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Caring for Generations

Midwifery

Midwives:

Hazel-Cazzini Hazel Cazzini Midwifery Manager

Bridget Caulfeld   Anne Cornyn    Noelle Farrell

Margaret Flanagan    Catherine Kinsella    Sarah Mc Cann

Janet Sexton    Jeannine Webster

Useful Numbers:

Appointments Private 01 8742155

Appointments Semi Private 01 8740992

Private Midwives direct line 01 8289502

Semi Private Midwives direct line 01 8289507

Emergency Room 01 8730700

General enquires 01 8742115

FAQ

Morning Sickness

This is a common problem but for the majority of women it settles between weeks 11 – 13. Here are some handy hints to reduce morning sickness: • Eat small portions regularly and often • Avoiding foods you do not like • Avoiding foods that are hard to digest, and that are likely to sit in your tummy for a long time. • Stay hydrated as dehydration leads to nausea and feeling unwell, so will exacerbate symptoms. • Drink a small amount regularly, e.g. 50 mls every 30 minutes, throughout the day. Tea or milk with sugar or carbonated drinks (gone flat if that helps) will ensure you will help you through this period of pregnancy. • If the problem persists please contact your consultant or midwife for further advice.

Exercise During Pregnancy?

The more active and fit you are during your pregnancy, the easier it will be for you to adapt to your changing shape and putting on weight. It will also help you to cope with labour and get back into shape after birth. If you feel tense after a day’s work, physical activity is a good way of relaxing and it will help you to sleep well. While you are pregnant keep up your normal every day physical activity or exercise for as long as you feel comfortable. Don’t exhaust yourself and remember that you may need to slow down as your pregnancy goes on, or if your doctor or midwife tells you to. Helpful hints • If you didn’t do any exercise before you were pregnant, don’t suddenly take up strenuous exercise. • Try to keep active every day. Try and put 30 minutes into your every day routine. • Try not to do any strenuous exercise in hot weather. • If you go to exercise classes, make sure that your teacher knows that you are pregnant. • Swimming is an excellent way to exercise during pregnancy. The water will support your extra weight. • You should be able to talk with somebody as you exercise without getting short of breath. This is a useful guide to help you determine an appropriate level of activity.

Back care Three out of four women can have some back pain during their pregnancy. Walking, swimming or cycling will help increase your muscle tone and strength. You should change your position often, including stretching throughout the day, and sleeping on your side with a pillow between your legs may help to relieve the pain. Back strengthening exercises during pregnancy will help you during labour and birth and for caring for your baby after birth.

Pelvic floor exercises The muscles of your pelvic floor come under great strain while you are pregnant and giving birth. The pelvic floor is made up of layers of muscles, which stretch from your pubic bone in front to the end of your backbone. You can help to strengthen the muscles by doing these exercises: • Close up your back passage as if trying to stop a bowel movement. At the same time, draw in your vagina as if you are gripping a tampon, and your urethra as if you want to stop passing urine. • Do this exercise quickly – tightening and releasing the muscles immediately and then do the exercise slowly – holding the position for up to ten seconds before relaxing. • Repeat both exercises ten times, four to six times a day.

Yoga for pregnancy and birth The word ’yoga’ means ’union’ in Sanskrit, the classical Indian language. The practice of yoga is a coming together of the mind, body and spirit. Although yoga in pregnancy follows the same principles as all yoga, it is quite different from regular yoga because it is designed with the specific needs of the pregnant woman in mind. Because of this, yoga in pregnancy is always safe and gentle. Most healthy women can join the yoga classes. Minor disorders of pregnancy generally do not pose a problem. No previous experience of yoga is necessary and you join the classes by phoning up yourself or by getting a letter from your doctor or midwife. The classes are provided by a midwife, are held in the evenings and last about 1 hour 15 minutes to 1 hour 30 minutes. The classes run for six weeks and there is an associated cost. Courses can be repeated. Yoga is not only a physical workout, it brings greater self awareness to the woman, where she can nurture herself in a safe, warm and encouraging environment and take time out to enjoy being pregnant and connect with her unborn baby. Women become more aware of their body and their posture; they experience increased confidence in their ability to give birth; they become more relaxed; and they tend to have easier labours. The studies looking at the impact of practising yoga or other kinds of relaxation for pregnant women have shown encouraging results. Yoga encourages relaxation, internal focus and slowed breathing patterns. It may help relieve many of the common discomforts of pregnancy, such as lower back pain, nausea, insomnia, and headaches. In addition, prenatal yoga classes often offer a supportive environment in which pregnant women can share their experiences, which may help relieve feelings of anxiety The many benefits of pregnancy yoga include. 1. Improves physical strength and flexibility which can increase stamina and fitness for labour. 2. Deep slow breathing ensures a good supply of oxygen for the woman and her baby plus breathing techniques can be used as a coping mechanism during labour. 3. Deep relaxation helps release fear, stress and tension and promotes sleep. Being relaxed helps the woman be more intuitive and instinctive during labour. 4. Better posture, balance and coordination. Good posture reduces the risk of backache. 5. Strengthens and tones the pelvic floor muscles in preparation for birth and beyond.

