Midwifery is founded on respect for women and on a strong belief in the value of women’s work of bearing and rearing each generation.

Midwifery considers women in pregnancy, during childbirth and early parenting to be undertaking healthy processes that are profound and precious events in each woman’s life. These events are also seen as inherently important to society as a whole.

Midwifery is emancipatory because it protects and enhances the health and social status of women, which in turn protects and enhances the health and wellbeing of society.

Midwifery is a woman centred, political, primary health care discipline founded on the relationships between women and their midwives.

Midwifery:

• focuses on a woman’s health needs, her expectations and aspirations
• encompasses the needs of the woman’s baby, and includes the woman’s family, her other important relationships and community, as identified and negotiated by the woman herself
• is holistic in its approach and recognises each woman’s social, emotional, physical, spiritual and cultural needs, expectations and context as defined by the woman herself
• recognises every woman’s right to self-determination in attaining choice, control and continuity of care from one or more known caregivers
• recognises every woman’s responsibility to make informed decisions for herself, her baby and her family with assistance, when requested, from health professionals
• is informed by scientific evidence, by collective and individual experience and by intuition
• aims to follow each woman across the interface between institutions and the community, through pregnancy, labour and birth and the postnatal period so all women remain connected to their social support systems; the focus is on the woman, not on the institutions or the professionals involved
• includes collaboration and consultation between health professionals.

She must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant. This care includes preventative measures, procurement of medical assistance and the execution of emergency measures in the absence of medical help. She has an important task in health counselling and education, not only for the woman, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynaecology, family planning and child care. She may practice in hospitals, clinics, health units, domiciliary conditions or in any other service.

(This definition was jointly developed by the International Confederation of Midwives and the International Federation of Gynaecology and Obstetrics and later adopted by the World Health Organisation)

Midwives around the world celebrate on May 5 each year

The International Confederation of Midwives (ICM) launched the ‘International Day of the Midwife’ initiative in 1992.

The aim of the day is to celebrate midwifery and to bring awareness of the importance of midwives’ work to as many people as possible. This is achieved in many different ways according to what works best in each country.

Midwife of the Year Award

JOHNSONS® baby Midwife of the Year Award was launched on International Midwives Day (IMD), May 5, in 2000 to raise the profile of midwives and increase public awareness of the important role midwives play in the care of women and their families before, during and after the birth of their babies.

Although the award is only in its infancy it has already been a wonderful success in lifting the mood, spirit and profile of midwives. This success has the capacity to make this event one that will be clearly recognised and anticipated annually for what it is – a celebration and acknowledgment of the vital role midwives play in our communities.

The JOHNSONS® baby Midwife of the Year Awards are appreciated by midwives and the Australian College of Midwives values Johnson & Johnsons efforts in giving new mothers across Australia the opportunity to say a big public “thank you” to their midwife. Most midwives love working with women and babies and they don’t expect or even want a public fuss about what they do. But it’s nice to be recognised as having made a difference to a woman’s life.

This is a fantastic idea and is a symbol of recognition to all midwives. It is lovely to see the profile of Midwives exposed and lifted. Being named Johnson’s baby Midwife of the Year was an extremely high point in my career.

Nominate a Midwife of the Year

Rewards

The Johnsons’® baby Midwife of the Year receives a weekend away including flights, two nights accommodation, all meals, a pampering session plus a gift basket of Neutrogena® skincare products.

The finalist in each state and territory receives a night on the town for two, including overnight accommodation and dinner at a luxury city hotel.

The people who nominate the above winners each receive gift packs of Johnson & Johnson products valued at $100 each.

Pre-conception check up
Your first step should be to take a trip, with your partner, to your doctor for a pre-conception visit. This will enable you to make sure that you are up to date with your regular health screenings and immunisations, to discuss any concerns about the pregnancy that you may have and to decide on any lifestyle changes that may need to be made. Your doctor will be able to get a good picture of your overall health and any aspects of your medical history and your family’s medical history that could affect your pregnancy. You should also be asked if you are taking any prescription or over-the-counter medications, as well as any herbs or supplements, as these may have to be altered before or after conception.

If you, as the prospective mother, have a pre-existing medical condition, such as diabetes, asthma, lupus or high blood pressure, it is important for both you and your baby to make sure that the condition is under control before you get pregnant. For instance, women with diabetes must ensure that they have excellent control of blood sugar levels around the time of conception as this reduces the chance of the baby having a congenital abnormality.

Contraceptive pill
If you are taking the contraceptive pill, but are planning to get pregnant in the near future, your doctor may recommend using a barrier method of contraception, such as a condom or a diaphragm, for a few months before trying to conceive. This will give your body the time it needs to re-establish your normal hormonal balance; it can take up to several months for your periods to return to a regular pattern.

