A Broad Overview of Pregnancy

Introduction to Pregnancy, labour and birth

Many women find when they commence reading books on pregnancy and birth they discover, what seems like a whole language of new words and terms they might not have come across before. Suddenly there is much to learn to enable the woman to understand what is happening within her body and what is yet to occur. Many women and their partners are surprised and delighted when they find out they are pregnant and then depending on the stories they hear and the books and articles they read they might become anxious.

Your childbirth educator will be able to spend some time explaining the terms, in an inspiring way which will fascinate you, showing you life like models and examples. She will be able to answer your questions and clarify aspects which otherwise might have been confusing. In a good supportive educational atmosphere the information received from a childbirth educator will automatically reduce fear and increase confidence.

Pregnancy, labour, birth Terms and their Meaning

Amniotic Sac – It is the “bag of waters” or membranous sac which has two thin strong layers similarly to glad wrap; stretchy and strong, which surrounds the baby in slippery clear fluid to protect and cushion the baby as it floats comfortably, gently cradled within.
Cervix – In a mother having her first baby is the long firm thick closed neck of the womb/uterus, for a mother having a second and subsequent baby her cervix will be a little thinner and softer.
Contractions – Refers to the action of the uterus during labour to thin out and draw open the cervix and then push the baby along the vaginal birth canal to be born.
Embryo – The term used to describe the growing baby in the uterus during the first trimester or the first three months of the pregnancy. Watching the growth and development of the embryo on a DVD documentary showing it by time lapse photography is awesome. Your childbirth educator may have such DVD’s to show you.
Newborn – A baby from birth to three months.
Foetus – The term used to describe the growing baby from twelve weeks through to full term pregnancy.
Placenta – It provides the baby with nutrients and oxygen during the pregnancy and is connected to the baby by the umbilical cord, the soft, slippery placenta also known as the afterbirth and is born after the baby. In Germany the common language for the placenta is “mother cake”. In some cultures it is important to respect the work the placenta has already carried out of successfully nourishing the baby throughout the pregnancy by burying it in a hole and planting a shrub or tree over it as a symbol of life and growth. The tree is referred to then as the child’s tree.
Umbilical Cord – This thick strong curly cord connects the baby to the placenta, it contains three blood vessels; two arteries and a vein which are contained in a thick jelly called Wharton’s jelly which protects the blood vessels if compressed. The cord is almost a metre long at full term and thicker than a telephone cord. The process of delayed cord clamping would be explained in a childbirth education course.
Uterus – Also known as the womb, is the thick powerful ball like shaped muscle deep inside the pelvis where the fertilised egg implants in the lining of the uterus and then grows as a foetus being nourished by the placenta.

Your Developing Baby and Your Pregnancy

6-7 weeks
At seven weeks, the baby is about eight mm long from head to bottom. The brain is developing and the heart is beginning to beat. Physical features, such as the ears, eyes, arms and legs, are also developing.
8-9 weeks
At nine weeks, the baby is about 17 mm long from head to bottom. The face is slowly forming, with the eyes becoming more obvious. There is a mouth and tongue. Hands and feet, with ridges where the fingers and toes will be, are also beginning to develop.
10-14 weeks
Just 12 weeks after conception, the baby is fully formed. It has all its organs, muscles, limbs and bones. From now on it will grow and mature. The baby is already moving about, but the movements cannot yet be felt. First time mothers tend to feel the baby first move at about 20 weeks, while for second time mothers, the first movements are felt at about 16 weeks.
28 weeks
At 28 weeks, the baby is over 38 cm long and is about 0.9 kg in weight. The baby’s skin begins to develop a thick, white, soft, fat-rich covering called vernix, which waterproofs the skin, preventing the baby from becoming wrinkled and prune like in the amniotic fluid and acts as an insulator to help keep baby warm for the first hours after the birth. The baby’s movements can easily be felt at this stage.
40 weeks
At 40 weeks, the baby is 50 cm long and weighs over 3 kg. Over the past four months the baby has fully developed and the lungs have matured, ready for birth.

Twins

Non-identical twins result from two eggs being fertilised at the same time and are more common. Identical twins develop from one fertilised egg splitting into two separate cells. They therefore have the same genes, are the same sex, and look very alike.

