Weight management
Weight management
Monitoring your baby’s growth
Monitoring your baby’s growth
During pregnancy your midwife or doctor will be checking to ensure that your baby is growing well. This is done at defined stages in the pregnancy, either by measuring your bump with a tape measure or by routine ultrasound scans. If there is a concern about the growth of your bump you may be referred for a growth scan. Your baby’s progress is plotted on a chart by the person taking the measurement (midwife, doctor or sonographer).
If your baby is found to be growing smaller than expected you may require additional ultrasound scans and antenatal appointments to monitor your baby’s wellbeing.
Coping with Covid
Coping with Covid
What should I do if get COVID-19 whilst pregnant?
If you test positive for COVID-19 outside of a hospital setting, you should contact your community midwife or maternity team to make them aware of your diagnosis. If you have no symptoms or mild symptoms, you will be advised to recover at home. If you have more severe symptoms, you might be treated in hospital. In most cases Covid during pregnancy is a mild viral illness. It is advisable to keep well hydrated and to monitor your temperature. Low temperature (less than 36 degrees) or high temperature (above 37.5 degrees) should be notified to your maternity team. If you feel your symptoms are worsening or if you are not getting better, you should contact your maternity care team, your GP, or use the NHS 111 online service/NHS 24 for further information and advice. In an emergency, call 999. If you develop more severe symptoms or your recovery is delayed, this may be a sign that you are developing a more significant chest infection that requires specialised care. This advice is important for all pregnant women/birthing people, but particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. This includes women who are in their third trimester, from a Black, Asian or minority ethnic background, over the age of 35, overweight or obese, or have a pre-existing medical problem, such as high blood pressure or diabetes. If you have concerns about the well-being of yourself or your unborn baby during your illness, contact your community midwife or, if out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.I am not a UK resident
I am not a UK resident
If you are a non-UK resident visiting from overseas, you will need to provide information in order to receive NHS treatment (including maternity care). This will include proof of all the following:
- your identity
- your permanent address
- permission for you to live/work in the UK.
Portal: I am not a UK resident
Group B Streptococcus (GBS): Frequently asked questions
Group B Streptococcus (GBS): Frequently asked questions
How is the diagnosis made?
Group B streptococcus (GBS) is a bacterium that lives in the body and causes no harm to you; it can cause a serious infection in a baby around the time of birth. GBS is carried in the vagina or rectum of up to 40% of women. It can be found on a vaginal or rectal swab or a urine test. In the UK there is no current screening programme for the carriage of GBS.What does this mean?
For me:
If you are found to carry GBS in your current pregnancy you will be recommended to receive intravenous antibiotics during labour, to minimise the chance of your baby developing a GBS infection. If GBS is found in your urine during pregnancy, you should receive antibiotic treatment.For my baby:
Most babies that come into contact with GBS during birth are well and do not develop GBS infection. If a baby does show signs of GBS infection, with prompt treatment most babies will recover completely. Rarely, GBS infection can be the cause of a neonatal death or longer term disability.What will the medical team recommend?
Intravenous antibiotic prophylaxis (IAP) for you during labour. If there are any concerns about your baby after birth, the neonatal team may recommend they receive antibiotics as well.What are the ‘red flag’ symptoms/concerns, which mean that they should be reported immediately?
If you are known to carry GBS, you should inform your maternity unit straight away when your waters break, or if you are having regular labour pains.Timing of birth
If your pregnancy progresses to term (after 37+0 weeks) IAP should be commenced as soon as labour starts or when your waters break, if they do so before labour. If your waters break before labour, induction of labour will be recommended to reduce the time your baby is exposed to the GBS bacteria.How may this impact my birth choices?
IAP is not available at home, or in some midwifery led units, so if you agree with the recommendation to receive IAP you may need to plan labour and birth in an obstetric unit.How may this affect care after the birth?
Depending on how long your receive IAP for before your baby is born, your baby may need some additional observation in hospital before you are able to go home.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
In a future pregnancy you will be offered IAP again in labour, or testing for GBS carriage 3-5 weeks before birth is expected.Where can I find out more information about this condition?
Royal College of Obstetricians & Gynaecologists: GBS in pregnancy and newborn babiesSafety in NHS services
Safety in NHS services
This document outlines some recent NHS initiatives aimed at maximising safety, whilst keeping quality of care at the centre of maternity services. This will help you understand how care is designed and how you can seek more support.