Exercise
Get into the routine of doing some regular exercise: visit the gym, swim or go for long, brisk walks together with your partner. You will need to have a reasonable level of physical fitness to cope with the new demands that will be placed on your body during a pregnancy. If you are healthy, it should be safe for you to continue with your usual exercise programme when trying to conceive and into the early part of your pregnancy. If you are overweight, lose weight now, rather than after you become pregnant. Being overweight may reduce some women’s fertility.

Nutrition
It’s obvious that the food you will be eating when you are pregnant will be nourishing your growing baby, but recent research has shown just how crucial an adequate food supply is to your baby during its first few weeks of development — which means that you must establish healthy eating habits before getting pregnant. You should try to eat more vegetables, fruits, grains, dairy products and foods rich in protein, and fewer artificial sweeteners and ‘empty’ calories (foods and drinks that are high in calories but don’t contain useful nutrients).

Folate
Pregnant women need to increase their intake of dietary folate to cover their own needs and those of the baby. Folate is found in many fresh fruits and vegetables (especially green leafy vegetables such as broccoli and spinach), as well as nuts, chickpeas and dried beans. In addition to consuming food folate from a varied diet, it is also recommended that women begin taking a supplement of 0.4 mg per day of folic acid for one month before conceiving and during the first 3 months of pregnancy to reduce the risk of having a baby with a neural tube defect, such as spina bifida.

It is important to take folate while you are trying to get pregnant because the baby needs adequate amounts of folate in the first weeks of life — when you may not know you have conceived — for normal neurological development. If you are having trouble eating during the early stages of pregnancy due to morning sickness, your doctor may advise you to take a daily supplement containing 0.6 mg of folate.

Iodine
Keep your iodine levels up as well, as this will reduce the risk of thyroid disease in both you and your baby. Iodine is found in seafood, vegetables grown in iodine-rich soil, and iodised table salt. There is a risk of mental retardation in children born to women who are iodine deficient.

Multivitamin and mineral supplements
It can sometimes be difficult to eat a balanced diet when you are pregnant, especially if you have morning sickness. Look for supplements that are specifically designed for women who are pregnant or trying to conceive, with adequate amounts of all the things you need and without too much vitamin A, as this may harm the baby. Also, consult your pharmacist about whether the formula design is adequate. In 2006, the Australian National Health and Medical Research Council revised its recommended daily nutrient intakes for pregnant women, and older formulations may not have been updated.

Vitamin and mineral supplements can help you get:

the essential nutrients you and your baby will need, including adequate amounts of folate and iodine (as mentioned above) as well as iron;

nutrients that can help reduce the risk of problems (for example calcium may help reduce the risk of a serious pregnancy-related condition called pre-eclampsia); and

other nutrients that may help your health and the baby’s growth and development, such as omega-3 fatty acids.

Caffeine
Try to cut down on your caffeine intake as it is not certain what level of caffeine is considered safe during pregnancy. Some researchers have found a connection between high caffeine intake and miscarriage, stillbirth and low-weight birth in babies.

Alcohol
Most doctors also recommend that you totally avoid alcohol during a pregnancy because it is not possible to identify what level of drinking is safe for pregnant women. Prenatal exposure to alcohol can have serious long-term health consequences for your baby, including learning disabilities, mental retardation, behavioural problems and slower growth. The risk of stillbirth and miscarriage is also increased by excessive drinking. Additionally, alcohol can reduce the fertility of both males and females.

Smoking
Put simply, there is no safe level of smoking during pregnancy. The more you smoke, the more risks for you and your baby. Smokers are less fertile than non-smokers, and have a higher incidence of miscarriage and stillbirth. Smoking while pregnant interferes with the baby’s blood supply, which tends to result in low birth weight babies and babies with developmental problems. Babies born to mothers who smoke also have a greater chance of Sudden Infant Death Syndrome (SIDS). Your partner should also kick the habit: exposure to second-hand tobacco smoke can increase the risk of problems such as SIDS and having a low birth weight baby.

Rubella (German measles) vaccination
This viral illness can severely affected the baby if the mother contracts it while she is pregnant. Among other things, it can cause blindness and severe mental retardation. Fortunately, the disease can be prevented with a vaccine; unfortunately, the vaccine cannot be given if you are already pregnant. Most women will have been vaccinated as children or teenagers, however, their immunity may have waned by the time they are ready to start a family. Consequently, it is important to have a simple blood test before you become pregnant to find out whether you need a booster shot.

What’s healthy for you is often healthy for your baby. What’s harmful to you may harm your baby even more. Before and after you become pregnant:

• do not use recreational or illicit drugs;
• do not drink alcohol; and
• do not smoke.

Keeping you and your baby healthy

• Diet and exercise before and during pregnancy play a big role in your health. To help you and your baby remain healthy:
• take a daily vitamin supplement that contains folic acid (a vitamin that reduces the chance of some birth defects), calcium, iodine and iron, but does not have a high level of vitamin A (check with your doctor or pharmacist that the formulation is appropriate);
• eat a high fibre, well balanced diet rich in fruits and vegetables;
• stay physically active; and
• keep to a healthy bodyweight, but do not diet to lose weight during pregnancy.

