Baby/fetal Movements
You will usually start feeling your baby move between 16 and 22 weeks. Some second time mothers feel 'movements' earlier and describe them as a 'bubbly feeling'.
Later in pregnancy, your baby will develop their own pattern of movements. This will range from kicks, flutters and jerks to rolls and ripples. Sometimes your baby will hiccup. You will very quickly get to know the pattern of your baby's movements.
It's a myth that babies move less towards the end of pregnancy.
You can start keeping track of your baby's movement pattern from 24 weeks.
Your midwife will ask about your baby's movements at every appointment from about 25 weeks onwards. Become familiar with your baby's usual daily pattern of movements.
55% women who had a stillbirth noticed their movements had slowed down or stopped, but they didn't report it.
Your baby's movements in pregnancy
Feeling your baby move is a sign that they are well
Movements Matter
If you feel that your baby is not moving as much as usual, you should contact your maternity unit or Triage immediately. Do not worry about calling: our teams are here to advise you even if you are uncertain.
You must not wait until the next day to seek help if you are worried about your baby's movements
This is because when a baby is unwell, they may conserve energy by slowing down their movements. It is therefore really important that you contact a midwife for urgent advice.
Contact your community midwife and they should see you the same day.
Your baby's heartbeat will be checked and you will have a full check-up that should include:
- checking your blood pressure
- testing your urine for protein
- listening to the baby's heart beat
You would usually be seen in Triage or your local maternity centre, and you should contact them in the usual way.You will have an antenatal check-up.
Your bump will be measured. Your baby's heart beat will be monitored using CTG. These checks usually show that all is well with your baby.
You may have an ultrasound scan if:
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- Your baby is smaller than expected
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- Your pregnancy has other risk factors associated with stillbirth
Contact your community midwife and they should see you the same day.
If you are over 26 weeks
You should contact your local Triage or maternity unit in the usual way.
Useful links
Tommy's - a registered charity. It provides accredited midwife-led pregnancy health information for parents-to-be, and funds research into the causes of pregnancy loss. They fund four maternal and fetal research centres in the UK.
MAMA Academy - a registered charity that supports parents and midwives to help babies arrive safely.
Vaginal Bleeding after 24 weeks
Bleeding can come from anywhere in the birth canal, including the afterbirth (placenta). Occasionally, there may be an abruption, where part of the placenta separates from the uterus, which puts the pregnancy at great risk. If the placenta is low lying, tightenings or contractions may also cause bleeding.
After the 24th week of pregnancy, painful, light to heavy vaginal bleeding is most often caused by placental abruption, in which the placenta becomes partially separated from the wall of the uterus.
Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24 weeks.
You will be invited into the hospital. Any vaginal loss should be reported immediately, day or night. Don't wait until your next appointment, even if the bleeding is only a very small amount. There may be a large amount of concealed bleeding with only a small amount of revealed vaginal bleeding.
Some women may experience a light bleed later on in their pregnancy. This is may not be from inside the womb, but from the cervix, for example, bleeding after sexual intercourse can occur due to this. This may settle and doesn't necessarily mean there is a problem, but you should always let your midwife or doctor know immediately of any bleeding.
You will have tests and you will be advised to stay in hospital for assessment until the bleeding has stopped or the baby is born. If you are Rhesus negative and you do not know that your unborn baby is Rhesus negative, you will require anti-D injection.
5-16 weeks of pregnancy: Early Pregnancy Assessment Clinic (EPAC) link to EPAC Self Referral Form. For all other Maternity enquiries, please call RUH Maternity's central contact number: 01225 826454 and select Option 1 to speak to Triage.
GWH Swindon:
Up to 22 Weeks:
- Contact your GP / emergency out of hours service OR your named midwife if you are being cared for by a Continuity of Care team.
- You will be referred by your midwife or GP and seen in the early pregnancy unit (EPU) on the 2nd floor at GWH.
- The EPU is open 24 hours a day but does US scans by appointment between 9 & 12pm Monday - Friday.
22+ weeks: please contact Delivery Suite on 01793 604575
Please refer to the Cervical screening during pregnancy page for more information.
Low-lying placenta
Blood clots and Reducing the Risks
A venous thrombosis embolism (VTE) refers to the formation of a clot within veins. This can occur anywhere in the venous system but mostly occur in the vessels of the leg (giving rise to deep vein thrombosis or DVT) and in the lungs (resulting in a pulmonary embolism or PE).
VTE is common in pregnancy and in the first 6 weeks postnatally. It can occur at any stage in pregnancy but the first 6 weeks following birth is the time of highest risk, with the risk increasing by 20-fold.