NHS Long Term Plan (2019) aims to:
- Improve access to support for mental health with the same urgency as physical health for birthing people, their partners and families. Look out for local information in the app or speak to your healthcare professional.
- Improve safety for baby through the NHS England Saving Babies’ Lives Care Bundle standards, by:
- 1. Offering choice and personalised care with respect for autonomy and decisions.
- 2. Offering support to reduce smoking.
- 3. Undertaking risk assessment and appropriate management of babies who might be at risk of growth restriction (slow growth).
- 4. Informing pregnant people of the importance of promptly reporting a reduction in baby’s movements.
- 5. Undertaking effective monitoring of the baby’s wellbeing during labour and birth.
- 6. Reducing the number of preterm births and optimising care when preterm delivery cannot be prevented through:
a) Prediction
- Undertake a risk assessment and refer to the low, intermediate or high-risk pathway and develop a personalised care plan for the birthing person.
b) Prevention
- Assess if aspirin is required from 12 weeks of pregnancy.
- Support to stop smoking.
- Offer a urine test at the first antenatal appointment (Booking appointment) to screen for urine infection. If treatment is indicated, a repeat urine test should be taken to ensure infection has cleared up.
c) Preparation
- Optimise place of birth to ensure that birth occurs in a maternity unit that has the appropriate neonatal care services to support your baby.
- Birthing people are offered corticosteroid injections between 24 and 33+6 weeks, optimally at 48 hours before birth. This is to reduce the risk of your baby having breathing difficulties, gut problems, or bleeding in the brain.
- Birthing people who are in established labour, or who are having a planned preterm birth within the following 24 hours, are offered magnesium sulphate infusion between 24+0 and 29+6 weeks of pregnancy (or considered for this infusion between 30+0 and 33+6 weeks of pregnancy) to reduce the risk of cerebral palsy in babies.
- Improving general health outcomes for you and your baby. NHS England is funding a 6-8 weeks mother’s health check with your General Practitioner (GP)in addition to the baby check to assess your ongoing health and wellbeing needs.
Ockenden Report (2020)
This report aims to improve safety for you through pregnancy and post-birth through:- Enhanced safety in maternity units by undertaking a risk assessment at each contact with the birthing person to ensure that care is tailored to your needs.
- Maternity services must ensure that birthing people, their partners and their families are listened to.
- Care in complex pregnancies is managed with appropriate expertise and discussion and referrals made to specialist centres where necessary.
- Maternity services follow best practice in monitoring of the baby in labour.
- Provide access to accurate information to facilitate informed choice of intended place of birth and type of birth.
- Ensure there is access to translation services if communication in English is difficult.
Shared decision making
- All professionals should support you to make informed, value-based decisions by:
- introducing you to the options available, including their advantages and disadvantages
- helping you to explore these in the context of your preferences
- empowering you to make decisions – all professionals should support you to make informed, value-based decisions by:
- Ask yourself these three questions:
- What are my options?
- What are the pros and cons of each option for me?
- How do I get support to help me make a decision that is right for me?
Systemic Lupus Erythematosus (SLE): Frequently asked questions
Systemic Lupus Erythematosus (SLE): Frequently asked questions
Most people with Lupus can safely get pregnant and with appropriate support and care can have normal pregnancies and healthy babies. However, pregnancy with SLE carries a higher risk to mother and baby compared with pregnancy in women with no medical concerns. For this reason, your maternity team will consider such pregnancy as ‘high risk” to ensure that care is appropriate for your clinical condition and involves several healthcare professionals. We recommend that you access the BUMPS website (Best Use of Medicines in Pregnancy), for information and advice relating to medications taken prior to and during pregnancy. It is important not to stop any medication before checking with your doctor as this may be harmful to you or your baby.What does this mean for my pregnancy?