To make an appointment phone 01 8745115 between 8.30 am and 4.00 pm, Monday to Friday. Our Facebook Page also has details of the next starting date.

Healthy eating during Pregnancy

Healthy eating is important for everyone, but it is particularly important as you are trying to grow a healthy baby. What you eat and drink may impact on you and your baby’s health for a lifetime. Make sure you are getting the nutrition you need by reading the ‘Healthy Eating for Pregnancy’ booklet from the Health Service Executive (HSE).

When is my due date (with link back to Preg calculator)

Click  Here to use our Pregnancy Calculator

Calcium for Healthy Bones

Calcium is key to building healthy bones and teeth – both for you and your baby. Foods that have a lot of calcium are milk, cheese, yoghurt, fortified soya milks and fortified orange juice. Take five portions of these foods every day. You also need vitamin D to absorb the calcium from your diet. The best sources of vitamin D are oily fish like salmon, sardines and mackerel, vitamin D fortified milk, fortified margarines and some breakfast cereals. If you do not drink milk, tolerate dairy foods or take vitamin D foods, ask your doctor, midwife or dietitian if you need a supplement.

One portion of calcium rich food is: 200 ml fortified milk 30 g cheese 125 g yoghurt 200 ml calcium fortified soya milk 45 g tinned sardines (eaten with the small, soft bones)

Why is an Iron rich diet important

While you are pregnant it is important that you have enough iron. If you don’t have enough iron in your diet you can get anaemia or low levels of iron in your blood. If you are anaemic, you may feel tired, short of breath and have no energy. You can improve your levels of iron by eating foods high in iron every day as well as having a healthy diet. Eating a diet that has lots of iron rich foods, such as red meat, fortified breakfast cereals, eggs, green vegetables and beans or pulses should be enough for most women.

If you are still anaemic after eating more iron rich foods, then your doctor may prescribe iron supplements for you. Some women can feel some side effects from iron supplements such as constipation or mild stomach cramps. If this happens, try taking the tablets every second or third day at first. Then gradually increase the tablets over two to three weeks, until you are able to take one every day. If you buy natural iron supplements, that are available over the counter from pharmacies and health food stores, you must take these with orange juice or another source of vitamin C. You should only take these if you have mild anaemia and not if you have a very big drop in your iron levels.

Iron supplements can stop some blood pressure medications or thyroid medications from working properly. Take your iron tablet and any medications you have been prescribed at least two hours apart.

Ways to get more iron in your diet: You should include one serving of these a few times per week: • beef • corned beef • lamb or mutton • pork • salmon (two to three times a week) • tuna – up to 280 grams (drained) a week • sardines

You should include one or more of these good iron sources with each meal: • eggs • wholemeal bread • iron fortified breakfast cereals: Special K, Bran Flakes, All-Bran • dark green leafy vegetables: cabbage, brussels sprouts, spinach, kale, broccoli • beans: kidney, chick peas, baked beans, peas, or pulses like lentils • dried fruit: apricots, raisins, sultanas, prunes

Vitamin C helps you absorb iron in vegetables. Take good vitamin C sources daily: • orange juice or vitamin C fortified fruit juice • oranges, grapefruit, lemons, or limes • strawberries, melon, or kiwi fruit • green, red, or yellow peppers • fresh tomatoes

Wait 30 to 60 minutes after a meal to drink tea, as tea can reduce the amount of iron you can absorb.

Vegetarian diet

If you are vegetarian and your diet is varied and balanced, you will get enough nutrients for you and your baby during your pregnancy. However, it can be hard to get iron, vitamin D and vitamin B12 from a vegetarian diet. Talk to your dietitian, doctor or midwife about how to get more iron and more of these vitamins into your diet.

If you are vegan, where you cut out all animal products from your diet, or you follow another type of restricted diet, such as gluten free, because of food intolerance (for example, coeliac disease) or for religious reasons, talk to your doctor or midwife. Ask them to refer you to a dietitian for advice on how to make sure you are getting all the nutrients you need for yourself and your baby.

Foods to avoid during pregnancy

You should try not to eat certain foods during your pregnancy because they can have bacteria in them, too much vitamin A or other toxins that may harm you or your baby.

Don’t eat: • Raw or undercooked eggs, homemade mayonnaise or mousse made with raw eggs. • Unpasteurised or mould-ripened and blue-veined cheeses such as Brie, Camembert or Stilton. • Unpasteurised milk products or juices. • Raw or undercooked meat, poultry or fish and paté.

These foods can have salmonella, listeria or e-coli bacteria that can cause illness.

Vitamin A in large amounts can cause birth defects in babies. Do not take multivitamins with vitamin A unless your doctor prescribes them. Do not take cod liver oil supplements. Herbal supplements may not be safe for pregnant women. Tell your doctor, midwife or dietitian about any supplements you decide to take.

Caffeine in large amounts may be harmful. Caffeine is found naturally in coffee and tea and in a range of foods such as chocolate. It is also added to some soft drinks and ‘energy’ drinks and is in some cold and flu remedies. You should only drink a total of four cups of regular coffee, tea and cola drinks a day. Try drinking decaffeinated tea and coffee, fruit juice or mineral water instead.

Avoid eating shark, marlin and swordfish and eat less tuna. These types of fish have high levels of mercury that may damage your baby’s developing nervous system. Only eat one tuna steak or two cans (each of 140 g drained weight) of tuna a week. This also applies if you are breastfeeding.

Food Hygiene

Follow these good / safe food hygiene practices always:

• Wash your hands before and after handling any food. • Thoroughly wash all fruit and vegetables, including ready-prepared salads before eating them. • Cook raw meat and poultry thoroughly. Make sure that you properly reheat ready-to-eat poultry and cooked chilled meals and they are piping hot before you eat them. • Always wash your hands after handling raw meat or poultry and make sure that you store raw foods separately from ready-to-eat foods. • Use a separate chopping board for raw meat. • Keep cooked food and raw food away from each other. • Make sure that your fridge is at 5°C or below. • Put chilled food in the fridge straight away and eat it as soon as possible. • Throw out food that is gone past the ‘use by’ or the ‘best before’ date.

Folic Acid

Folic acid helps to prevent spina bifida and other neural tube defects in your baby. The baby’s spine develops very early in pregnancy, even before you may realise you are pregnant, so it is important to start taking folic acid before you become pregnant – ideally at least three months before. If you didn’t take folic acid before your pregnancy, you should start to take it straight away and continue to take it until 12 weeks. Include folate rich foods in your diet every day, like green leafy vegetables, breakfast cereals, beans and citrus fruits, as well as taking the folic acid tablet.

You can buy folic acid tablets over the counter from your pharmacist. If you are on medication for a condition such as epilepsy, it is important to talk to your GP about how to take folic acid with these. This is because some types of medication work against folic acid and you might need to take a higher amount. If you are also taking a multivitamin tablet, make sure that it is ok for you to take it during your pregnancy.

Weight gain during pregnancy, what is normal?

Most women gain between 10kg and 12.5kg in weight during pregnancy. Much of the extra weight is due to your baby growing. However, putting on too much weight can affect your health in a negative way; being overweight can increase the risk of complications to both you and your baby. It is important that you eat healthily to reduce the risks in this pregnancy and in future pregnancies. Try and stay active by keeping up your normal daily activity or exercise.

In Ireland almost 20% of women are overweight before they get pregnant. At your first antenatal visit the midwife will record your weight and height to calculate your body mass index (BMI). A healthy BMI is above 18.5 and less than 25. A person is considered overweight if their BMI is above 25, obese if the BMI is above 30, severely obese with a BMI over 35 and morbidly obese when the BMI is over 40. The risk of complications rises with a higher BMI.

What are the risks of a raised BMI during pregnancy? Some complications associated with being overweight include a thrombosis or blood clot, high blood pressure or the development of gestational diabetes. If you have a BMI over 30 you are three times more likely to develop diabetes during your pregnancy compared to a woman with a normal BMI. If you are overweight, your baby will have an increased risk of obesity and diabetes in later life. For this reason all women with a BMI greater than 30 will have their blood glucose levels checked during the pregnancy.

Pre-eclampsia is a condition in pregnancy which is associated with high blood pressure. If you have a high BMI at the beginning of your pregnancy your risk for developing pre-eclampsia is doubled compared to women with a normal BMI. Pregnant women have an increased risk of developing a blood clot; the risk increases with a high BMI and the doctor may consider giving you injections of a blood thinning agent if your BMI is high.

Usually women with a high BMI have a low store level of Vitamin D. This vitamin is essential for the body to function properly. It regulates cells all over the body – including the brain, heart, kidney, bone, bowel, skin and the immune system. Vitamin D is important for bone health because it regulates calcium and phosphorus levels in the blood and decreases the risk of heart attack and stroke. For your baby it is essential for strong bones and teeth. It also helps to prevent diabetes by modifying the release and response to insulin. Women who have a high BMI are recommended to take a daily dose of 10 micrograms of vitamin D supplements during pregnancy.

If you are overweight we can give you extra help and support during pregnancy to minimise the risk of complications for you and your baby. If you are concerned about your weight, talk to your midwife or doctor. They can arrange an appointment for you to see the dietitian or another specialist. The dietitian will focus on minimizing weight gain during your pregnancy and on healthy eating.

I don’t feel happy why? Depression

Your emotional and mental wellbeing are also key to your healthy pregnancy. From the moment you suspect or confirm that you are pregnant, things begin to change. Finding out you are pregnant is usually a very emotional experience – you are either delighted, terrified, or somewhere in between. What surprises many women and their partners is the ongoing emotional changes that they feel during their pregnancy. This is perfectly normal, but understanding what to expect and why, will help both you and your partner get the most enjoyment out of this amazing experience. Your feelings change – about yourself, your baby, your relationships and your future. You begin to think about the realities of being a mother and how you will adapt to this new role. Many women think more about their own childhood and their relationship with their own mother during pregnancy. If this is your first pregnancy you may feel a little anxious about being a good parent, and about caring for your baby. This is perfectly normal – most women worry about not being able to cope with the day-to-day baby care. Having a good support network in place like your partner and family before the birth will help you feel more confident that you can do it, so make sure you discuss your fears and worries with them. Try and learn as much as you can about caring for a newborn baby, and speak to other mothers that you know. Having this knowledge will make you feel better prepared when your baby is born.

There will be big changes in your hormone levels during pregnancy. It is common for you to have mood swings and it is not something you have much control over. Nearly all pregnant women have emotional ups and downs. You can have times of feeling unsure and panicky, having extreme reactions to minor things and crying. Getting used to the changes in pregnancy is not always easy. Changes in your hormone levels also mean you have physical symptoms like feeling sick and tiredness, so remember to get plenty of rest and continue to do what you enjoy doing. Talking about your feelings and your concerns to your partner, or to somebody close to you, will help to put things in perspective and help you to cope.

It is normal for couples, and especially the mother, to worry about the health of their baby. What if there is something wrong? Will he or she be normal? It is helpful to know that many other pregnant women have worries, anxieties and fears like yours – about pregnancy, labour and looking after a new baby. Although it is normal to have some worries while you are pregnant and to feel a bit down from time to time, it is more serious if you are feeling low or depressed a lot of the time. Talk about your concerns with your GP, midwife or obstetrician. The parent education classes will help to answer some of your concerns and you will have an opportunity to talk with other women who are around the same stage in pregnancy as you.

