antenatal care

What is antenatal care and why is it important

Care given to mother and her unborn child during pregnancy and happen from 8th week

Antenatal classes: what food should women avoid

• fish high in mercury such as swordfish as can affect baby’s brain and nervous system

• Undercooked/raw eggs: risk of food poisoning such as salmonella

• Alchohol: can cross placenta and cause fetal alchohol spectrum disorder which effects growth and baby’s brain

Advantages and disadvantages of screening test

A: no risk of miscarriage (safe), can help prepare mother for care if child has abnormality

D: does not confirm only risk

Food advised to mother

• foods high in folic acid: brocilli , avocados, cabbage

• Iron sources: beans as iron helps makes red blood cells which prevents anemia in mothers

Why is antenatal care important

• gives parents advice how to parent

• Monitor growth and health of mother an baby to see if complications occur

• Advice on labour

Advice how partner can support mother

Advice on diet and excercise

Physical support during pregnancy

• do shopping for her as may feel tired

• Prepare and supply with food and drinks

• Look after other children by bathing them

• Physically comfort her by offering massages

• Drive her to appointments to show support

Emotional support during pregenancy

• spend time with her so she feels comforted if feels anxious

• Reassure her if feels worried about labour

• Attend antenatal classes so she feels supported with pregenancy

• Support healthy lifestyle changes by joining in (avoiding smoking)

What care can partner give to the mother

• physical support

• - massages, offer food and drinks, clean and cook, look after other children, shop

• Emotional support

• - give reassurance if anxious and tell her everything she is feeling is normal , if scared let her know it will be okay ,

• Encouragement, spend quality time with her as may feel lonely

how can birth partner physically support mother during labour

• hold hand during labour to take mind off pain

• offer her drinks during labour to cool her down and keep hydrated

• support mothers body to help her find comfy position

when may an epistomy be needed

• baby’s head is too big to fit through vagina

• mother is too exhausted to push baby out

• to prevent vaginal tear/tear becoming worse

What do antenatal clinics provide

• routine tests

• Screening tests

• Diagnostic tests

• Antenatal classes

What are the routine tests antenatal clinics provide

• blood tests

• Blood pressure tests

• Babys heartbeat test

• Examination of uterus

• Weight check

• Urine test

What is the babys heartbeat test

it will be monitored at each appointment to test if baby is healthy (110-160 beats per min)

• to reassure parents baby is alive

• To test for foetal distress

Blood pressure of mother test

• healthy blood pressure is 110/70-120/80 if above 140/90 can indicate pre-eclampsia

• high BP can increase risk of preeclampsia

• High bp can reduce blood flow, therefore less oxygen to baby

What is the blood test of mother

• taken when booking her into maternity system to reveal any problems such as anemia in which can indicate she is lacking red blood cells which carry oxygen to mother - if reduced then baby may have a lack of oxygen

• high blood sugar - test if blood sugar levels are healthy

Examination of uterus

• performed throughout pregnancy by doctors and midwife’s

• Place finger into uterus up to cervix to assess how soft it is, thinning or opening of cervix and position to see how far baby has descended and which way baby is facing

Urine test

Taken to reveal any problems such as infection or pre-eclampsia, diabetes which can be harmful to baby

Weight check

• gaining more weight than expected is a sign of pre-eclampsia

• Weight loss can indicate baby has stopped growing and can be a sign of illness in mother

• Expected to gain (10-12kg) during a healthy pregnancy

Role of midwife for antenatal care

• advice on diet and excercise

• Monitors health and growth of mother and baby

• educate mother on labour strategies and techniques and advice for labour.

• check up on mental health and wellbeing of mother

Role of obstetrician

• supports mother during labour if any complications arise such as medical conditions

• Performs medical procedures - c section

• Monitor health of mother and baby by performing scans

Role of GP

Give diet and excercise advice

Treat minor illness duringg pregnancy

• make specific referals to other health professional if problem with mother/babies health to support her

Sonographer role

• Carries out ultrasound scans to check babies growth and position

Paediatrician role

• supports mothers if planned to have pre-mature baby

• Advice if a san shows problem with babies growth

Role of anaestheic

• provide pain relief during labour

• Advice on pain relief

• Monier mothers health during pain relief

what are the benefits of screening tests

• these can inidicate if any health conditions of baby growing in womb such as down syndrome which can help parents prepare how to care and support development

• also used to see if baby is developing properly so if not will get medical support which is a benefit a early treatment can prevent serious contiiosn

• can reassure parents child is alive and growing healthily

What is a screening test

Offered to all pregnant mothers to revel if baby has a chance of being born with conditions/abnormalities