For me:
In general, pregnancy does not cause flares (worsening) of SLE, but higher risk of flares is noted in women who have had flares within the six months prior to pregnancy, have had very active disease, or if SLE treatment has been stopped. If flares happen, they often occur during first or second trimester of pregnancy or in the first few months after the birth. It is vital to report flares promptly as they increase the risk of complications. Complications can include pre-eclampsia, blood clot in deep veins or lung, severe infection, and stroke.For my baby
SLE in pregnancy increases the risk of miscarriage, preterm birth, slower growth in the womb (intrauterine growth restriction) and stillbirth, compared to a woman with no medical concerns. Factors such as previous miscarriage, antiphospholipid syndrome, active Lupus before or during pregnancy, kidney disease and pre-eclampsia increase this risk. Your blood tests will include checking your antibodies status for anti-Ro and anti-La antibodies. If these are present, there is a small chance these antibodies may cross the placenta and therefore could affect the baby causing a 2% risk of congenital heart block and 5% risk of cutaneous neonatal lupus (where certain antibodies cross from mother to baby). However, having neonatal Lupus does not appear to increase the chance of your baby developing SLE in adult life.What will the medical team recommend?
The aim will be to personalise the care to you and your clinical condition. You will be seen more frequently in a specialist consultant-led maternal medicine antenatal clinic and offered regular scans to monitor baby’s growth, alongside the care provided by your midwifery team. If you have Ro and La antibodies, the team will organise a specialist heart scan for your baby (echocardiogram). You will be advised to take 75mg of aspirin each night from 12 weeks until 36 weeks to reduce your risk of pre-eclampsia. You may require calcium supplementation. Since there is an increased risk of developing a blood clot (thrombosis) you may be advised to take additional medication such as blood-thinning injections. Other medical treatment will be tailored according to your disease severity and will be discussed in detail by your clinical team.What tests will/may be considered? How often may they be needed?
At the start of pregnancy, baseline blood tests will also include kidney and liver function tests, antibody tests like anti-Ro and La antibodies, if these haven’t been done previously, and other disease relevant tests. Urine will be tested for protein. Based on your past medical history, other tests like echocardiogram, lung function test may be considered. If you are at risk of Vitamin D deficiency, these levels will be also be checked. Throughout the pregnancy, your blood pressure, urine protein levels and blood results will be closely monitored. More frequent blood pressure and urine checks will happen if you have hypertension, pre-eclampsia and/ or renal disease.What symptoms and signs should I be looking out for?
Differentiating between pregnancy-related symptoms and those of SLE can be difficult. You may notice a range of changes throughout pregnancy that may be unrelated to your SLE, but it is important to mention any symptoms that are worrying you. You must try and avoid triggers that you may know can set off your flare ups.What are the symptoms/concerns, which mean that they should be reported immediately?
Flares of SLE is when your symptoms worsen and make you feel unwell. Often, this involves symptoms you have noticed previously, and some people may also develop new symptoms. Common symptoms that indicate a flare include raised body temperature not due to an infection, painful and swollen joints, increase in tiredness, rashes, ulcers in your mouth or nose and increased swelling of your legs. You should also immediately report symptoms like shortness of breath, chest pain, heart palpitations, painful swollen calf, feeling unwell; severe headache, seeing flashing lights or experiencing pain in upper tummy, contractions, vaginal bleeding, rupture of membranes or reduced baby movements.How are recommendations made regarding my care?
Treatment options
There are overarching guiding principles on the use of medications during pregnancy and breast feeding. Based on the individual clinical condition medications will vary. In general, SLE medications that are safe in pregnancy, during breast feeding and required to maintain remission and/or treat flares include hydrochloroquine, azathioprine, cyclosporine and tacrolimus. Aspirin and paracetamol are safe in pregnancy. Corticosteroids are safe to control active disease. Medications to control high blood pressure may become necessary.Timing of birth
People with SLE are more likely to have a preterm birth, that is birth before 37 weeks. The risk is particularly increased in the presence of active Lupus, kidney disease, hypertension and pre-eclampsia. Birth may start spontaneously or may be induced due to concerns relating to your or your baby’s health. Your team will discuss the timing of birth with you, considering your and your baby’s health.How may this impact my birth choices?
For most people with SLE vaginal birth should be possible, but choices will be influenced by how this pregnancy progresses, your previous births and other possible concerns. Discuss your personal birth preferences with the team.How may this affect care after the birth?
Your team should make a care plan with you relating to your and your baby’s care after the birth. You will be given guidance on medications that need to continue and will be safe to take whilst breastfeeding. There is an increased risk of SLE flare after the birth and you must report these immediately so that the medications can be adjusted. You will require blood thinning medications as the risk of blood clots increases significantly after the birth. These may need to continue for up to six weeks after the birth.What will this mean for future pregnancies?
