and talk about it. It’s the same for everything. It’s not being a nuisance, it’s being interested. I think the staff like it if you’re interested.’
If you have a disability which means that you have special requirements for your antenatal appointments or for labour, let your midwife know so that arrangements can be made in advance.
DATE WEEKS WEIGHT URINE ALB BP HEIGHT PRESENTATION RELATION OF FH OEDEMA Hb NEXT SIGN. NOTES
SUGAR FUNDUS AND POSITION PP TO BRIM
15/6/99 13 58 kg nil 110/60 15 – – – – 12.0 20/7 CS u/s arranged for 17/7 to check
maturity
20/7/99 18 59.2 kg Nil 125/60 18–20 – – FMF – – 21/8 CS
21/8/99 22 61 kg Nil 135/65 20 - – - – 18/9 CS taking iron
18/9/99 26+ 64 kg Nil 125/75 24–26 – H – 11.2 28/10 CS
28/10/99 30 66 kg Nil 125/70 30 ceph 5/5 FHH - - 27/11 CS Mat B1 given, Hb taken
27/11/99 34 - Nil 115/75 34 ceph 4/5 FHH - 11.0 15/12 CS
DATEThis is the date of your antenatal visit.
WEEKSThis refers to the length of your pregnancy in weeks from the date of your last menstrual period.
HEIGHT OF FUNDUS By gently pressing on your abdomen, the doctor or midwife can feel your womb. Early in pregnancy the top of the womb, or ‘fundus’, can be felt low down, below your navel. Towards the end it is well up above your navel, just under your breasts. So the height of the fundus is a guide to how many weeks pregnant you are.
This column gives the length of your pregnancy, in weeks, estimated according to the position of the fundus. The figure should be roughly the same as the figure in the ‘weeks’ column. If there’s a big difference (say, more than two weeks), ask your doctor about it. Sometimes the height of the fundus may be measured with a tape measure and the result entered on your card in centimetres.
RELATION TO BRIM
At the end of pregnancy your baby’s head (or bottom, or feet if it is in the breech position) will start to move into your pelvis. Doctors and midwives ‘divide’ the baby’s head into ‘fifths’
and describe how far it has moved down into the pelvis by judging how many ‘fifths’ of the head they can feel above the brim (the bone at the front).
They may say that the head is ‘engaged’ – this is when 2/5 or less of the baby’s head can be ‘felt’
(palpated) above the brim. This may not happen until you are in labour. If all of the baby’s head can be felt above the brim, this is described as
‘free’ or 5/5 ‘palpable’.
PRESENTATION This refers to which way up the baby is. Up to about 30 weeks, the baby moves about a lot. Then it usually settles into its head
downward position, ready to be born head first. This is recorded as ‘Vx’ (vertex) or ‘C’ or ‘ceph’ (cephalic). Both words mean the top of the head. If your baby stays with its bottom downwards, this is a breech (‘Br’) presentation. ‘PP’ means presenting part, that is the bit of the baby that is coming first. ‘Tr’ (transverse) means your baby is lying across your tummy.
URINE These are the results of your urine tests for protein and sugar. ‘+’ or ‘Tr’
means a quantity (or trace) has been found. ‘Alb’ stands for ‘albumin’, a name for one of the proteins detected in urine. ‘Nil’ or a tick or
‘NAD’ all mean the same:
nothing abnormal discovered.
‘Ketones’ may be found if you have not eaten recently
BLOOD PRESSURE (BP)This usually stays at about the same level throughout pregnancy. If it goes up a lot in the last half of pregnancy, it may be a sign of pre-eclampsia which can be dangerous for you and your baby (see page 84).
OEDEMA This is another word for swelling, most often of the feet and hands. Usually it is nothing to worry about, but tell your doctor or midwife if it suddenly gets worse as this may be a sign of pre-eclampsia (see page 84).
Hb This stands for
‘haemoglobin’. It is tested in your blood sample to check you are not anaemic.
FETAL HEART‘FHH’ or just ‘H’ means ‘fetal heart heard’. ‘FMF’ means ‘fetal movement felt’.
POSITION The above abbreviations are used to describe the way the baby is lying – facing sideways, for example, or frontwards or backwards. Ask your midwife to explain the way your baby is lying.
Antenatal care and antenatal classes
38
24
12 R.O.L. or R.O.T. L.O.P
L.O.L.
L.or
O.T R.O.A. R.O.P.
L.O.A. 2/5felt
3/5engaged
Antenatal care and antenatal classes
•
A community midwifewill probably get to know you before your baby is born and will visit you at home, after you leave hospital during the early weeks.Community midwives are sometimes attached to GPs’
practices and may be involved in giving antenatal care. They are also involved in delivering babies in community and GP or midwife units and are responsible for home deliveries. Some community midwives also accompany women into the hospital maternity unit to be with them for the birth.
•
Your general practitioner (GP) can help you to plan yourantenatal care. This may be given at the hospital, but it is quite often shared with the GP.