What is a diagnostic test

Offered to mother after screening test if test showed baby may be born with abnormality , optional , increase risk of miscarriage

Dating scan

• carried out10-14th week

• Sonographer moves device over stomach to amine baby

• Tests to see baby’s development, how many babies, if any health conditions

Anomaly can

• carried out 18-21st week Sonographer moves

• Screens for open spina Bfidia, Edward’s and patau syndrome

NUCHAL FOLD TRANSLUCENCY TEST NFTT

• 11th - 14th week Sonographer moves

• Measures baby Nuchal fold translucency - a fluid space behind neck - done through vagina

• Screens to see any risk of chromosomal abnormality

Triple test - blood test

Carried out 16-18th week

Measures alpha feta protein, human chorionic and encojugated estrol

Screens for down and patau syndrome

Non-invasive prenatal test - NIPT - BLOOD TEST

Carried out 10th week

Takes sample of blood to look for abnormalities in foetus dna

Tests fo down and Edward’s syndrome

What are te two diagnostic tests

Chronic villus sampling and amniocentesis

Chronic villus sampling

Carried out 11th - 14th week

Sample of ells is taken from placenta through trans abdominal

Diagnoses Edward’s or Down syndrome

Carries risk of miscarriage

Amniocentesis

• carried out 15th-20th week

• Needle inserted into abdominal wall to take sample of amniotic fluid

• Diagnoses patau and Down syndrome

• Risk is miscarriage

What is epidural anaesthetic and th advantages and disadvantages

A needle is inserted into spinal epidural catheter whilst allowing mother to remain awake

It numbs nerves that carries impulses from birth canal to the brain

A: doesnt cause long term back ache, most cases complete pain relief (reduces pain significantly), allows mother to remain awake and allert

D: blood pressure drops and legs feel heavy

It

What are the signs labour has started

1. A show

2. Waiters break

3. Contractions begin

What is a show

When a plug of mucus has sealed off uterus due to cervix dialation which will be stained with blood

Describe waters breaking

Amniotic fluid around baby bursts due to increased pressure from babies head, if this happens sign to rush to hospital as

there is a risk of infection for baby

What happens when contractions begin

Sign labour has started, this is where muscles of uterus tighten and gradually become stronger and increase closer together, last around 30-70s

Stage 1 of labour

1. Cervix gradually Dialates to 8-10cm(12-15h) which is the longest stage

2. Water may break which can speed up stage 1

3. Contractions begin and become stronger and closer each time so pain relief may be needed as contractions get stronger

4. babies head may become engaged in mothers pelvis if not already there

5. May experience sweat, vomit due to pressure of babies head

Stage 2 of labour

1. Cervix will be fully dilated (10cm)

2. Vagin and cervix form birth canal and head of baby moves to it

3. Mother pushes with each contraction

4. Mother should rest between each contraction

5. Crowning will take place when head of baby can be seen and head must be born slow to prevent vaginal tear

6. Babies body is then turned to allow birth of rest of body

7. Umbilical cord clamped nd cut

Stage 3 of labour

1. Contractions begin again to push out placenta

2. An injection (Syntocinon) may be given to speed up process which prevents blood loss and helps mother if exhausted

3. If tear in perineum it will be sewn up under local anaesthetic

When may methods of assisted birth be needed

• if baby is in awkward position (oblique/breech)

• If baby is lacking oxygen

• If cervix not dilated enough

• Mother too exhausted

What is forceps, what do they do, what are the consequences of having it

A curved metal instrument tgat fits around babies head, turn baby to correct position,

They are usually more successful then ventouse but more risk of vaginal tear

What is a ventouse and what are the consequences

Plastic metal cup that fits firmly onto babies head ad attached b suction to pull baby out

• cannot use on babies born before 34 weeks of pregnancy and may leave swelling or temporary bruise on head

Wha are the risks of assisted birth

• vaginal tear

• Leaking rinse

• Blood clots

What may be done to see if assisted birth is needed

A doctor will insert catheter which is a small tube that is inserted into vagina to take urine to examine properly

What is a catheter

Thin flexible tube inserted into vagina that drains bladder of urine to low baby move down birth canal more easier

How can a catheter be used to test if assisted methods of birth I needed

As professionals can take an accurate assessment if the baby is truly needs help being delivered or if it was struggling due to blockage of urine

Wht is a cAESAREAN SECTION

Major operations to deliever baby through a cut made in womb, can be elective(planned) or emergency

what is an epistomy

a cut made in perineum during 2nd stage of labour to enlarge opening for baby to pass through, stitched up under local anaesthetic

