Pregnancy and Postpartum Care

Pregnancy

Should I be taking Prenatal vitamins?

1. Folic Acid: You should be taking a folic acid tablet daily during your pregnancy, ideally before you’re pregnant, up until you are 12 weeks pregnant. This can help prevent any birth defects such as spina bifida. Don’t worry if you did not start taking folic acid supplements before you conceived, but you should start as soon as you find out you are pregnant. You can buy folic acid (400 micrograms) over the counter, or in some cases, depending on medical history, you may need a prescription for a higher dose (5milligrams). Your GP will be able to assist you further with this.
2. Vitamin D: It is recommended that whilst you are pregnant and breastfeeding that you take a vitamin D supplement (400IU) every day during the months of September to March. Most antenatal vitamins contain this dose of Vitamin D. This is to help regulate the levels of calcium and phosphate in the body which are essential in keeping your bones, teeth, and muscles healthy. During September to March, we don’t Make enough Vitamin D from sunlight alone, hence the need for a supplement.

Women at risk of Vitamin D deficiency are advised to have a blood test to check their Vitamin D level in early pregnancy. If a blood test shows a vitamin D deficiency, then the correct dose of Vitamin D will be prescribed. You can request a blood test from your doctor or midwife.

3. Calcium: Calcium is important for making your babies bones and teeth. You can get calcium from food sources like milk, cheese and yoghurt, green leafy vegetables, tofu, bread (or anything made with fortified flour).

Diet and pregnancy:

Having a healthy diet during pregnancy is important to ensure you get the right balance of nutrient that you need to help your baby develop and grow.

However, you don’t need to ‘eat for two’.

Food to avoid: Food such as brie, camembert, soft blue cheese, or other products made from unpasteurised milk should be avoided as they may contain Listeria bacteria which can lead to an infection called Listeriosis.

Listeria bacteria can also be found in ready-to-eat cold-smoked or cured fish, so it’s recommended that these are also avoided in pregnancy. Listeriosis can lead to miscarriage, still birth or make your newborn very unwell.

Also avoid raw or uncooked meat, liver, pate including vegetarian pate and game meats (i.e goose, pheasant), There is a slight risk of Toxoplasmosis if you eat raw or undercooked meat and can lead to miscarriage.

Other foods that you should avoid are swordfish, shark, raw shellfish as these can also lead to food poisoning and listeriosis which, as mentioned above, can be harmful to your unborn baby.

Vaginal changes in pregnancy:

Your labia majora (outer lips) and minora (inner lips) may look ‘puffy’ or swollen and darken in colour due to increased blood flow – this will usually resolve after giving birth and go back to its ‘normal’ colour. Occasionally your labia majora may slightly retract

and change shape which could make labia minora look larger or expose them for the first time – don’t worry, this is common during pregnancy.

You may experience increased amounts of vaginal discharge when you are pregnant. This helps to keep your pH balanced and maintain healthy levels of bacteria in your vagina. Products such as Femfresh Daily Intimate Wash or Femfresh 0% sensitive can be used to help maintain your pH and keep your intimate skin feeling fresh and cared for.

Discharge during this time is usually thin, milky and have a mild odour.

If you notice that your discharge is thick, lumpy (like cottage cheese), with a fishy odour and you are itching down below, then do speak to your midwife or doctor.

Breast changes in pregnancy:

During pregnancy, your hormone levels will change to help prepare your body to grow a baby, give birth and breastfeed. These changes can lead to changes in your breasts such as tingling, swelling, feeling heavy or tender. Your nipples may become larger during pregnancy and more sensitive; your areola may darken and the little bumps on your areola may get bigger. After about 3 months of pregnancy your breasts will start producing colostrum (first milk) which can sometimes leak from the nipple and is usually a pale-yellow colour.

Wear a comfortable, correctly fitting bra to aid comfort during your pregnancy. Ideal one made from a breathable fabric with wide straps that won’t dig into your shoulders and one that can adapt to your changing breast size.

During your pregnancy, if you find a lump in your breast do not ignore it! In the majority of cases a breast lump is not sinister and is usually a cyst, milk filled cyst, or harmless hard lumps called fibroadenomas. However, any lump should be checked by a doctor to rule out breast cancer.

Postpartum

C-section recovery tips:

After giving birth via a caesarean section, you may be too exhausted to absorb all of the information your healthcare provider explained to you about your C-section recovery. So, here’s a few tips:

1. Don’t be afraid to take painkillers, as long as there are no contraindications of course. Talk to your doctor or practice nurse during your post-natal check which painkiller is best for you.
2. Wear loose fitting clothing such as high waisted tracksuit bottoms, comfortable high waisted trousers, or continue wearing your maternity clothing during your recovery. This will prevent clothing rubbing against your C-section scar. Also, wear underwear that won’t rub against your C-section scar, loose fitting granny-panties may be a great choice during your recovery.
3. Look after your wound! You should gently clean and dry your wound every day and watch out for signs of infection. You should contact your midwife or GP if your wound becomes more red, painful, swollen or produces an offensive odour, or if you develop a fever – these are signs of infection and will need treatment.

What will happen at my post-natal check?

You will be offered a post-natal check 6 to 8 weeks after your baby is born to check that you are feeling well and that you are recovering properly. You can request a

female doctor for this appointment if it makes you feel more comfortable. Your baby will also be offered a 6 to 8 weeks check at the same time.

You will be asked about your vaginal health such as discharge and whether you have had a period since giving birth.

If you have had a caesarean section, have had an episiotomy (a cut made between the vagina and anus during childbirth) or a perineal tear then you will be offered an examination to see if your stitches have healed or are healing properly.

Your post-natal check is a good time to talk to the doctor about how you feel. If you’re feeling sad or anxious, as looking after a newborn baby can be very overwhelming, it’s good to speak to a doctor as there is help available to you.

Do I need a cervical smear test after I give birth?

If you are 25 years and over and have not had a smear test in the last 3 years (in England) then yes, you will be offered a cervical smear test. Normally, you should get this done when you are 12 weeks post-natal.

Contraception after giving birth:

There are lots of different types of contraception methods to think about after giving birth. The most effective method after giving birth is LARC (Long-Acting Reversible Contraception) such as Intrauterine contraception (IUD / Coil) and Progesterone only implant (IMP) which can be inserted immediately after birth.

If you are breast feeding your baby, progesterone only method of contraception may be best for you as they have no adverse effects on lactation, infant growth, or development. Your doctor will discuss methods of contraception with you during your post -natal check.