Sometimes the GP may be responsible for all your antenatal care and in some areas may be responsible for your care in hospital. If you have your baby in a GP or midwife unit or at home, your GP may be involved in your baby’s birth. If your baby is born in hospital, your GP will be notified of your baby’s birth and will arrange to see you soon after you return home. Don’t forget to register your baby with your GP.
•
An obstetricianis a doctor specialising in the care of women during pregnancy, labour and soon after the birth. If you are having a hospital birth you will usually be under the care of a consultant and the doctors on his or her own team, together with other professionals such as midwives. In some hospitals you will routinely see an obstetrician;in others, your midwife or GP
W H O ’ S W H O
Many mothers would like to be able to get to know the people who care for them during pregnancy and the birth of their baby. The NHS is now working to achieve this. However, you may still find that you see a number of different carers.
Professionals should, of course, introduce themselves and explain what they do but, if they forget, don’t hesitate to ask. It may help to make a note of who you have seen and what they have said in case you need to discuss any point later on.
Below are the people you’re most likely to meet. Some may have students with them who are being trained and you will be asked if you mind them being present.
•
A midwifeis specially trained to care for mothers and babies throughout normal pregnancy, labour and after the birth, and therefore provides all care for the majority of women at home or in hospital. Increasingly, midwives will be working both in hospital and in the community so that they can provide better continuity of care. You should know the name of the midwife who is responsible for your midwifery care.•
A hospital midwifewill probably see you each time you go to a hospital antenatal clinic.A midwife will look after you during labour and will probably deliver your baby, if your delivery is normal. If any complications develop during your pregnancy or delivery, a doctor will become more closely involved with your care. You and your baby will be cared for by midwives on the postnatal ward until you go home. You will probably also meet student midwives and
Antenatal care and antenatal classes
if they have a particular concern such as previous complications of pregnancy or labour or chronic illness. If everything is
straightforward, a midwife will usually deliver your baby. You should ask to see your consultant if you wish to discuss any matter you think is important.
•
A paediatricianis a doctor specialising in the care of babies and children. The paediatrician may check your baby after the birth to make sure all is well and will be present when your baby is born if you have had a difficult labour. If your baby should have any problems, you will be able to talk this over with the paediatrician. If your baby is born at home or your stay in hospital is short, you may not see a paediatrician at all. Your GP can check that all is well with you and your baby.•
An obstetric physiotherapist is specially trained to help you cope with the physical changes of pregnancy, childbirth and afterwards. Some attendantenatal classes and teach antenatal exercises, relaxation and breathing, active positions and other ways you can help yourself during pregnancy and labour. Afterwards, they advise on postnatal exercises to tone up your muscles again. When no obstetric physiotherapist is available your midwife can help you with these exercises.
•
Health visitorsare specially trained nurses concerned with the health of the whole family.You may meet yours before the birth of your baby. The health visitor will contact you to arrange a home visit when your baby is ten days old to offer help and support. You may continue to see your health visitor either at home, or at your Child Health Clinic, health centre or GP’s surgery, depending on where they are based.
•
Dietitians are available to advise you on healthy eating or if you need to follow a special diet such as that recommended for women with gestational diabetes.R
ESEARCHYou may be asked to participate in a research project during your antenatal care, labour or postnatally.
This may involve a new treatment or be to find out your opinions on an aspect of your care, for example.
The project should be fully explained to you and you are free to decline, but your participation will be most welcome. Such projects are vital if professionals are to improve maternity care.
S
TUDENTSMany of the professionals mentioned have students accompanying them at times.
They will be at various stages of their training but will always be supervised.
You can choose not to be seen by a student at any time but agreeing to their presence helps in their education and may even add to your experience of pregnancy and labour.
Think about what you hope to gain from antenatal classes so that, if there is a choice, you can find the sort of class that suits you best.
You need to start making enquiries early in pregnancy so that you can be sure of getting a place in the class you choose. You can go to more than one class. Ask your midwife, or health visitor, your GP, or the local branch of the National Childbirth Trust (see page 147).
Antenatal care and antenatal classes
Antenatal classes can help to prepare you for your baby’s birth and for looking after and feeding your baby.
They can also help you to keep yourself fit and well during pregnancy. They are often called parentcraft classes and may cover relaxation and breathing, and antenatal exercise. They’re a good chance to meet other parents, to talk about things that might be worrying you and to ask questions – and to make new friends. They are usually informal and fun.
You may be able to go to some introductory classes on babycare early in pregnancy. Otherwise, many classes will start about eight to ten weeks before your baby is due.
Classes are normally held once a week, either during the day or in the evening and last one or two hours. Some classes are for expectant women only. Others will welcome partners, either to all the sessions or
to some of them, or you can go alone or with a friend. In some areas there are classes especially for women whose first language is not English, classes for single mothers and classes for teenagers. The kinds of topics covered by antenatal classes are: