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October 2009
Bi-monthly Edition
Swine Flu and Pregnancy
Should I wait to get pregnant?
It's likely you've heard conflicting advice about conceiving and swine flu. This is because the initial official government advice did say that it may be sensible for those trying for children to consider delaying conception. However, the government now says that as the cases of swine flu in this country have been so mild, it is not advising anyone to delay conception.
Are pregnant women more at risk from swine flu?
The predictions are that the number of cases of swine flu will increase this autumn, with estimates that up to one in three people are likely to develop the virus. The good news is that, for the vast majority, the virus will be mild and most people will recover within five to seven days. However, if you are pregnant, you are in one of the higher-risk groups for swine flu infection. This is because the immune system is naturally suppressed during pregnancy to ensure that your body does not reject your growing baby. This in turn makes you more susceptible to all infections, in particular influenza illnesses such as swine flu and the possibility of developing complications. Be reassured however - your immune system is still functioning, so the risk of complications is actually very small and most pregnant women will have mild symptoms.
Signs and symptoms of swine flu
These are similar to regular flu. You are likely to have a high temperature (over 38OC) and two or more of the following symptoms:
I'm pregnant. What can I do to avoid getting swine flu?
The government advice, supported by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, is for pregnant women to try where possible to:
Would wearing a face mask help?
The available scientific evidence shows that the use of face masks will not protect you from becoming infected. The best way of reducing the risk of transmission is by careful hand washing using soap and water, or a sanitiser gel, and by using tissues to cover your nose and mouth when you cough and/or sneeze, ensuring that you dispose of any used tissues promptly. Because swine flu is spread by droplet infection through sneezing and coughing, it is also important to clean contact surfaces such as door handles with suitable products.
Should I take an antiviral like Tamiflu as a precaution against swine flu?
Antivirals do not work if you don't have the flu virus; however, if you are pregnant or your body's immunity is compromised, they may be recommended by your GP. Antiviral medication is not a cure, but can help you to recover more quickly, provided treatment is started within 48 hours of the onset of symptoms.
If I get swine flu, or someone in my family does, what should I do?
If someone you are in close contact with has swine flu, they should call the National Pandemic Flu Service (Tel: 0800 1 513 100) and they will be diagnosed over the phone.
If you develop symptoms of swine flu while pregnant, the advice is to contact your GP immediately for an assessment (this may be over the phone). If your GP confirms swine flu, you will be prescribed antiviral medication to take as soon as possible. If you have swine flu your symptoms are likely to be mild, and you may be prescribed a preventative antiviral called Relenza, which is taken by an inhaler so that it goes straight to your nose and throat, rather than entering your bloodstream. Relenza should not affect your pregnancy or the well-being of your growing baby.
What if I have swine flu and I am breastfeeding?
If you are breastfeeding you should continue to do so while receiving antiviral treatment, or prophylactic treatment, as they are not contraindicated in breastfeeding. Antiviral drugs are excreted into breast milk in very small amounts so won't harm your baby. Department of Health advice is to breastfeed on demand wherever possible, so that your baby receives as many of your antibodies as possible.
If I am pregnant can I be given the swine flu vaccine?
Research has shown that as pregnant women are four times more likely to be admitted to hospital with complications from the swine flu virus, they will be among the first to be offered the flu vaccine when it becomes available in late October 2009.
Is the swine flu vaccine safe for pregnant women?
There is no evidence of risk from vaccinating pregnant women.
How can I protect my newborn from swine flu?
Joint guidance from The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, says women will be discharged from hospital as soon as possible after giving birth to reduce the risk of contracting flu while in hospital. They will also be advised to limit visitors to a newborn baby to help avoid the risk of the baby catching swine flu.
What should I do if I am worried about pregnancy, swine flu, and my newborn?
Speak to your midwife, GP or health visitor; they will be able to offer you the latest advice, information and help.
MIDIRS 2009
News
Cot Death Charity Launches Social Networking Site for Teen Parents
The cot death charity, The Foundation for the Study of Infant Deaths (FSID), today launched the UK's first social networking site for teenage parents.
Latest figures show that mums under 20 are over four times more likely to have a baby die as a cot death than older mothers*.
The new site, www.bubbalicious.co.uk, offers support and safe sleep tips for both mums and young dads.
Users can chat, win prizes, upload 50 photos and take part in a four-level baby-care challenge. If successful, they are awarded the title of Top Dad or Big Sister which allows them to give advice to other parents on the site.
FSID's director, Joyce Epstein, said: "Sadly, the latest research shows that teenage mums have the highest rate of cot death, but we think that many are missing out on safe sleep advice.
"We developed bubbalicious after consulting with young parents across the country, and we really hope that the support available on the site will help improve the life chances of the UK's most vulnerable babies."
www.bubbalicious.co.uk was designed and developed by London-based digital marketing agency, Neoco www.neoco.com
Source: Foundation for the Study of Infant Deaths - press release - 25 September 2009
Bliss launches new comprehensive advice booklet on common winter illnesses for parents of premature and sick babies
Special care baby charity Bliss is today launching a new information resource to support parents taking their sick or premature baby home from hospital over the coming months. Common winter illnesses information booklet, supported by healthcare company, Abbott, is a common sense guide to help parents through the autumn and winter months when their baby could be at greater risk of infection.
Around 22,000 babies are admitted to intensive care units each year in the UK, and of these many will be coming home over the winter months. Premature babies and those with lung disease are at higher risk of becoming unwell at this time.
The booklet covers the common cold, respiratory syncytial virus (RSV), flu - including swine flu, pneumonia and bronchiolitis. There is also a section on general hygiene, on what a fever is, reducing the risk of infection, prevention and immunisation. It is a helpful guide to parents at what can be an already stressful time and aims to provide common sense tips to ensure parents are well-informed.
It also includes information in each section on symptoms, how best to help your baby get better, what treatments are available, when to call the doctor and how best to prevent the spread of infection.
Carmel Bartley, Family Support Manager at Bliss said," From talking to parents and health professionals all over the UK we found that there was a shortage of information available to parents of sick and premature babies about the risks they may face when taking their baby home during the colder months. The Common winter illnesses booklet is just one of our many publications for parents and it aims to offer practical advice and support to parents at this time and we hope they find it useful."
Dr Jonathan Coutts, Clinical Director of Neonatology, The Queen Mothers Hospital, Glasgow said, ""Parents of babies who have been unwell shortly after birth and required intensive care will always worry about winter coughs and colds. It is good that Bliss have developed this booklet to help parents deal with these common problems in a sensible way without running the risks of trying to be too overprotective when they should be enjoying being at home with their baby"
Katherine Huntly, Press and Campaigns Manager at the British Lung Foundation said, ‘The most commonly reported long term illnesses in babies and children are respiratory conditions so this information leaflet launched by Bliss will be a valuable resource for parents. We fully support any initiative which raises awareness of the lung diseases and seasonal conditions such as RSV and provides advice for worried parents".
The Common winter illnesses booklet is available for parents from their neonatal unit from early September. It can also be downloaded or ordered from the Bliss website, www.bliss.org.uk
BLISS - press release - 10 September 2009
Infections in pregnancy
When you are pregnant you are likely to become far more aware of the impact that a possible infection might have on your health and well-being, and even more importantly, that of your developing baby. For this reason MIDIRS has developed a new Informed Choice leaflet to help you recognise the importance of any signs of infection in pregnancy, so that you can seek care and advice as soon as possible.
People are susceptible to different infections, diseases, and health problems throughout their lifetime. Most pregnant women tend to be generally fit and healthy, and in an ‘altered state of normal health'; this may mean that they are not always aware that they have caught an infection until they begin to experience signs or symptoms, or develop health problems. In some cases, these only develop in the later stages of the infection or disease. While some infectious diseases can be fairly minor causing a few short-lived, bothersome symptoms, others can lead to serious health complications for the mother during pregnancy and after the birth, as well as for her developing and/or newborn baby.
During the early stages of your pregnancy you will be offered a range of antenatal screening tests, as part of your routine maternity care. These are mainly blood tests, which include those that identify possible abnormalities with the baby's development, as well as tests that give an indication of your general health and well-being. They also establish whether you are immune from certain infections, or vulnerable to them (this is called being ‘susceptible'), as well as identifying any infections that may have already been acquired. The blood tests screen for rubella (German measles), syphilis, hepatitis B and HIV, all of which have serious effects on the longer-term health and well-being of both you and your developing baby.
What infectious diseases are likely to occur during pregnancy?
There are a range of signs and symptoms that are linked to certain common infections. These include the signs of a cold, a cough, flu-like symptoms and stomach (gastric) upsets. It is likely that you would normally treat these symptoms yourself using medicines and remedies that can be bought over the counter at your local chemist. However, you need to be a lot more cautious when you are pregnant, because many of the remedies that you would normally take to treat minor ailments outside of pregnancy can be harmful to your developing baby. It is therefore important that you get all medicines checked by your midwife, GP, or your local pharmacist before you start taking them.