Being Pregnant

Once you know you are pregnant, there are several important decisions you need to make. These include choosing where you want to give birth eg, at your own home, in a birth centre in a maternity hospital or in the delivery suite in a maternity hospital and how you would like to give birth.
You also need to choose a midwife, or team midwifery, or case load midwife, or an obstetrician who will support your choices. Your caregiver can be a midwife, or shared care between midwife and a general practitioner, or an obstetrician.
The first few weeks of pregnancy up until the 14th week are called the first trimester. During this time look at the options available to you so that you can book into a birth centre as early as possible so you don’t miss out as they have a limit of the number of pregnant women they can accept each month.
Those pregnant women booked into a birth centre are “double booked” in that they also have the option of transferring to the delivery suite if the need arises, whereas pregnant women booked into the delivery suite are only booked into the delivery suite and have more limited options and cannot transfer to the birth centre if they desire.
If you are unsure then speak to a midwife at the hospital to check the options you have available.
Otherwise contact your local maternity hospital to do a tour and become informed of the birth choices they offer and can guide you as to which option will fulfil your needs.
Doing a tour of the maternity department of a couple of different local hospitals will help inform you of your options.
Keep in mind Medicare will cover the Public hospital option and all emergency facilities, qualified staff and services are available immediately if required.

Once you have either booked with an independent homebirth midwife, or into a public hospital birth centre or a public maternity hospital or private maternity hospital via a GP referral to a private Obstetrician, they then are responsible for the maternity care provided to you throughout your pregnancy and until six weeks after the birth of your baby.

Contact your Caregiver for all queries related to your pregnancy.
From the time you book in until your final maternity check, your Caregiver, or backup, is available to help you.
This availability is for phone advice, or visits if necessary, and is 24 hours a day, seven days a week. You can choose to change your Caregiver at any time, if you wish.

Keeping Healthy in Your Pregnancy

Keeping healthy throughout your pregnancy includes eating healthy food, a healthy lifestyle including exercise, getting enough rest, no smoking or drinking alcohol, and no recreational drugs. It also includes your cultural, spiritual and emotional wellbeing.

Your Caregiver will see you regularly throughout your pregnancy. She will palpate (feel) your abdomen to check your baby’s growth, position and heartbeat, take your blood pressure, and explain to you what these mean for your pregnancy. She will also explain how often you need to be seen during your pregnancy and whether these visits will be in your home, at a clinic, or at a maternity hospital.

Blood Testing in Early Pregnancy

You will be asked to give a sample of your blood early in your pregnancy to test for:

  • your blood group
  • your haemoglobin (iron content in your blood)
  • presence of any antibodies which may be harmful to your baby
  • whether you are immune to rubella
  • whether you are a hepatitis B carrier.

A blood test may also be done at about 26 to 28 weeks of pregnancy to test for diabetes in pregnancy. This is called a glucose tolerance test. Information is available to help you decide whether you need to be tested for this, or any other tests such as chlamydia, or other diseases which may affect your baby.

Antenatal Classes / Childbirth Education

Antenatal classes/childbirth education (also called pregnancy and parenting education) is about giving pregnant women, their partner, support person and their family the opportunity to:

  • learn more about choices and options available during pregnancy, labour and birth
  • find out about the care they are likely to receive
  • understand what happens after their baby is born
  • meet other parents-to-be.

Taking Care with Medicines

Some medicines can harm the developing baby. Only take those medicines that have been recommended by your midwife or your doctor. Always check with them or your pharmacist before taking anything else. X-rays and some local and general anaesthetics (including dental x-rays and anaesthetics) are best avoided during pregnancy.

Smoking in Pregnancy

Smoking during pregnancy affects the baby’s growth, and will mean more likelihood of health problems such as:

  • a lower birth weight that could be harmful if the baby is already small or born prematurely
  • an increased risk of cot death, pneumonia, asthma or glue ear
  • a risk of miscarrying or having a stillborn baby.

There are programmes available to help pregnant women give up or reduce smoking. There is also information available on how to quit smoking. You can call the Quitline 131848 also talk with your midwife or doctor about smoking in pregnancy.

