Pregnancy and maternity care important basics and information
-
Ōtautahi Midwives are community midwives who specialise in providing Lead Maternity Care (LMC) within the community or primary setting. Although we all hope everything goes smoothly for you, a vital part of our role is to recognise when aspects of your pregnancy, labour, birth or postnatal care may have deviated from normal. If this occurs, in consultation with you, we will arrange a (free) referral to the medical / obstetric team at the hospital. If you then require ongoing “secondary” care (also known as “complex” or “high risk” care) then after discussing this with you and the hospital team, it will be agreed who is best to now provide your maternity care. For minor concerns your midwife is likely to remain your main carer, working together with the hospital team. However, if your needs are more complex, then responsibility for your care will likely be transferred to the hospital team. Your midwife will then take on the role of providing support and advocacy, working closely with the hospital team and/or remaining in regular contact with yourself and the hospital team so she can maintain your continuity of care. All midwives are trained to provide emergency care should this become necessary.
-
During your pregnancy you will need to make many about your maternity care. Informed choice & consent means, you must be given unbiased information about the proposed treatment/procedure; unbiased information about other options; time to consider this information; and you must freely decide to give your consent. The acronym B.R.A.I.N. S. may help you to remember the questions you should ask and the factors you should take into consideration before making an informed choice.
B = Benefits
R = Risks
A = Alternatives
I = Intuition
N = Not now thanks
S = Second opinion
-
Regular visits are a very important part of your care. Your partner, family, support people are always welcome and encouraged to be part of your visits.
Your antenatal appointments are held where your LMC midwife holds her clinic.
We all have set days and times where we will be at clinic, the rest of the time we are out at births, postnatal visits or emergency assessments.
The schedule of antenatal visits will be negotiated with you, but is typically based closely to the recommended schedule of NICE (National Institute for Health and Care Excellence) as follows:
Booking visit (ideally by 10 weeks), 14/16 weeks, 20 weeks, 24 weeks, 28 weeks.
2-3 weekly from 28-36weeks
Weekly visits from 36/37 weeks and then as needed until your baby is born.
Once your baby is born, your midwife or a midwife from the practice will see you most days you are an inpatient at a primary birthing unit or hospital. We are then required to see you within 24 hours of discharge from a hospital.
Visits are then made to suit individual needs at your home. The first week is the most intensive, and then visits will space out from there. Discharge visits are scheduled between 4-6 weeks, depending on individual needs and well child providers visits, etc.
As you can imagine the schedule of a midwife can be unpredictable at times, due to the nature of urgent or emergency care and babies being born! Due to this there will be times we run a little early or late, or may need to reschedule your appointment. We will make every effort to keep you informed if we cannot make an appointment. Please be understanding if we have to postpone your appointment, one day we may be doing the same for you and your baby!
-
Your antenatal visits will be held at your midwifes antenatal clinic.
Your postnatal visits will be either at a unit or in your home when your baby is home with you.
Clinic locations are listed on the About page of the website.
-
If at any time in your pregnancy you have urgent needs and can not get hold of your LMC midwife please first contact her back up, after that call any other person from the team and they will help you and assess you in person if needed.
Annabel Bridgman: 027 275 8527
Sophie Dillon: 027 750 0255
Ashley Bonham: 027 383 0002
Jordyn Pomeroy: 027 244 9533
Rosa Wilkie: 027 811 0466
Kayla Stephen: 027 2777 514
Paris Coleman: 027 315 4069
Tazmin Rawlins: 022 5344 428
-
Before contacting your midwife for non-urgent matters please consider if your question or request could wait until your next appointment.
If not, please remember that we also have families/whanau and personal lives outside of midwifery and we ask you to keep all non-urgent contacts to a minimum.
Each midwife in the practice has their own preferences for contact. Please check with your midwife how best to contact her.
Always for URGENT needs it must be a phone call and NOT a text as these can easily be missed.
