Bellies and Beyond

Advanced midwifery services

How is my due date calculated?

A human pregnancy lasts on average 266 days from conception and 280 days from last menstrual period. The most accurate way to determine the expected date of delivery (EDD) is to take the date of the first day of the last menstrual period (LMP) add 7 days to that and subtract 3 months. It only works however if we had a regular 28 day menstrual cycle. We do early ultrasounds to correlate the EDD we get from the LMP and the one on scan. Correlating the 2 dates will give us quite an accurate EDD. This will give us the date for 40 completed weeks of pregnancy. We try to date the pregnancy as early as possible as we know this is when we will get the most accurate date. This will remain the EDD until the end of the pregnancy. If follow up scans reveal a date more than a week before or after the original due date it means the baby is growing too fast/slow. The EDD will never change, very much like your birthday will never change irrespective of weight gain/weight loss!

 

Is cramping normal?

Yes. The first 12 weeks you will feel a sensation similar to menstrual cramps which is normal, unless it is coupled with bleeding, a foul smelling discharge or burning of urine. Later on in pregnancy these pains are also caused by stretching of the uterine ligaments (running from the sides of the uterus, through the groin area and implanting on the inside of the outer lips of the vagina), and pressure on the bladder.

 

Is discharge normal?

Yes. Hormonal changes during pregnancy cause an increase in discharge from the vagina. It is usually transparent. Watch out for yellow/green/thick white cottage cheese like discharge that is offensive, itchy or burning. This might mean there is an infection. 


Is bleeding normal? 

At around 5-6 weeks one can have a small bleed which is normal and is called  the implantation bleed (the baby buries itself in the lining of the uterus). It is  also not unlikely to still have a normal menstrual cycle while being pregnant. It is however wise not to ignore bleeding but rather have it checked as it might  mean there is a hormone deficiency, infection or you are having a miscarriage.

Can we have sex in pregnancy? 

Yes, unless you had previous unexplained miscarriages or premature labour in a  previous pregnancy, bleeding early in this pregnancy or a low lying /placenta Previa.

What vitamins can I take?

You should ideally be on folic acid from before conception, but it is never too  late to start. Use it for the first 12 weeks.

As the first 12 weeks are usually accompanied by nausea it is not suggested  that you take a combined pregnancy vitamin. The iron in it usually makes the  nausea worse. After 12 weeks choose the best vitamin that you can afford. can suggest Pregomega plus as it has the multivitamin with iron and folic acid, a  calcium supplement and omega acids which is important for brain development.

 

What can I eat?

As long as it is cooked, you can eat anything. There is a bacteria called Listeria  that causes food poisoning that can cause miscarriages so be sure you do not  eat anything from an untrustworthy source. You can eat cooked fish, you really have to eat huge amounts before you will get mercury poisoning (avoid
swordfish, marlin and shark for that reason)

Make sure all your dairy products are pasturized and soft cheeses, especially the mouldy ones like blue cheese ect is cooked.

300mg of caffein (about 3 cups mild coffee) is considered safe. Remember hot  chocolate, black tea and chocolates also contains caffein!

NO alcohol.
NO smoking.

NO recreational drugs.  

What medicines are safe?

Nausea - Asic, Emex, Vomifene, Maxalon. If these does not work for you please  ask for a script for something stronger.

Diarrhoea - Smecta, Immodium

Cramps - Buscopan, Hyospasmol

Flu - Panado, Otrivin nasal spray (only shortterm use),Epigen cough syrup,  Sinupret forte (also good for sinusitis and allergies)

Antibiotics - mostly safe (tetracyclins can cause yellow teeth in the baby, Chlooramphenicol and co-amoxyclave can cause severe fetal problems if used near term)

Pain: Panado is safe. Any anti inflamatory (Brufen, Myprodol, Celebrex,Cataflam etc) is not. In cases of severe pain something stronger than Panado can be prescibed for short term use.

Sleeping tabs: Stillnox, Serepax. Please only use short-term! 

Please discuss all medications and changes to medication at all times!          