Work closely with your doctor or obstetrician to get answers to the questions you may have. You may need extra care during pregnancy if you have any of the following:

• a sexually transmitted disease (STD);
• diabetes;
• high blood pressure; or
• other chronic health problems (illnesses requiring long term treatment), especially heart or lung disease.

Special health care
Your doctor or obstetrician can give you more details about the care you will need. Women aged 35 years and older may need special care before and during pregnancy. You may want to learn more about the following issues.

Fertility counselling

As women and men age, their fertility decreases and getting pregnant can become difficult for women. Ask your doctor how long you should try to get pregnant before seeking help regarding infertility. If necessary, you and your partner can work with a specialist towards achieving conception.

Genetic counselling

Genetic counselling studies the risk of birth defects for your baby. As you get older, the risk of having a baby with a chromosomal abnormality gradually increases. You should ask your doctor for details. You will be asked detailed questions about your family health history. The information gained can help you and your doctor learn whether the fetus has a risk of health problems.

Amniocentesis

This test studies amniotic fluid (liquid that surrounds the fetus in the womb). Amniocentesis can help diagnose birth defects and other medical problems. Women aged 35 years and older often have this test, which is usually done at about 15 weeks.

Chorionic villus sampling

This test studies cells from the placenta, and can help diagnose birth defects and other medical problems. Women aged 35 years and older often have this test, which can be done as early as 10 to 12 weeks.

Other things to consider

Most women aged 35 years or older have normal pregnancies, but there are some particular things you need to think about before becoming pregnant. Once a woman reaches 35 years she has a greater chance of the following:

• having fertility problems;
• having a miscarriage or fetal loss in the second or third trimesters;
• developing diabetes or high blood pressure while pregnant;
• being constantly tired when pregnant;
• giving birth by Caesarean section (surgery needed to deliver a baby);
• having babies with chromosomal problems such as Down syndrome; or
• having multiple births.

This is a great time for you to become a mum, with many women over 35 years having first babies. By working with your doctor and obstetrician and getting regular antenatal care, you will help to ensure a healthy and rewarding pregnancy.

Good nutrition during pregnancy will help to keep a developing baby and its mother healthy. The need for certain nutrients such as calcium, iron and folate is increased at this time but only a small amount of extra energy (kilojoules) is needed. Women should be encouraged to eat to their appetite and monitor their weight. A normal weight gain is around 10-13kg for women who are a healthy pre-conception weight.

Healthy foods for pregnant women
It is important to choose a wide variety of foods to ensure the nutritional needs of both mother and baby are met. Try to eat:

Lots of fruit and vegetables, wholegrain breads and cereals

Moderate amounts of low fat dairy foods and lean meats

Small amounts of foods high in fat, sugar and salt

Lean meat, chicken and fish

Dried beans and lentils

Nuts and seeds

Low fat milk, cheese and yoghurt

Green leafy vegetables.

Folate supplements
As well as a healthy diet, it is also recommended that a folate supplement be taken prior to conception and for the first three months of pregnancy to help reduce the risk of neural tube defects such as spina bifida.

Anaemia and iron intake
Pregnancy increases the need for iron in the diet. The developing foetus draws enough iron from the mother to last it through the first five or six months after birth so a woman has an increased need for iron during pregnancy.

Iron losses are reduced during pregnancy because women are no longer menstruating and so are able to absorb more iron from the gut during pregnancy. It is useful to include foods that are good sources of iron in the diet every day (for example red meat) and to have foods that are good sources of vitamin C (like oranges) to help absorb the iron.

Recommended daily iron intake
The recommended daily intake (RDI) of iron during pregnancy is 22-36mg (10-20mg more than that for non-pregnant women). The amount needed depends on the amount of iron the mother has ‘stored’ in her body prior to pregnancy. If a woman’s iron stores are very low, she may need to get more from supplements. However, iron supplements can cause constipation.

Calcium
The RDI of calcium during pregnancy is 1,100mg per day (300mg per day more than for non-pregnant women). During the third trimester of pregnancy, there is a large shift of calcium to the baby as it starts to develop and strengthen its bones. If the mother isn’t getting enough calcium in her diet, the calcium needed by the developing baby is drawn from the mother’s bones.

Most women rapidly replace this bone loss once the baby has stopped breastfeeding. The woman should make sure she has enough calcium in her diet during pregnancy, as this should protect her bone mass while also meeting the needs of the foetus.

Dairy foods, such as milk, cheese and yoghurt, and calcium fortified soy milk are excellent sources of calcium.

Folate and neural tube defects
All women who are capable of getting pregnant, who are planning a pregnancy or who are in the early stages of pregnancy should increase their folate intake to 0.4-0.5mg per day.

