Screening in pregnancy

Whether or not to participate in screening is your choice.  Screening can provide some information about the chance of your baby having Down syndrome or another condition.  See the First Trimester Combined Screening Information Pamphlet  http://nsu.govt.nz/files/ANNB/First_Trimester_Combined_Screening_HE2256.pdf

There are two screening options available:

Antenatal HIV screening

Antenatal HIV screening, along with five other blood tests, is offered to all pregnant women as a routine part of their antenatal care.

Women who are found to have HIV can be offered treatment to reduce the chance that they will transmit the virus to the baby.

The number of people with HIV in NZ is low, but increasing. All pregnant women are offered an HIV test at the same time as they have their other pregnancy blood tests.

This programme aims to ensure all women are offered HIV screening along with their first pregnancy blood tests, so that transmission of the virus from mother to baby can be prevented.

Should supplements containing iodine be recommended to consumers?

Due to an increased need for iodine in pregnancy and breastfeeding, the Ministry recommends that pregnant and breastfeeding women take a registered 150 micrograms (mcg) daily iodine only tablet daily available from 1 July 2010 at pharmacies, as well as eating foods which are important sources of iodine. More information can be found in the pamphlet Folic Acid and Iodine(

Lead Maternity Carers (LMC)

Most Lead Maternity Carers (LMC) in New Zealand are Midwives. GPs still provide early pregnancy care if needed especially if you are unable to access a Midwife in your area. If you are a NZ citizen pregnancy care under a Midwife or GP is free. There is the option of paying to have a private Obstetric Consultant.

See Midwife listings on http://www.babywebnz.org/display/BabyWebNZ/Find+a+Midwife

0800 MUM 2 BE (0800 686 223)
The 0800 MUM 2 BE Maternity Consumer phone line is run by the Ministry of Health.
The 0800 line supplies lists of Lead Maternity Carers (LMCs) for requested areas.

Pregnancy Information Form

We have added new link "Information Forms" to www.babywebnz.org and www.birthresources.org websites. These forms provide guides to questions you may be asked and topics that will be covered during your pregnancy. Also there are lists that you can copy and fill out to help with preparing for the birth and care of your child. Click on following link: http://www.birthresources.org/display/BirthResources/Information+Forms

Childbirth Education

Our Wellington based childbirth classes are called BirthResources to complement them and deliver further information, we have set up a BirthResources website www.birthresources.org, packed with useful information for parents and Childbirth Educators.

Subscribe to our BirthResources monthly newsletter or read through previous issues here.

The following YouTube is about natural ways that may turn a breech baby into a head down position. A Yoga instructor and an acupuncturist share their secrets to turn your baby. http://www.birthresources.org/display/BirthResources/Videos

There is world health ultrasound guidelines. These principles follow the ALARA concept (as low as reasonably achievable) by applying the lowest acoustic output and scan time consistant with that required to obtain the necessary diagnostic information. This means that in NZ they follow guidelines to the reduce risks.

It may be helpful to go back to your Midwife and say to her that you would like to discuss this more with her. It is not good for you to spend your pregnancy being worried. Often if pregnant woman do not debrief (talk concerns over), they will just keep thinking about the issues which can increases the risk of stress or depression.

It is hard for me to tell you that it is or isn't safe, if still concerned I think you need to talk to a radiologist or lactation consultant. We get radiation from alot of things during our life time, sunlight is solar radiation. Increased exposure is something we should try to avoid if able to.

What I can say is that x-rays are ususally done to check on your health. If you become unwell it is not going to be good for your baby who needs you. I found the following information on this link http://www.christchurchradiology.co.nz/can-contrast-be-used-during-pregnancy-and-breast-feeding/

quote "Studies have not shown any ill effects to the embryo or foetus but there are no controlled studies in pregnant women to confirm the safety for use in humans too. Since, wherever possible, exposure to radiation should be avoided during pregnancy, the benefits of any X - ray examination, whether with or without contrast material, should for this reason alone be carefully weighed against the possible risk. Contrast media are poorly excreted in human breast milk. From experience gained so far, harm to the breast feeding infant is unlikely to occur".

When I think of Metformin it is usually for diabetics but yes I am aware that it is also used in the treatment of  polycystic ovary syndrome. Some drugs cross the placenta and go into the baby's system, this needs to considered and discussed with you. Therefore  I believe you need to talk to an O&G doctor about this as soon as possible.

Birth Resources classes are mainly have people having their first baby  but we also have people who have had babies before like yourself coming.

With Birth Resources if you want to just pick the classes you want to go to that is fine, and they would only charge for the ones attended.

Classes are 6 evening classes-Week one-pregnancy class, Week two-birth class, Week three-hospital tour, Week four-birth plans, interventions, Week five and six - baby care 

Weekend intensives- Week one-pregnancy, birth class. Week two- birth plans, interventions, hospital tour Week three- baby care . They are private classes so there is a cost which includes the woman and her partner/support person.

For more information or booking online see www.birthresources.org 

The primary care group and Matpro have people who have had babies before coming to their free classes. Also Parent Centre sometimes offers a pregnant again class.

Wellington Hospital offers free classes if you are booked with the Primary Care team. www.ccdhb.org.nz

The Women's Health Service hospital-based Primary Care team was established to provide maternity care for those women who are unable to find a community-based care provider.

MATPRO. The Wellington Maternity Project (MATPRO) provides assistance to women seeking access to LMC Midwives. If you live in the Capital & Coast DHB region, MATPRO will be happy to help you. They also offer free childbirth education classes in Newtown and Kenepuru. They can be contacted on 04 801 7808.

Birth Wise promotes wellness in pregnancy, natural birth and holistic parenting by empowering women and men to make infomed choices. Birth Wise is based in Wellington, New Zealand. http://birthwise.org.nz/about.php

Parent Centre Childbirth Education Classes are 6-8 weekly sessions led by qualified childbirth educators. They are usually held in the evenings so that partners can attend. Contact your local Parents Centre in the telephone directory or call the Parents Centre national office on (04) 2332022 Wellington Region Parents Centre Website: www.wnpc.org.nz -Wellington North PO Box 22-092 Khandallah -Wellington South PO Box 14-378 Kilbirnie www.wgtnparents.org.nz -Lower Hutt PO Box 31-197 Lower Hutt -Upper Hutt PO Box 40-231 Upper Hutt -Mana PO Box 50-367 Porirua -Kapiti Rita King Cottage, Rosetta Road

Plunket nurses provide support through home and clinic visits, mobile clinics and PlunketLine, a free telephone advice service for parents. Call 0800 933 922, New Zealand 24 hours a day, 7 days a week. 

Plunket also organises car seat rental schemes, parent groups, parenting education and toy libraries, drop in centres, playgroups and education in schools – most of which are available nationwide and free of charge.

Most Lead Maternity Carers (LMC) in New Zealand are Midwives. GPs still provide early pregnancy care if needed especially if you are unable to access a Midwife in your area. You can also see your GP about health concerns in pregnancy and  post-natal. If you a NZ citizen pregnancy care under a Midwife or GP is free. For scans there may be a charge if you go privately for this or there is not a medical reason to have one.

I found the following link via http://www.nzdoctor.co.nz/ that shows information for GPs about maternity care.

At the booking visit, bloods are taken to check rubella immunity, find out your blood group and if you have any antibodies, your hepatitis and HIV status, full blood count (FBC) and a VDRL test for syphilis. Your maternity health professional will ask you questions when booking you for care with them. It can help with the process to write down some information about yourself and your health, what you want, and any questions you have. This is a guide to possible questions you may be asked. See http://www.babywebnz.org/display/BabyWebNZ/Information+Forms

You will find the following information on the national screening website. Pregnant women are offered HIV screening and screening for Down syndrome and other conditions. Babies are screened for 28 metabolic disorders (the heel prick test), and for hearing loss. The National Screening Unit website provides the following information: http://www.nsu.govt.nz/current-nsu-programmes/3160.asp

Visit www.getthru.govt.nz to learn how you and your family can get ready, and get through.

Preparing for emergencies.

Two videos have been produced by Canterbury Civil Defence outlining how you can easily prepare emergency food and water supplies for your family can be found via this site.

You can also Download a checklist (PDF)

A good place to start with finding information is via the NZ multiple birth association.

On their website it states: The New Zealand Multiple Birth Association Incorporated is the national body representing 22 local Multiple Birth clubs consisting of over 1500 families throughout New Zealand. There were almost 900 sets of twins and triplets born last year in New Zealand, and 11 sets of triplets were born to new mothers (from the 2009 census). In 2009, 161 mothers who gave birth to twins or triplets already had at least two other children.

We aim to provide education and support to all of these families, through providing guidance and resources to their local multiple birth club.

Our objectives and how we meet them include:

• Providing information and advice to any individual directly involved with the care, raising and well being of a multiple birth through resources about issues relating specifically to raising multiples.
  
• Providing a communication medium for existing clubs for parents of multiple birth children through a website, quarterly newsletter and annual conference.
  
• Providing advocacy for national issues that face multiples and their families in the areas including social, health and education needs.
  

see http://www.multiples.org.nz/

http://tvnz.co.nz/good-morning/s2010-e150610-babywhisperer-video-3588900

Click on the above link to be redirected to the TVNZ Good Morning Shows Website. This recent clip features a Wellington MBC Members experience of the arrival of a multiple birth into a family with two older sisters.

Indications for caesarean delivery include:

* mother is unwell * previous Caesarean section (depends on how many and reasons for them) * pelvis abnormality or injury * prolonged labour, failure to progress (dystocia)or failed induction * fetal(baby)distress * cord prolapse * uterine rupture more than 2 babies (triplets) * placental problems (placenta praevia, placental abruption or placenta accreta ) * breech or transverse positions * failed instrumental delivery (by forceps or ventouse) * overly large baby (macrosomia) * umbilical cord abnormalities * HIV infection of the mother * Sexually transmitted infections such as active genital herpes * previous Caesarean section (depends on how many)

Breastfeeding Classes in Wellington.

BirthResources classes provide information on breastfeeding, also see http://www.birthresources.org/display/BirthResources/Resources on youtube clips about:

1: Preparing for breastfeeding

2: Birth - Initiaiting Early Feeds

3: A Good Latch - Early Days Chapter

4: Managing Challenges Chapter

5: Out and About Chapter

6: For Partners, Family and Supporters Chapter

7: Returning to Work

If you would also like to go to separate breastfeeding classes they are run at Wellington Hospital by Penny who is a Lactation Consultant.

http://www.healthpoint.co.nz/default,206432.sm

Also see Mama Licious breastfeeding classes http://www.mamalicious.co.nz They offer breastfeeding workshops for pregnant women, their partners, and supporters, to equip families with the practical knowledge and skills they need to get breastfeeding off to a good start.

New parents are often busy and tired looking after the needs of their baby. If you do not have family or friends who are able to help out and you can afford it, you may wish to look into the services available.

As it is school holidays student job search is an option. To have someone hang out the washing, make the beds and do some housework can be a great help. Student Job Search 0800 757 562 and www.sjs.co.nz,

Other agencies that I know about include:

Rock my Baby, which state: We have an extensive database of professional caregivers. Whether you require a nanny, babysitter, after-school care, mother's help, live in nanny, au pair, postnatal services, infant maternity care or home-based care - we are here to meet your childcare needs today. http://www.rockmybaby.co.nz/pages/home

Nannies on Demand state they are is a Nanny and Au Pair Agency with offices based in both Auckland and Wellington. We have over 17 years first hand professional experience in the Nanny industry and specialise in providing a range of high quality New Zealand Nannies, international Au Pairs and evening Babysitters to families throughout New Zealand, Australia and the UK. http://www.nanniesondemand.co.nz/

Training families for Wellington Nannies college · There are two intakes per year, beginning end of January and mid July. · Students attend class one day a week and are placed with one or more training families, on a live-in or live-out basis, for the duration of the 22-week course.

• Under the guidance of the college training families assist students to develop childcare and household skills and provide them with the opportunity to gain experience as a student nanny in their homes.
  
• Live-out students provide the training family with 30 hours a week of childcare and household help (this can be split between two families).
  
• Live-in students provide additional hours in return for full board. This is 5 hours for a five-day live-in or 10 hours for a 7-day live-in.
  

In return for the help provided by the student the training family pays the student’s course fee. (fees detail provided in info pack). For further information please phone 0800 844-888 or complete the on-line request form. An info pack with full cost details will be forwarded to you. Wellington Nannies College Ltd 55 Abel Smith Street PO Box 6381, Wellington 0800 844-888 info@wnc.co.nz

Pepsicles state: New mothers need and deserve to be looked after. We have carefully selected carers who will come in and look after the new mother, her household and her family. Most, if not all of our carers are mothers themselves and know what it is like to have a new baby. Our service is ideal if: You are expecting twins.You haven’t got family support close. You have an older preschooler at home. You had a traumatic or difficult birth. You had a Caesarian section and need to rest. Your partner/husband has a busy job and needs to get back to work soon after the birth http://www.pepsicles.co.nz/ 0508-PEPSICLES (0508 -737742 )

Alot of information about where babies should sleep has come from research on SUDI, also known as SIDS (Sudden infant death) and as cot death is defined as the sudden and unexplained death of an infant during sleep, including deaths from suffocation, less than one year of age. SIDS is responsible for between 40 – 50 deaths in New Zealand per year.

The present recommedations (2011)are that parents should be sleeping with baby in their room for the first 6 months. Having them close means you often can hear if they have breathing difficulties.

Other recommendations to reduce the risk of SUDI are:

• Having a smoke-free pregnancy and household
  
• On their back for sleeping with a clear face.
  
• Breastfeeding Ensuring your baby sleeps in its own bed, especially if premature, born small or your family is not smoke free.
  

Smoking in pregnancy means babies get less oxygen and food which will effect their development. They get used to less oxygen during before birth so as babies they sometimes do not breathe when they should when sleeping.

Plunket states the following: If you want your baby to sleep in bed with you it’s important you know that bed sharing does increase the risk of SUDI. Sleeping babies need to breathe. Air needs to get through to their lungs. Babies can roll face down on soft surfaces. They can get wedged against things on couches or chairs. Their faces can become covered by toys, pillows or bedding. They can be rolled on by people in the same bed.

There are 2 main myths that cause some parents to avoid the safety advice.

1. Choking - one myth is that there is more risk from choking if a baby sleeps on their back. This is not true. Babies gag and swallow in all sleeping positions. That is how they protect their airways. Also, the windpipe is above the food tube when babies lie on their back. In this position, the gagging reflexes are stronger and it is easier for babies to keep their airways safe. To sleep your baby on the side is false protection. It doubles the SUDI risk and babies can turn onto their front.

2. Flat heads - the other myth is that sleeping on the back causes flat heads. This is not true, either. Babies’ heads change shape due to pressure on a soft skull when the head rests on the same spot. This can happen in all sleep positions because babies have heavy heads and sleep a lot. A flat head can be avoided by varying the resting spot of the head and having plenty of upright time and tummy time when a baby is awake. It is false protection to avoid sleeping babies on the back as a way to prevent flat heads.

http://www.plunket.org.nz/your-child/family/?tab=70&art=1041&cat=242

Other links to information about sleep and SUDI: 

http://www.bbc.co.uk/health/physical_health/child_development/babies_sleeping.shtml http://www.plunket.org.nz/your-child/up-to-1-year/?tab=1276&art=1399&cat=171

http://www.midwife.org.nz/index.cfm/3,108,559/safe-sleeping-ratified-2010.pdf

The heart begins beating twenty two days after conception took place. This is the 5th week of pregnancy gestation (5 weeks post a period) or also called the 3rd week after conception. It is seen as a flickering in the chest on ultrasound at 4 weeks after conception, it is too hard to hear at this stage. At 5 weeks a fetal heart rate is about 80-85 beats per minute on ultrasound scans. It will increase during that first month.

From 12 weeks onwards the health professional may be able pick up the fetal heart rate by doppler at about 110-160 beats per minute. Listening into a babies heart rate takes training and sometimes buying a doppler so you can do this yourself at home can cause you concern especially if you pick up your own heart beat. An adults heart beat is around 70-80 beats per minute a babies is alot higher at 110-160 beats per minute.

It is important to concentrate on fetal movements as this is a sign of fetal health and talk to a health professional if concerned.

Birth Resources is the classes are run by Midwives who are also trained childbirth educators. Birth Resources is about seeking, sharing and receiving pregnancy, birth and parenting information and support. They run Childbirth Education Classes in Wellington, New Zealand. Classes are 6 evening classes or weekend intensives. They are private classes so there is a cost which includes the woman and her partner/support person.

For more information or booking online see www.birthresources.org

Wellington Hospital offers free classes if you are booked with the Primary Care team. www.ccdhb.org.nz

The Women's Health Service hospital-based Primary Care team was established to provide maternity care for those women who are unable to find a community-based care provider. The primary care midwives provide complete antenatal care from booking for women in hospital-based clinics or at home where there are extenuating circumstances. The primary care midwives also provide postnatal care for women and their infants for up to six weeks postpartum. The intrapartum (labour and birth) component of each woman’s care is provided by rostered core midwives in Delivery Suite. The Primary Care Midwifery team employed by the Women's Health Service will provide postnatal care to women living south of Whitby, and residing in the Wellington region.This excludes the Hutt Valley. Any woman living beyond these boundaries will be supported to access postnatal midwifery care by another midwifery provider. The team will arrange this transfer of care as and when required.

