Pregnancy

This page:

• your rights
• decision making–use your B.R.A.I.N.
• pregnancy diagnosis
• scans in pregnancy
• screening
  • blood tests
  • chromosomal
• support
• pregnancy discomforts

Your rights

Did you know that whenever you receive health care, your rights are protected? Know your rights: check out the Health & Disability Commissioner Code of Consumer Rights. Here’s the short version, and the long version is available from there too. If you believe that your rights have not been upheld by a health professional who has been involved in your care, you can make a complaint. In the first instance, if you can, you should talk to the person directly. If you feel that you can’t do that, you can talk to the Health & Disability Commissioner, or, if the health practitioner is a midwife, a useful starting place is the New Zealand College of Midwives’ Resolutions Committee, who will help you decide what steps to take.

Decision making: use your B.R.A.I.n.

At various stages of the maternity journey, there are lots and lots of diagnostic and screening tests which are offered. Just because they are offered, it doesn’t mean you have to have them. So how do you decide what’s right for you and what’s not? You can use your B.R.A.I.N.! Ask: what are the Benefits, Risks, and Alternatives for this?  What does my Intuition have to say? And what would happen if I choose to do Nothing?

Pregnancy “diagnosis”

There are many ways in which people can tell if a baby is on board which don’t necessitate 1) technology and 2) someone else’s say-so. When I was pregnant for the first time, even though we did a pregnancy test which we bought from a pharmacy, I didn’t trust myself or the “un-official” test, so only considered I was actually pregnant when I heard it from my doctor. Even though I had missed my very regular period and had tender nipples, that wasn’t enough for me to trust at that time. Now I know that there are many ways that women know they are pregnant, and it doesn’t require a “professional” to make it real!

Having said all that, I do carry pregnancy tests and you are welcome to use one if you wish. This doesn’t obligate you to have me as your midwife. Please don’t spend money on tests when you can get them for free!

A fun exercise would be to consider such a decision–to test or not to test–using your B.R.A.I.N….

Scans in pregnancy

Today there is an expectation that scans are a normal part of pregnancy. Of course, this was not always the way. One woman I met suggested that “if we are meant to see inside, there would be a window in my belly”. While we tend to take the safety of commonly-used technology as a given, scientific evidence does not always back this up. Here is some food for thought from Beverly Beech about ultrasounds in pregnancy. Also consider the Women’s Health Action information resource for parents, and, for those wanting a deeper dive, Jim West’s book 50 human studies, in utero, conducted in Modern China, indicate extreme risk for prenatal ultrasound: A new bibliography. As a midwife, I prefer to err on the side of caution, and for this reason I offer to use a Pinards instead of a doppler for listening to your baby’s heart sounds, and I do not routinely offer dating scan referrals (that is, there needs to be a good reason).

Screening

While there are many screenings offered in pregnancy, “offer” is the operative word. Routinely offered screening includes: blood tests, pre-eclampsia screening, chromosomal screening for things like Down syndrome, and gestational diabetes mellitus (GDM) screening. I will offer to have a copy sent to you if you wish.

Routine blood testing is offered 1) at the first antenatal visit, 2) at around 28 weeks, and 3) at around 36 weeks. The following tests can tell us:

• full blood count, including
  • haemaglobin (Hb): holds your useable iron. Low levels at birth are associate with increased chance of haemorrhage–heavy bleeding–and babies are born anaemic. Iron carries the oxygen around the body and is vital for good health;
  • the size and number of haemaglobin–the bigger haemoglobin is, the more oxygen it can carry, and, of course if there are plenty of them, all the better;
  • white blood cell counts–these can be raised when the body is unwell, such as a urinary infection or a cold;
• blood type
• antibody testing for
  • syphillis
  • herpes
  • rubella (a.k.a. German measles)
• optional:
  • HIV–human immuno-deficiency virus. This is an optional extra in the 1st trimester screening;
  • HbA1c–glycated haemaglobin, which gives an has an association with glucose levels in the blood over the last three months and, if raised, is an indicator of diabetes (more on that later). It is not considered accurate later than the first trimester as there is little research about what levels of HbA1c are “normal” as the pregnancy progresses.

Other blood tests may be offered at other times, when there is an indication. Examples include:

• hCG (human chorionic gonadotrophin–that’s a mouthful), if you are unsure of dates and want to have a dating scan or there are signs of potential miscarriage;
• vitamin D levels if you have a history of, or are at high risk of, deficiency;
• liver function tests (LFTs) if you develop symptoms of pre-eclampsia, or severe itching–a sign of cholestasis.

Chromosomal abnormality screening information is provided by the Ministry of Health/Te Whatu Ora here. If you wish to, you can also access NIPS testing, which is less invasive as it is only a blood test, it is diagnostic, with false positive/negative rates of almost zero, and it does not require further testing. However, this costs a lot of money–currently the price is $713.55. Some people choose to do this instead of the MoH/TWO screening mentioned above, and others opt to do the screening and, if the results of that screening indicate that there is an increased chance of abnormality, they can then do this test or continue with the funded diagnostic testing. 

NB: I am in the process of updating this section, please be patient while I find resources relevant to Westland to add here.

There are lots of support in the community and online, but how to find the right support at the right time? Here are a few which might be useful:

In Westland

• Birth Pool hire – West Coast Home Birth
• Breastfeeding support – La Leche League. It’s a great idea to get lots of breastfeeding education before your baby arrives, especially if you never get to see breastfeeding in your usual social circles. Would you expect to easily learn to ride a bike if you had never seen someone else do it?
• Pregnancy Help
• Car seat hire – Plunket or Baby Factory. Child restraint technicians are all around the regions. They can check an existing car seat and advise you what you need to comply with current laws.
• Social support
• Teen and young mother support.
• Green prescription: Ask your doctor.

New Zealand Nationally

• Home birth Aotearoa
• Perinatal Anxiety & Depression Aotearoa

Antenatal Education resources

Prior to my second birth, I learned about a resource called “The Pink Kit”, and met Wintergreen, the kit’s developer. It is now under a different brand name and you can find it under the name of “Birthing Better“. I have organised training workshops with one of the local proponents of this resource, to educate myself, colleagues and couples on how to implement this knowledge into birthing spaces. These workshops will be held on November 15th and 16th 2024. Please drop me a note if you would like more information.

Plunket also run antenatal classes locally.

EXERCISE

In pregnancy, it is important to keep using your body. Exercise can help regulate blood sugar levels and preventing gestation diabetes mellitus (GDM), and helps in maintaining great health for the work ahead of birthing and caring for your baby. Whatever exercise you do before pregnancy can be generally maintained for as long as you feel comfortable. If you want to join an exercise class, this one has a pregnancy specific class you can attend.

Pregnancy discomforts

As ligaments and joints soften in preparation for birthing, it is common for pregnant women to experience discomfort, as the extra weight of the baby-filled belly puts pressure on the hips. Belly binding may be helpful to support the body and help with the daily task of getting around. Pregnancy yoga stretches can also be useful for this.

Changes to connective tissue like ligaments and joints, as well as simply having less room in the abdomen, can also lead to reflux symptoms. While it is tempting to rely on over-the-counter or prescribed medications to soothe symptoms, long term this can lead to worse problems, like ulceration and impaired digestion. Ways you can minimise the occurrence of reflux are: 1) leave lots of time between eating dinner and going to bed. This may require eating earlier in the evening (rather than going to bed later!), and avoiding snacks after dinner; 2) You may consider eating your main meal in the middle of the day, rather than at the end of the day. Believe it or not, this used to be the cultural norm; 3) try to go to sleep on your left side. This means that the inlet of your stomach will be “upways” rather than sideways or “downways”. Cushions and pillows can help with side-lying. In a study out of Auckland University on late stillborn babies, the incidence was higher where mamas slept on their backs, less high on their right, and lowest on their left. While exactly why this is the case is not demonstrated in the study, we do know that the weight of the womb on the major arteries running down the back can decrease blood flow to baby.

Carpel tunnel syndrome also sometimes temporarily develops or worsens in pregnancy. For further information and some suggestions for natural remedies which may help, check out this website.