Spots of blood are collected from all babies at birth by midwives. The baby’s heel is pricked and small drops of blood are squeezed out and dabbed onto a special card. This is called the Guthrie test. The card is then sent away to check for certain rare abnormalities. These are:

• phenylketonuria (PKU),

• congenital hypothyroidism,

• sickle cell disorders, and

• cystic fibrosis (CF).

 

Families are advised immediately if any of the tests return a positive result.

Folic acid (vitamin B9) is very important to the healthy development of a foetus. It can reduce the risk of neural tube defects such as spina bifida. The Department of Health recommends that all women take a daily supplement of 0.4mg of folic acid before they conceive and for the first twelve weeks of pregnancy while the baby’s spine develops.

Several conditions either increase the need for folate or increase the risk of folic acid deficiency. They include those being treated by anti-convulsant medication, patients on kidney dialysis, or those with conditions such as liver disease, malabsorption or certain types of anemia.

You can get folic acid tablets from pharmacies, large supermarkets, health food stores and on prescription. Dietary sources of folic acid include green leafy vegetables, breakfast cereals and bread. Check with your doctor first if you are receiving treatment for any condition (such as epilepsy) that may not be compatible with folic acid supplementation.

There are many ways of relieving pain in labour. Some involve using your body’s own coping mechanisms, such as breathing and relaxation, to encourage the production of substances called endorphins. These are the body’s natural painkillers, and are released in response to pain.

Relaxation can be encouraged using the warmth and buoyancy of water in a bath or birthing pool, complementary therapies such as aromatherapy or homeopathy, effective breathing techniques, massage, and visualisation (focusing on a series of pictures or calming thoughts during contractions).

Other methods use drugs to stop or reduce the pain messages before they reach the brain. These methods may be given by various means:

• as a gas breathed through a mouthpiece,

• by injection,

• through an electrode (a pad that administers small amounts of electrical current, blocking pain signals and stimulating endorphins), or

• through a tiny tube (catheter) which is fed into the lower back, and which carries local anaesthetic to provide a numb sensation.

Where drugs are used to reduce pain during labour, there is no method that is 100% safe and free of side effects for mother and baby. Some painkilling drugs, such as pethidine, pass through the placenta to the baby, who may be less responsive immediately after birth. These drugs may be avoided close to the time of delivery to ensure that their effects have worn off by the time the baby is born.

The experience of childbirth and the ability to cope with pain varies greatly. It’s important to learn which options are available beforehand and discuss them with your birth partner and midwife.

An epidural is a local anaesthetic that provides relief from the pain of contractions and the last stages of delivery. It is carried out by an experienced anaesthetist. Epidurals can be a very effective method of pain relief, and are usually so accurate that they do not affect your ability to feel the pushing sensations during the final stage of active labour.

Local anaesthetic is injected into the space around the spinal cord, using a fine hollow tube (catheter) inserted into your lower back. This numbs the nerves and the pain of contractions, although you should still be able to feel a touch on your skin. The epidural will last for about two to four hours but can be 'topped up' through the catheter, usually via a small pump that delivers the anaesthetic at regular intervals.

Occasionally, some women experience a drop in blood pressure with an epidural. This is remedied by giving plenty of fluids directly into a vein (intravenous drip). A headache may develop after an epidural, caused when the needle accidentally pierces the dura, the membrane that holds the fluid surrounding the brain and spinal cord (cerebro-spinal fluid or CSF). If too much fluid leaks through the hole, the pressure in the rest of the fluid is reduced. When you sit up, the pressure around the brain is reduced further, giving headache symptoms that typically occur between one day and one week afterwards.

The hole in the dura will usually mend itself over a number of days or weeks. Severe headaches may be treated by an epidural ‘blood patch’ which is a similar procedure to the epidural itself, but the anaesthetist injects some of your blood to form a clot to block the hole in the dura. A blood patch is normally effective within 24 hours, during which time it is recommended that you lie down for as long as possible and avoid any heavy lifting.

Wherever you choose to have your baby, it should be a supportive and relaxing environment, with access to specialist care if required. Support during labour can help you to relax and focus. It’s important to have a partner, relative or friend to provide encouragement, practical help and assistance with decision-making.

Most women have their babies in hospital. This is the recommended option if you or your baby has any medical problems, if you know that you will want an epidural for pain relief, or if you prefer to have technology nearby to monitor the progress of the labour and the health of the baby. You are more likely to have an assisted birth, eg a forceps delivery or a caesarean section, if you labour in hospital. A short stay in hospital to recuperate after the birth also provides time to focus on your baby away from the demands of home and family.

Hospitals serving high-risk cases (eg babies likely to be born prematurely, mothers with complications during pregnancy or with existing health problems) offer a more medical setting with more equipment. However, most actively encourage a home-from-home setting wherever possible, and many have the option of birthing pools and low-risk delivery suites.