Folate (also known as folic acid) is a B-group vitamin found in a variety of foods listed in the table below. Some breakfast cereals have been fortified with folate and this will be listed on the labels.

If the woman does not consume enough folate during pregnancy, the baby may develop neural tube defects such as spina bifida. Folate taken before conception and during the first few weeks of pregnancy can prevent seven out of 10 cases of neural tube defects.

Folate in your diet
Excellent food sources of folate include:

Asparagus

Bran flakes

Broccoli

Brussels sprouts

Chick peas

Dried beans

Lentils

Spinach.

Very good food sources of folate include:

Cabbage

Cauliflower

Leeks

Oranges

Orange juice

Parsley

Peas

Wheat germ

Wholegrain bread.

Good food sources of folate include:

Hazelnuts

Vegemite

Parsnips

Potato

Salmon

Strawberries

Tomato

Unsalted peanuts

Walnuts.

Although liver is high in folate, it should not be recommended to women who are, or could be pregnant, because of its high vitamin A content. There is also a risk of listeriosis from raw or undercooked liver, for example pate. Both are a risk to the developing foetus.

Vitamin A
Although vitamin A requirements do increase during pregnancy, vitamin A supplements are rarely recommended for pregnant women. This is because they may cause birth deformities.

The best way to increase your intake of vitamin A, if it is low, is through food sources like milk, fish, eggs and margarine. Liver has too much vitamin A in it and this has been associated with birth defects so liver should be avoided during pregnancy.

Vitamin D
Vitamin D is essential to help absorb calcium from the gut. Margarine, cheese, fatty fish and eggs all contain vitamin D.

Vitamin supplements
Multivitamin and calcium supplements may be recommended for the following pregnant women: vegetarians, teenagers who may have an inadequate food intake, substance abusers (of drugs, tobacco and alcohol) and obese pregnant women who are restricting their energy intake to prevent large weight gains.

Eating for two
There is no need to eat more food during pregnancy. Experts recommend that, for the first trimester, a woman’s kilojoule intake should remain about the same as it was prior to the pregnancy. During the second and third trimesters, the kilojoule intake could increase by about 10 per cent or so, which is about an extra 600kJ a day. But remember, it is the nutritional quality of the diet not the kilojoule intake that is important.

The dangers of dieting
Some women fear the extra weight gain of pregnancy and decide to eat sparingly to avoid putting on body fat. Restricted eating or crash dieting in any form can seriously compromise a woman’s health and that of her baby.

Pregnancy in adolescence
Pregnant adolescents need more nutrients than adult women, because they are still growing. Adolescents may give birth to smaller infants because they are competing with the growing foetus for nutrients.

Anaemia is more common among adolescents than older women. Calcium intake is also important because young women have not yet reached their peak bone mass and inadequate calcium intake may increase the risk of osteoporosis developing later in life.

Nausea and vomiting
Nausea and vomiting, especially ‘morning sickness’ are common during pregnancy, particularly in the first trimester. Small carbohydrate snacks (a sandwich or fruit) every two to three hours may provide some relief. The following suggestions may also help:

Eat some dry bread, biscuits or cereal before getting up in the morning. Get up slowly, avoiding sudden movements.

Drink liquids between rather than with meals to avoid bloating which can trigger vomiting.

Avoid large meals and greasy, highly spiced foods.

Suck something sour like a lemon.

Relax, rest and get into the fresh air as much as possible. Keep rooms well ventilated and odour free.

Slowly sip a fizzy drink when feeling nauseated.

Try food and drinks containing ginger as these sometimes relieve nausea.

Heartburn
Heartburn is common in pregnancy because as the baby grows there is more pressure on the abdomen. Small, frequent meals may be better than large meals. Try to avoid:

Eating late at night

Bending, lifting or lying down after meals

Excessive consumption of tea, coffee or alcohol.

You may also like to try sleeping with your bed head raised a few inches. You can do this by putting a folded blanket or pillow under your mattress.

Alcohol during pregnancy
There is general agreement that women should not drink alcohol excessively during pregnancy. Excessive drinking in pregnancy increases the risk of miscarriage, low birth weight, congenital deformities and effects on the baby’s intelligence. However, there is not enough evidence to identify what is a safe amount to drink during pregnancy.

The Australian Alcohol Guidelines recommend that women who are pregnant or considering pregnancy should never become ‘drunk’, may like to consider not drinking at all or, if they choose to drink, have less than seven standard drinks in a week and no more than two standard drinks on any one day.

Listeria infection
The bacteria Listeria monocytogenes can contaminate some foods. Healthy people may experience no ill-effects at all, but the risks are substantial for pregnant women. The greatest danger is to the unborn baby, with increased risk of miscarriage, stillbirth or premature labour. A listeria infection is easily treated with antibiotics, but prevention is the best. Some foods are more prone to contamination than others; exclude these foods from your diet if you are pregnant:

Precooked or ready prepared cold foods that will not be reheated- for example, pre-prepared bought salads, pate, quiches, delicatessen meats like ham and salami

Unpasteurised foods

Soft serve icecream

Soft cheeses, such as Brie and Camembert.