Depression While most women feel that pregnancy and new motherhood is a happy time, another group of women find that they cannot feel happy at all. About one in five women have some level of depression in pregnancy – they worry, lose confidence, don’t sleep well and become exhausted. They think they are unlovable and unattractive, their relationships go wrong and they can feel numb, trapped and dull with little interest. They may feel irritable and angry. They may have a continuous bad mood. When you feel depressed, it may seem that no one cares or that nothing else matters. We don’t usually know the reason for having a low mood or depression in pregnancy. If you have had depression in the past then there is a risk it will happen again when you are pregnant and afterwards. There are many ways to treat depression in pregnancy. You can manage mild to moderate depression by having a well-balanced approach to life. Having a good diet and exercising will help you to stay well and overcome your low mood and depression. Some women need anti-depressant medication to control the difficult effects of their depression. If you are taking anti-depressant medication and you unexpectedly get pregnant, talk to your GP before you stop taking your medication.

A bad day is normal. A bad week is not. Talking to someone you trust is helpful. Accepting help early on means you could have a quicker recovery. If you are anxious about your pregnancy or the birth of your baby or had a previous difficult birth, then talking with your GP or midwife will help. If you feel anxiety or panic attacks are affecting your ability to do your normal activities then seek help early from either your GP or support midwife. The Rotunda offers women a supportive counselling service. Talking helps women to develop a sense of perspective about the situation and allows them to think about what steps they can take to get back a sense of control in their life. The Rotunda Hospital has a dedicated midwife who is happy to offer support and information to any woman who needs it during their pregnancy and after the baby’s birth.

To make an appointment with the mental health support midwife, telephone 01 817 1700 or 01 873 0632. Excellent information on mental health in pregnancy and postnatal mental health is available on the Royal College of Psychiatrists website: www.rcpsych.ac.uk

Although it might sound like your pregnancy is going to be nothing but a long string of emotional crises, this is not the case for most women. You will have various ups and downs, but you will usually be able to manage these, especially if you have a supportive and involved partner. Remember that most pregnant women experience all the emotions you are going through. They are perfectly normal and you shouldn’t allow yourself to get stressed by them. Pregnancy is a wonderful experience, so don’t allow normal emotional changes to ruin that experience for you!

Finally, remember that one of the main tasks for you during the nine months of your pregnancy is to mentally prepare yourself for motherhood. To successfully prepare yourself for becoming a mother you need to be completely honest and open about these feelings.

Things to avoid during Pregnancy

Alcohol The effects of alcohol on a person can vary from person to person. Any alcohol going into a pregnant woman’s bloodstream also goes into her baby’s system. Research shows that when you are thinking of getting pregnant, during your pregnancy and while you are breastfeeding, the best advice is “no alcohol leads to no risk”. Therefore, we recommend that you should not drink any alcohol during this time.

Smoking If you smoke and you are trying to get pregnant or you are pregnant already, you should try to give up. Smoking during pregnancy can seriously affect both your own health and your baby’s development. If you smoke when pregnant you have an increased risk of miscarriage and a higher risk of the placenta coming away from your womb before the baby is born, which can cause premature birth or stillbirth. Babies born to women who smoke have a lower birth weight and more of these babies die from cot death.

The sooner you stop smoking the better and it is never too late. Even stopping in the last few weeks of pregnancy can still benefit you and your baby. There are lots of groups and organisations that can help support you to stop smoking.

Medications and other drugs Some medicines, including painkillers, can harm your baby’s health. As a general rule you should: • assume that all medicines are dangerous until a doctor or pharmacist can tell you they are safe; • make sure your doctor or dentist knows you are pregnant before they prescribe anything or give you any treatment; and • talk to your doctor at the first possible moment if you take regular medication.

However, remember that it is safer to take some medicines, for example if you have epilepsy or diabetes, than to leave the illness untreated.

All illegal drugs, such as heroin, cannabis and cocaine, are dangerous for a pregnant woman. For your own health and the health of your baby, you should not take any of them from the time you first plan to become pregnant or learn that you are pregnant. For a pregnant woman, there are more risks linked to illegal drug taking. Firstly, drugs may harm your own health, and can affect your ability to support the pregnancy. Secondly, some drugs can directly affect the development of your baby in the womb.

These drugs go through the placenta – the organ that connects the baby to its mother in the womb – and reach the baby. The baby becomes addicted along with the mother. At birth, the baby is still dependent on the drug. Because the baby is no longer getting the drug after birth, they can have symptoms of withdrawal such as tremors, sleeplessness, muscle spasms, and sucking difficulties. You can prevent this condition by not taking any drugs during your pregnancy. Talk about all drug use with your midwife and doctor.

Information on breast feeding

Please follow the link to BreastFeeding.ie