Once you have confirmed your pregnancy with your GP, they will make a referral to the Community Midwifery Team who will arrange your antenatal care going forward.
Your first appointment with the community midwives will take place when you are between 8-12 weeks gestation. This is referred to as the 'booking appointment'. This will be face-to-face with a community midwife and will last approximately 1 hour. The midwife will ask a variety of questions. These will allow us to understand your medical, obstetric, family history and we will also be able to make further arrangements if you have any additional needs.
At the appointment the community midwife will provide you with your green handheld notes - it is vital that you bring these to every appointment with you, including ultrasound and obstetric appointments.
Your midwife will also have the opportunity to discuss with you; antenatal screening tests, pattern of appointments for antenatal care, what to eat and avoid in pregnancy as well as answer any questions you may have at this stage.
Where to have your baby
During your pregnancy, you will have the opportunity to discuss your birth preferences and where to deliver your baby. We use your pregnancy, any obstetric or medical history to make a recommendation.
- You may hear about these abbreviations either during your pregnancy or on the ward:
- AC - Abdominal Circumference
- AF - Artificial Feeding
- BF - Breastfeeding
- BMI - Body Mass Index
- BP - Blood Pressure
- BPM - Beats Per Minute
- EFM - Electronic Fetal Monitoring
- Ceph - Cephalic (head)
- CTG - Cardiotocograph
- FBC - Full Blood Count
- FH - Fetal Heart
- FM - Fetal Movements
- GBS - Group B Strep
- GTT - Glucose Tolerance Test
- Hb - Haemoglobin
- HVS - High Vaginal Swab
- IOL - Induction of Labour
- MSU - Midstream Specimen of Urine
- TENS - Transcutaneous Electrical Nerve Stimulation
- USS - Ultrasound Scan
Schedule of Antenatal Appointments
- Booking appointment (approximately 10 weeks) - 1 hour appointment
- 12 weeks - Dating scan and offer of screening tests
- 16 weeks - Routine antenatal appointment - 20 min appointment
Results of screening tests
- 18-20 weeks - Anomaly scan
- 25 weeks - For women having their first baby, or those requiring increased surveillance - 20 minutes
- 28 weeks - Routine antenatal appointment - 20 minutes
Offer of 28 week blood tests
(additional 20 mins for those requiring Anti D)
- 31 weeks - Routine antenatal appointment - 20 minutes
- 34 weeks - Routine antenatal appointment - 20 minutes
- 36 weeks - Routine antenatal appointment - 40 minutes
Discussion of birth preferences
- 38 weeks - Routine antenatal appointment - 20 minutes
- 40 weeks - Routine antenatal appointment - 20 minutes
- 41 weeks - Routine antenatal appointment - 20 minutes
What to eat in Pregnancy
Following a healthy diet and lifestyle will help to keep you well during your pregnancy, giving your baby the best possible start in life.
You don't need to follow a special diet, just make sure that you get a balance of nutrients that are important for you and your baby.
Please see the link below to the NHS website for the most up-to-date information.
Vitamins and Minerals
Eating a healthy, varied diet will help you to get the vitamins and minerals you need while you are pregnant. However, there are some that are especially important. These include; folic acid, vitamin D, iron, vitamin C and calcium.
What to avoid in Pregnancy
Food and drink to avoid
- There are some foods and drinks which should be avoided during pregnancy.
- Please find a comprehensive list here: Foods to avoid in pregnancy - NHS (www.nhs.uk)
- High levels of caffeine can result in babies having a low birth weight which can increase the risk of health problems in later life. Too much can also cause miscarriage.
- Caffeine is found naturally in lots of foods such as coffee, tea and chocolate and is added to some soft drinks and energy drinks. It can also be found in certain cold and flu remedies.
- You should have no more than 200mg a day or try decaffeinated tea and coffee, fruit juice or water and limit the amount of 'energy' drinks, which may be high in caffeine.
- Caffeine content of food and drink:
- 1 mug of instant coffee: 100mg
- 1 mug of filter coffee: 140mg
- 1 mug of tea: 75mg
- 1 can of cola: 40mg
- 1 can of 'energy' drink: up to 80mg
- 1 x 50g bar of plain chocolate: up to 50mg
- 1 x 50g bar of milk chocolate: up to 25mg
- Alcohol in pregnancy
- Experts are still unsure exactly how much alcohol, if any, is safe to have whilst you're pregnant. The Chief Medical Officer for the UK recommends the safest approach is not to drink any alcohol.