The organism that causes listeria is destroyed by heat, so properly cooked foods are not a risk.

Salmonella
Salmonella is a cause of food poisoning that can trigger miscarriage. The most likely sources of salmonella are raw eggs and undercooked poultry. Good food hygiene is the best way to reduce risk of salmonella and listeria infections. Suggestions include:

Always wash your hands before and after preparing food.

Keep your kitchen surfaces clean.

Do not let uncooked food contaminate cooked food.

Wash fruit, vegetables and salad before eating.

Cook food thoroughly.

Keep pets away from kitchen surfaces.

Wear rubber gloves when handling cat litter trays or gardening.

Store food at correct temperatures.

Mercury in fish
The Australian Dietary Guidelines advise eating one or two meals with fish every week for good health. Pregnant women can safely eat one or two meals of fish each week but they should choose the type of fish carefully.

There are a few types of fish that need to be limited because they contain high levels of mercury, which is dangerous for the developing foetus.

Pregnant women should:

Avoid fish with high levels of mercury – these are billfish (swordfish, broadbill and marlin), shark (flake), orange roughy (sea perch), gemfish, southern blue fin tuna and catfish.

Limit other fish, such as tuna steaks, to one portion per week or two 140g cans of tuna per week (smaller tuna contain less mercury).

There is no restriction needed on the amount of salmon, including canned salmon, which is eaten.

Women should not be worried if they’ve had the odd meal of fish with high levels of mercury. It is only a potential problem when that type of fish is eaten regularly, which causes a build-up of mercury in the mother’s blood.

Where to get help

Your doctor

Midwife

Obstetrician

Dietitian.

Things to remember

A pregnant woman needs to boost her nutrient intake, rather than her intake of kilojoules.

Pregnancy creates extra demands for certain nutrients including iron, calcium and folate.

Good food hygiene is particularly important during pregnancy.

You may need to modify your existing exercise program or choose a suitable new exercise program if you were sedentary before conceiving. Suggestions for exercise during pregnancy include walking, swimming and supervised classes such as yoga or tai chi. Pelvic floor exercises are also important before, during and after pregnancy.

Always consult your doctor, physiotherapist or health care professional to make sure your exercise routine won’t harm you or your unborn baby.

If you have high blood pressure, multiple foetuses, increased risk of premature labour, pre-eclampsia or heart disease, you should seek advice from your doctor. You may be advised to limit or avoid physical activity.

Benefits of physical activity during pregnancy
Some of the benefits of exercising regularly throughout your pregnancy include:

Resistance to fatigue.

Stronger back muscles, which can help manage back pain and strain as your belly grows.

Improved posture.

Smaller gain of body fat.

Stress relief.

Improved sleep and management of insomnia.

Preparation for the physical demands of labour.

Faster recuperation after labour.

Faster return to pre-pregnancy fitness and healthy weight.

Increased ability to cope with physical demands of motherhood.

The bodily changes associated with pregnancy
Pregnancy affects the way your body responds to exercise, including:

Hormones such as relaxin soften ligaments, which could increase your risk of joint injuries (for example, sprains).

Your growing belly will push your centre of gravity forwards, affecting your balance.

The average weight gain during pregnancy is 10 kg to 15 kg. This extra weight puts greater strain on your joints and muscles.

Pregnancy boosts your resting heart rate, so pre-pregnancy heart rate targets during exercise are no longer reliable.

Your blood pressure drops in the second trimester, so it is important to avoid activities that involve fast changes of position.

Your growing baby needs oxygen, so never exercise to the point of breathlessness.

Suggested activities
Activities and exercises that are recommended for pregnant women include:

Exercise in water (aquarobics)

Walking

Swimming

Yoga

Stretching

Dancing

Pilates

Cycling on a stationary bicycle

Pregnancy exercise classes.

General exercise suggestions
Be guided by your doctor, physiotherapist or health care professional, but general suggestions include:

Aim for four exercise sessions per week.

Don’t try to exercise too far beyond your current fitness level.

Warm up thoroughly for at least 10 minutes.

Exercise on soft surfaces, such as grass or carpet.

Maintain a moderate intensity – a general rule of thumb is to keep your heart rate below 140 beats per minute.

If exercising in water, keep your heart rate below 125 beats per minute.

Do no more than 20 minutes of vigorous activity per exercise session, and keep an eye on your heart rate.

Rest frequently, especially if you are feeling breathless.

Don’t hold your breath – as a rule, breathe out through the movements that need the most effort.

Change positions carefully and slowly.

Drink plenty of water before, during and after exercise.

Cool down thoroughly for at least 10 minutes.

Include gentle stretching in your exercise program – aim for slow, sustained stretches and avoid ‘bouncing’.

Monitor your body temperature – if you are feeling too hot slow down your activity and take in some water.

Wear multiple layers of clothing that you can remove, rather than one bulky layer. Choose natural fibres such as cotton.

Wear a supportive bra.

Have at least two rest days every week.

Exercises to avoid
Exercises to avoid during pregnancy include:

Outdoor cycling, rollerblading or vigorous stretching.

Contact sports, trampolining or activities that carry a risk of falling.

Competition sports, depending on the stage of pregnancy, the level of competition and your level of fitness.

After about the fourth month of pregnancy, avoid exercises that involve lying on your back. The weight of your baby can compress your main artery. This will lower your blood pressure and make you feel dizzy and light-headed.

In the later stages of pregnancy, activities that involve jolting or jarring the body, such as running and jumping, or that demand rapid changes of direction.

The level of exertion will depend on your level of fitness but even fit athletes should only exercise at moderate levels of intensity.

General cautions
Be guided by your doctor or physiotherapist, but general cautions include:

Avoid raising your body temperature too high – for example, don’t soak in hot spas or exercise to the point of heavy sweating.

Reduce your level of exercise on hot or humid days.

If weight training, choose low weights and medium to high repetitions – avoid lifting heavy weights altogether.

Don’t exercise if you are ill or feverish.

If you don’t feel like exercising on a particular day – then don’t! It is important to listen to your body to avoid unnecessarily depleting your energy reserves.

Pelvic floor exercises
The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, and support the bladder, uterus, vagina and bowel. Weak pelvic floor muscles can’t adequately support these organs, and could cause problems including incontinence and prolapsed uterus.

The weight of the growing baby puts excessive strain on the pelvic floor muscles, but you can perform simple exercises to help avoid future problems. Urethral muscles are those that stop urine in mid-flow, and the anal sphincter is responsible for ‘holding on’ when you need to pass a bowel motion. You can feel the muscles around your vagina by inserting a finger and squeezing or practice stopping your urine mid-flow.

Exercises to strengthen the pelvic floor include:

Squeeze your muscles slowly and hold for up to 10 seconds. Repeat 10 times.

Perform quick, strong squeezes. Repeat 10 times.

Squeeze the muscles whenever you sneeze, cough or clear your throat.

Abdominal exercises
Strong abdominal muscles support your spine. It is important to keep your abdominal muscles strong, particularly during the third trimester when the size and weight of your baby are rapidly increasing. Suggestions include:

Concentrate on drawing your belly button towards your spine.

Breathe out while pulling in your belly.

Hold the position and count to 10. Relax, and breathe in.

Repeat 10 times, as many times per day as you are capable.

You can perform this exercise sitting, standing, or on your hands and knees.

Consider doing your abdominal exercises and pelvic floor exercises at the same time.

Avoid conventional ‘crunches’ or sit-ups that involve lying on your back and drawing your ribcage and pelvis together.

Warning signs
If you experience any of the following during or after physical activity, stop exercising immediately and see your doctor:

Headache

Dizziness

Heart palpitations

Chest pain

Swelling of the face, hands or feet

Calf pain or swelling

Vaginal bleeding

Contractions

Deep back or pubic pain

Cramping in the lower abdomen

Walking difficulties

An unusual change in your baby’s movements

Amniotic fluid leakage.

Deciding against exercise
You may decide against exercise during your pregnancy. Perhaps you are experiencing severe and sustained morning sickness or you may have other problems (such as heart disease, hypertension, anaemia, pre-eclampsia or increased risk of premature labour) that prevent you from being physically active.

Consult with your doctor or health care professional for suggestions on how to keep yourself and your baby healthy.

Where to get help

Your doctor

Physiotherapist

National Continence Helpline Tel. 1800 330 066

Things to remember

Consult with your doctor, physiotherapist or health care professional to make sure your exercise routine won’t cause harm to you or your unborn baby.

If you don’t feel like exercising on a particular day – then don’t! It is important to listen to your body to avoid depleting your energy reserves.

If you have hypertension, multiple foetuses, increased risk of premature labour, pre-eclampsia or heart disease, it may be best to avoid exercise.

A cut-off point of 1 in 250 is usually used. If your risk is less than that, you will be described as ‘screen negative’ which means that you are extremely unlikely to be carrying a baby with Down’s (but it’s not impossible). The tests will detect many pregnancies affected by Down’s syndrome, but they will also identify some pregnancies as being at risk of Down’s syndrome when, in fact, they are not — these are known as ‘false-positives’. 
First trimester screening
From 11 to 14 weeks of pregnancy, a special ultrasound scan called a nuchal translucency (NT) test can be performed. This measures the fluid under the skin at the back of the baby’s neck and can be used to determine your risk of having a baby with Down’s syndrome.

There is also a blood test which you can have either in combination with the NT scan (the Combined Test) or on its own. The blood test measures:

- hCG (human chorionic gonadotrophin)
- PAPP-A (pregnancy associated plasma protein).