Risk factors include:
- previous VTE or thrombophilia (a tendency to form blood clots)
- increased maternal age
- admission to hospital during pregnancy
- other existing health problems such as heart disease, inflammatory bowel disease and pre-eclampsia
Anticoagulant (anti-clotting) Injections
You may be advised to start treatment with injections of anticoagulant which is used to thin the blood.
It is given as an injection under the skin (subcutaneous) at the same time every day (sometimes twice daily).
The dose is worked out for you depending on your risk factors and your weight in early pregnancy or before you became pregnant.
You may be on a low-dose or a high-dose regimen.
You (or a family member) will be shown how and where in your body to give the injections.
You will be provided with the needles and syringes (already made up) and will be given advice on how to store and dispose of these.
A risk assessment will be carried out after the birth of your baby. Even if you weren't having injections in pregnancy, you may need to start injections for the first time after birth.
This will depend on what risk factors you have for a deep vein thrombosis (DVT). You may be advised to have injections for 10 days after birth or sometimes for 6 weeks after birth.
If you were taking warfarin before pregnancy and have changed to injections during pregnancy, you can change back to warfarin usually 3 days after birth.
Reducing the risk of venous thrombosis in pregnancy and after birth
Breech Presentation
During pregnancy, babies change positions often. By the time labour begins most babies settle into a position that allows them to be born head first. That doesn't always happen though.
Feet first (breech baby)
If your baby is lying feet first with their bottom downwards, they are in the breech position. This can make your birth more complicated.
An obstetrician will discuss with you the best and safest form of care. You will be advised to have your baby in hospital. Your options will include : Planned Caesarean birth, planned vaginal breech birth or external cephalic version (ECV) - turning your baby back to a head down position. As maternity health professionals our role is to provide you with information to support your decision making and to help you understand the potential risks and benefits of the choices that are available to you.
Turning My Baby if it is Breech (ECV)?
If you baby stays in the breech position at 37 weeks, you may be offered the option of an external cephalic version (ECV) . ECV is not recommended for all women. For example, if you've had vaginal bleeding recently or you are expecting twins or more, it would not be safe to try it.
An ECV is when an obstetrician tries to turn the baby into a head-down position by applying pressure on your tummy. It is a safe procedure although it can be a little uncomfortable. You will be offered a drug to relax the womb.
Around half of breech babies can be turned using ECV, and of those, most stay head-down, allowing you to have a normal birth, although it is also possible that the baby may turn around again
An obstetrician experienced in performing ECV will undertake the procedure in hospital, where there is ultrasound scanning equipment and the ability to monitor the baby's wellbeing throughout..
Anti-D is offered only if you have a rhesus negative blood type and you do not know whether your baby is rhesus positive or rhesus negative.
There is a small chance that there could be mixing of the baby's blood and your blood during the procedure and so women who are rhesus negative are given an injection of "Anti-D" which will 'mop up' any rhesus positive antigens in your blood, preventing the production of antibodies against the baby, which could be a risk for the current or future pregnancies
Anti-D injections reduce the risk of a rhesus negative woman becoming sensitised.
ECV will not be performed if:
- Your womb is heart shaped (Bi-cornate uterus)
- You have recently experienced vaginal bleeding
- There is not enough fluid around your baby
- Your waters have broken
- You have had a previous caesarean section
- You have a twin pregnancy
If an ECV doesn't work, the obstetrician will discuss your options with you. Although breech babies can be born vaginally, you may be offered a planned caesarean birth at or near to your due date.
If you plan a caesarean and then go into labour before the operation, the caesarean will usually be done as an emergency. Occasionally it may be better for you to proceed with a vaginal birth if labour progresses quickly.
Breech baby at the end of pregnancy
Gestational Diabetes
Gestational diabetes is a type of diabetes that affects pregnant women, usually during the second or third trimester. Women with gestational diabetes don't have diabetes before their pregnancy, and after giving birth it usually goes away. In some women diabetes may be diagnosed in the first trimester, and in these cases the condition most likely existed before pregnancy.
Gestational diabetes is usually diagnosed through a Glucose Tolerance Test at 24-28 weeks into pregnancy.
If you have had the condition in a previous pregnancy you will be tested earlier.
Good management of gestational diabetes helps keep your pregnancy and baby healthy.
Gestational Diabetes and your diet.
Please also refer to the Healthy Diet section.
Please refer to the Vitamin Supplements section.
Glucose Tolerance Test (GTT)
This blood test is used to determine if you have gestational diabetes or not.
The night before your GTT is due you must not eat or drink anything after midnight. You can ONLY have sips of water.