- Avoid drinking alcohol if there is any chance you may be pregnant and if you have any concerns about your alcohol intake you should consult with a health professional.
Flying while pregnant
- Most airlines will not let you fly after week 37 of pregnancy or week 32 if you're pregnant with twins.
- Long distance flying (over five hours) has an increased risk of thrombosis (blood clots). Make sure that you drink plenty of water to keep hydrated. You can buy compression stockings from any pharmacy which will help to reduce your risk of blood clots and fluid being retained in your legs (oedema).
Safety in the car
- To protect yourself from injury during a potential car accident. Please ensure you wear your seatbelt with the diagonal strap across your body between your breasts and the lap strap over your upper thighs. The straps should lie above and below your bump.
- Protecting your baby from tobacco smoke is highly recommended during pregnancy. Cigarettes contain over 4000 chemicals and can restrict the essential oxygen supply to your baby. Babies born to mothers who smoke are on average 200g lighter than other babies. This can lead to problems during and after delivery and are more prone to making babies more likely to develop an infection. Stopping smoking will benefit you and your baby immediately, allowing your oxygen levels to return to normal, reduce the risk of stillbirth, and decrease the chances of having a premature baby with additional health problems.
- Please find additional information from NHs choices linked below: Stop smoking in pregnancy - NHS (www.nhs.uk)
- The devices currently on the market do not meet the appropriate standards of safety and quality. The level of risk associated with their use is not known.
- If you smoke and want help to give up then talk to your midwife or contact Guernsey Quit line www.gsyquitline.com
- Talk to your doctor if you take regular medication - ideally before you start trying for a baby or as soon as you find out you are pregnant, to make sure it is suitable whilst pregnant. Make sure that you inform all health professionals that you are pregnant before they prescribe you any medication or give you any treatment.
- Illegal drugs like cannabis, ecstasy, cocaine and heroin can harm your baby. If you use illegal drugs, it is important to talk to your midwife so they can refer you for additional support.
Medicinal Cannabis (CBD oil)
- Medicinal cannabis can be used to helps relieve chronic pain and even lowers the symptoms of anxiety and stress without the high. There is very limited evidence available to medicinal cannabis use in pregnancy and most health professionals advise against its use in pregnancy.
Exercise and keeping active in Pregnancy
The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and cope with labour. Keep up your normal daily physical activity or exercise (sport, dancing or just walking to the shops and back) for as long as you feel comfortable. Don't exhaust yourself, and remember that you may need to slow down as your pregnancy progresses or if advised to. As a general rule, you should be able to hold a conversation as you exercise. If you become breathless as you talk, then you are probably exercising too strenuously.
If you were inactive before you were pregnant, it is not advised to suddenly commence strenuous exercise. Begin exercising gradually with 10 minute episodes of moderate intensity continuous exercise building up to a total of 150 minutes across the week.
It is recommended that you warm up and cool down. Try to keep active on a daily basis, half an hour of walking each day can be enough. If you cannot manage that, any amount is better than nothing. Avoid any strenuous exercise especially in hot weather and take plenty of water and other fluids. Swimming is a good activity whilst pregnant as the water will support your increased weight.
Beau Sejour are currently offering aquanatal classes to pregnant people.
It consists of one 45 minute class, held in the main pool. This runs on a Monday from 6.30pm -7.15pm and is available during term time. More information can be found by contacting Beau Sejour directly.
An antenatal walking group has launched offering weekly walks for anyone who is over 16 weeks pregnant. The walks are free to join and classed as antenatal care so participants will be allowed time out of work to attend. They will be in different locations around the Island each month to include those who may lack suitable transport options. Find out more by contact Tracy Ward: email@example.com
Tests and screening
- During your pregnancy you will be offered a range of tests designed to check and assess the development and wellbeing of you and your baby.
- These include; urine sample, height and weight, blood pressure and blood tests. These can all provide reassurance about the progression of your pregnancy as well as help identify any problems that you may be experiencing.