There are often equally effective, pregnancy-friendly alternatives available that your health care professional will be able to advise you on!
If you are feeling unwell, and your symptoms continue or worsen over a few days, or you suddenly go on to develop a rash, you should always seek advice from your GP or midwife immediately.
Common infections: the risk to you and your baby
There are various openings (called ‘orifices') in our bodies where body fluids such as urine, excess mucus/phlegm can be removed, and where there is the potential for infections to enter (eg through the vagina, anus, ears, nose and throat). Infections can also enter our bodies through the surface of our skin, particularly where this natural barrier is weakened by cuts or abrasions. Some infections take particular advantage of certain parts of the body, where there is perhaps the moisture and warmth necessary for their growth. These include candidiasis (vaginal or oral thrush), urinary tract infections (cystitis) and gastro-intestinal (stomach) infections. If you have one of these conditions, it can be confirmed by taking a swab from the site of the infection, or by collecting urine or poo (stool) samples. Laboratory tests can then confirm the diagnosis so you can be prescribed the most effective treatment to fight off the infection, soothe the symptoms and, hopefully, help you to start feeling much better!
As pointed out earlier, it is very important that you tell your GP and/or midwife if you have, or think you might have, an infection. This advice also applies in situations where you are already receiving treatment for an infection, which does not appear to be getting any better. If left unchecked, some infections can cause further, more serious illness. For example, urinary infections can move up the urinary tract, so that your kidneys also become infected, and toothache/dental infections that are left untreated can worsen. Both of these can affect your baby's growth and lead to your going into labour too early (referred to as premature labour).
Your health and your baby's health and well-being are closely linked, so it is always best to take a more cautious approach. Should you have concerns that you might have been exposed to an infection or where you suspect an infection has developed, always seek advice from your midwife and/or GP.
For essential information that covers a wide range of infections see the Informed Choice leaflet, Infections in pregnancy - prevention, detection and treatment at: www.choicesforbirth.org
Health for parenthood - practical advice on how to maintain a healthy lifestyle
In order to help you decide what is right for you and your baby, you need information about any potential advantages or disadvantages associated with the options available.
Research shows that there are a range of factors that can affect a couple`s ability to conceive, as well as factors that can affect the overall health and well-being of the pregnancy and their baby-to-be. The risk of something going wrong with your baby`s health and development can be reduced by adopting a range of health measures. However, while precautions can be taken, you could find that you have little or no control over other factors. This is particularly so where concerns relate to a condition or disorder that is inherited (genetic).
Having information about these issues gives you an opportunity to consider whether you and your partner need to make any lifestyle and/or health behaviour changes. It can also offer you more time to think about the decisions that you may need to take before you decide to try for a baby.
Thinking about your health before you decide to become pregnant may involve the need to make some changes to your lifestyle. These should not only help you to achieve a healthy pregnancy and healthy baby, but may also have longer-term health benefits for you and your partner which extend throughout your lifetime. The information in this section is about planning a pregnancy as well as care in the early weeks of pregnancy, with a focus on the current guidance being offered in the United Kingdom (UK). It therefore looks at the choices, decisions and responsibilities of parents as individuals, as well as health services in the UK that are available to help, advise and support them. These services have an important role to play where you might need to make specific changes to your health and lifestyle...
Topics covered include:
Being prepared
Start the clock: conception and fertilisation
Skeletons in the cupboard
Your age
Your weight
Sex, drugs and alcohol
If you smoke
Hidden hazards around you.
To view the full text on this topic, either puchase the indivudual topic pdf or sign-up to a Gold Membership. Gold Members have unrestricted access to all 25 information topics.
Epidural pain relief in labour
How much pain we are able to cope with is personal to each of us. The amount of pain that we feel will also be affected by a number of physical and emotional factors, including how tired we are and whether we are feeling scared. It is perfectly normal for expectant mums to feel apprehensive about their labour and baby's birth, particularly where this is their first pregnancy and there may be a ‘fear of the unknown'. The uterine contractions that are part of a woman's labour are painful, which is why the term ‘labour pains' is commonly referred to in much of the pregnancy-related literature. This article provides a brief introduction to the use of epidurals as an option for your pain relief during labour.
So what is an epidural?