MATPRO. The Wellington Maternity Project (MATPRO) provides assistance to women seeking access to LMC Midwives. If you live in the Capital & Coast DHB region, MATPRO will be happy to help you. They also offer free childbirth education classes in Newtown and Kenepuru. They can be contacted on 04 801 7808.

Birth Wise promotes wellness in pregnancy, natural birth and holistic parenting by empowering women and men to make infomed choices. The focus of Birth Wise today is our Childbirth & Early Parenting Course although they are still actively involved in lobbying and consumer representation. Birth Wise supports: informed pregnancy, birth and after-care choices; home birth; Domino birth, that is, continuity of care with the option of early discharge from hospital within 2-3 hours (70% of women); midwife-only care; and shared care from midwife and general practitioner or specialist. Birth Wise also supports the Wellington Home Birth Association (WHBA). Birth Wise is based in Wellington, New Zealand. http://birthwise.org.nz/about.php

Parent Centre Childbirth Education Classes are 6-8 weekly sessions led by qualified childbirth educators. They are usually held in the evenings so that partners can attend. Contact your local Parents Centre in the telephone directory or call the Parents Centre national office on (04) 2332022 Wellington Region Parents Centre Website: www.wnpc.org.nz -Wellington North PO Box 22-092 Khandallah -Wellington South PO Box 14-378 Kilbirnie www.wgtnparents.org.nz -Lower Hutt PO Box 31-197 Lower Hutt -Upper Hutt PO Box 40-231 Upper Hutt -Mana PO Box 50-367 Porirua -Kapiti Rita King Cottage, Rosetta Road

Lower abdominal pain during the early weeks of pregnancy could be due to several things and without seeing or discussing this fully with you it is hard to say that it is implantantion pain but that is a possibility. Some women get discomfort during pregnancy which feels like period cramps due to changes in the uterus or from ligament pain but you should still talk to a health professional about it incase there is another reason for the pain especially if there are other symptoms. Notify a health professional straight away if you have bleeding, a high temperature, pain that hasn't gone away or becomes more than mild discomfort. There is also the chance the pain is not related to the pregnancy but a medical condition such as gallbladder or kidney stones.

*Implantation discomfort - happens around 5-12 days after ovulation when the fertilized embryo attachs into the wall of the uterus. Some women also get light pinkish or light brown loss.

* Ectopic Pregnancy - this happens in early pregnancy when the fertilized egg attaches outside of a woman's uterus such as the fallopian tube. It is serious because it could cause the fallopian tube to rupture. With an ectopic pregnancy you may have pain, sore/tender stomach, bleeding, or feel faint.

* Miscarriage - bleeding and cramping in your lower stomach or back can be signs of a miscarriage

* Preterm Labour - if the pain is latter in pregnancy (eg 24 weeks plus) then the hospital would try to stop labour from happening to allow the baby to grow more and develop its lungs. In latter pregnancy pain can also be from placenta abruption where the placenta starts to come away from the uterus.

I'm unsure what percentage of pregnancies are planned, I suspect there aren't a lot. Thus there are many women who realise they are pregnant and have not been taking any pregnancy multi-vitamins or who have had a few alcoholic drinks. In most cases it is fine, but I am unable to say that it will be for you, as I do not know. All you can do is focus now on looking after yourself and not drinking any more. If you spent the rest of your pregnancy being worried you would not allow yourself to be happy.

Chorionic villus (placental tissue) sampling (CVS) detects chromosomal abnormalities such as Down syndrome so it won't tell you about things related to fetal alcohol syndrome (FAS). If there is concerns outside of normal pregnancy then your Midwife usually refers to someone else. Different countries have different ideas about alcohol in pregnancy and most cases of FAS are seen in frequent heaving drinking of alcohol throughout the pregnancy. We don't know what is a safe amount so in New Zealand maternity providers will state that pregnant mothers should not drink any alcohol in pregnancy.

http://www.babycenter.com.au/pregnancy/ref/alcoholexpert/

http://www.scoop.co.nz/stories/GE1010/S00060/alcohol-and-pregnancy-research-confusing-message.htm

Alcohol and pregnancy research - confusing message Wednesday, 13 October 2010, 11:47 am Press Release:

Alcohol Healthwatch Alcohol and pregnancy research sends confusing message Alcohol Healthwatch is concerned by the conclusions reached by another highly questionable piece of research suggesting that light drinking during pregnancy presents no risk to child development.

The research, published in the Journal of Epidemiology and Community Health this week, has drawn criticism from both New Zealand and Australian experts who say the study’s methodology means we cannot be confident about its findings. Related Stories on Scoop Reasons to engage in the Alcohol Law Reform 09/11/2010 Auckland’s turn to shout about alcohol law reform 08/11/2010 Govt avoids effective measures on alcohol harm 23/08/2010 Tighten alcohol laws to protect youth, communities 30/07/2009 Alcohol and pregnancy dangers discussed 29/07/2009 Results powered by search.scoop.co.nz

More Related Stories  The study found that mothers who drank up to one or two drinks per occasion during pregnancy did not increase their children’s risk of behavioural difficulties or cognitive defects compared with children of non-drinking mothers. Alcohol Healthwatch Health Promotion Advisor Christine Rogan says the research methods used would not detect any subtle effects on the brain caused from lower levels of drinking. Neuropsychological testing would be required for this and this wasn't done. “This is the second study published in recent times, using parent interview methods to reach the same conclusions. “Both studies contradict thirty years of science that concludes there is no known safe level of alcohol consumption for pregnancy. We must promote a message of no alcohol use during pregnancy,” says Rogan. “The worst thing we can do is send a conflicting message to mums and future mums that alcohol might be ok when we know it isn't.” The advice from the Ministry of Health to New Zealand mothers is to abstain from drinking alcohol during pregnancy, when planning pregnancy and when breastfeeding. It also advises that stopping drinking at any time is beneficial to the health of the child.