- You do not need to have any of these tests, however it is important that you understand what the tests are for, so you are able to make an informed decision about your care. Your midwife will be able to answer any questions that you may have.
- Here is a useful link to the NHS choices website regarding antenatal testing
- Antenatal checks and tests - NHS (www.nhs.uk)
- You will routinely be offered two scans, the dating scan at 8-12 weeks which will determine the baby's due date and the anomaly scan at about 20 weeks.
- Ultrasound scans use sound waves to build a picture of the baby in the uterus. The scans are painless, have no side effects on mother and baby and can be carried out at any stage of pregnancy.
- At the dating scan, the sonographer will check your baby's measurements and be able to give you your baby's estimated date of delivery (EDD). It will confirm a single baby or if you are carrying twins as well as the position of the placenta.
- You will be asked to have a full bladder, this pushes your uterus up and gives a better picture of baby. Scans are medical procedures but many women see them as the highlight of the pregnancy.
- The anomaly scan checks the physical development of your baby, although it can't pick up every condition. It will look in detail at the baby's bones, heart, brain, spinal cord, face, kidneys and abdomen, checking for 11 rare conditions.
- Here is a useful video about screening
- Testing for Downs syndrome, Patau and Edwards syndrome
- Between 10 and 14 weeks you can have "the combined test". You will be offered a blood test and at the dating ultrasound scan the fluid at the back of your baby's neck will be measured (known as the nuchal translucency). The information from these 2 tests is combined to work out the chance of your baby having Down's syndrome, Edwards' syndrome or Patau's syndrome.
- If you are further along in your pregnancy you will be offered a blood test called the "quadruple test" usually between 14 and 20 weeks of pregnancy. The quadruple test is not quite as accurate as the combined test.
- The results of the test cannot tell you if your baby definitely has Down's syndrome, Edwards' syndrome or Patau's syndrome, it will give you a risk ratio which will determine if you are high or low risk for a pregnancy with any of these conditions.
- You can choose to have the screening test for all three conditions, or just for Down's syndrome, just for Edwards and Patau's syndrome or decline them all.
- You will get two results, one for Down's syndrome and a joint one for Edwards' syndrome and Patau's syndrome.
- If the test shows the risk of the baby having Down's syndrome, Edwards or Patau's syndrome is lower than the recommended national cut-off, this is known as having a 'low-risk' result, but it does not mean there is no risk.
- If you have a high risk result, you will be offered a diagnostic test to find out for certain whether or not your baby has Down's syndrome, Edwards' syndrome or Patau's syndrome.
- Diagnostic tests for Down's syndrome will also look at chromosomes 18 and 13, so will also tell you whether or not your baby has Edwards' syndrome or Patau's syndrome. Similarly, diagnostic tests for Edwards' syndrome and Patau's syndrome will also look at chromosome 21 for Down's syndrome.
- Video Screening tests for you and your baby: https://youtu.be/_afr5olIpTM
- In a small portion of women who elect to have the diagnostic test approx. 1 out of 200 women (0.5%) will miscarry as a result of the test. It is up to you whether or not to have the further test.
- There are two types of diagnostic tests:
- Chorionic villus sampling
- Chorionic villus sampling (CVS) is usually done from 11 to 14 weeks of pregnancy. A fine needle, usually put through the mother's abdomen, is used to take a tiny sample of tissue from the placenta. The cells from the tissue are then tested for Down's syndrome, Edwards' syndrome and Patau's syndrome.
- Amniocentesis is usually done after 15 weeks of pregnancy. A fine needle is passed through the mother's abdomen into the uterus to collect a small sample of the fluid surrounding the baby. The fluid contains cells from the baby, which are tested for Down's syndrome, Edwards' syndrome and Patau's syndrome.
- After finding out the results of the diagnostic testing a small number of women who have the diagnostic test will find out their baby has one of the conditions.
- Prior to and following, any diagnostic testing you will counselled by one of the Obstetricians. They will be able to discuss with you the risks of the procedure as well as the outcome of the tests, and what your options would be going forward.
You will usually start feeling some flutters or movements between 16 and 22 weeks. Later in pregnancy your baby will develop its own pattern of movements - which you will soon get to know and feel every day.
At each antenatal appointment, your midwife will talk to you about baby's movements, try to familiarise yourself with the daily pattern.
