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HELPING YOU THROUGH PREGNANCY

& CHILDBIRTH

Useful tips and helpful advice!

Welcome to Cavan Maternity Unit and Congratulations on

your Pregnancy.

Parentcraft Department

Maternity Unit

Cavan General Hospital

049 4376541

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Table of Contents

Introduction ………………………………………………………….3

What to bring to hospital……………………………………………..6

Achieving a healthy pregnancy………………………………………8

Lets get physical……………………………………………….8

Healthy eating…………………………………………………13

Common pregnancy complaints ……………………………...18

Stay safe in pregnancy ……………………………………………....21

Smoking in pregnancy ………………………………………..21

Seat belt use …………………………………………………..23

Pregnancy symptoms never to ignore ………………………...24

Perineal Massage …………………………………………………….26

Making space for no 2, 3, 4 ………………………………………….27

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Introduction to Cavan/Monaghan Hospital Group

Welcome to Cavan/Monaghan General Hospital. This hospital is under the

management of the HSE, Dublin North East and is part of the Cavan/Monaghan

Hospital Group.

The Maternity Department in Cavan/Monaghan General Hospital currently provides

Maternity Services for approximately 2000 pregnant women per year.

The options of care are;

1. Midwifery led care.

2. Consultant led public care.

3. Consultant led private care.

We also provide neonatal care for newborn babies caring for up to 300 babies per

year.

We aim to ensure that the best quality maternity service is available in partnership

with women and their families and we strive:

• To meet the holistic needs of woman and their families and encourage joint

decision making relating to care.

• To build an accessible cost effective service of excellence, where practice is of

highest standard and is based on proven research and governed by audit and

multidisciplinary team work.

• To foster an environment where individuality is respected, where safety is of

paramount importance.

• To promote and enhance the midwives role within the service, working as

autonomous practitioners in provision of care alongside their obstetric

colleagues.

We welcome you to the maternity unit and hope you will find your pregnancy and

delivery an enjoyable experience. We realise you may be apprehensive, and we

wish to assure you that our philosophy of care is designed to help you. We try to

ensure that all mothers and babies receive individualised care from competent

professionals in a kind, caring and safe manner. We respect your individual

wishes and rights within the confines of safe practice.

‘It is our aim at Cavan General Hospital to support, educate and inform women

regarding pregnancy, birth and baby care practices. Therefore we encourage you to

attend antenatal classes, and value your input and communication. All our staff strive

to make your pregnancy, birth and postnatal care a positive experience.’

Strict Visiting Hours; Monday to Sunday, including Bank Holidays; 6.30pm – 8.30pm.

Partners are permitted all day between 9am – 9pm.

Siblings can come to visit between 6.30pm – 8.30pm.

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You have just booked to have your baby in the

Cavan/Monaghan Hospital.

What happens next?

• The Midwife met you and took your medical history, organized your bloods

and discussed with you what clinic you wish to attend, either with the

Midwifery Led Unit (MLU) or with one of our 4 consultants in the Consultant

Led Unit (CLU).

• Subsequent visits to the hospital will be with your relevant caregiver and care

given specific to your needs. At a minimum this will include urine testing,

blood pressure monitoring and evaluation of the growth of your baby. At each

visit, please bring a sample of urine with you.

• More routine blood tests may be required in your pregnancy and if so, the

midwife will organize this for you.

• A date for your parentcraft class will be given to you while you attend for your

initial pre-assessment/booking visit. We also run Polish classes. If you do not

get an appointment for classes at your first visit please inform your midwife

on your return visit.

• Breastfeeding classes are held once a month on the last Tuesday. To book a

place please contact the breastfeeding specialist Midwife on 049 4376864.

• Antenatal care is shared with your GP whom you will visit alternately with the

hospital.

Models of Care Available to You

MLU Care CLU care

• In the MLU you will be seen by a

team of midwives and a

midwifery manager throughout

your antenatal period, birth and

postnatal period.

• In the CLU you will be seen by

the Consultant Obstetrician at

least once in the antenatal period

or more frequently if required.

Subsequent visits will be with a

member of his team.

• Following your pre assessment

appointment you will be given an

appointment to return for your

next visit in the midwifery led

unit.

• Following your pre assessment

appointment you will be given an

appointment to return for your

next visit in the out patients

department.

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• The Midwife in the MLU will

organise all your follow up

appointments with you before you

leave. Mlu care provides flexible

appointment dates and times to

suit your needs.

• Please make your return

appointment at the reception desk

in the out patient department

‘BEFORE’ leaving the hospital.

• On your return visit you may

come directly up to the MLU and

take a seat in the waiting room on

the unit. If you have changed any

personal details please inform the

midwife.

• On your return visit check in at

the reception desk in the out

patient department and take a seat.

If you have changed any personal

details please inform the

receptionist at this point.

• MLU care provides minimal

waiting times and the opportunity

to familiarise yourself with the

midwives who will look after you

in labour.

• A midwife will call you and will

confirm your personal details.

Your blood pressure will checked

and your urine tested.

• On subsequent visits the midwife

will check your blood pressure

and urine and will assess the well

being of both you and your baby.

• You will then go to the waiting

area to see one of the doctors

from your chosen doctor’s team.

• You will have 2 ultrasound scans

during your pregnancy. Further

ultrasounds may be required on

clinical grounds.

• On average you will have at least

2 ultrasound scans during your

pregnancy. A repeat ultrasound

scan may be performed later in

your pregnancy at the doctor’s

discretion

• PLEASE NOTE; The clinics are often very busy and

your doctor may also be covering the

labour ward and theatre. This may

cause some delays.

‘As for Cavan MLU, what can I say, anyone having a normal pregnancy would be

mad not to use these wonderful facilities. It is your right to request it, if you are

having a healthy pregnancy with no history of pregnancy issues. Where else can you

get a big private en-suite birthing room, with a warm pool to relax in, a quiet bed, and

even a telly and couch! The couch folds out to allow your birthing partner to get some

overnight rest also. And all for free!’ Sharon

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Are you packed and ready to go?

Its getting close now and you will soon be meeting your baby! Here are a few

suggestions from other mums and midwives on what to bring to hospital?

For Labour

Front opening night dress/ t-shirt Face cloth/sponge

Lip Balm Hair band

Books/Magazines Socks

Glucose Sweets/Drinks Your Own Music

Dark Coloured Towels

For You

Nightdress (front opening), Pyjamas, Dressing

gown

Slippers, Flip Flops

Toiletries

Dark Coloured Towels

Nursing Bra

Breast Pads

(Disposable or washable)

Maternity Sanitary Pads E.g.; Green sanitary pads in clear packaging

(Initially after delivery)

Sanitary Pads E.g.; ‘always with wings’

(2-3 days after delivery)

Disposable Underwear

Phone Charger, Camera

Hairdryer

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Postnatal Classes; All mums are expected to attend this class to receive all the relevant information for

discharge. Classes are held on the Maternity Unit on Mondays, Wednesdays and

Fridays from 10.30am – 12.00pm.

Don’t forget PPS numbers for the birth registration. Phone number for Maternity; 049 4376613

Going Home

Loose easy to wear clothes for you Car Seat

Warm Baby Clothes Warm Cellular Blanket & Hat for Baby

For Baby

Washed Towels x 2 Baby Gros x 7

Vests Hat & Mittens

Burping Cloths Nappies (Newborn size 1 or 2)

Cot Sheets & Cellular Blankets Cotton Wool Balls

Olive Oil Vaseline/Sudocrem

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ACHIEVING A HEALTHY PREGNANCY

‘Let’s Get Physical’

Whether you spent your evenings on a treadmill or in front of the television before

you were expecting, now is the time to get active and stay active! Exercising while

pregnant can help you to cope better during your pregnancy and your labour, as well

as being a proven stress-reliever. Chartered physiotherapist LESLEY-ANN ROSS

outlines the benefits to keeping yourself fighting-fit during these nine months. During

pregnancy your body is developing so it’s important to adapt or begin a fitness regime

that accommodates these changes. This might mean tweaking your existing

programme or swapping it for an activity that’s more appropriate during pregnancy.

Before deciding on a form of exercise, take account of how your body will change

during pregnancy: issues to be aware of include your changing body shape, weight

gain, hormonal changes, increased joint laxity, tiredness, a decrease in balance or

even a propensity for clumsiness.

THE BENEFITS Exercise, in general, can help to maintain cardiovascular fitness, posture, flexibility,

muscle strength, balance, body awareness and co-ordination. As a result, stress and

the occurrence of back/pelvic or other pains may be reduced and relaxation and

breathing control promoted. Exercise can improve physical wellbeing and can offer

the means to meet other mums-to-be at the same stage of pregnancy. Exercising

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during the antenatal period may also play a role in managing gestational diabetes

(accompanied by medication and a healthy diet) and in assisting postnatal recovery.

WHEN TO START Listen to your body and trust your instincts. If you are tired or suffering from morning

sickness then wait until a time you feel like exercising. If you are feeling fine in the

first trimester and have been exercising pre pregnancy, then in accordance with your

midwife or doctor’s advice, you can follow a similar exercise regime during

pregnancy, while bearing in mind the guidelines below. Many pregnancy exercise

classes encourage women to join from 16 to 20 weeks of pregnancy.

THINGS TO CONSIDER Remember that whatever is affecting you during pregnancy is also affecting your

baby.

With all forms of exercise, you need to be aware that:

• Your heart rate should not exceed 60–70 per cent of maximum heart rate

levels –i.e., approximately 140 beats per minute (being able to exercise and

talk at same time).

• Your body temperature will change – make sure that you have enough

ventilation and fluid intake when exercising and do not overheat.

• Your nutritional intake increases – if you are exercising regularly, make sure

you are eating regularly and enough. From 13 weeks, 300 extra kcal a day are

required, even if you are not exercising. It is advisable to consult a dietician if

you are uncertain about your intake.

• Any positions or movements that cause pain. Some movements may cause

discomfort or pain, depending on where the baby is lying or your body’s

flexibility. Avoid overstretching and any movements that are painful. Consult

a physiotherapist if necessary.

• Keep breathing during exercise and avoid holding your breath.

• Exercising flat on your back for longer than about five minutes is not

recommended after 16 weeks gestation due to circulatory adaptations.

• Contact sports should be avoided after 16 weeks.

• Scuba diving should be avoided at all stages of pregnancy.

SAFE EXERCISE Approximately 30 minutes or more of moderate exercise a day on most, if not all,

days of the week is recommended for pregnant women in the absence of medical or

obstetric complications. Moderate exercise intensity can be defined as being able to

exercise and talk at the same time, for example, walk and hold a conversation (ACOG

Guidelines 2002).

Cardiovascular exercise Walking, swimming or cycling are good cardiovascular exercises during pregnancy.

Guidelines suggest 20 minutes, three times a week progressing to 20–30 minutes

daily. Make sure to start off slowly and increase time gradually, particularly if you

have not been doing any exercise prior to becoming pregnant. You will most likely

need to slow down again in the latter weeks of pregnancy. Follow the guidelines

above for heart rate, nutritional intake and body heat.

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Gym work This is not necessarily the time to decide to join a gym. However, if you are already a

member, you could continue with some cardiovascular work such as on the treadmill

or bike. Gentle arm weights can also be used. Consult a fitness instructor on the

suitability of equipment for pregnant women. Lower weights with an increased

number of repetitions are advised. Higher impact exercise such as aerobics or step

classes are not advised due to the increase in joint laxity. Stop exercising if you are

feeling unwell, in pain or are very short of breath.

Exercise classes

Pilates, yoga or aqua classes are great for meeting other mums-to-be. Pick a class with

a particular focus on pregnancy, as they will have been modified to particular stages

of pregnancy and appropriate positions. Pregnancy classes will also focus on

breathing control, relaxation techniques and posture, all of which are important at this

time. For further details of local classes, contact your antenatal department and always

check that your instructor is qualified to take pregnancy classes.

“It is important to be aware of the signals from your body and your baby while

exercising and stop immediately if you are in any way uncomfortable”

Don’t exercise if:

• you are feeling unwell, tired, faint or dizzy, if your doctor or midwife has

advised against it, if you have pain or if you have any bleeding. Exercising

during pregnancy is not always suitable for everyone so consult your

doctor/midwife before engaging in any activity.

MAKING EXERCISE WORK FOR YOU If you are already a very active person and enjoy a regular exercise routine, you may

continue with this as long as you listen to your body and follow the guidelines above.

Other forms of exercise such as golf, gentle tennis, hill walking or dancing can be

continued well into your second trimester as long as you are feeling good. Any

queries should be discussed with your doctor or midwife. Competitive exercise that

can involve risk of impact or falling, such as basketball, horse riding or skiing, should

be discontinued to avoid risk to both mum and baby. Pregnancy is a time to maintain

fitness levels, not necessarily to try to increase them. Enjoy your exercise and use it as

time for you and your growing baby.

Making time Try to fit exercise sessions or classes into your weekly schedule, however, if classes

or the gym are not for you, there are other ways to exercise as part of your daily

routine. If possible, a daily walk to work or at lunch would help with your

cardiovascular fitness and taking the stairs instead of the lift can strengthen the leg

muscles. Gentle housework can also keep the body flexible and moving. Do be aware

of your posture when doing housework – bend from the knees and keep your feet and

your face in the same direction, so avoid twisting or turning. An active way to work

the pelvic muscles and relieve lower back strain is to sit on a large exercise ball.

These are often called ‘Swiss’, ‘physio’ or ‘birthing’ balls. Sitting on the ball while

relaxing, watching television or working at a desk can help movement and strength in

the back and pelvis. A suitably sized ball should allow your hips and knees to rest at

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approximately 90 degrees (too high or too low may irritate your back or pelvis). Ask

your physiotherapist for advice on size or suitability for you.

Postnatal Exercise Exercising after the birth of your baby will depend on your antenatal exercise levels,

your type of delivery, and how you and your baby are feeding and sleeping. Try to

attend a postnatal advice class in the maternity hospital if you can. As a general rule,

after six weeks is a good time to start gentle exercise. Up until this time, you can walk

as much as you feel up to, progressing your distance or pace gradually. After six

weeks, you may be able to join yoga, Pilates, low level class or start some gym work.

Higher-level exercise or contact sports should be progressed into gradually over three

to five months, as it takes this time for the hormone levels to reduce and joints to

stabilise. Each woman, body, baby and exercise is different. It is important to be

aware of the signals from your body and your baby while exercising and stop

immediately if you are uncomfortable or a movement does not feel right. Discuss

modifications with your instructor, if necessary.

CHOOSING THE RIGHT EXERCISE FOR YOU:

Swimming

• Cardiovascular, non-weightbearing exercise.

• Good for relieving postural strains and ‘taking the weight of the baby off the

spine’.

• Take care not to overstrain the pelvic joints – particularly in breast stroke

action.

Walking

• Cardiovascular, weightbearing exercise.

• Pace, distance and stride length may need to be modified as pregnancy

progresses.

• Supportive footwear recommended.

• ‘Respect’ pelvic joints and do not walk through pain.

Pilates

• Minimal weightbearing – modified positions

• Increases postural awareness as body changes

• Focus on awareness of and strengthening of pelvic support muscles – lower

abdominal muscles and pelvic floor muscles

• Flexibility and breathing work also incorporated

• Some classes will modify Pilates exercises to use Swiss balls

Yoga

• Minimal/modified weightbearing

• Flexibility exercises

• Relaxation and breathing exercises

• Classes often incorporate useful positions for labour

The Basics If you aren’t able to exercise during pregnancy, it is worth considering the following

points and basic exercises.

1. THINK SYMMETRY, Back and pelvic problems can often be aggravated

during pregnancy due to the ‘asymmetries of posture’. Most people will have

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one side more dominant than the other but a few simple tips can help to keep

your posture more symmetrical as it changes as pregnancy progresses.

• Think about keeping the weight equal through both ‘sit bones’ if sitting or

both feet if standing.

• Try not to ‘hang off one hip’ – particularly if standing for long periods

or carrying toddlers or other objects.

• Crossing your legs can contribute to pelvic asymmetry and circulatory

problems. Try to avoid it.

• If working at a desk or work station, try to keep your ‘tasks’ straight

ahead of

you, rather than over to one side, causing you to twist or rotate.

2. LOWER ABDOMINAL MUSCLES, The lower abdominal muscles are one

of the muscle groups supporting the weight of your baby. Good tone in this

muscle is needed to keep your lower back and pelvis strong. This muscle can

be activated if you gently ‘hug’ your baby in towards your spine by slowly

pulling in from your pubic bone up to your navel. This should be a gentle

contraction, hold for approximately ten seconds as you keep breathing. Ten

repetitions regularly are recommended. Incidentally, the upper abdominal

muscles often split during pregnancy. The size of this split can vary so please

ask a nurse in your maternity hospital, public health nurse or a chartered

physiotherapist to check this for you as specific exercises and advice may be

necessary.

3. PELVIC FLOOR EXERCISES, Awareness of your pelvic floor is

important during pregnancy to maintain good muscle tone as your baby

grows, to control urine and bowel, and to allow your pelvic floor to relax

sufficiently during delivery. Basic pelvic floor exercises include pulling up

your ‘water passage’ as if you are trying to stop yourself from passing urine.

Do not clench your buttock muscles. This exercise needs to be done quickly

(about ten repetitions at a time regularly during the day) and slowly (being

able to hold for ten seconds and do ten repetitions). If you have any problems

with leakage of urine during pregnancy or after delivery, please contact your

maternity hospital or a chartered physiotherapist specialising in this area for

advice. Other specific exercises will be discussed in antenatal or exercise

classes.

Lesley-Anne Ross, B.Sc, M.Sc, BCPT, is a chartered physiotherapist at the National

Maternity Hospital, Holles Street, Dublin.

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Eating well in pregnancy

Eating a balanced diet during pregnancy can help to protect the health of you and your

baby. It’s also a good idea to eat healthily if you’re trying for a baby because a healthy

pregnancy starts well before conception.

Folic Acid

Take at least 400 micrograms of folic acid a day while you’re trying to get pregnant, and during

the first 12 weeks of pregnancy. Folic acid reduces the risk of your baby having a neural tube

defect, such as spina bifida. A neural tube defect is when the foetus’s spinal cord (part of the

body’s nervous system) doesn’t form normally.

Folic acid tablets are widely available from pharmacies, or you can talk to your GP about getting a

prescription.

Don’t worry if you get pregnant unexpectedly and weren’t taking folic acid supplements. Start

taking them as soon as you find out, until you’re past the first 12 weeks of pregnancy.

• Do take your folic acid supplement every day.

• Do eat plenty of food rich in folate (the natural form of folic acid), such as green leafy

vegetables, including spinach and watercress, nuts, pulses, wholegrains and fruit juice.

Iron

In normal pregnancy the recommended iron intake is 3.5mgs rising slightly in the last trimester to

6-7mgs a day. Iron supplementation is not routinely requred for all pregnant women as it does not

benefit the mother’s or babies health and may have some unpleasant side effects (NICE, 2008). A

diet rich in iron is sufficeint unless your iron level runs low. Your health care provider will

monitor your iron levels during the pregnancy and if needed iron supplements will be

recommended.

Dried fruits such as apricots are great sources of iron, and they’re easy to snack on. Other good

sources for pregnant women include spinach, pumpkin, collards, kale and turnip greens. Beans

such as green peas, lentils and chick-peas are also good sources of iron.

Fruits and vegetables have nonheme iron, which while good, is a little harder for the body absorb.

It’s very important that you take these iron-rich foods with iron helpers (see below) so your body

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absorbs the iron rather than flushing it away.

If you’re getting your iron from meat sources, there are some things to keep in mind. Make sure

you’re cooking red meat to well done and microwaving any deli meat to steaming to prevent

listeriosis (a bacteria that can affect the baby). Poultry needs to be cooked well and you should

watch out for any contamination of raw poultry and other foods that you eat.

If you’re a vegetarian or vegan, speak to your care provider about ways to add iron to diet.

Increase Vitamin C (Helper) Intake

It’s not enough to just increase the amount of iron you eat; you also need vitamins that will help

you absorb the iron. Vitamin C is a great “helper” in iron absorption. Try drinking a glass of

orange juice as you eat foods high in iron. If you can’t stomach that, add a side of brightly colored

vegetables such tomatoes or peppers to your plate.

Watch out for These Foods

Some foods actually decrease your absorption of iron and shouldn’t be taken with iron-rich foods.

Calcium and caffeine both decrease the absorption of iron. So foods such as teas, milks and

coffees should be avoided while eating iron-rich foods. While you shouldn’t cut milk out of your

diet (pregnant women need the calcium), a better solution is to drink the milk between meals so

your body has a chance to absorb the iron from your meals.

Vitamin D

It is important to ensure that you maintain adequate Vitamin D stores during pregnancy. Vitamin

D promotes bone growth in the baby’s first year of life and decreases the risk of developing

rickets. In order to achieve this woman may choose to take 10 mcgs supplement of Vitamin D per

day, or ensure a good supply of Vitamin D as part of a well balanced diet. Foods rich in Vitamin D

include eggs, meat, Vitamin D fortified margarine, milk and breakfast cereal

And:

• Don’t take supplements that contain vitamin A, because too much vitamin A can cause

foetal abnormalities.

• Don’t eat liver or products that contain it, such as paté. Liver contains a lot of vitamin A.

Alcohol When you drink, alcohol reaches your baby through the placenta. Too much exposure to alcohol

can seriously affect your baby’s development. If you’re trying to conceive, or are already

pregnant, the government advises that you should avoid drinking alcohol.

Getting pregnant may be more difficult if you drink. It’s known that drinking heavily throughout

pregnancy can result in Foetal Alcohol Syndrome (FAS). Children with this syndrome have

restricted growth, facial abnormalities and learning and behavioural disorders. When a woman

drinks while pregnant, the alcohol passes into the baby’s bloodstream. The safest approach is to

not drink at all.

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Caffeine You don’t need to cut out caffeine completely, but don’t have more than 200mg a day as high

levels can result in babies having a low birth weight, which can increase the risk of health

problems in later life. Too much caffeine can also cause miscarriage. There’s caffeine in

chocolate, cola and ‘energy’ drinks, as well as tea and coffee.

The amount of caffeine in foods and drinks will vary, but each of the following contains

roughly 200mg of caffeine or less:

• Two mugs of tea (75mg each).

• Two mugs of instant coffee (100mg each).

• One mug of filter coffee (140mg each).

• Five cans of cola (around 40mg each).

• Two cans of ‘energy’ drink (around 80mg each).

• Four 50g bars of dark chocolate (around 50g of caffeine each). Milk chocolate contains

around half as much caffeine as dark chocolate.

Try to have less than 200mg of caffeine a day during the rest of your pregnancy.

Eat safely

Bacterial infections such as listeriosis, salmonella and toxoplasmosis can be dangerous for

pregnant women and their unborn babies. The bacteria can harm the unborn baby and interfere

with its normal development. Taking the following the steps can help you to avoid harmful

bacteria:

• Do cook eggs thoroughly until the whites and yolks are solid. Avoid any foods that contain

raw or lightly cooked eggs, such as home-made mayonnaise, sauces and puddings.

• Do make sure that all meats are cooked thoroughly. This is especially important with

poultry (such as chicken and turkey) and food made from minced meat (such as burgers

and sausages). Make sure that they’re very hot all the way through, and there’s no trace of

blood or pink meat. Treat all meat at barbecues with caution.

• Do wash your hands, utensils and work surfaces after handling raw meat. It may contain

bacteria, which can cause food poisoning.

• Do wash fruit, vegetables and salads to remove all traces of soil.

• Do heat ready meals until they’re very hot all the way through. This is especially important

for meals that contain poultry.

And:

• Don’t eat mould-ripened soft cheese, such as brie and camembert, or blue cheese, such as

Stilton or Danish blue. You can eat hard cheeses (e.g. cheddar, parmesan), cottage cheese,

mozarella, and processed cheese (such as cheese spread).

• Don’t eat any kind of paté, including vegetable paté, because it can contain listeria.

• Don’t eat liver or liver products, such as liver paté or liver sausage, as this is a very rich

source of vitamin A (which can harm your unborn baby).

• Don’t eat more than two portions of oily fish a week (for example, mackerel, trout or fresh

tuna), or more than four cans of tuna (around 140g per can). These contain high levels of

mercury, which can harm your baby’s developing nervous system.

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• Don’t eat marlin, shark or swordfish. These can contain high levels of mercury, which

can damage your baby’s developing nervous system.

• Don’t eat raw shellfish, as they can contain bacteria and viruses that can cause food

poisoning.

Balanced diet

A well-balanced diet will supply all the energy and nutrients needed by you and your growing

baby.

• Do eat plenty of fruit and vegetables (fresh, frozen, tinned, dried or juice); at least five

portions a day.

• Do eat plenty of foods from the starchy carbohydrate group, such as breads, cereals, rice,

pasta, noodles, maize, millet, yams and potatoes. Choose wholegrain versions whenever

you can.

• Do have milk and other dairy products (e.g. yoghurt, hard cheese) to ensure that you have a

good intake of calcium. Use low-fat varieties where you can. For example, semi-skimmed

or skimmed milk, low-fat yoghurt and reduced-fat hard cheese.

• Do get enough vitamin D. It keeps bones healthy and provides your baby with enough

vitamin D for the first few months of life. Take a 10-microgram supplement of vitamin D

each day. Your body makes vitamin D from exposure to sunlight, but the amount of time

you need in the sun to make enough vitamin varies from person to person. If you have dark

skin or always cover your skin, you may be at particular risk of vitamin D deficiency. Talk

to your midwife or doctor if you’re worried about this.

• Do get plenty of iron because some women can develop low iron levels during pregnancy.

Iron is found in meat, green leafy vegetables (such as spinach and watercress), pulses,

bread and fortified cereals. Your midwife can advise you whether you need to take an iron

supplement.

• Do eat protein foods, such as meat, fish, poultry, eggs, beans, soya, pulses and nuts (see

below for information on peanuts). Have a good variety to ensure that you get enough

protein and important nutrients, such as iron, zinc, magnesium and essential fatty acids.

Fatty acids include omega 3 fats (found in flaxseed oil, rapeseed oil, and oily fish, such as

mackerel and sardines).

• Do stay active and move around.

• Don’t eat for two. You don’t need extra calories until the final three months, when you

need around 200 extra calories a day (equivalent to two slices of toast with margarine or

butter). Be guided by your appetite. When you feel hungry between meals, choose a

healthy snack such as fruit, yoghurt or a bowl of cereal.

Nuts

If you want to eat peanuts or foods containing peanuts (such as peanut butter) during pregnancy,

you can do so as part of a healthy balanced diet, unless you’re allergic to them or your health

professional advises you not to.

If you have any queries, talk to your GP or midwife

References: National Institute for Clinical Excellence. (2008) Antenatal care: routine care for

healthy pregnant woman. NICE:London

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A Growing Mum & A Growing Baby

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Common Complaints of Pregnancy The problem The symptoms The solution

• Bleeding gums Dental problems are

common during pregnancy

because the gums soften,

allowing plaque to form

more easily.

� Bleeding when you

brush your teeth

� Brush your teeth extra

carefully and always use

dental floss.

� Book a check up with

your dentist and advise

him that you are pregnant.

� Remember that pregnant

women should avoid

certain dental treatments,

such as X-rays and

amalgam fillings.

• Heartburn • Hormone changes

relax the valve at the upper

end of the stomach,

allowing acid to pass back

into the food pipe between

your mouth and your

stomach. Your enlarging

uterus pushing on your

diaphragm doesn’t help

either.

� A searing, burning

sensation in your chest.

� Regurgitating small

amounts of very sour food

� Eat little and often,

avoiding fatty and spicy

foods

� Try sleeping in a more

upright position.

� Check with your

midwife doctor or

pharmacist – they can

recommend the best

course of action for you

• Leg cramps May have something to do

with a lack of calcium,

although the growing fetus

on certain nerves and

blood vessels are

considered responsible.

� Sudden painful muscle

contractions, usually in the

calves and the feet.

� Often happens at night

from stretching your legs

with the toes pointed

downwards.

� Stretch with your toes

flexed towards you.-

� Massage the affected leg

or foot or walk around

until the cramp subsides.

� Eat more calcium-rich

foods or see your doctor

for a special supplement.

• Haemorrhoids and

Constipation

Haemorrhoids (piles), the

varicose veins in your

rectum, are often

aggravated by

constipation. This is

usually due to increased

hormone levels relaxing

the intestinal muscle and

slowing down bowel

movement. Pressure from

the baby’s head can also

make them appear.

� Itching and soreness

around your anus

especially when you go to

the toilet.

� Straining to pass hard

dry stools is a sign of

constipation.

� Eat plenty of fibre and

drink lots of liquid.

� Don’t strain when you

go to the toilet – put your

feet on a footstool.

� Don’t stand or sit for

long periods.

� Keep your labia and

rectum clean – wipe from

front to back.

� If your piles persist or

you have any rectal

bleeding – see your

midwife or doctor.

19

• Swollen joints Some oedema (swelling) is

normal because your body

is retaining extra fluid.

Prolonged or sudden

severe swelling must

always be checked out

.

� Slightly puffy ankles,

usually at the end of a hot

day or when you’ve been

on your feet.

� Rings are tight on your

fingers, often first thing in

the morning

.

� Relax with your feet up.

� Rotate your ankles

gently or flex your fingers

above your head.

� See your midwife or

doctor immediately if the

swelling is marked or

persistent, as it could be a

sign of pre-eclampsia and

must be treated.

� Take your rings off

• Urinary problems Your growing baby may

be pressing on your

bladder, causing you to

urinate more frequently

and possibly leak urine.

Weak pelvic floor muscles

may also be responsible

for leaking

.� Going to the toilet more

often.

� Leaking urine when you

cough, sneeze or exert

yourself

� Always go to the toilet

when you need to –

hanging on may lead to

infection.

� Do your pelvic floor

exercises. Draw up the

muscle around your anus

and vagina like a lift. Hold

for 5-10 seconds, relax and

repeat Ten times aim for

100 every day! If

concerned discuss with

you GP or midwife who

can refer you to a

continence promotion

nurse.

• Morning Sickness Some women suffer from

morning sickness,

especially during the first

few months of pregnancy.

It can occur during the day

or night but is always

worse on an empty

stomach.

• Nausea / vomiting

• Have some tea and dry

toast or a biscuit before

getting up each

morning.

• Get up slowly

• Rest on the side of the

bed for a few minutes.

• Eat small frequent

snacks.

• Avoid fatty foods that

may make the nausea

worse.

• Avoid strong smells

that are likely to make

you feel sick

• Back pain Back pain, especially in

the lower back, occurs

during pregnancy. The

reasons are numerous,

• Back pain • Good posture is vital.

Stand tall, shoulders

relaxed, buttocks

tucked in and weight

spread evenly on both

20

including ligaments

softening and stretching

and posture changing as

your baby grows.

feet.

• Footwear should be

low-heeled.

• Sit with your lower

back well supported by

pillows.

• Avoid lifting heavy

objects.

• Do some exercises –

swimming may ease

back pain

21

Smoking & Pregnancy WHY STOP?

• Stopping Smoking is the single most important

thing you can do to protect your own and your

baby’s health.

• When you smoke you breathe in 4000 chemicals

many of them poisonous such as arsenic and

ammonia.

• The tar and chemicals build up inside your lungs

and may eventually cause cancer.

• Nicotine, carbon monoxide and other chemicals

reduce the amount of oxygen in your blood.

RISKS OF SMOKING WHEN PREGNANT

• Women who smoke while pregnant are more

likely to suffer from sickness, bleeding, miscarriage and other

pregnancy complications

• They are 1.5% to 2.5% more likely to have an ectopic

pregnancy than non-smokers

• Smokers are twice as likely to develop problems with their

placenta which supplies oxygen and nourishes the

developing fetus. There is a 1.4 to 2.4 fold increased risk of

placental abruption if you smoke. Potential complications

can lead to illness and/or death of mother and baby.

• 1:10 stillbirths are linked to smoking

• Pregnant women who smoke are likely to have lighter babies

on average 200gms/8ozs.

• Smaller babies are more at risk of infection and other health problems

• A SMALLER BABY WON’T MEAN AN EASIER DELIVERY AS THE

SIZE OF THE BABY’S HEAD IS NOT REDUCED!

RISKS AFTER DELIVERY

• Smoking increases the risks of cot death

by up to 3 times

• Studies have shown that a quarter of all

cot deaths are connected to parental smoking

• Babies are twice as likely to develop asthma

and at increased risk of other lung problems

such as wheezing and chest infections

• Increased risk of colic and ear infections

• Risk of Meningitis is increased by three and a half times.

If you Smoke…………

I Smoke Too………...

For help and advice to quit smoking contact -

National Smokers Quit line 1850 201 203

Or locally

Smoking Cessation Nurse Mary Gaffney 049 4361399 bleep 200 or leave a message on 049 4376388.

STOPPING AT ANY STAGE OF YOUR

PREGNANCY IS BENEFICAL.

AND STOPPING SMOKING BEFORE

PREGNANCY AVOIDS ALL RISKS –

DAD’S TOO.

22

PLANNING TO QUIT Some other reasons for quitting are…………

• Hair and Clothes will smell better

• Teeth whiter

• House and car will not smell or smoke

• And FINANCIAL –

The extra money you would have for yourself

and your baby for example 20 cigarettes cost approx.

• 9.30 Euro a day

• 65.10 Euro each week

• 260.40 Euro each month and

• 3,394.50 Euro each year

REMEMBER

• Don’t stop trying to quit you can succeed

• No two smokers will have the same reasons for quitting or encounter exactly

the same problems

PREPARATION

Ask yourself

• What changes do I need to make?

• When or where am I most likely to think of a cigarette?

STOPPING

• set a date and stick to it

STAYING STOPPED

• keep reminding yourself of your reasons for quitting. It is a great achievement

with huge benefits for you and your baby

Addiction to nicotine has now been shown to be as addictive as heroin.

Nicotine replacement therapy, which contains low level of nicotine without the other

poisonous chemicals, reduces withdrawal symptoms and has been found to double

MOTIVATED quitters chances of success. When you are pregnant you should discuss

its use with your midwife or doctor.

23

Seat Belts & Pregnancy

‘Above and below the bump, not over it’

The shoulder belt should go over the shoulder, collar

bone and down across the chest – between the breasts.

Wear the lap belt as low as possible under the abdomen

and the unborn child.

CEMD 1997-1999

24

Pregnancy Symptoms Never to Ignore

Some symptoms during pregnancy should immediately lead you to consult your

doctor or midwife. In many cases you will contact your caregiver, have your

symptoms checked out, your baby’s heartbeat monitored and be reassured that your

baby is fine and your pregnancy is progressing in a healthy manner. You should

contact the hospital if you experience or are concerned regarding any of the

following;

Baby Movements;

• It is important to have regular movements from your baby throughout

your pregnancy

• If you notice that your baby has become quiet, sit down, relax, have a

sugary cold drink and some food and concentrate on your baby’s

movements. This will often help to get your baby moving.

• If you have reduced movements you should contact the hospital and

come in to be monitored.

Vaginal Bleeding;

• If at any time you have fresh bleeding, you must contact the

maternity unit and come in to be checked out and monitored.

Abnormal Swelling, Severe Headache with Heartburn;

• Some swelling or oedema in pregnancy is normal, particularly

towards the last few weeks and often at the end of the day

• However, abnormal swelling where your feet and hands don’t reduce

after lying down or is worse in the mornings, or your face gets more

puffy – when combined with an associated headache, sudden weight

gain, stomach pain, high blood pressure and protein in your urine,

could indicate a condition called pre-eclampsia.

• If you experience any of these symptoms, contact the hospital or

your GP.

Extremely Itchy Skin;

• While it is normal to have itchy skin during pregnancy, intense itching

on the arms, legs, hands and feet is not normal.

• If it gets worse at night and you cannot sleep or eat and feel sick, see

your doctor straight away as it could indicate a liver condition called

obstetric cholestasis, which is more common in the second and third

trimester of pregnancy.

Fighting for Breath;

• Feeling slightly short of breath is common in pregnancy, especially

during the last trimester when your baby pushes against vital organs

including your lungs.

• Extreme shortness of breath while doing very little, painful or difficult

breathing, or chest pain should always be checked out.

25

Fever/Temperature;

• It is not good for you or your baby to develop a temperature of 39

degrees Celsius (102 degrees F) or more during pregnancy, so, if you

get a fever that you think is more than a head cold, take medical

advice.

• From the second trimester of pregnancy it is safe for you to take two

paracetamol, but if this doesn’t bring your temperature down its

important to see your midwife or doctor.

Group A Streptococcus;

• Group A streptococcus (GAS) is often found in the throat and

on the skin. People may carry it in their throat or on their skin

and not be ill. Most GAS infections are fairly mild illnesses

such as a ‘strep throat’ and impetigo (skin infection). It is

unusual for GAS to cause more severe illness but it can happen.

• It is easily spread by person-to-person contact or by droplet

spread from a person with the infection.

• Most people who come in contact with GAS remain well and

symptom free, or may develop mild illness such as a sore throat

or skin infection.

• If you develop any of the symptoms below, you should contact

your GP or maternity unit for advice;

� High fever greater than 39 degrees Celsius

� Muscle aches, pain or swelling

� Redness at the site of a cut or wound

� Dizziness and confusion

� A flat red rash over large areas of the body

• If you have symptoms of GAS you will be prescribed antibiotic

treatment. It is important that you complete the course of

antibiotics that is prescribed.

• To prevent GAS infection or any other infection, hand washing,

especially after coughing or sneezing and before preparing

foods or eating is the single most important factor to remember.

• All pregnant and recently delivered women need to be aware of

the importance of good basic hygiene.

26

PERINEAL MASSAGE

Your perineum will stretch a remarkable extent during the birth of your baby, but in

spite of this elasticity it is frequently torn. In extreme cases of either failure of your

perineum to stretch or sign that a bad tear will develop, your midwife may need to

perform an episiotomy.

RESEARCH HAS SHOWN THAT MASSAGING YOUR PERINEUM DAILY FOR 5 -

10 MINUTES IN THE LAST 6 WEEKS OF PREGNANCY WILL HELP PREVENT

TEARING OR THE NEED FOR EPISIOTOMY.

Before you begin;

o Make sure your bladder is empty

o Wash your hands

o Ensure you are propped up comfortably.

o When first starting you may find that a warm bath will help stretch the tissues.

o Select a natural oil – olive oil or almond oil, adding a little wheat germ oil if

you have scar tissue from previous tears or episiotomy as this oil will nourish

damaged tissue and encourage elasticity.

o Massage the carrier oil into your perineum and lower vaginal wall.

o Pay special attention to any scar tissue.

o Then place both your thumbs inside your vagina and press down towards your

rectum, maintaining a steady pressure move your thumbs along in a “T” type

movement, hold this stretch for 30 -60 seconds then release.

o Massage with more oil, stretch again to the maximum, hold, then release.

During your massage try to stretch you’re vaginal opening until you feel a

burning or tingling inside your muscles. This sensation is similar to what you

experience when your baby’s head begins to crown. At this point draw up your

pelvic floor muscles, the muscles you would tighten when you try to stop

urinating midstream, and feel how much more painful this sensation becomes.

o It is by consciously relaxing your pelvic floor muscles during the moment of

birth that you will help prevent further tissue damage.

o At first you may find it difficult to relax your pelvic floor muscles

consciously, but the moment you experience this tingling or burning sensation

during your perineal massage try to relax your muscles.

o Really concentrate and remember not to hold your breath, but continue to take

regular breaths in and out.

o When you first begin practicing perineal massage your tissues will feel tight,

but in time and practice they will relax and stretch.

o Perineal massage should not be painful, if you experience problems do not

hesitate to seek further advice.

27

Your Growing Family

Making space for number 2,3,4,etc…………

You have gone through the amazing experience

of having a baby. You have survived the birth,

the early weeks, the adjustment to your life and

all the problems that no one warned you about.

So now you are going to do the whole thing again.

Right?

Having a second and subsequent baby is a whole new experience. Rarely is

anything the same as the first time around so why should producing another child be

any different? The birth experience is different, the pregnancy is often different and

the child you produce may be totally different.

Bringing another child into your life is every bit as challenging as bringing the first, in many ways even more so. You start making space in your life before their

born. Perhaps your other child/children are old enough to understand there is a new

baby coming. You can let them feel the baby moving. Most children are loving and

protective of you and their new sibling. But it can be a time of great change for your

child/children; you need to be careful they don’t feel they are being replaced. Your

children may amaze you with their generosity of spirit and at this stage there are

rarely any problems – make sure you get enough rest!

The real test starts when you get home and the exhausting job of looking after yourself, your child and a new baby begins. This can be a difficult time for many

mothers. Rest, support and avoidance of housework are essential.

If you feel you need more help – Ask for it! Let someone do the cooking, cleaning

and shopping, giving you time to enjoy your baby and other children.

Involve your child/children in the care of the baby so they feel valued and not

excluded. But if they are not interested in helping – don’t force the issue, they will

adjust in their own time.

The rewards of having another child are wonderful. To see the special bond that

develops between your children is a wonderful experience. They support each other in

school and in their social world in a way the best mother in the world can never do.

And that’s what makes the effort worthwhile.