Questions and Answers

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