning with the hospital staff or with your own
Te Rãhui doctor because you may need contraception before your first postnatal
visit.
Possible methods of contraception are:
The Pill. If you are not breastfeeding, you can go back to taking
your usual contraceptive pill. But this is not reliable for the first seven
days of taking it, so for this time you will need to use some other sort
of contraception, such as a condom, as well.
_z If you are breastfeeding you may be offered a low dose pill
(sometimes called the mini pill) which contains progestogen-only and
-- which will not reduce your milk supply as the ordinary pill may. It is
V not quite so reliable. There is no evidence that this progestogen only pill
affects the baby in any way, but even so, some women prefer not to
take any sort of contraceptive pill while they are breastfeeding and use
another form of contraception instead. Women are usually less fertile
when they are breastfeeding, so a less reliable method can be
considered.
The Condom. Used by the man, this may be the best and simplest
choice for the early weeks. It works best if you use a spermicidal cream,
jelly, foam or pessary as well. Some makes of condom have a
spermicide in or on them.
The Cap or Diaphragm. A cap or diaphragm used before having
(1 a baby may not be the right size afterwards and so it won't be so
reliable. You can have a new one fitted at your postnatal check-up. In
the meantime you can use another method, such as condoms.
The IUCD. An IUCD may be inserted after delivery but it is more
likely to be expelled by the uterus. Most women wait until about eight
weeks after the birth of their baby before having one inserted. For those
women who are breastfeeding, there is a possible slight increase in the
risk of perforating the uterus. You will need to discuss this and other
possible complications with your doctor before making this decision.
This is a particularly suitable method for women who have completed
their family.

61
 The Injection. Some women choose to have a three monthly
injection of Depo Provera, either because it has worked for them
previously or because they had problems with other methods of

WA contraception. This does not appear to interfere with your milk supply.
You can discuss the advantages and disadvantages of this method of
contraception with your doctor.
Natural Family Planning. It is easier to use this method after you
NATURAL have had your baby if you have learnt the technique beforehand.
rMby Natural Family Planning Clinics have trained teachers who can help
PbflNNING couples recognise the times when intercourse could lead to pregnancy.

62
 You Have Access To Many Services During Pregnancy
He maha ngã ratonga kei te wãtea ki a koe I tO wã
hapUtanga
These are some of the services available. If you need to know
more, ask your family doctor.

This person or providing this service... can be contacted..

organisation...
family doctor health care including obsteric care, baby at health centre or doctors'
care and family planning rooms. See the front of the
phone book under medical
practitioners
practice nurse nursing care and treatment as above
obstetrician specialist obstetric care by referral from family
doctor to the specialist at
hospital clinic or private
rooms
midwife assists antenatal care, at delivery and at hospital clinic and labour
after the baby is born ward and postnatal ward

domiciliary midwife midwifery at home births by referral from doctor, or
through health development
units, area health boards or
Homebirth Association
district nurse home care after baby born particularly by referral from hospital or
if early discharge from hospital through family doctor

public health nurse family and child health advice and health development unit or
support
area health board - see phone
book

Plunket nurse family and child health advice and at Plunket rooms. See in
support
phone book under Plunket
Society
dentist dental health care see phone book
dietitian advice about food by referral from the family
doctor to hospital clinic or
private dietitian
physiotherapist fitness for pregnancy labour and the post- antenatal classes at hospital
natal period. or Parents Centre or by
Instruction in relaxation, breathing referral from family doctor to
techniques and coping skills for labour. the hospital clinic or private
Remedial treatement for the problems physiotherapist
arising during pregnancy, labour and the
post-natal period particularly bladder
control, muscle restoration and back care
Parents Centre antenatal classes. The groups continue see phone book
after the baby is born with postnatal
groups, coffee groups toddler courses

63
Department of Social advice on benefits see phone book
Welfare Offices
social worker assists with social problems at hospital, health centre, or
Department of Social Welfare
Homebirth Association advice on homebirth see phone book
Pregnancy Help help in pregnancy and after the baby see phone book
is born
New Mothers support once the baby is born through Plunket Society, or
Support Groups see phone book
La Leche League advice on breastfeeding see phone book
Family Planning family planning see phone book
Association
Natural Family Planning natural family planning see phone book
Association
District Manager, advice on early childhood services Early Childhood
Early Childhood development Unit
Development Unit see phone book

