Mother, Daughter and Childs Daughter

Women and Newborn Health Service

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King Edward Memorial Hospital

Midwifery The Antenatal Period FAQ

The Antenatal Period

1. If I choose KEMH, whom will I see as my Primary Health Care Provider?

Please see the Pregnancy Care at KEMH brochure for antenatal care choices.

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2. What is the Role of the Midwife in the Antenatal Period?

Your midwife will monitor the progress of your pregnancy and the growth of your baby in the antenatal clinic. She identifies any issues that may require referral to another member of the multidisciplinary team. She will address your concerns and provide information to assist you and your family throughout your pregnancy.

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3. What Should I do to Remain Healthy During my Pregnancy?

There are many things you can do in your pregnancy to remain healthy. During your first booking visit at KEMH, your midwife will talk to you about:

Healthy Eating:

  • It is important to eat a well-balanced diet from the five food groups especially fruit and vegetables, cereals and breads, meat, fish and dairy.
  • Avoid processed meats, soft cheeses and paté. (Ask your midwife for the Listeria Pamphlet)
  • Extra folic acid in the form of a supplement can help reduce the incidence of neural tube defects such as spina bifida. The recommended dose is 400 micrograms per day from before conception until the 12th week of pregnancy.
  • Vegetables such as spinach, asparagus, brussel sprouts, broccoli, green beans and lettuce are high in folic acid.
  • A KEMH published booklet "Nutritional Fitness in Pregnancy" will be given to each woman.
  • A dietitian is available for consultation on request or if needed.

Exercise:

  • If you have not been exercising on a regular basis, discuss an exercise program with your midwife.
  • Try walking, swimming, yoga or other low impact exercise.
  • The Physiotherapy Department provide an antenatal water aerobics class once a week for women who are birthing at KEMH.

Drugs/Alcohol/Smoking:

  • Illicit drugs, alcohol and smoking are not recommended during pregnancy.

    The Asthma Foundation of Western Australia and Quit WA offer information and support for pregnant women considering quitting smoking. The Women and Newborn Drug and Alcohol Service (WANDAS) provides specialist antenatal care for pregnant women with drug and alcohol problems.

    In the interest of the health of our patients, visitors and staff, the Women’s and Children’s Health Service (WCHS) is a smoke-free environment. Staff, visitors and patients are not permitted to smoke within any WCHS building, car park or grounds.

  • Inform your health care provider of all medications you are currently taking.

Mental Wellbeing:

During pregnancy hormonal changes can make you feel like you are on an emotional rollercoaster. If at any time you feel that the pregnancy is causing unwanted feelings and emotional distress, talk to one of the midwives in the antenatal clinic. They will listen to your concerns and discuss the community and hospital resources available to you.

Working:

Continuing to work is a decision for you and your family and is based on your own individual needs and wellbeing. Remember to make time for healthy meals, exercise and relaxation.

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4. When Should I come into the Hospital?

Please see the Pregnancy Care at KEMH pamphlet.

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5. Can I have a Vaginal Birth after a Caesarean Section (VBAC)?

Vaginal birth after a previous Caesarean section (commonly referred to as VBAC) is the recommended option for most women. It is important for you to discuss this with your midwife and/or obstetrician when you book into the hospital. Ask them for the VBAC pamphlet to read.

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6. How can I Prepare for the Labour and Birth?

Preparing for labour and birth is not always easy. It’s important to give some thought to your expectations and ensure you discuss these openly with your midwife. Researching and/or writing a birth plan is one way to ensure you have an opportunity to talk through the issues that are important to you and your family. For example, some things you may like to consider:

  • special foods or drinks for during and after labour
  • support people to help you through the labour
  • relaxation techniques/options for helping with the labour pain
  • ambience such as special music/aromatherapy
  • activity and positions during labour
  • who will cut the umbilical cord?
  • breastfeeding options

The Parent Education Department holds Preparation for Childbirth Classes for women and their support people who choose to birth at KEMH.

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7. What is Optimal Fetal Positioning?

Image of Occipito-anterior position Image of Occipito-posterior position
Occipito-anterior position Occipito-posterior position

During the late stages of pregnancy the majority of babies lie with their head down and their back pointing out or to the front of your belly. This is called the occipito-anterior (OA) position. This is considered to be the optimal position for the baby to be in when labour starts.

Sometimes, babies lie with their head down but looking towards the front (their back is on your back). This is called the occipito-posterior (OP) position. If a baby is in this position at the start of labour women may complain of backache and/or feeling their contractions ‘in their backs’. Labour can be longer when the baby is in this position.

So, how can I ensure my baby is in the ‘Occipito-Anterior’ position?

‘Optimal fetal positioning’ is a theory that is based on the belief a pregnant woman, through positioning and movements of her own body, can help move her baby into the right position before labour commences.

The baby’s back is the heaviest part of its body, and this willl naturally move towards your back if you maintain a slouched position.

Avoid positions such as leaning back in armchairs, sitting in car seats where you are leaning back, or any position where your knees are higher than your pelvis. Try instead to spend time sitting upright, leaning on your hands and knees and keeping your knees lower than your pelvis. 2-3

There are additional suggestions that encourage occipito-anterior babies on the homebirth website.

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8. My baby is overdue – what now?

Please see our brochure Management of Prolonged Pregnancy.

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9. My Baby is Breech (Bottom Down), What Does that Mean?

A breech baby is one that has it’s bottom and/or legs in your pelvis rather than it’s head. This occurs in 3-5% of single baby births. There are three main types of breech presentations:

image demonstrating the 3 main types of breech presentations - frank, complete and footling

  1. Frank breech - both the baby's legs are folded flat up against the head and the bottom is closest to the birth canal. (occurs in 50-70% of breeches)
  2. Complete breech - both of the baby's knees are bent and the foot and bottom are closest to the birth canal. (occurs in 5-10% of breeches)
  3. Footling breech - one or both legs are straight with a foot or feet presenting (occurs in 10-30% of breeches).

What causes my baby to be breech?

There is no direct cause for breech presentations but the following may increase the likelihood:

  1. prematurity (Breech presentation occurs in 25% of births before 28wks, 9% of births at 32 weeks and 1-3% of births at term.)
  2. more than one fetus in the uterus
  3. excess amniotic fluid (polyhydramnios)
  4. abnormally large fetal head (gravitates to the top of the uterus)
  5. abnormally shaped uterus or abnormal growths within it (such as fibroids)
  6. placenta praevia (placenta partially or completely covers the cervix)4

Current obstetric practice recommends a Caesarean section for babies in the breech position at term. Best evidence suggests that women with a healthy breech baby and no underlying reason for the breech presentation should be offered a procedure to turn the baby. This procedure is known as External Cephalic Version (ECV).

External Cephalic Version:

In simple terms ECV is the gentle but firm external movement of the baby to a head down position.

  1. Baby's bottom lifted out of the pelvis.
  2. Head brought down.
  3. Pressure onto head and bottom, bottom pushed upwards until head is lying in the pelvis.

The chance of sucessfully turning your baby varies widely from 35-86%. Information will be given to you if an ECV is going to be performed.

There are exercises you can do which may be helpful in turning your baby. Discuss these with your midwife.

Does my baby need to be in a head-first position to deliver vaginally?

Talk to your midwife and obstetrician about the advantages and disadvantages of vaginal breech delivery.

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