Any change, especially a reduction in movements, may be a warning sign that your baby may need further monitoring. If you have any concerns please contact Loveridge Ward straight away: 01481 224377
Infections during pregnancy
- While flu is a mild illness for most people, it can be very serious for pregnant people. Pregnant people are more likely to develop serious complications as a result of flu, and rarely even death, compared those who are not pregnant. There are also risks for the baby, including miscarriage and premature labour.
- Receiving the flu vaccine during pregnancy is the best way to protect you and your unborn baby from getting serious complications of flu, including death. The flu vaccine is licensed for use by the European Medicines Agency and is regularly used for pregnant people across the United Kingdom, Ireland and other countries.
- The flu vaccine is available every year from late September onwards, the start of the winter flu season, contact Loveridge ward to make your appointment. The vaccine can be given at any stage in your pregnancy but ideally as early in the season as possible in order to receive the best protection for you and your baby. Even if you received the flu vaccine in the past, you still need to get the vaccine as flu protection only lasts for one flu season.
- Pregnant people can suffer the same minor side effects as anyone else, including soreness where the vaccine was injected and, less often, a slight temperature and aching muscles for a couple of days after being vaccinated. Other reactions are very rare. Flu vaccine does not contain live virus and so it cannot give you flu. It will only protect you against flu.
- Whooping cough (pertussis) is an infection which can affect people of all ages but is particularly serious in babies. Most babies who get it will have to be admitted to hospital, some will end up in intensive care and it can even result in death.
- Very young babies (under three months) are at most risk of serious disease. All babies are vaccinated against whooping cough at two, three and four months of age. This means they can be vulnerable to the infection in the first two to three months of life before they get their vaccines.
- The best way to protect babies is to give the mother the vaccine during pregnancy, at any stage after 16 weeks. She will make antibodies that will be passed onto the unborn baby, which then protect the baby after they are born and get their own vaccine.
- All pregnant people are offered the whooping cough vaccine between 16 and 32 weeks of pregnancy. This is the recommended time so the unborn baby receives the highest level of protection. Studies have shown that giving the vaccine to pregnant people is very safe for both people
Group B streptococcus
- Group B strep or GBS is a bacterium, which can be found in the intestine and vagina. Approximately 28% of women carry GBS without any symptoms and approximately 20% of pregnant women & birthing people are colonised with GBS. In a very small number it infects the baby, usually just before or during labour and can lead to serious illness or death.
- You will be offered antibiotics in labour if you have previously had a baby with invasive GBS infection, GBS has been found in your urine in your current pregnancy, GBS has been found on swabs from your vagina which have been taken for another reason during this pregnancy, you have a high temperature during labour, you have an infection of the membranes around the baby (Chorioamnionitis).
- Please find additional information from the Group B Strep Support leaflet linked below:
Sexually Transmitted Infections (STI)
- STI's are on the increase, with chlamydia being the most common.
- Up to 70% of women and 50% of men show no symptoms of a STI. However, many STI's can affect your baby's health during pregnancy and after birth.
- If you have any reason to believe that you or your partner have should get checked out with your GP or the Orchard Centre
- Leaflet available: www.gov.gg/CHttpHandler.ashx?id=118932&p=0
Rash in pregnancy
- Itching is common in pregnancy. It can be caused by raised levels of certain chemicals in the blood, such as hormones. As your bump grows, the skin of your tummy (abdomen) is stretched and this may also feel itchy.
- If you develop a rash or illness at any time in your pregnancy then contact your midwife or GP as you will probably need extra investigations.
Problems in pregnancy
During pregnancy, your body goes through a lot of changes. Sometimes these changes can cause discomfort and make you worried about what is happening. It is important that you talk to your midwife and/or GP if you have any symptoms.
- During pregnancy your ligaments become softer, stretching to prepare you for labour. This can put strain on the joints in your back and pelvis.
- To reduce the risk of backache:
- Avoid lifting heavy objects
- Keep your back straight when lifting
- Wear flat shoes to allow your weight to be evenly distributed,
- When sitting, sit with your back straight and well supported.
- If you continue to suffer with backache ask your midwife to refer you to the physio.
- You may become constipated in early pregnancy because of the hormonal changes taking place in your body.