-
URGENT CONCERNS TO CALL ABOUT:
-Vaginal bleeding
-Continuous abdominal pain
-if you are experiencing preeclampsia symptoms and are over 20 weeks
-if your baby's movements have reduced or you haven't felt your baby move and you are past 26 weeks
-If you are experiencing itchiness on the palms of your hands and feet
-If you are less than 37 weeks and you are having regular, strong contractions.
-If you are less than 37 weeks and your waters have broken.
-If your waters break and they are brown or green in colour or smell offensive at ANY point of your pregnancy.
- If you have any abnormal swelling, pain in the upper right area of your abdomen (not associated with your baby's movements) visual disturbances and/or a headache that does not alleviate.
- When you are over 37 weeks and have established in labour
- You have any concerns about you or your baby's wellbeing.
-
If you are feeling unwell and it is NOT pregnancy related please see your doctor or after hours medical clinic.
NON-URGENT CONTACTS:
Before contacting us for non-urgent matters please consider if your question or request could wait until your next appointment. If not, please remember that we also have families/whanau and personal lives outside of midwifery and we ask you to keep all non-urgent contacts to a minimum.
-
Each midwife has her own preferences for text communication. It is best not to expect an immediate reply as midwives could be with other clients, at births, sleeping or off call.
Text if used will usually be responded to within 48hrs or possibly longer if over a weekend.
Please check with your LMC midwife what her preferred method of contact is.
If you have urgent needs, PLEASE CALL do not text as text can be easily missed.
-
Your LMC midwife will have times when she is off call and unable to provide care. At these times there will always be someone from the team who will look after you.
Usually this will be your back up midwife, but could be any midwfie from the team. The back up midwife covers your LMC midwife when she is on her weekend off call, on leave, unwell, at a birth or sleeping post birth.
When off call your midwife will forward her calls to her back up midwife or another midwife from the team, so sometimes you will call and have someone else answer the phone. Please tell the midwife your full name, how many weeks pregnant you are and what you need help with.
Partners/ back ups
Annabel - Rosa
Ashley - Kayla
Sophie - Jordyn
Paris - Tazmin
-
You will have access to your notes, scan reports and blood results for your review if wanting.
You can download the My Expect app and then ask your midwife for access if you do not have this already.
You will need a unique login code that will be emailed to you, please check your junk or spam folder as they sometimes end up here.
LAB AND SCAN RESULTS
Your midwife will check your results before you will be able to see them.
If you have a concerning abnormal result requiring treatment or referral your midwife will contact you before you.
Normal results will show on My Expect.
Bloods and scans usually come through in 1-2 days unless urgent, urine and swabs can take 3 working days. MSS1 results can take 5-7 days from receiving both scan and bloods.
BLURB here
First trimester info
-
Description text goes here
-
-
-
Many women will experience common pregnancy discomforts e.g. nausea (morning sickness), headaches back pain/cramping/ligament pain, haemorrhoids & constipation, food aversions, tiredness and exhaustion, body changes (weight gain, breast and nipple growth, areola darkening, increase in saliva, nasal congestion, etc.), increase or decrease in libido, heartburn or indigestion, disturbed sleep, increase in urination, feet and ankle swelling, varicose veins etc.
All of these things are normal to experience and some of the resources below may help you to navigate some of these.
Coping with common discomforts
-
-
It’s normal to feel a little worried and stressed when you’re pregnant, but for some people anxiety can become a real problem and they will need professional help. Postnatal depression affects up to 15 % of women after they have given birth and up to 9% of women during pregnancy.
Pregnancy and parenthood is a time of change for you, your partner and your family/whānau. It's normal to feel unsure, anxious or worried during pregnancy. If these feelings last longer than a few weeks they could be signs of antenatal depression or anxiety.
Signs include:
- Panic attacks.
- Constant worrying, often about fears for the health or wellbeing of your baby.
- Feeling sad or crying a lot.
- Feeling nervous or panicky.
- Withdrawing from friends and family.