A woman who is carrying a baby with Down’s syndrome will have abnormal levels of these two substances in her blood.

There is a lot of dispute about how good these tests are, but they do seem to be pretty accurate. The NT scan alone probably picks up about 75 per cent of babies with Down’s syndrome, and the blood test alone, about 60 per cent. If you put the two tests together, the detection rate can be as high as 90 per cent. However, the accuracy of the NT scan depends on many factors, including how good the sonographer is and how good the scanner is that she’s using.

Advantages of first trimester screening

• Good detection rates.

• You have time to think about what you want to do next if you are found to be at high risk for Down’s. Your options include doing nothing or having a diagnostic test, such as CVS or amniocentesis, to tell you for certain if your baby has Down’s.

• If you have a diagnostic test soon after your screening test, and you choose to end the pregnancy, you may be able to have a suction termination. This is less complicated than a medical termination (one that uses drugs to stimulate a mini-labour), and can only be used up to 12 or 14 weeks of pregnancy.

Disadvantages of first trimester screening

• NT scans are not available everywhere because sonographers have to be specially trained to do them and the scanning procedure takes quite a long time.

• There is a nationwide shortage of sonographers.

• The combined NT and blood test is only available privately because of the cost of the machine used to analyse the blood.
Second trimester screening
This is based on blood tests which are carried out between 15 and 20 weeks of pregnancy. The tests measure various ‘markers’ in your blood:

- hCG (human chorionic gonadotrophin)
- AFP (alpha fetoprotein)
- uE3 (oestriol)
- Inhibin A.

If you are carrying a baby with Down’s syndrome, you will have higher levels of hCG and inhibin A, and lower levels of AFP and uE3 in your blood.

There are several variations of this test available:

- The Double Test: measures two markers, hCG and AFP
- The Triple Test: measures three markers, hCG, AFP and uE3
- The Quadruple Test: measures four markers, hCG, AFP, uE3 and inhibin A.

Advantages of second trimester screening
- Blood samples are (usually!) easy to take
- Most laboratories can analyse bloods.

Disadvantages of second trimester screening
- They aren’t as good at detecting babies with Down’s syndrome as first trimester tests. The double test detects about 59 per cent and the quadruple, about 75 per cent. Blood tests are more accurate in older women (because older women are more likely to have babies with Down’s syndrome).
- By the time you get the results, you will be well into your pregnancy. If your risk is high, you have to decide whether to have an amniocentesis to confirm that your baby has Down’s. If he does, you have to decide whether to have a termination. A termination may be more traumatic at this stage of pregnancy.
Combined first and second trimester screening
The Serum Integrated Test combines a blood test for PAPP-A in the first trimester with a further blood test for hCG, AFP, uE3 and inhibin A in the second trimester.

The Integrated Test combines nuchal translucency scanning and a blood test for PAPP-A in the first trimester with a further blood test for hCG, AFP, uE3 and inhibin A in the second. It has a detection rate of about 94 per cent for Down’s syndrome.

These are very high quality tests, but are currently only available privately. They measure a whole series of indicators, but the results won’t be available to you until the second trimester. 
Which tests can I have?
Well, that’s currently a bit of a lottery, depending on where in the country you live. The first trimester NT scan, with or without the blood test, is not available at all hospitals. You may also have to pay privately for the Integrated Test, which is the best one currently available. Many hospitals offer only second trimester screening, and some only the Double Test which has quite a low detection rate for Down’s. Other hospitals offer just the Triple Test. In a few places, you may be offered no screening tests at all. Or, if you are over the age of 35, you may be offered an amniocentesis straight away.

In order to try to make screening services fairer, national screening guidelines have now been produced.
What are the national guidelines?
In 2003 the National Institute for Clinical Excellence (NICE) published an important set of guidelines called Antenatal care: routine care for the healthy pregnant woman. These include new guidelines and targets for screening for Down’s syndrome.

In future, NICE would like all women to be offered screening for Down’s with a test that has a 60 per cent detection rate or more, and a false positive rate of less that five per cent. This would reduce the number of women who go on to have a CVS or an amniocentesis unnecessarily.

Here’s what you should be offered (although this certainly isn’t available on the NHS in all areas yet):

Between 11 and 14 weeks:
• Nuchal translucency (NT) ultrasound scan, or
• The combined test (NT scan plus a blood test).

If your hospital can’t provide these tests, you should be offered a blood test later in your pregnancy:

Between 14 and 20 weeks:
• The Triple Test: a blood test to measure hCG, alpha-feto protein and uE3, or
• The Quadruple Test: a blood test to measure all of the above, plus inhibin A.