- How to avoid constipation:
- Eat foods that are high in fibre, like wholemeal breads, wholegrain cereals, fruit and vegetables, and pulses such as beans and lentils
- Exercise regularly
- Drink plenty of water
- It is a sudden sharp pain usually in the calf muscles or feet generally occurring at night. We are not always sure of the cause of cramp, however regular, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and therefore help to stop cramp.
- You may often feel faint due to the hormonal changes in your body and your brain not getting enough oxygenated blood.
- If your oxygen levels are too low you may actually faint. This can happen if you stand up too quickly or stand still for too long or even when lying on your back.
- To avoid feeling faint:
- Get up slowly from sitting or lying down.
- If you feel faint when standing still, sit down quickly until the feeling passes or lie on your side.
- It is not advisable to lie flat on your back later on in pregnancy or during labour.
- Some women suffer from headaches and migraines during pregnancy. It is important that you try to get regular rest and relaxation
- The recommended dose of paracetamol is safe to take in pregnancy.
- If the headache is severe or accompanied with blurred vision, swelling or heartburn then contact Loveridge Ward immediately.
- Incontinence is a common problem which can affect you during and after your pregnancy. Sometimes are unable to stop a small leak of urine when you cough, sneeze or laugh. This is because your pelvic floor muscles relax slightly in preparation for labour and delivery.
- In some cases, it can become a problem and you will be referred to urology for review.
Indigestion and heartburn
- Indigestion is caused by hormonal changes in late pregnancy and due to the growing uterus pressing on your stomach.
- Heartburn is more than indigestion, it is a strong burning sensation in the chest. It is caused by stomach acid passing from your stomach back into the tube leading to your stomach because of the valve relaxing.
- How to avoid indigestion:
- Eat little and often
- When eating sit up straight to take the pressure off your stomach
- Avoid fried and spicy foods
- How to avoid heartburn:
- Sleep well propped up with plenty of pillows
- Avoid eating and drinking a few hours before going to bed
- Drinking a glass of milk can help
Carpel tunnel syndrome
- Carpal tunnel syndrome is a condition that occurs as a result of swelling around the nerves of the wrist causing numbness, tingling or pain in one or both wrists. Pregnant people are prone to the disorder, with about 40% of women experiencing some symptoms during pregnancy.
- The intensity of symptoms can vary from mild irritation, to occasional soreness, to serious pain. Symptoms may stop you from sleeping or make it difficult to perform regular tasks such as working, getting dressed, cooking or caring for your baby.
- Symptoms can be worsened by:
- repeating the same hand movements frequently
- keeping your hands in the same position for an extended time
- putting weight on straightened arms
- The treatment will depend on the severity and the stage of your pregnancy.
- The pain can be reduced by simple self help:
- elevating your hands when you're resting or not using them
- keeping your wrists in a neutral position (not bent forwards or backwards) during the day, and as much as possible while you're sleeping
- maintaining good posture in your arms and wrists while working at a desk
- taking breaks every 20 minutes while working at a desk
- avoiding activities that strain your wrist
- applying an ice pack on your inner wrist or by placing your hand in cold water for between 30 seconds and 2 minutes can help
- Referral can be made to a physio where you may be given splints to wear on your wrists.
- Leaking nipples are normal and usually nothing to worry about. The leaking milk is colostrum, which is the first milk your breasts make to feed your baby.
- Anaemia is having low blood count. You may be unaware that your levels are low but if you feel tired, are pale, suffer from shortness of breath or dizzy then it is worth mentioning to your midwife. Women with anaemia during pregnancy are at higher risk of low birth weight babies and of needing a blood transfusion. Having anaemia can make caring for yourself and your baby more difficult.
- You will have a blood test for anaemia at your booking appointment. Ensure you have a varied diet that contain good sources of iron like red meat, chicken and fish. If you are vegetarian then you need to make sure you are getting enough iron from other foods such as tofu, beans, lentils, peas and dried fruits.
- Your GP may give you a prescription for iron tablets. When taking it is best to take on an empty stomach with foods rich with vitamin C e.g. orange juice which will ensure your body absorbs as much iron as possible. Tea, coffee, dairy products and antacids can all reduce the amount of iron you absorb, so avoid these for about two hours before taking your iron tablets. Iron tablets can make you constipated so make sure you drink plenty of fluids and have lots of fibre in your diet.