Do not :-
- take medications containing sugar (e.g. Gaviscon)
- smoke
- vape
- wear a nicotine replacement patch
- chew gum
- have anything with caffeine in it
as all these can affect the results.
You will first have blood taken to measure your blood glucose level.
Then you will be asked to drink a very sweet tasting, glucose drink.
You must finish the drink within 5 minutes.
Further blood samples will then be taken after 2 hours. The test could take up to 3 hours.
Between blood tests you will need to wait so it's best to bring some reading material, or something else to keep you occupied.
You mustn't eat anything until after the second blood test has been taken, but it's a good idea to bring a snack with you, as you will probably be hungry afterwards.
If your result is:
- Normal: your midwife will record the result at your 28 week appointment.
- Abnormal: your midwife contact you and refer you to the gestational diabetes clinic.
Abnormal results for pregnancy:
- Fasting glucose is over or equal to 5.6mmol/l
- At 2 hours glucose is over or equal to 7.8mmols/l
Useful links
Diabetes.org: Gestational Diabetes
Tommy's: Gestational Diabetes
Tommy's: Testing for Gestational Diabetes
Itching in Pregnancy- Intrahepatic Cholestasis of Pregnancy
Intrahepatic Cholestasis of Pregnancy (ICP) is a rare complication of pregnancy. ICP is a liver disorder that occurs in around one in 140 pregnancies in the UK. Pregnancy hormones can affect gallbladder function, resulting in slowing or stopping the flow of bile.
The gallbladder holds bile that is produced in the liver, which is necessary in the breakdown of fats in digestion. When the bile flow is stopped or slowed down, it causes a build-up of bile acids in the liver which can spill into the bloodstream.
Build-up of bile acids in the bloodstream causes a persistent itch, usually starting in the last third of pregnancy.
There can be an increased risk to your baby including stillbirth so your pregnancy will be closely monitored and you may be induced early. The symptoms go when you have your baby.
Intrahepatic Cholestasis of Pregnancy is more common in women carrying twins, triplets, or more. Mothers, daughters and sisters of affected women have a higher than average risk of also being affected when pregnant.
If you have ICP in one pregnancy, you have a high chance that it will occur in future pregnancies.
Intrahepatic Cholestasis of Pregnancy causes severe and persistent itching, especially on the palms of the hands and soles of the feet, there is often no rash or obvious cause for the itching.
This can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin.
Women with ICP are monitored more closely, and you will be under the care of an obstetrician. There may be a small increased risk of complications of pregnancy associated with this condition, but the evidence is not conclusive.
Induction of labour will be discussed with you at 36 weeks and a plan made with you, as to the best time to deliver your baby, usually around 37 or 38 weeks. This is done because it is thought that it may help prevent the possibility of stillbirth.
There have been no reports of any harmful effects to babies from ICP pregnancies once they have been delivered.
There is no cure for ICP. Doctors will monitor your condition, treat symptoms and may advise delivering your baby early. Topical creams such as calamine lotion and aqueous cream with menthol are safe and may provide some temporary relief from itching for some women.
A number of medications may be used in your treatment. As yet, a specific medication to manage ICP is not available, although clinical studies are in progress.
Medication is currently aimed at reducing the build-up of bile salts in your blood, to relieve the itching and to protect your baby.
It is important that if you are pregnant and itching, that you tell your doctor or midwife. A simple blood test is required to diagnose ICP. These blood tests are called liver function tests.
Please discuss with your midwife if you are worried.
Useful links
British Liver Trust
RCOG: ICP
Tommy's: ICP
Pre-eclampsia
Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.
At each routine antenatal appointment you will have your blood pressure and urine checked.
This is because early signs of pre-eclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria). It's unlikely that you'll notice these signs. In some cases, further symptoms can develop, including:
- swelling of the feet, ankles, face and hands caused by fluid retention (oedema)
- severe headache
- vision problems
- pain just below the ribs
Although many cases are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated (see below). The earlier pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby.
If you had this condition in a previous pregnancy, you are more likely to have it again, although it is likely to be less severe and starts later in pregnancy. It is more likely to happen again if you have a new partner.
Although the exact cause of pre-eclampsia isn't known, it is thought to occur when there is a problem with the placenta (the organ that links the baby's blood supply to the mother's).
Mild pre-eclampsia affects up to 6% of pregnancies, and severe cases develop in about 1-2% of pregnancies.