It is important to plan all future pregnancies to improve your chances of a successful pregnancy. It is advisable to wait a year before trying for another baby and to conceive when your SLE has been inactive for at least six months on treatment. You must see your doctor, three to six months before you plan to start trying for a pregnancy to enable a full health assessment and medication plan. Use contraceptives till you are ready to try for another pregnancy.Crohn’s Disease, Ulcerative Colitis and Inflammatory Bowel Disease (IBD): Frequently asked questions
Ulcerative Colitis and Inflammatory Bowel Disease (IBD): Frequently asked questions
How is the diagnosis made? This was made before pregnancy. All women with IBD, Crohn’s Disease or Ulcerative Colitis should receive preconception counselling to optimise their health before pregnancy.What does this mean?
For me:
You are at risk of preterm delivery and developing flares (worsening) of your symptoms. You may need to attend more hospital visits during pregnancy. You are at higher risk developing of pre-eclampsia.For my baby:
Your baby is at risk of preterm delivery.What will the medical team recommend?
You will be seen more frequently in a specialist consultant-led maternal medicine antenatal clinic.What tests will/may be considered? How often may they be needed?
You may need further tests if your symptoms worsen.What symptoms and signs should I be looking out for?
Abdominal pain, blood and/or mucus in your stool or increased frequency of passing stool (poo).What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you have a worsening (flare) of your symptoms.How are recommendations made regarding treatment options?
Most of the drugs used are safe during pregnancy. You may be on special medication (known as a biologic) for your condition. If you require these during the third trimester of pregnancy you will need to delay giving your baby live vaccines, this includes the BCG and rota virus until six months after birth. Be sure to discuss this with your medical team after the birth of your baby.How are recommendations made regarding timing of birth?
By 36 weeks your team should be working with you to plan your delivery.How may this impact my birth choices?
If you have had previous operation for your condition you may need to birth your baby by caesarean-section.How may this affect care after the birth?
A birth plan prior to delivery should have been agreed to ensure you are on medication that are safe to use during breastfeeding. Your medication may need to be increased or changed if your symptoms worsen after birth.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Optimise your health and your symptoms between pregnancies. What will this mean for future/ my long-term health and how can I influence this? Contraception and a follow up plan should be made to optimise your health for future pregnancies.Intrahepatic Cholestasis of Pregnancy (OC): Frequently asked questions
Intrahepatic Cholestasis of Pregnancy (OC): Frequently asked questions
How is the diagnosis made?
If you have itching without a rash in your pregnancy, then you will have blood tests including a liver function and bile acid level. Raised bile acids will confirm the diagnosis of Intrahepatic Cholestasis of Pregnancy (ICP) which is also known as Obstetric Cholestasis (OC).What does this mean?
For me
You may have severe itching, often starting on the hands and feet but can affect anywhere on your body. Your doctor can give you medication to calm the itching sensation but it will not disappear until you have given birth.For my baby
If the bile acids are very high (greater than 100) then there is an increased risk of the baby passing away whilst in the womb, so it is really important that the level of bile acids are monitored every week once the diagnosis is made or as long as you have itching.What will the medical team recommend?
Your medical team will recommend weekly blood tests at least weekly whilst you have symptoms of itching, and once you have a diagnosis of ICP.What tests will/may be considered? How often may they be needed?
Blood tests for your liver function and the concentration of bile acids in your blood will be checked regularly.What symptoms and signs should I be looking out for?
Itching in pregnancy without a rash, particularly if it occurs on the palms of your hands or the soles of your feet.What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If your baby isn’t moving like normal, then you should be seen at the hospital immediately.Likely recomendations
Treatment options
If your bile acids are more than 40 mmol/L, then your doctor may recommend treatment with ursodeoxycholic acid or, in severe cases, other medication such as rifampicin. Your itching can be treated with antihistamine tablets and menthol skin creams. Your medical team will provide a prescription if these medications are recommended to you.Timing of birth
This will depend on the level of your bile acids but would normally be after 38 weeks if the bile acids are less than 100 mmol/L, and around 36 weeks if your Bile Acids are 100 mmol/L or higher.How may this affect my birth choices?