Nausea and Morning Sickness
- Nausea is very common in the early weeks of pregnancy, some women feel sick and some are sick. It can happen at any time of day - or even all day long.
- Hormonal changes in the first three months are probably one cause and the nausea usually disappear around the 12th to 14th week.
- How to avoid nausea and morning sickness:
- If you feel sick first thing in the morning, get up slowly and if possible eat something like a plain biscuit or dry toast before you get up.
- Try to get plenty of rest and sleep whenever you can. Feeling tired can make the sickness worse.
- Eat little and often - don't stop eating. Eat bland, non-greasy foods, such as baked potatoes, pasta and milk puddings, which are simple to prepare.
- Drink plenty of fluids.
- Wear loose clothes without tight waist bands.
- Some women continue to feel nauseous and are unable to keep anything down leading to dehydration and weight loss. If you suffer from hyperemesis then you may need admission to hospital to help with rehydration via a drip and anti sickness medication. Vomiting may last up to 20 weeks or until the end of your pregnancy
Pelvic Girdle Pain (PGP)
- Pelvic girdle pain (PGP) is the general term for all pelvic pain. It includes pubic pain - previously called symphysis pubis dysfunction (SPD). PGP includes pain anywhere from the lower back down to the thigh, either at the front or back
- The pain may range from a mild ache to severe pain that limits your daily activities.
- Getting referred and diagnosed early can reduce ongoing discomfort and minimise pain with early referral to the physiotherapists
Skin and hair changes
- Hormonal changes in your pregnancy will make your nipples and the area around them to go darker. Birthmarks, freckles and moles may also darken.
- Some women develop a dark line down from their belly button to the pubic hair which gradually fades once your baby has been born.
- If you go out in the sun whilst pregnant make sure you apply a good high factor sunscreen as you will tan more easily and don't stay out in it for too long.
- Later in your pregnancy you might find getting a good night's sleep difficult. Lying down can be uncomfortable and when you get comfortable you need to go to the toilet. Lying on your side with a pillow between your legs and under your tummy may help.
- These are pink or purple lines which usually occur on your abdomen or sometimes on your upper thighs or breasts. Not all women get them, it depends on your skin type.
- Some women's skin is more elastic. You are more likely to get stretch marks if you gain weight.
- After your baby is born, the marks should gradually pale and become less noticeable.
Swollen Hands and Feet
- Ankles, feet and fingers often swell in pregnancy because your body is holding more water than usual. Towards the end of the day especially if the weather is hot or if you have been standing a lot, the extra water tends to gather in the lower parts of your body.
- Try to avoid standing for long periods, rest with your feet up higher than your heart as much as you can and wear comfortable shoes.
- In the early part of your pregnancy you may feel tired or even exhausted. Try to make time to rest with your feet up as well as accepting help from friends and family.
- At the end of your pregnancy you may feel tired because of the extra weight you are carrying. Make sure that you get plenty of rest.
- Most women will have increased vaginal discharge during pregnancy. Normal discharge should be clear and white and not smell.
- If the discharge is coloured or smells unpleasant or if you are experiencing itchy or soreness then you may have a vaginal infection. The most common infection is thrush and you need to speak to your midwife or GP for some medication.
- Mild itching is normal in pregnancy because of the increased blood supply to the skin. In late pregnancy the skin of the abdomen is stretched and this may also cause itchiness.
- Bleeding from the vagina at any time is concerning. It is important to find the cause quickly as some types of bleeding are more serious than others.
Bleeding after sex
- The cells on the surface of the cervix often change in pregnancy and make it more likely to bleed - particularly after sex. This is called a cervical erosion.
Bleeding in late pregnancy
- The most common bleeding in late pregnancy is the small amount of blood mixed with mucus that is known as a 'show'. This is a sign that the cervix is changing and becoming ready for labour to start. It may happen a few days before contractions start or during labour itself.
Your pregnancy usually lasts for 40 weeks, with most women going into labour within a week either side of the due date.
At your 40 week appointment you will be offered a membrane sweep which involves having a vaginal examination where your midwife will sweep her finger around your cervix aiming to separate the membranes from your cervix. This separation releases hormones (prostaglandins), which may kick-start your labour.
The examination isn't painful but can be uncomfortable.