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Q&A: Ask An Obstetrician (January 2013)

We’ve been joined by Consultant Obstetrician Dr Donald Gibb for our first Q&A.

He’s provided answers to the questions on your mind, about pregnancy, childbirth, and serious issues, such as screening for Down Syndrome in early pregnancy.

dr-donald-gibb

Azeez asks:

“I’m 18 weeks pregnant and I’ve been feeling pains all over my body for the past two weeks, especially around my waist and knees. Is this normal? I’m also feeling pains down my abdomen. What can I do to stop this?”

Azeez, sorry to hear you have all these pains.

Women in pregnancy do experience various pains but this seems a lot. There is no harm in taking Paracetamol – 1 gram up to three times a day, which should help.

I suggest you should tell your midwife or doctor about it. Soon you will start to feel the baby move and I am sure that will reassure you.

Gabriella asks:

“How will I know if I’m suffering from pre-eclampsia and what should I do if I suspect I have it?”

Pre-eclampsia occurs in the second half of pregnancy and tends to be more common in first time mothers. Essentially your blood pressure will rise; you will have swelling, often in the face in particular and the midwife may find protein in your urine.

You may have headaches, although many pregnant mothers get headaches. You may experience flashing lights in your vision.

Pain in the upper part of your tummy under the ribs on the right is another indicator. Doctors and midwives are very good at detecting pre-eclampsia early on, when it can be easily managed.

Dee asks:

“I’d like more information on pain relief during labour – what are your thoughts? And what are the effects on baby? Also, when should a pregnant lady be induced?”

Women experience pain differently. Those who are relaxed and prepared may do well with back massage, good psychological support, going in the bath, moving around and also having a TENS machine.

Others need gas and air. Injections can sometimes be helpful and also an epidural. The best pain relief is to deliver the baby! Maybe that is why nature gave the mother pain: in order to get motivated and push the baby out!

There is a lot of interest in hypnobirthing in recent times, with some women finding this very useful. Being relaxed, calm and positive is the key.

Labour should be induced when the doctor perceives a greater risk to the mother in the pregnancy continuing than finishing. Reasons include going overdue (usually by 7-10 days) or the water having broken for a day or two without labour coming on.

Melissa asks:

“My partner and I are trying for a baby however I’ve a family history of bad morning sickness. How will I know if I’m suffering from hyperemesis gravidarum? How common is this and would I need to stay in hospital to recoup?”

Don’t worry. There is not a strong link of this running in families.

Most women get some nausea and sickness throughout the day in early pregnancy, which resolves itself around 12 weeks.

Hyperemesis gravidarum is when it becomes more serious, however it is quite uncommon. It means that you do not eat or drink at all and your body starts to break down its reserves. The doctor or midwife will test a urine specimen to see if this is shown by the presence of ketones.

This is really quite unusual but can be very serious. In these cases a few days in hospital for intravenous fluid therapy and medication is useful.

Sarah asks:

“I gave birth to a gorgeous girl four years ago, who is down syndrome. My partner and I are now thinking of trying for another baby. I’m aware of the increased chances of having another baby with downs, especially as I’m older. How and when will I be able to tell that all’s well with my baby?”

I’m pleased to hear your little girl gives you such joy.

An early scan from a specialist when you are pregnant again will be useful to confirm viability at about 8 weeks. In the NHS you should get a detailed 12 week scan to assess your risk.

As you get older, and having had a previous Down’s baby, your risk rises. They may recommend that you have a chorion villous sample or amniocentesis to check definitively, however this involves putting a needle in your tummy and carries a 1% risk of miscarriage.

There is a new test available privately called the Harmony Test, which avoids a needle being put in your tummy and the risk of miscarriage. It looks at DNA from the baby in a simple blood test taken from you, and gives 99% reassurance that the baby is normal. It’s becoming very popular in our clinic.

Fiona asks:

“I’m excited but very nervous about giving birth, I’ve heard my fair share of horror stories and would like to know more about some of the unexpected complications that can occur, how best can I prepare for them.”

Relax.

People are much more ready to tell and exaggerate the bad stories rather than the good. There are lots of good stories too!

Remember pregnancy and birth in the main is natural and normal. Get a nice supportive midwife. You can best prepare by not listening to horror stories and not obsessing with the pregnancy (difficult, I know, in our modern society).

Just go with the flow and enjoy it!

We thank Dr Donald Gibb of The Birth Company for his time in answering these questions.

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