Pregnant what next?

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Published by NHS Health Scotland Edinburgh Office Woodburn House Canaan Lane Edinburgh EH10 4SG Glasgow Office Elphinstone House 65 West Regent Street Glasgow G2 2AF NHS Health Scotland, 2009 ISBN: 978-1-84485-470-7 NHS Health Scotland is a WHO Collaborating Centre for Health Promotion and Public Health Development.

Your pregnancy test is positive what next?

Now that you are pregnant, you should make an appointment to see a midwife as soon as possible from seven weeks onwards. To do this, you will need to phone your GP surgery, local health centre or maternity hospital, and ask for a booking appointment with a midwife. You can also phone 0800 224488 for your local contact.

Your first appointment

You will usually have one or two early appointments with your midwife. These are called booking appointments. In order to plan the best care for you and your baby, your midwife will need to ask a few questions about you and your family history, including details of any previous pregnancies, and your partners health and lifestyle. You will also be asked about your diet, whether you smoke or someone in your house smokes, how much alcohol you drink, and if you are taking any medication or drugs. At these appointments you will also be given the opportunity to discuss your relationship with your partner. Your midwife will also communicate with your GP to ensure she has your full medical history.

What about tests and checks?

Your midwife will offer you some tests and screening checks as part of your routine care. These tests are to protect you and your babys health. Your midwife will discuss these further with you, or look in Tests and checks you may have during pregnancy under the Your pregnancy section of Ready Steady Baby. You can also go online and check www.readysteadybaby.org.uk

Who will I see?

For most healthy women, the majority of your care will be provided in the community by a midwife. Midwives are highly-skilled, qualified professionals who care for women throughout their pregnancy, during childbirth and after the birth, and until your baby is roughly 10 days old. Your midwife will plan the care that is best for you using national guidelines so that you and your baby obtain the best care throughout your pregnancy. If you and your midwife feel you require additional support or investigation during your pregnancy, your care will be jointly managed by your midwife and the maternity team. This is known as maternity team care.

Maternity team care

Obstetricians are doctors who will help support you if you have complications during your pregnancy. GPs will continue to provide you with your routine healthcare throughout your pregnancy. In addition, some may also see you as part of your routine care before your baby is born. Neonatologists and paediatricians are doctors who specialise in caring for newborn babies and children, and may be present at the birth of your baby. A paediatrician or midwife will also examine your baby after they are born.

Anaesthetists are doctors who specialise in giving anaesthetics, such as epidurals, spinals or general anaesthetics. Physiotherapists help women adjust to the physical changes during pregnancy by giving advice on safe exercise, pelvic floor education, and also help to prepare you for labour by offering relaxation, breathing and positioning exercises. After you have had your baby, they will also give advice on pelvic floor exercises. Dieticians can give advice on food and nutrition, particularly if you have specific dietary requirements, for example, if you have diabetes or would like support with weight management during and after pregnancy. Ultrasonographers perform ultrasound scans to check for abnormalities and to measure your babys growth and due date. Maternity care assistants provide a supporting role to midwives and can support you with breastfeeding and parenting skills. Health visitors or public health nurses will support you and your baby at home when your baby is around 10 days old. They may also visit you before your baby is born. They will provide you with information about the routine health checks and vaccinations your baby will be offered, and will give you your babys Personal Child Health Record (or Red Book). Social workers can help support you if you are finding things difficult at home. They can also help where there are worries for the welfare of the child. Nursery nurses can offer you support and advice on caring for your baby and developing parenting skills. They may also carry out some of the checks your baby may require daily.

How often will I see my midwife?

During a first pregnancy, its typical to have around 10 appointments with your midwife, with visits becoming more frequent towards the end of your pregnancy. The pregnancy journey overleaf shows your visits. If you have had a baby before, you will see the midwife around eight times. The exact number will vary depending on you and your babys health throughout the pregnancy.

Your opportunity to ask questions big or small

You will probably have lots of questions throughout your pregnancy and your midwife and maternity team are there to support you. You might like to discuss:

any worries you have or symptoms that are causing you concern the types of tests you will be offered the facilities and birth options available to you what preparation for parenthood classes are available the type of exercise you can take how to care for your teeth and gums.

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Your pregnancy journey

Weeks 112 (1st trimester)
At this time your body is changing and adjusting to pregnancy. You are producing large amounts of pregnancy hormones and all your babys essential organs are forming. To give your baby the best start, its important to think about other changes you need to make such as giving up smoking, drinking, drug use, and eating a healthy diet.