Mothersafe 9382 6539 or 1800 647 848
Quit Smoking Information Line
131848

Alcohol in Pregnancy

During pregnancy, if a woman drinks alcohol, it is carried by her bloodstream through the placenta to her baby. Drinking alcohol during pregnancy may harm the baby; regular heavy drinking can cause brain damage to the baby. This damage is called Fetal Alcohol Syndrome/Fetal Alcohol Effects or FAS/FAE. There is no known safe level of alcohol use during pregnancy. If you think you are pregnant or know you are pregnant, it is safer to avoid alcohol altogether.

If you are experiencing difficulty stopping alcohol intake altogether ring Alcoholics Anonymous for advice and talk with your midwife or doctor.

Alcohol and Drug Information Service (02) 9361 8000 or 1800 198 02

Caffeine Intake During Pregnancy

Caffeine is a stimulant drug in coffee, some carbonated “energy” beverages, sports drinks, tea, chocolate and cola. Caffeine use has been linked with miscarriage, premature birth, increased risk of developing high blood pressure and unsettled babies who cry a lot. It is recommended to limit caffeine to 200mg daily, which is equal to about 2 cups of coffee

Cannabis and/or Other Recreational Drugs

Using cannabis and/or other recreational drugs when you are pregnant can affect the development of your baby, possibly causing premature birth or a low birth weight. The long term side effects on babies are unknown and under researched though it is expected that the baby’s neurological development may well be affected. If you are experiencing difficulty giving up talk to your midwife or doctor.

Infections During Pregnancy that Can Harm Baby

Some infections during pregnancy can cause harm to baby. If you are in contact with someone who has an infectious illness, or are not sure about any of the following, information is available to help you make any decisions about what you should do. Some of these infections include:

  • Rubella (German measles)
  • Listeria is a common bacterium which contaminates certain foods and causes illness. Pregnant women are at high risk of illness and the infection may be passed on to an unborn baby. You can reduce your risk from listeria by avoiding certain foods and by using safe food practices. Pregnant women should avoid eating:
    • pre-cooked chicken, ham, meat products and paté
    • pre-cooked or uncooked fish or seafood products
    • stored salads and coleslaws
    • raw (unpasteurised) milk.
  • Toxoplasmosis is an infection that pregnant women can get from handling cat faeces and which can pass through the placenta to the baby, if you have a cat ask your partner or other family member to clean out the cat litter tray. Wearing disposable gloves is important for anyone doing this task to minimise infection risk.
  • Human Immunodeficiency Virus (HIV)
  • Hepatitis B
  • Hepatitis C
  • Tuberculosis (TB)
  • Herpes. A range of other infections, such as streptococcus B (strep B), chicken pox (varicella), and sexually transmitted diseases such as chlamydia or gonorrhoea, may cause harm to mother and baby.

If medical complications arise during your pregnancy or labour, your care might need to be transferred to a hospital specialist services or a private specialist.  There are guidelines available to your midwife to help decide if referral to a specialist for a consultation is advisable or whether transfer of the responsibility of care in full is recommended. If responsibility for your care transfers to the hospital specialist services after you have established in labour, in most cases your midwife will continue to be available to support you.

Food Standards Australia New Zealand (02) 6271 2222

The Stages of Labour

There are three main stages in labour. The time taken for each stage will vary from woman to woman. In the first stage the cervix opens, in the second stage the baby is pushed down through the vagina and is born, and in the third stage the placenta comes away from the wall of the uterus and is pushed out through the vagina. The membrane that holds the amniotic fluid and your baby (often called ‘the waters’) can break at any time. Usually, this happens near the end of the first stage or at the beginning of the second stage of labour. How to know you’ve gone into labour and how to help yourself during the stages is covered in your childbirth education course.

Every birth is different and babies vary regarding when they arrive and how long they take. Your midwife or doctor can answer any questions you might have about your labour and birth and how you should prepare. When you think you are in labour, tell your midwife or doctor. S/he will then advise you what to do next. This may be that s/he will visit and assess you in your home, or meet you at the birth centre or delivery suite at the maternity hospital, or s/he may make some other suggestion.

Deciding Who Will Support You at the Birth

Plan ahead, about who you would like to support you, both physically and emotionally, at your baby’s birth. You may wish to have only your partner with you or you may like other members of your family. Your plan outlines the choices you prefer and the support you expect to receive during Labour, birth and after your baby is born.
The decisions you make about the birth that best suits you and your baby’s needs can be written down as your birth plan. This birth plan reflects what you want and you can use it as a communication tool with your partner as well as your midwife or doctor.
The midwife or doctor will discuss the options with you, respect the choices you have made and keep a copy of your birth plan in your file notes.
If you wish to make alterations or updates simply provide an updated copy to them.
How to make a birth plan, your options available and advantages and disadvantages of options are covered in your childbirth education course.