Continuous monitoring of your baby’s heartbeat in labour will be recommended whether you labour starts naturally or you are are induced, this is because ICP can affect your baby’s heart function.How may this affect care after the birth?
If you have had abnormal liver function, you will need to see your GP to retest your liver function levels to ensure they have returned to normal. Your baby will be reviewed by a baby doctor after birth to ensure all is well.What will this mean for future pregnancies? How can I reduce my risk of this happening again?
There is around 50% chance of having ICP in a subsequent pregnancy so you will be asked to keep a close eye out for symptoms of itching and your doctor may arrange some extra blood tests as part of your monitoring in pregnancy.What will this mean for future/my long-term health and how can I influence this?
ICP does not cause long term health problems but caution is recommended before taking the combined oral contraceptive pill. There is a strong genetic link so you may want to warn your sisters and daughters as they may also be at risk of having this condition in pregnancy.Pre-eclampsia during pregnancy: Frequently asked questions
Pre-eclampsia during pregnancy: Frequently asked questions
How is the diagnosis made?
Pre-eclampsia is a condition that only occurs in pregnancy and usually after 20 weeks. It causes high blood pressure (or makes existing high blood pressure worse) and leaky kidneys with protein in the urine. The diagnosis is made based on symptoms you may experience, blood tests and urine tests.What does this mean?
For me
The only cure for pre-eclampsia is giving birth to your baby (and placenta) but the timing of birth needs to be balanced with how unwell you and/or you baby are and what early birth would mean for your baby. You may experience headaches, blurred vision, vomiting, swelling of your hands and face or feel generally unwell. At worst, pre-eclampsia can cause kidney or liver failure, blood clotting problems and seizures.For my baby
Pre-eclampsia affects the way the placenta works and can cause babies not to grow well in the womb and need to be born early. Babies born early may need to spend time on the Neonatal Unit to help them with breathing, feeding and temperature control. Sadly, some babies don’t survive in the womb because of pre-eclampsia.What will the medical team recommend?
Your medical team will recommend regular checks and occasionally admission to hospital for very close monitoring. You will have regular blood tests to check your kidneys, liver and blood and your blood pressure will be monitored regularly. Extra scans of your baby will be recommended to check that they are growing well in the womb. If you develop pre-eclampsia before 37 weeks of pregnancy, then you may give birth earlier or be recommended to have labour induced at 37 weeks. If you develop pre-eclampsia after 37 weeks, induction of labour will be recommended straight away. This may be a difficult time for you and your family so it is important to have regular and open conversations with your medical team.What tests will/may be considered? How often may they be needed?
The amount of protein in your urine will be tested alongside tests of your blood, kidney and liver function. The blood test called Placental Growth Factor that shows how well the placenta is working and helps doctors and midwives make the diagnosis of pre-eclampsia before 37 weeks.What symptoms and signs should I be looking out for?
Headaches,swelling in your hands and face, blurred vision, pain in your tummy, vomiting, or your baby moving less than is normal.What are the ‘red flag’ symptoms/concerns, which should be reported immediately?
If your baby isn’t moving as normal, then you should be seen at the hospital immediately. If you have any of the symptoms of pre-eclampsia listed above then you should contact your maternity unit immediately.Likely recommendations
Treatment options
Tablet treatment for your blood pressure will be recommended if your blood pressure reading is more than or equal to 140/90 mmHg The tablets most commonly used are:- Labetalol
- Nifedipine
- Methyldopa
Timing of birth
This will depend on how well you and your baby are in the pregnancy. From 37 weeks, induction of labour will be recommended as the risks of remaining pregnant for you and your baby are higher than if you give birth after this time.How may this affect my birth choices?
Continuous monitoring of your baby’s heart beat in labour will be recommended whether you labour spontaneously or are induced, this is because the placenta may be working less well and we would not want to miss changes in the heart rate that would indicate the baby is not coping well with labour. This is available in hospital on the labour ward.How may this affect care after the birth?
- You will need to have your blood pressure checked very regularly and stay in the hospital for at least 24 hours after you give birth
- Any blood pressure treatment will be switched to those suitable for breastfeeding (enalapril or amlodipine)
- You may need to have magnesium and restrict how much fluid you drink
- You will need to see your GP for ongoing monitoring of your blood pressure and treatment after the birth