- Engaging in more risk taking behaviour (for example alcohol or drug use).
- Thoughts of death or suicide.
If you are experiencing any of the above signs or symptoms, please do let your midwife or GP know. There are treatment options, support and services available to help you through this journey.
Depression Helpline freephone: 0800 111 757
Plunketline freephone: 0800 933 922
Click on the mental health heading on the left hand side. Lots of wonderful resources around support, diet, hauora/wellbeing, medications and physical health to name a few.
Click on the links to find further information
-
Blood tests are offered during your pregnancy (typically at booking, 26-28weeks & 36 weeks, and any other time that may be indicated) to protect the health of yourself and your baby by identifying conditions or diseases as soon as, possible so that treatment can be offered.
-
Antenatal screening can provide some information about the chance of your baby having Down syndrome or other conditions such as trisomy 18 (Edwards syndrome), trisomy 13 (Patau syndrome) and some other rare genetic disorders. This screening is optional. There are two screening options available for women in New Zealand, who are less than 20 weeks pregnant. Both options are screening only, and not diagnostic.
First trimester combined screening (MSS1): (if you are less than 14 weeks pregnant) combines the results of a blood test from you (which you have between 9 weeks and 13 weeks + 6 days) and a nuchal translucency (NT) ultrasound scan (which is best taken at around 12 weeks, but can be taken between 11 weeks + 2 days and 13 weeks + 6 days) with other information, such as your age and weight. The NT scan is predominantly to take the measurement of the fluid filled space at the base of your baby's neck, and to have a generalised look at your baby.
Second trimester maternal serum screening (MSS2): (if you are 14-20 weeks pregnant ) combines the results of a blood test from you, with other information, such as your age and weight.
-
A healthy diet is important during pregnancy. But you can’t always get everything that you and your baby need from food.
Iodine:
Iodine helps the body to grow and develop, especially the brain. Because babies get iodine from their mothers, pregnant and breastfeeding women need more iodine. This is why it is recommended to take a 150mcg iodine supplement throughout pregnancy and breastfeeding.
Folic acid:
Folic acid helps the body to make new cells. Folic acid is important because it can help to prevent birth defects of a baby’s brain and spine, such as spina bifida. Spina bifida can cause walking, bladder and bowel problems. This is why we recommend a 0.8mg folic acid supplement from conception until 12 completed weeks of pregnancy.
Vitamin D:
Vitamin D is needed for strong bones and joints as well as healthy muscle and nerve activity. If you don’t have enough vitamin D during pregnancy, your baby may be born with low vitamin D levels. This can affect how your baby develops. The sun is our main source of vitamin D. We can get some vitamin D from some food sources, e.g. eggs, oily fish, milk and yoghurts, etc. however it is hard to get enough from diet alone. Unlike iodine and folic acid, we base vitamin D supplementation in pregnancy on risk factors. These are listed below.
- Having naturally very dark skin. This includes people from Africa, the Indian subcontinent and Middle East.
- Your skin not being regularly exposed to sunlight, eg: avoiding the sun, regularly wearing clothing that covers a lot of your skin, not going outside.
- If you live in the South Island (especially south of Nelson-Marlborough) and get little time outdoors.
- If you have liver or kidney disease, or are on certain medications that affect vitamin D levels, you may be at risk of vitamin D deficiency.
-
We encourage our clients to go to Pacific Radiology for any pregnancy scans needed.
Scans are subsidised and cost around $70 per scan
If you have a community services card this will be free of charge.
For complicated pregnancies, referrals can be made to the hospital for fully funded scans
-
About 1 in 5 women experience some form of bleeding in early pregnancy. It is normal to feel anxious if this does happen, but it is important to remember that not all pregnancies result in miscarriage if you do have some early pregnancy bleeding. If the bleeding is light/spotting, often the best thing to do over this time is wait and see. Waiting may feel stressful, but unfortunately there is no treatment that will change the outcome during this stage of pregnancy.