Labour and Birth

Coping with the Labour Experience

There are several things you and your partner and family/friends can do to help you cope with the labour and birth experience. These options would all be covered in a good comprehensive childbirth education course. Some safe natural methods include: resting completely between contractions, having an optimistic attitude and calm atmosphere, remaining active and upright, relaxation and breathing techniques, a warm bath or shower, the birthing pool, warm/hot packs applied to the lower belly and/or lower back are helpful.
Homeopathy or aromatherapy is also commonly used to assist with comfort measure during labour. The use of gas, injections of drugs, or an epidural or spinal anaesthetic, are available for use if required particularly with an abnormal labour, an unusually long and difficult labour or if medical interventions are required such as a c-section.

However, as all drugs pass across the placenta through the umbilical cord to the baby, and will have varying side effects for both the mother and the baby, it is considered wise to only use drugs in a situation where it is deemed genuinely necessary. Discuss any questions you might have with your midwife or doctor.

Variations in Labour and Birth

No two births are the same. Some women may need extra help for the baby’s birth.

Induction/Augmentation of Labour

Induction is when labour is started artificially because of risk to the mother or baby if the pregnancy went on any longer. Induction can be done by using the following:

  • applying medicated gel close to the cervix
  • breaking the membrane which holds the amniotic fluid and baby.

Inductions are likely to lead to increased intervention such as a ventouse or forceps birth or a caesarean section.

Augmentation (assisting a labour which has already commenced) can be done by using the following:

  • breaking the membrane which holds the amniotic fluid, to cause the release of some fluid
  • a synthetic hormone drip; Syntocinon to strengthen the contractions.

Ventouse/Forceps Birth

Ventouse or forceps are sometimes used to deliver a baby. A ventouse is a suction cap that is placed on the baby’s head and by firm pulling the baby can be born. The same method is used for a forceps birth with the forceps being placed around the baby’s head.
An episiotomy is usually done for a ventouse or forceps birth. An episiotomy is when the perineum (area at the base of the vaginal opening) is cut to make the opening bigger. Stitches are needed afterwards, which are dissolving stitches and normally drop out within a week or two.
Your Caregiver will check recovery at your six week check-up post-natally. Mention any residual problems you might be having at that check-up.

Caesarean Section

A caesarean section is the removal of the baby from the uterus by major abdominal surgery. The NSW Dept of Health policy states that this should only be done when there are medical reasons, because it is safer for a normal healthy woman and baby to have a vaginal birth compared to a birth by operation. An epidural or spinal anaesthetic is generally given. A general anaesthetic may be used when an emergency caesarean section is needed. After the operation, stitches or clips are used to seal up the wound.
These either dissolve or are removed about five to eight days later. It takes longer to heal after a caesarean section than a vaginal delivery. Caesarean section operation carries greater risks, such as infection and blood loss, to the mother and baby compared to a normal birth. Women require more assistance and support post-natally after a caesarean section compared to a normal birth and are not supposed to drive a vehicle for at least 6 weeks. If you are unsure about recommended restrictions after the operation ask your midwife or doctor.

After the Birth

This is the time for enjoying and getting to know your baby. It is also about eating well, drinking lots of water, resting with your baby and getting support from your family, friends and neighbours.

Your Baby

Your baby will be carefully examined by the midwife soon after birth. Some of the things you may notice are very common, for example:

Jaundice

Newborn babies can have some mild jaundice about the third day after the birth. Jaundice at birth is not normal. Jaundice gives the baby a yellow appearance and is easily remedied by exposure to sunlight, even indoors. Regular feeding is important.
More severely jaundiced babies may need a different kind of treatment, eg, phototherapy (treatment using ultra-violet light). If severe jaundice is left untreated, it can cause brain damage, that’s why it should not be ignored.

Feeding

Babies generally wake two to three hourly for feeding – sometimes more frequently. If your new baby is not waking and feeding contact your caregiver as dehydration can be a problem or your baby may be unwell.

