Tracey Donegan Pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.

Q I’m 36 weeks pregnant and apparently my baby is breech. What can I do to turn her? I really want to avoid a Caesarean!

A
Most babies have settled into a head down (vertex) position by 36 weeks however around 4%-5% stay breech. If this is not your first pregnancy then your baby may still turn spontaneously before 40 weeks. Research suggests that women with abnormal thyroid functioning are more likely to have a breech baby at full term.

Some maternity units have a weekly ‘breech clinic’ where you can be assessed for suitability for an ECV (manual turning of your baby). This is a safe procedure, but may be uncomfortable during the manipulation. The success rate in a first-time mum is about 50%. It is only performed by a midwife or doctor skilled in the procedure. The biggest risk in an ECV is that some babies don’t tolerate it well and a caesarean may become necessary.

There are also several options that are non-invasive that have been shown in studies to encourage a breech baby to turn.
> Moxa/acupuncture provided by a trained acupuncturist (70% success rate)
> Hypnosis (CD or hypnosis session with a hypnotherapist). (70 – 80%) I recommend combining both moxa and hypnosis to maximise success rates.
> Positioning (visit the Spinning Babies website for more information).

Although not routinely offered, a vaginal breech birth may be an option for you especially if this is not your first baby. Breech birth is a specialist skill and not available in all hospitals. New research suggests that in the hands of a skilled practitioner breech birth can be a safe option in an uncomplicated pregnancy. In the event that you prefer to have a Caesarean section or you are found to be unsuitable for ECV or a breech delivery there is lots you can do to have a positive Caesarean experience including lowering the screen as your baby is born, delayed cord clamping and immediate skin-to-skin contact if you and baby are well. Talk to your midwife or doctor for more information.

Q. My obstetrician mentioned a ‘membrane sweep’ at my last visit. My visits with him tend to feel very rushed, so I didn’t get to ask him for any further information on it. What is a ‘membrane sweep’ and is it likely to be painful or uncomfortable?

A
It’s important that women feel listened to at their antenatal visits but when your pregnancy is completely normal and you and baby are well, the visits can be excessively short. Write a list of questions and at the start of your next appointment let your caregiver know that you would like to discuss some things before you leave. This gives your caregiver an opportunity to advise the staff that your appointment will be longer than usual.
A ‘sweep’ is a method of induction involving an internal examination to stimulate the labour hormones. It will start labour within 48 hours for about one in eight women. A sweep can sometimes ‘excite’ the uterus, causing irregular contractions that stop after a few hours, which can be frustrating. Some women may find sweeps unpleasant and uncomfortable but it can be worth further discussion if you need to be induced for a medical reason, or are approaching 14 days past your EDD. Anecdotally, some women report that their waters were accidentally released during a sweep, which then resulted in a chemical induction as labour didn’t start right away.

You may want to have a sweep if:
> There is a medical indication for induction and you want to see if a sweep will start labour on its own.
> You are 42 weeks pregnant.
> You are almost 42 weeks pregnant and you are planning to have your baby in a midwife-led unit or at home (babies must be born in hospital units once you go past 42 weeks).

You may not want to have a sweep if:
> There is no medical reason to induce labour.
> You want to let labour start spontaneously.
> You have had unexplained vaginal bleeding during your pregnancy.
> Induction is urgently required and time is limited.
> You have group B strep (GBS) in your vagina or you are unaware of your GBS status.

As a sweep is a medical procedure, you must be asked for consent and have a detailed discussion of the pros/cons with your caregiver.

Q I am due to have a C-section and I was wondering will I get the opportunity to have skin-to-skin contact with my new baby straight away or will I have to wait until I am out of recovery?

