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 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.

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Ask Allison

Q My sister-in-law and I both work three-day weeks and we help each
other out with child minding on our working days, which up until recently has worked out really well. Between us, our kids are aged between five and nine years – the problem is that it’s now become quite apparent that we have very different parenting styles. I prefer my two daughters (seven and nine) to have a structured day. For example, in my house, we have allocated times for television and iPads, etc. My sister-in-law, however, lets the kids run loose after school – homework is ignored and my kids end up wired after eating sugary treats all afternoon. I am considering looking at after-school childcare for the kids, but I’m worried that this is going to cause a family argument. Is there a diplomatic way that I can ask my sister-in-law to introduce some discipline into her child-minding days? It certainly doesn’t do her two kids any harm when I am minding them in my own house!

A
In a word, no, there is no diplomatic way to do this as it may very likely seem like your saying that your parenting style is better than
hers. As L’Óreal says, ‘now here comes the science bit.’ Dr. Kaylene
Henderson, a child psychiatrist, wrote a very interesting blog about ‘the
science behind the Mummy Wars’. She explains that before she had
children of her own she hadn’t been aware of how parents have a
very specific sense of the right parenting style. She also found that parents could be very definite in defending their chosen parenting style. Dr. Henderson, who describes herself as a curious, scientific, open-minded person, was surprised at how defensive parents could be and, at times, of their judgemental attitude towards each other. She explained the neurology of the Mummy Wars; okay, I’ll need you to bear with me for a second. Warning; I’m about to use some neuro-techie language.

Why do we judge each other?
As we have all had different experiences, this means that we all have very different memories stored in our brains. Most of our memories are ‘explicit’ memories – these are ones that we can recall easily such as important dates that mean something to us; important birthdays, special events or stories of and about our lives.
There is another type of memory called ‘implicit’ memory that plays a
key role in our parenting. This type of memory is the stuff that you do on autopilot. Psychologists call these heuristics or rules of thumb –
such as tying your shoelace, or driving your car (once you have learnt
to do both first!). Otherwise we’d really waste a huge amount of time
pondering over tasks that we have readily available to us. This seems to be where the science bit of our parenting style kicks in. This implicit memory goes all the way back to when you were an infant being parented by your parents. This is when you started the process of storing up how they did it into your memories.
Unless you make a conscious choice and effort to parent differently, what you saw and unconsciously learnt will be your automatic go-to parenting style.

We learn habits
This can really kick into gear when we feel our parenting style is
being mirrored or highlighted by disapproval from another parent. I know the cold sweat you feel when your child decides to make their outstanding bad behaviour performance at, of course, the most public and worst time. The implicit autopilot of how your parents dealt with these outbursts will flow unconsciously from you if you haven’t worked super hard to be aware and consciously change the old habits.
What’s happening for the on-looking parent is that they see you doing something they are used to doing, but you are doing it all wrong. Simply, because that is not how they know how to do it.

Find a way that works
You both have different parenting styles – who is to say which type is correct? You just need to know what works best for your family and that’s the bottom line. The irksome feelings won’t go away. You can talk to your sister-in-law, but I’m adding a caveat that it would be hard not to hurt her feelings. What we’re possibly looking at is that you prefer a more structured form of parenting, whereas your sister-in-law has a more permissive style. I’m not sure the two styles can mix, the mixture is a bit like oil and water.
If a collaborative shared form of parenting style can be agreed upon, then that is great, but our learnt hardwiring may prove difficult to change despite the intent to do so.
Perhaps, your own instinct of changing childcare might work best for you. In terms of making childcare work; the fit is ultimately the most
important aspect as you want a cohesive congruent feeling of the other caregiver to just ‘getting it’, like in any good partnership. Best of luck
with this and I wish you both well.