An epidural is a method of blocking pain from your contracting womb (uterus) to specific nerve endings; this means that you should no longer feel the pain from uterine contractions during your labour. However, given the technical nature of epidurals and the specialist care and monitoring they require, this form of pain relief is only available in maternity units that also offer anaesthetic services. Epidurals are now used as a method of pain relief in labour by approximately 20% of women; however, while an epidural is the most effective method for ensuring a pain-free labour, it is also one of the most invasive methods currently on offer. It is therefore vital that you and your partner understand the advantages and disadvantages of having an epidural, so that you can make an informed choice about this option when you are in labour.
What does it involve?
An epidural is where an ‘anaesthetic' (an agent that removes all sensation, feeling or pain), or a pain-relieving drug (also called an ‘analgesic'), or both (anaesthetic and analgesic drugs), are inserted into a space around your spinal cord, called the epidural space. A very fine soft plastic tube (called a ‘catheter') is inserted into your lower back and the anaesthetic is then injected through this, which has the effect of numbing the nerve endings and stops you feeling the pain of your uterine contractions, and sometimes back pain also. An epidural will affect how much you are able to move your legs, stand up/weight bear, and walk around, and whether you can feel when your bladder is full and you need to pass urine.
Once inserted, you should feel the benefit of your epidural within 10-20 minutes of having it sited. You may be given a single dose (called a bolus dose) of the pain relieving drug/local anaesthetic, or can receive the drugs via a drip (also known as an ‘intravenous infusion'). In some hospitals you might be offered the use of a hand-held device which means you can control the amount of pain you are feeling; this is done by ‘topping up' the dose when you first begin to feel a return of the pain (this is called patient-controlled analgesia (PCA)). The dose and combination of drugs you are given and how they are used varies considerably between different hospitals. The reason for this is that there is no clear evidence that one method is substantially better than any of the others.
It is not uncommon for women to have very strong feelings against having an epidural when they are in labour. Where this is the case, it can still be helpful to talk with your midwife, GP or your obstetrician, so that any fears you might have about the procedure can be discussed. This can be particularly beneficial where circumstances change in pregnancy or during your labour and you may find that you need to reconsider the options available. Recent labour care guidance advises that adequate pain relief should be made available to all women if the location of their baby's birth and its facilities can provide this. This means that if you do request an epidural, it should be made available to you whether this is very early on in your labour (also known as the ‘latent first stage of labour'), or nearer to the time of your baby's birth.
Most women enter pregnancy having had little experience of painful procedures or hospitals, which is why it can be helpful to discuss your concerns about pain, and how you feel you will cope during your labour well in advance of your baby's due date. To find out more about having an epidural and for information on other options for pain relief during labour visit: www.choicesforbirth.org
Life as a new mum
Becoming a mother is arguably the most major life-changing event in a woman's life; few events are so irreversible and complete. The early weeks and months of parenthood are usually an exciting, happy, and rewarding time, as you and your partner get to know your new baby. However, this period can also be a time of letting go as you say goodbye to perhaps formerly more carefree and spontaneous lifestyles, which were free of responsibilities, for another tiny person. Understandably, this time can be very hard for many couples as they start adjusting to parenthood and the demands of their newborn. You might have had a clear idea of what you thought life would be like with your new baby and may now have discovered that the reality is very different to what you'd anticipated. This mismatch between what you were expecting and the reality of motherhood has been found to affect how well you adjust to being a new mum. In addition, extreme tiredness can make coping more difficult and you may not be able to be the mother that you think you should be. However, you can take reassurance from the knowledge that these are normal feelings and your midwife, health visitor and GP will willingly discuss any concerns that you might have, to support you and help put your mind at rest.
For women in particular, the major life changes and responsibilities that motherhood brings will affect how they feel both physically and emotionally. Alongside the exultant and often overwhelming feelings of happiness associated with being a new mum, the demands of caring for your newborn 24-hours a day can be a real challenge - not to mention totally exhausting. You may find your emotions shifting from highs to lows as you get to grips with being a new mum. Getting to know your baby is likely to bring precious, fulfilling times, as well as emotionally demanding and stressful times. Most mums will doubt their parenting abilities and, because their relationship with friends and social contacts shift, may also feel very isolated. However, you're not alone - the vast majority of new mums find the early weeks of motherhood just as joyful and every bit as tough!
Talk to your partner, family and friends and let them know how you're feeling; don't be afraid to ask for help or advice whether from family members, your midwife, health visitor or GP. Parenthood is a steep and progressive learning curve. As you get to know your baby and become more adept at recognising their needs, you will feel a lot more confident about being competent to care for them. Going along to your local postnatal group, postnatal exercise classes and/or a breastfeeding support group are all great ways to meet other new mums. It can also be very reassuring to know that others are experiencing the same challenges as you and you'll probably make some good friends along the way.