The present recommendation is 0.8mg of folic acid daily for 4 weeks before conception until 3 months post conception. Recommendations can change so to keep updated by speaking to your LMC (Doctor, Midwife) and see the www.nzfsa.govt.nz website which states: Folate is a B vitamin that is vital for healthy growth and development of blood cells and nerve tissue. Folate is found naturally in food, especially green vegetables and grains. Folate is important for everyone for cell growth and reproduction. Folate deficiency can result in a type of anaemia called 'megaloblastic anaemia'.

Food safety advice - the New Zealand Food Safety Authority (NZFSA) produces a Food safety in pregnancy booklet for expectant mothers. Pregnant women and growing babies are more vulnerable to foodborne illness. Food safety in pregnancy can be ordered (free) on 0800 693 721 (0800 NZFSA1) or downloaded from the NZFSA website. www.nzfsa.govt.nz

The Ministry of Health is also advising about making sure you have enough iodine in your diet now also when pregnant. http://www.moh.govt.nz/moh.nsf/indexmh/nutrition-iodine#midwives

Quote "Due to an increased need for iodine in pregnancy and breastfeeding, the Ministry recommends that pregnant and breastfeeding women take a registered 150 micrograms (mcg) daily iodine only tablet daily available from 1 July 2010 at pharmacies, as well as eating foods which are important sources of iodine. More information can be found in the pamphlet Folic Acid and Iodine (www.healthed.govt.nz). While consumption of other iodine containing supplements and kelp tablets will increase iodine intakes, care needs to be taken when considering this type of supplementation as this may lead to an intake of iodine beyond the safe upper level of intake. The margin between too much and too little is very narrow and the iodine content in seaweed products and kelp tablets is extremely variable."

BABIES FIRST BED

http://babywebnz.org/display/BabyWebNZ/Survival+Guide_What+you+need+list

Read the bed safety section on the Plunket website and talk to your LMC Midwife or Plunket nurse on the needs for your baby. The below is a general guideline for making up babies first bed.

While it is fine to put a baby straight into a cot from birth it is worth while having some form of portable sleeping equipment for the first couple of months as it means baby will always be near by. You will find you will get more done or relax more easily if you have them sleeping in the lounge with you during the day as you won't have to keep creeping into the bedroom to check on them. It also gets them used to sleeping through everyday noise (useful for later). Bassinet, Moses baskets and hammocks last from newborn until 3 - 9 months depending on the style and size of your child. Always buy a new mattress when using a borrowed or preloved bassinet, this is to reduce the chance of dust mites or bacteria. Look for portability, wheels with locks if there are other children around, storage friendly, good airflow and that it meets safety standards. 

You will need a few spare sheets as baby may spill or wet through the ones on the bed. This is a general list:

* Mattress Protector. * 2 - 3 Sets of Bassinet/Cot Sheets. Ideally good cotton or cotton blend. * 2 Wool Aircell or Merino Balnkets * At least 2 Cotton bassinet/cot blankets. * Pillowcases to put under baby's head so if there are spills or dribbles you won't need to change all the bedding. * 2 - 6 wraps either gauze, flannelette or cotton; useful in many ways to wrap baby, use as a towel, put over your shoulder for spills, use as bassinet sheets or a clean area for baby to lie. Polar fleece can be used during the day and is easy to wash, but avoid using on baby's bed as they can overheat. Avoid duvets which cannot be secured and can flap onto babies face. No toys in the cots or anything with tags, buttons, ribbons and ties. Plunket recommends not using sheepskins in babies bed.

HOW TO MAKE UP BABIES BED

1. Put the mattress protector onto the mattress according to manufacturers instructions. I prefer to put it from babies shoulder area down so babies head is not lying directly on this (a pillowcase can catch spills).

2. Fitted sheet next, securely tucked in.

3. Top sheet, I would advise putting the top sheet with the longest part going across the bassinet/cot (the opposite to what you would do on a bed). Secure the side further most away from you and the bottom tightly under the mattress and leave the section loosest to you to be tucked in once baby is in bed. This means you have more to work with and baby is less likely to kick off sheets/blankets.

4. Next a cotton blanket to put a layer between baby and the woollen blanket. Again long ways across the cot/bassinet to make it easy to tuck in.

5. Finally a woollen aircell or merino knit blanket doubled over (can be single in warmer weather) and secured tightly so unable to flick back onto babies face. When putting baby into a cot make up the bedding half way down so babies feet are touching the bottom of the cot. This way baby cannot shuffle down under the blankets. We recommend lots of light layers of breathable natural fibres for bedding.

Depending on your baby and the temperature of your house you will need to adjust how many layers you have. Test babies temperature but placing your finger down the back of the clothing between the shoulder blades they should feel neither cold nor clammy. Babies hands normally feel cold. In summer you may want 2 cotton blankets (or one which can be doubled over) and one wool thermaweave or aircell blanket. In winter you will want one cotton blanket and two or more layers of a wool thermaweave or aircell blanket. Do not use duvets and bumper pads for babies.

As a Midwife I have to practice within my scope of practice. Outside of normal pregnancy and birth there is a responsibility to refer to other health professionals. Thus I feel that it would be hard for me to comment on your treatment for this condition and think you need to go back to the people involved in your care and ask more questions from them. There is so much information available now, especially on the internet, that it is conflicting at times. The Wikipedia, the free encyclopedia can be helpful see http://en.wikipedia.org/wiki/Factor_V_Leiden

Sometimes it helps to write your questions down and take them with you when you go for your appointments. The questions to ask about any treatment or medication are: what is the benefits, what would happen if I don't take it, what are the alternatives.