Hospital Stay

Your midwife or doctor will visit you daily while you are in hospital. The length of your stay will depend on your clinical needs. The decision about when to leave will be made between you and your caregiver, in discussion with you and the hospital staff.

Home Visits

After the birth, you can expect the option of staying in hospital for a couple of days (normal length of stay in NSW statistically is 2-3 days), or going home and receiving home midwifery care in which case the hospital provides a midwife to care for the mother and her baby for about an hour per day up until the baby is six days old.
This care can be shortened or lengthened depending on the circumstances. If a medical complication arose for the mother or the baby then re-admission to hospital if required is certainly available. Many women prefer the option of going home to their own bed and own bathroom to settle in with their baby rather than the noise and busyness of the hospital post natal ward.
If you had your baby in hospital, you will receive your first home visit within 24 hours of going home from hospital. The postnatal care you will receive from your midwife includes assistance with and advice about feeding and caring for your baby, as well as advice about your nutritional needs and contraception.

Breastfeeding

Breastfeeding is the best nutrition for your baby and has advantages for you too. To help make your breastfeeding experience positive, ask for information and advice early in your pregnancy. You can also talk to other mothers who have enjoyed breastfeeding their babies. Breastfeeding is a skill that needs to be learned. Some women experience no problems, whereas others need more help and support to get started and continue feeding. Having the practical support of your partner, family and friends is important. Australia’s Breastfeeding Association provides mother to mother support in the form of mother’s groups all over Australia.

Benefits of Breastfeeding

The Department of Health recommends that all babies are fed exclusively breastmilk for the first six months of life. This means no water, infant formula or fruit juices. After six months it is recommended to slowly start your baby on solid foods and other fluids while you continue breastfeeding for two years or more. These guidelines were formed by the World Health Organisation as the safest and healthiest infant feeding recommendations.

Breastfeeding is best for your baby because:

  • it can assist with the development of a close bond between you and your baby
  • breastmilk is the only food which is exactly the right nutrition and temperature for your baby
  • it will help protect your baby from ear infections, gastroenteritis

Newborn Screening Programme

Mothers are offered the screening programme for the newborn. It is recommended all babies be screened at three to five days of age for some rare conditions, such as Hypothyroidism, Phenylketonuria, Galactosaemia and Cystic Fibroses; which if not detected early can lead to serious illness for the baby. If detected early, most can be treated through provision of medication or a special diet. Your caregiver; midwife or doctor will provide you with information about the newborn screening programme (heel prick test) before you sign the consent form for this test.

Vitamins

Vitamin K, in injection form will be offered to the mother for her baby within a couple of hours of the birth to prevent the development of bleeding, known as HDN Hemorrhagic Disease of the Newborn. Whilst HDN is very uncommon it can be serious. Studies about HDN have revealed some high risk factors are: mother’s smoking during pregnancy, mother’s moderate to high levels of drinking alcohol, mother’s using street drugs as well as some prescribed and non-prescribed over the counter medications, and medical intervention during delivery such as a forceps delivery, a vacuum delivery or a stressful difficult delivery for the baby and these factors increase the risks of HDN occurring in the newborn.
Vitamin K can be provided by injection or by mouth. If given by mouth three doses are required – at birth, at one week and at six weeks. It is important to get information from your caregiver, midwife or doctor before your baby is born so you can make an informed decision about whether or not your baby will need to have Vitamin K.

Registering your Baby’s Birth

The midwife at the hospital will give you a copy of the birth registration form for you to complete. By law, registering the birth is required within sixty days of your baby’s birth.
Register your baby with Medicare by filling in the form and lodging at the local Medicare office.
Maternity Payment and Family Tax Benefit: while you are in the hospital you’ll be given the Centrelink form that you use to claim the: Maternity Payment this is a one-off, non-income tested payment for each child born to Australian residents.
This payment is also made if the baby is stillborn or dies soon after birth.
Family Tax Benefit.
This is a payment to help families with the cost of raising children. It is worked out on your family’s total annual income, and the ages and number of dependent children in your family.
Forms are also available from Centrelink. You can get further information about benefits from the Family Assistance Office on 136150.

Final Maternity Check

This usually occurs four to six weeks after your baby’s birth. This marks the end of your maternity care provided by your midwife or doctor. However, you are still able to contact your caregiver about any maternity related problem.