Booklist This booklist is a small selection from a group of authors whose

He Rãrangi books many women have found helpful.
Pukapuka Kitzinger, S. The experience of childbirth. Reading: Penguin, 1984.
The Womanly Art of Breastfeeding. London: Angus and Robertson,
1988.
Leach P. Baby and Child. From birth to age -5. London: Penguin,
1979.
Gribben T. Coming ready or not. A beginner's guide to pregnancy
and birth. Auckland: Heinemann, 1985.
Llewellyn-Jones D. Everywoman. London: Faber & Faber, 1986.
Breastfeeding: Giving baby the best you've got. Wellington:
Department of Health, 1989.
Health & Development Record. Wellington: Department of Health,
1988.
Ewy, Donna and Roger. Preparation for Childbirth - Lamaze
Guide. Boulder, Colarado: Pruett Publishing, 1982.
Balaskis, Janet and Arthur. New Life - the Book of Exercises for
Pregnancy and Childbirth. London: Sidgwick & Jackson, 1983.
Kitzinger, S. Pregnancy and Childbirth. Sydney and Auckland:
Doubleday, 1987.

64
 Index
Almost every page has a reference to your doctor or midwife, so we
have only indicated those pages where special mention is really needed.
Key:
Chapter titles = Am I Pregnant?
Section titles = How Can I Help Myseif?
Subtitles = Eat well
Other entries = text
SUBJECT Page
A New Life • 24
abnormalities 12, 18, 35,
abortion 37
Action Plan for Pregnancy 8
adoptibn 14
After the birth 47
Alcohol 18
alcohol 9,17
Am I Pregnant? 6
ambulance 40
Amniocentesis 36
anaemia 9,35
anaesthetics 47
antenatal check - 10
Antenatal Checks 33
antenatal classes 15, 16,60
Any Problems? 19
Are you a heavy smoker? 18
artificial labour 49
baby's breasts 52
111 back exercises 10
bassinet 23
bath equipment 23
Being in hospital 54
benefits 14
Benefits, Leave and Help in Pregnancy 21
birth 43
birth registration 53
birthing positions 45, 47
birthmarks 52
Bleeding 20
Bleeding 54
blood 41
- pressure 34
- sample 34
- type 55
Booklist 64
bottles 31
Braxton Hicks contractions 13
breaking of the waters 41, 42
breaking suction 31
Breastfeeding 29
Breastfeeding in Public 32

65
 breasts 32
breathing exercises 45
Breech birth 50
Caesarian section 49, 50
C cap 61
carrycot 23
cervical smear 35
cervix 7
checks 57
Child care 60
child care 15,41
child care centres 60
children 15, 41
Citizens' Advice Bureau 14, 32
clothes 23
colostrum 30
Combined breathing and relaxation exercises 47
condom 61
constipation 19
Contacts 32
contacts 38
contraception 61
contractions 13, 41, 42, 43, 44
Coping alone 14
coping with depression 60
Coping With Pain 47
cord 47
Couples 12
couples 59
creches 61
crowning 45
cuddling 53
Cultural practices 32
delivery
D delivery date
49
40
dentist 9, 17
Department of Social Welfare 14,64
Depo Provera 62
Depression 59
development 24,26
diabetes 34
diaphragm 61
diet 8
dieting 9
dietitian 63
Difficulties 31
discharge 21
discharge from hospital 39
discomfort 57
district nurse 63
District Officer, Early Childhood Education 64
doctor 10, 33, 63
domiciliary midwife 39,63
Down's syndrome. . .. 12,36
drinking 9, 17

66
 Early discharge from hospital 39
E Eat well 8
Ectopic pregnancy 22
Epidurals 48
episiotomy 49
exercise 9, 10, 55, 56
fallopian tubes 7, 22
F family 12,41
family day care 61
Family Planning 61
Family Planning Association 64
Fathers 14
feeding 29
feelings. 57, 59
Feelings and Relationships 11
first milk 30
first stage 44
first visit 33
fitness 9
Fitting Everything In 57, 58
fontanelle 53
food 8,30
forceps 49
40 weeks 27
Gas 48
G German measles 18, 35, 55
Getting started 30
getting to hospital 40
Giving Birth 43
giving up smoking 17
Going to Hospital 43
Going to the toilet 19
Growing in the Womb 26
Growing in the Womb 24
haemophilia 36
H handicapped 36
Have a good look 52
Having the baby at home 39
Health and Development Record book 53, 57
Health Care in Pregnancy 33
Hearing 25
Heartburn or indigestion 19
Helping the Delivery - Forceps and 49
Caesarian Section
Helping yourself with depression 60
hepatitis B 18, 35
herpes 18
homebirth 39
Homebirth Association 39,64
hospital 43
hospital birth 37
hospital life 54
How breastfeeding works 30