Scope of Practice of the Midwife http://www.midwife.org.nz The midwife works in partnership with women, on her own professional responsibility, to give women the necessary support, care and advice during pregnancy, labour and the postpartum period up to six weeks, to facilitate births and to provide care for the newborn. The midwife understands, promotes and facilitates the physiological processes of pregnancy and childbirth, identifies complications that may arise in mother and baby, accesses appropriate medical assistance, and implements emergency measures as necessary. When women require referral midwives provide midwifery care in collaboration with other health professionals. Midwives have an important role in health and wellness promotion and education for the woman, her family and the community. Midwifery practice involves informing and preparing the woman and her family for pregnancy, birth, breastfeeding and parenthood and includes certain aspects of women’s health, family planning and infant well-being. The midwife may practise in any setting, including the home, the community, hospitals, or in any other maternity service. In all settings, the midwife remains responsible and accountable for the care she provides. To practise as a midwife in New Zealand, the midwife must have an annual practising certificate issued by the Midwifery Council of New Zealand.

In New Zealand you do not need to see a doctor in pregnancy unless there is a reason for this or you wish to. A Midwife can do all of the normal pregnancy care and can refer you to see a specialist if there is concerns.

They can do a pregnancy test if needed and book you. On booking you will be given information regarding the role of the Midwife and contact details. Information on health in pregnancy is provided and you will be asked about your family and obstetric history. You will be offered blood tests which includes screening for infectious diseases such as Hep B and HIV.

Together in partnership you will set out a plan of care for your pregnancy, birth and after birth.

The 0800 MUM 2 BE (0800 686 223) Maternity Consumer phone line is run by the Ministry of Health.

See information on the article http://www.birthresources.org/display/BirthResources/Early+Pregnancy

It is recommended to increase your Folic Acid intake before getting pregnant, and in early pregnancy as deficiency can cause possible congenital neural tube defects eg spina bifida.

After you realise you are pregnant then you will need to have antenatal (pregnancy) blood tests done this can be done by a Midwife, Doctor or some health clinics. At the booking visit bloods are taken to check rubella immunity, find out your blood group and if you have any antibodies, your hepatitis status, full blood count (FBC) and a VDRL test for syphilis. You will be offered HIV screening also. Women with HIV can have treatment to reduce the chance of the baby getting the virus.

Having scans is a personal decision.

See http://www.nsu.govt.nz

From 8 February 2010, there are two screening options available for antenatal screening for Down syndrome and other conditions. Screening for Down syndrome and other conditions is not diagnostic, it just tells you your risk factor. A low risk result means there is very little chance that the baby has any of the conditions screened for. An increased risk result means there is a higher chance that the baby has Down syndrome or another condition. Women with an increased risk result are offered diagnostic testing.

• First Trimester Combined Screening combines the results from a blood test taken between 9-13 weeks pregnant) and a nuchal translucency (NT) scan at 11-13 weeks pregnant with other information, such as age and weight, to give one risk result. The blood test is available free of charge. There may be a charge for the NT scan. 
• Second Trimester Maternal Serum Screening is at 14-18 weeks combines the results from a blood test with other information, such as age and weight, to give a single risk result. 

I do advise to book your LMC (midwife, Dr) early, often between 4-10 weeks pregnant. Early health care is important, so I would be looking to find a Midwife soon after you realise you are pregnant. It is hard for me to say whom to go with, because it is a partnership care model and it is always a personal thing - what you believe and want. In some areas independent midwives are booked up earlier than in other areas due to availability and popularity.

You will have the choice of a LMC who will be responsible for your maternity services. This may be a midwife, GP or private obstetric consultant. Some LMC's will provide all of your care during pregnancy, labour and birth, and postnatally, some may provide shared-care working with other maternity service providers.

The options of a place to give birth include: Home birth, birthing units, maternity hospital, and private maternity hospitals. It is important to have a LMC who understands and supports your wishes for your birth. See

http://www.babywebnz.org/display/BabyWebNZ/Find+a+Midwife_Wellington http://www.wellingtonmidwives.com/

The 0800 MUM 2 BE Maternity Consumer phone line is run by the Ministry of Health. The 0800 line has a person answering the phone between 9am and 2pm Monday to Friday. Voicemail is available to leave a message after hours and all messages will be responded to accordingly.

Fetal movements.

What kicks feel like depends at what gestation (how many weeks pregnant) you are. In early pregnancy it is hard to tell if it was a kick or not, especially if you haven't been pregnant before. Babies are moving at around 7-8 weeks but you often don't feel anything till 16 and 22 weeks. To begin with women have described movements as being like butterflies fluttering. As the baby grows the kicks will become stronger and easier to feel. In early pregnancy the baby has room to do lots of turning (acrobatics) but as they get bigger or when their head or bottom engages (enters into) in the pelvis in latter pregnancy they are less mobile. You should still feel them moving but they no longer have room to do big turns and stretches.

Kicks tell us the baby is awake. Women often report more movements when they are resting and after a meal. When a baby gets hiccups it can feel like a vibration.

If there are concerns about the number of kicks then you may be asked to count them. People do this in different ways but usually you time how long it takes for you to feel 10 movements, which includes kicks and body movements. If you are unsure if you baby has been moving it may be that you have been too busy to notice. If the mother has extra weight or the placenta is anterior she may not notice the movements as much.

If you think the baby hasn't moved much sit down or lie on your left side. Let your LMC (Midwife, Dr) know if the movements have reduced or stopped. Some LMC's say if you don't get 10 movements within 2 hours then let them know. Sudden spurts of frantic extreme activity, which feels different from before, should be report to your LMC. Talk to your LMC about when you should ring them about movements. Any change in the pattern or any concerns should be reported.

All pregnancy tests work by detecting human chorionic gonadotropin (hCG) in the urine or blood that is there when you are pregnant. The amount of hCG increases with the pregnancy duration. A blood test can pick up a pregnancy earlier than a urine test.