If bleeding is ongoing, or you have concerns regarding the viability of your pregnancy, your GP or midwife can arrange an HCG blood test (pregnancy hormone) +/- an ultrasound scan if indicated.
If you at any stage experience heavy bleeding e.g. flooding a maternity pad in less than an hour, passing blood clots bigger than the size of a golf ball, feel faint, etc. you need to go straight to A&E at Christchurch Hospital.
-
About 1 in 4 women experience some form of bleeding in early pregnancy. It is normal to feel anxious if this does happen, but it is important to remember that not all pregnancies result in miscarriage if you do have some early pregnancy bleeding. If the bleeding is light/spotting, often the best thing to do over this time is wait and see.
Waiting may feel stressful, but unfortunately there is no treatment that will change the outcome during this stage of pregnancy.
If bleeding is ongoing, or you have concerns regarding the viability of your pregnancy, your GP or midwife can arrange an HCG blood test (pregnancy hormone) +/- an ultrasound scan if indicated.
If you at any stage experience heavy bleeding e.g. flooding a maternity pad in less than an hour, passing blood clots bigger than the size of a golf ball, feel faint, etc. you need to go straight to A&E at Christchurch Hospital.
Below is some resources on early pregnancy bleeding and miscarriage. These also include support and helplines for miscarriage and early pregnancy bleeding.
Second trimester
Blurb ….
-
We recommend good antenatal education classes for first time parents.
Classes help with information on pregnancy, labour and birth, and baby cares.
The best time to book your course is 20 weeks so these can start around 26weeks and finish before you are 35weeks.
-
Typically you will first start to feel your baby move when you are between 16 – 22 weeks pregnant.
In the second trimester sometimes your baby wont have active movements periods everyday, this can be normal. When you get to 28 weeks, regular daily movements become important.
-
This scan is recommended to assess for fetal wellbeing assessing organs, bone and facial structure, abnormalities if present can often be identified at this scan.
Placenta location is also assessed.
-
Gestational diabetes mellitus (GDM) occurs when a pregnant woman has high levels of glucose in her blood because she is not producing enough insulin (a natural hormone produced by the body to take the sugar from your blood and move it into your cells, as an energy source for the various things that cells have to do). It affects 2 to 5% of women, and if not controlled is associated with increased pregnancy complications for the woman and her baby. All pregnant women are offered an HbA1c blood test test at booking to identify women with probable undiagnosed diabetes or prediabetes.
At 24–28 weeks’ gestation, women who are at high risk of GDM are offered the diagnostic two-hour, 75 g oral glucose tolerance test (OGTT). All other women should be offered screening using the one-hour, 50 g, oral glucose challenge test known as the polycose test. It is your decision whether you wish to be screened or not.
Risk factors for diabetes include:
- Maternal age.
- Family history of diabetes.
- Ethnic group (Indo-Asian, Māori, Pacific peoples, Middle Eastern).
- Maternal obesity.
- Medical conditions such as polycystic ovary syndrome (PCOS), cardiovascular disease, persistent hypertension (> 135/80 mmHg), elevated cholesterol, etc.
- Glycosuria (glucose in your urine) on two or more separate occasions in the current pregnancy.
- Previous GDM, unexplained stillbirth, neonatal death or macrosomia (baby >4000g).
- Multiple pregnancy.
- Long-term use of steroids/antipsychotic medication.
- Physical inactivity / sedentary lifestyle.
To book, you will need a referral from your midwife when you see her at clinic.
To book in for your test call Awanui labs 03 359 0900
-
Immunisations for Whooping Cough, Flu and covid are free for you and recommended in pregnancy.
-Whooping cough (from 16 weeks, best before 32 weeks)
-Flu (1st April - 31st Dec)
-Covid booster
To book these you should see your GP or pharmacist.
-
Depending on your situation you may be eligible for parental leave or other financial assistance. Your midwife can provide you with a letter confirming your pregnancy. These will only be given at scheduled appointments, so please remember to ask during these visits.