67
 How Can I Help S Myself? 8
How Can You Tell? 6
How Do You Feel? 57
How Should I Feed the Baby? 29
How will you get to hospital? 40
How will you know? 41
immunisation 55, 57
I indigestion 19
induction 49
infection 35
Infections 18
Injections 47
intercourse V
13
internal examination 6, 34,43
inverted nipples 29
IUCD 61
jaundice 52
J
Keep active 9
-K
La Leche League 32,64
L labour 40, 42, 43, 44, 49
length 26
letdown reflex 31
lifting 10
loneliness 14
Look after-your back 10
Love at first sight? 52
Make arrangements for the rest of your family 41
maternity leave 21
medicines 6, 17
men 14,59
V

meningitis 18
midwife 39,63
Midwife's examination 43
milia 52
V -

milk 29
milk supply 31
mineral supplements 9
mini pill-- 61
Miscarriage - 20
mongolism 12,36
More information 32
- . Movements 25
muscular dystrophy 36
nappies 23
N natural family planning 62
Natural Family Planning Association 64
navel 52
New Mothers Support Groups 60, 64
newborn baby 52
Nipples . V
29
nitrous oxide 48
Not long to go? 43

68

nurse 63
nutrients 9
obstetrician 63
O "oddities" 53
older children 15
Other special tests 37
Other Things That Can Happen 49
ovary 7
pain 47, 57
parental leave 21
Parents are people 57
Parents Centre 60,64
partner 12, 41, 43, 59
Partners and labour 43
Passing urine 28
pelvic tilt 9
periods 54
pethidine 47
pets 41
physiotherapist 63
Piles 55
Pill 61
placenta 7, 38, 46
Plan Ahead 40
Plunket 23
Plunket nurse 63
postal antenatal course 15
postnatal check 10
Postnatal checks 57
practice nurse 63
Practising breathing 28
pram 23
Pregnancy Help 21, 41, 64
Pregnancy sickness 19
preparation 40
Prepare for childbirth 15
prepared 38
Preparing for breastfeeding 29
problems 21
Problems with your partner 59
protein 34
public health nurse 63
questions 35
Questions at the first visit 33
reading 16, 32
R Regaining your figure 55
Registering your baby's birth 53
Regular visits 35
relationships 11, 12, 59
relaxation 16, 20, 56, 60
relaxation exercises 47
rest 9,20
Rest and relaxation 56
Returning to work 32
rhesus negative 34

69

Rhesus negative mothers 55

rooming in 31

rubella 18, 35, 55

S sadness
Safe and warm
39
53
scans 35
seatbelts 23
second stage 45
Seeing 25
services 63
sex 59
Sex in pregnancy 13
Should I give up smoking and drinking? 17
show of blood 41,42
sickness 19
Signs of pregnancy 6
6 weeks 26
16 weeks 26
6-week check 57
size 26
sleep 17, 56,58, 60
small babies 51
smear 35
smoking 17,18
social welfare 14, 21, 64
solid food 30
solo parents 14
Some Physical Problems 21
Some Words You'll Hear A Lot 7
Special Tests 35
spina bifida 12,36
spine injections 47
stages of labour 44
Start Collecting Things For The Baby 23
Starting again 20
Starting labour off artificially - induction 49
statistics 12
Stitches 54
stools 53
sucking 28
support 60
support (during birth) 41
Swallowing 28
syphilis 18,35

T Take five minutes to lose five inches

Taking Care of Yourself
56
54
Taking care with medicines 17
Talk to your family 12
talking together 13
Te Kohanga Reo 60
telephone numbers 38
TENS 48
termination 37
Tests at the first visit 34
test 6, 34, 35, 37

70
 The first stage 44
The . second stage 45
The Stages of Labour 44
The third stage 46
The three most common ways for labour to begin are: 41
Things you should avoid 41
Tiredness 20
tiredness 17, 41, 57
Tiredness: fitting everything in 57
toilet trips 19, 55
Transfer to another hospital 51
travel 23,41
triplets 22
Try these hints to stop smoking 18
tubal pregnancy 22
28 weeks 27
Twins 21
ultrasound scan
LII Ultrasound scans
22
35
urine 28
- sample 34
Useful telephone numbers 38
uterus 7
vagina
V Vaginal discharge
7
21
Varicose veins 21
visit 33, 34
Visit your doctor 10
vitamin supplements 9
vomiting 19
warmth 53
water 9
waters 41, 42
weight 9,26
What can the baby do now? 25
What Other Decisions Are There to Make? 37
What to Avoid 17
What will you ask? 35
What you can do for yourself 47
When Labour Starts 40
When labour starts 40
When will labour begin? 40
whenua 38,47
Where will you have your baby? 37
Who will be with you during the labour and the birth? 41
winter clothes 23
work 32
Worrying about abnormality 12
Worrying about the birth 12
You can't sleep; feel tired, your head's aching?
I'd You Have Access to Many Services During Pregnancy
17
63

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wQ
150 Ua^
YOU
85885

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