A
Every hospital has different policies and unfortunately despite the compelling evidence to keep mums and babies together after a surgical birth some hospitals continue to separate new mothers and their babies. Skin-to- skin is so important for all mums and babies whether mum is planning on breastfeeding or not. Your baby has just ‘moved house’ very suddenly and that time spent skin to skin with your baby calms his nervous system, regulates his temperature, blood sugar levels and breathing. Have a conversation with the midwife at your next appointment to find out what the policy is at your maternity unit and be sure to have written caesarean section birth preferences. If your maternity unit is not providing this option you can always change to a hospital where you and your baby can stay together. If you prefer not to change hospitals you can expect to be separated from your baby for up to two hours – this is a great opportunity for your partner to do skin-to-skin with your newborn and arrange for the staff to help you initiate breastfeeding as soon as you get back to the postnatal ward.

QI am eight months pregnant with my first baby. I’m quite nervous about the beginning of the labour process. What is the difference between true labour and false labour?

A
As a first-time mum, it can be unnerving when you get into those last few weeks – constantly wondering “is this it?” and “will I really know if this is it?” First off, there’s no such thing as false labour. Your body is not tricking you or playing games with your head – there is a huge amount of ‘behind the scenes’ work happening long before dilation begins, as your body is doing those last few preparations before the big day. Some mums experience what I call ‘warm ups’ during the last trimester. Think of your uterus as this amazing muscle that is warming up – just like you would warm up your muscles before any other athletic activity.
Warm ups will come and go – labour won’t stop when you change position, lie down or have a bath. Warm ups can happen if you’re dehydrated so make sure you’re drinking to thirst in pregnancy. They can also be your body signalling to you that you’re doing too much. Warm ups may be your body helping rotate your baby into a more favourable position before birth.
When labour starts it’s generally accompanied by other signs such as bloody mucous (show) waters releasing and an increasing need to really focus and reduce distractions around you. So until you’re having other signs that baby is making his way to you, rest, rehydrate and look forward to meeting your baby.

ASK LUCY

Q My son is 18 months old and has just started saying his first words. It is an extremely exciting time in our house and my husband and I are eager to encourage his speaking as much possible. What advice would you give us on how we can foster this without bombarding and confusing him?

AThere is nothing better than hearing your baby begin to talk. All the hard work you have put in over the last two years is coming back tenfold.
Toddlers will vary significantly with ability and speed of which they talk however a guide would be about 50 words by 2 years of age. The most important thing to watch for is that your baby/toddler is cooing and babbling and begins to string sounds together like “Mama/Dada” They should have a wide range of speech sounds and like to imitate you and things they hear.
There are many ways that you can promote Speech and Language development at home:
1. Slowing down your own speech and taking time over conversations with your little one. Every day is a new experience when you are 18 months, nappy changes, bath time, baking a cake brings endless opportunity for you to interact and offer new words for them to hear and repeat. Make eye contact, smile and use exaggerated tones to keep things interesting and fun for your tot.
2. Review the toys that you have on offer to your tot and ensure that they give plenty of open ended play opportunities. Role play is a wonderful way to allow children to take the lead. Kitchens with lots of plates, cups and pots. Fill the pots with dry pasta and allow your child to cook and serve you. Playdoh, painting, gardening and sandpits are also great for allowing your child to take the lead and babble about what they are doing. Read plenty of books together and point and allow them time to answer any questions that you ask.
3. Limit screen time. Overuse of televisions and iPads do not give your child opportunity to interact in a two way manner.
4. Ask your child lots of open ended questions “What’s that?” “Where are we?” Point at things they know the answer to for boosting confidence (Car/ Car, etc.) When they don’t know the answer, explain it to them. Limit baby talk and speak clearly with good pronunciation, remember you are the teacher and they will copy you.
If you are concerned about your child’s speech and language development, be sure to speak with your GP or developmental Health Nurse. They are very skilled at understanding the difference between speech delays and spotting something that may require professional attention.
Enjoy watching their little brains absorb the world around them and listen to what they have to say. It won’t be too long before they won’t stop talking to you, asking “Why Mummy/ Daddy?” every 5 minutes….

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Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.