There are a number of things that can increase your chances of developing pre-eclampsia, such as:
- having diabetes, high blood pressure or kidney disease before starting pregnancy
- having another condition, such as lupus or antiphospholipid syndrome
- having developed the condition during a previous pregnancy
Other things that can increase your chances of developing pre-eclampsia include:
- having a family history of the condition
- being over 40 years old
- it having been at least 10 years since your last pregnancy
- expecting twins or triplets
- having a body mass index (BMI) of 35 or over
If you have two or more of these together, then your chances are higher.
In early pregnancy, your midwife will screen you to see if you are at increased risk of developing pre-eclampsia and you may be advised to take low-dose aspirin daily from the 12th week of pregnancy until your baby is delivered.
If you are diagnosed with pre-eclampsia, you will be under the care of an obstetrician. You may be cared for as an outpatient on the Day Assessment Unit or may require admission to hospital. This is so we can monitor you more closely and determine how severe the condition is.
The only way to cure pre-eclampsia is to deliver the baby, so you will usually be monitored regularly until it is possible for your baby to be delivered. Your labour may need to be induced early; this would normally be after 37 weeks of pregnancy, but it may be earlier in more severe cases. If you become very unwell a caesarean may be necessary.
Medication may be recommended to lower your blood pressure while you wait for your baby to be born and you may also receive steroids to mature your baby's lungs if they are going to be born prematurely.
Although most cases of pre-eclampsia cause no problems and improve soon after the baby is delivered, there is a risk of serious complications developing if the condition goes unrecognised.
The mother can develop a condition called eclampsia which is associated with fits. These fits can be life-threatening for the mother and baby, but they are rare.
RUH:
Call Triage on 01225 826454 and choose Option 1.
GWH:
Day Assessment Unit - 01793 604826
Delivery Suite - 01793 604575
Useful links
Action on Pre-eclampsia
(also known as APEC)
NHS Choices
Tommy's Charity
Previous Caesarean Birth
If you have had one previous caesarean birth in the past you have a good chance of (around 75%) of having a vaginal birth this time.
This is known as VBAC - vaginal birth after caesarean. You will be offered an appointment with an obstetrician who will discuss with you the reasons for your last caesarean birth and your options for birth this time.
Labour after a previous caesarean birth is monitored more closely and we strongly recommend that you give birth in hospital. This is because of the small risk of your scar tearing.
Please refer to the Planned/Elective Caesarean Birth section
Birth options after previous caesarean section
Rupture of Membranes ("Waters breaking")
Your unborn baby lies in an amniotic sac of fluid or 'waters'. 'Waters breaking' means that the sac has ruptured or broken.
Your waters normally break around the time labour is due, but in around 2 in 100 pregnancies they break early for various reasons.
You may notice a 'gush' of fluid or you may feel damp.
The fluid (known as amniotic fluid or liquor) should be a clear or pinkish colour. Sometimes, it may appear 'greenish' or brown and this may be cause for concern.
Whenever you think your waters have broken, you should phone Triage or your local maternity unit in the usual way.
A midwife will assess you and your baby and confirm whether your waters have broken.
An internal examination using a small plastic instrument (a speculum) may be required to confirm that the membranes have or have not ruptured.
Please contact your midwife if you feel your waters have broken.
If your waters break early, you should phone Triage or your local maternity unit in the usual way.
Spontaneous rupture of membranes (SRoM) refers to when a pregnancy is at or has gone beyond 37 weeks and the "waters" around the baby have broken before the onset of labour.
Prolonged rupture of membrane (PROM) is when the waters break and labour does not start within 24 hours. You will be offered induction of labour to reduce the risks of infection.
Please contact your midwife if you feel your membranes have broken.
There is a risk of:
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- serious neonatal infection - with PROM alone, this is 1% ( 1 in 100) rather than 0.5% (1 in 200) for women with no risk factors and intact membranes
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- Most women with PROM will go into labour within 24 hours
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- Induction of labour is appropriate approximately 24 hours after PROM. For more information about Induction of labour (IOL) : Induction of labour - Maternity
No, providing your pregnancy has been uncomplicated and there are no concerns regarding your own or your baby's wellbeing, you will be able to go home and carry on with your normal activities.
If you have not gone into spontaneous labour we advise that you have your labour induced approximately 24 hours after your waters broke, to reduce the risk of infection.
You will be given information about what to do to reduce any possible risks of infection whilst you wait for labour to start and what will happen regarding being invited in to the hospital for Induction of labour if labour does not start spontaneously.
Contact your midwife / local maternity unit if you are concerned at any time.
For more information about Induction of labour (IOL) : Induction of Labour
If your baby is born more than 24 hours after your membranes have ruptured, we recommend that you stay in hospital after the birth and the baby is closely observed for any signs of developing infection during the first 12 hours of life.
Baby loss
Please visit the Baby loss page