AVOID

-Antibiotics - Tetracyclin, Chlooramphenicol, Streptomycin, Sulphonamides

- Warfarin

- ACE inhibitors (used for high bloodpressure)

-Hormones unless progeterone prescribed in 1st 12 weeks (combined contraceptive tablets,danazol,diethylstilbestrol, anabolic steroids)
-Anti inflammatories (aspirin, Brufen, Myprodol ect) 

-Morhine and codein based painkillers

-Vit A derivatives (Roaccutane, Retin A)

-Epanutin, Epilim, Rivortil (antiepileptic medication)

-Stocrin (HIV medication)

-Lithuim and tricyclic antidepressants and benzodiazepines

-Methotrexate

-Radioactive iodine

-Benzodiasepines

- Thalidomide

-Live virus vaccines (MMR, Chicken pox, Yellow fever)

-Any recreational drugs (cannabis, Tik, LSD, Cocaine)  
   

Where the weight goes:

Baby 3,3kg
Placenta 600g
Uterus 900g
Breasts 400g
B
lood l,4k
Fat 3.5 kg

Extracellular fluid 2,5kg

Exercise

You can continue at the level you were excersising before. Do not start a new  strenuous routine now to try to avoid weight gain! Adjust the routine as the  pregnany progresses to adapt to your bigger tummy. Most fitness instructors
will be able to assist you with more appropriate excersises
. Also avoid  dangerous sports such as motorbiking, jumping out of planes or horse back  riding, if you do wish to continue please do not fall!!

 How much weight can I gain? 

12-14kgs in a singleton pregnancy, 20 in a twin pregnancy. Anything more than that is just fat.
How much when?
I" trimester - 2kgs

2nd trimester - 5kgs
3rd trimester - 5kgs

Maternity leave?

This will depend on your HR department. If you and baby are healthy there is  no reason why you can not work until the very end. Most employers prefer for practical reasons that you stop working at 36 weeks. I will issue you with a
letter stating the EDD then you and the employer can discuss it.

 Travel

It is safe to travel by car throughout the pregnancy. If you are the driver make sure that you feel comfortable and can stop in an emergency situation. The use of a seatbelt is also recommended with the one strap going over the
shoulder and the other placed under the stomach.

Travelling by plane is also safe unless you suffer from hypertention or have a history of previous/current premature labour- Earlier years when cabin  pressure inside planes was a bit dodgy there Was some concerns that baby might suffer oxygen deficiency or brain damage, but these days cabin pressure is very well controlled. Most airlines however prefer that you  do not go into labour while on their plane, therefore domestic ailrlines will let you fly up to 36 weeks, international 30 weeks. Check with the airline before
you book
, and make sure that you ask for a letter should they want one. Precautions during any travel includes taking a walk at least every
90 minutes to keep circulation going and taking adequte fluids - both to
prevent blood clots.

Can I dye my hair?

Yes, just not every day, same goes for artificial nails, eyelashes ect 
 Spa? 
 Avoid the following - saunas, steamrooms. 

Aromatherapy oils to AVOID - almond,aniseed, angelica, basil, birch,blackpepper, baldo leaf, buchu, camphor, cassia, cedarwood, clove, fennel, ginger, hyssop, jasmyn, juniper, lemon, lemongrass, marjoram, mustard,
mugwort, myrrh, nutmeg, oregano,pennyroyal, peppermint, pine, rose, 
rosemary, sage, thyme, wintergreen.

Rather choose a spa pakage designed for pregnancy.

Can I go to the dentist?

Yes.

No X-rays, but local anaesthetic can be used and the antibiotic they prescribed are usually safe, check with me if you want to double check 
 

A General outline of visits

4-8 Weeks

Confirmation of pregnancy, check that it is inside the uterus and that the heartbeat is present.

Blood pressure and urine analysis

12 Weeks

Baby is fully developed, and we will be able to see a fetus of 6-8mm. 

Blood pressure and urine analysis

Down Syndrome screening - see Lancet brochure

Routine ante natal bloodtests (Full blood count, bloodgroup, Infections - HIV,
syphilis, Hepatitis B, german measels, glucose)

16 Weeks

Growth and development
Possible sex determination

Blood pressure and urine analysis

20 Weeks

Growth and development

Specifically check fetal heart and rest of fetal anatomy
Blood pressure, urine analysis

24 Weeks

Growth and development

Blood pressure and urine analysis
Bed booking - maternity ward

28 Weeks

Growth and development

Blood pressure and urine analysis

32 Weeks

Growth and development

Blood pressure and urine analysis

34 Weeks

Growth and development

Blood pressure and urine analysis