For urine tests it is best to do it first thing in the morning, but it is not necessary. Home urine pregnancy tests these days are pretty accurate if done by following the instructions. Most can even pick up a positive result one week after a missed period. The instructions usually state if a line or plus symbol appears, you are pregnant. It does not matter how faint the line is. A line, whether bold or faint, means the result is positive. New digital tests show the words pregnant or not pregnant. A control indicator is a line or symbol to shows whether the test is working properly. If the control indicator does not appear, the test is not working properly.

Sometimes a quantitative blood test (or the beta hCG test) may be ordered if for some reason the exact amount of hCG in your blood is needed to be checked. Quantitative HCG measurements can help to diagnose abnormal pregnancies, such as ectopic pregnancies, molar pregnancies, and those that there is concern of miscarrying. With a confirmed pregnancy either by a urine or blood test then antenatal screening bloods are done if you consent to this.

For more information about these bloods see this link on the everybody health site. http://www.everybody.co.nz/page-0b755006-b9db-4151-99b9-966d7c2e23c6.aspx

• ABO blood group test Blood group and for the presence of antibodies
  

• Rhesus blood group test. Most people are Rh+ but if you are Rh– this is important to know, if you are pregnant.
  
• Full blood count (FBC) mainly looks at iron and platelet levels.
  
• Rubella (German measles). To check to see if you are immune for rubella.
  
• Hepatitis B
  
• HIV. The risk of baby becoming infected if their mother is HIV positive can be reduced if diagnosed and treated during pregnancy.
  
• Syphilis
  

Further information about screening tests/programmes, or if you need to have information in a different language visit the National Screening Unit website: www.nsu.govt.nz

Down syndrome screening from February 2010 From 8 February 2010. These screening tests (combined blood test and nuchal translucency scan in first trimester, or blood test in second trimester) can show the likelihood of a fetus having Down syndrome or some other conditions. The screening tests do not give a definitive (final) result, but women whose screening results showed increased risk, will then be offered diagnostic tests, eg, chorionic villus sampling or amniocentesis. The new screening tests should prevent some women from having to undergo the more invasive diagnostic tests, if their screening results show a low risk of Down syndrome and other conditions. 

For more information about early pregnancy follow the link

http://www.babywebnz.org/display/BabyWebNZ/Survival+Guide_Mothers+Diary or http://www.babywebnz.org/display/BabyWebNZ/Articles_Early+Pregnancy

Reply to question dated July 2010

Tears can happen during birth and are defined on the degree of the area affected. It has been found that 85% of women have a tear during birth, and that an episiotomy (a cut) doesn’t prevent tears from happening. Most tears are usually small or superficial tears or first-degree lacerations. These are a skin tear, as they don’t go into muscle they usually don’t need any stitches and heal quickly. Second degree is into muscle. Third-degree laceration affects perineal muscles. A fourth-degree tear goes through the anal sphincter (back passage muscles). The anal sphincter muscle controls the passage of wind and faeces from the back passage, or rectum.

The pain felt and the time it takes to heal will depend on the area affected and the degree of the laceration. The stitches used in NZ for perineal tears are dissolvable and take around six weeks to disappear.

It is important to keep the area clean. For the first weeks you could try using a spray bottle or a jug of water to wash over the area after passing urine or having a bowel motion (poo). Avoid constipation, you may wish to use a stool softener so you don’t need to push when doing a poo. Natural laxatives include prunes and kiwi fruit. Supermarkets sell Kiwi Fruit Crush in the frozen section.

Only have sex when you feel comfortable, and lots of lubricant may help. Try getting in and out of bed without opening your legs to far by rolling onto your side first before getting up. This can reduce the pull on the stitches.

Be nice to yourself, I believe mothers need to look after themselves so they have enough energy to look after their baby. Seek out more advice from health professionals if needed. You may wish to see a physiotherapist who can give you exercises to help strength your pelvic floor muscles. Give yourself time to recover and get people to help you if able.

If the pain is not decreasing, there are signs of an infection, any problems controlling your bowels or passing urine, or you are feeling upset or have any concerns then you need to talk to your LMC.

For future pregnancies you might wish to try perineal massage. I am unsure if it prevents tears as sometimes these things happen for different reasons but I see no harm in doing it.

If travelling overseas you will need to organise a passport. Taking the photo can take a few attempts. They want a front profile. Also with newborns before 6 months it's hard to know what to record for their details - Eye colour: blue turning brown, hair colour brown turning blonde. Height: changes on a daily basis and signature well that could be interesting.

Ask the airline for a sky cot and baby food (if on solids) when you make the booking. Taking a tri-pillow is useful if breastfeeding. It is also good for them to sleep on. You may find that you get your baby off to sleep in the sky cot and the plane hits turbulence and you have to take them out and onto your knee with the baby seat belt on. So you may find it easier to have them sleep on the tri-pillow on our knee with the seat belt around them. The bulkhead seats have more room, but the armrests are fixed.

The airlines often provide you with baby food, but ask about 10 - 15mins in advance of wanting it, as the airhostesses are often busy. Some people use apron type covers or tops for breastfeeding in public such as http://www.talikins.co.nz/bhshop.html Breastfeed or give a bottle on the take off and decent as it is meant to help reduce the pressure in their ears by having them suck.

Changing his nappy in the toilets is a challenge as there isn't much room. What to take with you on the plane: Some airlines provide you with a few nappies and baby wipes on international flights, but best to have your own supply just in case. Some spare clothes for the baby and yourself is a good idea. Depending on their age, consider a spill resistant cup to give him water.

If using a baby sedative talk to your doctor about this and any possible side effects. A digital thermometer, bibs, new toys (that he hasn't seen before), baby wipes and baby snacks go in the baby bag.

