Issues & Extra Support

Most babies aren’t harmed if you get an infection during pregnancy but some bugs can have serious consequences, such as toxoplasmosis which is caused by an organism in cats’ faeces. Also our consultants, obstetricians and midwives endorse the guidance by the Chief Medical Officers, NHS Choices and the Royal College of Obstetricians and Gynaecologists that all pregnant women should be offered the Swine Flu vaccine together with the seasonal flu vaccine and we encourage women in our care to make the necessary arrangements with their GP.

Most women gain between 10kg and 12.5kg (22-28lb) while pregnant but much of that extra weight is due to the baby growing, or natural changes in the body. Try and keep active and limit your intake of fatty foods and sugar-laden snacks and, if you are concerned, talk to your midwife or GP.

Rather than just using weight to assess who is at risk, we use BMI (Body Mass Index), which takes into account people’s weight and height. It is a nationally recommended way of assessing health issues associated with weight. Internationally, a figure of 19-25 is classified as normal, 25-30 is overweight, 30-40 is obese and over 40 is very obese.

Liverpool Women’s provides a specialist service to woman who at the start of their pregnancy are found to have a body mass index of 40. They will be seen in a specialised clinic run by doctors and midwives.

Pregnant women with a BMI of 30 or more are more likely to have:

Diabetes in pregnancy
High blood pressure problems
Difficulties with assessing the growth and well being of the baby
Caesarean sections
Complications associated with caesareans or forceps deliveries
A higher risk of developing clots in the legs or lungs
Anaesthetic complications
Antenatal care: Women with a BMI of 35 or over will be referred for consultant-led care and will be offered a glucose tolerance test (GTT) around 28 weeks of pregnancy to assess their body’s ability to handle sugars and detect any tendency towards diabetes during pregnancy. Women with a BMI of 40 or more will also be referred to specialist consultant- led care and an antenatal clinic with a specialist midwife. Ideally women with a BMI of 30 or more should have taken folic acid 5mg up until 12 weeks. Some women may also be prescribed a vitamin D supplement and aspirin during pregnancy.

Scans: Scanning the unborn baby of a woman with a high BMI is technically more difficult as much of the power of the ultrasound waves is absorbed by the mother’s tissues. Therefore the images obtained may not be as accurate as those normally obtained. This may mean a reduced ability to detect problems, for instance at the 20 week anomaly scan. Further scans for growth may be arranged by the consultant or midwife, if they are concerned about the growth of the baby as pregnancy progresses. A scan may also be performed at 36 weeks of pregnancy to confirm which way the baby is lying and make a plan for the birth.

Labour and birth: If you have a BMI between 30 and 39 and have been fit and well during your pregnancy, you will be offered to give birth in the midwife-led unit, where normal birth is encouraged. You will also have the choice of a water birth if you wish. If your BMI is greater than 40 you will be advised to give birth in the delivery suite.

Pain relief in labour: There are a number of options available to you for pain relief during labour. These include entonox (‘gas and air’), water (if you are on the midwife-led unit), diamorphine and an epidural. Being obese can mean there is an increased risk of complications if you have an anaesthetic during labour and birth (epidural or spinal). Therefore, if your BMI is 40 or more, an appointment will be made for you to see an anaesthetist during your pregnancy, who will discuss this with you and make a plan for when you are in labour, should you wish to have an epidural.

Postnatal care: If you have a caesarean section to give birth to your baby, recovery following the operation may be slower if your BMI is 30 or more. You will be given antibiotics when you are in theatre to help prevent any infections. You are also encouraged to mobilise out of bed as soon as possible to help reduce the risk of blood clots developing in your legs or lungs and you may also need to have a daily injection to ‘thin’ your blood to help prevent this. These injections will be for seven days after you have had your baby.

Every cigarette a pregnant woman smokes harms her baby. Cigarettes contain over 4,000 chemicals and restrict the essential oxygen supply to the baby, forcing its heart to beat harder each time you smoke. Babies of mothers who smoke are, on average, 200g (about 8oz) lighter than other babies. They may have problems during and after labour and are more prone to infection and at a higher risk of cot death. The good news is that by quitting, the benefits to you and your baby begin almost immediately, with carbon monoxide and chemicals clearing from the body and oxygen levels returning to normal. Take advantage of the free NHS support that is available, as you are four times more likely to quit successfully this way. Call the NHS Pregnancy Smoking Helpline on 0800 169 9169 or we can put you in touch with the support provided by your Primary Care Trust. In some instances, patients also receive one-to-one support from our enhanced midwives.

When you drink, alcohol reaches your baby through the placenta. Too much exposure to alcohol can seriously affect your baby’s development. Drinking is not just dangerous for the baby in the first three months – alcohol can affect your baby throughout pregnancy. A particular group of problems known as Fetal Alcohol Syndrome (FAS) can affect babies of women who have drunk heavily through pregnancy. These include restricted growth, facial abnormalities and learning and behavioural disorders. You can get help from our team of enhanced midwives by seeking a referral through your GP. Confidential help and support is also available by contacting Drinkline on 0800 917 8282.

Illegal drugs such as cannabis, ecstasy, cocaine and heroin can also harm your baby. It’s important to talk to your doctor or midwife so they can provide support and advice to help you stop. Some dependent drug users initially need drug treatment to stabilise or come off drugs to keep the baby safe. You can get help from our team of enhanced midwives by seeking a referral through your GP from any of the midwives in the Antenatal Clinic at the hospital or through your community midwife. Help and support is also available from Narcotics Anonymous or talk to FRANK, the drugs information line on 0800 77 66 00.

Domestic abuse during pregnancy increases the risk of miscarriage, infection, premature birth, low birth rate, fetal injury and fetal death. If you are pregnant and are being abused - whether physically, sexually, emotionally or psychologically - there is help available. You can get help from our team of enhanced midwives by seeking a referral through your GP from any of the midwives in the antenatal clinic at the hospital or through your community midwife. We also run a domestic abuse drop-in centre every Monday afternoon in the Parent Education Room of our Antenatal Clinic within the Crown Street hospital or you can call the confidential National Domestic Violence Helpline on 0808 2000 247.

At Liverpool Women’s, we have a team of enhanced midwives that give extra support to vulnerable pregnant women and their families. The team is trained in dealing with women and families who have complex and often multiple needs around substance misuse, mental health, domestic abuse and other issues. You can get help from our team of enhanced midwives by seeking a referral through your GP from any of the midwives in the Antenatal Clinic at the hospital or through your community midwife.

Pregnant women suffering specifically from mental health issues can get support from our Perinatal Mental Health Team. The team runs two morning clinics, a weekly clinic on Tuesdays at Liverpool Women’s Crown Street hospital and a monthly clinic on Thursdays at the Aintree Centre for Women’s Health. Please call 0151 708 9988 for further information.