Weeks 79
Your first appointment with your midwife will take place now, either in your home or at your midwifes clinic. In some areas you will have two appointments with the second one lasting about an hour.

Weeks 1012
At this time you may be offered a booking or dating scan, providing information on your babys growth as well as some routine blood tests.

Weeks 1328 (2nd trimester)

Throughout this period your baby will be able to hear and move around, and you may feel like you have more energy as your hormone levels stabilise.

Weeks 1316
Some further routine blood tests and checks will be carried out to help protect you and your babys health. Your midwife will discuss any tests offered and whether you wish to have them.

Weeks 2022
You will be offered a detailed scan and, if youre thinking about how to feed your baby, the bump to breastfeeding DVD will give you lots of information.

Weeks 2940 (3rd trimester)

Your baby is fully formed now and putting on weight. You will be seen regularly by your midwife for checks at weeks 28, 34, 36, 39 and 41. If this is a first-time pregnancy, you will also be offered a midwife check at weeks 31 and 38.

Keeping healthy during your pregnancy

Healthy eating
A healthy diet will benefit you and ensure your baby has the best possible start. It will also help prevent pregnancy-related tooth decay and gum infections. It is recommended that you take 400 micrograms (mcg) of folic acid daily before you become pregnant, and for the first 12 weeks of your pregnancy, as its difficult to get enough from your diet alone. This is to help reduce birth defects, such as spina bifida. Folic acid tablets are widely available from pharmacies and supermarkets or can be prescribed by your GP. Good sources of folate include oranges, bananas, broccoli, peas, sprouts, chickpeas, and fortified breakfast cereals. A higher dose of 5,000 mcg (5 mg) of folic acid is recommended for women who have previously had a baby with spina bifida.

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Should I be taking other vitamins and minerals too?

During pregnancy, its also important to make sure that you get enough vitamin D and iron for strong bone growth in babies. For vitamin D, this is best achieved by taking a daily 10 mcg vitamin D supplement. If you or your family receive income support, income-based job seekers allowance, child tax credit, are on a low income, or you are a teenager, you will be eligible for free vitamins through Healthy Start. Speak to your midwife about how to get these. Caution very high levels of vitamin A in the first few weeks of pregnancy have been shown to harm the development of some babies. Therefore avoid liver or cod liver oil and general multi-vitamins unless you are advised to do so by a health professional. When youre pregnant, check any supplements you take carefully. For more information on foods to avoid, look in Eating well while youre pregnant in Ready Steady Baby.
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Smoking, drinking and drug use

Often, being pregnant, gives you the chance to think about your health, including thinking about stopping smoking, drinking alcohol or taking drugs. From the evidence we know that:

if you or someone in your household smokes, this will affect your babys health and development during pregnancy, after your baby is born, and into childhood stopping smoking will reduce your risk of miscarriage, stillbirth and your baby being born prematurely any alcohol you drink will reach your baby and may cause harm any recreational or street drugs you take may affect your babys development.

Its important to talk to your midwife about all of these issues so she can support you with any changes you want to make, and most areas will provide specialist support to make the process easier.

For further information about stop smoking services visit www.canstopsmoking.com or call 0800 84 84 84 or talk to your midwife.

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Caring for your teeth and gums

During pregnancy, your hormone balance changes and your gums may become red, swollen and bleed more easily. However, this should disappear after the birth of your baby.

What will help?

Continue to brush your teeth twice a day for two minutes using a toothpaste containing 1500 parts per million (ppm) fluoride. Remember, only spit out excess toothpaste dont rinse. If your gums bleed, it is important to keep brushing twice a day and, if it continues, contact your dental team. If you experience pregnancy sickness, avoid brushing your teeth immediately after being sick as this can wear away the top surface of enamel. Instead, rinse your mouth with alcohol-free fluoride mouthwash afterwards.

NHS dental care

For more information on how to register with a dentist, phone the NHS Helpline on 0800 224488, or speak to your midwife.

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How to contact your midwife

Your midwife will give you a contact number that you can call at any time so, if something is worrying you, theres no need to wait until your next appointment.

Your midwifes number

Your local maternity unit

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Remember, at each appointment you will be asked to bring your hand-held notes with you to record any information about your health and that of your baby.

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Notes/things to ask

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Notes/things to ask

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