Many areas have maternity units run by midwives, with consultants and obstetricians on call only if required. They are recommended if you are happy for midwives to provide all of your care, and if a homely atmosphere is important. For example, you may opt for a water birth); complementary therapies such as aromatherapy, massage or homeopathy; or home comforts like pillows, music, or pictures to focus on. Maternity units also give you the chance to meet other new mums, and a more relaxing environment in which to learn how to care for your baby.

There are a few independent birth centres in the UK. Most (if not all) charge fees for their services, but provide one-to-one care throughout the pregnancy, birth, and postnatal period. They also offer excellent facilities, where new mothers can stay with their partners to enjoy the first few days as a family.

Home birth is becoming increasingly popular. For healthy women experiencing a normal pregnancy with no major complications anticipated during the birth, studies have shown that it is equally safe to be attended by midwives in the comfort of their own home as to have their baby in hospital. If you do not plan to have an epidural, and want to be sure of having a midwife with you during your labour, home birth is a recommended choice. It also offers more flexibility if you already have other children (although it is wise to make arrangements for someone to entertain them during the late stages of labour). Although drug-based pain relief options are limited to the use of gas and air (Entonox) and sometimes Pethidine, most women feel much more at ease in a familiar setting and require less intervention. However, home birth is only available as an option in some areas (not all), and you must be prepared to transfer from home into hospital if complications arise during labour or delivery.

During pregnancy, it is important to eat a well-balanced and nutritious diet, in order to provide your baby with the nutrients it needs to grow. Your diet should also give you energy for the changes taking place in your body.

However, there are certain foods you shouldn’t eat whilst pregnant to avoid exposing yourself to the risk of food poisoning, as they can be potentially dangerous to the unborn baby.

Listeriosis is a rare, flu-like illness, which can be contracted from certain foods containing the listeria germ. Although rare in this country, listeriosis can cause stillbirth, miscarriage, or severe illness in newborn babies.

Remember to avoid the following:

• soft and blue veined cheese, such as Camembert, Brie and Stilton. (There is no risk of listeria associated with hard cheese such as Cheddar, cottage cheese and processed cheese),

• pâté (any type, including vegetable),

• certain prepared salads such as potato salad and coleslaw, and

• ready-prepared meals or re-heated food, unless they are piping hot all the way through.

Salmonella is a type of bacterial food poisoning found in unpasteurised milk, raw eggs/raw egg products, raw poultry and raw meat. Although it is unlikely to harm your baby, it is advisable to treat salmonella with caution.

The following steps will reduce your risk of getting salmonella:

• Avoid food containing raw or partially cooked eggs, such as homemade mayonnaise, and some mousses and sauces. Eggs should only be eaten if they are cooked until both the white and the yolk are solid.

• Avoid unpasteurised dairy products.

• Take care with food that contains meat at barbeques, parties and buffets. Bacteria breed quickly on food that is left uncovered in a warm environment.

• Make sure raw meat does not come into contact with other food (i.e. in the fridge). This is particularly important for food that is already cooked or that will be eaten raw.

• Cook all meat and poultry thoroughly, and take particular care with sausages and minced meat.

• Always wash your hands after handling raw meat.

Toxoplasmosis is another type of infection caused by a parasite found in cat faeces. It can also be present in raw or undercooked meat, and in the soil on unwashed fruit and vegetables. Although rare, the infection can occasionally be passed to the unborn baby, which can cause serious problems.

Pregnant women are therefore advised to avoid the following:

• unwashed raw fruit and vegetables,

• raw or undercooked meat, and

• unpasteurised goat’s milk or goat’s cheese.

It is also important to wear gloves when gardening and when changing cat litter trays.

Pregnant women should avoid consuming too much vitamin A. High levels of vitamin A can harm your baby. You should therefore avoid eating liver and associated liver products, such as pâté, which contain a large amount of vitamin A. Check with your doctor before taking any high dose multivitamins or cod liver oil supplement, which also contain vitamin A.

When pregnant, limit the amount of tuna you eat. Tuna contains a high level of mercury, which can have a damaging effect on the baby’s developing nervous system. You shouldn’t eat more than one tuna steak, or two medium-sized tins of tuna a week. This works out at about six rounds of tuna sandwiches or three tuna salads.

Shark, swordfish and marlin should be avoided for the same reason.

You should also limit the amount of alcohol you drink. Heavy drinking during pregnancy is associated with low birth weight, and other more serious defects. The Department of Health recommends drinking no more than two units of alcohol a week when pregnant, and strongly advises that you avoid binge drinking (eg drinking several units of alcohol in one session).

It is also advisable to cut down on the amount of caffeine you consume. Caffeine affects the body’s absorption of iron, which is very important for the baby’s development. Although up to 300mg of caffeine a day is thought to be safe, a study is currently investigating whether there are links between excessive consumption of caffeine, miscarriage and low birth weight.

300mg is roughly equivalent to either:

• 3 mugs of instant coffee,

• 3 cups of brewed coffee,

• six cups of tea,

• eight cans of regular cola, or

• eight standard bars of chocolate.