When may a c-section be performed

Wen baby is stuck or lacking oxygen

What is the breach position

Bottom or feet facing vagina

What is oblique position

Head of baby facing abdomen - baby lies AT an angle in abdomen

What is a transverse position

Baby lies at an angle across abdomen

independent midwife advantages and disadvantages

Advantages

• Be there since start of pregenancy So Comforting and provide friendly advice

• more flexibility for mother as can arrange visit times

• Disadvantages

• May be unavailable in the end

• Expensive and limited availability

private midwife advantages and disadvantages

advantage

• continuity of care for mother

• more flexible for mother as she can arrange times for visits

• Disadvantages

• Expensive

• if complications arise during birth may need to get transferred to NHS services which can be stressful

What is domino scheme

A system where midwife’s visit mothers in a set order which ensures all mothers get regular care and continuinity with same midwife

Domino scheme advantages and disadvantages

A: ensures all mothers receive regular care, mothers often see same midwife building trust, more efficient as allows midwife’s to plan work

D: less flexible for mothers as visits may be at set times, visits may delayed if midwife unavailable

domino scheme advantages and disadvantages

Advantages

• Short hospital stay

• Midwife meets mother at hospital

• Disadvantages

• Expensive

• May not undertake all responsibility of nhs midwife

home birth advantages and disadvantages

Home birth

• advantage

• Relaxed and similar to surroundings

• More likely to be looked after by midwife

No need to travel

• more privacy as less strangers around

• Disadvantages

• No pain relief

• if complications arise mother will have to be rushed to hospital

• Less access to medical equipment (forceps)

• if it’s 1st baby higher risks of poor outcomes for baby

hospital birth advantages and disadvantages

Advantages:

• Highly trained staff and equipment

• Have pain relief

• Disadvantages:

• Only one member allowed to watch

• have to rush to hospital once stage 1 labour begins - stressful

• Less comforting as can be overcrowded and noisy and not familiar to surroundings

• Possible delays

how does TENS work and what are the advantages and disadvantages

1. Electrodes taped onto back and connected by wires to a small battery which gives safe amount of current

2. Stimulates body to produce natural pain killers

A: Mother is in control of pain relief so reduced anxiety, no drugs entering system so no effect on baby, no side effects

D: cannot completely remove pain/milk pain relief but may nit remove pain if intense contractions

4. Cannot completely remove pain

how does pethidine work and the advantages and diss

Takes 20 mins after injection to work and lasts 2-4 hours

2. injection of medicine goes into buttox to relieve pain

3. advantages: lasts 2-4 hours and most cases provides complete pain relief, causes muscles to relax helping mother relax

4. disadvatages: if given close to delivery may affect baby’s breathing,taken. 20 mins to work, may be scared of needles

how does gas and air (entenox work) advantages and disadvantages

mother will breathe through a mask which provides oxygen and nitrous oxide gas to relieve pain. When contractions start, stop and end.

This affects pain receptors making contractions feeling less intense

• Advantages: easy to control and use, no harmful side effects, can take pain killer injections along with it

• Disadvantage: doesn’t provide complete pain relief, feel light headed, unable to concentrate

what method of pain relief is most likely to be given to a mother having a C section

Epidural Anaesthetic

why is the flu vaccination needed for pregnant women

• protects women against the flu as it becomes more severe effect to their health during pregnancy and admitted to hospital

• WBC develop antibodies to pass onto baby to fight off the flu pathogen - protected baby

• reduces risk of premature birth caused by flu

what is the purpose of women immunisations against whooping cough

• protects women and baby from developing whooping cough (respiratory infection) and prevents breathing difficulty in baby and mother

can babies get whooping cough vaccination

• babies can’t receive this until 6 weeks old so maternal vaccination provided early protection via antibodies

what is an immunisation

a vaccination that prevents illness to protect health of child/mother

why are immunisations important

help prevent disease that could affect growth or development or wellbeing

why is it important for mothers planning on a pregnancy to be up to date with immunisation

as immunisations contain a small amount of a dead pathogen (which is weak) in which white blood cells produce antibodies for the pathogen causing the virus which passes through placenta to baby to protect baby from infection

why is meningitis immunisation important

• this condition causes many babies to be admitted to hospital

• so by ensuring mother has immunisation it ensures that she produces antibodies to kill the pathogens causing the disease and protect baby

Why is MMR vaccination important and when must it be given to mother

• protects children against: mumps, measles, rubella

• must be given to mother before pregnancy not during pregnancy (rubella is harmful) in which can protect future babies

why is HPV vaccination important

• protects against genital cancers - eg: cervical cancer so is impotent for vaccination to ensure women’s reproductive system is healthy

• to support long term physical health

what is rubella

dangerous disease for pregnant women as it can cause miscarriages or birth defects