Your top 10 pregnancy FAQs answered
Dr Nick Walker provides expert answers to his most frequently asked questions.
Working as a Lead Maternity Carer (LMC), I’m frequently asked certain questions again and again. Perhaps it’s because these questions relate to common problems and/or the answers are not that easy to come by. The following is my miscellaneous list of such FAQs, in no particular order, alongside my FGAs – frequently given answers!
But first, one firm piece of advice: please refrain from using Google to answer your pregnancy-related questions! You will almost always find answers that are inapplicable, inaccurate, inconsistent, or downright terrifying. Always ask your LMC, who not only knows the answers, but also knows your clinical details, and can therefore give the most appropriate advice.
1. Do I need to keep taking folic acid supplements throughout the pregnancy?
No, these are recommended from, ideally, prior to conception through to twelve weeks gestation. Taking them beyond this time is not harmful, but it’s not necessary.
2. How about Iodine supplements?
Several years ago, the New Zealand Ministry of Health introduced and recommended universal supplementation of the important mineral iodine. This should be used throughout the entire pregnancy and even during lactation, as iodine also passes through the breast milk to your baby. The rationale for the recommendation is that fewer people are using ‘iodised’ salt for general consumption, and also that New Zealand’s soil, and thus domestic food sources, are relatively low in iodine.
3. When will I feel the baby move?
Foetal movements are actually felt when there is stimulation to the nerves of the abdominal muscles and the skin of your tummy; the uterus itself does not have the necessary nerve supply to feel any foetal movements. This explains why tiny babies seen actively moving on a 12-week scan cannot be felt. When the baby is ‘strong’ enough, the force of the foetal movement goes right through the uterine wall and is therefore felt in the abdominal wall, and for most women this tends to occur between 20 and 24 weeks. If the baby’s placenta is located at the front of the uterus (anterior) then that tends to cushion the movements – women who have had more than one pregnancy with a differently located placenta can usually feel this difference.
4. Why do we need a scan at 20 weeks if we don’t want to know the sex of the baby?
The 20-week scan, AKA the foetal anatomy scan, looks to check that all the vital parts of your baby have formed in the correct way. It is a complete top-to-toe assessment, and the most important problems to rule out are related to brain, heart and kidney malformations. With this scan, around 1% of babies are found to have a major birth defect, and detection of these allows for very careful planning for the remainder of the pregnancy and the birth. This scan also defines the position of the placenta. With all this in mind, the sex of the baby is irrelevant to your LMC, though of course knowing or not knowing is of special importance to expectant parents! The sex of the baby is never documented on the scan report, so it can’t be unintentionally revealed by your LMC.
5. Do I need a flu vaccine?
This is recommended and safe during any trimester of pregnancy. It is funded, free of charge, through your GP practice, because even during a healthy pregnancy, your immune system is altered in a way that makes you more susceptible to the flu – and if you do get the flu, it can be far more severe due to the pregnancy adaptations of your body (for example, your lungs have less space due to the bump). Even if you don’t habitually get an annual flu vaccine, try to make an exception if you’re pregnant.
CHOOSING YOUR LMC
☙ What experience and training have they had?
☙ What antenatal care do they provide?
☙ Do they work alone or in a group? (If it’s a group, you may want to meet the other people they work with)
☙ If you choose to birth at home or in a birthing centre, under what conditions would they recommend you were transferred to hospital?
☙ What is their policy on pain relief, episiotomies and routine monitoring?
☙ Can you walk around during labour and find the most comfortable position for yourself to birth?
☙ Will your baby be put to the breast immediately after birth?
6. What about THE whooping cough vaccine? Who needs to get it?
Similar to iodine supplementation, the whooping cough booster vaccine is a relative newcomer to the New Zealand antenatal schedule of standard care. Whooping cough is an illness caused by a bacterium that can be carried in the nose/throat of people who are apparently healthy. If a person has low immunity, the bacterium invades the lungs and causes a severe illness. Several years ago, a community outbreak of whooping cough caused many newborn babies to become ill, with some fatalities, as the babies were exposed to whooping cough prior to their six-week immunisations. A pregnant woman who receives a booster vaccine will pass on her heightened immunity through natural mechanisms to the baby in utero. The booster shot is timed between 28 and 38 weeks gestation to optimise this effect, and is also fully funded thus free of charge. Other family members are welcome to get vaccinated for their own health benefits, but they are not funded because obviously they cannot pass their immunity to your baby!
7. Do I really need to take the test for pregnancy diabetes?
Yes. Pregnancy diabetes is a ‘silent’ condition, and occurs when metabolism of blood glucose becomes affected by placental hormones. You cannot feel the difference between healthy and diabetic-range blood sugar levels, but your baby’s growth and metabolism will certainly be influenced. The testing is a hassle, having to drink liquid glucose and wait for an hour or two, but the benefits of knowing your glucose metabolism are absolutely worth it.
8. I keep waking up from sleep on my back but I know I must sleep on my side for safety – is this okay?
The safer-sleep position in pregnancy is indeed on your side (preferably left but right is okay). This is because when flat on your back and not moving, the weight of the pregnant uterus may compress its own blood supply and reduce oxygen levels to your baby. The most important detail to remember is that your starting sleep position matters most of all. When you first fall asleep, you are relatively immobile. Later on in your sleep, you naturally move about unconsciously, and this lessens the problem, so your eventual waking position is less important.
9. If I’m carrying a bigger baby, will he or she arrive sooner?
Not necessarily. It is not fully understood exactly what triggers the timing of your labour and birth, but baby size is not a factor. If you have a scan measuring the size of the baby and your baby is larger than average, you may notice the scan-machine giving you a different and nearer due-date: this is simply the machine comparing your baby to a preset range of ‘expected’ measurements derived from population averages.
10. What happens if I go over the due date? Is the placenta okay?
Maternity care in the last few weeks of pregnancy aims to determine the health of the baby, which is almost always directly related to the health of the placenta. This is one of the reasons why visits to your LMC are scheduled weekly during the last month. Your blood pressure, as well as the baby’s growth rate and amount of amniotic fluid, are indirect markers of placental function. Some placentae last longer than others, but it’s generally recommended that, by 42 weeks gestation, the upper limit of safety is reached and induction of labour is usually advised.
Dr Nick Walker is a specialist obstetrician working in both public practice at National Women’s Hospital, and private practice in Mt Eden, Auckland. He divides his time between these roles and helping his wife in caring for their four young children.
AS FEATURED IN ISSUE 43 OF OHbaby! MAGAZINE. CHECK OUT OTHER ARTICLES IN THIS ISSUE BELOW