Your rights as a pregnant worker
If you are working when you are pregnant, you may be able to get up to 10 days unpaid special leave to attend medical appointments, antenatal classes, etc.
third trimester
Testing this bit to see if it makes the topics show in correct order on the app version. Because I want this bit at the top not the other bit.
Here are some basics to get ready for when your baby/pēpi to arrive.
For further topics see the postnatal page and be sure to check the postpartum plan
-
You can choose how to feed your baby.
Breastfeeding breastmilk is the ‘gold standard with the most health benefits for both you and your baby.
Donor milk is a great alternative for those who can’t breastfeed or have a reduced supply. There is pasteurised donor milk or non pasteurised donor milk. See baby feeding section for more info.
Formula is a perfectly safe and healthy option for feeding your baby if you want to use it or need to.
-
Breastfeeding is the optimal way to feed your baby if you can.
Breastmilk is the biologically normal way of providing infants with the nutrients they need for healthy growth and development. It is recommended that you breastfeed exclusively until around six months of age, until your baby is ready to start solid foods. Then continued breastfeeding is recommended until 2 years of age to compliment a nutritious and varied diet.
As midwives we will support you in beginning your breastfeeding relationship. However if for some reason breastfeeding is not the right choice for you or your baby then we can discuss your options and support you with alternatives.
We strongly encourage all those choosing to breastfeed go to an antenatal breastfeeding class, they are incredibly informative and really help prepare you for a breastfeeding journey which can sometimes have its challenges. Sometimes breastfeeding is really hard so some preparation before can make a huge difference to your breastfeeding journey.
-
Donor milk is human milk donated by another mother.
There are two types of donor milk Pasteurised and non-pasteurised.
Pasteurised milk is donated by mothers who have been screened for infectious diseases and the milk has gone through heat processing to kill any bacteria.
Non pasteurised donor milk is usually donated direct from one parent to another, with no heat processing.
Some people will get donor milk from a friend or family member whilst pasteurised donor milk is only available from a milk bank.
New Zealand College of Midwives consensus statement on donor milk milk
MOH health info MOH health info
-
Unless you plan to pump or bottle feed you do not need to buy these things before your baby is born.
However, it may be useful to put aside some savings for if these items are needed.
Please talk to your midwife about what to buy if wanting to purchase items before babies arrival.
-
It is recommended that you prepare a safe sleep space for your baby. Please have this ready at your home by 37weeks.
We suggest a bassinet, wahakura, bedside co-sleeper, or Pēpi-Pod. This does not have to be new however a clean sleep space and new mattress is recommended.
If you are struggling to afford a safe sleep space, please talk to your midwife and she will organise one for you.
Please check the safe sleep information page.
-
The recommended and safest clothing material is wool and cotton. Your pēpi can not regulate its’ own temperature and these natural fibres will support your baby in not overheating and getting cold.
Merino wool on babies keeps them warm and keeps them from overheating and sweating which can then make them cold. A merino base layer is a great option.
Dressing your baby in one more layer than you are wearing is a good general rule for layering.
So outfits in sets of 2-3 layers are great.
e.g.
-merino singlet
-cotton stetch and grow
-cotton long sleeved onesie
Hats, socks and mittens are great for colder days
-
We suggest that from 28 weeks you spend some time each day getting to know your baby and focusing on your baby’s movements. Your baby should remain active during you entire pregnancy. When a healthy baby is awake they will usually move a good amount in a 2 hour period. If you feel a decrease in the normal daily activity of your baby, this may be cause for concern. If you have concerns you should first sit in a quiet place and focus on feeling your baby’s movements. You should CALL your midwife immediately (do not text):
- Your baby does not move at all one day.
- Your baby kicks less and less in the course of the day and you feel that there is too little activity from your baby.
-
Research has shown that going to sleep on your side from 28 weeks of pregnancy halves your risk of stillbirth compared with sleeping on your back.
Safe sleep info
-
The position you are in during your pregnancy impacts the position of your baby.