You will have to consider if you plan to take your car seat, as most taxis don't carry them. Also if you have a spare seat beside you, you can bring your car seat on the plane and strap it (like the car) and have your baby sit in it for a short period of time. Talk to the airline staff re this first to make sure there is room.

There is a web site called flying with kids that has lots of air travel tips see www.flyingwithkids.com If going to a completely different time zone it will take him some time to adjust and some nights they will wake wanting to play.

Wellington Hospital will provide you with a cardboard box to place your whenua (placenta) in. It will be in a plastic bag and then placed in the box which is free of charge to you from the hospital. It is your whenua (placenta), so it is up to you to do what you wish with it. The Capital and Coast DHB Website is www.ccdhb.org.nz. If it is sent to the lab for tests you should be asked to sign a form if you want it returned. If you do not keep the placenta then it is incinerated.

Wellington City Council provide a commemorative tree scheme - "Commemorative trees cost $180 (GST inclusive). This pays for the tree, its planting and initial care, and assists with maintenance over its lifetime. You will receive a certificate suitable for framing with a photo of your tree species, its GPS location and details of the planting." refer to website for more info - http://www.wellington.govt.nz/services/prksgrdnsserv/commemorative.html

You may also be interested in this product: "Capceco" Biodegradable Placenta Capsule http://www.ecostoredirect.co.nz

Product Description: For centuries the Placenta has received ceremonial handling around the world by many cultures.

New Zealand Maori bury the placenta or whenua in native soil as a gift to Papa-Tu-a-nuku, or Mother-Earth. Birth to Earth's "Capceco" Biodegradable Placenta Capsule is a world first, designed and made in New Zealand.

Birth to Earth are encouraging parents to keep and plant their child's Placenta under an oxygen giving tree which will remove up to a tonne of carbon emissions over its life. Included in the "Capceco" pack is "Your Tree" a beautiful child's keepsake story book that tells your child how their placenta was planted under a tree. Illustrated by Anton Petrov, "Your Tree" is a subtle way of encouraging children to care for nature. Parents can also record in the book what tree and where it was planted so the child has a permanent record of their birth tree. 

May 2010.

Wellington hospital has 3D scanners.

Outside of Wellington Hospital there is a cost for scans.

The two private places I know who do pregnancy Ultrasound are Pacific Radiology in Wellington and Horizon Radiology in Auckland.
http://www2.yellow.co.nz/search/wellington/radiology-1.html

They don't have a 3D scanner, just normal ones. Cost is around $40 per scan.

See Pacific Radiology Fees
All enquiries: 04 978 5500

Ultrasound pregnancy for a non-NZ Resident is around $127.70 (as of May 2009)

Ultrasound pregnancy if you are a NZ resident (partly funded by Maternity Benefits) is around $40.00 (as of May 2009)

Risks

Speak to your LMC and radiologist of the risks for and against scans.

The FAQ section on Pacific Radiology site states:

What is ultrasound?

Ultrasound is a technique that uses high frequency sound waves to build up an "echo picture" of internal organs. Bats and dolphins use the same principle to see in the dark and under water, as do the navy when using sonar to find submarines.

What is ultrasound used for?

Ultrasound is tremendously useful for looking at soft tissues, particularly the solid abdominal organs and the developing pregnancy. More recent applications have seen significant advancements in other areas, especially imaging muscles and tendons. So much so that ultrasound is now one of the front line techniques for investigation sports injuries. Another part of ultrasound, Colour Doppler, is an excellent non-invasive way of looking at blood vessels, and assessing for narrowings and blockages.

Is it safe?

Ultrasound is painless, does not affect the body's tissues, and does not use ionizing radiation, which makes it a perfect way of looking at pregnancies. Over the years, people have asked questions of the safety of ultrasound in imaging the foetus, but despite a multitude of investigations and accumulated experience world wide of millions and millions of pregnancy scans, there has never been any significant adverse effect shown.

What will happen to me?

The sonographer (specialised technologist who will perform your scan) will take you to the ultrasound suite, and depending on the area to be scanned may ask you to change into an examination gown. You will lie on an examination couch (or sit on a chair if more appropriate for your exam, eg for shoulder ultrasound) and the sonographer will usually ask you a few questions and go over the doctor's referral form with you. Then they will apply a special sound gel to the part in question, and perform the exam - which consists of placing the ultrasound probe lightly on your skin and moving it around to form an image. Most of our rooms have televisions linked to the ultrasound machines so that you can see what the sonographer can see (although you may not be quite as proficient at interpreting it!).
The examination can take any where from 15 minutes to over an hour, depending on what your doctor wants us to look at.
After the examination you can resume your normal activities. Usually you will take the films with you, and a full radiologist's report will go to your doctor.

3D Ultrasound advice from USA

However, the article on NursingCenter.com (USA) states:

Many expectant mothers are excited about the opportunity to obtain 3D or 4D (real-time 3D) ultrasounds to bond with their babies. Unfortunately, women do not know the potential risks involved in diagnostic testing when there is no medical indication. While women may be knowledgeable about obstetrical care, they may not understand the physiology of ultrasound and the potential risks of "fetal portraiture sessions."

Nondiagnostic 3D ultrasound facilities are not regulated by any State or the U.S. government. They often have cute and appealing names, but they use powerful diagnostic equipment that produces high energy levels to create images. Obstetrical providers have long voiced concerns about the unregulated use of medical diagnostic equipment for nondiagnostic purposes, and the FDA Consumer Magazine has issued a statement against Fetal Portraiture Studios (FDA, 2004).

Other Resources to review

Plunket is good with sleep issues.

Follow the link below to find Plunket near you:
Plunket in Wellington/Wairarapa area

You may wish to visit a Plunket Centre:
61 Freyberg Street,
Lyall Bay
04 387 7594

Or ring PlunketLine
0800 933 922

Do you think it is colic?
Is she crying a lot or just won't sleep?
Check this page on What to do about hiccups, colic & crying