Some hospitals may offer the Integrated Test or the Serum Integrated Test, instead (see Combined first and second trimester screening, above).
What does all this mean for me?
NICE has said that pregnant women must now be given information about any screening or diagnostic tests that they are offered. You should have the chance to talk to a midwife, doctor or screening counsellor and to ask as many questions as you want until you are clear in your mind about what the tests can and can’t tell you. You can decide not to have any tests at all, to have one test rather than another, or to have a screening test, but not a diagnostic test. Don’t feel rushed into tests — talk to your midwife at the earliest opportunity and then go away and think about what you want to do. Take your time and have the tests that are right for you.

Unlike other pregnancy tests such as ultrasound, CVS isn’t a general check of the baby’s health but a specific test for particular abnormalities, such as Down syndrome or cystic fibrosis. The risk of miscarriage following CVS is one in 100, so it is important to thoroughly understand the benefits, risks and complications before agreeing to take the test. Generally, CVS is offered between 10 and 19 weeks gestation.

A range of potential patients
The range of patients offered chorionic villus sampling could include women:

With a family history of an inherited disorder, either on her side of the family or on her partner’s side.

Over 37 years, since the babies of older mothers are at increased risk of abnormalities.

Who have already had a baby with chromosomal or other abnormalities.

Whose ultrasound test results showed a possible abnormality.

Who are particularly anxious about the possibility of abnormalities.

Medical issues to consider
Medical issues to consider may include:

CVS doesn’t check for spina bifida.

The risk of miscarriage following chorionic villus sampling is around one in 100.

Genetic counselling can help you decide whether or not you want to take the test. Issues discussed include the benefits, risks and complications of CVS, and information about the particular inherited disorder and associated birth defects.

If you decide to undergo CVS, your doctor will need to know your blood group and Rh status, so you may require a blood test beforehand.

The procedure
The CVS procedure includes:

You need to have a moderately full bladder.

You are dressed in a cotton hospital gown, and asked to lie on an examination table on your back. Sedative drugs such as nitrous oxide are available if you wish.

Your baby is checked first via ultrasound scan.

Your abdomen is swabbed with antiseptic solution.

The site is injected with local anaesthetic.

A slender needle, guided by ultrasound, is inserted through your abdomen wall until it reaches the edge of the placenta. The needle is nowhere near the amniotic sac or the baby at any stage.

A finer needle is threaded through the first needle, and a syringe is used to “vacuum” a small sample of placental tissue. This takes about two minutes or so.

You may feel a strange dragging or drawing sensation in your pelvis or legs – this is normal, and no cause for alarm.

It may be necessary to take a second sample.

Once the sample is taken, the needles are removed.

The baby is checked using the ultrasound scan.

You are then free to get dressed.

Generally, you can expect to be at the clinic for up to 90 minutes.

Immediately after the test
You may be asked to wait half an hour or so before leaving the clinic, just to make sure that both you and your baby are all right. It may be best if someone else drives you home, especially if you were given drugs during the test. The placental sample is sent to a laboratory and cultured. When enough cells have grown, the chromosomes are individually tested to make sure the number, appearance and size are correct. The results are usually sent to your doctor within a few weeks, so make sure you arrange for a follow-up appointment.

Possible complications
Some of the side effects, risks and possible complications of CVS include:

Light-headedness

Abdominal discomfort

Pains that feel similar to menstrual cramps

Haemorrhage

Infection

Ruptured amniotic sac

Miscarriage, estimated at one in 100

Increased risk of limb defects if the test was performed at nine weeks gestation or earlier

Inaccurate or unclear test results, estimated at one per cent.

Taking care of yourself at home
Be guided by your doctor, but general suggestions include:

Get plenty of rest for the remainder of the day.

Avoid hard physical activity, such as lifting heavy objects.

You should be able to go about your normal business in the next day or so.

See your doctor immediately if you notice any unusual vaginal discharge, such as bright red blood or watery fluid.

Long term outlook
If CVS shows that your baby has an abnormality, you can undergo counselling if you need help to make a decision. Terminating the pregnancy in the first trimester involves a straightforward dilatation and curette (D&C). The cervix is dilated and the contents of the uterus removed.

Other types of pregnancy tests
Other types of pregnancy tests that check for foetal genetic abnormalities include:

Vaginal CVS – a small needle is pushed through the cervix and into the side of the placenta, guided by ultrasound. Vaginal CVS carries a slightly higher risk of complications than transabdominal CVS.

Amniocentesis – a small amount of amniotic fluid is removed using a slender needle inserted through the abdomen. The needle is guided with the help of ultrasound. The fluid sample contains cells, which are then examined for chromosomal abnormalities. The risk of miscarriage following amniocentesis is around one in 250. Amniocentesis may be offered if your CVS test results were unclear.

Where to get help

Your doctor

Things to remember

Chorionic villus sampling (CVS) is a pregnancy test that checks the baby for genetic or biochemical abnormalities.

A small sample of the placenta is taken using a slender needle inserted through the abdomen, and the sample is then examined in a laboratory.

The risk of miscarriage following CVS is one in 100.