The position of your baby during labour can impact your birth.
Optimal fetal positioning (OFP) refers to encouraging your baby into the best possible position for birth. The optimum position for your baby is head down, spine facing outwards or slightly off to the side, with their chin tucked down onto their chest. If baby is not in the OFP then it can increase the chances of requiring medical interventions during labour and birth. There are many things that you can do and avoid doing, during your pregnancy to assist baby presenting optimally.
Things to avoid doing late in pregnancy that encourages poor fetal positioning:
- When seated at your desk try not to cross your legs.
- Sit upfront and forward rather than leaning/reclining/lying back
- Lie on your left side and avoid relaxing on your couch with your feet up in front of you and your butt tucked under (reclining).
- Side sleeping
- Avoid long car journeys (90 minutes+).
Follow this link for some in depth and great tips to help you and your baby achieve optimal positions for pregnancy, labour and birth
-
Packing your labour bag is a job best done by around 36-37 weeks unless there is an indication you may be requiring to have your baby earlier. The lists below are suggestions – you might not want to take everything. It may work best to pack different bags – one for when you are in labour and the hours after and then another for your postnatal stay.
Ideally everything would fit into a carry on luggage size bag.
For you:
- Comfortable loose clothes to labour in, clothes or pyjamas for afterwards (preferably easy to breastfeed in) and a set of clothes/shoes to wear home.
- Water bottle (with straw is best)/labour snacks (don’t forget your support people too).
- Money for parking/vending machines etc.
- Maternity bras, underwearcomfy big sized 'granny' knickers are the best), slippers (or socks) and a dressing gown.
- Sanitary pads (maximum absorbency, extra long – some women find the extra absorbent style incontinence pads/disposable underpants are also great for the first few days).
- Personal toiletries (hairbrush, soap, shampoo, deodorant, toothbrush, etc.) including your regular medications & glasses/contact lenses, hair ties.
- Optional: mobile phone & charger, camera, wheatie bag, music & player, massage oils, your own pillow, ear plugs, swim wear for partner (if getting into birth pool), TENS (if using), hypnobirthing tracks, affirmations, portable speaker, etc.
For Baby:
Baby’s can get cold quickly after birth and when dressed need 2-3 layers of clothing. These layers are best to be made from natural fibres (e.g. wool/cotton) to stay warm. Avoid synthetics e.g. polyester and polar fleece as these fabrics don’t breathe and may cause baby to overheat. We suggest you bring a set of clothes to put on soon after the birth (old is OK as baby wont be bathed following birth) and 3 more sets of clothes.
- Woolle/cotton singlet’s.
- Stretch and grows, or tops and pants that cover arms and legs.
- Hoodless long sleeve cardigan/tops.
- hat & booties (or socks).
- Wraps (cotton or wool).
You will also need a car seat (for the trip home). This is very IMPORTANT as you will not be able to leave your place of birth to head home without one. Please also note, that your midwife is not a car seat technician and you will need to have this installed by a professional or have undertaken appropriate advice around installation yourself. It is best to have your car seat fitted by 36 weeks gestation.
Some people choose to take their placenta (whenua) home. You may wish to bring a special container, such as an ipu whenua with you. We encourage you to send the placenta home with family members as soon as possible as there is no storage available at the hospital.
-
Under NZ law, all children under seven years of age must use an approved child restraint (appropriate for their age and size) when travelling in a vehicle. You can rent or buy an infant capsule (or car seat that's suitable for newborns). Make sure it fits in your car, and familiarise yourself with how to safely use it and have it installed by 36 weeks gestation. Please also note, that your midwife is not a car seat technician and you will need to have this installed by a professional or have undertaken appropriate advice around installation yourself.
Please make sure you bring your car seat with you in labour, as it may be needed in the case of transfer or to discharge home. This is very IMPORTANT as you will not be able to leave your place of birth without one.
Here is a link for car seat hire in Christchurch:
Car seat hire