Depending on the type of labour and birth that you had, you are likely to be feeling physically exhausted during the first few postnatal days. Everybody - friends, neighbours and family, will probably be eager to visit you and welcome your new addition. However, in all the excitement and jubilation, they often forget that you have recently been through one of the most physically gruelling experiences in a woman's life. You may also be getting to grips with breastfeeding, as well as coping with the hormonal changes that take place as your body starts to return to its non-pregnant state. These hormonal changes can leave you feeling emotional, bewildered and tearful, and are often referred to as the ‘Baby Blues'. However, they're usually short-lived and you should start feeling a lot brighter within a few days. If this isn't the case, it is important that you talk to your midwife, health visitor or GP to let them know how you are feeling.
Caring for your newborn baby is a full-time ‘around the clock' responsibility, meaning significant sleep deprivation, so don't be afraid to limit visitors in the early weeks, or tell them when it's time they should be leaving. You need to get as much sleep and rest as you can, so when your baby is asleep you should try to seize the opportunity to get some shut-eye yourself. This may only be for a few minutes at a time, but they all add up and everyone recognises the importance of ‘power-naps'. Help and support around the house can also be invaluable at this time, whether your mum is staying with you, or you have friends and family popping in regularly to help with grocery shops, the cooking and/or general household chores. If they want to ‘mother' you, let them; by relinquishing the usual household responsibilities, you'll be able to focus solely on your baby's care needs and give yourself the time you need to recover from the birth. This recovery time usually takes around six to eight weeks, which coincides with the six-week postnatal check, normally done by your GP. Maintaining a healthy diet and drinking plenty of water will help with the healing process, particularly if you've had a caesarean or a tear or cut (episiotomy) at the birth. A well-balanced diet will also ensure that you have the stamina to cope with the added demands of your young baby.
Where you have any concerns whatsoever about how you're feeling, contact your midwife or doctor immediately for their advice. They can check you over to make sure that your body is healing and recovering as it should be.
While some women may have previously worked in a high-flying job or established career, the transition from familiar and organised work routines and intellectual stimulation to the disordered and randomised chaos of the early weeks of becoming a mum can be rather a shock. Some mums appear to breeze through the early weeks of parenthood but others may struggle to adapt to the disturbed nights, what can feel like an endless routine of nappy changes and feeding, and their lost social life. Not surprisingly, at some point, all mums will find that being a parent is actually pretty tough. As such, it is important to take things at your own pace. Try and get outdoors for a few minutes each day, whether this is sitting in the garden, or taking your baby for a walk in their pram. Listen to your body and do activities that are comfortable. Involve your partner - where you are breastfeeding your baby, there are still plenty of things that your partner can do to get involved with baby care; nappy changes, bathing, play time, or generally keeping an eye and ear open while you enjoy a well-earned nap.
As you and your partner get to know your new baby, so you will both gain confidence in caring for them and will start to settle into your own familiar routines. After this time, both of you may feel more confident to make time to pursue the activities and interests that were an important part of your life before you became parents. One idea is for each of you to reserve one evening a week, so that while one has time for themselves, the other can babysit. This might mean just being able to enjoy a long, leisurely, uninterrupted soak in the bath! It is also important to make time for each other. Adult conversation, listening, responding to, and supporting each other, and generally keeping the romance alive in your relationship, can be easily eclipsed by the demands of a young baby. Good communication is important in any healthy relationship and as you will both be feeling over-tired, patience and sensitivity is vital at this time. Maintaining an intimate relationship can also be difficult, but it's worth looking at how you can remain intimate with each other until you're ready to think about sex again.
Getting used to life as a new mum can be a long and challenging process; however, time with your young baby will pass incredibly quickly so it is important that you take the time to enjoy them. While grandparents, friends and family are likely to offer well-intentioned advice or have their own expectations, what is most important is that you and your partner decide what both of you want for your new family!
Registered office: 9 Elmdale Road, Clifton, Bristol. BS8 1SL. Email: support@choicesforbirth.org. Tel: 0800 581 009.
Terms & Conditions
The MIDIRS Informed Choice website is provided for reference information only. MIDIRS is not responsible or liable for any diagnosis made by a user based on the content of the website. Although great care is taken to ensure reference information is both suitable and accurate, MIDIRS is not liable for the contents of any external internet sites referenced, nor does it endorse any commercial product or service mentioned or advised on any of these sites.
